Library

The *Suwen* (Basic Questions) states: Pulse diagnosis is usually performed in the early morning, when Yin Qi (Yin Energy) has not yet stirred, Yang Qi (Yang Energy) has not yet dispersed, food and drink have not been ingested, the Jingmai (Meridian Vessels) are not yet full, the Luomai (Collateral Vessels) are harmonious and even, and the Qi and Blood are not yet chaotic. Therefore, it is possible to diagnose abnormal pulses ("Guo" refers to pulse conditions that differ from normal signs). By palpating the movement and stillness of the pulse and observing the patient's eyes for spirit ("Jingming" refers to observing the patient's eyes; old annotations identifying this as the Jingming acupoint are incorrect), examining the Five Colors, observing whether the Zang organs (Solid Organs) have excess or deficiency, assessing the strength or weakness of the Fu organs (Hollow Organs), and evaluating the flourishing or declining state of the body, one can determine the division between life and death (from the chapter "Essential Secrets of Pulse Observation").

Wang Haizang said: In all pulse diagnoses, one must first palpate the palms and backs of the hands. Heat in the palms indicates internal injury; heat on the backs of the hands indicates external injury. Next, distinguish by pulse: Internal injury causes disharmony of the limbs and heat in both hypochondria, originating from the Shaoyang channel; this is a progression from inside to outside, starting with substantial pathology. External injury causes whole-body heat, originating from the Taiyang channel; this is a progression from outside to inside, initially without substantial pathology. If both the Renying pulse and the Qikou pulse are vigorous, or feel solid and large upon lifting and pressing, presenting with exterior fever and aversion to cold, abdominal discomfort, and excessive saliva, this indicates simultaneous internal and external injury.

The *Suwen* further states: One must thoroughly master Yin and Yang theory and not consult with others. What is meant by Yin and Yang? Departing is Yin, arriving is Yang; stillness is Yin, agitation is Yang; slowness is Yin, rapidity is Yang (from the chapter "Discussion on Distinctions of Yin and Yang"). It also states: The inner sides of both Chi positions correspond to the Jixie (hypochondriac region) (referring generally to both Chi pulses; the Jixie is near the Kidney, governed by the Chi pulse). The outer side of Chi observes the Kidney, while the inner side observes the abdomen ("Li" means "inside". Whenever "outer" is mentioned, it refers to the lateral aspect of the arm; whenever "inner" is mentioned, it refers to the aspect near the arm tendons. Above the Jixie is the domain of the Kidney, hence used to observe the Kidney. The observation of the Kidney has two aspects: the Left Chi observes the Kidney and Bladder, while the Right Chi observes the Mingmen (Gate of Life) and Sanjiao (Triple Burner). Inside the Jixie is the domain of the abdomen, hence used to observe the abdomen). Above the Chi position is the Guan position. The outer side of the Left Guan observes the Liver, and the inner side observes the Diaphragm ("Ge" is identical to "Di", i.e., the cardia; the Liver governs the cardia); the Right Guan (the text omits "above the Guan," inheriting the meaning from above) observes the Stomach on its outer side and the Spleen on its inner side (The Spleen resides in the center, so observed internally; the Stomach is the market of water and grain, so observed externally). Above the Guan is the Cun position. The outer side of the Right Cun observes the Lung, and the inner side observes the Chest Center (The lung lobes hang outward, so observed externally; the chest center governs the air passages, so observed internally); the Left Cun observes the Heart on its outer side and the Danzhong on its inner side (The Heart and Heart Master reside within the diaphragm. Danzhong belongs to the Upper Burner, located between the two breasts). The anterior part of the pulse observes the anterior body (Upper anterior refers to the Left Cun Kou; Lower anterior refers to the anterior chest and Qihai area). The posterior part observes the posterior body (Upper posterior refers to the Right Cun Kou; Lower posterior refers to the posterior back and Qihai area). Pulses extending upward to the Yuji point ("Jing" means end; Shang Jing Shang refers to reaching Yuji) concern matters of the chest and throat. Pulses extending downward to the end of the Chi pulse movement concern matters of the lower abdomen, waist, thighs, knees, shins, and feet (from the chapter "Essential Secrets of Pulse Observation"). Lou Quanshan said: The *Neijing* uses the Cun, Guan, and Chi pulses to observe Zang and Fu organs only in this manner. It was not until the *Nanjing* (Classic of Difficult Issues) that Cun, Guan, and Chi were formally established as three positions, and Floating, Middle, and Deep as nine observations. The *Nanjing* states: There are three positions of the pulse: Cun, Guan, and Chi. The upper position models Heaven, governing diseases from the chest up to the head; the middle position models Humanity, governing diseases from below the diaphragm to the umbilicus; the lower position models Earth, governing diseases from below the umbilicus to the feet. Each position has three observations: Floating, Middle, and Deep, totaling nine observations (summarized from Chapter 18 of the *Nanjing*).

Zhu Danxi said: The Lung governs Qi, and its pulse is located at the Right Cun; the Spleen, Stomach, Mingmen, and Sanjiao each operate through changes in Qi, so they are attached here. The Heart governs Blood, and its pulse is located at the Left Cun; the Liver, Gallbladder, Kidney, and Bladder are all channels and repositories of Essence and Blood, so they are also attached here. In men, if the disease presents with the Right pulse filling the Left side, there is Stomach Qi, and although severe, it is treatable. In women, if the disease presents with the Left pulse filling the Right side, there is Stomach Qi, and although severe, it is treatable. The reverse indicates extreme deficiency.

Chen Wuyue said: The Heart position on the Left Hand at Cun belongs to the Hand-Shaoyin channel and converges with the Hand-Taiyang Small Intestine channel. The Liver position at Guan belongs to the Foot-Jueyin channel and combines with the Foot-Shaoyang Gallbladder channel. The Kidney position at Chi belongs to the Foot-Shaoyin channel and combines with the Foot-Taiyang Bladder channel. The Lung position on the Right Hand at Cun belongs to the Hand-Taiyin channel and converges with the Hand-Yangming Large Intestine channel. The Spleen position at Guan belongs to the Foot-Taiyin channel and combines with the Foot-Yangming Stomach channel. The Kidney position at Chi belongs to the Hand-Jueyin Pericardium channel and combines with the Hand-Shaoyang Sanjiao channel.

The *Nanjing* further states: There are three positions of the pulse, each containing four meridians. The Hand-Taiyin Lung and Hand-Yangming Large Intestine belong to Metal; Metal generates Water, producing the Foot-Taiyang Bladder and Foot-Shaoyin Kidney. Water flows downward and cannot ascend, hence they are in the lower position. The Foot-Jueyin Liver and Foot-Shaoyang Gallbladder belong to Wood; Wood generates Fire, producing the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart. Fire flares upward and cannot descend, hence they are in the upper position. The Hand-Jueyin Pericardium and Hand-Shaoyang Sanjiao belong to Fire; Fire generates Earth, producing the Foot-Taiyin Spleen and Foot-Yangming Stomach. Earth governs the central nourishment, hence they are in the middle position. This is the mutual generation and nourishment of the Five Elements via mother-son relationships (excerpted from Chapter 18 of the *Nanjing*). It also states: The pulse has Yin and Yang aspects. Exhalation involves the Heart and Lung; inhalation involves the Kidney and Liver. Between breaths, the Spleen receives the essence of grains, and its pulse is in the middle. Floating pulses are Yang; sinking pulses are Yin. Both Heart and Lung pulses float; how to distinguish them? A floating, large, and scattered pulse is the Heart pulse; a floating, choppy, and short pulse is the Lung pulse. Both Kidney and Liver pulses sink; how to distinguish them? A firm and long pulse is the Liver pulse; a pulse that feels soft upon pressure but becomes solid when lifted is the Kidney pulse. The Spleen resides in the Central Plain, so its pulse is in the middle; this is the method of Yin and Yang (from Difficulty 4). Pulse palpation has degrees of weight. Initially holding the pulse with the weight of three beans, touching the skin and hair, is the Lung pulse (Shu refers to soybeans); with the weight of six beans, adapting to the blood vessels, is the Heart pulse; with the weight of nine beans, level with the tendons, is the Liver pulse; pressing to the bone, where the pulse comes rapidly upon lifting, is the Kidney pulse. This is what is meant by light and heavy pressure (from Difficulty 5).

The *Suwen* further states: All floating pulses without agitation indicate pathology in Yang, manifesting as heat (pathology in the Foot-Yang meridions; Yang represents Fire Qi, hence heat). If there is agitation, the pathology is in the Hand-Yang meridians (pathology in the Hand-Yang meridians). All fine and sinking pulses indicate pathology in Yin, manifesting as bone pain (if fine, sinking, and agitated, the pathology arises in the Hand-Yin meridians; Yin governs bones, hence bone pain). If there is stillness without agitation, the pathology is in the Foot-Yin meridians (still and non-agitated, pathology arises in the Foot-Yin meridians, from the chapter "Essential Secrets of Pulse Observation"). It also states: The Three Yang pulses are at the head, and the Three Yin pulses are at the hand; this is called "One" (Head refers to the Renying pulse, 1.5 cun lateral to the laryngeal prominence. Hand refers to the Qikou pulse, 1 cun posterior to the thenar eminence. The two correspond, coming and going together, equal in size like a drawn rope, called a healthy person, hence termed "One"). Those who can distinguish Yang know the contraindicated times for illness; those who can distinguish Yin know the period of death or survival (identifying the regularity of Qi allows knowing contraindications; clarifying success and failure allows knowing the timing of death or survival, from the chapter "Discussion on Distinctions of Yin and Yang"). The *Lingshu* states: The Qikou pulse observes Yin, governing internal issues; if vigorous and firm, it indicates food injury. The Renying pulse observes Yang, governing external issues; if vigorous and firm, it indicates cold injury (summarized from chapters "Four Seasons Qi", "Discussion on Forbidden Pulses", and "Five Colors").

The *Neijing* states: If the Renying pulse is one degree stronger than the Cun Kou pulse ("one degree stronger" means the Renying pulse is twice the size of the Cun Kou pulse; other degrees follow similarly), the disease is in the Foot-Shaoyang Gallbladder channel. One degree stronger and agitated indicates disease in the Hand-Shaoyang Sanjiao channel. Two degrees stronger indicates disease in the Foot-Taiyang Bladder channel. Two degrees stronger and agitated indicates disease in the Hand-Taiyang Small Intestine channel. Three degrees stronger indicates disease in the Foot-Yangming Stomach channel. Three degrees stronger and agitated indicates disease in the Hand-Yangming Large Intestine channel. Four degrees stronger, large, and rapid is named Yi Yang (Overflowing Yang); Yi Yang constitutes Wai Ge (External Grid) (four times or more is the extreme of Yang excess, leading to rejection, vomiting, and inability to ingest food). If the Maikou (i.e., Cun Kou) pulse is one degree stronger, the disease is in the Foot-Jueyin Liver channel. One degree stronger and agitated indicates disease in the Hand-Jueyin Pericardium channel. Two degrees stronger indicates disease in the Foot-Shaoyin Kidney channel. Two degrees stronger and agitated indicates disease in the Hand-Shaoyin Heart channel. Three degrees stronger indicates disease in the Foot-Taiyin Spleen channel. Three degrees stronger and agitated indicates disease in the Hand-Taiyin Lung channel. Four degrees stronger, large, and rapid is named Yi Yin (Overflowing Yin); Yi Yin constitutes Nei Guan (Internal Closure) (extreme Yin excess leads to closure and inability to urinate). Nei Guan unblocked leads to death and is untreatable. If both the Renying pulse and the Ta Yin Maikou (Cun Kou) are four times stronger, it is named Guan Ge (Grid Lock) (Maikou is also Ta Yin, specifically the Hand-Taiyin Lung channel). The pulse of Guan Ge is depleted; if it cannot exhaust the essence and Qi of Heaven and Earth, death ensues ("Ying" is interchangeable with "Ying" meaning full. When Yin and Yang are both excessive, extreme excess leads to decline and lack of mutual support, hence named Guan Ge, implying coexistence of two pathologies. Coexisting pathologies mean one cannot reach their natural lifespan, thus dying prematurely) (combined from *Lingshu: Zhong Shi* and *Suwen: Liu Jie Zang Xiang Lun*; Pang Anchang said: The key to pulse diagnosis lies urgently in observing Renying and Cun Kou. These two pulses correspond like two drawn ropes; if Yin and Yang are balanced, the ropes are of equal thickness. In healthy people, the Renying pulse is larger in spring and summer, while the Cun Kou pulse is larger in autumn and winter. What is the Renying pulse? It is taken at the side of the throat, referred to in the *Neijing* as distinguishing Yang. Qin Yueren only took the course of the Hand-Taiyin channel, measuring 1.9 cun posterior to Yuji, matching it with Yin-Yang numbers to derive Guan Ge pulses, but did not fully take pulses from the throat and hand, nor did he first seek the meaning of the throat-hand rope analogy, thereby obscuring the origins of Cun-Chi, Yin-Yang, and Guan Ge. If the Cun pulse is four times the Chi pulse, it extends upward to Yuji as an Overflow pulse; the Overflow pulse is the extreme where Cun exceeds Chi. The Overflow pulse is also called Wai Guan (External Grid), referring to the pulse extending outward from the Guan position upward; also called Nei Ge (Internal Grid), where Yin rejects Yang and moves outward; also called Yin Cheng pulse, where Yin originates at Cun and moves at Chi. Now, overflowing from Guan to Yuji, while the pulse after Guan runs submerged, is Yin overpowering Yang; when Yang is exhausted, death occurs. Such a pulse indicates death. This is what is meant by Cun Kou being four times Renying, constituting the Guan Yin pulse. After the Guan, the pulse should sink at one cun; exceeding this, the Chi pulse multiplies relative to Cun. At four times, it enters Chi as a Cover pulse; the Cover pulse is the extreme where Chi exceeds Cun. The Cover pulse is also called Nei Guan (Internal Grid), referring to the pulse inward from the Guan position; also called Wai Ge (External Grid), where Yang rejects Yin and enters inward; also called Yang Cheng pulse, where Yang originates at Chi and moves at Cun. Now, covering from Guan into Chize, while the pulse before Guan runs submerged, is Yang Yuan overpowering Yin; when Yin is exhausted, death occurs. Such a pulse indicates death. This is what is meant by Renying being four times Cun Kou, constituting the Ge Yang pulse. Although solitary Cover or Overflow can be regulated by tonification and sedation: Chi position one degree stronger, sedate Foot-Shaoyang, tonify Foot-Jueyin; two degrees stronger, sedate Foot-Taiyang, tonify Foot-Shaoyin; three degrees stronger, sedate Foot-Yangming, tonify Foot-Taiyin; these are two sedations and one tonification. Four degrees stronger implies extreme Yang; guide with order, advance to points of Shaoyang, Taiyang, and Yangming. If the pulse is quiet, take Three Yang on the foot; if rapid, take Three Yang on the hand. Sedate Yang two parts, tonify Yin one part. At Cun, reverse this. Furthermore, the pulse has nine observations, taking Floating, Middle, and Deep at Cun, Guan, and Chi. Yueren did not take twelve meridian points but combined Foot-Shaoyin and Foot-Yangming with Hand-Taiyin courses, dividing the 9 fen position from Chi to Cun into three positions, each with Floating, Middle, and Deep to match Heaven, Earth, and Humanity. He also stated: Wind-stroke belongs to Wood, Cold Injury belongs to Metal, Warm-Water-Hot-Fire. Warm diseases originate from Dampness; Dampness affects Earth; Earth pathology harms all viscera, rooted in changes of Metal, Wood, Water, and Fire. Floating Yang and Soft Yin is Wind-Warm; Rapid Yang and Solid Yin is Warm-Toxin; Soft Yang and Tight Yin is Damp-Warm; Excess Yin and Yang is Warm-Malaria. Treatment: Wind-Warm takes Foot-Jueyin Wood and Hand-Shaoyin Fire; Warm-Toxin takes Hand-Shaoyang Fire; Cold Injury takes Hand-Taiyin Metal and Hand-Shaoyin Fire; Damp-Warm takes Foot-Shaoyin Water. All can distinguish similarities and differences without confusion, precisely because Yin-Yang was determined at throat and hand, Cover-Overflow matched to Cun-Chi, Nine Observations embedded in Floating-Middle-Deep, and Four Warms distinguished from Cold Injury. These were initiated by Yueren; I have refined them by consulting various chapters of the *Neijing*, applying them prudently and treating according to principles, so diseases cannot escape (Note: The *Neijing* discusses Wai Guan first, following the order of Outer/Inner; Pang discusses Nei Ge first, following the meaning of Yin/Yang. Both have merit and do not contradict the classics. His omission of tonification/sedation methods and differentiation of Four Warms treatments especially reveals insights not previously expressed; students should study this carefully). The *Suwen* further states: The pulse has Yin and Yang. Knowing Yang allows knowing Yin; knowing Yin allows knowing Yang. What is Yin? It is the True Zang pulse (Zang organs belong to Yin, so Yin is the True Zang). Appearance of True Zang pulse indicates decay, and decay inevitably leads to death (Liver pulse arrives tense inside and out; Heart pulse arrives firm and beating; Lung pulse arrives large and empty; Kidney pulse arrives beating and abrupt; Spleen pulse arrives weak and intermittently rapid or slow—all constitute pulse appearance. Appearance means Zang decay and Spirit departure, hence certain death). What is Yang? It is the Yang of the Stomach House (Renying pulse Qi). Those who can distinguish Yang know the location of disease and its origin (added four characters based on *Yu Ji Zhen Zang Lun*); those who can distinguish Yin know the period of death or survival (from the chapter "Discussion on Distinctions of Yin and Yang"). It also states: The nine observations should correspond, upper and lower as one, not losing sync. If one observation lags, there is disease; if two lag, disease is severe; if three lag, disease is critical. "Lagging" means responses are not simultaneous (Ju means same, one). Observe the nine observations: unique smallness indicates disease, uniqueness in largeness indicates disease, uniqueness in speed indicates disease (Ji means fast, i.e., rapid), uniqueness in slowness indicates disease, uniqueness in heat indicates disease, uniqueness in cold indicates disease, uniqueness in depression indicates disease, and disharmony among Form and Qi indicates disease. Pulses of upper, lower, left, and right corresponding like pestle pounding in a mortar indicate severe disease (Can Chong refers to pulse being large, rapid, and pulsating, like a pestle pounding up and down). Flourishing form with fine pulse, shortness of breath indicating insufficiency of Qi indicates danger. Emaciated form with large pulse and excess Qi in the chest indicates death. Decreased observations in the middle position indicate death (decreased compared to upper and lower positions, also indicating Qi decline). Fluctuating frequency in the middle position indicates death (disorder of Qi). Even if the middle pulse is independently harmonious, loss of correspondence with other Zang organs indicates death (non-correspondence with upper and lower positions). Loss of correspondence among upper, lower, left, and right, uncountable, indicates death (more than ten beats per respiration). Loss of correspondence among all three positions and nine observations indicates death. Absence of pulse circulation indicates death (departure of Spirit). Sunken inner canthi indicate death (Taiyang pulse originates from the inner canthus; sunken inner canthus indicates Taiyang exhaustion). Bones protruding with immobile body indicate death (Qu means movement). Emaciated flesh and bones with harmonious nine observations still indicate death. Skin adhering to bone indicates death (desiccation of bone shaft) (sequentially excerpted from the chapter "Three Positions and Nine Observations").

Zhang Zhongjing said: If the Cun pulse does not reach down to the Guan position, it is Yang Extinction; if the Chi pulse does not reach up to the Guan position, it is Yin Extinction. Both are untreatable and certainly fatal. To calculate the remaining lifespan and timing of death, one must consider the elemental overcoming by monthly solar terms (Yang Extinction dies in Spring and Summer; Yin Extinction dies in Autumn and Winter; this speaks to their correspondence).