脉得四时之顺，曰病无他；脉反四时，曰病难已。春夏而脉瘦，小也。秋冬而
脉浮大，曰逆四时。春得秋脉，夏得冬脉，长夏得春脉，秋得夏脉，冬得长夏脉，
命死不治。春不沉，（春脉宜弦，然春初尤带冬沉，今但弦不沉也。余仿此。）夏不弦，秋
不数，冬不涩，是谓四塞。（为病脉。）沉甚、弦甚、数甚、涩甚，曰病，参见曰病，复
见曰病，未去而去曰病，去而不去曰病，反者死。
按脉与时违，须问有病无病。无病而得此，诚为可虞。（无病何因脉变，非无病也。不见
其病耳，如受蠹之木，如磨刀之石，不见其损，日有所亏，不无枝叶未坏，本实先拨之忧耳。）若因病而致，
不过难治，非必死也。（如秋月病热，脉得浮洪，为脉证相合，宁可断为必死乎？）
形盛脉细，少气不足以息者危。形瘦脉大，胸中多气者死。（经又云∶形气有余，脉气
不足死。脉气有余，形气不足生。当参看。）形气相得者生，参伍不调者病，三部九候皆相失者
（失常）死。上下左右相应如参舂，（此来彼去，如参舂者之彼起此落也。）不可数者死。中部独调。
（中部在手，即寸口。）众脏相失者死。（上部在头，下部在足，所候各脏若失常，中虽调亦死。）中部独减者
死。（上下部虽调，而中部独衰减亦死。）
脉从阴阳，（谓阳病见阳脉，阴病见阴脉也。）病易已。逆阴阳，病难已。脉从而病反者何
如？曰∶脉至而从，按之不鼓，诸阳皆然。（阳证见阳脉，为脉至而从矣。然使按之无力，不能鼓
指，便非真阳证，不可作热治。凡诸脉之似阳非阳者，皆然也。）诸阴之反何如？曰∶脉至而从，按之
鼓甚而盛也。（阴证虽见阴脉，然鼓指有力，则亦非阴。）热病，汗出而脉尚躁盛者死。（温病时疫，皆以
数盛有力为顺，细小无力为逆，汗后脉静身凉为顺，脉仍躁、身仍热为逆。）风热而脉静，泄、脱血而脉实，
病在中。（邪内结也。）脉虚，病在外。（外感也。）脉涩坚，皆难治。（以上皆经语。）诸卒仆暴厥证，
（旧名中风，张景岳易名非风。）皆元气素亏，故尔卒倒，不省人事，脉宜小弱，不宜数盛。中
毒宜浮大数实，（浮则毒尚活动，可行散。）不宜微细虚涩。（正被毒伤矣。）劳倦伤，脉以虚大弱缓
为顺，紧数大汗出，热不止者死。饮食伤，以滑大为顺。若胃停生冷则兼紧。霍乱
吐利后，搏大者逆，太微迟者逆。（未吐利前，脉伏或歇至，不妨，以气滞不行也。吐利后脉歇亦不妨，
以气暴虚，不能接续也。）噎膈，脉浮滑而大便润者顺，（不过痰气阻逆。）数弦涩，大便燥结者死。
（气血枯结也。）肿胀，宜浮大有力，忌短涩虚细。肺痿，虚数为顺。肺痈，过于洪
数者逆，已溃宜缓滑。失血证，脉宜虚弱，弦实数者逆，加以身热不得卧，必死。
蓄血？脉实大可攻，为顺。痢疾为里证，宜沉，恶浮与发热，（久痢，虚阳外越也。若初病
兼表邪者，不在此论。）宜缓细有神，恶强弦。头目痛，脉浮滑，为风痰上攻，可治。短涩
为血虚火逆，难治。卒视无所见者死。（清阳失守，邪火僭逆于上也。）瘕疝积聚之类，沉
实有力可治，虚弱者死。癫狂宜滑大，忌涩小。痈疮未溃，浮滑数大为顺，沉细迟涩
者逆。痉病，浮弦为阳，沉紧为阴，然过于坚强者不治。胎脉宜和滑流利，忌虚涩。
新产及崩漏宜缓弱，忌弦数。大抵新病阳病，凡属邪气有余之证，法当攻伐者，
须见盛大有余之脉，乃可受攻。若见细微不足之脉，则邪盛正衰，攻邪恐伤乎正。
仲景谓阳病见阴脉者死，虽未尽然，然亦难为力矣。久病阴病，凡属正气不足之证，
法当培补者，须见虚弱不足之脉，乃可受补。补之而脉之弱者渐大，虚者渐充，是
阴脉转为阳脉，此仲景所谓阴病见阳脉者生也。若见强实有余之脉，则土败木贼，
任补不应，或反以助邪，不可救矣。（凡败证脉脱，治后脉气以渐生复为佳。若陡然而出，如复元者
必复脱不可救矣。此灯将灭而复明之义也。）再按阳病而得盛大之脉，须察其胃气之虚实，必盛
大而和缓，方任攻伐。若弦多胃少，或形气不足，俱不可攻。若 瘕积聚，脉本带
弦，亦须看弦中胃气仍在，且形气未损，又处不得不攻之势，方可议攻。病去
六七即已，所谓大积大聚，衰其大半而止也。
脉象顺应四时变化，称为“顺”，表示病情没有其它隐患；脉象违背四时变化，称为“逆”，表示疾病难以痊愈。春夏季节脉象瘦小（指脉形细小），秋冬季节脉象浮大，这叫做违背四时规律。春季出现秋季的脉象（毛脉/涩脉），夏季出现冬季的脉象（石脉/沉脉），长夏（季夏）出现春季的脉象（弦脉），秋季出现夏季的脉象（钩脉/洪脉），冬季出现长夏的脉象（缓脉），这是死证，无法治疗。春季脉象不沉（春脉宜弦，但初春尚带冬令之沉意，若只有弦而无沉意），夏季脉象不弦，秋季脉象不数（疾），冬季脉象不涩，这叫做“四塞”（即病脉闭塞不通）。沉脉太过、弦脉太过、数脉太过、涩脉太过，都主病；兼见其他脉象主病；复见本脏脉主病；本脏脉未去而见他脏脉主病；他脏脉已去而本脏脉不去主病；脉象与季节完全相反者死。
诊察脉象若与时间（季节）相违，必须询问是否有病。如果没有生病却出现这种脉象，确实值得忧虑。（没有生病为何脉象会改变？并非真的无病，只是尚未显现出病症罢了，就像被虫蛀的树木、用来磨刀的石头，虽然看不见损伤，但每天都在亏损，难免有枝叶未坏、根本先断的担忧。）如果是因病导致的脉象变化，不过是难治，不一定是死证。（例如秋天患热病，脉象浮洪，这是脉证相符，怎么能断定必死呢？）
形体壮盛而脉象细弱，气短不足以呼吸的，属危证。形体消瘦而脉象盛大，胸中胀满多气的，属死证。（《内经》又说：形体和气有余，而脉气不足的，死；脉气有余，而形体和气不足的，生。应当参考对照。）形体与脉气相协调的，可生；参伍不调（参差不齐，不相协调）的，有病；三部九候（中医诊脉部位，泛指全身各处脉象）全部失常的，死。上下左右脉象相应，如同捣米杵那样此起彼落（指脉来急促无序，如参舂之状），次数不可数的，死。中部（寸口脉）独自调和，但众脏脉象失常的，死。（上部在头，下部在足，所候的各脏腑若失常，即使中部调和也会死。）中部脉独自衰减的，死。（上下部虽调和，而中部独衰减也会死。）
脉象从属于阴阳（谓阳病见到阳脉，阴病见到阴脉），病易愈。违背阴阳，病难愈。脉象看似顺从病情但实际上相反是怎么回事？答：脉象到来看似顺从，但重按之下不鼓指（无力），所有阳脉都是这样。（阳证见到阳脉，看似顺从。但如果重按无力，不能鼓动手指，便不是真正的阳证，不可当作热证治疗。凡是诸脉似阳非阳的，都是如此。）诸阴脉相反的情况怎么样？答：脉象到来看似顺从，但重按之下鼓指有力且盛大。（阴证虽见到阴脉，但如果鼓指有力，则也不是真正的阴证。）热病，汗出后脉象仍然躁动盛大的，死。（温病、时疫，都以脉数盛有力为顺，细小无力为逆；汗后脉静身凉为顺，脉仍躁动、身仍发热为逆。）风热病而脉象安静，泄泻、失血而脉象实大，这是病邪在内结聚。脉虚，是病邪在外（外感）。脉涩坚，都难治。（以上皆引自经典经文。）各种突然仆倒、暴厥的证候（旧称中风，张景岳改名为非风），都是元气素来亏虚，所以突然倒下，不省人事，脉象宜小弱，不宜数盛。中毒者脉象宜浮大数实（浮则说明毒邪尚活跃，可行散解毒），不宜微细虚涩（正气已被毒邪伤害）。劳倦损伤，脉象以虚大弱缓为顺，若见紧数、大汗出、热不止的，死。饮食损伤，脉象以滑大为顺。如果胃中停滞生冷食物，则脉象兼紧。霍乱吐利之后，脉象搏动大的为逆，过于微弱迟缓的也为逆。（未吐利之前，脉伏或歇止，不妨碍，因为气滞不行。吐利之后脉象歇止也不妨碍，因为气暴虚，不能接续。）噎膈（吞咽困难），脉浮滑而大便润通的为顺（不过是痰气阻逆），脉数弦涩、大便燥结的死（气血枯结所致）。肿胀病，宜脉浮大有力，忌短涩虚细。肺痿，脉虚数为顺。肺痈，脉过于洪数的为逆，已经溃破宜脉缓滑。失血证，脉宜虚弱，若见弦实数者为逆，加上身体发热不能卧睡的，必死。蓄血证，脉实大可攻下，为顺。痢疾属里证，脉宜沉，恶见浮脉与发热（久痢，乃虚阳外越所致。若是初病兼有表邪者，不在此论），宜缓细有神，恶见强弦。头目痛，脉浮滑，为风痰上攻，可治。脉短涩为血虚火逆，难治。突然失明看不见的，死（清阳失守，邪火僭逆于上）。瘕疝积聚之类病，脉沉实有力可治，虚弱者死。癫狂病宜脉滑大，忌涩小。痈疮未溃，脉浮滑数大为顺，沉细迟涩者为逆。痉病，脉浮弦为阳证，沉紧为阴证，但如果脉过于坚强有力的，不治。胎脉宜和滑流利，忌虚涩。新产及崩漏（非经期大量出血）宜脉缓弱，忌弦数。大抵新病、阳病，凡属邪气有余的证候，法当攻伐的，须见到盛大有余的脉象，才可承受攻伐。如果见到细微不足的脉象，则是邪盛正衰，攻邪恐怕会伤及正气。张仲景说阳病见阴脉者死，虽然不完全如此，但也很难救治了。久病、阴病，凡属正气不足的证候，法当培补的，须见到虚弱不足的脉象，才可承受补益。补益之后，弱的脉渐大，虚的脉渐充，这是阴脉转为阳脉，这就是张仲景所说的阴病见阳脉者生。如果见到强实有余的脉象，则是土败木贼（脾胃衰败，肝木乘克），任其补益也不见效，或者反而助长邪气，不可救药了。（凡是败证脉脱，治疗后脉气逐渐恢复为佳。如果陡然出现，像复原一样，必定又会脱绝，不可救药。这是灯将灭而复明的道理。）再按：阳病而得到盛大的脉象，必须考察其胃气的虚实，必须盛大而和缓，才允许攻伐。如果弦多胃少，或形体气力不足，都不可攻。如果是瘕积聚，脉本来带弦，也必须看弦中是否仍有胃气，且形体气力未损，又处于不得不攻的形势，才可以议论攻下。病去六七成即可停止，所谓大积大聚，削弱大半就停止。
When the pulse conforms to the changes of the four seasons, it is called "Shun" (Conforming), indicating that there are no other hidden dangers in the disease; when the pulse goes against the changes of the four seasons, it is called "Ni" (Rebellious), indicating that the disease is difficult to cure. If the pulse is thin and small during Spring and Summer, and floating and large during Autumn and Winter, this is called going against the seasons. If a Mao (Hairy/Metal) pulse appears in Spring, a Shi (Stone/Kidney) pulse in Summer, a Xuan (Bowstring/Liver) pulse in Late Summer, a Hong (Surging/Heart) pulse in Autumn, and a Huan (Moderate/Spleen) pulse in Winter, these are fatal conditions that cannot be treated. In Spring, the pulse should not lack the sinking quality (Spring pulse should be Xuan, but early spring retains some winter sinking quality; if only Xuan without sinking, it is pathological); in Summer, it should not lack the surging quality; in Autumn, it should not be rapid; in Winter, it should not be choppy. This state is called "Si Sai" (Four Obstructions), meaning the pulse qi is blocked and is a pathological sign. Excessively deep, excessively wiry, excessively rapid, or excessively choppy pulses all indicate disease. The appearance of mixed pulses, repeated appearance of specific pulses, old pulses remaining while new ones appear, or new pulses disappearing while old ones remain, all indicate disease. Pulse-sign mismatch indicates death.
If the pulse contradicts the season, one must ask whether the patient has a disease. If there is no disease but such a pulse appears, it is indeed alarming. (Why would the pulse change without disease? It implies that disease exists but symptoms have not yet manifested. Like a tree infested with insects or a whetstone being worn down, although damage is not visible, daily erosion occurs, leading to the fear that the roots may fail before the branches break.) If the pulse change is caused by an existing disease, it is merely difficult to treat, not necessarily fatal. (For example, in autumn, a heat disease presenting with a floating and洪 [Hong/Surging] pulse indicates that the pulse matches the syndrome; how can this be declared inevitably fatal?)
A robust physique with a thin pulse, accompanied by shortness of breath and inability to breathe deeply, is critical. A emaciated physique with a large pulse, accompanied by chest fullness and excess qi, is fatal. (The Classic also states: Robust form and qi but deficient pulse qi leads to death; abundant pulse qi but deficient form and qi leads to survival. These should be consulted together.) When form and pulse qi are harmonious, life is preserved; when pulse qi is disordered and irregular, disease exists; when all three positions and nine examinations (Cun, Guan, Chi on both hands, plus head, hand, foot locations) show loss of harmony, death ensues. If pulses at upper/lower/left/right correspond like a pestle pounding rice (rising and falling alternately) but are too fast to count, death ensues. If only the Middle position (Cunkou/Wrist pulse) is harmonious but the pulses of the various organs are lost, death ensues. (Upper refers to head, lower to feet; if organ pulses are lost, even if the middle is harmonious, death occurs.) If only the Middle position pulse is diminished, death ensues. (Even if upper and lower are harmonious, isolated diminution of the middle pulse leads to death.)
Pulses that follow Yin and Yang (Yang diseases showing Yang pulses, Yin diseases showing Yin pulses) are easy to cure. Pulses that contradict Yin and Yang are difficult to cure. What does it mean when the pulse seems to conform to the disease but acts oppositely? It means the pulse arrives seemingly conforming, but upon pressing, it does not drum against the finger; this applies to all Yang pulses. (A Yang syndrome showing a Yang pulse seems conforming. However, if it lacks force upon pressure and does not drum, it is not a true Yang syndrome and should not be treated as heat. All pulses that appear Yang but are not truly Yang follow this rule.) How do Yin syndromes act oppositely? It means the pulse arrives seemingly conforming (Yin syndrome showing Yin pulse), but upon pressing, it drums strongly and vigorously. (Although a Yin syndrome shows a Yin pulse, if it drums forcefully, it is not a true Yin condition.) In Heat diseases, if the pulse remains restless and vigorous after sweating, death ensues. (In warm diseases and epidemics, rapid and vigorous pulses are favorable, while thin and weak pulses are unfavorable; silence of pulse and cooling of body after sweating is favorable, while continued restlessness and fever are unfavorable.) Wind-heat with a quiet pulse, diarrhea or blood loss with a solid pulse, indicates pathogenic factors binding internally. A weak pulse indicates external disease (exterior contraction). Choppy and hard pulses are difficult to treat. (These are quotes from the Classics.) For sudden collapse and violent syncope (formerly called Zhong Feng/Stroke, renamed Fei Feng by Zhang Jingyue), the root cause is always constitutional deficiency of Yuan Qi. Thus, the patient collapses suddenly and loses consciousness; the pulse should be small and weak, not rapid and vigorous. For poisoning, the pulse should be floating, large, rapid, and solid (Floating indicates toxin is active and can be dispersed); it should not be micro, fine, empty, or choppy (indicating righteous qi is injured by toxin). For fatigue and exhaustion injuries, a Xu Da Ruo Huan (Empty, Large, Weak, Moderate) pulse is favorable; tight, rapid pulses with profuse sweating and unceasing heat indicate death. For dietary injury, a Hua Da (Slippery, Large) pulse is favorable. If cold/raw food stagnates in the stomach, the pulse becomes tight. After Huo Luan (Cholera-like vomiting and diarrhea), a Bo Da (Beating, Large) pulse is unfavorable, as is a pulse that is too micro and slow. (Before vomiting/diarrhea, a Fu [Hidden] or intermittent pulse is acceptable due to qi stagnation. After vomiting/diarrhea, intermittent pulses are also acceptable due to sudden qi deficiency preventing continuity.) For Ye Ge (Dysphagia), a Fu Hua (Floating, Slippery) pulse with moist stool is favorable (merely phlegm-qiu obstruction); a Shu Xian Se (Rapid, Wiry, Choppy) pulse with dry stool indicates death (exhaustion of blood and qi). For Swelling/Edema, a Fu Da You Li (Floating, Large, Forceful) pulse is favorable; Duan Se Xu Xi (Short, Choppy, Empty, Fine) is unfavorable. For Fei Wei (Lung Atrophy), a Xu Shu (Empty, Rapid) pulse is favorable. For Fei Yong (Lung Abscess), an excessively Hong Shu (Surging, Rapid) pulse is unfavorable; after ulceration, a Huan Hua (Moderate, Slippery) pulse is expected. For Blood Loss syndromes, a Xu Ruo (Empty, Weak) pulse is favorable; Xian Shi Shu (Wiry, Solid, Rapid) is unfavorable; combined with fever and inability to lie down, it is fatal.
For Xu Xue (Accumulated Blood), a Shi Ke (Solid, Large) pulse allows for purgative treatment and is favorable. Dysentery is an Interior syndrome; the pulse should be Chen (Deep). Floating pulses and fever are unfavorable (in chronic dysentery, this indicates floating of deficient Yang; however, initial cases with exterior pathogens are excluded here). A Huan Xi You Shen (Moderate, Fine, Spirit-bearing) pulse is favorable; Qiang Xian (Strong, Wiry) is unfavorable. Head and eye pain with a Fu Hua (Floating, Slippery) pulse indicates Wind-Phlegm attacking upward and is treatable. Duan Se (Short, Choppy) indicates Blood deficiency with Fire rebellion and is difficult to treat. Sudden blindness indicates death (loss of Clear Yang, rebellion of Evil Fire upwards). For Jia Shan Ji Ju (Masses, Hernias, Accumulations), a Chen Shi You Li (Deep, Solid, Forceful) pulse is treatable; a Xu Ruo (Weak) pulse indicates death. Dian Kuang (Manic-Depression/Epilepsy) favors a Hua Da (Slippery, Large) pulse; Se Xiao (Choppy, Small) is unfavorable. For abscesses/carbuncles before ulceration, Fu Hua Shu Da (Floating, Slippery, Rapid, Large) is favorable; Chen Xi Chi Se (Deep, Fine, Slow, Choppy) is unfavorable. For Jing Bing (Spasm/Stiffness), Fu Xian (Floating, Wiry) is Yang, Chen Jin (Deep, Tight) is Yin; however, excessively rigid pulses are untreatable. Pregnancy pulses should be He Hua Liu Li (Harmonious, Slippery, Smooth); Xu Se (Empty, Choppy) is unfavorable. Postpartum and Beng Lou (Metrorrhagia/Metrostaxis) favor Huan Ruo (Moderate, Weak) pulses; Xian Shu (Wiry, Rapid) is unfavorable.
Generally, for new Yang diseases involving excess pathogenic factors requiring attack, a Sheng Da You Yu (Vigorous, Large, Abundant) pulse is required to withstand the attack. If a Xi Bu Zu (Thin, Insufficient) pulse appears, it indicates excess pathogen and deficient righteous qi; attacking the pathogen may harm the righteous qi. Zhang Zhongjing stated that Yang diseases showing Yin pulses result in death; while not absolute, they are very difficult to manage. For chronic Yin diseases involving righteous deficiency requiring tonification, a Xu Ruo Bu Zu (Weak, Deficient, Insufficient) pulse is required to tolerate tonification. After tonification, if the pulse gradually enlarges from weak and fills from empty, transforming from Yin to Yang pulse, this aligns with Zhang Zhongjing's statement that Yin diseases showing Yang pulses result in life. If a Qiang Shi You Yu (Strong, Solid, Abundant) pulse appears, it indicates Earth failure and Wood invasion (Spleen failure with Liver overacting); tonification will be ineffective or may exacerbate the pathogen, leading to incurability. (For collapse syndromes where pulse vanishes, gradual recovery of pulse qi post-treatment is good. Sudden reappearance of pulse, resembling recovery, often leads to relapse and death, akin to a lamp flickering back before extinguishing.) Furthermore, when a Yang disease presents with a vigorous pulse, one must examine the Stomach Qi. Only if it is vigorous yet harmonious/moderate can aggressive treatment proceed. If Xian Duo Wei Shao (Excessive Wiry, Little Stomach Qi) or if form/qi is deficient, attack is contraindicated. For masses where the pulse is naturally wiry, one must ensure Stomach Qi persists within the wiriness, form/qi is intact, and the situation necessitates attack before proceeding. Treatment should cease when 60-70% of the disease is resolved, following the principle: for major accumulations, stop when half is reduced.