《黄帝八十一难经纂图句解》

The Collected Diagrams and Phrase-by-Phrase Explanation of the Yellow Emperor’s Classic of Eighty-One Difficulties is a work explaining the Classic of Difficulties. It is included in the Scripture of Nourishing and Preserving Life of the Great Clarity section of the Chinese Daoist Canon. The title also appears as The Illustrated Phrase-by-Phrase Explanation of the Yellow Emperor’s Classic of Eighty-One Difficulties. It was written by Li Si in the Song dynasty and comprises seven volumes. Its base text comes from the Taixuan section of the Orthodox Canon, with reference also made to the Collected Commentaries on the Classic of Difficulties and the Original Meaning of the Classic of Difficulties.

The contents are arranged by volume and list the sequence of chapters of the Classic of Difficulties and related questions. Volumes One through Three mainly discuss the channels and pulse diagnosis; Volume Four covers the channels and collaterals, the Eight Extraordinary Vessels, Ying and Wei, the Triple Burner, and the correspondences of the zang-fu organs; Volumes Five and Six address the measurements of the zang-fu organs, deficiency and excess, pathogenic and normal influences, and the transmission of disease among the organs. Some entries in the contents are repeated or out of order; they are reproduced here as listed: Volume Three includes “Difficulty Twenty-Three-One, Difficulty Twelve, Difficulty Thirteen, Difficulty Fourteen, Difficulty Fifteen”; Volume Six again includes “Difficulty Forty-Seven” and “Deficiency and Excess, Pathogenic and Normal Influences, Chapter Seven.”

The twelve meridians described in medical classics can all be felt as pulses. Here, “meridian” refers to a channel through which Qi regularly circulates. The hands and feet each have three Yin meridians and three Yang meridians: the Heart belongs to the Hand Shaoyin meridian, and the Small Intestine to the Hand Taiyang meridian; the Liver belongs to the Foot Jueyin meridian, and the Gallbladder to the Foot Shaoyang meridian; the Kidneys belong to the Foot Shaoyin meridian, and the Bladder to the Foot Taiyang meridian; the Lungs belong to the Hand Taiyin meridian, and the Large Intestine to the Hand Yangming meridian; the Spleen belongs to the Foot Taiyin meridian, and the Stomach to the Foot Yangming meridian; the Pericardium belongs to the Hand Jueyin meridian, and the Triple Burner to the Hand Shaoyang meridian. A pulse can be felt on each of these twelve meridians.

Since all twelve meridians have pulses, why, when diagnosing whether the Zang-Fu organs will fare well or poorly, or live or die, do practitioners examine only the pulse at the wrist’s Cun-Kou position? What is the reasoning behind this?

The point one inch from the fish-border bone is called the “inch opening” (cun-kou). The Liver, Heart, Spleen, Lung, and Kidneys are collectively called the Five Zang organs; the Gallbladder, Stomach, Large Intestine, Small Intestine, Bladder, and Triple Burner are collectively called the Six Fu organs. Why can examining only the inch opening reveal the condition of the Zang and Fu organs, as well as life, death, fortune, and misfortune? Here, “wei” means to ask about or explain.

The inch opening is an important place where the pulse Qi gathers, and it is where the pulse of the Hand Taiyin Lung Channel can be felt. The scripture says that the inch opening reflects the Zang and Fu organs because it is regarded as the key point for observing the pulse throughout the body.

With each exhalation, the pulse travels three inches; with each inhalation, it also travels three inches. In one complete, steady breath, the pulse travels six inches. The commentary explains that during exhalation, pulse Qi moves outward with Yang Qi, while during inhalation it moves inward with Yin Qi, passing through the corresponding channels in each case.

According to the scripture’s calculation, the channels complete one circuit in 270 breaths. Over the course of a day and night, they make 50 circuits, for a total of 13,500 breaths. As pulse Qi circulates, it makes 25 circuits through the Yang channels and 25 through the Yin channels, for 50 circuits in all, reaching throughout the whole body.

“Great Abyss” (Taiyuan) is the name of an acupoint on the Hand Taiyin Lung Channel. It is an important place where the pulse Qi of the twelve channels gathers, and is also the site of the pulse beat described in the scripture.

When the water in the clepsydra has dripped away through one hundred marks, exactly one day and night has passed. The bronze vessel stores water for measuring time; a day and night is divided into twelve double-hours, totaling one hundred marks. During the day, Ying and Wei—the Qi and blood circulating through the human body—move through the Yang aspect twenty-five times. At night, they move through the Yin aspect twenty-five times. Together, these make fifty circuits, carrying them throughout the body.

Ying belongs to blood and is Yin; it circulates within the vessels. Wei belongs to Qi and is Yang; it circulates outside the vessels. When a person is awake, Qi and blood circulate through the body; during sleep, they circulate through the internal organs. This continues without interruption, day and night. With 270 breaths, the Qi in the vessels travels 162 zhang and 2 chi, the equivalent of two marks on the clepsydra. With 13,500 breaths, it travels 810 zhang, the equivalent of one hundred marks. Ying and Wei complete twenty-five circuits through the Yang aspect and twenty-five through the Yin aspect; together, these form one full circuit in a day and night.

Thus, after making fifty circuits, Ying and Wei return to Hand Taiyin (the Lung Meridian of Hand Taiyin). The Yang channels circulate outward twenty-five times, and the Yin channels circulate inward twenty-five times, making fifty circuits in all. Ying and Wei begin in the Middle Burner, the region between the chest and abdomen where Qi circulates. They first flow into Hand Taiyin and Hand Yangming, then from Hand Yangming into Foot Yangming and Foot Taiyin. They continue in sequence through Hand Shaoyin and Hand Taiyang; Foot Taiyang and Foot Shaoyin; Hand Jueyin and Hand Shaoyang; and Foot Shaoyang and Foot Jueyin, before returning to Hand Taiyin.

The Cun-kou, the pulse-taking point at the radial artery of the wrist, is where the Qi of the five viscera and six bowels begins and ends its circulation. For this reason, pulse diagnosis is performed at the Cun-kou.

The pulse at the wrist begins on the right hand with the Lung channel, passing in sequence through the Lung, Large Intestine, Stomach, and Spleen, then the Heart, Small Intestine, Bladder, Kidney, and Heart Protector (the network of vessels around the Heart), followed by the Triple Burner (the upper, middle, and lower burners of Chinese medicine), then the Gallbladder and Liver, and finally returning to the Lung. This cycle continues without end. Accordingly, the proper method for examining the pulse is to assess the wrist pulse from both sides and use it to judge life and death, fortune and misfortune.

The Second Difficulty: An explanation of the second difficult question.

The pulse is divided into the “inch” and the “foot.” What does this mean?

Why is the pulse divided into the inch and foot positions?

Answer: The inch and foot are important points where the pulse gathers.

The inch position belongs to Yang, where Yang Qi gathers; the foot position belongs to Yin, where Yin Qi gathers. The inch and foot are important positions for examining the pulse.

The area from the bar position—the middle of the three pulse positions of inch, bar, and foot—to the Chize acupoint is called the inner foot, and belongs to the region governed by Yin. The area from the bar position to the thenar bone is called the inner inch, and belongs to the region governed by Yang. The bar position is where Yin and Yang meet: in front of it is Yang, and behind it is Yin. The distance from the bar position to the Chize acupoint is about one foot. This section belongs to the foot position and governs Yin. The pulse area of the foot position is actually only one inch; it is called the “foot” because the name refers to its fundamental position. The area from the bar position to the thenar bone belongs to the inch position and governs Yang. The inch area is about one inch long, while the pulse itself extends for about nine tenths of an inch.

Thus, the inch and foot are divisions derived from the fundamental positions of the pulse. By dividing the foot position into the inch position, and the inch position into the foot position, one can use the inch and foot to distinguish the wrist pulse from the foot position.

The Yin region occupies one inch within the inner foot, while the Yang region occupies nine tenths of an inch within the inner inch. The number for Yin is even, and the number of Earth is ten, so the Yin region is assigned one inch. The number for Yang is odd, and the number of Heaven is nine, so the Yang region is assigned nine tenths of an inch. Together, the inch and foot positions join end to end to make one inch and nine tenths, and are called the “inch and foot.”

Yang Qi begins at the cubit position and its pulse is felt at the inch position; Yin Qi begins at the inch position and its pulse is felt at the cubit position. Thus the pulse is compared with the changes of Yin and Yang through the four seasons. From the Beginning of Spring to Grain in Ear, Yang Qi gradually flourishes. This is called “Three Yang” (the stages in which Yang Qi gradually grows) occupying the front, with the pulse corresponding to nine fen within the inch position, where it is relatively superficial. From the Summer Solstice onward, the Qi momentum turns downward and continues until the Beginning of Winter. Yin Qi gradually flourishes; this is called “Three Yin” (the stages in which Yin Qi gradually grows) occupying the rear, with the pulse corresponding to one cun within the cubit position, where it is relatively deep. This shows that within the domain of Yang Qi, the changes of Yin and Yang each have their beginning and end.

Yin Qi also begins to arise at the Beginning of Autumn and reaches its corresponding stage at the Winter Solstice, when its count is ten. After the Winter Solstice, lesser Yang (newly arising Yang Qi) rises in turn, reaching a count of nine by the Beginning of Summer. This shows that within the domain of Yin Qi, the changes of Yin and Yang also each have their beginning and end. The inch and cubit positions each have a starting point and an endpoint. One cun is divided into nine fen; hence they are called the “inch and cubit.”

The Third Difficult Question:

As in the preceding text.

A pulse may be excessive, exceeding the normal measure, or deficient, falling short of it. Excess and deficiency each correspond to particular pulse positions.

There is also Yin and Yang encroaching upon one another: a Yin pulse appears in a Yang position, or a Yang pulse appears in a Yin position.

There is also the “overturning” pulse, whose force extends from the bar position to the cubit position; and the “overflowing” pulse, whose Qi fills and spills outward from the inch opening, reaching up to the fish-border bone (the bone beside the base of the thumb in the palm).

What are “blockage” and “rejection”?

“Blockage” means obstruction, and “rejection” means resistance. When Yin Qi is excessive and Yang Qi cannot move, this is called “rejection.” When Yang Qi is excessive and Yin Qi cannot move, this is called “blockage.” When both Yin and Yang are excessive and cannot move in harmony with one another, this is called “blockage and rejection.”

What does this expression mean?

The explanation is that the area before the bar position is where the pulse of Yang Qi is felt.

Yang Qi begins at the cubit position and its pulse is felt at the inch position. The area before the bar position is called the inch opening; it is where the pulse of Yang Qi is felt.

The area before the bar is where the Yang pulse is active. The pulse should be superficial and about nine fen long. Yang numbers are odd, with nine as their representative, so the pulse at the cun position should be superficial and extend nine fen.

If the pulse exceeds nine fen and extends to one cun, it is considered excessive. The cun pulse is naturally superficial; if, when pressed, it also feels full and strong, that too is excessive.

If the pulse falls short of nine fen, measuring only eight, seven, or six fen, it is considered deficient. The cun pulse is naturally superficial; if it feels weak and fine when pressed lightly, that too is deficient.

When the pulse extends beyond the fish border—the bony area at the base of the palm on the thumb side—it is called “overflowing.” If the pulse is superficial, full, and strong, and extends beyond the fish border, this is “Yang overflow,” indicating excessive Yang Qi. If the pulse is superficial but weak and fine, Yang Qi is deficient. When Yang Qi is deficient, Yin Qi encroaches on the area where the Yang pulse is located; this is called “Yin overflow.”

This pulse pattern is called “the outer gate closed, the inner barrier blocked.” “Outer gate closed” means that the pulse Qi on the inner side cannot pass outward; this is deficiency, also called Yin Qi encroaching on the pulse. “Inner barrier blocked” means that the pulse Qi on the outer side cannot enter; this is excess, also called an overflowing pulse. Here, the passage describes a pulse in which Yin Qi encroaches on the area where the Yang pulse is located.

The area behind the bar is where the Yin pulse is active. Yin Qi originates at the cun position and manifests as a pulse movement at the chi position; the chi area behind the bar is precisely where Yin Qi is active.

The pulse behind the bar should be deep and about one cun long. Yin numbers are even, with ten as their representative, so the chi pulse should be deep and extend one cun.

If the chi pulse exceeds one cun, reaching one cun and two, three, four, or five fen, it is considered excessive. The chi pulse is naturally deep; if it also feels full and strong when pressed firmly, this too indicates excessive Yin Qi.

If the pulse is shorter than one cun, it is considered deficient.

The pulse called “Han” (the original text may have said “Jian,” meaning “reduced”) is less than one cun in length, extending only eight, seven, or six fen. Yin pulses are naturally deep and soft. When pressure makes the pulse weaker and smaller, this indicates a deficiency of Yin Qi.

When the pulse extends into the cubit position, it is called “Fu” (covering).

The Fu pulse reaches from the bar position to the area of the Chize point, with a pulse one cun long visible at the cubit position. Deeper down, the pulse’s course lies hidden and cannot be seen. When deep pressure makes the pulse weaker and smaller, this indicates a deficiency of Yin Qi. When Yin Qi is deficient, Yang Qi takes advantage of the weakness and enters. This is called “Yang covering,” also known as “inner closure and outer obstruction.”

This is what “inner closure and outer obstruction” means.

“Inner closure” means that Qi in the outer part cannot enter. This happens because Yin Qi is deficient and Yang Qi takes advantage of the weakness to enter. “Outer obstruction” means that Qi in the inner part cannot move outward. This happens when Yin Qi is excessive and is also called “Yang covering.”

This is the pulse pattern in which Yang Qi enters the Yin pulse.

In other words, the Yin pulse extends into the Yang position, so it is called “covering and overflowing.”

When various Yin pulses are too deficient to appear, the text also describes this as excessive Yin Qi, calling it “Yang covering.”

This is the pulse pattern in which Yang Qi enters the Yin pulse.

In other words, the Yin pulse extends into the Yang position, so it is called “covering and overflowing.”

When Yin Qi is deficient, Yang Qi takes advantage of the weakness and enters; this is called “covering.” When Yang Qi is deficient, Yin Qi takes advantage of the weakness and enters; this is called “overflowing.”

These are True Organ pulses, in which the pulse pattern characteristic of a single organ appears alone. A person may die even without showing any symptoms.

When a True Organ pulse shows the pattern of only one organ, it is generally regarded as a sign of impending death. An extreme excess of either Yang Qi or Yin Qi can also be dangerous.

The Fourth Difficulty asks:

What are the rules governing Yin-Yang changes in the pulse?

Pulses have Yin and Yang aspects. What is their pattern?

The answer: Exhalation is associated with the heart and lungs.

The heart and lungs are above the diaphragm and belong to the Yang among the organs and bowels. Exhalation follows the outward movement of Yang Qi, so exhaled breath is associated with the heart and lungs.

Inhalation is associated with the kidneys and liver.

The liver and kidneys are below the diaphragm and belong to Yin among the organs and bowels. Inhalation follows the inward movement of Yin Qi, so inhaled breath is associated with the kidneys and liver.

Between inhalation and exhalation, the spleen receives the flavors of food, and the spleen pulse lies in the middle.

The spleen is in the center, with the heart and lungs above and the kidneys and liver below, so it corresponds to the interval between inhalation and exhalation. The spleen and stomach are like storehouses for grain, receiving the five grains. Here, “five grains” means food grains. The spleen receives the flavors of food and serves as the foundation of respiratory activity.

The floating pulse (a pulse felt with a light touch at the skin’s surface) corresponds to Yang; the deep pulse (felt only with firmer pressure, close to the sinews and bones) corresponds to Yin. Pulse qualities can be broadly divided into floating and deep: the floating pulse runs between the skin and muscles, while the deep pulse runs close to the sinews and bones.

The Spleen lies at the center of the body, with the Heart and Lungs above it and the Kidneys and Liver below. Thus, as the breath Qi moves through the middle of the body, it corresponds to the Spleen. The Spleen and Stomach are like officials in charge of storing grain, responsible for receiving food and drink. Grain is both the food received by the Spleen and, it is believed, the foundation of the breath Qi.

The pulses of the Heart and Lungs are both floating. How can they be distinguished? The Heart belongs to Fire, whose nature is manifest, so the Heart pulse is floating. The Lungs belong to Metal and are positioned higher, so their pulse is also floating. The Heart pulse is identified by being floating, large, and scattered: “large” corresponds to the pulse of an organ, and “scattered” to that of a bowel. The Lung pulse is identified by being floating, short, and rough. A pulse that falls short of its proper position is called “short”; one that is fine and slow, moves with difficulty, and occasionally pauses is called “rough.” “Short” corresponds to the pulse of an organ, and “rough” to that of a bowel.

The Liver and Kidneys are both below the diaphragm, so their pulses are both deep. How can they be distinguished? The Liver pulse is firm and long. The Liver belongs to Wood, which takes root in the earth, hence it is called “firm”; its branches and leaves reach toward the sky, hence it is called “long.” “Firm” corresponds to the pulse of an organ, and “long” to that of a bowel.

The Kidneys belong to Water, whose nature is soft on the outside and firm within. When pressed, the pulse feels soft; when the finger is lifted, it becomes full. This is the Kidney pulse. “Soft” corresponds to the pulse of an organ, and “full” to that of a bowel.

The Spleen lies at the center of the body and belongs to Earth.

The kidneys correspond to Water and have a soft, moist nature. Water is soft at the surface; when pressed, it feels moist and yielding. Within, however, it has a solid quality, and when lifted, it feels full. Here, “moist” refers to the kidneys’ capacity to store Jing (essence); “solid” refers to their function as a storehouse.

The spleen is like a central province.

The spleen corresponds to Earth and is positioned at the center. “Province” can refer to a prefecture or county; here, the “central province” means the spleen, which lies at the center of the body.

Thus, the spleen pulse lies in the middle.

The heart and lungs are above, the liver and kidneys below, and the spleen pulse lies between them.

This is the system for classifying Yin and Yang.

The heart is a Yang organ, located in the upper burner, the upper region of the body. As a Yang organ in a Yang position, it is “Yang within Yang.” The lungs are Yin organs, also located in the upper burner. As Yin organs in a Yang position, they are “Yin within Yang.” The kidneys are Yin organs, located in the lower burner, the lower region of the body. As Yin organs in a Yin position, they are “Yin within Yin.” The liver is a Yang organ, located in the middle burner, the central region of the body. As a Yang organ in a Yin position, it is called “Yang within Yin.” The spleen is a Yin organ, located in the middle burner. As Greater Yin, a category marked by relatively abundant Yin Qi, in a Yin position, it is “the utmost Yin within Yin.”

Pulse patterns are described as “one Yin and one Yang,” “one Yin and two Yang,” and “one Yin and three Yang”; there are also “one Yang and one Yin,” “one Yang and two Yin,” and “one Yang and three Yin.” In other words, pulse patterns can show different combinations, with Yin and Yang together or with Yang Qi or Yin Qi predominating.

That is what is meant.

It is an explanation of Yin and Yang pulse patterns.

Can all six pulse patterns beat at once at the cun position, the point at the wrist where the pulse is taken?

The question here is whether “one Yin and one Yang,” “one Yin and two Yang,” “one Yin and three Yang,” “one Yang and one Yin,” “one Yang and two Yin,” and “one Yang and three Yin” at the cun position mean that all six pulse patterns appear at the same time.

The answer is that these phrases refer to six categories of pulse patterns.

They do not mean that all six pulse patterns beat at the cun position simultaneously.

Rather, they refer to the different qualities a pulse may display, such as floating, deep, long, short, slippery, or rough.

Here, the pulses of the Three Yin and Three Yang are used to correspond to the Six Qi: Wind, Cold, Summer Heat, Dampness, Dryness, and Fire. Floating, slippery, and long are Three Yang pulses; deep, short, and rough are Three Yin pulses.

The floating pulse belongs to Yang and indicates that the pulse is at the surface. It corresponds to Shaoyang; the slippery pulse belongs to Yang and corresponds to Yangming; the long pulse belongs to Yang and corresponds to Taiyang. The deep pulse belongs to Yin and corresponds to Shaoyin; the short pulse belongs to Yin and corresponds to Jueyin; the choppy pulse belongs to Yin and corresponds to Taiyin.

“One Yin and one Yang” refers to a pulse that is deep and slippery. “One Yin” means the deep pulse, and “one Yang” means the slippery pulse. If this pulse appears at the left wrist’s cubit position, which is used to examine the kidneys and bladder, it indicates that these paired interior-exterior organs are in harmony. If it appears at the left wrist’s inch position, the pulse position and pulse quality do not correspond, which is an adverse sign.

“One Yin and two Yangs” refers to a pulse that is deep, slippery, and long. “One Yin” means the deep pulse, and “two Yangs” means the slippery and long pulses. If this pulse appears at a Yin position, it indicates that the Qi of the Yang pulse has instead entered the Yin position.

“One Yin and three Yangs” refers to a pulse that is floating, slippery, and long, but occasionally shows a deep quality. “One Yin” means the deep pulse, and “three Yangs” means the floating, slippery, and long pulses. If the cubit pulse is already floating, slippery, and long, yet at times sinks deep, this is called Yin concealed within Yang: a Yin quality is hidden within the Yang pulse.

“One Yang and one Yin” refers to a pulse that is floating and choppy. “One Yang” means the floating pulse, and “one Yin” means the choppy pulse. A floating, choppy pulse is the lung pulse and should normally appear at the right wrist’s inch position, which is used to examine the lungs. This means the pulse corresponds to its position; if it appears at the left wrist’s bar position, it is an adverse sign.

“One Yang and two Yins” refers to a pulse that is long, deep, and choppy. “One Yang” means the long pulse, and “two Yins” means the deep and choppy pulses. If the pulse appears at a Yang position but shows the qualities of a Yin pulse, this indicates deficiency of both Qi and blood. It is a sign of Yin encroaching upon and pressing down on the Yang position.

If the pulse presents as “one Yang and three Yin,” it arrives deep, rough, and short, but at times rises slightly. “One Yang” refers to the pulse rising; “three Yin” refers to its deep, rough, and short quality. The cun-kou pulse is already deep, rough, and short, yet often rises: this means a Yang pulse is concealed within a Yin pulse.

Judge whether the illness is progressing favorably or unfavorably according to the locations of the twelve channels associated with the pulse. Then observe how the pulse changes with the four seasons to determine whether the illness is following a favorable or unfavorable course.

The Fifth Difficulty:

Why do pulses have different degrees of lightness and heaviness?

When taking the pulse, the fingers press with varying force to distinguish Yin and Yang and their depth and location. What does this mean in practice?

Answer: When first taking the pulse, begin by examining the Lung pulse. The method can be explained using the Lung pulse as an example: suppose you begin by examining the Lung pulse at the cun-kou position on the right hand.

Press with a force as light as if pressing down three beans. The pulse corresponds to the skin and body hair; this is the Lung pulse. Shu means beans. The Lung governs the skin and body hair, so examine its pulse with a light touch.

Press with a force as heavy as if pressing down six beans. The pulse corresponds to the blood vessels; this is the Heart pulse. The Heart governs the blood vessels and lies beneath the Lung, so examine its pulse by pressing somewhat more firmly.

Press with a force as heavy as if pressing down nine beans. The pulse corresponds to the flesh; this is the Spleen pulse. The Spleen governs the flesh and lies beneath the Heart, so examine its pulse with a moderate touch.

Press with a force as heavy as if pressing down twelve beans. The pulse corresponds to the sinews; this is the Liver pulse. The Liver governs the sinews and lies beneath the Spleen, so examine its pulse by pressing somewhat more firmly again.

When pressed down to the bone and then released, the pulse comes rapidly and quickly. This is a Kidney pulse.

The Kidneys govern the bones, so when examining the Kidney pulse, press down firmly until the fingers reach the bone. Then release the pressure. If the pulse comes rapidly and quickly, it is a Kidney pulse.

This is what is called the “light and heavy” method of taking the pulse.

The Heart and Lungs lie above the diaphragm, the partition between the chest and abdomen. They belong to the Yang aspect of the organs and bowels, and Yang Qi floats in the upper region, so they are suited to light pressure. The Liver and Kidneys lie below the diaphragm. They belong to the Yin aspect of the organs and bowels, and Yin Qi settles in the lower region, so they are suited to heavy pressure.

The Sixth Difficulty says:

What does it mean when the pulse shows flourishing Yang and deficient Yin, or flourishing Yin and deficient Yang?

How should we understand the expressions “the Yang pulse is strong and the Yin pulse weak,” or “the Yin pulse is strong and the Yang pulse weak”?

Answer: With light pressure, the pulse weakens and becomes small.

The floating pulse belongs to Yang. If the pulse weakens and becomes small under light pressure, this indicates that the Yang pulse is weak. The cun position—the point at the wrist where the radial artery can be felt—belongs to Yang and is generally floating and forceful. Here, however, the pulse weakens and becomes small under light pressure, so Yang Qi is said to be insufficient.

With heavy pressure, the pulse is full and large.

The sunken pulse belongs to Yin. If the pulse is full and large under heavy pressure, this indicates that the Yin pulse is flourishing. The chi position—the section of the pulse near the elbow in cun-kou pulse diagnosis—belongs to Yin and is generally sunken and gentle. Here, however, the pulse becomes even fuller and larger under heavy pressure, showing that Yin is excessive.

Thus, this is a pulse of flourishing Yin and deficient Yang.

Now consider the other situation:

With heavy pressure, the pulse weakens and becomes small.

The sunken pulse belongs to Yin. If the pulse weakens and becomes small under heavy pressure, this indicates that the Yin pulse is weak. The pulse at the chi position is naturally sunken; if it becomes even weaker and smaller under heavy pressure, this shows that Yin Qi is insufficient.

With light pressure, the pulse is full and large.

The floating pulse belongs to Yang. If the pulse is full and large under light pressure, this indicates that the Yang pulse is flourishing. The pulse at the cun-kou position is naturally floating; if it becomes even more forceful and larger under light pressure, this shows that Yang is excessive.

Thus, this is a pulse of flourishing Yang and deficient Yin.

These are the meanings of deficiency and excess in Yin and Yang. In brief, they describe different pulse patterns in which Yin or Yang is either excessive or deficient.

This indicates that Yang Qi is excessive while Yin Qi is deficient.

From this, we can judge that the pulse shows excessive Yang and deficient Yin.

This explains the principle of deficiency and excess in Yin and Yang.

Here follows a general discussion of deficiency and excess in Yin and Yang.

Seventh Difficulty:

The text says that when the Qi of Lesser Yang arrives, the pulse alternates between large and small, short and long.

Lesser Yang is at its peak in the first and second months. Its Qi is still relatively weak at this time, so the pulse advances and retreats without a fixed pattern, and its size and length are likewise irregular.

When the Qi of Bright Yang arrives, the pulse is floating, large, and short.

Bright Yang is at its peak in the third and fourth months. Its Qi is just beginning to emerge and is not yet strong, so the pulse is floating, large, and short.

When the Qi of Greater Yang arrives, the pulse is surging and long.

Greater Yang is at its peak in the fifth and sixth months. Its Qi is at its strongest then, so the pulse is surging and long.

When the Qi of Greater Yin arrives, the pulse is tight, large, and long.

Greater Yin is at its peak in the seventh and eighth months. It carries over the Yang Qi remaining from summer, while Yin Qi is not yet strong, so the pulse is full, large, and long.

When the Qi of Lesser Yin arrives, the pulse is tight, fine, and faint.

Lesser Yin is at its peak in the ninth and tenth months. Yang Qi is declining and Yin Qi is growing strong, so the pulse is tight, fine, and faint.

When the Qi of Terminal Yin arrives, the pulse is deep, short, and solid.

When the Qi of Lesser Yin arrives, the pulse is tight, fine, and faint.

Lesser Yin is at its peak in the ninth and tenth months. Yang Qi is declining and Yin Qi is growing strong, so the pulse is tight, fine, and faint.

When the Qi of Terminal Yin arrives, the pulse is deep, short, and solid.

Terminal Yin is at its peak in the eleventh and twelfth months. Yin Qi is strong then, so the pulse is deep, short, and solid.

Are these six kinds of pulse peaceful pulses?

This asks whether the six kinds of pulse are peaceful pulses.

Or are they pathological pulses?

This asks whether they are pathological pulses.

The answer is: They are all pulses corresponding to the Qi that governs the season.

The question continues: In which months does each of these six kinds of Qi govern, and for how many days does each govern?

The answer is: After the winter solstice, on the first Jiazi day, the Qi of Lesser Yang begins to govern.

The heavens move according to six cycles of sixty days, which together make up a year. After the winter solstice, the first Jiazi day marks the beginning of the calculation for the first Qi phase of the coming year. This Jiazi day may fall around Lesser Cold or after Great Cold. At this time, Shaoyang Qi has not yet emerged from the Yin aspect, so the pulse alternates between large and small, short and long.

At the next Jiazi day, Yangming governs as the second Qi phase. The weather begins to warm, but Yang Qi is not yet strong, so the pulse is floating, large, and short.

At the next Jiazi day, Taiyang governs as the third Qi phase. This is a period when Yang Qi is strong, so the pulse is surging, large, and long.

At the next Jiazi day, Taiyin governs as the fourth Qi phase. Heat and dampness are then abundant, the Qi of autumn begins to arise, and the lingering Yang Qi of summer still remains. The pulse is therefore tight, large, and long.

At the next Jiazi day, Shaoyin governs as the fifth Qi phase. The climate is cool and clear, and the pulse is tight, fine, and faint.

At the next Jiazi day, Jueyin governs as the final Qi phase. This is a period when Yin Qi is strong; water freezes hard as stone, so the pulse is deep, short, and forceful.

Each Qi phase governs for sixty days. The three Yin and three Yang phases each govern for sixty days; together, the six periods total 360 days and make up a year. A year is reckoned as 360 days, from which the four seasons are determined. This summarizes the general pattern by which the three Yin and three Yang phases take turns in waxing and waning according to the Jiazi cycle.

How can a person die when the pulse at the wrist is even and regular? It is because the twelve meridians all depend on the source of life-giving Qi (vital energy). The “source of life-giving Qi” is the foundation of the twelve meridians. It refers to the Kidneys, because they are the source from which the pulse Qi arises.

This passage discusses the “moving Qi between the two kidneys”: the primordial Qi that a person receives from their parents before birth. The Qi-Rushing vessel also arises between the kidneys. This Qi is regarded as the foundation of the five viscera and six bowels, and the source of the twelve meridians.

The gate of breathing: The passage says that the meridians beside the kidneys ascend to the throat and connect with breathing. For this reason, the kidneys are called the “gate of breathing.”

The source of the Triple Burner: The Triple Burner is said to correspond to the three primordial energies of Heaven and Earth, with the kidneys as its source.

“The spirit that guards against harmful influences”: The passage calls the left kidney the kidney and the right kidney the Gate of Life. It says that a spirit guards the Gate of Life, preventing harmful influences from entering the “Will Chamber,” the name of an acupoint. If harmful influences enter the Will Chamber, the person will die.

Qi is therefore the foundation of human life. The moving Qi between the kidneys is what sustains life at its root. The passage compares this to a tree: the hand’s three Yin and three Yang meridians are like branches, while the foot’s three Yin and three Yang meridians are like roots. The pulse at the chi position relates to a person’s foundation, while the pulse at the cun opening is like the tree’s branches and leaves. When the roots are severed, the branches and leaves wither; when the kidneys’ Qi is cut off, the person dies.

Some people have a calm pulse at the cun opening yet still die. The passage explains that this happens because the life-sustaining Qi within the body has already been cut off between the kidneys. The cun pulse can reflect the grain Qi produced from food, and it may appear calm. But when the root of life is gone, the twelve meridians lose their support, and the person cannot survive.

The Ninth Difficulty asks: How can diseases of the viscera and bowels be distinguished?

The answer: A pulse that is unusually rapid usually indicates disease in the six bowels.

How can diseases of the five viscera and six bowels be distinguished?

Generally speaking, a rapid pulse is associated with the bowels. A consistently rapid pulse suggests that one of the six bowels may be diseased. A slow pulse is associated with the viscera, and a consistently slow pulse suggests that one of the five viscera may be diseased. A rapid pulse belongs to Yang and indicates heat patterns; a slow pulse belongs to Yin and indicates cold patterns. When Yang Qi is out of balance, the pulse quickens, so Yang patterns commonly show signs of heat. When Yin Qi is deficient, the pulse slows, so Yin patterns commonly show signs of cold. Diseases of the viscera and bowels can therefore be distinguished by whether the pulse is rapid or slow.

The Ten Difficulties says: “Why can one pulse position show ten different changes? Why can the pulse at the same location appear in several different ways?”

This refers to patterns formed when the firm and yielding qualities of the five pathogenic influences meet. The five influences are deficiency, excess, normal, slight, and destructive influences; “firm and yielding” refers to Yin and Yang. “Meet” means that at the natural pulse position of one viscus or bowel, the pulse of another appears. Each of the five viscera has an exterior-interior relationship with another organ, and they can affect one another. Thus, ten different changes can be inferred from a single pulse position. These changes reflect the ways the Five Phases generate and overcome one another, and exert control and counteraction. Here, “pathogenic influence” means a factor that departs from the normal state, intrudes upon the body, and causes illness.

For example, a tense and pronounced Heart pulse indicates that a pathogenic influence from the Liver is affecting the Heart. Taking the Heart pulse as an example: in summer, it should normally be floating, large, and scattered. If instead it is taut and tense, this indicates that the Liver pulse is affecting the Heart. The Liver belongs to Wood and the Heart to Fire. Since Wood generates Fire, the Liver is the mother and the Heart the child. When the mother’s Qi affects the child organ, this is called a “deficiency influence.” “To invade” means to overpower or affect.

A slightly rapid pulse in the Heart position indicates that pathogenic Qi from the Gallbladder has invaded the Small Intestine. The Small Intestine is the Heart’s fu organ, and the Gallbladder is the Liver’s fu organ. When the pulse in the Heart position feels somewhat rapid, this is therefore interpreted as Gallbladder pathogen invading the Small Intestine.

An extremely surging pulse in the Heart position indicates that the Heart itself is diseased. Although the Heart pulse is generally surging, it should still have Stomach Qi as its foundation. Now the pulse is excessively surging and has lost its Stomach Qi. This is called disease of the organ’s own regular channel, or “upright pathogen”; hence it is said that the Heart’s pathogen attacks the Heart itself.

A slightly enlarged pulse in the Heart position indicates that the Small Intestine itself is diseased: the Small Intestine’s pathogen is attacking the Small Intestine.

An extremely slow pulse in the Heart position indicates that pathogenic Qi from the Spleen has invaded the Heart. A slow pulse is associated with the Spleen. The pulse in the Heart position is now excessively slow; according to the generating and overcoming relationships of the Five Phases (Wood, Fire, Earth, Metal, Water), Fire is the mother and Earth the child. When the child’s Qi overwhelms the mother, this is called “excess pathogen.” Hence it is said that Spleen pathogen has invaded the Heart pulse.

A slightly slow pulse in the Heart position indicates that pathogenic Qi from the Stomach has invaded the Small Intestine. If, on lightly pressing the pulse at the Heart position, it feels somewhat slow, this is interpreted as Stomach pathogen invading the Small Intestine.

An extremely rough, hesitant pulse in the Heart position indicates that pathogenic Qi from the Lungs has invaded the Heart. A rough pulse is associated with the Lungs. A rough pulse at the Heart position indicates that Metal is counteracting Fire; in the classification used in the scripture, this is called “subtle pathogen.”

A slightly rough, hesitant pulse in the Heart position indicates that pathogenic Qi from the Large Intestine has invaded the Small Intestine. If a slightly rough pulse is felt at the Heart position, this is interpreted as Large Intestine pathogen invading the Small Intestine.

An extremely deep pulse in the Heart position indicates that pathogenic Qi from the Kidneys has invaded the Heart. A deep pulse is associated with the Kidneys. Heart Fire should rise, and its pulse is ordinarily surging; now it is instead deep and sunken, indicating that Water is overcoming Fire. In the scripture’s classification, this is called “thief pathogen.”

A slightly deep, sunken pulse in the Heart position indicates that pathogenic Qi from the Bladder has invaded the Small Intestine. If, on pressing firmly at the Heart position, the pulse feels somewhat deep, this is interpreted as Bladder pathogen invading the Small Intestine.

“Light pressure” and “firm pressure” refer to different degrees of pressure when taking the pulse. The text uses pulse qualities and the relationships among the Five Phases to associate pathogens in the Heart and Small Intestine with those in other organs and bowels.

Does each of the five viscera have both firmness and softness?

Firmness and softness are Yin and Yang. Each of the five viscera has Yin and Yang. The heart is used here as an example; the other organs can be understood in the same way.

Thus, a single pulse pattern can change into ten different forms.

A single pulse pattern contains many variations; within each section, there are five kinds of pathogenic Qi. Together, the ten variations amount to sixty different forms.

The Eleventh Difficulty says:

The classic says that the pulse stops once before reaching fifty beats.

Each of the five viscera has fifty pulse beats, making two hundred and fifty in all. This is called a normal pulse. If the pulse stops once before reaching fifty beats, it means that the Qi of one viscera has already become depleted. “Stopping” means that, when you feel the pulse with your fingers, you sense it suddenly break off beneath them.

Which viscera is meant when the Qi of one viscera has become depleted?

Answer: When a person breathes, the inhalation follows Yin Qi inward.

Inhalation enters through the mouth and nose and follows the Qi of the Liver and Kidneys. The Liver and Kidneys lie below the diaphragm, so they are called Yin.

Exhalation, by contrast, follows Yang Qi outward.

Exhalation proceeds through the Qi of the Heart and Lungs. The Heart and Lungs lie above the diaphragm, so they are called Yang.

Now, inhalation can no longer reach the Kidneys. It reaches only the Liver, then returns.

In normal breathing, Yin and Yang accompany one another, and the breath moves up and down through the five viscera. This is the condition of a healthy person. In this case, although exhalation proceeds through the Qi of the Heart and Lungs, inhalation reaches only the Liver before returning; it cannot reach the Kidneys. This shows that the innate primordial Qi in the Kidneys, inherited from one’s parents, has been exhausted. The pulse therefore stops once before reaching fifty beats, indicating that the patient is near death.

Thus, when the Qi of one viscera is said to be depleted, it means that the Kidney Qi has been exhausted first.

We can therefore see that when the primordial Qi of one viscera is depleted, it is the innate primordial Qi of the Kidneys that has first been severed; the pulse consequently stops once before reaching fifty beats.

The Twelfth Difficulty says:

The classic says that the pulse Qi of the five viscera has already been cut off internally.

Among the pulse signs of the five viscera, the liver and kidneys lie below the diaphragm and are therefore called “inner.” If the pulses of the five viscera have already ceased within, this means the Qi of the liver and kidneys has been exhausted. Yet the physician instead uses acupuncture and medicine to strengthen the heart and lungs.

The heart and lungs lie above the diaphragm and are therefore called “outer.” If the pulses of the five viscera have already ceased outside, this means the pulses of the heart and lungs have ceased. Yet the physician instead uses acupuncture and medicine to strengthen the liver and kidneys.

How can one distinguish between inner and outer exhaustion? When the pulses of the five viscera cease within, the Qi of the liver and kidneys has been exhausted, but the physician instead strengthens the heart and lungs. When the pulses cease outside, the Qi of the heart and lungs has been exhausted, but the physician instead strengthens the liver and kidneys.

The heart and lungs are above the diaphragm and belong to Yang; the liver and kidneys are below it and belong to Yin. When the Qi of the heart and lungs is exhausted outside, the skin may atrophy and the hair fall out. Yet the physician instead strengthens the liver and kidneys. This is “Yang exhausted, yet Yin is strengthened.” When the Qi of the liver and kidneys is exhausted within, the bones may grow weak and the sinews and vessels become disordered. Yet the physician instead strengthens the heart and lungs. This is “Yin exhausted, yet Yang is strengthened.”

This is called “strengthening what is already excessive”: the patient is already replete, and the physician’s treatment makes the condition even more replete. It is also called “further depleting what is already deficient”: the patient is already deficient, and the physician makes the deficiency worse, damaging Qi that is already insufficient. These are all cases of faulty diagnosis and treatment.

The patient was already weak, and the physician prescribed medicine that weakened him further. This is diminishing what is already deficient.

The patient was already weak and lacking in Qi, and the physician prescribed medicine that damaged his healthy Qi. This is diminishing what is already deficient.

The patient’s Blood and Qi were already abundant, yet the physician still prescribed medicine to tonify them. This is adding to what is already excessive.

If this leads to the patient’s death, the physician has caused that death.

The Thirteenth Difficulty:

The classic says that when examining a patient, if one sees a certain complexion but does not find the corresponding pulse, and instead finds a pulse that overcomes the organ represented by that complexion, the patient will die. If the pulse instead engenders the organ represented by the complexion, the patient will fall ill.

How should one compare a patient’s complexion and pulse to determine whether they correspond?

Each of the five zang organs has an associated color, which appears on the face: the Heart corresponds to red, the Liver to green, the Spleen to yellow, the Lung to white, and the Kidney to black. These complexions should also correspond to the pulses at the cun and chi positions.

The cun and chi positions are traditional sites for pulse diagnosis, referring generally to areas near the wrist where the pulse is examined. Since each of the five zang organs has its own color, the corresponding pulse should also be present during examination. Only then do the complexion and pulse correspond:

• With a green complexion, the pulse should be wiry and rapid. Green corresponds to the Liver, and a wiry, rapid pulse is characteristic of the Liver pulse; therefore, the Liver’s complexion and pulse correspond.
• With a red complexion, the pulse should be floating, large, and scattered. Red corresponds to the Heart, and a floating, large, scattered pulse is characteristic of the Heart pulse.
• With a yellow complexion, the pulse should feel moderate and large at the middle position. Yellow corresponds to the Spleen, and this pulse is characteristic of the Spleen pulse.
• With a white complexion, the pulse should be floating, rough, and short. White corresponds to the Lung, and this pulse is characteristic of the Lung pulse.
• With a black complexion, the pulse should be deep, soft, and slippery. Black corresponds to the Kidney, and this pulse is characteristic of the Kidney pulse.

Black is the color of the kidneys; a deep, soft, and slippery pulse is the kidney pulse. This shows that the color and pulse of the Kidney channel correspond to one another.

The five colors should be compared with the five pulse qualities: green corresponds to a wiry pulse, yellow to a moderate pulse, red to a surging pulse, white to a rough pulse, and black to a deep pulse.

When the pulse is rapid and tense, the skin of the forearm’s inner surface (the cubit skin) will also feel hot and tense. A rapid pulse belongs to the heart; “cubit” refers to the inner forearm. The pulse and cubit skin should confirm one another: when the pulse is rapid, the skin on the inner forearm also becomes warm.

When the pulse is tight, the cubit skin will also feel tight. A wiry and tight pulse belongs to the liver, and the skin on the inner forearm will also feel taut.

When the pulse is slow, the cubit skin will also feel slack. A moderate pulse belongs to the spleen, and the skin on the inner forearm will feel soft and weak.

When the pulse is rough and obstructed, the cubit skin will also feel rough. A rough pulse belongs to the lungs, and the skin on the inner forearm will also feel rough and obstructed.

When the pulse is slippery and smooth, the cubit skin will also feel smooth and moist. A slippery pulse belongs to the kidneys, and the skin on the inner forearm will also feel smooth.

Each of the five viscera has corresponding sounds, colors, odors, and flavors. These should all be compared with the cun-mouth pulse (the pulse point at the wrist) and the cubit skin.

The wiry liver pulse corresponds to green, shouting, a rancid odor, and a sour taste; the surging heart pulse corresponds to red, laughter, a scorched odor, and a bitter taste; the moderate spleen pulse corresponds to yellow, singing, a fragrant odor, and a sweet taste; the rough lung pulse corresponds to white, weeping, a fishy odor, and a pungent taste; the deep kidney pulse corresponds to black, groaning, a rotten odor, and a salty taste. This is called correspondence.

If these signs do not correspond with one another, it indicates illness.

For example, if a person has liver disease but shows a white complexion, often weeps, and favors pungent flavors and fishy odors, these are all signs of the lungs. In the Five Phases, Metal overcomes Wood, so this is called “aggressive pernicious influence”—an influence harmful to the diseased organ. These signs do not correspond to the liver, and the illness may be severe.

If the complexion is greenish, this reflects the Liver. If the pulse is floating, rough, and short, it is a Lung pulse, indicating that Lung Qi restrains Liver Wood. This is called a “thief pathogen,” in which one force is too strong and injures another. If the pulse is large and moderate, it is a Spleen pulse, indicating that Liver Wood restrains Spleen Earth. This is called a “slight pathogen,” a milder form of mutual restraint. This is why it is called “mutual overcoming,” the restraining relationship among the Five Phases.

A pulse that is floating, large, and scattered is a Heart pulse: Liver Wood can generate Heart Fire. A pulse that is small and slippery is a Kidney pulse: Kidney Water can generate Liver Wood. Both cases illustrate the generative relationships among the Five Phases.

The scripture says that one who understands one method of diagnosis is a lower-grade physician; one who understands two is a middle-grade physician; and one who understands three is an upper-grade physician. An upper-grade physician treats nine cases successfully out of ten, a middle-grade physician eight, and a lower-grade physician six.

Here, “grade” refers to the physician. An upper-grade physician knows how to examine the complexion, pulse, and skin, and understands the generative and restraining relationships among the Five Phases and their underlying principles. This is why such a physician can treat nine out of ten cases successfully. A middle-grade physician masters two of these methods but cannot fully distinguish the condition, and so succeeds in eight cases out of ten. A lower-grade physician masters only one method and does not understand the complete diagnostic process. Focusing only on symptoms that have already appeared, such a physician succeeds in six cases out of ten.

The Fourteenth Difficulty asks:

There are “depleting” pulses and “arriving” pulses. What do these terms mean?

The answer is: “Arriving pulses” refers to the number of times the pulse beats against the fingers during diagnosis.

Two beats during one exhalation are called a normal pulse. A normal pulse is harmonious, neither excessive nor deficient. One inhalation and one exhalation together count as a single breath. The scripture also says that four beats during one breath constitute a harmonious pulse.

Three beats during one breath are called “departing from the normal rhythm,” meaning that the number of beats deviates from the usual measure.

“Jing” means a constant way or regular pattern. In general, the channels make one complete circuit each day and night, returning to the Hand Taiyin Channel (the Hand Taiyin Lung Channel). The Hand Taiyin Channel is where the circulation of the channels begins to be counted.

During one breath, the pulse beats three times on the exhalation, and the Qi of the pulse travels four and a half cun. On the inhalation, it also beats three times and travels four and a half cun. Thus, in one breath, it beats six times and travels nine cun—more than the normal pulse rate—and no longer follows its usual channel. This is therefore called “departing from the channels.” The pulse is forceful and large.

When the pulse beats four times during one breath, this is called “essence being taken away.”

The Five Flavors in food nourish the body; the body depends on Qi, and Qi depends on Jing. Now, when the pulse beats only four times during one breath, the body declines and Qi is depleted. With nowhere for Jing and Qi to gather, they seem to have been taken away.

When the pulse beats five times during one breath, this is called “death.”

If the pulse beats five times in the interval of one inhalation or exhalation, it beats ten times over a full breath. That is twice the normal pulse rate. Qi and blood have nowhere to gather, so how could death be avoided?

When the pulse beats six times during one breath, this is called “life cut off.”

If the pulse beats twelve times in one breath, life can scarcely be preserved, and death will follow.

These kinds of pulse are called “reaching pulses.” The original text reads “pulses of death,” but I believe it should be corrected to “pulses of reaching,” since this passage is describing the number of times the pulse reaches a given rate.

What is meant by “depletion”?

Question: What is a depleted pulse like?

If the pulse beats only once during an exhalation, this is called “departing from the channels.” The earlier use of “departing from the channels” referred to a pulse beating half again as often as the normal rate. Here, in the description of a depleted pulse, it means that the pulse circulates at less than half the normal rate. A pulse that beats only twice during one breath is also called “departing from the channels.”

If the pulse beats only once over two exhalations, this is called “essence being taken away.” In this state, over a day and night the Qi of the pulse completes fewer than thirteen circuits through the body, traveling only 2,225 chi. The person becomes deficient in Qi and depleted of blood; the spirit grows listless, the complexion fades, and Jing and Qi seem to have been taken away. Hence this condition is also called “essence being taken away.”

If the pulse beats only once over three exhalations, this is called “death.” The Qi of the pulse then travels only one and a half cun. The person becomes depleted of blood, listless in spirit, and faded in complexion, as though Jing and Qi had been taken away.

After four breaths, the pulse beats only once, advancing just one and a half cun with each beat. Over the course of a day and a night, the pulse Qi travels less than sixty-seven zhang and five chi, falling short of five circuits through the whole body. When this pulse pattern appears, death is near.

When four breaths produce only one pulse beat, this is called “life ending.”

After four breaths, the pulse beats only once. In a day and a night, the pulse Qi travels less than four circuits through the whole body. The breath has already ceased, the internal organs are failing, and the spirit is dispersing; therefore it is called “life ending.”

This is the “depleting pulse.”

The above is a general account of the depleting pulse.

The “ascending pulse” is a pulse pattern in which pulse Qi travels from below upward.

There are fewer breaths and more pulse beats, so it is called “ascending.” Illnesses associated with the ascending pulse mostly occur in the Yang aspect. Yang Qi travels upward from below, so signs of decline gradually appear throughout the body, from top to bottom.

The depleting pulse, by contrast, is a pulse pattern in which pulse Qi travels from above downward.

There are more breaths and fewer pulse beats, so it is called “depleting.” Illnesses associated with the depleting pulse mostly occur in the Yin aspect. Yin Qi travels downward from above, and signs of decline gradually appear in the pulse as well; sometimes the pulse beats only once or twice with each breath.

What kinds of illnesses does the depleting pulse cause?

The first stage depletes Lung Qi. The lungs govern the skin and body hair, so the skin becomes wrinkled and the hair falls out.

The second stage damages the blood vessels. The heart governs the blood vessels; when the blood and vessels are deficient, they can no longer nourish the five viscera and six bowels.

The third stage damages the muscles. The spleen governs the muscles and also oversees the transformation and transportation of food. When food cannot be transformed into nourishment, the muscles waste away.

The fourth stage damages the sinews. The liver governs the sinews. When the sinews become slack and weak, they can no longer contract and support the body.

The fifth stage damages the bones. The kidneys govern the bones. When the bone marrow is exhausted, weakness and debility arise, and the person may even be unable to get out of bed.

The illnesses governed by the ascending pulse are the opposite of those described above.

The Yuanwen records that when the illness reaches the stage of “recovery,” the character xi should be changed to fan. The five disorders of the pulse described above belong to the category of “reaching-pulse” disorders.

When illness progresses from the upper part of the body downward, it is fatal once the bones become weak and the person can no longer get out of bed. The Spleen is above and the Kidneys below. The first stage damages the Lungs, the second the Heart, the third the Spleen, the fourth the Liver, and the fifth the Kidneys. When illness spreads from the Lungs all the way to the Kidneys, all five organs are damaged. The Kidneys govern the bones, so when the bones grow weak, death ultimately follows.

When illness progresses from the lower part of the body upward, it is fatal once the skin shrivels and the hair falls out. Illness that damages the Kidneys and then spreads upward to the Lungs likewise damages all five organs. The Lungs correspond to the skin and body hair. Once the Lungs are damaged, the skin shrivels and the hair falls out, and death follows.

When the Lungs are damaged, Lung Qi should be replenished. Exposure to cold or an irregular diet can damage the Lungs. Since the Lungs govern Qi, treatment should replenish Lung Qi.

When the Heart is damaged, the nutritive Qi and defensive Qi—the two kinds of Qi that nourish and protect the body—should be brought into harmony. Worry and excessive thought can damage the Heart. Since the Heart governs blood, treatment should harmonize the nutritive and defensive Qi.

When the Spleen is damaged, the diet should be regulated so that food and drink are neither too cold nor too hot. Irregular eating and excessive exertion can damage the Spleen. The temperature of food should be adjusted to the season so that the Spleen channel can return to harmony.

When the Liver is damaged, the movement of Qi in the chest and abdomen should be eased. Repressed anger rising upward can damage the Liver. The Liver corresponds to anger, and its Qi is prone to become tense. Sweet foods can be used in treatment because sweetness has a relaxing effect. Sweetness belongs to the Earth phase of the Spleen, and Earth occupies the center; hence this is called using the flavor of Earth to relax the Qi at the center.

When the Kidneys are damaged, Jing and Qi should be replenished. Sitting for a long time in damp places, straining oneself, or spending too much time wading through water can damage the Kidneys. The Kidneys govern Jing. When the Kidney channel is damaged, Jing and Qi should be replenished through gentle nourishment.

The above describes the principles for treating “damage-reaching” disorders, setting out the general standards for treating damage disorders and reaching disorders.

The pulse beats twice in the time it takes to breathe in and out.

This is the method of “decreasing and reaching” (sun zhi), which summarizes the patterns of illness associated with the “decreasing pulse” and the “reaching pulse.”

During one exhalation, a person’s pulse beats twice; during one inhalation, it also beats twice. If it beats three, four, five, or six times during each exhalation and inhalation, the meaning is likewise that the pulse beats the corresponding number of times during each breath.

If the pulse beats only once during an exhalation and once during an inhalation, it falls below the standard count: according to the account here, there should be two beats during each exhalation and inhalation, but there is only one. If, over two successive exhalations and two inhalations, the pulse beats only twice in total, it is likewise far below the standard count. The original text then mentions “breathing reaches again.” The commentary suggests this may mean that, over two exhalations and two inhalations, the pulse beats twice in total. But it also points out that the preceding passage treats two beats during each breath as normal and one beat during each as insufficient, so this phrase is difficult to explain and must be left for later scholars to examine.

How can these pulse rates be used to distinguish illnesses?

The pulse follows the breath. If it beats twice during one exhalation and twice during one inhalation, neither too fast nor too slow, it is called a “balanced pulse”: a normal, even pulse.

If it beats three times during one exhalation and three times during one inhalation, it indicates illness.

Between one inhalation and one exhalation, the pulse beats six times and feels broad and forceful. This is called “leaving the ordinary channels” (li jing) and indicates that the illness has only just begun.

When the front part of the pulse is large and the rear part small, it points to headache and blurred vision. “Front large” means that the outer side of the cun kou pulse is large; “rear small” means that its inner side is small. The cun kou is associated with the upper body. In the ancient system of pulse diagnosis, the upper body corresponds to the chest and everything above it, up to the head, which explains the headache and dizziness.

When the front part of the pulse is small and the rear part large, it points to fullness and tightness in the chest and shortness of breath. “Front small” means that the outer side of the cun kou pulse is small; “rear large” means that its inner side is large.

Eight beats between one inhalation and one exhalation suggest that the illness may be worsening. A normal pulse beats about four times in that span. Eight beats is double that number and may indicate a worsening condition.

If the pulse is forceful and surging among these eight beats, the person commonly feels restless and has fullness and distention in the chest and abdomen. The scripture classifies such illnesses as “the Three Yang” (illnesses governed by the Three Yang channels), often associated with an excess of Yang Qi.

A deep, fine pulse commonly accompanies abdominal pain. The scripture classifies such illnesses as “the Three Yin” (illnesses governed by the Three Yin channels). Yin governs the interior, so the pain is usually in the abdomen.

A slippery pulse indicates an invasion by heat.

A choppy pulse indicates an invasion by cold carried in mist and dew.

Ten beats between one inhalation and one exhalation indicate that the person will feel drowsy and weak.

Among these ten beats, a deep, fine pulse means the illness often worsens at night; a floating, large pulse means it often worsens during the day.

If the pulse is neither large nor small, the illness can still be treated even when the person feels drowsy.

When the pulse is neither floating and large nor deep and fine, the illness may still be treated, even if it is severe and debilitating.

If the pulse is sometimes large and sometimes small, treatment is difficult.

A pulse that is extremely floating and large indicates an excess of Fire Qi, like a bell-shaped flame going out. A pulse that is extremely deep and fine indicates that Water Qi is weakened and nearing exhaustion.

If the pulse beats only once during one inhalation and one exhalation, this is called a “depleted pulse.” Under normal conditions, it should beat four times in that span; if it beats only twice, that too is called a “depleted pulse.”

Even if the patient can still walk, they should rest in bed. This is because both Qi and blood have become deficient.

If the pulse beats only twice during one inhalation and one exhalation, this is called “soullessness.” To be “soulless” means that the patient is about to die. More exhalations and fewer pulse beats indicate that the hun and po have withered away. The hun belongs to Yang, and Yang Qi governs life. When the hun departs, one can judge that the patient is near death. Though the patient may still walk, it is like a corpse walking.

A pulse in the upper part means that a pulse is still present at the cun position of the wrist pulse; no pulse in the lower part means that none is present at the chi position. Such a person should vomit. If they do not, they will die, because the Qi of life within them has been completely cut off.

Someone with no pulse in the upper part but a pulse in the lower part will not die from the illness, even if it is severe and debilitating. When there is no pulse at the cun position but one remains at the chi position, it is like a person having a pulse at the wrist and a tree having roots. As long as the roots remain, life still has a foundation.

Although the pulse at the cun position is as withered and weak as a tree’s branches and leaves, as long as a pulse remains at the chi position, the root is still there, and vitality may return.

The cun position is like a tree’s branches and leaves; the chi position is like its roots. If a person still has a pulse at the chi position, then even if no pulse can be felt at the cun position, there is still a possibility of survival.

The pulse has a root. Its root is at the chi position: if a pulse remains there, this shows that the pulse has a root.

People have original Qi—the vital energy received at birth—so we can tell that they have not yet died. Between the two kidneys there is moving Qi, called the original Qi received from one’s parents. If a pulse can still be felt at the chi position, this shows that the original Qi has not been exhausted, so we can know that the person is not yet dead.

The Fifteenth Difficulty says:

The classic says that the pulse in spring is like a taut string.

The pulse in spring feels like a bowstring or zither string, with a taut quality.

The pulse in summer is like a hook.

The pulse in summer curves like the hook of a steelyard.

The pulse in autumn is like a feather.

The pulse in autumn is light and floating, like a feather.

The pulse in winter is like a stone.

The pulse in winter is heavy and sunken, like a stone.

Are these the pulses that flourish in their respective seasons, or are they diseased pulses?

Answer: The string-like, hook-like, feather-like, and stone-like pulses are the pulses associated with the four seasons.

The string-like pulse flourishes in spring, the hook-like pulse in summer, the feather-like pulse in autumn, and the stone-like pulse in winter. None of them is a diseased pulse.

The pulse in spring is like a string because the liver corresponds to Wood in the East.

Spring corresponds to the East, the heavenly stems Jia and Yi, and Liver Wood; therefore, the spring pulse has a string-like quality. All things are just beginning to grow, and their branches and leaves have not yet appeared.

The tender shoots of plants are just emerging from the roots, and their branches and leaves have not yet grown. So when the spring pulse arrives, it is gentle, faint, and long. This quality is called “string-like.” “Long” describes a pulse that resembles a string; “gentle, faint, and long” means the pulse has only a slight string-like quality. A slight string-like quality shows that the pulse still retains Stomach Qi, the calm and vital quality present in a healthy pulse.

The pulse in summer is like a hook because the heart corresponds to Fire in the South. Summer corresponds to the South, the heavenly stems Bing and Ding, and Heart Fire; therefore, the summer pulse has a hook-like quality.

When all things grow lush and flourishing, their branches droop and their leaves spread out, bending downward like hooks.

Summer is the season when all things grow and flourish.

The pulse of summer is called the “hook pulse,” corresponding to the south, Bing and Ding, the heart, and Fire. The summer pulse should be even and harmonious.

In summer, all things grow and thrive. Branches and leaves become dense, and flowers and leaves spread outward, taking shapes like curved hooks.

Thus, the pulse comes quickly and recedes slowly, which is why it is called a “hook.” Its quick arrival indicates flourishing Yang Qi, with a faster pulse at the cun position. Its slow retreat indicates somewhat deficient Yin Qi, with a slower pulse at the chi position. To say that the pulse comes quickly also describes it as broad and forceful. A pulse that comes quickly, recedes slowly, and is slightly broad and forceful shows that Stomach Qi remains in the pulse—the fundamental Qi that gives the pulse calmness and vitality.

The pulse of autumn is called the “hair pulse,” corresponding to the west, Geng and Xin, the lungs, and Metal.

In autumn, all things move toward their end. The flowers and leaves of grasses and trees fall away, leaving only the branches, like fine hairs.

Autumn is the season when all things are subdued and cut down. The flowers and leaves of grasses and trees wither and fall, leaving only the stems, sparse as fine hairs.

Thus, the autumn pulse is light, floating, and weak when it arrives, which is why it is called “hair.” Lung Qi floats upward and governs the body hair, so the lung pulse rises and resembles hair.

The pulse of winter is called the “stone pulse,” corresponding to the north, Ren and Gui, the kidneys, and Water.

In winter, all things withdraw and lie dormant.

In the depths of winter, the weather is cold, the earth freezes, and water congeals; frozen water becomes like stone.

Thus, the winter pulse is deep, soft, and slippery when it arrives, which is why it is called “stone.” A deep pulse is normal for winter. Deep, soft, and slippery means that it sinks only slightly, showing that Stomach Qi remains in the pulse.

The above describes the pulses of the four seasons.

“What should one do when the pulse changes?”

“How should one judge a pulse that differs from its usual state?”

Answer: In spring, the pulse should be wiry—straight and long as it arrives, like a finger pressed against a string. A pulse that differs from the normal spring pulse is a diseased pulse. What counts as a difference? In spring, one should normally find a wiry pulse; this refers to the fact that each of the four seasons has its corresponding pulse.

In spring, one should normally find a wiry pulse. If the pulse differs from this, there may be a liver disorder. How can an abnormal pulse be recognized?

Answer: When the pulse Qi (vital energy) arrives full and forceful, excessively strong, this is called “excess”; the disease is on the body’s exterior. Spring is the season when the Qi of Lesser Yang is in command. The normal pulse should be slightly wiry and also have Stomach Qi—a calm, gentle pulse indicating that the Qi of the spleen and stomach is still present. If the pulse Qi now arrives full and forceful, it is excessive, showing that Yang Qi is too strong and that the disease is on the exterior. Possible signs include being fastidious about cleanliness, a bluish complexion, and a tendency to anger.

When the pulse Qi arrives weak and faint, this is called “insufficiency”; the disease is within the body. The Qi of Jueyin corresponds to the sinews, and the pulse should be wiry. Since the pulse Qi is now weak and faint, it is called insufficient. Yin governs the interior, so the disease is located within. Possible signs include distension and fullness in the limbs, obstruction and pain, difficulty passing stool, and spasms of the sinews and vessels.

When the pulse Qi arrives soft and gentle, like a finger brushing across an elm leaf, this is a normal pulse. In spring, the Qi of Lesser Yang and Jueyin come together, and the pulse should be as soft and harmonious as leaves stirred by the spring breeze. This is a normal pulse. A calm, balanced pulse is also said to have Stomach Qi.

A pulse that is fuller and more slippery than usual, like touching a long pole, is a diseased pulse. “Full and slippery” means that the wiry pulse is too strong; “like a long pole” means that its shape is long and straight, without softness. It is still a wiry pulse, but it lacks Stomach Qi and is therefore considered diseased.

A pulse that arrives rapid, rigid, and even more forceful, like a bowstring newly drawn taut, is a death pulse. It is urgent, tense, straight, and powerful, like a newly strung bow. Because it is only taut, rapid, and rigid, without the gentle ease of Stomach Qi, it is regarded as a death pulse.

In spring, a pulse that is slightly wiry is called a normal pulse.

When the pulse is slightly taut, it means that a faint taut quality is present in the pulse. It does not mean that the pulse is weak and also tightly taut. In a slightly taut pulse, one part is Stomach Qi and two parts are taut Qi. When both qualities appear together, the pulse is called slightly taut.

When taut Qi is relatively abundant and Stomach Qi relatively scarce, this indicates illness.

If the pulse is not merely slightly taut but distinctly taut, it indicates that Stomach Qi is insufficient, and illness arises from this.

When the pulse shows only a taut quality, with no Stomach Qi at all, it is called a “true-organ pulse” (a critical pulse in which the organs’ own Qi appears alone and Stomach Qi has been exhausted) and foretells death.

If all three parts of the pulse are taut Qi, with no Stomach Qi, this is the appearance of a “true-organ pulse,” and it too foretells death.

In spring, the pulse should have Stomach Qi as its foundation.

The pulse Qi of the Five Zang organs must all be harmonized by Stomach Qi and must not appear on its own. This is like something rigid, which cannot be used alone: hardness by itself makes it easy to break, while hardness and softness together make it strong. The Stomach is where food and drink gather. People obtain Qi from what they eat; after food enters the Stomach, it is conveyed to the Zang-Fu organs. Thus the Liver pulse has Stomach Qi as its foundation, and the same applies to the other four organs.

In summer, the pulse should be like a hook (flourishing as it arrives and weakening as it recedes, with a rise and fall in its force). A pulse that is contrary to this indicates illness. What does “contrary” mean?

In summer, the Heart pulse should have the quality of a hook. If it is contrary to this, the Heart is diseased. What does “contrary” mean?

Answer: When the pulse Qi arrives full and forceful, this is called excess, and the illness is on the exterior.

A pulse that is floating, large, and dissipated is the expected Heart pulse. If instead it is full and forceful, this is excess. Signs visible on the exterior may include a reddened complexion, dry mouth, and a tendency to laugh.

When the pulse Qi arrives weak and faint, this is called insufficiency, and the illness is within.

The Heart pulse should be vigorous in summer. If instead it is weak and faint, this is insufficiency, and the illness is within. Symptoms may include distress in the Heart, Heart pain, and heat in the palms. In severe cases, death may be a risk.

A pulse that comes in successive waves, rising and falling in a circular rhythm, like a finger moving over rounded beads of langgan (a jade-like stone), is called a normal pulse.

When the pulse feels full and strong, with a slight roundness and smoothness like a bead beneath the fingers, the Heart pulse is in harmony.

A pulse that gradually quickens, moving rapidly like a parrot lifting its feet as it walks, is called a pathological pulse.

The Heart pulse should generally be floating and scattered, but not too rapid. Now the pulse is so fast that it is like a hawk stepping swiftly along; this is why it is said that the Heart is diseased.

The pulse bends and lacks strength in its forward section, while its rear section is rigid and motionless, like a hand gripping a belt hook. This pulse indicates death. “Bending in front” means that the forward section of the pulse is curved and weak; “fixed behind” means that the rear section is raised, hard, and rigid. “Gripping” means holding, as though clutching the hook on a belt.

In summer, a pulse with a slight hook-like quality is a balanced pulse (a normal pulse). The summer pulse shows a little of this hook-like quality, but it is not purely hook-shaped: it also has Stomach Qi (the pulse’s calm, vital quality). That is why it is called a balanced pulse.

A pronounced hook-like quality with little Stomach Qi is a diseased pulse. The pulse is not sufficiently gentle, and its hook-like quality is too marked, indicating that Stomach Qi is insufficient. If the pulse is entirely hook-shaped, with no Stomach Qi at all, it is a death pulse. When all three pulse positions are hook-shaped and lack Stomach Qi, this shows that the true-organ pulse (a critical pulse in which the organs’ own Qi is exposed, without the harmonizing influence of Stomach Qi) has appeared, foretelling death.

In summer, the pulse is rooted in Stomach Qi. The ordinary Qi of a healthy person is generated by the Stomach, as it is in spring.

The pulse in autumn should be light and floating, like fur. A pulse that departs from this is diseased. What counts as a departure? The autumn pulse should be light and floating; if instead it takes on the Heart pulse’s hook-like quality and lacks Stomach Qi, the Heart is diseased. If the true-organ pulse appears, it foretells death.

When the pulse Qi arrives full and forceful, this is called excess, and the disease is in the body’s exterior. The autumn pulse should be light and floating, but if it is instead full and forceful, it is excessive. External signs may include a pale complexion, frequent sneezing, sadness and sorrow, low spirits, and a desire to weep.

When the pulse Qi arrives weak and faint, this is called insufficiency, and the disease is in the body’s interior. The Lung pulse should be light, empty, and floating. If pressing down makes it even weaker and fainter, this indicates a lack of Stomach Qi. Related symptoms include panting, coughing, aversion to cold, and shivering.

A pulse that is light, floating, and expansive, like a carriage canopy, and that feels even broader when pressed down, is a balanced pulse. A carriage canopy is the cover over the top of a small carriage. A pulse like this canopy is light, floating, and expansive; if it feels broader still when pressed down, that indicates Stomach Qi, so it is a normal pulse.

A pulse that is neither floating nor sinking, and feels as though it slides along the feathers of a parrot, is a diseased pulse.

The Lungs belong to Metal, and Lung Qi tends toward Yin, so its pulse should normally be deep. In summer, residual heat remains and affects Lung Metal, causing the pulse to float upward. But when it neither rises nor sinks, and feels rough and sluggish, like a hand passing over a hawk’s feathers, this is called a diseased pulse.

When pressed, the pulse feels scattered and empty, like hair stirred by the wind. Hair blown by the wind drifts about without settling anywhere. In this case, when the pulse is felt, the Qi seems to disperse: only the floating, hairlike quality remains, with no Stomach Qi—the fundamental Qi that sustains the pulse and life. This is called a death pulse.

In autumn, a fine pulse with a downy quality is called a normal pulse. Though faint, it only slightly resembles a downy pulse. One part of it is Stomach Qi, and two parts are downy Qi; both can be discerned in the pulse.

When the downy quality is pronounced and Stomach Qi is diminished, this is called a diseased pulse. Here, the pulse does not merely faintly resemble down; downy Qi is excessive and Stomach Qi insufficient, indicating illness.

When the pulse contains only downy Qi and no Stomach Qi, it is called a death pulse. All three parts of the pulse’s Qi consist of downy Qi, with no Stomach Qi at all. This means the true Qi of the Five Viscera—the pulse Qi inherent to the organs—has become exposed, foretelling death.

In autumn, Stomach Qi is the foundation of the pulse. All Five Viscera receive Qi from the Stomach, which is their root. The Qi of the Five Viscera cannot reach the Hand Taiyin on its own; it must rely on Stomach Qi to arrive there. Here, Hand Taiyin refers to the Lung channel at the cun-kou pulse position. If Stomach Qi does not arrive there along with it, only the organs’ inherent true Qi appears in the pulse. When true Qi is exposed on its own, it shows that pathogenic influence has overwhelmed the Qi of the organs; this is therefore called a death pulse.

In winter, the pulse should be deep and firm, like a stone sinking in water. A pulse that differs from this is called contrary. A contrary pulse is one that appears in some other form when the winter pulse should be deeply hidden, indicating disease of the Kidneys.

When the pulse Qi arrives forcefully and feels full and hard, it is called excessive, and the disease lies in the body’s exterior. The winter pulse should be deeply hidden and gentle, but here it is instead full and hard; this is excess. Outwardly, the person’s face appears dark, they are easily frightened, and they yawn often.

When the pulse Qi arrives weakly and faintly, it is called insufficient, and the disease lies within the body.

In winter, the pulse should be deep and rough. Here it is instead weak and faint, indicating that the Qi of the pulse is insufficient. The corresponding symptoms include rebellious Qi, pain and cramping in the lower abdomen, diarrhea accompanied by tenesmus, and coldness in the foot meridians with disordered Qi movement.

When the upper part of the pulse is large and the lower part tapers to a fine point, and the pulse is gentle and smooth, it resembles a sparrow’s beak. This is a normal pulse.

“Pecking sparrow’s beak” means that the root of the pulse is relatively large and gradually narrows as it advances. The large upper part shows that the pulse Qi of the Foot Taiyang responds to the touch and feels pronounced. The fine lower part means that when examining the Foot Shaoyin, the pulse is smaller. Yin and Yang are each in their proper place, showing that stomach Qi is sufficient; this is therefore a normal pulse.

The pulse comes continuously, like a bird pecking; there is a slight curve within it. This is a pathological pulse.

“Pecking, pecking” means that the pulse does not pause, so it is called continuous. The pulse force is somewhat relaxed and slightly curved. This indicates that the Spleen pulse is restraining the Kidney pulse, and therefore signals illness.

The pulse comes like a loosened cord, weak and slack, without a firm root; when it recedes, it is as abrupt as a stone being flung away. This is a death pulse.

When the winter pulse injures Kidney Qi through restraint, this kind of change occurs.

The pulse comes like a loosened cord and recedes like a stone being flung away. This is a death pulse.

“Unraveling cord” describes a pulse that comes loosely and slowly, without a root. It recedes as abruptly as a stone being flung away, so it is judged to be a death pulse.

In winter, a pulse that is faintly deep and firm is normal.

“Faintly firm” means that the pulse seems somewhat deep and firm, but the firmness is not pronounced. One part is stomach Qi and two parts are deep, firm Qi. When both appear together, it is called faintly firm.

When deep, firm Qi predominates and stomach Qi is diminished, this is a pathological pulse.

If the pulse is no longer merely faintly deep and firm, but instead lacks sufficient stomach Qi, it is pathological.

If there is only a deep, firm quality and no stomach Qi at all, this is a death pulse.

If all three parts of the pulse are entirely deep and firm, with no stomach Qi, the true organ pulse has appeared, and death is inevitable.

In winter, stomach Qi is the foundation of the pulse.

This is the same as in spring.

The stomach is where food and drink gather.

The stomach is one chi and five cun in girth, one chi and five cun wide and two chi and six cun long. It curves across the body and can hold three dou and five sheng of food and drink. It usually retains two dou of grain and one dou and five sheng of water.

The stomach governs the reception of the changes of the four seasons, so the pulses of all four seasons take stomach Qi as their foundation.

The pulses of spring, summer, autumn, and winter must all have stomach Qi as their foundation.

These are the pathological pulses brought about by the changes of the four seasons.

In spring, the pulse is mainly wiry, with relatively little Stomach Qi; in summer, it is mainly hook-like, also with relatively little Stomach Qi; in autumn, it is mainly hair-like, with more Stomach Qi; and in winter, it is mainly stone-like, with relatively little Stomach Qi. In all four seasons, Stomach Qi is the foundation of the pulse.

These are the signs of illness brought about by seasonal changes, and they are also crucial for judging life and death. When the Qi of the Five Zang organs is in harmony with Stomach Qi, a person can live. When a pure pulse of the true Zang organs appears, wholly lacking Stomach Qi, death will follow. The key to life and death lies in Stomach Qi.

The Spleen occupies the center of the body, like the central province governing the four directions. When the Spleen meridian is in balance, its pulse Qi is sustained in each of the four seasons, so it is ordinarily difficult to detect on its own. Only when Spleen Qi declines does its pulse become apparent.

When the pulse comes like a sparrow pecking at food, broad at the top and narrow and pointed below, with a soft, slippery feel, it is called the “sparrow-pecking pulse.” In terms of the Five Phases’ generating and overcoming cycles, this is Kidney Water overcoming Spleen Earth, indicating that Spleen Qi is deficient.

When the pulse comes like water dripping from a roof, beating at times and stopping at others, it is called the “leaky-roof pulse.” This occurs when Kidney Qi overwhelms the Spleen, indicating that Spleen disease is pronounced.

The appearance of either the “sparrow-pecking pulse” or the “leaky-roof pulse” is a sign of declining Spleen Qi.

End of Volume Two of The Collected Diagrams and Phrase-by-Phrase Explanations of the Huangdi’s Classic of Eighty-One Difficulties.

The following are textual notes from the classic, recording differences among editions and the editors’ judgments about emendations:

1. The character “gan” was missing from the original text and has been supplied on the basis of Benyu.

2. After “urinary bladder,” Jizhu has an additional character, “xie.”

3. In context, the character “li” seems as though it should be “nai.”

4. The character “wu” appears to have been “wu” in the original.

5. In Benyu, the character “mai” appears as “qi.”

6. The character “fei” appears to be a corruption of “mai.”

7. In light of its use below, the character “xu” seems as though it should be “xue.”

8. After the character “dang,” Jizhu has an additional character, “yu.”

9. The character “shen” seems as though it should be “shen,” meaning “to groan.”

10. In context, the character “ci” seems as though it should be “bi.”

11. In context, the character “huan” seems as though it should be “yu.”

12. The character “pi” seems as though it should be “fei.”

13. Before “ran,” Benyu and Jizhu both have the six characters “How should the method for treating depletion be applied?”

14. The character “shi” seems as though it should be “ling.”

15. The character “qi” seems as though it should be “shi.”

16. The original character “xiao” has been changed to “zhe” in light of the meaning.

17. Before “yi,” Benyu and Jizhu both have these twenty characters: “Six beats with one exhalation and six beats with one inhalation constitute a fatal pulse. If it is deep and fine, death may come at night; if floating and large, death may come by day.” This means that six pulse beats during a single breath indicate a fatal pulse. A deep, fine pulse may signal death at night, while a floating, large pulse may signal death by day.

18. The original character “ye” was “zhe.” It has been corrected on the basis of Benyu and Jizhu.

19. In Jizhu, the character “ru” appears as “mai.”

20. The original character “mai” was “lai.” It has been corrected on the basis of Benyu and Jizhu.

21. The character “mai” seems to have been omitted after “qi.”

22. Following the format above, the character “shu” is missing after “qiu.”

23. The original character “fu” was “fu.” It has been changed to “fu” in light of the meaning.

24. Following the format above, the character “shu” is missing after “dong.”

25. In Lü’s commentary on Difficulty Fifteen in Jizhu, the character “biao” appears as “yang.”

26. In Ding’s commentary on Difficulty Fifteen in Jizhu, the phrase “illness signs: panting, coughing, and chills” appears as “internal signs: panting, coughing, chills, and fever.”

27. After “blowing on a hair,” Benyu and Jizhu both have the two characters “death by day.”

28. In Benyu and Jizhu, the character “yin” appears as “bing.”

29. In light of the meaning, the character “fang” seems as though it should be “xian.”

30. In light of the surrounding text, the character “duo” seems as though it should be “shao.”

The Sixteenth Difficulty asks: Pulse diagnosis involves the three positions, the nine indicators, Yin and Yang, light and heavy pressure, and sixty pulse patterns; pulse patterns also change with the four seasons. The ancient sages are long gone, and different schools use different methods of pulse diagnosis. How should these methods be distinguished?

The “three positions” are the cun, guan, and chi positions. The “nine indicators” are three ways of examining the pulse at each of the upper, middle, and lower positions, making nine in all. At the cun position, the pulse is felt at a depth of nine fen and is floating, belonging to Yang; at the chi position, it is felt at a depth of one cun and is deep, belonging to Yin. Use lighter finger pressure to examine Yang pulses and heavier pressure to examine Yin pulses.

Pulse examination begins with six basic patterns: floating, deep, long, short, slippery, and rough. These are then divided into the pulse patterns of the three Yin and three Yang categories, making sixty patterns in all. Pulse patterns also change with the seasonal climate. The details are discussed in the Tenth Difficulty under “one pulse gives rise to ten changes.” By Yue Ren—traditionally identified as Qin Yueren, who lived during the Spring and Autumn period—the ancient sages had already been gone for a long time. The three positions, nine indicators, Yin and Yang, light and heavy pressure, and sixty pulse patterns each constitute a method of pulse diagnosis. There are many such methods, and they are difficult to distinguish.

How, then, should they be distinguished? Observe the patient’s internal and external signs: examine the spirit, gaze, and complexion, and use palpation to investigate further. This makes it possible to determine whether the condition is internal or external. The final sentence asks: “How, exactly, is this illness to be distinguished?”

When the Liver pulse is detected, it should be taut, gentle, and long.

The outward signs of Liver disease include being unusually fond of cleanliness, a bluish complexion, and a tendency to anger. The Gallbladder is a clear, cool organ, which accounts for the fondness of cleanliness. The Liver corresponds to the color green-blue, so the complexion becomes bluish. The Gallbladder governs decision-making, while the Liver corresponds to anger in the emotions; hence the tendency to anger.

The inward signs of Liver disease include a throbbing sensation to the left of the navel, with hardness and pain when pressed. The accumulation disorder of the Liver, called “Fat Qi,” lies to the left of the navel and feels hard and painful to the touch.

The limbs may also feel distended, tight, and uncomfortable. The Liver belongs to Wood, the Spleen to Earth, and the Spleen governs the limbs. When Liver disease affects Spleen Earth, the limbs become distended and uncomfortable. There may also be pain in the genital region and difficulty urinating, because the Liver channel passes through the genital region. Bowel movements may be difficult because the Liver and Kidneys are located in the lower body; when Liver disease causes Qi to rebel, it cannot descend smoothly. There may also be cramping and spasms of the sinews, because the Liver stores Blood to nourish them, and disease of the Liver deprives them of nourishment.

These signs indicate a pattern of Liver disease. Without them, the pattern is not present.

When the Heart pulse is detected, it should be floating, large, and scattered.

The outward signs of Heart disease include a red complexion and a dry mouth. The Heart belongs to Fire and corresponds to the color red, so the complexion becomes red. The Heart channel connects to the area beneath the tongue; when the Heart is troubled by pathogenic heat, the mouth becomes dry and lacks fluids. There may also be a tendency to laugh.

In the five sounds, the heart corresponds to laughter.

An internal sign of the heart is a throbbing sensation above the navel, with hardness or pain when pressed.

A heart accumulation, a disorder involving a mass associated with the heart, is called Fuliang. It lies above the navel and feels hard and painful to the touch.

This condition may cause restlessness and heart pain, heat in the palms, and discomfort in the throat.

The heart governs the five Zang organs. It can sense when any of the other four are diseased, so symptoms such as pain may also arise. How much more so when the heart itself is ill? Persistent pain in the heart region usually indicates a disorder of the pericardial vessel, the channel connected with the pericardium. The heart itself is not invaded by pathogenic Qi; when it is diseased, the condition is often extremely serious. Even when the disorder lies in the pericardium, the palms may become hot and the heart feel oppressed and restless. The pericardial vessel is the Hand Jueyin vessel, or Hand Jueyin Pericardium channel. It begins at the tip of the middle finger and descends into the palm. The point located by bending the ring finger is called Laogong.

When these symptoms are present, they belong to the heart pattern; without them, it is not a heart pattern.

Suppose the pulse of the spleen is found. Its quality is relaxed and broad.

An outward sign of the spleen is a yellow complexion, since yellow corresponds to the spleen.

Frequent belching is a sign that the spleen Qi is out of harmony.

When these symptoms are present, they belong to the spleen pattern; without them, it is not a spleen pattern.

Suppose the spleen pulse is found: it is relaxed and broad. The outward signs are a yellow complexion, frequent belching, and a persistent sweet taste in the mouth. This is because the spleen governs sweetness, and sweetness also corresponds to the sense of taste.

An internal sign of the spleen is a throbbing sensation at the navel, with hardness or pain when pressed.

A spleen accumulation, a disorder involving a mass associated with the spleen, is called Piqi. It lies at the center of the navel and feels hard and painful to the touch.

This condition may cause abdominal fullness and difficulty digesting food. An excess of dampness causes abdominal fullness; when Yang Qi stagnates below, food also becomes difficult to digest.

The body may also feel heavy, the joints may ache, the spirit may be weary, and there may be fatigue and a tendency to sleep. The limbs may move with difficulty.

When these symptoms are present, they belong to the spleen pattern; without them, it is not a spleen pattern.

If these signs are absent, it is not a Spleen pattern. If the pulse is diagnosed as a Spleen pulse, the outward signs are weakness in the limbs and an inability to hold or grasp. When these signs appear, it is a Spleen pattern; if they are absent, it is not a Spleen pattern.

If the pulse is diagnosed as a Lung pulse, it is floating, interrupted, and short. The outward signs are a pale complexion, since white corresponds to the Lung; frequent sneezing, since the nose is the passage through which clear Qi is breathed and corresponds to the Lung, and the nose tends to itch and sneeze when the Lung is affected by wind and cold; and a sorrowful, worried, depressed mood, since sorrow is the emotion associated with the Lung. The person may also feel like crying. When crying is accompanied by sound, it is called weeping.

The internal sign is a movement of Qi to the right of the navel. It feels firm when pressed, as if painful. The Lung accumulation is called “Xi Ben” (“Restless Panting”); it lies to the right of the navel and feels hard and painful to the touch. Lung illness may also bring panting and coughing. The Lung is like a canopy covering the five viscera and favors coolness. When it is affected by wind and cold, the airways become obstructed, causing panting and coughing. The person may also feel chilled, with alternating periods of cold and heat: when the Lung is deficient, they tend to feel cold; when it is replete, they tend to develop a fever. Pressing the affected area may also reveal hardness and pain. When these signs appear, it is a Lung pattern; if they are absent, it is not a Lung pattern.

If the pulse is diagnosed as a Kidney pulse, it is deep, short, and forceful. The outward signs are a dark complexion, since black corresponds to the Kidney, and a tendency toward fear, since fear is the emotion associated with the Kidney. The person may also yawn; yawning can also occur when the Greater Yang (Taiyang) channel is weak.

The internal sign is a movement of Qi below the navel. It feels firm when pressed, as if painful. The Kidney accumulation is called “Ben Tun” (“Running Piglet”); it lies below the navel and feels hard and painful to the touch. Kidney illness may also cause Qi to surge upward.

When Kidney Qi is deficient, it damages the Chong vessel, an important channel associated with the Kidney meridian, causing Qi to rebel upward.

There is urgent, severe pain in the lower abdomen. The Foot Shaoyin Kidney meridian passes through the lower abdomen and meets the Foot Jueyin Liver meridian and the Foot Taiyin Spleen meridian below the navel. Since the Kidney is diseased, the lower abdomen hurts.

Diarrhea and tenesmus may also occur. This refers to a kind of diarrhea accompanied by cramping in the abdomen, a heavy, drooping sensation at the anus during bowel movements, and frequent urges to go to the toilet without being able to pass stool. There may also be pain in the penis.

The channels in the feet become cold, and Qi becomes disordered and rebels. Five cun above the inner ankle is a site where the artery of the Foot Shaoyin Kidney meridian can be felt. When the Kidney is diseased, the channels in the feet become cold and Qi rebels.

These symptoms indicate a pattern of Kidney disease; without them, it is not a Kidney disease pattern.

The Seventeenth Difficulty says:

The scriptures say that some illnesses lead to death, some recover without treatment, and some remain uncured for many years. Can a person’s survival or death be determined by feeling the pulse?

Answer: It can be assessed in full from the pulse.

When examining an illness, if the patient keeps their eyes closed and does not wish to see anyone, this indicates Liver disease. The pulse should show the characteristics of the Liver pulse: wiry and long. A normal Liver pulse is wiry, gentle, and long; if instead it is forceful and tight, this indicates an abnormality.

If, at that point, the pulse felt is instead a Lung pulse—floating, short, and choppy—this is a dangerous sign, and the patient may die.

When the Liver is diseased, if the pulse instead shows the floating, short, and rough qualities of a Lung pulse, this is a sign of impending death. The Liver belongs to Wood and the Lung to Metal; Metal overcomes Wood. A Lung pulse appearing in Liver disease means that the “true demon”—the pathogenic force that overcomes and harms the affected organ—has taken advantage of its weakness and arrived. Death is therefore certain.

If the patient’s eyes are open, they are thirsty, and the area below the heart is hard and tense, the pulse should be tight and rapid. This is the pulse associated with Heart disease. If instead the pulse is deep, soft, and faint, the patient will die. The Heart belongs to Fire and the Kidneys to Water. This pulse belongs to the Kidneys, and Water overcomes Fire. An illness showing Yang signs accompanied by a Yin pulse is therefore a fatal sign.

If the patient vomits blood and also bleeds from the nose, or has clear nasal discharge, these are all signs of Lung disease. Blood belongs to Yin, so the pulse should be deep and fine, in keeping with the condition. If instead it is floating, large, and firm, this is a fatal sign. It is not a Lung pulse but a Heart pulse. The condition and the pulse are at odds, and Fire overcomes Metal, making the situation dangerous.

If the patient speaks deliriously, their words are confused and unclear; if they speak irrationally, their speech is disordered and incoherent. When Heart disease disturbs the spirit, the body should be hot and the pulse forceful and large, in keeping with the condition. If the hands and feet are cold and the pulse is instead deep, fine, and weak, this is a fatal sign. The body should be hot and the pulse forceful and large, yet signs of Yin and cold appear: the condition and the pulse are at odds.

If the patient’s abdomen is distended and they have diarrhea, this is caused by excessive Dampness and the Spleen’s inability to contain it. The pulse should be faint, fine, and rough, in keeping with Spleen disease. If instead it is tight, large, and slippery, this is a fatal sign.

The spleen pulse is absent. Instead, the liver pulse is tight, forceful, and slippery. The liver belongs to Wood, and the spleen to Earth; Wood overcomes Earth. Since the pulse does not correspond to the spleen’s illness but instead shows Liver Qi attacking Spleen Earth, the prognosis is dangerous.

The Eighteenth Difficulty says: “The pulse has three positions.”

The Cun, Guan, and Chi are the three positions at which the pulse is examined.

Each position involves four channels.

The Cun, Guan, and Chi each have a left and right side, making six sites in all. Each site corresponds to two channels, giving twelve channels. The statement that “each position has four channels” refers to the channels’ arrangement in upper and lower pairs. The Hand Taiyang and Hand Shaoyin, and the Foot Taiyang and Foot Shaoyin, form two pairs that each express the nature of Water and Fire. Each pair follows its own governing pattern and cannot generate and communicate between upper and lower in the way the other channels do. The remaining eight channels, by contrast, have relationships of generation between the hands and feet. That is why each position is said to have four channels.

Hand Taiyin is the Lung channel, and Hand Yangming is the Large Intestine channel. Foot Taiyang is the Bladder channel, and Foot Shaoyin is the Kidney channel. The Lung belongs to the upper region, and the Kidney to the lower. Why are they divided this way? Hand Taiyin and Hand Yangming both belong to Metal and are associated with the Lung and Large Intestine, respectively. Foot Shaoyin and Foot Taiyang both belong to Water and are associated with the Kidney and Bladder, respectively. Metal generates Water: Lung Metal is above, while the Kidney Water it generates is below. Water naturally flows downward and cannot rise upward on its own, so it is assigned to the lower region.

Foot Jueyin is the Liver channel, and Foot Shaoyang is the Gallbladder channel; both belong to Wood. Wood, in turn, generates the Fire represented by Hand Taiyang and Hand Shaoyin.

The heart and small intestine belong to Fire. Liver Wood can generate Fire, so Liver Wood is their mother.

Fire rises upward and cannot flow downward, so the pulse positions of the heart and small intestine belong to the upper region.

Fire rises upward and cannot nourish the feet. Instead, it generates the Fire of the Heart Governor and Shaoyang in the hands—that is, ministerial Fire in the right Chi position—so these two channels belong to the upper region. The heart is sovereign Fire, while the fires of the pericardium and Triple Burner are ministerial Fire. The two channels referred to here are the pericardium and the Triple Burner.

Ministerial Fire can, in turn, nourish the Earth of Foot Taiyin and Foot Yangming. Foot Taiyin is the spleen, and Foot Yangming is the stomach. The spleen and stomach belong to Earth, and ministerial Fire can generate Earth, so their pulse positions are in the middle region. Earth occupies the center and is therefore also called the Earth that governs the central palace.

These are all relationships of mutual generation and nourishment between child and mother among the Five Phases: Metal at the right Cun generates Water at the left Chi; Water generates Wood at the left Guan; Wood generates sovereign Fire at the left Cun; sovereign Fire generates ministerial Fire at the right Chi; and ministerial Fire then generates Earth at the right Guan. This is why the process is called the mutual generation of child and mother.

The pulse is divided into three regions and nine indicators. Which parts of the zang-fu organs do they each correspond to?

The three regions are the Cun, Guan, and Chi positions: the Cun opening belongs to Yang, the Guan position lies at the boundary between Yin and Yang, and the Chi position belongs to Yin. The nine indicators are the three pulse-taking depths: floating, middle, and deep. Each of the three positions—Cun, Guan, and Chi—is examined at all three depths, making nine in total; hence they are called the nine indicators. A floating pulse belongs to Yang and corresponds to the fu organs; a deep pulse belongs to Yin and corresponds to the zang organs; the middle depth corresponds to stomach Qi—that is, the pulse of the middle burner.

The upper region takes its model from Heaven and is used to assess illnesses from the chest upward to the head. The Cun openings on both hands belong to the upper region, taking their image from Heaven above: the outer side of the Cun position corresponds to the head, and the inner side to the chest.

The middle region takes its model from humanity and is used to assess illnesses below the diaphragm and above the navel.

The cun pulse at both wrists belongs to the upper region, which takes its model from Heaven above. On the outer side, the cun pulse corresponds to the head; on the inner side, it corresponds to the chest.

The middle region takes its model from humanity and reflects illnesses below the diaphragm and above the navel. It is where the guan pulses of both hands are located. Using half the width of the second finger as the dividing point, the section toward the fingertips corresponds to the area below the diaphragm, while the section toward the wrist corresponds to the area above the navel.

The lower region takes its model from Earth and reflects illnesses from below the navel down to the feet. It is where the chi pulses of both hands are located. Using half the width of the third finger as the dividing point, the section toward the fingertips corresponds to the area below the navel, while the section toward the wrist corresponds to the feet.

When examining the pulse, proceed from head to foot, distinguishing the upper, middle, and lower regions.

Question: Can a longstanding illness caused by an accumulation that has not dispersed be detected by feeling the pulse?

Answer: On examination, if there is an accumulation of Qi in the right flank, the pulse in the Lung region will show a knotted quality. A knotted pulse comes with pauses and indicates a mass. The Lung corresponds to the right side, so a knotted, rough pulse in the Lung region indicates an accumulation of Qi in the right flank. The more pronounced the knotted quality, the more severe the accumulation; if it is slight, the accumulation is also mild.

Question: If no knotted quality is detected in the Lung pulse, but there is an accumulation of Qi in the right flank, why is that?

Answer: Even if the Lung pulse does not show a pronounced knotted quality, the pulse in the right hand should still be deep and hidden. A deep, hidden pulse lies far beneath the surface and is not readily apparent; it indicates stagnation within the internal organs. A floating, knotted pulse, by contrast, indicates a gathering caused by illness of the bowels.

Question: Is the method of diagnosis the same when these accumulations cause pain on the outside, or is it different?

Question: When someone has an illness such as a hard lump on the body’s surface, should it be examined together with Qi accumulation in the right flank? Is the method of diagnosis different?

Answer: There are two kinds of pulse: “knotted” and “hidden.” If the pulse repeatedly pauses as it comes and goes, with no regular interval between pauses, it is called a “knotted pulse.” A knotted pulse is slow, pauses from time to time, and has no regular pattern to its pauses.

A “hidden pulse” runs beneath the tendons. When taking the pulse, it lies deep under the tendons; only very firm pressure, down to the bone, can detect it.

A “floating pulse” runs at the surface of the muscles. It floats over the muscles and is hard to feel with light pressure; lifting the finger slightly makes it easier to detect.

The methods for examining the left and right sides, and the exterior and interior, are the same. Here, “left and right” refers to the flanks. Examining the exterior reveals the condition of the Fu organs; examining the interior reveals the condition of the Zang organs. The methods follow the principles described above.

If the pulse is both knotted and hidden, but there is no internal accumulation, the hidden pulse should indicate an interior disorder. If the pulse has these qualities but no accumulation can be found, then the pulse does not correspond to the illness; according to the text, this is a fatal condition.

If the pulse is both floating and knotted, but there is no corresponding surface disorder, the floating pulse should indicate an exterior disorder. If the pulse has these qualities but there is no illness such as a hard lump, this too is a mismatch between pulse and illness and, according to the text, a fatal condition.

Conversely, if there is an illness involving accumulation but no knotted, hidden pulse, or a hard lump but no floating, knotted pulse, the pulse and illness likewise do not correspond. The text holds that when the pulse does not match the illness, or the illness does not match the pulse, the condition is fatal.

The pulse should correspond to the patient’s condition. If the two do not correspond, life may be in danger.

The Nineteenth Difficulty in the Classic of Difficulties says:

The classics speak of pulse patterns as either contrary or harmonious. Men and women, too, each have pulse patterns that are normal or abnormal in their own way. The saying “Yang embracing Yin gives birth, and Yin embracing Yang gives birth” means that a person can be born only when Yin and Yang come together.

Men and women each have characteristic pulse patterns, but sometimes the pulse runs contrary to what is normal. Why is this?

A man is born in the month of Yin. Yin corresponds to Wood, and Wood is Yang. According to the ancient method of using the twelve earthly branches to calculate conception and birth, a boy’s progression begins at the Zi position and moves to the left. After ten months, it reaches the Yin position, so he is born in the month of Yin. Yin corresponds to the eastern Wood of Jia and Yi, whose nature is Yang.

A woman is born in the month of Shen. Shen corresponds to Metal, and Metal is Yin. By the same method, a girl’s progression begins at the Zi position and moves to the right. After ten months, it reaches the Shen position, so she is born in the month of Shen. Shen corresponds to the western Metal of Geng and Xin, whose nature is Yin.

Therefore, a man’s pulse is usually stronger above the bar position. The area above the bar is the cun region, on the Yang side. According to this theory of Yin and Yang, a man’s Yang qi is stronger, so the pulse in the cun region is usually more forceful.

A woman’s pulse is usually stronger below the bar position. The area below the bar is the chi region, on the Yin side. A woman’s Yin qi is stronger, so the pulse in the chi region is usually more forceful.

For this reason, a man’s chi pulse is usually weaker.

A man’s qi begins with Lesser Yang and gradually reaches Greater Yang. When Lesser Yang qi first arrives, the pulse alternates between large and small, short and long. This corresponds to the Return hexagram in the Classic of Changes, indicating that the qi of the first Yang is in the chi region. When Bright Yang qi arrives, the pulse is floating and large, and somewhat short. This corresponds to the Approach hexagram, indicating that the qi of the second Yang is in the bar region. When Greater Yang qi arrives, the pulse is forceful, large, and long. This corresponds to the Peace hexagram, indicating that the qi of the third Yang is in the cun region. The qi of the three Yang grows upward from below. Thus, a man’s pulse is stronger in the cun region and weaker in the chi region.

A woman’s chi pulse is usually stronger.

In women, the Qi of the meridians begins with Greater Yin (Taiyin) and develops to its peak at Terminal Yin (Jueyin). When Greater Yin Qi arrives, the pulse is tight, large, and long, corresponding to the Gou hexagram in the Yijing, which signifies one Yin line at the cun position. When Lesser Yin Qi arrives, the pulse is tight, fine, and faint, corresponding to the Dun hexagram, which signifies two Yin lines at the guan position. When Terminal Yin Qi arrives, the pulse is deep, short, and forceful, corresponding to the Pi hexagram, which signifies three Yin lines at the chi position. Women’s pulses are therefore generally deeper at the cun position and more abundant at the chi position.

Here, hexagrams from the Yijing are used to illustrate changes in the Yin and Yang of the pulse Qi. Cun, guan, and chi are the three diagnostic positions of the cun-mouth pulse, corresponding to different locations of the pulse at the wrist. Gou, Dun, and Pi serve as metaphors for the gradual growth of Yin Qi.

“Reversal” refers to a man having a pulse commonly found in women, or a woman having a pulse commonly found in men. What illnesses do these pulse patterns indicate?

A man’s pulse at the chi position is usually weaker, but now it is strong; a woman’s pulse at the chi position is usually more abundant, but now it is weak. What illness might these reversed pulse patterns indicate?

When a man has a woman’s pulse pattern, it indicates insufficiency of Yang Qi and an illness located internally. The cun-mouth pulse belongs to Yang, and men are governed primarily by Yang Qi. Now the corresponding Yang pulse cannot be detected at the cun position; instead, the pulse appears at the chi position. An abundant pulse at the chi position is normally common in women. When a man has the same pattern, it indicates insufficiency of Yang Qi. Yin governs the interior, so the illness is internal.

If this pulse pattern is detected in the left hand, the illness is on the left side of the body; if detected in the right hand, the illness is on the right side. The location of the illness is judged here from the side on which the pulse pattern appears.

When a woman has a man’s pulse pattern, it indicates that the pulse is excessive. A woman’s pulse at the chi position is normally relatively floating; when the pulse now also appears at the cun position, it is called excessive.