Library

Zhang Jingyue posits: Pericardium, Lung, Danzhong (Chest Center), Liver, Gallbladder, Spleen, Stomach, Kidney, Bladder, Large Intestine, Mingmen (Gate of Vitality), Sanjiao (Triple Burner), Small Intestine. *Yizong Jinjian* (Golden Mirror of Medicine) posits: Heart, Danzhong (Chest Center), Lung, Xiongzhong (Chest Middle), Liver, Gallbladder, Spleen, Stomach, Kidney, Bladder, Small Intestine, Kidney, Large Intestine. The aforementioned schools of thought all base their allocation of the Zang and Fu organs on the *Huangdi Neijing* (Yellow Emperor's Inner Canon). Their divergence lies in the attribution of the Large Intestine, Small Intestine, and Sanjiao (Triple Burner). The three positions correspond to Cun (Inch), Guan (Bar), and Chi (Cubit); the nine examinations refer to Superficial (Fu), Moderate (Zhong), and Deep (Chen) palpation. The opinions of various schools are consistent: each of the three positions has Superficial, Moderate, and Deep palpation, hence termed the "Nine Examinations." The upper part (Cun position) primarily reflects diseases from the chest upwards to the head; the middle part primarily reflects diseases from below the diaphragm to the umbilicus; the lower part primarily reflects diseases from below the umbilicus to the feet. Clinically, whenever there is Lung Heat or wind-fire causing cough and panting, the Right Cun pulse presents as Wiry-Slippery or Floating-Big-Slippery-Rapid; when suffering from Lung Abscess with fever, the Right pulse is Slippery-Rapid, with the Right Cun being particularly prominent; for hypertension headache caused by Yin Deficiency with Yang Hyperactivity, the Cun pulse is stronger than the Chi pulse; when myocarditis or valvulitis causes alternating chills and fever, the pulse is Slippery-Rapid or Wiry-Rapid, more pronounced in the Left pulse; once the fever subsides, the pulse is no longer Slippery-Rapid, but the Left Cun often presents as Deep-Slippery, and in severe cases, an irregular pulse may be seen. All these illustrate the clear signs of "Cun reflects the upper" and "Left corresponds to Heart, Right to Lung." When Spleen and Stomach diseases occur, the Right Guan pulse changes accordingly: in acute gastritis, the Right pulse is Wiry-Rapid or Wiry-Slippery, with the Right Guan being most prominent; in stomach pain, the Right Guan often presents as Wiry-Tight; whereas in chronic gastritis, the Right Guan mostly presents as Deep-Slippery or Deep-Wiry-Rapid; in spasmodic stomach pain due to deficiency-cold, the Right Guan often presents as Wiry-Deficient. In pancreatitis with fever and abdominal pain, the pulse is mostly Wiry-Slippery-Rapid or Wiry-Big-Tight, more pronounced in the Right pulse; in Spleen and Stomach weakness with abdominal distension, epigastric fullness, and indigestion, the Right pulse is Wiry-Fine-Weak. This is the clear sign that "Right Guan reflects Spleen and Stomach." In damp-heat of the Bladder, presenting with stranguria, turbid urine, or blood in stool, the Chi pulse presents as Deep-Slippery or Wiry-Big; in lower limb swelling and pain, or joint swelling, or edematous pain of tinea pedis, the Chi pulse often presents as Deep-Slippery or Wiry-Rapid-Floating-Big, illustrating that "Chi reflects the lower." In the early stage of hepatitis, the Left Guan pulse is Wiry-Big, Wiry-Slippery, or Wiry-Rapid. In patients with chronic hepatitis, the pulse mostly presents a Wiry quality; the more Wiry, the heavier the disease; the less Wiry, the milder the condition. The development and remission of the disease should be judged by the severity of the Wiry pulse, predominantly evident at the Left Guan. Therefore, it can be known that the ancient disagreements did not exceed the basic theoretical scope of the *Neijing* principle of "Cun reflects the upper, Guan reflects the middle, Chi reflects the lower." What is called Danzhong, Pericardium, and Xiongzhong were originally included within the Cun pulse. A Slippery-Rapid-Wiry-Big Cun pulse with cough and panting indicates heat pathogen invading the Lung. If there is chest bi (obstruction) with fullness and pain, chest disease should be considered. Palpitations, shortness of breath, confusion, and delirium should be linked to Danzhong. Chest fullness, palpitations, shortness of breath, inability to breathe fully, or a sense of oppression, accompanied by an irregular pulse rate, mostly indicate Heart disease. A Wiry-Rapid or Wiry-Slippery Chi pulse, accompanied by urgent/frequent urination, hematuria, or painful stranguria, indicates Bladder or Small Intestine disease. If there is dry constipation, or abdominal pain with diarrhea, tenesmus, or passage of pus and blood, it indicates Large Intestine disease. Reddish, astringent, and difficult urination, along with generalized edema, indicates disease in the Sanjiao (Triple Burner). This also illustrates that TCM diagnosis requires combining pulse and symptom analysis; one must never rely solely on the pulse. Understanding this resolves ancient disputes. There is another diagnostic method involving the Renying, Cunkou, and Fuyang pulses. The Renying pulse is the carotid artery on the side of the neck; Renying is also the name of an acupuncture point. For general diseases, diagnosing via Cunkou (radial artery) to assess the abundance or decline of Zang qi is sufficient for diagnosis. When necessary, Renying and Cunkou must be cross-referenced; for example, in hypertension, the Renying pulse is often twice as large as the Cunkou pulse. In critical conditions where the Cunkou pulse is scattered or faint and nearly imperceptible, taking the Fuyang pulse is more reliable. The Fuyang pulse is the dorsalis pedis artery. Sometimes, the three positions must be consulted together for comprehensive analysis to reach a correct conclusion. (Table 2)

Cun, Guan, Chi
Left: Heart (Pericardium), Liver (Gallbladder), Kidney (Bladder, Small Intestine)
Right: Lung (Chest Center), Spleen (Stomach), Kidney (Mingmen, Large Intestine)

IV. Normal Pulse Qualities

Pulse diagnosis first requires identifying normal pulse qualities before distinguishing abnormal ones. The pulse is an important component of the entire organism. Although not diseased, the organism's response to climate changes or emotional impulses can cause temporary changes in pulse quality; such changes cannot be termed pathological pulses. A normal person's pulse is neither floating nor deep, neither rapid nor slow, beating four times per respiration cycle (64-80 beats/min), calm and moderate, with consistent rhythm, termed "having Stomach Qi." Regardless of whether a pathological pulse is floating, deep, slow, or rapid, if it possesses a graceful and moderate quality, it is "having Stomach Qi," which represents the basic balance of Yin and Yang in the organism. Therefore, attention to Stomach Qi should be maintained during pulse taking. No pulse quality should be excessive; if excessively floating, deep, rapid, or slow without a graceful and moderate meaning, it is "lacking Stomach Qi." Excessive floating indicates the external pathogen is too strong, the resistance is too aggressive, causing significant damage to Zheng Qi (Upright Qi), making it unable to maintain the minimum balance of its own Yin and Yang, thus indicating a serious condition. Excessive rapidity indicates excessive heat pathogen and damaged Yin Qi, where the restraining power cannot control the rapidity, all resulting from extreme Yang hyperactivity where Yin cannot sustain it, a severe condition. The ancients said, "Having Stomach Qi means safety; lacking Stomach Qi means danger." Pulses lacking Stomach Qi are also called True Zang Pulses because they are hard and lack softness, resulting from Yin-Yang excess, forming a trend of separation, thus the disease is difficult to treat. Therefore, paying attention to the presence or absence of Stomach Qi while palpating is the key to pulse diagnosis and disease determination. Besides Stomach Qi, pulse diagnosis should also pay attention to having Root and Spirit. Having Spirit in the pulse means that regardless of floating/deep, slow/rapid, slippery/astringent, big/small qualities, upon pressing, the fingers feel orderly and neat, graceful and moderate. If pressing feels scattered, present sometimes and absent others, coming with strength but departing weakly, present on light pressure but completely absent on heavy pressure, intermittently continuous and intermittent, wanting to continue but unable, wanting to connect but failing, appearing faint amidst deep-fine pulses, or suddenly ethereal amidst big pulses, these are all "lacking Spirit," caused by the collapse of Zheng Qi, where Zheng Qi is damaged in the struggle against pathogens and cannot maintain normal physiological states. Having Root means the body's Zheng Qi has a foundation. The ancients believed that the twelve meridians rely on the moving Qi between the Kidneys for nourishment. The survival of Kidney Qi is like a tree having roots; even if branches and leaves wither, if the root is intact, there is still vitality. If Kidney Qi is not exhausted, the pulse must have Root. Deep palpation reflects the Kidney; if the pulse responds to deep pressure with calm and strength, it is called having Root. If the Chi pulse responds with graceful strength, it is also having Root.

V. Relationship Between Pulse and Internal/External Factors

Humans grow in nature, and seasonal climate changes inevitably bring corresponding changes to the human body. The normal four-season pulse qualities differ: in the three months of Spring, all six pulses are Wiry; in Summer, all are Surging; in Autumn, pulses are slightly Floating; in Winter, all are Deep. Women's pulses are often softer and weaker than men's. Young and vigorous people's pulses are mostly solid and big; elderly people's pulses are mostly deficient and weak; infants' pulses are rapid and numerous; children aged five or six often have six beats per respiration; tall and large individuals show pulse locations over a longer distance, while short individuals show shorter distances; thin and weak individuals often have slightly Floating pulses, while robust and plump individuals often have Deep pulses. Those who commonly have all six pulses deep and fine without other illnesses are called Six-In pulses. Those who commonly have all six pulses surging and big without other illnesses are called Six-Yang pulses. Pulses not found at Cunkou but visible on the radial side of the thumb are called Fan-Guan pulses; pulses slanting from the Chi position towards the wrist side of the Tiger's Mouth are called Flying-Side pulses; both belong to radial artery anomalies. After strenuous labor, pulses are mostly Surging-Rapid; after long journeys, pulses are mostly rapid and urgent. Mental workers' pulses are often weaker than physical workers'. After drinking alcohol, pulses are mostly rapid and urgent; after meals, pulses are mostly Surging-Slippery and strong; after prolonged fasting, pulses are mostly deficient and weak. Emotional agitation also changes the pulse, but this is not a pathological pulse; once emotions return to calm, the pulse returns to normal. The *Mai Jing* (Pulse Classic) states: "When a person suffers from fear and terror, what does their pulse resemble? The Master said: 'The pulse shape resembles touching silk threads, continuously connected, and the face loses color.' 'What does the pulse of an ashamed person resemble?' The Master said, 'Its pulse is naturally floating and weak, and the face alternates between white and red.'" Fear, excitement, worry, and impatience all cause pulse changes.

VI. Classification of Pulse Qualities and Principles of Pulse Differentiation

Pulse diagnosis is the main basis for TCM syndrome differentiation and treatment. Methods of classification by physicians throughout history have varied, often leaving practitioners confused. Zhang Shiwen of the Qing Dynasty classified pulses into the most numerous and detailed categories, totaling 32 pulses; Li Binhu classified them into 27 pulses; Chen Xiuyuan classified them into 28 pulses; currently, 28 pulses are generally still used. Based on clinical experience, pulse classification should not be too extensive to avoid mutual confusion. According to clinical needs, if the commonly used 28 pulses can be clearly distinguished, carefully experienced, and skillfully used, it will facilitate clinical syndrome differentiation, application of the Eight Principles and Eight Methods for diagnosis, prescription formulation, and medication, achieving ease and proficiency. Due to the complexity of pulse qualities, predecessors considered methods to simplify the complex. Zhang Zhongjing of the Han Dynasty divided pulses into two major categories: Yin and Yang, classifying Big, Floating, Rapid, Agitated, and Slippery as Yang pulses, and Deep, Astringent, Weak, Wiry, and Faint as Yin pulses. Hua Borren of the Yuan Dynasty advocated governing all pulses with six pulses: Floating, Deep, Slow, Rapid, Slippery, and Astringent, using Floating/Deep to reflect location, Slow/Rapid to reflect rate, and Slippery/Astringent to reflect shape. Chen Xiuyuan advocated governing all pulses with eight pulses: Floating, Deep, Slow, Rapid, Deficient, Excess, Big, and Moderate. Koubu pulses include Koubu, Ge, and San pulses. Deep pulses include Lao and Fu pulses. Slow pulses include Jie and Dai pulses. Rapid pulses include Cu, Jin, and Dong pulses. Deficient pulses include Ruo, Ru, Fine, Faint, Short, and Astringent pulses. Excess pulses include Slippery, Long, Surging, and Wiry pulses. Big pulses include Moderate pulses. The above 28 pulses can be identified through pulse position, rate, force, and shape. For example, Floating/Deep differ in position; Slow/Rapid differ in rate; Big/Fine/Faint/Small differ in shape; Excess/Deficient/Koubu/Ruo differ in force. These pulse qualities form during the struggle between pathogens and Zheng Qi. Diseases have exterior/interior, cold/heat, deficiency/excess; bodies have prosperity/decline, strength/weakness; thus pulses have differences in Floating/Deep, Slow/Rapid, Big/Fine, Long/Short. Therefore, taking eight pulses as the guideline for the 28 pulses is a method of simplifying the complex for beginners. First master these eight pulse qualities, then further detail the 28 pulses, progressing from shallow to deep, step by step. Pulse studies are not difficult to comprehend. Following previous classification methods, we concretize them here, using Floating, Deep, Slow, Rapid, Long, Short, Fine, and Big as guidelines, attaching combined pulses to them. To facilitate analysis and memory, we compiled the "Eight Guidelines of Pulse Qualities in Four-Character Verse," appended below for beginners:

Floating pulse governs exterior, belongs to Fu, belongs to Yang; light touch reveals its image clearly.
Floating with strength is Surging pulse, fire blazing; floating without strength is Deficient pulse, Yin injury.
Floating with great deficiency is San pulse, irregular; floating like a scallion tube is Koubu pulse, blood disaster.
Floating like pressing a drum is Ge pulse, externally strong; floating with softness and fineness is Ru pulse, dampness injury.
Floating combined with six pulses requires careful distinction; Deep pulse governs interior, belongs to Zang, belongs to Yin.
Heavy hand seeks until understood in heart; deep reaching bone is Fu pulse, pathogen deep.
Deep with hard bottom is Lao pulse, cold invasion; deep with fine weakness is Ruo pulse, deficiency search.
Deep combined with three pulses must follow rules; Slow pulse governs cold, Zang disease also.
Two to three beats, number can be estimated; slow without extension is Huan pulse, disease resolving.
Slow without smoothness is Se pulse, blood stasis; slow with occasional stop is Jie pulse, depression/excess.
Slow stop with regular interval is Dai pulse, mostly death; Rapid pulse governs heat, Fu disease same.
Five beats or more, seven or eight are ominous; rapid with smoothness is Slippery pulse, phlegm surging.
Rapid with twisting is Jin pulse, cold attacking; rapid with occasional stop is Cu pulse, heat baking.
Rapid seen at Guan is Dong pulse, uterine bleeding; seeing four rapid pulses, do not be vague.
Long governs natural strength, rarely obtained; extending to fish area and Chi, long and not short.
Long and straight is Wiry pulse, belonging to Liver; under fingers long, Qi depression often seen.
Short pulse naturally weak, not from injury; aligning up and down, shrunk not long.
Often due to congenital deficiency, thin and withered; seeing this in various pulses, benefit Yin and Yang.
Fine governs all deficiencies, spider-silk image; pulse channel belongs to Yin, condition imaginable.
Fine not obvious is Faint pulse, Qi disaster; fine and small-deep is Ruo pulse, loss of nourishment.
Three fine pulses must be distinguished clearly; Big governs all excesses, broad shape easy to know.
Yang pulse disease implies pathogen excess; big and surging is Surging pulse, heat presiding.
Big and hard is Excess pulse, pathogen rampant; big combined with two pulses, disease盛, pathogen fierce.