痉病异于常症，痉脉异于常脉。其曰∶太阳病发热，脉沉而细者名曰痉，为难治。发热为太阳证，沉
细为少阴脉。凡见微脉即阳之微，见细脉即阴之细。微则易于亡阳，细则易于亡阴，所以难治。其曰∶
太阳病，脉反沉迟，此为痉。虽亦阳症阴脉，而迟与微细大有不同，迟为营血不为充养筋脉而成痉，治不
与少阴同法。两证夹阴之脉，其辨如此。《脉经》云痉家其脉伏坚，直上下，而复以按之紧而弦，直上下
行，互发其义。明伏非伏藏，按之可得，即所谓其脉沉也。坚即紧如弦，不为指挠，邪气坚实也。直上下
行者，督脉与太阳合行脊里，太阳邪盛，督脉亦显其盛，故见直上直下。《脉经》曰∶直上直下者，督脉也。
见则大人癫，小儿痫者是也。惟其夹于沉脉之内，所以病癫及痉。若举指即见，则病为阳
狂，登高俞垣，勇力且倍平昔，何至挛缩如是？痉脉中有阳，其辨又如此。盖体强其脉亦强，求其柔
软和缓，必不可得。况强脉恒杂于阴脉之内，所以沉弦沉紧，邪深脉锢，难于亟夺耳。可见痉证之欲解，
必紧实之脉转为微弱，乃可渐解也。
后人所述损脉，宗本越人，以脉来软者为虚，缓者为虚，滞为虚，芤为中虚，弦为中虚，脉来细而
微者血气并虚，脉小者血气俱少，脉沉小迟者脱气。虚损之脉，似可一言而毕，实未足以尽其底里。仲
景曰虚劳之脉，多兼浮大，所以男子平人脉大为劳，极虚亦为劳。又谓脉浮者里虚。又谓劳之为病，其脉浮
大，手足烦，春夏剧，秋冬瘥。男子脉浮弱而涩，为无子。脉得诸芤动微紧，男子失精，女子梦交。
脉极虚芤迟，为消谷、亡血、失精。脉虚弱细微者，善盗汗。而总结其义曰∶脉弦而大，弦则为减，大则为
芤，减则为寒，芤则为虚，虚寒相搏，此名为革，妇人半产漏下，男子则亡血失精。可见浮大弦紧，外象有
余，中藏不足。不专泥迟缓微弱一端以验脉，而脉之情状，莫逃于指下。
《金匾》有论迟数之脉曰∶
寸口脉浮而迟，浮脉则热，迟脉则潜，热潜相搏，名曰沉。趺阳脉浮而数，浮脉即热，数脉即止，热止相搏，
名曰伏。沉伏相搏，名曰水。沉则络脉虚，伏则小便难，虚难相搏，水走皮肤，即为水矣。如是言脉，令聪
明知见，全不得入。夫寸口肺脉所过，趺阳胃脉所过，二脉合诊表里。《内经》∶三阴结，谓之水。当以寸
口、趺阳定其诊也。寸口脉浮而迟，浮为卫为阳，迟为营为阴，卫不与荣和，其阳独居脉外则为热，营不从
卫匿于脉中则为潜，营卫之间，热潜之脉，相搏而至，则肺气不能布化，故自结而沉也。脾与胃以膜相连
而为表里，趺阳脉浮而数，胃阳不与脾阴相合，浮而独居于表则为热；脾阴不得胃阳以和，反
为阳气所促而变量，数则阴血愈虚而止矣。数止相搏名曰伏者，趺阳之脉本不伏，以热止之故而脉伏
也。寸口之沉，趺阳之伏，相搏于中则为水，岂非三阴结一定之诊乎？然肺合皮毛者也，皮肤者络脉
之所过，肺沉而气不为充，营潜而血不为养，则络脉虚；脾为胃行津液者也，脾伏则津液不入膀胱，故
小便难。络虚便难，水之积者乘虚而走皮间为肿矣。
程郊倩曰∶脉浮、数、大、动、滑，此名阳矣。仲景于浮大脉有曰∶浮则无血，大则为寒。于数脉有曰
∶数为虚，虚为寒。于动、滑脉有曰∶此三焦伤也。曰∶滑则为哕。此等虚实关头，即阴阳转换处，
学人未辨到脉理之精微，穷其变伏，防其胜复，则于脉疑处无有犀烛，何能于病难时下得雷斧？
张隐庵曰∶识脉难，审脉更难。如浮、沉、迟、数、滑、涩，及二十四脉，以对待之法识之，犹易分
别于指下。所谓审脉者，体气强壮之脉何因，所主之病何症，以心印心，而后得确者。叔和曰∶浮
为在表，沉为在里，数为在腑，迟为在脏。又曰∶浮则为热，浮则为风，浮为气实，浮为气虚，浮
则无血，浮则为虚。是将为外感乎？为内伤乎？为气乎？为血乎？为实乎？为虚乎？是必审其证之表里阴
阳，寒热虚实，病之久病新病，脉之有力无力，而断之以意也。
痉病不同于一般的病症，痉脉也不同于一般的脉象。文中说：太阳病出现发热，但脉象沉而细的，称为痉病，属于难治之证。发热是太阳病的证候，沉细则是少阴经的脉象。凡是见到微脉，就是阳气微弱；见到细脉，就是阴血细弱。阳气微弱容易导致亡阳，阴血细弱容易导致亡阴，所以难以治疗。文中又说：太阳病，脉象反而沉迟，这是痉病。虽然这也属于阳证见阴脉，但“迟”与“微细”有很大不同。“迟”是因为营血不能充分充养筋脉而导致痉病，治疗方法不与少阴病相同。这两种证候都夹有阴脉，其辨别方法就是这样。《脉经》说：患痉病的人，其脉象伏而坚劲，直上下行，并且按压时感觉紧而弦，也是直上下行，这两者互相阐发其义理。这说明“伏”并非潜伏藏匿，而是按压时可以摸到，这就是所谓的脉沉。“坚”就是紧如弦，不为指力所挠动，表示邪气坚实。“直上下行”，是因为督脉与太阳经共同行于脊里，当太阳经邪气盛实，督脉也显现出盛实之象，所以脉象表现为直上直下。《脉经》说：直上直下的脉象，属于督脉。出现这种脉象，大人会患癫狂，小儿会患痫病。正因为这种脉象夹杂在沉脉之中，所以会导致癫疾及痉病。如果轻取即见（举指即现），则病为阳狂，患者登高爬墙，勇力甚至超过平时一倍，怎么会像痉病那样发生挛缩呢？痉脉中兼有阳脉，其辨别方法又是如此。大概身体强壮的人，其脉象也强，想要找到柔软和缓的脉象，绝对不可能得到。况且强脉常常夹杂在阴脉之内，所以出现沉弦、沉紧，表示邪气深入，脉气被束缚，难以迅速祛除。由此可见，痉证想要解除，必须是紧实的脉象转变为微弱，才可以逐渐缓解。
后人所述的损脉，以越人（扁鹊）为本，认为脉来软弱的为虚，缓弱的为虚，滞涩的为虚，芤脉为中焦虚，弦脉为中焦虚，脉来细而微的是气血并虚，脉小的气血俱少，脉沉小迟的是脱气。虚损的脉象，似乎可以用一句话概括，但实际上不足以穷尽其深奥道理。张仲景说：虚劳病的脉象，多兼见浮大，所以男子平人脉大为劳，极虚也是劳。又说脉浮表示里虚。又说劳病，其脉浮大，手足烦热，春夏季节加重，秋冬季节减轻。男子脉浮弱而涩，表示无子。脉见诸芤、动、微、紧，男子失精，女子梦交。脉极虚、芤、迟，表示消谷善饥、亡血、失精。脉虚弱细微，容易盗汗。最后总结其义理说：脉弦而大，弦则表示阳气减损，大则表示中空如芤，减损则为寒，中空则为虚，虚寒相搏结，这叫做革脉。妇人会出现半产漏下，男子则会出现亡血失精。可见浮大弦紧，外表看似有余，内部却藏不足。不能专门拘泥于迟缓微弱一端来验证脉象，而脉的情状，没有能逃过手指感知的。
《金匮要略》中有论述迟数脉道：寸口脉浮而迟，浮脉主热，迟脉主潜（沉潜），热与潜相互搏结，名叫沉。趺阳脉浮而数，浮脉主热，数脉主止（气机阻滞），热与止相互搏结，名叫伏。沉与伏相互搏结，名叫水病。沉则络脉空虚，伏则小便困难，虚与难（小便难）相互搏结，水湿走窜皮肤，就形成了水肿。像这样解释脉象，让聪明有见识的人，完全无法理解。因为寸口是肺脉经过的地方，趺阳是胃脉经过的地方，这两处脉合诊可以判断表里。《内经》说：三阴经气结聚，称为水病。应当以寸口、趺阳来确定诊断。寸口脉浮而迟，浮代表卫气、属阳，迟代表营气、属阴，卫气不与营气调和，阳气独居脉外则为热，营气不从卫气隐匿于脉中则为潜，营卫之间，热与潜的脉象相互搏结而至，导致肺气不能布散化生，所以自然结聚而沉。脾与胃以膜相连而为表里，趺阳脉浮而数，胃阳不与脾阴相合，浮而独居于表则为热；脾阴得不到胃阳的和助，反而被阳气催促而变生量变，数脉表示阴血更虚而气机阻滞。数与止相互搏结名叫伏的，是因为趺阳脉本不伏，因为热与止的缘故导致脉伏。寸口的沉，趺阳的伏，在中焦相互搏结就形成水病，这难道不是三阴结这一确定的诊法吗？然而肺合皮毛，皮肤是络脉经过的地方，肺沉而气不能充养，营潜而血不能滋养，则络脉空虚；脾为胃运行津液，脾伏则津液不能进入膀胱，所以小便困难。络脉空虚且小便困难，积聚的水湿乘虚走窜皮间形成浮肿。
程郊倩说：脉浮、数、大、动、滑，这些名为阳脉。张仲景对于浮大脉曾说：浮则无血，大则为寒。对于数脉曾说：数为虚，虚为寒。对于动、滑脉曾说：这是三焦受伤。又说：滑则为哕。这些虚实的关键关头，也就是阴阳转换之处，学习者如果不能辨明脉理的精微，穷究其变化伏藏，防范其胜复关系，那么在脉象可疑之处就没有像犀角烛火一样的洞察力，怎么能在这种疑难病症下得下如雷斧般果断的治疗决策呢？
张隐庵说：识别脉象很难，审察脉象更难。如浮、沉、迟、数、滑、涩，以及二十四种脉象，用对待比较的方法去识别，在手指下还容易分别。所谓审察脉象，是指体质强壮者的脉象成因是什么，所主的病症是什么，以心印心，然后才能得到确切的判断。王叔和说：浮为在表，沉为在里，数为在腑，迟为在脏。又说：浮则为热，浮则为风，浮为气实，浮为气虚，浮则无血，浮则为虚。这究竟是外感呢？还是内伤呢？是气病呢？还是血病呢？是实证呢？还是虚证呢？必须审察证候的表里阴阳、寒热虚实，疾病的久暂新久，脉象的有力无力，然后用意念进行断决。
Jing disease (Spasm Disease) differs from ordinary diseases, and Jing pulse (Spasm Pulse) differs from ordinary pulses. It is stated: "In Taiyang disease (Disease of the Taiyang/Bladder channel), if there is fever but the pulse is deep and fine, it is named Jing disease, which is difficult to treat." Fever is a symptom of Taiyang disease, while deep and fine pulses are characteristic of Shaoyin (Disease of the Shaoyin/Kidney channel). Whenever a Wei pulse (Fine/Micropulse indicating Yang deficiency) is seen, it indicates weak Yang; whenever a Xi pulse (Fine pulse indicating Yin/Blood deficiency) is seen, it indicates thin Yin. Weakness leads easily to collapse of Yang, and fineness leads easily to collapse of Yin; therefore, it is difficult to treat. It is also stated: "In Taiyang disease, if the pulse is unexpectedly slow, this is Jing disease." Although this is also a Yang syndrome presenting with a Yin pulse, "Slow" differs significantly from "Wei and Fine." Slow indicates that Ying blood (Nutritive Blood) fails to adequately nourish the sinews, resulting in spasm; its treatment method does not align with that of Shaoyin disease. The differentiation between these two conditions involving Yin pulses is as described above. *Mai Jing* (Pulse Classic) states: "For those suffering from Jing, the pulse is Fu (Hidden/Deep) and firm, running straight up and down; upon palpation, it feels tight and wiry, also running straight up and down," mutually elucidating their meanings. This clarifies that "Fu" does not mean hidden or concealed, but rather palpable upon pressure, which is what is meant by "deep pulse." "Firm" means tight like a wire, unyielding to finger pressure, indicating solid pathogenic factors. "Running straight up and down" occurs because the Du vessel (Governing Vessel) and the Taiyang channel run together within the spine. When Taiyang pathogenic factors are abundant, the Du vessel also manifests abundance, hence the pulse appears straight up and down. *Mai Jing* says: "Straight up and down indicates the Du vessel. Its appearance causes epilepsy in adults and convulsive disorders in children." Because it is intermingled with the deep pulse, it leads to epilepsy and Jing disease. If the pulse is visible with light touch (lifting the finger reveals it), the disease is Yang mania; the patient climbs high walls and fences, possessing strength double that of usual, how could they end up with such spasms? Thus, Jing pulses contain Yang elements, and their differentiation is as follows. Generally, a strong constitution yields a strong pulse; finding a soft, harmonious, and moderate pulse is absolutely impossible. Moreover, strong pulses often intermingle with Yin pulses, resulting in deep-wiry or deep-tight pulses, indicating deep-seated pathogens and constrained pulses, which are hard to rapidly dispel. Therefore, for Jing syndrome to resolve, the tight and solid pulse must transform into a weak and faint one before gradual relief can occur.
Later descriptions of Sun (Damage) pulses follow Yue Ren (Bian Que) as the source, considering soft pulses as deficiency, slow pulses as deficiency, stagnant pulses as deficiency, Kong pulse (Hollow pulse) as middle-jiao deficiency, and wiry pulses as middle-jiao deficiency. Pulses that are fine and microporous indicate simultaneous deficiency of Qi and Blood; small pulses indicate scarcity of both Qi and Blood; deep, small, and slow pulses indicate loss of Qi. Deficiency damage pulses seem summarizable in one phrase, yet this is insufficient to exhaust their profound principles. Zhang Zhongjing said: "The pulse of Xu Lao (Deficiency Consumption) often combines floating and large characteristics. Hence, in healthy men, a large pulse indicates labor/depletion, and extreme weakness also indicates depletion." He further stated that a floating pulse indicates interior deficiency. He also said that for labor disease, the pulse is floating and large, accompanied by vexatious heat in the hands and feet, worsening in spring and summer, and improving in autumn and winter. In men, a floating, weak, and choppy pulse indicates infertility. A pulse presenting with Kong, Agitated, Microporous, or Tight qualities in men indicates loss of essence; in women, it indicates dream intercourse. An extremely weak, Kong, and slow pulse indicates excessive hunger, loss of blood, and loss of essence. A weak, deficient, fine, and minute pulse predisposes to night sweats. Summarizing the meaning: "A wiry and large pulse: wiry indicates reduction, large indicates Kong; reduction implies cold, Kong implies deficiency. Deficiency and cold clashing together is named Ge pulse (Leather pulse). In women, it causes miscarriage and bleeding; in men, it causes loss of blood and essence." Thus, floating, large, wiry, and tight pulses appear sufficient externally but lack substance internally. One should not rigidly rely solely on slow, delayed, weak, or faint pulses to verify the pulse state; the nuances of the pulse cannot escape the fingertips.
*Jin Gui Yao Lue* discusses slow and rapid pulses: "Cunkou (Radial artery at wrist) pulse is floating and slow. Floating indicates heat; slow indicates submergence (latent). Heat and submergence clashing is named Chen (Sinking). Zuyang (Dorsalis pedis artery) pulse is floating and rapid. Floating indicates heat; rapid indicates cessation/stagnation. Heat and stagnation clashing is named Fu (Hidden). Sinking and Hidden clashing is named Water (Edema). Sinking implies empty collaterals; Hidden implies difficulty in urination. Emptiness and difficulty clashing cause water to flow into the skin, forming edema." Such explanations make even intelligent and knowledgeable individuals unable to comprehend. Cunkou is where the Lung pulse passes; Zuyang is where the Stomach pulse passes; diagnosing these two together determines exterior and interior. *Nei Jing* states: "Constriction of the Three Yin channels is called Water." Diagnosis should be determined via Cunkou and Zuyang. At Cunkou, floating indicates Wei Qi (Defensive Qi)/Yang, and slow indicates Ying Qi (Nutritive Qi)/Yin. If Wei does not harmonize with Ying, Yang resides alone outside the pulse causing heat, while Ying hides inside the pulse without Wei, causing submergence. Between Ying and Wei, the clashing of heat and submergence pulses prevents Lung Qi from distributing and transforming, leading to natural constriction and sinking. The Spleen and Stomach are connected by membranes and form an interior-exterior pair. At Zuyang, floating and rapid indicate Stomach Yang failing to combine with Spleen Yin. Floating and residing alone at the exterior causes heat; Spleen Yin, lacking Stomach Yang's harmony, is urged by Yang Qi to undergo quantitative changes; rapidity indicates Yin blood becomes more deficient and stagnates. Clashing of rapidity and stagnation is named Fu (Hidden); although Zuyang pulse is not inherently hidden, it becomes hidden due to heat and stagnation. The sinking at Cunkou and hidden nature at Zuyang clash in the middle jiao to form water, which is indeed the definitive diagnosis of Three Yin constriction? Since the Lung governs the skin and hair, and skin is where collaterals pass, Lung sinking and Qi failing to nourish, along with Ying submerging and Blood failing to nourish, result in empty collaterals. The Spleen transports fluids for the Stomach; Spleen hiddenness prevents fluids from entering the Bladder, causing urinary difficulty. Empty collaterals and urinary difficulty allow accumulated water to enter the skin interspace, causing swelling.
Cheng Jiaoqian stated: "Floating, rapid, large, agitated, and slippery pulses are named Yang." Regarding floating and large pulses, Zhang Zhongjing said: "Floating indicates lack of blood; large indicates cold." Regarding rapid pulses: "Rapid indicates deficiency; deficiency indicates cold." Regarding agitated and slippery pulses: "These indicate injury to the Sanjiao (Triple Burner)." He also said: "Slippery indicates hiccups." These critical junctures of excess and deficiency are precisely where Yin and Yang transform. If learners cannot discern the subtleties of pulse pathology, exhaust their variations and latent forms, and prevent their overcoming and recurrence, they will lack sharp insight into doubtful pulses and how can they wield decisive treatment like thunderous axes for difficult diseases?
Zhang Yinan stated: "Identifying pulses is difficult; examining pulses is even harder." For pulses such as floating, sinking, slow, rapid, slippery, and choppy, and the twenty-four pulse types, using comparative methods to identify them is still relatively easy to distinguish under the fingers. What is meant by "examining pulses" is understanding why a pulse appears in a robust constitution, what symptoms the governed disease presents, achieving certainty through intuitive resonance ("heart-to-heart"). Wang Shuhe said: "Floating indicates exterior; sinking indicates interior; rapid indicates Fu organs; slow indicates Zang organs." He also said: "Floating indicates heat, wind, Qi excess, Qi deficiency, lack of blood, and deficiency." Is this external contraction or internal injury? Is it Qi or Blood? Is it Excess or Deficiency? One must examine the exterior-interior, Yin-Yang, cold-heat, and excess-deficiency of the syndrome, the duration (old vs. new) of the disease, and the forcefulness or weakness of the pulse, then make a judgment based on reasoning.