脉学渊微，非悟彻神化之机，必不能心与神归，见微知着。初非仅仅于浮、沉、迟、数
、大、小、滑、涩之间，辨其迹象而已。可谓尽诊察之能事，得脉理之精神者也。然为初学
言之，亦不能不先迹象而遽谈化境，惟能审其真理，观其会通，乃有得心应手之妙，而拘拘
于古人之成说无当焉。所以古今医学诸家，据脉辨证，未尝不极其详备。形描摹形迹者，有
时而失之呆滞；高谈玄理者，有时而失之凿空。且有自古相承，久经定论，而一按其实在之
情形，反觉不能切合病机者，则理想之辞，拘泥太甚，而不自知其不适于实用也。如必详析
辨论，求其坐可言而立可行，未免梗塞难终，言之辞费。此非自为专书，不能详尽。寿颐不
揣愚陋，辑有《脉学正义》一篇，尚能阐发一二，以补古人所未及。然大率皆为内科言之，
于外疡不能兼及。兹为疡科计，则证发于外，而脉见于里，亦自有彼此附应，历验不爽之理
。姑就各种脉象之切合于外疡者，详其形态，溯其源流，以定吉凶，以别疑似。颇觉世传治
疡诸书，容有未尽明言其底蕴者，虽曰信手拈来，不无挂漏，或有一得之见，即在此中。请
举所知，以告同嗜。
浮沉者，脉之浅深也。脉显在上，轻手可得，谓之浮。脉隐在下，重手始得，谓之沉。
以禀赋言之，则体质壮盛，气血充实者，其脉有余，轻按易得，有似于浮；体质孱弱，气血
衰微者，其脉不及，轻取不见，有似于沉。以形质言之，则瘦人肉少，寸口 瘠者，脉道
显
者
之
之脉皆细软，必近于沉。以天时言之，则春生夏长，气泄于外，脉亦为之浮显；秋收冬藏，
气敛于中，脉亦为之沉着。以人事言之，则劳力奔走，饮醇酒之余，气血奋张，其脉无不浮
露；而凝默寡言，安居静坐之候，情志泰然，其脉无不沉静。此皆恒常之脉象，各随其人之
气体动静，而相与推移。窃谓凡二十八种脉象无一不当作如是观，必不能仓猝下指，而即知
其若者主某病，若者主某病者也。即以病脉之属于浮沉者而言，昔人每谓浮脉主表属腑属阳
，沉脉主里属脏属阴。约略读之，鲜不谓此以表里内外阴阳，分别论证，必无不妥。抑知浮
主表而沉主里，亦尚是理想之论断，笼统之泛辞，已不能切中病情，确合事理。而浮脉属阳
，沉脉属阴，浮脉主腑，沉脉主脏，则颇有语病，未可拘执矣。盖浮脉之可以诊得表病者，
惟表邪最盛时为然；而外感之轻者，脉必不浮。若夫身热甚厉之病，脉必洪大滑数，以其热
势方张，所以亦见浮象。此则气火俱盛而轻按即得，虽似于浮，实非浮脉之正旨。病此者表
里俱热，必不当以其脉之浮，而只知其为表病也。又风热之外感者，其脉浮，是为浮脉主表
之一证。然肝阳恣肆，为眩晕，为头痛者，气火升腾，其脉亦浮。则病本内因，亦非表证矣
。若谓浮脉属阳，而沉脉属阴，亦只可以论其常。若阴盛于内，阳格于外，则脉且浮大，而
重按无根，岂得概谓之阳证。又热结于里，气道不通，则脉亦沉着而凝涩不流，岂得概以为
阴证。至谓浮主腑病，沉主脏病，则宋金以前本无是说，而自明季以来，编入四言脉诀，几
于无人不读。（四言脉诀，本宋人崔氏所着，而明人多有改本，浮脉主表属腑之说，尚非崔
氏
遂
脏之表。若以全体言之，腑亦深藏于里，安得谬以为在表。岂可误认此表之一字，而竟谓病
在腑者，其脉当浮。假使腑病可作表病，而脉为之浮，则经络之病，肌肉之病，皮毛之病，
其脉又当若何。此理之必不可通，而亦事之万不能有者。然今之医者，多读脉诀，固无不知
有浮脉主表，属腑属阳之八字，可见俗书误人真是不小。究之浮脉主表，沉脉主里，尚是含
混言之，或无不可，若必谓浮主腑病，沉主脏病，胶执太甚，最是不通。
颐谓古今脉书，所称某脉主某病者，无不有是有非，得失互见。学人必须自具见解，识
透真理，方不为古人所愚。
兹姑就浮沉一条，聊申是说，以为举一反三之计。只欲借以纠正世俗通行之误，非好与
古人作无端之辨难也。若以浮沉二脉之属于外疡者言之，则肿疡脉浮，惟上焦风热诸证有之
。如发颐、 腮、耳门牙槽诸痈，病本在表，而又属风邪热毒，蕴于上部，其脉无不浮数滑
疾。有痰宜泄，有热宜清，亦不得以其脉浮属表，而但与疏风解表，反令气火越浮，疡患益
炽。若时邪袭于经络而发流注，则寒热交炽，表邪全盛之时，其脉亦必浮数。此则解表消肿
，双方并进，而表邪得泄，肿疡自化。若疡已成脓，其毒全盛而未泄，脉亦应之为浮数，为
滑大，则决去其脓毒而脉自静。若溃后脓泄而脉仍浮者，苟非外感之未尽，即防续发之成脓
。若感邪既化，疡无续发，而尚见脉浮，则正气散耗，非吉症也。若肿疡脉沉，则惟附骨大
疽、 癖积聚之证，寒凝络窒、气血壅塞者偶有之。其毒甚深，其势固结，而脉为之沉凝不
显，决非轻恙。苟不急与宣通，以疏达其凝结，必不易治。而寻常肌肉之痈肿，经络之疮疡
，于脉必无沉法。若夫痈疽既溃，脓毒已泄，气血疏通，更无脉沉之理。如或有之，则其气
犹结，其血犹凝，亦非佳象。总之，疡患为肌肉之病，虽曰痛则不通，脉必不宜过于浮露。
然壅者不化，结者不开，脉常沉涩不起，而治之不应，其为害又当何如耶。
脉学的深奥精微，如果不能领悟神妙变化的机理，就不能做到心神专注，从细微处洞察显著的道理。这绝不仅仅是通过浮、沉、迟、数、大、小、滑、涩等脉象的迹象来辨别病情而已。可以说，这是穷尽了诊察的能事，掌握了脉理精神的境界。然而对于初学者来说，也不能不先从迹象入手，而不能急于谈论化境（指融会贯通的境界）。只有能够审察真理，观察其会通之处，才能达到得心应手的妙境，而拘泥于古人的成说是不恰当的。所以古今医学各家，依据脉象辨证，未尝不极其详细完备。那些只描摹形迹的人，有时失之呆滞；高谈玄理的人，有时失之空泛。而且有些自古相承、久经定论的说法，一旦按切其实际情形，反而觉得不能切合病机，这是因为理想化的言辞，拘泥太甚，而自己不知道它不适用于实用。如果一定要详细分析辩论，要求坐而言立可行，未免梗塞难终，言之辞费。这不是专门著书，不能详尽。寿颐（作者自指）不自量力，辑录有《脉学正义》一篇，尚能阐发一二，以弥补古人所未及之处。但大体都是针对内科而言，对外科疮疡不能兼及。现在为了疡科（外科）考虑，则证候发于体表，而脉象见于体内，自有彼此附应、历验不爽的道理。姑且就各种切合于外疡的脉象，详述其形态，追溯其源流，以判断吉凶，以辨别疑似。颇觉世间流传的治疗疡科的诸书，可能有未尽明言其底蕴的地方，虽然说是信手拈来，不无挂漏，或许有一得之见，就在这里。请列举所知，以告知同好。
浮脉和沉脉，是指脉位的深浅。脉象显现于浅表，轻手即可触及，称为浮脉。脉象隐伏于深层，重手才能触及，称为沉脉。从禀赋体质来说，体质壮盛、气血充实的人，其脉有余，轻按易得，有似于浮脉；体质孱弱、气血衰微的人，其脉不足，轻取不见，有似于沉脉。从形体质地来说，瘦人肌肉少，寸口部位消瘦者，脉道显露，其脉皆细软，必近于沉脉。从天时来说，春生夏长，气泄于外，脉象也随之浮显；秋收冬藏，气敛于中，脉象也随之沉着。从人事活动来说，劳力奔走、饮醇酒之后，气血奋张，其脉无不浮露；而沉默寡言、安居静坐之时，情志泰然，其脉无不沉静。这些都是恒常的脉象，各随其人的气体动静，而相互推移。我认为凡二十八种脉象，无一不当作如是观，绝不能仓促下指，就知道哪种脉主某种病，哪种脉主另一种病。就以属于浮沉的病脉来说，前人常说浮脉主表、属腑、属阳，沉脉主里、属脏、属阴。粗略读来，很少有人不认为这是以表里内外阴阳分别论证，必定没有不妥之处。殊不知“浮主表而沉主里”，也是理想化的论断，笼统的泛辞，已经不能切中病情，确合事理。而说浮脉属阳、沉脉属阴，浮脉主腑、沉脉主脏，则颇有语病，不可拘执。大概浮脉可以诊得表病，只有在表邪最盛时才如此；而外感较轻的，脉必不浮。至于身热很厉害的病，脉必洪大滑数，因为热势正盛，所以也见浮象。这是气火俱盛而轻按即得，虽似于浮脉，实则不是浮脉的正旨。患此病者表里俱热，决不应因其脉浮，就只知道它是表病。另外，风热之外感，其脉浮，这是浮脉主表的一个证据。然而肝阳恣肆，导致眩晕、头痛者，气火升腾，其脉也浮。这说明病本在内因，并非表证。如果说浮脉属阳，沉脉属阴，也只可以用来论述常态。若阴盛于内，阳格于外，则脉且浮大，而重按无根，怎么能一概称之为阳证。又热结于里，气道不通，则脉亦沉着而凝涩不流，怎么能一概认为是阴证。至于说浮主腑病，沉主脏病，这在宋金以前本来没有这种说法，而从明代以来，编入四言脉诀，几乎无人不读。（四言脉诀，本是宋代崔氏所著，而明代人多有改本，浮脉主表属腑之说，尚非崔氏原意。）脏腑是相对的，脏为阴，腑为阳，脏居里，腑居表，但这只是相对之表，相对于脏而言腑在表。若以全体而言，腑亦深藏于体内，怎能谬误地认为在表？岂可误认这个“表”字，就说病在腑者，其脉当浮。假使腑病可作表病，而脉为之浮，那么经络之病、肌肉之病、皮毛之病，其脉又应当如何？这是道理上必不可通的，也是事情上万不可能有的。然而现在的医者，多读脉诀，固无不知有“浮脉主表，属腑属阳”这八个字，可见俗书误人真是不小。究其实，浮脉主表，沉脉主里，尚是含糊言之，或许无不可，若必谓浮主腑病，沉主脏病，胶执太甚，最是不通。
寿颐认为古今脉书，所称某脉主某病者，无不有是有非，得失互见。学人必须自具见解，识透真理，方不为古人所愚。
这里姑且就浮沉一条，聊申是说，以为举一反三之计。只想借此纠正世俗通行之误，并非好与古人作无端之辨难。若以浮沉二脉属于外疡来说，则肿疡（未溃之疮疡）脉浮，惟上焦风热诸证有之。如发颐、腮痈、耳门牙槽诸痈，病本在表，而又属风邪热毒，蕴于上部，其脉无不浮数滑疾。有痰宜泄，有热宜清，也不得因其脉浮属表，而只给予疏风解表，反令气火越浮，疡患益炽。若时邪袭于经络而发流注，则寒热交炽，表邪全盛之时，其脉亦必浮数。此时则解表消肿，双方并进，而表邪得泄，肿疡自化。若疡已成脓，其毒全盛而未泄，脉亦应之为浮数，为滑大，则决去其脓毒而脉自静。若溃后脓泄而脉仍浮者，苟非外感之未尽，即防续发之成脓。若感邪既化，疡无续发，而尚见脉浮，则正气散耗，非吉症也。若肿疡脉沉，则惟附骨大疽、瘕癖积聚之证，寒凝络窒、气血壅塞者偶有之。其毒甚深，其势固结，而脉为之沉凝不显，决非轻恙。苟不急与宣通，以疏达其凝结，必不易治。而寻常肌肉之痈肿，经络之疮疡，于脉必无沉法。若夫痈疽既溃，脓毒已泄，气血疏通，更无脉沉之理。如或有之，则其气犹结，其血犹凝，亦非佳象。总之，疡患为肌肉之病，虽曰痛则不通，脉必不宜过于浮露。然壅者不化，结者不开，脉常沉涩不起，而治之不应，其为害又当何如耶。
The profundity and subtlety of pulse diagnosis cannot be grasped unless one comprehends the mechanism of divine transformation, thereby enabling the mind and spirit to converge, allowing one to perceive the significant from the minute. It is by no means merely distinguishing symptoms through the indications of floating (Fu), deep (Chen), slow (Chi), rapid (Shu), large (Da), small (Xiao), slippery (Hua), and choppy (Se) pulses. One can say that this exhausts the capabilities of examination and captures the essence of pulse theory. However, for beginners, it is impossible to skip the initial signs and immediately discuss the realm of transformation (mastery/integration). Only by examining the truth and observing the connections can one achieve the wonder of ease and proficiency; being rigidly attached to the established theories of the ancients is inappropriate. Therefore, medical scholars throughout history, who diagnosed syndromes based on pulses, have been extremely detailed. Those who merely described the physical traces sometimes lost in rigidity; those who talked high about metaphysical principles sometimes lost in speculation. Moreover, some doctrines inherited since ancient times and long settled as conclusions, when checked against actual conditions, often fail to fit the pathogenesis. This is because idealistic language is too dogmatic, and practitioners do not realize its impracticality. If one were to analyze and debate in detail, seeking statements that are valid upon sitting and actions that are feasible upon standing, it would inevitably be obstructed and difficult to conclude, wasting words. This cannot be fully elaborated without a dedicated book. Shouyi (the author's self-reference), presuming his own ignorance and lack of talent, has compiled an article titled "Correct Meaning of Pulse Studies" (Mai Xue Zheng Yi), which can still elucidate a few points to supplement what the ancients missed. However, these are generally discussed in the context of internal medicine and do not cover external sores (Wai Yang). Now, considering the field of external surgery (Yang Ke), where manifestations appear externally while pulses reflect internally, there is indeed a principle of mutual correspondence that has been verified without error. I will briefly examine various pulse images relevant to external sores, detailing their forms, tracing their origins, determining auspiciousness or inauspiciousness, and distinguishing between similar and distinct conditions. It seems that many existing books on treating external sores may not have fully clarified their underlying principles. Although this compilation is somewhat haphazard and may have omissions, it may contain some unique insights. I present what I know to share with fellow enthusiasts.
Floating and deep refer to the depth of the pulse. When the pulse appears superficially and can be felt with light pressure, it is called Floating Pulse (Fu Mai). When the pulse is hidden deeply and requires heavy pressure to be felt, it is called Deep Pulse (Chen Mai). From the perspective of constitution, individuals with robust constitutions and abundant Qi and Blood have a surplus pulse that is easily detected with light pressure, resembling a Floating Pulse; those with weak constitutions and deficient Qi and Blood have an insufficient pulse that is not visible with light touch, resembling a Deep Pulse. From the perspective of physique, thin individuals with little flesh and atrophic Cun Kou (inch position at the radial artery) have exposed pulse channels, and their pulses are fine and soft, tending towards Deep. From the perspective of seasons, spring growth and summer expansion cause Qi to vent outward, making the pulse float and manifest; autumn harvest and winter storage cause Qi to gather inward, making the pulse sink and settle. From the perspective of human activities, after strenuous labor or running, or consuming strong wine, Qi and Blood surge, and the pulse invariably floats and exposes itself; during silence and immobility, or sitting quietly at home, with a calm state of mind, the pulse invariably sinks and settles. These are constant pulse images, shifting according to each person's Qi-Blood dynamics and activity levels. I believe that none of the twenty-eight types of pulse images should be viewed otherwise; one cannot hastily place fingers and immediately know which pulse corresponds to which disease. Taking pathological pulses belonging to floating and deep as examples, predecessors often stated that Floating Pulse governs exterior, belongs to Fu organs, and is Yang; Deep Pulse governs interior, belongs to Zang organs, and is Yin. Reading this roughly, few would not consider this classification by exterior-interior, inside-outside, Yin-Yang to be perfectly appropriate. Yet, knowing that "Floating governs exterior and Deep governs interior" is still an idealistic judgment and a generalization that fails to precisely hit the condition and align with reality. Furthermore, saying Floating Pulse belongs to Yang and Deep Pulse to Yin, Floating Pulse governs Fu organs and Deep Pulse governs Zang organs, contains logical flaws and should not be rigidly adhered to. Generally, Floating Pulse can diagnose exterior diseases only when exterior pathogens are most vigorous; mild external contractions will not result in a floating pulse. As for diseases with severe fever, the pulse must be洪大 (Hong Da, Large and Surging) and 滑数 (Hua Shu, Slippery and Rapid) because the heat is flourishing, thus also showing a floating image. This is due to both Qi and Fire being excessive and detectable with light pressure; although it resembles Floating Pulse, it is not the true essence of Floating Pulse. Patients with this condition have heat in both exterior and interior; one must not assume it is solely an exterior disease just because the pulse floats. Additionally, external contraction of Wind-Heat results in a floating pulse, which is evidence that Floating Pulse governs the exterior. However, when Liver Yang acts recklessly, causing dizziness and headache, the rising of Qi and Fire also results in a floating pulse. This indicates the root cause is internal, not an exterior syndrome. Saying Floating Pulse belongs to Yang and Deep Pulse to Yin applies only to normal states. If Yin is excessive internally and Yang is repelled externally, the pulse may be large and floating, but rootless upon heavy pressure; how can this be generally called a Yang syndrome? Again, if Heat knots in the interior and Qi pathways are blocked, the pulse may be deep, stagnant, and sluggish; how can this be generally considered a Yin syndrome? Regarding the claim that Floating governs Fu organ diseases and Deep governs Zang organ diseases, this view did not exist before the Song and Jin dynasties. Since the Ming Dynasty, it was included in the Four-Character Pulse Rhymes (Si Yan Mai Jue), read by almost everyone. (The Four-Character Pulse Rhyme was originally authored by Cui Shi of the Song Dynasty, but Ming dynasty scholars made many revisions; the idea that Floating Pulse governs exterior and belongs to Fu organs was not in Cui Shi's original work.) Zang and Fu are relative; Zang is Yin, Fu is Yang; Zang is interior, Fu is exterior, but this is a relative exterior compared to the Zang. Speaking of the whole body, Fu organs are also deeply hidden within the interior; how can it be erroneously thought they are in the exterior? How can one mistake this character "exterior" to mean that diseases in Fu organs should have a floating pulse? If Fu organ diseases could be treated as exterior diseases resulting in a floating pulse, then what about diseases of the meridians, muscles, and skin/hair? Their pulses would have to be... This logic is untenable and factually impossible. However, current physicians, having read the pulse rhymes, certainly know the eight characters: "Floating Pulse governs exterior, belongs to Fu, belongs to Yang." This shows how much vulgar books mislead people. Ultimately, saying Floating Pulse governs exterior and Deep Pulse governs interior is vague and perhaps acceptable; but insisting that Floating governs Fu organ diseases and Deep governs Zang organ diseases is too dogmatic and completely illogical.
Shouyi believes that in ancient and modern pulse books, claims that "a certain pulse governs a certain disease" all have pros and cons, gains and losses. Students must possess their own insights and penetrate the truth to avoid being fooled by the ancients.
Here, I briefly elaborate on the topic of Floating and Deep pulses to serve as a basis for inferring other cases. My intention is merely to correct common secular errors, not to engage in pointless disputes with the ancients. Considering Floating and Deep pulses in the context of external sores: a Floating Pulse in a swelling sore (Zhong Yang, un-ulcerated abscess) occurs only in upper jiao Wind-Heat syndromes. For example, parotitis (Fa Yi), mumps (Sa Yong), and abscesses around the ear gate and dental alveolus originate in the exterior and involve Wind-Evil and Heat-Toxin accumulating in the upper part; their pulses are invariably Floating, Rapid, Slippery, and Quick. If there is phlegm, it should be drained; if there is heat, it should be cleared. One must not, because the pulse is Floating and belongs to the exterior, merely use methods to disperse Wind and release the exterior, which would instead cause Qi and Fire to float further, exacerbating the sore. If seasonal evils invade the meridians causing Liu Zhu (flowing deposits), with alternating chills and high fever, when exterior pathogens are fully vigorous, the pulse will also be Floating and Rapid. In this case, releasing the exterior and reducing swelling proceed together; once the exterior evil is expelled, the swelling sore resolves naturally. If the sore has formed pus, with full toxicity but not yet discharged, the pulse responds with Floating and Rapid, or Slippery and Large; draining the pus and toxin will cause the pulse to calm. If the pulse remains Floating after ulceration and pus discharge, unless the external contraction is not fully resolved, one must guard against secondary pus formation. If the pathogenic factor has transformed, the sore does not recur, yet the pulse remains Floating, it indicates dispersion and consumption of Righteous Qi, which is not an auspicious sign. A Deep Pulse in a swelling sore occurs occasionally in cases like Bone-Attached Major Abscess (Fu Gu Da Ju) or abdominal masses (Jia Pi Ji Ju), caused by Cold coagulation, meridian obstruction, and Qi-Blood stagnation. The toxin is very deep, the condition is consolidated, and the pulse is Deep, stagnant, and indistinct; this is definitely not a mild ailment. If not urgently treated with circulation-promoting methods to dissipate the condensation, it will be difficult to cure. Ordinary muscle abscesses and meridian sores will never show a Deep pulse. Once a carbuncle or malignant sore has ulcerated, pus and toxin are discharged, and Qi and Blood are unblocked, there is no reason for the pulse to be Deep. If it is, it means Qi is still knotted and Blood is still congealed, which is not a good sign. In summary, sores are diseases of the muscles. Although "pain implies blockage," the pulse should not be excessively floating. However, if stagnation is not resolved and knots are not opened, the pulse often remains Deep and Choppy without rising, and if treatment fails, the harm would be severe.