人之患病，不外七情六淫，其轻重死生之别，医者何由知之？皆必问其症，切其脉，而
后知
之。然症脉各有不同，有现症极明，而脉中不见者；有脉中甚明，而症中不见者。其中有宜
从症者，有宜从脉者，必有一定之故。审之既真，则病情不能逃，否则不为症所误，必为脉
所误矣。故宜从症者，虽脉极顺而症危，亦断其必死；宜从脉者，虽症极险而脉和，亦决其
必生。如脱血之人，形如死状，危在顷刻，而六脉有根，则不死。此宜从脉不从症也。如痰
厥之人，六脉或促或绝，痰降则愈，此宜从症不从脉也。阴虚咳嗽，饮食起居如常，而六脉
细数，久则必死。此宜从脉不宜从症也。噎膈反胃，脉如常人，久则胃绝而脉骤变，百无一
生。此又宜从症不从脉也。如此之类甚多，不可枚举。总之脉与症分观之，则吉凶两不可凭
。合观之，则某症忌某脉，某脉忌某症，其吉凶乃可定矣。又如肺病忌脉数，肺属金，数为
火，火刑金也。余可类推，皆不外五行生克之理。今人不按其症，而徒讲乎脉，则讲之愈密
，失之愈远。若脉之全体，则《内经》诸书详言之矣。
症者，病之发现者也。病热则症热，病寒则症寒，此一定之理。然症竟有与病相反者，
最易
误治，此不可不知者也。如冒寒之病，反身热而恶热；伤暑之病，反身寒而恶寒；本伤食也
，而反易饥能食本伤饮也，而反大渴口干。此等之病，尤当细考，一或有误，而从症用药，
即死生判矣。此其中盖有故焉。或一时病势未定，如伤寒本当发热，其归尚未发热，将来必
至于发热，此先后之不同也。或内外异情，如外虽寒而内仍热是也。或有名无实，如欲食好
饮，及至少进即止，饮食之后，又不易化是也。或有别症相杂，误认此症为彼症是也。或此
人旧有他病，新病方发，旧病亦现是也。至于脉之相反，亦各不同。或其人本体之脉，与常
人不同。或轻病未现于脉。或痰气阻塞，营气不利，脉象乖其所之。或一时为邪所闭，脉似
危险，气通即复。或其人本有他症，仍其旧症之脉。凡此之类，非一端所能尽，总宜潜心体
认，审其真实，然后不为脉症所惑。否则徒执一端之见，用药愈真而愈误矣。然苟非辨症极
精，脉理素明，鲜有不惑者也！
人患病，不外乎七情（喜、怒、忧、思、悲、恐、惊）和六淫（风、寒、暑、湿、燥、火）致病，其病情的轻重以及生死预后的区别，医生是从哪里知道的呢？都必须询问其症状，切按其脉象，然后才能知晓。然而症状和脉象各有不同，有的症状表现极其明显，但脉象中却看不出来；有的脉象非常清晰，但症状中却看不出来。其中有的情况应当依据症状来判断，有的情况应当依据脉象来判断，这背后必然有一定的道理。仔细审察之后如果真实无误，那么病情就无法隐瞒；否则，不是被症状所误导，就是被脉象所误导。所以，适宜从症判断的情况，即使脉象非常顺适，但症状危重，也要断定其必死；适宜从脉判断的情况，即使症状极其险恶，但脉象平和，也要断定其必生。例如失血过多的人，形体如同死状，危险就在顷刻之间，但如果六脉（寸、关、尺三部，左右手共六部脉）有根气，就不会死亡。这就是适宜从脉而不从症的情况。例如痰厥（因痰浊阻滞气机导致突然昏倒的病证）的人，六脉或急促或断绝，待痰浊降下后就会痊愈，这就是适宜从症而不从脉的情况。阴虚咳嗽（因肺肾阴虚引起的咳嗽），饮食起居如常，但六脉细数（脉形细如丝且跳动快速），时间久了必然死亡。这是适宜从脉而不宜从症的情况。噎膈反胃（吞咽困难或食入即吐的疾病），脉象如同常人，时间久了胃气衰竭而脉象突然改变，百人中无一人生还。这又是适宜从症而不从脉的情况。像这样的例子很多，无法一一列举。总之，将脉象与症状分开来看，则吉凶两方面都不可凭信；合起来看，则某种症状忌讳某种脉象，某种脉象忌讳某种症状，其吉凶才可以确定。例如肺病忌讳脉数（脉搏跳动快速），肺属金，数为火，这是火克金的道理。其余可以类推，都不外乎五行（木、火、土、金、水）生克的原理。现在的人不按察症状，而只空谈脉象，那么谈论得越细密，偏离真理就越远。至于脉象的全体内容，《内经》等书籍已经详细论述过了。
症状，是疾病的外在表现。病邪为热则症状表现为热，病邪为寒则症状表现为寒，这是一定的道理。然而症状竟然有与疾病本质相反的，最容易误治，这是不可不知晓的。例如受寒的疾病，反而身体发热且厌恶热；伤暑的疾病，反而身体发冷且厌恶寒冷；本来是伤食（饮食停滞不化），反而容易饥饿且能吃；本来是伤饮（水饮内停），反而极度口渴口干。这类疾病，尤其应当仔细考察，一旦有误，如果依据症状用药，就会决定生死。这其中大概是有原因的。或者是一时病势尚未定型，例如伤寒本当发热，其归经尚未显现发热，将来必定会发热，这是先后顺序的不同。或者是内外情况不一致，例如外表虽寒但内部仍然热。或者是名实不符，例如想吃好喝，但稍微进食就停止，饮食之后，又不易消化。或者是其他症状混杂，误将此症状认作彼症状。或者是此人旧有他病，新病刚刚发作，旧病的症状也同时出现。至于脉象与症状相反，也各不相同。或者是此人本体的脉象与常人不同。或者是轻病未在脉象上显现。或者是痰气阻塞，营气运行不利，脉象违背了其应有的规律。或者是暂时被邪气闭塞，脉象看似危险，气机通畅后即恢复。或者是此人原本有其他病症，仍保持旧病时的脉象。像这样的情况，不是一个方面所能穷尽的，总应当潜心体会认识，审察其真实情况，然后才不会被脉象和症状所迷惑。否则仅仅执着于某一方面的见解，用药虽然正确却更加错误。然而如果不是辨证极其精细，对脉理素来明了，很少有不迷惑的！
In human illness, it is no more than the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) and Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire). How does a physician know the differences in severity and life-and-death prognosis? One must inquire about the symptoms and palpate the pulse before knowing. However, symptoms and pulses vary. There are cases where symptoms are extremely clear but not visible in the pulse; there are cases where the pulse is very clear but not visible in the symptoms. In some cases, one should follow the symptoms; in others, one should follow the pulse. There must be a definite reason for this. If examined truly and accurately, the disease condition cannot escape detection; otherwise, one will be misled either by the symptoms or by the pulse. Therefore, in cases suitable for following symptoms, even if the pulse is extremely smooth, if the symptoms are critical, death is certain. In cases suitable for following the pulse, even if the symptoms are extremely dangerous, if the pulse is harmonious, survival is certain. For example, a person who has lost a large amount of blood may appear like a corpse, with danger imminent, but if the six pulses (Cun, Guan, Chi positions on both hands) have root qi, they will not die. This is a case of following the pulse rather than the symptoms. For example, a person with Tan Jue (Phlegm-Jue, sudden coma due to phlegm obstruction) may have a rapid or absent pulse, but will recover once the phlegm descends. This is a case of following the symptoms rather than the pulse. In Yin deficiency cough, diet and daily activities may be normal, but the six pulses are fine and rapid; over time, death is inevitable. This is a case of following the pulse rather than the symptoms. In Ye Ge Fan Wei (Dysphagia and regurgitation), the pulse may resemble that of a healthy person, but over time, stomach qi fails and the pulse changes suddenly, resulting in almost no survivors. This is another case of following the symptoms rather than the pulse. There are many such examples, which cannot be enumerated. In short, observing the pulse and symptoms separately makes neither reliable for determining auspiciousness or misfortune. Observing them together allows one to determine prognosis based on which symptoms contraindicate which pulses, and vice versa. For example, Lung diseases contraindicate a rapid pulse. The Lung belongs to Metal, and rapidity belongs to Fire; this is Fire punishing Metal. The rest can be inferred analogously, all governed by the principles of the Five Elements (Wood, Fire, Earth, Metal, Water) generation and restriction. Nowadays, people do not examine symptoms but only discuss the pulse; the more detailed their discussion, the further they stray from the truth. As for the entirety of pulse theory, it has been detailed in the *Nei Jing* and other texts.
Symptoms are the manifestations of disease. If the disease pathogen is Heat, symptoms manifest as Heat; if Cold, symptoms manifest as Cold. This is an immutable principle. However, symptoms sometimes contradict the nature of the disease, leading to easy misdiagnosis and mistreatment, which must be known. For instance, a disease caused by exposure to Cold may present with body heat and aversion to heat; a disease caused by Summerheat injury may present with body coldness and aversion to cold; a case of Shang Shi (Food Stagnation) may present with increased appetite and ability to eat; a case of Shang Yin (Fluid Retention) may present with extreme thirst and dry mouth. Such diseases require careful examination. A single error in treating based on symptoms can determine life or death. There are reasons for these contradictions. Sometimes the disease trend is not yet fixed; for example, in Shang Han (Cold Damage), fever is expected, but if it has not yet appeared, it will likely appear later. This is a difference in sequence. Sometimes internal and external conditions differ, such as external cold but internal heat. Sometimes there is name without substance, such as desiring good food and drink but stopping after slight intake, and difficulty digesting afterwards. Sometimes other symptoms are mixed in, leading to misidentifying one symptom pattern as another. Sometimes a patient has a pre-existing condition, and a new condition emerges, causing old symptoms to reappear. Regarding contradictory pulses, variations also exist. Some individuals have constitutions different from the norm. Mild diseases may not manifest in the pulse. Phlegm and Qi obstruction may hinder Ying Qi (Nutritive Qi) flow, causing the pulse to deviate from its normal course. Temporary closure by pathogens may make the pulse appear dangerous, but it returns to normal once Qi flows freely. Some patients retain the pulse of a pre-existing condition despite new symptoms. These situations are numerous and cannot be fully listed. One must deeply contemplate and recognize the true nature of the condition to avoid confusion by symptoms and pulses. Otherwise, adhering rigidly to one aspect leads to greater errors in treatment. Unless one is extremely precise in syndrome differentiation and well-versed in pulse theory, confusion is inevitable.