Library

Pulse is located prior to the movement of Qi and Blood. Palpation (Qie Zhen) is one of the Four Diagnostic Methods (Wang, Wen, Wen, Qie). In order to treat diseases, pulse diagnosis is paramount. However, the principles of pulse are extremely subtle. Unless one possesses skilled hands and a quick mind, it is rare not to make errors that lead to significant deviations from the truth.

Although the recorded pulse methods are not very detailed, the general outline is fully contained here.

The Yellow Emperor asked: "What is the method of diagnosis?"
Qi Bo replied: "Diagnosis is usually performed at dawn (Ping Dan). At this time, Yin Qi has not yet moved, Yang Qi has not yet dispersed, food and drink have not been taken in, the Jing Luo (Primary and Secondary Channels) are not yet vigorous, the collateral vessels are harmonious and uniform, and Qi and Blood are not yet chaotic. Therefore, only then can abnormal pulses be diagnosed." By palpating the movement and stillness of the pulse, observing the clarity of the eyes (Jing Ming), examining the five colors of the face, and assessing the excess or deficiency of the Five Zang Organs (Liver, Heart, Spleen, Lung, Kidney), the strength or weakness of the Six Fu Organs (Gallbladder, Small Intestine, Stomach, Large Intestine, Bladder, San Jiao), and the flourishing or decline of the physical form, these factors are compared and cross-referenced (Can Wu) to determine the boundary between life and death. ("Guo" refers to signs different from the normal state; "Qie" refers to pressing the finger close to the pulse. Note: 'Dong' is interpreted by some as pulse movement descending, but this meaning is hard to explain. At dawn, Yang Qi begins to function, human Qi is clear and bright, and Qi and Blood are not yet chaotic, so the gain or loss of pulse Qi can be examined. The six sentences about dawn explain why Qi and Blood are not yet chaotic. Interpreting 'Jing Ming' as an acupoint name is incorrect. The spirit of the whole body ascends to the eyes. Observing 'Jing Ming' means observing the brightness or dimness of the eye's spirit to know the person's essence and Qi, as seen in the following passage on 'Fu Jing Ming Zhe'. 'Can Wu' means comparing numbers of excess or deficiency, as stated in the I Ching: 'Can Wu Yi Bian'.)

The pulse is the residence (Fu) of Blood. (Fu means gathering; it means that the quantity of blood gathers and manifests in the Jing Luo.) Thus, the *Treatise on Acupuncture and Qi* says: "When the pulse is full, Blood is full; when the pulse is empty, Blood is empty. This is the norm; deviation from this indicates disease."

A long pulse indicates regulated Qi; a short pulse indicates diseased Qi; a rapid pulse indicates vexation of the heart; a large pulse indicates advancing disease. (Long indicates harmonious Qi and thus regulation; short indicates insufficiency and thus disease; rapid and urgent indicates Heat causing vexation; large indicates abundant pathogenic factors and thus advancing disease.) Excess in the upper part (Cun Kou / Inch position) indicates rebellious Qi; excess in the lower part (Chi position) indicates abdominal distension; a choppy/intermittent pulse (Dai Mai) indicates declining Qi; a thin pulse indicates deficient Qi; a choppy pulse (Se Mai) indicates heart pain. (Upper refers to Cun Kou, Lower refers to Chi Zhong, Excess refers to fullness. Dai Mai is characterized by pauses in the beat that do not self-correct. Xi Mai beats faintly like weeds. Se Mai is unsmooth and hesitant in its flow.) If the pulse is turbid and rushing like a gushing spring, the disease advances and the complexion deteriorates; if the pulse is faint and disappearing like a broken string, death ensues. (Hun Hun describes turbid and chaotic pulse Qi. Ge Zhi describes a pulse that is wiry, large, solid, and long. Like a gushing spring means the pulse flows out but does not return. Mian Mian describes a pulse that is faintly present but not easily felt. Like a broken string means the pulse suddenly cuts off like a severed string. If the disease progresses daily and the complexion becomes sallow, such pulses indicate certain death. Note: Wang Bing's commentary is clear and should be followed; the New Correction citing *Jia Yi Jing* and *Mai Jing* is incorrect.)

The clarity of the eyes and the five colors of the face are the blossoms (Hua) of Qi. (Note: Jing Ming refers to the eyes, Wu Se refers to the face. Clear eyes and correct facial colors indicate sufficient Yuan Qi, whose essence manifests externally.) Red should resemble white silk wrapping cinnabar, not hematite; White should resemble goose feathers, not salt; Green should resemble the luster of green jade, not indigo; Yellow should resemble raw yellow earth wrapped in silk, not plain yellow earth; Black should resemble heavy lacquer, not dark soil. (...Note: Colors should be moist and spirited; this discusses the five colors.) The clarity of the eyes is used to see all things, distinguish black from white, and judge length and shortness. If one mistakes long for short and white for black, the Essence is depleted. (Note: Depletion of Essence leads to lack of clarity in the eyes; this explains 'Jing Ming'.)

The Five Zang Organs are the guardians within. (Note: Fu organs are Yang and exterior; Zang organs are Yin and interior. Because they are interior, they are called 'Zhong' (Middle/Inside). Guardian refers to the place where the Five Spirits reside securely.) If there is excess in the Middle with organ fullness, and Qi rebellion injuring fear, the voice sounds as if coming from inside a room; this is dampness in the Middle Qi. (Note: Voice sounding like it comes from a room indicates Qi blockage preventing sound from reaching outside.) Speaking in a low voice and only speaking again after a whole day indicates depletion of Qi. Wearing clothes and blankets disheveled, speaking without regard for good or bad, and not avoiding intimacy or distance with relatives and strangers indicates chaos of the Spirit (Shen). Failure of the Granary (Spleen/Stomach) to store indicates failure of the gates to control. (Yao means restriction/control.) Unceasing urine indicates failure of the Bladder to store. (Note: E stands for abuse. When Yuan Qi is depleted, speech is intermittent; when Shen is confused, actions are erroneous, which is easy to understand. Regarding failure of the Granary to store, people blame the Spleen and Stomach, not realizing that if the Stomach is diseased it cannot receive, and if the Spleen is diseased it cannot transport. Here, it is not inability to receive or transport, but inability to store firmly, which is the responsibility of the Kidney. Why? The Kidney opens into the two yin openings. Kidney deficiency leads to inability to secure, just as unceasing urine, although it is the Bladder's failure to store, is ultimately due to Kidney Qi failing to hold. *Water Heat Acupoint Treatise* says: "The Kidney is the gate of the Stomach." This implies the meaning of the gate.) Those who retain their guardians live; those who lose them die. (Note: Spirit is stored by the Zang, and the Zang is guarded by the Spirit, so life and death are judged by this.)

The Five Zang Organs are the strength of the body. (When Zang are peaceful, Shen is guarded; when Shen is guarded, the body is strong.) The head is the residence of Jing Ming. If the head droops and the eyes are sunken, the Spirit is about to be depleted. The back is the residence of the Chest. If the back is curved and shoulders sag, the residence is about to fail. The waist is the residence of the Kidney. If turning and shaking is impossible, the Kidney is about to be exhausted. The knees are the residence of the Sinews. If flexion and extension are impossible, and walking requires stooping and leaning, the Sinews are about to be exhausted. The bones are the residence of Marrow. If standing for long periods is impossible, and walking causes trembling, the Bones are about to be exhausted. (Note: These are all signs of bodily weakness. Qing means tilting down. Shi Shen means sunken eye sockets. Sui means bending along with the back. Fu means leaning on objects because the body is too stooped to walk alone. Zhen Diao means trembling. Lou means inability to extend upright.) Those who retain strength live; those who lose strength die. (...Note: Constant strength prevents disease; once weak, disease follows, with unpredictable consequences.)

The Emperor said: "How does the pulse move with the four seasons? How do we know the location of the disease? How do we know the changes of the disease? How do we know when the disease is suddenly internal? How do we know when the disease is suddenly external? Please tell me about these five points."
Qi Bo said: "Let me speak of how they correspond to the great rotation of Heaven." (Note: The rotation of Heaven is endless, and the changes of these five points are similar.) Outside all things, within the Six Directions (Si He - North, South, East, West, Up, Down), the changes of Heaven and Earth, the response of Yin and Yang: the warmth of spring becomes the heat of summer; the severity (fen) of autumn becomes the anger (nu) of winter. The movement of the four changes corresponds to the rising and falling of the pulse. (Six Directions refer to the four cardinal directions plus up and down. Note: Spring Qi is harmonious and warm; Summer Qi is intense and hot. Quan Quanyi interpreted 'warm' as slow, which is incorrect. The commentary interprets 'fen' as urgent, describing Autumn Qi as sharp and urgent, which is good. Autumn Qi is sharp like anger; Winter Qi is肃杀 (solemn and killing) like rage. Qi changes with the times, and the pulse responds accordingly.) Spring pulse corresponds to the Circle (Gui); (Spring pulse is weak and slippery, resembling the shape of a circle, so Spring corresponds to Gui.) Summer pulse corresponds to the Square (Ju); (Summer pulse is洪大 (vast/large), combined with slippery and rapid, resembling the shape of a square, so Summer corresponds to Ju.) Autumn pulse corresponds to the Balance (Heng); (Autumn pulse is floating and fine, light, choppy, and scattered, resembling the balance of a scale, so Autumn corresponds to Heng.) Winter pulse corresponds to the Weight (Quan); (Winter pulse is like stone, combined with deep and slippery, resembling the weight of a scale, so Winter corresponds to Quan. Note: As the four seasons change, the pulse images respond differently, like the circle, square, balance, and weight. Do not interpret these four characters too rigidly.) Therefore, forty-five days after the Winter Solstice, Yang Qi slightly rises, and Yin Qi slightly descends; forty-five days after the Summer Solstice, Yin Qi slightly rises, and Yang Qi slightly descends. Yin and Yang have their times, and the pulse has its period. If the period passes and the pulse deviates, knowing the division of the pulse, and knowing that divisions have periods, one can know the time of death. (By observing the standard of Yin and Yang ascent and descent, one knows the image of meridian transition; by examining the loss of climatic transition, one knows the period of Qi and Blood combination and separation. If the division is accurate, one knows the time of death.) The subtlety lies in the pulse, which must not be neglected. Examination has a discipline, starting from Yin and Yang. Starting has classics, generated from the Five Elements. Generation has limits, appropriate for the four seasons. (Note: 'Yi' (appropriate) is written as 'Shu' (number) in *Tai Su*, which is incorrect. Pulse harmonizing with the four seasons indicates a healthy pulse.) Do not miss tonification or sedation; align with Heaven and Earth. (...Note: This refers to treatment methods.)

Therefore, when Yin is excessive, one dreams of crossing large waters and feeling fear; when Yang is excessive, one dreams of large fires burning; when both Yin and Yang are excessive, one dreams of killing and destruction. Excess in the upper part leads to dreams of flying; excess in the lower part leads to dreams of falling. Being very full leads to dreams of giving; being very hungry leads to dreams of taking. Liver Qi excess leads to dreams of anger; Lung Qi excess leads to dreams of crying. Many short parasites lead to dreams of gathering crowds; many long parasites lead to dreams of fighting and destruction. (Note: New Correction states: "Detailed examination shows that from 'Yin excess dreams of crossing water' to 'dreams of crying', this is text from *Ling Shu* misplaced here. It also lacks content regarding Heart, Spleen, and Kidney Qi excess, which is found in *Jia Yi Jing*. The lines about short and long parasites should not appear here and are likely lost slips from other chapters.")

Therefore, holding the pulse has a way: emptiness and stillness are precious. (Previously explained pulse response to seasons; now stating the principle of holding the pulse. The way of holding the pulse requires an empty mind and quiet will, to preserve surplus and deficit without error. Note: Wang's version uses 'Bao' (protect), which seems verbose. *Jia Yi Jing* uses 'Bao' (treasure), which makes more sense. We follow it; Bao means precious.) Spring pulse floats, like fish swimming in waves; (Though emerging, not fully floating. Note: Also has a gentle and slow image.) Summer pulse is in the skin, abundant like all things in summer; (Fan Fan means flat/surplus. Yang Qi is abundant, pulse Qi also resembles the abundance of all things, easy to take and vast/large.) Autumn pulse is below the skin, like hibernating insects preparing to leave; (Following the gradual descent of Yang Qi, hence 'below skin'. How do we know Yang Qi is descending? Because hibernating insects are about to hide.) Winter pulse is in the bone, like hibernating insects tightly packed, and gentlemen staying indoors. (...In bone means pulse is deep. Hibernating insects tightly packed means Yang Qi is hidden. Gentlemen staying indoors is human affairs. Note: New Correction states: "Detailed examination shows this previously answered the Emperor's question about pulse movement with the four seasons.")

If the Heart pulse beats firm and long, one should suffer from tongue retraction and inability to speak; (Bo means beating against the hand. All pulses that are firm and long indicate Heart labor leading to extreme deficiency of Zang pulse Qi. The Heart Hand-Shaoyin Meridian ascends from the Heart connection alongside the throat, causing tongue retraction and inability to speak. Note: Heart pulse firm and long, beating against fingers, indicates Fire excess and Qi floating. The tongue is the sprout of the Heart, hence retraction and inability to speak. The commentary attributes it to Heart labor and extreme Zang Qi deficiency, but it is doubtful that a firm and long pulse can be generally diagnosed as deficiency.) If the pulse is soft and scattered, one should suffer from Xiao Ke (Wasting-Thirst), which will resolve itself when the cycle completes. (All soft and scattered pulses indicate Qi excess and Blood deficiency. Xiao means dissipate, Huan means cycle, indicating its Jing Qi circulates like a ring, and when Fire is king, it dissipates naturally. Note: The meaning of 'Xiao Huan' is hard to explain. *Jia Yi Jing* reads 'Xiao Ke', Wang Bing reads 'dissipate around the cycle', neither is clear. Leave as doubt. Ruan sounds like ruan. Carefully: The Heart, Lung, Liver, Stomach, Spleen, and Kidney (Five Zang and one Fu, six meridians) all have pulses that are firm/long or soft/scattered, corresponding to different diseases. Wang Bing interprets all as deficiency. I have doubted this. The six meridians have different images and govern different diseases; how can they all be explained by firm/long and soft/scattered? Does the scripture have no intent? Upon reflection, 'firm and long' refers to Pathogenic Excess; 'soft and scattered' refers to Healthy Deficiency. Within one meridian, there is both excess and deficiency, and pulse and disease correspond respectively. Wang Bing failed to clarify the distinction between excess and deficiency, hence his vague and inaccurate statements. Although, the meaning of the six meridians is also debatable. For example, Heart pulse firm and long, beating against fingers, indicates Fire excess and Qi floating, which has many symptoms, not just tongue retraction. Such cases are likely generalizations or examples of the most severe symptoms, and should not be taken as absolute facts. Those who read *Nei Jing* well only grasp the general idea.)

If the Lung pulse beats firm and long, one should suffer from spitting blood; (Note: Lung pulse is normally floating, choppy, and short. Now it beats firm and long, indicating Fire pathogen attacking the Lung, causing spitting blood. Spitting blood means blood in saliva/phlegm.) If the pulse is soft and scattered, one should suffer from Guan Han (Pouring Sweat), which cannot be treated with diaphoresis anymore. Note: Sweat comes from Xuan Fu (pores), which is the union of the Lung. Now the Lung pulse is scattered, indicating Lung deficiency and pathogens entering through its union, hence Pouring Sweat. Guan Han means sweat oozes like pouring water; in such cases, further diaphoresis should not be used, as it would further weaken the Lung. Note New Correction: "Detailed examination shows that while other Zang discuss colors, Heart and Lung do not, suggesting missing text."

If the Liver pulse beats firm and long, and the color is not green, one should suffer from falling or beating injuries, with blood trapped under the ribs, causing wheezing and counterflow qi. (When pulses show the Qi of the respective meridian but the color does not match, the disease does not originate internally but comes from outside to overcome. The Liver Jueyin Meridian distributes to the hypochondrium and follows behind the throat. Its branch passes through the Liver, crosses the diaphragm, and enters the Lung. Now blood is under the ribs, and blood Qi steams upward to the Lung, causing wheezing and counterflow qi. Note: The commentary is correct, but the explanation of 'falling/beating' is unclear. Supplementing: Green is the color of the Liver. Internal Liver disease must manifest externally in color. Now the pulse indicates disease but the color does not, meaning the disease comes from outside. Falling and beating are external injuries. The Liver governs the hypochondrium and stores Blood. Falling or beating causes blood to rebel under the ribs. Blood leaving the vessels becomes stale and foul, steaming upward to the Lung and causing wheezing.) If the pulse is soft and scattered, and the complexion is lustrous, one should suffer from Yi Yin (Overflowing Drink). Yi Yin means sudden thirst and excessive drinking, with fluid easily entering outside the muscle, skin, stomach, and intestines. (Floating and lustrous complexion indicates internal Dampness. Blood deficiency with internal Dampness leads to failure of fluid metabolism, hence Yi Yin. Once fluid fills up, it overflows easily into muscle, skin, stomach, and intestines. Note: The commentary on 'Yi' is correct; *Jia Yi Jing* reads 'Yi', which is incorrect.)

If the Stomach pulse beats firm and long, and the color is red, one should suffer from She Bi (fractured thigh pain). (Note: Stomach pulse should be slow. Now it is firm, long, and beating, indicating Stomach Qi excess. Red color indicates Fire in the Stomach. Symptoms should include abundant food intake, heat, thirst, and limb pain, but the text says 'She Bi', which is inexplicable. Wang Bing's commentary is unclear, and seeking further meaning is futile. Leave as doubt. Bi refers to the femur.) If the pulse is soft and scattered, one should suffer from Shi Bi (Food Bi). (Note: Bi interpreted as pain by commentators is incorrect. The Stomach governs reception. Soft and scattered Stomach pulse indicates deficiency, causing water and grain to become blocked, hence Food Bi.)

If the Spleen pulse beats firm and long, and the color is yellow, one should suffer from Shao Qi (deficient Qi). (Note: Spleen pulse should be smooth and slow. Firm, long, and beating indicates loss of peaceful nature and Spleen disease. Spleen disease manifests externally in color, hence yellow. Spleen and Stomach are the mother of Yuan Qi. Spleen disease leads to non-transportation of Qi, hence deficient Qi.) If the pulse is soft and scattered, and the color is not lustrous, one should suffer from foot swelling resembling water. (Note: Ze means moist/lustrous, the Qi of Water. Spleen is Earth, controlling Water. Soft and scattered Spleen pulse indicates deficiency failing to control Water, allowing Water to insult Earth. If Water ascends, moist Qi would appear on the face. Since it does not, Water disease descends, hence foot swelling. Treatment involves strengthening Earth and promoting water drainage.)

If the Kidney pulse beats firm and long, and the color is yellow and red, one should suffer from Zhe Yao (broken waist pain). (Yellow and red colors indicate Heart and Earth insulting the Kidney, causing the Kidney to suffer from guest pathogens, hence waist pain like breaking. Waist is the residence of the Kidney, hence disease originates internally.) If the pulse is soft and scattered, one should suffer from Shao Xue (deficient Blood), unable to recover. (Note: Kidney pulse should be deep and solid. Now it is soft and scattered, indicating internal deficiency of Essence and Blood. How can True Yuan recover?)

The Emperor said: "Palpating the Heart pulse, it is urgent. What disease is this? What are the symptoms?"
Qi Bo said: "The disease name is Xin Shan (Heart Hernia), and there should be a mass in the lower abdomen."
The Emperor said: "Why do you say so?"
Qi Bo said: "The Heart is a Mu (Yang) Zang, and the Small Intestine is its envoy, therefore there should be a mass in the lower abdomen." (Urgent pulses all indicate Cold. The Heart is a Mu Zang, its Qi corresponds to Yang. Now the pulse indicates Cold, hence Hernia. Note: Interpreting 'lower abdomen' as Small Intestine is incorrect. Lower abdomen is below the navel, the lower half of the abdomen. Cold Qi gathers in the middle, hence a mass. The Heart is Tai Yang within Yang, hence a Mu Zang. The Small Intestine is its Fu, hence 'envoy'. However, the two sentences 'Heart is Mu Zang...' seem like introductory remarks in Qi Bo's answer to the Emperor. The reason for the mass is not explained, so the word 'Gu' (therefore) does not connect properly. There must be missing text here, which Wang Bing ignored, a true regret. I summarize the general idea and supplement: Heart and Small Intestine are interior-exterior pairs, both belonging to Fire. Now Cold pathogen attacks the Heart. The Heart is a Fire Zang, having no place for Cold, so the pathogen follows its union. Cold wanting to attack the Heart cannot stay, and transfers to the Small Intestine. The Small Intestine region corresponds externally to the lower abdomen, hence a mass in the lower abdomen. However, the disease originates in the Heart, hence 'Heart Hernia'.)

The Emperor said: "Palpating the Stomach pulse, what are the symptoms?"
Qi Bo said: "Stomach pulse excess indicates distension; deficiency indicates diarrhea." (Excess pulse means Qi surplus, hence distension; deficiency pulse means Qi insufficiency, hence diarrhea. Note: New Correction states: "Detailed examination shows this answers the Emperor's previous question about knowing the location of disease.")

The Emperor said: "What is meant by disease formation and transformation?"
Qi Bo said: "Wind becomes Cold-Heat; (Note: Wind pathogen invading humans always causes Cold-Heat.) Dan becomes Xiao Zhong; (Dan means Damp-Heat. Accumulated Heat internally transforms into Xiao Zhong. Note: New Correction states: "Wang Bing interprets Xiao Zhong as eating much and losing weight. According to this classic, Xiao Zhong is eating much and urinating frequently. Eating much and losing weight is actually Shi Gu disease; it should be said 'eating much and frequent urination'.") Jue becomes Dian Ji; (Jue means Qi rebellion. Qi rebelling upward without stopping transforms into disease at the vertex.) Long-term Wind becomes Sun Xie; (Liver Qi internally combines and overacts on Spleen, causing this disease. Note: Wind is the transformation of Wood. Long-term Wind not departing leads to Wood excess insulting Spleen, hence Sun Xie. 'Sun' means evening meal; Sun Xie is night diarrhea.) Pulse Wind becomes Li. *Feng Lun* says: 'Cold and Wind lodge in the pulse and do not depart, named Li Feng.' It also says: 'Li means Ying Qi has Heat attachment, its Qi is not clear, hence causing the nasal pillar to collapse and complexion to fail, skin ulcers and溃烂.' However, this is Leprosy (Lei). Note: Li originally reads Lei. Transformations of disease are countless. (Note: New Correction states: "Detailed examination shows this answers the Emperor's previous question about knowing disease transformations.")

The Emperor said: "Various abscesses, sinew spasms, and bone pain, how are these generated?"
Qi Bo said: "These are swellings of Cold Qi and changes of the Eight Winds." (Eight Winds refer to winds from the eight directions.)
The Emperor said: "How to treat them?"
Qi Bo said: "These are diseases of the four seasons; treat them with their overcoming [element] to cure." (Sheng means overcoming, e.g., Metal overcomes Wood, Wood overcomes Earth.)

The Emperor said: "If there is an old disease where the Five Zang activate, damaging the pulse and color, how can one distinguish whether it is a new or old disease?"
Qi Bo replied: "You ask thoroughly! If the pulse is small but the color is not depleted, it is a new disease; (Qi is lacking but Shen is still strong.) If the pulse is not depleted but the color is depleted, it is an old disease; (Shen holds but Evil insults Qi.) If the pulse and five colors..."