景岳心心包肺膻中肝胆脾胃肾膀胱大肠肾命门三焦小肠金鉴心膻中肺胸中肝胆脾胃肾膀胱小肠肾大肠以上各家学说，其分配五脏六腑，均以《内经》为根据。其分歧在于大小肠和三焦，三部系寸，关，尺，九候指浮、中、沉，各家意见一致，三部中，每部均有浮、中、沉，故称为九侯。上部(寸部)主胸以上至头部疾病，中部主膈以下至脐部疾病，下部主脐以下至足。临床凡肺热、风火咳嗽、喘促，则右寸弦滑或浮大滑数；肺痈发热时，右脉滑数，右寸尤为突出；阴虚阳亢的高血压头痛，则寸脉盛于尺脉；心肌炎、心瓣膜炎身发冷热时则脉象滑数或弦数，以左脉为甚，迨身热退，脉不滑数，而左寸脉每现沉滑，甚者可见不整脉，均说明寸以候上，左心右肺的明征。脾胃病右关脉即起变化，急性胃炎，则右脉弦数、弦滑，右关为甚，胃痛右关每现弦紧，而慢性胃炎右关多呈沉滑或沉弦数；虚寒痉挛性胃痛，右关多现弦虚。胰腺炎身热腹痛时，脉多弦滑数或弦大而紧，以右脉为甚，脾胃虚弱，腹胀脘满消化不良时，右脉弦细无力，这是右关以候脾胃的明征。膀胱湿热，淋浊便血，尺脉即现沉滑或弦大；下肢肿痛，或关节肿胀、脚气肿疼等症，则尺脉多现沉滑或弦数浮大，说明尺以候下。肝炎初期左关弦大、弦滑、弦数。慢性肝炎患者其脉象多现弦象，弦甚者病重，弦轻者病缓，其病势的发展与缓解，应以弦脉的轻重为判断，总以左关为明显。因此知古人分歧均未出寸以候上，关以候中，尺以候下为原则的内经基本理论范围，所谓膻中、心包、胸中，原已包括于寸脉之中，寸脉滑数弦大，咳嗽喘逆知热邪犯肺。若胸痹满而痛，可考虑胸病。心悸气短，神昏谵妄，即要联系膻中，胸满心悸气短不足以息或有压迫感，脉率不整，多为心病。尺脉弦数或弦滑，而有尿急尿频、尿血、淋痛，知为膀胱，小肠病。若大便燥结，或腹痛便泻，里急后重，便下脓血，知为大肠病。小便赤涩不畅，身现水肿，病在三焦。也说明中医的诊断应脉证合参，绝不可单纯拘泥脉象。知此则古人争执，可以迎刃而解。另有人迎、寸口、跗阳三部脉的诊法。人迎脉即项侧动脉，人迎为针灸穴位名。诊脉时，一般病用寸口以候脏气之盛衰，即可作出诊断。必要时，须人迎、寸口相互参证，如高血压病，则人迎脉常大于寸口脉一倍。病势垂危者，寸口脉已散乱，或微细欲绝，则取跗阳脉较为可靠。跗阳脉即足背动脉。诊脉时有的要三部互参，综合分析，方能得出正确的结论。(表二)
寸关尺
四、正常脉象
诊脉首先要识别正常脉象，然后才能辨别异常脉象。脉是整个机体重要的组成部分，机体对气候的影响，情绪的冲动，虽非患病，也可使脉象发生一时性变化，这种脉象的变化，不能称之为病脉。正常人脉象，不浮不沉，不急不徐，一呼一吸四至(64-80／分)从容和缓，节律一致，谓之“有胃气”。凡病脉不论浮沉迟数，但有雍容和缓之气，便是“有胃气”,乃机体阴阳基本平衡的表现，故持脉时应经常注意胃气。不论任何脉象都不能太过，如过浮、过沉、过数、过迟而无雍容和缓之意，即为无胃气。过浮为外邪过猛，抗病力过激，致正气受损较重，无力维持其自身阴阳的最低平衡，故病情较重。过数为热邪太盛、阴气损伤、潜敛之力不能制约其数，皆由阳亢极而阴不能维系之重症。古人谓有胃气则安，无胃气则危。无胃气的脉亦称之为真脏脉，因其坚硬而失柔和，皆由阴阳偏盛，将形成离决之势，故病属难治。因此医生切脉，注意有无胃气，是诊脉断病的关键。诊脉除注意胃气之外、还应注意有根有神。脉有神，(即脉的浮沉迟数，滑涩大小之脉，按之指下有条有理，秩然不乱，雍容和缓。倘按之散乱，或有或无，或来有力而去无力者，或轻取有，而重按绝无，或时而续、时而断者，或欲续而不能，或欲接而不得，或沉细之中倏现依稀之状，或洪大之内忽有飘渺之形，皆为无神，皆由正气衰败不支，即邪正斗争正气受损，不能维持机体正常生理状态所致。有根即人体正气有根基，古人认为人身十二经，全靠肾间动气以为生养，肾气之生存犹如树之有根，枝叶虽枯，根本不坏，尚有生机。肾气未绝，则脉必有根，沉以候肾，如脉沉取应指和缓有力，谓之有根，尺脉应指雍容有力，亦为有根。
五、脉与内外因素的关系
人生长于自然界，四时气候变化，人体必然也有相应的变化。正常人的四时平脉有所不同，春三月六脉俱弦，夏三月六脉俱洪，秋脉微浮，冬脉俱沉。妇女脉常较男人濡弱。少壮脉多实大，老年脉多虚弱，婴儿脉急数，五、六岁儿童脉，常一息六至，身高体大者脉显现的部位较长，矮小者部位较短，瘦弱者脉常微浮，胖盛者脉象多沉。凡常见六脉沉细而身无他病者，谓六阴脉。六脉常见洪大而身无他病，谓之六阳脉。脉不见于寸口，而见于大指腕侧部者，谓反关脉，脉从尺部斜向虎口腕侧者，谓斜飞脉，均属桡动脉畸形。剧烈劳动后脉多洪数，远行后脉多急疾。脑力劳动者脉多弱于体力劳动者。酒后脉多数急，饭后脉多洪滑有力，久饥脉多虚弱。精神冲动脉亦变化，但非病脉，精神恢复平静，脉象即可复正常。《脉经》中：“人病恐怖，其脉何类?师曰：‘脉形如循丝，累累然，其面白脱色’。‘人愧者其脉何等类?’师曰，‘其脉自浮而弱，面形乍白乍赤’。”恐惧、兴奋，忧虑、急躁诸情绪变化时，脉象也会发生变化。
六、脉象分类和辨脉纲领
脉诊是中医辨证论治的主要依据。历代医家分类方法不一，常使人无法适从。清张石顽对脉象分类最多最细，共分32脉；李濒湖分为27脉；陈修园分为28脉；现一般仍沿用28脉。据临床体会，脉象分类不宜过多，以免彼此易于混淆。根据临床需要，对一般常用的28脉，如能鉴别清楚，精心体会，使用熟练，对于指导临床辨证，运用八纲八法诊断疾病，立法用药，即能得心应手。由于脉象繁多，不易掌握，前人便考虑执简驭繁的办法。汉张仲景把脉象分为阴阳两大类，以大、浮，数、动、滑为阳脉，沉、涩、弱、弦、微为阴脉。元滑伯仁主张，以浮、沉、迟、数、滑、涩，六脉统辖各脉，以浮沉候部位，以迟数候至数，以滑涩候形状。陈修园则主张以浮、沉、迟、数、虚、实、大、缓八脉统各脉。芤浮脉包括芤脉、革脉、散脉。沉脉包括牢脉、伏脉。迟脉包括结、代。数脉包括促、紧、动。虚脉包括弱、濡、细、微、短、涩。实脉包括滑、长、洪、弦。大脉包括缓脉。以上28脉，可通过脉位、脉率、脉力、脉形来辨认。例如浮沉，是脉位的不同；迟数是脉率的不同；大小微细，是脉形的不同；虚实芤弱，是脉力的不同。这些脉象均是在病邪与正气斗争过程中形成的。病有表里寒热虚实，体有盛衰强弱，脉象就有浮沉迟数大细长短的不同，故取八脉，作为28脉的纲领，是初学诊脉的一种执简驭繁的方法。先掌握这八种脉象，再进一步详细体认28脉，由浅入深，循序渐进。脉学不难体会，今根据前人的分类方法，加以具体化，以浮沉迟数长短细大为纲，而以兼见之脉附于其中。为使易于分析记忆，编成脉象八纲四言体状歌，附录于后，为初学入门之用：
浮脉主表属腑属阳轻手一按形象彰彰
浮而有力洪脉火炀浮而无力虚脉阴伤
浮而虚甚散脉靡常浮如葱管芤脉血殃
浮如按鼓革脉外强浮而柔细濡脉湿伤
浮兼六脉疑似当详沉脉主里属脏属阴
重手寻按始了于心沉而着骨伏脉邪深
沉而底硬牢脉寒淫沉而细软弱脉虚寻
沉兼三脉须守规箴迟脉主寒脏病亦是
二至三至数目可揣迟而不衍缓脉病解
迟不流利濇脉血痞迟而时止结脉郁实
迟止定期代脉多死数脉主热腑病亦同
五至以上七八病凶数而流利滑脉痰涌
数而牵转紧脉寒攻数而时止促脉热烘
数见于关动脉崩中数见四脉休得朦胧
长主素强得之最罕上鱼入尺迢迢不短
长而端直弦脉属肝指下迢迢气郁多见
短脉素弱不由病伤上下相准缩而不长
多因禀虚瘦枯其相诸脉见此宜补阴阳
细主诸虚蛛丝其象脉道属阴病情可想
细不明显微脉气殃细而小沉弱脉失养
细有三脉辨须明详大主诸实形阔易知
阳脉为病邪实可思大而涌沸洪脉热司
大而坚硬实脉邪肆大兼二脉病盛邪炽
张景岳认为：心包、肺、膻中、肝、胆、脾、胃、肾、膀胱、大肠、命门、三焦、小肠。《医宗金鉴》认为：心、膻中、肺、胸中、肝、胆、脾、胃、肾、膀胱、小肠、肾、大肠。以上各家学说，在分配五脏六腑时，均以《黄帝内经》为根据。其分歧在于对大小肠和三焦的归属不同。三部脉分别对应寸、关、尺；九候指浮取、中取、沉取。各家的意见是一致的，即三部中，每部均有浮、中、沉三种取法，故称为九候。上部（寸部）主要反映胸部以上至头部的疾病，中部主要反映膈肌以下至脐部的疾病，下部主要反映脐以下至足部的疾病。临床上，凡出现肺热、风火引起的咳嗽、气喘急促，则右寸脉呈现弦滑或浮大滑数；患肺痈发热时，右脉滑数，右寸脉尤为突出；阴虚阳亢引起的高血压头痛，则寸脉盛于尺脉；心肌炎、心瓣膜炎患者身体发冷发热时，脉象滑数或弦数，以左脉为甚，待身热退去后，脉不再滑数，而左寸脉常现沉滑，严重者可见不整脉，这些都说明“寸以候上”、“左心右肺”的明确征象。脾胃病时，右关脉即起变化，急性胃炎，则右脉弦数、弦滑，右关脉为甚，胃痛时右关脉常现弦紧，而慢性胃炎右关脉多呈沉滑或沉弦数；虚寒痉挛性胃痛，右关脉多现弦虚。胰腺炎患者身热腹痛时，脉多弦滑数或弦大而紧，以右脉为甚；脾胃虚弱，腹胀脘满消化不良时，右脉弦细无力，这是“右关以候脾胃”的明确征象。膀胱湿热，淋浊便血，尺脉即现沉滑或弦大；下肢肿痛，或关节肿胀、脚气肿疼等症，则尺脉多现沉滑或弦数浮大，说明“尺以候下”。肝炎初期，左关脉弦大、弦滑、弦数。慢性肝炎患者其脉象多现弦象，弦甚者病重，弦轻者病缓，其病势的发展与缓解，应以弦脉的轻重为判断标准，总以左关脉为明显。因此可知，古人的分歧均未超出“寸以候上，关以候中，尺以候下”这一原则的《内经》基本理论范围。所谓膻中、心包、胸中，原已包括于寸脉之中，寸脉滑数弦大，咳嗽喘逆，知为热邪犯肺。若胸痹满闷而痛，可考虑胸病。心悸气短，神昏谵妄，即要联系膻中。胸满心悸气短不足以息或有压迫感，脉率不整，多为心病。尺脉弦数或弦滑，而有尿急尿频、尿血、淋痛，知为膀胱、小肠病。若大便燥结，或腹痛便泻，里急后重，便下脓血，知为大肠病。小便赤涩不畅，身现水肿，病在三焦。这也说明中医的诊断应脉证合参，绝不可单纯拘泥于脉象。知此则古人争执，可以迎刃而解。另有人迎、寸口、跗阳三部脉的诊法。人迎脉即项侧动脉，人迎为针灸穴位名。诊脉时，一般病用寸口以候脏气之盛衰，即可作出诊断。必要时，须人迎、寸口相互参证，如高血压病，则人迎脉常大于寸口脉一倍。病势垂危者，寸口脉已散乱，或微细欲绝，则取跗阳脉较为可靠。跗阳脉即足背动脉。诊脉时有的要三部互参，综合分析，方能得出正确的结论。（表二）
寸关尺
左：心（心包）、肝（胆）、肾（膀胱、小肠）
右：肺（胸中）、脾（胃）、肾（命门、大肠）
四、正常脉象
诊脉首先要识别正常脉象，然后才能辨别异常脉象。脉是整个机体重要的组成部分，机体对气候的影响，情绪的冲动，虽非患病，也可使脉象发生一时性变化，这种脉象的变化，不能称之为病脉。正常人脉象，不浮不沉，不急不徐，一呼一吸四至（64-80次/分），从容和缓，节律一致，谓之“有胃气”。凡病脉不论浮沉迟数，但有雍容和缓之气，便是“有胃气”，乃机体阴阳基本平衡的表现，故持脉时应经常注意胃气。不论任何脉象都不能太过，如过浮、过沉、过数、过迟而无雍容和缓之意，即为无胃气。过浮为外邪过猛，抗病力过激，致正气受损较重，无力维持其自身阴阳的最低平衡，故病情较重。过数为热邪太盛、阴气损伤、潜敛之力不能制约其数，皆由阳亢极而阴不能维系之重症。古人谓有胃气则安，无胃气则危。无胃气的脉亦称之为真脏脉，因其坚硬而失柔和，皆由阴阳偏盛，将形成离决之势，故病属难治。因此医生切脉，注意有无胃气，是诊脉断病的关键。诊脉除注意胃气之外，还应注意有根有神。脉有神，（即脉的浮沉迟数，滑涩大小之脉，按之指下有条有理，秩然不乱，雍容和缓。倘按之散乱，或有或无，或来有力而去无力者，或轻取有，而重按绝无，或时而续、时而断者，或欲续而不能，或欲接而不得，或沉细之中倏现依稀之状，或洪大之内忽有飘渺之形，皆为无神，皆由正气衰败不支，即邪正斗争正气受损，不能维持机体正常生理状态所致。有根即人体正气有根基，古人认为人身十二经，全靠肾间动气以为生养，肾气之生存犹如树之有根，枝叶虽枯，根本不坏，尚有生机。肾气未绝，则脉必有根，沉以候肾，如脉沉取应指和缓有力，谓之有根，尺脉应指雍容有力，亦为有根。
五、脉与内外因素的关系
人生长于自然界，四时气候变化，人体必然也有相应的变化。正常人的四时平脉有所不同，春三月六脉俱弦，夏三月六脉俱洪，秋脉微浮，冬脉俱沉。妇女脉常较男人濡弱。少壮脉多实大，老年脉多虚弱，婴儿脉急数，五、六岁儿童脉，常一息六至，身高体大者脉显现的部位较长，矮小者部位较短，瘦弱者脉常微浮，胖盛者脉象多沉。凡常见六脉沉细而身无他病者，谓六阴脉。六脉常见洪大而身无他病，谓之六阳脉。脉不见于寸口，而见于大指腕侧部者，谓反关脉，脉从尺部斜向虎口腕侧者，谓斜飞脉，均属桡动脉畸形。剧烈劳动后脉多洪数，远行后脉多急疾。脑力劳动者脉多弱于体力劳动者。酒后脉多数急，饭后脉多洪滑有力，久饥脉多虚弱。精神冲动脉亦变化，但非病脉，精神恢复平静，脉象即可复正常。《脉经》中：“人病恐怖，其脉何类？师曰：‘脉形如循丝，累累然，其面白脱色’。‘人愧者其脉何等类？’师曰，‘其脉自浮而弱，面形乍白乍赤’。”恐惧、兴奋，忧虑、急躁诸情绪变化时，脉象也会发生变化。
六、脉象分类和辨脉纲领
脉诊是中医辨证论治的主要依据。历代医家分类方法不一，常使人无法适从。清张石顽对脉象分类最多最细，共分32脉；李濒湖分为27脉；陈修园分为28脉；现一般仍沿用28脉。据临床体会，脉象分类不宜过多，以免彼此易于混淆。根据临床需要，对一般常用的28脉，如能鉴别清楚，精心体会，使用熟练，对于指导临床辨证，运用八纲八法诊断疾病，立法用药，即能得心应手。由于脉象繁多，不易掌握，前人便考虑执简驭繁的办法。汉张仲景把脉象分为阴阳两大类，以大、浮，数、动、滑为阳脉，沉、涩、弱、弦、微为阴脉。元滑伯仁主张，以浮、沉、迟、数、滑、涩，六脉统辖各脉，以浮沉候部位，以迟数候至数，以滑涩候形状。陈修园则主张以浮、沉、迟、数、虚、实、大、缓八脉统各脉。芤浮脉包括芤脉、革脉、散脉。沉脉包括牢脉、伏脉。迟脉包括结、代。数脉包括促、紧、动。虚脉包括弱、濡、细、微、短、涩。实脉包括滑、长、洪、弦。大脉包括缓脉。以上28脉，可通过脉位、脉率、脉力、脉形来辨认。例如浮沉，是脉位的不同；迟数是脉率的不同；大小微细，是脉形的不同；虚实芤弱，是脉力的不同。这些脉象均是在病邪与正气斗争过程中形成的。病有表里寒热虚实，体有盛衰强弱，脉象就有浮沉迟数大细长短的不同，故取八脉，作为28脉的纲领，是初学诊脉的一种执简驭繁的方法。先掌握这八种脉象，再进一步详细体认28脉，由浅入深，循序渐进。脉学不难体会，今根据前人的分类方法，加以具体化，以浮沉迟数长短细大为纲，而以兼见之脉附于其中。为使易于分析记忆，编成脉象八纲四言体状歌，附录于后，为初学入门之用：
浮脉主表属腑属阳，轻手一按形象彰彰。
浮而有力洪脉火炀，浮而无力虚脉阴伤。
浮而虚甚散脉靡常，浮如葱管芤脉血殃。
浮如按鼓革脉外强，浮而柔细濡脉湿伤。
浮兼六脉疑似当详，沉脉主里属脏属阴。
重手寻按始了于心，沉而着骨伏脉邪深。
沉而底硬牢脉寒淫，沉而细软弱脉虚寻。
沉兼三脉须守规箴，迟脉主寒脏病亦是。
二至三至数目可揣，迟而不衍缓脉病解。
迟不流利濇脉血痞，迟而时止结脉郁实。
迟止定期代脉多死，数脉主热腑病亦同。
五至以上七八病凶，数而流利滑脉痰涌。
数而牵转紧脉寒攻，数而时止促脉热烘。
数见于关动脉崩中，数见四脉休得朦胧。
长主素强得之最罕，上鱼入尺迢迢不短。
长而端直弦脉属肝，指下迢迢气郁多见。
短脉素弱不由病伤，上下相准缩而不长。
多因禀虚瘦枯其相，诸脉见此宜补阴阳。
细主诸虚蛛丝其象，脉道属阴病情可想。
细不明显微脉气殃，细而小沉弱脉失养。
细有三脉辨须明详，大主诸实形阔易知。
阳脉为病邪实可思，大而涌沸洪脉热司。
大而坚硬实脉邪肆，大兼二脉病盛邪炽。
Zhang Jingyue posits: Pericardium, Lung, Danzhong (Chest Center), Liver, Gallbladder, Spleen, Stomach, Kidney, Bladder, Large Intestine, Mingmen (Gate of Vitality), Sanjiao (Triple Burner), Small Intestine. *Yizong Jinjian* (Golden Mirror of Medicine) posits: Heart, Danzhong (Chest Center), Lung, Xiongzhong (Chest Middle), Liver, Gallbladder, Spleen, Stomach, Kidney, Bladder, Small Intestine, Kidney, Large Intestine. The aforementioned schools of thought all base their allocation of the Zang and Fu organs on the *Huangdi Neijing* (Yellow Emperor's Inner Canon). Their divergence lies in the attribution of the Large Intestine, Small Intestine, and Sanjiao (Triple Burner). The three positions correspond to Cun (Inch), Guan (Bar), and Chi (Cubit); the nine examinations refer to Superficial (Fu), Moderate (Zhong), and Deep (Chen) palpation. The opinions of various schools are consistent: each of the three positions has Superficial, Moderate, and Deep palpation, hence termed the "Nine Examinations." The upper part (Cun position) primarily reflects diseases from the chest upwards to the head; the middle part primarily reflects diseases from below the diaphragm to the umbilicus; the lower part primarily reflects diseases from below the umbilicus to the feet. Clinically, whenever there is Lung Heat or wind-fire causing cough and panting, the Right Cun pulse presents as Wiry-Slippery or Floating-Big-Slippery-Rapid; when suffering from Lung Abscess with fever, the Right pulse is Slippery-Rapid, with the Right Cun being particularly prominent; for hypertension headache caused by Yin Deficiency with Yang Hyperactivity, the Cun pulse is stronger than the Chi pulse; when myocarditis or valvulitis causes alternating chills and fever, the pulse is Slippery-Rapid or Wiry-Rapid, more pronounced in the Left pulse; once the fever subsides, the pulse is no longer Slippery-Rapid, but the Left Cun often presents as Deep-Slippery, and in severe cases, an irregular pulse may be seen. All these illustrate the clear signs of "Cun reflects the upper" and "Left corresponds to Heart, Right to Lung." When Spleen and Stomach diseases occur, the Right Guan pulse changes accordingly: in acute gastritis, the Right pulse is Wiry-Rapid or Wiry-Slippery, with the Right Guan being most prominent; in stomach pain, the Right Guan often presents as Wiry-Tight; whereas in chronic gastritis, the Right Guan mostly presents as Deep-Slippery or Deep-Wiry-Rapid; in spasmodic stomach pain due to deficiency-cold, the Right Guan often presents as Wiry-Deficient. In pancreatitis with fever and abdominal pain, the pulse is mostly Wiry-Slippery-Rapid or Wiry-Big-Tight, more pronounced in the Right pulse; in Spleen and Stomach weakness with abdominal distension, epigastric fullness, and indigestion, the Right pulse is Wiry-Fine-Weak. This is the clear sign that "Right Guan reflects Spleen and Stomach." In damp-heat of the Bladder, presenting with stranguria, turbid urine, or blood in stool, the Chi pulse presents as Deep-Slippery or Wiry-Big; in lower limb swelling and pain, or joint swelling, or edematous pain of tinea pedis, the Chi pulse often presents as Deep-Slippery or Wiry-Rapid-Floating-Big, illustrating that "Chi reflects the lower." In the early stage of hepatitis, the Left Guan pulse is Wiry-Big, Wiry-Slippery, or Wiry-Rapid. In patients with chronic hepatitis, the pulse mostly presents a Wiry quality; the more Wiry, the heavier the disease; the less Wiry, the milder the condition. The development and remission of the disease should be judged by the severity of the Wiry pulse, predominantly evident at the Left Guan. Therefore, it can be known that the ancient disagreements did not exceed the basic theoretical scope of the *Neijing* principle of "Cun reflects the upper, Guan reflects the middle, Chi reflects the lower." What is called Danzhong, Pericardium, and Xiongzhong were originally included within the Cun pulse. A Slippery-Rapid-Wiry-Big Cun pulse with cough and panting indicates heat pathogen invading the Lung. If there is chest bi (obstruction) with fullness and pain, chest disease should be considered. Palpitations, shortness of breath, confusion, and delirium should be linked to Danzhong. Chest fullness, palpitations, shortness of breath, inability to breathe fully, or a sense of oppression, accompanied by an irregular pulse rate, mostly indicate Heart disease. A Wiry-Rapid or Wiry-Slippery Chi pulse, accompanied by urgent/frequent urination, hematuria, or painful stranguria, indicates Bladder or Small Intestine disease. If there is dry constipation, or abdominal pain with diarrhea, tenesmus, or passage of pus and blood, it indicates Large Intestine disease. Reddish, astringent, and difficult urination, along with generalized edema, indicates disease in the Sanjiao (Triple Burner). This also illustrates that TCM diagnosis requires combining pulse and symptom analysis; one must never rely solely on the pulse. Understanding this resolves ancient disputes. There is another diagnostic method involving the Renying, Cunkou, and Fuyang pulses. The Renying pulse is the carotid artery on the side of the neck; Renying is also the name of an acupuncture point. For general diseases, diagnosing via Cunkou (radial artery) to assess the abundance or decline of Zang qi is sufficient for diagnosis. When necessary, Renying and Cunkou must be cross-referenced; for example, in hypertension, the Renying pulse is often twice as large as the Cunkou pulse. In critical conditions where the Cunkou pulse is scattered or faint and nearly imperceptible, taking the Fuyang pulse is more reliable. The Fuyang pulse is the dorsalis pedis artery. Sometimes, the three positions must be consulted together for comprehensive analysis to reach a correct conclusion. (Table 2)
Cun, Guan, Chi
Left: Heart (Pericardium), Liver (Gallbladder), Kidney (Bladder, Small Intestine)
Right: Lung (Chest Center), Spleen (Stomach), Kidney (Mingmen, Large Intestine)
IV. Normal Pulse Qualities
Pulse diagnosis first requires identifying normal pulse qualities before distinguishing abnormal ones. The pulse is an important component of the entire organism. Although not diseased, the organism's response to climate changes or emotional impulses can cause temporary changes in pulse quality; such changes cannot be termed pathological pulses. A normal person's pulse is neither floating nor deep, neither rapid nor slow, beating four times per respiration cycle (64-80 beats/min), calm and moderate, with consistent rhythm, termed "having Stomach Qi." Regardless of whether a pathological pulse is floating, deep, slow, or rapid, if it possesses a graceful and moderate quality, it is "having Stomach Qi," which represents the basic balance of Yin and Yang in the organism. Therefore, attention to Stomach Qi should be maintained during pulse taking. No pulse quality should be excessive; if excessively floating, deep, rapid, or slow without a graceful and moderate meaning, it is "lacking Stomach Qi." Excessive floating indicates the external pathogen is too strong, the resistance is too aggressive, causing significant damage to Zheng Qi (Upright Qi), making it unable to maintain the minimum balance of its own Yin and Yang, thus indicating a serious condition. Excessive rapidity indicates excessive heat pathogen and damaged Yin Qi, where the restraining power cannot control the rapidity, all resulting from extreme Yang hyperactivity where Yin cannot sustain it, a severe condition. The ancients said, "Having Stomach Qi means safety; lacking Stomach Qi means danger." Pulses lacking Stomach Qi are also called True Zang Pulses because they are hard and lack softness, resulting from Yin-Yang excess, forming a trend of separation, thus the disease is difficult to treat. Therefore, paying attention to the presence or absence of Stomach Qi while palpating is the key to pulse diagnosis and disease determination. Besides Stomach Qi, pulse diagnosis should also pay attention to having Root and Spirit. Having Spirit in the pulse means that regardless of floating/deep, slow/rapid, slippery/astringent, big/small qualities, upon pressing, the fingers feel orderly and neat, graceful and moderate. If pressing feels scattered, present sometimes and absent others, coming with strength but departing weakly, present on light pressure but completely absent on heavy pressure, intermittently continuous and intermittent, wanting to continue but unable, wanting to connect but failing, appearing faint amidst deep-fine pulses, or suddenly ethereal amidst big pulses, these are all "lacking Spirit," caused by the collapse of Zheng Qi, where Zheng Qi is damaged in the struggle against pathogens and cannot maintain normal physiological states. Having Root means the body's Zheng Qi has a foundation. The ancients believed that the twelve meridians rely on the moving Qi between the Kidneys for nourishment. The survival of Kidney Qi is like a tree having roots; even if branches and leaves wither, if the root is intact, there is still vitality. If Kidney Qi is not exhausted, the pulse must have Root. Deep palpation reflects the Kidney; if the pulse responds to deep pressure with calm and strength, it is called having Root. If the Chi pulse responds with graceful strength, it is also having Root.
V. Relationship Between Pulse and Internal/External Factors
Humans grow in nature, and seasonal climate changes inevitably bring corresponding changes to the human body. The normal four-season pulse qualities differ: in the three months of Spring, all six pulses are Wiry; in Summer, all are Surging; in Autumn, pulses are slightly Floating; in Winter, all are Deep. Women's pulses are often softer and weaker than men's. Young and vigorous people's pulses are mostly solid and big; elderly people's pulses are mostly deficient and weak; infants' pulses are rapid and numerous; children aged five or six often have six beats per respiration; tall and large individuals show pulse locations over a longer distance, while short individuals show shorter distances; thin and weak individuals often have slightly Floating pulses, while robust and plump individuals often have Deep pulses. Those who commonly have all six pulses deep and fine without other illnesses are called Six-In pulses. Those who commonly have all six pulses surging and big without other illnesses are called Six-Yang pulses. Pulses not found at Cunkou but visible on the radial side of the thumb are called Fan-Guan pulses; pulses slanting from the Chi position towards the wrist side of the Tiger's Mouth are called Flying-Side pulses; both belong to radial artery anomalies. After strenuous labor, pulses are mostly Surging-Rapid; after long journeys, pulses are mostly rapid and urgent. Mental workers' pulses are often weaker than physical workers'. After drinking alcohol, pulses are mostly rapid and urgent; after meals, pulses are mostly Surging-Slippery and strong; after prolonged fasting, pulses are mostly deficient and weak. Emotional agitation also changes the pulse, but this is not a pathological pulse; once emotions return to calm, the pulse returns to normal. The *Mai Jing* (Pulse Classic) states: "When a person suffers from fear and terror, what does their pulse resemble? The Master said: 'The pulse shape resembles touching silk threads, continuously connected, and the face loses color.' 'What does the pulse of an ashamed person resemble?' The Master said, 'Its pulse is naturally floating and weak, and the face alternates between white and red.'" Fear, excitement, worry, and impatience all cause pulse changes.
VI. Classification of Pulse Qualities and Principles of Pulse Differentiation
Pulse diagnosis is the main basis for TCM syndrome differentiation and treatment. Methods of classification by physicians throughout history have varied, often leaving practitioners confused. Zhang Shiwen of the Qing Dynasty classified pulses into the most numerous and detailed categories, totaling 32 pulses; Li Binhu classified them into 27 pulses; Chen Xiuyuan classified them into 28 pulses; currently, 28 pulses are generally still used. Based on clinical experience, pulse classification should not be too extensive to avoid mutual confusion. According to clinical needs, if the commonly used 28 pulses can be clearly distinguished, carefully experienced, and skillfully used, it will facilitate clinical syndrome differentiation, application of the Eight Principles and Eight Methods for diagnosis, prescription formulation, and medication, achieving ease and proficiency. Due to the complexity of pulse qualities, predecessors considered methods to simplify the complex. Zhang Zhongjing of the Han Dynasty divided pulses into two major categories: Yin and Yang, classifying Big, Floating, Rapid, Agitated, and Slippery as Yang pulses, and Deep, Astringent, Weak, Wiry, and Faint as Yin pulses. Hua Borren of the Yuan Dynasty advocated governing all pulses with six pulses: Floating, Deep, Slow, Rapid, Slippery, and Astringent, using Floating/Deep to reflect location, Slow/Rapid to reflect rate, and Slippery/Astringent to reflect shape. Chen Xiuyuan advocated governing all pulses with eight pulses: Floating, Deep, Slow, Rapid, Deficient, Excess, Big, and Moderate. Koubu pulses include Koubu, Ge, and San pulses. Deep pulses include Lao and Fu pulses. Slow pulses include Jie and Dai pulses. Rapid pulses include Cu, Jin, and Dong pulses. Deficient pulses include Ruo, Ru, Fine, Faint, Short, and Astringent pulses. Excess pulses include Slippery, Long, Surging, and Wiry pulses. Big pulses include Moderate pulses. The above 28 pulses can be identified through pulse position, rate, force, and shape. For example, Floating/Deep differ in position; Slow/Rapid differ in rate; Big/Fine/Faint/Small differ in shape; Excess/Deficient/Koubu/Ruo differ in force. These pulse qualities form during the struggle between pathogens and Zheng Qi. Diseases have exterior/interior, cold/heat, deficiency/excess; bodies have prosperity/decline, strength/weakness; thus pulses have differences in Floating/Deep, Slow/Rapid, Big/Fine, Long/Short. Therefore, taking eight pulses as the guideline for the 28 pulses is a method of simplifying the complex for beginners. First master these eight pulse qualities, then further detail the 28 pulses, progressing from shallow to deep, step by step. Pulse studies are not difficult to comprehend. Following previous classification methods, we concretize them here, using Floating, Deep, Slow, Rapid, Long, Short, Fine, and Big as guidelines, attaching combined pulses to them. To facilitate analysis and memory, we compiled the "Eight Guidelines of Pulse Qualities in Four-Character Verse," appended below for beginners:
Floating pulse governs exterior, belongs to Fu, belongs to Yang; light touch reveals its image clearly.
Floating with strength is Surging pulse, fire blazing; floating without strength is Deficient pulse, Yin injury.
Floating with great deficiency is San pulse, irregular; floating like a scallion tube is Koubu pulse, blood disaster.
Floating like pressing a drum is Ge pulse, externally strong; floating with softness and fineness is Ru pulse, dampness injury.
Floating combined with six pulses requires careful distinction; Deep pulse governs interior, belongs to Zang, belongs to Yin.
Heavy hand seeks until understood in heart; deep reaching bone is Fu pulse, pathogen deep.
Deep with hard bottom is Lao pulse, cold invasion; deep with fine weakness is Ruo pulse, deficiency search.
Deep combined with three pulses must follow rules; Slow pulse governs cold, Zang disease also.
Two to three beats, number can be estimated; slow without extension is Huan pulse, disease resolving.
Slow without smoothness is Se pulse, blood stasis; slow with occasional stop is Jie pulse, depression/excess.
Slow stop with regular interval is Dai pulse, mostly death; Rapid pulse governs heat, Fu disease same.
Five beats or more, seven or eight are ominous; rapid with smoothness is Slippery pulse, phlegm surging.
Rapid with twisting is Jin pulse, cold attacking; rapid with occasional stop is Cu pulse, heat baking.
Rapid seen at Guan is Dong pulse, uterine bleeding; seeing four rapid pulses, do not be vague.
Long governs natural strength, rarely obtained; extending to fish area and Chi, long and not short.
Long and straight is Wiry pulse, belonging to Liver; under fingers long, Qi depression often seen.
Short pulse naturally weak, not from injury; aligning up and down, shrunk not long.
Often due to congenital deficiency, thin and withered; seeing this in various pulses, benefit Yin and Yang.
Fine governs all deficiencies, spider-silk image; pulse channel belongs to Yin, condition imaginable.
Fine not obvious is Faint pulse, Qi disaster; fine and small-deep is Ruo pulse, loss of nourishment.
Three fine pulses must be distinguished clearly; Big governs all excesses, broad shape easy to know.
Yang pulse disease implies pathogen excess; big and surging is Surging pulse, heat presiding.
Big and hard is Excess pulse, pathogen rampant; big combined with two pulses, disease盛, pathogen fierce.