左手头指火之子。五行造化岂虚偏若将两肾脉分二。何独三焦经独专。水火相生滋养处
。土
金涵育委和全。自然神气存斯理。不识天真道不传。素问脉类五十余种。后世类为二十四种
。至如拒格者。素问谓阴胜
格阳。阳胜拒阴。非死脉也。皆宜详审。
脉是人身造化机。要须指下识其微。浮洪动滑弦如紧。微涩濡虚缓类迟。覆溢代牢诚莫
疗。细芤实弱可扶持。短长促结沉伏别。寒热参差必误医。
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浮脉不足举有余。芤脉中空两畔居。滑体如珠中有力。实形 与长俱。弦如始按弓弦
状。
紧若牵绳转索初。洪举按之皆极大。此名七表不同途。浮为中风芤失血。滑吐实下分明别。
弦为拘急紧为疼。洪大从来偏生热。
浮为在表
为风。(应人迎)为气。(应气口)为热。为痛。为呕。为胀。为痞。为喘。为厥。
为
内结。为满不食。浮大为鼻塞。浮缓为不仁浮大长。为风眩癫疾。浮滑疾。为宿食。
浮滑为饮为走刺。浮大而涩。为宿食滞气。浮短为肺伤诸气。浮细而滑为伤饮。浮滑疾
紧。为百合病。浮数。(大便坚小便数)浮紧为淋为癃闭。
芤为血
寸芤为吐血。微芤为衄血。关芤为大便出血。尺芤为下焦虚小便出血。
滑为吐
为满。 为咳。 为热。 为伏痰。 为宿食。 为蓄血。 为经闭。 为鬼疰。 为
血气俱实。 滑
散为瘫缓。 滑数为结热。 滑实为胃热 滑而大小不匀。必吐。为病进。为泄利。 滑而
和为妊娠。 滑而浮大小腹痛。弱则阴中痛。大便亦然。
实为热
为呕。 为痛。 为气塞。 为喘咳。 为大便不禁。 实紧为阴不胜阳。为胃寒。
为腰痛
弦为寒
为痛。 为饮。 为疟。 为水。 为中虚。 为厥逆。 为拘急。 为寒癖。 弦紧
为恶寒。为疝瘕为癖。双弦胁急痛。弦为钩。为胁下刺痛。 弦长为积随左右上下。紧
为寒
为痛。 为嗽。 为喘。 为满。 浮紧为肺有水。 紧滑为蛔动。为宿食。为逆吐。
紧急为遁尸。 紧数为寒热。
洪为胀
为满。为疮。 为热。
为烦。 洪实为癫。 洪紧为痈疽。为喘急。亦为胀。洪大为祟。洪浮为阳邪来见。
微来如有又如。无沉举都无按有余。迟缓息间三度至。(诀云。缓脉一息四至。迟脉。
一息三
至也。)濡来散止细仍虚。伏须切骨沉相类。弱脉沉微指下图。(诊而细。沉按之乃得。举之
若无为弱。)涩脉如刀轻刮竹。分明八里坦如途。(脉涩体细而迟。往来难而散。)
迟寒缓结微为痞。涩因血少沉气滞。伏为物聚濡气虚。弱则筋痿须审记。
微为虚
为弱。 为衄。 为呕。 为泄。 为亡汗。 为拘急。 微弱为少气。为中寒。
沉为在里
为实。 为水。 为寒。 为喘。 为 。 为瘕。 沉弱为寒热。 沉滑为风水。
为下
重。 沉细为少气。臂不能举。 沉紧为上热下冷 沉重而直前绝者为瘀血。 沉重而中
散。为寒食成瘕。 沉重不至寸。徘徊绝者为遁尸。 沉紧为悬饮。 沉迟为痼冷。 沉重
为
伤暑发热
缓为在下
为风。 为寒。 为弱。 为痹。 为疼。 为不仁。 为虚。 为气不足。 为眩晕
。缓而滑为热中。 缓而迟。 虚寒相搏。食冷则咽痛。
涩为少血
为亡汗。 热气不足。 为逆冷。 为下痢。 为恶寒。 为心痛。 涩而紧为痹。
为寒湿。 涩细大寒。
迟为寒为痛
迟而涩。为 瘕咽酸。 迟而滑为胀。 迟而缓为寒。
伏为霍乱
为疝瘕。 为水气。 为溏泄。 为停痰。 为宿食。 为诸气上冲。 为恶脓贯肌
濡为虚
为痹。 为自汗。 为气弱。 为下重。 濡而弱为内热外冷自汗
为小便难
弱为虚
为风热。 为自汗。
长脉流利通三部。短脉本部不及须。虚脉迟大而兼软。促脉来数急促欤结脉时止而迟缓
。代
脉不还真可吁。(结脉与代脉相类。但代脉不能自还。)牢脉如弦而更实。冲脉鼓动无定居。
细脉虽有但如线。九道之形乃自殊。
细为气血俱虚
为病在内。 为积。 为伤湿。 为后泄。 为寒。 为神劳。 为忧伤过度。 为腹
满。 通刺痛。 细而紧。而 瘕积聚。 细而滑。为僵仆。 为发热。 为呕吐。
动为痛
为惊。 为挛。 为泄。 为恐。
虚为寒
为虚。 为脚弱。 为食不消化。 为伤暑。
促脉有五
一曰气。二曰血。三曰饮。四曰食。五曰痰。但脏热则脉数。以气血痰饮留滞不行则止
促。非恶脉也。
结为痰
为饮。 为血。 为积。 为气。
长为热
为痫。 长而缓。病在下。 脉经有散脉而无长脉。陈氏释曰六腑气绝于外。主手足寒
而上气。五脏气绝于内。则下不禁。 甚者不仁。其脉皆散。散则不聚。病亦危矣。
短为气病
短而急病在上。 脉经有数脉。而无短脉。陈氏释曰。数为热。为虚。为烦渴。为烦满
。
牢(脉经作革)为满。
为急。 为虚寒相搏。 妇人半产漏下。○三因释曰。革者。革也。固结不移之状。三
部应之皆危脉也。
代为一脏气绝。
左手食指对应的脉位属火，是木之子。五行的造化难道会有虚妄偏颇吗？如果将两肾的脉象分为两部分，为何唯独三焦经独自专司其职呢？水火相生、相互滋养的地方，土金涵育使得委和之气得以保全。自然的神气存在于这种道理之中，如果不识得天真之道，医道便无法传承。《素问》中记载的脉类有五十多种，后世将其归纳为二十四种。至于拒格脉，《素问》称之为阴胜格阳、阳胜拒阴，并非死脉，都应当详细审察。
脉象是人体造化的枢纽，必须要在指下识别其细微变化。浮、洪、动、滑、弦、紧这六种脉象属于七表脉；微、涩、濡、虚、缓、迟这六种脉象属于七里脉；覆、溢、代、牢、细、芤、实、弱、短、长、促、结、沉、伏这十四种脉象则需仔细辨别。覆脉和溢脉通常难以治愈，而细、芤、实、弱脉尚可扶持调理。寒热错杂的脉象若分辨不清，必定会导致误诊。
浮脉轻取即得，举之有余，按之不足。芤脉中间空，两边实。滑脉形态如珠，中间有力。实脉形体充实且长。弦脉如同初次按压弓弦的感觉。紧脉如同牵拉绳索初转时的感觉。洪脉举按皆极大，这称为七表脉，各有不同途径。浮脉主中风，芤脉主失血，滑脉主呕吐，实脉主泻下，界限分明。弦脉主拘急，紧脉主疼痛，洪大脉多生热。
浮脉主表证，主风（对应人迎脉），主气（对应气口脉），主热，主痛，主呕，主胀，主痞，主喘，主厥逆，主内结，主满闷不食。浮大脉主鼻塞，浮缓脉主麻木不仁，浮大长脉主风眩癫疾，浮滑疾脉主宿食，浮滑脉主饮邪或走刺，浮大而涩脉主宿食滞气，浮短脉主肺伤及诸气病，浮细而滑脉主伤饮，浮滑疾紧脉主百合病，浮数脉（大便坚硬小便频数）主津亏，浮紧脉主淋证或癃闭。
芤脉主血证。寸部见芤脉主吐血，微见芤脉主鼻衄，关部见芤脉主大便出血，尺部见芤脉主下焦虚损导致的小便出血。
滑脉主呕吐，主满闷，主咳，主热，主伏痰，主宿食，主蓄血，主经闭，主鬼疰（一种传染性痨病），主血气俱实。滑散脉主瘫缓，滑数脉主结热，滑实脉主胃热。滑而大小不匀，必致呕吐，预示病情进展，或见泄利。滑而柔和主妊娠。滑而浮，主大小腹痛，若兼弱脉则阴中痛，大便亦痛。
实脉主热，主呕，主痛，主气塞，主喘咳，主大便不禁。实紧脉主阴不胜阳，主胃寒，主腰痛。
弦脉主寒，主痛，主饮，主疟，主水饮，主中虚，主厥逆，主拘急，主寒癖。弦紧脉主恶寒，主疝瘕积聚。双弦脉主胁肋急痛。弦脉如钩，主胁下刺痛。弦长脉主积块随左右上下移动。紧脉主寒，主痛，主嗽，主喘，主满。浮紧脉主肺中有水，紧滑脉主蛔虫动、宿食、逆吐。紧急脉主遁尸（一种潜伏的邪气）。紧数脉主寒热往来。
洪脉主胀，主满，主疮，主热，主烦。洪实脉主癫狂，洪紧脉主痈疽、喘急，也主胀。洪大脉主祟病（鬼神作祟或严重感染），洪浮脉主阳邪显现。
微脉若有若无，无根，沉取举取都无感觉。迟缓脉一息三至（诀云：缓脉一息四至，迟脉一息三至）。濡脉来去散漫止息，细而虚。伏脉须切骨方得，与沉脉相似。弱脉沉而微，指下细软，沉按乃得，举之若无。涩脉如刀轻刮竹子，往来艰难散漫。
迟脉主寒，缓脉主结滞，微脉主痞证，涩脉因血少，沉脉主气滞。伏脉主物聚，濡脉主气虚，弱脉主筋痿，须仔细记忆。
微脉主虚，主弱，主衄血，主呕，主泄，主亡汗，主拘急。微弱脉主少气，主中寒。
沉脉主在里，主实，主水，主寒，主喘，主痛，主瘕积。沉弱脉主寒热，沉滑脉主风水，主下身沉重。沉细脉主少气，手臂不能举起。沉紧脉主上热下冷。沉重而直前绝者主瘀血。沉重而中散者主寒食成瘕。沉重不至寸口，徘徊绝者主遁尸。沉紧脉主悬饮。沉迟脉主痼冷。沉重脉主伤暑发热。
缓脉主在下焦，主风，主寒，主弱，主痹，主疼，主不仁，主虚，主气不足，主眩晕。缓而滑脉主热中。缓而迟脉主虚寒相搏，食冷则咽痛。
涩脉主少血，主亡汗，主热气不足，主逆冷，主下痢，主恶寒，主心痛。涩而紧脉主痹，主寒湿。涩细脉主大寒。
迟脉主寒主痛。迟而涩脉主瘕积、咽酸。迟而滑脉主胀。迟而缓脉主寒。
伏脉主霍乱，主疝瘕，主水气，主溏泄，主停痰，主宿食，主诸气上冲，主恶脓贯肌。
濡脉主虚，主痹，主自汗，主气弱，主下重。濡而弱脉主内热外冷、自汗，主小便难。
长脉流利贯通三部，短脉本部不及。虚脉迟大而兼软，促脉来数急促，结脉时止而迟缓，代脉不能自还令人叹息（结脉与代脉相似，但代脉不能自还）。牢脉如弦而更实，冲脉鼓动无定居。细脉虽有但如线，九道脉形自然殊异。
细脉主气血俱虚，主病在内，主积，主伤湿，主后泄，主寒，主神劳，主忧伤过度，主腹满，主通身刺痛。细而紧脉主瘕积聚。细而滑脉主僵仆，主发热，主呕吐。
促脉有五种成因：一是气滞，二是血瘀，三是饮停，四是食积，五是痰阻。只是脏热则脉数，因气血痰饮留滞不行则脉止，促脉并非恶脉。
长脉主热，主痫。长而缓脉主病在下。《脉经》有散脉而无长脉，陈氏解释曰：六腑气绝于外，主手足寒而上气；五脏气绝于内，则下不禁，甚者不仁，其脉皆散，散则不聚，病亦危矣。
短脉主气病。短而急脉主病在上。《脉经》有数脉而无短脉，陈氏解释曰：数为热，为虚，为烦渴，为烦满。
牢脉（《脉经》作革脉）主满，主急，主虚寒相搏。妇人半产漏下。《三因方》解释曰：革者，革也，固结不移之状，三部应之皆为危脉。
代脉主一脏气绝。
The pulse position corresponding to the index finger of the left hand belongs to Fire, which is the son of Wood. Could the creation of the Five Elements be false or biased? If the pulses of the two kidneys are divided into two parts, why does the Sanjiao Meridian (Triple Burner) alone take exclusive charge? Where Water and Fire generate each other and nourish one another, Earth and Metal nurture and complete the harmonious Qi (Weihe). The natural Shen (Spirit) and Qi exist within this principle; if one does not understand the Heavenly Truth, the Dao of medicine cannot be transmitted. The *Suwen* records more than fifty types of pulses, while later generations categorized them into twenty-four types. As for the Ju-Ge pulses, the *Suwen* refers to Yin excess repelling Yang, and Yang excess rejecting Yin; these are not death pulses, and all should be examined in detail.
Pulse is the mechanism of human creation; one must recognize its subtleties under the fingers. Fu (Floating), Hong (Surging), Dong (Moving), Hua (Slippery), Xian (Wiry), and Jin (Tight) belong to the Seven Superficial pulses; Wei (Fine/Micro), Se (Choppy), Ru (Soggy), Xu (Deficient), Huan (Languid), and Chi (Slow) belong to the Seven Interior pulses; Fu-Yi (Over-reach/Overflow), Dai (Intercalated), Lao (Deep-Firm), Xi (Thready), Kou (Hollow), Shi (Excess), Ruo (Weak), Duan (Short), Chang (Long), Cu (Rapid-Irregular), Jie (Knotted), Chen (Deep), and Fu (Hidden) require careful differentiation. Fu-Yi pulses are generally difficult to treat, whereas Xi, Kou, Shi, and Ruo pulses can still be supported and managed. Differentiating cold and heat patterns from pulse discrepancies is essential to avoid medical errors.
[Fu-Zang Yin-Yang Cold-Heat Diagram]
[Ju-Ge Fu-Yi Pulse Example Diagram]
Fu (Floating) pulse is felt lightly upon pressure, abundant on top but deficient below. Kou (Hollow) pulse is empty in the middle but firm on both sides. Hua (Slippery) pulse feels like a bead rolling, with strength in the center. Shi (Excess) pulse is full and long. Xian (Wiry) pulse feels like pressing a bowstring initially. Jin (Tight) pulse feels like pulling a rope that is just beginning to twist. Hong (Surging) pulse is extremely large upon both light and deep pressure. These are called the Seven Superficial pulses, each having its own pathway. Fu pulse indicates Wind-Stroke; Kou pulse indicates Blood loss; Hua pulse indicates Vomiting; Shi pulse indicates Purging, with clear distinctions. Xian pulse indicates Tension/Spasm; Jin pulse indicates Pain; Hong-Da (Large) pulse tends to generate Heat.
Fu pulse indicates Exterior syndrome, Wind (corresponding to Renying point), Qi (corresponding to Qikou point), Heat, Pain, Vomiting, Distension, Fullness/Pi syndrome, Panting, Jue-Ni (Cold extremities/reversal), Internal Knotting, Fullness with anorexia. Fu-Da pulse indicates Nasal congestion; Fu-Huan pulse indicates Numbness; Fu-Da-Chang pulse indicates Wind-dizziness and Epilepsy; Fu-Hua-Ji pulse indicates Retained Food; Fu-Hua pulse indicates Fluid retention or Zou-Ci (wandering pain); Fu-Da-Se pulse indicates Retained food and stagnant Qi; Fu-Duan pulse indicates Lung injury and disorders of various Qi; Fu-Xi-Hua pulse indicates Injury by Fluids; Fu-Hua-Ji-Jin pulse indicates Bai-He disease (Lily disease); Fu-Shu pulse (with hard stool and frequent urination) indicates Yin deficiency; Fu-Jin pulse indicates Lin syndrome or Long-Bi (difficulty in urination).
Kou pulse indicates Blood disorders. Kou at Cun (Inch position) indicates Hematemesis; slight Kou indicates Epistaxis; Kou at Guan (Bar position) indicates Rectal bleeding; Kou at Chi (Cubit position) indicates Lower Jiao deficiency causing hematuria.
Hua pulse indicates Vomiting, Fullness, Cough, Heat, Hidden Phlegm, Retained Food, Accumulated Blood, Amenorrhea, Gui-Zhu (containing pestilence/tuberculosis), Excess of Blood and Qi. Hua-San pulse indicates Paralysis/Laxity; Hua-Shu pulse indicates Internal Heat accumulation; Hua-Shi pulse indicates Stomach Heat. If Hua pulse is uneven in size, vomiting will occur, indicating disease progression, or diarrhea. A gentle Hua pulse indicates Pregnancy. Hua-Fu pulse indicates lower abdominal pain; if accompanied by Ruo, it indicates pain in the yin organs and bowel.
Shi pulse indicates Heat, Vomiting, Pain, Qi obstruction, Panting/Cough, Incontinence of stool. Shi-Jin pulse indicates Yin unable to control Yang, Cold in Stomach, and Lower back pain.
Xian pulse indicates Cold, Pain, Fluid retention, Malaria, Water accumulation, Middle Deficiency, Jue-Ni, Tension, Cold Pi (masses). Xian-Jin pulse indicates Aversion to cold, Shan-Jia (hernia/masses), and Pi masses. Shuang-Xian (double wiry) pulse indicates hypochondriac urgency and pain. Xian pulse resembles a hook, indicating stabbing pain under the ribs. Xian-Chang pulse indicates masses moving up, down, left, or right. Jin pulse indicates Cold, Pain, Cough, Panting, Fullness. Fu-Jin pulse indicates Water in Lungs; Jin-Hua pulse indicates moving roundworms, retained food, and reverse vomiting. Jin-Ji pulse indicates Dun-Shi (latent pathogen). Jin-Shu pulse indicates alternating cold and heat.
Hong pulse indicates Distension, Fullness, Sores, Heat, Irritability. Hong-Shi pulse indicates Mania; Hong-Jin pulse indicates Carbuncles/Furuncles, urgent panting, and distension. Hong-Da pulse indicates Sui disease (severe infection/spiritual affliction); Hong-Fu pulse indicates the appearance of Yang pathogens.
Wei (Micro) pulse is faint, as if present yet absent, lacking root, undetectable upon deep or light pressure. Huan-Chi pulse beats three times per respiration (Note: Huan pulse beats four times per respiration, Chi pulse beats three times). Ru (Soggy) pulse comes scattered and stops, thin and deficient. Fu (Hidden) pulse requires pressing to the bone, similar to Chen (Deep) pulse. Ruo (Weak) pulse is deep, micro, and soft under the finger; it is felt only upon deep pressure and seems absent upon lifting. Se (Choppy) pulse feels like a knife scraping bamboo, with difficult and scattered flow.
Chi (Slow) indicates Cold; Huan indicates stagnation; Wei indicates Pi syndrome; Se is due to blood deficiency; Chen indicates Qi stagnation. Fu indicates mass accumulation; Ru indicates Qi deficiency; Ruo indicates sinew flaccidity; these must be carefully remembered.
Wei pulse indicates Deficiency, weakness, Epistaxis, Vomiting, Diarrhea, Profuse sweating, Tension. Wei-Ruo pulse indicates Shortness of Qi and Middle Cold.
Chen (Deep) pulse indicates Interior syndrome, Excess, Water, Cold, Panting, Pain, Masses. Chen-Ruo pulse indicates alternating cold and heat; Chen-Hua pulse indicates Feng-Shui (wind-edema) and heaviness in the lower body. Chen-Xi pulse indicates Shortness of Qi and inability to raise the arm. Chen-Jin pulse indicates Upper Heat and Lower Cold. Heavy and straight-cutting pulse indicates Blood stasis. Heavy and scattered pulse indicates Cold-food forming masses. Heavy pulse not reaching Cun indicates Dun-Shi. Chen-Jin pulse indicates Xuan-Yin (pleural effusion). Chen-Chi pulse indicates chronic cold. Heavy pulse indicates Summerheat fever.
Huan (Languid) pulse indicates Lower Jiao issues, Wind, Cold, Weakness, Bi syndrome, Pain, Numbness, Deficiency, Qi insufficiency, Dizziness. Huan-Hua pulse indicates Heat in the Middle. Huan-Chi pulse indicates Cold-Deficiency interaction, causing throat pain when eating cold food.
Se (Choppy) pulse indicates Blood deficiency, Profuse sweating, Insufficiency of Hot Qi, Cold extremities, Dysentery, Aversion to cold, Heart pain. Se-Jin pulse indicates Bi syndrome and Cold-Dampness. Se-Xi pulse indicates severe Cold.
Chi (Slow) pulse indicates Cold and Pain. Chi-Se pulse indicates masses and sour regurgitation. Chi-Hua pulse indicates Distension. Chi-Huan pulse indicates Cold.
Fu (Hidden) pulse indicates Huo-Luan (cholera-like syndrome), Shan-Jia, Water Qi, Loose stools, Retained Phlegm, Retained Food, Rushing of various Qi upwards, and foul pus penetrating muscle.
Ru (Soggy) pulse indicates Deficiency, Bi syndrome, Spontaneous sweating, Qi weakness, Heaviness in the lower body. Ru-Ruo pulse indicates Internal Heat with External Cold and spontaneous sweating, difficulty in urination.
Ruo (Weak) pulse indicates Deficiency, Wind-Heat, Spontaneous sweating.
Chang (Long) pulse flows smoothly through all three positions; Duan (Short) pulse does not reach its proper extent. Xu (Deficient) pulse is slow, large, and soft. Cu (Rapid-Irregular) pulse is rapid and abrupt. Jie (Knotted) pulse pauses occasionally and is slow. Dai (Intercalated) pulse fails to return, causing sighing (Jie and Dai are similar, but Dai cannot self-correct). Lao (Deep-Firm) pulse is wiry and firm; Chong pulse beats vigorously without fixed location. Xi (Thready) pulse is thread-like; the nine pulse forms are distinct.
Xi pulse indicates Deficiency of both Blood and Qi, Interior disease, Masses, Dampness injury, Post-diarrhea, Cold, Mental fatigue, Excessive sorrow, Abdominal fullness, General stabbing pain. Xi-Jin pulse indicates masses and accumulations. Xi-Hua pulse indicates falling stiffly, Fever, Vomiting.
Dong (Moving) pulse indicates Pain, Fright, Convulsion, Diarrhea, Fear.
Xu (Deficient) pulse indicates Cold, Deficiency, Weak legs, Indigestion, Summerheat injury.
Cu pulse has five causes: 1. Qi stagnation, 2. Blood stasis, 3. Fluid retention, 4. Food accumulation, 5. Phlegm. When internal organs are hot, the pulse is rapid; when Blood, Qi, Phlegm, or Fluids stagnate and fail to move, the pulse pauses. Cu is not necessarily a malignant pulse.
Jie pulse indicates Phlegm, Fluids, Blood, Masses, Qi stagnation.
Chang pulse indicates Heat and Epilepsy. Chang-Huan pulse indicates disease in the Lower Jiao. The *Mai Jing* mentions San (Scattered) pulse but not Chang pulse. Chen's interpretation states: Six Fu organs' Qi failing externally leads to cold limbs and rebellious Qi; Five Zang organs' Qi failing internally leads to incontinence of lower orifices, numbness, and scattered pulse, indicating critical illness.
Duan pulse indicates Qi disorders. Duan-Ji pulse indicates disease in the Upper Jiao. The *Mai Jing* mentions Shu (Rapid) pulse but not Duan pulse. Chen's interpretation states: Shu indicates Heat, Deficiency, Thirst/Irritability, and Fullness/Irritability.
Lao pulse (called Ge in *Mai Jing*) indicates Fullness, Urgency, and Cold-Deficiency interaction. In women, it indicates miscarriage or continuous bleeding. The *San Yin Fang* explains: Ge means change/solidification, a state of immovable knotting; appearing in all three positions, it is a critical pulse.
Dai pulse indicates the failure of Qi in one Zang organ.