脉浮而滑浮为阳滑为实阳实相搏其脉数疾卫气失度浮滑之脉数疾发热汗出者此为不治
脉浮而滑浮为阳滑为实阳与实合脉必数疾卫气失度浮滑之脉加以数疾再复发热汗出者阴阳消亡此为不治难经脉一呼
三至曰离经四至曰夺精五至曰死六至曰命绝正此浮滑数疾之脉也
脉理精微发于上编而其名义之纷赜形象之迁化诊候之机缄望切之窍妙所未详悉者设为问答发于此篇澄心渺虑传兹奥
旨诚崆峒访道之仙梯赤水求珠之秘渡也后世医理无传半缘脉法不解仲景脉法家藏而户收白首不解则终身不灵是胼拇支指
之呼吸不应也岂仲景传脉之心哉
营卫之消息是不一端脏腑之乘除是不一致支派分别不可纪极而溯本穷源不过阴阳二者而已诊阴阳之异同判死生之悬
殊生之与死孰美孰恶阴之与阳孰贵孰贱解此章之义则以下诸章决生断死之方起死回生之法悉具于此矣
问曰脉有阴阳何谓也答曰凡脉大浮数动滑此名阳也脉沉涩弱弦微此名阴也凡阴病见阳脉者生阳病见阴脉者死
阳道实阴道虚大浮数动滑者此名阳也沉涩弱弦微者此名阴也阳主生阴主死阴病见阳脉者阴盛而阳气之来复也阳病见
阴脉者阳浮而阴气之内盛也阳复者生阴盛者死阳贵阴贱训垂先圣至妇人女子皆知人之为阳鬼之为阴独至后世医家反经乱
道贵阴贱阳庸妄接踵以误天下宋元以来千年之久遂无一人稍解此理者何下愚之多而上智之少耶
脉象浮而滑。浮脉主阳，滑脉主实，阳气与实邪相互搏结，导致脉象数且急疾，卫气失去正常的节度。若出现浮滑的脉象，兼见数疾之象，并伴有发热、汗出的症状，这属于难以治愈的证候。
脉象浮而滑。浮为阳，滑为实，阳气与实邪相合，脉象必然表现为数且急疾，卫气失去常度。在浮滑脉的基础上，再出现数疾之象，同时伴有发热和汗出，这是阴阳之气即将消亡的表现，属于难治甚至不治之症。《难经》指出：一呼三至的脉象称为“离经”，四至称为“夺精”，五至称为“死”，六至称为“命绝”。这正是对浮滑数疾这种危重脉象的描述。
脉理精深微妙，在上编中已有阐述，但对于其名称含义的纷繁复杂、形态形象的千变万化，以及诊察候脉的关键机制、望诊切诊的奥妙之处，尚未详尽说明。因此在此篇中设立问答形式，以澄清深奥的宗旨。这需要澄澈心神、渺远思虑，将其作为崆峒山访道求仙的阶梯，以及赤水边寻求宝珠的秘密渡船。后世医理未能传承，一半是因为不理解脉法。张仲景的脉法被各家珍藏、户户收藏，但如果直到白头仍不能理解，则终身医术不灵，就像拇指旁生的赘肉或手指间的多余部分一样，呼吸之间都不应验（指无法灵活应用）。这难道符合张仲景传授脉法的本心吗？
营气和卫气的消长变化不止一端，脏腑之间的生克乘除也不止一种规律，分支派别繁多不可穷尽，但追溯本源，不过就是阴阳两个方面罢了。诊察阴阳的异同，可以判断生死的天壤之别。生与死哪个美好哪个恶劣？阴与阳哪个尊贵哪个低贱？理解了这一章的含义，那么以下各章中决断生死的方法、起死回生的方术，都包含在这里了。
问：脉象有阴脉和阳脉之分，这是什么意思呢？
答：凡是脉象大、浮、数、动、滑的，都称为阳脉；凡是脉象沉、涩、弱、弦、微的，都称为阴脉。凡是阴病见到阳脉的，预后良好（生）；阳病见到阴脉的，预后不良（死）。阳道多实，阴道多虚。大、浮、数、动、滑这些脉象称为阳脉；沉、涩、弱、弦、微这些脉象称为阴脉。阳主生发，阴主肃杀（死）。阴病见到阳脉，说明阴寒盛极而阳气来复；阳病见到阴脉，说明阳气外浮而阴寒内盛。阳气来复则生，阴寒内盛则死。阳贵阴贱的道理，是先圣留下的训诫，连妇女女子都知道人属阳、鬼属阴。唯独到了后世，医家反而违背经典、扰乱正道，贵阴贱阳，庸俗狂妄者接踵而至，从而误导天下人。自宋元以来，千年之久，竟然没有一个人能稍微理解这个道理，为什么下愚之人那么多而上智之人那么少呢？
The pulse is floating and slippery. Floating indicates Yang, and slippery indicates Excess. When Yang and Excess contend with each other, the pulse becomes rapid and hurried, causing the Wei Qi (Defensive Qi) to lose its normal regulation. If a floating and slippery pulse is accompanied by rapidity and hurrying, along with fever and sweating, this constitutes an intractable condition that is difficult to treat.
The pulse is floating and slippery. Floating represents Yang, and slippery represents Excess. When Yang combines with Excess, the pulse must become rapid and hurried, causing the Wei Qi (Defensive Qi) to deviate from its norm. If the floating and slippery pulse is further complicated by rapidity and hurrying, and if fever and sweating recur, this signifies the exhaustion of both Yin and Yang, making it a difficult or untreatable case. The *Nan Jing* (Classic of Difficult Issues) states: A pulse rate of three beats per breath is called "Li Jing" (Departing from the Normal); four beats is "Duo Jing" (Depletion of Essence); five beats is "Si" (Death); six beats is "Ming Jue" (Extinction of Life). This precisely describes the critical nature of the floating, slippery, rapid, and hurried pulse.
Pulse theory is profound and subtle, having been discussed in the earlier chapters. However, regarding the complexity of its nomenclature, the variability of its manifestations, the mechanisms of diagnosis, and the subtleties of observation and palpation, which were not fully detailed, questions and answers are set forth in this chapter to clarify these profound principles. It requires clearing the mind and focusing one's thoughts, serving as a ladder for seeking the Dao on Mount Kongtong and a secret ferry for seeking pearls by the Chi River. In later generations, medical theories have not been transmitted, partly because pulse methods were not understood. Zhang Zhongjing’s pulse methods were treasured by families and collected by households; yet, if one remains ignorant until old age, their lifelong medical practice will be ineffective, akin to superfluous fingers or toes that do not respond to breathing. Does this align with Zhang Zhongjing’s intention in transmitting pulse methodology?
The waxing and waning of Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) manifest in various ways, and the interactions among Zang-Fu organs follow diverse patterns. While branches and distinctions are countless, tracing them to their source reveals only two aspects: Yin and Yang. By diagnosing the similarities and differences between Yin and Yang, one can judge the vast difference between life and death. Which is preferable, life or death? Which is more noble, Yin or Yang? Understanding the meaning of this chapter encompasses all subsequent chapters’ methods for determining life and death, and techniques for reviving the seemingly dead.
Question: What is meant by Yin and Yang pulses?
Answer: Pulses that are large, floating, rapid, moving, and slippery are named Yang pulses. Pulses that are deep, choppy, weak, string-taut, and minute are named Yin pulses. In Yin diseases, the appearance of Yang pulses indicates survival; in Yang diseases, the appearance of Yin pulses indicates death. The Path of Yang tends toward Excess, while the Path of Yin tends toward Deficiency. Large, floating, rapid, moving, and slippery pulses are Yang; deep, choppy, weak, string-taut, and minute pulses are Yin. Yang governs life/generation, while Yin governs death/termination. In Yin disease, seeing Yang pulses indicates that Yang Qi is returning to counteract severe Yin Cold. In Yang disease, seeing Yin pulses indicates that Yang is floating outward while Yin Cold is surging inward. The return of Yang leads to life; the dominance of Yin leads to death. The principle that Yang is noble and Yin is base was handed down by the Sages; even women and children know that humans belong to Yang and ghosts belong to Yin. Yet, in later generations, physicians have reversed the classics and confused the Way, valuing Yin over Yang. Vulgar and absurd practitioners have followed one after another, misleading the world. Since the Song and Yuan dynasties, spanning a millennium, not a single person has slightly understood this principle. Why are there so many of the profoundly ignorant and so few of the wise?