Loading...
Chapter 3 of 10
难经
Overall Paraphrase
This chapter discusses two types of extreme abnormalities in pulse rate: the arriving pulse (excessively rapid pulse) and the waning pulse (excessively slow pulse).
The ancients counted the pulse using "one inhalation and one exhalation" as one respiratory cycle. The normal standard is two beats per inhalation and two beats per exhalation (approximately four beats per respiratory cycle). Deviations from this baseline:
Arriving pulse (too rapid) 💨: Three beats per inhalation is "departing from the norm," four beats per inhalation is "depleting essence," five beats per inhalation is "death" (extremely poor prognosis), and six beats per inhalation is "exhaustion of life." The pathological progression of the arriving pulse develops from the lower to the upper, penetrating layer by layer: skin and body hair → blood vessels → muscles → sinews → bones.
Waning pulse (too slow) 🔥: One beat per inhalation is "departing from the norm," one beat per two inhalations is "depleting essence," one beat per three inhalations is "death," and one beat per four inhalations is "exhaustion of life." The pathological progression of the waning pulse develops from the upper to the lower, shedding layer by layer: bones → sinews → muscles → blood vessels → skin and body hair.
Specific manifestations of the five waning states (the five levels of the waning pulse from superficial to deep):
Principles for treating waning conditions (understanding at the level of ancient medical theory, for study and reflection only):
This chapter also details the pulse-image changes accompanying different pulse rates and associated disease judgments: for example, a surging and large pulse with vexation and fullness, a deep and thin pulse with abdominal pain, a slippery pulse indicating heat damage, a rough pulse indicating exposure to mist and dew (external dampness pathogen), and so forth.
Finally, the presence or absence of the chi pulse is used to determine the root: if there is a pulse at the upper position (cun) but none at the lower position (chi), the person should vomit; if they do not vomit, death follows. If there is no pulse at the upper position but a pulse at the lower position, although distressed, the person will not die. The principle is like a tree having roots — the chi pulse is like the root; if the root remains, even though the branches and leaves wither, they may still revive.
This chapter explains the characteristics of normal pulse images for the four seasons (also called "king pulses," i.e., the pulses that govern the respective seasons) as well as the diagnosis of disease through excess and insufficiency.
Core assertion: All four seasons take stomach qi as their root. The stomach is the sea of grain and water (the source of food and drink digestion and absorption), governing reception and provision (supplying nourishment to the entire body). If the pulse has stomach qi, there is life; if it lacks stomach qi, there is death. The spleen occupies the central region; its harmonious and balanced quality is not ordinarily easily perceived — it only becomes manifest when declining — such as "a sparrow pecking at food" (intermittent and irregular) or "water dripping through a leak" (dribbling and feeble) — these are signs of splenic decline.
This chapter discusses how to determine which viscus is diseased by combining pulse images with symptoms. Although there are many methods of pulse diagnosis (three regions and nine indicators, yin and yang, light and heavy, etc.), the core lies in cross-referencing internal and external signs:
| Organ | External signs (visible on the body surface) | Internal signs (palpable within the abdomen) | Disease manifestations |
|---|---|---|---|
| Liver | Greenish face, fondness for anger, preference for cleanliness | Dynamic qi (palpable pulsation) on the left of the navel, firm and painful upon pressure | Fullness of the four limbs, difficult urination, cramping of the sinews |
| Heart | Reddish face, dry mouth, fondness for laughter | Dynamic qi above the navel, firm and painful upon pressure | Vexation of the heart, heart pain, heat in the palms, dry retching |
| Spleen | Yellowish face, fondness for belching, fondness for brooding, good at distinguishing flavors | Dynamic qi at the navel, firm and painful upon pressure | Abdominal distension and fullness, indigestion of food, heavy body with joint pain, lassitude and fondness for lying down |
| Lung | Whitish face, fondness for sneezing, sorrowful and prone to weeping | Dynamic qi on the right of the navel, firm and painful upon pressure | Wheezing and coughing, aversion to cold with fever |
| Kidney | Blackish face, fondness for fear, fondness for yawning | Dynamic qi below the navel, firm and painful upon pressure | Rebellious qi, cramping pain in the lower abdomen, diarrhea with tenesmus, cold lower legs and feet |
Diagnostic principle: "If these signs are present, it is that organ; if absent, it is not" — the pulse and signs must correspond in order to make a definite diagnosis; one cannot rely on a single manifestation alone.
This chapter enumerates five fatal conditions in which pulse and signs do not correspond:
Core thought: Correspondence between pulse and signs is the key to determining prognosis. When pulse and signs conform, there is an opportunity for the disease to resolve; when they oppose one another, it signals that the condition is critical.
This chapter elucidates the five-phase correspondence relationships between the cun, guan, and chi regions and the viscera and bowels, channels and networks:
Three regions and nine indicators: The three regions are cun, guan, and chi; each region has three indicators — floating, middle, and deep — totaling nine indicators.
This chapter also discusses the pulse diagnosis of accumulations: when the pulse pauses intermittently without fixed pattern, it is a knotted pulse, and the greater the knottedness, the greater the accumulation. The pulse traveling beneath the sinews is a hidden pulse; the pulse traveling above the flesh is a floating pulse. "The pulse not responding to the disease, or the disease not responding to the pulse" is a death sign — meaning that the clinical manifestations and the pulse image are completely disengaged.
This chapter explains the physiological differences between male and female pulses and their abnormalities:
This chapter discusses the phenomenon of yin and yang concealing one another in the pulse:
Double yang produces mania (extreme yang excess manifests as manic agitation); double yin produces epilepsy (extreme yin excess manifests as seizure disorders). Depletion of yang manifests as seeing ghosts (yang qi exhaustion presenting as hallucinations); depletion of yin manifests as blindness (yin essence exhaustion leading to loss of vision) — the ancients explained abnormal mental and sensory manifestations through the waxing and waning of yin and yang, reflecting the level of understanding at that time.
This chapter presents an important principle:
It should be noted, however, that "the form is diseased but the pulse is not" does not mean the pulse is truly perfectly normal — it means that the respiratory rate and pulse rate are no longer in proper correspondence (i.e., even though the pulse rate remains within the normal range, its coordination with the respiratory rhythm has already begun to deviate). This is a great principle of pulse diagnosis.
This chapter explains the distinction between "diseases of movement" and "diseases of generation" in the channel disease manifestations:
Qi governs warming and propelling; blood governs moistening and nourishing. External pathogens first attack the qi aspect; when qi stagnates and fails to move, this is qi being diseased first; subsequently, the movement of blood becomes congested and fails to nourish, this is blood being diseased afterward. Therefore, in the channel disease manifestations, "disease of movement" is listed first and "disease of generation" is listed afterward, reflecting the disease progression from qi to blood, from the shallow to the deep.
The core academic thought of these nine chapters can be summarized into three great principles: "Correlating pulse and signs, using the normal to measure the abnormal, and taking stomach qi as the root."
I. The diagnostic logic of using the normal to measure the abnormal. Chapters 14, 15, and 19 together construct a pulse-diagnosis framework of "first establishing the normal standard, then discussing the degree of deviation." Regardless of pulse rate (two beats per inhalation as normal), four-season pulse forms (spring wiry, summer hooked, autumn hairy, winter stony), or male-female differences (male chi weak, female chi strong), the physiological norm is first established, and then deviations are classified into levels (departing from the norm → depleting essence → death → exhaustion of life) to assess severity and prognosis. This kind of quantitative hierarchical thinking was extremely advanced for two thousand years ago.
II. The holistic view of correlating pulse and signs. Chapters 16, 17, 18, and 21 repeatedly emphasize: neither a single pulse image nor a single symptom suffices for a definite diagnosis — there must be cross-reference between internal and external signs, and correspondence between pulse and presentation. The dictum in Chapter 16 — "If these signs are present, it is that organ; if absent, it is not" — is a model of differential diagnosis by elimination. The five cases in Chapter 17 of "death when pulse and signs oppose" reflect the ancients' acute vigilance toward clinically contradictory phenomena. Chapter 18's statement that "the pulse not responding to the disease, or the disease not responding to the pulse, is death" further regards disengagement between pulse and manifestations as a critical sign.
III. Stomach qi as the root — the core of prognosis. In Chapter 15, "all four seasons take stomach qi as their root" is the pivotal concept in \textit{Classic of Difficulties} pulse theory. No matter how the four-season pulse changes, it must always contain the harmonious, unhurried, and relaxed quality of stomach qi — this is essentially the ancients' intuitive grasp of the body's capacity for self-regulation. When the pulse has stomach qi, it indicates that the viscera still retain buffering capacity; when it is wiry without stomach qi, it is like a bowstring drawn taut without elasticity, signaling that the regulatory capacity is exhausted.
IV. The transmission sequence of qi first, then blood. Chapter 22's "disease of movement is qi; disease of generation is blood" reveals the disease transmission pattern from the functional level → substantive level. Qi disease may still be reversed, while blood disease has already penetrated deeper. Together with Chapter 14's "the waning pulse descends from above" (from bone to skin and body hair) and "the arriving pulse ascends from below" (from skin and body hair to bone), this collectively constitutes a multi-dimensional model of disease transmission.
Among these contents, the relationship between pulse rate and prognosis has reasonable clinical foundations. Modern medicine likewise maintains that persistently significant tachycardia (e.g., heart rate >120 beats per minute) or bradycardia (e.g., heart rate <40 beats per minute) both indicate critical illness. Chapter 14's classification of pulse-rate deviation into four levels parallels modern medicine's grading of heart-rate abnormality severity.
The concept of "stomach qi as the root" closely aligns with the modern medical emphasis on nutritional status and overall functional reserve. A patient whose pulse "has stomach qi" (harmonious, forceful, regular rhythm) — whether from a Chinese medicine or modern medical perspective — generally commands a better prognosis than those whose pulse "lacks stomach qi" (wiry, hard, inelastic, or faint and nearly exhausted).
The principle of correlating pulse and signs shares the same methodology as the integrated multi-indicator judgment used in modern clinical diagnosis. A single laboratory finding is usually insufficient to confirm a diagnosis; one must comprehensively evaluate symptoms, signs, and ancillary investigations together. The "pulse-sign opposition" critical signs listed in Chapter 17 resemble "clinically paradoxical phenomena" in modern medicine — such as septic shock patients who should have fever and rapid pulse but instead present with hypothermia and a thready, weak pulse — which is precisely a sign of critical illness.
Limitations that should be honestly acknowledged: The theoretical framework in Chapters 15, 18, and 19, which uses five-phase generating and controlling to explain the correspondence between the pulse and the viscera, belongs to an ancient philosophical model of thought and lacks a basis in modern anatomy and physiology. Chapter 19's statement that "males are born from yin (wood) and females from shen (metal)" relates to the heavenly-stems and earthly-branches directional theory and should not be interpreted literally. Its clinical value lies in the observation that male and female pulses do indeed differ physiologically (modern medicine also recognizes gender-based differences in heart rate, blood pressure, etc.), but the explanatory mechanism requires updating. Chapter 20's "depletion of yang manifests as seeing ghosts; depletion of yin manifests as blindness" carries the cognitive limitations of its era and should be understood as an unsophisticated ancient description of psychiatric symptoms and visual impairment at the extremes of yin and yang exhaustion.
Related Concepts: Stomach qi (the calm, harmonious physiological elasticity in the pulse), rong-wei (nutritive qi and defensive qi, governing nourishment and defense respectively), three regions and nine indicators (the three positions of cun, guan, and chi, each divided into three levels of superficial, middle, and deep), movement disease and acquired disease (the qi-aspect and blood-aspect stages of meridian disorders), knotted pulse/deep pulse/floating pulse (abnormalities of rhythm and depth in pulse classification)
Further Reading: Suwen · Pingren Qixiang Lun (a monograph on the four-season and five-organ pulses with stomach qi as the foundation), Suwen · Yuji Zhenzang Lun (on true organ pulses and fatal signs), Maijing Volume 1 (secrets of pulse appearance under the fingers), Binhu Maixue (popular verses on the twenty-seven pulses)
This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.