（汪机撰）
夫脉者本乎营与卫也。而营行于脉之中。卫行于脉之外也。苟脏腑和平。营卫调畅。则脉无形状
之可议矣。或六淫外袭。七情内伤。则脏腑不和。营卫乖谬。而二十四脉之名状。层出而叠见矣。
是故风寒暑湿燥火。此六淫也。外伤六淫之脉。则浮为风。紧为寒。虚为暑。细为湿。数为燥。洪为火。
此皆可以脉而别其外感之邪也。喜怒忧思悲恐惊者。此七情也。内伤七情之脉。喜则伤心而脉缓。
怒则伤肝而脉急。忧则伤肺而脉涩。思则伤脾而脉结。恐则伤肾而脉沉。悲则气消而脉短。惊则气
乱而脉动。凡此者皆可以脉而辨其内伤之病也。然此特举其常。而以脉病相应者为言也。若论其变。
则有脉不应病。病不应脉。变出百端。而难一一尽凭于脉矣。试举一二言之。张仲景云。脉浮大。
邪在表。为可汗。若脉浮大。心下硬。有热。属脏者。攻之。不令发汗。此又非浮为表邪。可汗之脉也。
又云促脉为阳盛。宜用葛根黄芩黄连汤。若脉促厥冷为虚脱。非灸非温不可。此又非促为阳盛之脉也。
又云迟脉为寒。沉脉为里。若阳明脉迟。不恶寒。身体 汗出。则用大承气。此又非诸迟为寒之脉矣。
少阴病始得之。反发热而脉沉。宜麻黄细辛汤。微汗之。此又非沉为在里之脉矣。凡此皆脉难尽凭
之明验也。若只凭脉而不问症。未免以寒为热。以表为里。以阴为阳。颠倒错乱。而夭人长寿者有矣。
是以古人治病。不专于脉。而必兼于审症。良有以也。奈何世人不明乎此。
往往有病讳而不言。惟以诊脉而试医之能否。诊之而所言偶中。便视为良医。倾心付托。笃意委任。而于
病之根源。一无所告。药之宜否。亦无所审。惟束手听命于医。因循遂至于死。尚亦不悟。深可悲夫。
彼庸俗之人。素不嗜学。不识义理。固无足怪。近世士大夫家。亦未免狃于此习。是又大可笑也。
夫定静安虑格物致知。乃大学首章第一义。而虑者谓处事精详。格物者谓穷致事物之理。致知者谓
推极吾之所知。凡此数事。学人必常究心于此矣。先正又曰。为人子者不可以不知医。病卧于床。
委之庸医。比之不慈不孝。夫望闻问切。医家大节目也。苟于临病之际。惟以切而知之为能。其余三
事一切置而不讲。岂得为知医乎。岂得为处事精详乎。岂得为穷致事物之理。而推极吾之所知乎。
又岂得为父而慈。为子而孝乎。且医之良。亦不专于善诊一节。苟或动静有常。举止不妄。存心而
忠浓。发言而纯笃。察病详审。处方精专。兼此数者。亦可谓之良矣。虽据脉言症。或有少差。然一
脉所主非一病。故所言未必尽中也。若以此而遂弃之。所谓以二鸡子而弃干城之将。乌可与智者道哉。
姑以浮脉言之。脉经云。浮为风、为虚、为气、为呕、为厥、为痞、为胀、为满、不食、为热、
为内结等类。所主不下十数种病。假使诊得浮脉。彼将断其为何病耶。苟不兼之以望闻问。而欲的知
其为何病。吾谓戛戛乎其难矣。古人以切居望闻问之后。则是望闻问之间。已得其病情矣。不过再诊
其脉。看病应与不应也。若病与脉应。则吉而易医。脉与病反。则凶而难治。以脉参病。意盖如此。
曷尝以诊脉知病为贵哉。夫脉经一书。拳拳示人以诊法。而开卷入首。便言观形察色。彼此参伍。以
决死生。可见望闻问切。医之不可缺一也。岂得而偏废乎。噫。世称善脉莫过叔和。尚有待于彼此参伍。况
下于叔和万万者耶。故专以切脉言病。必不能不至于无误也。安得为医之良。抑不特此。世人又有以太
素脉而言人贵贱穷通者。此又妄之甚也。予尝考其义矣。夫太者始也。初也。如太极太乙之太。素
者质也。本也。如绘事后素之素。此盖言始初本质之脉也。始初本质之脉。果何脉耶。则必指元气而
言也。东垣云。元气者。胃气之别名。胃气之脉。蔡西山所谓不长不短。不疏不数。不大不小。应
手中和。意思欣欣。难以名状者是也。无病之人皆得此脉。以此脉而察人之有病无病。则可。以此
脉察人之富贵贫贱。则不可。何也。胃气之脉。难以形容。莫能名状。将何以为贵贱穷通之诊乎。
窃视其书。名虽太素。而其中论述。略无一言及于太素之义。所作歌括率多俚语。全无理趣。原其
初志。不过托此以为侥利之媒。后世不察。遂相传习。莫有能辩其非者。或又为之语曰。太素云者。
指贵贱穷通禀于有生之初而言也。即脉可以察而知之。非谓脉名太素也。予曰。固也。然则太素之所
诊者。必不出于二十四脉之外矣。夫二十四脉皆主病言。一脉见则主一病。贫富贵贱。何从而察知哉。
假如浮脉。其诊为风。使太素家诊之。将言其为风耶。抑言其为贵贱穷通耶。二者不可得兼。若言其
为风。则其所知亦不过病也。若遗其病而言其为贵贱穷通。则是近而病诸身者尚不能知。安得谓之太素。
则远而违诸身者。必不能知之也。盖贵贱穷通。身外之事。与身之血气了不相干。安得以脉而知之乎。
况脉之变见无常。而天之寒暑不一。故四时各异其脉。不能必其久而不变。是以今日诊得是脉。明日
诊之而或非。春间诊得此脉。至夏按之而或否。彼太素者。以片时之寻按。而断人一生之休咎。殆必
无是理。然纵使亿则屡中。亦是捕影捉蛇。仿佛形象。安有一定之见哉。噫。以脉
察病。尚不知病之的。而犹待于望闻问切。况能知人之贵贱穷通乎。使脉而能知贵贱穷通。则周公
之易。邵子之数。希夷之相。子平之命。皆不必作矣。何圣人之不惮烦也。何后世不从其脉之简便。
而犹以卜占风鉴星命。而谈不绝口哉。且脉肇于岐黄。演于秦越。而详于叔和。遍考素难脉经。并
无一字语及此者。非隐之也。殆必有不可诬者矣。若果如太素所言。古人当先为之矣。又何待后人
之驰骋耶。巢氏曰。太素脉者善于相法。特假太素以神其术耳。诚哉言也。足以破天下后世之惑矣。
又有善伺察者。以言 人。阴得其实。故于诊按之际。肆言而为欺罔。此又下此一等。无足论也。
虽然人禀天地之气以生。不能无清浊纯驳之殊。禀气之清者。则必形质清。血气清。而脉来亦清。
清则脉形圆净。至数分明。吾诊乎此。但知其主贵与富而已。若曰何年登科。何年升授。何日招财。
何年得子。吾皆不得而知矣。禀气之浊者。则必形质浊。气血浊。而脉来亦浊。浊则脉形重浊。至数
混乱。吾诊乎此。但知其主贫与贱而已。若曰某时招晦。某时失财。某时损妻。某时克子。吾亦莫
得而知矣。又有形浊而脉清者。此谓浊中之清。所主得意处多。而失意处少也。质清而脉浊者。此
谓清中之浊。所主失志处多。而得志处少也。又有形不甚清。脉不甚浊。但浮沉各得其位。大小不失
其等。亦主平稳而无大得丧也。富贵而寿。脉清而长。贫贱而夭。脉浊而促。其或清而促者。富贵而
夭也。浊而长者。贫贱而寿也。其他言有所未尽。义有所未备。学人可以准此而类推。是则吾之所
调以脉而知人富贵穷通者。一本于理而论也。岂敢妄为之说以欺人哉。噫。予所以着为是论者。盖以
世之有言太素脉者。靡不翕然称美。不惟不能以理折。又从而延誉之于人。纵使其言有谬。阴又与之委曲
而影射。此所谓误己而误人者也。果何益之有哉。又有迎医服药者。不惟不先言其所苦。甚至再三询叩。
终于默默。至有隐疾而困医者。医固为尔所困。不思身亦为医所困矣。吁。可慨也夫。此皆世之通患。
人所共有。故予不得不详论之。以致夫叮咛之意。俾聋瞽者或有所开发焉。孟子曰。予岂好辩哉。予不
得已也。（经曰。春伤于风。夏生飧泄。夏伤于暑。秋必 疟。秋伤于湿。冬生咳嗽。冬伤于寒。春
必病温。王安道注曰。四气之伤人。人岂能于未发病之前。预知其客于何经络。何脏腑。而成何
病乎。及其既发病。然后可以诊候。始知其客于某经络。某脏腑。成某病耳。飧泄也。 疟也。咳嗽也。温病也。
皆是因其病发之时。形诊昭着。乃逆推之。而知其昔日致病之原。为伤风。伤暑。伤湿。伤寒耳。
非是初受伤之时。能预定其必为此病也。机按。四气所伤。入于皮肤之内。藏于经脉之中。宜其见于
动脉。可以诊候而知也。而王氏所论。尚谓病若未发。难以诊候而知。彼富贵贫贱。天之命也。身
外事也。非若邪气入于皮肤。藏于血脉也。乌可以脉而知之乎。王氏此论。足以破太素之谬矣。故并附之。
以示来者。）
(Written by Wang Ji)
The pulse originates from Ying (Nutrient Qi) and Wei (Defensive Qi). Ying circulates within the vessels, while Wei circulates outside the vessels. If the Zang-Fu organs are in harmony and Ying and Wei are smooth and regulated, there would be no specific pulse shapes to discuss. However, if the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) invade externally or the Seven Emotions (Joy, Anger, Worry, Pensiveness, Fear, Sorrow, Fright) cause internal injury, the Zang-Fu will become disharmonious, and Ying and Wei will deviate. Consequently, the names and manifestations of the Twenty-Four Pulses will emerge one after another.
Therefore, Wind, Cold, Summerheat, Dampness, Dryness, and Fire constitute the Six Excesses. The pulses resulting from external invasion by these six excesses manifest as follows: Floating (Fu) indicates Wind, Tight (Jin) indicates Cold, Deficient (Xu) indicates Summerheat, Fine (Xi) indicates Dampness, Rapid (Shu) indicates Dryness, and Surging (Hong) indicates Fire. These can all be distinguished by the pulse to identify external pathogenic factors. Joy, Anger, Worry, Pensiveness, Sorrow, Fear, and Fright constitute the Seven Emotions. The pulses resulting from internal injury by these seven emotions manifest as follows: Joy injures the Heart, leading to a Slow/Relaxed (Huan) pulse; Anger injures the Liver, leading to a Tense (Ji) pulse; Worry injures the Lung, leading to a Choppy (Se) pulse; Pensiveness injures the Spleen, leading to an Intermittent (Jie) pulse; Fear injures the Kidney, leading to a Deep (Chen) pulse; Sorrow consumes Qi, leading to a Short (Duan) pulse; and Fright causes Qi chaos, leading to a Startled/Dashing (Dong) pulse. All of these can be differentiated by the pulse to identify internal injuries. However, this merely lists the general rules, using cases where the pulse corresponds to the disease as examples. When discussing variations, there are instances where the pulse does not correspond to the disease, or the disease does not correspond to the pulse, with hundreds of variations arising, making it difficult to rely solely on the pulse. Let us cite a few examples. Zhang Zhongjing stated: A Floating and Large pulse indicates the pathogen is in the Exterior, and sweating therapy is indicated. However, if the pulse is Floating and Large, accompanied by hardness below the heart and heat, indicating involvement of the Zang organs, purgation should be used, and sweating should not be induced. This shows that a Floating pulse is not always indicative of an Exterior pathogen suitable for sweating. He also stated: A Cursory (Cu) pulse indicates excessive Yang, and Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) is appropriate. However, if the pulse is Cursory accompanied by cold limbs, it indicates collapse of deficiency, requiring moxibustion and warming therapies. This shows that a Cursory pulse is not always indicative of excessive Yang. He further stated: A Slow (Chi) pulse indicates Cold, and a Deep (Chen) pulse indicates the Interior. However, in Yangming disease, if the pulse is Slow, without aversion to cold, but with sweating, Da Chengqi Tang (Major Order the Qi Decoction) should be used. This shows that not all Slow pulses indicate Cold. In Shaoyin disease, upon initial onset, if there is fever and a Deep pulse, Mahuang Xixin Tang (Ephedra, Asarum, and Prepared Rehmannia Decoction) is indicated to induce slight sweating. This shows that a Deep pulse is not always indicative of the Interior. All these are clear evidence that the pulse cannot be relied upon exclusively. If one relies only on the pulse without examining symptoms, one may mistakenly treat Cold as Heat, Exterior as Interior, and Yin as Yang, leading to confusion and premature death. Therefore, ancient physicians did not rely solely on the pulse but combined it with symptom examination, which is justified.
Why do people today fail to understand this? Often, patients conceal their illness and test the doctor's skill merely through pulse diagnosis. If the doctor's guess happens to be correct, they are regarded as excellent physicians, entrusted completely, and appointed with full confidence. Yet, the root cause of the illness is never disclosed, nor is the appropriateness of the medication scrutinized. Patients simply submit to the doctor's orders, delaying treatment until death, still unaware of their folly. This is truly pitiable. It is understandable that vulgar people, who dislike learning and lack understanding of principles, might act this way. However, it is laughable that scholars and officials in recent times have also fallen into this habit.
"Calm, Still, Peaceful, Thoughtful, Investigating Things, and Extending Knowledge" are the primary tenets of the first chapter of *The Great Learning*. "Thoughtful" means handling matters with precision and detail; "Investigating Things" means exhausting the principles of objects; "Extending Knowledge" means pushing one's knowledge to the extreme. Practitioners must constantly study these aspects. Ancients also said: "A son must know medicine." To leave a sick person in bed to the care of quacks is worse than being unfilial. Observation (Wang), Listening/Smelling (Wen), Inquiry (Wen), and Palpation (Qie) are the four major methods of diagnosis. If, when facing a patient, one considers only palpation as sufficient and neglects the other three, how can one claim to know medicine? How can one claim to handle matters with precision? How can one exhaust the principles of things and extend knowledge? How can one be considered a filial son or a benevolent father? Moreover, a good physician is not defined solely by skill in pulse diagnosis. If one maintains regularity in movement and stillness, acts without recklessness, harbors loyal and sincere intentions, speaks purely and honestly, examines diseases carefully, and prescribes precisely, such a person can be called a good physician. Although inferring symptoms from the pulse may have slight inaccuracies, since one pulse type may correspond to multiple diseases, the inference may not always be exact. To discard pulse diagnosis because of this would be like discarding a capable general over two chicken eggs. How could one discuss this with the wise?
Taking the Floating pulse as an example, the *Mai Jing* (Pulse Classic) states that the Floating pulse indicates Wind, Deficiency, Qi stagnation, vomiting, reversal, obstruction, distension, fullness, loss of appetite, heat, internal binding, etc., covering more than ten types of diseases. If a Floating pulse is detected, what disease would one diagnose? Without combining Observation, Listening, and Inquiry, it is extremely difficult to determine the exact disease. The ancients placed Palpation after Observation, Listening, and Inquiry because the condition was already understood through those methods. Palpation was merely used to verify if the pulse matched the disease. If the pulse matches the disease, the prognosis is favorable and treatment is easier; if the pulse contradicts the disease, the prognosis is poor and treatment is difficult. The purpose of correlating pulse with disease is thus clear. Was it ever considered superior to diagnose disease solely through pulse? The *Mai Jing*, while earnestly teaching diagnostic methods, begins by emphasizing observing form and color, cross-referencing them to determine life and death. This shows that Observation, Listening, Inquiry, and Palpation are indispensable and cannot be neglected. Alas! People say no one excels in pulse diagnosis more than Shuhe (Wang Shuhe), yet he still relied on cross-referencing. How much less so for those far inferior to him? Therefore, relying solely on palpation to diagnose disease inevitably leads to errors. How can this be considered good medicine? Furthermore, some people use "Taisu Pulse" (Primordial Pulse) to predict a person's nobility, poverty, success, or failure. This is extremely absurd. I have examined its meaning. "Tai" means beginning or origin, as in Taiji (Supreme Ultimate) or Taiyi (Great One). "Su" means substance or essence, as in "white comes after painting" (referring to the plain background). This supposedly refers to the pulse of primordial essence. What kind of pulse is this? It refers to Yuan Qi (Original Qi). Li Dongyuan stated that Yuan Qi is another name for Weiqi (Stomach Qi). The pulse of Stomach Qi, as described by Cai Xishan, is neither too long nor too short, neither too sparse nor too rapid, neither too large nor too small, harmonious and moderate under the fingers, vibrant yet indescribable. Healthy individuals possess this pulse. Using this pulse to determine health or illness is acceptable; using it to determine wealth or status is not. Why? Because the pulse of Stomach Qi is indescribable. What basis is there for diagnosing status?
Looking at the Taisu books, despite the name, the content never mentions the meaning of Taisu. The rhyming verses are mostly colloquial and lack logical depth. Their original intent was likely just a pretext for profit. Later generations, failing to investigate, adopted these practices without criticism. Some argue: "Taisu" refers to the innate destiny of status determined at birth, which can be read via the pulse, not that the pulse itself is named Taisu. I reply: Even so, the pulse diagnosed must fall within the Twenty-Four Pulse categories. Since each pulse indicates a disease, how can wealth or status be determined? If the pulse is Floating, indicating Wind, would a Taisu practitioner say it is Wind or status? They cannot be both. If they say Wind, they are diagnosing disease. If they ignore disease to discuss status, they cannot even know the immediate illness, let alone distant fate. Status and fortune are external matters unrelated to blood and qi. How can they be known via pulse? Moreover, pulse changes constantly, and seasons vary, so pulses differ by season and are not static. A pulse found today may change tomorrow; a spring pulse may differ in summer. How can a momentary palpation determine a lifetime of fortune? Even if guesses happen to be correct, it is grasping at shadows. There is no fixed rule. Alas! If diagnosing disease via pulse requires Observation, Listening, and Inquiry to be accurate, how can one predict status? If pulse could predict status, Zhou Gong's *I Ching*, Shao Yong's numerology, Xi Yi's physiognomy, and Ziping's astrology would be unnecessary. Why would sages bother? Why do people still discuss divination and astrology instead of using the simple pulse method? Pulse studies originated with Qibo and Huangdi, developed by Qin Yueren, and detailed by Shuhe. A thorough review of *Suwen*, *Nanjing*, and *Mai Jing* reveals no mention of this. It is not hidden; it is simply factually impossible. If true, ancients would have done it first. Chao Yuanfang said: Taisu pulse is essentially physiognomy disguised as pulse diagnosis. This truth breaks the delusion of later generations.
There are also cunning practitioners who gather information through conversation and deceive during palpation. This is even lower and unworthy of discussion.
However, humans are born with varying degrees of clarity and turbidity due to Heaven and Earth Qi. Those with clear Qi have clear forms, clear blood/qi, and clear pulses—round, clean, and distinct in rhythm. Diagnosing this, I can only infer nobility and wealth. I cannot predict specific years of exams, promotions, wealth, or children. Those with turbid Qi have turbid forms, turbid blood/qi, and turbid pulses—heavy, muddy, and chaotic. Diagnosing this, I can only infer poverty and low status. I cannot predict specific times of misfortune, financial loss, widowhood, or child loss. Some have unclear forms but clear pulses (clarity within turbidity), indicating more success than failure. Some have clear forms but turbid pulses (turbidity within clarity), indicating more failure than success. Some have neither clear nor turbid forms/pulses, with balanced floating/sinking and size, indicating stability without great gain or loss. Wealthy and long-lived people have Clear and Long pulses; poor and short-lived people have Turbid and Cursory pulses. Clear and Cursory indicates wealthy but short-lived; Turbid and Long indicates poor but long-lived. Other details are incomplete; students should extrapolate from this. This is my rational explanation of predicting status via pulse. I dare not fabricate stories to deceive. Alas! I wrote this because everyone praises Taisu pulse uncritically, spreading false reputations. Even if wrong, they cover for each other, misleading themselves and others. What benefit is there? Also, patients often hide their symptoms, remaining silent even when asked, causing distress to doctors. This is a common societal flaw, prompting my detailed explanation to awaken the ignorant. Mencius said: "Do I enjoy debating? I have no choice." (The Canon states: Spring wind injury leads to autumn diarrhea; Summer heat injury leads to autumn malaria; Autumn dampness injury leads to winter cough; Winter cold injury leads to spring warmth diseases. Wang Andao commented: Can one know before illness onset which meridian, organ, or disease pattern will result? Only after onset can diagnosis reveal the specific meridian, organ, and disease. Diarrhea, malaria, cough, and warmth diseases are identified retrospectively based on obvious symptoms, tracing back to wind, heat, dampness, or cold injury. One cannot predict the specific disease at the moment of initial injury. Wang Ji notes: Pathogens enter skin and meridians, appearing in arteries, theoretically diagnosable. But Wang Andao argues that pre-symptomatic diagnosis is difficult. Wealth and status are heavenly destiny, external matters, unlike pathogens entering blood vessels. How can pulse diagnose them? Wang Andao's argument refutes Taisu. I include it to show future generations.)