表里虚实四字。脉之纲也。表阳也。府也。凡六淫之邪袭于经络。而未入于胃府及脏者
皆表
也。里阴也。藏也。凡七情之气郁于心肺之间。不能越散饮食。五味之伤。留于脏腑之间。
不能消泄。皆属于里也。虚者元气之自虚。精神耗散。气力衰竭也。
实者贼邪之气实。繇
正气之本虚。邪得乘之。非元气之自实也。故虚者补正气。实者泻邪气。内经所谓邪气盛
则实。精气夺则虚此大法也。
难经云∶脉有伏匿然。谓阴阳更相乘。更相伏也。脉居阴部。而反阳脉见者。为阳乘阴
也。
脉虽时沉涩而短。此谓阳中伏阴也。脉居阳部而反阴脉见者。为阴乘阳也。脉虽时浮滑而长
。此谓阴中伏阳也。
（参后六十年运气延医）
天和脉只论三阴。南天高兮北泉深。太阴专主右尺寸。厥阴尺寸左边沉。少阴尺寸两不
应。
相交相反死相临。天和乃平脉也。诸阳为浮。诸阴为沉。故不言三阳司天在泉。南政以天道
言。甲己二岁。论脉则寸在南而尺在北。三阴司天。则两寸不应。太阴司天。右寸不应。少
阴司天。两寸不应。厥阴司天。左寸不应。三阴在泉。则两尺不应。太阴在泉。右尺不应。
少阴在泉。两尺不应。厥阴在泉。左尺不应。北政以地道言乙丙丁戊寅辛壬癸之岁。论脉则
寸。在北而尺在南三阴司天。则两尺不应。太阴司天。右尺不应。少阴司天两尺不应。厥阴
司天。左尺不应。三阴在泉则两寸不应。太阴在泉。右寸不应。少阴在泉。两寸不应。厥阴
在泉。左寸不应。不应者皆为沉脉也。绀珠经曰∶五行君火不用事。故南政少阴司天。君火
在上。则两寸不应。司泉君火在下。则两尺不应。厥阴司天。君火在左。故左寸不应。司泉
则左尺不应。太阴司天。君火在右。故右寸不应。司泉则右尺不应。北政少阴司天。君火在
上。则两尺不应。司泉君火在下。则两寸不应。厥阴司天。君火在左。故左尺不应。司泉则
左寸不应。太阴司天。君火在右。故右尺不应。司泉则右寸不应。凡不应者。谓脉沉而细不
应于手也。反之。则沉为浮细为大也。岁当君火在寸。而沉反见于尺。岁当君火在尺。而沉
响应于寸。经曰∶尺寸反者死。岁当君火在左。而沉反见于右。岁当君火在右。而沉反见于
左。经曰阴阳交者死。又曰学诊之士。必先岁气。良有以哉。李南丰云∶此与仲景丹溪所说
不同。然所论深得素问君火以退之旨。故从之。
“表、里、虚、实”这四个字，是脉诊的纲领。
表属阳，对应六腑。凡是六淫（风、寒、暑、湿、燥、火）邪气侵袭经络，但尚未进入胃腑及五脏的，都属于表证。
里属阴，对应五脏。凡是七情（喜、怒、忧、思、悲、恐、惊）之气郁结在心肺之间，无法发散；或者饮食五味损伤，滞留于脏腑之间，无法消化排泄的，都属于里证。
实证是指贼邪之气强盛，这是由于正气原本虚弱，邪气得以乘虚而入所致，并非元气自身强盛。因此，治疗原则是：虚证要补益正气，实证要泻除邪气。《黄帝内经》所说的“邪气盛则实，精气夺则虚”，就是这一大法。
《难经》说：脉象有潜伏隐匿的情况，指的是阴阳相互乘袭、相互潜伏。如果脉象出现在阴部（尺部），却反而出现阳脉（如浮、大、数等），这是阳邪乘袭阴位。虽然脉象有时表现为沉、涩、短，这称为“阳中伏阴”。如果脉象出现在阳部（寸部），却反而出现阴脉（如沉、细、弱等），这是阴邪乘袭阳位。虽然脉象有时表现为浮、滑、长，这称为“阴中伏阳”。
（参看后文关于六十年运气延医的内容）
天和脉只论述三阴脉的变化。“南天高兮北泉深”，太阴专主右手寸口和尺口，厥阴在左右手的寸口和尺口均见沉脉，少阴在左右手的寸口和尺口均不应指（即摸不到明显的脉搏跳动）。如果这些脉象相交相反，则是死脉相临。天和脉属于平脉（正常脉象）。一般来说，诸阳脉多为浮脉，诸阴脉多为沉脉，所以不单独论述三阳脉。
从天道角度而言（南政），甲年和己年，论脉时寸口在南（上），尺部在北（下）。当三阴司天时，两寸口不应指。其中，太阴司天，右寸口不应指；少阴司天，两寸口不应指；厥阴司天，左寸口不应指。当三阴在泉时，两尺部不应指。其中，太阴在泉，右尺部不应指；少阴在泉，两尺部不应指；厥阴在泉，左尺部不应指。
从地道角度而言（北政），乙、丙、丁、戊、寅、辛、壬、癸之年，论脉时寸口在北（下），尺部在南（上）。当三阴司天时，两尺部不应指。其中，太阴司天，右尺部不应指；少阴司天，两尺部不应指；厥阴司天，左尺部不应指。当三阴在泉时，两寸口不应指。其中，太阴在泉，右寸口不应指；少阴在泉，两寸口不应指；厥阴在泉，左寸口不应指。所谓“不应”，都是指脉象沉而细微，按之不应手。反之，如果本该沉的脉却浮起，本该细的脉却变大，即为反常。
如果岁运当君火位于寸口，却反而在尺部见到沉脉；岁运当君火位于尺部，却反而在寸口响应到沉脉，《黄帝内经》说：“尺寸反者死”。如果岁运当君火位于左侧，却反而在右侧见到沉脉；岁运当君火位于右侧，却反而在左侧见到沉脉，《黄帝内经》说：“阴阳交者死”。又说，学习诊脉的人，必须先了解当年的岁气，确实是有道理的。
The four characters "Exterior, Interior, Deficiency, Excess" are the outline of pulse diagnosis.
Exterior belongs to Yang and corresponds to the Fu organs (Six Bowels). Whenever the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade the meridians but have not yet entered the Stomach Fu or the Zang organs, it is classified as Exterior.
Interior belongs to Yin and corresponds to the Zang organs. Whenever the Qi of the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) stagnates between the Heart and Lungs and cannot disperse; or when dietary Five Flavors cause injury that remains within the Zang-Fu organs and cannot be digested or excreted, it belongs to Interior.
Deficiency refers to the self-deficiency of Yuan Qi (Original Qi), manifesting as dissipation of spirit and exhaustion of strength.
Excess refers to the abundance of pathogenic Qi ("Thief Evil"), which arises because the Righteous Qi was originally deficient, allowing the pathogen to take advantage. It is not due to the self-abundance of Yuan Qi. Therefore, the treatment principle is: for Deficiency, tonify the Righteous Qi; for Excess, drain the Pathogenic Qi. As stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "When pathogenic Qi is abundant, it is Excess; when essence and Qi are depleted, it is Deficiency." This is the general principle.
The *Nanjing* (Classic of Difficult Issues) states: "Pulses can be hidden and concealed." This refers to Yin and Yang mutually attacking and hiding from each other. If a pulse appears in the Yin position (Chi/Scaphoid section) but shows Yang pulse characteristics (such as floating, large, rapid), this is Yang attacking Yin. Although the pulse may sometimes appear deep, choppy, and short, this is called "Yin hidden within Yang." If a pulse appears in the Yang position (Cun/Wrist crease section) but shows Yin pulse characteristics (such as deep, fine, weak), this is Yin attacking Yang. Although the pulse may sometimes appear floating, slippery, and long, this is called "Yang hidden within Yin."
(See later sections on sixty-year climate cycles and medical extension.)
The Tianhe Pulse discusses only the Three Yin pulses. "The Southern Heaven is high, the Northern Spring is deep." Taiyin specifically governs the right Cun and Chi positions. Jueyin presents as deep pulses at both Cun and Chi positions on either hand. Shaoyin does not respond (pulse is imperceptible) at both Cun and Chi positions on either hand. If these pulses intersect and oppose each other, it indicates a fatal condition. The Tianhe pulse is considered a normal pulse (Ping Mai). Generally, Yang pulses are floating, and Yin pulses are deep; thus, the Three Yang pulses are not discussed separately.
Speaking from the perspective of Heavenly Dao (Southern Governance/Nan Zheng), in years of Jia and Ji, regarding pulse diagnosis, the Cun is South (upper) and the Chi is North (lower). When the Three Yin govern the Heaven (Si Tian), the two Cun positions do not respond. Specifically, if Taiyin governs Heaven, the right Cun does not respond; if Shaoyin governs Heaven, both Cun positions do not respond; if Jueyin governs Heaven, the left Cun does not respond. When the Three Yin govern the Earth (Zai Quan), the two Chi positions do not respond. Specifically, if Taiyin governs Earth, the right Chi does not respond; if Shaoyin governs Earth, both Chi positions do not respond; if Jueyin governs Earth, the left Chi does not respond.
Speaking from the perspective of Earthly Dao (Northern Governance/Bei Zheng), in years of Yi, Bing, Ding, Wu, Yin, Xin, Ren, and Gui, regarding pulse diagnosis, the Cun is North (lower) and the Chi is South (upper). When the Three Yin govern Heaven, the two Chi positions do not respond. Specifically, if Taiyin governs Heaven, the right Chi does not respond; if Shaoyin governs Heaven, both Chi positions do not respond; if Jueyin governs Heaven, the left Chi does not respond. When the Three Yin govern Earth, the two Cun positions do not respond. Specifically, if Taiyin governs Earth, the right Cun does not respond; if Shaoyin governs Earth, both Cun positions do not respond; if Jueyin governs Earth, the left Cun does not respond. "Not responding" means the pulse is deep and fine, failing to respond to palpation. Conversely, if a pulse that should be deep becomes floating, or one that should be fine becomes large, it is abnormal.
If the annual ruling Jun Huo (Ministerial Fire) should be at the Cun, but a deep pulse is instead found at the Chi; or if it should be at the Chi, but a deep pulse responds at the Cun, the Classic states: "Reversal of Cun and Chi leads to death." If the annual ruling Jun Huo should be on the left, but a deep pulse is found on the right; or if it should be on the right, but a deep pulse is found on the left, the Classic states: "Intersection of Yin and Yang leads to death." It is also said that those who study pulse diagnosis must first understand the annual climate qi, which is indeed well-founded.
Li Nanfeng stated: This differs from what Zhang Zhongjing and Zhu Danxi said. However, their discussion deeply captures the essence of the *Suwen* (Basic Questions) regarding "Jun Huo retreating." Therefore, I follow their view.