《孫真人備急千金要方》Vol. 86

Bian Que said that when examining the pulse of someone near death, its Qi is like a flock of birds gathering, a horse being driven, or streams of water crossing and rushing along in channels. It may also resemble a stone falling from a height. Sometimes the pulse appears over the sinews; sometimes it hides beneath them, held rigidly within the region of the wrist pulse. It does not follow the usual pathways through which Qi and blood circulate, so it is difficult to detect.

A patient who appears to have no illness may nevertheless die if the pulse resembles a leaking roof or a pecking sparrow. “Leaking roof” means that the pulse suddenly stops, pauses, then appears from time to time, with no continuity between beats. “Pecking sparrow” means that the pulse is rapid and frequent, then suddenly stops and abruptly starts beating again. Another medical text says that a person who has been ill for seven or eight days will also die if the pulse resembles a leaking roof or a pecking sparrow. Under the fingers, this pulse beats like millet grains bouncing.

A pulse that comes like a pebble striking and recedes like a rope coming undone means death. “Striking stone” describes a pulse that is rapid and forceful, pounding as it beats. “Unraveling rope” describes a pulse that is fast and irregular, gradually becoming more disordered until it loses all rhythm.

In someone who is critically ill, a pulse like a shrimp swimming or a fish gliding foretells death. “Shrimp swimming” describes a pulse that rises faintly to the surface, then quickly sinks again, difficult to detect. It takes a long time to appear again; when it does, it comes slowly and withdraws quickly. “Fish gliding” describes a pulse in which the body seems motionless, while only the tail and head move. The body sways, yet the pulse lingers for a long time.

A pulse like a hanging curtain being rolled up, or a rope coiling, means death. So does a pulse like a rotating bean, or one like an inverted knife. A pulse that surges without receding means death. So does a pulse that vanishes and reappears suddenly, stopping briefly before returning. A pulse that is broad in the middle means death; so does one that breaks apart above and below. A pulse that is present only at the surface and absent at depth also means death.

Medical texts say that when the pulse stops, the person will die. What is meant by a “knotted pulse”? When the pulse beneath the fingers feels as though it is moving like hemp seeds, it is associated with the Kidney pulse and is called a knotted pulse. Once this pulse appears, death is not far off.

If the pulse beats five times and then shows no increase or decrease, the person will die. Medical texts call this a “regularly interrupted pulse.” What is meant by a regularly interrupted pulse? It is a pulse that beats five times and then stops once. If the pulse beats seven times and still shows no increase or decrease over the span of one and a half breaths, it is also called a regularly interrupted pulse; this usually clearly foretells death.

Medical texts say that some illnesses are fatal, some are difficult to treat but heal on their own, and others persist for years without improvement. As for human death and survival…

Can these conditions be recognized by feeling the pulse? They can be diagnosed in detail. If a patient keeps their eyes closed and does not wish to see anyone, the pulse should show the taut, rapid, and long qualities of the Liver pulse. If instead it shows the floating, short, and rough qualities of the Lung pulse, this is a sign of impending death.

If a patient has their eyes open, is thirsty, and has hardness below the heart, the pulse should be tight, forceful, and rapid. If instead it is deep, slippery, and faint, this is a sign of impending death.

If a patient is vomiting blood and also has a nosebleed, the pulse should be deep and fine. If instead it is floating, large, and firm, this is a sign of impending death.

If a patient is confused and speaking incoherently, the body should be hot and the pulse should be surging and large. If instead the hands and feet are cold, and the pulse is deep, fine, and weak, this is a sign of impending death.

If a patient has abdominal distension and diarrhea, the pulse should be faint, fine, and rough. If instead it is tight, large, and slippery, this is a sign of impending death. These are the conditions being described.

The Inner Canon says that a person will die when the body, the pulse, and the illness contradict one another. What does this mean? For example, if a patient has a headache and eye pain, but the pulse is short and rough, this is a sign of impending death. If they have abdominal pain, but the pulse is floating, large, and long, this is a sign of impending death. If they have abdominal distension and panting, but the pulse is slippery and deep, this is a sign of impending death. If their limbs are cold, but the pulse is floating, large, and short, this is a sign of impending death. If they are deaf, but the pulse is floating, large, and rough, this is a sign of impending death. (The Supplement to the Prescriptions Worth a Thousand Gold says: “A large pulse means the patient may live; a deep, slow, fine, and weak pulse is difficult to treat.”)

If a patient’s eyes are dull and lifeless, but the pulse is large and moderate, this is a sign of impending death. If the illness is on the left but the pain is on the right, or the illness is on the right but the pain is on the left; if the illness is in the lower body but the pain is in the upper body, or the illness is in the upper body but the pain is in the lower body, all these are cases of illness in disorder. Such disorders lead to death and cannot be cured.

If the pulse, when pressed deeply, seems about to stop, but when touched lightly feels soft and floating, and pressing with the finger gives the impression that it keeps beating, the patient will die in about half a month. (Another version says “half a day.”) If the pulse is faint and fine, almost as if it were about to stop, the patient should die. A patient who is ill but has a normal pulse can survive; if the pulse is abnormal while the person appears well, they will die.

If a patient’s body is stiff like a corpse, they do not respond when called, and the pulse has stopped, they will die. If the pulse should be surging and large but is instead fine and small, the patient will die. If an obese person has a pulse as fine as a thread, almost disappearing, they will die; if a frail person has a restless, rapid pulse, they will die.

If the body feels dry and rough to the touch while the pulse flows smoothly, the patient will die; if the body feels smooth and moist while the pulse flows roughly and sluggishly, the patient will die. If a small, thin person has a coarse, large pulse, they will die; if a tall, large person has a fine, small pulse, they will die. If a short person has a long pulse, they will die; if a tall person has a short pulse, they will die.

The pulse at the Chi position should correspond upward with the pulse at the Cun position. If it is large and slow, the patient will die in about half a day. (The Pulse Classic says: “If the Chi pulse does not…” The original text ends here.)

(Pulse patterns) should correspond to the seasonal conditions assessed at the wrist pulse. If the pulse races as though flying, the patient will die within half a day. Examination of the five viscera, six bowels, and twelve channels reveals pulse patterns that run counter to their expected condition. The appearance of even one abnormal, reversed, and disordered pulse pattern is a sign of death.

Essentials for Diagnosing the Life and Death of All Diseases (Chapter Fifteen)

Whenever you take a pulse, observe the patient’s build and stature, as well as whether their temperament is calm or impatient. If the pulse’s speed, strength, and length accord with the patient’s body type and temperament, this is auspicious; if they do not, it is ominous.

In diagnosing cold damage (externally contracted febrile disease): when the fever is high, a floating, large pulse indicates survival, while a deep, small pulse indicates death. After diaphoresis for cold damage, a deep, small pulse indicates survival, while a floating, large pulse indicates death.

In warm disease (an externally contracted illness primarily marked by fever), if the patient has not sweated within the first three or four days, a surging, large, rapid pulse indicates survival. A fine, small pulse that is difficult to feel indicates death; the patient cannot be saved.

When warm disease is epidemic and the fever is very intense, a fine, small pulse indicates death. (At this point, the Pulse Classic writes “rangrang” in place of “seasonal epidemic.”)

In warm disease, diarrhea accompanied by severe abdominal pain indicates death; the patient cannot be saved. A patient with warm disease who does not sweat, or whose sweat does not reach the feet, will die. If the hands and feet are cold and the patient is sweating, a firm, forceful, rapid pulse indicates survival; a weak, moderate pulse indicates death.

On the second or third day of a febrile illness, if the body is hot, the abdomen distended, and the head painful, but the patient eats as usual, a straight, rapid pulse indicates death after eight days. On the fourth or fifth day, headache and abdominal pain with vomiting, together with a fine, forceful pulse, indicate death after twelve days. On the eighth or ninth day, if there is neither headache nor body pain, the eyes are not red, and the complexion has not changed, but diarrhea occurs instead, a continuous pulse that yields under pressure and at times seems large, with hardness below the heart, indicates death after seventeen days.

On the seventh or eighth day of a febrile illness, if the pulse is neither soft (another text reads “panting”) nor scattered (another text reads “rapid”), the patient will lose their voice. If they still have not sweated three days after losing their voice, they will die.

On the seventh or eighth day of a febrile illness, a faint, fine pulse, inability to urinate, and sudden dry mouth, together with an intermittent pulse and a parched, blackened tongue, indicate death.

If a patient with a febrile illness has not yet sweated and the pulse is exuberant, agitated, and rapid, they will survive if they can sweat; if they cannot, recovery will be difficult. If they have already sweated and the pulse is calm and steady, they will survive; an agitated pulse is difficult to treat.

If the pulse in a febrile illness is agitated and forceful but the patient cannot sweat, this means Yang Qi has reached its extreme: in every case, the patient will die, and cannot be saved. If the patient has already sweated but the pulse remains continuously agitated and forceful, Yin Qi has reached its extreme, and the patient will also die. (At this point, the Great Simplicity reads “Yang has reached its extreme.”) If the patient has already sweated but the high fever does not subside, they will also die. (Some editions read “persistent” in place of “great.”) If the patient has already sweated but the fever has not yet subsided, and the pulse is only slightly agitated, treat the case with caution; do not…

When treating a febrile illness, if the fever is very severe and both the Yin and Yang pulses are depleted, proceed with caution and under no circumstances use acupuncture. Otherwise, the patient will not only fail to sweat but will certainly develop diarrhea.

In examining someone who has become numb, paralyzed, or weak in the limbs after exposure to wind, with the feet unable to move: if the pulse is weak, the person can survive (the Chaoyuan says, “A weak and rapid pulse means survival”); if the pulse is hard, rapid, and forceful, the person will die.

In examining mania: if the pulse is vacuous, the condition can be treated; if it is replete, the person will die. In severe mania or seizure-like disorders, a firm, forceful pulse means survival, while a deep, fine, faint pulse means death. A large, slippery pulse may improve on its own after a long illness. A deep, small, rapid, replete pulse cannot be treated; a small, firm, rapid pulse is also difficult to save.

In examining headache and eye pain, if someone stares for a long time yet sees nothing, the person will die. (Some versions read “suddenly becomes unable to see” instead of “stares for a long time.”)

In examining accumulations in the chest and abdomen, including masses in the abdomen: a hard, forceful, rapid pulse means survival; a weak pulse means death. Another account says that a replete, forceful pulse means survival, while a deep, weak pulse means death. If the pulse is large, the abdomen swollen, and the limbs cold, and the pulse itself is long, the person will die.

Abdominal distension and fullness with blood in the stool, accompanied by a large pulse that comes and goes, means death. The same is true when there is profuse bleeding and the pulse is small and rapid.

For pain in the chest and abdomen so severe that the patient cannot rest, a small, fine, slow pulse means survival; a firm, large, rapid pulse means death.

In intestinal dysentery with bloody stools, a fever means death, while chills mean survival. If the stools contain white foam, a deep pulse means survival and a floating pulse means death. If the stools contain pus and blood, an interrupted pulse means death, while a slippery, large pulse means survival. In dysentery-like disorders, a fever with a pulse that is uninterrupted, slippery, and large means survival; an interrupted, rough pulse means death. The course of the illness can be estimated from the number of days the Five Zang organs have been affected. When pus and blood are passed, a deep, small pulse and a protracted illness mean survival; a rapid, large pulse with fever means death. If intestinal dysentery is accompanied by spasms in the sinews and vessels, a small, fine, steady pulse means survival; a floating, large, tight pulse means death.

In severe diarrhea, when food is not digested and pus and blood are also passed, a faint, small pulse means survival; a tight, rapid pulse means death. For watery diarrhea, a moderate pulse that is occasionally somewhat small and feels interrupted means survival; a floating, large, rapid pulse means death.

For yi shi yin zhu (a term in the original for disorders involving erosion of the genital region or a Yin-zhù condition), a vacuous, small pulse means survival; a rapid, urgent pulse means death.

For cough, a deep, tight pulse means death; a floating, straight pulse means survival, as does a floating, soft pulse. A small, deep, hidden pulse that is difficult to detect means death. If coughing is accompanied by wasting, a firm, large pulse means death. If coughing leads to wasting and fever, a small, firm, rapid pulse means death; coughing with severe bodily decline and a persistent fever also means death. If coughing is accompanied by vomiting, abdominal distension, and diarrhea, and the pulse is taut and rapid, as if about to stop, the person will die.

For vomiting blood or nosebleed, a slippery, small, weak pulse means survival; a replete, large pulse means death. With sweating or nosebleed, a small, slippery pulse means survival; a large, agitated, rapid pulse means death. Spitting saliva…

Those whose blood vessels are tense and forceful will die; those whose pulse is smooth and flowing will live. A person who spits blood, coughs, has Qi surging upward, a rapid pulse with signs of heat, and cannot lie down will die. A patient with cold damage who coughs, has Qi surging upward, and a rapid, scattered pulse will die, because the body has already been debilitated. A person with Qi surging upward and a rapid pulse will also die, because the body is debilitated.

A person whose Qi surges upward and whose breathing is rapid and labored, but whose pulse is smooth and flowing and whose hands and feet are warm, will live. Those with a rough, sluggish pulse and cold limbs will die. A person with Qi surging upward, a swollen face, shoulder lifting with each breath, and a large pulse cannot be saved. If diarrhea then occurs, death is certain. (Another version reads, “the illness becomes more severe.”)

A person with Qi surging upward and body fluids draining downward, whose pulse is weak, calm, and deep, will live; those with a hard, forceful pulse will die. When cold Qi surges upward, a full, smooth pulse indicates survival; a full but disordered, rough pulse indicates death. The Taisu records: “When cold Qi suddenly surges upward, the pulse is full and replete.” Asked, “What kind of pulse indicates survival?” the answer was: “If it is full and smooth, the person will live; if it is full and disordered, the person will die.” Asked again, “What is the pulse like in a patient whose body is extremely swollen?” the answer was: “In someone swollen all over, the pulse is rapid, surging, and hard, and the pulse at the cubit position is full and unresponsive. Such a patient will live if the pulse is orderly and die if it is contrary.” Asked, “What counts as orderly, and what as contrary?” the answer was: “Warm hands and feet are orderly; cold hands and feet are contrary.”

In wasting-thirst disease, marked by excessive drinking and eating, frequent urination, and weight loss, a rapid, surging pulse indicates survival; a fine, superficial, and short pulse indicates death. In xiaodan, a type of wasting-thirst disease, a full, surging pulse can be treated even if the illness has lasted a long time. If the illness has lasted a long time and the pulse is floating, fine, hard, and rapid, it is difficult to treat. In wasting-thirst disease, a deep, fine pulse indicates survival; a full, hard, surging pulse indicates death.

In water disease, caused by fluid accumulation in the body, a surging pulse can be treated; a faint, fine pulse cannot. In water disease with swelling and obstruction, a floating, large, gentle pulse indicates survival; a deep, fine, weak pulse indicates death. If water disease causes the abdomen to swell like a drum, a full pulse indicates survival and a weak pulse indicates death.

A person who suddenly suffers an acute illness attributed in ancient times to an attack by malign influences, and spits up several sheng of blood, will die if the pulse is deep, rapid, and fine; a floating, large, forceful pulse indicates survival. In such a sudden illness, if the abdomen is swollen and the limbs are edematous, a large, moderate pulse indicates survival. A tense, floating pulse indicates death, though a tense, fine, faint pulse can also indicate survival.

In a person with sores, stiffness and contraction of the lower back and spine accompanied by convulsions of the sinews and spasms of the hands and feet cannot be treated. A person with alternating chills and fever accompanied by convulsions will die if the pulse appears and disappears intermittently.

After excessive blood loss from a metal-inflicted wound, a weak, fine pulse indicates survival; a rapid, full, surging pulse indicates death. When a metal-inflicted wound is bleeding, a deep, fine pulse indicates survival; a floating, large pulse indicates death. After an axe wound with blood loss of one or two shi, a person with a surging pulse will die after twenty days. The outcome of a chopping or stabbing wound depends on the severity of the injury. If bleeding does not stop and the pulse ceases, then the pulse becomes surging again, … The original text ends here.

A person who has fallen from a height and has internal bleeding and abdominal distension can survive if the pulse is strong and forceful; if it is faint and weak, they will die. Someone poisoned or injured by various drugs will die if the pulse is faint and thin; if it is surging and comes on rapidly, they can survive. (The Mai Jing gives “slow” instead.)

When the illness is severe and the pulse is erratic, recovery is unlikely. When the illness is severe but the pulse is surging, recovery is more likely. If the Qi of both Yin and Yang is blocked, and the upper teeth look like cooked red beans while the pulse is restless, the person will die. (Some versions read “depleted” instead of “blocked.”)

A person who is weak both inside and out, with a cold body and sweating, slight vomiting, agitation, cold hands and feet, and an inability to keep still, will die. Someone whose pulse is full and robust, whose hands and feet are cold, and whose head is hot can survive in spring or autumn, but will die in winter or summer.

An elderly person with a faint pulse, weak Yang Qi, and relatively strong Yin Qi can survive. If the pulse is rapid and surging and the breathing is also rapid, the person will die. When Yin is weak and Yang is strong, a pulse that pauses after every beat signals death within two months.

A rough, firm pulse at the wrist-side section of the Cun pulse indicates that the blood aspect is congested and the Qi aspect is weak. The illness brings abdominal pain and distension, with Qi surging upward. This means the woman’s uterine region and related areas have been injured, leaving stagnant blood that has gradually formed a mass. If the illness begins in winter, she will die when millet and broomcorn millet ripen and turn red.

A thin, faint pulse at the wrist-side section indicates that both blood and Qi are deficient. If the pulse is thin but forceful when it arrives, this indicates a deficiency of grain Qi—the vital essence produced when the Spleen and Stomach transform food. For someone whose illness flares at a particular time of year, death will come when the jujube trees put out leaves. This illness began in autumn.

The Cun pulse at the left wrist is unusually active, varying in size and beating irregularly. The pulse at all three positions—from Cun, through Guan, to Chi—is unsettled, with each position differing from the others. If this person falls ill in midsummer, death will come when the peach blossoms fall. (Some versions read “leaves” instead of “blossoms.”)

The Chi pulse at the right wrist is sunken and hidden, varying between small and large: in the morning it is floating and large, but by evening it becomes sunken and hidden. When floating and large, it is excessively forceful, and the pulse Qi reaches the thenar eminence at the base of the thumb. When sunken and hidden, the pulse Qi descends and does not reach the Guan position. The pulse comes and goes without a consistent pattern, though at times it again becomes floating and large. This person will die when the elm leaves wither and fall. (Some versions read “pods” instead of “leaves.”)

The Chi pulse at the right wrist pauses once after every thirty beats, then resumes after a short while. Later, it pauses once after every twenty beats, sometimes rapid and sometimes sparse, with no correspondence to the rhythm of breathing. Even if such a person eats the Five Grains, they will not recover; death will come when plants begin to sprout.

The Chi pulse at the left wrist pauses once after every forty beats, then resumes. When the pulse returns, it is disordered and reversed, like touching a straight piece of wood or a taut bowstring, drawn tight as if two people were pulling it together…

When taking the pulse, the pulse qualities at the three positions—cun, guan, and chi—should generally be in rough proportion to one another. In children, slender people, and women, the pulse may be fine and soft. In children aged four or five, the pulse beats eight times during one breath cycle; a fine and rapid pulse is an auspicious sign.

The Qianjin Yifang says: Tall people have a fine pulse, while short people have a large pulse; those who are usually at ease have a full pulse, while those who often suffer hardship have an empty pulse; people of an impatient temperament have a slow pulse, while those of a placid temperament have an agitated pulse; the strong have a fine pulse, while the weak have a large pulse. These are all cases in which the pulse does not match the person’s constitution. They are called “contrary” and are generally difficult to treat. The opposite is called “accordant” and is easier to treat. Women’s pulses are generally softer and weaker than men’s. The pulse of a child aged four or five is naturally faster, beating about eight times during one breath cycle.

At times, the pulse may be detectable at the three positions and at other times not. This may be due to cold Qi in the stomach, obstructing the flow of pulse Qi. If the pulses at all three positions are empty, this is life-threatening in a person with a chronic illness. An empty pulse that is choppy, slippery, or slow is likewise dangerous in chronic illness. An empty, wiry, and tense pulse is also life-threatening when seen in a person with mania.

If the pulses at all three positions are full and long, this is dangerous in a person with a chronic illness. If the pulse is full and slippery, someone with a chronic illness may survive, but someone with a sudden illness is in danger. A full, slow pulse or a full, tight pulse is generally compatible with survival; mania with a full, tightly tense pulse can be treated.

If the pulses at all three positions are forceful and hard, and do not match the patient’s constitution, the patient may die. If they are feeble and weak and do not match the patient’s constitution, the patient may also be in danger of death. If the pulses at all three positions are coarse and long, a person with a chronic illness is in danger, while someone with a sudden illness may survive. If they are fine and soft, a person with a chronic illness may survive; a fine and rapid pulse is also compatible with survival. A faint and tight pulse is likewise compatible with survival. If the pulses at all three positions are faint, weak, and deep—so deeply hidden that they are hard to feel—a person with a chronic illness is in danger.

If the pulses at all three positions are soft, a person with a chronic illness may recover without treatment; rash treatment may instead endanger their life. Someone with a sudden illness who has this pulse may survive. If the pulses at all three positions are floating and knotted—a superficial pulse with an interrupted rhythm—a person with a chronic illness is in danger. A floating and slippery pulse is likewise dangerous in chronic illness. If the pulse is floating and rapid, a person with a chronic wind illness may survive, while someone with a sudden illness is in danger.

If the pulses at all three positions are hollow—a large, floating pulse that feels empty in the center—a person with a chronic illness may survive. If they are wiry and rapid, a person with a chronic illness may survive, but someone with a sudden illness is in danger. If they are leathery—a floating, hollow pulse with taut edges—a person with a chronic illness is in danger, while someone with a sudden illness may survive. If the pulses at all three positions are firm, full, and rapid, like the shaft of a silver hairpin, a person with gu-poisoning will certainly die. If the pulse is rapid and soft, someone with gu-poisoning may survive.

If the pulses at all three positions float and drift like foam on the surface of a pot of soup… [The original text ends here.]

A large, long, and forceful pulse is usually seen at the onset of a sudden illness, and the person may survive. If it appears during a chronic illness, however, it foretells a grave condition. When the pulses at the three positions—Cun, Guan, and Chi—continue without interruption and are as fine as spider silk, a person with a chronic illness will die, while one with a sudden illness may survive.

If the pulses at all three positions are rapid and forceful like a thunderclap, a person with a chronic illness will die. If they are taut like a drawn bowstring, the person will also die. If they roll along one after another like a string of beads, the person will likewise die.

If the pulses at all three positions flow slowly, as though submerged in water, the illness may resolve on its own if left untreated; rash treatment, however, may lead to death. If the pulses come and go like drops falling from a leaking roof, a person with a chronic illness will die after fourteen days (the Mai Jing says ten days). If they stop and start like a bird pecking at food, a person with a chronic illness will die after seven days.

If the pulses at all three positions surge and roil like water boiling in a pot, the person will die by evening if this appears in the morning; by noon if it appears at midnight; and by midnight if it appears at noon.

If the pulses at all three positions are rapid and tense, this indicates illness in the abdomen. If they also twist and turn, it indicates abdominal pain. Needling the upper and lower regions can improve the condition.

Sun Simiao, Essential Prescriptions for Emergencies Worth a Thousand Gold (Beiji Qianjin Yaofang), juan 86.