夫天地之道，曰阴与阳，阴阳在人，曰血与气。盖血者，荣也；气者，卫也。荣
者，荣于中；卫者，卫于外。所以荣行脉中，卫行脉外。脉者，血气之先也。血非
脉则焉能荣于中，气非脉则焉能卫于外，二者相资而行，内则通于五脏六腑、十二经
络，外则濡于九窍四肢、百节、万毛，昼夜循行，如环无端，以成其度，会于寸口，
变见于脉。故气血者，人之神也。脉者，气血之神也。所以治病之始，五决为纪。盖
五决者，五脏之色脉也。脉应于内，色应于外，其色之与脉，当相参应，故曰能合
色脉，可以万全也。凡为医先须调明色脉，况为疮科，若于此不精，虽聪慧辩博，亦不足委也。
脉理作为歌，便诵习也。其以浮沉至数辨，及不以浮沉至数辨者，各从其类，欲
其易分别也。浮沉等脉，即用浮沉等字之韵，欲其不混淆也。脉之应病，以《内
经》为主，《内经》未详者，以《脉经》补之，《脉经》未详者，以历代名医之说补之，
欲其简而赅也。有是脉即有主是病之由，复逐句笺释于其下，欲其明且畅也，较前人
脉赋脉诗，颇有胜处，有志医学人，由此入门，虽曰快捷方式，实为正路矣。
脉以轻取辨者，曰浮，轻手便得，如木浮水上。其以浮辨者，曰洪，浮大来有
力，去无力。曰虚，浮大按之无力。曰芤，
浮大无力，按之中央空，两边实。曰散，浮大无力，至数不齐，涣漫不收。曰微，浮
细无力，按之如欲绝，若有若无。（凡六脉）
\r右手经络图\p04-a41a6.bmp\r
（浮）《内经》谓之毛。
浮脉轻手得，如木水中浮，（浮，秋脉也，春夏冬见之，则病脉也。然在秋轻虚以浮，来急去散，则
为平脉，若中央坚，两边虚，此谓太过，细而微，此谓不及，亦病脉也。）有力表邪清涕嗽，恶寒发热
令人愁，（风邪自皮毛入，皮毛合肺，肺开窍于鼻，肺受寒，金寒则生水，故鼻流清涕。风邪迫肺则气逆，故
嗽。肺主卫，风邪入则皮毛闭固，卫气不能温外，故恶寒。肺与心皆在上，肺邪传心则心火郁，心主营，营行
血脉，故一身发热。仲景谓∶冬月寒伤营，则发热恶寒
无汗。风伤卫，则发热恶风有汗，此固然矣。然四时感冒者，亦发热恶寒，必用表药而愈。盖表药其昧皆辛，辛
开毛孔，散火郁，毛孔开则卫气外达，火郁散则营血内安，营卫调和则汗出而寒热解矣，）寸主头疼关腹
满，尺司癃闭好推求。（自胸至头，寸主之。诸阳经起于头，风邪自皮毛深入则归经，故头痛，肝脾与肾，
其脉常沉，今脉浮乃阳亡乘阴也，阳盛则热。木之性，寒则凋，热则旺，肝木旺则克脾土，脾虚则不欲食而腹满；
肾窍于二阴，其性恶燥，热盛则血燥而大肠不润，故闭，气燥而膀胱不化，故癃。癃者、小便不利也。）浮紧伤
寒浮虚暑，（寒伤营，营行脉中，寒气劲急，故脉紧；暑伤气，故脉虚。）浮缓风湿自宜搜，（湿气濡滞故脉
缓，凡头重身重，腿膝痛，浮肿，大便泄，小便黄者，风湿证也。）浮滑风痰浮数热，（滑主痰，带浮则为风痰；
数主热，带浮则为风热。）无力须将血弱谋。（阳盛故脉浮，阴虚故无力，遇此等脉，不宜轻用表药。）
\r《内经》切脉图\p04-a41a7.bmp\r
（洪）《内经》谓之钩，又谓之大。
应指虽浮大，来盛去衰便曰洪，（洪，夏脉也，春秋冬见之，则病脉也。然在夏来盛去衰如钩，则
为平脉，若来盛去亦盛，此为太过，来不盛去反盛，此为不及，亦病脉也。如钩者，浮候之，来盛下垂曲如钩
状，去衰则又柔和矣，故为平脉。）真阴不足，邪气相攻，（人之正气，阴阳相配者也。阴阳和则无病，阴
不足则阳盛，阳盛则生火，火者偏胜之气也，偏胜之气为邪气，邪气即邪火。）寸洪身热兼肤痛，咳唾烦
心亦可穷，（阳盛故生热，火不得泄故肤痛，火伤肺故咳唾，心恶热故烦。）呕与胀，察关中，（胃喜清凉而
恶热，呕者，火上炎也，火郁而不散也。）尺虚宜壮水，泄痢不宜逢。（尺脉洪，相火旺也，宜壮水以制阳光；
若泄痢尺脉洪者，难治。）
李濒湖谓∶洪脉非夏，升阳散火宜。愚按∶新病身强及洪见寸关者，升阳散火可也。若久病身弱及洪见两
尺者，又宜以滋阴降火为是。
（虚）濒湖引《内经》云∶气来虚微为不及，病在内。愚按∶虚脉浮大无力，微脉浮细无力，大中不能
见细，则虚不可兼言微矣。今考《内经》谓∶气来不实而微为不及。不实者细，无力之谓也，故可言微。濒湖
便以不实改作虚字，误。
虚来浮大软无力，夏月逢之暑病居，（暑病，发热有汗脉虚者，宜清暑益气；若发热恶寒无汗，脉
浮数而不虚者，宜清暑解表。）寸虚自汗多惊悸，（虚脉主气血虚，正气虚则邪气实，邪气实便是火，火愈甚
则表虚，汗者，心之液也，血所化，表既虚则营亦不固，血随火化，外泄于表自为汗；心藏神，血虚则神失所养，
故多惊；火气冲心，故跳动而多悸。）关主中宫胀不舒，（血虚肝郁则胀；脾胃虚，中气不足，亦胀。）潮热
骨蒸痿候尺，（阳气终巳，阴气始午，阴虚则交午时阴分，而阳气并之，阳胜则外越为肌肤热，内烁为骨髓
热，热在骨谓之骨蒸，曰如潮水之应时而至，谓之潮热，骨枯髓竭，足不任身，谓之骨痿。）却怜久病定亡躯。
（芤革）芤而弦曰革，主阴虚失血，与芤同，今附于此。《脉经》谓∶芤脉浮大而软，按之中央空，两
边实。旧谓前后为两边，固非矣。李士材以浮沉为两边，亦不是，有力谓之实，浮中沉相去无几，岂有浮候实，沉
候实，而中候独见其空者乎？据《内经》论浮脉云∶其气来毛，中央坚，两旁虚，此谓太过。由是推之，则两
边指两旁也，盖芤脉浮大而软，按之两旁实而中央独陷下，此血不充之象，故主失血诸证。
轻手取之浮大软，重按中空边实芤，（芤，草名。中空如葱。血行脉中，失血者其脉中空，故
以芤比之。）寸关吐衄肠痈病，尺部崩淋便血流。（吐血，衄血、肠痈、血崩、血淋、大便下血等证，
皆阳盛阴虚也，惟阳盛故其脉浮大，惟阴虚故其脉中空。）
（散）
有表无里大而散，至数不齐，杨花无定空中泛，左寸怔忡，右寸自汗，（散主气实血
虚，心主血，血虚则心神恍愧不宁曰怔忡。气实，邪气实也，邪气实则热，热则气泄，故自汗。）左关溢饮兮，
（阴虚生内热，胃热则津液耗而发渴，渴多饮，渗入肌肤肠胃之外，谓之溢饮。）右关食痹 肿亦堪断，（胃
热则不和，不和则不消谷，因而痞闷，曰食痹。 ，足胫也。阳明胃经下循胫外廉，胃热故 肿。）尺为血大
虚，两足如斯终寿算。（经以肾脉散为血少。戴同父曰∶肾脉散，诸病脉代散，皆不可治也。）
（微）
重手按之如欲绝，若有若无极其微，微属阴阳虚弱候，（惟阴阳皆虚，故其脉见若有若无之
象，而名之曰微。）恶寒发热汗霏霏，（阳虚则生寒，阴虚则生热，阳不外固，阴不内守则多汗。）寸微衄血
惊兼喘，关主中寒拘急危，（气血虚则中寒，寒则心下拘急。拘急，不宽畅也。）尺中厥逆元阳损，（阳
火生于阴精，阴精虚则阳火弱，阳火热则手足寒而为厥，阴阳不交，气上冲而为逆也。）女子崩中带下亏。
脉以重取辨者，曰沉，重按始得。其以沉辨者，曰伏，重按之，着骨乃得。（凡二脉。）
（沉）《内经》谓之石，又谓之营。（牢）牢即沉脉，长大弦而有力者，主寒主痛，与沉同，今削于此。
按始有，则为沉，（沉，冬脉也。春夏秋见之，则病脉也。然在冬其气来沉以搏，则为平脉；若来如弹
石者，此谓太过；其去如数者，此为不及，亦病脉也。）寸沉胸胁痛，水气膈间停，若居关与尺，腹
背及腰痛。（沉主阴，阴盛则克伐元气，故三部得沉者，皆主痛，宜温之；有水气者，宜利之。）沉缓寒湿沉
数热，沉滑当知痰食真，沉如无力，气虚甚明。（沉有力为实邪，故主寒主积，沉无力则气虚也。）
（崔紫虚《四言举要》云∶沉牢痼冷，沉实热极。愚按∶牢脉沉而长大有力，实脉沉取亦长大有力，同一沉
取长大有力，何以辨其为痼冷热极乎？）
（伏）
何以谓之伏，推筋按至骨，伤寒欲汗阳邪解，厥逆脐疼温药服。（濒湖曰∶伤寒一手伏
曰单伏，两手伏曰双伏，不可以阳证见阴为诊，及火邪内郁，不得发越，阳极似阴，故脉伏必有大汗而解，不
可发表。又有夹阴伤寒，先有伏阴在内，外复感寒，阴盛阳衰，四肢厥逆，六脉俱伏，须投姜附及灸关元，脉
乃复出，若太溪、冲阳皆无脉者，必死。）寸司呕吐关思痛，尺部疝瘕利水谷。（霍乱呕吐，腹痛，男子
疝，女子瘕聚痛甚者，其脉多伏，暴泄者，脉亦多伏。）
脉以浮沉合辨者，曰实，大而长，浮沉皆得。（凡一脉）
（实）
实脉大而长，浮沉皆有力，风热蕴蓄
深，谵语发狂疾。（邪气盛则实，浮有力、表实也；沉有力，里实也。所以然者，由风邪深入，郁而变热，热
甚则丧其神守，故谵语，更甚则发狂，所谓重阳者狂也。左于脉实者，宜发之，右手脉实腹满者，宜下之。）寸实
呕吐频，心胸苦气逆，积聚腹痛候在关，大便不通候在尺。（濒湖曰∶《脉诀》言尺实小便不禁，
与《脉经》尺实小腹痛，小便难之说何反？洁古不知其谬，药用姜附愈谬矣。愚按∶《脉诀》所言，亦出《脉
经》。《脉经》云∶尺脉实，小腹痛，小便不禁，宜服当归汤加大黄一两。据用大黄，则《脉经》以尺实为热，明
矣。洁古用姜附，可谓大误。但虚寒不足之证，火不能摄水，则小便不禁。此系实热，而《脉经》何以亦有小
便不禁之言？意者，热渴饮多，大便秘塞，水独归膀胱则小便数，小便数则不及溺之，即自出，亦谓之小便不
禁耶。）
脉以至数辨者，曰迟，一息三至。曰缓，一息四至。曰数，一息六至。曰结，缓
时一至。曰促，数时一至。曰代，止有常数，还入脉中，良久方来。（凡六脉）
（迟）
一息三至，号之曰迟，浮迟寒在表，沉迟作里医，有力无力皆寒证，抑阴扶阳不
用疑。寸迟心痛吐酸水，（寒气攻心故痛，胃虚而寒气客之，则水入于胃，不输于脾，停于胃脘，水得寒
气熏蒸，变而为酸，此是寒证，故《脉经》治以附子汤、茱萸汤。然此证亦有热者，肝移热于胃，土受木制，不
能胜水，水得木味，蕴而成酸，经所谓诸呕吐酸，皆属于热是也，当清热燥湿，此以脉之滑数辨之。）关尺寒
疼厥可知。（阴气盛，则从足五指至膝上寒，谓之寒厥，）迟涩 结，（迟滑则血虚寒，血虚寒则凝滞不行，渐成
结。）迟滑胀宜。（滑主气虚，主食积，气虚则寒，寒则气收，故胀；寒饮食积于肠胃，亦作胀。）
（缓）
缓脉均均来四至，贵无偏胜软而和，（缓主脾胃，又主风湿，在四季之月，不大不小，浮沉同等，
软而和者，平也；若三部不齐，则为偏胜，或又兼他脉者，病脉也。不在四季之月，他脉中带缓者，胃气也；若
独见缓者，病脉也。）肌肉不仁缓在寸，（风气之伤人多在上，寸部，心肺也。心主血脉，肺主皮毛，风邪入
客血脉，故肌肉之间不知痛痒曰不仁。）关知脾胃食难磨，（风气通肝，肝气移之于脾胃，脾胃实故不欲食。
实者，邪实也。）尺为脚弱下体肿，（湿气之伤人多在下，湿濡筋故脚弱，湿渗肌肤故下肿。）小便难而余
沥多，（湿积下焦，蕴而成热，湿热壅滞，则膀胱之气
不化，故小便难，有余沥也。）浮缓为风沉缓湿，若逢缓滑热为 。（经以缓而滑为热中。李士材以缓滑
为湿痰，误。）缓涩营虚缓细痹，（风寒湿三气皆能为痹，风胜为行痹，寒盛为痛痹，湿盛为着痹，脉缓细主
风湿痹。）推详三部自无讹。
（数）
一息六至称为数，只有儿童独安乐，（儿童以六至为平脉，外此皆为火。）浮沉实数散且清，
（浮数有力为实火在表，宜散；沉数有力为实火在里，宜清。）无力为虚宜补药。（数而无力，虚火也，宜补气
或益火之元。）寸为喉舌疼，呕吐嗽烦渴，（胃口当心，亦寸主之，胃有火故呕吐，火迫肺故为嗽为烦，肺
金燥故渴。）关中消谷易于饥，（胃有火则消谷善饥。）尺部恶寒气淋作。（《脉经》谓∶尺脉数，恶寒，小
便黄赤。又曰∶少阴脉数，男子气淋。盖肾为阴属水，阴虚而阳凑之，凶热故外恶寒，火伏水中，故小便黄赤，甚
则膀胱之气不化，小便不利，痛而为淋。）
（结）（《脉经》载扁鹊之言曰∶脉有表无里者死，经名曰结。何谓结脉，在指下如麻子动摇。按如麻子动
摇者，轻取之则散乱无纪，重按之则不可得，故有表无里，乃肾绝也。与缓时一止之结不同。）
缓时止，谓之结。阴盛阳衰凝气血，（气，温血行血者也。气虚不能温血，则血寒；气虚不能行血，
则血滞；血寒而滞则结，血结气亦结矣。）浮为痛积在外攻，沉为痛积内相迫。
（促）
The principle of heaven and earth lies in Yin and Yang; within the human body, Yin and Yang manifest as Blood and Qi. Specifically, Blood belongs to Ying (Nutritive Qi); Qi belongs to Wei (Defensive Qi). Ying nourishes internally; Wei protects externally. Therefore, Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels. The pulse is the precursor and manifestation of Qi and Blood. Without vessels, how can Blood nourish the interior? Without vessels, how can Qi protect the exterior? These two mutually support each other in their circulation: internally connecting with the Zang-Fu organs and the Twelve Meridians, and externally moistening the Nine Orifices, limbs, joints, and hairs. They circulate day and night without end, forming a complete cycle, converging at the Cun Kou (radial artery), and manifesting changes in the pulse. Thus, Qi and Blood are the spirit/vitality of humans; the pulse is the spirit/vitality of Qi and Blood. Therefore, the beginning of treating disease relies on the Five Determinations (Wu Jue) as the guideline. The Five Determinations refer to the complexion and pulse corresponding to the Five Zang organs. Pulse responds internally, while complexion responds externally; the complexion and pulse should be examined together for correspondence. Hence, it is said that one who can combine the observation of complexion and pulse can achieve perfect medical outcomes. Any physician must first master the differentiation of complexion and pulse, especially those practicing in surgery/dermatology (Chuang Ke); if they are not proficient in this, even if intelligent and erudite, they are not worthy of trust.
The principles of pulse diagnosis have been set into songs for easy recitation and study. Those differentiated by floating/sinking and rate are categorized separately from those not differentiated by these factors, to facilitate distinction. For pulses like floating and sinking, rhyming words are used to avoid confusion. Regarding pulse-disease correspondence, the *Huangdi Neijing* (Yellow Emperor's Inner Canon) is the primary source; where it is not detailed, the *Mai Jing* (Pulse Classic) supplements it; where the *Mai Jing* is not detailed, statements from famous physicians of successive dynasties supplement it, aiming for simplicity and comprehensiveness. Where there is a specific pulse, there is a cause for the corresponding disease; explanations are provided sentence by sentence below, aiming for clarity and fluency. Compared to previous pulse fu (rhapsodies) and poems, this has considerable advantages. For those aspiring to medicine, entering through this path, though called a shortcut, is actually the correct way.
Pulses identified by light palpation (light pressure on the skin surface) are called Floating (Fu). They are felt lightly, like wood floating on water. Further distinctions based on floating include: Surging (Hong), which is large and forceful upon arrival but weak upon departure; Deficient (Xu), which is large and floating but weak upon deep pressure; Scallion-stalk (Kou), which is large and floating but weak, feeling empty in the center and solid on the sides upon deep pressure; Scattered (San), which is large and floating but weak, with irregular rhythm and dissipated/unrestrained quality; and Fine/Micro (Wei), which is fine, small, and weak, feeling almost absent or intermittent upon deep pressure. (These are six types of pulses.)
[Right Hand Meridian Diagram]
(Floating Pulse) In the *Neijing*, it is called "Mao" (Feather).
The floating pulse is obtained with light touch, like wood floating in water. (Floating is the normal pulse of Autumn; appearing in Spring, Summer, or Winter indicates pathology. However, in Autumn, if the pulse is light, void, and floating, coming swiftly and departing dispersively, it is a normal pulse. If the center is firm and sides are void, it indicates Excess; if fine and micro, it indicates Deficiency; both are pathological.) A strong floating pulse indicates Exterior Pathogen, accompanied by clear nasal discharge and cough, causing aversion to cold and fever, leading to distress. (Wind pathogen enters via the skin and hair; skin/hair corresponds to the Lung. The Lung opens into the nose. Cold damaging the Lung causes Metal-Cold generating Water, hence clear nasal discharge. Wind forcing the Lung causes Qi rebellion, hence cough. The Lung governs Wei Qi; wind invasion closes pores, preventing Wei Qi from warming the exterior, hence aversion to cold. The Lung and Heart are both upper Jiao; Lung pathogen transmitting to Heart causes Heart Fire stagnation. Heart governs Ying Blood, circulating in vessels, hence general fever. Zhang Zhongjing stated: Winter cold damages Ying, causing fever, aversion to cold, and anhidrosis; Wind damages Wei, causing fever, aversion to wind, and diaphoresis. This is certain. However, common colds in all seasons also present with fever and aversion to cold, requiring exterior-releasing herbs to cure. Exterior-releasing herbs are typically acrid/pungent; Acrid opens pores, dissipates Fire stagnation. When pores open, Wei Qi reaches the exterior; when Fire stagnation dissipates, Ying Blood settles internally. When Ying and Wei harmonize, sweating occurs, resolving cold and heat.) The Cun position governs headache; Guan governs abdominal fullness; Chi governs strangury (difficulty urinating), which requires careful deduction. (From chest to head, governed by Cun. All Yang meridians originate at the head; wind pathogen penetrating deeply follows meridians, causing headache. Liver, Spleen, and Kidney pulses are usually sinking; now floating indicates Yang loss invading Yin. Yang excess generates heat. Wood's nature: withers in cold, thrives in heat. Liver Wood excess attacks Spleen Earth; Spleen deficiency leads to anorexia and abdominal fullness. Kidney opens at the two orifices, dislikes dryness. Heat excess dries blood, causing constipation; dries Qi, causing bladder transformation failure, hence strangury. Strangury refers to difficult urination.) Floating-Tight pulse indicates Cold Damage (Shang Han); Floating-Deficient pulse indicates Summerheat. (Cold damages Ying, circulating in vessels; Cold is tense, hence Tight pulse; Summerheat damages Qi, hence Deficient pulse.) Floating-Slow pulse is suitable for searching out Wind-Dampness. (Dampness is sticky/stagnant, hence Slow pulse. Symptoms include heavy head/body, knee/leg pain, edema, loose stools, yellow urine, indicating Wind-Damp syndrome.) Floating-Slippery pulse indicates Wind-Phlegm; Floating-Rapid pulse indicates Wind-Heat. (Slippery governs Phlegm; with floating indicates Wind-Phlegm; Rapid governs Heat; with floating indicates Wind-Heat.) If forceless, consider Blood Weakness. (Yang excess causes floating; Yin deficiency causes forcelessness. For such pulses, exterior-releasing herbs should not be used lightly.)
[Neijing Pulse Taking Diagram]
(Surging Pulse) In the *Neijing*, it is called "Gou" (Hook), also called "Da" (Large).
Though felt floating and large, it is called Surging only if the arrival is vigorous and the departure is weak. (Surging is the normal pulse of Summer; appearing in Spring, Autumn, or Winter indicates pathology. However, in Summer, if it arrives vigorously and depares weakly like a hook, it is normal. If arrival and departure are both vigorous, it indicates Excess; if arrival is weak but departure vigorous, it indicates Deficiency; both are pathological. Like a hook: upon light palpation, arrival is vigorous, descending curve like a hook; departure is weak and soft, hence normal.) True Yin deficiency, with pathogenic attack. (Human Zheng Qi involves Yin-Yang pairing. Harmony means no disease; Yin deficiency leads to Yang excess, Yang excess generates Fire. Fire is excessive Qi, which becomes pathogenic Qi/Xie Huo.) Surging at Cun indicates body heat and skin pain; coughing, expectoration, and vexation can also be traced to this. (Yang excess generates heat; Fire cannot vent, causing skin pain; Fire damages Lung, causing cough/expectoration; Heart dislikes heat, causing vexation.) Vomiting and distension are observed at the Guan position. (Stomach prefers coolness and dislikes heat; vomiting is Fire flaming upward, Fire stagnating without dispersing.) Chi deficiency requires strengthening Water; Diarrhea/Dysentery with Surging pulse is difficult to treat. (Chi Surging indicates Minister Fire excess, requiring strengthening Water to control Sun; if diarrhea/dysentery presents with Chi Surging, it is hard to treat.)
Li Binhu stated: Surging pulse outside Summer requires raising Yang and scattering Fire. I note: For new diseases with strong constitution and Surging at Cun/Guan, raising Yang/scattering Fire is appropriate. For chronic diseases with weak constitution and Surging at both Chis, nourishing Yin and descending Fire is correct.
(Deficient Pulse) Li Binhu cites *Neijing*: "Qi coming weak and micro indicates Deficiency, disease internal." I note: Deficient pulse is floating, large, and forceless; Micro pulse is floating, fine, and forceless. Large cannot contain fine, so Deficient cannot be conflated with Micro. Examining *Neijing*: "Qi coming not solid yet micro indicates Deficiency." Not solid means fine, meaning forceless, so Micro can be mentioned. Li Binhu changed "not solid" to "Deficient," which is an error.
Deficient comes floating, large, soft, and forceless; encountering it in Summer suggests Summerheat disease. (For Summerheat with fever, sweating, and Deficient pulse, clear Summerheat and tonify Qi is indicated; if fever, aversion to cold, anhidrosis, with Floating-Rapid but not Deficient pulse, clear Summerheat and release exterior is indicated.) Deficient at Cun indicates spontaneous sweating and frequent palpitations/fright. (Deficient pulse governs Qi/Blood deficiency. Zheng Qi deficiency allows Xie Qi excess; Xie excess implies Fire. Stronger Fire makes Exterior more deficient. Sweat is Heart fluid, transformed from Blood. If Exterior is deficient, Ying is unstable; Blood transforms with Fire, leaking outward as sweat. Heart houses Spirit; Blood deficiency leaves Spirit un-nourished, causing fright. Fire Qi rushing to Heart causes palpitations.) Guan governs Middle Palace (Spleen/Stomach) distension and discomfort. (Blood deficiency with Liver stagnation causes distension; Spleen/Stomach deficiency with insufficient Middle Qi also causes distension.) Chi governs tidal fever, bone-steaming, and flaccidity syndromes. (Yang ends at Si hour, Yin begins at Wu hour. Yin deficiency at Wu hour allows Yang to merge; Yang excess escapes outward as skin heat, scorches inward as marrow heat. Heat in bones is Bone-Steaming; arriving like tide water is Tidal Fever. Bone withering, marrow exhausting, legs unable to bear weight is Bone Flaccidity.) Pity the chronic patient whose body is surely destroyed.
(Kou and Ge Pulses) Kou combined with wiry is Ge, governing Yin deficiency and blood loss, same as Kou, attached here. *Mai Jing* states: Kou pulse is floating, large, and soft; pressing center is empty, sides are solid. Old theory saying front/back are sides is wrong. Li Shicai saying floating/sinking are sides is also wrong. "Solid" means forceful. If floating/middle/sinking are similar, how can floating be solid, sinking be solid, but middle be empty? Based on *Neijing* discussing Floating pulse: "Qi comes like feather, center firm, sides void," indicating Excess. Inferring from this, "sides" refers to lateral fingers. Kou is floating, large, soft; pressing sides are solid, center sinks. This indicates Blood insufficiency, thus governing various blood-loss conditions.
Light touch yields floating, large, soft; heavy press reveals empty center, solid sides is Kou. (Kou is a plant name, hollow like scallion. Blood flows in vessels; blood losers have hollow pulses, hence compared to Kou.) Cun/Guan governs hematemesis, epistaxis, intestinal abscess; Chi governs metrorrhagia, strangury, and bloody stool. (Hematemesis, epistaxis, intestinal abscess, metrorrhagia, bloody strangury, hematochezia are all Yang excess/Yin deficiency. Yang excess causes floating/large pulse; Yin deficiency causes hollow pulse.)
(Scattered Pulse)
Having exterior but lacking interior, large and scattered, irregular rhythm, like willow catkins drifting aimlessly in air. Left Cun indicates palpitations; Right Cun indicates spontaneous sweating. (Scattered governs Qi Excess/Blood Deficiency. Heart governs Blood; Blood deficiency causes unsettled Spirit, called palpitations. Qi Excess refers to Pathogen Excess; Pathogen excess generates Heat; Heat causes Qi leakage, hence sweating.) Left Guan indicates Overflowing Drink. (Yin deficiency generates internal heat; Stomach heat consumes fluids causing thirst; excessive drinking permeates skin/intestines, called Overflowing Drink.) Right Guan indicates Food Obstruction and leg swelling can be diagnosed. (Stomach heat causes disharmony; disharmony fails to digest food, causing stuffiness, called Food Obstruction. , refers to lower legs. Stomach Meridian descends along outer tibia; Stomach heat causes swelling.) Chi governs severe Blood deficiency; such symptoms in both feet indicate end of life span. (Classic says Kidney pulse scattered indicates Blood scarcity. Dai Tongfu said: Kidney pulse scattered, or any disease pulse alternating/scattered, is untreatable.)
(Micro Pulse)
Heavy press feels like it might cease, barely existent, extremely micro. Micro indicates Yin-Yang deficiency state. (Only when both Yin and Yang are deficient does the pulse feel barely existent, named Micro.) Aversion to cold, fever, and profuse sweating. (Yang deficiency generates cold; Yin deficiency generates heat. Yang fails to secure exterior; Yin fails to guard interior, causing much sweating.) Cun Micro indicates epistaxis, fright, and panting; Guan governs Middle Cold with cramping/spasm, critical. (Qi/Blood deficiency leads to Middle Cold; Cold causes subcardiac cramping. Cramping means lack of relaxation.) Chi indicates Reversal (Jue) and damage to Primordial Yang. (Yang Fire arises from Yin Essence; Yin Essence deficiency weakens Yang Fire. Yang Fire weakness causes cold hands/feet (Reversal); Yin-Yang disconnect, Qi rushes upward causing Reversal.) Women indicate Metrorrhagia, leukorrhea, and deficiency.
Pulses identified by heavy palpation are called Sinking (Chen), obtained only with deep pressure. Further distinction based on sinking includes Hidden (Fu), obtained only when pressing to the bone. (Two pulses.)
(Sinking Pulse) In *Neijing*, called "Shi" (Stone), also "Ying". (Firm Pulse) Firm pulse is Sinking, large, long, wiry, and forceful, governing Cold/Pain, same as Sinking, deleted here.
Obtained upon pressing is Sinking. (Sinking is Winter's normal pulse; appearing in Spring/Summer/Autumn is pathological. In Winter, coming sinking and pounding is normal; if coming like bouncing stone, it is Excess; if departing rapid, it is Deficiency; both pathological.) Cun Sinking indicates chest/hypochondriac pain, Water-Qi stagnating between diaphragm; if at Guan/Chi, indicates abdominal/back/waist pain. (Sinking governs Yin; Yin excess suppresses Yuan Qi, so Sinking in three positions governs Pain, requiring warming; if Water-Qi, requiring draining.) Sinking-Slow governs Cold-Damp; Sinking-Rapid governs Heat; Sinking-Slippery indicates true Phlegm/Food retention; Sinking forceless clearly indicates Qi deficiency. (Sinking forceful indicates Excess pathogen, governing Cold/Stagnation; Sinking forceless indicates Qi deficiency.)
(Cui Zixu's *Si Yan Ju Yao* says: Sinking-Firm indicates entrenched Cold; Sinking-Solid indicates extreme Heat. I note: Firm pulse is sinking, large, long, forceful; Solid pulse is also sinking, large, long, forceful. How to distinguish entrenched Cold from extreme Heat?)
(Hidden Pulse)
Why called Hidden? Push tendons, press to bone. Cold Damage seeking sweat resolves Yang pathogen; Reversal with umbilical pain requires warm herbs. (Li Binhu said: One-hand Hidden is Single Hidden; two-hand Hidden is Double Hidden. Do not diagnose Yang syndrome seeing Yin pulse. Also, Fire pathogen internal stagnation, unable to vent, Yang extreme resembling Yin, so Hidden pulse must resolve with heavy sweating; do not use exterior-releasing. There is also Yin-clasping Cold Damage, pre-existing hidden Yin inside, external cold added, Yin excess/Yang decline, limb reversal, six pulses all Hidden, must administer Ginger/Aconite and moxa Guanyuan, pulse returns; if Taichong/Chongyang pulses absent, death is certain.) Cun governs vomiting; Guan governs longing pain; Chi governs Hernia, Masses, and watery stool. (Vomiting/Diarrhea, abdominal pain, male Hernia, female Masses with severe pain often have Hidden pulse; acute diarrhea often has Hidden pulse.)
Pulses identified by combining floating/sinking are called Solid (Shi), large and long, obtained at both floating and sinking. (One pulse)
(Solid Pulse)
Solid pulse is large and long, forceful at both floating and sinking. Deep accumulation of Wind-Heat leads to delirium and madness. (Pathogen excess is Solid; Floating forceful is Exterior Solid; Sinking forceful is Interior Solid. This occurs because Wind pathogen penetrates deeply, stagnates, transforms to Heat. Extreme Heat loses Spirit control, causing delirium; worse, madness. So-called Yang-Repetition is Madness. Left hand Solid pulse: release it. Right hand Solid pulse with abdominal fullness: purge it.) Cun Solid indicates frequent vomiting, bitter Qi rebellion in heart/chest; Accumulation/Masses/Abdominal Pain at Guan; Constipation at Chi. (Li Binhu said: *Mai Jue* states Chi Solid indicates urinary incontinence, contrary to *Mai Jing* stating Chi Solid indicates lower abdominal pain and difficult urination. Jiegu did not know the error, using Ginger/Aconite made it worse. I note: *Mai Jue* derives from *Mai Jing*. *Mai Jing* says: Chi Solid, lower abdominal pain, urinary incontinence, use Dang Gui Tang plus 1 liang Dahuang. Using Dahuang shows *Mai Jing* considers Chi Solid as Heat. Jiegu using Ginger/Aconite is a major error. But for deficiency-cold, Fire cannot control Water, causing incontinence. This is Excess Heat, why does *Mai Jing* mention incontinence? Perhaps, due to heat-thirst drinking much, constipation, water goes only to Bladder, causing frequency, unable to hold, thus incontinence.)
Pulses identified by rate are: Chi (Slow), three beats per breath; Huan (Moderate/Relaxed), four beats per breath; Shu (Rapid), six beats per breath; Jie (Knotted), occasional stop during slow rhythm; Cu (Cursory), occasional stop during rapid rhythm; Dai (Intermittent), regular stops, returning after a long pause. (Six pulses)
(Chi Pulse)
Three beats per breath, called Chi. Floating-Chi indicates Cold in Exterior; Sinking-Chi indicates Interior Cold. Forceful or forceless, both are Cold syndromes; suppress Yin, support Yang without doubt. Cun Chi indicates heart pain and sour regurgitation. (Cold attacking Heart causes pain; Stomach deficiency allows Cold guest, water enters Stomach, fails to transport to Spleen, stagnates in Epigastrium. Water steamed by Cold turns sour. This is Cold syndrome, so *Mai Jing* treats with Fuzi Tang/Zhuyu Tang. However, this syndrome can also be Heat: Liver transfers Heat to Stomach, Earth controlled by Wood, fails to overcome Water, Water takes Wood flavor, accumulates to become sour. Classic says all vomiting/regurgitation of acid belongs to Heat. Clear Heat, dry Dampness, distinguished by Slippery-Rapid pulse.) Guan/Chi indicate Cold pain and Reversal. (Yin excess causes cold from toes to knees, called Cold Reversal.) Chi-Slippery-Jie. (Chi-Slippery indicates Blood deficiency Cold; Blood deficiency Cold causes stagnation, gradually forming Knot.) Chi-Slippery indicates Distension. (Slippery governs Qi deficiency, Food retention. Qi deficiency leads to Cold; Cold causes Qi contraction, hence distension; Cold food retention in intestines/stomach also causes distension.)
(Huan Pulse)
Huan pulse comes evenly, four beats per breath. Valued for no excess/deficiency, soft and harmonious. (Huan governs Spleen/Stomach, also Wind-Damp. In seasonal months, neither large nor small, equal floating/sinking, soft/harmonous is normal; if three positions unequal, indicates excess/deficiency or combination with other pulses, pathological. Outside seasonal months, Huan within other pulses is Stomach Qi; if Huan appears alone, pathological.) Muscle insensitivity (Bu Ren) at Cun. (Wind pathogen often affects upper body; Cun is Heart/Lung. Heart governs Blood vessels, Lung governs skin/hair. Wind pathogen enters vessels, causing muscle insensitivity.) Guan knows Spleen/Stomach difficulty grinding food. (Wind connects to Liver; Liver Qi transfers to Spleen/Stomach; Spleen/Stomach Excess causes anorexia. Excess refers to Pathogen Excess.) Chi indicates weak legs and lower body edema. (Damp pathogen often affects lower body; Damp moistens sinews causing weak legs; Damp infiltrates skin causing lower edema.) Difficult urination with residual drops. (Damp accumulates in Lower Jiao, generates Heat. Damp-Heat stagnation prevents Bladder Qi transformation, causing difficult urination and residue.) Floating-Huan is Wind; Sinking-Huan is Damp. If Huan-Slippery, Heat is [indicated]. (Classic says Huan-Slippery is Heat in Middle. Li Shicai said Huan-Slippery is Damp-Phlegm, error.) Huan-Slippery indicates Ying deficiency; Huan-Fine indicates Bi syndrome. (Wind-Cold-Damp all cause Bi; Wind excess is Moving Bi; Cold excess is Painful Bi; Damp excess is Fixed Bi. Huan-Fine pulse governs Wind-Damp Bi.) Detailed examination of three positions leaves no error.
(Shu Pulse)
Six beats per breath called Shu. Only children enjoy this peace. (Children consider six beats normal; otherwise all are Fire.) Floating/Sinking/Solid-Rapid scatter and clear. (Floating-Rapid forceful is Excess Fire in Exterior, disperse; Sinking-Rapid forceful is Excess Fire in Interior, clear.) Forceless is Deficiency, require tonifying herbs. (Rapid forceless is Deficiency Fire, tonify Qi or benefit Fire origin.) Cun indicates throat/tongue pain, vomiting, cough, vexation, thirst. (Stomach opening near heart, also governed by Cun. Stomach Fire causes vomiting; Fire forces Lung causing cough/vexation; Lung Metal dryness causes thirst.) Guan indicates digestion and easy hunger. (Stomach Fire digests food easily, causing hunger.) Chi indicates aversion to cold and Qi strangury. (*Mai Jing* says: Chi pulse rapid, aversion to cold, yellow-red urine. Also: Shaoyin pulse rapid, male Qi strangury. Kidney is Yin/Water; Yin deficiency attracts Yang, fierce heat causes external aversion to cold; Fire hidden in water causes yellow-red urine. Severe cases, Bladder Qi fails to transform, difficult urination, painful strangury.)
(Jie Pulse) (*Mai Jing* records Bian Que: Pulse with exterior but no interior is death, named Jie in classics. What is Jie pulse? Under fingers like hemp seeds shaking. Pressing like shaking hemp seeds: light touch is chaotic/disordered, heavy touch is unobtainable, hence exterior but no interior, Kidney exhaustion. Different from Jie with occasional stop in slow rhythm.)
Occasional stop in slow rhythm is called Jie. Yin excess, Yang decline congeals Qi and Blood. (Qi warms and moves Blood. Qi deficiency fails to warm Blood, causing Cold; fails to move Blood, causing Stasis. Blood Cold/Stasis leads to Knotting; Blood knots, Qi also knots.) Floating indicates Pain/Masses attacking externally; Sinking indicates Pain/Masses pressing internally.
(Cu Pulse)