经曰∶“调其脉之缓急大小滑涩，而病变定矣。”盖谓六者足以定诸脉之纲领也。又曰∶“小
大滑涩浮沉。”《难经》则曰∶“浮沉长短滑涩。”仲景曰∶“弦紧浮沉滑涩，此六者名为残贼，能
为诸脉作病。”滑伯仁曰∶“提纲之要，不出浮沉迟数滑涩之六脉。夫所谓不出于六者，亦其
足统表里阴阳、虚实冷热、风寒湿燥、脏腑血气之病也。浮为阳为表诊为风为虚。沉为阴为
里，诊为湿为实。迟为在脏，为寒为冷。数为在腑，为热为燥。滑为血有余。涩为气独滞。”此诸
说者，词虽稍异，义实相通。若以愚意论之，不出表里寒热虚实六者之辨而已。如浮为在表，
则散大而芤可类也。沉为在里则细小而伏可类也。迟者为寒则徐缓涩结之属可类也。数
者为热，则洪滑疾促之属可类也。虚者为不足，则短濡微弱之属可类也。实者为有余，则弦
紧动革之属可类也。此皆大概，人所易知。然即六者之中，复有相悬之要，则人或不能识，似
是而非误非浅矣。夫浮为表矣而凡阴虚者，脉必浮而无力，因真阴脱于下，而孤阳浮于上，
是浮不可以概言表，而可升散乎！沉为里矣，而凡表邪初感之盛者，阴寒束于皮毛，阳气不
能外达，则脉必先沉紧，是沉不可以概言里，而可攻下乎！迟为寒矣，而伤寒初退，余热未清，
脉多迟滑，是迟不可以概言寒，而可温中乎！数为热矣，而凡虚损之候，阴阳俱亏，气血败乱
者，脉必急数，愈数者愈虚，愈虚者愈数，是数不可以概言热，而可寒凉乎！微细类虚矣，而痛
极壅闭者，脉多伏匿，是伏不可以概言虚，而可骤补乎！洪弦类实矣，而真阴大亏者，必关格
倍常，是弦不可以概言实，而可消之乎！乃知诊法于纲领之中，而复有大纲领者存焉。设不
能以四诊相参，而欲孟浪任意，未有不覆人于反掌间者。
《黄帝内经》说：“通过调节脉象的缓、急、大、小、滑、涩，病变就能确定。”这说的是这六种脉象足以作为各种脉象的纲领。又说：“小、大、滑、涩、浮、沉。”《难经》则说：“浮、沉、长、短、滑、涩。”张仲景说：“弦、紧、浮、沉、滑、涩，这六种脉象被称为‘残贼’（指能损害人体正气并导致其他病证的脉象），能够引起各种脉象的病证。”滑伯仁说：“提纲挈领的关键，不出浮、沉、迟、数、滑、涩这六种脉象。所谓不出于这六种，是因为它们足以统摄表里、阴阳、虚实、冷热、风寒湿燥以及脏腑血气方面的病证。浮脉属阳、属表，诊为风邪或虚证；沉脉属阴、属里，诊为湿邪或实证；迟脉主脏病，主寒、主冷；数脉主腑病，主热、主燥；滑脉主血有余；涩脉主气机独滞。”这些说法，言辞虽然略有不同，但义理实际上是相通的。如果按我的观点来论述，不过是分辨表、里、寒、热、虚、实这六者罢了。比如浮脉主在表，那么散脉、大脉和芤脉都可以归类于此；沉脉主在里，那么细脉、小脉和伏脉都可以归类于此；迟脉主寒，那么徐缓、涩脉和结脉等都可以归类于此；数脉主热，那么洪脉、滑脉、疾脉和促脉等都可以归类于此；虚脉主不足，那么短脉、濡脉、微脉和弱脉等都可以归类于此；实脉主有余，那么弦脉、紧脉、动脉和革脉等都可以归类于此。这些都是大概的情况，人们容易知晓。然而就在这六者之中，又有相互区别的关键要点，人们如果不能识别，似是而非的错误就不浅了。浮脉主表，但是凡是阴虚的患者，脉象必然浮而无力，这是因为真阴脱失于下，孤阳浮越于上，所以浮脉不可以一概而论为表证，难道可以用升散法治疗吗？沉脉主里，但是凡是外感表邪初起且盛行的患者，阴寒束缚于皮毛，阳气不能向外通达，脉象必然先呈现沉紧，所以沉脉不可以一概而论为里证，难道可以用攻下法治疗吗？迟脉主寒，但是伤寒初退，余热未清时，脉象多呈迟滑，所以迟脉不可以一概而论为寒证，难道可以用温中法治疗吗？数脉主热，但是凡是虚损的症状，阴阳俱亏，气血败乱时，脉象必然急促快速，越是数脉表示越虚，越是虚弱表示脉越数，所以数脉不可以一概而论为热证，难道可以用寒凉法治疗吗？微脉、细脉类似虚证，但是疼痛极度壅闭时，脉象多潜伏隐匿，所以伏脉不可以一概而论为虚证，难道可以骤然进补吗？洪脉、弦脉类似实证，但是真阴严重亏损时，脉象必现关格且超过常度，所以弦脉不可以一概而论为实证，难道可以用消导法治疗吗！由此可知，诊法在纲领之中，还有更宏观的纲领存在。如果不以望、闻、问、切四诊合参，却想要鲁莽随意地诊治，没有不在顷刻间使病人陷入危境的。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "By adjusting the pulse's slow, rapid, large, small, slippery, and choppy qualities, the pathological changes can be determined." This implies that these six qualities are sufficient to serve as the guidelines for all pulses. It further states: "Small, large, slippery, choppy, floating, and sunken." The *Nan Jing* (Classic of Difficult Issues) states: "Floating, sunken, long, short, slippery, and choppy." Zhang Zhongjing states: "Wiry, tight, floating, sunken, slippery, and choppy; these six are named 'harmful pathogens' (pathogenic factors that damage healthy qi and induce other pathological pulses), capable of causing diseases in various pulses." Hua Boren states: "The essence of outlining the pulse does not go beyond the six types: floating, sunken, slow, rapid, slippery, and choppy. The reason they do not go beyond these six is that they are sufficient to govern diseases related to exterior-interior, yin-yang, deficiency-excess, cold-heat, wind-cold-dampness-dryness, and zang-fu organs and blood-qii. Floating indicates yang and exterior, diagnosed as wind or deficiency. Sunken indicates yin and interior, diagnosed as dampness or excess. Slow indicates involvement of the zang organs, cold, and chill. Rapid indicates involvement of the fu organs, heat, and dryness. Slippery indicates an excess of blood. Choppy indicates stagnation of qi alone." Although the wording of these various theories differs slightly, their meanings are essentially consistent. In my opinion, it boils down to distinguishing between the six categories: exterior, interior, cold, heat, deficiency, and excess. For instance, since floating indicates the exterior, the scattered, large, and hollow pulses can be categorized similarly. Since sunken indicates the interior, the fine, small, and deep-hidden pulses can be categorized similarly. Since slow indicates cold, the leisurely, choppy, and knotted pulses can be categorized similarly. Since rapid indicates heat, the surging, slippery, fast, and intermittent pulses can be categorized similarly. Since deficiency indicates insufficiency, the short, soggy, minute, and weak pulses can be categorized similarly. Since excess indicates surplus, the wiry, tight, moving, and leathery pulses can be categorized similarly. These are general principles, easily understood by people. However, among these six, there are crucial distinctions that may not be recognized by some, leading to significant errors of mistaking the similar for the correct. Floating indicates the exterior, yet in cases of yin deficiency, the pulse must be floating but forceless, because true yin has depleted below, leaving lone yang to float above. Therefore, floating cannot be universally equated with the exterior, nor should dispersing and ascending methods be used! Sunken indicates the interior, yet when exterior pathogenic factors are initially contracted and vigorous, with yin-cold binding the skin and hair, preventing yang qi from reaching the exterior, the pulse will first appear sunken and tight. Therefore, sunken cannot be universally equated with the interior, nor should purgative methods be used! Slow indicates cold, yet after the initial decline of cold damage, if residual heat remains unclarified, the pulse is often slow and slippery. Therefore, slow cannot be universally equated with cold, nor should warming middle-jiao methods be used! Rapid indicates heat, yet in conditions of deficiency and wasting, where both yin and yang are depleted and blood and qi are chaotic, the pulse must be urgent and rapid. The more rapid, the more deficient; the more deficient, the more rapid. Therefore, rapid cannot be universally equated with heat, nor should cooling methods be used! Minute and fine resemble deficiency, yet in cases of extreme pain and obstruction, the pulse often hides deeply. Therefore, hidden pulses cannot be universally equated with deficiency, nor should sudden tonification be applied! Surging and wiry resemble excess, yet when true yin is severely depleted, the pulse at the guan position may exceed normal limits significantly. Therefore, wiry cannot be universally equated with excess, nor should resolving methods be used! Thus, we know that within the guidelines of pulse diagnosis, there exists a higher-level guideline. If one does not integrate the four diagnostic methods (inspection, auscultation-olfaction, inquiry, and palpation), but instead acts rashly and arbitrarily, there will inevitably be those who cause harm to patients in the blink of an eye.