或问人身四肢百骸。脏腑经络诸病。皆取决于三部。究竟脉属何类。动是何气。而诊之之法。一如古圣所
言否。答言。脉本营气所主。为气血之源。故能出入脏腑。交通经络。行于肯綮之间。随气上下鼓动。其指下
发现之端。或清或浊。或小或大。或偏小偏大。虽言禀赋不同。实由性灵所发。非可一途而取。纵古圣曲为摩写形象
。以推阴阳寒热之机。然亦不过立法大义。明眼之士。贵在圆机活泼。比类而推。何难见垣一方人。盖脉之显
着虽微。而所关最钜。其受气在混沌未分之先。流行在胚胎方结之际。天地万物。靡不皆然。如璇玑玉衡。江
海潮汐。此天地脉运之常也。白虹贯日。洪水滔天。此天地脉络之病也。穷冬闪电。九夏雹冰。此天地气交之
乱也。天愁雨血。地震生毛。此天地非常之变也。至于夏暑冬寒。南暄北冽，乃天地阴阳之偏。人在气
交之中。脉象岂能无异。时值天地之变。诊切安得不殊。试观草木无心。其皮干茎叶，皆有脉络贯通。以行津
液。顽石无知。亦中怀脉理。以通山泽之气。适当亢 阴霖。严寒酷暑。则木石皆为变色。况于人乎。姑以
脉之常度言之。其始从中焦。循肺一经。而之三部。由中达外。为身中第一处动脉。较诸他处不同。古人虽有浮沉滑涩
等辨论之法。然究其源。有形之脉。乃水谷之精所布。禀乎地也。其鼓运之象。是无形
之气所激。禀乎天也。而交通天地之气。和合阴阳生生不息之机。此则禀乎气交也。况此气血之属。原不可以
方圆端倪。即如人之面目。虽五官无异。及细察之。千万人中。从未有一雷同者。经脉别论云。诊脉之道。观
人勇怯。骨肉皮肤。能知其情。以为诊法。故上古使僦贷季。理色脉而通神明。夫色者神气之所发。脉者血气
之所凭，是以能合色脉。万举万全。得其旨。则心目昭如日月。洵非下士可得而拟议焉。阴阳应象论言。善诊
者。察色按脉。先别阴阳。审清浊而知部分。视喘息。听声音。而知病所苦。观权衡规矩。而知病所主。按尺
寸浮沉滑涩。而知病所生。以治则不失矣。此即能合色脉。万举万全之互辞。然其所重。尤在适其性情。故诊不
知五过四失。终未免为粗工也。迩来病家亦有三般过差。一者匿其病情。令猜以验医之工拙。一者有隐蔽难言
之病。则巧为饰词。以瞒医师。一者未脉先告以故，使医溺于成说。略不加详。虽老成名宿。未免反费推敲。
多有自认错谬。喻之不省者。苟非默运内照。鲜不因误致误也。坐次一人问曰。夫子每云。能合色脉。万举万全。
设或深闺窈窕。密护屏帏。不能望见颜色。又当何如。曰。是何言之不聪也。尼父有云。举一隅。不以三隅
反。但须验其手腕色泽之苍白肥瘠。已见一斑。至若肌之滑涩。理之疏密。肉之坚软。筋之粗细。骨之大小。
爪之刚柔。指之肥瘦。掌之浓薄。尺之寒热。及乎动静之安危。气息之微盛。更合之以脉。参之以证。则气血
之虚实。情性之刚柔。形体之劳逸。服食之精粗。病苦之逆顺。皆了然心目矣。复问五色之应五脏。愚所共知。
余皆学人未谙。愿卒闻之。以启蒙昧。曰。某所谓色脉者。仓公五色诊也。乃玉机不刊之秘。知者绝罕。其间奥
妙。全在资禀色泽。以参脉证。如影随形。守一勿失。灵枢所谓粗守形上守神者。即此义也。夫神者色也。形
者质也。假令黄属脾胃。若黄而肥盛。胃中有痰湿也。黄而枯 。胃中有火也。黄而色淡。胃气本虚也。黄而色黯。津
液久耗也。黄为中
央之色。其虚实寒热之机。又当以饮食便溺消息之。色白属肺。白而淖泽。肺胃之充也。肥白而按之绵软。气
虚有痰也。白而消瘦。爪甲鲜赤。气虚有火也。白而夭然不泽。爪甲色淡。肺胃虚寒也。白而微青。或臂多青
脉。气虚不能统血也。若兼爪甲色青。则为阴寒之证矣。白为气虚之象。纵有失血发热。皆为虚火。断无实热
之理。苍黑属肝与肾。苍而理粗。筋骨劳 也。苍而枯槁。营血之涸也。黑而肥泽。骨髓之充也。黑而瘦削。
阴火内戕也。苍黑为下焦气旺。虽犯客寒。亦必蕴为邪热。绝无虚寒之候也。赤属心。主三焦。深赤色坚。素禀
多火也。赤而 坚。营血之充也。微赤而鲜。气虚有火也。赤而索泽。血虚火旺也。赤为火炎之色。只虑津枯
血竭。亦无虚寒之患。大抵火形人。从未有肥盛多湿者。即有痰嗽。亦燥气耳。若夫肌之滑涩。以征津液之盛
衰。理之疏密。以征营卫之强弱。肉之坚软。以征胃气之虚实。筋之粗细。以征肝血之充馁。骨之大小。以征
肾气之勇怯。爪之刚柔。以征胆液之淳清。指之肥瘦。以征经气之荣枯。掌之浓薄。以征脏气之丰歉。尺之寒
热。以征表里之阴阳。论疾诊尺云。尺肤热甚。脉盛躁者。病温也。其脉盛而滑者。病且出也。尺肤寒。其脉小者。泄
少气。斯皆千古秘密。一旦豁然。询是临机应用。信手拈来。头头是道底第一义。稔须着眼。
有人问：人身四肢百骸，脏腑经络的各种疾病，都取决于寸口脉的三部（寸、关、尺）。究竟脉属于哪一类？它动的是什么气？诊察脉象的方法，是否完全像古代圣人所说的那样呢？
回答说：脉是由营气所主管的，它是气血的源头，所以能够出入于脏腑，交通于经络，运行在筋骨间隙之间，随着气的升降而鼓动。它在手指下显现出的形态，有的清晰有的浑浊，有的小有的大，有的偏小偏大。虽然说是由于先天禀赋不同，但实际上是由人的精神灵性所发露出来的，不能只用一种固定的模式去套用。即使古代圣人极力描绘其形象，以推究阴阳寒热的机理，但也仅仅是确立了立法的大义。高明的人士，贵在思维圆融灵活，通过类比来推演，哪里难以做到洞察秋毫呢？
大概脉象的表现虽然细微，但所关联的意义最为重大。它接受元气是在混沌未分之前，流行变化是在胚胎刚刚形成之际。天地万物，没有不是这样的。比如天体运转如璇玑玉衡，江海潮汐涨落，这是天地脉运的正常规律；白虹贯日，洪水滔天，这是天地脉络的病变；严冬闪电，盛夏冰雹，这是天地气交混乱的表现；天降血雨，地震生毛，这是天地非常罕见的变异。至于夏天暑热冬天寒冷，南方温暖北方凛冽，这是天地阴阳的偏颇。人处在气交之中，脉象怎么能没有差异呢？正值天地发生变异之时，诊切脉象怎能不有所不同呢？
试着观察草木无心，但其皮干茎叶都有脉络贯通，以运行津液；顽石无知，其中也蕴含脉理，以通山泽之气。正当亢旱阴雨、严寒酷暑之时，树木石头都会因此变色，何况是人呢？
姑且从脉的正常度来说，它起始于中焦，沿着肺经，到达寸关尺三部，由内达外，是身体中第一处动脉，与其他部位不同。古人虽然有浮、沉、滑、涩等辨别论述的方法，但追究其根源，有形的脉象，是水谷精微所布散，禀受于地；其鼓动运行的景象，是无形的阳气所激发，禀受于天。而交通天地之气，和合阴阳生生不息的机理，则是禀受于气交。况且这种气血所属的东西，原本不能用方圆等具体形状去界定。就像人的面目，虽然五官基本无异，但仔细考察，千万人中从未有一个完全雷同的。《经脉别论》说：诊脉之道，要观察人的勇敢与怯懦，骨骼肌肉皮肤的状态，能了解他的情况，以此作为诊法。所以上古时代让僦贷季，调理色脉而通达神明。面色是神气的外发，脉象是血气的凭借，所以能将色脉结合，万举万全。得其宗旨，则心目明亮如日月，确实不是见识浅陋的人所能揣测议论的。《阴阳应象大论》说：善于诊察的人，观察面色并按摸脉象，先辨别阴阳；审察清浊而知病位；视喘息、听声音而知病痛所在；观权衡规矩而知病主何脏；按尺寸浮沉滑涩而知病之生成。这样治疗就不会失误了。这就是所谓“能合色脉，万举万全”的另一种说法。然而其所重视的，尤其在于适应患者的性情。所以诊病如果不懂“五过四失”，终究不免成为粗工。
近来病人也有三种过错：一是隐瞒病情，让医生猜测以验证医生的技艺高低；二是有隐蔽难言之病，则巧言掩饰以欺骗医师；三是未把脉就先告知旧疾，使医生沉溺于成见，不再详细诊察。即使是成名老医，也不免反而费心推敲，多有自认错谬，比喻劝解也不醒悟的。如果不是默运心神内照，很少有不因误诊而导致更严重错误的。
坐着的一个人问道：先生常说“能合色脉，万举万全”。假如深闺中的女子，严密保护屏风帷帐，不能望见脸色，又该怎么办呢？先生说：这是什么话不通啊！孔子说过：“举一隅不以三隅反，则不复也。”只要查验其手腕色泽的苍白肥瘦，已可见一斑。至于肌肤的滑涩，纹理的疏密，肌肉的坚软，筋骨的粗细，指甲的刚柔，手指的肥瘦，手掌的浓薄，尺肤的寒热，以及动静安危、气息微盛，再结合脉象，参证症状，那么气血的虚实，性情的刚柔，形体的劳逸，饮食的精粗，病苦的逆顺，都在心中了然了。
又问：五色对应五脏的道理，是我共知的，其余都是学人不懂的，希望听完以启蒙昧。回答说：我所说的色脉，就是仓公的五色诊法，这是《玉机真藏论》中不可磨灭的秘密，知道的人极少。其中的奥妙，全在于根据禀赋色泽，参合脉证，如影随形，坚守此道勿失。《灵枢》所谓“粗守形，上守神”，就是这个意思。
神表现为色，形表现为质。假设黄色属脾胃，如果黄而肥胖，说明胃中有痰湿；黄而枯槁，说明胃中有火；黄而色淡，说明胃气本虚；黄而色暗，说明津液久耗。黄色是中央之色，其虚实寒热的机理，应当通过饮食和二便来斟酌判断。
白色属肺，白而润泽，说明肺胃充盛；肥白而按之绵软，说明气虚有痰；白而消瘦，爪甲鲜红，说明气虚有火；白而夭然无光泽，爪甲色淡，说明肺胃虚寒；白而微青，或手臂多青筋，说明气虚不能统血。如果兼见爪甲色青，则为阴寒之证。白色是气虚之象，纵有失血发热，皆为虚火，断无实热的道理。
苍黑色属肝与肾，苍而纹理粗糙，说明筋骨劳损；苍而枯槁，说明营血枯竭；黑而肥泽，说明骨髓充盛；黑而瘦削，说明阴火内伤。苍黑为下焦气旺，虽感受客寒，也必然蕴结为邪热，绝无虚寒的征候。
赤色属心，主三焦，深赤色且坚硬，说明素禀多火；赤而坚硬，说明营血充盛；微赤而鲜艳，说明气虚有火；赤而干枯无泽，说明血虚火旺。赤为火炎之色，只担心津枯血竭，也没有虚寒的患害。大抵火形人，从未有肥胖多湿的，即使有痰嗽，也是燥气所致。
至于肌肤的滑涩，用来征验津液的盛衰；纹理的疏密，用来征验营卫的强弱；肌肉的坚软，用来征验胃气的虚实；筋骨的粗细，用来征验肝血的充馁；骨骼的大小，用来征验肾气的勇怯；指甲的刚柔，用来征验胆液的淳清；手指的肥瘦，用来征验经气的荣枯；手掌的浓薄，用来征验脏气的丰歉；尺肤的寒热，用来征验表里的阴阳。《论疾诊尺》说：尺肤很热，脉象盛大躁动的，是温病；脉象盛大而滑的，病将要外出；尺肤寒冷，脉象细小的，是泄泻少气。这些都是千古秘密，一旦豁然开朗，确实是临机应用、信手拈来的第一义理，必须着眼留意。
A question was asked: "Regarding the limbs and bones of the human body, and the various diseases of the Zang-Fu organs and meridians, all are determined by the three positions (Cun, Guan, Chi) of the radial pulse. To which category does the pulse belong? What Qi moves within it? And is the method of pulse diagnosis exactly as stated by the ancient sages?"
The answer was: "The pulse is governed by Ying-Qi (Nutritive Qi), serving as the source of Blood and Qi. Therefore, it can enter and exit the Zang-Fu organs, connect with the meridians, travel through the interstices of muscles and sinews, and pulsate up and down following the movement of Qi. The manifestations felt under the fingers may be clear or turbid, small or large, slightly small or slightly large. Although this is attributed to different congenital endowments, it is actually revealed by one's spiritual consciousness and cannot be judged by a single rigid standard. Even if the ancient sages meticulously described its forms to deduce the mechanisms of Yin-Yang and cold-heat, they merely established the general principles. Wise practitioners value flexible thinking and analogical reasoning; thus, achieving profound insight is not difficult.
Although the manifestations of the pulse are subtle, their significance is immense. It receives its vital energy before chaos was divided, and circulates when the embryo is just forming. This applies to all things in heaven and earth. For instance, the rotation of celestial bodies like the armillary sphere and the tides of rivers and seas represent the normal operation of heavenly pulses; white halos piercing the sun and floods covering the sky represent pathological changes in heavenly vessels; lightning in deep winter and hail in midsummer represent chaotic interactions of heavenly Qi; blood raining from the sky and hair growing during earthquakes represent extraordinary anomalies of heaven and earth. Summer heat and winter cold, southern warmth and northern chill, are deviations of Yin and Yang in heaven and earth. Since humans exist within this interaction of Qi, how can their pulse presentations remain unchanged? When heaven and earth undergo changes, how can pulse diagnosis remain the same?
Observe that although plants have no mind, their bark, stems, and leaves possess veins to transport fluids; even inert stones contain internal structures to communicate with mountain and marsh energies. During extreme droughts, heavy rains, severe cold, or intense heat, trees and stones change color, let alone humans.
Speaking of the normal degree of the pulse, it originates from the Middle Jiao, follows the Lung Meridian, and reaches the three positions (Cun, Guan, Chi). Extending from the interior to the exterior, it is the primary arterial point in the body, distinct from others. Although ancients discussed methods to distinguish floating, sinking, slippery, and choppy pulses, tracing their origin reveals that the有形 (form) of the pulse is distributed from the essence of food and water, endowed by Earth; while its pulsating motion is stimulated by无形 (formless) Qi, endowed by Heaven. The mechanism of communicating between Heaven and Earth, harmonizing Yin and Yang for continuous generation, is endowed by the interaction of Qi. Moreover, these attributes of Blood and Qi cannot be defined by geometric shapes. Just as human faces share similar features, careful examination shows that among millions, none are identical. *Jing Mai Bie Lun* states: 'In diagnosing the pulse, observe courage or timidity, bone structure, muscle, and skin to understand the condition.' Thus, in ancient times, Qiu Dai Ji was tasked with regulating complexion and pulse to achieve divine clarity. Complexion is the manifestation of Shen (Spirit), and pulse is the reliance of Blood and Qi. Therefore, combining complexion and pulse ensures success in every attempt. Grasping this principle makes one's mind and eyes bright as the sun and moon, truly beyond the speculation of inferior scholars. *Yin Yang Ying Xiang Da Lun* says: 'Those skilled in diagnosis observe complexion and palpate the pulse, first distinguishing Yin and Yang; examining clarity and turbidity to know the location; observing breathing and listening to voice to know the suffering; observing balance and rules to know the affected organ; pressing Cun-Chi for floating/sinking, slippery/choppy to know the origin of disease. Thus, treatment will not fail.' This is another expression of 'combining complexion and pulse for universal success.' However, what is emphasized most is adapting to the patient's temperament. If one does not understand the 'Five Faults and Four Errors' in diagnosis, one remains a crude practitioner.
Recently, patients exhibit three faults: First, concealing symptoms to test the doctor's skill through guessing; second, having hidden ailments and using clever words to deceive the physician; third, revealing past illnesses before pulse-taking, causing the doctor to rely on preconceived notions without detailed examination. Even renowned old doctors may waste effort deliberating, often admitting errors themselves, yet failing to heed advice. Without silent introspection, few avoid compounding mistakes due to misdiagnosis.
A person sitting nearby asked: 'Master often says, "Combining complexion and pulse ensures universal success." But what if a lady in the inner chambers is strictly veiled behind screens, preventing observation of her face? How should one proceed?' The Master replied: 'How ignorant such words are! Confucius said, "If I explain one corner and you cannot deduce the other three, I will not repeat myself." One need only examine the pallor or ruddiness, fatness or leanness of the wrist's skin to see a part of the whole. Furthermore, the smoothness or roughness of the flesh, the density of pores, the firmness or softness of muscles, the thickness of sinews, the size of bones, the hardness or flexibility of nails, the plumpness of fingers, the thickness of palms, the coldness or warmth of the Chi position, along with movements indicating safety or danger, and the strength or weakness of breath, combined with pulse and symptoms, allow one to clearly understand the deficiency or excess of Qi and Blood, the rigidity or gentleness of temperament, the labor or rest of the body, the quality of diet, and the favorable or unfavorable nature of the illness.
Another question arose: 'I know the correspondence of the five colors to the five Zang organs, but I am unfamiliar with the rest. Please enlighten me.' The reply was: 'What I refer to as complexion-pulse diagnosis is the Five-Color Diagnosis of Cang Gong, a secret from *Yu Ji Zhen Zang Lun* known to very few. Its subtlety lies in assessing constitution and complexion to correlate with pulse and symptoms, like a shadow following the form. Adhere to this without loss. As stated in *Ling Shu*, "Crude practitioners guard the form; superior practitioners guard the Spirit." This is the meaning.
Spirit manifests as complexion; form manifests as substance. Assume Yellow belongs to Spleen and Stomach: If yellow and obese, there is Phlegm-Dampness in the Stomach; if yellow and withered, there is Fire in the Stomach; if yellow and pale, Spleen-Stomach Qi is originally deficient; if yellow and dark, Body Fluids have been exhausted for a long time. Yellow is the color of the Center; its deficiency/excess and cold/heat mechanisms should be inferred from diet and urination/defecation.
White belongs to the Lung. White and moist indicates充盈 (fullness) of Lung and Stomach; fat and white, soft upon pressure, indicates Qi deficiency with Phlegm; white and emaciated, with bright red fingernails, indicates Qi deficiency with Fire; white and dull/lusterless, with pale fingernails, indicates Lung-Stomach Deficient-Cold; white with slight bluish tint, or many blue veins on arms, indicates Qi deficiency failing to control Blood. If accompanied by blue fingernails, it is a Cold-Yin syndrome. White is a sign of Qi deficiency; even with hemorrhage or fever, it is Deficient Fire, never Excess Heat.
Bluish-black belongs to Liver and Kidney. Bluish and coarse texture indicates strain on sinews and bones; bluish and withered indicates exhaustion of Ying-Blood; black and plump/moist indicates fullness of Marrow; black and thin/emaciated indicates internal damage by Yin-Fire. Bluish-black indicates vigorous Qi in the Lower Jiao; even if attacked by external Cold, it inevitably transforms into Pathogenic Heat, showing absolutely no signs of Deficient-Cold.
Red belongs to the Heart and governs the San Jiao. Deep red and hard indicates a constitution prone to Fire; red and hard indicates full Ying-Blood; slightly red and bright indicates Qi deficiency with Fire; red and dry/lusterless indicates Blood deficiency with hyperactive Fire. Red is the color of blazing Fire; one only worries about dried fluids and exhausted Blood, with no concern for Deficient-Cold. Generally, Fire-type individuals are never obese with much Dampness; even if they have phlegm-cough, it is due to Dryness.
Smoothness or roughness of skin reflects the abundance or scarcity of Body Fluids; density of pores reflects the strength or weakness of Ying and Wei Qi; firmness or softness of muscles reflects the deficiency or excess of Stomach Qi; thickness of sinews reflects the fullness or emptiness of Liver Blood; size of bones reflects the courage or timidity of Kidney Qi; hardness or flexibility of nails reflects the purity or turbidity of Gallbladder Juice; plumpness of fingers reflects the flourishing or withering of Jing-Qi; thickness of palms reflects the abundance or scarcity of Zang-Qi; coldness or warmth of the Chi area reflects the Yin-Yang of Exterior and Interior. *Lun Ji Zhen Chi* states: 'If Chi skin is very hot and pulse is盛大 (vigorous) and restless, it is a Warm Disease; if pulse is vigorous and slippery, the disease is about to exit; if Chi skin is cold and pulse is small, it is diarrhea with little Qi.' These are secrets of millennia, suddenly clarified, truly the primary principle for clinical application, grasped effortlessly. One must pay close attention to this."