（出丹溪）
脉之状不一。大率多兼见。人之病有四。曰寒、曰热、曰虚、曰实。故学诊者亦必以浮沉迟数
为之纲。以察病情。初学人又以浮数为热为有余。沉迟为寒为不足。其间最难体认者。涩脉也。最
难调治者。弦脉也。涩脉细而迟。往来难。且散。又曰短而止。皆是不足之象。得此脉者。固为寒。
为湿。为血少。为气多。为污血。然亦有病热与实者。不可不知。或因多怒。或因忧郁。或因浓味。
或因补剂。或因无汗。气腾血沸。清化为浊。老痰宿饮。胶固杂揉。脉道阻涩。亦见涩状。若重取
至骨。来似有力。且带数。以意参之于证。验之形气。但有热证。当作实热可也。医于指下见有不
足之象。便以为虚为寒。用药热补。误人多矣。弦为春令之脉。非春时而见木为病也。五脏更相制伏。
以防其太过。木为病则肝邪盛矣。肝之盛。金之衰也。金之衰。火之炎也。火之炎。水之弱也。金
不足以制木。则土病矣。考之诸家。皆曰弦者虚也。为反胃。为痛。沉弦为悬饮。弦长为积病。弦
紧而细主 。弦而伏主 不治。弦急为腹痛。弦而钩主蜚尸。弦小主寒痹。弦而大。主半产漏下。
亡血失精。双弦为寒。双弦而迟为心下坚。偏弦为饮。左寸弦头痛。右寸弦水走肠胃。左关弦怒而
血聚。右关弦寒痛四肢拘急。趺阳弦肠痔下血。尺中弦小腹痛。回肠结核。率是木邪风气。土极士
败为病。先哲常言之矣。惟金因火伏。木寡于畏之论。尚未发明。倘非滋水以降火。浓土以养金。
加以行湿散风导郁。为之辅佐。邪何由去。病何由安。况弦脉为病甚多。而治法又有隔二隔三之远。
故不容不辨。若曰不然。夫弦属阳。而仲景列于五阴之数。至于叙六残贼之脉。又以弦为之首。涩
为之终。其意可见。又云。痈疽而得浮洪弦数。气病脉也。岂可据此作热论。沉细弱涩。血病脉也。
岂可据此作寒论。此万病之根本。非特痈疽而已。（机按。丹溪论涩弦二脉。及痈疽之脉主病。
与诸家所主大不相侔。夫脉藏于血脉之中。形之于脉。宜其同也。何脉同而病异耶。此脉所以难凭。
务须观形而审证也。噫。脉本以察病。而病尚难以脉决。彼富贵贫贱。乃外来假设之事。非藏于
血脉中也。所谓赵孟所贵。赵孟能贱。岂得形之于脉。而可以脉之乎。）
（出自朱丹溪）
脉象的形态多种多样。大体上大多兼见其他脉象。人的疾病主要有四种：寒、热、虚、实。因此，学习诊脉的人必须以浮脉（轻取即得）、沉脉（重按始得）、迟脉（脉搏跳动缓慢）、数脉（脉搏跳动快速）作为纲领，来察辨病情。初学者往往认为浮脉和数脉属于热证、有余之证，沉脉和迟脉属于寒证、不足之证。其中最难体察辨认的是涩脉（往来艰涩不畅），最难调治的是弦脉（端直以长，如按琴弦）。
涩脉细而迟，往来艰难，且散乱无根，又说是短促且有止歇，这些都是正气不足的征象。得到这种脉象的人，固然可能是寒证、湿证、血少、气多、瘀血。然而也有病属热证和实证的情况，不可不知道。有的因为经常发怒，有的因为忧郁，有的因为食用浓味厚腻食物，有的因为服用补药，有的因为无汗，导致气机升腾、血液沸腾，清液转化为浊邪，老痰和陈年停饮胶结固着、混杂揉聚，阻碍脉道，因而也出现涩脉的形态。如果重取至骨，感觉来势似乎有力，并且带有数脉的特征，用心参合症状，验证形体和气色，只要有热证的表现，就应当当作实热证来处理。医生在指下见到不足的象，便以为是虚证或寒证，用药进行温补，误人太多了。
弦脉是春季正常的脉象，如果不是春季却出现弦脉，就是木行（肝）为病。五脏之间相互制约，以防其太过。木行发病则肝邪亢盛了。肝的亢盛，是因为金的衰弱；金的衰弱，是因为火的炎上；火的炎上，是因为水的虚弱。金不足以制约木，那么土就会生病。考察各家论述，都说弦脉主虚证，主反胃，主疼痛。沉弦主悬饮（水饮停聚胸胁），弦长主积聚病，弦紧而细主某种病症（原文此处可能有脱漏，通常指痛或疝），弦而伏主不治之症，弦急主腹痛，弦而钩主蜚尸（一种急性传染病或怪病），弦小主寒痹，弦而大主半产漏下（流产或不规则阴道出血），亡血失精。双弦主寒证，双弦而迟主心下痞硬，偏弦主饮邪。左寸部弦主头痛，右寸部弦主水气走窜肠胃，左关部弦主易怒且气血郁结，右关部弦主寒痛及四肢拘急，趺阳部弦主肠痔下血，尺中脉弦主小腹疼痛及回肠结核。大率都是木邪风气所致，土极衰败而为病。先哲常常谈论过这一点。只有“金因火伏”、“木寡于畏”的理论，尚未完全阐明。如果不是滋水以降火，厚土以养金，加上祛湿、散风、导滞的方法作为辅助，邪气如何能去除？疾病如何能安宁？况且弦脉所主的疾病很多，而治疗方法又有隔二脏、隔三脏的深远关系，所以不容不加以辨别。如果说不是这样，弦脉属阳，但张仲景将其列在五阴脉的数量之中。至于叙述六种贼邪之脉时，又以弦脉为首，涩脉为终，其中的意旨可以想见。又说，痈疽若得浮洪弦数之脉，是气分病变的脉象，难道可以据此作为热证论治吗？沉细弱涩之脉，是血分病变的脉象，难道可以据此作为寒证论治吗？这是万病的根本，不仅仅是痈疽而已。（朱震亨按语：丹溪论述涩脉、弦脉以及痈疽脉象的主病，与各家主张大不相同。脉藏于血脉之中，显现于脉象，按理应该相同。为什么脉象相同而疾病不同呢？这就是脉象难以凭信的原因，务必观察形体并审察症状。唉！脉本用来察病，但疾病尚且难以仅凭脉象决断。那些富贵贫贱，乃是外在假设的事情，并不藏在血脉中。所谓赵孟所尊贵的，赵孟也能使其卑贱，怎么能表现在脉象上，并依据脉象来判断呢？）
(From Zhu Danxi)
The manifestations of the pulse are diverse. Generally, they often appear in combination. Human diseases fall into four categories: Cold (Han), Heat (Re), Deficiency (Xu), and Excess (Shi). Therefore, those learning pulse diagnosis must take Floating (Fu), Sinking (Chen), Slow (Chi), and Rapid (Shu) pulses as the guiding principles to examine the condition of the disease. Beginners often consider Floating and Rapid pulses as signs of Heat and Excess, while Sinking and Slow pulses as signs of Cold and Deficiency. Among these, the most difficult to discern is the Choppy (Se) pulse, and the most difficult to treat is the String-taut (Xian) pulse.
The Choppy pulse is fine and slow, with a difficult and scattered flow; it is also described as short and intermittent. These are all indications of Deficiency. Patients presenting this pulse may indeed suffer from Cold, Dampness, Blood deficiency, Qi excess, or Stasis (Wuxue). However, cases of Heat and Excess also exist, which must not be overlooked. Some arise from frequent anger, depression, consumption of rich and greasy foods, use of tonifying agents, or anhidrosis (lack of sweating), leading to soaring Qi and boiling Blood, where clear fluids transform into turbid pathogens. Old phlegm and retained fluid become sticky and mixed, obstructing the pulse vessels, thereby producing a Choppy appearance. If deep pressure reveals a seemingly forceful onset accompanied by a Rapid quality, one must carefully correlate symptoms with physical constitution and qi-spirit. If heat signs are present, it should be treated as Excess Heat. Many doctors have erred by seeing signs of insufficiency under their fingers and assuming Deficiency or Cold, prescribing hot tonics, thus harming many patients.
The String-taut pulse is the normal pulse of Spring. If seen outside of spring, it indicates pathology of Wood (Liver). The five zang organs mutually restrain each other to prevent excess. When Wood pathology occurs, Liver Evil becomes excessive. Liver excess implies Metal deficiency; Metal deficiency implies Fire flaring up; Fire flaring up implies Water weakness. When Metal fails to restrain Wood, Earth becomes diseased. Reviewing various schools of thought, it is generally stated that the String-taut pulse indicates Deficiency, Regurgitation (Fanwei), and Pain. A Sinking-String-taut pulse indicates Suspended Fluid (Xuanyin); a Long-String-taut pulse indicates Accumulation disorders (Jibing); a Tight-and-fine String-taut pulse indicates [omitted in original]; a Hidden-String-taut pulse indicates untreatable conditions; a Urgent-String-taut pulse indicates abdominal pain; a Hooked-String-taut pulse indicates Feishi (a type of acute epidemic or strange disease); a Small-String-taut pulse indicates Cold Bi syndrome; a Large-String-taut pulse indicates miscarriage with continuous bleeding, loss of blood, and essence depletion. Bilateral String-taut pulses indicate Cold; bilateral String-taut and slow pulses indicate hardness below the heart; unilateral String-taut pulses indicate Fluid retention. A String-taut pulse at the Left Cun position indicates headache; at the Right Cun, water moving through the intestines and stomach; at the Left Guan, irritability and blood stasis; at the Right Guan, cold pain and limb rigidity; at the Duyang position, intestinal hemorrhoids and bloody stool; at the Chi position, lower abdominal pain and intestinal tuberculosis. These are largely caused by Wind-Evil of Wood, leading to extreme failure of Earth. This has been frequently discussed by ancient sages. However, the theories of "Metal suppressed by Fire" and "Wood lacking fear" remain unclarified. Unless one nourishes Water to descend Fire, thickens Earth to nourish Metal, and adds methods to move Dampness, scatter Wind, and guide stagnation as auxiliaries, how can the evil pathogen be expelled and the disease be cured? Moreover, since String-taut pulses are associated with many diseases, and treatment methods involve distant relationships between organs (Ge Er, Ge San), differentiation is essential.
If one argues otherwise: The String-taut pulse belongs to Yang, yet Zhang Zhongjing listed it among the Five Yin pulses. In describing the Six Zaire (Trespasser) pulses, he placed String-taut first and Choppy last, revealing his intent. He also stated that if carbuncles and sores present with Floating, Surging, String-taut, and Rapid pulses, it indicates Qi pathology; can one diagnose this as Heat based solely on this? If they present with Sinking, Fine, Weak, and Choppy pulses, it indicates Blood pathology; can one diagnose this as Cold based solely on this? This concerns the root of all diseases, not just carbuncles and sores. (Zhu Zhenheng's Note: Danxi’s discussion on Choppy and String-taut pulses, and their association with carbuncles and sores, differs significantly from other schools. Since the pulse resides within the blood vessels and manifests externally, it should theoretically be consistent. Why do identical pulses correspond to different diseases? This is why pulse diagnosis is difficult to rely upon; one must observe the physical form and scrutinize the symptoms. Alas! The pulse is meant to examine disease, yet disease cannot always be determined by the pulse alone. Wealth and poverty are external, hypothetical circumstances not stored within the blood vessels. As the saying goes, "What Zhao Meng honors, Zhao Meng can humble." How can such external factors manifest in the pulse and be judged by it?)