平脉者，平人不病之脉也。如四时平脉，五脏平脉，阴阳同等平脉之类是也。人病则脉不得其平矣。如四
时太过不及，阴阳脏腑，相乘相侮，及百病相错，生死不平之脉之类是也。平者又准之谓也。言诊者，诚能以
诸平脉准诸不平之脉，则凡太过不及之差，呼吸尺寸之乖，莫不了然于心手之间，而无少差谬。然后可以伤寒
之脉，准诸坏病；亦可以诸坏病之脉，准之伤寒，诚所谓一以贯之而余者已。
问曰∶脉有三部，阴阳相乘，营卫血气，在人体躬，呼吸出入，上下于中，因息游布，津液流通，随时动
作，效象形容∶春弦秋浮，冬沉夏洪。察色观脉，大小不同。一时之间，变无经常，尺寸参差，或短或长，上
下乖错，或存或亡，病辄改易，进退低昂。心迷意惑，动失纪纲，愿为具陈，令得分明。师曰∶子之所问，道
之根源。脉有三部，尺寸及关。营卫流行，不失衡铨。肾沉心洪，肺浮肝弦，此自经常，不失铢分。出入升降，
漏刻周旋。水下二刻，一周循环，当复寸口，虚实见焉。变化相乘，阴阳相干。风则浮虚，寒则牢坚，沉潜水
，支饮急弦，动则为痛，数则热烦。设有不应，知变所缘。三部不同，病各异端。太过可怪，不及亦然，邪
不空见，终必有奸。审察表里，三焦别焉。知其所舍，消息诊看；料度脏府，独见若神。为子条记，传与贤人。
【注】此总叙平脉之根源，借问答以示其法也。脉者，血之府，气血流行之动会也。三部者寸为上部，关
为中部，尺为下部也。三部既定，阴阳属焉，上部为阳，下部为阴。阴阳平则相易，阴阳偏则相乘。相易则和，
相乘则病。人之体躬，卫统气而行脉外，营统血而行脉中，故凡呼吸出入，上下于中，莫不因息以游布于四体，
随津液而流通于周身，故随时动作，而效象夫脉之形容也。察色，察五脏之色也。肝青，心赤，肺白，肾黑，
脾黄，各以其色合乎脏。然四脏又皆以黄色为主，他色为兼，以土寄旺于四季也。观脉，观五脏之脉也。肝弦，
心洪，肺浮，肾沉，脾缓，各以其脉主乎脏。然四脏又皆以缓脉为本，盖人以胃气为本也。其间，色或参差相
错，脉或大小相乖，一时之间，变无常经，病辄改易，或存或亡，无定象也。师曰∶子之所问，脉为医道之根
源，当以平旦复会于寸口之时诊之，而虚实见焉。寸口脉浮无力，为虚为风；牢坚有力，为实为寒。脉沉为水
，脉弦为支饮，脉动为痛，脉数为热，设或病脉不应，则于其三部太过不及，阴阳变化相乘之理，消息诊看。
料度脏腑，则顺逆吉凶，自然独见若神也。
师曰∶呼吸者，脉之头也。
【注】人一呼脉再动，一吸脉再动，呼吸定息脉四动，乃平人不病之缓脉也。闰以太息故五动，亦为平脉，
非呼吸不能定其至数，持脉时必从此始，故曰∶呼吸者，脉之头也。
【集注】方有执曰∶呼者，气之出，脉之来也；吸者，气之入，脉之去也。头，头绪也，脉随气之出入来
去，名状虽多，呼吸则其源头也。然脉有二，此以尺寸之脉言，若
以周身言之，则循环无端，浑然不断，无头尾之可言，学人当识之也。
初持脉，来疾去迟，此出疾入迟，名曰内虚外实也。初持脉，来迟去疾，此出迟入疾，名曰内实外虚也。
【注】此初持脉，以来去疾迟，而诊表里虚实法也。来，脉出来阳也，故以候表；去，脉入去阴也。故以
候里；疾，脉数疾有余也，故以候实；迟，脉徐迟不足也，故以候虚。言脉若出来疾，入去迟，为表实里虚，
故名曰内虚外实也。脉若出来迟，入去疾，为表虚里实，故名曰内实外虚也。
【集注】方有执曰∶来者自骨肉之分，而出于皮肤之际，气之升而上也；去者自皮肤之际，而还于骨肉之
间，气之降而下也。出呼而来也，入吸而去也。经曰∶来者为阳，去者为阴。疾为阳太过也，迟为阴不及也。
内虚外实者，阴不及而阳太过也；内实外虚者，阴太过而阳不及也。故来去出入者，脉之大关键也；内外虚实
者，病之大纲领也。知内外之阴阳，而辨其孰为虚孰为实者，诊家之切要也。
假令脉来微去大，故名反，病在里也；脉来头小本大，故名覆，病在表也。上微头小者，则汗出；下微本
大者，则为关格不通，不得尿。头无汗者可治，有汗者死。
【按】脉来头小本大者，当是“脉来大去小”。上微头小者，当是“上微小者为阴盛”。下微本大者，当
是“下微小者为阳盛”，始与上下之义相属。
【注】上以脉之来去疾迟，候内外虚实之诊，此以脉之来去大小，诊表里盛衰之病。脉上来微小，下去反
大，反之象也，故名曰∶反脉。上来益大，下去微小，覆之象也，故名曰∶覆。反者，病在里为阴盛；覆者，
病在表为阳盛。阳盛则病格，阴盛则病关，阴阳盛极不相交通，则病关格。头无汗者，阳未离阴，故可治；有
汗则阳以上脱，故曰死也。
寸口卫气盛名曰高，营气盛名曰章，高章相搏，名曰纲。卫气弱名曰 ，营气弱名曰卑， 卑相搏名曰损。
卫气和名曰缓，营气和名曰迟，迟缓相搏名曰沉。
【按】名曰沉之“沉”字，当是“强”字，玩下文自知。
【注】此详上条，脉之来去盛衰之状也。寸口，通指寸、关、尺而言也。卫主气为阳以候表，营主血为阴
以候里。脉随指有力上来，卫气盛也，谓之高；脉随指有力下去，营气盛也，谓之章。高者长盛也，章者分明
也。高章相合，名曰纲。纲者以营卫俱有余，有总揽之意也。脉随指无力上来，卫气弱也，谓之 ；脉随指无
力下去，营气弱也，谓之卑。 者恍惚也，卑者缩下也。 卑相合，名曰损。损者以营卫俱不足，有消缩之意
也。若高章、 卑之脉，与不疾、不徐缓迟之脉同见，则为盛者不过，弱者不衰，皆名和脉。强者，即下文所
着是也。
寸口脉缓而迟，缓则阳气长，其色鲜，其颜光，其声商，毛发长；迟则阴气盛，骨髓生，血满，肌肉紧，
薄鲜硬。阴阳相抱，营卫俱行，刚柔相得，名曰强也。
【按】“薄鲜硬”三字不成句，应是衍文，当删之。
【注】此承上条，以释“强”字之义。言凡人禀阳气盛，则得高章之盛；禀阴气盛，则得 卑之弱，此平
人之常。若能兼见缓迟平脉，斯为阴阳相抱，营卫相和，始名曰强。强者即色鲜颜光，血满肉紧之谓也。
【集注】方有执曰∶缓以候胃，迟以候脾。阳气长者，言胃气有余也。颜色声音毛发，皆阳也。鲜，丽也。
光，辉也。商，清也。长，美也。形容胃阳之有余也。阴气盛者，言脾
气充足也。骨髓生，血脉满，肌肉紧，骨髓血肉皆阴也，形容脾阴之充足也，相抱，言和洽也。俱行，言周流也。
相搏，言合一也。极言二气得其和平，皆由脾、胃盈余之所致，必如此，则其人之健旺而强壮可知，故曰∶强也。
师曰∶脉，肥人责浮，瘦人责沉，肥人当沉，今反浮，瘦人当浮，今反沉，故责之。
【注】上条以脉之盛衰，候人之强弱，此条以脉之浮中沉，分人之皮、脉、肉、筋、骨，以候五脏之诊法
也。心肺俱浮，肝肾俱沉，以皮之浮、脉之浮而别心肺之浮也；以筋之沉、骨之沉而别肝肾之沉也。脾主肌肉，
在浮沉之间，故候中也。肥人肌肤浓，脉当沉；瘦人肌肤薄，脉当浮。今肥人脉反浮，瘦人脉反沉，故当责其
病在何脏也。
【集注】方有执曰∶责，求也。肥人当沉者，肌肤浓，其脉深也，故求其病于浮。瘦人当浮者，肌肤薄，
其脉浅也，故求其病于沉。
问曰∶经说脉有三菽、六菽重者，何谓也？师曰∶脉，人以指按之，如三菽之重者，肺气也；如六菽之重
者，心气也；如九菽之重者，脾气也；如十二菽之重者，肝气也；按之至骨者，肾气也。假令下利，寸口、关
上、尺中悉不见脉，然尺中时一小见脉，再举头者，肾气也。若见损脉来，至为难治。
【注】此承上条详言皮、脉、肉、筋、骨，各有所主，以候五脏之病也。菽，豆也，约略轻重言之，非谓
有其形也。《难经》曰∶如三菽之重，与皮毛相得者，肺部也；六菽之重，与血脉相得者，心部也；九菽之重，
与肌肉相等者，脾部也；十二菽之重，与筋平者，肝部也；按之至骨，举之来疾者，肾部也。各随所主之部，
以候脏气也。至于寸口、关上、尺中，亦各有所主之位，以候脏气。左寸心也，右寸肺也，左关肝也，右关脾
也，尺中肾也。今特举肾脏之部例之，以概其余也。假令下利而甚，元气暴夺于中，寸口、关上、尺中全不见
脉，法当死；其不死者，必是尺中时有一小见之脉也。再举头者，谓一呼再起头，一吸再起头，合为四至也。
夫尺中时一小见之脉四至，则是肾间生气之源未绝，即下利未止，尚为易治。若一息二至，名曰损脉，是气衰
无胃，故为难治也。
【集注】程知曰∶《难经》三菽、六菽之说，盖言下指轻重有差等，以候五脏气也。又云∶下利，寸口、
关上、尺中悉不见脉者，是胃之阳气已绝也。《难经》以损脉为阳气下脱之脉，故曰损脉，至为难治也。
寸口脉，浮为在表，沉为在里，数为在腑，迟为在脏。假令脉迟，此为在脏也。
【注】寸口，通指三部言也。此以浮、沉、迟、数，候人表、里、脏、腑之诊法也。浮者，皮肤取而得之
脉也，浮主表，故曰∶浮为在表。沉者，筋骨取而得之脉也，沉主里，故曰∶沉为在里。数者，一息六至之脉
也，数主阳，腑属阳，故曰∶数为在腑。迟者，一息三至之脉也，迟主阴，脏属阴，故曰∶迟为在脏。假令诊
其人脉迟，此为病在脏。假令诊其人脉迟，此为病在脏，举一迟脉以例其余也。
【集注】程知曰∶躯壳之外，营卫为表，躯壳之内，脏腑为里，故以浮沉别之。诸阳虽皆属腑，诸阴虽皆
属脏，当以迟数别之。然伤寒中之传变，亦有数而入脏，迟而入腑者，熟读经文自知也。
张璐曰∶此以浮、沉、迟、数，定表、里、脏、腑，而全重于“迟为在脏”句，故重申以明之。设脉见浮
迟，虽有表证，只以小建中和之，终非麻黄、青龙所宜，以脏气本虚也。
阳脉浮大而濡，阴脉浮大而濡，阴脉与阳脉同等者，名曰缓也。
【注】此以阴阳同等，发明平人和缓之脉也。阳脉浮大而濡，阴脉浮大而濡，谓浮、中、沉，阴阳同等也。
名曰缓者，谓和缓之脉也。然缓脉有二义∶和缓之缓，脉有力濡柔，不大不小，以形状之缓，验二气之和也；
至数之缓，脉来四至从容，不徐不疾，以至数之缓，验胃气之和也。
【集注】方有执曰∶缓有二义，此以相兼言，盖谓气血和平也。
程知曰∶缓有和缓之义，宽缓之义，与浮大相类，不与迟相类。故经谓之浮大而濡，不曰浮大而迟也。盖
脉之迟数，以至数言，缓急以形状言耳！
张璐曰∶脉虽浮大而濡，按之仍不绝者为缓；若按之即无，是虚脉非缓脉也。
问曰∶东方肝脉，其形何似？师曰∶肝者木也，名厥阴，其脉微弦，濡弱而长，是肝脉也。肝病自得濡弱
者愈也。假令得纯弦脉者死，何以知之？以其脉如弦直，此是肝脏伤，故知死也。
【注】此已下四时、五脏平脉、病脉、死脉之诊法也。东方属木，主春令风，在天为风，在地为木，在人
为肝，故曰肝者木也。名足厥阴经，其脉当弦。若得微弦濡弱而长，此弦而有胃，是肝平脉也，病自易愈也；
若得微弦而长，而少濡弱和缓，为弦多胃少，肝病脉也；若得纯弦而直，无濡弱和缓，为但弦无胃，是肝死脉
也。下三脏虽无纯洪、纯浮、纯沉之文，省文也，当仿此。
【集注】方有执曰∶微非脉名，盖微微之弦，有胃气之谓也。
魏荔彤曰∶微弦，不甚弦，且带濡弱，如短促，亦非木之本性，又必兼长脉，是象木之柔和而修长，此肝
之本脉。肝脉见此，肝脏平脉，如有微疾，亦易愈也。假令纯弦，如树木将枯，枝干干硬，故知死也。
问曰∶二月得毛浮脉，何以处言至秋当死？师曰∶二月之时，脉当濡弱，反得毛浮者，故知至秋死。二
月肝用事，肝脉属木，脉应濡弱，反得毛浮脉者，是肺脉也。肺属金，金来克木，故知至秋死。他皆仿此。
【注】二月春令也，毛浮秋脉也，春得秋脉，何以断言至秋当死？盖春肝木旺，秋肺金旺，二月肝旺之
时，尚得毛浮肺脉，其衰可知，至秋金气愈旺，金乘木，木愈受克则绝，故知至秋当死也，余脏皆仿此。
【集注】方有执曰∶此以四时脉气属五行生克应病，以主吉凶生死之理。揭一以例其余，所以示人持诊
之要法也。
南方心脉，其形何似？师曰∶心者火也，名少阴。其脉洪大而长，是心脉也。心病自得洪大者，愈也。
【注】南方属火，主夏令热，在天为火，在地为热，在人为心，故曰∶心者火也，名手少阴经，其脉当
洪。若得洪大和缓，此洪而有胃，是心平脉也，虽有心病，自易愈也。若得洪大而少和缓，此洪多胃少，是心
病脉也。若得洪大而无和缓，此但洪无胃，是心死脉也。
【集注】方有执曰∶其脉洪大而长，应万物盛长之象也。
Ping Mai (Normal Pulse) refers to the pulse of a healthy person without disease. Examples include the normal pulses of the four seasons, the normal pulses of the five Zang organs, and pulses where Yin and Yang are balanced. Once a person becomes ill, the pulse loses its balance. Examples include pulses that are excessive or deficient according to the four seasons, pulses where Yin and Yang and the Zang and Fu organs mutually overcome or insult each other, and abnormal pulses associated with various diseases indicating life or death. "Ping" also means "standard". It means that if a practitioner can use various normal pulses as standards to measure abnormal pulses, then any differences in excess or deficiency, and any discrepancies in respiration and the Cun-Guan-Chi positions, will be clearly understood in mind and hand, without error. Then, one can use the pulse of Shanghan (Cold Damage) to evaluate Huai Bing (complicated/transformed diseases); conversely, one can use the pulses of various complicated diseases to evaluate Shanghan. This is indeed what is meant by "understanding one principle to encompass all others."
Question: The pulse has three positions, where Yin and Yang interact, Ying (Nutrient) and Wei (Defensive) Qi and Blood circulate within the body, moving up and down with respiration, spreading due to breath, and fluids flow freely, constantly changing and presenting different images: Spring is Xian (Wiry), Autumn is Fu (Floating), Winter is Chen (Deep), Summer is Hong (Surging). Observing complexion and pulse reveals differences in size. Within a short time, changes are unpredictable; Cun and Chi may vary, sometimes short, sometimes long, upper and lower positions may be disordered, appearing or disappearing, and the condition changes, advancing or retreating. One may become confused and lose the guiding principles. I wish for you to explain this in detail so I may distinguish them clearly. Master said: Your question touches upon the root of medical Dao. The pulse has three positions: Cun, Guan, and Chi. Ying and Wei circulate without losing their balance. Kidney pulse is Deep, Heart pulse is Surging, Lung pulse is Floating, Liver pulse is Wiry. These are the constant rules, accurate to the finest degree. Qi enters and exits, rises and falls, completing a cycle in two hours (Ke). Returning to Cun Kou (Radial Artery), Deficiency and Excess become apparent. Changes interact, Yin and Yang interfere. Wind presents as Floating and Empty, Cold presents as Firm and Hard, Water retention presents as Deep and Submerged, Branch-Fluid presents as Rapidly Wiry, Moving pulse indicates Pain, Rapid pulse indicates Heat and Irritability. If there are exceptions, understand the cause of the change. The three positions differ, and diseases have diverse origins. Excess is remarkable, deficiency is so too. Pathogenic factors do not appear empty-handed; there is always an underlying issue. Examine Exterior and Interior, distinguish the San Jiao (Triple Burner). Knowing where the pathogen resides and carefully observing allows one to estimate the Zang organs with divine insight. I record these points for you to pass on to worthy people.
[Note] This section generally summarizes the roots of Normal Pulse, using Q&A to demonstrate the method. Pulse is the residence of Blood, the convergence point of Qi and Blood circulation. The three positions refer to Cun as Upper, Guan as Middle, and Chi as Lower. Once the three positions are established, they belong to Yin and Yang: Upper is Yang, Lower is Yin. When Yin and Yang are balanced, they transform into each other; when biased, they overcome each other. Transformation leads to harmony; overcoming leads to disease. In the human body, Wei Qi governs Qi circulating outside the vessels, while Ying Qi governs Blood circulating inside the vessels. Thus, respiration and movement spread through the limbs via breath and circulate throughout the body via fluids, manifesting as pulse characteristics. Observing color involves checking the colors of the five Zang organs: Liver is Green, Heart is Red, Lung is White, Kidney is Black, Spleen is Yellow, each corresponding to its organ. However, the four Zang organs also prioritize Yellow, with other colors being secondary, because Earth flourishes during all four seasons. Observing pulse involves checking the pulses of the five Zang organs: Liver is Wiry, Heart is Surging, Lung is Floating, Kidney is Deep, Spleen is Slow, each governing its organ. However, the four Zang organs also prioritize the Slow pulse, as humans rely on Stomach Qi. Between these, colors may be mixed, and pulses may vary in size. Changes occur unpredictably, conditions shift, appearing or disappearing without fixed forms. The Master said: Your question addresses the root of medicine. Pulse should be examined at dawn (Ping Dan) when Qi and Blood reconvene at Cun Kou, revealing Deficiency and Excess. A Floating and weak Cun Kou pulse indicates Deficiency and Wind; a Firm and hard pulse indicates Excess and Cold. Deep pulse indicates Water; Wiry pulse indicates Branch-Fluid; Moving pulse indicates Pain; Rapid pulse indicates Heat. If pathological pulses do not match these patterns, analyze the excess/deficiency of the three positions and the interactions of Yin/Yang. Estimating the Zang organs allows one to discern favorable/unfavorable outcomes with divine clarity.
The Master said: Respiration is the source of the pulse.
[Note] During one exhalation, the pulse beats twice; during one inhalation, it beats twice. At the end of a full respiratory cycle, it beats four times. This is the Slow pulse of a healthy person. Occasionally, a deep sigh (Tai Xi) adds a fifth beat, which is also normal. Without respiration, pulse rate cannot be determined. Examination must start here, hence "Respiration is the source of the pulse."
[Collected Notes] Fang Youzhi stated: Exhalation is the outflow of Qi and the arrival of the pulse; inhalation is the inflow of Qi and the departure of the pulse. "Source" refers to the origin. Although pulse names and shapes are numerous, respiration is their root. Note that this discussion applies to the Cun-Knife-Chi positions. Regarding the whole body, circulation is endless and continuous, without beginning or end. Students should understand this.
Upon initially holding the pulse, if the arrival is rapid and the departure is slow (Out-rapid, In-slow), it is named Nei Xu Wai Shi (Interior Deficiency, Exterior Excess). If the arrival is slow and the departure is rapid (Out-slow, In-rapid), it is named Nei Shi Wai Xu (Interior Excess, Exterior Deficiency).
[Note] This describes the method of diagnosing Exterior/Interior and Deficiency/Excess based on the speed of arrival and departure. Arrival represents Yang emerging, thus indicating Exterior; Departure represents Yin entering, thus indicating Interior. Rapid indicates Excess/Sufficiency; Slow indicates Deficiency/Insufficiency. Out-rapid/In-slow indicates Exterior Excess and Interior Deficiency. Out-slow/In-rapid indicates Exterior Deficiency and Interior Excess.
[Collected Notes] Fang Youzhi stated: Arrival is from deep tissues to the skin surface, representing rising Qi; Departure is from the skin surface back to deep tissues, representing falling Qi. Out corresponds to exhalation and arrival; In corresponds to inhalation and departure. Classics state: Arrival is Yang, Departure is Yin. Rapid is Yang excess; Slow is Yin deficiency. Interior Deficiency/Exterior Excess is Yin deficiency and Yang excess; Interior Excess/Exterior Deficiency is Yin excess and Yang deficiency. Thus, arrival/departure are key to pulse diagnosis, and interior/exterior/deficiency/excess are the main outlines of disease. Distinguishing these is crucial for practitioners.
If the pulse arrives slightly but departs strongly, it is called Fan Mai (Reverse Pulse), indicating disease in the Interior. If the pulse head is small but the root is large, it is called Fu Mai (Overturned Pulse), indicating disease in the Exterior. If the upper part is small and the head is small, sweating occurs. If the lower part is small and the root is large, it indicates Guan Ge (Obstruction and Rejection) with inability to urinate. If there is no sweat on the head, it is treatable; if there is sweat, it is fatal.
[Commentary] "Pulse head small, root large" should likely be "Pulse large, departure small." "Upper small, head small" should be "Upper small indicates Yin Excess." "Lower small, root large" should be "Lower small indicates Yang Excess" to align with the logic of upper/lower.
[Note] The previous section used speed to diagnose interior/exterior deficiency/excess; this section uses size to diagnose exterior/interior abundance/decline. Pulse arriving small and departing large is a Reverse image, hence Fan Mai. Pulse arriving larger and departing small is an Overturned image, hence Fu Mai. Reverse indicates Interior disease with Yin Excess; Overturned indicates Exterior disease with Yang Excess. Yang Excess leads to Ge (Rejection); Yin Excess leads to Guan (Obstruction). Extreme imbalance prevents communication, resulting in Guan Ge syndrome. No sweat on the head means Yang has not separated from Yin, so it is treatable. Sweat indicates Yang escaping upward, hence fatal.
At Cun Kou, strong Wei Qi is named Gao (High); strong Ying Qi is named Zhang (Clear/Bright). When Gao and Zhang combine, it is named Gang (Outline/Major). Weak Wei Qi is named Ti (Hazy); weak Ying Qi is named Bei (Low). When Ti and Bei combine, it is named Sun (Damage/Loss). Harmonious Wei Qi is named Huan (Slow/Relaxed); harmonious Ying Qi is named Chi (Late/Slow). When Huan and Chi combine, it is named Chen (Deep) [Correction: Should be Qiang (Strong)].
[Commentary] The character "Chen" in "Named Chen" should be "Qiang" (Strong), evident from the following text.
[Note] This details the states of pulse strength and weakness. Cun Kou refers generally to Cun, Guan, and Chi. Wei governs Qi (Yang) for Exterior; Ying governs Blood (Yin) for Interior. A pulse rising strongly under the finger indicates strong Wei Qi, called Gao (Long/Abundant). A pulse descending strongly indicates strong Ying Qi, called Zhang (Distinct). Gao and Zhang combined indicate Gang, meaning both Ying and Wei are sufficient. A pulse rising weakly indicates weak Wei Qi, called Ti (Hazy). A pulse descending weakly indicates weak Ying Qi, called Bei (Shrinking). Ti and Bei combined indicate Sun, meaning both Ying and Wei are insufficient. If Gao/Zhang or Ti/Bei pulses appear alongside non-rapid/non-slow Huan/Chi pulses, it indicates balance (He Mai). "Strong" refers to the state described below.
Cun Kou pulse that is Huan (Relaxed) and Chi (Slow): Huan indicates growing Yang Qi, resulting in fresh complexion, bright face, clear voice, and lush hair. Chi indicates abundant Yin Qi, resulting in marrow generation, full blood, firm muscles, and tender yet hard texture [Note: "Tender yet hard" is likely a textual error]. When Yin and Yang embrace, Ying and Wei circulate together, and Rigidity and Softness achieve harmony, it is named Qiang (Strong).
[Commentary] "Tender yet hard" does not form a coherent sentence and is likely a scribal error; it should be deleted.
[Note] This explains the meaning of "Qiang" (Strong). Normally, strong Yang constitution yields Gao/Zhang pulses, and strong Yin constitution yields Ti/Bei pulses. Only when Huan and Chi normal pulses are present simultaneously is it true Yin-Yang embrace and Ying-Wei harmony, truly named Strong. Strength manifests as fresh complexion, bright face, full blood, and firm muscles.
[Collected Notes] Fang Youzhi stated: Huan assesses Stomach; Chi assesses Spleen. Growing Yang Qi means surplus Stomach Qi. Complexion, voice, and hair are Yang attributes. Fresh means beautiful; Bright means radiant; Shang (clear tone) means pure; Long means excellent. This describes surplus Stomach Yang. Abundant Yin Qi means sufficient Spleen Qi. Marrow generation, full blood vessels, and firm muscles represent Yin, describing sufficient Spleen Yin. Embrace means harmony; Circulate together means flowing everywhere; Combine means unity. This emphasizes that peace between the two energies results from Spleen and Stomach surplus, leading to robust health, hence "Strong."
The Master said: For the pulse, in obese individuals, we look for Floating; in thin individuals, we look for Deep. Obese individuals should have Deep pulses; if they are Floating, we investigate. Thin individuals should have Floating pulses; if they are Deep, we investigate.
[Note] The previous section used pulse strength to assess physical constitution; this section uses Floating/Middle/Deep to differentiate Skin/Vessel/Flesh/Tendon/Bone and diagnose the five Zang organs. Heart and Lung pulses are Floating; Liver and Kidney pulses are Deep. We distinguish Heart/Lung floating by skin/vessel superficiality, and Liver/Kidney deep by tendon/bone depth. Spleen governs muscle, located between floating and deep, so we examine the Middle position. Obese people have thick skin/flesh, so their pulse should be Deep; thin people have thin skin/flesh, so their pulse should be Floating. If an obese person's pulse is Floating, or a thin person's is Deep, we must investigate which Zang organ is diseased.
[Collected Notes] Fang Youzhi stated: "Zei" means to seek/investigate. Obese people should have Deep pulses due to thick flesh; thus, we seek pathology in the Floating aspect. Thin people should have Floating pulses due to thin flesh; thus, we seek pathology in the Deep aspect.
Question: The classics mention pulse pressure weights of three beans and six beans. What does this mean? Master said: When pressing the pulse with fingers, a weight equivalent to three beans indicates Lung Qi; six beans indicates Heart Qi; nine beans indicates Spleen Qi; twelve beans indicates Liver Qi; pressing to the bone indicates Kidney Qi. If a patient has diarrhea and no pulse is felt at Cun, Guan, or Chi, but occasionally a small pulse appears at Chi and rebounds (re-arises), this is Kidney Qi. If a Sun Mai (Damaged Pulse) appears, it is difficult to treat.
[Note] This elaborates on the previous section regarding Skin, Vessel, Flesh, Tendon, Bone, and their correspondence to the five Zang organs. "Dou" (bean) is used to approximate weight, not literal beans. *Nan Jing* states: Three beans' weight touching the skin corresponds to Lung; six beans to Heart; nine beans to Spleen; twelve beans to Liver; pressing to bone with rapid rebound to Kidney. Each position corresponds to specific Zang Qi. Left Cun is Heart, Right Cun is Lung; Left Guan is Liver, Right Guan is Spleen; Chi is Kidney. Here, Kidney is used as an example. Severe diarrhea depletes Yuan Qi; absence of pulse at all three positions usually indicates death. Survival depends on occasional pulse at Chi. "Re-arising" means beating four times per respiratory cycle. Four beats at Chi indicate surviving Source Qi of Kidney, making treatment easier even if diarrhea persists. Two beats per cycle is Sun Mai (Qi depletion without Stomach Qi), making it difficult to treat.
[Collected Notes] Cheng Zhi stated: The *Nan Jing* bean weights indicate varying pressure depths to assess Zang Qi. Diarrhea with absent pulse at all positions indicates exhaustion of Stomach Yang Qi. *Nan Jing* considers Sun Mai as downward escape of Yang Qi, hence difficult to treat.
Cun Kou pulse: Floating indicates Exterior; Deep indicates Interior; Rapid indicates Fu (Yang) organs; Slow indicates Zang (Yin) organs. If the pulse is Slow, the disease is in the Zang.
[Note] Cun Kou refers to the three positions. This uses Floating/Deep/Rapid/Slow to diagnose Exterior/Interior and Zang/Fu. Floating is felt at the skin level, indicating Exterior. Deep is felt at the bone level, indicating Interior. Rapid is six beats per cycle, indicating Yang/Fu. Slow is three beats per cycle, indicating Yin/Zang. Example: Slow pulse indicates Zang disease.
[Collected Notes] Cheng Zhi stated: Outside the body, Ying/Wei are Exterior; inside, Zang/Fu are Interior, distinguished by Floating/Deep. All Yang belongs to Fu, all Yin to Zang, distinguished by Slow/Rapid. However, in Shanghan transmission, Rapid can enter Zang, and Slow can enter Fu. Study the classics carefully.
Zhang Lu stated: This uses Floating/Deep/Slow/Rapid to determine Exterior/Interior/Zang/Fu, emphasizing "Slow indicates Zang." If Floating and Slow are present, even with Exterior symptoms, use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) to harmonize; Ma Huang Tang or Qing Long Tang are unsuitable due to inherent Zang deficiency.
Yang Mai (Yang Pulse) is Floating, Large, and Ru (Soft); Yin Mai (Yin Pulse) is Floating, Large, and Ru. When Yin and Yang pulses are equal, it is named Huan (Relaxed/Normal).
[Note] This explains the Normal Relaxed Pulse through equality of Yin and Yang. Floating, Large, and Ru at Floating, Middle, and Deep levels indicates equality. "Huan" refers to the Relaxed Pulse. Huan has two meanings: 1. Shape: Forceful yet soft, neither too large nor small, indicating harmony of Qi. 2. Rate: Four beats per cycle, leisurely, neither fast nor slow, indicating harmony of Stomach Qi.
[Collected Notes] Fang Youzhi stated: Huan has two meanings; here it implies combination, signifying harmony of Qi and Blood.
Cheng Zhi stated: Huan means relaxed/harmonious, similar to Floating/Large, not Slow. Hence the text says Floating/Large/Ru, not Floating/Large/Slow. Slow/Rapid refers to rate; Huan/Ji (Urgent) refers to shape.
Zhang Lu stated: If Floating/Large/Ru pulse remains unbroken upon pressure, it is Huan; if it disappears immediately, it is Deficient, not Huan.
Question: What does the Liver pulse of the East resemble? Master said: Liver is Wood, named Jue Yin. Its pulse is slightly Wiry, Ru (Soft), Weak, and Long. This is the Liver pulse. If Liver disease presents with Ru/Weak pulse, it heals. If it presents with Pure Wiry pulse, the patient dies. Why? Because the pulse is straight like a string, indicating Liver damage.
[Note] These sections describe Normal, Pathological, and Fatal pulses for the four seasons and five Zang organs. East corresponds to Wood, Spring wind, Heaven Wind, Earth Wood, Human Liver. Named Foot Jue Yin Meridian, pulse should be Wiry. Slightly Wiry, Ru, Weak, and Long indicates Wiry with Stomach Qi (Normal Liver Pulse), ensuring easy recovery. Slightly Wiry and Long but lacking Ru/Weak indicates Excess Wiry, Deficient Stomach Qi (Pathological Liver Pulse). Pure Wiry and Straight, lacking Ru/Weak, indicates Wiry without Stomach Qi (Fatal Liver Pulse). The same logic applies to other Zang organs despite omitted texts.
[Collected Notes] Fang Youzhi stated: "Wei" (Slight) is not a pulse name itself but indicates slight Wiry quality with Stomach Qi.
Wei Litong stated: Slightly Wiry, not excessively so, accompanied by Ru/Weak, resembles brevity, not the natural nature of Wood. Combined with Long, it reflects Wood's gentle and elongated nature. This is the fundamental Liver pulse. Seeing this indicates normal Liver function; minor illness will heal easily. Pure Wiry resembles a dying tree, dry and hard, indicating death.
Question: Why does obtaining Mao Fu (Hair-Floating) pulse in the second month predict death in autumn? Master said: In the second month, the pulse should be Ru/Weak. Obtaining Mao Fu instead predicts death in autumn. The second month is governed by Liver (Wood). Liver pulse should be Ru/Weak. Mao Fu is Lung (Metal) pulse. Metal overcomes Wood. Hence, death in autumn. Apply this logic to others.
[Note] Second month is Spring; Mao Fu is Autumn pulse. Spring getting Autumn pulse predicts death in autumn. Spring Liver Wood is prosperous; Autumn Lung Metal is prosperous. In the second month (Liver peak), obtaining Lung pulse indicates severe weakness. By autumn, Metal strengthens further, overcoming Wood completely, leading to extinction. Hence death. Same for other organs.
[Collected Notes] Fang Youzhi stated: This uses Five Element generation/overcoming relationships with seasonal pulses to predict fate. Using one example illustrates the rest, showing essential diagnostic methods.
What does the Heart pulse of the South resemble? Master said: Heart is Fire, named Shao Yin. Its pulse is Hong (Surging), Large, and Long. This is the Heart pulse. If Heart disease presents with Hong pulse, it heals.
[Note] South corresponds to Fire, Summer heat, Heaven Fire, Earth Heat, Human Heart. Named Hand Shao Yin Meridian, pulse should be Hong. Hong, Large, and Relaxed indicates Hong with Stomach Qi (Normal Heart Pulse), ensuring easy recovery. Hong, Large, but lacking relaxation indicates Excess Hong, Deficient Stomach Qi (Pathological Heart Pulse). Hong, Large, and lacking relaxation indicates Hong without Stomach Qi (Fatal Heart Pulse).
[Collected Notes] Fang Youzhi stated: Hong, Large, and Long corresponds to the flourishing growth of all things.