岐伯曰∶凡人形盛脉细，少气不足以息者，危；形瘦脉大，而胸中多气者，死。形气相
得者，生；参伍不调者，病。诚哉是言，脉病逆顺之不可不早辨也。盖人有强弱盛衰之不等，
而脉实应焉；脉有阴阳虚实之不同，而病实应焉。脉病形证相应而不相反，每万举而万全，
少有乖张，良工不能施其巧矣。故脉之于病，有利浮大而不利沉小者，有利沉小而不利浮大
者，有大小无拘，而以浮沉、滑涩、坚软为顺逆者，又有五行反克，而贼邪乘虚为深患者，
请条析而缕陈之。壮热，脉浮大而疾者生，沉小者死。癫痫，脉坚大而数者生，沉细者死。
谵语，脉洪大者生，厥逆而脉微者死。暴忤，脉实大者生，虚濡而小伏者死。诸药中毒，可
洪大紧急，不可微小而不齐。疝瘕、积聚，可坚急实强，不可沉小而虚弱。腹胀者，浮大则
顺，虚小则逆。头痛者，浮大则安，短涩则危。消渴之诊，贵乎数大紧实，不贵乎微细浮短。
（小急不可治。）水气之诊，贵乎浮而洪大，不贵乎虚细、沉微。击坠淤血，顺则脉坚强，
反则脉小弱。中恶、吐血，反则脉沉细，顺则脉浮洪。前所谓利浮大而不利沉小者，此也。
伤寒已得汗，沉小之脉安，浮大之脉危。自汗漏不止，虚细之脉安，躁盛之脉危。中恶腹胀，
紧细则可，洪急则否。心腹 痛，沉细则可，坚洪则否。厥逆之脉，顺则沉而涩，逆则大而
浮。痿缓之脉，顺则散而虚，逆则坚而疾。唾吐衄血，顺者小弱、沉滑，逆者坚躁、浮洪。
金疮血多，顺者微细而虚，逆者躁实而大。久嗽、尿血、羸瘦者，其正则脉微，其反则洪急。
大肠 泄筋挛者，其正则脉细，其反则坚洪。泄泻注谷、下痢，其正者，缓细、小结，其反
者，弦数、浮洪。金疮与诸下血，其正者，细滑而沉，其反者，紧急疾大。（发热亦反。）
蚀肛阴，可虚小而不可紧急。产后出血，可沉小而不可疾浮。前所谓利沉小，而不利浮大者，
此也。伤寒脉躁盛，而不得汗者，阳之极。其治也，难。伤寒已得汗，而脉躁盛者，阴之极。
其候即死。中风口噤，四肢不收，脉浮迟而恬静者存，脉洪数而气粗者亡。上气喘急，面目
浮肿，脉浮滑而手足温者存，脉涩涩而四肢厥者亡。（加痢即死。）心下牢强，胜则脉紧，负
则沉濡。水病腹肿，胜则脉实，负则虚散。病黄胆者，胜则缓大，负则弦急而坚。猝中恶者，
胜则洪缓，负则坚急而驰。腹胀便血，活者脉滑，殂者脉绝。肠痈肿结，活者脉浮，殂者脉
沉。脓血诸疾，活以滑细，殂以坚强。肠 下脓，活以其沉，殂以其浮。有迟滑而无紧数，
则崩中漏下不必虑；有滑实而无浮虚，则月经闭塞何足忧。诸肠 ，身不热而脉和滑者易愈，
身热而脉弦涩者难痊。诸咳嗽，声不焦而脉浮软者易安，弦绝沉坚或伏而大者难保。逆而坚
涩，顺而濡滑，其于上气为可推。反则急坚，正则虚缓，其于厥逆为可验。耳聋之脉，沉而
滑者可愈，浮而涩者难疗。蛊毒之脉，数而软者可苏，数而坚者难苏。（凡蛊毒脉，类如钗
股，其人吐甚，心下切痛如啮，而面目黄，或吐血不止者皆死。）前所谓大小无拘，而以浮
沉、滑涩、坚软为顺逆者，此也。心病，面赤，喜笑，心烦，掌热，口干，开目妄语，脐上
动气，脉当洪紧而数，反得沉濡而微者，水之克火，一不治；肝病，面青、筋急，多怒，目
痛，目闭不欲见人，脐左动气，脉当弦急而长，反得浮涩而短者，金之克木，二不治；肾病，
面黑恐，欠，足寒，逆气，腹痛，飧泄后重，脐下动气，脉当沉而滑，反得缓而大者，土之
克水，三不治；肺病，面白，悲愁，嚏，哭，吐衄交血，喘咳，寒热，脐右动气，脉当沉细
而涩，反得浮大而牢者，火之克金，四不治；五者，脾病，面黄，善思，善嗜，体重，节疼
，四肢不收，怠惰喜卧，腹满泄利，饮食不消，当脐动气，脉来缓大者，脾家正形也。设或
反是弦长而紧，是非木邪之克土乎？前所谓五行反克，而贼邪乘虚为深患者，此也。虽然，
健人之脉病，病患之脉健，阳病得阴脉，阴病得阳脉，凡此皆反也。而刘元宾以为形病脉和
人不死，张长沙以为阴病见阳脉者生，其言岂浓诬哉？经云∶脉病患不病曰行尸，人病脉不
病曰内虚。此二者虽皆非顺，然形病而脉和犹可用力，形和而脉病其死不疑。况脉和之与脉
健本自不同，刚驰暴躁之谓健，调平而有胃气之谓和。毫厘疑似之间，学人当于此而致其辨
矣。经云∶忽阳病得阴脉，阴病得阳脉者，死。此二者虽皆非正，然张长沙之论，特为伤寒
设，谓如伤寒心腹烦满而脉浮大之类是尔。腹满，病在太阴，浮大之脉属阳，亦脾家之本体
，故能生焉。学人当于此而通其故矣。逆顺之说，故备论之，以俟大贤之折衷云。（老者脉
，阳羸阴强顺，阴弱阳强逆。大人得小儿脉，不治。左病右痛，上病下痛，不治。下痢，手
足温易治，手足寒难治，手足厥冷脉，不至者死。吐血，发嗽上气，脉数有热，不得卧者死
。凡病患眼无魂，朦胧，白云如外障，并不治。病患脉和软者，生；刮涩如枝梗草根者，死
。）
Qibo said: When a person's physical constitution is robust but the pulse is thin, accompanied by shortness of breath and insufficient respiration, it indicates a critical condition; when a person is emaciated but the pulse is large, with excessive Qi in the chest, it indicates death. When the pulse and the Qi of the body are harmonious, life is preserved; when the pulse is irregular and uncoordinated, disease exists. This statement is indeed true; the relationship between reversibility (Ni) and normality (Shun) of pulses and diseases must be distinguished early. Generally, people vary in strength and decline, and the pulse should correspond to this; pulses differ in Yin-Yang, deficiency, and excess, and diseases should correspond to these. When the pulse, disease, and physical signs correspond without contradiction, success is almost guaranteed; if there is any discrepancy, even a skilled physician cannot exert their expertise. Therefore, regarding the pulse in relation to disease: some cases favor a floating-large pulse over a sunken-small one; some favor a sunken-small pulse over a floating-large one; some have no restriction on size, judging reversibility by floating/sunken, slippery/rough, firm/soft; and there are cases of Five Elements counter-restriction where pathogenic factors take advantage of deficiency to cause deep harm. These will be analyzed item by item.
For high fever (Zhuang Re), a floating-large and rapid pulse indicates survival, while a sunken-small pulse indicates death. For epilepsy (Dian Xian), a firm-large and rapid pulse indicates survival, while a sunken-thin pulse indicates death. For delirium (Chan Yu), a洪大 (Hong Da - large and full) pulse indicates survival, while Jue Ni (Jue Ni - reversal of cold/heat, extremities cold) with a faint pulse indicates death. For sudden wu (Bao Wu - sudden antagonism/abnormal state), a solid-large pulse indicates survival, while a deficient-soft, small, and hidden pulse indicates death. In various poisonings, the pulse may be large-full and urgent, but not small-faint and irregular. For Shan Xia (Shan Xia - hernia/masses) and Ji Ju (Ji Ju - accumulations/grasping masses), a firm-urgent-solid-strong pulse is acceptable, but a sunken-small and weak pulse is not. For abdominal distension (Fu Zhang), a floating-large pulse is favorable (Shun), while a deficient-small pulse is unfavorable (Ni). For headache (Tou Tong), a floating-large pulse indicates safety, while a short-rough pulse indicates danger. In Xiao Ke (Xiao Ke - wasting-thirst syndrome), the pulse should be numerous-large-tight-solid, not micro-float-short. (A small-urgent pulse is untreatable.) In Shui Qi (Shui Qi - water qi/edema), the pulse should be floating and large-full, not deficient-thin or sunken-micro. For trauma-induced blood stasis (Ji Zhui Yu Xue), a firm pulse is favorable, while a small-weak pulse is unfavorable. For Zhong E (Zhong E - sudden evil invasion) and hematemesis, a sunken-thin pulse is unfavorable, while a floating-hong pulse is favorable. This corresponds to the previously mentioned "favoring floating-large over sunken-small."
After sweating occurs in Shang Han (Shang Han - cold damage disease), a sunken-small pulse indicates safety, while a floating-large pulse indicates danger. With spontaneous sweating that does not stop, a deficient-thin pulse indicates safety, while a restless-grand pulse indicates danger. For Zhong E with abdominal distension, a tight-fine pulse is acceptable, but a hong-urgent pulse is not. For heart-abdominal pain, a sunken-fine pulse is acceptable, but a firm-hong pulse is not. For Jue Ni (Jue Ni - reversal), a favorable pulse is sunken and rough, while an unfavorable pulse is large and floating. For Wei Huan (Wei Huan - flaccidity/laxity), a favorable pulse is scattered and deficient, while an unfavorable pulse is firm and rapid. For spitting blood or epistaxis, a favorable pulse is small-weak or sunken-slippery, while an unfavorable pulse is firm-restless or floating-hong. For extensive bleeding from metal wounds, a favorable pulse is micro-fine and deficient, while an unfavorable pulse is restless-solid and large. For chronic cough, hematuria, and emaciation, the regular pulse is micro, while the reverse pulse is hong-urgent. For Da Chang Xie (Da Chang Xie - large intestine diarrhea) with tendon cramps, the regular pulse is fine, while the reverse pulse is firm-hong. For diarrhea with undigested food and dysentery, the regular pulse is slow-fine or small-knotted, while the reverse pulse is string-taut-numerous or floating-hong. For metal wounds and various lower bleeding, the regular pulse is fine-slippery and sunken, while the reverse pulse is urgent-rapid and large. (Fever is also a reverse sign.) For Shi Gang Yin (Shi Gang Yin - erosion of anus/genitals), a small-deficient pulse is acceptable, but an urgent pulse is not. For postpartum hemorrhage, a sunken-small pulse is acceptable, but a rapid-floating pulse is not. This corresponds to the previously mentioned "favoring sunken-small over floating-large."
In Shang Han, if the pulse is restless-grand but no sweat is produced, it indicates extreme Yang. Treatment is difficult. If Shang Han has produced sweat but the pulse remains restless-grand, it indicates extreme Yin, and death follows immediately. For stroke with locked jaw (Kou Jin) and inability to move limbs, a floating-slow pulse with calm demeanor indicates survival, while a hong-numerous pulse with coarse breathing indicates death. For upper asthma and急促 (Ji Cu - urgency), facial edema, a floating-slippery pulse with warm hands and feet indicates survival, while a rough pulse with cold limbs indicates death. (If accompanied by dysentery, death ensues.) For hardness below the heart, a tight pulse indicates victory (of healthy Qi), while a sunken-soft pulse indicates defeat. For water disease with abdominal swelling, a solid pulse indicates victory, while a deficient-scattered pulse indicates defeat. For Jaundice (Huang Dan), a slow-large pulse indicates victory, while a string-taut-joint pulse indicates defeat. For sudden Zhong E, a hong-slow pulse indicates victory, while a firm-urgent-relaxed pulse indicates defeat. For abdominal distension with bloody stool, a slippery pulse indicates life, while an absent pulse indicates death. For intestinal abscess with knotting, a floating pulse indicates life, while a sunken pulse indicates death. For various pus-blood diseases, a slippery-fine pulse indicates life, while a firm-strong pulse indicates death. For intestinal pus discharge, a sunken pulse indicates life, while a floating pulse indicates death. A slow-slippery pulse without tight-numerous qualities means uterine bleeding need not be worried about; a slippery-solid pulse without floating-deficient qualities means amenorrhea is not a concern. For various intestinal wind diseases, if the body is not hot and the pulse is harmonious-slippery, recovery is easy; if the body is hot and the pulse is string-tense-rough, recovery is difficult. For various coughs, if the voice is not hoarse and the pulse is floating-soft, peace is easily restored; if the pulse is string-absent, sunken-firm, or hidden-large, preservation is difficult. Reverse pulses are firm-rough, while regular pulses are soft-slippery; this can be deduced for upper Qi disorders. Reverse pulses are urgent-firm, while regular pulses are deficient-slow; this can be verified for Jue Ni disorders. For deafness, a sunken-slippery pulse indicates cure, while a floating-rough pulse indicates difficulty. For Gu Du (Gu Du - gu poison/poisoning), a numerous-soft pulse indicates revival, while a numerous-firm pulse indicates difficulty in revival. (Generally, Gu Du pulses resemble hairpins; if the patient vomits severely, has cutting pain in the epigastrium as if being bitten, yellow face, or incessant hematemesis, all indicate death.) This corresponds to the previously mentioned "no restriction on size, judging reversibility by floating/sunken, slippery/rough, firm/soft."
Heart disease presents with red face, laughter, mental restlessness, hot palms, dry mouth, open-eyed delirium, and movement above the navel. The pulse should be Hong-Jin-Shuo (Large-Tight-Numerous); if it is instead Sunen-Ruo-Wei (Sunken-Soft-Faint), this is Water overcoming Fire, constituting the first untreatable case. Liver disease presents with blue face, tendon tension, anger, eye pain, closed eyes unwilling to see people, and movement to the left of the navel. The pulse should be Xian-Ji-Chang (String-Taut-Long); if it is instead Fu-Se-Duan (Floating-Rough-Short), this is Metal overcoming Wood, constituting the second untreatable case. Kidney disease presents with black face, fear, yawning, cold feet, rebellious Qi, abdominal pain, incomplete digestion diarrhea with tenesmus, and movement below the navel. The pulse should be Sunen-Hua (Sunken-Slippery); if it is instead Huan-Da (Slow-Large), this is Earth overcoming Water, constituting the third untreatable case. Lung disease presents with white face, sorrow/worry, sneezing, crying, mixed hematemesis/epistaxis, asthma/cough, chills/fever, and movement to the right of the navel. The pulse should be Sunen-Xi-Se (Sunken-Fine-Rough); if it is instead Fu-Da-Lao (Floating-Large-Firm), this is Fire overcoming Metal, constituting the fourth untreatable case. Fifth, Spleen disease presents with yellow face, excessive thinking, drowsiness, heavy body, joint pain, inability to move limbs, lethargy preferring to lie down, abdominal fullness, diarrhea, and indigestion. Movement at the navel center occurs. The pulse comes as Huan-Da (Slow-Large), which is the normal form of the Spleen. If it is instead Xian-Chang-Jin (String-Long-Tight), this is Wood Evil overcoming Earth. This corresponds to the previously mentioned "Five Elements counter-restriction where pathogenic factors take advantage of deficiency."
Although generally, a healthy person having a diseased pulse, or a diseased person having a healthy pulse, or Yang disease getting a Yin pulse, or Yin disease getting a Yang pulse, are all reversals, Liu Yuanbin believed that "form diseased, pulse harmonious" does not lead to death, and Zhang Changsha (Zhang Zhongjing) believed that "Yin disease showing Yang pulse" leads to life. Are these words absurd? The Classic states: "Pulse diseased, person healthy" is called "Walking Corpse"; "Person diseased, pulse healthy" is called "Internal Deficiency." Both are non-standard, yet "form diseased, pulse harmonious" can still be treated, whereas "form healthy, pulse diseased" certainly leads to death. Moreover, "Harmonious Pulse" (Mai He) and "Robust Pulse" (Mai Jian) are different. "Jian" refers to rigid, loose, and irritable; "He" refers to balanced with Stomach Qi. Between subtle similarities, students must distinguish carefully. The Classic states: "Suddenly Yang disease gets Yin pulse, Yin disease gets Yang pulse" indicates death. Although both are non-standard, Zhang Changsha's theory was specifically set for Shang Han, such as Shang Han with epigastric fullness and floating-large pulse. Abdominal fullness is a disease of Taiyin; the floating-large pulse belongs to Yang, yet it is also the original form of the Spleen, hence survival is possible. Students should understand this rationale here. The discussion on reversibility and normality is thus complete, awaiting the judgment of great sages. (For the elderly: Yang deficiency/Yin strength is favorable; Yin deficiency/Yang strength is unfavorable. Adults with children's pulse are untreatable. Left pain on right side, upper pain on lower side are untreatable. Dysentery with warm hands/feet is easy to treat; cold hands/feet is difficult; cold limbs with absent pulse indicates death. Hematemesis with cough/upper Qi, numerous pulse with heat, and inability to sleep indicates death. Patients with soulless eyes, blurred vision, or white cloud-like opacity are untreatable. Patients with harmonious-soft pulses live; patients with scraping-rough pulses like branches/roots die.)