凡诊脉须先要识时脉。胃脉。与脏腑平脉。然后及于病脉。（时脉。谓春三月六部中俱
带弦。夏三月俱带洪。秋三月俱带浮。冬三月俱带沉。胃脉。谓中按得之脉和缓。脏腑平脉已见前章。
凡人脏腑脉既平。胃脉和。又应时脉。乃无病者也。反此为病。又曰三部之内。大小浮沉迟数同等。
尺寸阴阳高下相符。男女左右强弱相应。四时之脉不相戾。命曰平人。其或一部之内。独大独小。
偏迟偏疾。左右强弱之相反。四时男女之相背。皆病脉也。凡脉见在上曰上病。在下曰下病。左曰左病。
右曰右病。左脉不和。为病在表。为阳。主四肢。右脉不和。为病在里。为阴。主腹脏。以次推之。）
（附九候）
诊脉之时。人臂长则疏下指。臂短则密下指。寸为阳。为上部。（主头项以下至心胸之分。）关为阴阳之中。为中部。
（主脐腹 胁之分）尺为阴。为下部。（主腰足胫股之分）凡此三部之中。每部各有浮中沉。三候。三而三之。为九候也。
持脉之要有三。曰举。曰按。曰寻。（轻手取之曰举。重手取之曰按。不轻不重委曲求之曰寻。初持脉轻手候之。脉
见皮肤之间者。阳也。腑也。亦心肺之应也。所谓浮按消息是也。重手取之。脉附于肉下者。阴也。脏也。亦肾肝之应
也。所谓沉按消息是也。不轻不重。中而取之。脉应于血肉之间者。阴阳相适。中和之应。脾胃之候也。所谓中按消息
是也。若浮中沉之不
见。则委曲求之。若隐若见。则阴阳伏匿之脉也。所谓推而内之是也。三部皆然。一说左寸。浮。候左头角。中。候左
胁。沉。候少阴心。左关浮。候小肠胆。中。候左胁。沉。候厥阴肝。左尺。浮。候膀胱。中。候左腰。沉。候肾。右
寸。浮。候右头角。中。候两耳目。沉。候肺。右关。浮。候胃。中。候胸中。沉。候脾。右尺。浮。候三焦。中。候
右腰。沉。候命门。）
诊候推移指法。（推而外之。消息之。内而不外。有心腹积也。推而内之。消息之。外而不内。身有热也。推而上之。
消息之。上而不下。腰足清也。推而下之。消息之。下而不上。头项痛也。左寸。外以候心。内以候膻中。左关。外以
候肝。内以候膈。右寸。外以候肺。内以候胸中。右关。外以候胃。内以候脾。两尺。外以候肾。里以候腹中。是以有
推而内。推而外。消息之法也。一说左寸。推而上之。上而不下。头项痛也。推而下之。下而不上。胸胁痛也。推而内
之。内而不外。心腹积也。推而外之。外而不内。眼目昏也。左关。推而上之。上而不下。腰足清也。推而下之。下而
不上。肠胃痛也。推而内之。内而不外。筋骨痛也。推而外之。外而不内。主身有热也。左尺。推而上之。上而不下。
小肠痛也。推而下之。下而不上。足胫痛也。推而内之。内而不外。小便浊也。推而外之。外而不内。腰足痛也。右寸。
推而上之。上而不下。气喘急也。推而下之。下而不上。胸中痛也。推而内之。内而不外。咽喉痛也。推而外之。外而
不内。背脊痛也。右关。推而上之。上而不下。吐逆也。推而下之。下而不上。主下血也。推而内之。内而不外。腹有
虫也。推而外之。外而不内。肌肉痛也。右尺。推而上之。上而不下。小腹胀也。推而下之。下而不上。足胫痛也。推
而内之。内而不外。疝瘕也。推而外之。外而不内。小便秘也。机按。消息。谓详细审察也。推。谓以指挪移于部之
上下而诊之。以脉有长短之类也。又以指挪移于部之内外而诊之。以脉有双弦单弦之类也。又以
指推开其筋而诊之。以脉有沉伏止绝之类也。刊误谓内外以指按轻重言。推有数义。故特着之。非
但外以候心。内以候膻中之类也。自一说以下。所论亦无所据。姑录之以备参考。）
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察脉。须识上下来去至止六字。不明此六字。则阴阳虚实不别也。（上者为阳。来者为阳。至者
为阳。下者为阴。去者为阴。止者为阴也。上者。自尺部上于寸口。阳生于阴也。下者。自寸口下于尺
部。阴生于阳也。来者自骨肉之分。而出于皮肤之际。气之升也。去者自皮肤之际。而还于骨肉之分。
气之降也。应曰至。息曰止也。若短小而见于肌肉之间。阴乘阳也。洪大而见于肌肉之下。阳乘阴也。
寸尺皆然。）
诊脉。须辨表里虚实四字。（表。阳也。腑也。凡六淫之邪。袭于经络。而未入胃腑及脏者。
皆属于表也。里。阴也。脏也。凡七情之气。郁于心腹之内。不能散越。饮食之伤。留于脏腑之间。
不能流通。皆属于里也。虚者元气之自虚。精神耗散。气力衰弱也。宝者邪气之实。由正气之本虚。
邪气乘之。非元气之自实也。故虚者补其正气。实者泻其邪气。经曰所谓虚实。邪气盛则实。精
气夺则虚。此大法也。）
脉者血气之先也。气血胜则脉胜。气血衰则脉衰。气血热则脉数。气血寒则脉迟。气血微则脉弱。
气血平则脉治。又长人脉长。短人脉短。肥人脉沉。瘦人脉浮。性急人脉急。性缓人脉缓。左大顺男。
右大顺女。男子尺脉常弱。女子尺脉常盛。此皆其常也。反之者逆。（千金翼云。人大而脉
细。人细而脉大。人乐而脉实。人苦而脉虚。性急而脉缓。性缓而脉躁。人壮而脉细。人羸而脉大。此皆为逆。逆则难
治。反此为顺。顺则易治。凡妇人脉。常欲濡弱于丈夫。小儿四五岁脉。呼吸八至。细数者吉。男左大为顺。女右大为
顺。）
脉贵有神。（东垣云。不病之脉。不求其神。而神无不在也。有病之脉。则当求其神之有无。如六数七极。热也。脉
中有力。则有神矣。为泻其热。三迟二败。寒也。脉中有力。则有神矣。为去其寒。若数极迟败中。不复有力。为无神
也。将何所恃邪。苟不知此。而遽泻去之。神将何所根据而主邪。经曰。脉者气血之先。气血者人之神。善夫。）
凡取脉之道。理各不同。脉之形状。又各非一。凡脉之来不必单至。必曰浮而弦。浮而数。沉而紧。沉而细之类。
将何以别之。大抵提纲之要。不出浮沉迟数滑涩之六脉也。（浮为阳。轻手得之，而芤。洪。大。散。长。濡。弦。皆轻
手而得之之类也。沉为阴。重手得之。而伏。石。短。细。牢。实。皆重手而得之之类也。迟者。一息脉二至。而缓。
结。微。弱者。皆迟之类也。数者一息脉六至。而疾。促。皆数之类也。或曰滑。类乎数。涩。类乎迟。然脉虽似。而
理则殊。彼迟数之脉。以呼吸察其至数之疏密。此滑涩之脉。则以往来察其形状也。机按。脉虽种种不同。而浮沉迟数
四脉。可以统之。但识四脉则诸脉之象可以类推。难经于六难专言浮沉。九难专言迟数。既以四脉为重。近世陈无择诸
人亦皆言浮沉迟数。可统诸脉。良有旨哉。浮之有力。为洪。为长。为革。浮之无力。为芤。为虚。为微。为濡。为散。
皆浮脉所统也。沉之有力为弦。为牢。为实。沉之无力为短。为细。为弱。沉极为伏。皆沉之所统也。迟之有力。为缓。
为结。迟之无力。为涩。为代。皆迟之所统也。数之有力。为滑。为动。为紧。数之无力。为促。皆数之所统也。）
脉之提纲。不出六字者。盖以其足以统夫表里阴阳。冷热虚实。风寒燥湿。脏腑血气也。（浮为阳。为表诊。为风。为
虚。沉为阴。为里诊。为湿。为寒。实。迟为在脏。为寒。为冷。数为在腑，为热为燥，滑为血有余。涩为气独滞也。
人一身之变不越乎此。能于是六脉之中审求之。则 疾之在人者莫能逃焉。一说浮有力主风。无力主虚。沉有力主积。
无力主气。三因方为湿为实。沉有力主痛。无力主冷。数有力主热。无力主疮。为燥。）
Whenever palpating the pulse, one must first recognize the seasonal pulses. That is, the Stomach Qi pulse (a healthy pulse indicating sufficient Stomach Qi) and the normal pulses of the Zang-Fu organs (healthy organ-specific pulses), before proceeding to identify pathological pulses. (Seasonal pulses refer to: in the three months of Spring, all six positions exhibit a Wiry [Xian] quality; in Summer, all are Surging [Hong]; in Autumn, all are Floating [Fu]; in Winter, all are Deep [Chen]. The Stomach Qi pulse refers to a pulse that is harmonious and moderate when moderately pressed. The normal Zang-Fu pulses have been discussed in previous chapters. When a person's Zang-Fu pulses are balanced, the Stomach Qi pulse is mild and harmonious, and it conforms to the seasonal pulse, this indicates a disease-free state. Deviation from this constitutes a pathological pulse. It is also said that within the Cun, Guan, and Chi positions, if the magnitude, floating/deep, slow/rapid qualities are equivalent, the Yin-Yang attributes and high-low positions of the Cun and Chi correspond correctly, the strength differences between left and right hands match gender norms, and the four-seasonal pulses do not contradict the season, this is called a "Ping Ren" (healthy person). If within any single position, there is exclusively large or small, excessively slow or rapid, or if the left-right strength contrasts abnormally, or if the four-seasonal or male-female patterns oppose each other, these are all pathological pulses. A pulse manifesting in the upper part (Cun position) indicates Upper pathology; in the lower part (Chi position) indicates Lower pathology; on the Left indicates Left pathology; on the Right indicates Right pathology. Disharmony of the Left-hand pulse suggests pathology in the Exterior, belonging to Yang, governing the Four Limbs. Disharmony of the Right-hand pulse suggests pathology in the Interior, belonging to Yin, governing the Abdominal Viscera. One may deduce further by analogy.)
(Attached: Nine Palpations Method)
When palpating the pulse, if the patient's arm is long, the fingers should be spaced wider apart; if short, closer together. The Cun position belongs to Yang and is the Upper section. (It primarily corresponds to the area from below the head and neck down to the chest and heart.) The Guan position is the midpoint of Yin and Yang, constituting the Middle section. (It primarily corresponds to the area of the umbilical abdomen and hypochondrium.) The Chi position belongs to Yin and is the Lower section. (It primarily corresponds to the waist, legs, shanks, and thighs.) Within these three sections, each has three palpation depths: Floating, Moderate, and Deep. Three times three equals nine palpations.
The essentials of holding the pulse are three: Ju (Lifting), An (Pressing), and Xun (Seeking). (Lightly touching the skin to feel the pulse is called Ju; pressing heavily to reach the bone/muscle layer is called An; neither light nor heavy, seeking the pulse through careful exploration is called Xun. Initially, using light pressure, if the pulse is felt at the skin level, it is Yang, associated with Fu organs, and reflects the Heart and Lungs. This is referred to as "examining via Floating palpation." Pressing heavily, if the pulse is felt beneath the muscle, it is Yin, associated with Zang organs, and reflects the Kidney and Liver. This is referred to as "examining via Deep palpation." Neither light nor heavy, taking the middle, if the pulse is felt between flesh and blood, it represents a balance of Yin and Yang, a harmonious response, reflecting the Spleen and Stomach. This is referred to as "examining via Moderate palpation." If the pulse is not found in Floating, Moderate, or Deep levels, one must seek it carefully. If it appears faintly or intermittently, it is a pulse of hidden Yin and Yang. This is referred to as "pushing inward to investigate." This applies to all three sections. Another theory states: Left Cun Floating palpation examines the left temple/head corner; Moderate examines the left hypochondrium; Deep examines Shaoyin Heart. Left Guan Floating examines Small Intestine and Gallbladder; Moderate examines left hypochondrium; Deep examines Jueyin Liver. Left Chi Floating examines Bladder; Moderate examines left waist; Deep examines Kidney. Right Cun Floating examines right temple/head corner; Moderate examines both eyes and ears; Deep examines Lung. Right Guan Floating examines Stomach; Moderate examines Chest Middle; Deep examines Spleen. Right Chi Floating examines Sanjiao; Moderate examines right waist; Deep examines Mingmen.)
Palpation Pushing Techniques. (Pushing the finger outward to examine the exterior, while carefully observing; if the pulse moves inward but not outward, it indicates accumulation in the Heart and Abdomen. Pushing the finger inward to examine the interior, while carefully observing; if the pulse moves outward but not inward, it indicates heat in the body. Pushing the finger upward to examine the upper, while carefully observing; if the pulse moves upward but not downward, it indicates coldness in the waist and feet. Pushing the finger downward to examine the lower, while carefully observing; if the pulse moves downward but not upward, it indicates pain in the head and neck. Left Cun: Exterior examines Heart, Interior examines Danzhong. Left Guan: Exterior examines Liver, Interior examines Diaphragm. Right Cun: Exterior examines Lung, Interior examines Chest Middle. Right Guan: Exterior examines Stomach, Interior examines Spleen. Both Chis: Exterior examines Kidney, Interior examines Abdomen. Thus, there are methods of pushing inward, pushing outward, and careful observation. Another theory states: Left Cun, pushing upward where it does not go down, causes head/neck pain; pushing downward where it does not go up, causes chest/hypochondriac pain; pushing inward where it does not go outward, causes Heart/Abdomen accumulation; pushing outward where it does not go inward, causes blurry vision. Left Guan, pushing upward where it does not go down, causes cold waist/feet; pushing downward where it does not go up, causes intestinal/colonic pain; pushing inward where it does not go outward, causes bone/tendon pain; pushing outward where it does not go inward, causes body heat. Left Chi, pushing upward where it does not go down, causes Small Intestine pain; pushing downward where it does not go up, causes leg/shank pain; pushing inward where it does not go outward, causes turbid urine; pushing outward where it does not go inward, causes waist/foot pain. Right Cun, pushing upward where it does not go down, causes asthma/shortness of breath; pushing downward where it does not go up, causes chest pain; pushing inward where it does not go outward, causes throat pain; pushing outward where it does not go inward, causes back/spine pain. Right Guan, pushing upward where it does not go down, causes vomiting/reversal of Qi; pushing downward where it does not go up, causes lower bleeding; pushing inward where it does not go outward, indicates worms in the abdomen; pushing outward where it does not go inward, causes muscle pain. Right Chi, pushing upward where it does not go down, causes lower abdominal distension; pushing downward where it does not go up, causes leg/shank pain; pushing inward where it does not go outward, causes hernia/masses; pushing outward where it does not go inward, causes difficulty urinating. Ji notes: "Message/Observation" (Xiaoxi) means detailed examination. "Push" (Tui) means moving the finger up and down within the position to diagnose, due to variations in pulse length; moving the finger inside and outside the position to diagnose, due to variations like double-wiry or single-wiry pulses; and pushing aside tendons to diagnose, due to pulses being deep-hidden or intermittent. The editor of "Kangwu" argues that "inside/outside" refers to the weight of finger pressure. Since "push" has multiple meanings, it is specially noted here, not merely referring to exterior examining Heart and interior examining Danzhong. The discussions following "another theory" lack basis but are recorded for reference.)
Examining the pulse requires understanding the six characters: Shang (Up), Xia (Down), Lai (Coming), Qu (Going), Zhi (Arriving), Zhi (Stopping). Without understanding these six, one cannot distinguish Yin-Yang and Deficiency-Excess. (Up is Yang, Coming is Yang, Arriving is Yang; Down is Yin, Going is Yin, Stopping is Yin. Up refers to movement from the Chi position to the Cun position, representing Yang arising from Yin. Down refers to movement from the Cun position to the Chi position, representing Yin arising from Yang. Coming refers to Qi rising from the bone/flesh boundary to the skin surface. Going refers to Qi descending from the skin surface back to the bone/flesh boundary. The beat corresponding to inhalation/exhalation is called Zhi (Arriving); the pause during respiration is called Zhi (Stopping). If the pulse is short and small and felt between muscles, it is Yin invading Yang. If the pulse is surging and large and felt beneath the muscle, it is Yang invading Yin. This applies to both Cun and Chi positions.)
Diagnosing the pulse requires distinguishing four characters: Biao (Exterior), Li (Interior), Xu (Deficiency), Shi (Excess). (Exterior is Yang, associated with Fu organs. Any pathogenic factors of the Six Evils invading the meridians but not yet entering the Stomach/Fu organs or Zang organs belong to the Exterior. Interior is Yin, associated with Zang organs. Any emotional Qi stagnating within the heart and abdomen without dispersing, or dietary injury remaining between the Zang-Fu organs without circulating, belongs to the Interior. Deficiency refers to the self-depletion of Yuan Qi, with dissipation of spirit and weakening of energy. Excess refers to the fullness of Pathogenic Qi, resulting from original Righteous Qi being deficient, allowing Pathogenic Qi to invade; it is not the self-fullness of Yuan Qi. Therefore, Deficiency is treated by tonifying Righteous Qi, and Excess is treated by draining Pathogenic Qi. The Classics state: Regarding Deficiency and Excess, excess of Pathogenic Qi constitutes Excess, depletion of Essence/Qi constitutes Deficiency. This is the general principle.)
The Pulse is the precursor of Blood and Qi. When Blood and Qi are abundant, the pulse is vigorous; when depleted, the pulse is weak. When hot, the pulse is Rapid; when cold, the pulse is Slow. When minute, the pulse is Weak. When balanced, the pulse is Normal. Furthermore, tall people have long pulses, short people have short pulses, fat people have deep pulses, thin people have floating pulses, impatient people have urgent pulses, and calm people have slow pulses. In men, a larger Left pulse is favorable; in women, a larger Right pulse is favorable. Men's Chi pulses are typically weak; women's Chi pulses are typically strong. These are the norms. Deviations are considered adverse. (Qianjin Yi states: Large person with fine pulse, fine person with large pulse, happy person with solid pulse, suffering person with deficient pulse, impatient person with slow pulse, calm person with restless pulse, robust person with fine pulse, emaciated person with large pulse—these are all Adverse. Adverse conditions are difficult to treat; deviations from these are Favorable, and Favorable conditions are easy to treat. Generally, women's pulses should be softer/weaker than men's. For children aged 4-5, a pulse rate of eight beats per respiration, fine and rapid, is auspicious. Male Left-large is favorable, Female Right-large is favorable.)
The pulse values Shen (Spirit/Vitality). (Li Dongyuan said: For a non-diseased pulse, one does not need to seek its Shen, as Shen is inherently present. For a diseased pulse, one must determine the presence or absence of Shen. For example, a pulse beating seven times or extremely fast indicates Heat. If there is force within the pulse, it has Shen, and one may drain the Heat. A pulse beating three times or failing indicates Cold. If there is force within the pulse, it has Shen, and one may remove the Cold. However, if amidst extreme rapidity or failure/slowness, there is no longer any force, it lacks Shen. What can it rely upon? If one does not understand this and hastily applies draining methods, what foundation will Shen have to expel pathogens? The Classics say: The pulse is the precursor of Blood and Qi; Blood and Qi are the Shen of humans. How true this is!)
The principles of taking the pulse vary, and pulse shapes are numerous. Pulses do not arrive singly; they often combine, such as Floating-Wiry, Floating-Rapid, Deep-Tight, Deep-Fine, etc. How then to distinguish them? Broadly, the key提纲 (outline) does not exceed the six pulses: Floating, Deep, Slow, Rapid, Slippery, and Choppy. (Floating is Yang, obtained with light touch; Kun, Hong, Da, San, Chang, Ru, Xian all fall under this category. Deep is Yin, obtained with heavy touch; Fu, Shi, Duan, Xi, Lao, Shi all fall under this category. Slow refers to two beats per respiration; Huan, Jie, Wei, Ruo all belong to Slow. Rapid refers to six beats per respiration; Ji, Cu all belong to Rapid. Some ask: Slippery resembles Rapid, Choppy resembles Slow. Although similar, their principles differ. Slow/Rapid pulses are distinguished by counting beats relative to respiration; Slippery/Choppy pulses are distinguished by their shape of movement. Ji notes: Although pulses vary greatly, Floating, Deep, Slow, and Rapid can encompass them. Recognizing these four allows inference of others. Nan Jing Chapter 6 focuses on Floating/Deep, Chapter 9 on Slow/Rapid, emphasizing these four. Modern figures like Chen Wuyue also state these four govern all pulses, which is profound. Floating with force indicates Hong, Chang, Ge; Floating without force indicates Kun, Xu, Wei, Ru, San—all governed by Floating. Deep with force indicates Xian, Lao, Shi; Deep without force indicates Duan, Xi, Ruo; Extreme Deep is Fu—all governed by Deep. Slow with force indicates Huan, Jie; Slow without force indicates Se, Dai—all governed by Slow. Rapid with force indicates Hua, Dong, Jin; Rapid without force indicates Cu—all governed by Rapid.)
The outline of pulses involves six characters because they suffice to govern Exterior/Interior, Yin/Yang, Cold/Heat, Deficiency/Excess, Wind/Damp-Dry, Zang-Fu, and Blood/Qi. (Floating is Yang, indicates Exterior diagnosis, Wind, Deficiency. Deep is Yin, indicates Interior diagnosis, Damp, Cold. Solid and Slow indicate Zang involvement, Cold, Chill. Rapid indicates Fu involvement, Heat, Dryness. Slippery indicates excess Blood; Choppy indicates stagnant Qi alone. Human bodily changes do not exceed these. By scrutinizing these six pulses, diseases in humans cannot escape detection. Another theory states: Floating with force indicates Wind, without force indicates Deficiency; Deep with force indicates Accumulation, without force indicates Qi stagnation; *San Yin Fang* considers Deep as Damp/Excess, Deep with force indicates Pain, without force indicates Cold; Rapid with force indicates Heat, without force indicates Sores; Choppy indicates Dryness.)