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Capítulo 18 de 78
黄帝内经·素问
Overall Paraphrase
This chapter discusses the pulse patterns of healthy persons (pingren) and the diagnostic principles rooted in stomach qi (the vital qi derived from the spleen and stomach's transformation of water and grain).
The Yellow Emperor asked: What is the pulse pattern of a healthy person? Qi Bo replied: When a person exhales once, the pulse beats twice; when inhaling once, the pulse beats twice. During the pause between expiration and inspiration—the "settled breath" phase—the pulse beats once more, so one breath cycle yields about five beats. Occasionally, a longer breath (a tai xi, or deep sigh) adds one extra beat, which is still normal. This pulse rate defines the pingren, the person without disease. When a physician examines a patient, he should use his own disease-free breathing rhythm as the standard, calming the patient's breathing to measure the pulse rate.
If there is only one beat per expiration and one per inspiration, it indicates shao qi (insufficiency of vital qi). If there are three beats per expiration and per inspiration, with a restless pulse, accompanied by warmth of the skin on the forearm (chi region), it is a warm-heat disease. If the chi skin is not warm but the pulse is slippery, it is a wind ailment. If the pulse is rough/choppy, it is a bi syndrome (obstructive painful condition). If there are four or more beats per expiration, or if the pulse is intermittent, or irregularly fast and slow, the ancients regarded these as critical, potentially fatal signs.
The normal qi of a healthy person originates from stomach qi—the refined qi produced by the spleen and stomach's transformation of water and grain, which manifests in the pulse as a calm and gentle quality. Stomach qi is the fundamental qi of a healthy person. If the pulse lacks stomach qi, it is a counter-pattern, which the ancients believed could be fatal.
Next, the relationship between the four seasons, the five viscera, and stomach qi is discussed: In spring, a pulse with stomach qi that is slightly wiry (xian) is normal; predominantly wiry with little stomach qi indicates liver disease; purely wiry without stomach qi is fatal; if accompanied by the autumn "downy" (mao) pulse, it portends illness in autumn; if fluffy and marked, illness presents immediately. In summer, a slightly hooked/gently rising (gou) pulse is normal; predominantly hooked with little stomach qi indicates heart disease; purely hooked without stomach qi is fatal; if accompanied by the winter "stone-like" (shi) pulse, it portends illness in winter; if stone-like and marked, illness presents immediately. In late summer, a soft and weak (ruo) pulse is normal; predominantly weak with little stomach qi indicates spleen disease; purely weak without stomach qi is fatal; if the soft-weak pattern is accompanied by the winter stone pulse, it portends illness in winter; if weak and marked, illness presents immediately. In autumn, a slightly downy (mao) pulse is normal; predominantly downy with little stomach qi indicates lung disease; purely downy without stomach qi is fatal; if accompanied by the spring wiry pulse, it portends illness in spring; if wiry and marked, illness presents immediately. In winter, a slightly stone-like (shi) pulse is normal; predominantly stone-like with little stomach qi indicates kidney disease; purely stone-like without stomach qi is fatal; if accompanied by the summer hooked pulse, it portends illness in summer; if hooked and marked, illness presents immediately.
The genuine qi of the five viscera is distributed to corresponding tissues: the liver stores the qi of sinews and fascia, the heart stores the qi of blood vessels, the spleen stores the qi of muscles and flesh, the lungs move the rong and wei yin-yang (nutritive and protective aspects), and the kidneys store the qi of bone and marrow.
The great collateral of the stomach, called xuli, penetrates the diaphragm to connect with the lungs and emerges below the left breast. Its pulsation can touch the clothing—this is the manifestation of zong qi (the great qi of the chest, combining the refined qi of water and grain with inhaled natural air). If the pulsation at xuli is hyperactive, rapid, and intermittently pausing, the illness is within the chest and abdomen. If the pulsation is knotted and horizontally forceful, it indicates an accumulation (masses) within the body. If the pulsation ceases entirely, it is a fatal sign. If the pulsation below the left breast is so strong that it moves the clothing, it is the leakage of zong qi externally.
Examining the cunkou (the radial artery at the wrist used for pulse diagnosis) allows assessment of excess and deficiency: If the pulse is short, there is headache. If long, there is pain in the shin and foot. If rapid and pounding upward, there is shoulder and back pain. If deep and firm, illness lies within. If floating and vigorous, illness lies externally. If deep and weak, it indicates cold-heat patterns, hernia/abdominal masses, and lower abdominal pain. If deep and transverse, there are painful masses below the ribs or in the abdomen. If deep and panting-like, there is cold-heat pattern. If ample, slippery, and firm, illness lies externally. If small, firm, and hard, illness lies internally. If small, weak, and rough, it is chronic illness. If slippery, floating, and rapid, it is recent illness. If tight, it indicates hernia/abdominal masses and lower abdominal pain. If slippery, it indicates wind. If rough, it indicates bi syndrome. If slow/unhurried and slippery, it indicates heat in the middle jiao. If ample and tight, it indicates distension and fullness.
When the pulse accords with the yin-yang attributes and the seasonal changes, illness is easier to resolve; if contrary, it is difficult.
When prominent blue veins are visible on the arms, it indicates blood depletion. If the chi (proximal) pulse is slow and rough, the body is lethargic and weak. If the person lies still but the pulse is conversely vigorous, there is blood depletion. If the chi pulse is rough but the overall pulse is slippery, there is profuse sweating. If the chi skin is cold and the pulse is fine, there is diarrhea. If the chi skin is persistently warm, there is heat in the middle.
The ancients also applied the heavenly stems correlated with the five phases for mutual conquest deduction: Liver disease seeing geng-xin days, heart disease seeing ren-gui days, spleen disease seeing jia-yi days, lung disease seeing bing-ding days, and kidney disease seeing wu-ji days were considered appearances of the true visceral pulse, all deemed fatal. This deductive method carries the limitations of its era and should be viewed rationally.
Prominent pulsation of the renying (carotid) pulse at the neck, accompanied by panting and coughing, indicates water disease. Slight eyelid swelling resembling the rise of a silkworm indicates water disease. Dark yellow urine with a tendency to sleep indicates jaundice. Persistent hunger after eating indicates stomach jaundice. Facial swelling indicates wind pathogen. Swelling of the shin and feet indicates water. Yellow eyes indicate jaundice.
In women, prominent pulsation of the hand shaoyin heart meridian (near the shenmen acupoint) was considered a sign of pregnancy by the ancients.
The pulse may conform to or violate the four seasons. If in spring and summer, the pulse should be floating and ample but is instead deep and small, or if in autumn and winter the pulse should be deep and small but is instead floating and ample, it is called counter-seasonal. Also, in wind-heat syndromes, the pulse should be floating and rapid but is conversely still/sluggish; in diarrhea and blood depletion, the pulse should be vacuous but is conversely replete; when illness is internal, the pulse should be replete but is conversely vacuous; when illness is external, the pulse should be floating and slippery but is conversely rough and firm—all such cases are difficult to treat and are called contrary to the four seasons.
Human life is rooted in water and grain. If water and grain cease, death ensues. A pulse without stomach qi likewise leads to death. "Absence of stomach qi" means that only the true visceral pulse appears and stomach qi is not obtained by palpation. A pulse without stomach qi implies the liver pulse loses its gentleness in wiriness, and the kidney pulse loses its gentleness in stone-like firmness.
The pulse patterns of the three yang meridians: The sun (greater yang) pulse arrives great, large, and long. The shaoyang (lesser yang) pulse arrives sometimes fast, sometimes slow, sometimes short, sometimes long. The yangming (sunlight yang) pulse arrives floating, large, and short.
Specific pulse patterns for the five viscera—normal, diseased, and fatal: The normal heart pulse resembles a string of pearls, smooth to the touch like jade. The diseased heart pulse is rapid and continuous, with slight curving in its middle. The fatal heart pulse curves in its frontal section and is straight in its latter section, like grasping a hooked staff. The normal lung pulse is light, floating, and unhurried, drifting like falling elm seeds. The diseased lung pulse is neither rising nor falling, like touching the hard and rough middle of a chicken feather. The fatal lung pulse is like a thing floating on water, like wind scattering feathered hair. The normal liver pulse is soft, gentle, and serene, like lifting the tip of a long pole with a slight tremor. The diseased liver pulse is replete and slippery, like touching the full length of a long pole. The fatal liver pulse is urgent and forceful, like a drawn bowstring. The normal spleen pulse is harmonious, soft, and gentle, like a chicken stepping on the ground. The diseased spleen pulse is replete, full, rapid, like a chicken lifting its foot. The fatal spleen pulse is sharp and hard as a crow's beak or bird's claw, or like dripping from a leaky rooftop, or like dispersing water currents. The normal kidney pulse is deep and strong with a hook-like quality, firm under pressure. The diseased kidney pulse is like pulling a kudzu vine, increasingly firm under pressure. The fatal kidney pulse resembles a ship's rope violently wrenched/frustrated by warring oarsmen—springing, darting apart, darting upward then scattering, like flint-locks striking a stone.
The core of this chapter lies in the stomach-qi-oriented pulse diagnostic system. The ancients believed that a healthy person's pulse must be calm, gentle, and uniform—a quality born from stomach qi, produced by the spleen and stomach's transformation of water and grain. The normal pulsations of the four seasons and the five viscera are not isolated wiriness, hooking, downy, or stoniness, but rather "slight wiriness," "slight hooking," "slight downiness," and "slight stoniness" —meaning that within the innate qi of the five viscera, stomach qi must be present. If stomach qi diminishes, it indicates a diseased pulse. If stomach qi vanishes, leaving only the bare true qi of the relevant viscus, that constitutes the true visceral pulse, which the ancients considered fatal. Additionally, various diagnostic considerations—the healer using himself as standard, examining xuli for zong qi, integrating cunkou and chi skin readings, and using the accord or conflict between pulse and seasons, yin and yang, to determine prognosis—embody a holistic, dynamic, standard-vs-deviation approach to evaluation.
From a modern physiological perspective, the ancients' pace of "four to five beats per breath cycle" approximately corresponds to a resting heart rate of 60–70 beats per minute, demonstrating early crude observational awareness of the relationship between breathing and heart rhythm. The so-called stomach qi—gentle and calm—might reflect a combination of nutritional status, circulatory function, autonomic nervous regulation, etc. Certain pulse indications—such as “true visceral pulses,” “by turns sparse and rapid,” and “pulses ceasing entirely”—may correspond to critical states like severe arrhythmias or cardiovascular failure. Perhaps these patterns carried real clinical observational weight within historical experience. But predicated as these predictions are on subjective palpatory sensation, they lack objective quantitative basis. The notion of "when liver viscus is endangered by kong-day energies," and other cyclical progression-death-date forecasts, conform to “numerist” typology reasoning and cannot form a prognostic basis in current medical reasoning. The pregnancy interpretation singularly via the radial/“hand shaoyin” pulse is likewise epistemologically “antiquated.” Contemporary diagnostic practice must rely on tested scientific methods.
This remainder echoes across ordinary Yang Sheng concerns—most concretely in everyday care-seeking nourishment centered on the spleen and stomach qi. Concerning food—eat at regular intervals; think against extremes of hunger and splenetic excess; restrict cold, oily, or high-spice intakes; help transformation by moderate fluid ingestion. Concerning activity—cast pacing, timed reversals, breath care, reflective calm demeanor relieve slowness-of-qi winds have actual beneficial alignment —-protecting adequate sleep, restric-tempo city arousal/livid-anger. Concern respiration—ordinary human breathing occurs ample by its very habitus; we admonish practice by mindfulness or sustained aerobic exertion, foster intact coordination... in weatherlines: spring-sum comparative movements. These correspond to global healthy, generics prerequisites, not asserted measure-blunt regime specialized program otherwise.
This resource involves classical Chinese medicine ancient 'text'; offered solely for cultural traditions academic/study value. Poses absolutely no suitability act-of medicine diagnosis/care/precision clinical requirement; consult physician prior decisions. Kindly deliberate—health actions guided alongside tested health providers or licensed local clinicians always.