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Chapter 2 of 29
伤寒杂病论
Overall Paraphrase
I. Pulse Categorization into Yin and Yang, and Morbid Pulses
This section first establishes the general outline of yin and yang in pulse diagnosis: Any pulse manifestation that is large, floating, rapid, moving, or slippery belongs to yang pulse; any that is deep, rough, slow, taut, or faint belongs to yin pulse. The ancients believed that if a yin disease manifests a yang pulse, it indicates that the righteous qi can still resist the pathogen, and the prognosis is relatively good; if a yang disease manifests a yin pulse, it indicates that the righteous qi has declined, and the prognosis is relatively poor.
The moving pulse results from the mutual contention of yin and yang qi. If the yang aspect is disturbed, there is a tendency to sweat; if the yin aspect is disturbed, there is a tendency to fever. If accompanied by chills and aversion to cold, it indicates the San Jiao has been injured. If a rapid pulse manifests alone at the Guan position, shaped like a soybean, with no head or tail above and below, moving and unstable, it is also called a moving pulse.
The knotted pulse is one that is slow with occasional pauses; the skipping pulse is one that is rapid with occasional pauses. Yang excess causes a skipping pulse; yin excess causes a knotted pulse. These are all morbid pulses.
If the pulse moves and then stops, and upon returning slightly later is small and rapid, and it can still recover its beating in between, it is called knotting yin. If the pulse moves and stops but cannot recover on its own, and only resumes beating after an interval, it is called replacing yin. The ancients believed that seeing a replacing yin pulse indicated a condition that is difficult to treat.
If both the Cun and Chi positions show skipping pulses, it mostly indicates blood disorders, belonging to excess; if both show knotted pulses, it mostly indicates blood loss, belonging to deficiency. If the skipping pulse is markedly present at the Cun opening, there may be hematemesis or epistaxis; if present at the Chi section, there may be hemafecia; if the pulse alternates between skipping and knotted, the condition is more complex and difficult to treat.
If the rapid pulse continues without stop and then suddenly ceases, it is due to pathogenic qi accumulating and righteous qi being unable to recover, with the pathogen knotting in the viscera. At this time, the pathogen floats to the surface, corresponding with the skin and body hair. This kind of rapid pulse should not be treated with purging. If purgation is mistakenly applied, it will lead to vexation and incessant diarrhea.
II. Yang Knotting, Yin Knotting, and Special Pulses
Someone asks how to distinguish between yang knotting and yin knotting. The Master answers: A floating and rapid pulse with the ability to eat but with constipation belongs to excess, called yang knotting; ancient texts speculate "it will worsen on the seventeenth day." A deep and slow pulse with inability to eat, a heavy body, but unexpectedly hard stools, is called yin knotting; ancient texts speculate "it will worsen on the fourteenth day." The specific day calculations here carry a numerological flavor from antiquity and should not be interpreted mechanically.
A pulse described as floating, large, soft, and scattered like a "carriage canopy" is called yang knotting. A pulse that is deep, taut, and string-like like "feeling along a long pole" is called yin knotting. A pulse that is light and floating, fleeting and unsettled like "fat floating on soup", indicates exhaustion of yang qi. A pulse as thin as spider silk indicates decline of yin qi. A pulse that comes softly and continuously like lacquer about to break indicates blood loss.
III. Residual Noxious Pulses and Pulse Relationships of Multiplication and Subjugation
The six pulses – taut, tight, floating, slippery, deep, and rough – are called "residual noxious" pulses. The ancients believed they can disturb qi and blood and become the source of various diseases.
Pulse relationships include mutual multiplication, vertical, horizontal, counter-flow, and favorable. Water element riding over fire element, metal element riding over wood element, is called "vertical." Fire element riding over water, wood element riding over metal, is called "horizontal." Water element riding over metal, fire element riding over wood, is called "counter-flow." Metal element riding over water, wood element riding over fire, is called "favorable." These use the theory of the Five Elements' generation and subjugation cycles to explain the transmission of disease dynamics among viscera and bowels.
Someone asks how the soft and weak pulse can correspond to the eleven viscera and bowels. The Master answers: The five viscera and six bowels multiply one another, therefore there are eleven. If both yin and yang positions at the Cun opening are taut, and there are no cold-heat exterior manifestations, it mostly indicates fluid retention. If the taut pulse is at the floating level, the fluid is in the skin. If at the middle level, the fluid is in the channels and collaterals. If at the deep level, the fluid is in the muscles. A taut pulse at the Cun opening indicates fluid in the upper Jiao; at the Guan position, fluid in the middle Jiao; at the Chi position, fluid in the lower Jiao.
IV. Taut, Tight, Leather, Hollow, and Causes of Tight Pulses
A pulse that is taut and tight is anciently called "leather." A taut pulse is like a bowstring, not shifting upon pressure. A tight pulse is like a twisting rope, coming and going without fixity. A pulse that is taut and large – taut indicates reduction and cold, large but hollow indicates hollow and deficiency; cold and deficiency contending is called "leather." When women see this, there may be miscarriage or incessant vaginal bleeding. When men see this, there may be blood loss or seminal emission.
Causes of a tight pulse: The lung can be affected by cold due to excessive sweating or vomiting, which can cause a tight pulse. Drinking cold water after coughing can cause a tight pulse. Cold deficiency in the stomach due to diarrhea can also cause a tight pulse. If the Cun opening pulse is floating and tight, this originally indicates exterior cold. If the physician instead treats with purging, this is a major transgression. Floating indicates blood deficiency; tight indicates cold. Cold qi contending causes borborygmus. If this principle is not understood and the patient is instead given cold water to drink, so that sweat cannot emerge, water and cold contending will cause the patient to experience a sensation of blockage in the throat.
V. Individual Items on the Cun Opening Pulse
VI. Fuyang Pulse and Shaoyin Pulse
The Fuyang pulse is taken at the dorsum of the foot, primarily used by the ancients to assess the qi of the spleen and stomach. The Shaoyin pulse refers to the pulse of the Kidney channel of Foot Shaoyin, used by the ancients to assess kidney qi.
VII. Slippery Pulse and Related Pulses
Someone asks what it means when "a screening and suddenly deep pulse" is named slippery. The Master answers: Deep is pure yin; screening is aligned yang. Yin and yang harmonize and combine, thus the pulse becomes slippery. The Guan and Chi are naturally level. Fuyang pulse being slightly deep: food and drink become naturally balanced. Shaoyin pulse being slightly slippery: slippery is the floating quality of a tight pulse, belonging to yin excess. The patient may experience sweating on the inner thighs and dampness in the genitals.
Fuyang pulse floating and slippery: floating is yang, slippery is excess. Yang and excess contending makes the pulse rapid and urgent. Defense qi loses its regulation. If fever with sweating appears, the ancients called this untreatable.
Fuyang pulse slippery and tight: slippery indicates repletion of stomach qi; tight indicates strength of spleen qi. Repletion and strength striking each other instead harm the body itself, like holding the blade of a sword; sores and ulcers will develop.
Fuyang pulse deep and faint: deep indicates internal excess, rapid indicates digestion of grains; if a tight pulse appears, the disease is difficult to treat.
Fuyang pulse hidden and rough: hidden indicates vomiting with rebellious qi and nondigestion of water and grains; rough indicates inability of food to enter, called "barrier-repulsion."
VIII. Dual Injury to Yin and Yang After Mistreatment
The Master says: When a patient's pulse is faint and rough, it is often due to mistreatment by physicians. If profuse sweating is then followed by major purging, the patient loses blood. The disease should first manifest as chills and then fever, uninterrupted. In the height of summer's heat, the patient wants more clothing; in winter's deep cold, the patient wants exposure of the body. This is because yang faintness causes chills, and yin weakness causes fever. Mistaken sweating injures yang qi; mistaken purging injures yin qi. In the fifth month, yang qi resides at the exterior, while the stomach is vacuous and cold within. Because yang qi is internally faint, it cannot overcome cold, hence the desire for heavy clothing. In the eleventh month, yang qi resides in the interior, while the stomach becomes vexing and hot. Because yin qi is internally weak, it cannot overcome heat, hence the desire for exposure. If the yin pulse is slow and rough, this is an indication of blood loss.
Shaoyin pulse weak and rough: weak indicates slight vexation; rough indicates cold and reversal of the hands and feet. If the Fuyang pulse does not emerge, the spleen cannot ascend clarity and descend turbidity, and the body is cold with firm skin. If the Shaoyin pulse does not arrive, kidney qi is faint, essence and blood are scant. The rushed qi ascends to attack the chest and diaphragm; the ancestral qi in turn gathers and congeals; blood knots below the heart. Yang qi recedes downward and heat returns to the yin thighs, with the limbs becoming numb and insensitive. This is called "corpse reversal." The ancients considered needling Qimen (LR 14) and Julian (CV 14) appropriate, which belongs to ancient acupuncture emergency protocols; in modern times, this must not be self-administered.
In pregnancy, a taut, rapid, and thin pulse with lower abdominal pain and heat in the palms of the hands – the ancients believed this to be heat knotting in the uterine palace. If treated without timeliness, dystocia may result. In the postpartum period, a surging and rapid pulse that upon pressure is taut and tense indicates that lochia has not descended; if lochia has already descended but the pulse remains so, this is "soul detachment," and is relatively difficult to treat.
All floating and rapid pulses should ordinarily present with fever and chills. If there is a fixed painful location while eating and drinking remain normal, it is mostly indicative that an abscess has already formed.
IX. Emotions, Prognosis, and Terminal Pulses
Someone asks how the pulse manifests during fright. The Master answers: The pulse is thin and continuous, like following a silk thread, with the complexion turning pallid and ashen.
Someone asks how the pulse manifests when a person does not drink water. The Master answers: The pulse is rough, with dry lips and mouth.
Someone asks how the pulse manifests during shame. The Master answers: The pulse floats, and the complexion alternates between pallor and flushing.
At the Cun opening, all faint pulses indicate loss of yang; all soft pulses indicate loss of blood; all weak pulses indicate fever; all tight pulses indicate cold. When cold qi invades, the hands and feet become cold and reversed, consciousness may become clouded, and numbness may occur. Because the stomach lacks grain qi, the spleen is rough and blocked, the mouth and jaw become tight and cannot speak, and the body shivers with violent chills.
With fever, the pulse becomes agitated; with chills, the pulse becomes still. A pulse that follows the shifts of the symptoms suggests malaria. In febrile disease with cough and rebellious qi, a scattered pulse is a poor sign, because the body form is already damaged.
A pulse that is at times large, at times small, at times still, at times chaotic, with the person becoming fearful when seeing others – the ancients called this "onset arising from the gallbladder due to spirits." It is exhaustion of qi. This should not be understood as supernatural possession, but rather as emotional fright causing disorder and reversal of qi mechanism.
If the usual ratio of the pulse shows no abnormality and yet sudden severe illness strikes with loss of consciousness, the ancients called it an "evil ghost," advocating incantation therapy. Those who can still speak have a better prognosis; those who cannot speak have a poor prognosis. This section carries a distinctly archaic and superstitious coloring. In modern times, this should be treated as an acute emergency with immediate medical attention, not reliance on incantations.
Signs of extremity of life: a pulse that is floating and surging, body sweating like oil, unceasing panting, inability to then ingest water or broth, corporal numbness, and mental clarity alternating with confusion – is called "exhaustion of life."
Manifestations of exhaustion of each of the five viscera: sweating that then moistens the hair in unison, with unceasing panting, indicates initial exhaustion of the lung. Solitary yang heat remaining alone, a body appearing like smoke-dried remnants, eyes staring straight ahead with head shaking, indicates exhaustion of the heart. Lips showing cyanotic discoloration, with the four limbs twitching – exhaustion of the liver. Around the mouth lustrous black and the complexion ashen like oily yellow – exhaustion of the spleen. Urinary and fecal incontinence, delirious speech, eyes straightening backwards in death stare – exhaustion of the kidneys.
If yang qi fails first and yin qi withers subsequently, the corpse's complexion turns bluish at death. If yin qi fails first and yang qi subsequently withers, the corpse's complexion becomes reddish, with slight warmth in the armpits and heating in the cardiac region. These describe the late observations of the ancients at the precipice of death.
X. The Eight Extraordinary Vessels
The Eight Extraordinary Vessels refer to the Du, Ren, Chong, Dai, Yin Qiao, Yang Qiao, Yin Wei, and Yang Wei vessels. They are not subordinate generative heads subject primarily to conveyance by limb systems; rather, they have distinct routes of circulation; nevertheless, their disorders charge back to yin/yang and the twelve major vessels for treatment.
Yang Wei maintains connecting with all the yang. Yin Wei Maintains cross bind Yin weave. Being specific q branches now: Yang Wei anchoring threads channels connect jangling gate while latch each. Once over stress or shatter bands through 6 harmonic coasts from Yang gather rail to hang straight enfeiter on its prime neckline vertical runs lost sideways spirit trace too vague lying scattered wide set spokes. Hence comes its maladies with rising mislinked mostly in distant armor edge so ache in yang aspects common point includes high joint welts burning skin like laid coals numbs along wide row reach rounds limbs seizure float wander slack each beat via fill run hot short bark unsteady with breath late wheel closing, while catch then high ride cold fro static braced leash without cut showing her chin bleak chapped tears dry no marrow reeds bridge has failed bolster rear columns onward muscle slumping front leap forward sliding wide path teeth teeth grip loosen yet teeth closed gnash across lying plane silent lances thrown and whirled dead axle true tree leaning twain.
These hold gate harness functions cross knot for circuits they duplic spring relay block is stranded cable quiet and secure should then static tide breath outward through all that lean along that each call rollbacks stand then branch stops route star falls from rung drain through heel med toward.
The Wei vessels relate aliment that blood ensures or if sick that tied muscle contract dim runs beneath beside who twines rare q: Hence said:
Yang Wei sieges that what stays on distant runs feels ease in fever flush unstable temp catches drift ails rarely treated present dumps wrapped; such whence sweat appears great each pattern shakes.
Yin Wei lays array losing force interior tired vex nausea low chest beats heaving rises hearts knocking jump threatens through door waist spasm sash contract middle fields throb down under no measure sweat line settles sheen acrid stops upon back draw aches from inner pelvic strain stilly dizzy nausea void descent blood.
Q so vessel may holding course on own rise pattern irregular as chill taken warm within against as coat both while rot walls on its recess shore tears weep drift state range across crossing shared.
Thus vessels branch gives logic from each primal static gauge block basis energy realigned singular fine reserve by latent outer outer returns walk unvisited drift end built where transport worn the flood route falleth now y blocked then branches signal guard blood overflow whether whole in branch or bow that find which side on range their yang n points return within whole through wind fresh outward when tied only warping by cold stay within which he op internal left fail seeping lateral drought.
All only treated if on q exact scope matching route. q into these inner passed flow depth varying within across other per trunk drift up sides to joints from source spread row gate passes two not absorbed but resorption drive q and blood move through depths sway skin under same place direction.
Also means sickness due weary years exertions route derail injury lead not fierce breakout alone and root delay apparent by chronic attrition mark; simple:
Gu du vessel impaired: lumbar with spine little disposed erect loosing pain dull seated long it swells. Ren strain affects urination copious with white sedimentation turbid ring duct. Chong injured induce frequent coughing unleavable dry sound only with effort heave rattle exert pant. Dai vexed that gird all about clammy zones per outer seat q rides low. Yang Heel wound side left dull dead weight feel no wound evident through routes. Yin Heel Harmed; right-side tegument failure turns faint conduction reduced. Yang Wei lesioned notable aversion cold. Outer coat lies damp continuous across all span surfaces. Yin Wei weak then heat dominating. Flesh crepe by lose then marked tinder dry general parchment sanding friction.
Pulse markings for those routed latent eight: Gov pulse reads large yet coarse upon Chi flush lane. Con sequence heavy coarse alignment within Guan lat vert dense braid sliding he tied both gone course slight snap unsound reach breadth off half slip again tie gave array of broad per pull settle ground along where old small route stoop mid stack each was indeed no skip read step grazes jump line no.
Chong void: Cun brief root few deep far strand snaps dry arcing low thread winding backward reties count could mark but seam.
Dai one deep wash in coarse knit less flow.
Yang heel wave span tilt chording bow flosses ground from heavy stagger. Yin co goes drawn then slack till hook dips, ladder to low shore chord wandering returns from down.
Yang-wei hazy slack then lines wisp per lung stay knotted whip ends trace depth could strangle stave breaking groove their old binds wander those few been fit that inward then side ties smooth rope: yet that both entire be six section arcs coiled weave missing caught so equal through leaf co trail where crossed under knot long threads home center lat flow roll under out far toward next loom gauge shifting caught fresh across by stop broad sink belly weight sleep flux routes cut can knot never past pass bridge (as) land range via channel.
Yin further holds knit clasp crimped abraded she car wheel long pull slight quiver tension fray near bone.
Recover lines minded however should rearray way: Gu trauma b c marrow toward sea steep replenishment. Ren wounded dose to point store within build keep around replenish essence locked of kidney bellows. Chong breach y room deep sent q store pile bring fine to burn through. Dai wound touch reinforce water cloud conduits whose river routes kidneys that underpin. Qiao Yang wasting spleen drawback route apply wisdom full dredge bile cabinet for its cord wind gateway row. Yin- qiao laxity whose conduits wane who builds moist sea wood, support troughs where sour flow reroutes. Wei-Yang chills so thick within guarding porch this call fortress courtyard meridian thread hold open line wave; pick stanching wait heat body which wanders flows loosen ties around have set wind. Wei-yin tired flushet wave running bright scorch where within paths shuttered cross yet vein from reach flush, clothe with sight food their channel is old way nourish q & enrich blood return for it has du salt whole blazed arc eons flow chart move broken.
Thus its final formal doctrine grounded ancient practitioners sway real route take tangible yang solid caliber evaluate human frame thin crest surge chill real famine wailing grief deep still emptiness press lingering choosing q route fold then he over they line order depth weigh which drug f mode wait hold frame hold not fail.
As grand such abstraction few prescribe path less forms all have. Old weave canvas then never a packet.
This passage on "Pulse Discrimination Methods" (※平脉法) covers extremely vast ground. The central thought can be summarized in five points:
Pulse diagnosis is an important empirical diagnostic method in Chinese medicine. Some pulse descriptions bear a certain correspondence with modern cardiovascular states—for example, superficial or deep pulse may reflect whether blood vessels are shallow or deep-seated; slow or rapid pulse may correspond to heart rate; knotted, skipping, or intermittent pulses may indicate arrhythmia; slippery or rough pulse may relate to blood flow characteristics. However, pulse diagnosis is highly subjective and varies greatly from person to person, and cannot be equated with modern medical testing.
The text's statements about determining life or death based on Yin-Yang pulses, the deduction of Five-Phase mutual generation and conquest, and prognostic dates such as the seventeenth or fourteenth day carry an archaic numerological and speculative character. These should be understood as historical documents and not mechanically applied. Content such as "incantation" and "malevolent spirits" falls within the scope of ancient shamanistic medicine and should be viewed rationally in modern times; acute conditions must be treated medically.
The eight extraordinary vessels remain a theoretical model in Chinese medicine. Modern anatomy has not identified fully corresponding independent structures, and they are better understood as functional regulatory systems.
Some general life guidance can be distilled from this section:
These are merely general health-preservation principles and are not directed at any specific disease.
Bugu Tip: This content is based on classic Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a physician promptly if you feel unwell.