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Chapter 13 of 13
脉经
The human pulse originates fundamentally from Rong (Nutritive) and Wei (Defensive) — Rong pertains to yin blood and moves within the vessels; Wei pertains to yang qi and moves outside the vessels. The pulse itself does not move on its own; rather, it pulsates following the propulsion of qi. When qi moves, the pulse moves correspondingly — this is the principle of yin-yang correspondence. Qi acts like bellows, driving the blood which rises and falls like waves; qi and blood circulate throughout the body in an upward and downward cycle. All twelve channels contain dynamic pulses, but physicians typically examine the Hand-Taiyin Lung Channel pulse to observe the intake and output of respiration, because the Lung Channel connects upward to the throat and is the great convergence point of the pulse.
At the initial pulse examination, have the patient face the palm upward. The prominent bone behind the wrist is designated as the Guan (Bar) . The area before the Guan is yang, designated as the Cun (Inch) ; the area after the Guan is yin, designated as the Chi (Cubit) . The left and right hands each have their own Cun, Guan, and Chi positions. The pulses of men and women are generally the same, with the only difference in the Chi pulse: in men, the Chi pulse is typically weaker; in women, the Chi pulse is typically stronger. If the opposite is observed, it indicates a pathological condition.
The physician regulates their breathing — one inhalation and one exhalation constitute one xi (respiration cycle). Four to five beats per respiration cycle indicates a state of peace and balance. Three beats indicates a Slow Pulse (Chi Mai) , indicating cold; six beats indicates a Rapid Pulse (Shuo Mai) , indicating heat. The slower it is, the more cold; the faster it is, the more heat — but this must be interpreted flexibly in light of individual differences.
Pulse examination first distinguishes slow vs. rapid, then floating vs. sinking. Floating pertains to the exterior, sinking to the interior. Floating-rapid indicates exterior heat, sinking-rapid indicates interior heat; floating-slow indicates exterior deficiency, sinking-slow indicates interior cold congelation.
Next, examine the six positions of Cun, Guan, and Chi. Each position corresponds to one zang (solid organ) and one fu (hollow organ): Left Cun examines the Heart and Small Intestine; Left Guan examines the Liver and Gallbladder; Left Chi examines the Kidney and Urinary Bladder; Right Cun examines the Lung and Large Intestine; Right Guan examines the Spleen and Stomach; Right Chi examines the Life Gate (Mingmen) and Triple Burner (San Jiao). The three sections also correspond to regions of the body: Cun examines above the chest, Guan examines below the diaphragm, Chi examines from below the umbilicus down to the heel. The left pulse examines the left side of the body, and the right pulse examines the right side — whichever side or section the disease manifests in, the pulse will reflect it accordingly.
Though pulse theory is complex, it can be summarized under the four principal categories of floating, sinking, slow, and rapid. The ancients further divided pulses into the Seven Exterior (Floating, Hollow, Slippery, Excess, Wiry, Tight, Surging), Eight Interior (Faint, Sinking, Moderate, Choppy, Slow, Hidden, Soft, Weak), and Nine Pathways (Long, Short, Deficient, Abrupt, Knotted, Intermittent, Firm, Stirring, Thin, etc.). Various schools differ slightly in their categorizations, but they can complement one another.
Seven Exterior: Floating pulse — felt with light pressure and found lacking with heavy pressure, like a piece of wood floating on water; Hollow pulse — like pressing on a scallion stalk, solid on the edges and empty in the center; Slippery pulse — like a pearl rolling in a bowl; Excess pulse — full and forceful at floating, moderate, and sinking depths; Wiry pulse — like a taut bowstring; Tight pulse — like a fine thread pulled taut; Surging pulse — larger and more forceful than the floating pulse.
Eight Interior: Faint pulse — indistinct and elusive, difficult to locate; Sinking pulse — not felt with light pressure, only obtained with heavy pressure; Moderate pulse — similar to slow but not quite slow, calm and unhurried; Choppy pulse — like raindrops adhering to sand, rough and short; Slow pulse — extremely moderate; Hidden pulse — requires heavy pressure down to the bone; Soft pulse — soft and lacking force; Weak pulse — even softer and more indistinct.
Nine Pathways: Long pulse — extends beyond its normal position; Short pulse — does not reach its full position; Deficient pulse — large in shape but lacking force; The Abrupt, Knotted, and Intermittent pulses all feature pauses, but the Abrupt pulse pauses during a rapid rhythm, the Knotted pulse pauses during a slow rhythm, and the Intermittent pulse cannot resume on its own after pausing — these require careful differentiation; Firm pulse — more solid and tense than Wiry or Tight; Stirring pulse — shaking and unsettled; Thin pulse — as fine as a thread but with some force; Scattered pulse — diffuse and not gathering; Rapid pulse — swift and urgent.
When pulse signs and disease manifestations are cross-referenced, the location and prognosis of disease can be determined. However, the pulse and manifestations sometimes correspond and sometimes do not; one must not adhere mechanically to a single criterion. A person who appears well but whose pulse is already failing is termed a "walking corpse." A person who is ill but whose pulse remains moderate and harmonious with stomach qi will in most cases escape danger.
The following enumerates the pulse essentials of common diseases:
Wind Stroke: A floating-slippery pulse often coexists with phlegm qi; if a sinking-slippery pulse is observed, it should not be treated merely as external wind. When the pulse is faint and deficient, the ancients advocated first strengthening the vital qi and warming to transform phlegm turbidity, rather than rashly dispersing wind.
Cold Damage (Shanghan): Greater Yang disease presents with floating-tight-choppy pulse; Yang Ming disease with a long pulse; Shao Yang disease with a wiry pulse; Tai Yin internal entry often presents with slow-sinking pulse; Shao Yin disease with a tight pulse; Jue Yin deep heat may manifest as hidden pulse with cold extremities. The general treatment approach should follow Zhongjing (Zhang Zhongjing); only the general outline of pulse theory is stated here.
Warm Disease, Damp-Heat Disease, Summer-Heat Disease: Each has its characteristic pulse — yang floating and slippery with yin soft and weak indicates wind stroke; yang soft and weak with yin small and urgent indicates damp-heat; summer-heat injuring qi produces a deficient pulse, possibly presenting as wiry, thin, hollow, or slow.
Malaria: The pulse is naturally wiry; wiry-slow indicates more cold, wiry-rapid indicates more heat.
Bi Syndrome (Painful Obstruction): Wind, cold, and dampness combine to form Bi syndrome; the pulse appears floating, choppy, and tight.
Jiao Qi (Beriberi): In ancient times "jiao qi" did not mean modern athlete's foot. The pulse has four patterns: floating-wiry indicates wind, soft-weak indicates dampness, slow-choppy indicates cold, surging-rapid indicates heat.
Low Back Pain: The pulse is typically sinking-wiry; if also floating, it indicates wind; if also tight, cold; soft-thin indicates dampness; excess indicates traumatic sprain.
Vertigo: Wind produces floating pulse, cold produces tight pulse, dampness produces thin pulse, summer-heat produces deficient pulse, phlegm-drool produces wiry-slippery pulse, deficiency produces weak pulse. The ancients emphasized treating the phlegm qi first in vertigo, then treating according to the pattern.
Cough: Floating indicates wind, tight indicates cold, rapid indicates heat, thin indicates dampness, choppy indicates exhaustion from sexual overindulgence. Cough from the five zang organs is assessed by the pulse of the corresponding section. If the body is robust but the pulse is thin and breathing is weak, this is often critical; coughing with a floating-large pulse has a better prognosis.
Palpitations and Epilepsy: Heart palpitations often present with intermittent or knotted pulse; epilepsy presents with floating, surging, large, long pulse; mental confusion can manifest as the pulse suddenly becoming large then small, suddenly long then short.
Hemorrhage: A hollow pulse is commonly seen, and by identifying in which section the hollow pulse appears, the site of bleeding can be determined. After hemorrhage, the pulse should be sinking-thin; if instead it is floating-large, the prognosis is poor.
Edema: Differentiated into yin and yang types. Yin-type edema has a sinking-slow pulse, bluish-white complexion, absence of thirst with diarrhea, and clear but scanty urine; Yang-type edema has a sinking-rapid pulse, reddish-yellow complexion, thirst, red urine, and dry stools.
Distension and Fullness, Chest Oppression: Distension and fullness present with a wiry pulse; surging-rapid indicates heat-type distension, slow-weak indicates yin cold, floating indicates deficient fullness, tight indicates excess fullness; chest oppression with slippery pulse indicates more phlegm, wiry-hidden also indicates oppression, choppy indicates qi deficiency.
Accumulation and Gathering: Accumulations in the five zang organs each have their names and pulse-color correspondences — e.g., Liver accumulation Fei Qi (Fat Qi) presents with wiry-thin pulse and green color; Heart accumulation Fu Liang presents with sinking-hollow pulse and red color; Spleen accumulation Pi Qi presents with floating-large-long pulse and yellow color; Lung accumulation Xi Ben presents with floating-fluffy pulse and white color; Kidney accumulation Ben Tun presents with sinking-urgent pulse and dark complexion. Accumulations are fixed and do not move; gatherings appear and disperse intermittently. A robust, strong pulse suggests a better prognosis; sinking-small pulse suggests a poorer one.
Diarrhea and Dysentery: In food damage, the qi-opening pulse is tight and replete. In cholera with vomiting and diarrhea, an intermittent pulse is not a cause for alarm. In dysentery, a slippery-large pulse is favorable; floating-wiry-urgent indicates danger; sinking-thin indicates relative safety.
Jaundice and Bone-Steaming Consumptive Fever: Jaundice with excess heat presents with surging-rapid pulse; bone-steaming consumptive fever presents with rapid-deficient pulse. If fever is combined with choppy-thin pulse, or sweating with cough, the ancients considered this difficult to treat.
Abscesses and Intestinal Abscess: Abscesses in early stage present with floating-rapid pulse, chills, and fever; spreading abscess presents with wiry-surging pulse competing with each other. Lung abscess has a rapid-excess pulse at the Cun position; lung wilting has a rapid-deficient-choppy pulse at Cun. Intestinal abscess may be deduced from slippery-rapid pulse; if the pulse is rapid without fever, intestinal abscess should be suspected.
Women's Pregnancy and Childbirth: When the yin pulse stirs below and the yang pulse separates above, with harmonious q&blood, this indicates pregnancy; when the Shao Yin pulse moves with force and the Chi pulse is slippery-rapid and unceasing, this often indicates gestation. The left and right pulses can assist in distinguishing the sex but should not be taken as absolute evidence. Near labor, the "departing channel" pulse of six beats per respiration, sinking-thin-slippery, with labor pains extending through the lower back, suggests imminent delivery. Miscarriage with leaking pus can present with a leather pulse; weak pulse indicates blood exhaustion, which the ancients considered critical. For uterine bleeding and leukorrhea, whether cold fever or depletion-and-exhaustion, insufficiency and blockage, deficiency and taxation — all in one treatise; if summarized thoroughly: hematemesis with slippery-surging pulse, nosebleed.
Children: Pediatric pulse examination prioritizes floating and sinking — floating indicates exterior, sinking indicates interior — supplemented by assessing large/small, slippery/choppy, deficient/excess, slow/rapid. Women's pregnancy/childbirth and children's convulsions/teething fever have special considerations. Detailed inquiry is essential; the pulse cannot be relied upon solely, but rather the four diagnostic methods — inspection, auscultation/olfaction, inquiry, and palpation — must be combined.
Pulse diagnosis must also consider the four seasons. Spring pulse responds with wiriness, summer pulse responds with hooking, autumn pulse responds with fluffy (floating-choppy-short), winter pulse responds with stone (sinking). Excessive pulse indicates disease in the exterior; insufficient pulse indicates disease in the interior. Although seasonal pulses differ, all are rooted in stomach qi. Stomach qi is the calm, moderate, and harmonious quality of the pulse; excess and insufficiency both represent deviation.
The five organs’ normal, diseased, and terminal pulses:
Additionally, the pulse varies with a person’s body type — fat, thin, tall, or short: in fat persons the pulse tends toward sinking, in thin persons toward floating, in short persons it tends toward abruptness, in tall persons toward sparsity. Pulse diagnosis cannot be generalized. The principles of the pulse are profound; one must carefully comprehend them and practice repeatedly beneath the fingers. The author encourages future students to recite the material daily and gradually awaken to its subtle mysteries.
"Stomach Qi" as the Root of the Pulse
This chapter repeatedly emphasizes that "all pulses have stomach qi as their root." The so-called stomach qi refers to the state of the pulse being calm, harmonious, and spirited. Regardless of how the seasonal pulse may vary, as long as stomach qi is preserved, the prognosis is generally favorable; once the pulse loses its softness and reveals true organ pulses, it signals decline of the vital qi. This is the core concept in TCM for determining the presence or absence of vital vitality.
Floating/Sinking and Slow/Rapid as the Principal Framework Governing All Pulses
The author summarizes the complex categories of pulse imaging into four principal categories of floating, sinking, slow, and rapid, then derives the Seven Exterior, Eight Interior, and Nine Pathways from these. This classification attempts to unify pulse diagnosis through the fundamental pathogenesis of "exterior/interior and cold/heat," giving beginning students a method to follow.
Three Sections and Nine Indicators with Holistic Correspondence to Organs
The Cun, Guan, and Chi positions divide the examination among organs and the upper, middle, and lower body regions, embodying the holistic thinking of TCM that "local reflects the whole." Left hand Cun, Guan, and Chi examine the Heart, Liver, and Kidney; right hand Cun, Guan, and Chi examine the Lung, Spleen, and Life Gate — this constitutes an important component of the subsequent Cun-Kou pulse method.
Combined Assessment of Pulse and Manifestations, Never Mechanical
This chapter specifically notes that "there are cases where they correspond to disease and cases where they do not correspond; this is precisely where the most careful differentiation is needed, and one must not hold rigidly to a single point." The pulse must be cross-referenced with symptoms, tongue picture, complexion, etc.; particularly in women and children, the four diagnostic methods must be synthesized. This embodies the consistently flexible syndrome-differentiation spirit of TCM.
From the perspective of modern medicine, pulse diagnosis can partially reflect heart rate, cardiac rhythm, vascular tone, blood volume, and peripheral circulatory status. For example, abrupt, knotted, and intermittent pulses have some correspondence with arrhythmias; rapid pulse is commonly observed in fever and tachycardia; hidden and faint pulses may correlate with shock and circulatory failure. These are objectively observable physiological and pathological phenomena.
However, it must also be acknowledged that the organ divisions and the categorization into Seven Exterior, Eight Interior, and Nine Pathways found in this chapter represent the experience and theoretical constructions of ancient physicians, lacking direct evidence from modern anatomy and physiology. Descriptions such as "liver terminal pulse" or "kidney terminal pulse" should not be mystified; they likely correspond to severe circulatory disturbances, arrhythmias, or blood pressure collapse in the terminal stages and are manifestations of systemic failure, not supernatural omens. As for distinguishing fetal sex by pulse or prognostication of death, modern methods are far more reliable and should not serve as clinical grounds.
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Further Reading
Bu Gua note: This content is based on classical TCM texts and is provided exclusively for the study of traditional culture and research. It does not constitute any medical diagnosis, medication, or treatment recommendation. Please seek medical attention promptly if unwell.