春弦。夏洪。秋毛。冬石。长夏四季脉迟缓。
呼出心与肺。吸入肾与肝。呼吸之间。脾受谷味。其脉在中。心肺俱浮。浮而大散者心。浮而短涩者肺。肾肝俱沉。
牢而长者肝。濡而来实者肾。脾为中州。其脉在中。因指下轻重以定五脏。
即前所谓三菽六菽之重也。
（九候附）
寸为阳。为上部。主头项以下。至心胸之分也。关为阴阳之中。为中部。主脐腹 胁之分也。尺为阴。为下部。主
腰足胫股之分也。凡此三部之中。每部各有浮中沉三候。三而三之。为九候也。浮主皮肤。候表及府。中主肌肉。以候
胃气。沉主筋骨。候里及藏也。
凡诊脉之道。先须调平自己气息。男左女右。先以中指定得关位。却齐下前后二指。初轻按以消息之。次中按消息
之。再重按消息之。然后自寸关至尺。逐部寻究。一呼一吸之间。要以脉行四至为率。闰以太息。脉五至。为平脉也。
其有太过不及。则为病脉。看在何部。各以其部断之。
凡诊脉。须要先识时脉胃脉与腑脏平脉。然后及于病脉时脉谓春三月。六部中俱带弦。夏三月。俱带洪。秋三月。
俱带浮。冬三月。俱带沉。胃脉。谓中按得之。脉和缓。腑脏平脉。已见前章。凡人腑脏脉既平。胃脉和。又应时脉。
乃无病者也。反此为病。
诊脉之际。人臂长则疏下指。臂短则密下指。三部之内。大小浮沉迟数同等。尺寸阴阳高下相符。男女左右。强弱
相应。四时之脉不相戾。命曰平人。其或一部之内。独大独小。偏迟偏疾。左右强弱之相反。四时男女之相背。皆病脉
也。凡病脉之见在上曰上病。在下曰下病。左曰左病。右曰右病。左脉不和。为病在表。为阳。在四肢。右脉不和。为
病在里。为阴。主腹藏。以次推之。
凡取脉之道。理各不同。脉之形状。又各非一。凡脉之来。必不单至。必曰浮而弦。浮而数。沉而紧。沉而细之类。
将何以别之。大抵提纲之要。不出浮沉迟数滑涩之六脉也。浮沉之脉。轻手重手得之也。迟数之脉。以己之呼吸而取。
滑涩之脉。则察夫往来之形也。浮为阳。轻手而得之也。而芤洪散大长濡弦。皆轻手而得之之类也。沉为阴。重手而得
之也。而伏石短细牢实。皆重手而得之之类也。迟者一息脉三至。而缓微弱皆迟之类也。数者一息脉六至。而疾促皆数。
之类也。或曰滑类乎数。涩类乎迟。何也。然脉虽是而理则殊也。彼迟数之脉。以呼吸察其至数之疏数。此滑涩之脉。
则以往来察其形状也。数为热。迟为寒。滑为血多气少。涩为气多血少。所谓脉之提纲。不出乎六字者。盖以其足以统
夫表里阴阳冷热虚实风寒燥湿脏腑血气也。浮为阳为表。诊为风为虚。沉为阴为里。诊为湿为实。迟为在藏。为寒为冷。
数为在府。为热为燥。滑为血有余。涩为气独滞也。人一身之变。不越乎此。能于是六脉之中以求之。则疚病之在人者。
莫能逃焉（内经以滑为血少气多。涩为气少血多者。盖气盛而血不能壅之则滑血壅而气不能行之则涩也）持脉之要有三。
曰举。曰按。曰寻。轻手循之曰举。重手取之曰按。不轻不重。委曲求之曰寻。初持脉。轻手候之。脉见皮肤之间者。
阳也。腑也。亦心肺之应也。重手得之。脉附于肉下者。阴也。藏也。亦肝肾之应也。不轻不重。中而取之。其脉应于
血肉之间者。阴阳相适。中和之应。脾胃之候也。若浮中沉之不见。则委曲而求之。若隐若见。则阴阳伏匿之脉也。三
部皆然。
察脉。须识上下来去至止六字。不明此六字则阴阳虚实不别也。上者为阳。来者为阳。至者为阳。下者为阴。去者
为阴。止者为阴也。上者。自尺部上于寸口阳生于阴也。下者。自寸口下于尺部。阴生于阳也。来者。自骨肉之分而出
于皮肤之际。气之升也。去者。自皮肤之际而还于骨肉之分。气之降也。应曰至。息曰止也。明脉须辨表里虚实四字。
表阳也。府也。凡六淫之邪。袭于经络。而未入胃府及藏者。皆属于表也。里阴也。藏也。凡七情之气。郁于心腹之内。
不能越散。饮食五味之伤。留于腑脏之间。不能通泄。皆属于里也。虚者。元气之自虚。精神耗散。气力衰竭也。实者。
邪气之实。由正气之本虚。邪得乘之。非元气之自实也。故虚者补其正气。实者泻其邪气。经所谓邪气盛则实。精气夺
则虚。此大法也。
凡脉之至。在肌肉之上。出于皮肤之间者。阳也。府也。行于肌肉之下者。阴也。藏也。若短小而见于皮肤之间者。
阴乘阳也。洪大而见于肌肉之下者。阳乘阴也。寸尺皆然。
东垣云。不病之脉。不求其神。而神无不在也。有病之脉。则当求其神之有无。谓如六数七极。热也。脉中（此中
字浮中沉之中）有力。（言有胃气）即有神矣。为泄其热。三迟二败。寒也。脉中有力。（说并如上）即有神矣。为去其
寒。若数极迟败中。不复有力。为无神也。将何所恃邪。苟不知此。而遽泄之去之。人将何所根据而主耶。故经曰。脉者
气血之先。气血者人之神也。善夫。
春脉如弦。夏脉如洪。秋脉如毛。冬脉如石。长夏及四季的脉象迟缓。
呼气时，气通于心与肺。吸气时，气通于肾与肝。在呼吸之间，脾接受水谷精微之气。脾的脉象位于中部。心与肺的脉象都浮取可得。其中，浮大而散的脉象属于心；浮而短涩的脉象属于肺。肾与肝的脉象都沉取可得。其中，牢而长的脉象属于肝；濡软且来势充实的脉象属于肾。脾位居中州（中央），其脉象位于中部。通过手指下轻、中、重不同的力度按压，可以确定五脏的脉象特征。这就是前面所说的“三菽”、“六菽”的重量区别。
（九候附注）
寸口脉属阳，为上部，主要主管头项以下至心胸部位的病变。关部脉处于阴阳之中，为中部，主要主管脐腹胁肋部位的病变。尺部脉属阴，为下部，主要主管腰足胫股部位的病变。在这三部之中，每部又各有浮、中、沉三种候法。三乘以三，共为九候。浮取主要候察皮肤层面的病变，反映表证及腑病；中取主要候察肌肉层面的病变，以判断胃气的有无；沉取主要候察筋骨层面的病变，反映里证及脏病。
大凡诊脉的方法，首先必须调平自己的气息。男性诊左手，女性诊右手。先用中指定位找到关位，然后食指和无名指同时齐下按在前后的寸和尺位上。初次用轻力按压以细细体察脉象，接着用中等力度按压体察，再用重力按压体察。然后从寸、关到尺，逐部仔细寻究。在一呼一吸之间，脉搏跳动四次为标准。若有特殊的深呼吸（太息），脉搏跳动五次，也属于平脉（正常脉象）。如果脉象有过强或过弱的情况，则为病脉。需根据脉象出现的具体部位，分别进行判断。
大凡诊脉，必须先识别时令脉、胃气脉以及脏腑的平脉（正常脉象），然后再去辨别病脉。所谓时令脉，是指春季三个月，六部脉都带有弦象；夏季三个月，都带有洪象；秋季三个月，都带有浮象；冬季三个月，都带有沉象。所谓胃气脉，是指在中取时感到脉象和缓有力。脏腑平脉已在前面章节见过。凡是人的脏腑脉象平和，胃气和缓，又符合时令脉的特征，就是无病之人。反之，若不符合这些特征，即为有病。
诊脉时，如果患者手臂较长，则手指间距应稍疏；如果手臂较短，则手指间距应紧密。在三部之内，如果大小、浮沉、迟数等脉象表现均衡一致，寸部和尺部的阴阳高下相符，男女左右手的强弱相应，四时的脉象不违背常理，这就称为“平人”（健康人）。如果在某一部内，脉象单独变大或变小，偏迟或偏疾，左右手强弱相反，或者四时脉象、男女脉象相互背离，这些都是病脉。凡是病脉出现在上部，称为上病；出现在下部，称为下病；出现在左侧，称为左病；出现在右侧，称为右病。左脉不和，表示病在表，属阳，多在四肢；右脉不和，表示病在里，属阴，多主腹内脏腑。依此类推。
大凡切脉的道理各不相同，脉的形状也不止一种。凡是脉的到来，必然不是单一出现的，必定是复合脉象，如浮而弦、浮而数、沉而紧、沉而细等等。如何辨别它们呢？大概提纲挈领的关键，不出浮、沉、迟、数、滑、涩这六种基本脉象。浮脉和沉脉，是通过轻手和重手按压得来的。迟脉和数脉，是根据医生自己的呼吸节奏来计算的。滑脉和涩脉，则是通过观察脉气往来的形态来判断的。浮脉属阳，是用轻手按压得到的；而芤脉、洪脉、散脉、大脉、长脉、濡脉、弦脉，都属于轻手可得这一类。沉脉属阴，是用重手按压得到的；而伏脉、石脉、短脉、细脉、牢脉、实脉，都属于重手可得这一类。迟脉是一息（一呼一吸）脉动三次，而缓脉、微脉、弱脉都属于迟脉一类。数脉是一息脉动六次，而疾脉、促脉都属于数脉一类。有人问：滑脉似乎像数脉，涩脉似乎像迟脉，为什么呢？然而脉象虽然相似，但原理却不同。迟脉和数脉，是通过呼吸来考察脉动次数多少的；而滑脉和涩脉，是通过往来形态来考察其形状的。数脉主热，迟脉主寒；滑脉主血多气少，涩脉主气多血少。所谓脉的提纲，不出乎这六个字，是因为它们足以统摄表里、阴阳、冷热、虚实、风寒、燥湿、脏腑、血气等所有变化。人体一身之变，不超出这个范围。能在这六种脉象中去探求，那么疾病在人身的表现，就没有能逃过的了。（《内经》认为滑脉是血少气多，涩脉是气少血多，这是因为气盛而血不能壅滞则脉滑，血壅滞而气不能通行则脉涩。）持脉的要领有三点：叫作举、叫作按、叫作寻。轻手循摸叫做举，重手取之叫做按，不轻不重，委曲求之叫做寻。初持脉时，用轻手候察，脉象显现于皮肤之间的，属阳，属腑，也是心肺的对应脉象。用重手得到脉象，脉附于肉下的，属阴，属脏，也是肝肾的对应脉象。不轻不重，从中取之，脉象应于血肉之间的，是阴阳相适，中和的应象，是脾胃的候象。如果在浮、中、沉三部都找不到明显的脉象，就要委曲求之。如果脉象若隐若现，那就是阴阳伏匿的脉象。三部都是如此。
察脉，必须认识上、下、来、去、至、止这六个字。不明白这六个字，就无法辨别阴阳虚实。上者为阳，来者为阳，至者为阳；下者为阴，去者为阴，止者为阴。所谓“上”，是从尺部上行至寸口，这是阳生于阴。所谓“下”，是从寸口下行至尺部，这是阴生于阳。所谓“来”，是从骨肉之分出于皮肤之际，这是气的上升。所谓“去”，是从皮肤之际还于骨肉之分，这是气的下降。应指到达叫做“至”，呼吸停止叫做“止”。明辨脉象必须分辨表、里、虚、实四个字。表属阳，属腑。凡是六淫邪气，侵袭经络，而未入胃腑及脏的，都属于表。里属阴，属脏。凡是七情之气，郁结于心腹之内，不能发散；饮食五味之伤，留于腑脏之间，不能通泄，都属于里。虚者，是元气自身的虚弱，精神耗散，气力衰竭。实者，是邪气的亢盛，是由于正气本虚，邪气得以乘虚而入，并非元气自身的充实。所以虚证要补益正气，实证要泻除邪气。经书所说“邪气盛则实，精气夺则虚”，这是大法。
凡是脉气到达，在肌肉之上，出于皮肤之间的，属阳，属腑；行于肌肉之下的，属阴，属脏。如果脉短小却见于皮肤之间的，是阴乘阳；如果脉洪大却见于肌肉之下的，是阳乘阴。寸部和尺部都是这样。
李东垣说：没有病的脉象，不需要刻意寻求神气，神气自然无处不在。有病的脉象，则应当寻求神气的有无。比如脉数至六七次，极快，这是热证。如果脉在中取时仍有力量（即有胃气），就是有神。治疗时应清泄其热。如果脉迟至二三次，败绝无力，这是寒证。如果脉在中取时仍有力量（说法同上），就是有神。治疗时应去除其寒。如果在数、极、迟、败的脉象中，不再有力，就是无神。那还要依靠什么呢？如果不知道这一点，就急于清泄或温散，病人将依靠什么作为主导呢？所以经书说：“脉是气血的先导，气血是人的神气。”这话真是好啊。
Spring pulse resembles a string (Xian, 弦). Summer pulse resembles a surging wave (Hong, 洪). Autumn pulse resembles down (Mao, 毛). Winter pulse resembles stone (Shi, 石). The pulse during the late summer and the four seasons is slow and moderate (Chi Huan, 迟缓).
Exhalation connects with the Heart and Lung. Inhalation connects with the Kidney and Liver. Between breaths, the Spleen receives the essence of grain. Its pulse is located in the middle. Both the Heart and Lung pulses are superficial (Fu, 浮). Among them, a superficial, large, and scattered pulse belongs to the Heart; a superficial, short, and choppy (Se, 涩) pulse belongs to the Lung. Both the Kidney and Liver pulses are deep (Chen, 沉). Among them, a firm (Lao, 牢) and long pulse belongs to the Liver; a soft (Ru, 濡) pulse that comes with substantial force belongs to the Kidney. The Spleen resides in the Central Region (Zhong Zhou, 中州), and its pulse is located in the middle. By adjusting the light, medium, and heavy pressure of the fingers, one can determine the pulse characteristics of the five Zang organs. This refers to what was previously mentioned as the weight of "three beans" and "six beans."
(Attachment on Nine Probes)
The Cun position is Yang, representing the upper part, primarily governing areas from below the head and neck to the chest and heart. The Guan position is between Yin and Yang, representing the middle part, primarily governing the umbilical abdomen and hypochondrium. The Chi position is Yin, representing the lower part, primarily governing the waist, feet, shins, and thighs. Within these three positions, each has three probes: superficial (Fu, 浮), medium (Zhong, 中), and deep (Chen, 沉). Three times three equals nine probes. Superficial probing mainly observes changes at the skin level, reflecting exterior syndromes and Fu organ diseases. Medium probing mainly observes changes at the muscle level, used to assess the presence of Stomach Qi (Wei Qi, 胃气). Deep probing mainly observes changes at the bone and tendon level, reflecting interior syndromes and Zang organ diseases.
In general, the method of pulse diagnosis requires first regulating one's own breathing. For men, examine the left hand; for women, the right hand. First, use the middle finger to locate the Guan position, then place the index and ring fingers simultaneously on the Cun and Chi positions. Initially, press lightly to carefully observe the pulse, then press with medium force, and finally press heavily. Then, investigate each position sequentially from Cun to Guan to Chi. In one respiration cycle, four beats are considered normal. If there is a special deep sigh (Tai Xi, 太息), five beats are also considered a normal pulse (Ping Mai, 平脉). If the pulse is excessive or deficient, it is a pathological pulse. Judgment should be made based on the specific location where the pulse appears.
In general, pulse diagnosis requires first identifying seasonal pulses, Stomach Qi pulses, and normal pulses of the Zang and Fu organs, before distinguishing pathological pulses. Seasonal pulses refer to: in the three months of spring, all six positions carry a string-like (Xian, 弦) quality; in summer, a surging (Hong, 洪) quality; in autumn, a superficial (Fu, 浮) quality; in winter, a deep (Chen, 沉) quality. The Stomach Qi pulse refers to a moderate and forceful pulse felt during medium probing. Normal Zang and Fu organ pulses have been described in previous chapters. When a person's Zang and Fu organ pulses are harmonious, the Stomach Qi is moderate, and it conforms to the seasonal pulse, the person is healthy. Conversely, deviation indicates disease.
During pulse diagnosis, if the patient's arm is long, the fingers should be spaced wider; if short, closer together. Within the three positions, if the size, depth, speed, etc., are balanced, and the Yin-Yang height of Cun and Chi matches, and the strength of left and right hands corresponds to gender, and the seasonal pulses do not contradict norms, this is called a "Ping Ren" (healthy person). If within one position, the pulse is uniquely large or small, abnormally slow or fast, or if left and right strengths oppose, or seasonal/gender pulses contradict, these are pathological pulses. Pathological pulses appearing in the upper part indicate upper body disease; lower part indicates lower body disease; left side indicates left-side disease; right side indicates right-side disease. Disharmony of the left pulse indicates disease in the exterior, Yang, often in the limbs. Disharmony of the right pulse indicates disease in the interior, Yin, often in the abdominal Zang organs. Deduce accordingly.
The principles of taking the pulse vary, and pulse shapes are diverse. Pulses rarely appear singly; they are usually compound, such as superficial and string-like, superficial and rapid, deep and tight, deep and fine, etc. How to distinguish them? Generally, the key categories do not exceed the six basic pulses: superficial (Fu, 浮), deep (Chen, 沉), slow (Chi, 迟), rapid (Shu, 数), slippery (Hua, 滑), and choppy (Se, 涩). Superficial and deep pulses are obtained by light and heavy pressure, respectively. Slow and rapid pulses are counted based on the examiner's respiration. Slippery and choppy pulses are distinguished by observing the flow shape. Superficial pulse is Yang, obtained by light pressure; Kou (Kou, 芤), Hong (Hong, 洪), San (San, 散), Da (Da, 大), Chang (Chang, 长), Ru (Ru, 濡), and Xian (Xian, 弦) pulses belong to this category. Deep pulse is Yin, obtained by heavy pressure; Fu (Fu, 伏), Shi (Shi, 石), Duan (Duan, 短), Xi (Xi, 细), Lao (Lao, 牢), and Shi (Shi, 实) pulses belong to this category. A slow pulse has three beats per respiration; Huan (Huan, 缓), Wei (Wei, 微), and Ruo (Ruo, 弱) pulses fall under this category. A rapid pulse has six beats per respiration; Ji (Ji, 疾) and Cu (Cu, 促) pulses fall under this category. One might ask: does Slippery resemble Rapid, and Choppy resemble Slow? Although similar, their principles differ. Slow and Rapid pulses are judged by beat frequency via respiration, while Slippery and Choppy pulses are judged by flow morphology. Rapid indicates Heat, Slow indicates Cold. Slippery indicates abundant Blood and deficient Qi; Choppy indicates abundant Qi and deficient Blood. These six characters summarize the pulse because they encompass exterior-interior, Yin-Yang, cold-heat, deficiency-excess, wind-cold, dryness-dampness, Zang-Fu, and Qi-Blood dynamics. Human variations do not exceed this scope. By seeking within these six pulses, no disease can escape detection. (*Neijing* states Slippery means deficient Blood and abundant Qi, Choppy means deficient Qi and abundant Blood, because abundant Qi without Blood stagnation leads to Slipperiness, while Blood stagnation preventing Qi flow leads to Chopiness.) The essentials of holding the pulse are three: Ju (Ju, 举 - lifting), An (An, 按 - pressing), and Xun (Xun, 寻 - searching). Lightly touching is Ju; heavily pressing is An; neither light nor heavy, seeking thoroughly, is Xun. Initially, using light pressure, if the pulse is felt at the skin, it is Yang, Fu, corresponding to Heart and Lung. If felt deeply under the flesh with heavy pressure, it is Yin, Zang, corresponding to Liver and Kidney. Medium pressure finds the pulse between flesh and blood, indicating balanced Yin-Yang, harmony, and Spleen-Stomach condition. If the pulse is invisible in all three depths, search thoroughly. If it appears and disappears, it is a hidden Yin-Yang pulse. This applies to all three positions.
To observe the pulse, one must understand the six terms: Shang (Up), Xia (Down), Lai (Coming), Qu (Going), Zhi (Arriving), and Zhi (Stopping). Without these, Yin-Yang and Deficiency-Excess cannot be distinguished. Up, Coming, and Arriving are Yang; Down, Going, and Stopping are Yin. "Up" moves from Chi to Cun, Yang born from Yin. "Down" moves from Cun to Chi, Yin born from Yang. "Coming" moves from deep tissues to the skin, Qi ascending. "Going" returns from the skin to deep tissues, Qi descending. "Arriving" refers to the pulse striking the finger; "Stopping" refers to the pause in respiration. To clearly understand the pulse, one must distinguish Exterior, Interior, Deficiency, and Excess. Exterior is Yang and Fu. Six Evils invading meridians but not entering Stomach/Fu or Zang are Exterior. Interior is Yin and Zang. Seven Emotions郁结 in the heart/abdomen, or dietary injuries remaining in Zang/Fu without excretion, are Interior. Deficiency is intrinsic Yuan Qi weakness, mental depletion, and energy exhaustion. Excess is pathogenic strength due to prior Zheng Qi weakness allowing pathogens to invade, not intrinsic Yuan Qi abundance. Thus, tonify Zheng Qi for Deficiency, purge pathogens for Excess. As the classics say: "Excess is when pathogenic Qi is strong; Deficiency is when essential Qi is depleted." This is the fundamental principle.
Pulses reaching above muscles and emerging at the skin are Yang and Fu; those traveling below muscles are Yin and Zang. A short pulse appearing at the skin indicates Yin overacting on Yang. A large pulse appearing below muscles indicates Yang overacting on Yin. This applies to both Cun and Chi.
Li Dongyuan said: In a healthy pulse, one need not seek Shen (Spirit/Vitality), as it is naturally present. In a diseased pulse, one must check for the presence or absence of Shen. For example, a rapid pulse (6-7 beats) indicates Heat. If the pulse has force during medium probing (indicating Stomach Qi), it has Shen. Treat by clearing Heat. A slow pulse (2-3 beats) indicates Cold. If the pulse has force during medium probing, it has Shen. Treat by dispelling Cold. If in rapid/extreme/slow/degenerate pulses, there is no force, there is no Shen. What reliance is there? Without knowing this, hastily purging or dispersing leaves the patient without foundation. Hence, the classics state: "Pulse is the precursor of Qi and Blood; Qi and Blood are the Shen of humans." How true this is.