Discourse on Manifesting Composure
The Yellow Emperor sat at ease and summoned Leigong, saying to him: You have studied medicine and recited medical texts. If you can extensively peruse various doctrines, understand comparative analysis, and integrate medical principles thoroughly, then tell me about your expertise. The five zang-organs and six fu-organs, the gallbladder, stomach, large and small intestines, spleen, uterus, bladder, brain and marrow, nasal discharge and saliva, weeping and sadness, as well as the movement of fluids—these are all things on which the human body relies for survival. If you make errors in treatment, you must understand these principles to achieve a perfect cure rate of ten out of ten; if you cannot yet comprehend them, you will be resented by the world.
Leigong said: I have recited the upper and lower chapters of the Pulse Classic. The content is extensive, but when distinguishing similarities and differences and conducting comparative analysis, I still cannot achieve a perfect cure rate of ten out of ten. How, then, can I fully understand all of this?
The Yellow Emperor said: You should try to understand the diseases of the five zang-organs, the disharmony of the six fu-organs, errors in treatment with needles and stones, the appropriate use of toxic medicines, and the regulation of decoctions and flavors. Describe each situation in detail and answer me completely. May I ask what you still do not know?
Leigong said: Liver deficiency, kidney deficiency, and spleen deficiency all cause the body to feel heavy and the mind to be agitated and confused. Treatment should involve toxic medicines, needling, moxibustion, stone needles, and decoctions. Some cases are cured, and some are not. I wish to hear your explanation.
The Yellow Emperor said: Why is it that you are so advanced in age yet ask such shallow questions? I originally inquired about profound principles, yet you respond with content from the upper and lower chapters—why is this? Spleen deficiency causes the pulse to be floating and resemble the lung pulse; kidney deficiency causes the pulse to be slightly floating and resemble the spleen pulse; liver deficiency causes the pulse to be rapid, deep, and scattered, resembling the kidney pulse. These are conditions that medical practitioners often confuse. However, with calm and careful examination, they can be distinguished. As for the pulses of these three zang-organs being intermingled like earth, wood, and water, even a child knows this. Why do you ask about it?
Leigong said: There is a person who suffers from headache, tense and cramped sinews, heavy and painful bones, timidity and shortness of breath, belching and abdominal distension, frequent fright, and a dislike for lying down. Which zang-organ is diseased? The pulse is floating and taut, and when pressed, it feels as hard as stone. I do not understand its meaning, so I again inquire about these three zang-organs in order to clarify through comparative analysis.
The Yellow Emperor said: This is what is meant by the principle of calm and careful examination. For the elderly, one should seek the cause in the six fu-organs; for the young, in the channels; for the robust, in the five zang-organs. What you have said now is all wrong. When the eight winds stagnate and transform into heat, the essence of the five zang-organs is consumed and wasted, and pathogenic influences transmit and interact with each other. A floating and taut pulse indicates insufficiency of kidney qi; a deep and stone-like pulse indicates that kidney qi is lodged internally; timidity and shortness of breath indicate that the water passage is obstructed and the physical form and qi are dissipated and declining; coughing and restlessness indicate that kidney qi is rebelling upward. The disease qi of a person actually resides in only one zang-organ. To say that three zang-organs are simultaneously diseased does not conform to the principles.
Leigong said: There is a person who has weak and limp limbs, with wheezing, coughing, and bleeding from the lower body. I foolishly examined and believed it was injury to the lung. When I felt the pulse, it was floating, large, and tight. I dared not treat it. A crude physician used stone needles to let blood, and after the illness was cured, a large amount of blood was discharged. When the bleeding stopped, the body felt light and at ease. How is this so?
The Yellow Emperor said: You are capable of treating diseases and already know a great deal, yet your judgment of this case is mistaken. It is like a wild goose flying that can also ascend to the sky. When a sage treats disease, he follows the model, adheres to the rules, uses things as references for comparative analysis, adapts and transforms in the profound and subtle, and moves from above to below. Why must one rigidly adhere to conventions? Now, the pulse is floating, large, and vacuous—this indicates that the spleen qi is externally exhausted, having left the stomach and returned externally to the yang brightness channel. The two fires (referring to yang brightness) cannot overcome the three waters (referring to greater yin), so the pulse is chaotic and abnormal. Weak and limp limbs indicate that the spleen essence cannot be distributed; wheezing and coughing indicate that water qi has merged with the yang brightness channel; bleeding from the lower body indicates that the pulse pathway is urgent and blood has nowhere to go. As for considering it an injury to the lung, that is madness caused by error. Not using comparative analysis indicates unclear understanding. In cases of lung injury, the spleen qi cannot hold firm, the stomach qi cannot be pure and harmonious, the channel qi cannot function properly, the true zang-organ is damaged and split, the channels are severed laterally, and the essence of the five zang-organs leaks out. If it does not manifest as nosebleeding, then it will be vomiting. These two are not similar. It is like the sky having no form and the earth having no pattern; white and black are far apart. This is my fault. I thought you already knew, so I did not tell you. Clearly citing the principle of comparative analysis and calm examination, I therefore name it "Diagnosis of Ease." This is the highest medical path.