而不回者也。如脉俱沉细而数者。此少阴厥也。少阴之气。不上合于阳明。转输于脏腑。故惟见少阴本脉之沉细也。阳
明之热。反下入于阴中。故数也。若沉细数散者。此阴中所陷之阳。散而阴阳相乘。故为寒热也。如浮而散者。此复上
逆于阳分。故为 仆。经曰。清浊之气相干。乱于头。则为厥逆眩仆。此言阴阳之气。不能上下和平。循度环转。如阳
陷于阴中。则为沉细而数。如阴阳相乘。则为数散寒热。如阴反上逆于阳。则为浮散而 仆矣。）诸浮不躁者皆在阳。则
为热。其有躁者在手。诸细而沉者皆在阴。则为骨痛。其有静者在足。（此以浮沉躁静。而分手足之阴阳也。诸浮者。无
论左右三部之浮。而皆在于阳分。其浮而躁者。在手之三阳也。终始篇曰。人迎一盛。在足少阳。一盛而躁。在手少阳。
即此意也。无论左右三部之细而沉者。皆在于阴分。其沉细而有静者。在足之三阴也。手之十指。以应天之十干。足之
十二经脉。以应地之十二支。故其有静者。知在足也。太阳少阴。为水火阴阳之主。故为热为骨痛也。）数动一代者。病
在阳之脉也。泄及便脓血。（此申明浮沉之在气而不在经也。所谓诸浮在阳。诸沉在阴者。在阴阳之气也。故为热为骨痛。
如在阳之脉。则脉见数动。而为便脓血之经证矣。阳热在经。故脉数动。热伤血分。故便脓血。经血下泄。故一代也。）
诸过者切之。涩者阳气有余也。滑者阴气有余也。阳气有余。为身热无汗。阴气有余。为多汗身寒。阴阳有余。则无汗
而寒。（此论外淫之邪。而致阴阳气之为病者。脉证各有别也。诸过者。谓诸邪所伤。而为有过之脉也。有余者。邪气之
有余也。阳气有余。则阳气受伤。故脉涩。如邪入于阴。则经血沸腾。故脉滑也。邪在阳分。故身热无汗。邪在阴分。
故多汗身寒。阴阳并受其邪。则无汗而寒也。）推而外之。内而不外。有心腹积也。推而内之。外而不内。身有热也。
推而上之。上而不下。腰足清也。推而下之。下而不上。头项痛也。（推叶吹。此复结首章之义。首章以脉体而定形身脏
腑之外内上下。此以邪病于形身脏腑之外内上下。而以脉象证之。推、详也。推详其脉气之偏于外内上下也。推而外之
者。以左右之三指。向外以按之。脉偏盛向内而不外者。此邪在心腹之间而成积也。推而内之者。以左右三指。向内以
候之。脉偏盛于外而不内者。邪在外而身有热也。推而上之者。以三指平按而审之。上而不下者。其气上盛下虚。当主
腰足清冷也。推而下之。下而不上者。其气下盛上虚。当主头项痛也。外内论邪病之有余。上下论正气之不足。张兆璜
曰。吹推二义皆可。推而外之。内而不外。推而内之。外而不内者。此邪病偏盛于外内。故即推之而不移。推而上之。
上而不下。推而下之。下而不上。此推详其正气之虚于上下。故推而上之。不曰下而不上。而曰上而不下。推而下之。
不曰上而不下。而曰下而不上。莫子晋曰。书不尽言。言不尽意。邪病正气又当互换外存参。）按之至骨。脉气少者。腰
脊痛而身有痹也。（此反结上文而言。所谓外内上下者。非浮沉举按之法也。若谓浮为在外。沉为在内。病腰脊痛而身有
痹者。直按之至骨。如心腹之积。又当何如而按之。圣贤反复辨论。曲尽婆心。杨元如曰。病在阴者名曰痹。故当按
之至骨。此复以浮沉举复。以候皮肉筋骨之浅深。类而推之。亦可内合于五脏。然又一法也。）
（脉象）不回转的。如果脉象都沉细而数，这是少阴厥逆。少阴之气不能向上与阳明经相合，转输于脏腑，所以只见到少阴本脉的沉细之象。阳明的热邪反而下陷入阴分中，所以脉数。如果是沉细、数且散乱的脉象，这是阴分中陷落的阳气，散乱而阴阳相互乘袭，所以出现寒热往来。如果脉象浮而散乱，这是（阳气）再次上逆于阳分，所以会出现仆倒昏厥。《内经》说：清浊之气相互干扰，扰乱头部，就会导致厥逆、眩晕和仆倒。这里说的是阴阳之气不能上下调和，循着正常的规律环转运行。比如阳陷于阴中，脉象就表现为沉细而数；比如阴阳相互乘袭，脉象就表现为数散并伴有寒热；比如阴气反向上逆于阳分，脉象就表现为浮散并伴有仆倒昏厥。）
凡是浮脉而不躁动的，病都在阳分，所以表现为发热。其中伴有躁动特征的，病在手部经脉。凡是细脉而沉的，病都在阴分，所以表现为骨痛。其中伴有静缓特征的，病在足部经脉。（这里是通过浮沉、躁静来区分手足阴阳的方法。所有的浮脉，无论左右手寸关尺三部如何，都在于阳分。那些浮而躁动的，在手部的三阳经。《终始篇》说：人迎脉大一倍盛于寸口，病在足少阳经；一倍盛且躁动，在手少阳经。就是这个意思。无论左右手寸关尺三部如何，凡是细而沉的脉，都在于阴分。那些沉细而静缓的，在足部的三阴经。手的十指对应天的十天干，足的十二经脉对应地的十二地支。所以有静缓特征的，可知病在足部。太阳经和少阴经是水火阴阳的主宰，所以分别表现为热证和骨痛。）
脉数、动或代（间歇），病在阳分的脉象，症状为泄泻以及大便脓血。（这里进一步阐明浮沉脉象反映的是气的病变而非经络本身的病变。所谓诸浮脉在阳，诸沉脉在阴，是指阴阳之气的变化。所以表现为热或骨痛。如果在阳分的经脉有病，则脉象表现为数动，并出现便脓血的经络实证。阳热在经络中，所以脉数动；热邪损伤血分，所以大便脓血；经血向下泄漏，所以脉象出现代止。）
对于各种异常的脉象都要切按。脉涩说明阳气有余，脉滑说明阴气有余。阳气有余，表现为身体发热无汗；阴气有余，表现为多汗且身体发冷。阴阳之气都有余，则表现为无汗且身体发冷。（这里论述外感淫邪导致阴阳之气发生病变的情况，脉象和证候各有区别。“诸过”指各种邪气所伤导致的异常脉象。“有余”指邪气有余。阳气有余，则阳气受伤，所以脉涩；如果邪气侵入阴分，则经血沸腾，所以脉滑。邪气在阳分，所以身体发热无汗；邪气在阴分，所以多汗身寒。阴阳两分都受到邪气侵袭，则无汗且身体发冷。）
将手指推向外侧按压，脉气内敛而不外应，提示有心腹积块。将手指推向内侧按压，脉气外应而不内敛，提示身体有发热。将手指向上推按，脉气上行不下行，提示腰足寒冷。将手指向下推按，脉气下行不上行，提示头项疼痛。（“推”读作chuī，意为吹拂，引申为推移、详察。这里再次总结首章的意义。首章通过脉体形态来确定形体脏腑的外内上下关系，这里则是通过邪气在形体脏腑外内上下的病变，用脉象来验证。“推”意为详察。详察脉气偏盛于外、内、上、下的情况。所谓“推而外之”，是用左右三指向外按压，如果脉气偏盛向内而不向外，这是邪气在心腹之间形成积块。“推而内之”，是用左右三指向内候诊，如果脉气偏盛于外而不向内，这是邪气在外而身体发热。“推而上之”，是用三指平按以审察，如果脉气上盛而下虚，应当主病腰足清冷。“推而下之”，如果脉气下盛而上虚，应当主病头项疼痛。外和内论邪气的有余，上和下论正气的不足。张兆璜说：“吹”和“推”两种解释都可以。所谓“推而外之，内而不外；推而内之，外而不内”，是因为邪气偏盛于外或内，所以即使用力推移它，脉气也不移动位置。“推而上之，上而不下；推而下之，下而不上”，这是详察正气在上下部位的虚弱，所以“推而上之”不说“下而不上”而说“上而不下”，“推而下之”不说“上而不下”而说“下而不上”。莫子晋说：书本不能完全表达言语，言语不能完全表达意旨。邪气和正气的关系又应当互换思考，留存参考。）
重按至骨，脉气微弱不足的，提示腰脊疼痛且身体有痹症。（这里反过来总结上文所说的外内上下，并非指浮沉举按的手法。如果说浮脉代表在外，沉脉代表在内，那么治疗腰脊疼痛且身体有痹症的病证，直接重按至骨即可。如果是心腹的积块，又该如何按诊呢？圣贤反复辩论，极尽苦心。杨元如说：病在阴分的称为痹，所以应当重按至骨。这里再次通过浮沉举按，来候察皮肉筋骨浅深的层次，类推开来，也可以内合于五脏，但这又是另一种方法了。）
(When the pulse) does not return (to its normal state). If the pulses are all deep, fine, and rapid, this is Jue-ni (Jueverse) of the Shaoyin (Lesser Yin) channel. The Qi of Shaoyin fails to ascend and harmonize with the Yangming (Greater Yang) channel, nor does it transport to the Zang-Fu organs; therefore, only the root pulse of Shaoyin—deep and fine—is observed. The heat of Yangming instead sinks into the Yin aspect, resulting in a rapid pulse. If the pulse is deep, fine, rapid, and scattered, this indicates Yang Qi trapped within the Yin aspect, scattering such that Yin and Yang mutually invade each other, leading to alternating chills and fever. If the pulse is floating and scattered, this indicates (Yang Qi) again reversing upward into the Yang aspect, leading to syncope or falling. The Classic states: "When Clear and Turbid Qi interfere with each other and disturb the head, it results in Jue-ni, dizziness, and syncope." This refers to the failure of Yin and Yang Qi to harmonize above and below and circulate according to their proper order. For instance, when Yang sinks into Yin, the pulse appears deep, fine, and rapid; when Yin and Yang mutually invade, the pulse appears rapid, scattered, accompanied by chills and fever; when Yin reverses upward into Yang, the pulse appears floating and scattered, accompanied by syncope.)
Whenever the pulse is floating without restlessness, the disease resides in the Yang aspect, manifesting as heat. If there is restlessness associated with it, the disease is located in the Hand channels. Whenever the pulse is fine and deep, the disease resides in the Yin aspect, manifesting as bone pain. If there is stillness associated with it, the disease is located in the Foot channels. (This method distinguishes the Yin and Yang of the Hand and Foot channels based on floating/sinking and restlessness/stillness. All floating pulses, regardless of whether they appear in the left or right positions of the Cun, Guan, and Chi, belong to the Yang aspect. Those that are floating and restless correspond to the Three Yang channels of the Hand. The *Zhong Shi* chapter states: "If the Renying pulse is one-fold stronger than the Cunkou, the disease is in the Foot Shaoyang; if it is one-fold stronger and restless, it is in the Hand Shaoyang." This illustrates the same principle. Regardless of the left or right positions of the Cun, Guan, and Chi, all fine and deep pulses belong to the Yin aspect. Those that are deep, fine, and still correspond to the Three Yin channels of the Foot. The ten fingers of the Hand correspond to the Ten Heavenly Stems, and the twelve meridians of the Foot correspond to the Twelve Earthly Branches. Therefore, the presence of stillness indicates the disease is in the Foot. Taiyang (Greater Yang) and Shaoyin (Lesser Yin) are the masters of Water and Fire, and thus of Yin and Yang; hence, they manifest respectively as heat and bone pain.)
A pulse that is rapid, moving, or intermittent (Dai) indicates disease in the Yang aspect's vessels, with symptoms of diarrhea and pus/blood in the stool. (This further clarifies that floating and sinking pulses reflect disturbances in Qi rather than the meridians themselves. What is meant by "all floating pulses in Yang" and "all sinking pulses in Yin" refers to changes in Yin and Yang Qi. Thus, they manifest as heat or bone pain. However, if the disease is in the Yang meridians, the pulse appears rapid and moving, presenting as an excess syndrome of the meridions involving pus and blood in the stool. Yang-heat in the meridians causes the pulse to be rapid and moving; heat damaging the Blood aspect causes pus and blood in the stool; the downward leakage of meridian blood causes the intermittent pulse.)
Palpate all abnormal pulses. A Choppy (Se) pulse indicates Excess of Yang Qi; a Slippery (Hua) pulse indicates Excess of Yin Qi. Excess of Yang Qi manifests as body heat and absence of sweating; Excess of Yin Qi manifests as profuse sweating and cold body. Excess of both Yin and Yang Qi manifests as absence of sweating and cold body. (This discusses diseases caused by pathogenic influences invading and disturbing Yin and Yang Qi, where pulse signs and clinical manifestations differ. "All abnormalities" refers to abnormal pulses caused by various pathogens. "Excess" refers to the abundance of pathogenic factors. When Yang Qi is affected by excess, the Qi is injured, resulting in a Choppy pulse; if pathogens enter the Yin aspect, the meridian blood boils, resulting in a Slippery pulse. Pathogens in the Yang aspect cause body heat and no sweat; pathogens in the Yin aspect cause profuse sweating and cold body. If both Yin and Yang aspects are invaded by pathogens, there is no sweat and the body feels cold.)
Push the fingers outward to palpate; if the pulse energy is inward-directed and does not respond outwardly, it indicates abdominal masses. Push the fingers inward to palpate; if the pulse energy is outward-directed and does not respond inwardly, it indicates the body has heat. Push the fingers upward to palpate; if the pulse energy rises but does not descend, it indicates coldness in the waist and feet. Push the fingers downward to palpate; if the pulse energy descends but does not rise, it indicates pain in the head and neck. ("Tui" is pronounced 'chui', meaning to blow,引申 to mean push/deliberately examine. This reiterates the meaning of the first chapter. The first chapter determined the exterior/interior and upper/lower relationships of the body and Zang-Fu organs based on pulse morphology; here, we verify these relationships through pulse images corresponding to pathological locations in the body and organs. "Tui" means to examine carefully. To examine carefully for bias in pulse energy towards exterior/interior or upper/lower: "Push outward" means pressing outward with the three fingers; if the pulse energy is biased inward and does not extend outward, it indicates pathogens forming masses between the heart and abdomen. "Push inward" means holding inward with the three fingers; if the pulse energy is biased outward and does not go inward, it indicates pathogens in the exterior causing body heat. "Push upward" means pressing levelly with the three fingers to examine; if the energy is excessive above and deficient below, it indicates coldness in the waist and feet. "Push downward"; if the energy is excessive below and deficient above, it indicates pain in the head and neck. Exterior/Interior discusses the excess of pathogens; Upper/Lower discusses the deficiency of healthy Qi. Zhang Zhaohuang stated: Both interpretations of 'chui' and 'tui' are acceptable. Regarding "Push outward, inward but not outward; Push inward, outward but not inward," this is because pathogens are excessively biased toward the exterior or interior, so even when pushed, the pulse energy does not shift. Regarding "Push upward, upward but not downward; Push downward, downward but not upward," this examines the deficiency of healthy Qi in the upper and lower regions. Hence, "Push upward" says "upward but not downward" rather than "downward but not upward," and "Push downward" says "downward but not upward" rather than "upward but not downward." Mo Zijin stated: Text cannot fully express speech, and speech cannot fully express intent. The relationship between pathogens and healthy Qi should also be considered interchangeably for reference.)
Press down to the bone; if the pulse energy is weak and insufficient, it indicates pain in the waist and spine along with Bi-syndrome (obstruction) in the body. (This reversely summarizes the aforementioned exterior/interior and upper/lower concepts, which do not merely refer to the techniques of floating/sinking or lifting/pressing. If one were to say that a floating pulse represents the exterior and a sinking pulse represents the interior, then for diseases like waist/spine pain and Bi-syndrome, one would simply press to the bone. But what about abdominal masses? How would one press for those? The Sages debated repeatedly, showing utmost care. Yang Yuanru stated: Diseases in the Yin aspect are called Bi-syndrome, so one must press to the bone. This again uses floating/sinking and lifting/pressing to ascertain the depth of skin, flesh, sinews, and bones. By analogy, this can also correspond internally to the Five Zang organs, though this is yet another method.)