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Huangdi asked Qibo, saying: Pulse diagnosis is usually performed at dawn, when the Yin qi has not yet moved and the Yang qi has not yet dispersed. (There are five requirements for pulse diagnosis at dawn. Therefore, it is necessary to diagnose complexion and pulse at dawn because Lung Qi travels to the Hand-Taiyin Lung Meridian and all twelve meridians; all good or evil Qi gathers at the Cun Kou (radial artery). Thus it is said "not moved" and "not entered". Among the Yang meridians, it is said "not dispersed"; this is the first point.) Food and drink have not been taken. (After eating and drinking, the Qi moves, and good or evil Qi scatters, making it difficult to know. Thus it is said "food not taken"; this is the second point.) The Qi of the main meridians is not yet vigorous. (Because food and drink have not been taken, the Qi of the twelve main meridians is not yet vigorous; this is the third point.) The collateral vessels are balanced. (Because the main meridians are not vigorous, the large collaterals are also not vigorous, so the collateral vessels are balanced; this is the fourth point.) The Blood and Qi are not yet chaotic. (Wei Qi (Defensive Qi) and Ying Qi (Nutritive Qi) interact to travel their pathways, hence called chaos. Now they have not traveled, meaning Blood and Qi are not chaotic; this is the fifth point. Dawn possesses these five meanings, hence dawn is chosen to observe complexion and diagnose pulse, making it easy to discern good or evil.) For abnormal pulses, palpate the movement and stillness of the pulse. (When Ying Qi and Wei Qi carry the good or evil of various meridians through the Hand-Taiyin passing the Cun Kou, palpating the pulse's movement and stillness with the hand reveals its nature.) Simultaneously, observe the spirit in the eyes and distinguish the Five Colors. (Observe the subtleties of the face and Ming Tang (nose), distinguishing the essence and the differences of the Five Colors.) Observe the excess and deficiency of the Shu points of the Zang organs, and the strength or weakness of the Five Fu (Head, Back, Waist, Knees, Marrow) along with the flourishing or decline of the physical form. (The Five Fu here refer to the Head, Back, Waist, Knees, and Marrow. By palpating the pulse and observing the complexion, one can know the deficiency or excess of Zang organ Qi, the strength or weakness of Fu organ Qi, and the flourishing or decline of the body shape.) Synthesize these observations to determine the boundary between life and death. (By palpating the pulse and observing the complexion at dawn, understanding the Qi of the Zang organs and physical form, and synthesizing them, one decides the boundary of life and death.) The pulse is the residence of Blood. (Below discusses pulse diagnosis. Grain enters the Stomach, transforms into Blood, and travels in the meridians to nourish the body; thus the meridians serve as the residence of Blood.) A long pulse indicates regulated Qi; a short pulse indicates diseased Qi. (A pulse filling nine fen at the Cun Kou is long; eight fen is short.) A rapid pulse indicates vexation in the Heart. (Rapid beating is called Rapid.) A large pulse indicates advancing disease. (Vigorous and full is called Large.) Excess in the upper part indicates Qi rebellion (Ren Ying pulse is occasionally excessive). Excess in the lower part indicates Qi distension (Cun Kou pulse is not excessive, but Qi is distended). A Choppy pulse indicates Qi decline. (Slow and arriving once per breath is called Choppy.) A Slippery pulse indicates deficient Qi (Slippery pulse implies deficient Qi). A Wiry pulse indicates Heart pain (Difficult pulsation is called Wiry). (Chaotic and single arrival, surging like a spring entering the hand, indicates advancing disease.) If the pulse departs abruptly and weakly, like a broken string, it indicates death. (The meaning of "abruptly and weakly" is unclear. The pulse arrives suddenly and departs, compared to a broken string; this is a sign of death, indicating the root is severed and transformed into nothingness.) The spirit and the Five Colors are the brilliance of Qi. (Next, observe the complexion. The Qi of the Five Elements transforms into the brilliant colors of the Five Colors, appearing on the face and Ming Tang area; internally, the Ming Tang refers to the nose.) Red should resemble white silk wrapping cinnabar, not ochre. White should resemble the luster of a white jade disc, not chalk. Alternatively, white should resemble goose feathers, not... Yellow should resemble yellow silk wrapping realgar, not yellow earth. Black should resemble heavy lacquer, not charcoal. Alternatively, like earth. Green should resemble the luster of a green jade disc, not indigo. (Ochre is red earth; chalk is white earth.) If the subtle images of the Five Colors appear, the lifespan will not be long. (If the subtle, dark images of the spirit and Five Colors appear, it is called "pale complexion," indicating a short lifespan.) The spirit is used to see all things, distinguish black from white, and judge length and shortness. To mistake long for short, or white for black, indicates that Jing (Essence) is declining. (To see all things clearly allows distinction between black and white. If not clear, black and white are indistinguishable, which is a sign of premature aging.) The Zang organs are the residences of the Middle Jiao. Excess Qi in the middle leads to fright, and the voice sounds as if coming from a room; this indicates dampness in the Middle Qi. (Next, listen to the voice. The Six Fu store water and grain, serving as external Fu; the Five Zang store spirit, serving as internal Fu. Excess Qi in the Zang organs leads to fright; damage to the Middle Qi combined with dampness rising to the chest and throat causes the voice to sound heavy, as if speaking from inside a room.) Speaking in a low voice, only speaking a few words throughout the day, indicates loss of Qi. (Low voice and unwillingness to speak indicate Qi loss; there is little Qi.) Not arranging clothes and bedding, speaking without distinguishing good from bad, and ignoring kinship and distance, indicates confusion of the Shen (Spirit). (This is due to excessive heat in the Yangming Qi causing Heart confusion; thus the body does not know what to do, and speech lacks discrimination of good and bad, because the Five Shen have lost their post.) The storage of the Granaries cannot be controlled, indicating the gate is not closed. (Loss of control of Spleen and Stomach Qi means the Granaries cannot store; the mouth/gate cannot self-restrain, leading to ingestion of inappropriate substances.) Unceasing flow of water springs indicates the Bladder cannot store. ("Water springs" refers to urine. Inability to control urination occurs because the Bladder cannot restrain, leading to continuous enuresis.) Those who maintain control live; those who lose control die. (As mentioned before, if the Shen is not confused and maintains control, one lives; if the Shen is confused and loses control, one dies.) The Zang organs are the strength of the body. (The Zang organs store Shen; storing Shen makes them the master of the body, hence the strength of the body.) The head is the residence of the spirit. Head drooping and deep-set eyes indicate that Jing is being depleted. (The head is the heaven of the body; heaven has sun and moon, human head has two eyes, and the essence of the five Zang organs forms in the eyes. Thus the head is the residence of the spirit. When Jing is depleted, strength fails, head droops, and eyes sink.) The back is the residence of the Chest. Back curvature and shoulder drooping indicate the residence is failing. (The Shu points of the Heart and Lungs are located on the upper back, corresponding to the Taiyang; thus the back is the residence of the Chest. Back curvature and shoulder drooping compress the chest, indicating failure.) The waist is the residence of the Kidney. Inability to turn or shake indicates the Kidney is failing. (The Kidney is in the lumbar spine; thus inability to move the waist indicates Kidney failure. "Failing" means sick.) The knees are the residence of the sinews. Inability to bend and extend, stooping when walking, indicates the sinews are failing. (Large sinews gather at the knees. Inability to bend and extend, stooping when walking, results from tendon tightness or laxity at the knees, indicating sinew disease.) Marrow is the residence of the bones. Inability to stand for long periods, trembling when walking, indicates the bones are failing. (Marrow is the fluid of bone. High marrow levels cause shin pain, inability to stand long, and trembling when walking, indicating bone disease.) Gaining strength leads to life; losing strength leads to death. (Nourishing the aforementioned five residences and gaining bodily strength leads to life; losing them leads to death.) Qibo said: Violating the Four Seasons, excess indicates Jing victory, while deficiency indicates consumption. (Above, Huangdi was about to ask, but stated the meaning comprehensively himself. Thus Qibo speaks of gain and loss of strength. Even if one loses strength, violating the Four Seasons, having excess means the Five Zang Jing wins and leads to life; losing strength and having deficiency means the Five Zang are consumed and leads to death.) Responding to excessive deficiency indicates Jing victory; excess indicates consumption. (When Ren Ying and Cun Kou differ by more than one fold, it is called "Responding to Excessive Difference." If Qi is insufficient despite the difference, the Five Zang Jing wins; if Qi is excessive, it generates heat, consuming the Five Zang.) If Yin and Yang do not correspond, the disease is named Guan Ge (Closure and Obstruction). (When Ren Ying and Cun Kou differ by four times or more, it is called "Yin and Yang do not correspond." Non-correspondence means Yang Qi is obstructed externally and Yin Qi is closed internally.) Diagnosing blood vessels: many red indicates heat; many pain indicates stasis; many black indicates chronic Bi syndrome; many red, black, and green together indicate alternating cold and heat. Body pain, slightly yellow complexion, yellow dental plaque, yellow nails indicate Huang Dan (Jaundice). ("Blood vessels" refers to collaterals. Dan sounds like 'dan', an internal yellow disease.) Diagnosing eye pain: red vessels moving from top to bottom indicate Taiyang disease. (Foot-Taiyang Meridian starts from inner canthus and goes up to forehead; thus red vessels crossing the pupil from top to bottom indicate Taiyang collateral causing eye pain; treat Taiyang.) From bottom to top indicate Yangming disease. (Hand and Foot-Yangming meridians run from nose to inner canthus; thus red vessels moving from bottom to top indicate Yangming collateral causing eye pain; treat Yangming.) From outside to inside indicate Shaoyang disease. (Hand and Foot-Shaoyang meridians go from outside the eye to the outer canthus and then to the inner eye; thus red vessels entering the eye from outside indicate Shaoyang collateral causing eye pain; treat Shaoyang.) Diagnosing alternating cold and heat: red vessels extending from top to bottom to the pupil. Seeing one vessel predicts death in one year; seeing one and a half vessels predicts death in one and a half years; seeing two vessels predicts death in two years; seeing two and a half vessels predicts death in two and a half years; seeing three vessels predicts death in three years. (Red vessels from top to bottom are Taiyang collaterals. Taiyang collateral vessels extend from top to bottom to the pupil. If three vessels arrive simultaneously, death occurs in three years. If only one vessel arrives, death occurs in one year. San Yang is Taiyang; Taiyang Qi is largest, so seeing only one vessel predicts death in one year. Er Yang is Yangming; Yangming has two collaterals, seeing less Qi predicts death in two years. Yi Yang is Shaoyang; Shaoyang has three collaterals, seeing less Yang Qi predicts death in three years.) Diagnosing toothache: palpate the Yangming pulse. Where there is excess, there is isolated heat. Heat on the left corresponds to left heat; heat on the right corresponds to right heat; heat above corresponds to upper heat; heat below corresponds to lower heat. (Hand-Yangming Meridian runs from fingers up to lower teeth and nose; Foot-Yangming Meridian runs from nose down to upper teeth and toes. Disease in Hand and Foot-Yangming meridians causes isolated heat in the affected pathway. Isolated heat in the left side means left heat; isolated heat in the right side means right heat. Heat in Hand-Yangming pulse indicates lower tooth decay; heat in Foot-Yangming indicates upper tooth decay. Isolated heat in the head on the left is upper; in the foot on the right is lower. Tooth decay involves swelling, pain, or pus/blood in upper/lower teeth, caused by wind-heat. Thus heat is the sign. According to regular meridians, both sides diagnose Yangming/Taiyin, present in both hands. How could Spleen and Lung uniquely appear on the right? This reasoning is certainly incorrect.) Infant illness: if head hair stands on end, death is certain. (Kidney governs Blood; Kidney-Fu Foot-Taiyang Meridian goes up to the head to nourish head hair. Infant blood is deficient and near death, so head hair stands on end.) Blue veins appearing between the ears indicate convulsive pain. (Blue veins between ears are Foot-Shaoyang Gallbladder Meridian. Infants without illness have collapsed collaterals; with illness, they rise. Rising indicates convulsive pain.) Stool with red and green differentiation in infants with small diarrhea: cold hands and feet make it hard to cure; Sun Xie (undigested food diarrhea) with small pulse and warm hands/feet is easy to cure. (Infant stool with distinct red and green parts is called Sun Xie. Small pulse with cold hands/feet makes Sun Xie hard to cure; small pulse is favorable, warm hands/feet indicate Yang Qi nourishing extremities, making it easy to cure.) Huangdi asked: How to know if a pregnant woman is about to give birth? Qibo said: The body has symptoms, but the pulse is free of pathogenic signs. (Because the fetus is in the body, although there is illness, the pathological Qi does not reach the pulse, hence no pathogenic pulse.) Huangdi asked Qibo: Diagnosing a rapid and tense Heart pulse. What disease is this? What are the symptoms? Answer: The disease is named Xin Shan (Heart Hernia); there should be a mass in the lower abdomen. Asked: Why say so? Answer: The Heart is a Yang organ, and the Small Intestine is its envoy; thus there should be a mass in the lower abdomen. Huangdi said: Good. (Diagnosing Heart pulse: Heart is Yang; tension is Cold. Cold Qi in Heart affects Taiyang Small Intestine, causing mass in lower abdomen, known as hernia accumulation.) Huangdi asked: Diagnosing Stomach pulse, what is the hernia-like condition? Qibo said: Stomach pulse excess indicates distension; deficiency indicates diarrhea. (Soft Stomach pulse is normal. Excess pulse indicates Stomach distension; deficiency pulse indicates diarrhea due to Stomach deficiency.) Asked: How does disease change after formation? Answer: Wind becomes cold and heat. (Wind disease becoming extreme transforms into various cold and heat diseases.) Dan becomes Xiao Zhong (Middle Consumption). (Dan is Spleen/Stomach heat. Internal heat over time transforms into Xiao Zhong, a disease of internal consumption via soup/drinks.) Jue becomes Dian Ji (Manic Disorder). (Yangming heat Jue becomes extreme, upper excess and lower deficiency, transforming into manic disorder.) Long-term wind becomes Sun Xie (undigested food diarrhea). (Spring wind injury in intestines/stomach over time transforms into diarrhea.) Zei Feng (Robber Wind) becomes Li (Leprosy). (Zei Feng enters pores and does not exit; becoming extreme transforms into Li, also called major disease, causing eyebrow loss, nasal collapse, etc.) Changes of disease are countless. (Disease changes into other ailments in five ways. Depending on heart and object, variations are endless and countless. One can only use wisdom to adjust and find the center. Even a thousand medical volumes would not suffice to cover them all.) Huangdi asked: There is a patient with Jue (cold limbs). Right pulse is deep; left pulse is not so. Where is the disease primarily located? Qibo said: In winter diagnosis, the right pulse should naturally be deep and tight; this corresponds to the Four Seasons. (Jue refers to cold Jue. Left hand should not be deep and tight; getting floating and slow is why it is "not so". Winter is Yin; right hand is also Yin; deep and tight is also Yin. In winter, right hand getting deep/tight pulse naturally complies with Four Seasons.) Left is floating and slow; this violates the Four Seasons. On the left, the disease should be diagnosed in the Kidney, somewhat in the Lung, and should involve back pain. (Left is Yang; floating is Lung pulse. In winter, getting Lung pulse in left hand means empty pathogen attacks, causing Kidney disease and back pain, somewhat involving Lung. This is having Lung pulse in left hand.) Asked: Why say so? Answer: Shaoyin Meridian passes through Kidney, up to Stomach/Huang, and connects to Lung. Now getting Lung pulse, Kidney suffers disease, hence Kidney causes back pain. Huangdi said: Good. (Kidney pulse Foot-Shaoyin goes from Kidney up diaphragm into Lung; thus in winter, getting Lung pulse in left hand causes Kidney back pain.) Jueyin excess causes Yin Bi (Cold Pain in Genitals). (Foot-Jueyin Liver Meridian follows groin, enters pubic region, surrounds genitals, reaches lower abdomen. Excess pulse Qi means Yin Qi is abundant, hence Yin Bi, meaning cold pain in genitals.) Deficiency causes Re Bi (Heat Pain in Genitals). (Jueyin pulse Qi deficiency allows Shaoyang to attack; heat and pain in genitals occur.) Slippery indicates Hu Shan (Fox Hernia) and Wind. (Jueyin pulse Qi slippery means Yang Qi is abundant with slight heat. Abundant Qi and slight heat attack Yin, causing Fox Hernia/Wind. Fox hernia gets name because foxes cannot urinate at night but can at sunrise; human disease is similar. Alternatively, Gu Shan (Solitary Hernia), referring to Triple Burner as solitary Fu causing hernia.) Wiry indicates abdominal accumulation and Jue Qi. (Wiry indicates much Blood, little Qi, slight cold. Because Jueyin has much Blood and little Qi with cold, Blood accumulates in lower abdomen and Jue Qi arises.) Shaoyin excess causes Pi Bi (Skin Bi) and Yin Zhen (urticaria). (Shaoyin Foot-Kidney Meridian starts from Yongquan, passes Liver, returns to Lung, governs skin/hair. Excess Yin Qi causes Pi Bi and Yin Zhen, skin eruptions/wind disease.) Deficiency causes Shen Bi (Kidney Bi). (Shaoyin Lung deficiency accepts Cold-Damp Qi entering Kidney, causing Kidney Bi.) Slippery causes Shen Feng Shan (Kidney Wind Hernia). (Shaoyin Qi deficiency allows Taiyang to attack with slight heat, causing Kidney Wind Hernia pain.) Wiry indicates accumulation and hematuria. (Little Qi, slight cold, much Blood leads to Blood accumulation.) Taiyin excess causes Rou Bi (Muscle Bi) and Han Zhong (Cold in Middle). (Foot-Taiyin Spleen Meridian governs flesh. Taiyin abundance causes Muscle Bi and Cold in Middle.) Deficiency causes Pi Bi (Spleen Bi). (Taiyin deficiency means Spleen deficiency accepting pathogen, causing Spleen Bi.) Slippery causes Pi Feng Shan (Spleen Wind Hernia). (Getting Foot-Taiyin slippery pulse means Spleen deficiency, Yangming Qi attacks, causing Spleen Wind Hernia.) Wiry indicates accumulation and intermittent abdominal distension/fullness. (Getting Taiyin wiry pulse means little Qi, slight cold, much Blood, causing Blood accumulation. Taiyin pulse notes Heart; intermittent heart/abdominal distension occurs.) Yangming excess causes Mai Bi (Vessel Bi) and intermittent body heat. (Stomach Foot-Yangming Meridian branches to Spleen, enters abdomen, belongs to Stomach, disperses to Spleen, connects to Heart. Yangming excess/deficiency affects Heart. Heart governs vessels; thus Yangming excess causes Vessel Bi and intermittent body heat.) Deficiency causes Xin Bi (Heart Bi). (Yangming Qi deficiency allows Taiyin to attack, causing Heart Bi.) Slippery causes Xin Feng Shan (Heart Wind Hernia). (Yangming Qi abundant with slight heat causes Heart Wind Hernia.) Wiry indicates accumulation and frequent fright. (Yangming Qi deficiency allows Yin to attack, slight cold, much Blood causes accumulation. Accumulation Qi rushes to Heart intermittently, causing fright.) Taiyin excess causes Gu Bi (Bone Bi) and heavy body. (Foot-Taiyang Bladder Meridian. Taiyang Qi excess attacks Shaoyin. Shaoyin governs bones. Now Shaoyin disease is named Bone Bi; Cold-Damp in bones causes heaviness.) Deficiency causes Shen Bi (Kidney Bi). (Taiyang deficiency allows Shaoyin Kidney Qi to become abundant, causing Kidney Bi.) Slippery causes Shen Feng Shan (Kidney Wind Hernia). (Taiyang slippery pulse means Yang abundance, slight heat attacks Kidney, causing Kidney Wind Hernia.) Wiry indicates accumulation and frequent manic disorder. (Diagnosing Taiyang wiry pulse means little Qi, slight cold, much Blood, causing Blood accumulation below. Accumulation Qi rushes to head intermittently, causing manic disorder.) Shaoyang excess causes Jin Bi (Sinew Bi) and flank fullness. (Foot-Shaoyang Gallbladder Meridian. Liver governs sinews. Foot-Shaoyang abundance causes Yin disease, hence Sinew Bi; Liver disease causes flank fullness.) Deficiency causes Gan Bi (Liver Bi). (Yang deficiency, Yin abundance, hence Liver Bi.) Slippery causes Gan Feng Shan (Liver Wind Hernia). (Getting Shaoyang slippery pulse means Shaoyang Qi abundant, slight heat attacks Liver, causing Liver Wind Hernia.) Wiry indicates accumulation, frequent sinew stiffness, and eye pain. (Getting Shaoyang wiry pulse means Shaoyang Qi little, slight cold, much Blood causes accumulation. Foot-Shaoyang Meridian starts at outer canthus; thus pulse cold causes sinew stiffness and eye pain.)