小序 崔紫虚所着《四言脉诀》，由来尚矣。删补之者，为李月池氏，更名《四言举要》。予取两刻
而损益之，或繁或简，期合于理而已，敢曰崔、李之功臣哉。
脉为血脉，气血之先；血之隧道，气息应焉。
脉为气乎？而气为卫，卫行脉外，则知非气矣。脉为血乎？而血为营，营行脉中，则知非血矣。脉为经隧乎？
而经隧实繁，则知非经隧矣。善乎华元化云∶“脉者，气血之先也。”盖人之身，惟是精与气与神三者，精
气即血气，气血之先，非神而何？人非是神无以主宰血气，保合太和，流行三焦，灌溉百骸。故脉非他，即
神之别名也。明乎此，则气也、血也，浑沦条析；所谓气如橐 ，血如波澜，一升一降，以成其用，而脉道成
矣。
资始于肾，资生于胃；血脉气息，上下循环。
人未有此身，先有此肾，气血藉之以立基。而神根据于气，气根据于血，血资于谷，谷本于胃；是知胃气充则
血旺，血旺则气强，气强则神昌。故曰∶“先天之根本在肾，后天之根本在脾。”（脾胃相为夫妻。）神之昌与否，皆以
脉为征兆。脉之行也，气行而血随，上下周匝，起伏交会， 濡守使，各尽其职。
十二经中，皆有动脉；惟手太阴，寸口取决。
《难经·一难》曰∶“十二经皆有动脉，独取寸口，何谓也？扁鹊曰∶‘寸口者，脉之大会，手太阴之动脉
也。’”以肺为五脏六腑之华盖，布一身之阴阳，居于至高之位，凡诸脏腑皆处其下，肺系上连喉咙吭
嗌，以通呼吸。肺主一身之气，气非呼吸不行，脉非肺气不布故耳。然《素问·五脏别论》曰∶“帝曰‘气
口何以独为五脏主？’岐伯曰∶‘胃者，水谷之海，六腑之大源也。五味入口藏于胃，以养五脏气，气口亦
太阴也。是以五脏六腑之气味，皆出于胃，变见于气口。’”其义又所重在胃矣，细思之而理则一也。气
口本属太阴，而曰“亦太阴”者，盖气口属肺，手太阴也，布行胃气，则在于脾足太阴也。按《灵枢·营卫生会篇》
曰∶“谷入于胃，以传于肺，五脏六腑，皆以受气。”《厥论》曰∶“脾主为胃行其津液者也。”《素
问·经脉别论》曰∶“饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺。”脾气必归于肺，而后行于
脏腑营卫，所以气口虽为手太阴，而实即足太阴之所归，故曰“气口亦太阴”也。乃知五脏六腑之气
味，皆由胃入脾，由脾入肺，此地道卑而上行也。由肺而分布于脏腑，此天道下济而光明也。土居中而
为金之母，系诸脉之根；肺居高而有君之象，布诸脉之令；故曰肺朝百脉，而寸口为之大会，犹水之朝
宗于 也。又考气口即寸口也。肺主诸气，气之盛衰见于此，故曰气口。脉出太渊，共长一寸九分，故曰
寸口。又肺朝百脉，脉之大会聚于此，故曰脉口。其实一也。吴草庐曰∶“医者于寸、关、尺，辄名之曰此心
脉、此肺脉、此肝脉、此脾脉、此肾脉者，非也。五脏六腑凡十二经，两手寸、关、尺者，手太阴肺金之一脉也。
分其部位以候他藏之气耳。脉行始于肺，终于肝，而复会于肺，肺为气出入之门户，故名曰气口，而为
脉之大会，以占一身焉。”李时珍曰“两手六部，皆肺之经脉也，特取此以候五脏六腑之气耳，非五脏
六腑所居之处也。”《灵枢》、《素问》、《难经》载十二经脉有走于手而不从三部过者，如手阳明大肠
经之脉，起大指次指之端，从大指次指之间尽处为合谷一路，为臂之上廉，入肘外，上肩而终迎香，以
交于足阳明胃经也。与右寸无干。足阳明胃经之脉，起于鼻之交 中，下行属胃，络大肠，至足，而终于
厉兑，（足大指端。）以交于足太阴脾经也，与右关无干。足太阴脾经之脉，起于足之大指之端，上行膝股，入
腹中，以交于手少阴心经也。与右关无干。手少阴心经之脉，起于心中，下络小肠，其支者循 下，下肘
内后廉小指一路，终于小指之端，（即少冲穴。）以交于手太阳小肠经也。与左寸无干。手太阳小肠之脉，起
于小指之端，循臂外侧，左右交于两肩，下属小肠，上行于头，络于颧而终于耳中，（即听宫穴。）。以交于足太
阳膀胱经也。与左寸无干。足太阳膀胱之脉，起于目内 ，下行络肾，属膀胱，终于足小指，（至阴穴。）以交于
足少阴肾经也。与左尺无干。足少阴肾经之脉，起于足小指，上行循喉咙，挟舌本，注于膻中，以交于手
厥阴心包络经也。与左尺无干。手厥阴心包络经之脉，起于胸中，属心下之包络，入肘内之曲泽穴，行
臂两筋之间，入掌中，循中指出其端而终，以交于手少阳三焦经也。脉行中指一路，与左尺无干。手少
阳三焦之脉，起于小指次指之端，（即无名指。）行臂外两骨之间，下络膀胱，其支者从膻中而止耳，终于丝竹
空，而交于足少阳胆经也。小指一路，亦与右尺无干。足少阳胆经之脉，起于目锐 ，下胸中，络肝属胆，
入足小指次指之间，其支者自足跗出大指端，以交于足厥阴肝经也。足厥阴肝经之脉，起于足大指
丛毛之际，循阴器，属肝络胆，上贯膈，循喉咙之后，上入颃颡，连目系出额，其支者从目系下行至中脘，
以交于手太阴肺也。则足之少阳、厥阴、皆不行于手。惟有肺脉起于中焦，循臂内，上鱼际，终于大指之
端，（即少商穴。）其支者从腕后（臂骨尽处为腕。）出大指次指之端，以交于大肠经也。乃知此，经正属寸口，肺之动
脉所行之处也。至如诸经动脉，各从所行之处。手阳明大肠脉动合谷，（在手大指次指岐骨间。）手少阴心脉动极泉，（在
臂内腋下筋间。）手太阳小肠脉动天窗，（在颈侧大筋间曲颊下。）手少阳三焦脉动和 ，（在耳前。）手厥阴心包络脉动
劳宫，（在掌中，屈中指无名指尽处是。）足太阳膀胱脉动委中，（在膝骨约纹里。）足少阴肾脉动太 ，（在踝后跟骨上。）
足太阴脾脉动冲门，（在期门下尺五寸。）足阳明胃脉动冲阳，（足大指次指陷中为内庭，上内庭五寸是。）足厥阴肝脉动
太冲，（足大指本节后二寸。）足少阳胆脉动听会。（在耳前陷中。）夫诸经脉之动，各自不同，况不尽行于三部，伪诀胡
为漫无分疏乎？《难经·二难》虽言尺寸，其意以关为界，从关至鱼际为一寸为阳，阳得寸内之九分；从关至尺泽为一
尺为阴，阴得尺中一寸；乃以阴阳而言，未尝分经络也。然则脏腑果何借以诊乎？经不云乎，“呼出心与肺，吸入肾与
肝。呼吸之间，脾受谷味也。”脉之盛衰本于胃，出入由于肺。胃气如物之有轻重，肺气如物之轻重者权衡以平也。如
伪诀即以某部为某经，其凿甚矣。
脉之行于十二经络者，即手足三阴三阳之经脉也。《难经·二十三难》曰∶“经脉十二，络脉十五，何
始何穷也？然，经脉者，行血气，通阴阳，以营卫于一身者也。其始中焦注手太阴肺，手太阴肺注手阳明
大肠，手阳明大肠注足阳明胃，足阳明胃注足太阴脾，足太阴脾注手少阴心，手少阴心注手太阳小
肠，手太阳小肠注足太阳膀胱，足太阳膀胱注足少阴肾，足少阴肾注手厥阴心包，手厥阴心包注手
少阳三焦，手少阳三焦注足少阳胆，足少阳胆注足厥阴肝，足厥阴肝还复注手太阴，是谓一周也。”
身形之中，有营气，有卫气，有宗气，有脏腑之气，有经络之气，各为区分。其所以统摄脏腑、经络、营卫、而
令充满无间，环流不息于通体者，全恃胸中大气为之主持。大气之说，尝一言之。《素问·五营运大
论》曰∶“黄帝问地之为下否乎？岐伯曰∶‘地为人之下，太虚之中者也。’曰∶‘冯乎？’曰∶‘大气举之也。’”
可见太虚寥廓，而能充周磅因礴，包举地之全体者，莫非气也。故四虚无着，然后寒暑燥湿风火之气，入
地中而生化。若不繇大气苞地于无外，则地之崩坠震动，且不可言，胡以巍然中处，而永生其化耶！人
身亦然。五脏六腑，大经小络，昼夜循环不息，必赖胸中大气斡旋其间。大气一衰，出入废而升降息矣。
神机化灭，立见危殆。或谓大气即膻中之气，所以膻中为心主，宣布政令，臣使之官。然而参之天运，膻
中臣使，但可尽寒暑燥湿风火六入之职，必如太虚 穆，无可名象，苞举地形，永奠厥中，始为大气，膻
中既称臣使，是有其职，未可言大气也。或谓大气即宗气之别名。宗者，尊也，主也，十二经脉奉之为尊
主也。讵知宗气与营气、卫气分为三隧，既有隧之可言，即同六入地中之气，而非太虚之比矣。膻中之
诊，即心包络；宗气之诊，在左乳下。原不与大气混诊也。然则大气如何而诊之，《内经》标示昭然，而读
者不察耳。其谓“上附上，右外以候肺，内以候胸中”者，正其诊也。肺主一身之气，而治节行焉。苞举无
外之气于人身者，独由胸中之肺，故分其诊于右手主气之天部，朝百脉而称大会也。
脉之大会，息之出入；一呼一吸，四至为息。
医者调匀气息，自一呼人之脉再至，自一吸人之脉亦再至，呼吸之间，而脉准来四至者为平脉；间有
五至者，亦未可断病。盖人之气息，时长时短。凡鼓三息，必有一息之长，鼓五息，又有一息之长，名为太
息；如历家三岁一闰，五岁再闰也。言脉必有四至为平，五至便为太过，惟正当太息之时，亦曰无 ，此
息之长，非脉之急也。若非太息，正合四至也。
呼吸既定，合为一息；日夜一万，三千五百。
呼出于阳，吸入于阴。一呼脉二至，一吸脉二至，合四至为一息。一日一夜共计之，约一万三千五百息。
呼吸之间，脉行六寸；八百十丈，日夜为准。
即此一呼一吸计之，一呼气行三寸，一吸气行三寸，呼吸既定，脉气行去六寸。以一万三千五百息算
之，共得八百一十丈。以脉数之十六丈二尺折算，应周行身五十度，此昼夜脉行之度数准则也。按越
人《二十三难》云∶脉数总长十六丈二尺，任、督、二跷在内。以一呼一吸行六寸算之，昼夜一万三千五
百息，共计八百一十丈。周于身者，得五十度。后又云∶其始从中焦注手太阴，终于足厥阴，厥阴复还注
手太阴。所谓如环无端者，不知二跷、任、督，从何接入，岂附行于足少阴、太阳耶？附则不能在循环注接
之内，当俟知者。
凡诊病脉，平旦为准；虚静凝神调息细审。
平旦者，阴阳之交也。阳主昼，阴主夜；阳主表，阴主里。《灵枢·营卫生会篇》曰∶“平旦阴尽而阳受气
矣。日中而阳陇。日西而阳衰，日入阳尽而阴受气矣。”《灵枢·口问篇》曰∶“阳气尽，阴气盛，则目瞑。阴
气尽而阳气盛，则寤矣。”故诊法当于平旦初寤之时，阴气正平而未动，阳气将盛而未散，饮食未进，
谷气未行，故经脉未盛，络脉调匀，气血未至扰乱，脉体未及更改，乃可以诊有病之脉。又切脉之道，贵
于精诚，嫌其扰乱，故必心虚而无妄想，身静而不言动，然后可以得脉之妙也。
诊人之脉，令仰其掌；掌后高骨，是名关上。审位既确，可以布指；疏密得宜，长短不失。
凡诊脉者，令人仰手，医者覆手诊之。掌后有高骨对平处谓之关上，看定部位，徐以中指先下于关部，
次以食指下于寸部，次以无名指下于尺部。人长则下指宜疏，人短则下指宜密。指爪不可养长，长则
指头不能取齐，难于候脉。且沉取之时，爪长则按处必有深痕，在于闺阁，尤为不便。
布指轻重，各自不同；曰举按寻，消息从容。
看脉惟在指法之巧。大法轻手循之曰举，重手取之曰按，不轻不重，委曲求之曰寻。极须体认。如举必
先按之，按则必先举之，以举物必自下而上，按物必自上而下也。则举中有按，按中有举，抑扬反复，而
寻之义尽见矣。
《难经·五难》曰∶“脉有轻重，何谓也？然，初持脉，如三菽之重，与皮毛相得者，肺部也。如六菽之重，与
血脉相得者，心部也。如九菽之重，与肌骨相得者，脾部也。如十二菽之重，与筋平者，肝部也。按之至骨，
举指来疾者，肾部也。”盖言脉有六部，轻重不同。菽者，豆也。豆之多寡，因举按有轻重也。凡持脉者，下
手当明举按之法，先轻手取浮，而后重手取沉。肺脉甚浮而先得，故经文下“初持脉”三字，以下心、脾、
肝、肾脉一脏重于一脏。肺主皮毛，心主血脉，脾主肌肉，肝主筋，肾主骨。相得者，得其所主之分，而即得
其本部之脉也。肾部不言十五菽而言至骨者，因至骨明于十五菽也。
关前为阳，关后为阴；阳寸阴尺，先后推寻。
从鱼际至高骨却有一寸，因名曰寸。从尺泽至高骨有一尺，因名曰尺。界乎尺寸之间，因名曰关。关前
寸为阳，关后尺为阴。关居中若为阴阳界，而阴阳实互交于此。寸候上焦，关候中焦，尺候下焦。须先后
细为推寻，推其虚实，寻其体象也。
男子之脉，左大为顺；女人之脉，右大为顺。
朱丹溪曰∶“脉分属左右手。心、小肠、肝、胆、肾、膀胱在左主血，肺、大肠、脾、胃、命门在右主气。男以气
小序 崔紫虚所著的《四言脉诀》，流传年代已经很久了。经过删减补充的人，是李月池氏，他将书更名为《四言举要》。我选取这两个版本进行比对，加以增减修改，或繁或简，只求合乎医理罢了，岂敢自称是崔、李二人的功臣呢？
脉是血脉，是气血运行的先导；血运行的通道（隧道），气息在其中相应变化。
脉是气吗？但气属于卫气，卫气运行在脉管之外，由此可知脉不是气。脉是血吗？但血属于营气，营气运行在脉管之内，由此可知脉不是血。脉是经隧吗？但经隧实际上很多，由此可知脉不仅仅是经隧。华元化说得好：“脉，是气血的先导。”大概人的身体，只有精、气、神这三者，精气就是血气，作为血气的先导，如果不是神，还能是什么呢？人如果没有神，就无法主宰血气，保持阴阳和合，使气血在三焦中流行，灌溉全身骨骼。所以脉不是什么别的，就是神的别名。明白了这一点，那么气与血，就能既浑融又条理分明地分析清楚；所谓“气像风箱，血像波澜”，一升一降，从而发挥其作用，脉道也就形成了。
脉的起源在于肾，滋养依赖于胃；血脉与气息，上下循环往复。
人在形成身体之前，先有肾脏，气血凭借它来建立基础。而神依附于气，气依附于血，血滋养于谷物，谷物根本在于胃；因此知道胃气充足则血旺，血旺则气强，气强则神昌。所以说：“先天的根本在肾，后天的根本在脾。”（脾胃互为表里，如同夫妻。）神的昌盛与否，都以脉象作为征兆。脉的运行，气行则血随，上下周遍，起伏交会，濡养守卫，各尽其职。
十二经脉中，都有动脉；唯独手太阴肺经的寸口脉，可以决断病情。
《难经·一难》说：“十二经都有动脉，唯独取寸口脉，这是什么意思？”扁鹊说：“寸口，是脉的会合之处，是手太阴肺经的动脉。”因为肺是五脏六腑的华盖，布散一身之阴阳，居于最高的位置，所有脏腑都在其下。肺系上连喉咙咽喉，以通呼吸。肺主一身之气，气不通过呼吸就不能运行，脉不通过肺气就不能布散，就是这个原因。然而《素问·五脏别论》说：“黄帝问：‘气口为什么能单独作为五脏的主宰？’岐伯说：‘胃是水谷之海，六腑的大源头。五味入口藏于胃，用来滋养五脏之气，气口也属于太阴。因此五脏六腑的气味，都出于胃，变化显现于气口。’”这里的意义又重在胃了，仔细思考，道理其实是一致的。气口本属太阴肺经，却说“也属于太阴”，是因为气口属肺，即手太阴肺经；布行胃气，则在于脾，即足太阴脾经。按《灵枢·营卫生会篇》说：“谷物进入胃，传导给肺，五脏六腑都接受其气。”《厥论》说：“脾是为胃运行津液的器官。”《素问·经脉别论》说：“水饮进入胃，游溢精气，向上输送到脾，脾气散布精微，向上归于肺。”脾气必须归于肺，然后才行于脏腑营卫，所以气口虽然是手太阴肺经，但实际上就是足太阴脾经所归聚的地方，所以说“气口也属于太阴”。于是知道五脏六腑的气味，都是由胃入脾，由脾入肺，这是地道卑下而上行的道理。由肺分布到脏腑，这是天道下降而光明的道理。土居中而为金之母，系结诸脉之根；肺居高而有君王的象征，布散诸脉的命令；所以说肺朝百脉，而寸口是它们的会合之处，就像水向大海汇聚一样。又考证气口就是寸口。肺主诸气，气的盛衰显现于此，所以叫气口。脉出太渊穴，共长一寸九分，所以叫寸口。又因肺朝百脉，脉的大会聚于此，所以叫脉口。其实是一个东西。吴草庐说：“医生对于寸、关、尺，就命名为此心脉、此肺脉、此肝脉、此脾脉、此肾脉的，是不对的。五脏六腑共有十二经，两手的寸、关、尺，只是手太阴肺经的一条脉。划分部位来候察其他脏腑之气罢了。脉的运行始于肺，终于肝，然后又回会于肺，肺是气出入的门户，所以名叫气口，并成为脉的会合之处，以此来占测全身情况。”李时珍说：“两手六部，都是肺的经脉，特意取这里来候察五脏六腑之气罢了，并不是五脏六腑居住的地方。”《灵枢》、《素问》、《难经》记载十二经脉中有走向手部但不经过寸关尺三部的，比如手阳明大肠经的脉，起于食指末端，从食指与大拇指之间尽处为合谷一路，经过手臂的上廉，进入肘外，上肩而终至迎香穴，以交于足阳明胃经。这与右寸无关。足阳明胃经的脉，起于鼻翼旁的迎香穴附近，下行属胃，络大肠，至足，而终于厉兑穴（足大指端），以交于足太阴脾经，这与右关无关。足太阴脾经的脉，起于足大趾末端，上行膝股，入腹中，以交于手少阴心经，这与右关无关。手少阴心经的脉，起于心中，下络小肠，其支者沿腋下，下肘内后廉小指一路，终于小指末端（即少冲穴），以交于手太阳小肠经，这与左寸无关。手太阳小肠经的脉，起于小指末端，循臂外侧，左右交于两肩，下属小肠，上行于头，络于颧而终于耳中（即听宫穴），以交于足太阳膀胱经，这与左寸无关。足太阳膀胱经的脉，起于目内眦，下行络肾，属膀胱，终于足小趾（至阴穴），以交于足少阴肾经，这与左尺无关。足少阴肾经的脉，起于足小趾，上行循喉咙，挟舌本，注于膻中，以交于手厥阴心包络经，这与左尺无关。手厥阴心包络经的脉，起于胸中，属心下之包络，入肘内之曲泽穴，行臂两筋之间，入掌中，循中指指出其端而终，以交于手少阳三焦经。脉行中指一路，与左尺无关。手少阳三焦经的脉，起于无名指末端，行臂外两骨之间，下络膀胱，其支者从膻中而止耳，终于丝竹空，而交于足少阳胆经。小指一路，也与右尺无关。足少阳胆经的脉，起于目锐眦，下胸中，络肝属胆，入足小趾次趾之间，其支者自足背出大趾端，以交于足厥阴肝经。足厥阴肝经的脉，起于足大趾丛毛之际，循阴器，属肝络胆，上贯膈，循喉咙之后，上入颃颡，连目系出额，其支者从目系下行至中脘，以交于手太阴肺。那么足的少阳、厥阴，都不行于手部。惟有肺脉起于中焦，循臂内，上鱼际，终于大指末端（即少商穴），其支者从腕后（臂骨尽处为腕）出大指次指之端，以交于大肠经。于是知道这条经正属于寸口，是肺之动脉所行的地方。至于其他经脉的动脉，各自从其运行的地方。手阳明大肠脉动于合谷（在手大拇指与食指歧骨间），手少阴心脉动于极泉（在臂内腋下筋间），手太阳小肠脉动于天窗（在颈侧大筋间曲颊下），手少阳三焦脉动于和髎（在耳前），手厥阴心包络脉动于劳宫（在掌中，屈中指无名指尽处是），足太阳膀胱脉动于委中（在膝骨约纹里），足少阴肾脉动于太溪（在踝后跟骨上），足太阴脾脉动于冲门（在期门下尺五寸），足阳明胃脉动于冲阳（足大指次趾陷中为内庭，上内庭五寸是），足厥阴肝脉动于太冲（足大趾本节后二寸），足少阳胆脉动听会（在耳前陷中）。这些经脉的跳动，各自不同，何况并不都行于寸关尺三部，那些伪制的脉诀为何漫无分别呢？《难经·二难》虽然谈论尺寸，其意是以关为界，从关至鱼际为一寸为阳，阳得寸内之九分；从关至尺泽为一尺为阴，阴得尺中一寸；这是以阴阳而言，并未区分经络。那么脏腑究竟依靠什么来诊察呢？经文不是说吗，“呼出心与肺，吸入肾与肝。呼吸之间，脾受谷味。”脉的盛衰根本在于胃，出入由于肺。胃气如同物体的轻重，肺气如同权衡物体轻重的秤杆以保持平衡。如果像伪诀那样将某部定为某经，那就太穿凿附会了。
脉运行于十二经络的，就是手足三阴三阳的经脉。《难经·二十三难》说：“经脉十二，络脉十五，从哪里开始到哪里终结呢？回答是，经脉，运行血气，通调阴阳，以营卫于一身。它起始于中焦注入手太阴肺，手太阴肺注入手阳明大肠，手阳明大肠注入足阳明胃，足阳明胃注入足太阴脾，足太阴脾注入手少阴心，手少阴心注入手太阳小肠，手太阳小肠注入足太阳膀胱，足太阳膀胱注入足少阴肾，足少阴肾注入手厥阴心包，手厥阴心包注入手少阳三焦，手少阳三焦注入足少阳胆，足少阳胆注入足厥阴肝，足厥阴肝还复注入手太阴，这叫一周。”
身形之中，有营气，有卫气，有宗气，有脏腑之气，有经络之气，各自区分。之所以统摄脏腑、经络、营卫，令其充满无间，环流不息于全身，全赖胸中大气主持。关于大气之说，曾经提到过。《素问·五营运大论》说：“黄帝问地是在下面吗？岐伯说：‘地在人的下面，在太虚之中。’问：‘支撑着它的是什么？’答：‘是大气托举它。’”可见太虚空旷，而能充周磅礴，包举地的全体者，无非是气。所以四方虚无不着，然后寒暑燥湿风火之气，进入地中而生化。如果不靠大气包裹大地于无外，那么地的崩坠震动，就不可言说了，哪里能巍然处于中间，而永远产生生化呢！人身也是如此。五脏六腑，大经小络，昼夜循环不息，必赖胸中大气斡旋其间。大气一旦衰弱，出入废弛而升降停止。神机化灭，立刻见到危殆。有人说大气就是膻中之气，所以膻中为心主，宣布政令，是臣使之官。然而参验天运，膻中作为臣使，只能尽寒暑燥湿风火六气入体的职责，必须像太虚那样肃穆，无可名状，包举地形，永远奠定其中，这才叫大气。膻中既然称为臣使，是有其职能的，不能称为大气。有人说大气就是宗气的别名。宗，尊也，主也，十二经脉奉之为尊主。怎知宗气与营气、卫气分为三条隧道，既然有隧道可言，就同六气入地中之气一样，而非太虚之比了。膻中的诊察，即心包络；宗气的诊察，在左乳下。原本不与大气混同诊察。那么大气如何诊察，《内经》标示清晰，只是读者没有察觉罢了。所谓“上附上，右外以候肺，内以候胸中”的，正是它的诊法。肺主一身之气，而治节随之而行。包举无外之气于人身者，独由胸中之肺，所以将其诊法分于右手主气之天部，朝百脉而称大会。
脉的会合，息的出入；一呼一吸，四至为一息。
医者调匀气息，自一呼入脉再至，自一吸入脉亦再至，呼吸之间，而脉准来四至的为平脉；间或有五至的，也不能断定有病。大概人的气息，时长时短。凡鼓动三息，必有一息之长，鼓动五息，又有一息之长，名为太息；就像历法三年一闰，五年再闰一样。说脉必有四至为平，五至便为太过，只有在正当太息之时，也说无病，这息之长，并非脉之急促。如果不是太息，正合四至。
呼吸既定，合为一息；日夜一万三千五百。
呼出于阳，吸入于阴。一呼脉二至，一吸脉二至，合四至为一息。一日一夜共计之，约一万三千五百息。
呼吸之间，脉行六寸；八百一十丈，日夜为准。
即此一呼一吸计算，一呼气行三寸，一吸气行三寸，呼吸既定，脉气行去六寸。以一万三千五百息计算，共得八百一十丈。以脉数总长十六丈二尺折算，应周行身五十度，这是昼夜脉行的度数准则。按越人《二十三难》说：脉数总长十六丈二尺，任脉、督脉、二跷脉在内。以一呼一吸行六寸计算，昼夜一万三千五百息，共计八百一十丈。周于身者，得五十度。后又说：其始从中焦注手太阴，终于足厥阴，厥阴复还注手太阴。所谓如环无端者，不知二跷、任、督，从何接入，难道附行于足少阴、太阳吗？如果附着，就不能在循环注接之内，应当等待知情者解答。
凡诊病脉，以平旦为准；虚静凝神调息细审。
平旦，是阴阳交接之时。阳主昼，阴主夜；阳主表，阴主里。《灵枢·营卫生会篇》说：“平旦阴尽而阳受气矣。日中而阳隆盛。日西而阳衰，日入阳尽而阴受气矣。”《灵枢·口问篇》说：“阳气尽，阴气盛，则目瞑。阴气尽而阳气盛，则寤矣。”所以诊法应当在平旦初醒之时，阴气正平而未动，阳气将盛而未散，饮食未进，谷气未行，故经脉未盛，络脉调匀，气血未至扰乱，脉体未及更改，才可以诊察有病的脉。另外切脉之道，贵在精诚，嫌弃其扰乱，所以必须心虚而无妄想，身静而不言动，然后才可以得到脉的奥妙。
诊人之脉，令仰其掌；掌后高骨，是名关上。审位既确，可以布指；疏密得宜，长短不失。
凡诊脉者，令人仰手，医者覆手诊之。掌后有高骨对平处谓之关上，看定部位，徐以中指先下于关部，次以食指下于寸部，次以无名指下于尺部。人长则下指宜疏，人短则下指宜密。指爪不可养长，长则指头不能取齐，难于候脉。且沉取之时，爪长则按处必有深痕，对于闺阁女子，尤为不便。
布指轻重，各自不同；曰举按寻，消息从容。
看脉惟在指法之巧。大法轻手循之曰举，重手取之曰按，不轻不重，委曲求之曰寻。极须体认。如举必先按之，按则必先举之，以举物必自下而上，按物必自上而下也。则举中有按，按中有举，抑扬反复，而寻之义尽见矣。
《难经·五难》说：“脉有轻重，是什么意思？”回答是，初持脉，如三颗豆子的重量，与皮毛相得的，是肺部。如六颗豆子的重量，与血脉相得的，是心部。如九颗豆子的重量，与肌骨相得的，是脾部。如十二颗豆子的重量，与筋平的，是肝部。按之至骨，举指来疾的，是肾部。”大概说脉有六部，轻重不同。菽，就是豆。豆的多寡，因举按有轻重。凡持脉者，下手当明举按之法，先轻手取浮，而后重手取沉。肺脉甚浮而先得，故经文下“初持脉”三字，以下心、脾、肝、肾脉一脏重于一脏。肺主皮毛，心主血脉，脾主肌肉，肝主筋，肾主骨。相得者，得其所主之分，而即得其本部之脉也。肾部不言十五菽而言至骨者，因至骨明于十五菽也。
关前为阳，关后为阴；阳寸阴尺，先后推寻。
从鱼际至高骨却有一寸，因名曰寸。从尺泽至高骨有一尺，因名曰尺。界乎尺寸之间，因名曰关。关前寸为阳，关后尺为阴。关居中若为阴阳界，而阴阳实互交于此。寸候上焦，关候中焦，尺候下焦。须先后细为推寻，推其虚实，寻其体象也。
男子之脉，左大为顺；女人之脉，右大为顺。
朱丹溪说：“脉分属左右手。心、小肠、肝、胆、肾、膀胱在左主血，肺、大肠、脾、胃、命门在右主气。男以气……”
Preface Cui Zixu's "Four-Character Pulse Resolution" has been in circulation for a long time. Li Yuechi revised and supplemented it, renaming it "Four-Character Essentials". I selected these two versions, making additions and deletions, either elaborate or concise, aiming only to conform to medical principles. How dare I claim to be a merit-maker for Cui and Li?
The pulse is the blood vessel, the precursor of Qi and Blood; it is the tunnel through which Blood flows, with Respiration responding within it.
Is the pulse Qi? But Qi belongs to Wei Qi (Defensive Qi), which circulates outside the vessels; thus, we know the pulse is not Qi. Is the pulse Blood? But Blood belongs to Ying Qi (Nutritive Qi), which circulates inside the vessels; thus, we know the pulse is not Blood. Is the pulse the Jing-Luo (Meridian-Vessel) system? But there are many such systems; thus, we know the pulse is not merely the Meridian-Vessel system. Hua Yuanhua said well: "The pulse is the precursor of Qi and Blood." Generally, the human body consists of Essence (Jing), Qi, and Spirit (Shen). Essence and Qi are Blood and Qi; as the precursor of Blood and Qi, if not Shen, then what? Without Shen, humans cannot govern Qi and Blood, maintain Taihe (Great Harmony), circulate through the San Jiao (Triple Burner), and irrigate the entire skeleton. Therefore, the pulse is nothing other than another name for Shen. Understanding this, Qi and Blood can be analyzed both holistically and distinctly; as it is said, "Qi is like a bellows, Blood like waves," rising and falling to perform their functions, thereby establishing the Pulse Dao (Way of the Pulse).
Originating from the Kidney, nourished by the Stomach; Blood vessels and Respiration cycle up and down continuously.
Before the body forms, the Kidneys exist first, providing a foundation for Qi and Blood. Shen relies on Qi, Qi relies on Blood, and Blood is nourished by Grain, whose root lies in the Stomach. Thus, when Stomach Qi is sufficient, Blood is abundant; when Blood is abundant, Qi is strong; when Qi is strong, Shen is prosperous. Hence it is said: "The root of Pre-Heaven lies in the Kidney, and the root of Post-Heaven lies in the Spleen." (The Spleen and Stomach are mutually related, like husband and wife.) The prosperity or decline of Shen is signaled by the pulse. In the movement of the pulse, Qi moves and Blood follows, circulating throughout, rising and falling, meeting and intersecting, nourishing and guarding, each fulfilling its duty.
Among the Twelve Meridians, all have pulsating points; only the Cun Kou (Inch Port) of the Hand-Taiyin Lung Meridian determines the diagnosis.
"Nan Jing · First Difficulty" states: "All twelve meridians have pulsating points, why take only the Cun Kou?" Bian Que answered: "Cun Kou is the great assembly of pulses, the pulsating point of the Hand-Taiyin Lung Meridian." Because the Lung is the canopy of the five Zang and six Fu organs, distributing Yin and Yang throughout the body, occupying the highest position, while all other organs are below it. The Lung connects upwards to the throat and pharynx to facilitate respiration. The Lung governs the Qi of the whole body; Qi cannot move without respiration, and the pulse cannot distribute without Lung Qi. However, "Su Wen · Treatise on the Distinctions of the Five Zang Organs" says: "The Yellow Emperor asked: 'Why can the Qi Kou (Air Port) alone serve as the master of the five Zang organs?' Qibo replied: 'The Stomach is the sea of water and grain, the great source of the six Fu organs. Flavors enter the mouth and are stored in the Stomach to nourish the Qi of the five Zang organs. The Qi Kou also belongs to Taiyin. Therefore, the Qi and flavor of the five Zang and six Fu organs all originate from the Stomach and manifest at the Qi Kou.'" Here, the emphasis is again on the Stomach. Upon careful reflection, the principle is consistent. The Qi Kou originally belongs to the Taiyin (Lung), but saying it "also belongs to Taiyin" implies that while the Qi Kou belongs to the Lung (Hand-Taiyin), the distribution of Stomach Qi lies in the Spleen (Foot-Taiyin). According to "Ling Shu · Chapter on the Generation and Meeting of Ying and Wei": "Grain enters the Stomach, transmits to the Lung, and the five Zang and six Fu organs all receive its Qi." "Jue Lun" states: "The Spleen transports the fluids for the Stomach." "Su Wen · Treatise on the Divergent Meridians" says: "Drinks enter the Stomach, their essence floats up, is transported to the Spleen, the Spleen scatters the essence, and it returns upward to the Lung." The Spleen's essence must return to the Lung before circulating to the Zang-Fu and Ying-Wei. Thus, although the Qi Kou is the Hand-Taiyin, it is actually the convergence of the Foot-Taiyin, hence "the Qi Kou also belongs to Taiyin." It is known that the Qi and flavor of the five Zang and six Fu organs go from the Stomach to the Spleen, and from the Spleen to the Lung; this is the earthy path going low yet ascending. From the Lung, they distribute to the Zang-Fu; this is the heavenly path descending and shining. Earth is central and the mother of Metal, serving as the root of all pulses; the Lung is high and symbolizes the ruler, issuing commands for all pulses. Hence, "The Lung faces all pulses, and Cun Kou is their great assembly," just as water gathers in the ocean. Further research shows Qi Kou is Cun Kou. The Lung governs all Qi, and the abundance or deficiency of Qi manifests here, hence called Qi Kou. The pulse emerges from Tai Yuan acupoint, totaling one inch and nine fen, hence called Cun Kou. Since the Lung faces all pulses and they assemble here, it is also called Mai Kou (Pulse Port). They are essentially the same. Wu Caolu said: "Doctors who name the Cun, Guan, and Chi positions as the Heart, Lung, Liver, Spleen, and Kidney pulses respectively are incorrect. There are twelve meridians in the five Zang and six Fu organs. The Cun, Guan, and Chi of both hands are merely one pulse of the Hand-Taiyin Lung Metal. The positions are divided to observe the Qi of other organs. Pulse movement starts at the Lung, ends at the Liver, and returns to the Lung. The Lung is the portal for Qi entry and exit, hence named Qi Kou, and serves as the great assembly of pulses to assess the whole body." Li Shizhen said: "The six positions of both hands are all Lung meridians; they are taken specifically to observe the Qi of the five Zang and six Fu organs, not where the organs reside." "Ling Shu", "Su Wen", and "Nan Jing" record that among the twelve meridians, some travel to the hand but do not pass through the three positions. For example, the Hand-Yangming Large Intestine Meridian starts at the tip of the index finger, passes through Hegu between the thumb and index finger, goes along the upper aspect of the arm, enters the elbow, ascends the shoulder, and ends at Yingxiang, connecting to the Foot-Yangming Stomach Meridian. This has no connection with the Right Cun. The Foot-Yangming Stomach Meridian starts near the nose, descends to connect with the Stomach, links to the Large Intestine, reaches the foot, and ends at Lidui (tip of the second toe), connecting to the Foot-Taiyin Spleen Meridian. This has no connection with the Right Guan. The Foot-Taiyin Spleen Meridian starts at the tip of the big toe, ascends the knee and thigh, enters the abdomen, and connects to the Hand-Shaoyin Heart Meridian. This has no connection with the Right Guan. The Hand-Shaoyin Heart Meridian starts in the heart, descends to link to the Small Intestine; its branch follows the axilla, down the inner posterior aspect of the elbow to the little finger, ending at Shaochong (tip of the little finger), connecting to the Hand-Taiyang Small Intestine Meridian. This has no connection with the Left Cun. The Hand-Taiyang Small Intestine Meridian starts at the tip of the little finger, follows the lateral aspect of the arm, crosses both shoulders, descends to the Small Intestine, ascends to the head, links to the cheekbone, and ends in the ear at Tinggong, connecting to the Foot-Taiyang Bladder Meridian. This has no connection with the Left Cun. The Foot-Taiyang Bladder Meridian starts at the inner canthus, descends to link to the Kidney, connects to the Bladder, and ends at the little toe (Zhiyin), connecting to the Foot-Shaoyin Kidney Meridian. This has no connection with the Left Chi. The Foot-Shaoyin Kidney Meridian starts at the little toe, ascends along the throat, flanks the tongue root, pours into Danzhong, and connects to the Hand-Jueyin Pericardium Meridian. This has no connection with the Left Chi. The Hand-Jueyin Pericardium Meridian starts in the chest, connects to the pericardium below the heart, enters Quze in the elbow, runs between the two tendons of the arm, enters the palm, follows the middle finger to its end, and connects to the Hand-Shaoyang Sanjiao Meridian. The pulse travels along the middle finger, having no connection with the Left Chi. The Hand-Shaoyang Sanjiao Meridian starts at the tip of the ring finger, runs between the two bones of the outer arm, descends to link to the Bladder; its branch stops at the ear from Danzhong, ends at Sizhukong, and connects to the Foot-Shaoyang Gallbladder Meridian. The little finger path also has no connection with the Right Chi. The Foot-Shaoyang Gallbladder Meridian starts at the outer canthus, descends through the chest, links to the Liver and connects to the Gallbladder, enters between the fourth and fifth toes; its branch exits from the dorsum of the foot to the tip of the big toe, connecting to the Foot-Jueyin Liver Meridian. The Foot-Jueyin Liver Meridian starts at the hairline of the big toe, follows the genitalia, connects to the Liver and Gallbladder, pierces the diaphragm, follows behind the throat, ascends to the nasopharynx, connects to the eye system, emerges at the forehead; its branch descends from the eye system to Zhongwan, connecting to the Hand-Taiyin Lung Meridian. Thus, the Foot-Shaoyang and Foot-Jueyin do not travel to the hand. Only the Lung Meridian starts in the Middle Jiao, follows the inner arm, ascends to the Thenar eminence, and ends at the tip of the big toe (Shaoshang); its branch emerges from behind the wrist to the tip of the index finger, connecting to the Large Intestine Meridian. Knowing this, this meridian correctly belongs to Cun Kou, the location of the Lung's pulsating point. As for the pulsating points of other meridians, each is at its respective location. Hand-Yangming Large Intestine pulse beats at Hegu (between the metacarpals of the thumb and index finger); Hand-Shaoyin Heart pulse beats at Jiquan (in the axilla between tendons); Hand-Taiyang Small Intestine pulse beats at Tianchuang (in the neck between large tendons below the jaw); Hand-Shaoyang Sanjiao pulse beats at Heliao (in front of the ear); Hand-Jueyin Pericardium pulse beats at Laogong (in the palm where the middle and ring fingers bend); Foot-Taiyang Bladder pulse beats at Weizhong (in the popliteal crease); Foot-Shaoyin Kidney pulse beats at Taixi (behind the medial malleolus on the calcaneus); Foot-Taiyin Spleen pulse beats at Chongmen (below Qimen, 1.5 cun down); Foot-Yangming Stomach pulse beats at Chongyang (in the depression between the first and second metatarsal bones, 5 cun above Neiting); Foot-Jueyin Liver pulse beats at Taichong (2 cun proximal to the base of the big toe); Foot-Shaoyang Gallbladder pulse beats at Tinghui (in the depression in front of the ear). The movements of these meridians are all different, let alone whether they pass through the three positions. Why are the false resolutions so indiscriminate? Although "Nan Jing · Second Difficulty" discusses Cun and Chi, its intent uses Guan as the boundary. From Guan to Yuji is one inch, defined as Yang, obtaining nine fen within the inch; from Guan to Chize is one chi, defined as Yin, obtaining one inch within the chi. This speaks of Yin and Yang, not distinguishing meridians. Then how are the Zang-Fu diagnosed? Does not the classic say, "Exhalation involves the Heart and Lung, inhalation involves the Kidney and Liver. Between breaths, the Spleen receives the flavors of grain." The abundance and deficiency of the pulse are rooted in the Stomach; entry and exit depend on the Lung. Stomach Qi is like the weight of an object; Lung Qi is like the beam of a scale balancing that weight. If one follows the false resolution assigning specific meridians to specific positions, it is too arbitrary.
The pulse traveling through the twelve meridians refers to the Three Yin and Three Yang meridians of the hand and foot. "Nan Jing · Twenty-third Difficulty" states: "There are twelve Jing-Mai (Main Meridians) and fifteen Luo-Mai (Connecting Vessels). Where do they start and where do they end? Answer: The Jing-Mai transport Qi and Blood, connect Yin and Yang, and nourish the whole body. It starts in the Middle Jiao, injects into the Hand-Taiyin Lung; Hand-Taiyin Lung injects into Hand-Yangming Large Intestine; Hand-Yangming Large Intestine injects into Foot-Yangming Stomach; Foot-Yangming Stomach injects into Foot-Taiyin Spleen; Foot-Taiyin Spleen injects into Hand-Shaoyin Heart; Hand-Shaoyin Heart injects into Hand-Taiyang Small Intestine; Hand-Taiyang Small Intestine injects into Foot-Taiyang Bladder; Foot-Taiyang Bladder injects into Foot-Shaoyin Kidney; Foot-Shaoyin Kidney injects into Hand-Jueyin Pericardium; Hand-Jueyin Pericardium injects into Hand-Shaoyang Sanjiao; Hand-Shaoyang Sanjiao injects into Foot-Shaoyang Gallbladder; Foot-Shaoyang Gallbladder injects into Foot-Jueyin Liver; Foot-Jueyin Liver returns to inject into Hand-Taiyin. This is called one cycle."
Within the body, there is Ying Qi (Nutritive Qi), Wei Qi (Defensive Qi), Zong Qi (Gathering Qi), Zang-Fu Qi, and Jing-Luo Qi, each distinct. What unifies the Zang-Fu, Jing-Luo, Ying-Wei, filling them without gap and circulating endlessly throughout the body, is entirely dependent on the Da Qi (Great Qi) in the chest to preside over it. The concept of Da Qi has been mentioned once. "Su Wen · Treatise on the Five Movements and Six Operations" says: "The Yellow Emperor asked if the Earth is below. Qibo replied: 'Earth is below humans, within the Great Void.' Asked: 'What supports it?' Replied: 'The Great Qi lifts it.' Thus, the Great Void is vast, yet fills and encompasses the entire Earth, all due to Qi. Therefore, when the four directions are empty, the Qi of Cold, Heat, Dryness, Dampness, Wind, and Fire enters the Earth and generates transformations. If not for the Great Qi enveloping the Earth externally, the Earth would collapse and shake, how could it stand majestically in the center and perpetuate generation? The human body is the same. The five Zang and six Fu organs, major and minor collaterals, circulate day and night without rest, relying on the Great Qi in the chest to rotate them. If the Great Qi declines, entry and exit cease, and ascent and descent stop. The Shen Ji (Spirit Mechanism) perishes, leading immediately to danger. Some say Da Qi is the Qi of Danzhong, so Danzhong is the Master of the Heart, issuing orders, the official of ministers and messengers. However, observing celestial movements, Danzhong as a minister can only handle the six intruding Qi of Cold, Heat, Dryness, Dampness, Wind, and Fire. It must be like the Great Void, solemn and formless, encompassing the terrain, permanently stabilizing the center, to be called Da Qi. Since Danzhong is called a minister with duties, it cannot be called Da Qi. Others say Da Qi is another name for Zong Qi. Zong means respected and master; the twelve meridians respect it as their master. How can one know that Zong Qi, Ying Qi, and Wei Qi are divided into three tunnels? Since there are tunnels, they are similar to the Qi entering the Earth from the six directions, not comparable to the Great Void. The diagnosis of Danzhong is the Pericardium; the diagnosis of Zong Qi is under the left breast. Originally, they are not mixed in diagnosis. So how is Da Qi diagnosed? "Nei Jing" clearly indicates it, but readers fail to notice. When it says 'Upper attaches, right exterior observes the Lung, interior observes the Chest,' this is precisely its diagnostic method. The Lung governs the Qi of the whole body, and regulation follows. The Qi that encompasses everything in the body comes solely from the Lung in the chest. Therefore, its diagnosis is divided into the Heaven Position (upper part) of the Right Hand governing Qi, facing all pulses and called the Great Assembly.
The great assembly of the pulse, the entry and exit of respiration; one exhalation and one inhalation, four beats constitute one Xi (breath/respiration cycle).
The physician regulates their breath. With one exhalation, the pulse arrives twice; with one inhalation, the pulse arrives twice. Between respiration, if the pulse arrives four times steadily, it is a Ping Mai (Normal Pulse). Occasionally, five beats may occur, but disease cannot be determined solely on this. Human respiration varies in length. Every three breaths, there is one longer breath; every five breaths, there is one longer breath, called Tai Xi (Sigh); similar to the calendar intercalating every three years and twice every five years. Saying the pulse must have four beats to be normal, five beats is excessive. Only during a true Tai Xi is it considered no illness; this longer breath is not due to rapid pulse. If not Tai Xi, it strictly matches four beats.
Respiration established, combined as one Xi; ten thousand three hundred and fifty per day and night.
Exhalation comes from Yang, inhalation enters Yin. One exhalation pulse two beats, one inhalation pulse two beats, combining four beats as one Xi. Totaling day and night, approximately ten thousand three hundred and fifty Xi.
Between respiration, the pulse travels six cun; eight hundred and ten zhang, standard for day and night.
Calculating one exhalation and one inhalation: exhalation travels three cun, inhalation travels three cun. With respiration established, pulse Qi travels six cun. Calculated over ten thousand three hundred and fifty Xi, totaling eight hundred and ten zhang. Converted using the total pulse length of sixteen zhang and two chi, it should circulate the body fifty times. This is the standard degree measure for pulse circulation day and night. According to Yue Ren's "Nan Jing · Twenty-third Difficulty": The total pulse length is sixteen zhang and two chi, including Ren Mai, Du Mai, and the two Qiao Mai. Calculating six cun per Xi, over ten thousand three hundred and fifty Xi daily, totaling eight hundred and ten zhang. Circulating the body, it achieves fifty cycles. Later it says: Starting from Middle Jiao injecting into Hand-Taiyin, ending at Foot-Jueyin, Foot-Jueyin returns to inject into Hand-Taiyin. Called a circle without beginning or end. It is unknown where the two Qiao Mai, Ren, and Du connect. Do they attach to Foot-Shaoyin and Foot-Taiyang? If attached, they cannot be within the cyclic injection. This awaits clarification by experts.
When diagnosing disease pulses, use dawn as the standard; remain empty, quiet, concentrate spirit, regulate breath, and examine carefully.
Dawn is the intersection of Yin and Yang. Yang governs day, Yin governs night; Yang governs exterior, Yin governs interior. "Ling Shu · Chapter on Ying and Wei" says: "At dawn, Yin ends and Yang receives Qi. At noon, Yang peaks. At sunset, Yang declines; when sun sets, Yang ends and Yin receives Qi." "Ling Shu · Chapter on Mouth Questions" says: "When Yang Qi ends and Yin Qi is abundant, eyes close. When Yin Qi ends and Yang Qi is abundant, one wakes." Therefore, diagnosis should be done at dawn upon waking, when Yin Qi is balanced and unmoved, Yang Qi is about to become abundant but not scattered, food has not been consumed, Grain Qi has not circulated, so meridians are not yet full, collaterals are even, Qi and Blood are not disturbed, and pulse form has not changed. Only then can pathological pulses be diagnosed. Furthermore, pulse taking requires sincerity and precision, avoiding disturbance. Thus, the mind must be empty without delusions, the body still without movement or speech, to grasp the subtleties of the pulse.
To diagnose another's pulse, have them extend their palm; the high bone behind the palm is named Guan. Once position is confirmed, place fingers; spacing should be appropriate, length not lost.
For pulse diagnosis, have the person extend their hand, the physician covers it to diagnose. The level corresponding to the high bone behind the palm is called Guan. After confirming the position, slowly place the middle finger on Guan, then the index finger on Cun, then the ring finger on Chi. For tall people, finger placement should be sparse; for short people, dense. Fingernails should not be kept long; if long, fingertips cannot align, making pulse observation difficult. Moreover, during deep pressing, long nails leave deep marks, which is particularly inconvenient for women in seclusion.
Finger pressure varies; methods are Ju (Lift), An (Press), and Xun (Search), proceeding calmly.
Observing the pulse depends on skillful finger technique. The general rule: light touch along the surface is Ju (Lift); heavy touch to obtain is An (Press); neither light nor heavy, seeking thoroughly is Xun (Search). Careful embodiment is required. For example, lifting must precede pressing, and pressing must precede lifting, as lifting an object goes from bottom to top, pressing goes from top to bottom. Thus, lifting contains pressing, pressing contains lifting, alternating and repeating, revealing the meaning of Search.
"Nan Jing · Fifth Difficulty" states: "Pulses have different weights. What does this mean? Answer: Initially holding the pulse, with the weight of three beans, touching the skin and hair, is the Lung region. With the weight of six beans, touching the blood vessels, is the Heart region. With the weight of nine beans, touching muscle and bone, is the Spleen region. With the weight of twelve beans, level with tendons, is the Liver region. Pressing to the bone, lifting the finger quickly reveals the Kidney region." This describes six regions with different weights. Shu means bean. The number of beans varies due to light or heavy lifting/pressing. Those holding the pulse must understand lifting and pressing: first lightly lift to feel superficial, then heavily press to feel deep. Lung pulse is very superficial and felt first, hence the text adds "initially holding the pulse" before describing Heart, Spleen, Liver, and Kidney pulses, each heavier than the last. Lung governs skin and hair, Heart governs blood vessels, Spleen governs muscles, Liver governs tendons, Kidney governs bones. "Touching appropriately" means finding the portion governed by each and thus obtaining the pulse of that region. The Kidney region does not mention fifteen beans but says "to the bone" because reaching the bone clarifies the weight of fifteen beans.
Anterior to Guan is Yang, posterior to Guan is Yin; Yang is Cun, Yin is Chi, push and search sequentially.
From Yuji to the high bone is one inch, hence named Cun. From Chize to the high bone is one chi, hence named Chi. Between Cun and Chi is named Guan. Anterior to Guan, Cun is Yang; posterior to Guan, Chi is Yin. Guan is centered as the boundary of Yin and Yang, yet Yin and Yang actually intersect here. Cun observes Upper Jiao, Guan observes Middle Jiao, Chi observes Lower Jiao. One must sequentially and finely push and search, deducing deficiency and excess, searching for the pulse image.
For men, a larger pulse on the left is favorable; for women, a larger pulse on the right is favorable.
Zhu Danxi said: "Pulses are assigned to left and right hands. Heart, Small Intestine, Liver, Gallbladder, Kidney, Bladder on the left govern Blood; Lung, Large Intestine, Spleen, Stomach, Ming Men on the right govern Qi. Men prioritize Qi..."