《黃帝八十一難經纂圖句解》

The Yellow Emperor's Classic of Eighty-One Difficulties (Huangdi Bashiyi Nanjing) embodies profound medical wisdom. In his preface, Li Jiong (styled Xifanzi) reflects with emotion: Among all things that directly affect human life, none are more immediate than weapons and punishments, yet these represent visible life-and-death matters. Medical art, by contrast, is the invisible arbiter of life—an incompetent physician prescribing the wrong remedy can be as fatal as mishandling weapons or misapplying penalties.

Li Jiong recounts his transition from Confucian scholar to dedicated student of his family's medical tradition. Having previously annotated Wang Shuhe's Pulse Verses (Maijue) and the pediatric text Songs for the Young (Youyou Ge), he now turns to interpreting this classic transmitted by Bian Que (Qin Yueren) from the secret teachings of Master Sang. Structured as a dialogue addressing eighty-one medical conundrums, this text stands as one of the foundational sources of Chinese medical theory. Though commentators like Lü Guang and Yang Xuancao had previously annotated it, their explanations were either overly simplistic or mingled with inaccuracies, obscuring the classic's profound medical principles.

Emphasizing his rigorous methodology, Li Jiong bases his commentary on ten prior scholars' works, ensuring every phrase is substantiated and every character explicated. He urges medical students to study conscientiously, apprehending the Dao of medicine through observation of life's phenomena—thus naturally attaining the realm where revival of the dead becomes possible. Compared to the crude life-and-death control exercised through weapons and punishments, does not medicine's life-saving virtue (De) represent greater merit? This preface was composed in the first month of 1269 (the fifth year of the Xianchun era, Southern Song Dynasty).

A supplementary note clarifies that while attributed to the Yellow Emperor, the Eighty-One Difficulties was actually composed by the Warring States period physician Bian Que (surname Qin, personal name Yueren)—the very figure Sima Qian documented in Records of the Grand Historian (Shiji) as the renowned physician from Lu. Its format of hypothetical questions and answers addressing medical complexities gives the text its name. As a medical classic, its theoretical lineage is orthodox rather than speculative. Regrettably, the uneven quality of circulating commentaries had prevented this classic's profound medical principles from being fully illuminated.

While studying this medical text, I attempted to grasp the true meaning of the ancients' words and provide annotations. At the end of the book, I distilled its core principles and created diagrams based on the theories from the Suwen (Basic Questions). Where Yang Xuancao's commentaries deviated from medical principles, I pointed them out and provided detailed analyses. Through this approach, the essential framework of pulse diagnosis becomes clear, allowing physicians to reference these materials to distinguish right from wrong and dispel misconceptions.

Diagram illustrating the relationship between the Triple Burner (Sanjiao, the three functional systems of upper/middle/lower) and the Nutritive-Defensive (Rong-Wei, the Qi-blood circulation system) in terms of Yin-Yang:

Original Qi (in its static state called Yuan Qi, when flowing divided into the upper/middle/lower Sanjiao) and Dry-Heat (primarily located in the upper body, corresponding to the skin/hair system of the lungs/large intestine and the blood-vessel system of the heart/small intestine) reside in the upper body, analogous to the pivot between heaven and earth (this is what is called "Ming" or life-gate). Fire Qi (Sanjiao function) and the spleen-stomach muscle system are located in the middle region. Stomach Qi (static form called Wei Qi, flowing form called Rong-Wei Qi) and Wind-Cold (primarily in the lower body, corresponding to the sinew system of liver/gallbladder and the bone-marrow system of kidney/bladder) reside in the lower body.

Diagram of the Five Zang Organs and their corresponding pulse positions:

The five zang organs are divided into heart-lungs (upper), spleen (middle), and kidney-liver (lower).

Their corresponding pulse diagnosis positions are the Cun (proximal radial artery at the wrist), Guan (middle), and Chi (distal) positions.

In terms of Yin-Yang attributes: the Cun position belongs to Yang, the Guan position is the intersection of Yin-Yang, and the Chi position belongs to Yin.

Body regions corresponding to the three pulse positions:

Upper pulse (Cun) corresponds to Heaven, primarily treating diseases from the chest upward to the head.

Lower pulse (Chi) corresponds to Man, primarily treating diseases from below the navel to the feet.

Middle pulse (Guan) corresponds to Earth, primarily treating diseases from below the diaphragm to above the navel.

Nine categories of pulse manifestations:

Floating pulse (common in heart-lung patterns), Middle pulse (spleen pulse is centered), and Sunken pulse (common in kidney-liver patterns).

This classification is repeated three times to emphasize the fundamental patterns of pulse diagnosis.

Pulse manifestations of Yin-Yang excess/deficiency in Cold Damage disorders:

A floating pulse may indicate Yang excess (exuberant Yang Qi) or Yin deficiency (insufficient Yin Qi, where Yang pulse appears in Yin positions indicates Yang overwhelming Yin).

In normal conditions: the Cun pulse (Yang position) should be slightly floating, while the Chi pulse (Yin position) should be slightly sunken.

A sunken pulse may indicate Yang deficiency (insufficient Yang Qi, where Yin pulse appears in Yang positions indicates Yin overwhelming Yang) or Yin excess (exuberant Yin Qi).

This passage primarily discusses the characteristics of pulse diagnosis in Traditional Chinese Medicine, focusing on the correspondences between Yin-Yang excess/deficiency and organ systems, as well as the disease patterns and prognostic judgments associated with different pulse qualities.

Regarding Yin-Yang excess/deficiency and cold/heat symptoms: Excessive Yang Qi causes external heat manifestations (headache and irritability - sweating therapy would be dangerous here); excessive Yin Qi can also cause external heat (due to blocked internal fire, requiring acupuncture at transport points). Yang patterns mostly manifest as heat (when Yang is excessive, the body shows fever without sweating), while Yin patterns mostly manifest as cold (when Yin is excessive, there's profuse sweating with cold limbs). Yang deficiency causes cold limbs (sweating can cure this), while Yin excess leads to internal cold (manifesting as severe lower abdominal pain - purgative therapy would be fatal here).

Concerning the Yin-Yang attributes of organ pulses: A weak and rapid pulse belongs to Yang, corresponding to the six hollow organs; a full and floating pulse also belongs to Yang - both heart and lung pulses tend to be floating. A slow pulse belongs to Yin, corresponding to the five solid organs - both kidney and liver pulses tend to be deep. Specifically: the lung pulse is floating and rough (lung being the Yin within Yang), the heart pulse is floating and large (heart being the Yang within Yang), the spleen pulse is moderate and relaxed (spleen occupying the middle between Yin and Yang), the liver pulse is deep and wiry (liver being the Yang within Yin), and the kidney pulse is deep and small (kidney being the Yin within Yin). Each pulse quality has "severe" (pronounced) and "mild" variations, corresponding respectively to the organ itself and its paired hollow organ.

Regarding life-death prognosis through pulse: Weak, faint and thin pulses indicate insufficient vital Qi with disease internally; strong and forceful pulses indicate excessive pathogenic Qi with disease externally. Rapid pulses mostly indicate hollow organ disease, while slow pulses mostly indicate solid organ disease. Two pulse beats per normal respiration cycle indicates balance, three indicates deviation from normal, four indicates critical condition, five predicts death, and six indicates life termination. Only one pulse beat per respiration is also abnormal - one beat every two respirations indicates essence depletion, one beat every three respirations predicts death, and one beat every four respirations indicates life termination.

Finally, the characteristics of heart pulse: The heart pulse is floating and large, normally beating twice per inhalation and twice per exhalation - neither too large nor too small is optimal.

The spleen pulse, when exhibiting a harmonious and moderate rhythm, indicates normal physiological conditions. In a healthy individual, the pulse beats three times during exhalation and three times during inhalation—this represents balanced vitality.

A lung pulse that appears short and obstructed signifies the onset of illness. When the pulse beats four times during exhalation and four times during inhalation, this manifests as pathological pulse patterns.

A kidney pulse that sinks deep, becomes thin and weak indicates worsening disease. When the pulse beats five times during exhalation and five times during inhalation, the patient's condition is critical. Should it beat six times during both exhalation and inhalation, this signals imminent mortal danger.

On the Internal Pulse Mapping of the Human Body:

Yang Xuancao's commentary on the "Classic of Difficulties" (Nanjing) states: The cun position (radial artery at the wrist) on the left hand reflects the heart and small intestine pulses, while the chi position (near the elbow) reveals kidney and bladder conditions. The right hand's cun position corresponds to lung and large intestine pulses, the guan position (between cun and chi) shows spleen and stomach conditions, and the chi position indicates the Gate of Life (kidney yang) and triple burner. For example, a floating pulse at the left cun position suggests small intestine activity, while a sunken pulse indicates heart function. This theory originated in the "Pulse Method Eulogy" and was detailed in the "Pulse Classic."

Some mistakenly interpret "cun" solely as "cun position," further complicating matters by adding "guan position" and "chi position" distinctions (though Zhang Zhongjing mentioned these, they shouldn't be entirely dismissed). This has obscured traditional pulse diagnosis methods without solid foundation. Though later generations produced many renowned physicians, few could clarify these distinctions due to entrenched misconceptions. Consequently, accurate assessment of the five zang organs' deficiency/excess became impossible, and visceral pulse mapping grew increasingly confused.

Illustrated Explanation of Yin-Yang Ascent and Descent:

The following diagram uses black and white lines to distinguish cyclical Yin-Yang transformations. "Celestial Gate," "Earthly Door," "Human Gate," and "Ghost Gate" represent critical portals of Yin-Yang movement; "Qi Opening," "Human Welcoming," and "Left/Right Spirit Gates" correspond to the cun, guan, and chi pulse positions that fluctuate with respiration.

The operational principles of Yin-Yang qi are:

Yin qi begins growing at Autumn Commencement (Liqiu), peaking at Winter Commencement (Lidong);

Yang qi starts expanding at Spring Commencement (Lichun), culminating at Summer Commencement (Lixia).

Illustrated Explanation of Pulse Diagnosis Methods:

During pulse reading, place three fingers side-by-side lightly behind the wrist crease—the diagnostic area spans half a finger-width at the fingertips. The Yin pulse (internal channel) moves inward toward the cun position during exhalation, while the Yang pulse (external channel) shifts outward toward the chi position during inhalation.

This scripture discusses the pulse diagnosis methods and theories in ancient Chinese medicine, detailing the characteristics and corresponding Yin-Yang attributes of the three pulse positions (Cun, Guan, Chi) on both wrists.

When examining the left wrist, the inner side of the Cun position (radial artery at the wrist) corresponds to Yang within Yang, while the outer side corresponds to Yin within Yang. The Guan position (about one inch behind the Cun) has its front half associated with Yang and the rear half with Yin. The Chi position (about one inch behind the Guan) has its outer side linked to Yang and the inner side to Yin. Each position exhibits distinct pulse qualities: the outer Cun pulse feels floating and scattered, while the inner Cun pulse is floating and broad; the upper Guan pulse is wiry and elongated, whereas the lower Guan pulse is wiry and tight; the outer Chi pulse is deep and slippery, while the inner Chi pulse is deep and soft. These characteristics serve as key indicators for determining the Yin-Yang nature of the pulse.

The text also explores the diagnostic significance of the "Renying" (carotid artery in the neck) and "Qikou" (Cun pulse at the wrist), considered vital gateways where the body's Qi interacts with the energies of Heaven and Earth. It references Yang Shi (possibly the physician Yang Shangshan) and his method of dividing pulse diagnosis into three sections: the upper left wrist corresponds to the pericardium and triple burner meridians, while the middle section relates to the spleen and stomach meridians. However, this classification differs from the system recorded in the Mai Jing (Pulse Classic).

Lastly, the scripture cites the pulse theory of Wang Shuhe (a renowned physician of the Jin Dynasty): the left Cun corresponds to the heart and small intestine, the left Guan to the liver and gallbladder, and the left Chi to the kidneys; the right Cun corresponds to the lungs and large intestine, the right Guan to the spleen and stomach, and the right Chi to the "Gate of Life" (kidney Yang). It notes that for women, the left and right pulse correspondences are reversed. Additionally, the diagnostic scope of the three sections varies: the upper (Cun) primarily reflects disorders from the chest upward to the head, the middle (Guan) covers conditions below the diaphragm to above the navel, and the lower (Chi) pertains to ailments from below the navel down to the feet.

This scripture primarily describes the starting and ending acupoints of the twelve main meridians in the human body, with particular focus on the pathways of the three yin meridians of the hand, the three yang meridians of the hand, as well as the Liver Meridian of Foot-Jueyin and the Stomach Meridian of Foot-Yangming.

The text mentions that ancient renowned physicians like Bian Que and Wang Shuhe emphasized the need for meticulous care in pulse diagnosis. It then details the beginning and terminal acupoints of each meridian:

The Pericardium Meridian of Hand-Jueyin starts at Zhongchong (on the tip of the middle finger, about a leek leaf's width from the fingernail) and ends at Tiandi (one inch beside the nipple under the armpit, near the rib area).

The Lung Meridian of Hand-Taiyin originates at Shaoshang (on the inner side of the thumb, near the corner of the fingernail) and terminates at Zhongfu (one inch below Yunmen, between the third rib above the breast).

The Large Intestine Meridian of Hand-Yangming begins at Shangyang (on the outer side of the index finger, a leek leaf's width from the fingernail corner) and concludes at Yingxiang (above Heliao beside the nostril).

The Small Intestine Meridian of Hand-Taiyang starts at Shaoze (on the tip of the little finger, one fen below the fingernail) and ends at Tinggong (above the ear's pearl-like protrusion).

The Triple Burner Meridian of Hand-Shaoyang originates at Guanchong (on the outer side of the ring finger, a leek leaf's width from the fingernail) and terminates at Ermen (in the depression of the raised muscle in front of the ear).

Special note is made that the Heart Meridian of Hand-Shaoyin (corresponding to the sovereign fire) primarily treats external meridian disorders rather than internal diseases. This meridian begins at Shaoheng (on the inner side of the little finger, a leek leaf's width from the fingernail) and ends at Jiquan (in the arterial space between the tendons under the armpit).

The Liver Meridian of Foot-Jueyin starts at Dadun (on the tip of the big toe, a leek leaf's width from the toenail) and concludes at Qimen (one and a half cun beside Burong, at the end of the second rib).

The Stomach Meridian of Foot-Yangming originates at Lidui (on the tip of the second toe, a leek leaf's width from the toenail corner) and ends at Touwei (its exact location is not detailed in the text). These meridian pathways and acupoints form crucial channels for the circulation of Qi (vital energy) and blood in the human body.

This section explains the starting and ending acupoints of the twelve primary meridians in the human body along with pulse diagnosis methods:

The Foot Taiyang Bladder Meridian begins at the Jingming point (BL-1) at the inner canthus of the eye and terminates at the Zhiyin point (BL-67) on the lateral side of the little toe, approximately one leek leaf's width from the toenail. The Foot Shaoyin Kidney Meridian originates from the Yongquan point (KI-1) in the center of the sole (most evident when curling the toes in the depression of the foot), ending at the Shufu point (KI-27) two cun beside the clavicle. The Foot Shaoyang Gallbladder Meridian starts at the Qiaoyin point (GB-44) on the tip of the fourth toe (one leek leaf's width from the nail), concluding at the Tongziliao point (GB-1) five fen from the outer canthus. The Foot Taiyin Spleen Meridian begins at the Yinbai point (SP-1) on the medial side of the big toe (about one leek leaf's width from the toenail corner), finally reaching the Dabao point (SP-21) three cun below the armpit at the ninth intercostal space.

All twelve meridians exhibit palpable pulses, including the three yin and three yang meridians of both hands and feet: Hand Shaoyin Heart Meridian, Hand Taiyang Small Intestine Meridian, Foot Jueyin Liver Meridian, Foot Shaoyang Gallbladder Meridian, Foot Shaoyin Kidney Meridian, Foot Taiyang Bladder Meridian, Hand Taiyin Lung Meridian, Hand Yangming Large Intestine Meridian, Foot Taiyin Spleen Meridian, Foot Yangming Stomach Meridian, Hand Jueyin Pericardium Meridian, and Hand Shaoyang Triple Burner Meridian.

For pulse diagnosis, practitioners particularly examine the cunkou region at the wrist (one cun from the thenar eminence) to assess the health conditions of the five zang and six fu organs. The five zang organs refer to the liver, heart, spleen, lungs, and kidneys, while the six fu organs comprise the gallbladder, stomach, large intestine, small intestine, bladder, and triple burner. By observing pulse variations at the cunkou position, one can diagnose the prognosis of visceral diseases.

This passage explains the ancient Chinese medical practice of pulse diagnosis, focusing on the principles of "cunkou pulse reading" and the patterns of Qi (vital energy) and blood circulation in the human body.

The cunkou position on the right wrist is where the pulse of the Hand Taiyin Lung Meridian (one of the twelve primary meridians) can be felt. This location corresponds to the Taiyuan acupoint (a vital point), where the Qi and blood of all twelve meridians converge. During respiration, Qi and blood circulate through the meridians: with each exhalation, they travel three inches through the three Yang meridians (Taiyang, Shaoyang, and Yangming); with each inhalation, they move another three inches through the three Yin meridians (Taiyin, Shaoyin, and Jueyin). Thus, in one complete breath cycle (inhalation and exhalation), Qi and blood traverse a total of six inches.

Ancient physicians used water clocks (ancient timekeeping devices) to measure these processes. Over one full day-night cycle (equivalent to 24 hours), the water clock would complete one hundred "ke" (time units), during which the body would perform 13,500 respiratory cycles while Qi and blood completed fifty full circulations through the body. Twenty-five circulations occurred during daytime (Yang phase) and twenty-five during nighttime (Yin phase). During circulation, Nutritive Qi (Yin-type blood energy) flows within the blood vessels, while Defensive Qi (Yang-type energy) moves outside the vessels, maintaining continuous movement day and night.

Specifically: every 270 breaths correspond to Qi and blood traveling 16 zhang and 2 chi (ancient measurement units), equivalent to two "ke" on the water clock. When 13,500 breaths are completed, Qi and blood have traveled 810 zhang, precisely matching the full hundred "ke" cycle of the water clock (one complete day). After completing twenty-five Yang-phase and twenty-five Yin-phase circulations, Qi and blood reconverge at the cunkou position of the Hand Taiyin Lung Meridian, completing one full circulatory cycle.

This scripture explains the fundamental principles of pulse diagnosis in traditional Chinese medicine, focusing on the Yin-Yang distribution and diagnostic significance of the "cunkou pulse" (wrist pulse).

It begins by describing the circulatory pathway of Qi and blood in the human body: starting from the middle burner (spleen-stomach region), flowing sequentially through the Hand Taiyin Lung Meridian, Hand Yangming Large Intestine Meridian, Foot Yangming Stomach Meridian, Foot Taiyin Spleen Meridian, and the other twelve primary meridians to form a complete cycle. The cunkou pulse holds diagnostic importance because it reflects the Qi-blood condition of all five zang and six fu organs.

Regarding the specific divisions of the cunkou pulse:

• The radial artery pulsation point at the wrist crease is called the "guan position," serving as the boundary between Yin and Yang
• The one-cun area from the guan position toward the elbow (ulnar side) is the "chi position," belonging to Yin
• The nine-fen area from the guan position toward the thumb (thenar eminence) is the "cun position," belonging to Yang

This division follows Yin-Yang numerical principles:

• Yin numbers use even numbers like "ten," hence the chi position measures one cun (a divisor of ten)
• Yang numbers use odd numbers like "nine," hence the cun position measures nine fen

The patterns of Yin-Yang manifestation in pulse diagnosis:

• Yang Qi originates from the chi position and manifests in the cun position
• Yin Qi originates from the cun position and manifests in the chi position
• This corresponds with nature's rhythm where Yang Qi begins growing at the Start of Spring (Lichun) and reaches its peak around Grain in Ear (Mangzhong)

Therefore, by observing pulse changes in the cun, guan, and chi positions, practitioners can assess the waxing and waning of Yin-Yang and Qi-blood, determine the normal functioning of internal organs, and predict disease prognosis. This diagnostic method embodies the holistic view of correspondence between heaven and humanity.

This passage explains the patterns of Yin-Yang pulse manifestations in traditional Chinese pulse diagnosis. It first describes seasonal influences on pulse quality: from the summer solstice to the beginning of winter, Yang Qi gradually descends, causing pulses to transition from floating to deep—this reflects the natural principle of Yin concealed within Yang. From the beginning of autumn to the winter solstice, Yin Qi gradually grows, and after the winter solstice, as Lesser Yang (Shaoyang) Qi ascends, it peaks by the summer solstice, demonstrating the cyclical pattern of Yang contained within Yin. A normal pulse manifests across the three positions (Cun, Guan, Chi) with a total length of 1.9 cun (approximately 6 cm).

The third difficulty (from the Classic of Difficulties) discusses abnormal pulse conditions: some pulses beat excessively strong (hyperactive), others excessively weak (hypoactive); sometimes Yin pulses appear in Yang positions, or Yang pulses in Yin positions. There are also "reversed pulses" (where Qi flows backward from the Guan position to the Chi Ze) and "overflowing pulses" (where Qi surges upward from the Cun position to the thenar eminence).

It specifically explains the concept of "barrier and obstruction" (Guan Ge): when excessive Yin Qi blocks Yang Qi circulation, it's called "obstruction" (Ge); when excessive Yang Qi blocks Yin Qi, it's called "barrier" (Guan); when both Yin and Yang Qi are hyperactive and mutually repelling, it's termed "barrier-obstruction" (Guan Ge). Normally, Yang pulses should be distinctly palpable at the Cun position (radial artery at the wrist), measuring 0.9 cun (about 3 cm) with floating characteristics. Exceeding this standard indicates hyperactivity, while falling short indicates deficiency.

When the pulse surges upward to the thenar eminence (the fleshy mound at the thumb's base), it's called an "overflowing pulse": if it's a strong, forceful floating pulse, it signifies excessive Yang Qi; if it's a weak, feeble floating pulse, it indicates deficient Yang Qi causing rebellious Yin Qi ascent. External barrier with internal obstruction refers either to internal pulse Qi failing to reach the surface (deficiency/Yin overwhelming the pulse) or excessive external pulse Qi invading inward (hyperactivity/overflowing pulse).

This passage describes the condition where yin meridians (yin-dominated pulse manifestations) invade yang regions (yang pulse positions). Specifically:

During pulse diagnosis, the chi section (the region near the elbow beyond the guan pulse at the wrist crease) is the domain where yin qi circulates. A normal yin pulse should be calm and steady, approximately one cun in length. If palpation reveals the chi pulse exceeding one cun, reaching even 1.2 to 1.5 cun, with an especially full and forceful sensation upon pressure, this indicates excessive yin qi. Conversely, if it measures less than one cun—only seven to eight fen—and feels weak and thin upon pressure, this signifies deficient yin qi.

When yin qi is deficient, yang qi takes advantage of this weakness to form a "covering pulse" (an abnormal pulse where yang qi presses down on yin positions), a condition termed "internal obstruction with external rejection" (neiguan waige)—where internal pulse qi is obstructed while external pulse qi becomes resistant. Similarly, when yang qi is deficient, yin qi may rise aggressively to form a "spilling pulse" (an abnormal pulse where yin qi overflows into yang positions). Such yin-yang imbalances producing "true organ pulses" (life-threatening pulses revealing the visceral qi) indicate impending death even if the patient shows no apparent symptoms.

The fourth difficulty discusses the yin-yang principles of pulse diagnosis: during exhalation, pulse qi correlates with the heart and lungs (yang organs above the diaphragm), while during inhalation, it relates to the liver and kidneys (yin organs below the diaphragm). The spleen, positioned centrally, receives the essence of food and drink between breaths, with its pulse qi manifesting in the middle pulse position.

(Note: The translation retains specialized TCM terms like "chi section," "guan pulse," and "covering pulse," supplemented with basic explanations in parentheses. Classical diagnostic criteria are rendered into modern pulse descriptions for clarity, while necessary explanations are provided for technical concepts like "internal obstruction with external rejection" and "true organ pulses.")

The spleen functions as the body's warehouse manager, specializing in receiving and processing the Five Grains. When food enters the system, the spleen transforms it into nutritional essence (Jing), which becomes the foundational energy sustaining vital breath.

In pulse diagnosis, the superficial pulse belongs to Yang channels, circulating between the skin and blood vessels at the muscular surface level. The deep pulse corresponds to Yin channels, flowing along tendons close to the bones. This constitutes what traditional medicine describes as the Yin-Yang pulse manifestations.

Though both heart and lung pulses appear superficial, they can be distinguished by their characteristics: the heart pulse is broad and diffuse like spreading fire, while the lung pulse is short and constrained like contracting metal. Similarly, both liver and kidney pulses manifest as deep pulses, yet differ in quality - the liver pulse feels firm and enduring like tree roots anchoring in earth, whereas the kidney pulse seems soft upon pressure but reveals resilient strength when fingers are lifted, embodying water's soft exterior and strong interior.

The spleen occupies the body's central position, analogous to a nation's capital. Its pulse manifests at the intermediate level - above it lie the heart and lung, below reside the liver and kidney. This illustrates the Yin-Yang positioning method: The heart (Yang) resides in the upper burner (upper thoracic cavity) as Yang within Yang; the lung (Yin) occupies the upper burner as Yin within Yang; the kidney (Yin) dwells in the lower burner (lower abdominal cavity) as Yin within Yin; the liver (Yang) positioned in the middle burner (mid-abdomen) represents Yang within Yin; while the spleen (Yin) centered in the middle burner constitutes the ultimate Yin within Yin.

This scripture discusses the six Yin-Yang pulse variations encountered in traditional Chinese pulse diagnosis. Pulse conditions can be classified into two major categories: Yin pulses and Yang pulses, specifically manifested through six characteristics: floating (浮), deep (沉), long (长), short (短), slippery (滑), and hesitant (涩).

The floating pulse belongs to the Yang category, corresponding to the Lesser Yang (Shaoyang) channel; the slippery pulse is also Yang, corresponding to the Bright Yang (Yangming) channel; and the long pulse is likewise Yang, corresponding to the Greater Yang (Taiyang) channel. The deep pulse belongs to the Yin category, corresponding to the Lesser Yin (Shaoyin) channel; the short pulse is also Yin, corresponding to the Reverting Yin (Jueyin) channel; and the hesitant pulse is likewise Yin, corresponding to the Greater Yin (Taiyin) channel.

A one-Yin-one-Yang pulse refers to a condition where both deep and slippery characteristics appear simultaneously. If this pulse manifests at the left chi (尺) position (corresponding to the kidneys and bladder), it indicates a normal harmony between the exterior and interior. However, if it appears at the left cunkou (寸口) position (corresponding to the heart and lungs), it signifies an abnormal, pathological pulse.

A one-Yin-two-Yang pulse refers to a condition where deep, slippery, and long characteristics coexist. When this pulse appears in areas corresponding to Yin channels, it indicates that Yang Qi has invaded the Yin channels.

A one-Yin-three-Yang pulse refers to a condition where the pulse primarily displays Yang characteristics such as floating, slippery, and long, but occasionally exhibits a deep pulse. This suggests that a Yin pulse is latent within the Yang pulse.

A one-Yang-one-Yin pulse refers to a condition where both floating and hesitant characteristics appear together. If this pulse manifests at the right cunkou (寸口) position (corresponding to the lungs), it is normal; but if it appears at the left guan (关) position (corresponding to the liver and gallbladder), it signifies an abnormal, pathological pulse.

A one-Yang-two-Yin pulse refers to a condition where long, deep, and hesitant characteristics coexist. These pulse variations reflect different states of Yin-Yang imbalance in the body, and traditional Chinese medicine uses them to diagnose illnesses by discerning these specific pulse features.

This passage explains the Yin-Yang principles of pulse diagnosis in traditional Chinese medicine and specific palpation techniques:

Regarding the Yin-Yang attributes of pulse manifestations: Yang pulses appear long and floating, while Yin pulses manifest as deep and hesitant. If Yin pulse characteristics appear in areas that should exhibit Yang pulses, it indicates dual deficiency of Qi and blood, where Yin energy suppresses Yang energy. When a pulse is deep, hesitant and short but occasionally surfaces, this reveals Yang energy latent within Yin. By observing the seasonal variations in the twelve meridians, one can determine the progression or regression of an illness.

Detailed explanation of palpation pressure (using the right cunkou pulse as example):

The lung pulse is most superficial - light contact equivalent to the weight of three beans touching just below the skin surface suffices, requiring gentle pressure. The heart pulse lies slightly deeper, needing pressure equal to six beans to reach the blood vessel level. The spleen pulse requires moderate pressure like nine beans to reach the muscle layer. The liver pulse demands heavier pressure equivalent to twelve beans to reach the tendons. The kidney pulse is deepest - one must press firmly to the bone then suddenly release, with only a swift rebounding pulse qualifying as the true kidney pulse.

The principle lies in: The heart and lungs belong to Yang, positioned above the diaphragm, thus their pulses tend to float and require lighter touch; the liver and kidneys belong to Yin, located below the diaphragm, hence their pulses sink and need heavier pressure.

Regarding Yin-Yang excess and deficiency: Excessive Yang pulses cause Yin pulses to weaken, while excessive Yin pulses make Yang pulses appear deficient. For instance, when the floating (Yang) pulse becomes overly strong, the deep (Yin) pulse will seem weak; conversely when the deep (Yin) pulse dominates, the floating (Yang) pulse appears deficient. This waxing-waning relationship between Yin and Yang serves as the key to determining disease patterns of excess or deficiency.

This passage explains the patterns of Yin-Yang deficiency and excess in traditional Chinese pulse diagnosis. First describing the manifestations of Yang pulse (Cunkou pulse) deficiency: when lightly palpated, the pulse feels floating, thin and weak—the normally substantial and strong Yang pulse becomes deficient and insufficient. However, when pressed firmly, the pulse sinks and feels full and strong, indicating excessive dominance of the Yin pulse (Chi pulse). This condition is called "Yin excess with Yang deficiency."

Conversely, if firm pressure reveals a thin and weak Yin pulse, it signifies insufficient Yin Qi (vital energy). Meanwhile, a light touch detects an abnormally surging Yang pulse, indicating excessive Yang Qi. This is termed "Yang excess with Yin deficiency." These examples illustrate the fundamental patterns of Yin-Yang fluctuation.

The text then explains the seasonal characteristics of the Six Meridian pulses (Shaoyang, Yangming, Taiyang, Taiyin, Shaoyin, Jueyin): During the first and second lunar months when Shaoyang dominates, the pulse varies between large/small and long/short. In the third and fourth months under Yangming influence, the pulse becomes floating, large yet short. The fifth and sixth months governed by Taiyang show a surging, large and long pulse. Taiyin's reign in the seventh and eighth months produces a tight, large and long pulse. Shaoyin in the ninth and tenth months manifests as a tight, thin and faint pulse. Finally, Jueyin in the eleventh and twelfth months presents a deep, short and heavy pulse.

The passage concludes with a critical question: Are these six pulse conditions normal balanced states or pathological manifestations? This requires careful contextual judgment in clinical practice.

This scripture explains the seasonal patterns governing the body's three Yin and three Yang meridians (the six primary energy channels in traditional Chinese medicine). Ancient scholars used the sexagenary cycle of heavenly stems and earthly branches to calculate time, observing that beginning from the first Jiazi day after the winter solstice, each of the six meridians would successively govern the body's Qi and blood circulation for sixty days.

Specifically: Starting from the first Jiazi day after winter solstice (typically around Minor Cold or Major Cold solar terms in the lunar calendar), the Lesser Yang (Shaoyang) meridian - representing the nascent Yang energy in the body - assumes dominance. Here, Yang Qi has just begun emerging from Yin, resulting in pulse manifestations that alternate between large/small and short/long characteristics.

During the next Jiazi cycle, the Bright Yang (Yangming) meridian - representing stronger Yang energy - takes charge. As weather warms but Yang Qi remains unfulfilled, the pulse appears floating, large yet short.

When the third Jiazi arrives, the Greater Yang (Taiyang) meridian - the most Yang-dominant channel - governs during midsummer, producing a pulse that's surging, large and long.

The fourth Jiazi sees the Greater Yin (Taiyin) meridian - governing dampness - dominate during late summer and early autumn when heat and humidity persist, creating a pulse that's tense, large and elongated.

During the fifth Jiazi, the Lesser Yin (Shaoyin) meridian - governing cold energy - assumes control as autumn deepens and chill intensifies, manifesting a pulse that's tight, thin and faint.

Finally, the sixth Jiazi brings the Reverting Yin (Jueyin) meridian - the most Yin-dominant channel - to prominence during severe winter when Yin cold congeals, producing a deep, short and heavy pulse.

This complete six-Jiazi cycle of 360 days forms one annual revolution, illustrating the fundamental waxing and waning patterns of the three Yin and three Yang meridians with seasonal changes. Ancient practitioners observed these pulse variations to assess whether a person's Qi-blood circulation harmonized with natural rhythms.