Suwen · The Subtle Essentials of the Pulse

The text

The Yellow Emperor asked: What is the method of examination? Qi Bo replied: The method of examination is always at the calm dawn, when yin-qi has not yet stirred, yang-qi has not yet scattered, drink and food have not yet entered, the channel-pulses are not yet abundant, the collateral pulses are even, and qi and blood are not yet disordered — only then can one examine a pulse that has gone too far. Feel the movement and stillness of the pulse, and look at the jing-brightness; examine the five colors; observe surplus and insufficiency in the five zang, strength and weakness in the six fu, flourishing and decline in the form. Compare these with one another, and decide the divide between death and life. The pulse is the mansion of blood. When it is long, qi is in order; when it is short, qi is ill. When it is rapid, the heart is troubled; when it is large, the illness is advancing. When the upper is abundant, qi is high; when the lower is abundant, qi swells. When it is intermittent, qi is declining; when it is fine, qi is little; when it is rough, there is pain in the heart. When it comes rushing, rushing, like a bursting spring, the illness is advancing and the color is ruined; when it leaves, faint, faint, like a string snapping — death. The jing-brightness and the five colors are the flowering of qi. Red should be like cinnabar wrapped in white silk, not like ochre. White should be like a goose feather, not like salt. Green should be like the sheen of a dark jade disk, not like indigo. Yellow should be like realgar wrapped in gauze, not like yellow earth. Black should be like the color of heavy lacquer, not like ashen ground. When the subtle images of the five colors appear plainly, the years will not be long. Jing-brightness is that by which one sees the ten thousand things, distinguishes white and black, and judges short and long. To take the long as short, the white as black — in this the jing has already declined. The five zang are the keepers of the center. When the center is abundant and the zang are full, when qi prevails and injures by fear, the voice is as if speaking from inside a room — this is dampness of the center-qi. Speech that is faint, and only after a whole day is repeated — this is qi seized away. Clothes and covers not gathered, speech good and evil without regard to near or far — this is the disorder of spiritual brightness. When the granary does not store, the gates and doors do not hold. When the water-spring does not stop, the bladder does not store. Those who keep, live; those who lose the keeping, die. The five zang are the strength of the body. The head is the mansion of jing-brightness; when the head tilts and the gaze is deep, the jing and the spirit are about to be seized. The back is the mansion of the chest; when the back is bent and the shoulders follow, the mansion is about to fail. The waist is the mansion of the kidney; when it cannot turn and sway, the kidney is about to be exhausted. The knee is the mansion of the sinews; when it cannot bend and stretch, and walking is stooped and clinging, the sinews are about to be exhausted. The bone is the mansion of the marrow; when one cannot stand long, and walking shakes and sways, the bone is about to be exhausted. Those who obtain strength, live; those who lose strength, die. Qi Bo said: Those who go against the four seasons — surplus is jing; insufficiency is wasting. When it should be too much, and there is insufficiency, that is jing; when it should be insufficient, and there is surplus, that is wasting. When yin and yang do not answer one another, the illness is called blockage and refusal. The Emperor said: How does the pulse move with the four seasons? How does one know where the illness is? How does one know how the illness changes? How does one know when the illness is suddenly within? How does one know when the illness is suddenly without? I ask about these five — may I hear them? Qi Bo said: Let me speak of how they turn, great as heaven. Beyond the ten thousand things, within the six directions: the changes of heaven and earth, the answering of yin and yang. The warmth of that spring becomes the heat of summer; the severity of that autumn becomes the rage of winter. The movement of the four changes — the pulse goes up and down with them. Spring answers as if within the compass; summer as if within the square; autumn as if within the balance-beam; winter as if within the steelyard-weight. Therefore in the forty-five days from the winter solstice, yang-qi rises a little and yin-qi descends a little. In the forty-five days from the summer solstice, yin-qi rises a little and yang-qi descends a little. Yin and yang have their times, and keep appointment with the pulse. When the appointment is missed, one knows where the pulse has divided; the divisions have their times, and so one knows the hour of death. The subtlety is in the pulse; it must be examined. Examination has its thread, beginning from yin and yang. The beginning has its channels, born from the five phases. Birth has its measures, taking the four seasons as what is fitting. In filling and draining do not lose this; be as one with heaven and earth. Obtain the condition of the one, and you know death and life. Therefore the voice joins the five tones, color joins the five phases, the pulse joins yin and yang. Thus one knows: when yin is abundant one dreams of wading great waters in fear; when yang is abundant one dreams of great fires burning; when yin and yang are both abundant one dreams of killing and of being destroyed. When the upper is abundant one dreams of flying; when the lower is abundant one dreams of falling. When very full one dreams of giving; when very hungry one dreams of taking. When liver-qi is abundant one dreams of anger; when lung-qi is abundant one dreams of weeping. When short worms are many one dreams of crowds gathering; when long worms are many one dreams of striking and of being destroyed. Therefore there is a Dao in holding the pulse: emptiness and stillness are the safeguard. On a spring day it floats, like a fish swimming in the waves. On a summer day it is in the skin, spreading, spreading, as if the ten thousand things had surplus. On an autumn day it is under the skin, as the hibernating insects are about to go. On a winter day it is in the bone, the hibernating insects sealed all around, the junzi dwelling in his room. Therefore it is said: those who know the inside press and take the thread; those who know the outside go from end to beginning. These six are the great method of holding the pulse. When the heart pulse beats firm and long, there should be illness of the tongue rolling and inability to speak; when it is soft and scattered, there should be wasting that circles and ends of itself. When the lung pulse beats firm and long, there should be illness of spitting blood; when it is soft and scattered, there should be illness of pouring sweat, and to this day it does not gather and scatter again. When the liver pulse beats firm and long, and the color is not green, there should be illness from a fall or a blow, because blood is under the ribs, making a person pant and reverse; when it is soft and scattered and the color is moist, there should be overflowing drink — overflowing drink is sudden thirst and much drinking, which easily enters the flesh, the skin, and the outside of the intestines and stomach. When the stomach pulse beats firm and long, and the color is red, there should be illness as if the thigh were broken; when it is soft and scattered, there should be illness of food impediment. When the spleen pulse beats firm and long, and the color is yellow, there should be illness of little qi; when it is soft and scattered and the color is without sheen, there should be illness of swelling in the lower leg, as if of water. When the kidney pulse beats firm and long, and the color is yellow and red, there should be illness as if the waist were broken; when it is soft and scattered, there should be illness of little blood, and to this day it does not return. The Emperor said: On examination one obtains a heart pulse that is urgent. What illness is this, and what is the form of the illness? Qi Bo said: The name of the illness is heart-shan; there should be a form in the lesser abdomen. The Emperor said: Why do you say this? Qi Bo said: The heart is a yang zang; the small intestine is its envoy. Therefore it is said there should be a form in the lesser abdomen. The Emperor said: On examination one obtains a stomach pulse. What is the form of the illness? Qi Bo said: When the stomach pulse is replete there is swelling; when it is vacuous there is draining. The Emperor said: When the illness is complete and then changes — what is meant? Qi Bo said: Wind becomes cold and heat; dan becomes wasting of the center; reversal becomes vertex illness; long wind becomes food-diarrhea; vessel-wind becomes li. The changes of illness cannot be counted to the end. The Emperor said: The various welling-swellings, sinew cramps, and bone pains — where are all these born? Qi Bo said: These are swellings of cold qi, the changes of the eight winds. The Emperor said: How are they treated? Qi Bo said: These are illnesses of the four seasons; treat them by what overcomes them, and they heal. The Emperor said: There are old illnesses that stir from the five zang, and thereby injure pulse and color. How, in each case, does one know a long-standing illness from one that has arrived suddenly? Qi Bo said: How complete your question is. If you find the pulse small and the color not seized, it is a new illness. If you find the pulse not seized and the color seized, this is a long illness. If you find pulse and the five colors both seized, this is a long illness. If you find pulse and the five colors both not seized, it is a new illness. When the liver and kidney pulses arrive together, and the color is dark-green and red, there should be illness from destruction and injury. If blood is not seen, or if blood has already been seen, it is damp, as if struck by water. The inner sides of the chi, on both flanks, are the floating ribs. The outer chi is used to assess the kidney; the inner chi is used to assess the abdomen. At the middle attachment above: on the left, the outer is used to assess the liver, the inner to assess the diaphragm; on the right, the outer is used to assess the stomach, the inner to assess the spleen. At the upper attachment above: on the right, the outer is used to assess the lung, the inner to assess the chest; on the left, the outer is used to assess the heart, the inner to assess the danzhong. The front is used to assess the front; the rear is used to assess the rear. What reaches the utmost above is a matter of the chest and throat; what reaches the utmost below is a matter of the lesser abdomen, the waist, the thighs, the knees, the shins, and the feet. When it is coarse and large, yin is insufficient and yang has surplus — this is heat in the center. When it comes quickly and leaves slowly, the upper is replete and the lower vacuous — this is reversal and vertex illness. When it comes slowly and leaves quickly, the upper is vacuous and the lower replete — this is malignant wind. Therefore those struck by malignant wind have received it in the yang-qi. When the pulses are all sunken, fine, and rapid, it is shaoyin reversal; when sunken, fine, rapid, and scattered, it is cold and heat; when floating and scattered, it is dizziness and falling. All that float and are not restless are in yang, and so there is heat; those that are restless are in the hand. All that are fine and sunken are in yin, and so there is bone pain; those that are quiet are in the foot. When it is rapid, moving, and then skips once — the illness is in a yang channel: draining, and pus and blood in the stool. Of all that have gone too far: on feeling, the rough means yang-qi has surplus; the slippery means yin-qi has surplus. Yang-qi with surplus: heat in the body and no sweat. Yin-qi with surplus: much sweat and a cold body. Yin and yang both with surplus: no sweat, and cold. Push it outward: if it stays inward and will not go out, there is an accumulation in the heart and abdomen. Push it inward: if it stays outward and will not go in, there is heat in the body. Push it upward: if it stays above and will not go down, the waist and feet are clear-cold. Push it downward: if it stays below and will not go up, the head and nape ache. Press it to the bone: if the pulse-qi is little, there is pain in the waist and spine, and impediment in the body.

The line

The pulse is the mansion of blood. When it is long, qi is in order; when it is short, qi is ill. When it is rapid, the heart is troubled; when it is large, the illness is advancing. When the upper is abundant, qi is high; when the lower is abundant, qi swells. When it is intermittent, qi is declining; when it is fine, qi is little; when it is rough, there is pain in the heart. When it comes rushing, rushing, like a bursting spring, the illness is advancing and the color is ruined; when it leaves, faint, faint, like a string snapping — death.

The note

One examines at the calm dawn because drink, food, and thought have not yet stirred the water. The pulse is the mansion of blood — a mansion is where a thing lives, not a table of names.