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*Suwen Chao* (Excerpts from the Suwen), Chapter on Pulse Conditions (1/3)

Huangdi asked: "What is the method of pulse diagnosis?" Qibo replied: "Pulse diagnosis is usually performed at dawn (pingdan). At this time, yin qi has not yet been disturbed, yang qi has not yet dissipated, food and drink have not yet entered the body, the qi of the meridians is not yet vigorous, the qi of the collaterals is harmonious and even, and the blood and qi are not in disorder. Therefore, it is possible to diagnose abnormal pulses."

Palpate the movement and stillness of the pulse, observe the spirit in the eyes (jingming), examine the five colors of the face, assess the excess and deficiency of the zang organs, the strength and weakness of the fu organs, and the flourishing or declining state of the physique. By integrating and comparing these aspects, one can determine the boundary between life and death.

The vessels (mai) are the residence where blood gathers. (Residence means gathering; thus, if the pulse is full, blood is full; if the pulse is empty, blood is deficient.) A long pulse indicates regulated qi; a short pulse indicates diseased qi; a rapid pulse (shu) indicates mental restlessness; a large pulse indicates advancing disease. Excess at the upper part (cunkou) indicates rebellious qi; excess at the lower part (chizhong) indicates abdominal distension. A choppy or intermittent pulse (dai) indicates declining qi; a fine pulse indicates deficient qi; a rough pulse (se) indicates heart pain. A chaotic, turbid, and firm pulse like a gushing spring, which flows out but does not return, indicates worsening disease. If the complexion is withered, and the pulse departure is continuous yet faint, disappearing like a broken string, this is a sign of death.

The subtlety of pulse theory must be carefully examined. Examination requires a principle, starting with yin and yang. It begins with the meridians, follows the laws of generation and destruction among the Five Elements, and conforms to the appropriateness of the four seasons. Thus, sounds correspond to the five tones, complexions correspond to the five elements, and pulses correspond to yin and yang. The way to hold the pulse is to maintain an empty mind and quiet will, which is the guarantee.

In spring, the pulse floats near the skin, like fish swimming in waves. In summer, the pulse is superficial, abundant like the flourishing growth of all things. In autumn, the pulse sinks below the skin, like hibernating insects about to hide. In winter, the pulse is deep in the bones, like hibernating insects gathered closely, just as gentlemen stay indoors.

The inner side of the chi position corresponds to the hypochondrium (ji xie). The outer side of chi probes the kidneys; the inner side probes the abdomen. Above the guan position, the left outer side probes the liver; the inner side probes the diaphragm. The right outer side probes the stomach; the inner side probes the spleen. Above that (at the cun position), the right outer side probes the lungs; the inner side probes the chest. The left outer side probes the heart; the inner side probes the Danzhong (chest center). The anterior aspect probes the front of the body; the posterior aspect probes the back. The upper end of the cun pulse relates to the chest and throat; the lower end of the chi pulse relates to the lower abdomen, waist, thighs, knees, shins, and feet.

Huangdi asked: "What is the pulse of a normal person?" Qibo answered: "When a person exhales, the pulse beats twice; when they inhale, the pulse also beats twice. Between breaths, it beats once more, totaling five beats per respiratory cycle. This is called a normal person (pingren). If the pulse beats once per exhale and once per inhale, it is called 'deficient qi' (shaoqi). If the pulse beats three times per exhale and three times per inhale, and the skin at the chi position is hot, it is a warm disease (wenbing). If the chi skin is not hot, the pulse is slippery, it is a wind disease; if the pulse is rough, it is bi syndrome. If the pulse beats four times or more per exhale/inhale, it is a dying pulse. If the pulse ceases completely, it is a dying pulse. If the pulse is irregularly slow and fast, it is also a dying pulse."

The vital qi of a normal person originates from the stomach; the stomach is the source of normal vital qi. If a person lacks stomach qi, it is called 'reversal' (ni); reversal leads to death.

A spring pulse slightly wiry (xian) is a normal pulse; excessive wiriness with little stomach qi indicates liver disease; only wiriness without stomach qi indicates death. If a spring pulse has a floating (mao) quality, illness will occur in autumn; pronounced floating indicates current illness. The true qi of the liver disperses into the liver, which governs the sinews. Again, a normal liver pulse comes softly and gently, like the tip of a long pole held high, indicating a healthy liver. Spring relies on stomach qi as its foundation. A diseased liver pulse comes full and slippery, like feeling a long pole that is hard rather than soft, indicating liver disease. A dead liver pulse comes urgent and forceful, like a newly strung bow, indicating liver death. Again, when the true organ pulse appears, it is tense inside and out, like touching a knife edge or pressing a lute string, with a cyan-white complexion lacking luster and brittle hair, leading to death.

A summer pulse slightly hooked (gou) is a normal pulse; excessive hooking with little stomach qi indicates heart disease; only hooking without stomach qi indicates death. If a summer pulse has a stone-like (shi/deep) quality, illness will occur in winter; pronounced stone-like quality indicates current illness. The true qi of the heart communicates with the heart, which governs the blood vessels. Again, a normal heart pulse comes continuously like linked pearls, smooth like langgan beads, indicating a healthy heart. Summer relies on stomach qi as its foundation. A diseased heart pulse comes rapid and connected, slightly curved in the middle, indicating heart disease. A dead heart pulse comes curved at the beginning and fixed at the end, like holding a belt hook, indicating heart death. Again, when the true heart pulse appears, it is hard and beating like coix seeds, with a red-black complexion lacking luster and brittle hair, leading to death.

A late summer pulse slightly weak and soft is a normal pulse; excessive weakness with little stomach qi indicates spleen disease; only a choppy pulse (dai) without stomach qi indicates death. If a weak pulse has a stone-like quality, illness will occur in winter; pronounced weakness indicates current illness. The true qi of the spleen moistens the spleen, which governs the muscles. Again, a normal spleen pulse comes harmonious and separated, like a chicken stepping on the ground, indicating a healthy spleen. Late summer relies on stomach qi as its foundation. A diseased spleen pulse comes solid and rapid, like a chicken lifting its foot, indicating spleen disease. A dead spleen pulse comes sharp and hard, like a bird pecking, like a bird's claw, like water leaking from a roof, or like flowing water, indicating spleen death. Again, when the true spleen pulse appears, it is weak and intermittently slow and fast, with a yellow-cyan complexion lacking luster and brittle hair, leading to death.

An autumn pulse slightly floating (mao) is a normal pulse; excessive floating with little stomach qi indicates lung disease; only floating without stomach qi indicates death. If an autumn pulse has a wiry quality, illness will occur in spring; pronounced wiriness indicates current illness. The true qi of the lungs is high, facilitating the circulation of defensive and nutritive qi and yin and yang. Again, a normal lung pulse comes gentle and light, like falling elm seeds, indicating a healthy lung. Autumn relies on stomach qi as its foundation. A diseased lung pulse comes neither up nor down, like feeling a chicken feather (firm in the center, empty on sides), indicating lung disease. A dead lung pulse comes floating like an object or scattered like wind-blown hair, indicating lung death. Again, when the true lung pulse appears, it is large and empty, like feathers hitting people, with a red-white complexion lacking luster and brittle hair, leading to death.

A winter pulse slightly stone-like (shi/deep) is a normal pulse; excessive stone-like quality with little stomach qi indicates kidney disease; only stone-like without stomach qi indicates death. If a winter pulse has a hooked quality, illness will occur in summer; pronounced hooking indicates current illness. The true qi of the kidneys descends to the kidneys, which govern the bone marrow. Again, a normal kidney pulse comes continuously like a hook, firm upon pressure, indicating a healthy kidney. Winter relies on stomach qi as its foundation. A diseased kidney pulse feels like pulling a vine, becoming harder upon pressure, indicating kidney disease. A dead kidney pulse feels like pulling a rope, clicking like striking stones, indicating kidney death. Again, when the true organ pulse appears, it beats fiercely and abruptly, clicking like striking stones, with a black-yellow complexion lacking luster and brittle hair, leading to death.

Huangdi asked: "Why is the spring pulse called wiry?" Qibo answered: "The spring pulse corresponds to the liver, East, Wood, and the beginning of all things' growth. Its qi comes soft, light, void, slippery, straight, and long, resembling a string, hence 'wiry'. The opposite is pathological. How so? If the qi comes solid and strong, it is 'excessive' (tai guo), disease is external. If the qi comes insubstantial and weak, it is 'deficient' (bu ji), disease is internal. Excess causes anger, dizziness, and head diseases. Deficiency causes chest pain radiating to the back and hypochondriac fullness."

Huangdi asked: "Why is the summer pulse called hooked?" Qibo answered: "The summer pulse corresponds to the heart, South, Fire, and the flourishing growth of all things. Its qi comes vigorous and departs weak, resembling a hook, hence 'hooked'. The opposite is pathological. How so? If the qi comes vigorous and departs vigorous, it is 'excessive', disease is external. If the qi comes weak and departs vigorous, it is 'deficient', disease is internal. Excess causes fever, skin pain, and spreading sores. Deficiency causes mental restlessness, coughing/sputum above, and qi leakage below."

Huangdi asked: "Why is the autumn pulse called floating?" Qibo answered: "The autumn pulse corresponds to the lungs, West, Metal, and the harvest of all things. Its qi comes light, void, and floating, rapid in arrival and scattered in departure, resembling 'floating', hence 'floating'. The opposite is pathological. How so? If the qi comes like hair but firm in the center and empty on sides, it is 'excessive', disease is external. If the qi comes like hair but weak, it is 'deficient', disease is internal. Excess causes rebellious qi, back pain, and depression. Deficiency causes panting, shortness of breath, cough, hemoptysis above, and abnormal sounds below."

Huangdi asked: "Why is the winter pulse called 'ying' (or stone)?" Qibo answered: "The winter pulse corresponds to the kidneys, North, Water, and the storage of all things. Its qi comes deep and beating, like a fortified camp, hence 'ying' or 'stone'. The opposite is pathological. How so? If the qi comes like striking stones, it is 'excessive', disease is external. If the qi departs like a rapid pulse, it is 'deficient', disease is internal. Excess causes lethargy, spinal pain, and reluctance to speak. Deficiency causes a feeling of hunger, coldness in the hypochondrium, spinal pain, abdominal fullness, and urinary changes."

Huangdi asked: "What does the spleen pulse alone govern?" Qibo answered: "The spleen pulse belongs to Earth, the solitary organ, which irrigates the other four organs. A good spleen pulse is invisible; a bad one is visible. If it comes like flowing water, it is 'excessive', disease is external. If it comes like a bird's beak, it is 'deficient', disease is internal. Excess causes inability to move the limbs. Deficiency causes obstruction of the nine orifices."

Food entering the stomach: turbid qi (grain qi) returns to the heart, overflowing essence into the vessels. Vessel qi flows through the meridians; meridian qi returns to the lungs. The lungs oversee all vessels, transmitting essence to the skin and hair. Skin and vessel essence combine, moving qi to the 'fu' (sea of qi/Danzhong). Essence and spirit remain in the four organs, balancing the qi. When balanced, the radial artery forms the cun position, determining life and death.

Drinking enters the stomach, overflowing essence, transported upward to the spleen. The spleen scatters essence upward to the lungs, regulating water passages, transporting downward to the bladder. Water essence distributes everywhere, five meridians circulate together, conforming to the four seasons and yin-yang of the five organs as the constant standard. Humans rely on water and grain; without them, death occurs. Pulses without stomach qi also die. 'No stomach qi' means only seeing the true organ pulse. 'Pulse lacking stomach qi' means the liver pulse is not slightly wiry, and the kidney pulse is not slightly stone-like.