（出士材三书）
脉状繁多。未可以二十八字尽也。然于表里阴阳气血虚实之义。颇能括其纲要矣。如内经之所曰鼓者。且浮且大也。
曰搏者。且大且强也。曰坚者。实之别名也。曰横者。洪之别名也。曰急者。紧之别名也。曰喘者。且浮且数也。曰躁
者。且浮且疾也。曰疏者。且迟且软也。曰格者。人迎倍大也。曰关者。气口倍大也。此二脉者。后世不深维内经之旨。
而误作病名也。（阴阳不相应。病名曰关格。即以脉名病。有何不可。仲景曰。关则吐逆。格则不得小便。未尝专为病名。）
曰溢者。自寸口上越鱼际。气有余也。曰覆者 。自尺部下达臂间。血有余也。如仲景论脉。曰纵者。水乘火金乘木也。
曰横者。火乘水。木乘金也。曰逆者。水乘金火乘木也。曰顺者。金乘水木乘火也。曰反者。来微去大。病在里也。曰
覆者 。头小本大。病在表也。曰高者。卫气盛也。阳脉强也。曰章者。营血盛也。阴脉强也。曰刚者。高章相搏也。曰
者。卫气弱也。阳脉衰也。曰卑者。营血弱也。阴脉衰也。曰损者。 卑相搏也。内经十二。仲景十二。凡得二十四
脉。未尝非辨证之旨诀。而世皆置若无闻。则有惭于司命之职矣。虽二十八字。亦以含藏诸义。然不详二十四字之义。
又安能入二十八字之奥哉。而犹不止此也。阴阳不可不分而剖。色脉不可不合而稽。尺肤不可不详而考。主病不可不谙
而识。四者得而持脉之道。思过半矣。脉要精微论曰。微妙在脉。不可不察。察之有纪。从阴阳始。始之有经。从五行
生。生之有度。四时为宜。彼春之暖。为夏之暑。彼秋之忿。为冬之怒。四变之动。脉与之上下。是以圣人。持脉之道。
先后阴阳而持之。若阳动阴静。阳刚阴柔。阴升阴降。阳前阴后。阳上阴下。阳左阴右。数者为阳。迟者为阴。表者为
阳。里者为阴。至者为阳。去者为阴。进者为阳。退者为阴。其恒经也。或阴盛之极。反得阳象。或阳亢之极。反得阴
征。或阳穷而阴乘之。或阴穷而阳乘之。随证更迁。与时变易。此阴阳之不可不分而剖也。岐伯曰。察脉动静。而视精
明。察五色。观五脏有余不足。六腑强弱。形之盛衰。以此参伍。决死生之分。又曰。形气相得。谓之可治。色泽以浮。
谓之易已。脉从四时。谓之可治。脉弱以滑。是有胃气。灵枢曰。色脉与尺。如鼓桴相应。青者脉弦。赤者脉钩。黄者
脉代。白者脉毛。黑者脉石。见其色而不得其脉。反得相胜之脉。则死矣得相生之脉。则病已矣。又云。精明五色者。
气之华也。赤欲如白裹朱。不欲如赭。白欲如鹅羽。不欲如盐。青欲如苍璧。不欲如蓝。黄欲如罗裹雄黄。不欲如黄土。
黑欲重漆色。不欲如地苍。此色脉不可不合而稽也。灵枢曰。审尺之缓急大小滑涩。肉之坚脆。而病形定矣。目窠微肿。
颈脉动。时咳。按之手足。 而不起。风水肤胀也。尺肤滑而淖泽者风也。尺肉弱者解 。安卧脱肉者寒热。不治。尺
肤涩者。风痹也。尺肤粗如枯鱼之鳞者。 饮也。尺肤热甚。脉盛躁者。病温也。脉盛而滑者。汗且出也。尺肤寒。脉
小者。泄而少气。尺肤炬然。寒热也。肘所独热者。腰以上热。手所独热者。腰以下热。肘前独热者。膺前热。肘后独
热者。肩背热。臂中独热者。腰腹热。肘后粗以下三四寸热者。肠中有虫。掌中热者腹热。掌中寒者腹寒。鱼上有青脉
者胃中寒。尺炬然热。人迎大。当夺血。尺坚大。脉小。少气 。有加立死。又曰。脉急者尺肤亦急。脉缓者尺肤亦缓。
脉小者尺肤亦减而少气。脉大者尺肤亦贲而起。脉滑者尺肤亦滑。脉涩者尺肤亦涩。此尺肤不可不详而考也。脉要精微
论曰。长则气治。短则气病。数则烦心。大则病进。上盛则气高 。下盛则气胀。代则气衰。细则气少。涩则心痛。浑浑
革至如涌泉。病进而色弊。绵绵其去如弦绝者死。平人气象论曰。脉短者头痛。脉长者足胫痛。脉促上击者肩背痛。脉
沉而坚者病在中。脉浮而盛者病在外。脉沉而弱。寒热及疝瘕少腹痛。脉沉而横。胁下有积。腹中有横积痛。脉沉而喘
曰寒热。脉盛滑坚者病在外。脉小实而坚者病在内。小弱以涩。谓之久病。浮滑而疾。谓之新病。脉急者疝瘕少腹痛。
脉滑曰风。脉涩曰痹。缓而滑曰热中。盛而紧曰胀。臂多青脉曰脱血。尺脉缓涩。谓之解 。安卧脉盛。谓之脱血。尺
涩脉滑。谓之多汗。尺寒脉细。谓之后泄。尺脉粗常热者。谓之热中。此主病之不可不谙而识也。如上所述。不过大略
耳。若欲达变探微。非精研灵素。博综百家。不可也。许引宗曰。脉之候幽而难明。我意所解。口莫能宣也。口且莫能
宣。而笔又乌能写乎。博极而心灵自启。思极而神鬼将通。则三指有隔垣之照。二竖无膏肓之遁矣。
（出自李士材《三书》）
脉象种类繁多，不能仅用二十八字完全概括。然而，关于表、里、阴、阳、气、血、虚、实的基本含义，却大致能涵盖其纲要。例如，《内经》中提到的“鼓”脉，是指脉象既浮又大；“搏”脉，是指既大又强劲；“坚”脉，是“实”脉的别名；“横”脉，是“洪”脉的别名；“急”脉，是“紧”脉的别名；“喘”脉，是指既浮又快；“躁”脉，是指既浮又疾速；“疏”脉，是指既迟又柔软；“格”脉，是指人迎脉比正常大一倍；“关”脉，是指气口脉比正常大一倍。这后两种脉象，后世医家没有深入探究《内经》的宗旨，而错误地将它们当作病名。（阴阳之气不相呼应，疾病称为“关格”，如果直接用脉名作为病名，又有什么不可以呢？张仲景说：“关则呕吐逆乱，格则小便不通。”他并未专门将其作为病名。）“溢”脉，指脉气从寸口向上越过鱼际部位，这是气有余的表现；“覆”脉，指脉气从尺部向下延伸至臂间，这是血有余的表现。如张仲景论述脉象时说：“纵”脉，是水气乘袭火金（水克火，金被水侮）；“横”脉，是火气乘袭水，木气乘袭金（火克水，金被木侮）；“逆”脉，是水气乘袭金，火气乘袭木（水克火，金被水侮，此处原文逻辑似有特定五行生克语境，直译其意）；“顺”脉，是金气乘袭水，木气乘袭火（金生水，木生火，此处指相生之序或特定克制关系，依原文直译）；“反”脉，指脉来微弱而去盛大，病在里；“覆”脉（此处另指一种形态），头小本大，病在表；“高”脉，指卫气盛，阳脉强盛；“章”脉，指营血盛，阴脉强盛；“刚”脉，是高脉与章脉相互搏击所致；“卑”脉（原文缺字，据上下文补为卑/弱之意，指卫气弱，阳脉衰弱）；“卑”脉，指营血弱，阴脉衰弱；“损”脉，是卑脉与另一种脉象相搏所致（原文此处有脱漏，指代某种虚弱相搏之象）。《内经》记载十二种脉，张仲景记载十二种脉，共计二十四种脉，这些未尝不是辨证的关键诀要，但世人皆置若罔闻，这就有愧于治病救人的职责了。虽然只有二十八字，但也蕴含了各种义理，如果不详究这二十四字的含义，又怎能进入二十八字脉学的奥妙之中呢？而且还不止于此。阴阳不可不分开辨析，色与脉不可不结合考察，尺肤不可不详细考证，主病之理不可不熟识并掌握。这四点做到了，持脉的道理就掌握了一半以上。《脉要精微论》说：脉理的微妙之处，不可不仔细察辨。察辨要有纲纪，从阴阳开始；起始要有经典依据，从五行产生；产生要有法度，顺应四时变化。那春天的温暖，化为夏天的暑热；那秋天的肃杀，化为冬天的严寒。四季变化的动态，脉象也随之上下起伏。因此圣人持脉之道，是先分辨阴阳再行诊察。比如阳动阴静，阳刚阴柔，阴升阴降，阳前阴后，阳上阴下，阳左阴右，数为阳，迟为阴，表为阳，里为阴，至者为阳，去者为阴，进者为阳，退者为阴，这是恒常的规律。或者阴盛到了极点，反而出现阳的征象；或者阳亢到了极点，反而出现阴的征兆；或者阳气穷尽而阴气乘袭它，或者阴气穷尽而阳气乘袭它。随着证候的变化而变化，随时间的推移而改变，这就是阴阳不可不分开辨析的原因。岐伯说：诊察脉动的动静，观察眼睛的神采，诊察五色，观察五脏的有余和不足，六腑的强弱，形体的盛衰，以此综合参验，决定死生的界限。又说：形体与正气相协调，叫做可治；色泽明润浮泽，叫做容易痊愈；脉象顺应四时，叫做可治；脉象软弱而滑利，说明有胃气。《灵枢》说：面色、脉象和尺肤，像鼓槌击鼓一样相应。青色对应弦脉，赤色对应钩脉，黄色对应代脉，白色对应毛脉，黑色对应石脉。看到这种面色却得不到相应的脉象，反而得到相克制的脉象，就会死亡；得到相生助的脉象，病就会好了。又说：眼睛的神采和五色，是气血精华的外现。红色应该像白绢包裹着朱砂，不应该像赭石；白色应该像鹅的羽毛，不应该像盐；青色应该像青玉，不应该像靛蓝；黄色应该像罗纱包裹着雄黄，不应该像黄土；黑色应该像重漆的颜色，不应该像地苍（灰暗无光）。这就是色与脉不可不结合考察的原因。《灵枢》说：审察尺肤的缓急、大小、滑涩，以及肌肉的坚脆，那么疾病的形态就可以确定了。眼睑微微浮肿，颈部动脉跳动，时常咳嗽，按压手足凹陷不起，这是风水肤胀病。尺肤滑润而光泽的，是风病。尺部肌肉瘦弱的，叫作懈惰，嗜睡且肌肉消瘦脱落的，是寒热病，难以治愈。尺肤粗糙的，是风痹病。尺肤粗糙得像枯鱼的鳞片，是有饮邪停聚。尺肤很热，脉象盛大躁动的，是温病。脉象盛大而滑利的，汗将要出来。尺肤寒冷，脉象细小的，是泄泻且气短。尺肤灼热如火，是寒热病。肘部单独发热的，腰以上发热；手部单独发热的，腰以下发热。肘前单独发热的，胸膺前发热；肘后单独发热的，肩背发热。手臂中间单独发热的，腰腹部发热。肘后粗纹以下三四寸处发热，是肠中有虫。掌心发热的是腹热，掌心寒冷的是腹寒。大鱼际上有青色脉络的，是胃中寒。尺部灼热如火，人迎脉大，应当放血治疗。尺部坚硬而大，脉象细小，气短，加重后会立即死亡。又说：脉象紧急的，尺肤也紧急；脉象缓和的，尺肤也缓和；脉象细小的，尺肤也减薄且气短；脉象大的，尺肤也贲起；脉象滑利的，尺肤也滑利；脉象涩滞的，尺肤也涩滞。这就是尺肤不可不详细考证的原因。《脉要精微论》说：脉长说明气机调畅，脉短说明气机有病，脉数说明心烦，脉大说明病势进展，上部脉盛说明气逆，下部脉盛说明气胀，代脉说明气衰，脉细说明气少，脉涩说明心痛，脉象浑浑革急如涌泉，病势进展且面色败坏，脉去绵绵如弦断者死。《平人气象论》说：脉短的人头痛，脉长的人足胫痛，脉促而上击者肩背痛，脉沉而坚实者病在中焦，脉浮而盛大者病在外，脉沉而弱，是寒热及疝瘕少腹痛，脉沉而横，胁下有积块，腹中有横向积块疼痛，脉沉而急促说是寒热，脉盛滑坚实者病在外，脉小实而坚者病在内，脉小弱而涩，说是久病，脉浮滑而疾速，说是新病，脉紧急者是疝瘕少腹痛，脉滑者是风病，脉涩者是痹病，缓而滑者是热中，盛而紧者是胀病，手臂多青筋者是失血，尺脉缓涩，叫作懈惰，嗜睡脉盛，叫作失血，尺涩脉滑，叫作多汗，尺寒脉细，叫作后泄（便溏），尺脉粗常热者，叫作热中。这就是主病之理不可不熟识并掌握的原因。如上所述，不过是大概情况罢了。如果想要通达变通、探求精微，不精心研究《灵枢》《素问》，广泛综览各家学说，是不可能的。许胤宗说：脉象的征候幽深而难以阐明，我心里所理解的，嘴上无法表达。既然嘴上都无法表达，笔又怎么能写出来呢？博览至极而心灵自然开启，思考至极而神鬼都将相通，那么三指之下就有隔墙视物般的洞察，病魔也无从遁逃了。
(From Li Shicai's *San Shu*)
Pulse conditions are numerous and cannot be fully exhausted by the twenty-eight characters. However, regarding the principles of exterior (Biao), interior (Li), yin, yang, qi, blood, deficiency (Xu), and excess (Shi), these can roughly encompass the general outline. For instance, as stated in the *Neijing* (*Inner Canon*), "Gu" (Drum-like) refers to a pulse that is both floating (Fu) and large; "Bo" (Beating) refers to one that is both large and strong; "Jian" (Firm) is an alias for "Shi" (Excess); "Heng" (Horizontal) is an alias for "Hong" (Surging); "Ji" (Urgent) is an alias for "Jin" (Tight); "Chuan" (Panting) refers to a pulse that is both floating and rapid (Shu); "Zao" (Restless) refers to one that is both floating and swift; "Shu" (Sparse) refers to one that is both slow (Chi) and soft; "Ge" (Grid) refers to the Renying (ST9) pulse being double its normal size; "Guan" (Closed) refers to the Qikou (Cunkou/Radial artery at Cun position) pulse being double its normal size. These two pulses, later generations failed to deeply ponder the purport of the *Neijing*, and mistakenly treated them as disease names. (When yin and yang do not correspond, the disease is named "Guan Ge"; using pulse names as disease names, what is wrong with that? Zhang Zhongjing said: "Guan leads to vomiting and reversal, Ge leads to inability to urinate." He did not treat them exclusively as disease names.) "Yi" (Overflowing) refers to qi exceeding from the Cun Kou upwards past the Yuji (LU10) area, indicating excess of qi; "Fu" (Covering) refers to qi extending downwards from the Chi (Cun) section to the arm, indicating excess of blood. As Zhang Zhongjing discussed pulses: "Zong" (Vertical) indicates water overcoming fire and metal overcoming wood; "Heng" (Horizontal) indicates fire overcoming water and wood overcoming metal; "Ni" (Reverse) indicates water overcoming metal and fire overcoming wood; "Shun" (Smooth/Normal) indicates metal overcoming water and wood overcoming fire; "Fan" (Opposite) refers to the pulse coming weakly and departing strongly, indicating disease in the interior; "Fu" (Covering - morphological type) refers to a pulse head small and root large, indicating disease in the exterior; "Gao" (High) indicates flourishing Wei Qi (Defensive Qi) and strong Yang pulses; "Zhang" (Distinct) indicates flourishing Ying Blood (Nutritive Blood) and strong Yin pulses; "Gang" (Rigid) results from the interaction of Gao and Zhang pulses; "Bei" (Low/Humble) indicates weak Wei Qi and declining Yang pulses; "Bei" indicates weak Ying Blood and declining Yin pulses; "Sun" (Damaged) results from the interaction of Bei pulses. The *Neijing* records twelve types, Zhang Zhongjing records twelve types, totaling twenty-four pulses. These were undoubtedly key formulas for syndrome differentiation, yet the world treats them as if unheard of, which is shameful for those responsible for saving lives. Although there are only twenty-eight characters, they contain various meanings. If one does not detail the meaning of these twenty-four characters, how can one enter the profundity of the twenty-eight-character pulse theory? Moreover, it does not stop here. Yin and Yang must not be separated without analysis; color and pulse must not be examined without integration; the skin of the forearm (Chifu) must not be investigated without detail; the diseases governed by pulses must not be recognized without familiarity. If these four are mastered, half of the way of holding the pulse has been thought through. The *Mai Yao Jing Wei Lun* says: The subtlety lies in the pulse, which must not fail to be observed. Observation has its discipline, starting from Yin and Yang. The beginning has its classics, arising from the Five Elements. Arising has its measure, suitable for the Four Seasons. The warmth of spring becomes the heat of summer; the severity of autumn becomes the anger of winter. The movement of the four changes causes the pulse to rise and fall accordingly. Thus, the sages hold the pulse by first distinguishing Yin and Yang before examining it. Such as Yang moving and Yin still, Yang rigid and Yin soft, Yin ascending and Yin descending, Yang preceding and Yin following, Yang above and Yin below, Yang left and Yin right, rapid is Yang, slow is Yin, exterior is Yang, interior is Yin, arriving is Yang, departing is Yin, advancing is Yang, retreating is Yin; these are the constant meridians. Or when Yin excess reaches the extreme, it contrary obtains Yang images; or when Yang hyperactivity reaches the extreme, it contrary obtains Yin signs; or when Yang exhausts and Yin takes advantage, or when Yin exhausts and Yang takes advantage. Following the syndrome, changes migrate; changing with time, this is why Yin and Yang must not be separated without analysis. Qibo said: Observe the movement and stillness of the pulse, look at the brightness of the eyes, observe the five colors, view the surplus and deficiency of the Zang organs, the strength and weakness of the Fu organs, and the flourishing and decline of the form. By comparing these, determine the division of life and death. It also says: When form and Qi match, it is called treatable. When color and luster are floating and bright, it is called easily cured. When the pulse follows the four seasons, it is called treatable. When the pulse is weak and slippery, it possesses Stomach Qi. The *Ling Shu* says: Color, pulse, and Chifu respond to each other like a drumstick striking a drum. Green corresponds to Xian (Wiry) pulse, Red corresponds to Gou (Hook) pulse, Yellow corresponds to Dai (Knotted/Intermittent) pulse, White corresponds to Mao (Feather) pulse, Black corresponds to Shi (Stone) pulse. Seeing the color but not obtaining its corresponding pulse, and instead obtaining a mutually overcoming pulse, means death; obtaining a mutually generating pulse means the illness will resolve. It also says: The brightness of the eyes and the five colors are the splendor of Qi. Red should resemble white silk wrapping cinnabar, not resembling jasper; White should resemble goose feathers, not resembling salt; Green should resemble dark jade, not resembling indigo; Yellow should resemble raw silk wrapping realgar, not resembling yellow earth; Black should resemble heavy lacquer, not resembling dull ground. This is why color and pulse must not be combined without examination. The *Ling Shu* says: Examine the slackness/tightness, size, slipperiness, and roughness of the Chifu, and the firmness/brittleness of the flesh, then the disease form is determined. Slight swelling of the eye sockets, pulsation of the neck vessels, occasional cough, pressing the hands and feet leaves an indentation that does not rise immediately: this is Feng Shui (Wind-Water) skin distension. Slippery and glossy Chifu indicates Wind disease. Weak flesh at the Chi indicates Xie Duan (Laxity), lying down excessively with emaciated muscles indicates Han Re (Cold-Heat) disease, untreatable. Rough Chifu indicates Feng Bi (Wind-Damp Bi). Chifu rough as dead fish scales indicates Yin accumulation (fluid retention). Very hot Chifu with a surging and restless pulse indicates Wen Bing (Warm Disease). Surging and slippery pulse indicates sweat will emerge. Cold Chifu with a small pulse indicates diarrhea and shortness of breath. Burning hot Chifu indicates Cold-Heat disease. Heat only at the elbow indicates heat above the waist; heat only at the hand indicates heat below the waist. Heat only at the front of the elbow indicates heat in the anterior chest; heat only at the back of the elbow indicates heat in the shoulder and back. Heat only in the middle of the arm indicates heat in the waist and abdomen. Heat three to four inches below the thick part at the back of the elbow indicates worms in the intestines. Heat in the palm indicates abdominal heat; cold in the palm indicates abdominal cold. Blue veins on the大鱼际 (Thenar eminence) indicate cold in the stomach. Burning hot Chi and large Renying pulse indicates blood loss should be drained. Hard and large Chi with small pulse and shortness of breath indicates imminent death upon worsening. It also says: Urgent pulse corresponds to urgent Chifu; slack pulse corresponds to slack Chifu; small pulse corresponds to diminished Chifu and shortness of breath; large pulse corresponds to bulging Chifu; slippery pulse corresponds to slippery Chifu; choppy pulse corresponds to choppy Chifu. This is why Chifu must not be investigated without detail. The *Mai Yao Jing Wei Lun* says: Long pulse indicates regulated Qi; short pulse indicates diseased Qi; rapid pulse indicates vexatious heart; large pulse indicates progressing disease; upper excess indicates high Qi (rebellious Qi); lower excess indicates distended Qi; Dai pulse indicates depleted Qi; thin pulse indicates little Qi; choppy pulse indicates heart pain; chaotic and革 (leather-like) arrival like a gushing spring indicates progressing disease and deteriorated complexion; continuous departure like a breaking string indicates death. The *Ping Ren Qi Xiang Lun* says: Short pulse indicates headache; long pulse indicates pain in the shins; surging and striking upward pulse indicates shoulder and back pain; deep and firm pulse indicates disease in the interior; floating and vigorous pulse indicates disease in the exterior; deep and weak pulse indicates cold-heat and hernia/lower abdominal pain; deep and horizontal pulse indicates accumulation under the ribs and horizontal accumulation pain in the abdomen; deep and panting pulse indicates cold-heat; vigorous, slippery, and firm pulse indicates disease in the exterior; small, solid, and firm pulse indicates disease in the interior; small, weak, and choppy pulse indicates chronic disease; floating, slippery, and rapid pulse indicates new disease; urgent pulse indicates hernia and lower abdominal pain; slippery pulse indicates wind; choppy pulse indicates bi-syndrome; slack and slippery pulse indicates heat in the center; vigorous and tight pulse indicates distension; many blue veins in the arm indicates blood loss; Chi pulse slack and choppy indicates laxity; excessive lying down with vigorous pulse indicates blood loss; Chi choppy and pulse slippery indicates excessive sweating; Chi cold and pulse fine indicates posterior discharge (diarrhea); Chi pulse coarse and constantly hot indicates heat in the center. This is why the diseases governed by pulses must not be recognized without familiarity. What has been described above is merely a general outline. If one wishes to reach transformation and explore the subtle, without meticulously studying the *Ling Shu* and *Su Wen*, and comprehensively synthesizing the hundred schools, it is impossible. Xu Yinzong said: The manifestations of the pulse are profound and difficult to clarify; what I understand in my mind, my mouth cannot declare. Since the mouth cannot declare it, how can the pen write it? Exhausting learning opens the mind naturally; exhausting thought allows spirits and ghosts to communicate. Then, with three fingers, one sees through walls; no disease can hide in the Gaohuang acupoints.