雀啄 连三五至而歇，歇而再至，如雀啄食，脾绝也。
屋漏 良久一至，屋漏滴水之状，胃绝也。
弹石 从骨间劈劈而至，如指弹石，肾绝也。
解索 散乱如解绳索，精血竭绝也。
虾游 沉时忽一浮，如虾游然，静中一动，神魂绝也。
鱼翔 浮时忽一沉，譬鱼翔之似有似无，命绝也。
釜沸 如釜中水，火燃而沸，有出无入，阴阳气绝也。
岐伯曰∶“察九候七诊，（九候注见前。）独小者病，独大者病，独疾者
病，独迟者病，独热者病，独寒者病，独陷下者病。（此言九候之中，有独见之脉，而
与他部不同，即按其部而知其病之所在也。七者之中，既言独疾则主热矣，既言独
迟则主寒矣，而又言独寒独热者，何也？必于阴部得沉微迟涩之脉，故又言独寒
也；必于阳部得洪实滑数之脉，故又言独热也。独陷下者，沉伏而不起者也。）形肉已脱，九候虽调犹死。
（形肉脱去者，大肉尽去也。脾主肌肉，为五脏之本，未有脾气脱而能
生者。虽九候之中无独见之七诊，然终不免于死亡矣。）七诊虽见，九候皆从者不死。”（
从，顺也。谓脉顺四时之令，合五脏之常，及与病症为顺也。既得顺候，虽有独大、独小等，不至于死也。）
《素问·征四失篇》曰∶“诊病不问其始，忧患饮食之失节，起居之过度，或伤于毒，不先言此，卒持气口，妄言作
名，为粗所穷，何病能中？”（此言不问其症之所由起，先与切脉，未免模糊揣度，必不能切中病情者矣。）
《素问·疏五过篇》云∶“凡未诊病者，必问尝贵后贱，虽不中邪，病从内生，名曰脱营；尝
富后贫，名曰失精。”（脱营、失精，皆阴气亏损也。贵者忽贱，富者忽贫，未免抑郁而下舒，气滞则血
滞，久则新者不生，滞者成疾，故言脱、言失者矣。）
【按】古之神圣未尝不以望闻问切四者互相参考，审察病情，然必
先望其气色，次则闻其音声，次则问其病源，次则诊其脉状，此先后之次
第也。近世医者既自附于知脉，而病家亦欲试其本领，遂绝口不言，惟
伸手就诊，而医者即强为揣摩；若揣摩偶合，则信为神手，而揣摩不合，
则薄为愚昧。噫嘻！此《内经》所谓“妄言作名，为粗所穷”，如是而欲拯
危起殆，何异欲其入室而反闭门耶！王海藏云∶“病患拱默，惟令切脉，
试其知否。夫热则脉数，寒则脉迟，实则有力，虚则无力，可以脉知也。
若得病之由，及所伤之物，岂能以脉知哉！故医者不可不问其由，病者
不可不说其故。”苏东坡云∶“我有病状，必尽告医者，使其胸中了然，然
后诊脉，则疑似不能惑也。我求愈疾而已，岂以困医为事哉！”若二公之言，可以发愚蒙之聋 矣。
雀啄脉：连续跳动三五次后停止，停歇后再跳动，就像麻雀啄食的样子，这是脾气绝灭的征象。
屋漏脉：很久才跳动一次，像屋顶漏水滴落的样子，这是胃气绝灭的征象。
弹石脉：从骨间劈劈地传来，像手指弹击石头一样，这是肾气绝灭的征象。
解索脉：散乱无章，如同解开绳索一般，这是精血枯竭绝灭的征象。
虾游脉：沉伏时忽然浮起一下，像虾在水中游动一样，在静止中突然一动，这是神魂绝灭的征象。
鱼翔脉：浮起时忽然沉下一下，譬如鱼游水时似有似无，这是生命绝灭的征象。
釜沸脉：像锅中的水，火燃烧而沸腾，只有出气没有进气，这是阴阳之气绝灭的征象。
岐伯说：“诊察九候（指寸、关、尺三部，每部又分天、地、人三候，合为九候）和七诊（指独小、独大、独疾、独迟、独热、独寒、独陷下这七种异常脉象），如果某一部脉单独细小是病证，单独粗大是病证，单独快速是病证，单独缓慢是病证，单独发热感是病证，单独发冷感是病证，单独沉陷不起是病证。（这里说的是在九候之中，有单独显现的脉象，与其他部位不同，只要按摸该部位就能知道病所在的位置。在七种情况中，既然说了单独快速就主热证，既然说了单独缓慢就主寒证，却又说单独寒冷和单独发热，为什么呢？必定是在阴部得到沉微迟涩的脉象，所以又说单独寒冷；必定是在阳部得到洪实滑数的脉象，所以又说单独发热。所谓单独沉陷不起，是指脉象沉伏而不显现。）如果形体肌肉已经脱失，即使九候脉象调和也必死。（形体肌肉脱失，是指大肌肉全部消减。脾主肌肉，是五脏的根本，没有脾气脱失还能存活的。虽然九候中没有单独显现的七诊脉象，但最终仍不免于死亡。）如果七诊脉象虽然出现，但九候脉象都顺应四时规律则不死。”（“顺”，即顺从。指脉象顺应四时的时令，符合五脏的正常规律，以及与病症表现相顺。既然得到了顺应的脉候，虽然有单独粗大、单独细小等情况，也不会导致死亡。）
《素问·征四失篇》说：“诊治疾病如果不询问发病的起因，如忧患情绪、饮食失节、起居过度，或者中毒受伤，不先说明这些情况，贸然只切按气口（手腕桡动脉处）脉象，胡乱定名诊断，就会被医术粗疏所困窘，怎么能切中病情呢？”（这里说的是不询问病症的起因，就先进行切脉，难免模糊揣测，一定不能准确切合病情。）
《素问·疏五过篇》说：“凡是未诊治疾病的人，必须询问是否曾经地位高贵后来变得卑贱，即使没有受到外邪侵袭，病也会从内生，名叫‘脱营’；曾经富裕后来变得贫穷，名叫‘失精’。”（脱营、失精，都是阴气亏损的表现。地位高贵者忽然变得卑贱，富裕者忽然变得贫穷，难免抑郁而不能舒展，气机阻滞则血液运行也滞涩，时间久了新的气血不能生成，滞涩的成为疾病，所以称为‘脱’和‘失’。）
【按语】古代神圣的医生未曾不以望、闻、问、切四种方法互相参考，审察病情，但是必须先观察其气色，其次听其声音，再次询问其病源，最后诊察其脉状，这是先后次序。近世的医生既然自认为懂得脉诊，而病人也想试探医生的本领，于是闭口不言，只是伸出手让医生诊脉，而医生就强行揣摩；如果揣摩偶然吻合，就相信他是神医，如果揣摩不吻合，就轻视他愚昧无知。唉！这就是《内经》所说的“胡乱定名诊断，被医术粗疏所困窘”，像这样想要挽救危重、起死回生，与想要让人进屋却反手关门有什么区别呢！王海藏说：“病人拱手沉默，只让医生切脉，来试探医生是否知晓病情。发热则脉数，寒冷则脉迟，实证则有力，虚证则无力，这些可以通过脉象得知。但是得病的缘由，以及所伤害的事物，难道能通过脉象知道吗！所以医生不可以不问病因，病人不可以不说清原委。”苏东坡说：“我有病症表现，一定全部告诉医生，使他在心中了然清楚，然后诊脉，那么疑似之症就不能迷惑他了。我只求治愈疾病罢了，哪里是以难倒医生为目的呢！”如果这两位先生的话，可以唤醒愚昧无知者的聋聩了。
Que Zhuo (Sparrow Pecking) Pulse: Beats three to five times consecutively then pauses, and after the pause beats again, resembling a sparrow pecking for food; this indicates the exhaustion of Spleen Qi.
Wu Lou (House Leaking) Pulse: Beats only once after a long interval, resembling water dripping from a leaking roof; this indicates the exhaustion of Stomach Qi.
Dan Shi (Finger Striking Stone) Pulse: Arrives abruptly from between the bones with a cracking sound, like a finger striking a stone; this indicates the exhaustion of Kidney Qi.
Jie Suo (Untying Rope) Pulse: Disordered and scattered like an untied rope; this indicates the exhaustion of Essence and Blood.
Xia You (Shrimp Swimming) Pulse: Suddenly floats up when it was previously deep, like a shrimp swimming; a sudden movement amidst stillness; this indicates the exhaustion of Hun and Shen (Spirit).
Yu Xiang (Fish Gliding) Pulse: Suddenly sinks when it was previously superficial, akin to a fish gliding in water appearing present yet absent; this indicates the exhaustion of Life Force.
Fu Fei (Cauldron Boiling) Pulse: Like water boiling in a cauldron over fire, with only outward flow and no inward return; this indicates the exhaustion of Yin and Yang Qi.
Qibo said: "Examine the Nine Palpations (Nine Palpations refer to the pulse positions at the Cun, Guan, and Chi locations on both wrists, each divided into Superficial, Middle, and Deep levels, totaling nine) and the Seven Diagnoses (Seven Diagnoses refer to seven types of abnormal pulses: exclusively small, exclusively large, exclusively rapid, exclusively slow, exclusively hot, exclusively cold, and exclusively sunken). If one location is exclusively small, it indicates disease; if exclusively large, it indicates disease; if exclusively rapid, it indicates disease; if exclusively slow, it indicates disease; if exclusively hot, it indicates disease; if exclusively cold, it indicates disease; if exclusively sunken/depressed, it indicates disease. (This refers to the presence of an exclusive pulse manifestation within the Nine Palpations that differs from other regions; by palpating that specific region, one can locate the disease. Regarding the Seven Diagnoses: since 'exclusively rapid' implies Heat, and 'exclusively slow' implies Cold, why are 'exclusively cold' and 'exclusively hot' also mentioned? This is because if a Chen, Micro, Slow, or Choppy pulse is obtained in a Yin region, it is described as 'exclusively cold'; if a Hong, Solid, Slippery, or Rapid pulse is obtained in a Yang region, it is described as 'exclusively hot'. 'Exclusively sunken' refers to a pulse that is deep and hidden without rising.) If the form and flesh have already wasted away, even if the Nine Palpations are harmonious, death will occur. (Wasting of form and flesh means the complete loss of the large muscles. The Spleen governs the muscles and is the root of the Five Zang organs; there is no case where Spleen Qi exhaustion allows for survival. Even if the Seven Diagnoses do not show exclusivity within the Nine Palpations, death is ultimately unavoidable.) However, if the Seven Diagnoses are observed but the Nine Palpations all follow the seasonal norms, death will not occur." ('Follow' means compliance. It refers to the pulse complying with the seasons, conforming to the normal patterns of the Five Zang organs, and being consistent with the symptoms. If compliant pulse signs are obtained, despite exclusivities such as exclusively large or small, death will not ensue.)
The *Su Wen · Zheng Si Shi Pian* states: "If diagnosing illness does not inquire about its onset, such as emotional distress, dietary irregularities, excessive lifestyle habits, or toxic injury, and fails to address these first, but instead abruptly palpates the Qi Kou (Radial Artery), rashly assigning names to diagnoses, one will be confounded by crude methods and how can one hit the mark?" (This emphasizes that failing to inquire about the origin of symptoms before palpation leads to vague speculation and an inability to accurately grasp the condition.)
The *Su Wen · Shu Wu Guo Pian* says: "For those not yet diagnosed, one must ask if they were formerly noble and now lowly; even without external pathogens, disease arises internally, named 'Tuo Ying' (Depleted Camp); formerly wealthy and now poor, named 'Shi Jing' (Lost Essence)." (Tuo Ying and Shi Jing both indicate the depletion of Yin Qi. A sudden fall from nobility or wealth causes depression and lack of comfort, leading to Qi stagnation and subsequent Blood stasis; over time, new generation fails while stagnation becomes pathology, hence the terms 'depletion' and 'loss'.)
[Commentary] Ancient sage physicians always referred to the four diagnostic methods of Observation (Wang), Listening/Smelling (Wen), Inquiry (Wen), and Palpation (Qie) to examine conditions, but the order was strictly: first observe complexion, second listen to voice, third inquire about the source of illness, and fourth palpate the pulse. Modern physicians, claiming expertise in pulse diagnosis, and patients wishing to test their skills, often remain silent and merely extend a hand for palpation, forcing the physician to guess. If the guess coincidentally matches, they believe the physician is divine; if it misses, they dismiss the physician as ignorant. Alas! This is what the *Nei Jing* calls "rashly assigning names, being confounded by crude methods." To attempt to save critical cases under such circumstances is like trying to enter a room while closing the door behind you. Wang Haicang said: "Patients sit silently, allowing only pulse taking to test knowledge. Heat yields a Rapid pulse, Cold yields a Slow pulse, Excess yields strength, Deficiency yields weakness; these can be known via pulse. But the cause of illness and the specific injuries—can these be known by pulse alone? Therefore, the physician must not fail to ask the cause, nor should the patient fail to state the reason." Su Dongpo said: "I will inform the physician of all my symptoms so he understands clearly before palpating; thus, ambiguity cannot confuse him. I seek only recovery, not to hinder the physician." These words can awaken the deafness of the ignorant.