长则气治，过于本位。长而端直，弦脉应指。
脉位有三，寸关尺也。长则透出本位。惟其透出，乃见长象。非气之充畅，不
能有此，故曰治。若长而端直，应于指下，是为弦脉。即《素问》玉机真藏论曰∶
其气来软弱轻虚而滑，端直以长者是也。
短则气病，不能满部，不见于关，惟尺寸候。
一脉一形，各有主病。数脉相兼，则见诸证。
脉短，则气不充畅，无论在寸在尺，俱不能满足本部。惟其不能满部，乃见短
象。气不足，非病而何？然此惟尺寸见之。设若在关而不满本部，则与尺寸不相接
矣，理无此脉。盖脉类多矣。有一脉，自有一脉之形。形有不同，故病亦各异。若
脉数形兼见，而病亦数种兼成。仲景所谓此自经常，不失铢分者也。如下文云云。
浮脉主表，里必不足。有力风热，无力血弱。
浮迟风虚，浮数风热，浮紧风寒，浮缓风湿，
浮虚伤暑，浮芤失血，浮洪虚火，浮微劳极，
浮濡阴虚，浮散虚极，浮弦痰饮，浮滑痰热。
皮毛曰表，言在外也。浮脉与皮毛相得。亦有势泛泛外浮者，皆主表。气应于
表，其里必虚，故里不足。浮亦主风。浮而有力，风热所为。盖风为阳邪，其性轻
浮动荡，加之以热，势必壅盛，故有力也。（宜荆防羌壳芩栀石膏之类。）无力则浮而虚矣。血
主里，气主表。血弱不能谐气，故反浮，亦里不足之义。（宜参 四物汤之类。）脉浮而迟，
乃鼓动之不及也，为风虚。（宜四君子汤或防桂参 之类。）脉浮而数，乃鼓动之太过也，为风
热。（宜荆防膏薄栀芩丹皮生地之类。）脉浮而紧，紧则紧敛，寒之性也，风中有寒。（九味羌活汤、麻
黄汤或苏 羌杏姜葱之类。）脉浮而缓，缓则缓漫，湿之性也，风中有湿。（宜羌防苍白术防己黄 桂附
之类。）浮虚伤暑者，暑伤乎气。气主浮外，而暑性张散，故伤暑者多汗。经曰脉虚身
热，得之伤暑者是也。（宜清暑益气汤、十味香薷饮之类。）浮芤失血者，血去脉空耳。盖卫行脉
外，营行脉中，血失则营损，营损则脉中空，如芤草之状也。（宜黄 归芍或当归补血汤、琼
玉膏之类。）脉浮而洪，充涌指下，火之象也。但浮则有表无里，故曰虚火。（宜当归补血汤、
四物汤、六味丸、八味丸之类。）浮微劳极，阳气欲绝也。《素问》生气通天论曰∶阳气者，烦劳
则张，精绝辟积。于夏使人煎厥，目盲不可以视，耳闭不可以听。溃溃乎若坏都，
汨汨乎不可止。盖言阳气清净，烦劳则阳精张散而竭绝。积于夏长之时，当振发而
反退陷，故变病如上，是名煎厥。煎厥者，气应振而反靡，应出而反入，如煎迫之
自外及里，煎熬之由多渐少，即《难经》十四难所谓自皮毛以及于骨之五损，从上
下者是也。今之五劳六极，虚怯损瘵，皆煎厥之类。阳主浮，以其因于耗阳，故脉
浮微耳。（宜十全大补汤、生脉散、大造丸、四君子汤、八珍汤之类。）脉浮而濡，衰薄之甚，仅有其上，
若无其下，故主阴虚。（宜四物汤、六味丸之类。）若浮而散，则又阴虚之极矣。阳在外，阴之
使；阴在内，阳之守。阴虚极而不能为守，则阳无所根据，浮越而散，略无阴凝内敛
之象，故阴虚剧。然而孤精于内，气耗于外，谓之阴阳两虚亦可。（宜十全大补汤、金匮肾
气丸之类。）脉浮弦者痰饮。痰饮何自而生乎？《素问》经脉别论曰∶饮食入胃，游溢精气，
上输于脾。脾气散精，上归于肺。通调水道，下输膀胱，水精四布，五经并行。又
营卫生会篇曰∶上焦如雾，中焦如沤，下焦如渎。二说虽殊，其理则一。方饮之由
胃游溢而上输于脾也，腐熟如酒酵之喷发，炊釜之沸腾，即中焦之如沤。由脾散精
而上归于肺也，拔粹升纯，氤氲若 ，即上焦之如雾。由肺之通调而下输膀胱也，
气化开通，溲便注泄，即下焦之如渎。名虽有三，实则一气。若气虚寒不运，则饮
亦停留不行，随不运之处停留，则随停留之处见病矣。大约暴则为饮，久则成痰。
清薄则为饮，浊浓则成痰；寒多则为饮，热多则成痰。熬汁收膏，煮水结盐之义也。
弦乃阴脉，为阳不足。仲景云∶弦为阳运，正言阳之不能运也。又云∶沉潜水蓄，
支饮急弦，俱言阳气衰弱，不能营运其饮，故见此弦敛不鼓之脉耳。（宜金匮苓桂术甘汤、
小青龙汤之类。）水饮应沉，而言浮者，当在上焦。若浮而滑，则非弦敛不鼓之脉，寒当
化热，饮当成痰，此必然之理也。（宜二陈汤，或栀芩花粉玄明粉之类。）
长脉表示气机调畅，其脉象超过寸关尺的本位范围。若脉象长且端直，如按琴弦，则为弦脉。
脉位分为三部：寸、关、尺。长脉的特征是脉动透出本位范围。正因为透出了本位，才呈现出长的形象。若非气机充盛通畅，不能出现这种脉象，所以称之为“治”（调畅）。如果脉象长而端直，应指于手指之下，这就是弦脉。正如《素问·玉机真脏论》所说：“脉气来时软弱、轻虚而滑，形态端直且长”，指的就是这种情况。
短脉表示气机有病，脉体不能充满脉位，在关部往往不明显，仅在寸部和尺部可以诊察到。
每一种脉象都有其对应的主病。多种脉象相兼出现时，就会表现出各种复杂的证候。
脉象短促，说明气机不充盛通畅，无论是在寸部还是尺部，都不能满足该部的脉位要求。正因为不能充满脉位，才呈现出短的形象。气机不足，难道不是生病了吗？然而这种脉象只在寸部和尺部显现。假如在关部也不满部，那么脉气就无法与寸、尺两部相接，从医理上讲是不存在这种脉象的。因为脉的种类繁多，每一种脉都有自己独特的形态。形态不同，所主的疾病也各异。如果脉象和形态兼见，那么疾病也会多种并发。这正是张仲景所说的“遵循常道，毫厘不差”。如下文所述。
浮迟脉主风虚，浮数脉主风热，浮紧脉主风寒，浮缓脉主风湿，
浮虚脉主伤暑，浮芤脉主失血，浮洪脉主虚火，浮微脉主劳损至极，
浮濡脉主阴虚，浮散脉主虚极，浮弦脉主痰饮，浮滑脉主痰热。
皮毛称为表，意指在体表之外。浮脉与皮毛相应。也有气势泛泛外浮的，都主表证。气机应于表，则里气必虚，所以说是里不足。浮脉也主风邪。浮而有力，是风热所致。因为风为阳邪，性质轻扬浮动，再加上热邪，势必壅盛，所以脉象有力。（适宜使用荆芥、防风、羌活、枳壳、黄芩、栀子、石膏等药物。）无力则是浮而虚弱。血主里，气主表。血虚不能调和气机，所以脉反浮，这也是里不足的义理。（适宜使用人参、四物汤等药物。）脉浮而迟，是因为鼓动力量不及，属于风虚。（适宜使用四君子汤或防风、桂枝、人参等药物。）脉浮而数，是因为鼓动力量太过，属于风热。（适宜使用荆芥、防风、石膏、薄荷、栀子、黄芩、牡丹皮、生地黄等药物。）脉浮而紧，紧脉表现为紧敛，这是寒邪的性质，风中夹有寒邪。（适宜使用九味羌活汤、麻黄汤或苏叶、羌活、杏仁、生姜、葱白等药物。）脉浮而缓，缓脉表现为缓漫，这是湿邪的性质，风中夹有湿邪。（适宜使用羌活、防风、苍术、白术、防己、黄芪、桂枝、附子等药物。）浮虚脉主伤暑，是因为暑邪损伤了气机。气机主浮越于外，而暑性张扬发散，所以伤暑的人多汗。经书说：“脉虚身热，得之于伤暑”，指的就是这种情况。（适宜使用清暑益气汤、十味香薷饮等药物。）浮芤脉主失血，是因为血液流失导致脉管中空。卫气行于脉外，营气行于脉中，失血则营气受损，营气受损则脉中空虚，像芤草一样。（适宜使用黄芪、当归、白芍或当归补血汤、琼玉膏等药物。）脉浮而洪，充盈涌跃于指下，是火的征象。但浮脉只见于表而无里，所以称为虚火。（适宜使用当归补血汤、四物汤、六味丸、八味丸等药物。）浮微脉主劳损至极，是阳气即将衰竭的表现。《素问·生气通天论》说：“阳气，因烦劳而亢张，精气枯竭，积久不散。到了夏天使人发生煎厥，眼睛看不见，耳朵听不到。混乱不堪就像城墙崩塌，滔滔不绝无法停止。”这是在说阳气本应清净，烦劳则阳精张扬发散而竭绝。积聚于夏季生长之时，本当振奋反而退陷，所以变病如上所述，这叫做煎厥。煎厥，是指气机应当振奋反而萎靡，应当外出反而内入，如同被煎熬逼迫，由外向内，由多变少逐渐减少，也就是《难经·十四难》所说的从上到下、自皮毛及于骨的“五损”。现在的五劳六极、虚怯损瘵，都属于煎厥一类。阳主浮，因为是由于耗伤阳气所致，所以脉象浮微。（适宜使用十全大补汤、生脉散、大造丸、四君子汤、八珍汤等药物。）脉浮而濡，衰薄得很厉害，只有上部脉象，好像没有下部脉象，所以主阴虚。（适宜使用四物汤、六味丸等药物。）如果是浮而散，那就是阴虚到了极点。阳在外，是阴的役使；阴在内，是阳的守持。阴虚至极而不能守持，则阳无所依附，浮越而散，完全没有阴凝内敛的迹象，所以阴虚严重。然而孤精在于内，气耗在于外，也可以称为阴阳两虚。（适宜使用十全大补汤、金匮肾气丸等药物。）脉浮弦者，主痰饮。痰饮是如何产生的呢？《素问·经脉别论》说：“饮食进入胃，游溢精气，上输于脾。脾气散精，上归于肺。通调水道，下输膀胱，水精四布，五经并行。”又《营卫生会篇》说：“上焦如雾，中焦如沤，下焦如渎。”这两种说法虽然不同，道理却是一致的。方饮之液由胃游溢而上输于脾，腐熟发酵如同酒酵喷发、炊釜沸腾，这就是中焦的“如沤”。由脾散精而上归于肺，拔萃升纯，氤氲弥漫如同雾气，这就是上焦的“如雾”。由肺的通调而下输膀胱，气化开通，小便排泄，这就是下焦的“如渎”。名称虽有三种，实则是一气运行。如果气虚寒而不运化，则水饮也会停留不行，随着不运化的地方停留，也就随着停留的地方出现病症。大致来说，新发的叫饮，久留的叫痰；清稀的叫饮，浑浊的叫痰；寒多则为饮，热多则为痰。这就像熬汁收膏、煮水结盐的道理一样。
弦脉属于阴脉，代表阳气不足。张仲景说：“弦为阳运”，正是说阳气不能运化的意思。又说：“沉潜水蓄，支饮急弦”，都是说阳气衰弱，不能营运水饮，所以出现这种弦敛而不鼓动的脉象。（适宜使用金匮苓桂术甘汤、小青龙汤等药物。）水饮应当沉伏，如果说浮，说明病位在上焦。如果是浮而滑，就不是弦敛不鼓的脉象，寒邪应当化热，水饮应当变成痰，这是必然的道理。（适宜使用二陈汤，或栀子、黄芩、花粉、玄明粉等药物。）
Long pulse indicates that Qi mechanism is regulated and smooth, extending beyond its normal position. If the pulse is long and straight, resembling a taut string under the fingers, it is a Wiry pulse (Xian Mai).
The pulse positions are divided into three: Cun (Inch), Guan (Bar), and Chi (Cubit). The characteristic of a Long pulse is that the pulsation extends beyond the boundaries of these positions. Precisely because it extends beyond, the image of "long" is revealed. Without abundant and free-flowing Qi, such a pulse cannot occur; hence it is termed "Zhi" (regulated/healthy). If the pulse is long and straight, responding directly to the fingertips, this constitutes a Wiry pulse (Xian Mai). As stated in the *Su Wen: Yu Ji Zhen Zang Lun* (Treatise on the Jade Machine and True Viscera): "When the Qi comes, it is soft, weak, light, void, and slippery, with a shape that is straight and long," referring to this condition.
Short pulse indicates pathological Qi. The vessel body cannot fill the pulse position; it is often not apparent at the Guan position and can only be palpated at the Cun and Chi positions.
Each pulse form has its corresponding primary disease. When multiple pulse qualities combine, various syndromes manifest.
A Short pulse signifies that Qi is not abundant or free-flowing. Whether at the Cun or Chi position, it fails to fill the respective segment. Because it cannot fill the position, the image of "short" appears. Insufficient Qi—how could this not be a disease? However, this pulse is seen only at the Cun and Chi positions. If the Guan position were also unfilled, the pulse qi would fail to connect with the Cun and Chi positions; theoretically, such a pulse does not exist. There are many types of pulses; each has its own unique form. Different forms correspond to different diseases. If pulse qualities and forms combine, diseases may also present concurrently. This aligns with Zhang Zhongjing's statement: "Following the constant principles, without losing even a fraction." As described below.
Floating pulse (Fu Mai) primarily indicates Exterior syndrome, implying that Interior deficiency must exist. A Floating pulse with force suggests Wind-Heat; without force, it suggests Blood deficiency.
Floating and slow indicates Wind-Deficiency; Floating and rapid indicates Wind-Heat; Floating and tight indicates Wind-Cold; Floating and relaxed indicates Wind-Dampness;
Floating and deficient indicates Summerheat injury; Floating and hollow indicates Blood loss; Floating and surging indicates Deficient Fire; Floating and faint indicates Extreme exhaustion from overwork;
Floating and soggy indicates Yin deficiency; Floating and scattered indicates Extreme deficiency; Floating and wiry indicates Phlegm-Fluid retention; Floating and slippery indicates Phlegm-Heat.
Skin and hair are called the Exterior, meaning located outside the body. The Floating pulse corresponds with the skin and hair. Even if the momentum floats outward diffusely, it still indicates an Exterior syndrome. Since Qi responds to the Exterior, the Interior must be deficient; thus, it is said to be Interior insufficiency. The Floating pulse also indicates Wind pathogen. A Floating pulse with force is caused by Wind-Heat. Wind is a Yang pathogen, characterized by lightness and floating agitation; combined with Heat, the condition inevitably becomes congested and vigorous, resulting in a forceful pulse. (Appropriate herbs include Jingjie [Schizonepetae Spica], Fangfeng [Saposhnikoviae Radix], Qianghuo [Notopterygii Rhizoma et Radix], Zhike [Aurantii Fructus], Huangqin [Scutellariae Radix], Zhizi [Gardeniae Fructus], Shigao [Gypsum Fibrosum].) Lack of force indicates a Floating and deficient state. Blood governs the Interior, while Qi governs the Exterior. Blood deficiency fails to harmonize Qi, causing the pulse to float reversely, which also signifies Interior insufficiency. (Appropriate formulas include Renshen [Panacis Ginseng Radix] and Siwu Tang [Four Substances Decoction].) A Floating and slow pulse indicates insufficient driving force, categorized as Wind-Deficiency. (Appropriate formulas include Sijunzi Tang [Four Gentlemen Decoction] or Fangfeng [Saposhnikoviae Radix], Guizhi [Cinnamomi Ramulus], Renshen [Panacis Ginseng Radix].) A Floating and rapid pulse indicates excessive driving force, categorized as Wind-Heat. (Appropriate herbs include Jingjie [Schizonepetae Spica], Fangfeng [Saposhnikoviae Radix], Shigao [Gypsum Fibrosum], Bohe [Menthae Haplocalycis Herba], Zhizi [Gardeniae Fructus], Huangqin [Scutellariae Radix], Mudanpi [Moutan Cortex], Shengdihuang [Rehmanniae Radix].) A Floating and tight pulse: Tightness implies contraction, a nature of Cold; here, Wind contains Cold. (Appropriate formulas include Jiuwei Qianghuo Tang [Nine-Ingredient Notopterygium Decoction], Mahuang Tang [Ephedra Decoction], or Suzye [Perillae Folium], Qianghuo [Notopterygii Rhizoma et Radix], Xingren [Armeniacae Semen Amarum], Shengjiang [Zingiberis Rhizoma Recens], Congbai [Allii Fistulosi Bulbus].) A Floating and relaxed pulse: Relaxation implies looseness, a nature of Dampness; here, Wind contains Dampness. (Appropriate herbs include Qianghuo [Notopterygii Rhizoma et Radix], Fangfeng [Saposhnikoviae Radix], Cangzhu [Atractylodis Rhizoma], Baizhu [Atractylodis Macrocephalae Rhizoma], Fangji [Stephaniae Tetrandrae Radix], Huangqi [Astragali Radix], Guizhi [Cinnamomi Ramulus], Fuzi [Aconiti Lateralis Radix Praeparata].) Floating and deficient indicates Summerheat injury, as Summerheat damages Qi. Qi tends to float outward, and Summerheat has a dispersing nature; thus, those injured by Summerheat sweat profusely. The Classics state: "Pulse is deficient, body is hot, acquired from Summerheat injury." (Appropriate formulas include Qingshu Yiqi Tang [Clear Summerheat and Boost Qi Decoction] or Shiwei Xiangru Yin [Ten-Ingredient Elsholtzia Drink].) Floating and hollow indicates blood loss, as blood loss leaves the vessel empty. Wei Qi circulates outside the vessels, Ying Qi inside. Blood loss damages Ying Qi; damaged Ying Qi results in an empty pulse, resembling the hollow stem of the Kungcao plant. (Appropriate herbs include Huangqi [Astragali Radix], Danggui [Angelicae Sinensis Radix], Shaoyao [Paeoniae Radix Alba], or Danggui Buxue Tang [Danggui Tonify Blood Decoction], Qiongyu Gao [Jade Elixir].) A Floating and surging pulse fills and surges under the fingers, representing the image of Fire. However, since Floating indicates Exterior presence without Interior substance, it is termed Deficient Fire. (Appropriate formulas include Danggui Buxue Tang [Danggui Tonify Blood Decoction], Siwu Tang [Four Substances Decoction], Liuwei Wan [Six-Ingredient Pill], Bawei Wan [Eight-Ingredient Pill].) Floating and faint indicates extreme exhaustion from overwork, where Yang Qi is about to perish. The *Su Wen: Shengqi Tongtian Lun* states: "Yang Qi, when subjected to vexatious labor, expands; essence perishes and accumulates. In summer, this causes Jianjue (Frying Jue), where eyes cannot see and ears cannot hear. It is chaotic like a collapsing city wall, unstoppable like rushing water." This describes how Yang Qi, originally clear and quiet, becomes dispersed and exhausted due to labor. Accumulating during the summer growth phase, instead of rising, it sinks and collapses, leading to the aforementioned diseases, named Jianjue. Jianjue means Qi should rise but instead collapses; it should exit but instead enters, as if being fried from outside to inside, diminishing from much to little. This corresponds to the "Five Damages" from skin to bone described in the *Nan Jing: Chapter 14*, moving from top to bottom. Current conditions of Five Labors, Six Extremes, deficiency, and consumption belong to the category of Jianjue. Yang governs Floating; because it results from consuming Yang, the pulse is Floating and faint. (Appropriate formulas include Shiquan Dabu Tang [Ten-Ingredient Great Tonifying Decoction], Shengmai San [Generate Pulse Powder], Dazao Wan [Great Creation Pill], Sijunzi Tang [Four Gentlemen Decoction], Bazhen Tang [Eight-Treasure Decoction].) Floating and soggy pulse indicates severe thinning, with pulse felt only superficially and lacking depth, thus indicating Yin deficiency. (Appropriate formulas include Siwu Tang [Four Substances Decoction], Liuwei Wan [Six-Ingredient Pill].) If Floating and scattered, it represents extreme Yin deficiency. Yang outside is the servant of Yin; Yin inside is the guardian of Yang. Extreme Yin deficiency cannot guard, so Yang has no foundation, floating away and scattering, lacking any sign of Yin condensing inward; thus, Yin deficiency is severe. However, with isolated essence inside and depleted Qi outside, it can also be termed Dual Deficiency of Yin and Yang. (Appropriate formulas include Shiquan Dabu Tang [Ten-Ingredient Great Tonifying Decoction], Jin Gui Shenqi Wan [Kidney Qi Pill from the Golden Cabinet].) Floating and wiry pulse indicates Phlegm-Fluid retention. How is Phlegm-Fluid generated? The *Su Wen: Jingmai Bie Lun* states: "Food and drink enter the Stomach, their essence floats and rises, transmitting to the Spleen. The Spleen scatters essence, sending it up to the Lung. The Lung regulates water passages, transmitting down to the Bladder. Water essence distributes everywhere, flowing through the five meridians." The *Yingweishenghui Pian* states: "Upper Jiao is like mist, Middle Jiao is like fermentation, Lower Jiao is like a ditch." Though phrased differently, the principle is one. Fluids enter the Stomach, float up to the Spleen, fermenting like yeast or boiling water, which is the Middle Jiao's "fermentation." From the Spleen, essence ascends to the Lung, refining and rising like mist, which is the Upper Jiao's "mist." From the Lung, regulation transmits fluids down to the Bladder, where Qi transformation opens passages for urination, which is the Lower Jiao's "ditch." Though named three, they are one Qi process. If Qi is deficient and cold, failing to transform, fluids stagnate where transformation fails, causing disease at those sites. Generally, acute cases are Fluids (Yin), chronic cases become Phlegm (Tan); clear/thin are Fluids, turbid/thick are Phlegm; more Cold yields Fluids, more Heat yields Phlegm. This is like reducing juice to paste or boiling water to salt crystals.
Wiry pulse (Xian Mai) is a Yin pulse, indicating insufficient Yang. Zhang Zhongjing said: "Wiry indicates Yang movement," meaning Yang fails to move. He also said: "Sunken and submerged water accumulation, urgent Wiry pulse for Branch Fluids," all stating that Yang Qi is weak and cannot transport fluids, resulting in this contracting, non-driving pulse. (Appropriate formulas include Jin Gui Linggui Zhugan Tang [Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction from the Golden Cabinet], Xiao Qinglong Tang [Minor Blue Dragon Decoction].) Water-fluids should be Sunken; if described as Floating, the pathology is in the Upper Jiao. If Floating and Slippery, it is not a contracting, non-driving pulse; Cold should transform into Heat, and Fluids should become Phlegm, which is inevitable. (Appropriate formulas include Erchen Tang [Two-Aged Decoction], or Zhizi [Gardeniae Fructus], Huangqin [Scutellariae Radix], Huafen [Trichosanthis Radix], Xuanmingfen [Mirabilite].)