土得天地冲和之气，长养万物，分王四时，而人胃应之。凡平人之常，受气于谷。谷入于胃，五脏六腑皆
以受气。故胃为脏腑之本。此胃气者，实平人之常气，不可一日无者，无则为逆，逆则死矣。胃气之见于
脉者，如《素问·玉机真藏论》曰∶“脉弱以滑，是有胃气。”《终始篇》曰∶“邪气来也紧而疾，谷气来也
徐而和。”是皆胃气之谓。故四时有四时之脉，四时有四时之病，但土灌溉四旁，虽病态百出，必赖之
以为出死入生之机也。比如春令木旺，其脉当弦，但宜微弦而不至太过，是得春胃之冲和。若脉来过
于弦者，是肝邪之胜，胃气之衰，而肝病见矣。倘脉来但有弦急，而绝无冲和之气者，乃春时胃气已绝，
而见肝家真藏之脉，病必危矣。钩、毛、石俱准此。以此察胃气之多寡有无，而病之轻重存亡，燎然在目
矣。故蔡氏曰∶“不大不小，不长不短，不滑不涩，不疾不迟，应手中和，意思欣欣，悠悠扬扬，难以名状者，
胃气脉也。”东垣曰∶“有病之脉，当求其神。如六数、七极，热也。脉中有力，即有神矣。为泄其热。三迟、二败，
寒也。脉中有力，即有神矣。为去其寒。若数极、迟败，脉中不复有力，为无神也。而遽泄之、去之，神将何根据
耶！故经曰∶‘脉者，气血之先；气血者，人之神也。’”按王宗正诊脉之法，当从心肺俱浮，肝肾俱沉，脾在
中州。即王氏之说，而知东垣所谓脉中有力之中，盖指中央戊己土，正在中候也。胃气未散，虽数而至
于极，迟而至于败，尚可图也。故东垣之所谓有神，即《内经》之所谓有胃气也。
三至为迟，迟则为冷；六至为数，数即热证。
一息而脉仅三至，即为迟慢而不及矣。迟主冷病。若一息而脉遂六至，即为急数而太过矣。数主热病。
若一息仅得二至，甚而一至，则转迟而转冷矣。若一息七至，甚而八至九至，则转数而转热矣。凡一二
至与八九至，皆死脉也。
迟数既明，浮沉须别。
迟则为寒，数则为热，固一定之理。欲知寒热之所属，又当别乎浮沉耳。
浮沉迟数。辨内外因。
因则有二，此内外之不可不辨也。
外因于天，内因于人。
外感六淫，因之于天。内伤七情，因之于人。
天有阴阳，风雨晦明；人喜怒忧，思悲恐惊。
《左传》医和云∶“阴淫寒疾，阳淫热疾，风淫末疾，雨淫腹疾，晦淫惑疾，明淫心疾”也。淫者，淫佚偏胜，久
而不复之谓。故阴淫则过于清冷，而阳气不治，寒疾从起，如上下厥逆，中外寒栗之类。阳淫则过于炎
燠，而阴气不治，热疾从起，如狂谵烦渴，血泄吐衄之类。风淫则过于动摇，而疾生杪末，如肢废毛落，昏
冒螈 之类。雨淫则过于水湿，而疾生肠腹，如腹满肿胀，肠鸣濡泄之类，晦淫则过于昏暗，阳光内郁
而成惑疾，如百合狐惑，热中脏燥之类。明淫则过于彰露，阳光外散而成心疾，如恍惚动悸，错妄失神
之类。七情者，人之喜怒忧思悲恐惊也，即所谓七气。喜则气缓，怒则气上，忧则气乱，思则气结，悲则气
消，恐则气下，惊则气乱。喜气缓者，喜则气和，营卫通利，故气缓矣。怒气上者，怒则气逆，甚则呕血及食，
故气上矣。忧气乱者，忧则抑郁不解，故气乱矣。思气结者，思则身心有所止，气留不行，故气结矣。悲气
消者，悲则心系急，肺布叶举，使上焦不通，营卫不散，故气消矣。恐气下者，恐则精却，精却则上焦闭，故
气还，还则下焦胀，故气下矣。惊则心无所倚，神无所归，虑无所定，故气乱矣。
老弱不同，风土各异；既明至理，还贵圆通。
老弱之盛衰，与时变迁。风土之刚柔，随地移易。如老弱之人，脉宜缓弱，若过于旺者，病也。少壮之人，脉
宜充实，若过于弱者，病也。东极之地，四时皆春，其气暄和，民脉多缓。南极之地，四时皆夏，其气炎蒸，民
脉多软。西极之地，四时皆秋，其气清肃，民脉多劲。北极之地，四时皆冬，其气凛冽，民脉多石。然犹有说
焉。老人脉旺而躁者，此天禀之浓，引年之叟也，名曰寿脉；躁疾有表无里，则为孤阳，其死近矣。壮者脉
细而和缓，三部同等，此天禀之静，清逸之士也，名曰阴脉；若脉细小而劲直，前后不等，其可久乎？东南
卑湿，其脉软缓，居于高巅，亦西北也。西北高燥，其脉刚劲，居于污泽，亦东南也。南人北脉，取气必刚。北
人南脉，取气必柔。东西不齐，可以类剖。又永年者天禀必浓，故察证则将绝而脉犹不绝。夭促者天禀
必薄，故察证则未绝而脉已先绝。其可执一乎？《左传》曰∶“土浓水深，居之不疾。”《淮南子》曰∶“坚土
人刚，弱土人肥，垆土人大，沙土人细，息土人美，耗土人丑。山气多男，泽气多女，水气多喑，风气多聋，林
气多癃，木气多伛，湿气多肿，石气多力，阴气多瘿，暑气多夭，寒气多寿，谷气多痹，丘气多狂，野气多仁，
陵气多贪。轻土人利，重土人迟；清水音小，浊水音大；湍水人轻，迟水人重；中土多圣。”凡此数端，乃一
定之论也。然一地而或妍媸寿夭之各异同者，盖其生虽由于水土之气，而偏全浓薄，又自不同也。
脾胃属土，禀受天地冲和之气，能长养万物，分主四季，而人体的胃与之相应。大凡健康人的常态，是依靠摄入水谷来化生气血。水谷进入胃中，五脏六腑都能从中汲取营养。所以，胃是脏腑的根本。这种胃气，实际上是健康人常有的正气，是一天也不能缺少的，如果没有了就是逆证，逆证则会导致死亡。
胃气反映在脉象上，如《素问·玉机真藏论》所说：“脉象柔弱且滑利，这是有胃气的表现。”《终始篇》说：“邪气来的时候，脉象紧促而急疾；水谷精气（谷气）来的时候，脉象徐缓而平和。”这些都是指胃气。因此，四季各有四季的脉象，四季也有四季的疾病，但土（脾胃）灌溉滋养四方，虽然病态百出，但必须依赖胃气作为起死回生的关键。比如春季木气旺盛，脉象应当呈弦象，但应当是微弦而不致太过，这就是得到了春季胃气的冲和之象。如果脉象过于弦硬，这是肝邪亢盛、胃气衰弱的表现，肝病就显现出来了。倘若脉象只有弦急，完全没有冲和之气，那就是春季胃气已绝，出现了肝脏的真脏脉，病情必定危险。钩脉（夏脉）、毛脉（秋脉）、石脉（冬脉）都以此类推。通过这样观察胃气的多少有无，疾病的轻重存亡，就一目了然了。所以蔡氏说：“脉象不大不小，不长不短，不滑不涩，不急不慢，按之中和，神意欣欣向荣，悠悠扬扬，难以用语言形容的，就是胃气脉。”李东垣说：“有病时的脉象，应当探求其‘神’。如脉数至六次或极快，属于热证。只要脉中有力量，就是有‘神’。治疗应泄其热。脉迟至三次或败弱，属于寒证。只要脉中有力量，就是有‘神’。治疗应去其寒。如果脉既极数又极迟败弱，脉中不再有力，就是无‘神’。此时若急于泄热或散寒，神气将依附于何处呢！所以经书说：‘脉是气血的先导；气血是人的神气所在。’”根据王宗正的诊脉方法，心肺脉俱浮，肝肾脉俱沉，脾脉在中部。即使按照王氏的说法，也能知道李东垣所说的“脉中有力之中”，大概是指中央戊己土，正处于中候的位置。胃气未散，即使脉数至极或迟至败弱，还有救治的希望。所以李东垣所说的“有神”，就是《内经》所说的“有胃气”。
一息脉跳三次为迟脉，迟脉主冷证；一息脉跳六次为数脉，数脉主热证。
一呼一吸之间脉仅跳动三次，就是迟慢而不及。迟脉主冷病。如果一呼一吸之间脉跳动六次，就是急数而太过。数脉主热病。如果一呼一吸间仅得两次，甚至一次，则更加迟慢而更加寒冷。如果一呼一吸间七次，甚至八次九次，则更加急数而更加炎热。凡是每呼吸一至二至或八九至，都是死脉。
明确了迟数和浮沉的区别。
迟脉主寒，数脉主热，这是确定的道理。想要知道寒热所属的病位，又应当辨别脉象的浮沉。
通过浮沉迟数，辨别内因和外因。
病因有两类，这是内外因不可不辨别的。
外因源于天气，内因源于人体情志。
外感六淫（风、寒、暑、湿、燥、火），是源于天气的因素。内伤七情（喜、怒、忧、思、悲、恐、惊），是源于人体的因素。
天有阴阳，风雨晦明；人有喜怒忧思悲恐惊。
《左传》中医和说：“阴气过盛会引发寒疾，阳气过盛会引发热疾，风气过盛会引发四肢末端的疾病，雨气过盛会引发腹部疾病，昏暗环境过盛会引发迷惑之疾，光明过度过盛会引发心脏疾病。”所谓“淫”，是指淫佚偏胜，久留不复发的意思。所以阴气过盛则过于清冷，阳气不能正常治理，寒疾随之而起，如上下厥逆、内外寒栗之类。阳气过盛则过于炎热，阴气不能正常治理，热疾随之而起，如狂躁谵语、烦渴、便血吐血之类。风气过盛则过于动摇，疾病产生于四肢末端，如肢体废用、毛发脱落、昏晕抽搐之类。雨气过盛则过于水湿，疾病产生于肠腹，如腹胀满肿胀、肠鸣濡泄之类。昏暗环境过盛则过于昏暗，阳光内郁而成迷惑之疾，如百合病、狐惑病、热中脏燥之类。光明过度过盛则过于彰露，阳光外散而成心脏疾病，如恍惚心悸、错妄失神之类。七情，就是人的喜怒忧思悲恐惊，也就是所谓的七气。喜则气缓，怒则气上，忧则气乱，思则气结，悲则气消，恐则气下，惊则气乱。喜气缓者，是因为喜则气和，营卫通利，所以气缓。怒气上者，是因为怒则气逆，甚则呕血及食物，所以气上。忧气乱者，是因为忧则抑郁不解，所以气乱。思气结者，是因为思则身心有所止，气停留不行，所以气结。悲气消者，是因为悲则心系紧急，肺叶布举，使上焦不通，营卫不散，所以气消。恐气下者，是因为恐则精却退，精却退则上焦闭塞，所以气还，气还则下焦胀满，所以气下。惊则心无所倚，神无所归，虑无所定，所以气乱。
老人与弱者不同，风俗与地理各异；既然明白了至理，还贵在圆融通达。
老人与弱者的盛衰，随时间变迁而变化。风俗与地理的刚柔，随地域移动而改变。比如老弱之人，脉象宜缓弱，如果过于旺盛，就是病态。少壮之人，脉象宜充实，如果过于微弱，就是病态。东方极远之地，四季皆如春，气候温暖平和，百姓脉象多缓。南方极远之地，四季皆如夏，气候炎热蒸腾，百姓脉象多软。西方极远之地，四季皆如秋，气候清肃，百姓脉象多劲。北方极远之地，四季皆如冬，气候凛冽，百姓脉象多石。然而还有说法。老人脉旺而躁动，这是天赋浓厚，是高寿的老人，名叫寿脉；如果脉躁疾有表无里，则是孤阳，离死期不远了。壮年人脉细而和缓，三部同等，这是天赋安静，是清逸之士，名叫阴脉；如果脉细小而劲直，前后不等，还能长久吗？东南地势低洼潮湿，脉象软缓，如果居住在高山之巅，脉象也类似西北。西北地势高燥，脉象刚劲，如果居住在沼泽污地，脉象也类似东南。南方人出现北方脉象，取气必然刚强。北方人出现南方脉象，取气必然柔和。东西方脉象不齐，可以类比剖析。又长寿的人天赋必然浓厚，所以察证时即使病势将绝而脉犹不绝。短命的人天赋必然薄弱，所以察证时病势未绝而脉已先绝。怎么能固执一端呢？《左传》说：“土地肥沃水深，居住在那里不容易生病。”《淮南子》说：“坚硬的土壤人生性刚强，松软的土壤人生性肥胖，垆土（黑土）人生性高大，沙土人生性瘦小，肥沃的土地人生性美丽，贫瘠的土地人生性丑陋。山气多生男孩，泽气多生女孩，水气多导致失音，风气多导致耳聋，林气多导致癃闭，木气多导致驼背，湿气多导致水肿，石气多导致力气大，阴气多导致甲状腺肿，暑气多导致早夭，寒气多导致长寿，谷气多导致痹症，丘气多导致狂躁，野气多导致仁慈，陵气多导致贪婪。轻土人生性敏捷，重土人生性迟缓；清水声音小，浊水声音大；湍急的水流使人轻盈，缓慢的水流使人沉重；中原地区多出圣人。”以上这些，都是一定的理论。然而同一地方，人或美丑寿夭各异，这是因为虽然生命源于水土之气，但偏全浓薄又各自不同。
The Earth element, receiving the harmonious Qi of Heaven and Earth, nourishes all things and governs the four seasons; correspondingly, the human Stomach aligns with it. In a healthy individual, Qi is derived from grain. Once grain enters the Stomach, the Five Zang and Six Fu organs all receive its Qi. Thus, the Stomach is the root of the Zang and Fu organs. This Stomach Qi (Wei Qi) is essentially the normal Qi of a healthy person and cannot be absent for even a day; its absence constitutes a reversal (Ni), which leads to death.
Regarding the manifestation of Stomach Qi in the pulse, as stated in *Su Wen: Yu Ji Zhen Zang Lun*: "A pulse that is weak and slippery indicates the presence of Stomach Qi." The *Zhong Shi Pian* states: "When pathogenic Qi arrives, the pulse is tight and rapid; when Grain Qi (Gu Qi) arrives, the pulse is slow and harmonious." These both refer to Stomach Qi. Therefore, each season has its own seasonal pulse and seasonal diseases. However, since Earth irrigates the four directions, despite various pathological manifestations, one must rely on Stomach Qi as the mechanism for survival. For instance, in Spring, Wood Qi is prosperous, and the pulse should be Wiry (Xian). It should be slightly wiry but not excessive, indicating the harmonious nature of Spring's Stomach Qi. If the pulse is excessively wiry, it signifies the excess of Liver Pathogen (Gan Xie) and the decline of Stomach Qi, revealing Liver disease. If the pulse is merely wiry and urgent, completely lacking harmony, it means the Stomach Qi of Spring is exhausted, and the True Organ Pulse (Zhen Zang Mai) of the Liver appears, indicating a critical condition. The Hook (Gou/Autumn), Hair (Mao/Winter), and Stone (Shi/Winter) pulses follow this same principle. By observing the abundance or absence of Stomach Qi, the severity and prognosis of the disease become clear. Cai Shi said: "A pulse that is neither large nor small, neither long nor short, neither slippery nor choppy, neither rapid nor slow, feeling moderate upon touch, with a spirit of vitality, leisurely and graceful, difficult to describe in words, is the Stomach Qi pulse." Li Dongyuan said: "In pathological pulses, one must seek the 'Shen' (Spirit). A pulse rate of six beats per respiration or extremely rapid indicates Heat. If there is strength within the pulse, there is Shen. Treatment should vent the Heat. A pulse rate of three beats per respiration or failing indicates Cold. If there is strength within the pulse, there is Shen. Treatment should dispel the Cold. If the pulse is both extremely rapid and failing, and lacks strength, there is no Shen. To hastily vent heat or dispel cold would leave the Shen without foundation! Thus, the Classics state: 'The pulse is the precursor of Qi and Blood; Qi and Blood are the Shen of humanity.'" According to Wang Zongzheng's method of pulse diagnosis, the Heart and Lung pulses are superficial (Fu), the Liver and Kidney pulses are deep (Chen), and the Spleen pulse is in the middle region (Zhong Zhou). Even adhering to Wang's theory, we can understand that Li Dongyuan's reference to "strength in the middle" refers to the Central Wu-Ji Earth, located at the Middle Modality (Zhong Hou). As long as Stomach Qi has not dissipated, even if the pulse is extremely rapid or extremely slow/failing, recovery is still possible. Thus, Li Dongyuan's concept of "having Shen" is equivalent to the *Nei Jing*'s concept of "having Stomach Qi".
Three beats per respiration constitute a Slow (Chi) pulse, which indicates Cold; six beats per respiration constitute a Rapid (Shu) pulse, which indicates Heat.
If the pulse beats only three times during one respiration cycle, it is Slow and deficient. Slow pulses indicate Cold diseases. If the pulse beats six times during one respiration cycle, it is Rapid and excessive. Rapid pulses indicate Heat diseases. If the pulse beats only twice, or even once, per respiration, it becomes increasingly Slow and Cold. If it beats seven times, or even eight or nine times, it becomes increasingly Rapid and Hot. Any pulse beating once or twice, or eight or nine times, per respiration is a Death Pulse.
Once Slow and Rapid are clarified, Superficial and Deep must be distinguished.
Slow indicates Cold, and Rapid indicates Heat; this is a fixed principle. To determine the location of Cold and Heat, one must distinguish between Superficial (Fu) and Deep (Chen) pulses.
Using Superficial, Deep, Slow, and Rapid to differentiate Internal and External Causes.
There are two types of causes, which must be distinguished as internal and external.
External causes originate from Heaven (Nature); Internal causes originate from Humans (Emotions).
External contraction of the Six Evils (Liu Yin) arises from Heaven. Internal injury of the Seven Emotions (Qi Qing) arises from Humans.
Heaven has Yin and Yang, wind, rain, darkness, and brightness; Humans have joy, anger, worry, thought, grief, fear, and shock.
Yi He in *Zuo Zhuan* stated: "Excess Yin induces Cold diseases, Excess Yang induces Heat diseases, Excess Wind induces diseases of the extremities, Excess Rain induces abdominal diseases, Excess Darkness induces confused diseases, Excess Brightness induces Heart diseases." "Yin" here refers to excessive deviation that persists. Excess Yin leads to excessive coldness, preventing Yang Qi from governing, resulting in Cold diseases such as Jue Ni (reversal of cold in limbs) and chills inside and out. Excess Yang leads to excessive heat, preventing Yin Qi from governing, resulting in Heat diseases such as mania, delirium, thirst, bleeding, and hematemesis. Excess Wind leads to excessive movement, causing diseases in the extremities, such as limb paralysis, hair loss, dizziness, and convulsions. Excess Rain leads to excessive dampness, causing diseases in the intestines and abdomen, such as abdominal distension, swelling, borborygmus, and loose stools. Excess Darkness leads to excessive gloom, suppressing sunlight internally, causing confused diseases like Bai He Bing (Lily Disease) and Hu Huo Bing, and dryness in the Zang organs. Excess Brightness leads to excessive exposure, scattering sunlight externally, causing Heart diseases like mental confusion, palpitations, and loss of spirit. The Seven Emotions are Joy, Anger, Worry, Thought, Grief, Fear, and Shock, also known as the Seven Qi. Joy relaxes Qi, Anger raises Qi, Worry scatters Qi, Thought knots Qi, Grief consumes Qi, Fear sinks Qi, and Shock scatters Qi. Joy relaxes Qi because joy harmonizes Qi and unblocks Ying and Wei, thus relaxing Qi. Anger raises Qi because anger causes Qi to rebel; severely, it causes vomiting blood and food, thus raising Qi. Worry scatters Qi because worry causes depression and unresolved stagnation, thus scattering Qi. Thought knots Qi because thought fixes the mind and body, causing Qi to stagnate and not move, thus knotting Qi. Grief consumes Qi because grief tightens the Heart connection and lifts the Lung leaves, blocking the Upper Jiao, preventing Ying and Wei from dispersing, thus consuming Qi. Fear sinks Qi because fear causes Essence to retreat; retreating Essence blocks the Upper Jiao, causing Qi to return; returning Qi causes distension in the Lower Jiao, thus sinking Qi. Shock causes the Heart to have no support, the Shen to have no return, and thoughts to have no stability, thus scattering Qi.
The elderly and weak differ; wind and soil vary; having understood the ultimate principle, one must value flexibility.
The decline and vigor of the elderly and weak change with time. The rigidity and softness of local customs change with geography. For example, the elderly and weak should have Slow and Weak pulses; if overly vigorous, it is pathological. The young and strong should have Full pulses; if overly weak, it is pathological. In the extreme East, where all seasons resemble Spring, the climate is warm and harmonious, and people's pulses are often Slow. In the extreme South, where all seasons resemble Summer, the climate is hot and steaming, and people's pulses are often Soft. In the extreme West, where all seasons resemble Autumn, the climate is clear and austere, and people's pulses are often Firm. In the extreme North, where all seasons resemble Winter, the climate is biting cold, and people's pulses are often Stone-like. However, there are nuances. An elderly person with a vigorous and restless pulse has thick congenital endowment and is a long-lived elder, called a Longevity Pulse; if the pulse is restless and rapid with exterior but no interior, it is Lone Yang, and death is near. A strong person with a fine, harmonious, and slow pulse, equal in all three positions, has a quiet congenital endowment and is an elegant scholar, called a Yin Pulse; if the pulse is fine, small, firm, and unequal front-to-back, can it last long? Southeastern lowlands are damp, with Soft and Slow pulses; living in high peaks, the pulse resembles that of the Northwest. Northwestern highlands are dry, with Firm pulses; living in marshes, the pulse resembles that of the Southeast. Southerners with Northern pulses take Qi that is necessarily rigid. Northerners with Southern pulses take Qi that is necessarily soft. Eastern and Western pulses are uneven and can be analyzed by analogy. Furthermore, those who live long have thick congenital endowment, so when examining symptoms, even if the disease is terminal, the pulse may not cease. Those who die young have thin congenital endowment, so when examining symptoms, the pulse may cease before the disease does. How can one be rigid? *Zuo Zhuan* says: "Where soil is rich and water deep, residence does not lead to illness." *Huainanzi* says: "People in hard soil are rigid; people in soft soil are fat; people in Lu soil (black earth) are tall; people in sandy soil are thin; people in fertile soil are beautiful; people in barren soil are ugly. Mountain Qi produces more males; Marsh Qi produces more females; Water Qi causes aphonia; Wind Qi causes deafness; Forest Qi causes strangury; Wood Qi causes kyphosis; Damp Qi causes edema; Stone Qi gives strength; Yin Qi causes goiter; Summer Qi causes premature death; Cold Qi promotes longevity; Valley Qi causes Bi syndrome; Hill Qi causes madness; Wild Qi causes benevolence; Mound Qi causes greed. Light soil makes people agile; Heavy soil makes people sluggish; Clear water produces small sounds; Turbid water produces loud sounds; Swift water makes people light; Slow water makes people heavy; Central soil produces sages." All these are established theories. However, in one place, people may differ in beauty, ugliness, longevity, and early death. Although life stems from the Qi of water and soil, the bias, completeness, thickness, and thinness vary individually.