昔人所云反关之脉。但言脉位之异。未审所见之脉，与平常之人可例推乎。抑别有所异乎。答
曰。凡脉之反关者。皆由脉道阻碍。故易位而见。自不能条畅如平常之脉也。其反关之因。各有不同。而反关
之状。亦自不一。有胎息中惊恐颠仆而反关者。有襁褓束缚致损而反关者。有幼时跌仆动经而反关者。有龆龀
疳积。伐肝太过。目连 而左手偏小。有似反关者。有大惊丧志。死绝复苏而反关者。有一手反关者。有两手
反。关者。有从关斜走至寸而反关者。有反于内侧。近大陵而上者。有六部原有如丝。而阳溪列缺。别有一脉大
于正位者。有平时正取侧取俱无。覆手取之而得者。有因病而正取无脉。覆手诊之乃得者。总皆阴阳伏匿之象。
有伤寒欲作战汗。脉伏而误认反关者。大抵反关之脉。沉细不及。十常八九。坚强太过者。十无二三。欲求适
中之道。卒不易得也。亦有诸部皆细小不振。中有一粒如珠者。此经脉阻结于其处之状。故其脉较平人细小
者。为反关之常。较平人反大者绝少。不可以为指下变异。谓之怪脉也。凡遇反关殊异平常之脉。须细询。其
较之平时稍大。即为邪盛。比之平时愈小。即为气衰。更以所见诸证参之。
门人问曰。人迎主表。气口主里。东垣内外伤辨。言之详矣。而盛启东又以新病之死生。
系乎右手之关脉。宿病之死生。主乎左手之关尺。斯意某所未达。愿闻其义云何。答云。病有新久。证有逆顺。新
病谷气犹存。胃脉自应和缓。即或因邪鼓大。因虚减小。然须至数分明。按之有力。不至浊乱。再参语言清爽
。饮食知味。胃气无伤。虽剧可治。如脉至浊乱。至数不明。神昏语错。病气不安。此为神识无主。苟非大
邪瞑眩。岂宜见此。经云。脉浮而滑。谓之新病。脉小以涩。谓之久病。故新病而一时形脱者死。不语者亦死。
口开眼合。手撒喘汗遗尿者。俱不可治。新病虽各部脉脱。中部独存者。是为胃气。治之必愈。久病而左手关
尺软弱。按之有神。可卜精血之未艾。
他部虽危。治之可生。若尺中弦紧急数。按之搏指。或细小脱绝者。法在不治。盖缘病久胃气向衰。又当求其
尺脉。为先天之根气也。启东又云。诊得浮脉。要尺内有力。为先天肾水可恃。发表无虞。诊得沉脉。要右关有
力。为后天脾胃可凭。攻下无虞。此与前说互相发明。言虽异而理不殊也。
前人所说的反关脉，只是指出了脉位异常，但未审察所见之脉与常人相比是否可以类推，或者是否有其他不同之处。回答说：凡是反关脉，都是因为脉道受阻，所以位置发生变动而显现出来，自然不能像平常的脉那样条达通畅。反关脉形成的原因各不相同，其表现形态也不一。有的在胎儿时期因惊恐跌仆而形成；有的在襁褓中因束缚损伤而形成；有的在幼年时跌仆触动经脉而形成；有的因儿童时期疳积，过度伐伤肝脏，导致目连（眼睑下垂）且左手脉偏小，有类似反关脉的表现；有的因大惊丧志，假死复苏后形成；有的仅一只手反关；有的两只手都反关；有的从关部斜行至寸部而反关；有的反于内侧，靠近大陵穴向上行；有的六部脉原本细如丝线，而在阳溪、列缺处另有一脉大于正位者；有的平时正取侧取均无脉，翻手诊察才能得脉；有的因病导致正取无脉，翻手诊察方能得脉。这些总归都是阴阳伏匿的现象。有的伤寒欲作战汗，脉伏而被误认为反关脉。大抵反关脉多沉细不及，十常八九；坚强太过者，十无二三。想要寻求适中之道，终究难以得到。也有诸部脉皆细小不振，中间有一粒如珠者，这是经脉阻结于该处的表现。因此，其脉较常人细小是反关脉的常态，较常人反大者极少，不可将其视为指下的变异怪脉。凡遇到反关这种殊异于平常的脉象，必须详细询问。如果比平时稍大，即为邪气盛；比平时愈小，即为正气衰。再结合所见的各种证候进行参详。
门人问道：人迎脉主表，气口脉主里，李东垣在《内外伤辨》中论述得非常详尽。但盛启东又认为新病生死系于右手关脉，宿病生死主于左手关尺。这一观点我未能通达，希望听听其中的道理。回答说：疾病有新久之分，证候有逆顺之别。新病谷气尚存，胃脉自然应当和缓。即使因邪气鼓动而变大，或因虚损而减小，但至数必须分明，按之有力，不至于浊乱。再参看语言清爽，饮食知味，说明胃气未伤，即使病情严重也可治愈。如果脉象浊乱，至数不明，神志昏迷言语错乱，病气不安，这是神识无主的表现。如果不是大邪引起的瞑眩反应，怎么会出现这种情况？经书说：脉浮而滑，称为新病；脉小以涩，称为久病。所以新病如果出现一时形脱（精气耗竭），就会死亡；不语也是死证。口开眼合，手撒肢冷，气喘出汗，遗尿者，都不可治。新病虽然各部脉象消失，唯独中部脉存在，这是胃气尚存，治疗必能痊愈。久病如果左手关尺脉软弱，但按之有神，可以推断精血尚未枯竭。他部脉虽危重，治疗仍可生还。如果尺中脉弦紧急数，按之搏指，或细小欲绝者，法在不治。这是因为病久胃气趋向衰弱，此时又当求之于尺脉，因为尺脉为先天之根气。盛启东又说：诊得浮脉，要尺内有力，说明先天肾水可恃，发表发汗无虞；诊得沉脉，要右关有力，说明后天脾胃可凭，攻下无虞。这与前一种说法互相发明，言辞虽异，但道理相同。
The "reverse-guan pulse" (Fǎn Guān Mài) mentioned by the ancients merely refers to an abnormal pulse position. It does not clarify whether the observed pulse can be inferred to be similar to that of ordinary people, or if there are other differences. The answer is: All reverse-guan pulses are caused by obstruction in the pulse channel, leading to a displacement in position. Consequently, they cannot flow smoothly and freely like normal pulses. The causes of the reverse-guan pulse vary, and its manifestations are diverse. Some result from fright or falls during fetal development; some arise from binding injuries in infancy; some stem from falls damaging meridians in childhood; some are due to infantile malnutrition (Gān Jī, 疳积) excessively injuring the Liver, causing ptosis (Mù Lián, 目连) and a smaller-than-normal pulse on the left hand, resembling a reverse-guan pulse; some occur after severe fright causing loss of spirit and revival from apparent death; some affect only one hand; some affect both hands; some deviate obliquely from the Guan position to the Cun position; some appear on the medial side, ascending near the Daling (LI4) acupoint; in some cases, all six positions have threads-like pulses, yet at Yangxi (LI5) and Lieque (LU7), another pulse larger than the standard position exists; in some, no pulse is felt in standard or lateral positions but is obtained when the hand is turned over; in others, no pulse is found in the standard position due to illness, but is detected upon turning the hand over. These are all manifestations of Yin and Yang hiding within. For instance, in cold damage (Shāng Hán, 伤寒) where battle-sweat is about to occur, a hidden pulse may be mistaken for a reverse-guan pulse. Generally, reverse-guan pulses are deep and fine, accounting for eight or nine out of ten cases; those that are strong and excessive account for only two or three out of ten. Achieving a moderate balance is difficult. In some cases, all positions show small and weak pulses, except for one bead-like pulse, indicating meridian blockage at that site. Thus, a pulse finer than normal is common for reverse-guan pulses, while one larger than normal is rare. This should not be considered a bizarre variation under the fingers, nor labeled as a strange pulse (Guài Mài, 怪脉). Whenever encountering such unusual pulses, detailed inquiry is necessary. If slightly larger than usual, it indicates excess pathogenic factors; if smaller than usual, it indicates deficiency of Qi. These findings must be correlated with other clinical signs.
A disciple asked: The Renying (人迎) pulse governs the exterior, and the Qikou (气口) pulse governs the interior. Li Dongyuan discussed this in detail in his *Differentiation of Internal Injury*. However, Shengqidong further stated that the prognosis of new diseases depends on the Guan pulse of the right hand, while the prognosis of chronic diseases depends on the Guan and Chi pulses of the left hand. I do not fully understand this concept and wish to hear the rationale. The response was: Diseases have new and old stages, and syndromes have favorable and unfavorable courses. In new diseases, grain Qi remains intact, so the Stomach pulse should naturally be harmonious and slow. Even if enlarged by pathogens or reduced by deficiency, the rate and rhythm must be distinct, forceful upon palpation, and not turbid or chaotic. Additionally, clear speech and good appetite indicate unharmed Stomach Qi; even severe cases can be treated. If the pulse is turbid, rhythm unclear, consciousness clouded, speech disordered, and disease Qi restless, this indicates loss of mental mastery. Unless it is a detoxification reaction (Míng Xuàn, 瞑眩) from strong pathogens, such signs are inappropriate. The Classics state: A floating and slippery pulse indicates a new disease; a small and choppy pulse indicates a long-standing disease. Therefore, sudden collapse of form in a new disease leads to death; muteness also indicates death. Open mouth, closed eyes, relaxed hands, panting, sweating, and urinary incontinence are untreatable. If in a new disease, pulses in all positions vanish but the middle position remains, this signifies preserved Stomach Qi, and treatment will surely succeed. In chronic diseases, if the left Guan and Chi pulses are weak but spirited upon palpation, it suggests essence and blood are not yet exhausted. Although other positions are critical, recovery is possible. If the Chi pulse is wiry, tight, rapid, and pounding against the fingers, or thread-like and nearly absent, the condition is untreatable. This is because Stomach Qi declines in long-standing diseases, and one must then examine the Chi pulse, which represents the root Qi of congenital constitution. Shengqidong also said: When detecting a floating pulse, strength in the Chi position indicates reliable congenital Kidney Water, ensuring safety in releasing the exterior. When detecting a sunken pulse, strength in the right Guan position indicates reliable postnatal Spleen and Stomach, ensuring safety in purging downward. These statements complement each other; though the wording differs, the principle is the same.