切脉时。男先诊左。女先诊右。以中指先按关部。（即手掌后高骨下、动脉应指处。
）次下前后二指。前指按寸口。后指按尺部。人长则疏排三指。人短则密排三指。人瘦
则肌肉薄。宜轻取。人肥则肌肉浓。宜重取。初排指于皮肤上。轻手诊之曰浮举。浮以
候神。凡脉浮举有力不劲疾者。为有神。浮举无力而涣散者。为无神。继乃排指于皮肤之
下。肌肉之间。略重诊之曰中寻。中以候胃。凡脉中候有力。应手中和而搏指者。为有
胃。中候虽有力。应手急劲而勒指者。为无胃。终则重指切至肌肉之下。筋骨之间。重手诊
之曰沉按。沉以候根。凡脉沉按有力有神。能应指而如按鼓上者。为有根。沉按无力
无神。不应指而如入灰中者。为无根。沉按寸口数大。两尺弦劲勒指者。亦为无根。沉
按寸口应指。两尺沉微欲绝者。尤为无根。以两尺为根中之根也。至证之阴阳寒热。在
沉按中区分。为予数十年历验之秘诀。总之脉以胃神根三字为最要。此诊寸关尺九候之
要诀。
【廉勘】昔吴草庐曰。医者以寸关尺。辄名之曰此心脉。此肺脉。此脾脉。此肝脉
。此肾脉者。非也。五脏六腑。凡十二经。两寸关尺。皆手太阴之一脉也。分其部位。
以候他脏之气耳。脉行始于肺。终于肝。而复会于肺。肺为出气之门户。故名气口。而
为六脉之大会。以占一身焉。故诊察脉位。分而不分。不分而分。全在
临诊时一片灵机。又按英医合信氏曰。中国所分三部九候。实难凭信。盖周身脉管。皆
由心系总管而出。散布四肢百体。流行贯通。岂两手寸许之管。五脏六腑遂遍系于此耶。
且直通一贯。何以知三指分部。寸关尺必不紊耶。故谓一脉可验周身之病则可。谓某部
之脉。独决某经之病则不可。合二说而观之。手脉分寸关尺。按部可知其五内病所。却
是一疑问题。考总脉管由心左下房而出。直插上房。而上离二寸许。即回屈而下。变作
一拱。拱之上。歧为三大支。左二右一。离右支寸许。复歧为二。一由颈右达脑。一由
右肩达手。此即右手寸口脉之源也。其左二支。一由颈左达脑。一由左肩达手。此即左
手寸口脉之源也。周身皆有动脉。寸口独分三部之理由。惟唐容川解释。语尚明通。试
节述其说曰。脉为血脉。西医名为脉管。脉管之内。内经名营。脉管之外。皆其网膜。
内经名腠理。为卫气往来之所。故诊脉有单论脉管者。脉管只是一条。数则均数。迟
则均迟。细则均细。大则均大。皆是应心而动。故无三部之分。知此。则凡脉管中营分
所主者。如小、散、芤、涩、革、弱等脉理均可识矣。亦有单论气分者。气附脉行。脉
动而气亦应之。气升则脉浮。气降则脉沉。气盛则脉洪。气衰则脉微。皆是随气呈露
。故有寸浮尺沉寸洪尺微之异。随气之部分。而异其强弱。所以有三部之别。知此。则
凡脉管外气分所主者。如弦、紧、滑、濡、牢、结等脉理均可识矣。总之辨脉能知气在
脉外。血在脉中。脉之动根于心。气之原生于肺。于仲景一切脉法。自然贯通。
When palpating the pulse, for males, the left hand is examined first; for females, the right hand is examined first. The middle finger is placed first on the Guan position (the area below the styloid process of the radius where the arterial pulsation is felt). Then the front and back fingers are lowered: the front finger presses the Cun position (distal), and the back finger presses the Chi position (proximal). For tall individuals, the three fingers are spaced widely; for short individuals, they are placed closely together. For thin individuals with thin muscles, light pressure is appropriate; for obese individuals with thick muscles, heavy pressure is appropriate.
Initially, the fingers are arranged on the skin surface, and a light touch examination is called "Fu Ju" (Floating Lift). Floating pulse assessment gauges Shen (Spirit/Vitality). If the pulse is strong upon floating lift but not rapid or forceful, it indicates the presence of Shen. If it is weak and scattered upon floating lift, it indicates the absence of Shen.
Next, the fingers are arranged beneath the skin, between the muscles, and a slightly heavier examination is called "Zhong Xun" (Middle Search). Middle pulse assessment gauges Wei Qi (Stomach Qi/Digestive Function). If the pulse is strong at the middle level, responding softly yet firmly to the touch, it indicates the presence of Wei Qi. Although strong, if the pulse responds with urgency and forcefulness that constricts the finger, it indicates the absence of Wei Qi.
Finally, heavy pressure is applied down to beneath the muscles and between the sinews and bones, and a heavy touch examination is called "Chen An" (Deep Press). Deep pulse assessment gauges Gen Qi (Root Qi/Kidney Essence). If the pulse is strong and spirited upon deep press, responding like pressing on a drumhead, it indicates the presence of Gen Qi. If it is weak and spiritless upon deep press, failing to respond as if sinking into ash, it indicates the absence of Gen Qi. If, upon deep press, the Cun pulse is rapid and large, while both Chi pulses are wiry, forceful, and constricting, this also indicates an absence of Gen Qi. If, upon deep press, the Cun pulse responds, but both Chi pulses are deep, faint, and nearly imperceptible, this is particularly indicative of an absence of Gen Qi, because the two Chi positions are the root of the roots. Regarding the differentiation of Yin/Yang and Cold/Heat in syndromes, this must be distinguished during the deep press phase; this is a secret method verified by my decades of clinical experience. In summary, the most crucial aspects of the pulse are the concepts of Wei (Stomach Qi), Shen (Spirit), and Gen (Root). This is the essential principle for examining the nine positions of the Cun, Guan, and Chi.
[Lian Kan] Wu Caolu once stated: It is incorrect for physicians to simply refer to the Cun, Guan, and Chi positions as "this Heart pulse," "this Lung pulse," "this Spleen pulse," "this Liver pulse," or "this Kidney pulse." The five Zang and six Fu organs comprise twelve meridians. The Cun, Guan, and Chi on both hands are all branches of the Hand Taiyin Lung Meridian. They merely divide the locations to assess the Qi of other Zang organs. Pulse Qi begins in the Lung, ends in the Liver, and returns to meet in the Lung. The Lung is the portal for exhalation, hence it is called "Qi Kou" (Air Gate) and serves as the great assembly of the six pulses, used to assess the entire body. Therefore, when examining pulse positions, one must understand both separation and non-separation; this depends entirely on the physician's intuitive agility during clinical practice.
Additionally, according to the British physician Dr. Hobson: The Chinese division of Three Regions and Nine Positions is difficult to trust. All blood vessels in the body originate from the heart's main trunk and distribute throughout the limbs and body, flowing continuously. How can the vessels in the two hands, only about one cun long, be connected to all five Zang and six Fu organs? Moreover, since they are continuous, how can we ensure that the three-finger division of Cun, Guan, and Chi remains orderly? Thus, it is acceptable to say that a single pulse can reflect diseases of the whole body, but it is unacceptable to claim that the pulse at a specific position exclusively determines disease in a specific meridian.
Observing these two perspectives together, dividing the hand pulse into Cun, Guan, and Chi allows us to know the location of internal organ pathology by region, yet this remains a problematic issue. Examining the anatomy, the main vessel originates from the left ventricle, ascends directly to the ascending aorta, and after rising about two cun, curves downward into the aortic arch. Above the arch, it divides into three major branches: two on the left and one on the right. About one cun from the right branch, it divides again into two: one travels up the right neck to the brain, and the other goes via the right shoulder to the hand; this is the source of the right hand's Cun Kou pulse. Its two left branches travel up the left neck to the brain and via the left shoulder to the hand; these are the sources of the left hand's Cun Kou pulse. Since arteries exist throughout the body, the reason why only the Cun Kou is divided into three regions was explained clearly by Tang Rongchuan. Briefly summarizing his view: The pulse refers to blood vessels, known as "vessels" in Western medicine. Inside the vessel, the *Neijing* calls it Ying (Nutritive Qi); outside the vessel are the membranes, which the *Neijing* calls Cili (Cou Li/Cutaneous spaces), the residence of Wei (Defensive Qi) circulation. Therefore, pulse diagnosis sometimes focuses solely on the vessel itself. Since there is only one vessel, a rapid rate applies equally everywhere, a slow rate applies equally, a fine quality applies equally, and a large quality applies equally; these all respond to the heart's movement, so there is no distinction among the three regions. Understanding this allows one to recognize pulse qualities governed by Ying within the vessel, such as Xiao (Small), San (Scattered), Kou (Hollow), Se (Choppy), Ge (Leather), and Ruo (Weak).
There is also a focus solely on Qi. Qi accompanies the pulse; when the pulse moves, Qi responds. When Qi rises, the pulse floats; when Qi descends, the pulse sinks; when Qi is abundant, the pulse is Hong (Surging); when Qi is deficient, the pulse is Wei (Faint). These manifest according to Qi. Hence, differences arise such as floating at Cun and sinking at Chi, or surging at Cun and faint at Chi, varying in strength according to the distribution of Qi, thus creating the distinction of three regions. Understanding this allows one to recognize pulse qualities governed by Wei outside the vessel, such as Xian (Wiry), Jin (Tight), Hua (Slippery), Ru (Soggy), Lao (Hard), and Jie (Knotted). In summary, if one can distinguish the pulse by knowing that Qi is outside the vessel and Blood is inside, that the pulse's movement originates from the Heart, and that Qi's origin lies in the Lung, then one will naturally comprehend all of Zhang Zhongjing's pulse methods.