洪脉指下极大。来盛去衰。来大去长。体为阳藏。司心。时属夏。运主火也。为阳盛阴
虚之
病。若逢炎夏。诊有胃气。乃应时之脉也。若泄痢失血。久嗽。及痞满反胃。见之增剧难瘥
。或沉兼洪弦涩。主痰红火炽之症。若形瘦脉大多气虚死。又曰脉大则病进。若春秋冬月见
之。治主升阳散火。若洪而有力。乃实脉非洪脉须投寒凉此相类。宜细别耳。又有如洪之脉
。乃阴虚假热阳虚暴症。脉虽洪大。按而无力。此又不得投以凉剂。致败胃气又人临死。从
阳散而绝者。脉必先见洪大滑盛。乃真气尽脱于外也。不可不察。
细脉似微而常有。细直而 。若丝线之应指。宜于秋冬老弱。为血气两衰之病。或伤精
泄汗
。或湿气下侵。或泄利脱阴。或丹田虚冷。或胃虚腹胀。或目眩筋痿。脉经云细为血少气衰
。有此症则顺。否则逆。故吐衄脉沉细者生。忧劳过度者脉亦细。治须温补。至有如细之脉
。或因暴受寒冷。痛极壅塞经络。致脉沉细。不得宣达。是细不得概言。虚而可误施。滋补
固结邪气也。又有痨怯困殆。脉见弦细而数。盖弦主气衰。细主血少。数主虚火煎熬。奄奄
待毙。医于此时尚欲清之平之良可慨已。
伏脉深于沉。诊须推筋着骨。细寻方见。主寒凝经络脏腑。或霍乱吐泻。腹疼沉困。或
宿食
沉蓄。或老痰胶固。或厥逆重阴。散寒温里。急宜着力。伤寒太阳初症。得此最为吉兆。故
濒湖曰∶伤寒一手脉伏曰单伏。两手脉伏曰双伏。不可以阳症见阴为诊。乃火邪内郁。不得
发越。阳极似阴。故脉伏。必有大汗而解。政如久旱将雨。六合阴晦。雨后庶物皆苏之义。
又有夹阴伤寒。先有伏阴在内。外复感寒。阴盛阳衰。四肢厥逆。六脉沉伏。须投姜附。及
灸关元。脉乃复出也。若太溪冲阳皆无脉者必死。以上皆正伏脉也。又有如伏之脉。乃病久
阴阳两亏。脉见断续沉陷。或隐或现。真气随亡。岂初病消散之。比乎。此乃脉脱非脉伏也
。至有暴惊暴怒暴厥。亦见沉伏。少待经尽气复。不治当自愈。若人年过四十以上。元气素
虚。忽然昏 。不省人事。此为类中风。而非真中风也。喉声曳锯。六脉沉伏。惟急治以三
生饮。加人参一两。亦有得生者。如遗尿汗泄。口开目合。便不救矣。凡诊此伏脉与如伏脉
。当兼察病因。庶免枉治。
洪脉在指下感觉极大。来势盛大，去势衰退。来时宽大，去时悠长。其体性属于阳，对应心脏，季节归属于夏季，运化主司火气。这是阳盛阴虚的病证。如果在炎热的夏天诊察到这种脉象，且带有胃气（和缓之象），则是顺应时令的正常脉象。如果是泄泻痢疾、失血、长期咳嗽，以及痞满、反胃等病症中出现此脉，会使病情加重且难以痊愈。如果脉象沉取兼见洪、弦、涩，主痰火炽盛的病证。如果形体消瘦而脉大，且气息虚弱，是死证。又说脉大表示病势进展。如果在春、秋、冬三个月出现洪脉，治疗应以升阳散火为主。如果洪脉有力，那是实脉而非洪脉，必须投用寒凉药物，这两者相似，需要仔细辨别。又有类似洪脉的脉象，是阴虚假热或阳虚暴症的脉象。脉虽然洪大，但按之无力，这种情况也不能投用凉剂，以免败坏胃气。另外，人临死前，阳气从体表散绝时，脉象必定先出现洪大滑盛，这是真气完全脱逸于外的表现，不可不仔细考察。
细脉似微脉但持续存在，细直而柔和，像丝线一样应指。多见于秋冬季节及年老体弱者，是气血两衰的病证。或因耗伤精气、过度出汗，或因湿气下侵，或因泄利导致阴液脱失，或因丹田虚冷，或因胃虚腹胀，或因目眩筋痿。《脉经》说细脉主血少气衰，有此症状则顺，否则为逆。所以吐血衄血而脉象沉细的能生，忧劳过度的人脉象也细，治疗需要温补。至于有类似细脉的脉象，可能是因为突然受寒，疼痛极度导致经络壅塞，致使脉象沉细，不能宣通达表。因此细脉不能一概而论，若是实证误施滋补，会固结邪气。又有痨病怯弱、困顿危急时，脉象见弦细而数。弦主气衰，细主血少，数主虚火煎熬，病人奄奄一息等待死亡，医生在这个时候还想用清热平肝的方法治疗，实在令人感慨。
伏脉比沉脉更深，诊察时必须推筋着骨，细细寻找才能见到。主寒凝经络脏腑，或霍乱吐泻、腹痛沉重困倦，或宿食停滞蓄积，或老痰胶固，或厥逆重阴，应当急用力散寒温里。伤寒太阳病初起症状，得到此脉是最为吉利的征兆。所以李时珍（濒湖）说：伤寒一手脉伏叫单伏，两手脉伏叫双伏，不能因为阳证见到阴脉就诊断为阴证，这是因为火邪内郁，不得发散，阳极似阴，所以脉伏，必定要出大汗才能解病，正如久旱将雨，天地昏暗，雨后万物复苏的道理。又有夹阴伤寒，先有伏阴在内，外面又感受寒邪，阴盛阳衰，四肢厥逆，六脉沉伏，必须投用干姜、附子，并灸关元穴，脉象才会复出。如果太溪、冲阳穴都没有脉搏，必定死亡。以上都是正伏脉。又有类似伏脉的脉象，是病久阴阳两亏，脉象见断续沉陷，或隐或现，真气随之亡失，这岂是初病消散所能比的？这是脉脱而非脉伏。至于有突然惊恐、暴怒、暴厥，也会见到沉伏脉，稍待经脉之气恢复，不治也能自愈。如果人年过四十以上，元气素来虚弱，忽然昏倒，不省人事，这是类中风，而不是真中风。喉中有声如拉锯，六脉沉伏，只有紧急治疗用三生饮，加入人参一两，也有得救活着的。如果出现遗尿、汗泄、口开目合、大便失禁，就不能救治了。凡是诊察这种伏脉与类似伏脉，应当兼察病因，以免错误治疗。
The Hong (Surging) pulse feels extremely large under the fingers. It comes vigorously and departs weakly; it is broad upon arrival and prolonged upon departure. Its nature belongs to Yang, corresponds to the Heart (Xin), is associated with the Summer season, and governs the Fire element. It indicates a disease of Yang excess and Yin deficiency. If encountered in the炎炎 (scorching) summer, provided there is a Stomach Qi (Wei Qi, indicating harmony and health) present in the pulse, it is a pulse corresponding to the season. However, if seen in cases of diarrhea/dysentery, blood loss, chronic cough, as well as fullness/stagnation (Pi Man) or regurgitation (Fan Wei), it exacerbates the condition and makes recovery difficult. If the pulse is deep and combined with Hong, Xian (Wiry), and Se (Choppy) qualities, it indicates symptoms of Phlegm-Fire blazing. If the body is emaciated yet the pulse is large, accompanied by Qi deficiency, it is a sign of death. It is also said that a large pulse indicates the progression of the disease. If seen in Spring, Autumn, or Winter, treatment should focus on raising Yang and dispersing Fire. If the Hong pulse is forceful, it is a Shi (Excess) pulse rather than a true Hong pulse, requiring cold-cooling herbs; these two are similar and must be carefully distinguished. There is also a pulse resembling Hong, which appears in Yin deficiency with false heat or sudden Yang deficiency syndromes. Although the pulse is large and surging, it is powerless upon pressure. In such cases, cooling agents must not be administered, lest they damage Stomach Qi. Furthermore, when a person is near death and Yang Qi scatters and severs from the exterior, the pulse first appears large, surging, slippery, and vigorous, indicating that the True Qi has completely escaped to the exterior. This must not be overlooked.
The Xi (Fine/Thready) pulse resembles the Wei (Micro) pulse but is continuous. It is fine, straight, and soft, responding to the finger like a silk thread. It is suitable for Autumn and Winter, and for the elderly and weak, indicating a disease of dual deficiency of Blood and Qi. It may result from injury to Essence and excessive sweating, invasion of Dampness from below, leakage/depletion of Yin through diarrhea, deficiency-cold of the Dantian, Stomach deficiency with abdominal distension, dizziness, or flaccidity of sinews. The Mai Jing (Classic of Pulse Diagnosis) states that a Fine pulse indicates little Blood and declining Qi; if accompanied by these symptoms, the prognosis is favorable (Shun); otherwise, it is unfavorable (Ni). Therefore, patients with hematemesis or epistaxis who have a deep and fine pulse will survive. Those suffering from excessive worry and fatigue also have a fine pulse, and treatment requires warming and tonification. As for a pulse resembling Xi, it may occur due to sudden exposure to cold, extreme pain causing obstruction of collaterals and meridians, resulting in a deep and fine pulse that cannot circulate freely. Thus, the Fine pulse cannot be generalized; if applied to excess patterns, tonifying methods will consolidate pathogenic factors. In cases of consumption (Lao Que) with critical weakness, the pulse may appear Xian, Xi, and Shu (Rapid). Xian indicates Qi decline, Xi indicates Blood deficiency, and Shu indicates torridity from deficient fire. The patient is lingering and awaiting death; it is lamentable that physicians at this stage still attempt to clear and level the condition.
The Fu (Hidden) pulse is deeper than the Chen (Deep) pulse. Diagnosis requires pushing the tendons down to the bone and searching carefully to perceive it. It indicates Cold stagnation in collaterals, meridians, Zang-Fu organs, or Huoluan (cholera-like syndrome) with vomiting and diarrhea, severe abdominal pain and heaviness, retained food accumulation, old Phlegm congealing, or Jue Ni (cold extremities) with Heavy Yin. Treatment should urgently focus on dispelling Cold and warming the interior. In the initial stage of Taiyang syndrome in Shanghan (Cold Damage), encountering this pulse is a very auspicious omen. Therefore, Li Shizhen (Binhu) stated: In Shanghan, a Fu pulse in one hand is called Dan Fu (Single Hidden), and in both hands is called Shuang Fu (Double Hidden). One should not diagnose it as a Yin syndrome simply because a Yin pulse appears in a Yang syndrome. Rather, it is due to Fire pathogen being internally constrained and unable to vent out; Extreme Yang resembles Yin, hence the pulse is hidden. Resolution must come through profuse sweating, just as after a long drought, the sky becomes dark before rain, and all things revive after the rain. There is also "Jiao Yin Shanghan" (Shanghan with concealed Yin), where latent Yin exists internally, and external Cold is contracted. With Yin excess and Yang decline, leading to cold extremities and six pulses being deep and hidden, one must administer Ginger and Aconite decoctions and moxa the Guanyuan (CV4) acupoint until the pulse reappears. If the Taixi (KI3) and Chongyang (ST42) pulses are absent, death is certain. These are all standard Fu pulses. There is also a pulse resembling Fu, occurring in prolonged illness with dual deficiency of Yin and Yang, where the pulse is intermittent, sunken, sinking, appearing and disappearing intermittently, with True Qi perishing. This is not comparable to the dispersion of acute illness; it is Pulse Depletion (Mai Tuo), not Pulse Hidden. Sudden fright, rage, or syncope may also present with deep and hidden pulses; after a short while, as meridian Qi recovers, self-healing occurs without treatment. If a person over forty, whose Yuan Qi has always been weak, suddenly faints and loses consciousness, this is Lei Zhong Feng (Stroke-like syndrome), not true Zhong Feng (Wind Stroke). With a rattling sound in the throat like a saw, and six pulses deep and hidden, urgent treatment with Sansheng Yin (Three-Life Decoction) plus one liang of Renshen (Ginseng) may save the life. However, if incontinence, sweating, open mouth, closed eyes, and fecal incontinence occur, it is incurable. When diagnosing either the standard Fu pulse or the pulse resembling Fu, one must simultaneously investigate the etiology to avoid misdiagnosis and mistreatment.