《素问》曰∶诊法常以平旦阴气未动，阳气未散，饮食未进，经脉未盛，络脉调匀，气血未乱，故乃可诊
有过之脉（过，谓脉之异于常候者），切脉动静而视精明（精明，谓视病患之目，旧注指睛明穴者非），察五
色，观五脏有余不
足，六腑强弱，形之盛衰，以此参决死生之分（《脉要精微论篇》）。
王海藏曰∶凡诊必先扪手心手背，手心热则内伤，手背热则外伤。次以脉别之，内伤手足不和，两胁俱热，
先少阳也，从内之外者，先有形也；外伤一身尽热，先太阳也，自外之内者，先无形也。人迎、气口俱盛，或
举按皆实大，表发热而恶寒，腹不和而口液，此内外两伤也。
《素问》又曰∶谨熟阴阳，无与众谋。所谓阴阳者，去者为阴，至者为阳；静者为阴，动者为阳；迟者为
阴，数者为阳（《阴阳别论篇》）。又曰∶尺内两旁，则季胁也（通两尺脉而言，季胁近肾，尺脉主之），尺
外以候肾，尺里以候腹中（里，亦内也。凡言外者，皆指臂之外侧；凡言内者，皆指近臂筋。季胁之上，肾之
分也，故以候肾。肾候有二，左尺以候肾、膀胱，右尺以候命门、三焦。季胁之内，腹之分也，故以候腹中）。
附上，左（近手为上两关脉，在尺之上。左，左关脉也）外以候肝，内以候鬲（鬲，与膈同，贲也，肝主贲）；
右（右关脉也，不言附上者，蒙上文）外以候胃，内以候脾（脾居中，故以内候之，胃为市，故以外候之）。
上附上，右（上，谓寸脉，又在关之上也。附上，即关也。右，右寸脉也）外以候肺，内以候胸中（肺叶垂外，
故以外候之，胸中主气管，故以内候之）；左（左寸脉也）外以候心，内以候膻中（心，心主，鬲中也。膻中，
上焦也，在两乳间）。前以候前（上前，谓左寸口。下前，谓胸之前膺及气海也），后以候后（上后，谓右寸
口，下后为胸之后背及气海也）。上竟上者（竟尽也。上竟上，谓至鱼际），胸喉中事也；下竟下者（谓尽尺
脉动处），少腹腰股膝胫足中事也（《脉要精微论篇》）。娄全善曰∶《内经》
以寸关尺脉候脏腑者，止于如此。至《难经》始定寸关尺为三部，浮中沉为九候云。《难经》曰∶脉有三部，
寸、关、尺也，上部法天，主胸以上至头之有疾；中部法人，主膈以下至脐之有疾；下部法地，主脐下至足之
有疾。部有三候，浮中沉也，总为九候（ 括《十八难》篇文）。
朱丹溪曰∶肺主气，其脉居右寸，脾胃、命门、三焦各以气为变化运用，故皆附焉。心主血，其脉居左寸，
肝、胆、肾、膀胱，皆精血之遂道 库，故皆附焉。男子病右脉充于左者，有胃气也，虽重可治。女子病左脉
充于右者，有胃气也，虽重可治。反此者虚之甚也。
陈无择曰∶左手心部在寸，属手少阴经，与小肠手太阳经会；肝部在关，属足厥阴经，与胆足少阳经合；
肾部在尺，属足少阴经，与膀胱足太阳经合。右手肺部在寸，属手太阴经，与大肠手阳明经合；脾部在关，属
足太阴经，与胃足阳明经合；肾部在尺，属手厥阴心包络，与三焦手少阳经合。
《难经》又曰∶脉有三部，部有四经，手太阴、阳明属金，生足太阳、少阴水，水流下行，而不能上，故
在下部；足厥阴、少阳属木，生手太阳、少阴火，火炎上行，而不能下，故在上部∶手心主、少阳属火，生足太
阴、阳明土，土主中营，故在中部，此五行子母更相生养者也（稍节《十八难》篇文）。又曰∶脉有阴阳，呼
出心与肺，吸入肾与肝，呼吸之间，脾受谷味，其脉在中。浮者，阳也。沉者，阴也。心肺俱浮，何以别之？
浮而大散者心也，浮而涩短者肺也。肾肝俱沉，何以别之？牢而长者肝也，按之濡，举指来实者肾也。脾者中
州，故其脉在中，是阴阳之法也（《四难》）脉有轻重，初持脉如三菽之重，与皮毛相胃者，肺部也（菽，
大豆也）；如六菽之重，与血脉相得者，心部也；如九菽之重，与筋平者，肝部也；按之至骨，举指来疾者，
肾部也，是轻重之谓也（《五难》）。
《素问》又曰∶诸浮不躁者皆在阳，则为热（病在足阳脉之中，阳为火气，故为热）；其有躁者在手（病
在手阳脉之中）。诸细而沉者皆在阴，则为骨痛（细沉而躁，则病生于手阴脉之中，阴主骨，故骨痛）；其有
静者在足（静而不躁者，病生于足阴脉之中，《脉要精微论篇》）。又曰∶三阳在头，三阴在手，所谓一也
（头，谓人迎脉，在结喉两旁一寸五分。手，谓气口脉，在手鱼际之后一寸。两者相应，俱往俱来，若引绳大
小齐等，名曰平人，故谓一也）。别于阳者知病忌时，别于阴者知死生之期（识气定期，故知病忌。审明成败，
故知死生之期。《阴阳别论篇》）。《灵枢曰》∶气口候阴，主中，盛坚者，伤于食，人迎候阳，主外，盛坚
者，伤于寒（ 括《四时气》、《论禁脉》、《五色》三篇文）。
《内经》曰∶人迎一盛（一盛，谓人迎脉大于寸口脉一倍也。余盛法同）病在足少阳（胆经），一盛而躁
病在手少阳（三焦经）；二盛病在足太阳（膀胱经），二盛而躁病在手太阳（小肠经）；三盛病在足阳明（胃
经），三盛而躁病在手阳明（大肠经）；四盛且大且数，名曰溢阳，溢阳为外格（四倍以上，阳盛之极，故格
拒吐逆，而食不得入）。脉口（即寸口）一盛，病在足厥阴（肝经），一盛而躁病在手厥阴（心包经）；二盛
病在足少阴（肾经），二盛而躁病在手少阴（心经）；三盛病在足太阴（脾经），三盛而躁病在手太阴（肺经）；
四盛且大且数，名曰溢阴，溢阴为内关（阴盛之极，故关闭而溲不得通也），内关不通死不治。人迎与太阴脉
口俱盛四倍以上，命曰关格（脉口，亦太阴也，
手太阴肺脉所行），关格之脉赢，不能极于天地之精气则死矣（赢，与盈通。阴阳俱盛，盛极则衰而不相营，
故名曰关格，言兼二病也。兼二病则不得尽期而死）。（合《灵枢·终始》、《素问·六节藏象论》两篇文；
庞安常曰∶察脉之要，莫急于人迎、寸口，二脉相应，如两引绳，阴阳均则绳之大小等。凡平人之脉，人迎
大于春夏，寸口大于秋冬。何谓人迎？喉旁取之，《内经》所谓别于阳者也。秦越人但取手太阴之行度，鱼
际后一寸九分，以配阴阳之数，而得关格之脉，然不尽取之穴之脉，不先求喉手引绳之义，则昧尺寸、阴阳、
关格之所起矣。夫寸四倍于尺，则上鱼而为溢；溢者，寸倍尺之极也。溢之脉，一名外关，外关者，自关以
上外脉也；一名内格，内格者，阴拒阳而外出也；一名阴乘之脉，阴乘者，阴生于寸，动于尺。今自关以上
溢于鱼际，而关以后脉伏行是为阴，壮乘阳，而阳竭则死，脉有是者死矣。此所谓寸口四倍于人迎，为关阴
之脉者也。关以后脉当一寸而沉，过则尺倍于寸，至四倍则入尺而为覆，覆者，尺倍寸之极也。覆之脉，一
名内关，内关者，自关以下内脉也；一名外格，外格者，阳拒阴而内入也；一名阳乘之脉，阳乘者，阳生于
尺，动于寸。今自关以下，覆入尺泽，而关以前，脉伏行，是为阳元乘阴，而阴竭则死，脉有是者死矣。此
所谓人迎四倍于寸口，为格阳之脉者也。虽然独覆独溢，则补泻以生之。尺部一盛，泻足少阳，补足厥阴；
二盛，泻足太阳，补足少阴；三盛泻足阳明，补足太阴，皆二泻而一补之；四盛则三阳极，导之以序，当进
取少阳、太阳、阳明之穴；脉静者取三阳于足，脉数者取三阳于手，泻阳二，当补阴一。至寸而反
之。且脉有九候者，取浮中沉于寸关尺也。越人不取十二经穴，但以足少阴、阳明二经，配合手太阴行度，自尺
至寸九分之位，复分三部，部有浮中沉，以配天地人。又谓∶中风木，伤寒金，温水热火。夫温病起于湿，湿
则土病，土病而诸脏受害，其本生于金木水火四脏之变。阳浮阴濡为风温，阳数阴实为温毒，阳濡阴急为湿温，
阴阳俱盛为温疟。其治之也，风温取足厥阴木。手少阴火，温毒取手少阳火，伤寒取手太阴金、手少阴火，湿
温取足少阴水。皆能辨其疑似而不乱，良由定阴阳于喉手，配覆溢于尺寸，寓九候于浮中沉，分四温于伤寒，
此皆越人开其端，予则参以《内经》诸篇考究而得其说，审而用之，顺而治之，病不能逃矣（按∶《内经》先
外关者，循外、内之序，庞氏先内格者，顺阴阳之义，要亦有见，而非立异于经也。其未言补泻之方，辨四温
之治，尤能发前人所未发，学人宜究心焉）。《素问》又曰∶脉有阴阳，知阳者知阴，知阴者知阳，所谓阴者
真脏也（五脏属阴，故阴为真脏），见则为败，败必死也（肝脉至中外急，心脉至坚而搏，肺脉至大而虚，肾
脉至搏而绝，脾脉至弱而乍数乍疏，皆为脉见。见则脏败，神去故必死）。所谓阳者，胃脘之阳也（人迎脉气）。
别于阳者，知病处，知病从来（据《玉机真藏论》增此四字）；别于阴者，知死生之期（《阴阳别论篇》）。
又曰∶九候之相应也，上下若一，不得相失。一候后则病，二候则病甚，三候后则病危。所谓后者，应不俱也
（俱，犹同也，一也）。察九候独小者病，独大者病，独疾者病（疾，速也，即数也），独迟者病，独热者病，
独寒者病，独陷下者病，形气参伍不调者病。上下左右之脉，相应如参舂者病甚（参舂，谓脉大数而鼓，如
参舂杵之上下也），形盛脉细，少气不足以息者危。形瘦脉
大胸中多气者死，中部之候相减者死（减于上下两部，亦是气衰），中部乍疏乍数者死（气之丧乱也），中部
之脉虽独调，与众脏相失者死（与上下两部不相应也），上下左右相失不可数者死（谓一息十至以上也），三
部九候皆相失者死，脉不往来者死（精神去也），目内陷者死（太阳之脉，起于目内 ，目内陷者，太阳绝也），
脱骨身不去者死（去，犹行也），形肉已脱，九候虽调犹死，皮肤着者死（骨干枯也）。（次弟《三部九候论
篇》文）
张仲景曰∶寸脉下不至关为阳绝，尺脉上不至关为阴绝，此皆不治决死也，若计其余命死生之期，以月节
克之（阳绝死于春夏，阴绝死于秋冬，此言其应）。
《素问》说：诊脉通常选择在清晨进行，此时阴气尚未发动，阳气尚未耗散，饮食尚未摄入，经脉之气尚未充盛，络脉之气调和均匀，气血运行未受干扰而紊乱，因此才可以诊断出异常的脉象（“过”，指脉象异于正常征候）。通过切按脉搏的动静变化并观察患者眼睛的神采（“精明”，指观察患者的双目，旧注中将其解释为睛明穴是不正确的），审察五色，观察五脏之气的有余或不足、六腑功能的强弱以及形体状态的盛衰，以此来决断生死界限（出自《脉要精微论篇》）。
王海藏说：凡是诊脉，必须先触摸患者的手心手背。如果手心发热，则是内伤；如果手背发热，则是外伤。接着通过脉象来辨别：内伤导致手足不和，两胁俱热，病起于少阳经，这是由内向外发展的，先有实质性的病变；外伤则全身发热，病起于太阳经，这是由外向内发展的，起初没有实质性的病变。如果人迎脉和气口脉都盛大，或者举按之下都显得实大，表现为体表发热且恶寒，腹部不适且唾液增多，这是内外同时受伤的情况。
《素问》又说：务必熟练掌握阴阳理论，不要与众人商议。所谓的阴阳，离去的是阴，到来的是阳；静止的是阴，躁动的是阳；迟缓的是阴，急促的是阳（出自《阴阳别论篇》）。又说：尺部内侧两旁，对应季胁（泛指双尺脉而言，季胁靠近肾脏，尺脉主候此处），尺部外侧以候肾，尺部内侧以候腹中（“里”，也是“内”的意思。凡言“外”，皆指手臂的外侧；凡言“内”，皆指靠近手臂肌腱的一侧。季胁之上，是肾的分野，所以用来候肾。肾的候应有两处，左尺脉候肾和膀胱，右尺脉候命门和三焦。季胁之内，是腹的分野，所以用来候腹中）。在尺部之上附上的是关脉，左手关脉外侧以候肝，内侧以候膈（“鬲”，同“膈”，即贲门，肝主司贲门）；右手关脉（文中省略了“附上”二字，承袭上文之意）外侧以候胃，内侧以候脾（脾居中焦，故以内侧候之；胃为水谷之海，故以外侧候之）。再往上附上的是寸脉，右手寸脉外侧以候肺，内侧以候胸中（肺叶垂于外侧，故以外侧候之；胸中主管气管，故以内侧候之）；左手寸脉外侧以候心，内侧以候膻中（心与心主位于膈中。膻中，属于上焦，位于两乳之间）。脉象的前部以候身体前部（上前部，指左寸口；下前部，指胸部前方及气海穴区域），脉象的后部以候身体后部（上后部，指右寸口；下后部，指背部及气海穴区域）。脉象向上延伸至鱼际者（“竟”，意为尽。上竟上，指脉气到达鱼际），主候胸部和喉部的疾病；脉象向下延伸至尺泽者（指尺脉波动的尽头），主候小腹、腰、股、膝、胫、足等部位的疾病（出自《脉要精微论篇》）。娄全善说：《内经》用寸、关、尺三部脉候脏腑的方法，仅仅如此。到了《难经》，才正式确定寸、关、尺为三部，浮、中、沉为九候。《难经》说：脉有三部，即寸、关、尺。上部法天，主候胸部以上至头部的疾病；中部法人，主候膈以下至脐部的疾病；下部法地，主候脐以下至足部的疾病。每部有三候，即浮、中、沉，总共为九候（概括自《十八难》篇内容）。
朱丹溪说：肺主气，其脉位于右寸；脾胃、命门、三焦各以气的变化运用为主，所以也附属于此。心主血，其脉位于左寸；肝、胆、肾、膀胱，都是精血运行的通道和仓库，所以也都附属于此。男子患病，如果右脉充实于左侧，说明还有胃气，即使病情严重也可治愈。女子患病，如果左脉充实于右侧，说明还有胃气，即使病情严重也可治愈。与此相反的情况，则是虚损非常严重。
陈无择说：左手寸部属心，归属于手少阴经，与小肠手太阳经相会合；左手关部属肝，归属于足厥阴经，与胆足少阳经相合；左手尺部属肾，归属于足少阴经，与膀胱足太阳经相合。右手寸部属肺，归属于手太阴经，与大肠手阳明经相合；右手关部属脾，归属于足太阴经，与胃足阳明经相合；右手尺部属肾，归属于手厥阴心包络，与三焦手少阳经相合。
《难经》又说：脉有三部，每部有四条经络。手太阴肺经和手阳明大肠经属金，金生水，生足太阳膀胱经和足少阴肾经，水流下行而不能上行，所以在下部；足厥阴肝经和足少阳胆经属木，木生火，生手太阳小肠经和手少阴心经，火炎上行而不能下行，所以在上部；手厥阴心包经和手少阳三焦经属火，火生土，生足太阴脾经和足阳明胃经，土主居中营卫，所以在中部，这是五行子母相生养育的关系（节选自《十八难》篇内容）。又说：脉有阴阳之分。呼气时，气出于心与肺；吸气时，气入于肾与肝。呼吸之间，脾接受水谷的精微，其脉位于中部。浮脉属阳，沉脉属阴。心肺二脏的脉都浮，如何区分？浮大而散的脉是心脉，浮而涩短的脉是肺脉。肾肝二脏的脉都沉，如何区分？牢而长的脉是肝脉，按之柔软、举指时感觉坚实的脉是肾脉。脾居中州，所以其脉在中，这就是阴阳的法则（出自《四难》）。诊脉有轻重之分，初持脉时如三颗大豆的重量，接触皮毛的，是肺脉（菽，即大豆）；如六颗大豆的重量，与血脉相适应的，是心脉；如九颗大豆的重量，与筋平齐的，是肝脉；按至骨部，举指时脉来疾速的，是肾脉，这就是诊脉轻重的含义（出自《五难》）。
《素问》又说：所有浮而不躁动的脉，病都在阳分，表现为热证（病在足阳脉之中，阳为火气，所以表现为热）；如果有躁动的，病在手部阳脉（病在手阳脉之中）。所有细而沉的脉，病都在阴分，表现为骨痛（如果细沉而躁动，则病生于手阴脉之中，阴主骨，所以骨痛）；如果有静而不躁动的，病在足部阴脉（静而不躁，病生于足阴脉之中，出自《脉要精微论篇》）。又说：三阳脉在头部，三阴脉在手腕部，这叫做“一”（头，指人迎脉，位于结喉旁开一寸五分处。手，指气口脉，位于手鱼际后一寸处。两者相应，往来一致，如同拉紧的绳子大小相等，称为平人，所以叫作“一”）。善于辨别阳脉的人，知道疾病禁忌的时间；善于辨别阴脉的人，知道死生的期限（识别气数的定期，所以知道疾病的禁忌；审明成败，所以知道死生的期限，出自《阴阳别论篇》）。《灵枢》说：气口脉候阴，主内部疾病，脉象盛坚的是伤食；人迎脉候阳，主外部疾病，脉象盛坚的是伤寒（概括自《四时气》、《论禁脉》、《五色》三篇内容）。
《内经》说：人迎脉比寸口脉大一倍（“一盛”，指人迎脉大于寸口脉一倍。其余类推），病在足少阳胆经；大一倍且躁动，病在手少阳三焦经；大两倍，病在足太阳膀胱经；大两倍且躁动，病在手太阳小肠经；大三倍，病在足阳明胃经；大三倍且躁动，病在手阳明大肠经；大四倍且大且数，名叫溢阳，溢阳属于外格（四倍以上，是阳盛至极，所以格拒吐逆，食物无法进入）。脉口（即寸口）大一倍，病在足厥阴肝经；大一倍且躁动，病在手厥阴心包经；大两倍，病在足少阴肾经；大两倍且躁动，病在手少阴心经；大三倍，病在足太阴脾经；大三倍且躁动，病在手太阴肺经；大四倍且大且数，名叫溢阴，溢阴属于内关（阴盛至极，所以关闭而小便不通），内关不通则死，不可治疗。人迎脉和太阴脉口（寸口）都盛大四倍以上，名叫关格（脉口，也是太阴脉，即手太阴肺脉所行之处），关格的脉气亏损，不能竭尽天地精气就会死亡（“赢”，通“盈”。阴阳俱盛，盛极则衰而不相互滋养，所以名叫关格，意思是兼有二病。兼有二病则不能活到自然寿命而死）。（综合《灵枢·终始》、《素问·六节藏象论》两篇内容；庞安常说：诊脉的要领，没有比观察人迎、寸口更急迫的了，这两脉相应，如同两股拉紧的绳子，阴阳均衡则绳子的粗细相等。凡是正常人的脉象，人迎脉在春夏季节较大，寸口脉在秋冬季节较大。什么是人迎脉？在喉旁取脉，《内经》所说的辨别阳脉就是这里。秦越人只取手太阴肺经的行度，在鱼际后一寸九分，配合阴阳之数，从而得出关格脉，然而并没有全面取喉部和手部的脉象，不先探究喉手如引绳的意义，就会模糊尺寸、阴阳、关格的起源。如果寸脉是尺脉的四倍，则向上延伸至鱼际而为溢脉；溢脉，是寸脉超过尺脉的极限。溢脉，一名外关，外关是指从关部以上向外的脉；一名内格，内格是指阴拒阳而外出；一名阴乘之脉，阴乘是指阴生于寸，动于尺。现在从关部以上溢至鱼际，而关部以后的脉伏行，这是阴壮乘阳，而阳竭则死，脉象有这样的就会死亡。这就是所说的寸口四倍于人迎，为关阴的脉象。关部以后的脉应当在一寸处下沉，超过则尺脉倍数于寸脉，达到四倍则深入尺部而为覆脉；覆脉，是尺脉超过寸脉的极限。覆脉，一名内关，内关是指从关部向内的脉；一名外格，外格是指阳拒阴而内入；一名阳乘之脉，阳乘是指阳生于尺，动于寸。现在从关部以下，覆入尺泽，而关部以前，脉伏行，这是阳元乘阴，而阴竭则死，脉象有这样的就会死亡。这就是所说的人迎四倍于寸口，为格阳的脉象。虽然单独出现覆脉或溢脉，可以通过补泻来调理。尺部大一倍，泻足少阳，补足厥阴；大两倍，泻足太阳，补足少阴；大三倍，泻足阳明，补足太阴，都是二泻一补；大四倍则三阳极，引导以秩序，应当进取少阳、太阳、阳明的穴位；脉静的取足部三阳经，脉数的取手部三阳经，泻阳二，当补阴一。到了寸部则反过来。而且脉有九候，即在寸关尺取浮中沉。秦越人不取十二经穴，只以足少阴、足阳明二经，配合手太阴的行度，从尺至寸九分的部位，再分三部，部有浮中沉，以配天地人。又说：中风属木，伤寒属金，温水热火。温病起于湿，湿则土病，土病则诸脏受害，其根本源于金木水火四脏的变化。阳浮阴濡为风温，阳数阴实为温毒，阳濡阴急为湿温，阴阳俱盛为温疟。治疗方面，风温取足厥阴木经和手少阴火经；温毒取手少阳火经；伤寒取手太阴金经和手少阴火经；湿温取足少阴水经。都能辨别疑似而不混乱，确实是因为确定了喉手阴阳，配合覆溢于尺寸，寓九候于浮中沉，区分四种温病于伤寒，这些都是秦越人开创的先端，我则参考《内经》诸篇考究而得到这些说法，审慎使用，顺应治疗，疾病就无法逃脱了（按：《内经》先讲外关，遵循外、内的顺序；庞氏先讲内格，顺应阴阳的意义，总归是有见地的，并非违背经典。他没有提及补泻的方法，辨析四种温病的治疗，尤其能发挥前人所未发之处，学习者应当用心研究）。《素问》又说：脉有阴阳，知阳者知阴，知阴者知阳。所谓阴，指的是真脏脉（五脏属阴，所以阴为真脏），见到真脏脉则为败象，败象必然死亡（肝脉至中外急，心脉至坚而搏，肺脉至大而虚，肾脉至搏而绝，脾脉至弱而乍数乍疏，都称为脉见。见到则脏气败坏，神气离去，所以必死）。所谓阳，指的是胃脘之阳（人迎脉气）。善于辨别阳脉的人，知道疾病所在，知道疾病由来（据《玉机真藏论》增加这四个字）；善于辨别阴脉的人，知道死生的期限（出自《阴阳别论篇》）。又说：九候脉象应当相应，上下如一，不得相失。一候落后则病，二候落后则病重，三候落后则病危。所谓的落后，是指应期不同步（俱，犹同也，一也）。察九候，独小者为病，独大者为病，独疾者为病（疾，速也，即数也），独迟者为病，独热者为病，独寒者为病，独陷下者为病，形气参伍不调者为病。上下左右之脉，相应如舂米杵上下捣击者，病重（参舂，谓脉大数而鼓动，如舂米杵之上下也），形体盛但脉细，少气不足以息者危。形体瘦但脉大，胸中多气者死，中部之候减弱者死（减于上下两部，也是气衰），中部脉乍疏乍数者死（气之丧乱也），中部之脉虽独自调匀，但与众脏不相适应者死（与上下两部不相应也），上下左右相失不可计数者死（指一息十至以上也），三部九候皆相失者死，脉不往来者死（精神去也），目内陷者死（太阳之脉，起于目内眦，目内陷者，太阳绝也），脱骨身不去者死（去，犹行也），形肉已脱，九候虽调犹死，皮肤着骨者死（骨干枯也）。（依次摘录自《三部九候论篇》内容）
张仲景说：寸脉下不到关部为阳绝，尺脉上不到关部为阴绝，这都是不治之症，必定死亡。如果要计算剩余寿命的死生期限，需根据月令节气相克来判断（阳绝死于春夏，阴绝死于秋冬，这是言其应验）。
The *Suwen* (Basic Questions) states: Pulse diagnosis is usually performed in the early morning, when Yin Qi (Yin Energy) has not yet stirred, Yang Qi (Yang Energy) has not yet dispersed, food and drink have not been ingested, the Jingmai (Meridian Vessels) are not yet full, the Luomai (Collateral Vessels) are harmonious and even, and the Qi and Blood are not yet chaotic. Therefore, it is possible to diagnose abnormal pulses ("Guo" refers to pulse conditions that differ from normal signs). By palpating the movement and stillness of the pulse and observing the patient's eyes for spirit ("Jingming" refers to observing the patient's eyes; old annotations identifying this as the Jingming acupoint are incorrect), examining the Five Colors, observing whether the Zang organs (Solid Organs) have excess or deficiency, assessing the strength or weakness of the Fu organs (Hollow Organs), and evaluating the flourishing or declining state of the body, one can determine the division between life and death (from the chapter "Essential Secrets of Pulse Observation").
Wang Haizang said: In all pulse diagnoses, one must first palpate the palms and backs of the hands. Heat in the palms indicates internal injury; heat on the backs of the hands indicates external injury. Next, distinguish by pulse: Internal injury causes disharmony of the limbs and heat in both hypochondria, originating from the Shaoyang channel; this is a progression from inside to outside, starting with substantial pathology. External injury causes whole-body heat, originating from the Taiyang channel; this is a progression from outside to inside, initially without substantial pathology. If both the Renying pulse and the Qikou pulse are vigorous, or feel solid and large upon lifting and pressing, presenting with exterior fever and aversion to cold, abdominal discomfort, and excessive saliva, this indicates simultaneous internal and external injury.
The *Suwen* further states: One must thoroughly master Yin and Yang theory and not consult with others. What is meant by Yin and Yang? Departing is Yin, arriving is Yang; stillness is Yin, agitation is Yang; slowness is Yin, rapidity is Yang (from the chapter "Discussion on Distinctions of Yin and Yang"). It also states: The inner sides of both Chi positions correspond to the Jixie (hypochondriac region) (referring generally to both Chi pulses; the Jixie is near the Kidney, governed by the Chi pulse). The outer side of Chi observes the Kidney, while the inner side observes the abdomen ("Li" means "inside". Whenever "outer" is mentioned, it refers to the lateral aspect of the arm; whenever "inner" is mentioned, it refers to the aspect near the arm tendons. Above the Jixie is the domain of the Kidney, hence used to observe the Kidney. The observation of the Kidney has two aspects: the Left Chi observes the Kidney and Bladder, while the Right Chi observes the Mingmen (Gate of Life) and Sanjiao (Triple Burner). Inside the Jixie is the domain of the abdomen, hence used to observe the abdomen). Above the Chi position is the Guan position. The outer side of the Left Guan observes the Liver, and the inner side observes the Diaphragm ("Ge" is identical to "Di", i.e., the cardia; the Liver governs the cardia); the Right Guan (the text omits "above the Guan," inheriting the meaning from above) observes the Stomach on its outer side and the Spleen on its inner side (The Spleen resides in the center, so observed internally; the Stomach is the market of water and grain, so observed externally). Above the Guan is the Cun position. The outer side of the Right Cun observes the Lung, and the inner side observes the Chest Center (The lung lobes hang outward, so observed externally; the chest center governs the air passages, so observed internally); the Left Cun observes the Heart on its outer side and the Danzhong on its inner side (The Heart and Heart Master reside within the diaphragm. Danzhong belongs to the Upper Burner, located between the two breasts). The anterior part of the pulse observes the anterior body (Upper anterior refers to the Left Cun Kou; Lower anterior refers to the anterior chest and Qihai area). The posterior part observes the posterior body (Upper posterior refers to the Right Cun Kou; Lower posterior refers to the posterior back and Qihai area). Pulses extending upward to the Yuji point ("Jing" means end; Shang Jing Shang refers to reaching Yuji) concern matters of the chest and throat. Pulses extending downward to the end of the Chi pulse movement concern matters of the lower abdomen, waist, thighs, knees, shins, and feet (from the chapter "Essential Secrets of Pulse Observation"). Lou Quanshan said: The *Neijing* uses the Cun, Guan, and Chi pulses to observe Zang and Fu organs only in this manner. It was not until the *Nanjing* (Classic of Difficult Issues) that Cun, Guan, and Chi were formally established as three positions, and Floating, Middle, and Deep as nine observations. The *Nanjing* states: There are three positions of the pulse: Cun, Guan, and Chi. The upper position models Heaven, governing diseases from the chest up to the head; the middle position models Humanity, governing diseases from below the diaphragm to the umbilicus; the lower position models Earth, governing diseases from below the umbilicus to the feet. Each position has three observations: Floating, Middle, and Deep, totaling nine observations (summarized from Chapter 18 of the *Nanjing*).
Zhu Danxi said: The Lung governs Qi, and its pulse is located at the Right Cun; the Spleen, Stomach, Mingmen, and Sanjiao each operate through changes in Qi, so they are attached here. The Heart governs Blood, and its pulse is located at the Left Cun; the Liver, Gallbladder, Kidney, and Bladder are all channels and repositories of Essence and Blood, so they are also attached here. In men, if the disease presents with the Right pulse filling the Left side, there is Stomach Qi, and although severe, it is treatable. In women, if the disease presents with the Left pulse filling the Right side, there is Stomach Qi, and although severe, it is treatable. The reverse indicates extreme deficiency.
Chen Wuyue said: The Heart position on the Left Hand at Cun belongs to the Hand-Shaoyin channel and converges with the Hand-Taiyang Small Intestine channel. The Liver position at Guan belongs to the Foot-Jueyin channel and combines with the Foot-Shaoyang Gallbladder channel. The Kidney position at Chi belongs to the Foot-Shaoyin channel and combines with the Foot-Taiyang Bladder channel. The Lung position on the Right Hand at Cun belongs to the Hand-Taiyin channel and converges with the Hand-Yangming Large Intestine channel. The Spleen position at Guan belongs to the Foot-Taiyin channel and combines with the Foot-Yangming Stomach channel. The Kidney position at Chi belongs to the Hand-Jueyin Pericardium channel and combines with the Hand-Shaoyang Sanjiao channel.
The *Nanjing* further states: There are three positions of the pulse, each containing four meridians. The Hand-Taiyin Lung and Hand-Yangming Large Intestine belong to Metal; Metal generates Water, producing the Foot-Taiyang Bladder and Foot-Shaoyin Kidney. Water flows downward and cannot ascend, hence they are in the lower position. The Foot-Jueyin Liver and Foot-Shaoyang Gallbladder belong to Wood; Wood generates Fire, producing the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart. Fire flares upward and cannot descend, hence they are in the upper position. The Hand-Jueyin Pericardium and Hand-Shaoyang Sanjiao belong to Fire; Fire generates Earth, producing the Foot-Taiyin Spleen and Foot-Yangming Stomach. Earth governs the central nourishment, hence they are in the middle position. This is the mutual generation and nourishment of the Five Elements via mother-son relationships (excerpted from Chapter 18 of the *Nanjing*). It also states: The pulse has Yin and Yang aspects. Exhalation involves the Heart and Lung; inhalation involves the Kidney and Liver. Between breaths, the Spleen receives the essence of grains, and its pulse is in the middle. Floating pulses are Yang; sinking pulses are Yin. Both Heart and Lung pulses float; how to distinguish them? A floating, large, and scattered pulse is the Heart pulse; a floating, choppy, and short pulse is the Lung pulse. Both Kidney and Liver pulses sink; how to distinguish them? A firm and long pulse is the Liver pulse; a pulse that feels soft upon pressure but becomes solid when lifted is the Kidney pulse. The Spleen resides in the Central Plain, so its pulse is in the middle; this is the method of Yin and Yang (from Difficulty 4). Pulse palpation has degrees of weight. Initially holding the pulse with the weight of three beans, touching the skin and hair, is the Lung pulse (Shu refers to soybeans); with the weight of six beans, adapting to the blood vessels, is the Heart pulse; with the weight of nine beans, level with the tendons, is the Liver pulse; pressing to the bone, where the pulse comes rapidly upon lifting, is the Kidney pulse. This is what is meant by light and heavy pressure (from Difficulty 5).
The *Suwen* further states: All floating pulses without agitation indicate pathology in Yang, manifesting as heat (pathology in the Foot-Yang meridions; Yang represents Fire Qi, hence heat). If there is agitation, the pathology is in the Hand-Yang meridians (pathology in the Hand-Yang meridians). All fine and sinking pulses indicate pathology in Yin, manifesting as bone pain (if fine, sinking, and agitated, the pathology arises in the Hand-Yin meridians; Yin governs bones, hence bone pain). If there is stillness without agitation, the pathology is in the Foot-Yin meridians (still and non-agitated, pathology arises in the Foot-Yin meridians, from the chapter "Essential Secrets of Pulse Observation"). It also states: The Three Yang pulses are at the head, and the Three Yin pulses are at the hand; this is called "One" (Head refers to the Renying pulse, 1.5 cun lateral to the laryngeal prominence. Hand refers to the Qikou pulse, 1 cun posterior to the thenar eminence. The two correspond, coming and going together, equal in size like a drawn rope, called a healthy person, hence termed "One"). Those who can distinguish Yang know the contraindicated times for illness; those who can distinguish Yin know the period of death or survival (identifying the regularity of Qi allows knowing contraindications; clarifying success and failure allows knowing the timing of death or survival, from the chapter "Discussion on Distinctions of Yin and Yang"). The *Lingshu* states: The Qikou pulse observes Yin, governing internal issues; if vigorous and firm, it indicates food injury. The Renying pulse observes Yang, governing external issues; if vigorous and firm, it indicates cold injury (summarized from chapters "Four Seasons Qi", "Discussion on Forbidden Pulses", and "Five Colors").
The *Neijing* states: If the Renying pulse is one degree stronger than the Cun Kou pulse ("one degree stronger" means the Renying pulse is twice the size of the Cun Kou pulse; other degrees follow similarly), the disease is in the Foot-Shaoyang Gallbladder channel. One degree stronger and agitated indicates disease in the Hand-Shaoyang Sanjiao channel. Two degrees stronger indicates disease in the Foot-Taiyang Bladder channel. Two degrees stronger and agitated indicates disease in the Hand-Taiyang Small Intestine channel. Three degrees stronger indicates disease in the Foot-Yangming Stomach channel. Three degrees stronger and agitated indicates disease in the Hand-Yangming Large Intestine channel. Four degrees stronger, large, and rapid is named Yi Yang (Overflowing Yang); Yi Yang constitutes Wai Ge (External Grid) (four times or more is the extreme of Yang excess, leading to rejection, vomiting, and inability to ingest food). If the Maikou (i.e., Cun Kou) pulse is one degree stronger, the disease is in the Foot-Jueyin Liver channel. One degree stronger and agitated indicates disease in the Hand-Jueyin Pericardium channel. Two degrees stronger indicates disease in the Foot-Shaoyin Kidney channel. Two degrees stronger and agitated indicates disease in the Hand-Shaoyin Heart channel. Three degrees stronger indicates disease in the Foot-Taiyin Spleen channel. Three degrees stronger and agitated indicates disease in the Hand-Taiyin Lung channel. Four degrees stronger, large, and rapid is named Yi Yin (Overflowing Yin); Yi Yin constitutes Nei Guan (Internal Closure) (extreme Yin excess leads to closure and inability to urinate). Nei Guan unblocked leads to death and is untreatable. If both the Renying pulse and the Ta Yin Maikou (Cun Kou) are four times stronger, it is named Guan Ge (Grid Lock) (Maikou is also Ta Yin, specifically the Hand-Taiyin Lung channel). The pulse of Guan Ge is depleted; if it cannot exhaust the essence and Qi of Heaven and Earth, death ensues ("Ying" is interchangeable with "Ying" meaning full. When Yin and Yang are both excessive, extreme excess leads to decline and lack of mutual support, hence named Guan Ge, implying coexistence of two pathologies. Coexisting pathologies mean one cannot reach their natural lifespan, thus dying prematurely) (combined from *Lingshu: Zhong Shi* and *Suwen: Liu Jie Zang Xiang Lun*; Pang Anchang said: The key to pulse diagnosis lies urgently in observing Renying and Cun Kou. These two pulses correspond like two drawn ropes; if Yin and Yang are balanced, the ropes are of equal thickness. In healthy people, the Renying pulse is larger in spring and summer, while the Cun Kou pulse is larger in autumn and winter. What is the Renying pulse? It is taken at the side of the throat, referred to in the *Neijing* as distinguishing Yang. Qin Yueren only took the course of the Hand-Taiyin channel, measuring 1.9 cun posterior to Yuji, matching it with Yin-Yang numbers to derive Guan Ge pulses, but did not fully take pulses from the throat and hand, nor did he first seek the meaning of the throat-hand rope analogy, thereby obscuring the origins of Cun-Chi, Yin-Yang, and Guan Ge. If the Cun pulse is four times the Chi pulse, it extends upward to Yuji as an Overflow pulse; the Overflow pulse is the extreme where Cun exceeds Chi. The Overflow pulse is also called Wai Guan (External Grid), referring to the pulse extending outward from the Guan position upward; also called Nei Ge (Internal Grid), where Yin rejects Yang and moves outward; also called Yin Cheng pulse, where Yin originates at Cun and moves at Chi. Now, overflowing from Guan to Yuji, while the pulse after Guan runs submerged, is Yin overpowering Yang; when Yang is exhausted, death occurs. Such a pulse indicates death. This is what is meant by Cun Kou being four times Renying, constituting the Guan Yin pulse. After the Guan, the pulse should sink at one cun; exceeding this, the Chi pulse multiplies relative to Cun. At four times, it enters Chi as a Cover pulse; the Cover pulse is the extreme where Chi exceeds Cun. The Cover pulse is also called Nei Guan (Internal Grid), referring to the pulse inward from the Guan position; also called Wai Ge (External Grid), where Yang rejects Yin and enters inward; also called Yang Cheng pulse, where Yang originates at Chi and moves at Cun. Now, covering from Guan into Chize, while the pulse before Guan runs submerged, is Yang Yuan overpowering Yin; when Yin is exhausted, death occurs. Such a pulse indicates death. This is what is meant by Renying being four times Cun Kou, constituting the Ge Yang pulse. Although solitary Cover or Overflow can be regulated by tonification and sedation: Chi position one degree stronger, sedate Foot-Shaoyang, tonify Foot-Jueyin; two degrees stronger, sedate Foot-Taiyang, tonify Foot-Shaoyin; three degrees stronger, sedate Foot-Yangming, tonify Foot-Taiyin; these are two sedations and one tonification. Four degrees stronger implies extreme Yang; guide with order, advance to points of Shaoyang, Taiyang, and Yangming. If the pulse is quiet, take Three Yang on the foot; if rapid, take Three Yang on the hand. Sedate Yang two parts, tonify Yin one part. At Cun, reverse this. Furthermore, the pulse has nine observations, taking Floating, Middle, and Deep at Cun, Guan, and Chi. Yueren did not take twelve meridian points but combined Foot-Shaoyin and Foot-Yangming with Hand-Taiyin courses, dividing the 9 fen position from Chi to Cun into three positions, each with Floating, Middle, and Deep to match Heaven, Earth, and Humanity. He also stated: Wind-stroke belongs to Wood, Cold Injury belongs to Metal, Warm-Water-Hot-Fire. Warm diseases originate from Dampness; Dampness affects Earth; Earth pathology harms all viscera, rooted in changes of Metal, Wood, Water, and Fire. Floating Yang and Soft Yin is Wind-Warm; Rapid Yang and Solid Yin is Warm-Toxin; Soft Yang and Tight Yin is Damp-Warm; Excess Yin and Yang is Warm-Malaria. Treatment: Wind-Warm takes Foot-Jueyin Wood and Hand-Shaoyin Fire; Warm-Toxin takes Hand-Shaoyang Fire; Cold Injury takes Hand-Taiyin Metal and Hand-Shaoyin Fire; Damp-Warm takes Foot-Shaoyin Water. All can distinguish similarities and differences without confusion, precisely because Yin-Yang was determined at throat and hand, Cover-Overflow matched to Cun-Chi, Nine Observations embedded in Floating-Middle-Deep, and Four Warms distinguished from Cold Injury. These were initiated by Yueren; I have refined them by consulting various chapters of the *Neijing*, applying them prudently and treating according to principles, so diseases cannot escape (Note: The *Neijing* discusses Wai Guan first, following the order of Outer/Inner; Pang discusses Nei Ge first, following the meaning of Yin/Yang. Both have merit and do not contradict the classics. His omission of tonification/sedation methods and differentiation of Four Warms treatments especially reveals insights not previously expressed; students should study this carefully). The *Suwen* further states: The pulse has Yin and Yang. Knowing Yang allows knowing Yin; knowing Yin allows knowing Yang. What is Yin? It is the True Zang pulse (Zang organs belong to Yin, so Yin is the True Zang). Appearance of True Zang pulse indicates decay, and decay inevitably leads to death (Liver pulse arrives tense inside and out; Heart pulse arrives firm and beating; Lung pulse arrives large and empty; Kidney pulse arrives beating and abrupt; Spleen pulse arrives weak and intermittently rapid or slow—all constitute pulse appearance. Appearance means Zang decay and Spirit departure, hence certain death). What is Yang? It is the Yang of the Stomach House (Renying pulse Qi). Those who can distinguish Yang know the location of disease and its origin (added four characters based on *Yu Ji Zhen Zang Lun*); those who can distinguish Yin know the period of death or survival (from the chapter "Discussion on Distinctions of Yin and Yang"). It also states: The nine observations should correspond, upper and lower as one, not losing sync. If one observation lags, there is disease; if two lag, disease is severe; if three lag, disease is critical. "Lagging" means responses are not simultaneous (Ju means same, one). Observe the nine observations: unique smallness indicates disease, uniqueness in largeness indicates disease, uniqueness in speed indicates disease (Ji means fast, i.e., rapid), uniqueness in slowness indicates disease, uniqueness in heat indicates disease, uniqueness in cold indicates disease, uniqueness in depression indicates disease, and disharmony among Form and Qi indicates disease. Pulses of upper, lower, left, and right corresponding like pestle pounding in a mortar indicate severe disease (Can Chong refers to pulse being large, rapid, and pulsating, like a pestle pounding up and down). Flourishing form with fine pulse, shortness of breath indicating insufficiency of Qi indicates danger. Emaciated form with large pulse and excess Qi in the chest indicates death. Decreased observations in the middle position indicate death (decreased compared to upper and lower positions, also indicating Qi decline). Fluctuating frequency in the middle position indicates death (disorder of Qi). Even if the middle pulse is independently harmonious, loss of correspondence with other Zang organs indicates death (non-correspondence with upper and lower positions). Loss of correspondence among upper, lower, left, and right, uncountable, indicates death (more than ten beats per respiration). Loss of correspondence among all three positions and nine observations indicates death. Absence of pulse circulation indicates death (departure of Spirit). Sunken inner canthi indicate death (Taiyang pulse originates from the inner canthus; sunken inner canthus indicates Taiyang exhaustion). Bones protruding with immobile body indicate death (Qu means movement). Emaciated flesh and bones with harmonious nine observations still indicate death. Skin adhering to bone indicates death (desiccation of bone shaft) (sequentially excerpted from the chapter "Three Positions and Nine Observations").
Zhang Zhongjing said: If the Cun pulse does not reach down to the Guan position, it is Yang Extinction; if the Chi pulse does not reach up to the Guan position, it is Yin Extinction. Both are untreatable and certainly fatal. To calculate the remaining lifespan and timing of death, one must consider the elemental overcoming by monthly solar terms (Yang Extinction dies in Spring and Summer; Yin Extinction dies in Autumn and Winter; this speaks to their correspondence).