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(Lingshu, Genjie Chapter)

In one day and night, the meridians circulate fifty times to nourish the essence and qi of the five zang organs. If the pulse movements do not conform to this number, it is called "kuang sheng" (wild generation, referring to a life state that is chaotic and whose outcome is uncertain). (Note: "Ying" means to circulate or operate. The human meridians circulate in the body fifty times in a day and night to operate and nourish the essence and qi of the five zang organs, which is consistent with the meaning in the Lingshu, Wushi Ying Chapter. The specific data are as follows: there are twenty-eight meridians in total above and below, left and right, front and back, with a combined length of sixteen zhang and two chi. The Zong Qi (Gathering Qi) of the human body accumulates in the chest, governing respiration and driving blood through the collaterals. In one exhalation, the pulse moves three cun; in one inhalation, it moves three cun. In one complete breath cycle (ding xi), the pulse moves six cun. Based on six cun per breath, there are thirteen thousand five hundred breaths in a day and night. The meridians circulate fifty times in the body, covering a total distance of eight hundred ten zhang. If the pulse frequency is excessive or insufficient and does not match this standard, it is called "kuang sheng." "Kuang" implies chaos or delusion, meaning that although the person is alive, their fate is unpredictable.)

The so-called "Wushi Ying" (Fifty Circulations) refers to the fact that the five zang organs all receive qi. During examination, hold the pulse at the Cun Kou (Pulse Gate) and count the beats. (The aforementioned fifty circulations refer to the qi received by the five zang organs. By examining the Cun Kou and counting its beats, one can determine the decline or prosperity of the zang qi. The meaning of "Cun Kou" is detailed in Zangxiang Class, Section 11. "Shu" is pronounced with the rising tone.)

If the pulse beats fifty times without any intermission, the five zang organs are all receiving qi; ("Dai" means replacement or substitution. It refers to an abnormality within a normal pulse, such as suddenly appearing weak, alternating between rapid and slow, or stopping and then restarting. This occurs because damage to a zang organ leads to a deficiency of qi, causing such changes in the pulse, all of which are termed "Dai." If there are fifty beats without any intermission, it indicates that the five zang organs are sufficiently nourished by qi, representing a harmonious and healthy pulse.)

If the pulse beats forty times before showing one intermission, it indicates that one zang organ lacks qi; (An intermission after forty beats signifies a deficiency in one of the five zang organs. Commentary: Nan Jing, Chapter 11 states: The classic says if the pulse stops once before reaching fifty beats, it indicates one zang lacks qi. Which zang is it? The answer is: Inhalation follows Yin inward, and exhalation follows Yang outward. Now, if inhalation cannot reach the Kidney but returns at the Liver, we know that one zang lacks qi, specifically that Kidney Qi has been exhausted first. Thus, when the five zang are harmonious, the qi and pulse are long; when diseased, they are short. Observing this, the lack of qi in one zang must begin with the Kidney. Following the logic for two, three, four, and five zangs lacking qi mentioned later, the progression should be from distant to near, shortening sequentially: from Kidney to Liver, Liver to Spleen, Spleen to Heart, and Heart to Lung. Therefore, in critical conditions, patients inevitably exhibit rapid breathing resembling asthma, confined only to a few cun in the chest. This is due to the exhaustion of True Yin below and the floating of solitary Yang above, representing the extreme of shortness of breath. At this juncture, if a physician attempts to treat with dispersing methods, death will inevitably follow, which is truly lamentable. Human life and death depend on Qi; the gathering and scattering of Qi depend on Yin. The continuation of labored breathing relies solely on a thread of unextinguished Qi. Hence, the importance of carefully observing zang qi cannot be overstated.)

If the pulse beats thirty times before showing one intermission, it indicates that two zang organs lack qi;
If the pulse beats twenty times before showing one intermission, it indicates that three zang organs lack qi;
If the pulse beats ten times before showing one intermission, it indicates that four zang organs lack qi;
If the pulse shows an intermission in fewer than ten beats, it indicates that the five zang organs all lack qi. A prognosis of death may be given, based on the principles of the Zhongshi Chapter. ("Yu" is synonymous with "give." "Duanqi" refers to the time of death. This means that when the five zang lack qi, a definite time of death can be assigned. "Zhongshi" is the title of a chapter in the original text, detailing the termination and beginning of the twelve meridians.)

The statement "fifty beats without intermission" serves as the norm, allowing one to ascertain the condition of the five zang. The indication of imminent death is characterized by irregularities in speed and rhythm. (Considering it the norm means that a normal human pulse should be like this, thus allowing observation of the qi of the five zang. To identify the time of death, one looks for pulses that are intermittently rapid and slow. This represents a change in timing, differing from the regular "Dai" pulse. It results from the deterioration of zang qi, leading to a loss of control and deviation from normalcy. Hence, chapters like Sanbu Jiuhou Lun state that "intermittently rapid and slow" pulses indicate death. Commentary: Regarding the meaning of "Dai Mai" (Intermittent Pulse), Zhang Zhongjing and Wang Shuhe both stated: "Beats stop midway, cannot return spontaneously, and then resume; a Dai pulse indicates death." They also said: "Five beats followed by one stop, without further increase or decrease, indicates death, termed Dai in the classics." Seven beats (equivalent to half a breath cycle) without increase or decrease are also termed Dai, unequivocally indicating death. Wang Bing’s commentary on the Dai pulse similarly states: "Beats stop midway and cannot return." Later, Hua Borén elaborated: "Beats stop midway, cannot return, resume, stop again; after searching for a long time, they rise forcibly. This is Dai." Consequently, later generations grouped Jie (Knotted), Cu (Rapid-intermittent), and Dai together as "stopping pulses," which fails to capture their full meaning. A slow pulse with intermittent stops is Jie; a rapid pulse with intermittent stops is Cu. Their frequencies may vary (three, five, seven, or eight beats per interval), but the rhythm is distinct, and the starts and stops are forceful. These are caused by Qi rebellion and phlegm obstruction, Qi and Blood depletion, or congenital stagnation affecting vessel flow. However, the differentiation of Dai Mai differs. For instance, Xuanming Wuqi Pian states "Spleen pulse is Dai," and Xieqi Zangfu Bingxing Pian states "Yellow complexion corresponds to a Dai pulse." Both refer to the normal manifestation of zang qi, not a stopping pulse. Furthermore, Pingren Qixiang Lun states: "In late summer, a slight weakness in the Stomach pulse is normal; but a Dai pulse without Stomach Qi indicates death." This refers to the departure of Stomach Qi and the appearance of the True Zang pulse, signifying death, not merely a stopping pulse. From this, we see that "Dai" has multiple meanings. "Fifty beats without intermission" refers to the numerical aspect of Dai, as described in this chapter. If a normally uniform pulse suddenly becomes strong or weak, it refers to physical variation, as mentioned in Pingren Qixiang Lun. If the Spleen governs the four seasons and changes accordingly, it refers to climatic variation, as noted in Xuanming Wuqi Pian. Any pulse without a fixed pattern that changes frequently is termed Dai. One must observe the specific variations to understand their significance. Failure to comprehend this leads to misunderstanding the classics and inability to distinguish auspicious from inauspicious pulse signs, rendering diagnostic discussion futile. Detailed explanations are found in Nan Jing Chapter 11 and Disease Class, Section 25. Additional Commentary: This chapter only discusses the number of beats and stops to diagnose the lack of qi in the five zang, without explicitly predicting years of survival. However, Wang Shuhe’s Mai Jing added specific timelines: Forty beats with one stop indicates one zang lacks qi, death in four years when spring grass grows. Thirty beats with one stop indicates two zangs lack qi, death in three years when wheat ripens. Twenty beats with one stop indicates three zangs lack qi, death in two years when mulberries turn red. Ten beats with one stop indicates four zangs lack qi, death within the year. Five beats with one stop indicates five zangs lack qi, death in five days. Subsequent authorities have adhered to this view, yet it is unlikely that one could survive four years with one zang lacking qi or three years with two zangs lacking qi. Practitioners should critically evaluate this claim.)