（素问脉要精微论）
夫脉者血之府也，（府，聚也，府库之谓也。血必聚于经脉之中，故刺志论曰，脉实血实，脉虚血虚也。然此血字，
实兼气为言，非独指在血也。故下文曰∶长则气治，短则气病。又如逆顺篇曰∶脉之盛衰者，所以候血气之虚实有余不
足也。义可知矣。）长则气治，气充和也。短则气病，（气不足也。）数则烦心，火热盛也。大则病进，（邪方张也。）上盛
则气高，（寸为上，上盛者，邪壅于上也。气高者，喘满之谓。）下盛则气胀，（关尺为下，下盛者邪滞于下，故腹为胀满，）
代为气衰，（脉多更改不常者曰代，气虚无主也。）细则气少，（脉来微细，正气不足也。）涩则心痛，（涩为血少气滞，故
为心痛。）浑浑革至如涌泉，病进而色弊，绵绵其去如弦绝死。（浑浑，浊乱不明也。革至，如皮革之坚 也。涌泉，其
来汨汨无序，但出不返也。若得此脉而病加日进，色加憔弊，甚至绵绵如泻漆，及如弓弦之断绝者，皆真气已竭，故死。
绵音眠。 ，硬同。）
粗大者，阴不足、阳有余，为热中也。（粗大者，浮洪之类，阳实阴虚，故为内热。来疾去徐，上实下虚？为厥巅疾；
来疾者，其来急也。去徐者，其去缓也。上实者，寸盛也。下虚者，尺弱也。皆阳强之脉，故为阳厥顶巅之疾。 滑伯
仁曰∶察脉须识上下来去至止六字，不明此六字，则阴阳虚实不别也。上者为阳，来者为阳，至者为阳；下者为阴，去
者为阴，止者为阴。上者，自尺部上于寸口，阳生于阴也。下者，自寸口下于尺部，阴生于阳也。来者，自骨肉之分而
出于皮肤之际，气之升也。去者，自皮肤之际而还于骨肉之分，气之降也。应曰至，息曰止也。）来徐去疾，上虚下实，
为恶风也。故中恶风者，阳气受也。（来之徐，上之虚者，皆阳不足也。阳受风气，故阳虚者必恶风，而恶风之中人，亦
必阳气受之也。恶，上去声，下入声。）有脉俱沉细数者，少阴厥也。（沉细者，肾之脉体也，兼数则热，阴中有火也，
故为少阴之阳厥。）沉细数散者，寒热也。（沉细为阴，数散为阳，阴脉数散，阴不固也。故或入之阴，或出之阳，而为
往来寒热。）浮而散者为 仆。（浮者阴不足，散者神不守，浮而散者阴气脱，故为 仆也。 ，雄绢切，眩运也。）诸
浮不躁者，皆在阳，则为热；其有躁者在手。（脉浮为阳，而躁则阳中之阳，故但浮不躁者，皆属阳脉，未免为热。若浮
而兼躁，乃为阳极，故当在手。在手者，阳中之阳，谓手三阳经也。此与终始篇人迎一盛、病在足少阳、一盛而躁、病
在手少阳义同。详见针刺类二十九。）诸细而沉者，皆在阴，则为骨痛；其有静者在足。（沉细为阴，而静则阴中之阴，
故脉但沉细者，病在阴分，当为骨痛。若沉细而静，乃为阴极，故当在足。在足者，阴中之阴，谓足三阴经也。）数动一
代者，病在阳之脉也，泄及便脓血。（数动者，阳脉也。数动一代者，阳邪伤其血气也。故为泄及便脓血。 ，泄同。）
诸过者切之，涩者阳气有余也，滑者阴气有余也。（脉失其常曰过，可因切而知也。阳有余则血少，故脉涩。阴有余则血
多，故脉滑。）阳气有余为身热无汗，阴气有余为多汗身寒，（阳有余者，阴不足也，故身热无汗。阴有余者，阳不足也，
故多汗身寒。以汗本属阴也。）阴阳有余则无汗而寒。（阳余无汗，以表实也。阴余身寒，以阴盛也。阴阳有余，阴邪实
表之谓也。）推而外之，内而不外，有心腹积也。（此下言察病之法，当推求于脉以决其疑似也。凡病若在表而欲求之于
外矣，然脉则沉迟不浮，是在内而非外，故知其心腹之有积也。推音吹，诸释作推展之推者非。）推而内之，外而不内，
身有热也。（凡病若在里而欲推求于内矣，然脉则浮数不沉，是在外而非内，故知其身之有热也。）推而上之，上而不下，
腰足清也。（凡推求于上部，然脉止见于上，而下部则弱，此以有升无降，上实下虚，故腰足为之清冷也。）推而下之，
下而不上，头项痛也。（凡推求于下部，然脉止见于下，而上部则亏，此以有降无升，清阳不能上达，故为头项痛也。或
以阳虚而阴凑之，亦为头项痛也。按∶此二节，甲乙经以上而不下作下而不上，下而不上作上而不下，似与上文相类而
顺。但既曰下而不上，则气脉在下，何以腰足反清？且本经前二节反言之，后二节顺言之也，一反一顺，两得其义，仍
当以本经为正。）按之至骨，脉气少者，腰脊痛而身有痹也。（按之至骨沉，阴胜也。脉气少者，血气衰也。正气衰而阴
气盛，故为是病。痹义见疾病类六十七。）
（《素问·脉要精微论》）
脉，是血液汇聚的府库。（府，即聚集之意，指府库。血液必然聚集在经脉之中，所以《刺志论》说：脉象充实则血实，脉象虚弱则血虚。然而这里的“血”字，实际上兼带“气”而言，并非单指血液。所以下文说：脉长则气机调畅，脉短则气机有病。又如《逆顺篇》说：脉象的盛衰，是用来候察气血虚实有余不足的。其中的义理可以由此推知。）
脉长，说明气机充盛调和。脉短，说明气机不足。（气不足。）脉数，说明心中烦乱，这是火热亢盛的表现。脉大，说明病势正在进展，（邪气正盛。）寸口脉上部盛，说明气机上逆喘满，（寸部为上部，上部盛，是邪气壅滞于上。气高，是指喘促胀满。）尺部脉下部盛，说明腹部胀满，（关部和尺部为下部，下部盛，是邪气滞留于下，所以腹部胀满。）脉代，说明气机衰弱，（脉象多次更改、不规律者称为代脉，这是气虚无主的表现。）脉细，说明正气减少，（脉来微弱细小，是正气不足。）脉涩，说明心痛，（涩脉是因为血少气滞，所以导致心痛。）脉象浑浊急疾如涌泉般汩汩而出且只出不返，病情会加重且面色憔悴；脉象绵绵而去像弓弦断绝一样，这是死证。（浑浑，指脉象浊乱不明。革至，指脉象坚硬如皮革。涌泉，形容脉来汩汩无序，只有出而没有回。如果得到这种脉象且病情日益加重，面色更加憔悴，甚至脉去时像泻出的漆液或像弓弦突然断绝，这都是真气已经竭尽，所以死亡。绵音同眠。革，硬同。）
脉象粗大，说明阴气不足、阳气有余，这是内热证。（粗大的脉象，属于浮洪之类，阳实阴虚，所以表现为内热。脉来急去缓，上部实下部虚，会导致厥逆和头顶部的疾病；来急，指脉来急促。去缓，指脉去缓慢。上实，指寸脉盛大。下虚，指尺脉虚弱。这些都是阳强盛的脉象，所以会导致阳厥和顶巅部的疾病。滑伯仁说：诊察脉象必须识别上、下、来、去、至、止这六个字，如果不明白这六个字，就无法辨别阴阳虚实。上者为阳，来者为阳，至者为阳；下者为阴，去者为阴，止者为阴。上，指从尺部上行至寸口，阳生于阴。下，指从寸口下行至尺部，阴生于阳。来，指从骨肉之分出于皮肤之际，是气的上升。去，指从皮肤之际返回骨肉之分，是气的下降。应指至，息指止。）脉来缓去急，上部虚下部实，这是恶风证。所以中受恶风邪气的人，是阳气受了邪。（来缓、上虚，都是阳气不足。阳气容易受风气侵袭，所以阳虚的人必定恶风，而恶风邪气伤人，也必然是阳气先受之。恶，上声读wù，入声读è。）
脉象都沉细数的，是少阴厥证。（沉细是肾的脉象特征，兼见数脉则有热，这是阴中有火，所以称为少阴的阳厥。）脉象沉细数而散的，是寒热往来证。（沉细属阴，数散属阳，阴脉见数散，说明阴气不固。所以有时入于阴，有时出于阳，从而出现往来寒热。）脉象浮而散的，是眩晕仆倒证。（浮表示阴气不足，散表示神气不守，浮而散表示阴气脱失，所以导致眩晕仆倒。 ，音同雄绢切，意为眩晕。）
凡是脉浮而不躁动的，病都在阳分，就会发热；如果脉浮而兼有躁动，病就在手经。（脉浮属阳，躁动则是阳中之阳，所以仅浮不躁的，都属于阳脉，难免发热。如果浮而兼躁，就是阳极，所以病在手经。在手经，是指阳中之阳，即手三阳经。这与《终始篇》中说人迎脉大一倍，病在足少阳；一倍而躁动，病在手少阳的道理相同。详见针刺类第二十九。）
凡是脉细而沉的，病都在阴分，就会骨痛；如果脉细沉而静，病就在足经。（沉细属阴，静则是阴中之阴，所以脉仅沉细的，病在阴分，应当骨痛。如果沉细而静，就是阴极，所以病在足经。在足经，是指阴中之阴，即足三阴经。）脉数动而时有间歇的，是阳分的病脉，会有腹泻及大便脓血的症状。（数动是阳脉。数动而有间歇，是阳邪损伤了血气。所以会出现腹泻及大便脓血。 ，同泄。）
凡是脉象失常的，通过切按可知：脉涩是阳气有余，脉滑是阴气有余。（脉失去常态称为过，可以通过切脉得知。阳气有余则血少，所以脉涩。阴气有余则血多，所以脉滑。）阳气有余表现为身体发热无汗，阴气有余表现为多汗身寒，（阳气有余，是因为阴气不足，所以身体发热无汗。阴气有余，是因为阳气不足，所以多汗身寒。因为汗液本属阴。）阴阳都有余则无汗且身寒。（阳有余导致无汗，是因为表实。阴有余导致身寒，是因为阴盛。阴阳有余，是指阴邪实于体表。）
将脉象向外推求（轻取），如果脉象沉迟而不浮，说明病在内，有心腹积聚。（这里讲的是诊察疾病的方法，应当通过推求脉象来决断疑似之症。凡病若在表而想要向外寻求，但脉象却沉迟不浮，这说明病在内而非外，所以知道心腹有积聚。推，音吹，各种解释作推展之推的是错误的。）将脉象向内推求（重取），如果脉象浮数而不沉，说明身体有热。（凡病若在里而想要向内寻求，但脉象却浮数不沉，这说明病在外而非内，所以知道身体有热。）向上推求，如果脉象见于上部而不见于下部，说明腰足清冷。（凡是向上推求，脉象只见于上部，而下部则弱，这是因为有升无降，上实下虚，所以腰足因此清冷。）向下推求，如果脉象见于下部而不见于上部，说明头项疼痛。（凡是向下推求，脉象只见于下部，而上部则亏，这是因为有降无升，清阳不能上达，所以导致头项疼痛。或者因为阳虚而阴气凑集，也会导致头项疼痛。按：这两节，《甲乙经》将“上而不下”作“下而不上”，将“下而不上”作“上而不下”，似乎与上文相似且顺畅。但既然说“下而不上”，气脉在下，为什么腰足反而清冷？况且本篇前两节是反言之，后两节是顺言之，一反一顺，两者得其义，仍应以本篇原文为正。）按之至骨，脉气微少的，是腰脊痛且身体有痹证。（按之至骨为沉，是阴胜。脉气少，是血气衰败。正气衰而阴气盛，所以导致这些病症。痹的含义见疾病类第六十七。）
(Su Wen: Mai Yao Jing Wei Lun)
The pulse is the mansion (collection point) of blood. (Mansion refers to gathering, like a treasury. Blood must gather within the meridians; thus, Ci Zhi Lun states: "When the pulse is full, blood is full; when the pulse is deficient, blood is deficient." However, the term "blood" here actually encompasses "qi," not referring solely to blood. Hence, the following text says: A long pulse indicates regulated qi; a short pulse indicates diseased qi. Similarly, Ni Shun Pian states: The flourishing or declining state of the pulse is used to observe the excess or deficiency of blood and qi. The meaning is clear.)
A long pulse indicates that qi is abundant and harmonious. A short pulse indicates that qi is diseased (deficient). A rapid pulse indicates mental restlessness due to excessive heat. A large pulse indicates that the disease is progressing (as pathogenic factors are flourishing). Excess at the upper part (Cun position) indicates upward rushing of qi (shortness of breath and distension); excess at the lower part (Guan and Chi positions) indicates abdominal distension. A choppy/intermittent pulse (Dai Mai) indicates qi deficiency (irregular changes in the pulse reflect a lack of qi as the master). A thin pulse indicates a decrease in qi (faint and fine pulse reflects insufficient righteous qi). A rough pulse indicates heart pain (roughness signifies blood deficiency and qi stagnation, leading to heart pain). A turbid, rapid pulse arriving like a gushing spring, where it comes but does not return, indicates worsening disease and deteriorated complexion; a pulse that fades away continuously like a broken bowstring indicates death. (Turbid means unclear and chaotic. Rapid arrival feels hard like leather. Gushing spring describes an unordered, one-way flow. If such a pulse appears with worsening disease and sallow complexion, or if the departing pulse resembles leaking lacquer or a snapped string, it signifies exhaustion of true qi, hence death.)
A coarse and large pulse indicates yin deficiency and yang excess, manifesting as internal heat. (Coarse and large pulses belong to floating and surging types; yang excess and yin deficiency result in internal heat. Rapid arrival and slow departure, with excess above and deficiency below, lead to jue syndrome and disorders of the vertex. Rapid arrival means swift onset; slow departure means gradual decline. Excess above refers to strong Cun pulse; deficiency below refers to weak Chi pulse. These are all pulses of strong yang, causing yang jue and vertex diseases. Hua Boren said: To examine the pulse, one must understand the six characters: Shang (Up), Xia (Down), Lai (Coming), Qu (Going), Zhi (Arrival), Zhi (Stop). Without understanding these, yin-yang and deficiency-excess cannot be distinguished. Up, Coming, and Arrival are yang; Down, Going, and Stop are yin. Up means moving from Chi to Cun, where yang arises from yin. Down means moving from Cun to Chi, where yin arises from yang. Coming means emerging from the flesh/bone level to the skin surface, representing ascending qi. Going means returning from the skin surface to the flesh/bone level, representing descending qi. Ying corresponds to Zhi, and Xi corresponds to Zhi.)
Slow arrival and rapid departure, with deficiency above and excess below, indicate aversion to wind. Thus, those afflicted by evil wind suffer from damage to yang qi. (Slow arrival and upper deficiency both indicate yang insufficiency. Yang is susceptible to wind pathogens; therefore, those with yang deficiency inevitably fear wind, and wind pathogens attack the yang first.)
Pulses that are all deep, fine, and rapid indicate Shaoyin jue syndrome. (Deep and fine are the characteristics of the Kidney pulse; combined with rapidity, it indicates heat within yin, hence called Shaoyin yang jue.) Deep, fine, rapid, and scattered pulses indicate alternating cold and heat. (Deep and fine are yin; rapid and scattered are yang. Yin pulses showing rapidity and scattering indicate insecure yin. Thus, pathogens may enter yin or exit yang, causing alternating cold and heat.) Floating and scattered pulses indicate dizziness and collapse. (Floating indicates yin deficiency; scattered indicates unsettled spirit. Floating and scattered together indicate yin qi depletion, leading to dizziness and collapse.)
All floating pulses without agitation belong to the yang aspect and indicate heat; if there is agitation, the disease is in the hand meridians. (Floating is yang; agitation is yang within yang. Therefore, floating without agitation belongs to yang pulses and causes heat. If floating accompanies agitation, it represents extreme yang, so the disease is in the hand meridians. Hand meridians refer to the three yang meridians of the hand. This aligns with Zhong Shi Pian regarding Ying Ren pulse being one-fold stronger indicating Foot Shaoyang disease, and one-fold stronger with agitation indicating Hand Shaoyang disease. See Needling Category 29 for details.)
All fine and deep pulses belong to the yin aspect and cause bone pain; if quiet, the disease is in the foot meridians. (Deep and fine are yin; quietness is yin within yin. Thus, merely deep and fine pulses indicate disease in the yin division, causing bone pain. If deep, fine, and quiet, it represents extreme yin, so the disease is in the foot meridians. Foot meridians refer to the three yin meridians of the foot.)
Rapid, active pulses with intermittent stops belong to yang vessel pathology, manifesting as diarrhea and pus-blood in stool. (Rapid and active are yang pulses. Rapid, active, and intermittent stops indicate yang pathogens damaging blood and qi, leading to diarrhea and pus-blood in stool.)
For all abnormal pulses, palpation reveals: Roughness indicates excess yang; smoothness indicates excess yin. (Abnormality in pulse is termed "Guo," known through palpation. Yang excess leads to blood deficiency, hence rough pulse. Yin excess leads to blood abundance, hence smooth pulse.) Yang excess manifests as body heat and no sweat; yin excess manifests as profuse sweating and cold body. (Yang excess implies yin deficiency, causing heat and anhidrosis. Yin excess implies yang deficiency, causing diaphoresis and coldness. Sweat belongs to yin.) Excess in both yin and yang results in no sweat and coldness. (Yang excess causes anhidrosis due to exterior excess; yin excess causes coldness due to yin abundance. Excess in both yin and yang refers to yin pathogens solidifying at the exterior.)
Pushing outward (light pressure): If the pulse is internal (deep) and not external (floating), there are accumulations in the heart and abdomen. (This section discusses diagnosing ambiguous conditions via pulse analysis. If the disease is in the exterior but the pulse is deep and slow rather than floating, it indicates an interior condition, suggesting accumulations in the chest and abdomen. "Tui" here sounds like "Chui," not meaning pushing/expanding.) Pushing inward (heavy pressure): If the pulse is external (floating) and not internal (deep), there is heat in the body. (If the disease is interior but the pulse is floating and rapid rather than deep, it indicates an exterior condition, suggesting body heat.) Pushing upward: If the pulse is present above but absent below, the waist and feet are cold. (Seeking the upper part, if the pulse is only visible above while the lower part is weak, this indicates rising without descending, excess above and deficiency below, causing coldness in the waist and feet.) Pushing downward: If the pulse is present below but absent above, there is pain in the head and neck. (Seeking the lower part, if the pulse is only visible below while the upper part is deficient, this indicates descending without rising, preventing clear yang from ascending, causing head and neck pain. Alternatively, yang deficiency allowing yin to congregate also causes head and neck pain. Note: Jia Yi Jing swaps "above but not below" with "below but not above," which seems smoother but contradicts the logic. Since "below but not above" should not cause cold feet, and the original text uses reverse and direct statements for balance, the original text is correct.) Pressing to the bone: If pulse qi is scanty, there is pain in the waist and spine along with bi-syndrome. (Pressing to the bone yields a deep pulse, indicating yin dominance. Scanty pulse qi indicates blood and qi decline. Righteous qi decline with yin excess causes these symptoms. Meaning of Bi-syndrome is found in Disease Category 67.)