或问诊切之法。何者为宗。答曰。诊切之法。心空为宗。得其旨。言下可了。不得其旨。虽遍读五车。转
增障碍。只如日月。岂不净耶。而盲者不见。是盲者过。非日月咎。客云。若尔则古人历陈某脉某病。凿凿诸例。
将有适于用乎。无适于用乎。答曰。大似向泥人祈祷。有时灵应。有时不灵应。客云。法法纰缪。安得涤除玄览。参五
色之诊乎。答曰。除却胸中落索。空空地向
己灵上究去。了得浮脉之义。便了得沉脉之义。触类旁通。诸脉皆了无余蕴矣。夫脉学人。大医王之心印。非大
智能。大辨才。难以语此。吾尝疾首生民。不闻炎黄之垂诲。永违仲景之至言。逮后唐处士千金方。直接长沙
一脉。又以立法险峻。不易跻攀。乃致造诣日卑。风斯日下。今我不惜广长。开陈圣教。为众生运无尽灯。譬诸
一灯燃百千灯。冥者皆明。明终无尽。庶不没宿昔先师垂诲。吾当逐一为汝陈之。
【浮】浮脉者。下指即显浮象。按之稍减而不空。举之泛泛而流利。不似虚脉之按之不振。芤脉之寻之中
空。濡脉之绵软无力也。浮为经络肌表之应。良由邪袭三阳经中。鼓搏脉气于外。所以应指浮满。在暴病得之
。皆为合脉。然必人迎浮盛。乃为确候。若气口反盛。又为痰气逆满之征。否则其人平素右手偏旺之故。有始
病不浮。病久而脉反浮者。此中气亏乏。不能内守。反见虚痞之兆。若浮而按之渐衰。不能无假象发见之虞。
伤寒以尺寸俱浮。为太阳受病。故凡浮脉主病。皆属于表。但须指下有力。即属有余客邪。其太阳本经风寒营
卫之辨。全以浮缓浮紧分别而为处治。其有寸关俱浮。尺中迟弱者。南阳谓之阳浮阴弱。营气不足。血少之故。
见太阳一经。咸以浮为本脉。一部。
不逮。虚实悬殊。亦有六脉浮迟。而表热里寒。下利清谷者。虽始病有热。可验太阳。其治与少阴之虚阳发露
不异。又有下后仍浮。或兼促兼弦兼紧兼数之类。总由表邪未尽。乃有结胸咽痛。胁急头疼之变端。详结胸
脏结及痞之证。皆为下早。表邪内陷所致。究其脉虽变异。必有一部见浮。死生虚实之机。
在关上沉细紧小之甚与不甚耳。惟阳明腑热攻脾。脉虽浮大。心下反硬者。急需下之。所谓从证不从脉也。其
在三阴。都无浮脉。惟阴尽复阳。厥愈足温而脉浮者。皆为愈证。故太阴例有手足温。身体重而脉浮者。少阴
例有阳微阴浮者。厥阴例有脉浮为欲愈。不浮为未愈者。须知阳病浮迟兼见里证。合从阴治。阴病脉浮。证显
阳回。合从阳治。几微消息。当不越于圣度也。近世陶尚文浮中沉三法。举世共推。虽卓立己见。究其所云。
不论脉之浮沉迟数。但以按之无力。重按全无者。便是阴证。曷知按之无力者。乃虚散之脉。与浮何预哉。逮
夫杂证之脉浮者。皆为风象。如类中风痱之脉浮。喘咳痞满之脉浮。烦瞑衄血之脉浮。风水皮水之脉浮。消瘅
便血之脉浮。泄泻脓血之脉浮。如上种种。或与证相符。或与证乖互。咸可治疗。虽内经有肠 下白沫。脉沉
则生。脉浮则死之例。然风木乘脾之证。初起多有浮脉。可用升散而愈者。当知阴病见阳脉者生。非若沉细虚
微之反见狂妄躁渴。难于图治也。
【沉】沉脉者。轻取不应。重按乃得。举指减小。更按益力。纵之不即应指。不似实脉之举指 。伏脉之
匿于筋下也；沉为脏腑筋骨之应。盖缘阳气式微。不能统运营气于表。脉显阴象而沉者。则按久愈微。若阳
气郁伏。不能浮应卫气于外。脉反伏匿而沉者。则按久不衰，阴阳寒热之机。在乎纤微之辨。伤寒以尺寸俱沉
为少阴受病。故于沉脉之中辨别阴阳。为第一关捩。若始病不发热。无头痛。而手足厥冷脉沉者。此直中阴经
之寒证也。若先曾发热头痛。烦扰不宁。至五七日后。而变手足厥
冷。躁不得寐而脉沉者。此厥深热深。阳邪陷阴之热证也。亦有始本阳邪。因汗下太过。而脉变沉迟。此
热去寒起之虚证也。有太阳证下早。胸膈痞硬。而关上小细沉紧者。此表邪内陷。阳分之结胸也。若能食自
利。乃阳邪下陷。阴分之脏结矣。有少阴病自利清水。口干腹胀。不大便而脉沉者。此热邪陷于少阴也。有
少阴病始得之。反发热脉沉者。麻黄附子细辛汤温之。是少阴而兼太阳。即所谓两感也。此与病发热头痛。脉
反沉。身体痛。当温之。宜四逆汤之法。似是而实不同也。有寸关俱浮。而尺中沉迟者。此阳证夹阴之脉也。
若沉而实大数盛。动滑有力。皆为阳邪内伏。沉而迟细微弱。弦涩少力。皆属阴寒无疑。有冬时伏邪。发于春
夏。烦热躁渴。而反脉沉。足冷。此少阴无气。毒邪不能发出阳分。下虚死证也。凡伤寒温热。时疫感冒。得
汗后脉沉。皆为愈证。非阳病阴脉之比。有内外有热。而脉沉伏。不数不洪。指下涩小急疾。无论伤寒杂病。
发于何时。皆为伏热。不可以其脉之沉伏。而误认阴寒也。至如肠 自利而脉沉。寒疝积瘕而脉沉。历节痛痹
而脉沉。伏痰留饮而脉沉。石水正水而脉沉。胸腹结痛而脉沉。霍乱呕吐而脉沉。郁结气滞而脉沉。咸为应病
之脉。若反浮大虚涩。或虽沉而弦细坚疾。为胃气告匮。未可轻许以治也。
【迟】迟脉者。呼吸定息。不及四至。而举按皆迟。不似涩
脉之参伍不调。缓脉之去来徐缓也。迟为阳气不显。营气自和之象。故昔人皆以隶之虚寒。而人迎主寒湿外袭。
气口主积冷内滞。又以浮迟为表寒。沉迟为里寒。迟涩为血病。迟滑为气病。此论固是。然多有热邪内结。寒
气外郁。而见气口迟滑作胀者。讵可以脉迟概谓之寒。而不究其滑涩之象。虚实之异哉。详仲景有阳明病脉迟。
微恶寒而汗出多者。为表未解。脉迟头眩腹满者。不可下。有阳明病脉迟有力。汗出不恶寒。身重喘满。潮
热便硬。手足 然汗出者。为外欲解。可攻其里。又太阳病脉
浮。因误下而变迟。膈内拒痛者为结胸。若此皆热邪内结之明验也。当知迟脉虽现表证。亦属脏气不充。不能
统摄百骸。所以邪气留连不解。即有腹满而头眩脉迟。阳分之患未除。禁不可下。直待里证悉具。然后下之。
圣法昭然，岂不详审慎重乎。迟为阳气失职。胸中大气不能敷布之候。详迟为在脏一语。可罔顾虑脏气之病乎。
【数】数脉者。呼吸定息六至以上。而应指急数。不似滑脉之往来流利。动脉之厥厥动摇。疾脉之过于
急疾也。数为阳盛阴亏。热邪流薄于经络之象。所以脉道数盛。火性善动而躁急。故伤寒以烦躁脉数者为传。
脉静者为不传。有火无火之分也。即经尽欲解。而脉浮数。按之不芤。其人不虚。不战汗出而解。则知数而按
之芤者。皆为虚矣。又阳明例云。病患脉数。数为热。当消谷引食。而反吐者。以发汗。令阳气微。膈内虚
。脉乃数也。数为客热。不能消谷。胃中虚冷。故吐也。又胃反而寸口脉微数者。为胸中冷。又脉阳紧阴数为
欲吐。阳浮阴数亦吐。胃反脉数。中气大虚。而见假数之象也。人见脉数。悉以为热。不知亦有胃虚。及阴盛
拒阳者。若数而浮大。按之无力。寸口脉细者。虚也。经曰。脉至而从。按之不鼓。诸阳皆然。病热而脉数。
按之不鼓甚者。乃阴盛拒阳于外而致病。非热也。形证似寒。按之鼓击于指下者。乃阳盛拒阴而生病。非寒也
。丹溪云。脉数盛大。按之而涩。外有热证者。名曰中（平声）寒。盖寒留血脉。外证热而脉亦数也。凡乍病
脉数。而按之缓者为邪退。久病脉数。为阴虚之象。瘦人多火。其阴本虚。若形充色泽之人脉数。皆痰湿郁
滞。经络不畅而蕴热。其可责之于阴乎。若无故脉数。必生痈疽。如数实而吐臭痰者为肺痈。数虚而咳涎沫者为
肺痿。又历考数脉诸例。有云数则烦心者。有云滑数心下结热者。皆包络火旺而乘君主之位也。有云细数阴虚
者。水不制火。真阴亏损也，有云数为在腑者。阳邪干阳。脏气无预也。有云数则为寒
者。少火气衰。壮火食气也，大抵虚劳失血。喘嗽上气。多有数脉。但以数大软弱者为阳虚。细小弦数者为阴
虚。非若伤寒衄血之脉浮大。为邪伏于经。合用发汗之比。诸凡失血。脉见细小微数无力者为顺。脉数有热。
及实大弦劲急疾者为逆。若乍疏乍数。无问何病。皆不治也。
【滑】滑脉者。举之浮紧。按之滑石。不似实脉之 应指。紧脉之往来劲急。动脉之见于一部。疾脉
之过于急疾也。仲景云。翕奄沉。名曰滑。滑者紧之浮名也。言忽浮忽沉。形容流利之状。无以过之。滑为多
血少气之脉。而昔人又以滑大无力。为内伤元气。曷知滑脉虽有浮沉之分。却无无力之象。盖血由气生。若果
气虚。则鼓动之力先微。脉何由而滑耶。惟是气虚不能统摄阴火。而血热脉滑者有之。尝考诸内经。有脉滑曰
病风。缓而滑曰热中。脉浮而滑曰新病。脉盛滑坚者曰病在外。脉弱以滑是为胃气。滑者阴气有余也。则知滑
脉之病。无虚寒之理。他如伤寒温热时行等病。总以浮滑而濡者为可治。故先师论脉。首言大浮数动滑为阳。
而杂病以人迎浮滑为风痰。缓滑为中风。气口缓滑为热中。滑数为宿食。尺中弦滑。为下焦蓄血。又呕吐而寸口
迟滑，为胸中实。下利而关上迟滑。为下未尽。厥逆而脉滑。为里有实。详此则滑脉之病。可不言而喻。即经
有滑者阴气有余一语。是指阴邪搏阳而言。岂以阴气有余。多汗身寒之病。便可目为血多。又以滑大之脉。牵
合无力。而为内伤元气乎。平人肢体丰盛。而按之绵软。六脉软滑。此痰湿渐渍于中外。终日劳役。不知倦怠
。若安息则重着 疼矣。夫脉之滑而不甚有力者。皆浮滑缓滑濡滑微滑之类。终非无力之比。滑为血实气壅之
脉。悉属有余。妇人身有病而脉和滑者为孕。临产脉滑疾者曰离经。若滑而急强。辟辟如弹石。谓之肾绝。滑
不直手。按之不可得。为大肠气予不足。以其绝无和缓胃气。故经予之短期。
【涩】涩脉者。指下涩滞不前。内经谓之参伍不调。叔和喻以轻刀刮竹。通真子譬之如雨沾沙。长沙又以
泻漆之绝。比拟虽殊。其义则一。不似迟脉之指下迟缓。缓脉之脉象纡徐。濡脉之来去绵软也，良由津血亏
少。不能濡润经络，所以涩涩不调。故经有脉涩曰痹。寸口诸涩亡血。涩则心痛。尺热脉涩为懈 。种种皆阴
血消亡。阳气有余。而为身热无汗之病。亦有痰食胶固中外。脉道阻滞。而见涩数模糊者。阴受水谷之害也。
金匮云。寸口脉浮大。按之反涩。尺中亦微而涩。知有宿食。有发热头痛。而见浮涩数盛者。阳中雾露之气也
。雾伤皮腠。湿流关节。总皆脉涩，但兼浮数沉细之不同也。有伤寒阳明腑实。不大便而脉涩。温病大热而脉
涩。吐下微喘而脉涩。水肿腹大而脉涩。消瘅大渴而脉涩。痰证喘满而脉涩。病在外而脉涩。妇人怀孕而脉涩
。皆证脉相反之候。间有因胎病而脉涩者。然在二三月时有之。若四月胎息成形之后。必无虚涩之理。平人无
故脉涩。为贫窘之兆。尺中蹇涩则艰于嗣。金匮云。男子脉浮弱而涩则无子。精气清冷。其有脉塞而鼓如省客
。左右旁至如交漆。按之不得如颓土。皆乖戾不和。殊异寻常之脉。故素问列之大奇。
【虚】虚脉者。指下虚大而软。如循鸡羽之状。中取重按。皆弱而少力。久按仍不乏根。不似芤脉之豁然
中空。按久渐出，涩脉之软弱无力。举指即来。散脉之散漫无根。重按久按。绝不可得也。虚为营血不调之候
。叔和以迟大而软为虚。每见气虚喘乏。往往有虚大而数者。且言血虚脉虚。独不详仲景脉虚身热。得之伤暑。
东垣气口脉大而虚者。为内伤于气。若虚大而时显一涩。为内伤于血。凡血虚之病。非显涩弱。则弦细芤迟。如
伤暑脉虚为气虚。弦细芤迟为血虚。虚劳脉极虚芤迟。或尺中微细小者。为亡血失精。男子平人脉虚弱微细者。
善盗汗出。则气血之分了然矣。慎斋有云。脉洪大而虚者防作泻。可知虚脉多脾
家气分之病。大则气虚不敛之故。经云。脉气上虚尺虚。是谓重虚。病在中。脉虚难治。仲景有脉虚者不可吐。
腹满脉虚复厥者不可下。脉阴阳俱虚。热不止者死。可见病实脉虚。皆不易治。盖虚即是毛。毛为肺之平脉。
若极虚而微。如风吹毛之状。极虚而数。瞥瞥如羹上肥者。皆为肺绝之兆也。惟癫疾之脉虚为可治者。以其神
出舍空。可行峻补。若实大为顽痰固结。搜涤不应。所以为难耳。
【实】实脉者。重浊滑盛。相应知参舂。而按之石坚。不似紧脉之迸急不和。滑脉之往来流利。洪脉之来
盛去衰也。实为中外壅满之象。经云。邪气盛则实。非正气本充之谓。即此一语。可为实脉之总归。夫脉既实
矣。谅虚证之必无也。证既实矣。谅假象之必无也。但以热邪亢极而暴绝者有之。其为病也。实在表则头痛
身热。实在里则 胀腹满。大而实者。热由中发。细而实者。积自内生。在伤寒阳明病。不大便而脉实则宜下
Someone asked about the methods of inquiry and palpation, what is the fundamental principle? I answered: The fundamental principle of palpation lies in an empty (clear and unclouded) mind. If one grasps its essence, it can be understood immediately; if one fails to grasp its essence, even having read five cartloads of books will only increase obstacles. It is like the sun and moon, are they not pure and bright? Yet a blind person cannot see them; this is the fault of the blind person, not the fault of the sun and moon. The guest said: In that case, do the specific examples recorded by the ancients regarding certain pulses corresponding to certain diseases have practical application or not? I answered: This is somewhat like praying to a clay idol; sometimes it is effective, sometimes it is not. The guest said: If the methods are full of flaws, how can one achieve a clear mind (Dichu Xuanlan - clearing away mental clutter to see deeply) and participate in the diagnosis of the five colors? I answered: One must first remove the clutter from the chest and investigate upon one's own spiritual awareness. Once the meaning of the floating pulse is understood, the meaning of the sinking pulse is also understood. By touching one thing and understanding others (Chu Lei Pang Tong), all pulses can be fully comprehended without remainder. Learning pulseology is the heart-seal of the Great Medical King; without great intelligence and great eloquence, it is difficult to discuss this with one. I often feel distressed for the people, hearing no teachings from Yan and Huang, and forever violating the supreme words of Zhang Zhongjing. Later, the *Qianjin Fang* by the Tang dynasty recluse Sun Simiao directly inherited the lineage of Changsha (Zhang Zhongjing). However, because its legal formulations were steep and arduous, difficult to climb, medical attainment declined day by day, and the ethos deteriorated. Now, I do not spare my efforts to expound the sacred teachings, lighting an endless lamp for sentient beings. It is like one lamp lighting hundreds of thousands of lamps; darkness becomes light, and light is endless. I hope not to obscure the teachings of past masters. I will explain them to you one by one.
[Floating] The Floating Pulse appears as soon as the finger touches lightly. Pressing slightly reduces it but it is not empty. Lifting the finger reveals a floating and slippery flow. It is unlike the Deficient Pulse which lacks strength when pressed heavily, the Knotted Pulse which is hollow in the middle when searched, or the Soggy Pulse which is soft and weak. The Floating Pulse corresponds to the meridians and muscle surface. It is largely due to pathogenic factors attacking the Three Yang meridians, driving the pulse qi outward, thus responding to the finger as floating and full. In acute diseases, obtaining this pulse indicates conformity with the disease. However, it must be that the Renying point pulse is floating and vigorous to be a definite sign. If the Qikou point pulse is instead vigorous, it is a sign of phlegm and qi counterflow and fullness; otherwise, it may be due to the person's right hand pulse being naturally stronger. There are cases where the pulse is not floating at the onset of illness but becomes floating after a long duration; this indicates deficiency of Middle Qi unable to maintain interior stability, manifesting as a sign of deficiency bloating. If a floating pulse gradually weakens upon pressing, there is a risk of false signs appearing. In Cold Damage, floating pulses in both Cun and Chi positions indicate Shaoyang disease; therefore, floating pulses generally indicate exterior syndromes. Provided the pulse is forceful under the finger, it belongs to excess external pathogens. The differentiation between Wind-Cold, Ying, and Wei in the Taiyang meridian is entirely based on distinguishing between Floating-Relaxed and Floating-Tight for treatment. If Cun and Guan are both floating while Chi is slow and weak, Zhang Zhongjing calls this "Yang Floating and Yin Weak," caused by insufficient Ying Qi and blood deficiency. In Taiyang channel diseases, floating is considered the root pulse. If one part of the pulse is deficient, there is a vast difference between deficiency and excess. There are also cases where all six pulses are floating and slow, presenting with exterior heat and interior cold, and diarrhea with undigested food. Although there was initial fever, it can be verified as Taiyang disease. Its treatment is similar to that of Shaoyin disease with exposed deficient yang. After purgation, if the pulse remains floating, or is accompanied by rapid, wiry, tight, or rapid pulses, it is generally due to incomplete exterior pathogens, leading to complications such as Chest Binding, sore throat, rib stiffness, and headache. Detailed examination of Chest Binding, Zang Binding, and Pi syndromes shows they are caused by premature purgation leading to interior invasion of exterior pathogens. Although the pulse varies, there must be floating in one position. The mechanism of life/death and deficiency/excess lies in the severity of the sinking, fine, tight, and small pulse at the Guan position. Only in Yangming Fu-heat attacking the spleen, where the pulse is floating and large but the epigastrium is hard, is immediate purgation required; this is called "following the syndrome rather than the pulse." In the Three Yin channels, there are no floating pulses. Only when Yin exhaustion returns to Yang, convulsion resolves, feet become warm, and the pulse floats, is it a sign of recovery. Thus, in Taiyin examples, there are cases of warm hands and feet, heavy body, and floating pulse; in Shaoyin examples, there are cases of faint Yang and floating Yin; in Jueyin examples, there are cases where floating pulse indicates impending recovery, and non-floating indicates no recovery. One must know that Yang diseases with floating and slow pulses accompanied by interior symptoms should be treated according to Yin principles; Yin diseases with floating pulses and obvious Yang recovery signs should be treated according to Yang principles. These subtle changes should not exceed the sage's standards. Recently, Tao Shangwen proposed three methods of Floating, Middle, and Sinking, widely praised by the world. Although he stood out with his own views, what he said ignores whether the pulse is floating, sinking, slow, or rapid, claiming that any pulse that is weak upon pressing and completely absent upon heavy pressing is a Yin syndrome. How does he know that a pulse weak upon pressing is a Deficient and Scattered pulse, unrelated to the Floating pulse? As for miscellaneous diseases with floating pulses, they all indicate Wind phenomena. For example, pulse floating in apoplexy-like flaccidity, panting/cough/bloating, irritability/dizziness/epistaxis, wind-water/skin-water, diabetes/blood in stool, diarrhea/pus and blood. As mentioned above, whether consistent or inconsistent with the syndrome, they can all be treated. Although the *Neijing* states that for dysentery with white mucus, a sinking pulse means survival and a floating pulse means death, in cases of Wood overacting on Spleen, early stages often show a floating pulse, which can be cured with ascending and dispersing methods. One should know that Yin diseases showing Yang pulses indicate survival, unlike sinking, fine, deficient, and faint pulses which reverse into madness, restlessness, and thirst, making treatment difficult.
[Sinking] The Sinking Pulse does not respond to light pressure but is obtained with heavy pressure. When lifting the finger, the pulse shape decreases; pressing harder makes it more distinct. Releasing the finger does not immediately respond to the touch. It is unlike the Excess Pulse which responds immediately upon lifting, nor the Hidden Pulse which hides beneath the tendons. The Sinking Pulse corresponds to the Zang-Fu organs, sinews, and bones. It is generally due to the decline of Yang Qi, unable to circulate Ying Qi to the exterior, causing the pulse to manifest Yin characteristics and sink; thus, the longer it is pressed, the weaker it becomes. If Yang Qi is depressed and hidden, unable to float to respond to Wei Qi externally, the pulse reverses to hide and sink; thus, pressing for a long time does not diminish. The mechanism of Yin/Yang and Cold/Heat lies in minute distinctions. In Cold Damage, sinking pulses in both Cun and Chi positions indicate Shaoyin disease. Therefore, distinguishing Yin and Yang within the Sinking Pulse is the first key point. If there is no fever or headache at onset, but cold limbs and a sinking pulse, this is a Cold Syndrome directly invading the Yin channels. If there was previously fever, headache, and restlessness, which after five to seven days turns into cold limbs, restlessness, inability to sleep, and a sinking pulse, this is a Heat Syndrome where deep convulsion leads to deep heat, and Yang pathogen sinks into Yin. There are also cases where it started as Yang pathogen but became slow and sinking due to excessive sweating or purgation; this is a Deficiency Syndrome where heat leaves and cold arises. In Taiyang syndrome, premature purgation leads to chest/diaphragm stuffiness and hardness, with a small, fine, sinking, and tight pulse at Guan; this is exterior pathogen sinking into the Yang portion, causing Chest Binding. If the patient can eat and has spontaneous diarrhea, it is Yang pathogen sinking into the Yin portion, causing Zang Binding. In Shaoyin disease with spontaneous diarrhea of clear water, dry mouth, abdominal distension, constipation, and sinking pulse, this is Heat pathogen sinking into Shaoyin. In early Shaoyin disease with contrary fever and sinking pulse, use Mahuang Fuzi Xixin Tang to warm it; this is Shaoyin combined with Taiyang, known as "Two Feelings" (Liang Gan). This is similar to but actually different from fever, headache, contrary sinking pulse, body pain, requiring warming with Sini Tang. If Cun and Guan are floating while Chi is sinking and slow, this is a Yang syndrome with Yin involvement. If sinking but solid, large, rapid, and vigorous, with moving and slippery qualities, it is all Yang pathogen internally hidden. If sinking, slow, fine, weak, wiry, and choppy with little force, it undoubtedly belongs to Yin Cold. Winter latent pathogens erupting in spring/summer with irritability, heat, thirst, contrary sinking pulse, and cold feet indicate Shaoyin Qi deficiency, poison unable to emerge to Yang portion, lower deficiency, a fatal syndrome. In Cold Damage, warm diseases, and seasonal epidemics, a sinking pulse after sweating indicates recovery, not comparable to Yang disease with Yin pulse. With internal and external heat but sinking and hidden pulse, neither rapid nor surging, feeling choppy, small, and urgent under the finger, regardless of Cold Damage or miscellaneous diseases or timing, it is Hidden Heat; do not mistake sinking/hidden pulse for Yin Cold. As for dysentery with spontaneous diarrhea and sinking pulse, cold hernia/masses and sinking pulse, joint pain/rheumatism and sinking pulse, retained phlegm/fluid and sinking pulse, Stone Water/Regular Water and sinking pulse, chest/abdominal binding pain and sinking pulse, cholera/vomiting and sinking pulse, depression/qi stagnation and sinking pulse, these are all appropriate pulses for the disease. If contrary to floating, large, deficient, and choppy, or although sinking, wiry, fine, hard, and rapid, it indicates depletion of Stomach Qi, and treatment should not be lightly promised.
[Slow] The Slow Pulse beats less than four times per respiration cycle, slow upon lifting and pressing. It is unlike the Choppy Pulse which is irregular, nor the Moderate Pulse which is leisurely. The Slow Pulse is a sign of Yang Qi not manifesting and Ying Qi harmonizing itself. Hence, ancients mostly attributed it to Deficiency-Cold. Renying pulse indicates external Cold-Damp invasion; Qikou pulse indicates internal accumulation of Cold. Floating-Slow indicates Exterior Cold; Sinking-Slow indicates Interior Cold; Slow-Choppy indicates Blood disease; Slow-Slippery indicates Qi disease. This discussion is valid, yet there are many cases of internal Heat binding and external Cold constraint presenting with Qikou Slow-Sluggish and bloating. How can one generalize Slow pulse as Cold without investigating Slippery/Choppy qualities and Deficiency/Excess differences? Examining Zhang Zhongjing: Yangming disease with Slow pulse, slight aversion to cold, and profuse sweating indicates exterior unresolved; Slow pulse with dizziness and abdominal fullness indicates purgation is forbidden. Yangming disease with Slow pulse but forceful, sweating, no aversion to cold, heavy body, panting/fullness, tidal fever, hard stool, and continuous sweating of hands/feet indicates exterior resolving, interior attackable. Taiyang disease with Floating pulse becoming Slow due to erroneous purgation, with rejection pain in diaphragm indicating Chest Binding. All these are clear evidence of internal Heat binding. One must know that although Slow pulse presents with exterior signs, it also belongs to insufficient Zang Qi unable to control the body, so pathogens linger. Even with abdominal fullness, dizziness, and Slow pulse, if Yang portion affliction is not removed, purgation is forbidden. Wait until interior signs are complete before purging. The Sage's method is clear, how could it not be detailed and cautious? Slow pulse indicates Yang Qi failing in its duty, Thoracic Grand Qi unable to distribute. Regarding "Slow indicates Zang disease," can one ignore Zang Qi pathology?
[Rapid] The Rapid Pulse beats more than six times per respiration cycle, urgent and rapid under the finger. It is unlike the Slippery Pulse which flows smoothly, the Moving Pulse which trembles, or the Hasty Pulse which is excessively urgent. Rapid pulse indicates Yang Excess and Yin Deficiency, Heat pathogen flowing thinly into meridians. Thus, pulse vessels are numerous and vigorous; Fire nature moves and agitates easily. In Cold Damage, irritability and Rapid pulse indicate transmission; quiet pulse indicates no transmission, distinguishing presence or absence of Fire. Even near resolution, if Floating-Rapid pulse is not Knotted upon pressing, and the patient is not deficient, resolution occurs without chills and sweating. Thus, Rapid pulse that is Knotted upon pressing indicates Deficiency. Yangming example: Patient with Rapid pulse, Rapid indicates Heat, should digest grain and seek food, but vomits instead. This is because sweating made Yang Qi slight, Diaphragm interior deficient, pulse became Rapid. Rapid indicates Guest Heat, unable to digest grain, Stomach interior Cold-Cool, hence vomiting. Stomach Reversal with Cun Kou pulse slightly Rapid indicates Cold in Chest. Yang Tight Yin Rapid indicates desire to vomit; Yang Floating Yin Rapid also vomits. Stomach Reversal with Rapid pulse indicates Great Deficiency of Middle Qi, showing false Rapid appearance. People seeing Rapid pulse assume Heat, not knowing there is also Stomach Deficiency and Yin Excess rejecting Yang. If Rapid and Floating-Large, weak upon pressing, Cun Kou pulse fine, it is Deficiency. Classic says: Pulse arrives following [syndrome], but does not drum upon pressing; all Yang pulses are like this. Hot disease with Rapid pulse, not drumming upon pressing severely, is Yin Excess rejecting Yang externally causing disease, not Heat. Symptoms resembling Cold, but drumming under finger, is Yang Excess rejecting Yin causing disease, not Cold. Danxi said: Rapid and Surging pulse, Choppy upon pressing, with exterior Heat symptoms, is named "Zhong Han" (Middle Cold). Because Cold stays in blood vessels, exterior symptoms are Heat and pulse is also Rapid. Acute illness with Rapid pulse, slow upon pressing, indicates pathogen retreating. Chronic illness with Rapid pulse indicates Yin Deficiency. Thin people have much Fire, their Yin is originally deficient. If plump, lustrous people have Rapid pulse, it is Phlegm-Damp stagnation, meridian blockage, and accumulated Heat; how can this be blamed on Yin? If无故 (without cause) Rapid pulse, carbuncles/furuncles will arise. Rapid-Solid with foul sputum indicates Lung Carbuncle; Rapid-Deficient with frothy saliva indicates Lung Flaccidity. Examining various Rapid pulse examples: "Rapid causes vexation"; "Slippery-Rapid chest binding heat" all indicate Pericardium Fire旺盛 (prosperous) attacking the Sovereign position. "Fine-Rapid Yin Deficiency" indicates Water not controlling Fire, True Yin loss. "Rapid indicates Fu organ" indicates Yang pathogen attacking Yang, Zang Qi unaffected. "Rapid indicates Cold" indicates Little Fire Qi衰 (declined), Strong Fire consumes Qi. Generally, Consumption/Blood Loss/Panting/Air Rising often have Rapid pulse. But Rapid-Large-Weak indicates Yang Deficiency; Fine-Small-Wiry-Rapid indicates Yin Deficiency. Unlike Cold Damage Epistaxis with Floating-Large pulse, where pathogen hides in meridians, requiring sweating. For all blood loss, Fine-Small-Slight-Rapid-Weak pulse is Auspicious; Rapid with Heat, Solid-Large-Wiry-Tense-Hasty pulse is Inauspicious. If suddenly intermittent and Rapid, regardless of disease, it is untreatable.
[Slippery] The Slippery Pulse is Floating-Tight upon lifting, smooth like sliding stone upon pressing. It is unlike the Excess Pulse which firmly responds to finger, the Tight Pulse which is tense and urgent, the Moving Pulse seen in one position, or the Hasty Pulse which is excessively urgent. Zhang Zhongjing said: Xi Yan Chen is named Slippery. Slippery is the Floating name of Tight. Meaning suddenly floating, suddenly sinking, describing smooth flow, nothing exceeds it. Slippery pulse is Multi-Blood, Less-Qi pulse. Ancients also considered Slippery-Large-Weak as Internal Injury to Yuan Qi. How does he know Slippery pulse, though divided by Floating/Sinking, has no Weak appearance? Blood is generated by Qi; if Qi is truly deficient, driving power is first slight, how can pulse be Slippery? Only when Qi is deficient and cannot control Yin Fire, and Blood Heat makes pulse Slippery, is this possible. Examining Neijing: Slippery pulse indicates Wind disease; Moderate-Slippery indicates Heat in Middle; Floating-Slippery indicates New Disease; Surging-Slippery-Firm indicates Disease Outside; Weak-Slippery indicates Stomach Qi; Slippery indicates Excess Yin Qi. Thus, Slippery pulse diseases have no Deficiency-Cold logic. Other than Cold Damage, Warm Diseases, Seasonal Epidemics, total Floating-Slippery-Soggy indicates treatable. Hence, ancestors discussing pulse first stated Large-Floating-Rapid-Moving-Slippery are Yang. Miscellaneous diseases: Renying Floating-Slippery indicates Wind-Phlegm; Moderate-Slippery indicates Stroke; Qikou Moderate-Slippery indicates Heat in Middle; Slippery-Rapid indicates Retained Food; Chi Wiry-Slippery indicates Lower Jiao Accumulated Blood. Vomiting with Cun Kou Slow-Slippery indicates Chest Solid; Diarrhea with Guan Slow-Slippery indicates Incomplete Downward Flow; Convulsion with Slippery pulse indicates Interior Solid. Detailing this, Slippery pulse diseases are self-evident. Even classic "Slippery indicates Excess Yin Qi" refers to Yin Pathogen contending with Yang. How can Excess Yin Qi, with symptoms of much sweat and cold body, be viewed as Multi-Blood? And how can Slippery-Large pulse be forced to match Weakness for Internal Injury to Yuan Qi? A healthy person with abundant limbs, soft upon pressing, six pulses Soft-Slippery, indicates Phlegm-Damp infiltrating inside and outside. Working all day without fatigue. Resting brings heaviness and pain. Pulses that are Slippery but not very forceful are Floating-Slippery, Moderate-Slippery, Soggy-Slippery, Micro-Slippery, etc., ultimately not comparable to Weakness. Slippery is Blood Solid, Qi Obstructed pulse, all belonging to Excess. Women with disease but Harmonious-Slippery pulse are pregnant. Childbirth Slippery-Rapid pulse is called Li Jing. If Slippery but Urgent-Strong, popping like striking stone, it is Kidney Extinction. Slippery not straight to hand, unobtainable upon pressing, indicates Large Intestine Qi insufficiency, because it completely lacks Harmonious Stomach Qi, hence classic gives short term.
[Choppy] The Choppy Pulse is obstructed and stagnant under finger, Neijing calls it Can Wu Bu Tiao (irregular). He Shu compares it to light knife scraping bamboo, Tong Zhen Zi likens it to rain soaking sand, Changsha compares it to pouring lacquer stopping abruptly. Though metaphors differ, meaning is one. It is unlike Slow pulse sluggish under finger, Moderate pulse leisurely, or Soggy pulse soft coming/going. Largely due to deficiency of Jin-Ye and Blood, unable to moisten meridians, so Choppy and irregular. Hence classic says Choppy pulse indicates Bi syndrome; Cun Kou all Choppy indicates Blood loss; Choppy then Heart Pain; Chi Heat Choppy indicates Lassitude. All these are Yin-Blood consumption, Yang Qi Excess, causing body heat and no sweat. There are also cases of Phlegm-Food cementing inside/outside, pulse pathway blocked, showing Choppy-Rapid-Vague, Yin suffering from Grain-Water harm. Jingui says: Cun Kou pulse Floating-Large, pressing contrary Choppy, Chi also Micro-Choppy, knows there is Retained Food. Fever/headache with Floating-Choppy-Rapid-Surging, Yang mist/dew qi. Mist injures skin/collaterals, damp flows to joints, all Choppy pulse, but combined with Floating-Rapid/Sinking-Fine differences. Cold Damage Yangming Fu-Shi, constipation with Choppy pulse; Warm Disease high fever with Choppy pulse; Vomit/Purge slight panting with Choppy pulse; Edema abdomen large with Choppy pulse; Diabetes great thirst with Choppy pulse; Phlegm Panting/Fullness with Choppy pulse; Disease outside with Choppy pulse; Pregnant woman with Choppy pulse, all are Syndrome-Pulse opposite situations. Occasionally due to fetal disease with Choppy pulse, but only in 2-3 months. After 4 months when fetus forms, surely no Deficiency-Choppy logic. Healthy person无故 Choppy pulse indicates poverty/distress. Chi Jian Se indicates difficulty in offspring. Jingui says: Man Floating-Weak-Choppy pulse means no son, Essence-Qi cold. Those with pulse blocked and drumming like Sheng Ke, left-right side like Jiao Qi, unobtainable pressing like Tui Tu, all are perverse and discordant,殊异 (very different) from ordinary pulses. Hence Suwen lists them as Da Qi (Great Oddities).
[Deficient] The Deficient Pulse is Void-Large and Soft under finger, like tracing chicken feather. Middle and Heavy pressing, all weak and lacking force, long pressing still has root. Unlike Knotted pulse sudden hollow middle, pressing long gradually emerges; unlike Choppy pulse weak-forceless, lifting comes immediately; unlike Scattered pulse scattered rootless, heavy/long pressing absolutely unobtainable. Deficient is Ying-Blood disharmonious state. He Shu considers Slow-Large-Soft as Deficient. Often seeing Qi Deficiency panting/lack of breath, often have Void-Large-Rapid. Also saying Blood Deficiency pulse Deficient,唯独 (only) not detailing Zhang Zhongjing Pulse Deficient Body Heat, acquired from Summerheat. Dongyuan says Qikou pulse Large-Deficient is Internal Injury to Qi. If Void-Large occasionally shows one Choppy, is Internal Injury to Blood. All Blood Deficiency diseases, either show Choppy-Weak, or Wiry-Fine-Knotted-Slow. Like Summerheat Pulse Deficient is Qi Deficiency; Wiry-Fine-Knotted-Slow is Blood Deficiency. Consumption Pulse Extreme-Deficient-Knotted-Slow, or Chi Micro-Fine-Small, is Blood Loss/Essence Loss. Man healthy pulse Weak-Deficient-Micro-Fine, prone to night sweats, then Qi-Blood division is clear. Shenzhen said: Pulse Surging-Large-Deficient prevents diarrhea. Knows Deficient pulse mostly Spleen Qi-Fen disease, Large is Qi Deficiency not gathering. Classic says: Pulse Qi Upper Deficient Chi Deficient is called Chong Xu (Double Deficiency). Disease in Middle, Pulse Deficient difficult to treat. Zhang Zhongjing says Pulse Deficient cannot vomit; Abdominal Fullness Pulse Deficient recurring Cold cannot purge; Pulse Yin-Yang both Deficient, Heat not stopping dies. Visible Disease Excess Pulse Deficient, all not easy to treat. Deficient is Mao (Hair), Mao is Lung Ping Mai (Normal Pulse). If Extreme-Deficient-Micro, like wind blowing hair; Extreme-Deficient-Rapid, fleeting like fat on soup, all are Lung Extinction omens. Only Mania Pulse Deficient is treatable, because Spirit leaves house empty, can perform severe tonification. If Solid-Large is stubborn Phlegm solidified, searching/cleansing not responding, hence difficult.
[Excess] The Excess Pulse is Heavy-Turbid-Slippy-Surging, responding like pounding grain, pressing stone-hard. Unlike Tight pulse bursting-urgent-discordant, Slippery pulse flowing-smooth, or Surging pulse coming-surging-going-decaying. Excess is Inside-Out Fullness image. Classic says: Pathogen Excess then Excess, not Zheng Qi originally full. This one sentence is the summary of Excess Pulse. Since pulse is Excess, surely Deficiency syndrome is impossible. Since syndrome is Excess, surely false appearance is impossible. But there are cases of Heat pathogen extreme and sudden extinction. Its disease: Excess in Exterior then Headache/Body Heat; Excess in Interior then Distension/Abdominal Fullness. Large-Excess, Heat originates from Middle; Fine-Excess, Accumulation generates from Inside. In Cold Damage Yangming disease, constipation and Excess pulse suitable for purging.