推而外之，内而不外，有心腹疾也。推而内之，外而不内，身有热也。推而上之，上而不下，腰足
清也。推而下之，下而不上，头项痛也。按之至骨，脉气少者，腰脊痛而身有痹也。
此系以手推病法，亦诊例也。
柯韵伯曰∶按脉内侧推而外，欲候筋骨、气血、肌肉等病，脉反内着，知病已在内，故牢不可移，
是胸腹有积聚为患，故脉如是也。推脉外侧而内求之，以候胸腹诸病，指欲内而脉反外鼓，是病已外发，气
从外向，形身有热，为可证矣。
寸脉为阳而主降，反脉为阴而主升，天地气交，火既济之理也。按寸推而上之，究其胸喉以上之病，
其脉气上而不下，是阳虚而不降，则阴中无阳，腰足清也。按尺推而下之，究其小腹腰股膝胫中病，其脉下
而不上，是阴虚而气不上升，阳中无阴，头项痛可知也。
不内不外，是脉气有余；不上不下，皆因脉气不足。然阴阳外降以为和，及其偏胜，则阳下陷入阴
中而发热，阴气
上入阳中而脑髓恶寒，更可以上下之法神而明之矣。
按之至骨，所以候肾。举指不实，便是少气，肾附腰脊，故痛，精髓不足，故身有痹也。
粗大者，阴不足阳有余，为热中也。来疾去徐，上实下虚，为厥巅疾。
粗大者，浮洪之类，阳实阴虚，故为内热。上实者寸盛，下虚者尺弱，皆阳强之脉，故为阳厥巅
顶之疾。
来徐去疾，上虚下实，为恶风也。故中恶风，阳气受也。
来之徐，知上之虚，皆阳不足也。阳虚必恶风。
有脉俱沉细者，少阴厥也。
沉细肾脉，兼数则热，阴中有火，此少阴之厥也。然愈虚则愈数。沉细之数，厥则何疑？又不
可以火断也。
沉细数散者，寒热也。
沉细为阴，数散为阳，阴脉数散，阴不固也。故或入之阴，或出之阳，而为来往寒热也。
浮而散者为 仆。
浮者阴不足，散者神不守，浮而散，阴气脱，故为 仆。
数动一代者，病在阳之脉也，泄及便脓血。
数动阳脉也，一代阳邪伤其血气也，故为泄脓血。
肝满肾满肺满皆实，即为肿，肺之壅，喘而两胁满，肝壅，两胁满，卧则惊，不得小便。肾壅，
胁下至少腹满，胫有大小，髀 大跛，易偏枯。
满，邪气壅滞而为胀满也。三经皆能为满，若其脉实，当为浮肿。肺居膈上，其系横出腋下，故肺
壅则喘而两胁满。肝
之脉环阴器布胁肋，故壅则两胁满不得小便。肝主惊，卧则愈壅，故多惊也。肾脉循内踝，上 出 ，络膀
胱而上行，故壅则胁下至少腹满也。或肿或消，是谓大小跛。易偏枯，不能营运所致。
心脉满大，痫螈筋挛。肝脉小急，痫螈筋挛。
心脉满大，火有余也；火盛则血涸。故痫螈筋挛。肝藏血，小为血不足，急为邪有余，故为是病。
夫痫螈筋挛病一也，而心肝二经皆有之，一以内热，一以风寒，寒热不同，血衰一也。
肝脉骛暴，有所惊骇，脉不至若喑，不治自己。
骛，驰骤也。惊骇肝病，肝脉急乱，因惊而然。此特一时气逆耳，通则无喑也。
肾脉小急，肝脉小急，心脉小急，不鼓皆为瘕。
三脉细小而急，阴邪聚于阴分也，故当随经而为瘕。
肝肾并沉为石水，并浮为风水，并虚为死，并小弦欲惊。
水病有阴阳，肾肝在下，肝主风，肾主水。俱沉者阴中阴病也，石水凝结少腹，沉坚在下。俱浮
者阴中阳病也，风水游行四体，泛浮于上。并虚者，一为根本，一为发生，根本空虚，有表无里，当死。
并小真阴虚，小而兼弦木邪胜，气虚胆怯，故为欲惊。
肾脉大急沉，肝脉大急沉，皆为疝。
疝者，寒气结聚所为。急者，挟肝邪。沉者，在阴分。沉急而大，阴邪盛也。肝肾之脉络小腹，结于
阴器，寒邪居之，故疝，按疝病乃寒邪挟肝邪之证，或结小腹，或结睾丸，或结于丸之左右上下。而筋急
绞痛，脉必急搏者，多以寒邪结聚阴分，而挟风木之气也。经曰肝风疝，脾风疝，皆兼一风字，其必挟肝邪
可知。
心脉搏滑急为心疝，肺脉沉搏为肺疝。
心脉搏滑急，寒挟肝邪乘心。肺沉搏，寒挟肝邪乘肺。
三阳急为瘕，三阴急为疝。
三阳，太阳也。三阴，太阴也。阳为瘕聚，阴为疝气。凡脉急，皆邪盛也。寒邪气聚，皆可名疝，
故五脏皆有之。
二阴急为痫厥，二阳急为惊。
二阴，少阴也。二阳，阳明也。脉急者为风寒邪乘心肾，故为痫为厥；木邪乘胃，故发为惊。
脾脉外鼓，沉为肠 ，久自己。肝脉小缓为肠 ，易治。肾肝小搏沉，为肠 下血，血温身热者死。心
肝亦下血，二脏同病者可治，其脉小沉涩为肠 ，其身热者死，热见七日死。
肠 ，下痢也，凡心、肝、脾，肾皆主阴分，或寒湿，或热，各有所伤，乃自大肠下血，均谓肠 。
血温身热者，邪火有余，真阴衰败，故死。心主血，肝藏血，故二脏 于下血，同病为顺而可治。若肝
脾同病，为土败木贼，其难治也明矣。小沉而涩为肠 者，以阴不足而伤血也。然脉沉细不当热，今身热，
是为逆。七日，六阴败尽也。
胃脉沉鼓涩，胃外鼓大，心脉小坚急，皆膈偏枯。
沉鼓涩，阳不足也。外鼓大，阴受伤也。小坚而急，心火郁而内热也，胃为水谷之海，胃气既伤，
心部又病，此上下痞满，膈偏枯矣。
脉至而搏，血衄身热者死，脉来悬钩浮为常脉。
搏，脉坚强，阴虚最忌。若血衄脉搏身热，真阴败脱也。然失血之证多阴虚，阴虚之脉多浮大，故悬
钩浮乃其常脉，无足虑也。
脉至如喘，名曰暴厥，暴厥者不知与人言，脉至如数，使
人暴惊，三四日自己。
如数，非真数之脉，以猝动肝心之火，故令人暴惊。
心脉搏坚而长，当病舌卷不能言；其软而散，当消环自己。
心脉坚搏，肝邪乘心，脏气亏甚，少阴脉从心系上挟咽，故令舌卷不能言。搏坚之脉，皆肝邪盛也
，五脏皆畏之。盖五脏以
胃气为本，脉无胃气则死。凡木强者土必衰，脉搏者胃多败，故坚搏为诸脏所忌。搏之微，邪亦微；搏之甚
，则几于真脏矣。故当以搏之微甚，而察病之浅深。
肺脉搏坚而长，当病唾血；其软而散者，当病灌汗，至令其不复发散也。
肺脉搏坚，邪乘肺也。肺系连喉，故为唾血。软散，肺虚不敛，汗出如水且亡阳，故不可更为发散。
肝脉搏坚而长，色不青，当病坠若搏，因血在胁下，令人喘逆；其软而散色泽者，当病溢饮。溢饮者，
渴暴多饮，而易入肌皮肠胃之外也。
胃脉搏坚而长，其色赤，当病折髀，其软而散当病食痹。
胃脉搏坚，木乘土也。色赤，则阳明火盛也。木火交炽，胃经必伤，阳明下行者，从气街下行抵
伏兔，故病髀如折也。软散则胃气本虚，食则气逆，滞闷不行，而为食痹。
脾脉搏坚而长，其色黄，当病少气；其软而散色不泽者，当病足胫肿，若水状也。
邪脉乘脾，脾虚无以生血，故本脏之色见，脾弱不能生肺，故为少气。若软散色不泽者，尤见脾虚，
脾络内踝前廉。循 骨后，故病足胫肿。若水状，以脾不制水也。
肾脉搏坚而长，其色黄而赤者，当病折腰；其软而散者，当病少血，至今不复也。
邪干肾气必衰，色黄赤为火土有余，故病腰如折也。软散则本虚，肾主水以生化津液，今肾气不化，
故病少血。按五脏病脉，一曰搏坚，一曰软散，而其为病多皆不足。盖搏坚之脉，邪胜于正，是谓
邪之所凑，其气必虚，软散者，本原不足，谓正气夺则虚也。有邪致虚，无邪本虚。虚若一而病本不同，
所当辨也。
阴搏阳别，谓之有子。
阴，主少阴而言。肾主子宫，胎孕之所主也。阳别者，言阴脉搏手，似乎阳邪，然其鼓动滑利，
本非邪脉。盖以阴中见阳，而别有和调之象，是谓阴搏阳别也。然犹当察孕妇之强弱老少，及平日之偏
左偏右，尺寸之素强素弱，斯足以尽其义矣。
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。
缓因胃热，滑以阳强，故病热中。缓谓纵缓之状，非迟也。盛则中气滞紧，则邪有余，故为胀也。
阴阳虚，肠 死。
阴阳虚，尺寸俱虚也。胃气不留，魄门不禁而阴阳虚者，脏气竭也。故死。
阳加于阴，谓之汗。
阳言脉体，阴言脉位，汗液属阴，而阳加以阴，阴气泄矣。
阴虚阳搏，谓之崩。
阴虚，沉取不足；阳搏，浮取有余。阳实阴虚，故曰内崩失血。
三阴俱搏，二十日夜半死。二阴俱搏，十三日夕时死。一阴俱搏，十日平旦死。三阳俱搏且鼓，
三日死。三阴三阳俱
搏，心腹满。发尽不得隐曲，五日死。二阳俱搏，其病温，死不治，不过十日死。
三阴俱脾肺也。搏即真脏之击搏。二十日，肺脾成数。夜半阴极气尽，故死。二阴俱心肾也。十三日，
心肾之成数。夕时阴阳相半，水火分争也。一阴俱心主与肝也。平旦木火旺极，而邪更甚，故死。三阳俱
手足两太阳也。水一火二，故死。在三日，既搏且鼓，阳邪盛极矣。三阴三阳，四脏俱搏，则上下俱病。故
在上则心腹满胀，至于发尽；在下则不得隐曲，阴道不通也。四脏俱病，惟以胃气为主，五谷尽而死矣。
二阳俱，大肠胃也。独阙一阳，必脱简。
用手推按脉象的寸部向外，如果脉气反而向内沉伏，说明病在心腹部。用手推按脉象的尺部向内，如果脉气反而向外鼓动，说明身体有发热。用手推按脉象的上部向上，如果脉气上逆而不下行，说明腰脚发冷。用手推按脉象的下部向下，如果脉气下陷而不上升，说明头项疼痛。按压脉象直到骨头，如果脉气微弱，说明腰脊疼痛且身体有痹症。
这是用手推按来诊断疾病的方法，也是诊脉的常规法则。
柯韵伯说：在脉象内侧推按并外探，是为了候察筋骨、气血、肌肉等部位的病变，如果脉气反而内着不移，说明病邪已在体内，所以牢固不可移动，这是胸腹有积聚之邪为患，所以脉象如此。推按脉象外侧并向内求索，以候察胸腹诸病，手指欲向内而脉气反而向外鼓动，说明病邪已外发，气从外向，身体发热，可以以此作为证据。
寸脉属阳而主降，反脉（指与正常相反或特定的脉象变化）属阴而主升，这是天地之气相交，水火既济的道理。按压寸部并推而上行，以究察胸喉以上的病变，如果脉气上逆而不下降，是阳气虚弱而不能下降，导致阴中无阳，所以腰脚发冷。按压尺部并推而下行，以究察小腹、腰、股、膝、胫中的病变，如果脉气下陷而不上升，是阴气虚弱而气不能上升，导致阳中无阴，所以头项疼痛可知。
脉气不内不外，说明脉气有余；脉气不上不下，皆因脉气不足。然而阴阳应当外降以维持和谐，一旦偏胜，则阳气下陷入阴中而发热，阴气上入阳中而脑髓恶寒，更可以通过上下推按的方法来神妙地阐明这一道理。
按压至骨，是为了候察肾脏的情况。举指时感觉不实，就是少气（元气不足），肾附于腰脊，所以疼痛，精髓不足，所以身体有痹症。
脉象粗大，说明阴不足而阳有余，是热邪在中焦。脉势来势急去势缓，说明上实下虚，是厥逆和巅顶的疾病。
脉象粗大，属于浮洪之类，是阳实阴虚，所以为内热。上实是指寸脉盛，下虚是指尺脉弱，都是阳强盛的脉象，所以为阳厥和巅顶之疾。
脉势来势缓去势急，说明上虚下实，是厌恶风邪。这是因为中受风邪，阳气受损。
沉细是肾脉，兼见数脉则有热，阴中有火，这是少阴的厥证。然而越虚则脉数越明显。沉细而数的脉象，既然是厥证，有什么可疑的呢？又不可以用单纯的火证来判断。
沉细属阴，数散属阳，阴脉出现数散，说明阴气不固。所以有时入于阴分，有时出于阳分，从而出现往来寒热的症状。
浮说明阴不足，散说明神不守舍，浮而散，说明阴气脱失，所以为仆倒昏厥。
脉象数动且间歇（代脉），是病在阳分的脉象，伴有泄泻及便脓血。
数动是阳脉，一代（间歇）说明阳邪损伤了血气，所以为泄泻脓血。
肝、肾、肺三脏脉气满实，就会发生浮肿。肺壅滞，则喘息且两胁满闷；肝壅滞，则两胁满闷，卧则惊悸，小便不通。肾壅滞，则胁下至少腹满闷，小腿粗细不一，大腿粗大且跛行，容易偏枯。
“满”，指邪气壅滞而导致胀满。这三条经脉都能导致满证，如果脉象实，应当出现浮肿。肺位于膈上，其经络横出腋下，所以肺壅滞则喘息且两胁满闷。肝的经络环绕阴器散布于胁肋，所以壅滞则两胁满闷且小便不通。肝主惊，卧时气机更加壅滞，所以多惊悸。肾脉循行内踝，上行出腘窝，联络膀胱而上行，所以壅滞则胁下至少腹满闷。或肿或消，称为大小跛。容易偏枯，是由于气血运行不畅所致。
心脉满大，会发生痫证、抽搐和筋挛。肝脉小急，也会发生痫证、抽搐和筋挛。
心脉满大，是火有余；火盛则血液枯竭。所以发生痫证、抽搐和筋挛。肝藏血，脉小为血不足，脉急为邪气有余，所以发生这些病。
痫证、抽搐和筋挛是同一种病，但心和肝两条经脉都有此病，一个是由于内热，一个是由于风寒，寒热不同，但血衰是一样的。
肝脉如马奔驰般急促暴乱，如果有惊吓，脉象不至或声音嘶哑，不治也能自愈。
“骛”，指驰骤。惊吓伤肝，肝脉急乱，是因为惊吓所致。这只是一时的气逆罢了，气通则不会声音嘶哑。
肾脉小急，肝脉小急，心脉小急，如果不鼓动（无力），皆为瘕积。
肝肾脉象都沉，是石水；都浮，是风水；都虚，是死证；都小弦，是想惊悸。
水病有阴阳之分，肾和肝在下焦，肝主风，肾主水。都沉，是阴中之阴病，石水凝结于少腹，沉坚在下。都浮，是阴中之阳病，风水游行于四肢，泛浮于上。都虚，一个是根本，一个是发生，根本空虚，有表无里，当死。都小是真阴虚，小兼弦是木邪胜，气虚胆怯，所以想惊悸。
疝气，是由寒气结聚造成的。急，是挟带肝邪。沉，是在阴分。沉急而大，是阴邪盛也。肝肾的脉络经过小腹，结于阴器，寒邪居于此，所以为疝。按疝病乃是寒邪挟带肝邪的证候，或结于小腹，或结于睾丸，或结于丸子的左右上下。而筋脉紧急绞痛，脉象必定急搏，多以寒邪结聚阴分，而挟带风木之气。经文说肝风疝、脾风疝，都兼有一个“风”字，可知必挟带肝邪。
心脉搏滑急，是寒邪挟带肝邪乘袭心脏。肺脉沉搏，是寒邪挟带肝邪乘袭肺脏。
三阳，指太阳经。三阴，指太阴经。阳经为瘕聚，阴经为疝气。凡是脉急，都是邪气盛也。寒邪气聚，都可以名为疝，所以五脏都有疝病。
二阴，指少阴经。二阳，指阳明经。脉急者为风寒邪气乘袭心肾，所以为痫为厥；木邪乘袭胃，所以发为惊悸。
脾脉外鼓，沉取为肠澼，久病能自愈。肝脉小缓为肠澼，容易治疗。肾肝脉小搏沉，为肠澼下血，如果血温身热则死。心肝也下血，两脏同病的可治，如果脉小沉涩为肠澼，其身热则死，热见七日死。
“肠澼”，即下痢。凡心、肝、脾、肾都主阴分，或寒湿，或热，各有所伤，乃自大肠下血，均称为肠澼。
血温身热，是邪火有余，真阴衰败，所以死。心主血，肝藏血，所以两脏关于下血的病，同病为顺而可治。如果肝脾同病，为土败木贼，其难治是明显的。脉小沉而涩为肠澼，是因为阴不足而伤血。然而脉沉细不应当热，现在身热，是为逆证。七日，是六阴败尽的时候。
沉鼓涩，是阳气不足。外鼓大，是阴受伤。小坚而急，是心火郁而内热。胃为水谷之海，胃气既伤，心部又病，这是上下痞满，膈噎和偏枯。
脉来搏击有力，伴有鼻出血和身热的，是死证；脉来悬钩浮是正常的脉象。
搏，指脉坚强，阴虚最忌。如果鼻出血、脉搏强劲、身热，是真阴败脱。然而失血的病症多阴虚，阴虚的脉象多浮大，所以悬钩浮是其常脉，无需担忧。
脉来如喘，名叫暴厥，暴厥的人不知道与人说话；脉来如数，使人突然惊悸，三四天能自愈。
如数，不是真正的数脉，而是因为猝然触动肝心之火，所以令人暴惊。
心脉搏坚而长，应当病舌卷缩不能言语；如果脉软而散，应当病消渴，能自愈。
心脉坚搏，是肝邪乘袭心脏，脏气亏甚，少阴脉从心系上挟咽喉，所以令舌卷缩不能言语。搏坚的脉象，都是肝邪盛也，五脏都畏惧它。盖五脏以胃气为本，脉无胃气则死。凡木强者土必衰，脉搏者胃多败，所以坚搏为诸脏所忌。搏之轻微，邪亦微；搏之严重，则几近真脏脉了。所以应当根据搏之微甚，来察知病的浅深。
肺脉搏坚而长，应当病唾血；如果脉软而散，应当病灌汗（大汗淋漓），至今不再复发发散。
肺脉搏坚，是邪气乘袭肺脏。肺系连喉，所以为唾血。软散，是肺虚不敛，汗出如水且亡阳，所以不可再发散。
肝脉搏坚而长，面色不青，应当病坠跌或击打，因血在胁下，令人喘逆；如果脉软而散色泽润泽，应当病溢饮。溢饮，是口渴暴多饮水，而易入肌皮肠胃之外。
胃脉搏坚而长，面色赤，应当病髀骨折断样疼痛；如果脉软散，应当病食痹。
胃脉搏坚，是木乘土。面色赤，则是阳明火盛。木火交炽，胃经必伤，阳明经下行者，从气街下行抵伏兔，所以病髀如折。软散则胃气本虚，进食则气逆，滞闷不行，而为食痹。
脾脉搏坚而长，面色黄，应当病少气；如果脉软散色不泽，应当病足胫肿，像水状。
邪脉乘脾，脾虚无以生血，所以本脏之色现，脾弱不能生肺，所以为少气。如果软散色不泽，尤其显示脾虚，脾络内踝前廉，循胫骨后，所以病足胫肿。像水状，是因为脾不制水。
肾脉搏坚而长，面色黄而赤，应当病折腰；如果脉软散，应当病少血，至今不复。
邪干肾气必衰，色黄赤为火土有余，所以病腰如折。软散则本虚，肾主水以生化津液，今肾气不化，所以病少血。按五脏病脉，一曰搏坚，一曰软散，而其病多皆不足。盖搏坚之脉，邪胜于正，是谓邪之所凑，其气必虚；软散者，本原不足，谓正气夺则虚也。有邪致虚，无邪本虚。虚若一而病本不同，所当辨也。
阴，主要指少阴而言。肾主子宫，是胎孕之所主。阳别者，是说阴脉搏手，似乎阳邪，然而其鼓动滑利，本非邪脉。盖以阴中见阳，而别有和调之象，是谓阴搏阳别。然而还应当察看孕妇的强弱老少，以及平日之偏左偏右，尺寸之素强素弱，这才足以尽其义理。
脉急，叫做疝瘕少腹痛。脉滑，叫做风。脉涩，叫做痹。缓而滑，叫做热中。盛而紧，叫做胀。
缓因胃热，滑以阳强，所以病热中。缓谓纵缓之状，不是迟脉。盛则中气滞，紧则邪有余，所以为胀。
阴阳虚，指尺寸俱虚。胃气不留，魄门不禁而阴阳虚者，是脏气竭也。所以死。
阳加于阴，叫做汗。
三阴脉俱搏，二十日夜半死。二阴脉俱搏，十三日夕时死。一阴脉俱搏，十日平旦死。三阳脉俱搏且鼓，三日死。三阴三阳脉俱搏，心腹满。发尽不得隐曲，五日死。二阳脉俱搏，其病温，死不治，不过十日死。
三阴俱指脾肺。搏即真脏之击搏。二十日，是肺脾成数。夜半阴极气尽，所以死。二阴俱指心肾。十三日，是心肾之成数。夕时阴阳相半，水火分争。一阴俱指心主与肝。平旦木火旺极，而邪更甚，所以死。三阳俱指手足两太阳。水一火二，所以死。在三日，既搏且鼓，阳邪盛极了。三阴三阳，四脏俱搏，则上下俱病。所以在上则心腹满胀，至于发尽；在下则不得隐曲，阴道不通。四脏俱病，惟以胃气为主，五谷尽而死。
Pushing the pulse outward (from the interior to the exterior), if the pulse qi instead sinks inward, it indicates disease in the heart and abdomen. Pushing the pulse inward (from the exterior to the interior), if the pulse qi instead bulges outward, it indicates heat in the body. Pushing the pulse upward, if the pulse qi rises but does not descend, it indicates coldness in the waist and feet. Pushing the pulse downward, if the pulse qi sinks but does not rise, it indicates pain in the head and neck. Pressing the pulse down to the bone, if the pulse qi is weak, it indicates pain in the waist and spine and bi-syndrome (obstruction syndrome) in the body.
This method uses the hand to push and press for diagnosis; it is also a standard diagnostic example.
Ke Yunbo said: Pushing from the inner side of the pulse outward aims to observe diseases of the sinews, bones, qi, blood, and muscles. If the pulse instead adheres inwardly, it indicates that the pathogen has entered the interior, becoming firm and immovable. This suggests accumulation and stagnation in the chest and abdomen, hence such a pulse. Pushing from the outer side of the pulse inward aims to observe various diseases of the chest and abdomen. If the fingers seek inward but the pulse bulges outward, it indicates that the disease has emerged externally, with qi moving outward, manifesting as body heat, which serves as evidence.
The cun (inch) pulse belongs to Yang and governs descent; the reversed pulse belongs to Yin and governs ascent. This reflects the interaction of Heaven and Earth Qi and the principle of Fire and Water having achieved balance (Ji Ji). Pressing the cun position and pushing upward investigates diseases above the chest and throat. If the pulse qi rises but does not descend, it indicates Yang deficiency failing to descend, resulting in Yang absent within Yin, leading to coldness in the waist and feet. Pressing the chi (cubit) position and pushing downward investigates diseases in the lower abdomen, waist, thighs, knees, and shins. If the pulse qi sinks but does not rise, it indicates Yin deficiency failing to ascend, resulting in Yin absent within Yang, making head and neck pain evident.
Pulse qi neither entering nor exiting indicates excess pulse qi; pulse qi neither rising nor falling indicates deficient pulse qi. However, Yin and Yang should descend externally to maintain harmony. When biased and excessive, Yang sinks into Yin causing fever, and Yin enters Yang causing coldness in the brain marrow. The methods of pushing up and down can further elucidate this spiritually.
Pressing to the bone is used to inspect the Kidney. If lifting the finger feels empty, it indicates Shaoyang Qi deficiency (shortness of Qi). Since the Kidney attaches to the waist and spine, pain occurs; due to insufficiency of essence and marrow, bi-syndrome occurs.
A coarse pulse indicates Yin insufficiency and Yang excess, representing heat in the interior. A rapid arrival and slow departure indicate upper excess and lower deficiency, representing jue (reversal) and diseases of the vertex.
A coarse pulse belongs to floating and flooding types, indicating Yang excess and Yin deficiency, thus internal heat. Upper excess refers to a strong cun pulse; lower deficiency refers to a weak chi pulse. Both are pulses of strong Yang, thus indicating Yang jue and vertex diseases.
A slow arrival and rapid departure indicate upper deficiency and lower excess, representing aversion to wind. This occurs when wind evil invades the center, damaging Yang Qi.
A slow arrival indicates upper deficiency, all due to Yang insufficiency. Yang deficiency inevitably leads to aversion to wind.
If both pulses are deep and fine, it represents Shao Yin jue.
Deep and fine is the Kidney pulse; if accompanied by rapidity, there is heat, meaning fire within Yin. This is Shao Yin jue. However, greater deficiency leads to greater rapidity. With deep, fine, and rapid pulses, how can one doubt jue? It cannot be judged solely as a fire condition.
Deep, fine, rapid, and scattered pulses indicate alternating cold and heat.
Deep and fine belong to Yin; rapid and scattered belong to Yang. An Yin pulse appearing rapid and scattered indicates Yin failing to consolidate. Thus, sometimes entering Yin, sometimes emerging to Yang, it results in alternating cold and heat.
A floating and scattered pulse indicates sudden collapse (pu).
Floating indicates Yin insufficiency; scattered indicates Shen (Spirit) failing to reside. Floating and scattered indicate Yin Qi depletion, hence sudden collapse.
Rapid, active pulses with intermittent pauses (dai pulse) indicate disease in the Yang aspect, accompanied by diarrhea and pus/blood in the stool.
Rapid and active are Yang pulses; intermittent pauses indicate Yang pathogens injuring Qi and Blood, hence diarrhea with pus and blood.
When Liver, Kidney, and Lung pulses are full and solid, swelling occurs. Lung congestion causes panting and distension in both hypochondria. Liver congestion causes distension in both hypochondria, fright upon lying down, and inability to urinate. Kidney congestion causes distension from the hypochondria to the lower abdomen, varying sizes of calves, enlarged thighs with limping, and predisposition to hemiplegia.
"Full" refers to distension caused by pathogenic stagnation. All three meridians can cause fullness; if the pulse is solid, edema should occur. The Lung resides above the diaphragm, its channels extending horizontally to the axilla; thus, Lung congestion causes panting and hypochondriac distension. The Liver channel circles the genitalia and spreads over the hypochondria; thus, congestion causes hypochondriac distension and urinary retention. The Liver governs fright; lying down increases congestion, causing more fright. The Kidney channel follows the medial malleolus, ascends out of the popliteal fossa, connects with the Bladder, and ascends; thus, congestion causes distension from the hypochondria to the lower abdomen. Swelling or wasting leads to unequal limb size and limping. Hemiplegia is caused by impaired circulation.
Full and large Heart pulses indicate epilepsy, convulsions, and tendon spasms. Small and urgent Liver pulses also indicate epilepsy, convulsions, and tendon spasms.
Full and large Heart pulses indicate excess Fire; excessive Fire dries up Blood, leading to epilepsy, convulsions, and tendon spasms. The Liver stores Blood; small pulses indicate Blood insufficiency, and urgent pulses indicate excess pathogens, hence these diseases.
Epilepsy, convulsions, and tendon spasms are the same disease, yet appear in both Heart and Liver meridians. One is due to internal heat, the other to wind-cold. Although cold and heat differ, Blood decline is common to both.
Wu (galloping/rushing) and sudden Liver pulses, following fright, may result in absent pulses or aphasia, which will resolve spontaneously without treatment.
"Wu" means galloping. Fright injures the Liver, causing urgent and chaotic Liver pulses due to fright. This is merely temporary Qi reversal; once unblocked, aphasia resolves.
Small, urgent pulses in the Kidney, Liver, and Meridies, if lacking pulsation force, indicate jia (masses).
Small, thin, and urgent pulses in all three indicate Yin pathogens gathering in the Yin divisions, forming masses along the meridians.
Simultaneously deep Liver and Kidney pulses indicate Stone Water (Shi Shui); simultaneously floating indicates Wind Water (Feng Shui); simultaneously void indicates death; simultaneously small and wiry indicates impending fright.
Water diseases have Yin and Yang aspects. Kidney and Liver are in the lower jiao; Liver governs Wind, Kidney governs Water. Both deep indicates Yin within Yin disease; Stone Water congeals in the lower abdomen, deep and firm below. Both floating indicates Yang within Yin disease; Wind Water travels through the four limbs, floating above. Both void indicates one as root, one as sprout; root emptiness means exterior without interior, leading to death. Both small indicates True Yin deficiency; small with wiry indicates Wood pathogen excess, Qi deficiency, and gallbladder timidity, hence impending fright.
Large, urgent, and deep pulses in the Kidney and Liver both indicate hernia (shan).
Hernia is caused by cold pathogen aggregation. Urgent indicates accompanying Liver pathogen. Deep indicates location in Yin division. Large, urgent, and deep indicate盛 Yin pathogens. Kidney and Liver channels pass through the lower abdomen and connect to the genitalia; cold pathogens residing here cause hernia. Hernia involves cold pathogens accompanying Liver pathogens, aggregating in the lower abdomen, testicles, or surrounding areas, causing urgent tendon cramping and pain, with urgent and forceful pulses. This is due to cold pathogens aggregating in Yin divisions, accompanying Wind-Wood Qi. Classics mention Liver Wind Hernia and Spleen Wind Hernia, implying they always accompany Liver pathogens.
Rapid, slippery, and urgent Heart pulses indicate Heart Hernia; deep and forceful Lung pulses indicate Lung Hernia.
Rapid, slippery, and urgent Heart pulses indicate cold accompanying Liver pathogen attacking the Heart. Deep and forceful Lung pulses indicate cold accompanying Liver pathogen attacking the Lung.
Urgent pulses in the Three Yang meridians indicate jia (masses); urgent pulses in the Three Yin meridians indicate hernia.
Three Yang refers to Tai Yang. Three Yin refers to Tai Yin. Yang meridians relate to jia masses; Yin meridians relate to hernia Qi. Any urgent pulse indicates excess pathogens. Cold pathogen aggregation can be named hernia, so all five Zang organs can have hernias.
Urgent pulses in the Two Yin meridians indicate epilepsy and jue; urgent pulses in the Two Yang meridians indicate fright.
Two Yin refers to Shao Yin. Two Yang refers to Yang Ming. Urgent pulses indicate wind-cold pathogens attacking Heart and Kidney, causing epilepsy and jue; Wood pathogen attacking Stomach causes fright.
Spleen pulse bulging outward, deep upon pressure, indicates Chang Pi (dysentery/bloody stool), which heals itself after a long time. Small and slow Liver pulse indicates Chang Pi, easy to treat. Small, forceful, and deep Kidney/Liver pulses indicate Chang Pi with bloody stool; if blood is warm and body hot, it is fatal. Heart and Liver also involve bloody stool; simultaneous disease of these two organs is treatable. If pulses are small, deep, and choppy indicating Chang Pi, and body heat appears, it is fatal; heat persisting for seven days leads to death.
"Chang Pi" refers to dysentery with bloody stool. Heart, Liver, Spleen, and Kidney all govern Yin divisions; whether injured by cold-dampness or heat, bleeding from the large intestine is called Chang Pi.
Warm blood and body heat indicate excess pathogenic fire and failure of True Yin, hence fatal. Heart governs Blood, Liver stores Blood; thus, bloody stool from these two organs is harmonious and treatable. Simultaneous Liver and Spleen disease indicates Earth failure and Wood encroachment, clearly difficult to treat. Small, deep, and choppy pulses for Chang Pi indicate Yin insufficiency injuring Blood. However, deep and fine pulses should not present with heat; current body heat is contrary. Seven days represent the exhaustion of Six Yin.
Stomach pulse deep, bulging, and choppy; Stomach pulse bulging outward and large; Heart pulse small, firm, and urgent—all indicate Ge (diaphragmic obstruction) and pian ku (hemiplegia).
Deep, bulging, and choppy indicate Yang insufficiency. Bulging outward and large indicates Yin injury. Small, firm, and urgent indicate Heart Fire depression and internal heat. Stomach is the Sea of Water and Grain; with damaged Stomach Qi and diseased Heart region, upper and lower blockage leads to Ge and hemiplegia.
Pulse striking forcefully with epistaxis and body heat indicates death; suspended hook floating pulse is a normal pulse.
Striking indicates pulse firmness, most taboo for Yin deficiency. Epistaxis with forceful pulse and body heat indicates True Yin depletion. However, blood loss cases often show Yin deficiency, and Yin deficiency pulses are often floating and large; thus, suspended hook floating is normal and not worrying.
Pulse like panting is named Bao Jue (sudden reversal); patients do not speak. Pulse like rapid rate causes sudden fright, resolving in three to four days.
Like rapid rate is not a true rapid pulse; it is sudden stirring of Liver and Heart Fire, causing sudden fright.
Firm and long Heart pulse indicates tongue retraction and inability to speak; soft and scattered Heart pulse indicates Xiao Huan (wasting-thirst), resolving spontaneously.
Firm and beating Heart pulse indicates Liver pathogen attacking Heart, severe organ Qi deficiency. Shao Yin channel ascends from Heart connection to flank throat, causing tongue retraction and speechlessness. Firm pulses indicate excess Liver pathogen, feared by all Five Zang. Five Zang rely on Stomach Qi; pulse without Stomach Qi indicates death. Strong Wood leads to weak Earth; forceful pulses indicate Stomach failure, so firm/forceful pulses are avoided by all organs. Slight forcefulness indicates slight pathogen; extreme forcefulness approaches True Zang pulse. Assess depth/shallowness based on forcefulness.
Firm and long Lung pulse indicates spitting blood; soft and scattered Lung pulse indicates Guan Han (profuse sweating), preventing further dispersal.
Firm Lung pulse indicates pathogen attacking Lung. Lung connection links to throat, causing spitting blood. Soft/scattered indicates Lung deficiency failing to consolidate, sweating like water and Yang collapse, so dispersal is contraindicated.
Firm and long Liver pulse without green complexion indicates trauma/blow, blood in hypochondrium causing panting/reversal; soft, scattered, and lustrous Liver pulse indicates Yi Yin (overflowing drink). Yi Yin involves sudden thirst, excessive drinking, fluid entering muscle/skin/gastrointestinal exterior.
Firm and long Stomach pulse with red complexion indicates broken thigh pain; soft and scattered Stomach pulse indicates Shi Bi (food obstruction).
Firm Stomach pulse indicates Wood attacking Earth. Red complexion indicates Yang Ming Fire excess. Wood-Fire blazing injures Stomach channel. Yang Ming descends via Qichuan to Futu, causing thigh pain like breaking. Soft/scattered indicates original Stomach Qi deficiency; eating causes Qi reversal, stagnation, and food obstruction.
Firm and long Spleen pulse with yellow complexion indicates shortness of Qi; soft, scattered, and dull Spleen pulse indicates leg/calf swelling resembling water.
Pathogenic pulse attacking Spleen, Spleen deficiency fails to generate Blood, showing organ color. Weak Spleen fails to generate Lung, causing shortness of Qi. Soft/scattered/dull especially shows Spleen deficiency. Spleen channel precedes medial malleolus, follows tibia posteriorly, causing leg swelling. Resembling water indicates Spleen failing to control Water.
Firm and long Kidney pulse with yellow-red complexion indicates broken waist pain; soft and scattered Kidney pulse indicates Blood deficiency, never recovering.
Pathogen interfering with Kidney Qi causes decline. Yellow-red complexion indicates Fire/Earth excess, causing waist pain like breaking. Soft/scattered indicates original deficiency. Kidney governs Water to transform fluids; now Kidney Qi fails to transform, causing Blood deficiency. Regarding Five Zang disease pulses: one is firm/forceful, one is soft/scattered; diseases are mostly deficiency. Firm/forceful pulses indicate Pathogen > Zheng, "where pathogen gathers, Qi must be deficient." Soft/scattered pulses indicate original deficiency, "when Zheng Qi is taken, it becomes deficient." Pathogen-induced deficiency vs. original deficiency without pathogen. Though both are deficiency, origins differ; must distinguish.
Yin pulse beating distinctly different from Yang indicates pregnancy.
Yin refers primarily to Shao Yin. Kidney governs the uterus, seat of conception. "Yang Bie" means Yin pulse feels like Yang pathogen, but its beating is slippery and smooth, not actually pathological. It shows Yang within Yin with harmonious imagery, called "Yin Bo Yang Bie." Must also examine pregnant woman's strength/age, habitual left/right bias, and inherent Cun/Chi strength/weakness to fully understand.
Urgent pulse indicates Shan Jia (hernia/mass) and lower abdominal pain. Slippery pulse indicates Wind. Choppy pulse indicates Bi. Slow and slippery pulse indicates Re Zhong (heat in middle). Full and tight pulse indicates distension.
Slow due to Stomach heat; slippery due to Yang excess, hence Re Zhong. Slow means laxity, not slowness. Full indicates central Qi stagnation; tight indicates excess pathogen, hence distension.
Yin and Yang deficiency with Chang Pi indicates death.
Yin and Yang deficiency means Cun and Chi both deficient. Stomach Qi fails to retain, anus fails to control, Yin/Yang deficient indicates Zang Qi exhaustion, hence death.
Yang added to Yin is called Sweat.
Yang refers to pulse body, Yin refers to pulse position. Sweat belongs to Yin; Yang adding to Yin causes Yin Qi leakage.
Yin deficiency with Yang forceful pounding indicates Beng (metrorrhagia).
Yin deficiency means insufficient deep pressure; Yang forceful means excess superficial pressure. Yang excess and Yin deficiency indicate internal bleeding/metrorrhagia.
Three Yin pulses all beating: death at midnight on day 20. Two Yin pulses all beating: death at dusk on day 13. One Yin pulse all beating: death at dawn on day 10. Three Yang pulses all beating and bulging: death in 3 days. Three Yin and Three Yang pulses all beating: abdominal fullness. Hair stands on end, inability to bend/stretch: death in 5 days. Two Yang pulses all beating: warm disease, untreatable, death within 10 days.
Three Yin refers to Spleen and Lung. Beating indicates True Zang striking. 20 days is the completion number for Lung/Spleen. Midnight is Yin extreme, Qi exhausted, hence death. Two Yin refers to Heart and Kidney. 13 days is completion number for Heart/Kidney. Dusk is Yin/Yang half, Water/Fire competing. One Yin refers to Pericardium and Liver. Dawn is Wood/Fire peak, pathogen worse, hence death. Three Yang refers to Hand/Foot Tai Yang. Water 1, Fire 2, hence death. In 3 days, beating and bulging, Yang pathogen extreme. Three Yin/Three Yang, Four Zang beating, upper/lower diseased. Upper: abdominal fullness, hair standing; Lower: inability to bend/stretch, Yin pathway blocked. Four Zang diseased, relying on Stomach Qi; when grains exhausted, death occurs.
Two Yang beating refers to Large Intestine/Stomach. Missing one Yang implies lost text.