体象 革大弦急，浮取即得；按之乃空，浑如鼓革。
主病 革主表寒，亦属中虚。左寸之革，心血虚痛。右寸之革，金衰气壅。左关遇之，疝瘕为祟。右
关遇之，土虚为疼。左尺之革，精空可必。右尺之革，殒命为忧。女人得之，半产漏下。
【按】革者，皮革之象也。表邪有余，而内则不足也。恰如鼓皮，外则绷急，内则空虚也。浮举之而弦
大，非绷急之象乎？沉按之而豁然，非中空之象乎？惟表有寒邪，故弦急之象见焉；惟中亏气血，故空虚之象
显焉。仲景曰∶“革脉弦而芤，弦则为寒，芤则为虚。虚寒相搏，此名为革。男子亡血失精，女人半产漏
下。”王叔和云∶“三部脉革，长病得之死，卒病得之生。”李时珍云∶“此芤弦二脉相合，故均主失血之候。
诸家脉书皆以为即牢脉也，故或有革无牢，或有牢无革，溷淆莫辨，不知革浮牢沉，革虚牢实，形与症皆异
也。”《甲乙经》云∶“浑浑革至如涌泉，病进而色弊，绵绵其去如弦绝者死。”谓脉来混浊革变，急如泉
涌，出而不返也。观其曰涌泉，则浮取之不止于弦大，而且数且搏且滑矣；曰弦绝，则重按之不止于豁然，而
且绝无根蒂矣，故曰死也。王贶以为溢脉者，自寸而上贯于鱼际，直冲而上，如水之沸而盈溢也，与革脉奚涉
乎？丹溪曰∶“如按鼓皮”，其于中空外急之义，最为亲切之喻。
体象：脉形宽大、弦急，轻取（浮取）即可触及；重按则感觉中空，整体感觉如同按压鼓皮一般。
主病：革脉主要主表寒证，也属于中焦虚损。左寸部出现革脉，提示心血亏虚疼痛；右寸部出现革脉，提示肺气衰弱、气机壅滞。左关部遇到革脉，提示疝气或腹内结块（瘕聚）为患。右关部遇到革脉，提示脾胃虚弱导致疼痛。左尺部出现革脉，提示肾精亏空无疑。右尺部出现革脉，提示有危及生命的忧虑。女性患者若出现此脉，提示可能发生小产或非经期阴道出血（漏下）。
【按语】革脉，是皮革的形象比喻。体表邪气有余，而体内正气不足。恰如鼓皮，外部绷急，内部空虚。轻举手指诊察时脉象弦大，这不是绷急的形象吗？沉按手指诊察时脉象豁然中空，这不是中空的形象吗？正因为体表有寒邪，所以显现出弦急的形象；正因为中焦气血亏虚，所以显现出空虚的形象。张仲景说：“革脉兼具弦脉和芤脉的特征，弦脉主寒，芤脉主虚。虚与寒相互搏结，这就叫做革脉。男子出现革脉多因失血或遗精，女子出现革脉多因小产或漏下。”王叔和说：“三部脉皆见革象，久病者得之预后不良（主死），突发疾病者得之预后较好（主生）。”李时珍说：“这是芤脉和弦脉两种脉象的结合，所以都主失血的征候。各家脉书都认为革脉就是牢脉，所以有的书中只有革脉没有牢脉，有的只有牢脉没有革脉，混淆不清无法辨别。他们不知道革脉位浮、牢脉位沉，革脉主虚、牢脉主实，形态与症状都不同。”《甲乙经》说：“脉来浑浊急变如涌泉，病情加重且面色败坏；脉去连绵不绝如琴弦断绝，主死。”这是指脉来混浊变异，急促如泉水涌出，只出不返。看它说“涌泉”，说明轻取不仅不止于弦大，而且数急、搏指且滑利；说“弦绝”，说明重按不仅不止于豁然中空，而且完全没有根蒂，所以说主死。王贶认为溢脉是从寸部向上贯穿至鱼际，直冲而上，像水沸腾溢出一样，这与革脉有什么关系呢？朱丹溪说：“如同按压鼓皮”，这个比喻对于中空外急的含义，最为贴切亲切。
Physical Manifestation: The pulse is large, wiry, and tense; it can be felt upon light palpation (superficial touch); upon heavy pressure, it feels empty in the center, resembling the sensation of pressing on a drum skin.
Predominant Diseases: The Ge pulse primarily indicates exterior cold syndromes and also belongs to deficiency of the middle jiao. A Ge pulse at the left Cun position indicates deficiency of heart blood causing pain. A Ge pulse at the right Cun position indicates decline of lung metal and qi stagnation. Encountering a Ge pulse at the left Guan position suggests pathology from hernia or abdominal masses (Jia-Jia). Encountering a Ge pulse at the right Guan position indicates pain due to deficiency of spleen earth. A Ge pulse at the left Chi position confirms emptiness of essence. A Ge pulse at the right Chi position raises concern for life-threatening conditions. In women, obtaining this pulse suggests spontaneous abortion or continuous uterine bleeding (Lou-Xia).
[Commentary]: The Ge pulse represents the image of leather. There is an excess of pathogenic factors on the exterior, while there is insufficiency within. It is exactly like a drum skin: tight on the outside and empty on the inside. When lifted lightly, the pulse appears wiry and large; is this not the image of tension? When pressed deeply, the pulse feels suddenly hollow; is this not the image of central emptiness? Because there is cold pathogen on the exterior, the image of wiriness and tension appears; because of the deficiency of qi and blood in the middle, the image of emptiness becomes manifest. Zhang Zhongjing said: "The Ge pulse is wiry and knotted (Kou); wiry indicates cold, knotted indicates deficiency. Deficiency and cold combine, this is named Ge. In men, it indicates loss of blood and essence; in women, spontaneous abortion and leakage." Wang Shuhe stated: "If the pulses in all three positions are Ge, a chronic patient will die, but an acute patient will survive." Li Shizhen said: "This is a combination of the Kou and Wiry pulses, thus both indicate signs of blood loss. Various pulse texts consider it identical to the Lao pulse, hence some have Ge without Lao, or Lao without Ge, causing confusion and inability to distinguish. They do not know that Ge is superficial while Lao is deep, Ge indicates deficiency while Lao indicates excess, and their forms and symptoms are entirely different." The *Jia Yi Jing* states: "When the pulse comes turbid and changing like surging springs, the disease advances and the complexion deteriorates; when it goes continuously like a broken string, death ensues." This refers to the pulse coming turbid and altered, urgent like a gushing spring, exiting without returning. Observing its description as "surging spring," it implies that upon superficial palpation, it is not only wiry and large but also rapid, pounding, and slippery; describing it as "broken string" implies that upon deep palpation, it is not only suddenly hollow but completely lacks root, hence it is said to indicate death. Wang Kuang considered the Yi pulse to rise from the Cun position above to the Yuji area, rushing straight up like boiling water overflowing; how does this relate to the Ge pulse? Zhu Danxi said: "Like pressing on a drum skin"; this metaphor is most apt and intimate regarding the meaning of emptiness inside and tension outside.