脉盛滑坚者，曰病在外；脉小实而坚者，曰病在内。脉小弱以涩，谓之久病；脉滑浮而疾者，谓之新病。脉
急者，曰疝瘕，少腹痛；脉滑，曰风；脉涩，曰痹；缓而滑，曰热中；盛而紧，曰胀。
此亦言两手之脉现病状也。盛滑坚者，浮按盛而滑，沉按则坚，此外邪盛，而脏腑之气不得舒和，而脉坚
实，故曰病在外也；若小者，浮按不足，沉按则实而坚，此邪在腑脏，故曰病在内；是阴邪结于阴分也。其小
弱而涩者，气血两伤，故知其为久病，然比小实坚之脉为吉，凡脉而至坚硬者，非难治之痼疾，即伤本元之重
病也；若滑浮而疾，此外感邪热，元气未伤，故知其为新病也。脉急者，无柔和之气，此阴凝之邪，故有疝瘕、少腹
痛之病也；脉滑曰风者，是内风挟痰，若外风，其脉必浮也；涩者，寒湿滞于血脉而为痹也；缓而滑者，热邪
伤中，故脉纵缓而滑，有力则为热病，无力则为痿病；盛而紧者，阴邪积滞于中，必胀满也。
《素问·脉要精微论》曰∶心脉搏坚而长，当病舌卷不能言；其软而散者，当消环自已。
搏坚而长者，弦强有力，肝邪乘心也，心主血，肝藏血，舌为心苗，肝主筋，血少则筋急，《经筋篇》言，
手少阳之筋转，则舌卷，故病舌卷不能言也；若其脉软而散者，血伤气耗也，消环二字必有错讹，《甲乙经》
作消渴自已，盖血伤气耗，津液不生，当病消渴，然脉既软散，心火已微，但静养自愈也。
肺脉搏坚而长，当病唾血；其软而散者，当病灌汗，至令不复散发也。
肺主气，肝藏血，脉搏坚而长者，肝邪横逆犯肺，血随气升而唾出也；若其脉软而散者，肺气大伤，腠理
开泄，当病大汗淋漓，如水灌身，至令不能还复，以津气外散而发越也。
肝脉搏坚而长，色不青，当病坠若搏，因血在胁下，令人喘逆；其软而散，色泽者，当病溢饮，溢饮者，
渴暴多饮，而易入肌皮肠胃之外也。
肝脉搏坚而长者，弦硬有力也，肝邪盛，色当青，乃反不青，是因坠跌，若搏击伤血，血瘀结于胁下，胁
为肝之部位，血瘀，则气逆中焦，升降不利，故喘而气逆也；若其脉软而散，则气血两伤，色当枯瘁，今反润
泽而明者，因水饮漫溢，经气不循轨路，故脉软散，由渴时暴多饮，遂易入肌皮之内，溢于肠胃之外，将有肿
胀之变也。上编云∶肝脉微缓为水瘕痹，涩甚亦为溢饮。大抵微缓涩及软散，同为虚弱之脉，但观其色，如枯瘁不
泽，则非水溢之病矣。
胃脉搏坚而长，其色赤，当病折髀；其软而散者，当病食痹。
心肝火邪乘胃，胃脉搏坚而长，故其色赤，髀者，胃经所行之部，火邪流于经，其髀痛如打折也；其脉软
而散者，胃气伤，食而不能消化，反加黄瘦，病名食痹也。
脾脉搏坚而长，其色黄，当病少气；其软而散，色不泽者，当病足 肿，若水状也。
脾脉本应柔缓，乃反搏坚而长，是木横土困，故面黄，其无力鼓运，则病少气也；其脉软而散，面无色泽
者，是脾土衰，而气下坠，故足 肿，若水状而非水病，如水邪色必泽而明。此当大培脾土，其肿可渐消也。
肾脉搏坚而长，其色黄而赤者，当病折腰；其软而散者，当少血，至令不复也。
肾藏天一真水，其脉沉实柔滑，反现搏坚而长者，水亏不能涵木，木盛火炽，火又生土而并旺，故现黄赤
之色，土本克水，腰者肾之府，肾水亏极，故腰痛如折也；其脉软而散者，精血少而气亦耗，故脉软散，至令
不能复元也。
帝曰∶诊得心脉而急，此为何病？病形何如？岐伯曰∶病名心疝，少腹当有形也。帝曰∶何以言之？岐伯
曰∶心为牡脏，小肠为之使，故曰少腹当有形也。
疝者，俗名小肠气也。牡，阳也。小肠心之腑，经络相通，而为表里，寒邪客于小肠，而心脉现紧急之象，
以心为阳脏，小肠为之使，故病形现于少腹，小肠所居之部也。
帝曰∶诊得胃脉，病形何如？岐伯曰∶胃脉实则胀，虚则泄。帝曰∶病成而变何谓？岐伯曰∶风成为寒
热，瘅成为消中，厥成为巅病，久风为飧泄，脉风成为疠。病之变化，不可胜数。
胃司纳谷消化，以生气血，其脉实者，邪积而食不消，故脘中胀满也；脉虚，则气虚下陷，而为泄泻，此
虚实两病也，至其病变，如风客于表，则营卫不和，而成寒热之病，以卫气生于胃也；邪火内蕴，则成瘅，瘅者，
善能消食，而反瘦削，名中消病也；胃气以下行为顺，胃者，阳明也，阳明行气于三阳，或邪气阻格，使三阳
之气厥逆，成巅顶疼痛之病，即前文所云∶上实下虚，成厥巅疾也；若风邪客于胃，风性疏泄迅利，谷食不及
消化而即下泄，病名飧泄也；如风邪入于血脉之中，闭而成热，胃为水谷之海，而主肌肉，邪热水湿蒸腐血脉，
渐致肌肉溃烂，痛痒相兼，名为疠风，俗名大麻风，最为恶病也。是故病变不可胜数，要在明阴阳五行生化、
八风邪正虚实而已。
《素问·大奇论》肾脉小急，肝脉小急，心脉小急，不鼓，皆为瘕。
心肝肾，皆统营血者，三部之脉，或有一部小而急者，皆为营血内结，成有形 瘕也。盖营行脉中，以其
闭结，故脉小不能鼓，按之则急强不和也。
肾肝并沉，为石水；并浮，为风水；并虚，为死；并小弦，欲惊。
肾主寒水，肝主风木，肾肝两脉俱沉者，木沉水中，病名石水，少腹按之必坚，此阳衰水中无气，阴凝如
石而不化也；肾肝俱浮，则风胜而水从风鼓，病名风水也，肝肾并虚，则水涸木枯，生气竭矣，故死；肝肾并
小而弦者，水亏不能涵木，虚风内动而欲惊，肝主惊故也。
肾脉大急沉，肝脉大急沉，皆为疝。心脉搏滑急，为心疝；肺脉沉搏，为肺疝。
疝者，或由风寒，或由湿热，自腑及脏，牵连筋脉，肝主筋，故不离乎肝邪，而肝肾同源，故脉象相同，
此言脉搏急者，风寒之邪多绞痛也，其言 疝者，顽木不痛，湿热之邪也，方书多种，已详明之。今肾肝心肺
之脉皆搏急，谓急强不和，是风寒之邪，故其部位不同而邪则同，故病同，然心疝为小肠病，如上文所云，则
肺疝为大肠病可知矣。
三阳急为瘕，三阴急为疝，二阴急为痫厥，二阳急为惊。
三阳者，太阳也，三阴者，太阴也，瘕者，假物成形也，故其脉急，皆邪气闭结，结于阳为瘕，结于阴为
疝，邪同而病异也；二阴者，少阴也，脉急者，风寒之邪乘心肾，故为痫厥，是抽搐昏厥，不省人事也；二阳
者，阳明也，脉急者，木邪乘胃，所谓闻木音则惕然而惊也。
脉象盛大、滑利且坚硬的，称为病邪在体表；脉象细小、坚实且坚硬的，称为病邪在体内。脉象细小、虚弱而涩滞的，称为久病；脉象滑利、浮浅而疾速的，称为新病。
脉象紧急的，称为疝瘕（腹内结块），伴有少腹部疼痛；脉象滑利的，称为风病；脉象涩滞的，称为痹证（气血运行不畅引起的肢体疼痛麻木）；脉象缓而滑利的，称为热中（内脏有热）；脉象盛大而紧的，称为胀满。
这里也是论述两手脉象所反映的疾病状况。脉象盛大、滑利且坚硬，指轻取时脉势盛大滑利，重按则感觉坚硬，这是外邪盛实，导致脏腑之气不能舒展调和，因而脉象坚实，所以说是病邪在体表；如果脉象细小，轻取时力量不足，重按时则感觉坚实坚硬，这是邪气在脏腑内部，所以说是病邪在体内；这是阴邪结聚在阴分。脉象细小、虚弱而涩滞的，是气血两伤，所以知道它是久病，然而比起脉象细小、坚实且坚硬的脉象来说算是吉兆，凡是脉象达到坚硬程度的，不是难以治疗的顽固疾病，就是损伤根本元气的重病；如果脉象滑利、浮浅而疾速，这是外感邪热，元气尚未受损，所以知道它是新病。脉象紧急的，没有柔和之气，这是阴凝之邪，所以会有疝瘕、少腹痛的疾病；脉象滑利称为风病的，是内风挟带痰浊，如果是外风，其脉象必定浮浅；脉象涩滞的，是寒湿阻滞于血脉之中而形成痹证；脉象缓而滑利的，是热邪损伤中焦，所以脉象纵缓而滑，有力则是热病，无力则是痿病（肢体软弱无力）；脉象盛大而紧的，是阴邪积滞在中焦，必然出现胀满。
《素问·脉要精微论》说：心脉搏动坚实而长，应当发生舌卷缩不能说话的症状；如果脉象软而散漫，应当自愈（原文可能有误）。
搏动坚实而长的，是指脉象弦强有力，这是肝邪侵犯心脏，心主血，肝藏血，舌为心之苗窍，肝主筋，血少则筋脉拘急，《经筋篇》中说，手少阳之筋发生转筋，就会导致舌卷缩，所以发生舌卷缩不能说话的症状；如果脉象软而散漫，是血液损伤、气机耗竭的表现，“消环”二字必有错误，《甲乙经》作“消渴自已”，大概是血液损伤、气机耗竭，津液不生，应当发生消渴病，然而脉象既然软散，说明心火已经微弱，只要静养即可自愈。
肺脉搏动坚实而长，应当发生唾血的症状；如果脉象软而散漫，应当发生大汗淋漓的病，以至于不能再散发出来。
肺主气，肝藏血，肺脉搏动坚实而长，是肝邪横逆侵犯肺脏，血液随着气机上逆而吐出；如果脉象软而散漫，是肺气大伤，腠理开泄，应当发生大汗淋漓，像水灌在身上一样，以至于不能恢复，这是因为津气和阳气向外发散逸失所致。
肝脉搏动坚实而长，面色不发青，应当是因坠落或搏击受伤，因为血液瘀结在胁下，使人喘息气逆；如果脉象软而散漫，面色润泽，应当发生溢饮病，溢饮病的特点是口渴突然大量饮水，水液容易进入肌肉皮肤和肠胃之外。
肝脉搏动坚实而长，是指脉象弦硬有力，肝邪盛实，面色应当发青，现在反而不青，是因为坠落跌倒，或者被搏击导致伤血，血液瘀结在胁下，胁部是肝脏的部位，血瘀则气机逆乱于中焦，升降不利，所以发生喘息和气逆；如果脉象软而散漫，则是气血两伤，面色应当枯槁无光泽，现在反而润泽明亮，是因为水饮漫溢，经气不循常规路径，所以脉象软散，由于口渴时突然大量饮水，于是容易进入肌肉之内，溢于肠胃之外，将有发生肿胀的变化。上编中说：肝脉微缓为水瘕痹，涩甚也为溢饮。大抵微缓、涩及软散的脉象，同为虚弱的脉象，但观察其面色，如果枯槁无光泽，就不是水饮漫溢的疾病了。
胃脉搏动坚实而长，面色发红，应当发生髀部（大腿）疼痛如折断的症状；如果脉象软而散漫，应当发生食痹病。
心火和肝火邪气乘袭胃部，胃脉搏动坚实而长，所以面色发红，髀部是胃经所经过的部位，火邪流注于经络，髀部疼痛如同折断一样；如果脉象软而散漫，是胃气受伤，食物不能消化，反而加重消瘦，病名叫做食痹。
脾脉搏动坚实而长，面色发黄，应当发生气少的症状；如果脉象软而散漫，面色无光泽，应当发生足部肿胀，像水肿的样子。
脾脉本来应该柔缓，现在反而搏动坚实而长，这是木邪横逆克制脾土，所以面色发黄，脉象无力鼓动运化，就会发生气少的症状；如果脉象软而散漫，面无色泽，这是脾土衰败，气机下坠，所以足部肿胀，像水的样子而不是水病，如果是水邪，面色必定润泽明亮。这应当大力培补脾土，肿胀可以逐渐消退。
肾脉搏动坚实而长，面色黄中带红，应当发生腰部疼痛如折断的症状；如果脉象软而散漫，应当发生血少，以至于不能再恢复。
肾藏天一真水，其脉象应当沉实柔滑，现在反而出现搏动坚实而长的脉象，这是肾水亏虚不能涵养肝木，肝木盛实火热炽盛，火又生土而使土气并旺，所以出现黄赤之色，土本克水，腰是肾的府邸，肾水亏虚到了极点，所以腰痛如折断一样；如果脉象软而散漫，是精血少而气也耗损，所以脉象软散，以至于不能再恢复元气。
黄帝说：诊察到心脉紧急，这是什么病？病症表现如何？岐伯说：病名叫心疝，少腹部应当有有形之物。黄帝说：为什么这样说？岐伯说：心是牡脏（阳脏），小肠是它的使道（腑），所以说少腹部应当有有形之物。
疝病，俗称小肠气。牡，指阳。小肠是心的腑，经络相通，互为表里，寒邪客居在小肠，而心脉呈现紧急的象，因为心是阳脏，小肠是它的使道，所以病症表现出现在少腹部，即小肠所在的部位。
黄帝说：诊察到胃脉，病症表现如何？岐伯说：胃脉实则胀满，虚则泄泻。黄帝说：疾病形成后发生变化是什么意思？岐伯说：风邪成为寒热病，瘅热成为消中病，厥逆成为巅顶病，久风成为飧泄病，脉中风邪成为疠风病。疾病的变化，数不胜数。
胃主管受纳谷物消化，以生成气血，胃脉实的，是邪气积聚而食物不消化，所以脘腹胀满；脉虚的，是气虚下陷，而发生泄泻，这是虚实两种病，至于病变，如风邪客居在体表，则营卫不和，而成寒热病，因为卫气生于胃；邪火内蕴，则成瘅热，瘅热的特点是善于消化食物，反而身体消瘦，名叫中消病；胃气以下行为顺，胃属阳明，阳明在三阳经中运行气机，如果邪气阻格，使三阳之气厥逆，形成巅顶疼痛的病，就是前文所说的：上实下虚，形成厥逆巅疾；如果风邪客居在胃，风性疏泄迅利，谷食来不及消化就向下排泄，病名叫飧泄；如果风邪进入血脉之中，闭塞而成热，胃是水谷之海，而主管肌肉，邪热与水湿蒸腐血脉，逐渐导致肌肉溃烂，痛痒兼有，名叫疠风，俗称大麻风，是最为恶毒的疾病。所以病变不可胜数，关键在于明白阴阳五行生化、八风邪正虚实罢了。
《素问·大奇论》说：肾脉小且急，肝脉小且急，心脉小且急，按之不鼓动，都称为瘕病。
心、肝、肾，都统摄营血，三部脉中，如果有一部脉小而急的，都是营血内结，形成有形的瘕病。大概营气行于脉中，因为闭结，所以脉小不能鼓动，按之则感觉急强而不和缓。
肾脉和肝脉都沉，称为石水；都浮，称为风水；都虚，预后不良（死）；都小且弦，将要发生惊悸。
肾主寒水，肝主风木，肾肝两脉都沉的，是木沉在水中，病名叫石水，少腹部按压必定坚硬，这是阳气衰微，水中无气，阴气凝结如石头而不能化解；肾肝两脉都浮，则是风胜而水随风鼓动，病名叫风水；肝肾两脉都虚，则是水涸木枯，生气竭尽，所以死亡；肝肾两脉都小且弦的，是肾水亏虚不能涵养肝木，虚风内动而想要惊悸，因为肝主惊的缘故。
肾脉大、急、沉，肝脉大、急、沉，都称为疝病。心脉搏动滑利而急，称为心疝；肺脉沉而搏动有力，称为肺疝。
疝病，有的由风寒引起，有的由湿热引起，自腑传及脏，牵连筋脉，肝主筋，所以离不开肝邪，而肝肾同源，所以脉象相同，这里说脉搏紧急的，多是风寒之邪导致的绞痛，这里说的[隐]疝，是顽木不痛，属于湿热之邪，方书中记载很多，已经详细说明。现在肾、肝、心、肺的脉象都搏动紧急，谓之急强不和，是风寒之邪，所以虽然部位不同但邪气相同，因此疾病相同，然而心疝是小肠病，如上文所说，那么肺疝是大肠病就可以知道了。
三阳脉紧急产生瘕病，三阴脉紧急产生疝病，二阴脉紧急产生痫厥病，二阳脉紧急产生惊病。
三阳指的是太阳经，三阴指的是太阴经，瘕病是假借物成形，所以脉象紧急，都是邪气闭结，结于阳经为瘕病，结于阴经为疝病，邪气相同而疾病不同；二阴指的是少阴经，脉象紧急的，是风寒之邪乘袭心肾，所以发生痫厥病，即抽搐昏厥，不省人事；二阳指的是阳明经，脉象紧急的，是木邪乘袭胃，所谓听到木音就惊恐不安。
When the pulse is full, slippery, and firm, it indicates that the disease is in the exterior; when the pulse is small, solid, and firm, it indicates that the disease is in the interior. When the pulse is small, weak, and choppy, it is called a chronic disease; when the pulse is slippery, floating, and rapid, it is called an acute disease.
When the pulse is tense, it is called Shan-Jia (abdominal masses), accompanied by pain in the lower abdomen; when the pulse is slippery, it indicates Wind disease; when the pulse is choppy, it indicates Bi syndrome (impediment syndrome caused by obstruction of Qi and Blood); when the pulse is slow and slippery, it indicates Heat in the Middle Jiao; when the pulse is full and tight, it indicates distension.
This also discusses the pathological manifestations reflected by the pulses of both hands. A pulse that is full, slippery, and firm means that upon light pressure, the pulse force is full and slippery, but upon heavy pressure, it feels firm. This indicates that external pathogens are abundant, causing the Qi of the Zang-Fu organs to fail to spread and harmonize, resulting in a firm pulse, thus indicating that the disease is in the exterior. If the pulse is small, lacking strength upon light pressure but feeling solid and firm upon heavy pressure, this indicates that the pathogen is inside the Zang-Fu organs, thus indicating that the disease is in the interior; this is Yin pathogens knotting in the Yin divisions. When the pulse is small, weak, and choppy, it signifies injury to both Qi and Blood, so we know it is a chronic disease. However, compared to a small, solid, and firm pulse, this is considered auspicious. Whenever the pulse becomes hard and firm, it is either a difficult-to-treat stubborn disease or a severe illness damaging the Yuan Qi. If the pulse is slippery, floating, and rapid, this indicates external contracted pathogenic heat with undamaged Yuan Qi, so we know it is an acute disease. A tense pulse lacks a soft and harmonious quality, indicating Yin condensing pathogens, hence the diseases of Shan-Jia and lower abdominal pain. A slippery pulse indicating Wind disease refers to internal Wind carrying Phlegm; if it were external Wind, the pulse would necessarily be floating. A choppy pulse indicates Cold-Dampness stagnating in the blood vessels forming Bi syndrome. A slow and slippery pulse indicates Heat pathogens injuring the Middle Jiao; thus the pulse is relaxed and slippery. If forceful, it is a Heat disease; if forceless, it is Wei syndrome (flaccidity syndrome). A full and tight pulse indicates Yin pathogens accumulating and stagnating in the middle, inevitably leading to distension.
The *Su Wen: Mai Yao Jing Wei Lun* states: "If the Heart pulse beats firmly and long, one should expect tongue retraction and inability to speak; if it is soft and scattered, it will resolve on its own."
Firm and long beating refers to a string-tight, strong, and forceful pulse, where Liver pathology invades the Heart. The Heart governs Blood, the Liver stores Blood, and the tongue is the sprout of the Heart. The Liver governs sinews; when Blood is deficient, sinews become tense. The *Jing Jin Pian* states that if the Hand Shaoyang sinew twists, it causes tongue retraction, hence the disease of tongue retraction and inability to speak. If the pulse is soft and scattered, it indicates injury to Blood and depletion of Qi. The term "Xiao Huan" likely contains an error; the *Jia Yi Jing* reads "Xiao Ke zi yi" (Wasting-thirst will resolve on its own). Likely, due to Blood injury and Qi depletion, Body Fluids are not generated, leading to Xiao Ke (Wasting-thirst). However, since the pulse is soft and scattered, Heart Fire has already diminished, and recovery can occur through quiet nourishment.
If the Lung pulse beats firmly and long, one should expect spitting of blood; if it is soft and scattered, one should expect profuse sweating, which cannot be stopped.
The Lung governs Qi, and the Liver stores Blood. A firm and long Lung pulse indicates Liver pathology invading the Lung horizontally, causing Blood to rise with Qi and be spat out. If the pulse is soft and scattered, Lung Qi is severely damaged, and the Cou Li (pores) are open, leading to profuse sweating like water pouring over the body, unable to recover, because Jing Qi and Yang Qi are dispersing outward.
If the Liver pulse beats firmly and long, but the complexion is not green, it indicates injury from falling or striking, with blood stasis knotting in the hypochondrium, causing panting and rebellious Qi. If the pulse is soft and scattered, but the complexion is lustrous, it indicates Yi Yin (overflowing fluid) disease. Yi Yin is characterized by sudden thirst and excessive drinking, where fluids easily enter outside the muscles, skin, and intestines.
A firm and long Liver pulse indicates a string-hard and forceful pulse. Liver pathology is abundant, so the complexion should be green; the fact that it is not green indicates injury from falling or striking, causing blood stasis to knot in the hypochondrium. The hypochondrium is the region of the Liver; blood stasis causes Qi rebellion in the Middle Jiao, disrupting ascending and descending, hence panting and rebellious Qi. If the pulse is soft and scattered, it indicates injury to both Qi and Blood, and the complexion should be withered and dull. The fact that it is now lustrous and bright indicates overflowing fluids, where Jing Qi does not follow its normal course, hence the soft and scattered pulse. Due to sudden excessive drinking during thirst, fluids easily enter the muscles and overflow outside the intestines, potentially leading to swelling. The upper compilation states: "A slightly slow Liver pulse indicates Water Shan-Jia Bi; a very choppy pulse also indicates Yi Yin." Generally, slightly slow, choppy, and soft/scattered pulses are all weak pulses. Observing the complexion, if it is withered and dull, it is not a disease of overflowing water.
If the Stomach pulse beats firmly and long, and the complexion is red, one should expect pain in the thigh (Bi) as if broken. If the pulse is soft and scattered, one should expect Shi Bi (food impediment).
Heart and Liver Fire pathogens attacking the Stomach cause the Stomach pulse to beat firmly and long, hence the red complexion. The Bi (thigh) is the area traversed by the Stomach meridian; Fire pathogens flowing into the meridian cause Bi pain as if broken. If the pulse is soft and scattered, Stomach Qi is injured, food cannot be digested, and emaciation worsens; this disease is named Shi Bi.
If the Spleen pulse beats firmly and long, and the complexion is yellow, one should expect shortness of Qi. If the pulse is soft and scattered, and the complexion lacks luster, one should expect foot swelling resembling edema.
The Spleen pulse should naturally be soft and slow. If it beats firmly and long, it indicates Wood pathology overcoming Earth, hence the yellow face. With no power to drive transformation, Shortness of Qi occurs. If the pulse is soft and scattered and the face lacks color/luster, it indicates Spleen Earth decline and sinking Qi, hence foot swelling resembling water, though it is not true water disease. If it were water pathology, the complexion would be lustrous and bright. One must strongly tonify Spleen Earth for the swelling to gradually subside.
If the Kidney pulse beats firmly and long, and the complexion is yellowish-red, one should expect lower back pain as if broken. If the pulse is soft and scattered, one should expect deficiency of Blood, unable to recover.
The Kidney stores Tian Yi True Water; its pulse should be deep, solid, soft, and slippery. A firm and long pulse indicates Kidney Water deficiency failing to nourish Liver Wood. Liver Wood becomes abundant and Fire blazes; Fire generates Earth, making Earth prosperous, hence the yellow-red complexion. Earth controls Water. The waist is the mansion of the Kidney. Extreme Kidney Water deficiency causes lower back pain as if broken. If the pulse is soft and scattered, it indicates deficiency of Essence and Blood and depletion of Qi, hence the soft and scattered pulse, unable to recover Yuan Qi.
The Yellow Emperor said: "I diagnose a tense Heart pulse. What is this disease? What are the symptoms?" Qibo said: "The disease is named Xin Han (Heart Hernia), and there should be a palpable mass in the lower abdomen." The Yellow Emperor asked: "Why do you say so?" Qibo replied: "The Heart is a Yang organ (Mu Zang), and the Small Intestine is its envoy (Fu). Therefore, there should be a palpable mass in the lower abdomen."
Han (Hernia) is commonly known as Small Intestine Qi. Mu refers to Yang. The Small Intestine is the Fu of the Heart, connected by meridians, forming interior-exterior pairs. Cold pathogens lodging in the Small Intestine cause the Heart pulse to appear tense. Since the Heart is a Yang organ and the Small Intestine is its envoy, the disease manifestation appears in the lower abdomen, the location of the Small Intestine.
The Yellow Emperor asked: "I diagnose the Stomach pulse. What are the symptoms?" Qibo said: "A full Stomach pulse indicates distension; a deficient Stomach pulse indicates diarrhea." The Yellow Emperor asked: "What is meant by changes after disease formation?" Qibo said: "Wind becomes Cold-Heat; Dan (fever/heat) becomes Xiao Zhong (Middle Wasting); Jue (reversal) becomes Dian Bing (head disease); chronic Wind becomes Sun Xie (undigested stool diarrhea); Wind in the pulse becomes Li Feng (leprosy). The changes of disease are countless."
The Stomach governs receiving grain and digestion to generate Qi and Blood. A full pulse indicates pathogen accumulation and indigestion, hence epigastric distension. A deficient pulse indicates Qi deficiency and sinking, leading to diarrhea; these are two diseases of excess and deficiency. Regarding pathological changes: if Wind lodges in the exterior, Ying and Wei become disharmonious, forming Cold-Heat disease, because Wei Qi is generated by the Stomach. Internal entrapment of pathogenic Fire forms Dan. Dan is characterized by good appetite but emaciation, named Zhong Xiao (Middle Wasting-Thirst). Stomach Qi prefers descending. The Stomach belongs to Yangming. Yangming circulates Qi among the Three Yang channels. If pathogenic factors obstruct, causing reversal of Qi in the Three Yang channels, it forms headache at the vertex, i.e., the previously mentioned Upper Excess Lower Deficiency forming Jue Dian Ji. If Wind pathogens lodge in the Stomach, their nature is dispersing and rapid, causing food to pass down undigested, named Sun Xie. If Wind pathogens enter the blood vessels, blocking and generating heat, and since the Stomach is the Sea of Water and Grain and governs muscles, pathogenic heat steams and corrupts the blood vessels, gradually causing muscle ulceration with pain and itching, named Li Feng (commonly Leprosy/Great Wind), the most malignant disease. Thus, disease changes are countless, depending on understanding Yin-Yang, Five Elements generation/transformation, Eight Winds, and the reality/deficiency of pathogens.
The *Su Wen: Da Qi Lun* states: "If the Kidney pulse is small and urgent, the Liver pulse is small and urgent, and the Heart pulse is small and urgent, and does not beat forcefully upon pressure, all indicate Jia (masses)."
The Heart, Liver, and Kidney all govern Ying Blood. If any of the three positions presents a small and urgent pulse, it indicates Ying Blood knotting internally, forming tangible Jia masses. Ying flows within the vessels; due to blockage, the pulse is small and cannot beat forcefully; upon pressure, it feels urgent, strong, and unharmonious.
If the Kidney and Liver pulses are both deep, it is Shi Shui (Stone Water); if both are floating, it is Feng Shui (Wind Water); if both are deficient, it indicates death; if both are small and string-tight, it indicates impending fright.
The Kidney governs Cold Water, and the Liver governs Wind Wood. If both Kidney and Liver pulses are deep, Wood sinks in Water, named Shi Shui. Pressing the lower abdomen reveals hardness; this is Yang decline, lack of Qi in Water, and Yin condensation like stone without transformation. If both Kidney and Liver pulses are floating, Wind prevails and Water follows Wind to surge, named Feng Shui. If both Kidney and Liver pulses are deficient, Water dries up and Wood withers, vital Qi is exhausted, hence death. If both Kidney and Liver pulses are small and string-tight, Kidney Water deficiency fails to nourish Liver Wood, internal defunct Wind moves causing fright, because the Liver governs fright.
If the Kidney pulse is large, urgent, and deep, and the Liver pulse is large, urgent, and deep, both indicate Han (Hernia). If the Heart pulse is slippery and urgent, it indicates Xin Han (Heart Hernia); if the Lung pulse is deep and beating forcefully, it indicates Fei Han (Lung Hernia).
Han may be caused by Cold-Wind or Damp-Heat, spreading from Fu to Zang, involving sinews. The Liver governs sinews, so it always involves Liver pathology. Since Liver and Kidney share the same source, the pulse images are similar. Here, urgent pulses indicate mostly Cold-Wind causing colic pain. The [obscured] Han refers to numbness without pain, caused by Damp-Heat pathogens, detailed in various medical texts. Now, since the Kidney, Liver, Heart, and Lung pulses all beat urgently (urgent, strong, and unharmonious), it indicates Cold-Wind pathogens. Although locations differ, the pathogen is the same, hence the disease is similar. However, Xin Han is a Small Intestine disease; as stated above, Fei Han must therefore be a Large Intestine disease.
Urgent pulses in the Three Yang channels produce Jia masses; urgent pulses in the Three Yin channels produce Han; urgent pulses in the Two Yin channels produce Xian Jue (epileptic convulsions and fainting); urgent pulses in the Two Yang channels produce Jing (fright).
Three Yang refers to Taiyang; Three Yin refers to Taiyin. Jia masses take shape from false entities. Urgent pulses indicate pathogen closure and knotting. Knotting in Yang produces Jia; knotting in Yin produces Han; the pathogen is the same, but the disease differs. Two Yin refers to Shaoyin. Urgent pulses indicate Cold-Wind pathogens attacking Heart and Kidney, producing Xian Jue (convulsions, fainting, loss of consciousness). Two Yang refers to Yangming. Urgent pulses indicate Wood pathology attacking the Stomach, i.e., being startled by the sound of wood.