《黃帝內經素問補註釋文》Vol. 7

The Yellow Emperor asked, "The human body has the Four Jing (jing, classics or channels) and the Twelve Cong (cong, follows). What do these mean?" Qibo replied, "The Four Jing correspond to the four seasons, and the Twelve Cong correspond to the twelve months, which are also the twelve channels."

The Four Jing refer to the characteristic pulse of each season: wiry in spring, surging in summer, floating in autumn, and deep in winter. The Twelve Cong mean that Qi (vital energy) moves through the twelve Earthly Branches in sequence, which is why they correspond to the twelve months. The months are grouped by season: spring comprises the months of Yin, Mao, and Chen; summer, the months of Si, Wu, and Wei; autumn, the months of Shen, You, and Xu; and winter, the months of Hai, Zi, and Chou. The Twelve Pulses refer to the three yin and three yang channels of each hand and foot, twelve in all. Because they correspond through the numbers of Qi, they are explained together.

Pulses have both yin and yang. One who understands the yang pulses must also understand the yin pulses, and one who understands the yin must also understand the yang. Only through thorough study can one fully grasp how they change.

There are five kinds of yang pulses, each with five variations, for a total of twenty-five yang pulses.

The "five yang" refer to the yang Qi of the five viscera. The five viscera correspond to the four seasons, and each season displays a characteristic pulse that contains the yang Qi of all five viscera. Multiplying the five categories by five yields the "twenty-five yang." The Xin Jiao Zheng (New Collation) notes that the Yuji Zhenzang Lun states, "There are five changes in illness, five times five, twenty-five changes," and this conveys the same meaning.

The "yin" refers to the true visceral pulses (zhenzang mai), which appear when the essential Qi (jing) of the five viscera is in decline. Once a true visceral pulse appears, it signals that visceral Qi is failing and usually indicates mortal danger.

For example, when the liver pulse arrives, its force is urgent both inside and outside, like touching the edge of a blade, carrying a sense of haste, as if pressing on a taut string. When the heart pulse arrives, it is hard and forceful, like touching coix seeds, grainy and clustered. When the lung pulse arrives, its body is broad yet hollow, like a feather brushing the skin. When the kidney pulse arrives, its force comes and goes intermittently, like a finger flicking a stone, with a rapid "pi-pi" quality. When the spleen pulse arrives, its force is feeble, sometimes rapid and sometimes sparse. When these pulses appear, they all indicate that visceral Qi is in decline and Shen (spirit) is dispersing, and so they foretell a critical illness.

The "yang" refers to the yang Qi of the stomach duct (weiguan), as reflected in the Renying pulse. In examination, one observes whether the activity of this pulse Qi is calm or agitated and whether the pulse is large or small, and then compares it with the Cunkou (the radial pulse at the wrist) to see whether the two correspond. The stomach is where water and grain converge, so by examining stomach Qi one can determine where the disease lies. The Renying pulse lies on either side of the Adam's apple, where the pulsation can be felt.

The normal pulse at the hand is smaller on the left and larger on the right. The small left pulse is generally used to examine the zang (organs), and the large right pulse is generally used to examine the fu (bowels). One interpretation explains this as the "yang of the weipao (stomach sac)," but that is incorrect. (The character for "wan" in this passage is pronounced the same as "guan.")

From the yang pulses one can discern where the disease lies, and from the yin pulses one can infer the limit of life and death. The yang pulses govern the protection of the body's surface and keep the body firm, so when an external pathogen invades, examining the yang pulses clarifies where the illness is. The yin pulses govern the storage of jing (essence) and shen (spirit) and guard the interior of the body. By examining the true condition of the pulse and the success or failure of the disease's course, one can judge from the yin pulses whether the patient can survive.

The Xinjiao Zheng (Newly Corrected Edition) states: The Yuji Zhenzang Lun (Treatise on the True Viscera of the Jade Pivot) records: "From the yang pulses one can discern where the disease comes from; from the yin pulses one can know the limit of life and death."

The three yang pulses are in the head, and the three yin pulses are in the hand. The saying that "the two combine as one" refers to this principle. The head refers to the renying (Human Welcome) pulse, and the hand refers to the qikou (Breath Opening) pulse. The two sites respond to each other, and their beats rise and fall together. If the pulses are even in size, the person is called a pingren, a healthy ordinary person, which is why the two are said to unite. The qikou lies one cun behind the fish border of the wrist, and the renying lies one and a half cun to either side of the Adam's apple. Both can be used to examine the qi of the zang and fu organs.

From the yang pulses one can discern the inauspicious days on which the disease may flare, and from the yin pulses one can know the limit of life and death. Understanding the pulse qi and determining the course of the disease reveals the inauspicious times of an attack. Carefully distinguishing the success or failure of the disease's course allows one to infer the limit of life and death.

Examining the pulse qi with care and mastering the changes of yin and yang skillfully means one need not consult with others.

The yin and yang spoken of here refer to different manifestations of the pulse. When the pulse qi recedes, it is yin; when it arrives, it is yang. Quiet is yin, agitated is yang. Slow is yin, rapid is yang. All of these describe the changes of the pulse.

For anyone who examines the zhenzang mai (true visceral pulses) of the five zang organs: if the liver pulse shows the true visceral appearance, suspended and urgent, death follows within eighteen days. If the heart pulse does so, death follows within nine days. If the lung pulse does so, death follows within twelve days. If the kidney pulse does so, death follows within seven days. If the spleen pulse does so, death follows within four days.

"True visceral pulse" means that each of the five zang organs reveals an abnormal pulse peculiar to itself. The commentaries hold that these day counts are derived from the remainders of the generating-completion numbers of the Five Phases. The eighteen days take the remainder of the completion numbers of Metal and Wood, the nine days take the remainder of the generating numbers of Water and Fire, the twelve days take the remainder of the generating numbers of Metal and Fire, the seven days take the remainder of the generating numbers of Water and Earth, and the four days take the remainder of the generating number of Wood. Accordingly, the Pingren Qixiang Lun (Treatise on the Qi Appearances of the Healthy Person) says: "When the liver pulse shows on a gengxin day, one dies; when the heart pulse shows on a ren day..."

On the gui day, if the lungs show illness, death follows when the bing or ding days arrive. On the ren day, if the kidneys show illness, death follows when the wu or ji days arrive. On the wu day, if the spleen shows illness, death follows when the jia or yi days arrive. The death referred to here means that when the illness reaches the corresponding day and meets the Five Phases (Wood, Fire, Earth, Metal, Water) qi that is unfavorable to the affected organ, the condition may worsen and lead to death.

Why does this happen? Because when the qi of the Five Phases that controls and harms the diseased organ arrives, the illness advances.

When the Two-Yang channels (the Yangming channels, comprising the large intestine and stomach channels) fall ill, they affect the heart and spleen, producing difficulty in carrying on hidden and intricate matters; in women, menstruation ceases. "Yinqu" (hidden and intricate matters) refers to what is secret and hard to speak of directly, and it includes sexual activity. When the intestines and stomach are affected, the heart and spleen are involved. If the heart is affected, the blood does not circulate smoothly. If the spleen is affected, food cannot be properly transformed into refined essence. When blood circulation is obstructed, women may stop menstruating. When food cannot be transformed into refined essence, men become deficient in essence and qi. Therefore, hidden and intricate matters also cannot proceed.

The "Discourse on Yin-Yang Correspondences" (Yinyang Yingxiang Da Lun) states that when essence and qi are deficient, one should nourish them through diet, and if food cannot be properly transformed into refined essence, essence and qi will decline. The "Discussion of Strange Illnesses" (Qibing Lun) states that the uterus (bao tai) is connected to the kidneys. The "Discussion of Febrile Diseases" (Ping Re Bing Lun) states that when menstruation ceases, the bao mai (uterine channel) is blocked. The bao mai belongs to the heart and connects with the uterus. If qi surges upward and disturbs the heart channel, qi cannot descend and flow freely, and so menstruation stops. The "Plain Questions on Ancient True Nature" (Shanggu Tianzhen Lun) further states that around age fourteen, women reach tiangui (the vital substance that promotes reproductive development). Then the Renmai (Conception Vessel) flows freely, the Chong mai (Thoroughfare Vessel) becomes full, and menstruation comes on schedule. Around age sixteen, men reach tiangui, and their essence and qi become sufficient for emission. From this it follows that in women the illness may appear as amenorrhea, and in men as deficiency of essence and qi.

If the illness is prolonged, and the stomach disease penetrates deeper and passes to the spleen, wind-heat forms and the body grows thin. If the large intestine disease becomes severe and passes to the lungs, wheezing and qi rising upward appear. These illnesses involve the intestines, stomach, spleen, and lungs, and they also implicate the heart. When several organs control and harm one another in this way, the condition may become critical and difficult to treat. The character here, "ben" (to rush), is read as "ben."

When the Three-Yang channels (the large intestine, small intestine, and bladder channels) fall ill, alternating chills and fever appear. When the illness lies in the lower body, it may form abscesses and swelling, and it may also produce weijue (limb weakness and cold extremities) and a painful calf condition. The small intestine channel runs from the arm over the shoulder and up to the head. The bladder channel runs down from the head along the back and buttocks, passes the back of the knee, and continues down the calf. Therefore, when the illness lies in the upper body, it may cause chills, and when it lies in the lower body, it may cause abscesses, calf pain, and weijue. "Wei" means weakness of the limbs, and "jue" means coldness of the feet, which may also indicate disordered qi movement. The term for calf soreness refers to pain in the calf muscle.

This continues the earlier discussion, describing the symptoms that arise when different jingmai (meridians) are afflicted and the pulse patterns that accompany them.

When heat evil is severe, it dries up jing (essence) and blood, and the skin loses its moist, healthy complexion. Yang qi sinks downward while Yin vessels contend upward against it, and this upward counterflow produces more signs of cold. The downward sinking of Yang slackens the sinews and vessels, so the testicles droop and become lax, and within the abdomen a tuishan (a hernia-type disorder) forms.

When the Shaoyang (lesser Yang) channels are afflicted, qi becomes scant, and one is prone to coughing and diarrhea. The "one Yang" here refers to the gallbladder channel and the Sanjiao (Triple Burner) channel. Gallbladder qi affects the stomach, which is why diarrhea occurs; disorder within the Sanjiao makes qi scant; and Yang qi rising to steam the lungs causes coughing. Heart fire, which corresponds to these channels internally, can also produce these signs.

When the illness progresses and changes, there may be a pulling pain in the heart region, or obstruction in the diaphragm. Diaphragmatic qi rushing up toward the heart brings heat into the heart, and Yang qi pulling inside causes pain. Stagnation within the Sanjiao and accumulated heat block the chest and diaphragm. (Che means to pull or tug.)

Shaoyang and Jueyin illness mainly presents as fright, back pain, frequent belching, and yawning, a condition called fengjue (wind reversal). The "one Yin" here refers to the Jueyin pericardium channel and liver channel. The pericardium channel begins in the chest and connects with the heart. According to the quoted text, heart disease may cause pain between the chest, back, and shoulder blades. Qi disorders readily produce belching, which explains the back pain and frequent belching. When heart qi is insufficient, kidney qi rises to take advantage of the void. The liver governs fright, which accounts for the fright and frequent yawning. Liver qi stirs like wind, and kidney qi counterflows upward. Because both wind-stirring and qi-counterflow are present, the condition is called fengjue.

Shaoyin and Shaoyang illness brings easy abdominal distension, oppression in the heart, and frequent escape of breath. The "two Yin" here refers to the Shaoyin heart and kidney channels. Kidney qi and gallbladder qi rise together in disorder, the qi mechanism of the Sanjiao runs poorly, and qi congests in the upper body, producing oppression in the heart. When the lower body is weak and the upper body is excessive, qi escapes outward.

Taiyang and Taiyin illness presents as hemiplegia, weakness, and limbs unable to move. The text holds that insufficiency of the three Yin channels leads to hemiparalysis (pianku), while excess of the three Yang channels causes limb weakness. Here "yi" refers to limbs that once moved normally undergoing a change and becoming feeble.

A pulse that beats like a hook is called gou (hook). One that beats like a hair is called mao (hair). When Yang qi predominates and the pulse is urgent and taut, it is called xian (string). When Yang qi arrives and then suddenly cuts off, it is called shi (stone). When Yin and Yang qi pass through alternately, it is called liu (flowing). This passage explains how to distinguish Yin and Yang disorders from the pulse. For example, when one Yang beats, the pulse presents as gou. The text goes on to explain that one Yang refers to the Sanjiao, and that the heart corresponds to the Sanjiao. The hook pulse that matches the beating of one Yang is therefore the pulse of the heart.

The passage speaks of the pulse. The Jueyin (a yin channel, specifically the Jueyin channel among the yin channels) belongs to the Wood qi of the liver. The "hair pulse" belongs to Metal, the lungs. When Metal qi invades Wood qi, the pulse takes on the features of a hair pulse. If Metal qi attacks Wood from within while Wood's yang qi still predominates, the pulse becomes rapid and takes on a wiry (xian) quality. When yang qi arrives and the pulse is rapid and forceful, this is called the "wiry pulse," which belongs to the liver. When yang qi arrives and the pulse seems suddenly to break off, this is called the "stone pulse," which belongs to the kidneys. If yin and yang qi meet without suppressing each other, the pulse is smooth, like flowing water.

When yin qi struggles within and yang qi stirs without, sweat flows continuously and cannot be contained, and the hands and feet also turn cold. When qi rises against its normal course, it steams the lungs, causing panting and a wheezing sound in the throat.

If Metal qi keeps stirring and yang qi grows very strong, yin and yang reach a standoff, struggling within and agitating without. Sweat then flows without end, yet the hands and feet grow cold. In severe cases, yang qi burns inside the body, sweat pours out uncontrollably, and heat evils attack the lungs. Therefore, when qi rises against its course and steams the lungs, the result is panting and a wheezing sound in the throat.

The root of how yin qi is generated lies in harmony. Only when the root is in harmony can one speak of true balance.

The "yin" here refers to the essence (jing) and spirit (shen) stored in the five zang organs. The five zang organs are able to nourish and preserve a person's true vitality because each follows its own nature and keeps to stability and calm. If one departs from a suitable state, other pathogenic influences invade, and various diseases arise. How could one not be careful in nourishing the Way of life?

Thus, when strong yang is added to strong yang, yang disperses and yin is also extinguished.

"Strong" (gang) refers to yang. When yang qi steams within the body, sweating heavily outward and burning without end, the result is an excess of yang piled upon yang. Such extreme excess cannot last, and yang will eventually dissipate on its own. Once yang has collapsed, yin cannot survive alone, so when yang disperses, yin perishes with it. This is what it means that striving to overcome others leads instead to ruin.

If the blood is thin and the firm and the yielding are out of balance, the qi of the channels will be cut off.

Those with thin blood tend to have excess yang, and they should carefully regulate their qi so that it flows freely and continuously. If one cannot reflect deeply on restraining desire, and the order of qi's circulation becomes disordered and declines, yang will become excessive and scorch the viscera from within. In this case, death is not far off, and how could one live long?

The condition called "dead yin" leads to death within three days at most.

This is Fire qi invading Metal qi.

The condition called "living yang" leads to death within four days at most.

This is Wood qi invading Fire qi. The Xinjiaozheng (New Collation) states that some editions read "live after four days," while Quan Yuanqi's annotated edition reads "finished after four days." Both readings make sense. Judging from the surrounding context, the reading "die after four days" is not appropriate.

As for "living yang" and "dead yin," they mean that when liver qi passes to the heart, this is called "living yang"...

The mother's qi arrives and draws near the child's qi, so it is called "generating yang" (sheng yang). This does not only mean that wood gives rise to fire. It also shows that yang qi by nature governs growth.

The relationship between heart and lung is called "dead yin" (si yin). Yin qi governs killing and punishment, and fire qi in turn restrains metal qi. When metal is overcome by fire, it declines and perishes, so the condition is called "dead yin."

The relationship between lung and kidney is called "heavy yin" (chong yin). Lung and kidney also stand in a mother-child relationship, but both belong to yin qi, and so the condition is called "heavy yin."

The relationship between kidney and spleen is called "obstructive yin" (pi yin), and it is a fatal condition that is difficult to cure. When earth qi grows excessive and absorbs water qi, water qi can barely rise. The state in which earth qi suppresses water qi and keeps it from ascending is called "obstructive yin."

When yang qi is stagnant, the limbs swell, because the limbs are the root site where the qi of all the yang channels gathers and circulates.

When yin qi is stagnant, blood appears in the stool, with bleeding of up to one sheng (a unit of volume). Yin governs blood, so stagnation of yin qi leads to bleeding. When the yin stagnation worsens, it is called "repeated binding" (zai jie), and the bleeding reaches two sheng. A further worsening is called "triple binding" (san jie), with bleeding of up to three sheng. The "two excess" mentioned here is the "repeated binding," and the "three excess" is the "triple binding."

When yin and yang qi are stagnant and skewed, with yin in excess and yang deficient, the condition is called "stone water" (shi shui), and it presents as swelling of the lower abdomen. This results from failure to regulate and treat the condition properly.

Binding of the "two yang" is called "wasting" (xiao). The two yang refer to the stomach and the large intestine. When heat qi stagnates in both, heat accumulates in the intestines and stomach, so a person digests food quickly and is often hungry. The collator remarks that, according to this explanation, the original text appears to have omitted the item "two-yin binding."

Binding of the "three yang" is called "obstruction" (ge). The three yang refer to the small intestine and the bladder. When heat qi stagnates in both, heat binding in the small intestine dries the blood vessels, and heat binding in the bladder exhausts the fluids. The qi therefore becomes blocked, and excretion is impaired.

Binding of the "three yin" is called "water" (shui). The three yin refer to the channels of the spleen and the lung. When cold qi stagnates in both, the movement and transformation of qi go awry, and fluids collect and form water.

Binding of "one yin and one yang" is called "throat obstruction" (hou bi), a condition of a blocked and painful throat. The one yin refers to the vessel of the heart's governor, and the one yang refers to the vessel of the triple burner. Both of these channels connect to the throat. If heat qi stagnates internally, throat obstruction forms.

"Yin throbbing and yang separate" (yin bo yang bie) indicates that pregnancy is possible. Yin refers to the pulse at the cubit position, and bo means that the pulse is strong and forceful to the touch. When the cubit pulse beats powerfully and differs from the pulse at the inch opening, and the yang qi also appears upright and abundant, this is a sign of possible pregnancy. Here ren is read in the departing tone and refers to gestation.

When yin and yang are both deficient and the intestines malfunction, the condition is fatal. The word bi refers to blockage of yin qi. But if stomach qi cannot be retained and the intestinal gate stands wide open, yin qi cannot be nourished. This shows that true qi is exhausted, and so death follows. The collator notes that in the Quan Yuanqi edition (Quan Yuanqi ben), this bi is written with a different character, also pronounced bi, which means "to avoid."

When yang qi is placed above yin qi, the result is called "sweat" (han). When yang is below and yin is above, yang surges upward, and yin unites with it. The two then steam, and sweat forms.

...turn into sweat.

Yin qi is weak while yang qi strikes forcefully. This is called "beng" (collapse), a disorder of Yin-Yang imbalance that leads to massive bleeding.

When the yin vessels are deficient and the yang vessels are vigorous with abnormal throbbing, internal collapse occurs and blood flows downward.

When all three yin vessels show abnormal throbbing, death occurs at midnight twenty days later.

This is the remainder of the generative numbers of the spleen and lungs. The "bo" (throbbing) described here refers to a pulse that is deep and hidden yet surging, unlike the normal pulse.

Yin qi has reached its extreme, so death occurs at midnight.

When two yin vessels show abnormal throbbing, death occurs at dusk thirteen days later.

This corresponds to the generative numbers of the heart and kidneys. Yin qi has not yet reached its extreme, so death occurs at dusk.

When one yin vessel shows abnormal throbbing, death occurs at dawn ten days later.

This corresponds to the generative numbers of the liver and heart.

When all three yang vessels show abnormal throbbing, and the throbbing is pronounced, death occurs three days later.

This is because yang qi arrives with urgency.

When all three yin and three yang vessels show abnormal throbbing, causing fullness and distension of the heart and abdomen and complete loss of control over defecation and urination, death occurs five days later.

This is because yin qi is also affected. "Yinqu" refers to defecation and urination.

When two yang vessels show abnormal throbbing, qi overflows, the condition is critical and untreatable, and death comes within ten days at most.

This is the generative number of the intestines and stomach.

The New Collation remarks that on close reading, this passage appears to be missing an entry concerning "one yang throbbing."