问曰濡弱何以反适十一头师曰五脏六腑相乘故令十一问曰何以知乘腑何以知乘脏师曰诸阳浮数为乘腑诸阴迟涩为乘
脏也
濡弱者脉之最虚何以反居十一种之先濡弱木象木居五行之先此以五脏六腑因其濡弱而相乘故令脉具十一之形像也如
濡弱而见弦是肝脏之乘也见微弦是胆腑之乘也心脉钩脾脉缓肺脉毛肾脉石仿此类推言脉得濡弱则五脏六腑皆来相乘故濡
弱之中兼具十一之象而濡弱常在十一之先也何以知乘我者为腑为脏凡诸阳脉浮数者为乘于腑诸阴脉迟涩者为乘于脏也
（阴阳以尺寸言）
问曰脉有相乘有纵有横有逆有顺何谓也师曰水行乘火金行乘木名曰纵火行乘水木行乘金名曰横水行乘金火行乘木名
曰逆金行乘水木行乘火名曰顺也
脉有脏腑相乘（上章）而相乘之中有纵有横有逆有顺水行乘火金行乘木是乘其所胜名曰纵火行乘水木行乘金是乘其
所不胜名曰横水行乘金火行乘木是子乘其母名曰逆金行乘水木行乘火是母乘其子名曰顺也
伤寒腹满谵语寸口脉浮而紧此肝乘脾也名曰纵刺期门
伤寒腹满谵语是脾病也寸口脉浮而紧见肝家之弦脉此肝木乘脾土也名曰纵当刺厥阴之期门以泄肝气脉浮而紧者名曰
弦也（脉法三十九）肝脉弦故知为肝乘
伤寒发热啬啬恶寒大渴欲饮水其腹必满自汗出小便利其病欲解此肝乘肺也名曰横刺期门
伤寒发热啬啬恶寒大渴欲饮水其腹必满是肺病也自汗出小便利见风木之疏泄此肝乘肺金也名曰横亦当刺厥阴之期门
以泄肝热肺统卫气而性收敛肝司营血而性疏泄发热恶寒大渴腹满是金气敛闭而木不能泄也汗出便利是木气发泄而金不能
收也营泄而卫宣故其病欲解
问：濡脉和弱脉为什么反而居于十一种脉象之首？
老师回答：因为五脏六腑之间相互乘袭，所以呈现出十一脉的形态。
问：如何知道是乘袭了腑？如何知道是乘袭了脏？
老师回答：凡是阳脉表现为浮数，就是乘袭了腑；凡是阴脉表现为迟涩，就是乘袭了脏。
濡脉和弱脉是最虚弱的脉象，为什么反而位居十一种脉象之前？濡弱属于木象，木在五行中居先。这是因为五脏六腑因濡弱之脉而相互乘袭，所以使脉象具备了十一脉的形象。例如，濡弱脉中见到弦脉，是肝脏的乘袭；见到微弦脉，是胆腑的乘袭。心脉钩、脾脉缓、肺脉毛、肾脉石，仿照此类推演。所以说，脉象出现濡弱，则五脏六腑都会来相乘，因此濡弱之中兼具十一脉的象，而濡弱常在十一脉之前。如何知道乘袭我的是腑还是脏？凡是阳脉浮数的，是乘袭于腑；凡是阴脉迟涩的，是乘袭于脏。（这里的阴阳是指寸口脉的尺寸部位而言）
问：脉象中有相乘，有纵、横、逆、顺，这是什么意思？
老师回答：水行乘火，金行乘木，称为“纵”；火行乘水，木行乘金，称为“横”；水行乘金，火行乘木，称为“逆”；金行乘水，木行乘火，称为“顺”。
脉象中有脏腑之间的相乘（见上一章），而在相乘之中又有纵、横、逆、顺的区别。水行乘火，金行乘木，这是乘袭其所胜（即我所克者），称为“纵”；火行乘水，木行乘金，这是乘袭其所不胜（即克我者），称为“横”；水行乘金，火行乘木，这是子乘其母，称为“逆”；金行乘水，木行乘火，这是母乘其子，称为“顺”。
伤寒病出现腹部胀满、说胡话，寸口脉浮而紧，这是肝乘脾，称为“纵”，针刺期门穴。
伤寒病出现腹部胀满、说胡话，这是脾病；寸口脉浮而紧，见到肝家的弦脉，这是肝木乘袭脾土，称为“纵”。应当针刺厥阴经的期门穴以疏泄肝气。脉浮而紧称为弦脉（见《脉法三十九》）。肝脉主弦，所以知道是肝气乘袭。
伤寒病发热、怕冷、极度口渴想喝水，腹部必然胀满，自汗出、小便通利，病情将要解除，这是肝乘肺，称为“横”，针刺期门穴。
伤寒病发热、怕冷、极度口渴想喝水、腹部必然胀满，这是肺病；自汗出、小便通利，见到风木之气的疏泄作用，这是肝乘袭肺金，称为“横”。也应当针刺厥阴经的期门穴以疏泄肝热。肺统摄卫气而性质收敛，肝主管营血而性质疏泄。发热、恶寒、大渴、腹满是金气敛闭而木气不能疏泄的表现；汗出、便利是木气发泄而金气不能收敛的表现。营血外泄而卫气宣散，所以病情将要解除。
Q: Why do the soft (Ru) and weak (Ruo) pulses appear at the head of the eleven pulse types?
A: Because the five zang organs and six fu organs mutually overcome each other, thus presenting the forms of eleven pulses.
Q: How can one know if it is overcoming a fu organ? How can one know if it is overcoming a zang organ?
A: Whenever yang pulses are floating and rapid, it indicates overcoming a fu organ; whenever yin pulses are slow and choppy, it indicates overcoming a zang organ.
The soft and weak pulses are the most deficient. Why do they rank first among the eleven pulse types? Softness and weakness belong to the Wood image, and Wood precedes in the Five Phases. This is because the five zang organs and six fu organs, due to the soft and weak condition, mutually overcome each other, thereby causing the pulse to exhibit the imagery of the eleven types. For instance, if a soft and weak pulse presents with a wiry (Xian) quality, it represents the overacting of the Liver zang; if it presents with a slightly wiry quality, it represents the overacting of the Gallbladder fu. The Heart pulse is hooked, the Spleen pulse is moderate, the Lung pulse is hairy, and the Kidney pulse is stone-like; these follow by analogy. Therefore, when the pulse exhibits softness and weakness, all five zang and six fu organs come to overact upon it. Thus, within the soft and weak pulse lies the imagery of all eleven types, yet softness and weakness always precede the others. How does one know whether the overactor is a fu or a zang? Whenever yang pulses are floating and rapid, it is an overaction upon a fu organ; whenever yin pulses are slow and choppy, it is an overaction upon a zang organ. (Here, yin and yang refer to the cun and chi positions of the radial pulse.)
Q: In pulse diagnosis, there is mutual overacting, as well as Zong, Heng, Ni, and Shun. What do these mean?
A: Water overcoming Fire, and Metal overcoming Wood, is called "Zong" (Vertical/Longitudinal); Fire overcoming Water, and Wood overcoming Metal, is called "Heng" (Horizontal/Lateral); Water overcoming Metal, and Fire overcoming Wood, is called "Ni" (Rebellious/Opposite); Metal overcoming Water, and Wood overcoming Fire, is called "Shun" (Smooth/Favorable).
In pulse diagnosis, there is mutual overacting between zang and fu organs (see previous chapter), and within this overacting, there are distinctions of Zong, Heng, Ni, and Shun. Water overcoming Fire and Metal overcoming Wood constitute overcoming what one controls (the element I overcome), termed "Zong"; Fire overcoming Water and Wood overcoming Metal constitute overcoming what controls me (the element that overcomes me), termed "Heng"; Water overcoming Metal and Fire overcoming Wood constitute the child overcoming the mother, termed "Ni"; Metal overcoming Water and Wood overcoming Fire constitute the mother overcoming the child, termed "Shun".
In Shaoyang disease, abdominal fullness and delirium, with a floating and tight pulse at the Cun position, indicate Liver overacting on Spleen, termed "Zong". Treat by puncturing Qimen (LR14).
Abdominal fullness and delirium in Shaoyang disease indicate Spleen pathology. The floating and tight pulse at the Cun position reveals the wiry pulse of the Liver, indicating Liver Wood overacting on Spleen Earth, termed "Zong". One should puncture Qimen (LR14) of the Jueyin channel to drain Liver Qi. A floating and tight pulse is termed wiry (see Pulse Method 39). Since the Liver pulse is wiry, we know it is Liver overacting.
In Shaoyang disease, fever, aversion to cold, intense thirst with desire to drink water, and inevitable abdominal fullness, accompanied by spontaneous sweating and free urination, indicate the disease is about to resolve. This is Liver overacting on Lung, termed "Heng". Treat by puncturing Qimen (LR14).
Fever, aversion to cold, intense thirst, and abdominal fullness in Shaoyang disease indicate Lung pathology. Spontaneous sweating and free urination reveal the dispersing action of Wind-Wood, indicating Liver overacting on Lung Metal, termed "Heng". One should also puncture Qimen (LR14) of the Jueyin channel to drain Liver heat. The Lung governs Wei (Defensive) Qi and has a contracting nature; the Liver governs Ying (Nutritive) Blood and has a dispersing nature. Fever, aversion to cold, intense thirst, and abdominal fullness result from Metal Qi being contracted and closed while Wood Qi cannot disperse. Sweating and free urination result from Wood Qi dispersing while Metal Qi cannot contract. When Ying dissipates and Wei disperses, the disease is destined to resolve.