身必热，脉盛躁者，阳邪有余，故当为温病。若脉虽盛而兼滑者，是脉已
不躁而正气将复，故不久当愈。出，渐愈之谓。）尺肤寒，其脉小者泄，少气。（肤寒脉小，阳气衰也，故
为泄，为少气。）尺肤炬然，先热后寒者，寒热也。尺肤先寒久大之而热者，亦寒热也。（炬然，火热貌。
或先热而后寒，或先寒而后热，皆寒热往来之候。）肘所独热者，腰以上热，手所独热者，腰以下热；（肘，
臂膊之节也。一曰曲池以上为肘。肘在上，手在下，故肘应腰上，手应腰下也。）肘前独热者，膺前热；肘
后独热者，肩背热。（肘前，内廉也，手三阴之所行，故应于膺前。肘后，外廉也，手太阳之所行。故应于
肩背。）臂中独热者，腰腹热；（肘下为臂，臂在下，故应腰腹。）肘后粗以下三四寸热者，肠中有虫。
（肘后粗以下三四寸，谓三里以下，内关以上之所，此阴分也。阴分有热，故应肠中有虫。）掌中热者，
腹中热；掌中寒者，腹中寒。（掌中者，三阴之所聚，故或热或寒，皆应于腹中。）鱼上白肉有青血脉者，
胃中有寒。（鱼上脉青，胃之寒也。）尺炬然热，人迎大者，当夺血。尺坚大，脉小甚，少气， 有
加，立死。（尺炬然热，火在阴也，人迎大者，阳之胜也，故当失血。若尺肤坚大，而脉则小甚，形有余
而气衰少也。阴虚既极，而烦 再加，故当立死。 ，美本切。）脉之缓、急、大、小、滑、涩之病形，
五脏之病变也。（六者为脉之提纲，五脏之病变系焉。）心脉急甚者为螈 ，微急为心痛引背，食不下；（
急者，弦之类。急主风寒，心主血脉，故心脉急甚，则为螈 。筋脉引急曰螈，弛张曰 。弦急之脉
多主痛，故微急为心痛引背。心胸有邪，食当不下也。大抵弦急之脉，当为此等病，故急甚亦可为心痛，
微急亦可为螈 ，学人当因理活变可也。）缓甚为狂笑，微缓为伏梁，在心下，上下行，时唾血；（心气
热则脉纵缓，故神散而为狂笑，心在声为笑也。若微缓则为伏梁，在心下，而能升能降，及时而唾血。此皆
心脏之不清也。）大甚为喉 ，微大为心痹引背，善泪出；（心脉大甚，心火上炎也，故喉中 然有声；若其
微大而为心痹引背，善泪出者，以手少阴之脉挟咽喉，连目系也。 ，音介。痹，音秘。）小甚为善哕，
微小为消瘅；（心脉小甚，则阳气虚而胃上寒，故善哕。若其微小，亦为血脉枯少，故病消瘅。消瘅者，肌肤
消瘦也。哕，于决切。瘅，音丹。）滑甚为善渴，微滑为心疝引脐，小腹鸣；（心脉滑甚则血热，血热则燥，
故当为渴。若其微滑，则热在于下，当病心疝而引脐腹。心为牡脏，小肠为之使，故小腹当有形也。）涩甚
为喑，微涩为血溢、维厥、耳鸣、颠疾。（心脉涩甚，则血气滞于上，声由阳发，滞则为喑也。微涩为血溢，
涩当伤血也。维厥者，四维厥逆也，以四肢为诸阳之本，而血衰气滞也。为耳鸣、为颠疾者，心亦开
窍于耳，心虚则神乱也，喑，音音，声哑也。）肺脉急甚为颠疾，微急为肺寒热，怠惰，咳，唾血，引腰背
胸，若鼻息肉不通；（肺脉急甚，风邪胜也，木反乘金，故主颠疾。若其微急，亦以风寒有余，因而
致热，故为寒热、怠惰等病。）缓甚为多汗，微缓为痿 ，偏风，头以下汗出不可止；（肺脉缓甚者皮毛
不固，故表虚而多汗。若其微缓而为痿 ，偏风，头下汗出，亦以阳邪在阴也。）大甚为胫肿，微大为
肺痹引胸背，起恶日光；（肺脉大甚者，心火烁肺，真阴必涸，故为胫肿。若其微大，亦由肺热，故
为肺痹引胸背。肺痹者，烦满喘而呕也。起畏日光，以气分火甚而阴精衰也。）小甚为泄，微小为消瘅；（肺脉
小甚，则阳气虚而腑不固，病当为泄。若其微小，亦以金衰，金衰则水弱，故为消瘅。）滑甚为息贲上气，
微滑为上下出血；（肺脉滑甚者气血皆实热，故为息贲上气。息贲，喘急也。若其微滑，亦为上下出血。上言
口鼻，下言二阴也。贲，音奔。）涩甚为呕血，微涩为鼠 在颈支腋之间，下不胜其上，其应善酸矣。（涩脉
因于伤血，肺在上焦，故涩甚当为呕血。若其微涩，气当有滞，故为鼠 在颈腋间。气滞则阳
病，血伤则阴虚，故下不胜其上，而足膝当酸软也。）肝脉急甚者为恶言，微急为肥气，在胁下若覆杯；（
肝脉急甚，肝气强也。肝强者
多怒少喜，故言多嗔恶也。若其微急，亦以木邪伤土，故为肥气在胁下。胁下者，肝之经也，肥气者，肝之积
也，当在左。）缓甚为善呕，微缓为水瘕痹也；（缓为脾脉，以肝脉而缓甚，木土相克也，故善呕。若微
缓而为水瘕，为痹者，皆土为木制，不能营运而然。水瘕，水积也。）大甚为内痈，善呕气，微大为肝痹、
阴缩，咳引小腹；（肝脉大甚，肝火甚也。木火交炽，故为内痈；血热不藏，故为呕衄。若其微大而为肝
痹，为阴缩，为咳引小腹，皆以火在阴分也。衄，泥六切，鼻血也。）小甚为多饮。微小为消瘅；（肝藏血，
肝脉小甚，则血少而渴，故多饮。若其微小，亦以阴虚血燥而为消瘅也。）滑甚为 疝，微滑为遗溺；
（肝脉滑甚者，热壅于经，故为 疝，若其微滑而为遗溺，以肝火在下而疏泄不禁也。）涩甚为溢饮，微涩
为螈挛、筋痹。（脾脉涩甚，血气衰滞也。肝木不足，土反乘之，故湿溢肢体，是为溢饮，若其微涩而为螈挛，
为筋痹，皆血不足以养筋也。螈，翅、系二音。挛，音栾。筋急缩也。）脾脉急甚为螈 ，微急为膈中，
食饮入而还出，后沃沫；（脾脉急甚，木乘土也。脾主肢体，而风气客之，故为螈 。若其微急，亦为肝邪侮
脾，则脾不能运而膈食还出，土不制水而复多涎沫也。）缓甚为痿厥，微缓为风痿，四肢不用，心慧然若无
病；（脾脉宜缓，而缓甚则热。脾主肌肉四肢，故脾热则为肉痿及为厥逆。若微缓而为风痿、四肢不
用者，以土弱则木生风也，亦曰脾风痿。弱在经而脏无恙，故心慧然若无病。）大甚为击仆，微大为疝气，
腹里大，脓血在肠胃之外；（脾主中气，脾脉大甚为阳极，阳极则阴脱，故如击而仆地。若其微大为疝
气，以湿热在经，而前阴为太阴、阳明之所合也。腹里大者，以脓血在肠胃之外，亦脾气壅滞所致。）
小甚为寒热，微小为消瘅；（脾脉小者，以中焦之阳气不足，故甚则为寒热，而微则为消瘅。）滑甚为 癃，微
滑为虫毒 蝎，腹热；（脾脉滑甚，太阴实热也。太阴合宗筋，故为 癃疝。若其微滑，湿热在脾，
湿热熏蒸，故生诸虫及为腹热。 、蛔同。）
涩甚为肠 ，微涩为内 ，多下脓血。（脾脉涩甚而为肠 ，微涩而为内 及多下脓血者，以涩为气滞血伤，
而足太阴之别入络肠胃也。肠 、内 ，远近之分耳，一曰下肿病，盖即疝漏之属。）肾脉急甚为骨
癫疾，微急为沉厥，奔豚，足不收，不得前后；（肾脉急甚者，风寒在肾。肾主骨，故为骨癫疾。若微急而
为沉厥、足不收者，寒邪在经也。为奔豚者，寒邪在脏也。为不得前后者，寒邪在阴也。按，肾之积曰
奔豚，当发于少腹上至心下，若豚突然。）缓甚为折脊，微缓为洞，洞者食不化，下嗌还出；（肾脉缓甚者
阴不足，故为折脊，以足少阴脉贯脊循脊内也。若其微缓，肾气亦亏，肾亏则命门气衰，下焦不化，下
不化则复而上出，故病为洞而食入还出也。）大甚为阴痿，微大为石水，起脐以下至小腹， 然，上至胃
脘，死不治；（肾脉大甚，水亏火王也，故为阴痿。若其微大，肾阴亦虚，阴虚则不化，不化则
气停水积而为石水。若至胃脘，则水邪甚极，反乘土脏，泛滥无制，故死不治。 ，重坠也，音垂。）小甚为
洞泄，微小为消瘅；（肾脉小甚则元阳下衰，故为洞泄。若其微小，真气亦亏，故为消瘅。按，五脏俱有消
瘅，心肺肝三脏专指阴血而言，脾与肾则兼阳气言之，可见阴阳互倚，未有此伤而彼能独全者也。）滑甚为癃
，微滑为骨痿，坐不能起，起则目无所见；（肾脉滑甚，阴火盛也，故为癃 。癃，膀胱不利也。
，疝也。若其微滑，亦由火王，火王则阴虚，故骨痿不能起，起则目暗无所见。）涩甚为大痈，微涩为
不月，沉痔。（肾脉涩者为精伤，为血少，为气滞，故甚则为大痈，微则为不月，为沉痔。）病有六变∶诸
急者多寒，（急者，弦紧之谓。脉浮而紧者，名曰弦也。紧则为寒，紧则阴气胜，故凡紧急之脉多风寒，而
气化从乎肝也。）缓者多热，（缓者，纵缓之状，非迟缓之谓。缓则阳气长，胃气有余，故凡纵缓之脉多中热，
而气化从乎脾胃也。）大者多气少血，（大为阳有余，阳盛则阴衰，故多气少血。若脉浮大者，气实
血虚也，故脉之大者多浮阳，而气化从乎心也。
）小者血气皆少，（小者，近于微细，在阳为阳虚；在阴为阴弱。脉体属阴，而气化从乎肾也。）滑者阳气盛，
微有热，（滑脉为阳，气血实也。故为阳气盛而微有热。滑者胃气实，脉弱以滑，是有胃气，故滑脉从乎胃
也。）涩者多血少气，微有寒。（涩为气滞，为血少。血既虚则阳气不足，故微有寒也。曰多血者，言
虚于血分为多，故令气亦虚少，虽有寒而不甚也。涩脉近毛，故气化从乎肺也。）是故刺急者，深内而久
留之；（急者多寒，寒从阴而难去也。内，与纳同。）刺缓者，浅内而疾发针，以去其热；（缓者多热，热
从阳而易散也。）刺大者，微泻其气，无出其血；（大者多阴虚，故无出其血。）刺滑者，疾发针而浅内之，
以泻其阳气而去其热；（与刺缓者略同。）刺涩者，必中其脉，随其逆顺而久留之，必先按而循之，已发针疾
按其 ，无令其血出，以和其脉。（脉涩者，气血俱少，难于得气。故宜必中其脉而察其逆顺，久留疾按
而无出其血，较之诸刺更宜详慎者，以脉涩本虚，而恐伤其真气耳。循，摩按也。 ，委、伟二音，刺瘢也。）
诸小者，阴阳形气俱不足，勿取以针，而调以甘药也。（脉小者为不足，勿取以针，可见气血俱虚者必不宜刺
而当调以甘药也。按，甘之一字，用意深矣。盖药食之入，必先脾胃，而后五脏得禀其气。胃气强则五
脏俱盛，胃气弱则五脏俱衰。胃属土而喜甘，故中气不足者非甘温不可。土强则金王，金王则水充，此所以
土为万物之母，而阴阳俱虚者必调以甘药也。五味各有补泻，以五行生克之理言之，此则当微兼五味而以甘
为主，庶足补中，如四季无土气不可，五脏无胃气不可，而春但微弦，夏但微钩之义，皆是也，况形不足者温
之以气，精不足者补之以味，故气味之相宜于人者，谓之为补则可，若用苦劣难堪之味而求其能补，无是
理也。气味攻补之学，不可不详也。）
身体必然发热，脉象盛大且躁动不安的，是阳邪有余，所以应当诊断为温病。如果脉象虽然盛大但兼有滑象的，说明脉象已不再躁动，正气即将恢复，所以不久就会痊愈。（“出”字，指逐渐痊愈的意思。）尺部皮肤寒冷，脉象细小的，是泄泻、气短。（皮肤寒冷而脉象细小，是阳气衰微的表现，所以出现泄泻和气短的症状。）尺部皮肤灼热如火，先热后冷的，是寒热往来的病证。尺部皮肤先冷，很久之后才变热的，也是寒热往来的病证。（“炬然”，形容像火一样热的样子。无论是先热后冷，还是先冷后热，都是寒热往来的征候。）肘部单独发热的，腰部以上发热；手部单独发热的，腰部以下发热。（肘，是臂膊的关节处。另一种说法认为曲池穴以上为肘。肘在上，手在下，所以肘部对应腰以上，手部对应腰以下。）肘前部单独发热的，胸膺前部发热；肘后部单独发热的，肩背部发热。（肘前，即内侧，是手三阴经循行的部位，所以对应胸膺前部。肘后，即外侧，是手太阳经循行的部位，所以对应肩背部。）臂中部单独发热的，腰腹部发热。（肘下为臂，臂在下，所以对应腰腹。）肘后侧粗隆以下三四寸处发热的，肠中有虫。（肘后侧粗隆以下三四寸，是指足三里穴以下、内关穴以上的区域，这是阴分所在。阴分有热，所以对应肠中有虫。）手掌中心发热的，腹中发热；手掌中心寒冷的，腹中寒冷。（手掌中心是三阴经汇聚的地方，所以无论热或寒，都对应腹中的状况。）大鱼际上白肉处有青色血脉的，胃中有寒。（大鱼际处脉色青，是胃寒的表现。）尺部皮肤灼热如火，人迎脉搏动大的，应当发生失血。尺部皮肤坚硬且大，脉象却非常细小，气短，如果再加烦躁，会立即死亡。（尺部皮肤灼热，说明火在阴分；人迎脉搏动大，说明阳盛，所以应当失血。如果尺部皮肤坚硬且大，而脉象却非常细小，这是形体有余而正气衰少。阴虚已经极度严重，如果再出现烦躁，所以会立即死亡。“烦”，读音同“美本切”。）脉象的缓、急、大、小、滑、涩所反映的病形，对应五脏的病变。（这六种脉象是脉诊的提纲，五脏的病变都关联其中。）心脉急甚的，会出现抽搐；微急的，会导致心痛牵引背部，饮食不下；（“急”，属于弦脉之类。“急”主风寒，心主血脉，所以心脉急甚，就会出现抽搐。筋脉牵引拘急称为“瘛”，松弛称为“疭”。弦急的脉象多主疼痛，所以微急会导致心痛牵引背部。心胸有邪气，食物自然不能下行。大致来说，弦急的脉象应当导致这类疾病，所以急甚也可能导致心痛，微急也可能导致抽搐，学习的人应当根据医理灵活变通。）缓甚的，会出现狂笑；微缓的，会出现伏梁病，病灶在心下，上下移动，时常唾血；（心气热则脉象纵缓，所以神志散乱而狂笑，心在声音方面表现为笑。如果微缓，则形成伏梁病，病灶在心下，能够升降，并且时常唾血。这些都是心脏功能不清爽的表现。）脉象大的甚的，会导致喉痹；脉象大的微的，会导致心痹牵引背部，容易流泪；（心脉大甚，是心火上炎，所以喉中有阻塞的声音；如果脉象微大而导致心痹牵引背部、容易流泪，是因为手少阴心经挟咽喉，连目系。“痹”，读音同“介”。“痹”，读音同“秘”。）脉象小的甚的，容易呃逆；脉象微小的，会出现消瘅病；（心脉小甚，则阳气虚而胃气上逆寒冷，所以容易呃逆。如果脉象微小，也是血脉枯少，所以病发消瘅。消瘅，是指肌肤消瘦。“哕”，读音同“决”。“瘅”，读音同“丹”。）脉象滑的甚的，容易口渴；脉象滑的微的，会导致心疝牵引脐部，小腹鸣响；（心脉滑甚则血热，血热则燥，所以应当口渴。如果脉象微滑，则热在下焦，应当病发心疝并牵引脐腹。心为牡脏，小肠为其使役，所以小腹应当有有形之邪。）脉象涩的甚的，会导致失音；脉象涩的微的，会导致出血、四肢厥逆、耳鸣、癫疾。（心脉涩甚，则气血滞于上部，声音由阳气发出，滞塞则失音。脉涩微则出血，涩脉会伤血。所谓“维厥”，是指四维厥逆，因为四肢是诸阳之本，而血衰气滞。出现耳鸣、癫疾，是因为心开窍于耳，心虚则神志混乱。“喑”，读音同“音”，指声音嘶哑。）肺脉急甚的，会导致癫疾；微急的，会导致肺寒热，倦怠乏力，咳嗽，唾血，牵引腰背胸部，或者鼻息肉不通；（肺脉急甚，是风邪胜，木反乘金，所以主癫疾。如果脉象微急，也是因为风寒有余，因而致热，所以出现寒热、倦怠等疾病。）缓甚的，出汗多；微缓的，会出现痿证，偏风，头部以下汗出不止；（肺脉缓甚，皮毛不固，所以表虚而多汗。如果脉象微缓而出现痿证、偏风、头下汗出，也是因为阳邪侵入阴分。）脉象大的甚的，小腿肿胀；脉象大的微的，会导致肺痹牵引胸背，起身时害怕阳光；（肺脉大甚，是心火灼烧肺金，真阴必枯竭，所以小腿肿胀。如果脉象微大，也是因为肺热，所以导致肺痹牵引胸背。肺痹，表现为烦闷喘促而呕吐。起身畏日光，是因为气分火盛而阴精衰败。）脉象小的甚的，泄泻；脉象微小的，出现消瘅病；（肺脉小甚，则阳气虚而腑气不固，病当为泄泻。如果脉象微小，也是因为金气衰，金衰则水弱，所以出现消瘅病。）脉象滑的甚的，出现息贳、气逆上冲；脉象滑的微的，出现上下出血；（肺脉滑甚，气血皆实热，所以出现息贳、气逆上冲。息贳，指喘急。如果脉象微滑，也出现上下出血。上文说的“上”指口鼻，“下”指二阴。“贲”，读音同“奔”。）脉象涩的甚的，呕血；脉象涩的微的，颈部腋下之间出现鼠瘰，下肢无力支撑上身，膝盖应当酸软。（涩脉因于伤血，肺在上焦，所以涩甚应当呕血。如果脉象微涩，气应当有滞塞，所以出现颈部腋下的鼠瘰。气滞则阳病，血伤则阴虚，所以下肢无力支撑上身，而足膝应当酸软。）肝脉急甚的，表现为恶言（说讨厌的话/易怒）；微急的，出现肥气，位于胁下像倒扣的杯子；（肝脉急甚，肝气强盛。肝气强盛的多怒少喜，所以言语多嗔恶。如果脉象微急，也是因为木邪伤土，所以出现肥气在胁下。胁下是肝经所在，肥气是肝之积，应当在左侧。）缓甚的，容易呕吐；微缓的，出现水瘕痹；（缓是脾脉，以肝脉而见缓甚，是木土相克，所以容易呕吐。如果微缓而出现水瘕、痹证，都是因为土被木制，不能营运所致。水瘕，是水积聚。）脉象大的甚的，出现内痈，容易呕吐气逆；脉象大的微的，出现肝痹、阴缩、咳嗽牵引小腹；（肝脉大甚，肝火甚。木火交炽，所以出现内痈；血热不藏，所以出现呕吐衄血。如果脉象微大而出现肝痹、阴缩、咳嗽牵引小腹，都是因为火在阴分。“衄”，读音同“泥六切”，指鼻血。）脉象小的甚的，多饮；脉象微小的，出现消瘅病；（肝藏血，肝脉小甚，则血少而渴，所以多饮。如果脉象微小，也是因为阴虚血燥而出现消瘅病。）脉象滑的甚的，出现疝气；脉象滑的微的，出现遗尿；（肝脉滑甚，热壅于经脉，所以出现疝气。如果脉象微滑而出现遗尿，是因为肝火在下而疏泄不禁。）脉象涩的甚的，出现溢饮；脉象涩的微的，出现抽搐痉挛、筋痹。（脾脉涩甚，血气衰滞。肝木不足，土反乘之，所以湿气溢出肢体，这叫溢饮。如果脉象微涩而出现抽搐痉挛、筋痹，都是因为血不足以养筋。“瘛”，读音同“翅”、“系”。“挛”，读音同“栾”，指筋急缩。）脾脉急甚的，出现抽搐；微急的，出现膈中病，饮食入胃后又吐出，大便排出涎沫；（脾脉急甚，是木乘土。脾主肢体，风气客之，所以出现抽搐。如果脉象微急，也是因为肝邪侮脾，则脾不能运化而膈食还出，土不制水而反复多涎沫。）缓甚的，出现痿厥；微缓的，出现风痿，四肢不能用，心神清爽好像没病；（脾脉宜缓，而缓甚则热。脾主肌肉四肢，所以脾热则出现肉痿及厥逆。如果脉象微缓而出现风痿、四肢不用，是因为土弱则木生风，也叫脾风痿。病弱在经络而脏腑无恙，所以心神清爽好像没病。）脉象大的甚的，出现被打倒般的昏仆；脉象大的微的，出现疝气，腹部胀大，脓血在肠胃之外；（脾主中气，脾脉大甚为阳极，阳极则阴脱，所以像被击打而仆倒在地。如果脉象微大而出现疝气，是因为湿热在经络，而前阴是太阴、阳明经会合之处。腹部胀大，是因为脓血在肠胃之外，也是脾气壅滞所致。）脉象小的甚的，寒热；脉象微小的，出现消瘅病；（脾脉小，是因为中焦阳气不足，所以甚则为寒热，而微则为消瘅。）脉象滑的甚的，出现疝癃；脉象滑的微的，出现虫毒蝎螫，腹热；（脾脉滑甚，太阴实热。太阴合宗筋，所以出现疝癃。如果脉象微滑，湿热在脾，湿热熏蒸，所以生各种虫及出现腹热。“蛔”，同“蛔”。）脉象涩的甚的，出现肠痔；脉象涩的微的，出现内痔，多下脓血。（脾脉涩甚而出现肠痔，脉象微涩而出现内痔及多下脓血，是因为涩代表气滞血伤，而足太阴之别络入络肠胃。肠痔、内痔，只是远近之分罢了。另一种说法叫下肿病，大概属于疝漏一类。）肾脉急甚的，出现骨癫疾；微急的，出现沉厥、奔豚、足不收、大小便不通；（肾脉急甚，是风寒在肾。肾主骨，所以出现骨癫疾。如果脉象微急而出现沉厥、足不收，是寒邪在经络。出现奔豚，是寒邪在脏腑。出现大小便不通，是寒邪在阴分。按：肾之积叫奔豚，应当发作于少腹上至心下，像小猪突然跑上来一样。）缓甚的，出现折脊；微缓的，出现洞泄，洞泄是指食物不消化，咽下后又吐出来；（肾脉缓甚，阴不足，所以出现折脊，因为足少阴脉贯穿脊柱沿脊内而行。如果脉象微缓，肾气也亏，肾亏则命门气衰，下焦不化，下焦不化则复而上出，所以病为洞泄，食物吃进去又出来。）脉象大的甚的，出现阴痿；脉象大的微的，出现石水，从肚脐以下至小腹，沉重下垂，上至胃脘，死不治；（肾脉大甚，水亏火旺，所以出现阴痿。如果脉象微大，肾阴也虚，阴虚则不化，不化则气停水积而为石水。如果水邪上至胃脘，则水邪极盛，反而乘犯土脏，泛滥无制，所以死不治。“重坠”，读音同“垂”。）脉象小的甚的，出现洞泄；脉象微小的，出现消瘅病；（肾脉小甚则元阳下衰，所以出现洞泄。如果脉象微小，真气也亏，所以出现消瘅病。按：五脏都有消瘅，心肺肝三脏专指阴血而言，脾与肾则兼阳气言之，可见阴阳互倚，没有此受伤而彼能独全的道理。）脉象滑的甚的，出现癃闭；脉象滑的微的，出现骨痿，坐起困难，起来则眼睛看不见东西；（肾脉滑甚，阴火盛，所以出现癃闭。癃，指膀胱排尿不利。疝。如果脉象微滑，也是因为火旺，火旺则阴虚，所以骨痿不能起，起来则眼睛昏暗看不见。）脉象涩的甚的，出现大痈；脉象涩的微的，出现女子月经不来、沉痔。（肾脉涩，是精伤、血少、气滞，所以甚则为大痈，微则为月经不来、沉痔。）疾病有六种变化：凡是脉急的多寒，（“急”，指弦紧。脉浮而紧，名叫弦。紧则为寒，紧则阴气胜，所以凡是紧急的脉象多主风寒，气化从乎肝。）缓的多热，（“缓”，是纵缓的状态，不是迟缓的意思。缓则阳气长，胃气有余，所以凡是纵缓的脉象多主中热，气化从乎脾胃。）大的多气少血，（大为阳有余，阳盛则阴衰，所以多气少血。如果脉浮大，是气实血虚，所以脉大的多主浮阳，气化从乎心。）小的是血气皆少，（小，近于微细，在阳为阳虚；在阴为阴弱。脉体属阴，气化从乎肾。）滑的是阳气盛，微有热，（滑脉为阳，气血实。所以为阳气盛而微有热。滑者胃气实，脉弱而滑，是有胃气，所以滑脉从乎胃。）涩的是多血少气，微有寒。（涩为气滞，为血少。血既虚则阳气不足，所以微有寒。说“多血”，是说血分虚得多，所以令气也虚少，虽然有寒但不严重。涩脉近毛，所以气化从乎肺。）所以针刺急脉的，要深刺并久留针；（急脉多寒，寒从阴而难去。“内”，通“纳”。）刺缓脉的，浅刺并快出针，以去除其热；（缓脉多热，热从阳而易散。）刺大脉的，轻微泻其气，不要放血；（大脉多阴虚，所以不要放血。）刺滑脉的，快出针并浅刺，以泻其阳气而去其热；（与刺缓脉略同。）刺涩脉的，必须中其脉，随其逆顺而久留针，必须先按压并循摩，已出针后要快按针孔，不让其出血，以调和其脉。（脉涩者，气血俱少，难于得气。所以适宜必须中其脉而察其逆顺，久留针快按而不让其出血，比其他的刺法更宜详慎，是因为脉涩本虚，恐怕损伤其真气。“循”，摩按。“瘢”，读音同“委”、“伟”，指针刺后的瘢痕。）凡是脉小的，阴阳形气都不足，不要用针刺，而用甘药调理。（脉小为不足，不要用针刺，可见气血俱虚者必定不宜刺而当用甘药调理。按：“甘”这个字，用意很深。药物食物进入人体，必先经过脾胃，然后五脏才能禀受其气。胃气强则五脏俱盛，胃气弱则五脏俱衰。胃属土而喜甘，所以中气不足者非甘温不可。土强则金旺，金旺则水充，这就是为什么土为万物之母，而阴阳俱虚者必须用甘药调理的原因。五味各有补泻，从五行生克的道理来说，这里应当微兼五味而以甘为主，才足以补中，就像四季没有土气不行，五脏没有胃气不行，以及春季脉微弦、夏季脉微钩的意义一样。况且形体不足的用气来温补，精气不足的用味来滋补，所以气味相宜于人的，叫做补。如果用苦劣难吃的味道而求它能补，是没有道理的。关于气味攻补的学问，不可不详审。）
The body will inevitably be hot, and the pulse is vigorous and restless; this indicates an excess of Yang pathogenic factors, thus it should be diagnosed as Warm Disease (Wen Bing). If the pulse is vigorous but also slippery, it means the pulse is no longer restless and the healthy Qi is about to recover, so recovery will occur soon. ("Chu" refers to gradual recovery.) If the skin at the Chi position is cold and the pulse is thin, it indicates diarrhea and shortness of breath. (Cold skin and a thin pulse indicate the decline of Yang Qi, hence diarrhea and shortness of breath.) If the skin at the Chi position is burning hot, alternating between heat and cold, it is a sign of alternating Cold and Heat. If the skin at the Chi position is initially cold and becomes hot after a long time, it is also a sign of alternating Cold and Heat. ("Ju ran" describes a fiery heat. Whether heat precedes cold or cold precedes heat, both are signs of alternating Cold and Heat.) Isolated heat at the elbow indicates heat above the waist; isolated heat at the hand indicates heat below the waist. (The elbow is the joint of the arm. Alternatively, the area above Quchi [LI11] is considered the elbow. Since the elbow is superior and the hand is inferior, the elbow corresponds to the upper body and the hand to the lower body.) Isolated heat at the anterior aspect of the elbow indicates heat in the anterior chest; isolated heat at the posterior aspect of the elbow indicates heat in the shoulder and back. (The anterior aspect of the elbow, i.e., the medial side, is the pathway of the Three Yin meridians of the Hand, corresponding to the anterior chest. The posterior aspect, i.e., the lateral side, is the pathway of the Hand-Taiyang Bladder Meridian, corresponding to the shoulder and back.) Isolated heat in the middle of the arm indicates heat in the waist and abdomen. (Below the elbow is the arm; since the arm is inferior, it corresponds to the waist and abdomen.) Heat three to four cun below the prominence at the posterior-lateral aspect of the elbow indicates intestinal parasites. (This area, below Zusanli [ST36] and above Neiguan [PC6], belongs to the Yin aspect. Heat in the Yin aspect corresponds to intestinal parasites.) Heat in the center of the palm indicates heat in the abdomen; cold in the center of the palm indicates cold in the abdomen. (The center of the palm is where the Three Yin meridians converge, so heat or cold here corresponds to conditions in the abdomen.) Blue blood vessels on the white flesh of the thenar eminence indicate Cold in the Stomach. (Blue vessels on the thenar eminence signify Stomach Cold.) Burning heat at the Chi position combined with a large Renying pulse [ST9] indicates impending hemorrhage. If the skin at the Chi position is firm and large, yet the pulse is extremely thin, accompanied by shortness of breath, and if irritability is added, death will ensue immediately. (Burning heat at the Chi position indicates Fire in the Yin; a large Renying pulse indicates Yang excess, hence hemorrhage. If the Chi skin is firm and large while the pulse is extremely thin, it signifies excess in form but deficiency in Qi. Extreme Yin deficiency compounded by irritability leads to immediate death. "Fan" is pronounced like "mei ben qie".) The pathological manifestations of the pulse being slow, rapid, large, small, slippery, or choppy correspond to diseases of the Five Zang organs. (These six types are the outline of pulse diagnosis, linked to Zang organ pathologies.) An extremely rapid Heart pulse indicates convulsions; a slightly rapid pulse causes heart pain radiating to the back and inability to swallow food. ("Rapid" is similar to the Wiry pulse. Rapid pulses indicate Wind-Cold. The Heart governs blood vessels; thus, an extremely rapid Heart pulse leads to convulsions. Tension and relaxation of sinews are termed "chi" and "zong" respectively. Wiry-rapid pulses often indicate pain, so a slightly rapid pulse causes heart pain radiating to the back. Pathogens in the heart and chest prevent food from descending. Generally, wiry-rapid pulses cause such diseases; thus, extreme rapidity may cause heart pain, and slight rapidity may cause convulsions. Practitioners should apply these principles flexibly.) An extremely slow Heart pulse indicates manic laughter; a slightly slow pulse indicates Fu Liang disease located below the heart, moving up and down, with occasional hemoptysis. (Heart Qi heat causes the pulse to relax, leading to scattered spirit and manic laughter, as the Heart's sound is laughter. A slightly slow pulse forms Fu Liang below the heart, capable of ascending and descending, causing hemoptysis. These reflect unclear Heart function.) An extremely large Heart pulse causes throat obstruction (Hou Bi); a slightly large pulse causes Heart Bi radiating to the back and excessive tearing. (Extreme largeness indicates Heart Fire flaring upward, causing noisy obstruction in the throat. Slight largeness leads to Heart Bi radiating to the back and tearing because the Hand-Shaoyin meridian passes through the throat and connects to the eye system. "Bi" is pronounced "jie"; "Bi" is pronounced "mi".) An extremely small Heart pulse indicates frequent hiccups; a minute pulse indicates Xiao Dan disease. (Extreme smallness indicates Yang deficiency and Cold reversing in the Stomach, causing hiccups. Minute size indicates depleted blood vessels, leading to Xiao Dan. Xiao Dan refers to emaciation. "Yue" is pronounced "jue"; "Dan" is pronounced "dan".) An extremely slippery Heart pulse indicates excessive thirst; a slightly slippery pulse causes Xin Han radiating to the umbilicus and borborygmus in the lower abdomen. (Extreme slipperiness indicates Blood heat and dryness, causing thirst. Slight slipperiness places heat in the Lower Jiao, causing Xin Han radiating to the umbilicus. As the Heart is a Yang organ and the Small Intestine its assistant, there should be palpable abnormalities in the lower abdomen.) An extremely choppy Heart pulse causes aphonia; a slightly choppy pulse causes bleeding, limb厥逆 (Jue Ni), tinnitus, and epilepsy. (Extreme chopiness indicates stagnation of Qi and Blood in the upper jiao; since voice originates from Yang, stagnation causes aphonia. Slight chopiness causes bleeding due to blood injury. "Wei Jue" refers to厥逆 of the four extremities, as limbs are the root of Yang, and blood deficiency with Qi stagnation leads to this. Tinnitus and epilepsy occur because the Heart opens into the ears, and Heart deficiency causes mental confusion. "Yin" is pronounced "yin", meaning hoarseness.) An extremely rapid Lung pulse causes epilepsy; a slightly rapid pulse causes Lung Cold-Heat, lethargy, cough, hemoptysis, radiation to the waist, back, and chest, or nasal polyps obstructing breathing. (Extreme rapidity indicates Wind pathogen excess, with Wood overacting on Metal, causing epilepsy. Slight rapidity, due to excess Wind-Cold generating heat, causes Cold-Heat and lethargy.) An extremely slow Lung pulse indicates profuse sweating; a slightly slow pulse causes Wei syndrome, hemiplegia, and unstoppable sweating below the head. (Extreme slowness indicates insecure exterior and pores, causing sweating. Slight slowness leads to Wei syndrome and hemiplegia due to Yang pathogens invading Yin.) An extremely large Lung pulse causes swelling of the shins; a slightly large pulse causes Lung Bi radiating to the chest and back, with aversion to sunlight upon rising. (Extreme largeness indicates Heart Fire scorching Lung Metal, depleting True Yin, causing shin swelling. Slight largeness indicates Lung heat causing Lung Bi. Lung Bi presents with fullness, panting, and vomiting. Aversion to light occurs because Qi-level Fire is excessive and Yin essence is depleted.) An extremely small Lung pulse causes diarrhea; a minute pulse causes Xiao Dan disease. (Extreme smallness indicates Yang deficiency and insecure Fu organs, leading to diarrhea. Minute size indicates Metal deficiency; Metal deficiency weakens Water, causing Xiao Dan.) An extremely slippery Lung pulse causes Xi Ben (panting and rebellious Qi); a slightly slippery pulse causes bleeding from the upper and lower orifices. (Extreme slipperiness indicates excess Heat in Qi and Blood, causing panting. Slight slipperiness causes bleeding from mouth/nose and anus. "Ben" is pronounced "ben".) An extremely choppy Lung pulse causes hematemesis; a slightly choppy pulse causes Shu Luo (scrofula) in the neck and axilla, lower body weakness, and knee soreness. (Choppy pulses result from blood injury. The Lung is in the Upper Jiao, so extreme chopiness causes hematemesis. Slight chopiness causes Qi stagnation and Shu Luo in the neck/axilla. Qi stagnation harms Yang, blood injury harms Yin, leading to lower body weakness and knee soreness.) An extremely rapid Liver pulse manifests as irritable speech; a slightly rapid pulse causes Fei Qi (Liver accumulation) under the hypochondrium, resembling an inverted cup. (Extreme rapidity indicates strong Liver Qi. Strong Liver Qi leads to anger and irritability. Slight rapidity indicates Wood pathogen injuring Earth, causing Fei Qi in the Liver meridian area, typically on the left.) An extremely slow Liver pulse causes frequent vomiting; a slightly slow pulse causes Shui Jia Bi (water accumulation and obstruction). (Slowness is the Spleen pulse. In the Liver pulse, extreme slowness indicates Wood-Earth conflict, causing vomiting. Slight slowness leads to water accumulation due to Earth being controlled by Wood.) An extremely large Liver pulse causes internal abscesses and vomiting of Qi; a slightly large pulse causes Liver Bi, yin retraction, and cough radiating to the lower abdomen. (Extreme largeness indicates severe Liver Fire. Wood-Fire interaction causes internal abscesses; Blood heat failing to store causes vomiting and epistaxis. Slight largeness leads to Liver Bi, yin retraction, and cough due to Fire in the Yin aspect. "Nu" is pronounced "ni liu qie", meaning epistaxis.) An extremely small Liver pulse causes polydipsia; a minute pulse causes Xiao Dan disease. (The Liver stores Blood. Extreme smallness indicates Blood deficiency and thirst. Minute size indicates Yin deficiency and Blood dryness causing Xiao Dan.) An extremely slippery Liver pulse causes Shan Han (hernia); a slightly slippery pulse causes enuresis. (Extreme slipperiness indicates Heat congestion in meridians causing hernia. Slight slipperiness causes enuresis due to Liver Fire in the Lower Jiao causing uncontrolled discharge.) An extremely choppy Liver pulse causes Yi Yin (overflowing fluid); a slightly choppy pulse causes convulsions and Jin Bi (sinew obstruction). (Spleen pulse chopiness indicates Qi-Blood stagnation. Liver Wood deficiency allows Earth to overact, causing dampness overflow. Slight chopiness fails to nourish sinews, causing convulsions and sinew obstruction. "Chi" is pronounced "chi/xi"; "Luan" is pronounced "luan", meaning sinew contraction.) An extremely rapid Spleen pulse causes convulsions; a slightly rapid pulse causes Ge Zhong disease, where food is vomited back out, and copious saliva is passed via the rectum. (Extreme rapidity indicates Wood overacting on Earth. Wind invading the Spleen causes convulsions. Slight rapidity indicates Liver pathogen insulting Spleen, impairing transportation, causing regurgitation and excessive saliva due to Earth failing to control Water.) An extremely slow Spleen pulse causes Wei Jue (flaccidity and厥逆); a slightly slow pulse causes Feng Wei, paralysis of the four limbs, while the mind remains clear as if healthy. (Spleen pulse should be slow; extreme slowness indicates Heat. Spleen Heat causes muscle Wei and厥逆. Slight slowness causes Feng Wei due to weak Earth generating Wind. The disease is in the meridians, not the Zang, so the mind remains clear.) An extremely large Spleen pulse causes sudden collapse; a slightly large pulse causes Hernia Qi, abdominal distension, and pus/blood outside the intestines. (Spleen governs Middle Qi. Extreme largeness indicates Extreme Yang leading to Yin collapse, causing collapse. Slight largeness indicates Damp-Heat in meridians affecting the anterior orifice. Abdominal distension results from pus/blood accumulation and Spleen Qi stagnation.) An extremely small Spleen pulse causes Cold-Heat alternation; a minute pulse causes Xiao Dan disease. (Small Spleen pulse indicates insufficient Middle Jiao Yang. Extreme smallness causes Cold-Heat; minute size causes Xiao Dan.) An extremely slippery Spleen pulse causes Shan Long (hernia and strangury); a slightly slippery pulse causes worm infestation and abdominal heat. (Extreme slipperiness indicates Taiyin Excess Heat. Taiyin combines with Zong Jin, causing hernia/strangury. Slight slipperiness indicates Damp-Heat steaming in the Spleen, generating worms and abdominal heat. "Hui" is synonymous with "hui".) An extremely choppy Spleen pulse causes Chang Zhi (intestinal hemorrhoids); a slightly choppy pulse causes Nei Zhi (internal hemorrhoids) and purulent bloody stools. (Choppy pulse indicates Qi stagnation and blood injury. The Foot-Taiyin collateral enters the intestines. Extreme chopiness causes intestinal hemorrhoids; slight chopiness causes internal hemorrhoids. These differ only in location.) An extremely rapid Kidney pulse causes Gu Dian Ji (bone epilepsy); a slightly rapid pulse causes Chen Jue (deep厥逆), Ben Tun (running piglet), inability to move the feet, and retention of urine and feces. (Extreme rapidity indicates Wind-Cold in the Kidney. Kidney governs bones, causing bone epilepsy. Slight rapidity causes deep厥逆 and immobility due to Cold in meridians. Ben Tun occurs due to Cold in the Zang. Retention occurs due to Cold in the Yin aspect. Ben Tun is a Kidney accumulation starting from the lower abdomen to the epigastrium.) An extremely slow Kidney pulse causes broken spine sensation; a slightly slow pulse causes Dong Xie (hole-like diarrhea), where food is not digested and regurgitated. (Extreme slowness indicates Yin deficiency, affecting the Foot-Shaoyin meridian which runs along the spine. Slight slowness indicates Kidney Qi deficiency and Mingmen decline, failing to transform the Lower Jiao, leading to regurgitation.) An extremely large Kidney pulse causes Yin痿 (impotence); a slightly large pulse causes Shi Shui (stone water edema), extending from below the navel to the stomach, heavy and sinking. If it reaches the stomach, it is fatal and untreatable. (Extreme largeness indicates Water deficiency and Fire hyperactivity, causing impotence. Slight largeness indicates Yin deficiency failing to transform, leading to water accumulation. If water reaches the stomach, it overwhelms Earth, leading to death. "Zhong zhui" is pronounced "chui", meaning heavy/sinking.) An extremely small Kidney pulse causes Dong Xie; a minute pulse causes Xiao Dan disease. (Extreme smallness indicates decline of Yuan Yang, causing Dong Xie. Minute size indicates loss of True Qi, causing Xiao Dan. All five Zang can have Xiao Dan; Heart/Lung/Liver refer to Yin/Blood, while Spleen/Kidney involve Yang, showing Yin-Yang interdependence.) An extremely slippery Kidney pulse causes Long Bi (strangury); a slightly slippery pulse causes Gu Wei (bone flaccidity), inability to sit or stand, and blindness upon standing. (Extreme slipperiness indicates Yin Fire excess, causing strangury. Slight slipperiness indicates Fire excess damaging Yin, causing bone flaccidity and visual impairment.) An extremely choppy Kidney pulse causes Da Yong (large abscess); a slightly choppy pulse causes amenorrhea and Chen Zhi (deep hemorrhoids). (Choppy pulse indicates Essence injury, Blood deficiency, and Qi stagnation. Extreme chopiness causes abscesses; slight chopiness causes amenorrhea and hemorrhoids.) Diseases exhibit six variations: Rapid pulses mostly indicate Cold. (Rapid implies Wiry-Tight. Floating-Tight is Wiry. Tight indicates Cold and Yin excess, associated with Liver Qi transformation.) Slow pulses mostly indicate Heat. (Slow implies relaxation, not slowness. It indicates Yang growth and sufficient Stomach Qi, associated with Spleen/Stomach Qi transformation.) Large pulses indicate excess Qi and deficient Blood. (Large indicates Yang excess and Yin deficiency, associated with Heart Qi transformation.) Small pulses indicate deficiency of both Qi and Blood. (Small implies minute/thin, indicating Yang or Yin deficiency, associated with Kidney Qi transformation.) Slippery pulses indicate abundant Yang Qi with slight Heat. (Slippery is Yang, indicating solid Qi-Blood and sufficient Stomach Qi, associated with Stomach Qi transformation.) Choppy pulses indicate relatively more Blood deficiency than Qi deficiency, with slight Cold. (Choppy indicates Qi stagnation and Blood deficiency, leading to mild Yang deficiency and cold, associated with Lung Qi transformation.) Therefore, for rapid pulses, needle deeply and retain for a long time. (Rapid pulses indicate Cold, which is hard to dispel from Yin. "Nei" means insert.) For slow pulses, needle shallowly and withdraw quickly to dissipate Heat. (Slow pulses indicate Heat, which disperses easily from Yang.) For large pulses, mildly drain Qi but do not bleed. (Large pulses indicate Yin deficiency, so avoid bleeding.) For slippery pulses, withdraw quickly and needle shallowly to drain Yang Qi and Heat. (Similar to treating slow pulses.) For choppy pulses, ensure accurate needle placement, retain for a long time according to flow direction, massage beforehand, and press the acupoint firmly after withdrawal without bleeding to harmonize the pulse. (Choppy pulses indicate Qi-Blood deficiency, making Deqi difficult. Care must be taken not to damage True Qi.) For all small pulses, where Yin-Yang, Form, and Qi are deficient, do not use needles; instead, regulate with Sweet Herbs. (Small pulses indicate deficiency. Needling is unsuitable for Qi-Blood deficiency; Sweet herbs are preferred. Sweet herbs enter the Spleen/Stomach first, strengthening the Middle Jiao. Earth generates Metal, Metal generates Water. Thus, Sweet herbs tonify the Mother element. One should combine the Five Flavors with Sweet as the primary agent. Form deficiency requires Qi warming; Essence deficiency requires Flavor tonification. Bitter flavors cannot tonify. The study of flavor actions requires careful examination.)