躁脉有浮沉两种，沉而来去如掣，或兼细、兼滑、兼弦，而无远近盛衰之异者，阳气之
虚而
内陷，是自郁也；若为寒湿所遏者，必兼紧数矣。浮而来盛去衰，来远去近，甫去即来，未
能极底，如人之以手探汤而回者，此内热而中气不安于内，是阴气不吸也。兼洪缓者，为风
热、湿热之有余；兼弱散者，为阴虚骨蒸之不足。凡患血燥，脉多如此。其证为懊 烦躁，
夜不安眠，大便秘结，头目昏眩，呼吸短促，多梦纷纭。又骨性坚敛，气主内吸。骨热者，
脉来上促，出多入少。其证为骨中如坚，肢软欲痿，头颅胀疼，筋脉抽掣，心中惊惕，是髓
中有热也；若加浮散，是髓枯也。《内经》曰∶热病髓热者死。此之谓也。
《脉简补义》论实散之脉，近于洪而不数不盛。其所以异同之故，尚未揭出。夫洪者，
或阴
虚阳陷，而阳盛于阴，或阴本不虚，而阳邪自盛。此偏于阳盛一边，故其脉洪大而充实有力
。实散者，或内湿菀久化燥，或风邪内扰其阴。此偏于阴虚一边，故其脉涣而平软少力。《
慎柔五书》又谓虚损久病，其脉中沉之分，必见虚洪。此又气虚血少，阴阳两亏，而中枢不
运者也。血少故不聚不坚，气虚故起伏甚小而无力，是虚散之未甚者。虚洪见于中沉，升降
无力，阳气弱而犹未离根；虚散仅见于浮，阴不维阳，阳气散而无根也。故治洪脉，重在泄
火
，而兼养阴；治实散，重在养阴，而兼理气；治虚洪，补血益气，而剂取轻清；治散脉，益
气补血，而剂取温润重浊，收摄滋填矣。此四脉者，其辨只在阴阳虚实、偏轻偏重、一微一
甚之间。
The Zao (Restless) pulse is divided into two types: floating and deep. When felt at the deep level, the pulse comes and goes rapidly as if being pulled, or it may be accompanied by a Fine (Xi), Slippery (Hua), or Wiry (Xian) quality, without differences in distance or strength. This indicates deficiency of Yang Qi sinking inward, resulting in self-stagnation; if constrained by Cold-Dampness, it must be accompanied by a Tight (Jin) and Rapid (Shu) quality. When felt at the floating level, the pulse arrives with great force but departs weakly, coming from afar and departing near, returning immediately after leaving without reaching the bottom, similar to a hand dipping into hot water and withdrawing quickly. This indicates internal heat with Middle Qi unable to remain settled within, reflecting Yin Qi's failure to grasp and retain. If accompanied by a Surging (Hong) and Slow (Huan) quality, it indicates excess of Wind-Heat or Damp-Heat; if accompanied by a Weak (Ruo) and Scattered (San) quality, it indicates insufficiency due to Yin deficiency with bone-steaming fever. In cases of Blood Dryness, the pulse is often like this. The symptoms include mental restlessness and vexation, insomnia at night, constipation, dizziness of the head and eyes, shortness of breath, and frequent dreaming. Furthermore, the nature of Bone is firm and convergent, while the nature of Qi primarily moves inward. In cases of Heat in the Bone, the pulse arrives hurriedly, with more outward movement than inward. The symptoms include a sensation of hardness in the bones, flaccidity and weakness of the limbs resembling paralysis, distending pain in the head, twitching and pulling of sinews and vessels, and palpitations with fear in the heart, indicating Heat in the Marrow; if accompanied by a Floating and Scattered pulse, it indicates exhaustion of the Marrow. The *Neijing* states: "In febrile diseases, Heat in the Marrow leads to death." This refers to that condition.
*Maijian Buyi* discusses the Shi San (Excess Scattered) pulse, which resembles the Hong (Surging) pulse but is neither Rapid nor Excessive. The reasons for their similarities and differences have not yet been elucidated. The Hong pulse arises either from Yin deficiency with Yang sinking, causing Yang to exceed Yin, or when Yin is originally not deficient but Pathogenic Yang becomes naturally excessive. This leans towards the side of Yang Excess, hence its pulse is Surging, large, full, and forceful. The Shi San pulse arises either from internal Dampness stagnating for a long time transforming into Dryness, or from Wind Pathogen disturbing the interior Yin. This leans towards the side of Yin Deficiency, hence its pulse is scattered, flat, soft, and lacking force. *Shenrou Wushu* further states that in chronic deficiency syndromes, the pulse at the middle and deep levels will invariably show a Xu Hong (Deficient Surging) quality. This again indicates Qi and Blood deficiency, dual deficiency of Yin and Yang, and dysfunction of the Central Pivot. Due to Blood deficiency, the pulse does not gather or become firm; due to Qi deficiency, the fluctuations are small and weak, representing an early stage of the San (Scattered) pulse. The Xu Hong pulse appears at the middle and deep levels, with weak ascending and descending movements; Yang Qi is weak but has not yet lost its root. The Xu San (Deficient Scattered) pulse appears only at the floating level; Yin fails to anchor Yang, causing Yang Qi to scatter without a root. Therefore, treating the Hong pulse focuses on draining Fire while simultaneously nourishing Yin; treating the Shi San pulse focuses on nourishing Yin while simultaneously regulating Qi; treating the Xu Hong pulse involves tonifying Blood and benefiting Qi, using light and clear formulations; treating the San pulse involves benefiting Qi and tonifying Blood, using warm, moistening, heavy, and turbid formulations to consolidate, nourish, and fill. The differentiation among these four pulses lies merely in the subtle distinctions between Yin and Yang, Excess and Deficiency, slight versus severe deviations, and minor versus major degrees.