脉舌已详前论总诀之中。兹又一再叮咛。重语以申明之者。诚以切脉辨舌。为临证
断病。医生行道之必要。证有疑似凭诸脉。脉有疑似凭诸舌。前论只详六经脉舌。而切
胀则诊法若何。部分若何。常脉怪脉若何。辨舌则形质若何。苔色若何。真苔假苔若何
。未曾一一申论。故特分切脉举要。辨舌举要两道。以作临病之指南针。然脉理精微。
心中易了。指下难明。舌色显著。既能目睹。又可手扪。辨舌较切脉为尤易。舌色之确切
。究不同脉理之微茫。但其苔之易于变化。较脉象为尤速。即假苔染苔。亦必细观而详
问。故临证切脉辨舌。全凭活法推求。可意会不可言传。经验多。心思细。自能得诊宗
三昧。今试晰。言其要。
【荣斋按】四明胡安邦对诊脉辨舌方面，有一种经验的见解。其说如下∶“诊断上
之各种脉舌，不过树其大体，吾人既能略明此脉主何病？此舌主何病后？即当寻得其系
统。如∶舌苔白腻为表寒，黄为化热而渐入里，干黄为热盛于内，干黑即热极而津枯；
又如舌质淡红为正色，正红为热，深红为热深，绛为热甚，紫为热极。此其一。更须辨
其疑似，如∶脉迟而不流利则为涩，中有歇止则为结，浮大且软为虚；又如∶脉数而弦
急则为紧，流利则为滑，中有歇止则为促，来如豆粒则为动，来而过极则为疾。此其二
。前者能明，则逐日观其脉舌，可知病情传变之轻重；后者能明，则临诊观其脉舌，可
知病情之隐微显著。至于初临诊时，指下渺茫，舌苔变幻，不能确断病状；则唯一之法
，先事细询详问，听其所言，证以脉舌之象，自然能中肯綮。故内经曰∶
三伍合参，以决死生。又曰∶能合色脉，可以万全。非谓得其片段，即能尽诊断之能事
也。如病患言咳嗽，观其脉浮苔白，则为风寒；脉数苔黄，则为燥热；脉细数而舌质红
，则为阴虚；脉濡滑而苔浓腻，则为痰湿。于是疏之清之，养阴温化，无不攸利。”这
样的举例帮助，颇能从感性认识而进入理性认识的阶段。
脉象与舌象的论述已在之前的总诀中详细说明。这里再次反复叮嘱，用重复的话语来申明其意，实在是因为切脉和辨舌是临床诊断疾病、医生行医的必要手段。证候有疑似难辨之处，需凭借脉象来判断；脉象也有疑似难明之处，需凭借舌象来辨别。前文只详细论述了六经病的脉象和舌象，而对于腹部胀满的诊察方法如何、各部位的症状表现如何、常脉与怪脉的区别如何，以及辨舌时舌质的形态如何、苔色的变化如何、真苔与假苔的区别如何，都未曾一一深入阐述。因此特别分为“切脉举要”和“辨舌举要”两部分，作为临床诊疗的指南。然而脉理精微奥妙，心中容易理解，但手指下却难以明确感知；舌色显著，既能亲眼目睹，又可以亲手触摸，所以辨舌比切脉更为容易。但舌色的确切判断，终究不像脉理那样细微深奥，只是舌苔的变化比脉象更加迅速。即使是假苔或染苔，也必须仔细观察并详细询问。因此，临床切脉辨舌，全凭灵活变通的方法去推求，只能心领神会，难以用言语完全表达。经验多、心思细密的人，自然能领悟诊断的要旨。现在试着清晰地阐述其要点。
【徐荣斋按语】四明人胡安邦在诊脉辨舌方面有一种基于经验的见解，其说法如下：“诊断上的各种脉象和舌象，不过是树立一个大体的框架。我们既然能大致明白此脉主何病、此舌主何病之后，就应当寻找到其内在的系统规律。例如：舌苔白腻属于表寒，黄色表示化热且逐渐入里，干燥发黄表示内热炽盛，干燥发黑则表示热极而津液枯竭；又如舌质淡红为正常颜色，正红色表示有热，深红色表示热势较深，绛色表示热甚，紫色表示热极。这是第一点。更须辨别那些似是而非的情况，例如：脉迟而不流利则为涩脉，中有间歇则为结脉，浮大且柔软则为虚脉；又如：脉数而弦急则为紧脉，流利则为滑脉，中有间歇则为促脉，脉搏跳动如豆粒般明显则为动脉，脉搏来得过快超过极限则为疾脉。这是第二点。前者若能明了，则每日观察其脉舌，可以知道病情传变的轻重；后者若能明了，则临诊时观察其脉舌，可以知道病情中隐微与显著的部分。至于初诊时，指下感觉渺茫，舌苔变幻莫测，不能确切断定病状；那么唯一的方法，就是事先仔细询问详查，听取患者的陈述，再结合脉象和舌象进行验证，自然能切中要害。所以《内经》说：‘参伍相合，以决死生。’又说：‘能结合面色与脉象，可以达到万无一失。’这并不是说得到片面的信息，就能尽到诊断的所有职责。例如患者诉说咳嗽，观察其脉浮苔白，则是风寒；脉数苔黄，则是燥热；脉细数而舌质红，则是阴虚；脉濡滑而苔浓腻，则是痰湿。于是采用疏解、清热、养阴、温化等方法，无不适宜。”这样的举例帮助，颇能从感性认识进入理性认识的阶段。
The discussions on pulse and tongue have already been detailed in the previous general principles. Here, repeated admonitions are made, using reiterated words to clarify the points, truly because palpating the pulse and examining the tongue are essential for clinical diagnosis and for a physician's practice. When symptoms are ambiguous, rely on the pulse; when the pulse is ambiguous, rely on the tongue. The previous discussion only detailed the pulses and tongues of the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin), but did not elaborate one by one on how to diagnose abdominal distension, what the manifestations of different body parts are, what constitute normal versus abnormal pulses, what the morphology of the tongue body is, what the colors of the coating are, and what distinguishes true from false coatings. Therefore, "Essentials of Pulse Palpation" and "Essentials of Tongue Examination" are specifically divided into two sections to serve as a compass for clinical guidance. However, the principles of the pulse are subtle and profound; they are easy to understand in the mind but difficult to discern under the fingers. Tongue color is conspicuous, visible to the eye and palpable by hand, so examining the tongue is easier than palpating the pulse. Yet, the exactness of tongue color is fundamentally different from the subtlety of pulse principles, although the coating changes more rapidly than the pulse image. Even false or stained coatings must be carefully observed and thoroughly inquired about. Thus, clinical pulse palpation and tongue examination rely entirely on flexible application and deduction; they can be intuitively understood but are hard to fully express in words. With abundant experience and meticulous thinking, one will naturally grasp the essence of diagnosis. Now, let us clearly expound its essentials.
[Commentary by Xu Rongzhai]: Hu Anbang from Siming had an experiential insight regarding pulse palpation and tongue examination. His view is as follows: "Various pulses and tongues in diagnosis merely establish a general framework. Once we roughly understand which disease each pulse and tongue indicates, we should then seek their systematic connections. For example: a white and greasy tongue coating indicates exterior cold; yellow indicates transformation into heat and gradual entry into the interior; dry yellow indicates excessive internal heat; dry black indicates extreme heat with exhaustion of fluids. Similarly, a pale red tongue body is the normal color; bright red indicates heat; deep red indicates deeper heat; crimson indicates severe heat; purple indicates extreme heat. This is the first point. One must also distinguish between similar and distinct conditions: for instance, a slow pulse that is not smooth is a Choppy pulse (Se Mai); if it has intermittent pauses, it is a Knotted pulse (Jie Mai); floating, large, and soft indicates Deficiency (Xu). Again, a rapid pulse that is wiry and urgent is a Tight pulse (Jin Mai); if smooth, it is a Slippery pulse (Hua Mai); if it has intermittent pauses, it is a Rapid-intermittent pulse (Cu Mai); if it comes like a bean grain, it is a Pulsating pulse (Dong Mai); if it comes excessively fast beyond the limit, it is a Hasty pulse (Ji Mai). This is the second point. If the former is understood, daily observation of pulse and tongue can reveal the severity of disease progression; if the latter is understood, observing pulse and tongue during consultation can reveal hidden versus prominent aspects of the condition. As for initial consultation, where finger sensations are vague and tongue coatings change unpredictably, making definitive judgments is difficult; the only method is to inquire carefully beforehand, listen to the patient's account, and verify it with pulse and tongue signs, thereby naturally hitting the key points. Thus, the *Neijing* states: 'Combine three and five [methods] to decide life and death.' It also says: 'Combining complexion and pulse ensures perfection.' This does not mean that obtaining fragmented information suffices for all diagnostic tasks. For example, if a patient complains of coughing, and the pulse is floating with a white coating, it is Wind-Cold (Feng Han); if the pulse is rapid with a yellow coating, it is Dry-Heat (Zao Re); if the pulse is fine and rapid with a red tongue body, it is Yin Deficiency (Yin Xu); if the pulse is soggy and slippery with a thick greasy coating, it is Phlegm-Dampness (Tan Shi). Consequently, methods such as dispersing, clearing, nourishing Yin, and warming transformation are all appropriate." Such examples help elevate understanding from perceptual cognition to rational cognition.