口苦是胆热。口甜是肝热。口淡是胃热。舌干口燥是胃家热极。心下满，若因下
早者，为痞气。若手按拍之有声，又软者，是停水。若手按则散者，此虚气。若手按硬
痛者，是宿食。凡喜明而向外睡者，属阳，而元气实。喜暗而向壁睡者，属阴而元气
虚。凡病初起，觉不舒快少情绪者，是夹气伤寒。凡病起觉倦卧，骨腿酸疼胁痛者，是
劳力伤寒。凡耳聋因邪气入深者，难治。然有兼虚证者，或因少阳证者，不可不知。
左右手脉俱急紧盛，是夹食伤寒。右手脉来空虚，左手脉来紧盛，是劳力伤寒。左
手脉来紧盛，右手洪滑，或寸脉沉伏，身热恶寒，隐隐头痛，喘咳烦闷，胸胁体痛，是
夹痰伤寒。左手脉来紧涩，右手脉沉数，心胸肋下，小腹有痛处，是血郁内伤外感。
杂病以弦为阳，伤寒以弦为阴，杂病以缓为弱，伤寒以缓为和。两手无脉曰双伏，
一手无脉曰单伏，必有正汗也。寸口阳脉中或见沉细者，但无力者，为阳中伏阴。尺部
阴脉中，或见沉数者，为阴中伏阳。寸口数大有力为重阳，尺部沉细无力为重阴，寸脉
浮而有力，主寒邪，表实宜汗。浮而无力，主风邪，表虚宜实。尺脉沉而有力，主阳邪
在里，为实宜下。无力主阴邪在里，为虚宜温。寸脉弱而无力，切忌发吐。尺脉弱而无
力，切忌汗下。初按来疾去迟，名曰内虚外实。去疾来迟，名曰内实外虚。尺寸俱同，
名曰缓，缓者，和而生也。汗下后脉静者生，乃正气复也。躁乱身热者，死，乃邪气
胜也。温之后脉来歇至者，正气脱而不复生也。纯弦之脉名曰负，负者，死。按之解索，
名曰阴阳离，离者，死。阴病见阳脉者，生。阳病见阴脉者，死。
按∶阴脉有沉、有紧、有数，而仲景统以微细言之。盖沉必重按始得，紧数亦在沉
细中见，不似阳症浮大而紧数也。薛氏曰∶人知数为热，不知沉细中见数为寒甚。真阴
寒症，脉常有七八至者，但按之无力而数耳，宜深察之。故曰∶脉数为热，浮数为表
热，沉数为里热，数而有力为实热，无力为虚热，况细数乎。
鬼脉 得病之初，便谵语发狂，六部无脉，大指之下寸口之上有脉动者是也。
反美脉 如病患六部无脉，便不可言其无脉，要在掌后切看，脉来动者是反关脉也。
心脏 心病舌强，笑面赤燥烦，掌热口干谵，脐上动气洪紧数，反得沉微，命不全。
肝脏 肝家面青目痛闭，筋急怒容，脐左气，脉当弦急，或兼长浮涩短兮，名不治。
脾脏 脾家不食，面皮黄体重，肢痛喜卧床，动气当脐脉缓大，弦长而紧是凶殃。
肺脏 肺家面白带忧愁，吐血寒温喘嗽，求脐右气兮，沉细涩大而牢者死根由。
肾脏 肾家面黑爪甲青，耳闭足寒泄腹疼，脐下气兮，脉沉滑缓而大者死之形。
口苦是胆经有热。口甜是肝经有热。口淡无味是胃经有热。舌干口燥说明胃中热邪极盛。心下（胃脘部）胀满，如果是因过早使用泻下法导致的，属于痞气证。如果用手按压拍打时有水声，且感觉柔软，这是水饮内停。如果用手按压时感觉胀满消散，这是虚气。如果用手按压感到坚硬且疼痛，这是宿食停滞。凡是喜欢明亮环境、面向外侧睡觉的，属于阳证，表明元气充实。凡是喜欢昏暗环境、面向墙壁睡觉的，属于阴证，表明元气虚弱。凡是疾病初起，感觉身体不适、情绪低落不畅快的，是夹气伤寒（兼有气机郁滞的伤寒）。凡是疾病初起感觉疲倦嗜卧、骨节腿脚酸痛、胁肋疼痛的，是劳力伤寒（因劳累过度感邪所致）。凡是耳聋是因为邪气深入导致的，难以治疗。然而如果有兼见虚证的情况，或者属于少阳病证的，不可不知晓。
左右手脉象都急促、紧束且盛大，是夹食伤寒（兼有食积的伤寒）。右手脉象空虚，左手脉象紧束盛大，是劳力伤寒。左手脉象紧束盛大，右手脉象洪大滑利，或者寸脉沉伏，身体发热怕冷，隐隐头痛，气喘咳嗽烦闷，胸胁及身体疼痛，是夹痰伤寒（兼有痰浊的伤寒）。左手脉象紧涩，右手脉象沉数，心胸、胁下及小腹有疼痛部位，是血郁内伤兼外感。杂病以弦脉为阳，伤寒以弦脉为阴；杂病以缓脉为弱，伤寒以缓脉为平和之象。两手都摸不到脉搏称为双伏脉，一手摸不到脉搏称为单伏脉，这种情况必然会出现正汗（正常的汗出）。在寸口阳脉中如果出现沉细脉，只要无力，就是阳中伏阴。在尺部阴脉中，如果出现沉数脉，就是阴中伏阳。寸口脉数大有力称为重阳，尺部脉沉细无力称为重阴。寸脉浮而有力，主寒邪，表实应当发汗。浮而无力，主风邪，表虚应当固表（注：原文“宜实”在此语境下通常指补益或固护，结合伤寒论理，表虚不宜再汗，此处依字面译为适宜固护/补益，但考虑到上下文对比，也可能指需要填补正气，暂译作适宜固护）。尺脉沉而有力，主阳邪在里，属实应当攻下。无力主阴邪在里，属虚应当温补。寸脉弱而无力，切忌使用催吐法。尺脉弱而无力，切忌使用发汗和攻下法。初按时脉搏来势急去势慢，名叫内虚外实。去势急来势慢，名叫内实外虚。尺寸两部脉象相同，名叫缓脉，缓脉代表和气而生。发汗或攻下后脉象平静的，预后良好，这是正气恢复的表现。烦躁混乱且身体发热的，预后不良，这是邪气胜过的表现。温补之后脉象出现间歇停顿的，这是正气脱失而不能复生的表现。纯弦的脉象名叫负脉，负者，死证。按之如解索般散乱无根，名叫阴阳离决，离决者，死证。阴病见到阳脉的，预后良好。阳病见到阴脉的，预后不良。
按语：阴脉包括沉脉、紧脉、数脉，而张仲景统称为微细脉。因为沉脉必须重按才能触及，紧脉和数脉也常在沉细脉中出现，不像阳证那样表现为浮大而紧数。薛己说：人们知道数脉主热，却不知道在沉细脉中出现数脉是寒邪极盛的表现。真正的阴寒证，脉象常有七八至（每分钟跳动次数多），但按之无力且数，应当仔细辨别。所以说：脉数主热，浮数主表热，沉数主里热，数而有力主实热，无力主虚热，何况是细数脉呢？
鬼脉：患病之初，就出现胡言乱语、发狂，六部脉都摸不到，但在大拇指下方寸口之上的位置有脉动，这就是鬼脉。
反关脉：如果病患六部脉都摸不到，不要立即断言无脉，要在手腕后方切按，如果脉象从掌后经过并跳动，这就是反关脉。
心脏：心病表现为舌体僵硬，面部发红干燥烦躁，手掌发热口干胡言乱语，脐上动气处脉象洪紧数，如果反而出现沉微脉，性命难保。
肝脏：肝病表现为面色青、眼睛痛闭合，筋脉拘急、愤怒面容，脐左侧有动气，脉象应当弦急，如果兼见长、浮、涩、短等脉象，名为不治之症。
脾脏：脾病表现为不想进食，面色黄、身体沉重，肢体疼痛喜欢卧床，脐部动气处脉象缓大，如果变为弦长而紧，是凶险之兆。
肺脏：肺病表现为面色白、带有忧愁神色，吐血、寒热往来、气喘咳嗽，求诊于脐右侧动气处，如果脉象沉细涩大而牢，是死亡的根源。
Bitter taste in the mouth indicates Gallbladder Heat (Dan Re). Sweet taste in the mouth indicates Liver Heat (Gan Re). Bland taste in the mouth indicates Stomach Heat (Wei Re). Dry tongue and parched mouth indicate extreme Heat in the Stomach (Wei Jia Re). Fullness below the heart (epigastric region) caused by premature purgation is Pi Qi (Stagnant Qi/Pi Syndrome). If tapping with the hand produces a splashing sound and feels soft, it is Water Retention (Ting Shui). If fullness dissipates upon pressing, it is Deficient Qi (Xu Qi). If hardness and pain are felt upon pressing, it is Retained Food (Su Shi). Those who prefer bright environments and sleep facing outward belong to Yang patterns, indicating solid Yuan Qi (Primal Qi). Those who prefer dark environments and sleep facing the wall belong to Yin patterns, indicating deficient Yuan Qi. Illnesses beginning with discomfort and low mood are Jia Qi Shang Han (Shang Han complicated by Qi stagnation). Illnesses beginning with fatigue, desire to lie down, soreness of bones and legs, and hypochondriac pain are Lao Li Shang Han (Shang Han due to overexertion). Deafness caused by deep penetration of pathogenic factors is difficult to treat. However, one must be aware of cases with concurrent deficiency patterns or Shaoyang syndrome (Lesser Yang disorder).
Rapid, tight, and vigorous pulses on both left and right hands indicate Jia Shi Shang Han (Shang Han complicated by food retention). An empty pulse on the right hand and a rapid, tight, vigorous pulse on the left hand indicate Lao Li Shang Han. A rapid, tight, vigorous pulse on the left hand and a surging, slippery pulse on the right hand, or a sunken and hidden pulse at the Cun position, accompanied by fever, aversion to cold, vague headache, wheezing, cough, restlessness, chest/hypochondriac/body pain, indicate Jia Tan Shang Han (Shang Han complicated by phlegm). A rapid, choppy pulse on the left hand and a sunken, rapid pulse on the right hand, with pain in the chest, heart, hypochondrium, and lower abdomen, indicate Blood Stasis (Xue Yu) from internal injury combined with external contraction. In miscellaneous diseases, a Wiry (Xian) pulse is Yang; in Shang Han, a Wiry pulse is Yin. In miscellaneous diseases, a Slow (Huan) pulse indicates weakness; in Shang Han, a Slow pulse indicates harmony. Absence of pulse in both hands is called Shuang Fu (Double Hidden); absence in one hand is Dan Fu (Single Hidden); this condition will inevitably result in Zheng Han (Normal sweating). A sunken, fine pulse appearing in the Yang positions of the Cun Kou (Radial artery), if forceless, indicates Yin hidden within Yang (Yang Zhong Fu Yin). A sunken, rapid pulse appearing in the Yin positions of the Chi position indicates Yang hidden within Yin (Yin Zhong Fu Yang). A rapid, large, and forceful pulse at Cun indicates Chong Yang (Extreme Yang); a sunken, fine, and forceless pulse at Chi indicates Chong Yin (Extreme Yin). A floating and forceful Cun pulse indicates Cold Evil, suitable for diaphoresis in Exterior Excess. A floating but forceless Cun pulse indicates Wind Evil, requiring consolidation in Exterior Deficiency. A sunken and forceful Chi pulse indicates Yang Evil in the Interior, suitable for purgation in Interior Excess. A forceless Chi pulse indicates Yin Evil in the Interior, suitable for warming in Interior Deficiency. A weak and forceless Cun pulse strictly prohibits emesis. A weak and forceless Chi pulse strictly prohibits diaphoresis and purgation. A pulse that comes rapidly and departs slowly is named Nei Xu Wai Shi (Interior Deficiency, Exterior Excess). A pulse that departs rapidly and comes slowly is named Nei Shi Wai Xu (Interior Excess, Exterior Deficiency). Identical pulses at Cun and Chi are named Huan (Slow); Huan represents harmonious generation. After diaphoresis or purgation, a quiet pulse indicates survival, as Righteous Qi recovers. Restlessness with fever indicates death, as Pathogenic factors prevail. After warming treatment, an intermittent pulse indicates collapse of Righteous Qi without recovery. A purely Wiry pulse is named Fu (Negative); Fu indicates death. A pulse feeling like untied cords upon pressure is named Yin Yang Li (Separation of Yin and Yang); separation indicates death. Yin diseases showing Yang pulses indicate survival. Yang diseases showing Yin pulses indicate death.
Commentary: Yin pulses include Sunken (Chen), Tight (Jin), and Rapid (Shu), but Zhang Zhongjing generally describes them as Micro (Wei) and Fine (Xi). This is because a Sunken pulse requires heavy pressure to detect, and Tight/Rapid qualities often appear within Sunken/Fine contexts, unlike Yang syndromes which present as Floating, Large, Tight, and Rapid. Xue Ji stated: People know Rapid pulses indicate Heat, but do not realize that a Rapid pulse within a Sunken/Fine context indicates extreme Cold. True Yin-Cold syndromes may show 7-8 beats per unit time, but feel forceless and rapid upon pressure; this must be carefully observed. Thus, it is said: Rapid pulse indicates Heat; Floating-Rapid indicates Exterior Heat; Sunken-Rapid indicates Interior Heat; Rapid and Forceful indicates Excess Heat; Forceless indicates Deficiency Heat; how much more so for Fine-Rapid?
Ghost Pulse (Gui Mai): At the onset of illness, delirium and mania occur, with no pulse in the six positions. However, pulsation is felt above the Cun Kou under the thumb. This is Ghost Pulse.
Reverse Guan Pulse (Fan Mei): If no pulse is found in the six positions, do not immediately conclude there is no pulse. Check behind the palm; if pulsation occurs there, it is Reverse Guan Pulse (a congenital anatomical variation where the radial artery passes dorsally).
Heart Disease: Heart disease presents with a stiff tongue, red/dry face, irritability, hot palms, dry mouth, and delirium. Pulsation above the umbilicus shows a Surging, Tight, Rapid pulse. If it instead appears Sunken and Micro, life is endangered.
Liver Disease: Liver disease presents with a greenish face, eye pain/closure, tendon stiffness, and angry expression. Pulsation to the left of the umbilicus should show a Wiry, Rapid pulse. If accompanied by Long, Floating, Choppy, Short, etc., it is termed incurable.
Spleen Disease: Spleen disease presents with anorexia, yellowish complexion, heavy body, limb pain, and desire to lie down. Pulsation at the umbilicus should be Slow and Large. If it becomes Wiry, Long, and Tight, it is ominous.
Lung Disease: Lung disease presents with a white complexion, sorrowful expression, hemoptysis, alternating chills/fever, wheezing, and cough. Pulsation to the right of the umbilicus, if Sunken, Fine, Choppy, Large, and Firm, indicates a root cause of death.
Kidney Disease: Kidney disease presents with a black complexion, bluish nails, deafness, cold feet, diarrhea, and abdominal pain. Pulsation below the umbilicus, if Sunken, Slippery, Slow, and Large, is a form of death.