躁脉有浮沉两种，沉而来去如掣，或兼细、兼滑、兼弦，而无远近盛衰之异者，阳气之
虚而
内陷，是自郁也；若为寒湿所遏者，必兼紧数矣。浮而来盛去衰，来远去近，甫去即来，未
能极底，如人之以手探汤而回者，此内热而中气不安于内，是阴气不吸也。兼洪缓者，为风
热、湿热之有余；兼弱散者，为阴虚骨蒸之不足。凡患血燥，脉多如此。其证为懊 烦躁，
夜不安眠，大便秘结，头目昏眩，呼吸短促，多梦纷纭。又骨性坚敛，气主内吸。骨热者，
脉来上促，出多入少。其证为骨中如坚，肢软欲痿，头颅胀疼，筋脉抽掣，心中惊惕，是髓
中有热也；若加浮散，是髓枯也。《内经》曰∶热病髓热者死。此之谓也。
《脉简补义》论实散之脉，近于洪而不数不盛。其所以异同之故，尚未揭出。夫洪者，
或阴
虚阳陷，而阳盛于阴，或阴本不虚，而阳邪自盛。此偏于阳盛一边，故其脉洪大而充实有力
。实散者，或内湿菀久化燥，或风邪内扰其阴。此偏于阴虚一边，故其脉涣而平软少力。《
慎柔五书》又谓虚损久病，其脉中沉之分，必见虚洪。此又气虚血少，阴阳两亏，而中枢不
运者也。血少故不聚不坚，气虚故起伏甚小而无力，是虚散之未甚者。虚洪见于中沉，升降
无力，阳气弱而犹未离根；虚散仅见于浮，阴不维阳，阳气散而无根也。故治洪脉，重在泄
火
，而兼养阴；治实散，重在养阴，而兼理气；治虚洪，补血益气，而剂取轻清；治散脉，益
气补血，而剂取温润重浊，收摄滋填矣。此四脉者，其辨只在阴阳虚实、偏轻偏重、一微一
甚之间。
躁脉分为浮、沉两种类型。脉象沉取时，来去急促如牵拉状，或者兼见细脉、滑脉、弦脉，而没有远近盛衰差异的，是阳气虚弱而内陷，属于自我郁结；如果是被寒湿邪气遏制，必然兼见紧数脉。脉象浮取时，来势盛大而去势衰弱，来时远而去时近，刚离去又立即回来，未能到达极深处，就像人手探入热水中随即收回的样子，这是内部有热而中气不能安守于内，是阴气不能摄纳的表现。如果兼见洪缓脉，是风热、湿热邪气有余；如果兼见弱散脉，是阴虚骨蒸导致的不足。凡是患有血燥证的，脉象大多如此。其症状表现为心中烦闷懊恼、烦躁不安，夜间无法安睡，大便秘结，头目昏眩，呼吸短促，多梦纷纭。另外，骨的特性是坚硬收敛，气的特性主向内吸纳。骨中有热的，脉象来势急促，出多入少。其症状表现为骨中感觉坚硬，肢体软弱欲痿废，头颅胀痛，筋脉抽搐掣动，心中惊悸警惕，这是髓中有热；如果再加上浮散脉，就是髓枯了。《内经》说：热病导致髓热的会死亡。说的就是这个情况。
《脉简补义》论述实散之脉，接近洪脉但不数且不盛。它们之所以有同异之处，尚未揭示清楚。所谓洪脉，或者是阴虚阳陷，导致阳盛于阴，或者阴本不虚，而阳邪自然亢盛。这偏重于阳盛一方面，所以其脉洪大而充实有力。实散脉，或者是内湿郁积日久化燥，或者风邪内扰损伤其阴。这偏重于阴虚一方面，所以其脉涣散且平软少力。《慎柔五书》又说虚损久病，其脉在中取和沉取的分位，必见虚洪脉。这又是气虚血少，阴阳两亏，而中焦枢纽不运转的情况。因为血少所以不聚拢不坚实，因为气虚所以起伏很小且无力，这是虚散脉尚未严重的表现。虚洪脉见于中取和沉取，升降无力，阳气微弱但尚未离根；虚散脉仅见于浮取，阴不能维系阳，阳气涣散而无根。所以治疗洪脉，重在泻火，同时兼顾养阴；治疗实散脉，重在养阴，同时兼顾理气；治疗虚洪脉，补血益气，药方选取轻清之品；治疗散脉，益气补血，药方选取温润重浊之品，以收摄滋填为主。这四种脉象，其辨别关键在于阴阳虚实、偏轻偏重、一微一甚之间的细微差别。
The Zao (Restless) pulse is divided into two types: floating and deep. When felt at the deep level, the pulse comes and goes rapidly as if being pulled, or it may be accompanied by a Fine (Xi), Slippery (Hua), or Wiry (Xian) quality, without differences in distance or strength. This indicates deficiency of Yang Qi sinking inward, resulting in self-stagnation; if constrained by Cold-Dampness, it must be accompanied by a Tight (Jin) and Rapid (Shu) quality. When felt at the floating level, the pulse arrives with great force but departs weakly, coming from afar and departing near, returning immediately after leaving without reaching the bottom, similar to a hand dipping into hot water and withdrawing quickly. This indicates internal heat with Middle Qi unable to remain settled within, reflecting Yin Qi's failure to grasp and retain. If accompanied by a Surging (Hong) and Slow (Huan) quality, it indicates excess of Wind-Heat or Damp-Heat; if accompanied by a Weak (Ruo) and Scattered (San) quality, it indicates insufficiency due to Yin deficiency with bone-steaming fever. In cases of Blood Dryness, the pulse is often like this. The symptoms include mental restlessness and vexation, insomnia at night, constipation, dizziness of the head and eyes, shortness of breath, and frequent dreaming. Furthermore, the nature of Bone is firm and convergent, while the nature of Qi primarily moves inward. In cases of Heat in the Bone, the pulse arrives hurriedly, with more outward movement than inward. The symptoms include a sensation of hardness in the bones, flaccidity and weakness of the limbs resembling paralysis, distending pain in the head, twitching and pulling of sinews and vessels, and palpitations with fear in the heart, indicating Heat in the Marrow; if accompanied by a Floating and Scattered pulse, it indicates exhaustion of the Marrow. The *Neijing* states: "In febrile diseases, Heat in the Marrow leads to death." This refers to that condition.
*Maijian Buyi* discusses the Shi San (Excess Scattered) pulse, which resembles the Hong (Surging) pulse but is neither Rapid nor Excessive. The reasons for their similarities and differences have not yet been elucidated. The Hong pulse arises either from Yin deficiency with Yang sinking, causing Yang to exceed Yin, or when Yin is originally not deficient but Pathogenic Yang becomes naturally excessive. This leans towards the side of Yang Excess, hence its pulse is Surging, large, full, and forceful. The Shi San pulse arises either from internal Dampness stagnating for a long time transforming into Dryness, or from Wind Pathogen disturbing the interior Yin. This leans towards the side of Yin Deficiency, hence its pulse is scattered, flat, soft, and lacking force. *Shenrou Wushu* further states that in chronic deficiency syndromes, the pulse at the middle and deep levels will invariably show a Xu Hong (Deficient Surging) quality. This again indicates Qi and Blood deficiency, dual deficiency of Yin and Yang, and dysfunction of the Central Pivot. Due to Blood deficiency, the pulse does not gather or become firm; due to Qi deficiency, the fluctuations are small and weak, representing an early stage of the San (Scattered) pulse. The Xu Hong pulse appears at the middle and deep levels, with weak ascending and descending movements; Yang Qi is weak but has not yet lost its root. The Xu San (Deficient Scattered) pulse appears only at the floating level; Yin fails to anchor Yang, causing Yang Qi to scatter without a root. Therefore, treating the Hong pulse focuses on draining Fire while simultaneously nourishing Yin; treating the Shi San pulse focuses on nourishing Yin while simultaneously regulating Qi; treating the Xu Hong pulse involves tonifying Blood and benefiting Qi, using light and clear formulations; treating the San pulse involves benefiting Qi and tonifying Blood, using warm, moistening, heavy, and turbid formulations to consolidate, nourish, and fill. The differentiation among these four pulses lies merely in the subtle distinctions between Yin and Yang, Excess and Deficiency, slight versus severe deviations, and minor versus major degrees.