体象 牢在沉分，大而弦实；浮中二候，了不可得。
主病 牢主坚积，病在乎内。左寸之牢，伏梁为病。右寸之牢，息贲可定。左关见牢，肝家血积。
右关见牢，阴寒痞癖。左尺牢形，奔豚为患。右尺牢形，疝瘕痛甚。
【按】牢有二义，坚牢固实之义，又深居在内之义。故树木以根深为牢，盖深入于下者也。监狱以禁囚
为牢，深藏于内者也。仲景曰∶“寒则牢固”，又有坚固之义也。沈氏曰∶“似沉似伏，牢之位也。实大弦长，
牢之体也。牢脉所主之症，以其在沉分也，故悉属阴寒；以其形弦实也，
故咸为坚积。若夫失血亡精之人，则内虚，而当得革脉，乃为正象；若反
得牢脉，是脉与症相反，可以卜死期矣。”伪诀云∶“寻之则无，按之则有”，但依稀仿佛，却不言实大弦长
之形象，是沉脉而非牢脉矣。又曰∶“脉入皮肤辨息难”，更以牢为死亡之脉矣，其谬可胜言哉！叔和《脉经》云∶
“牢脉似沉似伏，实大而长，微弦”，可谓明尽其状。至伏脉虽重按之亦不可见，必推筋至
骨，乃见其形，而牢脉既实大弦长，才重按之，便满指有力矣，又何以谓之似伏乎？脉之义幽而难明，非字
字推敲，展转审辨，能无遗后学之疑惑哉！
体象 散脉浮乱，有表无里；中候渐空，按则绝矣。
主病 散为本伤，见则危殆。左寸见散，怔忡不寐。右寸见散，自汗淋漓。左关之散，当有溢饮。
右关之散，胀满蛊疾。左尺见散，北方水竭。右尺得之，阳消命绝。
【按】散有二义，自有渐无之象，亦散乱不整之象也。当浮候之，俨然大而成其为脉也；及中候之，
顿觉无力而减其十之七八矣；至沉候之，杳然不可得而见矣。渐重渐无，渐轻渐有。明乎此八字，而散字之
义得，散脉之形确着矣。故叔和云∶“散脉大而散，有表无里”，字字斟酌，毫不苟且者也。崔氏云∶“涣
漫不收”，盖涣漫即浮大之义，而不收即无根之义；虽得其大意，而未能言之凿凿也。柳氏云∶“无统纪，无
拘束，至数不齐，或来多去少，或去多来少，涣散不收，如杨花散漫之象。”夫杨花散漫，即轻飘而无根之
说也。其言至数不齐，多少不一，则散乱而不整齐严肃之象也。此又补叔和未备之旨，深得散脉之神者也。
戴同父云∶“心脉浮大而散，肺脉短涩而散，皆平脉也。心脉软散而怔忡，肺脉软散为汗出，肝脉软散为
溢饮，脾脉软散为 肿，皆病脉也。肾脉软散，诸病脉见散，皆死脉也。”古人以代散为必死者，盖散为肾
败之征，代为脾绝之候也。肾脉本沉，而散脉按之不可得见，是先天资始之根本绝也。脾脉主信，而代脉歇至
不愆其期，是后天资生之根本绝也。故二脉独见，均为危殆之候；而二脉交见，尤为必死之符。
【体象】牢脉位于沉取部位，脉形大而弦且实；在浮取和中取两个候位时，完全无法触及。
【主病】牢脉主病为体内坚硬的积块，病变位置在内脏。左寸部出现牢脉，提示患有伏梁病（腹中结块）。右寸部出现牢脉，可确定为息贲病（肺积）。左关部见到牢脉，是肝脏血瘀积滞所致。
右关部见到牢脉，是阴寒导致的痞块癖积。左尺部呈现牢脉形态，会引发奔豚病（气从少腹上冲心胸）。右尺部呈现牢脉形态，疝气和瘕聚疼痛剧烈。
【按语】“牢”字有两层含义：一是坚固牢固的意思，二是深居在内的意思。所以树木以根深蒂固为牢，是因为深深扎根于地下。监狱以禁囚为牢，是因为深藏于内部。张仲景说：“寒冷则使事物牢固”，这里又有坚固的含义。沈氏说：“似沉似伏，这是牢脉的位置特征；实大弦长，这是牢脉的形体特征。”牢脉所主的病症，因为它位于沉分，所以都属于阴寒证；因为它的形状弦而坚实，所以都是坚硬积聚之症。如果是失血或精气耗损的人，体内本已虚弱，应当出现革脉，这才是正常的脉象；如果反而出现牢脉，这就是脉象与症状相反，可以推断其死期将至了。伪诀中说：“寻取时无，重按时有”，只是隐约可见，却不提及实大弦长的形象，这是沉脉而不是牢脉了。又说：“脉入皮肤辨息难”，更是将牢脉视为死亡的脉象，这种谬误怎能说得完呢！王叔和《脉经》中说：“牢脉似沉似伏，实大而长，微带弦意”，可以说把它的形态描述得极其详尽。至于伏脉，即使重按也看不见，必须推筋至骨，才能看到它的形态；而牢脉既然实大弦长，只要稍加重按，就满指有力了，又怎么能说是“似伏”呢？脉学的义理幽深难以明了，如果不逐字推敲、辗转审辨，怎么能消除留给后学的疑惑呢！
【体象】散脉浮取时杂乱无章，只有表浅部分而没有里层根基；中取时逐渐空虚，重按时则完全消失。
【主病】散脉表示根本受损，出现此脉则病情危殆。左寸部见到散脉，会有心悸怔忡、失眠的症状。右寸部见到散脉，会有大汗淋漓的症状。左关部的散脉，应当有溢饮病（水液停聚四肢肌肤）。
右关部的散脉，会有腹胀满和蛊疾（腹部胀大如鼓的疾病）。左尺部见到散脉，表示肾水枯竭。右尺部见到此脉，表示阳气消亡、生命终结。
【按语】“散”字有两层含义：一是逐渐消散无有的景象，二是散乱不整齐的景象。应当在浮取时观察，俨然宏大而成其为脉象；等到中取时，顿时觉得无力，减弱了十分之七八；到了沉取时，杳然不可见。逐渐加重按压力度则脉象逐渐消失，逐渐减轻按压力度则脉象逐渐显现。明白了这八个字，就能理解“散”字的含义，散脉的形态也就明确了。所以王叔和说：“散脉大而散，有表无里”，每个字都经过斟酌，毫不马虎。崔氏说：“涣漫不收”，大概涣漫就是浮大的意思，而不收就是无根的意思；虽然抓住了大意，但说得不够确切。柳氏说：“没有统纪，没有拘束，至数不齐，有时来多去少，有时去多来少，涣散不收，像杨花散漫的样子。”杨花散漫，就是轻飘而无根的说法。他说至数不齐，多少不一，这是散乱而不整齐严肃的景象。这又补充了王叔和未完备的宗旨，深得散脉的神韵。戴同父说：“心脉浮大而散，肺脉短涩而散，都是平脉（正常脉象）。心脉软散而伴有心悸，肺脉软散而有汗出，肝脉软散而有溢饮，脾脉软散而有浮肿，都是病脉。肾脉软散，各种病脉见到散脉，都是死脉。”古人认为代脉和散脉同时出现是必死的征兆，大概散脉是肾败坏的征象，代脉是脾气绝灭的候象。肾脉本来深沉，而散脉重按不可见，这是先天资始的根本断绝。脾脉主信（规律），而代脉间歇出现且不违背周期，这是后天资生的根本断绝。所以这两种脉象单独出现，都是危殆的候象；而如果两种脉象同时出现，更是必定死亡的符兆。
[Physical Characteristics] The Lao pulse (Firm Pulse) is located at the deep level; its form is large, wiry, and solid. It cannot be detected at all at the superficial and middle levels.
[Main Diseases] The Lao pulse indicates firm accumulations within the interior. A Lao pulse at the left Cun position indicates Fuliang disease (abdominal mass). A Lao pulse at the right Cun position indicates Xifen disease (lung accumulation). A Lao pulse at the left Guan position indicates blood stasis and accumulation in the Liver.
A Lao pulse at the right Guan position indicates cold-induced epigastric masses or癖积 (fixed lumps). A Lao pulse at the left Chi position indicates Ben Tun disease (Qi rushing upward from the lower abdomen to the chest). A Lao pulse at the right Chi position indicates severe pain from hernia and Jia masses (abdominal tumors).
[Commentary] The term "Lao" has two meanings: one refers to being firm and solid, and the other refers to being deeply situated within. Therefore, trees are described as having a "firm" root because they are deeply rooted underground. Prisons are called "Lao" because prisoners are deeply confined inside. Zhang Zhongjing said, "Cold makes things firm," implying another meaning of solidity. Shen Shi said, "Resembling Chen (Deep) and Fu (Hidden), this is the positional characteristic of Lao; Solid, Large, Wiry, and Long, this is the physical characteristic of Lao." Regarding the diseases indicated by the Lao pulse: because it is located at the deep level, all such conditions belong to Yin-Cold syndromes; because its shape is wiry and solid, all such conditions represent firm accumulations. For individuals who have lost blood or essence, the interior is deficient, and they should present with a Ge pulse (Leather Pulse), which would be the correct image; if they instead present with a Lao pulse, the pulse contradicts the symptoms, indicating that death is imminent. A spurious prescription states, "Absent when searching lightly, present when pressing heavily," describing only a vague presence without mentioning the solid, large, wiry, and long characteristics; this describes a Chen pulse, not a Lao pulse. It further states, "The pulse enters the skin, making breath differentiation difficult," treating Lao as a pulse of death; how can such errors be enumerated? Wang Shuhe's *Mai Jing* (Pulse Classic) states, "The Lao pulse resembles Chen and Fu, is solid, large, long, and slightly wiry," which describes its morphology comprehensively. As for the Fu pulse (Hidden Pulse), even with heavy pressure, it is invisible; one must push the tendons to the bone to see its form. However, since the Lao pulse is already solid, large, wiry, and long, it feels full and powerful upon slight heavy pressure; how can it be described as "resembling Fu"? The principles of pulse diagnosis are profound and difficult to understand. Without scrutinizing every word and examining them repeatedly, how can the doubts left for future generations be resolved?
[Physical Characteristics] The San pulse (Scattered Pulse) is floating and chaotic, existing only on the surface without a root in the interior. At the middle level, it gradually becomes empty; upon heavy pressure, it disappears completely.
[Main Diseases] The San pulse indicates damage to the fundamental Qi; its appearance signifies critical danger. A San pulse at the left Cun position indicates palpitations (Zhengchong) and insomnia. A San pulse at the right Cun position indicates profuse spontaneous sweating. A San pulse at the left Guan position suggests Yi Yin disease (water retention in the limbs and skin).
A San pulse at the right Guan position indicates abdominal distension and Gu disease (ascites with emaciation). A San pulse at the left Chi position indicates exhaustion of Kidney Water. A San pulse at the right Chi position indicates the extinction of Yang and the end of life.
[Commentary] The term "San" has two meanings: one is the image of gradually fading away, and the other is the image of being scattered and disordered. When felt at the superficial level, it appears grand and distinct as a pulse; however, at the middle level, it suddenly feels weak, reducing by seventy to eighty percent; at the deep level, it is imperceptible. With increasing pressure, it gradually vanishes; with decreasing pressure, it gradually reappears. Understanding these eight characters clarifies the meaning of "San" and firmly establishes the morphology of the San pulse. Thus, Wang Shuhe stated, "The San pulse is large and scattered, having a surface but no interior," words carefully chosen without negligence. Cui Shi said, "Dispersed and unrestrained," where "dispersed" implies floating and large, and "unrestrained" implies lacking a root; although he grasped the general idea, his description was not precise enough. Liu Shi said, "Without order, without constraint, irregular in rhythm, sometimes coming more and going less, sometimes going more and coming less, scattered and unrestrained, like willow catkins drifting aimlessly." Willow catkins drifting aimlessly refers to being light-floating and rootless. His mention of irregular rhythms and varying quantities describes a scattered and unrigorous image. This supplements the incomplete points in Wang Shuhe's work and captures the essence of the San pulse. Dai Tongfu said, "Heart pulse floating, large, and scattered; Lung pulse short, choppy, and scattered; these are normal pulses (Ping Mai). Heart pulse soft, scattered, accompanied by palpitations; Lung pulse soft, scattered, accompanied by sweating; Liver pulse soft, scattered, accompanied by Yi Yin; Spleen pulse soft, scattered, accompanied by edema; these are pathological pulses. Kidney pulse soft and scattered; any pathological pulse appearing as scattered is a death pulse." Ancients considered the simultaneous appearance of Dai (Intermittent) and San pulses as a sign of certain death. Generally, the San pulse is a sign of Kidney failure, while the Dai pulse is a sign of Spleen exhaustion. The Kidney pulse is naturally deep, but the San pulse is imperceptible upon pressure, indicating the severance of the congenital foundation. The Spleen pulse governs regularity, but the Dai pulse shows intermittent beats without missing their cycle, indicating the severance of the acquired foundation. Therefore, the independent appearance of either pulse is a critical sign; their simultaneous appearance is an even stronger omen of certain death.