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*Suwen: Pulse Essentials and Subtleties*

The Yellow Emperor asked, "How should diagnosis be conducted?" ("Zhen" refers to observation, examination, and pulse palpation. All methods such as taking the pulse, observing complexion, and inquiring about the cause of disease can be termed "zhen," but this section specifically discusses pulse diagnosis." Qi Bo replied, "Pulse diagnosis is usually performed at dawn (pingdan). At this time, yin qi has not yet stirred, yang qi has not yet dispersed, food and drink have not been ingested, the meridians are not yet full, the collaterals are harmonious and uniform, and qi and blood are not yet chaotic. Therefore, it is possible to diagnose abnormal pulses." (Dawn is the junction of yin and yang. Yang governs the day, yin governs the night; yang governs the exterior, yin governs the interior. The Ying and Wei qi circulate fifty times through the body in one day and night. During the day, they travel through the yang aspects; during the night, through the yin aspects. By dawn, they all converge at the Cun Kou (radial artery). Thus, the *Nanjing* states: 'Cun Kou is the great assembly of pulses, where the qi of the five zang organs and six fu organs begins and ends.' The *Yingweishenghui Chapter* states: 'At dawn, yin is exhausted and yang receives qi.' At noon, yang is abundant; at sunset, yang declines; after sunset, yang is exhausted and yin receives qi. The *Kouwen Chapter* states: 'When yang qi is exhausted and yin qi is abundant, the eyes close for sleep; when yin qi is exhausted and yang qi is abundant, one awakens.' Therefore, pulse diagnosis should be conducted at dawn upon waking. At this moment, yin qi is stable and undisturbed, yang qi is about to become abundant but has not yet dispersed, food has not been ingested, and grain qi has not yet circulated. Consequently, the meridians are not yet full, the collaterals are harmonious, qi and blood are not chaotic, and the pulse body has not changed. Only then can abnormal pulses be diagnosed. 'You guo' refers to pulses that deviate from the norm and exhibit abnormalities. The pulse is the precursor of qi and blood. When qi and blood are abundant, the pulse is strong; when deficient, the pulse is weak; when hot, the pulse is rapid; when cold, the pulse is slow. When qi and blood are faint, the pulse is weak; when balanced, the pulse is harmonious. Furthermore, tall people tend to have long pulses, short people short pulses, those with irritable temperaments have rapid pulses, and those with calm temperaments have slow pulses. These are all normal conditions. Deviations are considered adverse. All these cases constitute what is meant by 'you guo'.) By palpating the movement and stillness of the pulse, observing the clarity and spirit of the eyes, examining the five colors, assessing 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 physical form, and by cross-referencing these factors (*can wu*), one can determine the boundary between life and death. ("Qie" means pressing and searching with fingers. Palpating the pulse's movement and stillness diagnoses yin and yang. Observing the clarity of the eyes diagnoses Shen qi (spiritual qi). Examining changes in the five colors diagnoses generation/restriction cycles, pathogenic factors, and healthy qi. Observing the deficiency and excess of zang organs diagnoses internal conditions; distinguishing the flourishing or declining appearance diagnoses external conditions. Therefore, in diagnosing diseases, one must combine pulse, color, and internal/external factors, using cross-reference (*can wu*) to seek the truth. In doing so, the nature of yin/yang, interior/exterior, deficiency/excess, and cold/heat will be revealed, and treatments regarding priority, urgency, authenticity, and reversal will be without error. Thus, one can determine the boundaries of life and death, let alone ordinary diseases. This is a subtle application of medicine and should not be regarded as trivial. The meaning of *can wu* is: comparing three things is called *can*; classifying five things is called *wu*. It involves mutual reflection, verifying similarities and differences, and seeking hidden subtleties. As the *I Ching* says: 'Can wu leads to change, interlacing numbers. Through understanding change, the patterns of heaven and earth are formed; by exhausting numbers, the images of the world are determined.' Who else but those who master the greatest changes could achieve this? This is what is meant.")