弦脉主饮，病属胆肝。弦数多热，弦迟多寒。
浮弦支饮，沉弦悬痛。阳弦头痛，阴弦腹痛。
夫饮入于胃，必阳气为之游溢输布。脏腑受其灌溉，形体赖其濡滋。若阳运之
力薄，则不能游溢输布，停留于中，而饮之诸证起矣。其脉弦者，弦为阴脉，敛束
急直，无抑扬鼓动之势，正阳运之不足也。若非有饮而见弦脉，病又当在胆与肝耳。
盖胆为甲木，肝为乙木。自北而东，在肝为厥阴而阴尽，在胆为少阳而阳微。初春
之象，逗气尚少，升如一缕，有弦义焉。数则为热，弦而兼数者，病亦兼热。迟则
为寒，弦而兼迟者，病亦兼寒。弦则为饮。弦而浮，则饮停在上，名曰支饮。支者，
支分之义，不在胃而支留于心胸间也。（宜仲景苓桂术甘汤、小青龙汤、和剂倍术丸、破饮丸、六
君子汤、仲景泽泻汤、海藏五饮汤之类。）弦而沉，则饮停在下，当为悬痛。悬者，悬阁之义，不在胃，
而悬留于腹胁间也。以寒饮而留于阴分，故在内痛。（宜济生八神来复丹、三因控涎丹之类。）弦
脉不但主饮，而又主痛者，以弦寒敛束，气不舒之故耳。阳弦者，寸弦也。邪在三
阳，三阳走头，故头痛。（宜玄珠茶调散、半夏白术天麻汤、仲景吴茱萸汤之类。）阴弦者，尺弦也。邪
在三阴，三阴走腹，故腹痛。（宜仲景小建中汤、香砂理中汤、东垣浓朴汤、仲景四逆汤之类。）
弦脉主要主司水饮病，病变部位属于胆经和肝经。弦脉兼数脉，多表示有热；弦脉兼迟脉，多表示有寒。
浮取见弦脉，是支饮（水饮停聚胸膈）的表现；沉取见弦脉，是悬痛（水饮停聚腹胁引起的疼痛）的表现。寸部见弦脉（阳弦），会导致头痛；尺部见弦脉（阴弦），会导致腹痛。
大凡水饮进入胃中，必须依靠阳气的蒸腾气化作用来游溢并输布全身。脏腑受到它的灌溉，形体依赖它的濡润滋养。如果阳气运化的力量薄弱，就不能进行游溢输布，导致水饮停留于中焦，于是各种水饮病的症状就产生了。出现弦脉的原因在于：弦脉属于阴脉，其形态敛束、急迫、直挺，没有起伏鼓动的态势，这正是阳气运化不足的表现。如果不是因为水饮而见到弦脉，那么疾病又应当发生在胆与肝。
这是因为胆属甲木，肝属乙木。从方位上看，自北向东，在肝脏表现为厥阴经，是阴气之尽；在胆腑表现为少阳经，是阳气微弱。这就像初春的景象，萌发的生气还很少，升发之气仅如一丝一缕，具有“弦”的意象。脉数则表示热，弦脉兼见数脉，病情也就兼夹热邪。脉迟则表示寒，弦脉兼见迟脉，病情也就兼夹寒邪。弦脉主水饮。弦脉且浮，说明水饮停聚在上部，称为支饮。“支”的意思是分支、支撑，指水饮不在胃中，而是支撑留滞于心胸之间。（适宜使用张仲景的苓桂术甘汤、小青龙汤，以及《太平惠民和剂局方》的倍术丸、破饮丸、六君子汤，张仲景的泽泻汤，李东垣/王海藏的五饮汤等方剂。）
弦脉且沉，说明水饮停聚在下部，应当表现为悬痛。“悬”的意思是悬挂、搁置，指水饮不在胃中，而是悬挂留滞在腹胁之间。因为寒性水饮留滞在阴分，所以会在体内产生疼痛。（适宜使用《济生方》的八神来复丹，《三因极一病证方论》的控涎丹等方剂。）
弦脉不仅主水饮，而且主疼痛，是因为弦脉带有寒性，使气机敛束，导致气机不能舒展的缘故。所谓“阳弦”，是指寸口脉弦。邪气在三阳经，三阳经循行走向头部，所以引起头痛。（适宜使用《玄珠密语》的茶调散，半夏白术天麻汤，张仲景的吴茱萸汤等方剂。）所谓“阴弦”，是指尺部脉弦。邪气在三阴经，三阴经循行走向腹部，所以引起腹痛。（适宜使用张仲景的小建中汤，香砂理中汤，李东垣的浓朴汤，张仲景的四逆汤等方剂。）
The *Xian* (Wiry) pulse primarily indicates fluid retention (*Yin*), with the pathology belonging to the Gallbladder and Liver channels. A *Xian* pulse combined with a rapid (*Shuo*) pulse suggests excess heat; a *Xian* pulse combined with a slow (*Chi*) pulse suggests excess cold.
A floating *Xian* pulse indicates *Zhi Yin* (Supporting Fluid, fluid retention in the chest and diaphragm); a deep *Xian* pulse indicates *Xuan Tong* (Hanging Pain, pain caused by fluid retention in the abdomen and hypochondrium). An *Yang Xian* (superficial/cun position wiry pulse) leads to headache; an *Yin Xian* (deep/chest position wiry pulse) leads to abdominal pain.
Generally, when fluids enter the Stomach, they must be vaporized and distributed throughout the body by the power of Yang Qi. The Zang-Fu organs receive its irrigation, and the physical form relies on its moistening nourishment. If the power of Yang transformation is weak, it cannot vaporize and distribute the fluids, causing them to stagnate in the middle jiao, thereby giving rise to various symptoms of fluid retention. The reason for the appearance of a *Xian* pulse is that the *Xian* pulse is a Yin pulse; its morphology is constrictive, tense, and straight, lacking the dynamic surge and decline of Qi movement, which precisely reflects the insufficiency of Yang transformation. If a *Xian* pulse appears without fluid retention, the pathology should lie within the Gallbladder and Liver.
This is because the Gallbladder belongs to Jia Wood, and the Liver belongs to Yi Wood. Geographically, moving from North to East, in the Liver it manifests as the Jueyin channel, where Yin reaches its end; in the Gallbladder it manifests as the Shaoyang channel, where Yang is weak. This resembles the imagery of early spring: the sprouting Qi is still scant, rising like a single thread, possessing the meaning of "wiry" (tense). Rapidness indicates heat; a *Xian* pulse combined with rapidness implies the pathology also involves heat. Slowness indicates cold; a *Xian* pulse combined with slowness implies the pathology also involves cold. The *Xian* pulse indicates fluid retention. A *Xian* pulse that is floating indicates fluid retention in the upper jiao, termed *Zhi Yin*. "Zhi" means branching or supporting; it indicates that the fluid is not in the Stomach but is supported and retained between the Heart and the chest. (Appropriate formulas include Ling Gui Zhu Gan Tang [Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction] by Zhang Zhongjing, Xiao Qing Long Tang [Minor Green Dragon Decoction] by Zhang Zhongjing, Bei Shu Wan [Double Atractylodes Pill] and Po Yin Wan [Fluid-Breaking Pill] from the *Taiping Huimin Heji Jufang*, Liu Jun Zi Tang [Six Gentlemen Decoction] by Zhang Zhongjing, Ze Xie Tang [Alisma Decoction] by Zhang Zhongjing, and Wu Yin Tang [Five Fluids Decoction] by Wang Haizhang/Li Dongyuan.)
A *Xian* pulse that is deep indicates fluid retention in the lower jiao, which should manifest as *Xuan Tong*. "Xuan" means hanging or suspended; it indicates that the fluid is not in the Stomach but is suspended and retained between the abdomen and hypochondrium. Because cold-fluid remains in the Yin divisions, pain occurs internally. (Appropriate formulas include Ba Shen Lai Fu Dan [Eight Spirits Revival Pill] from the *Jisheng Fang* and Kong Xian Dan [Phlegm-Draining Pill] from the *Sanyin Ji Yi Bing Zheng Fang Lun*.)
The *Xian* pulse not only indicates fluid retention but also pain, because the *Xian* pulse carries cold qualities that constrict the Qi, preventing its free flow. "Yang Xian" refers to a wiry pulse at the Cun (inch) position. Pathogens in the Three Yang channels travel to the head, thus causing headache. (Appropriate formulas include Cha Tiao San [Tea-Powdering Powder] from the *Xuanzhu Mi Yu*, Ban Xia Bai Zhu Tian Ma Tang [Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction], and Wu Zhu Yu Tang [Evodia Decoction] by Zhang Zhongjing.) "Yin Xian" refers to a wiry pulse at the Chi (cubit) position. Pathogens in the Three Yin channels travel to the abdomen, thus causing abdominal pain. (Appropriate formulas include Xiao Jian Zhong Tang [Minor Construct the Middle Decoction] by Zhang Zhongjing, Xiang Sha Li Zhong Tang [Costus and Amomum Regulate the Middle Decoction], Nong Po Tang [Thick Magnolia Bark Decoction] by Li Dongyuan, and Si Ni Tang [Four Counterflow Decoction] by Zhang Zhongjing.)