（出程观泉医述。系衰辑景岳士材之书而成。以其简切。故僭注而附录之。其论各脉情势。盖校之滑氏枢要。尤见
真谛云。）
浮脉。只轻手便得。非必中沉俱无。若崔氏云。有表无里。有上无下。则脱然无根。混于散脉矣。非浮脉之真面目
也（脉有素浮素沉之体。故浮无定候。以指面初到脉上为候也。）
洪脉。只是根脚阔大。却非坚硬。若大而坚硬。则为实脉。而非洪脉矣。经曰。大则病进。谓其气方张也。又曰。
形瘦脉大。多气者死。谓形与脉不合也。（洪兼情势。横宽而起伏又大也。）
虚之异于散者。虚脉按之虽 。犹可见也。散脉按之绝无。不可见也。虚之异于芤者。虚则愈按而愈 。芤则重按
而仍见也。（虚脉中空。散脉边散。芤血虚且寒。故浮面多一层硬皮也。）
散有二义。一自有渐无之象。一散乱不整之象。比如杨花散漫。或至数不齐。或多寡不一。为危殆之候。若心脉浮
大而散。肺脉短涩而散。皆平脉也。软散则病脉矣。肾脉软散。肾败之征。脾脉代散。土绝之候。若二脉交见。尤为必
死之符。（乍大乍小。乍疏乍数。至之散也。乱如麻子。形之散也。皆主死。寻常病脉。只是形体宽泛。而两边不敛。浑
浑不清耳。）
营行脉中。脉以血形。芤脉中空。脱血之象也。诀云。寸芤积血在胸中。关内逢芤肠胃痈。是以芤为蓄血积聚之实
脉。非失血虚家之空脉矣。且云两头有。以头字换脉经之边字。便相去千里矣。（芤脉浮大而弦。按之中空。故两头有。
指下无。非如阴绝阳绝之不因。按而自不至也。诀语未误。寸芤积血。关芤肠痈。古人已有验之者。）
濡脉之浮 。与虚脉相类。但虚脉形大。而濡脉形小也。濡脉之细小。与弱脉相类。但弱在沉分。而濡在浮分也。
伪诀云。按之似有举还无。是弱脉而非濡脉矣。濡脉之无根。与散脉相类。但散脉从浮大而渐至于沉绝。濡脉从浮小而
渐至于不见也。从大而至无者。全凶之象。从小而至无者。凶吉相半也。在久病老年之人见之。尚未至于必绝。若平人
少壮暴病见之。名为无根。去死不远矣（濡即所谓芤而有胃气者若浮薄至极。则为散不为濡矣。）
微之为言无也。其象极细极软。仲景曰。萦萦如蛛丝。状其细而难见也。瞥瞥如羹上肥。状其软而无力也。轻取如
无。故曰阳气衰。重按欲绝。故曰阴气竭。久病得之多不可救。谓正气将次灭绝也。卒病得之犹或可生。谓邪气不至深
重也。（曾诊工人感冒。力作不休。数日困极。身燥气喘。脉在皮毛。 然。一息不知十几至。用大温润。兼通营卫。
天明得汗而解。若正发汗死矣。）
向以革脉即牢脉。非也。盖革浮而牢沉。革虚而牢实。形与证皆异也。叔和云。三部脉革。久病得之死。卒病得之
生。甲乙经曰。浑浑革至如涌泉。病进而色弊。绵绵其去如弦绝者死。言急如涌泉。则浮取之不止于弦大。而且数且搏
且滑矣。曰弦绝。不止于豁然。而且无根蒂矣。（绵绵其去如弦绝。乃别一事。不与上文连义也。解弦绝。尤不合。）
肾之为藏。配坎应冬。万物蛰藏。阳气下陷。故其脉主沉。阴而居里。若误与之汗。则如蛰虫。出而见霜。若误与
之下。则如飞蛾。入而见汤。
伏脉主病。在沉阴之分隐深之处。非轻浅之剂。所得破其藩垣也。伤寒以一手脉伏为单伏。两手脉伏为双伏。不可
以阳证见阴脉为例。火邪内郁不得发越。乃阳极似阴。故脉伏者。必得大汗而解。如久旱将雨。必先六合阴晦。一回雨
后。庶物咸苏也。又有阴证伤寒。先伏阴在内。而外复感寒邪。阴盛阳衰。四肢厥逆。六脉沉伏。须投姜附。及灸关元。
阳始回而脉始出矣。若太溪冲阳皆无脉者。必死无疑。（伏者。以其中藏有物也。故无温补之法。若中虚不宜疏散者。皆
脱脉之类也。篇中所指两条。一阳气之自窒。一阴气之见逼也。）
树以根深为牢。盖深入于下者也。监狱以禁固为牢。盖深藏于内者也。仲景云。寒则牢坚。又有坚固之义也。沈氏
曰。似沉似伏。牢之位也。实大弦长。牢之体也。牢脉主病以其在沉分也。故悉属阴寒。以其形弦实也。故咸为坚积。
若失血亡精之人。内虚当得革脉。若反得牢脉。是脉与证反。可卜死期矣。（冬脉如营。营即牢之义也。阳藏于内。故深
居而充实有力也。若阴踞于内。则阳熄而死硬矣。牢脉动力盛大。不得为死。以有阳也。）
实为邪气盛满坚劲有余之象。既大矣而且长且坚。三候皆然。则诸阳之象。莫不毕备。故但主实热。不主虚寒。
紧与实虽相似而实相悬。紧者热为寒束。故其象绷急而不宽舒。实者邪为火迫。故其象坚满而不和柔。（一寒裹于外。
一邪充于内。）
素问云。脉弱以滑。是有胃气。脉弱以涩。是为久病。盖弱堪重按。阴犹未绝。若兼涩象。则气血交败。生理灭绝
矣。（指下波澜。形之滑也。起伏自然。势之滑也。一血充。一气畅也。）
微脉模糊而难见。细脉则显而易见。故细比于微。稍稍较大也。细为血少气衰。故吐利失血。得沉细者生。忧劳过
度之人。脉亦多细。为自戕其血气也。大抵细脉微脉。俱为阳气衰残之候。非行温补。何以复其散失之元乎。（微有极细。
亦有极薄。细则有浓有薄。有弱有强。各有主病不同。不得专指为微细也。）
阴性多滞。故阴寒之证。脉必见迟。与缓脉绝不相类。盖缓以形之宽纵得名。迟以至数不及为义。缓脉四至。宽缓
和平。迟脉三至。迟滞不前。二脉迥别。
涩脉往来迟难。有类乎止。而实非止也。有类乎散。实非散也。须知浮而极细极软。似有若无。为微脉。浮而且细
且软。为濡脉。沉而且细且软。为弱脉。三脉皆有似于涩。而实有分别。（涩脉专在动势上见。故往来迟难四字至切。微
濡弱三脉以形见。有兼涩者。有不兼涩者。涩脉不尽类散也。）
古人譬诸徐行而怠。偶 一步。可为结脉传神。大凡热。则流行寒则凝。结如冬冷则冰。坚理势然也。人惟少火衰
弱中气虚寒失其干健之。运则气血痰食互相纠缠。营运之机不利。故脉应之而成结也。（结即涩脉之兼紧者。）
结促之止。止无常数。代脉之止。止有常数。结促之止。一止即来。代脉之止。良久方至。内经以代脉之见。为藏
气衰微。脾经脱绝之候。惟伤寒心悸。怀胎三月。或七情太过。跌打重伤。及风家痛家。俱不忌代脉。或无病而羸瘦脉
代者。危候也。久病脉代。万难回春。又云。少得代脉者死。老得代脉者生。自当通变（结促是有一至略间而并来。代
乃直少一至也。仍须细察脉神。以定吉凶。少得代死。老得代生。必是专指一病。非可概论也。）
缓脉以宽舒和缓为义。与紧脉相反。若阳寸阴尺。上下同等。浮大而软。无有偏胜。为缓而和匀。此真胃气脉也。
土为胃气之母。中气调和。则百病不生。一切脉中。皆须挟缓。谓之胃气。非病脉也。兼乎浮迟虚濡细涩之形者。为病
不足。为风为表虚也。（指下柔匀。形之缓也。来去从容如一。气之缓也。若病脉。皆属于湿热之类）
数之为义。躁急而不能中和也。火性急速。故阳盛之证。脉来必数肺部见之。为金家贼脉。秋月逢之。为克令凶征。
滑之为言。往来流利。而不滞涩也。盖脉者血之府也。血枯则脉涩。血盛则脉滑。（滑涩固由于血。实由于津液之载
血而行者。有盛衰也。故涩脉之治。宜行血而生津。）
紧者绷急而兼绞转之象。热则筋纵。寒则筋急。此为热郁于内而寒束于外。故紧急绞转之象见焉。合观内经之左右
弹。仲景之如转索。丹溪之如纫线。叔和之如切绳。可见紧之为义。不独纵有挺急抑且横有转侧也紧脉之挺急。与弦相
类。但比之于弦。有更加挺劲之异。与转如绳索之殊也。（巢氏以弦洪相搏为紧。此即热气内郁之象。脉诀所论紧脉主病
是也。若内外皆寒。则坚细而涩。当属之结脉矣。）
促脉之故。得于藏气乖违者。十之六七。得于真元衰惫者。十之二三。或。因气滞。或因血凝。或因痰停。或因食
壅。或外因六气。内因七情。皆能阻其营运之机而为促也。如止数渐稀。则病瘥。止数渐增。则病剧。（与前论结脉义同
宜玩味。）动脉两头俯中间起极与短脉相似。但短脉为阴不数不硬不滑也。动脉为阳且数且硬且滑也（由阴出阳。怒之象
也。）疾一名极。总是急速之形。数之盛者也。惟伤寒热极。方见此脉。非他疾所恒有也。若劳瘵虚惫之人见之。则阴髓
下竭。阳光上亢。有日无月。短期近矣。（此条乃李士材所创。其名实本内经。但当以内经静躁之义为说。不当仍隶于数
也。予详辨于补义中）
弦如琴弦之挺直。而略带长也。经曰。少阳之气。温和软弱。故脉为弦。其气来实强。为太过。病在外。其气不实
而微。为不及。病在中。又肝脉来。濡弱迢迢。如循长竿末梢。曰肝平。若过实则肝病。急劲则肝死。弦脉与长脉。皆
主春令。但弦为初春之象。阳中之阴。天气犹寒。故如琴弦之端直。而挺然稍带一分之紧急也。长为暮春之象。纯属于
阳。绝无寒意。故如木干之迢直以长。纯乎发生之气象也。（弦以脉形之挺直言。长以脉气之充足言。）
长脉之应。与弦脉略同。但弦之木。为万物之始生。此主春生之正令。天地之气至此发舒。故脉象应之为长也。经
云长则气治。李月池曰。心脉长者。神强气旺。肾脉长者。蒂固根深。皆言平脉也。然惟长而和缓。乃合春生之气。为
健旺之征。若长而硬劲。即属火亢之形。而为疾病之应也。（长而硬劲。为火亢。不曰木横者。气充形直。其象为洪。而
不仅为弦也。）
短反乎长。彼应春。此应秋。彼属肝。此属肺。肺主气。气属阳。宜乎充沛。短脉独见。气衰之兆。素问曰。肺之
平脉。厌厌聂聂。如落榆荚。则短中自有和缓之象。气仍治也。若短而沉且涩。则气病矣。
大抵长短二脉。为有余不及之象。长类于弦而盛于弦。为有余。短类于动而衰于动。为不及。弦脉带急而长脉带缓。
动脉形滑而且数。短脉形涩而必迟。诚能细心较量。锱铢不爽者也。（长盛于弦。可见弦为形急。长为气充也。）
（出自程观泉的《医述》。这是由我摘录整理张景岳和李士材的著作而成的。因为内容简明扼要，所以我冒昧地加注并附录于此。他们论述各种脉象的情势，比起滑寿的《诊家枢要》，更能体现真谛。）
浮脉（Fú Mài, Floating Pulse）：只需轻手触按即可触及，并非一定要中取、沉取都无脉象。如果像崔氏所说“有表无里，有上无下”，那就完全失去了根基，混淆于散脉（Sàn Mài, Scattered Pulse）了，这不是浮脉的真实面目。（脉象本身有素来偏浮或偏沉的体质特点，所以浮脉没有固定的候诊位置，以指面刚接触到脉搏表面作为候诊标准。）
洪脉（Hóng Mài, Surging Pulse）：只是根部宽阔宏大，但并不坚硬。如果脉大而坚硬，那就是实脉（Shí Mài, Excess Pulse），而不是洪脉了。经书说：“大则病进”，是指邪气正盛。又说：“形体消瘦而脉大，多气者死”，是指形体与脉象不相符合。（洪脉兼具情势，横宽且起伏又大。）
虚脉（Xū Mài, Deficient Pulse）与散脉的区别在于：虚脉重按时虽然感觉空虚，但脉形仍可见；散脉重按时完全消失，不可见。虚脉与芤脉（Kōu Mài, Scallion Stalk Pulse）的区别在于：虚脉越按越感觉空虚无力；芤脉重按时中间虽空，但两边仍有脉形。（虚脉中空，散脉边缘散乱，芤脉主血虚兼寒，所以浮取时外面好像多了一层硬皮。）
散脉有两种含义。一种是逐渐消失的象，一种是散乱不整齐的象。比如杨花散漫，或者至数不齐，或多寡不一，这是危重的征候。但是如果心脉浮大而散，肺脉短涩而散，这都是平脉（Píng Mài, Normal Pulse）。软散则是病脉。肾脉软散，是肾败坏的征象；脾脉代散（Dài Sàn, Intermittent and Scattered），是脾气绝灭的征候。如果这两种脉象同时出现，更是必死的征兆。（脉象乍大乍小，乍疏乍数，是至数的散乱；脉形乱如麻子，是形态的散乱，都主死。寻常的病脉，只是形体宽泛，而两边不收敛，浑浊不清罢了。）
营气（Yíng Qì, Nutritive Qi）行于脉中，脉以血液为形。芤脉中空，是失血的象。诀语说：“寸口见芤脉，胸中有积血；关部逢芤脉，肠胃生痈脓。”因此芤脉被认为是蓄血积聚的实脉，而不是失血虚家的空脉。而且说“两头有”，如果把“头”字换成脉经中的“边”字，意思就相差千里了。（芤脉浮大而弦，按之中空，所以说两头有，指下无。这不像阴绝阳绝那样，不按就自然不至。诀语没有错误，寸口芤主积血，关部芤主肠痈，古人已有验证过的案例。）
濡脉（Rú Mài, Soft Pulse）的浮而细软，与虚脉相似。但虚脉形大，而濡脉形小。濡脉的细小，与弱脉（Ruò Mài, Weak Pulse）相似。但弱脉在沉分，而濡脉在浮分。伪诀说：“按之似有，举之还无”，这是弱脉而不是濡脉。濡脉的无根，与散脉相似。但散脉从浮大逐渐至于沉取绝迹；濡脉从浮小逐渐至于不见。从大而至无，是全凶的象；从小而至无，是吉凶参半。在久病老年之人身上见到，尚未至于必绝。如果在平人少壮暴病时见到，名为无根，离死不远了。（濡脉即所谓芤脉而有胃气者。如果浮薄至极，就是散脉而不叫濡脉了。）
微脉（Wēi Mài, Fine Pulse）的“微”字意为无。其象极细极软。仲景说：“萦萦如蛛丝”，形容其细而难见；“瞥瞥如羹上肥”，形容其软而无力。轻取似乎没有，所以说阳气衰；重按欲绝，所以说阴气竭。久病得此脉大多不可救，是说正气即将灭绝。突然患病得此脉或许还能生，是说邪气不至深重。（曾诊治一名工人感冒，拼命劳作不停，数日困倦至极，身体燥热气喘，脉在皮毛，怫郁然，一息不知跳多少下。用大温润药，兼通营卫，天明得汗而解。如果此时正发汗，病人就会死了。）
以前认为革脉（Gé Mài, Drum Skin Pulse）即牢脉（Láo Mài, Deep-Firm Pulse），这是不对的。盖革脉浮而牢脉沉，革脉虚而牢脉实，形态与证候都不同。叔和说：“三部脉革，久病得之死，卒病得之生。”《甲乙经》说：“浑浑革至如涌泉，病进而色弊；绵绵其去如弦绝者死。”意思是急如涌泉，则浮取不止于弦大，而且数、搏、滑。说“弦绝”，不止于豁然，而且无根蒂了。（“绵绵其去如弦绝”是另一回事，不与上文连义。解释“弦绝”尤其不合。）
肾为藏，配坎卦应冬季，万物蛰伏收藏，阳气下陷，所以其脉主沉。阴居里位，如果误用发汗法，就像冬眠的虫子出来见到霜冻；如果误用泻下法，就像飞蛾投入汤火。
伏脉（Fú Mài, Hidden Pulse）主病，在沉阴之分隐深之处，不是轻浅的药剂所能攻破藩篱的。伤寒病中，一手脉伏称为单伏，两手脉伏称为双伏，不能以阳证见阴脉为例。火邪内郁不得发越，乃是阳极似阴，所以脉伏者，必须得大汗而解，就像久旱将雨，必先天地昏暗，一场雨后，万物复苏。又有阴证伤寒，先伏阴在内，而外复感寒邪，阴盛阳衰，四肢厥逆，六脉沉伏，须投姜附（干姜、附子），及灸关元穴，阳气才能回返而脉才能出。如果太溪、冲阳穴皆无脉者，必死无疑。（伏脉是因为其中藏有物，所以没有温补之法。如果是中虚不宜疏散者，都属于脱脉之类。篇中所指两条，一是阳气自窒，一是阴气逼迫。）
树以根深为牢，大概是深入于下的意思。监狱以禁固为牢，大概是深藏于内的意思。仲景说：“寒则牢坚”，又有坚固的意思。沈氏说：“似沉似伏，是牢脉的位置；实大弦长，是牢脉的体性。”牢脉主病，因为它在沉分，所以悉属阴寒；因为它形弦实，所以咸为坚积。如果是失血亡精之人，内虚应当得革脉，如果反得牢脉，是脉与证相反，可以预测死期了。（冬脉如营，营即牢的意思。阳藏于内，所以深居而充实有力。如果阴踞于内，则阳熄而死硬了。牢脉动力盛大，不为死脉，因为有阳。）
实脉是邪气盛满坚劲有余的象。既大而且长且坚，三部皆然，则诸阳之象无不具备。所以只主实热，不主虚寒。
紧脉（Jǐn Mài, Tight Pulse）与实脉虽相似而实则悬殊。紧者是热被寒束，所以其象绷急而不宽舒；实者是邪被火迫，所以其象坚满而不和柔。（一个是寒裹于外，一个是邪充于内。）
《素问》说：“脉弱以滑，是有胃气；脉弱以涩，是为久病。”盖弱脉堪重按，阴犹未绝。如果兼涩象，则气血交败，生理灭绝了。（指下波澜起伏，是形的滑；起伏自然，是势的滑。是一血充，一气畅。）
微脉模糊而难见，细脉（Xì Mài, Thready Pulse）则显而易见。所以细比于微，稍稍较大。细脉主血少气衰，所以吐利失血，得沉细者生。忧劳过度的人，脉也多细，是自戕其血气。大抵细脉、微脉，俱为阳气衰残之候，不用温补，怎么能恢复其散失的元气呢？（微有极细，也有极薄；细则有浓有薄，有弱有强，各有主病不同，不能专指为微细。）
阴性多滞，所以阴寒之证，脉必见迟（Chí Mài, Slow Pulse）。与缓脉（Huǎn Mài, Moderate Pulse）绝不相类。盖缓脉以形的宽纵得名，迟脉以至数不及为义。缓脉四至，宽缓和平；迟脉三至，迟滞不前。二脉迥别。
涩脉（Sè Mài, Choppy Pulse）往来迟难，有类似止，而实非止；有类似散，实非散。须知浮而极细极软，似有若无，为微脉；浮而且细且软，为濡脉；沉而且细且软，为弱脉。这三脉皆有似于涩，而实有分别。（涩脉专在动势上见，所以“往来迟难”四字最贴切。微、濡、弱三脉以形见，有兼涩者，有不兼涩者。涩脉不尽类散。）
古人比喻为徐行而怠，偶绊一步，可为结脉（Jié Mài, Knotted Pulse）传神。大凡热则流行，寒则凝。结脉如冬冷则冰，坚理势然也。人惟少火衰弱，中气虚寒，失其干健之运，则气血痰食互相纠缠，营运之机不利，故脉应之而成结。（结脉即涩脉之兼紧者。）
结脉、促脉（Cù Mài, Rapid-Pulse-with-Interruption）之止，止无常数；代脉（Dài Mài, Interrupted Pulse）之止，止有常数。结、促之止，一止即来；代脉之止，良久方至。《内经》以代脉之见，为脏气衰微、脾经脱绝之候。惟伤寒心悸、怀胎三月、或七情太过、跌打重伤，及风家痛家，俱不忌代脉。或无病而羸瘦脉代者，是危候。久病脉代，万难回春。又云：“少得代脉者死，老得代脉者生”，自当通变。（结、促是有一至略间而并来，代乃直少一至也。仍须细察脉神，以定吉凶。“少得代死，老得代生”，必是专指一病，非可概论也。）
缓脉以宽舒和缓为义，与紧脉相反。若阳寸阴尺，上下同等，浮大而软，无有偏胜，为缓而和匀，此真胃气脉也。土为胃气之母，中气调和，则百病不生。一切脉中，皆须挟缓，谓之胃气，非病脉也。兼乎浮、迟、虚、濡、细、涩之形者，为病不足，为风、为表虚也。（指下柔匀，是形的缓；来去从容如一，是气的缓。若病脉，皆属于湿热之类。）
数脉（Shuò Mài, Rapid Pulse）之为义，躁急而不能中和也。火性急速，所以阳盛之证，脉来必数。肺部见之，为金家贼脉；秋月逢之，为克令凶征。
滑脉（Huá Mài, Slippery Pulse）之为言，往来流利，而不滞涩也。盖脉者血之府也。血枯则脉涩，血盛则脉滑。（滑涩固由于血，实由于津液载血而行者，有盛衰也。所以涩脉的治疗，宜行血而生津。）
紧脉者，绷急而兼绞转之象。热则筋纵，寒则筋急。此为热郁于内而寒束于外，所以紧急绞转之象见焉。合观《内经》之左右弹，仲景之如转索，丹溪之如纫线，叔和之如切绳，可见紧之为义，不独纵有挺急，抑且横有转侧也。紧脉之挺急，与弦脉（Xián Mài, Wiry Pulse）相类，但比之于弦，有更加挺劲之异，与转如绳索之殊也。（巢氏以弦洪相搏为紧，此即热气内郁之象，脉诀所论紧脉主病是也。若内外皆寒，则坚细而涩，当属之结脉矣。）
促脉的缘故，得于脏气乖违者的十之六七，得于真元衰惫者的十之二三。或因气滞，或因血凝，或因痰停，或因食壅，或外因六气，内因七情，皆能阻其营运之机而为促也。如止数渐稀，则病瘥；止数渐增，则病剧。（与前论结脉义同，宜玩味。）
动脉两头俯中间起，极与短脉（Duǎn Mài, Short Pulse）相似。但短脉为阴，不数、不硬、不滑；动脉为阳，且数、且硬、且滑。（由阴出阳，怒之象也。）
疾脉（Jí Mài, Very-Rapid Pulse）一名极，总是急速之形，是数脉之盛者也。惟伤寒热极，方见此脉，非他疾所恒有也。若劳瘵虚惫之人见之，则阴髓下竭，阳光上亢，有日无月，短期近矣。（此条乃李士材所创，其名实本《内经》，但当以内经静躁之义为说，不当仍隶于数也。予详辨于补义中。）
弦脉如琴弦之挺直，而略带长也。经曰：“少阳之气，温和软弱，故脉为弦。”其气来实强，为太过，病在外；其气不实而微，为不及，病在中。又肝脉来，濡弱迢迢，如循长竿末梢，曰肝平。若过实则肝病，急劲则肝死。弦脉与长脉（Cháng Mài, Long Pulse），皆主春令。但弦为初春之象，阳中之阴，天气犹寒，故如琴弦之端直，而挺然稍带一分之紧急也。长为暮春之象，纯属于阳，绝无寒意，故如木干之迢直以长，纯乎发生之气象也。（弦以脉形之挺直言，长以脉气之充足言。）
长脉之应，与弦脉略同。但弦之木，为万物之始生，此主春生之正令。天地之气至此发舒，故脉象应之为长也。经云：“长则气治。”李月池曰：“心脉长者，神强气旺；肾脉长者，蒂固根深。”皆言平脉也。然惟长而和缓，乃合春生之气，为健旺之征。若长而硬劲，即属火亢之形，而为疾病之应也。（长而硬劲，为火亢，不曰木横者，气充形直，其象为洪，而不仅为弦也。）
短脉反乎长，彼应春，此应秋；彼属肝，此属肺。肺主气，气属阳，宜乎充沛。短脉独见，是气衰之兆。《素问》曰：“肺之平脉，厌厌聂聂，如落榆荚。”则短中自有和缓之象，气仍治也。若短而沉且涩，则气病矣。
大抵长短二脉，为有余不及之象。长类于弦而盛于弦，为有余；短类于动而衰于动，为不及。弦脉带急而长脉带缓，动脉形滑而且数，短脉形涩而必迟。诚能细心较量，锱铢不爽者也。（长盛于弦，可见弦为形急，长为气充也。）
(From Cheng Guanquan's *Yi Shu*. This is compiled by excerpting and organizing the works of Zhang Jingyue and Li Shicai. Because the content is concise and clear, I have presumptuously added annotations and appended it here. Their discussion on the conditions of various pulses reveals the true essence even more than Hua Shou's *Zhen Jia Shu Yao*.)
Floating Pulse (Fú Mài): It can be felt with light pressure alone; it is not necessary for the middle and deep pressures to yield no pulse. If, as Cui Shi stated, there is "surface but no interior, upper but no lower," it completely lacks a root and is confused with the Scattered Pulse (Sàn Mài). This is not the true appearance of the Floating Pulse. (Pulses naturally tend to be either floating or sinking, so the Floating Pulse has no fixed location for palpation; it is assessed when the fingertip first touches the pulse surface.)
Surging Pulse (Hóng Mài): It is merely broad and large at the base, but not hard. If the pulse is large and hard, it is an Excess Pulse (Shí Mài), not a Surging Pulse. The Classics state: "Large indicates disease progression," meaning the pathogenic qi is flourishing. It also states: "Emaciated body with a large pulse indicates excess qi and death," meaning the body form does not match the pulse. (The Surging Pulse combines both condition and momentum, being wide horizontally with significant up-and-down movement.)
The difference between the Deficient Pulse (Xū Mài) and the Scattered Pulse is that although the Deficient Pulse feels empty upon heavy pressure, its form remains visible. In contrast, the Scattered Pulse completely disappears upon heavy pressure and becomes invisible. The difference between the Deficient Pulse and the Scallion Stalk Pulse (Kōu Mài) is that the Deficient Pulse feels increasingly empty and weak with deeper pressure, whereas the Scallion Stalk Pulse, though empty in the center upon heavy pressure, still shows presence on the sides. (The Deficient Pulse is empty in the center; the Scattered Pulse is scattered at the edges; the Scallion Stalk Pulse indicates blood deficiency with cold, so upon superficial palpation, it seems to have an extra layer of hardness.)
The Scattered Pulse has two meanings. One is the image of gradually disappearing; the other is the image of disorderly irregularity. For example, like scattered willow catkins, or with inconsistent beat counts or varying magnitudes, this is a critical sign. However, if the Heart pulse is floating, large, and scattered, or the Lung pulse is short, choppy, and scattered, these are Normal Pulses (Píng Mài). A soft and scattered quality indicates a pathological pulse. A Kidney pulse that is soft and scattered is a sign of Kidney failure; a Spleen pulse that is intermittent and scattered is a sign of Spleen qi extinction. If these two pulses appear together, it is a definite sign of death. (Irregularities in magnitude and frequency indicate scattering of the beats; chaos in shape like hemp seeds indicates scattering of the form; both signify death. Common pathological pulses are merely broad in shape without收敛 (convergence) on the sides, appearing turbid and unclear.)
Nutritive Qi (Yíng Qì) circulates within the vessels, and the vessel form is based on blood. The Scallion Stalk Pulse, being empty in the center, is an image of blood loss. The Aphorism states: "Scallion Stalk pulse at the Cun position indicates accumulated blood in the chest; Scallion Stalk pulse at the Guan position indicates intestinal abscess." Thus, the Scallion Stalk Pulse is considered a solid pulse of accumulated blood and masses, not an empty pulse of blood loss and deficiency. Furthermore, stating "present at both ends" differs significantly from the Classic's statement of "present at both sides." (The Scallion Stalk Pulse is floating, large, and wiry, but empty in the center upon pressure, hence "present at both ends, absent under the finger." This is unlike Yin or Yang exhaustion where the pulse naturally fails to appear without pressure. The aphorism is correct; Cun Scallion Stalk indicates accumulated blood, Guan Scallion Stalk indicates intestinal abscess, which has been verified by ancients.)
The Floating and fine-soft quality of the Soft Pulse (Rú Mài) is similar to the Deficient Pulse. However, the Deficient Pulse is large in form, while the Soft Pulse is small. The fine nature of the Soft Pulse is similar to the Weak Pulse (Ruò Mài). However, the Weak Pulse is found at the deep level, while the Soft Pulse is at the superficial level. The spurious aphorism states: "Seems present upon pressing, disappears upon lifting"; this describes the Weak Pulse, not the Soft Pulse. The rootlessness of the Soft Pulse is similar to the Scattered Pulse. However, the Scattered Pulse goes from floating-large to deep-absent, whereas the Soft Pulse goes from floating-small to invisible. Going from large to non-existent is a fully ominous sign; going from small to non-existent is half-ominous, half-auspicious. In elderly patients with chronic illness, this has not yet reached inevitable extinction. However, if seen in a healthy young person with acute illness, it is named "rootless" and death is near. (The Soft Pulse is what is referred to as a Scallion Stalk Pulse possessing Stomach Qi. If it becomes extremely thin and floating, it is a Scattered Pulse, not a Soft Pulse.)
The term "Wei" (Fine Pulse, Wēi Mài) means non-existence. Its image is extremely fine and soft. Zhongjing said: "Like a spider's thread," describing its fineness and difficulty to see; "like the fat floating on soup," describing its softness and lack of strength. Lightly taken, it seems absent, thus indicating decline of Yang Qi; heavily pressed, it nearly vanishes, thus indicating exhaustion of Yin Qi. Chronic illness presenting this pulse is mostly incurable, indicating imminent extinction of righteous qi. Acute illness presenting this pulse may still be survivable, indicating the pathogen is not deeply entrenched. (I once treated a worker with a common cold who worked tirelessly for days until exhausted, with dry skin, panting, and a pulse located in the skin and hair, oppressed and rapid, with unknown beats per breath. I used strongly warming and moistening herbs combined with regulating Ying and Wei Qi. He sweated and recovered by dawn. Had diaphoresis been induced directly, he would have died.)
Previously, it was believed that the Drum Skin Pulse (Gé Mài) was the same as the Deep-Firm Pulse (Láo Mài), which is incorrect. The Drum Skin Pulse is floating, while the Deep-Firm Pulse is deep; the Drum Skin Pulse is deficient, while the Deep-Firm Pulse is excess. Their forms and corresponding syndromes are different. He Suhe stated: "Drum Skin pulse in all three positions leads to death in chronic illness but survival in acute illness." The *Jia Yi Jing* states: "Chaotic and surging like a gushing spring indicates disease progression and deteriorating complexion; continuous departure like a broken string indicates death." Meaning urgent like a gushing spring, superficial palpation reveals not just wiry and large, but also rapid, beating, and slippery. "Broken string" implies not just sudden emptiness, but also lack of root. ("Continuous departure like a broken string" is a separate matter and does not connect with the previous text. Explaining "broken string" in this context is inappropriate.)
The Kidney corresponds to the Kan trigram and winter, when all things hibernate and store, and Yang Qi sinks downward. Therefore, its pulse governs sinking. Yin resides in the interior. If sweating methods are mistakenly applied, it is like hibernating insects emerging to face frost; if purgative methods are mistakenly applied, it is like moths flying into boiling water.
The Hidden Pulse (Fú Mài) governs diseases in the deep Yin regions, hidden and profound. It cannot be penetrated by mild or superficial remedies. In Cold Damage (Shāng Hán), a hidden pulse in one hand is called Single Hidden, and in both hands is called Double Hidden. This cannot be exemplified by Yang syndromes presenting Yin pulses. Internal stagnation of Fire Evil unable to vent outward results in Extreme Yang resembling Yin. Therefore, patients with a hidden pulse must resolve through profuse sweating, just as before rain after a long drought, the sky must first darken, and after the rain, all things revive. There is also Yin-type Cold Damage, where Yin is internally latent and externally exposed to Cold Evil. With Yin excess and Yang decline, leading to cold limbs and six hidden pulses, one must administer Ginger and Aconite (Gan Jiang, Fu Zi) and moxa Guanyuan point. Only then will Yang Qi return and the pulse emerge. If both Taixi and Chongyang pulses are absent, death is certain. (The Hidden Pulse exists because something is concealed within; thus, warming and tonifying methods are not applicable. Cases of central deficiency unsuitable for dispersal belong to the category of Collapsing Pulses. The two cases mentioned in the chapter refer to one of self-obstruction of Yang Qi and one of oppression by Yin Qi.)
Trees are firm due to deep roots, implying depth downwards. Prisons are firm due to confinement, implying deep storage within. Zhongjing said: "Cold makes firm and solid," adding the meaning of solidity. Shen Shi said: "Resembling deep and hidden, this is the position of the Deep-Firm Pulse; large, wiry, and long, this is the substance of the Deep-Firm Pulse." The Deep-Firm Pulse governs disease because it is at the deep level, thus belonging entirely to Yin-Cold. Because its form is wiry and solid, it signifies all firm accumulations. For those who have lost blood or essence and suffer internal deficiency, the Drum Skin Pulse should be obtained. If instead the Deep-Firm Pulse is obtained, the pulse contradicts the syndrome, allowing prediction of the time of death. (Winter pulse is like a camp/garrison; "camp" implies firmness. Yang hides within, residing deeply and being substantial and powerful. If Yin occupies within, Yang extinguishes and becomes rigid. The Deep-Firm Pulse has strong dynamic power and is not a death pulse because Yang is present.)
Excess Pulse represents the image of pathogenic qi being full, solid, tough, and excessive. It is large, long, and hard. If all three positions exhibit this, all Yang images are complete. Therefore, it only governs Excess-Heat, not Deficiency-Cold.
Although the Tight Pulse (Jǐn Mài) resembles the Excess Pulse, they are fundamentally different. The Tight Pulse occurs when heat is bound by cold, resulting in a tense and unrelaxed image. The Excess Pulse occurs when pathogen is forced by fire, resulting in a solid and full but not gentle image. (One is cold wrapping externally; the other is pathogen filling internally.)
The *Su Wen* states: "Weak and slippery pulse indicates Stomach Qi; weak and choppy pulse indicates chronic illness." The Weak pulse can withstand heavy pressure, indicating Yin is not yet exhausted. If accompanied by a choppy image, it indicates mutual deterioration of Qi and Blood, and extinction of physiological life. (Ripples under the finger indicate the slipperiness of form; natural up-and-down movement indicates the slipperiness of momentum. This reflects abundant blood and smooth Qi.)
The Fine Pulse (Wēi Mài) is vague and difficult to see, whereas the Thready Pulse (Xì Mài) is clearly visible. Thus, Thready is slightly larger than Fine. Thready Pulse indicates insufficient Blood and declining Qi. Therefore, in vomiting, diarrhea, or blood loss, obtaining a deep-thready pulse indicates survival. People overworked and worried often have thready pulses, damaging their own Qi and Blood. Generally, both Fine and Fine pulses are signs of residual Yang Qi decline. Without warming and tonifying methods, how can the scattered Yuan Qi be restored? (Fine has extreme fineness and extreme thinness; Thready has density and thinness, weakness and strength. Each has different governing diseases and cannot be exclusively identified as Fine-Thready.)
Yin nature tends to stagnation, so in Yin-Cold syndromes, the pulse must be Slow (Chí Mài). It is absolutely distinct from the Moderate Pulse (Huǎn Mài). Moderate Pulse gets its name from its wide and relaxed form, while Slow Pulse is defined by insufficient beat count. Moderate Pulse has four beats per breath, wide and peaceful; Slow Pulse has three beats per breath, sluggish and stagnant. The two pulses are distinctly different.
The Choppy Pulse (Sè Mài) moves slowly with difficulty, resembling an interruption but not truly interrupting; resembling scattering but not truly scattering. One must know that floating, extremely fine, extremely soft, seeming present yet absent, is the Fine Pulse; floating, fine, and soft is the Soft Pulse; deep, fine, and soft is the Weak Pulse. These three pulses resemble Choppy but are actually distinct. (Choppy Pulse is seen specifically in the dynamics of movement, so "slow and difficult movement" is very accurate. Fine, Soft, and Weak pulses are seen in form; some accompany Choppy, others do not. Choppy Pulse does not entirely resemble Scattering.)
Ancients compared it to walking slowly and lazily, occasionally stumbling, which vividly describes the Knotted Pulse (Jié Mài). Generally, Heat flows freely, Cold coagulates. Knotted Pulse is like ice in winter cold, a natural tendency of firm structure. When Minfire declines and Middle Qi is deficient and cold, losing its vigorous transport function, Qi, Blood, Phlegm, and Food stagnate and tangle, hindering circulation. Thus, the pulse manifests as Knotted. (Knotted Pulse is essentially Choppy Pulse combined with Tightness.)
The interruptions of Knotted and Rapid-Pulse-with-Interrupted (Cù Mài) pulses have no constant number; the interruptions of the Interrupted Pulse (Dài Mài) have a constant number. In Knotted and Rapid-Pulse-with-Interrupted, the pulse returns immediately after an interruption; in Interrupted Pulse, it takes a long time to return. The *Nei Jing* regards the appearance of Interrupted Pulse as a sign of Zang Qi decline and Spleen Meridian collapse. Exceptions include palpitations in Cold Damage, pregnancy at three months, excessive emotional stress, severe trauma, and patients with wind or pain syndromes. Interrupted Pulse is not taboo in these cases. However, if seen in emaciated individuals without illness, it is a critical sign. Chronic illness with Interrupted Pulse is rarely recoverable. It is also said: "Young people getting Interrupted Pulse die; old people getting Interrupted Pulse survive." This requires flexible interpretation. (Knotted and Rapid-Pulse-with-Interrupted have slight gaps followed by combined beats; Interrupted simply misses one beat. One must carefully observe the Pulse Spirit to determine auspiciousness or inauspiciousness. "Young die, old survive" likely refers to specific diseases and cannot be generalized.)
Moderate Pulse implies wide, comfortable, and relaxed qualities, opposite to Tight Pulse. If the Yang Cun and Yin Chi positions are equal, floating and large but soft, without bias, it is moderate and harmonious, representing true Stomach Qi. Earth is the mother of Stomach Qi; if Middle Qi is harmonized, hundred diseases do not arise. All pulses must contain moderation, called Stomach Qi, which is not a pathological pulse. If accompanied by floating, slow, deficient, soft, thready, or choppy forms, it indicates deficiency, wind, or exterior deficiency. (Soft and uniform under the finger is the form of moderation; leisurely arrival and departure is the Qi of moderation. Pathological pulses generally belong to Damp-Heat types.)
The meaning of Rapid Pulse (Shuò Mài) is restless and urgent, lacking harmony. Fire nature is swift, so in Yang Excess syndromes, the pulse must be rapid. Seen in the Lung position, it is a thief pulse for Metal; encountered in autumn, it is an inauspicious sign of overcoming the ruling element.
Slippery Pulse (Huá Mài) means smooth flow without stagnation or choppy resistance. Vessels are the residence of Blood. Dry Blood leads to choppy pulses; abundant Blood leads to slippery pulses. (Slipperiness and choppy nature depend on Blood, but actually on Jin Ye carrying Blood, which has abundance or scarcity. Therefore, treatment for Choppy Pulse should promote Blood circulation and generate Jin Ye.)
Tight Pulse presents as tense and twisting. Heat causes muscle relaxation; Cold causes muscle tension. This case involves Heat郁 (stagnant) internally and Cold binding externally, hence the tense and twisting image appears. Observing *Nei Jing*'s "beating left and right," Zhongjing's "like turning rope," Danxi's "like sewing thread," and He Suhe's "like cutting rope," we see that Tightness implies not only longitudinal tension but also transverse rotation. The tension of Tight Pulse is similar to Wiry Pulse (Xián Mài), but differs by being more rigid and distinct from the twisting of a rope. (Chao Shi described Tight as the interaction of Wiry and Surging, which is the image of internal Heat stagnation, consistent with the aphorism's description of Tight Pulse governing diseases. If both interior and exterior are cold, the pulse is firm, fine, and choppy, belonging to Knotted Pulse.)
The cause of Rapid-Pulse-with-Interrupted Pulse is 60-70% due to Zang Qi disharmony and 20-30% due to True Yuan depletion. It may be due to Qi stagnation, Blood coagulation, Phlegm retention, or Food obstruction, or external Six Evils and internal Seven Emotions, all of which can hinder circulation and cause interruptions. If the number of interruptions gradually decreases, the disease improves; if it increases, the disease worsens. (Same meaning as the previous discussion on Knotted Pulse; worth pondering.)
Arterial Pulse rises in the middle with depressed ends, very similar to Short Pulse (Duǎn Mài). However, Short Pulse is Yin, not rapid, not hard, not slippery. Arterial Pulse is Yang, and is rapid, hard, and slippery. (Emerging from Yin to Yang, an image of anger.)
Rapid Pulse (Jí Mài), also called Extreme Pulse, always presents a rapid form, being the peak of Rapid Pulse. It is seen only in extreme Heat of Cold Damage, not commonly in other diseases. If seen in patients with consumption and debility, it indicates exhaustion of Yin Marrow below and hyperactivity of Yang Sun above, having sun but no moon, with death near. (This section was created by Li Shicai, based on *Nei Jing*, but should be explained using the *Nei Jing*'s concept of stillness and agitation, not classified under Rapid Pulse. I detailed this distinction in the supplementary meaning.)
Wiry Pulse is straight like a lute string, slightly long. The Classics state: "Shaoyang Qi is warm, mild, and soft, thus the pulse is Wiry." If the Qi comes strong and forceful, it is Excess, indicating disease in the Exterior. If the Qi is not substantial and weak, it is Deficiency, indicating disease in the Interior. Also, Liver pulse coming soft, weak, and distant, like touching the tip of a long bamboo pole, indicates healthy Liver. If overly solid, it is Liver disease; if urgent and stiff, it is Liver death. Wiry Pulse and Long Pulse (Cháng Mài) both govern Spring. However, Wiry is the image of early Spring, Yin within Yang, weather still cold, thus straight like a lute string with a hint of urgency. Long is the image of late Spring, purely Yang, devoid of cold, thus straight and long like a tree trunk, purely the image of growth. (Wiry refers to the straight form of the pulse; Long refers to the sufficiency of pulse Qi.)
The manifestation of Long Pulse is slightly similar to Wiry Pulse. But Wiry wood represents the beginning of all things, governing the proper command of Spring generation. Heaven and Earth Qi expands here, so the pulse image responds as Long. The Classics say: "Long indicates regulated Qi." Li Yuechi said: "Long Heart pulse indicates strong spirit and abundant Qi; Long Kidney pulse indicates solid foundation and deep roots." Both describe normal pulses. However, only Long and moderate matches the Qi of Spring generation, indicating vigor. If Long and stiff/hard, it belongs to Fire Hyperactivity and indicates disease. (Long and stiff/hard indicates Fire Hyperactivity, not Wood Overacting, because abundant Qi and straight form manifest as Surging, not just Wiry.)
Short Pulse is opposite to Long. Long responds to Spring, Short responds to Autumn; Long belongs to Liver, Short belongs to Lung. Lung governs Qi, Qi belongs to Yang, and should be abundant. Short Pulse appearing alone is a sign of Qi decline. *Su Wen* says: "Normal Lung pulse is gentle and fluttering, like falling elm seeds." Thus, within Shortness there is moderation, and Qi is still regulated. If Short, deep, and choppy, then Qi is diseased.
Generally, Long and Short pulses represent Excess and Deficiency images. Long resembles Wiry but is stronger than Wiry, indicating Excess. Short resembles Arterial but is weaker than Arterial, indicating Deficiency. Wiry Pulse carries urgency while Long Pulse carries relaxation; Arterial Pulse form is slippery and rapid; Short Pulse form is choppy and necessarily slow. Careful comparison reveals no discrepancy. (Long is stronger than Wiry, showing Wiry is form urgency, Long is Qi sufficiency.)