虚寒而脉数者，元气不能安其宅，如人之皇皇无所根据也。其形浮大而芤，其情势应指即
回，
无充沛有余之意。夫元气所以不安其宅者，有风、寒、湿邪，从足心、从腰脐上冲，直捣元
穴；有因病误服清肺利水之剂，使三焦膀胱真气下泄太过，发为上喘下癃之证，是从下、从
里撤其元气之根基也。故气浮于外， 而数，宜用酸敛入辛温剂中。若因劳倦、忧思，伤
其大气，以致内陷，而沉细而数者，是阳虚于表，阴又虚于里，非如上文之阳伤于里而越于
表也。不但不宜酸敛，亦并不宜辛温，而宜用甘温，如东垣补中益气、仲景小建中之制。《
内经》所谓∶阴阳俱竭，调以甘药者也。故脉之浮数者，有阳伤于内，自越于外者，以酸温
敛阳；有阴盛于内，格阳于外者，以辛温消阴。脉之沉数者，有阴虚于内，而阳内陷者，以
甘润益阴，甚者以咸温佐之；有阳伤于表，而自内陷者，以甘温助阳，佐以气之芳香者鼓舞
之。此四者，皆内伤之数脉，偏属虚寒，而无与实热者也。其治皆宜于补，皆宜于温，而有
辛甘酸之不同。
朱丹溪以弦、涩二脉为难治，而慎柔谓∶老人或久病患，六脉俱浮缓，二三年间当有大
病，
或死。何也?脉浮无根，乃阳气发外，而内尽阴火也，用四君、建中服之，阳气内收，反见
虚脉，或弦或涩，此正脉也。照脉用药，脉气待和，病愈而寿亦永矣。盖浮缓者，直长而软
，如曲 之挺于指下，起伏怠缓，中途如欲止而不前者，重按即空，或分动于两边而成两线
矣。此脉，凡寒湿脱血，血竭气散，将死之人多有之，老年无病而见此者，精华已竭也。
虚寒证而见数脉的，是元气不能安居于体内，就像人惊慌失措、无所依托一样。其脉象浮大而中空（芤脉），按之感觉脉搏应指即回，没有充沛有余的感觉。元气之所以不能安居于体内，是因为风、寒、湿邪气，从足心或腰部、肚脐向上冲逆，直捣元气根本之穴；也有因为患病误服清肺利水的药物，导致三焦和膀胱的真气下泄太过，引发上气喘促、下小便不通的病症，这是从下部、从内部撤去了元气的根基。所以气浮越于外而见数脉，适宜在辛温剂中加入酸敛药。如果是因劳累倦怠、忧思过度，损伤了胸中大气，导致气机内陷，而见沉细而数的脉象，这是阳气虚于体表，阴气又虚于体内，不像上文所说的是阳气伤于内部而浮越于体表。这种情况不仅不宜用酸敛药，也不宜用辛温药，而适宜用甘温药，比如李东垣的补中益气汤、张仲景的小建中汤的制方思路。《黄帝内经》所说的：“阴阳俱竭，调以甘药”，就是这个道理。所以脉象浮数的，有的是阳气伤于内部，自然浮越于外部，应用酸温药收敛阳气；有的是阴气盛于内部，格拒阳气于外部，应用辛温药消散阴寒。脉象沉数的，有的是阴气虚于内部，而阳气内陷，应用甘润药滋养阴液，严重的用咸温药辅助；有的是阳气伤于体表，而自然内陷，应用甘温药助益阳气，佐以气味芳香的药物来鼓舞正气。这四种情况，都属于内伤引起的数脉，偏属于虚寒证，而与实热证无关。它们的治疗都适宜于补法，都适宜于温法，只是分别有辛、甘、酸的不同侧重。
朱丹溪认为弦脉和涩脉难以治疗，而慎柔说：老年人或者久病患者，如果六部脉象都呈现浮缓，两三年内可能会发生大病，甚至死亡。为什么呢？脉象浮而无根，是阳气发散于外，而内部全是阴火，服用四君子汤、小建中汤后，阳气内收，反而出现虚脉，或者表现为弦脉或涩脉，这才是正常的脉象。诊察脉象并据此用药，待脉气调和，病愈而寿命也能长久。所谓浮缓脉，脉形直长而柔软，像弯曲的琴弦挺立在指下，起伏缓慢怠惰，中途好像要停止而不前进，重按时感觉空虚无物，或者分动于两边而形成两条线。这种脉象，凡是患有寒湿、失血过多、血枯气散、濒临死亡的人多有此脉，老年人无病而见此脉的，说明精气神已经耗竭了。
In cases of deficiency-cold presenting with a rapid pulse (Shu Mai, rapid pulse), the Yuan Qi (Original Qi) fails to reside securely within its "house" (root), akin to a person feeling panicked and without support. The pulse form is floating, large, and hollow (Kou Mai, hollow pulse); upon palpation, it rebounds immediately upon contact, lacking any sense of abundance or excess. The reason why Yuan Qi fails to reside securely is due to Wind, Cold, and Dampness pathogens rushing upward from the sole of the foot or the waist and umbilicus, directly attacking the root of the Yuan Qi; or it may result from mistakenly administering formulas that clear the Lungs and promote urination during illness, causing excessive leakage of the True Qi of the San Jiao (Triple Burner) and Bladder downward, leading to symptoms of upper asthma and lower urinary retention. This constitutes the withdrawal of the foundation of Yuan Qi from the lower and interior aspects. Therefore, when Qi floats outward resulting in a rapid pulse, it is appropriate to use sour-astringent herbs within acrid-warm formulas. If, however, labor fatigue or excessive worry damages the Great Qi (Da Qi, vital energy in the chest), causing Qi to sink inward, resulting in a deep, fine, and rapid pulse, this indicates Yang deficiency at the exterior and Yin deficiency at the interior. This differs from the aforementioned scenario where Yang is injured internally and floats outward. In such cases, not only should sour-astringent herbs be avoided, but acrid-warm herbs are also inappropriate; instead, sweet-warm herbs should be used, following the principles of Li Dongyuan's Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Zhang Zhongjing's Xiaojianzhong Tang (Minor Construct the Middle Decoction). As stated in the *Neijing* (Inner Canon): "When both Yin and Yang are exhausted, regulate them with sweet medicines." Thus, regarding a floating and rapid pulse: if it arises because Yang is injured internally and naturally floats outward, sour-warm herbs should be used to consolidate Yang; if it arises because Yin is abundant internally and repels Yang to the exterior, acrid-warm herbs should be used to dissipate Yin cold. Regarding a deep and rapid pulse: if it arises because Yin is deficient internally while Yang sinks inward, sweet-moistening herbs should be used to benefit Yin, with salty-warm herbs added in severe cases; if it arises because Yang is injured at the exterior and naturally sinks inward, sweet-warm herbs should be used to assist Yang, aided by aromatic Qi-moving herbs to encourage and boost it. These four scenarios all represent rapid pulses caused by internal injury, predominantly belonging to deficiency-cold, and have no relation to excess-heat. Their treatment all suits tonification and warming, differing only in their emphasis on acrid, sweet, or sour properties.
Zhu Danxi considered the Wiry (Xian Mai, wiry pulse) and Choppy (Se Mai, choppy pulse) difficult to treat, whereas Shen Rou stated: "For elderly patients or those with chronic illnesses, if all six positions of the pulse present as Floating and Slow (Fu Huan Mai, floating and slow pulse), a major illness or death may occur within two to three years." Why? A floating pulse without root indicates Yang Qi dispersing outward while the interior is filled with Yin Fire. After administering Sijunzi Tang (Four Gentlemen Decoction) and Xiaojianzhong Tang, as Yang Qi retracts inward, the pulse may revert to a Deficient pulse, or manifest as Wiry or Choppy; this represents the normal pulse state. By examining the pulse and prescribing medication accordingly, waiting for the pulse Qi to harmonize, the illness will heal and longevity will be extended. The Floating and Slow pulse is described as straight, long, and soft, like a curved string standing firm under the fingers; its rise and fall are sluggish and slow, appearing as if it wants to stop and not advance midway; upon heavy pressure, it feels empty, or it may divide into two lines on either side. This type of pulse is commonly seen in individuals suffering from Cold-Dampness, massive blood loss, exhaustion of Blood and dispersion of Qi, and those near death. For elderly people without apparent illness who exhibit this pulse, it signifies that their Essence and Qi have been completely exhausted.