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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Suwen 17 · Essentials and Subtleties of the Pulse
Read in English. Switch to Original for word notes, or select text to ask a question.
The Yellow Emperor asked: “What is the method of diagnosis?”
Qi Bo replied: “Diagnosis is ordinarily made at dawn. Yin qi has not stirred, yang qi has not dispersed, food and drink have not entered, the channels are not full, the network vessels are even, and qi and blood are not disturbed. One can then examine pulses that depart from normal. Palpate their movement and stillness, observe the brightness of the eyes and the five colors, and examine excess or insufficiency of the five zang organs, strength or weakness of the six fu organs, and flourishing or decline of bodily form. Compare these to decide the distinction between life and death.
The vessels are the dwelling of blood. A long pulse means ordered qi; short means disordered qi; rapid means agitation at Heart; large means advancing illness. Abundance above means rising qi; abundance below distending qi. An intermittent pulse means declining qi; fine means scant qi; rough means Heart pain. Turbulent, forceful arrivals like a surging spring mean advancing illness and deteriorating color. A barely continuing departure like a snapped string means death.
The brightness of the five colors is the flowering of qi. Red should resemble vermilion wrapped in white, not ochre. White should resemble goose feathers, not salt. Blue-green should resemble the sheen of a dark jade disc, not indigo. Yellow should resemble realgar wrapped in gauze, not yellow earth. Black should resemble layered lacquer, not the dark color of the ground. When the subtle signs of the five colors appear in this failing form, life will not be long.
The brightness of the eyes sees all things, distinguishes white from black and judges short and long. Taking long for short or white for black means essence has declined.
The five zang organs guard the interior. Fullness within and in the organs, qi prevailing with fright, and a voice as though speaking from inside a room indicate dampness of the interior qi. Faint speech that takes all day to recur means qi has been depleted. Clothing left unfastened and words both good and bad spoken without regard for kin or strangers mean disordered spiritual brightness. Granaries failing to store mean the gates no longer hold. An unceasing water spring means Bladder fails to store. Maintaining the guard means life; losing it means death.
The five zang organs are the body’s strength. The head houses clear perception: a drooping head and deep-set gaze mean essence and spirit are about to be depleted. The back houses the chest: a bent back and drooping shoulders mean that dwelling is about to fail. The waist houses Kidney: inability to turn or sway means Kidney is about to be exhausted. Knees house the sinews: inability to bend or straighten and a stooped, supported gait mean sinews are about to be exhausted. Bones house marrow: inability to stand long and shaking when walking mean bones are about to be exhausted. Retaining strength means life; losing it means death.”
Qi Bo said: “When contrary to the seasons, surplus is called jing and insufficiency consumption. In responding to excess, insufficiency is called jing; in responding to insufficiency, surplus is called consumption. Yin and yang failing to correspond is called closure and obstruction.
Reading note: Jing, 精, remains the supplied category. Wang Bing distinguishes the stronger harmful influence from depletion of blood and qi; the reciprocal clauses are retained rather than regularized.
The Emperor asked: “How does the pulse move with the seasons? How is the illness’s location known? How is its transformation known? How is illness suddenly inside known? How is illness suddenly outside known? May I hear these five matters?”
Qi Bo said: “Let me speak of its great turning with heaven. Beyond individual things, within the six directions, heaven and earth change and yin and yang respond. Spring warmth becomes summer heat; autumn severity becomes winter’s fierceness. Through these four changes the pulse rises and falls: spring answers the compass, summer the square, autumn the balance beam and winter the weight.
Forty-five days after the winter solstice, yang qi rises slightly and yin qi descends slightly. Forty-five days after the summer solstice, yin qi rises slightly and yang qi descends slightly. Yin and yang have their times, setting the pulse’s periods. When period and pulse fail to agree, their divergence is known; divergence has its appointed time, so the time of death is known.
The subtle lies in the pulse and must be examined. Examination has an ordering principle, beginning with yin and yang. Its beginning has a standard arising from the five phases; their generation has a measure suited to the seasons. Do not miss supplementation and draining. Be as one with heaven and earth; grasping this oneness reveals life and death.
Voice corresponds to five tones, color to five phases, and pulse to yin and yang. Thus strong yin brings dreams of crossing great water in fear; strong yang dreams of blazing fire. Both strong bring dreams of mutual killing and injury. Abundance above brings dreams of flight; abundance below dreams of falling. Great fullness brings dreams of giving; great hunger dreams of taking. Strong Liver qi brings dreams of anger; strong Lung qi dreams of weeping. Many short worms bring dreams of crowds; many long worms dreams of fighting and injury.
Pulse examination has a Way: emptiness and stillness preserve it. In spring the pulse floats like fish moving among waves. In summer it lies at the skin, broadly afloat as all things have a surplus. In autumn it lies below the skin as hibernating creatures prepare to depart. In winter it lies at bone, as creatures seal themselves away and the gentleman dwells indoors. Thus to know inside, press and order it; to know outside, follow ending into beginning. These six are the great methods of pulse examination.
Heart’s pulse beating firm and long brings a curled tongue and inability to speak. Soft and scattered, it disperses and ends of itself as the circuit completes.
Lung’s pulse beating firm and long brings spitting blood. Soft and scattered, it brings the disorder called guan sweat, whose outward release has still not recovered.
Liver’s pulse beating firm and long without blue-green color indicates a fall or blow, with blood beneath the ribs producing panting counterflow. Soft and scattered with lustrous color indicates overflowing drink: thirst and sudden great drinking allow fluid to enter skin and flesh outside intestines and stomach.
Stomach’s pulse beating firm and long with red color brings pain as though the thigh were broken. Soft and scattered, it brings food obstruction.
Spleen’s pulse beating firm and long with yellow color brings scant qi. Soft and scattered without luster, it brings swelling of the lower legs like Water.
Kidney’s pulse beating firm and long with yellow-red color brings pain as though the waist were broken. Soft and scattered, it brings diminished blood that has still not recovered.
Reading note: The supplied 足鴬腫 is read through the annotated 足䯒腫, swelling of the lower legs. Guan sweat remains the source’s unusual 灌汗 term, not a newly named modern disease.
The Emperor asked: “When the Heart pulse is urgent, what illness is this and what form does it take?”
Qi Bo said: “It is called Heart hernia. There should be a formed mass in the lower abdomen.”
The Emperor asked: “Why say this?”
Qi Bo said: “Heart is a male zang organ and Small Intestine its envoy. Thus there should be a formed mass in the lower abdomen.”
The Emperor asked: “When a Stomach pulse is found, what form does the illness take?”
Qi Bo said: “A replete Stomach pulse means distention; a deficient one diarrhea.”
The Emperor asked: “What is meant by illness forming and transforming?”
Qi Bo said: “Established Wind becomes cold and heat; established heat disorder becomes wasting within; counterflow becomes illness at the crown. Longstanding Wind becomes diarrhea with undigested food; vessel Wind becomes li, a destructive skin disorder. The transformations of illness cannot be counted.”
The Emperor asked: “Where do abscesses, swellings, sinew contractures and bone pain arise?”
Qi Bo said: “They are swellings from cold qi and transformations of the eight winds.”
The Emperor asked: “How are they treated?”
Qi Bo said: “These are seasonal illnesses. Treat with what overcomes them, and recovery follows.”
The Emperor asked: “Old illnesses may stir among the five zang organs and injury may affect pulse and color. How can one distinguish longstanding illness from sudden onset?”
Qi Bo said: “How comprehensive the question! A small pulse without depleted color indicates new illness. An undepleted pulse with depleted color indicates old illness. Both pulse and five colors depleted indicate old illness; neither depleted indicates new illness.
Liver and Kidney pulses arriving together with blue-green and red color indicate injury without visible blood. If blood has already appeared, dampness or water involvement is present.”
The two sides within the chi region correspond to the lower ribs. Outside chi assesses Kidney; inside assesses the abdomen. Above the middle, left outside assesses Liver and inside the diaphragm; right outside assesses Stomach and inside Spleen. At the uppermost region, right outside assesses Lung and inside the chest; left outside assesses Heart and inside the Center of the Chest. Front assesses front and back assesses back. The utmost upper region concerns chest and throat; the utmost lower concerns lower abdomen, waist, thighs, knees, shins and feet.
A coarse, large pulse indicates insufficient yin and surplus yang: internal heat. Fast arrival and slow departure indicate excess above and deficiency below: counterflow and crown illness. Slow arrival and fast departure indicate deficiency above and excess below: aversion to wind.
When harmful wind strikes, yang qi receives it. Pulses all sinking, fine and rapid indicate Shaoyin counterflow. Sinking, fine, rapid and scattered indicate cold and heat. Floating and scattered means dizziness and collapse. Floating without agitation lies in yang and means heat; agitation places it at the hand. Fine and sinking lies in yin and means bone pain; stillness places it at the foot. Several beats followed by an interruption indicate illness in the yang vessels, with diarrhea and discharge of pus and blood.
In abnormal pulses, roughness means surplus yang qi and slipperiness surplus yin qi. Surplus yang means a hot body without sweat; surplus yin means much sweat and a cold body. Both surplus means cold without sweat.
Push outward: if it stays inside and does not go out, there is accumulation in Heart and abdomen. Push inward: if it stays outside and does not enter, the body has heat. Push upward: if it rises without descending, waist and feet are cold. Push downward: if it descends without rising, head and nape are painful. Press to bone: scant pulse qi means waist and spine pain with bodily obstruction.”
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