摇摆之脉，《脉简补义》论之详矣。夫邪痼于外，其脉摇摆，在于脉之起而来，此不过
邪气
痰血之阻滞。正虚于内，其脉摇摆，在于脉之返而去，是必元气脱根，内吸无力，故气不能
深稳也。此乃中气虚怯之极，或下寒、内寒，真阳无主；或下热、内热，真阴无主。其情似
不欲内返，而其势衰弱；又似迫欲下息，故为之摇摆而下也。如人之力弱举重者，方其举时
，犹可撑持，及其下时，遂战栗不支矣。在内寒暴病，尚可急救，其久病及内热而然者，内
竭已极，复何能为?
此脉急病，远行入房，寒邪直入命门者有之；久病，虚劳骨蒸，及温热骨髓枯竭，痉而
齿口噤，与香港脚冲心者有之。张石顽论痰饮短气，分呼吸出入，用肾气丸、苓桂术甘汤。其义
甚精，与此参看。《史记·仓公传》有云∶脉实而大，其来难者，是蹶阴之动也。所以然者
，为其气滞于血中，即来而摇摆也。又云∶脉来数疾，去难而不一者，病主在心。此即去而
摇摆之脉也。曰病在心者，心主脉。脉之不宁，心气之不能内宁也。津气消灼，燥痰据于心
络，以致怔忡、谵语者，所谓狂言失志者死也。夫气升出不利，其来也摇；降入不利，其去
也摇。邪气外束，升出不利宜也；至降入不利，非邪踞于内，即正竭于内也，其危也何如乎
关于摇摆脉，《脉简补义》中已有详细论述。邪气固结于体表，其脉象表现为摇摆，主要体现在脉搏升起和来势的过程中，这不过是邪气、痰浊或瘀血阻滞所致。正气虚弱于体内，其脉象表现为摇摆，主要体现在脉搏返回和去势的过程中，这必然是元气脱失根基，内部吸纳无力，因此气不能深沉安稳。这是中气极度虚怯，或者是下焦寒、内寒，导致真阳失去主宰；或者是下焦热、内热，导致真阴失去主宰。其情状似乎不想向内返回，但气势衰弱；又似乎迫切想要向下平息，所以出现摇摆向下的脉象。就像力气弱的人举重物，当举起时，还可以支撑，但当放下时，就会战栗无法支持。在内寒引起的急病中，尚可急救，若是久病以及因内热导致的，内部精气已极度枯竭，还能有什么作为呢？
这种脉象在急病中，有因远行、房事过度，寒邪直接侵入命门的情况；在久病中，有因虚劳骨蒸，以及温热病导致骨髓枯竭，发生痉挛且牙关紧闭，还有脚气冲心的情况。张石顽论述痰饮短气时，区分呼吸的出入，使用肾气丸、苓桂术甘汤。其义理非常精妙，可与此文参照阅读。《史记·仓公传》中说：脉象实大，来势艰难的是厥阴经的病变。之所以这样，是因为气滞留在血中，即来势时摇摆不定。又说：脉来数疾，去势艰难且不一致的，病位主要在心。这就是去势时摇摆的脉象。说病在心，是因为心主血脉。脉象不宁静，是心气不能安宁。津液和气被消灼，燥痰占据心络，导致怔忡、谵语，所谓“狂言失志”是死证。气升发不利，其来势就摇摆；气降入不利，其去势就摇摆。邪气外束，升发不利是应当的；至于降入不利，不是邪气占据体内，就是正气耗尽于体内，其危险程度如何呢？
Regarding the "swaying pulse" (Yao Mai), *Mai Jian Bu Yi* has discussed it in detail. When pathogenic factors are entrenched externally, the pulse sways, primarily manifesting during the rising and coming phase of the pulse; this is merely due to the obstruction by pathogenic factors, phlegm, or blood stasis. When healthy qi is deficient internally, the pulse sways, primarily manifesting during the returning and departing phase of the pulse; this necessarily indicates that the Yuan Qi (Original Qi) has lost its root, internal suction is weak, and thus the qi cannot be deep and stable. This represents an extreme deficiency of Middle Qi (Zhong Qi), or cold in the lower jiao/internal jiao where True Yang (Zhen Yang) lacks a master; or heat in the lower jiao/internal jiao where True Yin (Zhen Yin) lacks a master. The condition seems reluctant to return inward, yet its momentum is weak; it also seems urgently trying to settle downward, hence the swaying descent. It is like a person with weak strength lifting a heavy weight: when lifting, they can still support it, but when lowering it, they tremble and cannot sustain it. In acute diseases caused by internal cold, emergency rescue is still possible; however, in chronic diseases or those caused by internal heat, internal exhaustion is already extreme, so what else can be done?
This type of pulse occurs in acute diseases due to long-distance travel, excessive sexual activity, or direct invasion of cold pathogens into the Mingmen (Gate of Life); in chronic diseases, it occurs due to deficiency consumption with bone-steaming fever, or marrow depletion from warm-heat diseases, accompanied by spasms, locked jaw, or Hongxiangjiao (Gouty Carditis/Heart involvement in Beriberi). Zhang Shiwan discussed shortness of breath due to phlegm-fluid retention, distinguishing between inhalation and exhalation, and used Shenqi Wan (Kidney Qi Pill) and Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction). His reasoning is very profound and should be read in conjunction with this text. *Shiji: Biography of Cang Gong* states: "A pulse that is solid and large, with a difficult coming phase, indicates movement in the Jueyin channel." The reason for this is that qi is stagnant within the blood, causing swaying during the coming phase. It further states: "A pulse that comes rapidly and frequently, but departs with difficulty and irregularity, indicates the disease is primarily in the Heart." This refers to the swaying pulse during the departing phase. Saying the disease is in the Heart is because the Heart governs the vessels. Restlessness in the pulse reflects the inability of Heart Qi to remain tranquil. When body fluids and qi are consumed and scorched, dry-phlegm occupies the Heart collaterals, leading to palpitations (Zhengchong) and delirious speech (Chanyu); this is referred to as "delirious words and loss of will," which signifies death. If the ascending and exiting of qi is obstructed, the coming phase sways; if the descending and entering of qi is obstructed, the departing phase sways. External constraint by pathogenic factors makes obstructed ascending and exiting expected; however, obstructed descending and entering indicates either pathogenic factors occupying the interior or exhaustion of healthy qi within, how critical is this situation?