雍曰。辨脉者。辨伤寒之脉也。平脉者。平众脉也。今辨脉法中。
虽有意相槎桠者。世以仲景之法。只此二篇。垂百世之师范。虽王叔
和撰次。一字不敢妄易。仍旧次第录之。其问答。皆仲景本文也。
仲景问曰。脉有阴阳。何谓也。答曰。凡脉大、浮、数、动、滑。此
名阳也。脉沉、涩、弱、伏、（一作弦）微。此名阴也。凡阴病见阳脉者
生。阳病见阴脉者死。雍曰。此谓阴脉阳脉。非谓脉之阴阳也。
又问曰。脉有阳结阴结者。何以别之。答曰。其脉浮而数。能食
不大便者。此为实。名曰阳结也。期十七日当剧。其脉沉而迟。不能
食。身体重。大便反硬者。名曰阴结也。期十四日当剧。
又问曰。病有洒淅恶寒而复发热者何。答曰。阴脉不足。阳往从
之。阳脉不足。阴往乘之。曰。何谓阳不足。答日。假令寸口脉微。名
曰阳不足。阴气上入阳中。则洒淅恶寒也。曰。何谓阴不足。答曰。尺
脉弱。名曰阴不足。阳气下陷入阴中。则发热也。阳脉浮。阴脉弱（浮
一作微）者。则血虚。血虚则筋急也。其脉沉者。营气微也。其脉浮而
汗出如流珠者。卫气衰也。营气微者。加烧针。则血流不行。更发热
而躁烦也。
又曰。脉蔼蔼如车盖者。名曰阳结也。（一云秋脉）
又曰。脉累累如循长竿者。名曰阴结也。（一云夏脉）
又曰。脉瞥瞥如羹上肥者。阳气微也。
又曰。脉萦萦如蜘蛛丝者。阳气衰也。（一云阴气）
又曰。脉绵绵如泻漆之绝者。亡其血也。
又曰。脉来缓。时一止复来者。名曰结。脉来散。时一止复来者。
名曰促。（一作纵）脉阳盛则促。阴盛则结。此皆病脉。
又曰。阴阳相搏。名曰动。阳动则汗出。阴动则发热。形冷恶寒
者。此三焦伤也。若数脉见于关上。上下无头尾。如豆大。厥厥动摇
者。名曰动也。
又曰。阳脉浮大而濡。阴脉浮大而濡。阴脉与阳脉同等者。名曰
缓也。
又曰。脉浮而紧者。名曰弦也。弦者。状如弓弦。按之不移也。脉
紧者。如转索无常也。
又曰。脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。寒
虚相搏。此名为革。妇人则半产漏下。男子则亡血失精。
又问曰。病有战而汗出。因得解者。何也。答曰。脉浮而紧。按之
反芤。此为本虚。是以发战。以脉浮。故当汗出而解也。若脉浮而数。
按之不芤。此人本不虚。若欲自解。但汗出耳。不发战也。
又问曰。病有不战而汗出解者。何也。答曰。脉大而浮数。故知
不战汗出而解也。雍曰。即前问不芤之证。
又问曰。病有不战不汗出而解者。何也。答曰。其脉自微。此以
曾经发汗。若吐。若下。若亡血。以内无津液。此阴阳自和。必自愈。
故不战不汗出而解也。
又问曰。伤寒三日。脉浮数而微。病患身凉和者。何也。答曰。此
为欲解也。解以夜半。脉浮而解者。 然汗出也。脉数而解者。必能
食也。脉微而解者。必大汗出也。
又问曰。脉病欲知愈未愈者。何以别之。答曰。寸口、关上、尺中
三处。大、小、浮、沉、迟、数同等。虽有寒热不解者。此脉阴阳为和
平。虽剧当愈。
又曰。立夏得洪大脉。（洪一作浮）是其本位。其人病身体苦疼
重者。须发其汗。若明日身不疼不重者。不须发汗。若汗 然自出
者。明日便解矣。何以言之。立夏脉洪大。是其时脉。故使然也。四时仿此。
又问曰。凡病欲知何时得。何时愈。答曰。假令夜半得病。明日
日中愈。日中得病。夜半愈。何以言之。日中得病夜半愈者。以阳得
阴则解也。夜半得病明日日中愈者。以阴得阳则解也。
又曰。寸口脉浮为在表。沉为在里。数为在腑。迟为在脏。假令
脉迟。此为在脏也。
又曰。趺阳脉浮而涩。少阴脉如经者。其病在脾。法当下利。何
以知之。若脉浮大者。气实血虚也。今趺阳脉浮而涩。故知脾气不
足。胃气虚也。以少阴脉弦而浮（一作沉）才见。此为调脉。故称如经
也。若反滑而数者。故知当屎脓也。
又曰。寸口脉浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤
营。营卫俱病。骨节烦疼。可发其汗。
又曰。趺阳脉迟而缓。胃气如经也。趺阳脉浮而数。浮则伤胃。
数则动脾。此非本病。医特下之所为也。营卫内陷。其数先微。脉反
但浮。其人必大便硬。气噫而除。何以言之。本以数脉动脾。其数先
微。故知脾气不治。大便硬。气噫而除。今脉反浮。其数改微。邪气独
留。心中则饥。邪热不杀谷。潮热发渴。数脉当迟缓。脉因前后度数
如法。病者则饥。数脉不时。则生恶疮也。
又师曰。病患脉微而涩。此为医所病也。大发其汗。又数大下
之。其人亡血。病当恶寒。后乃发热无休止时。夏月盛热。欲着覆衣。
冬月盛寒。欲裸其身。所以然者。阳微则恶寒。阴弱则发热。此医发
其汗。使阳气微。又大下之。令阴气弱。五月之时。阳气在表。胃中虚
冷。以阳气内微。不能胜冷。故欲着覆衣。十一月之时。阳气在里。胃
中烦热。以阴气内弱。不能胜热。故欲裸其身。又阴脉迟涩。故知亡
血也。
又曰。脉浮而大。心下反硬。有热属脏者攻之。不令发汗。属腑
者不令溲数。溲数则大便硬。汗多则热愈。汗少则便难。脉迟尚未可
攻。
又曰。脉浮而洪。身汗如油。喘而不休。水浆不下。形体不仁。乍
静乍乱。此命绝也。又未知何脏先受其灾。若汗出发润。喘不休者。
此为肺先绝也。阳反独留。形体如烟熏。直视摇头者。此为心绝也。
唇吻反青。四肢 习者。此为肝绝也。环口黧黑。柔汗发黄者。此为
脾绝也。溲便遗失。狂言。目反直视者。此为肾绝也。又未知何脏阴
阳前绝。若阳气前绝阴气后竭者。其人死。身色必青。阴气前绝阳气
后竭者。其人死。身色必赤。腋下温。心下热也。
又曰。寸口脉浮大。而医反下之。此为大逆。浮则无血。大则为
寒。寒气相搏。则为肠鸣。医乃不知。而反饮冷水。令汗大出。水得寒
气。冷必相搏。其人即KT 。（音壹）
又曰。趺阳脉浮。浮则为虚。浮虚相搏。故令气KT 。言胃气虚竭
也。脉滑则为哕。此为医咎。责虚取实。守空迫血。脉浮。鼻中燥者。
必衄也。
又曰。诸脉浮数。当发热而洒淅恶寒。若有痛处。饮食如常者。蓄积有脓也。
又曰。脉浮而迟。面热赤而战惕者。六七日当汗出而解。反发热者瘥迟。迟为无阳。不能作汗。其身必痒也。
又曰。寸口脉阴阳俱紧者。法当清邪中于上焦。浊邪中于下焦。清邪中上。名曰洁也。浊邪中下。名曰浑也。阴中
于邪。必内 也。表气微虚。里气不守。故使邪中于阴也。阳中于邪。必发热头痛。项强
颈挛。腰痛胫酸。所谓阳中雾露之气。故曰清邪中上。浊邪中下。阴
气为 。足膝逆冷。便溺妄出。表气微虚。里气微结。三焦相溷。内外
不通。上焦怫郁。脏气相熏。口烂食 也。中焦不治。胃气上冲。脾气
不转。胃中为浊。营卫不通。血凝不流。若卫气前通者。小便赤黄。与
热相搏。因热作使。游于经络。出入脏腑。热气所过。则为痈脓。若阴
气前通者。阳气厥微。阴无所使。客气内入。嚏而出之。声 咽塞。寒
厥相追。为热所拥。血凝自下。状如豚肝。阴阳俱厥。脾气孤弱。五液
注下。下焦不阖。清便下重。令便数难。脐筑湫痛。命将难全。
又曰。脉阴阳俱紧者。口中气出。唇口干燥。蜷卧足冷。鼻中涕
出。舌上苔滑。勿妄治也。到七日以来。其人微发热。手足温者。此为
欲解。或到八日以上。反大发热者。此为难治。设使恶寒者。必欲呕
也。腹内痛者。必欲利也。
又曰。脉阴阳俱紧。至于吐利。其脉独不解。紧去人安。此为欲
解。若脉迟。至六七日不欲食。此为晚发。水停故也。为未解。食自可
者。为欲解。病六七日。手足三部脉皆至。大烦。而口噤不能言。其
人躁扰者。必欲解也。若脉和。其人大烦。目重。脸内际黄者。此欲
解也。
又曰。脉浮而数。浮为风。数为虚。风为热。虚为寒。风虚相搏。
则洒淅恶寒也。
又曰。脉浮而滑。浮为阳。滑为实。阳实相搏。其脉数疾。卫气失
度。浮滑之脉数疾。发热汗出者。此为不治。
又曰。伤寒咳逆上气。其脉散者死。谓其形损故也。
Guo Yong stated: Bianmai (Differentiating Pulse) refers to differentiating the pulse of Shanghan (Cold Damage disease). Pingmai (Normal Pulse) refers to assessing various pulses. In the current "Bianmai Fa" (Methods for Differentiating Pulses), although there are some contradictory and interwoven contents, the world considers that Zhang Zhongjing's medical methods are contained only in these two chapters, serving as a model for a hundred generations. Even when Wang Shuhe compiled and arranged them, he dared not arbitrarily change a single word, recording them in their original order. The questions and answers therein are all original texts by Zhang Zhongjing.
Zhang Zhongjing asked: The pulse has Yin and Yang aspects. What does this mean? It is answered: Whenever the pulse is large (Da), floating (Fu), rapid (Shu), moving (Dong), or slippery (Hua), this is named Yang pulse. Whenever the pulse is deep (Chen), choppy (Se), weak (Ruo), hidden (Fu), or minute (Wei) [one version says wiry (Xian)], this is named Yin pulse. Generally, if a Yin disease presents with a Yang pulse, the prognosis is good; if a Yang disease presents with a Yin pulse, the prognosis is fatal. Guo Yong said: This refers to the attributes of Yin and Yang pulses, not the Yin and Yang nature of the pulse itself.
He further asked: There are Yang Jie (Yang Knotting/Binding) and Yin Jie (Yin Knotting/Binding) in the pulse. How can they be distinguished? It is answered: If the pulse is floating and rapid, and the patient can eat but suffers from constipation, this is an Excess syndrome, named Yang Jie. It is expected that the condition will worsen on the seventeenth day. If the pulse is deep and slow, the patient cannot eat, feels heavy in the body, and suffers from hard stool, this is named Yin Jie. It is expected that the condition will worsen on the fourteenth day.
He further asked: In diseases, there is aversion to cold like being splashed with cold water, followed by fever. What is the cause? It is answered: When Yin pulse is insufficient, Yang Qi goes to attach to it; when Yang pulse is insufficient, Yin Qi goes to invade it. Asked: What is meant by Yang insufficiency? It is answered: For example, if the Cun Kou (Inch position) pulse is minute, it is called Yang insufficiency. When Yin Qi enters the Yang region, aversion to cold like being splashed with cold water occurs. Asked: What is meant by Yin insufficiency? It is answered: If the Chi (Cubit position) pulse is weak, it is called Yin insufficiency. When Yang Qi sinks into the Yin region, fever occurs. If the Yang pulse is floating and the Yin pulse is weak [floating one version says minute], then Blood deficiency exists. Blood deficiency leads to tendon tension. If the pulse is deep, Ying Qi (Nutritive Qi) is weak. If the pulse is floating and sweating is profuse like flowing pearls, Wei Qi (Defensive Qi) is declining. If Ying Qi is weak and moxibustion with burning needles is applied, blood flow will stagnate, leading to increased fever and irritability.
It is also stated: A pulse that is grand and expansive like a chariot canopy is named Yang Jie [one version says Autumn pulse].
It is also stated: A pulse that is continuous and rolling like feeling along a long bamboo pole is named Yin Jie [one version says Summer pulse].
It is also stated: A pulse that is fleeting like fat floating on soup indicates weak Yang Qi.
It is also stated: A pulse that is thin and winding like a spider's silk indicates declining Yang Qi [one version says Yin Qi].
It is also stated: A pulse that is continuous and soft like the end of pouring lacquer indicates loss of Blood.
It is also stated: A pulse that comes slowly and occasionally stops before resuming is named Jie (Knotted) pulse. A pulse that comes scattered and occasionally stops before resuming is named Cu (Surging) pulse [one version says Zong pulse]. Yang excess leads to Cu pulse, Yin excess leads to Jie pulse. These are all pathological pulses.
It is also stated: When Yin and Yang Qi fight each other, it is named Dong (Moving) pulse. Yang Dong leads to sweating, Yin Dong leads to fever. If the body is cold and there is aversion to cold, this indicates injury to the San Jiao (Triple Burner). If a rapid pulse appears at the Guan (Bar) position, without head or tail above and below, about the size of a bean, trembling vigorously, it is named Dong pulse.
It is also stated: If the Yang pulse is floating, large, and soft, and the Yin pulse is floating, large, and soft, and the Yin and Yang pulses are equal in degree, it is named Huan (Slow/Lax) pulse.
It is also stated: A pulse that is floating and tight is named Xian (Wiry) pulse. The Xian pulse feels like a bowstring, firm upon pressure. A Jin (Tight) pulse feels like a turning rope, changing constantly.
It is also stated: A pulse that is Xian and large, where Xian indicates reduction, and large indicates Kong (Hollow), implies Cold due to reduction, and Deficiency due to hollowing. The combination of Cold and Deficiency is named Ge (Leather) pulse. In women, this presents as miscarriage and dripping bleeding; in men, it presents as loss of Blood and essence.
He further asked: In diseases, there is shivering followed by sweating, leading to resolution. What is the reason? It is answered: If the pulse is floating and tight, but feels hollow upon pressure, this is due to underlying deficiency, hence the shivering. Because the pulse is floating, resolution through sweating is expected. If the pulse is floating and rapid, and does not feel hollow upon pressure, the person is fundamentally not deficient. If self-resolution is desired, only sweating will occur, without shivering.
He further asked: In diseases, there is resolution through sweating without shivering. What is the reason? It is answered: The pulse is large, floating, and rapid, so it is known that resolution will occur through sweating without shivering. Guo Yong said: This refers to the syndrome mentioned earlier where the pulse does not feel hollow upon pressure.
He further asked: In diseases, there is resolution without shivering and without sweating. What is the reason? It is answered: The pulse is naturally minute, because the patient previously underwent sweating, vomiting, purgation, or lost Blood, resulting in a lack of fluids inside. This represents self-harmonization of Yin and Yang, leading to inevitable self-recovery. Thus, resolution occurs without shivering or sweating.
He further asked: After three days of Shanghan, the pulse is floating, rapid, and minute, and the patient's body is cool and peaceful. What is the reason? It is answered: This indicates impending resolution. Resolution occurs at midnight. If resolved via floating pulse, slight sweating will occur. If resolved via rapid pulse, appetite will return. If resolved via minute pulse, profuse sweating will occur.
He further asked: Regarding pulse and disease, how to know if recovery is imminent? It is answered: At the Cun Kou, Guan, and Chi positions, if the characteristics of large/small, floating/deep, slow/rapid are consistent, even if cold-heat symptoms persist, this indicates harmonious Yin and Yang pulses. Even if severe, recovery is expected.
It is also stated: Obtaining a Hong (Surging) pulse [Hong one version says Fu] at Lixia (Start of Summer) is the normal pulse for that season. If the patient suffers from body pain and heaviness, sweating should be induced. If the next day the body is pain-free and light, sweating is unnecessary. If spontaneous sweating occurs, resolution will happen the next day. Why? Because the Hong pulse at Lixia is the seasonal pulse, hence the result. This applies to all four seasons.
He further asked: For any disease, how to know when it started and when it will resolve? It is answered: For example, if illness begins at midnight, it resolves at noon the next day; if it begins at noon, it resolves at midnight. Why? Illness beginning at noon resolving at midnight is because Yang obtains Yin to resolve; illness beginning at midnight resolving at noon is because Yin obtains Yang to resolve.
It is also stated: Cun Kou pulse floating indicates exterior location; deep indicates interior location; rapid indicates Fu organ location; slow indicates Zang organ location. If the pulse is slow, it indicates Zang organ involvement.
It is also stated: If the Zu Yang (Foot-Yang/Stomach) pulse is floating and choppy, and the Shao Yin (Kidney) pulse is normal, the disease is in the Spleen. According to method, diarrhea should occur. How do we know? If the pulse is floating and large, it indicates Qi excess and Blood deficiency. Now, since the Zu Yang pulse is floating and choppy, it is known that Spleen Qi is insufficient and Stomach Qi is weak. Because the Shao Yin pulse is wiry and floating [one version says deep] and just appearing, this is a regulated pulse, hence called normal. If it instead slips and becomes rapid, it is known that pus in stool will occur.
It is also stated: Cun Kou pulse floating and tight, floating indicates Wind, tight indicates Cold. Wind injures Wei Qi, Cold injures Ying Qi. If both Ying and Wei are diseased, causing bone and joint pain, sweating should be induced.
It is also stated: Zu Yang pulse slow and relaxed indicates normal Stomach Qi. Zu Yang pulse floating and rapid, floating injures Stomach, rapid disturbs Spleen. This is not the primary disease but caused by the physician's inappropriate purgation. Ying and Wei sink inward. The rapid quality first becomes minute, and the pulse reverses to only floating. The patient will likely have hard stool, belching, and relief of distension. Why? Originally, the rapid pulse disturbed the Spleen, but its rapidity first became minute, indicating Spleen Qi dysfunction, hard stool, belching, and relief. Now the pulse reverses to floating, and rapidity changes to minute. Pathogenic Qi remains alone. The heart feels hungry, but pathogenic heat cannot digest food. There is tidal fever and thirst. The rapid pulse should become slow and relaxed. If the pulse changes follow proper rules, the patient will feel hungry. If the rapid pulse appears irregularly, malignant sores will develop.
The Master also said: If the patient's pulse is minute and choppy, this is iatrogenic injury. Profuse sweating was induced, followed by repeated strong purgation. The patient has lost Blood. The disease should present with aversion to cold, followed by unremitting fever. In summer heat, the patient desires to wear covers; in winter cold, the patient desires to expose the body. Why? Yang minute leads to aversion to cold; Yin weak leads to fever. The physician's sweating made Yang Qi minute, and purgation made Yin Qi weak. In May, Yang Qi is in the exterior, and the Stomach is cold and empty. Due to internal Yang deficiency, cold cannot be overcome, hence desiring covers. In November, Yang Qi is in the interior, and the Stomach is烦热 (hot and restless). Due to internal Yin deficiency, heat cannot be overcome, hence desiring exposure. Additionally, Yin pulse slow and choppy indicates Blood loss.
It is also stated: Pulse floating and large, with hardness in the epigastrium. If heat belongs to the Zang, attack it with purgation, do not induce sweating. If heat belongs to the Fu, do not allow frequent urination. Frequent urination leads to hard stool. Profuse sweating increases heat; scant sweating makes stool difficult. If the pulse is slow, purgation is not yet appropriate.
It is also stated: Pulse floating and surging, sweat like oil, unceasing panting, inability to take fluids, insensibility of the body, alternating quietness and chaos—this is terminal exhaustion. It is unknown which Zang suffers first. If sweat wets the hair and panting is unceasing, this is Lung exhaustion. Yang remains alone, body looks like smoke, staring eyes, and shaking head—this is Heart exhaustion. Lips turn green, limbs twitch—this is Liver exhaustion. Mouth ring turns black, soft sweat turns yellow—this is Spleen exhaustion. Loss of urine and stool, delirium, fixed staring eyes—this is Kidney exhaustion. It is unknown whether Yin or Yang exhausts first. If Yang exhausts first and Yin follows, death occurs, body color turns blue. If Yin exhausts first and Yang follows, death occurs, body color turns red, armpits warm, epigastrium hot.
It is also stated: Cun Kou pulse floating and large, but the physician incorrectly uses purgation. This is a great reversal. Floating indicates lack of Blood, large indicates Cold. Cold Qi fights, causing bowel sounds. The physician does not realize this and instead gives cold water to induce profuse sweating. Water meets Cold Qi, cold fights, and the patient makes a sound "Yi" (a guttural sound).
It is also stated: Zu Yang pulse floating indicates deficiency. Floating and deficiency fight, causing belching (Qi Yi), indicating Stomach Qi exhaustion. Slippery pulse indicates hiccups, this is the physician's fault. Treating deficiency as excess, guarding emptiness while forcing Blood. Floating pulse with dry nose indicates epistaxis.
It is also stated: All floating and rapid pulses should present with fever and aversion to cold. If there is a painful area but diet is normal, it indicates accumulated pus.
It is also stated: Pulse floating and slow, with facial heat/redness and trembling/shivering. In six to seven days, sweating and resolution are expected. If fever persists, resolution is delayed. Slow indicates lack of Yang, inability to sweat, and body itching.
It is also stated: Cun Kou pulse Yin and Yang both tight. By law, clear pathogen attacks the Upper Jiao, turbid pathogen attacks the Lower Jiao. Clear pathogen attacking upper is named Jie (Clean). Turbid pathogen attacking lower is named Hun (Muddy). Yin attacked by pathogen leads to internal bi (obstruction). Exterior Qi is slightly deficient, Interior Qi does not guard, allowing pathogen to enter Yin. Yang attacked by pathogen leads to fever, headache, neck stiffness, backache, and leg soreness. This is Yang attacked by fog/dew Qi. Hence clear pathogen attacks upper, turbid pathogen attacks lower. Yin Qi obstruction causes cold feet/knees and erratic urination/defecation. Exterior Qi slightly deficient, Interior Qi slightly knotted. San Jiao mixed, interior/exterior blocked. Upper Jiao stagnant, Zang Qi熏 (fumes), causing mouth ulcers and rotting food. Middle Jiao dysfunctional, Stomach Qi rushes up, Spleen Qi does not transform, Stomach becomes turbid, Ying/Wei blocked, Blood coagulates. If Wei Qi passes first, urine is dark yellow, fighting with heat, traveling meridians/Zang-Fu, causing abscesses/pus where heat passes. If Yin Qi passes first, Yang Qi is cold/weak, Yin has no use, guest Qi enters, sneezes out, voice hoarse/throat blocked. Cold/Jue chase each other,擁 (surrounded) by heat, Blood coagulates and exits downward, looking like pig liver. Both Yin/Yang Jue, Spleen Qi lonely/weak, five fluids pour down, Lower Jiao fails to close, clear stool heavy, frequent difficult defecation, umbilical cramping pain, life difficult to save.
It is also stated: Pulse Yin and Yang both tight, breath from mouth, dry lips/mouth, curled sleeping, cold feet, runny nose, slippery tongue coating. Do not treat rashly. By the seventh day, if slight fever and warm hands/feet appear, this is impending resolution. If after eight days, high fever returns, this is difficult to treat. If aversion to cold exists, vomiting is likely. If abdominal pain exists, diarrhea is likely.
It is also stated: Pulse Yin and Yang both tight, leading to vomiting/diarrhea, but pulse alone does not resolve. If tightness leaves and patient feels safe, this is impending resolution. If pulse is slow, and after six-seven days there is no desire to eat, this is late onset, due to water retention. Not resolved. If eating is normal, this is impending resolution. Disease for six-seven days, pulses at hand/wrist/foot all arrive, great irritability, jaw locked unable to speak, restlessness—this is impending resolution. If pulse is harmonious, patient irritable, eyes heavy, inner face yellow—this is impending resolution.
It is also stated: Pulse floating and rapid, floating is Wind, rapid is Deficiency. Wind is Heat, Deficiency is Cold. Wind/Deficiency fight, causing aversion to cold.
It is also stated: Pulse floating and slippery, floating is Yang, slippery is Excess. Yang/Excess fight, pulse rapid/frequent, Wei Qi loses regulation. Floating/slippery pulse rapid/frequent, with fever and sweating—this is untreatable.
It is also stated: Shanghan with cough/reversal Qi. If pulse is scattered, death. Because form is damaged.