湿脉皆呆软也，挟寒兼敛，挟热兼散，而湿之深伏血分及下焦者，大率挟寒为多。其脉
专见
于沉分，若挟热者，必连及中、浮也。尝诊上感风寒，痰多肺闭，热遏于胃，素又肝燥，上
寒中热，肝胃火冲，而肺不得宣，以致气逼欲喘，舌苔薄黄而燥，两边反浓，然证甚于夜。
其脉右弦左弱，中按皆弱而散，沉按皆指下有线，长而呆软不动，知其下焦小肠、膀胱伏有
寒湿也。其气冲喘逼，固由肝火，亦由寒湿自下格火上迫也。《脉简补义》谓湿据阴分，其
沉分必呆板不灵者，即此。法以芳香轻清宣上，苦坚咸润清中，辛降淡渗搜下，此三焦异气
并治之法也。若上焦无外感，即无须宣上，而下焦辛降，不妨稍从燥烈矣。若下焦湿已化热
，脉浊不清，即无须搜下，而苦坚可以兼治矣。(按《金匮》以桂苓味甘汤治冲气，加干姜
、细辛。即冲气复动，其为肾寒而肝燥有热可知。此宜得《内经》食而过之之义。)
结气与伏热在内者，其脉皆沉滑也。何以别之?大抵气脉必兼弦，以其气实于内也；热
脉必
兼洪，以其热鼓于内也。亦有气脉单沉弦而不滑者，不兼热也；若热盛，即兼洪，而兼伏热
矣。热脉单沉洪而不滑者，以无郁也；若郁甚，即兼弦，而兼结气矣。结气之治，辛平宣散
，不必降也；伏热之治，苦寒消降，必兼散之。(凡病日久，大率皆有伏结，三焦之气不能
专一。故丹溪治病，必兼郁法。)
湿邪导致的脉象通常表现为呆滞而软弱。若兼夹寒邪，脉象多收敛；若兼夹热邪，脉象多散漫。然而，深伏于血分及下焦的湿邪，大多兼夹寒邪。这类脉象专门出现在沉取（重按）的部位；如果是兼夹热邪的，必然波及中取和浮取（轻取）。
我曾诊治一例患者，因外感风寒，导致痰多、肺气闭塞，热气郁遏在胃中，且患者素来肝阴不足导致肝燥，形成上寒中热的局面。肝胃之火上冲，致使肺气无法宣发，从而出现气逆欲喘的症状。舌苔薄黄且干燥，舌两边反而浓厚。症状在夜间加重。诊其脉象，右侧弦急，左侧虚弱，中取时皆弱而散漫，沉取时指下感觉如线般清晰，但长而呆滞软弱、毫无动感。据此判断，其下焦的小肠和膀胱潜伏有寒湿之邪。这种气逆冲撞、逼迫作喘的症状，固然由肝火引起，也是由于寒湿自下焦格拒、阻碍火势上迫所致。《脉简补义》中说，湿邪占据阴分，其沉取部位必然呆板不灵动，说的就是这种情况。
治疗方法应采用芳香轻清之品宣通上焦，苦味坚阴与咸味润下之品清泄中焦，辛味降逆与淡味渗湿之品搜剔下焦。这是三焦不同病气并治的方法。如果上焦没有外感，就不需要宣通上焦；而下焦使用辛味降逆药，不妨稍用燥烈之品。如果下焦湿邪已经化热，脉象浑浊不清，就不需要搜剔下焦，而苦味坚阴之法可以兼治。（按：《金匮要略》用桂苓味甘汤治疗冲气证，加入干姜、细辛。即使冲气再次发作，可知这是肾寒而肝燥有热的缘故。此法符合《内经》“饮食过量则致病”的道理。）
结聚之气与潜伏的热邪位于体内的，其脉象都表现为沉滑。如何辨别它们？大致来说，气病的脉象必然兼带弦象，因为气实于体内；热病的脉象必然兼带洪象，因为热气鼓动于体内。也有气脉仅表现为沉弦而不滑的，说明不兼夹热邪；如果热盛，就会兼见洪象，这就属于兼夹伏热了。热脉仅表现为沉洪而不滑的，是因为没有郁结；如果郁结严重，就会兼见弦象，这就属于兼夹结气了。
治疗结气，应用辛平之品宣散，不必使用降逆之法；治疗伏热，应用苦寒之品消导降泄，必须兼用散法。（凡是疾病日久，大多都有潜伏的结滞，三焦之气不能专一。所以朱丹溪治病，必定兼用解郁的方法。）
The pulse associated with dampness is generally sluggish and soft. When accompanied by cold, it tends to be constricted; when accompanied by heat, it tends to be scattered. However, dampness that is deeply latent in the blood level (xue fen) and the lower jiao (lower burner) mostly accompanies cold. Such pulses are specifically found at the deep level (chen fen). If accompanied by heat, it must involve the middle (zhong) and superficial (fu) levels.
I once treated a case where external wind-cold invasion caused excessive phlegm and lung obstruction, with heat constrained in the stomach. The patient had a constitutional dryness of the liver. This resulted in cold above and heat in the middle, with fire from the liver and stomach rushing upward, preventing the lungs from diffusing. Consequently, there was air forcing toward asthma. The tongue coating was thin, yellow, and dry, while the sides were conversely thick. Symptoms were worse at night. The pulse was wiry on the right and weak on the left; at the middle pressure, it was both weak and scattered; at the deep pressure, it felt like a thread under the fingers—long, sluggish, soft, and immobile. From this, I knew that cold-dampness was latent in the lower jiao, specifically in the small intestine and bladder. The qi rushing and forcing asthma was indeed due to liver fire, but also because cold-dampness from below was obstructing and forcing the fire upward. *Mai Jian Bu Yi* states that when dampness occupies the yin level, the deep pulse must be rigid and inflexible; this refers to such cases. The treatment method involves using aromatic and light-clear herbs to diffuse the upper jiao, bitter-astringent and salty-moistening herbs to clear the middle jiao, and acrid-descending and bland-permeating herbs to search out the lower jiao. This is a method of treating different pathogens in the three jiao simultaneously. If there is no external pathogen in the upper jiao, there is no need to diffuse the upper; for the lower jiao, the acrid-descending approach may slightly employ drying and hot herbs. If the dampness in the lower jiao has transformed into heat, and the pulse is turbid and unclear, there is no need to search out the lower; instead, bitter-astringent methods can treat it concurrently. (Note: *Jin Gui Yao Lue* uses Guiling Ganwei Tang to treat rushing qi, adding Ganjiang (Dried Ginger) and Xixin (Asarum). Even if the rushing qi recurs, it indicates kidney cold and liver dryness with heat. This accords with the principle in *Nei Jing* regarding illness caused by overindulgence in food.)
When knotting qi (jie qi) and latent heat (fu re) are internal, their pulses are both deep and slippery. How to distinguish them? Generally, the qi pulse must accompany a wiry quality because qi is substantial internally; the heat pulse must accompany a flooding quality because heat is鼓动 (surging) internally. There are cases where the qi pulse is solely deep-wiry without slipperiness, indicating no accompanying heat; if heat is abundant, it will accompany a flooding quality, thus constituting an accompanying latent heat. A heat pulse that is solely deep-flooding without slipperiness indicates no stagnation; if stagnation is severe, it will accompany a wiry quality, thus constituting an accompanying knotting qi. The treatment for knotting qi involves acrid-neutral herbs to diffuse and scatter, without necessity to descend; the treatment for latent heat involves bitter-cold herbs to eliminate and descend, which must be combined with dispersing methods. (Generally, diseases lasting a long time mostly have latent knots, and the qi of the three jiao cannot remain focused. Therefore, Zhu Danxi, when treating diseases, always incorporates methods for resolving stagnation.)