《内经·脉要精微篇》曰∶脉大则病进。丹溪云∶脉，血之所为，属阴。大，洪之名，火之
象，属阳。其病得之于内伤者，阴虚为阳所乘，故脉大当作虚治之。其病得于外伤者，邪客于经，
脉亦大，当作邪胜治之。合二者观之，皆病证方长之势也，谓之病进不亦宜乎！（《格致余论》）
甫按∶脉大则病进。脉之大者，乃邪气之盛也，邪气盛则正气虚可知矣，先是正气虚弱，然
后邪气得以乘之，而恣其盛大之势。脉为气血之精华，果无邪气相干，则自雍容和缓，如蔡西山
之所谓意思忻忻，难以名状。今脉之大者，谓其大而过于寻常畴昔之时，故知其为邪气所乘也。
人虽病之未形而邪已形于脉中，所以逆知病之必进也。为治之计，当先急则治其标，发散邪气，
随后调其正气，庶几可矣。丹溪谓∶内伤者，阳所乘；外感者，邪客经。似以既病而言，非为未病而进之
谓也。又谓∶脉，血之所为，属阴。经曰∶浊气归心，淫精于脉。《举要》云∶脉不自行，随气
而至。可见脉亦不可外气而为言也。王海藏云∶君兼臣权，尤其曲说。丹溪医之哲也，甫何敢辩，
姑言之以俟知者。
浮以候表，沉以候里，虚则病虚，实则邪实。各部所司，病宜分治。寸脉候上，心肺之位。
关脉候中，肝脾之地。尺脉候下，膀胱肾水大肠小肠皆在于内。
【左寸脉候】
表虚主病∶浮而无力主表虚。自汗腠理不固，寒气不卫，恶寒，寒战，恶风。
表实主病∶浮而有力主表邪盛。头痛发热，目 赤涩，身疼或口干。
里虚主病∶沉而无力主里虚。悸怖惊恐，恶人声，精神恍惚，健忘，夜不寐。
里实主病∶沉而有力为里实。心烦而躁，内热，梦遗，恶热口渴，颠狂谵语。
【左关脉候】
表虚主病∶浮而无力主表证。目视不明，目生花。
表实主病∶浮而有力表邪证。主胁痛腹胀，目痛目胀。
里虚主病∶沉而无力主里虚。为惊恐，为血痹，为多疑，为犹豫。
里实主病∶沉而有力里邪实。主肥气，主多怒，为筋急或疝痛。
【左尺脉候】
表虚主病∶浮而无力主表虚。为盗汗，为耳聋，膀胱癃，小便短。
表实主病∶浮而有力表邪实。为淋沥，小便难，便赤便浊。
里虚主病∶沉而无力里虚证。为精冷不固，为足寒，为腰冷腰重。
里实主病∶沉而有力里实证。为肾气盛，阴旺，腰痛膝痹，疝痛，左睾丸偏大。
【右寸脉候】
表虚主病∶浮而无力表虚证。自汗，恶寒，恶风，皮肤瘙痒，背恶寒，喷嚏流清涕。
表实主病∶浮而有力表实邪盛。为发热头痛，头风眩运。
里虚主病∶沉而无力主里虚。为气短不续，为寒嗽，虚喘，吐清痰。
里实主病∶沉而有力里邪盛。咳嗽有痰积，老痰咳吐不出，气壅喘甚。
【右关脉候】
表虚主病∶浮而无力主表虚。四肢不举，倦怠嗜卧，或面目浮肿。
表实主病∶浮而有力主表实。主腹胀，胸膈痞满。
里虚主病∶沉而无力主里虚。胃寒恶食，泄泻，恶心，呕吐翻胃。
里实主病∶沉而有力里邪盛。寒积，宿食，有陈积。
【右尺脉候】
表虚主病∶浮而无力与左同。
表实主病∶浮而有力。主肠风，风痹，耳鸣。
里虚主病∶沉而无力。主肾虚，腰重如带五千钱、肾水不足，腰痹不能转摇。
里实主病∶沉而有力。主寒疝痛，腰痛，或为痢积。
《黄帝内经·脉要精微篇》中说：脉象宏大，意味着病情正在发展加重。朱丹溪说：脉，是由血液所化生，属性为阴。大，是洪大的名称，是火的征象，属性为阳。如果疾病是由于内伤引起的，属于阴虚而阳气乘虚侵袭，所以脉大应当作为虚证来治疗。如果疾病是由于外感引起的，邪气客居在经脉中，脉象也会变大，应当作为邪气亢盛来治疗。综合这两种情况来看，都是病证正处于进展发展的态势，称之为“病进”不也是合适的吗！（出自《格致余论》）
徐春甫按语：脉象宏大则病情加重。脉象大的情况，乃是邪气旺盛的表现，邪气旺盛则正气虚弱是可以推知的了，先是正气虚弱，然后邪气才得以乘虚而入，肆意形成盛大的气势。脉是气血的精华，如果没有邪气干扰，脉象自然会雍容和缓，就像蔡西山所说的“心意欣然”，难以用语言形容。现在脉象宏大，是指它比平常时候过大，所以知道这是被邪气所侵犯。人虽然病症还没有显现于形体，但邪气已经在脉中显现，所以能预先推断病情必然加重。治疗的方法，应当先紧急治其标，发散邪气，随后调理正气，这样就可以了。丹溪说：内伤者，是阳气乘虚；外感者，是邪气客居经脉。这似乎是以已经生病的情况来说的，而不是针对未病而病情进展的说法。又说：脉，是由血液所化生，属性为阴。经书说：浊气归于心，溢精于脉。《脉诀举要》说：脉不能自行，随气而行。可见脉也不能脱离气来单独谈论。王海藏说：君兼臣权，尤其是一种牵强的解释。丹溪是医学哲人，我徐春甫怎么敢辩解，姑且说出来以等待懂行的人指正。
浮脉用来诊察表证，沉脉用来诊察里证，脉虚则主虚证，脉实则主邪实。各部脉象所主管的部位，病证应当分别治疗。寸脉诊察上部，是心和肺的位置。关脉诊察中部，是肝和脾的地盘。尺脉诊察下部，膀胱、肾水、大肠、小肠都在内部。
【左寸脉候】
表虚主病：浮而无力主表虚。自汗，腠理不固密，寒气不能卫护体表，恶寒，寒战，恶风。
表实主病：浮而有力主表邪盛。头痛发热，眼睛红赤涩痛，身体疼痛或者口干。
里虚主病：沉而无力主里虚。心悸惊恐，害怕人的声音，精神恍惚，健忘，夜间失眠。
里实主病：沉而有力为里实。心烦急躁，内热，梦遗，怕热口渴，癫狂胡言乱语。
【左关脉候】
表虚主病：浮而无力主表证。视物不明，眼前出现花影。
表实主病：浮而有力为表邪证。主要症状为胁痛腹胀，眼睛疼痛胀满。
里虚主病：沉而无力主里虚。表现为惊恐，血痹，多疑，犹豫不决。
里实主病：沉而有力为里邪实。主要症状为肥气（腹部积块），容易发怒，筋脉拘急或疝痛。
【左尺脉候】
表虚主病：浮而无力主表虚。盗汗，耳聋，小便不通畅（癃闭），尿量少。
表实主病：浮而有力为表邪实。淋沥不尽，小便困难，尿色红赤浑浊。
里虚主病：沉而无力为里虚证。精液清冷不固摄，脚冷，腰部冷重。
里实主病：沉而有力为里实证。肾气过盛，阴气旺盛，腰痛膝痹，疝痛，左侧睾丸偏大。
【右寸脉候】
表虚主病：浮而无力为表虚证。自汗，恶寒，恶风，皮肤瘙痒，背部怕冷，打喷嚏流清鼻涕。
表实主病：浮而有力为表实邪盛。发热头痛，头风眩晕。
里虚主病：沉而无力主里虚。气短接续不上，寒咳，虚喘，吐出清稀痰液。
里实主病：沉而有力为里邪盛。咳嗽有痰积，老痰咳吐不出，气壅喘促严重。
【右关脉候】
表虚主病：浮而无力主表虚。四肢无法抬起，倦怠嗜睡，或者面目浮肿。
表实主病：浮而有力主表实。主要症状为腹胀，胸膈痞闷胀满。
里虚主病：沉而无力主里虚。胃寒厌恶食物，泄泻，恶心，呕吐翻胃。
里实主病：沉而有力为里邪盛。寒积，宿食，有陈旧的积滞。
【右尺脉候】
表虚主病：浮而无力与左尺相同。
表实主病：浮而有力。主要症状为肠风，风痹，耳鸣。
里虚主病：沉而无力。主要症状为肾虚，腰部沉重如系五千钱，肾水不足，腰痹不能转动摇晃。
里实主病：沉而有力。主要症状为寒疝痛，腰痛，或者为痢疾积滞。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon), chapter "Mai Yao Jing Wei" (Essential Details of Pulse Diagnosis), states: "A large pulse indicates that the disease is progressing." Zhu Danxi said: The pulse is formed by blood and belongs to Yin. "Large" refers to the surging pulse, which is an image of Fire and belongs to Yang. If the disease arises from internal injury, it involves Yin deficiency with Yang encroaching; therefore, a large pulse should be treated as a deficiency pattern. If the disease arises from external contraction, pathogenic factors lodge in the meridians, and the pulse also becomes large; this should be treated as an excess of pathogens. Observing both cases together, they both represent a trend where the disease syndrome is advancing; thus, calling it "disease progression" is appropriate! (*Gezhi Yulun*)
Xu Chunfu adds: A large pulse indicates disease progression. A large pulse signifies the flourishing of pathogenic qi; knowing that pathogenic qi is flourishing, one can deduce that healthy qi is deficient. Initially, healthy qi was weak, allowing pathogenic qi to take advantage and assume a dominant position. The pulse is the essence of Qi and Blood. Without interference from pathogenic factors, the pulse would naturally be graceful and moderate, as Cai Xishan described as "a state of joy difficult to name." Now, when we speak of a large pulse, we mean it is larger than usual, indicating invasion by pathogenic factors. Although the disease has not yet manifested physically, the pathogen is already visible in the pulse; thus, one can predict that the disease will inevitably progress. In treatment, one must first address the acute symptoms (biao) by dispersing pathogens, followed by regulating healthy qi; only then is recovery likely. Danxi stated: "In internal injuries, Yang encroaches; in external contractions, pathogens lodge in the meridians." This seems to refer to the state after illness has occurred, rather than the progression before illness manifests. He also stated: "The pulse is formed by blood and belongs to Yin." The Classics say: "Turbid Qi returns to the Heart, overflowing into the vessels." The *Juyao* (Summary of Essentials) states: "Vessels do not move on their own but follow Qi." Thus, the pulse cannot be discussed independently of Qi. Wang Haicang said: "The Ruler assumes the authority of the Ministers," which is a particularly forced interpretation. Danxi was a philosophical physician; how dare I, Xu Chunfu, debate him? I merely record these thoughts for those who understand.
Floating pulses are used to diagnose exterior conditions, while sunken pulses are used to diagnose interior conditions. Deficiency pulses indicate deficiency syndromes, and excess pulses indicate pathogenic excess. Each section governs specific areas, and diseases should be treated according to differentiation. The Cun (inch) pulse diagnoses the upper jiao, the location of the Heart and Lungs. The Guan (bar) pulse diagnoses the middle jiao, the territory of the Liver and Spleen. The Chi (cubit) pulse diagnoses the lower jiao, where the Bladder, Kidney Water, Large Intestine, and Small Intestine reside internally.
[Left Cun Pulse Diagnosis]
Exterior Deficiency Main Disease: Floating and forceless indicates exterior deficiency. Spontaneous sweating, insecure interstices (couli), inability of Cold Qi to protect the exterior, aversion to cold, shivering, aversion to wind.
Exterior Excess Main Disease: Floating and forceful indicates exterior pathogenic excess. Headache and fever, red and gritty eyes, body pain or dry mouth.
Interior Deficiency Main Disease: Sunken and forceless indicates interior deficiency. Palpitations and fright, fear of human voices, mental confusion, forgetfulness, insomnia at night.
Interior Excess Main Disease: Sunken and forceful indicates interior excess. Mental restlessness and irritability, internal heat, nocturnal emission, aversion to heat and thirst, mania and delirium.
[Left Guan Pulse Diagnosis]
Exterior Deficiency Main Disease: Floating and forceless indicates exterior syndromes. Blurred vision, visual hallucinations (seeing spots).
Exterior Excess Main Disease: Floating and forceful indicates exterior pathogenic syndromes. Main symptoms include hypochondriac pain and abdominal distension, eye pain and swelling.
Interior Deficiency Main Disease: Sunken and forceless indicates interior deficiency. Manifests as fright, Bi-syndrome due to Blood stasis, suspicion, and indecision.
Interior Excess Main Disease: Sunken and forceful indicates interior pathogenic excess. Main symptoms include Feiqi (abdominal mass), irritability, tendon tension, or hernia pain.
[Left Chi Pulse Diagnosis]
Exterior Deficiency Main Disease: Floating and forceless indicates exterior deficiency. Night sweats, deafness, strangury (difficulty urinating), scanty urine.
Exterior Excess Main Disease: Floating and forceful indicates exterior pathogenic excess. Dribbling urine, dysuria, red and turbid urine.
Interior Deficiency Main Disease: Sunken and forceless indicates interior deficiency syndromes. Cold semen without consolidation, cold feet, cold and heavy lower back.
Interior Excess Main Disease: Sunken and forceful indicates interior excess syndromes. Excessive Kidney Qi, flourishing Yin, lower back pain and knee Bi-syndrome, hernia pain, left testicle enlarged.
[Right Cun Pulse Diagnosis]
Exterior Deficiency Main Disease: Floating and forceless indicates exterior deficiency syndromes. Spontaneous sweating, aversion to cold, aversion to wind, pruritus cutis, aversion to cold in the back, sneezing with clear nasal discharge.
Exterior Excess Main Disease: Floating and forceful indicates exterior pathogenic excess. Fever and headache, cephalalgia due to Wind-Xuan (vertigo/dizziness).
Interior Deficiency Main Disease: Sunken and forceless indicates interior deficiency. Shortness of breath, cold cough, deficiency asthma, expectoration of clear phlegm.
Interior Excess Main Disease: Sunken and forceful indicates interior pathogenic excess. Cough with phlegm accumulation, retention of old phlegm, Qi stagnation with severe wheezing.
[Right Guan Pulse Diagnosis]
Exterior Deficiency Main Disease: Floating and forceless indicates exterior deficiency. Inability to raise limbs, fatigue and desire to lie down, or edema of the face and eyes.
Exterior Excess Main Disease: Floating and forceful indicates exterior excess. Main symptoms include abdominal distension and chest/epigastric fullness/stuffiness.
Interior Deficiency Main Disease: Sunken and forceless indicates interior deficiency. Stomach cold with food aversion, diarrhea, nausea, vomiting and regurgitation.
Interior Excess Main Disease: Sunken and forceful indicates interior pathogenic excess. Cold accumulation, retained food, chronic stagnation.
[Right Chi Pulse Diagnosis]
Exterior Deficiency Main Disease: Floating and forceless is the same as the Left Chi.
Exterior Excess Main Disease: Floating and forceful. Main symptoms include Changfeng (wind affecting the intestines), Wind-Bi, tinnitus.
Interior Deficiency Main Disease: Sunken and forceless. Main symptoms include Kidney deficiency, heaviness in the waist as if bound by five thousand coins, insufficiency of Kidney Water, lumbar Bi-syndrome with inability to turn or sway.
Interior Excess Main Disease: Sunken and forceful. Main symptoms include cold hernia pain, lower back pain, or dysentery accumulation.