温疫得里证，神色不败，言动自如，别无怪证，忽然六脉如丝，沉细而软，甚至
于无，或两手俱无，或一手先伏，察其人不应有此脉，今有此脉者，皆缘应下失下，内结壅
闭，营气逆于内，不能达于四末，此脉厥也。亦多有过用黄连石膏诸寒之剂，强遏其热，致
邪愈结，脉愈不行，医见脉微欲绝，以为阳证得阴脉为不治，委而弃之，以此误人甚众，若
更用人参、生脉散辈，祸不旋踵，宜承气缓缓下之，六脉自复。
表证脉不浮者，可汗而解，以邪气微，不能牵引正气，故脉不应。里证脉不沉者
，可下而解，以邪气微不能抑郁正气，故脉不应。阳证见阴脉，有可生者，神色不败，言动
自
如，乃禀赋脉也。再问前日无此脉，乃脉厥也。下后脉实，亦有病愈者，但得证减，复有实
脉，乃天年脉也。夫脉不可一途而取，须以神气形色病证相参，以决安危为善。
张昆源正，年六旬，得滞下。后重窘急，日三四十度，脉常歇止，诸医以为雀啄脉，必死
之候，咸不用药。延予诊视，其脉参伍不调，或二动一止，或三动一止，而复来，此涩
脉也。年高血弱，下利脓血，六脉短涩，固非所能任，询其饮食不减，形色不变，声音烈烈，言
语如常，非危证也。遂用芍药汤加大黄三钱，大下纯脓成块者两碗许，自觉舒快，脉气渐续
，而利亦止。数年后又得伤风，咳嗽，痰涎涌甚，诊之又得前脉，与杏桔汤二剂，嗽止脉调
。乃见其妇，凡病善作此脉，大抵治病，务以形色脉证参考，庶不失其大体，方可定其吉凶也。
温疫病出现里实证，患者神色未败，言语行动自如，没有其他怪异症状，突然六脉细如丝线，沉细而软弱，甚至摸不到脉搏，或者两手都无脉，或一只手先伏匿不见。观察其人本不应有此脉象，现在出现此脉，都是因为应当使用下法却失于使用，导致体内邪气结聚壅闭，营气逆乱于内，不能通达四肢末端，这就是“脉厥”。也有许多因为过度使用黄连、石膏等寒凉药物，强行遏制热邪，致使邪气更加结聚，脉气更加不通畅。医生见到脉微细欲绝，认为阳证出现阴脉属于不治之症，便放弃治疗，因此误人甚多。如果此时再用人参、生脉散之类的补益药，灾祸立刻降临。适宜用承气汤类方剂缓缓攻下，六脉自然恢复。
表证阶段脉象不浮的，可以用发汗法解除，因为邪气轻微，不能牵引正气，所以脉象表现不典型。里证阶段脉象不沉的，可以用泻下法解除，因为邪气轻微不能郁滞正气，所以脉象表现不典型。阳证出现阴脉，有可以存活的，如果神色未败，言语行动自如，这是患者原本的体质脉象。再询问前几日是否有此脉，如果没有，则是“脉厥”。泻下之后脉象变得充实有力，也有病愈的情况，只要症状减轻，重新出现实脉，这是正常的寿命脉象。诊脉不可仅凭单一途径判断，必须将神气、形色、病证相互参照，以此决断安危才是好的做法。
张昆源正，六十岁，患痢疾。后重窘急，每天排便三四十次，脉象常有间歇。众医认为是“雀啄脉”，是必死的征候，都不用药。请我诊治，其脉象参伍不调，有时两动一止，有时三动一止，然后又来，这是涩脉。年高血弱，下利脓血，六脉短涩，本来难以承受攻伐，但询问其饮食未减，形色未变，声音洪亮，言语如常，并非危重证候。于是用芍药汤加大黄三钱，大下纯脓成块者约两碗，自觉舒快，脉气逐渐接续，痢疾也停止了。数年后又患伤风，咳嗽，痰涎涌盛，诊察又得到前述脉象，给予杏桔汤两剂，咳嗽停止，脉象调和。后来见到他的妻子，凡是生病都喜欢出现这种脉象。大致治病，务必以形色、脉证参考印证，才不至于失去大体，方可定其吉凶。
When a warm epidemic disease presents with interior excess syndrome, the patient's spirit and complexion remain intact, speech and movement are normal, and there are no other bizarre symptoms. Suddenly, the six pulses become thread-like, deep, fine, and soft, or even imperceptible; both hands may lack a pulse, or one hand's pulse may vanish first. Observing that the person should not naturally have this pulse, its appearance here is due to the failure to use purgation when indicated. Internal accumulation and blockage cause Ying Qi (nutritive energy) to reverse internally, unable to reach the four extremities. This is called "Pulse Jue" (Pulse Collapse). It also often occurs from the overuse of cold agents such as Huanglian (Coptis Rhizome) and Shigao (Gypsum Fibrosum), which forcibly suppress heat, causing the pathogen to bind more tightly and the pulse to flow even less smoothly. Physicians seeing a faint, nearly absent pulse may consider it an exterior Yang condition presenting with interior Yin pulse—a sign of untreatability—and abandon treatment, thus harming many people. If Ren Shen (Ginseng Radix) or Sheng Mai San (Generate the Pulse Powder) are then administered, disaster will follow immediately. The appropriate treatment is to slowly purge using Chengqi Tang (Gut-Regulating Decoction), after which the six pulses will naturally recover.
In the exterior stage, if the pulse does not float, sweating can be used to resolve the condition because the pathogen is slight and cannot draw out the Zheng Qi (healthy energy), resulting in atypical pulse presentation. In the interior stage, if the pulse does not sink, purgation can be used to resolve the condition because the pathogen is slight and cannot depress the Zheng Qi, again resulting in atypical pulse presentation. When a Yang condition presents with a Yin pulse, survival is possible if the spirit and complexion are intact and speech/movement are normal; this indicates the patient's constitutive pulse. Further inquiry reveals whether this pulse was present previously; if not, it is "Pulse Jue." After purgation, if the pulse becomes full and forceful, recovery is also possible; provided symptoms subside and a full pulse returns, this is the normal pulse of longevity. Pulse diagnosis must not rely on a single criterion; one must correlate spirit, qi, physical appearance, and clinical signs to determine prognosis accurately.
Zhang Kunyuanzheng, aged sixty, suffered from dysentery. He experienced tenesmus and urgency, defecating thirty to forty times daily. His pulse frequently skipped beats. Other physicians identified this as Quezhuo Mai (Sparrow Pecking Pulse), a sign of certain death, and refused to prescribe medicine. Upon my examination, his pulse was irregular (Canwu Bu Tiao), sometimes two beats followed by a pause, or three beats followed by a pause, then resuming. This is a Se Mai (Choppy Pulse). Given his advanced age, weak blood, and dysentery with pus and blood, his short and choppy six pulses suggested he could not tolerate strong treatment. However, his diet remained unchanged, his complexion unaltered, his voice robust, and his speech normal, indicating this was not a critical condition. I prescribed Shaoyao Tang (Peony Decoction) with an addition of 3 qian of Dahuang (Rhubarb Root and Rhizome). He passed approximately two bowls of pure, clotted pus. He felt relieved, his pulse qi gradually resumed continuity, and the dysentery ceased. Several years later, he contracted wind-cold, suffering from cough and profuse phlegm. Examination revealed the same previous pulse pattern. Two doses of Xingjie Tang (Apricot Seed and Forsythia Decoction) stopped the cough and regulated the pulse. I later observed his wife, who exhibited this same pulse pattern whenever ill. Generally, in treating diseases, one must carefully cross-reference physical appearance, pulse, and symptoms to avoid missing the overall picture, thereby correctly determining auspicious or ominous outcomes.