《孫真人備急千金要方》Vol. 84

Essential Prescriptions for Emergencies Worth a Thousand Pieces of Gold by Master Sun the True Person, juan 84 (“Hidden Section II”)

Formulas for Cultivating Nature and Pacifying the Pulse

The First Great Method of Pacifying the Pulse (Seven Discussions)

The discussion says: Pulse diagnosis is an exceedingly important branch of medicine. If one does not investigate its principles deeply, how can one become a physician? Thus, the wise physicians of antiquity were unlike ordinary people whether awake or asleep, bending forward or looking upward. In haste, they thought of medicine; in hardship, they thought of medicine. This enabled them to communicate with spirits and understand Heaven and Earth, relieve the people, and become those whom others could trust and rely upon. If they simply drifted along like ordinary people, everything would fall into ruin. Who, then, could people depend on? From this we can see that those who study medicine should cast aside worldly distractions and devote themselves to the Dao of medicine. Only then might they attain the remarkable skill of Bian Que and He Huan.

The medical classic says: Pulse diagnosis should generally be performed at dawn. At that time, Yin Qi has not yet stirred and Yang Qi has not yet dispersed. The patient has not eaten, and the Qi and blood in the channels have not been invigorated by food. The network vessels are also relatively calm, and the Qi and blood have not been disturbed. This is therefore a suitable time to examine abnormal pulses. (The Pulse Classic says that if the pulse is not taken at this time, the diagnosis may be inaccurate.) While taking the pulse, observe its movement and stillness, and also examine whether the eyes are bright and what the complexion is like. Determine whether the Five Zang organs have excess or deficiency, whether the Six Fu organs are strong, and whether the body is flourishing or depleted. By comparing these signs with one another, one can judge the boundary between life and death.

It also says: A balanced pulse should always be examined at dawn. Neither the physician nor the patient should eat or speak. They should sit quietly, regulate their breathing, and let the breath settle. If either has been active beforehand, they should rest for roughly the time it takes to eat a meal; the physician must do the same. Once the body is calm, first examine the cun-kou pulse, on the palm side of the wrist. Press down firmly until the fingers reach the bone, then gradually lift them until the pressure is neither too light nor too heavy, just touching the skin and hair, as though three beans were resting on the skin. Adjust the pressure according to the person’s strength and build, whether robust or slender, and carefully vary the pressure of the fingers so that it accords with the pulse’s depth. The different pulses should also be compared with the seasons, the Five Phases (Wood, Fire, Earth, Metal, Water), and the body’s Five Zang organs. If they do not correspond, look for signs in how the pulse changes under varying degrees of pressure, and distinguish cold from heat and the body’s gains and losses.

People differ in constitution and in the Qi they receive at birth. Some are balanced and moderate, while others are restless or quiet; the rise and fall of their Qi and pulse also vary according to their individual dispositions. In general, the pulse beats twice during one exhalation and twice during one inhalation. It beats once more between the exhalation and inhalation, making five beats in all. This is a balanced, moderate pulse. At the spring and autumn equinoxes, day and night are equal…

At other times, the pulse may beat more often during exhalation and less often during inhalation; the reverse may also occur, with more beats during inhalation and fewer during exhalation. This variation is like the differences in the length of winter and summer, and of day and night. A person’s breathing and pulse change over the course of day and night and also correspond to the seasons. Yet when measured against a single breath, five pulse beats remain the norm, without becoming irregular. This is like the changing lengths of the sundial’s hours across the seasons: the number of days in a year remains complete.

People’s constitutions differ in strength, and their breathing rates are affected by these differences. Even so, the total number of breaths in a day and night still varies with the duration shown by the water clock, an ancient timekeeping device. This is called breathing in accord with the changes of day and night and corresponding to the four seasons.

When taking the pulse, first quiet your mind and observe your own breathing. Then adjust the rhythm of taking the pulse so that your breathing corresponds to the patient’s, and observe the pulse rate. Five beats during one breath is the normal pulse of a healthy person. If the number is higher or lower, examine the pulse further, determine the cause of the illness, and assess the appropriate treatment accordingly.

Question: What are the “three pulse positions”?

Answer: They are the cun, guan, and chi positions. People’s arms vary in length and shape. To locate the cun, guan, and chi positions, measure the distance from the wrist crease to the crease behind the thenar eminence, the raised area at the base of the thumb. Divide this distance into ten parts. From the wrist crease toward the base of the palm, measure nine parts to mark the chi position. From the crease behind the thenar eminence, measure back one tenth of the distance to mark the cun position. The area within the cun position near the wrist where the pulse can be felt is called the cun kou. A bone projects at the cun kou; hence it is said that the chi position extends one cun and the cun position nine fen. From the cun kou toward the elbow, measure six fen inward to locate the guan position; measure another six fen inward to locate the chi position.

Another account says that the cun kou is the one cun measured back from the thenar eminence to the prominent bone, the radial styloid at the wrist. The area from the cun kou to the chi position is called the chi ze. The place behind the cun kou and before the chi position is called the guan. The guan is where Yin and Yang meet: Yang Qi moves outward from here, and Yin Qi moves inward. The cun, guan, and chi positions are like the three realms of Heaven, Earth, and humanity. The cun position corresponds to the upper burner and reflects conditions from the head and body hair to the hands; the guan position corresponds to the middle burner and reflects conditions in the abdomen and lower back; the chi position corresponds to the lower burner and reflects conditions from the lower abdomen to the feet. This is the method of interpreting the three positions, which also correspond to Heaven, Earth, and humanity, and to the head, abdomen, and feet.

All twelve meridians have pulsating vessels. Why, then, can the life, death, good fortune, and misfortune of the five viscera and six bowels be judged by taking the pulse only at the cun kou? …

The pulse is where Qi and blood circulate and gather. The pulse of the Hand Greater Yin channel, or Lung channel, beats here. With each exhalation, the pulse travels three cun; with each inhalation, it also travels three cun. Over one full breath, followed by a brief pause, it travels a total of six cun. A person breathes about 13,500 times in a day and night, and the pulse circulates around the body fifty times. By the ancient system of timekeeping, a day and night consists of one hundred ke. The nutritive Qi and defensive Qi—the two kinds of Qi that circulate within the body—travel twenty-five circuits on the body’s surface and twenty-five within the body, together making one complete circuit. After fifty circuits, the pulse returns to the Hand Greater Yin. Its pulse point is the cun-kou, the place at the wrist where the pulse is taken. The Qi and blood of the five zang organs and six fu organs both begin and end here, so pulse diagnosis is performed at the cun-kou. The human body has 360 channels, corresponding to the 360 days of the year.

How to assess the relative depth of the pulses of the five zang organs

When first taking the pulse, press with a touch as light as if pressing on three beans. At this light pressure, the pulse corresponding to the skin and hair belongs to the Lung, corresponds to Metal among the Five Phases, and is associated with the three months of autumn and the Qi of Geng and Xin.

Press as if on six beans, and the pulse corresponds to the blood vessels. It belongs to the Heart, corresponds to Fire, and is associated with the three months of summer and the Qi of Bing and Ding.

Press as if on nine beans, and the pulse corresponds to the muscles. It belongs to the Spleen, corresponds to Earth, and is associated with the periods when Earth is dominant at the end of each season—specifically, the sixth lunar month, late summer—and the Qi of Wu and Ji.

Press as if on twelve beans, and the pulse corresponds to the sinews. It belongs to the Liver, corresponds to Wood, and is associated with the three months of spring and the Qi of Jia and Yi.

Press down to the bone; when you release your fingers, the pulse comes quickly. This belongs to the Kidney, corresponds to Water, and is associated with the three months of winter and the Qi of Ren and Gui.

The Heart and Lung pulses are both somewhat floating. How can they be distinguished? A pulse that is floating, large, and spreading out is the Heart pulse; one that is floating, short, and rough is the Lung pulse.

The Kidney and Liver pulses are both somewhat deep. How can they be distinguished? A pulse that is firm and long is the Liver pulse. One that feels soft under pressure but full and strong when the fingers are lifted is the Kidney pulse. The Kidney pulse is soft and yielding like water, yet has strength beneath the pressure.

The Spleen lies in the middle burner, the central part of the body, so its pulse occupies the middle position, neither floating nor deep. It is a pulse that combines Yin and Yang. The Qianjin Yifang says that a pulse that is slow and long belongs to the Spleen.

Pulse qualities felt beneath the fingers

Floating pulse: It feels full when the fingers rest lightly on the surface, but deficient when pressed down.

Deep pulse: It feels deficient when the fingers rest lightly on the surface and becomes full only when pressed down.

Rough pulse: The pulse is fine and slow, and its movement feels rough and obstructed.

A “scattered pulse” sometimes pauses briefly and then resumes. Another account describes it as floating and short, or short and abrupt with occasional pauses, as if it were about to disperse.

A “slippery pulse” flows smoothly as it comes and goes, like a rolling bead, moving continuously with each beat following the last. To the touch, it resembles a “rapid pulse,” which beats relatively fast. Another account describes it as floating within the pulse position, with what seems to be one ninth of each beat perceptible.

A “surging pulse” feels extremely large beneath the fingers. Another account describes it as floating and large.

A “fine pulse” is small yet remains palpable throughout; only its shape is fine.

A “faint pulse” is extremely fine and soft, seemingly on the verge of ceasing, and barely perceptible beneath the fingers. Another account calls it small; others say it feels fast and thin, or nearly disappears when pressed.

A “wiry pulse” cannot be felt when the fingers are raised lightly, but under pressure it feels like a taut bowstring. Another account says it is tense like a bowstring and does not shift when pressed. Some also call a pulse that is floating and tense a wiry pulse.

A “tight pulse” beats relatively fast and feels like a taut rope being cut beneath the fingers. Another account describes it as resembling a turning rope, with an unpredictable quality.

A “slow pulse” beats three times during one inhalation and exhalation, and moves slowly in both directions. Another account says it feels weak under light pressure but firm under heavy pressure. Others say it remains firm when pressed all the way down, but cannot be felt when the fingers are raised lightly.

A “scattered pulse” comes and goes abruptly. Another account says it beats six or seven times during one breath. Some also explain “rapid” as meaning that the pulse advances more quickly.

A “moderate pulse” comes and goes slowly, but is slightly faster than a slow pulse. Another account describes it as floating, large, and soft, with both Yin and Yang pulses clearly perceptible.

A “weak pulse” is extremely soft, deep, and fine; when pressed, it nearly disappears beneath the fingers. Another account says it can be felt only under pressure and vanishes as soon as the fingers are lifted.

A “moving pulse” appears at the “bar” position—the middle of the wrist’s three positions, known as inch, bar, and cubit. It has no distinct beginning or end, is about the size of a bean, and beats prominently with a wavering motion.

A “hidden pulse” can be felt only by pressing firmly with the fingers down to the bone. Another account says that when the pulse at the bar position lies deep and does not appear, it is called a hidden pulse. Others say it can be felt beneath the hand only as a faint beat and cannot be detected when the fingers are raised lightly.

A “hollow pulse” is floating, large, and soft. When pressed, it is empty in the middle but firm at the sides. Another account says no pulse is felt beneath the pressed finger, though it can be felt on either side.

A “soft pulse” is extremely soft, floating, and fine. Another account says it cannot be felt under pressure but can be felt when the fingers are raised lightly; others describe it as small and yielding. The Qianjin Yifang writes “soft” with the character meaning “moist.”

A “deficient pulse” is slow, large, and soft. It lacks strength under pressure and feels hollow and unfilled beneath the fingers.

A “replete pulse” is large and long, with some force, and feels full and substantial under pressure. Another account holds that it can be felt under both light and deep pressure.

An “intermittent rapid pulse” comes and goes relatively quickly, pauses after a run of beats, and then resumes.

An “intermittent slow pulse” comes and goes relatively slowly, pauses after a run of beats, and then resumes.

A bound pulse pauses in the middle of its beat, and after stopping cannot resume on its own, though it begins beating again later.

An intermittent pulse resumes in a regular pattern after a pause. It is considered a critical sign associated with impending death. A scattered pulse is floating, large, and loose. This pulse indicates abundant Qi and deficient Blood, with signs of an exterior condition but none of an interior condition. The leather pulse resembles a deep, hidden, forceful pulse; it is also large and long, with a slight wiry quality. In this passage, the Qianjin Yifang writes “firm” instead of “leather.”

The following pulse qualities resemble one another: the wiry and tight pulses; the soft and weak pulses; and the floating and hollow pulses. Another account says the floating pulse resembles the surging pulse. The faint and rough pulses resemble one another; so do the deep and hidden pulses, and the moderate and slow pulses. Another account says the soft pulse resembles the slow pulse. The leather pulse resembles the replete pulse; the Qianjin Yifang gives “the firm pulse resembles the replete pulse.” The slippery pulse resembles the rapid pulse.

Fourth: The Pulse Qualities Associated with the Five Viscera

The Heart pulse is at the left wrist, in the cun position before the bar, also called “Welcoming Qi.” The Liver pulse is at the left wrist above the bar, and the Kidney pulse is below the bar, in the chi position.

The Lung pulse is at the right wrist, in the cun position before the bar, also called the “Qi opening.” The Spleen pulse is at the right wrist above the bar, and the Kidney pulse is below the bar, in the chi position.

The Ode on the Pulse Method says:

The pulses of the Liver and Heart appear on the left hand; those of the Spleen and Lungs appear on the right. The pulses of the Kidneys and the Gate of Life both appear in the chi positions. The Hun, Po, and Grain Spirit—concepts associated with a person’s spirit and the transformation of food—can all be discerned from the cun pulse.

The left hand is used to examine the “officials,” and the right hand to examine the “storehouses.” The pulse on the left accords with men, and the pulse on the right accords with women. The area one fen before the bar is vital to human life. The left hand is called Welcoming Qi, and the right hand the Qi opening. The Spirit Gate, a pulse position near the chi used to assess illness, can serve as a guide; it is located on both sides below the bar. If a person has a pulse on only one side, the illness will be difficult to cure, and death may be a risk.

Damage and decline in the various channels should be assessed separately according to their corresponding positions. Observe carefully which of the Three Yin and Three Yang pulses appears first and which appears later. For Yin illnesses, treat the “officials” (here meaning the inner viscera); for Yang illnesses, treat the “storehouses” (here meaning the outer bowels).

Where does pathogenic Qi lodge, and how can it be detected and located? Examine the illness carefully. Once it has been identified, apply acupuncture, and the illness can be cured.

The pulse is divided into three regions, where Yin and Yang Qi interact. Nutritive Qi, Defensive Qi, and Blood Qi circulate within the body, moving in and out with the breath and flowing through the upper and lower body. Qi circulates and spreads throughout, and fluids move along with it. The pulse changes with the seasons, taking different forms: wiry in spring, floating in autumn, deep in winter, and surging in summer.

When observing complexion and examining the pulse, one must also attend to differences in the pulse’s size. At this point, the original text continues with “within a moment,” but the sentence remains unfinished.

The pulse does not have a fixed appearance. The pulses at the cun, guan, and chi positions may not align; at times the pulse is short, at times long. Its upper and lower positions may also be disordered, sometimes clearly perceptible and sometimes difficult to detect. The condition changes accordingly, as the pulse grows stronger or weaker, sinks or rises. This can leave the examiner uncertain and make it easy to lose the essential points of diagnosis. I hope these patterns can be explained one by one, so their principles will become clear.

The Master said: You ask about the fundamental principles of pulse diagnosis. The pulse is divided into three positions: cun, guan, and chi. The body’s nutritive Qi and defensive Qi—the Qi that sustains the body’s functions and protects it—circulate throughout the body, and the pulse should remain balanced. The kidney pulse is deep, the heart pulse surging, the lung pulse floating, and the liver pulse taut and straight. These are common pulse patterns and generally do not vary in subtle ways.

Qi and blood enter and leave, rise and descend, circulating at their appointed times. After two ke in the clepsydra’s measurement of time, the pulse Qi makes a complete circuit of the body and returns to the cun position, the pulse examination point at the wrist. From this, one can discern whether the pulse is replete or deficient.

Different pulse patterns influence one another, and Yin and Yang also intersect. When wind pathogen invades, the pulse is usually floating and deficient; when cold is present, it is usually tight and taut; when fluids accumulate, it is usually deep and hidden. In the case of branch fluid retention, an urgent, taut pulse is often seen. A moving, taut pulse usually indicates pain; a rapid, surging pulse usually indicates intense heat and agitation. If the pulse does not accord with these patterns, one must investigate the reason for the change.

The pulses at the cun, guan, and chi positions differ, as do the conditions they reflect. Excess or insufficiency in the pulse both merit attention. Pathogenic Qi does not appear without cause; there must ultimately be a factor that brought on the illness. In diagnosis, distinguish exterior patterns from interior patterns, identify where the pathogen has lodged among the Three Burners—the upper, middle, and lower functional regions of the body in traditional medicine—and then examine the pulse closely in light of changes in the condition. Use it to infer the state of the organs and strive to see the illness clearly.

Fifth: Distinguishing the Forms of Illness Patterns

A rapid pulse usually indicates illness in the bowels; a slow pulse usually indicates illness in the organs. A long, taut pulse usually indicates illness in the liver. A small pulse indicates scant blood and usually points to illness in the heart. Bian Que’s account says that a large, surging pulse indicates a disorder originating in the heart. If the lower part of the pulse is firm and the upper part weak, the illness is usually in the spleen and stomach. A slippery pulse (some versions read “rough”) that is faintly floating usually indicates illness in the lungs. A large, firm pulse usually indicates illness in the kidneys; Bian Que’s account says the pulse is small and tight.

A slippery pulse usually indicates abundant blood and scant Qi; a rough pulse indicates scant blood and abundant Qi; a large pulse indicates abundance of both Qi and blood. Another account says that a large, firm pulse indicates that Qi and blood are both replete; a small pulse indicates that both are scant; and a fine, faint pulse indicates that both are deficient.

A deep, fine, slippery, and rapid pulse indicates heat; a slow, tight pulse indicates cold. The Pulse Classic says that surging, rapid, slippery, and swift pulses indicate heat, while rough, slow, deep, and fine pulses indicate cold. A strong, large, slippery, and tight pulse usually indicates an exterior illness and belongs to heat; a small, replete, and tight pulse usually indicates an interior illness and belongs to cold. A small, weak, and rough pulse is called a chronic illness; a slippery, floating, and swift pulse is called a recent illness. A floating, slippery pulse…

The patient appears to have a fever, with pain that moves about as if caused by wind-evil, and fluid-retention evil that has gathered and stagnated. This condition is difficult to treat. A deep, tight pulse indicates heat in the upper burner and cold in the lower burner; exposure to cold brings on diarrhea. A deep, fine pulse indicates cold in the lower burner.

Frequent urination, persistent cramping pain, and unremitting diarrhea, together with a floating, tight, slippery pulse whose shape is straight and long, indicate that the illness is worsening.

A fever on the exterior, heat in the head, and a carbuncle or swelling, together with a fine, faint, and rapid pulse, indicate that the illness is worsening.

When internal cold forms shan masses and accumulations—lumps or stagnation in the abdomen—and causes stabbing abdominal pain, a deep, forceful, straight, and long pulse that breaks off midway indicates illness in the blood aspect and intestines. A deep, forceful pulse that becomes scattered midway indicates that cold has caused food stagnation and formed a mass. A straight, long pulse that becomes scattered or breaks off midway indicates consumptive thirst (xiaoke); one interpretation identifies this instead as spreading sores, a skin disease whose ulcers continue to spread.

A deep, forceful pulse that fails to reach the cun position at the wrist, lingering there or breaking off, indicates illness in the flesh, called “hidden corpse” (dunshi), an ancient disease name. A pulse that turns to the left and is deep and forceful indicates weak Qi, with Yang Qi congested in the chest. A pulse that turns to the right but fails to reach the cun position indicates a flesh mass inside the body.

A pulse that rises and falls continuously like a string of beads, yet does not reach the cun position, indicates wind-cold lodged in the large intestine and lying dormant. A pulse that rises and falls continuously as if halted, fails to reach the cun position, and is soft indicates heat bound in the membrane of the small intestine and lying dormant. A pulse that extends forward and beats on both sides indicates illness in the blood vessels, called “embryonic blood” (the original term; its precise meaning is unclear). A pulse that moves backward and beats on both sides indicates illness in the sinews and bones.

When the pulse is large at the front and small at the rear, headache and dizziness occur; when it is small at the front and large at the rear, there is tightness in the chest and shortness of breath. If there is a pulse in the upper part but none in the lower, the patient should vomit; if vomiting does not occur, the condition is life-threatening. If there is no pulse in the upper part but one in the lower, the patient may be debilitated, but there is usually no serious danger.

The pulse is where Blood and Qi circulate. A long pulse indicates that Qi flows freely; a short pulse indicates disordered Qi; a rapid pulse indicates agitation in the heart; a large pulse indicates that the illness is worsening; a forceful pulse in the upper part indicates Qi surging upward; a forceful pulse in the lower part indicates distension from Qi; an intermittent pulse indicates that Qi is weakening; a fine pulse (the Taishu reads “slippery”) indicates scant Qi; and a rough pulse indicates heart pain.

A chaotic, coarse, rapid pulse, like water gushing from a spring, indicates that the illness is worsening and dangerous. A faint, slow, and scattered pulse that disappears as if a taut string had snapped is a sign of death. A short, rapid pulse indicates illness in the upper part; a long, slow pulse indicates illness in the lower part. A deep, wiry, rapid pulse indicates illness inside the body; a floating, surging pulse indicates illness on the body’s exterior. A replete pulse indicates illness inside the body; an empty pulse indicates illness on the exterior. The upper part corresponds to the exterior, and the lower part to the interior; a floating pulse corresponds to the exterior, and a deep pulse to the interior.

A slippery pulse indicates an excess of pathogenic Qi and may also suggest that the illness is moving downward. It can likewise indicate Yang Qi or illness within the body. A rapid pulse indicates deficiency or heat; a floating pulse indicates Wind pathogen and may also indicate deficiency. A moving pulse indicates pain or palpitations with fright; a deep pulse indicates retained fluids or excess pathogenic Qi, and may also indicate ghost-injection (a kind of illness that the ancients attributed to malevolent spirits). A weak pulse indicates deficiency or palpitations; a slow pulse indicates cold; a rough pulse indicates insufficient blood; a moderate pulse indicates deficiency. A surging pulse indicates abundant Qi, though some editions read “heat.” A tight pulse indicates cold; a wiry pulse combined with rapidity is often seen in malaria. The pulse in malaria is usually wiry: wiry and rapid indicates heat, while wiry and slow indicates cold. A faint pulse indicates deficiency; an intermittent or scattered pulse indicates a poor prognosis.

A wiry pulse indicates pain or impediment syndrome (obstructed flow of Qi and blood, with numbness and pain in the limbs); some editions instead read, “A floating pulse indicates invasion by Wind pathogen.” A pulse tending toward wiriness indicates retained fluid pathogen, while a double-wiry pulse indicates tightness and pain below the ribs, often accompanied by chills and shivering. A large pulse indicates pathogenic cold and heat within the body. A hidden pulse (deep and difficult to detect) may indicate cholera, an ancient term for acute illnesses involving vomiting and diarrhea. A forceful pulse indicates blood loss.

The pulse may be tight, floating, and large as a result of excessive sweating, cold in the Lungs, drinking cold water, coughing, diarrhea, or deficiency-cold in the Stomach. A floating and large pulse indicates Wind pathogen; a floating-large pulse indicates Windstroke. A floating and moderate pulse indicates a heavy head and nasal congestion, or Wind-Cold invading the muscles and causing numbness of the skin. A slippery, floating, and scattered pulse indicates flaccid Wind paralysis, an ancient term for illnesses involving slackness of the limbs and paralysis. A slippery pulse indicates ghost-injection; a rough and tight pulse indicates impediment disease. A floating, surging, large, and long pulse indicates Wind dizziness or epilepsy; a large, firm pulse with a forceful onset indicates epilepsy.

A wiry and hooked pulse indicates knife-like pain below the ribs, with symptoms resembling “flying corpse,” an ancient term for a kind of sudden, severe illness. Even when the patient is extremely debilitated, death may not come immediately. A tight and rapid pulse indicates “wandering corpse,” another ancient term for a kind of sudden, severe illness. A surging and large pulse indicates a severe febrile illness due to Cold Damage. When Cold Damage presents with a floating, surging, and large pulse, the prognosis is better in autumn; in spring, the illness may worsen and become severe.

A floating and slippery pulse indicates retained food. A floating, slippery, and rapid pulse indicates that food cannot be digested and that the Spleen and Stomach are failing to transform and transport it properly. A short, rapid, and slippery pulse indicates an alcohol-related illness; a floating, fine, and slippery pulse indicates excessive drinking. A slow and rough pulse indicates internal cold. If there is an abdominal mass (a lump inside the abdomen), the pulse is rapid and tight, and the site of the mass has a throbbing pain. A wiry and rapid pulse indicates a hernia-like mass or lower abdominal pain; it may also indicate an accumulation disorder within the abdomen, though some editions read “impediment disease.”

A slow and slippery pulse indicates abdominal distention; a forceful and tight pulse is also called abdominal distention. A wiry and small pulse indicates cold accumulation in the abdomen caused by Cold pathogen. A deep and wiry pulse indicates internal pain caused by suspended fluid, or retained fluid lodged in the body. A wiry and rapid pulse indicates cold fluid; it is difficult to treat in both winter and summer.

A tight and slippery pulse indicates vomiting; a small, weak, and rough pulse indicates Stomach Reversal, in which Stomach Qi rebels upward and food is vomited back after being eaten. A slow and moderate pulse indicates cold; a faint and tight pulse also indicates cold. A deep and slow pulse indicates cold pathogenic factors in the internal organs. A faint and weak pulse indicates cold and scant Qi. A replete and tight pulse indicates cold in the Stomach, making it difficult for the patient to eat. If diarrhea is also frequent, the condition is difficult to treat; another edition reads, “Frequent vomiting and hiccups make it difficult to treat.”

A slippery and rapid pulse indicates bound heat below the heart; a forceful, slippery, and rapid pulse indicates heat in the Stomach.

A slow and slippery pulse indicates internal heat. A deep and rapid pulse means the person has been injured by summer heat, with a sudden onset of deficiency heat. A floating pulse that occasionally stops indicates that the movement of Qi is obstructed. A large and slippery pulse, accompanied by shortness of breath, indicates a mixture of symptoms. A floating, short pulse shows that the person’s lungs have been injured and all forms of Qi are faint and deficient. The person will not live beyond a year, and is likely to have a cough. A deep and rapid pulse indicates water Qi within the body; in winter, the condition will improve on its own even without treatment. A short and rapid pulse indicates heart pain and vexation. A wiry and tight pulse indicates pain in the ribs and injury to the internal organs, with blood stasis (one version reads “congealed blood”). A deep and slippery pulse indicates a heavy, downward sensation, and may also involve pain in the muscles beside the spine.

A pulse that comes fine and slippery, feels weak under pressure, then suddenly becomes tight and forceful indicates rigidity and collapse caused by a fall from a height; the illness is internal. A slightly floating pulse is auspicious in autumn but will become an illness in winter. A slightly rapid pulse will not develop into a serious illness, even if it appears severe, but the person must not overexert themselves. A floating, slippery, rapid, and tight pulse indicates a combination of various pathogenic influences; after a long time, it is actually likely to heal.

When Yang pathogens arrive, the pulse is floating and surging; when Yin pathogens arrive, it is deep and fine; when the Qi of food and drink arrives, it is firm and substantial. A pulse that suddenly grows large or small, long or short, is caused by a ghostly disturbance. A surging, large pulse that is soft and wavering is also a disturbance pulse. A deep, moist pulse accompanied by numbness and heaviness in the limbs is the pulse of an earth spirit, corresponding to the Qi of the flesh. A pulse that remains forceful as it comes can be treated with purgation. A wiry, small, and tight pulse can also be purged. When the pulse is tight and rapid and chills and fever occur together, purgation is essential for recovery. A wiry and slow pulse is suited to warming medicines; a tight and rapid pulse can be treated by inducing sweating.

The Sixth Section: Correspondences and Indications of the Three Pulse Positions (“Three Pulse Positions” refers to the Cun, Guan, and Chi positions; this section explains which parts of the body correspond to the pulse at each position.)

When floating, wiry, deep, tight, rough, or slippery pulses appear at the Cun position, they indicate illness above the diaphragm, in the head and chest. At the Guan position, they indicate illness below the stomach, in the abdomen. At the Chi position, they indicate illness below the kidneys, in the lower back and legs.

A normal pulse at the Cun position is slippery and slightly slow, neither deep nor floating, neither long nor short. This means there is no illness; the same applies to both hands.

To determine whether the pulse at the Cun position is excessive or deficient: if its beat feels short beneath the finger, it indicates headache; if it feels long, it indicates pain in the shins; if it beats urgently and surges upward, it indicates pain in the shoulders and back. A deep and firm pulse at the Cun position indicates illness inside the body; a floating and forceful pulse indicates illness on the body’s surface. A deep and weak pulse at the Cun position indicates alternating chills and fever, as well as shan and jia disorders (abdominal accumulations or lumps) and lower abdominal pain (one version reads “heat” instead of “Qi”; another reads “middle”). A deep and weak pulse at the Cun position also means the hair will certainly fall out. A deep and tight pulse at the Cun position indicates cold beneath the heart, with frequent pain.

A deep, slippery pulse at the cun position indicates fluid in the chest. If the face and the area around the eyes are swollen, with a slight fever, this is wind-water swelling, caused by wind pathogens contending with fluid. A deep, large, and slippery pulse at the cun position means that excess pathogenic factors are present in the blood aspect, as shown by the depth, and in the Qi aspect, as shown by the slipperiness. If Qi and blood contend and the pathogens enter the zang organs, the condition becomes critical; if they enter the fu organs, recovery is possible.

A deep pulse at the cun position, with shortness of breath in the chest, indicates constrained breathing. A deep pulse accompanied by panting indicates the presence of cold and heat pathogens. A floating, slippery pulse at the cun position indicates pain in the head. A large, floating pulse that feels rough under pressure, together with slight roughness at the chi position, points to Qi stagnation and retained food—food that has remained undigested.

A wiry, tight pulse at the cun position indicates that the defensive Qi is not flowing smoothly; when its flow is obstructed, there is aversion to cold. When fluid moves through the intestines and stagnates there, the cun pulse becomes tight. A tight or floating pulse indicates cold above the diaphragm and fluid below the lungs. A tight pulse rising beyond the cun position indicates windstroke and is often accompanied by headache; another account holds that it may also indicate a headache from cold damage. A wiry pulse rising beyond the cun position indicates retained food; when the pulse force descends, headache may result.

A wiry, large pulse at the cun position may indicate prolonged bleeding between periods in a woman, or blood loss and seminal emission in a man. A faint, weak pulse indicates aversion to cold through its faintness and fever through its weakness. If an expected illness does not occur, there may instead be pain and vexation in the joints. If vexation is expected but does not occur, profuse sweating may follow. A faint, weak cun pulse may also indicate deficiency of both Qi and blood: a man may vomit blood, while a woman may have uterine bleeding, accompanied by vomiting and sweating.

A moving, weak pulse at the cun position indicates fright through its movement and palpitations through its weakness. A slow, delayed pulse indicates deficiency through its slowness and cold through its delay. When deficiency and cold combine, there is a desire for warm foods; eating cold foods may then cause pain in the throat. A delayed, slow pulse indicates cold through its delay and Qi through its slowness. When cold Qi contends, it may cause colicky pain. A delayed, rough pulse indicates cold through its delay and a shortage of blood through its roughness.

When the pulse crosses the cun position and enters the thenar eminence—the raised area at the base of the thumb—it indicates involuntary urination. When the pulse extends beyond the thenar eminence, it indicates rebellious Qi and panting. A cun pulse that shows only excess indicates strain of the heart.

A cun pulse that beats lightly and floats, like oil floating on the surface of soup, indicates weakened Yang Qi. A fine, continuous, weak pulse, like a spider’s thread, indicates declining Yin Qi. If the Yang pulses at the cun positions of both hands are cut off, there may be cold below the heart and heat in the mouth. If the pulse is cut off on one side at the cun position, one arm may become unable to move; if the pulses in both hands are cut off, the condition is difficult to rescue.

A cun pulse that alternates between large and small indicates disease of the Yin network vessels, often with obstruction by Yin wind and trembling during attacks. A cun pulse that alternates between small and large indicates disease of the Yang network vessels, often accompanied by skin disorders, sweating, and aversion to cold.

When a part of the body becomes numb and unresponsive and the cun-kou pulse is floating (felt near the surface), this indicates fever and headache after exposure to wind. Guizhi Decoction or Gegen Decoction is appropriate. Needle Fengchi and Fengfu points, then warm the body by the fire, apply a wind-treating ointment, and cover the person with bedding to induce sweating.

When the cun-kou pulse is tight and accompanied by headache, this indicates Cold Damage, a disorder caused by externally contracted cold pathogens. Mahuang Decoction is appropriate to induce sweating. Needle Meichong and Taiyang points, and apply Cold Damage ointment.

When the cun-kou pulse is faint and weak and there is aversion to cold, nosebleeds may occur. Wuweizi Decoction is appropriate, along with an ointment of ephedra and evodia, to induce sweating.

When the cun-kou pulse is rapid, vomiting may occur. This is because there is heat in the epigastrium, whose vapors rise and steam the chest. Use medicine to induce vomiting, needle the epigastric region, and then take a decoction that clears heat pathogens.

If, seven or eight days to ten days into Cold Damage, heat pathogens remain in the body and cause restlessness, abdominal distension and fullness, and thirst, Zhimu Decoction is appropriate.

When the cun-kou pulse is large and forceful and the chest and flanks feel distended and full, Shengjiang Decoction and Baiwei Pills are appropriate. The medicine may also be taken with Ziyuan Decoction. Needle the Shangwan, Qimen, and Zhangmen points.

When the cun-kou pulse is moderate and the skin is numb and unresponsive, this indicates wind and cold lodged in the muscles. Fangfeng Decoction is appropriate, together with a warm medicinal compress. Moxibustion may also be applied to the points used to treat wind disorders.

When the cun-kou pulse is slippery and Yang Qi is relatively exuberant, with congestion and distension in the chest and vomiting, Qianhu Decoction is appropriate. Needle the Taiyang and Jueque points to drain the pathogenic Qi.

When the cun-kou pulse is wiry, with oppression and distension below the heart, mild headache, and fluid below the heart, Gansui Pills are appropriate. Needle Qimen to drain the pathogen.

A weak cun-kou pulse indicates deficient Yang Qi and a tendency to spontaneous sweating. Fuling Decoction and Neibu Powder are appropriate. Regulate diet and daily routine, and avoid overexertion. Needle the epigastric region to strengthen the upright Qi.

A choppy cun-kou pulse indicates insufficient stomach Qi. Gandi Huang Decoction is appropriate, along with restoring the body through proper care and a balanced diet. Needle the epigastric region (another account gives Zusanli) to strengthen stomach Qi.

A hollow cun-kou pulse indicates vomiting blood; a pulse that is slightly hollow may indicate a nosebleed. This is due to bodily depletion after blood loss. Zhu Pi Decoction and Huangtu Decoction are appropriate, and moxibustion should be applied to Danzhong.

A hidden, hard-to-detect cun-kou pulse, with rebellious Qi in the chest and a sensation of blockage, indicates various forms of Qi counterflow surging upward into the chest. Qianhu Decoction and Dajian Pills are appropriate. Needle Jueque to drain the pathogen.

A deep cun-kou pulse, with pain in the chest that extends into the flanks, indicates fluid in the chest. Zeqi Decoction is appropriate. Needle Jueque to drain the pathogen.

A soft and weak cun-kou pulse with a tendency to spontaneous sweating indicates a wasting disorder. Gandi Huang Decoction, Shanyao Pills, Neibu Powder, and Muli Powder are appropriate; dust the body with Muli Powder. Needle Taichong to strengthen the upright Qi.

A slow cun-kou pulse indicates cold in the upper burner, the area above the diaphragm. It may cause heart pain, sourness in the throat, and regurgitation of sour fluid. Fuzi Decoction is appropriate.

Take ginger decoction and cornel-fruit pills, regulate the diet, and nourish the body with warm foods. A forceful pulse at the cun position, on the wrist, indicates heat in the Spleen and Lungs. Vomiting and blocked Qi may occur. A weak pulse indicates cold in the Spleen and Stomach, so food cannot be digested. For a heat pattern, bamboo-leaf decoction or kudzu-root decoction is suitable; for a cold pattern, cornel-fruit pills or ginger decoction is suitable.

If the cun pulse is fine and there is fever and vomiting, Scutellaria and gentian decoction is suitable. For persistent vomiting, tangerine-peel and platycodon decoction is suitable, along with moxibustion at the Zhongfu point.

The following explains the disorders governed by the guan position, the part of the cun pulse corresponding to the Spleen and Stomach, and their treatments.

A floating, large pulse at the guan position indicates pathogenic Wind in the Stomach. The mouth may hang open as the person gasps and lifts the shoulders to breathe; there may be uneasiness below the heart, with a desire to eat and to vomit. A slightly floating pulse at the guan position indicates accumulated heat in the Stomach. The person may vomit roundworms, feel unsettled in spirit, and become forgetful.

A slippery pulse at the guan position that varies unevenly in size means vomiting and rebellious Qi are certain, and an attack is imminent. It may recur after a day or two. The person wants to drink a great deal of water, but immediately has diarrhea after drinking. If the diarrhea stops, the person will survive; if it continues without stopping, the condition is dangerous.

A tight, slippery pulse at the guan position indicates roundworms in motion. If the pulse is wiry and long (another version reads “wiry and large”), there may be stabbing pain like a knife. The pain may be around the navel, above or below it, or to either side. The Mai Jing says this indicates an accumulation around the navel.

A rough, firm pulse at the guan position that is large and forceful, and does not weaken under pressure, indicates an excess pattern in the middle burner, where the Spleen and Stomach are located. There are hidden accumulations and blocked Qi in the Spleen and Lungs, with excess heat in the Stomach.

If the guan pulse is large and agitated while the pulses at the cun and chi positions are fine, the person must have cold accumulations in the heart and abdomen, with concretions and conglomerations, and a desire for hot food. A guan pulse that comes and goes unpredictably—at times large or small, at times slow or rapid—indicates mixed cold and heat in the Stomach. The person is weak and thin, has no appetite, and shows symptoms like malaria.

A floating guan pulse accompanied by abdominal fullness and loss of appetite points to fullness due to deficiency. Pingwei pills, poria decoction, or ginger and antiphlogistic-ledebouriella decoction is suitable. Needle the Weiguan point, first reducing and then tonifying.

A tight guan pulse with fullness and pain below the heart points to an excess pattern. Cornel-fruit and angelica decoction is suitable; two liang of rhubarb may also be added. The Mai Jing says rhubarb decoction is a better treatment. Needle the Jueque and Xiaguan points using the reducing method.

A faint guan pulse indicates cold in the Stomach and a tightening below the heart. Aconite decoction, ginger decoction, or aconite pills is suitable. Needle the Jueque point using the tonifying method.

A rapid guan pulse indicates an external heat pathogen in the Stomach. Anemarrhena decoction (another version reads Anemarrhena pills) or heat-clearing decoction is suitable. Needle the Jueque and Shangguan points using the reducing method. The original text ends here, unfinished.

The correspondences between pulse qualities at the guan position of the cun-kou pulse and spleen-stomach disorders, along with their treatments, are as follows:

A slow, weak pulse at the guan position, together with loss of appetite, indicates a deficiency of Spleen-Stomach Qi. Take Pingwei Pills or a Spleen-Tonifying Decoction, and needle the Zhangmen point using the reinforcing method.

A slippery pulse at the guan position indicates heat in the Stomach. A slippery pulse belongs to excess heat: Qi is congested and full, causing loss of appetite and vomiting after eating. Take a Puxiao-Mahuang Decoction or Pingwei Pills (other versions give Ziwan Decoction or Ginseng Great Pingwei Pills), and needle the Weiguan point using the reducing method.

A wiry pulse at the guan position indicates cold in the Stomach and rebellious Qi below the heart. A wiry pulse also indicates weak Stomach Qi. Take a Zhuyu Decoction, regulate the diet gently, and needle the Weiguan point using the reinforcing method.

A weak pulse at the guan position indicates deficient Stomach Qi with stagnant heat in the Stomach. The weak pulse points to a deficiency-heat pattern. The classical text also says that even when heat is present, it should not be attacked forcefully with harsh methods; once the heat subsides, a cold pattern may follow. Take a Bamboo Leaf Decoction and needle the Weiguan point using the reinforcing method.

A fine, empty pulse at the guan position accompanied by abdominal distension calls for a Ginger Decoction, a Zhuyu-Sichuan Pepper Decoction, or Baiwei Pills, along with acupuncture and moxibustion at the Three Guan points.

A rough pulse at the guan position indicates impeded circulation of Blood and Qi, with disordered Qi and Blood and signs of cold; a rough pulse may also indicate Blood deficiency. Take a Dried Rehmannia Decoction or Four Tonics Powder, and needle above the Taichong point on the foot using the reinforcing method.

A hollow pulse at the guan position, accompanied by blood in the stool, calls for raw Rehmannia and a Fresh Bamboo Skin Decoction, along with moxibustion at the Geshu point. If bleeding is caused by excessive purging, needle the Guanyuan point; in severe cases, take Dragon Bone Pills. (Some versions give “Jueque” instead of “Guanyuan.”)

A hidden pulse at the guan position, accompanied by retained fluid and loose, watery stools, calls for Mercury Pills and needling at the Guanyuan point to promote urination and stop the diarrhea. Once urination flows freely, the diarrhea will also stop.

A surging pulse at the guan position indicates heat in the Stomach, necessarily accompanied by vexation and distension. Take Pingwei Pills and needle the Weiguan point, first using the reducing method and then the reinforcing method.

A deep pulse at the guan position indicates cold below the heart, often felt as distension and acid regurgitation. Take Baiwei Pills, Poria Pills, or an Aconite Decoction, and needle the Weiguan point using the reinforcing method.

A soft pulse at the guan position, accompanied by discomfort from deficiency and cold, indicates Spleen Qi weakness and severe diarrhea. Take a Red Halloysite Decoction or Nüwei Pills, and needle the Guanyuan point using the reinforcing method.

A slow pulse at the guan position indicates cold in the Stomach. Take Cinnamon Twig Pills or a Zhuyu Decoction, and needle the Weiguan point using the reinforcing method.

A replete pulse at the guan position indicates pain in the Stomach. Take a Gardenia Decoction or Zhuyu-Aconite Pills, and needle the Weiguan point using the reinforcing method.

A firm pulse at the guan position indicates that Qi in the Spleen and Stomach is obstructed and heat is strong, causing abdominal distension and intestinal rumbling. Take Ziwan Pills or a Spleen-Draining Pill, and use acupuncture and moxibustion at the Weiguan point with the reducing method.

The correspondences between pulse qualities at the chi position and their treatments are as follows: a floating pulse at the chi position indicates that an external Yang pathogen has lodged in the lower body…

A weak pulse at the cubit position indicates cold in the lower burner—the lower part of the body, including the kidneys, bladder, and reproductive system—and insufficient Yang Qi, with deficiency heat surging upward to the head and face. If the cubit pulse is weak while the inch pulse is strong, this indicates injury to the Stomach network. If the cubit pulse is somewhat slippery and rapid, and the face is flushed as if from drinking wine, the illness is caused by external heat. A faint, thin cubit pulse accompanied by loose stools or diarrhea indicates cold in the lower body. The Suwen says that coldness at the cubit position with a thin pulse is called “lower diarrhea.”

A deficient, small cubit pulse indicates cold, weakness, and numbness in the calves, as well as foot pain. A choppy cubit pulse indicates poor blood circulation in the lower body and a tendency to sweat profusely. The Suwen says that a choppy cubit pulse with a smooth, flowing pulse is called profuse sweating. A deep, slippery cubit pulse indicates the presence of tapeworms. A thin, rapid cubit pulse indicates cramping and numbness in the sinews and vessels, making walking impossible. A large cubit pulse indicates heat in the bladder, with red urine and pain. A thick, large cubit pulse accompanied by a persistent sensation of heat is called “internal heat”; it causes pain in the lower back and hips, and hot, reddish urine.

If pressure on the cubit pulse still reveals an unbroken pulse, a woman may have blocked blood vessels. If it corresponds with the pulse at the bar position and is calm and smooth, in a man it indicates abundant Qi and blood; in a woman, it may indicate pregnancy. If the cubit pulse comes and goes intermittently, a man may have stagnant Qi in the lower abdomen, while a woman may have obstructed menstruation.

If the cubit pulses on both sides are soft and weak, there is internal stagnant heat, while the hands and feet are cold and sweating. If both cubit pulses are deep and no pulse can be felt at the bar position, the patient will feel oppression below the heart, near the pit of the stomach, and have shortness of breath. If both cubit pulses are deep but a pulse can still be felt at the bar position, the patient will suffer from cold, pain below the heart, coldness in the genital area, and numbness in the feet. If both cubit pulses are faint and weak, the heart is weak and the patient does not wish to speak. This indicates deficiency of Qi and blood, and may cause weakness in the feet and shortness of breath.

A rapid cubit pulse indicates heat in the hands, feet, head, and face. A slow cubit pulse indicates cold, with the hands, feet, head, and face becoming cold as if exposed to wind and cold. A floating cubit pulse indicates heat in the lower body as well as difficulty urinating. Suitable treatments are Qumai Decoction and Huashi Powder, together with draining needling at the Henggu and Guanyuan points.

A tight cubit pulse indicates lower abdominal pain. Suitable treatment is Danggui Decoction, moxibustion at the Tianshu point, and tonifying needling at the Guanyuan point. A faint, weak cubit pulse accompanied by cold, stiff hands and feet and cramping in the lower abdomen indicates cold Qi. Suitable treatment is Xiaojianzhong Decoction and needling at the Qihai point. A rapid cubit pulse accompanied by aversion to cold, heat and pain below the navel, and yellow-red urine calls for Jizi Decoction and Baiyu Powder, together with draining needling at the Henggu point.

A moderate cubit pulse accompanied by weakness in the feet, swelling in the lower legs, difficulty urinating, and lingering dribbling after urination calls for Huashi Decoction and Qumai Powder, together with draining needling at the Henggu point. A slippery cubit pulse indicates abundant Qi and blood, but impeded circulation through the channels. Suitable treatment is Puxiao Decoction and Dahuang Decoction to purge and expel menstrual blood, together with draining needling at the Guanyuan point. A taut cubit pulse accompanied by lower abdominal pain and cramping in the sinews of the lower abdomen and feet calls for…

When the pulse at the cubit position is weak, Qi is deficient and there is fever with troublesome heat in the joints and bones: take Jianzhong Decoction and Angelica Decoction, and needle the Qihai point using the reducing method.

When the pulse at the cubit position is weak and Qi is deficient, with fever and troublesome heat in the bones: take Peucedanum Decoction and Rehmannia-Fu Ling Decoction, and needle the Guanyuan point using the reinforcing method.

When the pulse at the cubit position is rough, the feet and shins are cold, and the urine is reddish: take Aconite Sini Decoction, and needle the Taichong point on the foot using the reinforcing method.

When the pulse at the cubit position is hollow, the lower burner is deficient, and there is blood in the urine: take Bamboo Skin and Fresh Rehmannia Decoction, and apply moxibustion to the Dantian and Guanyuan points.

When the pulse at the cubit position is hidden and submerged, there is pain in the lower abdomen, abdominal masses or hernia, and food cannot be digested: take Great Pingwei Pill and Platycodon Pill, and needle the Guanyuan point using the reinforcing method.

When the pulse at the cubit position is deep, there is pain in the lower back and back: take Kidney Qi Pill, and needle the Jingmen point using the reinforcing method.

When the pulse at the cubit position is soft, the feet cannot move freely, there is wind impediment—numbness, pain, or impaired movement of the limbs caused by pathogenic wind—and urination is difficult: take Dianthus Decoction and White Fish Powder, and needle the Guanyuan point using the reducing method.

When the pulse at the cubit position is firm and forceful, the abdomen is distended and full, and the genital area is constricted: take Lepidium and Evodia Pill, and needle the Dantian, Guanyuan, and Zhongji points.

When the pulse at the cubit position is slow, there is cold in the lower burner: take Cinnamon Twig Pill, and needle the Qihai and Guanyuan points using the reducing method.

When the pulse at the cubit position is replete, there is pain in the lower abdomen and urinary incontinence: take Angelica Decoction, adding one liang of rhubarb to promote bowel movement, and needle the Guanyuan point using the reinforcing method.

— Sun the Immortal’s Essential Prescriptions Worth a Thousand in Emergencies, juan 84