涩脉状如轻刀刮竹。如雨沾沙。如病蚕食叶。主参伍不调。伤精亡血之病。为血痹。为
寒
湿入营。为心痛。为胁痛为解 。为反胃为亡阳。为肠结。为不月。为胎病。为溲淋。亦为
气
滞。经曰脉弱以涩。是谓久病。然亦有不同者。或人赋禀经脉不利。或七情伤怀莫解
。或过服补剂。以致血气壅盛。或饮食过度。不即运化。或痰多而见独涩。或久卧久坐。体
拘不运此。又非专主于伤精亡血之病也。至于虚劳细数而涩。或兼结代。死期可卜。凡诊此
脉。须察病机。庶无谬治。
迟与数为阴阳对待之体。数六至。迟三至。息数甚悬。而缓与迟又依稀相似。但迟只三
至。
缓得四至。虽略相似。主病则异。至离经之脉。则仅二至。内经谓之少气。然迟主藏病。多
属寒。浮迟表寒。沉迟里寒。有力冷痛。无力虚寒。或主不月。或见阴疝。或血脉凝泣。或
瘕沉痼。皆主阳虚阴盛之病也。而独有如迟之脉。凡人伤寒初解。遗热未清。经脉未充。
胃气未复。必脉见迟滑。或见迟缓。亦可投以温中而益助余邪乎。此虚实之不容不辨也。
紧脉形如转索无常。又如切绳。乃热为寒束之脉。故似急数而不甚鼓。暴症见之为腹痛
身疼。
寒客太阳。或主风痉痫症。在尺阴冷脉疝。在关心腹沉痛。在左紧盛伤寒。在右紧盛伤食。
若中恶浮紧。咳
嗽沉紧。皆主死。此证与脉反也。又有如紧之脉。乃伤寒阴症绝阳七日九日之间。得此脉。
仲景云∶脉见转索者即日死。盖紧本属病脉而非死。脉但以新久之。异便有生死之分不可不
察。
涩脉的形态就像用轻刀刮竹子，又像雨滴沾在沙子上，还像生病的蚕在吃叶子。它主要提示气血参差错乱、不相协调，以及耗伤精血导致的疾病。涩脉可见于血痹、寒湿侵入营分、心痛、胁痛、身体懈惰无力、反胃、亡阳、大便干结、月经闭止、妊娠病证、小便淋沥等症状，也可见于气机阻滞的情况。经书说：“脉象虚弱而涩，这是久病的表现。”然而，涩脉也有不同的成因：有的人先天禀赋导致经脉运行不畅；有的因七情内伤，情怀郁结无法排解；有的过度服用补药，导致气血壅滞旺盛；有的饮食过量，不能及时运化；有的痰多而出现单独的涩脉；有的长期卧床或久坐，身体拘急不活动。这些情况又并非专门主司耗伤精血的疾病。至于虚劳病出现细数而涩的脉象，或者兼见结代脉，死亡的时间可以推测出来。凡是诊察到这种脉象，必须审察疾病的机理，才能避免误治。
迟脉与数脉是阴阳相对立的两种脉象。数脉一息六至，迟脉一息三至，呼吸次数相差很大。缓脉与迟脉又依稀相似，但迟脉只有一息三至，缓脉有一息四至。虽然略微相似，但所主的疾病却不同。至于离经之脉，则仅有一息二至，《内经》称之为少气。迟脉主要主藏腑病变，多属于寒证。浮取见迟脉为表寒，沉取见迟脉为里寒。有力者为冷痛，无力者为虚寒。或者主月经闭止，或者见阴疝，或者血脉凝滞不通，或者有积块沉痼难愈，这些都主阳气虚弱、阴气盛实的疾病。但是也有类似迟脉的情况：凡是人患伤寒初愈，余热未清，经脉尚未充盈，胃气尚未恢复，必然出现迟滑脉，或者迟缓脉。这时是否可以投用温中药物而助长余邪呢？这是虚实不容不加以辨别的。
紧脉的形态像转动的绳索变化无常，又像切按绳子。它是热被寒邪束缚的脉象，所以看起来急促但并不十分鼓指。暴发性病症见到紧脉，表现为腹痛身疼。寒邪客于太阳经，或者主风痉痫症。在尺部见到紧脉，主阴冷脉疝。在关部见到紧脉，主腹中沉痛。左手脉紧盛，主伤寒；右手脉紧盛，主伤食。如果中恶邪气，浮紧脉主死；咳嗽伴沉紧脉，也主死。这是证候与脉象相反的情况。又有类似紧脉的情况，是在伤寒阴证绝阳的第七日或第九日之间，出现这种脉象。张仲景说：“脉象像转索一样，当天就会死亡。”大概紧脉本属于病脉而不是死脉，只是根据新病久病的不同，便有生死之分，不可不仔细考察。
The sensation of the Choppy pulse (Se Mai, 涩脉) is like scraping bamboo with a light knife, like raindrops adhering to sand, or like a diseased silkworm eating leaves. It primarily indicates disorders where Qi and Blood are irregular and uncoordinated (Can Wu Bu Tiao), as well as diseases resulting from the depletion of Essence and Blood (Shang Jing Wang Xue). It is seen in Blood Bi (Xue Bi, blood stasis obstruction), Cold-Dampness invading the Ying level (Ying Fen), Heartache (Xin Tong), Hypochondriac pain (Xie Tong), physical lassitude and weakness (Jie Dai), Regurgitation (Fan Wei), Collapse of Yang (Wang Yang), intestinal constipation (Chang Jie), amenorrhea (Bu Yue), pregnancy-related disorders (Tai Bing), dysuria (Suo Lin), and also in Qi stagnation (Qi Zhi). The Classics state: "A pulse that is weak and choppy indicates a chronic disease." However, there are differences. In some cases, it arises from innate constitutional deficiency causing poor meridian circulation; from emotional injuries where feelings are unresolved; from excessive intake of tonics leading to Qi and Blood congestion and excess; from overeating causing failure of immediate transformation and transportation; from excessive phlegm presenting as an isolated choppy pulse; or from prolonged lying down or sitting, causing physical stiffness and lack of movement. These situations do not exclusively indicate diseases of Essence and Blood depletion. As for consumptive diseases presenting with a Fine, Rapid, and Choppy pulse, or one combined with Intermittent (Jie) and Knotted (Dai) pulses, the time of death can be predicted. When diagnosing this pulse, one must examine the pathogenesis to avoid erroneous treatment.
The Slow pulse (Chi Mai, 迟脉) and the Rapid pulse (Shu Mai, 数脉) are opposites in Yin and Yang. The Rapid pulse beats six times per respiration cycle, while the Slow pulse beats three times, showing a significant disparity in respiratory rate. The Moderate pulse (Huan Mai, 缓脉) resembles the Slow pulse but differs slightly: the Slow pulse has three beats per cycle, whereas the Moderate pulse has four. Although similar, they indicate different diseases. The Pulse Deviating from the Normal Course (Li Jing Zhi Mai) has only two beats per cycle and is referred to as Shortness of Qi (Shao Qi) in the *Nei Jing*. The Slow pulse primarily indicates Zang organ diseases, mostly belonging to Cold patterns. Floating Slow indicates Exterior Cold; Deep Slow indicates Interior Cold. Forceful Slow indicates cold pain; Deficient Slow indicates deficiency-cold. It may also indicate amenorrhea, Yin Hernia (Yin Han), coagulation and stagnation of blood vessels, or deep-seated masses (Jia Jia). All these indicate diseases of Yang deficiency and Yin excess. However, there are pulses resembling the Slow pulse. When a person has just recovered from Cold Damage (Shang Han), with residual heat unclarified, meridians not yet filled, and Stomach Qi not yet restored, the pulse may appear Slow and Slippery (Chi Hua) or Slow and Moderate (Chi Huan). Can warm-middle herbs be administered then, potentially aiding the residual pathogenic factors? This distinction between Deficiency and Excess cannot be ignored.
The Tight pulse (Jin Mai, 紧脉) feels like a twisting rope changing constantly, or like cutting a rope. It is the pulse of Heat constrained by Cold. Thus, it appears urgent but does not beat forcefully. In acute conditions, its appearance indicates abdominal pain and body ache. If Cold invades the Taiyang channel, it may indicate Wind-Spasm or Epilepsy. At the Chi position, it indicates cold genital hernia. At the Guan position, it indicates deep abdominal pain. A Tight pulse at the Left Cun/Guan positions indicates Cold Damage; at the Right positions, it indicates Food Injury. If Evil Qi strikes suddenly, a Floating-Tight pulse indicates death; if accompanied by cough, a Deep-Tight pulse also indicates death. This represents a contradiction between syndrome and pulse. There is also a pulse resembling Tightness occurring between the seventh and ninth days of Cold Damage Yin syndromes where Yang is severed. Zhang Zhongjing stated: "If the pulse feels like a twisting rope, death occurs on that day." Generally, the Tight pulse belongs to pathological pulses rather than terminal ones; the distinction between new and old diseases determines life and death, which requires careful examination.