右手〔命〕（肾）脉三指下。五十动足不须怕。一十九动默然沉。有死无生命绝也。指下急急动
如弦。肾脏有风犹且治。七动沉沉更不来。努力今朝应是死。
〔一〕浮者阳也。指下〔寻〕（按）之不足。举之有余。〔再再寻之如太过〕（脉在肉上行）曰浮。
主咳嗽气促。冷汗自出。背膊劳倦。夜卧不安。
脉诀曰。如太过曰浮。既曰举之有余矣。如何而太过。曰太过。则浮洪浮紧浮弦之脉。如何诊之。
脉经并无如太过之文。又寻与按不同。按者重手于肌肉筋骨部也。寻则或上或下。或左或右。随脉
部以寻之。浮脉按之不足。非寻之不足也。
按之不足举之余。再再寻之指下浮。脏中积冷荣中热。欲得生精用补虚。
寸浮中风头热痛。关浮腹胀胃虚空。尺部见之风入肺。大肠干涩故难通。
〔二〕芤者阳也。〔指下寻之两头即有中间全无〕（举之。浮大而软。按之。两边实。中间虚。）
曰芤。〔主淋沥气入小肠〕（主失血。）
芤、草名。其叶类葱。中心虚空。故以指按芤草叶。喻失血之脉。芤之名不见于内经。又曰安卧脉
盛。谓之脱血。至仲景伤寒论曰。脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。虚寒相搏。
此名为革。亦未尝以芤为定名。但附见于革。至王叔和始立芤脉。脉经曰。芤脉。其象两边似有。
中间全无。今脉诀乃曰。两头则有。中间全无。则误矣。夫尺脉上不至关为阴绝。寸口下不至关为阳绝。
若两头似有。中间全无。则是阴阳绝脉也。安得为芤脉乎。经曰。营行脉中。是血在脉中行。脉以血
为形。血盛则脉盛。血虚则脉虚。故芤脉中空者。血之脱也。芤脉。先举指时浮大而软。因按而中空。
今脉诀首言指下寻之。非也。仲景曰。脉浮而紧。按之反芤。其人本虚。若浮而数。按之不芤。此人本
不虚。是皆于按上以见芤脉。寻者在浮举沉按之间耳。下仿此。
指下寻之中且虚。邪风透入小肠居。患时〔淋沥〕（尿血）兼疼痛。大作汤丸必自除。
诸家论芤皆为失血之诊。今曰邪风入小肠而淋沥。非其证也。盖是尿血之证矣。
寸芤积血在胸中。关内逢芤肠里痈。尺部见之虚在肾。小便遗沥血凝脓。
〔三〕滑者阳也。〔指下寻之三关如珠动按之即伏不进不退〕（往来前却。流利展转。替替然与数珠
相似。应指圆滑。又曰漉漉如欲脱。）曰滑。主肢体困弊。脚手酸痛。小便赤涩。
脉经曰。轻手得之为浮滑。重手得之为沉滑。其象往来流利。应指圆滑。若珠之隐指。今脉诀曰。
按之即伏。不进不退。则是有浮滑而无沉滑也。经曰。一阴一阳者。谓脉来沉而滑也。是沉中亦有滑也。故王裳
言脉诀论表不及里也。且脉有独见于一部者。有通三部见者。今曰三关如珠动。非也。按之即伏。
不进不退。则是脉不往来而定。岂所谓滑乎。今取脉经所载。而去其浮中而有力之语。盖此语只言浮滑。
亦一偏之言。夫血多则脉滑。滑之本体也。若气血和顺。其动不涩不急不缓。和滑之脉。为不病。
妇人为妊子。今若曰滑为阳为病热为实。则此滑字。当带数及小实言之。大抵此脉诀言脉之形状。
往往未当。今据经改正之。而脉下所主之证。多与本脉不类。改之则不胜改。姑置之可也。
滑脉如珠动曰阳。腰中生气透前肠。胫酸只为生寒热。大泻三焦必得康。
滑脉寸居多呕逆。关滑胃〔寒〕（热）不下食。尺部见之〔脐似冰〕（热下焦。）〔饮水下焦声
沥沥〕（月信不通尿血涩。）
前脾脏歌云。单滑脾家热。今云胃寒不下食。何也。脉经曰。关滑。胃中有热。又云中实逆滑为
热实。故不欲食。食即吐逆。可明为热。池氏谬言肝木克脾土。致寒弦为肝脉。滑岂肝脉乎。
脉经曰。尺滑下利少气。脉赋解义云。男子尺滑。主膀胱冷气。小腹急胀。便漩利数。又云尺滑。
主胞络极冷。月经不调。直以滑脉为阴。主冷。不当。不若脉经所谓尺滑。血气实。妇人经脉不利。
男子尿血为得。今脉诀云。脐似冰。则滑为阴证。又曰饮水。则滑为阳热。又曰沥沥作声。则滑为
停水之证。既言冷又言热。不知何谓。今正之。
〔四〕实者阳也。〔指下寻之不绝举之有余〕（浮中沉三候皆有力）曰实。主伏阳在内。脾虚不食。
肢体劳倦。柳氏曰。实者气结不通。欠疏快意。上部实。则气壅。下部实。则气胀。中部实。中脘不快。
素问曰。气来实
强。是谓太过。病在外。气来虚微。是谓不及。病在内。此表里虚实之诊也。今脉实而曰脾虚。未敢信。
实脉〔寻之举〕（浮沉皆）有余。伏阳蒸内致脾虚。食少只缘生胃壅。温和汤药乃痊除。
举有余。止言浮实。故改之。
实脉关前胸热甚。当关切痛中焦恁。尺部〔如绳应指来〕（当为下痢疼。）腹胀小便〔都〕（淋）不〔禁〕（忍）。
如绳。非实脉之比。乃紧脉也。故改之。脉经曰。尺实小腹痛。小便不禁。又云小便难。少腹
牢痛。盖气来实强者。太过之脉。与淋沥相应。若云小便不禁。则膀胱不固。水泉不止。为下焦剧
寒之证矣。脉经用当归汤加大黄。盖因热而用也。小便不禁。必传写之误。后云小便难者是也。洁古于此。一
用姜附。一用承气。为两可之辞。将以为寒乎。以为热乎。
愚按洁古药注脉诀及难经。皆他人托之洁古。必非此翁之书。
〔五〕弦者阳也。〔指下寻之不足举之有余状若筝弦时时带数〕（端直以长。如弦隐指。）曰弦。
主劳风乏力。盗汗多出。手足酸疼。皮毛枯槁。
指下左右皆无。从前中后直过。挺然于指下。曰弦。此血气收敛不舒之候。脉诀以弦为阳。伤寒论
以弦为阴。脉赋解义亦云弦滑虽属七表。皆主于阴。活人书云。若弦而洪数者为阳。弦疾而沉且微细者为
阴。主拘急。以愚观之。经曰阴中之阳肝也。当为半阴半阳之脉。脉诀曰。指下寻之不足。举之有余。则是
有浮弦而无沉弦也。经曰。脉沉而弦者。主悬饮内痛。是沉中亦有弦。又曰时时带数。则是弦数二脉相
兼。非单弦脉也。素问曰。气来 弱。轻虚以滑。端直以长。曰弦。今不取轻虚以滑。恐有弦数
弦迟兼他脉之诊。故止以弦本状。端直以长为弦。然有弦而细。有弦而粗。看在何部。弦而 其病轻。
弦而硬其病重。大率弦脉急强。血气不和之所生也。又有偏弦双弦之诊。
〔弦脉为阳〕（端直以长）状若弦。四肢更被气相煎。三度〔解〕（温）劳风始退。常须固济下丹田。
弦浮数大四者皆劳也。大者易治。脉气未衰。可敛而正也。弦者难治。血气已耗而难补。双弦则
贼邪侵脾。尤为难治。加数则殆矣。内经曰。劳者温之。不可用解。
〔寸部脉紧一条弦胸中急痛状绳牵关中有弦寒在胃下焦停水满丹田〕（寸弦头痛胸中痛。左关
癖痛挛拘。右关有饮寒留胃。尺弦腹痛腰脚拘。）
既歌弦脉。又言脉紧。非也。此歌脉证未是未尽。今改作。脉经曰。寸弦。心下 。微头痛。
心下有水气。一云。胸中拘急。关弦胃寒。心下厥逆。一云心下拘急。此胃气虚故尔。尺弦。小便痛。
小腹及脚中拘急。一云脐下拘急。
〔六〕紧者阳也。〔指下寻之三关通度按之有余举指甚数状如洪弦〕（来往有力。左右弹人手。既
如转索。又如切绳。）
曰紧。主风气。伏阳上冲。化为狂病。
内经、难经。未言紧也。内经曰急不曰紧。曰来而左右弹人手。有紧脉之状。未有紧脉之名。至仲
景曰紧者如转索无常。又曰紧脉从何而来。假令亡汗若吐。以肺里寒。假令咳者。坐饮冷水。假令下利。以胃中
虚冷。皆因寒而脉紧。故脉急为寒。诸紧为寒至。王叔和脉经。则又增如切绳状。故愚合三书所论以形
容之。左右弹人手者。紧脉来之状。左右弹人手也。转索无常者。索之转动。不常在一处。或紧转
在左。或紧转在右。此举指而得紧脉之状也。切绳状者。绳以两股三股纠合为徽缠。又以物切之。其展
转之紧。得之于按指而见。以指按脉。犹如切绳。合此三者论之。方备。脉经曰。重手得之为沉紧。
轻手得之为浮紧。故咳嗽之脉沉紧则死。中恶之脉浮紧则死。今脉诀曰。状若洪弦。此误也。紧为寒为痛。
弦为寒为饮。洪为气为热。主疾既殊。治之亦异。一概言之为害甚矣。且弦小于紧。数大于弦。洪则不然。
举按盛大。非与二脉同也。又紧而迟为寒。紧而数为热。若曰按有余。举甚数。则又类实脉。若紧迟紧细。
又何以诊。又总曰三关。不曰三部。又昧于尺寸之名。今悉改之。论此紧脉者。或曰在筋肉之间通度。
或曰按之实数。是有三部之通紧。而无各部之独紧。有按之紧。而无浮之紧。皆一偏之辞。仲景曰。脉至
如转索者。其日死。为其紧急不软。无胃气也。转索一也。有死生之分。宜详辨之。
紧脉三关数又弦。上来风是正根元。忽然强语人惊怕。不遇良医不得痊。
前言状若洪弦。今曰数又弦。是见之不明。而频移其说以迁就也。前云主风气伏阳。化为狂。今去伏阳
独言风。仲景及脉经。皆曰诸紧为寒。非可以为风狂伏阳之诊。难经曰。重阳者狂。岂紧脉为重阳乎。
重阳者、谓阳部更有洪大滑长数等脉见耳。内经曰。阴不胜其阳。则脉流薄疾。并乃狂。薄疾者、极虚而急
数。并、谓盛实。亦非紧脉也。
紧脉关前头里痛。到关切痛无能动。〔隐指寥寥〕（转索无常）入尺来。〔缴结〕（疼痛）绕脐长手捧。
脉紧如转索。非隐指寥寥之状。缴结非痛之状。今改之。李氏曰阳脉至阴部。自然隐伏指下。寥寥入来。
若在寸部。则不寥寥。以愚视之。脉随病而见。不随部而改。小腹痛必寒气固结。攻击于下焦。所以脉紧。
安有因在尺部。而脉变形乎。
〔七〕洪者阳也。〔指下寻之极大举之有余〕（极大在指下。来大去长而满指。）曰洪。主头痛。
四肢洪热。大肠不通。燥热。粪结。口干。遍身疼痛。
指下寻之极大。举之有余。是浮沉皆大之象。有类实脉矣。脉经曰。极大在指下。不言举按。可以见
洪之本状。诊者自当随其见于浮沉以参求尔。极大在指下者。指下前后左右四旁。脉来皆盛大满指。是
言本体之形大也。来大去长。言其来去之形大也。
洪脉根元本是阳。遇其〔季夏〕（夏月）自然昌。若逢秋〔季〕（月）及冬〔季〕（月）。发汗通肠始得凉。
仲景曰。立夏得洪大脉。是其本位。为应时之脉。今曰季夏。池氏迁就以为季夏心火渐退。得脾土偃之。
其热病自退。若然。则秋冬只在九月十二月。得洪脉。方可发汗通肠乎。今季字皆改为月字。
洪脉关前热在胸。当关翻胃〔几千重〕（热来冲）。更向尺中还若是。小便赤涩脚酸疼。
右手尺部（命门/肾）脉诊，需将三指置于该部位。脉搏跳动五十次而无歇止，便无需担忧。若脉搏仅跳动十九次便突然沉伏不起，这是死症，生命即将断绝。若指下脉搏急促跳动，状如琴弦，说明肾脏受风邪侵袭，尚可治疗。若脉搏仅跳动七次便沉伏不起且不再出现，患者今日努力支撑也难免一死。
〔一〕浮脉属阳。指下轻取（寻按）感觉力量不足，重举则感觉有余。反复轻取感觉脉气在肌肉层之上运行，称为浮脉。浮脉主咳嗽、气促、冷汗自出、背部及手臂疲劳倦怠、夜间睡眠不安。
《脉诀》说：“像太过那样称为浮。”既然已经说了“举之有余”，为什么又说“太过”？所谓“太过”，是指浮洪、浮紧、浮弦等脉象，如何诊断呢？《脉经》中并没有“如太过”的文字。另外，“寻”与“按”是不同的。“按”是用重手按压在肌肉筋骨部位；“寻”则是或上或下、或左或右，顺着脉位去探寻。浮脉是“按之不足”，而不是“寻之不足”。
按下去感觉力量不足，举起来感觉有余，反复轻取指下感觉浮起。脏腑中有积冷，营血中有热。想要获得生机，需用补虚之法。
寸口见浮脉，主中风引起的头部发热疼痛；关部见浮脉，主腹胀、胃气空虚；尺部见浮脉，主风邪入肺，大肠干涩导致排便困难。
〔二〕芤脉属阳。指下轻取感觉两头有脉而中间全无（重举时，脉形浮大柔软；重按时，两边实而中间虚），称为芤脉。芤脉主淋沥不尽、气入小肠（主失血）。
芤是一种草名，其叶子像葱，中心是空的。所以用手指按压芤草的叶子，来比喻失血后的脉象。芤这个名称在《内经》中未见。又有人说：“安卧而脉盛大，称为脱血。”到了张仲景的《伤寒论》中说：“脉弦而大，弦则为减，大则为芤。减则为寒，芤则为虚。虚寒相搏，此名为革。”也未曾把芤作为定名，只是附见于革脉之后。直到王叔和才确立芤脉。《脉经》说：“芤脉的形象是两边似有，中间全无。”现在的《脉诀》却说：“两头则有，中间全无”，这就错了。如果尺脉上不至关为阴绝，寸口下不至关为阳绝。若是两头似有、中间全无，那就是阴阳绝脉了，怎么能说是芤脉呢？《经》说：“营气行于脉中”，即血在脉管中运行。脉以血为形体，血盛则脉盛，血虚则脉虚。所以芤脉中空，是血液脱失的表现。芤脉，先举指时浮大而软，因重按而中空。现在《脉诀》首先说“指下寻之”，这是不对的。张仲景说：“脉浮而紧，按之反芤，其人本虚；若浮而数，按之不芤，此人本不虚。”都是在“按”的过程中发现芤脉的。“寻”是在浮举沉按之间进行的。以下仿照此理。
指下轻取感觉中间且虚，邪风透入小肠居住之处。患病时伴有尿血兼疼痛，服用汤剂或丸药必定能治愈。
各家论述芤脉都认为它是失血的征象，现在却说邪风入小肠导致淋沥，这不是正确的证候。这应该是尿血的证候。
寸口见芤脉，主胸中有积血；关部逢芤脉，主肠内有痈肿；尺部见芤脉，主肾虚，小便遗沥、血凝成脓。
〔三〕滑脉属阳。指下轻取感觉三部如珠子滚动，重按即伏，不进不退（脉气往来前却，流利展转，连续不断如同数珠相似，应指圆滑。又说漉漉如水欲脱）。滑脉主肢体困倦疲弊，手脚酸痛，小便赤涩。
《脉经》说：“轻手得之为浮滑，重手得之为沉滑。”其形象往来流利，应指圆滑，像珠子隐没在指下。现在《脉诀》说：“按之即伏，不进不退”，那么就只有浮滑而没有沉滑了。《经》说：“一阴一阳者，谓脉来沉而滑也。”说明沉脉中也有滑象。所以王裳说《脉诀》论述表证不及里证。而且脉象有独见于一部者，有通见于三部者。现在说“三关如珠动”，是不对的。“按之即伏，不进不退”，则是脉气不往来而静止，哪里称得上是滑呢？现在依据《脉经》所载，去掉其中关于浮中有力之类的语句。因为那些话只讲了浮滑，也是一种偏颇的说法。大体上血多则脉滑，这是滑脉的本体。若气血调和顺畅，其跳动不涩、不急、不缓，这种和滑之脉，表示无病。妇女怀孕也是滑脉。现在如果说滑为阳、为病热、为实证，那么这个“滑”字，应当带上数脉和小实脉来说。大抵这部《脉诀》描述脉的形状，往往不准确。现在依据经典改正它，而脉象下所主的病症，大多与本脉不符。如果要改，改不胜改，姑且放置不管吧。
滑脉如珠子滚动，称为阳脉。腰部中生出的热气透向前肠。小腿酸痛是因为产生寒热。通过大泻三焦必然能得到康复。
滑脉多见于寸口，主呕吐逆气；关部滑，主胃热（原误作寒）不下食；尺部见滑，主下焦热（原误作脐似冰），月经不通或尿血涩滞（原误作饮水下焦声沥沥）。
前面的脾脏歌诀说：“单滑为脾家热。”现在却说“胃寒不下食”，为什么呢？《脉经》说：“关滑，胃中有热。”又说：“中实逆滑为热实，故不欲食，食即吐逆。”可以明确其为热证。池氏错误地认为肝木克脾土，导致寒弦成为肝脉。滑脉难道是肝脉吗？
《脉经》说：“尺滑主下利少气。”《脉赋解义》说：“男子尺滑，主膀胱冷气，小腹急胀，小便频数。”又说：“尺滑，主胞络极冷，月经不调。”直接把滑脉当作阴证，主冷，这不恰当。不如《脉经》所说：尺滑，血气实，妇人经脉不利，男子尿血，这才是正确的。现在《脉诀》说“脐似冰”，则滑为阴证；又说“饮水”，则滑为阳热；又说“沥沥作声”，则滑为停水之证。既说冷又说热，不知道是什么意思。现在予以纠正。
〔四〕实脉属阳。指下轻取感觉连绵不绝，重举感觉有余（浮、中、沉三候皆有力），称为实脉。实脉主伏阳在内，脾虚不食，肢体劳倦。柳氏说：实者是气结不通，缺乏疏快感意。上部实，则气壅塞；下部实，则气胀满；中部实，则中脘不适。
《素问》说：“气来实强，是谓太过，病在外；气来虚微，是谓不及，病在内。”这是表里虚实诊法的依据。现在脉象表现为实，却说是脾虚，我不敢相信。
实脉轻取重按都有余，伏阳蒸腾内部导致脾虚。吃得少只因为胃气壅滞。用温和的汤药才能痊愈。
“举有余”只说了浮实，所以改为“浮沉皆有余”。
实脉在关前，胸部热甚；当关切部时，感到中焦疼痛。尺部脉象如绳应指而来（应为下痢疼痛），腹胀，小便淋沥不禁（原误作都禁忍）。
“如绳”不是实脉的样子，而是紧脉。所以改为“下痢疼痛”。《脉经》说：“尺实小腹痛，小便不禁。”又说：“小便难，少腹牢痛。”大概气来实强，是太过的脉象，与淋沥相应。如果说小便不禁，则是膀胱不固，水泉不止，属于下焦严重寒证的范畴。《脉经》使用当归汤加大黄，是因为热证而用的。小便不禁，必然是传写错误，后面说的“小便难”才是对的。洁古对此，一会儿用姜附，一会儿用承气，模棱两可。究竟认为是寒还是热？
我按：洁古对《脉诀》及《难经》的药注，都是他人假托洁古之名，必定不是这位老先生的著作。
〔五〕弦脉属阳。指下轻取感觉力量不足，重举感觉有余，形状像筝弦，时时带有数象（端直以长，如弦隐指），称为弦脉。弦脉主劳风乏力，盗汗多出，手足酸疼，皮毛枯槁。
指下左右都没有阻碍，从前中后直过，挺然于指下，称为弦。这是血气收敛不舒的征候。《脉诀》以弦为阳，《伤寒论》以弦为阴。《脉赋解义》也说弦滑虽属七表，但都主于阴。《活人书》说：“若弦而洪数者为阳，弦疾而沉且微细者为阴。”主拘急。依我看来，《经》说肝是阴中之阳，应当是半阴半阳的脉。《脉诀》说：“指下寻之不足，举之有余”，那么就是有浮弦而没有沉弦了。《经》说：“脉沉而弦者，主悬饮内痛。”说明沉脉中也有弦象。又说“时时带数”，则是弦脉与数脉相兼，不是单纯的弦脉。《素问》说：“气来弱，轻虚以滑，端直以长，曰弦。”现在不取“轻虚以滑”，恐怕有弦数、弦迟兼其他脉象的诊断，所以只以弦的本状，端直以长为弦。然而有弦而细的，有弦而粗的，要看出现在的部位。弦而软弱，其病轻；弦而坚硬，其病重。大率弦脉急强，是血气不和所产生的。又有偏弦、双弦的诊断。
弦脉（端直以长）状如弦，四肢更被气机煎熬。三次温散劳风始退，常须固护下丹田。
弦、浮、数、大四者都是劳损之脉。大的容易治，脉气未衰，可以收敛而纠正。弦的难治，血气已耗损而难以补益。双弦则是贼邪侵犯脾脏，尤为难治。加上数脉就危险了。《内经》说：“劳者温之”，不可用解散法。
寸口脉紧一条弦，胸中急痛状如绳牵；关中有弦，寒在胃，下焦停水满丹田（寸弦头痛胸中痛。左关癖痛挛拘。右关有饮寒留胃。尺弦腹痛腰脚拘。）
既歌弦脉，又言脉紧，这是不对的。这首歌诀的脉证未尽，现在改正。《脉经》说：“寸弦，心下痞，微头痛，心下有水气。一说胸中拘急。”关弦，胃寒，心下厥逆。一说心下拘急，这是胃气虚的缘故。尺弦，小便痛，小腹及脚中拘急。一说脐下拘急。
〔六〕紧脉属阳。指下轻取感觉三部通畅，重按感觉有余，举指时非常快速，形状像洪脉和弦脉（来往有力，左右弹人手，既如转索，又如切绳），称为紧脉。紧脉主风气，伏阳上冲，化为狂病。
《内经》、《难经》没有提到紧脉。《内经》说“急”而不说“紧”，说“来而左右弹人手”，有紧脉的形状，但没有紧脉的名称。到了张仲景说：“紧者如转索无常。”又说紧脉从何而来？假如亡汗或呕吐，是因为肺里寒；假如咳嗽，是因为喝冷水；假如下利，是因为胃中虚冷。都是因为寒而导致脉紧。所以脉急为寒，诸紧为寒至。王叔和《脉经》，又增加“如切绳状”。所以我综合三本书的论述来形容它。“左右弹人手”，是紧脉来的形状，左右弹击人手。“转索无常”，是绳索转动，不常在一处，有时紧转在左，有时紧转在右，这是举指时得到的紧脉形状。“切绳状”，是用两股或三股绞合而成的徽缠，再用物切割，其辗转的紧束感，是在按指时显现的。用手指按脉，犹如切绳。综合这三点论述，才算完备。《脉经》说：“重手得之为沉紧，轻手得之为浮紧。”所以咳嗽的脉象如果是沉紧则死，中恶的脉象如果是浮紧则死。现在《脉诀》说：“状若洪弦”，这是错误的。紧为寒为痛，弦为寒为饮，洪为气为热。主治的疾病既然不同，治疗方法也不同，一概而论危害很大。而且弦小于紧，数大于弦，洪则不然，举按盛大，不与这两脉相同。又紧而迟为寒，紧而数为热。如果说按之有余，举之甚数，那就类似实脉了。如果紧迟、紧细，又怎么诊断？又总说“三关”，不说“三部”，又不懂尺寸的名称，现在全部改正。讨论此紧脉的人，有的说在筋肉之间通畅，有的说按之实数，这是有三部通用的紧脉，而没有各部独立的紧脉，只有按之紧，而没有浮之紧，都是一偏之辞。张仲景说：“脉至如转索者，其日死。”因为其紧急不软，无胃气。转索这一种脉，有死生之分，应该详细辨别。
紧脉在三关，数而又弦，上来风邪是正根元。忽然强语让人惊怕，不遇良医不得痊愈。
前面说形状像洪弦，现在说数而又弦，这是见识不明，频繁改变说法以迁就。前面说主风气伏阳化为狂，现在去掉伏阳独言风。仲景及《脉经》都说诸紧为寒，不能诊断为风狂伏阳。《难经》说：“重阳者狂。”难道紧脉就是重阳吗？重阳，是指阳部更有洪大滑长数等脉出现罢了。《内经》说：“阴不胜其阳，则脉流薄疾，并乃狂。”薄疾，是极虚而急数；并，是盛实。也不是紧脉。
紧脉在关前，头里痛；到关切部，疼痛无法动弹。（隐指寥寥）进入尺部，（缴结）绕脐长手捧。
脉紧如转索，不是隐指寥寥的样子。缴结不是疼痛的样子。现在改正。李氏说：阳脉至阴部，自然隐伏指下，寥寥而来。若在寸部，则不寥寥。依我看来，脉随病而见，不随部位而改变。小腹痛必是寒气固结，攻击于下焦，所以脉紧。哪有因为在尺部，脉就变形的道理？
〔七〕洪脉属阳。指下轻取感觉极大，重举感觉有余（极大在指下，来大去长而满指），称为洪脉。洪脉主头痛，四肢洪热，大肠不通，燥热，粪结，口干，遍身疼痛。
指下轻取感觉极大，重举感觉有余，这是浮沉皆大的形象，有点像实脉。《脉经》说：“极大在指下”，不说举按，可以看出洪脉的本状。诊者自然应当随着它在浮沉中的表现来参悟寻求。极大在指下，是指下前后左右四旁，脉来皆盛大满指，这是说本体的形大。来大去长，是说其来去的形大。
洪脉根元本是阳，遇到夏季自然昌盛。若逢秋季及冬季，发汗通肠始得凉。
张仲景说：“立夏得洪大脉，是其本位，为应时之脉。”现在说季夏，池氏迁就解释为季夏心火渐退，得脾土偃之，其热病自退。如果这样，那么秋冬只在九月十二月，得洪脉，才可以发汗通肠吗？现在把“季”字都改为“月”字。
洪脉在关前，热在胸；当关翻胃热来冲；更向尺部还若是，小便赤涩脚酸疼。
The pulse at the right hand's Chi position (Mingmen/Kidney) is assessed with three fingers placed on that area. If the pulse beats fifty times without interruption, there is no need for worry. If the pulse beats only nineteen times and then suddenly sinks and ceases, it indicates a fatal condition where life is about to end. If the pulse under the fingers beats rapidly and feels taut like a string, it indicates wind pathogen invading the Kidney, which is still treatable. If the pulse beats only seven times and then sinks and does not return, despite efforts today, death is inevitable.
[I] The Floating Pulse (Fu Mai, 浮脉) belongs to Yang. Under the fingers, light pressure (Xun, 寻) feels insufficient in strength, while lifting reveals excess. Repeatedly feeling lightly, if the pulse qi seems to run above the muscle layer, it is called Floating. The Floating pulse governs cough, shortness of breath, spontaneous cold sweat, fatigue and soreness of the back and arms, and restless sleep at night.
The *Mai Jue* says: "Like 'excess' is called Floating." Since it has already said "lifting reveals excess," why does it say "excess"? By "excess," it refers to pulses such as Floating-Hong, Floating-Tight, and Floating-Wiry. How are they diagnosed? The *Mai Jing* contains no text saying "like excess." Furthermore, "Xun" (seeking/light palpation) and "An" (pressing/heavy palpation) are different. "An" involves pressing heavily on the muscle and bone-tendon level; "Xun" involves moving up or down, left or right, following the pulse position to seek it. The Floating pulse is "insufficient upon An," not "insufficient upon Xun."
Insufficient upon pressing, excess upon lifting; repeatedly seeking lightly, the pulse feels floating under the fingers. Cold accumulation in the Zang organs, heat in the Ying (Nutritive) level. To achieve survival, tonification for deficiency is required.
Floating at the Cun (Inch) position governs wind-stroke causing head heat and pain; Floating at the Guan (Bar) position governs abdominal distension and empty Stomach Qi; Floating at the Chi (Cubit) position governs wind pathogen entering the Lung, dryness and astringency of the Large Intestine leading to difficult defecation.
[II] The Scallion-Leaf Pulse (Kou Mai, 芤脉) belongs to Yang. Under the fingers, light pressure reveals presence at both ends but absence in the middle (upon heavy lifting, the pulse shape is large, floating, and soft; upon heavy pressing, the sides are solid but the center is void), it is called Kou. The Kou pulse governs dribbling urination and Qi entering the Small Intestine (governs blood loss).
Kou is a plant name, its leaves resembling scallions, hollow in the center. Thus, pressing a Kou leaf with the finger is used to metaphorize the pulse after blood loss. The term Kou does not appear in the *Nei Jing*. It is also stated: "Resting quietly with a surging pulse is called blood depletion." Later, Zhang Zhongjing's *Shang Han Lun* states: "Pulse wiry and large; wiry implies reduction, large implies Kou. Reduction implies cold, Kou implies deficiency. Deficiency and cold clashing together is named Ge (Leather)." It did not establish Kou as a fixed name but attached it to the Ge pulse. It was Wang Shuhe who first established the Kou pulse. The *Mai Jing* states: "The image of the Kou pulse is that the sides seem present, but the middle is completely absent." The current *Mai Jue* says: "Both ends are present, the middle is completely absent," which is an error. If the Chi pulse does not reach the Guan from above, it is Yin Extinction; if the Cun pulse does not reach the Guan from below, it is Yang Extinction. If both ends seem present and the middle is completely absent, this is a pulse of Yin and Yang extinction, how can it be called Kou? The Classics state: "Ying Qi circulates within the vessels," meaning blood flows within the vessel walls. The vessel takes blood as its form; when blood is abundant, the pulse is full; when blood is deficient, the pulse is empty. Therefore, the hollow center of the Kou pulse indicates blood depletion. The Kou pulse, upon initial light lifting, is large, floating, and soft; it becomes hollow in the center upon pressing. The *Mai Jue* begins by saying "under the fingers seeking," which is incorrect. Zhang Zhongjing said: "Pulse floating and tight, upon pressing it is contrary Kou, the person is originally deficient; if floating and rapid, upon pressing it is not Kou, the person is originally not deficient." These all reveal the Kou pulse through "pressing." "Seeking" occurs between floating-lifting and sinking-pressing. The following imitates this logic.
Under the fingers, seeking reveals emptiness in the middle; evil wind penetrates into the dwelling of the Small Intestine. During illness, hematuria accompanied by pain occurs; taking decoctions or pills will surely cure it.
Various schools discuss Kou as a diagnosis of blood loss. Now it says evil wind enters the Small Intestine causing dribbling, which is not the correct syndrome. This should be a syndrome of hematuria.
Kou at the Cun position governs accumulated blood in the chest; Kou at the Guan position governs abscesses in the intestines; Kou at the Chi position governs Kidney deficiency, with dribbling urination and coagulated blood turning to pus.
[III] The Slippery Pulse (Hua Mai, 滑脉) belongs to Yang. Under the fingers, light pressure feels like beads rolling across the three positions, heavy pressing makes it subside, neither advancing nor retreating (Qi moves forward and backward, smooth and continuous, resembling a string of beads, round and smooth under the fingers. Also described as gurgling like water about to escape). The Slippery pulse governs limb fatigue and debility, soreness and pain in hands and feet, and red, scanty, or painful urination.
The *Mai Jing* states: "Obtained with light hand is Floating-Slippery; obtained with heavy hand is Sinking-Slippery." Its image is smooth flow, round and smooth under the fingers, like a bead hiding under the finger. The current *Mai Jue* says: "Subsides upon pressing, neither advancing nor retreating," implying there is only Floating-Slippery and no Sinking-Slippery. The Classics state: "One Yin and One Yang means the pulse comes sinking and slippery," indicating slipperiness exists within sinking pulses. Thus, Wang Shang said the *Mai Jue* discusses exterior conditions but fails to address interior ones. Moreover, pulses may appear exclusively in one position or throughout all three. Saying "beads rolling across the three Guan" is incorrect. "Subsiding upon pressing, neither advancing nor retreating" means the pulse Qi does not flow but is static; how can this be called Slippery? Now, based on the *Mai Jing*, we remove phrases regarding strength in floating and middle layers. Those words only describe Floating-Slippery, representing a biased view. Generally, abundance of blood leads to a Slippery pulse; this is the essence of the Slippery pulse. If Qi and Blood are harmonious and smooth, their movement is not astringent, not rapid, not slow; this Harmonious-Slippery pulse indicates no disease. Pregnancy in women also presents with a Slippery pulse. If one now says Slippery is Yang, pathological heat, or excess, this character "Slippery" should be discussed alongside Rapid and Small-Full pulses. Broadly, the *Mai Jue*'s description of pulse shapes is often inaccurate. Now correcting it according to classics, the syndromes governed under the pulse names mostly do not match the pulse itself. There are too many corrections needed, so we shall leave them aside for now.
Slippery pulse like rolling beads is called Yang. Heat generated in the waist penetrates to the anterior intestine. Shin soreness is due to generating cold and heat. Great purgation of the San Jiao will surely bring recovery.
Slippery pulse mostly at Cun governs vomiting and reverse Qi; Slippery at Guan governs Stomach Heat (originally erroneous Cold) preventing food intake; Slippery at Chi governs Lower Jiao Heat (originally erroneous "navel like ice"), amenorrhea or painful, scanty hematuria (originally erroneous "drinking water, gurgling sound in lower Jiao").
The previous Spleen song states: "Single Slippery is Spleen Heat." Now it says "Stomach Cold preventing food intake." Why? The *Mai Jing* states: "Guan Slippery, heat in the Stomach." It also states: "Middle Excess Reverse Slippery is Heat Excess, therefore no desire to eat; eating causes vomiting and reverse Qi." This clearly indicates a Heat syndrome. Chi Shi erroneously claimed Liver Wood overacts on Spleen Earth, causing Cold Wiry to become the Liver pulse. Is Slippery the Liver pulse?
The *Mai Jing* states: "Chi Slippery governs diarrhea and shortness of Qi." The *Mai Fu Jie Yi* states: "Male Chi Slippery governs Bladder Cold Qi, acute abdominal distension, frequent urination." It also states: "Chi Slippery governs extreme Cold of the Conception Vessel, irregular menstruation." Directly treating Slippery as Yin governing Cold is inappropriate. It is better to follow the *Mai Jing*: Chi Slippery, Blood and Qi are Excess; in women, menstrual difficulty; in men, hematuria, which is correct. Now the *Mai Jue* says "navel like ice," making Slippery a Yin syndrome; it also says "drinking water," making Slippery Yang-Heat; it says "gurgling sound," making Slippery a Water-Stagnation syndrome. It mentions both Cold and Heat, not knowing what it means. Now corrected.
[IV] The Full Pulse (Shi Mai, 实脉) belongs to Yang. Under the fingers, light pressure feels continuous and unbroken, heavy lifting feels excessive (Full in Floating, Middle, and Sinking phases), it is called Shi. The Full pulse governs hidden Yang inside, Spleen deficiency preventing eating, and limb fatigue. Mr. Liu said: Fullness is Qi knotting and not flowing freely, lacking relief. Upper Fullness means Qi stagnation; Lower Fullness means Qi distension; Middle Fullness means discomfort in the Zhong Wan.
The *Su Wen* states: "Qi coming strong and firm is called Excess, disease is external; Qi coming weak and faint is called Deficiency, disease is internal." This is the diagnosis of Interior/Exterior and Deficiency/Excess. Now the pulse appears Full, yet it is said to be Spleen Deficiency; I dare not believe it.
Full pulse seeking and lifting both show excess; hidden steaming Yang inside causes Spleen Deficiency. Low food intake is due to Stomach congestion. Only warm and mild decoctions can cure it.
"Lifting excess" only refers to Floating Fullness, so it is changed to "Floating and Sinking both have excess."
Full pulse before the Guan, chest heat is severe; at the Guan, mid-Jiao pain is felt. At the Chi position, the pulse comes like a rope responding to the finger (should be dysentery pain), abdominal distension, and urinary incontinence (originally erroneous "all incontinence").
"Like a rope" is not the comparison for a Full pulse; it is a Tight pulse. So it is changed to "dysentery pain." The *Mai Jing* states: "Chi Fullness, lower abdominal pain, urinary incontinence." It also states: "Difficulty urinating, severe lower abdominal pain." Generally, Qi coming strong and firm is an Excess pulse, corresponding to dribbling urination. If it says urinary incontinence, it means the Bladder is not secure, water springs flow endlessly, which is a severe Cold syndrome of the Lower Jiao. The *Mai Jing* uses Dang Gui Tang plus Da Huang because it is a Heat syndrome. Urinary incontinence must be a transcription error; "difficulty urinating" mentioned later is correct. Jiegu here uses Jiang Fu once and Cheng Qi once, offering ambiguous advice. Does he consider it Cold or Heat?
I note: Jiegu's medicinal notes on the *Mai Jue* and *Nan Jing* are forgeries attributed to him; they are certainly not his writings.
[V] The Wiry Pulse (Xian Mai, 弦脉) belongs to Yang. Under the fingers, light pressure feels insufficient, heavy lifting feels excessive, shaped like a zither string, sometimes carrying a Rapid quality (straight and long, like a string pressing into the finger), it is called Xian. The Wiry pulse governs labor-wind fatigue, profuse night sweats, soreness and pain in hands and feet, and withered skin and hair.
Without obstruction left or right under the fingers, passing straight from front to back, standing erect under the fingers, it is called Xian. This is a sign of Qi and Blood contracting and not舒展 (expanding). The *Mai Jue* treats Xian as Yang; the *Shang Han Lun* treats Xian as Yin. The *Mai Fu Jie Yi* also says although Xian and Hua belong to the Seven Superficial Pulses, they all govern Yin. The *Huo Ren Shu* states: "If Xian is Hong and Rapid, it is Yang; if Xian is rapid, sinking, and micro-fine, it is Yin." It governs spasm. In my opinion, the Classics state the Liver is Yin containing Yang, so it should be a Half-Yin Half-Yang pulse. The *Mai Jue* says: "Seeking is insufficient, lifting is excessive," implying there is only Floating-Xian and no Sinking-Xian. The Classics state: "Pulse sinking and Xian governs suspended fluid and internal pain," indicating Xian exists in sinking pulses. It also says "sometimes carrying Rapid," meaning Xian and Rapid pulses combine, not a single Xian pulse. The *Su Wen* states: "Qi coming weak, light and void yet smooth, straight and long, is called Xian." Now we do not take "light and void yet smooth," fearing diagnoses combining Xian-Rapid or Xian-Chi with other pulses, so we only take the essential shape of Xian: straight and long is Xian. However, there is Xian-thin and Xian-thick, depending on the position. Xian-soft indicates mild disease; Xian-hard indicates severe disease. Generally, Xian pulse is urgent and strong, produced by disharmony of Qi and Blood. There are also diagnoses of Single-Xian and Double-Xian.
Wiry pulse (straight and long) shaped like a string; limbs are further tormented by Qi. Three times resolving labor-wind finally recedes; always must consolidate and protect the Lower Dantian.
Xian, Floating, Rapid, and Large are all Labor (consumptive) pulses. Large is easier to treat, pulse Qi is not yet exhausted, can be gathered and corrected. Xian is hard to treat, Qi and Blood are depleted and hard to tonify. Double-Xian means thief-pathogen invading the Spleen, even harder to treat. Adding Rapid is perilous. The *Nei Jing* states: "For Labor, use Warmth," do not use dispersal methods.
Cun pulse tight and one strand of Xian, chest urgency and pain like being pulled by a rope; Guan has Xian, Cold in Stomach, water retention in Lower Jiao filling Dantian (Cun Xian: headache and chest pain. Left Guan: mass pain and spasms. Right Guan: fluid-cold remaining in Stomach. Chi Xian: abdominal pain and leg/waist stiffness.)
Singing of Xian pulse, then mentioning Tight pulse, is incorrect. This song's pulse-syndrome mapping is incomplete; now corrected. The *Mai Jing* states: "Cun Xian, epigastric stuffiness, slight headache, fluid-Qi in heart. Alternatively, chest constraint." Guan Xian, Stomach Cold, epigastric reversal. Alternatively, epigastric constraint, due to Stomach Qi deficiency. Chi Xian, painful urination, constraint in lower abdomen and legs. Alternatively, constraint below the navel.
[VI] The Tight Pulse (Jin Mai, 紧脉) belongs to Yang. Under the fingers, light pressure feels open across the three positions, heavy pressing feels excessive, lifting feels very rapid, shaped like Hong and Xian pulses (coming with force, snapping left and right against the hand, like twisting cords, or like cutting ropes), it is called Jin. The Tight pulse governs Wind pathogen, hidden Yang rushing upward, transforming into mania.
The *Nei Jing* and *Nan Jing* do not mention the Tight pulse. The *Nei Jing* says "Urgent" not "Tight," stating "coming and snapping left and right against the hand," having the shape of a Tight pulse but not the name. Until Zhang Zhongjing said: "Tight is like twisting cords without constancy." He also asked: "Where does the Tight pulse come from?" For example, loss of sweat or vomiting is due to Cold in the Lungs; coughing is due to drinking cold water; diarrhea is due to Cold deficiency in the Stomach. All are caused by Cold leading to Tight pulse. Thus, urgent pulse is Cold; all Tights are Cold arriving. Wang Shuhe's *Mai Jing* added "like cutting ropes." Therefore, I combine the discussions of these three books to describe it. "Snapping left and right against the hand" is the shape of the Tight pulse coming, snapping left and right. "Twisting cords without constancy" means the cord turns, not staying in one place; sometimes tightening on the left, sometimes on the right; this is the shape of the Tight pulse obtained by lifting. "Cutting rope shape" means a rope twisted from two or three strands, tightened further by cutting; its辗转 (rotational) tightness is seen upon pressing. Pressing the pulse with the finger is like cutting a rope. Combining these three discussions makes it complete. The *Mai Jing* states: "Heavy hand obtains Sinking-Tight; light hand obtains Floating-Tight." Therefore, Cough with Sinking-Tight is fatal; Zhong-E (Evil Strike) with Floating-Tight is fatal. The current *Mai Jue* says: "Shaped like Hong and Xian," which is an error. Tight is Cold and Pain; Xian is Cold and Fluid; Hong is Qi and Heat. Since the diseases governed differ, treatments differ; generalizing them causes great harm. Moreover, Xian is smaller than Jin, Rapid is larger than Xian; Hong is different, large upon lifting and pressing, not similar to these two pulses. Also, Tight and Slow is Cold; Tight and Rapid is Heat. If it says pressing has excess, lifting is very rapid, it resembles the Full pulse. If Tight-Slow or Tight-Fine, how to diagnose? It also generally says "Three Guan," not "Three Positions," showing ignorance of Cun and Chi names; now all corrected. Discussers of this Tight pulse say either it passes through muscles/tendons, or it is solid and rapid upon pressing; this has the general Tight of the three positions but no independent Tight of each part, only Tight upon pressing, no Floating-Tight; these are one-sided statements. Zhang Zhongjing said: "Pulse coming like twisting cords, death on that day." Because it is urgent and not soft, lacking Stomach Qi. Twisting cords is one type, but has distinctions of life and death; one must distinguish carefully.
Tight pulse in the three positions, rapid and wiry; coming up, Wind is the true root. Suddenly speaking strongly frightens people; without a good doctor, cannot recover.
Previously said shaped like Hong and Xian, now says rapid and wiry; this shows unclear vision and frequently changing theories to accommodate. Previously said governing Wind pathogen and hidden Yang transforming into mania; now removing hidden Yang and speaking only of Wind. Zhongjing and *Mai Jing* both say all Tights are Cold, not a diagnosis for Wind-Mania or Hidden Yang. *Nan Jing* states: "Double Yang results in Mania." Is the Tight pulse Double Yang? Double Yang means Yang positions show additional Hong, Large, Slippery, Long, Rapid pulses. *Nei Jing* states: "Yin cannot overcome Yang, then pulse flows thin and rapid, merging becomes Mania." Thin and rapid means extremely weak yet urgent and rapid; Merging means fullness/excess. This is not the Tight pulse.
Tight pulse before Guan, head and interior pain; reaching Guan, pain prevents movement. (Hidden under fingers, sparse) entering Chi, (Knotted) circling the navel, long hand holding.
Pulse Tight like twisting cords is not the appearance of "hidden under fingers, sparse." Knotted is not the appearance of pain. Now corrected. Mr. Li said: Yang pulse reaching Yin position naturally hides under fingers, coming sparsely. If at Cun, it is not sparse. In my view, pulse appears with disease, not changing with position. Lower abdominal pain must be Cold Qi consolidating and attacking the Lower Jiao, hence Tight pulse. How can the pulse deform just because it is in the Chi position?
[VII] The Surging Pulse (Hong Mai, 洪脉) belongs to Yang. Under the fingers, light pressure feels extremely large, heavy lifting feels excessive (Extremely large under fingers, coming large, going long, filling the fingers), it is called Hong. The Surging pulse governs headache, surging heat in limbs, Large Intestine blockage, dryness-heat, fecal impaction, dry mouth, and body-wide pain.
Light pressure feels extremely large, heavy lifting feels excessive; this is the image of both Floating and Sinking being large, resembling the Full pulse. The *Mai Jing* states: "Extremely large under fingers," without mentioning lifting or pressing, allowing one to see the original shape of Hong. The diagnostician should naturally seek its manifestation in Floating or Sinking. "Extremely large under fingers" means behind, in front, left, right, and around the fingers, the pulse comes large, full, and fills the fingers; this describes the physical largeness of the body. "Coming large, going long" describes the shape of its coming and going.
Surging pulse root is originally Yang; encountering Summer months naturally prospers. If encountering Autumn and Winter months, sweating and purging bowels brings coolness.
Zhang Zhongjing said: "Obtaining Hong-Large pulse at Start of Summer is its proper position, corresponding to the season." Now it says Late Summer; Chi Shi accommodated this by saying Late Summer Heart Fire gradually retreats, supported by Spleen Earth, so heat disease self-retreats. If so, then in Autumn and Winter, only in September and December, obtaining Hong pulse allows sweating and purging? Now the character "Season" (Ji) is changed to "Month" (Yue).
Surging pulse before Guan, heat in chest; at Guan, reverse vomiting with Heat rushing up; if still so at Chi, red/scanty urination and sore/aching legs.