凡 瘕、积聚、痰凝、水溢、 肿、痞满、喘促、咳逆、蓄血、停食、风热瘾疹、寒
湿筋骨
疼痛、心胃气痛，以及忧愁、抑郁、大怒、久思、久坐、夜深不寐，与夫因病过服凉泄，胃
气遏伏不通，妇人月闭、妊娠，脉皆常有停止，有停一二至者，有停二、三十至而复来者，
即仲景所谓厥脉也。又小儿脉多雀斗不匀，此其多寡疏密之数，举不足为吉凶之据也。详考
其辨，盖有四端；一察其不停之至，应指之有力无力，起伏之有势无势也。力与势盛，即为
有神；力与势衰，即为无神。一察其停至之顷，是在脉气下伏之后，其力不能外鼓而然者，
是为邪所遏，阳不能嘘也；若在脉气上来之后，其力不能内返，因从指下即散，如弦之绝，
而不见其下去者，是元根已离，阴不能吸，其余气游弋经络之中而将外脱也。一察其停至之
至，是于脉气下伏之后，全不能起，径少一至，是邪气内结也；若非全不能起，已至中途，
不能上挺，指下喘喘然摇摆而去者，是中气内陷不振，而将下脱也，稍迟即当变见虾游、鱼
翔之象矣。一察其既停之后，复来之至，将起未起之际，有努力上挣艰涩难起之意者，即知
其停是邪气所阻也；若起伏自然，如常流利，略无努挣艰涩之情，是其停为元根已离，其余
气徘徊于三焦胸腹之空中，进退无定，而将上脱也，稍迟即当变见雀啄、屋漏之象矣。更察
其脉之形，无论为紧敛，为洪大，但能通长匀浓，应指有力，高下停匀，或来微衰而去盛者
吉也；若应指少力，来盛去衰，及宽大中挟一细线，指下挺亘不移，或上驶如驰如射；又断
而累累如珠，及指下如参量线不能敛聚者，是中气败散，为痰所隔而不合，即所谓解索也。
故有偶停一二至，而即决其必死者，为其气败而不续也；有久停二三十至，而仍决其可治者
，为其气闭而内伏也。更察其证，有病之人必痰塞气逼，不得宣畅，神识昏迷，谵妄躁扰，
狂越可骇者，吉也；若气高不下，时时眩目，及神识清明而静者，凶也。无病之人，必胸膈
不清，肋胀腹痛，气闷不舒，心中惊惕，寐中肢掣，夜梦纷纭，及见恶物入暗洞者，吉也；
若四肢无力，稍动即喘，气高不能吸纳，胸中时时如饥而又不欲食，二便清利频数者，凶也
大凡瘕（腹内结块，推之不移）、积聚（腹内结块，或痛或不痛）、痰凝（痰浊凝结）、水溢（水液泛滥）、肿（水肿）、痞满（胸脘部堵塞感且胀满）、喘促（呼吸急促）、咳逆（咳嗽气逆）、蓄血（瘀血停滞）、停食（饮食积滞）、风热瘾疹（风热引起的皮肤瘙痒红斑）、寒湿筋骨疼痛、心胃气痛，以及忧愁、抑郁、大怒、久思、久坐、深夜失眠，还有因病过度服用寒凉泻下药物导致胃气被遏制伏留、不通畅，妇女月经闭止、妊娠等情况，脉象都常常出现停止。有的停止一二次搏动，有的停止二三十次搏动后又恢复跳动，这就是张仲景所说的“厥脉”。另外，小儿的脉象多表现为像鸟雀啄食般不均匀，这种脉搏次数多少、疏密不均的情况，根本不足以作为判断吉凶的依据。详细考察其辨别方法，大概有四个方面：一是观察没有停止时的脉搏，感应指下的有力还是无力，起伏是否有气势。力量与气势旺盛，就是有神；力量与气势衰弱，就是无神。二是观察脉搏停止的那一刻，如果是在脉气下沉潜伏之后，因力量不能向外鼓动而导致的停止，这是被邪气所遏制，阳气不能呼出；如果是在脉气上升之后，因力量不能向内返回，随即从指下消散，像琴弦断裂一样，看不到它下降的过程，这是元气根基已经离散，阴气不能吸入，其余的气游荡在经络之中即将外脱。三是观察停止的那一次搏动，如果是在脉气下沉潜伏之后，完全不能升起，直接少了一次搏动，这是邪气在内结聚；如果不是完全不能升起，已经到达中途，不能向上挺起，指下感觉气喘喘地摇摆而去，这是中气在内下陷不振，即将向下脱失，稍晚一点就会变成虾游、鱼翔的脉象了。四是观察停止之后，再次来到的搏动，在将要升起还未升起之际，如果有努力向上挣扎、艰涩难起的样子，就知道这次停止是被邪气阻碍；如果起伏自然，像平常一样流利，完全没有努力挣扎艰涩的情态，这是它的停止是因为元气根基已经离散，其余的气徘徊在三焦胸腹的空隙中，进退不定，即将向上脱失，稍晚一点就会变成雀啄、屋漏的脉象了。再观察脉的形状，无论是紧敛还是洪大，只要能通达长匀浓，应指有力，高低均匀，或者来时微弱去时盛大，都是吉兆；如果应指力量少，来时盛大去时微弱，以及在宽大的脉象中夹杂一条细线，指下挺直固定不移，或者向上冲驶如奔跑如射箭；又或者是中断后累累如珠子，以及指下像参量线一样不能收敛聚集的，这是中气败散，被痰浊阻隔而不能合拢，就是所谓的“解索”脉。所以，有的偶然停止一二次搏动，就断定必死，是因为气机败坏而不能接续；有的长期停止二三十次搏动，却仍断定可以治疗，是因为气机闭塞而内伏。再观察症状，有病的人一定痰塞气逼，不得宣畅，神识昏迷，胡言乱语躁扰不安，狂越令人惊骇的，是吉兆；如果气高不下，时时眩晕，以及神识清明安静的，是凶兆。没有病的人（指健康人或病情较轻者），一定胸膈不清爽，两肋胀痛腹痛，气闷不舒服，心中惊恐警惕，睡眠中肢体抽搐，夜间梦境纷纭，以及见到恶物进入暗洞的，是吉兆；如果四肢无力，稍微活动就喘息，气高不能吸纳，胸中时时像饥饿但不想吃东西，大小便清利频数的，是凶兆。
Generally speaking, in cases of *jia* (masses with fixed location), *ji ju* (accumulations and aggregations), phlegm coagulation, water overflow, edema, epigastric fullness and obstruction, panting and shortness of breath, cough with reversed qi, blood stasis, food retention, wind-heat urticaria, pain in sinews and bones due to cold-dampness, qi pain in the heart and stomach, as well as sorrow, depression, great anger, prolonged thinking, prolonged sitting, insomnia at night, and conditions where excessive use of cooling and purgative medicines for illness has suppressed and trapped Stomach Qi causing blockage, or in women with amenorrhea and pregnancy, the pulse often exhibits interruptions. There are instances of one or two missed beats, or interruptions of twenty to thirty beats before resuming. This is what Zhang Zhongjing referred to as "Jue Pulse" (Pulse of Reversal). Furthermore, children's pulses are often irregular like a sparrow pecking; the variation in frequency and density is insufficient basis for determining prognosis. A detailed examination of differentiation reveals four aspects: First, observe the pulse when it is not interrupted, assessing whether it is forceful or feeble upon palpation, and whether its rising and falling possesses momentum. Strong force and momentum indicate the presence of Shen (Spirit/Vitality); weak force and momentum indicate the absence of Shen. Second, observe the moment of interruption. If the pause occurs after the pulse qi sinks and lies hidden, because the force cannot outwardly鼓动 (surge), this indicates obstruction by pathogenic factors, with Yang Qi unable to exhale. If the pause occurs after the pulse qi rises, but the force fails to return inward, dissipating immediately under the fingers like a broken string without a descending phase, this indicates that the root of Yuan Qi (Original Qi) has detached, Yin Qi cannot inhale, and residual qi wanders within the meridians, impending external collapse. Third, observe the specific beat that is missed. If, after the pulse qi sinks, it completely fails to rise, directly missing one beat, this indicates internal knotting of pathogenic qi. If it does not completely fail to rise but reaches the midpoint and cannot thrust upward, feeling erratic and swaying under the fingers, this indicates sinking and failure of Middle Qi, impending downward collapse; shortly thereafter, it may transform into the appearance of "Shrimp Swimming" or "Fish Floating" pulses. Fourth, observe the returning beat after the pause. At the moment just before rising, if there is an effortful struggle and difficulty in rising, it indicates obstruction by pathogenic qi. If the rising and falling are natural and smooth, lacking any sense of forced struggle, it indicates that the pause results from detached Yuan Qi roots, with residual qi hovering in the void of the San Jiao (Triple Burner), chest, and abdomen, indecisive in movement, impending upward collapse; shortly thereafter, it may transform into the appearance of "Sparrow Pecking" or "House Leaking" pulses. Additionally, observe the pulse shape. Whether tight and constricted or large and surging, if it is continuous, uniform, thick, forceful upon palpation, even in height, or slightly weak on arrival but strong on departure, it is auspicious. If it is slightly weak upon palpation, strong on arrival and weak on departure, or contains a thin thread within a broad pulse, remaining rigid and immobile under the fingers, or rushing upward like running or shooting; or if it breaks and beads up like pearls, or feels like a measuring line that cannot gather, this indicates the dissipation of Middle Qi, blocked by phlegm preventing convergence, known as "Untying the Cord" pulse. Therefore, an occasional pause of one or two beats leading to a verdict of certain death is due to failed Qi failing to continue; a long pause of twenty to thirty beats still deemed treatable is due to closed Qi lying hidden internally. Further observe the symptoms: In patients, if there is phlegm obstruction and Qi compression preventing free flow, with unconsciousness, delirium, restlessness, and terrifying mania, this is auspicious. If Qi rises excessively without descending, frequent dizziness, yet consciousness remains clear and quiet, this is ominous. In healthy individuals (or those without severe disease), if there is unclear sensation in the chest and diaphragm, distending pain in the ribs and abdomen, stifling Qi, mental apprehension, limb twitching during sleep, vivid dreams, and seeing evil objects entering dark holes, this is auspicious. If there is weakness in the four limbs, panting upon slight exertion, excessive Qi rising unable to be inhaled, a constant hunger-like sensation in the chest without desire to eat, and frequent clear urination and defecation, this is ominous.