表病脉浮轻手得。所以为虚为无力。毫发差殊便不同。工意之人能自识。
脉来无力号为虚。外象豁然中则枯。弱比虚来虚更甚。按之如有亦如无。
微似慈葱细似线。细大于微殊易辨。应之指下得之心。心内了然皆洞见。
根据根据细细为微脉。弱则虚之而又虚。弱是体虚微细小。细寻真象莫模糊。
三五不调名曰涩。如雨沾炒短且难。迟唯一息二三至。非短非难力但宽。
短于本部为不及。短复迟难为涩脉。休将短涩一般看。短自时长滑时涩。
散与大相类(散为浮大为洪之别名也)
脉形涣漫名为散。有表那堪里却无。大则其中还翕翕。好将二脉较锱铢。
缓而时止复来者。便可将为结脉呼。止不能为方是代。结生代死必殊途。
脉来既数复中止。便呼为促莫狐疑。阴盛而然非能代。须知止脉易差池。
伏则全无绝则然。过饶厥逆命难全。按之隐隐其形伏。不觉开通病便痊。
(一首以上出刘三点脉诀)
人身之脉。本乎荣卫。荣者阴血。卫者阳气。荣行脉中。卫行脉外。脉不自行。随气而
至。
气动脉应。阴阳之义。气如 。血如波澜。血脉气息。上下循环。十二经中。皆有动脉。
手太阴经。可得而悉。此经属肺。上系吭嗌。脉之大会。息之出入。初持脉时。令仰其掌
。掌后高骨。是谓关上。关前为阳。关后为阴。阳寸阴尺。先后推寻。寸关与尺。两手各有
。
揣得高骨。上下左右。男女脉同。惟尺则异。男弱女盛。反此病至。调停自气。呼吸定息。
四至五至。平和之则。三至为迟。迟则为冷。六至为数。数即热证。转迟转冷。转数转热。
在人消息。在人差别。迟数既得。即辨浮沉。浮表沉里。深浅酌斟。浮数表热。沉数里热。
浮迟表虚。沉迟冷结。察其六部。的在何处。一部两经。一脏一腑。左寸属心。合于小肠。
关为肝胆。尺肾膀胱。右寸主肺。大肠同条。关则脾胃。尺命三焦。(命。即心包络脉也。)
不特脏腑。身亦主之。上下中央。三部分齐。寸候胸上。关候膈下。尺下于脐。直至跟踝。
左脉候左。右脉候右。病随所在。不病者否。浮沉迟数。有内外因。外因于天。内因于人。
天则阴阳。风雨晦暝。人则喜怒。忧思恐惊。外因之浮。则为表证。沉里迟寒。数则热甚。
内因脉浮。虚风所为。沉气迟冷。数燥何疑。表(浮)里(沉)寒(迟)热(数)风(浮)气(沉)冷(
迟)燥。(数)辨内外因。脉证参考。浮沉之脉。亦有当然。浮为心肺。沉属肾肝。脾者中州
。浮沉之间。肺重三菽。皮毛相得。六菽为心。得之血脉。脾九菽重。得于肌肉。肝与筋平
。重十二菽。惟有肾脉。独沉之极。按之至骨。举指来疾。脉理浩繁。总括于四。谓浮沉
迟数也。)六难七难。专衍其义。析而言之。七表八里。又有九道。其名乃备。浮而无力。
是名芤脉。有力为洪。形状可识。沉而有力。其脉为实。无力微弱。伏则沉极。脉迟有力。
滑而流利。无力缓涩。漫同一例。数而有力。脉名为紧。小紧为弦。疑似宜审。合则为四。
杂为七八。天机之秘。神授之诀。举之有余。按之不足。泛泛浮浮。如水漂木。芤脉何似。
绝类慈葱。指下成窟。有边无中。滑脉如珠。往来转旋。举按皆盛。实脉则然。弦如张弦。
紧如细线。洪较之浮。大而力健。隐隐约约。微脉难寻。举无按有。便指为沉。似迟不迟。
是谓之缓。如雨沾沙。涩难而短。迟则极缓。伏按至骨。濡而软软。弱则忽忽。既知七表。
又知八里。九道之形。不可不记。诸家九道。互有去取。不可相无。可以相有。过于本位。
相引日长。短则不及。来者乖张。形大力薄。其虚可知。促结俱止。促数结迟。代止不然。
止难回之。三脉皆止。当审毫厘。牢比弦紧。转益坚劲。动则动摇。厥厥不定。细如一线。
小而有力。弦大虚芤。脉曰改革。涣漫不收。其脉为散。急疾曰数。数则易见。即脉求病。
病无不明。病参之脉。可决死生。然有应病。有不相应。此最宜详。不可执定。人安脉病。
是曰行尸。人病脉和。可保无危。中风脉浮。滑兼痰气。其或沉滑。勿以风治。或浮或沉。
而微而虚。扶危降痰。风未可疏。寒中太阳。浮紧而涩。及传而变。名状难悉。阳明则长。
少阳则弦。太阴入里。迟沉必兼。及入少阴。其脉遂紧。厥阴热深。脉伏厥冷。在阳发汗。
次利小便。表解里病。其脉实坚。此其大略。治法之正。至于大法。自有仲景。伤寒有五。
脉非一端。阴阳俱盛。紧涩者寒。阳浮而滑。阴濡而弱。此名中风。勿用寒药。阳濡而弱。
阴小而急。此非风寒。乃湿温脉。阳脉浮滑。阴脉濡弱。更遇于风。变成风湿。阳脉洪数。
阴脉实大。更遇湿热。变为温毒。阳脉濡弱。阴脉弦紧。更遇湿气。变为湿温。阴阳俱盛。
重感于寒。变为温疟。病同异名。同脉异经。
滑氏曰。伤寒例。言湿疫。而无湿温。叔和言湿温。而无温疫。此亦异耳。
阴阳俱盛。病热之极。浮之而滑。沉之散涩。惟有湿病。脉散诸经。各随所主。不可指
名。暑
伤于气。所以脉虚。弦细芤迟。体状无余。或涩或细。或濡或缓。是皆中湿。可得而断。疟
脉自弦。弦迟自寒。弦数多热。随时变迁。风寒湿气。合而为痹。浮涩而紧。三脉乃备。脚
气之脉。其状曰四。浮弦为风。濡弱湿气。迟涩因寒。洪数热郁。风汗湿温。热下寒熨。腰
痛之脉。皆沉而弦。兼浮者风。兼紧者寒。濡细则湿。实则闪肭。指下既明。治斯不忒。尺
脉虚弱。缓涩而紧。病惟足痛。或时痿痹。涩则无血。厥寒为甚。尺微无阴。下利逆冷。热
厥脉伏。时或而数。便必秘难。治不可错。疝脉弦急。积聚在里。牢急者生。弱急者死。沉
迟浮涩。疝瘕寒痛。痛甚则伏。或细或动。风寒暑湿。气郁生涎。下虚上实。此晕而眩。风
浮寒紧。湿细暑虚。涎弦而滑。虚脉则无。治眩晕法。尤当审谛。先理痰气。次随证治。滑
数为呕。代者霍乱。微滑者生。涩数死断。偏弦为饮。或沉弦滑。或结或伏。痰饮停结。咳
嗽所因。浮风紧寒。数热细湿。房劳涩难。右关濡者。饮食伤脾。左关弦短。疲极肝衰。浮
短肺伤。法当咳嗽。五脏之嗽。各视本部。浮紧虚寒。沉数实热。洪滑多痰。弦涩少血。形
胜脉细。不足以息。沉小伏匿。皆是死脉。惟有浮大。而嗽者生。外证内脉。参考称停。下
手脉沉。便知是气。沉极则伏。涩弱难治。其或沉滑。气兼痰饮。沉弦细动。皆是痛证。心
痛在寸。腹痛在关。下部在尺。脉象显然。心中惊悸。脉必代结。饮食之悸。沉伏动滑。癫
痫之脉。浮洪大长。滑大坚疾。痰蓄心狂。乍大乍小。乍短乍长。此皆邪脉。神志昏乱。肝
脉浮虚。或濡或涩。软散洪大。渴饮无余。遗精白浊。当验于尺。结芤动紧。二证之的。鼻
头色黄。小便必难。肺浮弦涩。名为不便。便血则芤。数则赤黄。实脉癃闭。热在膀胱。诸
证失血。皆见芤脉。随其上下。以验所出。大凡失血。脉贵沉细。设见浮大。后必难治。水
泻之证。有阴有阳。察脉视象。问证须详。阴脉沉迟。其色青白。不渴而泻。小便清涩。脉
或沉数。色赤而黄。燥屎赤溺。兼渴为阳。胀满脉弦。脾制于肝。洪数热胀。迟弱阴寒。浮
为中满。紧则中实。浮则可治。虚小危急。痞脉则滑。为有痰结。弦伏亦痞。涩则气劣。肝
积肥气。弦细青色。心为伏梁。沉芤色赤。脾气积痞。浮大而长。其色脾土。中央之黄。肺
积息贲。浮毛色白。奔豚属肾。沉急面黑。五脏为积。六腑为聚。积在本位。聚无定处。驶
紧浮牢。小而沉实。或结或伏。为聚为积。实强者生。沉小者死。生死之别。病同脉异。气
口紧盛。为伤于食。食不消化。浮滑而疾。滑而不匀。必是吐泻。吐泻之脉。脉代勿讶。夏
月泄泻。脉大暑湿。洪而数溲。脉必虚极。治暑湿泻。分其小便。虚脱固肠。罔或不痊。无
积不痢。脉宜滑大。浮弦为死。沉细无害。五疸湿热。脉必洪数。如或微涩。其证虚弱。骨
蒸劳热。脉数而虚。热而涩小。必殒其躯。如汗加嗽。非药可除。头痛阳弦。浮风紧寒。风
热洪数。湿细而坚。痰气头痛。虽弦必涩。痰厥则滑。肾厥坚实。痈疽浮数。恶寒发热。若
有痛处。痈疽所发。脉数发热。而疼者阳。不数不热。不疼阴疮。发痈之脉。弦洪相搏。细
沉时滑。肺肝俱数。寸数而实。肺痈已成。寸数虚涩。肺痿之形。肺痈色白。
脉宜短涩。死者浮大。不白而赤。肠痈难知。滑数可推。数而不热。肠痈何疑。迟紧未脓。
下
以平之。洪数脓成。不下为宜。阴搏于下。阳别于上。血调气和。有子之象。手之少阴。其
脉动甚。尺按不绝。此为有孕。少阴属心。心主血脉。肾为胞门。脉应于尺。或寸脉微。关
滑尺数。往来流利。如雀之啄。或诊三脉。浮沉一止。或平而虚。当问月水。妇人有病。而
无邪脉。此孕非病。所以不月。男女之别。以左右取。左疾为男。右疾为女。沉实在左。浮
大在右。右女左男。可以预判。离经六至。沉细而滑。阵痛连腰。胎实时脱。血瘕弦急。而
大者生。虚小弱者。即是死形。半产漏下。革脉主之。弱即血耗。立见倾危。诊小儿脉。浮
沉为先。浮表沉里。便知其源。大小滑涩。虚实迟驶。各根据脉形。以审证治。大凡妇人。及
夫婴稚。病同丈夫。脉即同例。惟有妇人。胎产血气。小儿惊疳。变蒸等类。各有方法。与
丈夫异。要知妇孺。贵识证形。问始知详。脉难尽凭。望闻问切。神圣工巧。愚者昧之。明
者了了。病脉诊法。大略如斯。若夫持脉。尤所当知。谓知春弦。夏洪脉钩。秋则脉毛。冬
则为石。实强太过。病见于外。虚微不及。病决在内。四脉各异。四时各论。皆以胃气。而
为之本。胃气者何。脉之中和。过与不及。皆是偏颇。春主肝木。夏主心火。脾土乘旺。则
在长夏。秋主肺金。冬主肾水。五脏脉象。与五运配。肝脉弦长。厌厌聂聂。指下寻之。如
循榆叶。益实而滑。如循长竿。是谓太过。受病于肝。急如张弦。又如循刃。如按琴瑟。肝
死之应。浮大而散。心和且安。累累如环。如循琅 。病则益数。如鸡足举。死操带钩。前
曲后距。浮涩而短。蔼蔼如盖。此肺之平。按之益大。病如循羽。不下不上。死则消索。吹
毛扬扬。沉濡而滑。肾平则若。上大下锐。滑如雀啄。肾之病脉。啄啄连属。连属之中。然
而微曲。来如解索。去如弹石。已死之肾。在人审识。脾为中州。平和不见。
然亦可察。中缓而短。来如雀啄。如滴漏水。脾脏之衰。脉乃见此。人有肥瘦。修长侏儒。
肥沉瘦浮。短促长疏。各分诊法。不可一途。难尽者意。难穷者理。得之于心。应之于指。
勉□小子。日诵琅琅。造道之玄。筌蹄可忘。
表证（病邪在体表）的脉象浮，轻取即可触及。这是因为正气虚弱、脉气无力所致。毫厘之间的差异便有所不同，只有医术精湛的医生才能自行识别。
脉来无力称为虚脉。外表看似豁然开朗，内部却干枯空虚。弱脉比虚脉更严重，重按下去仿佛有脉又仿佛没有。
微脉像慈葱（一种蔬菜）中空的样子，细脉像线一样细。细脉比微脉大，容易辨别。心中领会指下的感觉，内心了然，洞若观火。
根据细细的感觉定为微脉。弱脉是虚之又虚。弱脉体现体质虚弱且脉形细小。仔细探寻真象，不要模糊不清。
三五不调称为涩脉，像雨滴沾在炒过的米上，短促且艰难。迟脉一息只跳动二三至，不长也不艰难，只是力量宽缓。
在本部脉位显得短促为不及脉。如果既短又迟且艰难，就是涩脉。不要把短脉和涩脉混为一谈。短脉有时长有时涩。
散脉与大脉相似（散脉是浮大洪脉的别名）。脉形涣散漫无根称为散脉，有表证时难以承受里证却无实邪。大脉中间还显得翕翕有力。要仔细比较这两者的细微差别。
脉来缓慢且时有中止，复来者，可称为结脉。中止后不能立即恢复方为代脉。结脉主生，代脉主死，二者必然殊途。
脉来急促且时有中止，便称为促脉，不要犹豫。这是阴盛所致，并非代脉。须知止脉容易混淆出错。
伏脉完全摸不到，绝脉则是断绝之象。过于厥逆则性命难全。重按隐隐约约见到脉形为伏脉，不觉开通则病痊愈。
人体的脉象，根本在于营卫。营是阴血，卫是阳气。营行于脉中，卫行于脉外。脉不能自行，随气而至。
气动脉应，体现了阴阳的道理。气如风，血如波澜。血脉气息，上下循环。十二经脉中，都有动脉。手太阴肺经，可以详细推究。此经属肺，上连咽喉。脉之大会，呼吸出入。初诊脉时，令患者仰掌。掌后高骨，称为关。关前为阳，关后为阴。阳寸阴尺，先后推寻。寸、关、尺三部，两手各有分布。
揣得高骨，上下左右。男女脉象相同，唯独尺脉不同。男弱女盛，反之则为病至。调停自身气息，以呼吸定息为标准。四至五至，是平和的标准。三至为迟脉，迟则主冷。六至为数脉，数即主热证。转迟转冷，转数转热。在于人的消息调节，在于人的差别。得到迟数之后，随即辨别浮沉。浮主表，沉主里，深浅斟酌。浮数主表热，沉数主里热。浮迟主表虚，沉迟主冷结。察其六部，确实在何处。一部两经，一脏一腑。左寸属心，合于小肠。关部为肝胆，尺部为肾膀胱。右寸主肺，大肠同条。关部为脾胃，尺部为命门三焦。（命门，即心包络脉也。）
不仅脏腑，身体也主司之。上下中央，三部分齐。寸部候胸上，关部候膈下，尺部候脐下直至跟踝。左脉候左边，右脉候右边。病随所在，不病者排除。浮沉迟数，有内外因。外因于天，内因于人。天则阴阳，风雨晦暝。人则喜怒，忧思恐惊。外因之浮，则为表证。沉主里，迟主寒，数主热甚。内因脉浮，为虚风所为。沉主气，迟主冷，数主燥何疑。表（浮）、里（沉）、寒（迟）、热（数）、风（浮）、气（沉）、冷（迟）、燥（数）。辨内外因，脉证参考。浮沉之脉，亦有当然。浮主心肺，沉属肾肝。脾为中州，在浮沉之间。肺重三菽，皮毛相得。六菽为心，得之血脉。脾九菽重，得于肌肉。肝与筋平，重十二菽。惟有肾脉，独沉之极，按之至骨。举指来疾。脉理浩繁，总括于四，谓浮沉迟数也。六难七难，专衍其义。析而言之，七表八里，又有九道，其名乃备。
浮而无力，是名芤脉。有力为洪，形状可识。沉而有力，其脉为实。无力微弱，伏则沉极。脉迟有力，滑而流利。无力缓涩，漫同一例。数而有力，脉名为紧。小紧为弦，疑似宜审。合则为四，杂为七八。天机之秘，神授之诀。举之有余，按之不足，泛泛浮浮，如水漂木。芤脉何似？绝类慈葱，指下成窟，有边无中。滑脉如珠，往来转旋，举按皆盛，实脉则然。弦如张弦，紧如细线。洪较之浮，大而力健。隐隐约约，微脉难寻。举无按有，便指为沉。似迟不迟，是谓之缓，如雨沾沙。涩难而短，迟则极缓。伏按至骨，濡而软软，弱则忽忽。既知七表，又知八里，九道之形，不可不记。诸家九道，互有去取，不可相无，可以相有。
过于本位，相引日长。短则不及，来者乖张。形大力薄，其虚可知。促结俱止，促数结迟，代止不然，止难回之。三脉皆止，当审毫厘。牢比弦紧，转益坚劲。动则动摇，厥厥不定。细如一线，小而有力。弦大虚芤，脉曰改革。涣漫不收，其脉为散。急疾曰数，数则易见。即脉求病，病无不明。病参之脉，可决死生。然有应病，有不相应，此最宜详，不可执定。人安脉病，是曰行尸。人病脉和，可保无危。
中风脉浮，滑兼痰气。其或沉滑，勿以风治。或浮或沉，而微而虚，扶危降痰，风未可疏。寒中太阳，浮紧而涩。及传而变，名状难悉。阳明则长，少阳则弦。太阴入里，迟沉必兼。及入少阴，其脉遂紧。厥阴热深，脉伏厥冷。在阳发汗，次利小便。表解里病，其脉实坚。此其大略，治法之正。至于大法，自有仲景。
伤寒有五，脉非一端。阴阳俱盛，紧涩者寒。阳浮而滑，阴濡而弱，此名中风，勿用寒药。阳濡而弱，阴小而急，此非风寒，乃湿温脉。阳脉浮滑，阴脉濡弱，更遇于风，变成风湿。阳脉洪数，阴脉实大，更遇湿热，变为温毒。阳脉濡弱，阴脉弦紧，更遇湿气，变为湿温。阴阳俱盛，重感于寒，变为温疟。病同异名，同脉异经。
滑氏曰：伤寒例言湿疫，而无湿温。叔和言湿温，而无温疫。此亦异耳。
阴阳俱盛，病热之极。浮之而滑，沉之散涩。惟有湿病，脉散诸经，各随所主，不可指名。暑伤于气，所以脉虚。弦细芤迟，体状无余。或涩或细，或濡或缓，是皆中湿，可得而断。疟脉自弦，弦迟自寒，弦数多热，随时变迁。风寒湿气，合而为痹，浮涩而紧，三脉乃备。脚气之脉，其状曰四。浮弦为风，濡弱湿气，迟涩因寒，洪数热郁。风汗湿温，热下寒熨。腰痛之脉，皆沉而弦。兼浮者风，兼紧者寒，濡细则湿，实则闪肭。指下既明，治斯不忒。
尺脉虚弱，缓涩而紧，病惟足痛，或时痿痹。涩则无血，厥寒为甚。尺微无阴，下利逆冷。热厥脉伏，时或而数，便必秘难，治不可错。疝脉弦急，积聚在里。牢急者生，弱急者死。沉迟浮涩，疝瘕寒痛。痛甚则伏，或细或动。风寒暑湿，气郁生涎，下虚上实，此晕而眩。风浮寒紧，湿细暑虚，涎弦而滑，虚脉则无。治眩晕法，尤当审谛。先理痰气，次随证治。
滑数为呕，代者霍乱。微滑者生，涩数死断。偏弦为饮，或沉弦滑，或结或伏，痰饮停结，咳嗽所因。浮风紧寒，数热细湿，房劳涩难，右关濡者，饮食伤脾。左关弦短，疲极肝衰。浮短肺伤，法当咳嗽。五脏之嗽，各视本部。浮紧虚寒，沉数实热，洪滑多痰，弦涩少血。形胜脉细，不足以息。沉小伏匿，皆是死脉。惟有浮大，而嗽者生。外证内脉，参考称停。
下手脉沉，便知是气。沉极则伏，涩弱难治。其或沉滑，气兼痰饮。沉弦细动，皆是痛证。心痛在寸，腹痛在关，下部在尺，脉象显然。心中惊悸，脉必代结。饮食之悸，沉伏动滑。癫痫之脉，浮洪大长。滑大坚疾，痰蓄心狂。乍大乍小，乍短乍长，此皆邪脉，神志昏乱。
肝脉浮虚，或濡或涩。软散洪大，渴饮无余。遗精白浊，当验于尺。结芤动紧，二证之的。鼻头色黄，小便必难。肺浮弦涩，名为不便。便血则芤，数则赤黄。实脉癃闭，热在膀胱。诸证失血，皆见芤脉。随其上下，以验所出。大凡失血，脉贵沉细。设见浮大，后必难治。
水泻之证，有阴有阳。察脉视象，问证须详。阴脉沉迟，其色青白，不渴而泻，小便清涩。脉或沉数，色赤而黄，燥屎赤溺，兼渴为阳。胀满脉弦，脾制于肝。洪数热胀，迟弱阴寒。浮为中满，紧则中实。浮则可治，虚小危急。痞脉则滑，为有痰结。弦伏亦痞，涩则气劣。
肝积肥气，弦细青色。心为伏梁，沉芤色赤。脾气积痞，浮大而长，其色脾土，中央之黄。肺积息贲，浮毛色白。奔豚属肾，沉急面黑。五脏为积，六腑为聚。积在本位，聚无定处。驶紧浮牢，小而沉实，或结或伏，为聚为积。实强者生，沉小者死。生死之别，病同脉异。
气口紧盛，为伤于食。食不消化，浮滑而疾。滑而不匀，必是吐泻。吐泻之脉，脉代勿讶。夏月泄泻，脉大暑湿。洪而数溲，脉必虚极。治暑湿泻，分其小便。虚脱固肠，罔或不痊。无积不痢，脉宜滑大。浮弦为死，沉细无害。五疸湿热，脉必洪数。如或微涩，其证虚弱。骨蒸劳热，脉数而虚。热而涩小，必殒其躯。如汗加嗽，非药可除。
头痛阳弦，浮风紧寒。风热洪数，湿细而坚。痰气头痛，虽弦必涩。痰厥则滑，肾厥坚实。痈疽浮数，恶寒发热。若有痛处，痈疽所发。脉数发热，而疼者阳。不数不热，不疼阴疮。发痈之脉，弦洪相搏。细沉时滑，肺肝俱数。寸数而实，肺痈已成。寸数虚涩，肺痿之形。肺痈色白，脉宜短涩。死者浮大，不白而赤。肠痈难知，滑数可推。数而不热，肠痈何疑。迟紧未脓，下以平之。洪数脓成，不下为宜。
阴搏于下，阳别于上，血调气和，有子之象。手之少阴，其脉动甚。尺按不绝，此为有孕。少阴属心，心主血脉。肾为胞门，脉应于尺。或寸脉微，关滑尺数，往来流利，如雀之啄。或诊三脉，浮沉一止，或平而虚，当问月水。妇人有病，而无邪脉，此孕非病，所以不月。男女之别，以左右取。左疾为男，右疾为女。沉实在左，浮大在右。右女左男，可以预判。离经六至，沉细而滑，阵痛连腰，胎实时脱。血瘕弦急，而大者生。虚小弱者，即是死形。半产漏下，革脉主之。弱即血耗，立见倾危。
诊小儿脉，浮沉为先。浮表沉里，便知其源。大小滑涩，虚实迟驶，各根据脉形，以审证治。大凡妇人，及夫婴稚，病同丈夫，脉即同例。惟有妇人，胎产血气，小儿惊疳，变蒸等类，各有方法，与丈夫异。要知妇孺，贵识证形。问始知详，脉难尽凭。望闻问切，神圣工巧。愚者昧之，明者了了。病脉诊法，大略如斯。
若夫持脉，尤所当知。谓知春弦，夏洪脉钩，秋则脉毛，冬则为石。实强太过，病见于外。虚微不及，病决在内。四脉各异，四时各论。皆以胃气，而为之本。胃气者何？脉之中和。过与不及，皆是偏颇。春主肝木，夏主心火。脾土乘旺，则在长夏。秋主肺金，冬主肾水。五脏脉象，与五运配。
肝脉弦长，厌厌聂聂，指下寻之，如循榆叶。益实而滑，如循长竿，是谓太过。受病于肝，急如张弦。又如循刃，如按琴瑟。肝死之应，浮大而散。心和且安，累累如环，如循琅玕。病则益数，如鸡足举。死操带钩，前曲后距。浮涩而短，蔼蔼如盖，此肺之平。按之益大，病如循羽，不下不上。死则消索，吹毛扬扬。沉濡而滑，肾平则若。上大下锐，滑如雀啄。肾之病脉，啄啄连属。连属之中，然而微曲。来如解索，去如弹石。已死之肾，在人审识。
脾为中州，平和不见。然亦可察，中缓而短。来如雀啄，如滴漏水。脾脏之衰，脉乃见此。人有肥瘦，修长侏儒。肥沉瘦浮，短促长疏。各分诊法，不可一途。难尽者意，难穷者理。得之于心，应之于指。勉□小子，日诵琅琅。造道之玄，筌蹄可忘。
Exterior syndromes (illnesses where pathogens are located on the body surface) present with a floating pulse, which can be felt with light pressure. This is because of deficiency of healthy qi and lack of force in the pulse. Differences as slight as a hair's breadth make a distinction; only skilled physicians can recognize this themselves.
A pulse that comes with weakness is called a Deficiency pulse (Xu Mai). Externally it appears open and vast, but internally it is dry and empty. The Weak pulse (Ruo Mai) is more severe than the Deficiency pulse; upon heavy pressure, it feels as if there is a pulse or as if there is none.
The Fine pulse (Wei Mai) resembles the hollow center of a green onion (Cibotium barometz stem contextually used for texture description), while the Thready pulse (Xi Mai) is thin like a thread. The Thready pulse is larger than the Fine pulse and is easy to distinguish. One must grasp the sensation under the fingers mentally; understanding within leads to clear perception.
Based on the fine and thin sensation, it is defined as the Fine pulse. The Weak pulse is deficiency compounded by deficiency. The Weak pulse reflects a constitution that is deficient and the pulse shape is minute. Carefully seek the true image; do not be vague.
Irregular rhythm with intervals of three, five, etc., is named the Choppy pulse (Se Mai), resembling raindrops hitting fried rice—short and difficult. The Slow pulse (Chi Mai) beats two or three times per respiration; it is neither short nor difficult, but merely broad in strength.
Shortness at the main position indicates insufficiency. If it is both short and slow and difficult, it is the Choppy pulse. Do not confuse the Short pulse (Duan Mai) with the Choppy pulse. The Short pulse may sometimes be long and sometimes choppy.
The Scattered pulse (San Mai) is similar to the Large pulse (Da Mai) (the Scattered pulse is an alias for the Floating, Large, and Surging pulses combined). A pulse form that is scattered and rootless is called the Scattered pulse; when there is an exterior syndrome, one cannot bear interior excess without real pathogenic factors. The Large pulse still has a fluttering fullness in the center. Compare these two pulses carefully for subtle differences.
When the pulse comes slowly and occasionally stops, then resumes, it can be called the Knotted pulse (Jie Mai). If the stop does not resume immediately, it is the Intermittent pulse (Dai Mai). The Knotted pulse indicates life/prognosis is better, while the Intermittent pulse indicates death; their paths are necessarily different.
When the pulse comes rapid and occasionally stops, it is called the Hasty pulse (Cu Mai); do not hesitate. This is caused by Yin excess, not the Intermittent pulse. Know that pulses with stops are easily confused.
The Deep pulse (Fu Mai) is completely imperceptible, while the Extinct pulse (Jue Mai) signifies cessation. Severe reversal-cold (Jue Ni) endangers life. Pressing deeply reveals a faint form as the Deep pulse; if unblocked, the illness recovers.
(Above verse from Liu Sandian's *Mai Jue*)
Human pulses originate from Ying (Nutritive Qi) and Wei (Defensive Qi). Ying is Yin blood, Wei is Yang Qi. Ying circulates within the vessels, Wei circulates outside. Vessels do not move on their own; they follow Qi. Qi moves, Pulse responds, embodying Yin and Yang. Qi is like wind, Blood is like waves. Blood vessels and Qi circulate up and down. In the twelve meridians, all have arterial pulses. The Hand-Taiyin Lung Meridian can be examined in detail. This meridian belongs to the Lung, connecting upwards to the throat. It is the great meeting of pulses, governing breath entry and exit. When initially palpating, instruct the patient to extend their palm upward. The high bone behind the palm is called Guan (Bar). Anterior to Guan is Yang, posterior is Yin. Yang corresponds to Cun (Inch), Yin to Chi (Cubit). Search sequentially through Cun, Guan, and Chi. Both hands have distributions of Cun, Guan, and Chi.
Locate the high bone, above and below, left and right. Male and female pulses are the same, except at Chi. Males are weak, females are strong; reversal indicates disease. Regulate your own breath; use respiration as the standard. Four to five beats per respiration is the standard for a Harmonious pulse. Three beats is Slow (Chi), indicating Cold. Six beats is Rapid (Shu), indicating Heat. Slower means colder, faster means hotter. It depends on individual variation. Once Slow and Rapid are determined, distinguish Floating (Fu) and Deep (Chen). Floating indicates Exterior, Deep indicates Interior; judge depth carefully. Floating-Rapid indicates Exterior Heat, Deep-Rapid indicates Interior Heat. Floating-Slow indicates Exterior Deficiency, Deep-Slow indicates Cold accumulation. Examine the six positions to locate the pathology precisely. Each position relates to two meridians, one Zang organ, and one Fu organ. Left Cun belongs to the Heart, harmonizing with the Small Intestine. Guan is Liver and Gallbladder. Chi is Kidney and Bladder. Right Cun governs the Lung, sharing with the Large Intestine. Guan is Spleen and Stomach. Chi is Mingmen (Gate of Life) and Sanjiao (Triple Burner). (Mingmen refers to the Pericardium meridian.)
Not only organs, but the whole body is governed. Upper, middle, and lower correspond to three parts equally. Cun probes the chest above, Guan probes below the diaphragm, Chi probes below the navel down to the heel/ankle. Left pulse probes the left side, Right pulse probes the right side. Disease follows location; non-diseased areas are excluded. Floating, Deep, Slow, Rapid have internal and external causes. External causes relate to Heaven (nature); internal causes relate to Humans (emotion/lifestyle). Heaven involves Yin/Yang, wind/rain/darkness. Humans involve joy/anger, worry/thought/fear/surprise. External Floating indicates Exterior syndrome. Deep indicates Interior, Slow indicates Cold, Rapid indicates intense Heat. Internal Floating is caused by deficient wind. Deep indicates Qi stagnation, Slow indicates Cold, Rapid indicates Dryness. Differentiate internal/external causes: Exterior (Floating), Interior (Deep), Cold (Slow), Heat (Rapid), Wind (Floating), Qi (Deep), Cold (Slow), Dryness (Rapid). Reference pulse and symptoms. Floating/Deep pulses have specific associations. Floating belongs to Heart/Lung; Deep belongs to Kidney/Liver. Spleen is the Central Earth, situated between Floating and Deep. Lung pulse requires light pressure (3 grains of hemp seed), touching skin/hair. Heart pulse requires 6 grains, touching vessels. Spleen pulse requires 9 grains, touching muscle. Liver pulse matches tendons, requiring 12 grains. Only the Kidney pulse sinks extremely deep, pressing to the bone. Lifting the finger brings a quick response. Pulse theory is vast, summarized in four: Floating, Deep, Slow, Rapid. Chapters 6 and 7 expand on this. Analyzing further, there are Seven Superficial (Biao) and Eight Interior (Li) pulses, plus Nine Channels, completing the names.
Floating but weak is the Hollow pulse (Kou Mai). Strong is the Surging pulse (Hong Mai), recognizable by shape. Deep and strong is the Full pulse (Shi Mai). Weak and faint, sinking to the extreme is the Deep pulse (Fu Mai). Slow and strong is Slippery (Hua) and fluent. Weak and slow is Choppy (Se), appearing similar. Rapid and strong is Tight (Jin Mai). Small and tight is Wiry (Xian Mai); distinguish carefully. Combined they form four, mixed they form seven or eight. Secrets of nature, divine teachings. Lifting shows excess, pressing shows insufficiency, floating vaguely like wood on water. What is the Hollow pulse? Like a green onion, forming a cavity under the finger, edges present, center empty. Slippery pulse is like a pearl, rolling back and forth, strong on lift and press, characteristic of the Full pulse. Wiry is like a drawn bowstring. Tight is like a thin thread. Compared to Floating, Surging is large and strong. Faint and obscure, the Fine pulse is hard to find. Absent on lift, present on press, this is called Deep. Similar to Slow but not quite, this is called Moderate (Huan), like rain soaking sand. Choppy is difficult and short. Slow is extremely moderate. Deep presses to the bone. Soft (Ru) is soft and tender. Weak (Ruo) is fleeting. Knowing Seven Superficial and Eight Interior, the forms of Nine Channels must be memorized. Various schools select differently from the Nine Channels; none can be omitted, some can coexist.
Extending beyond the normal position, pulling long. Short indicates insufficiency, coming irregularly. Large shape but weak force indicates deficiency. Hasty and Knotted both have stops; Hasty is Rapid, Knotted is Slow. Intermittent stops are different, hard to recover. All three have stops; examine minutely. Firm (Lao) is wiry and tight, becoming harder. Moving (Dong) shakes, uncertain. Thin as a line, small but strong. Wiry, Large, Empty, Hollow are termed "Reform". Scattered and unrestrained is the Scattered pulse. Rapid is called Rapid (Shu), easy to see. Seek disease from pulse, disease becomes clear. Refer disease to pulse to decide life/death. However, some match disease, some do not; this requires detail, do not rigidly adhere. Healthy person with diseased pulse is called "Walking Corpse". Diseased person with harmonious pulse ensures safety.
Wind-stroke pulse is Floating, slippery with phlegm-qi. If Deep and slippery, do not treat as wind. Whether Floating or Deep, if Fine and weak, support crisis, reduce phlegm, wind cannot be dispersed. Cold invading Taiyang presents as Floating-Tight-Choppy. Transmission changes, names hard to list. Yangming is Long. Shaoyang is Wiry. Taiyin enters interior, Slow-Deep must accompany. Entering Shaoyin, pulse becomes Tight. Jueyin deep heat, pulse Deep with reversal-cold. In Yang stages, induce sweating, then promote urination. Exterior resolved, interior disease remains, pulse is Full-Firm. This is the general outline, correct treatment methods. For major principles, Zhang Zhongjing provides them.
Cold damage (Shanghan) has five types, pulses are not uniform. Yin and Yang both盛 (excessive), Tight-Choppy indicates Cold. Yang Floating-Slippery, Yin Moist-Weak, this is Wind-Strike (Zhong Feng), do not use cold medicines. Yang Moist-Weak, Yin Small-Urgent, this is not Wind-Cold, but Damp-Warmth pulse. Yang Floating-Slippery, Yin Moist-Weak, encountering wind becomes Wind-Dampness. Yang Surging-Rapid, Yin Full-Large, encountering damp-heat becomes Warm-Toxin. Yang Moist-Weak, Yin Wiry-Tight, encountering dampness becomes Damp-Warmth. Yin and Yang both excessive, re-contracting cold becomes Warm-Malaria. Same disease different names, same pulse different meridians.
Master Hua says: *Shanghan* examples mention Damp-Epidemic but not Damp-Warmth. He Suhe mentions Damp-Warmth but not Warm-Epidemic. This is a difference.
Yin and Yang both excessive, extreme heat. Floating makes it Slippery, Deep makes it Scattered-Choppy. Only Damp disease, pulse scatters through meridians, following each master, cannot be named specifically. Summerheat injures Qi, so pulse is Empty. Wiry-Fine-Hollow-Slow, forms complete. Or Choppy or Fine, or Moist or Moderate, all indicate Dampness, can be judged. Malaria pulse is naturally Wiry. Wiry-Slow indicates Cold. Wiry-Rapid indicates Heat, changing with time. Wind-Cold-Dampness combine to form Bi obstruction. Floating-Choppy-Tight, three pulses prepared. Foot-Qi pulse has four states. Floating-Wiry is Wind. Moist-Weak is Dampness. Slow-Choppy is Cold. Surging-Rapid is Heat郁 (stagnation). Wind induces sweat, Damp/Warmth, Heat promotes urination, Cold applies moxibustion. Waist pain pulse is all Deep-Wiry. Accompanying Floating is Wind. Accompanying Tight is Cold. Moist-Fine is Dampness. Full indicates sprain. Finger clarity ensures correct treatment.
Chi pulse weak, Moderate-Choppy-Tight, disease is foot pain or occasional flaccidity-bi. Choppy indicates no blood, severe reversal-cold. Chi micro indicates no Yin, diarrhea with reversal-cold. Heat-reversal pulse is Deep, occasionally Rapid, stool must be difficult, treatment must not err. Hernia pulse is Wiry-Urgent, accumulation inside. Firm-Urgent indicates survival, Weak-Urgent indicates death. Deep-Slow-Floating-Choppy, hernia-mass cold pain. Pain severe becomes Deep, or Fine or Moving. Wind-Cold-Summerheat-Dampness, Qi stagnation generates saliva/phlegm, lower deficiency upper excess, this is dizziness and vertigo. Wind Floating, Cold Tight, Damp Fine, Summerheat Empty, Saliva/Phlegm Wiry-Slippery, Empty pulse indicates none. Treating vertigo requires careful examination. First regulate Phlegm-Qi, then treat according to syndrome.
Slippery-Rapid indicates vomiting. Intermittent indicates Cholera. Micro-Slippery indicates survival, Choppy-Rapid indicates death. Oblique Wiry indicates Fluid retention, or Deep-Wiry-Slippery, or Knotted or Deep. Phlegm-Fluid stagnation causes cough. Floating Wind, Cold Tight, Heat Rapid, Damp Fine. Sexual exhaustion Choppy-Difficult. Right Guan Moist indicates food injuring Spleen. Left Guan Wiry-Short indicates liver exhaustion from fatigue. Floating-Short Lung injury, method should address cough. Five Zang coughs, each view main position. Floating-Tight-Empty-Cold, Deep-Rapid-Full-Heat. Surging-Slippery much phlegm. Wiry-Choppy little blood. Form exceeds pulse fine, insufficient breath. Deep-Small-Deep-Hidden, all are death pulses. Only Floating-Large, and coughing indicates survival. External signs and internal pulses, reference balance.
Starting with Deep pulse, know it is Qi. Extreme Deep becomes Hidden, Choppy-Weak hard to treat. If Deep-Slippery, Qi combines with Phlegm-Fluid. Deep-Wiry-Fine-Moving, all are Pain syndromes. Heart pain at Cun, Abdominal pain at Guan, Lower part at Chi, pulse image obvious. Heart fright palpitation, pulse must be Intermittent-Knotted. Food-induced palpitation, Deep-Hidden-Moving-Slippery. Epilepsy pulse, Floating-Surging-Large-Long. Slippery-Large-Firm-Rapid, Phlegm accumulates in Heart causing madness. Suddenly large suddenly small, suddenly short suddenly long, these are evil pulses, spirit confusion.
Liver pulse Floating-Empty, or Moist or Choppy. Soft-Scattered-Surging-Large, thirst drinking without relief. Seminal emission white turbid, verify at Chi. Knotted-Hollow-Moving-Tight, definitive for these two conditions. Nose tip yellow, urine must be difficult. Lung Floating-Wiry-Choppy, named difficulty in defecation. Blood stool is Hollow, Rapid indicates red-yellow. Full pulse strangury, heat in Bladder. All bleeding syndromes show Hollow pulse. Follow up/down to verify source. Generally bleeding, pulse values Deep-Fine. If Floating-Large seen, later hard to treat.
Water diarrhea has Yin and Yang. Check pulse/image, ask symptoms detailed. Yin pulse Deep-Slow, color blue-white, no thirst but diarrhea, urine clear-choppy. Pulse maybe Deep-Rapid, color red-yellow, dry stool red urine, accompanied by thirst is Yang. Distension-fullness pulse Wiry, Spleen controlled by Liver. Surging-Rapid heat distension, Slow-Weak Yin cold. Floating indicates middle fullness, Tight indicates middle solid. Floating treatable, Weak-Small critical. Pi (Glomus) pulse is Slippery, indicates Phlegm knot. Wiry-Deep also Pi, Choppy indicates poor Qi.
Liver accumulation Fei Qi, Wiry-Fine blue color. Heart is Fu Liang, Deep-Hollow red color. Spleen Qi accumulation Pi, Floating-Large-Long, color Spleen Earth, Central Yellow. Lung accumulation Xi Ben, Floating-Hairy white color. Ben Tun belongs to Kidney, Deep-Urgent black face. Five Zang are Accumulations (Ji), Six Fu are Gatherings (Ju). Accumulation at main position, Gathering has no fixed place. Fast-Tight-Floating-Firm, Small-Deep-Real, or Knotted or Deep, become Gathering or Accumulation. Full-Strong indicates survival, Deep-Small indicates death. Difference between life/death, same disease different pulse.
Qi Kou (Radial artery at wrist) Tight-Excessive, injured by food. Food not digesting, Floating-Slippery-Rapid. Slippery but uneven, must be vomiting/diarrhea. Vomiting/Diarrhea pulse, do not startle at Intermittent. Summer month diarrhea, pulse Large Summerheat-Dampness. Surging-Rapid urine, pulse must be extremely weak. Treat Summerheat-Dampness diarrhea, separate urine. Collapse solidify intestine, invariably cure. No accumulation no dysentery, pulse should be Slippery-Large. Floating-Wiry is death, Deep-Fine harmless. Five Jaundices damp-heat, pulse must be Surging-Rapid. If Micro-Choppy, syndrome weak. Bone-steaming劳热 (consumptive fever), pulse Rapid-Empty. Heat-Choppy-Small, must perish body. If sweat adds cough, medicine cannot remove.
Headache Yang Wiry, Floating Wind Tight Cold. Wind-Heat Surging-Rapid, Damp Fine Hard. Phlegm-Qi headache, though Wiry must be Choppy. Phlegm Reversal is Slippery, Kidney Reversal Firm-Solid. Carbuncles/Furuncles Floating-Rapid, aversion to cold fever. If painful area, carbuncle develops. Pulse Rapid fever, and painful is Yang. Not Rapid not hot, not painful is Yin sore. Developing carbuncle pulse, Wiry-Surge interact. Fine-Deep occasional Slippery, Lung-Liver both Rapid. Cun Rapid-Real, Lung abscess formed. Cun Rapid-Empty-Choppy, Lung萎 (flaccidity) form. Lung abscess color white, pulse should be Short-Choppy. Death is Floating-Large, not white but red. Intestinal abscess hard to know, Slippery-Rapid can deduce. Rapid but not hot, intestinal abscess what doubt? Slow-Tight no pus, purge to level it. Surging-Rapid pus formed, purging not suitable.
Yin pulses below, Yang distinct above, blood harmonious Qi peaceful, sign of pregnancy. Hand-Shaoyin, its pulse moves strongly. Chi press uninterrupted, this is pregnancy. Shaoyin belongs to Heart, Heart governs blood vessels. Kidney is womb gate, pulse responds at Chi. Or Cun pulse micro, Guan Slippery Chi Rapid, flowing smoothly like sparrow pecking. Or diagnose three pulses, Floating-Deep one stop, or Flat-Empty, ask menstruation. Woman has disease, but no evil pulse, this pregnancy not disease, hence no period. Male/Female difference, take left/right. Left rapid is male, Right rapid is female. Deep-Real on Left, Floating-Large on Right. Right Female Left Male, can predict early. Departed from standard six beats, Deep-Fine-Slippery,阵痛 (paroxysmal pain) connects waist, fetus mature then sheds. Blood mass Wiry-Urgent, and Large indicates survival. Weak-Small-Weak, is death form. Half-birth leakage, Ge (Leather) pulse governs. Weak indicates blood consumption, immediate danger.
Diagnose child pulse, Floating-Deep first. Floating Exterior Deep Interior, know source. Large-Small-Slippery-Choppy, Empty-Full-Slow-Fast, each according to pulse form, to examine syndrome treatment. Generally women and infants, disease same as men, pulse same example. Only women, pregnancy/birth blood-qi, children fright/consumption, Bian Zheng (transformation) etc., each has methods, different from men. To know women/children, value recognizing syndrome form. Ask to know detailed, pulse hard to rely entirely. Look/Hear/Ask/Cut, Divine/Sage/Work/Clever. Foolish ones ignorant, Bright ones clear. Disease/Pulse diagnosis method, general outline like this.
Regarding holding pulse, especially should know. Say know Spring Wiry, Summer Surging Hook pulse, Autumn then Hairy pulse, Winter then Stone pulse. Full-Strong too much, disease appears outside. Weak-Micro insufficient, disease decided inside. Four pulses different, four seasons discuss each. All with Stomach Qi as root. What is Stomach Qi? Pulse harmony/middle. Excess and insufficient, all are bias. Spring governs Liver Wood, Summer governs Heart Fire. Spleen Earth rides prosperity, then in Late Summer. Autumn governs Lung Metal, Winter governs Kidney Water. Five Zang pulse images, match Five Movements. Liver pulse Wiry-Long, gentle/fluttering, seeking under finger, like walking elm leaves. More solid and slippery, like walking long bamboo pole, this is Excess. Sick in Liver, urgent like drawn bowstring. Like walking blade, like pressing zither strings. Liver death response, Floating-Large-Scattered. Heart harmonious and peaceful, piled like ring, like walking agate. Sick then more rapid, like chicken foot lifting. Death holds belt hook, front curved back stiff. Floating-Choppy-Short, abundant like canopy, this Lung Peace. Pressing more large, sick like walking feather, not down not up. Death then disappears, blowing feathers flying. Deep-Moist-Slippery, Kidney Peace is like... Large top small bottom, slippery like sparrow pecking. Kidney sick pulse, pecking continuously. Among continuity, however slightly curved. Coming like untied rope, going like flicking stone. Dead Kidney, in human careful recognition.
Spleen is Central Earth, peace not seen. But can observe, Moderate-Slow-Short. Coming like sparrow pecking, like dripping leaking water. Spleen organ decline, pulse then sees this. People have fat/thin, tall/stout. Fat Deep Thin Floating, Short-Fast Long-Sparse. Each divide diagnosis method, cannot one path. Hard to exhaust meaning, hard to穷 (fathom) principle. Obtained in heart, responded in finger. Encourage young son, daily chant loudly. Profound way of Dao, fish trap can be forgotten.