持脉之道，贵乎活泼。（脉，按内经谓之经隧，后人谓之经脉，林之翰指为肌肉空松之处，包藏营气，
而
为昼夜营运不息之道路，所以载脉者也。）若拘泥不通，病难以测。姑以部位论之∶如左寸心部也，其候在心
与膻中；右寸肺部也，其候在肺与胸中；左关肝部也，其候在肝胆，右关脾部
也，其候在脾胃；左尺肾部也，其候在肾部膀胱小肠；右尺三焦部也，其候在肾与三焦命门大肠；寸上为鱼
际，尺下为尺泽；故察两寸而知头面咽喉口齿头痛肩背之疾，察关而知胁肋腹背之疾，察尺而知腰腹阴道
脚膝之疾，此皆就上以候上，中以候中，下以候下之谓也。（内经曰∶尺内两旁，则季胁也。尺外以候肾，尺
里以候腹中。附上，左外以候肝，内以候膈；右外以候胃，内以候脾。上附上，右外以候胸，内以候胸中；左
外以候心，内以候膻中。前以候前，后以候后。上竟上者，胸喉中事也；下竟下者，少腹腰股膝胫中事也。张
景岳曰∶小肠大肠，皆下部之腑，自当应于两尺。而二肠又连于胃，气本一贯，故内经亦不言其定处，而但曰
大肠小肠，皆属于胃，是又于胃气中察二肠之气。自叔和以心与小肠，合于左寸；肺与大肠，合于右寸。其谬
甚矣。绣按∶论脉经络贯接，则大小肠自当诊于两寸；论脉上下位置，则大小肠又当诊于两尺。而乌程林之翰
专推王氏脉经，本以经络贯注当诊于寸之说，着为管窥附余，其理虽属不易；但将诸家大小肠诊尺之说，借为
诋毁，以表独得，不惟理与内经相违，且更生其上下倒置之弊矣。）然五脏六腑，其脉靡不悉统于肺。肺虽五
脏之一，而实为气之大会，故于右关之前一分号为气口，候之以占终身焉。（吴草庐曰∶脉行始于肺，终于肝，
而复会于肺。肺为气所出之门户，故名曰气口，而为脉之大会，以占终身。）且诸气不能自致于肺，又必
借胃水谷以为输将，以为灌溉；故胃又为先天之气化，后天之本源，而为诸气之统司焉。每见阴虚血耗之
人，日服六味四物而不得阴长之力，其故实基此耳。岂尽于六部是求，而不归于气口胃气是诊乎。（提出胃气
为诊脉之要。胃气者，谷气也。谷气减少，即为胃气将绝，血何从生。今人好用四物，而罔顾瞻谷食多寡，以阻生血之
源者，比比皆是。经脉别论云∶食气入胃，经气归于肺，肺朝
百脉，气归于权衡，权衡以平，气口成寸，以决死生。营卫生会云∶人食气于谷，谷入于胃，以传于肺，五脏
六腑，皆以受气。其清者为营，浊者为卫，营行脉中，卫行脉外。）命门相火，虽寄在右，肾水虽寄在左；然
肾同居七节，一阴一阳，精气皆主，闭蛰封藏，令各得司，岂肾独归于左，而不于右可诊乎。至于三部并取而
为九候，则在表在里在中，又各见于六部之浮中沉。是盖外以候外，里以候里，中以候中。岂尽寸阳尺阴，所
能统其表里者乎。头痛在上，本应寸见。而少阳阳明头痛，则又在于两关；（邪传足少阳胆经，头痛在左关；
邪传足阳明胃经，头痛在右关。）太阳（膀胱）头痛，则又在于左尺。是痛在于上者，又不可以上拘矣。淋遗
在下，本应尺求。而气虚不摄。则病偏在右寸；神衰不固。则病偏在左寸。是淋遗在下者，又不可以下拘矣。
中气虚而吐泻作，则吐似在于寸，泻亦应在于尺；如何偏于关求以固脾胃。二气混而中道塞，则治应在两关；
如何偏宜升清以从阳，苦降以求阴。则病在于上中下者，又不可尽以所见之部拘之矣。部位难拘如此。（绣按∶
六部之浮，皆可以候心肺；六部之沉，皆可以候两肾；六部之中，皆可以候肝脾。且两肾之脉，有时偏以浮见
寸见；心肺之脉，有时偏以沉见尺见；肝脾之脉，有时偏以浮沉见尺寸见。王宗正曰∶诊脉当从心肺俱浮，肝
肾俱沉，脾在中州之说。若王叔和独守寸关尺部位以测病，甚非。）
诊察脉象的原则，贵在灵活变通。（脉，按照《内经》称为经隧，后人称为经脉，林之翰指为肌肉空松之处，包藏营气，作为昼夜营运不息的道路，所以承载脉气。）如果拘泥固执、不通变，疾病就难以推测。暂且从部位来论述：比如左寸是心部，其候应在心与膻中；右寸是肺部，其候应在肺与胸中；左关是肝部，其候应在肝胆；右关是脾部，其候应在脾胃；左尺是肾部，其候应在肾、膀胱和小肠；右尺是三焦部，其候应在肾、三焦、命门和大肠；寸脉之上为鱼际，尺脉之下为尺泽；所以通过观察两寸脉可以知晓头面、咽喉、口齿、头痛、肩背的疾病，通过观察关脉可以知晓胁肋、腹部、背部的疾病，通过观察尺脉可以知晓腰部、腹部、阴道、脚膝的疾病，这都是“上以候上，中以候中，下以候下”的说法。（《内经》说：尺肤内两旁，对应季胁。尺肤外侧以候肾，尺肤内侧以候腹中。附上部位，左侧外侧以候肝，内侧以候膈；右侧外侧以候胃，内侧以候脾。再往上，右侧外侧以候胸，内侧以候胸中；左侧外侧以候心，内侧以候膻中。前侧以候身体前部，后侧以候身体后部。上尽端者，对应胸喉中的事；下尽端者，对应少腹、腰、股、膝、胫中的事。张景岳说：小肠大肠，都是下部之腑，自然应当对应两尺。而大小肠又连接于胃，气本是一贯的，所以《内经》也不说它们的固定位置，只说大肠小肠皆属于胃，这是又在胃气中察知二肠之气。自从王叔和将心与小肠合于左寸，肺与大肠合于右寸。这种说法谬误很大。绣按：论脉经络贯通连接，则大小肠自然应当在两寸诊察；论脉上下位置，则大小肠又应当在两尺诊察。而乌程林之翰专门推崇王叔和的《脉经》，原本依据经络贯注应当在寸部诊察的说法，著录在《管窥附余》中，其理论虽然不易推翻；但是借以诋毁诸家关于大小肠诊于尺部的说法，以显示自己独得之妙，这不仅理论与《内经》相违背，而且更产生了上下倒置的弊病。）然而五脏六腑，其脉无不统摄于肺。肺虽然是五脏之一，但实为气的汇聚之所，所以在右关之前一分称为气口，通过诊察它来占断终身运势。（吴草庐说：脉行始于肺，终于肝，然后又汇聚于肺。肺为气所出之门户，所以名叫气口，而为脉之大会，用来占断终身。）况且诸气不能自行到达肺，又必须借助胃中水谷精气来输送灌溉；所以胃又是先天之气化，后天之本源，而成为诸气的统司。常见阴虚血耗的人，每天服用六味地黄丸和四物汤却得不到滋阴长养的功效，其原因实在基于此啊。难道仅仅在六部中寻求，而不归于诊察气口胃气吗？（提出胃气是诊脉的关键。胃气，就是谷气。谷气减少，就是胃气将要绝灭，血液从何而生。现在的人好用四物汤，而不顾瞻饮食多少，从而阻碍生血之源的，比比皆是。《经脉别论》说：食气入胃，经气归于肺，肺朝百脉，气归于权衡，权衡平和，气口成寸，以此决断死生。《营卫生会》说：人从谷物摄取气，谷入于胃，传于肺，五脏六腑都接受其气。其中清者为营气，浊者为卫气，营行脉中，卫行脉外。）命门相火，虽然寄居在右，肾水虽然寄居在左；然而肾同居七节之处，一阴一阳，精气皆主司，闭蛰封藏，令各得其职，难道肾只归属于左，而不在右诊察吗？至于三部并取成为九候，则在表在里在中，又分别见于六部的浮、中、沉。这大概是外以候外，里以候里，中以候中。难道仅仅是寸为阳尺为阴，所能统括表里的吗？头痛在上，本应在寸脉见到。而少阳、阳明头痛，则又在于两关脉；（邪气传入足少阳胆经，头痛在左关；邪气传入足阳明胃经，头痛在右关。）太阳（膀胱）头痛，则又在于左尺。是痛在上部的，又不可以仅以上部拘泥了。淋证遗溺在下部，本应在尺脉求治。而气虚不摄，则病偏在右寸；神衰不固，则病偏在左寸。是淋遗在下部的，又不可以仅以下部拘泥了。中气虚而吐泻发作，则吐似乎在于寸脉，泻也应当在尺脉；为何要偏于关脉求治以固护脾胃？二气混浊而中道阻塞，则治疗应当在两关；为何要偏宜升清以从阳，苦降以求阴？那么病在上中下部的，又不可以完全以所见之部位拘泥了。部位难以拘泥如此。（绣按：六部的浮脉，都可以候心肺；六部的沉脉，都可以候两肾；六部的中脉，都可以候肝脾。而且两肾之脉，有时偏以浮脉见于寸部；心肺之脉，有时偏以沉脉见于尺部；肝脾之脉，有时偏以浮沉脉见于尺寸部。王宗正说：诊脉应当遵循心肺俱浮，肝肾俱沉，脾在中州的说法。如果王叔和独自坚守寸关尺部位来测度疾病，非常不对。）
The principle of pulse taking lies in flexibility and adaptability. (Pulse, referred to as Jing Sui (meridian tunnels) in the *Nei Jing* (Inner Canon), later called Jing Mai (meridians) by subsequent authors. Lin Zhihan pointed out it as the loose areas within muscles, containing Ying Qi (nutritive qi), serving as the road for ceaseless day-and-night operation, thus carrying the pulse.) If one is rigid and inflexible, diseases become difficult to predict. Let us discuss from the perspective of positions: For instance, the Left Cun (Cun position on the left wrist) corresponds to the Heart region, where the pulse reflects the condition of the Heart and Dan Zhong (Pericardium); the Right Cun corresponds to the Lung region, reflecting the Lungs and Chest Middle; the Left Guan (Guan position on the left wrist) corresponds to the Liver region, reflecting the Liver and Gallbladder; the Right Guan corresponds to the Spleen region, reflecting the Spleen and Stomach; the Left Chi (Chi position on the left wrist) corresponds to the Kidney region, reflecting the Kidneys, Bladder, and Small Intestine; the Right Chi corresponds to the San Jiao (Triple Burner) region, reflecting the Kidneys, San Jiao, Ming Men (Gate of Life), and Large Intestine. Above the Cun position is Yu Ji (Fish Border), and below the Chi position is Chi Ze (Pool Marsh). Therefore, observing the two Cun pulses allows one to know diseases of the head, face, throat, teeth, headache, shoulders, and back; observing the Guan pulses allows one to know diseases of the hypochondrium, abdomen, and back; observing the Chi pulses allows one to know diseases of the waist, abdomen, vagina, feet, and knees. This is what is meant by "upper parts reflect upper regions, middle parts reflect middle regions, lower parts reflect lower regions." (*Nei Jing* states: The inner sides of the Chi area correspond to the lateral costal margins. The outer side of Chi reflects the Kidneys, and the inner side reflects the abdominal cavity. Attached above, the left outer side reflects the Liver, and the inner side reflects the Diaphragm; the right outer side reflects the Stomach, and the inner side reflects the Spleen. Further up, the right outer side reflects the Chest, and the inner side reflects the Chest Middle; the left outer side reflects the Heart, and the inner side reflects Dan Zhong. The anterior aspect reflects the anterior body, and the posterior aspect reflects the posterior body. The extreme upper end corresponds to matters of the chest and throat; the extreme lower end corresponds to matters of the lower abdomen, waist, thighs, knees, and shins. Zhang Jingyue said: The Small Intestine and Large Intestine are both Fu organs of the lower part, naturally corresponding to the two Chi positions. Since the two intestines connect to the Stomach, their Qi is continuous, so the *Nei Jing* does not specify fixed locations but states that the Large and Small Intestines belong to the Stomach, implying that the Qi of the two intestines is observed within the Stomach Qi. Since Wang Shuhe combined the Heart with the Small Intestine at the Left Cun, and the Lungs with the Large Intestine at the Right Cun, this error is significant. Xi notes: Discussing the connection of meridians and vessels, the Large and Small Intestines should naturally be diagnosed at the two Cun positions; discussing the upper-lower positions of pulses, they should be diagnosed at the two Chi positions. However, Lin Zhihan of Wucheng exclusively promoted Wang Shuhe's *Mai Jing*, based on the theory that due to meridian continuity, they should be diagnosed at the Cun position, recording this in *Guan Kui Fu Yu*. Although his reasoning is hard to refute, he used it to disparage other schools' views on diagnosing the intestines at the Chi position to highlight his unique insight. This not only contradicts the *Nei Jing* but also creates the flaw of reversing upper and lower.) Nevertheless, the pulses of the Five Zang and Six Fu organs are all governed by the Lungs. Although the Lungs are merely one of the Five Zang organs, they are actually the assembly point of Qi. Therefore, the one-fen portion before the Right Guan is called Qi Kou (Qi Gate), and its diagnosis can predict one's entire life. (Wu Caolu said: Pulse circulation starts at the Lungs, ends at the Liver, and returns to assemble at the Lungs. The Lungs are the gateway for Qi emission, hence named Qi Kou, and serve as the great assembly of pulses to predict lifelong fortune.) Moreover, various Qis cannot reach the Lungs by themselves; they must rely on the water and grain essence from the Stomach for transport and irrigation. Thus, the Stomach is the transformation of Pre-Heaven Qi and the root of Post-Heaven Qi, governing all Qis. It is often seen that individuals with Yin deficiency and blood depletion take Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) and Si Wu Tang (Four Substance Decoction) daily without gaining the benefit of nourishing Yin. The reason lies precisely here. Shouldn't we seek beyond the six positions and focus on diagnosing the Qi Kou and Stomach Qi? (This highlights that Stomach Qi is the key to pulse diagnosis. Stomach Qi is Grain Qi. When Grain Qi decreases, Stomach Qi is about to perish; how can Blood be generated? Nowadays, people frequently use Si Wu Tang without considering dietary intake, thereby obstructing the source of Blood generation, which is common. *Jing Mai Bie Lun* states: Food Qi enters the Stomach, Jing Qi returns to the Lungs. The Lungs direct the Hundred Vessels, and Qi returns to balance. When balanced, Qi Kou forms an inch-length pulse, determining life and death. *Ying Wei Sheng Hui* states: Humans obtain Qi from grain. Grain enters the Stomach, transmits to the Lungs, and the Five Zang and Six Fu organs all receive its Qi. The clear part becomes Ying Qi (Nutritive Qi), the turbid part becomes Wei Qi (Defensive Qi). Ying Qi circulates within the vessels, while Wei Qi circulates outside.) Ming Men Fire (Ministerial Fire) resides on the right, and Kidney Water resides on the left; however, the Kidneys share the seventh vertebral level, governing both Yin and Yang, Essence and Qi, storing and sealing, allowing each to perform its function. Can the Kidneys be diagnosed solely on the left and not on the right? When taking pulses at all three positions (Cun, Guan, Chi) to form Nine Probes (Jiu Hou), whether superficial or deep, interior or exterior, these manifest differently in the floating, moderate, and deep levels of the six positions. This is essentially "exterior reflects exterior, interior reflects interior, middle reflects middle." Is it true that only Cun being Yang and Chi being Yin can govern interior and exterior? Headaches located above should naturally appear in the Cun pulse. However, Shaoyang (Lesser Yang) and Yangming (Bright Yang) headaches may appear in the two Guan pulses. (When pathogenic factors transmit to the Foot-Shaoyang Gallbladder Meridian, headache appears at the Left Guan; when transmitting to the Foot-Yangming Stomach Meridian, headache appears at the Right Guan.) Taiyang (Greater Yang/Bladder) headaches may appear at the Left Chi. Thus, pain located above cannot be confined strictly to the upper positions. Lin syndrome (dysuria) and enuresis located below should naturally be sought in the Chi pulse. However, due to Qi deficiency failing to hold, the disease may bias toward the Right Cun; due to Spirit decline failing to consolidate, it may bias toward the Left Cun. Thus, conditions located below cannot be confined strictly to the lower positions. When Middle Qi is deficient causing vomiting and diarrhea, vomiting seems related to the Cun pulse, and diarrhea to the Chi pulse; why should treatment focus on the Guan pulse to strengthen the Spleen and Stomach? When Yin and Yang Qi mix and block the central pathway, treatment should target the two Guan pulses; why should one prioritize ascending the clear to follow Yang and bitter descending to seek Yin? Therefore, diseases in the upper, middle, and lower parts cannot be entirely confined to the observed positions. Positions are so difficult to confine. (Xi notes: Floating pulses at all six positions can reflect the Heart and Lungs; deep pulses at all six positions can reflect the two Kidneys; moderate pulses at all six positions can reflect the Liver and Spleen. Furthermore, Kidney pulses sometimes appear floating or at the Cun position; Heart and Lung pulses sometimes appear deep or at the Chi position; Liver and Spleen pulses sometimes appear floating or deep at the Cun or Chi positions. Wang Zongzheng said: Pulse diagnosis should follow the principle that Heart and Lung pulses are generally floating, Kidney and Liver pulses are generally deep, and Spleen resides in the Central Region. If Wang Shuhe exclusively relied on Cun, Guan, and Chi positions to diagnose diseases, it is highly inappropriate.)