问曰。脉有三部。阴阳相乘。荣卫血气。在人体躬。呼吸出入。上下于中。因息游
布。津液流通。随时动作。效象形容。春弦秋浮。冬沉夏洪。察色观脉。大小不同。一
时之间。变无经常。尺寸参差。或短或长。上下乖错。或存或亡。病辄改易。进退低昂。
心迷意惑。动失纪纲。愿为具陈。令得分明。师曰。子之所问。道之根源。脉有三部。
尺寸及关。
寸为上部。关为中部。尺为下部。
荣卫流行。不失衡铨。
衡铨者。称也。可以称量轻重。内经曰。春应中规。夏应中矩。秋应中衡。冬应中
权。
荣行脉中。卫行脉外。荣卫与脉。相随上下。应四时。不失其常度。
肾沉心洪。肺浮肝弦。此自经常。不失铢分。
肾北方水。王于冬而脉沉。心南方火。王于夏而脉洪。肺西方金。王于秋而脉浮。
肝东方木。王于春而脉弦。此为经常。铢分之不差也。
出入升降。漏刻周旋。水下二刻。一周循环。
人身之脉。计长一十六丈二尺。一呼。脉行三寸。一吸。脉行三寸。一呼一吸为一
息。脉行六寸。一日一夜。漏水下百刻。人一万三千五百息。脉行八百一十丈。五十度
周于身。则一刻之中。人一百三十五息。脉行八丈一尺。水下二刻。人二百七十息。脉
行一十六丈二尺。一周于身也。脉经之行。终而复始。若循环之无端也。
当复寸口。虚实见焉。
脉经之始。从中焦注于手太阴寸口。二百七十息。脉行一周身。复还至于寸口。
寸口为脉之经始。故以诊视虚实焉。经曰。虚实死生之要。皆见于寸口之中。
变
化相乘。阴阳相干。风则浮虚。寒则牢坚。沉潜水蓄。支饮急弦。动则为痛。数则热
烦。
风伤阳。故脉浮虚。寒伤阴。故脉牢坚。蓄积于内者。谓之水蓄。故脉沉潜。支
散于外者。谓之支饮。故脉急弦。动则阴阳相搏。相搏则痛生焉。数为阳邪。气胜阳胜。
则热烦焉。
设有不应。知变所缘。三部不同。病各异端。
脉与病不相应者。必缘传变之所致。三部以候五脏之气。随部察其虚实焉。
太过可怪。不及亦然。邪不空见。中必有奸。审察表里。三焦别焉。知其所舍。消
息诊看。料度腑脏。独见若神。为子条记。传与贤人。
太过不及之脉。皆有邪气干于正气。审看在表在里。入腑入脏。随其所舍而治之。
师曰。呼吸者。脉之头也。
难经曰。一呼。脉行三寸。一吸。脉行三寸。以脉随呼吸而行。故言脉之头也。
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。
外为阳。内为阴。内经曰。来者为阳。去者为阴。是出以候外。入以候内。疾为有
余。有余则实。迟为不足。不足则虚。来疾去迟者。阳有余而阴不足。故曰内虚外实。
来迟去疾者。阳不足而阴有余。故曰内实外虚。
问曰。上工望而知之。中工问而知之。下工脉而知之。愿闻其说。师曰。病家人请
云。病患若发热。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。
望以观其形证。问以知其所苦。脉以别其表里。病苦发热身疼。邪在表也。当卧不
安。而脉浮数。今病患自卧而脉沉迟者。表邪缓也。是有里脉。而无表证。则知表邪
当愈也。
王三阳云。亦有病与脉相反者。必自卧方瘥。
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。
若里有病者。脉当沉而细。今脉浮大。故知愈也。
腹痛者。里寒也。痛甚。则不能起。而脉沉细。今病患自坐。而脉浮大者。里寒
散也。是有表脉而无里证也。则知里邪当愈。是望证、问病、切脉。三者相参而得之。
可为十全之医。针经曰。知一为上。知二为神。知三神且明矣。
王三阳云。腹痛诸因不同。亦有其脉自浮大者。必自坐方愈。
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。
脉下和。处言已愈。
发热烦极。则不能静卧。今向壁静卧。知热已去。
设令向壁卧。闻师到不惊。起而盼视。盖三言三止。脉之。咽唾者。此诈病也。设
令脉自和。处言汝病大重。当须服吐下药。针灸数十百处乃愈。
诈病者非善人。以言恐之。使其畏惧则愈。医者意也。此其是欤。
师持脉。病患欠者。无病也。
针经曰。阳引而上。阴引而下。阴阳相引。故欠。阴阳不相引则病。阴阳相引则和。
是欠者无病也。
脉之。呻者、病也。
呻为呻吟之声。身有所苦则然也。
言迟者。风也。
风客于中。则经络急。舌强。难运用也。
摇头言者。里痛也。
里有病。欲言则头为之战摇。
行迟者。表强也。
表强者。由筋络引急。而行步不利也。
坐而伏者。短气也。
短气者。里不和也。故坐而喜伏。
坐而下一脚者。腰痛也。
内经曰。腰者、身之大关节也。腰痛。为大关节不利。故坐不能正。下一脚。以缓
腰中之痛也。
里实护腹。如怀卵物者。心痛也。
心痛则不能伸仰。护腹以按其痛。
师曰。伏气之病。以意候之。今月之内。欲有伏气。假令旧有伏气。当须脉之。若
脉微弱者。当喉中痛似伤。非喉痹也。病患云。实咽中痛。虽尔。今复欲下利。
冬时感寒。伏藏于经中。不即发者。谓之伏气。至春分之时。伏寒欲发。故云今月
之内。欲有伏气。假令伏气已发。当须脉之。审在何经。得脉微弱者。知邪在少阴。少
阴之脉循喉咙。寒气客之。必发咽痛。肾司开阖。少阴治在下焦。寒邪内甚。则开阖不
治。下焦不约。必成下利。故云虽尔咽痛。复欲下利。
问曰。人病恐怖者。其脉何状。师曰。脉形如循丝。累累然。其面白脱色也。
内经曰。血气者。人之神。恐怖者。血气不足。而神气弱也。脉形似循丝。累累然。
面白脱色者。针经曰。血夺者。色夭然不泽。其脉空虚。是知恐怖为血气不足。
问曰。人不饮。其脉何类。师曰。其脉自涩。唇口干燥也。
涩为阴。虽主亡津液。而唇口干燥。以阴为主内。故不饮也。
问曰。人愧者。其脉何类。师曰。脉浮。而面色乍白乍赤。
愧者、羞也。愧则神气怯弱。故脉浮。而面色变改不常也。
问曰。经说脉有三菽六菽重者。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。
菽、豆也。难经曰。如三菽之重。与皮毛相得者。肺部也。如六菽之重。与血脉相
得者。心部也。如九菽之重。与肌肉相得者。脾部也。如十二菽之重。与筋平者。肝部
也。按之至骨。举指来疾者。肾部也。各随所主之分。以候脏气。
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。
脉经曰。冷气在胃中。故令脉不通。下利。不见脉。则冷气客于脾胃。今尺中时一
小见。为脾虚。肾气所乘。脉再举头者。脾为肾所乘也。若尺中之脉。更或减损。为肾
气亦衰。脾复胜之。鬼贼相刑。故云难治。是脾胜不应时也。
问曰。脉有相乘。有纵有横。有逆有顺。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
火。名曰顺也。
金胜木。水胜火。纵者。言纵任其气。乘其所胜。横者。言其气横逆。反乘所不胜
也。
纵横。与恣纵、恣横、之义通。水为金子。火为木子。子行乘母。其气逆也。母行
乘子。其气顺也。
问曰。脉有残贼。何谓也。师曰。脉有弦、紧、浮、滑、沉、涩。此六者。名曰残
贼。能为诸脉作病也。
为人病脉。名曰八邪。风、寒、暑、湿。伤于外也。饥、饱、劳、逸。伤于内也。
经脉者荣卫也。荣卫者阴阳也。其为诸经脉作病者。必由风寒暑湿。伤于荣卫。客于阴
阳之中。风则脉浮。寒则脉紧。中暑则脉滑。中湿则脉涩。伤于阴则脉沉。伤于阳则脉
浮。所以谓之残贼者。伤良曰残。害良曰贼。以能害正气也。
唐不岩云。既言内外八邪。所致残贼。后却单举外伤。学人以意得之可也。
问曰。脉有灾怪。何谓也。师曰。假令人病。脉得太阳。与形证相应。因为作汤。
比还送汤。如食顷。病患乃大吐。若下利。腹中痛。师曰。我前来不见此证。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。故名灾怪耳。
医以脉证与药相对。而反变异。为其灾可怪。故名灾怪。
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。
是肝脉也。
肝病自得濡弱者愈也。
难经曰。春脉弦者肝。东方木也。万物始生。未有枝叶。故脉来濡弱而长。故曰弦。
是肝之平脉。肝病得此脉者。为肝气已和也。
假令得纯弦脉者死。何以知之。以其脉如弦直。是肝脏伤。故知死也。
纯弦者。为如弦直而不软。是中无胃气。为真脏之脉。内经曰。死肝脉来急。益劲。
如新张弓弦。
南方心脉。其形何似。师曰。心者。火也。名少阴。其脉洪大而长。是心脉也。心
病自得洪大者愈也。
心王于夏。夏则阳外胜。气血淖溢。故其脉来洪大而长也。
假令脉来微去大。故名反。病在里也。脉来头小本大者。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。
心脉来盛去衰为平。来微去大。是反本脉。内经曰。大则邪至。小则平。微为正气。
大为邪气。来以候表。来微则知表和。去以候里。去大则知里病。内经曰。心脉来不
盛。去反盛。此为不及。病在中。头小本大者。即前小后大也。小为正气。大为邪
气。则邪气先在里。今复还于表。故名曰覆。不云去而止云来者。是知在表。脉经曰。
在上为表。在下为里。汗者。心之液。上微。为浮之而微。头小。为前小。则表中气
虚。故主汗出。下微。为沉之而微。本大。为后大。沉则在里。大则病进。内经曰。心
为牡脏。小肠为之使。今邪甚下行。格闭小肠。使正气不通。故不得尿。名曰关格。脉
经曰。阳气上出。汗见于头。今关格正气不通。加之头有汗者。则阳气不得下通而上脱
也。其无汗者。虽作关格。然阳未衰。而犹可治。
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。
轻虚浮曰毛。肺之平脉也。缓迟者。脾之脉。脾为肺之母。以子母相生。故云皆愈。
数者。心之脉。火克金。为鬼贼相刑。故剧。肺主皮毛。数则为热。热客皮肤。留而不
去。则为痈疡。经曰。数脉不时。则生恶疮。
问曰。二月得毛浮脉。何以处言至秋当死。师曰。二月之时。脉当濡弱。反得毛浮
者。故知至秋死。二月肝用事。肝脉属木。应濡弱。反得毛浮者。是肺脉也。肺属金。
金来
克木。故知至秋死。他皆仿此。
当春时。反见秋脉。为金气乘木。肺来克肝。夺王脉而见。至秋肺王。肝气则绝。故
知至秋死也。
师曰。脉肥人责浮。瘦人责沉。肥人当沉。今反浮。瘦人当浮。今反沉。故责之。
肥人肌肤浓。其脉当沉。瘦人肌肤薄。其脉当浮。今肥人脉反浮。瘦人脉反沉。必
有邪气相干。使脉反常。故当责之。
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
命死生之期。期以月节克之也。
脉经曰。阳生于寸。动于尺。阴生于尺。动于寸。寸脉下不至关者为阳绝。不能下
应于尺也。尺脉上不至关者为阴绝。不能上应于寸也。内经曰。阴阳离决。精气乃绝。
此阴阳偏绝。故皆决死。期以月节克之者。谓如阳绝死于春夏。阴绝死于秋冬。
师曰。脉病患不病。名曰行尸。以无王气。卒眩仆不省人者。短命则死。人病脉不
病。名曰内虚。以无谷神。虽困无苦。
脉者。人之根本也。脉病患不病。为根本内绝。形虽且强。卒然气绝。则眩晕僵仆
而死。不曰行尸而何。人病脉不病。则根本内固。形虽且羸。止内虚尔。谷神者。谷气
也。谷气既足。自然安矣。内经曰。形气有余。脉气不足死。脉气有余。形气不足生。
问曰。翕奄沉。名曰关尺谓也。沉为纯阴。翕为正阳。阴阳和合。故令脉滑。滑何
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。
脉来大而盛。聚而沉。谓之翕奄沉。正如转珠之状也。沉为脏气。故曰纯阴。翕为
腑气。故曰正阳。滑者。阴阳气不为偏胜也。关尺自平。阳明脉微沉者。当阳部见阴脉。
Question: The pulse is divided into three positions. Yin and Yang interact with each other. Ying (Nutritive) Qi and Wei (Defensive) Qi, along with Blood and Qi, exist within the human body. Through inhalation and exhalation, Qi moves up and down within the body. Driven by breath, it circulates and distributes; fluids flow smoothly. The pulse changes with the seasons, manifesting specific forms: in Spring it is Wiry (Xian), in Autumn it is Floating (Fu), in Winter it is Deep (Chen), and in Summer it is Surging (Hong). Observing the complexion and examining the pulse reveals differences in size. Within a short time, the pulse changes unpredictably. The Cun (Inch), Guan (Bar), and Chi (Cubit) positions may vary, being either short or long. The upper and lower pulse qualities may be disordered, appearing present in some instances and absent in others. The disease condition shifts accordingly, advancing and retreating, rising and falling. One may become confused and lose the guiding principles. I wish for you to explain this thoroughly so that I may distinguish them clearly.
The Master said: What you ask about is the root of the pulse method. There are three pulse positions: Cun (Inch), Guan (Bar), and Chi (Cubit).
Cun is the Upper position, Guan is the Middle position, and Chi is the Lower position.
Ying (Nutritive) and Wei (Defensive) Qi circulate without losing their balance and measure.
Balance and measure refer to scales, used to weigh weight and lightness. The *Nei Jing* (Inner Canon) states: Spring pulses should conform to the compass (round), Summer pulses to the square, Autumn pulses to the level beam, and Winter pulses to the counterweight.
Ying (Nutritive) Qi flows within the vessels, while Wei (Defensive) Qi flows outside the vessels. Ying and Wei Qi follow the vessels up and down, adapting to the four seasons without deviating from their normal rhythm.
The Kidney pulse is Deep (Chen), the Heart pulse is Surging (Hong), the Lung pulse is Floating (Fu), and the Liver pulse is Wiry (Xian). These are the constant, normal pulses, accurate to the finest degree.
Kidney belongs to Water in the North, prospers in Winter, hence the pulse is Deep (Chen). Heart belongs to Fire in the South, prospers in Summer, hence the pulse is Surging (Hong). Lung belongs to Metal in the West, prospers in Autumn, hence the pulse is Floating (Fu). Liver belongs to Wood in the East, prospers in Spring, hence the pulse is Wiry (Xian). These are the constant pulses, precise to the smallest fraction.
Qi enters and exits, rises and descends, cycling according to the clepsydra (water clock). When two marks of water have elapsed, the pulse completes one cycle.
The total length of the pulse channels in the body is 16 zhang and 2 chi. With one exhalation, the pulse travels 3 cun; with one inhalation, it travels 3 cun. One exhalation and one inhalation constitute one respiratory cycle (Xi), during which the pulse travels 6 cun. In one day and night, 100 marks of water pass, and the person takes 13,500 breaths, causing the pulse to travel 810 zhang, circulating around the body 50 times. Thus, in one mark of water time, there are 135 breaths, and the pulse travels 8 zhang and 1 chi. When two marks of water pass, there are 270 breaths, and the pulse travels 16 zhang and 2 chi, completing one full circulation around the body. The movement of the pulse channels ends and begins again, like a circle without end.
One should return to the Cun Kou (Radial Artery at the wrist) to observe where Deficiency (Xu) and Excess (Shi) manifest.
The pulse channel begins at the Middle Jiao (Middle Burner) and pours into the Hand Taiyin Lung Meridian at Cun Kou. After 270 breaths, the pulse circulates the entire body and returns to Cun Kou.
Cun Kou is the starting point of the pulse channels; therefore, Deficiency and Excess are diagnosed here. The Classics state: The key to Deficiency, Excess, death, and life all appear within Cun Kou.
Changes intermingle, and Yin and Yang interfere. Wind causes Floating (Fu) and Empty (Xu) pulses; Cold causes Firm (Lao) and Solid (Jian) pulses. Sunken and submerged pulses indicate Water Retention (Shui Xu); urgent and wiry pulses indicate Branch Drinking (Zhi Yin). A Moving (Dong) pulse indicates pain; a Rapid (Shuo) pulse indicates Heat and restlessness.
Wind injures Yang, hence the pulse is Floating (Fu) and Empty (Xu). Cold injures Yin, hence the pulse is Firm (Lao) and Solid (Jian). Accumulation inside is called Water Retention (Shui Xu), hence the pulse is Sunken (Chen) and Submerged (Qian). Dispersion outside is called Branch Drinking (Zhi Yin), hence the pulse is Urgent (Ji) and Wiry (Xian). Movement (Dong) occurs when Yin and Yang struggle against each other; such struggle generates pain. Rapid (Shuo) represents Yang Pathogen; when Qi and Yang prevail, Heat and restlessness arise.
If there is no correspondence, understand the cause of the change. The three positions differ, and the origins of disease vary.
Excessive pulses are strange, as are deficient ones. Pathogens do not appear without cause; there must be internal evil. Examine the Exterior and Interior, distinguish the Three Jiao (Triple Burner). Knowing where the pathogen resides, assess its waxing and waning, and estimate the Zang-Fu organs. With unique insight akin to divine perception, record these points systematically to pass on to worthy individuals.
Both excessive and deficient pulses involve pathogens interfering with healthy Qi. Determine if the pathogen is in the Exterior or Interior, entering the Fu organs or Zang organs, and treat according to its location.
The Master said: Respiration is the head (guide) of the pulse.
The *Nan Jing* (Classic of Difficult Issues) states: With one exhalation, the pulse travels 3 cun; with one inhalation, it travels 3 cun. Since the pulse follows respiration, respiration is considered the guide of the pulse.
When initially holding the pulse, if the arrival is rapid and the departure is slow, this is rapid exit and slow entry, named Internal Deficiency (Nei Xu) and External Excess (Wai Shi). If the arrival is slow and the departure is rapid, this is slow exit and rapid entry, named Internal Excess (Nei Shi) and External Deficiency (Wai Xu).
The Exterior is Yang, the Interior is Yin. The *Nei Jing* states: Arrival is Yang, departure is Yin. Exit observes the Exterior, entry observes the Interior. Rapid indicates Excess (You Yu); Excess implies Solidity (Shi). Slow indicates Deficiency (Bu Zu); Deficiency implies Vacuity (Xu). Rapid arrival and slow departure mean Yang is Excess and Yin is Deficient, hence Internal Deficiency and External Excess. Slow arrival and rapid departure mean Yang is Deficient and Yin is Excess, hence Internal Excess and External Deficiency.
Question: The superior physician knows through observation, the average physician through inquiry, and the inferior physician through pulse diagnosis. I wish to hear the explanation.
The Master said: The patient's family says: "The patient has fever and body pain." The patient lies down. When the Master arrives and palpates the pulse, finding it Deep (Chen) and Slow (Chi), he knows the patient will recover. Why?
When there is disease in the Exterior, the pulse should be Floating (Fu) and Large (Da). Now the pulse is instead Deep (Chen) and Slow (Chi); therefore, recovery is known.
Observation examines form and symptoms; inquiry learns of suffering; pulse differentiation distinguishes Exterior and Interior. Fever and body pain indicate pathogen in the Exterior. One should lie down uncomfortably, with a Floating (Fu) and Rapid (Shuo) pulse. Now the patient lies quietly, yet the pulse is Deep (Chen) and Slow (Chi), indicating the Exterior pathogen has eased. This presents an Interior pulse without Exterior signs, so the Exterior pathogen is expected to resolve.
Wang Sanyang noted: There are cases where disease and pulse contradict; recovery requires quiet lying.
Suppose the patient says: "Sudden abdominal pain." The patient sits. When the Master arrives and palpates, finding a Floating (Fu) and Large (Da) pulse, he knows recovery is near. Why?
Disease in the Interior typically presents with a Deep (Chen) and Fine (Xi) pulse. Now the pulse is Floating (Fu) and Large (Da); therefore, recovery is known.
Abdominal pain indicates Interior Cold. Severe pain prevents rising, accompanied by a Deep (Chen) and Fine (Xi) pulse. Now the patient sits independently, and the pulse is Floating (Fu) and Large (Da), indicating Interior Cold has dispersed. This presents an Exterior pulse without Interior signs, so the Interior pathogen is expected to resolve. Thus, observing signs, asking about illness, and feeling the pulse—these three methods combined allow for perfect medical practice. The *Zhen Jing* (Classic of Acupuncture) states: Knowing one is superior, knowing two is divine, knowing three is both divine and clear.
Wang Sanyang noted: Causes of abdominal pain vary; some present with naturally Floating (Fu) and Large (Da) pulses, requiring sitting for recovery.
The Master said: The patient's family reports: "The patient is extremely feverish and irritable." The next day, when the Master arrives, the patient faces the wall and lies still. This indicates the heat has gone. If the pulse is harmonious below, declare the patient cured.
Extreme fever and irritability prevent quiet lying. Facing the wall and lying still indicates heat has subsided.
If facing the wall but showing no surprise upon hearing the Master's arrival, getting up to look around, speaking hesitantly, and swallowing saliva while the pulse appears natural, this is feigned illness. Even if the pulse is harmonious, the doctor should say: "Your illness is severe. You must take emetic and purgative medicines, and receive dozens or hundreds of acupuncture points to be cured."
Feigning illness is dishonest. Intimidating the patient with words induces fear, leading to cure. The physician must use intuitive understanding; this is an example.
When the Master palpates the pulse and the patient yawns, there is no disease.
The *Zhen Jing* states: Yang pulls upward, Yin pulls downward; their mutual attraction causes yawning. Lack of mutual attraction indicates disease; mutual attraction indicates harmony. Thus, yawning signifies health.
Groaning during pulse diagnosis indicates disease.
Groaning is the sound of suffering; bodily pain causes this.
Speaking slowly indicates Wind.
Wind lodging internally causes meridians to tighten, tongue stiffness, and difficulty in articulation.
Shaking the head while speaking indicates Interior pain.
Interior disease causes the head to tremble when attempting to speak.
Walking slowly indicates Exterior Stiffness (Biao Qiang).
Exterior stiffness results from tendon and meridian tension, leading to difficult gait.
Sitting and bending forward indicates Shortness of Breath (Duan Qi).
Shortness of breath stems from Interior disharmony; thus, one prefers sitting and bending forward.
Sitting with one leg hanging down indicates Waist Pain.
The *Nei Jing* states: The waist is the major joint of the body. Waist pain causes joint dysfunction, preventing proper sitting posture; lowering one leg relieves waist pain.
Protecting the abdomen as if holding an egg indicates Heart Pain (Xin Tong).
Heart pain prevents extension and reclining; protecting the abdomen alleviates the pain.
The Master said: Latent Qi (Fu Qi) disease is discerned by intuition. Within this month, latent Qi may emerge. If latent Qi existed previously, pulse diagnosis is required. If the pulse is Weak (Wei Ruo), throat pain resembling injury should occur, but it is not Hou Bi (Throat Bi). The patient claims true throat pain. Even so, diarrhea is now anticipated.
Winter cold, hidden in the meridians without immediate onset, is called Latent Qi (Fu Qi). By the Spring Equinox, latent cold desires to emerge, hence "within this month, latent Qi may appear." If latent Qi has emerged, pulse diagnosis determines the affected meridian. A Weak (Wei Ruo) pulse indicates pathogen in Shaoyin (Lesser Yin). The Shaoyin meridian runs along the throat; cold lodging there causes throat pain. The Kidney governs opening and closing; Shaoyin manages the Lower Jiao. Severe internal cold disrupts opening/closing, leading to uncontrolled Lower Jiao and diarrhea. Thus, despite throat pain, diarrhea is expected.
Question: What is the pulse shape in people suffering from terror/fear?
The Master said: The pulse feels like following a thread, continuous and small; the face is pale and devoid of color.
The *Nei Jing* states: Blood and Qi are the spirit of man. Terror arises from insufficient Blood and Qi and weak Shen (Spirit). A thread-like, continuous pulse, pale face, and lack of luster indicate blood loss. The *Zhen Jing* states: When blood is depleted, complexion is dull and lacks luster, and the pulse is empty. Thus, terror indicates deficiency of Blood and Qi.
Question: What is the pulse in people who do not drink water?
The Master said: The pulse is Choppy (Se), and lips and mouth are dry.
Choppy (Se) belongs to Yin. Although it primarily indicates fluid depletion, dry lips and mouth suggest Yin dominance internally, leading to refusal to drink.
Question: What is the pulse in people who feel ashamed?
The Master said: The pulse is Floating (Fu), and the complexion alternates between white and red.
Ashamed implies shyness. Shame causes timid Shen (Spirit), resulting in a Floating (Fu) pulse and fluctuating complexion.
Question: The Classics mention pulse pressure equivalent to three or six beans. What does this mean?
The Master said: When pressing the pulse with fingers: Pressure equivalent to three beans indicates Lung Qi. Six beans indicates Heart Qi. Nine beans indicates Spleen Qi. Twelve beans indicates Liver Qi. Pressing to the bone indicates Kidney Qi.
"Bean" refers to soybeans. The *Nan Jing* states: Pressure of three beans, touching skin and hair, corresponds to the Lung. Six beans, touching blood vessels, corresponds to the Heart. Nine beans, touching muscle, corresponds to the Spleen. Twelve beans, level with tendons, corresponds to the Liver. Pressing to the bone, with quick rebound, corresponds to the Kidney. Each position corresponds to specific depths to assess Zang Qi.
In cases of diarrhea, if no pulse is felt at Cun, Guan, or Chi, but occasionally a small pulse appears at Chi, rising twice, this indicates Kidney Qi.
If a Damaged (Sun) pulse appears, treatment is difficult.
The *Mai Jing* (Pulse Classic) states: Cold Qi in the stomach obstructs the pulse, causing diarrhea and absence of pulse, indicating cold lodging in Spleen and Stomach. Occasional appearance at Chi suggests Spleen Deficiency invaded by Kidney Qi. Two rises indicate Spleen overwhelmed by Kidney. Further weakening of Chi pulse indicates declining Kidney Qi, allowing Spleen to regain control. This mutual destruction makes it difficult to treat, representing Spleen overcoming at an inopportune time.
Question: What are multiplication, longitudinal, transverse, reverse, and順 (Shun) in pulses?
The Master said: Water multiplying Fire, and Metal multiplying Wood, are called Longitudinal (Zong). Fire multiplying Water, and Wood multiplying Metal, are called Transverse (Heng). Water multiplying Metal, and Fire multiplying Wood, are called Reverse (Ni). Metal multiplying Water, and Wood multiplying Fire, are called Smooth/Conforming (Shun).
Metal overcomes Wood; Water overcomes Fire. Longitudinal means allowing Qi to multiply what it overcomes. Transverse means Qi acts transversely, multiplying what it cannot normally overcome.
Longitudinal and Transverse correspond to indulgent and arrogant meanings. Water is the child of Metal; Fire is the child of Wood. Child multiplying Parent is Reverse (Ni). Parent multiplying Child is Smooth (Shun).
Question: What are "Residual and Harmful" (Can Zei) pulses?
The Master said: Wiry (Xian), Tight (Jin), Floating (Fu), Slippery (Hua), Deep (Chen), and Choppy (Se) are called Residual and Harmful. These six can cause pathology in other pulses.
These eight evils cause disease. Wind, Cold, Summerheat, and Dampness injure externally. Hunger, Fullness, Labor, and Rest injure internally.
Meridians are Ying and Wei; Ying and Wei are Yin and Yang. Pathology in meridians stems from Wind, Cold, Summerheat, and Dampness injuring Ying and Wei, lodging in Yin and Yang. Wind causes Floating (Fu) pulse; Cold causes Tight (Jin) pulse; Summerheat causes Slippery (Hua) pulse; Dampness causes Choppy (Se) pulse; Yin injury causes Deep (Chen) pulse; Yang injury causes Floating (Fu) pulse. They are called Residual and Harmful because they damage healthy Qi.
Tang Buyan noted: Having mentioned eight external and internal evils causing harm, yet only listing external injuries later, students should infer the meaning.
Question: What is "Disaster and Wonder" (Zai Guai)?
The Master said: Suppose a patient has a Taiyang pulse matching symptoms, and decoction is prepared. Before the medicine is administered, after about the time it takes to eat a meal, the patient vomits severely or suffers diarrhea with abdominal pain. The Master says: "I did not see these symptoms earlier; now they have changed. This is Disaster and Wonder." Asked why vomiting/diarrhea occurs: The answer is old medication taken previously is now taking effect, hence "Disaster and Wonder."
When pulse and symptoms match the prescription, but sudden changes occur, it is deemed a disaster and wonder, hence the name.
Question: What does the Liver pulse of the East resemble?
The Master said: Liver is Wood, named Jueyin (Terminal Yin). Its pulse is slightly Wiry (Xian), Soft-Weak (Ru Ruo), and Long (Chang). This is the Liver pulse.
If Liver disease presents with Soft-Weak (Ru Ruo) pulse, recovery occurs.
The *Nan Jing* states: Spring Wiry (Xian) pulse belongs to Liver, East Wood. As things begin to grow without branches, the pulse comes Soft-Weak (Ru Ruo) and Long (Chang), hence Wiry (Xian). This is the Normal Pulse (Ping Mai) of Liver. Liver disease presenting this pulse indicates harmonious Liver Qi.
If a purely Wiry (Xian) pulse appears, death ensues. Why? Because the pulse is straight like a string, indicating Liver organ damage.
Purely Wiry means straight and unyielding, lacking Stomach Qi, representing True Organ Pulse (Zhen Zang Mai). The *Nei Jing* states: Dead Liver pulse comes urgent and stiff, like a newly strung bowstring.
What does the Heart pulse of the South resemble?
The Master said: Heart is Fire, named Shaoyin (Lesser Yin). Its pulse is Surging (Hong) and Large (Da), and Long (Chang). This is the Heart pulse.
If Heart disease presents with Surging (Hong) and Large (Da) pulse, recovery occurs.
Heart prospers in Summer; Yang prevails externally, causing abundant Qi and Blood, hence Surging (Hong) and Large (Da), Long (Chang) pulse.
If the pulse arrives微弱 (Wei - slight/weak) and departs Large (Da), it is called Reverse (Fan), indicating Interior disease. If the pulse head is Small (Xiao) and base is Large (Da), it is called Overturning (Fu), indicating Exterior disease. Upper slight/small head indicates sweating. Lower slight/large base indicates Guan Ge (Obstruction and Refusal) with inability to urinate. Head without sweat is treatable; with sweat is fatal.
Heart pulse arriving vigorous and departing weak is Normal. Arriving weak and departing large is Reverse to Normal. The *Nei Jing* states: Large indicates pathogen; Small indicates peace. Weak indicates Healthy Qi; Large indicates Pathogenic Qi. Arrival observes Exterior; weak arrival indicates Exterior harmony. Departure observes Interior; large departure indicates Interior disease. The *Nei Jing* states: Heart pulse arriving not vigorous but departing vigorously indicates Deficiency, disease in the Middle. Small head/Large base means front small/back large. Small is Healthy Qi; Large is Pathogenic Qi. Pathogen was first in Interior, now returns to Exterior, hence Overturning (Fu). Not mentioning departure but arrival indicates Exterior location. The *Mai Jing* states: Upper is Exterior, Lower is Interior. Sweat is the fluid of the Heart. Upper slight means floating and weak; small head means front small; thus Exterior Qi deficiency causes sweating. Lower slight means sinking and weak; large base means back large; sinking indicates Interior, large indicates worsening. The *Nei Jing* states: Heart is Yang Organ, Small Intestine is its envoy. Now pathogen sinks heavily, blocking Small Intestine, preventing Healthy Qi flow, causing inability to urinate, named Guan Ge (Obstruction and Refusal). The *Mai Jing* states: Yang Qi emerges upward, sweat appears on head. Now Guan Ge blocks Healthy Qi; plus head sweat, Yang Qi cannot descend and escapes upward. Without head sweat, although Guan Ge exists, Yang is not exhausted, so it is treatable.
What does the Lung pulse of the West resemble?
The Master said: Lung is Metal, named Taiyin (Greater Yin). Its pulse is Hair-like Floating (Mao Fu). If Lung disease presents this pulse, or Slow (Huan Chi) pulse, recovery occurs. If Rapid (Shuo) pulse appears, disease worsens. Why? Rapid is Southern Fire; Fire overcomes Western Metal, likely causing Carbuncle/Swelling (Yong Zhong), making it difficult to treat.
Light, void, and floating is Hair-like (Mao), the Normal Pulse of Lung. Slow (Huan Chi) is Spleen pulse; Spleen is Mother of Lung;母子 (Mother-Child) generation implies recovery.
Rapid is Heart pulse; Fire overcomes Metal, representing destructive interaction, hence worsening. Lung governs skin and hair; Rapid indicates Heat. Heat lodging in skin remains, causing Carbuncles/Ulcers. Classics state: Persistent Rapid pulse generates foul sores.
Question: Obtaining Hair-like Floating (Mao Fu) pulse in February, why predict death in Autumn?
The Master said: In February, pulse should be Soft-Weak (Ru Ruo). Obtaining Hair-like Floating (Mao Fu) instead predicts death in Autumn. February is Liver season; Liver pulse belongs to Wood, corresponding to Soft-Weak (Ru Ruo). Obtaining Hair-like Floating (Mao Fu) is Lung pulse. Lung belongs to Metal; Metal overcomes Wood, hence death in Autumn. Other cases follow this logic.
Seeing Autumn pulse in Spring indicates Metal Qi overcoming Wood, Lung overcoming Liver, usurping the Prosperous pulse. By Autumn, Lung prospers, Liver Qi perishes, hence death in Autumn.
The Master said: For obese persons, check for Floating (Fu) pulse; for thin persons, check for Deep (Chen) pulse. Obese persons should have Deep (Chen) pulse; if Floating (Fu), investigate. Thin persons should have Floating (Fu) pulse; if Deep (Chen), investigate.
Obese persons have thick flesh; pulse should be Deep (Chen). Thin persons have thin flesh; pulse should be Floating (Fu). If obese pulse is Floating (Fu) or thin pulse is Deep (Chen), pathogen interference causes abnormal pulse, requiring investigation.
The Master said: Cun pulse not reaching Guan is Yang Absence (Yang Jue); Chi pulse not reaching Guan is Yin Absence (Yin Jue). Both are untreatable and fatal. To calculate remaining lifespan, consider monthly and seasonal overcoming relationships.
The *Mai Jing* states: Yang originates at Cun, moves at Chi. Yin originates at Chi, moves at Cun. Cun pulse not reaching Guan is Yang Absence, unable to connect to Chi. Chi pulse not reaching Guan is Yin Absence, unable to connect to Cun. The *Nei Jing* states: When Yin and Yang separate, Essence and Qi perish. This partial separation of Yin and Yang leads to certain death. Calculating lifespan by monthly/seasonal overcoming means: Yang Absence dies in Spring/Summer; Yin Absence dies in Autumn/Winter.
The Master said: Pulse matches disease, but body is healthy, named Walking Corpse (Xing Shi), lacking Prosperous Qi. Sudden dizziness and collapse without consciousness lead to short life and death. Body shows disease, but pulse is healthy, named Internal Deficiency (Nei Xu), lacking Grain Spirit (Gu Shen). Though distressed, there is no suffering.
Pulse is the root of man. Pulse matches disease but body is healthy means internal root severance. Though body seems strong, sudden Qi cessation causes dizziness, collapse, and death. Why not call it Walking Corpse? Body shows disease but pulse is healthy means internal root is solid. Though body is emaciated, it is merely Internal Deficiency. Grain Spirit is Grain Qi. Sufficient Grain Qi brings natural peace. The *Nei Jing* states: Excess Form/Qi, Deficient Pulse Qi leads to death. Excess Pulse Qi, Deficient Form/Qi leads to survival.
Question: Xi Yan Chen (Gathering then Sinking), named Guan Chi Wei. Chen is Pure Yin; Xi is Correct Yang. Yin-Yang harmony makes pulse Slippery (Hua). How does Slipperiness achieve peace? Yangming pulse slightly Deep (Chen), eating/drinking normal. Shaoyin pulse slightly Slippery (Hua). Slippery is the floating name of Tight (Jin). This is Yin Excess; person必定股内汗出，阴下湿也 (will have sweat inside thighs and dampness in genitals).
Pulse coming large and vigorous, gathering and sinking, is called Xi Yan Chen, like rolling pearls. Chen is Zang Qi, hence Pure Yin. Xi is Fu Qi, hence Correct Yang. Slippery means Yin-Yang Qi do not overpower each other. Guan and Chi are naturally balanced. Yangming pulse slightly Deep (Chen) means Yin pulse appears in Yang position.