左右须候四时脉。
经曰。左右者。阴阳之道路也。故人之左尺水生左关木。左关木生左寸
火。左寸火生右尺火。右尺火生右关土。右关土生右寸金。右寸金生左
尺水。又左寸火克右寸金。右寸金克左关木。左关木克右关土。右关土
克左尺水。左尺水克左寸火。一往一来。左右互相生克。即洪范九畴以
左右合。而明吉凶之义也。然亦须随其四时以诊之。假令左关肝脉固
宜弦长。而春三月左右手六部中。亦须带弦。又令右寸肺脉固宜浮涩。
若秋三月左右手六部中。亦须带涩。故曰左右须候四时脉也。
四十五动为一息。
张世贤曰。动脉至也。息脉止也。非呼吸之息也。愚谓平人之脉。循环无
已。虽四十五动之外。无有巳时。而此云四十五动为一息者。言其脉之
一小周也。犹之以三百六十日为一岁。非三百六十日之外。有一上而
后为第二岁。所谓以四十五动为一息者。体九畴之数。五九四十五也。
五则五行之气。全九则九畴之数备矣。
指下弦急洪紧时。便是有风兼热极。
弦急。不缓也。洪紧。大而不和也。弦急洪紧四脉皆阳。诸阳为热。热则生
风。故曰便是有风兼热也。
忽然匿匿慢沉细。冷极缠身兼患气。
匿匿隐而不现也。慢。迟也。匿慢沉细四脉皆阴。诸阴为冷。冷即生气。故
曰冷疾缠身兼患气也。
贼脉频来问五行。
贼脉。鬼克之脉也。如心脉沉细。肝脉涩小。脾脉弦急。肺脉洪大。肾脉迟
缓。又令春脉涩短。夏脉沉迟。季夏脉弦长。秋脉洪散。冬脉缓慢。是皆贼
脉。项问五行之克我者是也。
屋漏雀啄终不治。
屋漏。迟缓而一止也。雀啄。急数而一止也。二者皆为脾气绝。屋漏为脾
之阳。气绝阳行速也。雀啄为脾之阴。气绝阴行迟也。脾主中州。灌溉五
脏六腑。脾家之元阴元阳既绝。则十二经俱危矣。故曰终不治。
按经云。脉病患不病。脉来如屋漏雀啄者死。注云。屋漏者。其来既绝而
止。时时复起而不相连属也。雀啄者。脉来甚数而疾绝止。复顿来也。又
经言得病七八日。脉如屋漏雀啄者死。注云。脉弹人手如黍米也。
左右手的脉象需要结合四季的变化来诊察。
经典中说：“左右，是阴阳运行的道路。”因此，人体左尺部（肾水）水生左关部（肝木），左关部（肝木）生左寸部（心火），左寸部（心火）生右尺部（命门火/相火），右尺部（命门火/相火）生右关部（脾土），右关部（脾土）生右寸部（肺金），右寸部（肺金）生左尺部（肾水）。此外，左寸部（心火）克右寸部（肺金），右寸部（肺金）克左关部（肝木），左关部（肝木）克右关部（脾土），右关部（脾土）克左尺部（肾水），左尺部（肾水）克左寸部（心火）。一往一来，左右相互滋生和克制，这就像《洪范》九畴中通过左右配合来阐明吉凶的道理一样。然而，也必须随着四季的变化来诊察。例如，左关部的肝脉本来适宜呈现弦长之象，但在春季三个月里，左右手六部脉中也必须带有弦象。又如，右寸部的肺脉本来适宜呈现浮涩之象，在秋季三个月里，左右手六部脉中也必须带有涩象。所以说，左右手的脉象必须结合四季来诊察。
脉搏跳动四十五次称为一息（一小周天）。
张世贤说：“动脉至也，息脉止也”，这里的“息”不是指呼吸的“息”。我认为正常人的脉象循环无已时，即使在四十五次跳动之外，也没有停止的时候。这里说“四十五动为一息”，是指脉气运行的一小周天。这就好比以三百六十日为一岁，并不是说在三百六十日之外，有一天过后才进入第二年。所谓“以四十五动为一息”，是取法《洪范》九畴的数理，五九得四十五。五代表五行之气完备，九代表九畴之数齐全。
手指下感觉到脉象弦急、洪大或紧束时，就是体内有风邪兼热极的表现。
弦急，就是不缓和；洪紧，就是盛大而不调和。弦、急、洪、紧四种脉象都属于阳脉，诸阳主热，热则生风，所以说就是有风邪兼热极。
忽然出现隐匿、缓慢、沉细的脉象，则是冷极缠身兼患气滞的表现。
匿匿，指脉象隐伏不现；慢，即迟脉。匿、慢、沉、细四种脉象都属于阴脉，诸阴主冷，冷即导致气机凝滞，所以说有冷疾缠身兼患气滞。
贼脉频频出现，询问其五行相克的道理。
贼脉，是被鬼所克的脉象。例如：心脉应见沉细，肝脉应见涩小，脾脉应见弦急，肺脉应见洪大，肾脉应见迟缓。又如：春季脉象应见涩短，夏季脉象应见沉迟，长夏脉象应见弦长，秋季脉象应见洪散，冬季脉象应见缓慢。这些都是贼脉，指的是五行中克我者的脉象。
屋漏脉和雀啄脉最终无法治愈。
屋漏脉，指脉来迟缓且偶尔停顿一次；雀啄脉，指脉来急数且偶尔停顿一次。这两种脉象都代表脾气绝灭。屋漏脉反映脾之阳气绝，阳气行速故脉乍停；雀啄脉反映脾之阴气绝，阴气行迟故脉乍停。脾主中州，灌溉五脏六腑，脾家的元阴元阳既已绝灭，则十二经脉都危险了，所以说最终无法治愈。
根据经典记载：“脉病患不病，脉来如屋漏雀啄者死。”注解说：屋漏脉，其来势既绝而止，时时复起但不相连属；雀啄脉，脉来非常急数且突然中止，然后又顿然来至。另外经典又说：“得病七八日，脉如屋漏雀啄者死。”注解说：脉弹击人手的感觉像黍米颗粒一样坚硬突兀。
The pulse at the left and right wrists must be examined in accordance with the four seasons.
The Classics state: "Left and right are the pathways of Yin and Yang." Therefore, in the human body, Water at the Left Chi (Kidney Water) generates Wood at the Left Guan (Liver Wood); Wood at the Left Guan generates Fire at the Left Cun (Heart Fire); Fire at the Left Cun generates Fire at the Right Chi (Ministerial Fire); Fire at the Right Chi generates Earth at the Right Guan (Spleen Earth); Earth at the Right Guan generates Metal at the Right Cun (Lung Metal); and Metal at the Right Cun generates Water at the Left Chi. Furthermore, Fire at the Left Cun controls Metal at the Right Cun; Metal at the Right Cun controls Wood at the Left Guan; Wood at the Left Guan controls Earth at the Right Guan; Earth at the Right Guan controls Water at the Left Chi; and Water at the Left Chi controls Fire at the Left Cun. Moving back and forth, the left and right sides mutually generate and control each other, just as the Nine Categories of Hongfan utilize left and right coordination to elucidate the principles of auspiciousness and inauspiciousness. However, examination must also follow the changes of the four seasons. For instance, the Liver pulse at the Left Guan is inherently suitable for a Wiry and Long quality (Xian Chang). Yet, during the three months of Spring, all six positions of both hands should also exhibit a Wiry quality. Similarly, the Lung pulse at the Right Cun is inherently suitable for a Floating and Choppy quality (Fu Se). During the three months of Autumn, all six positions of both hands should also exhibit a Choppy quality. Thus it is said that the pulses at the left and right must be examined in relation to the four seasons.
Forty-five pulsations constitute one "Xi" (a small cycle of Qi circulation).
Zhang Shixian stated: "Dong Mai (Pulsating Pulse) refers to arrival; Xi Mai refers to cessation." Here, "Xi" does not refer to respiration. I believe that in a healthy person, the pulse circulates endlessly without cessation. Even beyond forty-five pulsations, there is no stopping point. The statement "forty-five pulsations constitute one Xi" refers to a small cycle of the pulse's Qi movement. This is analogous to considering 360 days as one year; it does not mean that after 360 days, one day passes before entering the second year. The concept of "forty-five pulsations as one Xi" aligns with the numerology of the Nine Categories of Hongfan, where five times nine equals forty-five. Five represents the completeness of the Five Elements' Qi, and nine represents the completeness of the Nine Categories.
When the pulse feels Wiry and Urgent (Xian Ji), or Surging and Tight (Hong Jin) under the fingers, it indicates the presence of Wind combined with Extreme Heat.
"Wiry and Urgent" means not relaxed; "Surging and Tight" means large but not harmonious. The four pulse qualities—Wiry, Urgent, Surging, and Tight—all belong to Yang pulses. All Yang relates to Heat, and Heat generates Wind. Therefore, it is said that this indicates Wind combined with Extreme Heat.
If suddenly the pulse becomes Hidden (Ni Ni), Slow (Man), Deep (Chen), and Fine (Xi), it indicates Cold extreme entangling the body accompanied by Qi disorders.
"Hidden" means the pulse is concealed and not visible; "Slow" refers to the Sluggish pulse (Chi). The four pulse qualities—Hidden, Slow, Deep, and Fine—all belong to Yin pulses. All Yin relates to Cold, and Cold leads to Qi stagnation. Therefore, it is said that this indicates Cold diseases entangling the body accompanied by Qi disorders.
When the Thief Pulse (Ze Mai) frequently appears, one must inquire into the Five Elements' controlling relationships.
The Thief Pulse is a pulse controlled by the "Ghost" (the element that controls me). For example: the Heart pulse should appear Deep and Fine; the Liver pulse should appear Choppy and Small; the Spleen pulse should appear Wiry and Urgent; the Lung pulse should appear Surging and Large; the Kidney pulse should appear Sluggish and Moderate. Additionally: the Spring pulse should appear Choppy and Short; the Summer pulse should appear Deep and Sluggish; the Late Summer pulse should appear Wiry and Long; the Autumn pulse should appear Surging and Scattered; the Winter pulse should appear Slow and Moderate. These are all Thief Pulses, referring to the pulses of the element that controls the respective organ according to the Five Elements.
The House-Leak Pulse (Wu Lou) and the Sparrow-Pecking Pulse (Que Zhuo) are ultimately incurable.
The House-Leak Pulse is slow with occasional pauses; the Sparrow-Pecking Pulse is rapid with occasional pauses. Both indicate the exhaustion of Spleen Qi. The House-Leak Pulse reflects the exhaustion of Spleen Yang Qi, where Yang moves quickly causing intermittent stops; the Sparrow-Pecking Pulse reflects the exhaustion of Spleen Yin Qi, where Yin moves slowly causing intermittent stops. The Spleen governs the Central Region and irrigates the Five Zang and Six Fu organs. Once the Primordial Yin and Yang of the Spleen are exhausted, the Twelve Meridians are all in danger. Therefore, it is said that they are ultimately incurable.
According to the Classics: "If the pulse matches the disease while the patient appears well, or if the pulse resembles the House-Leak or Sparrow-Pecking, death ensues." The commentary notes: The House-Leak pulse comes to an end and stops, occasionally rising again but not connecting continuously. The Sparrow-Pecking pulse comes very rapidly and abruptly stops, then suddenly returns. Furthermore, the Classics state: "After seven or eight days of illness, if the pulse resembles the House-Leak or Sparrow-Pecking, death ensues." The commentary notes: The pulse feels like millet grains striking the hand.