弦者，脉之刚劲有力，端直而长者也，为肝阳之自旺，为痰饮之郁结。紧者，脉之固定
坚直，应指不挠者也，为寒邪之外束，为实邪之内凝。《素问》有脉实坚之说。《伤寒论·
平脉篇》∶寒则牢坚。《脉经》引之作寒则紧弦，是紧脉亦可谓之坚脉，皆以形容其指下有
力耳。叔和以紧脉为转索无常，非是。盖紧即有力不散，亦与虚实之实脉相近。革者，浮候
之坚大有力；牢者，沉候之坚大有力。一为孤阳之浮越于外，一为阴寒之凝结于中。脉理主
病，适得其反，而情势之坚固有力则一。此四者，皆脉象之属于实者也。疡患得此，无非病
势方张，其毒甚盛，可从上条实脉之例求之。
软弱者，脉之应指无力者也。昔人每谓浮细无力为软，沉细无力为弱，分为二种。颐谓
软与弱，按其字义本难区别，若即以一浮一沉定为二候，但据脉之部位而言固无不可。然论
其所主之病，则固同是气血之不足耳。似不如浑融言之，较为圆相。《千金翼》始有濡脉一
条，而后之言脉者，几以濡脉软脉，别为两类。考《素问·平人气象论》平肝脉来，软弱招
招，《脉经》引之则作濡软。盖濡即软字变体，最古只有 字，后乃作 ，俗则作
之字，汉人隶书亦多从需，二字音读虽各不同，而字形字义皆近，遂至不可复正。所以《
内经》脉 之 ，后人竟作脉濡，实非濡湿濡滞之濡字。寿颐言脉，有 无濡
微脉者，即软之尤甚者也。若更涣散不收，指下似有如无，则为散脉。此四者，皆脉象
之属于虚者。
以言外疡，则未溃属实，软弱之脉，皆非所宜。然在病势不重，疡患不巨者，偶见软弱
，亦未必遽呈败象。若在即溃之后，其正已伤，脉形软弱，尤为合辙。惟微脉则无力太甚，
未免元气不支。散脉则散漫不收，多是本实之先拨，无论肿疡溃疡，都无吉象。是皆当从上
条虚脉之例以求之，亦可举一反三者也。
弦脉，是指脉搏刚劲有力、端直且长的形态，它代表肝阳的亢盛，也代表痰饮的郁结。紧脉，是指脉搏固定坚直、按之抵抗而不屈服的形态，它代表寒邪在体表的束缚，也代表实邪在体内的凝滞。《素问》中有“脉实坚”的说法。《伤寒论·平脉篇》说：“寒则牢坚。”《脉经》将其引用为“寒则紧弦”，这说明紧脉也可以称为坚脉，都是为了形容手指下感觉到的力量。王叔和认为紧脉像扭转的绳索一样无常变化，这是不正确的。大概紧脉就是有力而不散漫，也与虚实辨证中的“实脉”相近。革脉，是指在浮取时感觉坚硬、大而有力；牢脉，是指在沉取时感觉坚硬、大而有力。前者是孤阳外越的表现，后者是阴寒凝结于内的表现。虽然这两者在主病原理上恰好相反，但其指下坚固有力的态势是一致的。这四种脉象，都属于实脉的范畴。外科患者出现这些脉象，无非是病势正盛，毒气非常强盛，可以参考上一条关于实脉的例子来推断。
软弱脉，是指脉搏按之无力的形态。古人常说浮而细无力为软脉，沉而细无力为弱脉，将其分为两种。我（张寿颐）认为，“软”与“弱”从字义上看本来难以区分，如果仅以浮取和沉取来定为两种脉候，仅仅依据脉的部位来说固然也可以。但是论述它们所主的疾病时，其实都是气血不足的表现。不如将它们融合在一起论述，更为圆融恰当。《千金翼方》开始有了“濡脉”这一条记载，此后谈论脉象的人，几乎将濡脉和软脉分为两类。考证《素问·平人气象论》中关于平和肝脏脉象的描述：“软弱招招”，《脉经》引用时写作“濡软”。看来“濡”即“软”字的变体，最古老的写法只有某个古字（注：原文此处缺字，通常指‘耎’），后来写作另一个字形，俗体则作现在的“软”字，汉代人的隶书也多从“需”旁。这两个字读音虽不同，但字形字义都相近，导致无法再纠正。所以《内经》中的那个字，后人竟写成了“脉濡”，这里的“濡”并非湿润、濡滞的“濡”字。张寿颐说，脉象中有软、无、濡、微脉，其中软脉是最严重的无力状态。如果更加涣散不收摄，指下感觉似有似无，那就是散脉。这四种脉象，都属于虚脉的范畴。
谈到外科疮疡，在未溃破时属实证，出现软弱脉是不适宜的。然而，如果病势不重，疮疡不大，偶尔见到软弱脉，也未必立刻呈现败象。如果在已经溃破之后，正气已伤，脉形表现为软弱，这就特别符合病情。只有微脉则是无力太过，未免元气支撑不住。散脉则是散漫不收摄，多是根本先被拔除（根基动摇）的表现，无论是肿疡还是溃疡，都没有吉祥的迹象。这些都应当参考上一条关于虚脉的例子来推断，也可以由此举一反三。
Xuan (String-like) pulse refers to a pulse that is rigid, forceful, straight, and long. It indicates hyperactivity of Liver Yang or the stagnation of Phlegm-Fluids. Jin (Tight) pulse refers to a pulse that is fixed, firm, and vertical, resisting pressure without yielding. It indicates external constraint by Cold pathogen or internal coagulation of Excess pathogens. The *Suwen* mentions the concept of "pulse being solid and firm." In the *Ping Mai Pian* (Chapter on Normal Pulse Diagnosis) of the *Shanghan Lun*, it states: "Cold leads to firmness and solidity." The *Mai Jing* cites this as "Cold leads to Jin and Xuan pulses," suggesting that the Jin pulse can also be termed a Jian (Firm) pulse; both terms describe the sensation of force felt under the fingers. Wang Shuhe's description of the Jin pulse as "like a twisted rope, irregular" is incorrect. Essentially, the Jin pulse is forceful and not scattered, resembling the Shi (Excess) pulse in the context of Deficiency-Excess differentiation. Ge (Leather) pulse is characterized by firmness, largeness, and forcefulness upon superficial palpation (Fu position); Lao (Deep-Firm) pulse is characterized by firmness, largeness, and forcefulness upon deep palpation (Chen position). The former represents the floating outward of isolated Yang, while the latter represents the condensation of Yin-Cold within. Although their pathological implications are opposite, the physical sensation of firmness and force is identical. These four types all belong to the category of Excess pulses. When patients with surgical diseases present these pulses, it invariably indicates that the disease process is vigorous and the toxicity is severe; one may refer to the principles outlined for Excess pulses in the preceding section.
Ruo (Weak) and Ruan (Soft) pulses refer to pulses that lack force upon palpation. Ancients often distinguished them as follows: floating, thin, and forceless is Ruan (Soft); sunken, thin, and forceless is Ruo (Weak), treating them as two distinct types. I consider that, semantically, "Ruan" and "Ruo" are difficult to distinguish. If defined strictly by superficial versus deep positions, it is acceptable merely as a positional distinction. However, regarding the diseases they indicate, both essentially reflect insufficiency of Qi and Blood. Therefore, it is more appropriate to discuss them collectively for a more comprehensive understanding. The *Qianjin Yi Fang* introduced the Ru (Soggy) pulse, after which most pulse theorists categorized Ru and Ruan as separate classes. Examining the *Ping Ren Qi Xiang Lun* chapter of the *Suwen*, the normal Liver pulse is described as "Ruan Ruan Zhao Zhao" (Soft and gentle). The *Mai Jing* cites this as "Ru Ruan." It appears that "Ru" is a variant form of "Ruan." The oldest character was likely '耎' (ruan), later evolving into other forms, and eventually becoming the common character '软'. In Han dynasty clerical script, many characters derived from the phonetic component 'Xu' (需). Although the pronunciations differed, the shapes and meanings were similar, leading to confusion that could no longer be rectified. Thus, the character in the *Neijing* was later written as "Ru" in "Ru Mai," but this "Ru" does not mean moist or stagnant. Zhang Shouyi stated that among the pulses—Ruan, Wu, Ru, and Wei—the Ruan pulse represents a more pronounced degree of weakness. If the pulse becomes even more scattered and unrestrained, feeling as if it exists and yet does not under the fingers, it is called the San (Scattered) pulse. These four types all belong to the category of Deficiency pulses.
Regarding external surgical sores, before ulceration, the condition is Excess, so a Ruo/Ruan pulse is generally inappropriate. However, if the disease severity is mild and the sore is small, the occasional appearance of a Ruo/Ruan pulse does not necessarily indicate immediate collapse. After ulceration, when the healthy Qi has been damaged, a Ruo/Ruan pulse is particularly consistent with the pathology. A Wei (Micro) pulse, however, indicates excessive weakness, suggesting that Yuan Qi (Original Qi) cannot sustain itself. A San (Scattered) pulse, being diffuse and unrestrained, usually indicates prior destruction of the root foundation. Whether in the case of a swelling (Zhong Yang) or an ulcerated sore (Kui Yang), it presents no auspicious signs. These should be inferred by referring to the principles of Deficiency pulses in the preceding section, allowing one to deduce other cases from this example.