脉为血府。气血之神。心机舒缩。逼令循行。资始于肾。资生于胃。阴阳相贯。本
乎营卫。营行脉中。卫行脉外。脉不循行。营壅卫败。气如橐 。血如波澜。血脉气息
。上下循环。十二经中。皆有动脉。惟手太阴。寸口取决。脉之大会。息之
出入。脉行六寸。一呼一吸。初持脉时。令仰其掌。掌后高骨。是谓关上。关前为阳。关
后为阴。阳寸阴尺。先后推寻。心肝居左。肺脾居右。肾与命门。两尺推究。左大顺男
。右大顺女。男左女右。各宜分主。关前一分。十二经注。左为人迎。右为气口。神门
决断。两在关后。人无二脉。病死不愈。男女脉同。惟尺则异。脉有七诊。曰浮中沉。
上下左右。消息求寻。又有九候。举按轻重。三部浮沉。各候五动。寸候关上。关后膈
下。尺候于脐。下至跟踝。左脉候左。右脉候右。病随所在。不病者否。浮主心肺。沉
主肾肝。脾胃中洲。浮沉之间。专主中气。脉宜和缓。命门元阳。右尺同断。春弦夏洪
。秋毛冬石。四季和缓。是谓平脉。太过实强。病生于外。不及虚微。病生于内。四时
百病。胃气为本。脉贵有神。不可不审。
【秀按】此总括《内》《难》二经脉理诊法之精义。句句名言。字字金玉。学人当
熟读之。
【荣斋按】本节开首“脉为血府”四字，是内经原文。帮助了脉之所以搏动，搏动
之所以有差别，皆本于血行，也皆本于心脏的舒缩，这就是所谓血行循环。至于脉搏的
迟数，关系着血行的快慢；脉搏的软硬，关系着心脏的弛张；脉搏的顿挫，关系着心脏
瓣膜的启闭。不过，这里有一个先决问题∶就是血为什么能够行？心脏为什么能够舒缩
？我体会出主要是在乎“气”；气与血是不能分家的，所以下文说∶“气如橐 ，血如
波澜。”也帮助了“气”与“血”是脉搏的主要动力。下文讲到“七诊”“九候”∶我
认为“七诊”只浮、沉两诊可靠，中、上、下、左、右这五诊都无着落。至于九候，
也难肯定；因血管决不能分作三层，血液在脉管中间，其量常超过血管的客积，所以轻
按重按，可能候脉搏的虚实，中按则无标准可得了。
调停自气。呼吸定息。四至五至。
平和之则。三至为迟。迟则为冷。六至为数。数即热症。转迟转冷。转数转热。迟数既
明。浮沉当别。浮沉迟数。辨内外因。外因于天。内因于人。天有阴阳。风雨晦冥。人
喜怒忧。思悲恐惊。外因之浮。则为
表症。沉里迟阴。数则阳盛。内因之浮。虚风所为。沉气迟泠。数热何疑。浮数表热。
沉数里热。浮迟表虚。沉迟冷结。表里阴阳。风气冷热。辨内外因。脉症参别。脉理浩
繁。总括于四。既得提纲。引申触类。浮脉法天。轻手可得。泛泛在上。如水漂木。有力
洪大。来盛去悠。无力虚大。迟而且柔。虚甚则散。涣漫不收。有边无中。其名曰芤。
浮小为濡。绵浮水面。濡甚则微。不任寻按。沉脉法地。近于筋骨。深深在下。沉极为
伏。有力为牢。实大弦长。牢甚则实。 而强。无力为弱。柔小如绵。弱甚则细。如
蛛丝然。迟脉属阴。一息三至。小 于迟。缓不及四。三损一败。病不可治。两息夺精
。脉已无气。浮大虚散。或见芤革。浮小濡微。沉小细弱。迟细为涩。往来极难。促则
来数。一止即还。结则来缓。止而复来。代则来缓。止不能回。数脉属阳。六至一息。七
疾八极。九至为脱。浮大者洪。沉大牢实。往来流利。是谓之滑。有力为紧。弹如转
索。数见寸口。有止为促。数见关中。动脉可候。厥厥动摇。状如小豆。长则气治。过
于本位。长而端直。弦脉应指。短则气病。不能满部。不见于关。惟尺寸候。
【秀按】此总括各脉常象之精义。
【廉勘】前哲王燕昌曰。临证先问病因。因、乃病之由来也。问明病因。然后切脉问
证。望其形体之强弱。容色之枯润。闻其声音之巨细。呼吸之缓急。则是据其病因。参
合望闻问切四法。虽一脉有 侗。或反形。或闭伏。而病情已得于四法中矣。指下之疑
自释也。否则脉仅二三十象。病乃千变无穷。一脉不仅属一病一症。而一病一症。亦不
仅见于一脉。故临诊先据见症。最有把握。如九窍者。脏腑之门户也。必先据九窍所见
之症。与脉核对。自胸至头有症。脉必见象于寸。脐上两手两胁有症。脉必见象于关。
少腹两腿二便有症。脉必见象于尺。此其大要也。总之凡诊诸脉。均合四诊以施治。
乃不致率尔操觚。如谓不须望闻问。但一诊脉。即
能悉其病状。抉其病隐。明其病源。达其病变。乃术士欺人语耳。
又曰。每临一症。六脉皆动。须先明其何部之脉无病。然后一一比较。乃知其何经
有病。如诊外感时病。执定浮沉以辨其寸关尺。盖初感由于经络。病在表。轻者寸浮盛
。重者关尺亦浮盛。迨传入里生内热。则沉部盛矣。病在上则见于寸。病在中则见于关
。病在下则见于尺。又诊内伤杂症。执定寸关尺以辨其浮沉。盖初病即分脏腑。其脉各
见于本位。病在腑则本部浮。病在脏则本部沉。迨日久有腑病而连引脏者。有脏病而伤
及腑者。有数经兼病者。皆按部而察其浮沉。凡数经兼病。须治其紧要者为主。盖有当
前之症候形色。与致病之原因。核对于所诊脉象。要归一路。则得其主脑而治之。其余
连类相及。与旧有之病。或可兼治缓治。尤必问其本脉。庶诊时之脉。乃能有准。总之
脉之作用。不过揣测心力之强弱。肺气之盛衰。以定其病之表里阴阳。寒热虚实而已。
于望闻问三者。已得其病之真相。然后与脉核对互勘耳。
一脉一形。各有主病。数脉相兼。则见诸症。浮脉主表。里必不足。有力风热。
无力血弱。浮迟风虚。浮数风热。浮紧风寒。浮缓风湿。浮虚伤暑
。浮芤失血。浮洪虚火。浮微劳极。浮细阴虚。浮散虚剧。浮弦痰食。浮滑痰热。沉脉
主里。主寒主积。有力痰食。无力气郁。沉迟虚寒。沉数热伏。沉紧冷痛。沉缓水蓄。
沉牢痼冷。沉实热极。沉弱阴虚。沉细痹湿。沉弦饮痛。沉滑宿食。沉伏吐利。阴毒聚
积。迟脉主脏。阳气伏潜。有力为痛。无力虚寒。数脉主腑。主吐主狂。有力为热。无
力为疮。滑脉主痰。或伤于食。下为蓄血。上为吐逆。涩脉少血。或中寒湿。反胃结肠
。自汗厥逆。弦脉主饮。病属胆肝。弦数多热。弦迟多寒。浮弦支饮。沉弦悬痛。阳弦
头痛。阴弦腹痛。紧脉主寒。又主诸痛。浮紧表寒。沉紧里痛。长脉气平。短脉气病。
细则血少。大则病进。浮长风痫。沉短宿食。血虚脉虚。气实脉实。洪脉为热。其阴则
虚。细脉为湿。其
血则虚。缓大者风。缓细者湿。缓涩血少。缓滑内热。濡小阴虚。弱小阳竭。阳竭恶寒
。阴虚发热。阳微恶寒。阴微发热。男微虚损。女微泻血。阳动汗出。阴动发热。为痛
与惊。崩中失血。虚寒相搏。其名为革。男子失精。女子失血。阳盛则促。肺痈阳毒。
阴盛则结。疝瘕积郁。代则气衰。或泄脓血。伤寒心悸。女胎三月。
【秀按】此为各脉主病之大要。
脉之主病。有宜不宜。阴阳顺逆。凶吉可推。中风浮缓。急实则忌。浮滑中痰。沉
迟中气。尸厥沉滑。卒不知人。入脏身冷。入腑身温。风伤于卫。浮缓有汗。寒伤于营
浮紧无汗。暑伤于气。脉虚身热。湿伤于血。脉缓细涩。伤寒热病。脉喜浮洪。沉微涩
小。症反必凶。汗后脉静。身凉则安。汗后脉躁。热甚必难。阳病见阴。病必危殆。阴
病见阳。虽困无害。上不至关。阴气已绝。下不至关。阳气已竭。代脉止歇。脏绝倾危
。散脉无根。形损难医。饮食内伤。气口急滑。劳倦内伤。右脉大弱。欲知是气。下手
脉沉。沉极则伏。涩弱久深。六郁多沉。滑痰紧食。气涩血芤。数火细湿。滑主多痰。
弦主留饮。热则滑数。寒则弦紧。浮滑兼风。沉滑兼气。食伤短疾。湿留濡细。疟脉自
弦。数弦者热。弦迟者寒。代散者折。泄泻下痢。沉小滑弱。实大浮洪。发热则恶。呕
吐反胃。浮滑者昌。弦数紧涩。结肠者亡。霍乱之候。脉代勿讶。厥逆迟微。是则可怕
。咳嗽多浮。聚肺关胃。沉紧小危。浮濡易治。喘急息肩。浮滑者顺。沉涩肢寒。散脉
逆症。病热有火。洪数可医。沉微无火。无根者危。骨蒸发热。脉数而虚。热而涩小。
必殒其躯。劳极诸虚。浮软微弱。土败双弦。火炎急数。诸病失血。脉必见芤。缓小可
喜。数大可忧。瘀血内蓄。却宜牢大。沉小涩微。反成其害。遗精白浊。微涩而弱。火
盛阴虚。芤濡洪数。三消之脉。浮大者生。细小微涩。形脱可惊。小便淋闭。鼻头色黄
。涩小无血。数大何妨。大便燥结。须分气血。阳
数而实。阴迟而涩。癫乃重阴。狂乃重阳。浮洪吉兆。沉急凶殃。痛脉宜虚。实急者恶
。浮阳沉阴。滑痰数热。喉痹之脉。数热迟寒。缠喉走马。微伏则难。诸风眩晕。有
火有痰。左涩死血。右大虚看。头痛多弦。浮风紧寒。热洪湿细。缓滑厥痰。气虚弦软
。血虚微涩。肾厥弦坚。真痛短涩。心腹之痛。其类有九。细迟从吉。浮大延久。疝气
弦急。积聚在里。牢急者生。弱急者死。腰痛之脉。多沉而弦。兼浮者风。兼紧者寒。
弦滑痰饮。濡细肾着。大乃肾虚。沉实闪肭。香港脚有四。迟寒数热。浮滑者风。濡细者湿。
痿病肺虚。脉多微缓。或涩或紧。或细或濡。风寒湿气。合而为痹。浮涩而紧。三脉
乃备。五疸实热。脉必洪数。涩微属虚。切忌发渴。脉得诸沉。责其有水。浮气与风。
沉石在里。沉数为阳。沉迟为阴。浮大出厄。虚小可惊。胀满脉弦。脾受肝克。湿热数
洪。阴寒迟弱。浮为虚满。紧则中实。浮大可治。虚小危极。五脏为积。六腑为聚。实
强者生。沉细者死。中恶腹胀。紧细者生。脉若浮大。邪气已深。痈疽浮数。恶寒发热
。若有痛处。痈疽所发。脉数发热。若痛者伤。不数不热。不疼阴疮。未溃痈疽。不怕
洪大。已溃痈疽。洪大可怕。肺痈已成。寸数而实。肺痿之形。数而无力。肺痈色白。
脉宜短涩。不宜浮大。唾糊呕血。肠痈实热。滑数可知。数而不热。关脉芤虚。微涩而
紧。未脓当下。紧数脓成。切不可下。
【秀按】此为脉症宜忌之大要。
【廉勘】昔赵晴初老友曰。是病应得是脉者为顺。不应得是脉者为逆。此余三十
余年阅历。为诊脉辨症之要诀。
妇人之脉。以血为本。血旺易胎。气旺难孕。少阴动甚。谓之有子。尺脉滑利。妊
娠可喜。滑疾不散。胎必三月。但疾不散。五月可别。左疾为男。右疾为女。女腹如箕
。男腹如釜。关或滑大。代促无妨。舌青脉伏。其胎必伤。尺滑带数。胎气
过强。沉迟而涩。其胎防僵。六七月后。脉喜实长。八月弦实。沉细不祥。神门微紧。
胎必防伤。大劳惊仆。胎血难藏。沉细短涩。终多凶殃。足月脉乱。反是吉象。临产六
至。脉号离经。沉细急数。胎已下临。浮大难产。急于色征。面舌唇色。忌黑与青。面赤
舌青。子死母活。面青舌赤。母死子活。面舌俱青。口喷热秽。若胎在腹。子母俱殒。
新产之脉。缓滑为吉。实大弦牢。诸病皆逆。沉细虚弱。产后相合。涩疾血崩。血脱阴
竭。
【廉勘】古人论孕。脉多主尺。皆以左疾左大为男。右疾右大为女。独张石顽老人
。谓寸口滑实为男。尺中滑实为女。两寸俱滑实为双男。两尺俱滑实为双女。右尺左寸
俱滑实。为一男一女。自信历验不爽。以余所验。亦不尽然。惟孙真人千金方云。左乳
房有核是男。右乳房有核是女。名医周八先生曰。左乳胀为男。右乳胀为女。历验多准
。又中指之末名冲良穴。凡妇人血旺者。孕则此穴脉动。亦多经验。他如尺脉涩微。经
期定愆。尺大而旺。有胎可庆。滑疾而代。亦为有胎。将产之脉。脉必离经。产后血崩
。尺不上关。其血已尽。大命将倾。皆为专门妇科之要诀。惟以脉辨胎。不如用闻症筒
按腹。听婴儿之声为有据。
小儿之脉。七至为平。更察色证。与虎口纹。
【廉勘】孟河马良伯脉法韵语曰。小儿之脉。宜定至息。二至为殃。三至亦卒。五
至为虚。四至损怯。六至平和。九十至剧。浮缓伤风。浮洪风热。浮紧伤寒。沉细乳积
。沉紧腹痛。弦紧喘息。紧促痘疹。急惊弦疾。虚软慢惊。疟痢弦急。弦细为虫。便秘
数实。此为四五六岁小儿脉候之要诀。若数月至二三岁。总以腹诊问诊望色望苗窍为有
据。若虎口纹（即手络）看法。起于滑伯仁。歌曰。小儿三岁下。虎口看三关。紫热红
伤寒。青惊白是疳。淡红淡黄者。斯为无病看。又谓纹见下节风关为轻。纹见中节气关
为重。纹见上节命关为危。若紫黑色直透三关。为大危。是为要诀。历试辄验。其说亦
本于内经。灵枢曰。凡诊络脉。脉色青则寒且痛。赤
则有热。胃中寒。手鱼之络多青矣。胃中有热。鱼际络赤。其暴黑者。留久痹也。其有
The pulse is the mansion of blood, the spirit of qi and blood. The heart's mechanism of contraction and expansion forces circulation. It originates from the Kidney and is nourished by the Stomach. Yin and Yang interconnect, rooted in Ying (Nutrient) and Wei (Defensive) Qi. Ying circulates within the vessels, while Wei circulates outside the vessels. If the pulse does not circulate properly, Ying becomes stagnant and Wei deteriorates. Qi moves like a bellows (Tuoyue), and blood flows like waves. Blood vessels and breath cycle up and down. In the twelve meridians, there are all pulsating arteries, but only the Cun Kou (Inch Port) of the Hand Taiyin Lung Meridian is decisive. This is the great meeting of pulses, with breath entering and exiting. The pulse travels six cun per respiration (one exhalation and one inhalation).
When initially palpating the pulse, instruct the patient to extend their palm upward. The prominent bone behind the palm is called Guan (Crotch/Bar). The area anterior to Guan is Yang, and the area posterior to Guan is Yin. Yang corresponds to Cun (Inch), and Yin corresponds to Chi (Cubit); search sequentially. On the left hand, Xin (Heart) and Gan (Liver) reside; on the right hand, Fei (Lung) and Pi (Spleen) reside. Both Chi positions investigate Shen (Kidney) and Mingmen (Gate of Life). A larger pulse on the left is favorable for men, and a larger pulse on the right is favorable for women; men and women each have their respective dominions. One fen anterior to Guan reflects the injection of the twelve meridians. The left position corresponds to Renying (Human Welcome), and the right position corresponds to Qikou (Qi Port). Shenheng (Divine Gate) indicates decision-making; located on both sides posterior to Guan. If there are no pulses here, death occurs and the disease cannot be cured. Men and women share similar pulses, except for the Chi position.
There are seven diagnostic methods: Floating (Fu), Middle (Zhong), and Sinking (Chen) techniques, along with searching through Upper, Lower, Left, and Right positions. There are also nine inspections (Jiu Hou), using lifting (Ju) and pressing (An) with varying degrees of pressure. At the three positions (Cun, Guan, Chi) in floating and sinking levels, observe five movements at each. Cun inspects above the diaphragm; Guan inspects below the diaphragm; Chi inspects from the umbilicus down to the heels and ankles. The left pulse inspects the left side of the body, and the right pulse inspects the right side. Disease follows the location; where there is no disease, there is no abnormality.
Floating pulse governs Xin and Fei; Sinking pulse governs Shen and Gan. Pi and Wei occupy the central region, appearing between floating and sinking, specifically governing Middle Qi. The pulse should be harmonious and relaxed. Mingmen Yuan Yang (Primal Yang of the Gate of Life) is diagnosed together with the Right Chi. Spring pulses are Wiry (Xian), Summer pulses are Surging (Hong), Autumn pulses are Hairy/Floaty (Mao), and Winter pulses are Stone/Deep (Shi). Harmonious pulses in the four seasons are called Ping Mai (Normal Pulse). Excessive strength indicates external disease; deficiency and weakness indicate internal disease. For hundred diseases across four seasons, Stomach Qi is the root. The pulse must possess Shen (Spirit); this must not be overlooked.
[Commentary by Xiu]: This section summarizes the essence of meridian theory and diagnostic methods from the *Neijing* (Inner Canon) and *Nanjing* (Classic of Difficult Issues). Every sentence is a famous saying, every word is gold and jade. Students should memorize it thoroughly.
[Commentary by Rongzhai]: The opening four characters "Mai wei xue fu" (Pulse is the mansion of blood) are original text from the *Neijing*. This helps explain why pulses beat and why beats differ; all stem from blood circulation and the heart's contraction and expansion, which is what is meant by blood circulation. Regarding the slowness or speed of the pulse, it relates to the speed of blood flow; the softness or hardness relates to the relaxation or tension of the heart; the pauses relate to the opening and closing of heart valves. However, there is a prerequisite question: why can blood flow? Why can the heart contract and expand? My understanding is that it mainly depends on "Qi"; Qi and Blood cannot be separated, hence the following text says: "Qi like a bellows, Blood like waves." This also helps clarify that "Qi" and "Blood" are the main driving forces of the pulse. Regarding the discussion of "Seven Diagnoses" and "Nine Inspections": I believe only the Floating and Sinking diagnoses among the "Seven Diagnoses" are reliable; the Middle, Upper, Lower, Left, and Right diagnoses lack a solid basis. As for the Nine Inspections, they are also difficult to confirm; because blood vessels cannot be divided into three layers, and blood volume in the vessel often exceeds the vessel's capacity, light and heavy pressing may detect pulse deficiency or excess, but middle pressing has no standard to rely on.
Regulation comes from Qi. Respiration determines the rate. Four to five beats per respiration is the standard of peace. Three beats constitute Chi (Slow) pulse, indicating Cold. Six beats constitute Shu (Rapid) pulse, indicating Heat. Slower means colder; faster means hotter. Once Slow and Rapid are clear, distinguish Floating and Sinking. Floating, Sinking, Slow, and Rapid differentiate External and Internal causes. External causes come from Heaven; Internal causes come from Humans. Heaven has Yin and Yang, wind, rain, darkness, and gloom; Humans have joy, anger, worry, thought, sorrow, fear, and fright. External Floating leads to Exterior Syndromes. Sinking, Interior, Slow, and Yin; Rapid indicates Yang Excess. Internal Floating is caused by Deficient Wind; Sinking Qi is Slow and Cold; Rapid Heat is beyond doubt. Floating-Rapid indicates Exterior Heat; Sinking-Rapid indicates Interior Heat; Floating-Slow indicates Exterior Deficiency; Sinking-Slow indicates Cold Accumulation. Differentiate Exterior/Interior, Yin/Yang, Wind/Cold, Heat/Cold to identify External/Internal causes. Correlate pulse and symptoms. Pulse theory is vast, summarized in four basics. Having the outline, extend by analogy.
Floating pulse follows Heaven; obtainable with light touch, floating above, like wood drifting on water. Forceful indicates Hong (Surging) pulse: large, vigorous onset, leisurely decline. Weak indicates Xu (Deficient) pulse: large, slow, and soft. Extreme deficiency leads to San (Scattered) pulse: dissipated and unrestrained. Edges present but center empty is named Kou (Hollow) pulse. Small and floating is Ru (Soft) pulse, lying softly on the water surface. Extreme softness leads to Wei (Minute) pulse, resisting palpation.
Sinking pulse follows Earth; near tendons and bones, deep within. Extreme sinking is Fu (Hidden) pulse. Forceful is Lao (Tight/Firm) pulse: solid, large, wiry, and long. Extreme firmness is Shi (Excess) pulse: strong and rigid. Weak is Ruo (Weak) pulse: soft and small like cotton. Extreme weakness is Xi (Fine) pulse, like a spider's thread.
Chi (Slow) pulse belongs to Yin, three beats per respiration. Smaller than Chi is Huan (Moderate) pulse, less than four beats. Three damages lead to failure; disease is incurable. Two respirations losing essence means the pulse has lost Qi. Floating, large, deficient, scattered, or showing Kou/Gem pulses. Floating, small, Ru, Wei; Sinking, small, Xi, Ruo. Slow and fine is Se (Choppy) pulse, extremely difficult to move. Cu (Crisis) pulse is rapid, stopping once then returning. Jie (Knotted) pulse is slow, stopping then returning. Dai (Intermittent) pulse is slow, stopping without returning.
Shu (Rapid) pulse belongs to Yang, six beats per respiration. Seven beats is Ji (Fast) pulse; eight beats is Ji (Extreme) pulse; nine beats is Tuo (Depletion) pulse. Floating and large is Hong (Surging) pulse. Sinking, large, Lao, Shi. Smooth and fluent movement is Hua (Slippery) pulse. Forceful is Jin (Tight) pulse, snapping like a turning rope. Rapid at Cun with stops is Cu pulse. Rapid at Guan, Dong (Moving) pulse can be observed, quivering and shaking, like a small bean. Chang (Long) pulse indicates Qi regulation, extending beyond its position. Long and straight, Xian (Wiry) pulse responds to the finger. Duan (Short) pulse indicates Qi disease, failing to fill the position, not seen at Guan, only at Cun and Chi.
[Commentary by Xiu]: This section summarizes the essence of common pulse images.
[Commentary by Liankan]: The late scholar Wang Yanchang said: In clinical practice, first ask for the cause of illness, as the cause is the origin of the disease. After clarifying the cause, then palpate the pulse and ask about symptoms. Observe the strength of the physique and the dryness/luster of the complexion. Listen to the loudness/softness of the voice and the slowness/speed of breathing. Thus, based on the cause, combine the four methods of Observation, Auscultation/Olfaction, Inquiry, and Palpation. Even if a pulse appears identical or contrary, or hidden, the condition is understood through the four methods. Doubts under the fingers will resolve themselves. Otherwise, there are only twenty to thirty pulse images, but diseases change infinitely. One pulse does not belong to only one disease or symptom, nor does one disease or symptom appear in only one pulse. Therefore, basing diagnosis on visible symptoms first is most reliable. The nine orifices are the gates of the Zang-Fu organs. First, correlate symptoms seen in the nine orifices with the pulse. Symptoms from chest to head manifest at Cun; symptoms above the umbilicus, hands, and hypochondrium manifest at Guan; symptoms in the lower abdomen, legs, and bowels/bladder manifest at Chi. This is the general principle. In short, diagnosing all pulses must combine the four methods to treat, avoiding rash actions. To claim that observation, auscultation, and inquiry are unnecessary, and that a single pulse diagnosis can reveal all symptoms, hidden pathologies, origins, and changes, is merely the deceptive talk of charlatans.
Furthermore: When facing a syndrome, all six pulses move. First determine which part of the pulse is healthy, then compare them one by one to know which meridian is diseased. For example, when diagnosing exterior contracted seasonal diseases, use Floating/Sinking to distinguish Cun, Guan, and Chi. Initially, infection affects meridians, disease is in the Exterior; mild cases show strong Floating at Cun, severe cases show strong Floating at Guan and Chi. When it transmits to the Interior generating heat, the Sinking position becomes strong. Disease in the Upper manifests at Cun; disease in the Middle at Guan; disease in the Lower at Chi. When diagnosing interior injury miscellaneous diseases, use Cun, Guan, Chi to distinguish Floating/Sinking. Initially, disease divides by Zang-Fu, with pulses appearing in their respective positions. Disease in Fu organs shows Floating in that position; disease in Zang organs shows Sinking in that position. Over time, Fu disease may affect Zang, Zang disease may damage Fu, or multiple meridians may be involved simultaneously. Inspect Floating/Sinking by position. For multiple meridian involvement, treat the critical aspect as primary. Correlate current symptoms and colors with the cause of illness against the diagnosed pulse image, aiming for unity. Then grasp the core to treat. Remaining related issues and old diseases may be treated concurrently or slowly. Must ask about the baseline pulse so that the diagnostic pulse is accurate. In short, the function of the pulse is merely to estimate the strength of Heart power and the abundance/decline of Lung Qi, to determine the Exterior/Interior, Yin/Yang, Cold/Heat, and Deficiency/Excess of the disease. Only after obtaining the true nature of the disease through Observation, Auscultation, and Inquiry should it be cross-checked with the pulse.
Each pulse shape has its governing disease. Combined pulses show various symptoms. Floating pulse governs Exterior, implying Interior insufficiency. Forceful indicates Wind-Heat; weak indicates Blood deficiency. Floating-Slow indicates Wind-Deficiency; Floating-Rapid indicates Wind-Heat; Floating-Tight indicates Wind-Cold; Floating-Relaxed indicates Wind-Damp; Floating-Deficient indicates Summerheat Injury; Floating-Hollow indicates Blood Loss; Floating-Surging indicates Deficient Fire; Floating-Minute indicates Extreme Fatigue; Floating-Fine indicates Yin Deficiency; Floating-Scattered indicates Severe Deficiency; Floating-Wiry indicates Phlegm-Food retention; Floating-Slippery indicates Phlegm-Heat.
Sinking pulse governs Interior, Cold, and Accumulation. Forceful indicates Phlegm-Food; weak indicates Qi Stagnation. Sinking-Slow indicates Deficient Cold; Sinking-Rapid indicates Hidden Heat; Sinking-Tight indicates Cold Pain; Sinking-Relaxed indicates Water Retention; Sinking-Firm indicates Stubborn Cold; Sinking-Excess indicates Extreme Heat; Sinking-Weak indicates Yin Deficiency; Sinking-Fine indicates Bi-Dampness; Sinking-Wiry indicates Fluid-Pain; Sinking-Slippery indicates Retained Food; Sinking-Hidden indicates Vomiting/Diarrhea; Yin Poison Accumulation.
Slow pulse governs Zang, with Yang Qi latent. Forceful indicates Pain; weak indicates Deficient Cold.
Rapid pulse governs Fu, vomiting, and mania. Forceful indicates Heat; weak indicates Sores.
Slippery pulse governs Phlegm or Food injury. Downward indicates Blood Stasis; upward indicates Vomiting/Reflux.
Choppy pulse indicates Little Blood or Cold-Damp invasion. Reflux, colon constipation, spontaneous sweating, cold limbs.
Wiry pulse governs Fluid retention, disease belonging to Gallbladder and Liver. Wiry-Rapid indicates much Heat; Wiry-Slow indicates much Cold. Floating-Wiry indicates Branch Fluid; Sinking-Wiry indicates Suspended Pain. Yang-Wiry indicates Headache; Yin-Wiry indicates Abdominal Pain.
Tight pulse governs Cold and various pains. Floating-Tight indicates Exterior Cold; Sinking-Tight indicates Interior Pain.
Long pulse indicates Qi peace; Short pulse indicates Qi disease. Fine indicates Little Blood; Large indicates Disease progression. Floating-Long indicates Wind Epilepsy; Sinking-Short indicates Retained Food. Blood Deficiency shows Deficient pulse; Qi Excess shows Excess pulse.
Surging pulse indicates Heat, with Yin deficiency. Fine pulse indicates Dampness, with Blood deficiency. Relaxed-Large indicates Wind; Relaxed-Fine indicates Dampness. Relaxed-Choppy indicates Little Blood; Relaxed-Slippery indicates Internal Heat. Soft-Small indicates Yin Deficiency; Weak-Small indicates Yang Depletion. Yang Depletion causes aversion to cold; Yin Deficiency causes fever. Yang Micro indicates aversion to cold; Yin Micro indicates fever. Male Micro indicates Deficiency damage; Female Micro indicates bleeding diarrhea. Yang Movement causes sweating; Yin Movement causes fever, pain, and fright, metrorrhagia, and blood loss. Deficient Cold combining is named Ge (Leather) pulse. Male spermatorrhea, female blood loss. Yang Excess leads to Cu (Crisis) pulse, Lung Abscess, Yang Poison. Yin Excess leads to Jie (Knotted) pulse, hernia, masses, stagnation. Dai (Intermittent) indicates Qi decline, or pus/blood discharge. Shaoyang palpitations, female fetus three months.
[Commentary by Xiu]: This is the general principle of diseases governed by each pulse.
Pulses governing diseases have suitability and unsuitability. Yin/Yang順逆 (favorable/unfavorable) allow deduction of auspiciousness and inauspiciousness. Stroke shows Floating-Relaxed; Tight-Excess is taboo. Floating-Slippery indicates Phlegm strike; Sinking-Slow indicates Qi strike. Corpse fainting shows Sinking-Slippery, sudden unconsciousness. Entering Zang causes cold body; entering Fu causes warm body. Wind injuring Wei shows Floating-Relaxed with sweat. Cold injuring Ying shows Floating-Tight without sweat. Summerheat injuring Qi shows Deficient pulse with body heat. Damp injuring Blood shows Relaxed-Fine-Choppy pulse. Shaoyang/Heat diseases favor Floating-Surging pulses. Sinking-Micro-Choppy-Small pulses with contrary symptoms are definitely ominous. After sweating, quiet pulse and cool body indicate safety. After sweating, restless pulse and severe heat indicate difficulty. Yang disease showing Yin pulse indicates critical danger. Yin disease showing Yang pulse, though difficult, is harmless. Pulse not reaching Guan indicates Yin Qi exhaustion. Pulse not reaching Guan from below indicates Yang Qi exhaustion. Intermittent pulse stopping indicates Zang failure and critical danger. Scattered pulse without root indicates physical damage and difficult cure. Dietary internal injury shows urgent-slippery Qi Kou pulse. Labor/fatigue internal injury shows large-weak Right pulse. To know this Qi, press deeply; pulse sinks. Extreme sinking is Hidden; Choppy-Weak indicates deep duration. Six Stagnations mostly show Sinking pulse. Slippery indicates Phlegm; Tight indicates Food. Qi Choppy, Blood Hollow. Rapid indicates Fire; Fine indicates Damp. Slippery governs much Phlegm; Wiry governs retained fluid. Heat shows Slippery-Rapid; Cold shows Wiry-Tight. Floating-Slippery combines Wind; Sinking-Slippery combines Qi. Food injury shows Short-Rapid; Damp retention shows Soft-Fine. Malaria pulse is naturally Wiry. Wiry-Rapid indicates Heat; Wiry-Slow indicates Cold. Intermittent-Scattered indicates fracture/death. Diarrhea/dysentery shows Sinking-Small-Slippery-Weak. Solid-Large-Floating-Surging indicates fever厌恶 (aversion). Vomiting/reflux shows Prosperous Floating-Slippery. Wiry-Rapid-Tight-Choppy indicates colon obstruction leading to death. Cholera presentation: do not be surprised by intermittent pulse. Cold limbs, slow-micro pulse is terrifying. Cough mostly shows Floating, gathering in Lung/Guan/Stomach. Sinking-Tight-Small is critical; Floating-Soft is easy to treat. Panting with shoulder elevation shows Smooth Floating as favorable. Sinking-Choppy with cold limbs, Scattered pulse indicates adverse syndrome. Fever with fire shows Surging-Rapid as curable. Sinking-Micro without fire, rootless pulse is critical. Bone-steaming fever shows Rapid-Deficient pulse. Heat with Choppy-Small indicates certain death. Extreme fatigue and all deficiencies show Floating-Soft-Weak pulse. Earth failure shows Double Wiry; Fire flare shows Urgent-Rapid. All blood loss diseases show Hollow pulse. Slow-Small is pleasing; Rapid-Large is worrying. Internal blood stasis favors Firm-Large pulse. Sinking-Small-Choppy-Micro becomes harmful. Spermatorrhea/cloudy urine shows Micro-Choppy-Weak. Fire Excess Yin Deficiency shows Hollow-Soft-Surging-Rapid. Sanxiao (Three Consumptions) pulse: Floating-Large indicates life; Small-Fine-Micro-Choppy with physical depletion is alarming. Dysuria with yellow nose tip shows Choppy-Small without blood; Rapid-Large is acceptable. Dry stool defecation requires distinguishing Qi/Blood. Yang shows Rapid-Excess; Yin shows Slow-Choppy. Dian (Manic depression) is Heavy Yin; Kuang (Mania) is Heavy Yang. Floating-Surging is auspicious; Sinking-Urgent is inauspicious. Pain pulse should be Deficient; Tight-Excess is bad. Floating is Yang, Sinking is Yin. Slippery is Phlegm, Rapid is Heat. Throat bi pulse: Rapid-Heat, Slow-Cold. Wrapping throat/marching horse shows Micro-Hidden, difficult to treat. Various wind vertigo/dizziness: with fire or phlegm. Left Choppy indicates dead blood; Right Large indicates Deficiency view. Headache mostly Wiry; Floating-Wind, Tight-Cold. Heat-Surging, Damp-Fine, Relaxed-Slippery indicates Jue-Phlegm. Qi Deficiency shows Wiry-Soft; Blood Deficiency shows Micro-Choppy. Kidney Jue shows Wiry-Firm; True pain shows Short-Choppy. Heart/Abdominal pain has nine types. Fine-Slow follows auspiciousness; Floating-Large prolongs duration. Hernia Qi shows Wiry-Urgent, accumulation inside. Firm-Urgent indicates life; Weak-Urgent indicates death. Low back pain pulse mostly Sinking-Wiry. Combining Floating indicates Wind; combining Tight indicates Cold. Wiry-Slippery indicates Phlegm-Fluid; Soft-Fine indicates Kidney Dampness. Large indicates Kidney Deficiency; Sinking-Solid indicates sprain/injury. Foot gout has four types: Slow-Cold, Rapid-Heat. Floating-Slippery indicates Wind; Soft-Fine indicates Dampness. Atrophy disease Lung Deficiency shows mostly Micro-Relaxed pulse. Or Choppy, or Tight, or Fine, or Soft. Wind-Cold-Dampness combine to form Bi. Floating-Choppy-Tight completes the three pulses. Five Jaundices show Excess-Heat, pulse must be Surging-Rapid. Choppy-Micro indicates Deficiency, strictly avoid thirst. Pulses showing all Sinking blame Water. Floating indicates Qi and Wind; Sinking-Stone indicates Interior. Sinking-Rapid is Yang; Sinking-Slow is Yin. Floating-Large exits disaster; Small-Deficient is alarming. Distension shows Wiry pulse, Spleen受肝克 (controlled by Liver). Damp-Heat shows Rapid-Surging; Yin-Cold shows Slow-Weak. Floating indicates Deficient fullness; Tight indicates Solid middle. Floating-Large is treatable; Small-Deficient is critically dangerous. Five Zang form Ji (Accumulation); Six Fu form Ju (Gathering). Solid-Excess indicates life; Sinking-Fine indicates death. Zhong'e (Evil attack) abdominal distension shows Tight-Fine indicating life. Pulse Floating-Large indicates deep evil qi. Carbuncles/ulcers show Floating-Rapid, aversion to cold and fever. If painful, it is the site of carbuncle/ulcer. Rapid pulse with fever indicates injury if painful. Not rapid, not hot, not painful indicates Yin sore. Unruptured carbuncle/ulcer fears not Surging-Large. Ruptured carbuncle/ulcer fears Surging-Large. Lung abscess formed shows Cun-Rapid-Excess. Lung萎 (Flaccidity) shape shows Rapid-Weak. Lung abscess color white, pulse should be Short-Choppy, not Floating-Large. Spitting paste/vomiting blood. Intestinal abscess shows Excess-Heat, known by Slippery-Rapid. Rapid without heat, Guan pulse Hollow-Deficient. Micro-Choppy-Tight: if no pus, purge; if Tight-Rapid, pus formed, absolutely do not purge.
[Commentary by Xiu]: This is the general principle of pulse-symptom suitability and taboos.
[Commentary by Liankan]: Old friend Zhao Qingchu said: Disease corresponding to its pulse is Favorable (Shun); disease not corresponding to its pulse is Unfavorable (Ni). This is my secret for pulse diagnosis and syndrome differentiation after thirty years of experience.
Women's pulses are based on Blood. Abundant Blood makes conception easy; Abundant Qi makes conception difficult. Strong movement at Shaoyin indicates pregnancy. Slippery-and-smooth Chi pulse indicates pleasant pregnancy. Slippery-rapid without scattering indicates three-month fetus. Only rapid without scattering distinguishes five-month fetus. Left rapid indicates male; Right rapid indicates female. Female abdomen like a basket; male abdomen like a pot. Guan may be Slippery-Large; Dai/Cu (intermittent/crisis) is permissible. Cyan tongue and Hidden pulse indicate fetal injury. Slippery-Chi with Rapid indicates excessive fetal Qi. Sinking-Slow-Choppy indicates risk of fetal stiffening. After six/seventh months, pulse favors Solid-Long. Eighth month Wiry-Solid; Sinking-Fine is inauspicious. Shenheng slightly tight indicates risk of fetal injury. Great labor/fright/fall makes fetal blood hard to contain. Sinking-Fine-Short-Choppy ultimately brings many disasters. Full-term chaotic pulse is actually an auspicious sign. Delivery approaching: six beats, pulse called Li Jing (Departing from Channel). Sinking-Fine-Urgent-Rapid indicates fetus is descending. Floating-Large indicates difficult delivery. Urgently check color signs. Face/tongue/lip colors: avoid Black and Cyan. Red face/Cyan tongue: child dies, mother lives. Cyan face/Red tongue: mother dies, child lives. Face and tongue both cyan, mouth spits hot foul odor: if fetus in abdomen, both mother and child perish. Postpartum pulse: Slow-Slippery is auspicious. Solid-Large-Wiry-Firm, all diseases are adverse. Sinking-Fine-Weak matches postpartum state. Choppy-Rapid blood flooding indicates Blood loss and Yin depletion.
[Commentary by Liankan]: Ancients discussing pregnancy mostly focused on Chi pulse. All considered Left Rapid/Left Large as male, Right Rapid/Right Large as female. Only Zhang Shiweng stated Cun Kou Slippery-Solid as male, Chi Slippery-Solid as female. Both Cun Slippery-Solid as twin males; both Chi Slippery-Solid as twin females. Right Chi and Left Cun both Slippery-Solid as one male one female. Confident in verified accuracy. In my experience, it is not entirely so. Only Sun Simiao's *Qianjin Fang* states: Nodule on left breast is male; nodule on right breast is female. Famous doctor Mr. Zhou Ba said: Left breast swelling is male; right breast swelling is female. Verified often accurately. Also, the end of the middle finger is called Chongliang point. In women with abundant blood, this point pulses during pregnancy, also experienced. Others: Chi pulse Choppy-Micro indicates definite menstrual delay. Chi Large and Vigorous indicates pregnancy celebration. Slippery-Rapid and Dai also indicates pregnancy. Approaching delivery, pulse must depart from channel. Postpartum blood flooding, Chi does not reach Guan, blood is exhausted, major life is collapsing. These are key secrets of specialized gynecology. However, distinguishing fetus by pulse is less reliable than using a hearing tube to press the abdomen and listen to the infant's sound.
Children's pulse: Seven beats is normal. Further observe color and symptoms, and Tiger Mouth Veins.
[Commentary by Liankan]: Menghe Ma Liangbo's pulse rhyme says: Children's pulse should determine beats per respiration. Two beats is disaster, three beats is sudden death. Five beats is Deficiency, four beats is damaged/frail. Six beats is peaceful, ninety beats is severe. Floating-Relaxed indicates Wind Injury; Floating-Surging indicates Wind-Heat; Floating-Tight indicates Cold Damage; Sinking-Fine indicates Milk Accumulation; Sinking-Tight indicates Abdominal Pain; Wiry-Tight indicates Wheezing; Tight-Urgent indicates Chickenpox/Rash; Urgent-Wiry indicates Acute Convulsion; Weak-Soft indicates Slow Convulsion. Malaria/Dysentery shows Wiry-Urgent; Wiry-Fine indicates Worms. Constipation shows Rapid-Solid. This is the key to pulse patterns for four-to-six-year-old children. For several months to two-to-three years, always rely on abdominal diagnosis, inquiry, observing color, and looking at mucous membranes/orifices as reliable. Regarding Tiger Mouth Vein (hand collaterals) observation, originating from Hua Bolin. Rhyme says: Below three years old, look at three passes in Tiger Mouth. Purple-Heat, Red-Cold Damage, Green-Fright, White-Gan (Malnutrition). Pale Red/Pale Yellow indicates no disease. Also, vein appearing in lower segment Feng Pass is mild; appearing in middle segment Qi Pass is serious; appearing in upper segment Ming Pass is critical. If Purple-Black penetrates all three passes directly, it is critically critical. This is the key secret. Tested repeatedly with verification, the theory is also based on the *Neijing*. *Lingshu* says: Generally diagnosing collateral vessels,青色 (cyan color) indicates Cold and Pain; Red indicates Heat. Cold in Stomach, many cyan veins on hand Yu area. Heat in Stomach, red veins at Yuji. Sudden black indicates long-standing Bi. Those who have...