体象 沉行筋骨，如水投石；按之有余，举之不足。
沉之为义，如石之沉水底也。其脉近在筋骨，非重按不可得，有深深下沉之势。
主病 沉脉为阴，其病在里。左寸沉者，心寒作痛。沉在左关，气不得申。左尺得沉，精寒血结。
右寸沉者，痰停水蓄。沉在右关，胃寒中满。右尺得沉，腰痛病水。
五脏属阴，其应在里，故沉主里病也。心失煦燠之权，为寒所制则痛。木失条达之性，为寒所遏则结。肾
主精血，若有阴而无阳，譬之水寒则凝。肺位高脉浮，布一身之阴阳者也。倘使倒置，则真气不运，而或
痰或水为害。脾胃喜温，不浮不沉，是其候也。脉形偏于近下，则土位无母，何以营运三焦，熟腐五谷，中
满吞酸之证至矣。腰脐以下，皆肾主之。右肾真火所寓，而元阳痼冷，则精血衰败，腰脚因之不利。病水
者，肾居下焦，统摄阴液，右为相火，火既衰熄，则阴寒之水不得宣泄。
兼脉 无力里虚，有力里实。沉迟痼冷，沉数内热。沉滑痰饮，沉涩血结。沉弱虚衰，沉牢坚积。
沉紧冷疼，沉缓寒湿。
无力里原非实，但气不申；有力有物在里。沉为在里而复迟，虚寒可必；沉为在里而加数，伏热何疑？滑
则阴凝之象也，见于沉分，宜有痰饮；涩则血少之征也，按而后得，应为积血。沉为阴，弱为虚，沉弱必主
阴虚；沉为里，牢为积，沉牢定为痼冷。沉而紧则寒为敛实，故冷痛也；沉而缓则阳不健行，故湿成焉。
按沉脉法地，重浊在下之象，在卦为坎，在时为冬，在人为肾。《素问·玉机真藏论》曰∶“黄帝曰∶‘冬脉
如营，何如而营？’岐伯对曰∶‘冬脉，肾也，北方之水也，万物所以合藏，其气来沉以软，故曰营。其气如弹
石者，此为太过，病在外，令人解 ，脊脉痛而少气，不欲言。其虚如数者，此谓不及，病在中，令人心悬如
饥，胫中清，脊中痛，小腹痛，小便黄赤。’”《素问·平人气象论》曰∶“平肾脉来，喘喘累累如钩，按之而
坚，曰肾平。冬以胃气为本。病肾脉来，如引葛，按之益坚，曰肾病。死肾脉来，发如夺索，辟辟如弹石，曰肾
死。”杨氏曰∶“如绵裹砂，内刚外柔；审度名义，颇不相戾。”伪诀云∶“缓度三关，状如烂绵。”则是弱脉而
非沉脉矣。若缓度三关，尤不可晓。须知沉而细软为弱脉，沉而弦劲为牢脉，沉而着骨为伏脉，刚柔浅
深之间，宜熟玩而深思也。
肾之为藏，配坎应冬，万物蛰藏；阳气下陷，冽为雪霜；故脉主沉阴而居里。若误与之汗，则如飞蛾出而
见汤矣。此叔和入理之微言，后世之司南也。
【脉象特征】
沉脉的脉体位于筋骨之间，就像石头投入水中一样下沉；重按时感觉脉搏有力，轻取时感觉脉搏不足。
沉脉的含义，就像石头沉入水底一样。其脉位靠近筋骨，必须重按才能触及，呈现出深深下沉的趋势。
【主病】
沉脉属于阴脉，所主的病症在里。左寸部出现沉脉，表示心寒导致疼痛。沉脉出现在左关部，表示气机不得舒展。左尺部出现沉脉，表示精寒血结。
右寸部出现沉脉，表示痰饮停聚、水液蓄积。沉脉出现在右关部，表示胃寒且中焦胀满。右尺部出现沉脉，表示腰痛或水肿病。
五脏都属于阴，其对应病位在里，所以沉脉主要主里证。心失去温煦的功能，被寒气制约就会疼痛。肝木失去条达的特性，被寒气遏制就会郁结。肾主管精血，如果只有阴而没有阳，就像水寒冷而凝结一样。肺的位置高，脉象应浮，是布散一身阴阳的器官。倘若脉象倒置（肺脉反沉），则真气不能运行，从而产生痰或水的危害。脾胃喜欢温暖，脉象不浮不沉是其正常征候。脉形偏向近下（沉），则脾土之位没有母气（火不生土），凭什么营运三焦，腐熟五谷，于是中焦胀满、吞酸等症状就出现了。腰脐以下，都由肾所主。右肾是真火寄居之处，如果元阳痼冷，则精血衰败，腰脚因此不利。患水肿病的人，肾居下焦，统摄阴液，右肾为相火，火既衰熄，则阴寒之水不得宣泄。
【兼脉】
沉而无力主里虚，沉而有力主里实。沉迟脉主久治不愈的寒冷，沉数脉主内部热邪。沉滑脉主痰饮，沉涩脉主血结。沉弱脉主虚衰，沉牢脉主坚硬的积聚。沉紧脉主冷痛，沉缓脉主寒湿。
沉而无力，原本就不是实证，只是气机不畅；沉而有力，说明里有实物。沉脉在里又见迟象，虚寒是可以确定的；沉脉在里又加数象，伏热有什么可怀疑的呢？滑脉是阴凝之象，出现在沉分，应当有痰饮；涩脉是血少的征象，重按后才得，应当是积血。沉属阴，弱属虚，沉弱必主阴虚；沉主里，牢主积，沉牢定为痼冷。沉而紧，则寒邪收敛结实，所以冷痛；沉而缓，则阳气不健行，所以湿气形成。
按沉脉法地，是重浊在下之象，在八卦中属于坎卦，在季节中对应冬季，在人体对应肾脏。《素问·玉机真藏论》说：“黄帝问：‘冬脉如营，怎样才算营？’岐伯回答说：‘冬脉，就是肾，是北方的水，万物因此合藏，其气来势沉而软，所以叫营。其气像弹石一样的，这是太过，病在外，使人懈怠嗜卧，脊脉痛而少气，不想说话。其气像数脉一样的，这叫不及，病在中，使人心中悬空如饥，胫中清冷，脊中痛，小腹痛，小便黄赤。’”《素问·平人气象论》说：“正常的肾脉来势，喘喘累累如钩，按之坚实，叫做肾平。以冬季胃气为本。病变的肾脉来势，像牵引葛藤，按之更加坚实，叫做肾病。死亡的肾脉来势，像夺索一样，辟辟像弹石，叫做肾死。”杨氏说：“像棉裹砂，内刚外柔；审度名义，颇不相违背。”伪诀说：“缓度三关，状如烂绵。”这是弱脉而不是沉脉了。如果是缓度三关，尤其不可理解。须知沉而细软为弱脉，沉而弦劲为牢脉，沉而着骨为伏脉，刚柔深浅之间，应该熟玩而深思。
肾作为脏，配坎卦应冬季，万物蛰伏收藏；阳气下陷，凛冽化为雪霜；所以脉象主沉阴而居于里。如果误用发汗法，就像飞蛾扑火一样自取灭亡。这是王叔和深入医理的微言，是后世的指南针。
[Characteristics of Pulse Image]
The *Chen Mai* (Sinking Pulse, 沉脉) is located between the muscles and bones, sinking like a stone thrown into water; it feels forceful upon heavy pressure but insufficient upon light palpation.
The meaning of the *Chen Mai* (Sinking Pulse, 沉脉) is like a stone sinking to the bottom of water. Its position is close to the tendons and bones, requiring heavy pressure to be felt, presenting a deeply sinking trend.
[Main Diseases]
The *Chen Mai* (Sinking Pulse, 沉脉) belongs to Yin, and the diseases it indicates are in the interior (*Li*, 里). If the *Chen Mai* (Sinking Pulse, 沉脉) appears at the left Cun position (寸部), it indicates heart cold causing pain. If the *Chen Mai* (Sinking Pulse, 沉脉) appears at the left Guan position (关部), it indicates Qi stagnation failing to extend. If the *Chen Mai* (Sinking Pulse, 沉脉) is found at the left Chi position (尺部), it indicates cold essence and blood coagulation.
If the *Chen Mai* (Sinking Pulse, 沉脉) appears at the right Cun position (寸部), it indicates phlegm retention and fluid accumulation. If the *Chen Mai* (Sinking Pulse, 沉脉) appears at the right Guan position (关部), it indicates stomach cold and middle-jiao fullness. If the *Chen Mai* (Sinking Pulse, 沉脉) is found at the right Chi position (尺部), it indicates lower back pain or edema disease.
The Five Zang Organs (五脏) all belong to Yin, and their corresponding pathological positions are in the interior; therefore, the *Chen Mai* (Sinking Pulse, 沉脉) mainly indicates interior diseases. When the Heart loses its warming power and is constrained by cold, pain occurs. When Liver Wood loses its free-flowing nature and is suppressed by cold, coagulation occurs. The Kidney governs essence and blood; if there is Yin without Yang, it is like water freezing due to cold. The Lung is high in position and its pulse should be floating, as it distributes Yin and Yang throughout the body. If the pulse image is inverted (Lung pulse sinks instead of floats), then True Qi cannot circulate, leading to harm from phlegm or water. The Spleen and Stomach prefer warmth, and a pulse that is neither floating nor sinking is their normal sign. If the pulse form leans towards the deeper level (sinking), the Earth element lacks its mother (Fire not generating Earth); how can it then transport the San Jiao (Triple Burner, 三焦) and ripen/cook the five grains? Thus, symptoms of middle-jiao fullness and acid regurgitation arise. From the waist down to the navel, everything is governed by the Kidney. The Right Kidney is where the True Fire resides; if Original Yang is entrenched with cold, essence and blood decline, causing disadvantage in the waist and legs. In edema disease, the Kidney resides in the Lower Jiao (下焦) and controls Yin fluids; the Right Kidney is the location of Ministerial Fire (相火). Once this fire declines and extinguishes, Yin-cold water cannot be excreted.
[Combined Pulses]
A *Chen Mai* (Sinking Pulse, 沉脉) that is weak indicates Interior Deficiency (*Li Xu*, 里虚); one that is forceful indicates Interior Excess (*Li Shi*, 里实). A *Chen Chi Mai* (Sinking-Slow Pulse, 沉迟脉) indicates entrenched cold; a *Chen Shu Mai* (Sinking-Rapid Pulse, 沉数脉) indicates internal heat. A *Chen Hua Mai* (Sinking-Slippery Pulse, 沉滑脉) indicates phlegm-fluids; a *Chen Se Mai* (Sinking-Choppy Pulse, 沉涩脉) indicates blood coagulation. A *Chen Ruo Mai* (Sinking-Weak Pulse, 沉弱脉) indicates deficiency and decline; a *Chen Lao Mai* (Sinking-Firm Pulse, 沉牢脉) indicates hard accumulations. A *Chen Jin Mai* (Sinking-Tight Pulse, 沉紧脉) indicates cold pain; a *Chen Huan Mai* (Sinking-Slow/Relaxed Pulse, 沉缓脉) indicates cold-dampness.
A *Chen Mai* (Sinking Pulse, 沉脉) that is weak is originally not an excess condition, but merely Qi failing to flow freely; a *Chen Mai* (Sinking Pulse, 沉脉) that is forceful indicates a pathogenic factor in the interior. A *Chen Mai* (Sinking Pulse, 沉脉) in the interior combined with a Slow rate (*Chi*, 迟) confirms deficiency-cold; a *Chen Mai* (Sinking Pulse, 沉脉) in the interior combined with a Rapid rate (*Shu*, 数) leaves no doubt about hidden heat. Slipperiness (*Hua*, 滑) is a sign of Yin condensation; appearing in the *Chen* (Sinking) layer, it suggests phlegm-fluids. Choppy quality (*Se*, 涩) is a sign of blood deficiency; felt only after heavy pressure, it indicates accumulated blood. *Chen* (Sinking) is Yin, *Ruo* (Weak) is Deficiency; *Chen Ruo* must indicate Yin Deficiency. *Chen* (Sinking) indicates Interior, *Lao* (Firm) indicates Accumulation; *Chen Lao* definitely indicates entrenched cold. *Chen Jin* (Sinking-Tight) means cold contracts and solidifies, hence cold pain; *Chen Huan* (Sinking-Slow) means Yang fails to move vigorously, hence dampness forms.
According to the method of correlating the *Chen Mai* (Sinking Pulse, 沉脉) with Earth, it represents the image of heaviness and turbidity below. In the Eight Trigrams (Bagua, 八卦), it corresponds to Kan (坎); in seasons, to Winter; in the human body, to the Kidney. *Su Wen: Yu Ji Zhen Cang Lun* states: "Yellow Emperor asked: 'The Winter pulse is like Ying (camping/gathering), what does Ying look like?' Qibo replied: 'The Winter pulse is the Kidney, the Water of the North, where all things gather and store. Its Qi comes sinking and soft, hence called Ying. If its Qi is like bouncing stones, this is Excess, disease is external, causing lethargy, spinal pain, shortness of breath, and reluctance to speak. If its Qi is like a rapid pulse, this is Deficiency, disease is internal, causing a feeling of hunger-like emptiness in the heart, cold shins, spinal pain, lower abdominal pain, and yellow-red urine.'" *Su Wen: Ping Ren Qi Xiang Lun* states: "A healthy Kidney pulse comes bustling and continuous like a hook, firm upon pressure, called Healthy Kidney. It takes Stomach Qi as the foundation for Winter. A diseased Kidney pulse comes like pulling a vine, becoming firmer upon pressure, called Diseased Kidney. A dying Kidney pulse comes like pulling a rope, crackling like bouncing stones, called Dying Kidney." Master Yang said: "Like sand wrapped in cotton, internally firm and externally soft; examining the name and meaning, they do not contradict each other." The false prescription says: "Slowly crossing the three positions, resembling rotten cotton." This describes the *Ruo Mai* (Weak Pulse, 弱脉), not the *Chen Mai* (Sinking Pulse, 沉脉). If it slowly crosses the three positions, it is particularly incomprehensible. One must know that *Chen* combined with fine and soft is the *Ruo Mai* (Weak Pulse, 弱脉); *Chen* combined with string-like and vigorous is the *Lao Mai* (Firm Pulse, 牢脉); *Chen* pressing against the bone is the *Fu Mai* (Hidden Pulse, 伏脉). Between hardness/softness and shallow/deep, one should study thoroughly and think deeply.
The Kidney as a Zang Organ corresponds to Kan and Winter, where all things hibernate and store; when Yang Qi sinks, biting cold turns into snow and frost; thus the pulse primarily indicates Sinking-Yin residing in the interior. If mistakenly treated with sweating methods, it is like a moth flying into a flame. This is Wang Shuhe's profound insight into medical principles, serving as the compass for later generations.