夫脉之大体二十六种，此诊脉之纪纲也。细而论之，毫厘少差，举治必远。总而言之，
虚实，阴阳而已，两者议之，以要其中。谨于诸家脉法中，撮其机要，剪去繁芜，载其精义
浮脉之诊，浮于指下，按之不足，举之有余。再再寻之，状如太过。瞥瞥然见于皮毛间
为表证，或为风，或为虚。浮而大散者心也，浮而短涩者肺也。浮而数者热也。浮数之脉应
发热，其不发热而反恶寒者，疮疽之谓也。
洪脉之诊，似浮而大，按举之则泛泛然满三部，其状如水之洪流，波之涌起。其主血实
。疮肿论曰∶脉洪大者，疮疽之病进也。如疮疽结脓未成者宜下之，脓溃之后，脉见洪大则
难治，若自利者不可救治也。
滑脉之诊，实大相兼，往来流利如珠，按之则累累然滑也。其主或为热，或为虚，此阳
脉也。疮疽之病，脓未溃者，宜内消也；脓溃之后，宜托里也。所谓始为热而终为虚也。
数脉之诊，按之则呼吸之间，动及六至，其状似滑而数也。若浮而数则表热也，沉而数
热也。又曰∶诸数为热。仲景曰∶脉数不时见则生恶疮也。又曰∶肺脉洪数则生疮也。诊诸
疮洪数者，里欲有脓结也。
散脉之诊，似浮而散，按之则散而欲去，举之则大而无力。其主气实而血虚，有表无里
肿脓溃之后，而烦痛尚未痊退者，诊其脉，洪滑粗散难治也，以其正气虚而邪气实也。又曰
∶肢体沉重，肺脉大则毙，谓浮散者也。
芤脉之诊，似浮而软，按之中央空，两边实。其主血虚，或为失血疮肿之病。诊得芤脉
，脓溃后易治，以其脉病相应也。
长脉之诊，按之则洪大而长，出于本位。其主阳气有余也。伤寒得之，欲汗出自解也；
长而缓者，胃脉也，百病皆愈，谓之长则气治也。
牢脉之诊，按之则实大而弦，且沉且浮，而有牢坚之意，若瘰瘰结肿。诊得牢脉者，不
可内消也。
实脉之诊，按举有力而类结曰实。经曰邪气胜则实，久病则虚，人得此最忌。疮疽之人
得此，宜急下之，以其邪气与脏腑俱实故也。
弦脉之诊，按之则紧而弦，其似紧者为弦，如按弦而不移，紧如内绳而转动，以此为异
脉浮弦而平，不时见则为饮为痛，主寒主虚。疮疽论曰∶弦洪相搏，外紧内热，欲发疮疽也
紧脉之诊，似弦而紧，按之如切绳而转动。其主切痛积癖也；疮肿得之，气血沉涩也，
亦主痛也。
涩脉之诊，按之则散而复来，举之则细而不足，脉涩则气涩也，亦主血虚，疮肿溃后得
之，无妨也。
短脉之诊，按举则不及本位。《内经》曰∶短则气病，以其无胃气也。诸病脉短，皆难
治也；疮肿脉短，真气短也。
细脉之诊，按之则萦萦如蜘蛛之丝而欲绝，举之如无而似有。细而微，其主元阳衰也；
疮肿之病，脉来细而沉，时直者，里虚而欲变证也。
微脉之诊，按之则软小而极微。其主虚也。真气复者生，邪气胜者危；疮肿之病，溃后
脉微而匀举自瘥也。
迟脉之诊，按举来迟，呼吸定息，方得三至，其状似缓而稍迟。痼疾得之则善，新疾得
之则正气虚惫；疮肿得之，溃后自瘥。
缓脉之诊，按举似迟，而稍驶于迟。仲景曰∶阳脉浮大而濡，阴脉浮大而涩，阴阳同等
缓。脉见长缓，百疾自瘳；凡诸疮肿溃后，其脉涩迟缓者皆易愈，以其脉候相应，是有胃气
沉脉之诊，举之不足，按之方见如烂绵，其主邪气在脏也。水气得之则逆，此阴脉也；
疮肿得之，邪气深也。
伏脉之诊，比沉而伏，举之则无，按之至骨，方得与沉相类，而邪气益深矣。
虚脉之诊，按之不足，迟大而软，轻举指下，豁然而空。经曰∶脉虚则血虚。血虚生寒
，阳气不足也；疮肿脉虚，宜托里和气养血也。
软脉之诊，按之则如帛在水中，极软而沉细，亦谓之濡。其主胃气弱；疮肿得之，补虚
排脓托里。
弱脉之诊，似软而极微，来迟而似有。仲景曰∶微弱之脉，绵绵如泻漆之绝。其主血气
俱虚，形精不足；大抵疮象沉迟濡弱，皆宜托里。
促脉之诊，按之则来去数，时一止而复来。仲景曰∶阳盛则促，主热蓄于里也，下之则
和；疮肿脉促，亦急下之。
结脉之诊，按之则往来迟缓，时一止而复来。仲景曰∶阴盛则结。经曰∶促结则生，代
代脉之诊，按之则往来，动则中止不能自还，因而复动者，曰代脉也。代者气散也，诸
病见之不祥；大凡疮肿之病，脉促结者难治，而况见代脉乎！
动脉之诊，见于关上，无头尾，如豆大，厥厥然而动摇者是也。《脉经》曰∶阴阳相搏
谓之动。动于阳则阳气虚而发厥，动于阴则阴气虚而发热。是阳生于尺而动于寸，阴生于寸
而动于尺，不可不辨也。
大抵脉象的总体分类共有二十六种，这是诊察脉象的纲领。细致地分析起来，毫厘之差，治疗就会相差甚远。总而言之，不外乎虚和实、阴和阳两类，通过辨析这两者，以把握其中的关键。谨从各家脉法中，摘录其精要，删去繁杂冗余的内容，记载其核心义理。
浮脉的诊察：脉位浮于指下，重按感觉力量不足，轻取感觉有余。反复寻按，脉势好像过于盛大。脉象忽然显现于皮毛之间。主表证，或是风邪，或是虚证。浮而大散的脉象主心病；浮而短涩的脉象主肺病。浮而数的脉象主热证。浮数之脉应当出现发热症状，如果不发热反而恶寒，这是疮疽病的表现。
洪脉的诊察：脉象似浮且大，重按或轻取时，脉波泛泛然充满寸关尺三部，其状如水之洪流，波浪涌起。主血分实证。《疮肿论》说：脉象洪大的，是疮疽病势进展的表现。如果疮疽脓液尚未形成，适宜用攻下法；如果脓液已经溃破，脉象仍见洪大，则难以治疗，如果此时伴有自利（腹泻），则不可救治。
滑脉的诊察：脉形实大兼有滑利之感，往来流利如珠滚动，重按时累累然滑利。主证或是热，或是虚，这属于阳脉。疮疽病，脓未溃破时，适宜内消法；脓溃之后，适宜托里法。这就是所谓开始为热证，最终转为虚证。
数脉的诊察：重按时，一呼一吸之间，脉搏跳动达六次以上，其状似滑而快。如果浮而数，主表热；沉而数，主里热。又说：各种数脉都主热证。张仲景说：脉数不时出现，则会生恶疮。又说：肺脉洪数，则会生疮疡。诊察各种疮疡，若见洪数脉，说明体内将要化脓结聚。
散脉的诊察：脉象似浮且散漫，重按时脉气散乱欲去，轻取时脉体大而无力。主气实而血虚，有表无里。疮肿脓溃之后，烦痛尚未痊愈消退的，诊其脉，若见洪滑粗散，属难治，因为正气虚而邪气实。又说：肢体沉重，若肺脉大（浮散），预后不良，会导致死亡。
芤脉的诊察：脉象似浮而软，重按中间空，两边实。主血虚，或是失血、疮肿等疾病。诊得芤脉，在脓溃之后容易治疗，因为脉象与病情相应。
长脉的诊察：重按时脉象洪大而长，超出本位。主阳气有余。伤寒病见到此脉，想要出汗自然解除；长而缓的脉，是胃脉，百病皆愈，称为“长则气治”。
牢脉的诊察：重按时脉象实大且弦，既沉又浮，但有牢坚之意，如同瘰疬结肿。诊得牢脉，不可使用内消法。
实脉的诊察：轻取重按都有力，类似结脉称为实。经书说：邪气胜则脉实，久病则脉虚，人得此脉最忌讳。疮疽病人得此脉，宜急用攻下法，因为邪气与脏腑俱实。
弦脉的诊察：重按时脉紧而弦，其似紧者为弦，如按琴弦而不移动；紧脉如内绳转动，以此相区别。脉浮弦而平，不时出现则为饮邪或疼痛，主寒主虚。《疮疽论》说：弦脉与洪脉相搏，外紧内热，将要发疮疽。
紧脉的诊察：脉象似弦而紧，重按时如切绳转动。主切痛、积癖等病；疮肿得此脉，说明气血沉涩，也主痛证。
涩脉的诊察：重按时脉散而复来，轻取时脉细而不足。脉涩说明气机涩滞，也主血虚。疮肿溃后得此脉，无妨碍。
短脉的诊察：轻取重按都不及本位。《内经》说：短脉主气病，因为没有胃气。各种疾病见短脉，都难治；疮肿见短脉，是真气短少。
细脉的诊察：重按时脉萦萦如蜘蛛丝将断，轻取时如无而似有。细而微的脉，主元阳衰败；疮肿病，脉来细而沉，直而无神，是里虚且欲发生变证。
微脉的诊察：重按时脉软小而极微。主虚证。真气恢复者生，邪气胜者危；疮肿病，溃后脉微而匀，身体自然痊愈。
迟脉的诊察：轻取重按来势迟缓，一呼一吸定息，方得三次跳动，其状似缓但稍迟。痼疾得此脉则好，新疾得此脉则正气虚惫；疮肿得此脉，溃后自然痊愈。
缓脉的诊察：轻取重按似迟，但比迟脉稍快。张仲景说：阳脉浮大而濡，阴脉浮大而涩，阴阳同等即为缓。脉见长缓，百病自愈；凡各种疮肿溃后，脉涩迟缓的都易愈，因为脉候相应，是有胃气的表现。
沉脉的诊察：轻取不足，重按才见，如烂绵一般，主邪气在脏。水气得此脉则逆，这是阴脉；疮肿得此脉，说明邪气深。
伏脉的诊察：比沉脉更伏，轻取时无脉，重按至骨才得，与沉脉相似，但邪气更深。
虚脉的诊察：重按不足，迟大而软，轻举指下，豁然空虚。经书说：脉虚则血虚。血虚生寒，阳气不足；疮肿脉虚，宜用托里、和气、养血法。
软脉（濡脉）的诊察：重按时如帛在水中，极软而沉细，也称为濡脉。主胃气弱；疮肿得此脉，宜补虚、排脓、托里。
弱脉的诊察：似软而极微，来迟而似有。张仲景说：微弱之脉，绵绵如泻漆之绝。主血气俱虚，形体精神不足；大抵疮象见沉、迟、濡、弱，都宜托里。
促脉的诊察：重按时脉来去快速，时常有一次停顿后又复来。张仲景说：阳盛则促，主热蓄于里，用下法则和；疮肿脉促，也宜急下。
结脉的诊察：重按时脉往来迟缓，时常有一次停顿后又复来。张仲景说：阴盛则结。经书说：促脉、结脉见之可生，代脉见之则死。
代脉的诊察：重按时脉往来跳动，动则中止不能自还，因而复动的，称为代脉。代脉主气散，各种病见之不祥；大凡疮肿病，脉促、结者难治，何况见到代脉呢！
动脉的诊察：见于关上，无头尾，如豆大，厥厥然而动摇。《脉经》说：阴阳相搏谓之动。动于阳则阳气虚而发厥，动于阴则阴气虚而发热。阳生于尺部而动于寸部，阴生于寸部而动于尺部，不可不辨别。
There are generally twenty-six major types of pulses, which serve as the outline for pulse diagnosis. Analyzed in detail, a slight deviation can lead to significantly different treatments. In summary, they fall into two categories: deficiency and excess, yin and yang. By discussing these two, one grasps the essence. From various pulse methods, we extract the key points, discard the superfluous, and record the core principles.
**Floating Pulse (Fu Mai):** The pulse is felt superficially under the fingers; pressure reveals insufficiency, while light touch reveals abundance. Repeated searching shows a sensation of excessive fullness. It appears suddenly between the skin and hair. It indicates exterior syndromes, wind pathogens, or deficiency. A floating and large/diffuse pulse indicates Heart pathology; a floating and short/choppy pulse indicates Lung pathology. A floating and rapid pulse indicates Heat. While a floating-rapid pulse should present with fever, if there is no fever but instead aversion to cold, it signifies carbuncles and sores (Chuang Ju).
**Surging Pulse (Hong Mai):** The pulse seems floating and large; upon pressing or lifting, it feels broadly filling all three positions (cun, guan, chi), resembling a torrent of water or rising waves. It indicates Blood excess. *Treatise on Carbuncles and Sores* states: "A surging-large pulse indicates the progression of carbuncle and sore diseases." If pus has not yet formed in a carbuncle/sore, purgation is appropriate. However, if pus has drained and the pulse remains surging-large, treatment is difficult; if accompanied by spontaneous diarrhea, it is incurable.
**Slippery Pulse (Hua Mai):** The pulse is solid and large, flowing smoothly like rolling pearls; pressing reveals a continuous slippery quality. It indicates either Heat or deficiency, belonging to Yang pulses. For carbuncles and sores, if pus has not ulcerated, internal resolution is suitable; after ulceration, supporting the interior is suitable. This reflects the transition from initial Heat to final deficiency.
**Rapid Pulse (Shu Mai):** Upon pressing, the pulse beats six times per respiration cycle, appearing slippery and fast. Floating and rapid indicates Exterior Heat; sinking and rapid indicates Interior Heat. It is said that all rapid pulses indicate Heat. Zhang Zhongjing stated: "If a rapid pulse appears intermittently, malignant sores will arise." He also said: "A Lung pulse that is surging and rapid leads to sores." Diagnosing various sores, a surging-rapid pulse suggests impending suppuration.
**Scattered Pulse (San Mai):** The pulse seems floating and scattered; pressing causes it to disperse and fade, while lifting reveals a large but forceless pulse. It indicates Qi excess and Blood deficiency, having an exterior without an interior. After carbuncles/sores ulcerate, if pain and irritability persist, a surging-slippery-rough-scattered pulse indicates a difficult prognosis due to deficient healthy Qi and excess pathogenic factors. Additionally, heavy limbs combined with a large (floating/scattered) Lung pulse indicate fatal outcomes.
**Gourd Seed Pulse (Kou Mai):** The pulse seems floating and soft; pressing reveals emptiness in the center and solidity on the sides. It indicates Blood deficiency or conditions involving blood loss/carbuncles. Obtaining a gourd seed pulse after pus drainage indicates ease of treatment because the pulse matches the disease state.
**Long Pulse (Chang Mai):** Pressing reveals a surging, large, and long pulse extending beyond its normal position. It indicates excess Yang Qi. In Cold Damage (Shang Han), this pulse suggests sweating will resolve the condition. A long and slow pulse is the Stomach pulse, indicating recovery from all diseases, termed "long means Qi is regulated."
**Firm Pulse (Lao Mai):** Pressing reveals a solid, large, and wiry pulse, both sinking and floating, with a firm and hard quality, resembling scrofula nodules. Obtaining a firm pulse contraindicates internal resolution therapies.
**Excess Pulse (Shi Mai):** Forceful upon both light and deep pressure, similar to a knotted pulse, is called Excess. Classics state: "Pathogen dominance makes the pulse excess; chronic illness makes it deficient." This pulse is most feared. In carbuncle patients, urgent purgation is required because both pathogen and Zang-Fu organs are excess.
**Wiry Pulse (Xian Mai):** Pressing reveals tightness and wiriness. Unlike the tight pulse which rotates like a rope, the wiry pulse feels like pressing a string without movement. A floating-wiry pulse that appears intermittently indicates fluid retention or pain, ruling Cold and deficiency. *Carbuncle Treatise* states: "Wiry and surging pulses interacting indicate exterior tightness and interior heat, heralding carbuncles."
**Tight Pulse (Jin Mai):** Similar to wiry but tighter, feeling like cutting a rotating rope. It indicates sharp pain or accumulations. In carbuncles, it indicates stagnant and sluggish Qi and Blood, also ruling pain.
**Choppy Pulse (Se Mai):** Pressing reveals dispersion then return; lifting reveals thinness and insufficiency. Choppy pulses indicate Qi stagnation and Blood deficiency. In post-ulceration carbuncles, it is not harmful.
**Short Pulse (Duan Mai):** Light and deep pressure fail to reach the normal position. *Neijing* states: "Short pulses indicate Qi pathology due to lack of Stomach Qi." Short pulses in any disease are difficult to treat; in carbuncles, it indicates depletion of True Qi.
**Fine Pulse (Xi Mai):** Pressing reveals a thread-like pulse like a spider's silk about to break; lifting feels non-existent yet present. Fine and minute pulses indicate decline of Primordial Yang. In carbuncles, a fine and sinking pulse with straight/unyielding qualities indicates interior deficiency and potential transformation of the disease.
**Minute Pulse (Wei Mai):** Pressing reveals a soft, small, and extremely minute pulse. It indicates deficiency. Recovery of True Qi brings life; dominance of pathogens brings danger. In carbuncles, a minute and even pulse after ulceration indicates natural healing.
**Slow Pulse (Chi Mai):** Light and deep pressure reveal a slow rate, beating only three times per respiration cycle, appearing slightly slower than a moderate pulse. In chronic diseases, it is favorable; in acute diseases, it indicates exhausted healthy Qi. In carbuncles, it indicates self-healing after ulceration.
**Moderate Pulse (Huan Mai):** Similar to slow but slightly faster. Zhang Zhongjing stated: "Yang pulse floating-large and moist, Yin pulse floating-large and choppy, equalized Yin and Yang constitutes Moderate." Long-moderate pulses heal all diseases; post-ulceration carbuncles with choppy-moderate pulses heal easily due to corresponding pulse signs and presence of Stomach Qi.
**Sinking Pulse (Chen Mai):** Insufficient on light pressure, visible only on deep pressure, feeling like rotten cotton. It indicates pathogens in the Zang organs. Water pathogens cause rebellion with this Yin pulse; in carbuncles, it indicates deep-seated pathogens.
**Hidden Pulse (Fu Mai):** Deeper than sinking; invisible on light pressure, felt only at the bone level. Similar to sinking but indicates deeper pathogens.
**Deficient Pulse (Xu Mai):** Insufficient on pressure, slow, large, and soft; light lifting feels hollow. Classics state: "Deficient pulse indicates Blood deficiency." Blood deficiency generates Cold and Yang Qi insufficiency. In carbuncles with deficient pulses, therapy should support the interior, harmonize Qi, and nourish Blood.
**Soft Pulse (Ruan Mai / Ru Mai):** Pressing feels like silk in water, extremely soft, sinking, and fine, also called Ru (Damp) pulse. It indicates weak Stomach Qi. In carbuncles, it requires tonifying deficiency, draining pus, and supporting the interior.
**Weak Pulse (Ruo Mai):** Similar to soft but extremely minute, slow, and faint. Zhang Zhongjing described weak-minute pulses as continuous like leaking lacquer. It indicates dual deficiency of Qi and Blood, and insufficiency of form and spirit. Generally, carbuncle presentations with sinking, slow, soft, or weak pulses all require supporting the interior.
**Racing Pulse (Cu Mai):** Pressing reveals rapid coming and going with occasional pauses followed by resumption. Zhang Zhongjing stated: "Yang excess causes racing pulses, indicating Heat accumulation in the interior; purgation brings harmony." In carbuncles, racing pulses also warrant urgent purgation.
**Knotted Pulse (Jie Mai):** Pressing reveals slow, intermittent pulses with pauses followed by resumption. Zhang Zhongjing stated: "Yin excess causes knotted pulses." Classics state: Racing and knotted pulses allow for survival, whereas Dai pulses indicate death.
**Intermittent Pulse (Dai Mai):** Pressing reveals pulses that stop and cannot resume immediately, then move again. Dai pulses indicate Qi scattering; seeing them in any disease is inauspicious. In carbuncles, racing or knotted pulses are difficult to treat, let alone Dai pulses.
**Moving Pulse (Dong Mai):** Seen at the Guan position, headless and tailless, bean-sized, quivering and shaking. *Mai Jing* states: "Interaction of Yin and Yang is called Moving." Movement in Yang indicates Yang Qi deficiency and syncope; movement in Yin indicates Yin Qi deficiency and fever. Yang originates at Chi and moves to Cun; Yin originates at Cun and moves to Chi. This distinction must not be overlooked.