按脉者血之府。精气之源神之。用水谷为宗。盖脉不自行随五脏元真变化于经隧之间。
显见
于气口。阴阳之蕴也。自轩岐以下。难经仲景。始约言其要。迨晋王叔和以脉鸣时。撰有脉
经。可谓周备详切。惜乎以大小肠诊之两寸。部位错乱。瑕瑜莫掩而后之妄男子高阳生。复
创七表八里九道之名。集为脉诀。妄立图形。夫脉从心解。其可以形得耶。庸俚纰缪。大乖
经旨。俗医习诵。以为权舆。迨臻颁白。脉理竟昧。讹承惑HT 。至今罔觉。于是脉诀行而脉
经隐。至内经胗候。越人难经。仲景脉法。则益沦没不彰矣。宋庞安常始得经旨。而有人迎
气口之分。西山戴同父复着刊误。亦辟其非。崔紫虚之四言脉法。滑伯仁之诊家枢要。李言
闻之四诊发明。立论玄奥。李濒湖之脉学奇经。解释精详。皆有功于后学。允为当世之指南
者也。医而知此。何病不瘳。故脉不明则无以别症。症不别则无以施治。脉其可以不辨乎。
夫曰浮。曰沉。曰迟。曰数。曰滑。曰涩。曰虚。曰实。曰长。曰短。曰洪。曰细。曰弦。
曰紧。曰芤。曰濡。曰微。曰弱。曰伏。曰动。曰促。
曰结。曰牢。曰革。曰缓。曰散。曰代。此二十七脉者乃脉之大纲也。逐节解悟。固无难悉
。而滑伯仁谓提纲之要。不出浮沉迟数滑涩似乎太简。而实未足以尽脉。尤须察其阴阳乘伏
。五行生克者。上下去来至止者。有部位不容颠倒者。有至数不容混淆者。有彼此相类者。
有疑似难别者。有真假相混者。有有胃气无胃气胃气少之殊者。有从四时。反四时者。有与
证相反相合者。有一病而兼见数脉者。有一脉而兼病数症者。有杂投舛剂。致藏气不定。脉
随变幻者。有确守良药。症无进退。脉不转移者。有人病而脉不病。脉病而人不病者。有脉
不转移。而良剂稍辍。便见虚陷者。有老少衰旺之不同者。有新病久病之宜忌者。有寿夭吉
凶之预定者。有纯阴纯阳之偏禀者。有形体之相反相应者。有合闻问望而兼诊者。有僧尼
寡妇
室女童男之异常人者。有贫富贵贱正人奸人六气七情之各殊者又有真藏脉。有奇经脉。有太
素脉。有天和脉。有人迎脉。有关格脉。有妊娠脉。有五逆脉。有六绝脉。有七独脉。皆应
详辨精确。服膺弗失。一遇诊按。生死吉凶。子了指下矣。庶神而明乎。愚按先哲有云∶余
念古良医治疾。未有不先诊脉。自轩岐已然。辨人鬼。别男女。特其粗尔。微茫呼吸之间。
而生死系焉。如济北才人。颜色不变。而在死法中。其脉病也。吁、是固神于脉矣。然脉特
四诊之一也。独恨近代传授匪真。偏遵脉诀。致令治疾乖讹。而倡明斯道。实乏其人。即有
明良辈出。不免调高寡和。行高谤多。故刖璞怀光。鲜有识之者。嗟此生人。虽幸生偏安之
宇。不死于盗贼水火。乃阴阳为患。甘枉没于时师之手。是时师本代天以降殃。固劫运所应
尔。亦生人之。自取是真可为。痛哭流涕者矣。切以为医不明脉固无以别病而不明真假疑似
之脉又无以别脉不明真假疑似脉之
脉又无以别元气之虚实。而洞明生死吉凶之大要也脉其仅治疾云乎哉。夫浮沉迟数二十七种
。
此为大纲。固无难识即其中有兼见者不过诵记之繁。有相类者而只比拟之殊。亦易易晓也。
然独此真假疑似之脉。如坡公所云∶大实有羸状。至虚有盛候。脉之难辨。为医之难。职此
故耳。若夫二十七脉。与前论所云∶或阴阳乘伏。或息数部位。或胃气有无。或时症相应相
反。一切诊法。悉宜遵根据内经难经。仲景叔和脉经。伯仁机要。濒湖脉学。是皆宗传正印。
炳如日星。无庸赘矣。至于真假疑似关头。此处差池。生死反掌虽先圣前哲。屡亦有言。但
未悉阐其义。致使后学不察。往往混治杀人。余故不揣庸鄙。逐种详辨。虽未诸精奥室。但
虚实犁然。一诊而明生死。未病而图预防。存神指下。识气兆先。庶几轩岐微蕴之彰而非时
师拘挛之见矣。上士欲会其全非备四诊不可。今特举其脉之疑。似者列后。此而不力。为救
正则。终无复明之日矣。
脉，是血液汇聚的府库。精气之源在于神，以水谷精微为根本。脉管本身不能自行运行，而是随着五脏元真之气在经络隧道之间变化。其盛衰显见于气口（寸口脉）。这是阴阳蕴蓄的表现。自轩辕、岐伯以下，到《难经》和张仲景，才开始简练地概括其要点。等到晋代王叔和凭借诊脉闻名于世，撰写了《脉经》，可以说详尽周密。可惜他将大小肠的诊察部位错误地放在两寸，导致部位错乱，虽有优点也无法掩盖瑕疵。此后狂妄的男子高阳生，又创立“七表、八里、九道”的名称，汇编成《脉诀》，妄立图形。脉象应从心的功能去理解，岂能通过外形来求得？这些庸俗粗浅的错误，大大违背了经典旨意。世俗医生习惯诵读此书，将其作为入门基础，直到头发花白，对脉理竟然依然懵懂。讹误传承，迷惑后人，至今无人察觉。于是《脉诀》盛行而《脉经》隐没，至于《内经》的诊候方法、扁鹊《难经》、张仲景的脉法，则更加沉沦埋没而不彰明了。宋代庞安常开始领悟经典旨意，区分了人迎脉和气口脉；西山戴同父又著书刊误，也驳斥了这种错误。崔紫虚的《四言脉法》、滑伯仁的《诊家枢要》、李言闻的《四诊发明》，立论深奥；李时珍的《脉学》与《奇经八脉考》，解释精详，都对后学大有益处，堪称当世的指南。医生如果通晓这些，什么病治不好呢？所以脉理不明就无法辨别病症，病症不辨就无法施治，脉诊怎么可以不辨析呢？
所谓浮脉、沉脉、迟脉、数脉、滑脉、涩脉、虚脉、实脉、长脉、短脉、洪脉、细脉、弦脉、紧脉、芤脉、濡脉、微脉、弱脉、伏脉、动脉、促脉、结脉、牢脉、革脉、缓脉、散脉、代脉，这二十七种脉象是脉诊的大纲。逐节理解领悟，本来没有困难全部掌握。但滑伯仁认为提纲的要领，不出浮、沉、迟、数、滑、涩六者，似乎太简单，实际上不足以穷尽脉象。尤其必须考察其阴阳乘侮潜伏、五行生克关系、上下往来至止的变化。有的部位不容颠倒，有的至数不容混淆，有的彼此相似，有的疑似难辨，有的真假混杂，有的有胃气、无胃气或胃气少的区别，有的顺应四时而有的违背四时，有的与症状相反或相合，有一种病兼见多种脉象的，有一种脉象兼见多种症状的，有杂投错误药方，导致脏气不定，脉象随之变幻的，有坚守使用良药，症状无进退，脉象不转移的，有人有病而脉无病，脉有病而人无病的，有脉象不转移，而稍停服良剂，便出现虚陷情况的，有老少盛衰不同的，有新病久病宜忌不同的，有寿夭吉凶预先决定的，有纯阴纯阳偏禀赋不同的，有形体相反相应的，有结合闻、问、望而兼诊的，有僧尼、寡妇、室女、童男等异常人群的，有贫富贵贱、正人奸人以及六气七情各不相同的。还有真脏脉、奇经脉、太素脉、天和脉、人迎脉、关格脉、妊娠脉、五逆脉、六绝脉、七独脉，都应详细辨析精确，铭记在心不失。一旦遇到诊察按压，生死吉凶，立刻就能在手下知晓。这样才能神妙地明察事理。
我按：先哲曾说：我回想古代良医治病，没有不先诊脉的，自从轩辕、岐伯时代就是这样。辨别人鬼、男女，只是粗略的方面。在呼吸微茫之间，生死就系于此。比如济北才人，面色不变，但在死法之中，他的脉象显示有病。唉，这确实是精通脉诊啊。然而脉诊只是四诊之一。遗憾的是近代传授不真，偏信《脉诀》，导致治疗疾病出现差错，而倡导阐明这一正道的人实在缺乏。即使有明达之士辈出，也不免曲高和寡，行高谤多。所以像卞和那样怀璧待识的人很少。唉，当今世人，虽然侥幸生在偏安之世，不死于盗贼水火，却因阴阳失调为患，甘愿枉死于庸医之手。这些庸医本是上天降下的灾殃，固然是劫运所应，也是世人自取。这真是令人痛哭流涕的事情啊。我认为医生如果不明白脉理，固然无法辨别疾病；如果不明白真假疑似的脉象，又无法辨别脉象；如果不辨别脉象，就无法辨别元气的虚实，也就无法洞明生死吉凶的大要。脉诊难道仅仅是用来治病吗？
那浮、沉、迟、数等二十七种脉象，这是大纲，本来不难识别。其中虽然有兼见的情况，不过是诵读记忆繁杂；有相似的情况，也只是比拟的差异，也容易明白。然而唯独这真假疑似的脉象，正如苏东坡所说：“大实有羸状，至虚有盛候。”脉象难以辨别，是医生难做的关键原因。至于二十七种脉象，与前文所说的：或阴阳乘侮，或息数部位，或胃气有无，或与时症相应相反，一切诊法，都应当遵循《内经》、《难经》、张仲景和王叔和的《脉经》、滑伯仁的《机要》、李时珍的《脉学》。这些都是正宗传承，如日月星辰般光明，无需赘述。至于真假疑似的关键关头，此处若有差池，生死就在反掌之间。虽然先圣前哲屡次也有提及，但未完全阐发其义，致使后学不察，往往混治杀人。所以我斗胆不自量力，逐种详细辨析。虽然未入精奥之室，但虚实分明，一诊即可明晓生死，未病之时图谋预防，存神于指下，识气兆于先机，或许能彰显轩辕、岐伯的微深蕴意，而非拘泥于庸医的偏见。上等资质的医者想要融会贯通，非备齐四诊不可。现在特别列举脉诊中疑惑相似的条目列在后面。对此若不致力研究，想要救正谬误，终究没有重见天日的时候了。
Pulse is the residence of blood. Its source lies in Jing-Qi (Essence and Qi), governed by Shen (Spirit), with water and grain essence as its foundation. The vessels do not move on their own but change within the meridians and collaterals following the Yuan-Zhen Qi (Primal True Qi) of the five Zang organs. This becomes manifest at the Qi-Kou (Cunkou pulse, located at the radial artery). It represents the accumulation of Yin and Yang. Since Xuanyuan and Qibo, down to the *Nan Jing* (Classic of Difficult Issues) and Zhang Zhongjing, the essentials were first concisely summarized. Later, during the Jin Dynasty, Wang Shuhe gained fame for his pulse diagnosis and compiled the *Mai Jing* (Pulse Classic), which can be described as comprehensive and detailed. Unfortunately, he erroneously placed the diagnosis of the Large Intestine and Small Intestine at the two Cun positions, causing confusion in locations; thus, despite its merits, its flaws could not be concealed. Subsequently, the arrogant Gao Yangsheng created the names "Seven Tables, Eight Interiors, Nine Channels," compiling them into the *Mai Jue* (Pulse Rhymes), and absurdly established diagrams. Pulse should be understood through the Heart's function; how can it be grasped merely by form? These vulgar and erroneous statements greatly deviate from the classic principles. Quack doctors habitually recite this book, taking it as a starting point, yet even when their hair turns white, they remain ignorant of pulse theory. Errors are passed down, confusing future generations, who remain unaware to this day. Thus, the *Mai Jue* became popular while the *Mai Jing* was hidden; furthermore, the diagnostic methods of the *Nei Jing* (Inner Canon), Bian Que's *Nan Jing*, and Zhang Zhongjing's pulse methods fell into obscurity and disrepute.
In the Song Dynasty, Pang Anchang began to grasp the classic principles, distinguishing between the Ying-Kou (Carotid pulse) and Qi-Kou pulses. Dai Tongfu of Xishan further wrote corrections, refuting these errors. Cui Zixu's *Four-Character Pulse Method*, Hua Borin's *Diagnosis Essentials*, and Li Yanwen's *Elucidation of Four Diagnostic Methods* presented profound theories. Li Shizhen's *Pulse Studies* and *Treatise on the Eight Extraordinary Vessels* provided detailed explanations. All these contributed significantly to later learners and served as guides for the times. If a physician masters these, what disease would remain incurable? Therefore, if pulse understanding is unclear, symptoms cannot be distinguished; if symptoms are not distinguished, treatment cannot be applied. How can pulse diagnosis fail to be analyzed?
The floating (Fu), sinking (Chen), slow (Chi), rapid (Shu), slippery (Hua), choppy (Se), deficient (Xu), excess (Shi), long (Chang), short (Duan), surging (Hong), fine (Xi), wiry (Xian), tight (Jin), knotted (Kou), soggy (Ru), minute (Wei), weak (Ruo), deep-hidden (Fu), moving (Dong), hurried (Cu), knotted/stopped (Jie), firm (Lao), leathery (Ge), relaxed (Huan), scattered (San), and intermittent (Dai) pulses—these twenty-seven types constitute the general outline of pulse diagnosis. Understanding them section by section is inherently easy. However, Hua Borin stated that the essential提纲 (outline) does not go beyond floating, sinking, slow, rapid, slippery, and choppy. While seemingly too simple, this is insufficient to exhaustively describe all pulses. One must particularly examine Yin-Yang overacting or hiding, Five Elements generating and overcoming, upward/downward and coming/going movements, and arrival/cessation patterns. Some have fixed locations that cannot be reversed; some have specific frequencies that cannot be confused; some resemble each other; some are similar yet hard to distinguish; some mix true and false; some differ in having Stomach Qi, lacking Stomach Qi, or having little Stomach Qi; some conform to the four seasons while others contradict them; some correspond or oppose the symptoms; one disease may present multiple pulse types; one pulse type may accompany multiple symptoms. There are cases where incorrect medications cause unstable organ Qi and changing pulses; there are cases where correct medication yields no symptom progression but stable pulses; there are cases where the patient is ill but the pulse is normal, or the pulse is abnormal but the patient seems well; there are cases where stopping good medicine briefly leads to deficiency collapse; there are differences between young/old and strong/weak; contraindications for new vs. chronic diseases; predetermined longevity or premature death; pure Yin or pure Yang constitutions; corresponding or opposite physical forms; combined use of listening, asking, and observing; and abnormalities in monks, nuns, widows, virgins, and boys. Furthermore, distinctions exist among the poor, rich, noble, base, upright, and deceitful, as well as variations due to Six Qi and Seven Emotions. Additionally, there are True Zang Pulses, Extraordinary Pulses, Tai Su Pulses, Tian He Pulses, Ying Kou Pulses, Guan Ge Pulses, Pregnancy Pulses, Five Rebellious Pulses, Six Extinct Pulses, and Seven Solitary Pulses. All must be carefully distinguished and precisely identified, kept in mind without loss. Upon palpation, life and death, fortune and misfortune, become immediately apparent under the fingers. Only then can one divine and understand profoundly.
I note: Ancient sages said, "I recall that ancient excellent physicians never treated illness without first diagnosing the pulse, a practice dating back to Xuanyuan and Qibo." Distinguishing humans from ghosts, men from women, was merely superficial. Within the subtle space of breath, life and death are determined. For instance, the talented man from Jibei had an unchanging complexion, yet his pulse indicated impending death according to fatal signs. Alas, this demonstrates mastery of pulse diagnosis. However, pulse diagnosis is only one of the Four Diagnostic Methods. I regret that modern transmission is often inaccurate, relying solely on the *Mai Jue*, leading to medical errors. Few advocate clarifying this path. Even when enlightened scholars emerge, they face isolation due to high standards and many critics. Thus, like Bian He holding his jade, few recognize their value. Sigh! People today, though fortunate to live in peaceful times, spared from bandits and disasters, suffer from Yin-Yang imbalances and willingly die at the hands of quacks. These quacks act as agents of heavenly disaster, fulfilling karmic retribution, yet also bringing suffering upon themselves. This is truly a cause for tears.
I believe that if a physician does not understand pulse, they cannot distinguish diseases; if they do not understand true/false and similar/dubious pulses, they cannot differentiate pulse types; if they cannot differentiate pulse types, they cannot assess the deficiency or excess of Yuan Qi, nor comprehend the major principles of life and death. Is pulse diagnosis merely for treating illness? The twenty-seven pulses (floating, sinking, slow, rapid, etc.) form the outline and are generally easy to recognize. Variations in combination require more memorization; similarities require comparative analysis, both of which are understandable. However, the true/false and dubious pulses are difficult. As Su Dongpo said, "Great excess presents with deficiency-like symptoms; extreme deficiency presents with excess-like symptoms." The difficulty in distinguishing pulses makes being a physician challenging. Regarding the twenty-seven pulses and previous discussions on Yin-Yang interactions, respiration rates, locations, presence/absence of Stomach Qi, and correspondence with seasonal symptoms—all diagnostic methods should follow the *Nei Jing*, *Nan Jing*, Zhang Zhongjing, Wang Shuhe's *Mai Jing*, Hua Borin's *Ji Yao*, and Li Shizhen's *Mai Xue*. These are orthodox traditions, bright as sun and stars, requiring no further elaboration. At critical junctures of true vs. false pulses, a slight error can reverse life and death. Although ancient sages mentioned this, they did not fully elucidate it, causing later learners to confuse treatments and kill patients. Therefore, I humbly attempt to analyze each type in detail. Though I have not reached the deepest mysteries, I clarify deficiency and excess, allowing life and death to be known in one palpation, and prevention before illness occurs. By preserving spirit under the fingers and recognizing qi omens beforehand, perhaps the profound teachings of Xuanyuan and Qibo will be revealed, rather than the rigid views of contemporary quacks. Superior practitioners seeking completeness must master all Four Diagnostic Methods. Here, I specifically list doubtful and similar pulse conditions. Without effort here, correcting errors will never be achieved.