（素问脉要精微论）
心脉搏坚而长，当病舌卷不能言；（搏，谓弦强搏击于手也。心脉搏坚而长者，肝邪乘心，脏气亏甚而失和平之气也。
手少阴脉从心系上挟咽，故令舌卷不能言。 愚按∶搏击之脉，皆肝邪盛也。肝本属木，而何五脏皆畏之？盖五脏皆以
胃气为本，脉无胃气则死，凡木强者土必衰，脉搏者胃多败，故坚搏为诸脏所忌。兹心脉搏坚而长者，以心藏之胃气不
足而邪有余也。搏之微则邪亦微，搏之甚则几于真脏矣。故当以搏之微甚，而察病之浅深。后四脏者彼此。）其 而散者，
当消环自已。（若证如前而脉则 散者，心气将和也。消，尽也。环，周也。谓期尽一周而病自已矣。 音软。）肺脉搏
坚而长，当病唾血；其 而散者，当病灌汗，至令不复散发也。（肺脉搏坚而长，邪乘肺也，肺系连喉，故为唾血。若
而散，则肺虚不敛，汗出如水，故云灌汗，汗多亡阳，故不可更为发散也。）肝脉搏坚而长，色不青，当病坠若搏，因血
在胁下，令人喘逆；其 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，肝自病
也，脏病于中，色必外见，其色当青而不青者，以病不在脏而在经也。必有坠伤，若由搏击。则血停胁下而气不利，故
令人喘逆。若其 散，则肝木不足，脾湿胜之，湿在肌肤，故颜色光泽，病为溢饮。又肝脉涩甚为溢饮，义见前章。）胃
脉搏坚而长，其色赤，当病折髀；其 而散者，当病食痹。（胃脉搏坚，木乘土也，加之色赤、则阳明火盛，木火交炽，
胃经必伤。阳明下行者，从气冲下髀抵伏兔，故病髀如折也。若 而散者，胃气本虚。阳明支别上行者，由大迎人迎，
循喉咙入缺盆，下膈属胃络脾，故食即气逆，滞闷不行而为食痹。 又食痹义详运气类二十八。）脾脉搏坚而长，其色黄，
当病少气；其 而散、色不泽者，当病足 肿，若水状也。（邪脉乘脾，脾气必衰，脾虚无以生血，故本脏之色见于外。
脾弱不能生肺，故为少气。若其 散而色不泽者，尤属脾虚。脾经之脉，从拇指上内踝前廉，循 骨后，交出厥阴之前，
故病足 肿若水状者，以脾虚不能制水也。）肾脉搏坚而长，其色黄而赤者，当病折腰；其 而散者，当病少血，至令不
复也。（邪脉干肾，肾气必衰，其色黄赤，为火土有余而肾水不足，故病腰如折也。若其 散，肾气本虚，肾主水以生化
津液，今肾气不化，故病少血。本原气衰，故令不能遽复。愚按∶本篇五脏脉病，一曰搏坚而长，一曰 而散，而其为
病，多皆不足何也？盖搏坚而长者，邪胜乎正，是谓邪之所凑，其气必虚也。 而散者，本原不足，是谓正气夺则虚也。
一以有邪而致虚，一以无邪本虚，虚虽若一，而病本不同，所当辨也。）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。（心为牡脏，气本属阳，今脉紧急，阴寒胜也，以阳藏而为阴胜，故病心疝。心疝者，
形在少腹，而实以寒乘少阴所致。）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。（牡，阳也。
心属火而居于膈上，故曰牡脏。心与小肠为表里，故脉络相通而为之使。小肠居于少腹，故少腹当有形也。使，上声。）
帝曰∶诊得胃脉病形何如？歧伯曰∶胃脉实则胀，虚则泄。（实为邪有余，故胀满。虚为正不足，故泄利。）
《素问·脉要精微论》
心脏的脉搏如果搏动坚实且长，应当发生舌体卷缩、不能言语的病证；（“搏”，是指脉象弦强有力，搏击于指下。心脏脉搏坚实而长，是肝木之邪侵犯心脏，导致脏气极度亏损，失去了平和之气。手少阴心经从心系向上挟行于咽喉两侧，所以会导致舌体卷缩、不能言语。我按语道：凡是搏击有力的脉象，都是肝邪旺盛的表现。肝脏本属木，为什么五脏都畏惧它呢？大概是因为五脏都以胃气为根本，脉象如果没有胃气就会死亡，凡是木气过旺则土气必然衰弱，脉搏坚实搏击说明胃气大多败坏，所以坚搏的脉象是各脏腑所忌讳的。现在心脏脉搏坚实而长，是因为心脏藏中的胃气不足而邪气有余。搏动轻微则邪气也轻微，搏动剧烈则接近真脏脉了。所以应当根据搏动的轻微或剧烈，来察知病情的浅深。后文关于其他四脏的情况与此类似。）如果脉象细弱而散漫，应当出现消瘦环状病变，经过一个周期后疾病自然痊愈。（如果症状像前面所说的那样，但脉象却细弱而散漫，说明心气将要调和。“消”，意为尽、消失。“环”，意为周、周期。意思是期望经过一个周期后疾病自然痊愈。“软”音同“软”。）肺脏的脉搏如果坚实而长，应当发生唾血的病证；如果脉象细弱而散漫，应当发生灌汗（汗出如水淋漓）的病证，直到此时不能再使用发汗解表的方法。（肺脏脉搏坚实而长，是邪气侵犯肺脏，肺系连接喉咙，所以导致唾血。如果脉象细弱而散漫，则是肺气虚弱不能收敛，汗出如水淋漓，所以称为灌汗，汗多会耗亡阳气，所以不可再给予发散治疗。）肝脏的脉搏如果坚实而长，面色不发青，应当发生因坠落或搏击受伤导致的病证，因为瘀血停留在胁下，使人喘息气逆；如果脉象细弱而散漫、面色有光泽，应当发生溢饮病，溢饮病的特征是口渴突然大量饮水，水液容易流入肌肉皮肤和肠胃之外。（肝脏脉搏坚实而长，是肝脏自身的病变，内脏有病，面色必定外现，颜色应当发青而不发青，是因为病不在脏而在经络。一定是有坠落损伤，或者由搏击引起，导致血液停滞在胁下而气机不利，所以使人喘息气逆。如果脉象细弱而散漫，则是肝木不足，脾土湿气胜之，湿气在肌肤之间，所以面色光泽，病名为溢饮。另外，肝脉涩甚也会导致溢饮，含义见前章。）胃脏的脉搏如果坚实而长，面色发红，应当发生髋部疼痛如折断般的病证；如果脉象细弱而散漫，应当发生食痹病。（胃脏脉搏坚实，是木邪乘克土邪，再加上面色发红，则是阳明火气旺盛，木火交相炽盛，胃经必然受损。阳明经下行的分支，从气冲穴下行至髀关，抵达伏兔穴，所以病发时髋部感觉像折断一样。如果脉象细弱而散漫，则是胃气本来虚弱。阳明经支别上行的部分，由大迎穴、人迎穴进入缺盆，向下穿过膈肌属于胃并联络脾脏，所以进食后气机上逆，滞闷不通而形成食痹。另外，食痹的含义详见运气类第二十八篇。）脾脏的脉搏如果坚实而长，面色发黄，应当发生少气的病证；如果脉象细弱而散漫、面色无光泽，应当发生足胫浮肿，像水肿一样的病证。（邪脉侵犯脾脏，脾气必然衰败，脾虚无法生成血液，所以本脏的颜色显露于外。脾弱不能生养肺金，所以导致少气。如果脉象细弱而散漫且面色无光泽，尤其属于脾虚。脾经的脉络，从足大趾内侧上行至内踝前缘，沿胫骨后侧行走，交出厥阴肝经之前，所以病发足胫浮肿像水肿一样，是因为脾虚不能制约水湿的缘故。）肾脏的脉搏如果坚实而长，面色黄中带红，应当发生腰部疼痛如折断般的病证；如果脉象细弱而散漫，应当发生血少的病证，直到此时也不能恢复。（邪脉干扰肾脏，肾气必然衰败，面色黄赤，是火土有余而肾水不足，所以病发腰部像折断一样。如果脉象细弱而散漫，肾气本来虚弱，肾主水以生化津液，现在肾气不能气化，所以病发血少。由于本源元气衰败，所以导致不能迅速恢复。我按语道：本篇中五脏脉象与疾病的关系，一种是脉搏坚实而长，一种是脉象细弱而散漫，但它们所导致的疾病，大多都是虚证，为什么呢？大概是因为脉搏坚实而长，是邪气胜过正气，这就是所说的“邪之所凑，其气必虚”。脉象细弱而散漫，是本原不足，这就是所说的“正气夺则虚”。一种是因为有邪气而导致虚损，一种是因为没有邪气而原本就虚，虽然都是虚证，但病根不同，应当加以辨别。）黄帝说：诊察到心脏的脉搏紧急，这是什么病？病症表现如何？岐伯说：病名叫做心疝，小腹部应当有有形之物。（心为阳脏，气本属阳，现在脉象紧急，说明阴寒胜邪，因为阳脏被阴邪所胜，所以病发心疝。所谓心疝，形态表现在小腹，但实际上是因为寒邪乘袭少阴所致。）黄帝说：凭什么这样说？岐伯说：心为阳脏，小肠作为它的使道，所以说小腹部应当有有形之物。（牡，意为阳。心属火而居于膈上，所以称为阳脏。心与小肠互为表里，所以脉络相通而作为使道。小肠居于小腹，所以小腹部应当有有形之物。“使”读作上声。）黄帝说：诊察到胃脉，病症表现如何？岐伯说：胃脉实症表现为腹胀，虚症表现为泄泻。（实证是因为邪气有余，所以胀满。虚证是因为正气不足，所以泄利。）
*Suwen: Pulse Essentials and Subtle Discussions*
If the heart pulse is firm and long, one should expect pathology involving tongue retraction and inability to speak; ("Firm" refers to a pulse that is wiry, strong, and striking against the fingers. A heart pulse that is firm and long indicates Liver [Gan] evil invading the Heart [Xin], causing severe depletion of zang qi and loss of harmonious qi. The Hand-Shaoyin meridian ascends from the heart system along both sides of the pharynx, thus causing tongue retraction and inability to speak. My commentary: Pulses that are striking indicate excessive Liver [Gan] evil. The Liver belongs to Wood; why do all five zang organs fear it? This is because all five zang organs rely on Stomach [Wei] qi as their foundation; if the pulse lacks Stomach qi, death ensues. Whenever Wood is excessively strong, Earth inevitably weakens; when pulses are firm and striking, Stomach qi is often ruined. Therefore, firm and striking pulses are taboo for all zang organs. In this case, the heart pulse is firm and long because the Stomach qi within the Heart [Xin] organ is insufficient while pathogenic factors are in excess. If the striking is mild, the pathogen is mild; if severe, it approaches the True Zang pulse. Thus, one must assess the depth of the disease based on the severity of the striking. The conditions for the other four zang organs are similar.) If the pulse is thin and scattered, one should expect wasting with circular lesions, which will resolve naturally after one cycle. (If the symptoms are as described previously but the pulse is thin and scattered, it indicates that Heart [Xin] qi is about to harmonize. "Xiao" means to disappear or exhaust. "Huan" means a cycle or period. It implies that after one cycle, the disease will resolve naturally. "Ruan" sounds like "soft".) If the lung pulse is firm and long, one should expect spitting blood; if the pulse is thin and scattered, one should expect profuse sweating (sweat flowing like water), at which point dispersing methods should no longer be used. (A firm and long lung pulse indicates pathogenic factors invading the Lung [Fei]. Since the lung system connects to the throat, spitting blood occurs. If the pulse is thin and scattered, it signifies Lung [Fei] qi deficiency failing to consolidate, leading to sweat flowing like water, termed "Guhan" (pouring sweat). Excessive sweating depletes Yang qi, so dispersing treatments are contraindicated.) If the liver pulse is firm and long, but the complexion is not green, one should expect pathology due to falling or beating injuries, with blood stasis remaining under the hypochondrium, causing wheezing and rebellious qi; if the pulse is thin and scattered and the complexion is lustrous, one should expect 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 self-pathology of the Liver [Gan]. Internal zang pathology manifests externally in the complexion, which should be green. If it is not green, the disease lies in the meridians rather than the zang. There must have been a fall or blow, causing blood to stagnate under the hypochondrium and qi to become obstructed, leading to wheezing and rebellious qi. If the pulse is thin and scattered, Liver Wood is deficient, allowing Spleen [Pi] dampness to prevail. Dampness in the skin and muscles results in a lustrous complexion, diagnosed as Yi Yin. Additionally, a very choppy liver pulse can also cause Yi Yin, as explained in the previous chapter.) If the stomach pulse is firm and long, and the complexion is red, one should expect pain in the thigh as if broken; if the pulse is thin and scattered, one should expect Shi Bi (food obstruction). (A firm stomach pulse indicates Wood overacting on Earth. With a red complexion, Yangming Fire is excessive, and Wood and Fire blaze together, injuring the Stomach [Wei] meridian. The descending branch of the Yangming meridian runs from Qichong down to Biguan and Fubao; thus, the thigh feels as if broken. If the pulse is thin and scattered, Stomach [Wei] qi is originally deficient. The ascending branch of the Yangming meridian passes through Daying and Renying, enters Quepen, descends through the diaphragm to belong to the Stomach [Wei] and connect with the Spleen [Pi]. Consequently, eating causes qi rebellion, stagnation, and fullness, resulting in Shi Bi. For further details on Shi Bi, see Wind, Cold, Summer-Heat, Dampness category, article 28.) If the spleen pulse is firm and long, and the complexion is yellow, one should expect shortness of breath; if the pulse is thin and scattered and the complexion is dull, one should expect edema of the lower legs resembling water retention. (Pathogenic pulses invading the Spleen [Pi] cause Spleen [Pi] qi to decline. Spleen [Pi] deficiency fails to generate blood, so the organ's color appears externally. Weak Spleen [Pi] cannot nourish Lung [Fei], causing shortness of breath. If the pulse is thin and scattered and the complexion is dull, it particularly indicates Spleen [Pi] deficiency. The Spleen [Pi] meridian ascends from the big toe to the anterior margin of the medial malleolus, runs behind the tibia, and crosses anterior to the Jueyin meridian. Thus, edema of the lower legs resembling water retention occurs because Spleen [Pi] deficiency fails to control Water.) If the kidney pulse is firm and long, and the complexion is yellowish-red, one should expect back pain as if broken; if the pulse is thin and scattered, one should expect blood deficiency that does not recover. (Pathogenic pulses interfering with the Kidney [Shen] cause Kidney [Shen] qi to decline. The yellowish-red complexion indicates excess Fire and Earth with insufficient Kidney [Shen] Water, causing back pain as if broken. If the pulse is thin and scattered, Kidney [Shen] qi is originally deficient. The Kidney [Shen] governs Water to transform body fluids; now, with impaired Kidney [Shen] qi transformation, blood deficiency occurs. Due to the decline of primordial qi, recovery is slow. My commentary: In this chapter, regarding the relationship between five zang pulses and diseases, one type is firm and long, and the other is thin and scattered, yet both lead to deficiency syndromes. Why? Firm and long pulses indicate pathogen exceeding righteous qi, meaning "where pathogenic factors gather, qi must be deficient." Thin and scattered pulses indicate deficiency of the root, meaning "when righteous qi is depleted, there is deficiency." One is deficiency caused by pathogens; the other is original deficiency without pathogens. Although both are deficiencies, their roots differ and must be distinguished.) The Yellow Emperor said: If the heart pulse is felt to be urgent, what is this disease? What are the clinical manifestations? Qibo said: The disease is named Xin Han (Heart Hernia), and there should be palpable masses in the lower abdomen. (The Heart is a Yang organ, and its qi is inherently Yang. An urgent pulse indicates Yin-cold excess. Because a Yang organ is overcome by Yin, Xin Han occurs. Xin Han manifests as masses in the lower abdomen, actually caused by cold invading the Shaoyin.) The Yellow Emperor said: How do you know this? Qibo said: The Heart is a Yang organ, and the Small Intestine [Xiao Chang] serves as its envoy. Therefore, it is said that there should be masses in the lower abdomen. ("Mu" means Yang. The Heart belongs to Fire and resides above the diaphragm, hence called a Yang organ. The Heart and Small Intestine [Xiao Chang] are interior-exterior pairs, so their meridians connect and serve as envoys. The Small Intestine [Xiao Chang] resides in the lower abdomen, hence masses appear there. "Shi" is pronounced with the rising tone.) The Yellow Emperor said: If the stomach pulse is diagnosed, what are the clinical manifestations? Qibo said: A full Stomach [Wei] pulse presents with abdominal distension; a deficient Stomach [Wei] pulse presents with diarrhea. (Fullness indicates excess pathogenic factors, causing distension. Deficiency indicates insufficient righteous qi, causing diarrhea.)