Chapter 4 of The Systematic Classic of Acupuncture and Moxibustion — Study of Channels and Pulse Diagnosis

Overall Paraphrase

I. Channels Number One (Part One) — Renying-Cunkou Pulse Method and the Visceral Pulse Manifestations

Lord Lei asked the Yellow Emperor: It is said externally that "all bound together as one." I do not understand its meaning. May I ask how to grasp the essentials of the pulse method? The Yellow Emperor replied: Cunkou (the radial artery at the wrist, which governs the qi of the internal organs) primarily reflects the internal viscera, while Renying (the carotid artery at the neck, which governs the qi of the yang channels on the body surface) primarily reflects the channels of the exterior. The two respond to each other and come and go together, like pulling a single rope, with balanced strength. In spring and summer, the Renying pulse is slightly more ample; in autumn and winter, the Cunkou pulse is slightly more ample—such a person is a normal healthy person (one free from disease).

🌸 The Renying-Cunkou Comparative Pulse Diagnosis: When the Renying pulse is twice the size of the Cunkou pulse, the disease is in Shaoyang (the half-exterior, half-interior channel); when three times as large, the disease is in Taiyang (the most superficial channel); when four times as large, the disease is in Yangming (the channel of deepest interior heat). A full pulse indicates heat, a vacuous pulse indicates cold, a tight pulse indicates painful bi (painful and numb conditions), and a regularly intermittent pulse indicates symptoms alternating between mild and severe. For fullness, use reducing method; for vacuity, use supplementing method; for tightness, needle between the sinews and flesh; for intermittence, select the blood luo-connecting vessels for bloodletting and combine with medication; for a sunken pulse, use moxibustion; for neither excess nor vacuity, select the primary channel for regulation—this is called channel needling. When Renying is four times larger, it is called external repulsion—the pulse is both large and rapid, and is a fatal condition with no cure. One must carefully examine the root and branch of the illness and investigate its cold and heat to verify the disease of the viscera.

Conversely, when the Cunkou pulse is twice the size of Renying, the disease is in Jueyin (the deepest yin channel); when three times as large, the disease is in Shaoyin. When full, there is abdominal distension; when cold, food is not digested; when vacuous, there is internal heat, diarrhea, scant qi, and changes in urine color; when tight, there is painful bi; when intermittent, there is alternating cold and heat, with heat below and cold above. Likewise, reduce for fullness, supplement for vacuity; for tightness, needle first then moxa; for intermittence, first select the blood luo-connecting vessels and then regulate; for a sunken pulse, use moxibustion—because a sunken pulse indicates that blood stasis has congealed in the blood vessels, with cold blood and obstruction, hence moxibustion is appropriate. When Cunkou is four times larger, it is called internal barrier, with a large and rapid pulse indicating a fatal condition.

The Yellow Emperor further asked: How does one determine whether a condition is worsening or in decline? Qi Bo said: There are indicators both internally and externally to examine. If the radial pulse (i.e., Cunkou) is slippery, small, tight, and deep, the disease is internally aggravated; if Renying is large, tight, and floating, the disease is externally aggravated. When the radial pulse is floating and slippery, the condition is progressing daily; when Renying is deep and slippery, the condition is gradually improving. When the radial pulse is slippery and deep, the disease is progressing internally; when Renying is slippery, full, and floating, the disease is progressing externally. When the floating or deep quality of the pulse and equal sizes of Renying and Qikou appear together, the disease is difficult to cure. When disease is in the visceral organs, a deep and large pulse indicates easy recovery, while a small pulse is counter-indicative; when disease is in the bowels, a floating and large pulse indicates easy recovery. When Renying is full and tight, the injury is from cold; when the radial pulse is full and tight, the injury is from improper food intake.

🌬️ The Normal Healthy Pulse Rate: With one inhalation of the breath, the pulse beats twice, and with one exhalation, it also beats twice; with the pause between breaths, there is one additional beat (five beats in total), plus the surplus from deeper breathing—this is the normal pulse rate. One beat per exhalation and one beat per inhalation is called scant qi. Three beats per exhalation with agitation, and hot skin at the cubit region, indicates a warm disease; if the cubit is not hot but the pulse is slippery, it indicates a wind disease. Four or more beats per exhalation is a fatal sign; a pulse that completely stops is fatal; a pulse that alternates between fast and slow is fatal.

The human body always receives essential qi from the stomach (the sea of water and grain, the root of acquired constitution), and the pulse takes the stomach qi as its foundation. A pulse without stomach qi is called counterflow (ni), and those with such a pulse die. Palpating the radial pulse, if among fifty movements there is not a single intermittent beat (dai pulse), it indicates that all five viscera are normally receiving essential qi. If there is one intermittent beat among forty movements, one viscus has lost its qi; among thirty movements, two viscera have lost their qi; among twenty movements, three viscera have lost their qi; among ten movements, four viscera have lost their qi; and if there is one intermittent beat before ten movements, all five viscera have lost their qi. Based on this, one can predict the time of death.

🌿 The Fundamental Pulses of the Five Viscera: The liver pulse is wiry (like a bowstring), the heart pulse is hook-like (coming full and going into decline), the spleen pulse is regularly intermittent (relaxed and harmonious), the lung pulse is hair-like (light and floating like feathers), and the kidney pulse is stone-like (deep and firm like a stone).

The Normal, Diseased, and Fatal Pulses of the Five Viscera:

• Heart Pulse: When it comes continuously like a string of beads or like touching a beautiful jade, it is normal; when it has slight curvature within its continuity, it indicates disease; when it is hooked in front and straight behind, like holding a belt hook, it indicates death.
• Lung Pulse: When it comes light and floating like elm leaves falling, it is normal; when it neither ascends nor descends, like touching chicken feathers, it indicates disease; when it is like an object floating on water or like wind blowing feathers, it indicates death.
• Liver Pulse: When it comes soft, like lifting the tip of a long pole, it is normal; when it is full and slippery, like touching a long pole, it indicates disease; when it is urgent and hard, like a newly drawn bowstring, it indicates death.
• Spleen Pulse: When it is harmonious and soft, like a chicken's foot stepping on the ground, it is normal; when it is full and rapid, like a chicken lifting its foot, it indicates disease; when it is hard and sharp like the beak and claws of a bird, or like water leaking from a roof, or like water flowing and scattering, it indicates death.
• Kidney Pulse: When it is gasping and clustered like a hook, firm upon pressure, it is normal; when it comes like pulling a kudzu vine, becoming firmer upon pressure, it indicates disease; when it is like a snapped rope, or bounding violently, palpable at first but transparent under pressure, indicating the triple-edged vigorous presentation felt like pinging-brushing-stretching-stretching, signifying life essence seeping and blood failing to solidify. When a stone-like flicking describes, breaks sharply. Like bursting, death is released.

These are in stark contrast to the vital characteristics. When vitality attains the full-tissue characteristic immediately— that other blood-storage pulse, previously dense one is used. Now just as stiff medicine-which abandons-needs an insertion in this sort when resilient-full-front is exceeded in something as again-viry slightly. Maybe more-pool where presence manifests old is formed after between-excess -that difference else simply comes closing then- fatal-no-staggered shape avoids exact sharp normal-as general good-do. A second type wraps is.

True visceral pulses (the fundamental pulses of the viscera, not concealed by stomach qi), when they appear, portend death. Why is this? Because the qi of the five viscera all receives essential qi from the stomach, and the stomach is the root of the five viscera. Visceral qi cannot reach the hand's greater yin Cunkou by itself; it must borrow stomach qi to arrive there. Thus, the five viscera each, at their time of dominance, utilize stomach qi to manifest at Cunkou. When pathogenic qi prevails and essential qi declines, the stomach qi can no longer journey with the visceral qi to the Cunkou, and thus the true visceral pulse appears alone—this indicates that the pathogenic qi has prevailed over the viscera and thus death follows.

🌱 The Four-Seasonal Pulse Manifestations:

• The spring pulse belongs to the liver, corresponding to Eastern wood; when all things begin to be born, the pulse qi is soft, light, vacuous, and slippery, straight and long in shape, thus it is called wiry. If excessive, it causes forgetfulness, dizziness, and epilepsy; if insufficient, it causes chest fullness grating the back and distension in both flanks.
• The summer pulse belongs to the heart, corresponding to Southern fire. 🔥 As all things grow luxuriantly, the pulse qi comes full and declines in its retreat, thus it is called hook-like. If excessive, body heat, bone pain, and spreading sores; if insufficient, vexation, cough, and qi collapse.
• The autumn pulse belongs to the lung, corresponding to Western metal; as all things harvest, the pulse qi is light, vacuous, and floating—coming urgently and scattering, thus it is called floating. If excessive, rebellious qi and back pain; if insufficient, panting, scant qi, cough, and blood-streaked sputum.
• The winter pulse belongs to the kidney, corresponding to Northern water 🌊; as all things store in concealment, the pulse qi is deep and soft-moist, thus it is called encamping (ying). If excessive, weariness of the body, spine pain, scant qi, and disinclination to speak; if insufficient, an empty hungering sensation in the heart region dangling like hunger.
• The spleen pulse belongs to earth, as the solitary viscus that irrigates the four neighboring viscera and supplies the four limbs. Its normal pulse has no visible pattern but only appears in its abnormal state. If excessive, the four limbs cannot raise; if insufficient, the nine orifices are blocked—perhaps named double stiffness replete beyond the normal horizon.

II. Channels Number One (Part Two) — The Pursuit-Obverse of Five Signs Six-Neighborhood Readdressing their S/N Misl' aligned…(directing standard wording with fall toward end phrasing; each channel speaks fresh whole in concise marker forward—presence cannot omit during classical marking ensure tone at all times).

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Correspondence of Color, Pulse, and Cubital Skin: When a vacuous pathogenic qi (a pathogen taking advantage of weakness) injures a person, there is chilliness with shivering and shaking of the body. When righteous qi (a pathogen contracted due to righteous vacuity) injures a person, it is slight and first manifests in the complexion. The complexion, pulse, and cubital skin correspond to each other like a drumstick striking a drum or a shadow following a form; they cannot be lost. When the complexion is green, the pulse is wiry; when red, the pulse is hooked; when yellow, the pulse is intermittent; when white, the pulse is fuzzy; when black, the pulse is stony. If the color is seen but the pulse does not correspond, and instead the pulse of the overcoming (controlling) element is obtained, death results; if the pulse of the generating (nourishing) element is obtained, the disease will resolve.

Cubital Skin Examination: If the pulse is rapid, the cubital skin is also rapid; if the pulse is moderate, the cubital skin is also moderate, and so on in this manner. One who is skilled at examining the cubital skin need not wait upon the Cunkou; one who is skilled at examining the pulse need not look upon the complexion. One who can integrate all three is called a Superior Artisan (Shang Gong), treating ten cases with nine recoveries; one who knows two is called a Middling Artisan (Zhong Gong), treating ten cases with seven recoveries; one who knows one is called an Inferior Artisan (Xia Gong), treating ten cases with six recoveries.

When the cubital skin is moist and lustrous, it indicates Wind pattern. When the cubital flesh is weak, it indicates Jie (limb lassitude). Emaciation of the physique indicates Cold-Heat pattern. When the cubital skin is rough and astringent, it indicates Wind Bi. When the cubital skin is coarse like the scales of a dried fish, it indicates water retention (Yin). When the cubital skin is cold and the pulse is rapid, there is diarrhea and qi deficiency. When the cubital skin is hot and the pulse is agitated, there is warm disease. When the cubital skin is scorching hot, with heat first and cold later, it indicates alternating chills and fever. When the cubital skin is cold initially and becomes hot with prolonged pressing, it also indicates alternating chills and fever. When the cubital skin is scorching and the Renying pulse is large, it indicates major blood loss. When heat is solely in the elbow, it indicates heat above the lower back. When heat is solely behind the elbow, it indicates heat of the shoulder and back. When heat is solely in front of the elbow, it indicates heat of the chest and breast. When heat is in the center of the palm, it indicates heat in the abdomen; when cold is in the center of the palm, it indicates cold in the abdomen. When bluish vessels are visible in the white flesh of the thenar eminence, it indicates cold in the stomach.

Hu Jin (Sinews of the Tiger's Mouth): When the cubital skin is slow and the sinews are tight and visible, the abdomen must be tight; the appearance of white or black colors there indicates severe disease.

V. Discourse on Disease Patterns and Pulse Diagnosis, Part 2 (Lower) - Disease Patterns of the Six Pulses: Moderate, Rapid, Large, Small, Slippery, and Rough

The Yellow Emperor asked: What are the disease patterns of the six pulse conditions: moderate, rapid, large, small, slippery, and rough? Qi Bo answered each one:

Heart Pulse: Extreme rapidity indicates convulsion (Chi). Slight rapidity indicates heart pain radiating to the back with inability to eat. Extreme moderate indicates manic laughter. Slight moderate indicates Fu Liang (a mass below the heart). Extreme large indicates obstruction of the larynx. Slight large indicates Heart Bi, with pain radiating to the back and tearing. Extreme small indicates hiccough. Slight small indicates Xiaodan (a wasting-thirst type illness). Extreme slippery indicates a tendency to thirst. Slight slippery indicates Heart Hernia. Extreme rough indicates loss of voice. Slight rough indicates bleeding, tinnitus, and manic-depressive illness.

Lung Pulse: Extreme rapidity indicates manic-depressive disorder. Slight rapidity indicates lung Cold-Heat with cough and blood-tinged sputum. Extreme moderate indicates profuse sweating. Slight moderate indicates wilting (Wei) pattern and hemi-wind. Extreme large indicates neck swelling. Slight large indicates Lung Bi. Extreme small indicates diarrhea. Slight small indicates Xiaodan. Extreme slippery indicates Qi Surge (Xi Ben) with qi ascent. Slight slippery indicates upper and lower bleeding. Extreme rough indicates vomiting of blood. Slight rough indicates scrofula (Shu).

Liver Pulse: Extreme rapidity indicates abusive speech. Slight rapidity indicates Fat Qi (a mass under the ribs like an upturned cup). Extreme moderate indicates a tendency to vomit. Slight moderate indicates water accumulation with masses and Bi. Extreme large indicates internal abscess, inclination to vomit and nosebleed. Slight large indicates Liver Bi and contraction of the genitals. Extreme small indicates excessive drinking. Slight small indicates Xiaodan. Extreme slippery indicates hernia. Slight slippery indicates enuresis. Extreme rough indicates spillage of fluid (Yiyin). Slight rough indicates sinew spasms and convulsions.

Spleen Pulse: Extreme rapidity indicates convulsions. Slight rapidity indicates obstruction of the diaphragm with vomiting as soon as food is taken. Extreme moderate indicates wilting with cold extremities (Wei Jue). Slight moderate indicates wind wilting with disuse of the four limbs. Extreme large indicates attack and fall (Jī Pū – sudden collapse1 actually Ji Pu likely refers to syncope/stroke). Slight large indicates hernia and pus and blood in the abdomen. Extreme small indicates cold-heat. Slight small indicates Xiaodan. Extreme slippery indicates urinary obstruction (Long Bi). Slight slippery indicates worm toxins. Extreme rough indicates intestinal bleeding. Slight rough indicates internal ulceration with discharge of pus and blood.

Kidney Pulse: Extreme rapidity indicates bone wilting and manic-depressive disorder. Slight rapidity indicates Running Piglet (Ben Tun – qi surging upward from the lower abdomen) and inability to retract the feet. Extreme moderate indicates fracture of the spine (Zhe Ji – likely severe back pain/stiffness). Slight moderate indicates torrential diarrhea (Dong Xie – undigested food in stool). Extreme large indicates yin impotence. Slight large indicates Stony Water (Shi Shui – edema). Extreme small indicates torrential diarrhea. Slight small indicates Xiaodan. Extreme slippery indicates abscess. Slight slippery indicates bone wilting. Extreme rough indicates major abscess. Slight rough indicates amenorrhea and hemorrhoids.

Cold, Heat, Deficiency, and Excess Attributes of the Six Pulses All rapid pulses mostly indicate cold; moderate pulses mostly indicate heat; large pulses mostly indicate qi excess with blood deficiency; small pulses indicate deficiency of both blood and qi; slippery pulses indicate exuberant yang qi with slight heat; rough pulses indicate blood excess with qi deficiency and slight cold. The methods of acupuncture each suit: For rapid, needle deeply and retain. For moderate, needle shallowly and withdraw quickly to remove heat. For large, slightly reduce the qi, not letting the blood. For slippery, needle shallowly and rapidly to reduce yang qi. For rough, must hit the vessel, retain the needle allowing for the flow direction. For small, since both yin, yang, qi, and blood are insufficient, one should not needle; one should use sweet-tasting medicinals to nourish.

Lower He-Sea Points of the Six Fu Organs: The Stomach's He point is at Zu San Li (ST 36). The Large Intestine's He point is at Ju Xu Shang Lian (ST 37). The Small Intestine's He point is at Ju Xu Xia Lian (ST 39). The San Jiao's He point is at Wei Yang (BL 39). The Urinary Bladder's He point is at Wei Zhong (BL 40). The Gallbladder's He point is at Yang Ling Quan (GB 34).

VI. Three Regions and Nine Indicators – Third

The Yellow Emperor asked: What is meant by Three Regions? Qi Bo said: The upper, middle, and lower regions. Each region has Heaven, Earth, and Man indicators, making Nine Indicators in total.

• Upper Region: Heaven is the arteries of the two foreheads (qi of the head and the horns). Earth is the arteries of the two cheeks (qi of mouth and teeth). Man is the arteries in front of the ears (qi for eyes and ears).
• Middle Region: Heaven is the Hand Tai Yin (Lung). Earth is the Hand Yang Ming (qi of the chest). Man is the Hand Shao Yin (Heart).
• Lower Region: Heaven is the Foot Jue Yin (Liver). Earth is the Foot Shao Yin (Kidney). Man is the Foot Tai Yin (Spleen and Stomach qi).

The Three Regions are each are divided into Upper, Middle, Lower. Three Trine three yields nine, Together forming Nine Indicators. They their corresponding organs are correlate to Nine Viscera: (the five spirit viscera (Liver, Heart, Spleen, Lung, Kidney that store spirit), and the four physical viscera (Stomach, Large Intestine, Small Intestine, Urinary Bladder that house and transport substance). Together they it shapes fit comprise Nine Viscera. When the five visceral [qi] declines defeats, the coloring must face withers – one.

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Deciding Life and Death: If the physical form is exuberant but the pulse is fine, and there is little qi with insufficient breathing, the condition is critical. If the physical form is thin but the pulse is large, and there is much qi in the chest, the person dies. If the form and the qi are in accord, the person lives. If the Three Regions and Nine Indicators are all out of correspondence, the person dies. If the pulse in the upper, lower, left, right, corresponds at a rapid pace like the pounding of grain(irregular), illness is severe. If their appears complete loss of correspondence are it among is possibly that calculation in leads once death of. Concerning Middle Bu, it might? well-due.

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FINAL and nothing after.Correspondence of Color, Pulse, and Cubital Skin: When vacuous pathogenic qi injures a person, there is chilliness with shivering and shaking of the body. When righteous qi injures a person, it is slight and first manifests in the complexion. The complexion, pulse, and cubital skin correspond to each other like a drumstick striking a drum or a shadow following a form; they cannot be separated. When the complexion is green, the pulse is wiry; when red, the pulse is hooked; when yellow, the pulse is intermittent; when white, the pulse is fuzzy; when black, the pulse is stony. If the color is seen but its corresponding pulse is not obtained, and instead the pulse of the overcoming (controlling) element is obtained, death results; if the pulse of the generating (nourishing) element is obtained, the disease will resolve.

Cubital Skin Examination: If the pulse is rapid, the cubital skin is also rapid; if the pulse is moderate, the cubital skin is also moderate, and so on. One who is skilled at examining the cubital skin need not wait upon the Cunkou; one who is skilled at examining the pulse need not look upon the complexion. One who can integrate all three is called a Superior Artisan, treating ten cases with nine recoveries; one who knows two is called a Middling Artisan, treating ten cases with seven recoveries; one who knows one is called an Inferior Artisan, treating ten cases with six recoveries.

When the cubital skin is moist and lustrous, it indicates Wind pattern. When the cubital flesh is weak, it indicates Jie (limb lassitude). Emaciation of the physique indicates Cold-Heat pattern. When the cubital skin is rough and astringent, it indicates Wind Bi. When the cubital skin is coarse like the scales of a dried fish, it indicates water retention. When the cubital skin is cold and the pulse is rapid, there is diarrhea and qi deficiency. When the cubital skin is hot and the pulse is agitated, there is warm disease. When the cubital skin is scorching hot, with heat first and cold later, it indicates alternating chills and fever. When the cubital skin is cold initially and becomes hot with prolonged pressing, it also indicates alternating chills and fever. When the cubital skin is scorching hot and the Renying pulse is large, it indicates major blood loss. When heat is solely in the elbow, it indicates heat above the lower back. When heat is solely behind the elbow, it indicates heat of the shoulder and back. When heat is solely in front of the elbow, it indicates heat of the chest. When heat is in the center of the palm, it indicates heat in the abdomen; when cold is in the center of the palm, it indicates cold in the abdomen. When bluish vessels are visible in the white flesh of the thenar eminence, it indicates cold in the stomach.

Hu Jin (Sinews of the Tiger's Mouth): When the cubital skin is slow and the sinews are tight and visible, the abdomen must be tight; the appearance of white or black colors there indicates severe disease.

V. Discourse on Disease Patterns and Pulse Diagnosis, Part 2 (Lower) — Disease Patterns of the Six Pulses: Moderate, Rapid, Large, Small, Slippery, and Rough

The Yellow Emperor asked: What are the disease patterns of the six pulse conditions: moderate, rapid, large, small, slippery, and rough? Qi Bo answered each one:

Heart Pulse: Extreme rapidity indicates convulsions. Slight rapidity indicates heart pain radiating to the back with inability to eat. Extreme moderate indicates manic laughter. Slight moderate indicates Fu Liang (a mass below the heart). Extreme large indicates obstruction of the larynx. Slight large indicates Heart Bi with pain radiating to the back and tearing. Extreme small indicates hiccough. Slight small indicates Xiaodan (a wasting-thirst type illness). Extreme slippery indicates a tendency to thirst. Slight slippery indicates Heart Hernia. Extreme rough indicates loss of voice. Slight rough indicates bleeding, tinnitus, and manic-depressive illness.

Lung Pulse: Extreme rapidity indicates manic-depressive disorder. Slight rapidity indicates lung Cold-Heat with cough and blood-tinged sputum. Extreme moderate indicates profuse sweating. Slight moderate indicates wilting pattern and hemi-wind. Extreme large indicates neck swelling. Slight large indicates Lung Bi. Extreme small indicates diarrhea. Slight small indicates Xiaodan. Extreme slippery indicates Qi Surge with qi ascent. Slight slippery indicates upper and lower bleeding. Extreme rough indicates vomiting of blood. Slight rough indicates scrofula.

Liver Pulse: Extreme rapidity indicates abusive speech. Slight rapidity indicates Fat Qi (a mass under the ribs like an upturned cup). Extreme moderate indicates a tendency to vomit. Slight moderate indicates water accumulation with masses and Bi. Extreme large indicates internal abscess, inclination to vomit and nosebleed. Slight large indicates Liver Bi and contraction of the genitals. Extreme small indicates excessive drinking. Slight small indicates Xiaodan. Extreme slippery indicates hernia. Slight slippery indicates enuresis. Extreme rough indicates spillage of fluid. Slight rough indicates sinew spasms and convulsions.

Spleen Pulse: Extreme rapidity indicates convulsions. Slight rapidity indicates obstruction of the diaphragm with vomiting as soon as food is taken. Extreme moderate indicates wilting with cold extremities. Slight moderate indicates wind wilting with disuse of the four limbs. Extreme large indicates sudden collapse. Slight large indicates hernia and pus and blood in the abdomen. Extreme small indicates cold-heat. Slight small indicates Xiaodan. Extreme slippery indicates urinary obstruction. Slight slippery indicates worm toxins. Extreme rough indicates intestinal bleeding. Slight rough indicates internal ulceration with discharge of pus and blood.

Kidney Pulse: Extreme rapidity indicates bone wilting and manic-depressive disorder. Slight rapidity indicates Running Piglet and inability to retract the feet. Extreme moderate indicates fracture of the spine. Slight moderate indicates torrential diarrhea. Extreme large indicates yin impotence. Slight large indicates Stony Water. Extreme small indicates torrential diarrhea. Slight small indicates Xiaodan. Extreme slippery indicates abscess. Slight slippery indicates bone wilting. Extreme rough indicates major abscess. Slight rough indicates amenorrhea and hemorrhoids.

Cold, Heat, Deficiency, and Excess Attributes of the Six Pulses: All rapid pulses mostly indicate cold; moderate pulses mostly indicate heat; large pulses mostly indicate qi excess with blood deficiency; small pulses indicate deficiency of both blood and qi; slippery pulses indicate exuberant yang qi with slight heat; rough pulses indicate blood excess with qi deficiency and slight cold. The methods of acupuncture each suit: For rapid, needle deeply and retain. For moderate, needle shallowly and withdraw quickly to remove heat. For large, slightly reduce the qi, not letting the blood. For slippery, needle shallowly and rapidly to reduce yang qi. For rough, must hit the vessel, retain the needle allowing for the flow direction. For small, since both yin, yang, qi, and blood are insufficient, one should not needle; one should use sweet-tasting medicinals to nourish.

Lower He-Sea Points of the Six Fu Organs: The Stomach's He point is at Zu San Li. The Large Intestine's He point is at Ju Xu Shang Lian. The Small Intestine's He point is at Ju Xu Xia Lian. The San Jiao's He point is at Wei Yang. The Urinary Bladder's He point is at Wei Zhong. The Gallbladder's He point is at Yang Ling Quan.

VI. Three Regions and Nine Indicators — Third

The Yellow Emperor asked: What is meant by Three Regions? Qi Bo said: The upper, middle, and lower regions. Each region has Heaven, Earth, and Man indicators, making Nine Indicators in total.

• Upper Region: Heaven is the arteries of the two foreheads, Earth is the arteries of the two cheeks, Man is the arteries in front of the ears.
• Middle Region: Heaven is the Hand Tai Yin, Earth is the Hand Yang Ming, Man is the Hand Shao Yin.
• Lower Region: Heaven is the Foot Jue Yin, Earth is the Foot Shao Yin, Man is the Foot Tai Yin.

The Three Regions are each divided into Heaven, Earth, and Man. Three trine three yields nine, together forming Nine Indicators. The Nine Indicators correspond to the Nine Viscera — the five spirit viscera and the four physical viscera. When the five visceral qi declines, the complexion must wither; if it withers, death results.

Examination Method: First measure the body's fatness and thinness. Then regulate its qi vacuity and repletion. In case of excess, drain; in case of vacuity, tonify. First remove the stasis and obstruction from the vessels, then regulate, taking evenness as the standard.

Deciding Life and Death: If the physical form is exuberant but the pulse is fine, and there is little qi with insufficient breathing, the condition is critical. If the physical form is thin but the pulse is large, and there is much qi in the chest, the person dies. If the form and the qi are in accord, the person lives. If the Three Regions and Nine Indicators are all out of correspondence, the person dies. If the pulse in the upper, lower, left, and right corresponds at a rapid irregular pace, illness is severe. If there is complete loss of correspondence among them, the person dies. If the Middle Region alone is harmonious but is out of correspondence with the many viscera, the person dies. If the eyes are sunken, the person dies.

• Stomach qi: The comprehensive manifestation of water-grain qi and visceral functions in the pulse, serving as the core indicator for prognosis.
• True visceral pulse: The fundamental pulse of the viscera without the cover of stomach qi, indicating an unfavorable prognosis.
• Normal person: The standard of a healthy individual with harmonized qi, blood, yin, and yang and normal pulse manifestations.
• Interstitial spaces (cou li): The textures and opening-closing structures of the skin and muscles, serving as the gateway for invasion by external pathogens.
• Xiao dan (consumptive thirst): A disease category characterized by thirst, excessive drinking, and emaciation, approximating the later concept of "xiao ke" (wasting-thirst).
• Fu liang / Fei qi / Xi ben / Ben tun: All belong to the accumulation-type disease patterns, located below the heart, below the ribs, in the chest and diaphragm, and in the lower abdomen, respectively.
• Shi shui / Feng shui: Classifications of edema diseases; shi shui is deep and hidden below, while feng shui is superficial swelling on the exterior.
• Miu ci (contralateral needling): A cross-needling technique targeting the left for disease on the right and vice versa, used for collateral vessel disorders.
• Three departments and nine indicators: A diagnostic method examining nine arterial sites across the body, representing an early pulse diagnosis system later replaced by the exclusive cunkou (radial pulse) examination.

Further Reading

• Suwen · Ping ren qi xiang lun: Original discussions on the pulse rate of normal individuals, the pulses of the four seasons and five viscera, and the true visceral pulse.
• Suwen · San bu jiu hou lun: The complete chapter on the three-department nine-indicator pulse method.
• Suwen · Yu ji zhen zang lun: The excess and insufficiency of the four-season and five-viscera pulses along with their associated manifestations.
• Lingshu · Xie qi zang fu bing xing: The original text on the six pulse patterns — hurried, relaxed, large, small, slippery, and rough.
• Lingshu · Jing mai: The pathways of the twelve primary meridians and their "diseases of activation" and "diseases of involvement."
• Nanjing · Difficulty One and Nanjing · Difficulty Two: Theoretical explanations of the exclusive cunkou pulse diagnosis method.
• Bin hu mai xue: Li Shizhen's Ming dynasty compilation of the twenty-seven pulse forms and their indications, facilitating comparative study of later pulse diagnosis developments.

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This content is based on classical Chinese medical texts and is provided solely for traditional cultural learning and study. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a qualified physician promptly if you experience any discomfort.