Library

(Su Wen, Ping Ren Qi Xiang Lun)

Qibo said: When the pulse conforms to Yin and Yang, the disease is easy to cure; when the pulse contradicts Yin and Yang, the disease is difficult to cure. (Commentary on Su Wen, Ping Ren Qi Xiang Lun: A Yin syndrome presenting with a Yin pulse, or a Yang syndrome presenting with a Yang pulse, is called "Cong" (Following/Conforming), which indicates ease of recovery. When the pulse contradicts the condition, it is called "Ni" (Rebellious/Opposite), indicating difficulty in recovery.) When the pulse follows the regularity of the four seasons, it is said that there are no other complications; when the pulse rebels against the four seasons or involves "Jian Zang" (Intervening Viscera) transmission, it is said to be difficult to cure. (A wiry pulse in Spring, a hook-like pulse in Summer, a hairy pulse in Autumn, and a stone-like pulse in Winter are called conforming to the four seasons. Even if illness is present, there is no cause for concern. The meaning of rebelling against the four seasons is as described below. "Bu Jian Zang" (Not Intervening Viscera) also denotes difficulty in cure. "Bu Jian Zang" refers to situations such as Wood necessarily overcoming Earth, where Liver disease transmits to the Spleen; or Earth necessarily overcoming Water, where Spleen disease transmits to the Kidney. In these cases, the disease transmits to the organ it overcomes, without intercession. Such pulse and symptom patterns are named "Gui Zei" (Ghost Thieves), where the Qi mutually destroys each other, resulting in severe illness. If the disease transmits to the organ it generates by intervening through the organ it overcomes, this is called "Jian Zang". For example, the Liver does not transmit to the Spleen but to the Heart; the Heart does not transmit to the Lung but to the Spleen. Since their Qi generates each other, even if illness occurs, it is mild. Therefore, the *Biao Ben Bing Zhuan Lun* states: "For mild conditions, both paths operate together," referring to Jian Zang; "For severe conditions, only one path operates alone," referring to Bu Jian Zang. The *Nan Jing, Chapter 53* states: "Seven transmissions lead to death, intervening viscera lead to life." Seven transmissions refer to transmitting to the organ overcome. Intervening viscera refer to transmitting to the organ generated. All these refer to this principle. Examining Lu's commentary on *Nan Jing, Chapter 53*: "Jian Zang" means intervening through the overcome organ during transmission. Heart overcomes Lung, Spleen intervenes; Spleen overcomes Kidney, Lung intervenes; Lung overcomes Liver, Kidney intervenes; Kidney overcomes Heart, Liver intervenes; Liver overcomes Spleen, Heart intervenes. This is called transmitting to the organ generated. This explanation is also valid. Furthermore, the *Yu Ji Zhen Zang Lun* states: "When the five Zang organs are diseased, they each transmit to what they overcome." If untreated, according to standard rules, within three months or six months, or three days or six days, after transmitting through all five Zang organs, death ensues. This is the sequential transmission of overcoming, i.e., the meaning of "Bu Jian Zang". See detailed discussion in *Zang Xiang Lei*, Section 24. 'Jian' is pronounced with the departing tone.) There are pulses that rebel or conform to the four seasons. Even without the manifestation of true Zang pulses, if the pulse is thin/small in Spring and Summer, and floating/large in Autumn and Winter, this is called rebelling against the four seasons. ('Ni' means opposite/rebel. 'Cong' means following/conforming. Regarding pulses rebelling or conforming to the four seasons: although true Zang pulse forms have not yet appeared, if in Spring and Summer, when Wood and Fire commands prevail, the pulse should be floating and large but instead appears thin and small; or in Autumn and Winter, when Metal and Water commands prevail, the pulse should be deep and fine but instead appears floating and large—these are all rebellions against the four seasons.) Wind-heat presenting with a quiet pulse, diarrhea and blood loss presenting with a solid pulse, interior disease presenting with a deficient pulse, and exterior disease presenting with a choppy and firm pulse are all difficult to treat; this is called rebelling against the four seasons. (Wind-heat is a Yang pathogen; the pulse should be large but is instead quiet. Diarrhea and blood loss injure Yin; the pulse should be deficient but is instead solid. Disease in the interior Zang organs should present with a forceful pulse but is instead deficient. Disease in the muscle-surface should present with a floating and slippery pulse but is instead choppy and firm. These are all contradictory and difficult-to-treat syndromes, similar to pulses rebelling against the four seasons.) Humans rely on water and grain as their root; thus, humans die when cut off from water and grain, and death also occurs when the pulse lacks Stomach Qi. What is meant by lacking Stomach Qi is that only the true Zang pulse is obtained, without Stomach Qi. What is meant by the pulse lacking Stomach Qi is that the Liver pulse is not wiry and the Kidney pulse is not stone-like. (Human life depends on water and grain; therefore, Stomach Qi takes water and grain as its root, and the five Zang organs take Stomach Qi as their root. If the pulse lacks Stomach Qi and only the true Zang pulse appears alone, death results—this is like the previously mentioned "only wiry without Stomach Qi" or "only stone-like without Stomach Qi". However, although merely wiry or merely stone-like constitutes a true Zang pulse, if the Liver lacks Qi, it will not appear wiry; if the Kidney lacks Qi, it will not appear stone-like. This is also due to the five Zang organs failing to receive Stomach Qi, being equivalent to the state of true Zang pulses lacking Stomach Qi.)

Huangdi said: (Su Wen, Yu Ji Zhen Zang Lun) In treating any disease, one must observe the patient's form, Qi, color, and luster, the excess or deficiency of the pulse, and whether the disease is new or old, then proceed with treatment without delaying the appropriate time. (Observing form, Qi, color, luster, pulse excess/deficiency, and disease duration corresponds to the methods of inspection, auscultation/olfaction, inquiry, and palpation described in Nan Jing, Chapter 61. Once the condition is understood, treatment should be administered promptly. Delaying the timing will cause the disease to deepen daily; this is a stern warning.) When form and Qi are harmonious, it is called treatable. (Excessive form with excessive Qi, or deficient form with deficient Qi, indicates harmony.) When color and luster are bright and moist, it is called easily curable. ('Ze' means moist/lustrous. 'Fu' means bright/clear. Bright and lustrous complexion indicates the disease will likely resolve easily.) When the pulse conforms to the four seasons, it is called treatable. (Pulses conforming to the four seasons indicate harmonious Qi, hence treatable.) When the pulse is weak and slippery, it indicates the presence of Stomach Qi and is called easy to treat; treatment should be timed appropriately. (The arrival of Grain Qi is slow and harmonious; thus, a weak and slippery pulse indicates the acquisition of Stomach Qi, termed easy to treat.) When form and Qi are discordant, it is called difficult to treat. (Excessive form with deficient Qi, or excessive Qi with deficient form, both indicate discordance. The following four sections all discuss difficult-to-treat conditions.) When the complexion is dull, dark, and lacks luster, it is called difficult to cure. ('Yao' means dull and ugly. 'Bu Ze' means withered and scorched.) When the Lung pulse is full and firm, it indicates the disease is worsening. (The arrival of pathogenic Qi is tight and rapid; thus, a full and firm pulse indicates the disease will surely worsen.) When the pulse rebels against the four seasons, it is untreatable. (Meaning of rebelling against the four seasons is as described below.) One must carefully examine these four difficulties and clearly inform the patient. (The difficulties regarding form, Qi, color, and pulse as described in the previous four sections are called the "Four Difficulties." One must investigate them in detail and clearly advise the patient's family, allowing them to anticipate good or bad outcomes, thereby avoiding future resentment.) What is meant by rebelling against the four seasons is obtaining the Lung pulse in Spring, the Kidney pulse in Summer, the Heart pulse in Autumn, and the Spleen pulse in Winter, where the pulse beats are suspended, isolated, deep, and choppy; this is called rebelling against the four seasons. (Obtaining the Lung pulse in Spring represents Metal overcoming Wood. Obtaining the Kidney pulse in Summer represents Water overcoming Fire. Obtaining the Heart pulse in Autumn represents Fire overcoming Metal. Obtaining the Spleen pulse in Winter represents Earth overcoming Water. Added to the suspended, isolated, deep, and choppy qualities, this indicates extreme deviation of Yin and Yang, with no remaining harmonious Stomach Qi; this is the pulse rebelling against the four seasons.) Even without the manifestation of true Zang pulses, if the pulse is deep and choppy in Spring and Summer, and floating and large in Autumn and Winter, this is called rebelling against the four seasons. Fever presenting with a quiet pulse, diarrhea presenting with a large pulse, blood loss presenting with a solid pulse, interior disease presenting with a solid and firm pulse, and exterior disease presenting with a non-solid and non-firm pulse are all difficult to treat. (This section is slightly similar to the earlier text in Ping Ren Qi Xiang Lun. It implies that pulses rebelling against the season are difficult to treat, and pulses rebelling against the symptoms are also difficult to treat. For instance, fever with a quiet pulse indicates a Yang syndrome receiving a Yin pulse. Diarrhea with a large pulse or blood loss with a solid pulse indicates righteous Qi declining while pathogenic factors advance. This meaning is largely consistent with the previous text. The only difference is that interior disease with a solid/firm pulse and exterior disease with a non-solid/non-firm pulse are both considered difficult to treat, which seems contrary to the earlier Ping Ren Qi Xiang Lun. However, the earlier text stating "interior disease with a deficient pulse" refers to internal accumulation of excess pathogens, where a deficient pulse is inappropriate. Here, stating "interior disease with a solid/firm pulse" refers to internal injury causing deficiency, where a solid/firm pulse is inappropriate. The earlier text stating "exterior disease with a choppy/firm pulse" refers to abundant external pathogens, where a choppy/firm pulse is inappropriate because choppy/firm belongs to sinking Yin. Here, stating "exterior disease with a non-solid/non-firm pulse" refers to raging external pathogens, where weakness is inappropriate because non-solid/non-firm indicates lack of Yang. The distinction among these four cases collectively points to pulses where righteous Qi cannot overcome pathogenic factors, hence "difficult to treat." Although the wording seems contradictory, the underlying logic is consistent. The New Correction suggests an error in the classic text, but this fails to grasp the subtlety.)