肺痈而寸口数实，知脓已成矣。肺叶焦痿，火乘金也，是以数而无力。肺痈既作，则肺气虚损；白者西方
本色，所谓一脏虚则一脏之本色见也。短涩者，秋金之素体；若逢浮大，是谓火来乘金，克我者为贼邪，
血气败坏之证也。肠痈，实也。沉细，虚也。证实脉虚，死期将至矣。
喉痹之脉，迟数为常；缠喉、走马，微伏则难。
十二经脉与经别多过于此，即不然亦在其前后左右。其脉多数，数则为热故耳。间迟脉者，乃是外邪
袭经，经气不利，郁滞于所过之处，故亦为痹。脉来或迟，亦与病合。若肿痛麻痒之缠喉风，须臾闭绝之
走马疳，二者俱火中挟风，凶暴急烈，脉应浮大洪数，而反见微伏，是正衰邪盛，补泻罔从，不亦难乎？
中毒之候，尺寸数紧；细微必危，旦夕将殒。
数紧者，因毒瓦斯盘郁而搏击也。一见细微，知其正气已虚，毒邪深入，其能久乎？
金疮出血，脉多虚细，急实大数，垂亡休治。
受创血去已多，脉空自宜沉细，而反见急数，阴欲尽矣，治之何用。
妇人之脉，以血为本；血旺易胎，气旺难孕。少阴动甚，谓之有子；尺脉滑利，妊娠可喜。滑疾不
散，胎必三月；但疾不散，五月可别。左疾为男，右疾为女；女腹如箕，男腹如釜。
此言女人胎前之脉也。女为阴，阴主血，故女人以血为本，本足而成胎亦易；气旺则血反衰，是为本不
足，未有理失常而能孕者也。少阴动甚者，心手少阴之脉动甚也。心主血，动甚则血旺，血旺易胎，故云
有子，即《素问·平人气象论》所谓“妇人手少阴脉动甚者妊子也。”心脏主血，故胎结而动甚，乃往
来流利之义，非厥厥如豆之动也。尺脉者，左右肾脉也。肾为天一之水，主子宫以系胞，孕胎之根蒂也。
滑利则不枯涩，而且有替替含物之象，故喜其妊娠，即《素问·阴阳别论》所谓“阴搏阳别，谓之有
子。”盖寸为阳，尺为阴，言尺阴之脉搏指而动，与寸阳之脉迥然分别也。即此滑利之脉，应指滑而不
散，滑为血液疾，而不散乃血液敛结之象，是为有胎三月矣。若但疾而不散，是从虚渐实，从柔渐刚，血
液坚凝，转为形体，故不滑耳，此妊娠五月之脉。其疾左胜于右，是为男孕，以男属阳居左，胎气钟于阳，
故左胜。右胜于左，是为女孕，以女属阴居右，胎气钟于阴，故右胜。胜者，甚不甚之谓，非左疾右不疾也。
更视其腹如箕者为女胎，如釜者为男胎。盖男女之孕于胞中，女则面母腹，男则面母背，虽各肖父母
之形，亦阴阳相抱之理。女面腹则足膝抵腹，下大上小故如箕；男面背则背脊抵腹，其形正圆故如釜。
按男女之别，叔和《脉经》曰∶“左疾为男，右疾为女。”又曰∶“左手沉实为男，右手浮大为女。”又曰∶“尺
脉左偏大为男，右偏大为女。”又曰∶“得太阴脉为男，得太阳脉为女。太阴脉沉。太阳脉浮。”自后凡言
妊脉者，总不出此。及滑伯仁则曰∶“左手尺脉洪大为男，右手沉实为女。”近代徐东皋则曰∶“男女之
别，须审阴阳。右脉盛，阴状多，俱主弄瓦。左尺盛，阳状多，俱主弄璋。”备察诸义，固已详尽；然多彼此矛
盾，难为凭据；若其不易之理，则在阴阳二字。以左右分阴阳，则左为阳，右为阴。以脉体分阴阳，则鼓搏
沉实为阳，虚浮沉涩为阴。诸阳实者为男，诸阴虚者为女，乃为一定之论。更当察孕妇之强弱老少，及
平日之偏左偏右，尺寸之素强素弱，斯足以尽其法耳。
欲产之脉，散而离经。新产之脉，小缓为应；实大弦牢，其凶可明。
此言产中之脉也，其脉与十月怀妊平常见者忽异。假如平日之脉原浮，临产则脉忽沉；平日之脉迟，
临产则脉忽数；至如大小滑涩，临产皆忽然而异。盖十月胎气安定，一旦欲落，气血动荡，胞胎迸裂，自
与经常离异，而脉亦非平昔之状貌矣。及其已产也，气血两虚，其脉宜缓滑。缓则舒徐，不因气夺而急
促；滑则流利，不因血去而涩枯；均吉兆也。若脉实大弦牢，非产后气血俱虚者所宜。实为邪实，大为邪
进，弦为阴敛而宣布不能，牢为坚着而瘀凝不解，是皆相逆之脉，设外有证，又岂能顺乎？
小儿之脉，全凭虎口；风、气、命关，三者细剖。
虎口者，食指内侧连大指作虎口形，故曰虎口。此处肌皮嫩薄，文色显明，即肺手太阴经脉之尽处，诸
脉大位之地也。虽无五部之分，而有三关之别。指初节曰风关，二节曰气关，三节曰命关，男左女右侧
看之。文色见风关者轻；再进则上气关为重；再进则直透命关为最重，甚则主死。由风邪而干正气，正
气不能胜而迫及于命，渐进渐深之象也。
其色维何？色赤为热，在脉则数；色白为寒，在脉则迟；色黄为积，在脉则缓；色青黑痛，在脉沉
弦。
三岁以下小儿，纯阳之体，形质小，脉之周行 而应指疾；故若大法则以七至为平，其太过为数为热，
不及为迟为寒，此其大较矣。然而脉至七八，来往速而数息难，恐医者一时不能得病之情状。在五脏
之列于面，各有定部，如左腮属肝，右腮属肺，额上属心，鼻属脾，颏属肾是已。诸邪之见于三关，亦各有
定色，如上所列。识本知源，错综体认，存乎其人耳。
紫热伤寒。青则惊风。白为疳病。黄乃脾困。黑多赤痢，有紫相兼，口必加渴。虎口纹乱，气不调
和。红黄隐隐，乃为常候；无病之色，最为可喜。至夫变态，由乎病甚。因而加变，黄盛作红，红盛
作紫，紫盛作青，青盛作黑，黑而不杂，药又何及！
此以色合病也。
三岁以上，便可凭脉。独以一指，按其三部；六至七至，乃为常则。增则为热，减则为寒。脉来浮
数，乳痫风热。虚濡惊风。紧实风痫。弦紧腹痛。弦急气逆。牢实便秘。沉细为冷。乍大乍小，知为
祟脉。或沉或滑，皆由宿食。脉乱身热，汗出不食，食已即吐，必为变蒸。浮则为风。伏结物聚。单
细疳劳。气促脉代。散乱无伦，此所最忌，百难必一。
三岁以上，便可切脉断证。但小儿正属纯阳，阳盛必数，故以六七至为常也。小儿三部狭小，故以一指
诊之。
所有死证，虽治无成；眼上赤脉，下贯瞳神。
赤脉属心，瞳神属肾，乃心火胜肾水，水干则不生木，致肾肝皆绝也。
囟门肿起，兼及作坑。
颅囟者，精神之门户，关窍之橐 ，气实则合，气虚则开。诸阳会于首，外生风邪而乘诸阳，所以肿起。风
气乘于阳，阳极则散，散则绝。所以陷者死。
鼻干黑燥。
鼻者肺之窍，肺金燥则不能生肾水，故鼻干黑燥则死。
肚大青筋。
土被木克，以致脾虚而欲绝，故腹胀现青筋者死。
目多直视，睹不转睛。
戴眼者，精不转而返视，此是太阳已绝。
指甲青黑。
肝之合筋也，其荣爪也。爪甲乃肝之华，肝绝而不能荣，故色黑。
忽作鸦声。
人之言语出于肺，肺属金，扣之则响。肺金既绝，故欲语而不成声，但如鸦鸟之哑哑而已。
虚舌退场门。
舌者，心之苗。心气已绝，故舌纵而不收。
啮齿咬人。
齿者，骨之余也。肾脏精而主骨。肾气已绝，齿多咬啮。心为阳，肾为阴，阴阳相离，安得不死。
鱼口气急，啼不作声。
鱼口，张而不合也，是谓脾绝。气急作喘，哭而无声，是谓肺绝。
蛔虫既出，必是死形。
蛔虫生于胃，藉谷食以养。胃绝而谷食不食，虫乃出也。
按《素问·通评虚实论》∶“帝曰∶‘乳子而病热，脉悬小者，何如？’岐伯曰∶‘手足温则生，寒则死。’（此统言小
儿之内外证也。病热脉悬小者，阳证阴脉，本为大禁。但小而缓者，阳之微也，其愈则易；小而急者，邪之
甚也，为可虑耳。脉虽小而手足温者，以四肢为诸阳之本，阳犹在也，故生；若四肢寒冷，则邪胜其正，
元阳去矣，故死。）帝曰∶‘乳子中风热，喘鸣肩息者，脉何如？’岐伯曰∶‘喘鸣肩息者，脉实大也。
缓则生，急则死。’”（此言小儿之外感也。风热中于阳分，为喘鸣肩息者，脉当实大。但大而缓，则
胃气存，邪渐退，故生；实而急，则真藏见，病日进，故死。）
经文二节之义，可见古人之诊小儿者，未尝不重在脉，即虽初脱胞胎，亦自有脉可辨。何后世幼科，如
《水镜诀》及《全幼心鉴》等书，别有察三关之说。及遍考《内经》并无其名，惟《灵枢·经脉篇》有察
手鱼之色者，若乎近之，乃概言诊法，非独为小儿也。然则三关之说，特后世之别名耳。夫三关又为手
阳明之浮络，原不足以候脏腑之气；且凡在小儿，无论病与不病，此脉皆紫白而兼乎青红，虽时有浓
淡之异，而四色常不相离，何以辨其紫为风，红为寒，青为惊，白为疳，又何以辨其为雷惊、人惊、水惊、兽
惊之的确乎？此说自正。但余见富贵之家，儿女娇弱，一见医者，动辄喊哭，若将握手诊视，势必推阻百
端，宛转悲啼，汗流浃背。父母姑息，惟恐因哭受伤，不觉从旁蹙额。况因近来止看虎口一法，相沿成俗，
则病家反以诊脉为迂。总之幼科大者，曰痘、曰痧，杂证曰吐、泻、惊、疳之类，其发也莫不先有昭然之形
证可据，不须布指切脉，而用药未致悬殊，则虎口一说，原可借用，正不以古今为限也。因备录虎口之
说，以通诊法旁门云耳。
脉之指趣，吉凶先定；更有圆机，活泼自审。从证舍脉，从脉舍证；两者画然，药无不应。
脉之合证，是其常也。又有不当执者，更不可不知，于伤寒尤为吃紧。如脉浮为表，治宜汗之，是其常也，
而亦有宜下者焉。仲景云∶“若脉浮大，心下硬，有热，属脏者，攻之，不令发汗”是也。脉沉为里，治宜下之，
是其常也，而亦有宜汗者焉。“少阴病，始得之，反发热而脉沉者，麻黄附子细辛汤微汗之”是也。脉促
为阳，当用葛根芩连清之矣。若脉促厥冷为虚脱，非灸非温不可，此又非促为阳盛之脉也。脉迟为寒，
当用干姜附子温之矣。若阳明脉迟，不恶寒，身体 汗出，则用大承气。此又非迟为阴寒之脉矣。四
者皆从证不从脉也。世有切脉而不问证，其失可胜言哉！表证汗之，此其常也。仲景曰∶“病发热头痛，
脉反沉，身体疼痛，当救其里，用四逆汤。”此从脉之沉也。里证下之，此其常也。“日晡发热者，属阳明，脉
浮虚者，发汗，用桂枝汤。”此从脉之浮也。结胸证具，当以大小陷胸下之矣。“脉浮大者，不可下，下之则
死。”是宜从脉而治其表也。身疼痛者，当以桂枝、麻黄解之矣。然“尺中迟者，不可汗，以营血不足故
也。”是宜从脉而调其营矣。此皆从脉不从证也。世有问证而忽脉者，得非仲景之罪人乎？
肺痈（肺部化脓性病变）患者寸口脉象数而实，可知脓液已经形成。肺叶焦枯萎弱，是火邪侵犯肺金所致，因此脉象数而无力。肺痈既已发作，肺气必然虚损；白色是西方肺的本色，所谓一脏虚弱，则该脏的本色显露于面部或脉象中。脉象短涩，是秋季肺金的常态体质表现；如果反而出现浮大之脉，这是火来乘袭肺金，克我者为贼邪，属于血气败坏的危重证候。肠痈（肠道化脓性病变），脉实为实证；脉沉细为虚证。证候属实而脉象属虚，预示死期将至。
喉痹（咽喉肿痛闭塞）的脉象，迟或数为正常；若是缠喉风、走马疳等急重症，脉象微伏则预后困难。
十二经脉及其经别大多经过此处（指寸口），即使不如此，也位于其前后左右。这些部位的脉象多数表现为数脉，因为数脉主热。间或有迟脉者，乃是外邪侵袭经脉，导致经气不利，郁滞于所经过之处，所以也会形成痹证。脉来或迟，也与病情相合。如果是肿痛麻痒的缠喉风，或是须臾间即可致人闭绝死亡的走马疳，这两种病都是火中挟风，凶暴急烈，脉象应当浮大洪数，反而见到微伏脉，这是正气衰败、邪气盛实，补法泻法都无从下手，难道不难治吗？
中毒的症状，尺寸部脉象数紧；若见细微脉必危险，早晚将死亡。
数紧脉，是因为毒瓦斯盘结郁滞而搏击脉道所致。一旦见到细微脉，就知道正气已经虚弱，毒邪深入体内，还能维持多久呢？
金疮出血，脉象多虚细；若反见急实大数脉，是元气垂危，不可救治。
受创后失血过多，脉空自宜呈现沉细，反而见急数脉，说明阴血即将耗尽，治疗还有什么用呢？
妇人的脉象，以血为本；血旺容易受孕，气旺难以怀孕。少阴脉动甚，称为有孕；尺脉滑利，妊娠可喜。脉滑疾而不散，胎必三月；仅见疾脉而不散，五月可辨男女。左脉疾为男胎，右脉疾为女胎；女腹如箕（簸箕状），男腹如釜（锅状）。
这是说女人怀孕前的脉象。女性属阴，阴主血，所以女人以血为本，根本充足则成胎也容易；气旺则血反衰，这是根本不足，没有违背常理而能怀孕的。少阴动甚，是指手少阴心经的脉动明显。心主血，动甚则血旺，血旺易成胎，所以说有子，即《素问·平人气象论》所说的“妇人手少阴脉动甚者妊子也。”心脏主血，所以胎结而动甚，是往来流利之意，并非像豆子那样厥厥跳动的动脉。尺脉，是左右肾脉。肾为天一之水，主管子宫以系胞，是孕育胎儿的根本。滑利则不枯涩，而且有充实含物的象，所以喜欢这种妊娠脉，即《素问·阴阳别论》所说的“阴搏阳别，谓之有子。”盖寸为阳，尺为阴，是说尺阴脉搏指而动，与寸阳之脉迥然不同。就这滑利的脉象而言，应指滑而不散，滑为血液运行疾速，而不散乃血液敛结之象，这是怀孕三个月了。如果仅见疾而不散，是从虚渐实，从柔渐刚，血液坚凝，转化为形体，所以不再滑，这是怀孕五个月的脉象。其疾脉左胜于右，是为男胎，因为男属阳居左，胎气钟聚于阳，所以左胜。右胜于左，是为女胎，因为女属阴居右，胎气钟聚于阴，所以右胜。胜者，是指盛与不盛的区别，并非左疾右就不疾。再观察其腹部如箕状的是女胎，如釜状的是男胎。大概男女在胞中孕育，女面向母腹，男面向母背，虽然各自模仿父母的形态，也是阴阳相抱的道理。女面腹则足膝抵腹，下大上小所以如箕；男面背则背脊抵腹，其形正圆所以如釜。
按男女之别，叔和《脉经》说：“左疾为男，右疾为女。”又说：“左手沉实为男，右手浮大为女。”又说：“尺脉左偏大为男，右偏大为女。”又说：“得太阴脉为男，得太阳脉为女。太阴脉沉。太阳脉浮。”此后凡是谈论妊娠脉的，总不出这些说法。到了滑伯仁则说：“左手尺脉洪大为男，右手沉实为女。”近代徐东皋则说：“男女之别，须审阴阳。右脉盛，阴状多，俱主弄瓦（生女）。左尺盛，阳状多，俱主弄璋（生男）。”详细考察各种义理，固然已经详尽；然而大多彼此矛盾，难以作为凭据；如果是不变的道理，就在“阴阳”二字。以左右分阴阳，则左为阳，右为阴。以脉体分阴阳，则鼓搏沉实为阳，虚浮沉涩为阴。诸阳实者为男，诸阴虚者为女，这才是定论。更应当观察孕妇的强弱老少，以及平日偏左还是偏右，尺寸部原本强还是原本弱，这样才能穷尽诊脉之法。
将要生产的脉象，散乱且偏离常经。新产后的脉象，小缓为顺应；若见实大弦牢脉，其凶险可以明了。
这是说生产中的脉象，其脉与十月怀胎平时常见的突然不同。假如平时的脉原浮，临产时脉忽然沉；平时的脉迟，临产时脉忽然数；至于大小滑涩，临产时也都忽然改变。大概十月胎气安定，一旦欲落，气血动荡，胞胎迸裂，自然与经常状态离异，脉象也就不是平昔的样子了。等到已经生产，气血两虚，脉象宜缓滑。缓则舒徐，不因气夺而急促；滑则流利，不因血去而涩枯；都是吉兆。如果脉实大弦牢，不是产后气血俱虚者应有的脉象。实为邪实，大为邪进，弦为阴敛而宣布不能，牢为坚着而瘀凝不解，这些都是相逆的脉象，假设外在有证候，又怎么能顺乎病情呢？
小儿的脉象，全凭虎口（食指指纹）；风关、气关、命关，三者需仔细分辨。
虎口，是指食指内侧连大拇指形成的虎口形状，所以叫虎口。此处肌皮嫩薄，纹路颜色显明，是手太阴肺经的尽头处，也是诸脉汇聚的大位之地。虽然没有五脏五部的区分，但有三关的区别。指初节叫风关，二节叫气关，三节叫命关，男看左手，女看右手。纹路颜色见于风关者轻；再进而上气关为重；再进而直透命关为最重，甚至主死。由风邪干扰正气，正气不能战胜而迫及于命，是渐进渐深的象。
它的颜色是什么？色赤为热，在脉则数；色白为寒，在脉则迟；色黄为积滞，在脉则缓；色青黑主痛，在脉则沉弦。
三岁以下的幼儿，是纯阳之体，形体小，脉气周行快而应指疾；所以若以大法则，以七至为平脉，太过为数脉主热，不及为迟脉主寒，这是大概情况。然而脉至七八至，来往迅速而数息难测，恐怕医者一时不能掌握病情状况。在五脏之列于面部，各有定部，如左腮属肝，右腮属肺，额上属心，鼻属脾，颏属肾，就是这样。各种邪气见于三关，也各有定色，如上所列。认识本源，错综体认，在于医者本人罢了。
紫色主热伤寒。青色主惊风。白色主疳病。黄色主脾困。黑色多主赤痢，若有紫色相兼，口中必定加渴。虎口纹乱，气机不调和。红黄隐隐，乃是常候；无病的颜色，最为可喜。至于变态，由于病重。因而加变，黄盛作红，红盛作紫，紫盛作青，青盛作黑，黑而不杂，药物又怎么来得及！
这是结合颜色判断疾病。
三岁以上，便可凭脉诊。独用一指，按其三部；六至七至，乃是常则。增则为热，减则为寒。脉来浮数，主乳痫风热。虚濡主惊风。紧实主风痫。弦紧主腹痛。弦急主气逆。牢实主便秘。沉细主冷。乍大乍小，知为祟脉（怪病之脉）。或沉或滑，皆由宿食。脉乱身热，汗出不食，食已即吐，必为变蒸（婴幼儿生长发育过程中的生理现象）。浮则为风。伏结物聚。单细主疳劳。气促脉代。散乱无伦，这是最忌讳的，百难必一。
三岁以上，便可切脉断证。但小儿正值纯阳，阳盛必数，所以以六七至为常。小儿三部狭小，所以以一指诊之。
所有死证，虽治无成；眼上有赤脉，下贯瞳神。
赤脉属心，瞳神属肾，乃心火胜肾水，水干则不生木，致肾肝皆绝也。
囟门肿起，兼及作坑（凹陷）。
颅囟者，精神之门户，关窍之橐籥，气实则合，气虚则开。诸阳会于首，外生风邪而乘诸阳，所以肿起。风气乘于阳，阳极则散，散则绝。所以陷者死。
鼻干黑燥。
鼻者肺之窍，肺金燥则不能生肾水，故鼻干黑燥则死。
肚大青筋。
土被木克，以致脾虚而欲绝，故腹胀现青筋者死。
目多直视，睹不转睛。
戴眼者，精不转而返视，此是太阳已绝。
指甲青黑。
肝之合筋也，其荣爪也。爪甲乃肝之华，肝绝而不能荣，故色黑。
忽作鸦声。
人之言语出于肺，肺属金，扣之则响。肺金既绝，故欲语而不成声，但如鸦鸟之哑哑而已。
虚舌退场门（舌卷缩）。
舌者，心之苗。心气已绝，故舌纵而不收。
啮齿咬人。
齿者，骨之余也。肾脏精而主骨。肾气已绝，齿多咬啮。心为阳，肾为阴，阴阳相离，安得不死。
鱼口气急，啼不作声。
鱼口，张而不合也，是谓脾绝。气急作喘，哭而无声，是谓肺绝。
蛔虫既出，必是死形。
蛔虫生于胃，藉谷食以养。胃绝而谷食不食，虫乃出也。
按《素问·通评虚实论》：“帝曰：‘乳子而病热，脉悬小者，何如？’岐伯曰：‘手足温则生，寒则死。’”（这是统言小儿的内外证。病热脉悬小者，阳证阴脉，本为大禁。但小而缓者，阳之微也，其愈则易；小而急者，邪之甚也，为可虑耳。脉虽小而手足温者，以四肢为诸阳之本，阳犹在也，故生；若四肢寒冷，则邪胜其正，元阳去矣，故死。）帝曰：“乳子中风热，喘鸣肩息者，脉何如？”岐伯曰：“喘鸣肩息者，脉实大也。缓则生，急则死。””（这是言小儿之外感。风热中于阳分，为喘鸣肩息者，脉当实大。但大而缓，则胃气存，邪渐退，故生；实而急，则真藏见，病日进，故死。）
经文两节的意义，可见古人诊小儿，未尝不重在脉，即使刚脱离胞胎，也自有脉可辨。为何后世幼科，如《水镜诀》及《全幼心鉴》等书，别有察三关之说。及遍考《内经》并无其名，惟《灵枢·经脉篇》有察手鱼之色者，若乎近之，乃概言诊法，非独为小儿也。然而三关之说，特后世之别名耳。夫三关又为手阳明之浮络，原不足以候脏腑之气；且凡在小儿，无论病与不病，此脉皆紫白而兼乎青红，虽时有浓淡之异，而四色常不相离，何以辨其紫为风，红为寒，青为惊，白为疳，又何以辨其为雷惊、人惊、水惊、兽惊之的确乎？此说自正。但余见富贵之家，儿女娇弱，一见医者，动辄喊哭，若将握手诊视，势必推阻百端，宛转悲啼，汗流浃背。父母姑息，惟恐因哭受伤，不觉从旁蹙额。况因近来止看虎口一法，相沿成俗，则病家反以诊脉为迂。总之幼科大者，曰痘、曰痧，杂证曰吐、泻、惊、疳之类，其发也莫不先有昭然之形证可据，不须布指切脉，而用药未致悬殊，则虎口一说，原可借用，正不以古今为限也。因备录虎口之说，以通诊法旁门云耳。
脉之指趣，吉凶先定；更有圆机，活泼自审。从证舍脉，从脉舍证；两者画然，药无不应。
脉之合证，是其常也。又有不当执者，更不可不知，于伤寒尤为吃紧。如脉浮为表，治宜汗之，是其常也，而亦有宜下者焉。仲景云：“若脉浮大，心下硬，有热，属脏者，攻之，不令发汗”是也。脉沉为里，治宜下之，是其常也，而亦有宜汗者焉。“少阴病，始得之，反发热而脉沉者，麻黄附子细辛汤微汗之”是也。脉促为阳，当用葛根芩连清之矣。若脉促厥冷为虚脱，非灸非温不可，此又非促为阳盛之脉也。脉迟为寒，当用干姜附子温之矣。若阳明脉迟，不恶寒，身体汗出，则用大承气。此又非迟为阴寒之脉矣。四者皆从证不从脉也。世有切脉而不问证，其失可胜言哉！表证汗之，此其常也。仲景曰：“病发热头痛，脉反沉，身体疼痛，当救其里，用四逆汤。”此从脉之沉也。里证下之，此其常也。“日晡发热者，属阳明，脉浮虚者，发汗，用桂枝汤。”此从脉之浮也。结胸证具，当以大小陷胸下之矣。“脉浮大者，不可下，下之则死。”是宜从脉而治其表也。身疼痛者，当以桂枝、麻黄解之矣。然“尺中迟者，不可汗，以营血不足故也。”是宜从脉而调其营矣。此皆从脉不从证也。世有问证而忽脉者，得非仲景之罪人乎？
Lung abscess (a purulent disease of the lung) presenting with a rapid and excess pulse at the Cun position indicates that pus has already formed. Withering and drying of the lung lobes is caused by fire invading metal (lung), hence the pulse is rapid but weak. Once lung abscess occurs, Lung Qi becomes deficient; white is the true color of the West (Metal/Lung). It is said that when one Zang organ is deficient, its true color appears. A short and choppy pulse represents the natural constitution of Autumn Metal; if it instead presents as floating and large, this signifies fire attacking metal. The element that conquers me is called "robber evil" (Zei Xie), representing a critical condition of corrupted blood and Qi. Intestinal abscess (a purulent disease of the intestine): Excess pulse indicates an Excess syndrome; Deep and fine pulse indicates a Deficiency syndrome. When the syndrome is Excess but the pulse is Deficient, death is imminent.
For throat obstruction (Hou Bi - painful swelling and difficulty swallowing in the throat), a slow or rapid pulse is normal; however, for severe conditions like "Coiling Throat Wind" (Chan Hou Feng) or "Running Horse Cancre" (Zou Ma Gan), a faint and hidden pulse indicates a difficult prognosis.
The Twelve Primary Meridians and their Branches mostly pass through this area (the radial artery/Cun Kou); even if not so, they are located anteriorly, posteriorly, laterally, or medially to it. The pulses here are mostly Rapid because Rapidness indicates Heat. Occasionally, a Slow pulse may be seen; this occurs when external pathogens invade the meridians, causing meridian Qi to stagnate and obstruct at the passage points, thus forming a Bi syndrome. A Slow pulse arriving can also correspond to the disease. In cases of Coiling Throat Wind characterized by swelling, pain, numbness, and itching, or Running Horse Cancre which can cause sudden closure and death, both are Fire combined with Wind, fierce and violent. The pulse should be Floating, Large, Surging, and Rapid. If instead a Faint and Hidden pulse is seen, it indicates that Righteous Qi is declining while Pathogenic Evil is flourishing. Neither tonification nor purgation can be effectively applied; is this not difficult to treat?
Signs of poisoning present with Rapid and Tight pulses at both Cun and Chi positions. A Fine and Minute pulse indicates danger, with death imminent within days.
A Rapid and Tight pulse occurs because toxic vapors are coiled and stagnant, striking against the vessel walls. Once a Fine and Minute pulse is observed, it is known that Righteous Qi has become deficient and toxic pathogens have penetrated deeply; how long can the patient survive?
For traumatic wounds with bleeding, the pulse is mostly Empty and Fine. If it suddenly becomes Urgent, Excess, Large, and Rapid, it indicates impending collapse and is untreatable.
After significant trauma and blood loss, an Empty pulse naturally tends toward Deep and Fine. If it instead becomes Urgent and Rapid, Yin Blood is about to be exhausted; what use is treatment?
In women, the pulse is based on Blood. Abundant Blood facilitates conception, while abundant Qi makes pregnancy difficult. Hyperactivity of the Shao Yin pulse indicates pregnancy. A Slippery and free-flowing pulse at the Chi position is auspicious for pregnancy. A Slippery and Rapid pulse that does not scatter suggests a three-month gestation. A merely Rapid pulse without scattering allows differentiation by the fifth month. A Rapid pulse on the Left indicates a male fetus; on the Right, a female fetus. A female-shaped abdomen resembles a winnowing basket (Ji); a male-shaped abdomen resembles a cauldron (Fu).
This describes the pulse before pregnancy in women. Women belong to Yin, and Yin governs Blood; therefore, women's constitution is based on Blood. When the root (Blood) is sufficient, conception is easy. If Qi is abundant, Blood may become deficient, meaning the root is insufficient. No one who violates normal physiological laws can conceive. "Hyperactivity of Shao Yin" refers to the pronounced movement of the Hand-Shao Yin Heart Meridian. The Heart governs Blood; pronounced movement indicates abundant Blood, facilitating conception, hence "having a child." This aligns with the *Su Wen: Ping Ren Qi Xiang Lun*: "When the Hand-Shao Yin pulse moves vigorously in women, she is pregnant." The Heart governs Blood, so fetal formation causes vigorous movement, implying smooth and fluid flow, not the bean-like throbbing of a distinct arterial pulse. The Chi pulse corresponds to the Kidneys on both sides. The Kidney is the Water of Tian Yi, governing the uterus and holding the Bao (womb), serving as the root of gestation. A Slippery and free-flowing pulse indicates fullness rather than dryness, containing the image of substance, hence auspicious for pregnancy. This matches the *Su Wen: Yin Yang Bie Lun*: "When Yin pulses beat distinctly different from Yang, it indicates pregnancy." Cun is Yang, Chi is Yin; this means the Yin pulse at Chi beats distinctly against the finger, clearly differing from the Yang pulse at Cun. Regarding this Slippery pulse, if it feels Slippery upon pressure but does not scatter, Slipperiness indicates rapid blood flow, while non-scattering indicates the gathering and condensation of blood, signifying three months of pregnancy. If it is merely Rapid without scattering, it progresses from Deficiency to Excess, from soft to firm, as blood condenses and transforms into form, losing its slipperiness; this is the pulse of five months' pregnancy. If the Rapidness is greater on the Left than the Right, it indicates a male fetus, as males belong to Yang and reside on the Left, with fetal Qi concentrating in Yang. If greater on the Right, it indicates a female fetus, as females belong to Yin and reside on the Right, with fetal Qi concentrating in Yin. "Greater" refers to degree, not that the Right is absent. Observing the abdomen: basket-shaped indicates a female fetus; cauldron-shaped indicates a male fetus. Generally, in utero, females face the mother's abdomen, and males face the mother's back. While mimicking parental forms, this reflects the principle of Yin-Yang embracing. Females facing the abdomen have knees pressing against it, making the lower part larger and upper smaller, resembling a basket. Males facing the back have their spine pressing against it, making the shape round like a cauldron.
Regarding gender differentiation, He Huanzhi in the *Mai Jing* stated: "Rapid Left indicates male, Rapid Right indicates female." Also: "Deep and Solid Left indicates male, Floating and Large Right indicates female." Also: "Chi pulse larger on the Left indicates male, larger on the Right indicates female." Also: "Obtaining Tai Yin pulse indicates male, obtaining Tai Yang pulse indicates female. Tai Yin pulse is Deep. Tai Yang pulse is Floating." Since then, all discussions on pregnancy pulses have generally adhered to these. Hua Bolin later stated: "Large and Surging Left Chi indicates male, Deep and Solid Right indicates female." Xu Donggao of recent times stated: "To distinguish male and female, one must examine Yin and Yang. If the Right pulse is strong, showing more Yin characteristics, it indicates a girl. If the Left Chi is strong, showing more Yang characteristics, it indicates a boy." Examining all these theories is thorough; however, they often contradict each other and are hard to rely upon. The unchanging principle lies in the words "Yin and Yang." Dividing by left and right, Left is Yang, Right is Yin. Dividing by pulse quality, pounding and deep-solid are Yang; empty, floating, deep-choppy are Yin. All Yang-Excess cases indicate males; all Yin-Deficiency cases indicate females. This is the definitive theory. One must also observe the pregnant woman's strength, age, habitual left/right bias, and inherent strength/weakness of the Cun and Chi positions to fully master the method.
The pulse before delivery is Scattered and deviates from the regular meridian pattern. The pulse after new delivery should be Small and Slow; if it is Excess, Large, Wiry, or Firm, the prognosis is ominous.
This discusses the pulse during childbirth, which differs suddenly from the usual ten-month pregnancy pulse. For example, if the pulse was usually Floating, it suddenly becomes Deep at labor; if usually Slow, it suddenly becomes Rapid. Whether Large, Small, Slippery, or Choppy, all change suddenly at labor. For ten months, fetal Qi is stable; once delivery begins, Qi and Blood surge, the fetal sac ruptures, and everything deviates from the norm, so the pulse changes from its usual appearance. After delivery, Qi and Blood are both deficient, so the pulse should be Slow and Slippery. Slow indicates relaxation, not urgency due to Qi depletion; Slippery indicates fluidity, not dryness due to blood loss. Both are auspicious signs. If the pulse is Excess, Large, Wiry, or Firm, it is unsuitable for postpartum Qi and Blood deficiency. Excess indicates pathogenic excess; Large indicates pathogenic progression; Wiry indicates Yin constriction preventing distribution; Firm indicates solidity with unresolved stasis. These are contrary pulses. If external symptoms exist, how can the condition be favorable?
Pediatric pulses rely entirely on the Tiger Mouth (finger veins on the index finger). The Wind, Qi, and Life gates must be carefully analyzed.
The Tiger Mouth is the area where the inner side of the index finger connects with the thumb, forming a tiger-mouth shape. The skin is thin, and vein colors are clear. This is the end point of the Hand-Taiyin Lung Meridian and a major convergence point for pulses. Although there are no Five Zones, there are Three Gates. The first phalanx is the Wind Gate; the second is the Qi Gate; the third is the Life Gate. Observe the left hand for boys and the right for girls. Veins visible only at the Wind Gate indicate mild illness; progressing to the Qi Gate indicates severity; penetrating straight to the Life Gate indicates critical illness, possibly fatal. This progression shows wind pathogens affecting righteous Qi, which fails to overcome them, forcing the pathogen toward life-threatening levels.
What are the colors? Red indicates Heat (pulse Rapid); White indicates Cold (pulse Slow); Yellow indicates accumulation (pulse Slow); Blue-Black indicates pain (pulse Deep and Wiry).
Children under three are pure Yang bodies with small frames; their pulse circulates quickly and feels rapid. Using the adult standard of seven beats per breath as normal, more than seven is Rapid (Heat), and less is Slow (Cold). This is the general rule. However, 7-8 beats per breath are too fast to count accurately, making it hard to assess the condition precisely. Regarding facial diagnosis, organs correspond to specific areas: Left cheek-Liver, Right cheek-Lung, Forehead-Heart, Nose-Spleen, Chin-Kidney. Similarly, pathogens manifest specific colors at the Three Gates as listed above. Understanding the source and synthesizing observations depends on the physician's skill.
Purple indicates Heat and Shang Han (Cold Damage). Blue indicates Convulsions (Jing Feng). White indicates Guan Disease (malnutrition/worms). Yellow indicates Spleen distress. Black often indicates bloody dysentery; if mixed with purple, thirst will increase. Chaotic veins at the Tiger Mouth indicate disharmonious Qi. Hidden red and yellow are normal; a healthy color is most desirable. Changes occur due to severe disease. Progression: Yellow becomes Red, Red becomes Purple, Purple becomes Blue, Blue becomes Black. If Black appears without mixing, medicine cannot help!
This combines color with disease diagnosis.
For children over three, pulse diagnosis can be used. Use one finger to palpate the three positions. Six to seven beats per breath is normal. Increase indicates Heat; decrease indicates Cold. Floating and Rapid pulse indicates infantile convulsion due to Wind-Heat. Empty and Soft indicates Convulsion. Tight and Solid indicates Wind-Convulsion. Wiry and Tight indicates abdominal pain. Wiry and Urgent indicates rebellious Qi. Firm and Solid indicates constipation. Deep and Fine indicates Cold. Fluctuating size indicates strange/pathological pulses. Deep or Slippery indicates retained food. Chaotic pulse with fever, sweating, anorexia, and immediate vomiting after eating indicates Bian Zheng (physiological growth fever). Floating indicates Wind. Hidden indicates accumulated matter. Single and Fine indicates Guan consumption. Shortness of breath with intermittent pulse indicates critical state. Scattered and disordered pulses are most taboo; survival is rare.
For children over three, pulse diagnosis determines the syndrome. Children are pure Yang; Yang abundance leads to rapidity, so 6-7 beats is normal. Pediatric pulse positions are narrow, so one finger is used.
All terminal syndromes are incurable: Red vessels on the eyes extending down to the pupil.
Red vessels belong to the Heart; pupils belong to the Kidney. This indicates Heart Fire overcoming Kidney Water. When water dries, it cannot generate Wood, leading to exhaustion of both Kidney and Liver.
Fontanelle swelling, accompanied by sinking (depression).
The cranial fontanelle is the gate of spirit and qi. Qi solidifies closes it; Qi deficiency opens it. All Yang converges at the head. External wind pathogens attack Yang, causing swelling. Wind attacking Yang leads to extreme Yang dispersal and exhaustion. Hence, depression indicates death.
Dry, black, and scaly nose.
The nose is the opening of the Lung. Dry Lung Metal cannot generate Kidney Water. Thus, a dry, black, and scaly nose indicates death.
Distended abdomen with visible blue veins.
Earth is overcome by Wood, leading to Spleen deficiency and impending exhaustion. Distension with visible blue veins indicates death.
Eyes staring straight ahead, unable to move.
Upward gazing (Dai Yan) indicates essence failing to rotate and looking back. This signifies exhaustion of the Tai Yang meridian.
Blue-black fingernails.
The Liver governs tendons; its bloom is in the nails. Nails are the flower of the Liver. Liver exhaustion prevents nourishment, resulting in black color.
Sudden crow-like voice.
Speech originates from the Lung (Metal), which resonates. When Lung Metal exhausts, speech becomes incoherent, sounding like a crow's caw.
Flaccid tongue retracting to the mouth floor.
The tongue is the sprout of the Heart. Heart Qi exhaustion causes the tongue to relax and fail to return.
Teeth grinding or biting.
Teeth are the surplus of bone. Kidneys store essence and govern bone. Kidney Qi exhaustion leads to teeth grinding. Heart is Yang, Kidney is Yin. Separation of Yin and Yang leads to death.
Fish-mouth breathing, gasping, crying without sound.
Fish-mouth refers to open mouth unable to close, indicating Spleen exhaustion. Gasping and silent crying indicate Lung exhaustion.
If roundworms appear, the patient is dead.
Roundworms live in the stomach, feeding on grain. When Stomach Qi exhausts and food intake stops, worms emerge.
According to the *Su Wen: Tong Ping Xu Shi Lun*: "The Emperor asked: 'An infant has heat disease, and the pulse is suspended and small. What happens?' Qibo replied: 'If hands and feet are warm, the patient lives; if cold, the patient dies.' (This summarizes internal and external signs in infants. Heat disease with suspended-small pulse is a Yang syndrome with Yin pulse, generally forbidden. But small-slow indicates mild Yang, easy recovery; small-urgent indicates severe pathogen, concerning. Small pulse with warm limbs means Yang remains in the four extremities, so life; cold limbs mean pathogen overcomes righteousness, Yuan Yang departs, so death.) The Emperor asked: 'Infant contracts wind-heat, with wheezing and shoulder-lifting respiration. What is the pulse?' Qibo replied: 'Wheezing and shoulder-lifting respiration present a Large and Solid pulse. Slow indicates life; urgent indicates death.' (This discusses external contraction in infants. Wind-heat in Yang aspect causes wheezing/shoulder-lifting; pulse should be Large/Solid. Large/slow means Stomach Qi remains, pathogen recedes, so life; Solid/urgent means True Organ pulse appears, disease advances, so death.)"
These two passages show that ancient physicians valued pulse diagnosis in infants, even immediately after birth. Why do later pediatric texts like *Shui Jing Jue* and *Quan You Xin Jian* propose observing the Three Gates? A review of the *Nei Jing* finds no such name. Only the *Ling Shu: Jing Mai Pian* mentions observing the color of the hand fish (thenar eminence), which is similar but a general diagnostic method, not exclusive to infants. Thus, the Three Gates theory is a later alias. Furthermore, these gates are superficial collaterals of the Hand-Yangming, insufficient for assessing Zang-Fu Qi. Moreover, in children, regardless of health, these veins are always purple-white mixed with blue-red. Though shades vary, the four colors are always present. How can one distinguish purple as wind, red as cold, blue as fright, white as guan? And how to distinguish thunder fright, human fright, water fright, beast fright? This theory is flawed. However, I have seen wealthy families with delicate children who cry violently upon seeing a doctor, resisting examination, sweating profusely. Parents, fearing harm from crying, look on anxiously. Recently, the habit of only checking the Tiger Mouth has become common, leading patients to view pulse diagnosis as outdated. In essence, major pediatric diseases like smallpox and measles, or miscellaneous conditions like vomiting, diarrhea, fright, and guan, always present obvious physical signs before treatment. Pulse diagnosis is unnecessary, and herbal prescriptions do not vary greatly. Thus, the Tiger Mouth method can be borrowed, regardless of ancient or modern times. I record this Tiger Mouth theory here to illustrate alternative diagnostic approaches.
The pulse's indication determines fortune or misfortune beforehand; yet flexibility and active judgment are required. Follow the syndrome and discard the pulse, or follow the pulse and discard the syndrome; if clearly distinguished, medication will be effective.
Pulse matching syndrome is the norm. However, exceptions must be known, especially in Shang Han. Floating pulse indicates Exterior; sweating is the norm. Yet sometimes purgation is indicated. Zhang Zhongjing said: "If pulse is Floating and Large, epigastric hardness, and heat, belonging to the Zang, purge it, do not sweat." This is correct. Deep pulse indicates Interior; purgation is the norm. Yet sometimes sweating is indicated. "Shao Yin disease, just acquired, with fever and Deep pulse, use Mahuang Fuzi Xixin Tang to induce slight sweating." This is correct. Cramped pulse indicates Yang; Ge Gen Qin Lian Decoction should clear it. But if Cramped pulse with cold limbs indicates collapse, moxibustion and warming are essential; this is not a Yang-excess Cramped pulse. Slow pulse indicates Cold; Gan Jiang Fu Zi Tang should warm it. But Yang Ming Slow pulse, without aversion to cold, with body sweating, requires Da Cheng Qi Tang. This is not a Yin-Cold Slow pulse. These four cases follow the syndrome, not the pulse. Those who palpate pulse without asking symptoms commit grave errors! Sweating for Exterior syndrome is the norm. Zhang Zhongjing said: "Fever, headache, Reverse Deep pulse, body pain, save the Interior with Si Ni Tang." This follows the Deep pulse. Purgation for Interior syndrome is the norm. "Afternoon fever, belongs to Yang Ming, Floating and Empty pulse, sweat with Gui Zhi Tang." This follows the Floating pulse. Fullness syndrome requires Da/Xiao Xian Xiong Tang purgation. "Floating and Large pulse, do not purge, purging leads to death." This follows the pulse to treat the Exterior. Body pain requires Gui Zhi/Ma Huang release. But "Slow Chi pulse, do not sweat, due to insufficient Ying Blood." This follows the pulse to regulate Ying. These cases follow the pulse, not the syndrome. Those who ask symptoms but ignore the pulse are sinners against Zhang Zhongjing!