（浮大动滑数沉涩弱弦迟）
上古以三部九候中决死生。是遍求法。以人迎寸口趺阳辨吉凶。是扼要法。自难经独取寸口之说行。而人迎趺阳不
参矣。气口成寸。为脉之大会。死生吉凶系焉。今所传者只此耳。自有脉经以来。诸家继起。各以脉名取胜。泛而不切。
漫无指归。夫在诊法取其约。于脉名上着其繁。此仲景所云。驰竞浮华。不因根本者是也。仲景立法。只在脉之体用上
推求。不在脉之名目上分疏。故以阴阳为体。则以浮大动滑数为阳之用。沉涩弱弦迟为阴之用。以表里为体。则以浮为
表用。沉为里用。以脏腑为体。则以数为腑用。迟为脏用。如以浮沉为体。则以浮沉中各有迟数为用。以浮为体。则以
大动滑数为用之常。涩弱弦迟为用之变。以沉为体。则以涩弱弦迟为用之常。大数滑动为用之变。体用之间。见脉之变
化。而致病之因。与病情之虚实。病机之转移。亦随之而见。全在诊者指法之功。与看法之细耳。脉理浩繁。大纲不外
名阴名阳之十种。阴阳两分。自成对峙。阴阳配偶。惟见五端。浮沉是脉体。大弱是脉势。滑涩是脉气。动弦是脉形。
迟数是脉息。不得概以脉象视之也。脉有对看法。有正看法。有反看法。有平看法。有仄看法。有彻底看法。如有浮即
有沉。有大即有弱。有滑即有涩。有数即有迟。合之于病。则浮为在表。沉为在里。大为有余。弱为不足。滑为血多。
涩为气少。动为搏阳。弦为搏阴。数为在腑。迟为在脏。此对看法也。如浮大动滑数。脉气之有余者为阳。当知其中有
阳胜阴病之机。沉弦弱涩弦迟。脉气之不足者名阴。当知其中有阴胜阳病之机。此正看法也。夫阴阳之转旋也。有余而
往。不足随之。不足而往。有余从之。故其始也。为浮。为大。为滑。为动。为数。其继也。反沉。反弱。反涩。反
弦。反迟者。为阳消阴长之机。其病为进。其始也。为沉。为弱。为涩。为弦。为迟。其继也。微浮。微大。微滑。微
动。微数者。是阳进阴退之机。其病为欲愈。此反看法也。浮为阳。如更兼大动滑数之阳脉。是为纯阳。必阳盛阴虚之
病矣。沉为阴。而更兼弱涩弦迟之阴脉。是为重阴。必阴盛阳虚之病矣。此为平看法。如浮而数。浮而涩。浮而弦。浮
而迟者。此阳中有阴。其人阳虚。而阴脉伏于阳脉中也。将亡阳之变。当以扶阳为急务矣。如沉而大。沉而滑。沉而动。
沉而数。此阴中有阳。其人阴虚。而阳邪下陷于阴脉也。将有阴竭之患。当以存阴为深虑也。此为仄看法。如浮大动
滑数之脉。虽不变。然始为有力之强阳。终为无力之微阳。知阳将绝矣。沉涩弱弦微迟之脉。虽无变而为阳。如忽见浮
大动滑数之状。是阴极似阳。知反照之不长。余烬之易灭也。是为彻底看法。更有真阴真阳之看法。如凡阴病见阳脉者
生。阳病见阴脉者死也。成注只据伤寒立言。观凡字则知脉法不专为伤寒说。亦不是按承上文扩充之见。仲景治法。以
脉以胃气为本。观名阴名阳。见此等脉状。尚是阴阳之名。而非阴阳之实。因胃气稍虚。则阴阳偏重。较之平脉有余名
阳。不足名阴耳。此阳病兼外伤六气言。阴病兼内伤精气言。若专指伤寒之阴症阳症则浅矣。阳脉指胃脘之真阳。内经
所谓二十五阳者是也。阴病见阳脉。是胃气来复。五脏冲和之气发见。故主生。内经所云。别于阳者知病起时也。阴脉
指五脏之真阴。因胃脘之阳不至于手太阴。五脏之真阴来见也。阳病见阴脉。是脉无胃气。故主死。内经所谓别于阴者。
知死生之期也。要知沉涩弦弱迟。是病脉。不是死脉。其见于阳病最多。阳病浮大动数滑不休即为死脉。阴病见浮大动
数滑之脉多。阴极似阳。未必即可生之机也。若真脏脉至。如肝脉之中外急。心脉坚而搏。肺脉大而浮。肾脉如弹石。
脾脉如距啄。皆反见有余之象。岂可以阳脉名之。经曰。邪气来也紧而疾。谷气来也徐而和。则又不得以迟数论阴阳矣。
仲景表里脏腑之法。则又以浮沉迟数为大纲。浮沉是审起伏。迟数是察至数。浮沉之间。迟数寓焉。脉之不浮不沉而在
中。不迟不数而五至者。谓之平脉。是有胃气。可以神求。不可以象求也。若一见浮沉迟数之象。斯为病矣。浮沉迟数。
本不可以表里脏腑分。今既有阴阳之可名。即以 阳表阴里。腑阳脏阴。定其为阴阳所在耳。试观脉之浮为在表。应病
亦为在表。然浮脉亦有里症。或表邪初陷。或里邪初欲出。究竟不离于表。故主表其大纲也。沉象在里。应病亦为在里。
沉脉亦有表症。或阳病见于阴而危。或阴出之阳而愈。究竟病根于里。故主里其大纲也。数为阳。阳主热。而数有沉浮。
浮数应表热。沉数应里热。虽数脉多有病在脏者。然其由必自腑。盖六腑为阳。阳脉萦其腑。故主腑其大纲也。迟为阴。
阴主寒。而迟有浮沉。浮迟应表寒。沉迟应里寒。虽迟脉多有病在腑者。然其根必自脏。盖五脏为阴。阴脉萦其脏。
故主脏其大纲也。脉状总总该括于浮沉迟数。然四者之中。又以独浮。独沉。独迟。独数。为准则。而独见何部。即以
其
部定表里脏府之所在。病无遁情矣。然阴阳之十脉。表里脏府之四诊。皆指脉之体用言。而诊法之体用。则又以病为体。
而脉为用矣。请以浮脉言之。其他可类推。如浮脉者病在表。则必有发热恶寒之表症。然浮有不同。有但浮者。有三部
皆同息数无迟数。其气象亦无滑涩动弦大小。此太阳之脉体然也。因风寒在表。而巨阳之阳御之。内无太过不及之病。
故见此象。此病脉中之平脉。故可用麻黄汤。发汗而顿解。然此脉不可多得。所以发热即有发热之脉象。恶寒即见恶寒
之脉象。如寸口脉浮而紧。是浮为风象。紧为寒象也。此为阳中有阴。乃阳脉之变见矣。然寒不协风。则玄府不开。寒
在皮毛。卫气足以卫外而为固。虽受寒而不伤。寒去而身自和矣。若风不夹寒。但能鼓动卫气。使玄府不闭。皮肤受邪。
脉气不清而已。不能深入于营。而发热恶寒。头项骨节俱痛。惟风夹寒邪。其势始猛。此风则伤卫。寒则伤营。初非有
二义也。卫气不能卫外。反内扰营气而为烦。营气不得交通。内迫于骨节而作痛。营卫俱病。发热所由来耳。如脉浮而
数。为阳中见阳。是阳脉之正局。然不得即认为阳脉有余。实因阳气不足。反见有余之象也。夫脉为血府。实由气行。
长则气治。短则气病。弦脉象长。数脉象短。脉数因于气之不足。则数为虚可知。风为阳邪。风则为热。虚因寒邪。虚
则
为寒。虚寒相搏于营卫。卫气不足以御之。此恶寒所由来也。上条阳中有阴。而反征其发热。此条阴中见阳。同反征其
恶寒。是互文以见意。此二脉皆当发汗而已。但脉者不同。故又云脉紧者。法当身疼痛。宜以汗解之。假令尺中迟。不
可发汗。以营气不足。血少故也。可知用麻黄汤。专治伤寒营者。皆仲景法矣。又云脉浮数者。法当汗出而愈。若尺中
脉微。此里虚不可发汗。则又见脉浮数者。不得概用麻黄。又云伤寒解半日许。复烦脉浮数者。可更发汗。宜桂枝汤。
则所云须表里实。津液自和。便自汗出愈者。为 稀粥示法耳。夫人之尺脉。如树之有根。不拘浮数浮紧。皆据尺以审
虚实。此又仲景自作浮为在表之注疏矣。十脉中无紧脉。即弦之转旋。当知按之不移。是静为阴之体。转索无常。是动
为阳之用。故浮中见紧者。紧在中风。与伤寒之阴阳俱紧者殊矣。紧又与数相似。紧见于法象。数见于至数。然紧以气
来之长。反得为阴中有阳之实脉。数以气来之短。反得两阳合明之象。然脉浮不俱大。必至三日乃大。是阳明内热外见
之脉。此浮不得仍为在表。当知大为病进。故见心下反硬。而攻之不令发汗耳。若脉浮而迟。面热赤而战栗者。是阳中
见阴。故面见假热。而身真寒。此因迟为在脏。故无阳不能作汗。而浮为在表。则又当渍形为汗之法矣。迟因浮而从表。
浮因大而从里。浮兼数而反虚。紧入浮而或实。则表里脏腑阴阳虚实之间。悉属定不定法也。余义见六经病解。
（浮、大、动、滑、数、沉、涩、弱、弦、迟）
上古时期通过“三部九候”诊法来判断生死。这是全面遍查的诊脉方法。通过比较人迎穴、寸口和趺阳穴的脉象来辨别吉凶，这是抓住关键要领的方法。自从《难经》提出独取寸口的说法流行后，人迎和趺阳二部的脉象就不再参合运用了。气口（即寸口）形成寸脉，是脉气的总会聚之处，人的生死吉凶都系于此。现在流传下来的诊脉方法只有这一种了。自从王叔和编写《脉经》以来，各家医家相继兴起，各自以独特的脉名来标榜取胜，内容泛泛而不切中要害，漫无宗旨。在诊法上应该追求简约，却在脉名上搞得繁杂，这正是张仲景所说的“驰竞浮华，不因根本”的情况。张仲景确立的法则，只在脉的“体”与“用”上进行推求，不在脉的名目上进行分辨。所以，如果以阴阳为体，那么浮、大、动、滑、数就是阳的作用；沉、涩、弱、弦、迟就是阴的作用。如果以表里为体，那么浮就是表的作用，沉就是里的作用。如果以脏腑为体，那么数就是腑的作用，迟就是脏的作用。如果以浮沉为体，那么在浮沉之中又各有迟数的作用。如果以浮为体，那么大、动、滑、数是作用的常态，涩、弱、弦、迟是作用的变局。如果以沉为体，那么涩、弱、弦、迟是作用的常态，大、数、滑、动是作用的变局。在体用之间，可以看到脉的变化，而致病的病因、病情的虚实、病机的转移，也随之显现出来。这完全取决于诊脉者指法的功夫和观察的细致程度。脉理虽然浩繁，但大纲不外乎名为阴、名为阳的十种脉象。阴阳两分，自然形成对峙；阴阳配偶，只见于五个方面：浮沉是脉的形体，大弱是脉的态势，滑涩是脉的气机，动弦是脉的形状，迟数是脉的至数（频率）。不能一概把它们当作脉象来看待。
诊脉有对看法、正看法、反看法、平看法、仄看法、彻底看法。如有浮就有沉，有大就有弱，有滑就有涩，有数就有迟。结合病症来看，浮表示病在表，沉表示病在里；大表示有余，弱表示不足；滑表示血多，涩表示气少；动表示搏动于阳分，弦表示搏动于阴分；数表示病在腑，迟表示病在脏。这就是对看法。如浮、大、动、滑、数，属于脉气有余的阳脉，应当知道其中有阳胜阴病的机理；沉、涩、弱、弦、迟，属于脉气不足的阴脉，应当知道其中有阴胜阳病的机理。这就是正看法。阴阳的转化，有余而去，不足随之而来；不足而去，有余从之而来。所以起初表现为浮、大、滑、动、数，随后反而出现沉、弱、涩、弦、迟，这是阳消阴长的机理，病情在发展。起初表现为沉、弱、涩、弦、迟，随后反而出现微浮、微大、微滑、微动、微数，这是阳进阴退的机理，病情趋向痊愈。这就是反看法。浮属阳，如果再兼见大、动、滑、数等阳脉，这叫纯阳，必定是阳盛阴虚的病。沉属阴，如果再兼见弱、涩、弦、迟等阴脉，这叫重阴，必定是阴盛阳虚的病。这就是平看法。如浮而数、浮而涩、浮而弦、浮而迟，这是阳中有阴，其人阳气虚弱，阴脉潜伏在阳脉之中，将有亡阳的变故，应当把扶助阳气作为紧急任务。如沉而大、沉而滑、沉而动、沉而数，这是阴中有阳，其人阴液亏虚，阳邪下陷于阴脉之中，将有阴液枯竭的祸患，应当深刻忧虑并注重保存阴液。这就是仄看法。如浮、大、动、滑、数的脉象，虽然不变，但开始是有力的强阳，最终变为无力的微阳，可知阳气将绝。沉、涩、弱、弦、微迟的脉象，虽然不转变为阳脉，但如果忽然出现浮、大、动、滑、数的状貌，这是阴极似阳，可知残存的阳气难以长久，余烬容易熄灭。这就是彻底看法。更有真阴真阳的看法。如凡是阴病见到阳脉的预后良好，阳病见到阴脉的预后不良甚至死亡。成无己的注解只是依据伤寒立论，看到“凡”字就知道脉法不只是专门针对伤寒说的，也不是仅仅承接上文进行扩充的见解。张仲景的治疗法则，以脉象中的胃气为本。看到名为阴、名为阳的这些脉状，还只是阴阳的名称，而不是阴阳的实质。因为胃气稍微虚弱，则阴阳偏重，比起平脉中有余叫阳、不足叫阴罢了。这里的阳病兼指外感六气，阴病兼指内伤精气。如果专指伤寒的阴证阳证就浅薄了。阳脉指的是胃脘的真阳，也就是《内经》所说的“二十五阳”。阴病见到阳脉，是胃气来复，五脏冲和之气发露，所以主生。《内经》说：“别于阳者，知病起时。”阴脉指的是五脏的真阴，因为胃脘的阳气不到达手太阴肺经，五脏的真阴才显露出来。阳病见到阴脉，是脉中没有胃气，所以主死。《内经》说：“别于阴者，知死生之期。”要知道沉、涩、弦、弱、迟是病脉，不是死脉。它们多见于阳病。阳病如果出现浮、大、动、数、滑不止，即为死脉。阴病见到浮、大、动、数、滑的脉象较多，这是阴极似阳，未必就是可以生的生机。如果是真脏脉出现，如肝脉中外急迫，心脉坚硬搏指，肺脉大而浮，肾脉像弹石，脾脉像鸡啄米，都反常地出现有余的象，怎么能称为阳脉呢？经文说：“邪气来也紧而疾，谷气来也徐而和。”这就又不能单纯以迟数来论阴阳了。
张仲景关于表里脏腑的法则，又以浮、沉、迟、数为大纲。浮沉是审察脉位的起伏，迟数是察测脉率的快慢。浮沉之间，寓含着迟数。脉既不浮也不沉而在中部，既不迟也不数而每息五至的，叫做平脉。这是有胃气的表现，可以用神意去体会，不能用具体的形象去索求。如果一见到浮、沉、迟、数的形象，就是病了。浮、沉、迟、数本来不可以用表里脏腑来划分，现在既然有了阴阳的名称，就以阳为表、阴为里，腑为阳、脏为阴，来确定其阴阳所在罢了。试看脉浮表示病在表，对应的病症也在表，然而浮脉也有里症，或者是表邪初陷于里，或者是里邪初欲出于表，终究不离于表，所以以表为其大纲。沉象在里，对应的病症也在里，然而沉脉也有表症，或者是阳病见于阴脉而危重，或者是阴病出之于阳而痊愈，终究病根在里，所以以里为其大纲。数为阳，阳主热，而数脉有浮沉之分。浮数对应表热，沉数对应里热。虽然数脉多有病在脏的情况，但其根源必然发自腑。因为六腑属阳，阳脉萦绕其腑，所以以腑为其大纲。迟为阴，阴主寒，而迟脉有浮沉之分。浮迟对应表寒，沉迟对应里寒。虽然迟脉多有病在腑的情况，但其根源必然发自脏。因为五脏属阴，阴脉萦绕其脏，所以以脏为其大纲。脉状总括起来包括浮、沉、迟、数，但在四者之中，又以独浮、独沉、独迟、独数为准则，而独见于何部，就以其部位定表里脏腑的所在，病情就没有隐藏的了。然而阴阳的十种脉，表里脏腑的四诊，都是指脉的体用而言，而诊法的体用，则是以病为体，而以脉为用了。请以浮脉为例说明，其他的可以类推。如浮脉表示病在表，则必有发热、恶寒等表症。然而浮脉有所不同，有的仅见浮象，有的三部皆同，呼吸次数没有迟数之分，气象也没有滑涩、动弦、大小的区别，这是太阳病的脉体特征。因为风寒在表，巨阳（太阳经）的阳气抵御它，内部没有太过或不及的病，所以见此象。这是病脉中的平脉，所以可以用麻黄汤，发汗而立刻解除。然而这种脉象不可多得，所以发热即有发热的脉象，恶寒即见恶寒的脉象。如寸口脉浮而紧，浮是风象，紧是寒象。这是阳中有阴，是阳脉的变局。然而寒如果不配合风，则玄府（汗孔）不开，寒在皮毛，卫气足以卫护体表而固密，虽然受寒也不会受伤，寒去身体自然调和。如果风不夹寒，只能鼓动卫气，使玄府不闭塞，皮肤受邪，脉气不清而已，不能深入营分，也就不会出现发热、恶寒、头项骨节俱痛的症状。只有风夹寒邪，其势才猛烈。这风伤卫气，寒伤营气，起初并没有两种含义。卫气不能卫护体表，反而内扰营气导致烦躁；营气不得交通，内迫于骨节导致疼痛。营卫都生病，发热由此产生。如脉浮而数，是阳中见阳，是阳脉的正局。然而不能立即认为是阳脉有余，实因阳气不足，反而出现有余的象。脉是血之府，实则由气行推动。长则气治，短则气病。弦脉象长，数脉象短。脉数是因为气不足，所以数脉属于虚可知。风为阳邪，风则为热；虚因寒邪，虚则为寒。虚寒相搏于营卫，卫气不足以抵御，这就是恶寒产生的原因。上一条讲阳中有阴而反征发热，这一条讲阴中见阳同反征恶寒，这是互文见义。这两条脉象都应当发汗。但脉象不同，所以说脉紧的，法当身体疼痛，宜用汗法解之。假如尺中脉迟，不可发汗，因为营气不足，血少的原因。可知使用麻黄汤，专门治疗伤寒伤营的，都是张仲景的法度。又说脉浮数的，法当汗出而愈。如果尺中脉微，这是里虚不可发汗，则又见脉浮数的，不能一概用麻黄汤。又说伤寒解了一半左右，又烦闷，脉浮数的，可以再发汗，宜用桂枝汤。那么所说的必须表里实，津液自和，便自汗出而愈，是用喝稀粥来示意方法罢了。人的尺脉，如同树有根，不拘泥于浮数、浮紧，都要依据尺脉来审察虚实。这又是张仲景自作浮为在表的注疏。十脉中没有紧脉，即是弦脉的旋转变化。应当知道按之不移，是静为阴的体；转索无常，是动为阳的用。所以在浮脉中见到紧脉，紧脉在中风中，与伤寒的阴阳俱紧是不同的。紧脉又与数脉相似，紧见于法象，数见于至数。然而紧因为气来之长，反而得为阴中有阳的实脉；数因为气来之短，反而得两阳合明的象。然而脉浮如果不兼大，必至三日才变大，这是阳明内热外见的脉象。此浮脉不得仍认为在表，应当知道大为病进，所以见到心下反而硬满，攻下而不令发汗。如果脉浮而迟，面热赤而战栗，这是阳中见阴，所以面现假热，而身真寒。这是因为迟为在脏，所以无阳不能作汗，而浮为在表，则又应当用渍形为汗（温水浴）的方法了。迟因浮而从表，浮因大而从里，浮兼数而反虚，紧入浮而或实，那么表里脏腑阴阳虚实之间，都属于不确定之法。其余的含义见六经病解。
(Floating, Large, Surging, Slippery, Rapid, Deep, Choppy, Weak, Wiry, Slow)
In ancient times, life and death were determined through the "Three Regions and Nine Locations" (Sanbu Jiuhou) pulse diagnosis method. This was a comprehensive method of seeking everywhere. By comparing the Renying (Jugular artery), Cunkou (Radial artery at wrist), and Duyang (Dorsalis pedis artery) pulses to distinguish auspicious from inauspicious signs, this was a method of grasping the essentials. Since the theory of exclusively taking the Cunkou pulse propagated by the *Nan Jing* (Classic of Difficult Issues) became prevalent, the Renying and Duyang pulses were no longer consulted together. The Qi Kou (Cunkou) forms the Cun pulse, which is the great gathering of all pulses; life and death, auspiciousness and inauspiciousness, depend on it. What is transmitted today is only this one method. Since the compilation of the *Mai Jing* (Pulse Classic), various schools have risen successively, each striving for distinction with unique pulse names, resulting in generalizations that are not pertinent and lack clear direction. In diagnostic methods, one should seek simplicity, yet here complexity is added to pulse names. This is what Zhang Zhongjing referred to as "racing after superficial splendor without adhering to the root." Zhang Zhongjing established laws based only on the investigation of the "Substance" (Ti) and "Function" (Yong) of the pulse, rather than distinguishing among pulse names. Therefore, if Yin and Yang are taken as the Substance, then Floating, Large, Surging, Slippery, and Rapid constitute the Function of Yang; while Deep, Choppy, Weak, Wiry, and Slow constitute the Function of Yin. If Exterior and Interior are taken as the Substance, then Floating is the Function of Exterior, and Deep is the Function of Interior. If Zang and Fu organs are taken as the Substance, then Rapid is the Function of Fu organs, and Slow is the Function of Zang organs. If Floating and Deep are taken as the Substance, then within Floating and Deep there are respectively the Functions of Slow and Rapid. If Floating is taken as the Substance, then Large, Surging, Slippery, and Rapid are the constant manifestations of Function, while Choppy, Weak, Wiry, and Slow are the variable manifestations of Function. If Deep is taken as the Substance, then Choppy, Weak, Wiry, and Slow are the constant manifestations of Function, while Large, Rapid, Slippery, and Surging are the variable manifestations of Function. Between Substance and Function, changes in the pulse can be seen, and along with them, the causes of disease, the deficiency or excess of the condition, and the shift in pathogenesis also become visible. This entirely depends on the skill of the examiner's fingers and the subtlety of their observation. Although pulse theory is vast and complex, the main outline does not exceed ten types named Yin and Yang. When divided into Yin and Yang, they naturally form oppositions; when paired, they manifest in five aspects: Floating and Deep are the Substance of the pulse; Large and Weak are the Momentum of the pulse; Slippery and Choppy are the Qi of the pulse; Surging and Wiry are the Shape of the pulse; Slow and Rapid are the Rate of the pulse. These cannot generally be viewed merely as pulse images.
Pulse diagnosis involves viewing opposites, viewing directly, viewing inversely, viewing evenly, viewing obliquely, and viewing thoroughly. Where there is Floating, there is Deep; where there is Large, there is Weak; where there is Slippery, there is Choppy; where there is Rapid, there is Slow. Correlating with symptoms, Floating indicates the Exterior, Deep indicates the Interior; Large indicates Excess, Weak indicates Deficiency; Slippery indicates abundant Blood, Choppy indicates deficient Qi; Surging indicates pulsation in the Yang aspect, Wiry indicates pulsation in the Yin aspect; Rapid indicates disease in the Fu organs, Slow indicates disease in the Zang organs. This is viewing opposites. For example, Floating, Large, Surging, Slippery, and Rapid represent an abundance of pulse Qi belonging to Yang; one must understand that there is a mechanism of Yang excess causing Yin pathology. Deep, Choppy, Weak, Wiry, and Slow represent a deficiency of pulse Qi belonging to Yin; one must understand that there is a mechanism of Yin excess causing Yang pathology. This is viewing directly. The rotation of Yin and Yang dictates that where there is excess going, deficiency follows; where there is deficiency going, excess follows. Thus, initially presenting as Floating, Large, Slippery, Surging, Rapid, and subsequently reversing to Deep, Weak, Choppy, Wiry, Slow, this is the mechanism of Yang declining and Yin growing, indicating the disease is progressing. Initially presenting as Deep, Weak, Choppy, Wiry, Slow, and subsequently reversing to slightly Floating, slightly Large, slightly Slippery, slightly Surging, slightly Rapid, this is the mechanism of Yang advancing and Yin retreating, indicating the disease is tending toward recovery. This is viewing inversely. Floating belongs to Yang; if additionally accompanied by Yang pulses such as Large, Surging, Slippery, and Rapid, this is called Pure Yang, necessarily indicating a disease of Yang excess and Yin deficiency. Deep belongs to Yin; if additionally accompanied by Yin pulses such as Weak, Choppy, Wiry, and Slow, this is called Heavy Yin, necessarily indicating a disease of Yin excess and Yang deficiency. This is viewing evenly. For instance, Floating combined with Rapid, Floating combined with Choppy, Floating combined with Wiry, or Floating combined with Slow—these indicate Yin within Yang. The person has deficient Yang, and Yin pulses are hidden within Yang pulses. There will be a transformation of Yang collapse; assisting Yang must be made an urgent priority. Conversely, Deep combined with Large, Deep combined with Slippery, Deep combined with Surging, or Deep combined with Rapid—these indicate Yang within Yin. The person has deficient Yin, and Yang pathogens have sunk into the Yin pulses. There will be a danger of Yin exhaustion; preserving Yin requires deep concern. This is viewing obliquely. Regarding pulses such as Floating, Large, Surging, Slippery, and Rapid, although unchanged, they begin as strong Yang with force but end as weak Yang without force; knowing that Yang is about to perish. Regarding pulses such as Deep, Choppy, Weak, Wiry, and slightly Slow, although not transforming into Yang, if suddenly appearing as Floating, Large, Surging, Slippery, and Rapid, this is extreme Yin resembling Yang; knowing that the remaining glow cannot last long and embers extinguish easily. This is viewing thoroughly. Furthermore, there is the view of True Yin and True Yang. For example, whenever Yin diseases present with Yang pulses, survival is indicated; whenever Yang diseases present with Yin pulses, death is indicated. Cheng Wuji's commentary speaks only according to Shanghan (Cold Damage). Observing the character "whenever" (Fan), one knows that pulse methodology is not solely for discussing Shanghan, nor is it merely an expansion of the preceding text. Zhang Zhongjing's treatment principles take the Stomach Qi (Wei Qi) in the pulse as the root. Seeing these pulse conditions named Yin and Yang reveals they are still names of Yin and Yang, not their substance. Because slight deficiency of Stomach Qi leads to bias in Yin and Yang, compared to normal pulses where excess is named Yang and deficiency is named Yin. Here, Yang diseases refer to external contraction of the Six Qi, and Yin diseases refer to internal injury of Essence and Qi. If referring specifically to Yin and Yang syndromes of Shanghan, it would be shallow. Yang pulses refer to the True Yang of the Stomach and Intestines, what the *Nei Jing* calls the "Twenty-Five Yangs." Yin diseases presenting with Yang pulses indicate the return of Stomach Qi and the emergence of the harmonious Qi of the Five Zang organs, hence indicating life. The *Nei Jing* states: "Distinguishing from Yang, one knows the time of onset." Yin pulses refer to the True Yin of the Five Zang organs. Because the Yang of the Stomach and Intestines does not reach the Hand Taiyin Lung meridian, the True Yin of the Five Zang organs appears. Yang diseases presenting with Yin pulses indicate the absence of Stomach Qi in the pulse, hence indicating death. The *Nei Jing* states: "Distinguishing from Yin, one knows the period of death or life." One must know that Deep, Choppy, Wiry, Weak, and Slow are pathological pulses, not death pulses. They appear most frequently in Yang diseases. If Yang diseases present with incessant Floating, Large, Surging, Rapid, and Slippery pulses, these are death pulses. Yin diseases often present with Floating, Large, Surging, Rapid, and Slippery pulses; this is extreme Yin resembling Yang, and it does not necessarily indicate a chance for life. If True Visceral Pulses arrive, such as the Liver pulse being tight inside and out, the Heart pulse being firm and beating hard, the Lung pulse being large and floating, the Kidney pulse feeling like throwing stones, the Spleen pulse feeling like a chicken pecking grain—all these abnormally show signs of excess. How can these be named Yang pulses? The Classics say: "When evil qi comes, it is tight and rapid; when grain qi comes, it is slow and harmonious." Thus, one cannot discuss Yin and Yang solely based on Slow and Rapid rates.
Zhang Zhongjing's method regarding Exterior/Interior and Zang/Fu takes Floating, Deep, Slow, and Rapid as the main outline. Floating and Deep examine the rise and fall of the pulse position; Slow and Rapid observe the rate of beats. Within Floating and Deep, Slow and Rapid are contained. A pulse that is neither Floating nor Deep but intermediate, neither Slow nor Rapid but beating five times per respiration, is called a Normal Pulse (Ping Mai). This possesses Stomach Qi and can be sought through spirit/intuition, not through specific images. Once any image of Floating, Deep, Slow, or Rapid appears, it becomes pathological. Floating, Deep, Slow, and Rapid originally cannot be divided by Exterior/Interior or Zang/Fu. Now that they have names of Yin and Yang, we designate Yang as Exterior and Yin as Interior, Fu as Yang and Zang as Yin, to determine their location in Yin and Yang. Observe that a Floating pulse indicates disease in the Exterior, and the corresponding symptoms are also in the Exterior. However, Floating pulses can also have Interior symptoms, either because Exterior pathogens have just sunk inward, or Interior pathogens are just trying to emerge outward. Ultimately, it does not leave the Exterior, so Exterior is its main principle. Deep indications are in the Interior, and corresponding symptoms are also in the Interior. However, Deep pulses can also have Exterior symptoms, either because Yang disease presents in Yin leading to danger, or Yin disease emerges to Yang leading to recovery. Ultimately, the root of the disease is in the Interior, so Interior is its main principle. Rapid is Yang; Yang governs Heat. But Rapid pulses have Floating and Deep variations. Floating-Rapid corresponds to Exterior Heat, Deep-Rapid corresponds to Interior Heat. Although Rapid pulses often involve disease in the Zang organs, the origin must be from the Fu organs. Because the Six Fu organs are Yang, Yang pulses surround the Fu organs, so Fu organs are their main principle. Slow is Yin; Yin governs Cold. But Slow pulses have Floating and Deep variations. Floating-Slow corresponds to Exterior Cold, Deep-Slow corresponds to Interior Cold. Although Slow pulses often involve disease in the Fu organs, the root must be from the Zang organs. Because the Five Zang organs are Yin, Yin pulses surround the Zang organs, so Zang organs are their main principle. Pulse conditions are generally encompassed by Floating, Deep, Slow, and Rapid. Among these four, however, exclusive Floating, exclusive Deep, exclusive Slow, and exclusive Rapid serve as criteria. Depending on which region they appear exclusively, the location of the Exterior/Interior and Zang/Fu is determined, and the disease condition has nowhere to hide. Yet, the ten Yin/Yang pulses and the four diagnoses of Exterior/Interior/Zang/Fu all refer to the Substance and Function of the pulse. In the Substance and Function of diagnosis, Disease is the Substance, and Pulse is the Function. Let us speak of the Floating pulse as an example; others can be inferred similarly. If a Floating pulse indicates disease in the Exterior, there must necessarily be Exterior symptoms such as Fever and Aversion to Cold. However, Floating varies. Some are merely Floating; some are identical in all three positions, with no difference in respiratory rate (Slow/Rapid), and no difference in imagery (Slippery/Choppy, Surging/Wiry, Large/Small). This is the pulse substance of Taiyang (Greater Yang). Because Wind-Cold is in the Exterior, the Yang of Ju Yang (Taiyang Meridian) defends against it, and internally there is no excess or deficiency. Hence this image appears. This is a Normal Pulse within pathological pulses, so Mahuang Tang (Ephedra Decoction) can be used to induce sweating and resolve the condition immediately. However, this pulse is rare. Thus, fever presents with fever-specific pulse imagery, and aversion to cold presents with aversion-to-cold-specific pulse imagery. For example, if the Cunkou pulse is Floating and Tight, Floating is the image of Wind, and Tight is the image of Cold. This is Yang containing Yin, a variation of Yang pulses. However, if Cold does not cooperate with Wind, the Xuanfu (pores) do not open. Cold remains in the skin and hair; Wei Qi (Defensive Qi) is sufficient to defend the exterior and maintain solidity. Even if affected by Cold, injury does not occur; once Cold departs, the body harmonizes itself. If Wind does not carry Cold, it can only stir Wei Qi, preventing the closure of pores. Pathogens affect the skin, and pulse Qi becomes unclear, but it cannot penetrate deeply into Ying Qi (Nutritive Qi), so symptoms like fever, aversion to cold, headache, stiff neck, and bone/joint pain do not arise. Only when Wind carries Cold does the momentum become fierce. Wind injures Wei Qi, Cold injures Ying Qi; originally, there are not two separate meanings. If Wei Qi fails to defend the exterior, it disturbs Ying Qi internally, causing irritability. If Ying Qi cannot communicate, it presses inward on bones and joints, causing pain. With both Ying and Wei diseased, fever arises. If the pulse is Floating and Rapid, this is Yang seeing Yang, the standard pattern of Yang pulses. However, one cannot immediately assume Yang pulse excess. It is actually due to insufficient Yang Qi, manifesting as an appearance of excess. The pulse is the mansion of Blood, driven by Qi movement. Long indicates regulated Qi, Short indicates diseased Qi. Wiry pulses resemble Long, Rapid pulses resemble Short. Pulse Rapidness due to Qi insufficiency means Rapid pulses indicate deficiency. Wind is a Yang pathogen; Wind implies Heat. Deficiency caused by Cold pathogens implies Cold. Deficiency and Cold struggle within Ying and Wei; Wei Qi is insufficient to resist, which is the origin of aversion to cold. The previous clause discussed Yang containing Yin but manifested fever; this clause discusses Yin containing Yang but manifests aversion to cold. This is mutual textual implication revealing intent. Both pulse patterns require sweating therapy. But since the pulses differ, it is stated: "If the pulse is Tight, bodily pain is expected; sweating should be used to resolve it. If the Chi position pulse is Slow, sweating must not be used, because Ying Qi is insufficient and Blood is scarce." Thus, using Mahuang Tang to treat Cold Damage injuring Ying Qi is Zhang Zhongjing's method. It is also stated: "If the pulse is Floating and Rapid, sweating should lead to recovery. If the Chi position pulse is Micro, this is Interior deficiency, and sweating must not be used." Thus, seeing Floating and Rapid pulses, one cannot indiscriminately use Mahuang. It is also stated: "After Shanghan resolves for half a day, if restlessness returns and the pulse is Floating and Rapid, sweating may be administered again; Guizhi Tang (Cinnamon Twig Decoction) is suitable." Thus, what is said about requiring Interior-Exterior solidity and natural harmony of Jin Ye (Body Fluids) leading to spontaneous sweating and recovery refers to the method demonstrated by drinking thin porridge. The Chi pulse of a person is like the root of a tree. Regardless of Floating-Rapid or Floating-Tight, one must rely on the Chi pulse to assess deficiency and excess. This is another annotation by Zhang Zhongjing explaining why Floating indicates the Exterior. Among the ten pulses, there is no Tight pulse; it is merely the rotation of the Wiry pulse. One must know that pressing without moving is the Static Substance of Yin, while twisting irregularly is the Dynamic Function of Yang. Therefore, seeing Tightness within Floating differs from the simultaneous Yin-Yang Tightness in Shanghan. Tightness resembles Rapidness; Tightness is seen in morphology, Rapidness in rate. However, Tightness, due to the length of incoming Qi, paradoxically becomes a Real pulse of Yin containing Yang. Rapidness, due to the shortness of incoming Qi, paradoxically shows the image of Two Yangs combining. However, if a Floating pulse is not accompanied by Large, it becomes Large only after three days; this is the pulse of Yangming Internal Heat manifesting externally. This Floating pulse should no longer be considered Exterior; one must know that Large indicates disease progression. Hence, hardness in the epigastrium appears, and purgation is used instead of inducing sweating. If the pulse is Floating and Slow, with facial heat/redness and trembling/chills, this is Yang containing Yin. Hence the face shows false heat, while the body has true cold. Because Slow indicates disease in the Zang, there is no Yang to produce sweat. Although Floating indicates the Exterior, one should use the method of bathing the body in warm water to induce sweat. Slow, following Floating, relates to the Exterior; Floating, following Large, relates to the Interior; Floating combined with Rapid reverses to Deficiency; Tight entering Floating may be Excess. Thus, between Exterior/Interior, Zang/Fu, Yin/Yang, and Deficiency/Excess, everything belongs to indeterminate methods. Remaining meanings are found in the explanation of the Six Channels' diseases.