脉象要素与体质有什么对应关系呢?
今天简要举出几例,共同探讨。
一、强、弱
强弱是指脉搏压力的大小。当压下手指,脉搏反作用于手指有力谓之强,无力谓之弱。
周学海说:“强弱,以诊势之盛衰也。应指有力谓之强,无力谓之弱。”古人常以“有力”、“无力”称之。
从辨别疾病虚实来看,强弱是辨别整体虚实的标准之一,三部脉内压力均较大者机体的气血充实并邪气有余,为实证;三部脉内压力较小者机体气血亏虚,为虚证。
从体质来看,一般来说,脑力劳动者多脉弱;体力劳动多脉强。
脉搏“强”且有热发散感的属阳热体质,平时当加强体育锻炼以增加机体的能量消耗,同时饮食清淡,避免进补高热量的饮食。
脉象“弱”且有清冷感之人属阳虚体质,平时注意静养,以减少能量的消耗,并当进食温补食品。
二、枯、涩、细、数
枯是指脉干枯的感觉,与血液内水分的含量关系密切。
对应的中医理论有津液之说,一般来说,枯与津亏联系较多。
中医里的增液汤,左归丸等都可对应“枯”。
局部常见于左尺或左关有干瘪的感觉,同时伴有脉管的整体变细,是人内外体液都缺失的表现。
这种人多偏瘦,不爱喝水,宜进食润泽的食物。
人体中,津气血精液都是一体相互转化的,当细胞的水分减少,干瘪,呈现出“枯”象时,脉内容物之间的摩擦力变大,脉不流畅,会显示出“涩”的特征来,像“如雨粘砂”的感觉。
涩是指脉中血液流畅程度的降低,血液成份之间摩擦力大了就涩。
涩主病,可主有形实邪:气、血、湿、痰、血。主虚时为:津亏。在这里应用的是阴虚内热者,津亏血液浓缩,运行不畅而涩。如《医灯续焰》说:“况体为阴液,多则滑利,少则枯涩,理势之必然者(枯涩)。”
在系统辨证脉学理论体系中,细是指脉动应指的周向范围大小,即手指感觉到的桡动脉的外径大小。细多表示气血运行的收敛不舒。气血亏虚者,脉偏细。
脉细对心理状态也有很大的参考意义:典型的细表示患者心松不开,或者是压力大。我们经常提到的思虑过度状态也有细的表现。
系统辨证脉学理论体系中数的含义与二十八脉中的数有差异。数脉是指脉率的快,《素问·脉要精微论》中“数则烦心”,此处的“数”不是指脉搏频率的快,而是指烦躁状态时脉搏搏动的谐振波频率和幅度的增加,导致脉搏动跃不稳的感觉,古人称之为“如数”脉。
因此,数脉的意义就包含了脉搏频率快和谐振波增加的双重含义。从辨别疾病的寒热来看,“数则腑病为热”,有力实火,无力虚火,浮数表热,沉数里热,细数阴虚。
综上,脉 “枯”、“涩”而“细”、“数”者属阴虚内热体质,宜进食黏稠润泽的食物,而忌干燥、硬涩之品。
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