《孫真人備急千金要方》Vol. 85

After a person falls ill, they may develop one of three conditions: ji (“accumulation”), ju (“gathering”), or “grain Qi.” Ji is a disease of the zang-fu organs and is usually fixed in place. Ju is a disease of the fu organs; it comes and goes, and its pain shifts and changes, so it is relatively easier to treat. “Grain Qi” causes pulling pain beneath the ribs. Pressing the area brings temporary relief, but the pain later returns. Once an illness has been cured, it should not recur. If it does, the recurrence is what is meant here by “grain Qi.”

A general method for identifying ji is as follows: a fine, soft pulse that sinks deep beside the bone may indicate an accumulation. A knotted or bound pulse at the cun kou may indicate an accumulation in the chest; a pulse that deviates slightly outward from the cun kou may indicate one in the throat. A knotted or bound pulse at the guan may indicate an accumulation beside the navel; if the pulse at the guan shifts slightly downward, the accumulation may be in the lower abdomen. A knotted or bound pulse at the chi may indicate an accumulation above qi chong, the area near the groin. If an accumulation is beneath the heart, a pulse at the guan will show itself upward. If the pulse leans left, the accumulation is on the left; if it leans right, it is on the right. If it shows on both sides, the accumulation may be in the center. In diagnosis and treatment, determine the location according to the part of the pulse that corresponds to it.

A deep, transverse pulse at the cun kou indicates a possible transverse mass beneath the ribs or in the abdomen, accompanied by pain. A wiry pulse may indicate acute abdominal pain, with pain extending to the lower back. The same signs may also appear with cold shan disorders or abdominal masses such as jia.

A wiry, tight, fine, and faint pulse may indicate zheng, a hard, fixed mass in the abdomen. The pulses associated with cold impediment, zheng-jia masses, and ji-ju accumulations are mostly wiry and tight. If the illness is beneath the heart, the pulse at the cun is wiry and tight; if it is in the stomach region, the pulse at the guan is wiry and tight; if it is below the navel, the pulse at the chi is wiry and tight. Another account holds that a long, wiry pulse at the guan indicates a possible accumulation around the navel, to its left or right, above or below.

Another method for locating zheng from the pulse is as follows: if a transverse pulse appears on the left hand, the mass may be on the left; if it appears on the right hand, the mass may be on the right. If the pulse head is large, the illness may be in the upper part of the body; if the pulse head is small, it may be in the lower part.

A different account says that when a transverse pulse appears on the left hand, the accumulation is on the right; when it appears on the right hand, the accumulation is on the left. A pulse that is somewhat forceful, full, and slippery, or one that is wiry and tight, may also indicate an accumulation. A wiry, tight pulse may also occur with cold impediment or shan pain. An abdominal accumulation that does not show in the pulse is difficult to treat. When the pulse corresponds to the illness, treatment is easier; when the pulse and illness do not correspond, the condition is unsuitable for treatment by ordinary methods.

If the pulse on the left hand is large and the pulse on the right is small, the illness may be in the upper left side beneath the ribs or in the lower left foot. If the pulse on the right hand is large and the pulse on the left is small, the illness may be in the upper right side beneath the ribs or in the lower right foot. A wiry, deeply hidden pulse indicates an abdominal zheng; the illness is difficult to reverse and is generally hard to save.

If the pulse feels straight and taut, there may be an abscess or swelling in the body. If there is a “hidden beam” in the abdomen—a disorder in which an accumulation forms inside, as though a crossbeam were lying there—the pulse will be deep and deficient. A deep, small pulse indicates persistent diarrhea. A deep, small, forceful pulse indicates an accumulation in the stomach: food is difficult to swallow, and eating brings on vomiting.

Chapter Eight: Yin and Yang, Exterior and Interior, Deficiency and Excess

The wiry pulse belongs to Lesser Yang, the moderate pulse to Yang Brightness, and the surging pulse to Greater Yang. These are the three Yang pulses. The faint pulse belongs to Lesser Yin, the slow pulse to Reverting Yin, and the deep pulse to Greater Yin. These are the three Yin pulses.

When the classic speaks of “one Yin and one Yang,” “one Yin and two Yang,” “one Yin and three Yang,” and “one Yang and one Yin,” “one Yang and two Yin,” “one Yang and three Yin,” it does not mean that six kinds of pulse beat at the cunkou simultaneously. Rather, it describes combinations of pulse qualities such as floating, deep, long, short, slippery, and rough. In general, floating, slippery, and long pulses belong to Yang; deep, rough, and short pulses belong to Yin.

“One Yin and one Yang” means a pulse that is deep and slippery. “One Yin and two Yang” means a pulse that is deep, slippery, and long. “One Yin and three Yang” means a pulse that is floating, slippery, and long, with a deep quality appearing at intervals. “One Yang and one Yin” means a pulse that is floating and rough. “One Yang and two Yin” means a pulse that is long, deep, and rough. “One Yang and three Yin” means a pulse that is deep, rough, and short, with a floating quality appearing at intervals. The pulse must be considered in relation to the channel it belongs to in order to judge whether the course of the illness is favorable or unfavorable.

What is meant by Yang being exuberant and Yin deficient, or Yin being exuberant and Yang deficient? When the pulse weakens and becomes smaller under light pressure, but feels full and large under heavy pressure, this is called Yin exuberance and Yang deficiency. When the pulse weakens and becomes smaller under heavy pressure, but feels full and large under light pressure, this is called Yang exuberance and Yin deficiency. This is what deficiency and excess in Yin and Yang mean.

In general, floating, large, rapid, moving, long, and slippery pulses belong to Yang; deep, rough, weak, wiry, short, and faint pulses belong to Yin. When a Yin pulse appears in a Yang pattern, this is an unfavorable sign: the illness is severe and may even threaten life. When a Yang pulse appears in a Yin pattern, this is a favorable sign and usually indicates that the illness may turn around.

The region above the bar position belongs to Yang, and the region below it belongs to Yin. A rapid Yang pulse may bring on vomiting; a faint Yin pulse may bring on diarrhea. A wiry Yang pulse may cause headache, while a wiry Yin pulse may cause abdominal pain. The illness should be assessed by distinguishing the Yin and Yang qualities of the pulse.

The cubit pulse belongs to Yin and is generally deep and slow. The inch and bar pulses belong to Yang and are generally floating and rapid. If pulses are present only in the exterior positions but absent in the interior position, the place where the pathogenic influence is lodged may develop an unusual disorder. What are the exterior and interior positions? The inch and cubit positions belong to the exterior, while the bar position belongs to the interior. If there are pulses at both ends, in the inch and cubit positions, but the pulse at the bar position breaks off and does not pass through, this is called “complete interruption at the bar, with no pulse reaching it.” If the cubit pulse cannot rise to reach the bar position, this is called “Yin severance”; if the inch pulse cannot descend...

In terms of the pulse, when it does not reach the guan position, it is called “Yang exhaustion” or “Yin exhaustion.” If Yang Qi is weak and depleted, life is in danger and treatment is difficult. Exhalation corresponds to the body’s exterior and belongs to the Fu organs; inhalation corresponds to the interior and belongs to the Zang organs. When Yang Qi is weak, exhalation lacks strength; when Yin Qi is weak, inhalation lacks strength. If both are insufficient, one feels short of breath in the chest.

A weak pulse appearing at the guan position, a soft and feeble pulse appearing at the crown of the head, a faint pulse appearing instead in the upper region, or a rough, unsmooth pulse appearing instead in the lower region—all indicate that the pulse is in an abnormal position. A faint pulse indicates insufficient Yang Qi and may be accompanied by fever and sweating. A rough pulse indicates a lack of blood and may lead to reversal cold, with cold limbs and an aversion to cold.

The pulses of the Fu organs belong to Yang, and Yang pulses indicate heat; the pulses of the Zang organs belong to Yin, and Yin pulses indicate cold. When the Yang pulse is weak, sweating often occurs; when the Yin pulse floats, sweat flows spontaneously. (The Maijing reads “when Yin is weak.”) If the Yang pulse is rapid, sores are likely to develop in the mouth. If the Yin pulse is rapid and weak, the person will certainly fear the cold, feel restless and agitated, and have difficulty sleeping. A hollow pulse in the Yang indicates vomiting blood. (The Maijing reads, “If the Yang pulse is rapid, there will be vomiting of blood.”) A hollow pulse in the Yin indicates blood in the stool. (The Maijing reads, “If the Yin pulse is rough, there will be bleeding below.”) A lack of Yang Qi causes reversal cold; a lack of Yin Qi causes vomiting.

A floating, large, and rapid pulse at the cun position is called a “Yang within Yang” disorder. The patient will feel oppressed and distended, have a fever throughout the body and a headache, and feel heat in the abdomen as well. A deep, fine pulse at the cun position is called a “Yin within Yang” disorder. The patient may feel sorrowful and unhappy, be unwilling to hear voices, become short of breath, and sometimes sweat. When Yin Qi is obstructed—one version reads “converges”—the arms cannot be raised. (The Chaoyuan reads, “The arms are turned to one side and cannot be raised.”)

A deep, fine pulse at the chi position is called a “Yin within Yin” disorder. The patient will feel soreness and pain in both lower legs and be unable to stand for long. Yin Qi is depleted; after urinating, dribbling continues, and the genital area is damp and itchy. A slippery, floating, and large pulse at the chi position is called a “Yang within Yin” disorder. The patient will have pain and distention in the lower abdomen and be unable to urinate. Even when urination is possible, the genital area will hurt, as it will during bowel movements.

When the pulse at the chi position is firm, solid, and long, with no pulse at the guan position, this is called “Yin overriding Yang.” The patient will feel heaviness in both lower legs, and the lower abdomen will pull on the lower back, causing pain. When the pulse at the cun position is forceful and large, with no pulse at the chi position, this is called “Yang overriding Yin.” The patient will have pain in the lower back and spine, injury to the genital area, and cold feet and lower legs.

What are the “three vacuities and three excesses”? They are the vacuity or excess of the pulse, of the illness, and of the findings obtained through examination. As for the vacuity and excess of the pulse, a soft, weak pulse is vacuous, while a firm, solid pulse is excessive. As for the vacuity and excess of the illness, outward dispersal is vacuous, while inward contraction is excessive; speaking a great deal is vacuous, while saying nothing is excessive; a relaxed state is vacuous, while urgency is excessive. As for the vacuity and excess found through examination, itching is vacuous, while pain is…

Pain felt externally together with internal comfort is an excess condition on the outside and a deficiency condition within. Pain felt internally together with external comfort is an excess condition within and a deficiency condition on the outside.

When the exterior is weak, this is called “deficiency and excess.”

Question: What are deficiency and excess? Answer: When pathogenic Qi is flourishing, it is called excess; when Jing and Qi are depleted, it is called deficiency.

Question: What is meant by “severe excess”? Answer: “Severe excess” refers to a patient with a high fever, a feverish body, and a replete pulse.

A replete pulse, hot skin, abdominal distension, inability to pass urine or stool, and disturbed consciousness are the “Five Excesses.” A fine, weak pulse, cold skin, faint breathing, diarrhea or dysentery, incontinence of urine and stool, and inability to swallow food are the “Five Deficiencies.”

When Illness Arises: Chapter Nine

How can we tell that someone became ill from sleeping outdoors? This is Yin within Yang. How can we tell that someone became ill during summer? This is the Qi of all Yang entering the Yin aspect.

How can we tell that someone became ill in spring? The absence of a Liver pulse indicates spring illness. The absence of a Heart pulse in illness arising in summer, a Lung pulse in illness arising in autumn, a Kidney pulse in illness arising in winter, or a Spleen pulse in illness arising in the last month of any season likewise indicates an abnormal pulse for that season.

Bian Que and Hua Tuo’s Essentials for Examining the Voice and Complexion: Chapter Ten

When a patient’s Five Zang organs have become depleted of Jing and Qi, the spirit cannot settle, and the voice grows hoarse, the patient will die. A patient who keeps touching the seams of their clothes, speaks incoherently, and cannot be treated will die. A patient whose Yin and Yang Qi have both been severed, yet who tugs at their clothes, reaches out to grasp at empty space, and speaks incoherently, will die.

A patient who babbles, speaks incoherently, or cannot speak usually cannot be treated. If the patient has a febrile illness, however, they may recover. A patient whose Yin and Yang Qi have both been severed and who has lost their voice and cannot speak will die after three and a half days.

Yellowing at the inner and outer corners of a patient’s eyes indicates that the illness has just begun to improve. A patient with a yellow face and green eyes will not die; but if the green resembles the color of plants before they wither, the patient will die. A patient with a yellow face and red eyes will not die; but if the red resembles clotted blood, the patient will die. A patient with a yellow face and white eyes will not die; but if the white resembles dry bone, the patient will die. A patient with a yellow face and black eyes will not die; but if the black resembles the soot on the bottom of a pot, the patient will die. A patient whose facial color matches the color of their eyes will not die. A patient with a black face and green eyes will not die; one with a green face and white eyes will die. A patient with a red face and green eyes will die after six days; one with a yellow face and green eyes will die after nine days. These conditions are called “disordered channels,” meaning that the flow of Qi and blood through the channels is disrupted.

After drinking alcohol, exposure to wind and cold allows pathogenic Qi to invade the Stomach channel, while Gallbladder Qi surges outward in an uncontrolled way, causing the eyes to turn green. Even if Heaven were to come to the patient’s aid, they could not survive.

A patient with a red face and white eyes will die after ten days. Grief, anger, and excessive rumination deplete Heart Qi from within. If the face nevertheless appears unusually healthy at that point, a coffin should be prepared at once. A patient with a white face and black eyes will die. This is called “flourishing radiance” … The original text ends here unfinished.

The patient has lost a great deal of blood, leaving the blood vessels depleted. If the face turns black and the whites of the eyes turn pale, death will follow within eight days. If the Kidney Qi is injured internally and pathogenic influences remain and accumulate, a greenish face and yellow eyes indicate death within five days.

A patient who lies in bed with heart pain and shortness of breath, whose Spleen Qi is failing and who suffers from many internal ailments with a fluctuating course, may still be able to get up, yet wander unsteadily, sit down on the ground, and then lean against the bed when standing. Anyone who can cure this condition may be called a skilled physician. If the patient’s face has no luster, the complexion is earth-colored, and the patient cannot eat, death will follow within four days. If the eyes have lost their brightness and the teeth have turned black, the condition can no longer be treated.

If blackness appears around the ears, eyes, nose, or mouth and spreads toward the mouth, death is certain. Redness of the ears, eyes, cheekbones, and cheeks indicates death within five days. Blackness below the hairline on the forehead, along the bridge of the nose, and over the cheekbones on either side also indicates death within five days. Whether sick or healthy, if a person’s face suddenly turns black or white and the color spreads to the eyes, nose, and mouth, death will follow within three days.

If the patient’s face suddenly resembles a horse’s liver—greenish from afar and black when seen up close—the patient will die. A black face, fixed gaze, and fear of wind indicate death; so do a black face with greenish lips, or a greenish face with black lips. If the face is black, the flanks are distended and full, and the patient cannot turn over unaided, with the body leaning backward when attempting to turn, the patient will die.

If the patient’s eyes move abnormally and stare fixedly, and the shoulders rise and fall with each breath, death will follow within a day. If Yin Qi is bound and Yang Qi cut off, with the gaze unfocused and the mind confused, the patient will die. If Yin and Yang Qi are exhausted and the eye sockets sink in, the patient will die. If the roots of the eyebrows slant, death will follow within seven days.

If the patient’s mouth hangs open like a fish’s and can no longer close, with more breath going out than coming in, the patient will die. An open mouth indicates death within three days. Greenish lips and an abnormal philtrum—the groove between the nose and upper lip—indicate death within three days. If the lips turn outward and the philtrum bulges, the patient will die. If the lips suddenly become dry, the condition can no longer be treated; swollen lips and charred-black teeth indicate death. If the teeth suddenly turn black, death will follow within thirteen days.

If the patient’s tongue curls inward and the testicles contract, death is certain. If sweat cannot flow freely and the tongue curls and turns black, the patient will die. If the hair stands straight up, death will follow within fifteen days; hair like dry, withered hemp, together with irritability, indicates death. If the hair and eyebrows stand up together, the patient will die. Greenish fingernails indicate death; pale fingernails mean the condition can no longer be treated. If the flesh beneath the fingernails or toenails turns black, death will follow within eight days. The patient’s Nutritive Qi and Defensive Qi have already weakened and ceased...

Facial swelling is a grave sign of impending death. If a patient’s face suddenly swells and turns blue-black, that too is a sign of death. Swollen palms with the lines of the hands disappearing are a sign of death; a swollen, protruding navel is also a sign of death. Swelling of both the scrotum and penis is a sign of death. If a patient’s pulse ceases, their mouth hangs open, and both feet swell, they will die within five days. Swelling on the tops of the feet, accompanied by vomiting and a heavy head, is a sign of death. If the tops of the feet swell and both knees become as large as buckets, the patient will die within ten days. A patient who lies in bed and passes stool without awareness has a sign of impending death. If a corpse-like odor comes from the patient’s body, the condition cannot be treated.

If a patient with liver disease has pale skin, they will die on a Geng or Xin day (two days in the sexagenary cycle). If a patient with heart disease has darkened eyes, they will die on a Ren or Gui day. If a patient with spleen disease has bluish lips, they will die on a Jia or Yi day. If a patient with lung disease has red cheeks and swollen eyes, they will die on a Bing or Ding day. If a patient with kidney disease has a swollen face and yellow lips, they will die on a Wu or Ji day.

A healthy complexion should be as follows: blue-green, like lustrous jade, not dark like indigo; red, like cinnabar wrapped in white silk, not dull like ocher; white, like goose feathers, not dark like salt; black, like thick lacquer, not ashen like charcoal; yellow, like realgar wrapped in fine silk, not lusterless like yellow earth.

Signs That the Qi of the Five Zang and Six Fu Organs Has Been Exhausted (Section Eleven)

When a patient’s liver Qi is exhausted, they will die in eight days. How can this be recognized? Their face turns blue-green; they want only to lie face down; they look at people but do not recognize them; and sweat—or, according to another account, tears—streams out like water. (One account says they will die within one or two days.)

When a patient’s gallbladder Qi is exhausted, they will die in seven days. How can this be recognized? Their eyebrows become crooked.

When a patient’s sinew Qi is exhausted, they will die in nine days. How can this be recognized? The fingernails and toenails turn blue-green, and they shout and curse incessantly. (One account says they will die within one to eight days.)

When a patient’s heart Qi is exhausted, they will die in one day. How can this be recognized? They raise their shoulders as they gasp for breath, turn their head to look around, and soon die. (One account says their eyes stare straight ahead and their expression becomes blank; they will die within two days.)

When a patient’s intestinal Qi is exhausted—another account says this refers to the small intestine—they will die in six days. How can this be recognized? Their hair stands stiff like dry hemp and cannot be bent or straightened, and cold sweat pours out incessantly.

When a patient’s spleen Qi is exhausted, they will die in twelve days. How can this be recognized? Their lips feel cold, both feet swell, and the abdomen is hot and distended. They have diarrhea without being aware of it, and their bowel movements occur at irregular times. (One account says they will die within one to five days.)

When a patient’s stomach Qi is exhausted, they will die in five days. How can this be recognized? Their back aches, their lower back feels heavy, and they cannot turn over. (One account says their calves become flat and limp; they will die within nine days.)

When a patient’s flesh Qi is exhausted, they will die in six days. How can this be recognized? Their ears become dry…

The tongue is swollen, and there is blood in the urine and red, bloody diarrhea. After the feet swell, if a day passes, the patient may die nine days later. These are signs that the patient’s Lung Qi is failing; death may follow within three days. How can this be recognized? The patient’s mouth hangs open: breath is exhaled, but no breath is drawn back in. In some cases, the nostrils and mouth gape open and breathing becomes short. If the Qi of the Large Intestine is failing, the condition cannot be treated. How can this be recognized? The diarrhea is uncontrollable; when it stops, the person dies as well.

When a patient’s Kidney Qi is failing, death may follow within four days. How can this be recognized? The teeth suddenly become dry and withered, the complexion turns completely black, the eyes become yellow, the lower back hurts as if it were about to break, and cold sweat pours out in a stream. If the philtrum—the groove between the nose and upper lip—becomes flat and sunken, the patient may die within a day; death may also follow within seven days. When the patient’s Bone Qi is failing, the teeth turn yellow and fall out, and death may follow within ten days.

All floating pulses that lack a root are considered death pulses. Here, “root” refers to the Qi of the Five Zang and Six Fu organs.

Diagnosing Pulse Patterns That Run Counter to the Four Seasons (Chapter Twelve)

The three months of spring correspond to Wood, and the Liver pulse governs the season. In the proper sequence, the Liver pulse should appear first, followed by the Heart, Lung, and Kidney pulses. This is a pulse pattern that follows the season and reflects the succession of the organs’ Qi. In the sixth month, Earth Qi should be at its height, so the Spleen pulse ought to appear first. If the Spleen pulse is absent and the Kidney pulse appears first instead, this is called “the Kidney opposing the Spleen,” and the patient may die after seventy days.

What does “the Kidney opposing the Spleen” mean? In summer, Fire is at its height, so the Heart pulse should appear first, followed by the Lung pulse. If the Kidney pulse appears first instead, this too is called “the Kidney opposing the Spleen.” The patient is expected to avoid the days of Bing and Ding in the fifth and sixth months.

“When the Spleen opposes the Liver,” death may follow after thirty days. In spring, the Liver pulse should appear first. If the Liver pulse is absent and the Spleen pulse appears first instead, this is called “the Spleen opposing the Liver.” The patient is expected to avoid the days of Jia and Yi in the first and second months.

“When the Kidney opposes the Liver,” death may follow after three years. In spring, the Liver pulse should appear first. If the Liver pulse is absent and the Kidney pulse appears first instead, this is called “the Kidney opposing the Liver.” The patient is expected to avoid the days of Geng and Xin in the seventh and eighth months.

“When the Kidney opposes the Heart,” death may follow after two years. In summer, the Heart pulse should appear first. If the Heart pulse is absent and the Kidney pulse appears first instead, this is called “the Kidney opposing the Heart.” The patient is expected to avoid the days of Wu and Ji in the sixth month.

This passage does not discuss the Lung’s association with Metal Qi, and its account is rather brief and difficult to understand. The Five Phases relationships described below also contain several apparent reversals. The author says that the matter will be clarified after consulting other records.

Whenever treating an illness, one should examine the patient’s appearance, spirit and breath, the luster of the complexion, the strength of the pulse, and how long the illness has been present before judging whether it can be treated. When the body and breath are in proportion, the complexion is lustrous, and the pulse accords with the seasons, the condition is easy to treat. When the body and breath are out of proportion, the complexion is dull and without luster, and the pulse is hard and forceful yet contrary to the seasons, the condition is difficult to treat.

A pulse that goes against the changes of the four seasons means that a Lung pulse appears in spring, a Kidney pulse in summer, a Heart pulse in autumn, or a Spleen pulse in winter. If the pulse also feels floating and rootless, intermittent, and rough or sluggish, it is called “reversing the four seasons.” A deep, rough, and sluggish pulse in spring or summer, or a floating, forceful pulse in autumn or winter, is a diseased pulse. A quiet pulse accompanied by diarrhea or dysentery, a surging pulse accompanied by heavy blood loss, and a firm pulse indicate illness within the body; an insubstantial pulse indicates illness at the body’s surface. Pulses that do not accord with the season and go against the four seasons are very difficult to cure.

The pulses of all four seasons take “Stomach Qi”—a balanced, steady quality in the pulse—as their foundation. Even when a pulse accords with the season’s prevailing quality, recovery is difficult if Stomach Qi is absent. What does it mean to have Stomach Qi? A pulse that comes gently and feels smooth and moist has Stomach Qi; such an illness is easy to treat.

Estimating the Year and Month of Death by Counting Pauses in the Pulse (Section Thirteen)

If the pulse pauses after every beat, the records say the patient will die in two days; another medical text says death will come in one day. If it pauses after every two beats, death will come in three days. If it pauses after every three beats, death will come in four days, though some accounts say five days. If it pauses after every four beats, death will come in six days. If it pauses after every five beats, death will come in seven days, though some accounts say five days. If it pauses after every six beats, death will come in eight days; after every seven beats, in nine days; after every eight beats, in ten days. If it pauses after every nine beats, some say death will come in nine days, while others say eleven or thirteen days.

If the pulse pauses after every ten beats, some say death will come at the Beginning of Spring, while others say at the Beginning of Summer. If it pauses after every eleven beats, some say death will come at the Beginning of Summer, while others say at the Summer Solstice or the Beginning of Autumn. If it pauses after every twelve or thirteen beats, some say death will come at the Beginning of Autumn, while others say at the Beginning of Winter. If it pauses after every fourteen or fifteen beats, some say death will come at the Beginning of Winter, while others say at the Beginning of Summer.

If the pulse pauses after every twenty beats, some say death will come after one year, while others say at the Beginning of Autumn. If it pauses after every twenty-one beats, death will come after two years. If it pauses after every twenty-five beats, some say death will come after two years, while others say after one year or at the Beginning of Winter. If it pauses after every thirty beats, death will come after two or three years. If it pauses after every thirty-five beats, death will come after three years; after every forty beats, after four years; and after every fifty beats, after five years. If it pauses before reaching fifty beats, some accounts also say death will come after five years.

When the movement of the Five Phases Qi is complete and the numbers of Yin and Yang are in balance, Nutritive Qi and Defensive Qi—the Qi that circulates inside and outside the channels—enter and leave in an orderly way, and the channels continue to flow day and night. The Qi of the Five Phases generates in sequence, and the pulse completes fifty beats without a pause. This shows that all five Zang organs are nourished by Qi, and so there is no illness. If the pulse pauses after every forty beats, it shows that one of the Zang organs has no Qi… The original text ends here unfinished.

If death will come in four years, when plants begin to sprout in spring, the pulse pauses once after every thirty beats. This indicates that the Qi of two internal organs has already been depleted.

If death will come in three years, when the wheat ripens, the pulse pauses once after every twenty beats. This indicates that the Qi of three internal organs has already been depleted.

If death will come in two years, when mulberries turn red, the pulse pauses once after every ten beats. This indicates that the Qi of four internal organs has already been depleted.

To determine whether death will come within a year, one must consider the solar terms. If the illness has not persisted beyond Clear and Bright, death will come at Clear and Bright. If it continues through Grain Rain, death will come at Grain Rain.

If the pulse pauses once after every five beats, this indicates that the Qi of all five viscera has been depleted; death will come in five days.

If, after one beat, the pulse remains still for a long time before beating again, the longstanding illness is in the heart, and its location is called “center of the master.” If it remains still after two beats, the illness is in the liver, at the “center of the branch.” If it remains still after three beats, the illness is in the spleen, at the “lower center.” If it remains still after four beats, the illness is in the kidneys, at the “center of the space.” If it remains still after five beats, the illness is in the lungs, at the “center of the branch.” The source text gives no further explanation of these place names.

When the pulses of all five viscera show weakness and decline, a thin, frail person who exhibits this pattern will die. Medicines cannot cure the condition, and acupuncture cannot take effect in time. A robust person may still recover, because their Qi remains sufficient.