革脉最为病脉中之险脉，而人多忽之，以其不知革脉之真象，即知之亦多不知治法也。其形状如按鼓革，
外虽硬而中空，即弦脉之大而有力者。因其脉与弦脉相近，是以其脉虽大而不洪（无起伏故不洪），虽有力
而不滑（中空故不滑）。即此以揣摩此脉，其真象可得矣。其主病为阴阳离绝，上下不相维系，脉至如此，病
将变革（此又革脉之所以命名），有危在顷刻之势。丁卯在津，治愈革脉之证数次。惟有一媪八旬有六，治
之未愈，此乃年岁所关也。今特将其脉之最险者详录一则于下，以为治斯证者之嚆矢。
外孙王××，年五十，身体素羸弱，于仲夏得温病。心中热
而烦躁，忽起忽卧，无一息之停。其脉大而且硬，微兼洪象。其
舌苔薄而微黑，其黑处若斑点。知其内伤与外感并重也。其大便四日未行，腹中胀满，按之且有硬处。其家
人言，腹中满硬系宿病，已逾半载，为有此病，所以身形益羸弱。因思宿病宜从缓治，当以清其温热为急务。
为疏方用白虎加人参汤，方中石膏用生者两半，人参用野台参五钱，又以生山药八钱代方中粳米，煎汤两盅，
分三次温饮下。一剂，外感之热已退强半，烦躁略减，仍然起卧不安，而可睡片时。脉之洪象已无，而大硬
如故。其大便尤未通下，腹中胀益甚。遂用生赭石细末、生怀山药各一两，野台参六钱，知母、玄参各五钱，
生鸡内金钱半。煎汤服后，大便通下。迟两点钟，腹中作响，觉瘀积已开，连下三次，皆系陈积，其证陡变，
脉之大与硬，较前几加两倍，周身脉管皆大动，几有破裂之势，其心中之烦躁，精神之骚扰，起卧之频频不
安，实有不可言语形容者。其家人环视惧甚，愚毅然许为治愈。遂急开净萸肉、生龙骨各两半，熟地黄、生山
药各一两，野台参、白术各六钱，炙甘草三钱。煎汤一大碗，分两次温饮下，其状况稍安，脉亦见敛。当日按
方又进一剂，可以安卧。须臾，其脉渐若瘀积未下时，其腹亦见软，惟心中时或发热。继将原方去白术，
加生地黄八钱。日服一剂。三剂后，脉象已近平和，而大便数日未行，且自觉陈积未净，遂将萸肉、龙骨各
减五钱，加生赭石六钱，当归三钱。又下瘀积若干。其脉又见大，遂去赭石、当归，连服十余剂全愈。
革脉是病脉中最危险的脉象，但人们往往忽视它，因为不知道革脉的真实形态，即使知道了也不知道治疗方法。它的形状像按压鼓皮，外面虽然硬而中间空，也就是弦脉中粗大且有力的一种。因为这种脉与弦脉相近，所以它的脉虽然大却不洪（因为没有起伏所以不洪），虽然有力却不滑（因为中空所以不滑）。通过揣摩这种脉，就能得到它的真实形态。它主治的疾病是阴阳离绝，上下不相维系，脉象到了这种地步，病情即将发生变革（这也是革脉命名的原因），有顷刻间危及生命的态势。丁卯年在天津，治愈过几例革脉的证候。只有一位八十六岁的老妇人，治疗未愈，这是年龄关系导致的。现在特意将其中最危险的一则脉案详细记录如下，作为治疗此证者的先导。
外孙王××，五十岁，身体向来瘦弱，在仲夏得了温病。心中发热且烦躁，忽起忽卧，没有一刻停歇。他的脉大而且硬，略微兼有洪象。他的舌苔薄而微黑，黑色处像斑点。知道他是内伤与外感并重。他大便四天未行，腹部胀满，按压还有硬块。他的家人说，腹中满硬是宿疾，已经半年多了，因为有这个病，所以身形更加瘦弱。于是想宿疾应当从缓治疗，当以清除温热为紧急事务。于是开方用白虎加人参汤，方中生石膏用一两半，人参用野台参五钱，又用生山药八钱代替方中的粳米，煎汤两盅，分三次温服。一剂后，外感的热退去大半，烦躁略减，仍然起卧不安，但可以睡一会儿。脉的洪象已无，但大硬如故。他的大便尤其未通下，腹部胀满更严重。于是用生赭石细末、生怀山药各一两，野台参六钱，知母、玄参各五钱，生鸡内金钱半。煎汤服用后，大便通下。过了两个小时，腹中作响，感觉瘀积已开，连续下了三次，都是陈旧的积滞，病情突然变化，脉的大与硬，比之前几乎增加两倍，周身脉管都大动，几乎有破裂的态势，他心中的烦躁，精神的骚扰，起卧的频频不安，实在有不可用言语形容的。他的家人环视非常恐惧，我毅然许诺能治愈。于是急忙开净萸肉、生龙骨各一两半，熟地黄、生山药各一两，野台参、白术各六钱，炙甘草三钱。煎汤一大碗，分两次温服，状况稍安，脉也收敛。当天按方又进一剂，可以安卧。片刻后，他的脉渐渐像瘀积未下时那样，腹部也变软，只是心中有时发热。接着将原方去掉白术，加生地黄八钱。每天服一剂。三剂后，脉象已近平和，但大便几天未行，且自觉陈旧积滞未净，于是将萸肉、龙骨各减五钱，加生赭石六钱，当归三钱。又下了若干瘀积。他的脉又见大，于是去掉赭石、当归，连服十余剂全愈。
The Ge pulse (Reed Pulse) is the most perilous among pathological pulses, yet people often overlook it because they are unaware of its true manifestation; even those who know it often do not understand its treatment. Its shape resembles pressing on a drum skin: hard on the outside but hollow in the middle, which is essentially a Xian pulse (Wiry Pulse) that is large and forceful. Because this pulse is similar to the Xian pulse, although it is large, it is not Hong (Surging) due to the lack of up-and-down fluctuation; although it is forceful, it is not Hua (Slippery) due to its hollowness. By contemplating this pulse, its true nature can be discerned. It indicates a disease where Yin and Yang are severed, with no connection between the upper and lower parts. When the pulse reaches such a state, the illness is about to undergo transformation (hence the name "Ge" or Reed), presenting a critical situation where death could occur at any moment. In the Ding-Mao year in Tianjin, I cured several cases of Ge pulse syndrome. Only one case, an eighty-six-year-old woman, did not recover, which was due to her advanced age. Here, I specifically record the most dangerous case in detail below as a guide for treating such syndromes.
My grandson, Wang XX, aged fifty, had always been physically frail. In midsummer, he contracted a Warm Disease (Wen Bing). He experienced heat and irritability in the heart region, alternating between rising and lying down without any rest. His pulse was large and hard, slightly accompanied by a Hong (Surging) image. His tongue coating was thin and slightly black, with black spots resembling speckles. This indicated that both internal injury and external contraction were severe. His bowels had not moved for four days, and his abdomen was distended and hard upon palpation. His family stated that the abdominal fullness and hardness were chronic conditions lasting over half a year, which contributed to his increasing emaciation. Considering that the chronic condition should be treated slowly, clearing the warm-heat became the urgent priority. I prescribed Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), using 1.5 liang of raw Shigypsum Fibrosum (Gypsum), 5 qian of Yetaishen (Wild Panax ginseng from Taihang Mountains), and replacing the Jingmi (Oryza sativa var. japonica) in the formula with 8 qian of raw Shanyao (Dioscorea opposita). The decoction was prepared into two bowls and taken warm in three doses. After one dose, the external heat subsided significantly, and irritability decreased slightly, though he remained restless, able to sleep only briefly. The Hong (Surging) quality of the pulse disappeared, but it remained large and hard. His bowels still had not moved, and abdominal distension worsened. Consequently, I used 1 liang each of finely powdered Sheng Zheishi (Hematitum) and raw Huai Shanyao (Dioscorea polystachya), 6 qian of Yetaishen (Wild Panax ginseng), 5 qian each of Zhimu (Anemarrhenae Rhizoma) and Xuanshen (Scrophulariae Radix), and half a qian of raw Jineijin (Galli Gigerii Endothelium Corneum). After taking the decoction, his bowels moved. Two hours later, his abdomen made sounds, indicating that the stagnation had begun to clear. He passed stool three times consecutively, all consisting of old accumulation. Suddenly, his condition changed drastically: the largeness and hardness of the pulse increased nearly twofold compared to before, with all peripheral vessels pulsating strongly, almost threatening rupture. His cardiac irritability, mental disturbance, and frequent restlessness were indescribable. His family looked around in extreme fear, but I firmly promised to cure him. I immediately prescribed 1.5 liang each of purified Yurou (Corni Fructus) and raw Longgu (Fossilia Ossis Mastodi), 1 liang each of Shudi Huang (Rehmanniae Radix Praeparata) and raw Shanyao (Dioscorea opposita), 6 qian each of Yetaishen (Wild Panax ginseng) and Baizhu (Atractylodis Macrocephalae Rhizoma), and 3 qian of Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma). Prepared as a large bowl of decoction and taken warm in two doses, his condition stabilized somewhat, and the pulse began to gather. On the same day, another dose according to the prescription allowed him to lie down peacefully. Shortly after, his pulse returned to the state it was in before the evacuation of stagnation, and his abdomen softened, although he occasionally felt heat in the heart region. Subsequently, I removed Baizhu (Atractylodis Macrocephalae Rhizoma) from the original formula and added 8 qian of Sheng Di Huang (Rehmanniae Radix). One dose was taken daily. After three doses, the pulse became nearly peaceful, but his bowels had not moved for several days, and he felt that the old accumulation was not fully cleared. Therefore, I reduced the dosage of Yurou (Corni Fructus) and Longgu (Fossilia Ossis Mastodi) by 5 qian each and added 6 qian of Sheng Zheishi (Hematitum) and 3 qian of Danggui (Angelicae Sinensis Radix). He passed more old accumulation subsequently. His pulse became large again, so I removed Zheishi (Hematitum) and Danggui (Angelicae Sinensis Radix). After continuing the remaining prescription for more than ten doses, he completely recovered.