(此卷是发《脉简补义》未尽之余义也)
脉有单诊、总按不同者，或单诊强，总按弱也；或单诊弱，总按强也；或单诊细，总按
；或单诊大，总按细也。凡单按弱总按强者，此必其脉弦滑，一指单按，气行自畅，无所搏
激；三指总按，则所按之部位大，气行不畅，而搏激矣。此脉本强，而总按更强于单按也。
单按强总按弱者，此必其脉气本弱，但食指较灵，单按指下较显，名、中二指较木，总按即
不显其振指也。此脉本弱而总按更弱于单按也。单按细总按大者，是其脉体弦细而两旁有晕
也。总按指下部位大，而晕亦鼓而应指矣。单按大总按细者，必其人血虚气燥，脉体细弱，
而两旁之晕较盛也。食指灵，而晕能应指，名、中二指木，而晕不能应指矣。更有单按浮总
按沉，单按沉总按浮者，其浮即晕也；抑或脉体本弱，轻按气无所搏，力不能鼓，重按气乃
搏鼓也。又有医者操作用力，指尖动脉盛大，与所诊之脉气相击，而亦见盛大者。又有医者
久行久立，指头气满，皮肤 起，因与脉力相隔而不显者。此皆极琐细之处，前人所不屑言
，而所关正非浅鲜也。
大抵单诊、总按，而指下显判大小强弱之有余不足者，其有余总属假象。在无病之人固
为正
气衰微，即有病之人亦正气不能鼓载其邪，使邪气不能全露其形于指下，而微露此几希也。
当以正虚邪实例治之，固不得重于用攻；亦不得以为邪气轻微，专于用补也。即如总按大单
诊细者，其细多是指下梗梗如弦，起伏不大，其中气之怯弱可知；单诊大总按细者，其细多
是指下驶疾，累累似滑，是气力不足于上充，而勉强上争也，其中气之竭蹶更可知矣。强弱
亦如是也，总是因禀赋薄弱，或劳倦内伤，或久病气血困惫，胸中窄狭，动作乏力，乃多见
之。是因虚生实，清浊混处，气郁不舒之象也。
（这一卷是阐发《脉简补义》中未尽的余意）
脉诊有单指诊察和总按（三指同时下压）不同的情况：有的单指诊察时感觉强盛，而总按时感觉虚弱；有的单指诊察时感觉虚弱，而总按时感觉强盛；有的单指诊察时感觉细，而总按时感觉大；有的单指诊察时感觉大，而总按时感觉细。
凡是单指按觉得弱、总按觉得强的，这必定是因为脉象弦滑（脉管紧张如弓弦，往来流利），当一指单独按压时，气机运行自然通畅，没有搏激冲突；当三指同时按压时，所覆盖的部位变大，气机运行不畅，从而产生搏激。这种脉象本身强盛，但总按比单按更强盛。
单指按觉得强、总按觉得弱的，这必定是因为脉气本来虚弱，只是食指比较灵敏，单指按压时指下感觉较明显；而名指、中指比较迟钝，总按时就不能显现出振指的感觉。这种脉象本来虚弱，但总按比单按更虚弱。
单指按觉得细、总按觉得大的，是因为脉体弦细且两旁有晕圈（脉动范围超出脉管本身的界限）。总按时指下覆盖部位大，晕圈也鼓动并应指。
单指按觉得大、总按觉得细的，必定是此人血虚气燥，脉体细弱，而两旁的晕圈较盛。食指灵敏，能感应到晕圈；名指、中指迟钝，不能感应到晕圈。
更有单指按觉得浮、总按觉得沉，或单指按觉得沉、总按觉得浮的情况。这里的“浮”其实就是晕圈的表现；或者是脉体本来虚弱，轻按时气机没有搏激，力量不足以鼓动，重按时气机才发生搏动鼓起。
又有医者操作用力过猛，指尖动脉盛大，与所诊之脉气相互撞击，因而也显得盛大。又有医者久行久立，指头气满，皮肤紧绷，因为与脉力相隔而不显。这些都是极其细微之处，前人不屑于谈论，但其关系却并不浅显。
大抵通过单诊和总按，在指下明显判断出大小强弱有余不足的情况，其“有余”总属于假象。在无病之人身上，这固然是正气衰微的表现；即使是有病之人，也是正气不能鼓动承载邪气，使邪气不能完全显露于指下，而只微微显露这一丝迹象。应当以正虚邪实来治疗，固然不能重用攻法；也不能认为邪气轻微而专一使用补法。
就像总按大、单诊细的，这种“细”多是指下梗梗如弦，起伏不大，其中气怯弱可知；单诊大、总按细的，这种“细”多是指下驶疾，累累似滑，这是气力不足于上充，而勉强向上抗争，其中气竭蹶（困顿窘迫）更可知了。强弱也是如此，总是因为禀赋薄弱，或劳倦内伤，或久病气血困惫，胸中窄狭，动作乏力，这是多见的情形。这是因虚生实，清浊混杂，气郁不舒的现象。
(This volume elucidates the remaining meanings not fully expounded in *Mai Jian Bu Yi* [Supplement to the Brief Meaning of Pulse Diagnosis].)
Pulse diagnosis differs between single-finger palpation (Dan Zhen) and three-finger simultaneous pressing (Zong An). In some cases, the pulse feels strong under single-finger palpation but weak under three-finger pressing; in others, it feels weak under single-finger palpation but strong under three-finger pressing; in some, it feels fine under single-finger palpation but large under three-finger pressing; and in others, it feels large under single-finger palpation but fine under three-finger pressing.
When the pulse is weak under single-finger palpation but strong under three-finger pressing, this is invariably due to a Xian-Hua (String-taut and Slippery) pulse quality. When pressed by a single finger, the Qi flow is naturally smooth without turbulent agitation; however, when pressed by three fingers simultaneously, the area covered becomes larger, impeding smooth Qi flow and causing turbulent agitation. Thus, although the pulse is inherently strong, it appears even stronger under three-finger pressing than under single-finger palpation.
Conversely, when the pulse feels strong under single-finger palpation but weak under three-finger pressing, this is because the pulse Qi is inherently weak. The index finger is more sensitive, making the pulse distinct under single-finger pressure, whereas the ring and middle fingers are less sensitive, failing to perceive the pulsation during three-finger pressing. Hence, the pulse is inherently weak and appears even weaker under three-finger pressing.
When the pulse feels fine under single-finger palpation but large under three-finger pressing, it indicates that the pulse body is Xian-Xi (String-taut and Fine) with a surrounding halo (Yun, an expanded area of pulsation beyond the vessel walls). Under three-finger pressing, the broader contact area captures this halo, making it feel large.
When the pulse feels large under single-finger palpation but fine under three-finger pressing, it typically indicates Blood deficiency and dryness of Qi. The pulse body is fine and weak, but the surrounding halo is prominent. The sensitive index finger perceives the halo, while the less sensitive ring and middle fingers do not.
There are also instances where the pulse feels floating under single-finger palpation but deep under three-finger pressing, or vice versa. The "floating" sensation here often refers to the halo effect. Alternatively, if the pulse body is inherently weak, light pressure may fail to elicit a response due to insufficient force, while heavy pressure induces a palpable beat.
Furthermore, if the practitioner presses too forcefully, their own digital artery may become prominent and collide with the patient's pulse Qi, creating an illusion of strength. Similarly, if the practitioner has been walking or standing for a long time, their fingertips may be engorged with Qi and the skin taut, insulating them from the pulse force, leading to a diminished perception. These are extremely subtle details often overlooked by predecessors, yet they are of significant importance.
Generally, when single-finger palpation and three-finger pressing reveal clear discrepancies in size and strength indicating excess, these "excess" signs are mostly illusory. In healthy individuals, this reflects a decline in Zheng Qi (Upright Qi); in patients, it indicates that Zheng Qi is insufficient to mobilize and carry the pathogenic factor, preventing the pathogen from fully manifesting, revealing only a faint trace. Treatment should address both Zheng Qi deficiency and Pathogenic Excess. One must not resort to heavy purgation, nor should one assume the pathogen is mild and rely solely on tonification.
For example, in a case where three-finger pressing feels large but single-finger palpation feels fine, the "fine" quality often presents as stiff and string-like with minimal fluctuation, indicating weak Middle Qi. In a case where single-finger palpation feels large but three-finger pressing feels fine, the "fine" quality often presents as rapid and bead-like, resembling a Slippery pulse, indicating that Qi and strength are insufficient to rise and support, forcing a reluctant upward struggle, which reveals a state of exhaustion in the Middle Qi. The same logic applies to strength variations. These conditions usually stem from congenital weakness, fatigue-induced internal injury, or chronic illness depleting Qi and Blood, resulting in chest tightness and physical frailty. This represents a phenomenon of "Excess arising from Deficiency," where Clear and Turbid Qi mix, and Qi stagnation fails to circulate freely.