脉浮而大心下反硬有热属脏者攻之不令发汗属腑者不令溲数溲数则大便硬汗多则热愈汗少则便难脉迟尚未可攻
脉浮而大是太阳阳明之脉也若心下反硬则有阳明之腑邪也盖少阳之经自胃口而行两胁少阳经气侵逼阳明之腑腑气壅
遏逆而上行碍少阳下行之路经腑郁迫结于胸胁故心下痞硬若腑热伤及脏阴则攻之不令发汗若但是腑热则攻不必急而不令
其溲数溲数则其津液亡而大便硬汗多则营消而热愈增汗少则腑热郁而大便难是以不令汗尿而用攻下第攻亦有时脏宜急攻
（阳明少阴急下三证以缓攻之则腑热伤及脏阴不可救矣）腑宜缓攻而一见脉迟则内热未实尚未可攻也（此明料度脏腑之
义）
师曰脉肥人责浮瘦人责沉肥人当沉今反浮瘦人当浮今反沉故责之
肥人肌肉丰浓故脉气沉深瘦人肌肉减薄故脉气浮浅沉者浮而浮者沉是谓反常反常则病故责之
趺阳脉紧而浮浮为气紧为寒浮为腹满紧为绞痛浮紧相搏肠鸣而转转即气动膈气乃下少阴脉不出其阴肿大而虚也
趺阳足阳明脉动冲阳气冲人迎大迎冲阳在足趺上故谓之趺阳趺阳脉紧而浮浮为气逆紧为气寒以土位居中在于浮沉之
间气不应浮浮则为胃气之逆土性和缓脉不应紧紧则为胃气之寒胃主降浊胃逆脉浮则胃气壅塞浊气不降是以腹满胃主受盛
胃寒脉紧则胃气逼窄木邪迫侵故为绞痛浮紧相合肠鸣而转转则气滞行动膈间痞塞之气乃下及其寒邪冲突后注魄门而为泄
利则满痛稍减顷而寒凝气滞痛满又作此因于肾阳之虚也若少阴脉出则肾阳续复少阴脉不出则肾阳澌灭其阴器必肿大而虚
也缘水寒木郁陷而不升故阴器肿大（肝主筋前筋者诸筋之宗也足少阴脉动太溪阴谷太溪在内踝后阴谷在膝后 中内侧）
脉象浮而大，胃脘部反而坚硬，体内有热。若病邪归属于脏，应当采用攻下法，不可令其发汗；若病邪归属于腑，不可令其小便频数。小便频数则津液耗伤导致大便干硬；汗出过多则热势更盛；汗出少则排便困难。脉象迟，说明正气不足或寒邪内盛，此时尚不可使用攻下法。
脉浮而大，是太阳经和阳明经的脉象。如果胃脘部反而坚硬，说明有阳明腑实的邪气。这是因为少阳经脉从胃口经过两胁，少阳经气侵逼阳明之腑，导致腑气壅滞遏阻，逆而上行，阻碍了少阳气机下行的道路。经气与腑气郁结逼迫，结聚于胸胁部位，所以出现心下痞塞坚硬的症状。如果腑热损伤了脏阴，就应当攻下，但不可发汗；如果只是单纯的腑热，攻下不必急切，且不可令其小便频数。小便频数则津液亡失而大便干硬；汗多则营血消减而热势更加增加；汗少则腑热郁结而大便困难。因此，不令发汗和小便频数，而采用攻下法。但是攻下也有时机：脏病适宜急攻（阳明少阴急下三证，若用缓攻，则腑热伤及脏阴，不可救治）；腑病适宜缓攻。一旦见到脉迟，说明内热尚未结实，此时尚不可攻下。（这是阐明判断脏腑病证的义理）
老师说：对于肥胖的人，诊脉时以沉脉为常，若见浮脉则责其异常；对于消瘦的人，诊脉时以浮脉为常，若见沉脉则责其异常。肥胖的人肌肉丰厚，故脉气深沉；消瘦的人肌肉单薄，故脉气浮浅。沉脉反见浮象，浮脉反见沉象，这叫做反常。反常即为病态，所以要追究其病因。
趺阳脉紧而浮。浮主气逆，紧主寒邪。浮脉表现为腹部胀满，紧脉表现为绞痛。浮紧二脉相搏结，肠鸣辘辘转动，随即气机动膈，气机下行后，少阴脉不出，导致阴器肿大而虚软。
趺阳脉是足阳明胃经的动脉，包括冲阳、人迎、大迎等穴位，其中冲阳穴位于足背上方，所以称为趺阳脉。趺阳脉紧而浮，浮代表气逆，紧代表气寒。土性居中央，脉象应在浮沉之间，气不应浮，若浮则为胃气上逆；土性温和缓和，脉不应紧，若紧则为胃气受寒。胃主降浊，胃气上逆则脉浮，导致胃气壅塞，浊气不能下降，所以腹部胀满。胃主受纳腐熟水谷，胃寒则脉紧，导致胃气狭窄，木邪（肝气）迫侵，所以发生绞痛。浮紧相合，肠鸣转动，气机阻滞，膈间痞塞之气乃得下行。等到寒邪冲突，后注于魄门（肛门）而发生泄利，则胀满疼痛稍减。片刻之后，寒凝气滞，疼痛胀满又发作。这是由于肾阳虚衰所致。如果少阴脉复出，说明肾阳逐渐恢复；如果少阴脉不出，说明肾阳消亡，其阴器必然肿大而虚软。这是因为水寒木郁，气机陷而不升，所以导致阴器肿大。（足少阴肾经的动脉在太溪、阴谷，太溪在内踝后方，阴谷在膝后内侧）
The pulse is floating and large, the epigastrium is rigid, there is heat in the interior. If the pathogen belongs to the Zang organs, purgation should be used, and sweating should not be induced; if the pathogen belongs to the Fu organs, frequent urination should not be allowed. Frequent urination leads to fluid depletion and hard stool; excessive sweating increases the heat; insufficient sweating makes defecation difficult. A slow pulse indicates that purgation is not yet appropriate.
A floating and large pulse is characteristic of the Taiyang and Yangming channels. If the epigastrium is rigid, it indicates Yangming Fu-organ excess pathogens. This occurs because the Shaoyang channel runs from the stomach opening through the hypochondrium. When Shaoyang channel qi invades the Yangming Fu organs, it causes stagnation and obstruction of Fu organ qi, which rebels upward, blocking the downward pathway of Shaoyang qi. The stagnation and pressure of channel and Fu qi knot in the chest and hypochondrium, resulting in epigastric fullness and rigidity. If Fu heat injures Zang yin, purgation is indicated, but sweating must be avoided. If it is merely Fu heat, purgation need not be urgent, and frequent urination must be avoided. Frequent urination depletes fluids causing hard stool; excessive sweating consumes Ying blood and intensifies heat; scant sweating traps Fu heat making defecation difficult. Therefore, neither sweating nor frequent urination is permitted; instead, purgation is employed. However, the timing of purgation matters: Zang diseases require urgent purgation (the three urgent purgation indications for Yangming and Shaoyang; delayed purgation allows Fu heat to injure Zang yin irreparably), while Fu diseases are suited for gradual purgation. Upon observing a slow pulse, indicating that internal heat has not yet solidified, purgation is contraindicated. (This clarifies the principle of distinguishing Zang and Fu conditions.)
The Master said: In obese individuals, the pulse should be deep; if it is superficial, it is abnormal. In emaciated individuals, the pulse should be superficial; if it is deep, it is abnormal. Obese people have thick muscles, so their pulse qi is deep. Emaciated people have thin muscles, so their pulse qi is superficial. A deep pulse appearing superficial, or a superficial pulse appearing deep, is called contrary to normal. Contrary pulses indicate disease, hence they are investigated.
The Dubyang pulse is tight and floating. Floating indicates rebellious Qi; tight indicates Cold. Floating manifests as abdominal fullness; tight manifests as colicky pain. The combination of floating and tight causes intestinal borborygmus and rolling sensations, followed by Qi moving the diaphragm. After the Qi descends, if the Shaoyin pulse does not emerge, the genitalia become swollen and flaccid.
Dubyang refers to the arterial pulse of the Foot-Yangming Stomach channel, including Chongyang, Renying, and Daying points. Chongyang is located on the dorsum of the foot, hence the name Dubyang. A tight and floating Dubyang pulse indicates rebellious Qi (floating) and Cold Qi (tight). Earth resides in the center, and its pulse should lie between floating and deep; Qi should not float. Floating indicates Stomach Qi rebellion. Earth nature is gentle and moderate, so the pulse should not be tight. Tightness indicates Stomach Cold. The Stomach governs descending turbid Qi. Rebellious Stomach Qi causes floating pulse, leading to Stomach Qi stagnation and failure of turbid Qi to descend, resulting in abdominal fullness. The Stomach governs reception and decomposition. Stomach Cold causes tight pulse, narrowing Stomach Qi and allowing Wood pathogen invasion, resulting in colicky pain. The combination of floating and tight causes intestinal borborygmus and Qi stagnation. The obstructed Qi in the diaphragm then descends. When Cold pathogen conflicts and flows posteriorly to the Po Men (anus), causing diarrhea, the fullness and pain temporarily subside. Shortly after, Cold coagulation and Qi stagnation cause the pain and fullness to recur. This is due to Kidney Yang deficiency. If the Shaoyin pulse re-emerges, Kidney Yang recovers; if it does not emerge, Kidney Yang perishes, causing swelling and flaccidity of the genitalia. This is because Water Cold and Wood depression cause Qi to sink rather than ascend, leading to genital swelling. (The arterial pulses of the Foot-Shaoyin Kidney channel are Taixi and Yinggu; Taixi is behind the medial malleolus, Yinggu is behind the knee on the medial side.)