太阳脉浮。浮为在表。浮紧浮迟。皆主表寒。浮数浮洪。皆主表热。浮而细涩。浮而软散。凡证皆虚。浮
而紧数。浮而洪滑。凡证皆实。
【秀按】此以浮脉辨寒热虚实也。浮脉轻手一诊。形象彰彰。最多兼脉。如浮紧而涩。为寒邪在表。浮弦而
缓。为风邪在表。浮紧而数。为邪欲传里。浮而长。为传并阳明。浮而弦。为传并少阳。要以脉中有力为有
神。可用汗解。若浮而迟弱。浮而虚细。浮而微涩。皆属浮而无力为阳虚。盒饭温补。不可发汗。浮而尺中弱
涩迟细。皆内虚夹阴。急宜温补。尤忌妄汗。恐酿误汗亡阳之危候。
浮紧风寒。浮数风热。浮濡风湿。浮涩风燥。浮虚伤暑。浮洪火盛。
【秀按】同一浮脉而兼脉不同。则其病各异。盖风证多浮。寒证多紧。热证多数。湿证多濡。燥证多涩。暑
证多虚。火证多洪。此外感脉候之常象也。惟感证脉无单至。最多兼脉。临证者尤宜细辨。
【廉勘】六经感证。浮为风。紧为寒。虚为暑。濡为湿。涩为燥。洪为火。前哲皆以此为根据。然余历所经
验。亦难尽拘。假如风无定体者也。兼寒燥者紧救而浮。兼暑湿者濡缓而浮。暑湿挟秽之气。多从口鼻吸受。
病发于内。脉多似数似缓。或不浮不沉而数。甚或濡缓模糊。至数不清。即燥证亦无定体。上燥主气。脉右浮
涩沉数。下燥主血。脉左细弦而涩。火则无中立者也。六气多从火化。火化在经在气分。脉必洪盛。化火入胃
腑。与渣滓相搏。脉必沉实而小。或沉数而小。甚则沉微而伏。实而小。微而伏。皆遏象也。迨里邪既下。脉
转浮缓而不沉遏。日内必得汗解。若汗后脉仍沉数者。邪未尽也。汗后脉转浮躁者。邪胜正也。汗后必身凉脉
静。乃为邪尽。夫静者沉细之谓。然脉虽沉细。而至数分明。与暑湿之涩滞模糊者不同。数日内进食虚回。则
脉转圆浮矣。至若温病疫证。则又不同。温病有风温冷温湿温温热温燥温毒之各异。风温之脉。脉必右大于
左。左亦盛躁。尺肤热甚。冷温之脉。右虽洪盛。左反弦紧。湿温之脉。右濡而弱。左小而急。温热之脉。尺
寸俱浮。浮之而滑。沉之散涩。温燥之脉。右多浮涩沉散。左多浮弦搏指。温毒之脉。脉多浮俱盛。愈按愈
甚。疫症虽多。总由吸受种种霉菌之毒。酿成传染诸病。其为病也。不外阳毒阴毒。阳毒则血必实热。脉多右
手洪搏。左则弦数盛躁。阴毒则气多虚寒。脉多微软无力。甚则沉微似伏。或浮大而散。病初虽由外而受。成
证必由内而发。此六淫感证及一切疫证。脉象之异如此。故俞东扶谓治病之难。难在识证。识证之难。难在识
脉。良有以也。窃为吾国诊断学。以切脉居其末。非谓脉不可凭。谓仅恃乎脉而脉无凭。徒泥乎脉而脉更无
凭。必也观形察色。验舌辨苔。查病源。度病所。审病状。究病变。然后参之以脉。虽脉象无定。而治法在
人。自不为脉所惑矣。
少阳脉弦。弦主半表半里。弦而浮大。偏于半表。弦而紧小。偏于半里。弦迟风寒。弦数风热。弦滑夹痰。弦急
多痛。浮弦寒饮。沉弦热饮。浮弦而长。腠理邪郁。浮弦而数。相火已盛。弦少而实。邪实胃强。弦多而虚。
正虚胃弱。右弦勒指。土败木贼。左弦细搏。水亏木旺。
【秀按】凡病脉弦。皆阳中伏阴之象。盖初病虽在少阳。久则必归厥阴也。且多气结血郁之候。在感证表邪
全盛之时。凡浮脉中按之敛直。紧脉中按之埂指。滑脉中按之勒指。盒饭弦脉例治。和解法中。须参解结开郁
之药。则弦脉渐见柔缓。而应手中和矣。若里邪传腑入脏。属邪盛而见弦滑者。十常二三。腑病居多。属正虚
而见弦细者。十常六七。脏病居多。凡沉脉中按之强直。涩脉中按之细急。皆当弦脉类看。非肝阳上亢。即肝
阴郁结。所以伤寒坏病。弦脉居多。杂证内伤。弦常过半。岂仅少阳一经。多见弦脉哉。
阳明脉大。大主诸实。亦主病进。统主阳盛。大偏于左。邪盛于经。大偏于右。热盛于腑。大坚而长。胃多实
热。大坚而涩。胃必胀满。浮取小涩。重按实大。肠中燥结。浮取盛大。重按则空。阴竭阳越。诸脉皆大。
一部独小。实中夹虚。诸脉皆小。一部独大。虚中夹实。前大后小。阳邪内陷。其证多变。乍大乍小。元神无主。
其病必凶。
【秀按】大脉者。应指形阔。倍于寻常。有阴阳虚实之不同。大而洪搏。主热盛邪实。大而虚软。主阴虚阳
亢。在伤寒脉大为阳盛。在杂证脉大为虚劳。同一大脉。当知阳盛者最易烁阴。胃为津液之腑。必直清阳明。
而津液乃存。阴虚者不能维阳。肾为真阴之主。务交其心肾。而精血自足。尤必知阳伤及阴者。清必兼滋。张
景岳所以创立玉女煎也。阴损及阳者。补必兼温。冯楚瞻所以创立全真益气汤也。一清阳明实证。一补少阴虚
证。皆为大脉之生死开头。临证者毋以大脉作纯实无虚证勘。
太阴脉濡。濡主湿滞气虚。浮濡风湿。沉濡寒湿。濡而兼数。湿郁化热。濡而兼涩。湿竭化燥。濡而兼微。脾
阳垂绝。濡而兼细。脾阴将涸。
【秀按】濡作软读。其脉虚软少力。应指柔细。轻按浮软。重按小弱。为脾经湿滞。胃气未充之象。但气虽
不充。血犹未败。不过含一种软滞之象。轻手乍来。按之却窒滞不来。重手乍去。举之却窒滞不去耳。以脉参
证。湿重而气滞者。当以芳淡化湿为君。佐调气以导滞。湿着而气虚者。当以温补中气为君。佐香燥以化湿。
亦不得一见濡脉。恣用峻补峻温也。惟濡而微。急宜峻温。濡而细。急宜峻补。
少阴脉细。甚则兼微。细主阴虚。微主阳虚。寸细而浮。心阴虚竭。尺细而沉。肾阴涸极。细而兼数。阴虚
火亢。细而兼弦。水亏木旺。细而兼涩。阴枯阳结。细而兼微。阴竭阳脱。沉细欲绝。亡阴在即。沉微欲绝。亡阳顷刻。
【秀按】张长沙以脉微细为少阴主脉。微主阳气衰弱而言。细主阴血虚极而言。微者薄也。微薄如纸。指下
隐然。属阳气虚。细者小也。细小如发。指下显然。属阴血虚。盖卫行脉外。阳气虚。则约乎外者怯。脉故薄
而微。故少阴脉微欲绝。仲景用通脉四逆汤主治。营行脉中。阴血虚。则实其中者少。脉故小而细。故厥阴脉
细欲绝。仲景用当归四逆汤主治。一主回阳。一主救阴。两脉阴阳各异。最宜细辨。若形盛脉细。少气不足以
息。及病热脉细。神昏不能自持。皆脉不应病之危候。
厥阴脉涩。涩主阴虚化燥。初病右涩。湿滞血结。久病左涩。血虚精极。右寸浮涩。上燥主气。左关尺涩。下
燥主血。两
寸弦涩。心痛亡血。两关弦涩。络中瘀结。两尺涩弱。阴阳并竭。举之浮涩。按之数盛。阴虚伏热。举之浮大。
按之反涩。阳盛挟积。
【秀按】涩脉往来涩滞。轻刀刮竹。如雨沾沙。俱极形似。良由血虚液燥。不能濡润经脉。脉道阻滞。所以
涩滞不利也。凡物少雨露滋培。势必干涩。人少血液灌溉。亦必干涩。故以涩脉属阴虚化燥之病。此惟三阳经
邪热。传入厥阴经为然。若初病见涩数模糊。多属痰食胶固。或浮涩数盛。亦有雾伤皮腠。湿流关节之候。兼
有伤寒阳明腑实。不大便而脉涩。温病大热而脉涩。吐下微喘而脉涩。水肿腹大而脉涩。消瘅大渴而脉涩。痰
证喘满而脉涩。妇人怀孕而脉涩。皆脉证相反之候。故前哲有舍脉从证。舍证从脉之名论。
太阳病的脉象表现为浮脉。浮脉主病邪在表。浮而紧或浮而迟的脉象，都主表寒证；浮而数或浮而洪的脉象，都主表热证。若脉浮而细涩，或脉浮而软散，凡见此脉且伴有相应症状者，皆属虚证。若脉浮而紧数，或脉浮而洪滑，凡见此脉且伴有相应症状者，皆属实证。
【徐秀按语】这是通过浮脉来辨别寒、热、虚、实。浮脉只需轻手一诊，形象清晰可见，但常与其他脉象兼见。例如：浮紧而涩，是寒邪在表；浮弦而缓，是风邪在表；浮紧而数，是邪气欲传入里；脉浮而长，是邪气传入并涉及阳明经；脉浮而弦，是邪气传入并涉及少阳经。关键在于脉中是否有“神”，即脉来有力，方可使用发汗法解表。如果脉浮而迟弱，或浮而虚细，或浮而微涩，都属于浮而无力，为阳气虚弱，应当温补，不可发汗。如果尺部脉弱、涩、迟、细，属于内虚夹阴，急需温补，尤其忌讳妄用发汗，恐怕酿成误汗导致亡阳的危险局面。
浮紧主风寒，浮数主风热，浮濡主风湿，浮涩主风燥，浮虚主伤暑，浮洪主火盛。
【徐秀按语】同样是浮脉，但兼见的脉象不同，所主的疾病也就各异。大概风证多见浮脉，寒证多见紧脉，热证多数脉，湿证多濡脉，燥证多涩脉，暑证多虚脉，火证多洪脉。这是外感病脉象的常规表现。然而，外感病的脉象很少单独出现，最多是兼脉，临证时尤其需要仔细辨别。
【廉勘按语】六经感证中，浮主风，紧主寒，虚主暑，濡主湿，涩主燥，洪主火。前代医家都以此为根据。然而，根据我历来的临床经验，也不能完全拘泥于此。例如：风邪没有固定的形态，兼有寒邪和燥邪时，脉象紧而浮；兼有暑邪和湿邪时，脉象濡缓而浮。暑湿挟带秽浊之气，多从口鼻吸入致病，病发于体内，脉象多似数似缓，或者不浮不沉而数，甚至脉象濡缓模糊，至数不清。即使是燥证也没有固定形态，上燥主要影响气分，脉象右寸浮涩、沉取数；下燥主要影响血分，脉象左关尺细弦而涩。火邪则没有中立的状态，六气多从火化。火邪在经或在气分，脉象必洪盛；若化火入胃腑，与糟粕相搏结，脉象必沉实而小，或沉数而小，甚至沉微而伏。实而小、微而伏，都是邪气遏阻之象。等到里邪已下，脉象转为浮缓而不沉遏，日内必然得汗而解。如果汗后脉仍沉数，说明邪气未尽；汗后脉转浮躁，说明邪胜正衰。汗后必须身体凉爽、脉象静定，才算是邪气尽除。所谓“静”，是指脉象沉细。虽然脉象沉细，但至数分明，这与暑湿证的涩滞模糊不同。数日内进食后正气恢复，脉象就会转为圆活浮起。至于温病和疫病，则又不同。温病有风温、冷温、湿温、温热、温燥、温毒等差异。风温的脉象，右脉大于左脉，左脉也盛躁，尺肤热甚；冷温的脉象，右脉虽洪盛，左脉反而弦紧；湿温的脉象，右脉濡而弱，左脉小而急；温热的脉象，寸部俱浮，轻取滑，重取散涩；温燥的脉象，右脉多浮涩沉散，左脉多浮弦搏指；温毒的脉象，脉多浮俱盛，愈按愈甚。疫病种类虽多，总由吸入各种霉菌之毒，酿成传染诸病。其发病不外乎阳毒和阴毒。阳毒则血分实热，脉象多右手洪搏，左手弦数盛躁；阴毒则气分虚寒，脉象多微软无力，甚至沉微似伏，或浮大而散。病初虽然由外感受，但形成证候必定由内而发。这六淫感证及一切疫证的脉象差异如此之大。所以俞东扶说：治病之难，难在识证；识证之难，难在识脉。确实是有道理的。我认为我国的诊断学，以切脉居末位，并非说脉象不可凭信，而是说仅依靠脉象则脉象无凭，死守脉象则脉象更无凭。必须观察形体色泽，查验舌苔，查考病源，推测病位，审察病状，研究病变，然后参合脉象。虽然脉象没有定式，但治法在于人，自然不会被脉象所迷惑。
少阳病的脉象表现为弦脉。弦脉主半表半里证。弦而浮大，偏于半表；弦而紧小，偏于半里。弦迟主风寒，弦数主风热，弦滑主夹痰，弦急主多痛。浮弦主寒饮，沉弦主热饮。浮弦而长，是腠理邪气郁结；浮弦而数，是相火已盛。弦脉少而实，是邪实胃强；弦脉多而虚，是正虚胃弱。右关脉弦勒指，是土败木贼（脾胃虚弱肝木乘脾）；左关尺脉弦细搏指，是水亏木旺（肾阴不足肝阳上亢）。
【徐秀按语】凡是病脉见弦，都是阳中伏阴的征象。大概初病虽在少阳，久则必归厥阴。而且多有气结血郁的症状。在外感病表邪全盛之时，凡浮脉中按之敛直，紧脉中按之埂指，滑脉中按之勒指，都应当按弦脉的法则治疗。在和解法中，须参用解结开郁的药物，这样弦脉会逐渐变得柔缓，触手中和。如果里邪传腑入脏，属于邪盛而见弦滑脉的，十人中常有二三，多为腑病；属于正虚而见弦细脉的，十人中常有六七，多为脏病。凡是沉脉中按之强直，涩脉中按之细急，都应当归类为弦脉来看待。不是肝阳上亢，就是肝阴郁结。所以伤寒坏病中，弦脉居多；杂证内伤中，弦脉常占一半以上。难道仅仅只有少阳一经多见弦脉吗？
阳明病的脉象表现为大脉。大脉主诸实证，也主病势进展，统主阳盛。大脉偏于左手，是邪盛于经；大脉偏于右手，是热盛于腑。大坚而长，胃多实热；大坚而涩，胃必胀满。浮取小涩，重按实大，是肠中燥结；浮取盛大，重按则空，是阴竭阳越。诸脉皆大，唯一部独小，是实中夹虚；诸脉皆小，唯一部独大，是虚中夹实。前大后小，是阳邪内陷，其证多变；乍大乍小，是元神无主，其病必凶。
【徐秀按语】大脉，应指形阔，倍于寻常，有阴阳虚实之不同。大而洪搏，主热盛邪实；大而虚软，主阴虚阳亢。在伤寒病中，脉大为阳盛；在杂病中，脉大为虚劳。同是大脉，当知阳盛者最易灼伤阴液。胃为津液之腑，必须直清阳明，津液才能保存。阴虚者不能维系阳气，肾为真阴之主，务必交通心肾，精血自然充足。尤其必须知道阳伤及阴者，清热必兼滋阴，这就是张景岳创立玉女煎的原因。阴损及阳者，补益必兼温阳，这就是冯楚瞻创立全真益气汤的原因。一是清阳明实证，一是补少阴虚证，这都是大脉诊治中的生死关键。临证者不要将大脉当作纯实无虚的证候来判定。
太阴病的脉象表现为濡脉。濡脉主湿滞气虚。浮濡主风湿，沉濡主寒湿。濡而兼数，是湿郁化热；濡而兼涩，是湿竭化燥；濡而兼微，是脾阳垂绝；濡而兼细，是脾阴将涸。
【徐秀按语】濡读作“软”。其脉虚软少力，应指柔细，轻按浮软，重按小弱，是脾经湿滞、胃气未充的征象。但气虽不充，血犹未败，不过含有一种软滞之象。轻手乍来，按之却窒滞不来；重手乍去，举之却窒滞不去。以脉参证，湿重而气滞者，当以芳淡化湿为君药，佐以调气导滞；湿着而气虚者，当以温补中气为君药，佐以香燥化湿。也不能一见濡脉，就恣意使用峻补峻温之法。只有濡而微者，急宜峻温；濡而细者，急宜峻补。
少阴病的脉象表现为细脉，甚则兼见微脉。细脉主阴虚，微脉主阳虚。寸部细而浮，是心阴虚竭；尺部细而沉，是肾阴涸极。细而兼数，是阴虚火亢；细而兼弦，是水亏木旺；细而兼涩，是阴枯阳结；细而兼微，是阴竭阳脱。沉细欲绝，亡阴在即；沉微欲绝，亡阳顷刻。
【徐秀按语】张仲景以脉微细作为少阴病的主脉。微脉主阳气衰弱而言，细脉主阴血虚极而言。微者薄也，微薄如纸，指下隐然，属阳气虚；细者小也，细小如发，指下显然，属阴血虚。卫气行于脉外，阳气虚，则约束于外的力量怯弱，脉故薄而微，所以少阴脉微欲绝，仲景用通脉四逆汤主治。营气行于脉中，阴血虚，则充实其中的物质少，脉故小而细，所以厥阴脉细欲绝，仲景用当归四逆汤主治。一个主回阳，一个主救阴，两脉阴阳各异，最宜仔细辨别。如果形体壮盛而脉细，少气不足以息，以及患热病而脉细，神昏不能自持，都是脉不应病的危候。
厥阴病的脉象表现为涩脉。涩脉主阴虚化燥。初病右脉涩，是湿滞血结；久病左脉涩，是血虚精极。右寸浮涩，上燥主气；左关尺涩，下燥主血。两寸弦涩，心痛亡血；两关弦涩，络中瘀结；两尺涩弱，阴阳并竭。举之浮涩，按之数盛，是阴虚伏热；举之浮大，按之反涩，是阳盛挟积。
【徐秀按语】涩脉往来涩滞，像轻刀刮竹，又像雨沾沙，都非常形象。良由血虚液燥，不能濡润经脉，脉道阻滞，所以涩滞不利。凡是物体缺少雨露滋润，势必干涩；人缺少血液灌溉，也必干涩。所以将涩脉归属于阴虚化燥的病证。这只有在三阳经邪热传入厥阴经时才如此。如果初病见涩数模糊，多属痰食胶固；或浮涩数盛，也有雾伤皮腠、湿流关节的征候。兼有伤寒阳明腑实，不大便而脉涩；温病大热而脉涩；吐下后微喘而脉涩；水肿腹大而脉涩；消瘅大渴而脉涩；痰证喘满而脉涩；妇人怀孕而脉涩，这些都是脉证相反的征候。所以前代医家有“舍脉从证”、“舍证从脉”的名论。
The pulse of Taiyang disease presents as Floating (Fu Mai, Floating Pulse). A Floating pulse indicates the pathogen is in the Exterior. A Floating-Forceful (Fu Jin) or Floating-Slow (Fu Chi) pulse both indicate Exterior Cold; a Floating-Rapid (Fu Shu) or Floating-Hong (Fu Hong) pulse both indicate Exterior Heat. A Floating-Fine & Choppy (Fu Xi Se) or Soft & Scattered (Ru San) pulse, when accompanied by corresponding symptoms, all indicate Deficiency. A Forceful-Rapid (Jin Shu) or Forceful-Slippery (Hong Hua) pulse, when accompanied by corresponding symptoms, all indicate Excess.
[Commentary by Xu Xiu] This section uses the Floating pulse to differentiate between Cold, Heat, Deficiency, and Excess. The Floating pulse can be felt with light pressure, its image being clear and distinct, but it most often appears as a combined pulse. For instance: Floating-Forceful and Choppy indicates Cold pathogen in the Exterior; Floating-Wiry and Slow indicates Wind pathogen in the Exterior; Floating-Forceful and Rapid indicates the pathogen is about to transmit inward; a Long pulse while Floating indicates transmission involving the Yangming channel; a Wiry pulse while Floating indicates transmission involving the Shaoyang channel. The key lies in whether there is "Shen" (Spirit/Vitality) in the pulse, meaning the pulse is forceful, which allows for the use of diaphoresis (sweating method) to resolve the exterior. If the pulse is Floating-Slow and Weak, or Floating-Empty and Fine, or Floating-Micro and Choppy, these belong to Floating without force, indicating Yang Deficiency. Warm tonification should be used, and sweating must not be employed. If the Cun (Inch), Guan (Bar), or Chi (Cubit) positions at the Chi position are Weak, Choppy, Slow, and Fine, it indicates internal deficiency with Yin involvement. Urgent warm tonification is required, and reckless sweating is especially contraindicated, lest it precipitate the critical condition of Yang collapse due to erroneous sweating.
Floating-Forceful indicates Wind-Cold; Floating-Rapid indicates Wind-Heat; Floating-Soft indicates Wind-Dampness; Floating-Choppy indicates Wind-Dryness; Floating-Empty indicates Summerheat injury; Floating-Hong indicates Fire Excess.
[Commentary by Xu Xiu] Although the pulse is Floating, different combined pulses indicate different diseases. Generally, Wind patterns often show a Floating pulse, Cold patterns often show a Forceful pulse, Heat patterns often show a Rapid pulse, Dampness patterns often show a Soft pulse, Dryness patterns often show a Choppy pulse, Summerheat patterns often show an Empty pulse, and Fire patterns often show a Hong pulse. These are the common manifestations of external contraction pulse signs. However, external contraction pulses rarely appear alone; they are mostly combined pulses. Clinicians must distinguish them carefully.
[Commentary by Lian Kan] In the six-channel external contraction patterns, Floating indicates Wind, Forceful indicates Cold, Empty indicates Summerheat, Soft indicates Dampness, Choppy indicates Dryness, and Hong indicates Fire. Former sages took this as the basis. However, based on my clinical experience, one cannot strictly adhere to this. For example: Wind has no fixed form. When combined with Cold and Dryness, the pulse is Forceful and Floating; when combined with Summerheat and Dampness, the pulse is Soft, Slow, and Floating. Summerheat and Dampness carrying turbid qi are often inhaled through the mouth and nose, causing disease to originate internally. The pulse often seems Rapid or Slow, or neither Floating nor Sunken but Rapid, or even Soft, Slow, and blurred, with indistinct rate. Even Dryness has no fixed form. Upper Dryness affects Qi, with the right Cun position Floating and Choppy, and deep pressure Rapid; Lower Dryness affects Blood, with the left Guan and Chi positions Fine, Wiry, and Choppy. Fire has no neutral state; the six qi often transform into Fire. If Fire transformation is in the channels or Qi level, the pulse must be Hong and Full. If Fire transforms and enters the Stomach fu organ, combusting with residues, the pulse must be Deep, Solid, and Small, or Deep, Rapid, and Small, or even Deep, Micro, and Hidden. Solid and Small, Micro and Hidden, are all signs of obstruction. Once the interior pathogen is purged, the pulse turns Floating and Slow without sinking/obstruction, and sweating will likely occur within a day to resolve the disease. If the pulse remains Deep and Rapid after sweating, the pathogen is not fully exhausted. If the pulse becomes Floating and Restless after sweating, the pathogen overcomes the healthy Qi. After sweating, the body must become cool and the pulse quiet/still to indicate complete elimination of the pathogen. "Quiet" refers to a Deep and Fine pulse. Although the pulse is Deep and Fine, the rate is distinct, differing from the Choppy, sluggish, and blurred pulse of Summerheat-Dampness. Within a few days, after eating and recovering Qi, the pulse will turn round and Floating. As for Warm diseases and Epidemic diseases, they differ further. Warm diseases include Wind-Warm, Cold-Warm, Damp-Warm, Heat-Warm, Dry-Warm, and Toxic-Warm. The pulse of Wind-Warm is larger on the right than the left, with the left also盛 (Sheng, vigorous/restless), and the skin at the Chi position very hot. The pulse of Cold-Warm, although Hong and Full on the right, is Wiry and Forceful on the left. The pulse of Damp-Warm is Soft and Weak on the right, and Small and Urgent on the left. The pulse of Heat-Warm is Floating at both Cun positions, Slippery on light pressure, and Scattered-Choppy on deep pressure. The pulse of Dry-Warm is mostly Floating-Choppy and Deep-Scattered on the right, and mostly Floating-Wiry and Beating-to-the-finger on the left. The pulse of Toxic-Warm is mostly Floating and Full, becoming more intense with deeper pressure. Although epidemic diseases vary, they generally result from inhaling various mold toxins, brewing into contagious diseases. Their pathology does not exceed Yang Toxin and Yin Toxin. Yang Toxin involves Blood Excess-Heat, with the pulse mostly Right Hand Hong and Beating, Left Hand Wiry, Rapid, Full, and Restless. Yin Toxin involves Qi Deficiency-Cold, with the pulse mostly Soft and Weak, or even Deep, Micro, and seemingly Hidden, or Floating, Large, and Scattered. Although the disease initially originates from external invasion, the formed pattern must emerge from within. Thus, the pulse images of the six excesses (external pathogens) and all epidemic diseases differ so greatly. Therefore, Yu Dongfu said: The difficulty in treating disease lies in recognizing the pattern; the difficulty in recognizing the pattern lies in recognizing the pulse. This is indeed true. I believe that in our country's diagnostic science, palpation ranks last. This does not mean the pulse cannot be relied upon, but rather that relying solely on the pulse makes it unreliable, and rigidly adhering to the pulse makes it even less reliable. One must observe the form and color, examine the tongue and coating, investigate the disease source, estimate the disease location, scrutinize the disease state, and study the disease changes, and then refer to the pulse. Although the pulse image has no fixed form, the treatment method depends on the physician, so one will not be confused by the pulse.
The pulse of Shaoyang disease presents as Wiry (Xian Mai, Wiry Pulse). A Wiry pulse indicates the Half-Exterior Half-Interior level. Wiry and Floating-Large leans towards the Half-Exterior; Wiry and Forceful-Small leans towards the Half-Interior. Wiry-Slow indicates Wind-Cold; Wiry-Rapid indicates Wind-Heat; Wiry-Slippery indicates Phlegm retention; Wiry-Urgent indicates much pain. Floating-Wiry indicates Cold Fluid; Deep-Wiry indicates Heat Fluid. Floating-Wiry and Long indicates pathogen stagnation in the interstices; Floating-Wiry and Rapid indicates Ministerial Fire is abundant. Few Wiry pulses with Solid quality indicate Pathogen Excess and Stomach Strength; Many Wiry pulses with Empty quality indicate Healthy Qi Deficiency and Stomach Weakness. Right Guan position Wiry pressing against the finger indicates Earth Failure and Wood Encroachment (Spleen/Stomach weakness with Liver overacting); Left Guan and Chi positions Wiry, Fine, and Beating-to-the-finger indicate Water Deficiency and Wood Hyperactivity (Kidney Yin deficiency with Liver Yang rising).
[Commentary by Xu Xiu] Whenever the disease pulse is Wiry, it is a sign of Yin hidden within Yang. Generally, although the initial illness is in Shaoyang, it will eventually return to Jueyin over time. It also often presents with Qi knotting and Blood stasis. During the peak of exterior pathogen in external contraction diseases, if the middle pressure of a Floating pulse feels constrained and straight, the middle pressure of a Forceful pulse feels like ridges against the finger, or the middle pressure of a Slippery pulse feels constricting, they should all be treated according to the principles of the Wiry pulse. In harmonizing methods, herbs that resolve knots and open stagnation must be added, so that the Wiry pulse gradually becomes soft and slow, feeling harmonious to the touch. If interior pathogens transmit to the fu organs and zang organs, presenting as Wiry-Slippery due to Pathogen Excess, this occurs in 2-3 out of 10 cases, mostly fu organ diseases. Presenting as Wiry-Fine due to Healthy Qi Deficiency, this occurs in 6-7 out of 10 cases, mostly zang organ diseases. Whenever the middle pressure of a Deep pulse feels strong and straight, or the middle pressure of a Choppy pulse feels fine and urgent, they should all be viewed as belonging to the Wiry pulse category. This is either Liver Yang rising or Liver Yin stagnation. Therefore, in complicated conditions of Shanghan (Cold Damage), Wiry pulses are common; in miscellaneous internal injuries, Wiry pulses account for more than half. Is it only the Shaoyang channel that commonly shows Wiry pulses?
The pulse of Yangming disease presents as Large (Da Mai, Large Pulse). A Large pulse indicates various Excess conditions and also indicates disease progression, generally indicating Yang Abundance. Large leaning to the left indicates Pathogen Excess in the channels; Large leaning to the right indicates Heat Excess in the fu organs. Large, Firm, and Long indicates Stomach Excess-Heat; Large, Firm, and Choppy indicates Stomach fullness and distension. Light pressure Small and Choppy, deep pressure Solid and Large indicates dry accumulation in the intestines; Light pressure Large and Grand, deep pressure Empty indicates Yin Exhaustion and Yang floating away. If all pulses are Large but one position is uniquely Small, it is Excess mixed with Deficiency; if all pulses are Small but one position is uniquely Large, it is Deficiency mixed with Excess. Large anteriorly and Small posteriorly indicates Yang pathogen sinking inward, with variable symptoms; Fluctuating Large and Small indicates loss of Yuan Shen (Primordial Spirit), indicating a critical illness.
[Commentary by Xu Xiu] The Large pulse feels broad to the touch, double the usual size, and differs in Yin/Yang and Excess/Deficiency. Large, Hong, and Beating indicates Heat Excess and Pathogen Excess; Large, Empty, and Soft indicates Yin Deficiency and Yang Hyperactivity. In Shanghan, a Large pulse indicates Yang Abundance; in miscellaneous diseases, a Large pulse indicates Consumption (Xu Lao). For the same Large pulse, one must know that Yang Abundance easily scorches Yin. The Stomach is the fu organ of fluids and juices; one must directly clear Yangming to preserve fluids. If Yin Deficient, unable to sustain Yang, the Kidney is the master of True Yin; one must connect Heart and Kidney so that Essence and Blood naturally suffice. Especially, one must know that when Yang injury affects Yin, clearing heat must be combined with nourishing Yin—this is why Zhang Jingyue created Yü Nv Jian (Jade Woman Decoction). When Yin damage affects Yang, tonifying must be combined with warming—this is why Feng Chuzhan created Quan Zhen Yi Qi Tang (Complete True Vital Qi Decoction). One clears Yangming Excess, the other tonifies Shaoyin Deficiency; both are critical turning points in the life-and-death prognosis of the Large pulse. Clinicians must not mistake the Large pulse for a purely Excess condition without Deficiency.
The pulse of Taiyin disease presents as Soft (Ru Mai, Soft Pulse). A Soft pulse indicates Dampness stagnation and Qi Deficiency. Floating-Soft indicates Wind-Dampness; Deep-Soft indicates Cold-Dampness. Soft combined with Rapid indicates Dampness stagnation transforming into Heat; Soft combined with Choppy indicates Dampness exhaustion transforming into Dryness; Soft combined with Micro indicates Spleen Yang nearing extinction; Soft combined with Fine indicates Spleen Yin nearly dried up.
[Commentary by Xu Xiu] "Ru" is read as "Ruan" (Soft). The pulse is empty, soft, and lacks force, feeling tender and fine to the touch. Light pressure is Floating and Soft, deep pressure is Small and Weak, indicating Spleen channel Dampness stagnation and insufficient Stomach Qi. Although Qi is insufficient, Blood is not yet ruined; it merely contains a soft and stagnant quality. With light pressure coming down, pressing reveals stagnation and lack of flow; with heavy pressure lifting up, raising reveals stagnation and lack of movement. Correlating pulse with syndrome: for Heavy Dampness and Qi stagnation, aromatic and light-drying damp-resolving herbs should be the sovereign, assisted by Qi-regulating and stagnation-guiding herbs. For Persistent Dampness and Qi Deficiency, warm tonification of Middle Qi should be the sovereign, assisted by aromatic and drying herbs to resolve dampness. One must not see a Soft pulse and recklessly use harsh tonification or harsh warming. Only when Soft and Micro is urgent harsh warming needed; when Soft and Fine is urgent harsh tonification needed.
The pulse of Shaoyin disease presents as Fine (Xi Mai, Fine Pulse), sometimes combined with Micro. Fine indicates Yin Deficiency; Micro indicates Yang Deficiency. Cun position Fine and Floating indicates Heart Yin Exhaustion; Chi position Fine and Deep indicates Kidney Yin Extremity Exhaustion. Fine combined with Rapid indicates Yin Deficiency with Fire Hyperactivity; Fine combined with Wiry indicates Water Deficiency and Wood Hyperactivity; Fine combined with Choppy indicates Yin Withered and Yang Knotting; Fine combined with Micro indicates Yin Exhausted and Yang Collapsing. Deep-Fine nearing absence indicates imminent Yin Collapse; Deep-Micro nearing absence indicates impending Yang Collapse.
[Commentary by Xu Xiu] Zhang Zhongjing takes Micro and Fine as the main pulse of Shaoyin disease. Micro indicates Yang Qi衰弱 (decline/weakness); Fine indicates Yin Blood extreme deficiency. Micro means thin, like paper, faint under the finger, indicating Yang Qi Deficiency. Fine means small, like hair, distinct under the finger, indicating Yin Blood Deficiency. Wei Qi moves outside the vessels; Yang Qi Deficiency makes the exterior restraint weak, so the pulse is thin and Micro. Thus, Shaoyin pulse Micro nearing absence is treated by Zhongjing with Tong Mai Si Ni Tang (Pulse-Recovering Cinnamon Twig and Prepared Aconite Decoction) to restore Yang. Ying Qi moves inside the vessels; Yin Blood Deficiency means less substance to fill it, so the pulse is small and Fine. Thus, Jueyin pulse Fine nearing absence is treated by Zhongjing with Dang Gui Si Ni Tang (Angelica Sinensis Cinnamon Twig and Acute Decoction) to save Yin. One restores Yang, the other saves Yin; the two pulses differ in Yin and Yang, requiring careful differentiation. If the physique is robust but the pulse is Fine, with shortness of breath insufficient for respiration, or suffering from heat disease with a Fine pulse and coma unable to maintain consciousness, these are critical signs of the pulse not matching the disease.
The pulse of Jueyin disease presents as Choppy (Se Mai, Choppy Pulse). Choppy indicates Yin Deficiency transforming into Dryness. Initial illness Right Choppy indicates Dampness stagnation and Blood knotting; Chronic illness Left Choppy indicates Blood Deficiency and Essence extremity. Right Cun Floating-Choppy indicates Upper Dryness affecting Qi; Left Guan and Chi Choppy indicates Lower Dryness affecting Blood. Both Cun positions Wiry-Choppy indicate Heart pain and Blood loss; Both Guan positions Wiry-Choppy indicate collateral stasis knotting; Both Chi positions Choppy and Weak indicate Yin and Yang both exhausted. Light pressure Floating-Choppy, deep pressure Rapid-Abundant indicates Yin Deficiency with latent Heat; Light pressure Floating-Large, deep pressure conversely Choppy indicates Yang Abundance with accumulation.
[Commentary by Xu Xiu] The Choppy pulse flows sluggishly, like scraping bamboo with a light knife, or like rain soaking sand, all very descriptive. It arises from Blood Deficiency and fluid Dryness, failing to moisten the meridians, causing vessel obstruction, hence the sluggish and unsmooth flow. Just as objects lacking rain and dew inevitably become dry and rough, humans lacking blood irrigation inevitably become dry and rough. Thus, the Choppy pulse is attributed to diseases of Yin Deficiency transforming into Dryness. This applies only when heat pathogens from the Three Yang channels transmit to the Jueyin channel. If initially seen as Choppy, Rapid, and blurred, it mostly belongs to Phlegm and Food sticking together; or Floating-Choppy, Rapid, and Abundant, it may also indicate Fog injuring the skin and interstices, or Dampness flowing into the joints. Combined with Shanghan Yangming Fu Excess, constipation with Choppy pulse; Warm disease high fever with Choppy pulse; Vomiting/Purging followed by slight wheezing with Choppy pulse; Edema and abdominal distension with Choppy pulse; Xiao Dao (Wasting-Thirst) with great thirst and Choppy pulse; Phlegm patterns with wheezing/fullness and Choppy pulse; Pregnant women with Choppy pulse—all these are signs where the pulse and syndrome contradict each other. Hence, former sages have theories of "Abandoning the Pulse to follow the Syndrome" and "Abandoning the Syndrome to follow the Pulse."