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Chapter 7 of 13
脉经
The pulse is divided into three portions, namely cun, guan, and chi. Yin and yang interact and influence each other. Nutritive and defensive qi and blood (ying-wei, the nutrients and defensive qi that circulate unceasingly in the human body) flow through the body in a cycle. With inhalation and exhalation, the qi mechanism moves up and down through the center of the body; with each breath, qi and blood are distributed throughout the body, and fluids are able to flow freely.
The pulse manifestation changes with the four seasons: in spring it tends to be wiry, in autumn floating, in winter deep, and in summer full and large. When examining, one must observe the complexion and the pulse; the pulse size differs. Even within a short period, it can change and is not fixed. Cun and chi may be uneven in length, sometimes short, sometimes long; the upper and lower may be disordered, sometimes present, sometimes absent. Once the condition changes, the pulse also follows with variations in depth and height. If the mind is confused and loses the guiding principles, it becomes difficult to judge. I hope for a detailed explanation so that the principles become clear.
The teacher said: What you have asked is the very root of medicine. The pulse has three portions, namely cun, guan, and chi. The nutritive and defensive qi flows without losing balance; the kidney pulse is deep, the heart pulse is full and large, the lung pulse is floating, and the liver pulse is wiry — these are the normal patterns, without the slightest error. Qi and blood rise and fall in and out, as regular as the water-clock that drips to mark time. The ancients held that when the water descends two notches, the pulse qi completes one full circuit of the body and returns to the cunkou (pulse opening), whereupon the changes of vacuity and repletion become manifest.
Pulse changes interact and override one another; yin and yang disturb each other. When affected by wind, the pulse becomes floating and vacuous; when affected by cold, it becomes tight and wiry; when fluid retention is present internally, the pulse is deep; when there is limb-fluid (water retention in the chest and diaphragm), the pulse is rapid and wiry; when the pulse is stirring and wiry, there is mostly pain; when the pulse is rapid and full, there is mostly heat and vexation. If the pulse does not correspond to the condition, one must investigate the reason for the change. The three portions differ in their pulses, so the diseases they govern also differ. If the pulse is excessive, it is indeed strange, but if it is insufficient, it likewise deserves vigilance. Pathogenic qi does not arise without cause; behind it there is always a source. One must examine whether the disease is in the exterior or the interior, discriminate the portions of the three burners, understand where the pathogenic qi resides, examine carefully, and infer the condition of the viscera and bowels — in this way the condition becomes clear. It is recorded item by item for students, transmitted to the worthy.
The ancients divided a day into six periods under three yin and three yang: dawn belongs to greater yang, midday to yang brilliance, late afternoon to lesser yang, dusk to lesser yin, midnight to greater yin, and rooster's crow to reverting yin. These are the periods governed by the three yin and three yang.
The pulse patterns of each channel and their times of flourishing are as follows:
With regard to disease pulses:
When the reverting yin pulse is rapid and wiry, with the beating amplitude reaching above six tenths, the disease manifests as a slow pulse, cold signs, and pain in the lesser abdomen pulling the lower back; if wheezing is also present, the original text judges it fatal; if the pulse is relaxed, it is considered treatable. The treatment states to needle the foot reverting yin channel, to a depth of five tenths of an inch.
When the lesser yang pulse is alternately short and long, alternately large and small, with the beating amplitude reaching above six tenths. In disease, there is headache, fullness below the ribs, and vomiting — considered treatable; if restlessness and agitation appear, the original text judges it fatal. The treatment states to needle the ends of both floating ribs on the foot lesser yang channel, to a depth of seven tenths of an inch.
When the yang brilliance pulse is full, large, and floating, smooth and stirring as it arrives, large in front and thin behind, shaped like a tadpole, with the beating amplitude reaching above three tenths. In disease, there is dizziness and headache, abdominal fullness and pain, and vomiting — considered treatable; if restlessness and agitation appear, the original text judges it fatal. The treatment states to needle four inches above the navel and three inches below the navel, each to a depth of six tenths of an inch.
The original text also states: from the second month to the eighth month, the yang pulse is at the exterior; from the eighth month to the first month, the yang pulse is at the interior. The yang-attached pulse tends to be excessive; the yin-attached pulse tends to be weak.
Next follows a passage describing the chain of changes between pulse and symptoms: when the pulse becomes rapid and urgent, there is susceptibility to fright — how does the repletion pattern manifest? If the pulse is thin and deep, and drainage was not performed in time, after draining there will be vexation, after vexation thirst, after thirst abdominal fullness, after fullness stirring, and stirring leads to borborygmus, then the appearance of an intermittent pulse (dai mai), which comes and pauses abruptly. When the pulse is large and deep, there is coughing; coughing causes qi to flow upward; when the upper qi becomes severe, there is shoulder breathing (opening the mouth and raising the shoulders to breathe); when shoulder breathing becomes severe, oralbleeding, and tongue bleeding occurs; when bleeding is severe, nasal hemorrhaging occurs.
In addition, the original text uses various manifestations of the cunkou pulse to infer wind, fluid-retention, food stagnation, and other patterns:
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Having strong pulse at to three counts per breath: full reaches disease. At five-six-per,
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The Classic states: In disease, some result in death, some heal spontaneously without treatment, and some linger for years without recovery. Can life and death, survival and perishing, be known through pulse diagnosis? The answer: Yes. If a patient closes their eyes and is unwilling to see people, the pulse should show the Liver pulse—wiry, tense, and long. If instead the Lung pulse is seen—floating, short, and rough—death results. If a patient opens their eyes, is thirsty, and has a hard, full sensation beneath the heart, the pulse should be tight, replete, and rapid. If instead deep, slippery, and faint pulses are obtained, death results. If a patient vomits blood or has nosebleeds, the pulse should be deep and fine. If instead floating, large, and firm pulses are obtained, death results. If a patient speaks deliriously and rambles, and the body has heat, the pulse should be surging and large. If instead the hands and feet are ice-cold and the pulse is deep, faint, and fine, death results. If a patient has a large abdomen and diarrhea, the pulse should be faint, fine, and rough. If instead tight, large, and slippery pulses are obtained, death results.
The Classic states: When the physical appearance and pulse are contrary to the disease, death results. For example: with headache and eye pain, if the pulse is instead short and rough, death results; with abdominal pain, if the pulse is instead floating, large, and long, death results; with abdominal fullness and wheezing, if the pulse is instead slippery, gliding, and deep, death results; with cold reversal of the four limbs, if the pulse is instead floating, large, and short, death results; with deafness, if the pulse is instead floating, large, and rough, death results; with blurred vision, if the pulse is instead large and slow, death results. When there is disease on the left but pain on the right, disease on the right but pain on the left, disease below but pain above, or disease above but pain below—this is called contradiction (逆, nì). Those with contradiction die, and cannot be treated.
When the pulse arrives deep and is utterly soft upon pressing, or floating but does not stop, and pushes against the hand, death occurs within half a month. When the pulse arrives faint and fine to the point of extinction, the person will die from illness. When a person is ill but the pulse is not ill, life is preserved; when the pulse is ill but the person appears not ill, death results. When a person suffers from corpse-like syncope (尸厥), calls for them but there is no response, and the pulse is extinct, death results. When the pulse should be large but is instead small, death results.
Those in whom constitution and pulse are contrary: If a fat person has a pulse as fine as a silk thread, about to cease, death results. If an emaciated person gets an agitated pulse, death results. If the body is rough but the pulse is slippery, death results. If the body is smooth but the pulse is rough, death results. If the body is small but the pulse is large, death results. If the body is short but the pulse is long, death results. If the body is long but the pulse is short, death results. If the body is large but the pulse is small, death results. When the Chi pulse does not correspond to the Cun pulse, and at times moves like a galloping horse, death occurs within half a day.
When the pulses of the Five Viscera manifest together: When both Liver and Spleen pulses arrive, then water and grain are not transformed. If the Liver pulse predominates, death results. When both Lung and Liver pulses arrive, then abscesses and carbuncles occur with heavy limbs. If the Lung pulse predominates, death results. When both Heart and Lung pulses arrive, then Bi syndrome, wasting-thirst, and lassitude occur. If the Heart pulse predominates, death results. When both Kidney and Heart pulses arrive, then speech becomes difficult, the nine orifices are blocked, and the four limbs cannot be raised. If the Kidney pulse predominates, death results. When both Spleen and Kidney pulses arrive, then the five viscera are ruined. If the Spleen pulse predominates, death results. When both Liver and Heart pulses arrive, then intense heat occurs, sweat does not exit, and one has delusional visions of evil spirits. When both Liver and Kidney pulses arrive, then hernial lumps and abdominal masses occur with lower abdominal pain, and in women, menstruation ceases.
When the Liver, Kidney, and Lung are all full and replete, this results in swelling. With Lung engorgement, there is wheezing and fullness of both hypochondriac regions. With Liver engorgement, there is fullness of both hypochondriac regions, and when lying down, startling occurs, with inability to pass urine. With Kidney engorgement, there is fullness from the soles of the feet to the lower abdomen, the shins vary in size, the hip is large with lameness, and hemiplegia easily develops.
When the Heart pulse is full and large, epilepsy with muscle cramping results. When the Liver pulse is small and tight, epilepsy with muscle cramping results. When the Liver pulse is rapid and violent, there has been fright and shock. If the pulse does not arrive, and if there is muteness, it resolves without treatment. When the Kidney pulse is small and tight, the Liver pulse small and tight, or the Heart pulse small and tight—none of these drumming—all indicate abdominal masses (瘕, jiǎ). When Kidney and Liver are both deep, this is stone edema (石水). When both are floating, this is wind edema (风水). When both are vacuous, death results. When both are small and wiry, fright is imminent. When the Kidney pulse is large, tense, and deep, or the Liver pulse is large, tense, and deep, both indicate hernia. When the Heart pulse is gripping, slippery, and tense, it is Cardiac hernia. When the Lung pulse is deep and gripping, it is Lung hernia. When the Spleen pulse beats externally and is deep, it is intestinal dysentery (肠澼), resolving on its own after a long time. When the Liver pulse is small and moderate, it is intestinal dysentery, easily treated. When the Kidney pulse is small, gripping, and deep, it is intestinal dysentery with blood in the stool. If the body is warm with fever, death results. When Heart and Liver also have blood in the stool, if both viscera are ill together, it can be treated. When the pulse is small, deep, and rough in intestinal dysentery, and the body has fever, death results. If fever appears, death occurs within seven days.
When the Stomach pulse is deep, drumming, and rough, when the Stomach pulse beats externally and large, and when the Heart pulse is small, tight, and urgent—all these indicate esophageal obstruction (膈) with hemiplegia. In men the disease manifests on the left; in women, on the right. If there is no muteness and the tongue can move, it can be treated, with recovery in thirty days. In those where the course is favorable yet muteness develops, recovery takes three years. In those under twenty years of age, death occurs within three years.
When the pulse arrives and grips, and there is bleeding or nosebleed with body heat, death results. When the pulse comes like a hanging hook, and is floating, this indicates heat. When the pulse arrives like panting, this is called Qi reversal (气厥). In Qi reversal, the person does not know how to converse with others. When the pulse arrives as if rapid, causing sudden fright, recovery occurs in three to four days. When the pulse arrives like floating foam merging together—floating foam merging like rapid counting, with more than ten beats per breath—this indicates insufficiency of channel Qi. If faintly seen, death occurs in ninety days. When the pulse arrives like fire newly ignited, this indicates that the Heart essence has been seized; death occurs when grass dries. When the pulse arrives like scattered leaves, this indicates deficiency of Liver Qi; death occurs when tree leaves fall. When the pulse arrives like a visiting guest—the visiting guest being a pulse that is blocked then drums—this indicates insufficiency of Kidney Qi; death occurs when jujube blossoms hang. When the pulse arrives like a mud pellet, this indicates insufficiency of Stomach essence; death occurs when elm pods fall. When the pulse arrives like a horizontal grid—this indicates insufficiency of Gallbladder Qi; death occurs when grain ripens. When the pulse arrives like a string of silk thread, this indicates insufficiency of the Uterus and Bao essence. If the disease causes excessive talking, death occurs with frost. If there is no talking, it can be treated. When the pulse arrives like intertwined lacquer, arriving sideways to left and right—when faintly seen, death occurs in forty days. When the pulse arrives like a gushing spring, floating and drumming within the flesh, this indicates insufficiency of Large Intestine Qi, with shortness of breath. Death occurs at the time of leek flowering. When the pulse arrives like the appearance of heaped earth, and upon pressing it cannot be obtained, this indicates insufficiency of muscle Qi. If of the five colors, black appears first, death occurs when white millet sprouts. When the pulse arrives like a hanging uvula—floating upon superficial palpation but upon deeper pressing it becomes larger—this indicates insufficiency of the twelve Back-Shu points. Death occurs when water freezes. When the pulse arrives like a prone knife—floating, small, and tight; upon pressing, firm, large, and urgent—there is stagnation and heat of the five viscera, with cold and heat concentrated solely in the Kidney. The patient cannot sit. Death occurs at the beginning of spring. When the pulse arrives like a round pellet, slippery and not obeying the hand, and upon pressing, it cannot be obtained, this indicates insufficiency of Large Intestine Qi. Death occurs when jujube leaves grow. When the pulse arrives like pounding, it causes the person to be prone to fear, unwilling to sit or lie down, and while walking or standing they are always listening—this indicates insufficiency of Small Intestine Qi. Death occurs at the end of autumn.
Finally, there is a passage of dialogue and explanation: Once, in the second month, I examined a patient whose pulse was instead deep. The master determined that death would occur in autumn. Later the patient recovered instead. In the seventh month, the patient fell ill again. Upon re-examining, the pulse was still deep, and again it was determined that death would occur in winter. In the second month, the pulse should be soft, weak, and wiry. To instead obtain a deep pulse—when autumn arrives, the pulse should become floating; if it remains deep, death results. Therefore it was said death would occur in autumn. In the seventh month, the pulse was deep again. A deep pulse belongs to the Kidney, indicating a True Visceral pulse (真脏脉, zhēnzàng mài——a critical pulse pattern in which the organ's own qi is exposed without stomach qi), seen improperly out of season. The Classic speaks of the five-element waxing and waning law of King, Minister, Prisoner, Death (王相囚死): the winter pulse is the King pulse at that time and should not reappear. Therefore it was said death would occur in winter. And indeed, death occurred on the winter solstice. Hua Tuo also followed this method.