阴为虚悬之位矣。《灵枢·营卫生会篇》曰∶“上焦出于胃上口，并咽以上贯膈，而布胸中。中焦亦并
胃中，出上焦之后，泌糟粕，蒸精液，化精微而为血。下焦者别回肠，注于膀胱而渗入焉。水谷者，居于胃
中，成糟粕，下大肠，而成下焦。”又曰∶“上焦如雾，中焦如沤，下焦如渎。”繇是则明以上中下分三焦矣。
伪诀列于右尺，不亦妄乎！又曰∶“密理浓皮者，三焦浓。粗理薄皮者，三焦薄。”繇是则明有形象矣。伪诀
以为无形，不亦妄乎！又按《灵枢·本输篇》曰∶“三焦者，中渎之府也，水道出焉，属膀胱，是孤之府也。”
谓之中渎者，以其如川如渎，源流皆出其中，即水谷之入于口，出于便，自上而下，必历三焦，故曰，中渎
之府，水道出焉。膀胱受三焦之水，而当其疏泄之道，气本相根据，理同一致，故三焦下输出于委阳，并太
阳之正，入络膀胱，约下焦也。然于十二脏之中，惟三焦独大，诸脏无与匹者，故曰是孤之府也。要知三
焦虽为水渎之府，而实总护诸阳，亦称相火，是又水中之火府。故在《本输篇》曰∶“三焦属膀胱。”在
《素问·血气形志篇》曰∶“少阳与心主为表里。”盖其在下者为阴，属膀胱而合肾水，在上者为阳，合
包络而通心火，此三焦之所以际上极下，象同六合，而无所不包也。观《本输篇》六腑之别，极为明显，
以其皆有盛贮，因名为府。而三焦者曰“中渎之府”，“是孤之府”，分明确有一府；盖即脏腑之外，躯体
之内，包罗诸脏，一腔之大府也。故有“中渎”、“是孤”之名，而亦有大府之形。《难经》已谓其有名无形，
况高阳生之妄人哉！是盖譬之探囊以计物，而忘其囊之为物耳。遂致后世纷纷，无所凭据，有分为前
后三焦者，有言为肾傍之脂者，即如东垣之明，亦以手三焦、足三焦分而为二。夫以一三焦尚云其无
形，而诸论不一，又何三焦之多也。至韩飞霞巧其说曰∶“切脉至右尺，必两手并诊消息之。取三焦应
脉浮为上焦，与心肺脉合；中为中焦，与脾胃脉合；沉为下焦，与肝肾脉合。故曰，尺脉第三同断病。”此
又飞霞讹以传讹，违道愈远。《素问·脉要精微论》曰∶“尺外以候肾，尺里以候腹中。”未尝谓尺候三
焦也。《脉经》曰∶“尺脉芤，下焦虚。尺脉迟，下焦有寒。”又曰∶“尺脉浮者，客阳在下焦。”观此三言，则尺主
下焦耳。何以韩之巧说附入哉？《脉经·一卷·第七篇·脉法赞》云∶“右为子户，名曰三焦。”子户，命
门也。右肾为命门，男子以藏精，女子以系胞，故为子户。而名之为三焦者，此犹两额之傍亦名为太阳
云耳。非谓即太阳经也。安得执词而害义耶！若《第二卷·第二篇》虽云“右肾合三焦”，然上有“一
说云”三字，则叔和亦附此语，以俟参考，不敢自居为定论明矣。今论定上焦从两寸，中焦从两关，下
焦从两尺，斯则与《脉要精微论》“上竟上者，胸喉中事。下竟下者，少腹腰股膝胫足中事”二句符合，
更何必纷纷异议哉！一医常谓余曰∶吾四十余年行医，从不知分剖三焦，乃亦见推于当世矣。噫，浅近
如此者，犹存而不论，又安能司八正邪，别五中部，按脉动静耶？心、肝、脾、肺，俱各一候，惟肾一脏而分两
尺候者，谓肾有两枚，形如豇豆，分列于腰脊之左右。伪诀以左为肾，右为命门。考诸《明堂》、《铜人》等
经，命门一穴，在督脉十四椎下陷中，两肾之间，盖一阳居二阴之中，所以成乎坎也。且脉之应于指下
者，为有经络，循经朝于寸口。《内经》并无命门之经络，何以应诊而可列之右尺乎？夫男女之异，惟茎
户、精血及胞门、子户耳。若夫脉象，自有定位。如左尺水生左关木，左关木生左寸火。君火付权于相火，
故右尺火生右关土，右关土生右寸金，复生左尺水。五行循序相生之理也。伪诀乃云“女人反此背
看之”，岂理也哉！甚有以左尺候心，右尺候肺，本褚澄地道右行之说，而五行紊乱极矣。
《内经》候法，分发昭彰，如揭日月。从伪诀盛行，束《灵素》于高阁，千古阴霾，莫之能扫。因附列《素
问》脉法数则，示尊经也。世有不信鸣鼓之攻者，试进而求之于经，则趋向定矣。予言岂诬哉！
《素问·脉要精微论》曰∶“尺内两傍，则季胁也。”
季胁，小肋也。在胁下两傍，为肾所近之处也。
“尺外以候肾，尺里以候腹。”
尺外者，尺脉前半部也。尺里者，尺脉后半部也。前以候阳，后以候阴。人身以背为阳，肾附于背，故外以
候肾。腹为阴，故里以候腹。所谓腹者，凡大小肠、膀胱，皆在其中矣。以下诸部，俱言左右，而此独不分者，
以两尺皆主乎肾也。
“中附上，左外以候肝，内以候鬲。”
中附上者，言附尺之上而居乎中，即关脉也。左外者，言左关前半部；内者，言左关后半部。余仿此。肝为
阴中之阳藏，而亦附近于背，故外以候肝，内以候鬲。举一鬲而中焦之鬲膜、胆府皆在其中矣。
“右外以候胃，内以候脾。”
右关之前，所以候胃。右关之后，所以候脾。脾胃皆中州之官也，而以表里言之，则胃为阳，脾为阴，故外
以候胃，内以候脾也。
按寸口者，手太阴也。太阴行气于三阴，故曰，三阴在手，而主五脏。所以本篇止言五脏，而不及六腑。然
胃亦府也，而此独言之，何也？经所谓五脏皆禀气于胃，胃者，五脏之本也。藏气者，不能自致于手太阴
也，故胃气当于此察之。又《五脏别论》云∶“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。”然则此篇虽止言胃，而六腑之气亦并见乎此矣。
“上附上，右外以候肺，内以候胸中。”
上附上者，言上而又上，则寸脉也。五脏之位，惟肺最高，故右寸之前以候肺，右寸之后以候胸中。胸中
者，鬲膜之上皆是也。
“左外以候心，内以候膻中。”
心肺皆居膈上，故左寸之前以候心，左寸之后以候膻中。膻中者，即心包络之别名也。
按五脏所居之位，皆五行一定之理。火旺于南，故心居左寸。木旺于东，故肝居左关。金旺于西，故肺居
右寸。土旺于中，而寄位西南，故脾胃居右关。此即河图五行之次序也。
“前以候前，后以候后。”
此重申上下内外之义也。统而言之，寸为前，尺为后。分而言之，上半部为前，下半部为后。盖言上以候
上，下以候下也。
“上竟上者，胸喉中事也。下竟下者，少腹腰股膝胫足中事也。”
竟者，尽也。言上而尽于上，在脉则尽于鱼际，在体则应乎胸喉也。下而尽于下，在脉则尽于尺部，在体
则应乎少腹腰足也。
按此篇首言尺，次言中附上而为关，又次言上附上而为寸，皆自内以及外者，盖以太阴之脉，从胸走
手，以尺为根本，寸为枝叶也。故曰，凡人之脉，宁可有根而无叶，不可有叶而无根。
又按内外二字，诸家之注，皆云内侧。若以侧为言，必脉形扁阔，或有两条者乃可耳。不然，则于义不通
矣。如前以候前，后以候后，上竟上，下竟下者，皆内外之义也。观易卦六爻，自下而上，以上三爻为外卦，
以下三爻为内卦，则上下内外之义昭然矣。
“推而外之，内而不外，有心腹积也。”
推者，察也，求也。凡诊脉先推求于外，若但沉脉而无浮脉，是有内而无外矣，故知其病在心腹而有积
也。
“推而内之，外而不内，身有热也。”
推求于内，浮而不沉，则病在外而非内矣。惟表有邪，故身热也。
“推而上之，上而不下，腰足清也。”
清者，冷也。推求于腰，上部则脉强盛，下部则脉虚弱，此上盛下虚，故足清冷也。上下有二义∶以寸关尺
言之，寸为上，尺为下也；以浮中沉言之，浮为上，沉为下也。
“推而下之，下而不上，头项痛也。”
推求于下部，下部有力，上部无力，此清阳不能上升，故头项痛。或阳虚而阴凑之，亦头项痛也。
“按之至骨，脉气少者，腰脊痛而身有痹也。”
按之至骨，肾肝之分也。脉气少者，言无力也。肾水虚故腰脊痛，肝血亏则身有痹也。
按本篇上竟上者，言胸喉中事，下竟下者，言小腹膝足中事，分明上以候上，下以候下，而叔和乃谓
“心部在左手关前寸口，与手太阳为表里，以小肠合为府，合于上焦”云云，伪诀遂有左心、小肠之说。
不知自秦汉而下，从未有以大小肠取于两寸者，扁鹊、仲景诸君心传可考，伪诀何能以手障天也。
五脏不同，各有本脉。左寸之心，浮大而散。右寸之肺，浮涩而短。肝在左关，沉而弦长。肾在左
尺，沉石而濡。右关属脾，脉象和缓。右尺相火，与心同断。
心肺居上，脉应浮。肾肝居下，脉应沉。脾胃居心肺肾肝之间，谓之中州，脉亦应在浮沉之间。心肺同一
浮也，但浮大而散者象夏火，故属心；浮涩而短者象秋金，故属肺。肝肾同一沉也，但沉而弦长者象春
木，故属肝，沉石而濡者象冬水，故属肾。脉和而缓，气象冲融，土之性也，故属脾。右肾虽为水位，而相火
所寓，故与左寸同断也。
又按呼出者心与肺为阳，故心肺之脉皆浮。心为阳中之阳，故浮且大而散；肺为阳中之阴，故浮而兼
短涩。吸入者肾与肝为阴，故肾肝之脉皆沉。肾为阴中之阴，故沉而且实；肝为阴中之阳，故沉而兼长。
脾为中州，故不浮不沉，而脉在中。若赵正宗本《难经图说》，以土居金木水火之中，两关宜皆属脾；肝
既为阴，不宜在半浮半沉之左关。不知越人推明《素问》之义，约而可守，不必转滋议论也。
春弦夏洪，秋毛冬石；四季之末，和缓不忒。太过实强，病生于外；不及虚微，病生于内。
此言四季各有平脉也。天地之气，东升属木，位当寅卯，于时为春，万物始生。其气从伏藏中透出，如一
缕之烟，一线之泉，在人则肝应之，而见弦脉。即《素问·玉机真藏论》所谓其气来软弱，轻虚而滑，端
直以长《素问·平人气象论》所谓软弱招招，如揭长竿末梢者是也。气转而南属火，位当巳午；于时
为夏，万物盛长。其气从升后散大于外，如腾涌之波，燎原之火，在人则心应之，而见钩脉。即《玉机真
藏论》所谓其气来盛去衰；《平人气象论》所谓脉来累累如连珠，如循琅 者是也。气转而西属金，
位当申酉；于时为秋，万物收成。其气从散大之极自表初收，如浪静波恬，烟清焰息，在人则肺应之，而
见毛脉。即《平人气象论》所谓脉来厌厌聂聂，如落榆荚者是也。气转而北属水，位当亥子；于时为冬，
万物合藏。其气收降而敛实，如埋垆之火，汇潭之泉，在人则肾应之，而见石脉。即《玉机真藏论》所谓
其气来沉以搏；《平人气象论》所谓脉来喘喘累累如钩，按之而坚者是也。以上经论所云四时诸脉，
形状虽因时变易，其中总不可无和柔平缓景象。盖和缓为土，即是胃气，有胃气而合时，便是平脉。
《玉机真藏论》云∶“脾脉者，土也，孤藏以灌溉四旁者也。”今弦钩毛石中有此一种和缓，即是灌溉四
旁，即是土矣，亦即是脾脉矣。以其寓于四脉中，故又曰∶“善者不可得见。”《平人气象论》亦云∶“长夏
属脾，其脉和柔相离，如鸡践地。”察此脉象，亦不过形容其和缓耳。辰戌丑未之月，各有土旺一十八
日，即是灌溉四旁之义。故分而为四，有土而不见土也。若论五行，则析而为五，土居其中，是属长夏。况
长夏居金火之间，为相生之过脉，较他季月不同，故独见主时之脉。二说虽殊，其义不悖，当参看之。所
谓太过不及者，言弦、钩、毛、石之脉，与时相应，俱宜和缓而适中，欲其微似，不欲其太显；欲其微见，不欲
其不见。今即以一弦脉论之，若过于微弦而太弦，是谓太过，太过则气实强，气实强则气鼓于外而病
生于外。脉来洪大、紧数、弦长、滑实为太过，必外因风寒暑湿燥火之伤。不及于微弦而不弦，是谓不及，
不及则气虚微，气虚微则气馁于内而病生于内。脉来虚微、细弱、短涩、濡芤为不及，必内因喜怒忧思
悲恐惊七情之害。其钩、毛、石之太过不及，病亦犹是。
循序渐进，运合自然；应时即至，躁促为愆。
上古《脉要》曰∶“春不沉，夏不弦，秋不数，冬不涩，是谓四塞。”谓脉之从四时者，不循序渐进，则四塞而
不通也。所以初当春夏秋冬孟月之脉，则宜仍循冬春夏秋季月之常，未改其度，俟二分、二至以后，始
转而从本令之王气，乃为平人顺脉也。故天道春不分不温，夏不至不热，自然之运，悠久无疆。使在人
之脉，方春即以弦应，方夏即以数应，躁促所加，不三时而岁度终矣。其能长世乎！故曰，一岁之中，脉象
不可再见。如春宜弦而脉得洪，病脉见也，谓真藏之气先泄耳。今人遇立春以前而得弦脉，反曰时已
近春，不为病脉；所谓四时之气，成功者退，将来者进。言则似辨，而实悖于理矣。
四时百病，胃气为本；脉贵有神，不可不审。
三焦处于虚悬的位置。《灵枢·营卫生会篇》说：“上焦出于胃的上口，沿着咽喉向上贯穿膈肌，分布于胸中。中焦也位于胃中，在上焦之后，分别清浊，蒸化精液，将水谷转化为精微物质进而生成血液。下焦则别出回肠，注入膀胱并渗入其中。水谷存在于胃中，经过消化成为糟粕，下行至大肠，从而形成下焦的功能。”又说：“上焦像雾露一样弥漫，中焦像沤渍一样发酵腐熟，下焦像沟渠一样疏通排泄。”由此可以明确以上、中、下来划分三焦。伪诀（指高阳生所著《脉诀》）将三焦列在右尺脉，不是荒谬吗！又说道：“皮肤纹理细密且皮厚的人，三焦厚实；皮肤纹理粗糙且皮薄的人，三焦薄弱。”由此可以明确三焦是有具体形象的。伪诀认为三焦无形，不是荒谬吗！又查考《灵枢·本输篇》说：“三焦是中渎之府，水道由此而出，归属于膀胱，是孤独的府。”称为中渎，是因为它像河流和沟渠，源头和流向都出自其中，即水谷从口进入，从大小便排出，自上而下，必定经过三焦，所以叫作中渎之府，水道由此而出。膀胱接受三焦的水液，并主管其疏泄的通道，气机本来相互依存，道理一致，所以三焦的下行出口在委阳穴，并入足太阳膀胱经的正脉，入络于膀胱，约束下焦。然而在十二脏腑中，只有三焦最大，其他脏腑没有能与之匹敌的，所以叫它是孤独的府。要知道三焦虽然作为水液流通的府，但实际上总护诸阳之气，也被称为相火，这又是水中的火府。所以在《本输篇》中说：“三焦属于膀胱。”在《素问·血气形志篇》中说：“少阳与心包络互为表里。”大概在下部的属阴，归属膀胱而合肾水；在上部的属阳，合包络而通心火，这就是三焦之所以贯通上下至极，形象如同六合（天地四方），无所不包的原因。观察《本输篇》对六腑的区别，极为明显，因为它们都有盛贮功能，因此称为府。而三焦被称为“中渎之府”、“是孤之府”，分明有一个具体的府；大概就是位于脏腑之外、躯体之内，包罗诸脏的一个大腔体之府。所以有“中渎”、“是孤”的名称，也有大府的形态。《难经》已经说它有名无形，何况是高阳生这种狂妄之人呢！这大概是比喻探囊取物却忘了袋子本身也是物品一样。导致后世纷纷议论，无所凭据，有的将其分为前、后三焦，有的说是肾脏旁边的脂肪组织，即使是李东垣这样高明的人，也将手三焦、足三焦分为两个。既然一个三焦尚且说它无形，各种论述又不一致，又怎么会有这么多关于三焦的说法呢？到了韩飞霞巧妙地提出说法：“切脉诊到右尺时，必须两手同时诊察斟酌。取三焦对应的脉象，浮取为上焦，与心肺脉相合；中取为中焦，与脾胃脉相合；沉取为下焦，与肝肾脉相合。所以说，尺脉第三部共同判断疾病。”这又是韩飞霞以讹传讹，违背医道越来越远。《素问·脉要精微论》说：“尺部外侧候肾，尺部内侧候腹中。”从未说过尺部候三焦。《脉经》说：“尺脉芤，主下焦虚。尺脉迟，主下焦有寒。”又说：“尺脉浮者，客阳在下焦。”看这三句话，就知道尺部主要候下焦罢了。为什么要把韩飞霞那种巧妙的说法附会进去呢？《脉经·一卷·第七篇·脉法赞》说：“右手尺部为子户，名叫三焦。”子户，就是命门。右肾为命门，男子用以藏精，女子用以系胞，所以称为子户。而称之为三焦，这就像两额旁侧也称为太阳经一样。并不是说那就是太阳经本身。怎么能拘泥于文字而损害义理呢！如果《第二卷·第二篇》虽然写“右肾合三焦”，但上面有“一说云”三个字，那么王叔和也是附上此语，以备参考，不敢自认为是定论，这是很明显的。现在论定上焦对应两寸脉，中焦对应两关脉，下焦对应两尺脉，这就与《脉要精微论》中“上竟上者，指胸喉中的病变。下竟下者，指少腹腰股膝胫足中的病变”这两句话相符，又何必再有很多异议呢！有一位医生常对我说：“我行医四十多年，从来不知道分剖三焦，也被当时的人推崇。”唉，如此浅近的道理，还保留而不加讨论，又怎么能主持八正邪气的辨别，区分五中部的脉象，按察脉动的动静呢？心、肝、脾、肺，各有一个脉候，只有肾这一脏分为两尺来候，是因为肾有两个，形状像豇豆，分列在腰脊的左右两侧。伪诀认为左尺候肾，右尺候命门。考证《明堂》、《铜人》等经典，命门这个穴位，在督脉第十四椎下的凹陷中，两肾之间，大概是一阳居于二阴之中，从而构成坎卦。而且脉象应于指下的，是因为有经络，循经朝会于寸口。《内经》并没有命门的经络，凭什么应诊而将其列在右尺呢？男女的差异，只在于茎户、精血以及胞门、子户这些生殖器官方面。至于脉象，自有其定位。比如左尺水生左关木，左关木生左寸火。君火将权柄付托给相火，所以右尺火生右关土，右关土生右寸金，复生左尺水。这是五行循序相生的道理。伪诀竟然说“女人反过来看”，这哪里合乎道理呢！更有甚者，以左尺候心，右尺候肺，本是依据褚澄“地道右行”的说法，导致五行紊乱到了极点。
《内经》的候脉方法，分发清晰显著，如同日月昭彰。自从伪诀盛行以来，人们将《灵枢》、《素问》束之高阁，千古阴霾，无人能扫。因此附录《素问》脉法数条，以示尊崇经典。世上如果有不信从我如击鼓般猛烈抨击伪诀观点的人，试着进而来求索于经典，那么方向就确定了。我的话难道是欺骗吗！
《素问·脉要精微论》说：“尺部内侧两旁，候季胁。”
季胁，就是小肋。位于胁下两旁，是靠近肾脏的地方。
“尺外以候肾，尺里以候腹。”
尺外，是指尺脉的前半部（桡侧）。尺里，是指尺脉的后半部（尺侧）。前半部候阳，后半部候阴。人身以背部为阳，肾附着于背部，所以尺外候肾。腹部为阴，所以尺里候腹。所说的腹，凡是大肠、小肠、膀胱，都在其中了。以下各部，都讲左右，唯独这里不分左右的，是因为两尺都主候肾脏。
“中附上，左外以候肝，内以候鬲。”
中附上，是说依附于尺部之上而居于中间，就是关脉。左外，是指左关脉的前半部；内，是指左关脉的后半部。其余仿照此类。肝为阴中之阳脏，但也靠近背部，所以左外候肝，左内候鬲。举一个鬲字，中焦的膈膜、胆府都在其中了。
“右外以候胃，内以候脾。”
右关脉的前部，用来候胃。右关脉的后部，用来候脾。脾胃都是中州的官职（脏腑），如果从表里来说，胃为阳，脾为阴，所以右外候胃，右内候脾。
按：寸口脉属于手太阴肺经。太阴经在三阴经中运行气机，所以说，三阴经在手部，主候五脏。所以本篇只言五脏，而不涉及六腑。然而胃也是府，而这里独独提到它，为什么呢？经文所说五脏都禀受胃气，胃是五脏的根本。脏气不能自己到达手太阴脉，所以要在寸口察验胃气。另外《五脏别论》说：“五味入口藏于胃，以滋养五脏之气，气口也属于太阴。所以五脏六腑的气味，都出于胃，变化显现于气口。”既然如此，这篇虽然只言胃，但六腑的气也一并显现于此了。
“上附上，右外以候肺，内以候胸中。”
上附上，是说上而又上，就是寸脉。五脏的位置，只有肺最高，所以右寸的前部候肺，右寸的后部候胸中。胸中，就是膈膜以上的部位都是。
“左外以候心，内以候膻中。”
心肺都居于膈上，所以左寸的前部候心，左寸的后部候膻中。膻中，就是心包络的别名。
按：五脏所处的位置，都是五行一定的道理。火旺于南方，所以心居左寸。木旺于东方，所以肝居左关。金旺于西方，所以肺居右寸。土旺于中央，而寄位西南，所以脾胃居右关。这就是河图五行的次序。
“前以候前，后以候后。”
这是重申上下内外的含义。统而言之，寸为前，尺为后。分而言之，上半部为前，下半部为后。意思是说上部候上部，下部候下部。
“上竟上者，胸喉中事也。下竟下者，少腹腰股膝胫足中事也。”
竟，就是尽的意思。说上而尽于上，在脉象上尽于鱼际，在身体上应乎胸喉。下而尽于下，在脉象上尽于尺部，在身体上应乎少腹腰足。
按：本篇首先言尺，其次言中附上而为关，再次言上附上而为寸，都是从内及外的，因为太阴经脉从胸走手，以尺为根本，寸为枝叶。所以说，人的脉象，宁可只有根而没有叶，不可有叶而没有根。
又按：内外二字，各家注解，都说是内侧。如果说的是侧边，那必须是脉形扁阔，或者有两条脉的情况才可以。否则，在义理上就不通了。如前以候前，后以候后，上竟上，下竟下，都是内外的含义。观察易经卦象的六爻，自下而上，以上三爻为外卦，以下三爻为内卦，那么上下内外的含义就昭然若揭了。
“推而外之，内而不外，有心腹积也。”
推，是察究、寻求的意思。凡是诊脉先推求于外，如果只有沉脉而没有浮脉，就是有内而无外，所以知道病在心腹而有积聚。
“推而内之，外而不内，身有热也。”
推求于内，脉浮而不沉，那么病在外而不是在内。只有体表有邪气，所以身体发热。
“推而上之，上而不下，腰足清也。”
清，就是冷。推求于腰部，上部脉强盛，下部脉虚弱，这是上盛下虚，所以脚冷。上下有两层含义：以寸关尺而言，寸为上，尺为下；以浮中沉而言，浮为上，沉为下。
“推而下之，下而不上，头项痛也。”
推求于下部，下部有力，上部无力，这是清阳不能上升，所以头项痛。或者是阳虚而阴气凑集，也会头项痛。
“按之至骨，脉气少者，腰脊痛而身有痹也。”
按之至骨，是肾肝的分野。脉气少，是说无力。肾水虚故腰脊痛，肝血亏则身体有痹症。
按：本篇上竟上者，言胸喉中的病变，下竟下者，言小腹膝足中的病变，分明是上以候上，下以候下，而王叔和却说“心部在左手关前寸口，与手太阳小肠经为表里，以小肠合为府，合于上焦”等等，伪诀于是有了左心、小肠之说。不知道自秦汉以来，从未有以大小肠取候于两寸的，扁鹊、张仲景诸位的心传可以考证，伪诀怎么能只手遮天呢。
五脏不同，各有本脉。左寸的心脉，浮大而散。右寸的肺脉，浮涩而短。肝在左关，沉而弦长。肾在左尺，沉石而濡。右关属脾，脉象和缓。右尺相火，与左寸同断。
心肺居上，脉象应浮。肾肝居下，脉象应沉。脾胃居心肺肾肝之间，称为中州，脉象也应在浮沉之间。心肺同为浮脉，但浮大而散像夏天的火，所以属心；浮涩而短像秋天的金，所以属肺。肝肾同为沉脉，但沉而弦长像春天的木，所以属肝，沉石而濡像冬天的水，所以属肾。脉象和缓，气象冲融，是土的性情，所以属脾。右肾虽为水位，但相火寓居其中，所以与左寸同断。
又按：呼出者心与肺为阳，所以心肺的脉皆浮。心为阳中之阳，所以脉浮且大而散；肺为阳中之阴，所以脉浮而兼短涩。吸入者肾与肝为阴，所以肾肝的脉皆沉。肾为阴中之阴，所以脉沉而且实；肝为阴中之阳，所以脉沉而兼长。脾为中州，所以不浮不沉，脉在中部。如果赵正宗本的《难经图说》，认为土居金木水火之中，两关都应该属脾；肝既为阴，不应该在半浮半沉的左关。不知道越人（秦越人/扁鹊）推明《素问》的意义，简约而可守持，不必转而滋生议论。
春弦夏洪，秋毛冬石；四季之末，和缓不差。太过实强，病生于外；不及虚微，病生于内。
这是说四季各有平脉。天地之气，东升属木，方位当寅卯，在时为春，万物始生。其气从伏藏中透出，如一缕烟，一线泉，在人则肝应之，而见弦脉。即《素问·玉机真藏论》所谓其气来软弱，轻虚而滑，端直以长；《素问·平人气象论》所谓软弱招招，如揭长竿末梢的情形。气转而南属火，方位当巳午；在时为夏，万物盛长。其气从升后散大于外，如腾涌的波，燎原的火，在人则心应之，而见钩脉。即《玉机真藏论》所谓其气来盛去衰；《平人气象论》所谓脉来累累如连珠，如循琅玕的情形。气转而西属金，方位当申酉；在时为秋，万物收成。其气从散大之极自表初收，如浪静波恬，烟清焰息，在人则肺应之，而见毛脉。即《平人气象论》所谓脉来厌厌聂聂，如落榆荚的情形。气转而北属水，方位当亥子；在时为冬，万物合藏。其气收降而敛实，如埋垆之火，汇潭之泉，在人则肾应之，而见石脉。即《玉机真藏论》所谓其气来沉以搏；《平人气象论》所谓脉来喘喘累累如钩，按之而坚的情形。以上经文论述的四时诸脉，形状虽然因时变易，其中总不可没有和柔平缓的景象。盖和缓为土，即是胃气，有胃气而合时令，便是平脉。《玉机真藏论》说：“脾脉者，土也，孤藏以灌溉四旁者也。”如今弦钩毛石中有这种和缓，即是灌溉四旁，即是土，也就是脾脉。因为它寓于四脉中，所以又说：“善者不可得见。”《平人气象论》也说：“长夏属脾，其脉和柔相离，如鸡践地。”观察这种脉象，也不过是形容其和缓罢了。辰戌丑未之月，各有土旺的一十八日，即是灌溉四旁的意义。所以分而为四，有土而不见土。如果论五行，则析而为五，土居其中，属于长夏。况且长夏居金火之间，为相生之过脉，与其他季节月份不同，所以独见主时的脉。两种说法虽然不同，其义理不违背，应当参看。所谓的太过不及，是说弦、钩、毛、石的脉，与时相应，都宜和缓而适中，想要其微弱相似，不想要其太显露；想要其微见，不想要其不见。现在就以一弦脉为例，如果过于微弦而变成太弦，这叫太过，太过则气实强，气实强则气鼓动于外而病生于外。脉来洪大、紧数、弦长、滑实为太过，必是外因风寒暑湿燥火的伤害。不及于微弦而不弦，这叫不及，不及则气虚微，气虚微则气馁于内而病生于内。脉来虚微、细弱、短涩、濡芤为不及，必是内因喜怒忧思悲恐惊七情的危害。其钩、毛、石的太过不及，病因也是如此。
循序渐进，运合自然；应时即至，躁促为愆。
上古《脉要》说：“春不沉，夏不弦，秋不数，冬不涩，这叫四塞。”是说脉象顺应四时，如果不循序渐进，就会四塞不通。所以初春、初夏、初秋、初冬孟月的脉，应该仍然遵循冬春夏秋季月的常规，未改变其度数，等到二分、二至以后，才开始转变而从本令的王气，这才是平人顺脉。所以天道春不分不温，夏不至不热，是自然的运化，悠久无疆。如果在人的脉象，刚春就以弦应，刚夏就以数应，被躁促所加，不到三个季度一年的度数就结束了。还能长寿吗！所以说，一岁之中，脉象不可再见（指不该出现的脉象出现）。如春宜弦而脉得洪，是病脉出现，谓真藏之气先泄耳。今人遇到立春以前而得弦脉，反而说时候已近春，不认为是病脉；所谓四时之气，成功者退，将来者进。言语似乎辨析清楚，而实际上违背道理。
四时百病，胃气为本；脉贵有神，不可不审。
The Sanjiao (Triple Burner) occupies a position of hollow suspension. The *Ling Shu · Ying Wei Hui Hui* chapter states: "The Upper Jiao originates from the upper orifice of the stomach, ascends along the pharynx, pierces through the diaphragm, and spreads in the chest. The Middle Jiao is also located within the stomach, posterior to the Upper Jiao; it separates the clear from the turbid, steams and transforms the essence and fluids, converting them into subtle nutrients to generate blood. The Lower Jiao separates from the ileum, pours into the bladder, and permeates therein. Food and drink reside in the stomach, transform into dregs, descend into the large intestine, thereby forming the function of the Lower Jiao." It further states: "The Upper Jiao is like mist, the Middle Jiao like fermentation, and the Lower Jiao like a ditch." From this, it is clear that the Sanjiao is divided into Upper, Middle, and Lower based on location. To list the Sanjiao at the Right Chi pulse position, as the spurious *Mai Jue* does, is indeed absurd! It also says: "Those with fine skin texture and thick skin have a substantial Sanjiao; those with coarse skin texture and thin skin have a deficient Sanjiao." From this, it is evident that the Sanjiao has a physical form. For the spurious *Mai Jue* to claim it is formless is indeed absurd! Furthermore, consulting the *Ling Shu · Ben Shu* chapter states: "The Sanjiao is the Fu organ of the middle channels; water pathways emerge from it, connecting to the Bladder; it is the solitary Fu organ." It is called the "Middle Channel" because it resembles rivers and ditches, with sources and flows originating within it. Just as food and drink enter via the mouth and exit via urination and defecation, they must pass through the Sanjiao from top to bottom; hence it is called the Fu organ of the middle channels, from which water pathways emerge. The Bladder receives water from the Sanjiao and governs its drainage pathway; their Qi mechanisms inherently support each other, and their principles are consistent. Therefore, the descending outlet of the Sanjiao is at Weiyang (BL39), merging with the main branch of the Foot-Taiyang Bladder Meridian, entering and connecting to the Bladder, thus regulating the Lower Jiao. However, among the twelve Zang-Fu organs, only the Sanjiao is the largest, with no other organ matching it; hence it is called the "Solitary Fu Organ." One must understand that although the Sanjiao serves as the reservoir for water pathways, it actually protects all Yang Qi and is also referred to as Ministerial Fire, making it the Fire Fu organ within Water. Thus, in the *Ben Shu* chapter, it says: "The Sanjiao belongs to the Bladder." In the *Su Wen · Xue Qi Xing Zhi* chapter, it says: "Shaoyang (Gallbladder/SanJiao) and Pericardium are exterior-interior pairs." Generally, the lower part is Yin, belonging to the Bladder and combining with Kidney Water; the upper part is Yang, combining with the Pericardium and connecting to Heart Fire. This is why the Sanjiao extends from the extreme top to the extreme bottom, resembling the Six Directions (Heaven, Earth, and Four Cardinal Points), encompassing everything. Observing the distinction of the Six Fu organs in the *Ben Shu* chapter is very clear: because they all have capacity for storage, they are named Fu organs. The Sanjiao is called the "Fu organ of the middle channels" and the "Solitary Fu Organ," clearly indicating a specific Fu organ; it is essentially a large cavity Fu organ outside the Zang-Fu but within the body, enveloping all internal organs. Hence it bears the names "Middle Channel" and "Solitary," and possesses the form of a great Fu organ. The *Nan Jing* already stated it has a name but no form; how much more so for the arrogant Gao Yangsheng! This is akin to searching a bag for items while forgetting that the bag itself is an item. This led to endless disputes in later generations, lacking any basis: some divided it into anterior and posterior Sanjiao, others claimed it was the fat beside the kidneys. Even the brilliant Li Dongyuan divided the Hand-Sanjiao and Foot-Sanjiao into two. If one Sanjiao is said to be formless, and various theories differ, how can there be so many versions of the Sanjiao? Later, Han Feixia cleverly proposed: "When palpating the Right Chi pulse, both hands must be examined simultaneously. Taking the pulse corresponding to the Sanjiao, floating indicates Upper Jiao, combining with Heart and Lung pulses; mid-level indicates Middle Jiao, combining with Spleen and Stomach pulses; deep indicates Lower Jiao, combining with Liver and Kidney pulses. Thus it is said, the third division of the Chi pulse diagnoses diseases together." This is yet another error passed down by Feixia, deviating further from the Dao. The *Su Wen · Mai Yao Jing Wei Lun* states: "The lateral aspect of the Chi region corresponds to the Kidneys; the medial aspect corresponds to the abdomen." It never says the Chi pulse corresponds to the Sanjiao. The *Mai Jing* states: "A Choppy Chi pulse indicates deficiency in the Lower Jiao. A Slow Chi pulse indicates Cold in the Lower Jiao." It also says: "A Floating Chi pulse indicates Exogenous Yang in the Lower Jiao." From these three statements, it is clear that the Chi pulse primarily corresponds to the Lower Jiao. Why should Han's clever theory be attached? The *Mai Jing · Vol 1 · Chapter 7 · Mai Fa Zan* says: "The Right [Chi] is the Zi Hu (Child's Chamber), named Sanjiao." Zi Hu refers to Mingmen (Gate of Life). The Right Kidney is the Mingmen, storing Essence in men and anchoring the Uterus in women, hence called Zi Hu. Calling it Sanjiao here is similar to how the sides of the forehead are also named Taiyang; it does not mean it is the Taiyang Meridian itself. How can one cling to words and harm the meaning? Although *Vol 2 · Chapter 2* says "Right Kidney combines with Sanjiao," the preceding text includes "one theory says," indicating Wang Shuhe attached this remark for reference, not claiming it as a definitive conclusion. Now, it is determined that the Upper Jiao corresponds to the two Cun pulses, the Middle Jiao to the two Guan pulses, and the Lower Jiao to the two Chi pulses. This aligns with the *Mai Yao Jing Wei Lun*: "Upper reaching up corresponds to matters of the chest and throat. Lower reaching down corresponds to matters of the lower abdomen, waist, thighs, knees, shins, and feet." Why are there still numerous dissenting opinions? A physician once told me, "I have practiced medicine for over forty years and never knew to dissect the Sanjiao, yet I am still respected in my time." Alas, such superficial understanding, if preserved without discussion, how can one manage the Eight Corrective Evils, distinguish the Five Internal regions, and assess pulse dynamics? Heart, Liver, Spleen, and Lung each have one pulse position; only the Kidney is divided into two Chi positions because there are two Kidneys, shaped like kidney beans, located on the left and right of the lumbar spine. The spurious *Mai Jue* claims the Left Chi corresponds to the Kidney and the Right Chi to the Mingmen. Consulting classics like *Ming Tang* and *Tong Ren*, the acupoint Mingmen is located in the depression below the fourteenth thoracic vertebra of the Du Meridian, between the two Kidneys. This represents one Yang residing between two Yins, forming the Kan trigram. Moreover, pulses responding under the fingers exist because of meridians that converge at the Cun Kou. The *Nei Jing* mentions no meridian for the Mingmen; how can it be listed at the Right Chi for diagnosis? Differences between men and women lie only in the penis, essence/blood, and uterus/chamber. As for pulse images, they have fixed locations. For example, Water at Left Chi generates Wood at Left Guan; Wood at Left Guan generates Fire at Left Cun. Ruler Fire delegates authority to Ministerial Fire; thus, Fire at Right Chi generates Earth at Right Guan; Earth at Right Guan generates Metal at Right Cun; Metal generates Water at Left Chi. This is the principle of the cyclical generation of the Five Elements. The spurious *Mai Jue* claims "for women, look at it in reverse"; how can this be reasonable! Some even place the Heart at Left Chi and the Lungs at Right Chi, following Chu Cheng's theory of "Earth moves to the right," causing extreme disorder of the Five Elements.
The diagnostic methods of the *Nei Jing* are clear and manifest, like the sun and moon. Since the prevalence of the spurious *Mai Jue*, the *Ling Shu* and *Su Wen* have been shelved, leaving eternal gloom unswept. Therefore, I append several pulse methods from the *Su Wen* to show reverence for the classics. Those who do not believe my drum-beating attack on errors should seek verification in the classics, and their direction will be settled. Are my words false?
The *Su Wen · Mai Yao Jing Wei Lun* states: "The inner sides of the Chi region correspond to the hypochondrium."
The hypochondrium refers to the lower ribs. Located on both sides below the costal margin, it is near the Kidneys.
"The lateral aspect of the Chi corresponds to the Kidneys; the medial aspect corresponds to the abdomen."
"Lateral Chi" refers to the radial half of the Chi pulse. "Medial Chi" refers to the ulnar half. The anterior half corresponds to Yang, the posterior half to Yin. The back is Yang, and the Kidneys attach to the back, so the lateral aspect corresponds to the Kidneys. The abdomen is Yin, so the medial aspect corresponds to the abdomen. The term "abdomen" here encompasses the Large Intestine, Small Intestine, and Bladder. While subsequent sections specify left and right, this one does not, because both Chi pulses govern the Kidneys.
"Attached to the middle, the lateral aspect of the Left corresponds to the Liver; the medial aspect corresponds to the Diaphragm."
"Attached to the middle" means situated above the Chi and in the center, i.e., the Guan pulse. "Left lateral" refers to the anterior half of the Left Guan; "medial" refers to the posterior half. The rest follows this pattern. The Liver is a Zang organ of Yin containing Yang, and it is also close to the back, so the lateral aspect corresponds to the Liver, and the medial aspect to the Diaphragm. Mentioning the Diaphragm covers the Middle Jiao's diaphragmatic membrane and the Gallbladder Fu.
"The lateral aspect of the Right corresponds to the Stomach; the medial aspect corresponds to the Spleen."
The anterior part of the Right Guan corresponds to the Stomach. The posterior part of the Right Guan corresponds to the Spleen. The Spleen and Stomach are officials of the Central Region. Speaking of exterior-interior relations, the Stomach is Yang and the Spleen is Yin; thus, the lateral aspect corresponds to the Stomach, and the medial aspect to the Spleen.
Note: The Cun Kou pulse belongs to the Hand-Taiyin Lung Meridian. The Taiyin circulates Qi through the Three Yin meridians; hence, "Three Yin are in the hand, governing the Five Zang organs." This chapter mentions only the Five Zang organs, excluding the Six Fu organs. However, the Stomach is a Fu organ, yet it is mentioned here specifically. Why? The classic states that the Five Zang organs all receive Qi from the Stomach; the Stomach is the root of the Five Zang. Visceral Qi cannot reach the Hand-Taiyin on its own; therefore, Stomach Qi must be observed here. Additionally, the *Wu Zang Bie Lun* states: "Flavors enter and store in the Stomach to nourish the Qi of the Five Zang organs; the Qi Kou also belongs to the Taiyin. Thus, the Qi and flavors of the Five Zang and Six Fu organs all originate from the Stomach and manifest at the Qi Kou." Therefore, although this chapter mentions only the Stomach, the Qi of the Six Fu organs is also visible here.
"Attached to the upper, the lateral aspect of the Right corresponds to the Lungs; the medial aspect corresponds to the Chest Center."
"Attached to the upper" means uppermost, i.e., the Cun pulse. Among the Five Zang organs, the Lungs are the highest. Thus, the anterior part of the Right Cun corresponds to the Lungs, and the posterior part to the Chest Center. The Chest Center refers to all areas above the diaphragm.
"The lateral aspect of the Left corresponds to the Heart; the medial aspect corresponds to the Dan Zhong (Pericardium)."
Both the Heart and Lungs reside above the diaphragm. Thus, the anterior part of the Left Cun corresponds to the Heart, and the posterior part to the Dan Zhong. Dan Zhong is another name for the Pericardium.
Note: The positions of the Five Zang organs follow the fixed principles of the Five Elements. Fire flourishes in the South, so the Heart resides in the Left Cun. Wood flourishes in the East, so the Liver resides in the Left Guan. Metal flourishes in the West, so the Lungs reside in the Right Cun. Earth flourishes in the Center but寄位 (resides temporarily) in the Southwest, so the Spleen and Stomach reside in the Right Guan. This is the sequence of the Hetu Five Elements.
"The anterior corresponds to the anterior; the posterior corresponds to the posterior."
This reiterates the meanings of upper/lower and interior/exterior. Generally speaking, Cun is anterior, and Chi is posterior. Specifically, the upper half is anterior, and the lower half is posterior. It means the upper part corresponds to the upper body, and the lower part to the lower body.
"Upper reaching up corresponds to matters of the chest and throat. Lower reaching down corresponds to matters of the lower abdomen, waist, thighs, knees, shins, and feet."
"Jing" means end. "Reaching up to the end" means in the pulse, it ends at the Yu Ji area; in the body, it corresponds to the chest and throat. "Reaching down to the end" means in the pulse, it ends at the Chi region; in the body, it corresponds to the lower abdomen, waist, and feet.
Note: This chapter first discusses the Chi, then the middle attachment becoming the Guan, and finally the upper attachment becoming the Cun, all moving from interior to exterior. This is because the Taiyin meridian travels from the chest to the hand, taking the Chi as the root and the Cun as the branches. Hence, it is said that human pulses may have roots without branches, but cannot have branches without roots.
Furthermore, regarding the terms "interior" and "exterior," commentators generally interpret them as medial. If referring to sides, the pulse shape would need to be flat and broad, or there would need to be two distinct lines; otherwise, the meaning would not hold. Terms like "anterior corresponds to anterior," "posterior corresponds to posterior," "upper reaches up," and "lower reaches down" all express the meaning of interior/exterior. Observing the six lines of the I Ching hexagrams, from bottom to top, the upper three lines form the Outer Trigram, and the lower three lines form the Inner Trigram; thus, the meanings of upper/lower and interior/exterior become clear.
"Pushing outward, if it is interior but not exterior, there is accumulation in the heart and abdomen."
"Push" means to investigate or seek. When diagnosing, one first investigates the exterior. If there is only a Deep pulse without a Floating pulse, it indicates interior presence without exterior expression; thus, disease involves accumulation in the heart and abdomen.
"Pushing inward, if it is exterior but not inward, there is heat in the body."
Investigating the interior reveals a Floating pulse without Deepness, indicating disease is external rather than internal. Only when pathogens are on the surface does the body feel hot.
"Pushing upward, if it is upper but not downward, the waist and feet are cold."
"Qing" means cold. Investigating the waist, if the upper pulse is strong and the lower pulse is weak, this indicates excess above and deficiency below, resulting in cold feet. "Upper and lower" has two meanings: referring to Cun/Guan/Chi, Cun is upper and Chi is lower; referring to Floating/Middle/Deep, Floating is upper and Deep is lower.
"Pushing downward, if it is lower but not upward, there is pain in the head and neck."
Investigating the lower region shows strength in the lower pulse and weakness in the upper pulse. This indicates that Clear Yang cannot ascend, causing head and neck pain. Alternatively, Yang deficiency allowing Yin to gather can also cause head and neck pain.
"Pressing to the bone, if the pulse Qi is scanty, there is pain in the waist and spine and numbness in the body."
Pressing to the bone corresponds to the Kidney and Liver regions. Scanty pulse Qi means weakness. Deficiency of Kidney Water causes waist and spine pain; deficiency of Liver Blood causes bodily numbness (Bi syndrome).
Note: This chapter states that "upper reaching up" corresponds to chest/throat issues and "lower reaching down" corresponds to lower abdomen/knee/foot issues, clearly indicating upper corresponds to upper and lower to lower. Yet Wang Shuhe claimed, "The Heart region is at the Cun Kou before the Left Guan, exterior-interior with the Hand-Taiyang, forming a Fu with the Small Intestine, combining with the Upper Jiao," etc. The spurious *Mai Jue* then adopted the concept of Left Heart and Small Intestine. It is unknown since the Qin and Han dynasties that anyone used the Small/Large Intestines to correspond to the two Cun pulses. The oral transmissions of Bian Que and Zhang Zhongjing are verifiable; how could the spurious *Mai Jue* cover the sky with one hand?
The Five Zang organs differ, each having its own fundamental pulse. The Heart at Left Cun is Floating, Large, and Scattered. The Lungs at Right Cun are Floating, Choppy, and Short. The Liver at Left Guan is Deep, Wiry, and Long. The Kidney at Left Chi is Deep, Stone-like, and Soft. The Spleen at Right Guan has a Harmonious and Moderate pulse. The Ministerial Fire at Right Chi is diagnosed similarly to the Left Cun.
The Heart and Lungs reside superiorly, so their pulses should be Floating. The Kidneys and Liver reside inferiorly, so their pulses should be Deep. The Spleen and Stomach reside between the Heart/Lungs and Kidneys/Liver, termed the Central Region, so their pulses should be between Floating and Deep. Both Heart and Lung pulses are Floating, but Floating-Large-Scattered resembles Summer Fire, so it belongs to the Heart; Floating-Choppy-Short resembles Autumn Metal, so it belongs to the Lungs. Both Kidney and Liver pulses are Deep, but Deep-Wiry-Long resembles Spring Wood, so it belongs to the Liver; Deep-Stone-Soft resembles Winter Water, so it belongs to the Kidney. The pulse is Harmonious and Moderate, with a mild and blended atmosphere, reflecting the nature of Earth, so it belongs to the Spleen. Although the Right Kidney is in the Water position, Ministerial Fire resides within it, so it is diagnosed together with the Left Cun.
Furthermore, exhalation relates to the Heart and Lung as Yang, so their pulses are Floating. The Heart is Yang within Yang, so the pulse is Floating, Large, and Scattered; the Lung is Yin within Yang, so the pulse is Floating with Shortness and Choppy quality. Inhalation relates to the Kidney and Liver as Yin, so their pulses are Deep. The Kidney is Yin within Yin, so the pulse is Deep and Solid; the Liver is Yang within Yin, so the pulse is Deep with Long quality. The Spleen is the Central Region, so it is neither Floating nor Deep, but Middle. If Zhao Zhengzong's version of the *Nan Jing Tu Shuo* argues that Earth resides among Metal, Wood, Water, and Fire, so both Guan pulses should belong to the Spleen; and since Liver is Yin, it should not be at the semi-floating/semi-deep Left Guan... unaware that Yue Ren (Bian Que) clarified the meaning of the *Su Wen*, keeping it concise and maintainable, avoiding unnecessary debate.
Spring is Wiry, Summer is Hooked (Large), Autumn is Feather-like (Floating), Winter is Stone-like (Deep); at the end of the four seasons, the pulse is Harmonious and Moderate without error. Excess and strength indicate disease arising externally; deficiency and minuteness indicate disease arising internally.
This describes the normal pulses of the four seasons. Heaven and Earth Qi rise from the East, belonging to Wood, positioned at Yin and Mao, corresponding to Spring when all things begin to grow. Its Qi emerges from dormancy, like a wisp of smoke or a thread of spring water; in humans, the Liver responds, showing a Wiry pulse. This is what the *Su Wen · Yu Ji Zhen Zang Lun* calls "its Qi comes soft and weak, light, void, slippery, straight, and long," and what the *Ping Ren Qi Xiang Lun* describes as "soft and swaying, like holding the tip of a long bamboo pole." Qi turns south, belonging to Fire, positioned at Si and Wu; corresponding to Summer when all things flourish. Its Qi expands outward after rising, like surging waves or prairie fires; in humans, the Heart responds, showing a Hooked pulse. This is what the *Yu Ji Zhen Zang Lun* calls "its Qi comes abundant and departs declining," and the *Ping Ren Qi Xiang Lun* describes as "pulse coming continuously like linked pearls, like tracing agate." Qi turns west, belonging to Metal, positioned at Shen and You; corresponding to Autumn when all things are harvested. Its Qi begins to retract from maximum expansion outward; like calm waves and extinguished flames; in humans, the Lungs respond, showing a Feather-like pulse. This is what the *Ping Ren Qi Xiang Lun* describes as "pulse coming gently and softly, like falling elm seeds." Qi turns north, belonging to Water, positioned at Hai and Zi; corresponding to Winter when all things hide. Its Qi descends and condenses, like buried furnace fire or pooled spring water; in humans, the Kidneys respond, showing a Stone-like pulse. This is what the *Yu Ji Zhen Zang Lun* calls "its Qi comes deep and firm," and the *Ping Ren Qi Xiang Lun* describes as "pulse coming rapidly and heavily like a hook, firm upon pressure." Regarding the four seasonal pulses mentioned above, although their shapes change with the seasons, they must always contain a soft, gentle, and moderate appearance. Moderation and gentleness belong to Earth, representing Stomach Qi. Having Stomach Qi combined with the season constitutes a Normal Pulse. The *Yu Ji Zhen Zang Lun* says: "The Spleen pulse is Earth, the solitary Zang that irrigates the four directions." Today, within the Wiry, Hooked, Feather, and Stone pulses, this moderation and gentleness represents irrigation of the four directions, is Earth, and is also the Spleen pulse. Because it resides within the four pulses, it is also said: "The good ones cannot be seen." The *Ping Ren Qi Xiang Lun* also says: "Late Summer belongs to the Spleen; its pulse is soft and separated, like a chicken stepping on the ground." Observing this pulse image merely describes its moderation. In the months of Chen, Xu, Chou, and Wei, Earth prospers for eighteen days each, representing the meaning of irrigating the four directions. Thus, divided into four, there is Earth but Earth is not seen separately. If discussing the Five Elements, it is analyzed into five, with Earth in the middle, belonging to Late Summer. Moreover, Late Summer resides between Metal and Fire, representing an excessive phase of generation, different from other seasons/months, so it uniquely shows the ruling seasonal pulse. Although the two explanations differ, their meanings do not contradict; they should be consulted together. The terms "excess" and "deficiency" refer to the Wiry, Hooked, Feather, and Stone pulses corresponding to the times; they should all be moderate and适中 (appropriate), wanting them slightly present, not too obvious; wanting them slightly visible, not invisible. Taking the Wiry pulse as an example: if it goes beyond slightly Wiry to too Wiry, this is Excess. Excess means Qi is solid and strong; Qi strong means it bulges outward, and disease arises externally. Pulses that are Large, Tight, Rapid, Long-Wiry, Slippery, and Solid indicate Excess, caused by external pathogens of Wind, Cold, Summerheat, Dampness, Dryness, or Fire. If it is less than slightly Wiry and not Wiry at all, this is Deficiency. Deficiency means Qi is empty and minute; Qi minute means it collapses inward, and disease arises internally. Pulses that are Empty, Minute, Fine, Weak, Short, Choppy, and Soft indicate Deficiency, caused by internal harm from the Seven Emotions: Joy, Anger, Worry, Thought, Sorrow, Fear, and Fright. The excess and deficiency of Hooked, Feather, and Stone pulses follow the same logic.
Progress step by step, harmonizing with nature; arriving on time is correct, agitation and haste are errors.
The ancient *Mai Yao* states: "In Spring, no Deep; in Summer, no Wiry; in Autumn, no Rapid; in Winter, no Choppy; this is called the Four Obstructions." This means that if pulses do not follow the four seasons progressively, they become obstructed and blocked. Therefore, in the first months of Spring, Summer, Autumn, and Winter, the pulses should still follow the norms of Winter, Spring, Summer, and Autumn respectively, without changing their degree, waiting until after the Equinoxes and Solstices to transition to the ruling Qi of the current season; this is the smooth pulse of a healthy person. Thus, Heavenly Dao: Spring is not warm until the Equinox, Summer is not hot until the Solstice; this is natural operation, enduring forever. If human pulses were Wiry immediately in Spring and Rapid immediately in Summer, added to by agitation and haste, the yearly cycle would end in less than three quarters. How could one live long! Therefore, it is said that within a year, abnormal pulses should not reappear. For example, Spring should be Wiry, but if the pulse is Large, it is a pathological pulse, indicating the True Zang Qi has leaked prematurely. Nowadays, people encounter a Wiry pulse before the Start of Spring and claim the time is near Spring, not considering it pathological; saying "the Qi of the four seasons: those that succeed retreat, those that come next advance." The words seem辩 (dialectical), but actually violate reason.
For all diseases of the four seasons, Stomach Qi is the root; the pulse values Spirit/Shen, which must be carefully examined.