或问人身脉位。既无一定之法。但以指下几微之象。推原
脏腑诸病。益切茫无畔岸。愿得显示至教。开我迷云。答曰∶汝等今日各从何来？或言某从西南平陆而来，或
言某由西北渡水而来，或言某于东南仄径遇师于不期之中。因谕之曰∶良由汝等识吾居处，得吾形神。故不拘
所从，皆可邂逅，否则 面错过矣。故欲识五脏诸病。须明五脏脉形。假如肝得乙木春升之令而生。其脉若草
木初生。指下软弱招招。故谓之弦，然必和滑而缓，是为胃气。为肝之平脉。若弦实而滑，如循长竿，弦多胃
少之脉也。若弦而急强。按之益劲。但弦无胃气也。加以发热。指下洪盛。则木槁火炎而自焚矣。所谓火
生于木，焚木者，原不出乎火也。若微弦而浮，或略带数，又为甲木之象矣。若弦脉见于人迎，肝气自旺也。
设反见于气口，又为土败木贼之兆。或左关虽弦，而指下小弱不振，是土衰木萎之象，法当培土荣木，设投伐肝
之剂，则脾土愈困矣。若弦见于一二部，或一手偏弦，犹为可治。若六脉皆弦，而少神气，为邪气混一不分之
兆。灵枢有云。人迎与寸口气大小等者，病难已。气者，脉气也，凡脉得纯脏之气。左右六部皆然者。俱不治也。或肝
病证剧
六部绝无弦脉，是脉不应病，亦不可治。举此以为诸脉之例，不独肝脏为然也。心属丙丁而应乎夏。其脉若火之燃薪。
指下累累。微曲而濡。故谓之钩。然必虚滑流利。是为胃气。为心之平脉。若喘喘连属。其中微曲。钩多胃少之
脉也。若瞥瞥虚大。前曲后居。但钩无胃气也。若虚大浮洪。或微带数。又为丙火之象。故钩脉见于左寸。
包络之火自旺也。或并见于右寸。火乘金位之兆。设关之外微曲。又为中宫有物阻碍之兆也。脾为己土而应于
四季。虽禀中央湿土。常兼四气之化而生长万物。故其脉最和缓。指下纡徐而不疾不迟。故谓之缓。然于和缓之
中。又当求其软滑，是谓胃气。为脾之平脉。若缓弱无力。指下如循烂绵。缓多胃少之脉也。若缓而不能自还
。代阴无胃气也。若脉虽徐缓而按之盈实。是胃中宿滞蕴热。若缓而涩滞。指下模糊。按之不前。胃中寒食
固结。气道阻塞之故耳。若缓而加之以浮。又为风乘戊土之象矣。设或诸部皆缓。而关部独盛。中宫湿热也。
诸部皆缓。寸口独滑。膈上有痰气也。诸部皆缓。两尺独显弦状。岂非肝肾虚寒。不能生土之候乎。肺本辛
金而应秋气。虽主收敛。而合于皮毛。是以不能沉实。但得浮弱之象于皮毛间。指下轻虚。而重按不散。故
谓之毛。然必浮弱而滑。是为胃气。为肺之平脉。若但浮不滑。指下涩涩然如循鸡羽。毛多胃少之脉也。昔人
以浮涩而短。为肺脏平脉、意谓多气少血。脉不能滑。不知独受营气之先。营行脉中之第一关隘。若肺不伤燥
。必无短涩之理。即感秋燥之气。亦病肺耳。非肺气之本燥也。若浮而无力。按之如风吹毛。但毛无胃气也。加
以关尺细数。喘嗽失血。阴虚阳扰。虽神丹不能复图也。若毛而微涩。又为庚金气予不足之象矣。若诸部皆毛。
寸口独不毛者。阳虚浊阴用事。兼挟痰气于上也。诸部不毛。气口独毛者。胃虚不能纳食。及为泄泻之征也。肾
主癸水而应乎冬。脉得收藏之令。而见于筋骨之间。按之沉实，而举指流利。谓之曰石。然必沉濡而滑。是谓
胃气。乃肾之平脉。若指下形如引葛。按之益坚。石多胃少之脉也。若弦细而劲。如循刀刃。按之搏指。但石
无胃气也。若按之虽石。举之浮紧。又为太阳壬水受邪之象矣。若诸脉不石。左寸独石者。水气凌心之象。右
关独石者。沉寒伤胃之象也。可知五脉之中。必得缓滑之象。乃为胃气。方为平脉。则胃气之验。不独在于右
关也。况内经所言。四时之脉。亦不出乎弦钩毛石。是知五脏之气。不出五行。四时之气。亦不出于五行。故其
论脉。总不出五行之外也。但当察其五脉之中。偏少冲和之气，即是病脉。或反见他脏之脉，是本脏气衰，他
脏之气乘之也。每见医守六部之绳墨。以求脏腑之虚实者。是欲候其人。不识声形笑貌，但认其居处之地也。
若得其声形笑貌，虽遇之于殊方逆旅，暗室隔垣，未尝错认以为他人也。犹之此经之脉见于他部，未尝错认
以为他经之病也。
至于临病察脉，全在活法推求，如诊富贵人之脉，与贫贱者之脉，迥乎不侔。贵显之脉，常清虚流利，富浓之脉
常和滑有神。贱者之脉。常浊壅多滞，贫者之脉。常蹇涩少神，加以劳 则粗硬倍常。至若尝富贵而后贫贱，
则营卫枯槁，血气不调。脉必不能流利和滑。久按索然。且富贵之证治。与贫贱之证治。亦截然两途。富贵
之人。恒劳心肾。精血内戕。病脉多虚。总有表里客邪。不胜大汗大下。全以顾虑元气为主。略兼和营调胃足
矣。一切苦寒伤气。皆在切禁。贫贱之人。藜藿充肠。风霜切体。内外未尝温养。筋骸素惯疲劳。脏腑经脉。
一皆坚固。即有病苦忧劳。不能便伤神志。一以攻发为主。若参 桂附等药。咸非是辈所宜。惟尝贵后贱。尝
富后贫之人。素享丰腴。不安粗 。病则中气先郁。非但药之难应。参 或不能支。反增郁悒之患。在所必至。
非特富贵之脉证。与贫贱悬殊。即形体之肥瘠。亦是不同。肥盛之人，肌肉丰浓。胃气沉潜。纵受风寒。未得
即见表脉。但须辨其声音涕唾。便知有何客邪。设鼻塞声重。涕唾稠粘。风寒所伤也。若虽鼻塞声重。而屡咳
痰不即应。极力咯之。乃得一线粘痰。甚则咽 肿胀者。乃风热也。此是肥人外感第一关键。以肥人肌气充
盛。风邪急切难入。因其内多痰湿。故伤热最易。惟是酒客湿热。渐渍于肉理。风邪易伤者有之。否则形盛
气虚。色白肉松。肌腠不实之故。不可以此胶执也。瘦人肌肉浅薄。胃气外泄。即发热头痛。脉来浮数。多属
于火。但以头之时痛时止。热之忽重忽轻。又为阴虚火扰之候也。惟发热头痛。无间昼夜。不分重轻。人迎浮
盛者。方是外感之病。亦有表邪兼挟内火者。虽发热头痛。不分昼夜轻重。而烦渴躁扰。卧寐不宁。皆邪火烁
阴之候。虽宜辛凉发散。又当顾虑其阴。独形瘦气虚，颜白唇鲜。卫气不固者。最易伤风。却无内火之患矣。
矧吾江南之人。元气最薄。脉多不实。且偏属东方。木火最盛。治之稍过。不无热去寒起之虑。而膏粱之人。
豢养柔脆。调适尤难。故善治大江
以南病者。不难遍行宇内也。但要识其所禀之刚柔。情性之缓急耳。西北之人。惯拒风寒。素食煤火。外内坚固
。所以脉多沉实。一切表里诸邪。不伤则已。伤之必重。非大汗大下。峻用重剂。不能克应。滇粤之人。恒受
瘴热。惯食槟榔。表里疏豁。所以脉多微数。按之少实。纵有风寒。只宜清解。不得轻用发散。以表药性皆上
升横散。触动瘴气。发热漫无止期。不至津枯血竭不已也。经云。西北之气。散而寒之。东南之气，收而温之。
所谓同病异治也。是以他方之人。必问方隅水土。旁观者以为应酬套语。曷知其为察脉审证用药之大纲。故操
司命之权者。务宜外息诸缘。内心无惴。向生死机关下个竿头进步工夫。自然不落时人圈缋。当知医门学问。原无
深奥难明处。但得悉其要领。活法推求。便可一肩担荷。又何必搜罗百氏。博览群书。开凿寻文解义之端。
愈滋多歧之惑哉。
有人问：人体脉象的位置，既然没有固定的法则，只能凭借手指下极其细微的征象，来推究脏腑的各种疾病，这更加让人茫然无措、找不到边际。希望能得到高明的教导，解开我心中的迷雾。
回答说：你们今天各自是从哪里来的？有人说从西南平坦之地而来，有人说从西北渡水而来，有人说在东南狭窄的小路上偶然遇到老师。于是告诫他们说：这是因为你们认识我的住所，了解我的形体神态，所以无论从哪里来，都能相遇；否则就会面错过。因此，想要识别五脏的各种疾病，必须明白五脏的脉象形态。
假如肝脏顺应乙木春季升发之气而生，其脉象就像草木刚刚发芽，手指下感觉软弱柔和，所以称为“弦”脉，但必须兼有和滑而缓的特征，这才是胃气，是肝脏的正常脉象。如果弦实而滑，像触摸长竿一样，这是弦多胃少的脉象。如果弦急强劲，按压下去更加坚硬，这就是只有弦象而没有胃气的脉象。如果再伴有发热，手指下感觉洪大旺盛，那就是木枯火炎而自焚了。所谓火生于木，焚烧木头的，原本就是火本身造成的。如果脉微弦而浮，或者略带数象，这又是甲木（胆）的征象。如果弦脉出现在人迎穴部位，说明肝气自旺。如果反而出现在气口（寸口），这是土败木贼（脾虚肝乘）的征兆。或者左关部虽然见弦脉，但手指下感觉细小虚弱不振，这是土衰木萎的征象，治法应当培补脾土以荣养肝木，如果投用伐肝的药物，那么脾土会更加困顿。如果弦脉只出现在一两个部位，或者一只手偏弦，还可以治疗。如果六部脉都弦，而且缺少神气，这是邪气混杂不分明的征兆。《灵枢》说：人迎脉与寸口气大小相等，病难治愈。气，指的是脉气，凡是脉象呈现纯脏之气，左右六部都是如此，都属于不治之症。或者肝病症状严重，但六部完全没有弦脉，这是脉象与病情不符，也不可治疗。举这个例子作为其他脉象的类推，不仅肝脏是这样。
心脏属丙丁火而对应夏季，其脉象就像燃烧柴火的火焰，手指下感觉累累相连，微曲而濡软，所以称为“钩”脉。但必须虚滑流利，这才是胃气，是心脏的正常脉象。如果脉象喘促连续不断，中间微曲，这是钩多胃少的脉象。如果脉象瞥瞥虚大，前曲后直，只有钩象而没有胃气。如果脉象虚大浮洪，或者略带数象，这又是丙火（小肠）的征象。所以钩脉出现在左寸，是心包络之火自旺。或者同时出现在右寸，是火乘金位（心火犯肺）的征兆。如果关部之外微曲，这是中宫（脾胃）有物阻碍的征兆。
脾脏为己土而对应四季，虽然禀受中央湿土之气，常兼有四时之气化育万物，所以其脉象最和缓，手指下迂徐而不快不慢，所以称为“缓”脉。但在和缓之中，又应当寻求软滑的感觉，这叫胃气，是脾脏的正常脉象。如果脉缓弱无力，手指下像触摸烂棉絮，这是缓多胃少的脉象。如果脉缓而不能自行恢复节律，出现代脉且无胃气。如果脉象虽然徐缓但按之盈实，这是胃中有宿食停滞蕴热。如果脉缓而涩滞，手指下模糊不清，按之不前，这是胃中寒食固结，气道阻塞的缘故。如果脉缓再加上浮象，这又是风邪侵犯戊土（胃）的征象。如果各部脉都缓，而关部独盛，这是中宫湿热。各部脉都缓，寸口独滑，这是膈上有痰气。各部脉都缓，两尺部独显弦状，难道不是肝肾虚寒，不能生养脾土的候象吗？
肺脏本属辛金而对应秋气，虽然主收敛，但合于皮毛，所以脉不能沉实，只在皮毛间得浮弱之象，手指下轻虚，重按时不散开，所以称为“毛”脉。但必须浮弱而滑，这才是胃气，是肺脏的正常脉象。如果只浮不滑，手指下涩涩然像触摸鸡羽，这是毛多胃少的脉象。古人认为浮涩而短是肺脏平脉，意思是肺气多气少血，脉不能滑。不知道营气运行于脉中的第一关隘在于肺，如果肺不伤燥，必然不会有短涩的道理。即使感受秋燥之气，也是病肺而已，并非肺气本性干燥。如果脉浮而无力，按之像风吹羽毛，只有毛象而没有胃气。如果再伴有关尺细数，喘咳失血，这是阴虚阳扰，即使是神丹妙药也不能恢复了。如果脉毛而微涩，这又是庚金（大肠）气予不足的征象。如果各部脉都毛，寸口独不毛，这是阳虚浊阴用事，兼挟痰气于上。各部脉都不毛，气口独毛，这是胃虚不能纳食，以及泄泻的征象。
肾脏主癸水而对应冬季，脉得收藏之令，而见于筋骨之间，按之沉实，举手时流利，称为“石”脉。但必须沉濡而滑，这叫胃气，乃肾脏的正常脉象。如果手指下形状像牵引葛藤，按之更加坚硬，这是石多胃少的脉象。如果脉弦细而劲，像触摸刀刃，按之搏指，只有石象而没有胃气。如果按之虽石，举之浮紧，这又是太阳壬水（膀胱）受邪的征象。如果各部脉都不石，左寸独石，这是水气凌心的征象；右关独石，这是沉寒伤胃的征象。可知在五脉之中，必须得缓滑之象，才是胃气，方为平脉。那么验证胃气，不仅仅在于右关部。况且《内经》所说四时之脉，也不出弦、钩、毛、石四种，由此可知五脏之气不出五行，四时之气也不出五行，所以论脉总不出五行之外。只要观察五脉之中，偏少冲和之气，就是病脉。或者反见他脏之脉，是本脏气衰，他脏之气乘虚侵袭所致。
常常看到医生死守六部脉的常规，来求取脏腑的虚实，这是想要诊察病人，却不识其声音、形体、笑貌，只认其居住的地方罢了。如果得其声音、形体、笑貌，即使在异地旅店、暗室隔墙之处相遇，也未曾错认以为他人。这就好比此经的脉象出现在他部，未曾错认以为他经的疾病。
至于临病诊脉，全在于灵活推求。如诊富贵人的脉，与贫贱人的脉，截然不同。贵显之人的脉，常清虚流利；富浓之人的脉，常和滑有神。贱者之脉，常浊壅多滞；贫者之脉，常蹇涩少神。再加上劳累则脉粗硬倍于平常。至于曾经富贵而后变贫贱的人，则营卫枯槁，血气不调，脉必不能流利和滑，久按索然无味。而且富贵人的证治，与贫贱人的证治，也是截然两途。富贵之人，常劳心肾，精血内耗，病脉多虚，总有表里客邪，不胜大汗大下之法，全以顾虑元气为主，略兼和营调胃足矣。一切苦寒伤气的药物，都在切禁之列。贫贱之人，藜藿充肠，风霜切体，内外未尝温养，筋骸素惯疲劳，脏腑经脉，一概坚固。即使有病苦忧劳，也不能便伤神志，治疗一以攻发为主。如果参、桂、附等药，都不是这类人所宜用的。只有曾经贵后贱、曾经富后贫的人，素享丰腴，不安粗劣饮食，生病则中气先郁结，不仅是药物难以应对，人参也可能不能承受，反而增加郁悒之患，在所必至。
不仅富贵之脉证与贫贱悬殊，即形体之肥瘦，也是不同。肥胖之人，肌肉丰浓，胃气沉潜，纵然受风寒，未必立即见表脉，只需辨其声音涕唾，便知有何客邪。如果鼻塞声重，涕唾稠粘，是风寒所伤。如果虽鼻塞声重，而屡咳痰不即应，极力咯之，乃得一线粘痰，甚则咽喉肿胀者，是风热。这是肥人外感的第一关键。因为肥人肌气丰盛，风邪急切难入，因其内多痰湿，故伤热最容易。只是酒客湿热，渐渍于肉理，风邪易伤者有之，否则形盛气虚，色白肉松，肌腠不实，不可对此胶执。
瘦人肌肉浅薄，胃气外泄，即使发热头痛，脉来浮数，多属于火。但以头部的疼痛时痛时止，热势忽重忽轻，又是阴虚火扰的候象。只有发热头痛，无间昼夜，不分轻重，人迎脉浮盛的，才是外感之病。也有表邪兼挟内火者，虽发热头痛，不分昼夜轻重，而烦渴躁扰，卧寐不宁，都是邪火烁阴的候象。虽然宜用辛凉发散，又当顾虑其阴。唯独形瘦气虚，颜面白唇鲜红，卫气不固者，最易伤风，却无内火之患。
况且我们江南之人，元气最薄，脉多不实，且偏属东方，木火最盛，治疗稍有过当，不无热去寒起之虑。而膏粱之人，豢养柔脆，调适尤其困难。所以善于治疗大江以南疾病的人，不难遍行宇内。但要识别其所禀赋的刚柔，情性的缓急罢了。西北之人，习惯抵御风寒，素食煤火，外内坚固，所以脉多沉实。一切表里诸邪，不伤则已，伤之必重，非大汗大下，峻用重剂，不能克应。滇粤之人，恒受瘴热，习惯食用槟榔，表里疏豁，所以脉多微数，按之少实。纵有风寒，只宜清解，不得轻用发散，因为表药性皆上升横散，触动瘴气，发热漫无止期，不至津枯血竭不已。经文说：西北之气，散而寒之；东南之气，收而温之。所谓同病异治。因此对于其他地方的人，必须询问方位水土，旁观者以为是应酬套语，怎知这是察脉审证用药的大纲。所以掌握生死大权的人，务必外息诸缘，内心无惴，向生死机关下个竿头进步工夫，自然不落时人圈套。应当知道医门学问，原本没有深奥难明之处，只要得其要领，活法推求，便可一肩担荷。又何必搜罗百氏，博览群书，开凿寻文解义之端，愈滋多歧之惑呢？
A question was asked: "The positions of the pulse in the human body have no fixed method. We can only deduce the diseases of the Zang-Fu organs from the subtle sensations under the fingers, which makes one feel lost and without boundaries. I wish to receive your supreme teaching to dispel my confusion."
The reply was: "Where did you all come from today? Some said they came from the flat lands of the southwest, some from crossing waters in the northwest, and some met their teacher unexpectedly on a narrow path in the southeast. Then I instructed them: 'It is because you know my residence and recognize my form and spirit that you can meet me regardless of where you come from; otherwise, you would have missed each other face to face.' Therefore, to identify the diseases of the five Zang organs, one must understand the pulse forms of the five Zang organs.
For example, the Liver (Gan) generates according to the command of Yi Wood rising in spring. Its pulse resembles grass and trees just sprouting; under the fingers, it feels soft and weak yet flexible, hence called 'Xian' (String-like). However, it must be harmonious, slippery, and slow, indicating Stomach Qi (Wei Qi), which constitutes the normal pulse of the Liver. If the pulse is Xian, solid, and slippery, like feeling a long bamboo pole, it indicates more Xian than Stomach Qi. If it is Xian, rapid, and strong, becoming harder upon pressure, it indicates only Xian without Stomach Qi. If accompanied by fever, with a surging and abundant sensation under the fingers, it signifies dry wood and blazing fire leading to self-immolation. As it is said, 'Fire is born from Wood; the one burning the Wood is originally Fire itself.' If the pulse is slightly Xian and floating, or slightly rapid, it represents the image of Jia Wood (Gallbladder). If the Xian pulse appears at the Renying point (ST9), it indicates hyperactivity of Liver Qi. If it appears instead at the Qikou (Cunkou), it is an omen of Earth failure and Wood attacking (Spleen deficiency with Liver overacting). Or, if the Left Guan position is Xian but feels small, weak, and unenergetic under the fingers, it is an image of Earth decline and Wood withering. The treatment should focus on tonifying Earth to nourish Wood. If liver-attacking agents are administered, the Spleen Earth will become even more distressed. If the Xian pulse appears in only one or two positions, or is unilateral, it is still treatable. If all six positions are Xian and lack Shen Qi (Spirit), it signals chaotic and indistinguishable pathogenic factors. The *Ling Shu* states: 'When the Renying and Cunkou pulses are equal in size, the disease is difficult to cure.' 'Qi' refers to Pulse Qi. Whenever the pulse exhibits pure Zang organ Qi, consistent across left and right six positions, it is untreatable. Or, if Liver disease symptoms are severe but there is absolutely no Xian pulse in the six positions, this is a mismatch between pulse and disease, also untreatable. This example serves as a paradigm for other pulses; it applies not only to the Liver.
The Heart (Xin) belongs to Bing-Ding Fire and corresponds to summer. Its pulse resembles fire burning firewood; under the fingers, it feels clustered, slightly curved, and moist, hence called 'Gou' (Hook). However, it must be empty, slippery, and smooth, indicating Stomach Qi, which constitutes the normal pulse of the Heart. If the pulse is panting and continuous, with slight curvature in the middle, it indicates more Gou than Stomach Qi. If it is fleeting, empty, large, curved at the front and straight at the back, it has only Gou without Stomach Qi. If it is empty, large, floating, and surging, or slightly rapid, it represents the image of Bing Fire (Small Intestine). Thus, if the Gou pulse appears at the Left Cun, it indicates hyperactivity of Pericardium Fire. If it appears simultaneously at the Right Cun, it signals Fire invading Metal (Heart Fire affecting Lungs). If there is slight curvature outside the Guan position, it suggests obstruction in the Central Palace (Spleen/Stomach).
The Spleen (Pi) is Ji Earth and corresponds to the four seasons. Although it inherits Central Wet Earth, it often incorporates the transformations of the four Qi to grow all things. Hence, its pulse is the most harmonious and slow. Under the fingers, it is leisurely, neither fast nor slow, hence called 'Huan' (Slow). However, within this harmony and slowness, one should seek softness and slipperiness, which is Stomach Qi, constituting the normal pulse of the Spleen. If the pulse is Huan, weak, and powerless, feeling like touching rotten cotton under the fingers, it indicates more Huan than Stomach Qi. If the pulse is Huan but cannot recover its rhythm spontaneously, presenting Dai (Intermittent) pulse without Stomach Qi. If the pulse is leisurely and slow but feels full and solid upon pressure, it indicates retained food stagnation and accumulated heat in the Stomach. If it is Huan and choppy/stagnant, feeling vague under the fingers and resisting pressure advancement, it is due to cold-food consolidation in the Stomach and blocked Qi channels. If Huan is added with Floating, it represents Wind invading Wu Earth (Stomach). If all positions are Huan but the Guan position is exclusively vigorous, it indicates Damp-Heat in the Central Palace. If all positions are Huan but the Cunkou is exclusively slippery, it indicates Phlegm-Qi above the diaphragm. If all positions are Huan but both Chi positions exclusively show Xian characteristics, is this not a sign of Kidney-Liver Deficient Cold failing to generate Earth?
The Lung (Fei) is Xin Metal and corresponds to Autumn Qi. Although it governs convergence, it combines with the skin and hair, so the pulse cannot be deep and solid. It presents a Floating and weak image at the skin level; under the fingers, it feels light and empty, yet does not scatter when pressed heavily, hence called 'Mao' (Feather-like). However, it must be Floating, weak, and slippery, indicating Stomach Qi, constituting the normal pulse of the Lung. If it is only Floating without slipperiness, feeling rough like touching a chicken feather under the fingers, it indicates more Mao than Stomach Qi. Ancients considered Floating, Choppy, and Short as the normal pulse of the Lung, believing it meant abundant Qi and scarce Blood, making the pulse unable to be slippery. They failed to realize that the first passageway for Ying Qi (Nutritive Qi) circulating within the vessels lies in the Lung. If the Lung is not injured by Dryness, there would be no reason for Shortness and Choppy qualities. Even if affected by Autumn Dryness, it is a diseased Lung, not the intrinsic dryness of Lung Qi. If the pulse is Floating and powerless, feeling like wind-blown feathers upon pressure, it has only Mao without Stomach Qi. If accompanied by thin and rapid pulses at Guan and Chi, with wheezing, coughing, and blood loss, it indicates Yin deficiency with Yang disturbance; even divine medicines cannot restore it. If the pulse is Mao and slightly Choppy, it represents insufficient Qi of Geng Metal (Large Intestine). If all positions are Mao but the Cunkou is not Mao, it indicates Yang deficiency with turbid Yin acting, combined with Phlegm-Qi ascending. If all positions are not Mao but the Qikou is exclusively Mao, it indicates Stomach deficiency failing to accept food, and is a sign of diarrhea.
The Kidney (Shen) governs Gui Water and corresponds to Winter. The pulse receives the command of storage and collection, appearing between sinews and bones. Pressed, it is deep and solid; lifted, it is smooth, hence called 'Shi' (Stone-like). However, it must be Deep, soft, and slippery, indicating Stomach Qi, which constitutes the normal pulse of the Kidney. If under the fingers it feels like pulling a vine, becoming harder upon pressure, it indicates more Shi than Stomach Qi. If it is String-like, thin, and strong, like touching a knife edge, beating against the finger upon pressure, it has only Shi without Stomach Qi. If pressed it is Shi, but lifted it is Floating and Tight, it represents Shaoyang Ren Water (Bladder) being invaded by pathogens. If all pulses are not Shi but the Left Cun is exclusively Shi, it is an image of Water Qi overwhelming the Heart. If the Right Guan is exclusively Shi, it is an image of Deep Cold injuring the Stomach. Thus, among the five pulses, obtaining the Huan-Slippery image is necessary for Stomach Qi to constitute a normal pulse. Therefore, verifying Stomach Qi is not limited to the Right Guan. Furthermore, the *Nei Jing* states that the four-season pulses do not go beyond Xian, Gou, Mao, and Shi. From this, we know that the Qi of the five Zang organs does not exceed the Five Elements, nor does the Qi of the four seasons. Thus, pulse discussion never exceeds the Five Elements. One must observe whether the five pulses lack the moderate and harmonious Qi; if so, it is a pathological pulse. Or if it shows the pulse of another Zang organ, it means the Qi of the original Zang is declining, allowing the Qi of another Zang to invade.
I often see physicians rigidly adhering to the rules of the six positions to determine the deficiency and excess of Zang-Fu organs. This is like trying to identify a person by recognizing only their residence, ignoring their voice, form, and laughter. If one knows their voice, form, and laughter, even meeting them in a foreign inn, dark room, or behind a wall, one would never mistake them for someone else. Similarly, if the pulse of this meridian appears in another position, one should not mistakenly attribute it to a disease of another meridian.
Regarding pulse diagnosis during clinical practice, it entirely depends on flexible deduction. For instance, the pulse of a wealthy/noble person differs significantly from that of a poor/commoner. The pulse of the noble is often clear, empty, and smooth; the pulse of the rich is often harmonious, slippery, and spirited. The pulse of the lowly is often turbid, obstructed, and stagnant; the pulse of the poor is often stiff, choppy, and lacking spirit. With labor, the pulse becomes coarse and hard, twice as usual. For those who were once wealthy/noble but became poor/common, the Ying and Wei are withered, and Blood and Qi are disordered. The pulse will certainly not be smooth and harmonious; prolonged pressing reveals emptiness. Moreover, the treatment for conditions of the wealthy/noble differs completely from that of the poor/common. The wealthy/noble often strain their Heart and Kidney, damaging Essence and Blood internally. Their pathological pulses are mostly deficient. Even with exterior-interior exogenous pathogens, they cannot withstand heavy sweating or purging. Treatment must primarily protect Yuan Qi (Original Qi), supplemented by harmonizing Ying and regulating Stomach. All bitter-cold herbs that damage Qi are strictly prohibited. The poor/common eat coarse vegetables, endure wind and frost, lack internal and external warmth, and are accustomed to physical fatigue. Their Zang-Fu and meridians are generally sturdy. Even with illness and worry, their Shen and Zhi are not easily damaged. Treatment focuses mainly on attacking and releasing. Herbs like Ginseng, Cinnamon Twig, and Aconite Root are unsuitable for this group. Only those who were once noble then common, or rich then poor, accustomed to richness and discomfort with coarse food, suffer from initial depression of Middle Qi when ill. Not only are drugs difficult to match, but Ginseng may not be tolerated,反而 increasing depression, which is inevitable.
Not only do the pulse and symptoms of the wealthy/noble differ vastly from the poor/common, but also body fatness and leanness. Fat individuals have abundant muscles and dense flesh, with Sunken and profound Stomach Qi. Even if affected by Wind-Cold, exterior pulses may not appear immediately. One must distinguish based on voice and nasal discharge/sputum to identify exogenous pathogens. Nasal congestion, heavy voice, and thick sticky discharge indicate Wind-Cold injury. If there is nasal congestion and heavy voice, but frequent coughing yields no sputum initially, and after forceful effort only a thread of sticky sputum comes out, or even throat swelling occurs, it indicates Wind-Heat. This is the key to exterior contraction in fat people. Because fat people have abundant muscle-Qi, Wind pathogens enter reluctantly; however, due to internal Phlegm-Dampness, Heat injury is easiest. Those with alcohol-induced Damp-Heat infiltrating muscle tissue are susceptible to Wind, but otherwise, shape-excess with Qi-deficiency, pale complexion, loose flesh, and insecure肌腠 (muscle pores) should not be rigidly applied here.
Thin individuals have shallow muscles and leaking Stomach Qi. Even with fever and headache, if the pulse is Floating and Rapid, it mostly belongs to Fire. However, intermittent headache and fluctuating heat intensity indicate Yin deficiency with Fire disturbance. Only when fever and headache occur day and night, regardless of severity, and the Renying pulse is Floating and vigorous, is it an exterior contraction disease. There are cases where exterior pathogens combine with internal Fire. Although fever and headache occur day and night without regard to severity, accompanied by irritability, thirst, restlessness, and sleep disturbance, these are signs of Pathogenic Fire scorching Yin. Although辛凉 (Acrid-Cool) dispersants are appropriate, Yin must be protected. Only those who are thin, Qi-deficient, with pale faces and fresh red lips, and insecure Wei Qi, are most prone to Wind invasion without internal Fire concerns.
Moreover, people in our Jiangnan region have the thinnest Yuan Qi, and pulses are mostly insubstantial. Being in the East, Wood and Fire are strongest. Slight over-treatment may lead to Heat departing and Cold arising. People consuming rich foods are nurtured into fragility, making regulation particularly difficult. Thus, those skilled in treating diseases south of the Great River find it easy to practice anywhere. But one must recognize their innate constitution (Gang/Rou) and temperament (Huan/Ji). People in the Northwest are accustomed to resisting Wind-Cold, eating vegetarian diets and using coal fires, making their exterior and interior sturdy. Their pulses are mostly Deep and Solid. Any exterior-interior pathogen, if not contracted, is fine; if contracted, it is severe. Heavy sweating and purging, using potent decoctions, are required to overcome it. People in Dian-Yunnan and Guangdong are constantly exposed to Miasma-Heat and habitually eat betel nuts. Their exterior and interior are open and loose. Their pulses are slightly Rapid, feeling less solid upon pressure. Even with Wind-Cold, only clearing and resolving is suitable; dispersants should not be used lightly. Because exterior herbs ascend and spread horizontally, disturbing Miasma Qi, causing fever to last indefinitely until fluids are exhausted and blood is depleted. The Classics state: "The Qi of the Northwest is scattered and cooled; the Qi of the Southeast is gathered and warmed." This is called treating the same disease differently. Therefore, for people from other regions, one must inquire about local geography and water/soil conditions. Bystanders may think this is mere polite conversation, but how could they know it is the general principle for pulse diagnosis, syndrome differentiation, and medication? Those wielding the power of life and death must extinguish external distractions and keep their minds calm. They must make progress at the critical juncture of life and death. Naturally, they will not fall into the traps of contemporaries. One should know that medical knowledge has no profound obscurity. Grasping the essentials and applying flexible deduction allows one to shoulder the responsibility. Why search through hundreds of schools and read numerous books, opening doors to textual interpretation that only breeds confusion from too many divergent paths?