Library

Whenever one wishes to palpate the pulse, one must first regulate one's own breath, press to obtain the patient's pulse information, and observe whether it is slow or rapid, excessive or insufficient. This is referred to as "using my medical approach to address the patient," where wisdom and spirit converge, so that no one dares to violate this principle.

In all pulse diagnoses, one must first understand the terms "pulse" (Mai) and "breath/respiration" (Xi). Pulse refers to the movement of blood; breath refers to the movement of Qi. The pulse does not move on its own but is driven by Qi. As stated, a long pulse indicates regulated Qi, while a short pulse indicates diseased Qi.

In all examinations, one must recognize the Renying (Human Welcome) and Qikou (Qi Mouth) pulses to distinguish between external and internal causes. If the pulse does not correspond with Renying and Qikou, it belongs to the non-internal-non-external cause. This is known as "the one-fen point before the Guan (Cun-Guan-Chi position), which is the master of human life."

In all examinations, one must first recognize the original pulses of the Five Zang organs and Six Jing meridians before recognizing pathological pulses. When the yearly influence harms the Zang organs and climatic conditions transmit in reverse, Yin and Yang have their times, corresponding with the pulse changes; this is what is meant.

In all examinations, one must identify the names and forms of the twenty-four pulse types and ensure they correspond with the one-fen point before the Guan; deducing symptoms must correspond with the patient's condition to avoid errors, thereby enabling treatment based on the root cause.

The Classic states: "Usually, at dawn (Pingdan), when Yin Qi has not yet stirred, Yang Qi has not yet dispersed, food and drink have not been taken, the Jing Mai are not yet full, and the Luo Mai are harmonious and even, only then can one diagnose abnormal pulses." If there has been physical exertion, one should pause and rest for a moment until calm before diagnosing; the physician should also follow this rule.

Explanation: Pausing and waiting for calmness means not being strictly bound to the time of dawn. Moreover, if illness arises suddenly, why wait for dawn? Students should be aware of this.

The Classic states: "By palpating the dynamic stillness of the pulse, observing the clarity of the eyes, examining the five colors, observing the excess and deficiency of the Five Zang organs, the strength and weakness of the Six Fu organs, and the flourishing and declining state of the body, one can determine the division between life and death."

Explanation: Palpating the dynamic stillness of the pulse relies on the fact that the pulse tide converges at the Cun Kou (Radial Artery). In the three-position diagnosis, the one-fen point before the left Guan corresponds to Renying, used to monitor the Six Exogenous Pathogens (Liu Yin), representing the external cause; the one-fen point before the right Guan corresponds to Qikou, used to monitor the Seven Emotional Factors (Qi Qing), representing the internal cause; tracing the origin contrary to the classics represents the non-internal-non-external cause. Although the Three Causes are distinguished, this is not yet complete. Therefore, ancient sages categorized them into twenty-four pulse characters, known as Seven Superficial (Qi Biao), Eight Interior (Ba Li), and Nine Pathological (Jiu Dao). The Seven Superficial are: Floating (Fu), Knotted/Empty (Kou), Slippery (Hua), Full/Solid (Shi), Taut/String-like (Xian), Tight (Jin), and Surging (Hong). The Eight Interior are: Fine/Micro (Wei), Deep (Chen), Slow (Huan), Rough/Astringent (Se), Delayed (Chi), Hidden (Fu), Soft (Ru), and Weak (Ruo). The Nine Pathological are: Thin (Xi), Rapid (Shu), Agitated (Dong), Deficient (Xu), Hasty (Cu), Knotted (Jie), Intermittent (Dai), Leather (Ge), and Scattered (San). Although names and forms differ and symptoms vary, all are deduced through the Renying and Qikou one-fen points and correspond with the three positions to explain symptoms. Thus, the *Pulse Eulogy* states: "The one-fen point before the Guan is the master of human life; the left is Renying, the right is Qikou; Shenmen determines judgment, located on both sides behind the Guan." Han dynasty theories also state: "A tight and surging Renying indicates injury by Cold." By deduction, a floating and surging Renying indicates injury by Wind; weak, deep, and thin indicates Summerheat-Dampness; these are all external causes. Joy makes the pulse scatter, anger makes it agitated, worry makes it astringent, thought makes it knotted, grief makes it tight, fear makes it deep, and shock makes it agitated; these are all internal causes. By seeing which position the pulse corresponds to, one knows which meridian and Zang organ are diseased, thus not missing the disease mechanism. Regarding the meaning and state of superficial-interior diagnosis, see below. However, the Classic states that the pulse is the residence of blood; a long pulse indicates regulated Qi, a short pulse indicates diseased Qi, a rapid pulse indicates vexation in the heart, and a large pulse indicates disease progression. Although the literary style is elegant, the principles are hard to find. Descriptions of movement and stillness vary from broad to concise. Broadly speaking, the twenty-four pulse characters leave no detail unexamined; concisely speaking, Floating, Deep, Delayed, and Rapid summarize the guidelines. Thus, we know that Floating indicates Wind and Deficiency; Deep indicates Dampness and Excess; Delayed indicates Cold and Chilling; Rapid indicates Heat and Dryness. Wind, Dampness, Cold, and Heat belong to the external; Deficiency, Excess, Cold, and Dryness belong to the internal. Once external and internal are distinguished, the Three Causes become clear. Students should study carefully and not shy away from complexity.

What the Classic means by "observing the clarity of the eyes" is that the bright essence of the Five Zang organs gathers in the eyes. When essence is complete, the eyes are bright; when spirit is settled, vision is clear. If vision is unclear, the bright essence is ruined. Fixed gaze upward or dizziness and dimness can all be discussed alongside pulse analysis.

What is meant by "examining the five colors" is observing the brilliance of Qi. Red should resemble white silk wrapping cinnabar, not ochre; white should resemble the luster of a white jade disc, not chalk; green/blue should resemble the luster of dark jade, not indigo; yellow should resemble raw realgar wrapped in silk, not loess soil; black should resemble the heavy gloss of lacquer, not charcoal. If the five colors lose their essence, longevity will not be long.

What is meant by "observing the excess and deficiency of the Five Zang organs" is monitoring through the five sounds. The five sounds are the voices of the Zang organs, the guardians of the interior. When the interior is abundant, Qi is strong; when the interior is depleted, Qi is weak. Therefore, a voice sounding like it comes from within a room indicates stagnant Qi; speaking faintly and only speaking once a day indicates Qi depletion; delirious speech without regard for good or evil indicates chaos of the Spirit (Shen); fragmented speech lacking continuity indicates loss of Yin-Yang balance. Thus, it is said: those who retain balance live, those who lose balance die.

What is meant by "the strength and weakness of the Six Fu organs" is monitored by observing the flourishing and declining state of the body. The head is the residence of bright essence; a drooping head and sunken eyes indicate depleted spirit; the back is the residence of the chest; a curved back and drooping shoulders indicate the residence is failing; the waist is the residence of the Kidneys; inability to turn and sway indicates impending Kidney exhaustion; the knees are the residence of the sinews; inability to flex and extend indicates impending sinew exhaustion; the bones are the residence of the marrow; trembling while walking indicates impending bone exhaustion. Inability to store grain indicates unstable intestines and stomachs; continuous leakage of urine indicates the Bladder's failure to store. Retaining strength leads to life; losing strength leads to death. These symptoms are essential gates for physicians; they are difficult to clarify through pulse alone but easy to distinguish through symptoms. Therefore, the sages and wise ones have thoroughly discussed and taught these; students should understand them comprehensively and not neglect them.