霉酱色胎者，夹食伤寒也，由食填太阴，郁遏中焦，不得发越，久之，庵而成酱色矣。其证腹满、时痛者，桂枝汤加枳朴橘半。因冷食者，加炮姜；痛甚者，加大黄。(原注：霉黄胎舌，由湿热郁滞中宫)。
蓝胎色者，肝脏纯色也。病经汗下，胃气伤极，心火无气，脾土无依，则肺金不生，肝木无制，侮于脾土，故胎色如靛，不治之证。如略见蓝纹而不甚深者，为木受金伤，脏气未绝，脉不沉涩而微弦者，小柴胡汤去黄芩，加炮姜、肉挂主之。
目喜开者，为阳。目喜闭者，为阴。眼胞渐肿，为有水。目下灰色，为寒饮。目痛，属阳明表证。目赤，为经络热甚。目不了了者，阳明腑实也。目无精光者，肾气素虚也。目瞑、鼻燥而漱水者，阳盛欲衄也。目黄、头汗而恶食者，湿将发黄也。凡目暗、目瞠、目反、目正圆直视、戴眼反折，皆难治。
鼻头色青、腹中冷痛者(原注：木克土也)，死。鼻头色微黑者，有水气；色白者，亡血；色赤者，为风；色黄者，胸膈有寒，谷气不化，而有痰积也；色黑枯者，为劳。鼻流清涕者，伤寒也。鼻鸣干呕者，伤风也。鼻孔干而脉浮数者，欲衄也。鼻息鼾而语难出者，风温也。鼻孔扇动，为肺风。鼻如烟煤，为阳毒。
唇赤而焦者，脾热。唇赤而肿者，胃热。青黑者，为阴寒。淡白者，为气虚。唇口有疮，为狐惑。唇上燥裂，为热在肌肉。唇齿俱焦黑者，急下之。若唇吻反青，环口黧黑，张口如鱼，出气不复，唇口动颤不止，及人中反者，皆死证也。
声音清朗不异平时者，虽病易愈。声重鼻塞者，伤风也。声如瓮中出者，中湿也。语言迟涩者，风痰也。言将终乃复言者，气短也。骂詈不避亲者，神乱发狂也。出言懒怯，先轻后重，是内伤中气也。出言壮厉，先重后轻，是外感邪盛也。诊时攒眉呻吟，苦头痛也；呻吟不能行起，腰足痛也；叫喊以手按心中，脘痛也；诊时吁气者，郁结也；纽而呻者，腹痛也；形赢声哑、痨瘵之不治者，咽中有肺花疮也；暴哑者，风痰伏火、或暴怒叫喊所致也；坐而气促，痰火病也；久病气促，危证也。诊时独言独语，首尾不应，神伤也；新病呃逆，非火即寒也；久病呃逆，胃气欲绝也。(原注：病人语声寂寂然，喜惊呼者，骨节间病；语声暗暗然，不彻者，心膈间病；其声啾啾然，细而长者，头中病。)
一问起自何日，二问恶寒与发热，三问头痛身腰痛，四问曾否伤食物，五问四肢冷与温，六问呕逆渴不渴，七问胸紧或腹痛，八问二便通与塞，九问口味何所宜，十问喜怒劳忧郁。若诊妇女再精详，须问月信行与歇。问而懒答或点头，不是耳聋即虚怯。
人一呼脉再动，一吸脉亦再动，呼吸定息，脉五动，闰以太息，命曰平人(原注：呼出心与肺，吸入肝与肾。一呼脉行三寸，一吸脉行三寸，日夜一万三千五百息)。一呼一动、一吸一动、曰少气(原注：《脉诀》以为败脉，《难经》以为离经脉)。一呼脉三动，一吸脉三动，曰躁(原注：躁动印数脉之状)。尺热，曰病温(原注：尺阴寸阳，阴阳俱热)。尺不热，脉滑，曰病风；脉涩，曰痹(原注：滑为阳盛，涩为血少)。一呼脉四动以上者(原注：《脉诀》以为脱脉，《难经》以为夺精脉)，脉绝不至者，脉乍疏乍数者，脉无胃气者(原注：无和缓之象)，皆主死。春脉如弦。春脉者肝也，东方木也，万物之所以始生也，故其气来轻软而滑。端直以长，曰弦。弦软如揭长竿末稍，曰肝平；弦实如循长竿，曰肝病；弦劲如新张弓弦，曰肝死(原注：肝死藏浮之弱，按之如索不来，或曲如蛇行者，死)。夏脉如钩。夏脉者心也，南方之火也，万物之所以盛长也，故其气来盛去衰，曰钩。累累如贯珠，曰心平；喘喘连属，其中微曲，曰心病；前曲后居，如操带钩，曰心死(原注：真心脉至坚而抟。如循薏苡子，曰死。心死藏浮之实，如麻豆，按之益躁疾者，死)。秋脉如浮。秋脉者肺也，四方金也，万物之所以收成也，故其气来急去散，轻虚以浮，曰浮。浮缓如落榆荚，曰肺平；浮涩如循鸡羽，臼肺病；浮虚如风吹毛，曰肺死(原注：肺死藏浮之虚，按之弱如葱叶、下无根者，死)。冬脉如营。冬脉者肾也，北方水也，万物之所以合藏也，故其气来沉以抟，曰营。累累如钩，按之而坚，曰肾平；来如引葛，按之益坚，曰肾病；发如夺索，辟如弹石，曰肾死(原注：肾死藏浮之坚，按之乱如转丸，益下入尺者，死)。脾脉者土也，孤藏以灌四旁者也，和柔相离，如鸡践地，曰脾平；实而盈数，如鸡举足，曰脾病；如鸟之喙，如屋之漏，如水之流，曰脾死(原注：脾死藏浮之大坚，按之如覆杯洁洁，状如摇者，死)。五脏皆禀气于胃藏气，不能自致于手太阴，必因于胃气乃至于手太阴而行诸经，故脉以胃气为本(原注：脉来和缓为有胃气)。
脉从阴阳，病易已；逆阴阳，病难已(原注：阳病见阳脉，阴病见阴脉，为顺；阳病见阴脉，阴病见阳脉，为逆)。春夏而脉沉涩，秋冬而脉浮大。或春得秋脉，夏得冬脉，秋得夏脉，冬得长夏脉，命曰逆四时，病难已。风热而脉静，泄而脱血，脉实，病在中；脉虚，病在外；脉涩坚者，皆难治。春不沉，夏不弦，冬不涩，秋不数，是谓四塞。(原注：己虽专旺，而母气已绝。)
经脉为里(原注：直行经隧之里)，支而横者为络，络之别者为孙。络经脉不可见其虚实也，以气口知之(原注：气口一名寸口，乃百脉之大要会也)。
饮食入胃，游溢精气，上输于脾。脾气散精，上归于肺。肺朝百脉，输精于皮毛，通调水道，下输膀胱。
脉者血之府也，长则气治，短则气病，数则烦心，大为病进。上(原注：寸口也)盛，则气高；下(原注：尺中也)盛，则气胀。代则气衰，细则气少，涩则心痛(原注：血少也)。脉至如涌泉，去如弦绝，均不治(原注：右气口急，脉大而数者，中下热而涌，为涌疝。越人)。
邪气盛则实，精气夺则虚。气热脉满是谓重实，滑则从，涩则逆也。尺寸皆虚，是谓重虚，滑则生，涩则死也。肠擗便血，身热则死，寒则生；肠辩下沫，脉沉则生，浮则死(原注：痢疾忌身热脉浮)；肠澼下脓血，脉悬绝则死，滑大则生。癫疾之脉，大滑自已，小坚不治。消瘅病久，脉实大者可治，悬小坚者不治。
脉沉而坚者，病在中；浮而盛者，病在外。小弱以涩者，久病；浮滑而疾者，新病。脉急者，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。脉一日一夜五十营(原注：昼行阳二十五度，夜行阴二十五度)，以营五藏之精，五十动而不一代者，五藏皆受气也；四十动一代者，一藏无气；三十动一代者，二藏无气；二十动一代者，三藏无气；十动一代者，四藏无气；不满十动一代者，五藏无气，预之短期，
腹胀身热而脉大者，腹鸣而满、四肢清、泄而脉大者，衄不止而脉大者，咳且溲血脱形、脉小以劲者，咳且身热脱形、脉小以疾者，皆逆脉也，不过十五日而死。腹大胀、四末清、脱形、泄甚，一逆也；腹胀，便血，其脉大，时绝，二逆也；咳且溲血，形肉脱，脉搏三逆也；呕血，胸满引背，脉小而疾，四逆也；咳呕，腹胀，飧泄，其脉绝，五逆也。如是者，即死。
热病而脉静者，汗已出而脉盛躁者，病泄而脉洪大者，著痹、肉破身热、而脉偏绝者，淫而夺形、色白身热、下血衄者，寒热夺形、脉坚搏者，皆为逆脉。
内热甚而脉反不鼓，是阳盛格阴于外也；内寒而脉反鼓甚是阴盛格阳于外也，是谓脉证相反(原注：脉大而实，其来难者，是厥阴之动，疝气客于膀胱，小腹肿也。越人)。
诊法：常以平旦、饮食未进、气血未乱，乃可诊有过之脉。察之有纪，从阴阳始。始之有经，从五行生。生之有度，四时为宜。持脉有道，虚静为保。春日浮，如鱼之游在波；夏日在肤，泛泛乎万物有余；秋日下肤，蛰虫将去；冬日在骨，蛰虫周密。尺外以候肾，尺里以候腹(原注：左尺兼主小肠、膀胱、前阴之病，右尺兼主大肠、后阴之病。喻嘉言云：小肠当候于左尺，大肠、膀胱当候于右尺)；左关以候肝膈，右关以候脾胃；左寸候心与膻中；右寸候肺与胸中(原注：寸主上焦，以候咽喉；关主中焦，以候膈中；尺主下焦，以候腹中)。
浮取之而脉沉，心腹有积也；沉取之而脉浮，身有热也(原注：沉之而大坚、浮之而大紧者，病主在肾)。上部盛而下无(原注：阳气升而不降也)，腰足清也；下部盛而上无(原注：阳气降而不升也)，头项痛也；按之至骨，脉气少者，腰脊痛而身有痹也。
脉分三部(原注：寸关尺也)，有九候(原注：浮中沉也)，必先度其形之肥瘦(原注：肥人脉常沉，瘦人脉常浮)，以调其气之虚实(原注：肥人血实气虚，瘦人气实血虚)。形盛、脉细、少气不足以息者，危；形瘦、脉大、胸中喘满者，死；形气相得者，生；三五不调者病，独小者病，独大者病，独疾者病，独热者病，独寒者病，独沉伏者病。九候皆沉细弦绝者，死；皆盛躁喘数者，死；乍疏乍数、乍迟乍疾者，死；九候虽调、形肉已脱者，死；目内陷者，死(原注：肾脉涩而不联属者，月事不下)。
尺肤热甚、脉盛躁者，病温也；盛而滑者，病且出也；尺肤寒、脉小者，泄、少气。
关以前者阳之动，浮过而直上鱼者，为溢。此阴乘阳位，为外关内格也。病主外热而液汗不通，内寒而腹满吐食。关以后者阴之动，沉过而直入尺者，为覆。此阳乘阴位，为内关外格也。病主内热而大小便闭，外寒而手足厥冷，均主死。
浮者、长者、滑者，阳也；沉者、短者、涩者，阴也。浮之损小、沈之实大者，阴盛阳虚也；沉之损小、浮之实大者，阳盛阴虚也。(原注：大概脉浮紧者表邪，脉沈实者里邪。)
至脉从下而上，损脉从上而下。一损皮毛，皮聚而毛落；二损血脉不荣脏腑；三损肌肉，肌肉消瘦，饮食不能为肌肤；四损于筋，筋缓不能自收持；五损于骨，骨痿不能起于床。损其肺者，益其气；损其心者，调其荣卫；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。
一呼三至、一吸三至，为新病。前大后小、即头痛目眩。前小后大，即腹满气短。
一呼四至、一吸四至，为病甚。脉洪大者，苦烦满；沈细者，腹中痛；滑者，中热；涩者，中湿。
一呼一至、一吸一至，名曰损。人虽能行，犹当著床，血气皆不足故也。
上部有脉，下部无脉，其人当吐不吐者，死；上部无脉，下部有脉，犹有生机。
病积聚者，脉结若伏。假令脉结伏者内无积聚，脉浮结者外无痼疾，或有积聚而脉不结伏，有痼疾而脉不浮结，为脉不应病，难治。
脉居阴部而反阳脉见者，力阳乘阴脉。虽时沈涩而短，此谓阳中伏阴也。脉居阳部而反阴脉见者，为阴乘阳脉。虽时浮滑而长，此谓阴中伏阳也。
病若闭目不欲见人，当得肝脉强急而长，反得肺脉浮涩而短者，死也。
病若开目而渴、心下牢者，脉当紧实而数，反得沈濡而微者，死也。
病若谵语妄言，身当有热，脉当洪大而反手足厥冷、脉沈细而微者，死也。
病若大腹而泄，脉当微细而涩，反紧大而滑者，死也。(原注：此五条俱脉证相反。)
病人脉浮者在前，其病在表；浮者在后其病在里。若前后俱浮，则表里兼病也。(原注：关前为阳，表病主阳也。关后为阴，里病主阴也。)
风令脉浮，寒令脉急(原注：急即紧之象)。雾伤皮腠，湿流关节，食伤脾胃，风伤皮毛，热伤血脉，极寒伤经，极热伤络。
夫脉当取太过不及。阳脉微，阴脉弦，即胸痹而痛。所以然者，上焦阳虚而阴邪乘之也。
趺阳脉微弦，法当腹满。不满者，必便难，两肤疼痛。此虚寒欲从下而上也，当以温药服之。(原注：此弦脉，寒从内生，阴邪不散，则阴窍不通，故便难。)
寸脉弦者，即胁下拘急而痛其人啬啬恶寒也。(原注：此弦脉，寒从外至。)
脉数而紧乃弦。状如弓弦，按之不移。脉数弦者，当下其寒。脉紧大而迟者，必心下坚痞；脉大而紧者，阳中有阴，可下之。(原注：下之当以温药。)
夫病人饮水多，必暴喘满。凡食少饮多，水停心下，甚者，则悸；微者，短气；脉双弦者，寒也，皆大下后里虚。脉偏弦者，饮也。
脉诀歌
【望舌】
舌苔呈现霉酱色，是夹带食积的伤寒病。这是由于食物停滞在太阴脾经，郁结阻滞在中焦，导致气机不得宣发透达，久而久之，发酵形成酱色的舌苔。其症状表现为腹部胀满、时而疼痛的，用桂枝汤（Cinnamon Twig Decoction）加枳实、厚朴、陈皮、半夏治疗。如果是因食用冷食引起的，加入炮姜；如果疼痛剧烈的，加入大黄。（原注：舌苔霉黄，是由湿热郁滞在中焦所致）。
舌苔呈现蓝色，是肝脏的本色显露。疾病经过发汗或攻下治疗后，胃气受到极度损伤，心火失去根基，脾土失去依托，那么肺金无法生成，肝木失去制约，反侮脾土，所以舌苔颜色像靛蓝一样，属于不治之证。如果仅隐约可见蓝色纹路且颜色不深的，是木受金伤，脏气尚未绝灭，脉象不沉涩而微弦的，用小柴胡汤（Minor Bupleurum Decoction）去掉黄芩，加入炮姜、肉桂为主治方。
【望目】
眼睛喜欢睁开的，属阳证。眼睛喜欢闭合的，属阴证。眼睑逐渐肿胀，是有水湿停聚。眼下呈灰色，是有寒饮。眼睛疼痛，属于阳明经表证。眼睛发红，是经络热邪极盛。目光呆滞无神的，是阳明腑实证。眼睛没有精光的，是肾气素来虚弱。眼睛昏花、鼻干想含水漱口但不咽下的，是阳热过盛即将发生鼻衄。眼睛发黄、头部出汗且厌恶进食的，是湿气即将转化为黄疸。凡是眼神昏暗、眼球上翻、眼球后缩、眼球直视不动、戴眼反折的，都难以治疗。
【望鼻】
鼻头颜色发青、腹中冷痛的（原注：这是木克土的表现），主死。鼻头颜色微黑的，有水气；颜色白的，是失血；颜色红的，是有风邪；颜色黄的，是胸膈有寒，谷气不能运化，而有痰积；颜色黑而干枯的，是劳损。流清鼻涕的，是伤寒。鼻鸣且干呕的，是伤风。鼻孔干燥且脉浮数的，将要发生鼻衄。呼吸鼾声重且言语困难的，是风温。鼻孔扇动的，是肺风。鼻子像烟煤一样黑的，是阳毒。
【望唇】
嘴唇红而焦枯的，是脾热。嘴唇红而肿胀的，是胃热。青黑色的，是阴寒。淡白色的，是气虚。唇口生疮的，是狐惑病。嘴唇上部燥裂的，是热邪在肌肉。嘴唇和牙齿都焦黑的，应当急下攻逐。如果嘴唇四周发青，口周黧黑，张口像鱼嘴一样，气息不再回还，唇口颤动不止，以及人中沟反平的，都是死证。
【闻声】
声音清亮与平时无异的，虽然生病也容易痊愈。声音沉重伴鼻塞的，是伤风。声音像从瓮中发出的，是中湿。语言迟缓艰涩的，是风痰。话没说完又重复说的，是气短。骂人不知避讳亲疏的，是神志错乱发狂。说话懒慢怯懦，先轻后重的，是内伤中气。说话壮厉，先重后轻的，是外感邪气盛。诊察时皱眉呻吟，是头痛痛苦；呻吟得不能行走起身，是腰足痛；叫喊并用手按住心口，是脘腹痛；诊察时叹气，是气郁结；扭动身体呻吟，是腹痛；形体消瘦声音嘶哑、痨瘵病难治的，是咽喉中有肺花疮；突然失音的，是风痰伏火、或暴怒叫喊所致；坐着气喘急促，是痰火病；久病气喘急促，是危重证。诊察时自言自语，首尾不应答，是神伤；新病呃逆，不是火证就是寒证；久病呃逆，是胃气欲绝。（原注：病人说话声音寂静无声，却喜欢惊呼的，是骨节间有病；说话声音低沉不清晰的，是心膈间有病；声音细小而长的，是头部有病。）
【问证】
一问发病从哪一天开始，二问是否有恶寒与发热，三问是否有头痛身腰痛，四问是否曾伤食，五问四肢冷还是温，六问是否有呕逆及口渴与否，七问是否有胸闷或腹痛，八问大小便通利还是闭塞，九问口味偏好什么，十问是否有喜怒劳忧郁等情志因素。若诊治妇女需更加详细，必须询问月经行止情况。问诊时患者懒于回答或只是点头，不是耳聋就是虚怯。
人每呼气脉搏跳动两次，每吸气脉搏也跳动两次，一呼一吸之间（定息），脉搏跳动五次，加上偶尔的长息（太息），称为平人（正常健康的人）（原注：呼气时心与肺的气外出，吸气时肝与肾的气入内。一呼脉搏运行三寸，一吸脉搏运行三寸，日夜共一万三千五百息）。一呼脉搏动一次、一吸脉搏动一次，称为少气（原注：《脉诀》认为是败脉，《难经》认为是离经脉）。一呼脉搏动三次，一吸脉搏动三次，称为躁（原注：指脉搏躁动急促如数脉的状态）。尺部皮肤发热，称为病温（原注：尺部属阴，寸部属阳，阴阳俱热）。尺部不发热，脉滑，称为病风；脉涩，称为痹（原注：滑脉为阳盛，涩脉为血少）。一呼脉搏动四次以上的（原注：《脉诀》认为是脱脉，《难经》认为是夺精脉），脉搏停止不来的，脉搏忽快忽慢的，脉搏没有胃气的（原注：没有和缓之象），都主死。
春脉如弦。春脉对应肝脏，属东方木，是万物开始生长的季节，所以其脉气来时轻软而滑。端正直长，称为弦。弦而柔软，像提起长竿的末梢，称为肝平（正常）；弦而坚实，像触摸长竿，称为肝病；弦而劲急，像新拉开的弓弦，称为肝死（原注：肝的死脉，轻取弱，重按如绳索不来，或弯曲如蛇行，主死）。
夏脉如钩。夏脉对应心脏，属南方火，是万物盛大生长的季节，所以其脉气来时旺盛去时衰弱，称为钩。累累如贯珠，称为心平；喘喘相连属，其中微曲，称为心病；前曲后居，像拿着带钩的腰带，称为心死（原注：真心脉至坚而搏。像触摸薏苡子，主死。心的死脉，轻取坚实，像麻豆，重按更觉躁疾，主死）。
秋脉如浮。秋脉对应肺脏，属西方金，是万物收成季节，所以其脉气来时急去时散，轻虚而浮，称为浮。浮而缓，像落下的榆荚，称为肺平；浮而涩，像触摸鸡羽，称为肺病；浮而虚，像风吹毛发，称为肺死（原注：肺的死脉，轻取虚，重按弱如葱叶，下无根，主死）。
冬脉如营。冬脉对应肾脏，属北方水，是万物闭藏的季节，所以其脉气来时沉而搏指，称为营。累累如钩，重按坚实，称为肾平；来时像牵引葛藤，重按更坚，称为肾病；发作时像争夺绳索，弹石般坚硬，称为肾死（原注：肾的死脉，轻取坚，重按乱如转丸，益下入尺，主死）。
脾脉属土，是孤脏以灌溉四方脏腑的。脉气和柔相离，像鸡踩地，称为脾平；脉实而盈数，像鸡举足，称为脾病；像鸟之喙，像屋顶漏水，像水流淌，称为脾死（原注：脾的死脉，轻取大坚，重按如覆杯洁洁，状如摇动，主死）。五脏都禀受胃气，脏气不能自己到达手太阴肺经，必须依赖胃气才能到达手太阴肺经并运行于诸经，所以脉以胃气为本（原注：脉来和缓为有胃气）。
脉顺应阴阳，病易愈；违背阴阳，病难愈（原注：阳病见阳脉，阴病见阴脉，为顺；阳病见阴脉，阴病见阳脉，为逆）。春夏季节脉应浮大，若见沉涩；秋冬季节脉应沉小，若见浮大。或者春得秋脉，夏得冬脉，秋得夏脉，冬得长夏脉，称为逆四时，病难愈。风热病而脉静，泄泻及失血病而脉实，病在内；脉虚，病在外；脉涩坚者，都难治。春不见沉脉，夏不见弦脉，冬不见涩脉，秋不见数脉，这叫四塞（原注：虽然本气专旺，但母气已绝）。
经脉在里（原注：直行经隧之内），分支横出的称为络，络的别支称为孙。络脉和经脉看不出虚实，通过气口（寸口）可以知晓（原注：气口又名寸口，是百脉的大会合处）。
饮食进入胃，游溢精气，向上输送到脾。脾气散布精微，向上归于肺。肺朝会百脉，输精于皮毛，通调水道，向下输送到膀胱。
脉是血的府库。脉长则气治，脉短则气病，脉数则烦心，脉大则病进。上部（原注：寸口）盛，则气高；下部（原注：尺中）盛，则气胀。代脉则气衰，细脉则气少，涩脉则心痛（原注：血少）。脉至如涌泉，去如弦绝，都不治（原注：右气口急，脉大而数者，中下热而涌，为涌疝。越人）。
邪气盛则实证，精气夺则虚证。气热脉满是谓重实，脉滑则顺，脉涩则逆。尺寸脉皆虚，是谓重虚，脉滑则生，脉涩则死。肠澼便血，身热则死，身寒则生；肠澼下沫，脉沉则生，脉浮则死（原注：痢疾忌身热脉浮）；肠澼下脓血，脉悬绝则死，脉滑大则生。癫疾的脉，大滑可自行痊愈，小坚则难治。消瘅病久，脉实大可治，脉悬小坚则不治。
脉沉而坚，病在中；脉浮而盛，病在外。脉小弱而涩，是久病；脉浮滑而疾，是新病。脉急，称为疝瘕。少腹痛，脉滑为风，脉涩为痹；缓而滑为热中，盛而紧为胀。脉一日一夜循环五十周（原注：昼行阳二十五度，夜行阴二十五度），以滋养五脏之精，五十次跳动而不出现代脉的，五脏都受气；四十次跳动出现一次代脉的，一脏无气；三十次跳动出现一次代脉的，二脏无气；二十次跳动出现一次代脉的，三脏无气；十次跳动出现一次代脉的，四脏无气；不满十次跳动就出现代脉的，五脏无气，预知短期死亡。
腹胀身热而脉大的，腹鸣而满、四肢清冷、泄泻而脉大的，鼻衄不止而脉大的，咳嗽且尿血、形体脱失、脉小而劲的，咳嗽且身热、形体脱失、脉小而疾的，都是逆脉，不超过十五日而死。腹大胀、四肢清冷、形体脱失、泄泻严重，是一逆；腹胀，便血，脉大，时有时无，是二逆；咳嗽且尿血，形肉脱失，脉搏强劲，是三逆；呕血，胸满引背，脉小而疾，是四逆；咳嗽呕吐，腹胀，完谷不化，脉绝，是五逆。像这样的，即死。
热病而脉静的，汗出后脉反而盛躁的，患泄泻而脉洪大的，著痹、肌肉溃烂身热、而脉偏绝的，淫邪夺形、面色白身热、下血鼻衄的，寒热夺形、脉坚搏的，都是逆脉。
内热甚而脉反不鼓动，是阳盛格阴于外；内寒而脉反鼓动甚是阴盛格阳于外，这叫脉证相反（原注：脉大而实，来势艰难，是厥阴之动，疝气客于膀胱，小腹肿。越人）。
【诊候】
诊法：通常在平旦、饮食未进、气血未乱之时，才可以诊察有病的脉象。察脉有纲纪，从阴阳开始。起始有经络，从五行相生。生长有度数，以四时为适宜。持脉有道，虚心宁静为保。春日脉浮，像鱼游在波中；夏日脉在肤，泛泛乎万物有余；秋日脉下肤，像蛰虫将去；冬日脉在骨，像蛰虫周密。尺部外侧以候肾，尺部内侧以候腹（原注：左尺兼主小肠、膀胱、前阴之病，右尺兼主大肠、后阴之病。喻嘉言说：小肠当候于左尺，大肠、膀胱当候于右尺）；左关以候肝膈，右关以候脾胃；左寸候心与膻中；右寸候肺与胸中（原注：寸主上焦，以候咽喉；关主中焦，以候膈中；尺主下焦，以候腹中）。
浮取而脉沉，心腹有积；沉取而脉浮，身有热（原注：沉取大而坚、浮取大而紧者，病主在肾）。上部盛而下部无（原注：阳气升而不降），腰足清冷；下部盛而上部无（原注：阳气降而不升），头项痛；按之至骨，脉气少的，腰脊痛而身有痹。
脉分三部（原注：寸关尺），有九候（原注：浮中沉），必须先度量其体形的肥瘦（原注：肥人脉常沉，瘦人脉常浮），以调节其气的虚实（原注：肥人血实气虚，瘦人气实血虚）。形体盛、脉细、少气不足以息的，危；形体瘦、脉大、胸中喘满的，死；形气相得的，生；三五不调的病，独小的病，独大的病，独疾的病，独热的病，独寒的病，独沉伏的病。九候皆沉细弦绝的，死；皆盛躁喘数的，死；乍疏乍数、乍迟乍疾的，死；九候虽调、形肉已脱的，死；目内陷的，死（原注：肾脉涩而不联属者，月事不下）。
尺肤热甚、脉盛躁的，病温；盛而滑的，病将出；尺肤寒、脉小的，泄泻、少气。
关以前者是阳之动，浮过而直上鱼际的，称为溢。这是阴乘阳位，称为外关内格。病主外热而液汗不通，内寒而腹满吐食。关以后者是阴之动，沉过而直入尺部的，称为覆。这是阳乘阴位，称为内关外格。病主内热而大小便闭，外寒而手足厥冷，均主死。
浮、长、滑，属阳；沉、短、涩，属阴。浮取损小、沉取实大的，阴盛阳虚；沉取损小、浮取实大的，阳盛阴虚。（原注：大概脉浮紧者为表邪，脉沉实者为里邪。）
至脉从下而上，损脉从上而下。一损皮毛，皮聚而毛落；二损血脉，不荣脏腑；三损肌肉，肌肉消瘦，饮食不能化为肌肤；四损于筋，筋缓不能自收持；五损于骨，骨痿不能起于床。损其肺者，益其气；损其心者，调其荣卫；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。
一呼三至、一吸三至，为新病。前大后小，即头痛目眩。前小后大，即腹满气短。
一呼四至、一吸四至，为病甚。脉洪大的，苦烦满；沉细的，腹中痛；滑的，中热；涩的，中湿。
一呼一至、一吸一至，名曰损。人虽能行，犹当著床，血气皆不足故也。
上部有脉，下部无脉，其人当吐不吐的，死；上部无脉，下部有脉，犹有生机。
病积聚的，脉结或伏。假如脉结伏而内无积聚，脉浮结而外无痼疾，或有积聚而脉不结伏，有痼疾而脉不浮结，为脉不应病，难治。
脉居阴部而反见阳脉的，为阳乘阴脉。虽时沉涩而短，此谓阳中伏阴。脉居阳部而反见阴脉的，为阴乘阳脉。虽时浮滑而长，此谓阴中伏阳。
病若闭目不欲见人，当得肝脉强急而长，反得肺脉浮涩而短的，死。
病若谵语妄言，身当有热，脉当洪大而反手足厥冷、脉沉细而微的，死。
病若大腹而泄，脉当微细而涩，反紧大而滑的，死。（原注：此五条俱脉证相反。）
病人脉浮在前部（寸部），其病在表；浮在后部（尺部），其病在里。若前后俱浮，则表里兼病。（原注：关前为阳，表病主阳。关后为阴，里病主阴。）
风令脉浮，寒令脉急（原注：急即紧之象）。雾伤皮腠，湿流关节，食伤脾胃，风伤皮毛，热伤血脉，极寒伤经，极热伤络。
夫脉当取太过不及。阳脉微，阴脉弦，即胸痹而痛。所以然者，上焦阳虚而阴邪乘之也。
趺阳脉微弦，法当腹满。不满者，必便难，两胠疼痛。此虚寒欲从下而上也，当以温药服之。（原注：此弦脉，寒从内生，阴邪不散，则阴窍不通，故便难。）
寸脉弦者，即胁下拘急而痛，其人啬啬恶寒。（原注：此弦脉，寒从外至。）
脉数而紧乃弦。状如弓弦，按之不移。脉数弦者，当下其寒。脉紧大而迟者，必心下坚痞；脉大而紧者，阳中有阴，可下之。（原注：下之当以温药。）
夫病人饮水多，必暴喘满。凡食少饮多，水停心下，甚者，则悸；微者，短气；脉双弦者，寒也，皆大下后里虚。脉偏弦者，饮也。
脉诀歌
[Observation of Tongue]
A moldy, sauce-colored tongue coating indicates cold damage complicated by food retention. This is caused by food stagnating in the Taiyin Spleen meridian, obstructing and depressing the Middle Jiao, preventing Qi from dispersing and venting. Over time, it ferments into a sauce-colored coating. If the symptoms manifest as abdominal fullness and intermittent pain, Guizhi Tang (Cinnamon Twig Decoction) with Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Chenpi (Tangerine Peel), and Banxia (Pinellia Rhizome) should be used. If caused by consuming cold food, Paojiang (Prepared Ginger) should be added; if the pain is severe, Dahuang (Rhubarb Root) should be added. (Original note: Moldy yellow tongue coating is due to damp-heat stagnation in the Middle Jiao).
A blue tongue coating represents the pure color of the Liver organ. After the disease has been treated with sweating or purging methods, Stomach Qi is extremely damaged, Heart Fire loses its foundation, and Spleen Earth loses its support. Consequently, Lung Metal cannot be generated, Liver Wood loses its restraint, and rebels against Spleen Earth. Thus, the tongue coating becomes indigo-blue, which is an incurable condition. If only faint blue streaks are visible and not deep, it indicates Wood injured by Metal, and the Zang Qi is not yet exhausted. If the pulse is not deep and choppy but slightly wiry, Xiaochaihu Tang (Minor Bupleurum Decoction) with Huangqin (Scutellaria Root) removed, and Paojiang (Prepared Ginger) and Rougui (Cinnamon Bark) added, is the primary treatment.
[Observation of Eyes]
Eyes that prefer to be open indicate a Yang syndrome. Eyes that prefer to be closed indicate a Yin syndrome. Gradual swelling of the eyelids indicates water retention. Grayish discoloration under the eyes indicates cold fluid retention. Eye pain belongs to the Yangming exterior syndrome. Red eyes indicate excessive heat in the meridians. A dull gaze without spirit indicates Yangming fu-organ excess syndrome. Eyes lacking luster indicate inherent deficiency of Kidney Qi. Dazed eyes, dry nose, and rinsing the mouth with water without swallowing indicate excessive Yang heat about to cause epistaxis. Yellow eyes, head sweating, and aversion to eating indicate dampness about to transform into jaundice. Any condition involving dim vision, upward deviation of the eyes, retraction of the eyes, fixed staring, or "daiyan" (eyes fixed upward) is difficult to treat.
[Observation of Nose]
A bluish nose tip with cold pain in the abdomen (original note: Wood overcoming Earth) indicates death. A slightly black nose tip indicates water qi; white indicates blood loss; red indicates wind pathogen; yellow indicates cold in the chest and diaphragm, failure to transform grain Qi, and phlegm accumulation; dry and black indicates consumptive disease. Clear nasal discharge indicates cold damage. Nasal congestion with dry heaving indicates wind injury. Dry nostrils with a floating and rapid pulse indicate impending epistaxis. Heavy snoring and difficulty speaking indicate wind-warmth. Flaring nostrils indicate lung wind. A nose resembling soot indicates Yang toxicity.
[Observation of Lips]
Red and parched lips indicate spleen heat. Red and swollen lips indicate stomach heat. Blue-black lips indicate Yin cold. Pale white lips indicate Qi deficiency. Sores on the lips and mouth indicate Huhuo disease (aphthous stomatitis/complex ulcer). Dry cracks on the upper lip indicate heat in the muscles. Blackened lips and teeth require urgent purgation. If the corners of the mouth turn blue, the area around the mouth turns dark, the mouth opens like a fish's, breath does not return, lips tremble continuously, and the philtrum flattens, these are all signs of death.
[Auscultation and Olfaction of Voice]
A voice clear and unchanged from normal indicates easy recovery despite illness. A heavy voice with nasal congestion indicates wind injury. A voice sounding as if from a jar indicates dampness in the middle. Sluggish and hesitant speech indicates wind-phlegm. Repeating words at the end of a sentence indicates shortness of Qi. Cursing without avoiding relatives indicates mental confusion and mania. Lazy and timid speech, starting light and becoming heavy, indicates internal injury to Middle Qi. Loud and fierce speech, starting heavy and becoming light, indicates exuberant external pathogenic factors. Frowning and groaning during diagnosis indicates painful headache; groaning inability to walk or rise indicates waist and foot pain; shouting while pressing the heart region indicates epigastric pain; sighing during diagnosis indicates Qi stagnation; twisting and groaning indicates abdominal pain; emaciation with hoarseness in incurable tuberculosis indicates lung flower sores in the throat; sudden aphonia is caused by latent wind-phlegm and fire, or violent shouting in anger; sitting with shortness of breath indicates phlegm-fire disease; chronic shortness of breath is a critical sign. Mutters alone without responding to questions indicates Spirit injury. New onset hiccups indicate either fire or cold; chronic hiccups indicate impending exhaustion of Stomach Qi. (Original note: If a patient speaks silently but likes to startle with a shout, the disease is in the joints; if the voice is low and unclear, the disease is in the heart and diaphragm; if the voice is fine and long, the disease is in the head.)
[Inquiry into Symptoms]
First, ask when the illness began. Second, ask about aversion to cold and fever. Third, ask about headache and body/lower back pain. Fourth, ask about dietary indiscretion. Fifth, ask about cold or warmth of the four limbs. Sixth, ask about vomiting, regurgitation, and thirst. Seventh, ask about chest tightness or abdominal pain. Eighth, ask about the patency or obstruction of urination and defecation. Ninth, ask about taste preferences. Tenth, ask about emotional states such as anger, joy, labor, depression, and worry. For female patients, inquire further regarding the menstrual cycle. If the patient answers lazily or merely nods, it indicates deafness or deficiency-cold weakness.
Pulse Principles from *Suwen* and *Lingshu*
In one expiration, the pulse beats twice; in one inspiration, it also beats twice. Between breaths (fixed息), the pulse beats five times, plus occasional deep sighs (Tai Xi), called a healthy person (Ping Ren) (Original note: Exhalation involves Heart and Lung Qi moving out; inhalation involves Liver and Kidney Qi moving in. In one expiration, pulse moves 3 cun; in one inspiration, pulse moves 3 cun. Total 13,500 breaths per day and night). One beat per expiration and one per inspiration is called Shao Qi (deficient Qi) (Original note: *Mai Jue* considers this a failing pulse; *Nan Jing* calls it Li Lei Pulse). Three beats per expiration and three per inspiration is called Zao (restless) (Original note: Indicates a rapid pulse state). Heat in the Chi (cubital fossa) area indicates Warm Disease (Yuan note: Chi is Yin, Cun is Yang; both hot). No heat in Chi, slippery pulse indicates Wind Disease; choppy pulse indicates Bi Syndrome (Yuan note: Slippery indicates Yang excess; choppy indicates blood deficiency). More than four beats per expiration (Yuan note: *Mai Jue* calls this Tuo Pulse; *Nan Jing* calls it Duo Jing Pulse), pulse stopping intermittently, irregular rhythm, or lack of Stomach Qi (Yuan note: lacking harmonious and moderate quality) all indicate death.
Spring pulse resembles a string (Xian). Spring corresponds to Liver, East, Wood, and the beginning of growth. The Qi comes soft and slippery. Straight and long is Xian. Soft and string-like, like the tip of a long pole held up, is Normal Liver Pulse. Firm and string-like, like feeling a long pole, is Liver Disease. Hard and tense, like a newly strung bow, is Dead Liver Pulse (Yuan note: Dead liver pulse is weak on superficial palpation, feels like a cord on deep pressure without returning, or curved like a snake, indicating death).
Summer pulse resembles a hook (Gou). Summer corresponds to Heart, South, Fire, and peak growth. The Qi comes strong and departs weak, called Gou. Beads strung together is Normal Heart Pulse. Rapid and connected with slight curvature is Heart Disease. Curved front and stationary back, like holding a belt hook, is Dead Heart Pulse (Yuan note: True heart pulse is hard and rolling. Like feeling Coix seeds, indicates death. Dead heart pulse is solid on superficial palpation, like hemp seeds, more restless on deep pressure, indicating death).
Autumn pulse resembles floating (Fu). Autumn corresponds to Lung, West, Metal, and harvest. The Qi comes urgent and scatters, light and void, called Fu. Floating and slow, like falling elm seeds, is Normal Lung Pulse. Floating and choppy, like feeling chicken feathers, is Lung Disease. Floating and empty, like wind blowing hair, is Dead Lung Pulse (Yuan note: Dead lung pulse is empty on superficial palpation, weak like a green onion leaf on deep pressure, without root, indicating death).
Winter pulse resembles Ying (camp/deep). Winter corresponds to Kidney, North, Water, and storage. The Qi comes deep and firm, called Ying. Bead-like and firm on pressure is Normal Kidney Pulse. Coming like pulling vines, harder on pressure, is Kidney Disease. Emerging like a tug-of-war, snapping like stones, is Dead Kidney Pulse (Yuan note: Dead kidney pulse is hard on superficial palpation, chaotic like rolling pills on deep pressure, descending into Chi, indicating death).
Spleen pulse is Earth, the solitary organ irrigating the four directions. Harmonious and soft, like a chicken treading ground, is Normal Spleen Pulse. Solid and full-rapid, like a chicken lifting its foot, is Spleen Disease. Like a bird's beak, like a leaking roof, like flowing water, is Dead Spleen Pulse (Yuan note: Dead spleen pulse is large and hard on superficial palpation, like an inverted cup, clean and shaking on deep pressure, indicating death). All five Zang organs derive Qi from the Stomach. Zang Qi cannot reach the Hand-Taiyin Lung meridian alone; it must rely on Stomach Qi to reach the Hand-Taiyin and circulate through the meridians. Therefore, the pulse is rooted in Stomach Qi (Yuan note: Harmonious and moderate pulse indicates presence of Stomach Qi).
If the pulse follows Yin-Yang principles, the disease is easily cured; if it opposes them, it is difficult to cure (Yuan note: Yang disease with Yang pulse is favorable; Yin disease with Yin pulse is favorable. Yang disease with Yin pulse, or Yin disease with Yang pulse, is unfavorable). Floating and large pulses in Spring/Summer, or deep and choppy pulses in Autumn/Winter are normal variations. However, getting Autumn pulse in Spring, Winter pulse in Summer, Summer pulse in Autumn, or Long Summer pulse in Winter is called opposing the Four Seasons, and the disease is difficult to cure. Wind-heat with a quiet pulse, diarrhea/blood loss with a solid pulse (disease in interior), or empty pulse (disease in exterior), and choppy/firm pulses are all difficult to treat. Absence of deep pulse in Spring, wiry in Summer, choppy in Winter, or rapid in Autumn is called Si Sai (Four Obstructions) (Yuan note: Although the ruling Qi is prosperous, the Mother Qi is exhausted).
Jing Mai (Meridians) are inside (Yuan note: Inside the straight meridians); branches going horizontally are Luo Mai (Collaterals); distinct branches of Luo are Sun Mai (Sun Collaterals). The emptiness or fullness of Luo and Jing cannot be seen directly but is known via Qikou (Cunkou/Radial Artery) (Yuan note: Qikou, also known as Cunkou, is the great convergence of all pulses).
Food enters the Stomach, its essence overflows and travels up to the Spleen. Spleen Qi scatters the essence, sending it up to the Lung. Lung governs all vessels, distributing essence to skin and hair, regulating water passages, and transmitting downwards to the Bladder.
Pulse is the residence of Blood. Long pulse indicates regulated Qi; short indicates diseased Qi; rapid indicates vexation in Heart; large indicates progression of disease. Upper excess (Yuan note: Cun position) indicates high Qi; lower excess (Yuan note: Chi position) indicates abdominal distension. Dai (moderation/interruption) pulse indicates Qi decline; thin pulse indicates Qi scarcity; choppy pulse indicates Heart pain (Yuan note: Blood deficiency). Pulse coming like a spring gushing and leaving like a broken string are both untreatable (Yuan note: Urgent right Qikou, large and rapid pulse, heat surging from middle/lower, causing Yong Hernia. Yue Ren).
Excess of pathogenic Qi constitutes Excess syndrome; depletion of essential Qi constitutes Deficiency syndrome. Heat in Qi with full pulse is Heavy Excess; slippery is favorable, choppy is unfavorable. Empty Cun and Chi pulses constitute Heavy Deficiency; slippery indicates survival, choppy indicates death. Intestinal dysentery with bloody stool: fever indicates death, cold indicates survival; dysentery with mucus: deep pulse indicates survival, floating indicates death (Yuan note: Dysentery contraindicates fever and floating pulse); dysentery with pus and blood: hanging-abrupt pulse indicates death, slippery-large indicates survival. Epilepsy pulse: large and slippery will self-heal; small and firm is untreatable. Chronic Xiao Dao disease: large and solid pulse is treatable; hanging-small and firm is untreatable.
Deep and firm pulse indicates disease in the interior; floating and vigorous pulse indicates disease in the exterior. Small, weak, and choppy indicates chronic disease; floating, slippery, and rapid indicates new disease. Urgent pulse indicates Shan Jia (hernia/mass). Lower abdominal pain: slippery indicates Wind, choppy indicates Bi; slow and slippery indicates Heat in Middle, vigorous and tight indicates distension. Pulse circulates fifty times a day and night (Yuan note: Twenty-five cycles in Yang during day, twenty-five in Yin during night) to nourish Zang essence. Fifty beats without interruption means all five Zang receive Qi; one interruption in forty beats means one Zang lacks Qi; one in thirty means two Zang lack Qi; one in twenty means three Zang lack Qi; one in ten means four Zang lack Qi; less than ten beats before interruption means five Zang lack Qi, predicting imminent death.
Abdominal distension with fever and large pulse; borborygmus, fullness, cold limbs, diarrhea with large pulse; unceasing epistaxis with large pulse; coughing with hematuria, emaciation, small and firm pulse; coughing with fever, emaciation, small and rapid pulse—all are adverse pulses, death within fifteen days. Abdominal distension, cold extremities, emaciation, severe diarrhea is First Adverse; abdominal distension, bloody stool, large pulse with intermittence is Second Adverse; coughing with hematuria, flesh wasting, pulsating third is Third Adverse; vomiting blood, chest fullness radiating to back, small and rapid pulse is Fourth Adverse; coughing/vomiting, abdominal distension, undigested stool, absent pulse is Fifth Adverse. Such cases result in death.
Heat disease with quiet pulse; sweating followed by rapid/restless pulse; diarrhea with洪大 (large/surging) pulse; Bi syndrome with muscle erosion and fever with absent pulse; pathogenic invasion causing emaciation, white complexion, fever, bleeding; cold-heat alternating with emaciation and firm/pulsating pulse—all are adverse pulses.
Internal heat with pulse failing to surge indicates Yang excess repelling Yin to the exterior; internal cold with pulse surging excessively indicates Yin excess repelling Yang to the exterior. This is called pulse-symptom contradiction (Yuan note: Large and solid pulse, difficult arrival, indicates Jueyin movement, hernia Qi in Bladder, lower abdominal swelling. Yue Ren).
[Diagnosis Methods]
Diagnosis is best performed at dawn, before eating, when Qi and Blood are undisturbed. Observation has order, starting with Yin-Yang. Origin has meridians, arising from Five Elements. Growth has measure, suitable for Four Seasons. Holding pulse requires the Way, with emptiness and tranquility as guarantee. Spring pulse floats like a fish in waves; Summer pulse is at the skin, abundant like all things; Autumn pulse descends to the skin, like insects preparing to hibernate; Winter pulse is in the bone, like insects fully concealed. Outer Chi observes Kidney; Inner Chi observes Abdomen (Yuan note: Left Chi governs Small Intestine, Bladder, anterior yin; Right Chi governs Large Intestine, posterior yin. Yu Jiayan says: Small Intestine at Left Chi, Large Intestine and Bladder at Right Chi); Left Guan observes Liver/Diaphragm; Right Guan observes Spleen/Stomach; Left Cun observes Heart/Shanzhong; Right Cun observes Lung/Chest (Yuan note: Cun governs Upper Jiao, observing throat; Guan governs Middle Jiao, observing diaphragm; Chi governs Lower Jiao, observing abdomen).
Floating palpation revealing deep pulse indicates accumulation in Heart/Abdomen; Deep palpation revealing floating pulse indicates fever in body (Yuan note: Deep large/firm, floating large/tight indicates disease in Kidney). Upper excess, lower absence (Yang rising not descending) causes cold waist/feet; Lower excess, upper absence (Yang descending not ascending) causes head/neck pain. Pressing to bone with weak Qi indicates waist/spine pain and Bi syndrome.
Pulse has three positions (Yuan note: Cun, Guan, Chi) and nine inspections (Yuan note: Superficial, Middle, Deep). First assess body fat/thinness (Yuan note: Fat people usually have deep pulses; thin people usually have floating pulses) to adjust Qi excess/deficiency (Yuan note: Fat people: Blood excess, Qi deficiency; Thin people: Qi excess, Blood deficiency). Full form, thin pulse, shortness of breath is critical; Thin form, large pulse, chest wheezing/fullness is fatal; Form and Qi matching indicates life; Discrepancies indicate disease. Nine inspections all deep/small/wiry/absent indicate death; all vigorous/restless/rapid indicate death; irregular intervals indicate death; harmonious pulses but wasted flesh indicate death; sunken eyes indicate death (Yuan note: Choppy Kidney pulse without connection indicates amenorrhea).
Floating and slippery pulse indicates new disease. Small and choppy pulse indicates chronic disease.
Chi skin very hot, pulse vigorous/restless indicates Warm Disease; vigorous and slippery indicates disease exiting; Chi skin cold, pulse small indicates diarrhea and deficient Qi.
*Nan Jing* Pulse Methods
Before Guan is Yang movement; floating past and straight to Fish Sea is Yi (Overflow). This is Yin invading Yang position, called Exterior Guan Interior Ge. Disease manifests as exterior heat with no sweat, interior cold with abdominal fullness and vomiting. After Guan is Yin movement; sinking past and straight into Chi is Fu (Cover). This is Yang invading Yin position, called Interior Guan Exterior Ge. Disease manifests as interior heat with constipation/urinary retention, exterior cold with cold limbs, all indicating death.
Floating, long, slippery are Yang; deep, short, choppy are Yin. Damaged/small on floating, solid/large on deep indicates Yin excess/Yang deficiency; Damaged/small on deep, solid/large on floating indicates Yang excess/Yin deficiency. (Yuan note: Generally, floating-tight is exterior pathogen; deep-solid is interior pathogen).
Zhi pulse rises from below; Sun pulse descends from above. First Sun affects skin/hair; second Sun affects blood/vessels not nourishing Zang/Fu; third Sun affects muscles wasting, food not transforming; fourth Sun affects tendons relaxing; fifth Sun affects bones atrophying. Damage to Lung: benefit Qi; Damage to Heart: regulate Ying/Wei; Damage to Spleen: regulate diet, adjust cold/warmth; Damage to Liver: soothe center; Damage to Kidney: benefit Essence.
Three beats per expiration/inspiration is new disease. Large front/small back indicates headache/dizziness; Small front/large back indicates abdominal fullness/shortness of breath.
Four beats per expiration/inspiration is severe disease. Large pulse indicates vexation/fullness; deep/small indicates abdominal pain; slippery indicates interior heat; choppy indicates interior dampness.
Five beats per expiration/inspiration indicates fatigue; fluctuating size is difficult to treat.
One beat per expiration/inspiration is called Sun. Patient can walk but should stay in bed due to Qi/Blood deficiency.
Six beats per expiration/inspiration, or one beat every two breaths, are death pulses.
Pulse present above, absent below: if patient should vomit but does not, death; Pulse absent above, present below: still has vitality.
Accumulation diseases have knotted or hidden pulses. If knotted/hidden but no accumulation, or floating/knotted but no chronic disease, or having accumulation/disease but pulse doesn't match, it is pulse-disease mismatch, difficult to treat.
Pulse in Yin position showing Yang pulse is Yang invading Yin. Even if sometimes deep/choppy/short, this is Yang hiding Yin. Pulse in Yang position showing Yin pulse is Yin invading Yang. Even if sometimes floating/slippy/long, this is Yin hiding Yang.
Extreme Yang leads to Mania; Extreme Yin leads to Depression/Epilepsy. Loss of Yang leads to seeing ghosts; Loss of Yin leads to blindness.
Disease with closed eyes aversion to light should have strong/long Liver pulse; if instead Floating/Choppy/Short Lung pulse appears, death.
Disease with open eyes, thirst, and epigastric hardness should have tight/solid/rapid pulse; if instead deep/soft/micro pulse appears, death.
Disease with vomiting blood/epistaxis should have deep/small pulse; if instead floating/large/firm pulse appears, death.
Disease with delirium and fever should have large pulse; if instead cold limbs and deep/micro pulse appear, death.
Disease with large abdomen and diarrhea should have micro/choppy pulse; if instead tight/large/slippy pulse appears, death. (Yuan note: These five cases are all pulse-symptom contradictions.)
Excerpts from *Jingui Yaolue* Pulse Methods
Floating pulse in Cun position indicates exterior disease; floating in Chi position indicates interior disease. Both floating indicates exterior-interior concurrent disease. (Yuan note: Before Guan is Yang, exterior disease governs Yang; After Guan is Yin, interior disease governs Yin.)
Wind makes pulse float; Cold makes pulse urgent (tight). Fog injures skin/collaterals; Damp flows to joints; Food injures Spleen/Stomach; Wind injures skin/hair; Heat injures blood vessels; Extreme Cold injures meridians; Extreme Heat injures collaterals.
Meridian trembling leads to Wei syndrome over time.
Pulse should assess excess and deficiency. Micro Yang pulse, wiry Yin pulse indicates Chest Bi with pain. Reason: Upper Jiao Yang deficiency allowing Yin pathogen to invade.
Duyang pulse micro-wiry indicates abdominal fullness. If not full,必有 difficulty defecating and flank pain. This is deficiency-cold rising from below, treat with warming herbs. (Yuan note: Wiry pulse here indicates cold generating internally, Yin pathogen not dispersing, Yin orifices blocked, hence difficulty defecating).
Cun pulse wiry indicates hypochondriac stiffness/pain and aversion to cold. (Yuan note: Wiry pulse here indicates cold from exterior).
Rapid and tight pulse becomes wiry. Like bowstring, immovable on pressure. Rapid-wiry pulse requires purging cold. Tight-large-slow pulse indicates epigastric hardness; Large-tight pulse indicates Yang containing Yin, can be purged. (Yuan note: Purge with warming herbs).
Patient drinking much water causes sudden asthma/fullness. Eating little, drinking much, water stops in Heart region: severe cases palpitations; mild cases shortness of breath. Double wiry pulse indicates cold, usually after harsh purgation causing interior deficiency. Single wiry pulse indicates fluid retention.
All deep pulses should be suspected of water retention. Body swelling/heaviness, bright face, water disease with emerging pulse indicates death.
Deep, small, adhering-to-bone pulse indicates accumulation.
Pulse Formula Song