门人问曰。尝闻肥人之脉宜沉。肾肝之脉宜沉。冬月之脉宜沉。于此有人。年盛体丰
。冬时腰痛不能转侧。怯然少气。足膝常逆。证脉皆寒。与肾气丸不应。转增寒热喘满。何也。答曰。不在证
治也。夫肥人之脉沉者。湿伤血脉也。腰痛不能转侧者。湿滞经络也。怯然少气者。湿干肺胃也。足膝常逆者
。湿遏阳气。不能旁达四末也。法当损气以助流动之势。则痛者止而逆者温。反与滋腻养营之药。则痰湿愈壅。
经络不能条畅。而寒热喘满。势所必至也。昔有朔客。初至吴会。相邀诊视。时当夏月。裸坐盘飧。倍于常人。
而形伟气壮。热汗淋漓于头项间。诊时不言所以。切其六部沉实。不似有病之脉。惟两寸略显微数之象。但切其左。
则以右掌抵额。切其右。则易左掌抵额。知为肥盛多湿。夏暑久在舟中。时火鼓激其痰于上。而为眩晕也。询
之果然。因与导痰清湿而安。设不察所苦。但以脉沉。求其病之所属。失之远矣。医之手眼。可不临机活泼
乎。
诊切之要。逆顺为宝。若逆顺不明。阴阳虚实死生不别也。故南阳先师。首言伤寒阴病见阳脉者生。阳病
见阴脉者死。即此一语。可以推卒病之逆顺。亦可广诸病之死生。一着先机。至
微至显。奈何先辈专守王氏之绳墨。不达至圣之璇玑。以至脉学之言。愈阐愈昧。求脉之道。愈趋愈蹶。良由
不解活法推源之故。因是汇辑逆顺诸例。庶学人披卷晓然。虽以死生并列。而逆证尤不可忽。如伤寒未得汗。
脉浮大为阳。易已。沉小为阴。难已。伤寒已得汗。脉沉小安静为顺。浮大躁疾者逆。然多有发热头痛。而足冷
阳缩。尺中迟弱。可用建中和之者。亦有得汗不解。脉浮而大。心下反硬。合用承气攻之者。更有阴尽复阳。
厥愈足温。而脉续浮者。苟非深入南阳之室。恶能及此。迨夫温病热病。热邪亢盛虽同。绝无浮紧之脉。观内
经所云。热病已得汗而脉尚盛躁。此阴脉之极也。死。其得汗而脉静者生。热病脉尚盛躁而不得汗者。此阳脉
之极也。死。脉盛躁。得汗静者生。他如温病穣穣大热。脉数盛者生。细小者死。热病汗下后。脉不衰。反躁
疾。名阴阳交者死。历参温热诸病。总以数盛有力为顺。细小无力为逆。得汗后。脉不衰。反盛躁。尤逆也。
至于时行疫疠。天行大头。咸以脉数盛滑利为顺。沉细虚涩为逆。然湿土之邪内伏。每多左手弦小。右手数盛
者。总以辛凉内夺为顺。辛热外散为逆。当知温热时疫。皆热邪内蕴而发。若与表散。如炉冶得鼓铸之力耳。然疫
疠虽多人迎不振。设加之以下利足冷。又未可轻许以治也。故昔人有阴阳俱紧。头痛身热。而下利足冷者死。
谓其下虚也。至若温毒发斑。谵语发狂等证。总以脉实便秘为可治。脉虚便滑者难治。若斑色紫黑如果实靥。
虽便秘能食。便通即随之而逝矣。其狂妄躁渴。昏不知人。下后加呃逆者。此阳去入阴。终不可救。卒中风
口噤。脉缓弱为顺。急实大数者逆。中风不仁。痿 不遂。脉虚濡缓为顺。坚急疾者逆。中风遗尿盗汗。
脉缓弱为顺。数盛者逆。中风便溺阻涩。脉滑实为顺。虚涩者逆。中寒卒倒。脉沉伏为顺。虚大者逆。中暑自
汗喘乏。腹满遗尿。脉虚弱为顺。躁疾者逆。暑风卒倒。脉微弱为顺。散大者逆。大抵卒中天地之气。无论中风
中寒。中暑中 。总以
细小流连为顺。数实坚大为逆。散大涩艰。尤非所宜。不独六淫为然。即气厥痰厥。食痰蛔厥。不外乎此。盖卒
中暴厥。皆真阳素亏。故脉皆宜小弱。不宜数盛。中恶腹满。则宜紧细微滑。不宜虚大急数。中百药毒。则宜
浮大数疾。不宜微细虚涩。详中风中暑。一切暴中。俱有喘乏遗尿。如中风中寒。则为肾气之绝。中暑中 。
则为热伤气化。痰食等厥。又为气道壅遏所致。死生逆顺悬殊。可不辨而混治乎。凡内伤劳倦。气口虚大者为
气虚。弦细或涩者为血虚。若躁疾坚搏。大汗出。发热不止者死。以里虚。不宜复见表气开泄也。内伤饮食。
脉来滑盛有力者。为宿食停胃。涩伏模糊者。为寒冷伤脾。非温消不能克应。霍乱脉伏。为冷食停滞。胃气
不行。不可便断为逆。搏大者逆。既吐且利。不宜复见实大也。霍乱止而脉代。为元气暴虚。不能接续。不可
便断为逆。厥冷迟微者逆。阳气本虚。加以暴脱。非温补不能救疗。噎膈呕吐。脉浮滑大便润者顺。痰气阻逆。
胃气未艾也。弦数紧涩。涎如鸡清。大便燥结者逆。气血枯竭。痰火郁结也。腹胀。关部浮大有力为顺。
虚小无神者逆。水肿。脉浮大软弱为顺。涩细虚小者逆。又沉细滑利者。虽危可治。虚小散涩者不治。鼓胀。
滑实流利为顺。虚微短涩者逆。肿胀之脉。虽有浮沉之不同。总以软滑为顺。短涩为逆。咳嗽。浮软和滑者易
已。沉细数坚者难已。久嗽缓弱为顺。弦急实大者逆。劳嗽骨蒸。虚小缓弱为顺。坚大涩数者逆。弦细数疾者
尤逆。上气喘咳。脉虚宁宁伏匿为顺。坚强搏指者逆。加泻尤甚。上气喘息低昂。脉浮滑。手足温为顺。脉短
涩。四肢寒者逆。上气脉数者死。谓其形损故也。历陈上气喘咳诸例。皆以软弱缓滑为顺。涩数坚大者逆。盖
缓滑为胃气尚存。坚涩则胃气告匮之脉也。肺痿。脉虚数为顺。短涩者逆。数大实者。亦不易治。肺痈初起。
微数为顺。洪大者逆。已溃。缓滑为顺。短涩者逆。气病而见短涩之脉。气血交败。安可望其生乎。吐血衄血下血。
芤而小弱为顺。弦急实大者逆。
汗出若衄。沉滑细小为顺。实大坚疾者逆。吐血。沉小为顺。坚强者逆。吐血而咳逆上气。芤软为顺。细数者逆
。弦劲者亦为不治。阴血既亡。阳无所附。故脉来芤软。若细数则阴虚火炎。加以身热不得卧。不久必死。弦
劲为胃气之竭。亦无生理。蓄血。脉弦大可攻为顺。沉涩者逆。从高顿仆。内有血积。腹胀满。脉坚强可攻为
顺。小弱者逆。金疮出血太多。虚微细小为顺。数盛急实者逆。破伤。发热头痛。浮大滑为顺。沉小涩者逆。
肠下白沫。脉沉则生。脉浮则死。肠 下脓血。沉小留连者生。数疾坚大身热者死。久利。沉细和滑为顺
。浮大弦急者逆。虽沉细小弱。按之无神者不治。肠 下利。内经虽言脉浮身热者死。然初病而兼表邪。常有发热
脉浮。可用建中而愈者。非利久虚阳发露。反见脉浮身热。口噤不食之比。泄泻。脉微小为顺。急疾大数者逆。
肠泄泻。为肠胃受病。不当复见疾大数坚之脉也。小便淋秘。脉滑疾者易已。涩小者难已。消瘅脉实大。病
久可治。脉悬小坚病久不可治。消渴。脉数大软滑为顺。细小浮短者逆。又沉小滑为顺。实大坚者逆。头痛目
痛。卒视无所见者死。清阳失守。邪火僭逆于上也。其脉浮滑为风痰上盛。可治。短涩为血虚火逆。不治。心
腹痛。痛不得息。脉沉细迟小为顺。弦长坚实者逆。 瘕脉沉实者可治。虚弱者死。疝瘕脉弦者生。虚疾者死。
心腹积聚。脉实强和滑为顺。虚弱沉涩者逆。癫疾。脉搏大滑。久自已。小坚急。死不治。又癫疾脉虚滑为顺
。涩小者逆。狂疾。脉大实为顺。沉涩者逆。痿痹。脉虚涩为顺。紧急者逆。 蚀阴肛。虚小为顺。坚急者逆。
痈疽初起。脉微数缓滑为顺。沉涩坚劲者逆。未遗。洪大为顺。虚涩者逆。溃后。虚迟为顺。数实者
逆。肠痈。软滑微数为顺。沉细虚涩者逆。病疮。脉弦强小急。腰脊强。螈 。皆不可治。溃后被风。多此痉
病。脉浮弦为阳。沉紧为阴。若牢细坚劲搏指者不治。妊娠。脉宜和滑流利。忌虚涩不调。临月。脉宜滑数离经。忌虚
迟小弱。牢革尤非所宜。新产。脉宜缓弱。忌弦紧。带下。脉宜小弱。忌急疾。崩漏。脉宜微弱。忌实大。乳子而病热。
脉悬小。手足温则生。寒则死。凡崩漏胎产久病。脉以迟小缓滑为顺。急疾大数者逆。以上诸例。或采经论。或摭名言。
咸以病脉相符为顺。病脉相反为逆。举此为例。余可类推。颖悟之士。自能闻一知十。无烦余之屑屑也。
弟子问道：我常听说肥胖人的脉象应当沉，肾经和肝经的脉象应当沉，冬季的脉象也应当沉。这里有一人，正值壮年，身体丰满，冬天时腰痛不能翻身侧身，气息怯弱短少，双脚膝盖经常发凉（逆冷），症状和脉象都表现为寒证，服用肾气丸后不仅没有好转，反而增加了寒热往来、气喘胸满的症状，这是为什么呢？
先生回答说：这问题不在于证候的治疗本身。肥胖人之脉象沉，是因为湿气损伤了血脉；腰痛不能转侧，是因为湿气阻滞了经络；气息怯弱短少，是因为湿气干扰了肺和胃的功能；双脚膝盖经常发凉，是因为湿气遏制了阳气，使其不能通达四肢末端。治疗方法应当通过损耗（或化解）气滞以助气血流动之势，这样疼痛就会停止，逆冷也会温暖。如果反而给予滋腻养血的药物，那么痰湿会更加壅塞，经络不能条达通畅，从而导致寒热、气喘、胸满等症状，这是势所必然的结果。
过去有一位北方客商，刚到吴越之地，被人邀请诊治。当时正值夏季，他赤身坐在宴席上，饮食量是常人的两倍，形体魁伟，气力强壮，头颈间热汗淋漓。诊察时他不说明病因，切按其六部脉象，均呈沉实之象，不像是有病的脉象，只有两寸脉略微显现微数的征象。但当他切左手脉时，就用右手掌抵住额头；切右手脉时，就换左手掌抵住额头。据此判断，他是因体型肥胖且湿气重，夏天长期在舟中，时令之火鼓动激惹其体内的痰液上行，从而导致了眩晕。询问之后果然如此。于是给予导痰清湿的药物而痊愈。如果不考察其痛苦所在，仅仅因为脉沉，就去推测疾病的归属，那就差得太远了。医生的手眼功夫，难道不可以灵活变通吗？
诊脉的要领，以辨别逆顺为宝贵。如果对逆顺分辨不清，就无法区分阴阳、虚实以及死生。所以张仲景先师首先提出：伤寒阴病见到阳脉者生，阳病见到阴脉者死。仅这一句话，就可以推究急病的逆顺，也可以推广到各种疾病的死生判断。这是一个先机之着，极其微妙又极其明显。为何前辈们专门拘守王叔和的规范，却不理解至圣（孔子/医道本源）的精微奥妙，以至于脉学的言论，越阐发越晦暗，求索脉道的道路，越走越偏狭。这都是由于不理解灵活推源的方法的缘故。因此汇编辑录了逆顺的各种案例，希望学习者翻开书卷就能明白。虽然将死证和生证并列，但逆证尤其不可忽视。例如伤寒未得汗，脉浮大为阳，容易治愈；脉沉小为阴，难以治愈。伤寒已得汗，脉沉小安静为顺，脉浮大躁疾者为逆。然而也有发热头痛，但脚冷、阴茎内缩、尺中脉迟弱的，可以使用建中汤调和的；也有得汗后病不解，脉浮大，心下反而硬满，合适用承气汤攻下的；更有阴尽复阳，厥逆愈而脚温，但脉继续浮起的，如果不是深入钻研张仲景学术的人，怎么能达到这种境界呢？
至于温病、热病，虽然热邪亢盛相同，但绝无浮紧的脉象。观察《内经》所说：热病已得汗而脉尚盛大躁动，这是阴脉的极端表现，主死；得汗而脉静者主生。热病脉尚盛大躁动而不得汗者，这是阳脉的极端表现，主死；脉盛大躁动，得汗后转静者主生。其他如温病大热，脉数盛者主生，脉细小者主死。热病经过汗法、下法后，脉不衰减，反而躁疾，名为“阴阳交”，主死。历参温热各病，总以脉数盛有力为顺，脉细小无力为逆。得汗后，脉不衰减，反而盛大躁动，更是逆证。
至于时行疫病、天行大头瘟等，都以脉数盛滑利为顺，脉沉细虚涩为逆。然而湿土之邪内伏，往往多见左手脉弦小，右手脉数盛的情况，总以辛凉内泄为顺，辛热外散为逆。应当知道温热时疫，都是热邪内蕴而发作，如果使用表散法，就像炉冶得到了鼓铸的力量一样（助长火势）。然而疫病虽然多人发病，若人迎脉不振，如果再加之腹泻、脚冷，则不可轻易许诺能治愈。所以古人说：阴阳俱紧，头痛身热，而下利脚冷的，主死，这是因为下焦虚损的缘故。
至于温毒发斑、谵语发狂等证，总以脉实便秘为可治，脉虚便滑者难治。如果斑色紫黑像果实的痂盖，虽然便秘能食，大便一通随之而逝。那些狂妄躁渴、昏不知人，下法后加呃逆的，这是阳气离去入于阴分，终不可救。
卒然中风口噤，脉缓弱为顺，脉急实大数为逆。中风肢体麻木不仁、痿废不用，脉虚濡缓为顺，脉坚急疾者为逆。中风遗尿盗汗，脉缓弱为顺，脉数盛者为逆。中风小便不利，脉滑实为顺，脉虚涩者为逆。中寒卒倒，脉沉伏为顺，脉虚大者为逆。中暑自汗喘乏、腹满遗尿，脉虚弱为顺，脉躁疾者为逆。暑风卒倒，脉微弱为顺，脉散大者为逆。大抵卒中天地之气，无论中风、中寒、中暑、中湿，总以脉细小流连为顺，脉数实坚大为逆，脉散大涩艰，尤其不宜。不仅六淫致病如此，即使是气厥、痰厥、食积、蛔虫引起的厥证，也不外乎此理。大概卒中和暴厥，都是真阳素来亏虚，所以脉皆宜小弱，不宜数盛。中恶腹胀，则宜紧细微滑，不宜虚大急数。中百药毒，则宜浮大数疾，不宜微细虚涩。详细分析中风、中暑等一切暴中病症，都有喘乏遗尿的表现。如中风、中寒，则是肾气绝；中暑、中湿，则是热伤气化；痰食等厥，又是气道壅遏所致。死生逆顺悬殊，岂可不辨而混治呢？
凡是内伤劳倦，气口脉虚大的为气虚，脉弦细或涩的为血虚。如果出现躁疾坚搏，大汗出，发热不止的，主死，因为里虚，不宜再使表气开泄。内伤饮食，脉来滑盛有力的，为宿食停胃；脉涩伏模糊的，为寒冷伤脾，非用温消之法不能克制。霍乱脉伏，为冷食停滞，胃气不行，不可便断定为逆证；脉搏大者为逆，既吐且利，不宜再见实大之脉。霍乱止而脉代，为元气暴虚，不能接续，不可便断定为逆证；脉厥冷迟微者为逆，阳气本虚，加上暴脱，非用温补不能救疗。噎膈呕吐，脉浮滑大便润者为顺，这是痰气阻逆，但胃气未衰；脉弦数紧涩，涎如鸡清，大便燥结者为逆，这是气血枯竭，痰火郁结。腹胀，关部脉浮大有力为顺，脉虚小无神者为逆。水肿，脉浮大软弱为顺，脉涩细虚小者为逆；又脉沉细滑利的，虽危重可治，脉虚小散涩者不治。鼓胀，脉滑实流利为顺，脉虚微短涩者为逆。肿胀之脉，虽有浮沉的不同，总以软滑为顺，短涩为逆。咳嗽，脉浮软和滑者易愈，脉沉细数坚者难愈；久嗽脉缓弱为顺，脉弦急实大者为逆。劳嗽骨蒸，脉虚小缓弱为顺，脉坚大涩数者为逆，脉弦细数疾者尤为逆。上气喘咳，脉虚宁宁伏匿为顺，脉坚强搏指者为逆，再加腹泻则更严重。上气喘息声低昂，脉浮滑，手足温者为顺，脉短涩，四肢寒者为逆。上气脉数者死，这是因为形体受损的缘故。历陈上气喘咳诸例，都是以软弱缓滑为顺，涩数坚大为逆。大概缓滑表示胃气尚存，坚涩则表示胃气告竭的脉象。肺痿，脉虚数为顺，脉短涩者为逆；脉数大实者，也不易治。肺痈初起，脉微数为顺，脉洪大者为逆；已溃破，脉缓滑为顺，脉短涩者为逆；气病而见短涩之脉，气血交败，怎能期望其生呢？吐血、衄血、下血，脉芤而小弱为顺，脉弦急实大者为逆。汗出或衄血，脉沉滑细小为顺，脉实大坚疾者为逆。吐血，脉沉小为顺，脉坚强者为逆。吐血而咳逆上气，脉芤软为顺，脉细数者为逆，脉弦劲者也为不治。阴血既亡，阳无所附，所以脉来芤软；若脉细数，则是阴虚火炎，加上身热不得卧，不久必死；脉弦劲为胃气之竭，也无生理。蓄血，脉弦大可攻下为顺，脉沉涩者为逆。从高坠落跌倒，内有血积，腹胀满，脉坚强可攻下为顺，脉小弱者为逆。金疮出血太多，脉虚微细小为顺，脉数盛急实者为逆。破伤，发热头痛，脉浮大为顺，脉沉小涩者为逆。肠下白沫，脉沉则生，脉浮则死。肠下脓血，脉沉小留连者生，脉数疾坚大身热者死。久利，脉沉细和滑为顺，脉浮大弦急者为逆；虽脉沉细小弱，按之无神的，不治。肠下利，《内经》虽言脉浮身热者死，然而初病兼有表邪，常有发热脉浮，可用建中汤而愈的，并非痢久虚阳发露，反见脉浮身热、口噤不食的那种情况。泄泻，脉微小为顺，脉急疾大数为逆。肠泄泻，为肠胃受病，不应当再见疾大数坚之脉。小便淋秘，脉滑疾者易愈，脉涩小者难愈。消瘅脉实大，病久可治，脉悬小坚病久不可治。消渴，脉数大软滑为顺，脉细小浮短者为逆；又脉沉小滑为顺，脉实大坚者为逆。头痛目痛，卒然视物不见者死，这是清阳失守，邪火僭逆于上；其脉浮滑为风痰上盛，可治；脉短涩为血虚火逆，不治。心腹痛，痛不得息，脉沉细迟小为顺，脉弦长坚实者为逆。癥瘕脉沉实者可治，脉虚弱者死。疝瘕脉弦者生，脉虚疾者死。心腹积聚，脉实强和滑为顺，脉虚弱沉涩者为逆。癫疾，脉搏大滑，久则自愈；脉小坚急，死不治；又癫疾脉虚滑为顺，脉涩小者为逆。狂疾，脉大实为顺，脉沉涩者为逆。痿痹，脉虚涩为顺，脉紧急者为逆。阴蚀肛，脉虚小为顺，脉坚急者为逆。痈疽初起，脉微数缓滑为顺，脉沉涩坚劲者为逆；未溃破，脉洪大为顺，脉虚涩者为逆；溃破后，脉虚迟为顺，脉数实者为逆。肠痈，脉软滑微数为顺，脉沉细虚涩者为逆。病疮，脉弦强小急，腰脊强直，抽搐，都不可治。溃后被风，多为此痉病，脉浮弦为阳，脉沉紧为阴；若脉牢细坚劲搏指者，不治。妊娠，脉宜和滑流利，忌虚涩不调。临月，脉宜滑数离经，忌虚迟小弱，脉牢革尤其不宜。新产，脉宜缓弱，忌弦紧。带下，脉宜小弱，忌急疾。崩漏，脉宜微弱，忌实大。乳子而病热，脉悬小，手足温则生，手足寒则死。凡崩漏、胎产、久病，脉以迟小缓滑为顺，脉急疾大数为逆。以上诸例，有的采自经论，有的摘录名言，都以病脉相符为顺，病脉相反为逆。举这些为例，其余可类推。聪慧之士，自然能闻一知十，无需我啰嗦了。
A disciple asked, "I have often heard that the pulse of a fat person should be deep (Chen), the pulses of the Kidney and Liver meridians should be deep, and the pulse in winter should also be deep. Here is a person who is in his prime and physically robust. In winter, he suffers from lower back pain that prevents him from turning or lying on his side, feels timid with shortness of breath, and has cold feet and knees. The symptoms and pulse both indicate a Cold pattern. However, after taking Shenqi Wan (Kidney Qi Pill), there was no improvement; instead, chills and fever, wheezing, and chest fullness increased. Why is this?"
The Master replied, "The issue does not lie solely in treating the syndrome. The reason a fat person's pulse is deep is that Dampness injures the blood vessels. The reason for lower back pain preventing movement is that Dampness stagnates in the collaterals. The reason for feeling timid with shortness of breath is that Dampness interferes with the Lung and Stomach. The reason for cold feet and knees is that Dampness suppresses Yang Qi, preventing it from reaching the four extremities. The treatment method should involve resolving Qi stagnation to assist the flow of Qi and Blood, so that pain stops and coldness warms. If one instead administers cloying and nourishing-blood herbs, Phlegm-Dampness will become more congested, the collaterals will fail to flow smoothly, and chills, fever, wheezing, and chest fullness will inevitably ensue.
In the past, a merchant from the north arrived in the Wu-Yue region and was invited for diagnosis. It was summer, and he sat naked at a banquet, eating twice as much as usual. He was large in stature and strong in Qi, with profuse hot sweat dripping from his head and neck. During the consultation, he did not explain his condition. Palpating his six positions, all were Deep and Excess (Shi), resembling a healthy pulse rather than a diseased one. Only the two Cun positions showed a slightly rapid quality. However, when palpating the left wrist, he used his right palm to press against his forehead; when palpating the right wrist, he switched to his left palm pressing against his forehead. From this, I deduced that due to his obesity and excess Dampness, combined with spending long periods in boats during the summer heat, the seasonal Fire agitated Phlegm rising upward, causing dizziness. Inquiry confirmed this. I prescribed herbs to guide out Phlegm and clear Dampness, and he recovered. If one had not investigated his suffering but merely attributed the disease based on the Deep pulse, the error would have been great. Must not a physician's skill be flexible and adaptable?
The essence of pulse diagnosis lies in distinguishing between favorable (Shun) and unfavorable (Ni) patterns. If favorable and unfavorable patterns are not distinguished, Yin and Yang, Deficiency and Excess, death and life cannot be differentiated. Therefore, Master Zhang Zhongjing first stated: In Taiyang Cold Damage (Shanghan), if a Yin disease presents with a Yang pulse, there is hope for survival; if a Yang disease presents with a Yin pulse, death is likely. This single statement allows us to infer the favorable/unfavorable nature of acute diseases and can be extended to determine the prognosis of various diseases. This is a crucial insight, subtle yet obvious. Why do predecessors strictly adhere to Wang Shuhe's rules without grasping the profound principles of the Sages? Consequently, pulse theory becomes increasingly obscure, and the path to understanding pulses becomes more distorted. This is due to a failure to understand flexible, source-oriented methods. Thus, I have compiled examples of favorable and unfavorable patterns so that students may clearly understand upon reading. Although death and life cases are listed together, unfavorable patterns must not be neglected.
For example, in Taiyang Cold Damage before sweating, a Floating and Large pulse indicates Yang and suggests easy recovery; a Deep and Small pulse indicates Yin and suggests difficult recovery. After sweating, a Deep and Small, quiet pulse is favorable; a Floating, Large, and restless pulse is unfavorable. However, there are cases of fever and headache with cold feet, retracted penis, and a slow/weak Chi position pulse, which can be treated with Jianzhong Tang (Build the Middle Decoction). There are also cases where sweating fails to resolve the disease, the pulse is Floating and Large, and the epigastrium is hard, requiring Chengqi Tang (Gut-Draining Decoction) for purgation. Furthermore, when Yin exhaustion returns to Yang, and the cold limbs warm up but the pulse continues to Float, only those deeply versed in Zhang Zhongjing's teachings can recognize this.
Regarding Warm Diseases (Wenbing) and Heat Diseases (Rebing), although the hyperactivity of Heat pathogens is similar, a Floating-Tight pulse never occurs. As stated in the Neijing: If a Heat Disease patient sweats but the pulse remains盛大 (Grand/Surging) and restless, this is the extreme of Yin pulses and indicates death; if the pulse becomes quiet after sweating, there is hope for survival. If the pulse is Grand and restless but no sweat occurs, this is the extreme of Yang pulses and indicates death; if the pulse becomes quiet after sweating, there is hope for survival. Similarly, in Warm Diseases with high fever, a Rapid and Surging pulse indicates survival, while a Fine pulse indicates death. After sweating or purgation in Heat Diseases, if the pulse does not diminish but becomes restless, named 'Yin-Yang Intersection' (Yin Yang Jiao), it indicates death. Generally, for Warm and Heat diseases, a Rapid, Surging, and Forceful pulse is favorable, while a Fine, Weak, and Powerless pulse is unfavorable. If the pulse remains surging and restless after sweating, it is particularly unfavorable.
For epidemic diseases and severe head infections (Tou Da Wen), a Rapid, Surging, Slippery, and Smooth pulse is favorable, while a Deep, Fine, Empty, and Choppy pulse is unfavorable. However, when Damp-Earth pathogens are internally latent, the Left pulse is often Wiry and Small, and the Right pulse is Rapid and Surging. In such cases, using Acrid-Cool internal-draining methods is favorable, while Acrid-Warm external-dispersing methods are unfavorable. One must know that Warm and Epidemic diseases involve internal Heat accumulation; using exterior-releasing methods is like adding fuel to a furnace. Although epidemics affect many people, if the Renying pulse is weak and accompanied by diarrhea and cold feet, treatment should not be lightly promised. As ancients said: Tight pulses in both Yin and Yang, with headache, body heat, diarrhea, and cold feet indicate death due to lower deficiency.
For Warm-Toxin rashes, delirium, and mania, an Excess pulse with constipation is treatable, while a Deficient pulse with loose stools is difficult to treat. If the rash is purple-black like fruit scabs, even with constipation and appetite, resolution follows bowel movement. Mania, thirst, coma, and hiccups after purgation indicate Yang departing into Yin, which is incurable.
Sudden stroke with locked jaw: Slow/Weak pulse is favorable; Urgent, Excess, Large, Rapid pulse is unfavorable. Stroke with numbness or paralysis: Deficient, Wet, Slow pulse is favorable; Firm, Urgent, Rapid pulse is unfavorable. Stroke with enuresis and night sweats: Slow/Weak pulse is favorable; Rapid/Surging pulse is unfavorable. Stroke with urinary/fecal obstruction: Slippery/Excess pulse is favorable; Deficient/Choppy pulse is unfavorable. Sudden collapse from Cold: Deep/Hidden pulse is favorable; Deficient/Large pulse is unfavorable. Summerheat with spontaneous sweating, panting, abdominal fullness, and enuresis: Weak pulse is favorable; Restless pulse is unfavorable. Summerwind sudden collapse: Weak pulse is favorable; Scattered/Large pulse is unfavorable. Generally, for sudden attacks of Heaven and Earth pathogens (Stroke, Cold, Summerheat, Dampness), a Fine/Small, lingering pulse is favorable; a Rapid, Excess, Firm, Large pulse is unfavorable. A Scattered, Choppy, Difficult pulse is especially inauspicious. This applies not only to the Six Evils but also to Qi Syncope, Phlegm Syncope, Food Syncope, and Roundworm Syncope. Sudden stroke and syncope usually stem from inherent True Yang deficiency, so the pulse should be Small/Weak, not Rapid/Surging. Evil invasion with abdominal fullness should present with Tight, Fine, Micro, Slippery pulses, not Deficient/Large/Urgent. Poisoning by hundred medicines should present with Floating/Large/Rapid/Urgent pulses, not Micro/Fine/Deficient/Choppy.
Detailed analysis of sudden attacks shows panting, weakness, and enuresis. Stroke/Cold indicates Kidney Qi exhaustion; Summerheat/Damp indicates Heat injuring Qi transformation; Phlegm/Food syncope indicates airway obstruction. The difference in life/death and favorable/unfavorable is vast; how can they be mixed without differentiation?
For internal injury from overwork, a Xu/Large Qi Kou pulse indicates Qi Deficiency; a Wiry/Fine or Choppy pulse indicates Blood Deficiency. If Restless/Urgent/Firm, with profuse sweating and continuous fever, death is indicated due to interior Deficiency and open exterior pores. For dietary injury, a Slippery/Surging/Forceful pulse indicates retained food in the Stomach; a Choppy/Hidden/Vague pulse indicates Cold injuring the Spleen, requiring Warm-Digestion methods. Cholera with a Hidden pulse indicates cold food stagnation and Stomach Qi blockage, not necessarily unfavorable; a Surging/Large pulse is unfavorable. Vomiting and diarrhea should not show Excess/Large pulses. If cholera stops but the pulse is Intermitting (Dai), indicating sudden Yuan Qi Deficiency, it is not necessarily unfavorable; however, cold limbs with Micro pulse indicate Yang Deficiency and sudden collapse, requiring Warm-Nourishment.
Regurgitation and vomiting: Floating/Slippery pulse with moist stool is favorable (Phlegm-Qi obstruction but Stomach Qi intact); Wiry/Rapid/Tight/Choppy pulse with chicken-white saliva and dry stool is unfavorable (Blood/Qi exhaustion, Phlegm-Fire stagnation). Abdominal distension: Floating/Large/Forceful Guan pulse is favorable; Deficient/Small pulse without spirit is unfavorable. Edema: Floating/Large/Soft pulse is favorable; Choppy/Fine/Deficient/Small pulse is unfavorable. Deep/Fine/Slippery/Smooth is treatable even if critical; Deficient/Small/Scattered/Choppy is untreatable. Drum Distension: Slippery/Excess/Smooth is favorable; Deficient/Micro/Short/Choppy is unfavorable. Swelling pulses vary by Floating/Deep but generally Soft/Slippery is favorable, Short/Choppy is unfavorable. Cough: Floating/Soft/Smooth is easily cured; Deep/Fine/Rapid/Firm is difficult. Chronic cough: Slow/Weak is favorable; Wiry/Urgent/Excess/Large is unfavorable. Consumption with bone-steaming: Deficient/Small/Slow/Weak is favorable; Firm/Large/Choppy/Rapid is unfavorable; Wiry/Fine/Rapid/Urgent is particularly unfavorable. Upper Qi asthma/cough: Deficient/Quiet/Hidden is favorable; Firm/Palpable is unfavorable, worse with diarrhea. Upper Qi with low voice, Floating/Slippery pulse, warm hands/feet is favorable; Short/Choppy pulse, cold limbs is unfavorable. Upper Qi with Rapid pulse indicates death due to形体 damage. Generally, soft/slow/smooth is favorable for upper Qi issues; choppy/rapid/firm/large is unfavorable. Slow/Smooth indicates remaining Stomach Qi; Firm/Choppy indicates Stomach Qi exhaustion.
Lung萎 (Fei Wei): Deficient/Rapid is favorable; Short/Choppy is unfavorable; Rapid/Large/Excess is difficult. Lung Abscess (Fei Yong) early stage: Micro/Rapid is favorable; Grand/Large is unfavorable. After rupture: Slow/Slippery is favorable; Short/Choppy is unfavorable. Qi disease with Short/Choppy pulse indicates Blood/Qi failure, unlikely to survive. Hematemesis, Epistaxis, Rectal bleeding: Hollow (Kou) and Small/Weak is favorable; Wiry/Urgent/Excess/Large is unfavorable. Sweating or epistaxis: Deep/Slippery/Fine/Small is favorable; Excess/Large/Firm/Urgent is unfavorable. Hematemesis: Deep/Small is favorable; Firm is unfavorable. Hematemesis with reverse Qi and cough: Hollow/Soft is favorable; Fine/Rapid is unfavorable; Wiry/Firm is untreatable. After Yin/Blood loss, Yang has no attachment, so Hollow/Soft is expected. Fine/Rapid indicates Yin Deficiency with Fire flaming up; with fever and inability to lie down, death is imminent. Wiry/Firm indicates Stomach Qi exhaustion, no hope.
Blood stasis: Wiry/Large pulse amenable to attack is favorable; Deep/Choppy is unfavorable. Fall from height with internal blood accumulation and abdominal fullness: Firm pulse amenable to attack is favorable; Small/Weak is unfavorable. Metal wound with excessive bleeding: Deficient/Micro/Fine/Small is favorable; Rapid/Surging/Urgent/Excess is unfavorable. Broken injury with fever/headache: Floating/Large/Slippery is favorable; Deep/Small/Choppy is unfavorable. Intestinal discharge of white mucus: Deep pulse indicates life; Floating pulse indicates death. Intestinal discharge of pus/blood: Deep/Small/Lingering indicates life; Rapid/Urgent/Firm/Large with body heat indicates death. Chronic dysentery: Deep/Fine/Smooth is favorable; Floating/Large/Wiry/Urgent is unfavorable. Even if Deep/Fine/Small/Weak, if lacking spirit upon pressure, it is untreatable. Intestinal diarrhea: Neijing states Floating pulse with body heat indicates death, but early stages with exterior pathogens may have fever/Floating pulse, curable with Jianzhong Tang. This differs from chronic diarrhea with exposed Yang showing Floating pulse/body heat, locked jaw, and anorexia. Diarrhea: Micro/Small is favorable; Urgent/Rapid/Large is unfavorable. Intestinal diarrhea implies intestinal/stomach pathology, so Rapid/Large/Firm pulses are inappropriate. Dysuria/Retention: Slippery/Urgent is easily cured; Choppy/Small is difficult. Xiao Dao (Wasting-Thirst): Excess/Large pulse, chronic but treatable; Hanging/Small/Firm pulse, chronic and untreatable. Xiao Ke (Diabetes): Rapid/Large/Soft/Slippery is favorable; Fine/Small/Floating/Short is unfavorable; Deep/Small/Slippery is favorable; Excess/Large/Firm is unfavorable. Headache/Eye pain with sudden blindness: Death, due to Clear Yang failing and Evil Fire rebelling upward. Floating/Slippery pulse indicates Wind-Phlegm excess, treatable; Short/Choppy pulse indicates Blood Deficiency with Fire rebellion, untreatable. Heart/Abdominal pain with inability to breathe: Deep/Fine/Slow/Small is favorable; Wiry/Long/Firm is unfavorable. Masses (Zhen Jia): Deep/Excess is treatable; Deficient/Weak indicates death. Hernia/Masses: Wiry pulse indicates life; Deficient/Urgent indicates death. Heart/Abdominal accumulations: Excess/Firm/Smooth is favorable; Deficient/Weak/Deep/Choppy is unfavorable. Epilepsy: Pulse Large/Slippery resolves over time; Small/Firm/Urgent indicates death/untreatable. Deficient/Slippery is favorable; Choppy/Small is unfavorable. Mania: Large/Excess is favorable; Deep/Choppy is unfavorable. Paralysis/Joint Bi: Deficient/Choppy is favorable; Urgent/Firm is unfavorable. Genital/Anal erosion: Deficient/Small is favorable; Firm/Urgent is unfavorable. Carbuncles/Abscesses early stage: Micro/Rapid/Slow/Slippery is favorable; Deep/Choppy/Firm/Rigid is unfavorable. Before rupture: Grand/Large is favorable; Deficient/Choppy is unfavorable. After rupture: Deficient/Slow is favorable; Rapid/Excess is unfavorable. Intestinal abscess: Soft/Slippery/Micro/Rapid is favorable; Deep/Fine/Deficient/Choppy is unfavorable. Skin sores: Wiry/Firm/Small/Urgent, stiff spine, convulsions are untreatable. Post-ulcer wind exposure causes spasms: Floating/Wiry is Yang; Deep/Tight is Yin. Firm/Fine/Firm/Palpable is untreatable. Pregnancy: Pulse should be Smooth/Slippery/Flowing; avoid Deficient/Choppy/Irregular. Near term: Slippery/Rapid/Li Jing pulse is favorable; Deficient/Slow/Small/Weak is unfavorable; Firm/Leather-like is especially inauspicious. Postpartum: Slow/Weak is favorable; Wiry/Tight is unfavorable. Leukorrhea: Small/Weak is favorable; Urgent/Urgent is unfavorable. Metrorrhagia: Weak/Micro is favorable; Excess/Large is unfavorable. Nursing mother with fever: Hanging/Small pulse with warm hands/feeds indicates life; cold indicates death. Generally, for metrorrhagia, pregnancy/postpartum, and chronic illness, Slow/Small/Slow/Slippery is favorable; Urgent/Rapid/Large is unfavorable. These examples, drawn from classics and sayings, show that matching disease and pulse is favorable, while mismatching is unfavorable. Wise students will infer the rest; no need for further elaboration."