名虽三，而实则手太阴肺经一脉也。王叔和未详经旨，突谓左为人迎，右为气口，以致后人俱指两寸为寸口，
右关为气口，而不复知统两手而言矣。（《景岳全书》）
寸、关、尺，辄名心脉、肺脉、肝脉、脾脉、肾脉者非也，此手太阴肺经之动脉，分其部以候他脏之气耳。
李时珍曰∶非五脏六腑所居之处也。脉行始于肺，终于肝，而复会于肺。肺为气所出入之门户，故名曰气口，
而为脉之大会，以占一身焉。（吴草庐）
三部九候
帝曰∶何谓三部？岐伯曰∶有上部，有中部，有下部。各有三候。三候者，有天，有地，有人也。上部天，
两额之动脉；上部地，两颊之动脉；上部人，耳前之动脉。中部天，手太阴也；中部地，手阳明也；中部人，
手少阴也。下部天，足厥阴也；下部地，足少阴也；下部人，足太阴也。故下部之天以候肝，地以候肾，人以
候脾胃之气。帝曰∶中部之候奈何？岐伯曰∶亦有天，亦有地，亦有人。天以候肺，地以候胸中之气，入以候
心。帝曰∶上部以何候之？岐伯曰∶亦有天，亦有地，亦有人。天以候头角之气，地以候口齿之气，人以候耳
目之气。（《素问》）
脉有三部九候，各何所主之？然三部者，寸、关、尺也；九候者，浮、中、沉也。上部法天，主胸以上至
头之有疾也；中部法人，主膈下至脐之有疾也；尺为下部，法而应乎地，主脐下至足之有疾也。（《类经》）
又有九候，举按轻重，三部浮沉，各候五动。（崔紫虚）
按三部九候，《内经》明指人身上、中、下之动脉。盖上古诊法，于人身三部九候之脉，各有所候，以诊
诸脏之气，而针除邪疾，非独以寸口为言也。如仲景脉法，上取寸口，下取趺阳，是亦此意。观《十八难》
曰∶三部者，寸、关、尺也；九候者，浮、中、沉也。乃单以寸口而分三部九候之诊，后世言脉者，皆宗之。
虽亦诊家捷法，然非轩岐本旨，学人当并详其义。（《类经》）
形肉已脱，九候虽调犹死；七诊虽见，九候皆从者不死。（《素问》）
七诊者，独大、独小、独迟、独疾、独寒、独热、独陷下也。（《内经吴注》）
愚按∶七诊之法，本出此篇，而勿听子谬谓七诊者。诊宜平旦，一也；阴气未动，二也；阳气未散，三
也；饮食未进，四也；经脉未盛，五也；络脉调匀，六也；气血未乱，七也。夫此七者，焉得皆谓之诊？后世
谬传，失其本原，是真可以勿听矣。（《类经》）
呼吸至数
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。人一呼脉一动，一吸脉一动，
曰少气。人一呼脉三动，一吸脉三动而躁，尺热曰病温；尺不热脉滑，曰病风；脉涩曰痹。人一呼脉四动以上
曰死。脉绝不至曰死。乍疏乍数曰死。（《素问》）
所谓五十营者，五脏皆受气。持其脉口，数其至也∶五十动而不一代者，五脏皆受气；四十动一代者，
一脏无气；三十动一代者，二脏无气；二十动一代者，三脏无气；十动一代者，四脏无气；不满十动一代者五
脏无气，予之短期。（《灵枢》）
呼出心与肺，吸入肾与肝，呼吸之间，脾受谷味也，其脉在中。○人一呼脉行三寸，一吸脉行三寸，呼吸定
息，脉行六寸。人一日一夜，凡一万三千五百息，脉行五十度周于身。漏水下百刻，营卫行阳二十五度，行阴
亦二十五度，为一周也。○脉来一呼再至，一吸再至，不大不小曰平。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。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，为难治。一呼六至，一吸六至，为死脉也∶沉细夜死，浮大昼死。一呼一至，一吸一至，
名曰损人。虽能行，犹当着床，所以然者，气血皆不足故也。再呼一至，再吸一至，名曰无魂。无魂者，当死
也。人虽能行，名曰行尸。○脉有损至，何谓也？然至之脉，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。何谓损？一呼一至曰离经，二呼一至曰夺精，三呼一至曰死，四呼一至曰命
绝，此损之脉也。（《难经》）
按代脉之义，自仲景、叔和俱云动而中止，不能自还，因而复动，脉代者死。又曰脉五来一止，不复增减
者死，经名曰代。故王太仆之释代脉，亦云动而中止，不能自还也。自后滑伯仁因而述之，故后世以结促代并
言，均目之为止脉，岂足以尽其义哉？夫缓而一止为结，数而一止为促。其至，则或三、或五、或七八至不等，
然皆至数分明，起止有力。至于代脉之辨，则有不同。如《宣明五气篇》曰∶脾脉代。《邪气脏腑病形篇》曰∶
黄者，其脉代。皆言脏气之常候，非谓代为止也。又《平人气象论》曰∶长夏胃微软弱曰平，但代无胃曰死者，
乃言胃气去，而真脏见者死。亦非谓代为止也。由此观之，则代本不一；如五十动而不一代者，乃至数之代，
即本篇所云者是也；若脉本平匀，而忽强忽弱者，乃形体之代，即《平人气象论》所云者是也；又若脾主四
季，而随时更代者，乃气候之代，即《宣明五气》等篇所云者是也。凡脉无定候，更变不常，则均谓之代，但
当各因其变，而察其情。设不明此，非惟失经旨之大义，即于脉象之吉凶，皆茫然莫知所辨矣，乌足以言诊哉？（《类经》）
神力
诊脉，以有力无力二者为分辨，人皆知之。至于有力中求无力，无力中求有力，非上智莫能察也。有力中
求无力，则无力者，乃其真元虚弱，而有力者，火搏之则然，非本体之实也；无力中求有力，则有力者，乃其
真元禀浓，而无力者，乃胃气暂失所养则然，非本体之虚也。此所谓因其形似而求之真伪者也。（余傅山）
脉有有力而无神者，亦有无力而有神者。盖有神、无神，非即以有力、无力论也。如以有力即为有神，无
力即为无神，则凡脉之弦劲勒指者，可为有神，而许以生乎？脉之和缓软弱者，可为无神，而断以死乎？盖有
余之证，脉须有力，而有力之中，又贵有神；不足之证，脉宜无力，而无力之中，全在有神。数语为诊家之扼
要也。（《己任篇》）
求脉之道，当以有力、无力辨阴阳，有神、无神察虚实。和缓者，乃元气之来；强峻者，乃邪气之至。○病
自阳分传入三阴者，俱是脉沉，妙在指下有力、无力中分∶有力者，为阳、为实、为热；无力者，为阴、为虚、
为寒。（《景岳全书》）
脉之不病，其神不言当自有也。脉既病，当求其神之有无。如六数、七极，热也，脉中有力，即有神也；
三迟二败，寒也，脉中有力，即有神也。热而有神，当泄其热，则神在焉；寒而有神，当去其寒，则神在矣。
若寒热之脉，无力无神，将何恃而泄热去寒乎？苟不知此，而递泄去之，神将何根据？《经》曰∶脉者血气之先，
又云∶血气者人之神。可不察其有无乎？（王好古）
胃气
脉弱以滑，是有胃气，命曰易治。○平人之常气禀于胃，胃
者，平人之常气也。人无胃气曰逆，逆者死。○春胃微弦曰平，弦多胃少曰肝病，但弦无胃曰死。胃而有毛曰秋
病，毛甚曰今病。○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。○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，弱甚曰今病。○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。○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。（《素问》）
博约
凡脉，博之则二十七种，约之则浮、沉、迟、数、滑、涩、细、大为八要，又约之则为浮、沉、迟、数，
又至约则为浮、中、沉。是知浮、沉、迟、数四脉，真千古要诀也。（《医学入门》）
六经脉体
厥阴之至其脉弦，少阴之至其脉钩，太阴之至其脉沉，少阳之至大而浮，阳明之至短而涩，太阳之至大而长。（《素问》）
《经》言∶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；太阳之至，
紧大而长；少阴之至，紧细而微；厥阴之至，沉短而敦。（《难经》）
时脉
春日浮，如鱼之游在波；夏日肤，泛泛乎万物有余；秋日下肤，蛰虫将去；冬日在骨，蛰虫周密，君子居
室。○春应中规，夏应中矩，秋应中衡，冬应中权。○脉从四时，谓之可治；脉逆四时，为不可治。春得肺脉，
夏得肾脉，秋得心脉，冬得脾脉，其至皆悬绝沉涩，命曰逆四时也。（《素问》）
《经》言∶春脉弦，夏脉钩，秋脉毛，冬脉石，是王脉耶？将病脉也？然弦、钩、毛、石者，四时之脉也。
春脉弦者，肝，东方木也；万物始生，未有枝叶，故其脉之来，濡弱而长，故曰弦，夏脉钩者，心，南方火也；
万物之所茂，垂枝布叶，皆下曲
如钩，故其脉之来疾去迟，故曰钩。秋脉毛者，肺，西方金也；万物之所终，草木华叶，皆秋而落，其枝独在，
若毫毛也，故其脉之来轻虚以浮，故曰毛。冬脉石者，肾，北方水也；万物之所藏也，盛冬之时，水凝如石，
故其脉之来沉濡而滑，故曰石。此四时之脉也。（《难经》）
诊脉，须要先识时脉、胃脉与脏腑平脉，然后及于病脉。（滑伯仁）
时脉者，谓春三月俱带弦，夏三月俱带洪，秋三月俱带浮，冬三月俱带沉。脏脉平，胃脉又应四时，乃
无病也，反此病矣。太过病在外，是外感邪气也；不及病在中，是内伤正气也。（张三锡）
按前后诸篇，皆以春弦、夏钩、秋毛、冬石，分四季所属者，欲在明时令之脉，不得不然也。然脉之迭
见，有随时者，有不随时者。故或春而见钩，便是夏脉；春而见毛，便是秋脉；春而见石，便是冬脉。因变知
病，圆活在人，故有二十五变之妙。若谓春必弦，夏必钩，殊失胃气之精义矣。（《类经》）
平素脉体
凡人之脉，有生而洪大者，有生而弱小者。问其平素洪大，而今忽弱小者，此元气之夺也；问其平素弱
小，而今忽洪大者，此邪气之旺也。是究其素，而知其真，一治之可中的矣。若不问其平素，但见其脉洪大者，
遂断为有余，治以攻击，则元气随损，而羸败之患生焉；但见其脉弱小者，遂断为不足，治以温补，则邪火随
旺，而骨蒸之患生焉。是皆诊者，但窥其浅，而不究其素；病者欲试其术，而不告以素。由是治法倒施，变生
不测，医者损德，病者损身，皆由不问其素之故也。○许松径素脉洪大，偶有小恙，医诊之认为伤寒，欲为发
表，径曰∶予脉洪大，自幼已然。医知其素，遂免误。又有汪氏妇，体肥而脉沉细，按至骨，稍见些微。有疾，
医诊之，骇曰∶此气血两虚，阳将绝矣。遂用十全
大补，即发烦躁，已而发狂。予知其药误，投以三黄石膏汤救醒。（余午亭）
脉色参合
帝曰∶有故病，五脏发动，因伤脉色，各何以知其久暴至之病乎？岐伯曰∶征其脉小，色不夺者，新病也；
征其脉不夺，其色夺者，此久病也；征其脉与五色俱夺者，此久病也；征其脉与五色俱不夺者，新病也。○能
合脉色，可以万全。（《素问》）
色青者其脉弦，赤者其脉钩，黄者其脉代，白者其脉毛，黑者其脉石。见其色而不得其脉，反得相胜之脉，
则死矣；得其相生之脉，则病已矣。（《灵枢》）
脉证合与不合
形盛脉细，少气不足以息者危；形瘦脉大，胸中多气者死。形气相得者生，参伍不调者病。○脉从阴阳病
易已，脉逆阴阳病难已。○病热脉静，泄而脉大，脱血而脉实，病在中脉实坚，病在外脉不实坚者，皆难治。（《素问》）
何谓证与脉合，与脉不合？有外感之证脉，有内伤之证脉。外感者，蒸蒸发热，其脉必洪大浮数，是证与
脉合也；如发热而脉不洪大浮数，是证与脉不合也。传曰∶阳证得阴脉者死，然不可便断为死，此或者火遏也，
或胃阴不能充拓也，或肾水不能化其营血也。火遏者，逍遥散加生地、薄荷以发之，或加丹、栀屈曲下行以通
之；胃阴不能充拓者，左归饮去茯苓加归、芍合生脉以滋之；肾水不能化其营血者，六味、左归以补之。如内
伤而外不发热，其脉当静，而反浮躁洪大而数，是证与脉不合也。传曰∶阴证得阳脉者生，然亦不可便许为生，
此或者阴亡也，或阳明有食与火也，或肾虚不能纳气也，或过服乌、附，而下焦津液枯竭也。又有一种，重按
有力，从肌肉渗开，脉与肌肉无界限，此近于浮洪豁大，总是阴亡之象也。如阴亡，分先后天以救其阴。（《己任编》）
凡治病有舍证从脉者，有舍脉从证者。盖证有真假，脉亦有真假。如外虽烦热，而脉见微弱者，必火虚也；
腹虽胀满，而脉见微弱者，必胃虚也。虚火虚胀，其堪攻乎？此宜从脉之虚，不从证之实也。有本无烦热，而
虽然名称有三种，但实际上都是手太阴肺经这一条经脉。王叔和没有详细探究经络的宗旨，突然说左手为人迎脉，右手为气口脉，导致后人都将两手的寸部称为寸口，右关部称为气口，而不再知道统摄两手而言的道理了。（《景岳全书》）
将寸、关、尺分别命名为心脉、肺脉、肝脉、脾脉、肾脉是错误的，这是手太阴肺经的动脉，通过划分部位来诊察其他脏腑的气机罢了。李时珍说：这里并不是五脏六腑居住的地方。脉气运行始于肺，终于肝，然后又汇聚于肺。肺是气出入的门户，所以叫作气口，并且作为脉气的总会之处，用来占测全身的情况。（吴草庐）
三部九候
黄帝问：什么叫三部？岐伯回答：有上部，有中部，有下部。每部各有三候。所谓的三候，是指天、地、人。上部的天，指两额头的动脉；上部的地，指两颊的动脉；上部的人，指耳前的动脉。中部的天，指手太阴肺经；中部的地，指手阳明大肠经；中部的人，指手少阴心经。下部的天，指足厥阴肝经；下部的地，指足少阴肾经；下部的人，指足太阴脾经。所以下部的天用来诊察肝，地用来诊察肾，人用来诊察脾胃之气。黄帝问：中部的候法怎么样？岐伯说：也有天，也有地，也有人。天用来诊察肺，地用来诊察胸中之气，人用来诊察心。黄帝问：上部用什么来诊察？岐伯说：也有天，也有地，也有人。天用来诊察头角之气，地用来诊察口齿之气，人用来诊察耳目之气。（《素问》）
脉有三部九候，各自主治什么病呢？然而三部，指的是寸、关、尺；九候，指的是浮、中、沉三种取脉力度。上部效法天，主治胸部以上至头部的疾病；中部效法人，主治膈肌以下至肚脐的疾病；尺部为下部，效法地并顺应地气，主治肚脐以下至足部的疾病。（《类经》）
又有另一种九候的说法，是通过举按的轻重不同，在三部浮沉之间，各诊察五次搏动。（崔紫虚）
按照三部九候，《内经》明确指向人身上下中三部的动脉。大概上古时期的诊法，在人身三部九候的脉象上，各有对应的诊察对象，用以诊断各脏的气机，从而用针刺祛除邪气疾病，并不只是局限于寸口脉而言。比如张仲景的脉法，上面诊察寸口，下面诊察趺阳脉，也是这个意思。看《难经·十八难》说：三部，指的是寸、关、尺；九候，指的是浮、中、沉。这是单从寸口来划分三部九候的诊法，后世谈论脉学的人都尊崇这种方法。这虽然是诊脉的便捷方法，但并非轩辕、岐伯的本意，学习的人应当详尽了解其含义。（《类经》）
如果形体肌肉已经脱失，即使三部九候的脉象调和，也还是会死；如果七诊的病脉出现，但三部九候的脉象都顺从胃气（柔和），则不会死。（《素问》）
所谓七诊，是指脉象独大、独小、独迟、独疾（快）、独寒、独热、独陷下（沉伏不起）。（《内经吴注》）
我按语：七诊的方法，原本出自本篇，但勿听子错误地认为七诊是指：诊脉宜在平旦进行，这是一；阴气未动，这是二；阳气未散，这是三；饮食未进，这是四；经脉未盛，这是五；络脉调匀，这是六；气血未乱，这是七。这七点，怎么能都称之为“诊”呢？后世谬传，失去了本源，这确实是应该不予听从的。（《类经》）
呼吸至数
人每呼气一次，脉搏跳动两次；每吸气一次，脉搏也跳动两次；一呼一吸定息之间，脉搏跳动五次，加上偶尔的长息（太息），这就叫做平人（健康人）。人每呼气一次，脉搏跳动一次；每吸气一次，脉搏也跳动一次，这叫少气。人每呼气一次，脉搏跳动三次；每吸气一次，脉搏也跳动三次且躁急，尺部皮肤发热，这叫温病；尺部不发热，脉象滑利，这叫风病；脉象涩滞，这叫痹证。人每呼气一次，脉搏跳动四次以上，这叫死脉。脉搏断绝不再跳动，这叫死。脉搏忽慢忽快，这叫死。（《素问》）
所谓五十营，是指五脏都接受了水谷精微之气。持按其脉口，计算其搏动次数：五十次搏动中没有一次间歇的，说明五脏都接受了气；四十次搏动中出现一次间歇的，说明有一脏无气；三十次搏动中出现一次间歇的，说明有两脏无气；二十次搏动中出现一次间歇的，说明有三脏无气；十次搏动中出现一次间歇的，说明有四脏无气；不满十次搏动就出现一次间歇的，说明五脏无气，预后不良，给予短期的死亡期限。（《灵枢》）
呼出之气由心和肺主管，吸入之气由肾和肝主管，呼吸之间，脾接受水谷精微，其脉位于中部。○人每呼气一次，脉气运行三寸；每吸气一次，脉气运行三寸；一呼一吸定息，脉气运行六寸。人在一天一夜之间，总共一万三千五百次呼吸，脉气运行五十周遍全身。漏水滴下一百刻的时间，营卫之气行于阳分二十五周，行于阴分也是二十五周，合为一周。○脉来一呼跳动两次，一吸跳动两次，不大不小，这叫平脉。一呼跳动三次，一吸跳动三次，这是刚得病：如果前部脉大后部脉小，就会头痛目眩；如果前部脉小后部脉大，就会胸满短气。一呼跳动四次，一吸跳动四次，病情想要加重：脉象洪大的，苦于烦闷胀满；脉象沉细的，腹中疼痛；脉象滑利的，伤于热邪；脉象涩滞的，伤于雾露湿气。一呼跳动五次，一吸跳动五次，其人应当困倦：脉象沉细的夜间加重，脉象浮大的白天加重。脉象不大不小，虽然困倦也可治疗；如果脉象有大有小，就难以治疗。一呼跳动六次，一吸跳动六次，这是死脉：脉象沉细的夜间死，脉象浮大的白天死。一呼跳动一次，一吸跳动一次，名叫损人。虽然还能行走，但也应当卧床，之所以这样，是因为气血都不充足。两次呼才跳动一次，两次吸才跳动一次，名叫无魂。无魂的人，将会死亡。人虽然能行走，名叫行尸。○脉有损脉和至脉，是什么意思呢？至于至脉，一呼跳动两次叫平脉，三次叫离经，四次叫夺精，五次叫死，六次叫命绝，这就是至脉。什么叫损脉？一呼跳动一次叫离经，两次呼跳动一次叫夺精，三次呼跳动一次叫死，四次呼跳动一次叫命绝，这就是损脉。（《难经》）
关于代脉的含义，自从张仲景、王叔和都说脉搏动而中止，不能自行恢复，因而再次跳动，脉象表现为代，主死。又说脉搏五次搏动后停止一次，不再增减的，经文称为代。所以王冰对代脉的解释，也说脉搏动而中止，不能自行恢复。此后滑寿因此阐述它，所以后世将结脉、促脉、代脉并提，都称之为止脉，这难道足以穷尽它们的含义吗？缓脉而有一次停顿的叫结脉，数脉而有一次停顿的叫促脉。它们的至数，或者三次，或者五次，或者七八次不等，但是至数分明，起止有力。至于代脉的辨别，则有所不同。如《宣明五气篇》说：脾脉代。《邪气脏腑病形篇》说：面色黄的人，其脉代。这都是说脏气的正常表现，并不是说代为停止。又《平人气象论》说：长夏季节胃气微软弱叫平脉，只有代脉而没有胃气叫死脉，这是说胃气离去，真脏脉出现的就会死。也不是说代为停止。由此看来，代脉本不止一种意义：如五十次搏动中没有一次间歇的，这是至数上的代，就是本篇所说的；如果脉象本来平和均匀，却忽然变强或变弱的，这是形体上的代，就是《平人气象论》所说的；又若脾主四季，而随时更替变化的，这是气候上的代，就是《宣明五气》等篇所说的。凡是脉象没有固定的表现，变化无常的，都称为代，但应当根据各自的变化，来考察其情状。如果不明白这一点，不仅失去了经文的大义，就连脉象的吉凶，也都茫然不知如何辨别，哪里足以谈论诊脉呢？（《类经》）
神力
诊脉，以有力和无力的区别来分辨，人们都知道。至于在有力中寻求无力，在无力中寻求有力，不是智慧高超的人是不能察觉的。在有力中寻求无力，那么无力的部分，是真元虚弱，而有力的部分，是火邪搏击所致，并非本体的实证；在无力中寻求有力，那么有力的部分，是真元禀赋浓厚，而无力的部分，是胃气暂时失去滋养所致，并非本体的虚证。这就是所谓的因其外形相似而探求真伪的方法。（余傅山）
脉象有的有力但没有神，也有的无力但有神。所谓有神、无神，并不是仅以有力、无力来论定的。如果认为有力就是有神，无力就是无神，那么凡是脉象弦劲勒指的，可以算作有神，并许以生存吗？脉象和缓软弱的，可以算作无神，并断定为死亡吗？有余的病症，脉象必须有力，而在有力之中，又贵在有神；不足的病症，脉象宜于无力，而在无力之中，全在于有神。这几句话是诊脉家的扼要之谈。（《己任篇》）
探求脉道的道理，应当以有力、无力来辨别阴阳，以有神、无神来察验虚实。脉象和缓的，是元气到来；脉象强峻的，是邪气到达。○疾病从阳分传入三阴经的，脉象都是沉脉，妙处在于指下有力、无力中进行区分：有力的，属于阳、属于实、属于热；无力的，属于阴、属于虚、属于寒。（《景岳全书》）
脉象没有生病时，其神不言自明。脉象既已生病，应当探求其神的存在与否。如脉象数（快）或极（快），是热证，脉中有力，就是有神；脉象迟或败（微弱），是寒证，脉中有力，就是有神。热证而有神，应当清泄热邪，神就存在了；寒证而有神，应当去除寒邪，神就存在了。如果是寒热脉象，无力无神，凭借什么来清泄热邪、去除寒邪呢？如果不知道这一点，而依次清泄去除，神将依靠什么？《内经》说：脉是血气的前导，又说：血气就是人的神。能不考察其有无吗？（王好古）
胃气
脉象软弱而滑利，这是有胃气，名叫容易治疗。○健康人的常气禀受于胃，胃就是健康人的常气。人如果没有胃气就叫逆，逆者死。○春季脉象微带弦象叫平脉，弦象多而胃气少叫肝病，只有弦象而没有胃气叫死。脉中有胃气兼见毛（浮）象，预示秋季发病，毛象甚重叫现在发病。○夏季脉象微带钩（洪）象叫平脉，钩象多而胃气少叫心病，只有钩象而没有胃气叫死。脉中有胃气兼见石（沉）象，预示冬季发病，石象甚重叫现在发病。○长夏季节脉象微软弱叫平脉，弱象多而胃气少叫脾病，只有代象而没有胃气叫死；软弱兼见石象，预示冬季发病，弱象甚重叫现在发病。○秋季脉象微带毛（浮）象叫平脉，毛象多而胃气少叫肺病，只有毛象而没有胃气叫死；毛象兼见弦象，预示春季发病，弦象甚重叫现在发病。○冬季脉象微带石（沉）象叫平脉，石象多而胃气少叫肾病，只有石象而没有胃气叫死；石象兼见钩象，预示夏季发病，钩象甚重叫现在发病。（《素问》）
博约
大凡脉象，广泛论述则有二十七种，简要概括则为浮、沉、迟、数、滑、涩、细、大八种主要脉象，再简要概括则为浮、沉、迟、数四种，最简要概括则为浮、中、沉三种。由此可知，浮、沉、迟、数四种脉象，真是千古的要诀。（《医学入门》）
六经脉体
厥阴经的脉象是弦，少阴经的脉象是钩，太阴经的脉象是沉，少阳经的脉象大而浮，阳明经的脉象短而涩，太阳经的脉象大而长。（《素问》）
《内经》说：少阳经的脉象，忽大忽小，忽短忽长；阳明经的脉象，浮大而短；太阳经的脉象，洪大而长；太阳经的脉象，紧大而长；少阴经的脉象，紧细而微；厥阴经的脉象，沉短而敦厚。（《难经》）
时脉
春季脉象浮，像鱼在波浪中游动；夏季脉象在肤表，泛泛然万物生长有余；秋季脉象下沉至肤下，像冬眠的虫即将离去；冬季脉象在骨，像冬眠的虫严密包裹，君子居住在室内。○春脉应合乎规（圆），夏脉应合乎矩（方），秋脉应合乎衡（平），冬脉应合乎权（重）。○脉象顺应四时，叫做可治；脉象违背四时，叫做不可治。春季得到肺脉（毛），夏季得到肾脉（石），秋季得到心脉（钩），冬季得到脾脉（代/软），其脉象都悬绝沉涩，名叫逆四时。（《素问》）
《内经》说：春脉弦，夏脉钩，秋脉毛，冬脉石，这是旺脉呢？还是病脉呢？回答说：弦、钩、毛、石，是四时的正常脉象。春脉弦，对应肝，属东方木；万物开始生长，还没有枝叶，所以脉气来时濡弱而长，所以叫弦；夏脉钩，对应心，属南方火；万物茂盛，垂枝布叶，都向下弯曲如钩，所以脉气来时快去慢，所以叫钩。秋脉毛，对应肺，属西方金；万物终结，草木花叶都在秋天落下，只剩枝条，像毫毛一样，所以脉气来时轻虚以浮，所以叫毛。冬脉石，对应肾，属北方水；万物收藏，盛冬之时，水凝结如石头，所以脉气来时沉濡而滑，所以叫石。这就是四时的脉象。（《难经》）
诊脉，必须先识别时脉、胃脉与脏腑的平脉，然后才能涉及病脉。（滑伯仁）
时脉，是说春季三个月脉象都带有弦象，夏季三个月脉象都带有洪象，秋季三个月脉象都带有浮象，冬季三个月脉象都带有沉象。脏脉平和，胃脉又顺应四时，就没有病，反之就是病了。太过是病在外，是外感邪气；不及是病在内，是内伤正气。（张三锡）
按前后诸篇，都是以春弦、夏钩、秋毛、冬石，来分配四季所属的，想要在明了时令脉象，不得不这样做。然而脉象的交替出现，有随时间变化的，有不随时间变化的。所以春天见到钩脉，就是夏脉；春天见到毛脉，就是秋脉；春天见到石脉，就是冬脉。因变化而知病情，灵活运用于人，所以有二十五变的奥妙。如果说春天必定是弦脉，夏天必定是钩脉，就大大失去了胃气的精义了。（《类经》）
平素脉体
大凡人的脉象，有生来就洪大的，有生来就弱小的。询问他平素脉象洪大，而现在忽然变得弱小，这是元气被剥夺；询问他平素脉象弱小，而现在忽然变得洪大，这是邪气旺盛。探究其平素情况，就能知道真相，一次治疗就可以击中要害。如果不询问其平素情况，只见到脉象洪大，就断定为有余，用攻伐的方法治疗，那么元气随之受损，产生羸败的祸患；只见到脉象弱小，就断定为不足，用温补的方法治疗，那么邪火随之旺盛，产生骨蒸的祸患。这些都是诊脉者，只看表面浅层，而不探究其平素情况；病人想试探医术，而不告知其平素情况。因此治疗方法颠倒施用，变故产生不可预测，医者损害德行，病人损害身体，都是因为不问其平素情况的缘故。○许松径平素脉象洪大，偶然有小病，医生诊察认为是伤寒，想要发汗解表，许松径说：我的脉象洪大，从小就这样。医生知道他的平素情况，于是避免了误治。又有汪氏妇人，身体肥胖而脉象沉细，按到骨头，稍微显现一点。有病，医生诊察后惊恐地说：这是气血两虚，阳气将要断绝了。于是使用十全大补汤，随即发生烦躁，不久发狂。我知道是药物误治，投以三黄石膏汤救醒了她。（余午亭）
脉色参合
黄帝问：有旧病，五脏发动，因为损伤了脉色，各用什么方法知道是新病还是久病？岐伯说：征验其脉象小而色泽未衰的，是新病；征验其脉象未衰而色泽衰败的，这是久病；征验其脉象与五色都衰败的，这是久病；征验其脉象与五色都不衰败的，是新病。○能够结合脉象和色泽，就可以万无一失。（《素问》）
面色青的人其脉弦，赤色的人其脉钩，黄色的人其脉代，白色的人其脉毛，黑色的人其脉石。看到其面色而得不到相应的脉象，反而得到相克制的脉象，就会死；得到相生助的脉象，病就好了。（《灵枢》）
脉证合与不合
形体壮盛而脉象细弱，气短不足以呼吸的，危险；形体消瘦而脉象洪大，胸中气多的，死。形气相得的，生；参伍不调的，病。○脉象顺应阴阳，病易愈；脉象违背阴阳，病难愈。○患热病而脉象静，腹泻而脉象大，失血而脉象实，病在内部而脉象实坚，病在外部而脉象不实坚的，都难治。（《素问》）
什么叫证与脉合，与脉不合？有外感的证脉，有内伤的证脉。外感病，蒸蒸发热，其脉必洪大浮数，这是证与脉合；如果发热而脉象不洪大浮数，这是证与脉不合。传说：阳证得阴脉者死，但不能就此断定为死，这可能是火邪郁遏，或者是胃阴不能充拓，或者是肾水不能化生营血。火邪郁遏的，用逍遥散加生地、薄荷以发散，或者加丹皮、栀子屈曲下行以通利；胃阴不能充拓的，用左归饮去茯苓加当归、芍药合生脉散以滋润；肾水不能化生营血的，用六味地黄丸、左归丸以补益。如果内伤病而体表不发热，其脉应当安静，反而浮躁洪大而数，这是证与脉不合。传说：阴证得阳脉者生，但也不能就此许以生，这可能是阴亡，或者是阳明有食积与火邪，或者是肾虚不能纳气，或者是过服乌头、附子，而下焦津液枯竭。又有一种情况，重按有力，从肌肉渗开，脉与肌肉没有界限，这接近于浮洪豁大，总是阴亡的征象。如果是阴亡，分先后天来救其阴。（《己任编》）
大凡治病，有舍证从脉的，有舍脉从证的。因为证有真假，脉也有真假。如外表虽烦热，而脉象见微弱，一定是火虚；腹部虽胀满，而脉象见微弱，一定是胃虚。虚火虚胀，怎么可以攻伐呢？这应当从脉之虚，不从证之实。有本来没有烦热，而
Although the names are three, in reality, they are all one meridian of the Hand-Taiyin Lung Channel. Wang Shuhe failed to thoroughly understand the principles of the meridians and abruptly stated that the left pulse is Renying (Human Welcome) and the right pulse is Qikou (Qi Mouth), leading later generations to refer to the Cun (Inch) position of both hands as Cunkou (Cinch Mouth), and the Right Guan (Gate) position as Qikou, thereby no longer understanding the concept of integrating both hands into a unified diagnosis. (*Jingyue Quanshu*)
It is incorrect to name the Cun, Guan, and Chi positions respectively as Heart Pulse, Lung Pulse, Liver Pulse, Spleen Pulse, and Kidney Pulse. These are actually the arterial pulses of the Hand-Taiyin Lung Channel, where different positions are divided to observe the Qi of other Zang organs. Li Shizhen said: This is not the residence of the five Zang and six Fu organs. The movement of pulses begins at the Lung, ends at the Liver, and then converges back at the Lung. The Lung is the portal for the entry and exit of Qi, hence it is named Qikou (Qi Mouth), serving as the great convergence of pulses to diagnose the whole body. (Wu Caolu)
Three Regions and Nine Palpations
The Yellow Emperor asked: What are called the Three Regions? Qibo answered: There is the Upper Region, the Middle Region, and the Lower Region. Each has three palpations. The three palpations refer to Heaven, Earth, and Humanity. In the Upper Region, Heaven refers to the arteries on both foreheads; Earth refers to the arteries on both cheeks; Humanity refers to the arteries in front of both ears. In the Middle Region, Heaven refers to the Hand-Taiyin [Lung] channel; Earth refers to the Hand-Yangming [Large Intestine] channel; Humanity refers to the Hand-Shaoyin [Heart] channel. In the Lower Region, Heaven refers to the Foot-Jueyin [Liver] channel; Earth refers to the Foot-Shaoyin [Kidney] channel; Humanity refers to the Foot-Taiyin [Spleen] channel. Thus, the Heaven of the Lower Region diagnoses the Liver, the Earth diagnoses the Kidney, and Humanity diagnoses the Qi of the Spleen and Stomach. The Yellow Emperor asked: How are the palpations of the Middle Region conducted? Qibo said: There is also Heaven, Earth, and Humanity. Heaven diagnoses the Lung, Earth diagnoses the Qi of the chest, and Humanity diagnoses the Heart. The Yellow Emperor asked: How does the Upper Region conduct diagnosis? Qibo said: There is also Heaven, Earth, and Humanity. Heaven diagnoses the Qi of the head and angles, Earth diagnoses the Qi of the mouth and teeth, and Humanity diagnoses the Qi of the ears and eyes. (*Suwen*)
Pulses have three regions and nine palpations; what do they each govern? However, the three regions refer to Cun (Inch), Guan (Gate), and Chi (Cubit); the nine palpations refer to Floating (Fu), Moderate (Zhong), and Deep (Chen). The Upper Region models Heaven and governs diseases from the chest up to the head; the Middle Region models Humanity and governs diseases from below the diaphragm to the navel; the Chi region is the Lower Region, modeling and responding to Earth, governing diseases from below the navel to the feet. (*Leijing*)
There is another interpretation of the nine palpations, involving lifting and pressing with varying degrees of pressure, examining floating and deep positions in the three regions, each observing five beats. (Cui Zixu)
According to the Three Regions and Nine Palpations, the *Neijing* clearly points to the arterial pulses of the upper, middle, and lower parts of the human body. It seems that in ancient diagnostic methods, the pulses of the three regions and nine palpations on the body had specific diagnostic targets to assess the Qi of various organs and use acupuncture to remove pathogenic diseases, not just referring to the Cunkou pulse. For example, Zhang Zhongjing's pulse method diagnoses the Cunkou above and the Duzhong (Foot Yangming) pulse below, which reflects this same idea. Looking at the *Nan Jing (Difficult Issues)* Chapter 18, it states: The three regions are Cun, Guan, and Chi; the nine palpations are Floating, Moderate, and Deep. This divides the three regions and nine palpations solely based on the Cunkou pulse. Later generations who discuss pulse diagnosis all follow this method. Although it is a convenient method for pulse diagnosis, it is not the original intent of Xuanyuan (Yellow Emperor) and Qibo. Students should study its meaning in detail. (*Leijing*)
If flesh and muscles are already depleted, even if the nine palpations are harmonious, death will occur; if the seven diagnostics are observed but the nine palpations all follow [the stomach qi], death will not occur. (*Suwen*)
The so-called "Seven Diagnostics" refer to pulses that are exclusively large, exclusively small, exclusively slow, exclusively rapid, exclusively cold, exclusively hot, or exclusively sunken/depressed. (*Wu's Commentary on Neijing*)
My commentary: The method of the Seven Diagnostics originally comes from this chapter, but Wutingzi erroneously defined the Seven Diagnostics as: Diagnosis should be done at dawn, one; Yin Qi has not yet moved, two; Yang Qi has not yet scattered, three; Food and drink have not been taken in, four; Meridian Qi has not yet flourished, five; Collateral Qi is balanced, six; Blood and Qi are not yet chaotic, seven. How can these seven points all be called "diagnosis"? Later generations transmitted this erroneously, losing its origin. This is indeed something that should be disregarded. (*Leijing*)
Respiration and Pulse Beats
When a person exhales once, the pulse beats twice; when inhaling once, the pulse also beats twice. Between the end of exhalation and inhalation (fixed breath), the pulse beats five times. Occasionally, a long sigh (Tai Xi) occurs, which is called a healthy person (Ping Ren). If when exhaling once the pulse beats once, and when inhaling once the pulse beats once, it is called Sha Qi (Deficient Qi). If when exhaling once the pulse beats three times, and when inhaling once the pulse beats three times and is restless, with heat in the Chi position, it is called Wen Bing (Warm Disease); if the Chi position is not hot and the pulse is slippery, it is called Feng Bing (Wind Disease); if the pulse is choppy, it is called Bi Syndrome (Obstruction). If when exhaling once the pulse beats four times or more, it indicates death. If the pulse ceases and does not return, it indicates death. If the pulse is irregularly slow and fast, it indicates death. (*Suwen*)
The term "Fifty Circulations" refers to the fact that all five Zang organs receive Qi. Holding the pulse at the Cunkou and counting the beats: if there are fifty beats without any interruption, all five Zang organs receive Qi; if there is one interruption in forty beats, one Zang organ lacks Qi; if there is one interruption in thirty beats, two Zang organs lack Qi; if there is one interruption in twenty beats, three Zang organs lack Qi; if there is one interruption in ten beats, four Zang organs lack Qi; if there is an interruption in fewer than ten beats, all five Zang organs lack Qi, and a short life expectancy is predicted. (*Lingshu*)
Exhalation is governed by the Heart and Lung; inhalation is governed by the Kidney and Liver. Between respiration, the Spleen receives grain essence, and its pulse is located in the middle. ○ When a person exhales once, the pulse moves three cun; when inhaling once, the pulse moves three cun. Between fixed breaths, the pulse moves six cun. In one day and night, a person takes approximately 13,500 breaths, and the pulse circulates fifty times around the body. During the time it takes for water to drip one hundred marks, Ying (Nutrient) and Wei (Defensive) Qi travel twenty-five times through the Yang aspects and twenty-five times through the Yin aspects, completing one cycle. ○ If the pulse beats twice per exhalation and twice per inhalation, neither too large nor too small, it is a Ping (Normal) pulse. If it beats three times per exhalation and three times per inhalation, the disease has just begun: if the anterior pulse is large and the posterior is small, there will be headache and dizziness; if the anterior pulse is small and the posterior is large, there will be chest fullness and shortness of breath. If it beats four times per exhalation and four times per inhalation, the disease is worsening: if the pulse is surging and large, the patient suffers from vexation and fullness; if it is deep and fine, there is abdominal pain; if it is slippery, there is heat injury; if it is choppy, there is injury from fog and dew. If it beats five times per exhalation and five times per inhalation, the person will be exhausted: if deep and fine, symptoms worsen at night; if floating and large, symptoms worsen during the day. If neither large nor small, although exhausted, it is treatable; if there is variation in size, it is difficult to treat. If it beats six times per exhalation and six times per inhalation, it is a dying pulse: if deep and fine, death occurs at night; if floating and large, death occurs during the day. If it beats once per exhalation and once per inhalation, it is called Sun Ren (Damaged Person). Although they can walk, they should be bedridden because both Qi and Blood are insufficient. If it beats once after two exhalations and once after two inhalations, it is called Wu Hun (Soulless). Those who are soulless will die. Although the person can walk, they are called a Walking Corpse. ○ What are Damaged (Sun) and Arriving (Zhi) pulses? Regarding Arriving Pulses: beating twice per exhalation is Normal; three times is Li Jing (Departing from the Channel); four times is Duo Jing (Depletion of Essence); five times is Death; six times is Ming Jue (Extinction of Life). These are Arriving Pulses. What are Damaged Pulses? Beating once per exhalation is Li Jing; once after two exhalations is Duo Jing; once after three exhalations is Death; once after four exhalations is Ming Jue. These are Damaged Pulses. (*Nan Jing*)
Regarding the meaning of Dai (Intermittent) pulse, both Zhang Zhongjing and Wang Shuhe stated that the pulse beats, stops, cannot return on its own, and then beats again; a Dai pulse indicates death. They also stated that if the pulse stops after five beats and does not increase or decrease further, the classic calls it Dai. Therefore, Wang Bing's explanation of the Dai pulse also says the pulse beats, stops, and cannot return. Later, Hua Bo Ren elaborated on this, so later generations grouped Jie (Knotted), Cu (Rapid-intermittent), and Dai pulses together, calling them all "stopping pulses." Does this fully capture their meanings? A slow pulse with occasional stopping is Jie; a rapid pulse with occasional stopping is Cu. Their beat counts may vary—three, five, seven, or eight beats—but the rhythm is clear, and the start and stop are forceful. However, the differentiation of Dai pulse is different. As stated in the *Xuan Ming Wu Qi Pian*: "The Spleen pulse is Dai." And in the *Xie Qi Zang Fu Bing Xing Pian*: "For those with yellow complexion, the pulse is Dai." Both refer to the normal manifestation of Zang Qi, not implying Dai means stopping. Also, in the *Ping Ren Qi Xiang Lun*: "In late summer, a soft and weak pulse with Stomach Qi is normal; only Dai pulse without Stomach Qi indicates death." This refers to the departure of Stomach Qi and the appearance of the True Zang pulse, indicating death. It does not mean Dai implies stopping. From this, we see that Dai has multiple meanings. For instance, "fifty beats without interruption" refers to the rhythmic Dai mentioned in this chapter; if the pulse is normally uniform but suddenly becomes strong or weak, this is morphological Dai as mentioned in the *Ping Ren Qi Xiang Lun*; since the Spleen governs the four seasons and changes accordingly, this is climatic Dai as mentioned in the *Xuan Ming Wu Qi* chapters. Whenever a pulse lacks a fixed pattern and changes frequently, it is called Dai. One must examine the specific changes to understand the condition. If one does not understand this, not only will the major principles of the classics be lost, but one will also be confused about the auspicious or ominous nature of pulse images, making it impossible to speak of diagnosis. (*Leijing*)
Divine Power (Shen)
In pulse diagnosis, distinguishing between forceful (You Li) and non-forceful (Wu Li) pulses is known to everyone. However, seeking non-forcefulness within forcefulness, and forcefulness within non-forcefulness, can only be perceived by the wise. Seeking non-forcefulness within forcefulness reveals that the non-forceful aspect represents deficiency of true Yuan Qi, while the forceful aspect is due to Fire attacking, not a true excess of the本体 (original state). Seeking forcefulness within non-forcefulness reveals that the forceful aspect represents strong constitution of Yuan Qi, while the non-forceful aspect is due to temporary loss of nourishment by Stomach Qi, not a true deficiency of the original state. This is called seeking truth from false appearances. (Yu Fushan)
Some pulses are forceful but lack Shen (Spirit/Vitality), while others are non-forceful but possess Shen. Having Shen or lacking Shen is not determined solely by forcefulness or non-forcefulness. If forcefulness meant having Shen and non-forcefulness meant lacking Shen, then would a wiry and tight pulse gripping the fingers be considered having Shen and thus curable? Would a harmonious, soft, and weak pulse be considered lacking Shen and thus fatal? In excess conditions, the pulse must be forceful, but within forcefulness, possessing Shen is precious. In deficiency conditions, the pulse should be non-forceful, but within non-forcefulness, possessing Shen is essential. These words are the key to pulse diagnosis. (*Jiren Pian*)
To understand pulses, one should distinguish Yin and Yang by forcefulness/non-forcefulness, and examine deficiency/excess by presence/absence of Shen. Harmonious pulses indicate the arrival of Yuan Qi; harsh/rigid pulses indicate the arrival of Pathogenic Qi. ○ When diseases transmit from the Yang aspects to the Three Yin aspects, the pulse is always deep. The subtlety lies in distinguishing forceful vs. non-forceful under the fingers: forceful indicates Yang, Excess, and Heat; non-forceful indicates Yin, Deficiency, and Cold. (*Jingyue Quanshu*)
When the pulse is not diseased, its Shen is naturally present. Once the pulse is diseased, one must seek whether Shen is present. For example, a rapid (Shu) or extreme (Ji) pulse indicates Heat; if the pulse is forceful, it has Shen. A slow (Chi) or failing (Bai) pulse indicates Cold; if the pulse is forceful, it has Shen. If Heat presents with Shen, clearing the Heat preserves Shen. If Cold presents with Shen, dispelling the Cold preserves Shen. If the pulse for Cold or Heat is non-forceful and lacks Shen, upon what basis can one clear Heat or dispel Cold? If one does not know this and proceeds to clear and dispel, where will the Shen rely? The Classic says: "The pulse is the precursor of Blood and Qi," and also: "Blood and Qi are the Shen of man." Can one fail to examine their presence or absence? (Wang Haogu)
Stomach Qi
A pulse that is weak yet slippery indicates the presence of Stomach Qi and is termed easy to treat. ○ The normal Qi of a healthy person is derived from the Stomach; the Stomach is the source of normal Qi. If a person lacks Stomach Qi, it is called Ni (Reversal), and reversal leads to death. ○ In Spring, a pulse slightly wiry with Stomach Qi is normal; excessive wiriness with little Stomach Qi indicates Liver disease; wiriness alone without Stomach Qi indicates death. If Stomach Qi is present along with Mao (Hairy/Float) pulse, illness will occur in Autumn; severe Mao pulse indicates current illness. ○ In Summer, a pulse slightly hook-shaped (Hong/Surging) with Stomach Qi is normal; excessive hook-shape with little Stomach Qi indicates Heart disease; hook-shape alone without Stomach Qi indicates death. If Stomach Qi is present along with Shi (Stone/Deep) pulse, illness will occur in Winter; severe Shi pulse indicates current illness. ○ In Late Summer, a soft and weak pulse with Stomach Qi is normal; excessive weakness with little Stomach Qi indicates Spleen disease; Dai (Intermittent) pulse alone without Stomach Qi indicates death; weakness with Shi pulse indicates Winter illness; severe weakness indicates current illness. ○ In Autumn, a slightly Mao (Floating) pulse with Stomach Qi is normal; excessive Mao with little Stomach Qi indicates Lung disease; Mao alone without Stomach Qi indicates death. If Stomach Qi is present along with Xian (Wiry) pulse, illness will occur in Spring; severe Xian pulse indicates current illness. ○ In Winter, a slightly Shi (Deep) pulse with Stomach Qi is normal; excessive Shi with little Stomach Qi indicates Kidney disease; Shi alone without Stomach Qi indicates death. If Stomach Qi is present along with Gou (Hook) pulse, illness will occur in Summer; severe Gou pulse indicates current illness. (*Suwen*)
Broad and Concise
Generally speaking, pulses can be broadly described as twenty-seven types, but concisely summarized as eight essentials: Floating, Deep, Slow, Rapid, Slippery, Choppy, Fine, and Large. Further condensed, they are Floating, Deep, Slow, and Rapid. Most concisely, they are Floating, Moderate, and Deep. Thus, it is known that the four pulses of Floating, Deep, Slow, and Rapid are truly the eternal secrets of diagnosis. (*Yixue Rumen*)
Six Meridian Pulse Characteristics
The pulse of Jueyin is Xian (Wiry); the pulse of Shaoyin is Gou (Hook); the pulse of Taiyin is Chen (Deep); the pulse of Shaoyang is Da (Large) and Fu (Floating); the pulse of Yangming is Duan (Short) and Se (Choppy); the pulse of Taiyang is Da (Large) and Chang (Long). (*Suwen*)
The Classics state: The pulse of Shaoyang fluctuates between large and small, short and long; the pulse of Yangming is floating, large, and short; the pulse of Taiyang is surging, large, and long; the pulse of Taiyang is tight, large, and long; the pulse of Shaoyin is tight, fine, and subtle; the pulse of Jueyin is deep, short, and solid. (*Nan Jing*)
Seasonal Pulses
In Spring, the pulse floats, like a fish swimming in waves; in Summer, it is at the skin level, abundant like all things growing; in Autumn, it sinks below the skin, like hibernating insects preparing to leave; in Winter, it is in the bones, like hibernating insects tightly sealed, and gentlemen stay indoors. ○ Spring pulse should conform to the Compass (Round); Summer pulse to the Square Ruler (Square); Autumn pulse to the Balance Beam (Level); Winter pulse to the Plumb Bob (Heavy). ○ If the pulse follows the four seasons, it is treatable; if it opposes the four seasons, it is untreatable. Obtaining the Lung pulse (Mao) in Spring, Kidney pulse (Shi) in Summer, Heart pulse (Gou) in Autumn, or Spleen pulse (Dai/Ruan) in Winter, where the pulse is suspended, isolated, deep, and choppy, is called opposing the four seasons. (*Suwen*)
The Classics ask: Are the Spring Xian, Summer Gou, Autumn Mao, and Winter Shi pulses pulses of prosperity (Wang Mai) or pulses of disease? Answer: Xian, Gou, Mao, and Shi are the pulses of the four seasons. Spring pulse is Xian because it corresponds to the Liver, Wood of the East; as all things begin to grow without branches or leaves, the pulse comes forth soft, weak, and long, hence Xian. Summer pulse is Gou because it corresponds to the Heart, Fire of the South; as all things flourish with drooping branches and leaves curved like hooks, the pulse comes rapidly and departs slowly, hence Gou. Autumn pulse is Mao because it corresponds to the Lung, Metal of the West; as all things conclude and leaves fall leaving only bare branches like hairs, the pulse comes light, empty, and floating, hence Mao. Winter pulse is Shi because it corresponds to the Kidney, Water of the North; as all things are stored and water freezes like stone in deep winter, the pulse comes deep, soft, and slippery, hence Shi. These are the pulses of the four seasons. (*Nan Jing*)
In diagnosing pulses, one must first identify seasonal pulses, Stomach Qi pulses, and normal Zang organ pulses before proceeding to pathological pulses. (Hua Bo Ren)
Seasonal pulses mean that in the three months of Spring, all pulses carry a Xian quality; in Summer, all carry a Hong quality; in Autumn, all carry a Fu quality; in Winter, all carry a Chen quality. If the Zang pulse is normal and the Stomach Qi pulse conforms to the seasons, there is no disease; the reverse indicates disease. Excess indicates disease in the exterior (external pathogenic invasion); deficiency indicates disease in the interior (internal damage to righteous Qi). (Zhang Sanxi)
Reviewing previous chapters, all assign Spring-Xian, Summer-Gou, Autumn-Mao, and Winter-Shi to the four seasons to clarify seasonal pulses. However, pulse alternations include those that change with time and those that do not. Thus, seeing a Gou pulse in Spring is a Summer pulse; seeing a Mao pulse in Spring is an Autumn pulse; seeing a Shi pulse in Spring is a Winter pulse. Understanding disease through changes allows for flexibility, resulting in the wonder of "twenty-five variations." To say Spring must be Xian and Summer must be Gou greatly loses the profound meaning of Stomach Qi. (*Leijing*)
Constitutional Pulse Characteristics
Generally, people are born with either large/surging pulses or small/weak pulses. If one asks and finds their constitutional pulse was large/surging but now suddenly becomes small/weak, this is depletion of Yuan Qi. If one asks and finds their constitutional pulse was small/weak but now suddenly becomes large/surging, this is flourishing of Pathogenic Qi. Investigating their constitution reveals the truth, allowing treatment to hit the mark immediately. If one does not ask about their constitution and sees a large/surging pulse, concluding it is Excess and treating with attack methods will damage Yuan Qi, leading to debility. If one sees a small/weak pulse and concludes it is Deficiency, treating with warming and tonifying methods will exacerbate Pathogenic Fire, leading consumption fever. These errors arise because the physician looks only at the superficial and fails to investigate the constitution, while the patient tests the physician's skill and fails to disclose their constitution. Consequently, treatments are reversed, unpredictable complications arise, physicians lose virtue, and patients suffer bodily harm, all due to not asking about the constitution. ○ Xu Songjing had a constitutional large/surging pulse. Upon a minor ailment, a doctor diagnosed Wind-Cold and intended to induce sweating. Xu said: My pulse has been large/surging since childhood. The doctor knew his constitution and avoided error. Another case: Mrs. Wang was obese with a deep/fine pulse, barely perceptible even when pressed to the bone. Upon illness, a doctor was alarmed, saying: This is dual deficiency of Qi and Blood, Yang is about to perish. He prescribed Shiquan Dabu Decoction, causing immediate irritability and subsequent madness. I knew it was a medication error and administered Sanhuang Shigao Decoction to revive her. (Yu Wuting)
Integration of Pulse and Color
The Yellow Emperor asked: With pre-existing diseases, when the five Zang organs activate and affect the pulse and color, how can one distinguish new from old diseases? Qibo answered: If the pulse is small but the color is unimpaired, it is a new disease; if the pulse is unimpaired but the color is impaired, it is an old disease; if both pulse and five colors are impaired, it is an old disease; if both pulse and five colors are unimpaired, it is a new disease. ○ Combining pulse and color ensures complete success. (*Suwen*)
Those with green complexion have Xian (Wiry) pulses; red, Gou (Hook) pulses; yellow, Dai (Intermittent) pulses; white, Mao (Hairy/Float) pulses; black, Shi (Stone/Deep) pulses. Seeing the color but not obtaining the corresponding pulse, and instead obtaining a controlling (overcoming) pulse, indicates death; obtaining a generating pulse indicates recovery. (*Lingshu*)
Harmony and Disharmony of Pulse and Symptoms
If the body is robust but the pulse is fine, and there is shortness of breath, it is critical. If the body is emaciated but the pulse is large, and there is excess Qi in the chest, it is fatal. When Form and Qi are in harmony, life prevails; when they are discordant, disease occurs. ○ If the pulse follows Yin/Yang principles, the disease is easily cured; if it opposes them, it is difficult to cure. ○ Fever with a quiet pulse, diarrhea with a large pulse, blood loss with a solid pulse, internal disease with a solid/firm pulse, and external disease with an insubstantial pulse are all difficult to treat. (*Suwen*)
What constitutes harmony and disharmony between symptoms and pulse? There are symptom-pulse patterns for external invasions and internal injuries. In external invasions, with steaming fever, the pulse must be large, surging, floating, and rapid; this is harmony. If there is fever but the pulse is not large, surging, floating, and rapid, this is disharmony. It is said: "Yang syndrome with Yin pulse leads to death," but one cannot definitively declare death. This might be due to Fire suppression, inability of Stomach Yin to expand, or inability of Kidney Water to transform Ying Blood. For Fire suppression, use Xiaoyao San plus Shengdi and Bohe to disperse, or add Danpi and Zhizi to guide downward. For inability of Stomach Yin to expand, use Zuogui Yin minus Fuling plus Danggui and Shaoyao combined with Shengmai San to nourish. For inability of Kidney Water to transform Ying Blood, use Liuwei Dihuang Wan or Zuogui Wan to tonify. In internal injuries without external fever, the pulse should be quiet; if it is instead floating, surging, and rapid, this is disharmony. It is said: "Yin syndrome with Yang pulse leads to survival," but one cannot guarantee survival. This might be due to Yin collapse, Yangming food/fire retention, Kidney deficiency failing to grasp Qi, or overuse of Aconite/Wutou drying up lower Jiao fluids. Another case involves a pulse that is forceful upon heavy pressure, spreading from the muscle layer with no boundary between pulse and muscle, resembling a floating, surging, and hollow pulse, always indicating Yin collapse. In cases of Yin collapse, rescue Yin by distinguishing between Pre-Heaven and Post-Heaven sources. (*Jiren Bian*)
In treating diseases, sometimes one abandons symptoms to follow the pulse, and sometimes abandons the pulse to follow symptoms. Because symptoms can be false, and pulses can be false. For example, if there is external vexation and heat but the pulse is weak and faint, it must be Fire deficiency. If there is abdominal fullness but the pulse is weak and faint, it must be Stomach deficiency. Can deficiency-fire and deficiency-fullness be attacked? One should follow the deficiency of the pulse, not the apparent excess of the symptoms. There are cases with no initial vexation or heat, but...