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；来徐去疾，上虚下实，为恶风
也。故中恶风者，阳气受也。有脉俱沉细数者，少阴厥也；沉细数散者，寒热也；浮而散者，为 仆。诸浮不
躁者，皆在阳，则为热，其有躁者，在手；诸细而沉者，皆在阴，则为骨痛，其有静者，在足。数动一代者，
病在阳之脉也，泄及便脓血。
此举通体脉象阴阳虚实之纲，以辨外感内伤轻重之病也。夫脉之流行，一如溪水，而有源流澎湃之势，
其阴阳升降出入之理，存乎其中，故有上、下、来、去、至、止六字，教人揣摩领悟。自尺而上于寸为阳，
自寸而下于尺为阴；自沉而浮，为出为阳，自浮而沉，为入为阴；其上而出为来，其下而入为去；
应手为至，离手为止。是故粗大，为阴不足，阳有余，阳偏胜，为热中之病也。来疾去徐者，其气升出速，降
入迟，则上出气旺，故上实下虚，下虚则足厥冷，上实则巅顶或疼或胀之疾作也；来徐去疾者，升出气迟，
降入气速，则下入气旺，故下实上虚，上虚为阳虚，故恶风也。因其外感邪风，风为阳，故阳气受病，同类相
感也。其有脉俱沉细数者，邪热入阴部，故病在少阴肾经，厥者，气逆；若沉、细、数、散，兼营气不通，故
发寒热。如仲景云∶少阴病，反发热者，用麻黄附子细辛汤。然彼为寒邪，故脉微细，此为热邪，故脉沉细数
散，皆少阴兼营卫之病也。若浮而散，元气外脱，为 仆，忽而目眩跌仆也。诸浮而不躁者，其病皆在阳分，
而为热病，其躁者，在手经，以手经为心肺三焦之部，乃阳中之阳，故兼躁，即上文一盛而躁，病在手少阳之
义也；诸沉而细者，其病皆在阴分，深入于骨，而为骨痛，既沉细而有静者，其病在足经，以足经为阴中之阴，
正与躁为在手相对待也。此静躁或兼病状而言，皆当审察也。脉既数动，则为火，其病在阳，又兼一代，歇止
也，名促脉，此火邪下迫而泄泻，热邪入营，则便脓血，邪郁而气血伤，故脉一代也。以上诸病，或由外感，
或由内伤，更当审问其因也。
诸过者切之∶涩者，阳气有余也；滑者，阴气有余也。阳气有余，为身热无汗；阴气有余，为多汗身寒；
阴阳有余，则无汗而寒。推而外之，内而不外，有心腹积也；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。
诸过者，谓脉较本象太过也。言有余者，病气，非元气有余也。以病在卫阳，为阳气有余，故身热无汗，
腠理闭滞，故脉涩也；病在营阴，为阴有余，故多汗而身寒，以腠理开泄，津液流
通，故脉滑也；营卫俱病，为阴阳俱有余，营卫皆闭，故无汗而身寒。以上统论外感内伤之脉象，当审问其因
以分辨之也。推而外之，内而不外者，轻按浮部不应，重按沉部方见脉象，是内有结积在心腹，气闭不能达于
肌表也；推而内之，外而不内者，重按脉微，而旺于浮部，是感外邪，故身热也；推而上之，上而不下者，升
多降少，寸旺尺弱而下虚，故腰足清冷也；推而下之，下而不上者，升少降多，寸弱尺旺，而阳不伸，故头项
强痛也。按之至骨，脉气少者，肾元亏，阳气不足，故腰脊痛而身有痹也。腰为肾之府，脊为督脉，阳经之纲，风
寒湿合而成痹，由阳气不能充周于身也。
脉象粗大，是阴气不足、阳气偏盛的表现，属于热中病。脉来急促而去势缓慢，表示上部实而下部虚，这是厥逆和巅顶疾病的征象；脉来迟缓而去势急促，表示上部虚而下部实，这是恶风病的征象。所以患恶风病的人，是因为阳气受到邪气侵袭。如果脉象都表现为沉、细、数，这是少阴经的厥逆病；脉象沉、细、数且散乱，这是寒热错杂的病；脉象浮而散乱，这是仆倒（突然昏倒）的病。凡是脉浮而不躁动的，病都在阳分，属于热病；如果伴有躁动，病在手经。凡是脉细而沉的，病都在阴分，属于骨痛病；如果脉细沉而静止不动的，病在足经。脉数动且时有歇止的，是病在阳分的脉象，症状为泄泻以及大便脓血。
这一段总述全身脉象阴阳虚实的大纲，用来辨别外感和内伤疾病的轻重。脉搏的流行，就像溪水一样，有源头和澎湃的气势，其中蕴含着阴阳升降出入的道理，所以用“上、下、来、去、至、止”六个字，教导人们揣摩领悟。从尺部向上到寸部为阳，从寸部向下到尺部为阴；从沉脉变为浮脉，为出、为阳，从浮脉变为沉脉，为入、为阴；脉气向上向外为“来”，向下向内为“去”；手指感到脉动为“至”，离开手指感觉消失为“止”。因此，脉象粗大，是阴气不足、阳气有余，阳气偏胜，导致热中病。脉来急促去势缓慢，说明气机升出迅速，降入迟缓，所以上部气旺，导致上实下虚；下部虚则足部厥冷，上部实则导致巅顶疼痛或胀满的疾病发作；脉来迟缓去势急促，说明升出气迟，降入气速，所以下部气旺，导致下实上虚；上部虚即为阳虚，所以出现恶风。因为外感邪风，风属阳，所以阳气受病，这是同类相感的道理。如果有脉象都表现为沉、细、数的，是邪热进入阴分，所以病在少阴肾经；厥逆，是指气机逆乱；如果是沉、细、数、散并见，兼有营气不通，所以发寒热。正如张仲景所说：少阴病，反而发热的，用麻黄附子细辛汤治疗。然而那是寒邪致病，所以脉微细；这里是热邪致病，所以脉沉细数散，都是少阴经兼有营卫失调的病证。如果脉浮而散，是元气外脱，导致仆倒，即突然目眩跌仆。凡是脉浮而不躁动的，病都在阳分，属于热病；如果伴有躁动，病在手经，因为手经是心肺三焦的部位，属于阳中之阳，所以兼有躁动，这就是前文所说的“一盛而躁”，病在手少阳经的含义。凡是脉沉而细的，病都在阴分，深入于骨，导致骨痛；既然沉细且静止不动，病在足经，因为足经是阴中之阴，正好与躁动在手经相对待。这种静或躁可能兼指病状而言，都应当仔细审察。脉既数动，则为火邪，病在阳分，又兼有歇止，名为促脉，这是火邪下迫导致泄泻，热邪进入营分，导致大便脓血，邪气郁结而气血受伤，所以脉有歇止。以上各种疾病，有的由外感引起，有的由内伤引起，更应当审问病因。
对于各种异常脉象，切诊时：涩脉，是阳气有余；滑脉，是阴气有余。阳气有余，表现为身体发热无汗；阴气有余，表现为多汗身体寒冷；阴阳都有余，则无汗且身体寒冷。推按脉象向外（轻取），如果脉象在内（沉取）而不在外（浮取），是有心腹积块；推按脉象向内（重取），如果脉象在外（浮取）而不在内（沉取），身体有发热；推按脉象向上（寸部），如果脉象在上而不下达（尺部弱），腰足清冷；推按脉象向下（尺部），如果脉象在下而上不去（寸部弱），头项疼痛。按压至骨，脉气微弱的，是腰脊痛且身体有痹症。
所谓“诸过”，是指脉象较本象太过。说“有余”，是指病气有余，并非元气有余。因为病在卫阳，所以阳气有余，导致身体发热无汗，腠理闭滞，所以脉涩；病在营阴，所以阴气有余，导致多汗身体寒冷，因为腠理开泄，津液流通，所以脉滑；营卫都生病，是阴阳俱有余，营卫都闭塞，所以无汗且身体寒冷。以上统论外感和内伤的脉象，应当审问病因以分辨之。推按脉象向外，脉象在内而不在外，轻按浮部不应指，重按沉部才见到脉象，这是内有结积在心腹，气机闭塞不能达于肌表；推按脉象向内，脉象在外而不在内，重按脉微弱，而在浮部旺盛，这是感受外邪，所以身体发热；推按脉象向上，脉象在上而不下达，升多降少，寸部旺尺部弱而下虚，所以腰足清冷；推按脉象向下，脉象在下而上不去，升少降多，寸部弱尺部旺，而阳气不伸，所以头项强痛。按压至骨，脉气微弱的，是肾元亏虚，阳气不足，所以腰脊痛且身体有痹症。腰为肾之府，脊为督脉，是阳经的纲领，风寒湿合邪而成痹症，是由于阳气不能周流于全身所致。
A coarse and large pulse indicates insufficient Yin and excess Yang, manifesting as *Re Zhong* (Heat in the Middle) disease. A pulse that arrives swiftly but departs slowly signifies excess in the upper part and deficiency in the lower part, characteristic of *Jue* (Cold Reversal) and diseases of the vertex (*Dian Ji*); a pulse that arrives slowly but departs swiftly signifies deficiency in the upper part and excess in the lower part, characteristic of aversion to wind (*E Feng*). Therefore, those suffering from aversion to wind have their Yang Qi affected by pathogenic factors. If the pulse is simultaneously deep, fine, and rapid, it indicates *Shao Yin* (Lesser Yin) *Jue*; if it is deep, fine, rapid, and scattered, it indicates alternating cold and heat; if it is floating and scattered, it indicates sudden collapse or fainting (*Pu*). All floating pulses without agitation indicate the disease is in the Yang aspect, thus representing heat; if accompanied by agitation, the disease is in the Hand meridians. All fine and deep pulses indicate the disease is in the Yin aspect, manifesting as bone pain; if fine, deep, and still, the disease is in the Foot meridians. A pulse that is rapid, moving, and intermittent indicates a disease in the Yang aspect, with symptoms of diarrhea and pus-blood in the stool.
This section outlines the general principles of Yin-Yang and deficiency-excess in whole-body pulses to differentiate the severity of external contraction and internal injury diseases. The flow of the pulse is like a stream, possessing momentum from its source, containing the principles of Yin-Yang ascending, descending, exiting, and entering. Thus, six characters—Up, Down, Come, Go, Arrive, Stop—are provided for contemplation and understanding. Moving from the Chi position upward to the Cun position is Yang; moving from the Cun downward to the Chi is Yin. Moving from Deep to Floating is Exit and Yang; moving from Floating to Deep is Entry and Yin. Upward and outward movement is "Come"; downward and inward movement is "Go"; feeling the pulse under the fingers is "Arrive"; losing the sensation upon lifting the fingers is "Stop". Therefore, a coarse and large pulse indicates insufficient Yin and excess Yang, with Yang predominating, leading to *Re Zhong* disease. A pulse arriving swiftly and departing slowly means Qi ascends and exits quickly but descends and enters slowly, resulting in vigorous Qi in the upper part, causing excess above and deficiency below. Lower deficiency leads to cold feet (*Jue*), while upper excess causes pain or distension at the vertex. A pulse arriving slowly and departing swiftly means ascending Qi is slow and descending Qi is fast, resulting in vigorous Qi in the lower part, causing excess below and deficiency above. Upper deficiency implies Yang deficiency, hence aversion to wind. Because external wind pathogens invade, and wind is Yang, Yang Qi is diseased due to resonance between similar entities. If the pulse is deep, fine, and rapid, pathogenic heat has entered the Yin compartments, so the disease is in the *Shao Yin Kidney Meridian*. *Jue* refers to rebellious Qi. If deep, fine, rapid, and scattered are present together, indicating blocked Ying Qi, alternating cold and heat occur. As Zhang Zhongjing stated: In *Shao Yin* disease, if there is fever, use *Mahuang Fuzi Xixin Tang* (Ephedra, Aconite, and Asarum Decoction). However, that case involves cold pathogens, hence a micro-fine pulse; this case involves heat pathogens, hence a deep, fine, rapid, and scattered pulse. Both are diseases of *Shao Yin* complicated by Ying-Wei disharmony. If the pulse is floating and scattered, Yuan Qi is escaping externally, causing sudden dizziness and collapse (*Pu*). All floating pulses without agitation indicate the disease is in the Yang compartment, manifesting as heat; if accompanied by agitation, the disease is in the Hand meridians, as the Hand meridians belong to the Heart, Lung, and San Jiao, which are Yang within Yang. Thus, agitation corresponds to the earlier principle of "excess with agitation" pointing to the Hand Shaoyang meridian. All deep and fine pulses indicate the disease is in the Yin compartment, penetrating deeply into the bones, causing bone pain. If deep, fine, and still, the disease is in the Foot meridians, as the Foot meridians are Yin within Yin, contrasting with agitation in the Hand meridians. This stillness or agitation may refer to clinical manifestations and must be carefully examined. A rapid and moving pulse indicates Fire, with the disease in the Yang aspect. If accompanied by intermittent stops, it is named *Cu Mai* (Surging Pulse), indicating Fire pathogen forcing downward causing diarrhea, and Heat pathogen entering the Ying level causing pus-blood in stool. Pathogen stagnation injures Qi and Blood, hence the intermittent pulse. These diseases may arise from external contraction or internal injury; one must inquire into the etiology.
Regarding various excessive pulses during palpation: a Choppy pulse (*Se*) indicates excess Yang Qi; a Slippery pulse (*Hua*) indicates excess Yin Qi. Excess Yang Qi manifests as body heat and absence of sweating; excess Yin Qi manifests as profuse sweating and cold body; excess of both Yin and Yang manifests as absence of sweating and cold body. Pushing the pulse outward (light pressure): if the pulse is felt internally (deep) but not externally (superficial), there is accumulation in the heart and abdomen. Pushing the pulse inward (heavy pressure): if the pulse is felt externally but not internally, there is body heat. Pushing the pulse upward (Cun position): if the pulse is strong above but weak below, the waist and feet are cold. Pushing the pulse downward (Chi position): if the pulse is strong below but weak above, there is headache and neck stiffness. Pressing to the bone with weak pulse Qi indicates lower back and spine pain accompanied by Bi syndrome (obstruction).
"Excessive" refers to the pulse exceeding its normal image. "Excess" refers to pathological Qi, not healthy Yuan Qi. Since the disease is in the Wei (Defensive) Yang, Yang Qi is in excess, causing body heat and no sweat due to closed pores, resulting in a Choppy pulse. Since the disease is in the Ying (Nutritive) Yin, Yin Qi is in excess, causing profuse sweat and cold body due to open pores and flowing fluids, resulting in a Slippery pulse. Disease in both Ying and Wei implies excess of both Yin and Yang, with both levels blocked, causing no sweat and cold body. The above generally discusses pulses of external contraction and internal injury; one must inquire into the cause to differentiate. Pushing outward: pulse felt only on deep pressure indicates internal accumulation in the heart/abdomen, with Qi blocked from reaching the surface. Pushing inward: pulse felt strongly on superficial pressure but weak on deep pressure indicates external pathogen invasion, causing fever. Pushing upward: strong Cun and weak Chi indicate more ascending than descending Qi, leading to cold waist and feet. Pushing downward: weak Cun and strong Chi indicate less ascending than descending Qi, with Yang Qi unable to extend, leading to stiff neck and headache. Pressing to the bone with weak pulse Qi indicates deficiency of Kidney Yuan and insufficiency of Yang Qi, causing lower back/spine pain and Bi syndrome. The waist is the mansion of the Kidney; the spine is the Du Mai (Governing Vessel), the leader of Yang meridians. Bi syndrome formed by Wind, Cold, and Dampness occurs because Yang Qi cannot circulate throughout the body.