【Original Text】
Huangdi asked: In spring, the pulse is like a string, what does it mean to be like a string?
Qibo replied: The spring pulse corresponds to the liver, which is associated with the wood element of the east. It is the season when all things begin to grow, hence the qi is soft, light, weak, and slippery, straight and long, thus it is called a string. If it is contrary to this, it indicates illness.
The Emperor said: What does it mean to be contrary?
Qibo said: If the qi comes strong and solid, this is called excess, indicating illness is external. If the qi comes weak and insubstantial, this is called deficiency, indicating illness is internal.
The Emperor said: What are the manifestations of excess and deficiency in the spring pulse?
Qibo said: Excess leads to irritability, confusion, dizziness, and headaches; deficiency leads to chest pain radiating to the back, and fullness in the sides.
The Emperor said: Good. In summer, the pulse is like a hook, what does it mean to be like a hook?
Qibo said: The summer pulse corresponds to the heart, which is associated with the fire element of the south. In this season, all things flourish, hence the qi comes abundant and leaves weak, thus it is called a hook. If it is contrary to this, it indicates illness.
The Emperor said: What does it mean to be contrary?
Qibo said: If the qi comes abundant and leaves also abundant, this is called excess, indicating illness is external. If the qi comes weak and leaves strong, this is called deficiency, indicating illness is internal.
The Emperor said: What are the manifestations of excess and deficiency in the summer pulse?
Qibo said: Excess leads to body heat and skin pain, resulting in sores; deficiency leads to restlessness, coughing, and diarrhea.
The Emperor said: Good. In autumn, the pulse is like floating, what does it mean to be like floating?
Qibo said: The autumn pulse corresponds to the lungs, which are associated with the metal element of the west. In this season, all things are harvested, hence the qi comes light and weak, floating, coming quickly and dispersing, thus it is called floating. If it is contrary to this, it indicates illness.
The Emperor said: What does it mean to be contrary?
Qibo said: If the qi comes floating and soft but the center is firm, this is called excess, indicating illness is external. If the qi comes floating and weak, this is called deficiency, indicating illness is internal.
The Emperor said: What are the manifestations of excess and deficiency in the autumn pulse?
Qibo said: Excess leads to reversed qi and back pain, causing irritability; deficiency leads to shortness of breath, coughing, and blood in the sputum.
The Emperor said: Good. In winter, the pulse is like a camp, what does it mean to be like a camp?
Qibo said: The winter pulse corresponds to the kidneys, which are associated with the water element of the north. In this season, all things are stored, hence the qi comes heavy and strong, thus it is called a camp. If it is contrary to this, it indicates illness.
The Emperor said: What does it mean to be contrary?
Qibo said: If the qi comes like a hard stone, this is called excess, indicating illness is external. If the qi leaves weak and frequent, this is called deficiency, indicating illness is internal.
The Emperor said: What are the manifestations of excess and deficiency in the winter pulse?
Qibo said: Excess leads to fatigue, back pain, and shortness of breath; deficiency leads to a feeling of hunger, coldness in the lower abdomen, back pain, fullness in the lower abdomen, and changes in urination.
The Emperor said: Good.
The Emperor said: The sequence of the four seasons has its reversals and variations, but what about the spleen pulse, what does it govern?
Qibo said: The spleen pulse corresponds to the earth element, it is a solitary organ that nourishes the surrounding organs.
The Emperor said: Can the goodness or badness of the spleen be observed?
Qibo said: The good cannot be seen, but the bad can be seen.
The Emperor said: How can the bad be seen?
Qibo said: If the pulse comes like flowing water, this is called excess, indicating illness is external. If it comes sharp like a crow’s beak, this is called deficiency, indicating illness is internal.
The Emperor said: You say the spleen is a solitary organ, central and nourishing the others, what are the illnesses of excess and deficiency?
Qibo said: Excess leads to inability to lift the limbs, while deficiency leads to obstruction of the nine orifices, called heaviness and strength.
The Emperor stood up in realization, bowed, and said: Good. I have grasped the essentials of pulse diagnosis, which is the most important principle in the world. The principles in the texts such as “Five Colors,” “Pulse Changes,” “Measurements,” and “Strange Constants” are all unified, centered on the concept of “spirit.” The spirit must operate according to the laws of the four seasons without reversal; if it reverses, it cannot return, thus losing its opportunity. The essence of this principle is subtle and close to the heavenly mechanism, and it should be recorded on jade tablets and stored in the treasury, to be read every morning, called “Jade Machine.”
The five organs receive qi from their generating organs, transmit it to their controlling organs, store qi in their generating organs, and die in the organs they cannot control. When illness approaches death, it must first transmit to the organ it controls, and then death occurs. This is the reverse transmission of qi, hence death. The liver receives qi from the heart, transmits it to the spleen, stores qi in the kidneys, and dies in the lungs. The heart receives qi from the spleen, transmits it to the lungs, stores qi in the liver, and dies in the kidneys. The spleen receives qi from the lungs, transmits it to the kidneys, stores qi in the heart, and dies in the liver. The lungs receive qi from the kidneys, transmit it to the liver, store qi in the spleen, and die in the heart. The kidneys receive qi from the liver, transmit it to the heart, store qi in the lungs, and die in the spleen. This is all reverse death, divided into five parts over a day and night, which is how to predict the timing of life and death.
The Emperor said: The five organs are interconnected, and the transmission has its order. If any of the five organs are ill, they will transmit to their controlling organs. If untreated, the time may be three months, six months, three days, or six days, and if it transmits through the five organs, death is imminent, which is the order of transmission according to control. Therefore, it is said: “To distinguish the yang, one knows the origin of the illness; to distinguish the yin, one knows the timing of life and death.” This means knowing when the illness reaches the organ it cannot control and causes death.
Therefore, wind is the leader of all diseases. Now, if wind and cold invade a person, it causes the hair to stand on end, the skin to close and become hot. At this time, sweating and releasing is appropriate. If there is numbness, pain, or swelling, at this time, hot compresses and acupuncture can be used to dispel it. If untreated, the illness enters the lungs, called lung obstruction, leading to coughing and shortness of breath. If untreated, it transmits to the liver, called liver obstruction, causing pain in the sides and food aversion. At this time, pressing or acupuncture can be applied. If untreated, it transmits to the spleen, called spleen wind, causing jaundice, abdominal heat, restlessness, and yellowing of urine. At this time, pressing, medication, or hot baths can be applied. If untreated, it transmits to the kidneys, called hernia, causing lower abdominal heat and pain, with white discharge, also known as gu disease. At this time, pressing or medication can be applied. If untreated, it transmits to the heart, causing muscle and tendon contractions, called convulsions. At this time, moxibustion or medication can be applied. If untreated, after ten days, death is expected. If the kidney transmits to the heart, the heart then reverses and transmits to the lungs, causing cold and heat, and death is expected in three years; this is the order of the illness.
However, if the illness suddenly arises, it does not need to be treated according to the transmission order. Some illnesses do not follow this order, such as those caused by worry, fear, sadness, joy, and anger, which can lead to severe illness. For example, excessive joy can weaken the kidney qi; excessive anger can strengthen the liver qi; excessive sadness can strengthen the lung qi; excessive fear can weaken the spleen qi; excessive worry can weaken the heart qi. This is the principle of the five emotions causing changes that disrupt the order of transmission. Therefore, although there are five diseases, their transmission and transformation can lead to twenty-five variations. The so-called transmission and transformation refer to the name of the interaction.
Severe bone weakness, significant muscle atrophy, fullness in the chest, difficulty breathing, and movement causing vibrations indicate a six-month death prognosis, with the true organ pulse observed as the starting point for predicting death. Severe bone weakness, significant muscle atrophy, fullness in the chest, difficulty breathing, and internal pain radiating to the shoulders indicate a one-month death prognosis, with the true organ pulse observed as the starting point for predicting death. Severe bone weakness, significant muscle atrophy, fullness in the chest, difficulty breathing, internal pain radiating to the shoulders, body heat, and muscle atrophy indicate a ten-day death prognosis, with the true organ pulse observed as the starting point for predicting death. Severe bone weakness, significant muscle atrophy, shoulder marrow depletion, and declining movement indicate a one-year death prognosis, with the true organ pulse observed as the starting point for predicting death. Severe bone weakness, significant muscle atrophy, fullness in the chest, abdominal pain, discomfort in the heart, shoulder and body heat, muscle atrophy, and sunken eyes indicate immediate death; if the person can still see, it means the essence has not completely depleted, and death will occur when it reaches the point of no return.
If the righteous qi is suddenly depleted, and external pathogens invade, causing sudden illness, the five organ qi mechanisms become blocked, and the pulse pathways are obstructed, leading to an inability to predict death. If the pulse is absent, or beats abnormally fast, with five or six beats per breath, even if the body does not decompose, the true organ pulse is not seen, death is still imminent.
The true liver pulse is urgent and sharp, like pressing on a knife edge, or like pressing on a string, with a pale complexion and dry hair indicating death. The true heart pulse is firm and strong, like pressing on a round grain, with a red and dark complexion indicating death. The true lung pulse is large and empty, like a feather brushing against the skin, with a pale and red complexion indicating death. The true kidney pulse is strong and firm, like pressing on a stone, with a dark and yellow complexion indicating death. The true spleen pulse is weak and irregular, with a yellow and pale complexion indicating death. All true organ pulses indicate an incurable condition.
The Emperor said: Why does seeing the true organ pulse indicate death?
Qibo said: The five organs all rely on the stomach for nourishment, and the stomach is the root of the five organs. Therefore, the qi of the five organs cannot reach the hand taiyin on its own; it must rely on the stomach qi to reach the hand taiyin. Thus, the qi of the five organs can appear at the hand taiyin during their respective times, only if there is stomach qi. If the evil qi prevails, the essence qi will weaken. Therefore, when the illness is severe, the stomach qi cannot accompany the qi of the five organs to reach the hand taiyin, resulting in the appearance of the true organ pulse alone, indicating the victory of the evil qi and injury to the organ qi, hence it is said to be fatal.
The Emperor said: You are correct.
The Emperor said: In general, when treating illness, one must first observe the body’s condition, the strength of the qi, the color and luster, the pulse’s fullness and emptiness, and the age of the illness, and then treat it in a timely manner, without missing the opportunity. If the patient’s body and qi are in harmony, it is a treatable condition; if the complexion is bright and moist, the illness is also easy to cure; if the pulse corresponds to the four seasons, it is also treatable; if the pulse is weak and slippery, it indicates the presence of stomach qi, and the illness is also easy to treat, so treatment must be timely. If the body and qi are not in harmony, it is difficult to treat; if the complexion is dull and lacks luster, the illness is also difficult to cure; if the pulse is full and firm, the illness will worsen; if the pulse is contrary to the four seasons, it is incurable. One must carefully examine these four difficult conditions and clearly inform the patient.
The so-called pulse contrary to the four seasons is when the lung pulse is seen in spring, the kidney pulse in summer, the heart pulse in autumn, and the spleen pulse in winter, all of which are suspended and without root, or are deep and tight, which is called contrary to the four seasons. If the qi of the five organs cannot manifest according to the seasons, and in spring and summer, the pulse is deep and tight, while in autumn and winter, the pulse is floating and large, this is also called contrary to the four seasons.
In cases of heat illness, the pulse should be large and quiet; in diarrhea, the pulse should be small but is large; in blood loss, the pulse should be weak but is firm; if the illness is internal, the pulse is firm; if the illness is external, the pulse is not firm, all these are contrary pulse conditions and are difficult to treat.
The Emperor said: I have heard that the distinction between fullness and emptiness can determine life and death, and I wish to hear the details!
Qibo said: Five fullness leads to death, and five emptiness also leads to death.
The Emperor said: What are the five fullness and five emptiness?
Qibo said: A strong pulse, hot skin, abdominal distension, obstruction of the two excretions, and mental confusion indicate five fullness. A weak pulse, cold skin, low energy, diarrhea, and lack of appetite indicate five emptiness.
The Emperor said: Are there times when fullness and emptiness can recover?
Qibo said: If one can consume some porridge, gradually the stomach qi will recover, and if the diarrhea stops, then the empty condition can recover. If one originally had heat without sweating, but now sweats; if one originally had obstruction of the two excretions, but now has normal bowel and bladder function, then the full condition can also recover. This is the turning point for the recovery of five emptiness and five fullness.
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