脉阴阳俱紧。至于吐利。其脉独不解。紧去人安。此为欲解。若脉迟。至六七日。不欲食。此
为晚发。水停故也。为未解。食自可者为欲解。
此段又就脉阴阳俱紧申言之。以见脉之宜辨症。正所以证脉也。
病六七日。手足三部脉皆至。大烦。而口噤不能言。其人躁扰者。必欲解也。若脉和。其人大
烦。目重。睑内际黄者。此为欲解。
此段总承上阴阳俱紧三段而申言之。点出手足三部脉。以见不独寸口也。
脉浮而数。浮为风。数为虚。风为热。数为寒。风寒相搏。则洒淅恶寒也。脉浮而滑。浮为阳。
滑为实。阳实相搏。其脉数疾。卫气失度。浮滑之脉数疾。即发热汗出者。此为不治。
此段辨脉之浮数。以明症之轻重不同也。
伤寒。咳逆上气。其脉散者死。其形损故也。
此段结言辨脉之终。故就伤寒推究其所以死也。
师曰。呼吸者。脉之头也。初持脉。来疾去迟。此出疾入迟。名曰内虚外实也。初持脉。来
迟去疾。此出迟入疾。名曰内实外虚也。
此段先明呼吸为脉所自始。
问曰。上工望而知之。中工问而知之。下工脉而知之。顾闻其说。师曰。病家人请。云病患苦
发热。身体疼。病患自卧。师到。诊其脉。沉而迟者。知其瘥也。何以知之。表有病者。脉当浮大。
今脉反沉迟。故知愈也。
此段因脉辨症。
此所谓沉迟。是就初持脉寸口浮取而言。非持之而得沉迟。故为病愈。此等大有关系。故申明
之。
假令病患云。腹内卒痛。病患自坐。师到脉之。浮而大者。知其瘥也。何以知之。若更有病者。脉
当浮而细。今脉浮大。故知愈也。
此段亦是因脉知症。更有病。更即仍字义。非别病也。
师曰。病家人来请。云病患发热烦极。明日师到。病患向壁卧。此热已去也。设令脉不和。
处言已愈。设令向壁卧。闻师到。不惊起而盼视。若三言三止。脉之咽唾者。此诈病也。设令脉自和。
言此病太重。当须服吐下药。针灸数十百处。乃愈。
此段就病患情伪。察识其病之真假。而必以脉为定也。
言须服吐下药。针灸数十百处。以受尽痛苦吓之。彼诈病者惊闻。必不敢见欺。而自吐实情矣。
师持脉。病患欠者。无病也。脉之。呻者。病也。言迟者。风也。摇头言者。里病也。行迟者。
表强也。坐而伏者。气短也。坐而下脚者。腰痛也。里实护腹如怀卵物者。心痛也。
此段就持脉时。病患之声音状貌情态。以辨明何病。亦以佐辨脉察病之法也。
师曰。伏气之病。以意候之。今月之内。欲有伏气。假令旧有伏气。当须伏之。若脉微弱者。
当喉中痛似伤。非喉痹也。病患云。实喉中病。虽尔。今复欲下利。
此段辨明伏气之脉。故虽及症。而不言治法。
冬时感寒。伏藏经中者。为伏气。今月春分。伏寒欲发时也。欲有伏气。为时令言。假令旧有
伏气。诊于人而得之。脉微弱。指少阴也。喉痛如物伤之。而非火邪壅肿之喉痹。此正伏气。久已
变热也。病患果云实喉中痛。辨脉验症。伏气已真矣。虽尔。喉痛为伏气上冲。且必下决作利也。
问曰。人病恐怖者。其脉何状。师曰。脉行如循丝。累累然。其面白脱色。问曰。人不饮。其脉何
类。师曰。脉自涩。唇口干燥也。
问曰。人愧者。其脉何类。师曰。脉浮。面色乍白乍赤。
此段并言三症。皆辨脉而兼望色。以知病之情状也。
问曰。脉有三菽六菽重者。何谓也。师曰。脉者。人以指按之。如三菽之重者。肺气也。如六
菽之重者。心气也。如九菽之重者。脾气也。如十二菽之重者。肝气也。按之至骨者。肾气也。
此段明诊法轻重。以求脉于浅深。而知所属何脏也。
假令下利。寸口关上尺中。悉不见脉。然尺中时一小见。脉再举头者。肾气也。若见损脉来至。
为难治。
此段补叙少阴伏气。由元阳素虚。寒邪久蓄。变成热邪。上冲不透。下趋必利。为危候也。
问曰。脉有相乘。有纵有横。有顺有逆。何也。师曰。水行乘火。金行乘木。名曰纵。火行乘
水。木行乘金。名曰横。水行乘金。火行乘木。名曰逆。金行乘水。木行乘之。名曰顺。
此段就五行生克之理。辨脉之衰旺。乘者为病邪。所乘者为正气也。
问曰。脉有残贼。何谓也。师曰。脉弦、紧、浮、滑、沉、涩。此六者。名为残贼。能为诸脉
作病也。
此段申明病脉。有害于如经之脉。又以些六脉为关要。故举以示人。弦紧者。阴病脉。残贼阳
正脉之柔缓也。浮滑者阳病脉。残贼阴正脉之和缓也。浮而兼滑。大而芤也。沉涩者。亦阴病脉。
残贼阳正脉之流行充畅也。举此六者以概之。然凡病脉。皆能残贼正脉。使之变动而不安其常。
问曰。脉有灾怪。何谓也。师曰。假令人病。脉得太阳。与形症相应。因为作汤。比还送汤。
如食顷。病患乃大吐。若下利。腹中痛。师曰。我前来不见此症。今乃变异。是名灾怪。又问曰。
何缘作此吐利。答曰。或有旧时服药。今乃发作。故名灾怪也。
此段辨脉审症。推究以至于极也。脉得太阳。必用散邪升阳汤剂。旧服药。今发作。必是寒凉
之药。旧存于里。今得治表之汤。寒邪在表。未及驱逐。而寒药在里。先发作而吐泻矣。故曰灾怪。
然寒药中存者。得吐泻可除。即今表邪亦不
治而自散矣。何也。吐上越。必有汗可解也。
问曰。东方肝脉。其形何似。师曰。肝者。木也。名厥阴。其脉微弦。濡弱而长。是肝脉。肝
病自得濡弱者。愈也。假令得纯弦者死。何以知之。以其脉如弦直。是肝脏伤。故知死也。
南方心脉。其形何似。师曰。心者。火也。名少阴。其脉洪大而长。是心脉。心病自得洪大者。
愈。假令脉来微去大。故名反。病在里也。脉来头大本小者。故名覆。病在表也。上微头小者。
则汗出。下微本大者。则为关格不通。不得尿。头无汗者。可治。有汗者死。
西方肺脉。其形何似。师曰。肺者。金也。名太阴。其脉毛。浮也。肺病自得此脉。若得缓迟
者。皆愈。若得数者。则剧。何以知之。数者。南方火。火克西方金。法当痈肿。为难治也。
此三段因五行生克之理。已于前纵横顺逆详言之。今复就辨脉而知脏病。欲人审察之也。但言
三脏者。亦如辨脉篇但言夏令。人当自推及也。
问曰。二月得毛脉。何以遽言至秋当死。师曰。二月之时。脉当濡弱。反得浮者。故知至秋死。
二月肝用事。脉应濡。反得毛浮。是肺脉也。肺属金。金来克木。故知秋死也。他皆仿此。
此段因五脏辨脉。而推及于四时。亦举一以例其余也。
师曰。脉肥人。责浮。脉瘦人。责沉。肥人当沉。今反浮。瘦人当浮。今反沉。故责之。
此段就人形体。辨诊脉之轻重。以定责治之法也。
师曰。寸脉下不至关。为阳绝。尺脉上不至关。为阴绝。此皆不治。决死也。若计其余。有生
死之期。期以月节克之也。
此段承上关格。推言阴阳不顺接。上下不交通。凡病皆可决之于脉也。
师曰。脉病。人不病。名曰行尸。以无王气。卒眩仆不识人者。短命则死。人病。脉不病。名
曰内虚。以无谷神。虽因无苦。
此段因前文辨脉审症。而知所重惟在乎脉。而症不过证其脉也。
问曰。翕、奄、沉。名曰滑。何谓也。沉为纯阴。翕为正阳。阴阳相合。故令脉滑。关尺自平。
阳明脉微沉。食饮自可。少阴脉微滑。滑者。紧之浮名也。此为阴实。其人必股内汗出。阴下湿也。
此段专辨脉之沉。而兼及滑浮紧。正申言脉有残贼一节也。翕与辟对。奄与发对。掩同。脉属
气属阳。阳为阴所翕合而奄掩之。则脉沉也。再重按。形圆顶指。此沉乃流动有力而滑也。
问曰。曾为人所难。紧脉从何而来。师曰。假令亡汗。若吐。以肺里寒。故令脉紧也。假令咳
者。坐饮冷水。故令脉紧也。假令下利。以胃中虚冷。故脉紧也。
此段亦申言残贼脉也。前段论关尺二部之沉滑。于尺中辨阳虚阴实之紧脉。此言寸脉之紧。及
胃中虚冷之紧。皆明三部之阳虚阴实也。
寸口卫气盛。名曰高。荣气盛。名曰章。高章相搏。名曰纲。卫气弱。名曰 。荣气弱。名曰
卑。 卑相搏。名曰损。卫气和。名曰缓。荣气和。名曰迟。迟缓相搏。名曰沉。
此段分三节。辨脉之过不及。与中和之象。而审病机也。曰寸口者。以诸脉总会之首。实该三
部九候而辨之也。
寸口脉缓而迟。缓则阳气长。其色鲜。其颜光。其声商。毛发长。迟则阴气盛。骨髓生。血满。
肌肉紧薄鲜硬。阴阳相抱。荣卫俱行。刚柔相搏。名曰强。
此段紧接上迟缓为沉来。分别出迟缓又可名强也。亦曰寸口者。分以两寸统各三部。其左右六
部悉同等也。趺阳脉滑而紧。滑者。胃气实。紧者。脾气强。持实击强。痛还自伤。以手把刃。坐
作疮也。
此段承上强脉。并前段言阴实。专就脾胃表里。以明脉见强为平脉。亦有时为病脉也。脉贵和
平。胃实脾强。皆为病脉。如持阳实以击阴强。则水火相搏。不相逮者。真相搏矣。然非外敌。乃
自相残伤。如以手把刃。坐而自戕其躯体。以成疮疡也。但言持实击强。不言持强击实。可推其义。
寸口脉浮而大。浮为虚。大为实。在尺为关。在寸为格。关则不得小便。格则吐逆。趺阳脉伏
而涩。伏则吐逆。水谷不化。涩则食不得入。名曰关格。
此段就脉辨出关格之病。却有两种。然皆由阴阳为病。无错杂之邪阻碍。故尚轻于无尿但头汗
出之关格。
脉浮而大。浮为风虚。大为气强。风气相搏。必成瘾疹。身体为痒。痒者名泄风。久久为痂癞。
此段又就浮大脉。辨瘾疹痂癞之症。亦于寸口候表也。
寸口脉弱而迟。弱者。卫气微。迟者。荣气寒。荣为血。血寒则发热。卫为气。气微则心内饥。
饥而虚满。不能食也。
此段亦辨脉论症。总不外阳虚阴实之义。
趺阳脉大而紧者。当即下利。为难治。寸口脉缓而弱。弱者。阳气不足。缓者。胃气有余。噫
而吞酸。食卒不下。气填于胸上也。
此段亦辨脉论症。专以胃之虚实。验病之轻重。而实为阳虚阴实之见端也。
趺阳脉紧而浮。浮为气。紧为寒。浮为腹满。紧为绞痛。浮紧相搏。肠鸣而转。转即气动。膈
气乃下。少阴脉不出。其阴肿大而虚也。
此段就趺阳脉。辨少阴之症。而胃脉亦兼统焉。以趺阳主胃肾二经之脉也。程氏谓肾肿兼有水
蓄。亦是肾阳已衰。无湿不作虚肿也。然此水蓄。必在膀胱。气盛阳足。则自宣泄。不可作湿热治
也。
寸口脉微而涩。微者。卫气不行。涩者。荣气不足。荣卫不能相将。三焦无所仰。身体痹不仁。
荣气不足。则烦疼口难言。卫气虚。则恶寒数欠。三焦不归其部。上焦不归者。噫而吞酢。中焦不
归者。不能消谷引食。下焦不归者。则遗溲。沉而数。沉为实。数消谷。紧者病难治。
此段辨脉。乃就表之荣卫。里之三焦。而得阴阳两亏之脉。虽言寸口。实兼关尺二部。轻重取
之而得也。紧者病难治。以中气空虚之极所致。较浮而涩者更加等也。然皆不为预图之故。不重可
悔恨哉。
寸口脉微而涩。微者。卫气衰。涩者。荣气不足。卫气衰。面色黄。荣气不足。面色青。荣为
根。卫为叶。荣卫俱微。则根叶枯槁。而寒栗。咳逆。唾腥。吐涎沫也。
此段又就寸口脉分辨病情面色。而知阳虚阴实。更兼痰之候。
趺阳脉浮而芤。浮者。卫气衰。芤者。荣气伤。其身体瘦。肌肉甲错。浮芤相搏。宗气衰微。
四属断绝。
此段又就辨脉明荣卫之表气。而趺阳为胃脉。中焦之气出于胃。因可识宗气也。四属。四肢也。
断绝则荣卫不行。不止不足。将为半身不遂等症矣。
寸口脉微而缓。微者。卫气疏。疏则其肤空。缓者。胃气实。实则谷消而水化也。谷入于胃。
脉道乃行。水入于经。其血乃成。荣盛则其肤必疏。三焦绝经。名曰血崩。
此段因前二段寸口趺阳。候得荣卫俱微。遂专论卫微荣盛之症。亦于脉辨之也。里荣无所统摄。
多入于经者。亦易乱出于经。何也。气有行于荣中者。荣气也。气有护于荣外者。卫气也。卫气既
疏。则里血无力。血易泛滥。不由经道而下崩。此乃三焦经绝也。
趺阳脉微而紧。紧则为寒。微则为虚。微紧相搏。则为短气。少阴脉弱而涩。弱者。微烦。涩
者。厥逆。趺阳脉不出。脾不上下。
身冷肤硬。
此段又就脉辨得阳虚阴实之一症。余可类推。
少阴脉不至。肾气微。少精血。奔气促迫。上入胸膈。宗气反聚。血结心下。阳气退下。热归
阴股。与阴相动。令身不仁。此为尸厥。当刺期门巨阙。
此段就上趺阳脉不出。推出少阴脉。以趺阳主肾。故可明肾虚主症也。
寸口脉微迟。尺脉紧。其人虚损多汗。知阴常在。绝不见阳也。寸口诸微亡阳。诸濡亡血。诸
弱发热。诸紧为寒。诸乘寒者则为厥。郁冒不仁。以胃无谷气。脾涩不通。口紧不能言。战而栗也。
此段又就脉申言阳虚阴实之病。更推类以结之也。
脉象寸关尺三部皆呈现紧象，并出现呕吐、腹泻的症状。如果此时脉象依然紧而不解，说明病邪未除；若紧脉消失，患者感到安宁舒适，这是病情即将痊愈的征兆。如果脉象迟缓，到了第六七天，患者不想进食，这属于“晚发”（指寒邪潜伏较久才发作），是因为体内有水饮停聚所致，表明病仍未解；如果患者饮食正常，则是病情即将痊愈的表现。
这段文字进一步阐述“脉阴阳俱紧”的情况，旨在说明脉象应当结合症状来辨别，这正是通过症状来验证脉象的方法。
患病六七天，手太阴肺经、足阳明胃经、足少阴肾经等手足三部的脉搏都能触及，患者极度烦躁，且牙关紧闭不能说话，如果患者躁动不安，这是正气抗邪、病情即将痊愈的表现。如果脉象调和，患者虽然极度烦躁，但眼睑内侧颜色发黄，这也是病情即将痊愈的征兆。
这段文字总括上文关于“阴阳俱紧”的三段论述并加以阐发，特别指出要观察手足三部的脉象，以说明诊脉不仅限于寸口一处。
脉象浮而数。浮脉主风，数脉主虚；风邪致病多表现为热，数脉也可见于寒证（此处原文逻辑较为复杂，通常数主热，但结合上下文及后世注家，此处意在辨析风寒相搏之变）。风邪与寒邪相互搏结，患者会出现洒淅恶寒的感觉。脉象浮而滑，浮为阳脉，滑为实脉，阳邪与实邪相互搏结，导致脉象急促快速，卫气运行失去常态。如果浮滑的脉象变得急促快速，同时伴有发热、出汗的症状，这属于难治之症（不治）。
这段文字通过辨析浮数和浮滑的脉象，来说明症状轻重的不同。
伤寒病，出现咳嗽、气逆上冲的症状，如果脉象散乱无根，预后不良，会导致死亡，这是因为形体精气亏损的缘故。
这段文字作为辨脉篇的结语，因此针对伤寒病推究其导致死亡的机理。
老师说：呼吸是脉搏产生的源头。刚开始切脉时，如果脉搏来势急而去势缓，这叫“出疾入迟”，名为内虚外实证。刚开始切脉时，如果脉搏来势缓而去势急，这叫“出迟入疾”，名为内实外虚证。
这段文字首先阐明呼吸是脉搏生成的起始原因。
问：高明的医生望而知之，一般的医生问而知之，低劣的医生脉而知之。我听过这种说法。老师说：病人的家属请求诊治，说病人痛苦于发热、身体疼痛，病人自己躺着。医生到达后，诊察其脉象，发现脉沉而迟，就知道病人快要痊愈了。为什么这样知道？因为表证存在时，脉象应当浮大。现在脉象反而沉迟，所以知道病愈了。
这段文字是通过脉象来辨别症状。
这里所说的“沉迟”，是指初持脉时在寸口部位浮取所得，并非重按才得沉迟，所以判断为病愈。这种情况关系重大，因此特别说明。
假如病人说腹中突然疼痛，病人自己坐着。医生到达后诊脉，脉象浮而大，就知道病人快要痊愈了。为什么这样知道？如果还有病邪，脉象应当浮而细。现在脉象浮大，所以知道病愈了。
这段文字也是通过脉象来知晓症状。“更有病”中的“更”字意为“仍然”，不是指别的病。
老师说：病人的家属前来请求诊治，说病人发热烦躁至极。第二天医生到达，看到病人面向墙壁躺着，这说明热邪已经退去。假如脉象不和，医生也会说病已痊愈。假如病人面向墙壁躺着，听到医生到来，不惊起而是用眼睛斜视，或者说话断断续续（三言三止），诊脉时吞咽口水，这是装病。假如脉象自和，医生会说这个病很重，必须服用催吐或泻下的药物，并在数十上百个穴位进行针灸治疗，才能痊愈。
这段文字通过观察病人的情态真伪，来识别疾病的真假，并且必须以脉象作为最终判定依据。
说要服用吐下药，在数十百处穴位进行针灸，是为了让病人受尽痛苦从而吓唬他。那些装病的病人听到后，必定不敢再欺骗，而会吐出实情。
医生切脉时，病人打哈欠的，是没有病。诊脉时呻吟的，是有病。说话迟缓的，是中风。摇头说话的，是里有病。行走迟缓的，是表证强盛（肌肉僵硬）。坐着伏身的，是气短。坐着把脚放下的，是腰痛。里实证护住腹部像怀着蛋一样保护的，是心痛。
这段文字通过切脉时病人的声音、状貌、情态，来辨别是何种疾病，这也是辅助辨脉察病的方法。
老师说：伏气病，需要用心意去候察。如果在当月之内，想要有伏气发作。假如旧有伏气，应当予以伏藏治疗。如果脉象微弱，应当感觉喉咙痛像是受伤一样，但这不是喉痹（咽喉红肿溃烂）。病人说确实是喉咙痛。虽然是这样，但现在又想要下利（腹泻）。
这段文字辨析伏气的脉象，所以虽然涉及症状，但不讲治疗方法。
冬季感受寒邪，潜伏藏在经络中的，称为伏气。现在正值春分时节，是伏寒将要发作的时候。“欲有伏气”是针对时令而言。假如旧有伏气，诊察人体得到此脉，脉象微弱，对应少阴经。喉咙痛如同被物体损伤，而不是火邪壅肿导致的喉痹。这正是伏气，久已化热。病人果真是喉咙痛，通过辨脉验症，确认是伏气无疑。虽然是这样，但喉痛是伏气上冲所致，并且必然向下导致腹泻。
问：人患恐惧症时，脉象是什么样子？老师说：脉象运行如循摸丝线，连绵不断，面色苍白脱色。问：人不喝水时，脉象是什么样的？老师说：脉象自然涩滞，嘴唇口舌干燥。
问：人羞愧时，脉象是什么样的？老师说：脉象浮，面色忽白忽红。
这段文字并列讲述三种情况，都是通过辨脉兼望面色，来了解病情状况。
问：脉象有“三菽”、“六菽”重按的区别，是什么意思？老师说：脉象，医生用手指按压它。如三颗豆子的重量，是肺气。如六颗豆子的重量，是心气。如九颗豆子的重量，是脾气。如十二颗豆子的重量，是肝气。按至骨头，是肾气。
这段文字阐明诊法中轻重力度的区别，以求取深浅不同的脉象，从而知道所属的脏腑。
假如下利，寸口、关上、尺中三部都摸不到脉象，然而尺部偶尔轻微跳动一下，脉象两次举头（指脉搏起伏），这是肾气尚存。如果见到衰损的脉象到来，就难以治疗。
这段文字补充叙述少阴伏气，由于元阳素来虚弱，寒邪久积，变成热邪，向上冲透不了，向下趋行必然导致下利，属于危重证候。
问：脉象有相乘的现象，有纵、横、顺、逆之分，这是什么意思？老师说：水行乘火，金行乘木，叫做纵。火行乘水，木行乘金，叫做横。水行乘金，火行乘木，叫做逆。金行乘水，木行乘土（原文作“木行乘之”，据五行生克及上下文语境，通常指木乘土或金生水等，此处依原文直译并保留歧义，注：原文“木行乘之”后缺宾语，结合前文“水行乘火...名曰纵...名曰横...名曰逆...名曰顺”，通常顺为相生，逆为相克太过。此处依原文翻译），叫做顺。
这段文字根据五行生克的原理，辨析脉象的盛衰。乘者为病邪，所乘者为正气。
问：脉象中有“残贼”脉，是什么意思？老师说：弦、紧、浮、滑、沉、涩这六种脉象，称为残贼。它们能导致其他脉象发生病变。
这段文字申明病脉，有害于正常的经脉，又以这六种脉象为关键，所以列举出来给人看。弦、紧是阴病脉，损害阳正脉的柔缓特性。浮、滑是阳病脉，损害阴正脉的和缓特性。浮而兼滑，是大脉兼芤脉。沉、涩也是阴病脉，损害阳正脉的流行充畅特性。列举这六种来概括。然而凡是病脉，都能残害正脉，使其变动而不能保持常态。
问：脉象中有“灾怪”，是什么意思？老师说：假如有人生病，脉象呈现太阳病特征，与形症相应，因此开具汤药。等到送药回来，大约一顿饭的功夫，病人却剧烈呕吐，或者下利，腹痛。医生说：“我刚才没见到这些症状，现在竟然变异了，这就叫灾怪。”又问：“为什么会发生这种吐利？”回答说：“或许是因为以前服过药，现在才发作，所以名叫灾怪。”
这段文字辨析脉象审察症状，推究到了极点。脉象得太阳病，必用发散邪气、升发阳气的汤剂。以前的服药，现在发作，必定是寒凉性质的药物，以前存留在体内，现在遇到治疗表证的汤药，寒邪在表，还没来得及驱逐，而寒药在里，先发作导致吐泻。所以叫灾怪。然而存留的寒药通过吐泻可以去除，即现在的表邪也不治而自散了。为什么呢？吐法使邪气从上越出，必然伴随汗出而解。
问：东方肝脉，它的形状像什么？老师说：肝属木，名为厥阴。其脉微弦，濡弱而长，这就是肝脉。肝病如果自得濡弱脉，就会痊愈。假如得到纯弦脉，就会死亡。为什么这样知道？因为脉象如弦般直硬，说明肝脏受损，所以知道会死。
南方心脉，它的形状像什么？老师说：心属火，名为少阴。其脉洪大而长，这就是心脉。心病如果自得洪大脉，就会痊愈。假如脉来时微小，去时盛大，名叫“反”，病在里。脉来时头大根部小，名叫“覆”，病在表。上部微小头部小的，则出汗。下部微小根部大的，则为关格不通，不能排尿。头部不出汗的，可治；有汗的，死。
西方肺脉，它的形状像什么？老师说：肺属金，名为太阴。其脉毛，即浮脉。肺病如果自得此脉，如果得到缓迟脉，都会痊愈。如果得到数脉，则病情加重。为什么这样知道？数是南方火脉，火克西方金，按照法则应当发生痈肿，难以治疗。
这三段因五行生克的原理，已在前面纵横顺逆中详细论述。现在又通过辨脉来知晓脏腑疾病，希望人们仔细审查。只说三脏，也像辨脉篇只说夏令一样，人们应当自行类推其余。
问：二月得到毛脉（浮而无力，如羽毛），为什么就说到了秋天会死？老师说：二月的时候，脉应当濡弱，反而得到浮脉，所以知道到秋天会死。二月肝气当令，脉应濡弱，反而得到毛浮脉，这是肺脉。肺属金，金来克木，所以知道秋天会死。其他情况都仿照此类推。
这段文字因五脏辨脉，而推及四时，也是举一反三。
老师说：肥胖人的脉，责求其浮象；瘦人的脉，责求其沉象。肥胖人脉应当沉，现在反而浮，所以要责备（探究）其原因。瘦人脉应当浮，现在反而沉，也要责备其原因。
这段文字根据人的形体，辨别诊脉的轻重，以确定治疗原则。
老师说：寸脉向下不至关部，为阳绝。尺脉向上不至关部，为阴绝。这些都属于不治之症，断定会死。如果计算剩余寿命，生死期限以月节克制推算。
这段文字承接上文关格，推论阴阳不顺接，上下不交通，凡病都可以从脉象决断。
老师说：脉有病，人没有病，名叫“行尸”。因为没有王气（旺盛之气），突然眩晕仆倒不识人的，短命则死。人有病，脉没有病，名叫“内虚”。因为没有谷神（脾胃之气），虽然暂时没有痛苦。
这段文字因前文辨脉审症，而知道所重视的唯独在于脉，而症状不过是验证脉象而已。
问：翕、奄、沉，名叫滑，是什么意思？沉为纯阴，翕为正阳，阴阳相合，所以令脉滑。关尺两部自平。阳明脉微沉，饮食正常。少阴脉微滑，滑是紧脉的浮象名称。此为阴实，其人必然大腿内侧出汗，阴部潮湿。
这段文字专门辨析脉之沉，而兼及滑、浮、紧，正是申言脉有残贼这一节的内容。翕与辟相对，奄与发相对，“掩”同义。脉属气，气属阳，阳被阴所翕合而掩盖，则脉沉。再重按，脉形圆顶指，这种沉是流动有力而滑的。
问：曾经被人诘难，紧脉从何而来？老师说：假如亡汗，或者呕吐，因为肺里有寒，所以令脉紧。假如咳嗽，因为饮用冷水，所以令脉紧。假如下利，因为胃中虚冷，所以脉紧。
这段文字也申言残贼脉。前段论述关尺二部的沉滑，在尺部辨析阳虚阴实的紧脉，这里论述寸脉的紧，以及胃中虚冷的紧，都明确三部之阳虚阴实。
寸口卫气盛，名叫“高”。营气盛，名叫“章”。高章相搏，名叫“纲”。卫气弱，名叫“卑”（原文缺字，推测为“卑”或类似字，下文有“卑”）。营气弱，名叫“卑”。卑卑相搏，名叫“损”。卫气和，名叫“缓”。营气和，名叫“迟”。迟缓相搏，名叫“沉”。
这段分三节，辨析脉象的过与不及，以及中和之象，从而审察病机。说“寸口”，是因为它是诸脉总会之首，实际上统括三部九候来辨析。
寸口脉缓而迟，缓则阳气生长，面色鲜艳，容颜光亮，声音商亮，毛发长。迟则阴气盛，骨髓生，血满，肌肉紧薄鲜硬。阴阳相抱，营卫俱行，刚柔相搏，名叫“强”。
这段紧接上文迟缓为沉，分别出迟缓又可名为强。也说“寸口”，分为两寸统领各三部，左右六部完全同等。趺阳脉滑而紧，滑者，胃气实；紧者，脾气强。持实击强，痛还自伤，如同用手握刀刃，自己造成疮疡。
这段承接上文强脉，并前段言阴实，专门就脾胃表里，说明脉见强为平脉，有时也为病脉。脉贵和平，胃实脾强，皆为病脉。如持阳实以击阴强，则水火相搏，不相逮者，真相搏矣。然非外敌，乃自相残伤，如以手把刃，坐而自戕其躯体，以成疮疡也。但言持实击强，不言持强击实，可推其义。
寸口脉浮而大，浮为虚，大为实。在尺部为关，在寸部为格。关则不得小便，格则吐逆。趺阳脉伏而涩，伏则吐逆，水谷不化，涩则食不得入，名叫关格。
这段就脉象辨析出关格之病，却有两种。然而皆由阴阳为病，无错杂之邪阻碍，所以尚轻于无尿但头汗出之关格。
脉浮而大，浮为风虚，大为气强。风气相搏，必然成瘾疹，身体瘙痒。痒者名叫泄风，久久成为痂癞。
这段又就浮大脉，辨析瘾疹痂癞的症状，也在寸口候表。
寸口脉弱而迟，弱者，卫气微；迟者，营气寒。营为血，血寒则发热。卫为气，气微则心内饥。饥而虚满，不能进食。
这段也辨脉论症，总不外乎阳虚阴实的意义。
趺阳脉大而紧者，当即下利，为难治。寸口脉缓而弱，弱者，阳气不足；缓者，胃气有余。嗳气吞酸，食物突然不下，气填于胸上也。
这段也辨脉论症，专门以胃之虚实，验证病之轻重，而实为阳虚阴实之见端也。
趺阳脉紧而浮，浮为气，紧为寒。浮为腹满，紧为绞痛。浮紧相搏，肠鸣而转，转即气动，膈气乃下。少阴脉不出，其阴肿大而虚也。
这段就趺阳脉，辨析少阴之症，而胃脉亦兼统焉。以趺阳主胃肾二经之脉也。程氏谓肾肿兼有水蓄，亦是肾阳已衰，无湿不作虚肿也。然此水蓄，必在膀胱，气盛阳足，则自宣泄，不可作湿热治也。
寸口脉微而涩，微者，卫气不行；涩者，营气不足。营卫不能相将，三焦无所仰，身体痹不仁。营气不足，则烦疼口难言。卫气虚，则恶寒数欠。三焦不归其部，上焦不归者，噫而吞酢，中焦不归者，不能消谷引食，下焦不归者，则遗溲。沉而数，沉为实，数消谷，紧者病难治。
这段辨脉，乃就表之营卫，里之三焦，而得阴阳两亏之脉。虽言寸口，实兼关尺二部，轻重取之而得也。紧者病难治，以中气空虚之极所致，较浮而涩者更加等也。然皆不为预图之故，不重可悔恨哉。
寸口脉微而涩，微者，卫气衰；涩者，营气不足。卫气衰，面色黄；营气不足，面色青。荣为根，卫为叶。荣卫俱微，则根叶枯槁，而寒栗，咳逆，唾腥，吐涎沫也。
这段又就寸口脉分辨病情面色，而知阳虚阴实，更兼痰之候。
趺阳脉浮而芤，浮者，卫气衰；芤者，营气伤。其身体瘦，肌肉甲错。浮芤相搏，宗气衰微，四属断绝。
这段又就辨脉明营卫之表气，而趺阳为胃脉，中焦之气出于胃，因可识宗气也。四属，四肢也。断绝则营卫不行，不止不足，将为半身不遂等症矣。
寸口脉微而缓，微者，卫气疏；疏则其肤空。缓者，胃气实，实则谷消而水化也。谷入于胃，脉道乃行。水入于经，其血乃成。荣盛则其肤必疏，三焦绝经，名叫血崩。
这段因前二段寸口趺阳，候得营卫俱微，遂专论卫微荣盛之症，亦于脉辨之也。里营无所统摄，多入于经者，亦易乱出于经。何也？气有行于营中者，营气也。气有护于营外者，卫气也。卫气既疏，则里血无力，血易泛滥，不由经道而下崩。此乃三焦经绝也。
趺阳脉微而紧，紧则为寒，微则为虚。微紧相搏，则为短气。少阴脉弱而涩，弱者，微烦；涩者，厥逆。趺阳脉不出，脾不上下，身冷肤硬。
这段又就脉辨得阳虚阴实之一症，余可类推。
少阴脉不至，肾气微，少精血，奔气促迫，上入胸膈，宗气反聚，血结心下，阳气退下，热归阴股，与阴相动，令身不仁，此为尸厥。当刺期门巨阙。
这段就上趺阳脉不出，推出少阴脉，以趺阳主肾，故可明肾虚主症也。
寸口脉微迟，尺脉紧，其人虚损多汗，知阴常在，绝不见阳也。寸口诸微亡阳，诸濡亡血，诸弱发热，诸紧为寒，诸乘寒者则为厥，郁冒不仁，以胃无谷气，脾涩不通，口紧不能言，战而栗也。
这段又就脉申言阳虚阴实之病，更推类以结之也。
The pulse is tight at both Yin (Chi) and Yang (Cun/Guan) positions. When accompanied by vomiting and diarrhea, if the pulse remains tight and does not resolve, it indicates the pathogen has not been expelled; if the tightness disappears and the patient feels comfortable, this signifies that recovery is imminent. If the pulse is slow, and by the sixth or seventh day the patient loses their appetite, this is termed "late onset" (Wan Fa), caused by water retention in the body, indicating the disease is unresolved. If the patient's appetite remains normal, it indicates impending recovery.
This section elaborates on the "tight pulse at both Yin and Yang positions," illustrating that pulses should be differentiated according to symptoms, which serves to verify the pulse through clinical manifestations.
After six or seven days of illness, when pulses can be felt in the hand and foot三部 (Sanbu - three positions), and the patient experiences extreme restlessness, jaw stiffness preventing speech, and agitation, this indicates that the righteous Qi is fighting the pathogen and recovery is imminent. If the pulse is harmonious, and although the patient is extremely restless, the inner aspect of the eyelids appears yellow, this also indicates impending recovery.
This section summarizes the previous three paragraphs regarding the "tight pulse at both Yin and Yang positions" and elaborates on them, highlighting the observation of pulses in the hand and foot Sanbu to demonstrate that pulse diagnosis is not limited solely to the Cun Kou (radial artery).
The pulse is floating and rapid. Floating indicates Wind; Rapid indicates Deficiency. Wind pathogens typically manifest as Heat, while a Rapid pulse can also indicate Cold (in specific contexts of wind-cold interaction). When Wind and Cold pathogens contend with each other, the patient experiences chills and shivering (Sha Xi). The pulse is floating and slippery. Floating is a Yang pulse; Slippery indicates Excess. When Yang and Excess pathogens contend, the pulse becomes rapid and hurried, and the Wei Qi (Defensive Qi) loses its regulatory balance. If a floating-slippery pulse becomes rapid and hurried, accompanied by fever and sweating, this is considered untreatable (or difficult to treat).
This section differentiates the severity of symptoms by analyzing floating-rapid and floating-slippery pulses.
In Shang Han (Cold Damage) disease, if there is coughing and rebellious Qi rising upwards, and the pulse is scattered and rootless, death will ensue because the physical essence and Qi are depleted.
This section concludes the chapter on pulse differentiation by investigating the mechanisms leading to death in Shang Han diseases.
The Master said: Respiration is the origin of the pulse. Upon initially palpating the pulse, if the arrival is rapid and the departure is slow, this is called "rapid exit and slow entry," named Interior Deficiency and Exterior Excess. Upon initially palpating the pulse, if the arrival is slow and the departure is rapid, this is called "slow exit and rapid entry," named Interior Excess and Exterior Deficiency.
This section first clarifies that respiration is the starting point for pulse generation.
Question: An expert physician knows the disease through observation, an average physician through inquiry, and a poor physician through pulse diagnosis. I have heard this statement. The Master said: The patient's family requests treatment, stating the patient suffers from fever and body pain, and lies down quietly. When the physician arrives and palpates the pulse, finding it deep and slow, one knows the patient will recover. Why? Because when exterior pathogens exist, the pulse should be floating and large. Now that the pulse is instead deep and slow, we know the disease is resolving.
This section uses pulse diagnosis to differentiate symptoms.
The "deep and slow" mentioned here refers to the superficial palpation at the Cun Kou position initially, not the result of heavy pressure; thus, it indicates recovery. This distinction is crucial and therefore clarified.
Suppose the patient says they have sudden abdominal pain and sits quietly. When the physician arrives and palpates the pulse, finding it floating and large, one knows the patient will recover. Why? If pathology still existed, the pulse would be floating and thin. Now that it is floating and large, we know the disease is resolving.
This section also uses pulse to understand symptoms. "Geng you bing" (still having disease) implies "still," not a different disease.
The Master said: The patient's family requests treatment, stating the patient is extremely feverish and irritable. The next day, when the physician arrives, the patient lies facing the wall, indicating the heat has subsided. Even if the pulse is not perfectly harmonious, the physician may say the disease has resolved. However, if the patient lies facing the wall but, upon hearing the physician's arrival, does not startle up but instead glances sideways, speaks hesitantly (three words then stopping), and swallows saliva during pulse taking, this is feigned illness. Even if the pulse is naturally harmonious, the physician should say the disease is severe and requires emetic or purgative medicines, and acupuncture at dozens or hundreds of points, before recovery.
This section identifies the authenticity of the disease by observing the patient's behavioral discrepancies, using the pulse as the definitive criterion.
Prescribing emetics/purgatives and extensive acupuncture is intended to intimidate the feigner with the prospect of suffering, causing them to confess the truth out of fear.
When the physician palpates the pulse, if the patient yawns, there is no disease. If the patient groans during palpation, there is disease. If speech is sluggish, it is Feng (Wind/stroke). If the patient shakes their head while speaking, there is interior disease. If walking is slow, the exterior is stiff. If sitting with the body bent forward, there is shortness of breath. If sitting with legs extended, there is lower back pain. If protecting the abdomen like holding an egg due to interior excess, there is heart pain.
This section differentiates diseases based on the patient's sounds, postures, and behaviors during pulse taking, serving as an auxiliary method for pulse diagnosis.
The Master said: For Bing Fu Qi (latent pathogenic Qi), one must discern it mentally. If within the current month latent Qi is about to manifest, or if there is pre-existing latent Qi, it must be managed. If the pulse is weak and thready, the patient may experience throat pain resembling injury, but this is not Hou Bi (sore throat with swelling/ulceration). The patient claims true throat pain. Although so, diarrhea is likely to follow.
This section differentiates the pulse of latent Qi; thus, while symptoms are mentioned, treatment methods are not discussed.
Cold contracted in winter and hidden in the meridians is called Fu Qi. At the Spring Equinox, this latent cold is ready to emerge. "Desire for latent Qi" refers to the seasonal timing. If pre-existing latent Qi is diagnosed, and the pulse is weak/thready (indicating Shao Yin meridian involvement), the throat hurts as if injured, distinct from fire-toxin obstructed Hou Bi. This is indeed latent Qi that has transformed into heat over time. The patient's throat pain confirms latent Qi via pulse and symptom verification. However, since the throat pain results from latent Qi rushing upward, it will inevitably lead downward causing diarrhea.
Question: What is the pulse shape in cases of fear/terror? The Master said: The pulse moves like tracing a thread, continuous and small, and the face is pale. Question: What is the pulse in those who do not drink water? The Master said: The pulse is naturally choppy (Se), and the lips and mouth are dry.
Question: What is the pulse in cases of shame/blushing? The Master said: The pulse is floating, and the complexion alternates between white and red.
This section discusses three conditions, combining pulse differentiation with inspection of the complexion to understand the disease state.
Question: What is meant by the varying degrees of pressure in pulse taking, such as "three beans" or "six beans"? The Master said: When pressing the pulse with fingers: pressure equivalent to three beans corresponds to Lung Qi; six beans to Heart Qi; nine beans to Spleen Qi; twelve beans to Liver Qi; pressing to the bone corresponds to Kidney Qi.
This section clarifies the depth of pressure in diagnosis to locate the pulse and identify the associated Zang organ.
Suppose there is diarrhea, and no pulse is felt at Cun, Guan, or Chi positions. However, if the Chi position occasionally shows a slight beat, with the pulse rising twice, this indicates remaining Kidney Qi. If a deteriorated pulse appears, it is difficult to treat.
This section supplements the discussion on Shao Yin latent Qi, where primordial Yang deficiency allows cold pathogens to accumulate and transform into heat. Unable to rush upward effectively, it rushes downward causing diarrhea, a critical condition.
Question: What are Cheng (overacting), Zong (vertical), Heng (horizontal), Shun (smooth), and Ni (reverse) in pulses? The Master said: Water overacting on Fire, and Metal overacting on Wood, are called Zong. Fire overacting on Water, and Wood overacting on Metal, are called Heng. Water overacting on Metal, and Fire overacting on Wood, are called Ni. Metal overacting on Water, and Wood overacting on [Earth] (text omits object, implied by context of Five Elements), are called Shun.
This section analyzes pulse prosperity and decline based on the Five Elements' generating and controlling cycles. The overacting element is the pathogen; the overacted-upon element is the righteous Qi.
Question: What are Can Zei (harmful/destructive) pulses? The Master said: Xian (Wiry), Jin (Tight), Fu (Floating), Hua (Slippery), Chen (Deep), Se (Choppy). These six are called Can Zei because they can cause pathological changes in other pulses.
This section explains that these pathological pulses harm normal meridians and are highlighted as key indicators. Wiry and Tight are Yin disease pulses that damage the softness of Yang Zheng pulses. Floating and Slippery are Yang disease pulses that damage the harmony of Yin Zheng pulses. Floating combined with Slippery resembles Large and Kong (Hollow). Deep and Choppy are also Yin disease pulses damaging the smooth flow of Yang Zheng pulses. Listing these six covers the general principle: all pathological pulses can damage the regular pulse, causing instability.
Question: What is Zai Guai (disaster/mystery) in pulses? The Master said: Suppose a patient presents with Tai Yang pulse and corresponding symptoms, and a decoction is prescribed. Before the medicine is consumed, suddenly the patient vomits severely or has diarrhea with abdominal pain. The physician says, "I did not see these symptoms earlier; now they have changed. This is called Zai Guai." Asked why this happens, the answer is: Perhaps old medication taken previously is now reacting. Hence, Zai Guai.
This section explores pulse and symptom differentiation to its limits. A Tai Yang pulse requires dispersing and ascending formulas. Previous medication, likely cold-natured, remained internally. When the exterior-dispersing formula is administered, the internal cold medicine reacts first, causing vomiting/diarrhea. Thus, Zai Guai. However, vomiting/diarrhea expels the retained cold medicine, and the exterior pathogen dissipates spontaneously. Vomiting induces sweating, resolving the exterior.
Question: What does the Liver pulse of the East look like? The Master said: The Liver belongs to Wood, named Jue Yin. Its pulse is slightly wiry, soft-weak yet long. This is the Liver pulse. If a Liver disease patient naturally exhibits a soft-weak pulse, they will recover. If a purely wiry pulse is found, death occurs because the pulse is rigid, indicating liver damage.
What does the Heart pulse of the South look like? The Master said: The Heart belongs to Fire, named Shao Yin. Its pulse is Hong Da (Surging and Large) and long. This is the Heart pulse. If a Heart disease patient naturally exhibits a Surging-Large pulse, they will recover. If the pulse comes small and goes large, it is called Fan (Reverse), indicating interior disease. If the pulse head is large and the root is small, it is called Fu (Overturn), indicating exterior disease. If the upper part is small and the head is small, sweating occurs. If the lower part is small and the root is large, it is Guan Ge (Lock and Key) obstruction, preventing urination. If the head does not sweat, it is treatable; if it sweats, it is fatal.
What does the Lung pulse of the West look like? The Master said: The Lung belongs to Metal, named Tai Yin. Its pulse is Mao (Feather-like/Floating). If a Lung disease patient naturally exhibits this pulse, or a Huan Chi (Slow and Moderate) pulse, they will recover. If a Shu (Rapid) pulse is found, the condition worsens. Why? Shu is a Southern Fire pulse; Fire controls Metal. According to principles, abscesses should form, making it difficult to treat.
These three sections reiterate the Five Elements' interactions discussed earlier in Zong/Heng/Shun/Ni. They now use pulse differentiation to identify Zang diseases, urging careful examination. Only three Zang organs are mentioned, similar to mentioning only Summer in the Pulse Differentiation chapter; readers should infer the rest.
Question: In the second lunar month, why does obtaining a Mao pulse (feather-like/floating) predict death in autumn? The Master said: In the second month, the pulse should be Ru Ruo (Soft and Weak). Obtaining a Floating pulse instead predicts death in autumn. The second month is when Liver Qi governs; the pulse should be Soft. Obtaining a Feather-Floating pulse indicates a Lung pulse. Lung is Metal; Metal controls Wood. Hence, death in autumn. Other cases follow this logic.
This section extends five-Zang pulse differentiation to the four seasons, using one example to illustrate others.
The Master said: For obese individuals, investigate Floating pulses; for thin individuals, investigate Deep pulses. Obese people should have Deep pulses; if Floating, investigate the cause. Thin people should have Floating pulses; if Deep, investigate the cause.
This section adjusts palpation pressure based on body type to determine treatment strategies.
The Master said: If the Cun pulse does not extend down to the Guan position, it is Yang Jue (Yang Extinction). If the Chi pulse does not extend up to the Guan position, it is Yin Jue (Yin Extinction). Both are untreatable and fatal. Remaining lifespan can be calculated based on elemental overcoming cycles in months.
This section continues the discussion on Guan Ge, explaining that when Yin and Yang fail to connect and upper/lower energies do not communicate, death can be predicted via pulse.
The Master said: When the pulse indicates disease but the person appears healthy, it is called "Xing Shi" (Walking Corpse) due to lack of Wang Qi (Prosperous Qi). Sudden dizziness and collapse with loss of consciousness indicate short life and death. When the person is diseased but the pulse appears normal, it is called "Nei Xu" (Interior Deficiency) due to lack of Gu Shen (Grain Spirit/Spleen Qi). Although there may be no immediate suffering...
This section emphasizes that after differentiating pulse and symptoms, the pulse is paramount, while symptoms merely verify the pulse.
Question: Xi, Yan, and Chen together are called Hua (Slippery). What does this mean? Chen is pure Yin; Xi is correct Yang. Their combination creates a Slippery pulse. The Guan and Chi positions are balanced. Yang Ming pulse is slightly Chen; digestion is normal. Shao Yin pulse is slightly Hua. Hua is the floating name of Jin (Tight). This indicates Yin Excess. The patient will likely have sweating in the inner thighs and dampness in the genital area.
This section specifically differentiates the Chen pulse, involving Hua, Fu, and Jin, reiterating the concept of destructive pulses. Xi opposes Pi; Yan opposes Fa. "Yan" implies covering. Pulse relates to Qi and Yang. When Yin covers Yang, the pulse becomes Chen. Pressing deeper reveals a round, finger-lifting quality, indicating Chen is flowing, forceful, and Slippery.
Question: Previously challenged, how does the Jin (Tight) pulse arise? The Master said: If there is excessive sweating or vomiting due to cold in the Lungs, the pulse becomes Tight. If coughing results from drinking cold water, the pulse becomes Tight. If diarrhea results from deficiency-cold in the Stomach, the pulse becomes Tight.
This section also discusses destructive pulses. The previous paragraph discussed Chen-Hua in Guan/Chi and Jin in Chi (Yang deficiency/Yin excess). This paragraph discusses Jin in Cun and Stomach deficiency-cold Jin, clarifying Yang deficiency/Yin excess in all three positions.
At Cun Kou, strong Wei Qi is called Gao. Strong Ying Qi is called Zhang. Gao and Zhang contending is called Gang. Weak Wei Qi is called Bei. Weak Ying Qi is called Bei. Bei and Bei contending is called Sun. Harmonious Wei Qi is called Huan. Harmonious Ying Qi is called Chi. Huan and Chi contending is called Chen.
This section divides into three parts to analyze pulse excess/deficiency and harmony, assessing pathogenesis. "Cun Kou" refers to the radial artery, representing the convergence of all pulses, encompassing the three positions and nine locations.
Cun Kou pulse is Huan (Moderate) and Chi (Slow). Huan indicates growing Yang Qi: bright complexion, radiant face, clear voice, long hair. Chi indicates abundant Yin Qi: marrow generation, full blood, firm and thin muscles. Yin and Yang embrace, Ying and Wei circulate together, hardness and softness interact, named Qiang (Strong).
This follows the previous discussion of Huan-Chi forming Chen, distinguishing that Huan-Chi can also be named Qiang. "Cun Kou" here refers to the two Cun positions governing all three positions, with left and right six positions being equal. Fu Yang pulse is Hua (Slippery) and Jin (Tight). Hua indicates Stomach Qi Excess; Jin indicates Spleen Qi Strength. Holding Excess against Strength causes self-injury, like grasping a blade and creating wounds oneself.
This section connects to the previous Qiang pulse and Yin Excess discussion, focusing on the Spleen/Stomach interior/exterior relationship. It clarifies that while a Qiang pulse can be normal, it can also be pathological if Stomach is Excess and Spleen is Strong. Pulses should be harmonious; Stomach Excess and Spleen Strength are pathological. Like Yang Excess attacking Yin Strength, Water and Fire clash. This is self-inflicted harm, like cutting oneself with a blade. The text mentions "holding Excess to strike Strength," implying the danger of internal conflict.
Cun Kou pulse is Fu (Floating) and Da (Large). Fu indicates Deficiency; Da indicates Excess. At Chi, it is Guan (Lock); at Cun, it is Ge (Key). Guan prevents urination; Ge causes vomiting/reversal. Fu Yang pulse is Fu (Hidden) and Se (Choppy). Fu causes vomiting/reversal and indigestion; Se prevents food intake. This is named Guan Ge.
This section identifies Guan Ge disease via pulse, noting two types caused by Yin-Yang pathology without mixed pathogens, thus lighter than Guan Ge with anuria and head-only sweating.
Pulse is Fu and Da. Fu indicates Wind-Deficiency; Da indicates Qi-Strength. Wind and Qi contend, causing urticaria and itching. Itching is named Xie Feng (Leaking Wind); chronic cases become scaly crusts.
This section differentiates urticaria and scaly crusts via Fu-Da pulses, inspecting the exterior at Cun Kou.
Cun Kou pulse is Ruo (Weak) and Chi (Slow). Ruo indicates weak Wei Qi; Chi indicates cold Ying Qi. Ying is Blood; cold blood causes fever. Wei is Qi; weak Qi causes hunger. Hunger with false fullness leads to anorexia.
This section differentiates pulse and symptoms, adhering to the principle of Yang Deficiency and Yin Excess.
Fu Yang pulse is Da and Jin. Da and Jin immediately lead to diarrhea, which is difficult to treat. Cun Kou pulse is Huan and Ruo. Ruo indicates insufficient Yang Qi; Huan indicates excess Stomach Qi. Belching and acid regurgitation occur; food fails to descend, filling the chest and upper jiao.
This section differentiates pulse and symptoms, using Spleen/Stomach deficiency/excess to gauge severity, reflecting Yang Deficiency/Yin Excess.
Fu Yang pulse is Jin and Fu. Fu indicates Qi; Jin indicates Cold. Fu causes abdominal fullness; Jin causes colic. Fu and Jin contend, causing bowel sounds and movement. Movement generates Qi, pushing Diaphragm Qi downward. If Shao Yin pulse is absent, the genitals swell and feel empty.
This section uses Fu Yang pulse to differentiate Shao Yin symptoms, as Fu Yang governs Stomach/Kidney meridians. Cheng's commentary suggests kidney swelling with water retention indicates declining Kidney Yang; dampness causes edema. This water retention is in the Bladder; sufficient Qi and Yang allow natural excretion, so it should not be treated as Damp-Heat.
Cun Kou pulse is Wei (Micro) and Se (Choppy). Wei indicates non-moving Wei Qi; Se indicates insufficient Ying Qi. Ying and Wei cannot support each other; the Three Jiao lacks reliance. The body experiences numbness and bi-syndrome. Insufficient Ying Qi causes irritability, pain, and difficulty speaking. Weak Wei Qi causes aversion to cold and frequent yawning. If the Three Jiao fails to return to its sector: Upper Jiao failure causes belching and acid regurgitation; Middle Jiao failure causes inability to digest food; Lower Jiao failure causes urinary incontinence. Deep and Rapid: Deep indicates Excess; Rapid aids digestion. Tight indicates difficult-to-treat disease.
This section differentiates pulse regarding exterior Ying/Wei and interior Three Jiao, revealing dual Yin-Yang deficiency. Though stated as Cun Kou, it involves Guan/Chi via varying pressure. Tightness indicates difficulty due to extreme middle Qi emptiness, worse than Floating-Choppy. Regret arises from lack of early intervention.
Cun Kou pulse is Wei and Se. Wei indicates declining Wei Qi; Se indicates insufficient Ying Qi. Declining Wei Qi causes yellow complexion; insufficient Ying Qi causes green complexion. Ying is the root; Wei is the leaf. Dual deficiency causes withered roots/leaves, chills, coughing, bloody sputum, and salivation.
This section differentiates condition and complexion via Cun Kou pulse, identifying Yang Deficiency/Yin Excess with phlegm signs.
Fu Yang pulse is Fu and Kou (Hollow). Fu indicates declining Wei Qi; Kou indicates damaged Ying Qi. The body emaciates, skin becomes rough like fish scales. Fu and Kou contend, causing Zong Qi (Gathering Qi) decline and severance of the Four Limbs.
This section clarifies exterior Ying/Wei via pulse. Fu Yang is Stomach pulse; Middle Jiao Qi originates from Stomach, allowing identification of Zong Qi. "Four Limbs" refers to extremities. Severance stops Ying/Wei circulation, potentially leading to hemiplegia.
Cun Kou pulse is Wei and Huan. Wei indicates loose Wei Qi; looseness causes porous skin. Huan indicates solid Stomach Qi; solidity digests grain and transforms water. Grain entering the Stomach activates pulse channels. Water entering meridians forms blood. Abundant Ying Qi makes skin porous; Three Jiao meridians rupture, named Blood Collapse.
This section focuses on Wei Deficiency and Ying Excess symptoms following previous findings of dual deficiency. Internal Ying lacks control, flooding meridians. Qi circulating in Ying is Ying Qi; Qi protecting outside Ying is Wei Qi. Loose Wei Qi fails to contain blood, causing it to flood downwards. This is Three Jiao meridian rupture.
Fu Yang pulse is Wei and Jin. Jin indicates Cold; Wei indicates Deficiency. Wei-Jin contention causes shortness of breath. Shao Yin pulse is Ruo and Se. Ruo causes mild irritability; Se causes cold limbs. Fu Yang pulse absent indicates Spleen failing to ascend/descend, causing cold body and hard skin.
This section identifies another Yang Deficiency/Yin Excess symptom via pulse; others can be inferred.
Shao Yin pulse absent indicates weak Kidney Qi and scant Jing-Blood. Rushing Qi presses upward into the chest/diaphragm. Zong Qi gathers inversely; blood clots below the heart. Yang Qi retreats downward; heat returns to the inner thighs. Interaction with Yin causes bodily numbness. This is Shi Jue (Corpse Fainting). Acupoints Qimen and Juque should be needled.
This section infers Shao Yin pulse from absent Fu Yang pulse, as Fu Yang governs Kidney, clarifying Kidney Deficiency main symptoms.
Cun Kou pulse is Wei and Chi; Chi pulse is Jin. The patient is deficient, wasting, and sweaty. Yin persists; Yang is absent. All Wei pulses at Cun Kou indicate Yang loss; all Ru pulses indicate Blood loss; all Ruo pulses indicate Fever; all Jin pulses indicate Cold. All pulses overcome by Cold lead to Jue (Cold Reversal), depression, dizziness, and numbness. Due to lack of Grain Qi in Stomach and stagnation in Spleen, tight mouth prevents speech, trembling and chattering occur.
This section reiterates Yang Deficiency/Yin Excess via pulse, concluding with categorical examples.