沉行筋骨，主阴，主里，主气郁，主寒，主水；其病为停饮，为 瘕，为胀满，为厥逆
，为洞泄。沉细为少气，为寒饮，为胃中冷，为腰足痛，为 癖；沉迟为痼冷，为精寒；沉
滑为宿食，为伏痰；沉伏为霍乱，为胸腹痛；沉数为内热；沉弦为痰饮；沉紧为胸腹痛。然
沉虽主里，亦有外感初起，寒燥之气搏束皮毛，阳为阴蔽，脉不能达，反见沉紧而数者，见
有寒热、头痛等证，即是表邪。是沉不可概言里。更有沉而细者，或为阳气不舒，或为阳虚
气陷，又不得以沉专主气滞。凡此皆于有力、无力辨之，庶可不误。
迟脉三至，为阴，为寒，为虚。气寒则不行，血寒则凝滞。寸迟则气虚不化精，尺迟则
精虚不化气。若迟兼滑大，多主湿痰顽痹；迟兼细小，必是真阳亏损，或阴寒留蓄于中，则
为泄痛，或阳气不卫乎表，而生外寒，以迟为寒、为虚固也。然有湿温、暑温、温热初起，
脉见沉迟，此非虚寒也，乃湿热郁蒸之邪，口鼻吸入，从里而发，所以脉象模糊，至数不清
，有类沉迟也；遏而无力，亦勿作虚视，乃温热熏蒸散漫，所以脉不鼓指也。热病初退，余
邪未清，正气未复，脉多迟滑。是迟不可概言寒。凡此于气色、舌苔、神情、见证验之，乃
可无误。
数脉六至，有虚有实，不尽主热。热邪主蒸散，脉多缓滑。经曰∶缓者多热，缓而滑者
为热中。又曰∶数则烦心。及《难经》有数脉为热之说，举世宗之，要不可以不辨。一伤寒
在表，脉必紧数，此寒燥之气搏束使然，非热也。一疟作时，脉必浮数，疟止脉则和缓，岂
作则有热，止则无热乎？此营卫交争使然，非热也。一痢疾脉多数而弦、数而涩。仲景曰∶
弦为阴脉。沉弦为饮。其数而弦者，湿郁气血也；其数而涩者，（涩字与遏字不同，涩是干涩
，有如刀刮竹之象），燥伤血液也，非热也。一痈疡初起，脉多数，此邪壅气血也，非热也
。一痉病脉多数，表痉为风寒外搏，里痉为血燥生风，非热也。一 瘕里疽，脉多数而涩，
此血燥而结，脉所以数涩不利也，非热也。一胎脉多数而滑，此冲任血旺也，非热也。更有
阳虚者，数而缓大；阴虚者，数而弦涩。愈虚愈数，愈数愈危，真脏脉见，数而散乱，数而
坚劲，岂可误以为热乎？总之，邪正相争者，多数脉；阴虚成劳者，尤多数脉。数而有力为
实，数而无力为虚，是热非热可无瘥矣。
洪脉状如洪水，来盛去衰，是为阳脉。洪而有力，为阳实耗阴，或为头痛、面热、烦渴
、咽痛，或为痈疡、斑疹，或为动血，或为二便不通等证；若洪而无力，乃阴虚阳亢。是洪
不可概言实。
微脉纤细无神，浮弱之极，是为阴脉，主气虚、阳虚，或畏寒、少气，或胀满、食不化
，或呕吐、泄泻，或腰腹痛，或眩晕、厥逆。然亦有痛极气闭，营卫壅滞，似微而实遏者。
是微不可概言虚。
滑脉往来流利，如珠走盘，阳也。滑而和缓，为营卫充实，禀赋充浓。妇人滑而圆满，
经断无他病，为胎孕。大抵沉分圆滑者多男，浮分圆滑者多女。若病患缓滑而大，为内热蒸
散，滑数有力，为痰、为食，多见胀闷、呕吐等证。凡病虚损者，泻痢久者，脉多弦滑，此
脾、肾受伤故也，不得概以火论。
涩脉往来艰涩，如刀刮竹，阴也（此阴字，非阴寒也，血主阴，涩乃血少之象）。外感涩
而紧数，为寒燥搏束，主身热无汗，或皮肤刺痛，或咳嗽不爽，胸臆牵疼；内伤涩而弦数，
为血燥阴伤，男子伤精，妇人不孕。多由七情不遂，营气耗伤，血无以充，气无以畅，在上
有上焦之不舒，在下有下焦之不运，在外有筋脉之拘挛、麻痹、枯痿，在里有风、劳、蛊、
膈、瘰 、内疽、乳岩、 瘕等证。总之，皆血虚化燥，由燥而结，由结而坚，致成干涩内
着之候。
弦脉弹指，如张弓弦，按之有余，阳中阴也。（仲景谓弦为阴脉。阴非寒也，乃病伏于里
之说。观下诸病便知）。弦而滑大，病在阳、在外；弦而细涩，病在阴、在内。外病为痰饮
蓄水，阳中伏阴，或眩晕、呕酸，或胸胁疼胀，或为疟、痢、痹、疝（疟脉多弦，弦为饮邪
，饮即湿也，饮伏胸胁少阳部位，阻遏清阳，故脉多弦。世认弦为少阳风邪，又不尽然）；
内伤为水亏木炽，木强土弱，为虚劳、寒热、类中、偏枯、噎膈、蛊胀等证。凡人脏腑得胃
气所及，则五脏皆和；见肝木相侵，则五脏俱病。盖以木之滋生在水，培养在土。若木气过
强，则水土皆败，而且水又为肝阳所耗，土转被木贼而伤。肾为精血之本，胃为水谷之源，
根本受伤，生气败矣，所以木不宜强也。故凡病脉见和缓者顺，见弦强者逆，见弦甚者死，
为其脏阴已尽故也。观《内经》真脏脉见，即与之期日可知。
芤脉浮大中空，按如葱管，为孤阳脱阴之候，主阴虚发热，失血脱血，头晕目眩，惊悸
怔忡，喘急，盗汗，气无所归，血无所附。芤虽阳脉，而阳实无根，大虚之兆。
紧脉急疾有力，坚实搏指，阴多阳少，乃阴邪击搏之候，主寒燥，主痛。紧数在表，为
伤寒发热、无汗、头痛、项强等证，或为痹、为疟；沉紧在里，为心胁疼痛、胸腹胀满，为
中寒逆冷、泻痢、阴疝、 癖等证，在妇人为气逆经滞，在小儿为寒燥搏束生痉之候。
缓脉四至，从容和缓，浮沉得中，胃气冲和，是为平脉，必兼他脉，乃可断病。缓而滑
大，多主实热；缓而迟细，多主虚寒。然实热必缓大有力，或为烦热、胀满、二便不利，或
为痈疡，或伤寒、温病愈后，余热未清，亦多有此脉；虚寒必迟缓无力，为阳虚畏寒、气怯
眩晕、痹弱痿厥、飧泄疼痛、精寒肾冷、小便频数等证，在女子为经迟血少、气不统血等证
。凡病但得缓脉易愈，以其未失冲和之气故也。
结脉脉来忽止，止而复起。旧诀以数来一止为促，促脉为热，为阳极；缓来一止为结，
结脉为寒，为阴极。浮结为邪在表，沉结为积聚在里。促、结二脉，又通谓为气血痰食、积
聚瘕、七情郁结等证。又动而中止，不能即还，良久复动，动而复止，止有常数为代。主
五脏无气，为呼吸存亡之候；又为女胎三月，冲任恶阻，往往脉代，不主于病。观旧诀所云
，是以结、促为实，以代为虚也。以余验之，又不尽然。暴病见结、促、代脉，多主中有留
滞、郁结等证；久病见促、结、代脉、多主忧思气结、血结使然。但缓而结者多阳虚，数而
结者多阴虚，代脉为气血衰残，力不接续，更属虚极。缓者犹可，数者更甚，代者尤剧。此
可以结之微甚，察血气之消长，故总谓之结脉。又有无病而一生见结脉者，此禀赋之异也，
不可不知。
伏脉若有若无，附骨乃见，或火闭而伏，或寒闭而伏，乃一时阴阳潜伏，阻塞气机之象
。主霍乱痛极、疝瘕闭结、食滞水饮、怒忿厥逆等证。有心腹痛极而伏者，有气逆于经，脉
道不行而伏者，有偶因气脱，不相接续而伏者。然必暴病、暴逆乃有之，开其闭而脉自复矣
。若积困绵延，脉本微细，渐至隐伏者，乃炉火将绝之兆，安得尚有所伏哉？
虚脉无力无神，经所谓按之不鼓是也。浮而无力为血虚，阴气不内营也；沉而无力为气
虚，阳气不外鼓也；洪数无力为阴虚，阴不潜阳也；迟细无力为阳虚，气不化精也。阴虚则
金水亏伤，龙雷易炽，而五液神魂之病生焉。或喘咳、劳热，或惊悸、盗汗，或失血、梦遗
。阳虚则火土气衰，真元日损，而君相化源之病生焉。或头目昏眩、呕吐亡阳，或胸膈胀满
、泄则腹疼，或溺有余沥、寒精自滑。救阴者，壮水之主，以制阳光；救阳者，益火之原，
以消阴翳。渐长则生，渐消则死。
实脉举、按皆强，鼓动有力，为三焦壅塞之候。表邪实者，浮大有力；里邪实者，沉小
有力；火邪实者，洪滑有力；寒邪实者，沉紧有力。然实脉有真有伪，真者实而聚，伪者实
而散，辟辟如弹石，散乱如解索，乃肝肾真脏脉也，非实也，须兼形证察之，庶几不误。
凡此皆脉之有真有伪，不可不辨者也。
试再言常变。浮而无力为阳虚，常也。然阳虚者必反见阴脉，阳愈虚，脉愈沉细，此真
阳不能鼓舞也。如沉极而反浮，是微阳欲脱之兆；若得补药渐浮，而仅得之中候，乃为吉象
。倘忽然而浮，浮而短涩无根，是肺之真脏脉见；浮而散大无根，是心之真脏脉见，阳将脱
矣，汗出如珠不流乃死。沉而无力为阴虚，常也。然阴虚者必反见阳脉，阴愈虚，脉愈浮数
，此真阴不能潜阳也。如浮极而转沉，是真阴将绝之兆。若得补药渐沉，而仅得之中候，乃
为吉象。倘忽然而沉，沉而欲绝，知阴将脱矣，色黑黄不泽乃死。暴病脉当有力，而反模糊
不清者，此邪遏于内也，非虚也；其有沉弱细微，至数分明者，此正不胜邪也。久病脉当柔
软，而反弦涩细数者，此真阴欲涸也。浮沉辨表里，常也。然沉脉亦有表证，浮脉亦有里证
。凡察外感，当以紧数与否为辨。盖表寒主收引，脉皆紧数而浮；温热从里发，脉多紧数而
沉。更有脉息素小之人，见似紧非紧，较平日稍为滑急者，即是外邪。又有邪轻者，或初起
未甚者，亦多如此，是又不可不兼证察之。若其脉紧急太甚，和缓全无，脉虽浮大，自非表
邪。凡辨内伤，见甚浮、甚沉、甚迟、甚数、甚大、甚小、甚微、甚实，皆是劳伤之候。但
渐缓则有生意，若弦甚者病必甚，数甚者病必危，弦细再加紧数，则百无一生，以无胃气
故也。又有始也，为浮、为大、为滑、为动、为数（五阳脉）；继也，反沉、反弱、反涩、反
弦、反迟（五阴脉）。此由表入里，由腑入脏之机，其病也进。始也，为沉、为弱、为涩、为
弦、为迟；继也，微浮、微大、微滑、微动、微数。（微字宜玩，五阴脉虽喜转阳，若忽然暴
见，又是脱象）。此由里出表，由脏出腑之机，其病也退。又有脉体本大，而更加洪数，此
邪气日甚也，其病也进；脉体本小，而渐至缓大，此胃气将至也，其病也退。又有五阳脉终
为阳，而始为有力之强阳，继为无神无气之微阳，知阳将绝矣；五阴脉虽喜变阳，若忽然暴
见，知阳不附阴，孤阳飞越，反照之不长，余烬之将灭也。又有不以部位拘者，如诸弦皆属
肝脉，诸洪皆属心脉，诸软皆属脾脉，诸浮皆属肺脉，诸沉皆属肾脉是也。又如头痛一证，
脉应在寸，常也；若少阳、阳明之痛，则不候之寸而候之关，太阳里邪蓄水之痛，又不候之
寸而候之尺。遗、淋等证，脉应在尺，常也；若气不摄精，心为热灼，又不候之尺而候之寸
。又如六脉中有一脉独乖者，即当于独乖之一脉求之，景岳所谓操独见也。又有素大、素小
、素阴（六阴）、素阳（六阳）之脉，此禀之先天，非病也，病则脉又不同矣。
总之，脉以胃气为本。经曰∶脉弱以滑，是有胃气。又曰∶邪气来也，紧而疾；谷气来
也，徐而和。夫谷气，胃气也。胃气为气血之本原，故无论何脉，但得兼而软滑和柔之象，
便是有胃气，虽病无危。若今日尚和缓，明日更弦急，知邪气之愈进；今日甚弦急，明日稍
和缓，知胃气之渐至。顷刻之间，初急后缓者，胃气之来也；初缓后急者，胃气之去也。察
邪正进退生死，一以胃气为主，则得所指归矣。然又有一切痰脉，不能以常情论者。王中
曰∶痰滞气机，往往脉见虾游、雀啄、代止之形，顷刻之间，时有时无，时大时小，或
尺寸一有一无，或关上不见，或两三路乱动。有素息多痰，不时而然者，有忽然而然者，有
僵仆卒中而然者，皆非死脉也。凡此皆其变焉者也。知常知变，乃可与言诊。
且夫辨真伪，察常变，固贵求诸博；而审病因，观进退，决死生，又贵返诸约。盖以天
地不外阴阳，阴阳不外燥湿。春山先生分刚柔、圆遏、神气六字看法，最妙。病有燥湿，脉
有刚柔；病有进退，脉有圆遏；病有死生，脉有有无神气。学人以刚柔、圆遏、神气六字为
纲，以诸脉为目，则由博返约，纲举而目张矣。刚脉者，即古所谓弦、紧、动、涩、牢、革
诸脉是也，按之有尖滞弹指之象，主阴虚之燥病。凡物少雨露滋培，势必干涩，人少血液灌
溉，亦必干涩，有同然也，故以刚脉属阴虚化燥之病。柔脉者，即古所谓濡、缓、滥、滑、
微、细诸脉是也，按之如丝线，湿泥柔软之象，主阳虚之湿病。凡物少风日暄动，势必软滥
，人少火土蒸运，亦必软滥，无二理也，故以柔脉属阳虚化湿之病。夫阴阳以气言，刚柔以
质言，脉为血脉，有气有质者也。故欲知阴阳之气，须辨刚柔之质，不独内伤为然也，外感
亦然。但外感以刚、柔二字审病因，以圆、遏二字观进退。刚而遏者，为燥邪；柔而遏者为
湿邪。再以浮、中、沉三候，以察邪之浅深，自有心得。此皆气血为邪所阻，不能循其常席
，一“遏”字足以赅之。暑湿之气（温病即暑、湿、热三气夹杂之邪），从口鼻吸受，病发于
Chen pulse (Deep pulse) operates within the muscles and bones, governing Yin syndromes, interior syndromes, Qi stagnation, Cold syndromes, and Water retention; its diseases manifest as fluid retention (Ting Yin), masses (Jia), distension and fullness, Jue Ni (cold limbs or syncope), and severe diarrhea. A Chen-Xi (Deep and Fine) pulse governs shortness of breath (Shao Qi), cold-fluid retention, cold in the stomach, pain in the waist and feet, and accumulations (Pi); a Chen-Chi (Deep and Slow) pulse governs chronic cold and cold essence; a Chen-Hua (Deep and Slippery) pulse governs retained food and latent phlegm; a Chen-Fu (Deep and Hidden) pulse governs Huo Luan (cholera-like syndrome) and chest/abdominal pain; a Chen-Shu (Deep and Rapid) pulse governs internal heat; a Chen-Xian (Deep and Wiry) pulse governs phlegm-fluid; a Chen-Jin (Deep and Tight) pulse governs chest/abdominal pain. However, although Chen pulse primarily governs interior syndromes, in the early stage of external contraction, when Cold-Dry qi binds the skin and hair, Yang is obscured by Yin, and the pulse cannot reach the surface, it may instead present as Chen-Jin and Shu. If accompanied by symptoms such as chills and fever and headache, this indicates exterior pathogenic factors. Thus, Chen pulse cannot be generally regarded as an interior sign. Furthermore, a Chen pulse that is Xi (fine) may be due to unsmooth Yang Qi or sinking of Qi due to Yang deficiency; one cannot exclusively attribute Chen pulse to Qi stagnation. All these cases must be distinguished by assessing whether the pulse is You Li (forceful) or Wu Li (forceless) to avoid error.
Chi pulse (Slow pulse) beats three times per respiration, belongs to Yin, governs Cold, and governs Deficiency. Cold Qi fails to circulate, and Cold Blood becomes stagnant. Chi pulse at the Cun (inch) position indicates Qi deficiency failing to transform into essence; Chi pulse at the Chi (cubit) position indicates Essence deficiency failing to transform into Qi. If Chi pulse is combined with Hua (slippery) and Da (large), it mostly governs damp-phlegm and stubborn bi-syndrome; if Chi pulse is combined with Xi (fine) and Xiao (small), it definitely indicates loss of True Yang or accumulation of Yin-Cold in the middle, leading to diarrhea and pain, or Yang failing to protect the exterior causing external cold, for Chi pulse indeed governs Cold and Deficiency. However, in the early stages of Shi Wen (Damp-Warmth), Shu Wen (Summerheat-Warmth), and Wen Re (Warm-Heat) diseases, the pulse may appear Chen-Chi (deep and slow). This is not Deficiency-Cold, but rather pathogens of Damp-Heat steaming and郁蒸 (stagnating), inhaled through the nose and mouth, emerging from the interior. Therefore, the pulse image is vague, the beats are indistinct, resembling Chen-Chi; the pulse is suppressed and forceless, yet should not be viewed as Deficiency. This is because Warm-Heat steams and scatters, so the pulse does not beat forcefully against the fingers. After the initial decline of a Heat disease, if residual pathogens remain unclarified and Zheng Qi (Upright Qi) has not recovered, the pulse is often Chi-Hua (slow and slippery). Thus, Chi pulse cannot be generally regarded as Cold. All these situations require verification through complexion, tongue coating, spirit, and symptoms to ensure accuracy.
Shu pulse (Rapid pulse) beats six times per respiration, can be Deficient or Excess, and does not solely govern Heat syndromes. Heat pathogens govern steaming and scattering, so the pulse is often Huan (moderate/slow) and Hua (slippery). The Classics state: "Huan implies much Heat; Huan and Hua together indicate Heat in the Middle." It also states: "Shu causes vexation in the heart." The Nan Jing also posits that Shu pulse governs Heat, a view universally followed by the world, yet it requires careful differentiation. First, in Shang Han (Cold Damage) at the exterior, the pulse must be Jin (tight) and Shu; this is caused by Cold-Dry binding, not Heat. Second, during malaria attacks, the pulse must be Fu (floating) and Shu; when the attack stops, the pulse becomes Huan He (harmonious and moderate). Does this mean there is Heat during the attack and no Heat when stopped? No, this is due to the contention between Ying and Wei (Nutritive and Defensive Qi), not Heat. Third, in Li Ji (Dysentery), the pulse is often Shu and Xian (wiry) or Shu and Se (rough). Zhang Zhongjing said: "Xian is a Yin pulse." Chen-Xian indicates fluid retention. Shu-Xian indicates Dampness stagnating in Qi and Blood; Shu-Se (Se means dry and rough, like a knife scraping bamboo) indicates Dryness injuring Blood, not Heat. Fourth, in the early stage of Yong Yang (abscesses and sores), the pulse is often Shu; this is due to pathogenic obstruction of Qi and Blood, not Heat. Fifth, in Jing Bing (spasm disorders), the pulse is often Shu; Biao Jing (exterior spasm) is due to Wind-Cold externally attacking, while Li Jing (interior spasm) is due to Blood Dryness generating Wind, not Heat. Sixth, in Jia masses and inner abscesses, the pulse is often Shu and Se; this is Blood Dryness leading to knotting, making the pulse Shu, Se, and unsmooth, not Heat. Seventh, in pregnancy, the pulse is often Shu and Hua; this is due to flourishing Chong and Ren vessels and abundant blood, not Heat. Furthermore, those with Yang Deficiency have a Shu pulse that is Huan and Da; those with Yin Deficiency have a Shu pulse that is Xian and Se. The more deficient, the more rapid; the more rapid, the more critical. When Zang Fu True Pulses appear, the pulse is Shu and scattered, or Shu and rigid. How can this be mistaken for Heat? In summary, when Pathogen and Zheng Qi contend, Shu pulse is common; especially in Yin Deficiency transforming into Lao (chronic wasting), Shu pulse is frequent. Shu with strength indicates Excess; Shu without strength indicates Deficiency. Whether Heat or not can then be determined.
Hong pulse (Surging pulse) resembles floodwater, coming vigorously and departing weakly; it is a Yang pulse. Hong with strength indicates Yang Excess consuming Yin, or manifests as headache, facial heat, vexation and thirst, sore throat, or abscesses, macules and rashes, bleeding, or obstruction of urination and defecation; if Hong is without strength, it indicates Yin Deficiency with Yang Hyperactivity. Thus, Hong pulse cannot be generally regarded as Excess.
Wei pulse (Fine pulse) is thread-like and lacks Shen (spirit), representing the extreme of Fu Ruo (floating and weak); it is a Yin pulse, governing Qi Deficiency and Yang Deficiency, or manifesting as aversion to cold, shortness of breath, distension, undigested food, vomiting, diarrhea, waist/abdominal pain, dizziness, or Jue Ni. However, there are cases of extreme pain causing Qi closure and stagnation of Ying and Wei, appearing Wei but actually being suppressed (E). Thus, Wei pulse cannot be generally regarded as Deficiency.
Hua pulse (Slippery pulse) flows smoothly back and forth, like pearls rolling on a plate; it is Yang. Hua combined with Huan He indicates sufficient Ying and Wei and robust constitution. In women, a Hua and round pulse with amenorrhea and no other illness indicates pregnancy. Generally, roundness in the Chen (deep) layer suggests male fetus, while roundness in the Fu (superficial) layer suggests female fetus. If a patient's pulse is Huan Hua and Da, it indicates internal Heat steaming and scattering; Hua Shu with strength indicates Phlegm or Food retention, often manifesting as distension, stuffiness, vomiting, etc. In patients with Xu Sun (deficiency damage) or long-term diarrhea/dysentery, the pulse is often Xian Hua due to Spleen and Kidney injury; this should not be generally attributed to Fire.
Se pulse (Rough pulse) flows with difficulty, like a knife scraping bamboo; it is Yin (this Yin refers to Blood governing Yin, and Se is a sign of Blood deficiency). In external contraction, Se combined with Jin and Shu indicates Cold-Dry binding, governing body heat without sweat, stabbing skin pain, or unsatisfactory cough with chest pulling pain; in internal injury, Se combined with Xian and Shu indicates Blood Dryness and Yin injury, causing seminal emission in men and infertility in women. This often results from unresolved Seven Emotions damaging Ying Qi, leaving Blood unable to nourish and Qi unable to flow freely. Superiorly, there is upper Jiao discomfort; inferiorly, lower Jiao dysfunction; externally, tendon/muscle spasms, numbness, withering, and flaccidity; internally, Feng, Lao, Gu, Ge, Luo Li, inner abscesses, breast cancer, and Jia masses. In summary, all are due to Blood Deficiency transforming into Dryness, leading to knotting, hardness, and resulting in dry, rough, internal adherence.
Xian pulse (Wiry pulse) springs against the finger, like a drawn bowstring; pressing reveals excess; it is Yin within Yang. (Zhang Zhongjing stated Xian is a Yin pulse. Yin here does not mean Cold, but rather pathology hidden in the interior. See subsequent diseases for proof). Xian combined with Hua and Da indicates pathology in Yang/exterior; Xian combined with Xi and Se indicates pathology in Yin/interior. Exterior pathology involves Phlegm-Fluid and water retention, Yin hidden within Yang, or dizziness, sour regurgitation, chest/hypochondriac pain, malaria, dysentery, bi-syndrome, hernia (Malaria pulse is often Xian; Xian indicates Fluid pathogen, which is Dampness. Fluid hidden in the chest/hypochondrium/Shao Yang area obstructs Clear Yang, hence the pulse is often Xian. The world recognizes Xian as Shaoyang Wind pathogen, but this is not entirely accurate). Internal injury involves Water deficiency and Wood hyperactivity, strong Wood weakening Earth, leading to Xu Lao, alternating cold and heat, stroke-like conditions, hemiplegia, dysphagia, and abdominal distension. When organs receive Stomach Qi, the five Zang harmonize; if Liver Wood invades, all five Zang are diseased. Wood generates from Water and is nurtured by Earth. If Wood Qi is too strong, Water and Earth both fail, and Water is consumed by Liver Yang, while Earth is damaged by Wood overacting. Kidney is the root of Essence and Blood; Stomach is the source of Grain and Water. Injury to the root destroys Sheng Qi (vitality), so Wood should not be too strong. Therefore, pulses showing Huan He are favorable; Xian Qiang are unfavorable; Xian Shen are fatal, as Zang Yin is exhausted. As seen in Nei Jing regarding True Zang Pulses, death dates can be predicted.
Kou pulse (Hollow pulse) is floating, large, and empty in the center, feeling like a green onion stalk when pressed; it indicates solitary Yang escaping Yin, governing Yin Deficiency with fever, blood loss, dizziness, palpitations, asthma, night sweats, Qi having no residence, and Blood having no attachment. Although Kou is a Yang pulse, Yang Excess without root is a sign of great Deficiency.
Jin pulse (Tight pulse) is urgent, forceful, solid, and beats firmly against the finger; Yin exceeds Yang, indicating Yin pathogen striking. It governs Cold-Dry and Pain. Jin-Shu at the exterior indicates Shang Han fever, anhidrosis, headache, neck stiffness, bi-syndrome, or malaria; Chen-Jin in the interior indicates heart/hypochondriac pain, chest/abdominal distension, cold reversal, diarrhea/dysentery, Yin hernia, or Pi masses. In women, it indicates Qi reversal and menstrual stasis; in children, it indicates spasm due to Cold-Dry binding.
Huan pulse (Moderate pulse) beats four times per respiration, is leisurely and harmonious, balanced in floating and sinking, with harmonious Stomach Qi; it is a Ping Mai (Normal pulse). It must be combined with other pulses to diagnose disease. Huan combined with Hua and Da mostly governs Excess Heat; Huan combined with Chi and Xi mostly governs Deficiency Cold. However, Excess Heat must be Huan Da with strength, manifesting as vexing heat, distension, urinary/fecal obstruction, abscesses, or residual heat after recovery from Shang Han/Wen Bing; Deficiency Cold must be Chi Huan without strength, manifesting as Yang Deficiency with aversion to cold, Qi timidity with dizziness, bi/flaccidity/Jue Ni, undigested diarrhea/pain, cold essence/kidney, frequent urination, or delayed menstruation/scant blood/Qi failing to control blood in women. Diseases obtaining Huan pulse heal easily because they retain Chong He Qi (harmonious vital energy).
Jie pulse (Knotted pulse) suddenly stops and then resumes. Old formulas define Cu (Cursory) as stopping after rapid beats (Cu indicates Heat, extreme Yang); Jie as stopping after slow beats (Jie indicates Cold, extreme Yin). Fu Jie indicates pathogen at exterior; Chen Jie indicates accumulation in interior. Cu and Jie pulses are also collectively referred to as signs of Qi/Blood/Phlegm/Food retention, accumulations, or emotional stagnation. Dai pulse (Intermittent pulse) stops and cannot immediately resume, returning after a long time, with regular intervals. Dai governs lack of Qi in the five Zang, indicating survival status of breathing; it also occurs in pregnant women at three months due to Chong/Ren nausea, not necessarily indicating disease. Old formulas consider Jie/Cu as Excess and Dai as Deficiency. In my experience, this is not entirely true. Acute diseases showing Jie/Cu/Dai mostly indicate internal retention/stagnation; chronic diseases showing them mostly indicate emotional Qi knotting or Blood knotting. Huan Jie mostly indicates Yang Deficiency; Shu Jie mostly indicates Yin Deficiency. Dai indicates severe Qi/Blood depletion and lack of continuity, representing extreme Deficiency. Huan is tolerable; Shu is worse; Dai is most severe. One can observe the waxing/waning of Qi/Blood through the severity of Jie, hence collectively called Jie pulse. Some healthy people show Jie pulse throughout life due to constitutional differences; this must be known.
Fu pulse (Hidden pulse) seems present or absent, visible only when pressed deeply to the bone; it may be due to Fire closure or Cold closure, representing temporary Yin-Yang hiding and Qi mechanism obstruction. It governs Huo Luan with extreme pain, hernia/Jia blockage, food stagnation/fluid retention, or anger-induced syncope. Cases include extreme heart/abdominal pain causing Fu pulse, Qi reversal blocking pulse channels, or sudden Qi collapse causing discontinuity. However, this only occurs in acute diseases/reversals; opening the closure restores the pulse. If chronic illness leads from subtle/fine to hidden pulse, it signifies impending extinction of life fire, not a hidden pulse.
Xu pulse (Deficient pulse) lacks strength and Shen, described in classics as "not drumming when pressed." Floating and weak indicates Blood Deficiency (Yin failing to nourish internally); Deep and weak indicates Qi Deficiency (Yang failing to promote externally); Hong Shu weak indicates Yin Deficiency (Yin failing to anchor Yang); Chi Xi weak indicates Yang Deficiency (Qi failing to transform essence). Yin Deficiency damages Metal/Water, allowing Dragon-Lei fire to blaze, causing disorders of fluids and spirit. Symptoms include asthma/cough, consumption fever, palpitations, night sweats, blood loss, nocturnal emissions. Yang Deficiency weakens Fire/Earth, daily depleting Yuan Qi, causing disorders of Ministerial Fire sources. Symptoms include dizziness, vomiting with Yang collapse, chest/fullness, painful diarrhea, dribbling urine, spontaneous cold seminal emission. To save Yin, strengthen the master of Water to control Solar flare; to save Yang, benefit the origin of Fire to dissipate Yin shadows. Gradual growth brings life; gradual消 (decline) brings death.
Shi pulse (Excess pulse) is strong upon lifting and pressing, beating with force, indicating San Jiao obstruction. Exterior Excess is Fu Da with strength; Interior Excess is Chen Xiao with strength; Fire Excess is Hong Hua with strength; Cold Excess is Chen Jin with strength. However, Shi pulses have true and false forms. True Shi is gathered and solid; False Shi is scattered. "Pi Pi like striking stone" or "scattered like untied cords" are Liver/Kidney True Zang Pulses, not Excess. Must examine symptoms to avoid error. These illustrate the need to distinguish true/false pulses.
Let us discuss Normal vs. Abnormal. Floating and weak indicates Yang Deficiency, which is normal. However, Yang Deficiency must reverse to show Yin pulses; the more Yang Deficient, the deeper and finer the pulse, as True Yang cannot promote. If extremely deep reverses to floating, it signals impending departure of slight Yang; if medication gradually raises it to the middle layer, it is auspicious. If suddenly floating, short/severe/rootless, it is Lung True Zang Pulse; if floating, scattered, large, rootless, it is Heart True Zang Pulse, Yang about to depart, death with bead-like sweat. Deep and weak indicates Yin Deficiency, which is normal. However, Yin Deficiency must reverse to show Yang pulses; the more Yin Deficient, the more floating and rapid the pulse, as True Yin cannot anchor Yang. If extremely floating reverses to deep, it signals impending extinction of True Yin; if medication gradually lowers it to the middle layer, it is auspicious. If suddenly deep, nearly extinct, Yin is about to depart, death with dark/yellow lusterless complexion. Acute diseases should have forceful pulses; vague pulses indicate internal pathogen suppression, not Deficiency. Weak/subtle distinct pulses indicate Zheng failing to overcome Pathogen. Chronic diseases should have soft pulses; Xian/Se/Xi/Shu pulses indicate impending exhaustion of True Yin. Floating/Sinking distinguishes Exterior/Interior, which is normal. However, Chen pulse can have exterior signs, and Fu pulse can have interior signs. For external contraction, differentiate by Jin/Shu. Exterior Cold governs contraction, so pulses are Jin/Shu/Floating; Warm-Heat emerges from interior, so pulses are often Jin/Shu/Deep. People with naturally small pulses may show slightly slippery/urgent pulses resembling tightness, indicating external pathogen. Mild pathogens or early stages also show this; verify with symptoms. If pulse is excessively urgent with no harmony, even if floating/large, it is not exterior pathogen. For internal injury, extreme Fu/Chen/Chi/Shu/Da/Xiao/Wei/Shi indicate Lao Shang (consumption/injury). Gradual slowing indicates vitality; extreme Xian indicates severe disease; extreme Shu indicates critical condition; Xian/Xi plus Jin/Shu indicates hopeless prognosis due to lack of Stomach Qi. Initially showing Fu/Da/Hua/Dong/Shu (Five Yang pulses), then reversing to Chen/Ruo/Se/Xian/Chi (Five Yin pulses) indicates progression from exterior to interior, fu to zang. Initially showing Chen/Ruo/Se/Xian/Chi, then micro-Fu/Da/Hua/Dong/Shu indicates regression from interior to exterior, zang to fu. ("Micro" implies gentle transition; sudden appearance of Yin turning Yang indicates collapse). Large pulse becoming Hong/Shu indicates worsening pathogen; small pulse becoming Huan/Da indicates approaching Stomach Qi. Five Yang pulses ending in Yang: starting as strong Yang with strength, becoming weak Yang without Shen indicates impending Yang extinction. Five Yin pulses turning Yang: sudden appearance indicates Yang not attaching to Yin, solitary Yang flying away, dying embers. Pulse diagnosis is not limited to positions: all Xian belong to Liver, all Hong to Heart, all Ruan to Spleen, all Fu to Lung, all Chen to Kidney. Headache usually corresponds to Cun; Shaoyang/Yangming pain corresponds to Guan; Taiyang interior water retention pain corresponds to Chi. Seminal emission/dysuria usually correspond to Chi; Qi failing to secure essence/Heart heat scorched corresponds to Cun. If one of the six pulses is abnormal, focus on that pulse (Jing Yue's "manipulating uniqueness"). Naturally large/small/Yin/Yang pulses are congenital, not pathological; pathology changes the pulse.
In summary, the pulse relies on Stomach Qi as its root. Classics state: "Weak and slippery pulse indicates Stomach Qi." Also: "Pathogen comes tight and rapid; Grain Qi comes slow and harmonious." Grain Qi is Stomach Qi. Stomach Qi is the origin of Qi and Blood. Regardless of pulse type, if it shows soft, slippery, harmonious qualities, it has Stomach Qi, and danger is avoided. If today harmonious, tomorrow wiry/urgent, pathogen advances; today wiry/urgent, tomorrow softer, Stomach Qi returns. Quick change from urgent to soft indicates Stomast Qi arrival; soft to urgent indicates departure. Observing pathogen/Zheng advance/retreat and life/death depends on Stomach Qi. However, some Phlegm pulses defy normal logic. Wang Zhong said: Phlegm obstructing Qi mechanism often shows shrimp-swimming, sparrow-pecking, or intermittent forms. In moments, it appears/disappears, varies in size, exists/missing in Cun/Chi, absent at Guan, or chaotic in multiple channels. Some have chronic phlegm, some sudden onset, some collapse/stroke; none are death pulses. These are variations. Knowing normal and variable allows discussion of diagnosis.
Differentiating true/false and normal/abnormal requires breadth; examining etiology, observing advance/retreat, deciding life/death requires simplicity. Heaven and Earth are Yin-Yang; Yin-Yang are Dryness-Dampness. Mr. Chunshan’s six-character method (Gang Rou, Yuan E, Shen Qi) is excellent. Diseases have Dryness/Dampness; pulses have Gang/Rou. Diseases have Advance/Retreat; pulses have Yuan/E. Diseases have Life/Death; pulses have Shen/Qi. Students use Gang Rou Yuan E Shen Qi as guidelines and various pulses as details, achieving simplicity from complexity. Gang pulses (ancient Xian, Jin, Dong, Se, Lao, Ge) feel sharp, sticky, springing; they govern Yin Deficiency Dryness. Objects lacking rain/dew become dry; humans lacking blood irrigation become dry. Thus, Gang pulses belong to Yin Deficiency transforming into Dryness. Rou pulses (ancient Ru, Huan, Lan, Hua, Wei, Xi) feel like silk lines or wet mud; they govern Yang Deficiency Dampness. Objects lacking wind/sun become soft; humans lacking Fire/Earth steaming become soft. Thus, Rou pulses belong to Yang Deficiency transforming into Dampness. Yin-Yang refers to Qi; Gang Rou refers to Substance. Pulses are Blood Vessels, possessing both Qi and Substance. To know Yin-Yang Qi, distinguish Gang Rou Substance. This applies to both internal and external injuries. For external injuries, use Gang/Rou to determine etiology, Yuan/E to observe advance/retreat. Gang+E indicates Dryness pathogen; Rou+E indicates Dampness pathogen. Using Fu/Zhong/Chen three levels to check pathogen depth yields insight. All are due to Qi/Blood blocked by pathogens, unable to follow normal paths; "E" covers it all. Shu Shi Qi (Wen Bing is mixture of Summerheat, Damp, Heat) inhaled through nose/mouth causes disease...