Fourteenth Difficulty
The pulse has the distinctions of "rapid arrival" () and "diminished arrival" (). What does this mean?
It is answered: As for what is called the "rapid arrival" pulse, during one inhalation, the pulse beats twice—this is normal; beating three times indicates departure from the channels; beating four times indicates depletion and loss of essential qi; beating five times indicates approaching death; beating six times indicates the severance of life. This is the "rapid arrival" pulse. What is called "diminished arrival"? During one inhalation, the pulse beats once—this indicates departure from the channels; during two inhalations, it beats once—this indicates depletion and loss of essential qi; during three inhalations, it beats once—this indicates approaching death; during four inhalations, it beats once—this indicates the severance of life. This is the "diminished arrival" pulse. The "rapid arrival" pulse develops from below upward; the "diminished arrival" pulse develops from above downward.
What are the diseases caused by the "diminished arrival" pulse?
It is answered: The first type of damage harms the skin and body hair, causing the skin to contract and the body hair to fall out. The second type of damage harms the blood vessels, causing the blood vessels to become empty and the qi and blood to decrease so that they cannot nourish the five zang-organs and six fu-organs. The third type of damage harms the flesh and muscles, causing emaciation, so that food and drink cannot transform into flesh and skin. The fourth type of damage harms the sinews, causing the sinews to become slack and unable to contract and support themselves. The fifth type of damage harms the bones, causing the bones to become weak and soft, so that the person cannot rise from bed. The opposite of this is disease developing from below upward. For those developing from above downward, if the bones become weak and soft so the person cannot rise, death occurs. For those developing from below upward, if the skin contracts and body hair falls out, death occurs.
What is the method for treating "diminished arrival" disease?
It is answered: If damage reaches the lung, supplement its qi. If damage reaches the heart, harmonize its nutritive qi and defensive qi. If damage reaches the spleen, regulate food and drink and adapt to cold and warmth. If damage reaches the liver, soothe its qi mechanism. If damage reaches the kidney, supplement its essential qi. This is the method for treating "diminished arrival" disease.
The pulse may have two beats per inhalation and two beats per exhalation; or three beats per inhalation and three beats per exhalation; or four beats per inhalation and four beats per exhalation; or five beats per inhalation and five beats per exhalation; or six beats per inhalation and six beats per exhalation; or one beat per inhalation and one beat per exhalation; or one beat per two inhalations and one beat per two exhalations; or two beats per one inhalation and one exhalation. When the pulse manifests in these ways, how are they distinguished and judged in terms of the diseases they correspond to?
It is answered: When the pulse arrives, if it beats twice per inhalation and twice per exhalation, and the pulse is neither large nor small, this is normal. If it beats three times per inhalation and three times per exhalation, this is a newly acquired disease. If the pulse is large in the front and small in the rear, there will be headache and blurred vision. If it is small in the front and large in the rear, there will be chest oppression and shortness of breath. If it beats four times per inhalation and four times per exhalation, the disease condition is about to worsen. If the pulse is surging and large, there will be suffering from restlessness and chest oppression. If the pulse is deep and fine, there will be abdominal pain. If the pulse is slippery, it indicates injury from heat pathogen. If the pulse is rough, it indicates contraction of mist and dew pathogen. If it beats five times per inhalation and five times per exhalation, the person should be weary and weak. If the pulse is deep and fine, the condition worsens at night. If the pulse is floating and large, it worsens during the day. If the pulse is neither large nor small, although weary, it can still be treated. If the pulse is sometimes large and sometimes small, it is difficult to treat. If it beats six times per inhalation and six times per exhalation, this is a death pulse. If the pulse is deep and fine, death occurs at night. If the pulse is floating and large, death occurs during the day. If it beats once per inhalation and once per exhalation, this is called "diminished arrival." Although the person can still walk, they should lie down to rest. The reason for this is that both qi and blood are insufficient. When it beats once per two inhalations and once per two exhalations, and also when it beats twice per one inhalation and one exhalation, this is called "no soul." A person with no soul should die. Although such a person can still walk, they are called a "walking corpse." If the upper part [cun-kou] has a pulse but the lower part [chi] does not, this person should vomit; if they do not vomit, they will die. If the upper part has no pulse but the lower part does, although weary, it will not cause harm. The reason for this is that, for example, if a person has a chi pulse, it is like a tree having roots. Although the branches and leaves may wither, the roots will grow on their own. The pulse has a root, and the person has primordial qi. Therefore, it is known that they will not die.