明脉须辨表里虚实四字。表，阳也，腑也，凡六淫之邪袭于经络，而未入胃腑及脏者，皆属于
表也。里，阴也，脏也，凡七情之气郁于心腹之内，不能散越，及饮食之伤留于腑脏之间，不能通
泄，皆属于里也。虚者，元气之自虚，精神耗散，气力衰竭也。实者，邪气之实，由正气之本虚，
邪得乘之，非元气之自实也。故虚者补其正气，实者泻其邪气。经曰∶邪气盛则实，精气夺则虚，
此大法也。
东垣曰∶不病之脉，不求其神而神无不在也。有病之脉，则当求其神之有无，谓如六数七极，
热也，脉中有力，即有神矣，当泄其热；三迟二败，寒也，脉中有力，即有神矣，当去其寒。若数
极迟败中不复有力，为无神也，将何所恃耶？苟不知此而泄之去之，神将何以根据而为主？故经曰∶
脉者，血气之先，气血者，人之神也。善夫！
夫脉者，本乎营与卫也，而营行脉之中，卫行于脉之外，苟脏腑和平，营卫调畅，则脉无形状
之可议矣。或者六淫外袭，七情内伤，则脏腑不和，营卫乖谬，而二十四脉之名状，层出而叠见矣
。是故风寒暑湿燥火，此六淫也，外伤六淫之脉，则浮为风，紧为寒，虚为暑，细为湿，数为燥，
洪为火，此皆可以脉而别其外感之
邪也。喜怒忧思悲恐惊者，此七情也，内伤七情之脉，喜则伤心而脉缓，怒则伤肝而脉急，恐则伤
肾而脉沉，悲则气消而脉短，惊则气乱而脉动，此皆可以脉而辨其内伤之病也。然此特举其常，而
以脉病相应者为言也。
若论其变，则有脉不应病，病不应脉，变出百端，而难一一尽凭乎脉者矣。试举一二言之，如
张仲景云∶脉浮大，邪在表，为可汗。若脉浮大，心下硬，有热属脏者，攻之，不令发汗，此又非
浮为表邪可汗之脉也。又云∶促脉为阳盛，宜用葛根黄芩黄连汤。若脉促厥冷为虚脱，非灸作温不
可，此又非促为阳盛之脉也。又曰∶迟脉为寒，沉脉为里。若阳明脉迟，不恶寒，身体 汗出，
则用大承气，此又非诸迟为寒之脉矣；少阴病始得之，反发热而脉沉，宜麻黄细辛汤汗之，此又非
沉为在里之脉矣。凡此皆脉难尽凭之明验也。若只凭脉而不问证，未免以寒为热，以表为里，以阴
为阳，颠倒错乱，而夭人寿者多矣。是以古人治病，不专于脉，而必兼于审证，良有以也。
奈何世人不明乎此，往往有病讳而不言，惟以诊脉而试医之能否，脉之而所言偶中，便视为良
医而倾心付托，其于病之根源，一无所告，药之宜否，亦无所审，惟束手听命于医，因循遂至于死
，尚亦不悟，深可悲矣。彼庸俗之人，素不嗜学，固无足怪，奈近世士大夫家，亦未免狃于此习，
是又大可笑也。夫定静安虑，格物致知，乃《大学》首章第一义，而虑者谓虑事精详，格物者谓穷
致事物之理，致知者谓推极吾之所知，凡此数事，学人必当究心于此矣。先正又言，为人子者，不
可不知医，病卧于床，委之庸医，比之不慈不孝。夫望闻问切，医家大节目也，苟于临病之际，惟
以切而知之为能，其余三事，一切置而不讲，岂得谓知医乎？岂得为处事精详乎？岂得为穷致事物
之理而推极吾之所知乎？
且医之良，亦不专于善诊一节，凡动静有常，举止不妄，存心忠浓，发言纯笃，察病详审，处
方精专，兼此数者，庶可谓之良矣。虽据脉言证，或有少瘥，然一脉所主非一病，故所言未必尽中
也。若以此而遂弃之，
所谓以二卵而弃干城之将，乌可与智者道哉。姑以浮脉言之，《脉经》云，浮为风，为虚，为气，
为呕，为厥，为痞，为胀，为满不食，为热，为内结等类，所主不下数十余病，假使诊得浮脉，彼
将断其为何病耶？苟不兼之以望闻问，而欲的知其为何病，吾为戛戛乎其难矣。古人以切居望闻问
之后，则于望闻问之间，已得其病情矣，不过再诊其脉，看病应与不应也。若脉与病应，则吉而易
医，脉与病反，则凶而难治，以脉参病，意盖如此，曷以诊脉知病为贵哉？夫《脉经》一书，拳拳
示人以诊法，而开卷入首便言观形察色，彼此参伍以决死生，可见望闻问切，医之不可缺一也。噫
！世称善脉莫过叔和，尚有待于彼此参伍，况下于叔和者乎！故专以切脉言病，必不能不致于误也。
安得为医之良？
抑不特此，世人又有以《太素脉》而言人贵贱穷通者，此又妄之甚也。予尝考其义矣，夫太者
，始也，初也，如太极、太乙之太；素者，质也，本也，如绘事后素之素，此盖言始初本质之脉也。
此果何脉耶？则必指元气而言也。东垣曰∶元气者，胃气之别名。胃气之脉，蔡西山所谓不长不短
，不疏不数，不大不小，应手中和，意思欣欣，难以名状者是也。无病之人，皆得此脉，以此脉而
察人之有病无病则可，以此脉而察人之富贵贫贱则不可。何也？胃气之脉，难以形容，莫能名状，
将何以为贵贱穷通之诊乎？窃观其书，名虽太素，而其中论述，略无一言及于太素之义，所作歌括
，率多俚语，全无理趣。原其初意，不过托此以为徼利之媒，后世不察，遂相传习，莫有能辨其非
者。又或为之语曰∶太素云者，指贵贱穷通禀于有生之初而言也，然脉可以察而知之，非谓脉名太
素也。予曰∶固也，然则太素之所诊者，必不出于二十四脉之外矣。夫二十四脉皆主病，言一脉见
则主一病，贫贱富贵何从而察之哉？假如浮脉，其诊为风，使太素家诊之，将言其为风耶？抑言其
为贵贱穷通耶？二者不可得兼，若言其为风，则其所知亦不过病也；若遗其病而言其为贵贱穷通，
则是
近而病诸身者尚不能知，安得谓之太素，则远而违诸身者必不能知之也。盖贵贱穷通，身外之事，
与身之血气了不相干，安得以脉而知之乎？况脉之变见无常，而天之寒暑不一，故四时各异其脉，
必不能久而不变，是以今日诊得是脉，明日诊之而或非，春间诊得是脉，至夏按之而或否。彼太素
者，以片时之寻按，而断一生之休咎，殆必无是理，然纵使亿则屡中，亦是捕风捉影，仿佛形容，
安有一定之见哉。噫！以脉察病，尚不知病之的，而犹待乎望闻问，况能知其他乎。且脉兆于岐黄
，演于秦越，而详于叔和，遍考《素》、《难》、《脉经》，并无一字言及此者，非隐之也，殆必
有不可诬者耳。巢氏曰∶太素者，善于相法，特假太素以神其术耳。诚哉言也，足以破天下后世之
惑矣。又有善伺察者，以言 人，阴得其实，故于诊按之际，肆言而为欺妄，是又下此一等，无足
论也。
虽然，人禀天地之气以生，不能无清浊纯驳之殊，禀之清者，血气清而脉来亦清，清则脉形圆
净，至数分明。吾诊乎此，但知其主富贵而已，若曰何年登科，何年升授，何年招财，何年得子，
吾皆不得而知矣。禀之浊者，血气浊而脉来亦浊，浊则脉形不清，至数混乱。吾诊乎此，但知其主
贫贱而已，若曰某时招悔，某时破财，某时损妻，某时克子，吾亦莫得而知矣。又有形浊而脉清者
，此谓浊中之清；质清而脉浊者，此谓清中之浊。又有形不甚清，脉不甚浊，但浮沉各得其位，大
小不失其等，亦主平稳而无大得丧也。其他言有所未尽，义有所未备，学人可以类推，是则吾之所
谓知人者，十本于理而已矣，岂敢妄为之说以欺人哉。噫，予所以着为是论者，盖以世之有言太素
脉者，靡不翕然称美，不惟不能以理析，又从而延誉于人，纵使其言有谬，又必阴与之委曲影射，
此所谓误己而误人者也，果何益之有哉？又有迎医服药者，不惟不先言其所苦，甚至再三询叩，终
于默默，至有隐疾而困医者，医固为其所困，不思身亦为医所困矣。此皆世之通患，人所共有，
故予不得不详论之，以致夫丁宁之意，俾聋瞽者或有所开发焉。孟子曰∶予岂好辨哉，予不得已也
。
明确脉象必须辨别表、里、虚、实这四个字。表，属于阳，对应腑，凡是六淫（风、寒、暑、湿、燥、火）邪气侵袭经络，而尚未进入胃腑及五脏的，都属于表证。里，属于阴，对应脏，凡是七情（喜、怒、忧、思、悲、恐、惊）之气郁结在心腹之内，不能发散，以及饮食损伤留滞于腑脏之间，不能通泄的，都属于里证。虚，是指元气自身的虚弱，精神耗散，气力衰竭。实，是指邪气的盛实，这是由于正气原本虚弱，邪气得以乘虚而入造成的，并非元气自身的强实。所以，虚证要补益其正气，实证要泻除其邪气。《内经》说：邪气盛实就是实证，精气亏损就是虚证，这是治疗的大法。
李东垣说：没有疾病的脉象，不需要刻意寻求神气，神气自然无处不在。患有疾病的脉象，则应当考察其神气的有无。比如脉数至六七至或极快，主热证，若脉中有力，就是有神，应当清泄其热；脉迟至二三至或败绝，主寒证，若脉中有力，就是有神，应当祛除其寒。如果在数、极、迟、败的脉象中不再有力，就是无神，那还依靠什么呢？如果不知道这一点而随意清泄或祛除病邪，神气将凭借什么作为主宰呢？所以《内经》说：脉是血气的前导，血气是人的神气所在。说得真好！
脉象，根本在于营气和卫气。营气行于脉管之中，卫气行于脉管之外。如果脏腑平和，营卫调畅，那么脉象就没有具体的形状可供议论了。倘若六淫外袭，七情内伤，导致脏腑不和，营卫乖谬，那么二十四种脉象的名称和形态，就会层出不穷地显现出来。因此，风、寒、暑、湿、燥、火，这称为六淫，外伤六淫的脉象，浮脉主风，紧脉主寒，虚脉主暑，细脉主湿，数脉主燥，洪脉主火，这些都可以通过脉象来辨别外感邪气。喜、怒、忧、思、悲、恐、惊，这称为七情，内伤七情的脉象，喜则伤心而脉缓，怒则伤肝而脉急，恐则伤肾而脉沉，悲则气消而脉短，惊则气乱而脉动，这些都可以通过脉象来辨别内伤的病症。然而这只是列举其常理，以脉与病相应为例来说明。
如果论述其变化，则有脉不应病、病不应脉的情况，变化百端，难以完全依赖脉象来判断。试举一二来说明，如张仲景说：脉浮大，邪气在表，可以用发汗法。如果脉浮大，心下硬满，有热且属脏病，应当用攻下法，不令发汗，这又不是浮脉为表邪可汗的脉象了。又说：促脉为阳盛，适宜用葛根黄芩黄连汤。如果脉促且四肢厥冷，属于虚脱，不用艾灸温补不可，这又不是促脉为阳盛的脉象了。又说：迟脉主寒，沉脉主里。如果阳明病脉迟，不恶寒，身体出汗，则用大承气汤攻下，这又不是所有迟脉都主寒的脉象了；少阴病初起，反而发热而脉沉，适宜用麻黄附子细辛汤发汗，这又不是沉脉都在里的脉象了。凡此种种，都是脉象难以完全依赖的确凿证据。如果只凭脉象而不询问症状，难免会将寒当作热，将表当作里，将阴当作阳，颠倒错乱，导致折损寿命的人很多了。所以古人治病，不专凭脉象，而必须兼审症状，是有道理的。
无奈世人不明白这个道理，往往有病隐瞒不说，只靠诊脉来试探医生的能力，医生切脉后所言偶尔中肯，便视为良医而倾心托付，对于病的根源，一无所告，药物的适宜与否，也不加审察，只是束手听命于医生，因循拖延以至于死，仍然不觉悟，实在可悲啊。那些庸俗之人，平时不爱学习，本来不足为怪，可惜近世的士大夫家庭，也难免受此习俗束缚，这就更令人好笑了。定、静、安、虑、格物致知，是《大学》首章的第一要义，其中“虑”指考虑事情精详，“格物”指穷究事物的原理，“致知”指推极自己的知识，这几件事，学医的人必须用心探究。先贤又说，做子女的不能不懂医，病人卧床，委托给庸医，比之不慈不孝还要严重。望、闻、问、切，是医家的主要环节，如果在面对病人时，只以切脉能诊断为荣，其余三件事一概置之不理，怎么能叫懂医呢？怎么能叫处事精详呢？怎么能叫穷究事物原理并推极自己的知识呢？
况且医生的高明，也不仅仅擅长诊脉这一项。凡是动静有常度，举止不妄为，存心忠厚，发言纯朴笃实，察病详细审慎，处方精当专注，兼具这些方面，才可以称为良医。虽然依据脉象推断症状，或许稍有偏差，但一种脉象并不只主一种病，所以所言未必全都中肯。如果因此就抛弃医生，那就是所谓的因为两个鸡蛋就丢弃保卫国家的将领，这怎么能跟智者谈论呢？姑且以浮脉为例，《脉经》说，浮脉主风、主虚、主气逆、主呕吐、主厥逆、主痞块、主胀满、主满闷不食、主热、主内结等等类别，所主的疾病不下数十种，假如诊得浮脉，他将断定是什么病呢？如果不兼用望、闻、问，而想要确切知道是什么病，我认为是极其困难的。古人将切脉排在望、闻、问之后，那么在望、闻、问的过程中，已经了解了病情，不过是再诊脉，看脉象是否与病情相符罢了。如果脉与病相符，则吉而易治；脉与病相反，则凶而难治，用脉象参验病情，意思大概如此，怎么能把仅靠诊脉知病看得最珍贵呢？《脉经》一书，恳切地向人展示诊法，但在开篇卷首就说观察形体色泽，彼此参互比较以决断生死，可见望、闻、问、切，是医生不可缺少的。唉！世人称善于诊脉没有超过王叔和的，但他尚且需要彼此参互比较，何况不如王叔和的人呢！所以专门靠切脉言病，必然会导致误诊，怎么能成为良医？
不仅如此，世人又有通过《太素脉》来说人贵贱穷通的，这更是荒谬至极。我曾考证其含义，“太”是始、初的意思，如太极、太乙之太；“素”是质、本的意思，如绘事后素之素，这大概是说初始本质的脉象。这究竟是什么样的脉呢？那一定是指元气而言。李东垣说：元气是胃气的别名。胃气的脉象，蔡西山所说的那样：不长不短，不疏不数，不大不小，应手中和，意思欣欣，难以名状的，就是这种脉。没有病的人，都能得到这种脉，用这种脉来察知人是否有病是可以的，用这种脉来察知人的富贵贫贱就不行了。为什么呢？胃气的脉象，难以形容，无法名状，拿什么作为贵贱穷通的诊断依据呢？我私下观察这本书，名义上虽叫太素，但其中的论述，完全没有一句话涉及太素的含义，所作的歌诀，大多是粗俗语言，全无道理趣味。推究其初衷，不过是借此作为谋取利益的媒介，后世不加考察，于是相传习用，没有人能辨明其错误。又有人解释说：所谓太素，是指贵贱穷通禀受于生命之初而言，但脉可以察知，并不是说脉名叫太素。我说：固然如此，那么太素所诊断的，必定不出于二十四脉的范围之外。二十四脉都主病，说一见一脉就主一病，贫贱富贵从哪里察知呢？假如是浮脉，其诊断为风，如果太素家去诊，是说它是风呢？还是说它是贵贱穷通呢？两者不可兼得，如果说它是风，那么他所知的也不过是病；如果舍弃病而言它是贵贱穷通，那么连近在身上的病尚且不能知道，怎么还能知道远违于身的其他事情呢？大概贵贱穷通是身外之事，与身体的血气不相干，怎么能通过脉象来知晓呢？况且脉的变化无常，而天气的寒暑不一，所以四季的脉象各不相同，不可能长久不变，因此今天诊得这种脉，明天诊可能就不是了，春天诊得这种脉，到了夏天按摸可能又不一样了。那些太素家，凭借片刻的寻按，就断言一生的吉凶，这必定是没有道理的，即使猜测屡屡中肯，也是捕风捉影，模糊形容，哪里有一定的见解呢？唉！通过脉象察病，尚且不知病的确实情况，还需要等待望、闻、问，更何况能知道其他事情呢？而且脉学萌芽于岐伯、黄帝，演绎于秦越人，详备于王叔和，遍考《素问》、《难经》、《脉经》，并没有一个字提到这个，不是故意隐瞒，大概是必然有不可诬蔑的事实吧。巢元方说：太素，是善于相面的人，特意假借太素之名来神化他的医术。这话确实正确，足以破除天下后世人的疑惑了。又有善于窥探察访的人，通过言语刺探他人，暗中得知实情，所以在诊按之际，肆意说话进行欺骗妄语，这又是低劣一等，不值得讨论了。
虽然如此，人禀受天地之气而生，不能没有清浊纯驳的区别。禀受清气者，血气清而脉来亦清，清则脉形圆净，至数分明。我诊察于此，只知道他主富贵而已，至于哪年登科，哪年升授，哪年招财，哪年得子，我都无法知晓。禀受浊气者，血气浊而脉来亦浊，浊则脉形不清，至数混乱。我诊察于此，只知道他主贫贱而已，至于某时招悔，某时破财，某时损妻，某时克子，我也无从知晓。又有外形浊而脉清者，这叫浊中之清；体质清而脉浊者，这叫清中之浊。又有外形不甚清，脉不甚浊，但浮沉各得其位，大小不失其等，也主平稳而无大的得失。其他言语有所未尽，义理有所未备，学人可以类推，这就是我所认为的知人，十成基于理而已，怎敢妄加说法来欺骗人呢？唉，我之所以撰写这篇论述，是因为世上谈论太素脉的人，无不一致称赞美好，不仅不能用道理分析，反而在人面前延誉吹捧，纵然他们的言论有误，也必定暗中与之委曲影射，这就是所谓的误己而误人，到底有什么益处呢？又有迎请医生服药的病人，不仅不先说出自己的痛苦，甚至再三询问叩击，最终沉默不语，甚至有隐疾困扰医生的，医生固然被其所困，没想到身体也被医生所困。这些都是世间的通病，人所共有的，所以我不得不详细论述，以表达我的叮咛之意，使聋瞽之人或许有所启发。孟子说：我难道喜欢辩论吗？我是不得已啊。
To clearly understand the pulse, one must distinguish between four characters: Exterior (Biao), Interior (Li), Deficiency (Xu), and Excess (Shi). The Exterior refers to Yang and the Fu organs. Any pathogenic factors of the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) that invade the meridians but have not yet entered the Stomach Fu or the Zang organs all belong to the Exterior. The Interior refers to Yin and the Zang organs. Any Qi stagnation caused by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) that is depressed within the heart and abdomen and cannot dissipate, as well as injuries from diet that remain between the Fu and Zang organs and cannot be unblocked and discharged, all belong to the Interior. Deficiency refers to the self-deficiency of Yuan Qi (Original Qi), with dissipation of spirit and exhaustion of qi and strength. Excess refers to the excess of pathogenic factors, which arises because the healthy qi was originally deficient, allowing pathogens to take advantage; it is not a self-excess of Yuan Qi. Therefore, for deficiency, one tonifies the healthy qi; for excess, one drains the pathogenic factors. The Classics state: "When pathogenic factors are abundant, it is Excess; when essential essence is depleted, it is Deficiency." This is the general principle.
Li Dongyuan said: In the pulse of a person without disease, one does not need to seek for Shen (Spirit); it is inherently present everywhere. In the pulse of a person with disease, one must examine whether Shen is present or absent. For instance, if the pulse is rapid (6-7 beats per breath) or extremely rapid, it indicates Heat. If there is force within the pulse, it possesses Shen, and one should drain the Heat. If the pulse is slow (2-3 beats per breath) or failing, it indicates Cold. If there is force within the pulse, it possesses Shen, and one should dispel the Cold. However, if in pulses that are rapid, extremely rapid, slow, or failing, there is no longer any force, this indicates an absence of Shen; upon what can one rely? If one does not understand this and proceeds to drain or dispel, upon what will Shen rely as its master? Thus, the Classics state: "The pulse is the precursor of Blood and Qi; Blood and Qi are the Shen of man." How true this is!
The pulse originates from Ying (Nutritive) Qi and Wei (Defensive) Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels. If the Zang and Fu organs are harmonious and Ying and Wei Qi are smooth and regulated, then the pulse has no specific shape to be discussed. However, if the Six Evils attack externally or the Seven Emotions injure internally, leading to disharmony of the Zang and Fu organs and deviation of Ying and Wei Qi, then the names and forms of the Twenty-Four Pulses will emerge layer upon layer. Therefore, Wind, Cold, Summerheat, Dampness, Dryness, and Fire constitute the Six Evils. Regarding the pulses of external injury by the Six Evils: Floating (Fu) indicates Wind, Tight (Jin) indicates Cold, Empty (Xu) indicates Summerheat, Fine (Xi) indicates Dampness, Rapid (Shu) indicates Dryness, and Full (Hong) indicates Fire. All of these allow one to distinguish external pathogenic factors through the pulse. Joy, Anger, Worry, Pensiveness, Sorrow, Fear, and Fright constitute the Seven Emotions. Regarding the pulses of internal injury by the Seven Emotions: Joy injures the Heart, resulting in a Slow/Relaxed (Huan) pulse; Anger injures the Liver, resulting in a Wiry/Tense (Ji) pulse; Fear injures the Kidney, resulting in a Deep (Chen) pulse; Sorrow consumes Qi, resulting in a Short (Duan) pulse; Fright causes Qi chaos, resulting in a Startled/Moving (Dong) pulse. All of these allow one to differentiate internal injuries through the pulse. However, this merely cites the normal patterns where the pulse corresponds to the disease.
If discussing variations, there are cases where the pulse does not correspond to the disease, or the disease does not correspond to the pulse, with hundreds of variations arising, making it difficult to rely solely on the pulse. Let us cite a few examples. Zhang Zhongjing stated: "A floating and large pulse indicates the pathogen is at the Exterior, and sweating is indicated." But if the pulse is floating and large, accompanied by hardness below the heart and heat belonging to the Zang organs, purgation is indicated, not sweating; this is not a pulse indicating exterior pathogen suitable for sweating. He also stated: "A Cuo (Surging/Irregular) pulse indicates Yang Excess, and Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) is appropriate." But if the pulse is Cuo accompanied by cold limbs, it indicates collapse of Deficiency, requiring moxibustion and warming; this is not a pulse indicating Yang Excess. Furthermore: "Slow pulse indicates Cold, Deep pulse indicates Interior." But if the Yangming channel presents a Slow pulse, without aversion to cold, and with sweating of the body, Da Chengqi Tang (Major Order the Qi Decoction) is used; this shows not all Slow pulses indicate Cold. If Shaoyin disease begins with fever and a Deep pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is used for sweating; this shows not all Deep pulses indicate Interior. These are clear proofs that the pulse cannot be relied upon exclusively. If one relies only on the pulse without asking about symptoms, one may mistake Cold for Heat, Exterior for Interior, and Yin for Yang, leading to confusion and premature death. Thus, ancient physicians did not rely solely on the pulse but combined it with careful examination of symptoms, which is justified.
Alas, people today do not understand this. Often, they hide their illness and do not speak of it, testing the doctor's ability solely through pulse diagnosis. If the doctor's pulse reading happens to hit the mark, they regard him as a good doctor and entrust themselves completely, revealing nothing about the root cause of the disease and examining neither the appropriateness of the medication. They simply submit to the doctor's orders, delaying until death, yet still fail to realize this, which is truly pitiable. It is no wonder that vulgar people, who never loved learning, act this way. However, it is regrettable that scholars and officials in recent times also succumb to this habit, which is even more laughable. Stability, tranquility, peace, deliberation, investigating things to extend knowledge—these are the primary principles of the first chapter of *The Great Learning*. "Deliberation" means considering matters with precision; "Investigating things" means exhausting the principles of affairs; "Extending knowledge" means pushing one's understanding to the limit. Students of medicine must devote themselves to these aspects. Former sages also said that sons must know medicine; leaving a sickbed patient to a quack is worse than being unfilial. Observation, Listening/Smelling, Inquiry, and Palpation are the major procedures of medicine. If, when facing a patient, one considers only palpation as skillful and neglects the other three, how can one claim to know medicine? How can one claim to handle matters precisely? How can one claim to exhaust principles and extend knowledge?
Moreover, a good physician is not defined solely by skill in pulse diagnosis. One must have regular conduct, proper demeanor, a loyal and sincere mind, pure and honest speech, detailed and prudent observation of disease, and precise and dedicated prescription. Only by combining these qualities can one be called a good physician. Although inferring symptoms from the pulse may sometimes be slightly inaccurate, since one pulse type does not correspond to only one disease, the inference may not always be exact. To discard a physician because of this would be like discarding a general defending the state over two eggs; such thinking cannot be shared with the wise. Taking the Floating pulse as an example, the *Mai Jing* (Pulse Classic) states that Floating indicates Wind, Deficiency, Qi rebellion, vomiting, syncope,痞 (Pi - stuffiness), distension, fullness with loss of appetite, Heat, internal binding, etc., covering dozens of diseases. If a Floating pulse is diagnosed, how can one determine the specific disease? Without combining Observation, Listening/Smelling, and Inquiry, attempting to identify the disease accurately is extremely difficult. The ancients placed Palpation after Observation, Listening/Smelling, and Inquiry because the condition was already understood during those steps; palpation was merely to verify if the pulse matched the condition. If the pulse matches the disease, the prognosis is good and treatment is easy; if the pulse contradicts the disease, the prognosis is poor and treatment is difficult. The purpose of using the pulse to cross-reference the disease is thus clear; why elevate pulse diagnosis alone as the supreme method? The *Mai Jing* earnestly teaches diagnostic methods, yet opens with observing form and color, comparing them to decide life and death. This shows that Observation, Listening/Smelling, Inquiry, and Palpation are indispensable. Alas! The world claims Wang Shuhe excelled most in pulse diagnosis, yet he still relied on cross-referencing. How much more so for those inferior to him! Therefore, relying solely on palpation to diagnose disease inevitably leads to error; how can such a person be a good physician?
Furthermore, some people use *Tai Su Mai* (Great Origin Pulse) to predict nobility, poverty, success, or failure. This is extremely absurd. I have examined its meaning. "Tai" means beginning or origin, as in Taiji or Taiyi. "Su" means substance or origin, as in "white silk follows painted patterns." This supposedly refers to the pulse of initial essence. What kind of pulse is this? It must refer to Yuan Qi. Li Dongyuan said: Yuan Qi is another name for Stomach Qi. The pulse of Stomach Qi, as described by Cai Xishan, is neither too long nor short, neither sparse nor rapid, neither large nor small, feeling harmonious and moderate, with a sense of vitality, indescribable in words. Healthy people possess this pulse. Using it to detect health or disease is acceptable, but using it to determine wealth or status is not. Why? Because the Stomach Qi pulse is indescribable; what basis is there for diagnosing status? Observing the book, although named *Tai Su*, the text never mentions the meaning of "Tai Su." The rhymes are mostly vulgar and lack logical interest. Its original intent was likely just a pretext for profit. Later generations, unaware, copied it, and no one corrected it. Some argue: "Tai Su" refers to destiny determined at birth, but the pulse itself is not named Tai Su. I say: True, but the pulse diagnosed by Tai Su practitioners must fall within the Twenty-Four Pulses. Since all Twenty-Four Pulses indicate disease, seeing one pulse indicates one disease; how can wealth or status be detected? If it is a Floating pulse, diagnosed as Wind, would a Tai Su practitioner say it is Wind or say it indicates status? They cannot do both. If they say it is Wind, they only know disease. If they ignore disease to talk of status, they cannot even know the disease close to the body, let alone distant matters. Status and fortune are external to the body and unrelated to blood and qi; how can they be known by pulse? Moreover, pulses change constantly, and seasons vary, so pulses differ by season and are not static. A pulse found today may differ tomorrow; a spring pulse may differ in summer. Tai Su practitioners judge a lifetime's fortune based on a moment's palpation, which is unreasonable. Even if they guess correctly occasionally, it is grasping at shadows, vague and uncertain. Alas! If one cannot even accurately diagnose disease through pulse, let alone know other things. Pulse studies originated with Qibo and Huangdi, developed by Qin Yueren, and detailed by Wang Shuhe. Examining *Suwen*, *Nanjing*, and *Mai Jing*, there is not a single word on this. It is not hidden; it is simply factually impossible. Chao Yuanfang said: Tai Su practitioners were skilled physiognomists who borrowed the name "Tai Su" to mystify their art. This is true and dispels worldly confusion. Others who spy and probe to deceive are even lower and unworthy of discussion.
Although humans are born with varying degrees of clarity and turbidity from Heaven and Earth, those with clear constitution have clear blood and qi, and thus a clear pulse: round, clean, and distinct in rhythm. Diagnosing this, I can only infer wealth and status, but cannot know specific years of promotion or wealth. Those with turbid constitution have turbid blood and qi, and thus a turbid pulse: unclear form and chaotic rhythm. Diagnosing this, I can only infer poverty and low status, but cannot know specific years of misfortune. There are those with turbid form but clear pulse (clarity within turbidity) and clear form but turbid pulse (turbidity within clarity). There are also those whose form is neither very clear nor very turbid, with pulse positions and sizes balanced, indicating stability without great gain or loss. Other details are left for students to deduce. My understanding of people is based ten percent on reason; I dare not fabricate stories to deceive. I wrote this treatise because everyone praises *Tai Su Mai*, unable to analyze it logically, and even praising it falsely. Even if wrong, they cover for it, misleading themselves and others. What benefit is there? Also, patients often do not state their suffering, remaining silent even when asked, hiding secret ailments that confuse the doctor. The doctor is confused, and the patient suffers. These are common faults. I discuss them in detail to awaken the ignorant. Mencius said: "Do I enjoy debating? I am compelled to do so."