【注】趺阳之脉以候脾胃，脉当和缓，今反滑而紧者，以滑为胃气实，紧为脾气强，滑紧并见，如持实以
击强，故主急痛，痛还自伤脾胃也。以手把刃而成疮者，犹之操刃自割，而贻其害也。
【集注】方有执曰∶滑为食，故在胃，则主谷气实。紧为寒，故在脾，则主邪气强。持实击强，言胃实脾
强，两相搏击而为病。譬如以手把刃而自伤，盖谓非由脏腑而传变也。
趺阳脉沉而数，沉为实，数消谷。紧者，病难治。
【注】胃脉沉而数，沉主里，数主热，沉数为里实热，则能消谷。凡里病得此脉者，皆易治也。若不沉数
而沉紧，沉紧为里寒，则为残伤胃气之诊，故曰难治也。
【集注】方有执曰∶沉以候里，故在脾胃为土实，谷气实也。数为热，阳也；紧为寒，阴也。言趺阳主脾
胃，脾胃主谷，谷气实。若脉见数而阳热胜，阳能化谷，虽病不足为害；若脉得紧而阴寒胜，阴不化谷，故为
难治。
程知曰∶言趺阳沉数为消谷之病也。沉为实，沉主里也；数消谷，数为热也。紧盛为邪胜，故为难治也。
趺阳脉大而紧者，当即下利，为难治。
【注】下利者，不论寒热皆中虚之病，故脉宜小宜缓，为病脉相宜，则易治也。今趺阳胃脉大而紧，为病
虚脉实，则不相宜，故为难治也。
【集注】成无己曰∶大为虚，紧为寒，胃中虚寒，当即下利。下利脉亦微小，今反大紧，邪盛也，故曰难
治。经曰∶下利脉大者，为未止。
张璐曰∶趺阳脉紧，为寒邪伤胃，故必下利。下利脉大为邪盛，故难治也。
趺阳脉微而紧，紧则为寒，微则为虚，微紧相搏，则为短气。
【注】脉见浮微而沉紧，虚寒之诊也。趺阳胃脉似有似无为阳虚，重按似紧为中寒，胃阳虚寒则气短矣。
紧脉主痛而不痛者，以紧兼微，虽紧不劲，故不痛也。
【集注】程知曰∶言趺阳微紧，则中气虚寒，为短气之证也。
趺阳脉不出，脾不上下，身冷肤硬。
【注】趺阳脉伏不出，则中焦阳虚，脾胃不能上下输布，卫气不得，故病通身肤冷而硬也。
【集注】程知曰∶身冷者卫气不温也，肤
硬者营血不濡也。
趺阳脉浮而芤，浮者卫气衰，芤者荣气伤，其身体瘦，肌肉甲错。浮芤相搏，宗气衰微，四属断绝。
【注】胃脉浮芤，浮者胃脉衰，芤者营气伤。卫气衰，故身体瘦也；营气伤，故肌肉甲错也。浮芤相搏，
日久而宗气衰微，生气少矣。四属断绝，谓皮、肉、脂、髓四者俱竭，故一身枯瘦失滋养矣。
【集注】程应旄曰∶卫以营为根，营以卫为护，而营卫之统于宗气者，又以趺阳胃为根也。
趺阳脉紧而浮，浮为气，紧为寒；浮为腹满，紧为绞痛；浮紧相搏，肠鸣而转，转即气动，膈气乃下，
少阴脉不出，其阴肿大而虚也。
【按】阴肿大而虚之“虚”字，当是“痛”字。细玩可知。
【注】外感，六脉浮紧，寒气在外，故骨节烦痛；内伤，胃脉浮紧，寒气在内，故腹满绞痛。寒气相搏，
肠鸣而转，转则膈中寒气下趋洞泄也。若少阴脉浮不出，则下焦阳虚，寒气聚于阴器，不得发泄，故病疝阴肿
大而痛也。
【集注】方有执曰∶趺阳之土败，而少阴所以无制也。
少阴负趺阳者，为顺也。
【注】此少阴负趺阳大旨。盖少阴肾属水，趺阳胃属土，杂病恶土克水，而伤寒少阴病，惟恐土不能制
水，水一泛溢，则呕吐、下利，无所不至。若趺阳脉和，胃土有权，则水有制，而少阴负则为顺矣。顺者，土
不为水侮也。
【集注】方有执曰∶万物资生于土，而百骸藉养于胃，水土平成，物阜人安，非天下之至顺乎？古今谓趺
阳有脉者不死，有以哉！
汪琥曰∶趺阳脉，《图经》原名冲阳脉，在足跗中指端，上行五寸，去陷谷穴三寸，足阳明脉之所过也，
为原，故一名会原，诊法病重者切之以决死生。伤寒以胃气为本，趺阳之脉不衰，知胃气尚在，病虽危犹可治也。
少阴脉弱而涩，弱者微烦，涩者厥逆。
【注】少阴脉弱而涩，弱者肾阴虚，故微烦也；涩者脉道滞，故肢冷也。
【集注】方有执曰∶弱为虚损不足脉，阴虚生内热，所以烦，然属虚烦，故虽烦亦微也。涩为少血而不滑，
不能上与阳相顺接，所以厥而逆冷也。
程知曰∶言肾脉微涩之病也。少阴，肾动脉也，在足内踝后跟骨上陷中也。
少阴脉不至，肾气微，少精血，奔气促迫，上入胸膈，宗气反聚，血结心下；阳气退下，热归阴股，与阴
相动，令身不仁，此为尸厥。当刺期门、巨阙。
【注】少阴脉不至，是肾气衰微，精血少也。肾者，阴中藏阳者也。肾阴虚竭，不能藏阳，阳气上奔，迫
促胸膈，宗气反为所阻，聚而不行，血结心下。阳气既奔于上，极必退下，退下则阴股间热，与阴相动，所必
然也，虽令知觉冥，身不仁而不死，此为尸厥也。当刺期门以通结血，刺巨阙以行宗气，庶厥回而复苏也。
【注释】趺阳脉（足背动脉，候脾胃之气）用于诊察脾胃状况，脉象应当和缓。如今反而出现滑而紧的脉象，其中“滑”代表胃气实盛，“紧”代表脾气强盛。滑脉与紧脉同时出现，就像手持实物去撞击强劲之物，因此主要症状是急痛，这种疼痛反过来会损伤脾胃。这就像用手握住刀刃造成创伤一样，如同操作利器自伤，从而留下祸害。
【集注】方有执说：滑脉主食积，所以在胃中，主谷气实盛。紧脉主寒邪，所以在脾中，主邪气强盛。“持实击强”，是指胃实脾强，两者相互搏击而致病。好比用手握刃而自伤，这里的意思是病并非由脏腑之间传变而来。
趺阳脉沉而数，沉脉主实，数脉主消谷善饥。若见紧脉，则病情难治。
【注释】胃脉沉而数，沉脉主里证，数脉主热证，沉数并见为里实热证，因此能消谷善饥。凡是里证出现这种脉象的，都容易治疗。如果不表现为沉数而是沉紧，沉紧脉主里寒，这是残伤胃气的征象，所以说难治。
【集注】方有执说：沉脉以候里证，所以在脾胃表现为土实、谷气实。数脉主热，属阳；紧脉主寒，属阴。趺阳脉主脾胃，脾胃主受纳水谷，谷气实盛。如果脉象见数而阳热胜，阳气能消化水谷，即使有病也不足为害；如果脉象得紧而阴寒胜，阴气不能消化水谷，所以为难治。
程知说：这是在说明趺阳脉沉数是消谷善饥的病机。沉脉主实，也主里证；数脉主消谷，也主热证。紧脉盛则为邪气胜，所以为难治。
【注释】下利（腹泻），不论寒热都属于中焦虚损的病证，所以脉象宜小宜缓，此为病与脉相适宜，则容易治疗。如今趺阳胃脉大而紧，这是病势虚而脉象实，病与脉不相适宜，所以为难治。
【集注】成无己说：大脉主虚，紧脉主寒，胃中虚寒，应当立即出现下利。下利的脉象也应该是微小，如今反而见大紧脉，说明邪气盛，所以说难治。《内经》说：下利而脉大的，表示病未停止。
张璐说：趺阳脉紧，是寒邪伤害胃腑，所以必然下利。下利而脉大是邪气盛，所以难治。
趺阳脉微而紧，紧脉主寒，微脉主虚，微脉与紧脉相搏结，会导致短气。
【注释】脉象浮取微细、沉取紧，这是虚寒的征象。趺阳胃脉似有似无为阳虚，重按感觉紧为中寒，胃阳虚寒则导致气短。紧脉通常主痛，但若不痛的，是因为紧脉兼见微脉，虽然紧但不劲急，所以不痛。
【集注】程知说：这是在说明趺阳脉微紧，导致中气虚寒，出现短气的证候。
【注释】趺阳脉搏伏不出，说明中焦阳虚，脾胃不能上下输布精气，卫气不得宣通，所以导致全身皮肤冷而硬。
【集注】程知说：身冷是因为卫气不能温煦，皮肤僵硬是因为营血不能濡润。
趺阳脉浮而芤（中空如葱管），浮脉代表卫气衰败，芤脉代表荣气（营气）受伤，患者身体消瘦，肌肉干枯如鳞甲交错。浮脉与芤脉相搏结，宗气衰微，皮、肉、脂、髓四属断绝。
【注释】胃脉浮而芤，浮脉代表胃脉衰败，芤脉代表营气受伤。卫气衰败，所以身体消瘦；营气受伤，所以肌肉干枯如鳞甲交错。浮脉与芤脉相搏结，日久宗气衰微，生气减少。所谓“四属断绝”，是指皮、肉、脂、髓四种组织全部枯竭，所以全身枯瘦失去滋养。
【集注】程应旄说：卫气以营气为根本，营气以卫气为护卫，而营卫统摄于宗气，又以趺阳胃气为根本。
趺阳脉紧而浮，浮脉主气滞，紧脉主寒邪；浮脉主腹满，紧脉主绞痛；浮紧相搏结，肠鸣转动，转动则气动，膈间之气乃下行，少阴脉搏动不出，其外阴肿大且疼痛。
【按语】“阴肿大而虚”中的“虚”字，应当是“痛”字。仔细推敲可知。
【注释】外感病，六部脉皆浮紧，寒气在体表，所以骨节烦痛；内伤病，胃脉浮紧，寒气在体内，所以腹满绞痛。寒气相互搏结，肠鸣转动，转动则膈中寒气下趋导致洞泄（严重腹泻）。如果少阴脉搏动浮而出，则是下焦阳虚，寒气聚集于阴器，不得发泄，所以导致疝气、阴囊肿大而痛。
【注释】这是少阴脉与趺阳脉比较的大旨。盖因少阴肾属水，趺阳胃属土，杂病厌恶土克水，而伤寒少阴病，惟恐土不能制水，一旦水气泛溢，则呕吐、下利等症状无所不至。如果趺阳脉平和，胃土有权力制约，则水有制，少阴脉弱于趺阳脉就是顺证。所谓顺，是指土不被水反侮。
【集注】方有执说：万物依靠土而生，百骸依赖胃气滋养，水土平衡，物产丰富，人民安康，这不是天下最大的顺遂吗？古今认为趺阳脉存在者不死，是有道理的！
汪琥说：趺阳脉，《图经》原名冲阳脉，位于足背中指端，上行五寸，距陷谷穴三寸，是足阳明胃经经过的地方，为原穴，所以又名会原穴。诊断方法中，病情危重者切按此脉以决断生死。伤寒病以胃气为本，趺阳脉不衰，知道胃气尚在，病虽危重仍可治疗。
【注释】少阴脉弱而涩，弱脉代表肾阴虚，所以轻微烦躁；涩脉代表脉道滞涩，所以四肢冰冷。
【集注】方有执说：弱脉是虚损不足的脉象，阴虚生内热，所以烦躁，但属于虚烦，所以虽然烦躁也是轻微的。涩脉是血少而不滑利，不能上与阳气顺接，所以发生厥逆冷。
程知说：这是在说明肾脉微涩的病机。少阴脉是肾动脉，位于足内踝后方跟骨上的凹陷处。
少阴脉搏动不至，肾气微弱，精血不足，奔豚之气急促迫促，上入胸膈，宗气反而聚积，血液凝结在心下；阳气退居下部，热气归于阴股，与阴气相互激荡，导致身体麻木不仁，这称为尸厥。应当针刺期门穴、巨阙穴。
【注释】少阴脉搏动不至，是肾气衰微，精血亏少的表现。肾，是阴中藏阳的脏器。肾阴虚竭，不能潜藏阳气，阳气上奔，迫促胸膈，宗气反而被阻滞，聚积而不运行，血液凝结在心下。阳气既已奔涌于上，极必退下，退下则阴股间发热，与阴气相互激荡，这是必然的，即使导致知觉冥顽，身体麻木不仁，但不会死亡，这称为尸厥。应当针刺期门穴以疏通凝结的血液，针刺巨阙穴以运行宗气，这样厥逆可回，病人得以复苏。
[Commentary] The Duyang pulse (dorsalis pedis artery, used to inspect Spleen and Stomach Qi) is employed to examine the condition of the Spleen and Stomach; the pulse should be harmonious and moderate. Now it appears slippery and tight instead. "Slippery" indicates excess Stomach Qi, while "tight" indicates strong Spleen Qi. When Slippery and Tight pulses appear together, it is like holding a solid object to strike something powerful; therefore, the primary symptom is acute pain, which in turn damages the Spleen and Stomach. This is akin to causing a wound by grasping a blade with one's hand, similar to injuring oneself with a sharp tool, thereby bringing about harm.
[Collected Commentaries] Fang Youzhi stated: The Slippery pulse relates to food retention; thus, when present in the Stomach, it indicates excess Grain Qi. The Tight pulse relates to Cold pathogen; thus, when present in the Spleen, it indicates strong Pathogenic Qi. "Holding the substantial to strike the strong" refers to the Stomach being excess and the Spleen being strong, with the two battling each other to cause disease. It is like injuring oneself by grasping a blade; this implies that the disease does not arise from transmission between Zang-Fu organs.
When the Duyang pulse is Deep and Rapid, Deep indicates Excess, and Rapid indicates the ability to digest food (polyphagia). If the Tight pulse is present, the disease is difficult to treat.
[Commentary] A Stomach pulse that is Deep and Rapid: Deep indicates Interior syndrome, and Rapid indicates Heat. Deep and Rapid together indicate Interior Excess-Heat, which enables the digestion of food. For any Interior disease presenting with this pulse, it is easy to treat. However, if the pulse is Deep and Tight rather than Deep and Rapid, Deep and Tight indicates Interior Cold; this is a diagnosis of damaging Stomach Qi, hence it is said to be difficult to treat.
[Collected Commentaries] Fang Youzhi stated: The Deep pulse inspects the Interior; thus, in the Spleen and Stomach, it represents Earth Excess and excess Grain Qi. Rapid indicates Heat, which is Yang; Tight indicates Cold, which is Yin. Since Duyang governs the Spleen and Stomach, and the Spleen and Stomach govern grain, Grain Qi is excess. If the pulse shows Rapidness and Yang-Heat prevails, Yang can transform grain, so even if there is disease, it is not harmful. If the pulse shows Tightness and Yin-Cold prevails, Yin cannot transform grain, hence it is difficult to treat.
Cheng Zhi stated: This explains that the Deep and Rapid Duyang pulse indicates the disease of polyphagia. Deep indicates Excess and also Interior; Rapid indicates polyphagia and also Heat. An abundance of Tightness indicates Pathogen prevalence, hence it is difficult to treat.
If the Duyang pulse is Large and Tight, diarrhea should immediately occur, which is a difficult-to-treat condition.
[Commentary] Diarrhea, regardless of whether it is Cold or Heat, is a disease of Middle Jiao deficiency; therefore, the pulse should be Small and Slow. This indicates harmony between disease and pulse, making it easy to treat. Now, the Duyang Stomach pulse is Large and Tight, indicating that the disease is deficient while the pulse is excess; this disharmony makes it difficult to treat.
[Collected Commentaries] Cheng Wuji stated: Large indicates deficiency, and Tight indicates Cold. Deficient-Cold in the Stomach leads immediately to diarrhea. The pulse for diarrhea should also be minute and small; now it is unexpectedly Large and Tight, indicating Pathogen excess, hence it is difficult to treat. The Classic states: In diarrhea, a Large pulse means the disease has not stopped.
Zhang Lu stated: A Tight Duyang pulse indicates Cold Pathogen injuring the Stomach, so diarrhea must occur. A Large pulse in diarrhea indicates Pathogen excess, hence it is difficult to treat.
If the Duyang pulse is Faint and Tight, Tight indicates Cold, and Faint indicates Deficiency. The interaction of Faint and Tight leads to shortness of breath.
[Commentary] A pulse that is Faint on superficial palpation and Tight on deep palpation is a sign of Deficient-Cold. The Duyang Stomach pulse appearing faint and indistinct indicates Yang deficiency; feeling Tight upon heavy pressure indicates Middle Cold. Deficient-Cold of Stomach Yang leads to shortness of breath. Although the Tight pulse usually indicates pain, if there is no pain, it is because the Tightness is accompanied by Faintness; although Tight, it is not forceful, hence there is no pain.
[Collected Commentaries] Cheng Zhi stated: This explains that a Faint and Tight Duyang pulse causes Middle Qi Deficient-Cold, leading to the syndrome of shortness of breath.
If the Duyang pulse is imperceptible, the Spleen's Qi mechanism fails to circulate up and down, resulting in cold body and stiff skin.
[Commentary] If the Duyang pulse is hidden and imperceptible, it indicates Middle Jiao Yang deficiency. The Spleen and Stomach fail to distribute essence and Qi up and down, and Wei-Qi (Defensive Qi) cannot circulate freely, resulting in cold and stiffness throughout the body and skin.
[Collected Commentaries] Cheng Zhi stated: Body coldness is due to Wei-Qi failing to warm; skin stiffness is due to Ying-Qi (Nutritive Qi) failing to moisten.
If the Duyang pulse is Floating and Hollow (Kou), Floating indicates the decline of Wei-Qi (Defensive Qi), and Hollow indicates injury to Ying-Qi (Nutritive Qi). The body becomes emaciated, and muscles are dry and scaly like fish scales. The interaction of Floating and Hollow pulses leads to the decline of Zong-Qi (Gathering Qi), and the severance of the Four Belongings (Skin, Flesh, Fat, Marrow).
[Commentary] A Stomach pulse that is Floating and Hollow: Floating indicates the decline of Stomach pulse, and Hollow indicates injury to Ying-Qi. The decline of Wei-Qi leads to body emaciation; the injury to Ying-Qi leads to muscles becoming dry and scaly. The interaction of Floating and Hollow pulses over time leads to the decline of Zong-Qi and a reduction in vital Qi. "Severance of the Four Belongings" refers to the exhaustion of Skin, Flesh, Fat, and Marrow, causing the whole body to become withered and lose nourishment.
[Collected Commentaries] Cheng Yingmao stated: Wei-Qi takes Ying-Qi as its root, and Ying-Qi takes Wei-Qi as its protection. The unity of Ying and Wei under Zong-Qi takes the Duyang Stomach Qi as its root.
If the Duyang pulse is Tight and Floating, Floating indicates Qi stagnation, and Tight indicates Cold; Floating indicates abdominal fullness, and Tight indicates colic pain. The interaction of Floating and Tight leads to borborygmus and intestinal movement; movement generates Qi movement, allowing Diaphragm Qi to descend. If the Shaoyin pulse does not emerge, the external genitalia will be swollen and painful.
[Note] The character "Xu" (deficiency/empty) in "swollen and empty external genitalia" should likely be "Tong" (pain). This can be discerned through careful study.
[Commentary] In exterior contraction diseases, all six pulses are Floating and Tight; Cold Qi is on the exterior, causing bone and joint vexation and pain. In interior injury diseases, the Stomach pulse is Floating and Tight; Cold Qi is inside, causing abdominal fullness and colic pain. The interaction of Cold Qi causes borborygmus and intestinal movement; movement causes Cold Qi in the Diaphragm to descend into severe diarrhea. If the Shaoyin pulse floats but does not emerge, it indicates Lower Jiao Yang deficiency, with Cold Qi gathering in the genitalia without venting, leading to hernia and painful swelling of the penis/scrotum.
[Collected Commentaries] Fang Youzhi stated: The failure of Duyang Earth allows Shaoyin [Water] to be unconstrained.
When the Shaoyin pulse is weaker than the Duyang pulse, it is a favorable prognosis.
[Commentary] This is the main principle regarding the comparison between Shaoyin and Duyang pulses. Shaoyin Kidney belongs to Water, and Duyang Stomach belongs to Earth. In miscellaneous diseases, Earth overcoming Water is feared; however, in Shaoyin disease of Cold Damage, what is feared is Earth's inability to control Water. Once Water overflows, vomiting and diarrhea occur without limit. If the Duyang pulse is harmonious, Stomach Earth has authority to control, so Water is restrained, and a weaker Shaoyin pulse is considered favorable. Favorable means Earth is not insulted by Water.
[Collected Commentaries] Fang Youzhi stated: All things rely on Earth for birth, and the hundred bones rely on Stomach Qi for nourishment. When Water and Earth are balanced, resources are abundant, and people are peaceful; is this not the greatest favorability in the world? Since ancient times, it has been said that those with a Duyang pulse do not die; there is reason for this!
Wang Hu stated: The Duyang pulse, originally named Chongyang pulse in the *Tu Jing*, is located at the end of the middle toe on the dorsum of the foot, ascending five cun, three cun away from Xangu acupoint. It is where the Foot-Yangming Stomach Meridian passes and is the Yuan-Source point, hence also called Huiyuan. In diagnostic methods, pressing this pulse in critically ill patients determines life or death. Cold Damage disease takes Stomach Qi as its foundation; if the Duyang pulse does not decline, it is known that Stomach Qi remains, and although the disease is critical, it is still treatable.
If the Shaoyin pulse is Weak and Choppy, Weakness indicates slight vexation, and Choppyness indicates cold limbs (Jue Ni).
[Commentary] A Shaoyin pulse that is Weak and Choppy: Weakness indicates Kidney Yin deficiency, hence slight vexation; Choppyness indicates stasis in the pulse vessels, hence cold limbs.
[Collected Commentaries] Fang Youzhi stated: The Weak pulse is a sign of deficiency and insufficiency. Yin deficiency generates internal heat, causing vexation; however, since it is deficient vexation, the vexation is slight. The Choppy pulse indicates scant blood and lack of smoothness, unable to connect smoothly with Yang above, hence causing Jue (reversal) and cold limbs.
Cheng Zhi stated: This explains the pathology of the Kidney pulse being Micro and Choppy. The Shaoyin pulse is the Kidney artery, located in the depression above the heel bone behind the medial malleolus of the foot.
If the Shaoyin pulse is absent, Kidney Qi is micro, and Essence-Blood is scant. Rushing Qi (Ben Qi) presses urgently upward into the chest and diaphragm; Zong-Qi (Gathering Qi) gathers in reverse, and Blood coagulates below the Heart. Yang Qi retreats downward, Heat returns to the inner thighs, interacting with Yin, causing the body to become insensible. This is called Corpse-Jue (Shi Jue). One should puncture Qimen and Juque acupoints.
[Commentary] The absence of the Shaoyin pulse indicates the decline of Kidney Qi and scarcity of Essence-Blood. The Kidney is the organ that stores Yang within Yin. When Kidney Yin is exhausted, it cannot store Yang; Yang Qi rushes upward, pressing urgently on the chest and diaphragm. Zong-Qi is obstructed and gathers without moving, causing Blood to coagulate below the Heart. Having rushed upward, Yang Qi must eventually retreat downward; upon retreating, heat arises in the inner thighs, interacting with Yin, which is inevitable. Even if perception becomes dull and the body is insensible, death does not ensue; this is called Corpse-Jue. One should puncture Qimen to unblock coagulated Blood and puncture Juque to move Zong-Qi, so that Jue reverses and revival occurs.