病不出外因五气相感内因脏腑偏胜诊得其因方可论治若云某脉头痛某脉脚痛不及病因者徒夸不问知患暂骇人听终无
实效概置不录
尺内两旁则季胁也尺外以候肾尺内以候腹中附上左外以候肝内以候膈右外以候胃内以候脾上附上右外以候肺内以候
胸中左外以候心内以候膻中前以候前后以候后上竟上者胸喉中事也下竟下者少腹腰股膝胫足中事也（素脉要精微）此分
候五脏之定位也其内外两字难解一说诊脉其手必伸当以近尺泽处为内近鱼际处为外若然则肝在膈下而云外以候肝内以候
膈心在膻中之下而云外以候心内以候膻中则与上以候上下以候下之说左矣一说人之端拱则当以近尺泽处为外近鱼际处为
内若然则心肝两句与上以候上下以候下适相合而与前以候前后以候后不相谋矣
（彭）窃以为内外者即前以候前后以候后也盖人身背为阳腹为阴人垂两手以掌向前则手之三阴在前三阳在后与腹背
相应近身后为外其脉应在沉部以沉脉近后故也近身前为内其脉应在浮部以浮脉近前故也如肾与腹中同在尺部上见而肾在
腹中之后故尺之沉部候肾尺之浮部候腹中附上者掌后寸许按之有高骨陇起是也即名关上肝与膈同在左附上见而肝在膈之
后故左附上沉部候肝浮部候膈脾与胃同在右附上见而脾在胃之前故右附上沉部候胃浮部候脾上附上即寸部也肺近后胸近
前故右上附沉部候肺浮部候胸中心近后膻中近前故左上附沉部候心浮部候膻中如是则前后俱合矣
独小者病独大者病独疾者病独迟者病独热（疑作滑）者病独寒（疑作涩）者病独陷下者病（素三部九候）
此数语乃诊病之要诀鄙者恐世尽知竟以寒热易去经文二字殊属无解
诸急多寒缓者多热大者多气少血小者血气皆少滑者阳气盛微有热涩者多血少气微有寒（灵邪气脏腑病形）
急紧也非弦也仲景云脉浮而紧者名曰弦也弦者状如弓弦按之不移也脉紧者如转索之无常也缓者弱也非迟也故主热
尺寸者脉之大要会也从关至尺名尺内阴之所治也从关至鱼名寸口阳之所治也（二难）
尺寸分阴阳仲景亦宗此法
关之前者阳之动也当见九分而浮过曰太过减曰不及上鱼为溢为外关内格此阴乘脉也关以后者阴之动也当见一寸而沉
过曰太过减曰不及入尺为覆为内关外格此阳乘脉也是真藏之脉不病而死也（三难）
覆溢为真藏死脉未必尽应其尺寸应见长短不可不知故录之
呼出心与肺吸入肝与肾呼吸之间脾受谷味也其脉在中浮者阳也沉者阴也心肺俱浮浮而大散者心也浮而短涩者肺也肾
肝俱沉牢而长者肝也按之濡举指来实者肾也脾在中州故脉亦在中六脉者浮沉长短滑涩也浮滑长阳也沉短涩阴也脉有一阴
一阳者沉而滑也一阴二阳者沉而滑长也一阴三阳者浮滑而长时一沉也各以其经名病逆从也（四难）
首四句乃人身机括灵动处当细玩之
脉有伏匿者谓脉居阴部而反阳脉见者为阳乘阴也虽时沉涩而短此阳中伏阴也脉居阳部而反阴脉见者为阴乘阳也虽时
浮滑而长此阴中伏阳也重阳者狂重阴者癫脱阳者见鬼脱阴者目盲（二十难）
初持脉时如三菽之重与皮毛相得者肺部也如六菽之重与血脉相得者心部也如九菽之重与肌肉相得者脾部也如十二菽
之重与筋平者肝部也按之至骨举指来疾者肾部也（五难）
浮之损小沉之实大阴盛阳虚也沉之损小浮之实大阳盛阴虚也（六难）
春弦夏钩秋毛冬石者四时之脉也春脉濡弱而长故曰弦夏脉来疾去迟故曰钩秋脉轻虚以浮故曰毛冬脉沉濡而滑故曰石
（十五难）
春脉如弦春脉者肝也东方木也万物之所以始生也其来濡弱轻虚而滑端直以长故曰弦若来实而强此为太过病在外其来
不实而微此为不及病在中太过则令人善忘忽忽眩冒而癫疾其不及则令人胸痛引背下则两胁 满夏脉如钩夏脉者心也南方
火也万物之所以盛长也其来盛去衰故曰钩若来盛去亦盛此为太过病在外其来不盛去反盛此为不及病在中太过则令人身热
而肤痛为浸淫其不及则令人烦心上见咳唾下为气泄秋脉如浮秋脉者肺也西方金也万物之所以收成也其来轻虚以浮来急去
散故曰浮若来毛而中央坚两旁虚此为太过病在外其来毛而微此为不及病在中太过则令人逆气而背痛愠愠然其不及则令人
喘呼吸少气而咳上气见血下闻病音冬脉如营冬脉者肾也北方水也万物之所以合藏也其来沉以搏故曰营若来如弹石此为太
过病在外其去如数者此为不及病在中太过则令人解 脊脉痛而少气不欲言其不及则令人心悬如病饥 中清脊中痛少腹满
小便变脾脉者土也孤藏以灌四旁者也善者不可得见恶者可见其来如水之流者此为太过病在外如鸟之喙者此为不及病在中
太过则令人四肢不举其不及则令人九窍不通名曰重强（素玉机真藏）
春胃微弦曰平弦多胃少曰肝病但弦无胃曰死（脉弱以滑是有胃气出素问玉机真藏）胃而有毛曰秋病毛甚曰今病藏真
散于肝肝藏筋膜之气也夏胃微钩曰平钩多胃少曰心病但钩无胃曰死胃而有石曰冬病石甚曰今病藏真通于心心藏血脉之气
也长夏胃微软弱曰平弱多胃少曰脾病但代无胃曰死软弱有石曰冬病石甚曰今病藏真濡于脾脾藏肌肉之气也秋胃微毛曰平
毛多胃少曰肺病但毛无胃曰死毛而有弦曰春病弦甚曰今病藏真高于肺以行营卫阴阳也冬胃微石曰平石多胃少曰肾病但石
无胃曰死石而有钩曰夏病钩甚曰今病藏真下于肾肾藏骨髓之气也（素平人气象）
经言见其色而不得其脉反得相胜之脉者即死得相生之脉者病即是已何谓也曰五脏有五色皆见于面当与脉相应假令色
青脉当弦而急色赤脉当浮大而散色黄脉当中缓而大色白脉当浮涩而短色黑脉当沉濡而滑此为相应也五脏各有声色臭味皆
当与脉相应其不应者病也假令色青（肝木）其脉浮涩而短（肺金克肝木）若大而缓（脾土肝木克之）为相胜或浮大而散
（心火乃肝木所生）或小而滑（肾水能生肝木）为相生也（十三难）
十变言肝色青其臭臊其味酸其声呼其液泣心色赤其臭焦其味苦其声言其液汗脾色黄其臭香其味甘其声歌其液涎肺色
白其臭腥其味辛其声哭其液涕肾色黑其臭腐其味咸其声呻其液唾（三十四难）肝主色心主臭脾主味肺主声肾主液（四十
难）
假令得肝脉其外证善洁面青善怒其内证齐左有动气按之牢若痛其病四肢满闭淋溲便难转筋有是者肝也无是者非也假
令得心脉其外证面赤口干善笑其内证齐上有动气按之牢若痛其病烦心心痛掌中热而 有是者心也无是者非也假令得脾脉
其外证面黄善噫善思善味其内证当齐有动气按之牢若痛其病腹胀满食不消体重节痛怠惰嗜卧四肢不收有是者脾也无是者
非也假令得肺脉其外证面白善嚏悲愁不乐欲哭其内证齐右有动气按之牢若痛其病喘咳洒淅寒热有是者肺也无是者非也假
令得肾脉其外证面黑善恐欠其内证齐下有动气按之牢若痛其病逆气小腹急痛泄如下重足胫寒而逆有是者肾也无是者非也
（十六难）
心脉搏坚而长当病舌卷不能言其软而散者当消还自己肺脉搏坚而长当病唾血其软而散者当病灌汗至令不复也肝脉搏
坚而长色不青当病坠若搏因血在胁下令人喘逆其软而散色泽者当病溢饮溢饮者渴暴多饮而易入于肌皮肠胃之外也胃脉搏
坚而长其色赤当病折髀其软而散者当病食痹脾脉搏坚而长其色黄当病少气其软而散色不泽者当病足 肿若水状也肾脉搏
坚而长其色黄而赤者当病折腰其软而散者当病少血至令不复也粗大者阴不足阳有余为热中也来疾去徐上实下虚为厥巅疾
来徐去疾上虚下实为恶风也沉细数者少阴厥也浮而散者为 仆（素脉要精微）
寸口脉沉而横曰胁下有积腹中有横积痛脉急曰疝瘕少腹痛脉滑曰风脉涩曰痹缓而滑曰热中盛而紧曰胀尺脉缓涩谓之
解安卧脉盛谓之脱血尺涩脉滑谓之多汗尺寒脉细谓之后泄尺粗常热谓之热中（素平人气象）
结阳者肿四肢结阴者便血阴阳结斜多阴少阳曰石水少腹肿二阳结谓之消三阳结谓之隔三阴结谓之水一阴一阳结谓之
喉痹阴搏阳别谓之有子阴阳虚肠 死阳加于阴谓之汗阴虚阳搏谓之崩（素阴阳别论）
阴搏阳别王太仆云阴尺中也搏谓搏触于手也尺脉搏击与寸脉迥别孕子兆也此为确论盖胎在腹中则气血护胎自然盛于
腹中尺里以候腹中尺独搏击与寸迥别理固然也推之左搏为男右搏为女理亦无二而丹溪独云以医人之左右手而言则医人之
手以左诊右以右诊左又是妊妇之左搏为女右搏为男矣想亦试验而云然不敢妄以为非
妇人足少阴脉动甚者妊子也（素平人气象）
动者大如豆粒厥厥动摇也王太仆作手少阴脉在掌后锐骨下陷中直对小指非太渊脉谅必有所据全元起作足少阴于尺内
求之尺里以候腹中尤为近理
何以知怀子之且生也曰身有病而无邪脉也（素腹中论）女子以肾系胞三部浮沉正等按之不绝者妊子也
（彭）按人秉不同脉亦各异娠妇有见动脉者有不见动脉者有见搏击者有不见搏击者总之尺脉坚实与寸脉迥别为据耳
更有尺寸同等而亦怀娠者当于浮沉求之其按之不绝者肾实也
人一呼脉再动一吸脉再动呼吸定息脉五动名曰平人一呼脉一动一吸脉一动曰少气一呼脉三动一吸脉三动而躁尺热曰
病温尺不热脉滑曰病风脉涩曰痹（温风痹三句俱顶三动来句句有数字在内）一呼脉四动以上曰死脉绝不至曰死乍疏乍数
曰死（素平人气象）
经言脉有损至何谓也曰一呼再至曰平三至曰离经四至曰夺精五至曰死六至曰命绝此至之脉也一呼一至曰离经再呼一
至曰夺精三呼一至曰死四呼一至曰命绝此损之脉也至脉从下上损脉从上下也一损损于皮毛皮聚而毛落二损损于血脉血脉
虚少不能营于五脏六腑三损损于肌肉肌肉消瘦饮食不能为肌肤四损损于筋筋缓不能自收持五损损于骨骨痿不能起于床从
上下者骨痿不能起于床者死从下上者皮聚而毛落者死损其肺者益其气损其心者调其营卫损其脾者调其饮食适其寒温损其
肝者缓其中损其肾者益其精此治损法也（十四难）
东垣云虚损之疾寒热因虚而感也感寒则损阳上损渐及于下治宜辛甘淡过于胃则不可治也感热则损阴下损渐及于上治
宜苦酸咸过于脾则不可治也损及于下妇人月水不通故心肺损则色弊肝肾损则形痿脾胃损则谷不化吴门叶氏前辈云食少便
溏损及中州病已过半此语尤为显快
一呼三至一吸三至为适得病前大后小即头痛目眩前小后大即胸满短气一呼四至一吸四至病欲甚脉洪大者苦烦满沉细
者腹中痛滑者伤热涩者中雾露（此四句俱顶四至来）一呼五至一吸五至其人当困沉细夜加浮大昼加不大不小虽困可治其
有大小者难治一呼六至一吸六至者死沉细夜死浮大昼死一呼一至一吸一至名曰损人虽能行即当着床血气皆不足故也再呼
一至再吸一至人虽能行不久死也名曰无魂又曰行尸（十四难）
数者府也迟者藏也数则为热迟则为寒诸阳为热诸阴为寒（九难）
伤寒有五有中风有伤寒有湿温有热病有温病中风之脉阳浮而滑阴涩而弱湿温之脉阳浮而弱阴小而急伤寒之脉阴阳俱
盛而紧涩热病之脉阴阳俱浮浮之而滑沉之散涩温病之脉行在诸经不知何经之动也各随其经所在而取之（五十八难）
邪气盛则实精气夺则虚肠 便血何如身热则死寒则生肠 下白沫何如脉沉则生脉浮则死肠 下脓血何如脉悬绝则死
滑大则生肠 之属身不热脉不悬绝何如滑大者生悬涩者死以藏期之癫疾何如脉搏大滑久自已小坚急死不治消瘅何如脉实
大病久可治悬小坚病久不可治（素通评虚实）
少阳之至乍大乍小乍短乍长阳明之至浮大而短太阳之至洪大而长太阴之至紧大而长少阴之至紧细而微厥阴之至沉短
而敦此非平脉亦非病脉皆王脉也冬至后得甲子少阳王复得甲子阳明王复得甲子太阳王复得甲子太阴王复得甲子少阴王复
得甲子厥阴王王各六十日六六三百六十日以成一岁此三阳三阴之旺时日大要也（七难）
寸口脉平而死者生气独绝于内谓肾间动脉也（八难）上部有脉下部无脉其人当吐不吐者死上部无脉下部有脉虽困无
能为害人之有尺犹树之有根枝叶虽枯根将自生脉有根本人有元气故知不死（十四难）
经言脉不满五十动而一止一藏无气者何藏也曰吸随阴入呼因阳出今吸不能至肾至肝而还故知一藏者肾藏也（十一
难）
数动一代者病在阳之脉也泄及便脓血（素脉要精微）有所惊骇脉不至若喑不治自已（素大奇论）
诸疟而脉不见刺十指间出血血出必已（灵刺疟论）病若闭目不欲见人者当得肝脉强急而长反得肺脉浮短而涩者死也
病若开目而渴心下牢者脉当紧实而数反得沉涩而微者死也病若吐血鼽衄脉当沉细反浮大而牢者死也病若谵语妄言身当有
热脉当洪大而反手足厥逆脉沉细而微者死也病若大腹而泄脉当微细而涩反紧大而滑者死也（十七难）
右胁有积气肺脉当结结甚则积甚结微则积微不见结脉当得沉伏其外痼疾同法结者脉来去时一止无常数也伏者脉行筋
下也浮者脉在肉上行也左右表里皆相应假令脉结伏而内无积聚脉浮结而外无痼疾或内有积聚而脉不结伏外有痼疾而脉不
浮结是为脉不应病病不应脉死（十八难）
疾病不外乎外因的五气相感和内因的脏腑偏盛。诊察到病因，才可以讨论治疗。如果说某脉象对应头痛、某脉象对应脚痛，而不探究病因，只是夸夸其谈，虽然暂时能惊骇人的听闻，但最终没有实效。概略地不予收录。
尺部内侧两旁是季胁部位。尺部外侧以候肾，尺部内侧以候腹中。附上（寸口脉上部）左侧外侧以候肝，内侧以候膈；右侧外侧以候胃，内侧以候脾。上附上（寸口脉最上部）右侧外侧以候肺，内侧以候胸中；左侧外侧以候心，内侧以候膻中。前部以候身前，后部以候身背。从上部一直诊察到下部，分别对应胸喉部和少腹腰股膝胫足中的病变。（出自《素问·脉要精微论》）这是分候五脏定位的方法。“内外”二字难以理解。一种说法认为诊脉时手必伸展，所以靠近尺泽穴处为内，靠近鱼际穴处为外。如果这样，肝在膈下却说“外以候肝，内以候膈”，心在膻中之下却说“外以候心，内以候膻中”，这就与“上以候上，下以候下”的说法相左了。另一种说法认为人端坐拱手时，靠近尺泽处应为外，靠近鱼际处应为内。如果这样，心和肝两句就与“上以候上，下以候下”恰好相符，但与“前以候前，后以候后”不相吻合了。
（沈又彭）我私下认为，“内外”即指“前以候前，后以候后”。大概人身背部为阳，腹部为阴。人垂两手掌心向前，则手三阴经在前，手三阳经在后，这与腹背相应。靠近身后为外，其脉应在沉部，因为沉脉近后故也；靠近身前为内，其脉应在浮部，因为浮脉近前故也。如肾与腹中同在尺部，但肾在腹中之后，所以尺部的沉部候肾，尺部的浮部候腹中。“附上”是指掌后寸许按之有高骨隆起的地方，即名关上。肝与膈同在左附上，但肝在膈之后，所以左附上的沉部候肝，浮部候膈。脾与胃同在右附上，但脾在胃之前，所以右附上的沉部候胃，浮部候脾。“上附上”即寸部。肺近后，胸近前，所以右上附的沉部候肺，浮部候胸中。心近后，膻中近前，所以左上附的沉部候心，浮部候膻中。如此则前后都吻合了。
脉象独小的是病，独大的是病，独快（疾）的是病，独慢（迟）的是病，独滑（疑作滑）的是病，独涩（疑作涩）的是病，独陷下的是病。（出自《素问·三部九候论》）
这几句话是诊病的要诀。鄙人担心世人全都知道了，竟然用“寒热”替换经文中的两个字，这实在无法解释通。
脉急紧的多为寒证，脉缓的多为热证，脉大的多气少血，脉小的气血皆少，脉滑的阳气盛而有微热，脉涩的多血少气而有微寒。（出自《灵枢·邪气脏腑病形》）
“急”是紧，不是弦。张仲景说：“脉浮而紧者，名曰弦。”弦的形态像弓弦，按之不移。脉紧的像转动的绳索，无常形。“缓”是弱，不是迟，所以主热。
尺寸两部是脉的大要汇聚之处。从关至尺名为尺内，是阴所治理的部位；从关至鱼际名为寸口，是阳所治理的部位。（出自《难经·二难》）
关之前的脉是阳的动象，应当显现九分而浮。超过这个程度叫太过，不足叫不及。超过鱼际叫溢，叫外，这是阴乘阳脉。关之后的脉是阴的动象，应当显现一寸而沉。超过这个程度叫太过，不足叫不及。深入尺内叫覆，叫内，这是阳乘阴脉。这是真脏脉，不生病也会死。（出自《难经·三难》）
覆脉和溢脉是真脏死脉，未必完全应验。但其尺寸应见的长短不可不知，所以记录下来。
呼出由心与肺主导，吸入由肝与肾主导，呼吸之间脾受纳水谷之气。其脉在中。浮脉属阳，沉脉属阴。心肺俱浮，浮而大散的是心，浮而短涩的是肺。肝肾俱沉，牢而长的是肝，按之濡软举指来实的是肾。脾在中州，所以脉也在中。六脉有浮沉长短滑涩之分。浮滑长为阳，沉短涩为阴。脉有一阴一阳的，是沉而滑；一阴二阳的，是沉而滑长；一阴三阳的，是浮滑而长，时而一沉。各以其经脉命名，判断逆从。（出自《难经·四难》）
首四句是人体机括灵动之处，应当细细玩味。
脉有伏匿的，谓脉居阴部而反见阳脉，这叫阳乘阴。虽然有时沉涩而短，这是阳中伏阴。脉居阳部而反见阴脉，这叫阴乘阳。虽然有时浮滑而长，这是阴中伏阳。重阳者狂，重阴者癫。脱阳者见鬼，脱阴者目盲。（出自《难经·二十难》）
初持脉时，如三颗豆子的重量，与皮毛相得的，是肺脉。如六颗豆子的重量，与血脉相得的，是心脉。如九颗豆子的重量，与肌肉相得的，是脾脉。如十二颗豆子的重量，与筋平齐的，是肝脉。按之至骨，举指来疾的，是肾脉。（出自《难经·五难》）
浮取损小，沉取实大，是阴盛阳虚。沉取损小，浮取实大，是阳盛阴虚。（出自《难经·六难》）
春弦、夏钩、秋毛、冬石，是四季的脉象。春脉濡弱而长，所以说弦。夏脉来疾去迟，所以说钩。秋脉轻虚以浮，所以说毛。冬脉沉濡而滑，所以说石。（出自《难经·十五难》）
春脉如弦。春脉属于肝，属东方木，是万物始生的时候。其脉来濡弱轻虚而滑，端直以长，所以说弦。如果来势实而强，这是太过，病在外。如果来势不实而微，这是不及，病在中。太过则令人善忘、忽忽眩冒而发癫疾。不及则令人胸痛引背，下部两胁胀满。
夏脉如钩。夏脉属于心，属南方火，是万物盛长的時候。其脉来盛去衰，所以说钩。如果来盛去亦盛，这是太过，病在外。如果来不盛去反盛，这是不及，病在中。太过则令人身热而肤痛，为浸淫疮。不及则令人烦心，上见咳唾，下为气泄。
秋脉如浮。秋脉属于肺，属西方金，是万物收成的时候。其脉来轻虚以浮，来急去散，所以说浮。如果来势如毛而中央坚两旁虚，这是太过，病在外。如果来势如毛而微，这是不及，病在中。太过则令人逆气而背痛，愠愠然。不及则令人喘，呼吸少气而咳，上气见血，下闻病音。
冬脉如营。冬脉属于肾，属北方水，是万物合藏的时候。其脉来沉以搏，所以说营。如果来势如弹石，这是太过，病在外。如果去势如数，这是不及，病在中。太过则令人解㑊脊脉痛而少气不欲言。不及则令人心悬如病饥，眇中清，脊中痛，少腹满，小便变。
脾脉属土，是孤脏以灌溉四旁的。好的脾脉不可得见，坏的脾脉可见。其脉来如水之流的，这是太过，病在外。如鸟之喙的，这是不及，病在中。太过则令人四肢不举。不及则令人九窍不通，名叫重强。（出自《素问·玉机真脏论》）
春脉有胃气微弦称为平脉。弦多胃少称为肝病。但弦无胃气称为死脉。（“脉弱以滑是有胃气”出自《素问·玉机真脏论》）。胃气兼见毛脉，预示秋季发病；毛脉甚重，预示当下发病。脏真之气散于肝，肝藏筋膜之气。
夏脉有胃气微钩称为平脉。钩多胃少称为心病。但钩无胃气称为死脉。胃气兼见石脉，预示冬季发病；石脉甚重，预示当下发病。脏真之气通于心，心藏血脉之气。
长夏脉有胃气微软弱称为平脉。弱多胃少称为脾病。但代而无胃气称为死脉。软弱兼见石脉，预示冬季发病；石脉甚重，预示当下发病。脏真之气濡于脾，脾藏肌肉之气。
秋脉有胃气微毛称为平脉。毛多胃少称为肺病。但毛无胃气称为死脉。毛脉兼见弦脉，预示春季发病；弦脉甚重，预示当下发病。脏真之气高于肺，以行营卫阴阳。
冬脉有胃气微石称为平脉。石多胃少称为肾病。但石无胃气称为死脉。石脉兼见钩脉，预示夏季发病；钩脉甚重，预示当下发病。脏真之气下于肾，肾藏骨髓之气。（出自《素问·平人气象论》）
经文说：看到面色却得不到相应的脉象，反而得到相克（胜）的脉象，就会死；得到相生脉象的，病就会好。为什么呢？五脏有五色，都见于面部，应当与脉象相应。假如色青，脉应当弦而急；色赤，脉应当浮大而散；色黄，脉应当中缓而大；色白，脉应当浮涩而短；色黑，脉应当沉濡而滑。这叫相应。五脏各有声、色、臭、味，都应当与脉象相应。不相应的就是病。假如色青（肝木），其脉浮涩而短（肺金克肝木），或者大而缓（脾土，肝木克之），这叫相胜。或者浮大而散（心火，乃肝木所生），或者小而滑（肾水，能生肝木），这叫相生。（出自《难经·十三难》）
《十变》说：肝色青，其臭臊，其味酸，其声呼，其液泣。心色赤，其臭焦，其味苦，其声言，其液汗。脾色黄，其臭香，其味甘，其声歌，其液涎。肺色白，其臭腥，其味辛，其声哭，其液涕。肾色黑，其臭腐，其味咸，其声呻，其液唾。（出自《难经·三十四难》）
肝主色，心主臭，脾主味，肺主声，肾主液。（出自《难经·四十难》）
假如得肝脉，其外证是善洁面青、善怒；其内证是脐左有动气，按之牢若痛；其病是四肢满闭、淋溲便难、转筋。有这些症状的是肝病，没有这些症状的就不是。
假如得心脉，其外证是面赤、口干、善笑；其内证是脐上有动气，按之牢若痛；其病是烦心、心痛、掌中热。有这些症状的是心病，没有这些症状的就不是。
假如得脾脉，其外证是面黄、善噫、善思、善味；其内证是当脐有动气，按之牢若痛；其病是腹胀满、食不消、体重节痛、怠惰嗜卧、四肢不收。有这些症状的是脾病，没有这些症状的就不是。
假如得肺脉，其外证是面白、善嚏、悲愁不乐、欲哭；其内证是脐右有动气，按之牢若痛；其病是喘咳、洒淅寒热。有这些症状的是肺病，没有这些症状的就不是。
假如得肾脉，其外证是面黑、善恐、欠；其内证是脐下有动气，按之牢若痛；其病是逆气、小腹急痛、泄如下重、足胫寒而逆。有这些症状的是肾病，没有这些症状的就不是。（出自《难经·十六难》）
心脉搏坚而长，应当病舌卷不能言；其软而散的，应当自愈。肺脉搏坚而长，应当病唾血；其软而散的，应当病灌汗，至今不愈。肝脉搏坚而长，面色不青，应当病坠或搏伤，因血在胁下，令人喘逆；其软而散，色泽正常的，应当病溢饮。溢饮是渴暴多饮，而易入于肌皮肠胃之外。胃脉搏坚而长，其色赤，应当病折髀；其软而散的，应当病食痹。脾脉搏坚而长，其色黄，应当病少气；其软而散，色不泽的，应当病足肿，若水状。肾脉搏坚而长，其色黄而赤者，应当病折腰；其软而散的，应当病少血，至今不愈。
脉粗大的，是阴不足阳有余，为热中。脉来疾去徐的，上实下虚，为厥巅疾。脉来徐去疾的，上虚下实，为恶风。脉沉细数的，是少阴厥。脉浮而散的，为仆倒。（出自《素问·脉要精微论》）
寸口脉沉而横，曰胁下有积，腹中有横积痛。脉急，曰疝瘕，少腹痛。脉滑，曰风。脉涩，曰痹。缓而滑，曰热中。盛而紧，曰胀。
尺脉缓涩，谓之解㑊安卧。脉盛，谓之脱血。尺涩脉滑，谓之多汗。尺寒脉细，谓之后泄。尺粗常热，谓之热中。（出自《素问·平人气象论》）
结阳者肿四肢。结阴者便血。阴阳结斜，多阴少阳，曰石水，少腹肿。二阳结谓之消，三阳结谓之隔，三阴结谓之水。一阴一阳结谓之喉痹。阴搏阳别，谓之有子。阴阳虚，肠澼死。阳加于阴，谓之汗。阴虚阳搏，谓之崩。（出自《素问·阴阳别论》）
阴搏阳别，王太仆说：阴指尺中也。搏谓搏触于手也。尺脉搏击与寸脉迥别，是孕子的征兆。这是确论。大概胎在腹中，则气血护胎，自然盛于腹中尺里以候腹中，尺独搏击与寸迥别，理固然也。推之左搏为男，右搏为女，理亦无二。而丹溪独云以医人之左右手而言，则医人之手以左诊右，以右诊左，又是妊妇之左搏为女，右搏为男矣。想也是试验而云然，不敢妄以为非。
动者，大如豆粒，厥厥动摇也。王太仆作手少阴脉，在掌后锐骨下陷中，直对小指，非太渊脉，谅必有所据。全元起作足少阴，于尺内求之，尺里以候腹中，尤为近理。
何以知怀子之且生也？曰身有病而无邪脉也。（出自《素问·腹中论》）女子以肾系胞。三部浮沉正等，按之不绝者，妊子也。
（沈又彭）按：人禀赋不同，脉亦各异。娠妇有见动脉者，有不见动脉者；有见搏击者，有不见搏击者。总之，尺脉坚实与寸脉迥别为据耳。更有尺寸同等而亦怀娠者，当于浮沉求之，其按之不绝者，肾实也。
人一呼脉再动，一吸脉再动，呼吸定息脉五动，名曰平人。一呼脉一动，一吸脉一动，曰少气。一呼脉三动，一吸脉三动而躁，尺热曰病温，尺不热脉滑曰病风，脉涩曰痹。（温风痹三句俱顶三动来，句句有数字在内）。一呼脉四动以上曰死，脉绝不至曰死，乍疏乍数曰死。（出自《素问·平人气象论》）
经文说脉有损至，何谓呢？曰一呼再至曰平，三至曰离经，四至曰夺精，五至曰死，六至曰命绝。此至之脉也。一呼一至曰离经，再呼一至曰夺精，三呼一至曰死，四呼一至曰命绝。此损之脉也。至脉从下上，损脉从上下也。一损损于皮毛，皮聚而毛落；二损损于血脉，血脉虚少，不能营于五脏六腑；三损损于肌肉，肌肉消瘦，饮食不能为肌肤；四损损于筋，筋缓不能自收持；五损损于骨，骨痿不能起于床。从上下者，骨痿不能起于床者死；从下上者，皮聚而毛落者死。损其肺者益其气，损其心者调其营卫，损其脾者调其饮食适其寒温，损其肝者缓其中，损其肾者益其精。此治损法也。（出自《难经·十四难》）
李东垣说：虚损之疾，寒热因虚而感也。感寒则损阳，上损渐及于下，治宜辛甘淡，过于胃则不可治也。感热则损阴，下损渐及于上，治宜苦酸咸，过于脾则不可治也。损及于下，妇人月水不通。故心肺损则色弊，肝肾损则形痿，脾胃损则谷不化。吴门叶氏前辈云：食少便溏，损及中州，病已过半。此语尤为显快。
一呼三至一吸三至，为适得病。前大后小即头痛目眩，前小后大即胸满短气。一呼四至一吸四至，病欲甚。脉洪大者苦烦满，沉细者腹中痛，滑者伤热，涩者中雾露。（此四句俱顶四至来）。一呼五至一吸五至，其人当困。沉细夜加，浮大昼加。不大不小，虽困可治。其有大小者难治。一呼六至一吸六至者死。沉细夜死，浮大昼死。一呼一至一吸一至，名曰损人。虽能行，即当着床，血气皆不足故也。再呼一至再吸一至，人虽能行，不久死也。名曰无魂，又曰行尸。（出自《难经·十四难》）
数者府也，迟者藏也。数则为热，迟则为寒。诸阳为热，诸阴为寒。（出自《难经·九难》）
伤寒有五：有中风，有伤寒，有湿温，有热病，有温病。中风之脉，阳浮而滑，阴涩而弱。湿温之脉，阳浮而弱，阴小而急。伤寒之脉，阴阳俱盛而紧涩。热病之脉，阴阳俱浮，浮之而滑，沉之散涩。温病之脉，行在诸经，不知何经之动也，各随其经所在而取之。（出自《难经·五十八难》）
邪气盛则实，精气夺则虚。肠澼便血何如？身热则死，寒则生。肠澼下白沫何如？脉沉则生，脉浮则死。肠澼下脓血何如？脉悬绝则死，滑大则生。肠澼之属，身不热，脉不悬绝何如？滑大者生，悬涩者死。以藏期之。癫疾何如？脉搏大滑，久自已；小坚急，死不治。消瘅何如？脉实大，病久可治；悬小坚，病久不可治。（出自《素问·通评虚实论》）
少阳之至，乍大乍小乍短乍长。阳明之至，浮大而短。太阳之至，洪大而长。太阴之至，紧大而长。少阴之至，紧细而微。厥阴之至，沉短而敦。此非平脉，亦非病脉，皆王脉也。冬至后得甲子，少阳王；复得甲子，阳明王；复得甲子，太阳王；复得甲子，太阴王；复得甲子，少阴王；复得甲子，厥阴王。王各六十日，六六三百六十日，以成一岁。此三阳三阴之旺时日大要也。（出自《难经·七难》）
寸口脉平而死者，生气独绝于内，谓肾间动脉也。（出自《难经·八难》）
上部有脉，下部无脉，其人当吐，不吐者死。上部无脉，下部有脉，虽困无能为害。人之有尺，犹树之有根，枝叶虽枯，根将自生。脉有根本，人有元气，故知不死。（出自《难经·十四难》）
经文说脉不满五十动而一止，一藏无气者，何藏也？曰吸随阴入，呼因阳出。今吸不能至肾，至肝而还，故知一藏者肾藏也。（出自《难经·十一难》）
数动一代者，病在阳之脉也，泄及便脓血。（出自《素问·脉要精微论》）
有所惊骇，脉不至，若喑，不治自已。（出自《素问·大奇论》）
诸疟而脉不见，刺十指间出血，血出必已。（出自《灵枢·刺疟论》）
病若闭目不欲见人者，当得肝脉强急而长，反得肺脉浮短而涩者死也。病若开目而渴，心下牢者，脉当紧实而数，反得沉涩而微者死也。病若吐血、鼽衄，脉当沉细，反浮大而牢者死也。病若谵语妄言，身当有热，脉当洪大而反手足厥逆，脉沉细而微者死也。病若大腹而泄，脉当微细而涩，反紧大而滑者死也。（出自《难经·十七难》）
右胁有积气，肺脉当结，结甚则积甚，结微则积微。不见结脉，当得沉伏。其外痼疾同法。结者脉来去时一止，无常数也。伏者脉行筋下也。浮者脉在肉上行也。左右表里皆相应。假令脉结伏而内无积聚，脉浮结而外无痼疾，或内有积聚而脉不结伏，外有痼疾而脉不浮结，是为脉不应病，病不应脉，死。（出自《难经·十八难》）
Diseases arise neither from external causes (the interaction of the Five Qi) nor from internal causes (excessive dominance of Zang-Fu organs). Once the etiology is diagnosed, treatment can be discussed. If one merely states that a certain pulse corresponds to headache or another to foot pain without investigating the cause, it is mere boasting. Although it may temporarily shock people's ears, it ultimately has no practical effect. Such content is generally excluded and not recorded.
The inner side of both sides of the Chi position corresponds to the hypochondrium. The outer side of Chi observes the Kidney; the inner side of Chi observes the abdominal cavity. Above this (Shang Fu), the left outer side observes the Liver; the inner side observes the Diaphragm. The right outer side observes the Stomach; the inner side observes the Spleen. Above Shang Fu (Shang Shang Fu), the right outer side observes the Lung; the inner side observes the Chest Center. The left outer side observes the Heart; the inner side observes the Danzhong (Chest Center). The anterior aspect observes the front of the body; the posterior aspect observes the back. From the uppermost part down to the lowest part, these correspond to matters of the chest and throat, and the lower abdomen, waist, thighs, knees, shins, and feet, respectively. (From *Suwen: Pulse Essentials*) This describes the fixed positions for observing the five Zang organs. The terms "inner" and "outer" are difficult to interpret. One theory holds that during pulse diagnosis, the hand must be extended, so the area near the Chize point (LU-5) is considered "inner," and the area near the Yuji point (LU-10) is "outer." If this were true, since the Liver is below the diaphragm, saying "outer observes Liver, inner observes Diaphragm" would contradict the principle of "upper observes upper, lower observes lower." Similarly, since the Heart is below Danzhong, saying "outer observes Heart, inner observes Danzhong" would also conflict with this principle. Another theory suggests that when a person sits upright with hands folded, the area near Chize should be "outer" and the area near Yuji should be "inner." If this were true, the statements regarding the Heart and Liver would align perfectly with "upper observes upper, lower observes lower," but would conflict with "anterior observes anterior, posterior observes posterior."
(Shen Youpeng) I privately believe that "inner" and "outer" refer to "anterior observes anterior, posterior observes posterior." Generally, the human back is Yang and the abdomen is Yin. When a person hangs their hands with palms facing forward, the Three Yin Meridians of the Hand are in front, and the Three Yang Meridians of the Hand are behind, corresponding to the abdomen and back. The area closer to the back is "outer"; its pulse should be at the Chen (Deep) level because the Deep pulse is associated with the back. The area closer to the front is "inner"; its pulse should be at the Fu (Superficial) level because the Superficial pulse is associated with the front. For example, the Kidney and the abdominal cavity are both located at the Chi position, but the Kidney is posterior to the abdominal cavity. Therefore, the Chen level of Chi observes the Kidney, and the Fu level of Chi observes the abdominal cavity. "Shang Fu" refers to the area about one cun above the wrist crease where there is a bony prominence, known as the Guan position. The Liver and Diaphragm are both observed at the left Shang Fu, but the Liver is posterior to the Diaphragm. Thus, the Chen level of the left Shang Fu observes the Liver, and the Fu level observes the Diaphragm. The Spleen and Stomach are both observed at the right Shang Fu, but the Spleen is anterior to the Stomach. Thus, the Chen level of the right Shang Fu observes the Stomach, and the Fu level observes the Spleen. "Shang Shang Fu" is the Cun position. The Lung is posterior, and the Chest is anterior. Therefore, the Chen level of the right Shang Fu observes the Lung, and the Fu level observes the Chest Center. The Heart is posterior, and Danzhong is anterior. Therefore, the Chen level of the left Shang Fu observes the Heart, and the Fu level observes Danzhong. In this way, everything aligns with the anterior and posterior principles.
A pulse that is exclusively small indicates disease; exclusively large indicates disease; exclusively rapid (Ji) indicates disease; exclusively slow (Chi) indicates disease; exclusively slippery (Hua, suspected correction) indicates disease; exclusively choppy (Se, suspected correction) indicates disease; exclusively sunken/low indicates disease. (From *Suwen: Three Regions and Nine Observations*)
These few sentences are the essential keys to pulse diagnosis. I fear that if everyone knows them, they might replace two characters in the classic text with "Cold" and "Heat," which would make no sense.
An urgent/tight pulse often indicates Cold; a relaxed pulse often indicates Heat; a large pulse indicates abundant Qi and deficient Blood; a small pulse indicates deficiency of both Qi and Blood; a slippery pulse indicates excess Yang Qi with slight Heat; a choppy pulse indicates excess Blood and deficient Qi with slight Cold. (From *Ling Shu: Pathogenic Qi and Zang-Fu Disease Forms*)
"Urgent" here means Tight, not Wiry. Zhang Zhongjing stated: "When the pulse is Floating and Tight, it is named Wiry." The Wiry pulse feels like a bowstring, firm and unyielding to pressure. The Tight pulse feels like a twisting rope, changing constantly. "Relaxed" here means Weak, not Slow, and thus primarily indicates Heat.
The Cun and Chi positions are the major convergence points of the pulse. From the Guan to Chi is called Chi Nei, the domain governed by Yin. From the Guan to Yuji is called Cun Kou, the domain governed by Yang. (From *Nanjing: Chapter 2*)
Cun and Chi divide Yin and Yang, a method also followed by Zhang Zhongjing.
The pulse movement before the Guan is Yang. It should appear at nine fen depth and be Floating. Exceeding this is called "Excess" (Tai Guo); falling short is called "Deficiency" (Bu Ji). Extending beyond Yuji is called "Yi" (Overflow) or "Wai" (External), indicating Yin overacting on Yang. The pulse movement after the Guan is Yin. It should appear at one cun depth and be Deep. Exceeding this is "Excess"; falling short is "Deficiency." Extending into Chi is called "Fu" (Covering) or "Nei" (Internal), indicating Yang overacting on Yin. These are True Zang pulses; even without illness, death may occur. (From *Nanjing: Chapter 3*)
Fu and Yi pulses are True Zang death pulses and may not always manifest exactly as described. However, the expected lengths of Cun and Chi must be known, so they are recorded here.
Exhalation is governed by the Heart and Lung; inhalation is governed by the Liver and Kidney. Between breaths, the Spleen receives the essence of grain. Its pulse is in the middle. Floating pulses belong to Yang; Deep pulses belong to Yin. Both Heart and Lung pulses are Floating. A Floating, Large, and Scattered pulse belongs to the Heart; a Floating, Short, and Choppy pulse belongs to the Lung. Both Liver and Kidney pulses are Deep. A Firm and Long pulse belongs to the Liver; a pulse that is soft upon pressing but becomes solid upon lifting the finger belongs to the Kidney. The Spleen resides in the Central Region, so its pulse is also in the middle. The six pulses vary in Floating/Deep, Long/Short, Slippery/Choppy. Floating, Slippery, and Long are Yang; Deep, Short, and Choppy are Yin. A pulse with one Yin and one Yang element is Deep and Slippery. One Yin and two Yang elements is Deep, Slippery, and Long. One Yin and three Yang elements is Floating, Slippery, and Long, occasionally Deep. Diseases are named according to their meridians, and their favorable or unfavorable nature is determined. (From *Nanjing: Chapter 4*)
The first four sentences describe the dynamic mechanisms of the human body and should be carefully studied.
There are concealed pulses. If a pulse resides in the Yin region but reveals Yang characteristics, it is Yang invading Yin. Although it may sometimes be Deep, Choppy, and Short, this is Yang concealing Yin. If a pulse resides in the Yang region but reveals Yin characteristics, it is Yin invading Yang. Although it may sometimes be Floating, Slippery, and Long, this is Yin concealing Yang. Extreme Yang leads to Mania; Extreme Yin leads to Melancholia. Loss of Yang leads to hallucinations; loss of Yin leads to blindness. (From *Nanjing: Chapter 20*)
Upon initially holding the pulse, with the weight of three beans touching the skin and hair, it is the Lung pulse. With the weight of six beans touching the blood vessels, it is the Heart pulse. With the weight of nine beans touching the muscles, it is the Spleen pulse. With the weight of twelve beans reaching the tendons, it is the Liver pulse. Pressing to the bone, with a rapid return upon lifting the finger, it is the Kidney pulse. (From *Nanjing: Chapter 5*)
If the pulse is diminished/small when Floating but solid/large when Deep, it indicates Yin Excess and Yang Deficiency. If the pulse is diminished/small when Deep but solid/large when Floating, it indicates Yang Excess and Yin Deficiency. (From *Nanjing: Chapter 6*)
Spring is Wiry, Summer is Hooked, Autumn is Hairy (Floating), Winter is Stone-like (Deep). These are the seasonal pulses. Spring pulse is soft, weak, and long, hence called Wiry. Summer pulse comes rapidly and departs slowly, hence called Hooked. Autumn pulse is light, void, and floating, hence called Hairy. Winter pulse is deep, soft, and slippery, hence called Stone-like. (From *Nanjing: Chapter 15*)
Spring pulse is like a wire. Spring pulse belongs to the Liver, East Wood, the beginning of all things. It comes soft, weak, light, void, slippery, straight, and long, hence called Wiry. If it comes solid and strong, this is Excess, disease in the exterior. If it comes insubstantial and faint, this is Deficiency, disease in the interior. Excess causes forgetfulness, dizziness, and epilepsy. Deficiency causes chest pain radiating to the back and fullness in the lower hypochondrium.
Summer pulse is like a hook. Summer pulse belongs to the Heart, South Fire, the flourishing growth of all things. It comes vigorous and departs declining, hence called Hooked. If it comes vigorous and departs vigorous, this is Excess, disease in the exterior. If it comes insubstantial and departs vigorous, this is Deficiency, disease in the interior. Excess causes fever, skin pain, and spreading sores. Deficiency causes vexation, coughing up saliva upwards, and qi leakage downwards.
Autumn pulse is like floating. Autumn pulse belongs to the Lung, West Metal, the harvest of all things. It comes light, void, and floating, rapid in arrival and scattered in departure, hence called Floating. If it comes like hair but firm in the center and void on the sides, this is Excess, disease in the exterior. If it comes like hair but faint, this is Deficiency, disease in the interior. Excess causes rebellious qi, back pain, and a feeling of oppression. Deficiency causes panting, shortness of breath, cough, hemoptysis, and abnormal sounds in the lower body.
Winter pulse is like a camp (firm/deep). Winter pulse belongs to the Kidney, North Water, the storage of all things. It comes deep and pounding, hence called Camp. If it comes like throwing stones, this is Excess, disease in the exterior. If it departs like a rapid pulse, this is Deficiency, disease in the interior. Excess causes lethargy, spinal pain, shortness of breath, and reluctance to speak. Deficiency causes a feeling of hunger with an empty heart, coldness in the flanks, spinal pain, lower abdominal fullness, and changes in urination.
The Spleen pulse belongs to Earth, the solitary organ that irrigates the four directions. A healthy Spleen pulse is invisible; only a pathological one is visible. If it flows like water, this is Excess, disease in the exterior. If it resembles a bird's beak, this is Deficiency, disease in the interior. Excess causes inability to move the limbs. Deficiency causes obstruction of the nine orifices, termed "Heavy Rigidity." (From *Suwen: Jade Machine True Zang*)
In Spring, a pulse with slight Wiry quality and Stomach Qi is Normal. More Wiry than Stomach Qi indicates Liver disease. Purely Wiry without Stomach Qi indicates Death. (See *Suwen: Jade Machine True Zang* for "Weak and slippery indicates Stomach Qi"). If Stomach Qi combines with Hairy (Autumn) pulse, disease occurs in Autumn; severe Hairy pulse indicates current disease. The True Essence disperses to the Liver, which stores the Qi of the sinews.
In Summer, a pulse with slight Hooked quality and Stomach Qi is Normal. More Hooked than Stomach Qi indicates Heart disease. Purely Hooked without Stomach Qi indicates Death. If Stomach Qi combines with Stone-like (Winter) pulse, disease occurs in Winter; severe Stone-like pulse indicates current disease. The True Essence connects to the Heart, which stores the Qi of the blood vessels.
In Late Summer, a pulse with slightly soft/weak quality and Stomach Qi is Normal. More Weak than Stomach Qi indicates Spleen disease. Purely Alternating (Dai) without Stomach Qi indicates Death. Soft/weak combined with Stone-like pulse indicates disease in Winter; severe Stone-like pulse indicates current disease. The True Essence moistens the Spleen, which stores the Qi of the muscles.
In Autumn, a pulse with slight Hairy quality and Stomach Qi is Normal. More Hairy than Stomach Qi indicates Lung disease. Purely Hairy without Stomach Qi indicates Death. Hairy pulse combined with Wiry pulse indicates disease in Spring; severe Wiry pulse indicates current disease. The True Essence rises to the Lung to circulate Ying and Wei Qi and balance Yin and Yang.
In Winter, a pulse with slight Stone-like quality and Stomach Qi is Normal. More Stone-like than Stomach Qi indicates Kidney disease. Purely Stone-like without Stomach Qi indicates Death. Stone-like pulse combined with Hooked pulse indicates disease in Summer; severe Hooked pulse indicates current disease. The True Essence descends to the Kidney, which stores the Qi of the bones and marrow. (From *Suwen: Normal Person Pulse Phenomena*)
The Classic states: If the complexion is seen but the pulse does not match, and instead a controlling (overcoming) pulse is obtained, death ensues. If a generating pulse is obtained, the disease will resolve. Why? The five Zang organs have five colors visible on the face, which should correspond to the pulse. For example, Green color requires a Wiry and urgent pulse; Red requires a Floating, Large, and Scattered pulse; Yellow requires a Moderate, Slow, and Large pulse; White requires a Floating, Choppy, and Short pulse; Black requires a Deep, Soft, and Slippery pulse. This is correspondence. Each Zang has specific voice, color, odor, and taste that should correspond to the pulse. Non-correspondence indicates disease. For instance, Green color (Liver Wood) with a Floating, Choppy, and Short pulse (Lung Metal controls Liver Wood) or a Large and Slow pulse (Spleen Earth, controlled by Liver Wood) indicates overcoming. Floating, Large, and Scattered pulse (Heart Fire, generated by Liver Wood) or Small and Slippery pulse (Kidney Water, generates Liver Wood) indicates generation. (From *Nanjing: Chapter 13*)
The *Shi Bian* states: Liver is Green, odor Musky, taste Sour, sound Call, fluid Tears. Heart is Red, odor Scorched, taste Bitter, sound Speech, fluid Sweat. Spleen is Yellow, odor Fragrant, taste Sweet, sound Song, fluid Saliva. Lung is White, odor Fishy, taste Pungent, sound Cry, fluid Mucus. Kidney is Black, odor Putrid, taste Salty, sound Groan, fluid Spittle. (From *Nanjing: Chapter 34*)
Liver governs Color, Heart governs Odor, Spleen governs Taste, Lung governs Sound, Kidney governs Fluid. (From *Nanjing: Chapter 40*)
If the Liver pulse is obtained, external signs include a bright complexion, greenish hue, and irritability. Internal signs include pulsation at the left umbilicus, firm and painful upon pressure. Symptoms include limb fullness, urinary difficulty, constipation, and tendon spasms. Presence of these indicates Liver disease; absence indicates otherwise.
If the Heart pulse is obtained, external signs include red complexion, dry mouth, and excessive laughter. Internal signs include pulsation above the umbilicus, firm and painful upon pressure. Symptoms include vexation, heart pain, and heat in the palms. Presence of these indicates Heart disease; absence indicates otherwise.
If the Spleen pulse is obtained, external signs include yellow complexion, frequent belching, excessive thinking, and appreciation of taste. Internal signs include pulsation at the umbilicus, firm and painful upon pressure. Symptoms include abdominal fullness, indigestion, heavy body and joint pain, lethargy, and weakness of the limbs. Presence of these indicates Spleen disease; absence indicates otherwise.
If the Lung pulse is obtained, external signs include pale complexion, frequent sneezing, sadness, and desire to cry. Internal signs include pulsation at the right umbilicus, firm and painful upon pressure. Symptoms include cough, asthma, and aversion to wind/cold. Presence of these indicates Lung disease; absence indicates otherwise.
If the Kidney pulse is obtained, external signs include black complexion, fearfulness, and yawning. Internal signs include pulsation below the umbilicus, firm and painful upon pressure. Symptoms include rebellious qi, lower abdominal urgency/pain, diarrhea with heaviness, and coldness in the shins/feet. Presence of these indicates Kidney disease; absence indicates otherwise. (From *Nanjing: Chapter 16*)
A Heart pulse that is Firm and Long indicates tongue retraction and inability to speak. A Soft and Scattered Heart pulse indicates spontaneous recovery. A Lung pulse that is Firm and Long indicates spitting blood. A Soft and Scattered Lung pulse indicates profuse sweating that does not cease. A Liver pulse that is Firm and Long, despite a non-green complexion, indicates trauma or blow causing blood stasis in the hypochondrium, leading to wheezing/rebellious qi. A Soft and Scattered Liver pulse with normal luster indicates Overflowing Drink (Yi Yin), characterized by sudden thirst, excessive drinking, and fluid accumulation in muscle/skin/gut exteriors. A Stomach pulse that is Firm and Long with a red complexion indicates hip fracture. A Soft and Scattered Stomach pulse indicates food stagnation/bi syndrome. A Spleen pulse that is Firm and Long with a yellow complexion indicates shortness of breath. A Soft and Scattered Spleen pulse with dull luster indicates leg edema resembling water retention. A Kidney pulse that is Firm and Long with a yellow-red complexion indicates lower back fracture. A Soft and Scattered Kidney pulse indicates blood deficiency that does not recover.
A coarse/large pulse indicates Yin deficiency and Yang excess, resulting in Heat Middle. A pulse coming rapidly and departing slowly indicates Upper Excess and Lower Deficiency, leading to Jue or Head Disease. A pulse coming slowly and departing rapidly indicates Upper Deficiency and Lower Excess, leading to aversion to wind. A Deep, Fine, and Rapid pulse indicates Shaoyin Jue. A Floating and Scattered pulse indicates collapse/fainting. (From *Suwen: Pulse Essentials*)
At Cun Kou, a Deep and Transverse pulse indicates hypochondriac accumulation and horizontal abdominal pain. An Urgent pulse indicates Hernia/Jia and lower abdominal pain. A Slippery pulse indicates Wind. A Choppy pulse indicates Bi syndrome. A Relaxed and Slippery pulse indicates Heat in the Middle. A Vigorous and Tight pulse indicates Distension.
At Chi, a Relaxed and Choppy pulse indicates relaxation and lying down. A Vigorous pulse indicates blood loss. A Choppy Chi with Slippery pulse indicates excessive sweating. A Cold and Fine Chi pulse indicates posterior discharge/diarrhea. A Coarse and constantly Hot Chi pulse indicates Heat in the Middle. (From *Suwen: Normal Person Pulse Phenomena*)
Yang Knotting causes swelling of the four limbs. Yin Knotting causes bloody stool. Yin-Yang oblique knotting with more Yin than Yang is Stone Water, with lower abdominal swelling. Knotting of Two Yangs is Xiao (Consumption). Knotting of Three Yangs is Ge (Obstruction). Knotting of Three Yins is Shui (Edema/Water). Knotting of One Yin and One Yang is Hou Bi (Throat Bi). Yin Pulsing with distinct difference from Yang indicates pregnancy. Yin-Yang deficiency leads to death from intestinal dysentery. Yang added to Yin indicates sweat. Yin deficiency with Yang pounding indicates metrorrhagia. (From *Suwen: Discussion on Yin and Yang Differences*)
Wang Bing commented on "Yin Pulsing with distinct difference from Yang": Yin refers to the Chi position. "Bo" means beating against the fingers. The Chi pulse beats distinctly different from the Cun pulse, a sign of pregnancy. This is a definitive conclusion. Since the fetus is in the abdomen, Qi and Blood protect it, naturally becoming vigorous in the abdominal Chi region. The Chi pulse beating distinctly different from Cun is logical. Extending this, Left beating indicates male, Right beating indicates female. Danxi argued using the physician's hands (Left diagnoses Right, Right diagnoses Left), suggesting Left beating indicates female and Right indicates male. This seems based on trial and error; I dare not dismiss it.
In women, vigorous movement of the Foot Shaoyin pulse indicates pregnancy. (From *Suwen: Normal Person Pulse Phenomena*)
"Dong" (Movement) is like a bean, quivering. Wang Bing interpreted it as the Hand Shaoyin pulse under the styloid process opposite the little finger, not Taiyuan. Quan Yuanqi interpreted it as Foot Shaoyin, sought within Chi, which aligns well with Chi observing the abdomen.
How to know pregnancy is imminent? The body has symptoms but no pathogenic pulse. (From *Suwen: Abdominal Discussion*) Women relate the uterus to the Kidney. If the three positions (Cun, Guan, Chi) are equal in Floating/Deep quality and unceasing upon pressure, it indicates pregnancy.
(Shen Youpeng) Note: Individual constitutions vary, and pulses differ. Pregnant women may show Dong pulse or not; may show beating or not. Ultimately, the key is the Chi pulse being firm and distinct from Cun. Some pregnant women have equal Cun and Chi pulses; these should be sought via Floating/Deep quality, specifically unceasing upon pressure, indicating Kidney solidity.
One exhalation, two pulse beats; one inhalation, two pulse beats. At the end of respiration, five beats total, is a Normal person. One exhalation, one beat; one inhalation, one beat, is Short Qi. One exhalation, three beats; one inhalation, three beats, with agitation: Chi Heat indicates Warm Disease; Chi No Heat with Slippery pulse indicates Wind Disease; Choppy pulse indicates Bi syndrome. (Note: The last three phrases apply to the "three beats" scenario). Four beats per exhalation/inhalation or more indicates death. Absent pulse indicates death. Irregular interval indicates death. (From *Suwen: Normal Person Pulse Phenomena*)
The Classic discusses Damage (Sun) and Arrival (Zhi) pulses. Two beats per exhalation is Normal. Three beats is Li Jing (Departing from the Classic). Four beats is Duo Jing (Depriving Essence). Five beats is Death. Six beats is Life Exhaustion. These are Arrival pulses. One beat per exhalation is Li Jing. Two beats per two exhalations is Duo Jing. Three beats per three exhalations is Death. Four beats per four exhalations is Life Exhaustion. These are Damage pulses. Arrival pulses rise from below; Damage pulses descend from above. First Damage affects skin/hair (hair falls). Second Damage affects blood vessels (deficient, unable to nourish Zang-Fu). Third Damage affects muscles (emaciation, food cannot form flesh). Fourth Damage affects tendons (slack, unable to hold). Fifth Damage affects bones (atrophy, unable to rise from bed). Descending from above, inability to rise from bed indicates death. Ascending from below, hair falling indicates death. Treat Lung Damage by benefiting Qi. Treat Heart Damage by regulating Ying and Wei. Treat Spleen Damage by adjusting diet and temperature. Treat Liver Damage by soothing the interior. Treat Kidney Damage by benefiting Essence. This is the method for treating Damage. (From *Nanjing: Chapter 14*)
Li Dongyuan stated: Deficiency diseases involve cold/heat due to deficiency. Cold damages Yang; Upper Damage gradually affects Lower. Treatment uses Acrid, Sweet, and Pale flavors; exceeding the Stomach makes it untreatable. Heat damages Yin; Lower Damage gradually affects Upper. Treatment uses Bitter, Sour, and Salty flavors; exceeding the Spleen makes it untreatable. Damage affecting Lower causes amenorrhea in women. Thus, Heart/Lung damage causes complexion deterioration; Liver/Kidney damage causes physical atrophy; Spleen/Stomach damage causes failure to digest grains. Ye Shi of Wu Men said: Poor appetite and loose stools indicate damage to the Central Region; the disease is already half-way there. This statement is particularly clear.
Three beats per exhalation/inhalation is appropriate for early disease. Anterior Large/Posterior Small indicates headache/dizziness. Anterior Small/Posterior Large indicates chest fullness/shortness of breath. Four beats per exhalation/inhalation indicates worsening disease. Large pulse indicates vexation/fullness. Deep/Fine pulse indicates abdominal pain. Slippery pulse indicates Heat injury. Choppy pulse indicates mist/dew invasion. (Note: These four phrases apply to the "four beats" scenario). Five beats per exhalation/inhalation indicates exhaustion. Deep/Fine worsens at night; Floating/Large worsens by day. Neither Large nor Small, though exhausted, is treatable. Variable size is difficult to treat. Six beats per exhalation/inhalation is death. Deep/Fine dies at night; Floating/Large dies by day. One beat per exhalation/inhalation is named Sun Ren (Damaged Person). Though able to walk, they must lie down due to Qi/Blood deficiency. Two beats per two exhalations/inhalations, though able to walk, will die soon. Named Hunless, also called Walking Corpse. (From *Nanjing: Chapter 14*)
Rapid pulses belong to Fu organs; Slow pulses belong to Zang organs. Rapid indicates Heat; Slow indicates Cold. All Yang is Heat; All Yin is Cold. (From *Nanjing: Chapter 9*)
Shaohan (Cold Damage) has five types: Wind Stroke, Cold Damage, Damp-Warmth, Heat Disease, and Warm Disease. Wind Stroke pulse: Yang Floating/Slippery, Yin Choppy/Weak. Damp-Warmth pulse: Yang Floating/Weak, Yin Small/Urgent. Cold Damage pulse: Yin/Yang both Vigorous/Tight/Choppy. Heat Disease pulse: Yin/Yang both Floating, Floating/Slimy, Deep/Scattered. Warm Disease pulse: Moves through various meridians; identify the affected meridian and diagnose accordingly. (From *Nanjing: Chapter 58*)
Pathogen excess is Excess; Essence depletion is Deficiency. Intestinal dysentery with bloody stool: Body Heat indicates death; Cold indicates survival. Dysentery with white mucus: Deep pulse indicates survival; Floating pulse indicates death. Dysentery with pus/blood: Hanging-Absent pulse indicates death; Slippery/Large pulse indicates survival. Dysentery without Heat and non-hanging-absent pulse: Slippery/Large indicates survival; Hanging-Choppy indicates death. Judge by Zang timing. Epilepsy: Large/Slippery pulse recovers over time; Small/Firm/Urgent is untreatable/death. Xiao Dao (Consumption): Solid/Large pulse is treatable even if chronic; Hanging/Small/Firm is untreatable if chronic. (From *Suwen: Comprehensive Evaluation of Excess and Deficiency*)
Shaoyang pulse: Fluctuates Large/Small, Short/Long. Yangming pulse: Floating/Large/Short. Taiyang pulse: Huge/Long. Taiyin pulse: Tight/Large/Long. Shaoyin pulse: Tight/Fine/Minute. Jueyin pulse: Deep/Short/Round. These are not Normal or Disease pulses, but Wang (Prosperous) pulses. After Winter Solstice, upon receiving Jia Zi, Shaoyang prospers; next Jia Zi, Yangming prospers; next, Taiyang; next, Taiyin; next, Shaoyin; next, Jueyin. Each prospers for 60 days, totaling 360 days for one year. This is the general rule for the prosperity times of the Three Yang and Three Yin. (From *Nanjing: Chapter 7*)
Cun Kou pulse is Normal but the patient dies: The vital energy is solely cut off internally, referring to the Kidney Interstitial Artery pulse. (From *Nanjing: Chapter 8*)
Pulse present at Upper, absent at Lower: Patient should vomit; if not, death ensues. Pulse absent at Upper, present at Lower: Though distressed, no harm will come. The Chi pulse in humans is like roots in trees; even if branches/leaves wither, roots regenerate. Pulses have roots; humans have Yuan Qi, so life is preserved. (From *Nanjing: Chapter 14*)
Classic states: Pulse stops once every 50 beats, indicating one Zang lacks Qi. Which Zang? Inhalation follows Yin entering; Exhalation follows Yang exiting. Now, inhalation cannot reach the Kidney, stopping at the Liver and returning. Thus, the Zang lacking Qi is the Kidney. (From *Nanjing: Chapter 11*)
Rapid, Beating, and Alternating pulses indicate disease in Yang meridians, with discharge and bloody/purulent stool. (From *Suwen: Pulse Essentials*)
Due to fright/shock, pulse may be absent. If mute, it will heal spontaneously without treatment. (From *Suwen: Great Strange Theory*)
For all malaria cases where pulse is not visible, prick bleeding between the ten fingers; bleeding ensures cessation. (From *Ling Shu: Needling Malaria*)
Patient closing eyes, avoiding people: Should obtain Wiry/Long Liver pulse. If instead Floating/Short/Choppy Lung pulse is obtained, death ensues. Patient opening eyes, thirsty, with firm epigastrium: Should obtain Tight/Real/Rapid pulse. If instead Deep/Choppy/Micro pulse is obtained, death ensues. Patient vomiting blood/nosebleed: Should obtain Deep/Fine pulse. If instead Floating/Large/Firm pulse is obtained, death ensues. Patient delirious/speaking wildly, with body heat: Should obtain Huge/Large pulse. If instead extremities are cold and pulse is Deep/Fine/Micro, death ensues. Patient with large abdomen and diarrhea: Should obtain Micro/Fine/Choppy pulse. If instead Tight/Large/Slippery pulse is obtained, death ensues. (From *Nanjing: Chapter 17*)
Right hypochondriac qi accumulation: Lung pulse should be Knotting. Severe knotting = severe accumulation; mild knotting = mild accumulation. If Knotting pulse is not seen, expect Deep/Void pulse. Same method for external chronic diseases. Knotting pulse stops intermittently without regularity. Void pulse runs under tendons. Floating pulse runs above flesh. Left/Right, Interior/Exterior should correspond. If Knotting/Void pulse exists but no interior accumulation, or Floating/Knotting pulse exists but no external chronic disease, or interior accumulation exists without Knotting/Void pulse, or external disease exists without Floating/Knotting pulse, this is Pulse not matching Disease, Disease not matching Pulse, indicating death. (From *Nanjing: Chapter 18*)