脉要精微论曰∶夫脉者，血之府也。长则气治，短则气病，数则烦心，大则病进，上盛则气高，
下盛则气
胀，代则气衰，细则气少，涩则心痛，浑浑革至如涌泉，病进而色弊，绵绵其去如弦绝者死。粗大
者，阴不足，阳有余，为热中也。来疾去徐，上实下虚，为厥巅疾；来徐去疾，上虚下实，为恶风也
。故中恶风者，阳受气也。有脉俱沉细数者，少阴厥也。沉细数散者，寒热也。浮而散者，为 仆
。诸浮不躁者，皆在阳，则为热；其有躁者在手。诸细而沉者，皆在阴，则为骨痛；其有静者在足
。数动一代者，病在阳之脉也，泄及便脓血。涩者，阳气有余也；滑者，阴气有余也。阳气有余，
为身热无汗；阴气有余，为多汗身寒；阴阳有余，则无汗而寒。按之至骨，脉气少者，腰脊痛而身
有痹也。
阴阳别论曰∶阴阳虚，肠辟死。阳加于阴谓之汗。阴虚阳搏谓之崩。
平人气象论曰∶风热而脉静，泄而脱血脉实，病在中脉虚，病在外脉涩坚者，皆难治，命曰反
四时也。
玉机真藏论曰∶凡治病，察其形气色泽，脉之盛衰，病之新故，乃治之，无后其时。形气相得
，谓之可治；色泽以浮，谓之易已；脉从四时，谓之可治；脉弱以滑，是有胃气，命曰易治；形气
相失，谓之难治。色夭不泽，谓之难已；脉实以坚，谓之益甚；脉逆四时，为不可治。必察四难而
明告之。病热脉静，泄而脉大，脱血而脉实，病在中脉实坚，病在外脉不实坚者，皆难治。
按∶此二篇之义，如前篇言病在中脉虚者为难治，后篇言病在中脉实坚者为难治；前言病在外
脉涩坚者为难治，后言病在外脉不实坚者为难治，前后若乎相反，何也？盖实邪在中者，脉不宜虚
；虚邪在中者，脉不宜实也。阳邪在表者，宜滑而软，不宜涩而坚；外邪方盛者，宜实而大，不宜
虚而小也。此中各有精义，或者以其为误，是不达耳。
《素问·脉要精微论》说：脉，是血液汇聚的府库。脉象长，说明气机调畅；脉象短，说明气机有病；脉象数（快），说明心中烦乱；脉象大，说明病势进展；上部脉盛，说明气逆于上；下部脉盛，说明气滞于下导致胀满；脉象代（间歇），说明气衰；脉象细，说明气少；脉象涩，说明心痛；脉来浑浊急疾如涌泉，病情加重且面色败坏；脉去连绵不绝如弓弦断裂，主死证。脉象粗大的，是阴不足而阳有余，属于热中病。脉来急而去缓的，是上实下虚，会导致厥逆和头部疾病；脉来缓而去急的，是上虚下实，会导致恶风症。所以感受风邪的人，阳气受邪。如果脉象都沉、细、数，这是少阴经的厥证。脉象沉、细、数且散的，是寒热错杂之证。脉象浮且散的，会导致仆倒。凡是脉浮而不躁动的，病都在阳分，表现为热证；如果伴有躁动，病在手部经脉。凡是脉细且沉的，病都在阴分，表现为骨痛；如果伴有静象，病在足部经脉。脉数动且有一代止的，是阳分之脉的病，会出现泄泻及大便脓血。脉涩的，是阳气有余；脉滑的，是阴气有余。阳气有余，表现为身体发热无汗；阴气有余，表现为多汗身寒；阴阳都有余，则无汗且畏寒。重按至骨，脉气微弱的，是腰脊疼痛且身体有痹症。
《素问·阴阳别论》说：阴阳两虚，患肠辟（痢疾）会死亡。阳加于阴称为汗。阴虚而阳脉搏击有力称为崩漏。
《素问·平人气象论》说：患风热病而脉象平静，患泄泻且脱血而脉象实大，病在体内而脉象虚弱，病在体表而脉象涩且坚硬的，都属于难治之症，这被称为违背四时脉象规律。
《素问·玉机真藏论》说：凡治病，必须观察病人的形体、气色、色泽，诊察脉象的盛衰，判断疾病的久暂，然后进行治疗，不要错过时机。形体与气色相协调，称为可治；色泽明润浮泽，称为容易痊愈；脉象顺应四时变化，称为可治；脉象弱而滑利，是有胃气的表现，称为易治；形体与气色不相协调，称为难治。面色枯槁无光泽，称为难以痊愈；脉象实而坚硬，称为病情加重；脉象违背四时规律，为不可治。必须仔细考察这四种难治的情况并明确告知病人。患热病而脉象静止，患泄泻而脉象大，失血而脉象实，病在体内而脉象实坚，病在体表而脉象不实不坚的，都属于难治之症。
按语：这两篇经文的意义，如前篇说病在体内脉虚为难治，后篇说病在体内脉实坚为难治；前篇说病在体表脉涩坚为难治，后篇说病在体表脉不实不坚为难治，前后似乎相反，为什么呢？大概实邪在体内的，脉象不宜虚；虚邪在体内的，脉象不宜实。阳邪在体表的，脉象宜滑软，不宜涩坚；外邪正盛的，脉象宜实大，不宜虚小。这其中各有精义，有人认为是错误，是因为不通达医理罢了。
The *Suwen: Pulse Essentials and Subtleties* states: The pulse is the mansion of blood. A long pulse indicates regulated Qi; a short pulse indicates diseased Qi; a rapid pulse (Shu) indicates mental restlessness; a large pulse indicates advancing disease; excess in the upper part indicates Qi rebellion upwards; excess in the lower part indicates Qi stagnation leading to distension; an intermittent pulse (Dai) indicates Qi deficiency; a fine pulse indicates scanty Qi; a choppy pulse indicates heart pain; a pulse that comes turbid and rapid like a gushing spring, with worsening condition and deteriorated complexion, indicates advancing disease; a pulse that goes continuously like a breaking bowstring indicates death. A coarse and large pulse indicates Yin insufficiency and Yang excess, constituting Heat Zhong syndrome. A pulse that comes rapidly but departs slowly indicates excess above and deficiency below, leading to Jue and head diseases; a pulse that comes slowly but departs rapidly indicates deficiency above and excess below, leading to aversion to wind. Therefore, those afflicted by wind evil receive Qi [invasion]. If pulses are all deep, fine, and rapid, it is Shaoyin Jue. A deep, fine, rapid, and scattered pulse indicates alternating cold and heat. A floating and scattered pulse leads to collapse/fainting. All floating pulses without agitation indicate pathology in the Yang aspect, manifesting as heat; if accompanied by agitation, the pathology is in the hand meridians. All fine and deep pulses indicate pathology in the Yin aspect, manifesting as bone pain; if accompanied by stillness, the pathology is in the foot meridians. A pulse that is rapid, moving, and has one intermittent beat indicates pathology in the Yang pulse, presenting with diarrhea and pus-blood in stool. A choppy pulse indicates Yang Qi excess; a slippery pulse indicates Yin Qi excess. Yang Qi excess manifests as body heat and absence of sweat; Yin Qi excess manifests as profuse sweating and cold body; excess in both Yin and Yang manifests as absence of sweat and aversion to cold. Pressing down to the bone, if the pulse Qi is weak, it indicates lumbar and spinal pain with Bi syndrome in the body.
The *Suwen: Distinctions of Yin and Yang* states: When both Yin and Yang are deficient, death occurs from Chang Pi (dysentery). When Yang acts upon Yin, it is called sweat. Yin deficiency with vigorous Yang pulsation is called Beng (metrorrhagia/metrostaxis).
The *Suwen: Phenomena of Normal People* states: Wind-heat with a calm pulse, diarrhea with blood loss and a full pulse, internal disease with a deficient pulse, and external disease with a choppy and firm pulse are all difficult to treat; this is termed contrary to the Four Seasons.
The *Suwen: Jade Machine and True Zang Pulses* states: In treating any disease, one must observe the patient's form, Qi, color, and luster, assess the flourishing or declining state of the pulse, and determine whether the disease is new or old, then treat accordingly without delaying the timing. When form and Qi are harmonious, it is called treatable; when color and luster are bright and floating, it is called easily curable; when the pulse conforms to the Four Seasons, it is called treatable; when the pulse is weak and slippery, indicating Stomach Qi, it is called easy to treat; when form and Qi are discordant, it is called difficult to treat. When the complexion is dull and lacks luster, it is called difficult to cure; when the pulse is full and hard, it indicates worsening condition; when the pulse contradicts the Four Seasons, it is untreatable. One must carefully examine these four difficulties and clearly inform the patient. Heat disease with a quiet pulse, diarrhea with a large pulse, blood loss with a full pulse, internal disease with a full and firm pulse, and external disease with a not-full and not-firm pulse are all difficult to treat.
Commentary: The meaning of these two chapters seems contradictory as stated previously: the former chapter says internal disease with a deficient pulse is difficult to treat, while the latter says internal disease with a full and firm pulse is difficult to treat; the former says external disease with a choppy and firm pulse is difficult to treat, while the latter says external disease with a not-full and not-firm pulse is difficult to treat. Why do they seem opposite? Essentially, when Excess Evil is internal, the pulse should not be deficient; when Deficient Evil is internal, the pulse should not be full. When Yang Evil is external, the pulse should be slippery and soft, not choppy and firm; when External Evil is just flourishing, the pulse should be full and large, not deficient and small. There is profound meaning in each case; those who consider them errors simply fail to understand the principles.