失冲和。阳竭四末。神丹奚济。非特主产后而言。即妊娠亦不出于是也。婴儿病赤瓣飧泄。脉小手足寒。难已。
脉小手足温。泄易已。腹痛。脉细小而迟者易治。坚大而急者难治。洞泄食不化。脉微小流连者生。坚急者死
。谛观诸义。则病脉之逆从。可默悟矣。而显微又言。前大后小。则头痛目眩。前小后大。则胸满短气。即仲
景来微去大之变辞。虚中挟实之旨。和盘托出矣。
【芤】芤脉者。浮大弦软。按之中空。中按虽不应指。细推仍有根气。纵指却显弦大。按之减小中空。不
似虚脉之瞥瞥虚大。按之豁然无力也。芤为血虚不能濡气。故虚大如芤。然其中必显弦象。刘三点以为绝类慈
葱。殊失弦大而按之减小中空之义。盖虚则阳气失职。芤则经络中空。所以有虚濡无力。弦大中空之异。仲景
云。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。革则胃气告匮。而弦强搏
指。按之无根。非芤脉中空之比。按太阳病有脉浮而紧。按之反芤。本虚战汗而解者。暑病有弦细芤迟。血分
受伤者。芤为失血之本脉。经云。脉至如搏。血温身热者死。详如搏二字。即是弦大而按之则减也。又云。脉
来悬钩浮为常脉。言浮而中空。按之旁至。似乎微曲之状。虽有瘀积阻滞。而指下柔和。是知尚有胃气。故为
失血之常脉。若弦强搏指。而血温身热。为真阴槁竭。必死何疑。凡血脱脉芤。而有一部独弦。或带结促涩滞
者。此为阳气不到。中挟阴邪之兆。是即瘀血所结处也。所以芤脉须辨一部两部。或一手两手。而与攻补。方
为合法。
【濡】濡脉者。虚软少力。应指虚细。如絮浮水面。轻手乍来。重手乍去。不似虚脉之虚大无力。微脉之
微细如丝。弱脉之沉细软弱也。濡为胃气不充之象。故内伤虚劳。泄泻少食。自汗喘乏。精伤痿弱之人。脉虽
濡软乏力。犹堪峻补峻温。不似阴虚脱血。纯见细数弦强。欲求濡弱。绝不可得也。盖濡脉之浮软。与虚脉相
类。但虚则浮大，而濡则小弱也。濡脉之细小。与弱脉相类。但弱在沉分。而濡在浮分也。濡脉之软弱。与微
脉相类。但微则欲绝。而濡则力微也。濡脉之无力。与散脉相类。但散则从大而按之则无。濡则从小而渐至无
力也。夫从小而渐至无力。气虽不充。血犹未败。从大而按之即无。则气无所统。血已伤残。阴阳离散。将何
所恃。而可望其生乎。以此言之。则濡之
与散。不啻霄壤矣。
【动】动脉者。厥厥动摇。指下滑数如珠。见于关上。不似滑脉之诸部皆滑数流利也。动为阴阳相搏之候
。阳动则汗出。阴动则发热。是指人迎气口而言。然多有阴虚发热之脉。动于尺内。阳虚自汗之脉。动于寸口
者。所谓虚者则动。邪之所凑。其气必虚。金匮有云。脉动而弱。动则为惊。弱则为悸。因其虚而旺气乘之。
惟伤寒以大浮数动滑为阳。是专主邪热相搏而言。非虚劳体痛。便溺崩淋脉动之比。而妇人尺脉动甚。为有子
之象。经云。阴搏阳别。谓之有子。又云。妇人手少阴脉动甚者。妊子也。以肾藏精。心主血。故二处脉动。
皆为有子。辨之之法。昔人皆以左大顺男。右大顺女为言。然妊娠之脉。往往有素禀一手偏大偏小者。莫若以
寸动为男。尺动为女。最为有据。
【伏】伏脉者。隐于筋下。轻取不得。重按涩难。委曲求之。附着于骨。而有三部皆伏。一部独伏之异。
不似短脉之尺寸短缩。而中部显然。沉脉之三部皆沉。而按之即得也。伏脉之病。最为叵测。长沙有趺阳脉不
出。脾不上下。身冷肤硬。少阴脉不至。令身不仁。此为尸厥等例。详伏为阴阳潜伏之候。有邪伏幽隐而脉伏
不出者。虽与短脉之象有别。而气血涩滞之义则一。故关格吐逆。不得小便之脉。非偏大倍常。即偏小隐伏。
越人所谓上部有脉。下部无脉是也。凡气郁血结久痛。及疝瘕留饮。水气宿食。霍乱吐利等脉。每多沉伏。
皆经脉阻滞。营卫不通之故。所以妊娠恶阻。常有伏匿之脉。此又脉证之变耳。在伤寒失于表散。邪气不得发
越。而六脉俱伏者。急宜发汗。而脉自复。刘元宾曰。伏脉不可发汗。谓其非表脉也。而洁古又言。当以麻
黄附子细辛汤发之。临病适宜。各有权度。不可执一。若六七日烦扰不宁。邪正交并而脉伏者。又为战汗之兆。
如久旱将雨。六合阴晦。雨过庶物皆苏也。不可以伏为阴脉。误投辛热。顷刻昆仑
飞焰矣。
【细】细脉者。往来如发。而指下显然。不似微脉之微弱模糊也。细为阳气衰弱之候。伤寒以尺寸俱沉细
。为太阴受病。太阴职司敷化之权。今为热邪所传。营行之气。不能条畅百脉。所以尺寸皆沉细。不独太阴为
然。即少阴之脉。亦多沉细。故仲景有少阴病脉沉细数。不可发汗之禁。此皆外阴内阳。非若严冬卒中暴寒。
盛夏暑风卒倒。内外皆阴之比。内经细脉诸条。如细则少气。脉来细而附骨者积也。尺寒脉细。谓之后泄。头
痛脉细而缓为中湿。种种皆阴邪之证验。所以胃虚少食。冷涎泛逆。便泄腹痛。湿痹脚软。自汗失精。皆有细
脉。但以兼浮兼沉。在尺在寸。分别而为裁决。如平人脉来细弱。皆忧思过度。内戕真元所致。若形盛脉细。
少气不足以息。及病热脉细。神昏不能自持。皆脉不应病之候。不可以寻常虚细论也。
【疾】疾脉者。呼吸之间。脉七八至。虽急疾而不实大。不似洪脉之既大且数。却无躁疾之形也。疾脉有
阴阳寒热真假之异。如疾而按之益坚。乃亢阳无制。真阴垂绝之候。若疾而按之不鼓。又为阴邪炎威。虚阳发露之征。
尝攻先辈治按。有伤寒面赤目赤。烦渴引饮而不能咽。东垣以姜附人参汗之而愈。又伤寒蓄热内盛。阳厥极
深。脉疾至七八至以上。人皆误认阴毒。守真以黄连解毒治之而安。斯皆证治之明验也。凡温病大热躁渴。
初时脉小。至五六日后。脉来躁疾。大观发赤者死。谓其阴绝也。躁疾皆为火象。内经有云。其有躁者在手。
言手少阴厥阴二经。俱属于火也。阴毒身如被杖。六脉沉细而疾。灸之不温者死。谓其阳绝也。然亦有热毒入
于阴分而为阴毒者、脉必疾盛有力。不似阴寒之毒。虽疾而弦细乏力也。虚劳喘促声嘶。脉来数疾无伦。名曰
行尸。金匮谓之厥阳独行。此真阴竭于下。孤阳亢于上也。惟疾而不躁。按之稍缓。方为热证之正脉。脉法所
谓疾而洪大苦烦满。疾而沉细腹中痛。疾而不大不小。虽困可治。其有大小者。难治也。至若脉至如喘。脉至
如数。得之暴厥暴惊
者。待其气复自平。迨夫脉至浮合。浮合如数。一息十至以上。较之六数七疾八极更甚。得非虚阳外骛之兆乎。
【牢】牢脉者。弦大而长。举之减小。按之实强。如弦缕之状。不似实脉之滑实流利。伏脉之匿伏涩难。革
脉之按之中空也。叔微云。牢则病气牢固。在虚证绝无此脉。惟湿痉拘急。寒疝暴逆。坚积内伏。乃有是脉。历
考诸方，不出辛热开结。甘温助阳之治。庶有克敌之功。虽然。固垒在前。攻守非细。设更加之以食填中土。
大气不得流转。变故在于须臾。可不为之密察乎。若以牢为内实。不问所以。而妄行迅扫。能无实实虚虚之咎
哉。大抵牢为坚积内着。胃气竭绝。故诸家以为危殆之象云。
【革】革脉者。弦大而数。浮取强直。重按中空。如鼓皮之状。不似紧脉之往来劲急。弦脉之按之不移。
牢脉之按之益坚也。撄宁生曰。革乃变革之象。虽失常度。而按之中空。未为真脏。故仲景厥阴例中。有下利
肠鸣脉浮革者。主以当归四逆汤。得非风行木末。扰动根株之候乎。又云。妇人则半产漏下。男子则亡血失精
。金匮半产漏下。主以旋覆花汤。得非血室伤惫。中有瘀结未尽之治乎。其男子亡血失精。独无主治。云岐补
以十全大补。得非极劳伤精。填补其空之谓乎。是以长沙直以寒虚相搏例之。惟其寒。故柔和之气失焉。惟其
虚。故中空之象见焉。岂以革浮属表。罔顾肾气之内惫乎。
【促】促脉者。往来数疾中忽一止复来。不似结脉之迟缓。中有止歇也。促为阳邪内陷之象。经云。寸口
脉中手上击者。曰肩背痛。观上击二字。则脉来搏指。热盛于经之义。朗然心目矣。而仲景太阳例。有下之
后脉促胸满者。有下之利遂不止而脉促者。有下之脉促不结胸者。有脉促手足厥冷者。上四条。一为表邪未尽。
一为并入阳明。一为邪去欲解。一为传次厥阴。总以促为阳盛。里不服邪之明验。虽证见厥逆。只宜用灸以通
阳。不宜四逆以回阳。明非虚寒之理。具见言外。所以温热发斑。瘀
血发狂。及痰食凝滞。暴怒气逆。皆令脉促。设中虚无凝。必无歇止之脉也。
【结】结脉者。指下迟缓中。频见歇止。而少顷复来。不似代脉之动止不能自还也。结为阴邪固结之象。
越人云。结甚则积甚。结微则气微。言结而少力。为正气本衰。虽有积聚。脉结亦不甚也。而仲景有伤寒汗下不
解。脉结代。心动悸者。有太阳病身黄。脉沉结。少腹硬满，小便不利。为无血者。一为津衰邪结。一为热结
膀胱。皆虚中挟邪之候。凡寒饮死血。吐利腹痛。癫痫虫积等气郁不调之病。多有结脉。暴见即宜辛温扶正。
略兼散结开痰。脉结自退。尝见二三十至内有一至接续不上。每次皆然。而指下虚微。不似结促之状。此元气
骤脱之故。峻用温补自复。如补益不应。终见危殆。若久病见此。尤非合脉。夫脉之歇止不常。须详指下有力
无力。结之频与不频。若十余至或二三十至一歇。而纵指续续。重按频见。前后至数不齐者。皆经脉窒碍。阴
阳偏阻所致。盖阳盛则促。阴盛则结。所以仲景皆为病脉。
【代】代脉者。动而中止。不能自还。因而复动。名曰代阴。不似促结之虽见歇止。而复来有力也。代为
元气不续之象。经云。代则气衰。在病后见之。未为死候。若气血骤损。元神不续。或七情太过。或颠仆重伤
。或风家痛家。脉见止代。只为病脉。伤寒家有心悸脉代者。腹痛心疼。有结涩止代不匀者。凡有痛之脉止
歇。乃气血阻滞而然。不可以为准则也。若不因病而脉见止代。是一脏无气。他脏代之。真危亡之兆也。即因
病脉代。亦须至数不匀者。犹或可生。若不满数至一代。每次皆如数而止。此必难治。经谓五十动不一代者。
以为常也。以知五脏之期。予之短期者。乍疏乍数也。又云。数动一代者。病在阳之脉也。此则阳气竭尽无余
之脉耳。所以或如雀啄。或如屋漏。或如弦绝。皆真代脉。见之生理绝矣。惟妊娠恶阻。呕逆最剧者。恒见代
脉。谷入既少。气血尽并于胎息。是以脉气不能接续。然在二三月时有之。若至四月。胎已成形。当无歇止之
脉矣。
【散】散脉者。举之浮散。按之则无。去来不明。漫无根蒂。不似虚脉之重按虽虚。而不至于散漫也。散
为元气离散之象。故伤寒咳逆上气。其脉散者死。谓其形损故也。可知散脉为必死之候。然形象不一。或如吹
毛。或如散叶。或如悬雍。或如羹上肥。或如火薪然。皆真散脉。见之必死。非虚大之比。经曰。代散则死。
若病后大邪去。而热退身安。泄利止而浆粥入胃。或有可生者。又不当一概论也。古人以代散为必死者。盖散为肾败
之应。代为脾绝之兆。肾脉本沉。而散脉按之不可得见。是先天资始之根本绝也。脾脉主信。而代脉去来必愆
其期。是后天资生之根本绝也。故二脉独见。均为危亡之候。而二脉交见。尤为必死之征。
【清】清脉者。轻清缓滑。流利有神。似小弱而非微细之形。不似虚脉之不胜寻按。微脉之软弱依稀。缓脉
之阿阿迟纵。弱脉之沉细软弱也。清为气血平调之候。经云。受气者清。平人脉清虚和缓。生无险阻之虞。如
左手清虚和缓。定主清贵仁慈。若清虚流利者。有刚决权变也。清虚中有一种弦小坚实。其人必机械峻刻。右
手脉清虚和缓。定然富浓安闲。若清虚流利。则富而好礼。清虚中有种枯涩少神。其人虽丰。目下必不适意。
寸口清虚。洵为名裔。又主聪慧。尺脉清虚。端获良嗣。亦为寿征。若寸关俱清。而尺中蹇涩。或偏小偏大。
皆主晚景不丰。及艰子嗣。似清虚而按之滑盛者。此清中带浊。外廉内贪之应也。若有病而脉清楚。虽剧无害
。清虚少神。即宜温补以助真元。若其人脉素清虚。虽有客邪壮热。脉亦不能鼓盛。不可以为证实脉虚。而失
于攻发也。
【浊】浊脉者。重浊洪盛。腾涌满指。浮沉滑实有力。不似洪脉之按之软阔。实脉之举之减小。滑脉之往
来流利。紧脉之转
索无常也。浊为禀赋昏浊之象。经云。受谷者浊。平人脉重浊洪盛。垂老不得安闲。如左手重浊。定属污下。
右手重浊。可卜庸愚。寸口重浊。家世卑微。尺脉重浊。子姓卤莽。若重浊中有种滑利之象。家道富饶。浊而
兼得蹇涩之状。或偏盛偏衰。不享安康。又主夭枉。似重浊而按之和缓。此浊中兼清。外圆内方之应也。大约
Loss of the harmonious balance. Yang qi exhausts at the four extremities. How can miraculous elixirs help? This applies not only to postpartum conditions, but also to pregnancy conditions. An infant suffering from bloody loose stools (diarrhea with red mucus or blood streaks in the stool), with a fine pulse and cold hands and feet, is difficult to cure.
If the pulse is fine but the hands and feet are warm, the diarrhea is easy to cure. Abdominal pain with a fine and slow pulse is easy to treat; a firm and large yet rapid pulse is difficult to treat. Profuse watery diarrhea (severe watery diarrhea) with undigested food, where the pulse is minute and lingering, indicates survival; a firm and rapid pulse indicates death. Carefully observing these principles allows one to silently comprehend the favorable and unfavorable aspects of disease pulses. Furthermore, Xianwei stated: If the anterior pulse is large and the posterior is small, headache and dizziness occur; if the anterior pulse is small and the posterior is large, chest fullness and shortness of breath occur. This fully elucidates Zhang Zhongjing's concept of "initially subtle and finally large" and the principle of "deficiency mixed with excess."
[Khao Pulse] The Khao pulse is floating, large, wiry, and soft upon light pressure, feeling hollow in the middle upon heavy pressure. Although it does not respond to pressure in the middle, careful palpation reveals root qi. Pressing longitudinally reveals a wiry and large quality, while pressing heavily reduces the size and feels hollow. It differs from the Xu (Deficient) pulse, which is fleeting, large, and powerless upon pressure. Khao pulse arises because blood deficiency fails to nourish Qi, resulting in a large and empty appearance like a leek stalk. However, a wiry image must appear within it. Liu Sandian considered it similar to a Chinese onion, missing the meaning of being wiry and large yet reducing and hollow upon pressure. Generally, deficiency involves dysfunction of Yang Qi, whereas Khao involves emptiness in the meridians, distinguishing it from the weak and powerless nature of simple deficiency versus the wiry, large, and hollow nature of Khao. Zhang Zhongjing said: A pulse that is wiry and large; wiry indicates reduction, large indicates Khao. Reduction implies Cold, Khao implies Deficiency. The interplay of Deficiency and Cold creates the Ge (Leather) pulse. The Ge pulse indicates exhaustion of Stomach Qi, with a wiry strength beating against the fingers and no root upon pressure, unlike the hollow center of the Khao pulse. In Taiyang disease, a floating and tight pulse that feels Khao upon pressure indicates resolution through chills and sweating due to underlying deficiency. In Summerheat disease, a wiry, fine, Khao, and slow pulse indicates injury to the Blood level. Khao is the fundamental pulse for blood loss. The Classics state: If the pulse feels like striking, and the blood is warm with body heat, death ensues. The phrase "feels like striking" refers to a wiry and large pulse that reduces upon pressure. It also states: A hanging hook-like floating pulse is normal, describing a floating and hollow pulse where sides respond upon pressure, appearing slightly curved. Despite potential stasis obstruction, the gentle feel under the fingers indicates the presence of Stomach Qi, making it a common pulse for blood loss. If the pulse is wiry and strong against the fingers, accompanied by warm blood and fever, it indicates exhaustion of True Yin and certain death. In cases of blood depletion with a Khao pulse, if one section shows isolated wiriness or signs of Knotted, Rapid, Choppy, or stagnant qualities, this signals absence of Yang Qi and infiltration of Yin pathogenic factors, indicating blood stasis formation. Therefore, one must distinguish whether the Khao quality is in one or two sections, or on the left or right hand, to determine appropriate attacking or tonifying methods.
[Ru Pulse] The Ru (Soft) pulse is deficient, soft, and lacking force, feeling fine upon contact, like cotton floating on water. It seems present with light touch and absent with heavy pressure. It differs from the Xu (Deficient) pulse which is large and powerless, the Wei (Minute) pulse which is thread-like, and the Ruo (Weak) pulse which is deep, fine, and soft. Ru pulse indicates insufficient Stomach Qi. Thus, in internal injury, consumptive diseases, diarrhea, poor appetite, spontaneous sweating, panting fatigue, and essence injury with weakness, even if the pulse is Ru and weak, strong tonification and warming can still be used. This contrasts with Yin deficiency and blood loss, where the pulse is purely fine, rapid, wiry, and strong, making a Ru or weak quality impossible to find. While Ru pulse's floating softness resembles Xu pulse, Xu is large while Ru is small and weak. While Ru's fineness resembles Ruo pulse, Ruo is deep while Ru is superficial. While Ru's softness resembles Wei pulse, Wei is nearly imperceptible while Ru is merely weak. While Ru's lack of force resembles San (Scattered) pulse, San starts large and vanishes upon pressure, whereas Ru starts small and gradually loses force. Gradual loss of force from small indicates Qi is insufficient but Blood is not yet ruined; sudden disappearance from large indicates Qi has no control and Blood is damaged, leading to dispersion of Yin and Yang, making survival unlikely. Thus, Ru and San pulses differ as much as heaven and earth.
[Dong Pulse] The Dong (Moving) pulse trembles and moves, feeling slippery and rapid like a bead rolling under the finger, typically appearing at the Guan position. It differs from the Hua (Slippery) pulse, which is slippery and rapid throughout all positions. Dong pulse signifies the struggle between Yin and Yang. Yang movement causes sweating; Yin movement causes fever, referring to the Renying and Qikou pulses. However, Yin deficiency fever often presents with Dong pulse in the Chi position, while Yang deficiency spontaneous sweating presents with Dong pulse in the Cun position. As stated, "where there is deficiency, there is movement," because where pathogens gather, Qi must be deficient. The *Jin Gui Yao Lue* states: "A moving and weak pulse; movement indicates fright, weakness indicates palpitations." Because of deficiency, vigorous pathogenic factors invade. Only in *Shang Han Lun* are large, floating, rapid, moving, and slippery pulses considered Yang, specifically referring to the struggle of pathogenic heat, not to movements seen in consumptive diseases, body pain, or urinary/blood disorders. In women, pronounced movement in the Chi pulse indicates pregnancy. The Classics state: "Yin pulse beating distinctly different from Yang indicates pregnancy." Also: "Movement in the Hand Shaoyin pulse of women indicates conception." Since the Kidney stores Essence and the Heart governs Blood, movement in these areas indicates pregnancy. Traditionally, a larger left pulse suggests a male fetus and a larger right pulse suggests a female fetus. However, since congenital variations exist, it is more reliable to consider Cun movement as male and Chi movement as female.
[Fu Pulse] The Fu (Hidden) pulse hides beneath the tendons, undetectable with light pressure, difficult to feel with heavy pressure, requiring careful searching until it adheres to the bone. It can be hidden in all three positions or just one. It differs from the Duan (Short) pulse, which is short at the ends but obvious in the middle, and the Chen (Deep) pulse, which is deep in all positions but easily felt upon pressure. Fu pulse pathology is most unpredictable. Zhang Zhongjing described cases of absent Duyang pulse with spleen dysfunction causing cold body and stiff skin, or absent Shaoyin pulse causing numbness, known as Corpse Fainting. Fu represents the hiding of Yin and Yang. Pathogens hiding deeply cause the pulse to hide. Although distinct from the Short pulse, it shares the meaning of Qi and Blood stagnation. Thus, in Guan Ge (regurgitation and inability to urinate), the pulse is either abnormally large or hidden/small, as Bian Que described: "Pulse present above, absent below." Conditions like Qi stagnation, Blood stasis, chronic pain, hernia masses, fluid retention, food stagnation, and cholera often present with deep and hidden pulses due to meridian obstruction and failure of Ying and Wei circulation. Morning sickness in pregnancy often presents with hidden pulses, a variation of pulse-symptom relationships. In Shang Han, if exterior release is missed and pathogens cannot vent, causing all six pulses to hide, immediate diaphoresis is required to restore the pulse. Liu Yuanbin argued Fu pulse should not be treated with diaphoresis as it is not an exterior pulse, while Jiegu advocated using Mahuang Fuzi Xixin Tang. Clinical appropriateness varies, and one should not adhere rigidly to one method. If after six or seven days of restlessness with struggling pathogens and hidden pulse, it indicates impending chills and sweating, like rain after drought. One must not mistake Fu pulse for Yin and mistakenly administer acrid-warm herbs, which could cause dangerous hyperthermia.
[Xi Pulse] The Xi (Fine) pulse flows like a hair, clearly felt under the fingers, unlike the Wei (Minute) pulse which is weak and blurred. Xi pulse indicates declining Yang Qi. In *Shang Han Lun*, simultaneous deep and fine pulses at Cun and Chi indicate Taiyin involvement. Taiyin governs distribution and transformation; when transmitted by heat pathogens, Ying Qi cannot flow smoothly through the vessels, resulting in deep and fine pulses at both positions. This applies to Shaoyin as well, which often presents with deep and fine pulses. Hence, Zhang Zhongjing prohibited diaphoresis for Shaoyin disease with deep, fine, and rapid pulses. These represent external Yin and internal Yang, unlike sudden cold in winter or summerheat collapse which involve both external and internal Yin. Various passages in the *Nei Jing* regarding Xi pulse include: "Fine pulse indicates shortness of Qi," "Pulse fine and attached to bone indicates accumulation," "Cold Chi and fine pulse indicates posterior diarrhea," and "Headache with fine and slow pulse indicates dampness." All are signs of Yin pathogens. Thus, stomach deficiency with poor appetite, cold saliva regurgitation, diarrhea with abdominal pain, damp bi syndrome with weak legs, spontaneous sweating, and essence loss all present with Xi pulse. Differentiation depends on accompanying floating/deep qualities and Cun/Chi location. In healthy individuals, fine and weak pulses result from excessive worry damaging true Yuan Qi. If a robust person has a fine pulse with shortness of breath, or a febrile patient has a fine pulse with confusion, these are mismatches between pulse and disease, not ordinary deficiency.
[Ji Pulse] The Ji (Rapid) pulse beats seven or eight times per respiration. Although rapid, it is not large or solid, differing from the Hong (Surging) pulse which is large and rapid but lacks the frantic quality. Ji pulse has distinctions of Yin/Yang, Cold/Heat, and True/False. If rapid and becoming harder upon pressure, it indicates unrestrained Yang and impending exhaustion of True Yin. If rapid but not drumming upon pressure, it indicates fierce Yin pathogens exposing deficient Yang. Historical cases include a Shang Han patient with red face/eyes and thirst unable to swallow, cured by Li Dongyuan using Ginger, Aconite, and Ginseng via diaphoresis. Another case of internal heat accumulation with deep Yang reversal and rapid pulse (7-8 beats/respiration) was mistaken for Yin toxicity but cured by Zhu Zhenheng using Huanglian Jiedu Tang. In warm diseases with high fever and thirst, if the pulse is initially small but becomes frantic and red by day 5-6, death occurs due to Yin exhaustion. Frantic rapidity indicates Fire. The *Nei Jing* states: "Frantic qualities relate to the Hands," referring to Hand Shaoyin and Jueyin meridians belonging to Fire. Yin toxicity with body pain like being beaten, deep/fine/rapid pulses unresponsive to moxibustion, indicates Yang exhaustion and death. However, heat toxins entering Yin levels can also cause Yin toxicity with rapid, strong pulses, unlike cold toxins which are rapid but wiry/fine/weak. Consumptive asthma with hoarseness and extremely rapid pulses is called "Walking Corpse" or "Lone Yang Moving Alone" in *Jin Gui*, indicating lower Yin exhaustion and upper Yang hyperactivity. Only if rapid but not frantic, and slightly slowing upon pressure, is it a correct pulse for heat syndromes. Pulse texts state: Rapid and large with vexation/fullness, or rapid and deep/fine with abdominal pain, or moderate rapid without size extremes are treatable despite severity; varying sizes are difficult. Pulses like panting or counting after sudden collapse may recover spontaneously. Pulses like floating combinations, exceeding ten beats per respiration, indicate fleeing deficient Yang.
[Lao Pulse] The Lao (Firm) pulse is wiry, large, and long, reducing upon lifting, but solid and strong upon pressing, resembling a string. It differs from Shi (Solid) pulse which is slippery and smooth, Fu pulse which is hidden and difficult, and Ge pulse which is hollow upon pressure. Shuwei stated: Lao indicates firm disease qi, never seen in deficiency patterns. It appears in wet tetany, spasms, cold hernia, acute rebellion, and internal hard accumulations. Treatments historically involve acrid-warm agents to open knots and sweet-warm agents to assist Yang. However, with a fortified barrier ahead, attack and defense require caution. If food stagnation fills the middle warmer, preventing Qi circulation, changes can occur suddenly. Mistaking Lao for internal excess and purging blindly leads to exacerbating excess and depleting deficiency. Generally, Lao indicates internal hard accumulations and exhaustion of Stomach Qi, considered a critical sign by many authorities.
[Ge Pulse] The Ge (Leather) pulse is wiry, large, and rapid, strong and straight upon light pressure, hollow upon heavy pressure, like a drum skin. It differs from Jin (Tight) pulse which is tense and urgent, Xian (Wiry) pulse which does not shift upon pressure, and Lao pulse which becomes firmer upon pressure. Yingsheng said: Ge represents change. Although abnormal, the hollow center indicates it is not a True Visceral pulse. In Zhang Zhongjing's Jueyin examples, diarrhea with intestinal rumbling and floating/Ge pulse is treated with Danggui Sini Tang, representing wind stirring the roots. For women with miscarriage and bleeding, or men with blood loss and essence depletion, *Jin Gui* treats miscarriage bleeding with Xuanfuhua Tang, addressing blood chamber injury and residual stasis. For men's blood/essence loss, Yunqi suggested Shiquan Dabu Tang to fill the void. Zhang Zhongjing equated Ge to the interplay of Cold and Deficiency. Due to Cold, gentle Qi is lost; due to Deficiency, the hollow image appears. One must not assume Ge floating indicates exterior syndrome while ignoring internal Kidney deficiency.
[Cu Pulse] The Cu (Hasty) pulse is rapid and frequent but occasionally stops and resumes. It differs from Jie (Knotted) pulse which is slow with interruptions. Cu pulse indicates interior invasion of Yang pathogens. The Classics state: "If the Cun pulse strikes the hand upward, it indicates shoulder and back pain." This implies the pulse beats strongly against the finger, signifying intense heat in the meridians. In Zhang Zhongjing's Taiyang examples, post-purging Cu pulse with chest fullness, persistent diarrhea with Cu pulse, Cu pulse without chest binding, and Cu pulse with cold limbs represent four scenarios: incomplete exterior pathogens, transmission to Yangming, resolving pathogens, and transmission to Jueyin. Overall, Cu indicates Yang excess and rejection of pathogens in the interior. Even with cold limbs, moxibustion should be used to unblock Yang, not Sini Tang to restore Yang, clearly not a deficiency-cold pattern. Thus, warm diseases with macules, blood stasis with mania, phlegm-food stagnation, and anger-induced Qi rebellion all cause Cu pulse. Without interior deficiency or stagnation, interruptions would not occur.
[Jie Pulse] The Jie (Knotted) pulse is slow with frequent interruptions that resume after a moment. It differs from Dai (Intermittent) pulse where movement cannot return naturally. Jie pulse indicates consolidation of Yin pathogens. Bian Que stated: Severe knotting indicates severe accumulation; slight knotting indicates slight Qi deficiency. Weak knotting indicates original Qi decline; even with accumulations, the pulse knotting is not severe. Zhang Zhongjing described post-sweat/purge unresolved Shang Han with Jie/Dai pulse and palpitations, and Taiyang jaundice with deep/knotted pulse, hard hypogastrium, and urinary difficulty indicating blood stasis. These represent Qi deficiency with pathogen retention and Heat binding in the Bladder. Conditions like cold-fluid, dead blood, vomiting/diarrhea with abdominal pain, epilepsy, and parasitic accumulation often show Jie pulse due to Qi stagnation. Acute presentation requires acrid-warm support of Zheng Qi with mild knot-resolving and phlegm-dispersing actions. Occasionally, one beat fails to connect every 20-30 beats with a weak feel, indicating sudden Yuan Qi collapse, requiring strong warming and tonification. If ineffective, danger ensues. In chronic illness, this is inappropriate. Intermittent pulses must be evaluated for strength and frequency. Irregular intervals with continuous response upon heavy pressure indicate meridian obstruction and Yin-Yang imbalance. Yang excess causes Cu; Yin excess causes Jie. Thus, Zhang Zhongjing considered them pathological pulses.
[Dai Pulse] The Dai (Intermittent) pulse stops during movement and cannot return immediately, then resumes. It is named Dai Yin. Unlike Cu and Jie, which resume with force, Dai indicates discontinuity of Yuan Qi. The Classics state: "Dai indicates Qi decline." Seen post-illness, it is not necessarily fatal. However, sudden Qi/Blood loss, spirit discontinuity, extreme emotions, trauma, or pain syndromes showing intermittent pulses are pathological. In Shang Han, palpitations with Dai pulse, or abdominal/heart pain with irregular knotted/stopped pulses, result from Qi/Blood obstruction due to pain and should not be taken as standard criteria. If occurring without disease, it indicates one Zang lacks Qi and another compensates, signaling imminent death. Even if pathological, irregular intervals suggest potential survival. If every few beats stops regularly, it is difficult to treat. The Classics state: Fifty beats without interruption is normal. Knowing the five Zangs' cycles, predicting short life involves irregular rhythms. "Rapid with one interruption" indicates Yang disease. This represents complete Yang exhaustion. Pulses like bird pecking, leaking roof, or broken string are true Dai pulses, indicating extinction of life. However, severe morning sickness in pregnancy often shows Dai pulse due to scarce intake and Qi/Blood concentrating on fetal nourishment. This occurs in months 2-3; by month 4, when the fetus is formed, interruptions should cease.
[San Pulse] The San (Scattered) pulse is floating and scattered upon lifting, absent upon pressing, indistinct in arrival and departure, with no root. It differs from Xu (Deficient) pulse which is weak upon heavy pressure but not scattered. San pulse indicates dispersion of Yuan Qi. Thus, in Shang Han with coughing and reverse Qi flow, a Scattered pulse indicates death due to physical deterioration. It is a sign of certain death. Images vary: like blowing wool, scattered leaves, uvula, fat on soup, or burning firewood. All are true Scattered pulses indicating death, distinct from large deficiency. The Classics state: "Dai and San together indicate death." If post-illness, major pathogens leave, fever subsides, body is calm, diarrhea stops, and grain enters the stomach, survival is possible. Ancients considered Dai/San combination fatal because San reflects Kidney failure and Dai reflects Spleen extinction. Kidney pulse is deep; Scattered pulse is undetectable upon pressure, indicating extinction of先天 (Pre-heaven) foundation. Spleen pulse is regular; Dai pulse misses its rhythm, indicating extinction of 后天 (Post-heaven) foundation. Seeing either alone is critical; seeing both is definitely fatal.
[Qing Pulse] The Qing (Clear) pulse is light, clear, slow, and slippery, fluent with spirit, resembling small/weak but not Minute. It differs from Xu pulse which cannot withstand search, Wei pulse which is weak/faint, Huan (Moderate) pulse which is sluggish, and Ruo pulse which is deep/fine/soft. Qing pulse indicates balanced Qi and Blood. The Classics state: "Receiving Qi makes one Clear." Healthy people have clear, empty, and moderate pulses, free from danger. Left hand clear/empty/moderate indicates noble and benevolent character. Fluent clear/empty indicates decisiveness. Clear/empty with wiry/small/solid indicates cunning and harshness. Right hand clear/empty/moderate indicates wealth and leisure. Fluent clear/empty indicates wealth with propriety. Clear/empty with withered/choppy/lack of spirit indicates current dissatisfaction despite abundance. Cun clear/empty indicates distinguished lineage and intelligence. Chi clear/empty indicates good offspring and longevity. If Cun/Guan are clear but Chi is choppy or uneven, it indicates late-life poverty and difficulty having children. Clear/empty feeling slippery/heavy upon pressure indicates clarity mixed with turbidity, outward integrity but inward greed. If diseased but pulse is clear, severity does not matter. Clear/empty with lack of spirit requires warming and tonification. If a person normally has clear/empty pulse, even with exogenous high heat, the pulse will not surge; do not mistake this for excess disease/deficient pulse and fail to attack.
[Zhuo Pulse] The Zhuo (Turbid) pulse is heavy, turbid, surging, filling the fingers, slippery, solid, and forceful in floating and deep positions. It differs from Hong pulse which is soft/broad upon pressure, Shi pulse which reduces upon lifting, Hua pulse which is fluent, and Jin pulse which twists constantly. Zhuo pulse indicates turbid constitution. The Classics state: "Receiving Grain makes one Turbid." Healthy people with heavy/turbid/surging pulses may not enjoy leisure in old age. Left hand turbid indicates low status. Right hand turbid indicates mediocrity. Cun turbid indicates humble family background. Chi turbid indicates reckless descendants. If turbid with slippery quality, family is wealthy. Turbid with choppy quality or imbalance indicates lack of health and premature death. Turbid but moderate upon pressure indicates turbidity mixed with clarity, outward flexibility but inward uprightness. Approximately