即书有言病症虚实，止在脉之有力无力，以为辨别。（有力即属有根。难经曰∶上部有脉，
下
部无脉，其人当吐，不吐者死。上部无脉，下部有脉，虽困不害。所以然者，人之有尺犹树之有根，有根则不
死。无力即属无根。难经曰∶寸口脉平而死者，生气独绝于内也。平即中馁不能创建之象，故曰死。）
然试问其脉与症异，脉见坚劲有力，症见腹痛喜按，呕逆战栗，其脉可作有余而用苦寒泻实之药乎。脉见虚
软无力，症见腹满喘急痰鸣，其脉可作不足而用附桂理中之药乎。且脉所鼓在气，而气动而不守，保无气
自寒生，而气因寒而始振乎。脉之虚软在湿，而湿滞
而不动，保无热挟湿至，而脉因痰因湿而始软乎。（有力多因寒气热气内鼓，但今人仅知热气内结为实，而不
知有寒气内结为实也。无力多因寒湿热湿内软，但今人仅知寒湿为痰为虚，而不知热湿为痰为实也。凡此当以
望闻问数字并参。）
夫望闻问切，乃属医家要事。若仅以脉为诊，而致以寒为热，以热为寒，以表为里，以里为
表，颠倒错乱
，未有不伤人性命者矣。况经所云脉浮为风，为虚，为气，为呕，为厥，为痞，为胀，为满不食，为热内结，
类皆数十余症。假使诊脉得浮，而不兼以望闻问以究其真，其将何以断病乎。是以善诊脉者，于人禀赋浓薄，
（或禀浓而纯阳，或禀薄而纯阴。或禀不浓不薄而平。）形体肥瘦，（汇辨云∶肥盛之人气居于表，六脉常带浮
洪；瘦小之人气敛于中，六脉常带沉数。身长之人下指宜疏，身短之人下指宜密。北方之人常见强实，南方之
人常见软弱。少壮之人脉多大，老年之人脉多虚。醉后之脉常数，饮后之人常洪。室女尼姑多濡弱，婴儿之脉
常七至。又曰∶此道形气之常，然形气之中，又必随地转移，方能尽言外之妙也。）颜色枯润，（或枯而竭，
或润而和。）声音低昂，（或音低小而微，知其体阴病阴；或声高昂而壮，知其体阳病阳。）性情刚柔，（或刚
主阳，或柔主阴。汇辨云∶性急之人，五至方为平脉；性缓之人，四至便作热医。）饮食嗜好，（或喜气浓之
物，而知阳虚；或喜味浓之物，而知阴弱。）及平日脉象偏纯，（或脉体偏静而见六阴之脉，或脉体偏动
而见六阳之脉。或脉体不动不静而见至平之脉。仁斋曰∶阳脉虽病在寒，常见浮洪；阴脉虽病在热，常见微细。）
与今所患病症，是新是旧，（或新由于外感，其脉疾数洪大；或旧由于内伤，其脉细小短涩。）
是内是外，（或在外感属表易治，或在内伤属里难治。）是阴是阳，（或阳主表、主上、主气，主火，或阴主
里、主下、主血、主水。）并经医士是否药坏，（或假寒而用热药以坏，假热而用寒药以坏；或标病而
用本药以坏，本病而用标药以坏之类。）靡不细为详审。（要法真在此处。但今病家多不由医细察。宗 曰∶
素问言凡治病，察其形气色泽。观人勇怯骨肉皮肤，能知其情，以为诊法。若患人脉病不相应，既
不得见其形，医止据脉供药，其可得乎。今豪富之家，妇人居帏幔之内，复以帛蒙手臂。既无望色之神，听声
之圣，又不能尽切脉之巧，未免详问。病家厌繁，以为术疏，往往得药不服。是四诊之术，不得其一矣，可
谓难也。呜呼！）然后合于所诊脉象，以断病情，以定吉凶。（断要通盘会计，又要得其主脑。切勿头痛断头，
脚痛断脚。）如果病属有余，其脉应见浮洪紧数；若使其脉无神，或反见沉微细弱，便非吉矣。病属不足，其
脉应见沉微细弱；若使其脉鲜胃，或反见洪大数急，则非吉矣。推之暴病脉应见阳，久病脉应见阴，亦何莫不
应与病相符，而始可言顺矣。（灵枢动输篇云∶阳病而阳脉小者为逆，阴病而阴脉大者为逆。）
书中提到，病症的虚实辨别，往往仅凭脉象的有力或无力来判断。（有力即属于有根。《难经》说：上部有脉，下部无脉，病人应当呕吐，如果不呕吐则死亡。上部无脉，下部有脉，虽然病重但无大碍。之所以这样，是因为人的尺脉就像树木的根部，有根就不会死。无力即属于无根。《难经》说：寸口脉看似平和却导致死亡的，是生机在内完全断绝了。所谓“平”，是指中气虚弱、不能生发建起的征象，所以判定为死。）
然而试问，如果脉象与症状不一致，脉象表现为坚硬强劲有力，而症状表现为腹痛且喜欢按压，伴有呕吐逆气、寒战发抖，这种脉象能当作实证有余，从而使用苦寒泻实的药物吗？如果脉象表现为虚软无力，而症状表现为腹部胀满、气喘急促、痰鸣音响，这种脉象能当作虚证不足，从而使用附子、肉桂、理中汤类的温补药物吗？况且脉象的鼓动源于气，而气是流动而不静止的，怎能保证不是寒气内生，导致气因寒冷刺激才开始振奋呢？脉象的虚软源于湿，而湿气停滞而不流动，怎能保证不是热邪挟带湿气到来，导致脉象因痰湿阻滞才开始变得柔软呢？（脉象有力多因寒气或热气在体内鼓动所致，但如今的人只知道热气内结为实证，却不知道寒气内结也可形成实证。脉象无力多因寒湿或湿热在体内使脉道松弛所致，但如今的人只知道寒湿导致痰饮和虚证，却不知道湿热也可导致痰饮和实证。所有这些情况都应当结合望、闻、问三诊来综合参详。）
望、闻、问、切四诊，是医生诊疗的重要事务。如果仅仅依靠脉诊，而导致将寒证误认为热证，将热证误认为寒证，将表证误认为里证，将里证误认为表证，造成颠倒错乱，没有不危及患者性命的了。况且经典中所说脉浮可能对应风邪、虚证、气滞、呕吐、厥逆、痞证、胀满、食不下、热邪内结等数十种症状。假如诊得脉浮，却不结合望、闻、问来探究疾病的真相，那将如何判断病情呢？因此，善于诊脉的人，会考察患者的先天禀赋厚薄，（有的禀赋厚实而纯阳，有的禀赋薄弱而纯阴，有的禀赋不厚不薄而平和。）形体肥瘦，（《汇辨》说：肥胖之人气行于体表，六脉常带有浮洪之象；瘦小之人气敛于体内，六脉常带有沉数之象。身材高的人下指宜疏，身材矮的人下指宜密。北方人常见脉象强实，南方人常见脉象软弱。年轻力壮的人脉大多较大，老年人脉多虚软。醉酒后脉象常数，饮酒后脉象常洪大。处女和尼姑的脉多濡弱，婴儿的脉常七至。又说：这是形气的常态，但在形气之中，又必须随地域不同而转移变化，才能尽言外之妙。）面色枯润，（有的干枯枯竭，有的润泽调和。）声音高低，（有的声音低微细小，可知其体质属阴、病属阴；有的声音高昂壮盛，可知其体质属阳、病属阳。）性情刚柔，（有的刚强主阳，有的柔和主阴。《汇辨》说：性情急躁的人，五至才算是平脉；性情缓慢的人，四至便被视为热证。）饮食嗜好，（有的喜好气味浓烈的食物，可推知阳气虚弱；有的喜好味道浓重的食物，可推知阴液薄弱。）以及平日脉象的偏颇纯杂，（有的脉体偏静而呈现六阴之脉，有的脉体偏动而呈现六阳之脉，有的脉体不动不静而呈现至极平和之脉。仁斋说：阳脉即使病在寒证，也常见浮洪；阴脉即使病在热证，也常见微细。）与现在所患疾病的新旧，（有的新病由于外感，脉象疾数洪大；有的旧病由于内伤，脉象细小短涩。）病位是在内还是在外，（有的在表属外感易治，有的在里属内伤难治。）属性是阴还是阳，（阳主表、主上、主气、主火；阴主里、主下、主血、主水。）以及之前的医生是否用药失误，（有的假寒证用热药治坏，假热证用寒药治坏；有的标病用本药治坏，本病用标药治坏之类。）无不进行详细审慎的分析。（关键方法就在这里。但现在的病人大多不要求医生仔细察诊。宗氏说：《素问》讲凡是治病，要观察病人的形气色泽。看人的勇敢怯懦、骨肉皮肤，能了解其情状，以此作为诊法。如果病人的脉象与病情不相符合，既然无法看到其形体，医生只根据脉象提供药物，这可以吗？现在富贵人家，妇女躲在帷幔之内，又用丝帛蒙住手臂。既没有望色的神目，听声的圣耳，又不能尽切脉的技巧，未免需要详细询问。病人家属厌烦繁琐，认为医术疏漏，往往拿到药也不服用。这就是四诊之术，不得其一，可以说是很难啊。唉！）然后结合所诊得的脉象，来判断病情，决定吉凶。（判断要通盘考虑，又要抓住主要矛盾。切勿头痛医头，脚痛医脚。）如果病属实证有余，脉象应见浮洪紧数；如果脉象无神，或者反而出现沉微细弱，就不是吉兆。如果病属虚证不足，脉象应见沉微细弱；如果脉象缺乏胃气，或者反而出现洪大数急，也不是吉兆。推而言之，暴病脉象应见阳脉，久病脉象应见阴脉，也都应该与病情相符，这才可以说顺证。（《灵枢·动输篇》说：阳病而阳脉小的是逆证，阴病而阴脉大的是逆证。）
The text states that the differentiation of deficiency and excess in diseases is often based solely on whether the pulse is forceful or feeble. (Forcefulness indicates the presence of "root" vitality. The *Nan Jing* [Classic of Difficult Issues] says: If there is a pulse at the upper part but none at the lower part, the patient should vomit; if they do not vomit, death ensues. If there is no pulse at the upper part but there is one at the lower part, although the condition is severe, it is not fatal. This is because the Chi pulse [pulse felt at the wrist corresponding to the Kidneys] in humans is like the roots of a tree; as long as there are roots, death does not occur. Feebleness indicates the absence of root vitality. The *Nan Jing* says: If the Cun Kou pulse [radial artery pulse] appears level yet leads to death, it means the vital energy [Sheng Qi] is completely severed internally. "Level" here refers to an image of middle Qi deficiency and inability to generate, hence it is judged as death.)
However, consider cases where the pulse and symptoms contradict each other. If the pulse appears hard, strong, and forceful, while the symptoms include abdominal pain relieved by pressure, vomiting with counterflow qi, and shivering/chills, can this pulse be treated as an excess syndrome, thereby using bitter-cold herbs to purge excess? Conversely, if the pulse appears empty, soft, and feeble, while the symptoms include abdominal fullness, panting, and phlegm rales, can this pulse be treated as a deficiency syndrome, thereby using warming and tonifying formulas containing Aconite [Fuzi], Cinnamon Twig [Guizhi], or Lizhong Decoction [Belly Center Regulating Decoction]? Furthermore, the pulsation of the pulse originates from Qi, which flows and does not remain static. How can we ensure that cold qi has not generated internally, causing the Qi to stir only due to the stimulation of cold? The softness of the pulse stems from Dampness, which stagnates and does not move. How can we ensure that heat pathogen carrying dampness has not arrived, causing the pulse to become soft due to obstruction by Phlegm-Dampness? (Pulse forcefulness is often caused by internal stirring of cold or heat pathogens. However, people today only know that internal accumulation of heat constitutes excess, failing to realize that internal accumulation of cold can also constitute excess. Pulse feebleness is often caused by internal relaxation of the vessels due to cold-damp or heat-damp. However, people today only know that cold-damp leads to Phlegm and deficiency, failing to realize that heat-damp can also lead to Phlegm and excess. All such situations must be analyzed in conjunction with Observation, Auscultation-Olfaction, and Inquiry.)
Observation, Auscultation-Olfaction, Inquiry, and Palpation constitute the essential matters for physicians. If diagnosis relies solely on palpation, leading to misidentifying cold as heat, heat as cold, exterior as interior, or interior as exterior, resulting in chaotic reversal, it will inevitably endanger the patient's life. Moreover, classics state that a floating pulse may correspond to wind, deficiency, qi stagnation, vomiting, jue [cold extremities/reversal], pi [glomus/fullness], distension, inability to eat, or internal heat accumulation, among dozens of symptoms. If a floating pulse is detected without combining observation, auscultation-olfaction, and inquiry to investigate the truth, how can the disease be diagnosed? Therefore, those skilled in pulse diagnosis examine the patient's innate constitution thickness [vitality reserve], (some have thick constitution and pure Yang, some have thin constitution and pure Yin, some have average constitution and balance.), body fatness or leanness, (Hui Bian [Compendium of Differentiation] states: In obese individuals, Qi resides at the surface, and the six pulses often carry a floating and flooding quality; in slender individuals, Qi is contained within, and the six pulses often carry a deep and rapid quality. For tall persons, finger placement should be spaced widely; for short persons, closely. People from the North often show strong and solid pulses; people from the South often show weak and soft pulses. Young and vigorous people often have larger pulses; elderly people often have deficient pulses. After drunkenness, pulses are often rapid; after drinking alcohol, pulses are often flooding. Virgins and nuns often have soggy and weak pulses; infants' pulses are often seven beats per breath. It is also said: These are the norms of form and Qi, but within form and Qi, one must adapt to geographical changes to fully grasp the subtleties beyond words.) complexion dryness or luster, (either dry and exhausted, or moist and harmonious.) voice pitch and volume, (low and faint voice indicates Yin constitution and Yin disease; loud and robust voice indicates Yang constitution and Yang disease.) temperament rigidity or flexibility, (rigidity governs Yang, flexibility governs Yin. Hui Bian states: For irritable people, five beats per breath is the normal pulse; for slow-tempered people, four beats per breath may indicate heat.) dietary preferences, (preference for strongly aromatic foods suggests Yang deficiency; preference for strongly flavored foods suggests Yin weakness.) and habitual pulse characteristics, (pulse body leaning towards stillness showing Six Yin pulses; leaning towards movement showing Six Yang pulses; neither moving nor still showing extremely balanced pulses. Ren Zhai states: Even if the disease is cold, Yang pulses often appear floating and flooding; even if the disease is heat, Yin pulses often appear minute and fine.) along with the newness or chronicity of the current illness, (new illnesses due to external contraction often present with rapid, flooding, and large pulses; old illnesses due to internal injury often present with minute, short, and choppy pulses.) whether the pathology is internal or external, (external contraction belongs to the exterior and is easier to treat; internal injury belongs to the interior and is harder to treat.) whether the nature is Yin or Yang, (Yang governs exterior, upper, Qi, and Fire; Yin governs interior, lower, Blood, and Water.) and whether previous physicians caused harm through medication errors, (e.g., treating false cold with hot herbs, or false heat with cold herbs; treating branch symptoms with root-targeting drugs, or root symptoms with branch-targeting drugs, etc.), all of which require meticulous scrutiny. (This is the crucial method. However, patients today rarely request detailed examination by physicians. Zong stated: The Su Wen [Basic Questions] says that in treating any disease, one must observe the patient's form, Qi, color, and luster. Observing courage or timidity, bones, flesh, and skin allows one to understand their condition as a diagnostic method. If a patient's pulse and disease are inconsistent, and since one cannot see their form, relying solely on the pulse to prescribe medication—is this acceptable? Now, in wealthy households, women hide behind curtains and cover their arms with silk. Lacking the divine eye for observing color and the holy ear for hearing sounds, and unable to master the skill of palpation fully, detailed inquiry becomes necessary. Patients' families find this tedious, suspecting medical negligence, and often refuse the prescribed medicine. Thus, one fails to utilize the Four Diagnostic Methods, which is indeed difficult. Alas!) Only then, combining the diagnosed pulse image, can one judge the disease condition and determine auspiciousness or inauspiciousness. (Judgment requires a comprehensive assessment and grasping the main issue. Do not merely treat the head for head pain or the foot for foot pain.) If the disease is excess, the pulse should appear floating, flooding, tight, or rapid; if the pulse lacks Shen [spirit/vitality] or instead appears deep, minute, fine, or weak, it is not auspicious. If the disease is deficiency, the pulse should appear deep, minute, fine, or weak; if the pulse lacks Wei Qi [stomach Qi/nourishing quality] or instead appears flooding, large, rapid, or urgent, it is not auspicious. Extending this logic, acute diseases should present with Yang pulses, and chronic diseases with Yin pulses; all should correspond to the disease to be considered smooth/ favorable. (The Ling Shu [Spiritual Pivot] chapter Dong Shu states: Yang disease with small Yang pulses is adverse; Yin disease with large Yin pulses is adverse.)