《灵枢》以缓急大小滑涩六脉而定病变，可谓总诸脉之纲领。《素问》则曰∶大小滑涩
。《难经》曰∶浮沉长短滑涩。而仲景则曰∶弦紧浮沉滑涩。此六者，名为残贼，能为诸脉
作病。滑伯仁曰∶大抵纲领之要，不出浮沉迟数滑涩六脉。所谓不出者，以其足统夫表里阴
阳虚实冷热风寒湿燥脏腑血气之病也。浮为阳为表，证为风为虚；沉为阴为里，证为湿为实
；迟为在脏，为寒为冷；数为在腑，为燥为热；滑为血有余涩；为气独滞也。此诸说者，词
虽少异，意实相通。若以予见言之，总不出乎表里虚实寒热六者而已。如浮为在表，则散大
而芤可类也；沉为在里，则细小而伏可类也；数为热，则洪滑疾促之属可类也；迟为寒，则
涩结代缓之属可类也；虚为不足，则短弱濡微之属可类也；实为有余，则弦紧动革之属可类
也。然即此六者之中，又复有大相悬绝之要，则又不可不知。夫浮为在表，而凡阴虚者，脉
必浮而无力，是浮不可概言表矣，可升散乎？沉为在里，而凡邪初感之甚，阴寒束于皮肤，
阳气不能外达，则脉必先现沉紧，是沉不可概言里矣，可内攻乎？诸数为热，而凡阴虚之候
，阴阳俱虚，气血散乱者，脉必急数，愈数者愈虚，愈虚者愈数，是数不可概言热矣，可寒
凉乎？微细类虚，而痛极闭塞者，则多伏匿，是伏不可概言虚矣。可骤补乎？弦数类实，而真
阴大亏者，必关格倍常，是弦不可概言实矣，可消伐乎？夫如是是，即于纲领之中，而复有
大纲领者存焉。设不以四证相参，而孟浪任意，未有不覆人于反掌间者，此脉道所以难言，
而毫厘不可不辨也。
《灵枢》通过缓、急、大、小、滑、涩这六种脉象来确定病变，这可以说是所有脉象的纲领。《素问》则说：大、小、滑、涩……（原文此处有省略）。《难经》说：浮、沉、长、短、滑、涩。而张仲景则说：弦、紧、浮、沉、滑、涩。这六种脉象被称为“残贼”（指能损害正气、导致多种疾病的脉象），能够引起各种脉象的病变。滑伯仁说：大致来说，脉象的纲领要点，不出浮、沉、迟、数、滑、涩这六脉。所谓“不出”，是因为这六脉足以统摄表里、阴阳、虚实、冷热、风寒湿燥以及脏腑、血气等方面的疾病。浮脉属于阳、属于表，对应的证候多为风邪或虚证；沉脉属于阴、属于里，对应的证候多为湿邪或实证；迟脉病位在脏，对应寒证或冷证；数脉病位在腑，对应燥证或热证；滑脉表示血有余，涩脉表示气机独自阻滞。这些说法，文字虽然略有差异，但意旨实际上是相通的。如果以我的观点来看，总括起来也不出表、里、虚、实、寒、热这六个方面罢了。比如浮脉主在表，那么散脉、大脉和芤脉都可以归类于此；沉脉主在里，那么细脉、小脉和伏脉都可以归类于此；数脉主热，那么洪脉、滑脉、疾脉和促脉等都可以归类于此；迟脉主寒，那么涩脉、结脉、代脉和缓脉等都可以归类于此；虚脉主不足，那么短脉、弱脉、濡脉和微脉等都可以归类于此；实脉主有余，那么弦脉、紧脉、动脉和革脉等都可以归类于此。然而，就在这六者之中，又有极其重要的显著区别，这也是不可不知道的。浮脉主在表，但是凡是阴虚的患者，脉象必然浮而无力，这说明浮脉不能一概而论地认为是表证，难道可以用升散法治疗吗？沉脉主在里，但是凡是外邪初感且严重的情况，阴寒束缚于皮肤，阳气不能向外通达，脉象必然会先出现沉紧，这说明沉脉不能一概而论地认为是里证，难道可以用内攻法治疗吗？诸多数脉主热，但是凡是阴虚的证候，阴阳俱虚，气血散乱的患者，脉象必然急促而数，越是数脉越显示虚弱，越是虚弱脉象越数，这说明数脉不能一概而论地认为是热证，难道可以用寒凉法治疗吗？微脉、细脉类似虚证，但是疼痛极度严重导致闭塞的患者，脉象多潜伏隐匿，这说明伏脉不能一概而论地认为是虚证，难道可以骤然进补吗？弦脉、数脉类似实证，但是真阴严重亏损的患者，脉象必然大过常态（关格倍常），这说明弦脉不能一概而论地认为是实证，难道可以用消伐法治疗吗？像这样，就是在纲领之中，又存在着更高级别的纲领。如果不结合四诊（望闻问切）相互参照，而鲁莽随意地诊治，没有不在顷刻间害死人的，这就是脉学之所以难以言说，而且毫厘之间不可不仔细辨别的原因。
The *Ling Shu* (Spiritual Pivot) determines pathological changes based on the six pulse qualities: slow and rapid (Huanji), large and small (Daxiao), slippery and rough (Huase). This can be regarded as the general outline of all pulses. The *Su Wen* (Basic Questions) states: large, small, slippery, rough... [text omitted]. The *Nan Jing* (Classic of Difficult Issues) states: floating, deep, long, short, slippery, rough. Zhang Zhongjing states: wiry, tight, floating, deep, slippery, rough. These six are named "can zai" (harmful pathogens capable of inducing various pathological pulses) and can cause diseases manifesting in various pulses. Hua Borun stated: Generally speaking, the essence of the pulse outline does not exceed the six pulses of floating, deep, slow, rapid, slippery, and rough. The reason for saying "does not exceed" is that these six are sufficient to govern diseases related to exterior-interior, yin-yang, deficiency-excess, cold-heat, wind-cold-dampness-dryness, zang-fu organs, blood, and qi. Floating represents yang and the exterior; corresponding syndromes include wind and deficiency. Deep represents yin and the interior; corresponding syndromes include dampness and excess. Slow indicates involvement of the Zang organs, representing cold and chill. Rapid indicates involvement of the Fu organs, representing dryness and heat. Slippery indicates an excess of blood; rough indicates stagnation of Qi alone. Although the wording of these various theories differs slightly, their underlying meaning is actually consistent. In my opinion, they ultimately do not go beyond the six categories of exterior, interior, deficiency, excess, cold, and heat. For instance, since floating indicates the exterior, San Mai (Scattering Pulse), Da Mai (Large Pulse), and Kou Mai (Hollow Pulse) can be classified accordingly. Since deep indicates the interior, Xi Mai (Fine Pulse), Xiao Mai (Small Pulse), and Fu Mai (Hidden Pulse) can be classified accordingly. Since rapid indicates heat, Hong Mai (Surging Pulse), Hua Mai (Slippery Pulse), Ji Mai (Rapid Pulse), and Cu Mai (Intermittent Pulse) belong to this category. Since slow indicates cold, Se Mai (Rough Pulse), Jie Mai (Knotted Pulse), Dai Mai (Tied Pulse), and Huan Mai (Moderate Pulse) belong to this category. Since deficiency indicates insufficiency, Duan Mai (Short Pulse), Ruo Mai (Weak Pulse), Ru Mai (Soggy Pulse), and Wei Mai (Minute Pulse) belong to this category. Since excess indicates surplus, Xian Mai (Wiry Pulse), Jin Mai (Tight Pulse), Dong Mai (Moving Pulse), and Ge Mai (Leather Pulse) belong to this category. However, among these six, there are significant distinctions that must not be overlooked. Floating indicates the exterior, but in cases of Yin deficiency, the pulse is necessarily floating yet forceless; thus, floating cannot be universally equated with the exterior, nor should dispersing methods be indiscriminately used. Deep indicates the interior, but when pathogenic factors initially invade severely, with Yin-cold binding the skin and Yang Qi unable to reach the exterior, the pulse will first appear deep and tight; thus, deep cannot be universally equated with the interior, nor should internal attacking methods be indiscriminately used. Most rapid pulses indicate heat, but in cases of Yin deficiency where both Yin and Yang are deficient and Blood and Qi are chaotic, the pulse will necessarily be urgent and rapid; the more rapid, the more deficient, and the more deficient, the more rapid; thus, rapid cannot be universally equated with heat, nor should cooling methods be indiscriminately used. Wei Mai (Minute Pulse) and Xi Mai (Fine Pulse) resemble deficiency, but in cases of extreme pain and blockage, the pulse often hides; thus, Fu Mai (Hidden Pulse) cannot be universally equated with deficiency, nor should tonification be administered abruptly. Xian Mai (Wiry Pulse) and Shu Mai (Rapid Pulse) resemble excess, but in cases of severe depletion of True Yin, the pulse may become abnormally prominent (Guan Ge Bei Chang); thus, wiry cannot be universally equated with excess, nor should reducing or purging methods be indiscriminately used. In this way, within the general outline, a higher-level outline exists. If one does not integrate the four diagnostic methods (Four Examinations) for reference, but acts rashly and arbitrarily, there is no case where the patient will not be harmed in an instant. This is why pulse diagnosis is difficult to articulate and why every minute detail must be distinguished carefully.