（洪细附见）
大小者，脉之形体也。气血有余，指下壮盛，是之谓大。大而有力，则谓之洪。气血不
及，指下一线，则谓之小，亦谓之细。（大之与洪，一是形式之粗壮，一是气势之勇悍，形
神
能分析为二，故古人皆合为一。）平人之脉，或大或小，大率皆其人之禀赋使然，初不以有
病
疡气滞血凝，其病属实，其脉宜大而不宜小。然所患苟非坚巨，或其人素禀脉小者，则小而
有神，亦何往而非佳象。若大而有力，坚硬搏指，洪而气悍，汹涌奔腾，邪势太甚，非吉证
矣。溃疡气泄血耗，其病属虚，其脉宜小而不宜大。然所耗或尚无多，及其人身躯雄伟者，
则大而有神，正是病魔退舍之机，元气未亏之兆。若脉小形 ，外疡难敛，尤可虑也。惟肿
疡势盛之时，而其脉过于小弱不起，则正不胜邪，斯为危候。若大毒既泄之后，而其脉或豁
大无根，则元气已漓，无非败象。是皆当以形证与脉神参互考订，而孰吉孰凶，自有定论。
万不能于指下求其形似，而即以为凭脉辨证之要诀，尽在此中也。
滑涩者，脉之气势也。气旺血旺，其脉流利，是之谓滑。气少血少，其脉凝滞，是之谓
涩。凡痈疽当肿势坚硬之时，脉多涩滞，则气有所聚，血有所凝，蒂固根深，蟠结不化，是
其征也。而湿邪袭于经络，及湿痰蒙蔽中州，胃呆脑痞者，其脉无不涩滞。此皆实邪窒塞，
气行因而不利。治以疏通宣泄，则涩脉自起。若疡已酿脓，则气血相搏，其势方张，脉象应
之必多滑数。故肿疡已成未成之机，即可以脉之滑涩决之。涩则内尚无脓，犹可消散；滑则
脓已蒸酿，无不外溃矣。若痈疽即溃，则气结已通，血滞已泄，脉以滑利为顺，涩滞为逆。
盖脉滑者，其正气之充，清养化邪，调复必易。惟滑而大者，余焰方张，尚非正轨。而脉涩
者则血液已耗，神色必疲。滋养扶元，所不可缓。若更涩而小弱，色夺形 ，尤其可虑。
（洪脉与细脉的论述附见于此）
大小，是指脉搏的形体特征。气血充盛有余，手指下感觉壮实旺盛，这就叫做大脉。大而有力量，就称为洪脉。气血不足，手指下感觉如一线般微弱，这就叫做小脉，也叫做细脉。（大脉与洪脉的区别在于：一个是形体的粗壮，一个是气势的勇悍，形态与神气可以分析为两个层面，所以古人常将二者合为一谈。）正常人的脉象，或大或小，大体上都是由于个人的先天禀赋所致，起初并不因为生病而改变。如果是气滞血凝的外疡实证，其病属实证，脉象宜大而不宜小。然而，如果患处的肿块并非坚大，或者患者平素脉象就偏小，那么脉小而兼有神气，无论在哪里都算是吉兆。如果脉象大而有力，坚硬搏指，洪大且气势凶猛，汹涌奔腾，说明邪气势头太盛，就不是吉利的证候了。溃疡期气泄血耗，其病属虚证，脉象宜小而不宜大。但是，如果耗损尚不多，或者患者身躯雄伟者，脉大而有神气，正是病魔退去、元气未亏损的征兆。如果脉象细小且无神，外疡难以收敛，尤其令人担忧。只有在肿疡势盛之时，脉象却过于细小虚弱不起，这是正气不能战胜邪气，属于危重证候。如果在剧毒已泄之后，脉象反而豁大无根，说明元气已经枯竭，无非是败坏的征象。这些情况都应当结合形体症状与脉象的神气相互参验考订，从而判断吉凶，自有定论。绝不能仅仅在手指下追求脉象的形似，就认为凭脉辨证的关键全在于此。
滑脉与涩脉，是指脉搏的气势特征。气旺血旺，脉象流利，这就叫滑脉。气少血少，脉象凝滞，这就叫涩脉。凡是痈疽在肿势坚硬之时，脉象多呈涩滞，这是因为气有所聚，血有所凝，根基牢固，盘结不化，这是其征象。此外，湿邪侵袭经络，以及湿痰蒙蔽中焦脾胃，导致胃呆脑痞的患者，其脉象无不涩滞。这些都是实邪阻塞，气行因而不利。治疗以疏通宣泄为主，则涩脉自然消失。如果疮疡已经酿脓，则气血相搏，其势正盛，脉象相应地多表现为滑数。因此，肿疡已成脓或未成脓的时机，就可以通过脉象的滑涩来决断。涩脉表示内部尚无脓液，还可以消散；滑脉表示脓液已经蒸酿成熟，必然会向外溃破。如果痈疽已经溃破，则气结已通，血滞已泄，脉象以滑利为顺，涩滞为逆。因为脉滑说明正气充足，清养化邪，调理恢复必然容易。只有滑而大的脉象，表示余焰正盛，尚非正常的康复轨道。而脉涩则表示血液已经耗损，神色必定疲惫。滋养扶元的治疗不可迟缓。如果更兼涩而小弱，面色剥夺、形体消瘦，尤其令人担忧。
(The discussions on Hong [Surging] and Xi [Fine] pulses are attached here.)
Da [Large] and Xiao [Small] refer to the physical form of the pulse. When Qi and Blood are abundant and sufficient, the sensation under the fingers is robust and vigorous; this is called Da [Large]. If it is large and forceful, it is termed Hong [Surging]. When Qi and Blood are insufficient, the sensation under the fingers is like a single thread; this is called Xiao [Small], also referred to as Xi [Fine]. (The distinction between Da [Large] and Hong [Surging] lies in that one refers to the coarseness of the form, while the other refers to the ferocity of the momentum. Since form and spirit can be analyzed separately, ancient physicians often combined them into one category.) The pulse of a healthy person may be either large or small, generally determined by their innate constitution, and initially not altered by disease. In cases of external sores caused by Qi stagnation and Blood stasis, where the pathology is excess, the pulse should be large rather than small. However, if the lesion is not hard and massive, or if the patient's habitual pulse is small, then a small pulse with Shen [Spirit] is auspicious everywhere. Conversely, if the pulse is large and forceful, hard and beating against the fingers, surging and fierce, rushing violently, it indicates that the pathogenic factor is too excessive, which is not an auspicious sign. In the ulcerative stage, with leakage of Qi and consumption of Blood, the pathology is deficiency, and the pulse should be small rather than large. Yet, if the consumption is not yet significant, or if the patient has a robust physique, a large pulse with Shen [Spirit] is indeed a sign that the pathogen is retreating and the Yuan Qi [Original Qi] remains intact. If the pulse is small and formless without Shen [Spirit], the external sore will be difficult to heal, which is particularly worrying. Only when the swelling is severe but the pulse is excessively small, weak, and unarising, does it indicate that Zheng Qi [Upright Qi] cannot overcome the Xie Qi [Pathogenic Qi], constituting a critical condition. After the expulsion of severe toxins, if the pulse becomes vast and rootless, it indicates that Yuan Qi [Original Qi] has been depleted, representing a failing sign. All these situations must be evaluated by cross-referencing physical symptoms with the Shen [Spirit] of the pulse to determine auspiciousness or inauspiciousness. One cannot merely seek the physical resemblance under the fingers and assume that the key to pulse diagnosis lies solely therein.
Hua [Slippery] and Se [Rough] refer to the momentum of the pulse. When Qi and Blood are vigorous, the pulse flows smoothly; this is called Hua [Slippery]. When Qi and Blood are deficient, the pulse is stagnant; this is called Se [Rough]. In cases of carbuncles and ulcers during the phase of hard swelling, the pulse is often Se [Rough], indicating that Qi is gathered and Blood is congealed, with roots firmly established and knots unresolved, which is its characteristic sign. Additionally, patients suffering from Dampness invading the meridians, or Phlegm-Dampness clouding the Middle Jiao [Middle Burner], leading to gastric stagnation and mental cloudiness, invariably present with a Se [Rough] pulse. These are all cases of Excess pathogens blocking flow, causing Qi movement to be unfavorable. Treatment with dredging and venting will cause the Se [Rough] pulse to disappear. If the sore has formed pus, Qi and Blood contend, and the momentum is at its peak; the pulse corresponds to this with Hua [Slippery] and Shu [Rapid] qualities. Therefore, the timing of whether the swelling has formed pus or not can be determined by the Hua [Slippery] or Se [Rough] nature of the pulse. A Se [Rough] pulse indicates no pus inside yet, allowing for resolution; a Hua [Slippery] pulse indicates that pus has matured and will inevitably suppurate externally. If the carbuncle or ulcer has already ruptured, Qi stagnation has cleared, and Blood stasis has drained; the pulse should be Hua [Slippery] and smooth as favorable, and Se [Rough] as unfavorable. A Hua [Slippery] pulse indicates sufficient Zheng Qi [Upright Qi], making the clearing of pathogens and recovery easy. Only a Hua [Slippery] and Large pulse suggests that residual heat is still vigorous, which is not the normal track of recovery. A Se [Rough] pulse indicates that Blood has been consumed, and the complexion and spirit must be fatigued. Nourishing and supporting Yuan Qi [Original Qi] cannot be delayed. If accompanied by Se [Rough], Small, and Weak qualities, along with loss of luster and emaciation, it is particularly worrying.