数调匀也。然不若内经理备言详。其曰闰以太息者。闰在气盈朔虚之间。太息在呼吸之间。犹岁之闰。
非一呼一吸之外再有呼吸也。
太息者。呼吸定息在呼吸之间。脉因而又一动。以成五动之数。亦如呼出心与肺。吸入肾与肝。
而脾受谷气于中。在呼出吸入之间也。
三迟二败冷危困。六数七极热生多。八脱九死十归墓。十一十二绝魂瘥。
〔三至为迟一二败〕（一息一至着床害。）两息一至死非怪。
迟败。前已言矣。今重出。况下文两息一至正论损。损有四等。故改之以举其凡例。十四难曰。
何谓损。
一呼一至曰离经。二呼一至曰夺精。三呼一至曰死。四呼一至曰命绝。损脉从下上。自一呼一至。
而至四呼一至也。然离经夺精则必死矣。何待三呼四呼一至。故脉诀。两息一至即言死。仲景曰。
脉有四损三日死。平人四息。病患脉一至也。五损一日死。平人五息。病患脉一至也。六损一时死。
平人六息。病患脉一至也。此仲景于四损之上。又增五损六损。为一日一时死期。
迟冷数热古今同。难经越度分明载。
难经曰。数则为热。迟则为寒。越度者秦越人之法度也。
热〔即〕（积）生风冷〔生〕（动）气。用心指下丁宁记。
热岂能生风。热积之多则风生。冷不能生气。冷积之多则动气。然冷热。亦能动血而为病。不可专泥也。
春弦夏〔洪〕（钩）秋似毛。冬石根据经分节气。
素问曰。春脉如弦。其气来 弱轻虚以滑。端直以长。故曰弦。夏脉如钩。其气来盛去衰。故曰钩。
秋脉如浮。其气来轻虚以浮。来急去散。冬脉如营。其气来沉以抟。故曰营。难经曰。者弦。脉来
厌厌聂聂。如循榆叶。（当根据素问作脉来 弱。招招如揭长竿末梢。）曰平。益实而滑。如循长竿。
曰病。急而劲益。强如新弓弦。曰死。夏钩。脉来累累如环。如循琅 。曰平。来益数如鸡举足曰病。
前曲后倨。如操带钩曰死。秋毛。脉来蔼蔼。如车盖。按之益大。（当根据素问作厌厌聂聂如落榆叶。）
曰平。不上不下。如循鸡羽。曰病。按之消索如风吹毛曰死。冬石。脉来上大下锐。如雀之啄。曰平。
啄啄连属。其中微曲。曰病。来如解索。去如弹石。曰死。今按四时之脉。皆取法象本乎难经。夏脉不
当改作洪。
阿阿缓若春杨柳。此是脾家居四季。
四时之末。土旺十八日。此脾土之本位。然而四时之候。四脏之脉。皆以脾土胃气为本。难经曰。
脾者中州。其平和不可得见。衰乃见尔。来如雀之啄。如水之漏下。是脾家之衰见也。脉经曰。六月季夏建未。
坤之间。土之位。脾旺之时。其脉来阿阿而缓。名曰平脉。今脉诀增春杨柳以为法象。蔡氏曰。凡脉不
大不细。不长不短。不浮不沉。不滑不涩。应手中和。意思欣欣。难以名状者。为胃气。亦可谓善于形容者矣。
今按难经所言。四时之平脉者。有胃气之脉也。病脉者。四时脉多而胃气少者也。死脉者。但有四时
脉。而无胃气者也。如此则胃气之脉。随四时而寓于当时之脉之中。为平脉也。不可得而见。亦不可
得而形容。其曰阿阿而缓者。专以四季十八日中所诊而见者言之耳。
在意专心察细微。灵枢晓解通玄记。
浮芤滑实弦紧洪。〔七表〕（阳脉）还应是本宗。微沉缓涩迟并伏。濡弱相兼〔八里〕（阴脉）同。
脉不可以表里定名也。惟浮沉二脉。可以表里论。黄、岐、越人、仲景、叔和皆不言表里。脉经王氏所作。
无七表八里九道之名。今脉诀窃托叔和之名。其论脉却悖于脉经。自六朝以来。以七表八里九道为世
大惑。未有言其非者。王裳着阐微论。谓脉诀论表不及里。于脉之形状大有发明。至于表里则不言其
非。尚拘拘增数长二脉为九表。加短细二脉为十里。以九与十为阴阳数之极。呜呼。脉之变化。固从阴
阳生。然安可以名数拘之哉。从来之论脉有以浮沉长短滑涩为三阴三阳者。有以大小滑涩浮沉可以指别者。
有以大浮数动滑为阳。沉涩弱弦微为阴者。有以按尺寸。观浮沉滑涩。而知病所生以治者。是皆以阴
阳对举而互见也。未尝云七表八里九道也。但七表八里九道。果可以尽脉之数乎。内经曰鼓曰搏曰喘曰横
曰急曰躁。仲景曰 卑荣章纲损。曰纵横逆顺。岂七表八里九道之能尽也。然其名虽异。实不出乎阴阳。
故脉当以阴阳察形。不当以表里定名。内经曰脉合阴阳。又曰善诊者察色按脉。先别阴阳。诸脉因浮而见者。
皆云表。不拘于七表。诸脉因沉而见者。皆曰里。不拘于八里。沉而滑亦曰
里。浮而涩亦曰表。详辨在众脉条下。
血营气卫定息数。一万三千五百通。
素问曰。营者水谷之精气也。和调于五脏。洒陈于六腑。乃能入于脉也。故循脉上下。贯五脏。
络六腑也。卫者。水谷之悍气。其气 疾滑利。不能入于脉也。故循皮肤之中。分肉之间。（谓脉外）
熏于肓膜。散于胸腹。灵枢曰。人受气于谷。谷入于胃。以传与肺。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。营周不休。五十而大会。又曰谷气津液已行。营卫大通。乃化糟粕。
以次传下。又曰谷始入于胃。其精微者。先出于胃之两焦。以溉五脏。别出两行营卫之道。其大气
之抟而不行者。积于胸中。命曰气海。出于肺。循喉咽。故呼则出。吸则入。又曰其浮气之不循经
者为卫气。其精气之行于经者为营气。又曰五谷入于胃也。其糟粕津液宗气分为三队。故宗气积于胸中。
出于喉咙。以贯心肺。而行呼吸焉。营气者。泌其津液。注之于脉。化以为血。以营四末。内注五脏六腑。
以应刻数焉。卫气者。出其悍气之 疾。而先行于四末分肉皮肤之间。而不休者也。营气卫气。皆津
液之所行。又曰营卫者精气也。血者神气也。故血之与气。异名而同类焉。又曰营出中焦。卫出上焦。
又曰上焦开发。宣五谷味。熏肤充身泽毛。若雾露之溉。是谓气。中焦受气取汁。变化而赤。是谓血。
又曰经脉者。所以行血气。而营阴阳。濡筋骨。利关节者也。卫气者。所以温分肉。充皮肤。肥腠理。
司开阖者也。灵枢曰。人经脉周身十六丈二尺。漏水下百刻分昼夜。人一呼。脉再动。气行三寸。一吸。
脉亦再动。气行三寸。呼吸定息。气行六寸。十息。气行六尺。二
百七十息。气行十六丈二尺。一周于身。下水二刻。二千七百息。气行十周于身。下水二十刻。一
万三千五百息则气五十周。水下百刻。故五十营者。备得天地之寿矣。凡行八百一十丈也。又曰。卫
气之行。一日一夜。五十周于身。昼行于阳二十五周。夜行于阴二十五周。周于五脏。是故平旦
阴尽。阳气出于目。目张则气上行于头。循项。下足太阳。循背。下至小指之端。其散者。别于
目锐 。下手太阳。下至手小指之间外侧。其散者别于目锐 。下足少阳。注小指次指之间。以
上循手少阳之分侧。下至手小指之间。别者以上至耳前。合于颔脉。注足阳明。以下行至足跗上。
入五指之间。其散者从耳下。下手阳明。入大指之间。入掌中。其至于足也。入足心。出内踝下行
阴分。复合于目。故为一周。是故日行一舍。人气行身一周。与十分身之八。其始入于阴。常从
足少阴注于肾。肾注于心。心注于肺。肺注于肝。肝注于脾。脾复注于肾。为周。是故夜行一舍。
人气行于阴脏一周。与十分藏之八。亦如阳行之二十五周。而复会于目。（详见灵枢卫气行七十六）
此五十周卫气之行也。昼行阳二十五度。夜行阴二十五度。五十周而后大会于平旦者。营卫息数同
也。其始从中焦注手太阴阳明。阳明注足阳明太阴。太阴注手少阴太阳。太阳注足太阳少阴。少阴
注手心主少阳。少阳注足少阳厥阴。厥阴复还注手太阴。此经脉行度终始也。与卫气之行则各异。三
因方云。血为脉。气为息。一呼一吸一定息。脉行六寸。二百七十息。行尽十六丈二尺者。
血之脉也。气之息迟于脉。八息三分三厘三毫方行一寸。一万三千五百息。方行尽十六丈二尺。今
按经云气积于胃。以通营卫。各行其道。宗气流于海。下者注气街。上者走息道。如此则营卫各道。如上
文灵枢所言。营者水谷之精气。出于中焦。变化为赤。入于脉。与息数呼吸应。卫者水谷之悍气。
出于上焦。行于脉外。温分肉。充皮肤。司开阖。不与脉同行。不与营同道。不与息数同应营卫也。其
异如此。然而行于身也。昼夜五十周。则营与卫一也。三因以血为脉指营言。以气为息指卫言。而
谓营血之脉昼夜五十周。卫气之息昼夜一周。不知何据。而与古经如此其异也。又按难经曰。营气之行。
常与卫气相随上下。卫由息而动。巢元方谓气行则血行。气住则血住。皆疑其传误。王冰谓刺络通营卫。
不当兼言卫在络之间也。灵枢卫气行篇云。卫气之行。昼行阳。则目张而寤。夜行阴。则目瞑而寐。
谨按此节。言平旦阳气之出目。而下行于手足三阳也。皆一时分道并注。非有先后次第也。此经篇末
言水下一刻。人气在太阳。水下二刻。人气在少阳。水下三刻。人气在阳明。水下四刻。人气在阴分者。
则是先下太阳究竟。然后下少阳。俟少阳究竟。然后下阳明。俟阳明究竟。方上行阴分。大与此节矛盾。
并衍文也。又按此节。言阳气流行之周数。及下文言漏水所下之刻数合而推之，其为衍衣冠文物矣。何以言之。
夫昼日漏下之水。凡五十刻。昼日阳气之行。凡二十五周。以昼日漏水之刻数。配于昼日阳气之周数。
则阳气一周配漏水二刻也。又以漏水之二刻。配于阳气之一周。则阳气之从平旦出目。而分道并注下于
手足三阳也。盖配水下一刻焉。其从足心之出内踝。上行阴分。而复合于目。亦配水下一刻。是为一周
也。如此则水下一刻。人气当在三阳。水下二刻。人气当在阴分。而行一周于身也。水下三刻。人气又
当在三阳。水下四刻。人气又当在阴分。而行一周于身也。如此周流三阳与阴分。至水下五十刻。则得
二十五周于身，而与篇首昼日行阳之数相合。今此篇末。水下一刻。人气在太阳。二刻在少阳。三刻
在阳明。四刻在阴分之说。则是漏水下四刻。配人气行一周于身。水下八刻。配人气行二周于身。水下五
十刻。配人气行一十二周半于身。与篇首昼日行于阳二十五周之说不合。岂经之本旨耶。营气之行。自
手太阴始。至足厥阴终。为一周于身也。详其一周于身。外至身体四肢。内至五脏六腑。无不周遍。故
其五十周。无阴阳昼夜之殊。卫气之行则不然。昼但周阳。于身体四肢之外。不入五脏六腑之内。夜但
周阴。于五脏六腑之内。不出身体四肢之外。故必五十周。至平旦。方与营大会于肺手太阴也。
脉搏跳动次数多且节律均匀。然而，不如《内经》阐述得详尽完备。《内经》说“闰以太息”，这里的“闰”是指气有余（气盈）与气不足（朔虚）之间的调节；“太息”是指在一次呼吸周期之间。这就好比一年中的闰月，并不是在一呼一吸之外再额外增加一次呼吸。
所谓“太息”，是指在呼吸定息（呼吸转换的间隙）处于呼吸之间时，脉象因此又多跳动一次，从而凑成五次跳动的数目。这也如同呼气时心与肺的气机外出，吸气时肾与肝的气机内入，而脾脏在中焦接受水谷精气，其气机运行正处于呼出与吸入之间。
脉率三至为迟脉，主败冷、危困之证；六至为数脉，七至为极数，主热盛病多；八至为脱脉，九至为死脉，十至为墓脉（绝脉）；十一至、十二至为魂断脉，病情垂危。
〔三至为迟脉，一二至为败脉〕（一息一至，脉象沉伏着床，危害极大。）两息才一至，这是死脉，并不奇怪。
迟脉和败脉，前面已经论述过了，这里再次出现。况且下文提到的“两息一至”正是论述“损脉”。损脉有四等，所以改以此文来列举其凡例。《难经》说：什么是损脉？
一呼一至叫离经，二呼一至叫夺精，三呼一至叫死，四呼一至叫命绝。损脉的病势是从下往上发展的，从一呼一至发展到四呼一至。然而，到了离经、夺精阶段必然死亡，何必等到三呼、四呼才一至呢？所以《脉诀》在两息一至时就说是死脉。张仲景说：脉有四损，三日死。正常人一息四动，病人一息一动。五损，一日死。正常人一息五动，病人一息一动。六损，一时死。正常人一息六动，病人一息一动。这是张仲景在四损之上，又增加了五损、六损，定为一日或一时死亡的期限。
迟脉主寒，数脉主热，古今认识相同。《难经》越度篇记载得十分清楚。
热积多则生风，冷积多则动气。（用心指下丁宁记：仔细体会指下的感觉并牢记。）
热怎么能直接生风呢？是热邪积聚过多才生出风象。冷怎么能直接生气呢？是冷邪积聚过多才导致气机逆乱而动。然而冷热也能动血致病，不可固执拘泥。
春季脉弦，夏季脉洪（钩），秋季脉浮似毛，冬季脉沉似石，这都是根据经典分节气而来的。
《素问》说：春脉如弦，其气来弱轻虚以滑，端直以长，所以叫弦。夏脉如钩，其气来盛去衰，所以叫钩。秋脉如浮，其气来轻虚以浮，来急去散。冬脉如营（石），其气来沉以抟，所以叫营。《难经》说：弦脉，脉来厌厌聂聂，像抚摸榆叶一样柔和（应当根据《素问》作脉来弱，招招如揭长竿末梢），这叫平脉。更加实滑，像抚摸长竿，这叫病脉。急促劲强，像新弓弦，这叫死脉。夏脉钩，脉来累累如环，像抚摸琅玕玉珠，这叫平脉。来势更数，像鸡举足，这叫病脉。前曲后倨，像拿着带钩，这叫死脉。秋脉毛，脉来蔼蔼，像车盖，按之更大（应当根据《素问》作厌厌聂聂如落榆叶），这叫平脉。不上不下，像抚摸鸡羽，这叫病脉。按之消索，像风吹毛，这叫死脉。冬脉石，脉来上大下锐，像麻雀啄食，这叫平脉。啄啄连属，其中微曲，这叫病脉。来如解索，去如弹石，这叫死脉。现在考察四时之脉，都取法象于《难经》。夏脉不应当改为洪脉。
脉象阿阿缓若春柳，这是脾土居四季之中的表现。
四季之末，土旺十八日，这是脾土的本位。然而四时的气候，四脏的脉象，都以脾土胃气为本。《难经》说：脾为中州，其平和之气不可得见，只有衰败时才显现出来。脉来像雀啄，像水滴漏下，这是脾家衰败的表现。《脉经》说：六月季夏建未，坤卦之间，是土之位，脾旺之时。其脉来阿阿而缓，名叫平脉。现在的《脉诀》增加“春杨柳”作为法象。蔡氏说：凡是脉不大不小，不长不短，不浮不沉，不滑不涩，应手中和，意思欣欣，难以名状的，就是胃气。这也算是善于形容了。现在考察《难经》所说的四时平脉，就是有胃气的脉。病脉，是四时脉多而胃气少的脉。死脉，是只有四时脉而无胃气的脉。这样看来，胃气之脉随四时而寓于当时之脉中，表现为平脉，不可得而见，也不可得到形容。所谓“阿阿而缓”，是专门针对四季十八日中所诊察到的情况而言的。
要专心在意，观察细微，《灵枢》能晓解通玄之理并记录。
浮、芤、滑、实、弦、紧、洪，这〔七表〕（阳脉）原本是本宗。微、沉、缓、涩、迟并伏，濡弱相兼〔八里〕（阴脉）相同。
脉不可以表里来定名。只有浮、沉二脉，可以论表里。黄帝、岐伯、越人（秦越人）、仲景、叔和都不言表里。《脉经》是王叔和所作，没有七表、八里、九道之名。现在的《脉诀》窃托叔和之名，但其论脉却违背了《脉经》。自六朝以来，世人被七表、八里、九道所迷惑，没有人指出其错误。王裳著《阐微论》，认为《脉诀》论表不及里，对脉的形状大有发明，至于表里则不言其非，还拘泥地增加数、长二脉为九表，加短、细二脉为十里，以九与十为阴阳数之极。唉！脉的变化固然从阴阳产生，但怎么可以用名数来拘束呢？从来论脉有以浮、沉、长、短、滑、涩为三阴三阳的；有以大小、滑、涩、浮、沉可以指别的；有以大、浮、数、动、滑为阳，沉、涩、弱、弦、微为阴的；有以按尺寸，观浮、沉、滑、涩，而知病所生以治疗的。这些都是以阴阳对举而互见的，未曾说过七表、八里、九道。只是七表、八里、九道，果真能穷尽脉的数量吗？《内经》说有鼓、搏、喘、横、急、躁等脉。仲景说有卑、荣、章、纲、损，有纵横、逆顺。难道七表、八里、九道能穷尽吗？虽然名称不同，实际上不出乎阴阳。所以脉应当以阴阳察形，不应当以表里定名。《内经》说脉合阴阳，又说善诊者察色按脉，先别阴阳。诸脉因浮而见的，都叫表，不拘泥于七表。诸脉因沉而见的，都叫里，不拘泥于八里。沉而滑也叫里，浮而涩也叫表。详细辨别在各脉条下。
血、营、气、卫，定息数，一万三千五百通。
《素问》说：营是水谷的精气，调和于五脏，洒陈于六腑，才能进入脉中。所以循脉上下，贯五脏，络六腑。卫是水谷的悍气，其气疾滑利，不能进入脉中。所以循皮肤之中，分肉之间（谓脉外），熏于肓膜，散于胸腹。《灵枢》说：人受气于谷，谷入于胃，以传与肺，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。营周不休，五十而大会。又说：谷气津液已行，营卫大通，乃化糟粕，以次传下。又说：谷始入于胃，其精微者，先出于胃之两焦，以溉五脏，别出两行营卫之道。其大气之抟而不行者，积于胸中，命曰气海，出于肺，循喉咽，故呼则出，吸则入。又说：其浮气之不循经者为卫气，其精气之行于经者为营气。又说：五谷入于胃也，其糟粕、津液、宗气分为三队。故宗气积于胸中，出于喉咙，以贯心肺，而行呼吸焉。营气者，泌其津液，注之于脉，化以为血，以营四末，内注五脏六腑，以应刻数焉。卫气者，出其悍气之疾，而先行于四末分肉皮肤之间，而不休者也。营气卫气，皆津液之所行。又说：营卫者精气也，血者神气也。故血之与气，异名而同类焉。又说：营出中焦，卫出上焦。又说：上焦开发，宣五谷味，熏肤充身泽毛，若雾露之溉，是谓气。中焦受气取汁，变化而赤，是谓血。又说：经脉者，所以行血气，而营阴阳，濡筋骨，利关节者也。卫气者，所以温分肉，充皮肤，肥腠理，司开阖者也。《灵枢》说：人经脉周身十六丈二尺，漏水下百刻分昼夜。人一呼，脉再动，气行三寸。一吸，脉亦再动，气行三寸。呼吸定息，气行六寸。十息，气行六尺。二百七十息，气行十六丈二尺，一周于身，下水二刻。二千七百息，气行十周于身，下水二十刻。一万三千五百息则气五十周，水下百刻。故五十营者，备得天地之寿矣。凡行八百一十丈也。又说：卫气之行，一日一夜，五十周于身。昼行于阳二十五周，夜行于阴二十五周。周于五脏。是故平旦阴尽，阳气出于目。目张则气上行于头，循项，下足太阳，循背，下至小指之端。其散者，别于目锐眦，下手太阳，下至手小指之间外侧。其散者别于目锐眦，下足少阳，注小指次指之间，以上循手少阳之分侧，下至手小指之间。别者以上至耳前，合于颔脉，注足阳明，以下行至足跗上，入五指之间。其散者从耳下，下手阳明，入大指之间，入掌中。其至于足也，入足心，出内踝下行阴分，复合于目，故为一周。是故日行一舍，人气行身一周，与十分身之八。其始入于阴，常从足少阴注于肾。肾注于心，心注于肺，肺注于肝，肝注于脾，脾复注于肾，为周。是故夜行一舍，人气行于阴脏一周，与十分藏之八，亦如阳行之二十五周，而复会于目。（详见《灵枢·卫气行》第七十六）此五十周卫气之行也。昼行阳二十五度，夜行阴二十五度，五十周而后大会于平旦者，营卫息数同也。其始从中焦注手太阴阳明，阳明注足阳明太阴，太阴注手少阴太阳，太阳注足太阳少阴，少阴注手心主少阳，少阳注足少阳厥阴，厥阴复还注手太阴，此经脉行度终始也。与卫气之行则各异。《三因方》云：血为脉，气为息。一呼一吸一定息，脉行六寸。二百七十息，行尽十六丈二尺者，血之脉也。气之息迟于脉，八息三分三厘三毫方行一寸。一万三千五百息，方行尽十六丈二尺。现在考察经文说气积于胃，以通营卫，各行其道。宗气流于海，下者注气街，上者走息道。如此则营卫各道，如上文明《灵枢》所言：营者水谷之精气，出于中焦，变化为赤，入于脉，与息数呼吸应。卫者水谷之悍气，出于上焦，行于脉外，温分肉，充皮肤，司开阖，不与脉同行，不与营同道，不与息数同应营卫也。其异如此。然而行于身也，昼夜五十周，则营与卫一也。《三因》以血为脉指营言，以气为息指卫言，而谓营血之脉昼夜五十周，卫气之息昼夜一周，不知何据，而与古经如此其异也。又按《难经》说：营气之行，常与卫气相随上下。卫由息而动。巢元方谓气行则血行，气住则血住，皆疑其传误。王冰谓刺络通营卫，不当兼言卫在络之间也。《灵枢·卫气行》篇云：卫气之行，昼行阳，则目张而寤；夜行阴，则目瞑而寐。谨按此节，言平旦阳气之出目，而下行于手足三阳也，皆一时分道并注，非有先后次第也。此经篇末言水下一刻，人气在太阳；水下二刻，人气在少阳；水下三刻，人气在阳明；水下四刻，人气在阴分者，则是先下太阳究竟，然后下少阳，俟少阳究竟，然后下阳明，俟阳明究竟，方上行阴分，大与此节矛盾，并衍文也。又按此节，言阳气流行之周数，及下文言漏水所下之刻数合而推之，其为衍衣冠文物矣。何以言之？夫昼日漏下之水，凡五十刻。昼日阳气之行，凡二十五周。以昼日漏水之刻数，配于昼日阳气之周数，则阳气一周配漏水二刻也。又以漏水之二刻，配于阳气之一周，则阳气之从平旦出目，而分道并注下于手足三阳也，盖配水下一刻焉。其从足心之出内踝，上行阴分，而复合于目，亦配水下一刻，是为一周也。如此则水下一刻，人气当在三阳；水下二刻，人气当在阴分，而行一周于身也。水下三刻，人气又当在三阳；水下四刻，人气又当在阴分，而行一周于身也。如此周流三阳与阴分，至水下五十刻，则得二十五周于身，而与篇首昼日行阳之数相合。今此篇末，水下一刻人气在太阳，二刻在少阳，三刻在阳明，四刻在阴分之说，则是漏水下四刻，配人气行一周于身；水下八刻，配人气行二周于身；水下五十刻，配人气行一十二周半于身，与篇首昼日行于阳二十五周之说不合，岂经之本旨耶？营气之行，自手太阴始，至足厥阴终，为一周于身也。详其一周于身，外至身体四肢，内至五脏六腑，无不周遍，故其五十周，无阴阳昼夜之殊。卫气之行则不然，昼但周阳，于身体四肢之外，不入五脏六腑之内；夜但周阴，于五脏六腑之内，不出身体四肢之外。故必五十周，至平旦，方与营大会于肺手太阴也。
The pulse beats frequently but with a regular rhythm. However, the *Neijing* (Classic of Internal Medicine) elaborates on this in greater detail and completeness. It states that "intercalation relies on deep sighs" (Run Yi Tai Xi). Here, "intercalation" refers to the regulation between excess qi (Qi Ying) and deficient qi (Shuo Xu); "deep sigh" (Tai Xi) occurs within the interval of respiration. This is analogous to a leap month in a year; it does not mean adding an extra breath outside of one exhalation and inhalation.
A "deep sigh" means that at the moment of respiratory transition (Ding Xi), within the breathing cycle, the pulse beats one additional time, thus completing the count of five beats. This is similar to how during exhalation, the Qi of the Heart and Lungs moves outward, and during inhalation, the Qi of the Kidneys and Liver moves inward, while the Spleen receives Grain Qi in the Middle Jiao, operating precisely between exhalation and inhalation.
Three beats per respiration indicate a Slow Pulse (Chi Mai), signifying deficiency-cold, critical condition, and distress. Six beats indicate a Rapid Pulse (Shu Mai), seven beats indicate Extreme Rapidness, signifying excessive heat and numerous illnesses. Eight beats indicate Devastation (Tuo), nine beats indicate Death (Si), and ten beats indicate Tomb (Mu). Eleven and twelve beats indicate Soul Severance (Hun Chai), signaling a critical state.
[Three beats is Slow; one or two beats is Deficient/Broken] (One beat per respiration, pulse sinking to the bed, causes great harm.) Two respirations for one beat is a death pulse, which is not strange.
Slow and Broken pulses were discussed earlier; their re-appearance here serves to illustrate the general principles, as the following text discusses "Damage Pulses" (Sun Mai) regarding two respirations per beat. The *Nanjing* (Classic of Difficult Issues) asks: What is Damage?
One beat per exhalation is called "Leaving the Channel" (Li Jing); two beats per exhalation is called "Snatching Essence" (Duo Jing); three beats per exhalation is called "Death"; four beats per exhalation is called "Life Extinction". Damage pulses progress from lower to higher levels, evolving from one beat per exhalation to four beats per exhalation. However, if it reaches Li Jing or Duo Jing, death is inevitable; why wait for three or four beats per exhalation? Thus, the *Maijue* (Pulse Rhymes) states death at two respirations per beat. Zhang Zhongjing said: With four damages, death occurs in three days. A normal person has four beats per respiration, while a patient has one beat. With five damages, death occurs in one day. A normal person has five beats per respiration, while a patient has one beat. With six damages, death occurs in one shichen (two hours). A normal person has six beats per respiration, while a patient has one beat. Zhang Zhongjing added five and six damages to the four damages, setting death periods of one day or one shichen.
Slow pulses indicate cold, rapid pulses indicate heat; this understanding is consistent throughout ancient and modern times. The *Nanjing*, specifically the Yue Du chapter, records this clearly.
Accumulated heat generates wind; accumulated cold agitates Qi. [Pay careful attention under the fingers and remember.]
How can heat directly generate wind? It is the accumulation of heat that produces wind-like symptoms. How can cold directly generate Qi movement? It is the accumulation of cold that causes Qi agitation. However, both heat and cold can disturb Blood and cause disease; one must not be dogmatic.
Spring pulses are Wiry (Xian); Summer pulses are Surging/Hooked (Hong/Gou); Autumn pulses are Floating like hair (Mao); Winter pulses are Deep like stones (Shi). These are based on the classics according to solar terms.
The *Suwen* says: Spring pulses are like wires; their Qi comes weak, light, void, and slippery, straight and long, hence called Wire. Summer pulses are like hooks; their Qi comes abundant and departs declining, hence called Hook. Autumn pulses are floating; their Qi comes light, void, and floating, urgent in arrival and scattered in departure. Winter pulses are like camps (stones); their Qi comes deep and firm, hence called Camp. The *Nanjing* says: Wire pulse, coming gently and softly, like touching elm leaves (should be corrected according to *Suwen* to "weak, attracting like lifting the end of a long pole"), is a Healthy Pulse. More solid and slippery, like touching a long pole, is a Diseased Pulse. Urgent and strong, like a new bowstring, is a Dead Pulse. Summer Hook pulse, coming continuously like a ring, like touching lapis lazuli, is Healthy. Coming more rapidly like a chicken lifting its foot is Diseased. Bent front and stiff back, like holding a belt hook, is Dead. Autumn Hair pulse, coming abundant like a chariot canopy, enlarging upon pressure (corrected according to *Suwen* to "gently softly like falling elm leaves"), is Healthy. Neither up nor down, like touching chicken feathers, is Diseased. Disappearing upon pressure like wind blowing through hair is Dead. Winter Stone pulse, large above and sharp below, like a sparrow pecking, is Healthy. Pecking continuously, slightly curved within, is Diseased. Coming like untying a rope, departing like flicking a stone, is Dead. Examining the four seasonal pulses, they all take imagery from the *Nanjing*. The Summer pulse should not be changed to Surging (Hong).
Pulses soft and slow like spring willows indicate the Spleen Earth residing in the four seasons.
At the end of each season, Earth prospers for eighteen days, which is the fundamental position of Spleen Earth. However, the climate of the four seasons and the pulses of the four Zang organs all rely on Spleen Earth and Stomach Qi as the root. The *Nanjing* says: The Spleen is the Central Plain; its peaceful Qi cannot be seen; only when declining does it appear. Pulses coming like sparrow pecks or dripping water indicate the decline of the Spleen home. The *Maijing* says: In the sixth month, late summer, corresponding to the Wei branch and the Kun trigram, the position of Earth, when the Spleen prospers. Its pulse comes soft and slow, named a Healthy Pulse. The current *Maijue* adds "spring willows" as imagery. Cai Shi said: Any pulse that is neither large nor small, long nor short, floating nor sunken, slippery nor choppy, feels neutral and harmonious, with a joyful spirit, difficult to name, is Stomach Qi. This is also considered good description. Examining the *Nanjing*, the healthy pulses of the four seasons are those with Stomach Qi. Diseased pulses have more of the seasonal pulse and less Stomach Qi. Dead pulses have only the seasonal pulse and no Stomach Qi. Thus, the pulse of Stomach Qi resides within the seasonal pulse of the time, manifesting as a healthy pulse, invisible and indescribable. The phrase "soft and slow" specifically refers to what is observed during the eighteen days of each season.
Focus your mind and observe the subtle details; the *Lingshu* explains these profound mysteries.
Floating (Fu), Knife-edge (Kou), Slippery (Hua), Solid (Shi), Wiry (Xian), Tight (Jin), and Surging (Hong) are the [Seven Surfaces] (Yang Pulses), originally belonging to the same category. Fine (Wei), Sunken (Chen), Slow (Huan), Choppy (Se), Delayed (Chi), Hidden (Fu), Soft (Ru), and Weak (Ruo) combined are the [Eight Interior] (Yin Pulses).
Pulses cannot be named by Exterior/Interior. Only Floating and Sunken pulses can be discussed in terms of Exterior and Interior. Huang Di, Qi Bo, Yue Ren (Qin Yueren), Zhongjing, and Shuhe did not speak of Exterior/Interior. The *Maijing* was written by Wang Shuhe and has no names of Seven Surfaces, Eight Interiors, or Nine Channels. The current *Maijue* falsely attributes itself to Shuhe, yet its pulse theory contradicts the *Maijing*. Since the Six Dynasties, people have been confused by the Seven Surfaces, Eight Interiors, and Nine Channels, with no one pointing out the error. Wang Shang wrote *Chanwei Lun*, arguing that *Maijue* discusses Exterior but neglects Interior, greatly illuminating pulse shapes, but still did not correct the Exterior/Interior concept, instead rigidly adding Rapid and Long pulses to make Nine Surfaces, and Short and Fine pulses to make Ten Interiors, using nine and ten as the extremes of Yin and Yang numbers. Alas! Pulse changes indeed arise from Yin and Yang, but how can they be constrained by numbers? Historically, some classified Floating, Sunken, Long, Short, Slippery, and Choppy as Three Yin and Three Yang; some distinguished them by Size, Slipperiness, Choppy-ness, Floating, and Sunken; some classified Large, Floating, Rapid, Moving, and Slippery as Yang, and Sunken, Choppy, Weak, Wiry, and Fine as Yin; some diagnosed by pressing Cun and Chi, observing Floating, Sunken, Slippery, and Choppy to know the disease origin. All these pair Yin and Yang mutually, never mentioning Seven Surfaces, Eight Interiors, or Nine Channels. Can these categories exhaust the number of pulses? The *Neijing* mentions Drumming, Beating, Panting, Horizontal, Urgent, and Agitated pulses. Zhongjing mentions Bei, Rong, Zhang, Gang, Sun, and Vertical/Horizontal, Reverse/Smooth patterns. Do Seven Surfaces, Eight Interiors, and Nine Channels exhaust them? Although names differ, they essentially fall within Yin and Yang. Therefore, pulses should be examined by form through Yin and Yang, not named by Exterior/Interior. The *Neijing* says pulses conform to Yin and Yang, and skilled diagnosticians first distinguish Yin and Yang by observing color and feeling pulses. Pulses appearing due to Floating are called Exterior, not limited to Seven Surfaces. Pulses appearing due to Sunken are called Interior, not limited to Eight Interiors. Sunken and Slippery is also Interior; Floating and Choppy is also Exterior. Detailed distinctions are found under individual pulse sections.
Blood, Ying (Nutrient), Qi, and Wei (Defensive) have fixed respiration counts, totaling thirteen thousand five hundred passages.
The *Suwen* says: Ying is the essence of Water and Grain, harmonized in the Five Zang, distributed to the Six Fu, entering the vessels. Thus, it circulates up and down the vessels, penetrating the Five Zang, and connecting the Six Fu. Wei is the fierce Qi of Water and Grain, swift and slippery, unable to enter the vessels. Thus, it circulates among the skin and muscles (outside the vessels), steaming the Hui membranes, and dispersing in the chest and abdomen. The *Lingshu* says: Humans receive Qi from grain. Grain enters the Stomach and transmits to the Lung; the Five Zang and Six Fu all receive Qi. The clear part becomes Ying, the turbid part becomes Wei. Ying travels within the vessels, Wei travels outside. Ying circulates without rest, meeting every fifty cycles. It is also said: Once Grain Qi and Body Fluids circulate, Ying and Wei flow freely, turning into dregs, transmitted downwards. Also: Grain enters the Stomach; its fine essence first emerges from the two Jiaos of the Stomach to irrigate the Five Zang, separating into two paths of Ying and Wei. The condensed atmospheric Qi that does not circulate accumulates in the chest, named Sea of Qi, emerging from the Lung, following the throat, exiting on exhalation, entering on inhalation. Also: The floating Qi not following channels is Wei Qi; the fine essence traveling in channels is Ying Qi. Also: When five grains enter the Stomach, their dregs, fluids, and Zong (Gathering) Qi divide into three groups. Thus, Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart and Lung, and governs respiration. Ying Qi secretes body fluids, injects them into vessels, transforms them into Blood, nourishes the four extremities, and internally notes the Five Zang and Six Fu, responding to time units. Wei Qi releases its fierce swiftness, moving first in the four extremities, muscles, and skin, without rest. Ying and Wei are both flows of body fluids. Also: Ying and Wei are Essence Qi; Blood is Spirit Qi. Thus, Blood and Qi have different names but are of the same category. Also: Ying emerges from the Middle Jiao, Wei emerges from the Upper Jiao. Also: The Upper Jiao opens and develops, distributing the flavors of five grains, steaming the skin, filling the body, moistening hair, like mist and dew irrigation; this is called Qi. The Middle Jiao receives Qi, extracts juice, transforms it red; this is called Blood. Also: Vessels are used to move Blood and Qi, nourish Yin and Yang, moisten sinews and bones, and benefit joints. Wei Qi warms muscles, fills skin, plumps interstices, and controls opening and closing. The *Lingshu* says: Human vessels total sixteen zhang and two chi around the body. Water drips one hundred ke (time units) dividing day and night. One exhalation, pulse moves twice, Qi moves three cun. One inhalation, pulse moves twice, Qi moves three cun. At respiratory transition, Qi moves six cun. Ten respirations, Qi moves six chi. Two hundred seventy respirations, Qi moves sixteen zhang and two chi, completing one circuit around the body, water dropping two ke. Two thousand seven hundred respirations, Qi moves ten circuits, water drops twenty ke. Thirteen thousand five hundred respirations, Qi moves fifty circuits, water drops one hundred ke. Thus, Fifty Circuits prepare for the longevity of Heaven and Earth, traveling eight hundred ten zhang. Also: Wei Qi travels fifty circuits around the body in one day and night. Daytime travels Yang twenty-five circuits, nighttime travels Yin twenty-five circuits, circling the Five Zang. Thus, at dawn, Yin ends, Yang Qi emerges from the eyes. Eyes open, Qi moves up to the head, follows the neck, descends Foot Taiyang, follows the back, to the tip of the little toe. Scattered parts diverge from the outer canthus, descend Hand Taiyang, to the lateral side between hand little fingers. Scattered parts diverge from the outer canthus, descend Foot Shaoyang, note between the fourth and fifth toes, follow Hand Shaoyang laterally, to the hand little finger. Divergent parts go up to before the ear, merge with mandibular pulse, note Foot Yangming, descend to the dorsum of the foot, enter between five toes. Scattered parts go down from the ear, descend Hand Yangming, enter between the thumb and index, enter the palm. Reaching the foot, it enters the sole, exits the medial malleolus, descends Yin branches, and merges back at the eye, thus completing one circuit. Thus, as the sun moves one she (station), human Qi moves one circuit around the body, with 8/10th part. Entering Yin, it usually starts from Foot Shaoyin noting the Kidney. Kidney notes Heart, Heart notes Lung, Lung notes Liver, Liver notes Spleen, Spleen returns to Kidney, completing a circuit. Thus, as the moon moves one she, human Qi moves one circuit in Yin Zang, with 8/10th part of Zang, also twenty-five circuits like Yang, returning to meet at the eye. (See *Lingshu·Wei Qi Xing* Chapter 76). This is the fifty circuits of Wei Qi. Daytime travels Yang twenty-five degrees, nighttime travels Yin twenty-five degrees, meeting at dawn after fifty circuits, with Ying and Wei respiration counts being the same. Starting from Middle Jiao noting Hand Taiyin and Yangming, Yangming notes Foot Yangming and Taiyin, Taiyin notes Hand Shaoyin and Taiyang, Taiyang notes Foot Taiyang and Shaoyin, Shaoyin notes Hand Jueyin (Pericardium) and Shaoyang, Shaoyang notes Foot Shaoyang and Jueyin, Jueyin returns to note Hand Taiyin. This is the beginning and end of vessel circulation, different from Wei Qi travel. *Sanyin Fang* says: Blood is the pulse, Qi is the respiration. One exhalation, one inhalation, one transition, pulse moves six cun. Two hundred seventy respirations, traveling sixteen zhang two chi, is the pulse of Blood. Qi respiration is slower than pulse; eight respirations, 3.333... cun, move one cun. Thirteen thousand five hundred respirations, finally traveling sixteen zhang two chi. Now examining the classic: Qi accumulates in the Stomach to connect Ying and Wei, each following its path. Zong Qi flows into the Sea, downward notes Qichong, upward walks the respiratory tract. Thus Ying and Wei follow different paths, as stated in the *Lingshu*: Ying is essence of Water and Grain, emerging from Middle Jiao, transforming red, entering vessels, responding to respiration counts. Wei is fierce Qi of Water and Grain, emerging from Upper Jiao, traveling outside vessels, warming muscles, filling skin, controlling opening/closing, not traveling with vessels, not sharing the Dao with Ying, not responding to respiration counts with Ying and Wei. Their difference is such. However, traveling around the body, day and night fifty circuits, Ying and Wei are one. *Sanyin* takes Blood as pulse referring to Ying, and Qi as respiration referring to Wei, stating Ying-Blood pulses circulate fifty times day and night, while Wei Qi respiration circulates once day and night. On what basis is this, differing so much from ancient classics? Also examining *Nanjing*: Ying Qi travel often accompanies Wei Qi up and down. Wei moves by respiration. Chao Yuanfang said Qi moves then Blood moves, Qi stops then Blood stops; all suspect transmission errors. Wang Bing said needling collaterals to open Ying and Wei, shouldn't mention Wei in collaterals. *Lingshu·Wei Qi Xing* says: Wei Qi travel, daytime Yang, eyes open and awake; nighttime Yin, eyes closed and asleep. Carefully examining this section: Dawn Yang Qi emerges from eyes, descending to Hand and Foot Three Yang channels, all diverging simultaneously, not sequential. The end of this chapter says: Water drops one ke, Qi is in Taiyang; two ke, Shaoyang; three ke, Yangming; four ke, Yin branch. This implies descending Taiyang completely, then Shaoyang, then Yangming, then ascending Yin branch, contradicting this section, likely interpolations. Also examining this section: Combining the number of Yang Qi circuits and water ke drops mentioned below, it seems to be interpolated text. Why? Daytime water drops fifty ke. Daytime Yang Qi travels twenty-five circuits. Matching water ke to Yang circuits, one Yang circuit matches two water ke. Matching two water ke to one Yang circuit, Yang Qi from dawn emerging from eyes and diverging to Hand/Foot Three Yang matches one water ke. From sole exiting medial malleolus, ascending Yin branch, merging at eye, also matches one water ke, constituting one circuit. Thus, at one ke drop, Qi should be in Three Yang; at two ke drop, Qi should be in Yin branch, completing one circuit. At three ke drop, Qi again in Three Yang; at four ke drop, Qi again in Yin branch, completing one circuit. Cycling Three Yang and Yin branch until fifty ke drops, obtaining twenty-five circuits, matching the start of daytime Yang travel. But the end of this chapter says: One ke Taiyang, two ke Shaoyang, three ke Yangming, four ke Yin branch. This means four ke drops match one circuit; eight ke drops match two circuits; fifty ke drops match twelve and a half circuits, contradicting the twenty-five daytime Yang circuits at the start. Is this the original intent? Ying Qi travel starts from Hand Taiyin, ends at Foot Jueyin, one circuit around the body. Detailing one circuit, externally to limbs, internally to Five Zang and Six Fu, all covered. Thus its fifty circuits have no Yin/Yang or day/night distinction. Wei Qi travel is different: Daytime only circles Yang, outside limbs, not inside Zang/Fu; Nighttime only circles Yin, inside Zang/Fu, not outside limbs. Thus must complete fifty circuits, reaching dawn, to meet Ying at Lung Hand Taiyin.