赤有黑有青者。寒热气也。其青短者。少气也。足见经义之渊博。
崔真人脉诀一卷。为宋道士崔嘉言隐君撰。焦 国史经籍志始载之。厥后、元李东垣明李濒湖均采之。前清
四库提要及医宗金鉴亦收之。其书简而得要。便于记诵。足为后学读本。无待言矣。俞
氏又加增删。尤为精实。
（添加）
【荣斋按】本节原为第四节，篇名“钩玄”，其属性采自岐伯的四条，采自扁鹊的
一条，采自仲景的五条，加俞氏结语一条；共十一条。文本空洞而不具体，验之事实也
不符；何廉臣先生不参意见，仅于末条补入王燕昌论脉二则，加以按语说∶“此二则
（指王燕昌）洵得诊脉之实情实理。”可见以上俞氏所引的十条文本，都得不到诊脉的
实情实理；这种深刻的目光，蕴蓄的批判，针对着经典著作的糟粕部分，予以“存而不
论”的弃置。现下我把这十一条艰晦无用的文本全部扬弃，而以何氏所引王燕昌论脉二
则移在第二节四言脉诀中作附注；此处采入近人姜白鸥“中医脉学检讨”（见中医新生
命第四期）的首段，初步把脉搏的理由用实际文本介绍了一些，庶几比原文“有血有肉
”，不致“大而无当”了。姜氏原文如下∶“脉之搏动，系于心脏，心脏主血行者也。
血液之循环，以动脉为起点，静脉为终点，而心脏则为其出发与归宿之枢纽。心脏有弛
张开阖之作用，更有液体之压力以调节血行，当左心室每次收缩之际，均能使左心室之
血流入动脉，于是动脉管为之膨胀；动脉管壁，因有弹性，即起一种冲突状之运动，是
为脉搏。脉搏乃动力之震浪，始于心脏；是心脏之动作状态，可由脉搏窥知之也。既知
脉搏与心脏搏动一致，从知内经三部九候之说，脉经分部候脏之论，不足凭信。脉搏既
系于心脏之动作，动脉管壁之紧张，则肱动脉与桡骨动脉之弛张起落，
亦当然一致，更无有寸关尺之分；三部之说，无立足点矣。若夫九候，亦属无稽；血管
何有三层，血液在脉管中，其量恒溢出于管腔之容积，脉搏之动止，按之即得，瘦人且
可望而见之，若非大出血后，或罹心脏疾患，及其他直接间接之恶性贫血病者，脉无变
态。是故浮按沉按，可以验脉之盈虚，而中按乃无处着落。分部候脏之说，始见于脉经
所引之脉法赞，以左手寸关尺候心、肝、肾、右手寸关尺候肺、脾、命门，殊不可靠。
各脏器不能无病，有病亦不必见之于脉，即或有之，是间接因病毒之波及侵扰于心脏血
行者；脉之所见，乃心脏血液循环之变化，与原发病脏器已无关系，医者参证并发症候
之所见，探索其血行所以变态之故，而后得知其为某脏病也。
“脉经脉诀，分脉之类凡二十七则，徐洄溪脉诀启悟，增“疾”脉为二十八脉。
就管见所及，可分为两大纲∶即揭示心脏左心室排血力量之大或小者，细别为五项∶（
一）心脏排血量之关系。（二）脉管之关系。（三）心动之速度。（四）血压之关系。
（五）心组织机能障碍诸端是也。其二十八脉中，更就鄙见认为合理者，得十八脉，分
类区别如下∶
（一）心脏排血力量之关系
排血量充实者──洪。
排血量弱小者──芤、微、弱。
（二）脉管之关系
脉管粗而排血量充实者──洪。
脉管细而排血量充实者──弦。
脉管紧张程度减低者──濡。
脉管纤微萎缩及变硬者──紧、革。
血管收缩（末梢动脉收缩）──弦、迟。
血管扩张（末梢动脉扩张）──数、洪。
（三）心动之数度
心动弛缓者──迟。
心动亢进者──数。
（四）血压之关系
血压亢进──牢。
血压低降──濡。
（五）心组织机能障碍
僧帽瓣口狭窄心力衰弱者──濡、伏、细。
大动脉瓣闭锁不全──疾。
大动脉瓣口狭窄───缓。
瓣膜闭锁不全──促、结、代。
血管栓塞──促、结、代。
“上列五个原则，相互有密切之关系。其余浮、沉、滑、涩、虚、实、长、短、散
、动，此十者；皆不足为独立之脉。浮沉是指医者切脉而言，滑脉同于洪脉，涩脉与缓脉
类似，虚实是相对的代名词，长短散动，皆不足象脉，故不赘述。
“依旧说∶根据心脏左心室驱血力量之大小，以诀脉二十八脉，除“长短散动”不
足以象脉之四脉，“促结代”之特殊脉，及指切脉动作之“浮沉”二脉──共九种脉象
外；得十九脉而区别之。则洪、滑、数、实、紧、弦、疾、牢，属心脏驱血力量之大者
；微、涩、迟、弱、虚、濡、细、伏、缓、革、芤，属心脏驱血力量之小者。又伤寒论
十字脉除浮沉二脉外，则大、滑、动、数，属心脏驱血力量之大者；弱、涩、弦、微，
属心脏驱血力量之小者。虽此种分析粗疏，认此是治脉学人之快捷方式。”
从上面这篇文本里推勘，我们可以知道∶脉动之迟数，关系血液流行的快慢，脉搏
之软硬，关系心脏弛张的强弱，脉波之顿挫，关系心脏瓣膜的启闭；以心脏生理的变态
，直接观察到因病毒之波及侵扰于心脏血行之关系，间接掌握了病理机转的变化（即各
脉之主病）及预后之良否（即脉症的忌宜）。虽然所说的仅仅是一个开端，但理论是符
合实际的。其次，这篇文本里区分心脏排血力量之大小为两纲，也同于古医学中的“脉
之阴阳”；伤寒论以浮、大、滑、动、数属阳，沉、弱、涩、弦、迟属阴，本篇则以阳
脉属于心脏驱血力之大者，阴脉属于心脏驱血力之小者，看法虽不同，而原则是一致的
。复次，这篇文本的思想论点，完全是环绕着柯韵伯所说∶“脉有十种，阴阳两分，即
具五法；浮沉是脉体，大弱是脉势，滑涩是脉气，动弦是脉形，迟数是脉息。”的一段
理论而阐述出来；体会深刻，具有至理，可以由此作进一步研讨中医脉学的阶梯。
脉色呈现赤、黑、青色的，是寒热之邪的表现。其中青色且短促的，是元气不足的表现。这充分展现了中医经典理论的渊博深奥。
崔真人脉诀一卷，是由宋代道士崔嘉言隐君所撰写。焦竑的《国史经籍志》开始记载此书。此后，金元时期的李东垣和明代的李濒湖都采纳了其中的内容。前清时期的《四库全书总目提要》及《医宗金鉴》也收录了此书。这本书简明扼要，便于记诵，足以作为后学者的读本，这是不言而喻的。俞氏又对其进行了增删，更加精当切实。
（添加）
【荣斋按】本节原为第四节，篇名“钩玄”，其内容属性采自岐伯的四条，采自扁鹊的一条，采自张仲景的五条，加上俞氏的结语一条；共十一条。这些文本空洞而不具体，与事实检验不符；何廉臣先生未加参议意见，仅在最后一条补入了王燕昌论述脉象的两则内容，并加以按语说：“这两则（指王燕昌）确实得到了诊脉的真实情况和道理。”由此可见，以上俞氏所引用的十条文本，都没有得到诊脉的真实情况和道理；这种深刻的洞察力，蕴蓄的批判精神，针对着经典著作中的糟粕部分，予以“存而不论”的弃置处理。现在我将这十一条艰涩晦暗无用的文本全部扬弃，而把何氏所引用的王燕昌论脉两则移在第二节四言脉诀中作为附注；此处采入近代人姜白鸥的《中医脉学检讨》（见《中医新生命》第四期）的首段，初步用实际文本介绍了一些脉搏产生的原理，这样或许比原文“有血有肉”，不至于“大而空泛”了。姜氏原文如下：“脉搏的跳动，系于心脏，因为心脏是主司血液运行的器官。血液的循环，以动脉为起点，静脉为终点，而心脏则是其出发与归宿的枢纽。心脏具有舒张和收缩的作用，更有液体的压力来调节血行，当左心室每次收缩之际，都能使左心室的血液流入动脉，于是动脉管为之膨胀；动脉管壁，因为有弹性，就起一种冲击状的运动，这就是脉搏。脉搏乃是动力的震浪，始于心脏；因此心脏的动作状态，可以通过脉搏窥知。既然知道脉搏与心脏搏动一致，从而得知《内经》中三部九候的说法，《脉经》中分部候脏的理论，不足以凭信。脉搏既然系于心脏的动作，动脉管壁的紧张度，那么肱动脉与桡骨动脉的舒张起伏，当然也是一致的，更不存在寸、关、尺的区别；三部的说法，就没有立足点了。至于九候，也属于无稽之谈；血管哪有分层，血液在脉管中，其量常常溢出管腔的容积，脉搏的动止，按压即可得，瘦人甚至可以看到，如果不是大出血后，或患有心脏疾患，及其他直接间接的恶性贫血病患者，脉搏没有变态。所以浮按沉按，可以验证脉搏的盈虚，而中按却无处着力。分部候脏的说法，始见于《脉经》所引的《脉法赞》，认为左手寸关尺候心、肝、肾，右手寸关尺候肺、脾、命门，非常不可靠。各脏器不能没有病，有病也不一定表现在脉象上，即使有表现，也是间接因病毒波及侵扰心脏血行所致；脉象所见，乃是心脏血液循环的变化，与原发病的脏器已无关系，医者参考并发症候所见，探索其血行所以变态的原因，然后才知道它是某脏的病。
“《脉经》和《脉诀》，分类脉象凡二十七种，徐洄溪的《脉诀启悟》，增加‘疾’脉为二十八脉。就我个人的见解来看，可分为两大纲：即揭示心脏左心室排血力量之大或小者，细分为五项：（一）心脏排血量的关系。（二）脉管的关系。（三）心动速度的关系。（四）血压的关系。（五）心组织机能障碍诸端是也。在二十八脉中，更就我个人认为合理的，得十八脉，分类区别如下：
（一）心脏排血力量之关系
排血量充实者──洪脉。
排血量弱小者──芤脉、微脉、弱脉。
（二）脉管之关系
脉管粗而排血量充实者──洪脉。
脉管细而排血量充实者──弦脉。
脉管紧张程度减低者──濡脉。
脉管纤微萎缩及变硬者──紧脉、革脉。
血管收缩（末梢动脉收缩）──弦脉、迟脉。
血管扩张（末梢动脉扩张）──数脉、洪脉。
（三）心动之数度
心动弛缓者──迟脉。
心动亢进者──数脉。
（四）血压之关系
血压亢进──牢脉。
血压低降──濡脉。
（五）心组织机能障碍
僧帽瓣口狭窄心力衰弱者──濡脉、伏脉、细脉。
大动脉瓣闭锁不全──疾脉。
大动脉瓣口狭窄───缓脉。
瓣膜闭锁不全──促脉、结脉、代脉。
血管栓塞──促脉、结脉、代脉。
“上述五个原则，相互之间有密切的关系。其余浮、沉、滑、涩、虚、实、长、短、散、动，这十种脉象；都不足以作为独立的脉类。浮沉是指医者切脉的手法而言，滑脉同于洪脉，涩脉与缓脉类似，虚实是相对的代名词，长短散动，都不足以象征脉象，故不赘述。
“依照旧说：根据心脏左心室驱血力量之大小，来辨别二十八脉，除了‘长短散动’不足以象脉的四脉，“促结代”的特殊脉，及指切脉动作的‘浮沉’二脉──共九种脉象外；得出十九脉而区别之。则洪、滑、数、实、紧、弦、疾、牢，属于心脏驱血力量之大者；微、涩、迟、弱、虚、濡、细、伏、缓、革、芤，属于心脏驱血力量之小者。另外《伤寒论》十字脉除浮沉二脉外，则大、滑、动、数，属于心脏驱血力量之大者；弱、涩、弦、微，属于心脏驱血力量之小者。虽然此种分析粗疏，但认为这是研究脉学之人的快捷方式。”
从上面这篇文本里推勘，我们可以知道：脉动之迟数，关系血液流行的快慢，脉搏之软硬，关系心脏舒张收缩的强弱，脉波之顿挫，关系心脏瓣膜的启闭；以心脏生理的变态，直接观察到因病毒波及侵扰心脏血行的关系，间接掌握了病理机转的变化（即各脉之主病）及预后之良否（即脉症的忌宜）。虽然所说的仅仅是一个开端，但理论是符合实际的。其次，这篇文本里区分心脏排血力量之大小为两纲，也同于古医学中的“脉之阴阳”；《伤寒论》以浮、大、滑、动、数属阳，沉、弱、涩、弦、迟属阴，本篇则以阳脉属于心脏驱血力之大者，阴脉属于心脏驱血力之小者，看法虽不同，而原则是一致的。复次，这篇文本的思想论点，完全是环绕着柯韵伯所说：“脉有十种，阴阳两分，即具五法；浮沉是脉体，大弱是脉势，滑涩是脉气，动弦是脉形，迟数是脉息。”的一段理论而阐述出来；体会深刻，具有至理，可以由此作进一步研讨中医脉学的阶梯。
Those whose pulse colors appear red, black, or green indicate cold and heat pathogens. Among them, a greenish hue with a short quality indicates a deficiency of vital energy (Qi). This fully demonstrates the profound and extensive nature of classical medical theories.
The *Cui Zhenren Mai Jue* (Pulse Instructions by Master Cui), in one volume, was written by Cui Jiayan, a Daoist recluse of the Song Dynasty. It was first recorded in Jiao Hong's *Guo Shi Jing Ji Zhi* (Bibliography of National History). Later, Li Dongyuan of the Jin-Yuan period and Li Shizhen of the Ming Dynasty both incorporated its content. The *Siku Quanshu Zongmu Tiyao* (General Outline of the Complete Library of the Four Treasuries) of the late Qing Dynasty and the *Yi Zong Jin Jian* (Golden Mirror of Medicine) also included it. This book is concise yet captures the essentials, making it easy to memorize, and serves adequately as a textbook for students of medicine; this goes without saying. Mr. Yu further edited and revised it, making it even more precise and substantial.
(Added)
[Note by Rongzhai] This section was originally the fourth section, titled "Gou Xuan" (Extracting the Essence). Its attributes were drawn from four passages by Qibo, one by Bian Que, five by Zhang Zhongjing, plus one concluding remark by Mr. Yu; totaling eleven entries. These texts are empty and lack specificity, failing verification against facts. Mr. He Lianchen did not offer his own commentary but merely appended two discussions on pulse diagnosis by Wang Yanchang to the final entry, adding an annotation stating: "These two entries (by Wang Yanchang) truly capture the reality and principles of pulse diagnosis." This reveals that the ten entries cited by Mr. Yu above fail to grasp the true reality and logic of pulse diagnosis. Such profound insight and implicit criticism target the dross within classic works, subjecting them to disposal via "preservation without discussion." Currently, I have discarded all eleven of these obscure and useless texts entirely. Instead, I have moved the two pulse discussions by Wang Yanchang, cited by Mr. He, into Section 2 ("Four-Character Pulse Instructions") as footnotes. Here, I have incorporated the opening paragraph of Jiang Baio's "Review of Traditional Chinese Medicine Pulse Studies" (published in Issue 4 of *Zhongyi Xin Shengming* [New Life of TCM]) by a contemporary scholar. This preliminarily introduces some practical aspects of the rationale behind pulses using actual text, hopefully rendering the content more substantive ("flesh and blood") rather than overly broad and unsubstantiated ("large but inappropriate"). The original text by Mr. Jiang is as follows:
"The pulsation of the pulse is centered on the heart, which governs blood circulation. Blood circulation begins in the arteries and ends in the veins, with the heart serving as the hub of departure and return. The heart possesses functions of relaxation (diastole) and contraction (systole), along with fluid pressure to regulate blood flow. During each systole of the left ventricle, blood flows from the left ventricle into the arteries, causing arterial expansion. Due to their elasticity, the arterial walls undergo a wave-like motion, which constitutes the pulse. The pulse is essentially a shockwave of kinetic energy originating from the heart; thus, the state of cardiac action can be inferred from the pulse. Since it is known that the pulse aligns with cardiac pulsation, the theory of 'Three Regions and Nine Locations' in the *Neijing* (Inner Canon) and the theory of 'Regional Organ Diagnosis' in the *Mai Jing* (Classic of Pulse Diagnosis) cannot be relied upon. Given that the pulse depends on cardiac action and arterial wall tension, the rhythmic expansion and contraction of the brachial artery and radial artery should naturally correspond, leaving no basis for the distinction of Cun, Guan, and Chi positions; thus, the concept of 'Three Regions' lacks validity. As for 'Nine Locations,' it is equally baseless; how can blood vessels be layered? Blood volume within the vessel often exceeds the lumen's capacity. The pulse's movement and cessation are palpable upon pressing; in emaciated individuals, it may even be visible. Unless after severe hemorrhage, or suffering from cardiac diseases or other direct/indirect malignant anemias, the pulse does not exhibit abnormalities. Therefore, superficial and deep palpation can verify the fullness or emptiness of the pulse, whereas moderate pressure finds no distinct point. The theory of regional organ diagnosis first appeared in the *Mai Fa Zan* (Ode to Pulse Methods) cited in the *Mai Jing*, which claims the left Cun-Guan-Chi corresponds to the Heart, Liver, and Kidney, while the right Cun-Guan-Chi corresponds to the Lung, Spleen, and Mingmen (Gate of Vitality). This is highly unreliable. Organs may be diseased without manifesting in the pulse; even if they do, it is indirectly due to pathogens affecting cardiac blood circulation. What the pulse reflects are changes in cardiac blood circulation, unrelated to the primary diseased organ. Physicians must correlate observed complication symptoms to explore the reasons for hemodynamic changes before determining which organ is diseased.
"The *Mai Jing* and *Mai Jue* classify twenty-seven types of pulses. Xu Huixi's *Mai Jue Qi Wu* added the 'Rapid' (Ji) pulse, bringing the total to twenty-eight. Based on my limited understanding, these can be divided into two main categories: revealing whether the pumping force of the left ventricle is strong or weak, further subdivided into five items: (1) Relation to cardiac output volume. (2) Relation to vessel characteristics. (3) Relation to heart rate speed. (4) Relation to blood pressure. (5) Various functional disorders of cardiac tissue. Among the twenty-eight pulses, I consider eighteen to be reasonable based on my views, classified as follows:
"(1) Relation to Cardiac Pumping Force
Full pumping volume ── Full (Hong) pulse.
Weak pumping volume ── Empty (Kou), Minute (Wei), Weak (Ruo) pulses.
"(2) Relation to Vessel Characteristics
Coarse vessels with full pumping volume ── Full (Hong) pulse.
Fine vessels with full pumping volume ── String-taut (Xian) pulse.
Reduced vessel tension ── Soft (Ru) pulse.
Microscopic atrophy and hardening of vessels ── Tight (Jin), Leathery (Ge) pulses.
Vasoconstriction (peripheral arterial constriction) ── String-taut (Xian), Slow (Chi) pulses.
Vasodilation (peripheral arterial dilation) ── Rapid (Shu), Full (Hong) pulses.
"(3) Degree of Heartbeat
Sluggish heartbeat ── Slow (Chi) pulse.
Hyperactive heartbeat ── Rapid (Shu) pulse.
"(4) Relation to Blood Pressure
Hypertension ── Firm (Lao) pulse.
Hypotension ── Soft (Ru) pulse.
"(5) Cardiac Tissue Functional Disorders
Mitral stenosis with heart failure ── Soft (Ru), Deep/Floating-under-pressure (Fu), Fine (Xi) pulses.
Aortic valve insufficiency ── Rapid (Ji) pulse.
Aortic stenosis ── Moderate/Slow (Huan) pulse.
Valvular insufficiency ── Hasty (Cu), Knotted (Jie), Intermittent (Dai) pulses.
Vascular embolism ── Hasty (Cu), Knotted (Jie), Intermittent (Dai) pulses.
"The five principles listed above are closely interrelated. The remaining ten pulses—Floating (Fu), Deep (Chen), Slippery (Hua), Choppy (Se), Deficient (Xu), Excess (Shi), Long (Chang), Short (Duan), Scattered (San), and Moving (Dong)—are insufficient to stand as independent pulse categories. Floating and Deep refer to the physician's palpation technique. Slippery is similar to Full; Choppy resembles Moderate. Deficient and Excess are relative terms. Long, Short, Scattered, and Moving do not adequately represent pulse qualities, so they are not elaborated upon.
"According to traditional theory: Based on the magnitude of the left ventricle's driving force, distinguishing the twenty-eight pulses, excluding the four pulses ('Long, Short, Scattered, Moving') that inadequately represent pulse qualities, the special pulses of 'Hasty, Knotted, Intermittent,' and the two pulses referring to palpation action ('Floating, Deep')—totaling nine pulse images—we derive nineteen distinct pulses. Thus, Full, Slippery, Rapid, Excess, Tight, String-taut, Rapid/Ji, and Firm belong to those with strong cardiac driving force; Minute, Choppy, Slow, Weak, Deficient, Soft, Fine, Deep, Moderate, Leathery, and Empty belong to those with weak cardiac driving force. Furthermore, regarding the ten characteristic pulses in the *Shanghan Lun* (Treatise on Cold Damage), excluding Floating and Deep, Large, Slippery, Moving, and Rapid belong to strong cardiac driving force; Weak, Choppy, String-taut, and Minute belong to weak cardiac driving force. Although this analysis is rough, it is considered a shortcut for those studying pulseology.
"From the deduction of the above text, we can understand: The slowness or rapidity of pulse beats relates to the speed of blood flow; the hardness or softness of the pulse relates to the strength of cardiac diastole and systole; the cadence of the pulse wave relates to the opening and closing of heart valves. By observing physiological abnormalities of the heart, we directly observe the impact of pathogens on cardiac blood circulation and indirectly master pathological mechanisms (i.e., diseases associated with each pulse) and prognosis (i.e., contraindications between pulse and symptoms). Although this is merely a beginning, the theory aligns with reality. Secondly, dividing cardiac pumping force into two main categories in this text parallels the ancient medical concept of 'Yin and Yang of Pulses.' The *Shanghan Lun* classifies Floating, Large, Slippery, Moving, and Rapid as Yang, and Deep, Weak, Choppy, String-taut, and Slow as Yin. This text considers Yang pulses as those with strong cardiac driving force and Yin pulses as those with weak cardiac driving force. Although perspectives differ, the principles are consistent. Moreover, the ideological arguments of this text revolve entirely around the theory expounded by Ke Yunbo: 'There are ten types of pulses, divided into Yin and Yang, possessing five methods; Floating and Deep are pulse body, Large and Weak are pulse momentum, Slippery and Choppy are pulse qi, Moving and String-taut are pulse shape, Slow and Rapid are pulse rhythm.' This understanding is profound and contains sound reasoning, serving as a stepping stone for further study of TCM pulseology."