诊脉常以平旦阳脉未动。阴气未散。饮食未进。经脉未盛。络脉未调。血气未绝。端坐正平。乃可诊看有过之脉。
若怆悴之病者。即不拘平旦也。故切脉动静。而观精神。察五色。视五脏有余不足。六脉强弱。形之盛衰。以三五
决死生之分。切谓诊切以搏按切其脉也。动谓脉有燥。有动而不调者。或太过或不及也。动则为脉急也。静谓根据顺本位。
以应四时之和气。无太过不及。静守常脉而不病者也。精明者。诊视病患左右目内皆明。明堂两清。面部内或见五色。
观形切脉。皆谓之也。诊视色脉者。五脏六腑血脉相应也。见青色肝脉应。见赤色心脉应。见黄色脾脉应。见黑色肾脉
应。此色脉相应。然又察其病脉以相生者轻。而相克者甚。脉乱气见交泰者。死候也。是谓三五不调。色脉相交泰。推
其病势急者可知矣。盖取五行之气色相生也。木火土金水也。木生火。火生土也。相克者金木土水火也。金克木。木克
土。土克水。水克火。火克金是也。盖脉者血之府也。血实则脉实。血虚则脉虚。长则气治。短则气痛。数则烦心。大
则病
进。上盛则气高。下盛则气胀。代则血衰。细则气少。涩则心痛。所谓长脉者。脉气和滑而长。非谓太过而长。气和滑
而长者。乃和畅之气也。根据顺四时旺气而不病者也。长则气治。而气理气治矣。短脉者气痛也。脉短促于指下。正气不
长。故气病也。数则烦心者。脉数疾而又多至也。烦热者。火气动应于心。故烦痛也。大则心脉洪数。乃脉散大。是心
火燥动之气。又加之脉大盛者。邪亦大盛故病进也。上盛则气高者。人脉上盛邪气益盛。故人气喘病也。下盛则气胀者。
人脉下盛。邪气亦下盛。故人腹胀气满也。代则气衰者。代谓脉停待而脉方来也。脉强盛满。大来气甚。脉迟故曰气衰。
脉甚迟也。故气衰胀满。亦病进也。进则危甚矣。脉细则血少。脉来细小。气亦细小也。故气羸乏而亦细小也。涩则心
痛者。脉涩而真气不滑则于常经也。缓诸脉尽会于心。血气涩滞。故心气不足。则心痛矣脉之浮。芤。滑。实。弦。紧。
洪者。皆病在表。属阳也。主热重。热重者。盛为烦躁狂也。凉药冷服则瘥。重手按切见阴脉。名阴中阳病。必先寒后
热。凉药温服则愈。更虚实补泄为准。脉之微。沉。缓。涩。迟。伏。濡。弱者。皆病在里。属阴脉也。重手按之阴脉
也。名阴痛病。乃是中于阴寒多。则以温药热服而瘥。若手切得阴脉者。名曰阳中阴病。必先热而后寒。温凉药冷服而
效。脉之洪。大。浮。数。紧。动。滑。实者。皆为阳脉。来之有力。则为阳实。无力则为阳虚。其沉细微涩迟伏。皆
阴脉。来之有力则阴实。无力则阴虚。随病候诊之。实则泻。虚则补。阴阳证候损益治之。寒热治疗。脉证表里在阴阳。
兼于两寸口。左名人迎右名气口。兼以候之。浮为在表。沉为在里。数为在腑。迟为在脏。举此人迎气口。一经二部并
过。但兼于此二处定之。稍浮沉迟数三部为则者。便定表里冷热也。左寸人迎。并至血脉之会荣血也右寸气口。卫气也。
冷。热。虚。实。沉。浮。根据至数定之。治疗万全。凡人身血脉。循环昼夜不息。有如流水。流水得风寒。则水结而不
流。人中风寒。则血脉结涩而不行。水中风热。淖溢而受恶。血脉得风寒热。亦过溢而不调。和风寒冷热治疗不同。切
须详审无失。绳墨无差者。治热当以寒。治寒当以热。乃正治之法。不失绳墨也。更新之意。更在详思精察矣。诊之理
当端坐。听候其气正均平。乃可诊之。凡人一呼。脉再至。一吸脉再至。谓将不病患之气。应调此病患也。呼吸为一息。
共得四至。是脏腑气足。故合五九之数。四十五动。故一息之动间四至。乃平和之脉也。又须呼吸之间复一至者。名曰
闰大之息。若合得五十度。阴阳方足。命曰呼吸五至。方得平和。又须不大不小。谓以应四时五气。命曰脉气俱无病也。
今人受远天真。可终百年。或有太小不均之息。是脉不和。是五脏亦不调矣。然署脉息浮沉定病。诊之若及之者。又多
于五至平和之脉。是难经之脉。谓难平和。本经脉气之数。此即病脉。若诊前大后小。则病患头痛目痛眩。前小后大。
则背短气满。中热。迟则为寒。涩则中寒露冷气。紧则风寒伤骨。滑则为痰。迎为消。沉为温冷洞泄。缓为冷风之候迟
为气塞胀满。浮为中风在表。伏则有水蓄聚。弦急为风热所盛。则气结于肠中。芤则失血下痢。洪大则阳热伏留。令人
躁闷。动亦气血不利。微为气血虚乏。实则气满心腹胀。以前脉证。若在寸口脉见。其病在上主胸膺心肠。若在尺中脉
见。
其病在下。主脐腹腰脚。但根据寒。热。虚。实。补。泻。无不中效也。若脉未及七至。又多于少至。其病则甚。须
用意治疗。病防迁次。别有变动。缘五数既多。邪亦添深。故浮大昼加病。沉细夜
加病甚。其候也若更及八至者。乃精气消。神气乱。必有散脱精神之候须切急治疗。又加至九至十至者。虽返魂灵丹。
亦难疗矣。人生于地。悬命于天。人之性命。莫非天赋天数也。病候虽疾。脉至过多。且须度命。用心治之。恐是邪气
过盛。以滞天真。气乱不调。未可轻生至死。不与之疗。是为误矣。如脉有九至以上。更加之悬绝者。如物之悬断无根
本。
将何以生。脉溢如涌者。如泉涌出之状。脉无入气亦无来往之状。亦乃天真尽而元气绝也。故人气亦绝矣。死矣。凡诊
脉先观夫长短肥瘦。形气相得者病。形气损者危。而气尽死矣。形气既返。而脉又加之悬绝。形气俱病。见者立死。故
人长脉亦长。人短脉亦短。人肥脉亦浓。人瘦脉亦急。此形气之相得也。脉之状者。犹人之有眉眼耳口鼻也。但肥瘦长
短妍丑之不同也。令脉息亦然。浮沉迟数亦值人之长短肥瘦。性之缓急。而合于人形。见于指下者顺。反此者逆然人赖
五行以生。而常为邪气所攻。若非须有误中他邪得病。易为治疗。谓形气相得。形气不相得而反者。谓人长脉短之类。
若得病必难拯治。此是人之气候先病也。未病者。不久当病。必为近于死者。切须畏怠蹲节。和气调神。匆更恣意不慎。
转耗天真。至于弗救。乃自取困顺耳。凡脉顺四时者。谓春弦夏洪。秋毛冬实。中有和气。软滑而长。乃是不病之人。
纵病易为治疗也。盖从和气而生也。用法方全。如气反脉运。形气相失者。乃不可治也。由形盛气虚。形虚气盛。故不
可治也。凡人形气俱病。安妥者。不过期而死。安妥谓饮食且进期。是八节之气候诊脉治病。必先看其人之肥瘦。以调
气之虚实。虚则补之。实则泻之。故人形盛脉细。少气不足者危者。近于死也。犹有可治之理也。气不足而形盛故也。
言形瘦脉大。胸中多气者必死。是形气俱不足。而脉反有余。故死矣。其形气相得者生。乃人形气肥瘦长短。气候相得
故生也。三五不调者。病谓色脉交乱。而不调故也。上下寸关尺三部如参杂者。病甚也。三部脉左右手失。至不可数者
死。是一呼一吸。脉来往十至以上。血生气故死也。大凡诊脉先断四时之脉。辨取太过不及。虚实冷热寒温。至数损益。
阴阳盛衰。五行相克。脏腑所属看之。以为大法。然后取其人之形神长短。气候虚实盛衰。性气高下。衣食老幼强弱。
但
顺形神。四时五气。气候无过者生之本。及其形气。与五行克者危。病若过盛。而形气反逆克鬼贼脉。有悬绝者死不治
矣。谓五虚五实。虽皆死证亦有生者何。盖浆粥入胃。泄注止而虚者乱。身得汗出。大小便利则实者乱。此有生也。不
可见虚实病重。不急救治致其死。有生气者救之。三乱矣。大凡治病先看其病患之形肥瘦。候其气之盛衰。实则泻之。
虚则补之。急泻未利。急补缓补。皆疾病之紧慢。用法治之乃全矣。又经言先去血。然后调之去血者。缘人血脉为宗。
主血既瘀滞气。则不能流行。故必先去瘀血滞血。然后调和卫气。若瘀血在经脉之中。必终脉有肿毒。独异于常经也。
盒饭先决去恶血。然后调逆滞之气。无间大小新旧之病。以此为准。治之万全矣。若血在经络分内运动枢机斡旋之药去
之。如血在脏腑。须于大小便泻泄去之。但血在上则忘者。病患言诈而多忘也。血在下则狂言。多急速者。便须调之。
虚
则郑声。实则诚言。郑声者。郑重声散。不知高下也。诚语者。以其言语诚而多往。言必诚之事也。上皆病之虚实。若
发言而有热。去血则用大黄地黄之类。若病既有寒。破去涩血。则用当归水蛭之类治疗速效矣且稳也。诸病之起。未有
不因六气也。七情所感寒。暑。温。燥。热。怒。悲。思。忧。恐。惊。内外邪正。致生百病。风寒暑湿炎凉。证候各
异于常脉。邪血未入。血脉脏腑。皆可汗可泻。可平可治。可吐可泄。可和可渗。可决可祛。若邪气深。故腠理传入六
经。又加之用汤丸。其纯墨治疗无准。使大病又加传注者。则病传克则死。谓金木水火土相克也。仍别将证候脉息看详。
切从深浅缓急标本轻重治之。若见急病邪气。但从害命重处。先治之。更不问阴阳标本也。若体中有寒。则筋挛骨痛也。
治之以温。体中有热。则痿缓不收。瘫痪少力。治之以凉。更在仔细详之。凡人之国中病。便不如常者。则诊视脉证形
体。恶风者伤风。怯寒者病寒。脉之浮紧皆中风。寒在表则可汗之。宜用温药。五积散散之。小寒之邪乃可温之。大寒
之邪。可以热之。理中丸之类主之小逆者。可以和之。但身恶热者有热。脉洪数浮大皆中热也。从中风邪。更有轻重。
如大小续命汤之类加减主之。热在于表。热之解之。宜用凉药。小柴胡之类主之。小热之邪可以凉之。大热之邪。可以
冷之。则用大柴胡之类。虚热虚烦。竹茹汤温胆汤之类补解之。或有逆者。可以橘皮人参生姜汤。凉温药。和之正之。
如病证有寒热。有伤于中。寒热也。先寒者为先中寒伤于阳经。此乃阴邪在阳经之理也。寒气盛。故先寒动也。先热者。
先中于热。阳邪在表。故热先发也。但从热从寒。辨证诊脉。表里先后治之。若病患脉浮而紧盛。恶寒身体头面痹。项
强。四肢疼痛。腰脚皆疼。是太阳中邪。并可汗之。但脉紧实沉盛。或滞涩而头甚疼。体不恶寒。皆可治里。仍虚实且
泄调顺。不拘于日数。当从急重而治也。宜详之若表和里病。下之温之便愈。里和表病。散之汗之立愈。但四肢温和。
只是头疼心腹胀满。脉又沉实或伏缓者。此是表和里满。病不可下。须守待五日方泻。缘其病在里急。宜逐去邪气。虑
有变动。若出邪气。病不实时而愈。如脉浮或壮热。四肢烦痛。恶寒项强腰膝。此是表未和。里却无滞。不可下。下之
必危。急宜解表发汗。更根据日数次第。看证候调治。必愈。脉或微不可吐脉虚细不可下。阴虚者其脉沉微。气弱者不可
发汗。倘不根据证而妄行汗下者。医杀之也。当和之平之自然得效。令中病者。初得可吐可汗。可攻可泻。可平便愈。其
有邪盛。或治疗无准。渐传固疾。则别证候。理之万全。令再引五脏病症。记候调治之法也。不治损误矣。经云。肝病
者。两胁下痛引小腹。令人善怒。肝气实则怒病。重则目茫然无所见。耳无所闻。如人将捕而惊怖也。亦至喉咙气噎不
利。前所论血。如血脉中。血满独异如常脉。诊左右有血可先去恶瘀之血。（在上则忘。在下强也。）然后调气脉矣。谓
四时之脉。春肝合弦。弦多胃气少曰病。但弦不长。胃气绝曰死。盖春弦脉。如平规之象也。（此语浮中沉三部也。使而
体脉多者。盖中按不足。骨气少也。余脏仿此而推之。）脉见病证应太过之脉。令人善怒。忽忽眩冒。癫疾也。乃头也。
怒则肝气实也。不足者。谓不及中象也。又少如微弦之脉。却减下也。故来气不及于常也。令人胸痛引胁下。两胁弦
满痛也。胁谓腋下连胁出。故肝病委胁也。夏心脉合洪。洪多胃气少。曰病。洪无胃气。曰死。心南方火也。王气如钧。
按之钩者。来疾而去。迟如中短之象。火气王主心。夏应中矩和气。洪大兼之滑利。其气正中如矩之象也。太过者。不
和气也。过于本位洪大益盛。病在外。令人身热而虑痼。为浸淫热气也不及者。脉不根据中矩之象也。又却减下其数。亦
不洪数。其和气不平正而少也。是来气不及。令人短心也。上见嗽唾。不为气泄。癖也。秋肺脉合毛。毛多胃气少。曰
病。但毛无胃气。曰死。肺者。西方金也。其脉浮。胃轻毛软虚。名曰浮而短。和平之气也。其气正中高下。如中衡之
象也。正平象涩也。太过者。不和之气也。益盛于浮。浮盛而强虚轻。里坚者。是浮过也。令人逆气而背愠痛也。自背
痛而愠愠气温也。不及者。应脉见轻虚而毛。又不减于常脉也。按之不应中衡之象。而轻虚也。气虚故为气弱也。人病
喘而呼吸。少气而嗽上气。肺中声鸣也。冬脉者。肾也冬肾。合沉沉多胃气少。曰病。但沉无胃气。曰死。盖肾乃北方
诊脉通常选择在清晨，此时阳气尚未发动，阴气尚未散失，饮食尚未摄入，经脉之气尚未旺盛，络脉之气尚未调和，血气运行尚未因活动而紊乱。患者需端正坐姿，呼吸平稳，方可诊察是否有异常的脉象。
如果是神色憔悴的病人，则不必拘泥于清晨这一时间。因此，切按脉象的动静，以观察患者的精神状态；审视面部的五色，以考察五脏之气的有余或不足；判断六部脉象的强弱，以及形体盛衰的情况，以此综合决断生死界限。所谓“切”，是指通过搏按来诊察脉象；所谓“动”，是指脉象有躁动、不协调的现象，或者过于亢盛或不及，这种躁动表现为脉象紧急；所谓“静”，是指脉象顺应本位，符合四时平和之气，没有太过或不及，是守持常脉而不生病的状态。
所谓“精明”，是指在诊视病患时，观察其左右眼内皆明亮，明堂（鼻部）两清，面部隐约可见五色。观察形体和切按脉象，都称为“精明”。诊视色与脉的关系，是因为五脏六腑的血脉相互相应。见到青色，肝脉应之；见到赤色，心脉应之；见到黄色，脾脉应之；见到黑色，肾脉应之。这是色脉相应的道理。然而还要考察病脉与五行的关系：相生者病情轻，相克者病情重。如果脉乱且气机出现交泰（反常的和谐假象），这是死候。这被称为“三五不调”。色脉相交泰，推究其病势急迫的程度就可以知道了。这大概取法于五行之气的相生关系：木、火、土、金、水。木生火，火生土。相克的关系是：金克木，木克土，土克水，水克火，火克金。
大抵脉是血的府库。血实则脉实，血虚则脉虚。脉长则气机调治，脉短则气机疼痛，脉数则心烦，脉大则病势进展。上部脉盛则气逆喘促，下部脉盛则腹胀满。代脉表示血气衰败，细脉表示气少，涩脉表示心痛。所谓长脉，是指脉气调和滑利而长，并非指太过而长。脉气和滑而长，是和畅之气，顺应四时旺气而不生病。长则气机调治，气理通畅。短脉则是气痛，脉短促于指下，正气不长，所以是气病。数则烦心，是指脉数疾而且次数多。烦热是因为火气动应于心脏，所以烦痛。大则心脉洪数，脉象散大，这是心火燥动之气，加上脉大盛，邪气也盛大，所以病势进展。上盛则气高，是指人脉上部盛，邪气益盛，所以人气喘病。下盛则气胀，是指人脉下部盛，邪气亦在下盛，所以人腹胀气满。代则气衰，代脉是指脉有停顿等待而后才来。脉强盛满，大来气甚，但脉迟，所以说气衰，脉非常迟。所以气衰胀满，也是病势进展。进则危险严重了。脉细则血少，脉来细小，气也细小。所以气虚弱乏力而脉细小。涩则心痛，是指脉涩而真气不滑利，不能通达常经。各种脉象都会会聚于心，血气涩滞，所以心气不足，就会心痛。
脉象浮、芤、滑、实、弦、紧、洪的，都是病在表，属阳。主热重，热重会导致烦躁狂乱。凉药冷服则可痊愈。重手按切见到阴脉，名叫阴中阳病。必定先寒后热，凉药温服则可愈。更应根据虚实进行补泻。脉象微、沉、缓、涩、迟、伏、濡、弱的，都是病在里，属阴脉。重手按之是阴脉，名叫阴痛病。这是因为中于阴寒较多，所以用温药热服可愈。如果用手切得阴脉，名叫阳中阴病。必定先热后寒，温凉药冷服有效。脉象洪、大、浮、数、紧、动、滑、实的，都是阳脉。来势有力则为阳实，无力则为阳虚。其沉、细、微、涩、迟、伏的，都是阴脉。来势有力则阴实，无力则阴虚。随病候诊察，实则泻，虚则补，根据阴阳证候进行损益治疗。寒热治疗，脉证表里都在阴阳之中。兼看两寸口，左名人迎，右名气口，兼以诊察。浮为在表，沉为在里，数为在腑，迟为在脏。举此人迎气口，一经二部并过，只要兼于此二处确定。稍微区分浮沉迟数三部作为准则，就能确定表里冷热。左寸人迎，是血脉之会，荣血所在；右寸气口，是卫气所在。冷、热、虚、实、沉、浮，根据至数确定。治疗万全。
凡是人身血脉，循环昼夜不息，如同流水。流水遇到风寒，则水结冰而不流；人中风寒，则血脉结涩而不行。水中风热，则浑浊溢出而受污秽；血脉遇到风寒热，也会过度溢出而不调和。和风寒冷热的治疗不同，切须详细审察，不要失误。像绳墨一样没有差错，治热应当用寒，治寒应当用热，这是正治之法，不失绳墨。更新的意义，在于详细思考精察。诊脉的道理应当端坐，听候其气息正均平，才可以诊察。凡人一呼，脉跳动两次；一吸，脉跳动两次。这叫作不患病时的气，应当调理这个病患。呼吸为一息，共得四次跳动，这是脏腑气足，所以合五九之数，四十五动。所以一息之间跳动四次，乃是平和之脉。又须在呼吸之间再增加一次跳动，名叫闰大之息。如果合得五十次，阴阳方才充足，名叫呼吸五至，方才得到平和。又须不大不小，以顺应四时五气，名叫脉气俱无病。今人禀受远天的真气，可以终享百年。如果有太小不均的呼吸，是脉不和，五脏也不调了。
然而署脉息浮沉定病，诊察如果达到五次以上，多于五至平和之脉，这是《难经》所说的脉，谓难以平和，是本经脉气之数，此即病脉。如果诊脉前大后小，则病患头痛目痛眩晕。前小后大，则背短气满闷，心中热。迟则为寒，涩则中寒露冷气，紧则风寒伤骨，滑则为痰，迎为消渴，沉为温冷洞泄，缓为冷风之候，迟为气塞胀满，浮为中风在表，伏则有水蓄聚，弦急为风热所盛，则气结于肠中，芤则失血下痢，洪大则阳热伏留，令人躁闷，动亦气血不利，微为气血虚乏，实则气满心腹胀。以前脉证，如果在寸口脉见，其病在上，主胸膺心肠。若在尺中脉见，其病在下，主脐腹腰脚。但根据寒、热、虚、实、补、泻，无不中效。
如果脉未及七至，又多于少至，其病则重，须用意治疗，病防迁延，别有变动。缘五数既多，邪亦添深，所以浮大昼加病，沉细夜加病甚。其候也若更及八至者，乃精气消，神气乱，必有散脱精神之候，须急切治疗。又加至九至十至者，虽返魂灵丹，也难疗矣。人生于地，悬命于天。人之性命，莫非天赋天数也。病候虽疾，脉至过多，且须度命，用心治之。恐是邪气过盛，以滞天真，气乱不调，未可轻生至死，不与之疗，是为误矣。如脉有九至以上，更加之悬绝者，如物之悬断无根本，将何以生？脉溢如涌者，如泉涌出之状，脉无入气亦无来往之状，亦乃天真尽而元气绝也。故人气亦绝矣，死矣。
凡诊脉先观夫长短肥瘦，形气相得者病，形气损者危，而气尽死矣。形气既返，而脉又加之悬绝，形气俱病，见者立死。故人长脉亦长，人短脉亦短，人肥脉亦浓，人瘦脉亦急。此形气之相得也。脉之状者，犹人之有眉眼耳口鼻也。但肥瘦长短妍丑之不同也。令脉息亦然，浮沉迟数亦值人之长短肥瘦、性之缓急，而合于人形，见于指下者顺，反此者逆。然人赖五行以生，而常为邪气所攻。若非须有误中他邪得病，易为治疗。谓形气相得，形气不相得而反者，谓人长脉短之类。若得病必难拯治，此是人之气候先病也。未病者，不久当病，必为近于死者。切须畏怠蹲节，和气调神，匆更恣意不慎，转耗天真，至于弗救，乃自取困顺耳。
凡脉顺四时者，谓春弦夏洪，秋毛冬实。中有和气，软滑而长，乃是不病之人，纵病易为治疗也。盖从和气而生也。用法方全。如气反脉运，形气相失者，乃不可治也。由形盛气虚，形虚气盛，故不可治也。凡人形气俱病，安妥者，不过期而死。安妥谓饮食且进期，是八节之气候。诊脉治病，必先看其人之肥瘦，以调气之虚实。虚则补之，实则泻之。故人形盛脉细，少气不足者，危者，近于死也。犹有可治之理也，气不足而形盛故也。言形瘦脉大，胸中多气者必死，是形气俱不足，而脉反有余，故死矣。其形气相得者生，乃人形气肥瘦长短，气候相得故生也。
三五不调者，病谓色脉交乱，而不调故也。上下寸关尺三部如参杂者，病甚也。三部脉左右手失，至不可数者死，是一呼一吸，脉来往十至以上，血生气故死也。大凡诊脉先断四时之脉，辨取太过不及，虚实冷热寒温，至数损益，阴阳盛衰，五行相克，脏腑所属看之，以为大法。然后取其人之形神长短，气候虚实盛衰，性气高下，衣食老幼强弱，但顺形神，四时五气，气候无过者生之本。及其形气，与五行克者危。病若过盛，而形气反逆克鬼贼脉，有悬绝者死不治矣。谓五虚五实，虽皆死证亦有生者何？盖浆粥入胃，泄注止而虚者乱，身得汗出，大小便利则实者乱，此有生也。不可见虚实病重，不急救治致其死。有生气者救之，三乱矣。
大凡治病先看其病患之形肥瘦，候其气之盛衰。实则泻之，虚则补之。急泻未利，急补缓补，皆疾病之紧慢，用法治之乃全矣。又经言先去血，然后调之。去血者，缘人血脉为宗，主血既瘀滞气，则不能流行，故必先去瘀血滞血，然后调和卫气。若瘀血在经脉之中，必终脉有肿毒，独异于常经也。盒饭先决去恶血，然后调逆滞之气，无间大小新旧之病，以此为准，治之万全矣。若血在经络分内运动枢机斡旋之药去之。如血在脏腑，须于大小便泻泄去之。但血在上则忘者，病患言诈而多忘也。血在下则狂言，多急速者，便须调之。虚则郑声，实则诚言。郑声者，郑重声散，不知高下也。诚语者，以其言语诚而多往，言必诚之事也。上皆病之虚实。若发言而有热，去血则用大黄地黄之类。若病既有寒，破去涩血，则用当归水蛭之类治疗速效矣且稳也。
诸病之起，未有不因六气也。七情所感：寒、暑、温、燥、热、怒、悲、思、忧、恐、惊。内外邪正，致生百病。风寒暑湿炎凉，证候各异于常脉。邪血未入，血脉脏腑，皆可汗可泻，可平可治，可吐可泄，可和可渗，可决可祛。若邪气深，故腠理传入六经，又加之用汤丸，其纯墨治疗无准，使大病又加传注者，则病传克则死，谓金木水火土相克也。仍别将证候脉息看详，切从深浅缓急标本轻重治之。若见急病邪气，但从害命重处，先治之，更不问阴阳标本也。若体中有寒，则筋挛骨痛也，治之以温。体中有热，则痿缓不收，瘫痪少力，治之以凉。更在仔细详之。
凡人之国中病，便不如常者，则诊视脉证形体。恶风者伤风，怯寒者病寒。脉之浮紧皆中风。寒在表则可汗之，宜用温药，五积散散之。小寒之邪乃可温之，大寒之邪，可以热之，理中丸之类主之。小逆者，可以和之。但身恶热者有热，脉洪数浮大皆中热也。从中风邪，更有轻重，如大小续命汤之类加减主之。热在于表，热之解之，宜用凉药，小柴胡之类主之。小热之邪可以凉之，大热之邪，可以冷之，则用大柴胡之类。虚热虚烦，竹茹汤温胆汤之类补解之。或有逆者，可以橘皮人参生姜汤，凉温药，和之正之。
如病证有寒热，有伤于中，寒热也。先寒者为先中寒伤于阳经，此乃阴邪在阳经之理也。寒气盛，故先寒动也。先热者，先中于热，阳邪在表，故热先发也。但从热从寒，辨证诊脉，表里先后治之。若病患脉浮而紧盛，恶寒身体头面痹，项强，四肢疼痛，腰脚皆疼，是太阳中邪，并可汗之。但脉紧实沉盛，或滞涩而头甚疼，体不恶寒，皆可治里，仍虚实且泄调顺，不拘于日数，当从急重而治也。宜详之。若表和里病，下之温之便愈。里和表病，散之汗之立愈。但四肢温和，只是头疼心腹胀满，脉又沉实或伏缓者，此是表和里满，病不可下，须守待五日方泻。缘其病在里急，宜逐去邪气，虑有变动。若出邪气，病不实时而愈。如脉浮或壮热，四肢烦痛，恶寒项强腰膝，此是表未和，里却无滞，不可下，下之必危，急宜解表发汗，更根据日数次第，看证候调治，必愈。脉或微不可吐，脉虚细不可下。阴虚者其脉沉微，气弱者不可发汗。倘不根据证而妄行汗下者，医杀之也。当和之平之自然得效。令中病者，初得可吐可汗，可攻可泻，可平便愈。其有邪盛，或治疗无准，渐传固疾，则别证候，理之万全。令再引五脏病症，记候调治之法也。不治损误矣。
经云：肝病者，两胁下痛引小腹，令人善怒。肝气实则怒病，重则目茫然无所见，耳无所闻，如人将捕而惊怖也。亦至喉咙气噎不利。前所论血，如血脉中，血满独异如常脉，诊左右有血可先去恶瘀之血。（在上则忘，在下强也。）然后调气脉矣。谓四时之脉，春肝合弦。弦多胃气少曰病，但弦不长，胃气绝曰死。盖春弦脉，如平规之象也。（此语浮中沉三部也。使而体脉多者，盖中按不足，骨气少也。余脏仿此而推之。）脉见病证应太过之脉，令人善怒，忽忽眩冒，癫疾也。乃头也。怒则肝气实也。不足者，谓不及中象也。又少如微弦之脉，却减下也。故来气不及于常也。令人胸痛引胁下，两胁弦满痛也。胁谓腋下连胁出，故肝病委胁也。
夏心脉合洪。洪多胃气少，曰病。洪无胃气，曰死。心南方火也。王气如钧，按之钩者，来疾而去迟，如中短之象。火气王主心，夏应中矩和气，洪大兼之滑利，其气正中如矩之象也。太过者，不和气也。过于本位洪大益盛，病在外，令人身热而虑痼，为浸淫热气也。不及者，脉不根据中矩之象也。又却减下其数，亦不洪数，其和气不平正而少也。是来气不及，令人短心也。上见嗽唾，不为气泄，癖也。
秋肺脉合毛。毛多胃气少，曰病。但毛无胃气，曰死。肺者，西方金也。其脉浮，胃轻毛软虚，名曰浮而短，和平之气也。其气正中高下，如中衡之象也。正平象涩也。太过者，不和之气也。益盛于浮，浮盛而强虚轻，里坚者，是浮过也。令人逆气而背愠痛也。自背痛而愠愠气温也。不及者，应脉见轻虚而毛，又不减于常脉也。按之不应中衡之象，而轻虚也。气虚故为气弱也。人病喘而呼吸，少气而嗽上气，肺中声鸣也。
Pulse diagnosis is typically performed in the early morning, when Yang Qi (Yang Energy) has not yet stirred, Yin Qi (Yin Energy) has not yet dispersed, food and drink have not been ingested, Jing Mai (Primary Meridians) Qi is not yet vigorous, Luo Mai (Collateral Vessels) Qi is not yet harmonized, and Blood and Qi circulation has not been disturbed by activity. The patient should sit upright with a steady breath, so that abnormal pulses can be examined.
If the patient appears despondent or emaciated, one need not strictly adhere to the early morning time. Therefore, by palpating the movement and stillness of the pulse, one observes the patient's spiritual state; by inspecting the five colors of the face, one examines whether the Qi of the Zang Fu Organs (Five Zang and Six Fu Organs) is in excess or deficiency; by assessing the strength of the six pulse positions and the flourishing or decline of the physical form, one comprehensively determines the boundary between life and death. "Cutting" refers to palpating the pulse through pressing and grasping. "Movement" refers to a restless, uncoordinated pulse, either excessive or deficient, manifesting as a tense pulse. "Stillness" refers to a pulse that conforms to its proper position, harmonizing with the peaceful Qi of the four seasons, without excess or deficiency, maintaining a normal pulse without disease.
"Jing Ming" (Acuity/Clarity) refers to observing that both eyes of the patient are bright during examination, the Ming Tang (Bridge of the Nose) is clear, and the five colors are faintly visible on the face. Observing the form and palpating the pulse are all referred to as "Jing Ming". The relationship between color and pulse is examined because the blood vessels of the Zang Fu Organs correspond to each other. Seeing green corresponds to the Liver pulse; seeing red corresponds to the Heart pulse; seeing yellow corresponds to the Spleen pulse; seeing black corresponds to the Kidney pulse. This is the principle of color-pulse correspondence. However, one must also examine the relationship between the pathological pulse and the Five Elements: if they generate each other, the condition is mild; if they overcome each other, the condition is severe. If the pulse is chaotic and Qi exhibits "Jiao Tai" (abnormal interaction), it is a sign of death. This is called "San Wu Bu Tiao" (Disorder of Three and Five). By analyzing the intersection of color and pulse, the urgency of the disease can be deduced. This likely derives from the generative cycle of the Five Elements: Wood, Fire, Earth, Metal, Water. Wood generates Fire, Fire generates Earth. The overcoming cycle is: Metal overcomes Wood, Wood overcomes Earth, Earth overcomes Water, Water overcomes Fire, Fire overcomes Metal.
Generally, the pulse is the residence of Blood. If Blood is substantial, the pulse is substantial; if Blood is deficient, the pulse is deficient. A long pulse indicates regulated Qi; a short pulse indicates Qi pain; a rapid pulse indicates vexation in the heart; a large pulse indicates advancing disease. Excess in the upper part leads to Qi rebellion and asthma; excess in the lower part leads to abdominal distension. A Dai Pulse (Intermittent Pulse) indicates depletion of Blood and Qi; a Fine Pulse indicates scarcity of Qi; a Choppy Pulse indicates Heart pain. A Long Pulse means the Qi is harmonious, slippery, and long, not excessively long. Harmonious and slippery Qi is smooth and compliant with the prosperous Qi of the four seasons, indicating health. Long implies regulated Qi. A Short Pulse indicates Qi pain; the pulse feels short under the fingers, Zheng Qi (Upright Qi) is insufficient, hence Qi pathology. Rapid pulse with vexation means the pulse is rapid and frequent. Vexatious heat arises because Fire Qi moves and responds to the Heart, causing pain. A Large pulse indicates a Hong Pulse (Surging Pulse) of the Heart; the pulse is scattered and large, reflecting dry and moving Heart Fire. Since the pulse is large and vigorous, the Pathogenic Factor is also strong, so the disease advances. Upper excess causes Qi rebellion (asthma) due to strong pathogenic factors in the upper body. Lower excess causes abdominal distension due to strong pathogenic factors in the lower body. A Dai Pulse indicates Qi decline; it pauses before returning. Although the pulse may feel full and strong initially, it is slow, indicating Qi decline. Thus, Qi decline and distension signify advancing disease, which is critical. A Fine pulse indicates little Blood; the pulse comes fine and small, and Qi is also fine and small, indicating weak and deficient Qi. A Choppy pulse indicates Heart pain because the pulse is choppy, Zhen Qi (True Qi) is not slippery, and cannot flow through the regular meridians. Various pulses converge at the Heart; stagnant Blood and Qi lead to Heart Qi deficiency and Heart pain.
Floating, Kou (Hollow), Slippery, Solid, Wiry, Tight, and Hong pulses indicate disease in the Exterior and belong to Yang. They indicate severe Heat, which can cause restlessness and mania. Cool medicines taken cold can cure this. Heavy pressure revealing a Yin pulse is called "Yin within Yang disease," characterized by initial cold followed by heat; cool medicines taken warm can cure it. Treatment should be based on excess and deficiency using tonification and purgation. Micro, Deep, Slow, Choppy, Late, Hidden, Soft, and Weak pulses indicate disease in the Interior and belong to Yin. Heavy pressure reveals Yin pulses, called "Yin Pain Disease," caused by excessive Yin-Cold. Warm medicines taken hot can cure this. If a Yin pulse is felt lightly, it is called "Yang within Yin disease," characterized by initial heat followed by cold; warm/cool medicines taken cold can be effective. Hong, Large, Floating, Rapid, Tight, Moving, Slippery, and Solid pulses are Yang pulses. Forceful arrival indicates Yang Excess; forceless arrival indicates Yang Deficiency. Deep, Fine, Micro, Choppy, Late, and Hidden pulses are Yin pulses. Forceful arrival indicates Yin Excess; forceless arrival indicates Yin Deficiency. Diagnose according to symptoms: purge excess, tonify deficiency, and treat Yin-Yang syndrome imbalances. Cold and heat treatments depend on pulse-syndrome exterior-interior and Yin-Yang. Examine both Cun Kou (Radial Artery) positions: Left is Ren Ying, Right is Qi Kou. Floating indicates Exterior; Deep indicates Interior; Rapid indicates Fu Organs; Late indicates Zang Organs. Using Ren Ying and Qi Kou, and distinguishing floating/deep/late/rapid, one determines exterior-interior and cold-heat. Left Cun (Ren Ying) is the meeting of blood vessels and Ying Blood; Right Cun (Qi Kou) is Wei Qi. Cold, heat, excess, deficiency, deep, and floating are determined by pulse rate. Treatment will be comprehensive.
Human blood vessels circulate day and night like flowing water. If wind-cold hits water, it freezes and stops flowing; if humans contract wind-cold, blood vessels become stagnant and stop flowing. If wind-heat hits water, it becomes turbid and contaminated; if blood vessels encounter wind-cold-heat, they overflow and become disordered. Treatments for wind, cold, and heat differ; careful examination is essential. Treating heat with cold and cold with heat is the correct method, adhering to principles like a carpenter's ink line. Updating requires careful thought. Pulse diagnosis requires sitting upright and waiting for even breathing. In a healthy person, two beats occur per exhalation and two per inhalation, totaling four beats per breath (Xi). This represents sufficient Zang-Fu Qi, aligning with the number 45 (5x9). Four beats per breath is a peaceful pulse. Adding one more beat makes it a "Run Da Zhi Xi" (Leap Year Breath); fifty beats total indicates sufficient Yin-Yang and peace. The pulse should not be too large or small, conforming to the four seasons and five Qi. People born with distant Heavenly True Qi can live a hundred years. Irregular breaths indicate disharmony of pulses and Zang Organs.
However, determining disease by floating/deep pulses: if the pulse exceeds five beats per breath, it is difficult to maintain peace, indicating a pathological pulse based on meridian Qi numbers. If the pulse is large anteriorly and small posteriorly, the patient suffers headache, eye pain, and dizziness. If small anteriorly and large posteriorly, there is shortness of breath, chest fullness, and internal heat. Late indicates cold; Choppy indicates internal cold and exposure to cold air; Tight indicates wind-cold injuring bones; Slippery indicates phlegm; Ying indicates wasting-thirst; Deep indicates cold diarrhea; Slow indicates cold wind; Late indicates Qi obstruction and distension; Floating indicates wind-strike in the exterior; Hidden indicates fluid retention; Wiry and urgent indicate abundant wind-heat causing Qi knotting in the intestines; Kou indicates blood loss and dysentery; Hong and Large indicate latent Yang-heat causing restlessness; Moving indicates Qi-Blood stagnation; Micro indicates Qi-Blood deficiency; Solid indicates Qi excess and abdominal distension. If these pulses appear at the Cun Kou, the disease is upper, affecting the chest and heart/intestines. If at the Chi position, the disease is lower, affecting the umbilicus, abdomen, waist, and legs. Following cold/heat/excess/deficiency tonification/purgation yields accurate results.
If the pulse is less than seven beats but fewer than normal, the disease is severe and requires attentive treatment to prevent progression. More beats mean deeper pathogens. Floating/Large worsens by day; Deep/Fine worsens by night. Eight beats indicate consumption of Essence-Qi and chaos of Spirit-Qi, requiring urgent treatment. Nine to ten beats are nearly incurable, even with Resurrection Pills. Life depends on Heaven. Even if the disease is acute, if the pulse is too rapid, one must assess vitality and treat carefully. Do not abandon the patient, assuming death, as this is an error. If the pulse exceeds nine beats and is Xuan Jue (Suspension/Absence), like a severed object without root, life cannot continue. Pulses surging like springs, with no return or incoming Qi, indicate exhaustion of True Qi and Yuan Qi (Original Qi), leading to death.
First observe height and leanness. If Form and Qi match, the disease is manageable; if mismatched, it is critical; if Qi is exhausted, it is fatal. If Form and Qi recover but the pulse is Xuan Jue, and both Form and Qi are diseased, death is immediate. Tall people have long pulses; short people have short pulses; fat people have thick pulses; thin people have rapid pulses. This is matching Form and Qi. Pulse shapes are like facial features. Floating/Deep/Late/Rapid correspond to human form and temperament. Matching the form under the fingers is favorable; opposite is unfavorable. Humans rely on the Five Elements but are attacked by pathogens. If pathogens enter easily, treatment is easier. Matching Form and Qi is good; mismatching (e.g., tall person with short pulse) is bad and hard to treat. This indicates pre-existing constitutional weakness. Those not yet sick but showing signs may die soon. One must conserve energy, harmonize Qi and Spirit, and avoid recklessness to preserve True Qi.
Pulses conforming to seasons: Spring Wiry, Summer Hong, Autumn Feather-like, Winter Solid. With harmonious Qi, soft and long, the person is healthy and easy to treat if sick. Generated from harmony. If Qi reverses and pulse moves, and Form and Qi mismatch, it is untreatable. Due to strong Form/weak Qi or weak Form/strong Qi. If Form and Qi are both diseased but stable, death occurs before the expected time. Stable means eating/drinking continues. Diagnosis considers eight seasonal climates. First observe leanness/fatness to adjust Qi excess/deficiency: tonify deficiency, purge excess. Strong form with fine pulse and shortness of breath is critical, near death, but potentially treatable due to strong form. Thin form with large pulse and chest Qi is fatal because Form and Qi are both deficient while pulse is excessive. Matching Form and Qi ensures life.
"San Wu Bu Tiao" refers to chaotic color and pulse. Disordered Cun, Guan, Chi positions indicate severe disease. Pulses lost in left/right hands, uncountable, indicate death (10+ beats per breath consumes Blood/Qi). Generally, diagnose seasonal pulses first, distinguishing excess/deficiency, cold/heat, rate changes, Yin-Yang balance, Five Elements overcoming, and Zang-Fu affiliation. Then consider form, spirit, constitution, age, diet, etc. Conforming to Form/Spirit and Seasons is the root of life. Overcoming by Five Elements is dangerous. If disease is excessive and Form/Qi rebels against Ghost-Thief Pulses with Xuan Jue, death is untreatable. Five Deficiencies and Five Excesses can be fatal but may survive. If porridge enters the stomach and diarrhea stops, deficiency recovers. If sweating occurs and urination/bowel movements normalize, excess recovers. These indicate life. Do not ignore severe excess/deficiency; rescue those with vital signs.
Treat by observing form and Qi. Purge excess, tonify deficiency. Urgent purgation vs. slow tonification depends on disease urgency. Classics say remove Blood first, then regulate. Blood vessels are the root; stagnant Blood obstructs Qi flow. Remove stasis, then harmonize Wei Qi. Stasis in meridians causes swelling/toxins. Remove evil Blood, then regulate rebellious Qi, regardless of disease size/newness. If Blood is in meridians, use herbs to move pivot mechanisms. If in Zang-Fu, purge via bowels/urine. Blood above causes forgetfulness/deception; Blood below causes mania/rushing. Tonify deficiency (Zheng Sheng - fragmented speech), purge excess (Cheng Yan - sincere speech). Zheng Sheng is disjointed; Cheng Yan is consistent. For heat, remove Blood with Da Huang (Rhubarb Root) and Di Huang (Rehmannia Root). For cold, break stasis with Dang Gui (Angelica Sinensis) and Shui Zhi (Leech).
Diseases arise from Six Qi and Seven Emotions: Cold, Heat, Warmth, Dryness, Wind, Dampness; Joy, Anger, Worry, Pensive, Fear, Fright. Internal/External pathogens cause hundreds of diseases. Symptoms vary from normal pulses. Before pathogens enter deeply, Blood vessels and Zang-Fu can be treated via sweating, purging, calming, vomiting, draining, harmonizing, permeating, resolving, or expelling. If pathogens penetrate deep into the Six Channels via Cou Li (Interstitial Spaces), and decoctions/pills fail, transmission leads to death via Five Elements overcoming. Analyze symptoms and pulses carefully, treating based on depth, urgency, root/branch, and severity. Treat life-threatening pathogens first, ignoring Yin-Yang root/branch distinctions. Cold in body causes tendon spasms and bone pain; treat with warmth. Heat causes flaccidity and paralysis; treat with cooling.
Diagnose deviations from normal. Fear of wind indicates Wind Strike; aversion to cold indicates Cold disease. Floating/Tight pulses indicate Wind Strike. Cold in Exterior is treated by sweating with warm medicines, e.g., Wu Ji San (Five Accumulations Powder). Minor Cold is warmed; Major Cold is heated with Li Zhong Wan (Regulate the Middle Pill). Minor deviation is harmonized. Body heat with Hong/Rapid/Floating/Large pulses indicates Heat Strike. Severity varies; treat with modifications of Da/Xiao Xu Ming Tang. Heat in Exterior is resolved with cool medicines, e.g., Xiao Chai Hu Tang (Minor Bupleurum Decoction). Minor Heat is cooled; Major Heat is chilled with Da Chai Hu Tang. Deficient Heat/Vexation is treated with Zhu Ru Tang or Wen Dan Tang (Warm Gallbladder Decoction). Rebellious cases use Ju Pi Ren Shen Sheng Jiang Tang (Tangerine Peel, Ginseng, Ginger Decoction) to harmonize.
Cold/Heat injuries: Initial cold indicates Cold attacking Yang Channels (Yin Pathogen in Yang Channel). Initial heat indicates Heat attacking Exterior (Yang Pathogen in Exterior). Treat based on differentiation, Exterior/Interior sequence. Floating/Tight/Full pulse with aversion to cold, body/head numbness, stiff neck, limb pain, and back/leg pain indicates Tai Yang Channel invasion; treat by sweating. Tight/Solid/Deep/Full or Choppy pulse with severe headache but no aversion to cold indicates Interior disease; treat Interior by purging/regulating based on excess/deficiency, urgent/severe nature, regardless of days. If Exterior is harmonious and Interior is diseased, purge/warm to cure. If Interior is harmonious and Exterior is diseased, scatter/sweat to cure. If limbs are warm but headache/abdominal distension persist with Deep/Solid or Hidden/Slow pulse, this is Harmonious Exterior/Full Interior. Do not purge; wait five days to purge, as the disease is urgent internally. Expel pathogens to prevent complications. If pathogens exit, disease resolves quickly. If Floating pulse or high fever with limb pain, aversion to cold, stiff neck/knees, Exterior is unharmonized, Interior is clear. Do not purge; it is dangerous. Resolve Exterior by sweating. Follow daily sequences and symptom adjustment for cure. Micro pulse: do not vomit. Fine/Deficient pulse: do not purge. Yin Deficiency with Deep/Micro pulse: do not sweat. Qi Deficiency: do not sweat. Blindly sweating/purging without syndrome differentiation kills the patient. Harmonize and calm naturally for effect. Early stage: vomit, sweat, attack, purge, or calm to cure. If pathogens are strong or treatment fails, chronic diseases develop; re-evaluate symptoms for comprehensive treatment.
Classics state: Liver disease causes hypochondriac pain radiating to the lower abdomen, irritability. Liver Qi Excess causes anger. Severe cases involve blindness, deafness, and fear as if being hunted. Throat obstruction may occur. Regarding Blood: if Blood vessels are full and distinct from normal, examine left/right for evil stasis. Remove stasis first (Above causes forgetfulness, Below causes rigidity), then regulate Qi/Pulse.
Seasonal Pulses: Spring Liver matches Wiry. Many Wiry, few Stomach Qi indicates disease. Wiry without length, Stomach Qi absent indicates death. Spring Wiry resembles a level compass. (Refers to Superficial, Middle, Deep layers. Many body pulses suggest insufficient middle pressure and weak Bone Qi. Other organs follow this logic.) Disease pulses indicating excess cause anger, dizziness, epilepsy. Anger indicates Liver Qi Excess. Deficiency means failing to meet the central image. Slightly Wiry pulse indicates reduction. Qi arrival is insufficient, causing chest pain radiating to hypochondrium. Hypochondrium is underarm to rib area; Liver disease affects this.
Summer Heart matches Hong. Many Hong, few Stomach Qi indicates disease. Hong without Stomach Qi indicates death. Heart is South Fire. Prosperous Qi is like a weight. Pressing Hook pulse comes fast and leaves slow, resembling a short arc. Fire governs Heart. Summer should match Square Harmony. Hong/Large combined with Slippery indicates Qi centered like a square. Excess is disharmonious, exceeding position with strong Hong/Large, disease in Exterior, causing body heat and chronic issues, spreading heat. Deficiency does not match Square image, reduces rate, lacks Hong/Rapid, has little harmonious Qi. Insufficient Qi arrival causes shortness of heart. Upper cough/sputum indicates Qi failure and accumulation.
Autumn Lung matches Feather-like. Many Feather, few Stomach Qi indicates disease. Feather without Stomach Qi indicates death. Lung is West Metal. Pulse is Floating, light/stomach/soft/virtual, named Floating and Short, representing Peaceful Qi. Qi is centered high-low, like a balance scale. Normal is Choppy. Excess is disharmonious, stronger Floating, strong/virtual/light, interior firm, indicating excessive Floating. Causes reverse Qi and back pain. Deficiency shows light/virtual Feather, not reducing from normal. Pressing does not match Balance image, remains light/virtual. Qi deficiency causes weakness. Disease involves panting, shortness of breath, cough, wheezing.
Winter Kidney matches Deep. Many Deep, few Stomach Qi indicates disease. Deep without Stomach Qi indicates death. Kidney is North...