损之又损。至两息一至。则平人两息。而病患脉始一至也。是一昼夜间。
脉止行得六千七百五十动。以五十营计之。止一周身而尚不足。则死
也宜矣。譬之一骑。日行百里以为常。今筋力渐衰。日行六七十里。或可
望其复壮。及日行一二十里。而尚不能。其惫也甚矣。安得望其复生哉。
迟冷数热古今传。难经越度分明载。
此总结上文迟数损至之脉。谓迟则为冷。数则为热。其人之呼吸。脉之
尺寸。经之度数。具载于秦越人之难经中也。
热即生风冷生气。用心指下叮咛记。
肝主风热。则火盛金衰。不能制木。则木自旺而生风。肺主气冷。则水盛
火衰。不暇制金。则金自旺而生气也。
春弦夏洪秋似毛。冬石根据经分节气。
春弦者。即玉机真藏论。岐伯曰。春脉者肝也。东方木也。万物之所以始
生也。故其气来 弱轻虚而滑。端直以长。故曰弦。反此者病。帝曰。何如
而反。岐伯曰。其气来实而强。此谓太过病在外。其气来不实而微。此谓
不及病在中。帝曰。春脉太过与不及。其病皆何如。岐伯曰。太过则令人
善忘忽忽眩冒而颠疾。其不及则令人胸痛引背。下则两胁胀满。夏洪
者。即玉机真藏论。岐伯曰。夏脉者。心也。南方火也。万物之所以盛长也。
故其气来盛去衰。故曰钩。反此者病。帝曰。何如而反。岐伯曰。其气来盛
去亦盛。此谓太过。病在外。其气来不盛。去反盛。此谓不及。病在中。帝曰。
夏脉太过与不及。其病皆何如。岐伯曰。太过则令人身热而肤痛。为浸
淫。其不及。则令人烦心上见咳唾。下为气泄。秋毛者。即玉机真藏论。岐
伯曰。秋毛者。肺也。西方金也。万物之所以收成也。故其气来轻虚以浮。
来急去散。故曰浮。反此者病。帝曰。何如而反。岐伯曰。其气来毛而中央
坚。两旁虚。此谓太过。病在外。其气来毛而微。此谓不及病在中。帝曰。秋
脉太过与不及。其病皆何如。岐伯曰。太过则令人逆气而背痛愠愠然。
其不及。则令人喘呼吸少气而咳上气见血下闻病音。冬石者。即玉机
真藏论。岐伯曰。冬石者。肾也北方水也。万物之所以合藏也。故其气来
沉以搏。故曰营。反此者病。帝曰。何如而反。岐伯曰。其气来如弹石者。此
谓太过。病在外。其来如数者。此谓不及病在中。帝曰。冬脉太过与不及。
其病皆何如。岐伯曰。太过则令人解 。脊脉痛而少气不欲言。其不及
则令人心悬。如病饥 中清。脊中痛。少腹满。小便变。
阿阿缓弱春杨柳。此是脾家居四季。
按玉机真藏论。岐伯曰。脾脉者。土也。孤藏以灌四傍者也。帝曰。然则脾
善恶可得见之乎。岐伯曰。善者不可得见。恶者可见。帝曰。恶者如何得
见。岐伯曰。其来如水之流者。此谓太过病在外。如鸟之啄者。此谓不及
病在中。帝曰。夫子言脾为孤藏中央土以灌四傍。其太过与不及。其病
皆何如。岐伯曰。太过则令人四肢不举。其不及则令人九窍不通名曰
重强。
在意专心察细微。灵机应变通元记。
张世贤曰。在意。专心不他杂也。他事不杂于胸中。精察脉理之微细。则
灵机自然晓悟。元微之理贯通而不忘也。灵机。脉理也。脉理活动而不
执滞。故曰灵机。
浮芤滑实弦紧洪。七表还应是本宗。
浮芤滑实弦紧洪七脉。皆轻手取之而即得者。浮以候表。故曰七表。
微沉缓涩迟并伏。濡弱相兼八里同。
微沉缓涩迟伏濡弱八脉。轻取之不得。重手方得。沉以候里。故曰八里。
血营气卫定息数。一万三千五百通。
人受气于谷。谷入于胃。乃传之于五脏六腑。皆受于气。其清者为营。浊
者为卫。营行脉中。卫行脉外。营卫周流不息。五十周而复大会。阴阳相
贯。如环之无端。故血为荣气为卫。凡人所以得全其性命。气与血也。气
为阳。阳为卫。血为阴阴为荣。二气常流。所以无病也。经曰。人一呼脉行
三寸。一吸亦行三寸。呼吸定息。总行六寸。人一日一夜。凡一万三千五
百息。脉行五十度。周身漏水下百刻。营卫外行阳二十五度。内行阴亦
二十五度。为一周也。故五十度复会于手太阴寸口者。五脏六腑之所终始也。
损伤又损伤，直到两次呼吸脉搏才跳动一次，那么正常人的两次呼吸间，病患的脉搏才跳动一次。这样一昼夜之间，脉搏只能跳动六千七百五十次。按照“五十营”（气血在全身循环五十周）的理论计算，连完成一周身的循环都不足，那么死亡是必然的。这就好比一个骑手，每天行走百里是常态；如今体力逐渐衰退，每天只能走六七十里，或许还指望他能恢复强壮；如果每天只能走一二十里，甚至做不到，那他的疲惫已经非常严重了，怎么能指望他恢复生机呢？
迟脉主冷、数脉主热，这是古今相传的经验，《难经》中越度分明地记载了这一点。
这里总结上文关于迟脉、数脉、损脉和至脉的内容，意思是：迟脉则代表寒冷，数脉则代表热盛。人体的呼吸频率、脉诊时的寸口尺寸以及经络运行的度数，都详细记载在秦越人（扁鹊）所著的《难经》中。
热盛则生风，寒盛则生气，用心用手指下仔细体会并牢记。
肝主风，若热盛，则火旺金衰，不能制约木，于是木气自旺而生风。肺主气，若寒盛，则水旺火衰，无暇制约金，于是金气自旺而生气。
春季脉象弦，夏季脉象洪大，秋季脉象如毛般轻浮，冬季脉象如石般沉实，这都是根据经典对节气的划分。
所谓春弦，即出自《素问·玉机真脏论》。岐伯说：春脉对应肝脏，属东方木，是万物开始生长的时节。所以其脉气来时微弱、轻虚而滑，端直且长，所以称为“弦”。与此相反则为病态。黄帝问：怎样算是相反？岐伯说：其脉气来时坚实而强劲，这叫做“太过”，病在外；其脉气来时不实而微弱，这叫做“不及”，病在内。黄帝问：春脉的太过与不及，病症分别如何？岐伯说：太过则会让人容易遗忘、忽忽头晕目眩甚至颠仆疾病；不及则会让人胸痛牵引背部，向下则两胁胀满。
夏洪，即出自《素问·玉机真脏论》。岐伯说：夏脉对应心脏，属南方火，是万物盛大生长的时节。所以其脉气来时旺盛而去时衰弱，所以称为“钩”（形容脉来盛去衰如钩）。与此相反则为病态。黄帝问：怎样算是相反？岐伯说：其脉气来时旺盛，去时也旺盛，这叫做“太过”，病在外；其脉气来时不旺盛，去时反而旺盛，这叫做“不及”，病在内。黄帝问：夏脉的太过与不及，病症分别如何？岐伯说：太过则会让人身体发热且皮肤疼痛，发生浸淫疮疡；不及则会让人心烦，向上可见咳嗽吐唾，向下则出现气泄（如遗尿或失气）。
秋毛，即出自《素问·玉机真脏论》。岐伯说：秋脉对应肺脏，属西方金，是万物收成之时。所以其脉气来时轻虚而浮，来势急而去势散，所以称为“浮”。与此相反则为病态。黄帝问：怎样算是相反？岐伯说：其脉气来如毛但中央坚实，两旁虚弱，这叫做“太过”，病在外；其脉气来如毛但微弱，这叫做“不及”，病在内。黄帝问：秋脉的太过与不及，病症分别如何？岐伯说：太过则会让人逆气且背痛，心中郁结不适；不及则会让人喘息、呼吸短少气力且咳嗽，向上可见咳血，向下可听到病变的声音（如肠鸣等）。
冬石，即出自《素问·玉机真脏论》。岐伯说：冬脉对应肾脏，属北方水，是万物闭藏之时。所以其脉气来时沉而搏指，所以称为“营”（此处指沉石之象，亦通“石”）。与此相反则为病态。黄帝问：怎样算是相反？岐伯说：其脉气来时像弹石一样坚硬，这叫做“太过”，病在外；其脉气来时像数脉（急促）一样，这叫做“不及”，病在内。黄帝问：冬脉的太过与不及，病症分别如何？岐伯说：太过则会让人懈怠无力，脊背经脉疼痛且少气懒言；不及则会让人心里空虚感，像得了饥饿病一样，胃脘部清冷，脊中痛，小腹胀满，小便异常。
脉象阿阿缓弱如春柳般柔和，这是脾脏居中的表现，统摄四季之气。
按《素问·玉机真脏论》，岐伯说：脾脉属土，是孤独的脏器，用来灌溉四方（其他四脏）。黄帝问：既然这样，那么脾脏的好与坏可以看见吗？岐伯说：好的脾脉看不见，坏的脾脉才能看见。黄帝问：坏的脾脉如何看见？岐伯说：其脉气来时如水流动般滑利，这叫做“太过”，病在外；如鸟啄食般短促顿挫，这叫做“不及”，病在内。黄帝问：先生曾说脾为孤脏，居中央土以灌溉四方，其太过与不及，病症分别如何？岐伯说：太过则会让人四肢无法举起；不及则会让人九窍不通，名叫“重强”（身体沉重僵硬）。
在意专心观察细微之处，灵活应变以通达深奥的道理并牢记。
张世贤说：“在意”，就是专心致志，不被其他杂念干扰。心中不夹杂其他事务，精细考察脉理的微妙细节，那么灵动的机理自然就会领悟，深奥微妙的道理贯通于心而不会忘记。“灵机”，指的是脉理。脉理是活动变化而不固执僵滞的，所以叫“灵机”。
浮、芤、滑、实、弦、紧、洪，这七种脉象属于“七表”，还应是本宗（阳脉）。
浮、芤、滑、实、弦、紧、洪这七种脉，都是轻手取脉就能得到的。浮脉用以候表证，所以称为“七表”。
微、沉、缓、涩、迟、伏、濡、弱，这八种脉象相兼属于“八里”（阴脉）。
微、沉、缓、涩、迟、伏、濡、弱这八种脉，轻取不得，必须重手按压才能得到。沉脉用以候里证，所以称为“八里”。
血为营，气为卫，定息计数，一万三千五百次通畅运行。
人从谷物中摄取精气，谷物进入胃中，然后传输到五脏六腑，都受到精气的滋养。其中清纯的部分成为营气，浑浊的部分成为卫气。营气行于脉中，卫气行于脉外。营卫之气周流不息，循环五十周后再次大会合。阴阳相互贯穿，如同圆环没有端点。所以血被称为荣（营），气被称为卫。凡人之所以能保全性命，依靠的是气与血。气为阳，阳即为卫；血为阴，阴即为荣。这两股气常流不息，所以无病。经文说：人每呼一次，脉气运行三寸；每吸一次，也运行三寸。一呼一吸定息之间，总共运行六寸。人一天一夜，共有一万三千五百次呼吸。脉气运行五十周次，周身水流漏刻百刻。营卫之气外行于阳分二十五周次，内行于阴分也是二十五周次，合为一周。所以五十周次后重新会合于手太阴肺经的寸口处，这是五脏六腑气血终结和起始的地方。
Damage upon damage, until there is only one pulse beat per two breaths. In this case, for a healthy person's two breaths, the patient's pulse beats only once. Thus, in one day and night, the pulse beats only 6,750 times. Calculated according to the "Fifty Circulations" (Wushi Ying, the circulation of Qi and Blood through the whole body fifty times), it is insufficient even to complete one full circuit around the body; therefore, death is inevitable. It is like a rider who usually travels one hundred li per day. Now, as strength gradually declines, traveling only sixty or seventy li per day might still allow hope for recovery. But if he can travel only ten or twenty li per day, and cannot even do that, his exhaustion is extreme. How can one expect him to recover?
Slow pulse indicates cold, rapid pulse indicates heat, passed down from ancient times to modern days. The *Nan Jing* (Classic of Difficult Issues) clearly records these distinctions.
This summarizes the preceding text regarding slow (Chi), rapid (Shu), diminished (Sun), and excessive (Zhi) pulses. It means: a slow pulse implies coldness, while a rapid pulse implies heat. The person's respiration rate, the dimensions of the Cun and Chi positions on the wrist, and the degrees of meridian flow are all detailed in the *Nan Jing* by Qin Yueren (Bian Que).
Heat generates wind, cold generates Qi; keep this firmly in mind when palpating with your fingers.
The Liver governs wind. If heat is excessive, Fire flourishes and Metal weakens, failing to control Wood; thus, Wood becomes hyperactive and generates wind. The Lungs govern Qi. If cold is excessive, Water flourishes and Fire weakens, having no leisure to control Metal; thus, Metal becomes hyperactive and generates Qi.
Spring pulses are wiry (Xian), Summer pulses are surging (Hong), Autumn pulses resemble feathers (Mao), and Winter pulses resemble stones (Shi), based on the classical division of solar terms.
"Wiry" in Spring refers to the *Su Wen: Yu Ji Zhen Zang Lun*. Qibo said: The Spring pulse corresponds to the Liver, which belongs to East Wood, the season when all things begin to grow. Therefore, its Qi arrives weak, light, void, yet smooth, straight and long, hence called "wiry." Deviation from this indicates disease. The Yellow Emperor asked: How does it deviate? Qibo said: If the Qi arrives solid and strong, this is called "Excess" (Tai Guo), indicating disease in the exterior. If the Qi arrives not solid but faint, this is called "Deficiency" (Bu Ji), indicating disease in the interior. The Yellow Emperor asked: What are the symptoms of Excess and Deficiency in Spring pulses? Qibo said: Excess causes forgetfulness, dizziness, vertigo, and epileptic fits. Deficiency causes chest pain radiating to the back, and distension/fullness below in both hypochondriac regions.
"Surging" in Summer refers to the *Su Wen: Yu Ji Zhen Zang Lun*. Qibo said: The Summer pulse corresponds to the Heart, which belongs to South Fire, the season when all things flourish and grow. Therefore, its Qi arrives vigorous and departs declining, hence called "hook" (Gou, describing the pulse coming strong and going weak). Deviation from this indicates disease. The Yellow Emperor asked: How does it deviate? Qibo said: If the Qi arrives vigorous and departs also vigorous, this is called "Excess," disease in the exterior. If the Qi arrives not vigorous but departs vigorously, this is called "Deficiency," disease in the interior. The Yellow Emperor asked: What are the symptoms? Qibo said: Excess causes body heat and skin pain, leading to spreading sores (Jin Yin). Deficiency causes vexation, upward coughing and spitting, and downward leakage of Qi (such as incontinence).
"Feather-like" in Autumn refers to the *Su Wen: Yu Ji Zhen Zang Lun*. Qibo said: The Autumn pulse corresponds to the Lungs, which belong to West Metal, the season of harvest. Therefore, its Qi arrives light, void, and floating, coming swiftly and scattering upon departure, hence called "floating" (Fu). Deviation from this indicates disease. The Yellow Emperor asked: How does it deviate? Qibo said: If the Qi feels like a feather but is firm in the center and empty on the sides, this is called "Excess," disease in the exterior. If the Qi feels like a feather but is faint, this is called "Deficiency," disease in the interior. The Yellow Emperor asked: What are the symptoms? Qibo said: Excess causes rebellious Qi and back pain, with a feeling of oppression. Deficiency causes panting, shortness of breath, coughing, upward hemoptysis, and audible pathological sounds below.
"Stone-like" in Winter refers to the *Su Wen: Yu Ji Zhen Zang Lun*. Qibo said: The Winter pulse corresponds to the Kidneys, which belong to North Water, the season of storage. Therefore, its Qi arrives deep and pounding, hence called "ying" (referring to the deep/stony quality). Deviation from this indicates disease. The Yellow Emperor asked: How does it deviate? Qibo said: If the Qi arrives hard like bouncing stones, this is called "Excess," disease in the exterior. If the Qi arrives rapid, this is called "Deficiency," disease in the interior. The Yellow Emperor asked: What are the symptoms? Qibo said: Excess causes lethargy, pain in the spinal meridians, shortness of breath, and reluctance to speak. Deficiency causes a sensation of emptiness in the heart, as if hungry, coldness in the epigastrium, pain in the spine, fullness in the lower abdomen, and abnormal urination.
Pulses that are soft, slow, and weak like willow branches in spring indicate the Spleen dwelling centrally and governing the four seasons.
According to the *Su Wen: Yu Ji Zhen Zang Lun*, Qibo said: The Spleen pulse belongs to Earth. It is the solitary organ that irrigates the four surrounding organs. The Yellow Emperor asked: Can the good and bad states of the Spleen be seen? Qibo said: The good state cannot be seen; the bad state can be seen. The Yellow Emperor asked: How is the bad state seen? Qibo said: If the Qi arrives flowing like water, this is "Excess," disease in the exterior. If it arrives pecking like a bird, this is "Deficiency," disease in the interior. The Yellow Emperor asked: You stated the Spleen is the solitary organ, central Earth irrigating the four sides. What are the symptoms of Excess and Deficiency? Qibo said: Excess causes inability to lift the limbs. Deficiency causes obstruction of the nine orifices, named "Zhong Qiang" (heavy stiffness).
Focus your attention to observe subtleties; adapt flexibly to comprehend profound principles and remember them.
Zhang Shixian said: "Focus your attention" means concentrating without distraction. Do not let other matters clutter your mind. By meticulously examining the subtleties of pulse logic, the agile mechanism (Ling Ji) will naturally become clear. The profound and subtle principles will connect and be remembered. "Ling Ji" refers to pulse logic. Pulse logic is dynamic and not rigid, hence called "Ling Ji."
Floating (Fu), Knifelike (Kou), Slippery (Hua), Solid (Shi), Wiry (Xian), Tight (Jin), and Surging (Hong)—these seven belong to the "Seven Tables" (Yang pulses).
These seven pulses—Floating, Knifelike, Slippery, Solid, Wiry, Tight, and Surging—are all obtained with light pressure. Floating pulse diagnoses exterior conditions, hence they are called the "Seven Tables."
Micro (Wei), Deep (Chen), Slow (Huan), Rough (Se), Slow (Chi), Hidden (Fu), Soft (Ru), and Weak (Ruo)—these eight belong to the "Eight Li" (Yin pulses).
These eight pulses—Micro, Deep, Slow, Rough, Slow, Hidden, Soft, and Weak—are not felt with light pressure but require heavy pressure. Deep pulse diagnoses interior conditions, hence they are called the "Eight Li."
Blood is Ying (Nutrient), Qi is Wei (Defensive); counting breaths, 13,500 cycles pass smoothly.
Humans receive Qi from grain. Grain enters the Stomach and is transmitted to the Five Zang and Six Fu organs, all receiving Qi. The pure part becomes Ying Qi (Nutrient Qi), and the turbid part becomes Wei Qi (Defensive Qi). Ying Qi circulates within the vessels, while Wei Qi circulates outside. Ying and Wei Qi flow continuously, completing fifty circuits before meeting again. Yin and Yang interpenetrate like a circle without end. Thus, blood is Ying, and Qi is Wei. Humans preserve their life and nature through Qi and Blood. Qi is Yang, and Yang is Wei; Blood is Yin, and Yin is Ying. These two Qi flows constantly, ensuring health. The Classics state: With one exhalation, pulse Qi moves three cun; with one inhalation, it also moves three cun. At the pause between breaths, it moves six cun total. In one day and night, there are 13,500 breaths. The pulse Qi moves fifty times around the body, corresponding to one hundred water-clock divisions. Ying and Wei Qi move externally through the Yang aspects twenty-five times and internally through the Yin aspects twenty-five times, constituting one full cycle. Thus, after fifty cycles, they reconvene at the Cun Kou point of the Hand Taiyin Lung Meridian, which is where the Qi of the Five Zang and Six Fu organs ends and begins.