（汪机撰）
夫脉者本乎营与卫也。而营行于脉之中。卫行于脉之外也。苟脏腑和平。营卫调畅。则脉无形状
之可议矣。或六淫外袭。七情内伤。则脏腑不和。营卫乖谬。而二十四脉之名状。层出而叠见矣。
是故风寒暑湿燥火。此六淫也。外伤六淫之脉。则浮为风。紧为寒。虚为暑。细为湿。数为燥。洪为火。
此皆可以脉而别其外感之邪也。喜怒忧思悲恐惊者。此七情也。内伤七情之脉。喜则伤心而脉缓。
怒则伤肝而脉急。忧则伤肺而脉涩。思则伤脾而脉结。恐则伤肾而脉沉。悲则气消而脉短。惊则气
乱而脉动。凡此者皆可以脉而辨其内伤之病也。然此特举其常。而以脉病相应者为言也。若论其变。
则有脉不应病。病不应脉。变出百端。而难一一尽凭于脉矣。试举一二言之。张仲景云。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。
又云促脉为阳盛。宜用葛根黄芩黄连汤。若脉促厥冷为虚脱。非灸非温不可。此又非促为阳盛之脉也。
又云迟脉为寒。沉脉为里。若阳明脉迟。不恶寒。身体 汗出。则用大承气。此又非诸迟为寒之脉矣。
少阴病始得之。反发热而脉沉。宜麻黄细辛汤。微汗之。此又非沉为在里之脉矣。凡此皆脉难尽凭
之明验也。若只凭脉而不问症。未免以寒为热。以表为里。以阴为阳。颠倒错乱。而夭人长寿者有矣。
是以古人治病。不专于脉。而必兼于审症。良有以也。奈何世人不明乎此。
往往有病讳而不言。惟以诊脉而试医之能否。诊之而所言偶中。便视为良医。倾心付托。笃意委任。而于
病之根源。一无所告。药之宜否。亦无所审。惟束手听命于医。因循遂至于死。尚亦不悟。深可悲夫。
彼庸俗之人。素不嗜学。不识义理。固无足怪。近世士大夫家。亦未免狃于此习。是又大可笑也。
夫定静安虑格物致知。乃大学首章第一义。而虑者谓处事精详。格物者谓穷致事物之理。致知者谓
推极吾之所知。凡此数事。学人必常究心于此矣。先正又曰。为人子者不可以不知医。病卧于床。
委之庸医。比之不慈不孝。夫望闻问切。医家大节目也。苟于临病之际。惟以切而知之为能。其余三
事一切置而不讲。岂得为知医乎。岂得为处事精详乎。岂得为穷致事物之理。而推极吾之所知乎。
又岂得为父而慈。为子而孝乎。且医之良。亦不专于善诊一节。苟或动静有常。举止不妄。存心而
忠浓。发言而纯笃。察病详审。处方精专。兼此数者。亦可谓之良矣。虽据脉言症。或有少差。然一
脉所主非一病。故所言未必尽中也。若以此而遂弃之。所谓以二鸡子而弃干城之将。乌可与智者道哉。
姑以浮脉言之。脉经云。浮为风、为虚、为气、为呕、为厥、为痞、为胀、为满、不食、为热、
为内结等类。所主不下十数种病。假使诊得浮脉。彼将断其为何病耶。苟不兼之以望闻问。而欲的知
其为何病。吾谓戛戛乎其难矣。古人以切居望闻问之后。则是望闻问之间。已得其病情矣。不过再诊
其脉。看病应与不应也。若病与脉应。则吉而易医。脉与病反。则凶而难治。以脉参病。意盖如此。
曷尝以诊脉知病为贵哉。夫脉经一书。拳拳示人以诊法。而开卷入首。便言观形察色。彼此参伍。以
决死生。可见望闻问切。医之不可缺一也。岂得而偏废乎。噫。世称善脉莫过叔和。尚有待于彼此参伍。况
下于叔和万万者耶。故专以切脉言病。必不能不至于无误也。安得为医之良。抑不特此。世人又有以太
素脉而言人贵贱穷通者。此又妄之甚也。予尝考其义矣。夫太者始也。初也。如太极太乙之太。素
者质也。本也。如绘事后素之素。此盖言始初本质之脉也。始初本质之脉。果何脉耶。则必指元气而
言也。东垣云。元气者。胃气之别名。胃气之脉。蔡西山所谓不长不短。不疏不数。不大不小。应
手中和。意思欣欣。难以名状者是也。无病之人皆得此脉。以此脉而察人之有病无病。则可。以此
脉察人之富贵贫贱。则不可。何也。胃气之脉。难以形容。莫能名状。将何以为贵贱穷通之诊乎。
窃视其书。名虽太素。而其中论述。略无一言及于太素之义。所作歌括率多俚语。全无理趣。原其
初志。不过托此以为侥利之媒。后世不察。遂相传习。莫有能辩其非者。或又为之语曰。太素云者。
指贵贱穷通禀于有生之初而言也。即脉可以察而知之。非谓脉名太素也。予曰。固也。然则太素之所
诊者。必不出于二十四脉之外矣。夫二十四脉皆主病言。一脉见则主一病。贫富贵贱。何从而察知哉。
假如浮脉。其诊为风。使太素家诊之。将言其为风耶。抑言其为贵贱穷通耶。二者不可得兼。若言其
为风。则其所知亦不过病也。若遗其病而言其为贵贱穷通。则是近而病诸身者尚不能知。安得谓之太素。
则远而违诸身者。必不能知之也。盖贵贱穷通。身外之事。与身之血气了不相干。安得以脉而知之乎。
况脉之变见无常。而天之寒暑不一。故四时各异其脉。不能必其久而不变。是以今日诊得是脉。明日
诊之而或非。春间诊得此脉。至夏按之而或否。彼太素者。以片时之寻按。而断人一生之休咎。殆必
无是理。然纵使亿则屡中。亦是捕影捉蛇。仿佛形象。安有一定之见哉。噫。以脉
察病。尚不知病之的。而犹待于望闻问切。况能知人之贵贱穷通乎。使脉而能知贵贱穷通。则周公
之易。邵子之数。希夷之相。子平之命。皆不必作矣。何圣人之不惮烦也。何后世不从其脉之简便。
而犹以卜占风鉴星命。而谈不绝口哉。且脉肇于岐黄。演于秦越。而详于叔和。遍考素难脉经。并
无一字语及此者。非隐之也。殆必有不可诬者矣。若果如太素所言。古人当先为之矣。又何待后人
之驰骋耶。巢氏曰。太素脉者善于相法。特假太素以神其术耳。诚哉言也。足以破天下后世之惑矣。
又有善伺察者。以言 人。阴得其实。故于诊按之际。肆言而为欺罔。此又下此一等。无足论也。
虽然人禀天地之气以生。不能无清浊纯驳之殊。禀气之清者。则必形质清。血气清。而脉来亦清。
清则脉形圆净。至数分明。吾诊乎此。但知其主贵与富而已。若曰何年登科。何年升授。何日招财。
何年得子。吾皆不得而知矣。禀气之浊者。则必形质浊。气血浊。而脉来亦浊。浊则脉形重浊。至数
混乱。吾诊乎此。但知其主贫与贱而已。若曰某时招晦。某时失财。某时损妻。某时克子。吾亦莫
得而知矣。又有形浊而脉清者。此谓浊中之清。所主得意处多。而失意处少也。质清而脉浊者。此
谓清中之浊。所主失志处多。而得志处少也。又有形不甚清。脉不甚浊。但浮沉各得其位。大小不失
其等。亦主平稳而无大得丧也。富贵而寿。脉清而长。贫贱而夭。脉浊而促。其或清而促者。富贵而
夭也。浊而长者。贫贱而寿也。其他言有所未尽。义有所未备。学人可以准此而类推。是则吾之所
调以脉而知人富贵穷通者。一本于理而论也。岂敢妄为之说以欺人哉。噫。予所以着为是论者。盖以
世之有言太素脉者。靡不翕然称美。不惟不能以理折。又从而延誉之于人。纵使其言有谬。阴又与之委曲
而影射。此所谓误己而误人者也。果何益之有哉。又有迎医服药者。不惟不先言其所苦。甚至再三询叩。
终于默默。至有隐疾而困医者。医固为尔所困。不思身亦为医所困矣。吁。可慨也夫。此皆世之通患。
人所共有。故予不得不详论之。以致夫叮咛之意。俾聋瞽者或有所开发焉。孟子曰。予岂好辩哉。予不
得已也。（经曰。春伤于风。夏生飧泄。夏伤于暑。秋必 疟。秋伤于湿。冬生咳嗽。冬伤于寒。春
必病温。王安道注曰。四气之伤人。人岂能于未发病之前。预知其客于何经络。何脏腑。而成何
病乎。及其既发病。然后可以诊候。始知其客于某经络。某脏腑。成某病耳。飧泄也。 疟也。咳嗽也。温病也。
皆是因其病发之时。形诊昭着。乃逆推之。而知其昔日致病之原。为伤风。伤暑。伤湿。伤寒耳。
非是初受伤之时。能预定其必为此病也。机按。四气所伤。入于皮肤之内。藏于经脉之中。宜其见于
动脉。可以诊候而知也。而王氏所论。尚谓病若未发。难以诊候而知。彼富贵贫贱。天之命也。身
外事也。非若邪气入于皮肤。藏于血脉也。乌可以脉而知之乎。王氏此论。足以破太素之谬矣。故并附之。
以示来者。）
（汪机撰写）
脉象的根本在于营气与卫气。营气运行在脉管之中，卫气运行在脉管之外。如果脏腑功能平和，营卫之气调畅，那么脉象就没有什么特殊的形态可供议论了。若是六淫邪气从外部侵袭，七情内伤导致内部受损，就会造成脏腑不和，营卫失调，于是二十四种脉象的名称和形态，就层出不穷地显现出来了。
因此，风、寒、暑、湿、燥、火，这称为六淫。感受外感六淫邪气的脉象表现为：浮脉主风，紧脉主寒，虚脉主暑，细脉主湿，数脉主燥，洪脉主火。这些都可以通过脉象来辨别外感的邪气。喜、怒、忧、思、悲、恐、惊，这称为七情。内伤七情的脉象表现为：喜则伤心而脉象缓，怒则伤肝而脉象急，忧则伤肺而脉象涩，思则伤脾而脉象结，恐则伤肾而脉象沉，悲则耗气而脉象短，惊则气乱而脉象动。凡此种种，都可以通过脉象来辨别内伤的病症。然而，这里只是列举其常理，以脉象与病症相应为例来说明。如果论述其变化，则有脉象与病症不相符，病症与脉象不相应，变化百出，难以完全依赖脉象来判断了。试着举一两个例子来说明。张仲景说：脉象浮大，邪气在表，是可以发汗的。如果脉象浮大，心下硬满，有热，属于脏病者，应当攻下，不要发汗。这又说明浮脉并非都是表邪，是可以发汗的脉象。又说：促脉为阳盛，适宜使用葛根黄芩黄连汤。如果脉促且四肢厥冷，这是虚脱，非用艾灸和温补不可。这又说明促脉并非都是阳盛的脉象。又说：迟脉主寒，沉脉主里。如果阳明病脉迟，不恶寒，身体出汗，则使用大承气汤。这又说明并非所有的迟脉都是寒脉。少阴病刚得病时，反而发热而脉沉，适宜使用麻黄细辛附子汤，微发其汗。这又说明沉脉并非都是在里的脉象。凡此种种，都是脉象难以完全依赖的确凿证据。如果只凭脉象而不询问症状，难免会将寒证误认为热证，将表证误认为里证，将阴证误认为阳证，颠倒错乱，而导致人折寿早亡的情况发生了。所以古人治病，不专门依赖脉象，而必须兼审症状，是有道理的。
奈何世人不明白这个道理，往往有病隐瞒不说，只通过诊脉来试探医生的水平。医生诊脉后所说的偶尔中肯，就被视为良医，倾心托付，诚意委任，而对于病的根源，一点也不告知。药物的适宜与否，也不加审察，只是束手听命于医生，因循拖延以至于死亡，仍然不觉悟，真是可悲啊。那些庸俗之人，平时不喜欢学习，不懂义理，本来就不值得奇怪。近代士大夫家庭，也难免受这种习气影响，这就更令人可笑了。
定、静、安、虑、格物、致知，是《大学》首章的第一要义。所谓“虑”，是指处理事情精细详尽；所谓“格物”，是指穷尽事物的道理；所谓“致知”，是指推极自己的知识。这几件事，学医的人必须经常用心研究于此。先贤又说：作为子女不可以不懂医学。病人卧在床上，委托给庸医，比之不慈不孝还要严重。望、闻、问、切，是医家的主要环节。如果在面对病人时，只以切脉为能事，其余三件事一概搁置不讲，怎么能算是懂医学呢？怎么能算是处理事情精细详尽呢？怎么能算是穷尽事物的道理，并推极自己的知识呢？又怎么能算是父亲慈爱、儿子孝顺呢？况且医生的高明，也不仅仅擅长于诊脉这一方面。如果动静有常度，举止不妄为，存心忠诚厚道，说话纯朴笃实，察病详细审慎，处方精当专一，具备这些方面，也可以称得上是良医了。虽然依据脉象推断症状，或许会有少许偏差，但一种脉象所主的不止一种病，所以所说的未必完全准确。如果因此就抛弃脉诊，这就是所谓的因为两只鸡蛋而丢弃守城的大将，怎么能够跟智者谈论呢？
姑且以浮脉为例。《脉经》说：浮脉主风、主虚、主气滞、主呕吐、主厥逆、主痞块、主胀满、主饮食不进、主热、主内结等等类别，所主的疾病不下十几种。假如诊得浮脉，他将判断是什么病呢？如果不结合望、闻、问，就想确切知道是什么病，我认为是非常困难的。古人将切脉排在望、闻、问之后，那么在望、闻、问之间，已经了解了病情。不过是再诊察脉象，看脉象是否与病症相应罢了。如果脉象与病症相应，则吉利且容易治疗；脉象与病症相反，则凶险且难治。用脉象参验病症，大意就是这样。何曾以通过诊脉知晓病情为尊贵呢？《脉经》一书，恳切地向人们展示诊法，但在开篇卷首，就说观察形体、察辨面色，彼此参互验证，以决断生死。可见望、闻、问、切，是医生不可缺少的，怎么能偏废呢？唉！世人称善于诊脉没有超过王叔和的，但他尚且需要彼此参互验证，何况远不如王叔和万万倍的人呢？所以专门通过切脉来谈论病情，必然不能不出现错误。这怎么能算是良医呢？不仅如此，世人又有以太素脉来论断人的贵贱穷通的，这又是极其荒谬的。我曾考察过它的含义。“太”是开始、初始的意思，如太极、太乙的“太”。“素”是本质、本原的意思，如“绘事后素”的“素”。这大概说的是初始本质的脉象。初始本质的脉象，究竟是什么样的脉呢？那就一定是指元气而言。李东垣说：元气，是胃气的别名。胃气的脉象，正如蔡西山所说的那样：不长不短，不疏不数，不大不小，应手中和，意思欣欣，难以名状。无病的人都具备这种脉象。以此脉象来察看病人的有病无病，是可以的；以此脉象来察看病人的富贵贫贱，是不可以的。为什么呢？胃气的脉象，难以形容，无法名状，拿什么作为贵贱穷通的诊断依据呢？
私下看那本书，名义上叫太素，但其中的论述，完全没有一句话涉及太素的含义。所作的歌诀大多是粗俗的语言，全无义理趣味。推究其初衷，不过是借此作为谋取利益的手段。后世不加考察，于是相传习用，没有人能辩驳其错误。有人又说：所谓太素，是指贵贱穷通禀赋于生命之初，即通过脉象可以察知，并不是说脉名叫太素。我说：固然如此，那么太素所诊察的，一定不出于二十四脉的范围。二十四脉都是主治疾病的，一种脉象出现就主一种病，贫富贵贱，从哪里察知呢？假如是浮脉，其诊断为风，如果太素家去诊察，是说它是风邪呢，还是说它是贵贱穷通呢？两者不可兼得。如果说它是风，那么他所知道的也不过是病而已。如果抛开疾病而去谈论贵贱穷通，那就是连近在身上的疾病尚且不能知道，怎么能称之为太素呢？那么对于远离身体的事情，必定是不能知道的。大概贵贱穷通，是身外之事，与身体的血气没有关系，怎么能通过脉象来知道呢？况且脉象的变化无常，而天气的寒暑不一，所以四季的脉象各不相同，不能保证长久不变。因此今天诊得这种脉，明天诊察可能就不是了；春天诊得这种脉，到了夏天按摸可能又不一样了。那些太素家，凭借片刻的寻按，就断定一个人一生的吉凶祸福，这一定是没有道理的。然而即使猜测屡次中肯，也是捕风捉影，仿佛形象，怎么有一定的见解呢？唉！通过脉象察病，尚且不知道确切的病情，还需要等待望、闻、问、切，更何况能知道人的贵贱穷通呢？如果脉象能知道贵贱穷通，那么周公的《易经》、邵雍的数学、陈抟的相术、徐子平的命理，都不必创作了。为什么圣人不嫌麻烦呢？为什么后世不遵循脉诊的简便，而依然以占卜、风水、星命谈论不绝口呢？况且脉学肇始于岐伯、黄帝，演绎于秦越人，详备于王叔和。遍考《素问》、《难经》、《脉经》，并没有一个字提到这一点。不是故意隐瞒，大概是确实有不可诬蔑的事实吧。如果真的像太素所说，古人应当早就做了，又何须等待后人驰骋发挥呢？巢元方说：太素脉善于相面之术，特意假借太素之名来神化其技艺罢了。这话确实正确，足以破除天下后世人的疑惑。
又有善于窥探察言观色的人，通过言语套取信息，暗中得知实情，所以在诊脉按压之际，肆意言谈进行欺骗蒙蔽，这又是低劣一等，不值得讨论了。
虽然人禀受天地之气而生，不能没有清浊纯驳的区别。禀受清气的人，形体必然清，血气必然清，脉象来去也清。清则脉形圆净，至数分明。我诊察到此，只知道主贵与富罢了。如果说哪年登科，哪年升官，哪天招财，哪年得子，我都无法知道。禀受浊气的人，形体必然浊，气血必然浊，脉象来去也浊。浊则脉形重浊，至数混乱。我诊察到此，只知道主贫与贱罢了。如果说某时招晦气，某时失财，某时损妻，某时克子，我也无法知道。又有形体不甚清，脉象不甚浊，但浮沉各得其位，大小不失其等，也主平稳而无大的得失。富贵而长寿，脉象清而长；贫贱而夭折，脉象浊而促。或者清而促的，是富贵而夭折；浊而长的，是贫贱而长寿。其他言语有所未尽，义理有所未备，学医者可以据此类推。这就是我所说的通过脉象而知人富贵穷通，完全是基于道理而论说的。怎敢妄加说法来欺骗人呢？唉！我之所以撰写这篇论述，是因为世上谈论太素脉的人，无不一致称赞美好，不仅不能用道理驳斥，反而跟着在别人面前赞誉它。纵然他的话有误，暗中又委婉地影射迎合，这就是所谓的误己又误人。到底有什么好处呢？又有来看病服药的人，不仅不先说自己痛苦的地方，甚至再三询问，最终沉默不语，甚至有隐疾困扰医生。医生固然被你困住，没想到身体也被医生困住了。唉，真令人感慨啊。这些都是世间的通病，人所共有的，所以我不得不详细论述，以表达我的叮咛之意，使聋瞽之人或许有所启发。孟子说：我难道好辩吗？我是不得已啊。（经文说：春伤于风，夏生飧泄；夏伤于暑，秋必疟疾；秋伤于湿，冬生咳嗽；冬伤于寒，春必病温。王安道注解说：四气伤人，人难道能在未发病之前，预先知道邪气客居在哪条经络、哪个脏腑，形成什么病吗？等到已经发病，然后才可以诊候，才知道邪气客居在某经络、某脏腑，形成某病罢了。飧泄、疟疾、咳嗽、温病，都是因为在其病发之时，形症显著，才逆推回去，知道昔日致病的根源，是伤风、伤暑、伤湿、伤寒罢了。并不是在最初受伤的时候，就能预定一定会得这种病。汪机按语：四气所伤，进入皮肤之内，藏于经脉之中，理应见于动脉，可以通过诊候来知晓。但王氏所论述的，还说病若未发，难以通过诊候来知晓。那些富贵贫贱，是天定的命运，身外之事，不像邪气进入皮肤，藏于血脉那样明显，怎么能通过脉象来知道呢？王氏的这个论述，足以破除太素的谬误了。所以一并附上，以显示给后来者。）
(Written by Wang Ji)
The pulse originates from Ying (Nutrient Qi) and Wei (Defensive Qi). Ying circulates within the vessels, while Wei circulates outside the vessels. If the Zang-Fu organs are in harmony and Ying and Wei are smooth and regulated, there would be no specific pulse shapes to discuss. However, if the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) invade externally or the Seven Emotions (Joy, Anger, Worry, Pensiveness, Fear, Sorrow, Fright) cause internal injury, the Zang-Fu will become disharmonious, and Ying and Wei will deviate. Consequently, the names and manifestations of the Twenty-Four Pulses will emerge one after another.
Therefore, Wind, Cold, Summerheat, Dampness, Dryness, and Fire constitute the Six Excesses. The pulses resulting from external invasion by these six excesses manifest as follows: Floating (Fu) indicates Wind, Tight (Jin) indicates Cold, Deficient (Xu) indicates Summerheat, Fine (Xi) indicates Dampness, Rapid (Shu) indicates Dryness, and Surging (Hong) indicates Fire. These can all be distinguished by the pulse to identify external pathogenic factors. Joy, Anger, Worry, Pensiveness, Sorrow, Fear, and Fright constitute the Seven Emotions. The pulses resulting from internal injury by these seven emotions manifest as follows: Joy injures the Heart, leading to a Slow/Relaxed (Huan) pulse; Anger injures the Liver, leading to a Tense (Ji) pulse; Worry injures the Lung, leading to a Choppy (Se) pulse; Pensiveness injures the Spleen, leading to an Intermittent (Jie) pulse; Fear injures the Kidney, leading to a Deep (Chen) pulse; Sorrow consumes Qi, leading to a Short (Duan) pulse; and Fright causes Qi chaos, leading to a Startled/Dashing (Dong) pulse. All of these can be differentiated by the pulse to identify internal injuries. However, this merely lists the general rules, using cases where the pulse corresponds to the disease as examples. When discussing variations, there are instances where the pulse does not correspond to the disease, or the disease does not correspond to the pulse, with hundreds of variations arising, making it difficult to rely solely on the pulse. Let us cite a few examples. Zhang Zhongjing stated: A Floating and Large pulse indicates the pathogen is in the Exterior, and sweating therapy is indicated. 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, and sweating should not be induced. This shows that a Floating pulse is not always indicative of an Exterior pathogen suitable for sweating. He also stated: A Cursory (Cu) pulse indicates excessive Yang, and Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) is appropriate. However, if the pulse is Cursory accompanied by cold limbs, it indicates collapse of deficiency, requiring moxibustion and warming therapies. This shows that a Cursory pulse is not always indicative of excessive Yang. He further stated: A Slow (Chi) pulse indicates Cold, and a Deep (Chen) pulse indicates the Interior. However, in Yangming disease, if the pulse is Slow, without aversion to cold, but with sweating, Da Chengqi Tang (Major Order the Qi Decoction) should be used. This shows that not all Slow pulses indicate Cold. In Shaoyin disease, upon initial onset, if there is fever and a Deep pulse, Mahuang Xixin Tang (Ephedra, Asarum, and Prepared Rehmannia Decoction) is indicated to induce slight sweating. This shows that a Deep pulse is not always indicative of the Interior. All these are clear evidence that the pulse cannot be relied upon exclusively. If one relies only on the pulse without examining symptoms, one may mistakenly treat Cold as Heat, Exterior as Interior, and Yin as Yang, leading to confusion and premature death. Therefore, ancient physicians did not rely solely on the pulse but combined it with symptom examination, which is justified.
Why do people today fail to understand this? Often, patients conceal their illness and test the doctor's skill merely through pulse diagnosis. If the doctor's guess happens to be correct, they are regarded as excellent physicians, entrusted completely, and appointed with full confidence. Yet, the root cause of the illness is never disclosed, nor is the appropriateness of the medication scrutinized. Patients simply submit to the doctor's orders, delaying treatment until death, still unaware of their folly. This is truly pitiable. It is understandable that vulgar people, who dislike learning and lack understanding of principles, might act this way. However, it is laughable that scholars and officials in recent times have also fallen into this habit.
"Calm, Still, Peaceful, Thoughtful, Investigating Things, and Extending Knowledge" are the primary tenets of the first chapter of *The Great Learning*. "Thoughtful" means handling matters with precision and detail; "Investigating Things" means exhausting the principles of objects; "Extending Knowledge" means pushing one's knowledge to the extreme. Practitioners must constantly study these aspects. Ancients also said: "A son must know medicine." To leave a sick person in bed to the care of quacks is worse than being unfilial. Observation (Wang), Listening/Smelling (Wen), Inquiry (Wen), and Palpation (Qie) are the four major methods of diagnosis. If, when facing a patient, one considers only palpation as sufficient and neglects the other three, how can one claim to know medicine? How can one claim to handle matters with precision? How can one exhaust the principles of things and extend knowledge? How can one be considered a filial son or a benevolent father? Moreover, a good physician is not defined solely by skill in pulse diagnosis. If one maintains regularity in movement and stillness, acts without recklessness, harbors loyal and sincere intentions, speaks purely and honestly, examines diseases carefully, and prescribes precisely, such a person can be called a good physician. Although inferring symptoms from the pulse may have slight inaccuracies, since one pulse type may correspond to multiple diseases, the inference may not always be exact. To discard pulse diagnosis because of this would be like discarding a capable general over two chicken eggs. How could one discuss this with the wise?
Taking the Floating pulse as an example, the *Mai Jing* (Pulse Classic) states that the Floating pulse indicates Wind, Deficiency, Qi stagnation, vomiting, reversal, obstruction, distension, fullness, loss of appetite, heat, internal binding, etc., covering more than ten types of diseases. If a Floating pulse is detected, what disease would one diagnose? Without combining Observation, Listening, and Inquiry, it is extremely difficult to determine the exact disease. The ancients placed Palpation after Observation, Listening, and Inquiry because the condition was already understood through those methods. Palpation was merely used to verify if the pulse matched the disease. If the pulse matches the disease, the prognosis is favorable and treatment is easier; if the pulse contradicts the disease, the prognosis is poor and treatment is difficult. The purpose of correlating pulse with disease is thus clear. Was it ever considered superior to diagnose disease solely through pulse? The *Mai Jing*, while earnestly teaching diagnostic methods, begins by emphasizing observing form and color, cross-referencing them to determine life and death. This shows that Observation, Listening, Inquiry, and Palpation are indispensable and cannot be neglected. Alas! People say no one excels in pulse diagnosis more than Shuhe (Wang Shuhe), yet he still relied on cross-referencing. How much less so for those far inferior to him? Therefore, relying solely on palpation to diagnose disease inevitably leads to errors. How can this be considered good medicine? Furthermore, some people use "Taisu Pulse" (Primordial Pulse) to predict a person's nobility, poverty, success, or failure. This is extremely absurd. I have examined its meaning. "Tai" means beginning or origin, as in Taiji (Supreme Ultimate) or Taiyi (Great One). "Su" means substance or essence, as in "white comes after painting" (referring to the plain background). This supposedly refers to the pulse of primordial essence. What kind of pulse is this? It refers to Yuan Qi (Original Qi). Li Dongyuan stated that Yuan Qi is another name for Weiqi (Stomach Qi). The pulse of Stomach Qi, as described by Cai Xishan, is neither too long nor too short, neither too sparse nor too rapid, neither too large nor too small, harmonious and moderate under the fingers, vibrant yet indescribable. Healthy individuals possess this pulse. Using this pulse to determine health or illness is acceptable; using it to determine wealth or status is not. Why? Because the pulse of Stomach Qi is indescribable. What basis is there for diagnosing status?
Looking at the Taisu books, despite the name, the content never mentions the meaning of Taisu. The rhyming verses are mostly colloquial and lack logical depth. Their original intent was likely just a pretext for profit. Later generations, failing to investigate, adopted these practices without criticism. Some argue: "Taisu" refers to the innate destiny of status determined at birth, which can be read via the pulse, not that the pulse itself is named Taisu. I reply: Even so, the pulse diagnosed must fall within the Twenty-Four Pulse categories. Since each pulse indicates a disease, how can wealth or status be determined? If the pulse is Floating, indicating Wind, would a Taisu practitioner say it is Wind or status? They cannot be both. If they say Wind, they are diagnosing disease. If they ignore disease to discuss status, they cannot even know the immediate illness, let alone distant fate. Status and fortune are external matters unrelated to blood and qi. How can they be known via pulse? Moreover, pulse changes constantly, and seasons vary, so pulses differ by season and are not static. A pulse found today may change tomorrow; a spring pulse may differ in summer. How can a momentary palpation determine a lifetime of fortune? Even if guesses happen to be correct, it is grasping at shadows. There is no fixed rule. Alas! If diagnosing disease via pulse requires Observation, Listening, and Inquiry to be accurate, how can one predict status? If pulse could predict status, Zhou Gong's *I Ching*, Shao Yong's numerology, Xi Yi's physiognomy, and Ziping's astrology would be unnecessary. Why would sages bother? Why do people still discuss divination and astrology instead of using the simple pulse method? Pulse studies originated with Qibo and Huangdi, developed by Qin Yueren, and detailed by Shuhe. A thorough review of *Suwen*, *Nanjing*, and *Mai Jing* reveals no mention of this. It is not hidden; it is simply factually impossible. If true, ancients would have done it first. Chao Yuanfang said: Taisu pulse is essentially physiognomy disguised as pulse diagnosis. This truth breaks the delusion of later generations.
There are also cunning practitioners who gather information through conversation and deceive during palpation. This is even lower and unworthy of discussion.
However, humans are born with varying degrees of clarity and turbidity due to Heaven and Earth Qi. Those with clear Qi have clear forms, clear blood/qi, and clear pulses—round, clean, and distinct in rhythm. Diagnosing this, I can only infer nobility and wealth. I cannot predict specific years of exams, promotions, wealth, or children. Those with turbid Qi have turbid forms, turbid blood/qi, and turbid pulses—heavy, muddy, and chaotic. Diagnosing this, I can only infer poverty and low status. I cannot predict specific times of misfortune, financial loss, widowhood, or child loss. Some have unclear forms but clear pulses (clarity within turbidity), indicating more success than failure. Some have clear forms but turbid pulses (turbidity within clarity), indicating more failure than success. Some have neither clear nor turbid forms/pulses, with balanced floating/sinking and size, indicating stability without great gain or loss. Wealthy and long-lived people have Clear and Long pulses; poor and short-lived people have Turbid and Cursory pulses. Clear and Cursory indicates wealthy but short-lived; Turbid and Long indicates poor but long-lived. Other details are incomplete; students should extrapolate from this. This is my rational explanation of predicting status via pulse. I dare not fabricate stories to deceive. Alas! I wrote this because everyone praises Taisu pulse uncritically, spreading false reputations. Even if wrong, they cover for each other, misleading themselves and others. What benefit is there? Also, patients often hide their symptoms, remaining silent even when asked, causing distress to doctors. This is a common societal flaw, prompting my detailed explanation to awaken the ignorant. Mencius said: "Do I enjoy debating? I have no choice." (The Canon states: Spring wind injury leads to autumn diarrhea; Summer heat injury leads to autumn malaria; Autumn dampness injury leads to winter cough; Winter cold injury leads to spring warmth diseases. Wang Andao commented: Can one know before illness onset which meridian, organ, or disease pattern will result? Only after onset can diagnosis reveal the specific meridian, organ, and disease. Diarrhea, malaria, cough, and warmth diseases are identified retrospectively based on obvious symptoms, tracing back to wind, heat, dampness, or cold injury. One cannot predict the specific disease at the moment of initial injury. Wang Ji notes: Pathogens enter skin and meridians, appearing in arteries, theoretically diagnosable. But Wang Andao argues that pre-symptomatic diagnosis is difficult. Wealth and status are heavenly destiny, external matters, unlike pathogens entering blood vessels. How can pulse diagnose them? Wang Andao's argument refutes Taisu. I include it to show future generations.)