Discussion on the Subtleties of Pulse Diagnosis

The Yellow Emperor asked: What is the method for taking the pulse? Qi Bo replied: Taking the pulse should generally be done in the early morning, because at this time the yin qi has not been stirred, the yang qi has not been dissipated, food and drink have not yet been taken, the qi of the channels is not yet replete, the qi of the collateral channels is evenly harmonized, and the movement of qi and blood is not disordered. Thus, one can examine the pathological pulse. Observe the movement and changes of the pulse, while also examining the brightness of the eyes, scrutinizing the manifestations of the five colors, understanding the excess and insufficiency of the five viscera, the strength and weakness of the six bowels, and the abundance or decline of the physical form. Compare and integrate these several aspects to determine the distinction between life and death.

The pulse is the place where blood converges. A long pulse indicates harmonized qi movement; a short pulse indicates disease of qi; a rapid pulse indicates heat in the heart; a large pulse indicates progression of the disease; a replete pulse in the upper region indicates rebellious ascent of qi; a replete pulse in the lower region indicates distention of qi; an intermittent pulse indicates decline of qi; a thin pulse indicates insufficiency of qi; a rough pulse indicates pain from blockage in the heart vessels; a pulse that is turbid and urgent, like gushing spring water, indicates severe disease and deteriorating complexion; a pulse that is faint and insubstantial, scattering like a broken lute string, is a death pulse.

The eyes and the five colors are the external radiance of the essence qi of the five viscera. A red complexion should be like white silk wrapped around cinnabar, not like the dull red of ochre; a white complexion should be like goose feathers, not like the white of salt; a green complexion should be like the luster of a green jade, not like the dark green of indigo; a yellow complexion should be like yellow orpiment wrapped in thin silk, not like the withered yellow of earth; a black complexion should be like the gloss of multiple layers of lacquer, not like the gray-black of soot. If the subtle radiance of the essence qi of the five viscera is exposed externally, then the person’s lifespan will not be long. The eyes are used to observe the myriad things, distinguish white from black, and examine long from short. If one treats long as short, and white as black, this indicates that the essence qi has already declined.

The five viscera are the internal rulers of the human body. If the abdomen is full of qi and the viscera are distended, with qi repletion impairing fear, and the voice sounds as if coming from a closed chamber, this is a manifestation of dampness in the middle burner. If the voice is low and faint, and one repeats words only after a day, this is a condition of seized proper qi. If one is unaware of gathering clothes and bedding, cannot distinguish good from bad in speech, and does not avoid close and distant relatives, this is a condition of confused spirit brilliance. If the stomach and intestines cannot store water and grains, this is a condition of lost control at the anus. If the urine cannot be controlled, this is a condition of the bladder being unable to store fluids. If the five viscera maintain their normal functions, one can survive; if they lose their normal functions, one will die.

The five viscera are the foundation of the body’s strength. The head is the place where essence qi and spirit converge. If the head hangs low and the eyes are sunken, this indicates that the spirit is about to be seized. The back is the place where the thoracic viscera converge. If the back is bent and the shoulders droop, this indicates that the thoracic viscera are about to be damaged. The waist is the residence of the kidneys. If the waist cannot turn, this indicates that the kidneys are about to fail. The knees are the place where sinews converge. If the knees cannot bend or extend, and one walks hunched over, this indicates that the sinews are about to fail. The bones are the residence of marrow. If one cannot stand for long, and the body trembles when walking, this indicates that the bones are about to fail. If the five viscera are strong, one can survive; if they lose their strength, one will die.

Qi Bo said: If the pulse is contrary to the four seasons, then when there is an excess pulse, it indicates that pathogenic qi prevails; when there is an insufficiency pulse, it indicates that proper qi is diminished. If what should appear as an excessive pulse instead manifests as insufficiency, this means pathogenic qi prevails; if what should appear as an insufficiency pulse instead manifests as excess, this means proper qi is diminished. When yin and yang qi do not respond to each other, this disease is called Guange. The Yellow Emperor asked: How does the pulse change in accordance with the four seasons? How does one know the location of the disease? How does one know the changes of the disease? How does one know when the disease suddenly arises internally? How does one know when the disease suddenly arises externally? I ask these five questions; may I hear your explanation? Qi Bo said: Allow me to speak about the grand pattern of the pulse corresponding to the movement of heaven and earth. Beyond the myriad things, within the six directions, the changes of heaven and earth and the correspondence of yin and yang, such as the warmth of spring transforming into the heat of summer; the killing of autumn transforming into the severe cold of winter; the movement of the four seasons in their cycles, the pulse also responds by rising and falling accordingly. In spring, the pulse corresponds to the compass; in summer, to the carpenter’s square; in autumn, to the steelyard rod; in winter, to the steelyard weight. Thus, forty-five days after the winter solstice, yang qi rises slightly, and yin qi descends slightly; forty-five days after the summer solstice, yin qi rises slightly, and yang qi descends slightly. The changes of yin and yang have a fixed time pattern, and the correspondence with the pulse also has a fixed period. If the pulse does not conform to this period, one can know the division of the pulse’s location; having distinguished the location, there is again a fixed period, so one can predict the time of death. The subtlety of the pulse must be carefully examined. Examining the pulse has an outline; it must begin with yin and yang. Beginning has a pattern; it must start from the generation of the five phases. Generation has a method; the changes of the four seasons correspond to it. Supplementation and drainage should not be mistaken, but be in accord with heaven and earth’s natural order. Achieving the essence of this accord, one can predict life and death. Therefore, sound corresponds to the five notes, complexion corresponds to the five phases, and the pulse corresponds to yin and yang. Hence, it is known: When yin qi is abundant, one dreams of crossing large rivers and feels fear; when yang qi is abundant, one dreams of great fires blazing; when both yin and yang are abundant, one dreams of mutual killing and destruction; when qi is abundant in the upper region, one dreams of flying upward; when qi is abundant in the lower region, one dreams of falling downward; when excessively full, one dreams of giving things to others; when excessively hungry, one dreams of taking things; when liver qi is abundant, one dreams of anger; when lung qi is abundant, one dreams of weeping; when there are many short worms in the abdomen, one dreams of crowds of people gathering; when there are many long worms, one dreams of striking and injuring each other.

Therefore, there is a method for taking the pulse, with emptiness and tranquility as the essential. In spring, the pulse floats, like fish swimming in waves; in summer, the pulse is at the skin, floating as if the myriad things are abundant; in autumn, the pulse sinks below the skin, like hibernating insects about to enter their burrows; in winter, the pulse sinks to the bones, like hibernating insects hidden deep and secure, like a gentleman dwelling in an inner chamber. Thus it is said: To understand the internal condition, one can press and examine to record; to understand the external condition, one can follow the beginning and end to observe. These six points are the great principles of pulse diagnosis.

When the heart pulse moves with firmness and length, it will cause disease with the tongue curled and inability to speak; if the pulse is soft and scattered, it should cause dispersion-thirst, but it will heal on its own. When the lung pulse moves with firmness and length, it will cause disease with spitting of blood; if the pulse is soft and scattered, it should cause incessant sweating like pouring water, and even now it cannot recover its dispersion. When the liver pulse moves with firmness and length, and the complexion is not green, it should cause disease from falling from a height or from injury, because there is stagnant blood under the ribs, causing shortness of breath and rebellious qi; if the pulse is soft and scattered and the complexion is moist, it should cause overflow-rheum; overflow-rheum is due to excessive drinking of water when thirsty, so that the water easily seeps into the skin and muscles and outside the stomach and intestines. When the stomach pulse moves with firmness and length, and the complexion is red, it should cause disease with thigh pain like breaking; if the pulse is soft and scattered, it should cause food blockage. When the spleen pulse moves with firmness and length, and the complexion is yellow, it should cause disease with scant qi; if the pulse is soft and scattered and the complexion is not moist, it should cause disease with swelling of the lower leg, like water disease. When the kidney pulse moves with firmness and length, and the complexion is yellow with red, it should cause disease with lower back pain like breaking; if the pulse is soft and scattered, it should cause disease with scant blood, and even now it cannot recover.

Huangdi asked: When the heart pulse is diagnosed as rapid, what disease is this? What are the symptoms? Qibo said: The disease is called heart hernia, and there should be a mass appearing in the lower abdomen. Huangdi asked: Why is this said? Qibo said: The heart belongs to the yang viscera, and the small intestine is its official in charge of orders; therefore, it is said that there should be a mass in the lower abdomen. Huangdi asked: When the stomach pulse is diagnosed as diseased, what are the symptoms? Qibo said: When the stomach pulse is replete, there will be abdominal fullness; when the stomach pulse is vacuous, there will be diarrhea. Huangdi asked: After a disease forms, it undergoes changes; what does this mean? Qibo said: Wind evil lingering for a long time will transform into cold-heat disease; heat evil lingering for a long time will transform into wasting-thirst disease; qi mechanism rebelling upward will transform into vertex disease; wind evil persisting for a long time will transform into sunken diarrhea; wind evil entering the pulse will transform into leprosy disease; the changes of disease are countless. Huangdi asked: Various types of abscesses and swellings, sinew spasms, and bone pains—where do all these arise from? Qibo said: These are swellings due to cold qi, transformations brought about by the eight winds. Huangdi asked: How are they treated? Qibo said: These are diseases caused by the qi of the four seasons; treat them using the method of the five phases overcoming each other, and recovery will follow. Huangdi asked: When there is an old disease manifesting in the five viscera, thereby damaging the pulse and complexion, how does one distinguish whether it is a recent or chronic disease? Qibo said: You ask truly in detail! When the pulse is examined as small and the complexion has not changed, it is a recent disease; when the pulse is examined as unchanged but the complexion has already changed, it is a chronic disease; when both the pulse and the five colors have changed, it is a chronic disease; when both the pulse and the five colors have not changed, it is a recent disease. When the liver pulse and kidney pulse appear simultaneously, and the complexion is greenish-red, the disease should be external injury, without seeing blood; if blood has already been seen, it is injury from dampness harming the body like water qi invading internally.

The two sides of the skin on the forearm correspond to the floating ribs; the outer side of the forearm skin corresponds to the kidney, the inner side of the forearm skin corresponds to the abdominal center. Slightly above on the forearm skin: on the left, the outer side corresponds to the liver, the inner side corresponds to the diaphragm; on the right, the outer side corresponds to the stomach, the inner side corresponds to the spleen. Further upward to the inch-opening region: on the right, the outer side corresponds to the lung, the inner side corresponds to the chest center; on the left, the outer side corresponds to the heart, the inner side corresponds to the danzhong. The area in front of the inch-opening corresponds to the front of the chest; the area behind corresponds to the back of the chest. The region above the upper limit concerns matters of the chest and throat; the region below the lower limit concerns matters of the lower abdomen, lower back, thighs, knees, shins, and feet. When the pulse is large, it indicates insufficiency of yin and excess of yang, governing internal heat. When the pulse comes rapidly and goes slowly, it indicates upper body repletion and lower body vacuity, governing reversal and vertex disease; when the pulse comes slowly and goes rapidly, it indicates upper body vacuity and lower body repletion, governing aversion to wind. Therefore, when suffering aversion to wind, it is because yang qi is the first to receive the evil. When the pulse is entirely deep, thin, and rapid, it indicates shaoyin channel reversal; deep, thin, and rapid with scattering, governs cold-heat; when the pulse is floating and scattered, governs dizziness and falling. All pulses that are floating without agitation are in the yang aspect, governing heat; if the pulse is agitated, the disease is in the hand channels. All pulses that are thin and deep are in the yin aspect, governing bone pain; if the pulse is still, the disease is in the foot channels. When the pulse is rapid and occasionally stops, the disease is in the yang channels, governing diarrhea and passage of pus and blood. When all pulses have faults, in diagnosis: a rough pulse indicates excess of yang qi; a slippery pulse indicates excess of yin qi. Excess of yang qi governs the body having fever without sweating; excess of yin qi governs profuse sweating and a cold body; both yin and yang in excess, then there is no sweating and cold. When pressing outward on the pulse qi, but it goes inward and not outward, there is an abdominal mass in the heart and abdomen; when pressing inward on the pulse qi, but it goes outward and not inward, the body has heat; when pressing upward on the pulse qi, but it goes upward and not downward, there is cold in the lower back and feet; when pressing downward on the pulse qi, but it goes downward and not upward, there is pain in the head and neck. When pressing down to the bone, and the pulse qi is very sparse, there is pain in the lower back and spine, and the body has bi disorder.