上古以三部九候决死生，是遍求法；以人迎、寸口、趺阳辨吉凶，是扼要法。自《难经》独取寸口之说行，
人迎、趺阳不参矣。气口成寸，为脉之大会，死生吉凶系之焉，今所传者只此耳。自有《脉经》以来，诸家继起，
各以脉名取胜，泛而不切，漫无指归。夫在诊法取其约，于脉名取其繁，此仲景所云“驰竞浮华，不固根本”者
是也。仲景立法，只在脉之体用上推求，不在脉之名目上分疏。故以阴阳为体，则以浮、大、动、滑、数为阳之
用，沉、涩、弱、弦、迟为阴之用；以表里为体，则以浮为表用，沉为里用；以脏腑为体，则以数为腑用，迟为
脏用。如以浮沉为体，则以浮、沉中各有迟、数为用。以浮为体，则以大、动、滑、数为用之常，涩、弱、弦、
迟为用之变；以沉为体，则以涩、弱、弦、迟为用之
常，大、动、滑、数为用之变。体用之间，见脉之变化，而致病之因，与病情之虚实、病机之转移，亦随之而见，
全在诊者指法之巧，与看法之细耳。脉理浩繁，大纲不外名阳名阴之十种。阴阳两分，自成对峙，阴阳配偶，惟
见五端。浮、沉是脉体，大、弱是脉势，滑、涩是脉气，动、弦是脉形，迟、数是脉息，不得概以脉象视之也。
脉有对看法，有正看法，有反看法，有平看法，有侧看法，有彻底看法。如有浮即有沉，有大即有弱，有滑即有
涩，有数即有迟。合之于病，则浮为在表，沉为在里，大为有余，弱为不足，滑为血多，涩为气少，动为搏阳，
弦为搏阴，数为在腑，迟为在脏，此对看法也。如浮、大，动、数、滑脉气之有余者为阳，当知其中有阳胜阴病
之机；沉、涩、弱、弦、迟脉气之不足者为阴，当知其中有阴胜阳病之机。此正看法也。夫阴阳之转旋也，有余
而往，不足随之，不足而往，有余从之。故其始也，为浮为大为滑为动为数；其继也，反沉反弱反涩反弦反迟。
此是阳消阴长之机，其病为进。其始也，为沉为弱为涩为弦为迟；其继也，微浮微大微滑微动微数。此是阳进阴
退之机，皆病为欲愈。此反看法也。浮为阳，如更兼大、动、滑、数之阳脉，是为纯阳，必阳盛阴虚之病矣；沉
为阴，而更兼弱、涩、弦、迟之阴脉，是为重阴，必阴盛阳虚之病矣。此为平看法。如浮而弱、浮而涩、浮而弦、
浮而迟者，此阳中有阴，其人阳虚而阴脉伏于阳脉中也，将有亡阳之变，当以扶阳为急务矣；如沉而大、沉而滑、
沉而动、沉而数者，此阴中有阳，其人阴虚而阳邪下陷于阴脉中也，将有阴竭之患，当以存阴为深虑矣。此为侧
看法。如浮、大、动、滑、数之脉体虽不变，始为有力之阳强，终为无力之阳微，知阳将绝矣；沉、涩、弱、弦、
迟之脉，虽喜变而为阳，如急见浮、大，动、滑、数之状，是阴极似阳，知反照之不长，余烬之易灭也。是为彻
底看法。更有真阴真阳看法，如凡阴病见阳脉者生，阳病见阴脉者死也。成注只据伤寒立言，观凡字则知脉法不
专为伤寒设，亦不是承接上文，扩充之见仲景活法矣。脉以胃气为本，玩名阳名阴，见此等脉状，尚是阴阳之名，
而非阴阳之实，因胃气稍虚，则阴阳偏重，较之平脉有余名阳、不足名阴耳。此阳病兼外伤六气言，阴病兼内伤
精气言，若专指伤寒之阴症阳症，则浅矣。阳脉指胃脘之真阳，《内经》所谓二十五阳者是也。阴病见阳脉，是
胃气来复，五脏冲和之气发见，故主生，《内经》所云别于阳者，知病起时也。阴脉指五脏之真阴，因胃脘之阳，
不至于手太阴，五脏
之真阴来见也。阳病见阴脉，是脉无胃气，故主死，《内经》所谓别于阴者，知死生之期也。要见沉、涩、弱、
弦、迟，是病脉不是死脉，其见于阳病最多。阳病见浮、大、动、数、滑不休，即是死脉；阴病见浮、大、动、
数、滑之脉，多阴极似阳，未必即可生之机也。若真脏脉至，如肝脉之中外急，心脉坚而搏，肺脉浮而大，肾脉
如弹石，脾脉如距喙，皆反见有余之象，岂可以阳脉名之？《经》曰“邪气来也，紧而疾，谷气来也，徐而和，”
则又不得以迟数论阴阳矣。仲景表里脏腑之法，则又以浮沉迟数为大纲。浮沉是审起伏，迟数是察至数，浮沉之
间，迟数寓焉。凡脉之不浮不沉而在中，不迟不数而五至者，谓之平脉，是有胃气。可以神求，不可以象求。若
一见浮沉迟数之象，斯为病脉。浮沉迟数，本不以表里脏腑分，今既有阴阳之可名，即以阳表阴里、腑阳脏阴，
定其为病所在耳。试观脉之浮为在表，应病亦为在表，然脉浮亦有里症，或表邪初陷，或里邪欲出，究竟不离于
表，故主表其大纲也。沉为在里，应病亦为在里，然脉沉亦有表症，或阳病见阴而危，或阴出之阳而愈，究竟病
根于里，故主里其大纲也。数、阳主热，而数有浮沉，浮数应表热，沉数应里热，虽数脉多有病在脏者，然其由
必自腑，盖六腑为阳，阳脉萦其腑，故主腑其大纲也。迟为阴，阴主寒，而迟亦有浮沉，浮迟应表寒，沉迟应里
寒，虽迟脉多有病在腑者，然其根必自脏，盖五脏为阴，阴脉萦其脏，故主脏其大纲也。脉状种种，总括于浮沉
迟数。然四者之中，又以独见为准则，独见何部，即以其部定表里脏腑之所在，病无遁情矣。然阴阳之十脉，表
里脏腑之四诊，皆指脉之体用而言。而诊法之体用，则又以病为体，而脉为用。请以浮脉言之，其他可类推。如
脉浮者病在表，则必有发热恶寒之表症。然浮有不同，有但浮者，其三部皆同，无息数，无迟数，其气象亦滑、
涩、动、弦、大、小，此太阳之脉体然也。因风寒在表，而脉阳之阳御之，内无太过不及之病，故见此象。此病
脉中之平脉，故可用麻黄汤发汗而烦解，然此脉不可多得。所以发热即有发热之脉象，恶寒即有恶寒之脉象。如
寸口脉浮而紧，是浮为风象，紧为寒象也。此为阳中有阴，乃阳之变见矣。然寒不协风，则玄府不开，寒在皮毛。
卫气足以卫外而为固，虽受寒而不伤，寒去而身自和矣。若风不夹寒，但能鼓动卫气，使元府不闭，皮肤受邪，
肺气不清而已，不能深入于营，而发热恶寒，头项骨节俱痛。惟风挟寒邪，其势始猛，此风则伤卫，寒则伤营，
初非有二
义也。卫气不能卫外，反内扰营气而为烦；营气不得交通，内迫于骨节而作痛。营卫俱病，发热所由来耳。如脉
浮而数，为阳中见阳，是阳脉之正局，然不得认为阳脉有余，实因阳气不足，反见有余之象也。夫脉为血府，实
由气行，长则气治，短则气病。弦脉象长，数脉象短。脉数因于气之不足，则数为虚可知。风为阳邪，风则为热，
虚为阴邪，虚则为寒。虚寒相搏于营卫，卫气不足以御之，此恶寒所由来也。上条阳中有阴，而反征其发热，此
条阳中见阳，而反征其恶寒，是互文以见义。此二条皆当发汗，而与但浮者不同。故又云∶“脉浮紧者，法当身
疼痛，宜以汗解之。假令尺中迟，不可发汗，以营气不足，血少故也。”可知用麻黄汤不专治寒伤营者，皆仲景
法矣。又云∶“脉浮数者，法当汗出愈。若尺中脉微，此里虚不可发汗。”则又见脉浮数者，不得竟用麻黄汤。
又云∶“伤寒解半日许，复烦，脉浮数者，可更发汗，宜桂枝汤。”则所云须表里实，津液自和，便自汗出愈者，
为稀热粥示法耳。夫人之尺脉，如树之有根，不拘浮数浮紧，皆据尺脉以审虚实，此又仲景为浮为在表之注疏
矣。十脉中无紧脉，紧即弦之转旋。当知按之不移，是静为阴之体；转旋无常，是动为阳之用。故浮中见紧者，
系在中风，与伤寒之阴阳俱紧者殊矣。紧又与数相似，紧见于法象，数见于至数。然紧以气来之长，反得为阴中
有阳之实脉；数以气来之短，反得为阳中有阴之虚脉也。若脉浮而大，是阳中见阳，此两阳合明之脉。然脉不遽
大，必至三四日乃大，是阳明内热外见之脉，此浮不得仍为在表。当知大为病进，故见心下反硬，即攻之不令发
汗耳。若浮脉而迟，面热赤而战栗者，是阳中见阴，故面见假热，而身见真寒。此因迟为在脏，故无阳不能作汗，
而浮为在表，则又当用渍形为汗之法矣。迟因浮而从表，浮因大而从里，浮无数而反虚，紧入浮而成实，则表里
脏腑阴阳虚实之间，悉属定不定法也。
上古时期通过“三部九候”（遍诊全身多处动脉以判断病情）来决断生死，这是全面探查的方法；通过比较人迎穴、寸口穴和趺阳穴的脉象来辨别吉凶，这是抓住关键的方法。自从《难经》提出独取寸口（手腕桡动脉处）的理论流行后，人迎和趺阳两处的脉象就不再参合运用了。气口形成寸脉，是脉气的汇聚之处，生死吉凶都系于此，现在流传的脉法只有这一种罢了。自从王叔和《脉经》问世以来，各家医家相继兴起，各自凭借独特的脉名来标新立异，内容泛泛而不切中要害，漫无明确的指向。在诊法上追求简约，而在脉名上却追求繁杂，这正是张仲景所说的“竞相追逐浮华，不巩固根本”的情况。
张仲景确立法则，只在脉的“体”（本质形态）和“用”（功能表现）上进行推求，不在脉的名称目次上作繁琐区分。因此，如果以阴阳为体，那么浮、大、动、滑、数就是阳的作用；沉、涩、弱、弦、迟就是阴的作用；如果以表里为体，那么浮就代表表的作用，沉就代表里的作用；如果以脏腑为体，那么数就代表腑的作用，迟就代表脏的作用。例如以浮沉为体，那么在浮和沉之中又各自包含迟和数的作用。以浮为体，那么大、动、滑、数是正常的作用表现，涩、弱、弦、迟是变化的作用表现；以沉为体，那么涩、弱、弦、迟是正常的作用表现，大、动、滑、数是变化的作用表现。在体和用的关系中，可以看到脉象的变化，而致病的病因、病情的虚实、病机的转移，也随之显现出来，这完全取决于诊脉者指法的巧妙和观察的细致。
脉理虽然浩繁，但大纲不外乎命名为阳或名为阴的十种脉象。阴阳分为两类，自然形成对峙；阴阳相配，只见于五种端绪：浮、沉是脉的体态，大、弱是脉的气势，滑、涩是脉的气机，动、弦是脉的形状，迟、数是脉的至数（频率），不能一概当作脉象来看待。
诊脉有对看法、正看法、反看法、平看法、侧看法、彻底看法。如有浮就有沉，有大就有弱，有滑就有涩，有数就有迟。结合病症来看，浮表示病在表，沉表示病在里，大表示有余（实证），弱表示不足（虚证），滑表示血多，涩表示气少，动表示搏动于阳分，弦表示搏动于阴分，数表示病在腑，迟表示病在脏，这是对看法。如浮、大、动、数、滑这些脉气有余的属于阳，应当知道其中蕴含阳胜阴病的机理；沉、涩、弱、弦、迟这些脉气不足的属于阴，应当知道其中蕴含阴胜阳病的机理。这是正看法。
阴阳的转化循环，有余的时候前往，不足的时候随之而来；不足的时候前往，有余的时候跟从。所以起初表现为浮、大、滑、动、数，随后反而出现沉、弱、涩、弦、迟。这是阳消阴长的机理，病情正在进展。起初表现为沉、弱、涩、弦、迟，随后反而出现微浮、微大、微滑、微动、微数。这是阳进阴退的机理，病情将要痊愈。这是反看法。
浮属阳，如果再兼见大、动、滑、数等阳脉，这叫纯阳，必然是阳盛阴虚的病；沉属阴，如果再兼见弱、涩、弦、迟等阴脉，这叫重阴，必然是阴盛阳虚的病。这是平看法。如脉浮而弱、浮而涩、浮而弦、浮而迟，这是阳中有阴，此人阳气虚弱而阴脉潜伏在阳脉之中，将有亡阳的变故，应当把扶助阳气作为紧急任务；如脉沉而大、沉而滑、沉而动、沉而数，这是阴中有阳，此人阴液亏虚而阳邪下陷于阴脉之中，将有阴液枯竭的祸患，应当深入忧虑并注重保存阴液。这是侧看法。
如浮、大、动、滑、数的脉体虽然不变，开始是有力的阳强，最终变成无力的阳微，就知道阳气将要绝灭；沉、涩、弱、弦、迟的脉，虽然希望转变为阳脉，但如果突然见到浮、大、动、滑、数的状况，这是阴极似阳，知道残存的阳气像余烬一样容易熄灭。这是彻底看法。更有真阴真阳的看法，如凡是阴病见到阳脉的就能生，阳病见到阴脉的就会死。成无己的注解只依据伤寒立论，看到“凡”字就知道脉法不是专为伤寒设立的，也不是承接上文，而是扩充展现了张仲景的活法。
脉以胃气为本，玩味名为阳名为阴的脉状，见此等脉象，还只是阴阳的名目，而非阴阳的实质，因为胃气稍微虚弱，则阴阳偏重，比起平脉中有余叫阳、不足叫阴而言。这里说的阳病兼外伤六淫之气，阴病兼内伤精气，如果专指伤寒的阴症阳症，那就太浅薄了。阳脉指的是胃脘的真阳，《内经》所说的“二十五阳”就是指这个。阴病见到阳脉，是胃气来复，五脏冲和之气发露，所以主生，《内经》所说“别于阳者，知病起时”，是指能分辨出病发生的时间。阴脉指的是五脏的真阴，因为胃脘之阳不能到达手太阴肺经，所以五脏的真阴来显露。阳病见到阴脉，是脉中没有胃气，所以主死，《内经》所说“别于阴者，知死生之期”，是指能分辨出死亡或生存的期限。
要明白沉、涩、弱、弦、迟是病脉而不是死脉，它们出现在阳病中最常见。阳病见到浮、大、动、数、滑不止，即是死脉；阴病见到浮、大、动、数、滑的脉，多是阴极似阳，未必就是可以生的契机。如果出现真脏脉，如肝脉中外急迫，心脉坚硬而搏指，肺脉浮而大，肾脉像弹石，脾脉像鸟嘴喙，都反常地出现有余的现象，怎么能称为阳脉呢？《内经》说：“邪气来时，脉紧而疾速；谷气（胃气）来时，脉徐缓而柔和。”这样就不能单纯以迟数来论阴阳了。
张仲景关于表里脏腑的法则，又以浮、沉、迟、数为大纲。浮沉是审查脉位的起伏，迟数是察看病脉的至数，在浮沉之间，寓含着迟数。凡是脉既不浮也不沉而在中间，既不迟也不数而每息五至的，叫做平脉，这是有胃气的表现。可以用神意去体会，不能用形象去索求。如果一见到浮沉迟数的形象，这就是病脉。浮沉迟数，本来不以表里脏腑来划分，现在既然有了阴阳的名称，就以阳主表、阴主里、腑属阳、脏属阴，来确定病所在的位置。
试看脉浮表示病在表，对应症状也应在表，然而脉浮也有里症，或者是表邪初陷于里，或者是里邪欲出于表，终究不离于表，所以以表为大纲。沉表示病在里，对应症状也应在里，然而脉沉也有表症，或者是阳病见到阴脉而危重，或者是阴病转出阳分而痊愈，终究病根在于里，所以以里为大纲。数脉属阳主热，而数脉有浮沉之分，浮数对应表热，沉数对应里热，虽然数脉多有病在脏的情况，但其根源必然来自腑，因为六腑属阳，阳脉萦绕其腑，所以以腑为大纲。迟脉属阴，阴主寒，而迟脉也有浮沉之分，浮迟对应表寒，沉迟对应里寒，虽然迟脉多有病在腑的情况，但其根源必然来自脏，因为五脏属阴，阴脉萦绕其脏，所以以脏为大纲。脉状种种，总括于浮沉迟数。在这四者之中，又以单独出现的脉象为准则，单独出现在哪个部位，就用该部位来定表里脏腑所在，病情就没有隐藏的了。
然而阴阳的十种脉，表里脏腑的四诊，都是指脉的体用而言。而诊法的体用，则是以病为体，以脉为用。请以浮脉为例，其他的可以类推。如脉浮表示病在表，则必定有发热恶寒的表症。然而浮脉有不同情况，有单纯浮的，其寸关尺三部都一样，没有呼吸次数和迟数之分，其气象也是滑、涩、动、弦、大、小，这是太阳病的脉体表现。因为风寒在表，而脉阳中的阳气抵御它，内部没有太过或不及的病，所以出现这种象。这是病脉中的平脉，所以可以用麻黄汤发汗而烦热解除，但这种脉不可多得。所以发热就有发热的脉象，恶寒就有恶寒的脉象。如寸口脉浮而紧，浮是风象，紧是寒象。这是阳中有阴，是阳的变化表现。然而寒如果不配合风，则玄府（汗孔）不开，寒在皮毛。卫气足以护卫体表而固密，虽然受寒而不受伤，寒去而身体自然调和。如果风不夹寒，只能鼓动卫气，使元府不闭，皮肤受邪，肺气不清而已，不能深入营分，而出现发热恶寒、头项骨节俱痛。只有风挟带寒邪，其势才猛烈，这种风伤卫气，寒伤营气，起初并没有两种含义。卫气不能护卫体表，反而内扰营气而导致烦闷；营气不得交通，内迫于骨节而产生疼痛。营卫都生病，发热由此产生。
如脉浮而数，是阳中见阳，是阳脉的正局，但不能认为阳脉有余，实因阳气不足，反而出现有余的假象。脉是血府，实际上由气推动，气长则气治，气短则气病。弦脉象长，数脉象短。脉数是因为气不足，所以数脉可知为虚。风为阳邪，风则为热；虚为阴邪，虚则为寒。虚寒相搏结于营卫，卫气不足以抵御，这就是恶寒产生的原因。上一条说阳中有阴而反征发热，这一条说阳中见阳而反征恶寒，这是互文见义。这两条都应当发汗，但与单纯浮脉不同。所以又说：“脉浮紧者，法当身疼痛，宜以汗解之。假如尺中脉迟，不可发汗，因为营气不足，血少缘故。”可知使用麻黄汤不仅仅是治疗寒伤营，这都是张仲景的法度。又说：“脉浮数者，法当汗出愈。如果尺中脉微，这是里虚不可发汗。”这就显示脉浮数者，不能竟用麻黄汤。又说：“伤寒解半日许，复烦，脉浮数者，可更发汗，宜桂枝汤。”那么所谓必须表里实，津液自和，便自汗出愈，是用稀热粥来示法罢了。人的尺脉，如同树有根，不拘泥于浮数或浮紧，都依据尺脉来审察虚实，这又是张仲景为“浮为在表”做的注疏。
十脉中没有紧脉，紧就是弦的旋转变化。应当知道按之不移，是静为阴的体；转旋无常，是动为阳的用。所以在浮脉中见到紧脉，是系于中风，与伤寒中阴阳俱紧是不同的。紧脉又与数脉相似，紧脉见于法象（形态），数脉见于至数（频率）。然而紧脉因为气来之长，反而得为阴中有阳的实脉；数脉因为气来之短，反而得为阳中有阴的虚脉。
如果脉浮而大，是阳中见阳，这是两阳合明的脉。然而脉不会立即变大，必须到三四天才变大，这是阳明内热外见的脉，此时浮脉不能再仍视为在表。应当知道大为病进，所以见到心下反而硬满，即攻下而不令发汗。如果浮脉而迟，面热赤而战栗，这是阳中见阴，所以面部出现假热，而身体出现真寒。这是因为迟脉主在脏，所以无阳不能作汗，而浮脉主在表，则又应当用渍形为汗（温水浴等外治法）的方法了。迟因浮而从表，浮因大而从里，浮无数而反虚，紧入浮而成实，那么表里脏腑阴阳虚实之间，都属于不确定之法。
In ancient times, life and death were determined by the "Three Regions and Nine Locations" (a comprehensive method of palpating arteries throughout the body), which was a method of exhaustive investigation; comparing the Renying (Jiachezhen, ST8), Cunkou (Radial artery at wrist), and Duyang (Dorsalis pedis artery) pulses to distinguish auspicious from inauspicious signs was a method of grasping the essentials. Since the theory of exclusively taking the Cunkou pulse propagated by the *Nan Jing* (Classic of Difficult Issues), the Renying and Duyang pulses were no longer consulted together. The Qi Kou (Cunkou) forms the Cun position, serving as the great convergence of pulses, with life and death, auspiciousness and inauspiciousness depending upon it; what is transmitted today is only this one method. Since the publication of the *Mai Jing* (Pulse Classic) by Wang Shuhe, various schools have risen successively, each striving for distinction through unique pulse names, resulting in generalizations that are not incisive and lack clear direction. In diagnostic methods, simplicity is sought, yet in pulse nomenclature, complexity is pursued; this is precisely what Zhang Zhongjing referred to as "racing after superficial glamour without consolidating the root."
Zhang Zhongjing established his principles by deducing from the "Ti" (substance/structure) and "Yong" (function/application) of the pulse, rather than differentiating based on pulse names. Therefore, if Yin and Yang constitute the Ti, then Floating (Fu), Large (Da), Agitated (Dong), Slippery (Hua), and Rapid (Shu) represent the Yong of Yang; whereas Deep (Chen), Choppy (Se), Weak (Ruo), Wiry (Xian), and Slow (Chi) represent the Yong of Yin. If Exterior and Interior constitute the Ti, then Floating represents the Yong of Exterior, and Deep represents the Yong of Interior. If Zang and Fu organs constitute the Ti, then Rapid represents the Yong of Fu organs, and Slow represents the Yong of Zang organs. For instance, if Floating and Deep constitute the Ti, then within both Floating and Deep, there exist the Yong of Slow and Rapid. If Floating constitutes the Ti, then Large, Agitated, Slippery, and Rapid are the normal manifestations of Yong, while Choppy, Weak, Wiry, and Slow are the variable manifestations of Yong; if Deep constitutes the Ti, then Choppy, Weak, Wiry, and Slow are the normal manifestations of Yong, while Large, Agitated, Slippery, and Rapid are the variable manifestations of Yong. Between Ti and Yong, changes in the pulse can be observed, and consequently, the causes of disease, the deficiency or excess of the pathological condition, and the shift in pathogenesis also become apparent. This entirely depends on the dexterity of the practitioner's finger technique and the subtlety of their observation.
Although pulse theory is vast and complex, the general outline does not exceed ten types named as Yang or Yin. When divided into Yin and Yang, they naturally form a confrontation; when paired, they manifest in five aspects: Floating and Deep are the pulse body (Ti); Large and Weak are the pulse momentum (Shi); Slippery and Choppy are the pulse Qi (Qi); Agitated and Wiry are the pulse shape (Xing); Slow and Rapid are the pulse rate (Xi). These cannot simply be viewed as pulse images.
Pulse diagnosis involves viewing methods: comparative (Dui), orthodox (Zheng), reverse (Fan), balanced (Ping), lateral (Ce), and thorough (Chedi). Where there is Floating, there is Deep; where there is Large, there is Weak; where there is Slippery, there is Choppy; where there is Rapid, there is Slow. Correlating with symptoms, Floating indicates pathology in the Exterior, Deep indicates pathology in the Interior, Large indicates Excess, Weak indicates Deficiency, Slippery indicates abundant Blood, Choppy indicates deficient Qi, Agitated indicates pulsation in the Yang aspect, Wiry indicates pulsation in the Yin aspect, Rapid indicates pathology in the Fu organs, and Slow indicates pathology in the Zang organs. This is the Comparative View.
If Floating, Large, Agitated, Rapid, and Slippery pulses indicate an abundance of pulse Qi belonging to Yang, one must understand the mechanism of Yang prevailing over Yin pathology; if Deep, Choppy, Weak, Wiry, and Slow pulses indicate a deficiency of pulse Qi belonging to Yin, one must understand the mechanism of Yin prevailing over Yang pathology. This is the Orthodox View.
The rotation of Yin and Yang implies that where there is excess, deficiency follows; where there is deficiency, excess follows. Thus, initially presenting as Floating, Large, Slippery, Agitated, or Rapid, followed by a reversal to Deep, Weak, Choppy, Wiry, or Slow, indicates the mechanism of Yang declining and Yin growing, meaning the disease is progressing. Conversely, initially presenting as Deep, Weak, Choppy, Wiry, or Slow, followed by a subtle appearance of Floating, Large, Slippery, Agitated, or Rapid, indicates the mechanism of Yang advancing and Yin retreating, meaning the disease is about to heal. This is the Reverse View.
Floating belongs to Yang; if accompanied by other Yang pulses like Large, Agitated, Slippery, or Rapid, it is termed Pure Yang, indicating a disease of Yang Excess and Yin Deficiency. Deep belongs to Yin; if accompanied by other Yin pulses like Weak, Choppy, Wiry, or Slow, it is termed Heavy Yin, indicating a disease of Yin Excess and Yang Deficiency. This is the Balanced View.
If the pulse is Floating but also Weak, Choppy, Wiry, or Slow, this is Yang containing Yin. The person has deficient Yang, with Yin pulses潜伏 (latent) within the Yang pulse, predisposing them to a collapse of Yang; thus, supporting Yang becomes the urgent priority. If the pulse is Deep but also Large, Slippery, Agitated, or Rapid, this is Yin containing Yang. The person has deficient Yin, with Yang pathogens sinking into the Yin pulse, predisposing them to exhaustion of Yin; thus, preserving Yin requires deep concern. This is the Lateral View.
If the pulse body remains Floating, Large, Agitated, Slippery, or Rapid, starting as strong Yang strength but ending as weak Yang power, it indicates that Yang is about to perish. If the pulse is Deep, Choppy, Weak, Wiry, or Slow, but suddenly presents with Floating, Large, Agitated, Slippery, or Rapid characteristics, this is Extreme Yin resembling Yang, indicating that residual Yang is like dying embers easily extinguished. This is the Thorough View.
Furthermore, there is the view of True Yin and True Yang: generally, Yin diseases presenting with Yang pulses indicate survival, while Yang diseases presenting with Yin pulses indicate death. Cheng Wuji’s commentary only speaks based on Cold Damage (*Shanghan*), but the use of the word "generally" (Fan) shows that pulse methodology is not exclusive to Cold Damage, nor merely an extension of the preceding text, but rather expands upon Zhang Zhongjing’s flexible methods.
The pulse relies on Stomach Qi (Wei Qi) as its root. Observing these pulse states named as Yin or Yang reveals they are merely names, not the substance of Yin and Yang. Because slight deficiency in Stomach Qi leads to bias in Yin and Yang, compared to the Ping Pulse (Normal Pulse) where excess is named Yang and deficiency is named Yin. Here, Yang disease refers to external injury by the Six Qi (pathogens), and Yin disease refers to internal injury of Essence and Qi. If referring specifically to Yin and Yang syndromes of Cold Damage, it would be too shallow. Yang pulse refers to the True Yang of the Stomach and Intestines, as mentioned in the *Nei Jing* (Inner Canon) as the "Twenty-Five Yangs." When a Yin disease presents with a Yang pulse, it signifies the recovery of Stomach Qi and the emergence of the harmonious Qi of the Five Zang organs, hence indicating survival; as the *Nei Jing* states, "Distinguishing Yang allows one to know the onset of the disease." Yin pulse refers to the True Yin of the Five Zang organs. Because the Yang of the Stomach and Intestines does not reach the Hand-Taiyin Lung meridian, the True Yin of the Five Zang organs emerges. When a Yang disease presents with a Yin pulse, it signifies the absence of Stomach Qi in the pulse, hence indicating death; as the *Nei Jing* states, "Distinguishing Yin allows one to know the time of death or survival."
It must be understood that Deep, Choppy, Weak, Wiry, and Slow are pathological pulses, not necessarily death pulses, and they appear most frequently in Yang diseases. A Yang disease presenting with incessant Floating, Large, Agitated, Rapid, or Slippery pulses is a death pulse. A Yin disease presenting with Floating, Large, Agitated, Rapid, or Slippery pulses is mostly Extreme Yin resembling Yang and may not necessarily be a sign of recovery. If True Zang pulses arrive, such as the Liver pulse being urgent inside and out, the Heart pulse being firm and beating hard, the Lung pulse being floating and large, the Kidney pulse feeling like throwing stones, or the Spleen pulse resembling a bird's beak, all showing abnormal excess, how can these be called Yang pulses? The Classics say: "When evil Qi arrives, the pulse is tight and rapid; when Grain Qi (Stomach Qi) arrives, the pulse is slow and harmonious." Thus, one cannot judge Yin and Yang solely by Slowness and Rapidity.
Zhang Zhongjing’s method for Exterior/Interior and Zang/Fu takes Floating, Deep, Slow, and Rapid as the general outline. Floating and Deep examine the rise and fall of the pulse position; Slow and Rapid observe the frequency. Within Floating and Deep, Slow and Rapid are embedded. Any pulse that is neither floating nor deep but intermediate, and neither slow nor rapid but beating five times per breath, is called a Ping Pulse (Normal Pulse), indicating the presence of Stomach Qi. It can be apprehended by spirit/intuition, not by image. Once an image of Floating, Deep, Slow, or Rapid appears, it becomes a pathological pulse. Floating, Deep, Slow, and Rapid are not originally divided by Exterior/Interior or Zang/Fu; now that they have Yin/Yang names, we use Yang for Exterior and Fu, and Yin for Interior and Zang to determine the location of the disease.
Observe that a Floating pulse indicates pathology in the Exterior, and symptoms should also be in the Exterior. However, a Floating pulse can also accompany Interior symptoms, either because Exterior pathogens have just sunk inward, or Interior pathogens are attempting to emerge outward. Ultimately, it does not leave the Exterior, so Exterior is taken as the general rule. Deep indicates pathology in the Interior, and symptoms should also be in the Interior. However, a Deep pulse can also accompany Exterior symptoms, either because a Yang disease presents with Yin signs leading to danger, or a Yin disease emerges to Yang leading to healing. Ultimately, the root of the disease is in the Interior, so Interior is taken as the general rule.
Rapid pulses belong to Yang and govern Heat. Rapid pulses have Floating and Deep variations: Floating-Rapid corresponds to Exterior Heat, Deep-Rapid corresponds to Interior Heat. Although Rapid pulses often indicate pathology in the Zang organs, the origin must come from the Fu organs, because the Six Fu organs belong to Yang, and Yang pulses surround the Fu organs; thus, Fu is taken as the general rule. Slow pulses belong to Yin and govern Cold. Slow pulses have Floating and Deep variations: Floating-Slow corresponds to Exterior Cold, Deep-Slow corresponds to Interior Cold. Although Slow pulses often indicate pathology in the Fu organs, the root must come from the Zang organs, because the Five Zang organs belong to Yin, and Yin pulses surround the Zang organs; thus, Zang is taken as the general rule. Various pulse conditions are summarized in Floating, Deep, Slow, and Rapid. Among these four, the solitary appearance serves as the criterion. Whichever position shows the solitary pulse determines the location of the Exterior/Interior and Zang/Fu, leaving no hidden pathology.
However, the Ten Pulses of Yin/Yang and the Four Examinations of Exterior/Interior/Zang/Fu refer to the Ti and Yong of the pulse. The Ti and Yong of diagnostic methods, however, take Disease as the Ti and Pulse as the Yong. Let us discuss the Floating pulse as an example, and others can be inferred similarly. If the pulse is Floating, the disease is in the Exterior, and there must be Exterior symptoms like Fever and Aversion to Cold. However, Floating varies. There is simple Floating, identical in all three positions (Cun, Guan, Chi), without variation in breath count or speed, appearing Slippery, Choppy, Agitated, Wiry, Large, or Small. This is the pulse body of Taiyang disease. Because Wind-Cold is in the Exterior, the Yang Qi within the pulse resists it, and internally there is no excess or deficiency, so this image appears. This is a Normal Pulse within a pathological state, so Mahuang Tang (Ephedra Decoction) can be used to induce sweating and resolve vexation, though such pulses are rare. Therefore, fever has its corresponding pulse image, and aversion to cold has its corresponding pulse image.
For example, if the Cunkou pulse is Floating and Tight, Floating is the image of Wind, and Tight is the image of Cold. This is Yang containing Yin, a variation of Yang. However, if Cold does not combine with Wind, the Xuan Fu (pores) do not open, and Cold remains in the skin and hair. Wei Qi (Defensive Qi) is sufficient to protect the exterior and maintain solidity; although affected by Cold, it is not injured, and once the Cold leaves, the body harmonizes itself. If Wind does not carry Cold, it only agitates Wei Qi, preventing the closure of Yuan Fu, causing the skin to receive pathogens and Lung Qi to become unclear, but it cannot penetrate deeply into Ying Qi (Nutritive Qi). This results in fever, aversion to cold, and pain in the head, neck, and joints. Only when Wind carries Cold does the condition become severe. In this case, Wind injures Wei Qi, and Cold injures Ying Qi; initially, there is no dual meaning. Wei Qi fails to protect the exterior and instead disturbs Ying Qi internally, causing vexation; Ying Qi fails to circulate freely and presses inward against the joints, causing pain. With both Ying and Wei diseased, fever arises.
If the pulse is Floating and Rapid, it is Yang seeing Yang, the correct configuration of Yang pulses. However, one must not consider this as Yang excess; it is actually due to insufficient Yang Qi, presenting an image of excess. The pulse is the house of Blood, driven by Qi. Long Qi indicates healthy Qi; Short Qi indicates diseased Qi. The Wiry pulse resembles Long; the Rapid pulse resembles Short. Because the Rapid pulse stems from insufficient Qi, Rapidness indicates deficiency. Wind is a Yang pathogen, so Wind generates Heat; Deficiency is a Yin pathogen, so Deficiency generates Cold. The struggle between Deficiency and Cold in Ying and Wei, where Wei Qi is insufficient to resist, gives rise to aversion to cold. The previous clause discussed Yang containing Yin but manifested as fever; this clause discusses Yang seeing Yang but manifests as aversion to cold. This is a literary device (inter-textual meaning) to reveal the principle. Both clauses require sweating therapy, but differ from simple Floating. Hence it says: "If the pulse is Floating and Tight, bodily pain is expected according to the law, and sweating should be used to resolve it. If the Chi position pulse is Slow, sweating must not be used, because Ying Qi is insufficient and Blood is scarce." This shows that using Mahuang Tang is not exclusively for Cold injuring Ying; this is Zhang Zhongjing’s method. It also says: "If the pulse is Floating and Rapid, sweating should normally lead to recovery. If the Chi position pulse is Micro, this indicates Interior Deficiency, and sweating must not be used." This further shows that for Floating-Rapid pulses, Mahuang Tang cannot be blindly used. It also says: "After Cold Damage resolves for half a day, if vexation recurs and the pulse is Floating and Rapid, sweating may be administered again, preferably Guizhi Tang (Cinnamon Twig Decoction)." Thus, the statement that "when Exterior and Interior are solid and Fluids are harmonized, spontaneous sweating occurs and recovery follows" is demonstrated by drinking warm millet gruel.
The Chi pulse of a person is like the root of a tree. Regardless of whether it is Floating-Rapid or Floating-Tight, the Chi pulse is relied upon to assess Deficiency and Excess. This is another annotation by Zhang Zhongjing for "Floating indicates Exterior."
Among the Ten Pulses, Tight is absent; Tight is a rotation of Wiry. One must understand that pressing without moving is the stillness of Yin as Ti; rotating unpredictably is movement of Yang as Yong. Therefore, Tight found in a Floating pulse relates to Wind Strike (Zhong Feng), differing from the simultaneous Tightness of Yin and Yang in Cold Damage. Tight resembles Rapid, but Tight is seen in morphology (Fa Xiang), while Rapid is seen in frequency (Zhi Shu). However, because Tight comes with long Qi, it paradoxically becomes a Real pulse of Yang within Yin; because Rapid comes with short Qi, it paradoxically becomes a Deficient pulse of Yin within Yang.
If the pulse is Floating and Large, it is Yang seeing Yang, a pulse of Two Yangs combining brightness. However, the pulse does not immediately become Large; it becomes Large only after three or four days. This is a pulse of Interior Heat of Yangming revealing itself externally. At this point, Floating can no longer be considered Exterior. One must understand that Large indicates disease progression; thus, hardness below the heart appears, requiring purgation rather than sweating. If the pulse is Floating and Slow, with facial heat/redness and trembling, this is Yang seeing Yin. Thus, the face shows false heat, while the body shows true cold. Because Slow indicates pathology in the Zang, there is no Yang to generate sweat; because Floating indicates pathology in the Exterior, one should use the method of bathing the body in warm water to induce sweat. Slow following Floating derives from the Exterior; Floating following Large derives from the Interior. Floating without Rapidness turns Deficient; Tight entering Floating becomes Excess. Thus, among Exterior/Interior, Zang/Fu, Yin/Yang, and Deficiency/Excess, everything belongs to indeterminate methods.