Library

A question was asked: "The positions of the pulse in the human body have no fixed method. We can only deduce the diseases of the Zang-Fu organs from the subtle sensations under the fingers, which makes one feel lost and without boundaries. I wish to receive your supreme teaching to dispel my confusion."

The reply was: "Where did you all come from today? Some said they came from the flat lands of the southwest, some from crossing waters in the northwest, and some met their teacher unexpectedly on a narrow path in the southeast. Then I instructed them: 'It is because you know my residence and recognize my form and spirit that you can meet me regardless of where you come from; otherwise, you would have missed each other face to face.' Therefore, to identify the diseases of the five Zang organs, one must understand the pulse forms of the five Zang organs.

For example, the Liver (Gan) generates according to the command of Yi Wood rising in spring. Its pulse resembles grass and trees just sprouting; under the fingers, it feels soft and weak yet flexible, hence called 'Xian' (String-like). However, it must be harmonious, slippery, and slow, indicating Stomach Qi (Wei Qi), which constitutes the normal pulse of the Liver. If the pulse is Xian, solid, and slippery, like feeling a long bamboo pole, it indicates more Xian than Stomach Qi. If it is Xian, rapid, and strong, becoming harder upon pressure, it indicates only Xian without Stomach Qi. If accompanied by fever, with a surging and abundant sensation under the fingers, it signifies dry wood and blazing fire leading to self-immolation. As it is said, 'Fire is born from Wood; the one burning the Wood is originally Fire itself.' If the pulse is slightly Xian and floating, or slightly rapid, it represents the image of Jia Wood (Gallbladder). If the Xian pulse appears at the Renying point (ST9), it indicates hyperactivity of Liver Qi. If it appears instead at the Qikou (Cunkou), it is an omen of Earth failure and Wood attacking (Spleen deficiency with Liver overacting). Or, if the Left Guan position is Xian but feels small, weak, and unenergetic under the fingers, it is an image of Earth decline and Wood withering. The treatment should focus on tonifying Earth to nourish Wood. If liver-attacking agents are administered, the Spleen Earth will become even more distressed. If the Xian pulse appears in only one or two positions, or is unilateral, it is still treatable. If all six positions are Xian and lack Shen Qi (Spirit), it signals chaotic and indistinguishable pathogenic factors. The *Ling Shu* states: 'When the Renying and Cunkou pulses are equal in size, the disease is difficult to cure.' 'Qi' refers to Pulse Qi. Whenever the pulse exhibits pure Zang organ Qi, consistent across left and right six positions, it is untreatable. Or, if Liver disease symptoms are severe but there is absolutely no Xian pulse in the six positions, this is a mismatch between pulse and disease, also untreatable. This example serves as a paradigm for other pulses; it applies not only to the Liver.

The Heart (Xin) belongs to Bing-Ding Fire and corresponds to summer. Its pulse resembles fire burning firewood; under the fingers, it feels clustered, slightly curved, and moist, hence called 'Gou' (Hook). However, it must be empty, slippery, and smooth, indicating Stomach Qi, which constitutes the normal pulse of the Heart. If the pulse is panting and continuous, with slight curvature in the middle, it indicates more Gou than Stomach Qi. If it is fleeting, empty, large, curved at the front and straight at the back, it has only Gou without Stomach Qi. If it is empty, large, floating, and surging, or slightly rapid, it represents the image of Bing Fire (Small Intestine). Thus, if the Gou pulse appears at the Left Cun, it indicates hyperactivity of Pericardium Fire. If it appears simultaneously at the Right Cun, it signals Fire invading Metal (Heart Fire affecting Lungs). If there is slight curvature outside the Guan position, it suggests obstruction in the Central Palace (Spleen/Stomach).

The Spleen (Pi) is Ji Earth and corresponds to the four seasons. Although it inherits Central Wet Earth, it often incorporates the transformations of the four Qi to grow all things. Hence, its pulse is the most harmonious and slow. Under the fingers, it is leisurely, neither fast nor slow, hence called 'Huan' (Slow). However, within this harmony and slowness, one should seek softness and slipperiness, which is Stomach Qi, constituting the normal pulse of the Spleen. If the pulse is Huan, weak, and powerless, feeling like touching rotten cotton under the fingers, it indicates more Huan than Stomach Qi. If the pulse is Huan but cannot recover its rhythm spontaneously, presenting Dai (Intermittent) pulse without Stomach Qi. If the pulse is leisurely and slow but feels full and solid upon pressure, it indicates retained food stagnation and accumulated heat in the Stomach. If it is Huan and choppy/stagnant, feeling vague under the fingers and resisting pressure advancement, it is due to cold-food consolidation in the Stomach and blocked Qi channels. If Huan is added with Floating, it represents Wind invading Wu Earth (Stomach). If all positions are Huan but the Guan position is exclusively vigorous, it indicates Damp-Heat in the Central Palace. If all positions are Huan but the Cunkou is exclusively slippery, it indicates Phlegm-Qi above the diaphragm. If all positions are Huan but both Chi positions exclusively show Xian characteristics, is this not a sign of Kidney-Liver Deficient Cold failing to generate Earth?

The Lung (Fei) is Xin Metal and corresponds to Autumn Qi. Although it governs convergence, it combines with the skin and hair, so the pulse cannot be deep and solid. It presents a Floating and weak image at the skin level; under the fingers, it feels light and empty, yet does not scatter when pressed heavily, hence called 'Mao' (Feather-like). However, it must be Floating, weak, and slippery, indicating Stomach Qi, constituting the normal pulse of the Lung. If it is only Floating without slipperiness, feeling rough like touching a chicken feather under the fingers, it indicates more Mao than Stomach Qi. Ancients considered Floating, Choppy, and Short as the normal pulse of the Lung, believing it meant abundant Qi and scarce Blood, making the pulse unable to be slippery. They failed to realize that the first passageway for Ying Qi (Nutritive Qi) circulating within the vessels lies in the Lung. If the Lung is not injured by Dryness, there would be no reason for Shortness and Choppy qualities. Even if affected by Autumn Dryness, it is a diseased Lung, not the intrinsic dryness of Lung Qi. If the pulse is Floating and powerless, feeling like wind-blown feathers upon pressure, it has only Mao without Stomach Qi. If accompanied by thin and rapid pulses at Guan and Chi, with wheezing, coughing, and blood loss, it indicates Yin deficiency with Yang disturbance; even divine medicines cannot restore it. If the pulse is Mao and slightly Choppy, it represents insufficient Qi of Geng Metal (Large Intestine). If all positions are Mao but the Cunkou is not Mao, it indicates Yang deficiency with turbid Yin acting, combined with Phlegm-Qi ascending. If all positions are not Mao but the Qikou is exclusively Mao, it indicates Stomach deficiency failing to accept food, and is a sign of diarrhea.

The Kidney (Shen) governs Gui Water and corresponds to Winter. The pulse receives the command of storage and collection, appearing between sinews and bones. Pressed, it is deep and solid; lifted, it is smooth, hence called 'Shi' (Stone-like). However, it must be Deep, soft, and slippery, indicating Stomach Qi, which constitutes the normal pulse of the Kidney. If under the fingers it feels like pulling a vine, becoming harder upon pressure, it indicates more Shi than Stomach Qi. If it is String-like, thin, and strong, like touching a knife edge, beating against the finger upon pressure, it has only Shi without Stomach Qi. If pressed it is Shi, but lifted it is Floating and Tight, it represents Shaoyang Ren Water (Bladder) being invaded by pathogens. If all pulses are not Shi but the Left Cun is exclusively Shi, it is an image of Water Qi overwhelming the Heart. If the Right Guan is exclusively Shi, it is an image of Deep Cold injuring the Stomach. Thus, among the five pulses, obtaining the Huan-Slippery image is necessary for Stomach Qi to constitute a normal pulse. Therefore, verifying Stomach Qi is not limited to the Right Guan. Furthermore, the *Nei Jing* states that the four-season pulses do not go beyond Xian, Gou, Mao, and Shi. From this, we know that the Qi of the five Zang organs does not exceed the Five Elements, nor does the Qi of the four seasons. Thus, pulse discussion never exceeds the Five Elements. One must observe whether the five pulses lack the moderate and harmonious Qi; if so, it is a pathological pulse. Or if it shows the pulse of another Zang organ, it means the Qi of the original Zang is declining, allowing the Qi of another Zang to invade.

I often see physicians rigidly adhering to the rules of the six positions to determine the deficiency and excess of Zang-Fu organs. This is like trying to identify a person by recognizing only their residence, ignoring their voice, form, and laughter. If one knows their voice, form, and laughter, even meeting them in a foreign inn, dark room, or behind a wall, one would never mistake them for someone else. Similarly, if the pulse of this meridian appears in another position, one should not mistakenly attribute it to a disease of another meridian.

Regarding pulse diagnosis during clinical practice, it entirely depends on flexible deduction. For instance, the pulse of a wealthy/noble person differs significantly from that of a poor/commoner. The pulse of the noble is often clear, empty, and smooth; the pulse of the rich is often harmonious, slippery, and spirited. The pulse of the lowly is often turbid, obstructed, and stagnant; the pulse of the poor is often stiff, choppy, and lacking spirit. With labor, the pulse becomes coarse and hard, twice as usual. For those who were once wealthy/noble but became poor/common, the Ying and Wei are withered, and Blood and Qi are disordered. The pulse will certainly not be smooth and harmonious; prolonged pressing reveals emptiness. Moreover, the treatment for conditions of the wealthy/noble differs completely from that of the poor/common. The wealthy/noble often strain their Heart and Kidney, damaging Essence and Blood internally. Their pathological pulses are mostly deficient. Even with exterior-interior exogenous pathogens, they cannot withstand heavy sweating or purging. Treatment must primarily protect Yuan Qi (Original Qi), supplemented by harmonizing Ying and regulating Stomach. All bitter-cold herbs that damage Qi are strictly prohibited. The poor/common eat coarse vegetables, endure wind and frost, lack internal and external warmth, and are accustomed to physical fatigue. Their Zang-Fu and meridians are generally sturdy. Even with illness and worry, their Shen and Zhi are not easily damaged. Treatment focuses mainly on attacking and releasing. Herbs like Ginseng, Cinnamon Twig, and Aconite Root are unsuitable for this group. Only those who were once noble then common, or rich then poor, accustomed to richness and discomfort with coarse food, suffer from initial depression of Middle Qi when ill. Not only are drugs difficult to match, but Ginseng may not be tolerated,反而 increasing depression, which is inevitable.

Not only do the pulse and symptoms of the wealthy/noble differ vastly from the poor/common, but also body fatness and leanness. Fat individuals have abundant muscles and dense flesh, with Sunken and profound Stomach Qi. Even if affected by Wind-Cold, exterior pulses may not appear immediately. One must distinguish based on voice and nasal discharge/sputum to identify exogenous pathogens. Nasal congestion, heavy voice, and thick sticky discharge indicate Wind-Cold injury. If there is nasal congestion and heavy voice, but frequent coughing yields no sputum initially, and after forceful effort only a thread of sticky sputum comes out, or even throat swelling occurs, it indicates Wind-Heat. This is the key to exterior contraction in fat people. Because fat people have abundant muscle-Qi, Wind pathogens enter reluctantly; however, due to internal Phlegm-Dampness, Heat injury is easiest. Those with alcohol-induced Damp-Heat infiltrating muscle tissue are susceptible to Wind, but otherwise, shape-excess with Qi-deficiency, pale complexion, loose flesh, and insecure肌腠 (muscle pores) should not be rigidly applied here.

Thin individuals have shallow muscles and leaking Stomach Qi. Even with fever and headache, if the pulse is Floating and Rapid, it mostly belongs to Fire. However, intermittent headache and fluctuating heat intensity indicate Yin deficiency with Fire disturbance. Only when fever and headache occur day and night, regardless of severity, and the Renying pulse is Floating and vigorous, is it an exterior contraction disease. There are cases where exterior pathogens combine with internal Fire. Although fever and headache occur day and night without regard to severity, accompanied by irritability, thirst, restlessness, and sleep disturbance, these are signs of Pathogenic Fire scorching Yin. Although辛凉 (Acrid-Cool) dispersants are appropriate, Yin must be protected. Only those who are thin, Qi-deficient, with pale faces and fresh red lips, and insecure Wei Qi, are most prone to Wind invasion without internal Fire concerns.

Moreover, people in our Jiangnan region have the thinnest Yuan Qi, and pulses are mostly insubstantial. Being in the East, Wood and Fire are strongest. Slight over-treatment may lead to Heat departing and Cold arising. People consuming rich foods are nurtured into fragility, making regulation particularly difficult. Thus, those skilled in treating diseases south of the Great River find it easy to practice anywhere. But one must recognize their innate constitution (Gang/Rou) and temperament (Huan/Ji). People in the Northwest are accustomed to resisting Wind-Cold, eating vegetarian diets and using coal fires, making their exterior and interior sturdy. Their pulses are mostly Deep and Solid. Any exterior-interior pathogen, if not contracted, is fine; if contracted, it is severe. Heavy sweating and purging, using potent decoctions, are required to overcome it. People in Dian-Yunnan and Guangdong are constantly exposed to Miasma-Heat and habitually eat betel nuts. Their exterior and interior are open and loose. Their pulses are slightly Rapid, feeling less solid upon pressure. Even with Wind-Cold, only clearing and resolving is suitable; dispersants should not be used lightly. Because exterior herbs ascend and spread horizontally, disturbing Miasma Qi, causing fever to last indefinitely until fluids are exhausted and blood is depleted. The Classics state: "The Qi of the Northwest is scattered and cooled; the Qi of the Southeast is gathered and warmed." This is called treating the same disease differently. Therefore, for people from other regions, one must inquire about local geography and water/soil conditions. Bystanders may think this is mere polite conversation, but how could they know it is the general principle for pulse diagnosis, syndrome differentiation, and medication? Those wielding the power of life and death must extinguish external distractions and keep their minds calm. They must make progress at the critical juncture of life and death. Naturally, they will not fall into the traps of contemporaries. One should know that medical knowledge has no profound obscurity. Grasping the essentials and applying flexible deduction allows one to shoulder the responsibility. Why search through hundreds of schools and read numerous books, opening doors to textual interpretation that only breeds confusion from too many divergent paths?