沾沙刮竹一般看。滑涩当分滞利间。气郁作疼痰血积。元虚久病命须艰。（乍病身热。脉来
洪大。独有气口脉带涩。此真气虚也。理宜温补。不可寒凉）。
脉大当思病进。臣欺君弱胡行。欲知浓薄细推情。实泻虚温随症。（要略云。病患脉大为劳
。以元气虚也。盖气为君。火为臣。君弱臣欺。气虚火盛。故脉反见洪大。脉本不实。寒药宜忌。
余症脉大。寸尺举按皆然。法当下之。）
细如一缕是元虚。若是滞弦积有余。能辨久新求责治。根据经据理莫差迟。（久病脉细无力。防
危。凡脉来微细。真气虚也。症虽有余。亦从脉治。细而兼数。真阴虚也。形盛脉细。少气不足
以息者。死也。）
身热脉来频歇止。至数之中促不祥。若还病退渐无妨。愈进料应身丧亡。（此阳极之故。多
致不救。）
脉来带结七情伤。歇止中间要忖量。痰血滞经多此候。当分新久实虚方。（此阴极之故。久
病见之难治。暴病见之当温补。受补必复。如补之不复。终至危也。又有痰凝经络而歇止者。药
之必复也）。
轻按之满指。重按之则无。此阴虚也。伤寒得此。须用大剂参地。轻按之则无。重按之满指
。此阳虚也。轻按之满指。重按之亦然。此伤风脉也。浮而不敛。散脉也。此大虚之候。不治。
浮而迟。三至。此寒脉也。宜温之。浮而数。此假热也。宜温之。浮而滑。痰脉也。六君子汤。
女人主有娠。浮而弦。真脏脉见也。必死。（假热浮数。必重按全无。方可温补。若属火燥生风
者。大非所宜）。
诊脉时要像沾沙刮竹那样仔细体察。滑脉与涩脉应当区分气机阻滞与通利之间的差异。气机郁结会导致疼痛，痰浊和瘀血积聚也会引起不适，若元气亏虚且久病不愈，生命将十分艰难。（若是突发疾病身体发热，脉搏洪大，唯独气口脉带有涩象，这是真气虚弱所致。治疗理应温补，不可使用寒凉药物）。
脉象宏大应当考虑病情正在进展。如同臣子欺压君主、君主衰弱却胡作非为。想要知道邪气的浓薄深浅，必须细致推究病情。实证宜用泻法，虚证宜用温法，随症状而定。（《金匮要略》说：病人脉大为劳损之证，是因为元气虚弱。盖气为君，火为臣，君主弱而臣子欺，气虚火盛，所以脉象反而见洪大。脉象本不实，应忌用寒药。其余病症若脉大，寸部和尺部举按皆如此，治法应当攻下。）
脉细如一线是元气虚弱的表现。如果是滞涩弦紧且积滞有余，能够辨别病程的新久并寻求相应的治疗，依据经典和医理就不会有差错。（久病脉细无力，需防备危象。凡是脉来微细，都是真气虚弱。症状虽表现为有余，也应从脉象论治。细脉兼数脉，是真阴亏损。形体壮实但脉细，少气不足以呼吸的，属死证。）
身体发热脉搏出现频繁的歇止，在至数之中属于促脉，是不祥之兆。如果病情逐渐消退则无妨，若痊愈后饮食进量反而导致身体丧亡。（这是阳极的缘故，多导致无法救治。）
脉象带结象是七情内伤所致。在歇止中间需要仔细揣度。痰浊、瘀血阻滞经络多出现这种脉候，应当分辨新病久病、实证虚证来处方。（这是阴极的缘故，久病见到难治，暴病见到应当温补。受补后必能恢复，如果补益后不恢复，最终会危及生命。又有痰凝经络而导致脉歇止的，用药后必能恢复）。
轻取时满指有力，重按时则无，这是阴虚的表现。伤寒病得到此脉，须用大剂量的参、地（人参、地黄）等药。轻取时无力，重按时满指有力，这是阳虚的表现。轻取时满指有力，重按时亦然，这是伤风脉。浮而不收敛，是散脉，这是大虚之候，难以治愈。浮而迟，每息三至，这是寒脉，宜用温法。浮而数，这是假热，宜用温法。浮而滑，是痰脉，可用六君子汤。妇女主诉可能有妊娠。浮而弦，是真脏脉显现，必死。（假热浮数，必须重按全无，方可温补。若属于火燥生风的，则大不相宜）。
Pulse diagnosis requires careful observation, akin to feeling sand or scraping bamboo. One must distinguish between slippery (Hua) and choppy (Se) pulses to differentiate between stagnation and free flow. Qi stagnation causes pain, while phlegm and blood stasis accumulate; if primordial qi is deficient and the illness is chronic, life will be in peril. (In acute onset with fever, a surging pulse usually indicates excess, but if only the Qi Kou pulse shows a choppy quality, this signifies deficiency of true qi. Treatment should employ warming and tonifying methods, avoiding cold and cooling agents.)
A large pulse suggests disease progression, analogous to a minister bullying a weakened ruler. To discern the depth and thickness of the pathogen, one must carefully analyze the condition. Excess patterns require purgation, while deficiency patterns require warming, tailored to symptoms. (The *Jin Gui Yao Lue* states: "A patient with a large pulse suffers from exhaustion due to primordial qi deficiency." Qi acts as the sovereign, fire as the minister. When the sovereign is weak and the minister overpowers, qi deficiency leads to hyperactive fire, resulting in a surprisingly surging/large pulse. Since the pulse is not solid/excess, cold herbs are contraindicated. For other conditions where the pulse is large at both Cun and Chi positions upon lifting and pressing, the method should be purgation.)
A pulse fine as a single thread indicates primordial qi deficiency. If it is choppy, wiry, and indicates excess accumulation, one must distinguish between new and chronic onset to seek appropriate treatment. Adhering to classics and principles ensures no delay in correct therapy. (Chronic illness with a fine, powerless pulse warns of danger. Whenever the pulse is minute and fine, true qi is deficient. Even if symptoms suggest excess, treatment should follow the pulse. A fine pulse combined with rapidity indicates yin deficiency. A robust physique with a fine pulse and shortness of breath indicating insufficient respiration is a sign of death.)
Body heat accompanied by frequent intermittent pauses in the pulse, specifically the Cui (rapid with irregular pauses) pulse, is an inauspicious sign. If the disease recedes gradually, there is no harm; however, if recovery is followed by increased intake leading to demise, it indicates extreme yang. (This results from extreme yang, often leading to untreatable conditions.)
A Jie (knotted) pulse indicates injury from the seven emotions. The intervals of pause must be carefully considered. Phlegm, blood stasis, and meridian stagnation often present this pattern. One must differentiate between new/chronic and excess/deficiency to prescribe. (This results from extreme yin. It is difficult to treat in chronic illness but warrants warming and tonification in acute illness. Recovery follows successful tonification; if tonification fails to restore health, it ultimately becomes critical. Additionally, phlegm coagulation in meridians causing pauses can be cured with medication.)
If the pulse feels full under light pressure but disappears under heavy pressure, it indicates yin deficiency. In Shaoyang/Taiyang disorders (Shanghan), large doses of Ginseng and Rehmannia are required. If the pulse is empty under light pressure but full under heavy pressure, it indicates yang deficiency. If the pulse is full under both light and heavy pressure, it is a wind-injury pulse. A floating pulse that does not gather is a San (scattered) pulse, indicating severe deficiency and poor prognosis. A floating and slow pulse (three beats per respiration) indicates cold, suitable for warming. A floating and rapid pulse indicates false heat, suitable for warming. A floating and slippery pulse indicates phlegm, treatable with Liu Jun Zi Tang. In women, it may indicate pregnancy. A floating and wiry pulse reveals the Zang organ pulse, indicating certain death. (False heat presents as floating and rapid; only if it vanishes completely upon heavy pressing should warming tonification be used. If caused by fire dryness generating wind, this approach is highly inappropriate.)