夫诊脉之道，医者之难精也。若非灯下苦心勤于记诵，参师访友昼夜不遑，造次颠沛寤寐俯
仰存心于此，安能知神圣之妙哉！古人曰∶按其脉，知其疾，命曰神，其探赜索隐之妙也。又曰∶
切其脉，治其病，谓之巧，以明其指别之功也。盖三指相去毫厘之近，主病若千里之远，观夫指
别之功也，世人固以为难，命曰神，岂容易可至哉？常睹于经脉有三部寸关尺也，从鱼际至高骨
却行一寸曰寸，从寸一分曰鱼际，从寸至尺曰尺泽，尺前寸后为关，关前为阳则寸口也，关后为
阴则尺脉也，阴入阳出以关为界。寸主上焦头首皮毛，关主中焦胁腹及腰，尺主下焦小腹及足，
此三部所主之大略也。左手关前心之部也，左手当关肝之部也，左手关后肾之部也。右手关前肺
之部也，右手关上脾之部也，右手关后亦肾部也。（此六部原与《脉诀》脏腑配诊相同，今遵
《内经》诊候故删其府之配也。）六部脉候各按四时而有胃气，命曰平人，平人者不病之谓也。
盖平人之常气禀于胃，胃者平人之常气也。所以人常禀气于胃，故脉以胃气为本也。蔡西山曰∶
有胃气之脉，不大不小，不长不短，不滑不涩，不浮不沉，不迟不疾，意思欣欣，难以名状，此
胃气之脉也。反此者病。经曰∶察色按脉，先别阴阳。盖阴阳者，天地之道也。是以治病者必求
其本。本为阴阳四时寒暑五脏之根也。以脉言之则浮沉也，以部言之则尺寸也。故经六∶脉者阴
阳之法，以应五脏，是谓呼出心与肺，吸入肾与肝，呼吸之间脾受谷味，其脉在中也。以浮沉论
之则曰浮者阳也，沉者阴也。在脏腑则浮而大散者心也，浮而短涩者肺也，所以心肺俱浮也。牢
而长者肝也，按之而大举指来实者肾也，所以肝肾俱沉也。迟缓而长者脾也，脾为中州，所以脉
在中也。仲景曰∶脉浮数动滑皆阳也，沉涩弱弦微皆阴也。阳者热也，阴者寒也，所以寒则脉来
迟而沉，热则脉来浮而数。故曰∶诸数为热，诸
迟为寒，无如此验也。《脉经》曰∶诸浮为风，诸紧为痛，诸伏为聚，诸弦为饮，芤者失血。长
则气治，短则气病，数则烦心，大则病进。浮为在表，沉为在里，迟为诸寒，数为诸热。形壮脉
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，三五不调者病，三部九候皆
相失者死。此先圣诊脉之大法。故曰∶凡治病则察其形气色泽，治之无失其时也。所以形气相得
者生，色泽以浮者病易已。脉从四时者可治，脉弱以滑者是有胃气，此皆易治也。若形色相失色
不泽，及脉逆四时，或脉实益坚皆不可治，所谓必察四难而明告之。又若病热脉静、泻而脉大，
脱血而脉实，汗后脉躁，此皆难治也。若疮疽之人脓血大泻，脉滑数者难治也。若患肺痈喘咳脓
血，脉见洪滑，治之难痊。脉洪数应当发热而反恶寒，头项拘急，四肢烦痛，或复战栗渴甚者，
但有痛处必发疮肿也。（《精义》）
诊脉的方法，是医生难以精通的技艺。如果不是在灯下苦心钻研、勤于背诵，向老师请教、拜访朋友昼夜不停，即使在匆忙急迫或颠沛流离、睡觉醒来时都一心专注于此，怎么能知晓神圣医术的奥妙呢！古人说：通过按压脉搏，就能知道疾病，这称为“神”，这是探究深奥隐秘道理的妙处。又说：切按脉搏，治疗疾病，这称为“巧”，这是明确手指辨别功效的作用。大概三指之间的距离仅有毫厘之近，但所主知的病情却相差千里之远，观察这种手指辨别的功效，世人固然认为很难，称之为“神”，难道是可以轻易达到的吗？
经常看到经脉分为三部：寸、关、尺。从鱼际穴到高骨向后行一寸的地方叫作“寸”，从寸口向前一分叫作“鱼际”（此处原文表述有误，通常指寸部范围），从寸口到尺泽叫作“尺”，尺前寸后为“关”。关前为阳，即寸口；关后为阴，即尺脉。阴气入、阳气出以关为界限。寸部主要主管上焦的头面、首部和皮毛；关部主要主管中焦的胁肋、腹部及腰部；尺部主要主管下焦的小腹及足部，这是三部所主管的大致情况。左手关前是心的部位，左手当关（中间）是肝的部位，左手关后是肾的部位。右手关前是肺的部位，右手当关（中间）是脾的部位，右手关后也是肾的部位。（这六部的脏腑配属原本与《脉诀》相同，现在遵循《内经》的诊候原则，所以删去了腑的配属。）六部脉象如果都能顺应四时而带有胃气，就称为“平人”，平人就是指不生病的人。大概平人的常气禀受于胃，胃就是平人的常气。所以人常禀受气于胃，因此脉象以胃气为根本。蔡西山说：有胃气的脉象，不大不小，不长不短，不滑不涩，不浮不沉，不迟不疾，神态欣欣向荣，难以用语言形容，这就是有胃气的脉象。与此相反的即为病态。经书说：观察面色、切按脉象，首先要辨别阴阳。大概阴阳是天地运行的规律。所以治病的人必须探求根本。根本在于阴阳、四时寒暑和五脏的根源。从脉象来说，就是浮和沉；从部位来说，就是寸和尺。所以经文说：脉是阴阳的法度，用来对应五脏。呼气时心与肺之气外出，吸气时肾与肝之气内入，呼吸之间脾接受水谷精微，其脉象位于中部。从浮沉来论述，浮脉属于阳，沉脉属于阴。在脏腑方面，浮大而散的脉象属于心，浮而短涩的脉象属于肺，所以心和肺的脉象都表现为浮。牢靠而长的脉象属于肝，按之坚实、举指来时有力的脉象属于肾，所以肝和肾的脉象都表现为沉。迟缓而长的脉象属于脾，脾位居中州，所以脉象位于中部。张仲景说：脉象浮、数、动、滑都属于阳；沉、涩、弱、弦、微都属于阴。阳代表热，阴代表寒，所以寒证脉象来得迟且沉，热证脉象来得浮且数。所以说：多数脉象主热，迟数脉象主寒，没有比这更准确的验证了。《脉经》说：各种浮脉主风邪，各种紧脉主疼痛，各种伏脉主积聚，各种弦脉主饮邪，芤脉主失血。长脉表示气机调治，短脉表示气机有病，数脉表示心烦，大脉表示病情进展。浮脉表示病在表，沉脉表示病在里，迟脉主各种寒证，数脉主各种热证。形体壮实而脉细，少气不足以喘息的，危险；形体消瘦而脉大，胸中多气的，死亡。形与气相得的，能生；三五不调的，有病；三部九候脉象都失常的，死亡。这是先圣诊脉的大法。所以说：凡是治病，就要观察病人的形体、气色、色泽，治疗不要错失时机。所以形气相得的能生，色泽浮润的病容易痊愈。脉象顺应四时的可以治愈，脉象弱而滑的是有胃气，这些都属于容易治疗的。如果形色相失、面色无光泽，以及脉象违背四时，或者脉象实而更加坚硬的，都不可治愈，所谓必须察知四种难治的情况并明确告知病人。又如患热病而脉静、腹泻而脉大、失血而脉实、发汗后脉躁动，这些都属难治。如果是疮疽患者脓血大量泻出，脉象滑数的，也难治。如果患肺痈出现喘咳脓血，脉象见洪滑的，治疗难以痊愈。脉象洪数应当发热却反而恶寒，头项拘急，四肢烦痛，或者又出现战栗、口渴严重的，只要有疼痛之处，必定会发疮肿。（出自《精义》）
The method of pulse diagnosis is a skill that physicians find difficult to master. Unless one studies diligently by lamplight, memorizes constantly, consults teachers, visits friends day and night without rest, and keeps this in mind during hasty situations, turbulent times, waking or sleeping, how can one know the subtleties of divine medicine? The ancients said: "Pressing the pulse and knowing the disease is called 'Shen' (Divine), which reflects the wonder of exploring profound mysteries." It is also said: "Palpating the pulse and treating the disease is called 'Qiao' (Skillful), demonstrating the efficacy of finger differentiation." The distance between the three fingers is merely a hair's breadth, yet the diseases they indicate are as far apart as a thousand miles. Observing the efficacy of finger differentiation, people naturally consider it difficult; calling it 'Shen', how could it be easily attained?
It is commonly observed that the meridians are divided into three positions: Cun (Inch), Guan (Bar), and Chi (Cubit). One cun backward from the radial styloid process (Gao Gu) towards the fish际 (Yu Ji) is called Cun. From Cun forward one fen is Yu Ji. From Cun to Chi Ze is Chi. The area before Guan and after Cun is Guan. Anterior to Guan is Yang, known as the Cun Kou (Inch Port); posterior to Guan is Yin, known as the Chi Mai (Cubit Pulse). Yin enters and Yang exits with Guan as the boundary. The Cun position primarily governs the Upper Jiao (Upper Burner), including the head, face, and skin/hair. The Guan position primarily governs the Middle Jiao (Middle Burner), including the hypochondrium, abdomen, and waist. The Chi position primarily governs the Lower Jiao (Lower Burner), including the lower abdomen and feet. This is the general overview of what the three positions govern. On the left hand, anterior to Guan is the Heart position; at Guan is the Liver position; posterior to Guan is the Kidney position. On the right hand, anterior to Guan is the Lung position; at Guan is the Spleen position; posterior to Guan is also the Kidney position. (These six positions originally matched the Zang-Fu pairing in *Mai Jue*, but now following the diagnostic principles of *Nei Jing*, the Fu organ pairings have been deleted.) If the pulses of the six positions each possess Stomach Qi (Wei Qi, the vital energy derived from digestion indicating health) according to the four seasons, they are called "Ping Ren" (Normal Person), meaning a person who is not ill. Generally, the normal Qi of a healthy person is derived from the Stomach; the Stomach is the source of normal Qi for a healthy person. Therefore, humans constantly derive Qi from the Stomach, so the pulse is rooted in Stomach Qi. Cai Xishan said: A pulse with Stomach Qi is neither large nor small, neither long nor short, neither slippery nor choppy, neither floating nor sunken, neither slow nor rapid; it appears vibrant and lively, difficult to describe in words. This is a pulse with Stomach Qi. Anything contrary to this indicates disease. The Classics state: "Observe the complexion and palpate the pulse, first distinguishing Yin and Yang." Yin and Yang are the way of Heaven and Earth. Therefore, those who treat diseases must seek their root. The root lies in Yin-Yang, the four seasons, cold and heat, and the five Zang organs. In terms of pulse characteristics, this refers to Floating (Fu) and Sunken (Chen); in terms of positions, it refers to Cun and Chi. Thus, the Classics say: "Pulse is the law of Yin and Yang, corresponding to the five Zang organs. Exhalation corresponds to the Qi of the Heart and Lungs; inhalation corresponds to the Qi of the Kidneys and Liver. Between breaths, the Spleen receives grain essence, and its pulse is located in the middle." Discussing by Floating and Sunken: Floating is Yang, Sunken is Yin. Regarding Zang organs: A pulse that is Floating, Large, and Scattered belongs to the Heart; a pulse that is Floating, Short, and Choppy belongs to the Lung. Thus, both Heart and Lung pulses manifest as Floating. A pulse that is Firm (Lao) and Long belongs to the Liver; a pulse that is solid upon pressure and strong upon lifting belongs to the Kidney. Thus, both Liver and Kidney pulses manifest as Sunken. A pulse that is Slow (Chi) and Long belongs to the Spleen. Since the Spleen resides in the Central Region (Zhong Zhou), its pulse is located in the middle. Zhang Zhongjing said: "Floating, Rapid (Shuo), Moving (Dong), and Slippery (Hua) pulses are all Yang; Sunken, Choppy (Se), Weak (Ruo), Wiry (Xian), and Minute (Wei) pulses are all Yin." Yang represents Heat, and Yin represents Cold. Therefore, in Cold conditions, the pulse comes slowly and sunken; in Heat conditions, the pulse comes floating and rapid. Thus it is said: "Many rapid pulses indicate Heat; many slow pulses indicate Cold." There is no more accurate verification than this. *Mai Jing* states: "All Floating pulses indicate Wind; all Tight (Jin) pulses indicate Pain; all Deep/Fixed (Fu) pulses indicate Accumulation; all Wiry pulses indicate Fluid Retention (Yin); a Knotted/Empty (Kou) pulse indicates Blood Loss. A Long pulse indicates regulated Qi; a Short pulse indicates diseased Qi; a Rapid pulse indicates vexation of the Heart; a Large pulse indicates advancing disease. Floating indicates exterior location; Sunken indicates interior location; Slow indicates various Cold patterns; Rapid indicates various Heat patterns. If the body is robust but the pulse is thin, and there is shortness of breath insufficient for respiration, the condition is critical. If the body is emaciated but the pulse is large, and there is excessive Qi in the chest, death ensues. If Form and Qi are harmonious, life prevails; if the three positions and nine examinations are discordant, disease exists; if all three positions and nine examinations are lost/disordered, death occurs. This is the great method of pulse diagnosis of the ancient sages. Therefore, it is said: 'When treating any disease, observe the form, Qi, complexion, and color; do not miss the appropriate time for treatment.' Thus, if Form and Qi are harmonious, life prevails; if the complexion is floating/lustrous, the disease is easy to cure. If the pulse conforms to the four seasons, it is treatable; if the pulse is weak and slippery, it possesses Stomach Qi; these are all easy to treat. However, if Form and Color are discordant, and the complexion lacks luster, or if the pulse contradicts the four seasons, or if the pulse is Excessively Solid and even firmer, they are untreatable. This is what is meant by 'must examine the four difficulties and clearly inform [the patient].' Furthermore, if a patient has Heat but the pulse is quiet; diarrhea but the pulse is large; blood loss but the pulse is Excess; or post-sweating agitation of the pulse, these are all difficult to treat. If a patient with carbuncles/furuncles has severe discharge of pus and blood, and the pulse is Slippery and Rapid, it is difficult to treat. If suffering from Lung Abscess (Fei Yong) with wheezing, coughing, and pus-blood, and the pulse appears Large and Slippery, recovery is difficult. If the pulse is Large and Rapid, fever should occur, but instead there is aversion to cold; stiffness and tension in the head and neck; irritability and pain in the four limbs; or recurrent chills and severe thirst, where there is only a painful area, a carbuncle or swelling will inevitably develop." (From *Jing Yi*)