诸脉诊病杂法者，窍恐迷乱诊病大纲，故以杂法名之也。凡前篇脉之浮、沉、迟、数、
虚、实、洪、细、滑、涩，所指阴、阳、表、里、寒、热、血、虚、气实之病者，皆诊病之
大纲，学人常须识此，勿令误也。故《内经》论脉主病，必以阴阳相对言之，或以五脏分发
言之，未尝杂他法者，欲人识其纲也。故诊病先定大纲，然后杂究诸病，如诊得浮脉大纲主
表也，沉脉大纲主里也，然后杂究其或属寒属风属气等病之类是也。余见如左方。
〔无择〕浮为在表，为风，为气，为热，为痛，为呕，为胀，为痞，为喘，为厥，为内结
，为满不食。浮大为鼻塞，浮缓为不仁，浮大长为风眩癫疾，浮滑疾为宿食，浮大而涩为宿
食滞气，浮短为肺伤诸气，浮滑为饮为走刺，浮细而滑为伤饮，浮滑疾紧为百合病，浮数为
大便坚，小便数，浮紧为淋，为癃闭。
〔东垣〕辨脉浮所主病不同，浮者沉之反也，瞥瞥然见于皮毛上，与皮毛相得，微按之
则绝无，有如空中之浮云。所主病一则为风，一则为虚。古人云∶浮而有热者，虚也；浮而
无热者，风也。予谓此未尽善，盖风有八风，寒热温凉，各各不同，其中有风热。止言脉浮
，虽不能分别八面之风，兼见脉候，止说浮而已。须兼见的证，单在一脏或两脏相合，亦足
以分何脏之病，言风无热则非也。况八风之脉皆见于左手寸脉外侧，若右手行阴道脉中受虚
邪贼邪之风，亦于气口外侧显见，推而内之，外而不内者是也。其虚劳脉虽有传变，必显于
内侧。六脉互传，皆为不足之病，则是五脏传变，必从四时传变于外，六腑乃受之，如是则
胜复之作，不能相过，此之谓也。若浮而弦者风也，见于左关。浮而涩者虚也，见于右寸。
〔无择〕寸芤为吐血，微芤为衄血，关芤为更血，为肠痈；尺芤为下焦虚，小便血出。滑
为吐，为满，为热，为伏痰，为宿食，为蓄血，为经闭，为咳，为血气俱实。滑而浮散为瘫
痪，滑数为结热，滑实为胃热，滑利为妊娠，滑而大小不匀必吐，为病进，为泄利，滑而浮
大，小腹痛，溺则阴中痛，大便亦然。又滑为鬼疰。
〔《素》〕脉滑曰风。
无择∶实为热为呕，为痛，为气塞，为喘咳，为大便不禁。实紧为阴不胜阳，为胃寒，
为腰痛。弦为寒，为痛，为饮，为疟，为水气，为中虚，为厥逆，为拘急，为寒癖。弦紧为
恶寒，为疝瘕，为癖。弦而钩为胁下刺痛。弦长为积，随左右上下为瘀血。
〔仲〕弦则卫气不行。
〔无择〕紧为寒，为痛，为咳，为喘，为满。浮紧为肺有水。紧滑为蛔动。急为遁尸。紧
数为寒热，又为宿食，为吐逆。
〔《素》〕盛而紧曰胀。
〔《本事》〕记有人患伤寒六七日，心烦昏睡，咽燥，小便白色，自汗。予诊之，寸口尺
中俱紧。予曰∶寒中少阴之经，是以脉紧。仲景云∶脉紧而汗出者，亡阳也，属少阴，法当
咽痛而复下痢，盖谓此也。有难之曰∶《脉诀》紧脉属七表，仲景以紧脉属少阴，然则紧脉
属阳耶？属阴耶？予言∶仲景云，寸口脉俱紧者，清邪中于上焦，浊邪中于下焦。又云∶阴阳
俱紧者，口中气出，唇口干燥，蜷卧足冷，鼻中涕出，舌上滑苔，勿妄治也。又云∶紧则为
寒。又云∶诸紧为寒。又曰∶曾为人所难，紧脉从何而来？师云∶假令亡汗若吐，以肺里寒
，故令脉紧。假令咳者坐饮冷水，故令脉紧。假令下痢，以胃虚故令脉紧。又云∶寸口脉微
，尺脉紧，其人虚损多汗。由是观之，则是寒邪之气，久客经脉所致，皆虚寒之脉也。其在
阳经则浮而紧，在阴经则沉而紧。故仲景云∶浮紧名为伤寒。又曰∶阳明脉浮而紧者，必潮
热。此在阳则浮而紧也，在阴则沉而紧。故仲景云∶寸口脉微，尺脉紧，其人虚损多汗，则
阴当先绝而不见阳。又云∶少阴紧至七八日，自下痢，脉暴微，手足反温，脉紧反去者，此
欲解也。此在阴则沉而紧也。仲景云∶浮为在表，沉为在里，数为在腑，迟为在脏。欲知表
里脏腑，先以浮沉迟数为定，然后兼于证而别阴阳也。
〔无择〕洪为胀，为满，为痛，为热，为烦。洪实为癫。洪紧为痈疽，为喘急，亦为胀。
洪浮为阳邪，大为祟。
〔《素》〕粗大者，阴不足，阳有余，为热中也（《脉要精微论》）。大则病进。（丹溪云
∶大，洪之别名。其病得之于内伤者，阴虚为阳所乘，故脉大当作虚治之。其病得之于外伤
者，邪客于经脉亦大，当作邪胜治之。合二者观之，皆病方长之势也。谓之病进，不亦宜乎
。海藏云∶君侵臣是也）
〔仲〕平人脉大为劳。大则为虚。
〔无择〕数为热，为虚，为吐，为痛，为烦渴，为烦满。
促（经无文）
释曰∶其促有五∶一曰气，二曰血，三曰饮，四曰食，五曰痰。但脏热则脉促，以气血
痰饮留滞，不行则止，促非恶脉也。
散（经无文）
释曰∶六腑气绝于内，则手足寒，上气；五脏气绝于内，则下痢不禁，甚者不仁，其脉
皆散，散则不聚，病亦危矣。
革为满，为急，为虚寒相搏。妇人为半产漏下。
释曰∶革者，革也，固结不移之状。三部应之，皆危脉也。
微为虚，为弱，为衄，为呕，为泄，为亡汗，为拘急。微弱为少气，为中寒。
沉为在里，为实，为水，为寒，为喘，为瘕 。沉弱为寒热。沉细为少气，臂不能
举。沉滑为风水，为下重。沉紧为上热下冷。沉重而直前绝者为瘀血，沉重而中散者为寒食成
。沉重不至寸，细绝者为遁尸。沉紧为悬饮。沉迟为痼冷。沉重为伤暑发热。
缓为在下，为风，为寒，为弱，为痹，为疼，为不仁，为气不足，为眩晕。缓而滑为热
中。缓而迟虚寒相搏，食冷则咽痛。
涩为少血，为亡汗，热气不足，为逆冷，为下痢，为心痛。涩而紧为痹，为寒湿。
〔《素》〕脉涩曰痹。
丹∶脉之状不一，大率多兼见之。人之病有四∶曰实，曰热，曰寒，曰虚。故学人诊亦
必浮、沉、迟、数为之纲，以察病情。初学人又以浮数为热为有余，沉迟为寒为不足。其间
最难体认者，涩脉也。最难调治者，弦脉也。涩脉细而迟，往来难且散，又曰短而止。得此
脉者，固为寒，为湿，为血虚，为污血，为气多，然亦有病热与实者。或者得脉之带涩，徒
见其有细有迟又散，皆是不足之象，便以为虚而寒，猛浪用药，宁不误人。若夫或因多怒，
或因忧郁，或因浓味，或因补剂，燥剂，或因表里无汗，气腾血沸，清化为浊，老痰凝血，
胶固杂揉，脉道涩滞，亦见涩状。参之形证，病情斯得。先贤曰∶涩而坚，按之不减有力，
为中焦实，有伏结，脾肺气寒，实热在胃中，可不慎欤。弦为春令之脉，非春时而见者，木
为病也。五脏更相制伏，以防其太过，木为病则肝邪盛矣，肝之盛金之衰也，金之衰火之炎
也，火之炎水之弱也，金不足以制木，则土病矣。考之诸家，则曰弦者虚也，为反胃，为痛
痹。沉弦为疝瘕，弦长为积病，双弦为寒饮，双弦而迟为心下坚。偏弦，饮也。弦急为腹痛
，弦而钩主蜚尸，弦紧而微细主寒积，微弦而伏主 不治，弦而大主半产漏下亡血失精
，弦而小主寒痹，弦在左寸头痛，弦在右寸水走肠胃，弦在左关怒而血聚，弦在右关寒痛，
四肢拘急，弦在趺阳肠痔下血，弦在尺中，小腹痛白肠挺核，木邪风气上极，土败为病，先
哲盖常言之矣。惟金因火伏，木寡于畏之论，犹未发明，倘非滋水以降火，浓土以养金，而
又以行湿散风导郁，为之辅佐，邪何由去，病何由安。况弦脉为病甚多，而治法又有隔二隔
三之异，故不容于自默也。若曰不然，何弦属阳，而仲景列沉涩弱微弦为五阴之数。至于败
散残贼之脉，又以弦为之首，涩为之中，其意可见。（蜚，扶滑切）
〔无择〕迟为寒，为痛，迟而涩为 瘕咽酸。
伏为霍乱，为疝瘕，为水气，为溏泄，为停痰，为宿食，为诸气上冲，为恶脓死肌。
濡为虚，为痹，为自汗，为气弱，为下重。濡而弱为内热外冷自汗，为小便难。
弱为虚，为风热，为自汗。
细为血气俱虚，为病在内，为积，为伤湿，为后泄，为寒，为神劳，为忧伤过度，为腹
满。细而紧为 瘕积聚，为刺痛。细而滑为僵仆，为发热，为呕吐。
动为痛，为惊，为痹，为泄，为恐。
虚为寒，为脚弱，为虚，为食不消化，为伤暑。
结为痰，为饮，为血，为积，为气。
释曰∶气寒脉缓则为结，气热脉数则为促，虽缓数不同，亦当如促脉分别可也。
代者，一脏绝，他脏代至。
释曰∶代真死脉，不分三部，随应皆是。
〔《脉经》〕寸浮则中风，寸芤则胸中积血，寸滑则呕逆，寸实则胸中热，寸弦则胸中急
痛，寸紧则头项急，寸洪则热甚于胸中，寸微则阳虚，寸沉则阴中伏阳、胸中痰，寸缓则太
阳中湿，寸涩则中气虚，寸迟则阴溢于上，寸伏则胸中积气，寸濡则多自汗，寸弱则阳气虚
微。
关浮则腹胀满，关芤则肠中积血，关滑则胃寒不能食，关实则胃中切痛，关弦则胃寒不
能食，关紧则腹中郁结，关洪则番胃吐食，关微则气结于心下，关沉则心下痛，关缓则腰痛
难伸，关涩则血少而留停，关迟则粥浆不入，关伏则肠癖瞑目，关濡则少气精神散，关弱则
胃气虚。
尺浮则大便干涩，尺芤则小便有血，尺滑则下焦停寒，尺实则小腹胀、小便不禁，尺弦
则下焦停水，尺紧则脐腹痛，尺洪则阴绝，尺微则脐下有积，尺沉则腰脚重，尺缓则饮食不
消，尺涩则逆冷伤血，尺迟则寒甚于腰脚，尺伏则飧泄谷不化，尺濡则骨肉不相亲，尺弱则
阴气内绝。
〔《素》〕夫脉者，血之府也，长则气治，短则气病，数则烦心，大则病进，上盛则气高
下盛则气胀，代则气衰，细则气少，涩则心痛，浑浑革至如涌泉，病进而色敝，绵绵其去如
弦绝者，死。（《脉要精微论》）
寸口之脉中手短者，曰头痛。寸口脉中手长者，曰足胫痛。寸口脉中手促上击者，曰肩
背痛。脉小弱以涩者，谓之久病。脉滑浮而疾者，谓之新病（以上《平人气象论》）。征其脉
小色不夺者，新病也，征其脉不夺，其色夺者，此久病也。征其脉与五色俱夺者，此久病也
。征其脉与五色俱不夺者，新病也。推而外之，内而不外，有心腹积也（王注云∶脉附臂筋
，取之不审，推筋令远，使脉外行而不出外者，心腹积也）。推而内之，外而不内，身有热
也（王注云∶脉远臂筋，推之令近，远而不近，身有热也）。推而上之，上而不下，腰足清也
（“上而不下”《甲乙经》作“聚而不上，治宜举之”也）。推而下之，下而不上，头项痛也
（“下而不上”《甲乙经》“作上而不下，用宜抑之”也）。按之至骨，脉气少者，腰脊痛而
身有痹也。（以上《脉要精微论》）
〔孙〕按开宝寺僧，衣钵甚浓，常施惠于人，孙重之，与往还。一日，谓孙曰∶某有一事
，于翁约赏罚为戏，可否？孙曰∶如何为赏罚？僧曰∶若诊吾脉，若知某病，赏三十千为一筵
；若不中，罚十千归小僧。孙曰∶诺。与之诊，左手无脉，右手有脉，遂寻左手之脉，乃转
左臂上，动遥如常。孙曰∶此异脉也。医书不载。脉行常道，岂有移易之理，往昔少年为惊
扑震动心神，脉脱旧道，乍移臂外，复遇惊扑，不能再归，年岁长大，气血已定，不能复移
，目下无病尔。僧曰∶某襁褓而扑，皆几死，固宜脉失所，某亦平生无病，亦不曾诊脉，闻
公神医，试验之，果神医也。
诸脉诊病杂法，是担心学者在诊断疾病时迷失大纲，所以用“杂法”来命名。凡是前篇中提到的浮、沉、迟、数、虚、实、洪、细、滑、涩等脉象，以及它们所对应的阴、阳、表、里、寒、热、血虚、气实等疾病，都是诊断疾病的纲领，学习者必须牢记，不要弄错。所以《黄帝内经》论述脉象主病时，必定以阴阳相对来阐述，或者按照五脏分别论述，从未混杂其他方法，这是为了让人们认清纲领。因此，诊断疾病要先确定大纲，然后再详细探究各种具体病症。例如，诊得浮脉这一大纲主表证，沉脉这一大纲主里证，然后进一步探究其属于寒、风、气滞等具体病症。我的见解如下方所列。
〔无择〕浮脉主病在表，主风邪，主气滞，主热，主痛，主呕吐，主胀满，主痞塞，主气喘，主厥逆，主内结，主腹胀不食。浮大脉主鼻塞，浮缓脉主肌肤麻木不仁，浮大长脉主风眩癫疾，浮滑疾脉主宿食，浮大而涩脉主宿食与滞气，浮短脉主肺伤及诸气病，浮滑脉主饮邪或走注刺痛，浮细而滑脉主伤饮，浮滑疾紧脉主百合病，浮数脉主大便坚硬、小便频数，浮紧脉主淋证、癃闭。
〔李东垣〕辨别浮脉所主之病各不相同，浮脉是沉脉的反面，脉象瞥瞥然显现于皮毛之上，与皮毛相合，轻轻按压则完全感觉不到，就像空中的浮云一样。浮脉所主的病，一个是风邪，一个是虚证。古人说：浮而有热感的，是虚证；浮而无热感的，是风邪。我认为这种说法并不完善，因为风有八风（指八方之风），寒热温凉各不相同，其中也有风热。仅说脉浮，虽然不能分辨八方之风，但结合脉候，只说浮而已。必须兼见症状，单在一脏或两脏相合，也足以区分是哪一脏的病，如果说风没有热感就不对了。况且八方之风的脉象都见于左手寸脉的外侧，如果右手行阴道脉中受到虚邪贼风，也会在气口外侧显现，推而向内，外而不内的就是这种情况。其虚劳的脉象虽然有传变，必定显现在内侧。六脉互相传变，都是不足之病，这就是五脏传变，必定从四时传变于外，六腑乃受之，这样胜复之气发作，不会超过限度，说的就是这个道理。如果浮而弦的是风邪，见于左关部。浮而涩的是虚证，见于右寸部。
〔无择〕寸部芤脉主吐血，微芤脉主鼻出血，关部芤脉主便血，主肠痈；尺部芤脉主下焦虚，小便出血。滑脉主呕吐，主胀满，主热，主伏痰，主宿食，主蓄血，主经闭，主咳嗽，主气血俱实。滑而浮散主瘫痪，滑数主结热，滑实主胃热，滑利主妊娠，滑而大小不匀必呕吐，主病情进展，主泄利，滑而浮大主小腹痛，排尿时阴中痛，大便亦然。又滑脉主鬼疰。
无择：实脉主热，主呕吐，主痛，主气塞，主喘咳，主大便失禁。实紧脉主阴不胜阳，主胃寒，主腰痛。弦脉主寒，主痛，主饮邪，主疟疾，主水气，主中虚，主厥逆，主拘急，主寒癖。弦紧脉主恶寒，主疝瘕，主癖积。弦而钩主胁下刺痛。弦长主积聚，随左右上下部位不同主瘀血。
〔无择〕紧脉主寒，主痛，主咳嗽，主气喘，主胀满。浮紧脉主肺有水饮。紧滑脉主蛔虫动。急脉主遁尸。紧数脉主寒热，又主宿食，主吐逆。
〔《本事方》〕记载有人患伤寒六七日，心烦昏睡，咽燥，小便色白，自汗。我诊察他，寸口和尺中脉俱紧。我说：寒邪中于少阴经，所以脉紧。张仲景说：脉紧而汗出的，是亡阳，属少阴，法当咽痛且下痢，说的就是这个情况。有人质疑说：《脉诀》将紧脉列为七表脉之一，张仲景将紧脉归于少阴，那么紧脉属阳还是属阴？我说：张仲景说，寸口脉俱紧的，清邪中于上焦，浊邪中于下焦。又说：阴阳俱紧的，口中气出，唇口干燥，蜷卧足冷，鼻中涕出，舌上滑苔，不要妄治。又说：紧则为寒。又说：诸紧为寒。又说：曾经被人难倒，紧脉从何而来？老师说：假如亡汗或呕吐，因肺里有寒，所以令脉紧。假如咳嗽是因为喝冷水，所以令脉紧。假如下痢，因胃虚所以令脉紧。又说：寸口脉微，尺脉紧，其人虚损多汗。由此看来，这是寒邪之气久客经脉所致，都是虚寒之脉。其在阳经则浮而紧，在阴经则沉而紧。所以张仲景说：浮紧名为伤寒。又说：阳明脉浮而紧的，必有潮热。这是在阳经则浮而紧，在阴经则沉而紧。所以张仲景说：寸口脉微，尺脉紧，其人虚损多汗，则阴当先绝而不见阳。又说：少阴紧至七八日，自下痢，脉暴微，手足反温，脉紧反去者，这是欲解的表现。这是在阴经则沉而紧。张仲景说：浮为在表，沉为在里，数为在腑，迟为在脏。想要知道表里脏腑，先用浮沉迟数来确定，然后兼看症状来辨别阴阳。
〔无择〕洪脉主胀，主满，主痛，主热，主烦。洪实脉主癫狂。洪紧脉主痈疽，主喘急，也主胀。洪浮脉主阳邪，大脉主祟病。
〔《素问》〕脉粗大的，阴不足，阳有余，为热中（出自《脉要精微论》）。大脉表示病进。（朱丹溪说：大，是洪的别名。其病得之于内伤的，阴虚被阳乘袭，所以脉大当作虚证治疗。其病得之于外伤的，邪客于经脉也现大脉，当作邪胜治疗。综合两者观察，都是病势方长的表现。称为病进，不也是合适的吗？王海藏说：君侵臣就是这样）
促脉（经典原文无此条目）
解释：促脉有五种成因：一是气，二是血，三是饮，四是食，五是痰。只要脏热则脉促，因为气血痰饮留滞，不行则止，促脉不是恶脉。
散脉（经典原文无此条目）
解释：六腑气绝于内，则手足寒冷，上气；五脏气绝于内，则下痢不禁，严重的甚至不知痛痒，其脉皆散，散则不聚，病也很危险了。
革脉主胀满，主急，主虚寒相搏。妇女患革脉主半产漏下。
解释：革者，变革之意，固结不移的状态。三部脉应之，都是危脉。
微脉主虚，主弱，主鼻出血，主呕吐，主泄泻，主亡汗，主拘急。微弱脉主少气，主中寒。
沉脉主在里，主实，主水，主寒，主喘，主瘕积。沉弱脉主寒热。沉细脉主少气，手臂不能举。沉滑脉主风水，主下重。沉紧脉主上热下冷。沉重而直前绝者为瘀血，沉重而中散者为寒食成积。沉重不至寸口，细绝者为遁尸。沉紧脉主悬饮。沉迟脉主痼冷。沉重脉主伤暑发热。
缓脉主在下，主风，主寒，主弱，主痹，主疼，主不仁，主气不足，主眩晕。缓而滑脉主热中。缓而迟虚寒相搏，食冷则咽痛。
涩脉主少血，主亡汗，热气不足，主逆冷，主下痢，主心痛。涩而紧脉主痹，主寒湿。
朱丹溪：脉的形状不一，大体多兼见。人的病有四类：曰实，曰热，曰寒，曰虚。所以学习者诊脉也必须以浮、沉、迟、数为纲，来察看病情的初学人又以浮数为热为有余，沉迟为寒为不足。其中最难体认的是涩脉。最难调治的是弦脉。涩脉细而迟，往来难且散，又叫短而止。得此脉者，固然是寒，是湿，是血虚，是污血，是气多，但也有病热与实的。有的人得脉带涩，只见其有细有迟又散，都是不足之象，便以为是虚寒，猛浪用药，岂不误人。如果是由于多怒，或忧郁，或浓味，或补剂，燥剂，或因表里无汗，气腾血沸，清化为浊，老痰凝血，胶固杂揉，脉道涩滞，也见涩状。参之形证，病情才可得知。先贤说：涩而坚，按之不减有力，是中焦实，有伏结，脾肺气寒，实热在胃中，可不谨慎吗。弦脉是春令之脉，非春时而见的，是木为病。五脏更相制伏，以防其太过，木为病则肝邪盛矣，肝之盛金之衰也，金之衰火之炎也，火之炎水之弱也，金不足以制木，则土病矣。考之诸家，则曰弦者虚也，为反胃，为痛痹。沉弦为疝瘕，弦长为积病，双弦为寒饮，双弦而迟为心下坚。偏弦，饮也。弦急为腹痛，弦而钩主蜚尸，弦紧而微细主寒积，微弦而伏主不治，弦而大主半产漏下亡血失精，弦而小主寒痹，弦在左寸头痛，弦在右寸水走肠胃，弦在左关怒而血聚，弦在右关寒痛，四肢拘急，弦在趺阳肠痔下血，弦在尺中，小腹痛白肠挺核，木邪风气上极，土败为病，先哲盖常言之矣。惟金因火伏，木寡于畏之论，犹未发明，倘非滋水以降火，浓土以养金，而又以行湿散风导郁，为之辅佐，邪何由去，病何由安。况弦脉为病甚多，而治法又有隔二隔三之异，故不容于自默也。若曰不然，何弦属阳，而仲景列沉涩弱微弦为五阴之数。至于败散残贼之脉，又以弦为之首，涩为之中，其意可见。（蜚，扶滑切）
伏脉主霍乱，主疝瘕，主水气，主溏泄，主停痰，主宿食，主诸气上冲，主恶脓死肌。
濡脉主虚，主痹，主自汗，主气弱，主下重。濡而弱脉主内热外冷自汗，主小便难。
细脉主血气俱虚，主病在内，主积，主伤湿，主后泄，主寒，主神劳，主忧伤过度，主腹满。细而紧脉主瘕积聚，主刺痛。细而滑脉主僵仆，主发热，主呕吐。
解释：气寒脉缓则为结，气热脉数则为促，虽缓数不同，也应当像促脉那样分别对待。
代脉，一脏绝，他脏代至。
解释：代真是死脉，不分三部，随应皆是。
〔《脉经》〕寸部浮则中风，寸部芤则胸中积血，寸部滑则呕逆，寸部实则胸中热，寸部弦则胸中急痛，寸部紧则头项急，寸部洪则热甚于胸中，寸部微则阳虚，寸部沉则阴中伏阳、胸中痰，寸部缓则太阳中湿，寸部涩则中气虚，寸部迟则阴溢于上，寸部伏则胸中积气，寸部濡则多自汗，寸部弱则阳气虚微。
关部浮则腹胀满，关部芤则肠中积血，关部滑则胃寒不能食，关部实则胃中切痛，关部弦则胃寒不能食，关部紧则腹中郁结，关部洪则番胃吐食，关部微则气结于心下，关部沉则心下痛，关部缓则腰痛难伸，关部涩则血少而留停，关部迟则粥浆不入，关部伏则肠癖瞑目，关部濡则少气精神散，关部弱则胃气虚。
尺部浮则大便干涩，尺部芤则小便有血，尺部滑则下焦停寒，尺部实则小腹胀、小便不禁，尺部弦则下焦停水，尺部紧则脐腹痛，尺部洪则阴绝，尺部微则脐下有积，尺部沉则腰脚重，尺部缓则饮食不消，尺部涩则逆冷伤血，尺部迟则寒甚于腰脚，尺部伏则飧泄谷不化，尺部濡则骨肉不相亲，尺部弱则阴气内绝。
〔《素问》〕脉是血的府库，长则气治，短则气病，数则烦心，大则病进，上盛则气高，下盛则气胀，代则气衰，细则气少，涩则心痛，浑浑革至如涌泉，病进而色敝，绵绵其去如弦绝者，死。（出自《脉要精微论》）
寸口脉中手短的，叫头痛。寸口脉中手长的，叫足胫痛。寸口脉中手促上击的，叫肩背痛。脉小弱以涩的，叫做久病。脉滑浮而疾的，叫做新病（以上出自《平人气象论》）。征其脉小色不夺的，是新病，征其脉不夺，其色夺的，是久病。征其脉与五色俱夺的，是久病。征其脉与五色俱不夺的，是新病。推而外之，内而不外，有心腹积也（王冰注云：脉附臂筋，取之不审，推筋令远，使脉外行而不出外者，心腹积也）。推而内之，外而不内，身有热也（王冰注云：脉远臂筋，推之令近，远而不近，身有热也）。推而上之，上而不下，腰足清也（“上而不下”《甲乙经》作“聚而不上，治宜举之”也）。推而下之，下而不上，头项痛也（“下而不上”《甲乙经》“作上而不下，用宜抑之”也）。按之至骨，脉气少者，腰脊痛而身有痹也。（以上出自《脉要精微论》）
〔孙思邈〕按开宝寺僧人，衣钵丰厚，常施惠于人，孙思邈尊重他，与他交往。一天，他对孙思邈说：我有一件事，与您约定赏罚作为游戏，可以吗？孙思邈说：怎么定赏罚？僧人说：如果诊我的脉，如果知道我的病，赏三十千钱设宴；如果不中，罚十千钱归小僧。孙思邈说：好。给他诊脉，左手无脉，右手有脉，于是寻找左手的脉，原来是转到了左臂上，跳动遥远如常。孙思邈说：这是异脉。医书不载。脉行常道，岂有移易之理，往昔少年时受惊扑震动心神，脉脱旧道，乍移臂外，再遇惊扑，不能再归，年岁长大，气血已定，不能复移，眼下无病罢了。僧人说：我襁褓时摔扑，差点死掉，确实应该脉失所，我也平生无病，也不曾诊脉，听说您是神医，试验一下，果真是神医啊。
The miscellaneous methods of diagnosing diseases through various pulses are named "miscellaneous methods" because I fear that learners may become confused regarding the general principles of disease diagnosis. The pulse qualities mentioned in previous chapters—floating (Fu, 浮), sinking (Chen, 沉), slow (Chi, 迟), rapid (Shu, 数), deficient (Xu, 虚), excess (Shi, 实), surging (Hong, 洪), fine (Xi, 细), slippery (Hua, 滑), and choppy (Se, 涩)—along with their corresponding indications of Yin and Yang, exterior and interior, cold and heat, blood deficiency, and Qi excess, constitute the general principles of diagnosis. Learners must keep these in mind to avoid errors. Therefore, the *Neijing* (Yellow Emperor's Inner Canon) discusses pulse-disease relationships primarily through Yin-Yang opposition or by categorizing them according to the Five Zang organs, never mixing other methods, so as to help people grasp the essentials. Thus, when diagnosing, one must first establish the general principle, and then investigate specific diseases in detail. For instance, if a floating pulse is identified as indicating an exterior syndrome, and a sinking pulse indicates an interior syndrome, one then investigates whether the condition belongs to cold, wind, Qi stagnation, etc. My observations are listed below.
[Wuze] A floating pulse indicates disease in the exterior, wind pathogen, Qi stagnation, heat, pain, vomiting, distension, fullness, obstruction, asthma, reversal cold, internal binding, abdominal fullness with inability to eat. A large floating pulse indicates nasal congestion; a relaxed floating pulse indicates numbness; a long and large floating pulse indicates dizziness due to wind and epilepsy; a rapid and slippery floating pulse indicates retained food; a large, rough, and floating pulse indicates retained food and Qi stagnation; a short floating pulse indicates lung injury and Qi disorders; a slippery floating pulse indicates fluid retention or wandering stabbing pain; a fine, slippery, and floating pulse indicates injury from fluids; a tight, rapid, slippery, and floating pulse indicates Baihe disease (Lily Disease); a rapid and floating pulse indicates hard stool and frequent urination; a tight and floating pulse indicates strangury and difficulty in urination.
[Li Dongyuan] The diseases indicated by a floating pulse vary. Floating is the opposite of sinking; it appears fleetingly on the skin and hair level, adhering to the surface, and disappears completely upon slight pressure, like clouds in the sky. It indicates either wind or deficiency. Ancients said: Floating with heat sensation indicates deficiency; floating without heat sensation indicates wind. I consider this incomplete. Wind comprises eight types (Eight Winds), varying in cold, heat, warmth, and coolness, including wind-heat. Merely stating "floating pulse" cannot distinguish all winds, but combined with clinical signs, it can identify which organ is affected. Saying wind lacks heat is incorrect. Furthermore, pulses of the eight winds appear on the lateral side of the Cun position of the left hand. If the right hand, governed by Yin channels, is invaded by empty evil or thief wind, it also manifests on the lateral side of the Qi Kou position. Pushing inward reveals external but not internal characteristics. Deficiency labor pulses, though they transmit, manifest internally. Mutual transmission among six pulses indicates insufficiency diseases, meaning Five Zang transmission follows seasonal changes outward, affecting Six Fu organs, preventing excessive victory and revenge cycles. If floating and wiry, it is wind, appearing at the Guan position of the left hand. If floating and rough, it is deficiency, appearing at the Cun position of the right hand.
[Wuze] A hollow pulse at the Cun position indicates hematemesis; a slightly hollow pulse indicates epistaxis; a hollow pulse at the Guan position indicates rectal bleeding and intestinal abscess; a hollow pulse at the Chi position indicates lower Jiao deficiency and hematuria. A slippery pulse indicates vomiting, fullness, heat, hidden phlegm, retained food, blood stasis, amenorrhea, cough, and excess of both Qi and blood. Slippery and floating-scattered indicates paralysis; slippery and rapid indicates clustered heat; slippery and solid indicates stomach heat; slippery and smooth indicates pregnancy; slippery with uneven size indicates vomiting, disease progression, and diarrhea; slippery and large-floating indicates lower abdominal pain, pain in the urethra during urination, and similar bowel symptoms. Also, a slippery pulse indicates Gui Zhu (Ghost Stabbing).
*[Suwen]* A slippery pulse is called wind.
Wuze: A solid pulse indicates heat, vomiting, pain, Qi blockage, asthma and cough, and fecal incontinence. Solid and tight indicates Yin failing to overcome Yang, stomach cold, and lower back pain. A wiry pulse indicates cold, pain, fluid retention, malaria, water qi, middle deficiency, reversal cold, spasm, and cold accumulation. Wiry and tight indicates aversion to cold, hernia and masses, and accumulations. Wiry and hook-shaped indicates stabbing pain under the ribs. Wiry and long indicates accumulation, varying by location for blood stasis.
*[Zhang Zhongjing]* A wiry pulse means Wei Qi does not circulate.
[Wuze] A tight pulse indicates cold, pain, cough, asthma, and fullness. Floating and tight indicates lung water retention. Tight and slippery indicates Ascaris movement. Rapid indicates Dun Shi (Escaping Corpse). Tight and rapid indicates alternating cold and heat, retained food, and vomiting.
*[Suwen]* Full and tight indicates distension.
*[Benshi Fang]* Recorded a case of a patient with Shanghan (Cold Damage) for six or seven days, suffering from mental restlessness, drowsiness, dry throat, white urine, and spontaneous sweating. I diagnosed his Cun and Chi positions as both tight. I said: Cold has entered the Shaoyin channel, hence the tight pulse. Zhang Zhongjing stated: Tight pulse with sweating indicates loss of Yang, belonging to Shaoyin, likely leading to sore throat and dysentery. A skeptic asked: The *Maijue* classifies tight pulse among the Seven Superficial pulses (Yang), while Zhang Zhongjing associates it with Shaoyin (Yin). Is tight pulse Yang or Yin? I replied: Zhang Zhongjing said, when Cun and Chi are both tight, clear evil attacks the Upper Jiao, turbid evil attacks the Lower Jiao. He also said: When Yin and Yang are both tight, there is breath emission, dry lips and mouth, curling up, cold feet, runny nose, and slippery tongue coating; do not treat rashly. He also said: Tight indicates cold; all tight pulses indicate cold. Regarding the origin of tight pulse: If there is excessive sweating or vomiting due to cold in the Lung, the pulse becomes tight. If coughing results from drinking cold water, the pulse becomes tight. If dysentery results from stomach deficiency, the pulse becomes tight. Also, if Cun is micro and Chi is tight, the person is deficient and sweats much. Thus, tight pulse is caused by cold evil lingering in meridians, representing deficiency-cold. In Yang channels, it is floating and tight; in Yin channels, it is sinking and tight. Hence, Zhang Zhongjing said: Floating and tight is named Shanghan. Also: Yangming floating and tight implies tidal fever. This confirms floating-tight in Yang and sinking-tight in Yin. Zhang Zhongjing also said: Cun micro and Chi tight indicates Yin exhaustion without Yang manifestation. Also: Shaoyin tight persists for 7-8 days with spontaneous dysentery; if pulse suddenly becomes micro, hands and feet warm, and tightness disappears, it indicates resolution. This is sinking-tight in Yin. Zhang Zhongjing said: Floating indicates exterior, sinking indicates interior, rapid indicates Fu organs, slow indicates Zang organs. To determine exterior/interior and Zang/Fu, first use floating/sinking/rapid/slow, then combine with symptoms to distinguish Yin/Yang.
[Wuze] A surging pulse indicates distension, fullness, pain, heat, and vexation. Surging and solid indicates mania. Surging and tight indicates carbuncles and sores, urgent asthma, and distension. Surging and floating indicates Yang pathogen; large indicates demonic influence.
*[Suwen]* Coarse and large indicates Yin insufficiency and Yang excess, resulting in Heat Zhong (Heat in the Middle) (*Mai Yao Jing Wei Lun*). Large indicates disease progression. (Zhu Danxi said: Large is another name for Hong. If caused by internal injury, Yin deficiency allows Yang to invade, so treat large pulse as deficiency. If caused by external injury, pathogen in meridians causes large pulse, treat as pathogen excess. Both show disease advancing, hence "disease progression". Hai Zang said: Ruler invading minister is like this.)
*[Zhang Zhongjing]* In healthy people, a large pulse indicates劳 (Labor/Overwork). Large indicates deficiency.
[Wuze] A rapid pulse indicates heat, deficiency, vomiting, pain, vexation-thirst, and vexation-fullness.
Cu Pulse (Not in Classics)
Explanation: Cu pulse has five causes: Qi, Blood, Fluid, Food, Phlegm. Visceral heat causes Cu pulse because Qi, Blood, Phlegm, and Fluid stagnate and stop. Cu is not a malignant pulse.
San Pulse (Not in Classics)
Explanation: If Qi of Six Fu organs fails internally, hands and feet become cold, and Qi rebels upward. If Qi of Five Zang organs fails internally, there is uncontrollable dysentery, severe cases involve insensitivity. Pulses are all San (Scattered). Scattered means not gathered, indicating critical illness.
Ge Pulse indicates fullness, urgency, and struggle between deficiency and cold. In women, it indicates miscarriage and continuous bleeding.
Explanation: Ge means change or firmness, unmovable state. Appearing in three positions, it is a critical pulse.
Wei Pulse indicates deficiency, weakness, epistaxis, vomiting, diarrhea, loss of sweat, and spasm. Micro and weak indicates shortness of Qi and middle cold.
Sinking pulse indicates interior, excess, water, cold, asthma, and masses. Sinking and weak indicates alternating cold and heat. Sinking and fine indicates shortness of Qi and inability to raise arms. Sinking and slippery indicates Feng Shui (Wind Water edema) and heaviness below. Sinking and tight indicates upper heat and lower cold. Heavy and straight-cutting indicates blood stasis; heavy and scattered in the middle indicates cold-food accumulation. Heavy not reaching Cun, fine and cut off indicates Dun Shi. Sinking and tight indicates Xuan Yin (Suspension Fluid). Sinking and slow indicates chronic cold. Heavy indicates summerheat-fever.
Slow pulse indicates lower body, wind, cold, weakness, Bi syndrome, pain, numbness, Qi insufficiency, and vertigo. Slow and slippery indicates Heat Zhong. Slow and迟 (slow) with deficiency-cold struggle causes sore throat after eating cold food.
Choppy pulse indicates blood deficiency, loss of sweat, insufficient hot Qi, reversal cold, dysentery, and heart pain. Choppy and tight indicates Bi syndrome and cold-dampness.
*[Suwen]* Choppy pulse is called Bi.
Zhu Danxi: Pulse shapes vary, mostly combined. Diseases fall into four categories: Excess, Heat, Cold, Deficiency. Learners must use floating/sinking/rapid/slow as guidelines. Beginners often think floating/rapid means heat/excess, and sinking/slow means cold/deficiency. The hardest to recognize is the Choppy pulse; the hardest to treat is the Wiry pulse. Choppy is fine and slow, difficult and scattered to move, also called short and stopping. It indicates cold, dampness, blood deficiency, dirty blood, or excess Qi, but can also indicate heat and excess. Some see fine, slow, scattered Choppy pulse and assume deficiency-cold, prescribing recklessly, harming patients. However, anger, depression, rich food, tonics, drying agents, or lack of sweating causing Qi and Blood boiling, clearing turning to turbid, old phlegm and coagulated blood blocking vessels, also cause Choppy appearance. Combine with symptoms to diagnose. Ancients said: Choppy and firm, unyielding to pressure, indicates Middle Jiao excess, hidden binding, Spleen/Lung cold, and stomach heat. Be cautious. Wiry pulse is spring pulse; appearing out of season indicates Wood pathology. Five Zangs check each other to prevent excess. Wood disease means Liver Evil is strong; Liver strong, Metal weak; Metal weak, Fire flares; Fire flares, Water weak; Metal cannot control Wood, Earth suffers. Various texts say Wiry indicates deficiency, regurgitation, painful Bi. Sinking-wiry indicates hernia/masses; Wiry-long indicates accumulation; Double-wiry indicates cold-fluid; Double-wiry and slow indicates hardness below heart. Single-wiry indicates fluid. Wiry-rapid indicates abdominal pain; Wiry-hook indicates Fei Shi; Wiry-tight-micro-fine indicates cold accumulation; Micro-wiry-hidden indicates untreatable; Wiry-large indicates miscarriage/bleeding/loss of essence/blood; Wiry-small indicates cold-Bi; Wiry at Left Cun indicates headache; Wiry at Right Cun indicates water moving to intestines/stomach; Wiry at Left Guan indicates anger and blood gathering; Wiry at Right Guan indicates cold-pain and limb spasm; Wiry at Duyang indicates hemorrhoids/bloody stool; Wiry at Chi indicates lower abdominal pain and prolapse. Wood evil wind rises to extreme, Earth fails, disease ensues, as ancient sages often said. Only the theory of Metal suppressed by Fire and Wood lacking fear remains undeveloped. Unless nourishing Water to descend Fire, enriching Earth to nourish Metal, and assisting with moving dampness, dispersing wind, and guiding stagnation, how can evil leave and disease heal? Since Wiry disease is numerous and treatment varies (separating two or three organs), silence is unacceptable. If not, why is Wiry considered Yang, yet Zhang Zhongjing lists sinking, choppy, weak, micro, and wiry as five Yin numbers? Among destructive pulses, Wiry is first, Choppy second, revealing intent. (Fei, pronounced Fu-hua)
[Wuze] Slow pulse indicates cold and pain; slow and choppy indicates masses and sour belching.
Hidden pulse indicates Huoluan (Colic and Vomiting), hernia/masses, water qi, loose stool, retained phlegm, retained food, rising Qi of all kinds, foul pus, and necrotic muscle.
Soft pulse indicates deficiency, Bi, spontaneous sweating, Qi weakness, and heaviness below. Soft and weak indicates internal heat, external cold, spontaneous sweating, and difficult urination.
Weak pulse indicates deficiency, wind-heat, and spontaneous sweating.
Fine pulse indicates dual deficiency of Qi and Blood, internal disease, accumulation, dampness injury, late diarrhea, cold, mental fatigue, excessive sorrow, and abdominal fullness. Fine and tight indicates masses and accumulation, stabbing pain. Fine and slippery indicates sudden falling, fever, and vomiting.
Moving pulse indicates pain, fright, Bi, diarrhea, and fear.
Deficient pulse indicates cold, weak legs, deficiency, indigestion, and summerheat injury.
Knotted pulse indicates phlegm, fluid, blood, accumulation, and Qi.
Explanation: Cold Qi with slow pulse forms Knotted; Hot Qi with rapid pulse forms Cu. Though slow and rapid differ, they should be distinguished similarly to Cu pulse.
Intermittent Pulse: One Zang fails, another takes over.
Explanation: Intermittent is truly a death pulse, appearing in any position.
*[Maijing]* Floating at Cun indicates Wind Stroke; Hollow at Cun indicates blood accumulation in chest; Slippery at Cun indicates vomiting/reversal; Solid at Cun indicates heat in chest; Wiry at Cun indicates urgent chest pain; Tight at Cun indicates neck/head stiffness; Surging at Cun indicates intense chest heat; Micro at Cun indicates Yang deficiency; Sinking at Cun indicates hidden Yang in Yin/phlegm in chest; Slow at Cun indicates Taiyang dampness; Choppy at Cun indicates Middle Qi deficiency; Slow at Cun indicates Yin overflowing upward; Hidden at Cun indicates Qi accumulation in chest; Soft at Cun indicates spontaneous sweating; Weak at Cun indicates slight Yang deficiency.
Floating at Guan indicates abdominal fullness; Hollow at Guan indicates blood accumulation in intestines; Slippery at Guan indicates stomach cold and inability to eat; Solid at Guan indicates cutting stomach pain; Wiry at Guan indicates stomach cold and inability to eat; Tight at Guan indicates郁结 (depression/blockage) in abdomen; Surging at Guan indicates regurgitation/vomiting; Micro at Guan indicates Qi knot below heart; Sinking at Guan indicates pain below heart; Slow at Guan indicates stiff lower back; Choppy at Guan indicates blood deficiency and stagnation; Slow at Guan indicates inability to swallow porridge; Hidden at Guan indicates intestinal dysentery with closed eyes; Soft at Guan indicates shortness of Qi and scattered spirit; Weak at Guan indicates stomach Qi deficiency.
Floating at Chi indicates dry/hard stool; Hollow at Chi indicates blood in urine; Slippery at Chi indicates cold retention in lower Jiao; Solid at Chi indicates lower abdominal fullness and urinary incontinence; Wiry at Chi indicates water retention in lower Jiao; Tight at Chi indicates umbilical/abdominal pain; Surging at Chi indicates Yin exhaustion; Micro at Chi indicates accumulation below umbilicus; Sinking at Chi indicates heavy waist/legs; Slow at Chi indicates indigestion; Choppy at Chi indicates reversal cold and blood injury; Slow at Chi indicates severe cold in waist/legs; Hidden at Chi indicates undigested grain diarrhea; Soft at Chi indicates flesh and bone detachment; Weak at Chi indicates internal Yin exhaustion.
*[Suwen]* Pulse is the residence of Blood. Long indicates regulated Qi; Short indicates diseased Qi; Rapid indicates vexed heart; Large indicates disease progression; Upper excess indicates high Qi; Lower excess indicates distended Qi; Intermittent indicates Qi decline; Fine indicates little Qi; Choppy indicates heart pain; Turbulent and rapid like a gushing spring indicates disease progression and pale complexion; Continuous and fading like a broken string indicates death (*Mai Yao Jing Wei Lun*).
Cun pulse feeling short indicates headache. Cun pulse feeling long indicates leg/shin pain. Cun pulse feeling rapid and striking upward indicates shoulder/back pain. Small, weak, and choppy pulse indicates chronic disease. Slippery, floating, and rapid pulse indicates new disease (from *Ping Ren Qi Xiang Lun*). If pulse is small but complexion is unchanged, it is new disease; if pulse is unchanged but complexion is lost, it is chronic disease. If both pulse and five colors are lost, it is chronic disease. If neither pulse nor five colors are lost, it is new disease. Pushing outward, if internal but not external, indicates heart/abdominal accumulation (Wang Bing note: Pulse attached to arm tendon, if not taken carefully, pushing tendon away makes pulse move externally but not emerge, indicating heart/abdominal accumulation). Pushing inward, if external but not internal, indicates body heat (Wang Bing note: Pulse far from arm tendon, pushing it close, if still far, indicates body heat). Pushing upward, if upper but not lower, indicates cold waist/feet ("Upper not down" in *Jia Yi Jing* reads "Gathered but not up, treatment should lift"). Pushing downward, if lower but not upper, indicates head/neck pain ("Lower not up" in *Jia Yi Jing* reads "Up not down, treatment should suppress"). Pressing to bone, if Qi is scarce, indicates lower back/spine pain and Bi syndrome (from *Mai Yao Jing Wei Lun*).
*[Sun Simiao]* A monk at Kaibao Temple was wealthy and charitable. Sun respected him and visited. One day, the monk said: I have a matter to propose a bet on rewards/punishments. Sun asked: How? Monk: If you diagnose my pulse and know my disease, reward 30,000 coins for a feast; if wrong, punish me with 10,000 coins. Sun agreed. Diagnosing, left hand had no pulse, right hand had pulse. Searching left pulse, it was found on the left arm, moving normally. Sun said: This is an abnormal pulse, not recorded in medical books. Pulses follow normal paths; how can they shift? In youth, shock/jolt disturbed heart/mind, pulse left its path, moved to arm. Later shocks prevented return. Now adult, Qi/Blood fixed, cannot shift again, currently healthy. Monk said: I fell as an infant, nearly died, so pulse loss is expected. I have been healthy, never diagnosed, heard you are divine doctor, testing now proves it.