七、诊脉要分阴阳、达机理、明偏胜、知平衡、晓转化《素问?阴阳应象大论》云：“善诊者，察色按脉先别阴阳。审清浊而知部分。视喘息听音声而知所苦。观权衡规矩而知病所主。按尺寸，观浮沉、滑濇而知病所生以治，无过以诊则不失矣。”因为人体健康时应保持整体的阴阳平衡，主要是气血和动静的平衡，不论是由于内因或外因，使机体的阴阳失去平衡，势必导致疾病。祖国医学对于任何疾病的诊断和治疗，均为诊察机体的阴阳偏胜，调剂阴阳平衡。所以疾病是机体在一定的条件下，对外界有害因素作用的反应，内因使五脏损伤，不能调剂自身阴阳平衡，致机体对外界环境的适应受到限制，因而发生种种病证。如愤怒太甚肝气横逆，气机滞塞抑郁不舒，则肝阴受损，肝阳偏盛，不论肝阴损伤或肝阳偏盛，都能造成肝脏自身阴阳的不平衡，而致疾病。机体为了自卫，每使气血为抗病的工具，气血旺盛是人体防御疾病和消除疾病的主要机能。任何疾病的侵袭，或外界异物的损伤，人体总是通过气血功能，促使机体的气血津液发生变化，以抗御候病，保持人体健康。故病在表则抗病之机能即趋于表，而脉浮，病势重，则所需要抗病力强，故现洪大滑数之脉，病在内，则人体抗病之机能亦趋向于里，而现沉脉，病在上，则寸大于尺，病在下，则尺大于寸，正气虚，则脉现微细，邪气盛，则脉必洪大；邪在气分，则右脉大于左脉，邪入营分，则左脉偏盛。所以脉象变化是随机体防御性反射作用产生的。用持脉探测阴阳偏盛，作为调剂人体阴阳平衡的主要依据。所以在持脉时，应先分清其为阴脉阳脉表证里证，虚证实证，实证多为外邪之侵袭，虚证皆由正气不足。何为阳脉，如浮大滑数实之类，何谓阴脉，如沉细濇迟微之类。经过精心调治，脉象可随时演变，如浮大之阳脉，多有发热恶寒，心烦热之阳证。由于发热伤津烁液，饮食不思，营养障碍。如因循失治，或治疗欠当，则浮大滑数之阳脉，亦可转变为沉细虚弱之阴脉。体虚气弱者每现沉细虚弱之阴脉，治疗后，气充体健，脉象亦由细弱之阴脉转变为浮滑之阳脉。此即阴阳转化的道理。医者的扶偏救弊，应在阳证热证脉浮大有力，发热不退耗津灼液时，迅予退热排邪，祛病扶正。若脉浮大无力，是热邪过盛，阴津损伤，应速益阴以维阳，祛邪以扶正，都要根据脉象的演变，确定治疗之法则。脉由沉变浮，或由浮转沉，由无力变有力，或由有力转无力，系属病机由里出表，由表内陷，由正气不足而转变为气血渐复之象。医者应据脉象变化推测病机转变，予以扶正祛邪，或先祛邪而后扶正，或扶正中兼寓祛邪。扶正中是育阴还是扶阳，或阴阳俱补，按脉据证，妥善处理，务使立法用药，完全与病情相适应，阴阳相互维系互相制约的理论，对脉象的演变和病机的观察，病情转化、治则的拟订关系密切，阴阳代表机体各脏腑各组织之间、功能和器质之间矛盾着的各个方面。人体的上下内外平衡，各脏腑功能与器质的协调，都是阴阳双方相互依存和相互矛盾的结果。治疗的目的在于调剂机体上下、内外、浮沉、缓急诸方面的阴阳平衡、阳主升散，浮越，躁急。阴主潜敛、蛰藏、柔缓。机体在正常情况下，阳气升散之性，得阴气的潜敛以济之，则升散不致太过，而升降平衡，散敛适中，故能保持正常生理。如阳偏盛则升散太过，而潜敛不及，致阴阳乖和，现头眩心烦脉浮大之证候。脉象的浮大，多由于外邪侵袭，机体为抗御外邪，驱使气血抵御外邪，故脉现浮大，为气血充盛之征，然必有力。若大而无力，为阴虚不能维阳，阳气上泛的虚象。所谓有力，是脉力超过正常。一般正常人脉力假设为五个脉力单位，若脉力在5个脉力单位或6-7单位，都称有力。如在5单位以下，甚至为2-3单位，都称无力。总之差距愈大，阴虚愈甚。若浮取力较弱，重按全无，则为散脉。如浮取脉力超过正常，而重按仅一脉力单位左右，则为革脉。这些脉象都可通过浮沉脉力对比确定。这种脉象调整，应从两方面着手，一浮取有力应抑阳养阴，即削弱阳邪的偏盛，增强阴气潜敛，使之取得暂时的阴阳平衡，即强者抑之，虚者扶之之义。如阴寒偏盛，脉多沉缓或沉细，为升浮之力不足。而潜敛偏胜，阴盛则阳衰，甚则脉现沉迟、沉微，如阴寒暴侵则脉多沉紧。其证候常见脘满腹胀，大便溏泄，四肢厥冷之阴寒症。治宜扶阳温中散寒，新病宜温中散寒为主，久病应扶阳益气，俟沉脉转浮，迟脉转缓即为阳复阴化之佳象。总之阳偏盛，则现浮大滑数之阳脉，阴过强则现沉细濇迟之阴脉，如阴阳平衡，则脉浮沉适中，大小合度，为正常脉。以阳性升浮而阴性潜敛，阳气之升浮，得阴气之潜敛以维系之，方能浮沉适中。阴虚者，当阴气渐复则脉象即由浮而转沉，如因失眠、过劳、烦恼损伤阴气，则脉即由沉而转浮。再生障碍性贫血病人，贫血严重时脉虚数而浮，迨用育阴潜镇，健脾养血之剂，血象渐复，而脉象日趋沉敛，数象渐缓。在阴血渐复、脉象沉静之际，精神清爽，身觉有力，而心悸气短亦不明显。如脉象突然浮越，略有数意，是阴气损伤，不能维持阴阳平衡，应防止近期将有发热出血证候。同时也证实浮与升，沉与降的紧密联系。浮与升即脉浮，机体功能趋向于上与表，沉为人体功能趋向于下于里。如发汗药，为使气血趋表以抗病，同时血压上升，头眩面赤，是表与上的关系。用泄药，为使机能趋向于里于下。外邪未解，而用下药过早，每致外邪内陷，诱发结胸痞症，及邪热内陷之坏病，数脉虽为阳热之体现，如温热症在气分，脉洪大是温热炽盛抗病力强的表现。初期脉多不数，如温热凶猛，或阴气灼伤，则脉滑数，数是阳的特性。迟缓是阴的良能，阳的数急得阴的迟缓维系，脉象方能不急不徐，雍容和缓。当热邪外袭，抗病力猛增，阳气亢盛之际如阴气尚能维持平衡，则脉洪大浮滑而不数或略数，及阴液耗伤，则脉现数，毒热壅盛时，或阴气耗伤，则脉象变数，阴气损伤愈重，数象愈甚。关于阴阳互相维系、相互制约和脉象演变之原理，如不洞悉胸中，对于临床观察病人，不能早期探测疾病的变化，很难作到尽快地阻止疾病的发展。故阴阳互相维系的理论，是脉象演变的规律，探测病机的转化和揆度机体阴阳胜负的主要方法。
八、辨证应以脉证为依据，常见疾病要掌握脉象的演变规律疾病的发生，多由于外邪侵袭，正气之虚损。而抗病机能衰弱，更是致病的主要因素。正如《内经》中所说的“正气存内，邪不可干”。一旦病成，机体由于病理的反应，产生种种不适症候和脉象的变化，临床即据以“辨证”，分析疾病的性质、部位和虚实情况。医者临床辨证，主要依据病人脉证、体质情况，病程长短、病势的强弱进行全面分析，以达到对疾病的正确认识。中医辨证以八纲为辨证纲领，外感病多从六经、卫气营血、三焦辨证入手，内伤病则求之于脏腑辨证。由于外邪侵入的原因、性质、部位不同，而表现出不同的证候和脉象。病邪侵入某经，即呈现出某经之证候，也正由于出现某经之证候，可测知病邪侵入某经。或病邪侵入某脏某腑，即可表现某脏某腑的证候。如邪陷于肝，则有右胁胀痛，脘满心烦喜怒，现弦大之脉证。侵及心可能出现心悸气短胸闷，脉结代不整之脉证。犯脾则有消化不良、腹胀脘闷、食少纳呆，脉弦虚或沉滑之脉症。六经辨证也以脉证为基础，如发热恶寒、头痛项强、为太阳病，其脉必浮。如脉不浮而反沉，虽现发热恶寒之太阳表证，因其脉沉，而称为少阴病。所以六经辨证并非单纯在证候上的分析，更主要的是在脉象上的识别。只有四诊综合运用，脉证兼顾，才能全面了解病情，正确拟订治疗方案。以头晕为例：头晕的原因很多，肝阳上亢，虚阳上泛，痰火上涌，血虚气陷皆可致头晕。如不根据脉象和头眩情况，作深入细致的鉴别，辨证必成空谈。并发症在辨证上，也有一定作用，如认真诊清脉象，即如深夜燃犀，则病情即无所遁其形矣。如头晕脉浮弦伴寒热往来，为少阳病头晕；脉浮，身热恶寒为太阳头晕；如脉左关弦大、弦数，为肝热上冲之头晕；右关弦滑上午较重，多为痰火头晕；脉象细数或虚数伴失眠多梦，健忘神疲，多属阴虚火泛；脉象沉细，心悸气短、脘满身倦、消化不良、舌淡便溏，每见于血虚气陷之头晕。又如临床常见之咳嗽，表面看来有咳嗽、气短、有痰，可以止嗽化痰法治其标，但不能彻底治愈。只有针对病因、症状，标本兼治，效果才能理想。咳嗽常见的有风寒咳嗽，同时伴发热恶寒，头疼肢痛，鼻塞流涕，痰稀白，脉浮或浮紧，治宜疏风寒化痰止嗽法。风热咳嗽，咳不爽痰黄稠咽痛，脉浮数，宜疏风清热化痰止嗽法。伤暑咳嗽，头眩心烦，恶风身痛，脉濡数，宜清解暑热化痰止嗽法。燥热咳嗽，干咳无痰、或痰粘不易咳出，鼻咽干燥，脉细数或虚数，宜清肺润燥止嗽。热毒陷肺之咳嗽，身壮热恶寒或寒战，咳痰带血呈铁锈色，脉洪大滑数舌红，治宜清热解毒化痰止嗽。湿痰咳嗽，痰多稀白，脘闷便溏，脉弦细或虚弱，宜健脾化湿止嗽化痰。肝气犯肺咳嗽，胸满胁痛，食少脘闷，脉弦数或弦滑，治宜平肝宣肺清热止嗽。虚痨咳嗽，咳嗽潮热，盗汗痰中带血，脉细数或虚数，宜养阴抗痨清热化痰止嗽。故辨证时应认清六经之脉证及在某一疾病过程中，何者为主证，何者为兼证，何者为主脉，何者为兼脉，何者为变脉，临床应在复杂脉证中，认清病在何经，是并病，还是合病，治疗方有把握。如右胁胀痛，身倦脘满心烦喜怒，左脉弦大有力，知为肝中郁热，宜用疏肝清热宣郁法。如胃脘胀满腹痛，消化迟钝，脉沉细，为脾阳不振，气滞不宣，宜健脾和胃导滞。如脉不沉细而现弦滑，为食热壅滞、胃失和降，宜清化食热和胃导滞。若腹胀脘满，身热疼痛较剧，脉象滑数，为湿热壅滞，气郁酿毒，治宜清热解毒，理气化瘀。由此说明脉诊在辨证中占有重要地位。现代医学临床常见各种疾病，通过多年临床观察，其发生发展和转化，亦与脉象的演变有密切的联系，而且有规律可循，掌握这方面的知识，对防治疾病及预测转归，也有一定作用。仅就管见所及，简述如下：
1.急慢性肝炎脉象演变规律：肝炎初期，多左关弦大、弦滑、弦数、舌质红而苔黄腻，如伴冷烧时，左脉多弦滑而浮，左部大于右部。迨服清肝解毒疏肝化郁药后，症状减退，食欲好转，身觉有力时，则脉象大脉渐小，弦象渐柔，脉不滑数，而浮象逐渐沉敛，为病情好转稳定的阶段。如感冒发热，或忿怒伤肝，劳累过度，则左脉突变弦大而浮，知为肝病复发之脉。肝炎凡左脉弦大弦滑、弦数之脉，其转氨酶多高，凡脉弦细多为慢性肝炎，每多见于“麝浊”偏高患者。急性期，或因劳累、感冒、忿怒、脉再现弦大、弦滑、弦数，皆左脉大于右脉。肝炎慢性稳定期，脉弦细，弦虚、弦细数，多左脉小于右脉。盖初期或再发热毒壅盛，右脉不受影响，大为邪盛，故左脉大于右脉。慢性肝炎，脾胃恢复正常，而肝脉因损伤而气弱，故右大于左。凡阴虚型之肝炎，脉皆弦虚，或弦虚数，弦细数，其舌偏红或舌尖红，必失眠多梦或头眩腰酸遗精等证。脾虚型脉多弦细无力，舌淡边缘有齿痕，脘满腹胀食少纳呆，便溏等，如能掌握其脉象演变规律，常可掌握防治疾病的主动权。
2．再生障碍性贫血脉象演变规律：初期右手脉象多现浮大弦滑，常发热恶寒，或高热头眩鼻衄、齿龈出血。脉浮大滑数，右脉大于左脉，为热毒外袭，宜清热解毒，宣表凉血，以退热止血。迨热退身凉血止，脉现虚数，而贫血现象较前明显，宜育阴养血解毒清热滋补血液，防止发热。本病初期，多因反复发热，出血，促使病情发展，迨脉象沉敛不数，重按较有力时，可减清热解毒加健脾和胃之剂以增进饮食，育阴养血，在脉沉静虚软阶段为阴复血长之候，如脉象渐浮数，以阴伤阳泛为发热出血之先兆，宜养阴清热凉血。益阴以维阳，清热以退烧，如服养阴清热药过久，脉象沉细，病情稳定，而食少便溏，脘满舌淡，血象不增，是阴复阳微之象，宜健脾气，扶肾阳。治疗过程中应随时细心体察脉象变化，认清阴阳胜负，妥善调剂阴阳平衡。脉象由阴虚到阴阳平衡，阴虚脉初期为虚大，即浮取为4-5个脉力单位而重按1-2单位，为阴气虚损，不能维系阳气，故脉象偏浮而重按无力，如阴虚较重则脉现虚数，如阴虚甚而阳亦伤，则脉多现细数，及阴气渐复则数象渐减，即由每分钟100而95、90、85至，浮象亦见沉敛，沉取逐渐有力，迨浮沉适中，脉象缓和，重按有力，为阴阳暂时平衡。如再用养阴，则阴偏盛，脉现弦细无力，或沉细而微，宜扶阳益气。此即阴阳胜复脉象演变的规律，明乎此，可以补偏救弊，掌握防治主动权。
七、诊脉要分阴阳、达机理、明偏胜、知平衡、晓转化
《素问·阴阳应象大论》说：“善于诊察的医生，观察面色、按压脉搏，首先辨别阴阳。审视面色的清浊来知道病位的所在。观察呼吸、听声音来知道病人的痛苦。观察权衡规矩（指脉象的轻重缓急）来知道疾病的主攻方向。按寸口尺部，观察浮沉、滑涩等脉象来知道疾病的产生原因从而进行治疗，不犯诊断错误，就不会有失误了。”因为人体健康时应保持整体的阴阳平衡，主要是气血和动静的平衡。不论是由于内因或外因，使机体的阴阳失去平衡，势必导致疾病。祖国医学对于任何疾病的诊断和治疗，均为诊察机体的阴阳偏胜，调剂阴阳平衡。所以疾病是机体在一定的条件下，对外界有害因素作用的反应，内因使五脏损伤，不能调剂自身阴阳平衡，致机体对外界环境的适应受到限制，因而发生种种病证。如愤怒太甚肝气横逆，气机滞塞抑郁不舒，则肝阴受损，肝阳偏盛，不论肝阴损伤或肝阳偏盛，都能造成肝脏自身阴阳的不平衡，而致疾病。机体为了自卫，每使气血为抗病的工具，气血旺盛是人体防御疾病和消除疾病的主要机能。任何疾病的侵袭，或外界异物的损伤，人体总是通过气血功能，促使机体的气血津液发生变化，以抗御候病，保持人体健康。故病在表则抗病之机能即趋于表，而脉浮，病势重，则所需要抗病力强，故现洪大滑数之脉，病在内，则人体抗病之机能亦趋向于里，而现沉脉，病在上，则寸大于尺，病在下，则尺大于寸，正气虚，则脉现微细，邪气盛，则脉必洪大；邪在气分，则右脉大于左脉，邪入营分，则左脉偏盛。所以脉象变化是随机体防御性反射作用产生的。用持脉探测阴阳偏盛，作为调剂人体阴阳平衡的主要依据。所以在持脉时，应先分清其为阴脉阳脉表证里证，虚证实证，实证多为外邪之侵袭，虚证皆由正气不足。何为阳脉，如浮大滑数实之类，何谓阴脉，如沉细濇迟微之类。经过精心调治，脉象可随时演变，如浮大之阳脉，多有发热恶寒，心烦热之阳证。由于发热伤津烁液，饮食不思，营养障碍。如因循失治，或治疗欠当，则浮大滑数之阳脉，亦可转变为沉细虚弱之阴脉。体虚气弱者每现沉细虚弱之阴脉，治疗后，气充体健，脉象亦由细弱之阴脉转变为浮滑之阳脉。此即阴阳转化的道理。医者的扶偏救弊，应在阳证热证脉浮大有力，发热不退耗津灼液时，迅予退热排邪，祛病扶正。若脉浮大无力，是热邪过盛，阴津损伤，应速益阴以维阳，祛邪以扶正，都要根据脉象的演变，确定治疗之法则。脉由沉变浮，或由浮转沉，由无力变有力，或由有力转无力，系属病机由里出表，由表内陷，由正气不足而转变为气血渐复之象。医者应据脉象变化推测病机转变，予以扶正祛邪，或先祛邪而后扶正，或扶正中兼寓祛邪。扶正中是育阴还是扶阳，或阴阳俱补，按脉据证，妥善处理，务使立法用药，完全与病情相适应，阴阳相互维系互相制约的理论，对脉象的演变和病机的观察，病情转化、治则的拟订关系密切，阴阳代表机体各脏腑各组织之间、功能和器质之间矛盾着的各个方面。人体的上下内外平衡，各脏腑功能与器质的协调，都是阴阳双方相互依存和相互矛盾的结果。治疗的目的在于调剂机体上下、内外、浮沉、缓急诸方面的阴阳平衡、阳主升散，浮越，躁急。阴主潜敛、蛰藏、柔缓。机体在正常情况下，阳气升散之性，得阴气的潜敛以济之，则升散不致太过，而升降平衡，散敛适中，故能保持正常生理。如阳偏盛则升散太过，而潜敛不及，致阴阳乖和，现头眩心烦脉浮大之证候。脉象的浮大，多由于外邪侵袭，机体为抗御外邪，驱使气血抵御外邪，故脉现浮大，为气血充盛之征，然必有力。若大而无力，为阴虚不能维阳，阳气上泛的虚象。所谓有力，是脉力超过正常。一般正常人脉力假设为五个脉力单位，若脉力在5个脉力单位或6-7单位，都称有力。如在5单位以下，甚至为2-3单位，都称无力。总之差距愈大，阴虚愈甚。若浮取力较弱，重按全无，则为散脉。如浮取脉力超过正常，而重按仅一脉力单位左右，则为革脉。这些脉象都可通过浮沉脉力对比确定。这种脉象调整，应从两方面着手，一浮取有力应抑阳养阴，即削弱阳邪的偏盛，增强阴气潜敛，使之取得暂时的阴阳平衡，即强者抑之，虚者扶之之义。如阴寒偏盛，脉多沉缓或沉细，为升浮之力不足。而潜敛偏胜，阴盛则阳衰，甚则脉现沉迟、沉微，如阴寒暴侵则脉多沉紧。其证候常见脘满腹胀，大便溏泄，四肢厥冷之阴寒症。治宜扶阳温中散寒，新病宜温中散寒为主，久病应扶阳益气，俟沉脉转浮，迟脉转缓即为阳复阴化之佳象。总之阳偏盛，则现浮大滑数之阳脉，阴过强则现沉细濇迟之阴脉，如阴阳平衡，则脉浮沉适中，大小合度，为正常脉。以阳性升浮而阴性潜敛，阳气之升浮，得阴气之潜敛以维系之，方能浮沉适中。阴虚者，当阴气渐复则脉象即由浮而转沉，如因失眠、过劳、烦恼损伤阴气，则脉即由沉而转浮。再生障碍性贫血病人，贫血严重时脉虚数而浮，迨用育阴潜镇，健脾养血之剂，血象渐复，而脉象日趋沉敛，数象渐缓。在阴血渐复、脉象沉静之际，精神清爽，身觉有力，而心悸气短亦不明显。如脉象突然浮越，略有数意，是阴气损伤，不能维持阴阳平衡，应防止近期将有发热出血证候。同时也证实浮与升，沉与降的紧密联系。浮与升即脉浮，机体功能趋向于上与表，沉为人体功能趋向于下于里。如发汗药，为使气血趋表以抗病，同时血压上升，头眩面赤，是表与上的关系。用泄药，为使机能趋向于里于下。外邪未解，而用下药过早，每致外邪内陷，诱发结胸痞症，及邪热内陷之坏病，数脉虽为阳热之体现，如温热症在气分，脉洪大是温热炽盛抗病力强的表现。初期脉多不数，如温热凶猛，或阴气灼伤，则脉滑数，数是阳的特性。迟缓是阴的良能，阳的数急得阴的迟缓维系，脉象方能不急不徐，雍容和缓。当热邪外袭，抗病力猛增，阳气亢盛之际如阴气尚能维持平衡，则脉洪大浮滑而不数或略数，及阴液耗伤，则脉现数，毒热壅盛时，或阴气耗伤，则脉象变数，阴气损伤愈重，数象愈甚。关于阴阳互相维系、相互制约和脉象演变之原理，如不洞悉胸中，对于临床观察病人，不能早期探测疾病的变化，很难作到尽快地阻止疾病的发展。故阴阳互相维系的理论，是脉象演变的规律，探测病机的转化和揆度机体阴阳胜负的主要方法。
八、辨证应以脉证为依据，常见疾病要掌握脉象的演变规律
疾病的发生，多由于外邪侵袭，正气之虚损。而抗病机能衰弱，更是致病的主要因素。正如《内经》中所说的“正气存内，邪不可干”。一旦病成，机体由于病理的反应，产生种种不适症候和脉象的变化，临床即据以“辨证”，分析疾病的性质、部位和虚实情况。医者临床辨证，主要依据病人脉证、体质情况，病程长短、病势的强弱进行全面分析，以达到对疾病的正确认识。中医辨证以八纲为辨证纲领，外感病多从六经、卫气营血、三焦辨证入手，内伤病则求之于脏腑辨证。由于外邪侵入的原因、性质、部位不同，而表现出不同的证候和脉象。病邪侵入某经，即呈现出某经之证候，也正由于出现某经之证候，可测知病邪侵入某经。或病邪侵入某脏某腑，即可表现某脏某腑的证候。如邪陷于肝，则有右胁胀痛，脘满心烦喜怒，现弦大之脉证。侵及心可能出现心悸气短胸闷，脉结代不整之脉证。犯脾则有消化不良、腹胀脘闷、食少纳呆，脉弦虚或沉滑之脉症。六经辨证也以脉证为基础，如发热恶寒、头痛项强、为太阳病，其脉必浮。如脉不浮而反沉，虽现发热恶寒之太阳表证，因其脉沉，而称为少阴病。所以六经辨证并非单纯在证候上的分析，更主要的是在脉象上的识别。只有四诊综合运用，脉证兼顾，才能全面了解病情，正确拟订治疗方案。以头晕为例：头晕的原因很多，肝阳上亢，虚阳上泛，痰火上涌，血虚气陷皆可致头晕。如不根据脉象和头眩情况，作深入细致的鉴别，辨证必成空谈。并发症在辨证上，也有一定作用，如认真诊清脉象，即如深夜燃犀，则病情即无所遁其形矣。如头晕脉浮弦伴寒热往来，为少阳病头晕；脉浮，身热恶寒为太阳头晕；如脉左关弦大、弦数，为肝热上冲之头晕；右关弦滑上午较重，多为痰火头晕；脉象细数或虚数伴失眠多梦，健忘神疲，多属阴虚火泛；脉象沉细，心悸气短、脘满身倦、消化不良、舌淡便溏，每见于血虚气陷之头晕。又如临床常见之咳嗽，表面看来有咳嗽、气短、有痰，可以止嗽化痰法治其标，但不能彻底治愈。只有针对病因、症状，标本兼治，效果才能理想。咳嗽常见的有风寒咳嗽，同时伴发热恶寒，头疼肢痛，鼻塞流涕，痰稀白，脉浮或浮紧，治宜疏风寒化痰止嗽法。风热咳嗽，咳不爽痰黄稠咽痛，脉浮数，宜疏风清热化痰止嗽法。伤暑咳嗽，头眩心烦，恶风身痛，脉濡数，宜清解暑热化痰止嗽法。燥热咳嗽，干咳无痰、或痰粘不易咳出，鼻咽干燥，脉细数或虚数，宜清肺润燥止嗽。热毒陷肺之咳嗽，身壮热恶寒或寒战，咳痰带血呈铁锈色，脉洪大滑数舌红，治宜清热解毒化痰止嗽。湿痰咳嗽，痰多稀白，脘闷便溏，脉弦细或虚弱，宜健脾化湿止嗽化痰。肝气犯肺咳嗽，胸满胁痛，食少脘闷，脉弦数或弦滑，治宜平肝宣肺清热止嗽。虚痨咳嗽，咳嗽潮热，盗汗痰中带血，脉细数或虚数，宜养阴抗痨清热化痰止嗽。故辨证时应认清六经之脉证及在某一疾病过程中，何者为主证，何者为兼证，何者为主脉，何者为兼脉，何者为变脉，临床应在复杂脉证中，认清病在何经，是并病，还是合病，治疗方有把握。如右胁胀痛，身倦脘满心烦喜怒，左脉弦大有力，知为肝中郁热，宜用疏肝清热宣郁法。如胃脘胀满腹痛，消化迟钝，脉沉细，为脾阳不振，气滞不宣，宜健脾和胃导滞。如脉不沉细而现弦滑，为食热壅滞、胃失和降，宜清化食热和胃导滞。若腹胀脘满，身热疼痛较剧，脉象滑数，为湿热壅滞，气郁酿毒，治宜清热解毒，理气化瘀。由此说明脉诊在辨证中占有重要地位。现代医学临床常见各种疾病，通过多年临床观察，其发生发展和转化，亦与脉象的演变有密切的联系，而且有规律可循，掌握这方面的知识，对防治疾病及预测转归，也有一定作用。仅就管见所及，简述如下：
1. 急慢性肝炎脉象演变规律：肝炎初期，多左关弦大、弦滑、弦数、舌质红而苔黄腻，如伴冷烧时，左脉多弦滑而浮，左部大于右部。迨服清肝解毒疏肝化郁药后，症状减退，食欲好转，身觉有力时，则脉象大脉渐小，弦象渐柔，脉不滑数，而浮象逐渐沉敛，为病情好转稳定的阶段。如感冒发热，或忿怒伤肝，劳累过度，则左脉突变弦大而浮，知为肝病复发之脉。肝炎凡左脉弦大弦滑、弦数之脉，其转氨酶多高，凡脉弦细多为慢性肝炎，每多见于“麝浊”偏高患者。急性期，或因劳累、感冒、忿怒、脉再现弦大、弦滑、弦数，皆左脉大于右脉。肝炎慢性稳定期，脉弦细，弦虚、弦细数，多左脉小于右脉。盖初期或再发热毒壅盛，右脉不受影响，大为邪盛，故左脉大于右脉。慢性肝炎，脾胃恢复正常，而肝脉因损伤而气弱，故右大于左。凡阴虚型之肝炎，脉皆弦虚，或弦虚数，弦细数，其舌偏红或舌尖红，必失眠多梦或头眩腰酸遗精等证。脾虚型脉多弦细无力，舌淡边缘有齿痕，脘满腹胀食少纳呆，便溏等，如能掌握其脉象演变规律，常可掌握防治疾病的主动权。
2．再生障碍性贫血脉象演变规律：初期右手脉象多现浮大弦滑，常发热恶寒，或高热头眩鼻衄、齿龈出血。脉浮大滑数，右脉大于左脉，为热毒外袭，宜清热解毒，宣表凉血，以退热止血。迨热退身凉血止，脉现虚数，而贫血现象较前明显，宜育阴养血解毒清热滋补血液，防止发热。本病初期，多因反复发热，出血，促使病情发展，迨脉象沉敛不数，重按较有力时，可减清热解毒加健脾和胃之剂以增进饮食，育阴养血，在脉沉静虚软阶段为阴复血长之候，如脉象渐浮数，以阴伤阳泛为发热出血之先兆，宜养阴清热凉血。益阴以维阳，清热以退烧，如服养阴清热药过久，脉象沉细，病情稳定，而食少便溏，脘满舌淡，血象不增，是阴复阳微之象，宜健脾气，扶肾阳。治疗过程中应随时细心体察脉象变化，认清阴阳胜负，妥善调剂阴阳平衡。脉象由阴虚到阴阳平衡，阴虚脉初期为虚大，即浮取为4-5个脉力单位而重按1-2单位，为阴气虚损，不能维系阳气，故脉象偏浮而重按无力，如阴虚较重则脉现虚数，如阴虚甚而阳亦伤，则脉多现细数，及阴气渐复则数象渐减，即由每分钟100而95、90、85至，浮象亦见沉敛，沉取逐渐有力，迨浮沉适中，脉象缓和，重按有力，为阴阳暂时平衡。如再用养阴，则阴偏盛，脉现弦细无力，或沉细而微，宜扶阳益气。此即阴阳胜复脉象演变的规律，明乎此，可以补偏救弊，掌握防治主动权。
VII. Pulse Diagnosis Must Distinguish Yin and Yang, Understand Mechanisms, Identify Imbalances, Know Balance, and Comprehend Transformation
The *Suwen: Treatise on the Correspondence of Yin and Yang* states: "A skilled diagnostician observes the complexion and palpates the pulse, first distinguishing between Yin and Yang. By examining the clarity or turbidity of the face, one knows the location of the disease. By observing respiration and listening to voice sounds, one understands the patient's suffering. By observing the balance of weight and standard (referring to the heaviness, lightness, slowness, and speed of the pulse), one knows the primary direction of the disease. By pressing the Cun and Chi positions and observing floating, sinking, slippery, and choppy pulses, one determines the origin of the disease to treat it; avoiding diagnostic errors ensures no mistakes." Because health requires maintaining overall Yin-Yang balance, primarily the balance of Qi and Blood and of movement and stillness. Whether due to internal or external factors, if the body's Yin-Yang balance is lost, disease will inevitably result. Traditional Chinese Medicine (TCM) diagnoses and treats all diseases by observing the bias of Yin or Yang in the body and regulating Yin-Yang balance. Therefore, disease is the body's reaction to harmful external factors under certain conditions. Internal factors damage the Zang organs, preventing the regulation of self Yin-Yang balance, limiting the body's adaptation to the external environment, thus causing various syndromes. For example, excessive anger causes Liver Qi to rebel horizontally, leading to stagnation and depression of Qi mechanism, damaging Liver Yin and causing Liver Yang to prevail. Whether Liver Yin is damaged or Liver Yang prevails, it creates an imbalance of Yin and Yang within the Liver itself, resulting in disease. To defend itself, the body uses Qi and Blood as tools against disease; vigorous Qi and Blood are the main functions for defending against and eliminating disease. Upon invasion by any disease or injury from external agents, the body always alters its Qi, Blood, and Body Fluids through their functions to resist pathogens and maintain health. Thus, when disease is at the Exterior, the defensive function tends toward the Exterior, presenting a Floating pulse. When the disease severity is high, requiring strong defensive power, a Surging, Large, Slippery, and Rapid pulse appears. When disease is internal, the defensive function tends toward the Interior, presenting a Sinking pulse. When disease is superior, the Cun position is larger than the Chi position; when inferior, the Chi is larger than the Cun. When Righteous Qi is deficient, the pulse is Minute and Fine; when Pathogenic Qi is excess, the pulse must be Surging and Large. When pathogen is in the Qi Level, the Right pulse is larger than the Left; when entering the Ying (Nutritive) Level, the Left pulse prevails. Therefore, pulse changes arise from the body's defensive reflex actions. Palpating the pulse to detect Yin-Yang excess serves as the main basis for regulating human Yin-Yang balance. Thus, during palpation, one must first distinguish whether it is a Yin or Yang pulse, Exterior or Interior syndrome, Deficiency or Excess syndrome. Excess syndromes are mostly caused by external pathogen invasion, while deficiency syndromes are all due to insufficient Righteous Qi. What constitutes a Yang pulse? Such as Floating, Large, Slippery, Rapid, and Excess types. What constitutes a Yin pulse? Such as Sinking, Fine, Choppy, Slow, and Minute types. After careful treatment, pulse images can evolve at any time. For instance, a Floating and Large Yang pulse often accompanies Yang syndromes like fever, aversion to cold, and vexing heat. Due to fever damaging Body Fluids and fluids, loss of appetite, and nutritional obstacles, if treatment is delayed or inappropriate, a Floating, Large, Slippery, and Rapid Yang pulse may transform into a Sinking, Fine, and Weak Yin pulse. Those with weak constitutions and Qi often present Sinking, Fine, and Weak Yin pulses; after treatment, as Qi fills and the body strengthens, the pulse transforms from a Fine and Weak Yin pulse to a Floating and Slippery Yang pulse. This is the principle of Yin-Yang transformation. The physician's role in correcting deviations and saving deficiencies should be: when Yang syndromes and Heat syndromes present with a Floating, Large, and Forceful pulse, and fever persists consuming fluids, rapidly apply methods to reduce heat, expel pathogens, eliminate disease, and support Righteous Qi. If the pulse is Floating and Large but Forceless, it indicates excessive Heat pathogen damaging Yin fluids; one should quickly tonify Yin to sustain Yang, expel pathogens, and support Righteous Qi. All treatments must determine therapeutic principles based on pulse evolution. A pulse changing from Sinking to Floating, or Floating to Sinking, from Forceless to Forceful, or Forceful to Forceless, belongs to pathological mechanisms moving from Interior to Exterior, from Exterior sinking inward, or from Righteous Qi deficiency transforming into gradual recovery of Qi and Blood. Physicians should infer pathological changes from pulse variations, applying methods to support Righteous Qi and expel pathogens, either expelling pathogens first then supporting Righteous Qi, or supporting Righteous Qi while simultaneously expelling pathogens. In supporting Righteous Qi, whether to nourish Yin or tonify Yang, or tonify both, one must handle matters properly according to pulse and symptoms, ensuring legislation and medication completely adapt to the condition. The theory that Yin and Yang mutually sustain and constrain each other is closely related to pulse evolution, observation of pathological mechanisms, disease transformation, and formulation of therapeutic principles. Yin and Yang represent the contradictory aspects between various Zang organs and tissues, and between function and structure. The balance of upper/lower and interior/exterior in the human body, and the coordination of Zang organ functions and structures, are results of mutual dependence and contradiction between Yin and Yang. The purpose of treatment is to regulate Yin-Yang balance in aspects such as upper/lower, interior/exterior, floating/sinking, and slow/urgent. Yang governs ascending, dispersing, floating, and agitation. Yin governs submerging, storing, and softness/slowness. Under normal conditions, the ascending and dispersing nature of Yang Qi is aided by the submerging nature of Yin Qi, so ascending and dispersing do not exceed limits, maintaining balance of ascent/descent and moderation of dispersion/storage, thus preserving normal physiology. If Yang prevails, ascending and dispersing exceed limits, and submergence is insufficient, causing Yin-Yang disharmony, presenting symptoms of dizziness, vexation, and a Floating, Large pulse. The Floating and Large pulse image is mostly due to external pathogen invasion; to resist it, the body drives Qi and Blood to defend, hence the Floating and Large pulse, a sign of abundant Qi and Blood, which must be Forceful. If Large but Forceless, it is a deficiency image where Yin deficiency cannot sustain Yang, and Yang Qi floats upward. "Forceful" means pulse force exceeds normal. Assuming normal pulse force is five units, forces of 5, 6-7 units are called Forceful. Forces below 5 units, even 2-3 units, are called Forceless. Generally, the greater the gap, the more severe the Yin deficiency. If superficial pressure is weak and deep pressure is absent, it is a Scattered pulse. If superficial pressure exceeds normal but deep pressure is only about one unit, it is a Leathery pulse. These pulses can be determined by comparing superficial and deep force. Pulse adjustment should start from two aspects: if superficial pressure is Forceful, one should suppress Yang and nourish Yin, i.e., weaken the excess of Yang pathogen and enhance Yin submergence to achieve temporary Yin-Yang balance, meaning suppressing the strong and supporting the weak. If Cold-Yin prevails, the pulse is mostly Sinking-Slow or Sinking-Fine, indicating insufficient ascending force. If submergence prevails, Yin excess leads to Yang decline, even presenting Sinking-Slow or Sinking-Minute pulses; if Cold-Yin attacks suddenly, the pulse is mostly Sinking-Tight. Common symptoms include fullness in the epigastrium, abdominal distension, loose stools, and cold limbs—Cold-Yin syndromes. Treatment should support Yang, warm the Middle, and dispel Cold. New diseases focus on warming the Middle and dispelling Cold; chronic diseases should support Yang and boost Qi. Waiting for the Sinking pulse to turn Floating and Slow pulse to Slow indicates a good sign of Yang recovery and Yin transformation. In short, Yang excess presents Floating, Large, Slippery, Rapid Yang pulses; Yin excess presents Sinking, Fine, Choppy, Slow Yin pulses. If Yin-Yang is balanced, the pulse is moderately Floating/Sinking and appropriately sized, constituting a Normal pulse. Since Yang is ascending/floating and Yin is submerging/storing, Yang's ascent is sustained by Yin's submergence, allowing moderate floating and sinking. In Yin deficiency, as Yin Qi gradually recovers, the pulse turns from Floating to Sinking; however, if insomnia, overwork, or worry damages Yin Qi, the pulse turns from Sinking to Floating. In Aplastic Anemia patients, when anemia is severe, the pulse is Empty-Rapid and Floating; upon using herbs to nourish Yin, submerge and calm, strengthen Spleen, and nourish Blood, blood counts gradually recover, and the pulse becomes increasingly Sinking and restrained, with the Rapid quality slowing down. At this stage of Yin-Blood recovery and quiet pulse, spirit is clear, strength returns, and palpitations and shortness of breath are not obvious. If the pulse suddenly floats excessively with slight rapidity, it indicates Yin damage failing to maintain Yin-Yang balance; one should prevent imminent fever and bleeding syndromes. This also confirms the close connection between Floating and Ascending, Sinking and Descending. Floating and Ascending mean the pulse is Floating, and bodily functions tend toward Superior and Exterior; Sinking means functions tend toward Inferior and Interior. For example, diaphoretic drugs drive Qi and Blood to the Exterior to fight disease, simultaneously raising blood pressure, causing dizziness and flushed face, illustrating the relationship between Exterior and Superior. Purgative drugs make functions tend toward Interior and Inferior. If external pathogens are unresolved and purgatives are used too early, pathogens often sink inward, inducing Chest Binding and Glomus syndromes, or bad diseases from Heat pathogen sinking inward. Although the Rapid pulse reflects Yang-Heat, in Warm-Heat syndromes at the Qi Level, a Surging pulse indicates intense Warm-Heat and strong defensive power. Initially, the pulse is often not Rapid; if Warm-Heat is fierce or Yin Qi is scorched, the pulse is Slippery-Rapid. Rapidness is a characteristic of Yang. Slowness is a virtue of Yin. Yang's rapidity is sustained by Yin's slowness, allowing the pulse to be neither hurried nor sluggish, dignified and harmonious. When Heat pathogen attacks externally and defensive power increases sharply, if Yang Qi is hyperactive but Yin Qi can still maintain balance, the pulse is Surging, Large, Floating, and Slippery without being Rapid or only slightly Rapid. Once Yin fluids are consumed, the pulse becomes Rapid. When toxic heat is congested or Yin Qi is damaged, the pulse changes to Rapid; the heavier the Yin damage, the more severe the Rapidness. Regarding the principles of mutual sustenance, constraint, and pulse evolution of Yin and Yang, if not thoroughly understood, clinicians cannot detect disease changes early or stop disease progression quickly. Thus, the theory of mutual Yin-Yang sustenance is the law of pulse evolution and the main method for detecting pathological transformation and estimating Yin-Yang victory/defeat in the body.
VIII. Syndrome Differentiation Should Be Based on Pulse and Symptoms; Master the Evolution Laws of Pulses in Common Diseases
Disease occurrence is mostly due to external pathogen invasion and deficiency of Righteous Qi. Weakened defensive function is a major factor in causing disease. As stated in the *Neijing*: "If Righteous Qi exists internally, pathogens cannot interfere." Once disease forms, the body produces various uncomfortable symptoms and pulse changes due to pathological reactions. Clinically, one "differentiates syndromes" based on these to analyze the nature, location, and deficiency/excess status of the disease. Clinical differentiation mainly relies on comprehensive analysis of patient pulse/symptoms, constitution, disease duration, and severity to achieve correct understanding. TCM differentiation takes the Eight Principles as the guideline. External contraction diseases often start with Six Channels, Wei-Qi-Ying-Blood, or San Jiao differentiation; internal injury diseases seek differentiation via Zang-Fu organs. Due to different causes, natures, and locations of external pathogen invasion, different syndromes and pulses appear. When pathogen invades a specific channel, that channel's syndrome appears; conversely, observing that channel's syndrome allows inferring pathogen invasion of that channel. If pathogen invades a specific Zang or Fu organ, that organ's syndrome manifests. For example, if pathogen sinks into the Liver, there is distending pain in the right hypochondrium, epigastric fullness, vexation, anger, presenting a String-taut, Large pulse. Invasion of the Heart may cause palpitations, shortness of breath, chest tightness, presenting Knotted, Intermittent, irregular pulses. Invasion of the Spleen causes indigestion, abdominal distension, epigastric stuffiness, poor appetite, presenting String-taut, Empty or Sinking-Slippery pulses. Six Channel differentiation is also based on pulse and symptoms. For instance, fever, aversion to cold, headache, and stiff neck constitute Taiyang Disease, whose pulse must be Floating. If the pulse is not Floating but Sinking, although presenting Taiyang Exterior symptoms of fever and aversion to cold, because the pulse is Sinking, it is called Shaoyin Disease. Thus, Six Channel differentiation is not merely symptom analysis but primarily pulse identification. Only by comprehensively using the Four Diagnostic Methods and considering both pulse and symptoms can one fully understand the condition and correctly formulate treatment plans. Taking dizziness as an example: causes are numerous, including Hyperactive Liver Yang, floating deficient Yang, phlegm-fire surging, Blood deficiency with Qi sinking. Without detailed differentiation based on pulse and dizziness characteristics, differentiation becomes empty talk. Complications also play a role in differentiation; carefully diagnosing the pulse is like lighting a rhino horn at midnight, revealing the condition's true form. For example, dizziness with Floating-String-taut pulse accompanied by alternating chills and fever is Shaoyang Disease dizziness; Floating pulse, body heat, aversion to cold is Taiyang dizziness; Left Guan position String-taut-Large or String-taut-Rapid pulse is Liver Heat rushing upward dizziness; Right Guan String-taut-Slippery pulse, worse in the morning, is mostly Phlegm-Fire dizziness; Fine-Rapid or Empty-Rapid pulse accompanied by insomnia, dream-disturbed sleep, forgetfulness, and mental fatigue belongs to Yin deficiency with Fire flourishing; Sinking-Fine pulse with palpitations, shortness of breath, epigastric fullness, body fatigue, indigestion, pale tongue, and loose stools is often seen in Blood deficiency with Qi sinking dizziness. Similarly, common clinical cough, superficially showing cough, shortness of breath, and phlegm, can be treated symptomatically with stopping cough and resolving phlegm methods, but cannot be cured thoroughly. Only treating both root cause and symptoms yields ideal effects. Common coughs include Wind-Cold cough, accompanied by fever, aversion to cold, headache, limb pain, nasal congestion, runny nose, thin white phlegm, Floating or Floating-Tight pulse; treatment should disperse Wind-Cold, resolve phlegm, and stop cough. Wind-Heat cough, unsatisfactory expectoration, yellow thick phlegm, sore throat, Floating-Rapid pulse; treatment should disperse Wind, clear Heat, resolve phlegm, and stop cough. Summerheat Injury cough, dizziness, vexation, aversion to wind, body pain, Wavy-Rapid pulse; treatment should clear and resolve Summerheat, resolve phlegm, and stop cough. Dry-Heat cough, dry cough without phlegm or sticky phlegm hard to expectorate, dry nose/throat, Fine-Rapid or Empty-Rapid pulse; treatment should clear Lung, moisten Dryness, and stop cough. Heat-Toxin sinking into Lung cough, high fever, aversion to cold or chills, rust-colored bloody sputum, Surging-Large-Slippery-Rapid pulse, red tongue; treatment should clear Heat, detoxify, resolve phlegm, and stop cough. Damp-Phlegm cough, abundant thin white phlegm, epigastric stuffiness, loose stools, String-taut-Fine or Weak pulse; treatment should strengthen Spleen, transform Dampness, stop cough, and resolve phlegm. Liver Qi invading Lung cough, chest fullness, hypochondriac pain, poor appetite, epigastric stuffiness, String-taut-Rapid or String-taut-Slippery pulse; treatment should calm Liver, diffuse Lung, clear Heat, and stop cough. Consumption/Cough (Xulao) cough, tidal fever, night sweats, bloody sputum, Fine-Rapid or Empty-Rapid pulse; treatment should nourish Yin, combat consumption, clear Heat, resolve phlegm, and stop cough. Therefore, during differentiation, one must recognize Six Channel pulse-syndromes, identify main vs. accompanying syndromes/pulses, and varying pulses. Clinically, amidst complex pulse-symptom presentations, one must identify which channel is affected, whether it is concurrent disease or combined disease, to ensure successful treatment. For example, right hypochondriac distending pain, body fatigue, epigastric fullness, vexation, anger, Left pulse String-taut-Large and Forceful indicates Liver郁 Heat; treatment should soothe Liver, clear Heat, and diffuse郁. Epigastric distension, abdominal pain, slow digestion, Sinking-Fine pulse indicates Spleen Yang not stirring and Qi stagnation; treatment should strengthen Spleen, harmonize Stomach, and guide out stagnation. If pulse is not Sinking-Fine but String-taut-Slippery, it indicates food-Heat congestion and Stomach failing to descend; treatment should clear and transform food-Heat, harmonize Stomach, and guide out stagnation. Abdominal distension, epigastric fullness, severe body heat and pain, Slippery-Rapid pulse indicates Damp-Heat congestion and Qi郁 brewing toxicity; treatment should clear Heat, detoxify, regulate Qi, and resolve stasis. This illustrates the important position of pulse diagnosis in differentiation. Modern clinical common diseases, through years of observation, show that their development and transformation are closely linked to pulse evolution laws. Mastering this knowledge aids disease prevention, treatment, and prognosis prediction. Briefly summarized as follows:
1. Pulse Evolution Laws in Acute and Chronic Hepatitis: In early hepatitis, the Left Guan position is often String-taut-Large, String-taut-Slippery, or String-taut-Rapid; tongue body red with yellow greasy coating. If accompanied by low-grade fever, the Left pulse is often String-taut-Slippery and Floating, with Left larger than Right. After taking herbs to clear Liver, detoxify, soothe Liver, and resolve郁, symptoms subside, appetite improves, and strength returns; the Large pulse gradually shrinks, String-taut quality softens, pulse is no longer Slippery-Rapid, and Floating quality gradually sinks and restrains, marking a stage of improvement and stability. If caught a cold with fever, angered affecting Liver, or overworked, the Left pulse suddenly becomes String-taut-Large and Floating, indicating hepatitis relapse. In hepatitis, Left pulses that are String-taut-Large, String-taut-Slippery, or String-taut-Rapid often correlate with high transaminases; String-taut-Fine pulses are mostly chronic hepatitis, often seen in patients with elevated "Mushroom Turbidity" (a lab test). In the acute phase, due to fatigue, cold, or anger, the pulse reappears String-taut-Large, String-taut-Slippery, or String-taut-Rapid, all with Left larger than Right. In chronic stable hepatitis, the pulse is String-taut-Fine, String-taut-Empty, or String-taut-Fine-Rapid, mostly Left smaller than Right. Initially or upon recurrence of Heat-Toxin congestion, the Right pulse is unaffected; Large indicates pathogen excess, hence Left larger than Right. In chronic hepatitis, Spleen and Stomach return to normal, but Liver pulse is weak due to damage, hence Right larger than Left. For Yin-deficiency type hepatitis, the pulse is String-taut-Empty, or String-taut-Empty-Rapid, String-taut-Fine-Rapid; tongue is reddish or tip red,必定 accompanied by insomnia, dream-disturbed sleep, dizziness, sore waist, seminal emission, etc. Spleen-deficiency type pulse is mostly String-taut-Fine and Forceless, tongue pale with teeth marks on edges, epigastric fullness, abdominal distension, poor appetite, loose stools, etc. Mastering these pulse evolution laws often allows mastering the initiative in disease prevention and treatment.
2. Pulse Evolution Laws in Aplastic Anemia: In the initial stage, the Right hand pulse often presents as Floating, Large, String-taut, and Slippery, often with fever, aversion to cold, or high fever, dizziness, epistaxis, and gingival bleeding. Floating, Large, Slippery, Rapid pulse, Right larger than Left, indicates Heat-Toxin attacking externally; treatment should clear Heat, detoxify, diffuse Exterior, cool Blood, to reduce fever and stop bleeding. Once fever subsides, body cools, and bleeding stops, the pulse becomes Empty-Rapid, and anemia is more obvious; treatment should nourish Yin, nourish Blood, detoxify, clear Heat, and tonify blood to prevent fever. Initially, the disease progresses due to repeated fever and bleeding. When the pulse becomes Sinking, restrained, and not Rapid, and forceful upon deep pressure, one can reduce clearing Heat/detoxifying and add herbs to strengthen Spleen and harmonize Stomach to improve diet, nourish Yin and Blood. The Sinking, Quiet, Empty, Soft stage represents Yin recovery and Blood growth. If the pulse gradually becomes Floating-Rapid, indicating Yin damage and Yang floating as a precursor to fever and bleeding, treatment should nourish Yin, clear Heat, and cool Blood. Tonifying Yin to sustain Yang, clearing Heat to reduce fever. If Yin-nourishing and Heat-clearing herbs are taken too long, the pulse becomes Sinking-Fine, condition stabilizes, but appetite is poor, stools loose, epigastric fullness, pale tongue, blood count does not increase; this is Yin recovered but Yang微弱 (weak); treatment should strengthen Spleen Qi and support Kidney Yang. During treatment, one must carefully observe pulse changes, recognize Yin-Yang victory/defeat, and properly regulate Yin-Yang balance. From Yin deficiency to Yin-Yang balance, the initial Yin deficiency pulse is Empty-Large, i.e., superficial pressure is 4-5 force units and deep pressure is 1-2 units, indicating Yin Qi deficiency unable to sustain Yang Qi, hence pulse floats and is forceless upon deep pressure. If Yin deficiency is heavier, the pulse becomes Empty-Rapid; if Yin deficiency is severe and Yang is also damaged, the pulse is mostly Fine-Rapid. As Yin Qi gradually recovers, Rapidness decreases, e.g., from 100 to 95, 90, 85 beats per minute; Floating quality also sinks and restrains, deep pressure gradually becomes forceful. When Floating and Sinking are moderate, pulse is harmonious, and deep pressure is forceful, it is temporary Yin-Yang balance. If further Yin-nourishing is applied, Yin prevails, pulse becomes String-taut-Fine and Forceless, or Sinking-Fine and Minute; treatment should support Yang and boost Qi. This is the law of Yin-Yang victory/defeat pulse evolution. Understanding this allows correcting deviations and mastering the initiative in prevention and treatment.