鳌按。辨脉平脉二篇。理精词简。义达神清。与伤寒及金匮要略同一笔墨。的是仲景所撰。旧
本有韵语一段。庸浅肤鄙。乃叔和伪作。与仲景笔墨不类。前人或置之辨脉下平脉前。或将平脉倒
置辨脉前。而以韵语冠于首。或将辨脉平脉合为一篇。而以韵语终。至柏乡既知辨平二篇不可不分。
又知先辨后平之次。何得仍将韵语冠于首。不知韵语诚属叔和伪作。当直削之。毋俾滋混。而此二篇。
乃益见纯粹也。二篇注释。皆窜摘柏乡语。而以己见正之。
问曰。脉有阴阳者。何谓也。答曰。凡脉大浮动数滑。此名阳也。脉沉涩弱弦微。此名阴也。
凡阴病见阳脉者生。阳病见阴
脉者死。
此段首揭脉有阴阳。当辨于过不及之间。
元阳为气。元阴为精。脉者。不离乎气血。亦不杂乎气血。统乎精气。而得神之名也。气血有
盛衰。精气随有盈亏。于是神亦因之各异矣。故未辨病。先辨脉。脉虽合阳气阴血而成。既成。又必
分为二。不分则不见其合也。于是脉有阴阳。所必辨也。盛而盈者。阳脉也。气血之有余也。衰而
亏者。阴脉也。气血之不足也。病气之阴阳既成。脉之阴阳必应。阴病在脏在里。得阳脉。则正气
有余。阳病在腑在表。得阴脉。则正气不足。
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。名曰阴结也。期十四日当剧。此段
就阴阳之脉。辨出阴阳之症。阳实而结。阳非有余而阴正不足。故津液耗而阴亡。阴亡而阳何所根据
乎。阴虚亦结。阳正不足而阴邪有余。故阴寒凝滞而亡阳。阳亡而阴何所主乎。此段论结。俱验大
便。似乎专论阳明。但不必专论伤寒病之阳明。凡结症皆可以阴阳辨之于脉症之间。
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。答曰。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。假令尺脉弱。名曰阴不足。阳气下陷入阴中。则发热也。此段言人身阴阳之气。稍有过不及。
即互相交争而为病。不必定出于天地之阴阳邪气。伤人身之正气也。人身之中有部位。有界限。此
不足则虚。彼有余则实。实不就虚。则虚处无气。天地内。人身中。凡有空处。无非气塞。无无气
之空处。此部位界限内。既不足而虚。则彼部位界限内有余者。必来凑实。一定之理也。
本条问答。未可专言一病。
凡寒热皆本于阴阳从乘也。阳脉浮。则阴来乘。斯恶寒矣。阴脉数。则阳往从。斯发热矣。无寒热。
不是此义。阳脉浮。阴脉弱者。则血虚。血虚则筋急也。其脉沉者。荣气微也。其脉浮。而汗出
如流珠者。卫气衰也。荣气微者。加烧针。则血流不行更发热而烦躁也。
此段就脉之阴阳。以辨气血之或过或不及。其脉沉浮。接阳脉浮来。阳浮则阴自沉。荣气微者。
荣。血也。冲。气也。血亦气之化也。
卫气衰。宜补气以壮阳。荣气微。宜生血以滋阴。然荣气亦气。补气壮阳。未尝非滋阴也。
因筋急而加烧针。致有火邪入荣之患。脉霭霭如车盖者。名曰阳结也。脉累累如循长竿者。名
曰阴结也。脉瞥瞥如羹上肥者。阳气肥也。脉萦萦如蜘蛛丝者。阳气衰也。脉绵绵如泻漆之绝者。
亡其血也。
此段根上阳结阴结。申言之以辨阳统乎阴。阳微固不足行其气。阳衰更不能化血也。
二脉虽病脉。而浮中沉皆有力。结虽病邪。必有气聚之处。故邪反助脉而见力。如车盖如循竿
也。瞥瞥。顶汗出如珠之浮脉。脉虽浮。至瞥瞥之状。是阳脉中见弱也。萦萦。顶荣气微之沉脉。
沉虽同。至萦萦之状。是阴脉中兼见微弦细也。绵绵。承上阳从阴见绵绵之象。必平日亡血血虚。
故阳来凑荣阴之虚处。而实其隧道也。萦萦者。无将断不断之势。其细尚均匀也。绵绵者。忽细
忽微。细兼紧。尚有力。细不紧而微。则更无力矣。此所以细同。而细之中又不同也。绵绵之象。
从沉取而得。脉来缓。时一止。复来。名曰结。脉来数。时一止。名曰促。阳盛则促。阴盛则结。
此皆病脉。
此段辨脉有结促。皆病脉。不治。将至代结也。阴盛故缓。太缓无力而结。将为结代之结矣。
阳盛故数。太数无力而促。将至代矣。见诸于诊。人虽未病。脉已病矣。脉病。人未有不病者。
较结代虽尚可治。然退则吉。进则凶。辨脉者。当预图。
阴阳相搏名曰动。阳动则汗出。阴动则发热。形冷恶寒者。三焦伤也。若数脉见于关上。（动脉之
象）上下无头尾。厥厥动摇者。名曰动也。
此段辨明五阳脉中之动脉。及动脉主症。因摹动脉之形状。
关上。专主关脉言。厥厥动摇。且兼滑矣。阳动则汗出者。阳不足。阴乘而搏阳。沉取之。脉
必动。阴脉动。则阴强而阳弱不固。故汗出。阴动则发热者。阴不足。阳从而搏阴。浮取之。脉必
动。阳脉动。则阳强阴弱而荣不敛。故发热。此阴阳有太过不及。不能均平之故也。然又有不汗不
热。但形冷恶寒者。此三焦之里气损伤也。盖三焦根于少阴之少火。损伤则少火不能生气以充三焦。
而火亦衰。故形冷恶寒。然此非就动脉言症。乃就阴阳相搏之至极者。充类至义之尽也。反此。
大发热。汗出。烦躁不宁。可卜矣。阳脉浮大而濡。阴脉浮大而濡。阴脉与阳脉同等者。名曰缓也。
此段言平人之脉。阴阳中和。故缓脉应。然缓又论无力有力。又论兼浮兼沉。如阴脉阳脉。左
右诊之。俱浮而大。则有力。兼见濡。则有力而和柔。故为缓。
浮诊大而浮。恐其直硬弦紧见于沉取。则浮大乃亢而非和。必兼沉取之濡。则浮取不陷。中取
不弱。沉取有根。斯可谓无病之平脉也。阴阳五脉中。无缓与迟与濡。盖缓者。中和也。胃脉也。
不同于阴阳偏胜之脉。迟者。三息一至。太迟带止。则病脉近缓之微迟。尚未可名为病脉也。濡者。
柔软也。今人得之。为有湿邪。然湿邪之濡。寒湿水饮。俱兼紧细。湿热则兼数。此之濡。乃单见
和柔之象。非湿邪之濡也。大率辨脉者在神气。执一字以论专兼。如二十四脉之说。则后世之论。
非仲景本意也。
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。脉弦而大。
弦则为减。大则为芤。减则为寒。芤则为虚。虚寒相搏。此名为革。妇人则半产漏下。男子则亡血
失精。
此段辨明五阴脉中之弦脉。因论弦脉主症。
弦脉按之直劲不动。紧脉按之移动如转索。是弦乃紧之有力而硬
直者。紧乃弦之无力而细直者。弦虽兼浮紧。而弦自弦。紧自紧。明矣。弦减芤三脉。是递说。又
从三脉合看出革脉。若弦脉。似有力而大。却非硬直。亦非单弦。盖单弦则浮而见紧。兼大则中取
不紧。有渐微之象。是减也。如十分之物。减损一二分也。然见于浮。其损轻。见于沉弦且大。是
形大力薄。则不止于减损。其中且必亏伤。而呈中空外实。芤之形象。见减知寒。以弦紧皆阴脉。
阴乘阳而寒盛也。见芤知虚。以浮大之弦。渐成形大力薄。则阳不足而气中虚也。弦为减。减阳气
则不能和柔。大为芤。虚中气。则脉不能充实。虚寒相搏者。中阳既虚。必聚阴寒。故名革也。革
如鼓革。外硬中空。是为病脉。不必说为改革生命之革也。观下半产漏下。亡血失精。皆革脉之见
症。不外于中空外实之义也。中空。固正气空。外实者。阴气也。阳之根空于中。则外阳尽掣。不
能包阴。而阴散于外而实。是阴阳俱失其位。而血竭精枯。所必至也。失此不治。而鼓革之革。亦
且为改革之革矣。脉弦而芤。未尝言浮沉二取也。后条乃言脉弦而紧。按之反芤。可知浮与沉两取之
矣。所谓按之大。大而空。故谓之芤。言极简而意极该。正难一见了然耳。
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。故当战而汗
出也。其人本虚。是以发战。以脉浮。故当汗而解也。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。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。问曰。病有不战不汗而反解者。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。
此段因辨脉而知其症。故是辨脉。非辨症也。浮取。弦也。按之芤。则弦而大也。本虚者。中
气不足。不能使邪透表。邪又欲透表之甚。中气方振。汗作随之。故必身战而后汗出也。若脉浮而
数。即从上转下。言若汗出不战者。则气未虚。诊之而非紧。必数也。邪已将透表也。按之不芤。
是中取而得实象。知正气足以逐邪。汗出而不致身战也。再问不战而汗出。乃于浮数之中。见一大
字。不惟无弦紧。且浮数者亦有力。于此言大。知异乎沉取之弦而大也。彼弦紧之弦。
阴脉阳盛。此浮数之数。阳脉阳盛也。彼浮紧之弦。得于沉取。沉取则弦者大。大而空也。此浮
数之数。不待沉取。即见大。大而实也。彼此浮沉。为紧为弦为数为大。俱辨脉之必精者也。其脉
自微者。非正气微。乃邪气退而脉得宁静不弦紧。亦不浮数。虚之大实之大俱平也。故曰微脉。
虽弱而非病脉。不过因曾经发汗吐下亡血。正气弱。津液亡。故脉见微也。然无他病。致脉偏胜。
左右浮沉一例。则阴阳之气。虽微而自和合也。
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。
此段辨脉而知解之时。解之状。伤寒见病在表。亦可类推。脉浮。已有邪欲透表之势。不必兼
数兼微也。然兼见单见。皆各有义。故犹必验诸症。如脉浮数而微。病患身凉意和。可知其夜半病
解。盖浮数恐身热。浮数而微。恐正虚而烦。今身凉意和。不热不寒。知此浮数。乃邪急向外。病
后正虚之微。俟夜半阳生。阳不微。则驱邪有力。邪必透表。而浮数自罢矣。此浮兼微之诊也。或
但浮不数。则邪不盛不微。则正不虚。故不大汗而解。若但数。并不浮。是邪尚不能自然透表。然
不微。则中气足。必能食。食能助气。气能驱邪。故邪自解。若但微。似乎难解。然此微非病脉。
即前其脉自微之微。但既微。则正气虚。而卫稍虚。故必大汗出而表症以解。此三者。皆于辨脉而
得其症之本原。自能预知其解之时。解之状也。
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。
此段就脉辨之。而知阴阳自和。必自愈也。此又辨脉察症。进退之机也。曰脉病。以病时脉为
问也。今见此三处同等之脉。虽病寒热。亦可以和脉答之。
三处各有三诊。脉皆同等。所谓和也。盖大小浮沉迟数。皆可名病脉。至于三
处同等。则俱为和脉也。
前段言不战不汗而解。明其为阴阳自和。于何知之。于诊三处同等脉而知之也。立夏得洪大脉。
是其本位。其人身体苦疼重者。须发其汗。若明日身不疼不重者。不须发汗。若汗 自出者。
明日便解矣。何以言之。立夏得洪大脉。是其时脉。故使然也。四时仿此。
此段辨脉得时旺。则邪不胜正。可以察病之进退也。举夏以该三时。俟人推暨其余。
须发其汗句。是曲笔。犹云身体疼重。为阴寒邪气所伤。本须发汗。但见时脉。则邪不胜正。
明日即不疼重。故汗自出。又不大出。明日便解也。此得时脉洪大之吉征也。病患得时脉为最难。
非平日持身谨慎。不能得。此时旺之脉也。
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。
此段因时脉而辨及于每日之阴阳衰旺。则不尽求之脉矣。
前条四时旺脉。即六经各有旺时之义。此又就阴阳出入。推明病机。
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。
此段就浮沉迟数。因人内外浅深而辨别之。合两手之寸口。言寸关尺三部。虽三候。而寸口又
为气之所聚。易得察识也。于此得浮沉迟数之脉而辨之。则症自可明。而所祛之邪。亦自得当矣。
浮沉。就经脉分表里。迟数。就脏腑分表里。脉浮在表。沉似在脏腑矣。然寸口之沉。非关尺之沉。
故云里。亦表之里。而非里之里也。表里义无尽。未可就经络脏腑之一大表里。而不研究其极也。
寸口脉。浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤荣。荣卫病。骨节烦疼。当发其汗。
此段承上寸口脉浮一语申明之。示人推暨其余。
荣卫俱病。则经脉俱急。故骨节觉其烦疼也。此症言治邪在
Shen Jin'ao's commentary: The chapters on Differentiating Pulse (Bian Mai) and Level Pulse (Ping Mai) possess profound principles and concise language, with clear meanings and divine clarity. Their writing style is identical to that of *Treatise on Cold Damage* (Shanghan Lun) and *Essential Prescriptions of the Golden Casket* (Jingui Yaolue), undoubtedly authored by Zhang Zhongjing. In old editions, there was a section of rhymed verse, which was vulgar, shallow, and coarse, falsely attributed to Wang Shuhe, and inconsistent with Zhang Zhongjing's style. Previous scholars either placed it after the Differentiating Pulse chapter and before the Level Pulse chapter, or inverted the order, placing the Level Pulse chapter first and the rhymed verse at the beginning; some combined the two chapters and placed the verse at the end. Since Baixiang [Zhao Kaimi] realized that the Differentiating Pulse and Level Pulse chapters should be separated and that Differentiating Pulse should precede Level Pulse, why did he still place the rhymed verse at the beginning? Knowing that the verse is indeed a forgery by Wang Shuhe, it should have been directly deleted to prevent confusion. This would make these two chapters appear even more pure. The annotations for these two chapters are excerpts from Baixiang's words, corrected with my own insights.
Question: What does it mean that pulses have Yin and Yang? Answer: Pulses that are large (Da), floating (Fu), moving (Dong), rapid (Shu), or slippery (Hua) are named Yang. Pulses that are deep (Chen), choppy (Se), weak (Ruo), wiry (Xian), or minute (Wei) are named Yin. 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.
This passage introduces the concept of Yin and Yang in pulses, emphasizing the need to distinguish them based on excess (Guo) and deficiency (Bu Ji).
Original Yang transforms into Qi, and Original Yin transforms into Essence. The pulse is inseparable from Qi and Blood but does not mix with them; it integrates Jing and Qi, thereby acquiring the name "Shen" (Spirit). As Qi and Blood fluctuate between abundance and decline, Jing and Qi correspondingly wax and wane, causing the Shen to vary accordingly. Therefore, one must differentiate the pulse before differentiating the disease. Although the pulse is formed by the combination of Yang Qi and Yin Blood, once formed, it must be divided into Yin and Yang. Without this division, their integration cannot be seen. Thus, distinguishing Yin and Yang in pulses is essential. Abundant and full pulses are Yang pulses, indicating surplus Qi and Blood; deficient and depleted pulses are Yin pulses, indicating insufficiency of Qi and Blood. Once the Yin-Yang nature of the pathogenic Qi is established, the Yin-Yang nature of the pulse must correspond. In Yin diseases located in the Zang organs or interior, a Yang pulse indicates sufficient Righteous Qi; in Yang diseases located in the Fu organs or exterior, a Yin pulse indicates insufficient Righteous Qi.
Question: How can one distinguish between Yang Jie (Yang Knotting/Binding) and Yin Jie (Yin Knotting/Binding)? Answer: If the pulse is floating and rapid, the patient can eat, but suffers from constipation, this is an Excess pattern, called Yang Jie. It is expected to worsen on the seventeenth day. If the pulse is deep and slow, the patient cannot eat, feels heavy in the body, and has hard stool, this is called Yin Jie. It is expected to worsen on the fourteenth day.
This passage uses Yin and Yang pulses to differentiate Yin and Yang symptoms. Yang Jie involves Excess and knotting; it is not that Yang is excessive while Yin is deficient, leading to consumption of fluids and loss of Yin. When Yin is lost, what supports Yang? Yin deficiency also leads to knotting; it is not that Yang is deficient while Yin Evil is excessive, leading to stagnation of Yin-Cold and loss of Yang. When Yang is lost, who governs Yin? This discussion on Jie pulses focuses on bowel movements, seemingly discussing only the Yangming channel, but it applies generally to any Jie pattern, distinguishable by Yin-Yang in pulse and symptoms.
Question: Why do some patients experience chills (Sa Xi E Han) followed by fever? Answer: When Yin pulse is deficient, Yang Qi moves to join it; when Yang pulse is deficient, Yin Qi invades it. Question: What is meant by Yang deficiency? Answer: For example, if the Cun Kou (radial artery) pulse is faint, it is called Yang deficiency. When Yin Qi ascends into the Yang region, chills occur. Question: What is meant by Yin deficiency? Answer: For example, if the Chi pulse is weak, it is called Yin deficiency. When Yang Qi sinks into the Yin region, fever occurs.
This passage explains that slight imbalances in the body's Yin and Yang Qi lead to mutual contention and disease, not necessarily due to external Heaven-Earth Yin-Yang pathogens harming the body's Righteous Qi. The body has specific regions and boundaries. Deficiency here constitutes Xu (Deficiency), while excess there constitutes Shi (Excess). If Excess does not fill Deficiency, the deficient area lacks Qi. Within Heaven and Earth, and within the human body, all empty spaces are filled with Qi; there are no truly empty spaces without Qi. Given that one region is deficient and empty, the Qi-rich region nearby will inevitably move to fill it—a fixed principle.
The Q&A in this article should not be restricted to a single disease.
All chills and fevers originate from the mutual attachment and invasion of Yin and Yang. A floating Yang pulse allows Yin to invade, causing chills. A rapid Yin pulse allows Yang to attach, causing fever. Absence of chills and fever implies this mechanism is not at play. If the Yang pulse is floating and the Yin pulse is weak, it indicates Blood deficiency, leading to tendon tension. A deep pulse indicates weak Ying Qi (Nutrient Qi). A floating pulse with sweat like flowing pearls indicates衰竭 of Wei Qi (Defensive Qi). For weak Ying Qi, applying burning needles causes blood flow obstruction, worsening fever and irritability.
This passage uses Yin-Yang pulses to identify excess or deficiency in Qi and Blood. The deep/floating pulse connects to the previous floating Yang pulse; Yang floats, so Yin naturally sinks. Ying Qi refers to Blood; Chong refers to Qi; Blood is transformed from Qi.
For衰竭 of Wei Qi, tonifying Qi to strengthen Yang is appropriate; for weakness of Ying Qi, generating Blood to nourish Yin is appropriate. However, Ying Qi is also Qi; tonifying Qi and strengthening Yang indirectly nourishes Yin. Applying burning needles for tendon tension risks Fire Evil invading the Ying level.
A pulse resembling a cloud cover (Ai Ai) is called Yang Jie. A pulse resembling feeling along a long bamboo pole (Lei Lei) is called Yin Jie. A pulse flickering like fat on soup (Pie Pie) indicates abundant Yang Qi. A pulse thread-like like a spider web (Ying Ying) indicates declining Yang Qi. A pulse continuous like dripping lacquer (Mian Mian) indicates Blood loss.
This section expands on Yang Jie and Yin Jie to show Yang governing Yin. Weak Yang cannot move Qi; declining Yang cannot transform Blood.
Although these two pulses are pathological, they are forceful in Floating, Middle, and Deep positions. Although Jie represents pathogen, there must be Qi accumulation, so the pathogen enhances the pulse's force, appearing like a cloud cover or bamboo pole. "Pie Pie" follows the floating pulse of sweating like pearls; although floating, this state shows weakness within Yang. "Ying Ying" follows the deep pulse of weak Ying Qi; although deep, this state shows subtle, wiry, and thin qualities within Yin. "Mian Mian" continues the image of Yang joining Yin; it implies chronic Blood loss and deficiency, where Yang moves to fill the Ying-Yin void. "Ying Ying" has a tendency to break but remains fine and uniform. "Mian Mian" varies between fine and minute, often tight yet forceful. If fine, not tight, but minute, it is weaker. Thus, while both are fine, they differ. "Mian Mian" is obtained via Deep palpation.
A pulse that is slow and occasionally stops, then resumes, is called Jie. A pulse that is rapid and occasionally stops is called Cu. Yang Excess leads to Cu; Yin Excess leads to Jie. These are pathological pulses.
This passage distinguishes Jie and Cu as pathological pulses. Untreated, they may progress to Dai (Intermittent) or Jie. Yin Excess causes slowness; too slow and weak leads to Jie, potentially becoming Dai-Jie. Yang Excess causes rapidity; too rapid and weak leads to Cu, potentially becoming Dai. Clinically, the person may not yet feel ill, but the pulse is already diseased. A diseased pulse invariably leads to disease. Compared to Dai-Jie, which might still be treatable, retreating is auspicious, advancing is ominous. Physicians must plan ahead.
When Yin and Yang contend, it is called Dong (Moving). Yang Dong causes sweating; Yin Dong causes fever. Cold form and aversion to cold indicate San Jiao injury. If a rapid pulse appears at Guan (Cun-Guan-Chi middle position) [image of Moving pulse], lacking head and tail, trembling vigorously (Jue Jue), it is called Dong.
This passage clarifies the Dong pulse among the Five Yang Pulses and its main symptoms, describing its shape.
Guan specifically refers to the Guan position. Jue Jue trembling implies Slippery quality. Yang Dong causes sweating because Yang is deficient, allowing Yin to invade and contend with Yang. Deep palpation reveals movement. Yin pulse movement indicates strong Yin and weak, unconsolidated Yang, causing sweating. Yin Dong causes fever because Yin is deficient, allowing Yang to follow and contend with Yin. Superficial palpation reveals movement. Yang pulse movement indicates strong Yang and weak Yin, failing to consolidate Ying, causing fever. This results from imbalance in Yin-Yang excess/deficiency. However, some present only with cold form and aversion to cold without sweating or fever, indicating damage to San Jiao internal Qi. San Jiao roots in Shaoyin's Ming Men Fire; damage prevents fire from generating Qi to nourish San Jiao, leading to fire decline and coldness. This describes the extreme of Yin-Yang contention, not just the Dong pulse symptomatically. Conversely, high fever, sweating, and restlessness predict severe outcomes.
If Yang pulse is floating, large, and soft (Ru), and Yin pulse is floating, large, and soft, and Yin and Yang pulses are equal, it is called Huan (Slow/Relaxed).
This describes the pulse of a healthy person, where Yin-Yang harmony produces the Huan pulse. Huan pulse analysis considers forcefulness and association with floating/deep. If left and right Cun-Guan-Chi are floating and large, it is forceful. If additionally Ru (soft), it is forceful yet gentle, hence Huan.
Floating palpation reveals large and floating; one must fear rigidity/wiry/tightness upon deep palpation, which would indicate hyperactivity rather than harmony. One must check deep palpation for Ru (softness); if superficial is not sunken, middle is not weak, and deep has root, it is a normal pulse. Among the Five Yin/Yang pulses, Huan, Chi (Slow), and Ru (Soft) are distinct. Huan represents harmony and Stomach Qi, unlike biased pulses. Chi (three breaths per beat) with stopping is pathological, slightly slower than Huan, not yet clearly pathological. Ru means soft; modern interpretation links it to Dampness, but Dampness-related Ru is accompanied by tight/thin (Cold-Damp/Water) or rapid (Heat-Damp). This Ru is purely soft and gentle, not Dampness-related. Pulse differentiation relies on Shen Qi (Spirit/Energy); focusing solely on characters like the 24 pulse types is a later development, not Zhang Zhongjing's original intent.
A floating and tight pulse is called Xian (Wiry). Xian resembles a bowstring, firm upon pressure. A tight pulse resembles a twisting rope. A wiry and large pulse: Wiry indicates reduction (Jian); Large indicates Hollow (Kou). Reduction indicates Cold; Hollow indicates Deficiency. Deficiency and Cold contending is called Ge (Leather). In women, it manifests as miscarriage or bleeding; in men, as blood loss or essence depletion.
This clarifies the Xian pulse among the Five Yin Pulses and its symptoms.
Xian pulse is straight and rigid; Tight pulse moves like a twisting rope. Xian is Tight made forceful and rigid; Tight is Xian made weak and thin. Although Xian combines floating and tight, they are distinct. Xian, Jian, and Kou are discussed progressively to derive Ge. Xian seems forceful and large but is not rigid or singular. Single Xian shows tightness when floating; combined with Large, middle palpation is not tight, showing gradual decline (Jian). Like losing 1-2 parts out of 10. Loss at floating is mild; loss at deep Xian-Large indicates form large but strength weak, implying internal injury and hollow-outside-solid Kou image. Seeing Jian indicates Cold (Yin pulses invading Yang); seeing Kou indicates Deficiency (Yang deficiency and Qi emptiness). Xian as Jian means Yang Qi loss prevents gentleness; Large as Kou means Qi deficiency prevents fullness. Deficiency and Cold contending, with deficient Middle Yang gathering Yin Cold, is named Ge. Ge resembles drum leather: hard outside, hollow inside. It is pathological, not referring to "reforming life." Miscarriage, bleeding, blood loss, and essence depletion are manifestations of Ge, reflecting hollow-outside-solid meaning. Hollow is Zheng Qi emptiness; solid outside is Yin Qi. With Yang root empty inside, external Yang cannot contain Yin, causing Yin to scatter externally and become solid. Yin and Yang lose their positions, inevitably leading to blood exhaustion and essence depletion. Untreated, Ge becomes irreversible.
The text mentions Xian and Kou without specifying floating/deep, but later mentions Xian-Tight with hollow center upon pressure, implying both superficial and deep palpation. "Press large, large yet empty" defines Kou. Concise yet comprehensive, hard to grasp instantly.
Question: Why do some patients shiver and sweat, resolving the illness? Answer: Floating and tight pulse, hollow upon pressure, indicates fundamental deficiency, causing shivering and sweating. Fundamental deficiency causes shivering; floating pulse indicates resolution via sweating. If pulse is floating and rapid, not hollow upon pressure, the patient is not fundamentally deficient. Resolution comes via sweating alone, without shivering. Question: Why do some resolve without shivering or sweating? Answer: Large, floating, rapid pulse indicates resolution without shivering or sweating. Question: Why do some resolve without shivering or sweating, seemingly spontaneously? Answer: Pulse is self-faint (Wei), indicating prior sweating, vomiting, purging, or blood loss, leading to fluid depletion. Yin and Yang harmonize spontaneously, ensuring recovery without shivering or sweating.
This passage differentiates symptoms via pulse, thus it is pulse differentiation, not symptom differentiation. Superficial palpation shows Xian; deep palpation shows Kou (Xian-Large). Fundamental deficiency means Middle Qi insufficiency, unable to expel pathogen to exterior. Pathogen strives to exit; Middle Qi rallies, sweat follows. Hence shivering precedes sweat. If floating and rapid, transitioning down: if sweating without shivering, Qi is not deficient, pulse is not tight but rapid. Pathogen is about to exit. Non-hollow middle palpation indicates solid image, knowing Righteous Qi can expel pathogen via sweating without shivering. Asking about non-shivering sweating reveals "Large" within floating-rapid. No Xian-Tight, and floating-rapid is forceful. "Large" here differs from deep Xian-Large. That Xian-Tight is Yin pulse with Yang Excess; this floating-rapid is Yang pulse with Yang Excess. That Xian-Tight is found on deep palpation (large and empty); this floating-rapid is seen without deep palpation (large and solid). Both superficial/deep distinctions for tight/xian/rapid/large require precise pulse differentiation. Self-faint pulse here is not Righteous Qi faintness, but pathogen retreat, pulse calming, no longer xian-tight or floating-rapid. Both extreme deficiency and extreme excess are balanced. Hence "Wei" pulse, though weak, is not pathological. It results from prior sweating/vomiting/purging/blood loss weakening Righteous Qi and depleting fluids. With no other pathology causing pulse bias, left/right/superficial/deep are consistent, meaning Yin-Yang Qi, though faint, harmonizes.
Question: After three days of Shanghan, pulse is floating, rapid, and faint, patient is cool and comfortable. Why? Answer: This indicates impending resolution, occurring at midnight. Floating pulse resolves with steady sweating; rapid pulse resolves with appetite return; faint pulse resolves with profuse sweating.
This passage determines timing and manner of resolution via pulse. Exterior Shanghan patterns can be inferred similarly. Floating pulse indicates pathogen striving to exit exterior. Combination or isolation carries meaning, requiring symptom verification. Floating-rapid-faint with cool/comfortable state indicates midnight resolution. Floating-rapid fears heat; floating-rapid-faint fears deficiency irritability. Cool/comfortable state confirms pathogen moving outward and post-disease deficiency. Waiting for midnight Yang generation, Yang strengthens to drive pathogen out, ending floating-rapid. This is floating-with-faint diagnosis. Only floating (no rapid) means pathogen not strong/weak, Zheng not deficient, resolving without profuse sweat. Only rapid (no floating) means pathogen cannot exit naturally, but non-faint indicates sufficient Middle Qi and appetite, aiding Qi to drive pathogen out. Only faint seems hard to resolve, but this faint is not pathological (as previously defined). Faintness implies deficient Zheng and slightly deficient Wei, requiring profuse sweat to resolve exterior symptoms. These three cases show how pulse differentiation reveals symptom origins, predicting resolution time and manner.
Question: How to determine if a pulse disease will recover or not? Answer: If Cun Kou, Guan, and Chi positions show equal size, floating/deep, slow/rapid, even with unresolved chills/fever, the pulse Yin-Yang is peaceful, and severe cases will recover.
This passage identifies spontaneous Yin-Yang harmony via pulse, determining recovery. It analyzes pulse-symptom dynamics. "Pulse disease" asks about pulse during illness. Finding equal pulses at three positions, even with chills/fever, indicates harmony.
Three positions, three palpations each, all equal, constitute Harmony. Size, floating/deep, slow/rapid can be pathological, but equality across positions makes them Harmonious.
Previous passage on non-shivering/non-sweating resolution showed Yin-Yang harmony, known via equal pulses at three positions.
In Lixia (Start of Summer), Hong Da (Surging-Large) pulse is its proper season. If body aches heavily, sweating is needed. If next day pain/heaviness resolves, sweating is unnecessary. If spontaneous sweat occurs, resolution follows next day. Why? Surging-large pulse in summer is seasonal pulse, facilitating this. Four seasons follow this pattern.
This passage notes that obtaining seasonal vigorous pulse means Pathogen cannot overcome Zheng, allowing observation of disease progression/regression. Using Summer to represent other seasons invites further deduction.
"Sweating needed" is indirect phrasing. Body ache/heaviness caused by Yin-Cold pathogen requires sweating. But seeing seasonal pulse, Pathogen cannot overcome Zheng, pain resolves next day, spontaneous mild sweat occurs, resolving next day. This is auspicious sign of seasonal surging-large pulse. Obtaining seasonal pulse is difficult, requiring careful lifestyle. It reflects seasonal vigor.
Question: How to know when a disease started and when it will heal? Answer: If illness starts at midnight, it heals at noon next day. If starts at noon, it heals at midnight. Why? Noon illness-midnight healing: Yang resolves with Yin. Midnight illness-noon healing: Yin resolves with Yang.
This passage discusses daily Yin-Yang waxing/waning via seasonal pulse, extending beyond pulse alone.
Previous seasonal vigorous pulses imply Six Channels have specific vigorous times. This elaborates on Yin-Yang entry/exit to explain disease mechanism.
Cun Kou pulse: Floating indicates Exterior; Deep indicates Interior; Rapid indicates Fu organs; Slow indicates Zang organs. Slow pulse indicates Zang involvement.
This passage differentiates Exterior/Interior and Zang/Fu via floating/deep/slow/rapid, considering depth and organ location. Combining both hands' Cun Kou, discussing Cun-Guan-Chi three positions, though three rates, Cun Kou gathers Qi, easy to observe. Identifying floating/deep/slow/rapid clarifies symptoms and appropriate treatment.
Floating/Deep divides Exterior/Interior via meridians. Slow/Rapid divides Zang/Fu. Floating is Exterior; Deep seems Zang/Fu Interior. However, Cun Deep is not Guan-Chi Deep, so it is "Li" (Interior), but specifically "Exterior's Interior," not "Interior's Interior." The meaning of Exterior/Interior is endless; one must not stop at general meridian/organ dichotomy but explore its extremes.
Cun Kou pulse, floating and tight: Floating indicates Wind; Tight indicates Cold. Wind injures Wei Qi; Cold injures Ying Qi. Ying-Wei disease causes bone/joint pain; sweating is indicated.
This expands on "Cun Kou pulse floating," showing application to others.
Ying-Wei disease causes meridian tension, resulting in bone/joint pain. This symptom treats pathogen in...