平脉者，平人不病之脉也。如四时平脉，五藏平脉，阴阳同等平脉之类是也。人病则
脉不得其平矣。如四时太过不及，阴阳藏府，相乘相侮，及百病相错，生死不平之脉
之类是也。平者又准之谓也。言诊者，诚能以诸平脉准诸不平之脉，则凡太过不及之
差，呼吸尺寸之乖，莫不了然于心手之间，而无稍差谬。然后可以伤寒之脉，准诸坏
病；亦可以诸坏病之脉，准之伤寒，诚所谓一以贯之而无余者已。
@@@
问曰：脉有三部，阴阳相乘，荣卫血气，在人体躬，呼吸出入，上下于中，因息游布
，津液流通，随时动作，效象形容，春弦秋浮，冬沉夏洪，察色观脉，大小不同。一
时之间，变无经常，尺寸参差，或短或长，上下乖错，或存或亡，病辄改易，进退低
昂，心迷意惑，动失纪纲，愿为具陈，令得分明。师曰：子之所问，道之根源，脉有
三部，尺寸及关，荣卫流行，不失衡铨，肾沉心洪，肺浮肝弦，此自经常，不失铢分
，出入升降，漏刻周旋，水下二刻，一周循环，当复寸口，虚实见焉，变化相乘，阴
阳相干，风则浮虚，寒则牢坚，沉潜水滀，支饮急弦，动则为痛，数则热烦，设有不
应，知变所缘。三部不同，病各异端，太过可怪，不及亦然，邪不空见，终必有奸。
审察表里，三焦别焉，知其所舍，消息诊看，料度藏府，独见若神，为子条记，传与
贤人。
【注】
此总叙平脉之根源，借问答以示其法也。脉者血之府，气血流行之动会也。三部者，
寸为上部，关为中部，尺为下部也。三部既定，阴阳属焉，上部为阳，下部为阴，阴
阳平则相易，阴阳偏则相乘。相易则和，相乘则病。人之体躬，卫统气而行脉，外荣
统血而行脉中，故凡呼吸出入，上下于中，莫不因息以游布于四体，随津液而流通于
周身，故随时动作，而效像夫脉之形容也。察色，察五藏之色也。肝青、心赤，肺白
，肾黑，脾黄，各以其色合乎藏。然四藏又皆以黄色为主，他色为兼，以土寄旺于四
季也。观脉，观五藏之脉也。肝弦，心洪，肺浮，肾沉，脾缓，各以其脉主乎藏。然
四藏又皆以缓脉为本，盖人以胃气为本也。其间，色或参差相错，脉或大小相乖，一
时之间，变无常经，病辄改易，或存或亡，无定象也。师曰：子之所问，脉为医道之
根源，当以平旦复会于寸口之时诊之，而虚实见焉。寸口脉浮无力，为虚为风，牢坚
有力，为实为寒。脉沉为水滀，脉弦为支饮，脉动为痛，脉数为热，设或病脉不应，
则于其三部太过不及，阴阳变化相乘之理，消息诊看。料度藏府，则顺逆吉凶，自然
独见若神也。
@@@
师曰：呼吸者，脉之头也。
【注】
人一呼脉再动，一吸脉再动，呼吸定息脉四动，乃平人不病之缓脉也。闰以太息故五
动，亦为平脉，非呼吸不能定其至数，持脉时必从此始，故曰：呼吸者脉之头也。
【集注】
方有执曰：呼者，气之出，脉之来也；吸者，气之入，脉之去也。头，头绪也，脉随
气之出入来去，名状虽多，呼吸则其源头也。然脉有二，此以尺寸之脉言，若以周身
言之，则循环无端，浑然不断，无头尾之可言，学者当识之也。
@@@
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。
【注】
此初持脉，以来去疾迟，而诊表里虚实法也。来，脉出来阳也，故以候表；去，脉入
去阴也，故以候里；疾，脉数疾有余也，故以候实；迟，脉徐迟不足也，故以候虚。
言脉若出来疾，入去迟，为表实里虚，故名曰：内虚外实也。脉若出来迟，入去疾，
为表虚里实，故名曰：内实外虚也。
【集注】
方有执曰：来者自骨肉之分，而出于皮肤之际，气之升而上也；去者自皮肤之际，而
还于骨肉之间，气之降而下也。出呼而来也，入吸而去也。经曰：来者为阳，去者为
阴。疾为阳太过也，迟为阴不及也。内虚外实者，阴不及而阳太过也；内实外虚者，
阴太过而阳不及也。故来去出入者，脉之大关键也；内外虚实者，病之大纲领也。知
内外之阴阳，而辨其孰为虚孰为实者，诊家之切要也。
@@@
假令脉，来微去大，故名反，病在里也；脉来头小本大，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。
【按】
脉来头小本大者，当是「脉来大去小」。上微头小者，当是「上微小者为阴盛」。下
微本大者，当是「下微小者为阳盛」，始与上下之义相属。
【注】
上以脉之来去疾迟，候内外虚实之诊，此以脉之来去大小，诊表里盛衰之病。脉上来
微小，下去反大，反之像也，故名曰：反脉。上来益大，下去微小，覆之像也，故名
曰：覆。反者病在里为阴盛，覆者病在表为阳盛，阳盛则病格，阴盛则病关，阴阳盛
极不相交通，则病关格。头无汗者，阳未离阴，故可治，有汗则阳已上脱，故曰：死
也。
@@@
寸口卫气盛名曰高，荣气盛名曰章，高章相搏，名曰纲。卫气弱名曰惵，荣气弱名曰
卑，惵卑相搏，名曰损。卫气和名曰缓，荣气和名曰迟，迟缓相搏，名曰沉。
【按】
名曰沉之「沉」字，当是「强」字，玩下文自知。
【注】
此详上条，脉之来去盛衰之状也。寸口，通指寸、关、尺而言也。卫主气为阳以候表
，荣主血为阴以候里。脉随指有力上来，卫气盛也，谓之高；脉随指有力下去，荣气
盛也，谓之章。高者长盛也，章者分明也。高章相合，名曰纲，纲者以荣卫俱有余，
有总揽之意也。脉随指无力上来，卫气弱也，谓之惵；脉随指无力下去，荣气弱也，
谓之卑，惵者恍惚也，卑者缩下也。惵卑相合，名曰损；损者，以荣卫俱不足，有消
缩之意也。若高章、惵卑之脉，与不疾、不徐缓迟之脉同见，则为盛者不过，弱者不
衰，皆名和脉。强者，即下文所着是也。
@@@
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，血脉满，肌肉紧，薄鲜□，阴阳相抱，荣卫俱行，刚柔相得，名曰强也。
【按】
「薄鲜□」三字不成句，应是衍文，当删之。
【注】
此承上条，以释「强」字之义。言凡人禀阳气盛，则得高章之盛；禀阴气盛，则得惵
卑之弱，此平人之常。若能兼见缓迟平脉，斯为阴阳相抱，荣卫相和，始名曰强。强
者即色鲜颜光，血满肉紧之谓也。
【集注】
方有执曰：缓以候胃，迟以候脾。阳气长者，言胃气有余也。颜色声音毛发，皆阳也
。鲜，丽也。光，辉也。商，清也。长，美也。形容胃阳之有余也。阴气盛者，言脾
气充足也。骨髓生，血脉满，肌肉紧，骨髓血肉皆阴也，形容脾阴之充足也。相抱，
言和洽也。俱行，言周流也。相搏，言合一也。极言二气得其和平，皆由脾、胃盈余
之所致，必如此，则其人之健王而强壮可知，故曰：强也。
@@@
师曰：脉肥人责浮，瘦人责沉。肥人当沉。今反浮，瘦人当浮，今反沉，故责之。
【注】
上条以脉之盛衰，候人之强弱，此条以脉之浮中沉，分人之皮、脉、肉、筋、骨，以
候五藏之诊法也。心肺俱浮，肝肾俱沉。以皮之浮、脉之浮而别心肺之浮也；以筋之
沉、骨之沉而别肝肾之沉也。脾主肌肉，在浮沉之间，故候中也。肥人肌肤厚，脉当
沉；瘦人肌肤薄，脉当浮，今肥人脉反浮，瘦人脉反沉，故当责其病在何藏也。
【集注】
方有执曰：责，求也。肥人当沉者，饥肤厚，其脉深也，故求其病于浮。瘦人当浮者
，肌肤薄，其脉浅也，故求其病于沉。
@@@
问曰：经说脉有三菽、六菽重者，可谓也？师曰：脉，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。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。
【注】
此承上条详言皮、脉、肉、筋、骨，各有所主，以候五藏之病也。菽，豆也，约略轻
重言之，非谓有其形也。『难经』曰：如三菽之重，与皮毛相得者，肺部也；六菽之
重，与血脉相得者，心部也；九菽之重，与肌肉相等者，脾部也；十二菽之重，与筋
平者，肝部也；按之至骨，举之来疾者，肾部也，各随所主之部，以候藏气也。至于
寸口、关上、尺中，亦各有所主之位，以候藏气。左寸心也，右寸肺也，左关肝也，
右关脾也，尺中肾也，今特举肾藏之部例之，以概其余也。假令下利而甚，元气暴夺
于中，寸口、关上、尺中全不见脉，法当死；其不死者，必是尺中时有一小见之脉也
。再举头者，谓一呼再起头，一吸再起头，合为四至也。夫尺中时一小见之脉四至，
则是肾间生气之源未绝，即下利未止，尚为易治。若一息二至，名曰损脉，是气衰无
胃，故为难治也。
【集注】
程知曰：『难经』三菽、六菽之说，盖言下指轻重有差等，以候五藏之气也。又云：
下利，寸口、关上、尺中悉不见脉者，是胃之阳气已绝也。『难经』以损脉为阳气下
脱之脉，故曰损脉，至为难治也。
@@@
寸口脉，浮为在表，沉为在里，数为在府，迟为在藏，假令脉迟，此为在藏也。
【注】
寸口，通指三部言也。此以浮、沉、迟、数，候人表、里、藏、府之诊法也。浮者，
皮肤取而得之脉也，浮主表，故曰：浮为在表。沉者，筋骨取而得之脉也，沉主里，
故曰：沉为在里。数者，一息六至之脉也，数主阳，府属阳，故曰：数为在府。迟者
，一息三至之脉，迟主阴，藏属阴，故曰：迟为在藏。假令诊其人脉迟，此为病在藏
，举一迟脉以例其余也。
【集注】
程知曰：躯壳之外，荣卫为表，躯壳之内，藏府为里，故以浮沉别之。诸阳虽皆属府
，诸阴虽皆属藏，当以迟数别之，然伤寒中之传变，亦有数而入藏，迟而入府者，熟
读经文自知也。
张璐曰：此以浮、沉、迟、数，定表、里、藏、府，而全重于「迟为在藏」句，故重
申以明之。设脉见浮迟，虽有表证，祗以小建中和之，终非麻黄、青龙所宜，以藏气
本虚也。
@@@
阳脉浮大而濡，阴脉浮大而濡，阴脉与阳脉同等者，名曰缓也。
【注】
此以阴阳同等，发明平人和缓之脉也。阳脉浮大而濡。阴脉浮大而濡，谓浮、中、沉
，阴阳同等也。名曰缓者，谓和缓之脉也。然缓脉有二义，和缓之缓，脉有力濡柔，
不大不小，以形状之缓，验二气之和也。至数之缓，脉来四至从容，不徐不疾，以至
数之缓，验胃气之和也。
【集注】
方有执曰：缓有二义，此以相兼言，盖谓气血和平也。
程知曰：缓有和缓之义，宽缓之义，与浮大相类，不与迟相类。故经谓之浮大而濡，
不曰浮大而迟也。盖脉之迟数，以至数言，缓急以形状言耳！
张璐曰：脉虽浮大而濡，按之仍不绝者为缓，若按之即无，是虚脉非缓脉也。
@@@
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
脉也。肝病自得濡弱者愈也。假令得纯弦脉者死，何以知之？以其脉如弦直，此是肝
藏伤，故知死也。
【注】
此以下四时五藏平脉、病脉、死脉之诊法也。东方属木，主春令风，在天为风，在地
为木，在人为肝，故曰肝者木也，名足厥阴经，其脉当弦。若得微弦濡弱而长，此弦
而有胃，是肝平脉也，病自易愈也；若得微弦而长，而少濡弱和缓，为弦多胃少，肝
病脉也；若得纯弦而直，无濡弱和缓，为但弦无胃，是肝死脉也。下三藏虽无纯洪、
纯浮、纯沉之文，省文也，当仿此。
【集注】
方有执曰：微非脉名，盖微微之弦，有胃气之谓也。
魏荔彤曰：微弦不甚弦，且带濡弱，如短促，亦非木之本性，又必兼长脉，是象木之
柔和而修长，此肝之本脉。肝脉见此，肝藏平脉，如有微疾，亦易愈也。假令纯弦，
如树木将枯，枝干干硬，故知死也。
@@@
问曰：二月得毛浮脉，何以处言至秋当死？师曰：二月之时，脉当濡弱，反得毛浮者
，故知至秋死。二月肝用事，肝脉属木，脉应濡弱，反得毛浮脉者，是肺脉也，肺属
金，金来克木，故知至秋死，他皆仿此。
【注】
二月春令也，毛浮秋脉也，春得秋脉，何以断言至秋当死？盖春肝木旺，秋肺金旺，
二月肝旺之时，尚得毛浮肺脉，其衰可知，至秋金气愈旺，金乘木，木愈受克则绝，
故知至秋当死也。余藏皆仿此。
【集注】
方有执曰：此以四时脉气属五行生□应病，以主吉凶生死之理，揭一以例其余，所以
示人持诊之要法也。
@@@
南方心脉，其形何似？师曰：心者火也，名少阴，其脉洪大而长，是心脉也，心病自
得洪大者愈也。
平脉，是指健康无病之人的脉象。例如顺应四时变化的平脉、五脏正常的平脉、阴阳均衡的平脉等都属于此类。人一旦生病，脉象就会失去平和的状态。例如出现四时脉象太过或不及、阴阳脏腑之间相乘（过度克制）或相侮（反向克制），以及百病交错出现的生死异常脉象等，都属于此类。“平”字又有“准则”的意思。意思是说，诊脉者如果能以各种平脉作为标准来衡量各种不平之脉，那么凡是太过或不及的差异、呼吸与寸关尺尺寸之间的乖违，都能在心中和指下了然于胸，而不会有任何差错。然后就可以用伤寒病的脉象来衡量坏病（病情恶化或误治后的复杂病证）；也可以用各种坏病的脉象来衡量伤寒病，这确实可以说是融会贯通、毫无遗漏了。
@@@
问：脉有三部（寸、关、尺），阴阳相互影响，营卫气血存在于人体之中，随着呼吸出入，在体内上下运行，借助气息游布全身，津液随之流通，随时变动，呈现出不同的形象。春季脉弦，秋季脉浮，冬季脉沉，夏季脉洪，观察面色和脉象，大小各不相同。在一时之间，变化无常，寸尺参差，或短或长，上下错位，或存或亡，病情随时改变，进退起伏，让人心中迷惑，行动失去法度。希望老师详细陈述，让我能够分辨清楚。老师说：你所问的，是医道的根源。脉分三部，即寸、关、尺。营卫气血流行，不失衡平。肾脉沉，心脉洪，肺脉浮，肝脉弦，这是正常的规律，不差毫厘。脉气出入升降，一个时辰（两刻钟）循环一周，回到寸口，虚实之象便显现出来。变化相互影响，阴阳相互干扰，风邪致脉浮虚，寒邪致脉牢坚，水饮内停致脉沉潜，支饮（饮邪停留胸胁）致脉急弦，动脉主痛，数脉主热烦。如果有不应验的情况，要知晓变化的缘由。三部脉象不同，病症各异，太过令人惊怪，不及也是如此，邪气不会凭空出现，最终必有奸邪作祟。审察表里，区分三焦，知道病邪所在，斟酌诊察，推测脏腑，见解独到如神，为你条理记录，传给贤人。
@@@
老师说：呼吸是脉象的源头。
【注】
人每呼气一次，脉搏跳动两次；每吸气一次，脉搏跳动两次；一呼一吸之间（定息），脉搏跳动四次，这是健康无病之人的缓脉。偶尔因叹息而多跳一次（共五次），也属于平脉。不能通过呼吸来确定脉搏的次数，持脉时必须从这里开始，所以说：“呼吸是脉象的源头。”
【集注】
方有执说：呼气，是气的排出，也是脉的到来；吸气，是气的进入，也是脉的离去。“头”，指头绪。脉随气的出入来去，名称形状虽多，但呼吸是其源头。然而脉有两种说法，这里讲的是寸口部位的脉，如果讲全身的脉，则循环无端，浑然不断，没有头尾可言，学者应当明白这一点。
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初切脉时，脉来快而去慢，这种出快入慢的现象，称为“内虚外实”。初切脉时，脉来慢而去快，这种出慢入快的现象，称为“内实外虚”。
【注】
这是初切脉时，通过脉来的疾迟来判断表里虚实的方法。“来”，指脉气出来，属阳，所以用来候表；“去”，指脉气进去，属阴，所以用来候里；“疾”，指脉数且有余，所以用来候实；“迟”，指脉徐缓且不足，所以用来候虚。如果说脉出来快，进去慢，就是表实里虚，所以称为“内虚外实”。如果说脉出来慢，进去快，就是表虚里实，所以称为“内实外虚”。
【集注】
方有执说：“来”是从骨肉之分，而出于皮肤之际，是气的上升；“去”是从皮肤之际，而还于骨肉之间，是气的下降。出对应呼而来，入对应吸而去。经书说：来者为阳，去者为阴。疾为阳太过，迟为阴不及。内虚外实，是阴不及而阳太过；内实外虚，是阴太过而阳不及。所以来去出入，是脉的关键；内外虚实，是病的纲领。知道内外的阴阳，辨别孰虚孰实，是诊脉的要诀。
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假如脉，来微去大，名叫“反”，病在里；脉来头小本大，名叫“覆”，病在表。上部脉微头小，则汗出；下部脉微本大，则为关格不通，无法排尿。头部无汗者可治，有汗者死。
【按】
“脉来头小本大者”，应当是“脉来大去小”。上部微头小者，应当是“上微小者为阴盛”。下部微本大者，应当是“下微小者为阳盛”，这才与上下之义相符。
【注】
上文通过脉的来去疾迟，来诊察内外虚实；这里通过脉的来去大小，来诊察表里盛衰的病。脉上来微小，下去反而大，像反转的样子，所以叫“反脉”。上来更大，下去微小，像覆盖的样子，所以叫“覆脉”。反者病在里，为阴盛；覆者病在表，为阳盛。阳盛则病格，阴盛则病关。阴阳盛极不相交通，则病关格。头部无汗，说明阳未离阴，故可治；有汗则说明阳已上脱，所以说死。
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寸口脉，卫气盛名叫“高”，营气盛名叫“章”，高章相搏，名叫“纲”。卫气弱名叫“惵”，营气弱名叫“卑”，惵卑相搏，名叫“损”。卫气和名叫“缓”，营气和名叫“迟”，迟缓相搏，名叫“沉”。
【按】
名叫“沉”的“沉”字，应当是“强”字，玩味下文自然知晓。
【注】
这是详细解释上一条中，脉的来去盛衰的状态。寸口，泛指寸、关、尺三部。卫主气为阳以候表，营主血为阴以候里。脉随手指有力上来，是卫气盛，叫做“高”；脉随手指有力下去，是营气盛，叫做“章”。高者长盛，章者分明。高章相合，名叫“纲”，纲者因为荣卫俱有余，有总揽之意。脉随手指无力上来，是卫气弱，叫做“惵”；脉随手指无力下去，是营气弱，叫做“卑”，惵者恍惚，卑者缩下。惵卑相合，名叫“损”；损者因为荣卫俱不足，有消缩之意。如果高章、惵卑的脉，与不疾不徐的缓迟脉同时出现，则是盛者不过分，弱者不衰败，都叫和脉。强者，就是下文所说的“强”。
@@@
寸口脉缓而迟，缓则阳气长，面色鲜艳，容颜光亮，声音清亮，毛发修长；迟则阴气盛，骨髓生，血脉满，肌肉紧实，（此处原文有误，当删）。阴阳相抱，营卫俱行，刚柔相得，名叫“强”。
【按】
“薄鲜□”三字不成句，应是衍文，应当删除。
【注】
这是承接上一条，解释“强”字的含义。说凡人禀赋阳气盛，则得到高章的盛；禀赋阴气盛，则得到惵卑的弱，这是常人的常态。如果能兼见缓迟平脉，这才是阴阳相抱，营卫相和，才名叫“强”。强者就是面色鲜艳、容颜光亮、血满肉紧的意思。
【集注】
方有执说：缓以候胃，迟以候脾。阳气长者，是说胃气有余。颜色声音毛发，都是阳。鲜，丽也；光，辉也；商，清也；长，美也。形容胃阳的有余。阴气盛者，是说脾气充足。骨髓生，血脉满，肌肉紧，骨髓血肉都是阴，形容脾阴的充足。相抱，言和洽；俱行，言周流；相搏，言合一。极力形容二气得其和平，都是由脾胃盈余所致，必定如此，那么这个人的健壮强壮可知，所以说“强”。
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老师说：肥胖的人脉应责求其浮，瘦人脉应责求其沉。肥胖的人脉应当沉，现在反而浮；瘦人脉应当浮，现在反而沉，所以要责求其病。
【注】
上一条通过脉的盛衰，来候人的强弱；这一条通过脉的浮中沉，来分人的皮、脉、肉、筋、骨，以候五脏的诊法。心肺脉皆浮，肝肾脉皆沉。通过皮的浮、脉的浮来区别心肺之浮；通过筋的沉、骨的沉来区别肝肾之沉。脾主肌肉，在浮沉之间，所以候中。肥人肌肤厚，脉应当沉；瘦人肌肤薄，脉应当浮。现在肥人脉反而浮，瘦人脉反而沉，所以应当责求病在何脏。
【集注】
方有执说：责，求也。肥人应当沉，是因为肌肤厚，脉深，所以求病于浮。瘦人应当浮，是因为肌肤薄，脉浅，所以求病于沉。
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问：经书说脉有三菽、六菽重者，可以吗？老师说：脉，人用手指按之，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。假如下利，寸口、关上、尺中完全不见脉，然而尺中时常有一小现之脉，再举头（指脉搏再次升起），是肾气。如果见到损脉，到来很难治疗。
【注】
这是承接上一条，详细讲述皮、脉、肉、筋、骨各有所主，以候五脏的病。菽，是豆子，约略轻重而言，不是说真有豆子。《难经》说：如三颗豆子的重量，与皮毛相得，是肺部；六颗豆子的重量，与血脉相得，是心部；九颗豆子的重量，与肌肉相等，是脾部；十二颗豆子的重量，与筋平，是肝部；按至骨头，举之来疾，是肾部，各随所主的部位，以候脏气。至于寸口、关上、尺中，也各有所主的位臵，以候脏气。左寸心，右寸肺，左关肝，右关脾，尺中肾，现在特别举肾脏的部位为例，以概括其余。假如下利很严重，元气暴夺于中，寸口、关上、尺中全不见脉，法当死；如果不死，一定是尺中时常有一小现之脉。再举头，指一呼再起头，一吸再起头，合为四至。尺中时常一小现之脉四至，则是肾间生气之源未绝，即使下利未止，尚为易治。如果一息二至，名叫损脉，是气衰无胃，所以难治。
【集注】
程知说：《难经》三菽、六菽之说，大概是说下指轻重有差别，以候五脏之气。又说：下利，寸口、关上、尺中完全不见脉，是胃的阳气已绝。《难经》以损脉为阳气下脱之脉，所以叫损脉，到来很难治。
@@@
寸口脉，浮为在表，沉为在里，数为在腑，迟为在脏，假如脉迟，这就是在脏。
【注】
寸口，泛指三部。这是通过浮、沉、迟、数，来候人表、里、藏、府的诊法。浮者，是在皮肤取而得的脉，浮主表，所以说：浮为在表。沉者，是在筋骨取而得的脉，沉主里，所以说：沉为在里。数者，是一息六至的脉，数主阳，腑属阳，所以说：数为在腑。迟者，是一息三至的脉，迟主阴，脏属阴，所以说：迟为在脏。假如诊其人脉迟，这就是病在脏，举一例其余。
【集注】
程知说：躯壳之外，营卫为表，躯壳之内，脏腑为里，所以用浮沉来区别。诸阳虽皆属腑，诸阴虽皆属脏，应当用迟数来区别，然而伤寒中的传变，也有数而入脏，迟而入腑的，熟读经文自然知晓。
张璐说：这是用浮、沉、迟、数，定表、里、藏、府，而全重于“迟为在脏”一句，所以重申以明之。设脉见浮迟，虽有表证，只以小建中汤调和，终非麻黄、青龙所宜，因为脏气本虚。
@@@
阳脉浮大而濡，阴脉浮大而濡，阴脉与阳脉同等者，名叫“缓”。
【注】
这是通过阴阳同等，发明平人和缓之脉。阳脉浮大而濡，阴脉浮大而濡，指浮、中、沉，阴阳同等。名叫缓者，谓和缓之脉。然而缓脉有二义，和缓之缓，脉有力濡柔，不大不小，以形状之缓，验二气之和。至数之缓，脉来四至从容，不徐不疾，以至数之缓，验胃气之和。
【集注】
方有执说：缓有二义，这是以相兼言，大概谓气血和平。
程知说：缓有和缓之义，宽缓之义，与浮大相类，不与迟相类。所以经书谓之浮大而濡，不曰浮大而迟也。大概脉的迟数，以至数言，缓急以形状言耳！
张璐说：脉虽浮大而濡，按之仍不绝者为缓，若按之即无，是虚脉非缓脉也。
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问：东方肝脉，其形像什么？老师说：肝属木，名叫厥阴，其脉微弦，濡弱而长，这是肝脉。肝病自得濡弱者愈。假如得纯弦脉者死，怎么知道？因为其脉如弦直，这是肝脏伤，所以知死。
【注】
这是以下四时五脏平脉、病脉、死脉的诊法。东方属木，主春令风，在天为风，在地为木，在人为肝，所以说肝者木也，名足厥阴经，其脉当弦。若得微弦濡弱而长，此弦而有胃气，是肝平脉，病自易愈；若得微弦而长，而少濡弱和缓，为弦多胃少，肝病脉；若得纯弦而直，无濡弱和缓，为但弦无胃，是肝死脉。下三脏虽无纯洪、纯浮、纯沉之文，省文也，当仿此。
【集注】
方有执说：微非脉名，盖微微之弦，有胃气之谓也。
魏荔彤说：微弦不甚弦，且带濡弱，如短促，亦非木之本性，又必兼长脉，是象木之柔和而修长，此肝之本脉。肝脉见此，肝脏平脉，如有微疾，亦易愈。假如纯弦，如树木将枯，枝干干硬，故知死。
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问：二月得毛浮脉，何以处言至秋当死？老师说：二月之时，脉当濡弱，反得毛浮者，故知至秋死。二月肝用事，肝脉属木，脉应濡弱，反得毛浮脉者，是肺脉也，肺属金，金来克木，故知至秋死，他皆仿此。
【注】
二月春令也，毛浮秋脉也，春得秋脉，何以断言至秋当死？盖春肝木旺，秋肺金旺，二月肝旺之时，尚得毛浮肺脉，其衰可知，至秋金气愈旺，金乘木，木愈受克则绝，故知至秋当死也。余脏皆仿此。
【集注】
方有执说：这是以四时脉气属五行生克应病，以主吉凶生死之理，揭一以例其余，所以示人持诊之要法。
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南方心脉，其形像什么？老师说：心属火，名叫少阴，其脉洪大而长，这是心脉，心病自得洪大者愈。
Ping Mai (Normal Pulse) refers to the pulse of a healthy person without disease. Examples include pulses that conform to the four seasons, normal pulses of the five Zang organs, and pulses where Yin and Yang are balanced. Once a person becomes ill, the pulse loses its equilibrium. This includes pulses that are excessive or deficient according to the four seasons, pulses resulting from mutual over-restriction (Xiang Cheng) or counter-restriction (Xiang Wu) among Yin/Yang and Zang/Fu organs, as well as abnormal pulses indicating life or death amidst various diseases. The term "Ping" (Normal/Level) also implies a standard or criterion. It means that if a practitioner can use various normal pulses as standards to evaluate abnormal pulses, then any deviations due to excess or deficiency, or discrepancies in respiration and Cun/Guan/Chi positions, will be clearly understood both mentally and tactilely, leaving no room for error. Only then can one use the pulse patterns of Shanghan (Cold Damage) to evaluate Huai Bing (complicated/deteriorated conditions), or use the pulses of Huai Bing to evaluate Shanghan. This is indeed what is meant by mastering the principles comprehensively without omission.
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Question: The pulse has three positions (Cun, Guan, Chi), with Yin and Yang influencing each other. Ying (Nutrient) and Wei (Defensive) Qi and Blood exist within the body, moving up and down through inhalation and exhalation, circulating via breath, allowing fluids to flow smoothly. They change constantly, presenting different forms: String-like in Spring, Floating in Autumn, Deep in Winter, and Large/Hong in Summer. Observing complexion and pulse reveals differences in size. Within a short time, changes are unpredictable; Cun and Chi may vary, being short or long, with upper and lower parts misaligned, appearing or disappearing. Conditions change constantly, advancing or retreating, causing confusion and loss of direction. Please explain thoroughly so I may distinguish them clearly. Master said: Your question touches upon the root of medical Dao. The pulse is divided into three positions: Cun, Guan, and Chi. Ying and Wei Qi circulate without losing balance. Kidney pulse is Deep (Chen), Heart pulse is Large/Hong (Hong), Lung pulse is Floating (Fu), Liver pulse is String-like (Xian). These are the constant norms, accurate to the finest detail. Qi moves in and out, rising and falling, completing a cycle every two ke (approx. 48 minutes), returning to Cun Kou, where Deficiency (Xu) and Excess (Shi) become apparent. Changes interact, and Yin and Yang interfere. Wind causes Floating and Empty (Xu) pulses; Cold causes Firm (Lao) and Solid (Jian) pulses; Water retention causes Deep and Stagnant pulses; Branchal Fluid Retention (Zhi Yin) causes Rapid-Tight (Ji Xian) pulses; Moving (Dong) pulse indicates pain; Rapid (Shuo) pulse indicates heat and restlessness. If symptoms do not match, understand the cause of variation. Different pulses in the three positions indicate different pathologies. Excess is startling, but Deficiency is equally significant. Pathogenic factors do not appear randomly; there is always an underlying evil. Examine Exterior and Interior, differentiate the San Jiao (Triple Burner), identify the location of the pathogen, carefully diagnose, and predict Zang organ status. With insight as sharp as a deity, I record this for you to pass on to worthy successors.
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Master said: Respiration is the source of the pulse.
[Annotation]
In a healthy person, the pulse beats twice during one exhalation and twice during one inhalation. During the pause between breaths (Ding Xi), it beats four times. This is the Moderate (Huan) pulse of a healthy person. Occasionally, due to a deep sigh, it may beat five times, which is also considered a normal pulse. One cannot determine pulse frequency without reference to respiration. Pulse taking must begin with observing respiration; hence, "Respiration is the source of the pulse."
[Collected Annotations]
Fang Youzhi stated: Exhalation is the exit of Qi and the arrival of the pulse; Inhalation is the entry of Qi and the departure of the pulse. "Head" refers to the origin. Although pulse names and shapes vary, respiration is their source. However, there are two contexts for pulse: here referring to Cun Kou, if referring to the whole body, circulation is endless and continuous, having no head or tail. Students should recognize this.
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When initially palpating, if the pulse arrives quickly but departs slowly (Out-Quick, In-Slow), it is named "Nei Xu Wai Shi" (Interior Deficiency, Exterior Excess). When initially palpating, if the pulse arrives slowly but departs quickly (Out-Slow, In-Quick), it is named "Nei Shi Wai Xu" (Interior Excess, Exterior Deficiency).
[Annotation]
This describes the method of diagnosing Exterior/Interior and Deficiency/Excess based on the speed of the pulse's arrival and departure. "Arrival" (Lai) refers to the pulse emerging, associated with Yang, thus indicating the Exterior. "Departure" (Qu) refers to the pulse receding, associated with Yin, thus indicating the Interior. "Quick" (Ji) indicates rapidity and excess, thus indicating Excess. "Slow" (Chi) indicates slowness and insufficiency, thus indicating Deficiency. Therefore, an Out-Quick/In-Slow pulse indicates Exterior Excess and Interior Deficiency, hence "Interior Deficiency, Exterior Excess." An Out-Slow/In-Quick pulse indicates Exterior Deficiency and Interior Excess, hence "Interior Excess, Exterior Deficiency."
[Collected Annotations]
Fang Youzhi stated: "Arrival" moves from the muscle/bone layer to the skin surface, representing ascending Qi. "Departure" moves from the skin surface back to the muscle/bone layer, representing descending Qi. Exit corresponds to exhalation and arrival; Entry corresponds to inhalation and departure. The Classics state: Arrival is Yang, Departure is Yin. Quickness is Yang excess; Slowness is Yin deficiency. Interior Deficiency/Exterior Excess is Yin deficiency and Yang excess; Interior Excess/Exterior Deficiency is Yang deficiency and Yin excess. Thus, arrival/departure and interior/exterior are the key principles of pulse diagnosis and disease differentiation. Knowing the Yin/Yang of interior/exterior and distinguishing deficiency/excess is crucial for practitioners.
@@@
Suppose the pulse is微弱 (Wei/Micro) on arrival and large on departure; this is called "Fan" (Reverse), indicating disease in the Interior. Suppose the pulse head is small and the root is large; this is called "Fu" (Covered), indicating disease in the Exterior. If the upper part (Cun) is micro/small-headed, sweating occurs. If the lower part (Chi) is micro/large-rooted, it indicates Guan Ge syndrome (obstruction), leading to inability to urinate. If the head has no sweat, it is treatable; if there is sweat, it is fatal.
[Commentary]
"Pulse head small, root large" should likely be "Pulse large on arrival, small on departure." "Upper micro/small-headed" should be "Upper micro indicates Yin Excess." "Lower micro/large-rooted" should be "Lower micro indicates Yang Excess." This aligns better with the logic of upper/lower.
[Annotation]
The previous section used arrival/departure speed to diagnose interior/exterior deficiency/excess; this section uses arrival/departure magnitude to diagnose exterior/interior excess/deficiency. A pulse that is micro on arrival and large on departure resembles reversal, hence "Fan Mai" (Reverse Pulse). A pulse that is larger on arrival and micro on departure resembles covering, hence "Fu Mai" (Covered Pulse). Fan indicates Interior disease with Yin Excess; Fu indicates Exterior disease with Yang Excess. Yang Excess leads to Ge (blocking); Yin Excess leads to Guan (closing). Extreme excess of Yin and Yang prevents communication, resulting in Guan Ge syndrome. No sweat on the head indicates Yang has not separated from Yin, so it is treatable. Sweat indicates Yang has fled upward, hence fatal.
@@@
At Cun Kou, Excess of Wei Qi is named "Gao" (High); Excess of Ying Qi is named "Zhang" (Clear/Distinct). When Gao and Zhang combine, it is named "Gang" (Outline/General). Weakness of Wei Qi is named "Die" (Trepidation); Weakness of Ying Qi is named "Bei" (Low/Abased). When Die and Bei combine, it is named "Sun" (Damage/Loss). Harmony of Wei Qi is named "Huan" (Moderate); Harmony of Ying Qi is named "Chi" (Slow). When Huan and Chi combine, it is named "Chen" (Deep/Sunken - *Note: Text suggests this should be "Qiang" Strong*).
[Commentary]
The character "Chen" (Deep) in "Named Chen" should likely be "Qiang" (Strong), as inferred from the following text.
[Annotation]
This details the states of pulse strength and weakness. Cun Kou generally refers to Cun, Guan, and Chi. Wei governs Qi (Yang) to indicate the Exterior; Ying governs Blood (Yin) to indicate the Interior. If the pulse rises strongly under the finger, Wei Qi is excessive, called "Gao" (High/Long). If the pulse descends strongly under the finger, Ying Qi is excessive, called "Zhang" (Clear/Distinct). Gao implies long-lasting excess; Zhang implies clarity. Their combination is "Gang," implying total abundance of Ying and Wei. If the pulse rises weakly, Wei Qi is deficient, called "Die" (Trepidation/Unsteady). If the pulse descends weakly, Ying Qi is deficient, called "Bei" (Low/Shrinking). Their combination is "Sun," implying total deficiency of Ying and Wei. If Gao/Zhang or Die/Bei pulses appear alongside non-rapid/non-slow Moderate/Slow pulses, it indicates balance (neither too excessive nor too deficient), known as Harmonious Pulse. The "Strong" mentioned here refers to the condition described next.
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Cun Kou pulse is Moderate (Huan) and Slow (Chi). Huan indicates growth of Yang Qi, resulting in fresh complexion, radiant face, clear voice, and long hair. Chi indicates abundance of Yin Qi, resulting in marrow generation, full blood vessels, and tight muscles. [Text corruption here]. When Yin and Yang embrace, Ying and Wei circulate together, and Rigidity and Flexibility harmonize, it is named "Qiang" (Strong).
[Commentary]
"The characters 'Bo Xian □' do not form a sentence and are likely interpolations; they should be deleted."
[Annotation]
This explains the meaning of "Qiang" (Strong) following the previous section. Generally, those with abundant Yang Qi exhibit Gao/Zhang characteristics; those with abundant Yin Qi exhibit Die/Bei characteristics. This is normal. However, only when Huan and Chi normal pulses are present simultaneously does it signify Yin-Yang harmony and Ying-Wei balance, truly earning the name "Qiang." Qiang refers to fresh complexion, radiant face, full blood, and tight flesh.
[Collected Annotations]
Fang Youzhi stated: Huan diagnoses the Stomach; Chi diagnoses the Spleen. Growth of Yang Qi means sufficient Stomach Qi. Complexion, voice, and hair belong to Yang. Fresh means beautiful; Radiant means shining; Shang (clear) means clear; Long means fine. This describes surplus Stomach Yang. Abundance of Yin Qi means sufficient Spleen Qi. Marrow generation, full blood, tight muscles—all belong to Yin, describing sufficient Spleen Yin. Embrace means harmony; Circulate together means flowing throughout; Combine means unity. This emphasizes that peace between the two energies results from Spleen/Stomach surplus, ensuring robust health, hence "Qiang."
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Master said: For obese individuals, one should investigate Floating pulses; for thin individuals, one should investigate Deep pulses. Obese people should have Deep pulses; if they instead have Floating pulses, pathology is suspected. Thin people should have Floating pulses; if they instead have Deep pulses, pathology is suspected.
[Annotation]
The previous section used pulse strength to assess physical constitution; this section uses pulse depth (Floating/Middle/Deep) to differentiate skin, vessels, muscle, tendon, and bone, thereby diagnosing the Five Zang organs. Heart and Lung pulses are Floating; Liver and Kidney pulses are Deep. Skin and vessel superficiality distinguish Heart/Lung floating; tendon and bone depth distinguish Liver/Kidney deepness. Spleen governs muscle, situated between floating and deep, so it is diagnosed at the Middle level. Obese people have thick skin/flesh, so their pulse should be Deep; thin people have thin skin/flesh, so their pulse should be Floating. If an obese person has a Floating pulse or a thin person has a Deep pulse, one must investigate which Zang organ is affected.
[Collected Annotations]
Fang Youzhi stated: "Ze" (Investigate/Blame) means to seek. Obese people should have Deep pulses because their flesh is thick and the pulse is deep; thus, we look for pathology in the Floating aspect. Thin people should have Floating pulses because their flesh is thin and the pulse is shallow; thus, we look for pathology in the Deep aspect.
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Question: The Classics mention applying pressure equivalent to three or six beans (Shu). Is this valid? Master said: When pressing the pulse, a weight equivalent to three beans indicates Lung Qi; six beans indicates Heart Qi; nine beans indicates Spleen Qi; twelve beans indicates Liver Qi; pressing to the bone indicates Kidney Qi. Suppose a patient has diarrhea, and no pulse is felt at Cun, Guan, or Chi. However, if the Chi position occasionally shows a small pulse that re-emerges upon lifting, this indicates remaining Kidney Qi. If a Sun (Damaged) pulse appears, it is difficult to treat.
[Annotation]
This elaborates on the previous section regarding skin, vessels, muscle, tendon, and bone corresponding to the Five Zang organs. "Shu" means bean, used here to approximate weight, not literal beans. The *Nan Jing* states: Three beans' weight touching the skin corresponds to the Lung; six beans' weight touching the blood vessels corresponds to the Heart; nine beans' weight equal to muscle corresponds to the Spleen; twelve beans' weight equal to tendon corresponds to the Liver; pressing to the bone with a quick rebound corresponds to the Kidney. Each position corresponds to specific Zang Qi. Regarding Cun, Guan, and Chi: Left Cun is Heart, Right Cun is Lung, Left Guan is Liver, Right Guan is Spleen, Chi is Kidney. Here, the Kidney example illustrates the rest. Severe diarrhea depletes Yuan Qi; if no pulse is found anywhere, death is expected. Survival depends on the occasional small pulse at Chi. "Re-emerging" means beating four times per breath cycle (two per inhale, two per exhale). Four beats at Chi indicate the source of Vital Qi in the Kidneys is not exhausted; even if diarrhea persists, it is treatable. Two beats per breath is a Sun (Damaged) pulse, indicating Qi decline and lack of Stomach Qi, making it difficult to treat.
[Collected Annotations]
Cheng Zhi stated: The *Nan Jing*'s discussion of three/six beans refers to varying pressure depths to diagnose Five Zang Qi. Diarrhea with absent pulses at all positions indicates exhaustion of Stomach Yang Qi. The *Nan Jing* considers the Sun pulse as downward collapse of Yang Qi, hence difficult to treat.
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Cun Kou pulse: Floating indicates Exterior; Deep indicates Interior; Rapid indicates Fu (Organs); Slow indicates Zang (Viscera). Suppose the pulse is Slow; this indicates disease in the Zang.
[Annotation]
"Cun Kou" refers to the three positions collectively. This section uses Floating/Deep and Slow/Rapid to diagnose Exterior/Interior and Zang/Fu. Floating is felt at the skin level, indicating Exterior. Deep is felt at the bone/muscle level, indicating Interior. Rapid is six beats per breath, associated with Yang and Fu organs. Slow is three beats per breath, associated with Yin and Zang organs. A Slow pulse specifically points to Zang pathology, serving as an example for others.
[Collected Annotations]
Cheng Zhi stated: Outside the body, Ying/Wei constitute the Exterior; inside, Zang/Fu constitute the Interior, distinguished by Floating/Deep. While Yang generally relates to Fu and Yin to Zang, Slow/Rapid provides further distinction. Note that in Shanghan transmission, Rapid pulses can enter Zang, and Slow pulses can enter Fu; careful study of the classics will clarify this.
Zhang Lu stated: This uses Floating/Deep/Slow/Rapid to define Exterior/Interior/Zang/Fu, emphasizing "Slow indicates Zang." If a Floating-Slow pulse appears despite Exterior signs, one should use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) to harmonize, rather than Ma Huang Tang or Qing Long Tang, because the Zang Qi is inherently deficient.
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Yang pulse is Floating, Large, and Soft (Ru); Yin pulse is Floating, Large, and Soft (Ru). When Yin and Yang pulses are equal, it is named "Huan" (Moderate).
[Annotation]
This explains the Harmonious Moderate pulse through the equality of Yin and Yang. "Yang pulse" and "Yin pulse" refer to the pulse felt at Floating, Middle, and Deep pressures being equal. "Huan" refers to the Harmonious pulse. There are two meanings of Huan: 1. Shape: The pulse is forceful yet soft, neither too large nor too small, indicating harmony of Qi. 2. Frequency: The pulse beats four times per breath, leisurely and steady, indicating harmony of Stomach Qi.
[Collected Annotations]
Fang Youzhi stated: Huan has two meanings; here it refers to combined qualities, signifying peaceful Qi and Blood.
Cheng Zhi stated: Huan implies harmony and relaxation, similar to Floating/Large, but distinct from Slow. Hence the text says "Floating, Large, and Soft," not "Floating, Large, and Slow." Slow/Rapid refers to frequency; Huan/Tight refers to shape.
Zhang Lu stated: If the pulse is Floating, Large, and Soft but disappears completely upon heavy pressure, it is a Deficient (Xu) pulse, not a Huan pulse.
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Question: What does the Liver pulse of the East resemble? Master said: The Liver belongs to Wood, named Jue Yin. Its pulse is slightly String-like (Xian), Soft (Ru), Weak (Ruo), and Long. This is the Liver pulse. If a Liver disease patient presents with Ru/Ruo characteristics, they will recover. If a pure String-like pulse appears, death ensues. Why? Because the pulse is rigid like a string, indicating severe Liver damage.
[Annotation]
This section covers normal, pathological, and terminal pulses for the Five Zang organs across the four seasons. Liver corresponds to Wood and Spring wind. Its normal pulse should be String-like. A pulse that is slightly String-like, Soft, Weak, and Long indicates the presence of Stomach Qi (Wei Qi), representing a normal Liver pulse; recovery is likely. A pulse that is String-like and Long but lacks Soft/Weak moderation indicates "String-like with little Stomach Qi," a pathological Liver pulse. A pure, rigid String-like pulse lacking any Soft/Weak moderation indicates "Only String-like, no Stomach Qi," a terminal Liver pulse. The same logic applies to other organs (Heart, Lung, Kidney), though the text omits explicit mentions of "Pure Hong/Floating/Deep" for brevity.
[Collected Annotations]
Fang Youzhi stated: "Wei" (Micro) is not a pulse name itself but implies a slight String-like quality with Stomach Qi.
Wei Litong stated: Slightly String-like, accompanied by Soft/Weak, and combined with Long, reflects the gentle and elongated nature of Wood. This is the fundamental Liver pulse. If seen, even minor illness will heal. A pure String-like pulse resembles a dying tree—dry and hard—indicating death.
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Question: Why is it said that obtaining a Mao (Feather/Floating) pulse in the second month (Spring) predicts death in Autumn? Master said: In the second month, the pulse should be Ru (Soft) and Ruo (Weak). Obtaining a Mao (Floating) pulse instead indicates death in Autumn. The second month is governed by the Liver (Wood). The pulse should be Ru/Ruo. A Mao pulse belongs to the Lung (Metal). Metal overcomes Wood. Hence, death is predicted in Autumn. Apply this logic to other cases.
[Annotation]
The second month is Spring; Mao/Floating is an Autumn pulse. Obtaining an Autumn pulse in Spring predicts death in Autumn. In Spring, Liver Wood is prosperous; in Autumn, Lung Metal is prosperous. If a Lung (Metal) pulse appears when Liver (Wood) is strong, the Wood is already weakened. By Autumn, Metal becomes even stronger, overcoming the already weak Wood, leading to extinction. Hence, death is predicted. This logic applies to other Zang organs.
[Collected Annotations]
Fang Youzhi stated: This illustrates the principle of predicting life/death based on the Five Elements' interactions with seasonal pulse energies, providing a key diagnostic method.
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Question: What does the Heart pulse of the South resemble? Master said: The Heart belongs to Fire, named Shao Yin. Its pulse is Large/Hong (Hong), Large (Da), and Long. This is the Heart pulse. If a Heart disease patient presents with Hong characteristics, they will recover.