夫脉之大体二十六种，此诊候之纪纲也。细而论之，毫厘少差，举治必远。总
而言之，逆从虚实，阴阳而已，两者议之，以要其中，谨于诸家脉法中撮其机要，删
去繁芜，载其精义。
浮脉之诊，浮于指下，按之不足，举之有余，再再寻之，状如太过，瞥瞥然见
于皮毛间，其主表证，或为风，或为虚。浮而大散者，心也；浮而短涩者，肺也；浮
而数者，热也；浮数之脉应发热，其不发热而反恶寒者，疮疽之谓也。
洪脉之诊，似浮而大，按举之则泛泛然满三部，其状如水之洪流，波之涌起，其
主血实积热疮肿。论曰∶脉洪大者，疮疽之病进也。如疮疽结脓未成者，宜下之；脓
溃之后，脉见洪大，则难治；若自利者，不可救治也。
滑脉之诊，实大相兼，往来流利如珠，按之则累累然滑也，其主或为热，或为虚，
此阳脉也。疮疽之病，脓未溃者，宜内消
也；脓溃之后，宜托里也；所谓始为热，而继为虚也。
数脉之诊，按之则呼吸之间动及六至，其状似滑而数也。若浮而数，则表热也；沉
而数，即里热也。又曰∶诸数为热。仲景曰∶脉数不时见，则生恶疮也。又曰∶肺
脉洪数，则生疮也，诊诸疮洪数者，里欲有脓结也。
散脉之诊，似浮而数，按之则散而欲去，举之则大而无力，其主气实而血虚，有
表有里。疮肿脓溃之后而烦痛，尚未痊退者，诊其脉洪滑粗散，难治也，以其正气
虚而邪气实也。又曰∶肌体沉重，肺脉大而毙，谓浮散者也。
芤脉之诊，似浮而软，按之中央空，两边实，其主血虚，或为失血。疮肿之病，诊
得芤脉，脓溃后易治，以其脉病相应也。
长脉之诊，按之得洪大而长，出于本位，其主阳气有余也。伤寒得之，欲汗出
自解也。长而缓者，胃脉也，百病皆愈，谓之长则气治也。
牢脉之诊，按之则实大而弦，且沉且浮，而有牢坚之意，若瘰 结肿，诊得牢
脉者，不可内消也。
实脉之诊，按举有力而类结曰实。经曰∶邪气甚则实，久病则虚，人得此最忌。
疮疽之人得此，宜急下之，以其邪气与脏腑俱实故也。
弦脉之诊，按之则紧而弦，其似紧者为弦，如按弦而不移，紧如内绳而转动，以
此为异。春脉浮弦而平，不时见则为饮为痛，主寒主虚。疮疽论曰∶弦洪相搏，外
紧内热，欲发疮疽也。
紧脉之诊，似弦而紧，按之如切绳而转动，其主切痛积癖也。疮肿得之，气血
沉涩也，亦主痛也。
涩脉之诊，按之则散而复来，举之则细而不足，脉涩，则气涩也，亦主血虚疮
肿。溃后得之无妨也。
短脉之诊，按举则不及本位。《内经》
曰∶短则气病，以其无胃气也。诸病脉短，皆难治也；疮肿脉短，真气短也。
细脉之诊，按之则萦萦如蜘蛛之丝而欲绝，举之如无而似有，细而微，其主亡
阳。疮肿之病，脉来细而沉时直者，里虚而欲变证也。
微脉之诊，按之则软小而极微，其主虚也。真气复者生，邪气胜者危；疮肿之
病溃后，脉微而匀举自差也。
迟脉之诊，按举来迟，呼吸定息，方得三至，其状似缓而稍迟。痼疾得之，则
善；新疾得之，则正气虚惫。疮肿得之，溃后自痊。
缓脉之诊，按举似迟而稍疾于迟。仲景曰∶阳脉浮大而濡，阴脉浮大而涩，阴
阳同等谓之缓。脉见长缓，百疾自瘳；凡诸疮肿溃后，其脉涩迟缓者，皆易愈，以
其脉候相应，是有胃气也。
沉脉之诊，举之不足，按之方见如烂绵，其主邪气在脏也。水气得之则逆，此
阴脉也；疮肿得之，邪气深也。
伏脉之诊，比沉而伏，举之则无，按之至骨方得，与沉相类，而邪气益深矣。
虚脉之诊，按之不足，迟大而软，轻举指下豁然而空。经曰∶脉虚则血虚，血
虚生寒，阳气不足也。疮肿脉虚，宜托里，和气养血也。
软脉之诊，按之如帛在水中，极软而细，亦谓之濡。其主胃气弱，疮肿得之，补
虚排脓托里。
弱脉之诊，似软而极微，来迟而似有。仲景曰∶微弱之脉，绵绵如泻漆之绝。其
主血气俱虚，形精不足，大抵疮家沉迟濡弱，皆宜托里。
促脉之诊，按之则去数，来时一止而复来。仲景曰∶阳盛则促，主热蓄于里也，
下之则和，疮肿脉促，亦急下之。
结脉之诊，按之则往来迟缓，时一止而复来。仲景曰∶阴盛则结。经曰∶促结则生，代则死。
代脉之诊，按之则往来，动则中止，不能自还，因而复动者，曰代脉也。因其止
有常数而不忒，如十动一止，虽数十次，皆见于十动之后；如二十动一止，虽数十次，
皆见于二十动之后。代者，气衰也，诸病见之不祥。大凡疮肿之病，脉促结者难治，而况是代脉乎！
动脉之诊，见于关上，无头尾，如豆大，厥厥然而动摇者是也。《脉经》曰∶阴
阳相搏，故谓之动。动于阳则阳气虚而发厥，动于阴则阴气虚而发热，是阳生于尺
而动于寸，阴生于寸而动于尺，不可不辨也。
《脉诀》曰∶气血沉涩脉来紧，身有痛处，即发疮疽之兆。身应发热，脉浮数，人
反恶寒，即为疮疽之萌。
张仲景曰∶脉数不时见，则生恶疮。
又曰∶肺脉俱数则生疮。
又曰∶脉实大洪大，初起为病进，已溃为邪气未退。
又曰∶脉沉实沉伏，初起主邪气深伏，难痊，溃为余毒。
又曰∶脉芤、涩、迟、缓，溃后为脉证相应，无妨，若短细则将变证，此六脉宜于溃后，不利于初起。
又曰∶脉浮大浮数，初起为邪正相搏，有余，若促结则非吉兆，此六脉宜于初起，
不利于溃后。
朱丹溪曰∶脉数，热也，多兼实，阳证之所由生，若兼虚，后必陷为阴。脉迟，
寒也，多兼阴证之所由生，若兼实，后必返为阳。
王肯堂曰∶脉沉实，发热烦躁，外无 赤痛，其邪深在里，宜先疏通，以绝其源。
浮大数， 肿在外，当先托里，恐邪入内。
脉不沉不浮，内外证无，知其在经，当和营卫。
脉数，身无热，内有痈脓。
脉数，应当发热，而反恶寒，若有痛处，当发痈。
若数脉不时见，当生恶疮。
浮，肿疡为虚为风；溃疡为虚宜补。
洪，肿疡为虚，为热盛，宜宣热拔毒，年壮形实，宜下；溃疡为邪气盛，服药久不退者，难治。
滑，肿疡为热；溃疡为热为虚，为邪气未退。
数，肿疡为病退，为热，数而洪者欲脓。溃疡为难愈，数甚者难治。
散，肿疡为气不收敛，溃疡为痛未退，洪滑大散难治。
芤，肿疡为血虚。溃疡为脉病相应。
长，肿疡宜消退之法。溃疡为易愈，谓长则气治也。
牢，肿疡为邪盛，为欲脓；溃疡为邪气不退。
实，肿疡为邪气太盛；溃疡为邪不退，为实，缓豁大者为虚。
弦，肿疡为痛，为欲脓；弦洪相搏，外紧内热，为疽发也；溃疡为血虚、为痛。
紧，肿疡浮而紧，发热恶寒，或有痛处，是为痈疽；溃疡主气血沉涩，为痛，为有外寒。
涩，肿疡为气实，为气滞，溃疡为血虚，为脉病相应。
短，肿疡为元气不足；溃疡为大虚，宜补。
微，肿疡为虚，服药渐充者佳；溃疡为虚，若微而匀者，为脉病相应。
迟，肿疡为寒为虚，尺迟为血少；溃疡为虚，为气血不能滋荣于疮，为有外寒。
缓，肿疡为可治，大而缓为虚；溃疡缓而涩者愈；以其病脉相应，及胃气充也。
沉，肿疡为邪气深。溃疡为遗毒在内，寸沉为胸有痰。
伏，肿疡为阴中伏阳邪；溃疡为阳伏阴中，为内蚀，为流注浸淫，难治。
虚，肿疡便宜补而内托；溃疡脓既泄，
宜大补血气。
弱，肿疡为元气不足，宜内补托里。
结，肿疡为邪气结；溃疡渐匀则愈，不调则危。
促，肿疡为热，为病进；溃疡为热不减，渐进则死，渐退则生。
代，肿疡为气血败坏，元气损伤；溃疡为元气竭绝。
薛立斋曰∶谨按脉者，人身之造化，病机之外见，医家之准绳，不可不精究而熟
察；至于太溪、冲阳，又为诊法之要，生死之机也。故十二经脉皆系于生气，气乃
人之根本，寸口脉平而死者，生气独绝于内也。《难经》云∶上部有脉，下部无脉，
其人当吐不吐者死；上部无脉，下部有脉，难困无能为害，是脉有根本，人有元气也。
夫人受气于谷，乃传于脏腑，清者为荣，浊者为卫，荣行脉中，卫行脉外，阴阳相贯，
如环无端，周流一身，昼夜各有常度，其不相应者，病也。病至于甚，脉道乃乖，抑
尝治雀啄屋漏之类，若因药饵克伐所致，急用参 归术姜附之剂，多有复生者，不可
遂弃而不治也。
又曰∶痈疽未溃而脉先弱者，何以收敛。
脉象的总体分类共有二十六种，这是诊断候察的纲领。细致地分析起来，毫厘之间的微小差异，会导致治疗方向完全偏离。总而言之，不外乎逆顺、虚实、阴阳罢了，对这两方面进行审议，以把握其关键要点，谨慎地从各家脉法中摘录其精要，删去繁杂冗余的内容，记载其精髓义理。
浮脉的诊断特征：脉位浮于指下，重按感觉力量不足，轻取感觉有余，反复寻按，脉势显得太过，忽然显现于皮毛之间，它主表证，或者是风邪致病，或者是虚证。浮而大且散的脉象，对应心脏；浮而短且涩的脉象，对应肺脏；浮而数的脉象，主热证。浮数脉应当伴有发热症状，如果不发热反而恶寒，这就是疮疽（皮肤及皮下组织的化脓性感染）的表现。
洪脉的诊断特征：脉象似浮而大，重按和轻取都感觉泛泛然充满寸关尺三部，其状如水之洪流，波浪涌起，它主血实积热导致的疮肿。医论说：脉象洪大的，是疮疽病情进展的表现。如果疮疽结脓但尚未形成脓肿，适宜用攻下法；脓溃之后，脉象见洪大，则难以治疗；如果出现自发性腹泻，则不可救治。
滑脉的诊断特征：脉形实大兼有滑利感，往来流利如珠滚过，重按时感觉累累然滑润，它主热证或虚证，这属于阳脉。对于疮疽病，脓未溃时，适宜采用内消法；脓溃之后，适宜采用托里法；这就是所谓起初为热证，随后转为虚证。
数脉的诊断特征：重按时呼吸之间脉搏跳动达到六次以上，其状似滑而快。如果浮而数，则是表热；沉而数，则是里热。又说：各种数脉都主热证。张仲景说：脉数不时出现，就会生恶疮。又说：肺脉洪数，就会生疮，诊察各种疮疡见洪数脉的，说明体内将要结脓。
散脉的诊断特征：脉象似浮而数，重按时脉气散乱欲去，轻取时脉形大而无力，它主气实而血虚，病位既有在表也有在里。疮肿脓溃之后出现烦痛，尚未痊愈消退的，诊得脉象洪滑粗散，属于难治，因为正气虚弱而邪气盛实。又说：身体沉重，肺脉大而散（浮散），预示死亡。
芤脉的诊断特征：脉象似浮而软，重按中间空豁，两边实，它主血虚，或者是失血。疮肿之病，诊得芤脉，脓溃后容易治疗，因为脉象与病情相应。
长脉的诊断特征：重按时感到洪大而长，超出本位，它主阳气有余。伤寒病见到此脉，想要通过出汗自行解除。长而缓的脉象，是胃脉，百病皆愈，称为“长则气治”（脉长表示气血调和）。
牢脉的诊断特征：重按时脉象实大而弦，且沉且浮，而有牢坚之意，如果是瘰疬（颈部淋巴结结核）结肿，诊得牢脉者，不可使用内消法。
实脉的诊断特征：轻取重按都有力且类似结脉称为实。经书说：邪气盛则表现为实脉，久病则表现为虚脉，人得到实脉是最忌讳的。疮疽病人得到实脉，宜急用攻下法，因为邪气与脏腑都呈实象。
弦脉的诊断特征：重按时脉紧而弦，那种类似紧脉的是弦脉，如按琴弦而不移动，紧脉如内绳转动，以此作为区别。春脉浮弦而平和，不时出现则为饮邪或疼痛，主寒主虚。疮疽论说：弦脉与洪脉相搏，外紧内热，将要发疮疽。
紧脉的诊断特征：似弦而紧，重按时如切绳转动，它主切痛和积癖（积聚癖块）。疮肿得到此脉，说明气血沉涩，也主痛证。
涩脉的诊断特征：重按时脉气散而复来，轻取时脉细而不足，脉涩，说明气机涩滞，也主血虚疮肿。溃后得到此脉无妨。
短脉的诊断特征：轻取重按都不及本位。《内经》说：短脉主气病，因为它没有胃气。各种疾病见短脉，都难治；疮肿见短脉，是真气短少。
细脉的诊断特征：重按时脉气萦萦如蜘蛛丝将断，轻取时如无而似有，细而微，它主亡阳。疮肿之病，脉来细而沉直者，是里虚且将要发生变证。
微脉的诊断特征：重按时脉软小而极微，它主虚证。真气恢复则生，邪气胜则危；疮肿之病溃后，脉微而均匀，轻取即差（好转）。
迟脉的诊断特征：轻取重按来势迟缓，一呼一吸定息，才得三次搏动，其状似缓而稍迟。痼疾（久病）得到此脉，则好；新疾得到此脉，则正气虚惫。疮肿得到此脉，溃后自愈。
缓脉的诊断特征：轻取重按似迟而稍快于迟。张仲景说：阳脉浮大而濡，阴脉浮大而涩，阴阳同等称为缓。脉见长缓，百病自愈；凡各种疮肿溃后，脉象涩迟缓的，都易愈，因为脉候相应，是有胃气的表现。
沉脉的诊断特征：轻取感觉不足，重按方见如烂绵，它主邪气在脏。水气得此脉则逆，这是阴脉；疮肿得到此脉，说明邪气深。
伏脉的诊断特征：比沉脉更深伏，轻取时无，重按至骨方得，与沉脉相似，但邪气更深。
虚脉的诊断特征：重按感觉不足，迟大而软，轻举指下豁然空。经书说：脉虚则血虚，血虚生寒，阳气不足。疮肿脉虚，宜托里，和气养血。
软脉的诊断特征：重按时如帛在水中，极软而细，也称为濡脉。它主胃气弱，疮肿得到此脉，宜补虚排脓托里。
弱脉的诊断特征：似软而极微，来迟而似有。张仲景说：微弱之脉，绵绵如泻漆之绝。它主血气俱虚，形体精神不足，大抵疮家见沉迟濡弱，都宜托里。
促脉的诊断特征：重按时去数（快速），来时一止而复来。张仲景说：阳盛则促，主热蓄于里，攻下则和，疮肿脉促，也宜急下。
结脉的诊断特征：重按时往来迟缓，时一止而复来。张仲景说：阴盛则结。经书说：促结脉主生，代脉主死。
代脉的诊断特征：重按时往来，动则中止，不能自还，因而复动的，叫代脉。因其止有常数而不差错，如十动一止，虽数十次，皆见于十动之后；如二十动一止，虽数十次，皆见于二十动之后。代者，气衰也，诸病见之不祥。大凡疮肿之病，脉促结者难治，何况是代脉呢！
动脉的诊断特征：见于关上，无头尾，如豆大，厥厥然而动摇者是也。《脉经》说：阴阳相搏，故谓之动。动于阳则阳气虚而发厥，动于阴则阴气虚而发热，阳生于尺而动于寸，阴生于寸而动于尺，不可不辨。
《脉诀》说：气血沉涩脉来紧，身有痛处，即发疮疽之兆。身应发热，脉浮数，人反恶寒，即为疮疽之萌。
又说：脉芤、涩、迟、缓，溃后为脉证相应，无妨，若短细则将变证，此六脉宜于溃后，不利于初起。
又说：脉浮大浮数，初起为邪正相搏，有余，若促结则非吉兆，此六脉宜于初起，不利于溃后。
朱丹溪说：脉数，热也，多兼实，阳证之所由生，若兼虚，后必陷为阴。脉迟，寒也，多兼阴证之所由生，若兼实，后必返为阳。
王肯堂说：脉沉实，发热烦躁，外无赤痛，其邪深在里，宜先疏通，以绝其源。脉浮大数，肿在外，当先托里，恐邪入内。脉不沉不浮，内外证无，知其在经，当和营卫。脉数，身无热，内有痈脓。脉数，应当发热，而反恶寒，若有痛处，当发痈。若数脉不时见，当生恶疮。
洪，肿疡为虚，为热盛，宜宣热拔毒，年壮形实，宜下；溃疡为邪气盛，服药久不退者，难治。
数，肿疡为病退，为热，数而洪者欲脓。溃疡为难愈，数甚者难治。
弦，肿疡为痛，为欲脓；弦洪相搏，外紧内热，为疽发也；溃疡为血虚、为痛。
紧，肿疡浮而紧，发热恶寒，或有痛处，是为痈疽；溃疡主气血沉涩，为痛，为有外寒。
微，肿疡为虚，服药渐充者佳；溃疡为虚，若微而匀者，为脉病相应。
迟，肿疡为寒为虚，尺迟为血少；溃疡为虚，为气血不能滋荣于疮，为有外寒。
缓，肿疡为可治，大而缓为虚；溃疡缓而涩者愈；以其病脉相应，及胃气充也。
伏，肿疡为阴中伏阳邪；溃疡为阳伏阴中，为内蚀，为流注浸淫，难治。
薛立斋说：谨按脉者，人身之造化，病机之外见，医家之准绳，不可不精究而熟察；至于太溪、冲阳，又为诊法之要，生死之机也。故十二经脉皆系于生气，气乃人之根本，寸口脉平而死者，生气独绝于内也。《难经》云：上部有脉，下部无脉，其人当吐不吐者死；上部无脉，下部有脉，难困无能为害，是脉有根本，人有元气也。夫人受气于谷，乃传于脏腑，清者为荣，浊者为卫，荣行脉中，卫行脉外，阴阳相贯，如环无端，周流一身，昼夜各有常度，其不相应者，病也。病至于甚，脉道乃乖，抑尝治雀啄屋漏之类，若因药饵克伐所致，急用参归术姜附之剂，多有复生者，不可遂弃而不治也。
The general classification of pulse types comprises twenty-six kinds, which serve as the outline for diagnostic observation. Analyzed in detail, even a minute discrepancy can lead to treatment deviating significantly from the correct path. In summary, it boils down to reversal and compliance, deficiency and excess, yin and yang. By deliberating on these two aspects, one grasps the essential points, carefully extracting the core principles from various schools of pulse diagnosis, deleting redundancies, and recording the refined meanings.
**Floating Pulse (Fu Mai):** The pulse is felt floating under the fingers; pressure reveals insufficiency, while light touch reveals abundance. Repeated searching shows an excessive quality, appearing suddenly between the skin and hair. It indicates exterior syndromes, wind pathogens, or deficiency. A floating, large, and scattered pulse corresponds to the Heart; a floating, short, and choppy pulse corresponds to the Lung; a floating and rapid pulse indicates heat. While a floating-rapid pulse should be accompanied by fever, if there is no fever but rather aversion to cold, it signifies carbuncles and sores (Chuang Ju).
**Surging Pulse (Hong Mai):** The pulse seems floating and large; upon both pressing and lifting, it feels broadly filling all three positions (Cun, Guan, Chi). Its appearance is like a torrent of water or rising waves. It indicates blood excess and accumulated heat leading to swelling and sores. The treatise states: A surging-large pulse indicates the progression of carbuncles and sores. If pus has formed but not yet abscessed, purgation is appropriate. After rupture, if the pulse remains surging-large, it is difficult to treat. If spontaneous diarrhea occurs, it is incurable.
**Slippery Pulse (Hua Mai):** The pulse is full, large, and slippery, flowing smoothly like pearls rolling. Pressing reveals a continuous slippery sensation. It indicates heat or deficiency, belonging to yang pulses. For carbuncles and sores, before rupture, internal resolution is suitable; after rupture, supporting the interior is suitable. This reflects the transition from initial heat to subsequent deficiency.
**Rapid Pulse (Shu Mai):** Upon pressing, the pulse beats six times or more per respiration cycle. It resembles a slippery pulse but is faster. Floating and rapid indicates exterior heat; sinking and rapid indicates interior heat. Generally, rapid pulses indicate heat. Zhang Zhongjing stated: Intermittent rapid pulses indicate the development of malignant sores. Also: A lung pulse that is surging and rapid indicates sore formation. In diagnosing sores, a surging-rapid pulse suggests impending pus accumulation.
**Scattered Pulse (San Mai):** The pulse seems floating and rapid, but upon pressing, it scatters and fades; upon lifting, it is large and forceless. It indicates qi excess and blood deficiency, with pathology involving both exterior and interior. After rupture of a sore with lingering pain, a surging-slippy-rough-scattered pulse is difficult to treat due to deficient healthy qi and excess pathogenic factors. Additionally: Heavy body combined with a large, floating-scattered lung pulse indicates death.
**Gourd Kernel Pulse (Kou Mai):** The pulse seems floating and soft; pressing reveals emptiness in the center and solidity at the edges. It indicates blood deficiency or hemorrhage. In sores, a gourd kernel pulse after rupture indicates easy treatment because the pulse matches the condition.
**Long Pulse (Chang Mai):** Pressing reveals a surging, large, and long pulse extending beyond its normal position. It indicates excess yang qi. In cold damage, this pulse suggests sweating will resolve the condition. A long and moderate pulse is the stomach pulse, indicating recovery from various diseases ("Long implies harmonious qi").
**Firm Pulse (Lao Mai):** Pressing reveals a solid, large, and wiry pulse, deep yet firm. In cases of scrofula or nodular swelling, a firm pulse contraindicates internal resolution methods.
**Excess Pulse (Shi Mai):** Forceful upon both light and heavy pressure, resembling a knotted pulse. Classics state: Excess indicates strong pathogens; chronic illness indicates deficiency. Obtaining an excess pulse is generally unfavorable. In carbuncles and sores, urgent purgation is needed because both pathogens and organs are in an excess state.
**Wiry Pulse (Xian Mai):** Pressing reveals tightness and wiriness, distinct from tightness by its static nature like a string, whereas tightness moves like a rope. Spring pulses are floating and wiry and considered normal; otherwise, they indicate fluid retention or pain, cold, or deficiency. In sores: Wiry and surging pulses together indicate external tightness and internal heat, signaling impending carbuncle/sores.
**Tight Pulse (Jin Mai):** Similar to wiry but tighter, feeling like cutting a rotating rope. It indicates sharp pain and accumulations. In sores, it indicates stagnant qi and blood and pain.
**Choppy Pulse (Se Mai):** Pressing reveals scattering and returning; lifting reveals thinness and insufficiency. Choppy pulse indicates stagnant qi and blood deficiency in sores. It is acceptable after rupture.
**Short Pulse (Duan Mai):** Light and heavy pressure do not reach the normal position. *Neijing* states: Short pulse indicates qi disease due to lack of stomach qi. Short pulse in any disease is difficult to treat; in sores, it indicates depletion of true qi.
**Fine Pulse (Xi Mai):** Pressing feels like a spider's thread about to break; lifting feels non-existent yet present. It is fine and subtle, indicating collapse of yang. In sores, a fine, sinking, straight pulse indicates interior deficiency and impending transformation.
**Micro Pulse (Wei Mai):** Pressing reveals a soft, small, and extremely faint pulse. It indicates deficiency. Recovery of true qi brings life; dominance of pathogens brings danger. After sore rupture, a micro and uniform pulse indicates improvement.
**Slow Pulse (Chi Mai):** Coming slowly upon lifting and pressing, beating only three times per respiration cycle. It resembles a moderate pulse but slower. In chronic diseases, it is favorable; in acute diseases, it indicates exhausted healthy qi. In sores, it indicates self-healing after rupture.
**Moderate Pulse (Huan Mai):** Feels slightly faster than slow. Zhang Zhongjing defined moderate pulse via specific combinations of yin/yang positions. Long and moderate pulses indicate healing of hundred diseases. After sore rupture, choppy-slow-moderate pulses indicate easy recovery due to matching pulse-condition and presence of stomach qi.
**Sinking Pulse (Chen Mai):** Insufficient upon lifting, visible only upon pressing, feeling like rotten cotton. It indicates pathogens in the zang organs. Water pathogens cause rebellion; it is a yin pulse. In sores, it indicates deep-seated pathogens.
**Hidden Pulse (Fu Mai):** Deeper than sinking; invisible upon lifting, felt only when pressing to the bone. Pathogens are deeper than in sinking pulse.
**Deficient Pulse (Xu Mai):** Insufficient upon pressing, slow, large, and soft; lifting feels hollow. Classics state: Deficient pulse indicates blood deficiency, cold generation, and insufficient yang qi. In sores, support the interior, harmonize qi, and nourish blood.
**Soft Pulse (Ruan Mai):** Feels like silk in water, extremely soft and thin, also called Ru pulse. It indicates weak stomach qi. In sores, tonify deficiency, drain pus, and support the interior.
**Weak Pulse (Ruo Mai):** Similar to soft but extremely faint, slow, and seemingly present. Zhang Zhongjing described it as continuous like leaking lacquer. It indicates dual deficiency of qi and blood, lacking form and spirit. Generally, sores with sinking-slow-soft-weak pulses require interior support.
**Hasty Pulse (Cu Mai):** Rapid upon pressing, with occasional stops. Zhang Zhongjing stated: Yang excess causes hasty pulse, indicating heat accumulation in the interior; purgation harmonizes it. In sores, urgent purgation is indicated.
**Knotted Pulse (Jie Mai):** Slow upon pressing, with occasional stops. Zhang Zhongjing stated: Yin excess causes knotted pulse. Classics state: Hasty and knotted pulses indicate survival; substituted pulse indicates death.
**Substituted Pulse (Dai Mai):** Regular rhythm with fixed intervals of stopping, unable to recover immediately. E.g., one stop every ten beats. It indicates qi decline and is inauspicious in all diseases. In sores, hasty and knotted pulses are difficult to treat; substituted pulse is even worse.
**Moving Pulse (Dong Mai):** Felt at the Guan position, bean-sized, trembling without head or tail. *Mai Jing* states: Interaction of yin and yang creates moving pulse. Movement in yang indicates yang deficiency and syncope; movement in yin indicates yin deficiency and fever. Differentiation is crucial.
*Mai Jue* states: Sinking-choppy-tight pulse with body pain signals impending carbuncles/sores. Fever with floating-rapid pulse but aversion to cold signals early-stage carbuncles/sores.
Zhang Zhongjing stated: Intermittent rapid pulses indicate malignant sores. Lung pulses being rapid indicates sore formation. Large-excess-surging pulses indicate disease progression initially, or unresolved pathogens after rupture. Sinking-solid/hidden pulses indicate deep pathogens initially (hard to cure) or residual toxins after rupture. Gourd-kernel/choppy/slow/moderate pulses match conditions after rupture (acceptable); short-fine pulses indicate transformation (better after rupture, bad initially). Floating-large/floating-rapid pulses indicate pathogen-host struggle initially (good); hasty/knotted pulses are inauspicious initially (bad after rupture).
Zhu Danxi stated: Rapid pulse indicates heat, often with excess (yang syndrome); if combined with deficiency, it sinks into yin. Slow pulse indicates cold, often with yin syndrome; if combined with excess, it returns to yang.
Weng Kentang stated: Sinking-solid pulse with fever/restlessness but no external redness/pain indicates deep interior pathogens; clear pathways first. Floating-large-rapid pulse with external swelling requires supporting the interior to prevent inward invasion. Non-sinking/non-floating pulse with no internal/external symptoms indicates meridian involvement; harmonize Ying and Wei. Rapid pulse without fever indicates internal abscess. Rapid pulse with aversion to cold and pain indicates impending abscess. Intermittent rapid pulses indicate malignant sores.
Regarding Sores (Zhongyang/Ulkus):
- **Floating:** Initial stage indicates deficiency/wind; ulcerated stage indicates deficiency requiring tonification.
- **Surging:** Initial stage indicates deficiency/excessive heat (clear heat/detoxify; purge if young/strong); ulcerated stage indicates excess pathogens (hard to treat if unresponsive).
- **Slippery:** Initial stage indicates heat; ulcerated stage indicates heat/deficiency/unresolved pathogens.
- **Rapid:** Initial stage indicates disease retreat/heat (surging-rapid indicates pus formation); ulcerated stage indicates difficulty healing (severe rapidity is hard to treat).
- **Scattered:** Initial stage indicates qi dispersion; ulcerated stage indicates lingering pain (surging-slippy-large-scattered is hard to treat).
- **Gourd Kernel:** Initial stage indicates blood deficiency; ulcerated stage matches condition.
- **Long:** Initial stage suitable for resolution; ulcerated stage indicates easy healing ("Long implies harmonious qi").
- **Firm:** Initial stage indicates excess pathogens/impending pus; ulcerated stage indicates unresolved pathogens.
- **Excess:** Initial stage indicates extreme excess; ulcerated stage indicates unresolved pathogens (excess type) or deficiency (if loose/large).
- **Wiry:** Initial stage indicates pain/impending pus (wiry-surging indicates external tightness/internal heat/carbuncle); ulcerated stage indicates blood deficiency/pain.
- **Tight:** Initial stage floating-tight with fever/aversion to pain indicates abscess; ulcerated stage indicates stagnant qi/blood/pain/exterior cold.
- **Choppy:** Initial stage indicates qi excess/stagnation; ulcerated stage indicates blood deficiency/matching condition.
- **Short:** Initial stage indicates insufficient primal qi; ulcerated stage indicates severe deficiency requiring tonification.
- **Micro:** Initial stage indicates deficiency (improves with medication); ulcerated stage indicates deficiency (micro-uniform matches condition).
- **Slow:** Initial stage indicates cold/deficiency (Chi position slow indicates low blood); ulcerated stage indicates deficiency/inability to nourish sores/exterior cold.
- **Moderate:** Initial stage indicates treatability (large-moderate indicates deficiency); ulcerated stage slow-choppy indicates healing (matching condition/stomach qi).
- **Sinking:** Initial stage indicates deep pathogens; ulcerated stage indicates retained toxins (Cun position sinking indicates phlegm in chest).
- **Hidden:** Initial stage indicates hidden yang pathogens in yin; ulcerated stage indicates yang hidden in yin/internal erosion/metastatic infiltration (hard to treat).
- **Deficient:** Initial stage suitable for tonification/support; ulcerated stage after pus drainage requires major blood/qi tonification.
- **Weak:** Initial stage indicates insufficient primal qi (internal support needed).
- **Knotted:** Initial stage indicates pathogen knotting; ulcerated stage regularizes then heals, irregularity indicates danger.
- **Hasty:** Initial stage indicates heat/progression; ulcerated stage persistent heat leads to death, retreating heat leads to life.
- **Substituted:** Initial stage indicates blood/qi destruction/primal qi damage; ulcerated stage indicates primal qi exhaustion.
Xue Lizhai stated: Pulse diagnosis is the manifestation of bodily vitality and disease mechanisms, serving as the physician's standard. Acupoints Taixi and Chongyang are vital for determining life and death. All twelve meridians connect to vital qi, the root of humanity. If Cun Kou pulse is normal but death occurs, vital qi is internally severed. *Nan Jing* states: Upper pulse present, lower absent, with inability to vomit, indicates death. Upper absent, lower present, indicates difficulty but not necessarily fatal harm, showing pulse roots and yuan qi. Humans receive qi from grain, transmitted to organs; clear becomes Ying (Nutrient), turbid becomes Wei (Defensive). Ying circulates in vessels, Wei outside. Yin and Yang interconnect like a circle. Disruption indicates disease. Severe disease disrupts pulse channels. Treating "Sparrow Pecking" or "House Leaking" pulses caused by harsh drugs requires immediate use of Ginseng, Angelica, Atractylodes, Ginger, and Aconite decoctions, often resulting in recovery. Do not abandon treatment.
Also stated: If carbuncles/sores have not ruptured but the pulse is already weak, how can healing occur?