旧说脉之浮沉不同者，不过浮大沉小，浮小沉大，浮滑沉涩，浮涩沉滑云云耳!未有于
起伏
之间，察其中途变易者也。近来诊视，曾见有两种脉，一种其气之初起，自沉分而至于中也
，滑而踊跃有势，及至中分，忽然衰弱无力，缓缓而上至于浮，形如泥浆；其返也，亦自浮
缓缓而下于中，由中至沉，滑而有势，轻按重按，指下总是如此。其证身体困倦，终日昏迷
，似寐非寐，心中惊惕，恶闻人声，目畏光明，面带微热，四肢微冷，不饥不欲食，但口渴
索饮不止。此卫湿、荣热、风燥在肺、痰热在胃也。身中伏有湿邪，而又吸受亢燥之新邪也
。以防风、 本，通卫阳、驱表湿，紫菀、白薇、杏仁、蒌皮、宣泄肺中浊气，焦查、竹茹
、石膏、 瓦楞子，降涤胃中热痰，兼以白芍清肝，天竹黄清心，而神清气爽，身健胃开
矣。一种脉气，正与此相反。其初起自沉而中也，艰涩少力，由中而浮也，躁疾如跃；其返
也，亦由浮而疾下于中，由中而沉迟弱无势，轻按重按，指下总是如此。其人嗜好洋烟，饮
食不强，阴痿不起。此表分无病，而里有痰饮，又上虚热下虚寒也。治当疏中温下。此二脉
者，皆古书所未言也，岂真古人未见此脉哉?见之而词不能达，徒以浮滑、沉涩、浮数、沉
迟了之，不知浮沉之间，迟数不能有二，滑涩各自不同，与此之起伏中变者迥别也。故凡着
医案，于脉证曲折处，必不惮反复摩绘，方能开发后学。
旧有的说法认为，脉象的浮沉不同，不过是浮大沉小、浮小沉大、浮滑沉涩、浮涩沉滑等几种情况罢了！从未有人在脉象起伏的过程中，观察其中途发生的变化。近来在诊察时，我曾见过两种脉象：一种脉气初起时，从沉分（深层）上升到中分（中层），滑利且踊跃有力；等到到达中分时，突然变得衰弱无力，缓缓上升至于浮分（浅层），形态如同泥浆般浑浊黏滞；其回落时，也是从浮分缓缓下降至中分，再由中分降至沉分，此时又变得滑利而有势，无论轻按还是重按，指下的感觉总是如此。这种脉象对应的症状是身体困倦，整天昏昏沉沉，似睡非睡，心中惊惧警惕，厌恶听到人声，眼睛畏惧光亮，面部带有微热，四肢微冷，没有饥饿感也不想进食，只是口渴想喝水不止。这是卫分有湿、营分有热、风燥邪气在肺、痰热在胃的表现。体内潜伏有湿邪，同时又吸受了亢盛干燥的新邪气。治疗用防风、藁本（Gaoben, 藁本）来通达卫阳、驱散表湿，紫菀、白薇、杏仁、瓜蒌皮来宣泄肺中的浊气，焦山楂、竹茹、石膏、海瓦楞子来降逆涤除胃中的热痰，兼用白芍清肝，天竺黄清心，这样就能使神志清爽，身体康健，胃口大开。
另一种脉气，正好与此相反。其初起从沉分上升到中分时，艰涩且力量少，由中分上升到浮分时，躁动急疾如跳跃状；其回落时，也是从浮分急速下降至中分，再由中分降至沉分时，迟滞微弱而无势，无论轻按还是重按，指下的感觉总是如此。这种人嗜好吸食鸦片，饮食不强健，阳痿不起。这是表分无病，而里有痰饮，又是上虚热下虚寒。治疗应当疏理中焦、温补下焦。这两种脉象，都是古书中未曾记载的，难道真的是古人没见过这种脉吗？可能是见到了但无法用语言准确描述，仅仅以浮滑、沉涩、浮数、沉迟等常规脉象来概括了事，不知道在浮沉之间，迟和数不能同时存在，滑和涩也各自不同，这与上述在起伏中途发生变化的脉象截然不同。所以凡是撰写医案时，对于脉证曲折复杂的地方，必须不嫌反复细致描绘，才能启发后学。
Old theories stated that the differences in superficial (Fu) and deep (Chen) pulses were merely variations such as superficial-large and deep-small, superficial-small and deep-large, superficial-slippery (Hua) and deep-choppy (Se), or superficial-choppy and deep-slippery, etc. There was no observation of changes occurring midway through the pulse's rising and falling phases. In recent clinical practice, I have observed two types of pulses. The first type: initially, the qi rises from the deep level to the middle level, being slippery and vigorous with momentum; however, upon reaching the middle level, it suddenly becomes weak and powerless, rising slowly to the superficial level, resembling muddy sludge. Upon its return, it descends slowly from the superficial level to the middle, and then from the middle to the deep level, where it again becomes slippery and vigorous. Whether lightly or heavily pressed, the sensation under the fingers remains consistent. The corresponding symptoms include bodily fatigue, constant drowsiness, a state between sleep and wakefulness, mental palpitations and apprehension, aversion to human voices, photophobia, slight facial heat, slightly cold limbs, lack of appetite without thirst for food but excessive thirst requiring continuous drinking. This indicates dampness in the Wei (Defensive) level, heat in the Ying (Nutritive) level, wind-dryness affecting the Lung, and phlegm-heat in the Stomach. It arises from latent dampness in the body combined with the inhalation of new, excessively dry pathogenic factors. Treatment employs Fangfeng (Saposhnikoviae Radix) and Bencao (Ligustici Rhizoma et Radix) to unblock Wei Yang and expel exterior dampness; Ziwan (Asteris Radix), Baiwei (Anemarrhenae Rhizoma), Xingren (Armeniacae Semen Amarum), and Gualoupi (Trichosanthis Pericarpium) to vent turbid qi in the Lungs; Jiao Shanzha (Crataegi Fructus Carbonized), Zhuru (Bambusae Caulis in Taenia), Shigao (Gypsum Fibrosum), and Hilewangzi (Margarita) to descend and purge phlegm-heat in the Stomach; accompanied by Baishao (Paeoniae Radix Alba) to clear the Liver, and Tianzhuhuang (Calami Tuber) to clear the Heart, thereby restoring mental clarity, physical health, and appetite.
The second type of pulse is exactly the opposite. Initially, rising from the deep to the middle level, it is choppy and weak; rising from the middle to the superficial level, it is restless and rapid, like jumping. Upon return, it descends rapidly from the superficial to the middle, and then slows down to become slow, weak, and devoid of momentum when sinking from the middle to the deep level. Whether lightly or heavily pressed, the sensation remains consistent. Such individuals are addicted to opium, have poor dietary strength, and suffer from impotence. This indicates no pathology in the exterior levels, but phlegm-fluid retention internally, along with deficiency-heat above and deficiency-cold below. Treatment should focus on dispersing the Middle Jiao and warming the Lower Jiao. These two pulse types are not mentioned in ancient texts. Could it be that ancients never saw them? Perhaps they saw them but lacked the words to describe them accurately, simply dismissing them as superficial-slippery, deep-choppy, superficial-rapid, or deep-slow. They failed to realize that within the superficial-deep distinction, slow and rapid cannot coexist, nor can slippery and choppy be identical; these differ significantly from the mid-phase variations described above. Therefore, when writing medical cases, one must not hesitate to repeatedly and meticulously depict complex pulse and symptom patterns to enlighten future students.