Fifteenth Difficulty

The medical classic says: In spring, the pulse is wiry; in summer, the pulse is hook-like; in autumn, the pulse is fuzzy; in winter, the pulse is stony. Are these normal pulses, or are they disease pulses?

Response: The wiry, hook-like, fuzzy, and stony pulses correspond to the four seasons. In spring, the wiry pulse appears because the liver corresponds to the east and wood. All things are just beginning to grow, and have not yet put forth branches or leaves. Therefore, when the pulse arrives, it is moist, soft, and long, and thus it is called wiry. In summer, the hook-like pulse appears because the heart corresponds to the south and fire. All things grow luxuriantly, drooping branches and spreading leaves all bend downward like hooks. Therefore, when the pulse arrives, it is swift, and when it departs, it is slow, and thus it is called hook-like. In autumn, the fuzzy pulse appears because the lungs correspond to the west and metal. All things reach their end; the flowers and leaves of grasses and trees all wither and fall in autumn, leaving only the branches alone, like fine hairs. Therefore, when the pulse arrives, it is light, vacuous, and floating, and thus it is called fuzzy. In winter, the stony pulse appears because the kidneys correspond to the north and water. All things are in hiding; in the depths of winter, water congeals like stone. Therefore, when the pulse arrives, it is sunken, moist, and slippery, and thus it is called stony. These are the pulses of the four seasons.

What about when the pulses change?

Response: In spring, the pulse should be wiry; the opposite is a disease pulse. What is meant by opposite? Response: If the pulse qi arrives full and strong, this is called excess, and the disease is external. If the pulse qi arrives weak and fine, this is called insufficiency, and the disease is internal. When the pulse qi arrives soft and continuous, like stroking an elm leaf, it is called a normal pulse. When it is more full and slippery, like stroking a long bamboo pole, it is called a disease pulse. When it is rapid and forceful, like a bowstring just drawn taut, it is called a death pulse. In spring, a pulse with a slight wiry quality is called a normal pulse; much wiriness and little stomach qi is called a disease pulse; only wiriness without stomach qi is called a death pulse. In spring, stomach qi is the root.

In summer, the pulse should be hook-like; the opposite is a disease pulse. What is meant by opposite? Response: If the pulse qi arrives full and strong, this is called excess, and the disease is external. If the pulse qi arrives weak and fine, this is called insufficiency, and the disease is internal. When the pulse arrives continuous like a ring, like stroking jade, it is called a normal pulse. When it arrives increasingly rapid, like a chicken lifting its foot, it is called a disease pulse. When it is bent in front and straight behind, like grasping a belt hook, it is called a death pulse. In summer, a pulse with a slight hook-like quality is called a normal pulse; much hook-like quality and little stomach qi is called a disease pulse; only hook-like quality without stomach qi is called a death pulse. In summer, stomach qi is the root.

In autumn, the pulse should be fuzzy; the opposite is a disease pulse. What is meant by opposite? Response: If the pulse qi arrives full and strong, this is called excess, and the disease is external. If the pulse qi arrives weak and fine, this is called insufficiency, and the disease is internal. When the pulse arrives floating and large like a carriage canopy, and feels even larger when pressed, it is called a normal pulse. When it is neither rising nor falling, like stroking a chicken feather, it is called a disease pulse. When pressed, it is desolate and scattered, like wind blowing through hair, it is called a death pulse. In autumn, a pulse with a slight fuzzy quality is called a normal pulse; much fuzziness and little stomach qi is called a disease pulse; only fuzziness without stomach qi is called a death pulse. In autumn, stomach qi is the root.

In winter, the pulse should be stony; the opposite is a disease pulse. What is meant by opposite? Response: If the pulse qi arrives full and strong, this is called excess, and the disease is external. If the pulse qi arrives weak and fine, this is called insufficiency, and the disease is internal. When the pulse arrives large above and small below, moist and slippery like a sparrow's beak, it is called a normal pulse. When it pecks continuously, with slight bending in the middle, it is called a disease pulse. When it arrives like a rope being untied, and departs like a pellet shot from a slingshot, it is called a death pulse. In winter, a pulse with a slight stony quality is called a normal pulse; much stoniness and little stomach qi is called a disease pulse; only stoniness without stomach qi is called a death pulse. In winter, stomach qi is the root.

The stomach is the sea of water and grain, and it governs receiving nourishment from the four seasons. All take stomach qi as their root. This is the key to the changes of the four seasonal pulses giving rise to disease and determining life and death. The spleen resides in the central burner; its normal pulse cannot be observed, and it only becomes manifest when it is weakened. When the pulse arrives like a sparrow pecking at food, or like water dripping from a leak, this is the manifestation of the spleen's weakness.