Library

Luo Dongyi stated: Liu Shouzhen once wrote "Mai Yuan" (Origin of Pulse), asserting that the movement of the pulse is analogous to the circulation of the Five Zang organs and the Four Seasons. However, he failed to realize that the "Nei Jing" (Inner Canon) had already elaborated on this in great detail. Furthermore, the fundamental cause of the pulse's generation remained unexplored.

The pulse is the manifestation of human spirit and the root of Qi and Blood, appearing through the movement of Ying (Nutrient) Qi. The origin of Ying Qi's movement lies in two aspects: First, it arises from the grain spirit (Gu Shen) in the Middle Jiao, which transforms into essence and fluid and transports them to the Lung. The Lung governs regulation and distributes these substances via the collaterals; thus, the smooth flow of Ying Blood actually relies on the sufficiency and penetration of Stomach Qi. This illustrates that the pulse is rooted in Stomach Qi. Second, it originates at Taichong (LR3), emerges from the Shaoyin Kidney channel, gathers downward into the Sea of Blood (Jueyin Liver channel), and ascends to stimulate True Yang to the Taiyang channel. The essence and Qi of Taichong can irrigate the Twelve Channels, all relying on the vigorous Qi of the Yangming Stomach residing in the Middle Jiao. Together, they form Zong (Gathering) Qi, moving with Ying Qi through the Twelve Channels to complete fifty cycles. Therefore, when the pulse completes fifty cycles, Pre-Heaven (Innate) Qi and Post-Heaven (Acquired) Qi combine, and the true Qi of the Five Zang organs becomes complete. It then ascends to the Lung, which directs its flow, converging at Taiyuan (LU9). Hence it is said: "The Qi Kou (Radial Artery at the wrist) forms the cun position, determining life and death." The determination of life and death depends on the fact that the Qi Kou reveals Stomach Qi, reflects the true state of the Zang organs, predicts seasonal changes, and measures the six positions. What exists internally must manifest externally without error; this is why the pulse serves as the spirit of man.

The "Nei Jing" discusses pulse diagnosis starting from the lower body, tracing back to the hypochondrium, and sequentially defining the positions. From Quchi (LI11) in the elbow to Shenmen (HT7), a distance of one chi constitutes the "Chi" (Cubit) section. From Chi to Cun (Inch), a distance of one cun constitutes the "Cun" section. Diagnosis begins with Chi before Cun, and Yin before Yang, because human Yin and Yang Qi both originate from the soles of the feet, and the Qi of the Five Zang organs converges at Zhangmen (LR13). Zhangmen is located next to the hypochondrium, where the pulse rises from the Three Yin channels and the Foot Yangming channels ascend to meet. Thus, the "Nei Jing" instructs that pulse diagnosis must proceed from bottom to top.

However, the subtlety of diagnosis involves two aspects of prediction: In one respiration cycle, the pulse moves three cun; in another, three cun; total six cun per breath cycle. Flowing continuously without interruption over six hours of day and night, it completes fifty Ying cycles. This is prediction based on continuous flow. Fifty movements without an intermittent pause (Dai Mai) indicate the supreme harmony (Taihe) of life; fewer than this indicates organ deficiency of Qi, termed "Kuang Sheng" (abnormal life state). The method of observation is: left hand for the left side, right hand for the right side, upper for upper, lower for lower, anterior for anterior, posterior for posterior. With the six positions fixed, observation remains steady, using the Five Zang as the basis for prediction. This is prediction based on anatomical position.

Investigating the principle, the Lung commands Primary Qi and assists the Heart and Blood vessels. It not only meets the hundred vessels but also reveals them. Although the pulse relies on the Lung for fullness, the reason for this fullness lies in the deep accumulation of the Lung Spirit and True Qi. Within this accumulation, there are stationary and moving elements, providing a stable ground for diagnosis, rather than mere transient flow. Ultimately, the Primordial Spirit illuminates the hundred vessels like a mirror for the Five Zang, revealing purity or defect. Thus, the single vessel at Taiyuan reveals the entire state of the Five Zang. Consequently, the upper/lower and left/right can be predicted, and the six positions diagnosed.

Human Yin and Yang must follow Heaven and respond to the Four Seasons. Thus, Spring pulses are wiry (Xian), Summer hooked (Gou), Autumn floating/hairy (Mao), and Winter stone-like (Shi). Although each of the six pulses governs a specific organ, they must obey the command of the season. This is due to the unity of Heaven and Man, hence human Qi adheres to this law.

Furthermore, individuals have their own baseline pulse diagnosis. Differences in Yin-Yang endowment, Qi dynamics, and physical form result in different pulses, such as Six Yin/Six Yang patterns, or variations due to age, obesity, and thinness. A skilled practitioner first examines the root, then observes Stomach Qi, notes the normal state of Zang True Qi across seasons, distinguishes between young/old baselines, and only then addresses pathological pulses. Combining this with Observation, Auscultation/Olfaction, and Inquiry constitutes the Seven Diagnoses, mastering the Dao of the pulse.

Currently, people refer to the left hand pulse as Renying (Human Welcome), originating from the "Nan Jing" and adopted by Wang Shuhe. They do not know that Renying is the source point of the Yangming Stomach channel, located at the arterial pulse beside the Adam's apple. This is where the Six Yang channels converge, and ancients used it to observe the Yang of the Six Fu organs. Using the Cun Kou (Radial artery) on the right to observe this would not be observing Renying. Additionally, there is Duyang (Foot Yangming), an arterial point between the foot dorsum and three cun down, where the Stomach pulse descends and ascends again, merging with the Taichong pulse. Here, Pre-Heaven and Post-Heaven Qi combine, forming the root of life and the most critical site for diagnosing life and death. Therefore, Zhang Zhongjing's method involved simultaneous diagnosis of Duyang and Shaoyin pulses to determine various diseases. Modern neglect of this practice is what Zhang Zhongjing criticized as the work of incompetent physicians who "palpate the hands but fail to reach the feet."

Qibo stated: One exhalation causes two pulse beats, one inhalation causes two beats. Between the end of exhalation and inhalation, there are five beats. Occasionally supplemented by a deep sigh, this is called a "Ping Ren" (Normal Person). A Normal Person is disease-free. If one exhalation causes one beat and one inhalation one beat, it is called "Shao Qi" (Deficient Qi). If one exhalation causes three beats and one inhalation three beats, accompanied by restlessness, heat in the Chi area indicates Warm Disease; no heat with slippery pulse indicates Wind Disease; choppy pulse indicates Bi Syndrome. If one inhalation causes four or more beats, it indicates death. Absence of pulse indicates death. Irregular rhythm (fast and slow alternation) indicates death.

Fifty Ying cycles occur in a day and night to nourish the essence of the Five Zang. Failure to reach this number is termed Kuang Sheng. Regarding the fifty cycles, all Five Zang receive Qi. Holding the pulse mouth and counting: fifty movements without a pause mean all Five Zang receive Qi; forty movements with one pause mean one Zang lacks Qi; thirty movements with one pause mean two Zang lack Qi; twenty movements with one pause mean three Zang lack Qi; ten movements with one pause mean four Zang lack Qi; less than ten movements with one pause means all Five Zang lack Qi. Prognosis depends on the beginning and end. Fifty movements without pause is the norm, indicating the lifespan of the Five Zang. Prognosis of short life is indicated by irregular rhythm.

Zhang Jingyue stated: The "Nan Jing" asks: If the pulse stops after fewer than fifty movements, indicating one Zang lacks Qi, which Zang is it? The answer is: Inhalation follows Yin inward, exhalation follows Yang outward. If inhalation cannot reach the Kidney but returns at the Liver, it indicates that the Kidney Qi is exhausted first. Thus, harmonious Five Zang yield long Qi/pulse; diseased Five Zang yield short Qi/pulse. Observing this, if one Zang lacks Qi, it must involve the Kidney first. For two, three, four, or five Zang lacking Qi, the progression should be from distal to proximal, becoming progressively shorter: Kidney to Liver, Liver to Spleen, Spleen to Heart, Heart to Lung. Therefore, in critical illness, rapid breathing resembling asthma, confined to a few inches in the chest, indicates True Yin exhaustion below and Floating Lone Yang above—the extreme of short Qi. At this stage, any attempt to balance the condition will inevitably lead to death. Life and death depend on Qi; Qi aggregation and dispersion depend on Yin; survival relies on a thread of unextinguished Qi. Thus, Zang Qi must be carefully examined.

He further stated: The meaning of Dai Mai (Intermittent Pulse) since Zhang Zhongjing and Wang Shuhe has been described as a pulse that stops during movement, cannot return spontaneously, resumes, stops again, and after searching for a long time, rises weakly. Thus, later generations grouped Jie (Knotted), Cu (Rapid-intermittent), and Dai together as "stopping pulses," but this does not exhaust their meanings. Slow pulse with one stop is Jie; rapid pulse with one stop is Cu. The stops may vary (every 3rd, 5th, 7th, or 8th beat). These have clear rhythms and forceful starts/stops. Causes include Qi rebellion and phlegm obstruction, Qi and Blood collapse leading to discontinuity, or innate sluggishness of the pulse channel. These define Jie and Cu.

However, Dai Mai is different. "Xuan Ming Wu Qi Lun" states the Spleen pulse is Dai; "Zang Fu Bing Xing Pian" states yellow complexion corresponds to Dai pulse. Both refer to the normal fluctuation of Zang Qi, not necessarily a stop. "Ping Ren Qi Xiang Lun" states "Only Dai without Stomach Qi indicates death," referring to the loss of Stomach Qi and appearance of True Zang Qi, not merely a stop. Thus, Dai has multiple meanings. Fifty movements without a pause refers to the numerical regularity mentioned in the text. If the pulse is normally even but suddenly varies in strength, it is a morphological Dai, as described in "Ping Ren Qi Xiang Lun." If the Spleen governs the four seasons and changes accordingly, it is a climatic Dai, as in "Xuan Ming Wu Qi Pian." Any pulse without a fixed pattern that changes frequently is called Dai, but one must observe the variation to understand the condition. The original text only mentions movement and stopping to diagnose Zang Qi deficiency, without explicitly stating a death date. However, Wang Bing's commentary suggests that a slow pulse with one stop (one Zang lacking Qi) leads to death four years later when spring grass grows. This seems unlikely, as living four years with one Zang lacking Qi, or three years with two, defies logic. Practitioners should discern this carefully.