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Chapter 17 of 78
黄帝内经·素问
Holistic Paraphrase
I. General Diagnostic Principles: Dawn Pulse Taking and Comprehensive Four Examinations
The Yellow Emperor asked: What are the diagnostic methods? Qi Bo replied: The best time for pulse diagnosis is in the early morning (ping dan), when yin qi has not yet been stirred, yang qi has not yet been dissipated, no food or drink has been taken, the meridians are not overfilled, the collateral vessels are evenly regulated, and qi and blood are not disturbed. Therefore, diseased pulses are easier to detect. Palpate the movement and stillness of the pulse, observe the expression of both eyes, examine the changes in the five colors, investigate the five viscera for excess and deficiency, the strength and weakness of the six bowels, and the flourishing and decline of the physical body — cross-reference all these to determine survival or death.
Pulse is where blood gathers and circulates. If the pulse is long, qi is harmoniously regulated; if the pulse is short, qi is diseased; if the pulse is rapid, there is vexation of the heart; if the pulse is large, the disease is progressing; if the upper part of the pulse is replete, qi rebels upward; if the lower part is replete, there is abdominal distension; an intermittent pulse indicates qi decline; a thin pulse indicates qi deficiency; a rough pulse indicates heart pain; if the pulse comes rolling and urgent like a gushing spring, the disease is advancing and the complexion is deteriorating; if the pulse fades away weak like a bowstring breaking, it indicates death.
The expression of the eyes and the five colors are the external radiance of qi. Red should be like white silk wrapped around cinnabar — moist and reserved, not dark and withered like ochre; white should be like goose feathers, not dry and dull like salt; green should be lustrous like green jade, not somber like indigo; yellow should be like silk wrapped around realgar, not like yellow earth; black should be shiny like layered lacquer, not gray and spoiled like ground. If the essential qi of the five colors is completely exposed, life will not last long. The eyes observe all things, distinguishing black from white and examining long from short; if one takes long as short and white as black, it indicates that essential qi has already declined.
II. Five Viscera Guarding and Physical Strength or Weakness
The five viscera are the core that stores and guards essential qi internally. If the middle burner is congested, visceral qi is distended and full, and the voice is heavy and turbid as if coming from inside a room, it indicates dampness of the middle burner trapping and obstructing. Speech is faint, with long pauses between sentences, indicating qi is being snatched away; not grooming clothes and covers, speaking with likes and dislikes without avoiding kin or stranger, indicates disordered consciousness; the spleen and stomach being unable to receive water and grain indicates the gate cannot restrain; urinary incontinence indicates the bladder fails to store. What can be guarded lives; what fails to be guarded dies.
The five viscera also maintain the strength and health of the body: the head is the "house of bright essence" — if the head droops and the eye sockets are deeply sunken, it indicates the spirit is about to fail; the back is the "house of the chest" — if the back is bent and the shoulders droop, it indicates the qi of the chest is about to be ruined; the waist is the "house of the kidneys" — if turning the body is difficult, it indicates the kidneys are failing; the knees are the "house of sinews" — if flexion and extension are impaired, and one walks bent over supported by a staff, it indicates sinews are failing; the bones are the "house of marrow" — if one cannot stand for long and walks trembling, it indicates the bones are failing. With strength one lives; without strength one dies.
III. The Pulse Corresponding to the Four Seasons and the Waning and Waxing of Yin and Yang
Qi Bo said: When the pulse goes against the four seasons, excess always indicates pathogenic excess, and deficiency always indicates righteous deficiency. What should be excessive but is deficient, what should be deficient but is excessive — yin and yang failing to correspond — is called "guan ge" (rejection and blockage).
The Yellow Emperor wished to understand the pulse movement of the four seasons, disease locations, pathological transformations, and whether disease is internal or external. Qi Bo said: The pulse corresponds to the movement of heaven and earth. Beyond all things, within the six harmonies, the changes of heaven and earth, the responses of yin and yang: spring warmth develops into summer heat, autumn constriction like anger develops into winter cold like rage. In the four seasons' changes, the pulse rises and falls accordingly. The spring pulse responds to the "compass" — round and smooth; the summer pulse responds to the "carpenter's square" — grand and upright; the autumn pulse responds to the "steelyard beam" — calm and balanced; the winter pulse responds to the "counterpoise weight" — deep and sinking. Forty-five days after the winter solstice, yang qi gradually rises and yin qi gradually descends; forty-five days after the summer solstice, yin qi gradually rises and yang qi gradually descends. The waning and waxing of yin and yang have fixed times, and the pulse corresponds with the season. If the pulse does not correspond with the season, one can determine the classification of diseased pulses, and can also infer the time of death. The principle of the pulse is subtle and must not go unexamined. Examining the pulse begins from yin and yang, follows the laws of the five phases' generation and control, takes the four seasons as appropriate, misses nothing in supplementation and drainage, and becomes one with heaven and earth, thereby grasping survival and death.
The voice corresponds to the five notes, complexion corresponds to the five phases, and the pulse corresponds to yin and yang. Therefore, when yin predominates, one dreams of wading through great waters and being terrified; when yang predominates, one dreams of great fires and burning; when both yin and yang predominate, one dreams of mutual killing; when qi predominates in the upper body, one dreams of flying; when qi predominates in the lower body, one dreams of falling; when overfull, one dreams of giving; when hungry, one dreams of taking; when liver qi is replete, one dreams of anger; when lung qi is replete, one dreams of weeping; when there are many short worms in the abdomen, one dreams of crowds gathering; when there are many long worms, one dreams of fighting and mutual injury.
IV. The Great Method of Pulse Taking and Pulse Manifestations of the Five Viscera in Disease
Pulse diagnosis requires a state of emptiness and stillness, guarding the spirit. In spring, the pulse floats like fish swimming through waves; in summer, it lies at the skin surface, flushed and replete; in autumn, the pulse gradually sinks just below the skin, like insects about to hibernate; in winter, the pulse sinks to the bone, like insects deeply hidden and people residing quietly in their rooms. Knowing what is within, press and examine it with regularity; knowing what is without, order it from beginning to end. This is the great method of pulse taking.
Heart pulse that is firm and long upon palpation may cause the tongue to curl and inability to speak; if it is soft and scattered, it may manifest as wasting-thirst type disease, and some cases resolve on their own. Lung pulse that is firm and long upon palpation may indicate spitting of blood; if soft and scattered, it indicates profuse sweating like being drenched, with difficulty recovering. Liver pulse that is firm and long upon palpation, with the complexion not turning green, may indicate injuries from falling or blows, with stagnant blood beneath the ribs, causing panting and reversed qi; if soft and scattered with a lustrous complexion, it indicates "overflow syndrome" (yi yin), caused by thirst with excessive drinking, where fluid overflows to the body surface and outside the stomach and intestines. Stomach pulse that is firm and long upon palpation, with a red complexion, indicates pain in the thighs as if broken; if soft and scattered, it indicates "food obstruction" (shi bi). Spleen pulse that is firm and long upon palpation, with a yellow complexion, indicates qi deficiency; if soft and scattered with a lusterless complexion, it indicates swelling of the lower legs, like edema. Kidney pulse that is firm and long upon palpation, with a yellow-red complexion, indicates lower back pain as if broken; if soft and scattered, it indicates scarcity of essence and blood that does not recover for a long time.
V. The Yellow Emperor's Questioning and Examples of Disease Mechanisms
The Yellow Emperor asked: When the heart pulse is diagnosed as tense/urgent, what disease is it, and what are its manifestations? Qi Bo said: The disease is called "heart hernia" (xin shan), and the lower abdomen should show a visible mass. This is because the heart is a yang viscus, and the small intestine is internally-externally paired with the heart, so pain responds in the lower abdomen.
When diagnosing the stomach pulse, repletion indicates distension and fullness, deficiency indicates diarrhea. After the disease matures, what transformations occur? Wind evil can become cold-heat; internal heat can become "wasting middle" (xiao zhong); reversed qi can become "apex disease" (dian ji); prolonged wind can become "sun-channel diarrhea" (sun xie); wind evil entering the vessels can become "leprosy" (li feng). The transformations are too numerous to enumerate.
Where do welling abscesses, sinew spasms, and bone pain arise from? They arise from the congealing and stagnation of cold qi and the changes of the four seasons and eight winds. In treatment, the ancients believed that regulating according to the restraining/surpassing patterns of the four seasons and five phases could bring recovery, reflecting the idea of adapting treatment to the season. This is provided for study only and is not to be used as medication guidance.
The Yellow Emperor asked: When old diseases arise from the five viscera, harming the pulse and complexion, how does one distinguish chronic disease from new disease? Qi Bo said: Although the pulse is weak, if the complexion is not yet damaged, it is a new disease; if the pulse is not yet damaged but the complexion is already damaged, it is a chronic disease; if both the pulse and the complexion have become withered and defeated, it is a chronic disease; if both the pulse and the complexion have not declined, it is a new disease. When liver and kidney pulses arrive together, with green-red complexion, it is mostly external injury, regardless of whether bleeding occurred, and may be accompanied by signs of internal water-dampness retention.
VI. Forearm Skin (Chi) Examination and Pulse Pattern Deduction
The ancients also divided the ulnar aspects of the forearm into regions corresponding to the whole body: the two sides of the chi region at the wrist correspond to the flanks/hypochondria; the outside of the chi region examines the kidney, the inside of the chi region examines the abdomen; the middle segment — the left side examines the liver and diaphragm, the right side examines the stomach and spleen; the upper segment — the right side examines the lung and chest, the left side examines the heart and the chest center (dan zhong); the front part examines the front of the body, the rear part examines the back of the body; the uppermost end examines the chest and throat, the lowermost end examines the lower abdomen, lower back, hips, knees, shins, and feet.
If the pulse is rough and large, it indicates yin deficiency with yang excess, mainly heat in the interior; if the pulse comes quickly and leaves slowly, it indicates upper repletion with lower deficiency, mainly reversed cold/heat stroke at the apex; if the pulse comes slowly and leaves quickly, it indicates upper deficiency with lower repletion, mainly aversion to wind. If the pulse is deep, thin, and rapid, it indicates shaoyin reversed pulse/cold; if deep, thin, rapid, and scattered, it indicates cold-heat; if floating and scattered, it indicates dizziness and falling. If the floating pulse is not agitated, the disease is in the yang channels, mainly heat; if agitated, the disease is in the hand channels. If the pulse is thin and deep, the disease is in the yin channels, mainly bone pain; if deep and quiet, the disease is in the foot channels. If the pulse is rapid, moving, and occasionally intermittent, the disease is in the yang channels, mainly diarrhea and purulent, bloody stools.
Among abnormal pulses: a rough pulse indicates yang qi is in excess; a slippery pulse indicates yin qi is in excess. When yang qi is in excess, there is body heat without sweating; when yin qi is in excess, there is much sweating with a cold body; when both yin and yang are in excess, there is no sweating and the body is cold. Press the pulse outward, yet the pulse does not move outward — this indicates accumulation and stagnation in the heart and abdomen; press it inward, yet the pulse does not move inward — this indicates body heat; press it upward, yet the pulse does not move upward — this indicates cold purport clearing of the lower back and feet; press it downward, yet the pulse does not move downward — this indicates pain of the head and nape. Press heavily down to the bone, if the pulse qi is faint and weak, this indicates lower back and spine pain, and generalized bi-numbing pain of the body.
Bu Gua's Note: This content is based on classic texts of traditional Chinese medicine, provided for cultural heritage study and contemplative reading only. It does not constitute any medical diagnosis, medication or treatment recommendation. If you feel unwell, please consult a qualified healthcare provider in time.