脉状颇多，未可以二十八字尽之也。然于表里阴阳、气血虚实之义，已能括其纲要矣。如《内经》之所
曰鼓者，且浮且大也。曰搏者，且大且强也。曰坚者，实之别名也。曰横者，洪之别名也。曰急者，紧之别
名也。曰喘者，且浮且数也。曰躁者，且浮且疾也。曰疏者，且迟且软也。曰格者，人迎倍大也。
曰关者，气口倍大也。此二脉者，后世不能深维《内经》之旨，而误作病名，不知病因脉而得名也。曰溢者，
自寸口上越鱼际，气有余也。曰覆者，自尺部下达臂间，血有余也。如仲景论脉，曰纵者，水乘火，金乘
木也。曰横者，火乘水，木乘金也。曰逆者，水乘金，火乘木也。曰顺者，金乘水，木乘火也。曰反
者，来微去大，病在里也。曰覆者，头小本大，病在表也。曰高者，卫气盛也，阳脉强也。曰章者，营气盛
也，阴脉强也。曰纲者，高章相搏也。曰 者，卫气弱也，阳脉衰也。曰卑者，营气弱也，阴脉衰也。曰
损者， 卑相搏也。《内经》十二，仲景十二，凡得二十四脉，未尝非辨证之旨诀，而世皆置若罔闻，则有
于司命之职矣。虽二十八脉亦已含藏诸义，然不详于二十四字之义，又安能入二十八字之奥哉！而犹不
止此也。阴阳不可不分而剖，色脉不可不合而稽，尺肤不可不详而考，主病不可不谙而识，四者得，而持脉之
道思过半矣。《脉要精微论》云∶“微妙在脉，不可不察。察之有纪，从阴阳始。始之有经，从五行生。生
之有度，四时为宜。彼春之暖，为夏之暑。彼秋之忿，为冬之怒。四变之动，脉与之上下。是以圣人持脉之
道，先后阴阳而持之。若阳动阴静，阳刚阴柔，阳升阴降，阳前阴后，阳上阴下，阳左阴右；数者为阳，
迟者为阴，表者为阳，里者为阴，至者为阳，去者为阴，进者为阳，退者为阴，其恒经也。
或阴盛之极，反得阳象，或阳亢之极，反得阴征，或阳穷而阴乘之，或阴穷而阳乘之，随症更迁，与时变易，
此阴阳之不可不分而剖也。”岐伯曰∶“察脉动静，以视精明，察五色，观五脏有余不足，六腑强弱，形之盛
衰，以此参伍，决死生之分。”又曰∶“形气相得，谓之可治。色泽以浮，谓之易已。脉从四时，谓之可
治。脉弱以滑，是有胃气。”《灵枢》曰∶“色脉与尺如鼓桴相应，青者脉弦，赤者脉钩，黄者脉代，白者
脉毛，黑者脉石。见其色而不得其脉，反得相胜之脉，则死矣；得相生之脉，则病已矣。”又曰∶“精明五色
者，气之华也。赤欲如白裹朱，不欲如赭。白欲如鹅羽，不欲如盐。青欲如苍璧，不欲如蓝。黄欲如罗裹雄
黄，不欲如黄土。黑欲如重漆色，不欲如地苍。”此色脉之不可不合而稽也。《灵枢》曰∶“审尺之缓急大小
滑涩，肉之坚脆，而病形定矣。目窠微肿，颈脉动，时咳，按之手足 而不起，风水肤胀也。尺肤滑而淖泽
者，风也。尺肉弱者，解 安卧；脱肉者，寒热不治。尺肤涩者，风痹也。尺肤粗如枯鱼之鳞者，伤饮
也。尺肤热甚，脉盛躁者，病温也。脉盛而滑者，病且出也。尺肤寒，脉小者，泄而少气。尺肤炬然，寒
热也。肘所独热者，腰以上热；手所独热者，腰以下热。肘后粗以下三四寸热者，肠中有虫。掌中热者，
腹热；掌中寒者，腹寒。鱼上有青脉者，胃中寒。尺炬然热，人迎大，当夺血。尺坚大，脉小，少气，
有加，立死。”又曰∶“脉急者尺肤亦急，脉缓者尺肤亦缓，脉小者尺肤亦减而少气，脉大者尺肤
亦贲而起，脉滑者尺肤亦滑，
脉涩者尺肤亦涩，此尺肤之不可不详而考也。”《脉要精微论》曰∶“长则气治，短则气病。数则烦心，
大则病进。上盛则气高，下盛则气胀。代则气衰，细则气少，涩则心痛。浑浑革至如涌泉，病进而色弊。绵绵
其去如弦绝者死。”《平人气象论》曰∶“脉短者头疼，脉长者足胫痛，脉促上击者肩背痛。脉沉而坚
者病在中，脉浮而盛者病在外。脉沉而弱，寒热及疝瘕，少腹痛。脉沉而横，胁下有积，腹中有横积痛。脉沉
而喘曰寒热。脉盛滑坚者病在外，脉小实而坚者病在内。小弱以涩，谓之久病；浮滑而疾，谓之新病。脉急者，
疝瘕少腹痛。脉滑曰风，脉涩曰痹。缓而滑曰热中，盛而紧曰胀。臂多青脉曰脱血。尺脉缓涩，谓之解 安
卧。脉盛谓之脱血，尺涩脉滑，谓之多汗。尺寒脉细，谓之后泄。尺脉粗常热者，谓之热中。此主病
之不可不谙而识也。”如上所述，不过大略耳。若欲达变探微，非精研《灵》《素》，博综百家不可也。许胤
宗曰“脉之候幽而难明，吾意所解，口莫能宣也。口且莫能宣，而笔又乌能写乎？
博极而心灵自启，思深而神明自通，则三指有隔垣之照，二竖无膏肓之 矣。”
脉象的种类非常多，不能仅用二十八个字就将其全部概括。然而，这二十八字已经能够囊括表里、阴阳、气血、虚实的基本纲要了。例如《内经》中所说的“鼓”脉，是指脉象既浮又大的；所说的“搏”脉，是指脉象既大又强劲的；所说的“坚”脉，是实脉的别名；所说的“横”脉，是洪脉的别名；所说的“急”脉，是紧脉的别名；所说的“喘”脉，是指脉象既浮又快（数）的；所说的“躁”脉，是指脉象既浮又疾速的；所说的“疏”脉，是指脉象既迟又软的；所说的“格”脉，是人迎脉比气口脉大一倍的；所说的“关”脉，是气口脉比人迎脉大一倍的。这两种脉象，后世医家未能深入探究《内经》的宗旨，而错误地将其当作病名，不知道这是因为病因导致脉象而得名，而非脉象本身即是病名。所说的“溢”脉，是指脉气从寸口向上越过鱼际部位，这是气有余的表现；所说的“覆”脉，是指脉气从尺部向下延伸至臂间，这是血有余的表现。
如张仲景在论述脉法时，所说的“纵”脉，是水气乘袭火位，金气乘袭木位；所说的“横”脉，是火气乘袭水位，木气乘袭金位；所说的“逆”脉，是水气乘袭金位，火气乘袭木位；所说的“顺”脉，是金气乘袭水位，木气乘袭火位；所说的“反”脉，是指脉来微弱而去势盛大，主病在里；所说的“覆”脉（此处指另一种形态），是指脉头小根大，主病在表；所说的“高”脉，是卫气旺盛，阳脉强盛；所说的“章”脉，是营气旺盛，阴脉强盛；所说的“纲”脉，是高脉与章脉相互搏结；所说的“损”脉（原文缺字，据上下文推测为某种弱脉或特定脉象，结合后文“卑”脉，此处可能指代一种复合或特定状态，但原文此处有脱漏，依文意译为：卫气虚弱，阳脉衰退的状态），是卫气虚弱，阳脉衰退；所说的“卑”脉，是营气虚弱，阴脉衰退；所说的“损”脉，是上述两种虚弱脉象相互搏结。《内经》记载十二种脉，张仲景记载十二种脉，共计二十四种脉，这些未曾不是辨证的关键诀要，然而世人却都置之不理，这就违背了医生救死扶生的职责。虽然二十八脉也已经蕴含了各种脉义，但如果对那二十四种脉的含义不详细研究，又怎能深入理解二十八脉的奥妙呢？而且还不止于此。阴阳不可不加以区分和剖析，色与脉不可不结合起来考察，尺肤（前臂内侧皮肤）不可不详细检查，主病之理不可不熟识并掌握，这四点做到了，那么诊脉的道理也就掌握了一半以上了。
《脉要精微论》说：“脉理的微妙之处，不可不仔细考察。考察脉理有纲纪，从阴阳开始。确立纲纪有常规，从五行产生。五行变化有定度，以顺应四时为适宜。春天的温暖，演变为夏天的暑热；秋天的肃杀，演变为冬天的严寒。四季气候的变化，脉象也随之上下起伏。因此圣人诊脉的原则，是先辨别阴阳再行诊察。比如阳动阴静，阳刚阴柔，阳升阴降，阳前阴后，阳上阴下，阳左阴右；数脉属阳，迟脉属阴，表证属阳，里证属阴，至脉属阳，去脉属阴，进脉属阳，退脉属阴，这是恒常的规律。或者阴盛到了极点，反而出现阳的脉象；或者阳亢到了极点，反而出现阴的征象；或者阳气穷尽而阴气乘袭，或者阴气穷尽而阳气乘袭。随着症状的变化而变化，随时间的推移而改变，这就是阴阳不可不加以区分和剖析的原因。”岐伯说：“通过观察脉动的动静，来审视眼睛的神采（精明）；观察五色，来判断五脏的有余和不足，六腑的强弱，以及形体的盛衰，将这些因素综合参验，从而决定生死界限。”又说：“形体与正气相协调，称为可治。面色光泽且浮润，称为容易痊愈。脉象顺应四时变化，称为可治。脉象软弱而滑利，说明有胃气。”
《灵枢》说：“面色与脉象如同鼓槌击鼓那样相应合：青色对应弦脉，赤色对应钩脉，黄色对应代脉，白色对应毛脉，黑色对应石脉。看到相应的面色却得不到相应的脉象，反而得到相克（相胜）的脉象，就会死亡；得到相生脉象的，病就会痊愈。”又说：“眼睛的神采和五色，是精气的外华。红色应该像白布包裹着朱砂，不应该像赭石色；白色应该像鹅的羽毛，不应该像盐色；青色应该像青玉，不应该像蓝草色；黄色应该像罗纱包裹着雄黄，不应该像黄土色；黑色应该像重漆的颜色，不应该像灰黑色的土地色。这就是色与脉不可不结合起来考察的原因。”
《灵枢》说：“审察尺肤的缓急、大小、滑涩，以及肌肉的坚脆，那么疾病的形态就可以确定了。眼睑微微肿胀，颈动脉跳动，时常咳嗽，按压手足凹陷不起，这是风水肤胀病。尺肤滑润而有光泽的，是风病。尺部肌肉瘦弱的，是懈怠嗜卧；肌肉脱陷的，是寒热病且难以治愈。尺肤粗糙的，是风痹病。尺肤粗糙得像枯鱼的鳞片一样，是伤饮病。尺肤很热，脉象盛大躁动的，是温病。脉象盛大而滑利的，病将要外出（好转）。尺肤寒冷，脉象细小的，是泄泻且少气。尺肤灼热如火的，是寒热病。肘部单独发热的，是腰以上发热；手部单独发热的，是腰以下发热。肘后下方三四寸处发热的，肠中有虫。手掌心发热的，腹中热；手掌心寒冷的，腹中寒。大鱼际上有青色脉络的，胃中寒。尺部灼热，人迎脉大，应当放血治疗。尺部坚硬且大，脉象细小，少气，如果病情加重，会立即死亡。”又说：“脉象紧急的，尺肤也紧急；脉象缓和的，尺肤也缓和；脉象细小的，尺肤也减薄且少气；脉象盛大的，尺肤也隆起；脉象滑利的，尺肤也滑利；脉象涩滞的，尺肤也涩滞。这就是尺肤不可不详细检查的原因。”
《脉要精微论》说：“脉长则气机调畅，脉短则气机有病。脉数则心烦，脉大则病势进展。上部脉盛则气逆，下部脉盛则气胀。代脉则气衰，细脉则气少，涩脉则心痛。脉象浑浑乱乱，革脉到来如涌泉般急促，病势进展且面色败坏。脉象绵绵不断，离去时如弓弦断绝，主死。”《平人气象论》说：“脉短者头疼，脉长者足胫痛，脉促而上击者肩背痛。脉沉而坚的，病在中焦；脉浮而盛的，病在外。脉沉而弱的，有寒热及疝瘕，少腹痛。脉沉而横的，胁下有积块，腹中有横向积块疼痛。脉沉而喘（指脉来急促）的，是寒热病。脉盛滑坚的，病在外；脉小实而坚的，病在内。脉小弱而涩的，称为久病；脉浮滑而疾的，称为新病。脉急的，是疝瘕少腹痛。脉滑的是风病，脉涩的是痹病。缓而滑的是热中病，盛而紧的是胀病。手臂多青筋的是脱血。尺脉缓涩的，是懈怠嗜卧。脉盛的是脱血，尺涩脉滑的是多汗。尺寒脉细的是后泄（腹泻）。尺脉粗常热的，是热中病。这就是主病之理不可不熟识并掌握的原因。”如上所述，不过是大概情况罢了。如果想要通达变化、探求细微，非精深研究《灵枢》《素问》，广泛综合各家学说不可。许胤宗说：“脉象的征兆幽深而难以明了，我心中的理解，口中无法完全表达。既然口中都无法表达，笔又怎么能写出来呢？只有博览群书而心灵自然开启，思考深远而神明自然通达，那么三指之下就能有洞察隔墙事物的明照，两个竖子（病魔）就无法在膏肓之地作祟了。”
The forms of pulse are numerous and cannot be fully encompassed by twenty-eight characters. However, these twenty-eight characters can already summarize the essential principles of exterior and interior, yin and yang, qi and blood, and deficiency and excess. For instance, what *Neijing* (Inner Canon of the Yellow Emperor) calls "Gu" (Drum-like) refers to a pulse that is both floating and large. What it calls "Bo" (Beating) refers to a pulse that is both large and strong. What it calls "Jian" (Firm) is another name for the Shi (Full/Excess) pulse. What it calls "Heng" (Horizontal) is another name for the Hong (Surging) pulse. What it calls "Ji" (Urgent) is another name for the Jin (Tight) pulse. What it calls "Chuan" (Panting) refers to a pulse that is both floating and rapid (Shu). What it calls "Zao" (Restless) refers to a pulse that is both floating and swift. What it calls "Shu" (Sparse) refers to a pulse that is both slow and soft. What it calls "Ge" (Gridlocked) refers to the Renying (ST9) pulse being twice as large as the Qikou (LU9) pulse. What it calls "Guan" (Bolt) refers to the Qikou pulse being twice as large as the Renying pulse. These two types of pulses, later generations failed to deeply comprehend the intent of *Neijing*, mistakenly treating them as disease names, not realizing they are named after the etiology causing the pulse change, rather than being diseases themselves. What is called "Yi" (Overflowing) refers to the pulse qi rising from the Cun (Inch) position upwards beyond the Yuji (LU10) area, indicating an excess of Qi. What is called "Fu" (Covering) refers to the pulse qi extending downwards from the Chi (Cubit) position towards the arm, indicating an excess of Blood.
As Zhang Zhongjing discussed pulses, he described "Zong" (Vertical) as Water overcoming Fire, or Metal overcoming Wood. He described "Heng" (Horizontal) as Fire overcoming Water, or Wood overcoming Metal. He described "Ni" (Reverse) as Water overcoming Metal, or Fire overcoming Wood. He described "Shun" (Smooth/Following) as Metal overcoming Water, or Wood overcoming Fire. He described "Fan" (Contrary) as a pulse coming weakly but departing strongly, indicating disease in the Interior. He described "Fu" (Covering - distinct from the earlier definition) as a pulse head small and root large, indicating disease in the Exterior. He described "Gao" (High) as vigorous Wei (Defensive) Qi and strong Yang pulses. He described "Zhang" (Chapter/Manifest) as vigorous Ying (Nutritive) Qi and strong Yin pulses. He described "Gang" (Net/Cord) as the interaction between Gao and Zhang pulses. He described [missing character in text, context implies a deficient state] as weak Wei Qi and declining Yang pulses. He described "Bei" (Low/Humble) as weak Ying Qi and declining Yin pulses. He described "Sun" (Damage/Loss) as the interaction between these deficient states. *Neijing* records twelve pulses, Zhang Zhongjing records twelve pulses, totaling twenty-four pulses. These were never anything other than key formulas for syndrome differentiation, yet the world ignores them, which betrays the duty of saving lives. Although the twenty-eight pulses already contain various meanings, if one does not detail the meanings of those twenty-four characters, how can one enter the profound mysteries of the twenty-eight characters? Moreover, this is not all. Yin and Yang must not fail to be distinguished and analyzed; Color and Pulse must not fail to be examined together; Chi Skin (skin on the inner forearm) must not fail to be investigated in detail; the diseases governed by these signs must not fail to be familiarized and recognized. If these four are mastered, half of the way to understanding pulse diagnosis is complete.
*Ma Yao Jing Wei Lun* (Treatise on the Essential and Subtle Aspects of Pulse) says: "The subtlety lies in the pulse, which must not go unexamined. The examination has its discipline, starting with Yin and Yang. Establishing discipline follows the generation of the Five Elements. The generation has its measure, suited to the Four Seasons. The warmth of spring becomes the heat of summer; the severity of autumn becomes the anger of winter. The movement of the four changes causes the pulse to rise and fall accordingly. Thus, the sage's method of holding the pulse is to first distinguish Yin and Yang before examining. Such as Yang moving and Yin still, Yang rigid and Yin soft, Yang ascending and Yin descending, Yang preceding and Yin following, Yang above and Yin below, Yang left and Yin right; Rapid pulses belong to Yang, Slow pulses belong to Yin, Exterior conditions belong to Yang, Interior conditions belong to Yin, Approaching pulses belong to Yang, Departing pulses belong to Yin, Advancing pulses belong to Yang, Retreating pulses belong to Yin; these are the constant laws. Or, when Yin excess reaches the extreme, it may contrary show Yang signs; or when Yang hyperactivity reaches the extreme, it may contrary show Yin signs; or when Yang is exhausted, Yin takes over; or when Yin is exhausted, Yang takes over. Following symptoms, changes occur; changing with time, this is why Yin and Yang must not fail to be distinguished and analyzed." Qibo said: "Observe the movement and stillness of the pulse to view the spirit (Jing Ming); observe the five colors to see the excess and deficiency of the Zang organs, the strength and weakness of the Fu organs, and the flourishing and decline of the form. By comparing these, decide the division of life and death." He also said: "When form and Qi harmonize, it is called treatable. When color luster is floating and bright, it is called easily cured. When the pulse conforms to the four seasons, it is called treatable. When the pulse is weak and slippery, it indicates Stomach Qi."
*Ling Shu* (Spiritual Pivot) says: "Color and pulse correspond like drumsticks hitting a drum: Green corresponds to Xian (Wiry) pulse, Red corresponds to Gou (Hook) pulse, Yellow corresponds to Dai (Intermittent) pulse, White corresponds to Mao (Feather) pulse, Black corresponds to Shi (Stone) pulse. Seeing the color but not getting the corresponding pulse, but instead getting a mutually overcoming (Xiang Sheng) pulse, means death; getting a mutually generating pulse means the disease will resolve." He also said: "The spirit in the eyes and the five colors are the splendor of Qi. Red should be like white wrapping cinnabar, not like jasper. White should be like goose feathers, not like salt. Green should like bluish jade, not like indigo. Yellow should be like silk wrapping realgar, not like yellow earth. Black should be like heavy lacquer, not like dark soil. This is why Color and Pulse must not fail to be examined together."
*Ling Shu* says: "Examine the slackness/tightness, size, slipperiness/roughness of the Chi skin, and the firmness/fragility of the flesh, and the disease form is determined. Slight swelling of the eye sockets, pulsation of the neck vessels, occasional cough, pressing the hands and feet leaves an indentation that does not rise immediately, this is Feng Shui (Wind-Water) and skin distension. If Chi skin is slippery and glossy, it is Wind disease. If Chi flesh is weak, it is Jie Ji (lethargy) and An Wo (lying down); if flesh is wasted, it is Han Re (cold-heat) disease and untreatable. If Chi skin is rough, it is Feng Bi (Wind-Damp Bi). If Chi skin is coarse like dried fish scales, it is Shang Yin (damaged drinking/water retention). If Chi skin is very hot and the pulse is盛大 (sheng) and restless, it is Wen Bing (Warm Disease). If the pulse is盛大 and slippery, the disease is about to exit (resolve). If Chi skin is cold and the pulse is small, it is Xie (diarrhea) and Shao Qi (deficient Qi). If Chi skin is burning, it is Han Re (cold-heat). If only the elbow is hot, the upper waist is hot; if only the hand is hot, the lower waist is hot. If the area three or four inches below the back of the elbow is hot, there are worms in the intestines. If the palm center is hot, the abdomen is hot; if the palm center is cold, the abdomen is cold. If there are green veins on the Yu (thenar eminence), the stomach is cold. If Chi is burning and Renying is large, bloodletting is indicated. If Chi is firm and large, but the pulse is small and there is deficient Qi, if the condition worsens, death is immediate." He also said: "If the pulse is urgent, the Chi skin is also urgent; if the pulse is slack, the Chi skin is also slack; if the pulse is small, the Chi skin is also diminished and there is deficient Qi; if the pulse is large, the Chi skin is also bulging; if the pulse is slippery, the Chi skin is also slippery; if the pulse is choppy, the Chi skin is also choppy. This is why Chi skin must not fail to be investigated in detail."
*Ma Yao Jing Wei Lun* says: "Long pulse indicates regulated Qi; Short pulse indicates diseased Qi. Rapid pulse indicates vexation in the heart; Large pulse indicates advancing disease. Upper excess indicates high Qi (rebellious Qi); Lower excess indicates abdominal distension. Dai (Intermittent) pulse indicates Qi decline; Fine pulse indicates little Qi; Choppy pulse indicates Heart pain. Hun Hun Ge Zhi Ru Yong Quan (Chaotic and革-like arriving like a gushing spring) indicates advancing disease and deteriorating complexion. Mian Mian Qu Ru Xian Jue (Continuously departing like a broken string) indicates death." *Ping Ren Qi Xiang Lun* (Treatise on the Phenomena of Healthy People) says: "Short pulse indicates headache; Long pulse indicates pain in the shins; Cu (Rapid/Interrupted) and upward striking pulse indicates shoulder and back pain. Deep and firm pulse indicates disease in the Middle; Floating and盛大 pulse indicates disease in the Exterior. Deep and weak pulse indicates cold-heat and Shan Jia (hernia/masses), with lower abdominal pain. Deep and horizontal pulse indicates accumulation under the hypochondrium and transverse accumulation pain in the abdomen. Deep and panting (rapid) pulse indicates cold-heat.盛大, slippery, and firm pulse indicates disease in the Exterior; Small, solid, and firm pulse indicates disease in the Interior. Small, weak, and choppy indicates chronic disease; Floating, slippery, and rapid indicates new disease. Urgent pulse indicates Shan Jia and lower abdominal pain. Slippery pulse indicates Wind; Choppy pulse indicates Bi (obstruction). Slack and slippery indicates Re Zhong (Heat in the Middle);盛大 and tight indicates distension. Many blue veins on the arm indicates loss of blood. Chi pulse slack and choppy indicates lethargy and lying down.盛大 pulse indicates loss of blood; Chi choppy and pulse slippery indicates excessive sweating. Chi cold and pulse fine indicates posterior diarrhea (loose stools). Chi pulse coarse and constantly hot indicates Re Zhong (Heat in the Middle). This is why the diseases governed by these signs must not fail to be familiarized and recognized." As mentioned above, this is merely a general outline. If one wishes to reach transformation and explore the subtle, one must profoundly study *Ling Shu* and *Su Wen*, and comprehensively integrate the theories of hundreds of schools. Xu Yinzong said: "The indications of the pulse are profound and difficult to clarify; what I understand in my mind, my mouth cannot declare. If the mouth cannot declare it, how can the pen write it? Only by exploring extensively will the mind naturally open; only by thinking deeply will the spirit naturally connect. Then, under the three fingers, there will be illumination through walls, and the two Shu (demons of illness) will have no place in the Gaohuang (deep interior) to cause harm."