调停自气，呼吸定息。四至五至，平和之则。
三至为迟，迟则为冷。六至为数，数即热证。
转迟转冷，转数转热。迟数既明，浮沉当别。
医至病家，宜默坐片时。先调停自气，令呼吸均匀，方诊其脉。（平人气象论云常以不
病患调病患。医不病，故为病患平息以调之。）大约以我呼吸一息，得彼脉四至五至为准则。（呼吸闰
以太息，故在四至五至之间。）此为平和之脉，断为无病。虽病亦极微浅，以脉不为病变故也。（
病邪微，不能变易其脉。）若一息三至，不及四五，是名迟脉。迟则气寒而行慢，故病主冷。
若一息六至，过于四五，是名数脉。数则气热而行快，故病主热。转迟则更迟，在
三至以下，而冷者愈冷矣。转数则更数，在六至以上，而热者愈热矣。此迟数脉病
之相应也。迟数既明，寒热乃定。欲知寒热之所属，又当别乎浮沉耳。
浮沉迟数，辨内外因。外因于天，内因于人。
天有阴阳，风雨晦明，人喜怒忧，思悲恐惊。
外因之浮，则为表证。沉里迟阴，数则阳盛。
内因之浮，虚风所为。沉气迟冷，数热何疑。
浮数表热，沉数里热。浮迟表虚，沉迟冷结。
表里阴阳，风气冷热。辨内外因，脉证参别。
脉理浩繁，总括于四。既为提纲，引申触类。
在表则浮，在里则沉。迟则为寒，数则为热。固一定不易之理，而因则有二焉。
此内外之不可不辨也。外感六淫，因之于天。内伤七情，因之于人。六淫者，天之
阴阳风雨晦明也。即《左传》医和所云∶阴淫寒疾，阳淫热疾，风淫末疾，雨淫腹
疾，晦淫惑疾，明淫心疾也。淫者，淫佚偏胜。久而不复之谓。故阴淫则过于清冷，
而阳气不治，寒疾从起，如上下厥逆，中外寒栗之类。阳淫则过于炎燠，而阴气不
治，热疾从起，如狂谵烦渴，血泄浸淫之类。风淫则过于动摇，而疾生HT 末，如
肢废毛落、 习螈 之类。雨淫则过于水湿，而疾生肠腹，如腹满肿胀，肠鸣濡
泻之类。晦淫则过于昏暗，阳光内郁，而成惑疾，如百合狐惑，热中脏燥之类。明
淫则过于彰露，阳光外散，而成心疾，如恍惚动悸，错妄失神之类。七情者，人之
喜怒忧思悲恐惊也，即所谓七气。而巢氏《病源论》，以劳气易惊气，又增寒热二
气，广为九气。若配四时五脏，则又只言五气。如《素问·阴阳应象大论》云∶天
有四时五行，以生长收藏，以生寒暑燥湿风。人有五脏，化五气，以生喜怒悲忧恐
是已。据巢氏言九气之状，谓怒则气上，喜则气缓，悲则气消，恐则气下，寒则气
收聚，热则腠理开而气泄，忧则气乱，劳则气耗，思则气结。怒气上者，怒则气逆，
甚则呕血及食，故气上矣。喜气缓者，喜则气和，营卫通利，故气缓矣。悲气消者，
悲则心系急，肺布叶举，使上焦不通，营卫不散，热气在内，故气消矣。恐气下者，
恐则精却，精却则上焦闭。闭则气还，还则下焦胀，故气下矣。寒气收聚者，寒则
经络涩滞，故气收聚矣。热气泄者，热则腠理开窍，营卫通，故汗出而气泄矣。忧
气乱者，忧则心无所寄，神无所归，虑无所定，故气乱矣。劳气耗者，劳则喘且汗，
内动外泄，故气耗矣。思气结者，思则身心有所止，气留不行，故气结矣。是谓九
气，而七气即在其中。虽皆内因，而为病则有二种。一种因感触情境，气久不散，
着而为病者，病生于情也。一种因五行之盛衰，五脏之虚实，互相胜复，病中见情
者，情生于病也。病生于情者，如《素问》阴阳应象大论云∶喜怒伤气，寒暑伤形。
暴怒伤阴，暴喜伤阳。厥气上行，满脉去形。喜怒不节，寒暑过度，生乃不固。又
曰∶东方生风，在声为呼，在变动为握，在志为怒。怒伤肝，悲胜怒。南方生热，
在声为笑，在变动为忧，在志为喜。喜伤心，恐胜喜。中央生湿，在声为歌，在变
动为哕，在志为思。思伤脾，怒胜思。西方生燥，在声为哭，在变动为咳，在志为
忧。忧伤肺，喜胜忧。北方生寒，在声为呻，在变动为栗，在志为恐。恐伤肾，思
胜恐。又《灵枢》口问篇云∶夫百病之始生也，皆生于风雨寒暑，阴阳喜怒，饮食
居处。大惊卒恐，则血气分离，阴阳破散，经脉厥绝，脉道不通。阴阳相逆，卫气
稽留，经脉虚空，血气不次，乃失其常。又《素问》玉机真藏论云∶忧恐悲喜怒，
令不得以其次，故令人有大病矣。因而喜大虚，则肾气乘矣。怒则肝气乘矣。悲则
肺气乘矣。恐则脾气乘矣。忧则心气乘矣。又《灵枢》本神篇云∶怵惕思虑者则伤
神，神伤则恐惧流淫而不止。悲哀动中者，竭绝而失生。喜乐者，神惮散而不藏。愁
忧者，气闭塞而不行。盛怒者，迷惑而不治。恐惧者，神荡惮而不收。心怵惕思虑
则伤神，神伤则恐惧自失，破 脱肉。脾忧愁而不解则伤意，意伤则 乱，四肢不
举。肝悲哀动中则伤魂，魂伤则狂忘不精，当人阴缩而筋挛，两胁骨不举。肺喜乐
无极则伤魄，魄伤则狂，皮革焦。肾盛怒而不止则伤志，志伤则善忘其前言，腰脊
不可以俯仰屈伸。恐惧而不解则伤精，精伤则骨 痿厥，精时自下。又《素问》调
经论云∶喜怒不节，则阴气上逆。上逆则下虚，下虚则阳气走之，故曰实矣。喜则
气下，悲则气消，消则脉虚空。因寒饮食，寒气熏满，则血泣气去，故曰虚矣。又
《素问》痿论，岐伯曰∶悲哀太甚则胞络绝，胞络绝则阳气内动。发则心下崩，数溲
血也。又曰∶思想无穷，所愿不得，意淫于外，入房太甚，宗筋弛纵，发为筋痿及
为白淫。又《素问》遗篇云∶人忧愁思虑即伤心。恚怒气逆，上而不下即伤肝。又
《灵枢》邪气脏腑病形篇云∶愁忧恐惧则伤心。又《灵枢》口问篇云∶口鼻者，气之
门户也。故悲哀愁忧则心动，心动则五脏六腑皆摇，摇则宗脉感，宗脉感则液道开。
液道开，故涕泣出焉。又寿夭刚柔篇云∶忧恐忿怒伤气。气伤脏，乃病脏。又《素
问》血气形志篇云∶形乐志苦，病生于脉。形乐志乐，病生于肉。形苦志苦，病生
于咽嗌。形数惊恐，经络不通，病生于不仁。又《素问》疏五过论云∶尝贵后贱，
虽不中邪，病从内生，名曰脱营。尝富后贫，名曰失精，五气流连，病有所并。又
云∶暴乐暴苦、始乐后苦，皆伤精气。精气竭绝，形体毁沮。暴怒伤阴，暴喜伤阳。
厥逆上行，满脉去形。愚医治之，不知补泻，不知病情。精华日脱，邪气乃并。又
曰∶故贵脱势，虽不中邪，精神内伤，身必败亡。始富后贫，虽不伤邪，皮焦筋屈，
痿为挛。又《素问》生气通天论云∶阳气者，大怒则形气绝而血菀于上，使人薄
厥。又通评虚实论云∶隔则闭绝，上下不通，则暴怒之病也。又《灵枢》刺节真邪
篇曰∶饮食不节，喜怒不时，津液内溢，乃下留于睾。又《素问》经脉别论曰∶有
所堕恐，喘出于肝，淫气害脾。有所惊恐，喘出于肺，淫气伤心。惊而夺精，汗出
于心。疾走恐惧，汗出于肝。此皆病生于情也。情生于病者，如《素问》金匮真言
论曰∶东方色青，入通于肝，开窍于目，藏精于肝，其病发惊骇。又《素问》调经
论曰∶血并于阴，气并于阳，故为惊狂。又曰∶血并于上，气并于下，心烦惋善怒。
血并于下，气并于上，乱而喜忘。又宣明五气篇曰∶胃为气逆、为哕、为恐。又云∶
胆为怒。又云∶精气并于心则喜，并于肺则悲，并于肝则忧，并于脾则畏，并于肾
则恐。又云∶阳入之阴则静，阴出之阳则怒。又《素问》调经论曰∶神有余则笑不
休，神不足则悲。又曰∶血有余则怒，不足则恐。又《灵枢》行针篇曰∶多阳者多
喜，多阴者多怒。又《素问》解精微论曰∶水之精为志，火之精为神。水火相感，
神志俱悲，是以目之水生也。故谚言曰∶心悲名曰志悲。又《灵枢》本神篇曰∶肝
藏血，血舍魂。肝气虚则恐，实则怒。又云∶心藏脉，脉舍神。心气虚则悲，实则
笑不休。又玉机真藏论曰∶春脉太过，则令人善怒。又《素问》脉解篇云∶阳明所
谓甚则厥，恶人与火，闻木音则惕然而惊者，阳气与阴气相薄，水火相恶，故惕然
而惊也。又曰∶少阴所谓恐如人将捕之者，秋气万物未有毕去，阴气少，阳气入，
阴阳相薄，故恐也。又曰∶肝气当治而未得，故善怒。善怒者，名曰煎厥。又《灵
枢》根结篇曰∶厥阴为阖，阖折即气绝而喜悲。又《素问》缪刺篇曰∶邪客于足少
阴之络，令人无故善怒，气上走贲上。又《素问》生气通天论曰∶俞气化薄，传为
善畏，及为惊骇。又《灵枢》五变篇曰∶此人薄皮肤而目坚固以深者，长冲直扬。
其心刚，刚则多怒，怒则气上逆。胸中蓄积，血气逆留，髋皮充肌，血脉不行，转
而为热。热则消肌肤，故为消瘅，此言其人暴刚而肌肉弱者也。又《素问》痹论曰∶
心痹者，脉不通，烦则心下鼓，暴上气而喘，嗌干善噫，厥气上则恐。又曰∶肝痹，
夜卧则惊。此皆情生于病也。故病生于情者治其情，如喜胜悲，悲胜怒之类。情生
于病者治其病，如平肝怒解，温胆悸宁之类。外因之邪自表而入。当其在表，正气
应之，其脉必浮。若见沉脉，邪已去表而入里矣。若脉不及四至，名曰迟。迟则邪
在阴分，主冷。过于四至，名曰数。数则邪在阳分，主热。内因之邪，自内而生，
如暴喜、卒惊。暴怒阳气浮越，脉应之而浮，其中必虚。如今之暴怒蹶仆、卒惊晕
倒、大喜伛痛如中风状，而非外来之风，此即所谓虚风也。若忧思悲恐，久积沉郁，
脉应之而沉，以无虚浮风象，故直指曰气耳。迟则为冷。若脉迟，不论因于何气，
皆主冷也。数则为热。若脉数，不论因于何气，皆主热也。数皆主热。若浮而得之，
不论何因，其热在表。沉而得之，其热在里。迟既主冷，若浮而得之，不论何因，
其冷在表而虚。沉而得之，其冷在里而结。外因之表里阴阳，内因之风气冷热，非
参以脉，则不能分别。然而脉理浩繁，能提括其纲，自可条析其目，但以浮沉迟数
四者而触类焉。则引彼可以证此，申此可以例彼，而诊家之精义，思过半矣。
调匀自己的呼吸，以一次完整的呼吸定息为标准。一呼一吸之间，脉搏跳动四到五次，这是平和脉的准则。
脉搏一息三至，称为迟脉，迟脉主寒证；脉搏一息六至，称为数脉，数脉即热证。
脉象越迟，说明寒邪越重；脉象越快，说明热邪越盛。既然迟数和寒热的关系已经明确，接下来应当辨别浮脉和沉脉。
医生来到病人家中，应当静坐片刻。先调整自己的呼吸，使呼吸均匀，然后诊察病人的脉象。（《素问·平人气象论》说：通常用健康人来比量病人。医生没有生病，所以用医生平静的呼吸来调节衡量。）大约以我的一次呼吸，得到病人脉搏四到五次的跳动作为准则。（因为呼吸中偶尔会有深长的叹息，所以脉动次数在四至五次之间波动。）这属于平和的脉象，判断为无病。即使有病，也非常轻微浅表，因为脉象没有发生病变。（病邪轻微，不能改变正常的脉象。）如果一息只有三次跳动，少于四五次，这就叫迟脉。迟脉表示气机寒冷而运行缓慢，所以疾病主要属寒。如果一息有六次跳动，超过四五次，这就叫数脉。数脉表示气机发热而运行快速，所以疾病主要属热。脉象变得更迟，在三至以下，那么寒性病症就会更加严重。脉象变得更快，在六至以上，那么热性病症就会更加严重。这就是迟脉和数脉与疾病的相应关系。迟数和寒热既已明确，寒热的性质也就确定了。想要知道寒热所属的部位，还应当辨别浮脉和沉脉。
浮、沉、迟、数，用来辨别内因和外因。外因源于自然界（天），内因源于人的情志（人）。
自然界有阴阳变化，表现为风雨晦明；人有喜怒忧思悲恐惊等七情。
外感病邪引起的浮脉，属于表证；沉脉属里，迟脉属阴（寒），数脉属阳（热）。
内伤病因引起的浮脉，是虚风所致；沉脉属气滞，迟脉属冷，数脉属热，这有什么可疑的呢？
浮脉兼数，主表热；沉脉兼数，主里热；浮脉兼迟，主表虚；沉脉兼迟，主冷结于里。
表里、阴阳、风气、冷热，通过辨别内外因，结合脉象和症状进行区分。
脉理虽然浩繁，但总括起来就是这四者。既然作为提纲，就可以由此引申，触类旁通。
脉在表则现浮象，脉在里则现沉象。迟脉主寒，数脉主热。这是一定不变的道理，但其成因有两种。这就是内外因不可不加以辨别的缘故。外感六淫之邪，是由于自然气候的变化；内伤七情之变，是由于人的情志活动。所谓六淫，就是天的阴阳风雨晦明。正如《左传》中医和所说：“阴气过盛导致寒疾，阳气过盛导致热疾，风气过盛导致四肢末端的疾病，雨气过盛导致腹部疾病，昏暗过度导致神志惑乱之疾，光亮过度导致心脏疾病。”所谓“淫”，是指淫佚偏胜，久而不复原状。所以阴气过盛则过于清冷，阳气不能正常治理，寒疾随之而起，如上下厥逆、全身寒战之类。阳气过盛则过于炎热，阴气不能正常治理，热疾随之而起，如狂躁谵语、烦渴、出血浸淫之类。风气过盛则过于动摇，疾病产生于四肢末端，如肢体废用、毛发脱落、抽搐痉挛之类。雨气过盛则过于水湿，疾病产生于肠腹，如腹胀满肿胀、肠鸣泄泻之类。昏暗过度则阳光内郁，形成惑乱之疾，如百合病、狐惑病、体内燥热之类。光亮过度则阳光外散，形成心脏疾病，如恍惚心悸、错妄失神之类。七情，就是人的喜、怒、忧、思、悲、恐、惊，也就是所谓的七气。而巢元方《诸病源候论》中，将劳气代替惊气，又增加了寒气和热气，广为九气。如果配合四季五脏，则只讲五气。如《素问·阴阳应象大论》说：“天有四时五行，用以生长收藏，化生寒暑燥湿风。人有五脏，化生五气，从而产生喜怒悲忧恐。”就是这样。根据巢氏所言九气的状态，说是：怒则气上，喜则气缓，悲则气消，恐则气下，寒则气收聚，热则腠理开而气泄，忧则气乱，劳则气耗，思则气结。怒气上逆者，是因为怒则气逆，严重时呕血及食物，所以气向上冲。喜气舒缓者，是因为喜则气和，营卫通畅流利，所以气机舒缓。悲气消耗者，是因为悲则心系紧急，肺叶举布，使上焦不通，营卫不散，热气在内，所以气被消耗。恐气下沉者，是因为恐则精气退缩，精气退缩则上焦闭塞。闭塞则气还返，还返则下焦胀满，所以气向下陷。寒气收聚者，是因为寒则经络涩滞，所以气机收聚。热气外泄者，是因为热则腠理开窍，营卫通畅，所以汗出而气泄。忧气紊乱者，是因为忧则心无所寄托，神无所归依，思虑无定准，所以气机紊乱。劳气耗损者，是因为劳则喘息且出汗，内动外泄，所以气被耗损。思气郁结者，是因为思则身心有所止着，气停留不行，所以气机郁结。这叫做九气，而七气就包含在其中。虽然都属于内因，但致病有两种情况。一种是因为感触情境，气久不散，附着而成病，病生于情志；另一种是因为五行盛衰，五脏虚实，互相克制复归，病中表现出情志异常，情志生于疾病。病生于情志的，如《素问·阴阳应象大论》说：“喜怒伤气，寒暑伤形。暴怒伤阴，暴喜伤阳。厥气上行，充满经脉，脱离形体。喜怒不节制，寒暑过度，生命就不稳固。”又说：“东方生风，在声音为呼，在变动为握拳，在志为怒。怒伤肝，悲能胜怒。南方生热，在声音为笑，在变动为忧，在志为喜。喜伤心，恐能胜喜。中央生湿，在声音为歌，在变动为呃逆，在志为思。思伤脾，怒能胜思。西方生燥，在声音为哭，在变动为咳嗽，在志为忧。忧伤肺，喜能胜忧。北方生寒，在声音为呻吟，在变动为战栗，在志为恐。恐伤肾，思能胜恐。”又《灵枢·口问》篇说：“各种疾病的开始，都生于风雨寒暑、阴阳喜怒、饮食居处。大惊卒恐，则血气分离，阴阳破散，经脉厥绝，脉道不通。阴阳相逆，卫气稽留，经脉虚空，血气次序失常，于是失去常态。”又《素问·玉机真脏论》说：“忧恐悲喜怒，如果不按次序发作，就会使人患大病。因而大喜导致大虚，则肾气乘袭；大怒则肝气乘袭；大悲则肺气乘袭；大恐则脾气乘袭；大忧则心气乘袭。”又《灵枢·本神》篇说：“怵惕思虑则伤神，神伤则恐惧流淫而不止。悲哀触动内心，竭绝而丧失生机。喜乐过度，神惮散而不藏。愁忧者，气闭塞而不行。盛怒者，迷惑而不治。恐惧者，神荡惮而不收。心怵惕思虑则伤神，神伤则恐惧自失，肌肉破败脱肉。脾忧愁而不解则伤意，意伤则健忘混乱，四肢不能举动。肝悲哀触动内心则伤魂，魂伤则狂妄健忘不精明，当见阴茎收缩而筋挛，两胁骨不能抬起。肺喜乐无极则伤魄，魄伤则狂妄，皮肤枯焦。肾盛怒而不止则伤志，志伤则善忘前言，腰脊不可以俯仰屈伸。恐惧而不解则伤精，精伤则骨骼痿厥，精液时常自下。”又《素问·调经论》说：“喜怒不节制，则阴气上逆。上逆则下部虚，下部虚则阳气走之，所以说成为实证。喜则气下，悲则气消，消则脉虚空。因寒凉饮食，寒气熏满，则血液凝泣气去，所以说成为虚证。”又《素问·痿论》，岐伯说：“悲哀太甚则胞络绝，胞络绝则阳气内动。发作则心下崩漏，多次小便出血。”又说：“思想无穷，所愿不得，意淫于外，入房太甚，宗筋弛纵，发为筋痿及为白淫。”又《素问》遗篇说：“人忧愁思虑即伤心。恚怒气逆，上而不下即伤肝。”又《灵枢·邪气脏腑病形》篇说：“愁忧恐惧则伤心。”又《灵枢·口问》篇说：“口鼻者，气之门户也。故悲哀愁忧则心动，心动则五脏六腑皆摇，摇则宗脉感，宗脉感则液道开。液道开，故涕泣出焉。”又《寿夭刚柔》篇说：“忧恐忿怒伤气。气伤脏，乃病脏。”又《素问·血气形志》篇说：“形乐志苦，病生于脉。形乐志乐，病生于肉。形苦志苦，病生于咽嗌。形数惊恐，经络不通，病生于不仁。”又《素问·疏五过论》说：“尝贵后贱，虽不中邪，病从内生，名曰脱营。尝富后贫，名曰失精，五气流连，病有所并。”又说：“暴乐暴苦、始乐后苦，皆伤精气。精气竭绝，形体毁沮。暴怒伤阴，暴喜伤阳。厥逆上行，满脉去形。愚医治之，不知补泻，不知病情。精华日脱，邪气乃并。”又说：“故贵脱势，虽不中邪，精神内伤，身必败亡。始富后贫，虽不伤邪，皮焦筋屈，痿为挛。”又《素问·生气通天论》说：“阳气者，大怒则形气绝而血菀于上，使人薄厥。”又《通评虚实论》说：“隔则闭绝，上下不通，则暴怒之病也。”又《灵枢·刺节真邪》篇说：“饮食不节，喜怒不时，津液内溢，乃下留于睾。”又《素问·经脉别论》说：“有所堕恐，喘出于肝，淫气害脾。有所惊恐，喘出于肺，淫气伤心。惊而夺精，汗出于心。疾走恐惧，汗出于肝。此皆病生于情也。”情生于病的，如《素问·金匮真言论》说：“东方色青，入通于肝，开窍于目，藏精于肝，其病发惊骇。”又《素问·调经论》说：“血并于阴，气并于阳，故为惊狂。”又说：“血并于上，气并于下，心烦惋善怒。血并于下，气并于上，乱而喜忘。”又《宣明五气》篇说：“胃为气逆、为哕、为恐。”又说：“胆为怒。”又说：“精气并于心则喜，并于肺则悲，并于肝则忧，并于脾则畏，并于肾则恐。”又说：“阳入之阴则静，阴出之阳则怒。”又《素问·调经论》说：“神有余则笑不休，神不足则悲。”又说：“血有余则怒，不足则恐。”又《灵枢·行针》篇说：“多阳者多喜，多阴者多怒。”又《素问·解精微论》说：“水之精为志，火之精为神。水火相感，神志俱悲，是以目之水生也。故谚言曰：心悲名曰志悲。”又《灵枢·本神》篇说：“肝藏血，血舍魂。肝气虚则恐，实则怒。”又说：“心藏脉，脉舍神。心气虚则悲，实则笑不休。”又《玉机真脏论》说：“春脉太过，则令人善怒。”又《素问·脉解》篇说：“阳明所谓甚则厥，恶人与火，闻木音则惕然而惊者，阳气与阴气相薄，水火相恶，故惕然而惊也。”又说：“少阴所谓恐如人将捕之者，秋气万物未有毕去，阴气少，阳气入，阴阳相薄，故恐也。”又说：“肝气当治而未得，故善怒。善怒者，名曰煎厥。”又《灵枢·根结》篇说：“厥阴为阖，阖折即气绝而喜悲。”又《素问·缪刺》篇说：“邪客于足少阴之络，令人无故善怒，气上走贲上。”又《素问·生气通天论》说：“俞气化薄，传为善畏，及为惊骇。”又《灵枢·五变》篇说：“此人薄皮肤而目坚固以深者，长冲直扬。其心刚，刚则多怒，怒则气上逆。胸中蓄积，血气逆留，髋皮充肌，血脉不行，转而为热。热则消肌肤，故为消瘅，此言其人暴刚而肌肉弱者也。”又《素问·痹论》说：“心痹者，脉不通，烦则心下鼓，暴上气而喘，嗌干善噫，厥气上则恐。”又说：“肝痹，夜卧则惊。”这些都属于情生于病。所以病生于情志的，治疗其情志，如喜胜悲，悲胜怒之类。情生于疾病的，治疗其疾病，如平肝怒解，温胆悸宁之类。外因之邪自表而入。当其在表，正气应之，其脉必浮。若见沉脉，邪已去表而入里了。若脉不及四至，名叫迟。迟则邪在阴分，主冷。超过四至，名叫数。数则邪在阳分，主热。内因之邪，自内而生，如暴喜、卒惊。暴怒阳气浮越，脉应之而浮，其中必虚。如现在的暴怒蹶仆、卒惊晕倒、大喜伛痛如中风状，而非外来之风，这就是所谓的虚风。若忧思悲恐，久积沉郁，脉应之而沉，因为没有虚浮风象，所以直指为气。迟则主冷。若脉迟，不论因于何气，皆主冷也。数则主热。若脉数，不论因于何气，皆主热也。数皆主热。若浮而得之，不论何因，其热在表。沉而得之，其热在里。迟既主冷，若浮而得之，不论何因，其冷在表而虚。沉而得之，其冷在里而结。外因之表里阴阳，内因之风气冷热，非参以脉，则不能分别。然而脉理浩繁，能提括其纲，自可条析其目，但以浮沉迟数四者而触类焉。则引彼可以证此，申此可以例彼，而诊家之精义，思过半矣。
Regulate one's own breathing, using a complete breath cycle (one inhalation and one exhalation) as the standard unit. Between four and five pulse beats per breath cycle is the criterion for a harmonious pulse.
Three beats per breath cycle is called a *Chi* (Slow) pulse; a Slow pulse indicates Cold. Six beats per breath cycle is called a *Shu* (Rapid) pulse; a Rapid pulse indicates Heat.
The slower the pulse, the more severe the Cold; the faster the pulse, the more severe the Heat. Once the relationship between Slow/Rapid pulses and Cold/Heat is clear, one must then distinguish between Floating (*Fu*) and Sinking (*Chen*) pulses.
When a physician visits a patient, they should sit quietly for a moment. First, regulate their own breathing to ensure it is even, and only then palpate the patient's pulse. (*Suwen: Pingren Qixiang Lun* states: "Generally, use a healthy person to compare with the patient. Since the physician is not ill, use the physician's calm breathing to adjust and measure.") Approximately, obtaining four to five pulse beats from the patient during one of the physician's breath cycles serves as the standard. (Since occasional deep sighs occur in breathing, the beat count fluctuates between four and five.) This constitutes a Harmonious pulse, indicating no disease. Even if there is illness, it is extremely mild and superficial, because the pulse has not undergone pathological change. (The pathogenic factor is slight and cannot alter the normal pulse.) If there are only three beats per breath cycle, fewer than four or five, this is named a Slow pulse. A Slow pulse signifies that Qi is cold and its movement is slow; thus, the disease is primarily Cold. If there are six beats per breath cycle, exceeding four or five, this is named a Rapid pulse. A Rapid pulse signifies that Qi is hot and its movement is fast; thus, the disease is primarily Heat. If the pulse becomes even slower, falling below three beats, the Cold condition becomes more severe. If the pulse becomes even faster, rising above six beats, the Heat condition becomes more severe. This reflects the correspondence between Slow/Rapid pulses and diseases. Once Slow/Rapid and Cold/Heat are clarified, the nature of Cold and Heat is determined. To know the location of Cold and Heat, one must further distinguish between Floating and Sinking pulses.
Floating, Sinking, Slow, and Rapid pulses are used to differentiate Exogenous (External) and Endogenous (Internal) causes. Exogenous causes originate from Heaven (Nature); Endogenous causes originate from Human beings (Emotions).
Heaven has Yin and Yang, manifesting as wind, rain, darkness, and brightness; Humans have Joy, Anger, Worry, Thought, Sorrow, Fear, and Fright.
An Exogenous cause resulting in a Floating pulse indicates a Exterior syndrome. Sinking indicates Interior; Slow indicates Yin (Cold); Rapid indicates Yang (Heat).
An Endogenous cause resulting in a Floating pulse is caused by Deficient Wind. Sinking indicates Qi stagnation; Slow indicates Cold; Rapid indicates Heat—what doubt could there be?
Floating combined with Rapid indicates Exterior Heat; Sinking combined with Rapid indicates Interior Heat; Floating combined with Slow indicates Exterior Deficiency; Sinking combined with Slow indicates Cold accumulation in the Interior.
Exterior/Interior, Yin/Yang, Wind/Qi, Cold/Heat are distinguished by analyzing internal and external causes, cross-referencing pulse and symptoms.
Although pulse theory is vast, it can be summarized into these four categories. Having established this outline, one can extend it and apply it by analogy.
Pulse at the Exterior manifests as Floating; Pulse at the Interior manifests as Sinking. Slow indicates Cold; Rapid indicates Heat. This is an immutable principle, but there are two origins. This is why Internal and External causes must be distinguished. Exogenous pathogens (Six Evils) arise from natural climate changes; Endogenous injuries (Seven Emotions) arise from human emotional activities. The "Six Evils" refer to the Yin and Yang of heaven, specifically wind, rain, darkness, and brightness. As Yi He stated in *Zuo Zhuan*: "Excessive Yin leads to Cold diseases; excessive Yang leads to Heat diseases; excessive Wind leads to diseases of the extremities; excessive Rain leads to abdominal diseases; excessive Darkness leads to confused mental disorders; excessive Brightness leads to Heart diseases." "Yin" here refers to excess deviation, persisting without returning to balance. Thus, excessive Yin leads to excessive coldness, preventing Yang Qi from functioning normally, giving rise to Cold diseases, such as reversal coldness in the limbs and chills throughout the body. Excessive Yang leads to excessive heat, preventing Yin Qi from functioning normally, giving rise to Heat diseases, such as mania, delirium, restlessness, thirst, bleeding, and oozing. Excessive Wind leads to excessive agitation, causing diseases in the extremities, such as limb paralysis, hair loss, and convulsions. Excessive Rain leads to excessive dampness/water, causing diseases in the intestines and abdomen, such as abdominal fullness, swelling, borborygmus, and watery diarrhea. Excessive Darkness leads to the internal depression of sunlight, forming confused disorders, such as Baihe disease, Huhuo disease, and internal dryness-heat. Excessive Brightness leads to the external dispersion of sunlight, forming Heart diseases, such as mental fogginess, palpitations, confusion, and loss of spirit. The Seven Emotions are Joy, Anger, Worry, Thought, Sorrow, Fear, and Fright, also known as the Seven Qi. Chao Yuanfang's *Zhubing Yuanhou Lun* replaced Fright with Labor Qi and added Cold and Heat Qi, expanding it to Nine Qi. If matched with the Four Seasons and Five Zang organs, only Five Qi are discussed. As *Suwen: Yin-Yang Yingxiang Dalun* states: "Heaven has Four Seasons and Five Elements, which govern growth, flourishing, harvesting, and storage, generating Cold, Heat, Dryness, Dampness, and Wind. Humans have Five Zang organs, which transform into Five Qi, generating Joy, Anger, Sorrow, Worry, and Fear." According to Chao's description of the Nine Qi: Anger causes Qi to ascend; Joy causes Qi to relax; Sorrow causes Qi to dissipate; Fear causes Qi to descend; Cold causes Qi to gather/constrict; Heat causes pores to open and Qi to leak; Worry causes Qi to become chaotic; Labor causes Qi to be exhausted; Thought causes Qi to knot/stagnate. Anger causing Qi to ascend means anger leads to Qi rebellion; severely, it causes vomiting of blood and food, hence Qi ascends. Joy causing Qi to relax means joy leads to harmonious Qi, allowing Ying and Wei to flow freely, hence Qi relaxes. Sorrow causing Qi to dissipate means sorrow tightens the Heart connection and raises Lung lobes, blocking the Upper Jiao, preventing Ying and Wei from dispersing, trapping Heat inside, hence Qi dissipates. Fear causing Qi to descend means fear causes Essence to retreat; retreat of Essence blocks the Upper Jiao; blockage causes Qi to return; return causes Lower Jiao distension, hence Qi descends. Cold causing Qi to gather means cold causes meridians to become sluggish, hence Qi gathers. Heat causing Qi to leak means heat opens pores and collaterals, allowing Ying and Wei to flow, hence sweat occurs and Qi leaks. Worry causing Qi to chaos means worry leaves the Heart without support and Spirit without refuge, leading to unsettled thoughts, hence Qi becomes chaotic. Labor causing Qi to exhaust means labor causes panting and sweating, internal movement and external leakage, hence Qi is exhausted. Thought causing Qi to knot means thought fixes the mind and body, causing Qi to remain and not move, hence Qi knots. These are the Nine Qi, within which the Seven Qi are included. Although all are endogenous, pathology arises in two ways. One type arises from emotional triggers where Qi fails to disperse over time, attaching to form disease; disease originates from emotion. The other type arises from the waxing and waning of Five Elements and the deficiency/excess of Five Zang organs, interacting through mutual overcoming and restitution, where emotions appear as symptoms of disease; emotion originates from disease. Disease originating from emotion is described in *Suwen: Yin-Yang Yingxiang Dalun*: "Joy and Anger injure Qi; Cold and Heat injure Form. Violent anger injures Yin; violent joy injures Yang. Reversal Qi moves upward, filling the vessels and separating from form. Unregulated joy and anger, excessive cold and heat, lead to unstable life." It also states: "The East generates Wind, associated with shouting, movement involving grasping, and the emotion of Anger. Anger injures the Liver; Sorrow overcomes Anger. The South generates Heat, associated with laughter, movement involving Worry, and the emotion of Joy. Joy injures the Heart; Fear overcomes Joy. The Center generates Dampness, associated with singing, movement involving hiccups, and the emotion of Thought. Thought injures the Spleen; Anger overcomes Thought. The West generates Dryness, associated with crying, movement involving coughing, and the emotion of Worry. Worry injures the Lungs; Joy overcomes Worry. The North generates Cold, associated with groaning, movement involving shivering, and the emotion of Fear. Fear injures the Kidneys; Thought overcomes Fear." *Lingshu: Kouwen* states: "All diseases begin from wind, rain, cold, heat, Yin-Yang, joy, anger, diet, and living conditions. Great fright or sudden terror causes separation of Blood and Qi, disruption of Yin and Yang, cessation of meridians, and obstruction of vessel pathways. Yin and Yang reverse, Wei Qi stagnates, meridians become empty, Blood and Qi lose order, losing normalcy." *Suwen: Yuji Zhenzang Lun* states: "Worry, fear, sorrow, joy, and anger, if not occurring in proper sequence, cause major diseases. Excessive joy leads to great deficiency, allowing Kidney Qi to invade; excessive anger allows Liver Qi to invade; excessive sorrow allows Lung Qi to invade; excessive fear allows Spleen Qi to invade; excessive worry allows Heart Qi to invade." *Lingshu: Benshen* states: "Trepidation and thought injure Shen (Spirit); injured Shen leads to fear and involuntary discharge. Deep sorrow moving the center exhausts life force. Excessive joy scatters Shen, preventing it from storing. Sorrow and worry close Qi, preventing circulation. Extreme anger causes confusion and loss of control. Fear causes Shen to be agitated and unable to gather. Trepidation and thought injure Shen; injured Shen leads to self-loss of fear, muscle wasting, and flesh detachment. Chronic worry injures Yi (Intellect); injured Yi leads to confusion and inability to lift the limbs. Deep sorrow moving the center injures Hun (Ethereal Soul); injured Hun leads to madness, forgetfulness, lack of essence, penile retraction, tendon contraction, and inability to raise the costal margins. Limitless joy injures Po (Corporeal Soul); injured Po leads to madness and scorched skin/flesh. Unchecked extreme anger injures Zhi (Willpower); injured Zhi leads to forgetting previous words and inability to bend/extend the waist and spine. Unresolved fear injures Jing (Essence); injured Jing leads to bone萎 (atrophy/coldness) and spontaneous seminal emission." *Suwen: Tiaojing Lun* states: "Unregulated joy and anger cause Yin Qi to rebel upward. Upward rebellion causes lower deficiency; lower deficiency draws Yang Qi, resulting in Excess. Joy causes Qi to sink; sorrow causes Qi to dissipate, leaving vessels empty. Cold food/drink causes cold qi to fill, condensing blood and driving away Qi, resulting in Deficiency." *Suwen: Weilun*, Qibo states: "Excessive sorrow severs the Bao Luo (Pericardium Collaterals); severed Bao Luo causes internal movement of Yang Qi. This manifests as subcardiac hemorrhage and frequent bloody urination." It also states: "Endless thinking and unfulfilled desires, with intent wandering externally, plus excessive sexual activity, cause flaccidity of the Zong Jin (Major Tendons), leading to Sinew Atrophy and white discharge." *Suwen* Apocrypha states: "Sorrow and thought injure the Heart. Resentment and anger causing upward rebellion without descending injure the Liver." *Lingshu: Xieqi Zangfu Binxing* states: "Worry, sorrow, and fear injure the Heart." *Lingshu: Kouwen* states: "Mouth and nose are portals of Qi. Thus, sorrow and worry move the Heart; moved Heart shakes all Zang and Fu organs; shaken Zang/Fu affect the Zong Mai (Great Vessels); affected Zong Mai open fluid pathways; opened fluid pathways produce tears and mucus." *Shouyao Gangrou* states: "Worry, fear, and anger injure Qi. Injured Qi injures Zang, leading to Zang disease." *Suwen: Xueqi Xingzhi* states: "Comfortable body but distressed mind leads to vessel disease. Comfortable body and mind leads to flesh disease. Hardship in body and mind leads to throat disease. Frequent fear and fright leads to unblocked meridians and numbness/insensitivity disease." *Suwen: Shuwulun* states: "Once noble, now humble; though not struck by evil, disease arises internally, named Tuoying (Depletion of Ying). Once rich, now poor; named Shijing (Loss of Jing), with Five Qi lingering and diseases combining. Violent joy/sorrow, initial joy followed by sorrow, all injure Jing Qi. Exhausted Jing Qi destroys the form. Violent anger injures Yin; violent joy injures Yang. Reversal Qi moves upward, filling vessels and separating from form. Ignorant physicians do not know tonification/reduction or the condition. Essence depletes daily, pathogenic factors combine." It also states: "Loss of status for the noble, though not struck by evil, causes internal spiritual injury, leading to physical collapse. Initial wealth followed by poverty, though not injured by evil, causes scorched skin, contracted tendons, atrophy, and contracture." *Suwen: Shengqi Tongtian Lun* states: "Yang Qi: Great anger causes form and Qi to sever, with blood pooling above, causing Bojue (Thin Jue)." *Tongping Xushi Lun* states: "Obstruction and closure, upper and lower不通 (blockage), is a disease of violent anger." *Lingshu: Cijie Zhenxie* states: "Irregular diet and untimely emotions cause internal overflow of Jin Ye (Body Fluids), accumulating in the testes." *Suwen: Jingmai Belun* states: "Falling and fear cause panting from the Liver, with excessive Qi harming the Spleen. Fright and terror cause panting from the Lungs, with excessive Qi harming the Heart. Fright steals Jing, causing sweating from the Heart. Running fast in fear causes sweating from the Liver. All these are diseases born from emotion." Disease originating from emotion includes: *Suwen: Jin Gui Zhenyan Lun* states: "East, color Green, enters through the Liver, opens to the Eyes, stores Essence in the Liver, disease manifests as fright/terror." *Suwen: Tiaojing Lun* states: "Blood congregating in Yin, Qi congregating in Yang, leads to fright and mania. Blood congregating above, Qi below, leads to heart vexation and irritability. Blood below, Qi above, leads to confusion and forgetfulness." *Xuanming Wuqi* states: "Stomach causes Qi rebellion, hiccups, and fear. Gallbladder causes anger. Congregation of Essence/Qi in Heart brings Joy; in Lungs brings Sorrow; in Liver brings Worry; in Spleen brings Timidity; in Kidneys brings Fear. Yang entering Yin brings stillness; Yin exiting Yang brings anger." *Suwen: Tiaojing Lun* states: "Excess Shen leads to incessant laughter; deficient Shen leads to sorrow. Excess Blood leads to anger; deficient Blood leads to fear." *Lingshu: Xingzhen* states: "Those with much Yang are prone to joy; those with much Yin are prone to anger." *Suwen: Jiejingwei Lun* states: "Water's essence is Zhi; Fire's essence is Shen. Water and Fire interact; when Shen and Zhi are both sorrowful, water comes from the eyes. Hence the proverb: Heart sorrow is called Zhi sorrow." *Lingshu: Benshen* states: "Liver stores Blood, Blood houses Hun. Liver Qi deficiency causes fear; excess causes anger. Heart stores Mai (Vessels), Mai houses Shen. Heart Qi deficiency causes sorrow; excess causes incessant laughter." *Yuji Zhenzang Lun* states: "Spring pulse excessive leads to irritability." *Suwen: Maimie* states: "Yangming... severe cases involve Jue, aversion to people/fire, startle at wood sounds due to thinning of Yang and Yin, conflict of Water and Fire. Shaoyin... fear as if being chased, autumn Qi not fully gone, little Yin, Yang entering, conflict of Yin and Yang causes fear. Liver Qi failing to resolve leads to anger, named Jianjue (Boiling Jue)." *Lingshu: Genjie* states: "Jueyin is Closing; if Closing breaks, Qi ceases and sadness appears." *Suwen: Misian* states: "Pathogen in Foot Shaoyin collateral causes unprovoked anger, Qi moving upward to Fen Shang." *Suwen: Shengqi Tongtian Lun* states: "Shu Qi transformation pressing inward transmits to fear and fright." *Lingshu: Wubian* states: "Person with thin skin and deep, firm eyes, straight flowing hair. Rigid heart, rigid leads to anger, anger causes Qi rebellion. Accumulation in chest, reversed Qi and Blood stagnate, muscles swell, vessels blocked, transforming into Heat. Heat consumes flesh, causing Xiao Dao (Wasting-Thirst), describing someone violently rigid with weak muscles." *Suwen: Bilun* states: "Heart Bi, vessels blocked, vexation causes subcardiac pounding, sudden upward Qi and panting, dry throat, frequent belching, reversal Qi upward causes fear. Liver Bi, waking at night with fright." These are emotions born from disease. Therefore, disease born from emotion treats the emotion (e.g., Joy overcomes Sorrow, Sorrow overcomes Anger). Emotion born from disease treats the disease (e.g., Calming Liver resolves anger, Warming Gallbladder calms palpitations). Exogenous pathogens enter from the Exterior. When at the Exterior, Righteous Qi responds, pulse must be Floating. If Sinking pulse appears, pathogen has left Exterior and entered Interior. If pulse is less than four beats, it is named Slow. Slow indicates pathogen in Yin division, main sign is Cold. Over four beats, named Rapid. Rapid indicates pathogen in Yang division, main sign is Heat. Endogenous pathogens arise internally, e.g., sudden joy, abrupt fright. Sudden anger causes Yang Qi to float outward; pulse responds with Floating, indicating underlying Deficiency. Like sudden anger causing fainting, abrupt fright causing collapse, excessive joy causing stooping/pain resembling stroke—not external Wind, this is what is called Deficient Wind. If worry, thought, sorrow, fear accumulate deeply over time, pulse responds with Sinking, lacking Deficient Wind signs, so it is directly pointed to as Qi [stagnation]. Slow indicates Cold. Regardless of the Qi involved, a Slow pulse always indicates Cold. Rapid indicates Heat. Regardless of the Qi involved, a Rapid pulse always indicates Heat. Rapid always indicates Heat. If Floating, regardless of cause, Heat is in the Exterior. If Sinking, Heat is in the Interior. Slow indicates Cold. If Floating, regardless of cause, Cold is in the Exterior and Deficient. If Sinking, Cold is in the Interior and Knotting. Exogenous Exterior/Interior Yin/Yang and Endogenous Wind/Qi Cold/Heat cannot be distinguished without reference to the pulse. However, although pulse theory is vast, grasping the outline allows detailed analysis. By applying the four [Floating, Sinking, Slow, Rapid] by analogy, one can prove one point by another, exemplify one by another, and the profound meaning of pulse diagnosis will be more than half understood.