。下后脉实大。或暴微欲绝。热不止者死。厥阴病。下利脉实者。下之死。病脉之逆。从可见矣。盖实即是石
。石为肾之平脉。若石坚太过。辟辟如弹石状。为肾绝之兆矣。其消瘅鼓胀坚积等病。皆以脉实为可治。若泄
而脱血。及新产骤虚。久病虚羸。而得实大之脉。良不易治也。
【弦】弦脉者。端直以长。举之应指。按之不移。不似紧脉之状如转索。革脉之劲如弓弦也。弦为风木
主令之脉。故凡病脉弦。皆阳中伏阴之象。虚证误用寒凉。两尺脉必变弦。胃虚冷食停滞。气口多见弦脉。伤寒
以尺寸俱弦。为少阳受病。少阳为枢。为阴阳之交界。如弦而兼浮兼细。为少阳之本脉。弦而兼数兼缓。即有
入府传阴之两途。若弦而兼之以沉涩微弱。得不谓之阴乎。经言寸口脉弦者。胁下拘急而痛。令人啬啬恶寒。
又伤寒脉弦细。头痛发热者属少阳。此阳弦头痛也。痛必见于太阳。阳脉涩。阴脉弦。法当腹中急痛。此阴弦
腹痛也。痛必见于少
腹。皆少阳部分耳。少阴病欲吐不吐。始得之。手足寒。脉弦迟者。此胸中实。当吐之。若膈上有寒饮干呕者
。不可吐。急温之。详此。又不当以兼沉兼涩概谓之阴。弦迟为胸中实也。审证合脉。活法在人。贵在心手之
灵活耳。历诊诸病之脉。属邪盛而见弦者。十常二三。属正虚而见弦者。十常六七。其于他脉之中。兼见弦象
者。尤复不少。在伤寒表邪全盛之时。中有一部见弦。或兼迟兼涩。便是夹阴之候。客邪虽盛。急需温散。汗
下猛剂。咸非所宜。即非时感冒。亦宜体此。至于素有动气怔忡。寒疝香港脚。种种宿病。而挟外感之邪。于浮
紧数大之中。委曲搜求。弦象必隐于内。多有表邪脉紧。于紧脉之中。按之渐渐减小。纵之不甚鼓指。盒饭弦
脉例治。于浮脉之中。按之敛直。滑脉之中。按之搏指。并当弦脉类看。于沉脉之中。按之引引。涩脉之中。
按之切切。皆阴邪内伏。阳气消沉。不能调和百脉。而显弦直之状。良非客邪紧盛之兆。迨夫伤寒坏病。弦脉
居多。虚劳内伤。弦常过半。所以南阳为六残贼之首推也。他如病疟寒饮。一切杂病。皆有弦脉。按金匮云。
疟脉自弦。弦数多热。弦迟多寒。弦小坚者下之瘥。弦迟者可温之。弦紧者可发汗针灸也。浮大者可吐之。弦数
者风发也。以饮食消息主之。饮脉皆弦。双弦者寒也。偏弦者饮也。弦数者有寒饮。沉弦者悬饮内痛。他如腹
痛鼓胀。胃反胸痹。 瘕蓄血。中 伤风。霍乱滞下。中气郁结。寒热痞满等病。种种皆有弦脉。总由中气少
权。土败木贼所致。但以弦少弦多。以证胃气之强弱。弦实弦虚。以证邪气之虚实。浮弦沉弦。以证表里之阴阳。
寸弦尺弦。以证病气之升沉。无论所患何证。兼见何脉。但以和缓有神。不乏胃气。咸为可治。若弦而劲细。如
循刀刃。弦而强直。如新张弓弦。如循长竿。如按横格。皆但弦无胃气也。所以虚劳之脉。多寸口数大。尺中
弦细搏指者。皆为损脉。卢扁复生奚益哉。
【缓】缓脉者。从容和缓。不疾不徐。似迟而实未为迟。不似
濡脉之指下绵软。虚脉之瞥瞥虚大。微脉之微细而濡。弱脉之细软无力也。仲景云。阳脉浮大而濡。阴脉浮大
而濡。阴脉与阳脉同等者。名曰缓也。伤寒以尺寸俱微缓者。为厥阴受病。厥阴为阴尽复阳之界。故凡病后得
之。咸为相宜。其太阳病。发热头痛。自汗脉浮缓者。为风伤卫证。以其自汗体疏。脉自不能紧盛也。缓为脾
家之本脉。然必和缓有神。为脾气之充。若缓甚而弱。为脾气不足。缓而滑利。则胃气冲和。昔人以浮缓为伤
风。沉缓为寒湿。缓大为风虚。缓细为痹湿。又以浮缓为风中于阳。沉缓为湿中于阴。盖湿脉自缓。得风以播
之。则兼浮缓。寒以束之。则兼沉缓。若中于阴。则沉细微缓。以厥阴内藏风木之气。故脉虽沉。而有微缓之象也。
【洪】洪脉者。既大且数。指下累累如连珠。如循琅 。而按之稍缓。不似实脉之举按 。滑脉之软滑
流利。大脉之大而且长也。昔人以洪为夏脉。内经以钩为夏脉。遂有钩即是洪之说。以其数大而濡。按之指下
委曲旁出。固可谓之曰钩。火性虚炎。所以来盛去衰。按之不实。然痰食瘀积阻碍脉道。关部常屈曲而出。此
与夏脉微钩。似同而实不类也。洪为火气燔灼之候。仲景有服桂枝汤。大汗出。大烦渴不解。脉洪为温病。温
病乃冬时伏气所发。发于春者为温病。发于夏者为热病。其邪伏藏于内而发出于表。脉多浮洪而混混不清。每
多盛于右手。亦有动滑不常者。越人所谓行在诸经。不知何经之动也。当此不内联夺。反与解表。不至热交
营度不已也。若温热时行。证显烦渴昏热。脉反沉细小弱者。阳病阴脉也。有阳热亢极。而足冷尺弱者。为下虚
之证。皆不可治。又屡下而热势不解。脉洪不减。谓之坏病。多不可救。洪为阳气满溢。阴气垂绝之脉。故蔼
蔼如车盖者为阳结。脉浮而洪。身汗如油为肺绝。即杂病脉洪。皆火气亢甚之兆。若病后久虚。虚劳失血，泄
泻脱元。而见洪盛之脉。尤非所宜。惟悯浊下贱。脉多洪实。又不当以实热论也。
【微】微脉者。似有若无。欲绝非绝。而按之稍有模糊之状。不似弱脉之小弱分明。细脉之纤细有力也。
微为阳气衰微之脉。经言寸口诸微亡阳。言诸微者。则轻取之微。重按之微。气口之微。尺中之微。皆属气虚。
故所见诸证。在上则为恶寒多汗少气之患。在下则有失精脱泻少食之虞。总之与血无预。所以萦萦如蜘蛛丝者
。仲景谓阳气之衰。尝见中风卒倒而脉微。暑风卒倒而脉微。皆为虚风之象。其脉多兼沉缓。若中寒卒倒而脉
微。为阴邪暴逆。所以微细欲绝也。而伤寒尺寸俱微缓。为厥阴受病。病邪传至此经。不特正气之虚。邪亦向
衰之际。是以俱虚。不似少阴之脉微细。但欲寐耳。详二经之脉。同一微也。而有阴尽复阳。阳去入阴之异。
即太阳经病之脉微。而有发热恶寒。热多寒少。脉微为无阳者。有面有热色。邪未欲解，而脉微者。有阴阳俱
停。邪气不传。而脉反微者。若以微为虚象。不行攻发。何以通邪气之滞耶。必热除身安而脉微。方可为欲愈
之机。若太阳证具。而见足冷尺微。又为下焦虚寒之验。可不建其中气。而行正发汗之例乎。
【紧】紧脉者。状如转索。按之虽实而不坚。不似弦脉之端直如弦。牢革之强直搏指也。紧为诸寒收引之象。
亦有热因寒束。而烦热拘急疼痛者。如太阳寒伤营证是也。然必人迎浮紧。乃为表证之确候。若气口紧坚。又
为内伤饮食之兆。金匮所谓脉紧头痛。风寒腹中有宿食也。仲景又云。曾为人所难。紧脉从何而来。假令亡汗
若吐。以肺里寒。故令脉紧也。假令咳者。坐饮冷水。故令脉紧也。假令下利。以胃中寒冷。故令脉紧也。
详此三下转语。可谓曲尽紧脉为病之变端。而少阴经中。又有病患脉阴阳俱紧。反汗出者。亡阳也。此属少阴。
法当咽痛而复吐利。是谓紧反入里之微验。又少阴病脉紧。至七八日。下利脉暴微。手足反温。脉紧反去。为欲解也
。虽烦。下利必自愈。此即紧去人安之互辞。辨不可下脉证中。则有脉来阴阳俱紧。恶寒
发热。则脉欲厥。厥者。脉初来大。渐渐小。更来渐渐大。是其候也。此亦紧反入里之互辞。因误下而阳邪
内陷。欲出不出。有似厥逆进退之象。故言欲厥。脉虽变而紧状依然。非营卫离散。乍大乍小之比。而脉法
中。复有寸口脉微。尺脉紧。其人虚损多汗。知阴常在。绝不见阳之例。可见紧之所在。皆阳气不到之处。故
有是象。夫脉按之紧如弦。直上下行者痉。若伏坚者为阴痉。总皆经脉拘急。故有此象。若脉至如转索。而强
急不和。是但紧无胃气也。岂堪尚引日乎。
【弱】弱脉者。沉细而软。按之乃得。举之如无。不似微脉之按之欲绝。濡脉之按之若无。细脉之浮沉皆
细也。弱为阳气衰微之候。夫浮以候阳。今浮取如无。阳衰之明验也。故伤寒首言弱为阴脉。即阳经见之。亦
属阳气之衰。经言寸口脉弱而迟。虚满不能食。寸口脉弱而缓。食卒不下。气填膈上。上二条。一属胃寒。一
属脾虚。故皆主乎饮食。又形作伤寒。其脉不弦紧而弱。太阳中 。身热疼重而脉微弱。可见脉弱无阳。必无
实热之理。只宜辨析真阳之虚。与胃气之虚。及夏月伤冷水。水行皮中所致耳。在阴经见之。虽为合脉。然阳
气衰微已极。非峻温峻补。良难春回寒谷也。惟血痹虚劳。久嗽失血。新产及老人久虚。脉宜微弱。然必弱而
和滑。可卜胃气之未艾。若少壮暴病而见脉弱。咸非所宜。即血证虚证。脉弱而兼之以涩。为气血交败。其能
荣爨下之薪乎。
【长】长脉者。指下迢迢而过于本位。三部举按皆然。不似大脉之举之盛大。按之少力也。伤寒以尺寸俱
长。为阳明受病。内经又以长则气治。为胃家之平脉。胃为水谷之海。其经多气多血。故显有余之象。然必长
而和缓。方为无病之脉。若长而浮盛。又为经邪方盛之兆。亦有病邪向愈而脉长者。仲景云。太阴中风。四肢
烦疼。阳脉微。阴脉涩。而长者为欲愈。盖风本阳邪。因土虚木乘。陷于太阴之经。而长脉见于微涩之中。疼
热发于诸阳之本。询为欲愈之征。殊非病进之谓。且有阴气不充。而脉反上盛者。经言寸口脉中手长者。曰足胫痛是
也。此与秦越人遂上鱼为溢。遂入尺为覆。及上部有脉。下部无脉。关格吐逆。不得小便。同脉异证。不可与
尺寸俱长之脉。比例而推也。
【短】短脉者。尺寸俱短。而不及本位。不似小脉之三部皆小弱不振。伏脉之一部独伏匿不前也。经云。
短则气病。良由胃气厄塞。不能条畅百脉。或因痰气食积。阻碍气道。所以脉见短涩促结之状。亦有阳气不充而
脉短者。经谓寸口脉中手短者。曰头痛是也。仲景云。汗多重发汗。亡阳谵语。脉短者死。脉自和者不死。又
少阴脉不至。肾气绝。为尸厥。伤寒六七日。大下后。寸脉沉而迟。手足厥冷。下部脉不至。咽喉不利。唾脓
血者难治。戴同父云。短脉只当责之于尺寸。若关中见短。是上不通寸为阳绝。下不通尺为阴绝矣。曷知关
部从无见短之理。昔人有以六部分隶而言者。殊失短脉之义。
【大】大脉者。应指满溢。倍于寻常。不似长脉之但长不大。洪脉之既大且数也。大脉有虚实阴阳之异。经
云。大则病进。是指实大而言。仲景以大则为虚者。乃盛大少力之谓。然又有下利脉大者为未止。是又以积滞
未尽而言。非大则为虚之谓也。有六脉俱大者。阴不足。阳有余也。有偏大于左者。邪盛于经也。偏大于右者
。热盛于内也。亦有诸脉皆小。中有一部独大者。诸脉皆大。中有一部独小者。便以其部。断其病之虚实。
且有素禀六阳。或一手偏旺偏衰者。又不当以病论也。凡大而数盛有力。皆为实热。如人迎气口大紧以浮者。
其病益甚在外。气口微大。名曰平人。其脉大坚以涩者胀。乳子中风热。喘鸣肩息者。脉实大而缓则生。急则
死。乳子。是指产后以乳哺子而言。非婴儿也。产后脉宜悬小。最忌实大。今证见喘鸣肩息。为邪气暴逆。又
须实大而缓。方与证合。若实大急强。为邪胜正衰。去生远矣。此与乳子而病热。脉弦小。手足温则生。似乎相
左。而实互相发明也。伤寒热病。谵语烦渴。脉来实大。虽剧可治。得汗后热不止。脉反实大躁疾者死。温病大热不
得汗。脉大数急强者死。细小虚涩者亦死。厥阴病下利脉大者虚也。以其强下之也。阴证反大发热。脉虚大无
力。乃脉证之变。内证元气不足。发热脉大而虚。为脉证之常。虚劳脉大，为血虚气盛。金匮云。男子平人脉大
为劳。气有余便是火也。所以瘦人胸中多气而脉大。病久气衰而脉大。总为阴阳离绝之候。孰谓大属有余。而
可恣行攻伐哉。若脉见乍大乍小。为元神无主。随邪气之鼓动。可不慎而漫投汤液耶。
【小】小脉者。三部皆小。而指下显然。不似微脉之微弱依稀。细脉之微细如发。弱脉之软弱不前。短脉
之首尾不及也。夫脉之小弱。虽为元气不足。若小而按之不衰。久按有力。又为实
热固结之象。总由正气不充。不能鼓搏热势于外。所以隐隐略见滑热之状于内也。设小而证见热邪亢盛。则为
证脉相反之兆。亦有平人六脉皆阴。或一手偏小者。若因病而脉损小。又当随所见部分而为调适机用。不可不
治也，假令小弱见于人迎。卫气衰也。见于气口。肺胃弱也。见于寸口。阳不足也。见于尺内。阴不足也。凡
病后脉见小弱。正气虽虚。邪气亦退。故为向愈。设小而兼之以滑实伏匿。得非实热内蕴之征乎。经云。切其
脉口滑小紧以沉者。病益甚在中。又云。温病大热。而脉反细小。手足逆者死。乳子而病热。脉悬小。手足温
则生。寒则死。此条与乳子中风热互发，言脉虽实大。不至急强。脉虽悬小。四肢不逆。可卜胃气之未艾。若脉
下法之后，如果脉象实大，或者突然变得微弱几乎摸不到，而发热仍然不止的，属于死证。厥阴病出现腹泻，如果脉象实大的，使用下法会导致死亡。从这些情况可以看出病脉与正脉相逆的现象。所谓“实”脉就像石头一样坚硬。石脉是肾脏的正常脉象，但如果石脉过于坚硬，像弹石一样清脆坚硬，这是肾气绝灭的征兆。像消渴、鼓胀、坚积等病症，只要脉实都是可以治疗的；如果是泄泻脱血，以及刚生产完突然气血虚弱，或者久病身体极度消瘦虚弱的人，却出现了实大的脉象，就很难治疗了。
【弦】弦脉的特点是端正直长，轻取即应指，重按不移位，不像紧脉那样像扭转的绳索，也不像革脉那样劲急如弓弦。弦脉是由风木之气主令所形成的脉象，所以凡是病脉见弦，都是阳气中潜伏阴邪的表现。虚证误用了寒凉药物，两尺部的脉一定会变成弦脉；胃气虚弱，冷食停滞，气口（右寸）多见弦脉。伤寒病中，尺寸两部都见弦脉，说明是少阳经受病。少阳为枢机，是阴阳交界的地方。如果弦脉兼见浮细，这是少阳的本脉；如果弦脉兼见数缓，就有传入腑脏或传变入阴经的两个方向。如果弦脉兼见沉涩微弱，难道还能不说是阴脉吗？经文说寸口脉弦，胁下拘急疼痛，使人怕冷。又说伤寒脉弦细，头痛发热的属于少阳，这是阳弦引起的头痛。疼痛一定见于太阳经，阳脉涩，阴脉弦，按照法则应当腹中急痛，这是阴弦引起的腹痛。疼痛一定见于少腹部，都属于少阳经脉的范围。少阴病想吐又吐不出来，初起时手脚寒冷，脉象弦迟的，这是胸中有实邪，应当用吐法。如果是膈上有寒饮导致干呕的，不可用吐法，应当紧急温补。详细分析这些情况，又不应当一概地把兼见沉涩的弦脉称为阴脉。弦迟代表胸中实邪。审察症状结合脉象，灵活变通在于医者，贵在心思手法的灵活。诊察各种疾病的脉象，属于邪气盛而见弦脉的，十次中常有二三次；属于正气虚而见弦脉的，十次中常有六七次。在其他脉象中兼见弦象的，尤其不少。在伤寒表邪正盛的时候，如果其中一部脉见弦，或者兼见迟涩，就是夹阴的征候。虽然客邪很盛，急需温散，但汗下猛剂都不适宜。即使是非时感冒，也应当体会这一点。至于素有动气怔忡、寒疝、脚气等宿疾，又夹杂外感邪气的，在浮紧数大的脉象中，仔细搜寻，弦象必定隐藏在内部。多有表邪脉紧，在紧脉之中，按下去渐渐减小，放松后不太鼓指，应当作为弦脉来治疗。在浮脉之中，按下去收敛挺直；在滑脉之中，按下去搏指有力，都应当当作弦脉来看待。在沉脉之中，按下去引引有力；在涩脉之中，按下去切切有力，这都是阴邪内伏，阳气消沉，不能调和百脉，从而显现出弦直的状态，确实不是客邪紧盛的征兆。等到伤寒坏病，弦脉居多；虚劳内伤，弦脉常占一半以上。所以张仲景将弦脉列为六残贼之首。其他如疟疾、寒饮，一切杂病，都有弦脉。据《金匮要略》说：疟疾的脉自弦，弦数多热，弦迟多寒，弦小坚的用下法可愈，弦迟的可温之，弦紧的可发汗针灸，浮大的可吐之，弦数的是风发，以饮食调理为主。饮病的脉皆弦，双弦的是寒，偏弦的是饮，弦数的是有寒饮，沉弦的是悬饮内痛。其他如腹痛鼓胀、胃反胸痹、瘕聚蓄血、中风、霍乱滞下、中气郁结、寒热痞满等病，种种都有弦脉。总归是由于中气缺乏权变，土败木贼所致。只是根据弦脉的多少，来判断胃气的强弱；弦实的弦虚，来判断邪气的虚实；浮弦沉弦，来判断表里的阴阳；寸弦尺弦，来判断病气的升沉。无论患什么证，兼见什么脉，只要和缓有神，不失胃气，都可以治疗。如果弦而劲细，像触摸刀刃；弦而强直，像新拉开的弓弦，像触摸长竿，像按在横格上，这些都是只有弦象而没有胃气。所以虚劳的脉，多是寸口数大，尺中弦细搏指的，都属于损脉，即使卢医扁鹊复活又有什么益处呢？
【缓】缓脉的特点是从容和缓，不快不慢，似乎迟但实际上并不迟，不像濡脉那样指下绵软，不像虚脉那样瞥瞥虚大，不像微脉那样微细而濡，不像弱脉那样细软无力。张仲景说：阳脉浮大而濡，阴脉浮大而濡，阴脉与阳脉同等程度的，叫做缓脉。伤寒病中，尺寸两部都微缓的，是厥阴经受病。厥阴是阴尽复阳的界限，所以凡是病后见到这种脉象，都很适宜。太阳病，发热头痛，自汗，脉浮缓的，是风邪伤卫分的证候。因为自汗体表疏松，脉自然不能紧盛。缓脉是脾脏的本脉，但必须和缓有神，才是脾气充盛的表现。如果缓甚而弱，是脾气不足；缓而滑利，则是胃气冲和。古人认为浮缓是伤风，沉缓是寒湿，缓大是风虚，缓细是痹湿。又认为浮缓是风中于阳，沉缓是湿中于阴。大概湿脉自缓，得风邪吹拂，则兼见浮缓；得寒邪束缚，则兼见沉缓。如果中于阴，则脉沉细微缓，因为厥阴内藏风木之气，所以脉虽沉，而有微缓的象。
【洪】洪脉的特点是既大且数，指下累累如连珠，像抚摸琅玕玉一样，按下去稍缓，不像实脉那样举按坚实，不像滑脉那样软滑流利，不像大脉那样大而且长。古人认为洪是夏脉，《内经》认为钩是夏脉，于是有了钩即是洪的说法。因为洪脉数大而濡，按下去指下委曲旁出，固可以称之为钩。火性虚炎，所以来势盛而去势衰，按之不实。然而痰食瘀积阻碍脉道，关部常屈曲而出，这与夏脉微钩，看似相同实则不同。洪脉是火气燔灼的征候。张仲景说服用桂枝汤后，大汗出，大烦渴不解，脉洪大的，是温病。温病是冬天伏气所发，发于春天的叫温病，发于夏天的叫热病。其邪气伏藏在内而发出于表，脉多浮洪而混混不清，多在右手旺盛，也有动滑不定的。这就是越人所说的行在诸经，不知是哪一经的动脉。此时如果不内联夺（指正气内夺），反而给予解表药，不到热邪交争营卫不止是不会停止的。如果温热时行，证候显示烦渴昏热，脉反而沉细小弱的，这是阳病见阴脉。有阳热亢极，而脚冷尺脉弱的，是下虚的证候，都不可治。又多次攻下而热势不解，脉洪大不减的，叫做坏病，大多不可救。洪脉是阳气满溢，阴气垂绝的脉象。所以蔼蔼如车盖的是阳结，脉浮而洪，身汗如油的是肺绝。即使是杂病脉洪，也都是火气亢盛的征兆。如果是病后久虚，虚劳失血，泄泻脱元，却见到洪盛的脉象，尤其不适宜。只有地位低贱之人，脉多洪实，又不应当当作实热来论治。
【微】微脉的特点是似有若无，欲断未断，按下去稍有模糊的样子，不像弱脉那样小弱分明，不像细脉那样纤细有力。微脉是阳气衰微的脉象。经文说寸口诸微亡阳，说诸微，则轻取之微，重按之微，气口之微，尺中之微，都属于气虚。所以见到的各种证候，在上则为恶寒多汗少气的病患，在下则有失精脱泻少食的忧虑。总之与血没有预先的关系。所以萦萦如蜘蛛丝的脉，张仲景认为是阳气衰微。曾见中风卒倒而脉微，暑风卒倒而脉微，都是虚风的象。其脉多兼沉缓。如果是中寒卒倒而脉微，是阴邪暴逆，所以脉微细欲绝。而伤寒尺寸俱微缓，是厥阴受病。病邪传至此经，不仅正气虚，邪气也向衰之际，所以俱虚，不像少阴脉微细，但欲寐而已。详细分析这两经的脉，同样是微，但有阴尽复阳、阳去入阴的区别。即使是太阳经病的脉微，而有发热恶寒，热多寒少，脉微为无阳的；有面有热色，邪未欲解，而脉微的；有阴阳俱停，邪气不传，而脉反微的。如果把微当作虚象，不行攻发，怎么能通邪气之滞呢？必须热除身安而脉微，才可以作为欲愈的时机。如果太阳证具备，而见足冷尺微，又是下焦虚寒的验证，可不建立中气，而行正发汗的法则吗？
【紧】紧脉的特点是状如转索，按之虽实而不坚，不像弦脉那样端直如弦，不像牢革那样强直搏指。紧脉是诸寒收引的象，也有因寒束热而烦热拘急疼痛的，如太阳寒伤营证就是如此。但必须人迎脉浮紧，才是表证的确候。如果气口紧坚，又是内伤饮食的征兆。《金匮要略》所谓脉紧头痛，风寒腹中有宿食。张仲景又说：曾被人责难，紧脉从何而来？假如亡汗或呕吐，因为肺里寒，所以令脉紧。假如咳嗽，因为坐饮冷水，所以令脉紧。假如下利，因为胃中寒冷，所以令脉紧。详细这三段转折的话，可以说穷尽了紧脉为病的变端。而在少阴经中，又有病患脉阴阳俱紧，反汗出的，是亡阳。这属于少阴，法则应当咽痛而复吐利，这叫紧反入里的微验。又少阴病脉紧，至七八日，下利脉暴微，手足反温，脉紧反去，是欲解。虽然烦躁，下利必自愈。这就是紧去人安的互辞。在辨不可下脉证中，则有脉来阴阳俱紧，恶寒发热，则脉欲厥。厥者，脉初来大，渐渐小，更来渐渐大，是其候也。这也是紧反入里的互辞。因为误下而阳邪内陷，欲出不出，有似厥逆进退之象，故言欲厥。脉虽变而紧状依然，不是营卫离散，乍大乍小的比况。而脉法中，又有寸口脉微，尺脉紧，其人虚损多汗，知阴常在，绝不见阳的例子。可见紧之所在，都是阳气不到之处，所以有是象。夫脉按之紧如弦，直上下行者是痉。若伏坚者是阴痉，总皆经脉拘急，所以有此象。如果脉至如转索，而强急不和，是但紧无胃气也，岂能拖延时日呢？
【弱】弱脉的特点是沉细而软，按之乃得，举之如无，不像微脉那样按之欲绝，不像濡脉那样按之若无，不像细脉那样浮沉皆细。弱脉是阳气衰微的候象。浮以候阳，现在浮取如无，是阳衰的明证。所以伤寒首言弱为阴脉，即阳经见之，也属阳气之衰。经文说寸口脉弱而迟，虚满不能食；寸口脉弱而缓，食卒不下，气填膈上。上两条，一条属胃寒，一条属脾虚，所以都主乎饮食。又形作伤寒，其脉不弦紧而弱，太阳中暍，身热疼重而脉微弱。可见脉弱无阳，必无实热的道理，只宜辨析真阳之虚，与胃气之虚，及夏月伤冷水，水行皮中所致耳。在阴经见之，虽为合脉，然阳气衰微已极，非峻温峻补，良难春回寒谷也。惟血痹虚劳，久嗽失血，新产及老人久虚，脉宜微弱。然必弱而和滑，可卜胃气之未艾。若少壮暴病而见脉弱，咸非所宜。即血证虚证，脉弱而兼之以涩，为气血交败，其能荣爨下之薪乎？
【长】长脉的特点是指下迢迢而超过本位，三部举按皆然，不像大脉那样举之盛大，按之少力。伤寒以尺寸俱长，为阳明受病。《内经》又以长则气治，为胃家之平脉。胃为水谷之海，其经多气多血，故显有余之象。但必须长而和缓，方为无病之脉。如果长而浮盛，又为经邪方盛之兆。也有病邪向愈而脉长的。张仲景说：太阴中风，四肢烦疼，阳脉微，阴脉涩，而长者为欲愈。盖风本阳邪，因土虚木乘，陷于太阴之经，而长脉见于微涩之中，疼热发于诸阳之本，询为欲愈之征，殊非病进之谓。且有阴气不充，而脉反上盛者。经文说寸口脉中手长者，曰足胫痛是也。此与秦越人遂上鱼为溢，遂入尺为覆，及上部有脉，下部无脉，关格吐逆，不得小便，同脉异证，不可与尺寸俱长之脉，比例而推也。
【短】短脉的特点是尺寸俱短，而不及本位，不像小脉那样三部皆小弱不振，不像伏脉那样一部独伏匿不前。经文说：短则气病，良由胃气厄塞，不能条畅百脉，或因痰气食积，阻碍气道，所以脉见短涩促结之状。也有阳气不充而脉短的。经文谓寸口脉中手短者，曰头痛是也。张仲景说：汗多重发汗，亡阳谵语，脉短者死，脉自和者不死。又少阴脉不至，肾气绝，为尸厥。伤寒六七日，大下后，寸脉沉而迟，手足厥冷，下部脉不至，咽喉不利，唾脓血者难治。戴同父说：短脉只当责之于尺寸，若关中见短，是上不通寸为阳绝，下不通尺为阴绝矣。怎知关部从无见短之理？昔人有以六部分隶而言者，殊失短脉之义。
【大】大脉的特点是应指满溢，倍于寻常，不像长脉那样但长不大，不像洪脉那样既大且数。大脉有虚实阴阳之异。经文说：大则病进，是指实大而言。张仲景以大则为虚者，乃盛大少力之谓。然又有下利脉大者为未止，是又以积滞未尽而言，非大则为虚之谓也。有六脉俱大者，阴不足，阳有余也。有偏大于左者，邪盛于经也。偏大于右者，热盛于内也。亦有诸脉皆小，中有一部独大者；诸脉皆大，中有一部独小者，便以其部，断其病之虚实。且有素禀六阳，或一手偏旺偏衰者，又不当以病论也。凡大而数盛有力，皆为实热。如人迎气口大紧以浮者，其病益甚在外。气口微大，名曰平人。其脉大坚以涩者胀。乳子中风热，喘鸣肩息者，脉实大而缓则生，急则死。乳子，是指产后以乳哺子而言，非婴儿也。产后脉宜悬小，最忌实大。今证见喘鸣肩息，为邪气暴逆，又须实大而缓，方与证合。若实大急强，为邪胜正衰，去生远矣。此与乳子而病热，脉弦小，手足温则生，似乎相左，而实互相发明也。伤寒热病，谵语烦渴，脉来实大，虽剧可治。得汗后热不止，脉反实大躁疾者死。温病大热不得汗，脉大数急强者死，细小虚涩者亦死。厥阴病下利脉大者虚也，以其强下之也。阴证反大发热，脉虚大无力，乃脉证之变。内证元气不足，发热脉大而虚，为脉证之常。虚劳脉大，为血虚气盛。《金匮要略》云：男子平人脉大为劳，气有余便是火也。所以瘦人胸中多气而脉大，病久气衰而脉大，总为阴阳离绝之候。孰谓大属有余，而可恣行攻伐哉？若脉见乍大乍小，为元神无主，随邪气之鼓动，可不慎而漫投汤液耶？
【小】小脉的特点是三部皆小，而指下显然，不像微脉那样微弱依稀，不像细脉那样微细如发，不像弱脉那样软弱不前，不像短脉那样首尾不及。夫脉之小弱，虽为元气不足，若小而按之不衰，久按有力，又为实热固结之象。总由正气不充，不能鼓搏热势于外，所以隐隐略见滑热之状于内也。设小而证见热邪亢盛，则为证脉相反之兆。亦有平人六脉皆阴，或一手偏小者。若因病而脉损小，又当随所见部分而为调适机用，不可不治也。假令小弱见于人迎，卫气衰也。见于气口，肺胃弱也。见于寸口，阳不足也。见于尺内，阴不足也。凡病后脉见小弱，正气虽虚，邪气亦退，故为向愈。设小而兼之以滑实伏匿，得非实热内蕴之征乎？经文说：切其脉口滑小紧以沉者，病益甚在中。又说：温病大热，而脉反细小，手足逆者死。乳子而病热，脉悬小，手足温则生，寒则死。此条与乳子中风热互发，言脉虽实大，不至急强，脉虽悬小，四肢不逆，可卜胃气之未艾。若脉...
After purgation, if the pulse is solid and large, or suddenly becomes extremely faint and nearly imperceptible, while fever persists, it indicates a fatal prognosis. In Jueyin disease, if diarrhea presents with a solid pulse, the use of purgation will lead to death. From these scenarios, one can observe the reversal between pathological pulses and normal pulses. The term "solid" (Shi) resembles a stone. A Stone-like pulse is the normal pulse of the Kidney; however, if it is excessively hard, crisp and hard like a bouncing stone, it signifies the exhaustion of Kidney Qi. For conditions such as Xiao-Dao (wasting-thirst), Gu-Zhang (drum-like distension), and Jian-Ji (hard accumulations), a solid pulse indicates treatability. Conversely, in cases of hemorrhage from diarrhea, sudden deficiency after childbirth, or extreme emaciation due to chronic illness, the appearance of a solid and large pulse makes treatment difficult.
[Strung-like Pulse] The Strung-like (Xian) pulse is upright, straight, and long. It responds to light pressure and remains fixed under heavy pressure. Unlike the Tight pulse which feels like a twisting rope, or the Leathery pulse which is taut like a bowstring, the Strung-like pulse is governed by Wind-Wood energy. Therefore, any pathological pulse appearing Strung-like represents Yin hiding within Yang. If cold-natured herbs are mistakenly used for deficiency syndromes, the pulses at both Chi positions will likely transform into a Strung-like quality. Stagnation of cold food due to Spleen-Stomach deficiency often manifests as a Strung-like pulse at the Qi-Kou position (right Cun). In Shanghan (Cold Damage) diseases, a Strung-like pulse at both Cun and Chi positions indicates Shaoyang channel involvement. Shaoyang serves as the pivot and the boundary between Yin and Yang. A Strung-like pulse combined with Floating and Fine qualities represents the intrinsic pulse of Shaoyang. If combined with Rapid and Moderate qualities, it suggests two pathways: transmission to the Fu organs or transformation into Yin. If combined with Deep, Choppy, Weak, and Faint qualities, it cannot be denied as a Yin pulse. The Classic states that a Strung-like pulse at Cun causes hypochondriac stiffness and pain, accompanied by aversion to cold. Another passage notes that a Strung-like and Fine pulse with headache and fever belongs to Shaoyang, termed "Yang Strung headache." Pain associated with this typically involves the Taiyang region. When the Yang pulse is Choppy and the Yin pulse is Strung-like, abdominal cramping pain is expected according to the method, termed "Yin Strung abdominal pain," usually located in the lower abdomen, both falling within the Shaoyang domain. In Shaoyin disease, where there is an urge to vomit but nothing comes up, starting with cold hands and feet, and a Strung-like and Slow pulse, this indicates excess in the chest, warranting emesis. However, if dry heaving is caused by cold-fluid retention above the diaphragm, emesis is contraindicated, and urgent warming is required. Detailed analysis shows that one should not generally classify Strung-like pulses with Deep or Choppy qualities solely as Yin. Strung-like and Slow indicates chest excess. Examining symptoms alongside pulses requires flexibility. Among various diseases, Strung-like pulses due to pathogenic excess occur in 20-30% of cases, while those due to righteous deficiency occur in 60-70%. Strung-like qualities hidden within other pulses are also common. During the peak of exterior pathogens in Shanghan, if a Strung-like pulse appears in one position, or is combined with Slow/Choppy qualities, it indicates internal Yin involvement. Despite strong external pathogens, warm dispersal is needed; harsh sweating or purging methods are unsuitable. This applies even to non-seasonal colds. For patients with pre-existing conditions like moving Qi, palpitations, cold hernias, or gouty arthritis, who contract external pathogens, searching carefully within Floating-Tight-Rapid-Large pulses may reveal hidden Strung-like qualities. Often, a Tight exterior pulse may feel gradually weaker upon pressure, not beating strongly when released; this should be treated as a Strung-like case. Within a Floating pulse, if pressing reveals straightness; within a Slippery pulse, if pressing feels forceful; within a Deep pulse, if pressing feels continuous; within a Choppy pulse, if pressing feels distinct—all indicate internal Yin pathogens and sinking Yang failing to harmonize the vessels, manifesting as Strung-like rigidity, rather than mere external pathogen tightness. In complicated Shanghan diseases, Strung-like pulses are frequent; in consumptive internal injuries, they account for over half. Thus, Zhang Zhongjing ranked the Strung-like pulse as the primary among the six harmful pulses. Malaria, cold-fluid retention, and miscellaneous diseases all exhibit Strung-like pulses. As stated in *Jin Gui Yao Lue*: Malaria pulses are inherently Strung-like; Strung-like and Rapid indicates heat; Strung-like and Slow indicates cold; Strung-like, Small, and Firm improves with purgation; Strung-like and Slow responds to warming; Strung-like and Tight responds to sweating/acupuncture; Floating and Large responds to emesis; Strung-like and Rapid indicates wind-fire, managed by dietary regulation. Fluid retention pulses are all Strung-like; bilateral Strung indicates cold; unilateral Strung indicates fluid retention; Strung-like and Rapid indicates cold-fluid retention; Deep and Strung indicates suspended fluid with internal pain. Other conditions like abdominal pain, drum distension, vomiting, chest bi, masses, blood stasis, wind-stroke, cholera, dysentery, Qi stagnation, and alternating chills/fever with fullness also show Strung-like pulses. These result from insufficient middle Qi and Wood attacking Earth. The degree of Strung-like quality reflects Spleen/Stomach Qi strength; Solid vs. Empty Strung reflects pathogen excess vs. deficiency; Floating vs. Deep Strung reflects Exterior/Yin-Yang; Cun vs. Chi Strung reflects rising/sinking pathology. Regardless of the syndrome, as long as the pulse is harmonious and spirited, retaining Stomach Qi, it is treatable. However, if Strung-like and tense/fine like touching a blade, or rigid like a new bowstring, long pole, or horizontal bar, it indicates absence of Stomach Qi. In consumptive diseases, Cun pulses are often Rapid/Large while Chi pulses are Strung-like/Fine and forceful—these are damaging pulses, rendering medical intervention futile.
[Moderate Pulse] The Moderate (Huan) pulse is leisurely and harmonious, neither fast nor slow. It seems Slow but is not truly Slow. Unlike the Soft (Ru) pulse which feels绵软 (cotton-soft) under the finger, the Deficient (Xu) pulse which is fleeting and large, the Micro (Wei) pulse which is minute and soft, or the Weak (Ruo) pulse which is fine and powerless. Zhang Zhongjing stated: If Yang pulses are Floating, Large, and Soft, and Yin pulses are equally Floating, Large, and Soft, it is called Moderate. In Shanghan, moderate pulses at both Cun and Chi indicate Shaoyin involvement. Shaoyin is the boundary where Yin ends and Yang returns; thus, appearing after illness recovery is favorable. For Taiyang disease, fever, headache, spontaneous sweating, and a Floating-Moderate pulse indicate Wind injuring the Defensive layer. Due to sweating and loose pores, the pulse cannot be Tight. The Moderate pulse is the intrinsic pulse of the Spleen; it must be harmonious and spirited to indicate sufficient Spleen Qi. If excessive and weak, it indicates Spleen Qi insufficiency; if Moderate and Slippery, it indicates harmonious Stomach Qi. Ancients considered Floating-Moderate as Wind injury, Deep-Moderate as Cold-Damp, Moderate-Large as Wind-Deficiency, and Moderate-Fine as Bi-Damp. Floating-Moderate implies Wind affecting Yang; Deep-Moderate implies Damp affecting Yin. Dampness naturally creates a Moderate pulse; combined with Wind, it becomes Floating-Moderate; constrained by Cold, it becomes Deep-Moderate. If affecting Yin, the pulse is Deep, Minute, and Moderately Slow because Shaoyin contains Wind-Wood energy, so even if Deep, it retains a slight Moderate quality.
[Surging Pulse] The Surging (Hong) pulse is both Large and Rapid, feeling like connected pearls under the finger, smooth like lapis lazuli, but slightly slower upon deep pressure. It differs from the Full (Shi) pulse which is solid on both light and deep pressure, the Slippery (Hua) pulse which is soft and fluent, and the Large (Da) pulse which is simply large and long. Ancients viewed Surging as the Summer pulse; *Nei Jing* calls it Hook (Gou), leading to the equation of Hook equals Surging. Because it is Rapid, Large, and Soft, curving outward upon pressure, it can be called Hook. Fire nature rises vacuously, coming strong and departing weak, lacking solidity. However, phlegm-food-blood stasis obstructing the vessel may cause curvature at the Guan position, differing from the subtle Hook of the Summer pulse. Surging indicates blazing Fire. Zhang Zhongjing noted that after taking Guizhi Tang, if profuse sweating occurs with severe thirst and a Surging pulse, it indicates Warm Disease. Warm disease arises from winter latent qi, manifesting in Spring as Warm Disease or Summer as Heat Disease. Pathogens hide internally and emerge externally, often showing Floating-Surging and confused pulses, frequently stronger on the right hand, sometimes irregularly Slippery/Moving. This aligns with Yue Ren’s description of movement across channels without specific localization. If Zheng Qi is depleted internally yet exterior-releasing herbs are given, heat will clash in Ying/Blood levels without cessation. If epidemic heat presents with severe thirst/confusion but a Deep-Small-Weak pulse, it is Yang disease with Yin pulse. Extreme Yang heat with cold feet and weak Chi pulse indicates lower deficiency, untreatable. Persistent heat despite repeated purgation with un-abating Surging pulse indicates complicated disease, often incurable. Surging represents overflowing Yang and dying Yin. "Abundant like a chariot canopy" indicates Yang knotting; Floating-Surging with oily sweat indicates Lung exhaustion. Even in miscellaneous diseases, Surging signals excessive Fire. Post-illness chronic deficiency, consumptive bleeding, or dysentery causing Yuan Qi loss presenting with Surging pulse is highly unfavorable. Only low-status individuals may naturally have Surging-Solid pulses, not necessarily indicating Excess-Heat.
[Faint Pulse] The Faint (Wei) pulse seems present yet absent, on the verge of disappearing but not gone, feeling vague upon pressure. It differs from the Weak pulse which is clearly small/weak, or the Fine pulse which is thin but forceful. Faint indicates declining Yang Qi. The Classic states "All Faint pulses at Cun indicate Yang loss." Whether lightly taken, heavily taken, at Qi-Kou, or Chi, Faintness denotes Qi deficiency. Manifestations include upper body chills, excessive sweating, shortness of breath, or lower body seminal emission, diarrhea, and poor appetite. It primarily relates to Qi, not Blood. Zhongjing described it as "like a spider's thread," signifying Yang decline. Stroke or summerheat collapse with Faint pulse indicates deficient wind. Often combined with Deep/Moderate. Cold strike collapse with Faint pulse indicates violent Yin pathogen, leading to near-absence. Shanghan with Deep-Moderate pulses at Cun/Chi indicates Shaoyin disease; here both Zheng and Xie are weakening, unlike Shaoyin's Fine-Faint pulse with drowsiness. Both channels show Faintness but differ in Yin-ending/Yang-returning versus Yang-leaving/Yin-entering. Taiyang Faint pulse with fever/chills, more heat than cold, indicates no Yang. Facial redness with unresolved pathogen and Faint pulse, or Yin-Yang stagnation preventing transmission with reverse Faint pulse, require careful differentiation. Treating Faint solely as deficiency without addressing stagnation hinders resolution. True recovery is marked by resolved heat/body comfort and subsequent Faint pulse. Taiyang syndrome with cold feet and faint Chi pulse indicates lower Jiao cold-deficiency, requiring strengthening Middle Qi before standard sweating.
[Tight Pulse] The Tight (Jin) pulse resembles a twisting rope, solid upon pressure but not hard. It differs from Strung-like (upright/string-like) or Firm/Leathery (rigid/forceful) pulses. Tight indicates cold contraction. It can also appear with heat constrained by cold, causing irritability, stiffness, and pain, as in Taiyang Cold injuring Ying. Renying (left Cun) Floating-Tight confirms exterior syndrome. Qi-Kou (right Cun) Tight-Firm indicates internal food injury. *Jin Gui* links Tight headache to wind-cold and food retention. Zhongjing asks how Tight pulse arises: from lung cold after sweating/vomiting, cold water drinking causing cough, or stomach cold causing diarrhea. These explain Tight pulse variations. In Shaoyin, if Yin-Yang pulses are both Tight but sweating occurs, it indicates Yang collapse, with sore throat, vomiting, and diarrhea—Tight entering interior. If Shaoyin Tight pulse lasts 7-8 days, then diarrhea brings sudden faintness, warming hands, and disappearance of Tightness, recovery is imminent despite irritability. This is "Tight leaving, person safe." In contraindications for purgation, Yin-Yang Tight pulse with chills/fever suggests "Desire for Jue" (pulsatile fluctuation: large-small-large), indicating Yang sinking due to mistaken purgation, resembling Jue progression. Pulse changes retain Tight shape, unlike dispersed Ying/Wei. Another case: Cun Faint, Chi Tight, with deficiency/sweating, indicates Yin dominance, no Yang visible. Tight locations mark areas devoid of Yang. Tight-as-String vertical movement indicates Spasm. Hidden-Firm indicates Yin Spasm. All stem from meridian tension. Tight without harmony indicates no Stomach Qi, life expectancy short.
[Weak Pulse] The Weak (Ruo) pulse is Deep, Fine, and Soft, felt only on pressure, absent on lifting. It differs from Faint (near-disappearing), Soft (absent on pressure), or Fine (fine in all positions). Weak indicates Yang decline. Floating checks Yang; absence on floating confirms Yang deficiency. Thus, Weak is Yin pulse; even in Yang channels, it signifies Yang decline. Cun Weak-Slow indicates stomach cold/fullness/poor appetite; Cun Weak-Moderate indicates sudden inability to eat/Qi blocking diaphragm. Both relate to diet. Mimicking Shanghan but with non-Tight/Strung Weak pulse, or Taiyang Heatstroke with body heat/heaviness and Weak pulse, confirms no Excess-Heat with Weak/No-Yang. Differentiate True Yang deficiency, Stomach Qi deficiency, or summer cold-water injury. In Yin channels, though appropriate, extreme Yang decline requires strong warming/nourishing. In Blood Bi, consumptive disease, chronic cough/bleeding, postpartum, or elderly weakness, Weak pulse is expected. Must be Weak-Harmonious-Slippery to confirm remaining Stomach Qi. Acute illness in youth with Weak pulse is unfavorable. Even in Blood/Deficiency syndromes, Weak combined with Choppy indicates Qi-Blood failure, unable to sustain life.
[Long Pulse] The Long (Chang) pulse extends beyond its position in all three positions upon lifting/pressing. It differs from Large (grand on lift, weak on press). Shanghan links Long at Cun/Chi to Yangming. *Nei Jing* states Long means Qi governance, the normal Stomach pulse. Stomach, sea of water/grain, has abundant Qi/Blood, showing surplus. Must be Long-Harmonious to be healthy. Long-Floating-Excessive indicates flourishing pathogen. Recovery may also show Long pulse. Zhongjing: Taiyang Windstroke with limb pain, Yang Faint, Yin Choppy, but Long indicates recovery. Wind is Yang pathogen; Spleen deficiency allows Liver Wood invasion into Taiyin. Long within Faint-Choppy, pain originating from Yang bases, signals recovery, not progression. Alternatively, insufficient Yin causing upper excess: Cun Long indicates leg/shin pain. This differs from Yue Ren’s "Overflowing" (pulse reaching fish border) or "Covering" (reaching Chi), or Upper pulse/Lower no-pulse (Guan-Ge regurgitation/anuria). Same pulse, different signs; cannot compare directly with Bilateral Long.
[Short Pulse] The Short (Duan) pulse is short at Cun/Chi, not reaching its position. It differs from Small (all three positions weak) or Hidden (one position hidden). Classic: Short indicates Qi disease, caused by blocked Stomach Qi failing to flow through vessels, or phlegm/food obstruction. Results in Short-Choppy-Hasty-Bound pulses. Insufficient Yang can also cause Short. Cun Short indicates headache. Zhongjing: Excessive sweating leading to Yang collapse/delirium with Short pulse indicates death; Harmonious pulse indicates survival. Shaoyin pulse absence, Kidney Qi exhaustion, leads to Corpse Jue. Shanghan day 6-7 after severe purgation: Cun Deep-Slow, cold limbs, lower pulse absent, sore throat, spitting pus/blood—difficult to treat. Dai Tongfu: Short applies to Cun/Chi. Guan Short implies Yang/Yin extinction. But Guan never shows Short; classifying by six positions misses the meaning.
[Large Pulse] The Large (Da) pulse fills the finger, double the normal. Differs from Long (long but not large) or Surging (large and rapid). Large has Excess/Deficiency/Yin-Yang distinctions. Classic: "Large means disease progresses" refers to Excess-Large. Zhongjing: "Large means deficiency" refers to Grand but weak. Diarrhea with Large pulse means accumulation remains, not necessarily deficiency. Six Large pulses: Yin insufficient, Yang excessive. Left Larger: Pathogen in channels. Right Larger: Heat inside. One Large among Small pulses, or one Small among Large pulses, helps judge local excess/deficiency. Constitutional Yang excess or unilateral imbalance is not disease. Large-Rapid-Forceful indicates Excess-Heat. Renying/Qi-Kou Large-Tight-Floating indicates worsening exterior. Qi-Kou slightly Large is normal. Large-Firm-Choppy indicates distension. Postpartum woman with wind-heat, wheezing, shoulder breathing: Large-Slow-Harmonious pulse survives; Rapid/Tight dies. "Ru Zi" means postpartum nursing mother, not infant. Postpartum pulse should be Suspended-Small; Large is taboo. Wheezing indicates violent pathogen; Large-Slow matches condition. Large-Rapid-Tight indicates pathogen winning, Zheng losing, far from survival. Contrasts with postpartum heat, Strung-Fine pulse, warm hands survive. Shanghan heat disease, delirium/thirst, Large pulse: treatable. Post-sweat persistent heat with Large-Rapid-Irritable pulse: death. Warm disease high fever, no sweat, Large-Rapid-Tight pulse: death. Small-Weak-Choppy also death. Jueyin diarrhea with Large pulse indicates deficiency from forced purgation. Yin syndrome with fever and Large-Weak pulse is variation. Internal deficiency with fever and Large-Weak is constant. Consumptive Large pulse indicates Blood deficiency/Qi excess. *Jin Gui*: Normal man with Large pulse indicates consumption; Qi excess generates fire. Thin people with much Qi have Large pulse; chronic illness with Qi decline has Large pulse. Both signal Yin-Yang separation. Who says Large is Excess, allowing reckless attack? Fluctuating Large/Small indicates Yuan Shen lack, driven by pathogen; caution against random decoctions.
[Small Pulse] The Small (Xiao) pulse is small in all three positions, clearly felt. Differs from Faint (vague), Fine (hair-thin), Weak (soft/backward), or Short (ends not meeting). Small-Weak indicates insufficient Yuan Qi. If Small but firm upon pressure, lasting force, it indicates Excess-Heat consolidation. Insufficient Zheng Qi fails to drive heat outward, revealing hidden Slippery-Heat internally. If Small pulse with Excess-Heat symptoms, it contradicts. Normal people may have Yin-only or unilateral Small pulses. Disease-induced Small pulse requires adjustment based on location. Small-Weak at Renying: Wei Qi decline. At Qi-Kou: Lung/Stomach weakness. At Cun: Yang insufficiency. At Chi: Yin insufficiency. Post-illness Small-Weak indicates Zheng weak but Xie receding, signifying recovery. Small combined with Slippery/Solid/Hidden indicates internal Excess-Heat. Classic: Pulse mouth Slippery-Small-Tight-Deep indicates worsening internal disease. Warm disease high fever with reverse Small pulse, cold extremities: death. Postpartum heat with Suspended-Small pulse, warm extremities: survival; cold extremities: death. This complements postpartum wind-heat discussion: Large pulse not too tight, Suspended-Small pulse with warm limbs indicates remaining Stomach Qi. If pulse...