寸脉微细者，宜温补，（为阳气不足也。）尺脉微细者，宜温暖。（为阴气虚寒也。）
二尺浮大，肺气先绝。（张东扶曰∶二尺浮大知是肾虚，确缘肺金先败，不能生肾水之
故。）左尺微细不起，右尺带数，或浮大，病名虚损，调理二、三年方得愈。凡浮大之脉，见于右
尺者，俱是假火，假火从内伤施治。
右尺阳中之阴，（右尺脉主火，有离象焉，是为阳中之阴也。）若沉细数，阳中之阴虚也
，当救其阴，六味丸。若浮大而有力，阴虚火动，四物汤加黄柏知母，或六味汤，加生脉散。若
浮大而无力，当责其无火，宜补中扶阳，保元汤，用黄 必用肉桂，一敛一散，浮大而见豁
左尺阴中之阳，（左尺脉主水，有坎象焉，是为阴中之阳也。）若沉细数，阴中之阳虚也
，当
；浮大而见豁，阴气将绝，难以取效。
脉沉而有力，大便闭者，承气汤；沉而无力，大便闭者，芎归枳壳汤。凡脉沉而带数，
阴中伏火也，宜泻阴中之伏火，六味丸。
胃脉见豁大，保元四君子，加麦冬、五味；见于脾脉，保元汤，加干姜、白术；见于肺
脉，八味丸；见于心脉，大补阴丸；见于肝脉，四物汤加黄柏、知母。大凡豁大之脉，须沉缓者
可治，沉则胃不绝，缓则脾不绝也。倘非沉缓，其何能药？
凡脉豁大外有火，沉细里有火。六脉俱有火者，宜八珍汤和之，脉大亦火之使然。凡脉
浮大数，或两手俱浮大数，或轻按浮大，重按虚小，或肾脉重按无力不清，皆是中气不足。微紧
、微弦、微数，皆系脾胃不足。
凡脉沉迟，冷汗出，险。沉细，冷汗出，死。洪大，冷汗出，立死。（张东扶曰∶冷汗
、阳虚、沉迟、沉细、阳虚之脉，细甚于迟，故有险、死之别，洪大，虚阳脱矣，故云立死。）
如脾脉顿细，肾脉重按无力不清，外无表证，宜补中益气。（炳章按∶细为阴虚，脾脉
细宜补脾阴，且肾脉无力，尤为阴虚之征，不宜补中益气之升举。）
尺脉大于寸脉而俱有力，为阳虚阴盛，宜汗之。寸脉大于尺脉而俱有力，为阴虚阳盛，
宜下之（汗则从阳，下则从阴。）
尺脉浮而有力宜表；浮而无力宜补；沉而有力，滋阴降火；沉而无力，地黄丸。
左脉微弱，右脉豁大有力，六味丸，加五味、炮姜、益智。右尺大，君不主令，相火代
之，邪火不杀谷，宜用温火生土之义，六味丸，加五味、炮姜、益智。邪火不杀谷，土中无正火
也，单用六味则土寒，加此三味，可以退邪火，温正火矣。（张东扶曰∶左脉微弱血不足也
。右脉豁大有力阴火起也。用六味所以壮水制火，加下三味所以敛火归原，且不令水气得以
血证，脉见豁大无力可延，短数、紧数、细数，豁大有力，不祥之兆。（张东扶曰∶脉
数为胃气不足，宜补脾阴以养胃气。豁大，气虚有火，无力者，和软也。胃气犹在，故可延。短
则气疾，细则无水，紧数则表之阳虚，细数则里之阴虚，有力则无胃气，故为不祥之兆。）
下部见数，不得用炮姜。（炳章按∶数脉不得用热药。）宜用附子升气。上部见数，宜炮
姜，以其温中达下也。（张东扶曰∶干姜敛火归原，下部有火用之，则火固而不散。）
命门脉不起，是为心之正脉，沉小亦是正脉。（相不敢亢君也。）
豁大、心包络少血，宜归脾汤。为短为涩，俱是心包络不足。肝脉弦长，脾脉短，是为脾阴
不足，宜山药、莲子、五味之类。带数，中气不足，补中益气汤。脾脉缓，肝脉或弦或紧，
或弦紧洪数，俱从肝治之方愈。肺脉短涩，心脉浮洪，宜利小便，引心火下行。肺脉浮大，
或豁大，或微细，纵心脉不平，亦当从肺治之。（张东扶曰∶心火来克肺金，宜从肺中泻火，若单治心，则肺病不除。）
浮而有力当汗，无力当温。沉而有力当下，无力当补。凡豁大之脉，俱是阳虚，（张东
扶曰
，甘草五分，陈皮五分，研末，米汤调服。（炳章按∶胃强脾弱，当抑胃扶脾，枳术丸是也
。如用先生此方，当加川连。以抑胃，其义方全。）
脉细宜沉，细而浮，阳虚之渐，转沉为数，劳病不治。
脉弦，甘酸之剂皆可用。黄 建中汤。
脉洪，甘寒之剂皆可用。热邪所伤，三黄丸、调胃承气汤。
脾胃脉缓，如得本经太过，湿邪所伤，除湿渗痰之剂皆可用，平胃散，加白术、白茯苓
脉涩，燥热所伤，甘温甘润之剂皆可用，四君子，加熟地、当归，生脉散，加归身、山药。
脉沉细，寒邪所伤，甘热之剂皆可用，理中丸汤、四逆汤。寒甚，理中加附子，益黄散
六脉俱弦，指下有虚，脾胃虚弱病也。
六脉沉紧，按之不鼓，（一本于“不鼓”下多“膀胱胜小肠也。此水投于火”十一字。）大寒
之证也，宜温之。脉沉紧而涩，按之空虚，中寒证也。脉洪大而涩，按之不鼓而无力，是为
阴虚，（一本作寒）乃气血俱虚之极也。
脉缓而弦急，按之洪大，病在中，脾土受邪也。脉大则无火，脉细则无水。
凡杂病、伤寒、老人，见歇至脉者，俱将愈之证。唯吐而见歇至脉者，必死之证。盖病
后而见歇至者，邪去正虚也。吐属肾，吐后而见歇至者，肾气将绝，不能续也，故知必死。
尺脉浮沉俱有力，宜下，无力则为虚，宜补。寸脉浮沉俱有力，宜汗。无力则为虚，宜
升。
尺脉洪大，阴不足，阳往乘之，补中益气汤，加黄柏。左脉弦滑有力，热不退，四物汤加知
柏小柴胡之类。右脉弦数无力，补中益气汤，或补脾阴不足，左病右取，右病左取，上病下
求，下病上求。左尺浮紧有力，伤寒宜解表，汗出即愈。但有力不紧，清心莲子饮。无力则
为虚，六味地黄丸。沉实为寒，沉迟为虚，宜温宜补。沉微弱则为虚，不宜直补，所谓补肾
不若补脾，正与此同。沉数，阴中无阳，八味地黄丸汤。右尺浮而有力，系邪脉，后必泄泻
喘促而亡。（浮为阴虚，有力为邪火，泄泻下虚不固也，不能纳气归原也。）
凡脉浮取不得，为阴中之阳虚；沉取不得，为阳中之阴虚；未至而至者为实邪，应至而
不至者为虚邪；短为肺气虚，兼之以数，则火克金也。（学易草庐本，于望色切脉一篇，至“脉
细则无水”一句而止，以后二十行，系东扶续书于后者，盖亦是慎斋之辞，为他门人所录，
而此本未及编入，故补录之，今稍低一字，以别于学易草庐之原本。）
When the Cun (Inch) pulse is faint and fine, warming and tonification are appropriate, (this indicates insufficiency of Yang Qi.) When the Chi (Cubit) pulse is faint and fine, warming is appropriate. (This indicates deficiency and cold of Yin Qi.)
If both Chi pulses are floating and large, it signifies that Lung Qi has first exhausted itself. (Zhang Dongfu stated: Floating and large Chi pulses indicate Kidney deficiency; this is indeed due to the prior failure of Metal (Lung) failing to generate Water (Kidney).) If the Left Chi pulse is faint, fine, and unarising, while the Right Chi pulse is rapid or floating and large, the disease is named "Xu Sun" (Deficiency and Emaciation), requiring two to three years of regulation for recovery. Whenever a floating and large pulse appears at the Right Chi position, it represents False Fire; such cases should be treated according to internal injury principles.
The Right Chi position belongs to "Yin within Yang." (The Right Chi pulse governs Fire, possessing the image of Li (Fire trigram), thus termed Yin within Yang.) If the pulse is deep, fine, and rapid, it indicates deficiency of Yin within Yang; one should rescue Yin using Liuwei Wan (Six-Ingredient Rehmannia Pill). If the pulse is floating, large, and forceful, it indicates Yin deficiency with stirring fire; use Siwu Tang (Four Substance Decoction) added with Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome), or Liuwei Tang added with Shengmai San (Generate the Pulse Powder). If the pulse is floating, large, and weak, one must attribute it to lack of Fire; tonifying the middle and supporting Yang is appropriate, using Baoyuan Tang (Preserve the Origin Decoction); when using Huangqi (Astragalus Root), Rougui (Cinnamon Bark) must be included, creating a combination of astringing and dispersing. If the pulse is floating, large, and shows a hollow quality, it is critical.
The Left Chi position belongs to "Yang within Yin." (The Left Chi pulse governs Water, possessing the image of Kan (Water trigram), thus termed Yang within Yin.) If the pulse is deep, fine, and rapid, it indicates deficiency of Yang within Yin, and one should...; if the pulse is floating, large, and hollow, it indicates that Yin Qi is about to exhaust, making treatment difficult.
If the pulse is deep and forceful with constipation, Chengqi Tang (Gut-Purging Decoction) is used; if the pulse is deep and weak with constipation, Xiongguo Zhike Tang (Szechwan Lovage, Angelica, and Aurantium Decoction) is used. Whenever the pulse is deep and rapid, it indicates hidden fire within Yin; one should drain the hidden fire within Yin using Liuwei Wan.
If the Stomach pulse presents as hollow and large, use Baoyuan Tang combined with Sijunzi Tang (Four Gentlemen Decoction), added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry); if seen in the Spleen pulse, use Baoyuan Tang added with Ganjiang (Dried Ginger) and Baizhu (Atractylodes Rhizome); if seen in the Lung pulse, use Bawei Wan (Eight-Ingredient Pill); if seen in the Heart pulse, use Dabu Yin Wan (Great Tonification of Yin Pill); if seen in the Liver pulse, use Siwu Tang added with Huangbai and Zhimu. Generally, for hollow and large pulses, only those accompanied by deep and slow qualities are treatable; a deep pulse indicates Stomach Qi is not exhausted, and a slow pulse indicates Spleen Qi is not exhausted. If not deep and slow, how can medication be effective?
Whenever the pulse is hollow and large externally indicating fire, but deep and fine internally indicating fire: if all six pulses show fire, Bazhen Tang (Eight Treasure Decoction) is suitable for harmonization; a large pulse is also caused by fire. Whenever the pulse is floating, large, and rapid, or both hands are floating, large, and rapid, or light pressure reveals floating largeness while heavy pressure reveals emptiness and smallness, or the Kidney pulse is weak and unclear upon heavy pressure, these all indicate insufficiency of Middle Qi. Faintly tight, faintly wiry, or faintly rapid pulses all belong to Spleen and Stomach insufficiency.
Whenever the pulse is deep and slow with cold sweat, the condition is dangerous. Deep and fine with cold sweat indicates death. Large and surging with cold sweat indicates immediate death. (Zhang Dongfu stated: Cold sweat, Yang deficiency, deep-slow and deep-fine pulses are all signs of Yang deficiency; the fine quality is more severe than the slow, hence the distinction between danger and death. A large and surging pulse indicates collapse of deficient Yang, hence 'immediate death'.)
If the Spleen pulse suddenly becomes fine, and the Kidney pulse is weak and unclear upon heavy pressure, without external exterior symptoms, tonifying the middle and boosting Qi (using Buzhong Yiqi Tang) is appropriate. (Bingzhang noted: Fine pulses indicate Yin deficiency; a fine Spleen pulse requires tonification of Spleen Yin. Moreover, a weak Kidney pulse is a sign of Yin deficiency, making the ascending action of Buzhong Yiqi Tang inappropriate.)
If the Chi pulse is larger than the Cun pulse and both are forceful, it indicates Yang deficiency with Yin excess; sweating is appropriate. If the Cun pulse is larger than the Chi pulse and both are forceful, it indicates Yin deficiency with Yang excess; purging is appropriate (sweating follows Yang, purging follows Yin).
If the Chi pulse is floating and forceful, exterior release is appropriate; if floating and weak, tonification is appropriate; if deep and forceful, nourish Yin and descend fire; if deep and weak, use Dihuang Wan (Rehmannia Pill).
If the Left pulse is weak and faint, and the Right pulse is hollow, large, and forceful, use Liuwei Wan added with Wuweizi (Schisandra Berry), Paojiang (Prepared Ginger), and Yizhi (Alpinia Oxyphylla Fruit). If the Right Chi pulse is large, it means the Sovereign Fire does not command, and Ministerial Fire takes over; evil fire fails to digest food. The principle of warming fire to generate earth should be applied: use Liuwei Wan added with Wuweizi, Paojiang, and Yizhi. Evil fire failing to digest food occurs because there is no righteous fire in the earth; using only Liuwei Wan makes the earth cold. Adding these three ingredients can retreat evil fire and warm righteous fire. (Zhang Dongfu stated: Weak Left pulse indicates blood insufficiency. Hollow, large, forceful Right pulse indicates rising Yin fire. Liuwei Wan strengthens water to control fire; the three added ingredients gather fire and return it to its source, preventing water qi from affecting...)
For blood disorders, a hollow, large, and weak pulse allows for prolongation; short-rapid, tight-rapid, or fine-rapid pulses, or hollow-large and forceful pulses, are ominous signs. (Zhang Dongfu stated: Rapid pulse indicates insufficient Stomach Qi, suitable for tonifying Spleen Yin to nourish Stomach Qi. Hollow indicates Qi deficiency with fire; weak implies softness. Since Stomach Qi remains, prolongation is possible. Short indicates Qi distress, fine indicates lack of water, tight-rapid indicates exterior Yang deficiency, fine-rapid indicates interior Yin deficiency, and forceful indicates absence of Stomach Qi, thus an ominous sign.)
If a rapid pulse appears in the lower part, Paojiang (Prepared Ginger) must not be used. (Bingzhang noted: Rapid pulses contraindicate hot medicines.) Instead, Fuzi (Aconite Lateral Root) should be used to raise Qi. If a rapid pulse appears in the upper part, Paojiang is appropriate because it warms the middle and reaches downward. (Zhang Dongfu stated: Ganjiang (Fresh Ginger) gathers fire and returns it to its source; using it when fire exists in the lower part consolidates the fire and prevents dispersion.)
If the Mingmen (Gate of Life) pulse does not arise, this is the normal pulse of the Heart; a deep and small pulse is also normal. (Ministerial fire does not presume to overpower Sovereign fire.)
Hollow and large pulses indicate insufficient blood in the Pericardium; Guipi Tang (Restore the Spleen Decoction) is appropriate. Short or choppy pulses both indicate insufficiency of the Pericardium. A wiry and long Liver pulse with a short Spleen pulse indicates insufficiency of Spleen Yin; herbs like Shanyao (Dioscorea Rhizome), Lianzi (Lotus Seed), and Wuweizi are suitable. A pulse with rapid quality indicates insufficiency of Middle Qi; Buzhong Yiqi Tang is used. If the Spleen pulse is slow, and the Liver pulse is wiry, tight, or wiry-tight-surging-rapid, treatment should focus on the Liver for recovery. A short and choppy Lung pulse with a floating and surging Heart pulse indicates the need to promote urination to guide Heart fire downward. If the Lung pulse is floating and large, or hollow and large, or faint and fine, even if the Heart pulse is uneven, treatment should still focus on the Lung. (Zhang Dongfu stated: Heart fire attacking Lung metal requires draining fire from the Lung; treating only the Heart will not resolve the Lung disease.)
Floating and forceful pulses require sweating; weak pulses require warming. Deep and forceful pulses require purging; weak pulses require tonification. All hollow and large pulses indicate Yang deficiency. (Zhang Dongfu stated...) Gancao (Licorice Root) 5 fen, Chenpi (Tangerine Peel) 5 fen, ground into powder, taken with rice soup. (Bingzhang noted: For strong Stomach and weak Spleen, one should suppress the Stomach and support the Spleen, as in Zhizhu Wan. If using this formula, Huanglian (Coptis Rhizome) should be added to suppress the Stomach, completing the rationale.)
Fine pulses should be deep; fine and floating indicates gradual Yang deficiency. Turning deep and rapid indicates incurable labor disease.
Wiry pulses allow for the use of sweet and sour preparations. Huangqi Jianzhong Tang (Astragalus and Middle-Builder Decoction) is used.
Surging pulses allow for the use of sweet and cold preparations. For damage by heat pathogens, Sanhuang Wan (Three Yellow Pill) or Tiaowei Chengqi Tang (Regulating the Stomach Gut-Purging Decoction) are used.
If the Spleen and Stomach pulses are slow, but excessive in their own channel, it indicates damage by damp pathogens; damp-draining and phlegm-percolating agents are usable, such as Pingwei San (Calm the Stomach Powder) added with Baizhu and Baifuling (Poria).
Choppy pulses indicate damage by dryness-heat; sweet-warm and sweet-moistening agents are usable, such as Sijunzi Tang added with Shudi (Prepared Rehmannia Root) and Danggui (Angelica Sinensis Root), or Shengmai San added with Guishen (Angelica Root Head) and Shanyao.
Deep and fine pulses indicate damage by cold pathogens; sweet-hot agents are usable, such as Lizhong Wan/Tang (Middle-Warming Pill/Decoction) or Sini Tang (Frigid Extremities Decoction). For severe cold, Lizhong Tang added with Fuzi, or Yihuang San is used.
If all six pulses are wiry but feel empty under the fingers, it is a disease of Spleen and Stomach weakness.
If all six pulses are deep and tight, and do not rebound upon pressure, it is a syndrome of great cold, requiring warming. (One version adds eleven characters after "do not rebound": "Bladder overcomes Small Intestine. This is water thrown into fire.") If the pulse is deep, tight, and choppy, feeling empty upon pressure, it is a cold-in-the-middle syndrome. If the pulse is surging, large, and choppy, not rebounding and weak upon pressure, it indicates Yin deficiency (one version says cold), which is extreme deficiency of both Qi and Blood.
If the pulse is slow yet wiry and urgent, feeling surging and large upon pressure, the disease is in the middle, indicating Spleen Earth is affected by pathogens. A large pulse indicates no fire; a fine pulse indicates no water.
For miscellaneous diseases, Shanghan (Cold Damage), and the elderly, the appearance of intermittent pulses (Xiezhi Mai) indicates impending recovery. However, vomiting accompanied by intermittent pulses indicates certain death. This is because post-illness intermittent pulses indicate pathogen departure and righteous deficiency. Vomiting relates to the Kidney; intermittent pulses after vomiting indicate Kidney Qi is about to exhaust and cannot continue, hence certain death.
If the Chi pulse is forceful in both floating and deep positions, purging is appropriate; if weak, it is deficiency, requiring tonification. If the Cun pulse is forceful in both floating and deep positions, sweating is appropriate; if weak, it is deficiency, requiring lifting.
Surging and large Chi pulses indicate insufficient Yin, with Yang encroaching; Buzhong Yiqi Tang added with Huangbai is used. If the Left pulse is wiry, slippery, and forceful with persistent fever, Siwu Tang added with Zhi Bai (Anemarrhena and Phellodendron) or Xiao Chaihu Tang (Minor Blue Green Decoction) is used. If the Right pulse is wiry, rapid, and weak, Buzhong Yiqi Tang is used, or tonify Spleen Yin. Treat left disease by accessing the right, right disease by accessing the left, upper disease by seeking below, lower disease by seeking above. If the Left Chi is floating, tight, and forceful, Shanghan requires exterior release; sweating leads to recovery. If forceful but not tight, Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink) is used. If weak, it is deficiency; Liuwei Dihuang Wan is used. Deep and solid indicates cold; deep and slow indicates deficiency, requiring warming and tonification. Deep, weak, and faint indicates deficiency; direct tonification is inappropriate, aligning with the principle that tonifying the Spleen is better than tonifying the Kidney. Deep and rapid indicates no Yang within Yin; Bawei Dihuang Wan Tang (Eight-Ingredient Rehmannia Pill Decoction) is used. If the Right Chi is floating and forceful, it is an aberrant pulse, followed inevitably by diarrhea, panting, and death. (Floating indicates Yin deficiency; forceful indicates evil fire; diarrhea indicates lower deficiency and insecurity, inability to grasp Qi and return it to its source.)
Whenever the pulse cannot be felt upon superficial palpation, it indicates deficiency of Yang within Yin; if it cannot be felt upon deep palpation, it indicates deficiency of Yin within Yang. Pathogens arriving before their time are excess pathogens; pathogens failing to arrive when expected are deficiency pathogens. A short pulse indicates Lung Qi deficiency; if accompanied by rapidity, it indicates Fire overcoming Metal. (The Xueyi Caolu edition ends the "Observing Color and Palpating Pulse" chapter at the phrase "fine pulse indicates no water." The following twenty lines were continued by Dongfu later, likely also spoken by Shenzhai but recorded by his disciples and omitted from this edition. They are reproduced here, slightly indented to distinguish them from the original Xueyi Caolu text.)