从《湿热病篇》看薛生白对脉诊的认识

Study on Xue Shengbai’s insights into pulse taking from his Treatises on Damp-heat Diseases

薛生白《湿热病篇》中记录了16种脉象,很有湿热病特色。虚脉是湿热伤气的脉象,也代表着湿邪内阻脾阳不足;细脉不是阴虚,而是寒湿伤阳的脉象;脉细如丝或绝不是真阳外脱,而是湿热邪气内阻,表里气机不通;脉洪大而长为热重于湿的典型脉象;脉伏是脾胃之阳为寒湿所蒙,不得升越之象;数脉是湿热病中最常见的脉象,可以表现为细数、软数、滑数、脉数大按之豁然空者以及尺脉数、左关弦数等。这些代表湿热病主证的脉象,大大开阔了临床对湿热病脉象的认识。

Xue Shengbai summarizes in his Treatises on Damp-heat Diseases 16 pulse manifestations,which rather highlight the characteristics of damp-heat diseases.According to the work,a feeble pulse manifests the syndrome of damp-heat impairing qi,and the syndrome of spleen-yang deficiency due to the internal blockage of damp pathogens as well,while a thready pulse does not symbolize the syndrome of yin deficiency,rather the syndrome of cold-damp injuring yang.A thready pulse,though as thin as silk,does not necessarily denote the syndrome of kidney yang escaping outward,but the syndrome of obstructed qi movement between superficies and interior due to the internal blockage of damp-heat pathogens,while a surging and persisting pulse represents the typical syndrome that heat pathogens surpass damp pathogens.A deep-sited pulse refers to the syndrome that spleen-stomach yang qi is suppressed by cold-damp pathogens and cannot ascend and transform,while a rapid pulse is the most common pulse manifestations in damp-heat diseases and varies in its numerous manifestation categories.These pulse manifestations are assumed to embody the core syndromes of damp-heat diseases,and the summary of and exploration into them have greatly broadened the clinical understanding of this kind of diseases ever since.