Library

Human life depends on the smooth flow of blood and qi (vital energy), which circulate throughout the body; when the pulse is harmonious, various diseases do not arise. If blood and qi become rebellious, movement becomes sluggish, the pulse becomes chaotic, and a hundred illnesses are born. However, the subtleties of the pulse are clear in the mind but difficult to discern under the fingers; thus, Wang Shuhe of the Western Jin Dynasty also felt deep concern about this. During pulse diagnosis, one must clarify the spirit and calm the thoughts, using the count of breaths to determine the patient's pulse condition. Each hand has three positions, divided into Cun (Inch), Guan (Bar), and Chi (Cubit). The left three positions correspond to the Heart, Liver, and Kidney as Zang organs (solid organs), and the Small Intestine, Gallbladder, and Bladder as Fu organs (hollow organs); the right three positions correspond to the Lung, Spleen, and Mingmen (Gate of Vitality) as Zang organs, and the Large Intestine, Stomach, and Sanjiao (Triple Burner) as Fu organs. Each position is examined by light palpation (superficial), then moderate pressure (middle), and finally heavy pressure (deep). Superficial palpation diagnoses the Fu organs, revealing their prosperity or decline; deep palpation diagnoses the Zang organs, revealing their life/death status and fullness/emptiness; middle palpation diagnoses the Stomach Qi (digestive vitality). Since the Stomach is the sea of water and grain, and humans rely on food for life, presence of Stomach Qi means life, absence means death. Each of the three positions has three depths, totaling nine examinations, known as the "Nine Palpations" (Jiu Hou). Additionally, there are Seven Exterior pulses, Eight Interior pulses, Nine Dao pulses, and pulses caused by wind, cold, summerheat, and dampness pathogenic factors, as well as those caused by seven emotions, deficiency, and cold-heat imbalances, which should be analyzed separately.

The Seven Exterior pulses belong to Yang: Floating (Fu), Knotted/Hollow (Kou), Slippery (Hua), Full/Solid (Shi), Bowstring (Xian), Tight (Jin), and Surging (Hong). Floating feels like pressing on a scallion leaf (hollow center), Kou is hollow in the middle with solid edges, Hua resembles rolling pearls, Shi is strong and forceful, Xian is taut like a zither string, Jin is tense like a bowstring, and Hong feels extremely large upon lifting the finger. The Eight Interior pulses belong to Yin: Fine/Micro (Wei), Deep (Chen), Moderate/Slow (Huan), Rough (Se), Slow (Chi), Hidden (Fu), Soft (Ru), and Weak (Ruo). Wei feels thin as a silk thread under the finger, Chen feels like rotten cotton requiring heavy pressure to reach the bone, Huan comes and goes neither fast nor slow, Se is rough like a knife scraping bamboo, Chi is faintly perceptible, Fu is hidden beneath the bone requiring heavy pressure, Ru appears timid near the finger surface, and Ruo lacks strength in both arrival and departure. The Nine Dao pulses include Long (Chang), Short (Duan), Deficient (Xu), Rapid/Interrupted (Cu), Knotted/Knotting (Jie), Intermittent (Dai), Firm (Lao), Moving (Dong), and Thready/Fine (Xi). Chang and Cu belong to Yang; Duan, Xu, Jie, Dai, Lao, Dong, and Xi belong to Yin. Chang spans all three positions, Cu is extremely rapid upon searching, Duan does not reach its proper position upon pressing, Xu feels insufficient upon searching but excessive upon lifting, Jie gathers under the finger and then returns, Dai has an interruption during beating and resumes after a long pause (difficult to treat if seen in acute conditions, but no worry if due to rebellious Qi), Lao is fixed and immovable (if seen in all three positions, it is a sign of death), Dong stays in place upon repeated searching, and Xi is fine as silk and extremely subtle in movement. These twenty-four pulses, when distinguished carefully, can be summarized into four basic types: Floating, Deep, Slow, and Rapid.

Regarding Cold Damage (Shanghan), cold congeals blood, resulting in a Tight pulse. If Cold Damage is complicated by wind, the pulse is Floating and Moderate. In Lianggan disease (simultaneous involvement of exterior and interior meridians), a Deep and Large pulse indicates Taiyang and Shaoyin involvement; Deep and Long indicates Yangming and Taiyin; Deep and Bowstring indicates Shaoyang and Jueyin. Yang diseases presenting with Deep, Rough, Weak, Bowstring, or Micro pulses indicate death; Yin diseases presenting with Floating, Large, Rapid, Moving, or Slippery pulses indicate survival. Yang Toxic disease presents with extremely Floating and Surging pulses; Yin Toxic disease pulses are only palpable deep against the bone and disappear upon light pressure. Both Yin and Yang Jue (cold extremities) present with Deep pulses, causing confusion. Yin Jue pulse is Deep, Slow, and Weak; Yang Jue pulse is Deep, Hidden, and Slippery. Fever with diarrhea: Deep and Bowstring pulse indicates tenesmus; Large pulse indicates the disease has not stopped; Micro and Weak pulse indicates spontaneous recovery; even with fever, death is unlikely. Cold invasion pulse is also Tight, but combined with Bowstring in the Liver, Surging in the Heart, Deep in the Spleen, Slow and Rough in the Lung, and Deep and Slippery in the Kidney. Wind injury disperses Qi, resulting in a Floating pulse; if complicated by cold, it becomes Floating and Tight. Stroke (Zhong Feng) pulse is also Floating. Pathogens affecting the five Zang organs present pulses similar to cold invasion; generally, Slow and Floating pulses are auspicious, while Full, Large, Bowstring, and Rapid pulses are difficult to treat. Summerheat injury dissipates blood and Qi, resulting in a Weak and powerless pulse; heatstroke results in weak Yang and deficient Yin, with a Micro, Slow pulse resembling Kou. Dampness injury presents with Soft and Weak pulses; if Deep and Fine, it indicates internal dampness.

Seven emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright): Joy causes Scattered pulse, Anger causes Rapid/Interrupted pulse, Sorrow causes Knotted pulse, Fear and Thought cause Deep pulses, Worry causes Rough pulse, and Fright causes Trembling pulse; all arise from Qi disturbances. Deficiency and damage present with pulses that are either Floating and Large but powerless, or Deep and Fine but Micro and Weak. Excess Heat presents with significantly Bowstring and Rapid pulses under the finger, or exceptionally Fine and Rapid pulses. Generally, Spring pulses are Bowstring, Summer are Hook (Surging), Autumn are Feather (Floating), and Winter are Stone (Deep). Soft, Weak, and Long is Bowstring; Fast arrival and slow departure is Hook; Light, Empty, and Floating is Feather; Deep, Rough, and Weak is Stone. These are the normal seasonal pulses. Deviations include Excess and Deficiency, Fu and Yi pulses, and Guan and Ge patterns. Excess indicates surplus Qi: Cun pulse is naturally Floating, but if additionally Full and Large, it is Yang Excess; Chi pulse is naturally Deep, but if additionally Full and Large, it is Yin Excess. Deficiency indicates insufficient Qi: Damaged and small upon superficial palpation is Yang Deficiency; damaged and small upon deep palpation is Yin Deficiency. Yi pulse extends from Guan forward to Yuji, called Outer Guan Inner Ge, a Yin invading Yang pulse. Fu pulse extends from Guan backward into Chize, called Inner Guan Outer Ge, a Yang invading Yin pulse. Such patterns indicate mutual overacting of Zang organs and mutual overcoming of seasons; even if asymptomatic, once symptoms appear, death is inevitable and untreatable. It is said that if the three positions are fully traversed and excessively Surging and Large, it indicates wind or phlegm; if Deep and Fine, it is incurable. If the six positions are connected but cannot be felt upon pressing, or are extremely Floating and Micro, death occurs. If repeatedly searched and uninterrupted even at the bone level, longevity is expected. Regarding pulses indicating life and death in various diseases: Qi distension and fullness with Floating and Large pulse is treatable, but Weak and Small is hard to preserve. Dysentery should have Micro and Small pulses, not Large and Surging. Delirium and mania: Full and Large is favorable, Deep and Fine is unfavorable. Xiao Ke (wasting-thirst): Rapid and Large indicates survival, Weak and Small is hard to cure. Water Qi (edema): Floating and Large is suitable, Deep and Fine indicates recurrence after healing. Huo Luan (cholera-like disorder): Floating and Surging is salvageable, Micro and Slow with aphasia and low Qi is hard to recover. Epistaxis and hematemesis: Favorable with Deep and Fine, unfavorable with Floating and Large. Heart and abdominal pain: Should see Deep and Fine, not Floating and Large. Headache: Floating and Slippery is easy to resolve, Short and Rough is not curable. Upper Qi edema: Floating and Slippery brings peace, Micro and Fine is hard to treat. Zhong E (evil invasion): Tight and Fine is easy to treat, Floating and Large is hard to heal. Metal wound bleeding: Weak and Fine is suitable, Full and Large indicates danger. Poisoning: Surging and Large indicates survival, Fine and Micro indicates death.

The Ten Strange Pulses are: Cauldron Boiling (Fu Fei), Fish Swimming (Yu Xiang), Striking Stone (Dan Shi), Untying Rope (Jie Suo), Leaking Roof (Wu Lou), Shrimp Swimming (Xia You), Sparrow Pecking (Que Zhuo), Reclining Knife (Yan Dao), Rolling Bean (Zhuan Dou), and Hemp Rushing (Ma Cu). Fu Fei resembles boiling soup, with no respiratory rhythm, indicating extreme Yang without Yin; morning sighting means evening death, evening sighting means morning death. Yu Xiang floats on the skin surface, indicating extreme Yin, also called Yang collapse, definitely fatal. Dan Shi strikes the finger abruptly, urgent and hard, showing the True Zang pulse of the Kidney meridian; untreatable on Wu-Ji days. Jie Su is scattered and disordered, indicating loss of Qi in Kidney and Mingmen; worsens on Wu-Ji days, untreatable on Chen-Si days. Wu Lou resembles water dripping and splashing, indicating absolute exhaustion of Stomach Qi, Ying, and Wei; critical within 7-8 days. Xia You resembles shrimp swimming on water, disappearing suddenly then reappearing faintly; based on previous rules, conscious patients die in 7 days, comatose in 3 days. Que Zhuo comes three times then stops, like a sparrow pecking; indicates extinction of Spleen Yuan and Grain Qi; conscious patients die in 12 days, comatose in 6-7 days. Yan Dao feels like running a hand along a blade, no advance or retreat, irregular rate, caused by heart blood exhaustion and solitary Wei Qi; untreatable after 4 days. Zhuan Dou rotates like beans, lacking rhythm, indicating empty viscera and dissipated righteous Qi; death is imminent. Ma Cu feels chaotic like hemp seeds, extremely fine and subtle, indicating dried Wei and stagnant Ying blood; mild cases die in 3 days, severe in 1 day.

Furthermore, the 45-interval pulse is discussed, correlating with 24 solar terms and 72 pentads as standards for predicting death. Early Spring Lichun day: 15 beats per stop. Next year, East wind thaws ice, hibernating insects stir, fish rise carrying ice: 40 beats per stop. Fourth year, Orioles sing, eagles transform into doves: e.g., Mid-Spring Jingzhe peach blossoms day, 20 beats per stop. Next year Chunfen, swallows arrive, thunder sounds: 30 beats per stop. Third year Chunfen, first lightning, paulownia blooms: 40 beats per stop. Fourth year Late Spring Qingming, field mice transform into birds, rainbows appear; Guyu, duckweed grows, turtledoves brush feathers, hoopoes descend on mulberry trees. (Following pattern: Early Summer Lixia, mole crickets sing, earthworms emerge, melons grow. Xiaoman, bitter herbs flourish, soft grass dies, wheat harvest arrives. Mid-Summer Mangzhong, mantises appear, cicadas sing, mock orioles fall silent. Xiazhi, deer horns shed, pinellia grows, cicadas sing. Late Summer Xiaoshu, warm winds arrive, crickets dwell in walls, eagles hunt. Dashu, decaying grass transforms to fireflies, soil moist and hot, heavy rains frequent. Early Autumn Liqiu, cool winds arrive, white dew falls, autumn cicadas sing. Chushu, eagles sacrifice birds, heaven and earth begin to solemnize, grains ripen. Mid-Autumn Bai Lu, wild geese arrive, swallows return, birds store food. Qiufen, thunder ceases, insects seal holes, water dries up. Late Autumn Han Lu, wild geese come as guests, sparrows enter big water transforming into clams, chrysanthemums bloom yellow. Shuangjiang, jackals sacrifice animals, plants turn yellow and fall, hibernating insects bow. Early Winter Lidong, water begins to freeze, ground begins to frost, pheasants enter big water transforming into shells. Xiaoxue, rainbows hide, heaven Qi rises, earth Qi descends, closure forms winter. Mid-Winter Daxue, shrews cease singing, licorice shoots emerge, tigers mate. Dongzhi, earthworms knot, elk horns shed, spring waters move. Late Winter Xiaohan, wild geese fly north, magpies start nests. Pheasants call. Dahan, chickens lay eggs, raptors strike fiercely. Ice thickens in water centers.) Pulse patterns of seasonal epidemics have no fixed basis; they must be assessed according to the time, and should not be lightly judged. To know calamitous harm, Heart pulse is Empty and Scattered, Liver pulse is Surging and Excessive, or Floating/Deep/Long/Short/Large/Small are indefinite, or mixed and chaotic; special attention is required. All these pulses, though my humble opinion dares not omit any, whether favorable or unfavorable, still require detailed examination and adaptation; without rigidity but with flexibility, they can be mastered.