《脉简补义》谓濡、弱二脉，止以浮、沉分名，主病并无分别。究竟非无分别也，前人
未经
发明耳!夫濡即软也，形不硬也；弱，无力也，气不强也。故濡主湿邪，弱主气虚。凡肢体
困倦，肌肤 肿，以及疮疡癣疥，其脉多濡。史载之所谓按如泥浆者，湿兼热也，偏于邪实
；呼吸不足，不能任劳，以及盗汗自汗，泄利注下，其脉多弱，气衰不鼓也，偏于正虚。湿
能滞气，形软者，应指多是无力；虚能生寒，力弱者，其形不必皆软。故软而不弱，必湿中
热盛，浊气上逆也；弱而不软，必虚中挟寒，脉为寒急也。其软、弱并见，而软甚于弱者，
湿邪深入肝、脾，而肺、胃气郁也，证见胸膈痞满，肢体酸痿；弱甚于软者，心、肾真阳内
怯，而脾、肺气虚也，证见饮食不化，腹痛时泄。阴虚伤湿，脉多沉软；气虚伤风，脉多浮
弱。风者，温而毗于燥者也。若形软无力，指下如死曲 ，患风湿表证者可治，为其气血
郁停滞也；久病虚损必死，为其气血已呆而不灵，指下之形，乃阴浊之气浮溢经络而仅存未
散也。治濡脉者，芳香为主，甘温佐之；治弱脉者，甘温为主，芳香佐之。软而不弱，略加
苦寒；弱而不软，再入辛温。此大法也。
牢脉者，沉阴无阳之脉也，是寒湿深入肝脾；肝脾之体，其腠理为瘀血布满而胀大也。
故其
证气呼不入，稍动即喘，两胫无力，腰强不便，两胁 胀，皮肤微 似肿，最易出汗，声粗
气短，喉仲介介不清，皆肝脾气化内外隔绝所致，以其本体内塞，气无所输也。近年迭诊四
人，大率是忧思抑郁之士也。一以会试留京苦读，冬寒从两足深入上攻，立春之日，忽觉两
腿无力，行及数武，即汗大出、气大喘，延至长夏，痿废 肿，五液注下。一以久居卑湿，
经营伤神，春实时觉体倦食少；夏遂全不思食，体重面惨，腰下无汗，身冷不温，行动即喘
，肢软腰酸，不能久坐；入冬痿废，次春不起。一以经营劳力，又伤房室，寒湿内渍；夏
患咳嗽，误用清肺，咳极血出；入秋遂唾血沫，色赤如朱，遍身微 似肿，行动即喘，汗出
如注，肤凉不温，医仍作内热，治以清泄，秋分不起。一以被劾褫职，先患遍身 肿，气促
喘急，日夜危坐，不能正卧，医治暂愈，仍觉声粗气浮，两腿少力，秋分复发，无能为矣。
此四人者，其脉皆沉大而硬，以指极按至骨，愈见力强冲指而起，虽尽肘臂之力以按之，不
能断也。指下或弦紧不数，或混浊带数，或混浊之中更带滑驶，指下如拖带无数粘涎也。两
寸皆短，两关先左强右弱，后左右皆强，或右强于左，中间亦有时忽见和缓，而未几仍归于
牢，且或更甚于前日也。大便不硬而艰秘不下，仲景所谓腹满便坚，寒从下上者也。推其本
原，大率是体质强壮，气血本浊，加以湿邪深渍，原籍肝脾正气以嘘吸而疏发之，而乃劳以
房室，抑以忧思，久之肝脾正气内陷，不能疏发，而寒湿遂乘虚滞入肝脾之体矣。血遂凝于
腠
理，不得出入，而体为之胀满肿大矣。血凝而坚，气结而浊，故脉为之沉伏坚大也。何以知
其为肝脾胀大也?凡六腑五脏，皆有脉以通行于身。寒湿之邪，由脉内传于脏，脏气分布之
细络，闭塞不得输泄，而气专注于大脉矣。肝脾主血，其体坚实而涩，最易凝结，故斗殴跌
仆瘀血内蓄之人，其脉多有沉弦而大，重按不减者。又疟疾死者，西医谓肝脾胀大，倍于常
人。(《千金翼方》第二十六卷末，有疟证不能俯仰，目如脱，项似拔。叶天士《临证指南
》亦谓疟疾腰痛胀为肝病，是中医早有此说矣。西医谓此即疟母，殊未是。)每诊久疟败证
，胁胀腰急，其脉亦多是沉大而弦，重按不减也。且见是脉者，多死于秋，或死于春，罕见
死于正冬、正夏者。肝、脾受克之期，于病机尤宛然可征者也。当微见未甚之时，急用芳香
宣发之剂，疏化寒湿，舒肝醒脾，佐以苦降淡渗，使寒从下上者，仍从下出；加以行血通络
，使腠理瘀痹者，渐得开通，或可挽回一二。峻药急服，非平疲之法所能为力也。
《脉简补义》认为，濡脉和弱脉仅仅根据浮取、沉取来命名，主治疾病并没有区别。这终究不是没有区别，只是前人未曾阐明罢了！所谓濡脉就是软脉，指感不坚硬；弱脉，是指无力，气机不强盛。所以濡脉主湿邪，弱脉主气虚。凡是肢体困倦，肌肤肿胀，以及疮疡癣疥等病，其脉象多呈濡象。史载之所说的“按之如泥浆”，是湿邪兼有热象，偏于邪气实证；呼吸短促不足，不能从事劳累工作，以及盗汗自汗，泄泻痢疾或水样便下注，其脉象多呈弱象，这是气衰不能鼓动脉道，偏于正气虚弱。湿邪能阻滞气机，脉形柔软者，应指多半无力；虚证能产生寒象，脉力弱者，脉形不一定都柔软。所以，脉软但不弱，必定是湿中热盛，浊气上逆；脉弱但不软，必定是虚中夹寒，脉因寒而拘急。如果软、弱并见，且软甚于弱，是湿邪深入肝、脾，导致肺、胃气机郁滞，症状表现为胸膈痞满，肢体酸软痿废；若弱甚于软，是心、肾真阳内怯，而脾、肺气虚，症状表现为饮食不化，腹痛时常泄泻。阴虚伤于湿邪，脉多沉软；气虚伤于风邪，脉多浮弱。风邪，性质温和而接近燥性。如果脉形软而无力，指下感觉像死去的蚯蚓，患有风湿表证的患者可以治愈，这是因为气血郁滞停滞所致；若是久病虚损出现此脉则必死，这是因为气血已经呆钝而不灵动，指下的脉形，乃是阴浊之气浮溢于经络而仅存未散的表现。治疗濡脉，以芳香药为主，甘温药为辅佐；治疗弱脉，以甘温药为主，芳香药为辅佐。脉软而不弱，略加苦寒药；脉弱而不软，再加入辛温药。这是基本法则。
牢脉，是沉阴无阳的脉象，这是寒湿深入肝、脾；肝、脾的形体，其腠理被瘀血布满而胀大。所以其症状为气息呼入困难，稍微活动就气喘，两小腿无力，腰部僵硬不便，两胁部胀满，皮肤微肿似浮肿，极易出汗，声音粗重气短，喉间介介不清爽，这都是肝、脾气化功能内外隔绝所致，因为其本体内部闭塞，气无所输布。近年来连续诊治四人，大体都是忧思抑郁的人。其中一人因为会试留在京城刻苦读书，冬天寒气从两足深入向上攻冲，立春之日，忽然觉得两腿无力，行走几步，就大汗出、大气喘，拖延到长夏季节，出现痿废肿胀，五液（汗、涕、泪、涎、唾）下注。另一人长久居住在低洼潮湿之地，经营操劳损伤神气，春分时节自觉体倦食少；夏季完全不想进食，身体沉重面色惨淡，腰部以下无汗，身体冰冷不温暖，行动即气喘，肢软腰酸，不能久坐；入冬后痿废，次年春季无法起床。第三人因为经营劳力，又房事过度，寒湿内侵；夏季患咳嗽，误用清肺药，咳极而出血；入秋遂吐血色泡沫，色红如朱砂，遍身微肿似浮肿，行动即气喘，汗出如注，皮肤凉不温暖，医生仍当作内热治疗，用清泄法，至秋分日死亡。第四人被弹劾罢官，先患遍身浮肿，气促喘急，日夜危坐，不能正卧，医治暂时痊愈，仍觉声音粗重气浮，两腿少力，秋分复发，已无能为力了。这四个人，他们的脉象都是沉大而硬，用手指极重按至骨，越按力量越强冲撞手指，即使耗尽肘臂之力去按压，也不能使脉中断绝。指下感觉或弦紧不数，或混浊带数，或混浊之中更带滑利急速，指下感觉如同拖带着无数粘涎。两寸脉皆短，两关脉先左强右弱，后来左右皆强，或右强于左，中间有时也忽现和缓，但不久又归于牢脉，甚至比以前更严重。大便不硬但艰涩难下，这正是张仲景所说的腹满便坚，寒邪从下往上侵犯的情况。推究其本源，大体是体质强壮，气血本浑浊，加上湿邪深重浸渍，原本依赖肝、脾正气来嘘吸疏发，却反而因房室劳损，被忧思压抑，久而久之肝、脾正气内陷，不能疏发，于是寒湿乘虚滞入肝、脾之体。血液遂凝结于腠理，不得出入，从而身体为之胀满肿大。血凝而坚，气结而浊，所以脉象为之沉伏坚大。怎么知道它是肝、脾胀大呢？凡六腑五脏，都有脉通行于全身。寒湿之邪，由脉内传于脏，脏气分布的细络，闭塞不得输泄，而气专注于大脉。肝、脾主血，其体坚实而涩，最容易凝结，所以斗殴跌仆导致瘀血内蓄的人，其脉多有沉弦而大，重按不减的现象。另外疟疾死者，西医认为是肝、脾胀大，倍于常人。（《千金翼方》第二十六卷末尾，有疟证不能俯仰，眼睛像要脱出，项背像被拔起。叶天士《临证指南》也说疟疾腰痛胀属于肝病，这说明中医早有此说法。西医称之为疟母，并不准确。）每次诊治久疟败证，胁胀腰急，其脉也多沉大而弦，重按不减。而且见到这种脉象的人，多死于秋季，或死于春季，很少死于严冬、盛夏。这是肝、脾受克制的时期，在病机上尤为明显可征。当症状轻微尚未严重时，急用芳香宣发之剂，疏化寒湿，舒肝醒脾，辅佐苦降淡渗之品，使从下往上的寒邪，仍从下排出；加入行血通络药，使腠理瘀痹者，逐渐得以开通，或许可以挽回一二。峻猛药物急服，非平和疲软的治法所能奏效。
The *Mai Jian Bu Yi* (Supplement to the Meaning of Pulse Simplicity) states that the Ru (Soggy) pulse and Ruo (Weak) pulse are named solely based on their superficial (Fu, floating) and deep (Chen, sunken) positions, and there is no distinction in the diseases they govern. Ultimately, however, there is a distinction; it is merely that previous scholars had not elucidated it! The term "Ru" implies softness, meaning the form is not hard; "Ruo" implies lack of force, meaning the Qi is not strong. Therefore, the Ru pulse indicates Dampness pathogen, while the Ruo pulse indicates Qi deficiency. In cases of limb fatigue, skin swelling, as well as sores, ulcers, tinea, and scabies, the pulse is often Ru. As described by Shi Zaizhi, feeling like pressing into mud indicates Dampness combined with Heat, leaning towards excess pathogen; insufficient respiration, inability to endure labor, spontaneous sweating, night sweats, diarrhea, dysentery, and watery stools indicate the Ruo pulse, caused by Qi decline failing to propel the vessel, leaning towards deficiency of healthy Qi. Dampness can stagnate Qi; when the form is soft, the response to pressure is mostly without force; deficiency generates Cold; when the force is weak, the form is not necessarily always soft. Thus, if the pulse is soft but not weak, it must be due to excessive Heat within Dampness and counterflow of turbid Qi; if the pulse is weak but not soft, it must be due to Cold夹杂 (mixed with) in deficiency, causing the pulse to be tight due to Cold. If both softness and weakness are present, with softness exceeding weakness, it indicates Dampness pathogen has deeply entered the Liver and Spleen, leading to Qi stagnation in the Lung and Stomach, presenting with chest and diaphragm fullness and obstruction, and acid/flaccid flaccidity of limbs; if weakness exceeds softness, it indicates deficiency of True Yang in the Heart and Kidney, and Qi deficiency in the Spleen and Lung, presenting with indigestion, abdominal pain, and frequent loose stools. Yin deficiency injured by Dampness often presents with a deep-soft pulse; Qi deficiency injured by Wind often presents with a superficial-weak pulse. Wind is warm and close to Dryness. If the form is soft and without force, feeling under the fingers like a dead leech, patients with Wind-Damp exterior syndrome can be cured, because this indicates Qi and Blood stagnation and stasis; however, in chronic deficiency and damage, this pulse indicates death, because Qi and Blood have become dull and unresponsive. The form felt under the fingers represents Yin-turbid Qi floating overflowing in the collaterals, remaining undissipated. To treat the Ru pulse, aromatic herbs are primary, assisted by sweet-warm herbs; to treat the Ruo pulse, sweet-warm herbs are primary, assisted by aromatic herbs. If soft but not weak, slightly add bitter-cold herbs; if weak but not soft, further add acrid-warm herbs. This is the general principle.
The Lao (Firm/Deep-Fixed) pulse is a pulse of deep Yin without Yang, indicating Cold-Dampness deeply entering the Liver and Spleen. The physical structure of the Liver and Spleen is filled with blood stasis in its cou-li (interstices), leading to enlargement. Consequently, symptoms include difficulty inhaling, panting upon slight movement, weakness in both calves, stiff and inconvenient lower back, distension in both hypochondria, slight skin swelling, profuse sweating, coarse voice and shortness of breath, and a sensation of obstruction in the throat. These are all caused by the internal and external isolation of Liver-Spleen Qi transformation, due to internal blockage preventing Qi distribution. Recently, I examined four individuals, generally those prone to worry, thought, and depression. One suffered from intense study for the metropolitan examination in Beijing; winter cold penetrated upward from both feet. On the day of Li Chun (Start of Spring), he suddenly felt weakness in his legs; after walking a few paces, he experienced profuse sweating and severe panting. By late summer, he developed flaccidity, wasting, and swelling, with fluids pouring down. Another lived long in damp, low places, exhausting his spirit through business; during spring thunder season, he felt body fatigue and poor appetite; by summer, he lost all desire to eat, his body was heavy, his face pale, he had no sweat below the waist, his body was cold and unwarmed, he panted upon movement, his limbs were soft and his lower back sore, unable to sit for long; by winter he was disabled, and by the following spring could not rise. A third engaged in manual labor and overindulged in sexual activity, allowing Cold-Damp to infiltrate internally; in summer he suffered cough, mistakenly treated with Lung-clearing herbs, leading to hemoptysis from extreme coughing; by autumn he expectorated bloody froth, red as vermilion, his whole body was slightly swollen, he panted upon movement, sweated profusely, his skin was cool and unwarmed. Physicians still treated him as internal heat using clearing and purging methods, and he died on the Autumn Equinox. A fourth was impeached and dismissed from office; he first suffered generalized swelling, shortness of breath, and urgent panting, sitting precariously day and night, unable to lie flat. Treatment temporarily helped, but he still felt coarse voice and floating Qi, weakness in legs; the condition recurred on the Autumn Equinox, and he became incurable. For these four, the pulse was deep, large, and hard. Pressing extremely to the bone, the stronger the pressure, the more forcefully the pulse rebounded against the finger. Even exerting all strength of the arm could not suppress it. Under the fingers, it might be wiry and tight without rapidity, or muddy/turbid with rapidity, or muddy/turbid with slippery and fast qualities, feeling as if dragging countless sticky saliva. Both Cun (inch) pulses were short. At the Guan (bar) positions, initially the left was strong and right weak, later both were strong, or right stronger than left. Sometimes a harmonious/sluggish quality appeared briefly in the middle, but soon returned to Lao, even more severe than before. Bowel movements were not hard but difficult and constipated, exactly as Zhang Zhongjing described: abdominal fullness with hard stool, Cold ascending from below. Tracing the root cause, these individuals generally had robust constitutions but originally turbid Qi and Blood. Added to this was deep infiltration by Dampness. Originally relying on Healthy Qi of the Liver and Spleen for ventilation and dispersal, they exhausted themselves through sexual activity and suppressed themselves through worry/thought. Over time, Liver-Spleen Healthy Qi sank inward, unable to disperse, allowing Cold-Damp to take advantage of the deficiency and stagnate within the Liver-Spleen structures. Blood coagulated in the cou-li, unable to enter or exit, causing the body to become distended and enlarged. Blood coagulation makes it firm; Qi knotting makes it turbid; thus the pulse becomes deep, hidden, firm, and large. How do we know it is Liver-Spleen enlargement? All six Fu organs and five Zang organs have pulses circulating throughout the body. Cold-Damp pathogens transmit internally from vessels to organs. The fine collaterals distributing organ Qi become blocked and cannot drain, causing Qi to concentrate in the larger vessels. The Liver and Spleen govern Blood; their structure is firm and rough, most prone to coagulation. Thus, people with internal blood stasis from fighting or falls often have deep, wiry, large pulses that do not diminish with heavy pressure. Also, in deaths from malaria, Western medicine considers the liver and spleen enlarged, double the normal size. (*Qianjin Yifang*, Vol. 26 end) mentions malaria syndromes where one cannot bend or stretch, eyes bulge, neck feels pulled. Ye Tianshi's *Linzheng Zhinan* also states that malaria with lower back pain and distension is a Liver disease, indicating Traditional Chinese Medicine had this concept early on. Western medicine calls this "Maomu" (Malaria Mass), which is not entirely accurate. Each time I examine advanced-stage malaria syndromes with hypochondriac distension and lower back urgency, the pulse is often deep, large, and wiry, not diminishing with heavy pressure. Moreover, those presenting with this pulse often die in Autumn or Spring, rarely in mid-Winter or mid-Summer. These periods correspond to when the Liver and Spleen are overcome, clearly evident in the pathology. When symptoms are mild and not yet severe, urgently use aromatic, ventilating formulas to disperse and transform Cold-Damp, soothe the Liver and awaken the Spleen, assisted by bitter-descending and bland-leaching methods, so that Cold ascending from below may exit from below; add blood-invigorating and collateral-unblocking agents to gradually open the cou-li obstructions, potentially saving one or two lives. Potent drugs taken urgently cannot be achieved by mild, slackening methods.