体象 结为凝结，缓时一止；徐行而怠，颇得其旨。
主病 结属阴寒，亦因凝积。左寸心寒，疼痛可决。右寸
肺虚，气寒凝结。左关结见，疝瘕必现。右关结形，痰滞食停。左尺结见，痿 之 。右尺见结，阴寒为楚。
【按】结之为义，结而不散，迟滞中时见一止也。古人譬之徐行而怠，偶羁一步，可为结脉传神。大凡
热则流行，寒则停滞，理势然也。夫阴寒之中，且挟凝结，喻如隆冬天气严肃，流水冰坚也。少火衰弱，中气
虚寒，失其干健之运，则气血痰食，互相纠缠，营运之机缄不利，故脉应之而成结也。越人云∶“结甚则积
甚，结微则气微。浮结者外有痛积，伏结者内有积聚。”故知结而有力者，方为积聚；结而无力者，是真气衰
弱，违其运化之常，唯一味温补为正治也。仲景云∶“累累如循长竿，曰阴结。蔼蔼如车盖，曰阳结。”王叔
和云∶“如麻子动摇，旋引旋收，聚散不常，曰结，主死。”夫是三者，虽同名为结，而义实有别。浮分得之
为阳结；沉分得之为阴结；止数频多，参伍不调，为不治之症。由斯测之，则
结之主症，未可以一端尽也。伪诀云，“或来或去，聚而却还。”律以缓时一止之义，几同寐语矣。
体象 代为禅代，止有常数；不能自还，良久复动。
主病 代主脏衰，危恶之候。脾土败坏，吐利为咎。中寒
不食，腹疼难救。两动一止，三四日死。四动一止，六七日死。次第推求，不失经旨。
【按】代者，禅代之义也。如四时之禅代，不愆其期也。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，良久方还。《内经》以代脉一见，为脏气衰微，脾气脱绝之诊也。惟伤寒
心悸，怀胎三月，或七情太过，或跌打重伤，及风家痛症，俱不忌代脉，未可断其必死耳。滑伯仁曰∶“无病
而羸瘦脉代者，危候也。有病而气血乍损，只为病脉。”此伯仁为暴病者言也。若久病得代脉而冀其回春者，
万不得一也。《内经》曰∶“代则气衰。”又曰∶“代散者死。”夫代脉见而脾土衰，散脉见而肾水绝，二
脉交见，虽在神圣，亦且望而却走矣。大抵脉来一息五至，则肺心脾肝肾五脏之气皆足也。故五十动而不一止
者，合大衍之数，谓之平脉。反此，则止乃见焉。肾气不能至，则四十动一止；肝气不能至，则三十动一止；
脾气不能至，则二十动一止；心气不能至，则十动一止；肺气不能至，则四五动一止。戴同父云∶“三部九候，
每候必满五十动，出自《难经》，而伪诀五脏歌中，皆以四十五动为准，乖于经旨。”
伪诀又云∶“四十一止一脏绝，却后四年多殁命。”荒疵越理，莫此为甚。夫人岂有一脏既绝，尚活四年之理哉！
历考《内经》，而知代脉之义，别自有说。如《宣明五气篇》曰∶“脾脉代。”《邪气脏腑病形篇》云∶“
黄者其脉代。”皆言藏气之常候，非谓代为止也。《平人气象论》曰∶“长夏胃微软弱曰平，但代无胃曰死”
者，盖言无胃气而死，亦非以代为止也。如云“五十动而不一代”者，是乃至数之代也。若脉平匀而忽强忽弱
者，乃形体之代，即《平人气象论》所言者是也。若脾旺四季，而随时更代者，乃气候之代，即《宣明五气》
等篇所云者是也。脉无定候，更变不常，则均谓之代，各因其变而察其情，庶足以穷其妙耳。善化县黄桂岩，
心疼夺食，脉三动一止，良久不能自还。施笠泽云∶“五脏之气不至，法当旦夕死。”余曰∶“古人谓痛甚者
脉多代。周梅屋云∶‘少得代脉者死，老得代脉者生。’今桂岩春秋高矣，而胸腹负
痛，虽有代脉，不足虑也。”果越两旬而桂岩起矣。故医非博览，未易穷脉之变耳。
【体象】结脉的形态是脉搏凝结，在缓慢的跳动中偶尔出现一次停顿；其节奏如同人缓慢行走且感到疲倦，偶尔绊倒一步，这非常符合结脉的神韵。
【主病】结脉属于阴寒之证，也常因气血凝滞积聚所致。左寸部见结脉，可断定是心寒引起的疼痛；右寸部见结脉，多为肺气虚弱、寒气凝结；左关部见结脉，必然出现疝气或瘕积（腹内结块）；右关部见结脉，提示痰湿停滞、食物停积；左尺部见结脉，多见于痿证（肢体萎弱无力）；右尺部见结脉，表明阴寒为患，令人痛苦。
【按语】所谓“结”，意思是凝结不散，在迟滞的脉律中偶尔出现一次停顿。古人将其比喻为缓慢行走且疲倦时，偶然绊住一步，这生动地描绘了结脉的特征。大凡热邪则气血流行通畅，寒邪则气血停滞不行，这是自然的道理。在阴寒之中，若再夹杂凝结，就像隆冬时节天气严酷，流水结冰坚硬一样。如果少火（命门之火）衰弱，中焦之气虚寒，失去了刚健的运化功能，那么气血痰食就会互相纠缠，导致营运的气机闭塞不利，因此脉象表现为结脉。越人（秦越人/扁鹊）说：“结脉严重则积聚严重，结脉轻微则正气微弱。浮取见结脉，说明体表有痛症积聚；沉取见结脉，说明体内有积聚。”因此可知，结而有力的，才是积聚实证；结而无力的，是真气衰弱，违背了正常的运化规律，治疗应以温补为正法。张仲景说：“脉象累累如抚摸长竿，称为阴结；脉象蔼蔼如车盖般盛大，称为阳结。”王叔和说：“脉象像麻子动摇，旋转牵引又收回，聚散无常，称为结脉，主死证。”这三种情况，虽然都叫结脉，但含义实际上是有区别的。在浮分（浅层）摸到的是阳结；在沉分（深层）摸到的是阴结；如果停顿次数频繁，参差不齐不调匀，属于不治之症。由此推测，结脉的主治病症，不能仅凭一种情况来概括。伪诀中说：“脉象有时来有时去，聚集后又返回。”这与“缓时一止”的定义相比，简直如同梦呓胡话。
【体象】代脉如同禅让更替，停顿有一定的固定规律；脉搏不能自行恢复跳动，需要过很久才能再次搏动。
【主病】代脉主要主脏气衰败，是危重恶候。脾土败坏，会导致呕吐泄泻等灾祸。中焦受寒不进食，腹痛难救。脉搏每跳动两次出现一次停顿，预示三四日后死亡；每跳动四次出现一次停顿，预示六七日后死亡。按次序推求，不会违背经典宗旨。
【按语】“代”的意思是禅让更替。就像四季的更替，不会错过期限。结脉和促脉的停顿，没有固定的规律；代脉的停顿，则有固定的规律。结脉和促脉的停顿，停一下随即就来；代脉的停顿，要过很久才恢复。《内经》认为，只要见到代脉，就是脏气衰微、脾气脱绝的诊断指征。但是，伤寒引起的心悸、怀孕三个月、或者七情过度、跌打重伤，以及风家痛症等情况，都不忌讳代脉，不能断定必定死亡。滑伯仁说：“无病而身体消瘦出现代脉的，是危候；有病而气血暂时受损出现的代脉，只是病脉。”这是滑伯仁针对突发疾病而言的。如果是久病出现代脉却希望痊愈，万中无一。《内经》说：“代脉表示气衰。”又说：“代脉兼见散脉的，主死。”代脉出现表示脾土衰败，散脉出现表示肾水枯竭，这两种脉象同时出现，即使是神圣的医生，也会望而却步。大致来说，脉搏一息跳动五次，说明肺、心、脾、肝、肾五脏之气都充足。所以脉搏连续跳动五十次而不出现一次停顿的，符合大衍之数，称为平脉（正常脉）。与此相反，就会出现停顿。肾气不能到达，则四十次跳动出现一次停顿；肝气不能到达，则三十次跳动出现一次停顿；脾气不能到达，则二十次跳动出现一次停顿；心气不能到达，则十次跳动出现一次停顿；肺气不能到达，则四五次跳动出现一次停顿。戴同父说：“三部九候，每一候必须满五十次跳动，出自《难经》，而伪诀中的五脏歌诀都以四十五次跳动为标准，违背了经典宗旨。”伪诀又说：“四十一止一脏绝，之后四年多会死亡。”这种荒谬悖理的说法，没有比这更严重的了。人怎么会有某一脏气既已断绝，还能活四年的道理呢！广泛考证《内经》，才知道代脉的含义，另有说法。如《宣明五气篇》说：“脾脉代。”《邪气脏腑病形篇》说：“面色黄的人，其脉代。”这都是讲脏气的正常表现，并不是说代脉就是停顿。《平人气象论》说：“长夏季节，胃气微软弱称为平脉，只有代脉而没有胃气的，主死。”这里说的是没有胃气而死，也不是以代脉为停顿。如果说“五十动而不一代”，这里的“代”是指至数的交替。如果脉象平稳均匀却忽强忽弱，这是形体上的变化，即《平人气象论》所说的情况。如果脾旺于四季，随着季节更替而变化，这是气候上的更替，即《宣明五气》等篇所说的情况。脉象没有固定的模式，变化无常，都称之为代，根据各自的变化来察知其病情，才足以穷尽其奥妙。善化县人黄桂岩，心痛剧烈无法进食，脉象每三次跳动出现一次停顿，很久不能自行恢复。施笠泽说：“五脏之气不至，按照医法应当早晚死亡。”我说：“古人说疼痛剧烈的患者脉象多有代脉。周梅屋说：‘年轻人得代脉者死，老年人得代脉者生。’现在黄桂岩年纪已经很大了，而且胸腹遭受剧痛，虽然有代脉，也不必担忧。”果然过了二十多天黄桂岩就康复了。所以医生如果不博览群书，是很难穷尽脉象变化的。
[Physical Manifestation] The physical manifestation of the Jie Pulse (Knotted Pulse) is one of condensation and stagnation, with an occasional pause during a slow rhythm. Its movement is like walking slowly while fatigued, occasionally stumbling a step, which captures the essence of the Knotted Pulse.
[Pathogenesis] The Knotted Pulse belongs to Yin-Cold patterns and also arises from coagulation and accumulation. If seen at the Left Cun position (corresponding to the Heart), it indicates Heart-Cold causing pain; if seen at the Right Cun position (corresponding to the Lung), it indicates Lung-Qi deficiency with Cold coagulation; if seen at the Left Guan position (corresponding to the Liver/Gallbladder), it manifests as Hernia or Jia-Masses (abdominal masses); if seen at the Right Guan position (corresponding to the Spleen/Stomach), it indicates Phlegm stagnation and Food retention; if seen at the Left Chi position (corresponding to the Kidney/Yin), it is associated with Wei Syndrome (flaccidity syndrome); if seen at the Right Chi position (corresponding to the Kidney/Yang), it indicates suffering due to Yin-Cold.
[Commentary] The meaning of "Jie" (Knot) is condensation without dispersion, appearing as an occasional pause amidst a sluggish rhythm. Ancient physicians likened it to someone walking slowly and tiredly, occasionally tripping for a step, which vividly portrays the spirit of the Knotted Pulse. Generally, Heat causes circulation to flow freely, while Cold causes stagnation; this is the natural principle. Within Yin-Cold conditions, if accompanied by condensation, it is like the severe weather of mid-winter where flowing water turns to hard ice. When the Shao-Huo (Ministerial Fire) is weak and the Middle Qi is deficient and cold, losing its vigorous transformative function, then Blood, Qi, Phlegm, and Food will entangle each other. This leads to the obstruction of transportive mechanisms, resulting in the Knotted Pulse. Yue Ren (Bian Que) stated: "Severe knotting indicates severe accumulation; slight knotting indicates slight Qi deficiency. A Floating Knot indicates external painful accumulations; a Deep Knot indicates internal accumulations." Thus, we know that a Knotted Pulse with force indicates excess accumulation, whereas a Knotted Pulse without force indicates true Qi weakness, violating normal transformation. The correct treatment is solely warm tonification. Zhang Zhongjing said: "Pulse feeling like tracing a long bamboo pole is called Yin-Jie (Yin Knot); pulse feeling grand like a chariot canopy is called Yang-Jie (Yang Knot)." Wang Shuhe said: "A pulse that trembles like hemp seeds, rotating and retracting, gathering and scattering irregularly, is called Jie, indicating death." Although these three are all named Jie, their meanings differ. Finding it in the Floating layer indicates Yang-Jie; finding it in the Deep layer indicates Yin-Jie; frequent pauses with irregular intervals indicate an untreatable condition. From this, we can deduce that the manifestations of the Knotted Pulse cannot be summarized by a single aspect. The False Canon states: "Coming and going, gathering and returning." Compared to the definition of "an occasional pause during a slow rhythm," this is akin to sleep-talking.
[Physical Manifestation] The physical manifestation of the Dai Pulse (Intermittent Pulse) is like succession or replacement, with pauses occurring at regular intervals. It cannot recover spontaneously; after a long time, it beats again.
[Pathogenesis] The Dai Pulse primarily indicates organ decline, representing a critical and ominous sign. Failure of Spleen-Earth leads to vomiting and diarrhea. Cold invading the middle jiao causing loss of appetite and abdominal pain is difficult to save. If the pulse stops after two beats, death occurs in three to four days; if it stops after four beats, death occurs in six to seven days. Reasoning through these sequences aligns with the classic principles.
[Commentary] "Dai" means succession or replacement, like the changing of seasons, which never misses its time. The pauses in the Jie (Knotted) and Cu (Rapid) pulses have no fixed number; the pause in the Dai Pulse has a fixed number. In Jie and Cu pulses, the pause is followed immediately by the next beat; in the Dai Pulse, there is a long delay before recovery. The *Neijing* (Classic of Internal Medicine) states that the appearance of a Dai Pulse indicates the decline of Zang-Qi and the exhaustion of Spleen-Qi. However, in cases of palpitations due to Shanghan (Cold Damage), pregnancy at three months, excessive emotional stress, severe trauma, or pain syndromes in Wind disorders, the Dai Pulse is not necessarily fatal and should not be judged as certain death. Hua Borren said: "For those without disease who are emaciated and show a Dai Pulse, it is a critical sign. For those with disease whose Qi and Blood are temporarily damaged, it is merely a pathological pulse." This refers to acute illnesses. If a patient with chronic illness shows a Dai Pulse and hopes for recovery, it happens in less than one in ten thousand cases. The *Neijing* says: "Dai indicates Qi decline." And: "Dai combined with Scattered pulse indicates death." The appearance of a Dai Pulse indicates Spleen-Earth decline; the appearance of a Scattered pulse indicates Kidney-Water exhaustion. If both appear together, even a sage physician would retreat in dismay. Generally, five beats per respiration indicate sufficient Qi in the Five Zang organs (Lung, Heart, Spleen, Liver, Kidney). Therefore, fifty beats without a single pause conform to the Great Expansion Number and are considered a Normal Pulse. Conversely, pauses occur. If Kidney Qi fails to arrive, there is a pause every forty beats; if Liver Qi fails, every thirty beats; if Spleen Qi fails, every twenty beats; if Heart Qi fails, every ten beats; if Lung Qi fails, every four or five beats. Dai Tongfu said: "The Three Regions and Nine Positions require fifty beats per position, originating from the *Nanjing*. However, the False Canon's Song of the Five Zang uses forty-five beats as the standard, deviating from the classic intent." The False Canon further claims: "Forty-one pauses indicate one Zang is exhausted, leading to death within four years." This absurdity violates reason more than any other claim. How could a person survive four years after one Zang is exhausted? Extensive examination of the *Neijing* reveals that the meaning of the Dai Pulse has another interpretation. For instance, the *Xuanming Wuqi Pian* chapter says: "The Spleen pulse is Dai." The *Xiéqì Zàngfǔ Bìngxíng Pian* chapter says: "Those with yellow complexion have a Dai pulse." These refer to the normal seasonal manifestation of Zang-Qi, not a pause. The *Pingren Qixiang Lun* chapter says: "In late summer, a soft and weak Stomach-Qi pulse is normal; only Dai without Stomach-Qi indicates death." This refers to death due to lack of Stomach-Qi, not defining Dai as a pause. When it says "fifty beats without one Dai," "Dai" here refers to numerical alternation. If a pulse is generally uniform but suddenly becomes strong or weak, this is a morphological change, as mentioned in the *Pingren Qixiang Lun*. If the Spleen prospers in all four seasons and changes accordingly, this is climatic succession, as described in the *Xuanming Wuqi* chapters. Pulses without fixed patterns and varying constantly are all termed Dai. By observing their changes to understand the condition, one can fully grasp their subtleties. Huang Guiyan from Shanxian County suffered severe heart pain preventing eating. His pulse stopped every three beats and took a long time to recover. Shi Lizewei said: "When the Qi of the Five Zang does not arrive, death is imminent day or night." I said: "Ancients stated that severe pain often presents with a Dai pulse. Zhou Meiwo said: 'Young people with a Dai pulse die; old people with a Dai pulse live.' Mr. Guiyan is advanced in age and suffers chest/abdominal pain; although he has a Dai pulse, there is no need to worry." Indeed, Guiyan recovered after twenty days. Thus, unless a physician is widely read, it is difficult to exhaust the variations of the pulse.