《黃帝內經素問補註釋文》Vol. 14

The Yellow Emperor asked: What should the pulse of a healthy person normally be like?

Qi Bo replied: When a person exhales, the pulse beats twice; when they inhale, it also beats twice. During the brief pause between breaths, the pulse beats once more, making five beats in all. This is called the pulse of a “normal person”—that is, someone without illness.

The body’s channels complete one circuit over a total distance of sixteen zhang and two chi. As the person exhales and inhales, the pulse beats twice each time, then once during the pause between breaths, making five beats per breath in all. Over 270 breaths, Qi makes one circuit; over 13,500 breaths, it travels a total of 810 zhang. In this way, the movement of Qi accords with the regular patterns of Heaven and Earth: it is neither deficient nor excessive, and the pulse is harmonious. This is why the person is called normal.

The steady breathing of a healthy person is commonly used as a measure for assessing a patient’s breathing; this is a method of diagnosis. A physician who is free of illness should use their own steady breathing as the standard for judging a patient’s condition. If a person’s pulse beats only once during each breath—once on exhalation and once on inhalation—this is called “insufficient Qi,” or Qi deficiency.

When the pulse beats once on exhalation and once on inhalation, its rate is about half that of a normal person. Over 270 breaths, Qi travels eight zhang and one chi; over 13,500 breaths, it travels a total of 405 zhang. This shows the basis for understanding insufficient Qi.

If the pulse beats three times during exhalation and three times during inhalation, and the pulse at the chi position is hot and agitated, this indicates a warm disease. If the chi position is not hot but the pulse is smooth and flowing, this indicates a wind disease. If the pulse is rough and sluggish, this indicates a bi disorder, caused by obstructed movement of Qi and blood.

When the pulse beats three times on exhalation and three times on inhalation, its rate is about half again as fast as that of a normal person. Over 270 breaths, Qi travels a total of 24 zhang and three chi, revealing signs of illness. The chi position is where Yin is examined, and the cun position is where Yang is examined. If both positions are hot, this is a warm disease; if only the Yang aspect is agitated and excessive, then wind pathogen has invaded the Yang aspect. The Treatise on the Essential Subtleties of the Pulse says, “In windstroke, Yang Qi is affected.” A smooth, flowing pulse indicates an excess of Yang Qi, and is therefore associated with wind disease; a rough, sluggish pulse indicates that the flow of blood is obstructed, and is therefore associated with bi disorder.

Textual note: The New Collation points out that the phrase “A rough pulse indicates bi” in the Jia Yi Jing is repeated in the following passage.

If the pulse beats more than four times during one exhalation, it is called a “death pulse.” If the pulse ceases entirely and cannot be felt at all, that too portends death. A pulse that suddenly becomes sparse and then suddenly rapid is likewise a sign of impending death.

If the pulse beats four times during each inhalation and exhalation, it is already twice as fast as in a healthy person. By this reckoning, in 270 breaths, Qi circulates for thirty-two zhang and four chi. If the pulse is faster still, the condition is even more dangerous. The Pulse Methods says that four beats during each breath are called “Jing depletion” (the dispersal of essence and Qi), while five beats are called “death.” Four beats or more approaches five, and so also carries a risk of death. A pulse that ceases shows that the primordial Qi that sustains life has been exhausted. A pulse that alternates between fast and slow shows that the essence of grain and food (the vital essence produced from nourishment) has also declined. These are all signs of impending death. The New Corrected Edition notes that another version has “waned” in place of “these.”

A healthy person’s normal Qi comes from the stomach; the stomach is the foundation that sustains normal breathing. The Inner Classic of the Yellow Emperor: The Spiritual Pivot says that the stomach is the sea of water and grain. The Treatise on Correct Principles says that the pulse channels can circulate only after food enters the stomach. When a person lacks Stomach Qi, this is called “counterflow.” “Counterflow” means that the pulse differs from the signs found in healthy people, and this condition leads to death. The New Corrected Edition quotes the Classic of Acupuncture and Moxibustion, A and B: people ordinarily receive Stomach Qi, and the pulse takes Stomach Qi as its foundation. Lacking Stomach Qi is called “counterflow,” and counterflow leads to death.

In spring, a pulse that carries Stomach Qi and shows a slight stringlike quality is normal. This means that the pulse is only somewhat like a string, not distinctly so. The same applies to the hooked, soft and weak, floating, and sunken, firm qualities discussed below.

A predominance of the stringlike quality and a scarcity of Stomach Qi indicate liver disease. A stringlike quality without any Stomach Qi is a sign of impending death. Here, “stringlike” describes a pulse that is taut and forceful, like a drawn bowstring. If the pulse has Stomach Qi but also carries a floating quality (a light, superficial pulse commonly seen in autumn), it suggests that illness may arise in autumn. A pronounced floating quality indicates that illness is present now. This is because Wood is overcome by the harmful influence of Metal. The phrase “the true Qi of the storehouse disperses in the liver” means that true Qi spreads through and is stored in the liver, which stores the Qi of the sinews and membranes. This is like Yang Qi dispersing outward. The Treatise on the Correspondences of the Storehouse Qi with the Seasons says that liver Qi favors free movement; when it needs to be dispersed, foods with a pungent flavor may be used in moderation to follow the movement of Qi.

In summer, a pulse that carries Stomach Qi and shows a slight hooked quality is normal. A predominance of the hooked quality and a scarcity of Stomach Qi indicate heart disease. A hooked quality without any Stomach Qi is a sign of impending death. A hooked pulse means that the pulse first bends forward and then stops, like holding a hooked instrument in the hand. If the pulse has Stomach Qi but also carries a sunken, firm quality (a deep, firm pulse commonly seen in winter), it suggests that illness may arise in winter. A pronounced sunken, firm quality indicates that illness is present now. This is caused by Water Qi assailing Fire Qi. The phrase “the true Qi of the storehouse connects with the heart” means that true Qi runs through the heart, which stores the Qi of the blood vessels and symbolizes flourishing Yang Qi. The Treatise on the Correspondences of the Storehouse Qi with the Seasons says that heart Qi favors gentleness; when it needs to be made gentle, foods with a salty flavor may be used in moderation to follow the movement of Qi.

During late summer, the Stomach Qi (the calm, even, and gentle part of the pulse) is faint and soft. This is normal. If the pulse shows an excess of softness and weakness, with too little Stomach Qi, it indicates illness of the Spleen. If the pulse merely pauses intermittently, it is called an “intermittent pulse.” If Stomach Qi is entirely absent, the pulse is a death pulse.

Here, “intermittent” means that the pulse stops midway through its beat and does not resume on its own.

If a soft, weak pulse also has the quality of a stone pulse—deep, firm, and hard, like a stone beneath the fingers—it predicts possible illness in winter. The stone pulse corresponds to the Water Qi of winter. By the sequence of mutual overcoming and restraint among the Five Phases, one would expect a wiry pulse here. Late summer belongs to Earth, and when Earth Qi is depleted, a stone pulse appears. If the pulse is excessively soft and weak, this indicates a deficiency of Earth Qi, and illness will occur in the present season. The New Critical Collation notes that in the Jiayi Jing, the character translated here as “weak” is written as “stone.”

“True Qi is nourished in the Spleen” means that the Spleen stores the vital essence that nourishes the body. The Spleen governs the Qi of the muscles and transforms and receives food and drink; hence the saying that True Qi is nourished in the Spleen.

In autumn, the Stomach Qi in the pulse is faint, while the pulse’s hair-like quality—light and floating, like hair stirred by the wind—is gentle. This is normal. If the hair-like quality is pronounced and Stomach Qi is scant, it indicates illness of the Lung. A pulse with only the hair-like quality and no Stomach Qi is a death pulse.

If the hair-like pulse also has a wiry quality—the pulse is straight and taut, like a finger pressing a zither string—it predicts possible illness in spring. The wiry pulse corresponds to the Wood Qi of spring. By the sequence of mutual overcoming and restraint among the Five Phases, one would expect a hook pulse here. When Metal Qi presses upon Liver Wood, the pulse takes on a wiry quality; thus a wiry pulse appears in place of the expected hook pulse. If the wiry quality is excessive, this indicates that Wood Qi is rebelling and overpowering Metal, and illness will occur in the present season.

“True Qi is elevated in the Lung” means that the vital essence stored in the Lung lies higher in the body and is used to circulate nutritive Qi and defensive Qi, harmonizing Yin and Yang. The Lung is in the upper burner, the region of the organs in the upper chest, hence the saying that True Qi is situated high. The Lingshu Jing says that the circulation of nutritive Qi takes food and drink as its basis: food and drink enter the Stomach, the Stomach Qi conveys them to the Lung, and the Lung then distributes them inward and outward; the refined portion circulates through the channels. Because the Lung disperses this vital essence, it is said to set the circulation of nutritive and defensive Qi, and of Yin and Yang, in motion. The New Critical Collation notes that in some other editions, one occurrence of the character translated as “solid” is written as “treasure.”

In winter, the Stomach Qi in the pulse is faint, while the stone quality is gentle. This is normal. If the stone quality is pronounced and Stomach Qi is scant, it indicates illness of the Kidney. A pulse with only the stone quality and no Stomach Qi is a death pulse. The stone pulse feels like a taut rope plucked into vibration, or like a pebble bouncing: firm and forceful.

If the stone pulse also has a hook quality—a relatively broad pulse with a rising and falling movement—it predicts possible illness in summer. The hook pulse corresponds to the Fire Qi of summer and also carries Earth Qi. By the sequence of mutual overcoming and restraint among the Five Phases, a weak pulse should be mentioned here. But Earth, when strong in late summer, has no pulse quality of its own; therefore, a stone pulse with a hook quality also contains Earth Qi. If the hook quality is excessive, this indicates that Water is being disturbed by pathogenic Fire and Earth, and illness will occur in the present season.

“True Qi descends into the Kidney” means that the vital essence stored in the Kidney is situated low in the body. The Kidney lies in the lower burner, the region of the organs in the lower abdomen, and generates the marrow and governs the Qi stored in the bones; hence the saying.

The Stomach’s great network vessel is called “Xuli.” It passes through the diaphragm, connects with the Lung, and is visible below the left nipple; its pulsation moves the clothing. This pulsation reflects the state of ancestral Qi, the Qi that gathers in the chest and drives breathing and the circulation of Qi and blood.

“Zong” means something noble or supreme; here it refers to the chief of the twelve meridians. The Zong vessel passes through the diaphragm and connects with the lungs. Its Qi becomes perceptible below the left breast: it emerges from the diaphragm, reaches the area beneath the breast, and then links with the lungs.

If the Qi in the vessel is abundant, with labored breathing and a pulse that intermittently stops for a moment, this indicates illness in the abdomen. “Stopping” means a temporary interruption. A pulse that is knotted and sluggish, appearing transversely, indicates an accumulation; if the pulse disappears altogether, this is a fatal condition. These descriptions all refer to the pulse below the left breast. “Within” means inside the abdomen. If the movement beneath the breast is so strong that it can be felt through the clothing, this indicates that Zong Qi—the Qi that fills the chest and drives breathing and the pulse—is leaking outward. “Leaking” means dispersing or escaping outward.

The New Collation says that, according to the Quan Yuanqi edition, the Jia Yi Jing also lacks these eleven characters: “Below the breast, its movement responds to the clothing: Zong Qi is leaking.” In view of the surrounding passage, these characters may be an interpolation and should be deleted.

To determine whether the Cun Kou pulse—the pulse at the radial artery of the wrist—is excessive or deficient: if it feels short when pressed, this is called a headache; if it feels long, this is called pain in the lower leg. A short pulse indicates insufficient Yang Qi, so the illness is in the head. A long pulse indicates an excess of Yin, so the illness is in the legs.

If the Cun Kou pulse feels rapid and surges upward, this is called shoulder and back pain. This is because Yang Qi is excessive in the upper body, causing pain in the shoulders and back.

A deep and firm Cun Kou pulse indicates illness within the body; a floating and forceful pulse indicates illness on the body’s surface. Deep and firm qualities belong to Yin, so the illness is internal; floating and forceful qualities belong to Yang, so the illness is external.

A deep and weak Cun Kou pulse, according to the original text, indicates alternating chills and fever, abdominal masses such as hernias or lumps, and lower abdominal pain. The commentary explains that a deep pulse indicates cold and a weak pulse indicates heat, hence the term “alternating chills and fever.” It also says that depth belongs to an excess of Yin, while weakness means Yang Qi is still present in some measure. When Yin and Yang contend, the expected signs would be alternating chills and fever; the further mention of abdominal masses and lower abdominal pain therefore seems to result from a textual disorder in the ancient book. The New Collation notes that the Jia Yi Jing lacks fifteen characters in this passage. Since the text below already says, “A deep and labored Cun Kou pulse is called alternating chills and fever; an urgent pulse is called abdominal masses and lower abdominal pain,” it concludes that this passage is an interpolation and should be deleted.

A deep and transverse Cun Kou pulse indicates an accumulation beneath the ribs: a transverse mass in the abdomen accompanied by pain. This, too, is a sign of Yin Qi congealing within the body.

A deep and labored Cun Kou pulse indicates alternating chills and fever. Labored breathing reflects Yang Qi drawing inward and rising, while depth reflects Yin contending with it. As Yin and Yang struggle and their upward and downward movements press against each other, chills and fever arise.

A forceful, slippery, and firm pulse indicates illness outside the body; a small, substantial, and firm pulse indicates illness within. Forceful and slippery qualities belong to Yang, while small and substantial qualities belong to Yin. Yang illness is external; Yin illness is internal.

A pulse that is small and weak, and also rough and sluggish, is called a chronic illness.

A fine, small pulse indicates Qi deficiency; a rough, hesitant pulse indicates a shortage of blood. Because Qi and blood are both weak, this is said to be a long-standing illness.

A slippery, floating, and rapid pulse is called a recent illness. Slipperiness and floating indicate that Yang Qi is abundant, while rapidity indicates that the movement of Qi is still vigorous. Since Yang Qi and the movement of Qi are sufficient, the illness is recent and relatively mild.

A hurried, forceful pulse is associated with hernia-like masses and pain in the lower abdomen. This clarifies the pulse signs for these conditions mentioned earlier: a deep, weak pulse does not necessarily indicate a hernia-like mass, but a deep, hurried pulse is consistent with that diagnosis.

A slippery pulse is associated with Wind; a rough, hesitant pulse is associated with impediment (conditions in which Qi and blood flow poorly, causing numbness and pain in the limbs). Slipperiness belongs to Yang, so illness affecting the Yang aspect gives rise to Wind. A rough, hesitant pulse belongs to Yin, so illness affecting the Yin aspect gives rise to impediment.

A gentle, relaxed, slippery pulse is associated with internal heat; a full, tight pulse is associated with distention. Here, “relaxed” describes a broad, smooth pulse, not a slow beat. When Yang heat is abundant inside, the pulse is slippery and relaxed. When cold obstructs the body and the abdomen is distended, the pulse is full and tight. “Full and tight” means that the pulse is both forceful and tense.

When the pulse accords with Yin-Yang and the illness, recovery is easier; when it contradicts them, recovery is difficult. A pulse that matches the illness is called “conforming”; one that goes against it is called “contrary.”

When the pulse accords with the seasonal pattern, there are no other abnormalities beyond the illness itself. When it goes against the seasons, or when pathogenic influences fail to pass through the organs in sequence, recovery is difficult. An autumn pulse in spring, a winter pulse in summer, a summer pulse in autumn, or a late-summer pulse—in the final phase of the seasons, when Earth Qi is in command—in winter is called contrary to the seasons. Because the pulse does not accord with the Qi prevailing at that time, the illness is difficult to cure.

Numerous blue-green vessels on the arms indicate blood loss. When blood is depleted, the vessels become empty, making it easier for external cold to enter. Cold congeals the blood, causing the vessels to appear blue-green.

A relaxed, rough pulse at the wrist is called jieyi, a state of fatigue and weakness that is difficult to classify precisely. The wrist pulse belongs to the Yin aspect and is associated with the abdomen and kidneys. A relaxed pulse indicates internal heat, while a rough pulse indicates a shortage of blood. Internal heat combined with blood deficiency can produce jieyi. The patient’s condition cannot be accurately described as cold, hot, weak, or strong; there is an indescribable fatigue and weakness, hence the name jieyi. The “Treatise on the Essential Subtleties of the Pulse” says that the outer side of the wrist is used to examine the kidneys and the inner side to examine the abdomen, showing that the abdomen and kidneys are related to the wrist pulse.

If the pulse remains full and forceful while the patient lies quietly, this indicates blood loss. Prolonged bed rest damages Qi, and when Qi is damaged the pulse should usually be faint and weak. If the pulse remains full and forceful instead, this indicates that blood has been lost and Qi has lost its support. Here, “full and forceful” means a rapid, large, powerful pulse.

A rough-feeling skin at the wrist combined with a slippery wrist pulse indicates excessive sweating. This refers to skin at the wrist that feels rough, while the pulse there feels smooth and slippery. Rough skin indicates that the nutritive blood (the blood circulating within the vessels) has already been depleted internally…

A slippery pulse indicates an excess of Yang Qi. If the blood in the body has already been depleted while Yang Qi remains excessive, there will be profuse sweating, and the pulse will show the same pattern.

Cold skin and a fine, weak pulse at the cubit position—the part of the wrist pulse that corresponds to the lower burner—are called “lower discharge,” meaning diarrhea. The cubit position primarily reflects the lower burner, and its examination corresponds to the condition of the intestines and abdomen. Cold skin and a fine, weak pulse are therefore commonly seen in diarrhea. The Pulse Classic says, “When Yin is faint, illness descends.” This means that when the Yin Qi observed at the cubit position is deficient, disorders of the lower body arise.

A large pulse at the cubit position accompanied by frequent fever is called “internal heat,” referring to heat within the lower burner.

If the Liver pulse shows the signs of Geng and Xin, death is foreseen. Geng and Xin belong to Metal, which can overcome Liver Wood. If the Heart pulse shows the signs of Ren and Gui, death is foreseen. Ren and Gui belong to Water, which can extinguish Heart Fire. If the Spleen pulse shows the signs of Jia and Yi, death is foreseen. Jia and Yi belong to Wood, which can overcome Spleen Earth. If the Lung pulse shows the signs of Bing and Ding, death is foreseen. Bing and Ding belong to Fire, which can melt Lung Metal. If the Kidney pulse shows the signs of Wu and Ji, death is foreseen. Wu and Ji belong to Earth, which can restrain Kidney Water. These conditions are all called “the true organ pulses appearing.” The ancients regarded their appearance as a sign of critical illness and impending death. The Treatise on the Three Regions and Nine Indicators also says that when the true organ pulses appear, pathogenic Qi has prevailed and healthy Qi has declined, foretelling death. A large pulse at the cubit position accompanied by a true organ pulse has the same meaning.

A visibly throbbing pulse in the neck, accompanied by rapid breathing and coughing, is called “Water.” Water Qi surges upward and steams the Lungs, causing Yang Qi to rise as well. This makes the neck pulse beat prominently and brings on coughing and shortness of breath. The “neck pulse” referred to here is the Renying pulse below the ears, on either side of the throat.

Slight swelling beneath the eyelids, raised like a resting silkworm, is also called “Water.” The Treatise on Evaluating Heat Diseases says that Water belongs to Yin, as does the area beneath the eyes; the abdomen, too, is where Yin Qi gathers. Thus, when Water accumulates in the abdomen, the area beneath the eyes must also become swollen.

Urine that is yellow-red, together with an ability to lie down comfortably, indicates jaundice. Commentators explain that this is caused by Kidney strain and heat in the womb. The Corrected Treatise calls it “strain jaundice” and says that it results from sexual overexertion. The new collation notes that Wang Bing’s interpretation of “jaundice” as “strain” is inaccurate. It is reasonable to say that sexual overexertion can cause jaundice, but “jaundice” itself should not be interpreted as “strain.”

Feeling hungry immediately after eating is called “Stomach jaundice.” This is caused by heat in the Stomach: Stomach heat makes food digest too quickly, so hunger returns after a meal.

Swelling of the face is called “Wind.” Facial swelling is also a diagnostic sign of Stomach Wind. This is because the Stomach channel belongs to the Yangming channel. It begins at the middle of the root of the nose and descends along the outer sides of the nose.

Swelling around the shin bone is called “Water” and indicates Water in the lower burner. The Kidney channel, the Foot Shaoyin channel, begins at the sole of the foot and runs upward along the inner side of the lower leg and thigh. From the Kidney, it also ascends through the Liver and diaphragm. Therefore, when fluids accumulate in the lower burner, the shins may also become swollen.

Yellow eyes are called jaundice. Yang heat becomes congested in the upper region, and pathogenic heat gathers in the chest and then scorches upward, causing the eyes to turn yellow. The Lingshu Jing says, “When the eyes are yellow, the illness is in the chest.”

If a woman’s Hand Shaoyin pulse beats distinctly, she may be pregnant. The New Collation notes that the version by Quan Yuanqi reads “Foot Shaoyin” here. The “Hand Shaoyin pulse” refers to the pulse that can be felt in the hollow behind the palm, on the little-finger side. The Lingshu Jing says that the Shaoyin channel has no acupuncture points. Does this mean the heart itself cannot become ill? Qibo explains that the illness lies in the external course of the Shaoyin channel, not in the organ, so diagnosis and treatment focus on the channel at the end of the sharp bone behind the palm. Here, “moving” means the beat of an artery: the pulse is about the size of a bean, beating distinctly and shaking. The Zhengli Lun says that when Yin and Yang Qi strike against each other, this is called “movement.” The “Treatise on the Separate Functions of the Channels” also says that when Yin Qi meets Yang Qi, this can be used to determine pregnancy. The New Collation points out that this sentence does not appear in the “Treatise on the Separate Functions of the Channels.”

Pulse patterns change with the four seasons. When they do not accord with the season, this is called “going against the seasons.” If the pulse is thin and fine in spring and summer, but floating and large in autumn and winter, it is out of season. Here, “thin” means a deep, fine pulse. In general, the pulse should be floating and large in spring and summer, but is instead deep and fine; in autumn and winter, it should be deep and fine, but is instead floating and large. This is why it is said to be out of season. The New Collation says that the commentary on the “Treatise on the True Viscera of the Jade Pivot” reads “deep and rough” in place of “thin.”

In wind and heat disorders, the pulse should be agitated, but is instead calm. In diarrhea or blood loss, it should be weak, but is instead full. When illness is internal, the pulse should be full, but is instead empty. When illness is external, the pulse should be empty and slippery, but is instead firm and rough. These conditions are difficult to treat. The meaning is that wind and heat disorders usually produce an agitated pulse; diarrhea and blood loss usually produce a weak pulse; pathogenic Qi inside the body usually produces a full pulse; and illness on the body’s exterior usually produces an empty, slippery pulse. Because the pulse contradicts the disorder, the condition is difficult to treat. All these cases are called “going against the seasons,” meaning that the pulse runs counter to the Qi of the four seasons.

The New Collation also notes variant readings in the related passage in the “Treatise on the True Viscera of the Jade Pivot.” Some versions read “wind” or “illness”; others read “diarrhea with a large pulse, and blood loss with a full pulse.” The phrases “illness inside,” “illness outside,” and “a rough, firm pulse” also have variant readings.

Some regard the six characters “this is called reversing the four seasons” as a misplaced passage in an ancient book and believe they should be deleted. The passage from “before this, none had yet hidden their form” through “spring and summer,” a total of fifty-three characters, repeats wording found later in the Treatise on the Jade Pivot and True Storehouses.

Water and the five grains are the foundation of human life. That is why a person dies when deprived of food and drink, and also dies when the pulse has no Stomach Qi. “No Stomach Qi” means that the pulse reveals only the true pulses of the organs themselves, with no Stomach Qi apparent. It does not mean that the Liver pulse is no longer taut at all or that the Kidney pulse is no longer deep and stone-like; it means that these pulses have lost the gentle, subtly harmonious quality of Stomach Qi.

When the Taiyang pulse beats, it is surging and long.

This is because Yang Qi is abundant, giving the pulse this quality. ○ The New Collation states: According to Bian Que’s Method of Yin-Yang Pulses, the Taiyang pulse is surging and long, with its Qi floating over the sinews and a pulse amplitude of nine fen. It governs the Jiazi days of the third and fourth months. Lü Guang says that Taiyang governs the fifth and sixth months, when Yang Qi is at its height; hence the pulse is surging and long.

When the Shaoyang pulse beats, it is sometimes rapid and sometimes slow, sometimes short and sometimes long.

This is because Shaoyang Qi is at times unobstructed and at times not yet unobstructed. ○ The New Collation states: According to Bian Que’s Method of Yin-Yang, the Shaoyang pulse is sometimes small and sometimes large, sometimes long and sometimes short, with a pulse amplitude of six fen. It governs midnight on the Jiazi day of the eleventh month, as well as the Jiazi days of the first and second months. Lü Guang says that Shaoyang governs the first and second months, when Yang Qi is still relatively weak; hence the pulse advances and recedes unpredictably.

When the Yangming pulse beats, it is floating, large, and short.

This is because Grain Qi is full and abundant. ○ The New Collation notes that no explanation of the three Yin pulses appears here, so some text must have been lost from the ancient version. The Difficult Classic says: When the Taiyin pulse arrives, it is tight, large, and long; when the Shaoyin pulse arrives, it is tight, fine, and faint; when the Jueyin pulse arrives, it is deep, short, and firm. Lü Guang says that Yangming governs the third and fourth months, when Yang Qi has just begun to emerge and is not yet abundant; hence the pulse is floating, large, and short. Bian Que’s Method of Yin-Yang Pulses says that the Shaoyin pulse is tight and fine, with a pulse amplitude of six fen, and governs noon on the Jiazi day of the fifth month as well as the seventh and eighth months. The Taiyin pulse is tight, fine, and long, with its Qi moving along the sinews and a pulse amplitude of nine fen; it governs the Jiazi days of the ninth and tenth months. The Jueyin pulse is deep, short, and tight, with a pulse amplitude of three fen; it governs the Jiazi days of the eleventh and twelfth months.

A harmonious Heart pulse beats continuously, like a string of linked pearls or the grain of fine jade beneath the fingers. This is called “a balanced Heart.”

When the pulse is full and vigorous, yet feels faintly like a string of beads, it has the quality of langgan pearls—beads resembling fine jade.

In summer, the pulse takes Stomach Qi as its foundation. When Stomach Qi is present in the pulse, it flows continuously and feels slightly delicate, like a string of connected beads.

If the Heart pulse comes rapidly and without interruption, with a slight bend in it, this is called “Heart illness.” “Bent” means that, under the fingers, the pulse feels curved.

The collator comments: On close inspection, what Yue Ren (Bian Que) says is written as “pecking repeatedly without interruption, with a slight bend,” and is called kidney illness. This differs from the account in the Suwen.

If the tip of the Heart pulse is bent while its rear portion is arrested and motionless, like holding a belt hook in the hand, this is called “Heart death.” “Arrested” means stopped and motionless; “holding” means grasping; and “hook” refers to the hook on a leather belt.

When the Lung pulse is calm and even, it comes gently and delicately, like elm fruit pods falling. This is called “Lung level.” It means that the pulse is superficial and light, with a slight sense of emptiness.

The collator comments: Yue Ren’s account is more detailed: “Softly and faintly, like touching elm pods” is called the “spring level pulse”; “Lush and spreading like a carriage canopy, growing larger when pressed” is called the “autumn level pulse.” These differ from the account in the Suwen. Zhang Zhongjing says that the autumn pulse spreads out like a carriage canopy and is called “Yang binding”; the spring pulse is light, supple, and delicate, like elm pods stirred by the wind, and is called “rapid.” Perhaps Yue Ren’s account is mistaken.

In autumn, the pulse takes Stomach Qi as its foundation. When Stomach Qi is present in the pulse, it is somewhat light, floating, and hollow-soft, like elm pods.

If the Lung pulse is neither floating nor deep, and feels like a hand passing over a chicken’s feathers, this is called “Lung illness.” It means that the center of the pulse is firm while its two sides are weak.

If the Lung pulse is like something floating on water, or like feathers stirred by the wind, this is called “Lung death.” In other words, the pulse appears and disappears, drifting and scattered. The collator comments: Yue Ren’s account says that when pressed, the pulse becomes empty and scattered, without strength, like hair blown by the wind; this is called “death.”

When the Liver pulse is calm and even, it is soft and weak, moving gently, like the tip of a long pole being lifted. This is called “Liver level.” The pole tip is used here to compare the pulse to something soft and long.

In spring, the pulse takes Stomach Qi as its foundation. When Stomach Qi is present in the pulse, it is soft and long like the tip of a pole.

If the Liver pulse is full and smooth, like a hand passing along a long pole, this is called “Liver illness.” This means that although the pulse is long, it is not soft, so it feels like touching a pole.

If the Liver pulse is rapid and grows increasingly rigid, like a bowstring just drawn taut, this is called “Liver death.” “Taut” means that the pulse is rigid and forceful, and extremely urgent.

When the Spleen pulse is calm and even, it is soft, gentle, and harmonious, with each beat distinct from the next, like a chicken stepping on the ground. This is called “Spleen level.” It means that each pulse beat has a clear rhythm, moving back and forth with a harmonious pace.

In late summer, Stomach Qi is the foundation. When Stomach Qi is insufficient, the pulse feels firm and rapid.

When the Spleen is diseased, the pulse feels full and forceful, arriving rapidly, like a chicken lifting its feet as it walks. This is called “Spleen disease.” The Stomach Qi is insufficient, so the pulse seems full and rapid. “Lifting its feet” means that the pulse beats like a chicken raising its feet as it walks. The New Collation notes that Yue Ren considered this a sign of Heart disease.

When the Spleen is about to fail, the pulse is sharp and hard, like a crow’s beak. It may also resemble a bird’s claw, water dripping from a roof, or flowing water. This is called “Spleen death.” The crow’s beak and bird’s claw describe the pulse’s sharpness and hardness. Flowing water and roof drips describe how the pulse arrives: like flowing water, it comes gently but without a throbbing force; like drops from a leaking roof, it beats intermittently, then stops. The New Collation says that the Qianjin Fang reads “like a chicken’s beak.”

When the Kidney pulse is calm and even, it is continuous and rhythmic, shaped like a hook, and slightly firm under pressure. This is called “Kidney at peace.” This means that the pulse has a hooked shape like the Heart pulse and feels slightly firm under pressure. The New Collation cites Yue Ren: the pulse arrives larger at the upper part and tapering at the lower part, soft and smooth, like a sparrow pecking at food. Lü Guang explains that the larger upper part corresponds to the Foot Taiyang channel, and the tapering lower part to the Foot Shaoyin channel. When Yin and Yang each occupy their proper position, this shows that the Stomach Qi is abundant; hence it is called a normal pulse. “Like a sparrow’s beak” means wider at the base and tapering to a fine point. In winter, when examining the Kidney pulse, one must take the Stomach Qi as its foundation. When the Stomach Qi is insufficient, the pulse feels hard even without pressure.

When the Kidney is diseased, the pulse feels like a vine being pulled and grows harder under pressure. This is called “Kidney disease.” “Like a vine being pulled” means that the pulse is already hard without pressure and becomes more noticeably so when pressed.

When the Kidney is about to fail, the pulse suddenly surges forth as if a rope were being snatched away. It may also feel rapid and hard, like a stone bouncing. This is called “Kidney death.” “Surging forth like a rope being snatched away” is like a snake darting swiftly along; “like a bouncing stone” describes a pulse that is rapid and hard.