第一。平铺三指阔。（初持脉时。不必便寻三部。且阔铺三指。从尺外臂内。稍稍挪上探摸。要知皮肤端的。方可诊
候三部。十三难曰。脉数。而尺之皮肤亦数等语。古人先诊视三部。然后参以尺之皮肤。尺之皮肤者。第三部尺中脉之
外。臂肉内皮上也。此处不诊动脉。但探试皮肤。或数。或急。或缓。或涩。或滑。故以尺中皮肤言之。所以欲知尺之
皮肤者。欲以此法先得其身之冷热。形之腴瘠。肤之疏密。则浅深内外久近之疾。可得而识也。丁氏曰。臂内数者。皮
肤热。臂内急者。经络满实。缓者。肌肉消。愚故云。数。言臂肉。皮肤热便知病亦是热。皮肤不热者。病亦是不热。
其他极冷。与非冷非热。可以类推矣。急。言其肉实而皮急。是近病。营卫未消耗也。缓。言其肉皮宽。是久病。营卫
已消耗也。涩。言皮肤不滑泽。腠理闭。无汗。然也。滑。言其润滑。腠理疏。汗多然也。古人言不尽意。举此五者言
之。大意可见。或者不用三指。只以一指自上至下。逐部按之。未尝不可。然不可以得尺之皮肤。不足法也。尺之皮肤。
或男或女。只看一手便见。）
第二。三部准高骨。（人两手。掌后各有高骨。欲诊三部。先以中指揣得高骨。名为关上。既得高骨。微微抬起中指。
以食指。于高骨之前。取寸口脉。诊寸口毕。则微微抬起食指。再下中指。取关上脉。诊关上毕。复微微抬起中指。又
下无名指于高骨之后。取尺中脉。诊候之时。不可正对患人。要随左右偏立两傍。慎容止。调鼻息。专念虑。然后徐徐
诊候。若乖张失次非法矣。一说凡诊脉。以气息平定。方可下指。病者禁声勿言。医者闭息莫语。寂然敬静。绝无外听。
初则浮按消息之。次中按消息之。次重按消息之。次上竟消息之。次下竟消息之。次推指外消息之。次推指内消息之。
其详。见前推移用指法。）
第三。指法定宗源。（崔刘二师。止以浮沉迟数四脉。定风气冷热四病。以概百 。原此四者止是杂症。若卒诊伤寒
外感之疾。则有不可通者。今取仲景平脉法。参以崔刘所传。庶几并用而无遗恨。其曰。浮风。沉气。迟冷。数热。此
祖诀论杂病者也。其曰浮在表。沉在里。迟在脏。数在腑。今所定伤寒诊法也。须要知得伤寒与杂症诊法。皆须以浮沉
迟数四脉为宗。而又各有其类不可混淆。必得此诀。然后可读脉书。不然则泛无统会也。）
第四。通融叶于一。（以前法定得病症。又以病症参验前法。既因脉以知病。复随病以考脉。融会贯通。反复探讨。
实得病名。归一而后止。凡诊脉最难。有脉病相应者。有不相应者。有病得易愈之脉者。有治之而
即瘥者。有治之而增剧者。大要以我简易驭彼繁难。以我之一心制彼之万变。此所谓通一举万之道也。）
第五。观形勿泥形。（脉经曰。五脏各有声色臭味。当与寸口尺内相应。其不相应者病也。是知观形察色。与寸口尺
内相应。此古法也。谓如色青是肝病。当得弦而急肝脉之类。然仲景法又不止察五脏色脉而已。必观其起居动静。及诸
外症。可以望而知之者。要当目睹心推。洞见端的。方断吉凶。岂但察五脏别五色而已哉。）
第六。闻声不在声。（经云闻而知之谓之圣。亦如察色。以五脏所主相参。故曰闻其五音以别其病。此亦几于拘泥。
如中风不语为入脏。然有无故而喑。脉不至。不治自愈。为气暴逆者。虽与中风不语相似。而实不同。又如伤寒谵语。
为阳明病。胃中有燥屎。当下则愈。与虚病谵语。正气脱绝。精神散乱。若下之。则为重虚。此处一差。祸如反掌。又
曰声重咳嗽。固为寒邪。亦有风热上壅。及劳嗽失声。而为肺痿。难愈之症。症同实异。然则听声之法。岂可以宫商角
征羽之五音。而定五脏之病哉。须将患人之言语声音。与病家来请语言。及他一切旁观物议。皆当审听。入耳注心。斯
乃闻声之道。非古法所能尽也。）
第七。发言须当理。（望闻问切。谓之神圣工巧。问症本第三法。切脉本第四法。今世道不古。以切脉反居第一。以
问
视为最末。抱病不惟不言。虽再三义询叩。终亦不告。反谓医拙。甚至有隐疾而困医者。医固为尔所困。不思身亦为医
所
困矣。果何所益哉。虽然。为医者亦须贵乎有学。大率诊视已毕。不可便指病名。发言猝易。须从所得脉象说起。广引
经书以为证据。然后由浅而深。说归病症。务要精当确实。不可支离狂妄。说证已毕。然后徐徐问其所苦。或论说未尽。
使患者一一详告。却以彼说较吾所诊。或同或异而折衷之。如此则望闻问切四法兼全。彼我之间交相孚契。既无所惑。
必收全功。）
第八。慈悯济苍生。（孙思邈云。凡医治病。必须安神定志。无欲无求。不论贵贱贫富。视为一等。皆如至亲。亦不
得瞻前顾后。自虑吉凶。护惜身命。见彼苦恼若已有之。深加恻怆勿避险 。一心救难。无存形迹。如此。可谓慈悯济
苍生。太医反此则含灵巨贼。今考斯言。切中世医之病。衡阳罗氏云今之医者。每每毁訾前医。惊恐病家。意图浓赂。
尤为不仁之甚。昔皇子病 国医莫能治。长公主因言钱乙起草野。有异能。立召入。进黄土汤而愈。神宗问此何以能
愈斯疾。对曰。以土胜水，木得其平。则风自止。且诸医治亦将愈。小臣适逢其愈。上悦其对。擢太医丞。学人能以仲
阳之心为心。则善矣。愚谓医本末技。若不谋利不计功。则为仁人。苟患得患失则无所不至矣。况用心不仁之人。自有
果报。故于诊视之中。备述孙真人钱医丞嘉言善行。以为吾徒勉。）
First. Spread three fingers broadly. (When initially taking the pulse, there is no need to immediately seek the three positions; rather, spread three finger-widths wide, starting from the outside of the Chi position towards the inside of the forearm, slightly moving upward to probe and feel. One must clearly understand the exact location of the skin before one can diagnose the three pulse positions. The *Nan Jing* (Classic of Difficult Issues), Chapter 13, states: "If the pulse is rapid, the skin at the Chi position is also rapid," and similar phrases. Ancient practitioners first examined the three pulse positions and then correlated them with the condition of the skin at the Chi position. By 'skin at the Chi position,' it refers to the epidermis on the inner aspect of the arm muscle, outside the third position, the Chi pulse. At this location, arterial pulses are not diagnosed; instead, the skin is merely tested for temperature and texture—whether rapid, tense, slow, choppy, or slippery—hence the reference to the skin at the Chi position. The reason for understanding the skin at the Chi position is to use this method to first ascertain the patient's body heat or cold, corpulence or emaciation, and the density or looseness of the skin. In this way, the depth of the disease (superficial or deep), its location (internal or external), and the duration (recent or chronic) can be identified. Master Ding said: A rapid sensation in the inner forearm indicates hot skin; a tense sensation indicates fullness and excess in the meridians; a slow sensation indicates wasting of the muscles. Therefore, I have stated that 'rapid' refers to the flesh; if the skin is hot, the disease is also a heat pattern; if the skin is not hot, the disease is not a heat pattern. Other conditions, such as extreme cold or neither cold nor heat, can be inferred by analogy. 'Tense' refers to solid flesh and tight skin, indicating a recent illness where Ying and Wei Qi have not yet been depleted. 'Slow' refers to loose flesh and skin, indicating a chronic illness where Ying and Wei Qi have already been depleted. 'Choppy' refers to non-smooth skin, closed pores, and absence of sweat, which is correct. 'Slippery' refers to lubricity, open pores, and excessive sweating, which is correct. The ancients did not express their meaning fully; listing these five cases reveals the general principle. Alternatively, using one finger instead of three, pressing down from top to bottom, section by section, is also acceptable. However, this method cannot reveal the condition of the skin at the Chi position and is therefore insufficient as a standard. Regarding the skin at the Chi position, whether male or female, observing one hand is sufficient.)
Second. Align the three positions with the high bone. (In both hands, there is a prominent bone behind each palm. To diagnose the three positions, first use the middle finger to locate the high bone, naming this point Guan (Gate). Once the high bone is found, slightly lift the middle finger, and use the index finger anterior to the high bone to take the Cun (Inch) pulse. After diagnosing the Cun position, slightly lift the index finger, lower the middle finger again to take the Guan pulse. After diagnosing the Guan position, slightly lift the middle finger again, and lower the ring finger posterior to the high bone to take the Chi pulse. During diagnosis, do not face the patient directly; stand slightly to the side, left or right. Maintain dignified demeanor, regulate nasal breathing, focus mental attention, and then slowly diagnose. If one is erratic or out of order, it is unlawful. Another view holds that for all pulse diagnoses, one should only place fingers after the breath has stabilized. The patient should remain silent and not speak; the practitioner should hold their breath and not talk, maintaining silence, reverence, and stillness, free from external distractions. Initially, press lightly (Floating) to observe; next, press moderately (Middle) to observe; next, press heavily (Deep) to observe; next, push the finger to the distal end to observe; next, push the finger to the proximal end to observe; next, push the finger outward to observe; next, push the finger inward to observe. The details are described in the previous section on finger movement techniques.)
Third. Establish the finger method based on ancient sources. (Masters Cui and Liu relied solely on the Floating, Deep, Slow, and Rapid pulses to determine Wind, Qi, Cold, and Heat patterns, using these four to generalize over a hundred diseases. Investigating these four, they originally applied only to miscellaneous diseases. If suddenly diagnosing Shanghan (Cold Damage) or exogenous diseases, there are aspects that do not apply universally. Now, adopting Zhang Zhongjing's Ping Mai Fa (Method of Calm Pulse Diagnosis) and combining it with the transmission of Cui and Liu, perhaps we can use both without regret. They stated: Floating indicates Wind, Deep indicates Qi, Slow indicates Cold, Rapid indicates Heat; this is the ancestral theory for miscellaneous diseases. They stated: Floating is exterior, Deep is interior, Slow is Zang, Rapid is Fu; this is the current determined method for diagnosing Shanghan. One must know that both Shanghan and miscellaneous disease diagnoses must take the Floating, Deep, Slow, and Rapid pulses as the root, yet each has its own categories and must not be confused. Only by mastering this manual can one read pulse books; otherwise, the study will be vague and unorganized.)
Fourth. Integrate into unity. (Having determined the disease pattern by previous methods, verify these methods against the disease pattern. Since knowing the disease through the pulse, and examining the pulse according to the disease, integrate and comprehend thoroughly, exploring repeatedly until the actual disease name is obtained and unified. Diagnosing the pulse is the most difficult task. There are cases where the pulse and disease correspond, and cases where they do not. There are diseases with pulses indicating easy recovery, cases cured immediately by treatment, and cases aggravated by treatment. The general principle is to use my simplicity to manage their complexity, and my single-mindedness to control their myriad changes. This is what is called the way of grasping one to manage ten thousand.)
Fifth. Observe form but do not be rigidly bound by it. (*Mai Jing* [Pulse Classic] states: Each of the Five Zang organs has specific sounds, colors, odors, and tastes, which should correspond to the Cun and Chi positions within the wrist. If they do not correspond, it is disease. From this, we know that observing form and color, and correlating them with the Cun and Chi positions, is an ancient method. For example, green complexion indicates Liver disease, and one should expect a Wiry and Tense Liver pulse. However, Zhang Zhongjing's methodology goes beyond merely observing the colors and pulses of the Five Zang organs. One must observe the patient's daily activities and movements, as well as various external symptoms, which can be known through observation (Wang). One must see with eyes and deduce with mind, gaining clear insight, before judging auspiciousness or inauspiciousness. Is it merely about distinguishing five colors of the Five Zang organs?)
Sixth. Listen to voice but do not be limited to sound. (*Huang Di Nei Jing* [Yellow Emperor's Inner Canon] says: Knowing through hearing is called Sage. Like observing color, it correlates with what the Five Zang organs govern, hence saying: listening to the five tones to distinguish disease. This approach is somewhat rigid. For instance, aphasia due to stroke indicates pathogen entering the Zang organs. However, there are cases of sudden aphasia without cause, absent pulse, which heal spontaneously without treatment; this is due to sudden rebellion of Qi. Although similar to stroke aphasia, the nature is different. Again, delirious speech in Shanghan indicates Yangming disease with dry stool in the Stomach, requiring purgation for cure. This differs from deficiency-type delirium where Zheng Qi is exhausted and spirit is scattered; purging in such cases causes severe deficiency. A mistake here leads to disaster instantly. Also, heavy voice and coughing are indeed signs of Cold pathogen, but can also result from Wind-Heat obstructing upwards, or consumption cough leading to loss of voice, resulting in Fei Wei (Lung萎/Flaccidity), a difficult-to-cure syndrome. Symptoms may be similar, but the underlying nature differs. Thus, the method of listening to voice cannot rely solely on the five tones Gong, Shang, Jue, Zhi, Yu to determine diseases of the Five Zang organs. One must listen carefully to the patient's speech and voice, the language used when the family seeks medical help, and all other bystander comments. Let it enter the ears and focus the mind; this is the true way of listening, which ancient methods could not fully encompass.)
Seventh. Speech must be reasonable. (Observation, Listening/Smelling, Inquiry, and Palpation are called Divine, Sage, Skillful, and Ingenious. Inquiry is essentially the third method, and Palpation is the fourth. Nowadays, society is not like antiquity; Palpation is placed first, while Inquiry is considered last. Patients suffering from illness not only do not speak, but even when asked repeatedly and earnestly, they finally do not answer, instead claiming the doctor is incompetent. Some even hide serious illnesses, troubling the doctor. The doctor is indeed troubled by you, but fails to realize that the body is also troubled by the doctor. What benefit is there? Nevertheless, a physician must value learning. Generally, after completing the examination, one should not immediately state the disease name, as hasty speech leads to errors. One should start with the observed pulse qualities, extensively cite classics as evidence, then proceed from shallow to deep, concluding with the disease pattern. It must be precise and accurate, not disjointed or arrogant. After discussing the symptoms, slowly ask about the patient's suffering. If the discussion is incomplete, allow the patient to explain in detail, then compare their account with your diagnosis, reconciling similarities and differences. In this way, Observation, Listening, Inquiry, and Palpation are all complete. Mutual trust and harmony between doctor and patient will be achieved, eliminating confusion and ensuring complete success.)
Eighth. Compassion to save all living beings. Sun Simiao said: When treating diseases, physicians must calm their spirits and stabilize their wills, having no desires or demands. Regardless of noble or base, rich or poor, treat everyone equally, as if they were close relatives. Do not look forward or backward, worrying about good or bad fortune, or protecting one's own life. Seeing the patient's suffering as one's own, feel deep compassion, do not avoid danger or hardship, devote oneself entirely to saving lives, and leave no trace of self-interest. This can be called compassionate salvation of all living beings. A Grand Physician who acts contrary to this is a great thief among sentient beings. Examining these words today, they hit upon the ailments of contemporary physicians. Luo of Hengyang said: Modern physicians often slander previous doctors, frighten patients, and intend to gain large bribes, which is extremely inhumane. In the past, when the Crown Prince was ill, imperial physicians could not cure him. The Eldest Princess mentioned that Qian Yi, coming from common roots, had extraordinary skills, and he was immediately summoned. He administered Huang Tu Tang (Yellow Earth Decoction) and the prince recovered. Emperor Shenzong asked how he could cure this illness. He replied: Using Earth to overcome Water, Wood achieves balance, thus Wind stops naturally. Moreover, the other physicians were also approaching a cure; I happened to coincide with the recovery. The Emperor was pleased with his response and promoted him to Vice Director of the Imperial Medical Bureau. Scholars who can adopt the heart of Qian Bo Du (Qian Yi) will do well. I believe medicine is a minor skill; if one does not seek profit or calculate merit, one is a benevolent person. If one worries about gain and loss, one will go to any lengths. Furthermore, those with unkind hearts will surely face karmic retribution. Therefore, in this diagnostic guide, I recount the virtuous words and deeds of Sun Simiao and Vice Director Qian to encourage my disciples.)