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Question: How does the pulse diagnosis for women differ from that of men?
Answer: When a woman reaches fourteen years old, Tian Gui (the substance promoting reproductive maturation) becomes unblocked, and menstruation occurs on time. Therefore, the focus of pulse diagnosis lies entirely in the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel). The Chong and Ren Mai are the seas of essence and blood.
Their pulses typically follow the Qi of the Liver and Kidney. Thus, the Left Chi (Left Distal) pulse is regarded as the Ming Men (Gate of Life, root of Kidney Yang). The *Treatise on the Correspondences of Yin and Yang* states: Yin and Yang refer to the male and female attributes within blood and Qi. Left and right are the pathways of Yin and Yang. Generally, the Way of Heaven rotates left and governs Yang Qi, while the Way of Earth rotates right and governs Yin Blood. Yin often follows Yang, serving as its guardian. Hence, the Left Chi pulse bears the title of Ming Men. However, Yin endowment tends to be violent, and the pulse often rises with Qi; Yin nature tends to stagnate, and the pulse also sinks inward with Qi.
Although ancients held that women's Right pulses are often vigorous, and that the female pulse resides below the Guan (Middle) position, these are not definitive conclusions. Their diseases differ from men only in menstruation, pregnancy, and childbirth; otherwise, there is no distinction. If the Kidney pulse is faint and choppy, or if the pulse inside the Left Chi (distal to the Guan) is floating, or if the Liver pulse is deep and rapid, or if the Chi pulse is slippery but irregularly intermittent, these are signs of amenorrhea and irregular menstruation. For women with weak constitutions whose pulses are often faint, if the Chi position remains unceasing upon pressure, it indicates pregnancy. If menstruation has ceased accompanied by vomiting and loss of appetite, yet the six pulses show no pathological signs, this also indicates pregnancy. This is because in weak constitutions, the pulse manifestations are difficult to reveal. The *Mai Jing* (Pulse Classic) states: If a woman's three positions (Cun, Guan, Chi) show floating and sinking consistency, remain unceasing upon pressure, and she has no other illness but lacks menstruation, she is pregnant. Similarly, if the Chi pulse is rapid and vigorous. The *Jing* (Classic) asks: How do we know that a pregnancy is near term? The body shows symptoms but without pathogenic pulses; it further states: "Yin pulsation distinct from Yang" signifies pregnancy. This means the Yin pulse at the Chi position beats forcefully against the fingers, distinctly different from the Yang pulse at the Cun (Distal) position, containing Yang characteristics. When Yin and Yang interact and combine, conception occurs. "Yin deficiency with Yang pulsation" refers to Bing Lou (metrorrhagia and metrostaxis), meaning the Chi pulse is deficient, large, wiry, and rapid, indicating internal collapse and bleeding. If emaciation and panting occur with amenorrhea, this is a disease of the Er Yang (Stomach and Large Intestine) originating from the Heart and Spleen. In women with amenorrhea, if the pulse is slippery and rapid, and disperses under heavy pressure, the fetus is three months old. If it is harmonious, slippery, and exhibits Dai Mai (intermittent pulse), the fetus is slightly over two months old. If it is slippery and rapid without dispersion under heavy pressure, it is five months. To determine the sex of the fetus at four months of gestation, ancients generally considered a slippery and large Left Chi as male, and a slippery and large Right Chi as female, with both Chi positions being slippery and large indicating twins. However, sometimes a moving and slippery Left Cun indicates a male. This is because during menstruation, blood is discharged, Yin is often insufficient, so the Chi pulse is frequently deficient. One cannot rigidly adhere to the rule that only a slippery and large Chi pulse indicates pregnancy. The *Jing* states: "If the Hand Shaoyin pulse moves vigorously, it indicates pregnancy." The Cun position is Yang; thus, seeing movement and slipperiness indicates sufficient blood revealing Yang characteristics. Signs resembling male (bear and tiger) on the left and female (phoenix) on the right can be predicted with certainty.
Whenever a woman's menses have been absent for three months, if the pulse shows floating and large Cun positions, slippery and smooth Guan positions, and slippery, solid, and slightly rapid Chi positions, this is a fetal pulse. If there is form but no movement, or slight movement below the navel like holding a urn, feeling cold to touch, and the bilateral Chi pulses fluctuate between large and small, present and absent, floating and sinking, moving and stopping, varying morning and evening, this is a Ghost Fetus (ectopic or abnormal pregnancy). Continuous observation for two to three days is required to confirm. Treatment should involve tonifying Qi and invigorating blood, warming and nourishing the Spleen and Stomach, so that fluid metabolism proceeds and meridians clear naturally. If the pulse comes rapidly like chaotic raindrops, suddenly disappearing and returning after a long time, this is a Yaksha Fetus. There are also cases where the Left Guan pulse feels bifurcated under the fingers, leading to the birth of a Yaksha. In all such cases, the pulse differs significantly from normal. A weak pulse during pregnancy warns of miscarriage due to lack of Qi and Blood nourishment; urgent tonification is needed. A wiry and rapid pulse may also lead to miscarriage, indicating excessive Fire. If an pregnant woman's pulse is deep, fine, wiry, and rapid, accompanied by aversion to cold and high fever, with blue-black lips and mouth, the fetal Qi is damaged. One must ask if the fetus is moving. If there is no movement, but instead a sensation of upward rushing causing chest oppression and syncope, with a cold abdomen upon palpation, treat as a Dead Fetus. If a woman has amenorrhea with pregnancy but the pulse is wiry, heavy bleeding will likely follow, resulting in failure to sustain the pregnancy. However, if the wiry pulse is due to illness, preserving the fetus is paramount; when Qi becomes robust, the wiry quality will recede. A faint and slow Chi pulse in women is called Ju Jing (menstruation occurring once every three months), caused by insufficiency of Qi and Blood. A weak and choppy Chi pulse with cold intolerance in the lower abdomen indicates infertility in young women and barrenness in older women. If the choppy pulse is due to illness, maintaining pregnancy is difficult. In pregnancy complicated by external Wind pathogen, the pulse should be slow, slippery, and fluent; deficiency-choppy and restless-rapid pulses are most contraindicated. Deficiency-choppy implies instability, while restless-rapid implies excessive heat damaging the fetus, making treatment difficult. For diarrhea before delivery, the pulse should be slippery and small, not full and rapid; a full and rapid pulse warns of miscarriage, which is often fatal within seven days post-miscarriage. Treatment involving purging accumulation leads to death, as does using astringents. Urgently use Fulong Gan Decoction (Dragon's House Soil Decoction) to decoct medicines that warm and nourish the Spleen and Stomach; many survive. Generally, the pulse in pregnancy should be substantial, large, and forceful; deep, fine, wiry, rapid, deficient, and choppy pulses are contraindicated. For spontaneous abortion and dripping bleeding, the pulse should be fine and lingering; rapid, substantial, and irregularly intermittent pulses are contraindicated. At labor, the pulse should be slippery, rapid, and deviating from the regular course; deficient, slow, wiry, fine, short, and choppy pulses are contraindicated. Postpartum, the pulse should be deep, small, and faint; rapid, substantial, full, and rapid irregular pulses are contraindicated. In new postpartum yin injury with continuous bleeding, if the Chi pulse cannot reach the Guan position, it is fatal. In new postpartum wind-heat disease, the pulse should be floating, weak, and harmonious; small, rapid, and suspended-extreme pulses are contraindicated. For persistent metrorrhagia and metrostaxis, the pulse should be fine, small, hollow, and slow; deficient, choppy, rapid, and substantial pulses are contraindicated. Whenever diagnosing Shang Han (Cold Damage) or febrile diseases in unmarried women, one must inquire about menstrual status. Postpartum, one must inquire about the amount of Lochia (postpartum discharge) and whether there are masses in the lower abdomen. These are the general principles.