脉阴阳俱紧。至于吐利。其脉独不解。紧去人安。此为欲解。若脉迟。至六七日。不欲食。此
为晚发。水停故也。为未解。食自可者为欲解。
此段又就脉阴阳俱紧申言之。以见脉之宜辨症。正所以证脉也。
病六七日。手足三部脉皆至。大烦。而口噤不能言。其人躁扰者。必欲解也。若脉和。其人大
烦。目重。睑内际黄者。此为欲解。
此段总承上阴阳俱紧三段而申言之。点出手足三部脉。以见不独寸口也。
脉浮而数。浮为风。数为虚。风为热。数为寒。风寒相搏。则洒淅恶寒也。脉浮而滑。浮为阳。
滑为实。阳实相搏。其脉数疾。卫气失度。浮滑之脉数疾。即发热汗出者。此为不治。
此段辨脉之浮数。以明症之轻重不同也。
伤寒。咳逆上气。其脉散者死。其形损故也。
此段结言辨脉之终。故就伤寒推究其所以死也。
师曰。呼吸者。脉之头也。初持脉。来疾去迟。此出疾入迟。名曰内虚外实也。初持脉。来
迟去疾。此出迟入疾。名曰内实外虚也。
此段先明呼吸为脉所自始。
问曰。上工望而知之。中工问而知之。下工脉而知之。顾闻其说。师曰。病家人请。云病患苦
发热。身体疼。病患自卧。师到。诊其脉。沉而迟者。知其瘥也。何以知之。表有病者。脉当浮大。
今脉反沉迟。故知愈也。
此段因脉辨症。
此所谓沉迟。是就初持脉寸口浮取而言。非持之而得沉迟。故为病愈。此等大有关系。故申明
之。
假令病患云。腹内卒痛。病患自坐。师到脉之。浮而大者。知其瘥也。何以知之。若更有病者。脉
当浮而细。今脉浮大。故知愈也。
此段亦是因脉知症。更有病。更即仍字义。非别病也。
师曰。病家人来请。云病患发热烦极。明日师到。病患向壁卧。此热已去也。设令脉不和。
处言已愈。设令向壁卧。闻师到。不惊起而盼视。若三言三止。脉之咽唾者。此诈病也。设令脉自和。
言此病太重。当须服吐下药。针灸数十百处。乃愈。
此段就病患情伪。察识其病之真假。而必以脉为定也。
言须服吐下药。针灸数十百处。以受尽痛苦吓之。彼诈病者惊闻。必不敢见欺。而自吐实情矣。
师持脉。病患欠者。无病也。脉之。呻者。病也。言迟者。风也。摇头言者。里病也。行迟者。
表强也。坐而伏者。气短也。坐而下脚者。腰痛也。里实护腹如怀卵物者。心痛也。
此段就持脉时。病患之声音状貌情态。以辨明何病。亦以佐辨脉察病之法也。
师曰。伏气之病。以意候之。今月之内。欲有伏气。假令旧有伏气。当须伏之。若脉微弱者。
当喉中痛似伤。非喉痹也。病患云。实喉中病。虽尔。今复欲下利。
此段辨明伏气之脉。故虽及症。而不言治法。
冬时感寒。伏藏经中者。为伏气。今月春分。伏寒欲发时也。欲有伏气。为时令言。假令旧有
伏气。诊于人而得之。脉微弱。指少阴也。喉痛如物伤之。而非火邪壅肿之喉痹。此正伏气。久已
变热也。病患果云实喉中痛。辨脉验症。伏气已真矣。虽尔。喉痛为伏气上冲。且必下决作利也。
问曰。人病恐怖者。其脉何状。师曰。脉行如循丝。累累然。其面白脱色。问曰。人不饮。其脉何
类。师曰。脉自涩。唇口干燥也。
问曰。人愧者。其脉何类。师曰。脉浮。面色乍白乍赤。
此段并言三症。皆辨脉而兼望色。以知病之情状也。
问曰。脉有三菽六菽重者。何谓也。师曰。脉者。人以指按之。如三菽之重者。肺气也。如六
菽之重者。心气也。如九菽之重者。脾气也。如十二菽之重者。肝气也。按之至骨者。肾气也。
此段明诊法轻重。以求脉于浅深。而知所属何脏也。
假令下利。寸口关上尺中。悉不见脉。然尺中时一小见。脉再举头者。肾气也。若见损脉来至。
为难治。
此段补叙少阴伏气。由元阳素虚。寒邪久蓄。变成热邪。上冲不透。下趋必利。为危候也。
问曰。脉有相乘。有纵有横。有顺有逆。何也。师曰。水行乘火。金行乘木。名曰纵。火行乘
水。木行乘金。名曰横。水行乘金。火行乘木。名曰逆。金行乘水。木行乘之。名曰顺。
此段就五行生克之理。辨脉之衰旺。乘者为病邪。所乘者为正气也。
问曰。脉有残贼。何谓也。师曰。脉弦、紧、浮、滑、沉、涩。此六者。名为残贼。能为诸脉
作病也。
此段申明病脉。有害于如经之脉。又以些六脉为关要。故举以示人。弦紧者。阴病脉。残贼阳
正脉之柔缓也。浮滑者阳病脉。残贼阴正脉之和缓也。浮而兼滑。大而芤也。沉涩者。亦阴病脉。
残贼阳正脉之流行充畅也。举此六者以概之。然凡病脉。皆能残贼正脉。使之变动而不安其常。
问曰。脉有灾怪。何谓也。师曰。假令人病。脉得太阳。与形症相应。因为作汤。比还送汤。
如食顷。病患乃大吐。若下利。腹中痛。师曰。我前来不见此症。今乃变异。是名灾怪。又问曰。
何缘作此吐利。答曰。或有旧时服药。今乃发作。故名灾怪也。
此段辨脉审症。推究以至于极也。脉得太阳。必用散邪升阳汤剂。旧服药。今发作。必是寒凉
之药。旧存于里。今得治表之汤。寒邪在表。未及驱逐。而寒药在里。先发作而吐泻矣。故曰灾怪。
然寒药中存者。得吐泻可除。即今表邪亦不
治而自散矣。何也。吐上越。必有汗可解也。
问曰。东方肝脉。其形何似。师曰。肝者。木也。名厥阴。其脉微弦。濡弱而长。是肝脉。肝
病自得濡弱者。愈也。假令得纯弦者死。何以知之。以其脉如弦直。是肝脏伤。故知死也。
南方心脉。其形何似。师曰。心者。火也。名少阴。其脉洪大而长。是心脉。心病自得洪大者。
愈。假令脉来微去大。故名反。病在里也。脉来头大本小者。故名覆。病在表也。上微头小者。
则汗出。下微本大者。则为关格不通。不得尿。头无汗者。可治。有汗者死。
西方肺脉。其形何似。师曰。肺者。金也。名太阴。其脉毛。浮也。肺病自得此脉。若得缓迟
者。皆愈。若得数者。则剧。何以知之。数者。南方火。火克西方金。法当痈肿。为难治也。
此三段因五行生克之理。已于前纵横顺逆详言之。今复就辨脉而知脏病。欲人审察之也。但言
三脏者。亦如辨脉篇但言夏令。人当自推及也。
问曰。二月得毛脉。何以遽言至秋当死。师曰。二月之时。脉当濡弱。反得浮者。故知至秋死。
二月肝用事。脉应濡。反得毛浮。是肺脉也。肺属金。金来克木。故知秋死也。他皆仿此。
此段因五脏辨脉。而推及于四时。亦举一以例其余也。
师曰。脉肥人。责浮。脉瘦人。责沉。肥人当沉。今反浮。瘦人当浮。今反沉。故责之。
此段就人形体。辨诊脉之轻重。以定责治之法也。
师曰。寸脉下不至关。为阳绝。尺脉上不至关。为阴绝。此皆不治。决死也。若计其余。有生
死之期。期以月节克之也。
此段承上关格。推言阴阳不顺接。上下不交通。凡病皆可决之于脉也。
师曰。脉病。人不病。名曰行尸。以无王气。卒眩仆不识人者。短命则死。人病。脉不病。名
曰内虚。以无谷神。虽因无苦。
此段因前文辨脉审症。而知所重惟在乎脉。而症不过证其脉也。
问曰。翕、奄、沉。名曰滑。何谓也。沉为纯阴。翕为正阳。阴阳相合。故令脉滑。关尺自平。
阳明脉微沉。食饮自可。少阴脉微滑。滑者。紧之浮名也。此为阴实。其人必股内汗出。阴下湿也。
此段专辨脉之沉。而兼及滑浮紧。正申言脉有残贼一节也。翕与辟对。奄与发对。掩同。脉属
气属阳。阳为阴所翕合而奄掩之。则脉沉也。再重按。形圆顶指。此沉乃流动有力而滑也。
问曰。曾为人所难。紧脉从何而来。师曰。假令亡汗。若吐。以肺里寒。故令脉紧也。假令咳
者。坐饮冷水。故令脉紧也。假令下利。以胃中虚冷。故脉紧也。
此段亦申言残贼脉也。前段论关尺二部之沉滑。于尺中辨阳虚阴实之紧脉。此言寸脉之紧。及
胃中虚冷之紧。皆明三部之阳虚阴实也。
寸口卫气盛。名曰高。荣气盛。名曰章。高章相搏。名曰纲。卫气弱。名曰 。荣气弱。名曰
卑。 卑相搏。名曰损。卫气和。名曰缓。荣气和。名曰迟。迟缓相搏。名曰沉。
此段分三节。辨脉之过不及。与中和之象。而审病机也。曰寸口者。以诸脉总会之首。实该三
部九候而辨之也。
寸口脉缓而迟。缓则阳气长。其色鲜。其颜光。其声商。毛发长。迟则阴气盛。骨髓生。血满。
肌肉紧薄鲜硬。阴阳相抱。荣卫俱行。刚柔相搏。名曰强。
此段紧接上迟缓为沉来。分别出迟缓又可名强也。亦曰寸口者。分以两寸统各三部。其左右六
部悉同等也。趺阳脉滑而紧。滑者。胃气实。紧者。脾气强。持实击强。痛还自伤。以手把刃。坐
作疮也。
此段承上强脉。并前段言阴实。专就脾胃表里。以明脉见强为平脉。亦有时为病脉也。脉贵和
平。胃实脾强。皆为病脉。如持阳实以击阴强。则水火相搏。不相逮者。真相搏矣。然非外敌。乃
自相残伤。如以手把刃。坐而自戕其躯体。以成疮疡也。但言持实击强。不言持强击实。可推其义。
寸口脉浮而大。浮为虚。大为实。在尺为关。在寸为格。关则不得小便。格则吐逆。趺阳脉伏
而涩。伏则吐逆。水谷不化。涩则食不得入。名曰关格。
此段就脉辨出关格之病。却有两种。然皆由阴阳为病。无错杂之邪阻碍。故尚轻于无尿但头汗
出之关格。
脉浮而大。浮为风虚。大为气强。风气相搏。必成瘾疹。身体为痒。痒者名泄风。久久为痂癞。
此段又就浮大脉。辨瘾疹痂癞之症。亦于寸口候表也。
寸口脉弱而迟。弱者。卫气微。迟者。荣气寒。荣为血。血寒则发热。卫为气。气微则心内饥。
饥而虚满。不能食也。
此段亦辨脉论症。总不外阳虚阴实之义。
趺阳脉大而紧者。当即下利。为难治。寸口脉缓而弱。弱者。阳气不足。缓者。胃气有余。噫
而吞酸。食卒不下。气填于胸上也。
此段亦辨脉论症。专以胃之虚实。验病之轻重。而实为阳虚阴实之见端也。
趺阳脉紧而浮。浮为气。紧为寒。浮为腹满。紧为绞痛。浮紧相搏。肠鸣而转。转即气动。膈
气乃下。少阴脉不出。其阴肿大而虚也。
此段就趺阳脉。辨少阴之症。而胃脉亦兼统焉。以趺阳主胃肾二经之脉也。程氏谓肾肿兼有水
蓄。亦是肾阳已衰。无湿不作虚肿也。然此水蓄。必在膀胱。气盛阳足。则自宣泄。不可作湿热治
也。
寸口脉微而涩。微者。卫气不行。涩者。荣气不足。荣卫不能相将。三焦无所仰。身体痹不仁。
荣气不足。则烦疼口难言。卫气虚。则恶寒数欠。三焦不归其部。上焦不归者。噫而吞酢。中焦不
归者。不能消谷引食。下焦不归者。则遗溲。沉而数。沉为实。数消谷。紧者病难治。
此段辨脉。乃就表之荣卫。里之三焦。而得阴阳两亏之脉。虽言寸口。实兼关尺二部。轻重取
之而得也。紧者病难治。以中气空虚之极所致。较浮而涩者更加等也。然皆不为预图之故。不重可
悔恨哉。
寸口脉微而涩。微者。卫气衰。涩者。荣气不足。卫气衰。面色黄。荣气不足。面色青。荣为
根。卫为叶。荣卫俱微。则根叶枯槁。而寒栗。咳逆。唾腥。吐涎沫也。
此段又就寸口脉分辨病情面色。而知阳虚阴实。更兼痰之候。
趺阳脉浮而芤。浮者。卫气衰。芤者。荣气伤。其身体瘦。肌肉甲错。浮芤相搏。宗气衰微。
四属断绝。
此段又就辨脉明荣卫之表气。而趺阳为胃脉。中焦之气出于胃。因可识宗气也。四属。四肢也。
断绝则荣卫不行。不止不足。将为半身不遂等症矣。
寸口脉微而缓。微者。卫气疏。疏则其肤空。缓者。胃气实。实则谷消而水化也。谷入于胃。
脉道乃行。水入于经。其血乃成。荣盛则其肤必疏。三焦绝经。名曰血崩。
此段因前二段寸口趺阳。候得荣卫俱微。遂专论卫微荣盛之症。亦于脉辨之也。里荣无所统摄。
多入于经者。亦易乱出于经。何也。气有行于荣中者。荣气也。气有护于荣外者。卫气也。卫气既
疏。则里血无力。血易泛滥。不由经道而下崩。此乃三焦经绝也。
趺阳脉微而紧。紧则为寒。微则为虚。微紧相搏。则为短气。少阴脉弱而涩。弱者。微烦。涩
者。厥逆。趺阳脉不出。脾不上下。
身冷肤硬。
此段又就脉辨得阳虚阴实之一症。余可类推。
少阴脉不至。肾气微。少精血。奔气促迫。上入胸膈。宗气反聚。血结心下。阳气退下。热归
阴股。与阴相动。令身不仁。此为尸厥。当刺期门巨阙。
此段就上趺阳脉不出。推出少阴脉。以趺阳主肾。故可明肾虚主症也。
寸口脉微迟。尺脉紧。其人虚损多汗。知阴常在。绝不见阳也。寸口诸微亡阳。诸濡亡血。诸
弱发热。诸紧为寒。诸乘寒者则为厥。郁冒不仁。以胃无谷气。脾涩不通。口紧不能言。战而栗也。
此段又就脉申言阳虚阴实之病。更推类以结之也。
The pulse is tight at both Yin (Chi) and Yang (Cun/Guan) positions. When accompanied by vomiting and diarrhea, if the pulse remains tight and does not resolve, it indicates the pathogen has not been expelled; if the tightness disappears and the patient feels comfortable, this signifies that recovery is imminent. If the pulse is slow, and by the sixth or seventh day the patient loses their appetite, this is termed "late onset" (Wan Fa), caused by water retention in the body, indicating the disease is unresolved. If the patient's appetite remains normal, it indicates impending recovery.
This section elaborates on the "tight pulse at both Yin and Yang positions," illustrating that pulses should be differentiated according to symptoms, which serves to verify the pulse through clinical manifestations.
After six or seven days of illness, when pulses can be felt in the hand and foot三部 (Sanbu - three positions), and the patient experiences extreme restlessness, jaw stiffness preventing speech, and agitation, this indicates that the righteous Qi is fighting the pathogen and recovery is imminent. If the pulse is harmonious, and although the patient is extremely restless, the inner aspect of the eyelids appears yellow, this also indicates impending recovery.
This section summarizes the previous three paragraphs regarding the "tight pulse at both Yin and Yang positions" and elaborates on them, highlighting the observation of pulses in the hand and foot Sanbu to demonstrate that pulse diagnosis is not limited solely to the Cun Kou (radial artery).
The pulse is floating and rapid. Floating indicates Wind; Rapid indicates Deficiency. Wind pathogens typically manifest as Heat, while a Rapid pulse can also indicate Cold (in specific contexts of wind-cold interaction). When Wind and Cold pathogens contend with each other, the patient experiences chills and shivering (Sha Xi). The pulse is floating and slippery. Floating is a Yang pulse; Slippery indicates Excess. When Yang and Excess pathogens contend, the pulse becomes rapid and hurried, and the Wei Qi (Defensive Qi) loses its regulatory balance. If a floating-slippery pulse becomes rapid and hurried, accompanied by fever and sweating, this is considered untreatable (or difficult to treat).
This section differentiates the severity of symptoms by analyzing floating-rapid and floating-slippery pulses.
In Shang Han (Cold Damage) disease, if there is coughing and rebellious Qi rising upwards, and the pulse is scattered and rootless, death will ensue because the physical essence and Qi are depleted.
This section concludes the chapter on pulse differentiation by investigating the mechanisms leading to death in Shang Han diseases.
The Master said: Respiration is the origin of the pulse. Upon initially palpating the pulse, if the arrival is rapid and the departure is slow, this is called "rapid exit and slow entry," named Interior Deficiency and Exterior Excess. Upon initially palpating the pulse, if the arrival is slow and the departure is rapid, this is called "slow exit and rapid entry," named Interior Excess and Exterior Deficiency.
This section first clarifies that respiration is the starting point for pulse generation.
Question: An expert physician knows the disease through observation, an average physician through inquiry, and a poor physician through pulse diagnosis. I have heard this statement. The Master said: The patient's family requests treatment, stating the patient suffers from fever and body pain, and lies down quietly. When the physician arrives and palpates the pulse, finding it deep and slow, one knows the patient will recover. Why? Because when exterior pathogens exist, the pulse should be floating and large. Now that the pulse is instead deep and slow, we know the disease is resolving.
This section uses pulse diagnosis to differentiate symptoms.
The "deep and slow" mentioned here refers to the superficial palpation at the Cun Kou position initially, not the result of heavy pressure; thus, it indicates recovery. This distinction is crucial and therefore clarified.
Suppose the patient says they have sudden abdominal pain and sits quietly. When the physician arrives and palpates the pulse, finding it floating and large, one knows the patient will recover. Why? If pathology still existed, the pulse would be floating and thin. Now that it is floating and large, we know the disease is resolving.
This section also uses pulse to understand symptoms. "Geng you bing" (still having disease) implies "still," not a different disease.
The Master said: The patient's family requests treatment, stating the patient is extremely feverish and irritable. The next day, when the physician arrives, the patient lies facing the wall, indicating the heat has subsided. Even if the pulse is not perfectly harmonious, the physician may say the disease has resolved. However, if the patient lies facing the wall but, upon hearing the physician's arrival, does not startle up but instead glances sideways, speaks hesitantly (three words then stopping), and swallows saliva during pulse taking, this is feigned illness. Even if the pulse is naturally harmonious, the physician should say the disease is severe and requires emetic or purgative medicines, and acupuncture at dozens or hundreds of points, before recovery.
This section identifies the authenticity of the disease by observing the patient's behavioral discrepancies, using the pulse as the definitive criterion.
Prescribing emetics/purgatives and extensive acupuncture is intended to intimidate the feigner with the prospect of suffering, causing them to confess the truth out of fear.
When the physician palpates the pulse, if the patient yawns, there is no disease. If the patient groans during palpation, there is disease. If speech is sluggish, it is Feng (Wind/stroke). If the patient shakes their head while speaking, there is interior disease. If walking is slow, the exterior is stiff. If sitting with the body bent forward, there is shortness of breath. If sitting with legs extended, there is lower back pain. If protecting the abdomen like holding an egg due to interior excess, there is heart pain.
This section differentiates diseases based on the patient's sounds, postures, and behaviors during pulse taking, serving as an auxiliary method for pulse diagnosis.
The Master said: For Bing Fu Qi (latent pathogenic Qi), one must discern it mentally. If within the current month latent Qi is about to manifest, or if there is pre-existing latent Qi, it must be managed. If the pulse is weak and thready, the patient may experience throat pain resembling injury, but this is not Hou Bi (sore throat with swelling/ulceration). The patient claims true throat pain. Although so, diarrhea is likely to follow.
This section differentiates the pulse of latent Qi; thus, while symptoms are mentioned, treatment methods are not discussed.
Cold contracted in winter and hidden in the meridians is called Fu Qi. At the Spring Equinox, this latent cold is ready to emerge. "Desire for latent Qi" refers to the seasonal timing. If pre-existing latent Qi is diagnosed, and the pulse is weak/thready (indicating Shao Yin meridian involvement), the throat hurts as if injured, distinct from fire-toxin obstructed Hou Bi. This is indeed latent Qi that has transformed into heat over time. The patient's throat pain confirms latent Qi via pulse and symptom verification. However, since the throat pain results from latent Qi rushing upward, it will inevitably lead downward causing diarrhea.
Question: What is the pulse shape in cases of fear/terror? The Master said: The pulse moves like tracing a thread, continuous and small, and the face is pale. Question: What is the pulse in those who do not drink water? The Master said: The pulse is naturally choppy (Se), and the lips and mouth are dry.
Question: What is the pulse in cases of shame/blushing? The Master said: The pulse is floating, and the complexion alternates between white and red.
This section discusses three conditions, combining pulse differentiation with inspection of the complexion to understand the disease state.
Question: What is meant by the varying degrees of pressure in pulse taking, such as "three beans" or "six beans"? The Master said: When pressing the pulse with fingers: pressure equivalent to three beans corresponds to Lung Qi; six beans to Heart Qi; nine beans to Spleen Qi; twelve beans to Liver Qi; pressing to the bone corresponds to Kidney Qi.
This section clarifies the depth of pressure in diagnosis to locate the pulse and identify the associated Zang organ.
Suppose there is diarrhea, and no pulse is felt at Cun, Guan, or Chi positions. However, if the Chi position occasionally shows a slight beat, with the pulse rising twice, this indicates remaining Kidney Qi. If a deteriorated pulse appears, it is difficult to treat.
This section supplements the discussion on Shao Yin latent Qi, where primordial Yang deficiency allows cold pathogens to accumulate and transform into heat. Unable to rush upward effectively, it rushes downward causing diarrhea, a critical condition.
Question: What are Cheng (overacting), Zong (vertical), Heng (horizontal), Shun (smooth), and Ni (reverse) in pulses? The Master said: Water overacting on Fire, and Metal overacting on Wood, are called Zong. Fire overacting on Water, and Wood overacting on Metal, are called Heng. Water overacting on Metal, and Fire overacting on Wood, are called Ni. Metal overacting on Water, and Wood overacting on [Earth] (text omits object, implied by context of Five Elements), are called Shun.
This section analyzes pulse prosperity and decline based on the Five Elements' generating and controlling cycles. The overacting element is the pathogen; the overacted-upon element is the righteous Qi.
Question: What are Can Zei (harmful/destructive) pulses? The Master said: Xian (Wiry), Jin (Tight), Fu (Floating), Hua (Slippery), Chen (Deep), Se (Choppy). These six are called Can Zei because they can cause pathological changes in other pulses.
This section explains that these pathological pulses harm normal meridians and are highlighted as key indicators. Wiry and Tight are Yin disease pulses that damage the softness of Yang Zheng pulses. Floating and Slippery are Yang disease pulses that damage the harmony of Yin Zheng pulses. Floating combined with Slippery resembles Large and Kong (Hollow). Deep and Choppy are also Yin disease pulses damaging the smooth flow of Yang Zheng pulses. Listing these six covers the general principle: all pathological pulses can damage the regular pulse, causing instability.
Question: What is Zai Guai (disaster/mystery) in pulses? The Master said: Suppose a patient presents with Tai Yang pulse and corresponding symptoms, and a decoction is prescribed. Before the medicine is consumed, suddenly the patient vomits severely or has diarrhea with abdominal pain. The physician says, "I did not see these symptoms earlier; now they have changed. This is called Zai Guai." Asked why this happens, the answer is: Perhaps old medication taken previously is now reacting. Hence, Zai Guai.
This section explores pulse and symptom differentiation to its limits. A Tai Yang pulse requires dispersing and ascending formulas. Previous medication, likely cold-natured, remained internally. When the exterior-dispersing formula is administered, the internal cold medicine reacts first, causing vomiting/diarrhea. Thus, Zai Guai. However, vomiting/diarrhea expels the retained cold medicine, and the exterior pathogen dissipates spontaneously. Vomiting induces sweating, resolving the exterior.
Question: What does the Liver pulse of the East look like? The Master said: The Liver belongs to Wood, named Jue Yin. Its pulse is slightly wiry, soft-weak yet long. This is the Liver pulse. If a Liver disease patient naturally exhibits a soft-weak pulse, they will recover. If a purely wiry pulse is found, death occurs because the pulse is rigid, indicating liver damage.
What does the Heart pulse of the South look like? The Master said: The Heart belongs to Fire, named Shao Yin. Its pulse is Hong Da (Surging and Large) and long. This is the Heart pulse. If a Heart disease patient naturally exhibits a Surging-Large pulse, they will recover. If the pulse comes small and goes large, it is called Fan (Reverse), indicating interior disease. If the pulse head is large and the root is small, it is called Fu (Overturn), indicating exterior disease. If the upper part is small and the head is small, sweating occurs. If the lower part is small and the root is large, it is Guan Ge (Lock and Key) obstruction, preventing urination. If the head does not sweat, it is treatable; if it sweats, it is fatal.
What does the Lung pulse of the West look like? The Master said: The Lung belongs to Metal, named Tai Yin. Its pulse is Mao (Feather-like/Floating). If a Lung disease patient naturally exhibits this pulse, or a Huan Chi (Slow and Moderate) pulse, they will recover. If a Shu (Rapid) pulse is found, the condition worsens. Why? Shu is a Southern Fire pulse; Fire controls Metal. According to principles, abscesses should form, making it difficult to treat.
These three sections reiterate the Five Elements' interactions discussed earlier in Zong/Heng/Shun/Ni. They now use pulse differentiation to identify Zang diseases, urging careful examination. Only three Zang organs are mentioned, similar to mentioning only Summer in the Pulse Differentiation chapter; readers should infer the rest.
Question: In the second lunar month, why does obtaining a Mao pulse (feather-like/floating) predict death in autumn? The Master said: In the second month, the pulse should be Ru Ruo (Soft and Weak). Obtaining a Floating pulse instead predicts death in autumn. The second month is when Liver Qi governs; the pulse should be Soft. Obtaining a Feather-Floating pulse indicates a Lung pulse. Lung is Metal; Metal controls Wood. Hence, death in autumn. Other cases follow this logic.
This section extends five-Zang pulse differentiation to the four seasons, using one example to illustrate others.
The Master said: For obese individuals, investigate Floating pulses; for thin individuals, investigate Deep pulses. Obese people should have Deep pulses; if Floating, investigate the cause. Thin people should have Floating pulses; if Deep, investigate the cause.
This section adjusts palpation pressure based on body type to determine treatment strategies.
The Master said: If the Cun pulse does not extend down to the Guan position, it is Yang Jue (Yang Extinction). If the Chi pulse does not extend up to the Guan position, it is Yin Jue (Yin Extinction). Both are untreatable and fatal. Remaining lifespan can be calculated based on elemental overcoming cycles in months.
This section continues the discussion on Guan Ge, explaining that when Yin and Yang fail to connect and upper/lower energies do not communicate, death can be predicted via pulse.
The Master said: When the pulse indicates disease but the person appears healthy, it is called "Xing Shi" (Walking Corpse) due to lack of Wang Qi (Prosperous Qi). Sudden dizziness and collapse with loss of consciousness indicate short life and death. When the person is diseased but the pulse appears normal, it is called "Nei Xu" (Interior Deficiency) due to lack of Gu Shen (Grain Spirit/Spleen Qi). Although there may be no immediate suffering...
This section emphasizes that after differentiating pulse and symptoms, the pulse is paramount, while symptoms merely verify the pulse.
Question: Xi, Yan, and Chen together are called Hua (Slippery). What does this mean? Chen is pure Yin; Xi is correct Yang. Their combination creates a Slippery pulse. The Guan and Chi positions are balanced. Yang Ming pulse is slightly Chen; digestion is normal. Shao Yin pulse is slightly Hua. Hua is the floating name of Jin (Tight). This indicates Yin Excess. The patient will likely have sweating in the inner thighs and dampness in the genital area.
This section specifically differentiates the Chen pulse, involving Hua, Fu, and Jin, reiterating the concept of destructive pulses. Xi opposes Pi; Yan opposes Fa. "Yan" implies covering. Pulse relates to Qi and Yang. When Yin covers Yang, the pulse becomes Chen. Pressing deeper reveals a round, finger-lifting quality, indicating Chen is flowing, forceful, and Slippery.
Question: Previously challenged, how does the Jin (Tight) pulse arise? The Master said: If there is excessive sweating or vomiting due to cold in the Lungs, the pulse becomes Tight. If coughing results from drinking cold water, the pulse becomes Tight. If diarrhea results from deficiency-cold in the Stomach, the pulse becomes Tight.
This section also discusses destructive pulses. The previous paragraph discussed Chen-Hua in Guan/Chi and Jin in Chi (Yang deficiency/Yin excess). This paragraph discusses Jin in Cun and Stomach deficiency-cold Jin, clarifying Yang deficiency/Yin excess in all three positions.
At Cun Kou, strong Wei Qi is called Gao. Strong Ying Qi is called Zhang. Gao and Zhang contending is called Gang. Weak Wei Qi is called Bei. Weak Ying Qi is called Bei. Bei and Bei contending is called Sun. Harmonious Wei Qi is called Huan. Harmonious Ying Qi is called Chi. Huan and Chi contending is called Chen.
This section divides into three parts to analyze pulse excess/deficiency and harmony, assessing pathogenesis. "Cun Kou" refers to the radial artery, representing the convergence of all pulses, encompassing the three positions and nine locations.
Cun Kou pulse is Huan (Moderate) and Chi (Slow). Huan indicates growing Yang Qi: bright complexion, radiant face, clear voice, long hair. Chi indicates abundant Yin Qi: marrow generation, full blood, firm and thin muscles. Yin and Yang embrace, Ying and Wei circulate together, hardness and softness interact, named Qiang (Strong).
This follows the previous discussion of Huan-Chi forming Chen, distinguishing that Huan-Chi can also be named Qiang. "Cun Kou" here refers to the two Cun positions governing all three positions, with left and right six positions being equal. Fu Yang pulse is Hua (Slippery) and Jin (Tight). Hua indicates Stomach Qi Excess; Jin indicates Spleen Qi Strength. Holding Excess against Strength causes self-injury, like grasping a blade and creating wounds oneself.
This section connects to the previous Qiang pulse and Yin Excess discussion, focusing on the Spleen/Stomach interior/exterior relationship. It clarifies that while a Qiang pulse can be normal, it can also be pathological if Stomach is Excess and Spleen is Strong. Pulses should be harmonious; Stomach Excess and Spleen Strength are pathological. Like Yang Excess attacking Yin Strength, Water and Fire clash. This is self-inflicted harm, like cutting oneself with a blade. The text mentions "holding Excess to strike Strength," implying the danger of internal conflict.
Cun Kou pulse is Fu (Floating) and Da (Large). Fu indicates Deficiency; Da indicates Excess. At Chi, it is Guan (Lock); at Cun, it is Ge (Key). Guan prevents urination; Ge causes vomiting/reversal. Fu Yang pulse is Fu (Hidden) and Se (Choppy). Fu causes vomiting/reversal and indigestion; Se prevents food intake. This is named Guan Ge.
This section identifies Guan Ge disease via pulse, noting two types caused by Yin-Yang pathology without mixed pathogens, thus lighter than Guan Ge with anuria and head-only sweating.
Pulse is Fu and Da. Fu indicates Wind-Deficiency; Da indicates Qi-Strength. Wind and Qi contend, causing urticaria and itching. Itching is named Xie Feng (Leaking Wind); chronic cases become scaly crusts.
This section differentiates urticaria and scaly crusts via Fu-Da pulses, inspecting the exterior at Cun Kou.
Cun Kou pulse is Ruo (Weak) and Chi (Slow). Ruo indicates weak Wei Qi; Chi indicates cold Ying Qi. Ying is Blood; cold blood causes fever. Wei is Qi; weak Qi causes hunger. Hunger with false fullness leads to anorexia.
This section differentiates pulse and symptoms, adhering to the principle of Yang Deficiency and Yin Excess.
Fu Yang pulse is Da and Jin. Da and Jin immediately lead to diarrhea, which is difficult to treat. Cun Kou pulse is Huan and Ruo. Ruo indicates insufficient Yang Qi; Huan indicates excess Stomach Qi. Belching and acid regurgitation occur; food fails to descend, filling the chest and upper jiao.
This section differentiates pulse and symptoms, using Spleen/Stomach deficiency/excess to gauge severity, reflecting Yang Deficiency/Yin Excess.
Fu Yang pulse is Jin and Fu. Fu indicates Qi; Jin indicates Cold. Fu causes abdominal fullness; Jin causes colic. Fu and Jin contend, causing bowel sounds and movement. Movement generates Qi, pushing Diaphragm Qi downward. If Shao Yin pulse is absent, the genitals swell and feel empty.
This section uses Fu Yang pulse to differentiate Shao Yin symptoms, as Fu Yang governs Stomach/Kidney meridians. Cheng's commentary suggests kidney swelling with water retention indicates declining Kidney Yang; dampness causes edema. This water retention is in the Bladder; sufficient Qi and Yang allow natural excretion, so it should not be treated as Damp-Heat.
Cun Kou pulse is Wei (Micro) and Se (Choppy). Wei indicates non-moving Wei Qi; Se indicates insufficient Ying Qi. Ying and Wei cannot support each other; the Three Jiao lacks reliance. The body experiences numbness and bi-syndrome. Insufficient Ying Qi causes irritability, pain, and difficulty speaking. Weak Wei Qi causes aversion to cold and frequent yawning. If the Three Jiao fails to return to its sector: Upper Jiao failure causes belching and acid regurgitation; Middle Jiao failure causes inability to digest food; Lower Jiao failure causes urinary incontinence. Deep and Rapid: Deep indicates Excess; Rapid aids digestion. Tight indicates difficult-to-treat disease.
This section differentiates pulse regarding exterior Ying/Wei and interior Three Jiao, revealing dual Yin-Yang deficiency. Though stated as Cun Kou, it involves Guan/Chi via varying pressure. Tightness indicates difficulty due to extreme middle Qi emptiness, worse than Floating-Choppy. Regret arises from lack of early intervention.
Cun Kou pulse is Wei and Se. Wei indicates declining Wei Qi; Se indicates insufficient Ying Qi. Declining Wei Qi causes yellow complexion; insufficient Ying Qi causes green complexion. Ying is the root; Wei is the leaf. Dual deficiency causes withered roots/leaves, chills, coughing, bloody sputum, and salivation.
This section differentiates condition and complexion via Cun Kou pulse, identifying Yang Deficiency/Yin Excess with phlegm signs.
Fu Yang pulse is Fu and Kou (Hollow). Fu indicates declining Wei Qi; Kou indicates damaged Ying Qi. The body emaciates, skin becomes rough like fish scales. Fu and Kou contend, causing Zong Qi (Gathering Qi) decline and severance of the Four Limbs.
This section clarifies exterior Ying/Wei via pulse. Fu Yang is Stomach pulse; Middle Jiao Qi originates from Stomach, allowing identification of Zong Qi. "Four Limbs" refers to extremities. Severance stops Ying/Wei circulation, potentially leading to hemiplegia.
Cun Kou pulse is Wei and Huan. Wei indicates loose Wei Qi; looseness causes porous skin. Huan indicates solid Stomach Qi; solidity digests grain and transforms water. Grain entering the Stomach activates pulse channels. Water entering meridians forms blood. Abundant Ying Qi makes skin porous; Three Jiao meridians rupture, named Blood Collapse.
This section focuses on Wei Deficiency and Ying Excess symptoms following previous findings of dual deficiency. Internal Ying lacks control, flooding meridians. Qi circulating in Ying is Ying Qi; Qi protecting outside Ying is Wei Qi. Loose Wei Qi fails to contain blood, causing it to flood downwards. This is Three Jiao meridian rupture.
Fu Yang pulse is Wei and Jin. Jin indicates Cold; Wei indicates Deficiency. Wei-Jin contention causes shortness of breath. Shao Yin pulse is Ruo and Se. Ruo causes mild irritability; Se causes cold limbs. Fu Yang pulse absent indicates Spleen failing to ascend/descend, causing cold body and hard skin.
This section identifies another Yang Deficiency/Yin Excess symptom via pulse; others can be inferred.
Shao Yin pulse absent indicates weak Kidney Qi and scant Jing-Blood. Rushing Qi presses upward into the chest/diaphragm. Zong Qi gathers inversely; blood clots below the heart. Yang Qi retreats downward; heat returns to the inner thighs. Interaction with Yin causes bodily numbness. This is Shi Jue (Corpse Fainting). Acupoints Qimen and Juque should be needled.
This section infers Shao Yin pulse from absent Fu Yang pulse, as Fu Yang governs Kidney, clarifying Kidney Deficiency main symptoms.
Cun Kou pulse is Wei and Chi; Chi pulse is Jin. The patient is deficient, wasting, and sweaty. Yin persists; Yang is absent. All Wei pulses at Cun Kou indicate Yang loss; all Ru pulses indicate Blood loss; all Ruo pulses indicate Fever; all Jin pulses indicate Cold. All pulses overcome by Cold lead to Jue (Cold Reversal), depression, dizziness, and numbness. Due to lack of Grain Qi in Stomach and stagnation in Spleen, tight mouth prevents speech, trembling and chattering occur.
This section reiterates Yang Deficiency/Yin Excess via pulse, concluding with categorical examples.