〔《难》〕经言望而知之，谓之神；闻而知之，谓之圣；问而知之者，谓之工；切脉而知
之者，谓之巧，何谓也？望而知之者，望见其五色以知其病。闻而知之者，闻其五音以别其
病。问而知之者，问其所欲五味以知其病所起所在也。切脉而知之者，诊其寸口，视其虚实
，以知其病在何脏腑也。经言以外知之曰圣，以内知之曰神，此之谓也。
〔《素》〕诊法当以平旦，阴气未动，阳气未散，饮食未进，经脉未盛，络脉调匀，气脉
未乱，故乃可诊有过之脉。切脉动静而视精明，察五色，观五脏有余不足，六腑强弱，形之
衰盛，以此参伍，决死生之分。（《脉要精微论》）
〔丹〕∶经曰∶诊脉之道，观人勇怯，肌肉皮肤，能知其情，以为法也。凡人形长不及短
，大不及小，肥不及瘦。人之色白不及黑，嫩不及苍，薄不及浓。而况肥人湿多，瘦人火多
，白者，肺气虚；黑者，肾气足，形色既殊，脏腑亦异，外证虽同，治法迥别。所以肥人责
脉浮，瘦人责脉沉，躁人责脉缓，缓人责脉躁，不可一概述之。
仲景云∶肥人当沉今反浮，瘦人当浮今反沉，故责之。
〔《素》〕善诊者，察色按脉，先别阴阳；审清浊，而知部分；视喘息，听音声，而知所
苦；观权衡规矩，而知病所主；按尺寸，观浮沉滑涩，而知病所生，以治无过，以诊则不失
。（《阴阳应象论》）
闭户塞牖，系之病者，数问其情，以从其意。得神者昌，失神者亡（《移精变气论》）。
必审问其所始病，与今之所方病，而后各切循其脉，视其经络浮沉，以上下逆从循之（《三
部九候论》）。凡未诊病者，必问尝贵后贱，虽不中邪，病从内生，名曰脱荣。尝富后贫，
名曰失精。五气留连，病有所并。医工诊之，不在脏腑，不变躯形，诊之而疑，不知病名，
身体日减，气虚无精，病深无气，洒洒然时惊，病深者以其外耗于卫，内夺于荣，良工所失
，不知病情。（《疏五过论》）
〔东垣〕百病昼则增剧，夜则安静，是阳病有余，乃气病而血不病也。夜则增剧，昼则安
静，是阴病有余，乃血病而气不病也。昼则发热，夜则安静，是阳气自旺于阳分也。昼则安
静，夜则发热烦躁，是阳气下陷入阴中也，名曰热入血室。昼则发热烦躁，夜亦发热烦躁，
是重阳无阴，当亟泻其阳，峻补其阴。夜则恶寒，昼则安静，是阴血自旺于阴分也。夜则安
静，昼则恶寒，是阴气上溢于阳中也。夜则恶寒，昼亦恶寒，是重阴无阳，当急泻其阴，峻
补其阳。昼则恶寒，夜则烦躁，饮食不入，名曰阴阳交错者死矣。
〔丹〕肺主气，其脉居右寸，脾胃命门三焦，各以气为变化运用，故皆附焉。心主血，其
脉居左寸，肝、胆、肾、膀胱，皆精血之隧道管库，故皆附焉。男以气成胎，则气为之主。
女挟血成胎，则血为之主。男子病，右脉充于左者，有胃气也，病虽重可治。女子病，左脉
充于右者，有胃气也，病虽重可治。反此者，虚之甚也。
〔《素》〕脉有阴阳，知阳者，知阴；知阴者，知阳。凡阳有五，五五二十五阳。所谓阴
者，真藏也，见则为败，败必死也。所谓阳者，胃脘之阳也。别于阳者，知病处也。别于阴
者，知死生之期。三阳在头，三阴在手，所谓一也。别于阳者，知病忌时，别于阴者，知死
生之期（《阴阳别论》。王注曰∶头谓人迎脉，在结喉两傍一寸五分，手谓气口脉，在手鱼
际之后一寸，两者相应，俱往俱来，若引绳小大齐等者曰平人，故言“所谓一也”）。别于
阳者，知病从来。别于阴者，知死生之期。（《玉机真藏论》）
〔《灵》〕气口候阴，人迎候阳。（《四时气论》）
〔《素》〕谨熟阴阳，无与众谋。所谓阴阳者，去者为阴，至者为阳，静者为阴，动者为
阳，迟者为阴，数者为阳。（《阴阳别论》）
诸浮不躁者皆在阳，则为热，其有躁者在手。但浮不躁则病在足阳脉之中，其有躁者病
在手阳脉之中。）诸细而沉者皆在阴，则为骨痛，其有静者在足。（《脉要精微论》。沉细而
躁者病生于手阴脉之中，静者病生于足阴脉之中也。
〔《脉经》〕〔无择〕∶浮脉按之不足，举之有余。沉脉举之不足，按之有余。迟脉呼吸三至
，去来极迟。数脉去来促急。（一息六七至。）虚脉迟大而软，按之不足，指下豁豁然空。实脉
大而长，微强，按之隐指 然（一曰举按有力）。缓脉去来亦迟，小 于迟（一
曰浮大而软）。紧脉数如切绳状（一曰如转索之无常）。洪脉极大在指下。细脉小甚，似无而
有。滑脉往来前却，流利展转，替替然与数相似（一曰漉漉如欲脱。仲景云∶翕奄沉为滑，
沉为纯阴，翕为正阳，阴阳和合故名曰滑。许学士云∶仲景此三字论滑脉是也。翕，合也，
言张而复合也。奄沉，言忽降而下也。方翕而合，俄降而下，奄谓奄忽之间，仲景论滑脉可
谓谛矣）。涩脉细而迟，往来难且散，或一止复来（一曰短而止，《脉诀》云∶如刀刮竹痕。
陈无择云∶如雨沾沙）。弦脉举之无有，按之如弓弦状（弦而不大为弦，弦而大为革）。革脉
有似沉伏，实大而长，微弦（陈无择云∶如按鼓皮。仲景云∶弦而大）。软脉极软而浮细（软
，一作濡）。弱脉极软而沉细，按之欲绝指下。结脉往来缓，时一止复来（仲景云∶脉来动而
中止，更来小数，中有还者反动，名曰结，阴也。脉来动而中止，不能自还，因而复动，名
曰代，阴也，得此脉难治）。促脉来去数，时一止复来。芤脉浮大而软，按之中央空，两边
实。微脉极细而软，或时欲绝，若有若无。动脉见于关上，无头尾，大如豆，厥厥然动摇。
伏脉，极重指按之，着骨乃得。散脉大而散，散者气实血虚，有表无里。代脉来数而中止，
不能自还，因而复动（脉结者生，代者死）。
上阴阳相反脉状者，以王氏经文之脉形状移置。如陈氏《三因》云∶脉偶也。盖浮沉相
反，浮主表病属阳，沉主里病属阴也。迟数相反，迟主寒并病及阳气虚，数主热并病及血虚
也。虚实相反，虚主血气虚，实主血气实也。洪细相反，洪主血气多，细主血气少也。滑涩
相反，滑主血实气虚，涩主气实血虚也。缓紧相反，热主缓纵，寒主紧缩也。强革与濡弱相
反，强革主虚寒，濡弱主虚热，与缓紧同法推也。结促相反，结主阴盛，促主阳盛也。浮、
数、实、紧、洪、滑、强、革、芤、散属阳，沉、迟、虚、缓、细、涩、软、弱、结、微、
动、伏、代属阴，后贤因别阳脉为七表，阴脉为八里也。
浮与芤相类，弦与紧相类，滑与数相类，革与实相类，沉与伏相类，微与涩相类，软与
弱相类，缓与迟相类。
〔海藏〕气证则饮水，血证不饮水。气病则麻，血病则痛。无阳则厥，无阴则呕。阴证身
静重语无声，气难布息，目睛不了了，鼻中呼不出，吸不入，往来口与鼻中气冷，水浆不入
，大小便不禁而止，恶寒有如刀刮。阳证身动轻语有声，目睛了了，鼻中呼吸出入，能往能
来，口与鼻中气皆热。
〔《诊》〕两手脉浮之俱有阳，沉之俱有阴，阴阳皆实盛者，此为冲、督之脉也。冲、督
之脉者，十二经之道路也，冲督用事，则十二经不复朝于寸口，其人皆苦恍惚狂痴，不者必
当犹豫有两心也。两手阳脉浮而细微绵绵，不可知俱有，阴脉亦复细微绵绵，此为阴跷、阳
跷之脉也，此家曾有病鬼魅风，死苦恍惚，亡人为祸也。尺寸脉俱浮，直上直下，此为督脉
，腰背强痛，不得俯仰，大人癫病，小儿风痫疾。尺寸脉俱牢（一作“芤”）。直上直下，此
为冲脉，胸中有寒疝也。
〔《难》〕奇经之为病，何如？然，阳维维于阳，阴维维于阴，阴阳不能自相维，则怅然
失志，溶溶不能自收持。阴跷为病，阳缓而阴急。阳跷为病，阴缓而阳急。冲之为病，逆气
而里急。督之为病，脊强而厥（《素问》作“脊强反折”）。任之为病，其内苦结，男子为七
疝，女子为瘕聚。带之为病，腹满腰溶溶若坐水中。阳维为病，苦寒热。阴维为病，苦心痛
。此奇经八脉之为病也。（《二十九难》）
〔丹〕阳滞于阴，阴滞于阳论《精要》云∶阳滞于阴，脉浮、洪、弦、数。阴滞于阳，脉
沉、细、弱、涩。阳滞以寒治之，阴滞以热治之。窃详其意，阳滞阴滞，当作热滞寒滞，求
之寒热，固可作阴阳论，能于阴于阳分明，是于气血，他无可言也。热滞于气固矣，独无寒
滞耶。寒滞于血固矣，独无热滞耶。何寒不能伤气，何热不能伤血耶。以愚观之，气为阳，
行脉外；血为阴，行脉内。相并分派，周流循环，一身无停止，谓之脉。一呼脉行三寸，一
吸脉行三寸，呼吸定息，脉共得六寸，一身通七尺五寸，行得八百一十丈。得热则行速，为
太过；得寒则行迟，为不及。五味之偏，七情之过，气为疑滞，津液稠浓，积而久之，为饮
为痰，渗入脉内，血为所乱，因而凝浊，营运泣 ，或为沸腾，此阴滞于阳也，正是血
滞于气也。气病矣，或以药助邪，病上生病，血病日增，溢出脉外，隧道隘塞，升降有妨，
运化失令，此阳滞于阴也，正是气滞于血也。病分寒热者，当是禀受之索偏，虚邪之杂合，
岂可专以阳为热阴为寒耶。浮洪弦数，气病之脉也，岂可遽作热论。沉细弱涩，血病之脉也
，岂可遽作寒论。此万病之根本，岂止疥癣疮疡痈疽而已，幸相评其是否（ ，胡故切
，闭塞也）。
〔《素》〕寸口脉沉而坚者，曰病在中；寸口脉浮而盛者，曰病在外（《平人气象论》。
下同。海藏云∶脉浮为表。浮之实大，沉之损小，是为表也。浮之实大，沉之亦然，即非表
也，邪已入深矣）。脉盛滑坚者，病在外；脉小实而坚者，病在内。
〔《灵》〕气口主中，人迎主外（《禁服篇》）。人迎盛坚者，伤于寒；气口盛坚者，伤于
食。（《五色篇》）
上气口脉谓两手掌后手太阴之脉也，人迎脉谓挟喉两傍足阳明之脉也。
〔海〕∶辨内外伤，伤风鼻中气出粗，合口不开，肺气通乎天地；伤食口无味，津液不纳，
鼻息气匀，脾气通乎地也。外伤一身尽热，先太阳也，从外而之内者，先无形也。内伤手足
不和，两胁俱热，先少阳也，从内之外者，先有形也。内外俱伤，人迎气口俱盛，或举按皆
实大，表发热而恶寒，腹不和而口渴，此内外两伤也。凡诊则先扪手心手背，手心热则内伤
，手背热则外伤，次以脉别之。
〔《难》〕脉有三部九候，各有所主之。然，三部者，寸、关、尺也。九候者，浮、中、
沉也。上部法天，主胸以上至头有疾；中部法人，主膈下至脐上有疾；下部法地，主脐以下
至足有疾。宜审刺之。（《十八难》）
〔《活人》〕凡初下指，先以中指端按得关位，掌后高骨为关，乃齐下前后二指，为三部
脉，前指寸口也，后指尺部也。若人臂长乃疏下指，臂短则密下指。若先诊寸口，浮按消息
之，次中按消息之，次重按消息之，次上竟消息之，次下竟消息之，次推指外消息之，次推
指内消息之。凡诊脉以气息平定方下指，以一呼一吸为一息，其一息之间，脉息四至或五至
，不大不小，与所属部分四时相应者为平和脉矣。过则为至，不及则为损，损至之脉，《难
经》详言之矣。
仲景曰∶吸而微数，其病在中焦实也，当下之即愈，虚者不治。在上焦者，其吸促；在
下焦者，其吸远，此皆难治，呼吸动摇振振者不治。
〔《素》〕五脏不平，六腑闭塞之所生也。（《通评虚实论》）
〔《难》〕何以别知脏腑之病也？然，数者腑也，迟者脏也，数则为热，迟则为寒。诸阳
为热，诸阴为寒。故以别知脏腑之病也（《九难》）。病有欲得温者，有欲得寒者，有欲得见
人者，有不欲得见人者，而各不同，其病在何脏腑？然，病欲得寒而欲得见人者，病在腑也
。病欲得温而不欲得见人者，病在脏也。何以言之？腑者阳，阳病欲得寒，又欲见人。脏者
阴，阴病欲得温，又欲闭户独处，恶闻人声。故以别知脏腑之病也（《五十一难》）。脏腑发
病，根本等不？然，不等也。奈何？然，脏病者，止而不移，其病不离其处。腑病者，仿佛贲
响，上下行流，居处无常。（《五十二难》）
〔《素》〕帝曰∶夫百病之生也，皆生于风、寒、暑、湿、燥、火以之化之变也。经言盛
者泻之，虚者补之，余锡以方士，而方士用之尚未能十全，余欲令要道必行，桴鼓相应，犹
拔刺雪污，功巧神圣，可得闻乎？岐伯曰∶审察病机，无失气宜，此之谓也。帝曰∶愿闻病
机何如？岐伯曰∶诸风掉眩，皆属于肝。诸寒收引，皆属于肾，诸气 郁，皆属于肺。
诸湿肿满，皆属于脾。诸热瞀 ，皆属于火。诸痛痒疮，皆属于心。诸厥固泄，皆属于下。
诸痿喘呕，皆属于上。诸禁鼓栗，如丧神守，皆属于火。诸痉项强，皆属于湿。诸逆冲上，
【《难经》】经文说：通过观察神色就能知道病情，称为“神”；通过听声音、闻气味就能知道病情，称为“圣”；通过询问病史就能知道病情，称为“工”；通过切脉就能知道病情，称为“巧”。这是什么意思呢？所谓“望而知之”，是观察患者的五色（青、赤、黄、白、黑）来推断疾病。所谓“闻而知之”，是听取患者的五音（角、徵、宫、商、羽）来辨别疾病。所谓“问而知之”，是询问患者对五味（酸、苦、甘、辛、咸）的偏好，从而知道疾病的起因和所在部位。所谓“切脉而知之”，是诊察寸口脉，观察其虚实现象，从而知道疾病位于哪个脏腑。经文所说的“从外部征象判断称为圣，从内部机理判断称为神”，指的就是这个道理。
【《黄帝内经·素问》】诊脉应当在清晨进行，此时阴气尚未扰动，阳气尚未耗散，饮食尚未摄入，经脉之气尚未充盛，络脉之气调匀，气血运行尚未紊乱，因此可以诊察出异常的脉象。切按脉搏的动静，观察眼睛的神采，审视面部的五色，考察五脏的有余和不足、六腑的强与弱、形体的衰与盛，将这些情况综合参互比较，以此决断生死界限。（出自《脉要精微论》）
【朱丹溪】经文说：诊脉的道理，在于观察人的勇敢或怯懦，以及肌肉皮肤的状况，从而了解病情，作为诊断的依据。一般来说，身形长的人不及短的人（脉象不同），身形大的人不及小的人，肥胖的人不及瘦的人。面色白的人不及黑的人，肤质嫩的人不及粗糙的人，皮下脂肪薄的人不及厚的人。更何况肥胖之人湿气多，瘦弱之人火气多，面色白者肺气虚，面色黑者肾气足。既然形体和颜色已经不同，脏腑的功能也就各异，即使外在症状相同，治疗方法也截然不同。所以，对于肥胖之人，若脉象浮，应追究原因；对于瘦弱之人，若脉象沉，应追究原因；对于急躁之人，若脉象缓，应追究原因；对于迟缓之人，若脉象躁动，应追究原因，不能一概而论。
张仲景说：肥胖之人脉象应当沉，现在反而浮，所以要追究原因；瘦弱之人脉象应当浮，现在反而沉，所以要追究原因。
【《黄帝内经·素问》】善于诊病的人，观察面色并按摸脉象，首先辨别阴阳；审察面色的清浊，从而知道病变的部位；观察呼吸喘息，听取声音，从而知道病人的痛苦所在；观察权衡规矩（比喻脉象的变化规律），从而知道疾病的主攻方向；按摸尺肤和寸口，观察脉象的浮沉滑涩，从而知道疾病的产生原因，这样治疗就不会有过错，诊察就不会有失误。（出自《阴阳应象大论》）
关上窗户，专注于病人，多次询问他的情志和意愿，以顺从他的心意。得神者昌，失神者亡（出自《移精变气论》）。必须详细询问他最初发病的情况，以及现在正在发生的病症，然后分别切按循摸其脉象，观察经络的浮沉，根据上下逆从的规律来推求（出自《三部九候论》）。凡是还没有诊病之前，必须询问病人曾经显贵后来卑贱的经历，即使没有遭受外邪侵袭，疾病也会从内生发，名叫“脱荣”。曾经富有后来贫穷的经历，名叫“失精”。五脏之气留滞连累，疾病会相互合并。医生诊察时，发现病不在脏腑，形体也没有变化，诊察后感到疑惑，不知道是什么病名，但病人身体日渐消瘦，气虚无精，病深入而元气衰竭，时时感到洒洒恶寒且惊恐，这是因为病邪在外耗损卫气，在内掠夺营血，高明的医生如果失去这些，就是不了解病情。（出自《疏五过论》）
【李东垣】各种疾病如果在白天加重，夜间安静，这是阳病有余，属于气分有病而血分无病。如果在夜间加重，白天安静，这是阴病有余，属于血分有病而气分无病。白天发热，夜间安静，这是阳气在阳分旺盛。白天安静，夜间发热烦躁，这是阳气下陷进入阴分中，名叫“热入血室”。白天发热烦躁，夜间也发热烦躁，这是重阳无阴，应当紧急泻其阳，峻补其阴。夜间怕冷，白天安静，这是阴血在阴分旺盛。夜间安静，白天怕冷，这是阴气上溢于阳分中。夜间怕冷，白天也怕冷，这是重阴无阳，应当紧急泻其阴，峻补其阳。白天怕冷，夜间烦躁，饮食不进，这名叫“阴阳交错”，预后不良，主死。
【朱丹溪】肺主气，其脉位于右寸，脾胃、命门、三焦，都依靠气来进行变化和运用，所以都与肺相关。心主血，其脉位于左寸，肝、胆、肾、膀胱，都是精血运行的通道和仓库，所以都与心相关。男子以气成胎，所以以气为主。女子挟血成胎，所以以血为主。男子生病，右脉充实超过左脉的，说明有胃气，病虽然重但可以治愈。女子生病，左脉充实超过右脉的，说明有胃气，病虽然重但可以治愈。与此相反的，则是虚损非常严重。
【《黄帝内经·素问》】脉象有阴阳之分，懂得阳脉，就懂得阴脉；懂得阴脉，就懂得阳脉。凡阳脉有五种，五五二十五种阳脉。所谓的阴脉，是指真脏脉，出现真脏脉则预示脏腑败坏，败坏必然死亡。所谓的阳脉，是指胃脘之阳（胃气）。辨别阳脉，可以知道病变的部位；辨别阴脉，可以知道死亡的期限。三阳脉见于头颈部（人迎），三阴脉见于手部（气口），这就是所谓的“一”。辨别阳脉，可以知道疾病的禁忌时间；辨别阴脉，可以知道死亡的期限（出自《阴阳别论》。王冰注解说：头指人迎脉，在结喉两旁一寸五分处；手指气口脉，在手鱼际之后一寸处，两者相应，俱往俱来，像拉绳子一样大小整齐相等的是平人，所以说“所谓一也”）。辨别阳脉，可以知道疾病的来源；辨别阴脉，可以知道死亡的期限（出自《玉机真脏论》）。
【《黄帝内经·灵枢》】气口脉候察阴分，人迎脉候察阳分。（出自《四时气论》）
【《黄帝内经·素问》】谨慎熟习阴阳理论，不要与众人商议。所谓的阴阳，离去者为阴，到来者为阳，静止者为阴，运动者为阳，迟慢者为阴，快速者为阳。（出自《阴阳别论》）
所有浮脉但不躁动的，都在阳分，表现为热证，如果有躁动，则病在手部阳脉。只有浮脉而不躁动的，病在足部阳脉之中，如果有躁动，病在手部阳脉之中。所有细而沉的脉，都在阴分，表现为骨痛，如果有静象，则在足部。（出自《脉要精微论》。沉细而躁动的，病生于手部阴脉之中，静象的病生于足部阴脉之中。）
【王叔和《脉经》】【陈无择】浮脉按之力量不足，举之力量有余。沉脉举之力量不足，按之力量有余。迟脉一呼一吸之间跳动三次，往来极慢。数脉往来急促。（一息跳动六七次。）虚脉迟大而软，按之不足，指下豁然空虚。实脉大而长，略微强劲，按之隐然有力（一说举按都有力）。缓脉往来也迟，比迟脉稍快（一说浮大而软）。紧脉数急如同切绳状（一说如转索无常）。洪脉极大，在指下感觉明显。细脉非常小，似有似无。滑脉往来流利，展转替替然，与数脉相似（一说漉漉如欲脱。张仲景说：翕奄沉为滑，沉为纯阴，翕为正阳，阴阳和合故名曰滑。许学士说：张仲景这三个字论述滑脉是正确的。翕，合也，言张开又闭合。奄沉，言忽然降而下也。方翕而合，俄降而下，奄谓奄忽之间，张仲景论述滑脉可谓精确了）。涩脉细而迟，往来困难且散乱，或者跳一下停一下再跳（一说短而止，《脉诀》说：如刀刮竹痕。陈无择说：如雨沾沙）。弦脉举之无力，按之如弓弦状（弦而不大为弦，弦而大为革）。革脉似乎沉伏，实则大而长，略微带弦（陈无择说：如按鼓皮。张仲景说：弦而大）。软脉极软而浮细（软，一作濡）。弱脉极软而沉细，按之欲绝，指下感觉微弱。结脉往来缓慢，时常停一下再跳（张仲景说：脉来动而中止，更来小数，中有还者反动，名曰结，属阴。脉来动而中止，不能自还，因而复动，名曰代，属阴，得此脉难治）。促脉来去快速，时常停一下再跳。芤脉浮大而软，按之中间空，两边实。微脉极细而软，有时欲绝，若有若无。动脉见于关部，无头尾，大如豆粒，厥厥然动摇。伏脉，极重指按之，着骨才能取得。散脉大而散，散者气实血虚，有表无里。代脉来数而中止，不能自还，因而复动（脉结者生，代者死）。
上面提到的阴阳相反脉状，是根据王氏经文中的脉形状移置排列的。如陈氏《三因方》说：脉偶也。大概浮沉相反，浮主表病属阳，沉主里病属阴。迟数相反，迟主寒并病及阳气虚，数主热并病及血虚。虚实相反，虚主血气虚，实主血气实。洪细相反，洪主血气多，细主血气少。滑涩相反，滑主血实气虚，涩主气实血虚。缓紧相反，热主缓纵，寒主紧缩。强革与濡弱相反，强革主虚寒，濡弱主虚热，与缓紧同理推导。结促相反，结主阴盛，促主阳盛。浮、数、实、紧、洪、滑、强、革、芤、散属阳，沉、迟、虚、缓、细、涩、软、弱、结、微、动、伏、代属阴，后世贤者因此将阳脉分为七表，阴脉分为八里。
浮与芤相类似，弦与紧相类似，滑与数相类似，革与实相类似，沉与伏相类似，微与涩相类似，软与弱相类似，缓与迟相类似。
【张元素（海藏）】气证则想喝水，血证不想喝水。气病则麻木，血病则疼痛。无阳则四肢厥冷，无阴则呕吐。阴证身体安静，语声低微，气息难以布散，眼神不清，鼻中呼气出不去，吸气进不来，口鼻间气息寒冷，水浆不能入口，大小便失禁或停止，怕冷如同刀刮皮肤。阳证身体躁动，语声清晰响亮，眼神清明，鼻中呼吸出入顺畅，能往能来，口鼻间气息皆热。
【《脉诀》】两手脉象浮取都有阳脉，沉取都有阴脉，阴阳都实盛的，这是冲脉、督脉的脉象。冲脉、督脉，是十二经的道路，冲督二脉主事，则十二经不再朝会于寸口，这样的人都会苦恼于恍惚狂痴，否则必定犹豫不决，有二心。两手阳脉浮而细微绵绵，不可知是否都有，阴脉也细微绵绵，这是阴跷、阳跷的脉象，这类人曾经有病鬼魅风，死后苦恼恍惚，亡人为祸。尺寸脉都浮，直上直下，这是督脉，腰背强痛，不能俯仰，大人癫病，小儿风痫疾。尺寸脉都牢（一作“芤”），直上直下，这是冲脉，胸中有寒疝。
【《难经》】奇经八脉生病，怎么样呢？回答说：阳维维系于阳，阴维维系于阴，阴阳不能互相维系，则怅然失志，溶溶不能自我收持。阴跷脉生病，阳侧弛缓而阴侧拘急。阳跷脉生病，阴侧弛缓而阳侧拘急。冲脉生病，气逆而里急。督脉生病，脊背强直而厥逆（《素问》作“脊强反折”）。任脉生病，体内苦闷结聚，男子患七疝，女子患瘕聚。带脉生病，腹部满胀，腰部松软如坐水中。阳维脉生病，苦于寒热往来。阴维脉生病，苦于心痛。这就是奇经八脉的疾病。（出自《二十九难》）
【朱丹溪】阳滞于阴，阴滞于阳 讨论《精要》说：阳滞于阴，脉象浮、洪、弦、数。阴滞于阳，脉象沉、细、弱、涩。阳滞用寒凉法治，阴滞用温热法治。我仔细推敲其意，阳滞阴滞，应当作热滞寒滞解，寻求寒热，固然可以作阴阳论，能在阴阳分明，就是在气血方面，也没什么可说的了。热滞于气固然正确，难道没有寒滞吗？寒滞于血固然正确，难道没有热滞吗？为什么寒不能伤气，热不能伤血呢？依我看，气为阳，行于脉外；血为阴，行于脉内。相并分派，周流循环，一身无停止，谓之脉。一呼脉行三寸，一吸脉行三寸，呼吸定息，脉共得六寸，一身通七尺五寸，行得八百一十丈。得热则行速，为太过；得寒则行迟，为不及。五味的偏嗜，七情的过度，气为疑滞，津液稠浓，积而久之，为饮为痰，渗入脉内，血为所乱，因而凝浊，营运泣滞，或为沸腾，这是阴滞于阳，正是血滞于气。气病了，或者用药助长邪气，病上加病，血病日益增加，溢出脉外，隧道隘塞，升降受阻，运化失职，这是阳滞于阴，正是气滞于血。病分寒热的，应当是禀受素质偏颇，虚邪杂合，岂可专以阳为热阴为寒呢？浮洪弦数，是气病的脉象，岂可遽然作热论。沉细弱涩，是血病的脉象，岂可遽然作寒论。这是万病的根本，岂止是疥癣疮疡痈疽而已，希望相互评判是否正确（“泣”，胡故切，闭塞也）。
【《黄帝内经·素问》】寸口脉沉而坚的，说病在中焦；寸口脉浮而盛的，说病在外（《平人气象论》。下同。海藏说：脉浮为表。浮取实大，沉取损小，是为表证。浮取实大，沉取亦然，即非表证，邪已入深矣）。脉盛滑坚的，病在外；脉小实而坚的，病在内。
【《黄帝内经·灵枢》】气口主内伤病，人迎主外感病（《禁服篇》）。人迎脉盛坚的，伤于寒；气口脉盛坚的，伤于食。（《五色篇》）
上文所说的气口脉是指两手手掌后方手太阴肺经的脉，人迎脉是指挟喉两旁足阳明胃经的脉。
【张元素（海）】辨别内外伤，伤风者鼻中气息粗出，合口不开，因为肺气通乎天地；伤食者口中无味，津液不纳，鼻息气匀，因为脾气通乎地。外伤则一身尽热，先起于太阳经，是从外而入内的，先无形质。内伤则手足不和，两胁俱热，先起于少阳经，是从内而外的，先有形质。内外俱伤，人迎和气口脉都盛，或者举按都实大，表发热而恶寒，腹不和而口渴，这是内外两伤。凡是诊察，先扪摸手心手背，手心热则内伤，手背热则外伤，其次以脉象辨别。
【《难经》】脉有三部九候，各有所主的部位。回答说：三部，是指寸、关、尺。九候，是指浮、中、沉。上部法天，主胸以上至头部的疾病；中部法人，主膈下至脐上的疾病；下部法地，主脐以下至足部的疾病。应当审慎刺治。（出自《十八难》）
【朱肱《活人书》】凡是初下指，先用中指端按得关位，掌后高骨为关，然后齐下前后二指，为三部脉，前指寸口也，后指尺部也。如果人手臂长则疏下指，手臂短则密下指。如果先诊寸口，轻按消息之，次中按消息之，次重按消息之，次上竟消息之，次下竟消息之，次推指外消息之，次推指内消息之。凡是诊脉以气息平定才下指，以一呼一吸为一息，其一息之间，脉息四至或五至，不大不小，与所属部分四时相应的是平和脉。超过则为至，不及则为损，损至之脉，《难经》详言之了。
张仲景说：吸气而微数，病在中焦实，当下之即愈，虚者不治。在上焦者，其吸促；在下焦者，其吸远，此皆难治，呼吸动摇振振者不治。
【《黄帝内经·素问》】五脏不平，是由六腑闭塞所产生的。（《通评虚实论》）
【《难经》】如何区别知道脏腑的疾病呢？回答说：数脉属腑，迟脉属脏，数则为热，迟则为寒。诸阳为热，诸阴为寒。所以以此区别知道脏腑的疾病（《九难》）。病有想要温暖的，有想要寒冷的，有想要见人的，有不想要见人的，而且各不相同，病在哪个脏腑？回答说：病想要寒冷而又想要见人的，病在腑。病想要温暖而不想要见人的，病在脏。为什么说呢？腑属阳，阳病想要寒冷，又想要见人。脏属阴，阴病想要温暖，又想要关户独处，厌恶听到人声。所以以此区别知道脏腑的疾病（《五十一难》）。脏腑发病，根本相等吗？回答说：不相等。为什么呢？回答说：脏病者，止而不移，其病不离其处。腑病者，仿佛贲响，上下行流，居处无常。（《五十二难》）
【《黄帝内经·素问》】黄帝说：百病的产生，都生于风、寒、暑、湿、燥、火，由它们转化变异而成。经文说盛者泻之，虚者补之，我把方术赐给你，而方士使用它还不能十全十美，我想让要道必行，如桴鼓相应，犹如拔刺雪污，功巧神圣，可以听说吗？岐伯说：审察病机，无失气宜，这就是所说的道理。黄帝说：愿意听听病机是怎样的？岐伯说：诸风掉眩，皆属于肝。诸寒收引，皆属于肾，诸气郁，皆属于肺。诸湿肿满，皆属于脾。诸热瞀瘛，皆属于火。诸痛痒疮，皆属于心。诸厥固泄，皆属于下。诸痿喘呕，皆属于上。诸禁鼓栗，如丧神守，皆属于火。诸痉项强，皆属于湿。诸逆冲上，
[From *Nan Jing* (Classic of Difficult Issues)] The classic states: "To know through observation is called 'Shen' (Divine); to know through listening and smelling is called 'Sheng' (Sage); to know through questioning is called 'Gong' (Skilled artisan); to know through palpating the pulse is called 'Qiao' (Dexterous). What does this mean?" To know through observation means observing the Five Colors (Green, Red, Yellow, White, Black) to infer the disease. To know through listening and smelling means hearing the Five Tones (Jue, Zhi, Gong, Shang, Yu) to distinguish the disease. To know through questioning means asking about the patient's preference for the Five Flavors (Sour, Bitter, Sweet, Pungent, Salty) to know the origin and location of the disease. To know through palpating the pulse means diagnosing at the Cun Kou (Radial Artery), observing its deficiency or excess, to know which Zang-Fu organ is affected. The statement in the classic that "knowing from external signs is Sheng, knowing from internal mechanisms is Shen" refers to this.
[From *Su Wen* (Basic Questions)] Pulse diagnosis should be performed at dawn, when Yin Qi has not yet moved, Yang Qi has not yet dispersed, food and drink have not been taken, the Jing Mai (Regular Meridians) are not yet full, the Luo Mai (Connecting Vessels) are harmonious, and the Qi and pulse are not yet chaotic. Thus, abnormal pulses can be diagnosed. By feeling the movement and stillness of the pulse, observing the clarity of the eyes, examining the five colors of the face, and assessing the excess or deficiency of the Zang organs, the strength or weakness of the Fu organs, and the flourishing or declining state of the body form, these factors are cross-referenced to determine the division between life and death. (From *Mai Yao Jing Wei Lun*)
[Zhu Danxi] The classic says: "The way of pulse diagnosis lies in observing a person's courage or timidity, as well as their muscles and skin, to understand their condition and establish diagnostic methods." Generally, tall stature differs from short, large from small, and fat from thin. Pale complexion differs from dark, tender skin from rough, and thin subcutaneous tissue from thick. Moreover, fat people tend to have more Dampness, while thin people tend to have more Fire. Those with pale complexions have deficient Lung Qi; those with dark complexions have sufficient Kidney Qi. Since physical appearance and color differ, the functions of the Zang-Fu organs also differ. Even if external symptoms are the same, treatment methods are vastly different. Therefore, for fat people, a floating pulse requires investigation; for thin people, a deep pulse requires investigation; for restless people, a slow pulse requires investigation; for sluggish people, a rapid/agitated pulse requires investigation. One cannot generalize.
Zhang Zhongjing said: "For fat people, the pulse should be deep; if it is now floating, investigate. For thin people, the pulse should be floating; if it is now deep, investigate."
[From *Su Wen*] A skilled diagnostician observes the complexion and palpates the pulse, first distinguishing Yin and Yang; examines the clarity or turbidity of the complexion to know the location of the lesion; observes breathing and listens to voice sounds to know where the suffering lies; observes the balance, rules, circle, and square (metaphors for pulse variations) to know the main aspect of the disease; palpates the Chi and Cun positions, observing floating, deep, slippery, and choppy qualities to know the origin of the disease. In this way, treatment will have no errors, and diagnosis will be flawless. (From *Yin Yang Ying Xiang Da Lun*)
Close the doors and windows, focus on the patient, ask repeatedly about their emotional state and desires, and follow their intentions. Those who possess Shen (Spirit) prosper; those who lose Shen perish. (From *Yi Jing Bian Qi Lun*) You must carefully inquire about the initial onset of the disease and the current symptoms, then palpate each pulse, observing the floating or deep nature of the meridians, and trace them according to the principles of upward/downward and reverse/compliant movements. (From *San Bu Jiu Hou Lun*) Before diagnosing any illness, one must ask if the patient was formerly noble but became humble. Even without external pathogenic invasion, disease may arise internally, named "Tuo Rong" (Loss of Glory). If the patient was formerly rich but became poor, it is named "Shi Jing" (Loss of Essence). The Qi of the Five Zang organs may linger and affect each other, causing diseases to combine. When physicians diagnose, they may find the disease is not in the Zang-Fu, nor has the body shape changed. They diagnose with doubt, unaware of the disease name. The body wastes away daily, Qi becomes empty and Essence depleted, the disease is deep with exhausted Qi, and the patient feels chilly and startled frequently. This is because the pathogen externally depletes Wei Qi and internally robs Ying Blood. A competent physician who misses this fails to understand the condition. (From *Shu Wu Guo Lun*)
[Li Dongyuan] Various diseases that worsen during the day and quiet at night indicate Excess of Yang disease, meaning Qi is diseased while Blood is not. Diseases that worsen at night and quiet during the day indicate Excess of Yin disease, meaning Blood is diseased while Qi is not. Fever during the day with quietness at night indicates Yang Qi flourishing in the Yang divisions. Quietness during the day with fever and irritability at night indicates Yang Qi sinking into the Yin divisions, named "Re Ru Xue Shi" (Heat Entering the Blood Chamber). Fever and irritability both day and night indicate Double Yang without Yin; one must urgently drain Yang and vigorously tonify Yin. Chills at night with quietness during the day indicate Yin Blood flourishing in the Yin divisions. Quietness at night with chills during the day indicates Yin Qi overflowing into the Yang divisions. Chills both day and night indicate Double Yin without Yang; one must urgently drain Yin and vigorously tonify Yang. Chills during the day with irritability at night, inability to eat or drink, is named "Yin Yang Jiao Cuo" (Intermingling of Yin and Yang) and is fatal.
[Zhu Danxi] The Lung governs Qi, and its pulse is located at the Right Cun. The Spleen, Stomach, Ming Men, and San Jiao all rely on Qi for transformation and function, so they are associated with it. The Heart governs Blood, and its pulse is located at the Left Cun. The Liver, Gallbladder, Kidney, and Bladder are all channels and stores for Essence and Blood, so they are associated with it. Men conceive via Qi, so Qi is primary. Women carry fetus via Blood, so Blood is primary. In men, if the Right pulse is fuller than the Left, there is Stomach Qi; even if the disease is severe, it is treatable. In women, if the Left pulse is fuller than the Right, there is Stomach Qi; even if the disease is severe, it is treatable. The opposite indicates extreme deficiency.
[From *Su Wen*] Pulses have Yin and Yang aspects. Knowing Yang allows one to know Yin; knowing Yin allows one to know Yang. There are five types of Yang pulses, totaling twenty-five Yang manifestations. The so-called Yin pulses refer to the True Zang pulses; their appearance indicates failure, and failure leads to death. The so-called Yang pulses refer to the Yang of the Stomach cavity (Stomach Qi). Distinguishing Yang allows one to know the location of the disease; distinguishing Yin allows one to know the time of death. The Three Yang pulses are found at the head (Ren Ying), and the Three Yin pulses are found at the hand (Qi Kou); this is referred to as "One." Distinguishing Yang allows one to know the contraindicated times for disease; distinguishing Yin allows one to know the time of death. (From *Yin Yang Bie Lun*. Wang Bing's commentary: Head refers to Ren Ying pulse, 1.5 cun lateral to the Adam's apple; Hand refers to Qi Kou pulse, 1 cun posterior to the thenar eminence. The two correspond, moving together, equal in size like a drawn rope, indicating a healthy person, hence "referred to as One.") Distinguishing Yang allows one to know the origin of the disease; distinguishing Yin allows one to know the time of death. (From *Yu Ji Zhen Zang Lun*)
[From *Ling Shu*] Qi Kou diagnoses Yin; Ren Ying diagnoses Yang. (From *Si Shi Qi Lun*)
[From *Su Wen*] Carefully master Yin and Yang, do not consult with others. The so-called Yin and Yang: departing is Yin, arriving is Yang; stillness is Yin, motion is Yang; slowness is Yin, speed is Yang. (From *Yin Yang Bie Lun*)
All floating pulses without agitation belong to Yang, manifesting as Heat. If there is agitation, the disease is in the Hand Yang pulses. Only floating without agitation indicates disease in the Foot Yang pulses; if there is agitation, it is in the Hand Yang pulses. All fine and deep pulses belong to Yin, manifesting as bone pain. If there is stillness, it is in the Foot. (From *Mai Yao Jing Wei Lun*. Fine, deep, and agitated indicates disease in the Hand Yin pulses; stillness indicates disease in the Foot Yin pulses.)
[Wang Shuhe *Mai Jing*] [Chen Wuyue] Floating pulse: insufficient upon pressing, abundant upon lifting. Deep pulse: insufficient upon lifting, abundant upon pressing. Slow pulse: three beats per respiration, very slow. Rapid pulse: fast and urgent. (Six to seven beats per respiration.) Deficient pulse: slow, large, and soft; insufficient upon pressing, feeling hollow under the fingers. Excess pulse: large and long, slightly strong; firm upon pressing (or forceful upon both lifting and pressing). Moderate pulse: slow, slightly faster than slow (or floating, large, and soft). Tight pulse: rapid like cutting a rope (or like a twisting cord). Surging pulse: very large under the finger. Fine pulse: very small, seeming to exist but barely. Slippery pulse: fluent and rolling back and forth, similar to rapid (or gurgling like slipping off. Zhang Zhongjing said: Xi and An Chen constitute Slippery; Chen is pure Yin, Xi is positive Yang, their harmony is Slippery. Xu Xueshi said: These three characters by Zhang Zhongjing accurately describe Slippery pulse. Xi means closing, opening then closing. An Chen means suddenly descending. Just as it closes, it suddenly descends; An refers to the instant. Zhang Zhongjing's description of Slippery pulse is precise.). Choppy pulse: fine and slow, difficult and scattered to move, or stopping occasionally (or short and stopping. *Mai Jue* says: like a knife scraping bamboo marks. Chen Wuyue says: like rain soaking sand.). String-taut pulse: weak upon lifting, like a bowstring upon pressing (String-taut but not large is String-taut; string-taut and large is Leathery.). Leathery pulse: seems deep and hidden, actually large and long, slightly string-taut (Chen Wuyue says: like pressing a drum skin. Zhang Zhongjing says: String-taut and large.). Soft pulse: extremely soft, floating, and fine (Soft, also written as Ru.). Weak pulse: extremely soft, deep, and fine, nearly imperceptible upon pressing. Knotted pulse: slow with occasional stops (Zhang Zhongjing said: Pulse moves then stops, returns quickly, then moves again, named Jie, Yin type. Pulse moves then stops, cannot return immediately, then moves again, named Dai, Yin type; difficult to treat.). Urgent pulse: rapid with occasional stops. Scallion-stalk pulse: floating, large, and soft; empty in the center, solid on the sides. Minute pulse: extremely fine and soft, sometimes nearly absent, seeming to exist but not. Pulsating pulse: seen at Guan, no head or tail, size of a bean, quivering. Hidden pulse: requires extreme pressure, felt only against the bone. Dispersed pulse: large and scattered; indicates Qi excess and Blood deficiency, exterior without interior. Alternating pulse: rapid with stops, cannot return immediately, then moves again (Knotted pulse survives; Alternating pulse dies).
The above opposing pulse shapes are arranged according to Wang's classic. As Chen's *San Yin Fang* states: Pulses are paired. Floating and Deep oppose; Floating indicates Exterior/Yang disease, Deep indicates Interior/Yin disease. Slow and Rapid oppose; Slow indicates Cold/deficient Yang, Rapid indicates Heat/deficient Blood. Excess and Deficient oppose; Deficient indicates Blood/Qi deficiency, Excess indicates Blood/Qi excess. Large and Fine oppose; Large indicates abundant Blood/Qi, Fine indicates scarce Blood/Qi. Slippery and Choppy oppose; Slippery indicates Blood excess/Qi deficiency, Choppy indicates Qi excess/Blood deficiency. Moderate and Tight oppose; Heat causes relaxation (Moderate), Cold causes contraction (Tight). Strong/Leathery oppose Soft/Weak; Strong/Leathery indicate Deficient Cold, Soft/Weak indicate Deficient Heat, deduced similarly to Moderate/Tight. Knotted and Urgent oppose; Knotted indicates Yin excess, Urgent indicates Yang excess. Floating, Rapid, Excess, Tight, Large, Slippery, Strong, Leathery, Scallion-stalk, Dispersed belong to Yang. Deep, Slow, Deficient, Moderate, Fine, Choppy, Soft, Weak, Knotted, Minute, Pulsating, Hidden, Alternating belong to Yin. Later scholars divided Yang pulses into Seven Tables and Yin pulses into Eight Li.
Floating resembles Scallion-stalk; String-taut resembles Tight; Slippery resembles Rapid; Leathery resembles Excess; Deep resembles Hidden; Minute resembles Choppy; Soft resembles Weak; Moderate resembles Slow.
[Zhang Congzheng (Hai Zang)] Qi disorders involve thirst for water; Blood disorders do not. Qi disease causes numbness; Blood disease causes pain. No Yang leads to cold limbs; No Yin leads to vomiting. Yin disorder: body still, whispering, difficult breathing, unclear vision, breath unable to exit nose/inlet mouth, cold air from mouth/nose, inability to swallow, incontinence or retention of urine/feces, aversion to cold like skin scraping. Yang disorder: body active, loud speech, clear vision, smooth breathing, hot air from mouth/nose.
[From *Mai Jue*] Both hands' pulses show Yang upon floating and Yin upon deepening; both Yin and Yang are full and vigorous; this is the Chong and Du Mai. Chong and Du Mai are the pathways of the Twelve Regular Meridians. When Chong and Du are active, the Twelve Meridians no longer converge at Cun Kou. Such patients suffer from恍惚 (trance/madness); otherwise, they are indecisive with dual minds. Both hands' Yang pulses are floating, fine, and continuous; Yin pulses are also fine and continuous; this is Yin Qiao and Yang Qiao Mai. These patients previously had demon-wind illness, died in agony and trance, causing harm from the deceased. Chi and Cun pulses both floating, straight up and down; this is Du Mai, causing stiff back and waist, inability to bend or extend, adult epilepsy, infant wind-colic. Chi and Cun pulses both firm (or scallion-stalk), straight up and down; this is Chong Mai, indicating cold hernia in the chest.
[From *Nan Jing*] How do the diseases of the Extraordinary Vessels present? Answer: Yang Wei maintains Yang, Yin Wei maintains Yin. If Yin and Yang cannot maintain each other, the patient feels lost and despondent, unable to control themselves. Yin Qiao disease: Yang side relaxed, Yin side tense. Yang Qiao disease: Yin side relaxed, Yang side tense. Chong disease: rebellious Qi and abdominal urgency. Du disease: stiff spine and cold limbs (Su Wen says "stiff spine and opisthotonos"). Ren disease: internal knotting, seven types of hernia in men, masses in women. Dai disease: abdominal fullness and limp waist as if sitting in water. Yang Wei disease: aversion to cold and heat. Yin Wei disease: heart pain. These are the diseases of the Eight Extraordinary Vessels. (From *Nan Jing 29*)
[Zhu Danxi] Discussion on Yang Stagnation in Yin and Yin Stagnation in Yang. *Jing Yao* states: Yang stagnation in Yin presents with Floating, Surging, String-taut, or Rapid pulses. Yin stagnation in Yang presents with Deep, Fine, Weak, or Choppy pulses. Yang stagnation is treated with Cold; Yin stagnation with Heat. I scrutinize this intent: Yang/Yin stagnation should be read as Heat/Cold stagnation. Seeking Heat/Cold allows discussion of Yin/Yang, distinguishing Qi/Blood. Heat stagnating in Qi is clear, but what of Cold stagnation? Cold stagnating in Blood is clear, but what of Heat stagnation? Why can Cold not injure Qi, and Heat not injure Blood? I believe: Qi is Yang, moving outside the vessels; Blood is Yin, moving inside. They circulate together, never stopping, forming the pulse. In one exhalation, pulse moves 3 cun; in one inhalation, 3 cun. Total 6 cun per breath. Body length 7 chi 5 cun, total travel 810 zhang. Heat makes it fast (excess); Cold makes it slow (deficiency). Imbalance of Five Flavors and Seven Emotions causes Qi stagnation, thickens fluids, leading to Phlegm/Dampness entering vessels, disturbing Blood, causing turbidity, stasis, or boiling. This is Yin stagnating in Yang, i.e., Blood stagnating in Qi. Qi disease worsened by drugs aiding evil, Blood disease increases, leaking out of vessels, blocking channels, hindering ascent/descent, disrupting transformation. This is Yang stagnating in Yin, i.e., Qi stagnating in Blood. Disease differentiation into Cold/Heat depends on constitutional bias and mixed pathogens, not solely assigning Yang=Heat and Yin=Cold. Floating/Surging/String-taut/Rapid are Qi disease pulses, not necessarily Heat. Deep/Fine/Weak/Choppy are Blood disease pulses, not necessarily Cold. This is the root of ten thousand diseases, not just sores and ulcers. Please evaluate. ("Qi", pronounced Hu Gu, means blockage.)
[From *Su Wen*] Cun Kou pulse deep and firm indicates disease in the Interior; Cun Kou pulse floating and vigorous indicates disease in the Exterior. (From *Ping Ren Qi Xiang Lun*. Hai Zang says: Floating pulse indicates Exterior. If floating is large and firm, deep is diminished, it is Exterior. If floating is large and firm, and deep is also large and firm, it is not Exterior; pathogen has entered deeply.) Pulse vigorous, slippery, and firm indicates Exterior disease; pulse small, solid, and firm indicates Interior disease.
[From *Ling Shu*] Qi Kou governs Interior; Ren Ying governs Exterior. (From *Jin Fu Pian*). Ren Ying vigorous and firm indicates injury by Cold; Qi Kou vigorous and firm indicates injury by Food. (From *Wu Se Pian*)
Qi Kou refers to the pulse of the Hand Taiyin Lung Meridian behind the wrist. Ren Ying refers to the pulse of the Foot Yangming Stomach Meridian beside the throat.
[Zhang Congzheng (Hai)] Differentiating External vs. Internal Injury: Wind injury causes coarse nasal breathing, mouth closed, as Lung Qi connects to Heaven/Earth. Food injury causes loss of taste, lack of saliva, uniform nasal breathing, as Spleen Qi connects to Earth. External injury causes whole-body heat, starting in Taiyang, entering from outside (formless). Internal injury causes limb disharmony and bilateral hypochondriac heat, starting in Shaoyang, emerging from inside (formed). Both external and internal injury: Ren Ying and Qi Kou both vigorous, or forceful upon lifting/pressing; exterior fever with aversion to cold, abdominal discomfort with thirst. This is combined external/internal injury. Diagnosis: palpate palms and backs of hands. Palm heat indicates internal injury; back-of-hand heat indicates external injury. Then differentiate by pulse.
[From *Nan Jing*] Pulse has Three Parts and Nine Probes, each governing specific areas. Answer: Three Parts are Cun, Guan, Chi. Nine Probes are Floating, Middle, Deep. Upper part models Heaven, governing diseases from chest to head. Middle part models Humanity, governing diseases from diaphragm to umbilicus. Lower part models Earth, governing diseases from umbilicus to feet. Acupuncture should be applied carefully. (From *Nan Jing 18*)
[Zhu Gong *Huo Ren Shu*] Upon placing fingers, first use the middle finger to locate Guan. The high bone behind the palm is Guan. Place index and ring fingers before and after Guan for the Three Parts. Index is Cun, Ring is Chi. Long arms require wider spacing; short arms require closer spacing. If diagnosing Cun first, lightly press to assess, then moderately, then heavily. Assess upper and lower limits, and push fingers outward and inward. Diagnose only when breath is calm. One respiration (one exhale + one inhale) is one Xi. Four or five beats per Xi, neither too large nor small, corresponding to the season and location, is a Harmonious Pulse. More than this is "Zhi" (Excess); less is "Sun" (Deficiency). *Nan Jing* details Sun and Zhi pulses.
Zhang Zhongjing said: Rapid inhalation indicates Excess in Middle Jiao; purgation heals, deficiency is untreatable. Rapid inhalation in Upper Jiao; slow/deep inhalation in Lower Jiao; both are difficult to treat. Trembling during respiration is untreatable.
[From *Su Wen*] Disharmony of the Five Zang arises from obstruction of the Six Fu. (From *Tong Ping Xu Shi Lun*)
[From *Nan Jing*] How to distinguish Zang and Fu diseases? Answer: Rapid pulses belong to Fu, Slow pulses to Zang. Rapid indicates Heat, Slow indicates Cold. All Yang is Heat, all Yin is Cold. Thus, one distinguishes Zang and Fu diseases. (From *Nan Jing 9*). Diseases may desire warmth, cold, company, or solitude. Where is the disease? Desire cold and company indicates Fu disease. Desire warmth and solitude indicates Zang disease. Why? Fu is Yang; Yang diseases desire cold and company. Zang is Yin; Yin diseases desire warmth and solitude, avoiding noise. Thus, one distinguishes Zang and Fu diseases. (From *Nan Jing 51*). Do Zang and Fu diseases originate equally? No. Zang diseases are stationary and localized. Fu diseases are migratory and fluctuating. (From *Nan Jing 52*)
[From *Su Wen*] Huang Di said: All diseases arise from Wind, Cold, Summer-heat, Dampness, Dryness, and Fire, transforming and changing. The classic says: Drain the Excess, Tonify the Deficiency. I gave you medical arts, but practitioners are not always perfect. I wish for the essential Dao to work effectively, like a drumstick hitting a drum, pulling thorns, or washing dirt. Can you explain? Qi Bo said: Examine the disease mechanism, do not miss the Qi suitability. This is it. Huang Di asked about the disease mechanism. Qi Bo said: All wind-induced tremors and dizziness belong to the Liver. All cold-induced contraction and pulling belong to the Kidney. All Qi-related depression and stagnation belong to the Lung. All dampness-induced swelling and fullness belong to the Spleen. All heat-induced confusion and convulsions belong to Fire. All pain, itching, and sores belong to the Heart. All reversal, constipation, and incontinence belong to the Lower Jiao. All wasting, wheezing, and vomiting belong to the Upper Jiao. All locking, shivering, and loss of spiritual control belong to Fire. All spasms and neck stiffness belong to Dampness. All rebellious Qi rushing upward,