以脉主病而论∶则浮为风，紧为寒，虚为暑，濡为湿，数为燥，而脉火，此六淫应见之脉也。
喜伤心而脉散，怒伤肝而脉急，恐伤肾而脉沉，惊伤胆而脉动，思伤脾而脉短，忧伤肺而脉涩，悲伤心而脉
促，此七情受伤之脉也。脉之主病如是。（主病既明，则治自有定断。）
然总不越阴阳虚实为之条贯。盖脉之实者，其症必实（仍有寒实热实之分）；脉之虚者，其症
必虚（仍有火衰水衰之别）。若使脉实而症不实，非其所假在症，即其所假在脉也；脉虚而症不虚，非其所假
在脉，即其所假在症也。如外虽烦热而脉见微弱者，必火虚也。腹虽胀满而脉见微弱者，必胃虚也。虚火虚
胀，其堪取乎。此宜从脉之虚，不宜从症之实也。症即外寒而脉见滑数者，必假寒也。利即清水而脉见沉
实者，必假利也。假寒假利，其堪取乎。此宜从脉之实，不宜从症之虚也。然症实有假，而症虚无假。假
实者病症莫测，必须旁求他症，及以脉候，其假始出。若使症属虚候，其症即知。纵有假寒假利，貌若虚象
难明。然仔细考求，其寒止属外见，而内必有烦躁等症。利即清水，而内必有燥粪，其水止从旁流，脉必滑
数有力，仍与实脉实症相似，宁曰症有假虚，而脉可不深信哉。
凡此脉真无假，可以症应。若使专以脉求，而症竟不察识，则脉尚有难言者耳。何则？仲
景云∶伤寒脉浮大，邪在表，为可汗。若脉浮大，心下硬，有热属脏者攻之，不令发汗。此又非浮为表邪可
汗之脉也。又云∶脉促为阳盛，宜用干葛黄芩黄连汤。若脉促厥冷为虚脱，非灸非温不可。此又非促为阳盛
之脉也。又曰∶脉迟为寒，脉沉为里，若阳明脉迟不恶寒身体 汗出，则用大承气汤。此又非诸迟为寒之
脉矣。少阴病始得之反发热而脉沉，宜麻黄附子细辛汤微汗之。此又非沉为在里之脉矣。
从以脉象判断病证的角度来说：浮脉主风邪，紧脉主寒邪，虚脉主暑邪，濡脉主湿邪，数脉主燥邪，而洪脉（此处原文“脉火”疑为衍文或指代洪大之脉，结合语境及六淫对应，通常指洪脉主热/火，但原文仅写“脉火”，故直译为脉象表现为火热之象）主火热之邪，这是六种外感邪气应当出现的脉象。
喜悦过度会损伤心脏，导致脉象散乱；愤怒过度会损伤肝脏，导致脉象紧急；恐惧过度会损伤肾脏，导致脉象沉伏；惊吓过度会损伤胆腑，导致脉象动悸；思虑过度会损伤脾脏，导致脉象短促；忧愁过度会损伤肺脏，导致脉象涩滞；悲伤过度会损伤心脏，导致脉象急促。这是七情内伤所致的脉象。脉象对病证的指示作用就是这样。（既然明确了病证，治疗自然就有确定的决断。）
然而，总括起来，不离阴阳虚实作为纲领。凡是脉象实的，其症状必定也是实的（其中仍有寒实与热实的区别）；凡是脉象虚的，其症状必定也是虚的（其中仍有火衰与水衰的不同）。如果脉象实而症状不实，那么要么症状是假象，要么脉象是假象；如果脉象虚而症状不虚，那么要么脉象是假象，要么症状是假象。例如，体表虽然烦热，但脉象却微弱，这一定是阳气虚弱所致。腹部虽然胀满，但脉象却微弱，这一定是胃气虚弱所致。对于虚火和虚胀，怎么能按照实证来治疗呢？这种情况应当顺从脉象的虚证，而不宜顺从症状的实证。症状虽然表现为外寒，但脉象滑数，这一定是假寒证。腹泻虽然是清水样便，但脉象沉实，这一定是假利证。对于假寒和假利，怎么能按照虚证来治疗呢？这种情况应当顺从脉象的实证，而不宜顺从症状的虚证。然而，实证有假象，而虚证没有假象。所谓的假实证，病症难以揣测，必须旁求其他症状，并结合脉象诊察，其假象才会显露出来。如果是虚证候，其症状即可知晓。纵然有假寒和假利，表面看似虚象难以辨明。但是仔细考究，其寒冷只表现在外部，而内部必然有烦躁等症状。腹泻虽然是清水，但内部必然有燥结的粪便，清水只是从旁边流出，脉象必然滑数有力，仍然与实脉实证相似，怎能说症状有假虚，而脉象不可深信呢？
凡此种种，脉象真实无假，可以与症状相应。如果专门依据脉象求治，而完全不考察识别症状，那么脉象也就难以言说了。为什么呢？张仲景说：伤寒病脉象浮大，邪气在表，属于可以用发汗法治疗的。如果脉象浮大，心下硬满，且有热邪入里属脏者，应当用攻下法，不令发汗。这又不是浮脉代表表邪可汗之脉了。又说：脉象急促代表阳盛，适宜使用干葛黄芩黄连汤。如果脉象急促且四肢厥冷，属于虚脱证，非艾灸和非温补不可。这又不是促脉代表阳盛之脉了。又说：脉象迟代表寒，脉象沉代表里证。如果阳明病脉迟，但不恶寒、身体出汗，则使用大承气汤。这又不是所有迟脉都代表寒证的脉象了。少阴病初起，反而发热且脉沉，适宜使用麻黄附子细辛汤微发其汗。这又不是沉脉代表病在里的脉象了。
From the perspective of determining disease through pulse diagnosis: a floating pulse indicates Wind, a tight pulse indicates Cold, a deficient pulse indicates Summerheat, a soggy pulse indicates Dampness, a rapid pulse indicates Dryness, and a pulse reflecting Fire indicates Heat/Fire; these are the pulses corresponding to the six exogenous pathogens. Excessive joy damages the Heart, resulting in a scattered pulse; excessive anger damages the Liver, resulting in a tense pulse; excessive fear damages the Kidney, resulting in a deep pulse; excessive shock damages the Gallbladder, resulting in a trembling pulse; excessive thought damages the Spleen, resulting in a short pulse; excessive sorrow damages the Lung, resulting in a choppy pulse; excessive grief damages the Heart, resulting in an hurried pulse; these are the pulses resulting from injury by the seven emotions. Thus, the pulse indicates disease. (Once the disease is clearly identified, treatment decisions will naturally be determined.)
However, it all revolves around Yin and Yang, deficiency and excess as the guiding principles. Generally, if the pulse is excess, the symptoms must also be excess (distinguishing between cold-excess and heat-excess); if the pulse is deficient, the symptoms must also be deficient (distinguishing between fire-deficiency and water-deficiency). If the pulse is excess but the symptoms are not, either the symptoms are false or the pulse is false; if the pulse is deficient but the symptoms are not, either the pulse is false or the symptoms are false. For instance, although there is external vexation and heat, if the pulse is weak and faint, it must be due to Yang deficiency. Although there is abdominal distension and fullness, if the pulse is weak and faint, it must be due to Stomach Qi deficiency. How can one treat deficiency-fire or deficiency-distension as excess? In such cases, one should follow the deficiency indicated by the pulse, rather than the excess indicated by the symptoms. If the symptoms present as external cold, but the pulse is slippery and rapid, it must be false cold. If there is diarrhea with clear water, but the pulse is deep and solid, it must be false diarrhea. How can one treat false cold or false diarrhea as deficiency? In such cases, one should follow the excess indicated by the pulse, rather than the deficiency indicated by the symptoms. However, while excess patterns can have false manifestations, deficiency patterns do not have false manifestations. False excess patterns are unpredictable; one must seek other symptoms and correlate them with pulse findings to reveal the falsehood. If the pattern belongs to deficiency, the symptoms are evident. Even if there is false cold or false diarrhea, appearing superficially as deficiency, careful examination reveals that the cold is only external, while internally there are symptoms like vexation. The diarrhea of clear water occurs because dry stool is retained internally, and the water flows around it; the pulse will be slippery, rapid, and forceful, resembling excess pulse and excess symptoms. How can one say that symptoms have false deficiency, while the pulse cannot be trusted?
In all these cases, the pulse is true and without falsehood, corresponding to the symptoms. If one relies solely on the pulse for treatment without observing and identifying the symptoms, then the pulse becomes difficult to interpret. Why? Zhang Zhongjing stated: In cold damage, a floating and large pulse indicates pathogenic factors at the exterior, which can be treated with sweating methods. However, if the pulse is floating and large, accompanied by hardness below the heart and heat indicating involvement of the zang organs, purgation should be used, not sweating. This shows that a floating pulse does not always indicate exterior pathogen suitable for sweating. He also stated: A hurried pulse indicates flourishing Yang, suitable for using Ge Gen Huang Qin Huang Lian Tang. However, if the pulse is hurried accompanied by cold limbs, it indicates collapse of deficiency, requiring moxibustion and warming methods. This shows that a hurried pulse does not always indicate flourishing Yang. Furthermore, he stated: A slow pulse indicates cold, and a deep pulse indicates interior syndrome. However, in Yangming disease, if the pulse is slow but there is no aversion to cold and the body sweats, Da Cheng Qi Tang should be used. This shows that not all slow pulses indicate cold. In Shaoyin disease, if fever appears initially with a deep pulse, Ma Huang Fu Zi Xi Xin Tang should be used to induce slight sweating. This shows that a deep pulse does not always indicate interior syndrome.