察脉之要莫急于人迎寸口是二脉相应如两引绳阴阳均则绳之大小等凡平人之脉人迎大
于春夏寸口大于
秋冬何谓人迎喉旁取之内经所谓别于阳者也越人不尽取诸穴之脉但取手太阴之行度鱼际后一
寸
九分以配阴阳之数而得关格之脉然不先求喉手引绳之义则昧尺寸阴阳关格之所起寸四倍于尺
则上鱼而为溢故言溢者寸倍尺极矣溢之脉一名关一名内格一名阴乘之脉曰外关者自关以上外
脉也阴拒阳而出故曰外格阴生于寸动于尺今自关以上溢于鱼际而关以后脉伏行是为阴壮乘阳
而阳竭阳竭则死脉有是者死矣此所谓寸口四倍于人迎为关阴之脉者也关以后脉当一寸而沉过
者谓尺中倍于寸口至三倍则入尺而为覆故言覆者尺倍寸极矣覆之脉一名曰内关一名曰外格一
名曰乘阳之脉内关者关以下内脉也外格者阳拒阴而内入也阳生于尺动于寸今自关以下覆入尺
泽而关以前脉伏行则为阳亢乘阴而阴竭亦死脉有是者死矣此所谓人迎四倍于寸口为格阳之脉
也经曰人迎与寸口皆盛过四倍则为关格关格之脉羸不能极天地之精气而死所谓关格者覆溢是
也虽然独覆独溢则补泻以生之尺部一盛泻足少阳补足厥阴二盛泻足太阴补足少阴三盛泻足阳
明补足太阴皆二泻而一补之四盛则三阳极导之以针当尽取少阳太阴阳明之穴脉静者取三阳于
足脉数者取于手泻阳二当补于阴一至寸而反之脉有九候者寓浮中沉于寸关尺也且越人不取十
二经穴者直以二经配合于手太阴行度自尺至寸一寸九分之位复分三部部中有浮中沉以配天地
人也又曰中风木伤寒金温水热火温病起于湿湿则土病土病而诸脏受害其本生于金木水火四脏
之变也阳浮阴濡为风温阳数阴实为温毒阳濡阴急为湿温阴阳俱盛为温疟其治之也风湿取足厥
阴木手少阴火温毒专取少阳火伤寒取手太阴经手少阴火湿温取足少阴水乡人皆为我能与伤寒
语我察伤寒与四温变辩其疑似而不可乱也故定阴阳于喉手配覆溢于尺寸寓九候于浮沉分四温
于伤寒此皆扁鹊略开其端而余参以内经诸书考究而得其说审而用之顺而治之病不得逃焉(张
右史集)
考察脉诊的关键，没有比观察人迎穴和寸口穴更重要的了。这两处脉象相互对应，就像两根并引的绳子，如果阴阳平衡，那么这两根绳子的粗细就相等。大凡正常人的脉象，人迎脉在春夏季节稍大，寸口脉在秋冬季节稍大。
什么叫“人迎”？是在喉结旁取脉，《内经》称之为“别于阳”。扁鹊（越人）并没有取全身各处的脉，只是取手太阴肺经循行路线上，鱼际穴后一寸九分的位置，以此来配合阴阳的数理，从而得出关格脉象。然而，如果不先探究喉部与人手部脉象如两绳牵引的意义，就会不明白尺寸、阴阳、关格产生的根源。
如果寸口脉比尺中脉大四倍，脉气就会向上延伸至手掌大鱼际，这叫做“溢”。所以说，“溢”是指寸脉是尺脉的两倍极限。“溢”这种脉象，又名叫“关”，又名叫“内格”，又称作“阴乘之脉”。所谓“外关”，是指从关脉以上向外延伸的脉象。这是因为阴气拒绝阳气外出，所以叫“外格”。阴气生于寸口，动于尺中，现在从关脉以上溢出至鱼际，而关脉以后的脉象伏匿不行，这是阴气强盛侵犯阳气，导致阳气衰竭。阳气衰竭就会死亡，出现这种脉象的人就会死。这就是所说的“寸口脉四倍于人迎，为关阴之脉”。
如果关脉以后的一寸位置，脉象沉伏且超过限度，这叫“覆”。意思是尺中脉比寸口脉大一倍到三倍，脉气就会向下深入至尺泽穴，这叫做“覆”。所以说，“覆”是指尺脉是寸脉的两倍极限。“覆”这种脉象，又名叫“内关”，又名叫“外格”，又名叫“乘阳之脉”。“内关”是指关脉以下向内的脉象；“外格”是指阳气拒绝阴气向内侵入。阳气生于尺中，动于寸口，现在从关脉以下覆盖深入至尺泽，而关脉以前的脉象伏匿不行，这是阳气亢盛侵犯阴气，导致阴气衰竭，也会死亡。出现这种脉象的人就会死。这就是所说的“人迎脉四倍于寸口，为格阳之脉”。
《内经》说：人迎脉与寸口脉都盛大超过四倍，这就叫做“关格”。患关格病的病人，形体消瘦，无法穷尽天地精气而死。所谓的“关格”，指的就是“覆”和“溢”。
虽然如此，如果是单纯的“覆”或单纯的“溢”，可以通过补泻法来调理使之恢复。尺部脉象一盛（偏大），泻足少阳胆经，补足厥阴肝经；二盛，泻足太阴脾经，补足少阴肾经；三盛，泻足阳明胃经，补足太阴脾经。都是采用二泻一补的方法。如果是四盛，则是三阳极端亢盛，需要用针引导，应当取尽足少阳、足太阴、足阳明的穴位。如果脉象平静，则取足部的三阳经穴位；如果脉数，则取手部的穴位。泻阳经时，应当用两倍于补阴经的手法。
脉诊有“九候”，是将浮、中、沉三种指力寓于寸、关、尺三部之中。而且扁鹊不取十二经的所有穴位，而是直接将两条经脉配合在手太阴肺经的循行路线上，自尺至寸一寸九分的部位，再分为三部，每部中有浮、中、沉，以配合天、地、人三才。
又说：中风属于木，伤寒属于金，温病起于水、火，热病起于湿。湿气重则脾土受病，脾土受病则其他脏腑受害。其根本原因在于金、木、水、火四脏的变化。
脉象阳浮阴濡的是风温；阳数阴实的是温毒；阳濡阴急的是湿温；阴阳俱盛的是温疟。治疗方面：风湿取足厥阴肝经和手少阴心经；温毒专取少阳三焦经和手少阴心经；伤寒取手太阴肺经和手少阴心经；湿温取足少阴肾经。世人都认为我能谈论伤寒。我考察伤寒与四种温病的变化，辨析它们的相似与不同之处而不混乱。因此，在喉部和手部定阴阳，在尺寸部配覆和溢，在浮沉中寓九候，在伤寒中分四种温病。这些都是扁鹊略开其端，而我参考《内经》等书籍考究而得到的学说。审慎地使用它，顺应病情去治疗，疾病就无法逃脱被治愈的命运。（出自张右史集）
The key to pulse diagnosis lies most urgently in examining the Renying (Human Welcome) and Cunkou (Inch Port) pulses. These two pulses correspond to each other like two ropes pulled in opposite directions; if Yin and Yang are balanced, the thickness of these two "ropes" will be equal. Generally, in a healthy person, the Renying pulse is slightly larger during Spring and Summer, while the Cunkou pulse is slightly larger during Autumn and Winter.
What is called "Renying"? It refers to taking the pulse at the side of the throat, as mentioned in the *Neijing* (*Inner Canon*) as "distinguishing from Yang". Bian Que (Yue Ren) did not take pulses from all acupoints throughout the body but only took the position on the course of the Hand-Taiyin Lung Meridian, one cun and nine fen behind the Yuji point (LU10), to match the numerical principles of Yin and Yang, thereby deriving the Guan-Ge (Closing and Refusing) pulse pattern. However, without first understanding the significance of the Renying and Cunkou pulses being like two pulling ropes, one would remain ignorant of the origins of Chi/Cun positions, Yin/Yang dynamics, and Guan-Ge conditions.
If the Cunkou pulse is four times stronger than the Chi pulse, the pulse qi extends upward to the thenar eminence (Yu Ji area), which is called "Yi" (Overflow). Thus, "Yi" signifies that the Cun pulse reaches its extreme limit when it is double the Chi pulse. This "Yi" pulse is also named "Guan" (Closed), "Neige" (Internal Refusal), or "Yin Cheng Zhi Mai" (Pulse of Yin Overcoming Yang). The term "Waiguan" (External Closure) refers to the pulse extending outward above the Guan position. This occurs because Yin rejects Yang from exiting, hence it is called "Wage" (External Refusal). Yin originates at the Cun, moves at the Chi; now, overflowing from above the Guan to the thenar eminence, while the pulse below the Guan runs hidden, this indicates Yin is strong and overcoming Yang, leading to Yang exhaustion. When Yang exhausts, death ensues; those with such a pulse die. This is what is meant by "Cunkou pulse four times that of Renying, constituting the Guan-Yin pulse."
If the pulse at one cun below the Guan position sinks excessively, it is called "Fu" (Covering/Reversal). This means the Chi pulse is one to three times stronger than the Cunkou pulse, causing the pulse qi to extend downward into the Chize area (LU5), which is called "Fu". Thus, "Fu" signifies that the Chi pulse reaches its extreme limit when it is double the Cun pulse. This "Fu" pulse is also named "Neiguan" (Internal Closure), "Waige" (External Refusal), or "Chengyang Zhi Mai" (Pulse of Overcoming Yang). "Neiguan" refers to the pulse inward below the Guan position; "Waige" refers to Yang rejecting Yin from entering internally. Yang originates at the Chi, moves at the Cun; now, covering and sinking below the Guan into the Chize area, while the pulse above the Guan runs hidden, this indicates Yang is hyperactive and overcoming Yin, leading to Yin exhaustion, which also results in death. Those with such a pulse die. This is what is meant by "Renying pulse four times that of Cunkou, constituting the Ge-Yang pulse."
The Classics state: If both the Renying and Cunkou pulses are excessive by more than four times, it is called "Guan-Ge". Patients with Guan-Ge become emaciated and cannot sustain the essence and Qi of Heaven and Earth, leading to death. The so-called "Guan-Ge" refers specifically to "Fu" and "Yi".
Nevertheless, if there is only "Fu" or only "Yi", they can be regulated through tonification and sedation methods. If the Chi portion pulse is one-fold excessive, sedate Foot-Shaoyang Gallbladder Meridian and tonify Foot-Jueyin Liver Meridian; if two-fold excessive, sedate Foot-Taiyin Spleen Meridian and tonify Foot-Shaoyin Kidney Meridian; if three-fold excessive, sedate Foot-Yangming Stomach Meridian and tonify Foot-Taiyin Spleen Meridian. All involve two sedations and one tonification. If four-fold excessive, it represents the extremity of the Three Yang meridians; needle guidance should be used, taking points from Foot-Shaoyang, Foot-Taiyin, and Foot-Yangming meridians. If the pulse becomes calm, select points from the Three Yang meridities on the foot; if the pulse is rapid, select points on the hand. When sedating Yang, the manipulation should be twice that of tonifying Yin.
Pulse diagnosis involves "Nine Palpations," embedding Floating, Middle, and Deep pressures within the Cun, Guan, and Chi positions. Furthermore, Bian Que did not utilize all acupoints of the Twelve Meridians but directly paired two meridians along the course of the Hand-Taiyin Lung Meridian, dividing the one-cun-nine-fen segment from Chi to Cun into three parts, each containing Floating, Middle, and Deep pressures to correspond to Heaven, Earth, and Humanity.
It is also stated: Wind-stroke belongs to Wood; Cold Damage belongs to Metal; Warm diseases originate from Water and Fire; Heat diseases originate from Dampness. Heavy dampness causes disease in the Earth organ (Spleen); when Earth is diseased, all other Zang organs suffer. The root lies in the changes of the Four Zang organs of Metal, Wood, Water, and Fire.
A pulse that is Floating at Yang and Soft at Yin indicates Wind-Warmth; Rapid at Yang and Solid at Yin indicates Warm-Toxicity; Soft at Yang and Tight at Yin indicates Damp-Warmth; Excessive at both Yin and Yang indicates Warm-Malaria. In treatment: For Wind-Dampness, select Foot-Jueyin Liver and Hand-Shaoyin Heart meridians; for Warm-Toxicity, exclusively select Shaoyang Sanjiao and Hand-Shaoyin Heart meridians; for Cold Damage, select Hand-Taiyin Lung and Hand-Shaoyin Heart meridians; for Damp-Warmth, select Foot-Shaoyin Kidney meridian. People generally claim I am capable of discussing Cold Damage. I examine the variations of Cold Damage and the Four Types of Warmth, distinguishing their similarities and differences without confusion. Therefore, I determine Yin and Yang via the Throat and Hand, pair Fu and Yi with Chi and Cun, embed the Nine Palpations in Floating and Deep, and differentiate the Four Warmths within Cold Damage. These concepts were initially outlined by Bian Que, and I have refined them by consulting the *Neijing* and other texts. By applying them prudently and treating according to the principles, diseases cannot escape cure. (From Zhang You Shi Ji)