Shang Han Lun · Treatise on Cold Damage

2. Assessing Pulse Methods

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Question: The pulse has three regions, and yin and yang overtake each other. Nutritive and defensive qi, blood and qi dwell in the human body. With inhalation and exhalation they enter and leave, rising and falling within; following the breath, they circulate and spread, while fluids flow freely. Their movements accord with the seasons and display their forms: wiry in spring, floating in autumn, deep in winter and surging in summer. Yet in observing complexion and pulse, large and small differ; within a single moment they change without a constant pattern. Cun and chi are uneven, now short, now long; above and below disagree, now present, now absent. Illness continually alters them, advancing and retreating, falling and rising. The mind becomes confused and judgment loses its rules. Please set this out fully so that it can be understood clearly. The master says: What you ask concerns the root and source of the art. The pulse has three regions: cun, chi and guan. Nutritive and defensive qi circulate without losing their balance. The Kidney pulse is deep, the Heart surging, the Lung floating and the Liver wiry. These are their normal constants, differing by neither zhu nor fen. Entering and leaving, rising and falling, they revolve with the water-clock: while the water descends two ke, one circuit is completed. They should return to the cunkou, where deficiency and repletion appear. Transformations overtake one another, and yin and yang interfere. Wind gives a floating, deficient pulse; cold a firm, hard pulse. A deep, hidden pulse signifies accumulated water; supporting fluids give a tense, wiry pulse. Stirring signifies pain; rapidity signifies heat and agitation. If a correspondence fails, understand the reason for the change. When the three regions differ, the illnesses have different beginnings. Excess is remarkable, and insufficiency likewise. Harmful signs do not appear without cause; something disruptive must be within. Examine exterior and interior carefully and distinguish the three burners. Know where the illness lodges, assess its waxing and waning, and estimate the bowels and viscera: then your unique discernment will seem spirit-like. I set this down item by item for you, to transmit to worthy people. The master says: Inhalation and exhalation are the beginning of the pulse examination. When first taking the pulse, if it comes swiftly and leaves slowly, this is swift emergence and slow entry, called internal deficiency and external repletion. If it comes slowly and leaves swiftly, this is slow emergence and swift entry, called internal repletion and external deficiency. Question: The highest practitioner knows by looking, the middle practitioner by asking, and the lowest by taking the pulse. Please explain this. The master says: Suppose the patient's family summons the physician, saying that the patient has fever and bodily pain and lies down on their own. When the master arrives and finds the pulse deep and slow, he knows recovery is coming. How does he know? An exterior illness should have a floating, large pulse. Since the pulse is instead deep and slow, he knows the illness is resolving. Suppose the patient reports sudden pain inside the abdomen and sits up on their own. When the master arrives, a floating, large pulse tells him that recovery is coming. How does he know? An interior illness should have a deep, fine pulse. Since the pulse is now floating and large, he knows the illness is resolving. The master says: The patient's family comes to summon the physician, saying that the patient has fever and extreme agitation. When the master arrives the next day and finds the patient lying facing the wall, the heat has already departed. Even if the pulse is not harmonious, he declares that recovery has occurred. Suppose the patient lies facing the wall and, on hearing that the master has arrived, does not rise in alarm but looks askance, speaking three times and stopping three times, and swallowing saliva during pulse examination: this is feigned illness. Suppose the pulse itself is harmonious; the text then has the master say, 'Your illness is very grave. You must take medicines to induce vomiting and purging, and receive needling and moxibustion at dozens or hundreds of places, before you recover.' If the patient yawns while the master takes the pulse, there is no illness. If the patient groans during pulse examination, there is illness. Slow speech indicates wind. Speaking while shaking the head indicates internal pain. Slow walking indicates stiffness of the exterior. Sitting bent forward indicates shortness of qi. Sitting with one leg lowered indicates lower-back pain. With interior repletion, protecting the abdomen as if cradling an egg indicates Heart pain. The master says: Illness from latent qi is assessed with attentive judgment. Within the present month, latent qi is about to manifest. If latent qi has already been present, the pulse must be examined. If it is faint and weak, there should be pain in the throat as if injured, rather than throat impediment. The patient says, 'There really is pain in my throat.' Even so, diarrhea is now also about to occur. Question: What is the pulse like in a person suffering fear and terror? The master says: Its form is like following strands of silk, one after another; the face is pale and loses its color. Question: What is the pulse like in someone who does not drink? The master says: The pulse is naturally rough, and the lips and mouth are dry. Question: What is the pulse like in someone who feels shame? The master says: The pulse is floating, and the face alternates between pale and red. Question: The classic speaks of pulse pressures of three beans' weight and six beans' weight. What does this mean? The master says: When one presses the pulse with a finger, pressure like the weight of three beans corresponds to Lung qi; six beans to Heart qi; nine beans to Spleen qi; twelve beans to Liver qi; and pressure reaching the bone to Kidney qi. Suppose there is diarrhea and no pulse is visible at the cunkou, above the guan or within the chi, yet a slight pulse appears occasionally at the chi, its head rising twice: this is Kidney qi. If a damaged pulse is seen arriving, treatment is difficult. Question: In the pulse, what is meant by overtaking that is longitudinal, transverse, contrary or following? The master says: Water overtaking Fire, and Metal overtaking Wood, are called longitudinal. Fire overtaking Water, and Wood overtaking Metal, are called transverse. Water overtaking Metal, and Fire overtaking Wood, are called contrary. Metal overtaking Water, and Wood overtaking Fire, are called following. Question: What is meant by destructive pulses? The master says: Wiry, tight, floating, slippery, deep and rough pulses—these six are called destructive, because they can produce disorders among the various pulses. Question: What is meant by a disastrous anomaly in the pulse? The master says: Suppose an ill person's pulse indicates Taiyang and agrees with the bodily signs, so a decoction is prepared. In about the time needed to eat a meal, while it is being sent back, the patient begins to vomit greatly, or develops diarrhea and abdominal pain. The master says, 'When I came earlier these signs were absent; now an unexpected change has occurred.' This is called a disastrous anomaly. Question: What causes this vomiting and diarrhea? Answer: A medicine taken previously may only now have begun to act. That is why it is called a disastrous anomaly. What is the form of the Heart pulse of the south? The master says: The Heart is Fire and is called Shaoyin. Its pulse is surging, large and long: this is the Heart pulse. In Heart illness, the spontaneous appearance of a surging, large pulse means recovery. If the pulse arrives faint and departs large, this is called reversal, and the illness is in the interior. If its arriving head is small and its base large, this is called overturning, and the illness is in the exterior. Faintness above with a small head produces sweating. Faintness below with a large base produces guange obstruction, with inability to urinate. Absence of sweat on the head is treatable; sweating there means death. Question: If a downy, floating pulse is found in the second lunar month, why can one declare that death will occur in autumn? The master says: In the second month the pulse should be yielding and weak. Finding a downy, floating pulse instead tells us that death will come in autumn. The Liver governs in the second month; its pulse belongs to Wood and should be yielding and weak. A downy, floating pulse is instead the Lung pulse. The Lung belongs to Metal, and Metal comes to overcome Wood; hence death is expected in autumn. Other cases follow this pattern. The master says: In a fat person, question a floating pulse; in a thin person, question a deep pulse. A fat person's pulse should be deep but is instead floating; a thin person's should be floating but is instead deep. That is why these findings are questioned. The master says: If the cun pulse does not reach downward to the guan, yang has expired. If the chi pulse does not reach upward to the guan, yin has expired. Both are untreatable and signify certain death. To calculate the remaining lifespan and the time of death, determine the month or seasonal node that overcomes the affected phase. The master says: A diseased pulse in a person who does not appear ill is called a walking corpse, because governing qi is absent. Sudden dizziness, collapse and failure to recognize people indicate a shortened life and death. A person who is ill but whose pulse is not diseased is called internally deficient, because the spirit of grain is absent; even if exhausted, the person is not in grave danger. Question: Someone once challenged me: from where does a tight pulse arise? The master says: After loss of sweat or vomiting, cold inside the Lung makes the pulse tight. In a person with cough, drinking cold water makes it tight. In diarrhea, deficiency and cold within the Stomach make it tight. At the cunkou, abundant defensive qi is called high; abundant nutritive qi is called manifest. High and manifest striking together are called a guiding cord. Weak defensive qi is called fearful; weak nutritive qi is called low. Fearful and low striking together are called damage. Harmonious defensive qi is called relaxed; harmonious nutritive qi is called slow. Slow and relaxed striking together are called deep. When the Fuyang pulse is slippery and tight, slipperiness means replete Stomach qi and tightness means strong Spleen qi. Bringing repletion against strength makes the pain turn back and injure oneself, as when grasping a blade by hand and thereby making a wound. A hidden, rough Fuyang pulse: hiddenness means counterflow vomiting and failure to transform water and grain; roughness means food cannot enter. This is called guange obstruction. A weak, slow cunkou pulse: weakness means faint defensive qi, and slowness cold within the nutritive aspect. Nutritive qi corresponds to blood; cold blood produces fever. Defensive qi corresponds to qi; faint qi causes hunger within the Heart region, yet this hunger is accompanied by deficient fullness and inability to eat. A large, tight Fuyang pulse means that diarrhea should occur at once, and treatment will be difficult. A tight, floating Fuyang pulse: floating signifies qi and tightness cold; floating signifies abdominal fullness and tightness twisting pain. Floating and tightness strike together, making the intestines rumble and turn. Their turning is movement of qi, and the qi at the diaphragm then descends. If the Shaoyin pulse does not emerge, the genitals are swollen, enlarged and empty. A deep, rapid Fuyang pulse: depth signifies repletion and rapidity the digestion of grain. Tightness means the illness is difficult to treat. A faint, rough cunkou pulse: faintness means declining defensive qi, and roughness insufficient nutritive qi. Declining defensive qi gives a yellow complexion; insufficient nutritive qi gives a blue-green complexion. Nutritive qi is the root and defensive qi the leaves. If both are faint, root and leaves wither, with chills and trembling, cough and counterflow, fishy-smelling expectoration, and vomiting of thin saliva and foam. A faint, relaxed cunkou pulse: faintness means defensive qi is dispersed, leaving the skin empty. Relaxation means Stomach qi is replete, so grain is digested and water transformed. Grain enters the Stomach; the pulse pathways then move and enter the channels, and blood is formed. When nutritive qi is abundant, the skin must become loose and open. If the triple burner cuts off the channels, this is called flooding of blood. A faint, tight Fuyang pulse: tightness means cold and faintness deficiency. Faintness and tightness strike together, producing shortness of qi. A weak, rough Shaoyin pulse: weakness means slight agitation; roughness means reversal counterflow. If the Fuyang pulse does not emerge, the Spleen fails to move upward and downward; the body is cold and the skin hard. A faint cunkou pulse and a tight chi pulse, with deficiency-depletion and much sweating, show that yin remains constantly present while yang is entirely absent. At the cunkou, faint pulses indicate loss of yang; yielding pulses loss of blood; weak pulses fever; tight pulses cold. Those overtaken by cold develop reversal, clouded oppression and numbness. The Stomach lacks grain qi and the Spleen is rough and obstructed; the mouth is tense and cannot speak, with shaking and trembling. Question: Why do yielding and weak pulses instead extend to eleven heads? The master says: Because the five viscera and six bowels overtake one another, making eleven. The source's 'eleven heads' is retained as its own terminology. Question: How can one tell that the bowels are being overtaken, and how can one tell that the viscera are being overtaken? The master says: Floating, rapid yang pulses indicate overtaking of the bowels; slow, rough yin pulses indicate overtaking of the viscera.

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