This textbook’s section on pulse diagnosis must master the eleven types of pulse patterns, including floating, sinking, slow, and rapid, as required by the teaching syllabus. Therefore, this article mainly provides a brief analysis of these contents, offering necessary explanations for difficult words, phrases, and sentences, while other content is briefly mentioned. The aim is to help students enhance their understanding during the memorization process, making it easier to remember based on comprehension. The content is divided into two parts: “Four-character” and “Seven-character” verses.
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One |
“Analysis of Four-character Verses” |
This textbook divides the pulse diagnosis verses into twenty-eight sections based on the nature of the content. Sections one to twenty-five discuss “pulse diagnosis” within the context of “cut diagnosis,” while sections twenty-six to twenty-eight discuss “press diagnosis.” Both diagnostic methods involve the physician using their hands to touch and press the patient’s body surface to obtain important diagnostic information, collectively referred to as “cut diagnosis” in TCM. However, “pulse diagnosis” focuses on the patient’s arteries (referring to the arteries of the body’s meridians, as stated in the “Nanjing – First Difficulty”: “All twelve meridians have arteries”), while “press diagnosis” involves pressing on the patient’s skin, limbs, chest, and abdomen. Thus, the two methods are similar yet distinct. We will first analyze “pulse diagnosis” according to the textbook’s order.
(1) Pulse Diagnosis
This textbook’s twenty-five sections of verses include the basic content of TCM pulse diagnosis. In terms of diagnostic methods, TCM has developed three diagnostic methods over time: “comprehensive diagnosis,” “three-part diagnosis,” and “cun-kou diagnosis.” The verses mainly introduce the cun-kou diagnosis method, with only a brief mention of the comprehensive diagnosis method in the third section. From a clinical perspective, the cun-kou diagnosis method is the most commonly used, so students should strive to master and apply this method proficiently. Below is a segment-by-segment analysis:
The first section discusses the rationale behind TCM pulse diagnosis focusing on the “cun-kou” (寸口) method. The following eight lines describe the naming and positioning of the three parts of the cun-kou pulse: cun (寸), guan (关), and chi (尺).
〔Note〕
1. Blood Mansion: Refers to the place where blood circulates. The “Su Wen” states: “The pulse is the mansion of blood.”
2. Cun-kou: Refers to the position on the wrist where the radial artery is located, belonging to the Taiyin Lung Meridian. This pulse is approximately one inch long, hence the name “cun-kou,” also known as “pulse mouth” or “qi mouth.” The cun-kou includes the three parts: cun, guan, and chi. The positioning is as follows: the high bone at the back of the palm is the guan, the front of the guan is the cun, and the back of the guan is the chi. (See Figure 1)
3. Great Meeting at the Morning Assembly: This line indicates that the cun-kou pulse belongs to the Taiyin Lung Meridian, which governs qi and connects to all pulses. Simultaneously, the cun-kou pulse is also where the qi of the spleen and stomach converges, as the spleen and stomach are the foundation of postnatal life, and all organs depend on the nourishment of the spleen and stomach qi. Therefore, the condition of all internal organs, meridians, and qi-blood can be reflected in the “cun-kou pulse.” The “Nanjing” states: “The cun-kou is the great meeting of the pulse… hence the method is to take from the cun-kou.”
4. Diagnosing the pulse of a person, taken above the high bone: These two lines describe the specific method for diagnosing the cun-kou pulse. When diagnosing the pulse, the patient should place their hand flat on the pulse pillow, palm facing up, and the back of the hand facing down, allowing the hand to extend comfortably to facilitate smooth flow of qi and blood. During pulse diagnosis, the physician first presses the patient’s guan part with their middle finger, then places the index and ring fingers on the cun and chi parts, respectively.
5. Yang cun and Yin chi: TCM believes that from the guan to the back of the palm, there is approximately one inch, hence the name cun; it corresponds to the upper part of the body, thus it is yang. From the guan to the chi ze point at the elbow crease, it is about one foot long, hence the name chi; it corresponds to the lower part of the body, thus it is yin.
The second section: The first eight lines discuss the method of correlating the left and right hands’ cun, guan, and chi with the corresponding organs (see the table below).
Regarding the method of “cun-kou allocation of organs,” aside from what is described in the “Golden Mirror,” there are other differing allocation methods, which will be elaborated in the “Introduction to TCM” later.
This section discusses the importance of the two chi pulses in relation to the kidneys and the mingmen (命门). TCM believes that the mingmen is located between the two kidneys, hence pulse diagnosis is also performed at the chi part. Since the mingmen is the source of original qi in the human body and the residence of spirit, in men, the mingmen stores essence, while in women, it connects to the womb, and its qi is interconnected with the kidneys. The mingmen is also related to the five internal organs and is referred to as “the source of kidney qi,” considered the origin of life, the foundation of the internal organs, the root of the meridians, the gateway of respiration, and the source of the sanjiao. Therefore, if the mingmen is exhausted, life is extinguished. Hence, the verse states: “Without the two chi, one must die without recovery.”
The section “One division of the guan pulse” and the following four lines discuss the naming and main diseases of the “cun-kou pulse” regarding “renying” (人迎) and “qikou” (气口). The so-called “one division of the guan pulse” refers to one division above the guan of the cun-kou pulse. The ancients believed that the cun, guan, and chi parts of the cun-kou pulse occupy approximately one inch and nine tenths, with each part occupying about one third, approximately six tenths each. The left hand’s guan pulse is called “renying,” while the right hand’s guan pulse is called “qikou.” Since the left guan pulse corresponds to the liver and gallbladder, which govern wind, it is said: “When the renying pulse is strong, it indicates wind injury.” The right guan pulse corresponds to the spleen and stomach, which govern food and drink, hence it is said: “When the qikou pulse is strong, it indicates food injury.”
Regarding “renying” and “qikou,” TCM has some differing interpretations, but due to space limitations, they cannot all be detailed here.
The third section: The first four lines discuss the “seven diagnoses” of the cun-kou pulse. The so-called “seven diagnoses” refer to the floating, middle, sinking, upper, lower, left, and right methods. Floating refers to the floating pulse (音hoù, meaning to examine), which involves lightly placing the fingers on the skin to examine the pulse; middle refers to the middle pulse, which is slightly heavier than the floating pulse and examines the pulse between the muscles; sinking refers to the sinking pulse, which is heavier than the middle pulse and examines the pulse near the bones; upper refers to examining the two cun parts to diagnose diseases of the head, face, throat, and chest; lower refers to examining the two chi parts to diagnose diseases of the abdomen, waist, and knees. Left and right refer to examining the left and right hands, respectively.
“Men left, women right” below refers to the differences in pulse patterns between men and women observed by the ancients. Generally speaking, men’s left hand pulse should be strong, while women’s right hand pulse should be strong; men’s cun pulse is usually firmer while chi pulse is softer, whereas women’s cun pulse is usually weaker while chi pulse is firmer.
“There are also three parts” below discusses the “comprehensive diagnosis” of the three parts and nine conditions in the “Neijing.” The “Su Wen – Theory of Three Parts and Nine Conditions” divides the human body into three parts: the head and face as the upper part, the hands as the middle part, and the feet as the lower part, further divided into heaven, human, and earth, totaling nine conditions. Specific details of the nine conditions will be omitted here, as they will be elaborated in the “Introduction to TCM” later.
The fourth section mainly discusses the significance of the pulse being full with fifty movements during cun-kou diagnosis. TCM believes that the qi of the body’s meridians circulates fifty times within a day and night to transport the essence of the five internal organs. Therefore, the cun-kou pulse diagnosis should also show fifty movements without interruption as normal. If there are interruptions or irregular rhythms among the fifty movements, it indicates that the qi of the five internal organs has weakened, and the prognosis is often poor.
The fifth section: The first eight lines describe the normal pulses of the five internal organs. The last four lines describe the normal pulses that appear in the human body with the seasonal changes throughout the year.
〔Note〕
Fur: Refers to the floating pulse. The floating pulse should feel light as fur, hence the name. The “normal pulse” and “平脉” mentioned in this section are both normal pulse patterns. Although there are distinctions such as “floating large and scattered,” “floating thin and short,” and “spring string and summer flood,” they all share the common characteristics of being “calm and harmonious” and “gentle and harmonious.” TCM emphasizes that a normal pulse should have “stomach, root, and spirit.” The so-called “stomach” refers to stomach qi. The pulse is based on stomach qi; if the pulse is neither floating nor sinking, calm and gentle, with a consistent rhythm, it can be said to have stomach qi. The so-called “root” refers to kidney qi. Its condition is reflected in the chi part; if the chi pulse is taken and shows a calm, gentle, and strong appearance, it indicates the presence of “root.” The so-called “spirit” refers to the pulse being soft and strong. These three points are the internal meanings of the verses “calm and harmonious” and “gentle and harmonious.” Not only should the normal pulse exhibit these characteristics, but even in pathological pulses, one should also examine for “stomach, root, and spirit.” If these three are present, even if the disease is severe, the prognosis is often good; if these three are absent, it indicates true organ pulse (see section twenty-five), and the prognosis is often poor.
The sixth section: The first four lines discuss that if the patient’s pulse is stronger than the normal pulse of the five internal organs during the four seasons, it is often due to external pathogenic factors; if it is weaker than the normal pulse, it is often due to internal injuries from the seven emotions.
The last four lines discuss diseases caused by “non-internal and external factors” (injuries from diet, overwork), where the pulse reflects on the right guan pulse, with strength indicating a solid condition and weakness indicating a deficiency condition.
〔Note〕
1. External: Refers to external factors, namely the six excesses: wind, cold, heat, dampness, dryness, and fire.
2. Internal: Refers to internal factors, namely the seven emotions: joy, anger, worry, thought, sadness, fear, and fright.
The seventh section: The first four lines state that the physician should perform pulse diagnosis preferably in the morning, and during the diagnosis, the physician should maintain a calm mind, eliminate distractions, regulate their breathing, and focus entirely on examining the pulse.
The last six lines discuss the normal pulse during one breath. TCM refers to one inhalation and exhalation as one breath; if the pulse moves four to five times during each breath, it is considered a normal pulse.
The eighth section discusses the six representative pulse patterns among the twenty-nine pulse patterns of the cun-kou pulse and their corresponding diseases. Among them, three movements per breath indicate a slow pulse, which corresponds to cold conditions; six movements indicate a rapid pulse, which corresponds to heat conditions. These two pulses are distinguished based on the number of movements. If distinguished by pulse location, there is a clear difference between floating and sinking pulses. Generally, floating pulses often indicate superficial conditions caused by external pathogens, while sinking pulses often indicate deeper conditions caused by internal pathogens. Further analysis based on pulse shape distinguishes between slippery and rough pulses. Slippery pulses indicate smooth flow and are often caused by phlegm, qi, or food stagnation, while rough pulses indicate stagnation of fluids and blood. These six pulses are the most commonly encountered in clinical practice, and all other pulses can be understood starting from these six, so mastering these six pulses is essential.
Sections nine to eleven: These three sections specifically discuss the twenty-nine pulse patterns, including floating, sinking, soft, weak, firm, leathery, solid, empty, minute, scattered, hollow, hidden, slow, rapid, relaxed, hurried, knotted, intermittent, slippery, rough, string-like, tight, surging, large, small, moving, long, and short. The twelfth pulse pattern in section nine is distinguished based on pulse location, thus categorized under floating and sinking pulses. The seven pulse patterns in section ten are distinguished based on the number of movements, thus categorized under slow and rapid pulses. The ten pulse patterns in section eleven are distinguished based on pulse shape, thus categorized under slippery and rough pulses.
〔Note〕
Small refers to a pulse that is thin and reduced like silk, known as a small pulse. In this verse, “thin” and “small” are often used interchangeably, such as “floating thin qi less” and “sinking small interior deficiency,” where “thin” and “small” are synonymous, so please pay attention while reading. Additionally, the term “large pulse” mentioned in the verses is rarely referred to in modern times, so the commonly used pulse patterns are the twenty-eight types.
The twelfth section discusses the floating pulse and its accompanying pulses (two types of pulses appearing simultaneously are called accompanying pulses, such as floating and rapid, meaning the pulse is both floating and rapid) and their corresponding diseases.
〔Note〕
Floating yang indicates superficial conditions: Floating refers to the floating pulse. The floating pulse is felt lightly on the skin, belonging to the yang pulse, and its corresponding diseases are often initial external pathogenic invasions, with the disease location being superficial in the skin and meridians.
The thirteenth section discusses the sinking pulse and its accompanying pulses and their corresponding diseases.
〔Note〕
1. Qi solid: “Solid” is a mistake for “food,” which should be corrected. “Qi food” refers to qi stagnation and food accumulation.
2. Sinking yin indicates internal conditions: The sinking pulse is felt heavily when pressed down to the muscles and bones, belonging to the yin pulse, and its corresponding diseases are often due to internal pathogens, with the disease location being deep within the internal organs, indicating internal conditions of qi and blood.
The fourteenth section discusses the nine pulse patterns of soft, weak, minute, scattered, leathery, firm, empty, solid, and hollow, along with their corresponding diseases. 〔Note〕
1. Empty indicates various deficiencies: The first “empty” refers to “empty pulse,” while the second “empty” refers to “deficiency conditions.” The so-called “deficiency conditions” refer to a category of diseases characterized by insufficient yin, yang, qi, and blood. The “Neijing” states: “When essence and qi are depleted, it leads to deficiency.” This indicates that the empty pulse corresponds to various deficiency conditions.
2. Solid indicates various excesses: The first “solid” refers to “solid pulse,” while the second “solid” refers to “excess conditions.” The so-called “excess conditions” refer to a category of diseases characterized by excessive pathogenic factors and strong righteous qi. The “Neijing” states: “When pathogenic factors are excessive, it leads to excess.” This indicates that the solid pulse corresponds to various excess conditions.
The fifteenth section discusses the six pulse patterns of slow, rapid, relaxed, hurried, knotted, and intermittent, along with their corresponding diseases.
The sixteenth section discusses the ten pulse patterns of slippery, rough, string-like, tight, surging, moving, long, short, thin, and large, along with their corresponding diseases.
The seventeenth section: The first four lines summarize the content of the following sections and sections eighteen, nineteen, twenty, twenty-one, and twenty-two. It points out that various diseases have corresponding pulse patterns. If the pulse pattern corresponds to the disease, the prognosis is often good. If the pulse pattern does not correspond to the disease, specific analysis should be conducted. If a yin condition presents with a yang pulse, the disease is favorable, and the prognosis is good; if a yang condition presents with a yin pulse, the disease is unfavorable, and the prognosis is poor. This attention to the correlation between pulse patterns and diseases in pulse diagnosis is also an important consideration in TCM clinical practice, and students should be attentive to this.
The section from “Wind Stroke Pulse” below discusses the favorable and unfavorable pulse patterns for the diseases of “wind stroke” and “cold damage.”
〔Note〕
1. Yang condition with yin pulse: Yang conditions refer to a category of diseases characterized by excess pathogenic factors such as superficial, solid, and heat. Yin refers to a category of pulse patterns characterized by deficiency of righteous qi, such as sinking, thin, minute, and weak. Yang conditions should typically present with corresponding yang pulses, such as floating pulses for superficial conditions and rapid pulses for heat conditions. If a yang condition presents with a yin pulse, it indicates that the righteous qi cannot overcome the pathogenic factors, and the prognosis is often poor, hence “the heart is in danger.”
2. Yin condition with yang pulse: This is the opposite of the above, indicating that the righteous qi overcomes the pathogenic factors, hence “though troubled, there is no harm.”
The eighteenth section discusses the favorable and unfavorable pulse patterns for diseases such as “internal injury from overwork,” “malaria,” “diarrhea,” “vomiting,” and “cholera.”
The nineteenth section discusses the favorable and unfavorable pulse patterns for diseases such as “cough,” “asthma,” “heat,” “bone steaming heat,” and “deficiency heat.”
The twentieth section discusses the favorable and unfavorable pulse patterns for diseases such as “blood loss,” “blood accumulation,” “diabetes,” “urinary obstruction,” “epilepsy,” “mania,” and “convulsions.”
The twenty-first section discusses the favorable and unfavorable pulse patterns for diseases such as “abdominal pain,” “hernia,” “jaundice,” “swelling,” “accumulation,” and “poisoning.”
The twenty-second section discusses the favorable and unfavorable pulse patterns for diseases such as “abscesses,” “lung abscesses,” “lung atrophy,” and “intestinal abscesses.”
The diseases mentioned in sections seventeen to twenty-two will be detailed in future courses, and will not be elaborated here.
The twenty-third section discusses the pulse patterns during women’s pregnancy.
〔Note〕
1. Yin and Yang Separation: Yin refers to the chi part, while Yang refers to the cun part. If a woman has missed her period, the chi pulse should be slippery, indicating a separation from the cun pulse, often a sign of pregnancy.
2. Shaoyin Movement: Shaoyin refers to the left cun hand’s Shaoyin heart pulse, with significant movement indicating a slippery pulse, not to be interpreted as “artery movement.”
3. Ji (基): Refers to a winnowing basket, which is round.
4. Cauldron: An ancient type of pot. This indicates that when pregnant with a male fetus, the shape of the abdomen resembles an inverted pot, wider at the top and narrower at the bottom.
The twenty-fourth section discusses the location and nature of the “reverse guan pulse.”
〔Note〕
Reverse Guan: Refers to the reverse guan pulse. The so-called reverse guan pulse indicates that in some individuals, the cun-kou pulse is not located at the cun-kou part but appears on the back of the wrist, which does not follow the normal pulse pathway at the guan, hence it is called reverse guan. Additionally, there is another pulse where the chi part can still be pressed, while the guan and cun parts slant towards the back of the wrist, referred to as “oblique flying pulse” or “side guan pulse.” These are individual anatomical variations and are not considered pathological pulses.
The twenty-fifth section mainly discusses several pulse patterns that appear when the qi of the liver, heart, spleen, lung, kidney, and mingmen is exhausted. TCM refers to these pulse patterns as true organ pulses, also known as failing pulses, dead pulses, absolute pulses, and strange pulses.
〔Note〕
1. Sparrow Pecking: The pulse is rapid and irregular, resembling a sparrow pecking at food.
2. Fish Flying: The pulse is felt on the skin, steady at the head and fluctuating at the tail, resembling a fish flying.
3. Shrimp Swimming: The pulse is felt on the skin, appearing faint and sometimes jumping away, resembling a shrimp swimming. Although these true organ pulses have their characteristics, they share the commonality of lacking calmness and gentleness, indicating that the “stomach, root, and spirit” have been exhausted, and the prognosis is often poor.
(2) Press Diagnosis
This textbook’s sections twenty-six to twenty-eight mainly discuss the method of pressing on the patient’s elbow, arm, and abdomen to diagnose diseases.
〔Note〕
1. Elbow for Waist and Abdomen: In TCM, the upper part of the elbow is called the shoulder, and the lower part is called the arm. This means that pressing the upper part of the elbow (shoulder) can indicate diseases of the waist and abdomen.
2. Outer Arm for Shoulder and Back: The inner part of the arm is called the chi, and the outer part is called the arm. This means that pressing the outer part (arm) can indicate diseases of the shoulder and back.
3. Fish Blue for Stomach Cold: Fish refers to the area behind the thumb. If this area appears blue or shows blue veins, it often indicates cold in the stomach.
4. Cold and Heat Locations, Diseases Caused by Cold and Heat: The first cold and heat refer to the temperature changes in the pressed area, while the latter cold and heat refer to the diseases in the corresponding areas being either cold or hot.
5. Pulse and Chi Correspondence: The pulse refers to the pulse pattern, while chi refers to the skin between the hands from the guan to the chi ze point, also known as chi skin. This indicates that the pulse pattern corresponds to the chi skin. The “Ling Shu – Pathogenic Factors and Organ Disease Forms” states: “If the pulse is rapid, the chi skin is also rapid; if the pulse is slow, the chi skin is also slow…” This illustrates this correspondence.
6. Burning: Refers to a hot appearance.
7. Cold: Refers to a cold appearance.
Students can refer to the “Essentials of Four Diagnostic Methods” in the “Medical Classics of the Golden Mirror” when memorizing these verses, as well as the “Four-character Pulse Verses” by Li Zhongzi from the Ming Dynasty, or the modern compilation by He Ren titled “Explanations of the Essentials of Four Diagnostic Methods in the Medical Classics of the Golden Mirror” and other texts.
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Two |
“Interpretation of Seven-character Verses” |
This textbook’s “Seven-character Verses” are selected from the “Binhuh Pulse Studies,” with detailed content, practical relevance, and a rhythmic structure that makes them easy to memorize, thus highly regarded by practitioners. If students can memorize and contemplate these verses, they will surely benefit in future clinical practice. Below are explanations for difficult words, phrases, and sentences in the verses:
(1) Floating Pulse
〔Note〕
1. Three Autumns: Refers to the three months of autumn.
2. Illness: Refers to worry.
3. Slow Wind: Here, slow refers to a slow pulse. Wind refers to wind stroke. It means that a floating pulse combined with a slow pulse indicates wind stroke.
4. Earth Weak: Refers to weakness of the spleen and stomach.
5. Wood Strong: Refers to excessive liver wood.
(2) Sinking Pulse
〔Note〕
1. Help: Means to be close.
2. Turbid Residue: Turbid refers to cloudy urine, while residue refers to involuntary urination or ejaculation.
3. Lower Source: Refers to the lower jiao, or lower abdomen.
4. Pain: Sounds similar to “pain.”
(3) Slow Pulse
〔Note〕
1. Floating and sinking divide exterior and interior: Refers to floating slow indicating exterior cold, while sinking slow indicates interior cold.
2. Beneficial Fire Source: Refers to using warm or hot herbs to nourish the source of yang qi in the body, making yang qi strong and dispelling yin cold.
3. Sinking Stubborn: Here, it refers to stubborn symptoms caused by lingering cold pathogens.
(4) Rapid Pulse
〔Note〕
1. Yin Weak, Yang Strong: Yin refers to yin fluids, while yang refers to yang heat. Excessive yang heat can harm yin fluids, hence the phrase yin weak, yang strong.
2. Floating and sinking divide exterior and interior: Floating rapid indicates exterior heat, while sinking rapid indicates interior heat; rapid with strength indicates excess heat, while rapid without strength indicates deficiency heat.
3. Monarch and Minister Fire: Monarch fire refers to heart fire, while minister fire refers to liver and gallbladder fire (some versions state heart and kidney fire). Normally, the monarch and minister fires maintain the life force of the body; during illness, excessive heart fire or excessive liver and gallbladder fire can lead to heat conditions.
(5) Slippery Pulse
〔Note〕
Continuous: Refers to a continuous and unbroken appearance.
(6) Rough Pulse
1. Unbalanced: Refers to the pulse being either fast or slow, with an irregular rhythm.
2. Reflux: Refers to symptoms of vomiting food after a certain time.
3. Yang Loss: Refers to symptoms of excessive sweating leading to loss of yang qi.
(7) Surging Pulse
〔Note〕
Thumping: Refers to the pulse feeling like a thumping sensation.
(8) Tight Pulse
1. Lift: Lightly press.
2. Cut: Press heavily.
3. Running Pig: Refers to the condition where qi in the lower abdomen surges upward, causing abdominal pain that comes and goes, resembling a pig running.
(9) String-like Pulse
〔Note〕
1. Distant: Originally means far away. Here it describes a straight and long pulse.
2. Film: Refers to a membrane in the eye that causes blurred vision.
3. Floating and sinking slow and rapid must be distinguished: Floating string-like indicates fluid retention (stagnation of fluid in the chest), while sinking string-like indicates pain; string-like rapid indicates heat, while string-like slow indicates cold. Each has different corresponding diseases, so distinctions must be made.
4. Large and small have different weights: A large string-like pulse indicates qi deficiency, while a small string-like pulse indicates tightness of the meridians. A single hand with a string-like pulse indicates internal fluid retention; a double hand with a string-like pulse indicates prolonged cold. Each condition has different degrees of severity.
(10) Knotted Pulse
〔Note〕
Pure yin predominates: Refers to pure cold predominating.
(11) Intermittent Pulse
〔Note〕
Movement stops and cannot return, then moves again: This indicates that the intermittent pulse has pauses, and after pausing, it cannot return to normal, and the pauses are relatively long.
Both knotted and intermittent pulses are characterized by slowness and weakness, with irregular rhythms and intermittent pauses. However, the knotted pulse has no fixed duration for the pauses, and the pauses are short; the intermittent pulse has fixed durations for the pauses, and the pauses are long. This is the distinction between the two.
Students can refer to the “Binhuh Pulse Studies” in vernacular for memorizing these verses, edited by Beijing University of Chinese Medicine.
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