革脉如按鼓皮。主病为亡血遗精半产崩漏胀满中风感湿诸症。牢脉似沉似伏。大而长。
微弦
。扁鹊曰∶牢而长者肝也。仲景曰∶寒则坚牢。有牢固之象。徐东皋云沉而有力。动而不移
。牢之体也。主病为心腹疼痛疝颓 瘕。为气短息促。为皮肤着肿。是革牢二脉。固判若天
渊也。仲景曰∶弦则为寒。芤则为虚。虚寒相搏。此名曰革。男子主亡血失精。女人主半产
漏
下。脉经曰∶三部脉革。长病得之死。卒病得之生。濒湖曰∶此即芤弦二脉相合。故均主失
血之候。诸家脉书皆以为牢脉故或有革无牢。有牢无革。混淆不辨。不知革浮牢沉。革虚牢
实。形症皆异也。又牢为元气将绝者凶。牢忌见阴虚失血之病为虚病见实脉也。不可不辨
。
牢脉沉而有力动而不移。明主阴寒凝固之象也。若实脉则浮沉皆得。大而且长。指下鼓
击。
息数往来。动而能移。乃主阳盛实热之病。脉体固依稀相似而主病则已悬甚均一动也。只争
移与不移此徐东皋独得牢脉之。
神识超千古矣。及阅方书谓洁古实脉而投姜附此。必非实脉。乃牢脉也。不容不细别之。
芤形大如慈葱。两傍有中央空。同父曰∶营行脉中。脉以血为形芤脉中。空脱血之象也
。革脉则形按如鼓皮。虽体不同。大抵主病则皆失血亡阴之证。
革脉的触感如同按压在鼓皮上。它所主司的疾病包括亡血、遗精、半产（流产）、崩漏、胀满、中风以及感受湿邪等各种病症。
牢脉的脉象似沉似伏，脉体大而长，略微带弦意。扁鹊说：脉象牢而长的，对应肝脏。张仲景说：寒邪会导致脉象坚牢，呈现出一种牢固稳固的形态。徐东皋说：脉位沉且有力，搏动时位置固定不移，这就是牢脉的本质特征。它主司的疾病包括心腹疼痛、疝气及睾丸肿胀萎缩（疝颓）、癥瘕积聚（体内肿块），还有气短呼吸急促、皮肤浮肿等症状。因此，革脉和牢脉这两种脉象，确实相差如天壤之别。
张仲景说：脉弦则主寒，脉芤则主虚，虚与寒相互搏结，这种脉象称为革脉。男子出现革脉主要主亡血或失精，女子出现则主要主流产或经血淋漓不尽。《脉经》说：三部脉象均呈现革脉，久病者得此脉预后不良（主死），突发急病者得此脉尚有生机（主生）。李时珍（濒湖）说：这即是芤脉与弦脉两种脉象的结合，所以都主司失血的征候。各家脉学书籍都认为牢脉与革脉容易混淆，有的只提牢脉不提革脉，有的只提革脉不提牢脉，导致概念混淆无法分辨。殊不知革脉浮取可得而牢脉沉取方见，革脉主虚而牢脉主实，它们的形态和所主的症状都是不同的。另外，牢脉若出现在元气即将断绝的情况下是凶兆，牢脉忌讳出现在阴虚失血的疾病中，因为这是虚证却出现了实脉，这一点不可不加以辨别。
牢脉沉取有力，搏动位置固定不移，明确主司阴寒凝固的病理现象。如果是实脉，则浮取和沉取都能触及，脉体大而且长，指下感觉脉搏跳动有力如击鼓，呼吸节律中脉搏往来有序，搏动位置可以移动，这才是主司阳热亢盛、实证热病的脉象。这两种脉的形体虽然依稀相似，但所主的疾病却相差甚远，关键在于一个“动”字，只是区别在于位置是否移动。只有徐东皋独自领悟了牢脉的真谛，其见识超越千古。等到阅读方书时，看到有人将洁古（张元素）治疗实脉的方法投以干姜、附子等温热药，这必定不是实脉，而是牢脉，不容不仔细辨别。
芤脉的形态大而中空，像慈葱一样，两边有脉管壁而中间空虚。同父（可能是作者自述或引用前人观点，此处依原文直译）说：营气运行于脉管之中，脉以血液为形体基础，芤脉中间空虚，是血液脱失的征象。革脉的触感则是按之如鼓皮，虽然脉体形态不同，但大体上所主的疾病都是失血和亡阴的证候。
The Ge pulse (Reed Pulse) feels like pressing on a drum skin. It indicates diseases such as blood loss, seminal emission, miscarriage, metrorrhagia and metrostaxis, abdominal distension and fullness, wind-stroke, and conditions caused by dampness invasion.
The Lao pulse (Firm Pulse) resembles the Chen (Deep) or Fu (Hidden) pulses; it is large and long, with a slight Xian (Wiry) quality. Bian Que stated: A Lao and long pulse corresponds to the Liver. Zhang Zhongjing stated: Cold causes firmness and solidity, presenting an image of stability. Xu Donggao stated: Deep in position and forceful upon pressure, with movement that does not shift, this is the essence of the Lao pulse. It indicates diseases such as heart and abdominal pain, hernia with testicular swelling and atrophy (Shan Tui), mass formations (Zha Jia), shortness of breath and rapid respiration, and edema of the skin. Therefore, the Ge and Lao pulses are indeed as different as heaven and earth.
Zhang Zhongjing stated: Xian (Wiry) indicates Cold; Kou (Hollow) indicates Deficiency. The combination of Deficiency and Cold is named Ge (Reed). In men, it primarily indicates blood loss or loss of essence; in women, it primarily indicates miscarriage or continuous bleeding. The *Mai Jing* (Pulse Classic) states: If the pulses in all three positions are Ge, a chronic patient will die, while an acute patient will survive. Binhu (Li Shizhen) stated: This is the combination of the Kou (Hollow) and Xian (Wiry) pulses; thus, both indicate signs of blood loss. Various pulse manuals confuse Lao and Ge, sometimes mentioning only Lao without Ge, or vice versa, leading to indistinguishable concepts. One must not fail to realize that Ge is superficial (Fu) while Lao is deep (Chen); Ge indicates Deficiency while Lao indicates Excess; their forms and indicated symptoms are entirely different. Furthermore, if a Lao pulse appears when Yuan Qi (Original Qi) is about to perish, it is an ominous sign. The Lao pulse is contraindicated in Yin-deficient blood-loss diseases, as this represents an Excess pulse appearing in a Deficiency disease. This distinction must not be overlooked.
The Lao pulse is deep, forceful, and fixed in position, clearly indicating the pathological image of Yin-Cold coagulation. In contrast, the Shi (Solid/Excess) pulse can be felt in both superficial and deep positions; it is large and long, beating forcefully under the fingers like a drum, moving rhythmically with respiration, and its position can shift. This indicates diseases of Yang-excess and Excess-Heat. Although the physical forms of these two pulses are vaguely similar, the diseases they indicate differ vastly; the key lies in the "movement," specifically whether the position shifts or remains fixed. Only Xu Donggao uniquely grasped the essence of the Lao pulse, his insight surpassing antiquity. Upon reviewing medical formularies, I encountered cases where Jiegu's (Zhang Yuansu's) method for treating a Shi pulse involved administering Ginger and Aconite. This must not have been a true Shi pulse, but rather a Lao pulse. Such distinctions require careful analysis.
The Kou pulse is large and hollow, resembling a green onion, with walls on either side but empty in the center. Tongfu stated: Ying Qi (Nutritive Qi) circulates within the vessels; the vessel takes blood as its form. The emptiness in the middle of the Kou pulse is the image of blood depletion. The Ge pulse feels like a drum skin upon pressure. Although their physical forms differ, generally speaking, both primarily indicate syndromes of blood loss and Yin exhaustion.