若在尺中〔阴气绝酸疼引变主皮肤〕（阳气少。骨烦发热痛难居。）
脉经曰。尺弱阳气少。发热骨烦。又云少血。脉经曰骨烦者。肾主骨髓也。脉诀作皮肤。
乃肺之合。非肾所主。今改之。
通真子曰。七表八里为阴阳正脉。外有九种脉相通而见者。经所谓脉来浮滑而长。沉涩而短。
浮大而牢之类。是也。以愚观之。脉无正不正之定名也。为邪为病而见。则二十四字皆不正之脉。
因时而旺。随脏而应。则皆正脉也。脉合阴阳。难以七表八里为阴阳正脉。难经曰浮滑长皆阳脉。
沉涩短皆阴脉。非别以长短为阴阳正脉之外也。是长短与浮沉滑涩。同为阴阳也。又曰外有九种
脉相通而见。故曰九道。且脉之相通。乃众脉参互为一。以示证也。二十四字。除浮沉结促代伏。
居于上下。止于缓急。不能相通。其他皆相通。难经曰一阳一阴。谓浮而涩。是八里通乎七表也。
一阴一阳。谓沉而滑。是七表通乎八里也。内经所载。仲景所论。多通众脉而言病。脉经二十四字。
有散数。无短长。脉诀去散数。增长短。亦以足二十四字。脉经论。二十四字通为一处。亦无次
序之定。盖脉随变而见。但宜以阳脉从阳类。阴脉从阴类。不可以一浮二芤为定序。且三至为迟。
六至为数。迟阴在脏。数阳在腑。经文皆对言也。今取迟
去数。其可乎。是知脉不可以二十四字为定数也。亦不可立表里道之异名也。陈氏沈氏并用散数为
九道。用脉诀九道之名数。而不取短长。亦非也。今增散数二脉于后。以足脉经之所论。而不去长短者。
脉之所当述者也。既不拘于表里道二十四字之数。则脉之以一字立名。皆详论可也。或曰子既辨表
里道之非。不删而述其旧文何也。曰此朱文公作孝经刊误。程子述大学亲民之例也。不删者存其旧
也。用墨圈者当删者也。辨其下者。使人皆知其非。不复为旧文所惑。不删之删也。
〔一〕长者阳也。指下寻之。三〔关〕（部）如持竿之状。举之有余曰长。过于本位。亦
曰长。主浑身壮热。坐卧不安。
从尺至关。连寸口。直过如横竿之状。此三部之长脉。过于本位。谓或尺或关或寸。过于一指之外。
此各部之长脉。欲知其病。则必于浮沉迟数大小之间求之。若不大不小。不浮不沉。不迟不数。则气
自治而无病。经曰。长则气治是也。大概平人病患。脉长为吉。深且长。寿脉也。尺脉长。根深蒂固。
心脉长。神气有余。内经心脉搏坚而长。病舌卷不能言。至肾脉搏坚而长。病折腰。此六脉者非以长为病。
以搏坚相合而病也。春肝脉。软弱轻虚而滑。端直以长。肝脉。如循长竿末梢曰平。如循长竿曰病。
有余而过。故也。
长脉迢迢度三关。指下来时又却还。
通真子曰。此云来时又却还者。似一阴三阳之脉。愚曰非也。来而还。只可谓脉之来去。然诸脉
皆如是。若不能自还。则代而死矣。一阴三阳者。谓脉来浮滑而长时一沉也。是四脉共见也。
阳毒在脏三焦热。徐徐发汗始能安。
洁古曰。此阳明脉。尺寸俱长。当汗。阳化气也。今按假使是阳明证。亦难专于发汗。正阳阳明当下。
太阳阳明当汗。少阳阳明随证解利。当根据表里分汗下。
〔二〕短者阴也。指下寻之。不及本位曰短。主体虚恶寒。腹中冷气。（作生气非）宿食不消。
寸口尺中皆退促。附近关中见一半。如龟缩头曳尾之状。以其阴阳不及本位。故曰短。若关中短。
上、为寸脉。下不至关。下、为尺脉。上不至关。是阴阳绝脉。此皆不治决死。故关中不以短脉为诊。
脉经曰。短脉之象。应指而回。不能满部。浮而短者荣卫不行。沉而短者脏腑痞塞。短与长对。知长
则知短矣。
短脉阴中有伏阳。气壅三焦不得昌。脏中宿食生寒气。大泻通肠必得康。
通真子曰。脉诀以一阳三阴。脉来沉涩而短。时一浮。乃云有伏阳耳。今按脉诀单论短。为阴中
伏阳。盖以短为阴。脉短为气病。气不得舒畅。则阳气郁伏于内。非论沉涩短浮四脉共见也。内经曰
疏其血气。令其条达而致和平。今曰大泻通肠。亦当随病浅深用药可也。
〔三〕虚者阴也。〔指下寻之不足举之亦然〕（迟大而软。按之无力。隐指豁豁然空。）曰虚。
主少力多惊。
虚脉。因按而知其虚。其诊法与芤同。皆以按而见。浮大而软。按之中无旁有为芤。迟大而软。
按之隐指。豁豁然空为虚。内经曰脉虚血虚二脉。皆因血而见。失血则中无。血虚则中空。脉诀言寻之不足。
举指亦然。乃微濡之脉。非所以形容虚也。虚与实对。实于中为实。故浮中沉皆有力。内不足为虚。故按之豁
豁然空。
恍惚心中多愕惊。〔三关定息脉难成〕（按之无力脉虚轻。）血〔生〕（虚）脏腑生〔寒热〕（烦热。）
补益三焦便得宁。
〔四〕促者阳也。指下寻之。极数。并居寸口。（又曰来去数。时一止复来。）曰促。渐加则死。渐退则生。
促脉。尺微关细。寸口独实而滑数。并居于上。或来去数。时一止复来。黎氏曰促脉虽盛疾。必时一
止复来者。如趋之蹶也。故徐疾不常。
促脉前来已出关。并居寸口〔血成斑〕（证危难。）
血成斑非促脉证。
忽然渐退人生也。若或加时命在天。
〔五〕结者阴也。指下寻之。〔或来或去聚而却还〕（脉来缓。时一止复来。无常数。又曰脉来动而中止。
更来小数。中有还者反动。）曰结。主四肢。气闷。连痛。时来。
迟而小驶为缓。应指暂歇为止。缓而止为结。通真子曰据经谓往来缓。时一止复来。为结。其言是也。此
云或来或往。聚而却还。与之稍异。来去者脉之常也。聚而还。何以见脉之结。今根据仲景所论改之。
脉经只云来缓。时一止。难经又云无常数。今根据难经增之。盖止而复来。数至。间或三两至。或又一止。无常数。
若有常数。如五动一止。又五动一止。根据数而止。则为死脉。可根据止数。克死期矣。详见下代脉辨。仲景
曰。蔼蔼如车盖。曰阳结。乃阳气郁结于外。不与阴气和杂也。累累如循长竿。曰阴结。乃阴气郁
结于内。不与阳气和杂也。又曰脉浮数。能食。不大便。此为实。曰阳结。脉沉迟。不能食。身体重。
大便反硬。曰阴结。亦以阴阳气偏结。因兼证而分之。不以脉止为结也。内经曰结阳者肿四肢。四肢
者诸阳之本也。结阴者便血。阴主血也。二阳结谓之消。谓大肠胃热。三阳结谓之隔。谓小肠膀胱热。
三阴结谓之水。谓脾肺寒。一阴一阳结。谓之喉痹。谓心主三焦热。是亦分阴阳之结也。王氏脉经盖
因仲景之文。于脉缓止却为结阳。数止却为结阴。误甚。详述在代脉下。其实脉诀之结脉为阴。与
促脉为阳相对。非若内经与仲景所言。有阴阳之分也。若必论阴阳。结则缓而止为结阴。数而止为
结阳。方允当。
积气生于脾脏旁。大肠疼痛卒难当。渐宜稍泻三焦火。莫谩多方立纪纲。
〔六〕代者阴也。指下寻之。〔动而复起冉冉不能自还〕（动而中止。不能自还。因而复动。）
曰代。主形容羸瘦。口不能言。
代者。此脉已绝。他脉代其至之义。一脏气绝。而他脏之气代而至也。代与止异者。止者按之。
觉于指下而中止。代者忽还尺中。停久方来。则是歇至。数动。止而复来。因其呼吸阴阳相引乃复动也。
今脉诀曰动而复起。则不代矣。是不明动而中止为代也。冉冉不能自还之下。却不言因而复动。是不
能自还之后。脉绝不来矣。今以仲景原文改之。内经曰代则气衰。脾脉代。注云 弱也。仲景曰伤寒
脉结代。心动悸。炙甘草汤主之。皆不以代为死脉也。王氏脉经始曰脉结者生。代者死。仲景言结代脉曰。
脉按之
来缓。时一止复来。名曰结。又脉来。动而中止。更来小数。中有还者反动。名曰结。阴也。脉来。
动而中止。不能自还。因而复动。名曰代。阴也。得此脉者必难治。王氏脉经述之。而与仲景本文
有差。仲景两明结脉。总曰阴也。脉经分前一论来缓。时一止。名曰结阳。多添一阳字于后。一论中
有还者反动。改作不能自还。举之则动。却根据本文曰结阴也。以前为结阳。则脉缓非阳也。（此
盖脉诀所谓结脉）以后为结阴。则脉数乃阳也。（此盖脉诀所谓促脉）且不能自还与代脉同。何以
为结脉。且结代同。而中止皆同。自还为结。不能自还为代。正以分二脉之异。今混而同之不可也。
代则血气衰虚不能相续。因其呼吸相引复动。此所以代为难治。活人书云。阴盛则结。主胸满烦躁。
阳盛则促。主积聚气痞。忧思所成。大抵结促二脉。虽时一止。为病脉。非死脉也。代则真死矣。
或曰死脉必代。而代脉未必皆死者。何也。人见其脉动摇来往。略有一止。便以为代。便以为死。鲜
有不失者。盖代脉固以其有止。而有止者未可便以为代。何也。诸脉有止者四。涩促结代也。脉细而
迟。往来难。时一止者。为涩。脉来数。时一止者为促。脉来缓。时一止者为结。凡此三者均谓之止。
而其所以止者迥然不同。为病亦异。而皆非死脉也。甄别于此。毫发不爽。见其所谓止者。不过于涩
促结中之止。则随脉主病。真见其止如代中之止。然后断之为死。则不失矣。代脉之止。其止有常数
而不忒。如十动一止。则数十止皆见于十动之后。如二十动一止。则数十止皆见于二十动之后。及加
进亦如是。方为代脉。王氏脉经于代脉根据仲景。却改脉来作来数。则又混促脉之止。必全根据仲景本文方是。
〔代脉时时动若来〕（动而中止不能还。）〔再而复动似还无〕（复动因为代脉看。）三元
正气随风去。魂魄〔冥冥何所拘〕（升沉旦夕间。）
曰动若来。则不止也。一作动若浮。尤悖理。洁古亦随缪解之。何也。曰似还无。于脉状何似。故改之。
〔七〕牢者阴也。指下〔寻之则无按之则有〕（似沉似伏。实大而长。微弦。）曰牢。主骨
间疼痛。气居于表。
寻之则无。按之则有。则沉脉也。可以言牢脉所见之位。而失言牢脉之本状。似沉似伏者。牢脉
所居之位也。实大而长微弦者。牢脉之形也。脉经曰有似沉伏。沈氏分言似沉似伏。尤为明着。又
曰低而不浮曰沉。按之极下曰伏。隐指逼逼曰实。满指洪盛曰大。过于本位曰长。紧而直曰弦。兼是
数者为牢脉。黎氏曰牢者坚也。固围之象。气之郁结故如此。柳氏曰牢实不转移。主有积聚。主疼痛
不移其处。得此一脉。病邪牢坚。其病难愈。沈氏曰。阴阳革否其气沉伏在下。固结不移。其气欲上出
而不得。故曰革也。今按古今多以革与牢混论。素问云浑浑革至如涌泉。绵绵其去如弦绝。死。曰革
至如涌泉。流出之甚也。绵绵其去。流而不返义。如弦绝者。若弓弦琴瑟。弦断绝不可再续。故云死。
王贶曰革脉浑浑如涌泉。谓出而不返也。为阴气隔阳。又为溢脉。溢脉。盖自尺而出。上于鱼际。离经
无根本。又有覆脉。自寸口下退。过而入尺。皆必死。此等脉见于两手或一手。难以逐部求。或曰牢
脉即黄帝之所谓革脉。千金翼亦以革为牢。是以革牢同一义。然内经浑浑革至如涌泉。则此革不与脉
经沉伏之革同矣。然则牢革两义也。难经曰牢而长者肝也。牢阴长阳。因沉而得。为肝之平脉。又曰
脉之虚实。濡者为虚。紧牢者为实。
以邪气之盛为实也。此牢也。仲景曰脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。虚寒
相搏。此名为革。妇人则半产漏下。男子则亡血失精。此革也。（机按。牢主邪气实。革主精血虚。）
或又曰如挠鼓皮。鼓皮可以言革。而于实大弦长。难以取象。脉经曰三部脉革。长病得之死。卒病得
之生。兼病以断也。难经曰病若吐血。复鼽衄血者。脉当沉细。反得浮大而牢者死。脉病相违也。
仲景曰寒则牢坚。脉书往往以牢革为一。有牢则无革。有革则无牢。究而言之。诸书所谓牢者坚也。
紧牢为实。仲景所谓革者。虚寒相搏也。脉形脉理。二者不同。不可混也。因牢论革及此。若内经浑
浑革至云者。又别作一样看可也。
〔脉入皮肤辨息难〕（实大弦长沉伏间。）
牢脉居沉伏之位。非入皮肤之浮部也。牢以脉形固结。郁而在下。不与迟数辨息多少以立名。故
改之。时时气促在胸前。只缘水火相刑克。若待痊除更问天。
牢脉亦难以为水火相刑之象。五行各有相刑。皆有死症。
〔八〕动者阴也。指下〔寻之似有举之还无再再寻之不离其处不往不来〕（若数脉见于关上。上下无头尾如豆
大。厥厥动摇。）曰动。主体弱虚劳。崩中血痢。
仲景云。动脉若数脉。见于关上。上下无头尾如豆大。厥厥动摇。王氏脉经根据仲景文。而去若数脉及上
下五字。止云见于关上。无头尾如豆大。厥厥动摇。夫动必因数而后见。此五字不可除也。脉诀并不遵
根据。却自云寻之似有。举之还无。乃微弱沉之状。动脉厥厥动摇。出于众脉。岂举之还无乎。不离其处。果
If at the Chi position (pulse position near the elbow on the radial artery), [Yin Qi exhaustion causes soreness and pain with牵引 changes, mainly affecting the skin] (Yang Qi is insufficient. Bone烦 heat and pain make it difficult to lie down comfortably.)
The *Mai Jing* (Classic of Pulse Diagnosis) states: A weak Chi pulse indicates insufficient Yang Qi, presenting with fever and bone烦 pain. It also says blood is scanty. The *Mai Jing* explains that bone烦 arises because the Kidney governs the bone marrow. The *Mai Jue* (Pulse Rhymes) writes "skin," which is the area associated with the Lung, not governed by the Kidney. This is now corrected.
Tong Zhen Zi said: The Seven Superficial (Qi Biao) and Eight Interior (Ba Li) pulses are the normal Yin-Yang pulses. Additionally, there are nine types of pulses that manifest through mutual connection, such as those described in the classics as floating, slippery, and long; deep, choppy, and short; or large and firm, etc. In my view, pulses do not have fixed names of "normal" or "abnormal." If they appear due to pathogenic factors or disease, then all twenty-four pulse characters are abnormal; if they flourish according to the season and respond to the Zang-Fu organs, then they are all normal. Pulses conforming to Yin-Yang principles cannot be strictly defined as normal Yin-Yang pulses merely by the Seven Superficial and Eight Interior categories. The *Nan Jing* (Classic of Difficult Issues) states that floating, slippery, and long are Yang pulses, while deep, choppy, and short are Yin pulses; this does not establish them as normal Yin-Yang pulses separate from length. Thus, length, along with floating, deep, slippery, and choppy, all belong to the category of Yin and Yang. It also says "there are nine types of pulses manifesting through mutual connection," hence called "Nine Channels" (Jiu Dao). Moreover, the mutual connection of pulses refers to various pulses intermixing to indicate syndromes. Among the twenty-four pulse characters, except for Floating, Deep, Knotted, Rapid-with-Interruption, Intermittent, and Hidden, which reside in upper/lower positions and are limited to slow/rapid rhythms and cannot connect, the others can connect. The *Nan Jing* says "One Yang One Yin" refers to floating and choppy, meaning the Eight Interior connects to the Seven Superficial. "One Yin One Yang" refers to deep and slippery, meaning the Seven Superficial connects to the Eight Interior. Both the *Nei Jing* (Inner Canon) and Zhang Zhongjing's discussions often describe diseases by combining multiple pulses. The *Mai Jing*'s twenty-four pulses include Scattered and Rapid pulses but lack Short and Long pulses; the *Mai Jue* removes Scattered and Rapid and adds Long and Short to complete the twenty-four characters. In the *Mai Jing*, the twenty-four pulses are discussed collectively without a fixed order. Generally, pulses manifest according to pathological changes; Yang pulses should be categorized under Yang, and Yin pulses under Yin. One cannot fix the sequence as First Floating, Second Knife-edge, etc. Furthermore, three beats per breath constitute a Slow pulse, six beats a Rapid pulse; Slow is Yin and relates to Zang organs, Rapid is Yang and relates to Fu organs; the classic texts present these in pairs. To take Slow but omit Rapid, is this acceptable? Thus, it is known that pulses cannot be fixed at twenty-four characters, nor can distinct names of Exterior, Interior, and Channels be established. Chen Shi and Shen Shi both used Scattered and Rapid as the Nine Channels, borrowing the name and number from the *Mai Jue* but excluding Short and Long, which is also incorrect. Now, Scattered and Rapid pulses are added at the end to supplement the discussion in the *Mai Jing*, without removing Long and Short, because these are essential content for pulse theory. Since we are not confined to the number of twenty-four characters for Exterior, Interior, and Channels, any pulse named by a single character can be discussed in detail. Someone asked: Since you have refuted the errors of Exterior, Interior, and Channels, why do you not delete them but preserve the old text? I reply: This follows the example of Zhu Xi's *Xiaojing Kanwu* (Revisions to the Classic of Filial Piety) and Cheng Yi's exposition of "Ren Min" (Loving the People) in the *Daxue*. Not deleting preserves the original form. Text marked with ink circles should be deleted. The annotations below clarify the errors so that people know they are wrong and are no longer confused by the old text; this is deletion without physical removal.
[1] Long pulse belongs to Yang. Upon searching with the finger, the three positions (Cun, Guan, Chi) feel like holding a pole; lifting reveals excess, termed Long. Exceeding the standard position is also called Long. It indicates severe whole-body heat and restlessness.
From Chi to Guan, connecting to Cun, passing straight like a horizontal pole. This is the Long pulse of the three positions. Exceeding the standard position means any of Chi, Guan, or Cun extending beyond one finger's width. This is the Long pulse of individual positions. To determine the disease, one must seek within Floating, Deep, Slow, Rapid, Large, and Small. If neither large nor small, neither floating nor deep, neither slow nor rapid, then Qi is self-regulating and there is no disease. The classic says "Long means Qi is regulated," which is what this refers to. Generally, for healthy individuals or patients, a Long pulse is auspicious. Deep and Long indicates longevity. Long Chi pulse indicates deep roots. Long Heart pulse indicates abundant Shen Qi. The *Nei Jing* states that if the Heart pulse is firm and long, the disease manifests as a curled tongue and inability to speak; if the Kidney pulse is firm and long, the disease manifests as back strain. These six pulses do not cause disease because they are Long, but because they are firm and combined. In Spring, the Liver pulse should be soft, weak, light, void, and slippery, straight and long. A Liver pulse felt like the tip of a long pole is a Normal pulse; felt like the shaft of a long pole is a Diseased pulse, indicating excess and overextension.
The Long pulse stretches across the three guan, returning when the finger moves down.
Tong Zhen Zi said: Here, "returning when coming" seems to describe a One Yin Three Yang pulse. I say no. Coming and returning simply describes the pulse's movement; all pulses do this. If it cannot return on its own, it is an Intermittent pulse, leading to death. One Yin Three Yang refers to a pulse that is floating, slippery, and long, occasionally sinking. This is four pulses appearing together.
Yang toxin in the Zang organs and San Jiao heat requires gradual sweating to bring peace.
Jie Gu said: This is the Yangming pulse, with Long pulses at both Cun and Chi, requiring sweating. Yang transforms Qi. However, upon examination, even if it is a Yangming syndrome, sweating alone is difficult to justify. Zhengyang Yangming requires purgation; Taiyang Yangming requires sweating; Shaoyang Yangming requires treatment based on the syndrome. One should distinguish between Exterior and Interior to apply sweating or purgation accordingly.
[2] Short pulse belongs to Yin. Upon searching, it fails to reach the standard position, termed Short. It indicates body weakness and aversion to cold, cold qi in the abdomen, and undigested food retention.
Both Cun and Chi pulses retreat and are hurried, visible only halfway at Guan. Like a turtle retracting its head and dragging its tail. Because Yin and Yang Qi fail to reach the standard position, it is called Short. If the Guan pulse is Short, extending upwards not reaching Cun, and downwards not reaching Chi, this is a pulse of Yin-Yang exhaustion. These are untreatable and indicate certain death; therefore, the Guan position does not use the Short pulse for diagnosis.
The *Mai Jing* states: The image of the Short pulse returns upon pressing, failing to fill the position. Floating and Short indicates Wei and Ying Qi do not circulate; Deep and Short indicates Zang-Fu obstruction. Short opposes Long; knowing Long allows one to know Short.
Short pulse contains hidden Yang within Yin, Qi stagnates in the San Jiao preventing prosperity. Food retention in Zang generates cold qi, major purgation and bowel unblocking will bring health.
Tong Zhen Zi said: The *Mai Jue* considers One Yang Three Yang, where the pulse is deep, choppy, short, and occasionally floating, thus claiming hidden Yang. Upon examination, the *Mai Jue* discusses Short pulse alone as Yin containing hidden Yang. Essentially, Short is Yin, and a Short pulse indicates Qi pathology; Qi cannot flow freely, so Yang Qi is depressed internally. This does not refer to the simultaneous appearance of deep, choppy, short, and floating pulses. The *Nei Jing* says to dredge Blood and Qi, making them smooth and achieving harmony. Now, saying "major purgation" should also depend on the depth of the disease for medication.
[3] Deficient pulse belongs to Yin. [Searching yields insufficiency, lifting yields the same] (Slow, large, and soft; pressing yields weakness, feeling hollow upon the finger.) termed Deficient. It indicates fatigue and frequent fright.
Deficient pulse is known by pressing; its diagnostic method is similar to the Knife-edge pulse, both revealed by pressure. Floating, large, and soft, with emptiness in the center and fullness on the sides is Knife-edge; Slow, large, and soft, with emptiness upon pressing is Deficient. The *Nei Jing* states that Deficient pulse and Blood deficiency both manifest due to Blood issues. Blood loss results in central emptiness; Blood deficiency results in hollow center. The *Mai Jue* says searching yields insufficiency and lifting yields the same, describing a Micro-Soggy pulse, which does not adequately describe Deficient pulse. Deficient opposes Excess. Excess in the center is Excess, so Floating, Middle, and Deep are all forceful. Internal insufficiency is Deficient, so pressing feels hollow.
Frightened heart with much alarm. [Three guan steady breath pulse hard to form] (Pressing yields weakness, Deficient pulse is light.) Blood [deficiency] in Zang-Fu generates [irritability and heat.] Tonifying the San Jiao brings peace.
[4] Rapid-with-Interruption pulse belongs to Yang. Upon searching, it is extremely Rapid. It resides primarily at Cun. [Also said: Coming and going rapidly, occasionally stopping then resuming.] termed Rapid-with-Interruption. Gradually worsening leads to death; gradually improving leads to life.
Rapid-with-Interruption pulse: Chi is micro, Guan is fine, Cun is exclusively solid, slippery, and rapid. Residing in the upper position. Or coming and going rapidly, occasionally stopping then resuming. Li Shi said: Although Rapid-with-Interruption is vigorous and fast, it must occasionally stop then resume, like stumbling while walking. Thus, speed varies.
Rapid-with-Interruption comes past the Guan, residing at Cun [blood forms spots] [condition is critical.]
Blood forming spots is not a symptom of Rapid-with-Interruption pulse.
Suddenly improving allows life to continue. If it worsens, fate lies in Heaven.
[5] Knotted pulse belongs to Yin. Upon searching, [sometimes coming, sometimes going, gathering and returning] (Pulse comes slowly, occasionally stops then resumes. No fixed number. Also said: Pulse moves then stops, later comes slightly faster, among them returning reversely acts.) termed Knotted. It affects the four limbs, chest oppression, continuous pain, occurring intermittently.
Slow and slightly fast is Slippery. Pausing upon pressing is Stop. Slow with stop is Knotted. Tong Zhen Zi said: According to the classic, slow movement with occasional stop and resume is Knotted. This statement is correct. Here, "coming or going, gathering and returning" differs slightly. Coming and going is normal; how does gathering and returning show knotting? Now corrected according to Zhang Zhongjing.
The *Mai Jing* only says slow coming with occasional stop. The *Nan Jing* adds no fixed number. Now supplemented according to the *Nan Jing*. Basically, stopping then resuming, counting beats, occasionally two or three beats, or another stop, with no fixed number. If there is a fixed number, such as five beats then one stop, repeatedly, stopping according to the count, it is a Death pulse, and the time of death can be calculated by the stop count. See detailed discussion under Intermittent pulse below. Zhang Zhongjing said: Abundant like a chariot canopy, called Yang Knot, is Yang Qi knotted externally, not harmonizing with Yin. Cumulative like touching a long pole, called Yin Knot, is Yin Qi knotted internally, not harmonizing with Yang. He also said: Floating and Rapid pulse, able to eat, constipation, this is Excess, called Yang Knot. Deep and Slow pulse, unable to eat, heavy body, stool反而 hard, called Yin Knot. This distinguishes Yin and Yang knots by accompanying symptoms, not by pulse stop. The *Nei Jing* says Yang knot causes swelling of four limbs; four limbs are the root of all Yang. Yin knot causes bloody stool; Yin governs Blood. Two Yang knots cause Xiao (wasting-thirst); implies Large Intestine and Stomach heat. Three Yang knots cause Ge (obstruction); implies Small Intestine and Bladder heat. Three Yin knots cause Shui (water retention); implies Spleen and Lung cold. One Yin One Yang knot causes Hou Bi (sore throat); implies Heart Master and San Jiao heat. This also divides Yin and Yang knots. Wang Shi's *Mai Jing* likely due to Zhang Zhongjing's text, treats slow stop as Yang Knot and rapid stop as Yin Knot, which is very erroneous. Detailed in Intermittent pulse. Actually, the *Mai Jue*'s Knotted pulse is Yin, opposing Rapid-with-Interruption as Yang, unlike the *Nei Jing* and Zhang Zhongjing who discuss Yin-Yang distinction. If discussing Yin-Yang, Knotted is slow with stop (Yin Knot) and rapid with stop (Yang Knot), which is appropriate.
Accumulated Qi arises beside the Spleen, sudden pain in Large Intestine is unbearable. Gradually clear San Jiao fire, do not arbitrarily set up many prescriptions.
[6] Intermittent pulse belongs to Yin. Upon searching, [moving then rising slowly, unable to return itself] (Moving then stops. Unable to return itself. Then moves again.) termed Intermittent. It indicates emaciation and inability to speak.
Intermittent means this pulse has ceased, and other pulses take its place. When one Zang Qi ceases, another Zang Qi takes over. Intermittent differs from Stop: Stop is felt upon pressing as pausing; Intermittent suddenly returns to Chi, pauses for a long time before resuming, meaning missed beats, counting movements, stopping then resuming due to respiratory Yin-Yang attraction. Now the *Mai Jue* says "moving then rising," which is not Intermittent, showing ignorance that moving-then-stopping is Intermittent. Below "slowly unable to return itself," it omits "then moves again," implying after being unable to return, the pulse ceases and does not come. Now corrected using Zhang Zhongjing's original text. The *Nei Jing* says Intermittent means Qi decline. Spleen pulse Intermittent, commentary notes Weakness. Zhang Zhongjing said: Typhoid pulse Knotted-Intermittent, palpitations, treated with Zhi Gancao Decoction. Neither considers Intermittent a Death pulse. Wang Shi's *Mai Jing* first stated Knotted pulse lives, Intermittent pulse dies. Zhang Zhongjing discussed Knotted-Intermittent: Pulse pressing comes slow, occasionally stops then resumes, named Knotted. Pulse comes, moves then stops, later comes slightly faster, among them returning reversely acts, named Knotted, Yin. Pulse comes, moves then stops, unable to return itself, then moves again, named Intermittent, Yin. Obtaining this pulse is difficult to treat. Wang Shi's *Mai Jing* narrates it but differs from Zhang Zhongjing's text. Zhang Zhongjing clearly defines Knotted twice, totaling Yin. *Mai Jing* splits: first discusses slow coming, occasional stop, named Yang Knot, adding "Yang." Second discusses returning reversely acts, changed to unable to return itself, lifting moves, yet based on text says Yin Knot. Previous as Yang Knot, so slow pulse is not Yang. (This is likely the *Mai Jue*'s Knotted pulse). Later as Yin Knot, so rapid pulse is Yang. (This is likely the *Mai Jue*'s Rapid-with-Interruption pulse). Moreover, unable to return itself is same as Intermittent pulse, how can it be Knotted? And Knotted and Intermittent share stopping; returning self is Knotted, unable to return self is Intermittent, precisely to distinguish them. Mixing them now is unacceptable. Intermittent means Blood and Qi decline and cannot continue, resuming due to respiratory attraction. This is why Intermittent is difficult to treat. *Huoren Shu* says: Yin excess causes Knotted, main chest fullness and irritability. Yang excess causes Rapid-with-Interruption, main accumulation and Qi痞, caused by worry/thought. Generally, Knotted and Rapid-with-Interruption, though occasionally stopping, are Disease pulses, not Death pulses. Intermittent is truly Death.
Someone asked: Death pulse must be Intermittent, but Intermittent pulse is not necessarily Death. Why? People see pulse moving with slight stop, assume Intermittent, assume Death, rarely without error. Intermittent pulse indeed has stop, but having stop does not mean Intermittent. Why? Four pulses have stop: Choppy, Rapid-with-Interruption, Knotted, Intermittent. Fine and Slow pulse, difficult movement, occasional stop is Choppy. Rapid pulse, occasional stop is Rapid-with-Interruption. Slow pulse, occasional stop is Knotted. All three are called Stop, but reasons for stopping are vastly different. Diseases differ, none are Death pulses. Distinguish here, without error. Seeing stop only in Choppy, Rapid-with-Interruption, Knotted, follow pulse-disease correspondence. Truly seeing stop like in Intermittent, then judge as Death, then no error. Intermittent pulse stop has constant number without deviation. E.g., ten beats one stop, dozens of stops all appear after ten beats. Twenty beats one stop, dozens of stops all appear after twenty beats. Advancing similarly, only then is Intermittent pulse. Wang Shi's *Mai Jing* bases Intermittent on Zhang Zhongjing but changes pulse comes to comes rapid, mixing Rapid-with-Interruption stop. Must fully follow Zhang Zhongjing's text.
[Intermittent pulse moves often as if coming] (Moving then stops unable to return.) [Again then moves as if returning none] (Resuming move viewed as Intermittent pulse.) Three Yuan righteous Qi goes with wind, Souls [darkly where restrained] (Rising and sinking morning and evening.)
Saying "moves as if coming" means no stop. One version "moves as if floating" is especially illogical. Jie Gu also followed this error. Why? Saying "as if returning none," what pulse shape resembles this? Hence corrected.
[7] Firm pulse belongs to Yin. Upon [searching yields nothing, pressing yields something] (Seems Deep seems Hidden. Solid large and long. Slightly wiry.) termed Firm. It indicates pain between bones, Qi residing at surface.
Searching yields nothing, pressing yields something, is Deep pulse. This describes the position of Firm pulse but misses its fundamental shape. Seems Deep seems Hidden is the position of Firm pulse. Solid large and long slightly wiry is the shape of Firm pulse. *Mai Jing* says seems Deep Hidden. Shen Shi separates seems Deep seems Hidden, very clear. Also says low not floating is Deep, pressing extremely low is Hidden, pressing tightly is Solid, filling finger massively is Large, exceeding position is Long, tight and straight is Wiry. Combining these numbers is Firm pulse. Li Shi said Firm means solid. Enclosed image. Qi depression causes this. Liu Shi said Firm solid does not shift, main accumulation. Main pain not shifting location. Obtaining this one pulse, pathogen is firm, disease hard to cure. Shen Shi said: Yin-Yang revolution, Qi sinks and hides below, solidifies and does not shift. Qi wants to emerge but cannot, hence Revolution. Now I examine ancient and modern often confuse Revolution and Firm. *Su Wen* says chaotic Revolution comes like gushing spring, continuous leaving like string breaking, Death. Says Revolution comes like gushing spring, flowing out greatly. Continuous leaving, flowing not returning meaning. Like string breaking, bowstring guqin string, broken string cannot reconnect, hence Death. Wang Kuang said Revolution pulse chaotic like gushing spring, means exiting not returning. Yin Qi blocking Yang. Also Overflow pulse. Overflow pulse, emerges from Chi, rises to大鱼际, leaves channel without root. Also Reverse pulse, from Cun descends, passes into Chi, all must die. Such pulses appearing on both hands or one hand, hard to seek part by part. Or say Firm pulse is Huangdi's so-called Revolution pulse. *Qianjin Yi* also takes Revolution as Firm. Thus Revolution and Firm same meaning. But *Nei Jing* chaotic Revolution comes like gushing spring, then this Revolution is not same as *Mai Jing* Deep Hidden Revolution. Thus Revolution and Firm have two meanings. *Nan Jing* says Firm and long is Liver. Firm Yin Long Yang, obtained via Deep, is Liver Normal pulse. Also says pulse deficiency/excess, Soggy is deficiency, Tight Firm is excess. Taking pathogen abundance as excess. This is Firm. Zhang Zhongjing said pulse wiry and large, wiry means reduction, large means Knife-edge, reduction means cold, Knife-edge means deficiency, deficiency-cold combine, this named Revolution. Women half-birth leakage, men blood loss essence loss. This Revolution. (Ji notes: Firm main pathogen excess, Revolution main essence-blood deficiency.)
Or again say like scratching drum skin. Drum skin can describe Revolution, but for solid large wiry long, hard to take image. *Mai Jing* says three positions pulse Revolution, chronic disease obtains Death, acute disease obtains Life. Combined disease to judge. *Nan Jing* says disease if vomiting blood, repeated epistaxis, pulse should be Deep fine, reverse obtaining Floating large and Firm is Death. Pulse-disease contradiction. Zhang Zhongjing said cold then Firm solid. Pulse books often take Firm Revolution as one. Have Firm no Revolution, have Revolution no Firm. Ultimately speaking, all books say Firm means solid. Tight Firm is excess. Zhang Zhongjing says Revolution means deficiency-cold combine. Pulse shape and principle, two different, cannot mix. Discussing Revolution via Firm to this point, if *Nei Jing* chaotic Revolution comes, view separately.
[Pulse enters skin distinguishing breath hard] (Solid large wiry long Deep Hidden midst.)
Firm pulse resides in Deep Hidden position, not entering Skin Floating part. Firm due to pulse shape solidified, depressed below, not distinguishing Slow/Rapid breath amount to establish name, hence corrected. Frequent shortness of breath in chest, only due to Water-Fire mutual punishment. If waiting for recovery ask Heaven again.
Firm pulse also hard to be Water-Fire punishment image. Five Elements each have punishment, all have Death symptoms.
[8] Moving pulse belongs to Yin. Upon [searching seems having lifting still no again searching not leaving its place not going not coming] (If Rapid pulse seen at Guan. Up down no head tail like bean size. Quivering shaking.) termed Moving. It main body weak deficiency labor, uterine bleeding bloody dysentery.
Zhang Zhongjing said, Moving pulse like Rapid pulse, seen at Guan, up down no head tail like bean size, quivering shaking. Wang Shi's *Mai Jing* based on Zhang Zhongjing text, removed "like Rapid pulse" and "up down" five characters, only said seen at Guan, no head tail like bean size, quivering shaking. Moving must appear due to Rapid, these five characters cannot be removed. *Mai Jue* does not follow basis, but self-says searching seems having, lifting still no,乃微弱沉之状 (is weak micro deep state). Moving pulse quivering shaking, emerges from various pulses, how can lifting still no? Not leaving its place, indeed