余始撰《活人总括》、《婴儿指要》，俗皆以沽名讥。及《脉书》一行，于是敛肃而相告
曰∶诚不易也。谁肯倾 竭廪，以徇人哉？余曰∶尔亦知有天乎？天将寓其济人利物之心，
故资我以心通意晓之学。既得于天，还以事之，是盖造物初心之所期也。或者隙光自耀，藏
诸己而不溥诸人，政恐玉毁椟中，草木俱腐矣。虽然人有四百四病，或出于前三册之外者，
可不原证择方，揭为直指之捷径乎！明白易晓之谓直，发踪以示之谓指。剖前哲未言之蕴，
摘诸家已效之方，济以家传，参之《肘后》，使读者心目了然，对病识证，因证得药，犹绳
墨诚陈之不可欺，庶几仁意周流， 相续，非深愿欤？余尝慨而作曰∶天之予人以是物，
必使之有以用是物，有是物而不能用，非惟拂天，抑亦自弃其天者也。并书此为同志勉。
景定甲子良月朔。三山杨士瀛登父序。
夫在天之风，在地为木，在人为肝，惟肝则主风。在天之热，（暄、暑、炽、燠，热之
用也。）在地为火，在人为心，惟心则主热。在天之湿，在地为土，在人为脾，惟脾则主湿。
在天之燥，在地为金，在人为肺，惟肺则主燥。在天之寒，在地为水，在人为肾，惟肾则主
寒。吁！此天地自然之气也。气之愆伏，乘虚入人，而人不能克，百病之所由生。故风喜伤
肝，热喜伤心，湿喜伤脾，燥喜伤肺，寒喜伤肾，而暑喜伤心包络。（心包络曰膻中，在胸
膈间。盖心主暑，故暑气伏于三焦膈胃之间。）其或风气之胜，木邪乘土，则脾病生焉。热
气之胜，火邪乘金，则肺病生焉。湿气之胜，土邪乘水，则肾病生焉。燥气之胜，金邪乘木，
则肝病生焉。寒气大来，心火亦为肾水所乘矣。左关为人迎，可以知风寒暑湿热燥所从入之
门。右关为气口，可以别脏气郁畅与食气聚散盈虚之候。若乃忧愁思虑，易耗心神。恚怒气
逆，易损肝气。纵欲强志，肾之戕。形寒饮冷，肺之害。饥饱劳倦，脾之伤。外之六气相乘
，内之七情相感，凡是数者，皆为五脏之邪。因其所主，而寻其某脏所受之处，则得之矣。
心主血，所藏者神，上应舌，外应诸掌，其声言，其色赤，其臭焦，其味苦，其液汗。肝主
筋，所藏者魂，上应眼，外应爪甲，其声呼，其色青，其臭燥，其味酸，其液泣。肾主骨，
所藏者精与志，上应耳，外应腰背，其声呻，其色黑，其臭腐，其味咸，其液唾。（肾冷多
辛，其液涕。脾主肌肉，所藏者意与智，上应口，外应四肢，其声歌，其色黄，其臭香，其
味甘，其液涎。故心肺在上主脉气也，肝肾在下藏精血也，脾居中州又所以为精血脉气之养
也。心之平脉浮大而散，肝之平脉弦细而长，肾之平脉沉濡而滑，肺之平脉短涩而浮，脾
之平脉和缓而大。平者，五脏本然之正脉也。春弦、夏钩、（叔和云∶夏洪取火脉来盛之义。）
秋毛、冬石，以其四时当旺者，象之木火金水，四时各旺七十有二日。土为季脉，每季之月
寄旺一十八日。春则弦缓，夏则洪缓，秋则微缓，冬则沉缓。合四季而论，则亦七十有二日
矣。春弦者，端直之状，细弱而长是也。夏钩者，浮大而散，来疾去迟是也。秋毛者，稀软
之状，轻虚以浮是也。冬石者，沉濡而滑，举指来疾是也。土之脉，温浓气行乎脏腑之中，
平和不可得见，其衰则现焉。所谓弦、钩、毛、石，盖应时而略见耳。其中须有谷神胃气之
和。若弦如张弓弦，钩如操带钩，毛如风吹毛，石来如夺索，去如弹石，此皆危脉也。此绝
无胃气也。胃气亏绝，其能久乎？若夫春得金脉，夏得水脉，秋得火脉，冬得土脉，四季
得木脉，其与心之脉克肺，肺之脉克肝，肝之脉克脾，脾之脉克肾，肾之脉克心，此皆贼邪
也。一脏无气，况可以为人乎？然则诸腑之脉可得闻欤？曰∶小肠微洪，大肠微涩，膀胱微
沉，胃微缓而胆微弦急。此无他腑与脏合气，同气相求，斯有得其近似者矣。抑古人所谓九
脏者又何如耶？曰∶形脏四，一者头角，二者耳目，三者口齿，四者胸中。神脏五，在心藏
神，在肝藏魂，在肾藏志，肺藏魄而脾藏意。然脏者，神之舍；色者，神之旗。五脏已败，
其色必夭，槁怪异常，夭必亡矣。抑犹有说焉。微迟、濡弱，其候虽不同，而为寒为虚一也。
数实、长洪，其形虽不类，而为热为实一也。诸脉皆弦，吾知其病出于肝；诸脉皆缓，吾知
其病出于脾；诸脉皆涩，吾知其病出于肺。
脉皆浮洪，病不在心乎？脉皆沉滑，病不在肾乎？若合腑脏而观，假如数在左寸，数
主热也，沉之而得，则热入于心；浮之而得，则热入小肠。迟在左尺，迟主寒也，沉之而得
，则寒入于肾；浮之而得，则寒入膀胱。其余以此推之。噫！此通变法也。安得圆机之士与
之论此哉！
我起初撰写《活人总括》和《婴儿指要》时，世俗之人都用沽名钓誉来讥讽我。等到《脉书》这一部分问世后，他们于是收敛神色，互相告诫说：“确实是不容易啊。”谁愿意倾尽自己的积蓄，去迎合他人呢？我说：“你们也知道天意吗？上天将救济世人、利益万物的心意寄托于我，所以赋予我心灵相通、意念明晓的学问。既然从上天那里得到了这些，就应当用来侍奉上天（造福人类），这大概是造物者最初的期望吧。或许有人像缝隙中的阳光一样自我炫耀，将知识藏在自己心里而不广泛传播给众人，只怕这会像美玉毁在匣子中、草木一起腐烂一样可惜。虽然人有四百零四种疾病，或者有些病出现在前三册内容之外的，难道不可以推究证候、选择方剂，揭示出《直指》治疗的捷径吗？‘直’就是明白易懂的意思，‘指’就是指出路径以示人的意思。剖析前代哲人未曾言说的深意，摘取各家已经验证有效的方剂，结合家传秘方，参考《肘后备急方》，使读者心中眼里都清楚明了，面对疾病能识别证候，根据证候找到药物，就像墨线陈列在那里一样不可欺骗，这样仁爱之意就能周流不息，代代相传，这不是我深深的愿望吗？我曾经感慨地写道：上天给予人这样的物质（指医药/身体/智慧等），必定是让人能够使用它；有了这样的东西却不能使用，不仅违背了天意，也是自己抛弃了上天赋予的本性。写下这些话是为了与志同道合的人共勉。
景定五年（甲子年）十月一日。三山人杨士瀛（字登父）作序。
在上天的风，在地表现为木，在人对应肝，只有肝主管风。在上天的热（包括温暖、暑气、炽热、闷热，这些都是热的表现），在地表现为火，在人对应心，只有心主管热。在上天的湿，在地表现为土，在人对应脾，只有脾主管湿。在上天的燥，在地表现为金，在人对应肺，只有肺主管燥。在上天的寒，在地表现为水，在人对应肾，只有肾主管寒。唉！这是天地自然的气。气的失常潜伏，趁着人体虚弱侵入体内，而人体不能抵抗，这就是百病产生的原因。所以风容易伤害肝，热容易伤害心，湿容易伤害脾，燥容易伤害肺，寒容易伤害肾，而暑气容易伤害心包络。（心包络称为膻中，位于胸膈之间。因为心主暑，所以暑气潜伏在三焦、膈膜和胃之间。）如果风气过胜，木邪侵犯土，那么脾就会生病。热气过胜，火邪侵犯金，那么肺就会生病。湿气过胜，土邪侵犯水，那么肾就会生病。燥气过胜，金邪侵犯木，那么肝就会生病。寒气大至，心火也会被肾水所克制。左关脉为人迎穴对应的脉位，可以知道风寒暑湿热燥是从哪里侵入的。右关脉为气口，可以辨别脏气是否郁结通畅以及食气聚散盈亏的状态。至于忧愁思虑，容易消耗心神。愤怒气逆，容易损伤肝气。纵欲强忍意志，会戕害肾脏。形体受寒、饮食生冷，是肺的害处。饥饱不均、劳累倦怠，是脾的损伤。外来的六气相互侵犯，内在的七情相互感应，凡是这几方面，都是五脏的邪气。根据它们所主的脏腑，去寻找是哪个脏腑受到了侵害，就能找到病因了。
心主管血，所藏的是神，上应舌，外应手掌，其声音为言，其色为赤，其气味为焦，其味道为苦，其体液为汗。肝主管筋，所藏的是魂，上应眼，外应爪甲，其声音为呼，其色为青，其气味为燥，其味道为酸，其体液为泪。肾主管骨，所藏的是精与志，上应耳，外应腰背，其声音为呻，其色为黑，其气味为腐，其味道为咸，其体液为唾。（肾冷多辛味，其体液为涕。脾主管肌肉，所藏的是意与智，上应口，外应四肢，其声音为歌，其色为黄，其气味为香，其味道为甘，其体液为涎。）所以心肺在上主管脉气，肝肾在下储藏精血，脾居中州，又是精血脉气的滋养来源。心的正常脉象是浮大而散，肝的正常脉象是弦细而长，肾的正常脉象是沉濡而滑，肺的正常脉象是短涩而浮，脾的正常脉象是和缓而大。平脉，就是五脏本然的正脉。春季脉弦、夏季脉钩（王叔和说：夏洪取火脉来势盛大之意）、秋季脉毛、冬季脉石，这是因为四时当旺的脉象，象征木火金水，四季各旺七十二天。土脉为季脉，每季的最后一个月寄旺十八天。春季脉弦而缓，夏季脉洪而缓，秋季脉微而缓，冬季脉沉而缓。合四季而言，也是七十二天。春弦，是指端直的样子，细弱而长就是。夏钩，是指浮大而散，来势急而去势慢就是。秋毛，是指稀软的样子，轻虚而浮就是。冬石，是指沉濡而滑，手指抬起时来势急就是。土的脉象，温和浓厚的气行于脏腑之中，平和之象不容易见到，衰退时才会显现。所谓弦、钩、毛、石，不过是顺应时节略微显现而已。其中必须含有谷气和胃气的调和。如果弦得像张开的弓弦，钩得像拿着带钩，毛像风吹羽毛，石来时像争夺绳索，去时像弹石，这些都是危重的脉象。这是完全没有胃气的表现。胃气亏损断绝，怎么能长久呢？如果春天得到金的脉象，夏天得到水的脉象，秋天得到火的脉象，冬天得到土的脉象，四季得到木的脉象，这与心脉克肺脉、肺脉克肝脉、肝脉克脾脉、脾脉克肾脉、肾脉克心脉的道理一样，这都是贼邪。一个脏腑没有气，何况还能做人呢？那么各腑的脉象可以听一听吗？回答说：小肠脉微洪，大肠脉微涩，膀胱脉微沉，胃脉微缓而胆脉微弦急。这没有别的原因，是因为腑与脏相合，同气相求，所以有近似的情况。再说古人所说的九脏又是怎么回事呢？回答说：形脏有四，一是头角，二是耳目，三是口齿，四是胸中。神脏有五，在心藏神，在肝藏魂，在肾藏志，肺藏魄而脾藏意。然而脏，是神的居所；色，是神的旗帜。五脏已经败坏，面色必然夭折枯槁怪异异常，夭折必然死亡。还有进一步的解说：脉微迟、濡弱，虽然征候不同，但都属于寒和虚。脉数实、长洪，虽然形态不类似，但都属于热和实。诸脉皆弦，我知道病出于肝；诸脉皆缓，我知道病出于脾；诸脉皆涩，我知道病出于肺。诸脉皆浮洪，病不在心吗？诸脉皆沉滑，病不在肾吗？如果结合腑脏来看，假如左寸脉数，数主热，重按得之，则热入于心；轻取得之，则热入小肠。左尺脉迟，迟主寒，重按得之，则寒入于肾；轻取得之，则寒入膀胱。其余以此类推。唉！这是通变的方法。怎么能有圆通机敏的人士与我讨论这个呢！
I initially wrote *Huoren Zongguo* (General Summary for People's Survival) and *Ying'er Zhiyao* (Essential Guidelines for Infants), but the vulgar world mocked me for seeking fame. When the section on *Maishu* (Pulse Book) was published, they then restrained themselves and warned each other, saying, "It is indeed not easy." Who would be willing to empty their granaries to cater to others? I said, "Do you know Heaven? Heaven intends to entrust its heart of saving people and benefiting things to me, thus endowing me with the learning of mental clarity and intuitive understanding. Having received this from Heaven, one should return it to serve Heaven (benefit humanity); this is what the Creator originally expected. Perhaps some people shine like light through a crack, hoarding knowledge within themselves without spreading it to others; I fear this would be like jade destroying itself in a box or grass and trees rotting together. Although humans have 404 types of diseases, and some may fall outside the scope of the first three volumes, can we not investigate the syndromes and select formulas, revealing the direct path of *Zhizhi* (Direct Guidance)? 'Zhi' (Direct) means clear and easy to understand; 'Zhi' (Point/Guide) means indicating the way. By dissecting the hidden meanings left unspoken by past sages and extracting effective formulas from various schools, combined with family traditions and referenced against *Zhouhou Beiji Fang* (Emergency Prescriptions Kept Up the Sleeve), readers will have clear insight in mind and eye, recognizing syndromes upon facing diseases and finding medicines according to syndromes, just as a carpenter's ink line cannot deceive. Thus, the intention of benevolence will flow continuously, passing down generation to generation—is this not my deep aspiration? I once sighed and wrote: Heaven gives humans these materials (medicine/wisdom/body), surely intending for them to use them. To possess such things but fail to use them is not only to defy Heaven but also to abandon one's own heavenly endowment. I write this to encourage those of like minds.
On the first day of the good month of Jiazi year (Jingding era). Yang Shiying (Courtesy name Dengfu) of Sanshan writes the preface.
The wind in Heaven manifests as Wood on Earth, and corresponds to the Liver in humans; only the Liver governs Wind. The heat in Heaven (including warmth, summer heat, blazing heat, and muggy heat, which are manifestations of heat) manifests as Fire on Earth, and corresponds to the Heart in humans; only the Heart governs Heat. The dampness in Heaven manifests as Earth on Earth, and corresponds to the Spleen in humans; only the Spleen governs Dampness. The dryness in Heaven manifests as Metal on Earth, and corresponds to the Lungs in humans; only the Lungs govern Dryness. The cold in Heaven manifests as Water on Earth, and corresponds to the Kidneys in humans; only the Kidneys govern Cold. Alas! These are the natural Qi of Heaven and Earth. When Qi deviates or hides, invading humans when they are deficient, and humans cannot overcome it, this is how hundred diseases arise. Therefore, Wind easily injures the Liver, Heat easily injures the Heart, Dampness easily injures the Spleen, Dryness easily injures the Lungs, Cold easily injures the Kidneys, and Summer-heat easily injures the Pericardium (Xinbaoluo). (The Pericardium is called Danzhong, located between the chest and diaphragm. Since the Heart governs Summer-heat, Summer-heat Qi lies latent between the Sanjiao, diaphragm, and stomach.) If Wind Qi prevails, Wood evil attacks Earth, causing Spleen disease. If Heat Qi prevails, Fire evil attacks Metal, causing Lung disease. If Dampness Qi prevails, Earth evil attacks Water, causing Kidney disease. If Dryness Qi prevails, Metal evil attacks Wood, causing Liver disease. If Cold Qi arrives greatly, Heart Fire is also overcome by Kidney Water. The Left Guan pulse position (Renying) indicates the entry point of Wind, Cold, Summer-heat, Dampness, Heat, and Dryness. The Right Guan pulse position (Qikou) distinguishes whether Zang Qi is stagnant or smooth, and the accumulation/dispersion and fullness/deficiency of Food Qi. As for sorrow and overthinking, they easily consume Heart Spirit. Anger and qi rebellion easily damage Liver Qi. Indulgence in desires and forcing the will damage the Kidneys. External cold and cold drinks harm the Lungs. Hunger, fullness, fatigue, and overwork injure the Spleen. External Six Evils attacking each other and Internal Seven Emotions affecting each other—any of these constitute Evil of the Five Zang Organs. By following what each governs, one can trace where a specific Zang organ has been affected, and the cause will be found.
The Heart governs Blood, stores Shen (Spirit), corresponds superiorly to the tongue, exteriorly to the palms, its sound is speech, its color is red, its odor is scorched, its taste is bitter, and its fluid is sweat. The Liver governs Sinews, stores Hun (Ethereal Soul), corresponds superiorly to the eyes, exteriorly to the nails, its sound is shouting, its color is green, its odor is dry, its taste is sour, and its fluid is tears. The Kidneys govern Bones, store Jing (Essence) and Zhi (Will), correspond superiorly to the ears, exteriorly to the waist and back, its sound is groaning, its color is black, its odor is putrid, its taste is salty, and its fluid is saliva. (When Kidneys are cold, there is often pungency, and its fluid is nasal discharge. The Spleen governs Muscle, stores Yi (Intellect) and Zhi (Wisdom - note: distinct from Kidney Zhi), corresponds superiorly to the mouth, exteriorly to the four limbs, its sound is singing, its color is yellow, its odor is fragrant, its taste is sweet, and its fluid is drool. Thus, Heart and Lungs are above, governing Mai Qi (Pulse Qi); Liver and Kidneys are below, storing Jing and Blood; the Spleen is in the center, nourishing Jing, Blood, and Mai Qi. The normal Heart pulse is floating, large, and scattered; the normal Liver pulse is wiry, fine, and long; the normal Kidney pulse is deep, soft, and slippery; the normal Lung pulse is short, choppy, and floating; the normal Spleen pulse is harmonious, slow, and large. Ping (Normal) refers to the inherent correct pulses of the Five Zang Organs. Spring Wiry, Summer Hook (Wu Shuhe stated: Summer Full/Hong takes the meaning of Fire pulse coming strongly), Autumn Feather, Winter Stone—these correspond to the flourishing states of the Four Seasons, symbolizing Wood, Fire, Metal, and Water, each flourishing for 72 days. Earth pulse is the seasonal pulse, flourishing for 18 days in the last month of each season. Spring is Wiry-Slow, Summer is Full-Slow, Autumn is Subtle-Slow, Winter is Deep-Slow. Combined across seasons, this totals 72 days. Spring Wiry refers to a straight shape, fine, weak, and long. Summer Hook refers to floating, large, and scattered, coming fast and departing slow. Autumn Feather refers to a sparse and soft shape, light, void, and floating. Winter Stone refers to deep, soft, and slippery, coming fast when lifting the finger. Earth pulse: warm and thick Qi moves within the Zang-Fu organs; the peaceful state is hard to see, appearing only when declining. The so-called Wiry, Hook, Feather, and Stone merely appear slightly in accordance with the seasons. They must contain the harmony of Grain Spirit and Stomach Qi. If Wiry resembles a drawn bowstring, Hook resembles holding a belt hook, Feather resembles wind-blown feathers, Stone comes like pulling a rope and departs like shooting stones, these are all critical pulses. This indicates an absolute lack of Stomach Qi. If Stomach Qi is depleted and cut off, how can it last long? If Spring yields Metal pulse, Summer yields Water pulse, Autumn yields Fire pulse, Winter yields Earth pulse, and Four Seasons yield Wood pulse, this aligns with Heart pulse overcoming Lung pulse, Lung overcoming Liver, Liver overcoming Spleen, Spleen overcoming Kidney, and Kidney overcoming Heart—all are Thief Evils. How can a person exist if one Zang organ lacks Qi? Then, can we hear about the pulses of the Fu organs? It is said: Small Intestine pulse is slightly Full, Large Intestine is slightly Choppy, Bladder is slightly Deep, Stomach is slightly Slow, and Gallbladder is slightly Wiry and urgent. There is no other reason; Fu organs combine with Zang organs, same Qi seeks same Qi, hence approximations are obtained. Furthermore, what did the ancients mean by Nine Zang Organs? It is said: Form Zang includes four: head/horns, eyes/ears, mouth/teeth, chest/middle. Spirit Zang includes five: Heart stores Shen, Liver stores Hun, Kidneys store Zhi, Lungs store Po, and Spleen stores Yi. However, Zang organs are the residence of Spirit; complexion is the banner of Spirit. If Five Zang organs are ruined, the complexion must become premature and withered, abnormal and strange; premature decline leads to death. There is further explanation: Pulse Micro-Slow and Soft-Weak, though signs differ, both indicate Cold and Deficiency. Pulse Rapid-Excess and Long-Full, though forms differ, both indicate Heat and Excess. If all pulses are Wiry, I know the disease originates in the Liver; if all are Slow, in the Spleen; if all are Choppy, in the Lungs. If all pulses are Floating-Full, is the disease not in the Heart? If all are Deep-Slippery, is it not in the Kidneys? Observing Zang-Fu together: for example, if Rapid appears at Left Cun, Rapid indicates Heat. If felt deeply, Heat enters the Heart; if felt superficially, Heat enters the Small Intestine. If Slow appears at Left Chi, Slow indicates Cold. If felt deeply, Cold enters the Kidneys; if felt superficially, Cold enters the Bladder. The rest can be deduced similarly. Alas! This is the method of general adaptation. How can one discuss this with a round-minded scholar?