(出伤寒百证歌)
大浮数滑动阳脉。阴病见阳生可得。沉涩弦微弱属阴。阳病见有阴终死厄。阴阳交互最难明。
轻重斟量当别白。轻手脉浮为在表。表实浮而兼有力。但浮无力表中虚。自汗恶风常淅淅。
重手脉沉为在里。里实脉沉来亦实。重手无力大而虚。此是里虚宜审的。风则虚浮寒牢坚。
水停水 必沉潜。动则为痛数则热。支饮应须脉急弦。太过之脉为可怪。不及之脉亦如然。
荣卫太盛名高章。高章相搏名曰纲。荣卫微时名 卑。 卑相搏损名彰。荣卫既和名缓迟。
缓迟名沉此最良。九种脉中辨虚实。长沙之诀妙难忘。瞥瞥有如羹上肥。此脉定知阳气微。
萦萦来似蛛丝细。却是体中阴气衰。脉如泻漆之绝者。疾人亡血更何疑。阳结蔼蔼如车盖。
阴结循竿亦象之。阳盛则促来一止。阴盛则结缓而迟。纵横逆顺宜审察。残贼灾怪要须知。
脉静人病内虚故。人安脉病曰行尸。右手气口当主气。主血人迎左其位。气口紧盛食必伤。
人迎紧盛风邪炽。数为在腑迟为脏。浮为在表沉在里。浮紧兼涩寒伤荣。脉浮而缓风伤卫。
脉浮大忌令人吐。欲下犹防虚且细。沉微气弱汗为难。三者要须常审记。阳加于阴有汗证。
左手沉微却应未。跗阳胃脉定死生。太溪肾脉为根蒂。脉来六至与七至。邪气渐深须用意。
浮大昼加并属阳。沉细夜加分阴位。九至以上来短促。状若涌泉无入气。更加悬绝渐无根。
命绝天真当死矣。病患三部脉调匀。大小浮沉迟速类。此是阴阳气已和。勿药自然应可喜。
(From *Shanghan Baizheng Ge*)
Floating (Fu), large (Da), rapid (Shu), slippery (Hua), and surging (Dong) pulses belong to Yang pulses. If a Yin disease presents with a Yang pulse, it indicates that the healthy Qi is still present, the prognosis is good, and it is treatable. Sinking (Chen), choppy (Se), wiry (Xian), thin (Wei), and weak (Ruo) pulses belong to Yin pulses. If a Yang disease presents with a Yin pulse, it indicates that the healthy Qi is exhausted, the prognosis is poor, and there is a risk of death. The interplay between Yin and Yang pulses is the most difficult to clarify; one must carefully weigh the severity of the condition to distinguish them clearly.
A pulse felt lightly at the superficial level indicates a Exterior syndrome. An Exterior Excess pattern manifests as a floating pulse that is also forceful. If only a floating pulse without force is seen, it indicates an Exterior Deficiency pattern, where the patient often experiences spontaneous sweating, aversion to wind, and a sensation of shivering cold (Xi Xi).
A pulse felt heavily at the deep level indicates an Interior syndrome. An Interior Excess pattern manifests as a sinking pulse that is firm upon pressure. If heavy pressure reveals weakness, and the pulse shape is large yet empty, this is an Interior Deficiency pattern, which requires careful examination and confirmation.
Wind pathogens typically cause a deficiency-floating pulse; Cold pathogens typically cause a firm and hard pulse. Accumulation of water-fluids必然 results in a sinking and submerged pulse. A surging pulse indicates pain; a rapid pulse indicates heat. In cases of Zhi Yin (fluid retention under the diaphragm), an urgent and wiry pulse should be observed. Pulses that are excessively strong are startling, while those that are deficient are similarly notable.
When Ying (Nutrient) and Wei (Defensive) Qi are excessive, it is called "Gao Zhang" (High and Chapter). When Gao Zhang interacts, it is called "Gang" (Cord/Rope). When Ying and Wei Qi are weak, it is called "Bei" (Low/Humble). When Bei interacts, causing obvious damage, it is called "Zhang" (Manifest/Clear). When Ying and Wei are harmonized, the pulse is called "Huan Chi" (Slow and Delayed). A Huan Chi pulse that is sinking is considered the best. Distinguishing Deficiency and Excess among the nine types of pulses is the exquisite secret of Changsha (Zhang Zhongjing), which is wonderful and unforgettable.
A pulse that flits about like fat on the surface of soup indicates that Yang Qi is definitely weak. A pulse that is slender and fine like a spider's silk indicates that Yin Qi in the body is declining. A pulse that cuts off abruptly like pouring lacquer indicates blood loss in the patient, leaving no room for doubt.
The pulse of Yang Jie (Yang Knotting) is abundant and grand like a chariot canopy. The pulse of Yin Jie (Yin Knotting) is rigid like a bamboo rod. Yang excess leads to a Cui (Intermittent) pulse, stopping after every beat. Yin excess leads to a Jie (Knotted) pulse, slow and delayed. One must carefully examine longitudinal, transverse, reverse, and smooth pulses, and must know the residual, harmful, and abnormal pulses.
If the pulse is calm but the person is ill, it is due to internal deficiency. If the person appears well but the pulse is abnormal, it is called "Xing Shi" (Walking Corpse), a fatal sign. The Qi Kou pulse on the right hand primarily governs Qi; the Ren Ying pulse on the left primarily governs Blood. A tight and full Qi Kou pulse indicates injury from food stagnation. A tight and full Ren Ying pulse indicates rampant Wind pathogen. A rapid pulse indicates a Fu organ disease; a slow pulse indicates a Zang organ disease. A floating pulse indicates the Exterior; a sinking pulse indicates the Interior. Floating, tight, and choppy indicate Cold injuring the Ying blood. Floating and slow indicate Wind injuring the Wei Qi.
For a floating and large pulse, vomiting therapy is contraindicated. If considering purgative therapy, one must still guard against the pulse being deficient and fine. For sinking, minute, and weak pulses with deficient Qi, inducing sweat is difficult. These three situations must be constantly remembered and examined. When Yang adds to Yin, sweating occurs. However, if the left hand pulse is sinking and minute, sweating should not occur (or indicates a specific contradiction). The Fu Yang pulse (Stomach pulse) determines life and death; the Tai Xi pulse (Kidney pulse) is the root.
A pulse beating six to seven times per breath indicates that the pathogenic Qi is gradually deepening, requiring careful attention. A floating and large pulse worsening during the day belongs to Yang. A sinking and fine pulse worsening at night belongs to Yin. A pulse beating nine or more times per breath is short and abrupt, resembling a gushing spring with no return flow. If accompanied by a hanging and isolated quality and gradual loss of root, the Heavenly Truth is severed, and death is imminent.
If the pulses in the three positions of the patient are uniform, similar in size, depth, floating/sinking, speed, and slowness, this indicates that Yin and Yang Qi are already harmonized. Medication is unnecessary, and natural recovery should be a source of joy.