革则弦大而数，浮取强直，而按则中空。凡芤牢紧脉，皆属此类。不似紧脉按之劈劈，弦脉按
之不移，牢脉按之益坚也。（语出张璐。又濒湖体状诗曰∶革脉形如按鼓皮，芤弦相合脉寒虚；女人半产并崩
漏，男子营虚或梦遗。）革为变革之象。凡亡血失精，肾气内惫，或虚寒相搏，故脉少和柔，而有中空之状。
若不固肾补精，舒木除寒，而以革浮属表，妄用升发，其不真阴告绝者鲜矣。（仲景曰∶弦则为寒，芤则为虚，
寒虚相搏，此名曰革，男子亡血失精，妇人半产漏下。经曰∶三部脉革，长病得之死，卒病得之生。）
牢则弦大而长，按之强直搏指，状如弦缕。凡实伏弦涩，皆属此类。不似实脉之滑实流利，伏脉
之慝伏涩难。革脉之按之中空也。（语出张璐。又濒湖诗曰∶弦长实大脉来坚，牢位常居沉伏间；革脉芤弦自
浮起，革虚牢实要详看。沈氏曰∶似沉似伏，牢之位也；实大弦长，牢之体也。牢脉不可混于沉
脉伏脉，须细辨耳。沉脉如绵裹沙，内刚外柔，然不必兼大弦也。伏脉非推筋至骨不见其形。在于牢脉既实大
弦长，才重按之，便满指有力，以为别耳。）牢为坚积内着，胃气将绝之候。（吴草庐曰∶牢为寒
实，革为虚寒。）故或见为湿 拘急，寒疝暴逆，坚积内伏，治甚非易。倘不审其所因，而谓牢为内实，用以
苦寒，或因思食而以濡滞恣啖，则其病益固矣。（李时珍曰∶牢主寒实之病，木实则为痛。扁鹊云∶软为虚，牢
为实。失血者脉宜沉细，反浮大而牢者死，虚病见实脉也。张仲景曰∶寒则牢固。有坚固之义。）
革脉的脉象特征是弦、大且数，轻取时感觉强直，重按时则中间空虚。凡是芤脉、牢脉、紧脉，都属于这一类脉象范畴。它们不像紧脉那样重按时有弹击感（劈劈），也不像弦脉那样重按时位置固定不移，更不像牢脉那样重按时越发坚硬。（这段话出自张璐。另外李时珍在《濒湖脉学》中描述道：革脉的形状如同按压鼓皮，兼具芤脉和弦脉的特点，主寒证与虚证；女性出现半产或小产及崩漏症，男性出现营血亏虚或梦遗。）革脉象征着变革之象。凡是失血或精气耗损，肾气内部疲惫，或者虚邪与寒邪相互搏结，导致脉象缺少柔和之态，而呈现出中间空虚的状态。如果不固护肾脏、补益精气，疏泄肝木并驱除寒邪，反而将革浮脉误认为是表证，妄用升提发散的药物治疗，那么真阴枯竭告绝的情况就很少能避免了。（张仲景说：弦脉主寒，芤脉主虚，寒与虚相互搏结，这种脉象称为革脉；男子出现失血或失精，女子出现小产或漏下。医经记载：三部脉都呈现革象，久病者得此脉预后不良会死亡，急病者得此脉尚有生机。）
牢脉的脉象特征是弦、大且长，重按时感觉强直有力冲击手指，形状如同弦线一般。凡是实脉、伏脉、弦脉、涩脉，都属于这一类脉象范畴。它们不像实脉那样滑利充实流畅，也不像伏脉那样隐匿潜伏、涩滞难寻，更不像革脉那样重按时中间空虚。（这段话出自张璐。另外李时珍的诗中说道：弦、长、实、大，脉来坚实，牢脉通常位于沉脉和伏脉之间；革脉由芤脉和弦脉结合而从浮位起现，革脉属虚、牢脉属实，需要仔细辨别。沈氏说：似沉似伏，这是牢脉的位置特征；实、大、弦、长，这是牢脉的形态特征。牢脉不能混淆于沉脉和伏脉，必须仔细分辨。沉脉像棉絮包裹沙子，内刚外柔，但未必兼有大的弦象。伏脉不是推筋至骨就看不见其形。而在牢脉中，既然具备实、大、弦、长的特点，才重按时，便满指有力，以此作为区别罢了。）牢脉象征着坚积内着，是胃气即将断绝的征候。（吴草庐说：牢脉主寒实证，革脉主虚寒证。）所以有时表现为湿邪导致的拘挛紧急，寒疝突然逆上，坚积潜伏在内，治疗非常困难。如果不审察病因，认为牢脉是内实，从而使用苦寒药物，或者因为想吃东西而任由饮食滋腻停滞，那么病情就会更加顽固难愈。（李时珍说：牢脉主治寒实性质的疾病，肝木实盛则产生疼痛。扁鹊说：软脉主虚，牢脉主实。失血病人的脉象应当沉细，如果反而出现浮大而牢的脉象则是死证，这是虚病出现了实脉。张仲景说：寒邪会导致脉象牢固。这里有坚固的含义。）
The pulse characteristics of Ge (Reed) pulse are wiry, large, and rapid. Upon light palpation, it feels rigid; upon heavy pressure, the center is empty. Kou (Hollow), Lao (Deep-firm), and Jin (Tight) pulses all belong to this category. They differ from Jin pulse, which feels like striking a drum when pressed; from Xian (Wiry) pulse, which remains fixed in position when pressed; and from Lao pulse, which becomes harder upon pressing. (This passage is attributed to Zhang Lu. Additionally, Li Shizhen's poem in *Binhu Maixue* states: "Ge pulse feels like pressing on a drumhead, combining Kou and Xian qualities, indicating cold and deficiency; women may experience miscarriage or metrorrhagia, while men may suffer from Ying blood deficiency or nocturnal emission.") Ge pulse symbolizes transformation. It occurs in cases of blood loss or essence depletion, internal exhaustion of Kidney Qi, or the interplay of deficiency and cold, resulting in a lack of softness and an empty center. If one fails to tonify the Kidneys and replenish essence, soothe the Liver Wood, and dispel cold, but instead misinterprets the floating nature of Ge pulse as an exterior syndrome and recklessly uses ascending and dispersing methods, true Yin will likely be exhausted. (Zhang Zhongjing stated: "Xian indicates cold, Kou indicates deficiency. The interplay of cold and deficiency is named Ge pulse. In men, it manifests as blood loss or essence depletion; in women, as miscarriage or uterine bleeding." The Classics state: "If the pulses in all three positions are Ge, patients with chronic illness will die, whereas those with acute illness may survive.")
Lao pulse is characterized by being wiry, large, and long. Upon heavy pressure, it feels rigid and forceful against the fingers, resembling a string. Shi (Solid), Fu (Hidden), Xian (Wiry), and Se (Choppy) pulses fall into this category. They differ from Shi pulse, which is slippery, solid, and smooth; from Fu pulse, which is hidden and choppy, difficult to detect; and from Ge pulse, which is empty in the center upon heavy pressure. (This passage is attributed to Zhang Lu. Li Shizhen's poem notes: "Wiry, long, solid, and large, the pulse comes firm; Lao pulse usually resides between Shen and Fu positions. Ge pulse arises from the combination of Kou and Xian at the superficial level; one must carefully distinguish between the deficiency of Ge and the excess of Lao." Shen stated: "Resembling Shen and Fu, this is the location of Lao; solid, large, wiry, and long, this is the form of Lao. Lao pulse must not be confused with Shen or Fu pulses; careful differentiation is required. Shen pulse is like sand wrapped in cotton—firm inside, soft outside—but does not necessarily combine with large or wiry qualities. Fu pulse is not visible unless pushed to the bone. In contrast, Lao pulse, possessing solid, large, wiry, and long qualities, feels fully powerful under the fingers upon heavy pressure, serving as the distinction.") Lao pulse signifies deep-seated accumulation and is a sign that Stomach Qi is about to perish. (Wu Caolu stated: "Lao indicates cold-excess, while Ge indicates deficiency-cold.") Consequently, it may manifest as stiffness and urgency due to dampness, sudden reversal of cold hernia, or deep-seated hard accumulations, making treatment very difficult. If the underlying cause is not examined, and Lao pulse is mistaken for interior excess, leading to the use of bitter-cold herbs, or if dietary indulgence due to appetite causes stagnation, the disease will become more entrenched. (Li Shizhen stated: "Lao governs cold-excess diseases; Liver Wood excess leads to pain. Bian Que said: 'Soft indicates deficiency, Lao indicates excess.' In cases of blood loss, the pulse should be deep and fine; if it reverses to floating, large, and Lao, it is a death omen, representing an excess pulse appearing in a deficiency condition." Zhang Zhongjing stated: "Cold makes the pulse firm/secure," implying solidity.)