CCM 12

Huangdi Neijing
Kong, Y.C.
Published by The Chinese University of Hong Kong Press
Kong, Y.C.
Huangdi Neijing: A Synopsis with Commentaries.
The Chinese University of Hong Kong Press, 2010.
Project MUSE.muse.jhu.edu/book/24634.
For additional information about this book

https://muse.jhu.edu/book/24634
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4 Diagnosis by Pulse-taking
(Mai Zhen 脉診)
Exegesis
Diagnosis by pulse-taking is one of the four principal methods of diag-

nosis; it is the most important part of palpation, as the finger-tips can pick
up much more information from the pulse pattern than by palpating other
parts of the body. The term mai 脉 refers to the blood vessels, more
correctly the arteries (xuemai 血脉) [1], which can be felt pulsating. The
conduits in which the qi flows are called jingmai 經脉, or their subdivisions
like luomai 絡脉 and sunmai 孫脉. The character 脉 can also be written 脈
[2]. Although these two forms are interchangeable, even in some Song
dynasty versions of Neijing, Needham (1980) favoured using the character
脈 to mean the pulse, or the vessels where the pulse can be detected, i.e.
it carries a dynamic parameter (ref. 50, p. 24). In this case, it can be
written with the radical xue 血 (blood) instead of rou 月 (flesh). While this
form is rarely used, the character 脈 is also pronounced mo, meaning a
tender loving gaze (han qing mo mo 含情脈脈). This short discussion illus-
trates the importance of linguistic skill in studying Chinese medicine. For
the sake of simplicity, the character 脈 is used in this book in transcribing
the original text whereas the character 脉 is used elsewhere; its exact
meaning depends on its association with other words and the context of
the passage.
While Neijing was full of passages on pulses and their significance,
we have to wait until Wang Shu-he 王叔和 (180–270) for an appreciation
of the state of the art in his Maijing 脉經 (Canon of the Pulses) in 10 chap-
ters (juan 卷). Wang was an erudite medical scholar-cum-clinician; he was
subsequently summoned to the imperial court to serve as surgeon-general
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72 Neijing Zhiyao Yigu 內經知要譯詁
(taiyi ling 太醫令). His most outstanding contribution to pulse study was
the definition of 24 pulse patterns (maixiang 脉象) that are still observed
today.
Wang Shu-he was also well known for his effort to compile Shanghan
zabing lun 傷寒雜病論 (Treatise on Febrile and Miscellaneous Diseases)
by Zhang Ji 張機, also known as Zhong-jing 仲景 (ca. 150–215). This work
was later divided into two separate parts, Shanghan lun 傷寒論 (Treatise
on Febrile Diseases) and Jingui yaolüe 金匱要略 (Important Strategies
from the Golden Chest), and that is how it is known to us today. These
two important classics laid the foundation of clinical Chinese medicine, yet
we know little about Zhang Ji’s life and work apart from the fact that the
title “Governor of Changsha” was sometimes ascribed to him [3]. Never-
theless, because the two men lived at roughly the same time and had
equal clinical expertise, it can be trusted that Wang, because of his high
position, was able to collect the scattered manuscripts of Zhang and cred-
ited them to the genuine author instead of appropriating the honour
himself.
While Zhang’s principal method of treatment for his patients was the
use of herbal decoctions, his clinical approach involved pulse pattern
analysis, and from this evolved the “theory of analysing symptoms from
the six conduits” (liu jing bian zheng 六經辨證) . The reliance on pulse-
taking as the most informative method of diagnosis was corroborated by
the erudite Huang-Fu Mi 皇甫謐 in his monograph on acupuncture Jiayi
jing 甲乙經 (The Classic of the Main Conduits). To sum up, within a
century, three colossal figures appeared on the stage of clinical Chinese
medicine who were experts in jingluo theory and the clinical application of
pulse-taking. The influence of Wang Shu-he spread far and wide, so much
so that his work was known to the Nestorian monks practising medicine in
Syria (around the fifth century) and later mentioned in Avicenna’s Canon
(ca. the tenth century).
Pulse-taking not only reads the state of the heart, it can also provide a
window to look into the current state of the visceral organ functions. It is
the most informative, and at the same time, the most sophisticated
method of diagnosis by hand. Sophistication lies in the fact that pulse
pattern analysis uses a descriptive language that is hardly sufficient to
account for the quantitative nuances between two closely similar patterns,
as the six basic patterns (viz. floating, sinking, slow, quick, smooth and
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Diagnosis by Pulse-taking 73
hesitant) further subdivide into 28 recognizable patterns and an infinite

number of combinations of these patterns. One more dimension of refine-
ment with pulse-taking concerns site specificity. By taking the pulse at
particular sites on the wrist, which are only one centimetre or less apart,
the clinician is able to detect the current state of the particular visceral
organ that it represents. In the clinical practice of Zhang Zhong-jing, pulse-
taking sites were at the neck (carotid artery, renying 人迎), the wrist (radial
artery, cunkou 寸口) and at the instep near the ankle (anterior tibial artery,
fuyang 趺陽). Going back further in time, Neijing described three regions
(bu 部), viz. head, wrist and leg; in each region there were three individual
sites, each one of which could provide a signal (hou 候) that reflected
directly the function of certain visceral organs or body parts. Hence the
term “three regions and nine sites” (san bu jiu hou 三部九候). As early as
Wang Shu-he, pulse-taking sites were limited to the cunkou, which is
subdivided into the cun 寸, guan 關 and chi 尺 sites. In this way, the region
became the site. At each site, pulse-taking was executed at three different
modalities according to the pressure exerted by the fingers. (This was first
documented in Nanjing: Question 18). Thus the three sites (bu) provided
nine signals (hou). This is the current practice up to this day, although the
site specificity regarding the visceral organs has varied somewhat down
the ages. By the time of Liu Wan-su 劉完素 (ca. 1120–1200), one of the
four great clinical masters of the Jin-Yuan period, the organ-specificity of
these individual sites was clearly documented, e.g. the chi site was seen
as reading the kidney. (Shuanghan zhige: Sanbu jiuhou lun 傷寒直格．三
部九候論) Throughout the history of Chinese medicine, there has hardly
been a single successful clinician who has not left some comments on
pulse-taking. The most notable of them all must be Li Shi-zhen 李時珍
(1518–1593), also known as Pinhu 瀕湖, who raised the status of pulse-
taking to a speciality—sphygmology (maixue 脉學, as in his Pinhu maixue
瀕湖脉學). He is better known for his magnum opus on materia medica—
Bencao gangmu 本草綱目 (The Pandect of Natural History), completed in
1578). For a layman’s view on pulse-taking, see ref. 53. If the reader
prefers more professional insight, see Ten Lectures on Sphygmology in
Chinese Medicine by Ren Ying-qiu 任應秋 (1914–1984).1
1
Ren Yingqiu 任應秋, Zhongyi maixue shi jiang 中醫脉學十講 (Ten Lecture Notes
on Chinese Conduit) (Hong Kong: Tai Ping Publisher, reprinted 1971).
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Whilst pulse-taking is a unique method of diagnosis in Chinese medi-

cine, it is so popular that “taking the pulse of a situation” has become an
English idiom. Today people tend to equate visiting a Chinese medicine
practitioner with having their pulse taken. Thus a consultation is called
variously houmai 候脉, anmai 按脉, chimai 持脉, bamai 把脉, or dimai 睇
脉, depending on the local dialect, because this is an unavoidable step in
the course of a consultation. Consequently, a case history (yi-an 醫案) is
also called mai-an 脉案 because the clinician will write a short description
of the pulse pattern, which concludes the diagnosis. However, ever since
the time of Neijing, it has always been emphasised that information from
pulse-taking must be considered alongside results from the other three
methods of diagnosis (si zhen he can 四診合參). It is not unusual that a
clinician ignores the signals provided by the pulse pattern and sticks to his
gut feelings because he/she sees more convincing evidence elsewhere.
Naturally, the reverse is also true, when a telltale signal is detected in the
pulse before other more obvious signs and symptoms appear. In one
word, pulse patterns are the dynamic expression of the jingluo theory that
underpins the holistic approach in clinical Chinese medicine.
Neijing provided the earliest source of information on the theory and
practice of pulse-taking. Before the compilation of Neijing, several trea-
tises on pulses and related subjects were widely circulated; their titles,
and excerpts from them, were duly incorporated into various chapters of
Neijing (ref. 29). This chapter in NJZY culls the most important passages
on pulses from Suwen Chapters 7, 17, 18, 19, 20, 48, 78 and 80, as well
as Lingshu Chapter 5. They touch upon a broad range of subjects as
follows:
1. Appropriate timing for pulse-taking and the reasons for doing so.
2. Allocation of sites to read into the function of different visceral
organs.
3. Comparison of normal and abnormal pulse patterns and gleaning
of the pathological information therefrom.
4. Diurnal rhythm of pulse propagation.
5. The rationale of taking a pulse only at the wrist in order to detect
visceral organ function and provide a prognosis.
6. Detection of unique signals from one of the nine sites (jiu hou 九候)
and their significance.
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7. Prognosis based on the discordance between pulse dynamics

and body constitution.
8. Six primary considerations governing the interpretation of pulse
patterns with respect to seasons.
9. Seasonal variations of the normal pulse pattern.
10. The “stomach qi” component (weiqi 胃氣) as a differential factor
to distinguish a normal from a sick to moribund pulse pattern.
11. Correlation of the wrist pulse pattern with body constitution and
disease development.
12. Rarely observed abnormal pulse patterns and their prognosis.
13. Prognosis based on the correspondence between body constitu-
tion, pulse and symptoms.
14. How a pulse pattern without the weiqi component reflects the
actual functional state of the visceral organs so as to afford a
prognosis.
15. Detection of pregnancy by pulse-taking.
16. Importance of integrating pulse pattern with other methods of
diagnosis.
Footnotes
[1] xuemai: 血脉 “blood vessels”. According to Neijing, there was no doubt that
the heart pumped blood into the blood vessels (Suwen Chapter 44: On
Atrophy). Neijing (Suwen Chapter 21: Further Discussion on Conduits) also
demonstrates an awareness of pulmonary circulation (fei chao bai mai 肺朝
百脉, “all blood vessels drain into the lungs”). However, neither Neijing nor
later studies ever proposed the idea of a closed circuit circulation of the sort
posited by Harvey (1578–1657) in England. Even in the latter half of the Qing
dynasty, Wang Qing-ren (1768–1831) believed that qi flowed in the arteries
while blood flowed in the veins. Blood vessels are considered one of the odd
organs, because they are the reservoir of blood (xuefu 血府) and carry yingqi
營氣, the nutritive elements of blood. However, the sequential flow of qi from
one regular conduit to another is nothing short of a closed circulation. In
Lingshu there are passages that use the term jingmai 經脉 to mean a shared
conduit for blood and qi (Chapter 12: Jing shui, Chapter 47 Ben zang). For
further discussion on circulation of qi and blood, see Lu and Needham (ref.
50, p. 25).
[2] mai: An equivalent for the word mai as a structure (blood vessel) and as a
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function (pulse) can also be found in modern day use. For example, a moun-
tain range is shanmai 山脉 and mineral veins are kuangmai 礦脉; these are
static structures. In its functional context, terms like maichong 脉沖 (“a train
of pulses”) or maibo 脉搏 (“pulse”) clearly indicate that mai is only significant
in the expression of its dynamic aspect.
[3] Governor of Changsha: Changsha Taishou 長沙太守. Changsha was the
provincial capital of Hunan, south of the Yangzi River. How Zhang, who was a
native of Henan, north of the river, became a high-ranking official in the south,
at a time when China was carved up into three small kingdoms (in the north,
southwest and east of China respectively) at loggerheads with each other
during the chaotic Three Kingdoms period (220–265), remains unexplained.
[Section 4.1] Suwen Chapter 17: On the Finer Points of

Pulse-taking
《素問．脈要精微論》曰：診法常以平旦，陰氣未動，陽氣未散，飲食未
進，經脈未盛，絡脈調勻，氣血未亂，故乃可診有過之脈。
切脈動靜，而視精明，察五色，觀五藏有餘不足，六府強弱，形之盛
衰，以此參伍，決生死之分。
尺內兩傍，則季也。尺外以候腎，尺裡以候腹。中附上，左外以候
肝，內以候鬲：右外以候胃，內以候脾。上附上，右外以候肺，內以候胸
中；左外以候心，內以候膻中。
Pulse-taking usually takes place in early morning [1] when yinqi is not yet
active and yangqi has not yet dispersed. While the body is still fasting, the
pulses are not vigorous and the conduits are smooth and free-flowing, [in this
case] the movements of qi and blood are not disturbed. At this moment, any
excess [or inadequacy] in pulse pattern can be easily detected.
While taking the pulse, note the force and rate of the pulse but also
observe [the brilliance of] the pupils, and inspect the various shades of colour
on the face so as to assess whether the five zang-organs and six fu-organs are
functioning adequately and the body’s constitution is ample or insufficient.
Compare these signs with each other in order to provide a decisive prognosis.
On both sides of the chi site [2], [all organs lying as far as] the hypochon-
drium [3] can be detected. The distal part of the chi site [on the wrists] reads
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the kidney, proximal the abdomen. On the left [wrist], distal to the chi site [is
the guan site], its distal part reads the liver, proximal (closer to the chi site) the
diaphragm. On the right [wrist], the distal part [of the guan site] reads the
stomach, proximal the spleen. Uppermost [furthest] from the chi site [is the
cun site]; on the right [wrist], the distal part reads the lung, proximal the
chest. On the left [wrist], the distal part reads the heart, proximal the pericar-
dium [4].
Explanatory Notes
This is the first time pulse-taking at the wrist is precisely defined in Neijing.
Even then, the text does not specify the three sites but names them with refer-
ence to the chi site. According to Qin Bo-wei (1958), there are good reasons to
do so. From the cubital crease, where the biceps are attached to the radius
(acupoint chize LG-5 尺澤), to the horizontal crease behind the palm, where
the flexor muscle of the thumb is attached to the first metacarpus (acupoint
yuji LG-10 魚際), it measures one Chinese foot (chi 尺) and nine-tenths of a
Chinese inch (cun 寸). Consequently, by removing one “inch” from yuji and
one “foot” from chize, we find the chi site. That was why only the chi site is
mentioned in this passage; it was the most obvious precisely measurable site.
Zhang Jie-bin supported the view that the character chi indicated the chi site,
but not the chi fu 尺膚, i.e. the medial cubital surface. The present translation
is based on a precise chi site. Each site is subdivided into a distal and a prox-
imal portion. This makes twelve sub-sites altogether, as represented below:
Sub-site Right SITE Left

distal lung CUN heart
proximal chest 寸 pericardium
distal stomach GUAN liver
proximal spleen 關 diaphragm
distal kidney CHI kidney
proximal abdomen 尺 abdomen
The three sites were named for the first time in Nanjing 難經 (The Canon
of Difficult Issues, ca. ad 100) and their organ specificity is also described
there. Since then, great masters of sphygmology like Wang Shu-he, Li Shi-zhen
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and even Li Zhong-zi had contributed minor variations. In current practice,

the left cun site reads the heart and the left guan site, the liver. On the right,
the cun site reads the lung, the guan site the spleen, while the chi sites on both
wrists read the kidney. They agree roughly with the present text.
To take the pulse at the three separate sites, each with three modes of
increasing pressure, is called the “three sites and nine modes” today. This is
different from the classical meaning which appears later in this chapter.
Zhang Deng-ben (ref. 1) interpreted chi in this passage as chifu 尺膚, the
skin surface on the medial side of the forearm. It is true that by inspecting the
skin condition here, one can pick up some signs that form part of diagnosis by
visual inspection (se zhen 色診). But it makes no sense except in the first two
sentences regarding the hypochondrium. It should be noted that Suwen
Chapter 17 discusses many fine points of pulse-taking and their interpreta-
tion. Li Zhong-zi excerpted only the first paragraph and the penultimate para-
graph, where the naming of the chi site was the only occasion when a precise
site was mentioned. The rest of the text following the naming of chi refers to
the organ specificity of three different sites and their subtle differentiation
with regard to organ specificity.
Zhang was subscribing to a group of old and new annotators including
Wang Bing, Tamba Genkan and Zhang Can-jia. Wang Hong-tu even made a
drawing to show the various regions on the medial side of the forearm where
organ specificity is indicated.2 This is a formidable camp of experts and no
one would dare to question their opinion. However, it must be pointed out
that even though they might be correct, this passage concerns pulse-taking.
There is no other pulse-taking site on the forearm except at the wrist. If the
consensus of these great experts is correct, where do they expect us to take the
pulse? Medical classics are open to interpretation, but it must sound reason-
able to a modern mind.
Footnotes
[1] early morning: In the Chinese text, the term ping dan 平旦 is used; it means
daybreak, or more exactly, the moment the sun (日) rises above the horizon
(一). The importance of this moment lies in the fact that the circulation of
2
Wang Hong-tu 王洪圖, Neijing jiangyi 內經講義 (Lectures Notes on Neijing)
(Beijing: Renmin weisheng chubanshe, 2002), p. 225.
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yingqi 營氣 (nourishing qi) and that of weiqi 衛氣 (defensive qi), each

following a separate course, are now meeting at the cheirotelic tai-yin
pulmonic conduit at daybreak (Lingshu Chapter 18: Genesis and Confluence
of Yingqi and Weiqi《靈樞．營衛生會》). Yingqi flows along the 12 regular
conduits in their defined sequence (ibid. 6-1. See also ref. 53, Section 4.3.2),
undergoing 50 cycles in a day, more or less in the same way that blood flows
through the systemic blood vessels and then returns to the heart. Weiqi does
not follow the sequence of the regular conduits. In the daytime, it flows
mainly but not solely through the hand and foot yang conduits (which
govern the fu-organs) in a circuit of its own, and it repeats this 25 times. At
night, however, weiqi flows in the yin conduits from one zang-organ to
another, again 25 times. Since yingqi and weiqi are flowing together after
midnight, they are best detected at cunkou (acupoint LG-10 yuji), in the
pulmonic conduit. According to Zhang Jie-bin, and as later confirmed by Li
Zhong-zi, the appropriate time for this is daybreak. Weiqi often flows outside
the conduits, spreading under the body surface to defend against the inva-
sion of evil qi (pathogens) during the day. At night, when weiqi flows only in
the yin conduits, sleep ensues. Thus it has an influence on the diurnal
rhythm similar to that of melatonin. In order to grasp the idea of qi circula-
tion by analogy to blood circulation, we may understand yingqi as the blood
itself, together with the oxygen and nourishment it carries, going round the
body in the vascular system, although the rate is much slower than blood
flow as measured today. Weiqi can be likened to the lymphocytes and granu-
locytes (leukocytes), which can move in and out of the blood vessels,
defending the body by phagocytosis and release of cytokines. In the daytime,
the granulocytes are concentrated round the guts (fu-organs) and under the
skin (controlling the porosity of the couli), because of food passage and
exposure to the environment. At night, when peripheral circulation is
reduced the granulocytes are stationed by the lymph organs and the liver.
Wang Hong-tu (ref. 31) provides a diagram of the circuitry for weiqi based
on descriptions from Lingshu Chapter 76: Circulation of the Defensive Qi (《靈
樞．衛氣行》).
[2] chi site: Pulse-taking at the wrist, instead of over three different parts of the
body, was first established in Suwen Chapter 11: Normal and Odd Organs
(《素問．五臟別論》). Neijing only mentions the chi site as the point of
reference. Nanjing further differentiates the wrist site into three composite
sites and provides a new meaning to “three sites and nine modes” (Question
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18). From Wang Shu-he onwards, pulse-taking was limited to the cunkou (du
qu cun kou 獨取寸口, Nanjing: Question 1). Today, the guan site has become
the point of reference in feeling for the protuberance behind the palm that is
the styloid process of the radius (gaogu 高骨). Consequently, the cun site is
distal to the guan site and the chi site, proximal to it. But in the original text,
the cun and guan sites were not named; they were merely described as prox-
imal or distal to the chi site.
[3] hypochondrium: jixie 季脇 refers to the upper lateral region of the abdomen,
at the level of the eleventh/twelfth ribs, where the lower and cartilaginous
end of the costal arch (jilei 季肋, “the lesser ribs”) lies. This term often
appears in Neijing because this location is accessible to the liver (and gall
bladder) and the spleen by palpation. Pain in this region invariably indicates
trouble with the liver and gallbladder. Splenomegaly, for example in malaria,
is also detectable here.
[4] pericardium: danzhong 膻中, generally refers to the mid-point between the
two nipples towards which the primordial qi (zongqi 宗氣, see ref. 53) as well
as other kinds of qi, converge. It also refers to the acupoint RN-17 of the
same name, at the mid-point on the line linking the nipples at the level of
the fourth rib. The same term applies to the pericardium (xinbao 心包 or
xinbaoluo 心包絡), an extra zang-organ paired with the “three burners” and
is counted among the twelve visceral organs, each with one dedicated regular
conduit of its own. Danzhong, enveloping the heart, defends it and takes the
brunt of any evil qi that attacks the heart. In normal times, it controls the
expression of joy and happiness.
[Section 4.2] Suwen Chapter 18: On Normal Pulse Patterns
《素問．平人氣象論》曰：人一呼脈再動，一吸脈亦再動，呼吸定息脈五
動，閏以太息，命曰平人。平人者，不病也。
人一呼脈一動，一吸脈一動，曰少氣。人一呼脈三動，一吸脈三動而
躁，尺熱，曰病溫；尺不熱，脈滑，曰病風；脈澀，曰痺。人一呼脈四動
以上，曰死；脈絕不至，曰死；乍疏乍數，曰死。
[During a breathing cycle], the heart beats twice in exhalation, and again twice
in inhalation. In one breathing cycle, the heart may beat five times because of
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the extra time needed to change breath [1]. This is called the normal pulse. By
normal, it meant not sick.
If the heart beats only once when exhaling and again once when inhaling,
this indicates a lack of zhengqi. If the heart beats thrice when exhaling and
again thrice when inhaling, this indicates the agitation of zhengqi. When this is
accompanied by a warm feeling on the medial side of the forearm [2], this is a
sign of febrile disease [3]. If the medial side of the forearm does not feel warm
and the pulse pattern is smooth, this is due to an attack of the wind evil qi [4].
[Under similar circumstances], if the pulse pattern is hesitant [instead of
smooth] [5], this is a sign of arthralgia [6]. If the heart beats four times or
more when exhaling, this is a moribund symptom. The same is true for a total
arrest of the heartbeat or an irregular rhythm (arrhythmia) of either speeding
up or slowing down.
Explanatory Notes
Suwen Chapter 18 discusses the normal pulse pattern and its seasonal varia-
tions and visceral organ specificity, and thus it is necessary to define a “normal”
pattern. The six basic patterns can be considered the primary parameters of a
pulse profile; “floating and sinking” refers to amplitude, “slow and quick”
refers to speed of propagation, “smooth and hesitant” refers to the shape of
the slope of the pressure curve. The medium range of these parameters
together will indicate a “normal” pulse that is full, steady and regular (similar
to the sinus rhythm in modern medical parlance). This ideal performance is
equated with the pulse of a person who is well-nourished, energetic and in full
command of himself. It is described as having a good supply of weiqi 胃氣
(“stomach qi”, different from weiqi 衛氣, “defensive qi”), i.e. the spleen and
stomach system is functioning optimally with a positive energy balance. There
are several passages in this and the following chapter in Suwen that describe
weiqi, later elaborated by great masters like Zhang Jie-bin. Modern experts like
Liang Han-fen 梁翰芬 (1876–1960), in his unpublished manuscript, Chen
duanxue jiangyi 診斷學講義 (Lecture Notes on Diagnosis), quoting another
source, maintained that “for a pulse that is neither large nor small, long nor
short, floating nor sinking, hesitant nor smooth, but responds agreeably to
palpation as if happy to meet the touch, although overall being hard to
describe with precision, this is weiqi.” Liang’s words are quoted here to show
that from the time of Neijing to the early 1950s, when education in Chinese
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medicine was first established on an institutional basis among the populace,

and later fully supported by the state, the identification of pulse patterns still
relied on descriptive language. In any event, weiqi does not count as one of the
28 common normal pulse patterns; it is a degree of “normalcy” in any kind of
pulse pattern. The fullness, insufficiency or absence of this norm will distin-
guish a pulse pattern as normal, sick or moribund.
Footnotes
[1] breath: The Chinese word for a breath is xi 息. While it describes the move-
ment of air during respiration, it actually refers to the brief moment of
holding the breath at full inhalation. Thus xi means “stop, arrest, or recess”
(xiuxi 休息). According to Yijing 易經 (Book of Changes, originated ca. 11–8
bc): “A gentleman will never stop improving himself ” (jun zi yi zi qiang bu xi
君子以自強不息). When this moment is long enough, there will be time for
one more beat, making five heart beats in each breathing cycle. When this
brief stop is too long (taixi 太息), it ends with a deep breath followed by
long exhalation like a sigh. Bixi 鼻息 means the breath at the nostrils that
one seeks to detect, for example in cases of loss of consciousness. If it is
detectable (yi xi shang cun 一息尚存), the patient is still alive. Xiaoxi 消息 is
now usually translated as “news”, but in clinical situations it refers to the ebb
and flow of a disease.
[2] forearm: Here the word chi 尺 means chifu 尺膚. It is the medial side of the
forearm and an important site for visual inspection.
[3] febrile diseases: Here the Chinese term is bing wen 病溫 (sick with mild
fever). This refers to any disease with a mild febrile sign, not necessarily a
case of shanghan 傷寒 (literally, “hurt by exposure to cold”), which was
common at the time when Neijing was produced. The disease known as
wenbing 溫病 (warm disease) was a variation of the shanghan type of disease,
often caused by viral infection; it began to catch the attention of clinicians,
especially in the south, during the early Qing dynasty.
[4] wind evil qi: Here the Chinese words are bing feng 病風 (sick due to an attack
of evil wind). Wind (feng 風) counts among the six excesses of climatic
conditions (liu yin 六淫). Because these excesses can cause disease, they are
also called evil qi (xieqi 邪氣, “pathogens”) with respect to zhengqi 正氣
(defensive capacity). While it is easy to understand that there are wind-borne
pathogens, the term “wind disease” is more often used to describe the sudden
appearance and the migratory nature of certain kinds of neuroleptic or
Neijing.indb 82 2010/2/26 6:58:11 PM

spasmodic diseases such as epilepsy (yangxian feng 羊癇瘋／風). Very often,

chronic exposure to a wet and cold environment will cause rheumatism
(fengshi 風濕), hence the causative factor becomes the disease itself. Wind
evil is considered the most intractable of all pathogens, thus “Wind is the
chief of all [factors causing] diseases” (feng zhe bai bing zhi zhang 風者百病
之長, Suwen Chapter 19: On a Comparison between Normal Pulse Patterns
and Critical/Moribund Pulse Patterns).
[5] hesitant pulse: The original Chinese word means “astringent” (se 澀). But
astringency refers to a taste, not a movement. An astringent pulse (se mai 澀
脉) is one that comes and goes with difficulty, leaving a lingering feeling at
the fingertips. It can be compared to scraping the surface of a bamboo with a
knife. In contrast to a smooth pulse, that has a broad peak and smooth
slopes, and feels like pearls rolling on a flat plate, an astringent pulse has a
sharp peak and a bumpy slope. Therefore the pulse sensation is reduced in
time as if it is hard to come by, hence hesitant.
[6] arthralgia: The Chinese word is bi 痺, literally “numbness” or “anaesthesia”. It
is due to the blockage of qi and blood caused by wind, cold and wet evils and
results in numbness, pain and difficulty in moving.
[Section 4.3] Lingshu Chapter 5: Source and Terminal Points

of the Conduits
《靈樞．根結篇》曰：一日一夜五十營，以營五藏之精。不應數者，名曰狂
生。所謂五十營者，五藏皆受氣。持其脈口，數其至也。
五十動而不一代者，以為常也，以知五藏之期。予之短期者，乍數乍
疏也。
In one day and one night, ying (qi) [1] runs 50 times (round the body) [2] so
as to distribute the essence of the five zang-organs. If a person does not meet
this number, he is abnormal [3]. For those who can have 50 rounds (in a day),
their five zang-organs are all reached by (ying) qi. Then by holding the
pulsating site at the wrist [4] one can count the number of beats.
If there is not one missed beat in 50 beats [5], it is a normal pulse, indi-
cating optimal function of the five zang-organs. If the patient has more or
Neijing.indb 83 2010/2/26 6:58:12 PM

fewer beats than usual, this indicates a moribund state.
Explanatory Notes
This chapter in Lingshu describes the starting acupoint (gen 根, “root”) and
the terminal acupoint (jie 結, “knot; to terminate”) of the regular conduits for
three pairs of visceral organs, viz. spleen-stomach, liver-gall bladder and
kidney-urinary bladder. It also describes the starting acupoint and the course
of flow for the six (hand and foot) yang conduits, hence the title of this
chapter. But Li Zhong-zi focussed his attention rather on the passage that
describes the flow rate of the yingqi and, based on this regular speed, checked
for the occurrence of intermittent pulse (daimai 代脉). Li cited Lingshu
Chapter 17 Mai du 脉度 (Conduit Dimensions) in his annotation. There the
precise measurements of each conduit are given, so that for the yingqi to go
one complete cycle, it must travel 16.2 zhang 丈 (= 3.33 metres, equal to 10
Chinese feet, chi 尺). The itinerary includes 27 conduits, i.e. 12 bilateral
regular conduits on each side of the body, plus the Ren conduit, the Du
conduit and either the Yin-qiao or the Yang-qiao conduit, the latter being
gender-dependant and counted only once. That makes an average of six chi (60
cun) for each conduit. Since the yingqi advanced three cun 寸 (equal to one
Chinese inch, 1/10 of one chi 尺) while inhaling, and another three cun while
exhaling, it moves six cun for each breath, and it takes 10 breaths for yingqi to
travel the average length of one conduit (60 cun, range 35–80 cun). As there
are 5 beats in one breath (two for inhaling, two for exhaling, plus one extra
beat at full inhalation), yingqi travels the length of one conduit for a time of
50 beats. That is why the time span of 50 beats is considered optimal to check
for intermittent pulse, if there is one. Today, a clinician will not linger more
than one minute on each wrist (normal heart rate at 70–80/min.) at each site
(cun, guan, chi), as prolonged manipulation will affect cardiac performance. If
there are 50 circuits a day, it must take about half an hour to complete one
circuit. This flow rate is about 30 times slower than what is measured today.
However, Neijing was considering a sequential flow of yingqi that travels all
the length of the 27 conduits, while the Harveian circulation time counts the
minimal time for the blood to leave the heart, travel to the extremities (through
the arteries to the capillaries) and come back (through the veins) to the heart.
Therefore the “linear” flow rate in Neijing should be 27 times quicker, i.e.
Neijing.indb 84 2010/2/26 6:58:12 PM

about one minute. This brings the flow rate described in Neijing closer to the
modern day value of 30 seconds. Qin Bo-wei (1958) further argued that
maybe the original text in archaic versions of Neijing meant 50 rounds “each”
in both day and night. This is the way in which weiqi (defensive qi) was
described as travelling (ibid. 4-1-1). In this case, Neijing afforded a close
approximation of actual flow rate just by timing the pulse rate.
Footnotes
[1] ying (qi): There is no subject in this sentence, but it is meant to describe
yingqi.
[2] fifty rounds: wushi ying 五十營. The character ying appears three times in
this passage. The first and third time the ying in wushi ying means the flow of
yingqi. Here ying is pronoun for the “round” on which yingqi travels. The
second time the word ying occurs, in ying wu zang zhi jing 營五臟之精 (to
distribute the essence of the five zang-organs) it is used as a verb; it means
logistics (yingyun 營運). This tallies with the use of ying as a verb, as in yingshu
營輸 in Lingshu Chapter 48: Jin fu 禁服, and yingfu 營復 in Lingshu Chapter
47: Ben zang 本臟). It can also mean “nourishment” (yingyang 營養 and rong-
yang 榮養) (see Chapter 8, Section 12). All these terms convey the nutritive
function and distributive nature of yingqi, and so it is perplexing to note that
Unschuld (ref. 51) preferred to translate yingqi as “Camp Qi”. Indeed, the mili-
tary connotation of ying 營 (camp) paired with wei 衛 (“protect, defend”) is
irresistible. The metaphor can be found in Suwen Chapter 19: On a Compar-
ison between Normal Pulse Patterns and Critical/Moribund Pulse Patterns. Here
ying is used to compare the winter pulse pattern to a fortified garrison (yinglei
營壘), in that it is hard to detect but in fact strong (see Section 7 of this
Chapter). Ying appears three more times in NJZY, all meaning yingqi. In
Section 6.2, where it is the last word in the excerpt, it refers to an acupoint.
[3] abnormal: This term is used in English to avoid a verbatim translation of 狂生
(kuangsheng, “a maniac”) which in this passage means someone who is abnormal,
unconventional or unruly, with no implication of mental derangement.
[4] wrist: Here the Chinese words are maikou 脉口, the aperture (kou 口) where
one can detect the pulsation (mai 脉), which is the cunkou 寸口 at the wrist.
[5] missed beat: daimai 代脉 (intermittent pulse), is one of the 16 common pulse
patterns characterised by one missed beat in a train of pulses (ref. 53, Section
6.4.1.5). The arrest appears regularly, as compared to a “knotted pulse” (jiemai
結脉) that has occasional stops at no fixed rate. In this paragraph, Li Zhong-zi,
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for the sake of simplicity, omitted a long passage that correlated the rate of
stoppage with a zang-organ failure. For example, one missed beat in 50 beats
meant one zang-organ was not functioning (i.e. no qi can be detected or sent
out). One missed beat in 40 beats meant two zang-organs failing, and so on.
While occasional arrest can be tolerated, increasing intermittency means situa-
tion worsening and moving towards a moribund state. This careful selection of
the most salient points in Neijing to save space showed the genuine intention
of Li Zhong-zi to prepare an approachable first reading for beginners.
[Section 4.4] Suwen Chapter 20: On the Different Sites of

Pulse-taking
《素問．三部九候論》曰：獨小者病，獨大者病，獨疾者病，獨遲者病，獨
熱者病，獨寒者病，獨陷下者病。
[Among the three regions and nine sites, when an individual site provides] a
signal that is singularly [1] small [weak], or large [strong], or quick, or slow,
or hot [smooth], or cold [taut] [2] or sagging [3], the person is sick.
Explanatory Notes
This is a short passage from a long chapter that describes the reasons based on
which pulse-taking occurred at the three regions and nine sites. The three
regions (sanbu 三部) were upper (head), middle (wrist) and lower (leg). In
each region, there were three sites dubbed tian 天 (heaven), di 地 (earth) and
ren 人 (man) respectively. The ensemble gave nine signals (jiuhou 九候). The
following table shows the sites and organ specificity described in this chapter:
Region/site Conduit/location Indicated organ/

body part
HEAD
Upper-Heaven podotelic shao-yang gall bladder (temporal Head and brow
artery)
Upper-Man cheirogenic shao-yang small intestine (artery Ear and eye
in front of earlobe)
Upper-Earth podotelic yang-ming stomachic (mandibular Oral cavity and
artery) teeth
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WRIST
Middle-Heaven cheirotelic tai-yin pulmonic (radial artery at Lung
wrist, cunkou)
Middle-Man cheirotelic shao-yin cardiac (acupoint Heart
shenmen HT-7, over the ulnar artery at the
wrist)
Middle-Earth cheirogenic yang-ming large intestine Chest
(acupoint hegu LI-4, over the artery to the
thumb, the so-called hukou 虎口, “tiger’s
mouth”)
LEG
Lower-Heaven podogenic jue-yin hepatic (acupoint yinlian Liver
LR-11, over the femoral artery at the level of
pubic tubercle)
Lower-Man podotelic tai-yin spleenic (acupoint Spleen and
yinlingchuan SP-9, over the popliteal artery stomach
in the popliteal fossa)
Lower-Earth podogenic shao-yin renal (acupoint fuliu Kidney
KI-7, on the medial side over the posterior
tibial artery between the ankle and Achilles
tendon)
NB: The table is arranged along the vertical axis of a man standing
(head—wrist—leg) and heaven (tian)—man (ren)—earth (di) although it is
customary to say “tian—di—ren” in order of their importance. In Neijing,
only three sites located on the head are mentioned. For the other six sites, only
their pertinent conduits are mentioned. To provide the precise location of a
pulse-taking site, an acupoint is indicated, but a different source of reference
may use other acupoints nearby. Whatever the acupoint, it must lie on a hard
base, usually over a bone, so that a pulse can be detected. It is only appropriate
that this acupoint belongs to the same conduit as the one mentioned in
Neijing. Nomenclature of conduits follows ref. 53, that of acupoints, Sun
Wai-zhu.3
3
Sun Wai-zhu 孫外主, Zhenjiu linzheng zhiyao 針灸臨證指要 (Clinical Guide to
Acupuncture) (Hong Kong: The Commercial Press, 2004).
Neijing.indb 87 2010/2/26 6:58:13 PM

This table shows that Neijing was serious about the visceral organ/body
part affiliation of the nine sites. While this practice is abandoned today in
favour of the wrist only, it is not unusual to feel the pulse at the temple or the
neck. Even a general practitioner might take the femoral, brachial pulse, or the
pulse at the instep near the ankle (fuyang 趺陽, “anterior tibial artery”), on
top of the wrist, although not looking for the nuances that Chinese medicine
seeks.
The idea of taking a pulse at multiple sites stems from the assumption
that all pulse patterns at each individual site should agree with each other. If
this is not the case, the site at which a singular pulse pattern is noticed will
indicate which visceral organ or body part is affected. However, diagnosis
cannot be based on pulse pattern alone. It must agree with other symptoms
and the body’s constitution in general. This is discussed later in Section 4.11
of this book.
Footnotes
[1] singularly: The Chinese word is du 獨 (single, odd, only). Because qi flows
sequentially from one conduit to another, each time passing through its affil-
iated organ, the pulse pattern will change if this organ is not functioning well
and will show up at the organ-specific site.
[2] taut pulse: The Chinese text mentions a hot and cold pulse. “Hot” and “cold”
are not pulse patterns. But hot disease will produce a smooth pulse, while a
cold disease will produce a taut pulse. Hence the translation.
[3] sagging pulse: A sagging pulse lies deep and can only de detected by pressing
hard on the site, as if the pulse has sunk into the body. However, sagging is
not exactly the same as a sinking pulse (chenmai 沉脉), as opposed to a
floating pulse (fumai 浮脉). Sagging (xianxia 陷下) is due to the curdling of
blood in the vessels, according to Lingshu Chapter 48: Interdiction of the
Disclosure of Professional Secrets (Jin fu 禁服).
[Section 4.5] Suwen Chapter 80: On the Normal Practice of

Diagnosis
《素問．方盛衰論》曰：形氣有餘，脈氣不足，死；脈氣有餘，形氣不足，
生。
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When the body is in good shape [1] but the pulse [2] is feeble, one will die.
When the pulse is exuberant, albeit the body is not marvellous, one will live.
Explanatory Notes
This is a short chapter towards the end of Suwen. For an exegesis of this
chapter, see Section 8.26, where it is quoted more extensively. For the
moment, this chapter serves as a reminder of the importance of an overall
consideration in diagnosis. Although pulse-taking can reveal a great deal of
information, it is significant only when it is in agreement with other signs and
symptoms. In ancient times, people did not travel much (although there were
itinerant medical practitioners [3]) and a good clinician would be careful to
maintain his credibility in the neighbourhood or community. To do this, he
must not give false hope. Thus successful early detection of a terminal or
moribund state was vital to his good name. Today, people often turn to
Chinese medicine at a terminal stage, and that is not doing justice either to
Chinese medicine or to the patient.
There is an interesting passage in this chapter that describes the diag-
nostic significance of dreams. Because dreams are caused by the lack of qi,
when the lung has inadequate qi, one has dreams of white objects (the lung
belongs to the metal category among the five elements, and its representative
colour is white) and gory scenes of killing. When there is adequate qi in the
lung, one has dreams of war scenes. Suwen Chapter 17 also talked about
dreams and Lingshu Chapter 43 was entirely devoted to discussion of dreams.
On the whole, the nature of the dreams was correlated to the lack or exuber-
ance of yinqi or yangqi and the malfunction of a particular zang-organ. There
is a common saying that “an idiot tries to interpret his dreams” (chi ren shuo
meng 痴人說夢). The passages of Suwen do not seem idiotic when we see how
much importance psychoanalysis today places on dreams.
Footnotes
[1] good shape: The original text uses the term xing qi 形氣. Xing refers to the
outlook, the form or the physical constitution. “Qi” refers to zhengqi 正氣,
the strength and vigour to ward off disease. In short, it describes the physical
and mental state of a healthy body.
[2] pulse: The original text used the term maiqi 脉氣, that is simply the force
(amplitude) of the pulse.
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[3] itinerant medical practitioners: There have always been grass-roots clinicians
who roam from village to village, using simple treatments such as massage
and acupuncture, plus one or two uncommon drugs they are expert in using.
They provide the first line of primary health care in a rural society. They are
called “itinerant doctors” (zoufangyi 走方醫) or “bell doctors” (lingyi 鈴醫,
“medical tinkers”) because they ring a bell to announce their presence. Zhao
Xue-min 趙學敏 (ca. 1719–1805), famous for his “Bencao gangmu” shiyi 本
草綱目拾遺 (Addendum to Bencao gangmu), published a collection of
recipes from popular bell doctors entitled Chuan Ya 串雅 (In Search of
Elegance).

Pulse-taking
《素問．脈要精微論》曰：持脈有道，虛靜為保。春日浮，如魚之游在波；
夏日在膚，泛泛乎萬物有餘；秋日下膚，蟄蟲將去；冬日在骨，蟄蟲周
密，君子居室。故曰知內者按而紀之，知外者終而始之。此六者，持脈之
大法。
There are rules to observe in taking the pulse, the most important of all is to
remain peaceful and calm. The pulse pattern in spring is usually floating [easy
to detect], like fish swimming among the ripples [that are easy to observe]. In
summer, the pulse can be detected at the skin [body surface] as if it is spilling
over [the body], like everything beaming with exuberance at this time. In
autumn, the pulse is no longer detectable under the skin, as when hibernating
insects are moving underground [to seek hiding places]. In winter, the pulse is
deeply buried in the bone, as if a hibernating insect lies deep and well hidden,
or like a gentleman [1] living in an interior chamber, rarely venturing outside.
Therefore, in order to know how a zang-organ [in the interior] functions, [one
has to] seek the zang-organ specific sites. To know how the pulses are propa-
gating, monitor their movements at the exterior [surface of the body]. These
six cardinal rules are the basic principles of pulse-taking.
Explanatory Notes
This is the third selection from Suwen Chapter 17. The first excerpt (ibid. 3-1)
Neijing.indb 90 2010/2/26 6:58:13 PM

concerns the differentiation of colour in visual inspection. The second excerpt

(ibid. 4-1) defines the optimal moment for and the specific sites of pulse-
taking, the information from which must be corroborated with the constitu-
tion of the body (the five hues and physical appearance). This section
concerns the basic principles (seasonal variation) of pulse-taking, which
prepares the reader for the following section. A fourth excerpt (ibid. 4-9, see
below) on the importance of having an adequate amount of blood (euvolemia)
follows. Like Chapter 5: On the Phenomena of Yin-Yang, these two Chapters (5
and 17) of Suwen are quoted four times in NJZY, indicating the importance Li
Zhong-zi attached to the basic yin-yang principle and correct pulse-taking.
Although it describes the normal seasonal variation of pulse patterns, this
section leads to the description of the zang-organ specific profile of pulses that
are most evident at the relevant season; these are the string (liver), hook (heart),
feather (lung) and pebble (kidney) patterns (see below). The spleen pulse
pattern is in fact weiqi (stomach qi); this only becomes evident when it is not
normal.
Footnote
[1] gentleman: The Chinese term is junzi 君子. It is first mentioned in [ibid.

4-2-1]. Generally translated as “gentleman”, junzi has connotations far
beyond gentility. There are no less than 700 citations in the Shisan jing 十三
經 (The Thirteen Classics) that described the qualities of the junzi. Perhaps
the most straight forward definition can be found in Lunyu 論語 (Analects
of Confucius). Confucius said; “When nature and culture are in balance, you
get a gentleman”.4 (wen zhi bin bin, ran hou jun zi 文質彬彬，然後君子).
Here nature means a kind nature, unpretentious and honest; culture means
learning and fine literary taste. So a junzi is above all a gentle, polite, elegant
and sincere person, but at the same time well read with a fine taste in arts
and literature. Literacy is not the sole criterion for being a junzi, because
there can be gentleman scholars (junzi ru 君子儒) and philistine scholars
(xiaoren ru 小人儒). (Lunyu: 6.11 Yongya) Ever since ancient times, all
educated men have striven to be junzi, but alas, the world is full of fakes (wei
junzi 偽君子, “hypocrites”).
4
Simon Leys, The Analects of Confucius (W. W. Norton, 1997), 6.18.
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[Section 4.7] Suwen Chapter 19: On a Comparison between

Normal Pulse Patterns and Critical/Moribund Pulse Patterns
《素問．玉機真藏論》曰：春脈者，肝也。東方，木也，萬物之所以始生
也。故其氣來軟弱輕虛而滑，端直以長，故曰弦。反此者病。其氣來實而
強，此謂太過，病在外；其氣不實而微，此謂不及，病在中。太過，則令
人善忘，忽忽眩冒而巔疾；其不及，則令人胸痛引背，下則兩胠滿。
夏脈者，心也。南方，火也，萬物之所以盛長也。故其氣來盛去衰，
故曰鈎。反此者疾。其氣來盛去亦盛，此謂太過，病在外；其氣來不盛去
反盛，此謂不及，病在中。太過，則令人身熱而膚痛，為浸淫；其不及，
則令人煩心，上見咳唾，下為氣泄。
秋脈者，肺也。西方，金也，萬物之所以收成也。故其氣來輕虛以

浮，來急去散，故曰浮。反此者病。其氣來毛而中央堅，兩傍虛，此謂太
過，病在外；其氣來毛而微，此謂不及，病在中。太過，則令人逆氣而背
痛，慍慍然；其不及，則令人喘，呼吸少氣而咳，上氣見血，下聞病音。
冬脈者，腎也。北方，水也，萬物之所以合藏也。故其氣來沉以搏，
故曰營。反此者病。其氣來如彈石者，此謂太過，病在外；其去如數者，
此謂不及，病在中。太過，則令人懈亻亦，脊脈痛而少氣不欲言；其不及，
則令人心懸如病飢，眇中清，脊中痛，少腹滿，小便變。
脾脈者，土也，孤藏，以灌四傍者也。善者不可得見，惡者可見。其
來如水之流者。此謂太過，病在外；如烏之喙者，此謂不及，病在中。
The pulse pattern prevalent in spring is under the influence of the liver. [In
the language of the five elements], the liver is in the wood category and the
pertinent direction is east. With qi coming from the east [1], everything is
burgeoning. Therefore, the spring pulse is soft, light and smooth; it lasts a long
time and is called a string pulse [2]. A pulse pattern not conforming to this
description in spring indicates sickness. If the pulse is robust and strong, this
is excessive qi; the disease lies at the body surface or in the fu-organs. If the
pulse is not robust but feeble, this is inadequate qi; the disease lies in the zang-
organs or deep inside the body. Excessive liver qi will lead to brief loss of
memory and can even make one feel giddy and sick in the head. Inadequate
liver qi will cause pain in the chest and strain at the back while the hypochon-
drium feels congested.
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The pulse pattern prevalent in summer is under the influence of the

heart. [In the language of the five elements], the heart is in the fire category
and the pertinent direction is south. With qi coming from the south, every-
thing is flourishing. Therefore, the summer pulse rises strongly but abates
precipitously; it is called a hook pulse [3]. A pulse pattern not conforming to
this description in summer indicates sickness. If the pulse is rising strongly
and abates only gradually, this is excessive qi; the disease lies at the body’s
surface or in the fu-organs. If the pulse rises feebly and abates slowly, this is
inadequate qi; the disease lies in the zang-organs or deep inside the body.
Excessive heart qi causes fever and the skin hurts, leading to festering boils.
Inadequate heart qi will cause vexation, together with productive coughing
and flatulence.
The pulse pattern prevalent in autumn is under the influence of the lung.
[In the language of the five elements], the lung is in the metal category and
the pertinent direction is west. With qi coming from the west, everything is
ready for harvest. Therefore, the autumn pulse rises softly, as if like floating
upwards. The pulse comes on abruptly but disperses effortlessly; it is called a
floating pulse [4]. A pulse pattern not conforming to this description in
autumn indicates sickness. If the pulse is light like a feather, but carries a hard
core with soft sides, this is excessive qi; the disease lies at the body surface or in
the fu-organs. If the pulse is light to the touch like a feather and is hardly
detectable, this is inadequate qi; the disease lies in the zang-organs or deep
inside the body. Excessive lung qi tends to reverse in its flux, causing back pain
and a feeling of oppression. Inadequate lung qi causes panting, shortness of
breath and coughing. Upward gusts of qi may cause coughing with blood
(haemoptysis) and asthmatic breathing.
The pulse pattern prevalent in winter is under the influence of the kidney.
[In the language of the five elements], the kidney is in the water category and
the pertinent direction is north. With qi coming from the north, everything is
concealing itself. Therefore the winter pulse lies deep yet forceful; it is called a
garrison pulse [5]. A pulse pattern not conforming to this description indi-
cates sickness. If the pulse rises abruptly like the flicking of a pebble, this is
excessive qi; the disease lies at the body’s surface or in the fu-organs. If the
pulse abates in a staccato manner, this is inadequate qi; the disease lies in the
zang-organs or deep inside the body. Excessive kidney qi makes one feel listless
and tired [6], causes pain in the vertebral column, shortness of breath and a
disinclination to talk. Inadequate kidney qi will make one feel unsettled, as if
Neijing.indb 93 2010/2/26 6:58:14 PM

having fasted for some time, with a cold sensation in the soft ribs, pain in the
backbone, congestion in the underbelly and unusual urination habits.
The spleen belongs to the earth category [according to the “five elements”
theory]. The spleen is a solitary zang-organ [7] in the sense that it supplies the
four other zang-organs [all year round]. [Therefore the spleen pulse pattern
has no seasonal variation]. Under normal circumstances, the spleen pulse
pattern is not evident. Only abnormal pulse patterns of the spleen are notice-
able. If the pulse arises like water flushing downwards, this is excessive qi; the
disease lies at the body’s surface or in the fu-organs. If the pulse pattern is [sharp
and hard] like the beak of a raven, this is inadequate qi; the disease lies in the
zang-organs or deep inside the body.
Explanatory Notes
Suwen Chapter 19: Yuji zhenzang lun 玉機真臟論, literally “Zang-organ
Specific Genuine Pulse Patterns Recorded on Jade Plates”. The chapter title can
be paraphrased as “Comparison between Normal Pulse Patterns and a Crit-
ical/Moribund Pulse Patterns”. While this renders the essence of this chapter, it
still leaves a need for explanation of the key terms yuji and zhenzang. In Suwen
Chapter 18: On Normal Pulse Patterns, partly excerpted in Section 4.2 above,
the importance of weiqi 胃氣 (“stomach qi”) as the basic dynamic feature of a
normal pulse was discussed, though not selected by Li Zhong-zi.
In Suwen Chapter 19, a zang-organ specific pulse pattern is described as a
pulse pattern devoid of weiqi. In this case, it shows from which zang-organ the
pulse is derived and how sick this zang-organ is, hence the term “genuine zang
pulse” (zhen zangqi 真臟氣, or zhen zangmai 真臟脉). When this occurs, the
patient has not been able to take nourishment for some time and is seriously
emaciated. Death is inevitable, but it befits to evaluate the time left, from 10
days to one year. An accurate prognosis is of paramount importance, as is
discussed in the Exegesis. However, to predict a terminal period incorrectly is
as bad as raising false hopes. Thus this chapter begins with detailed descrip-
tions on seasonal pulse patterns, in order to avoid misinterpretation due to
normal deviations.
Yuji 玉機 (jade armillary) is at first sight self-explanatory. Huangdi,
having been enlightened by Qibo as to the meaning of different pulse patterns,
promises to “write [carve] them on jade plates and store them [securely] in
deep mansions, so that [he can] read them everyday. This is called ‘yuji’”.
Neijing.indb 94 2010/2/26 6:58:14 PM

Exactly the same passage appears twice, in Chapter 15 and Chapter 19. It is
the title given to a collection of treatises on pulses. As such, it simply serves
to highlight the importance of these passages. Similar terms, such as yuban
玉版 (jade tablet), jingui 金匱 (golden chest), shishi 石室 (stone chamber)
and lanshi 蘭室 (orchid chamber) appeared in book titles to emphasise
the precious nature of these scripts. But yuji is also the abbreviation of
yuheng xuanji 玉衡璇璣, in which tianxuan 天璇, tianji 天璣 and yuheng
玉衡 are respectively the beta (second), gamma (third) and epsilon (fifth) stars
of the Great Bear constellation (Ursa Major, Big Dipper). Ancient astronomers
used the “handle” of the Big Dipper to measure time according to the direc-
tion it was pointing (dou zhuan xing yi 斗轉星移, “the Dipper turns and stars
are displaced”). Thus heng means a scale, a balance used to measure weight
(hengqi 衡器), or (metaphorically) “to maintain an equilibrium” (pingheng
平衡), “to weigh the pros and cons” (quanheng 權衡; tianquan 天權, being the
delta star of the constellation). The title explains the importance of this
chapter.
Closely associated with the term yuji in both Chapters 15 and 19 is the
quotation “shen zhuan bu hui, hui ze bu zhuan, nai shi qi ji” (神轉不回，回則
不轉，乃失其機). Translated plainly, this is: “ The spirit [mechanism of circu-
lation] rotates [turns round and round] but never turns back. If it turns back,
vitality is lost”. Because the entire chapter concerns pulses, the “spirit [mecha-
nism]” here means the dynamism of pulsation that propagates forward, failing
which life is in danger. This short passage is construed as knowledge of the
circulation of blood, although not exactly in Harveian terms.
This section is taken from the first part (approximately a third) of the
chapter, where the four typical zang-organ specific pulse patterns, viz. string
(xian 弦), large (gou ), floating (like a feather in air, mao 毛) and sinking
(like a pebble in water, shi 石) are described. The fifth pulse pattern belonging
to the spleen is not given a name because it is hard to describe in the sense
that it is the medium range of all parameters. This is the weiqi 胃氣 (“stomach
qi”). When there is plentiful weiqi, all other seasonal or zang-organ specific
pulse patterns are just about detectable. If it is too evident, or out of
season, there is something wrong. Li Zhong-zi left the rest of the chapter for
readers wanting to know the pathological deviations. A short paragraph on
pulse patterns of diseases of excess and deficiency will appear in Section 8.8
below. Nanjing: Question 15 describes these typical pulse patterns in great
detail.
Neijing.indb 95 2010/2/26 6:58:15 PM

Footnotes
[1] qi from the east: Here qi is neither wind nor air current; it is the climate (qihou
氣候). Qi from the east means the climate of spring (east) prevails. In the
same way, qi from other directions is associated with the seasons related to
those directions.
[2] string pulse: The Chinese word is xian 弦 (“string of a musical instrument”).
Because the string needs to be taut to produce a note, so a “string pulse” is
actually likened to a taut string. Yet a string must also be flexible enough to
yield under pressure at a certain point, in order to produce a definite note.
So a string pulse is characterised by its pliancy or elasticity while still being
taut. If the string pulse is too hard (lacking pliancy), there is liver malfunc-
tion; if it is too supple, it shows that liver function is deficient.
[3] hook pulse: The Chinese word is gou (hook ). Wang Bing was correct in
saying that the hook refers to the curved surface when water flows over a
weir. Li Zhong-zi described this image as a (horizontal) bough with the
terminal branch drooping. A hook pulse is the equivalent of what is known
as a “strong pulse” (hong mai 洪脉) today, the hook referring to the crest of
the wave.
[4] floating pulse: One of the common pulse patterns, the floating pulse is easy
to detect by placing the fingers lightly on the wrist. It is light and soft, like
touching a feather (mao 毛, “downy feather”), hence its name.
[5] garrison pulse: The Chinese word is ying 營 (barrack, garrison, army camp).
This is a different meaning of ying from its meaning in yingqi, “nourishment”
(ibid. 4-3-2). It refers to a heavily guarded garrison that reveals little on the
outside yet is strongly armed. Ying mai is also called chen mai 沉脉 (sinking
pulse) because the clinician must sink his fingers deeply to detect the pulse.
The name for this pattern is “pebble” (shi 石). With the garrison pulse, the
seasonal variations of organ-specific pulse patterns are complete. To
recapitulate:
Season Pulse Code Pulse Pattern Zang-organ
Spring string (xian) smooth liver
Summer hook (gou) strong heart
Autumn feather (mao) floating lung
Winter garrison (pebble, shi) sinking kidney
[6] listless and tired: The Chinese term is xie yi (解亦 homonym of 懈  xie
ji, literally “loose gesture”). This refers to general fatigue due to weak bones
Neijing.indb 96 2010/2/26 6:58:15 PM

and loose tendons because of inadequate kidney (bone) and liver (tendon)
functions. Described in Suwen Chapter 18: On Normal Pulse Patterns, it is
characterised by a slow and hesitant pulse pattern detected at the chi site.
[7] solitary zang-organ: The spleen belongs to the earth category and the perti-
nent direction is the centre. The centre can hardly be called a direction on
the compass; it was invented to accommodate the five zang-organs into the
five elements framework. However, it fits well with the idea that the spleen-
stomach system supplies nourishment to the other four zang-organs all year
round so that spleen pulse pattern does not show seasonal variation. The
spleen pulse pattern is the basis of weiqi (“stomach qi”) (see Section 4.2
Explanatory Notes and Section 4.8). It has a distinct regularity and ampli-
tude, and readily responds to touch, so that it dominates all other pulse
patterns unless it exceeds its normal range.
《素問．平人氣象論》曰︰夫平心脈來，累累如連珠，如循琅玕，曰心平。
夏以胃氣為本。病心脈來，喘喘連屬，其中微曲，曰心病。死心脈來，前
曲後居，如操帶鈎，曰心死。
平肺脈來，厭厭聶聶，如落榆莢，曰肺平。秋以胃氣為本。病肺脈
來，不上不下，如循鷄羽，曰肺病。死肺脈來，如物之浮，如風吹毛，曰
肺死。
平肝脈來，軟弱招招，如揭長竿末梢，曰肝平。春以胃氣為本。病肝
脈來，盈實而滑，如循長竿，曰肝病。死肝脈來，急益勁，如新張弓弦，
曰肝死。
平脾脈來，和柔相離，如鷄踐地，曰脾平。長夏以胃氣為本。病脾脈
來，實而盈數，如鷄舉足，曰脾病。死脾脈來，銳堅如烏之喙，如鳥之
距，如屋之漏，如水之流，曰脾死。
平腎脈來，喘喘累累如鈎，按之而堅，曰腎平。冬以胃氣為本。病腎
脈來，如引葛，按之益堅，曰腎病。死腎脈來，發如奪索，辟辟如彈石，
曰腎死。
A normal pulse pattern of the heart should feel regular, like a string of pearls,
and smooth like jade. Since the weiqi [with characteristic regularity and
amplitude] is the dominant feature [of a normal pulse pattern] in summer, a
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sick cardiac pulse arises hurriedly on the heels of one another. The clinician
will feel a robust surge but a feeble tapering off, as if there is a hook. This indi-
cates disease at the heart. A moribund cardiac pulse is robust on the rise but
rigid on the decline, like a leather belt held tightly in place with a hook [lack
of elasticity]. This indicates a failing heart moving towards impending death.
A normal pulse pattern of the lung should feel soft and light, like elm
pods falling leisurely to earth. Since the weiqi is the dominant feature in
autumn, a sick pulmonic pulse is neither floating nor sinking, like stroking the
feathers of a cockerel against the grain [1]. This indicates disease in the lung.
A moribund pulmonic pulse feels like a floating object without anchorage, or
feathers dispersed by a gust of wind. This indicates a failing lung moving
towards impending death.
A normal pulse pattern of the liver is long and supple like a long piece of
bamboo with a dangling end. Since weiqi is the dominant feature in spring, a
sick hepatic pulse feels like a rigid pole, smooth but hard. This indicates
disease in the liver. A moribund hepatic pulse comes quick and strong; it is
tense like the string of a newly-strung bow. This indicates a failing liver
moving towards impending death.
A normal pulse pattern of the spleen is leisurely yet firm, like a cock strut-
ting. Since weiqi is the dominant feature in a long summer [2], a sick spleenic
pulse is brusque and forceful like a cock sharply lifting it feet. A moribund
spleenic pulse is hard and pointed like the beak of the raven, sharp like a
(cock’s) spur, disorderly like a leaking roof or spilled water flowing in all direc-
tions. This indicates a failing spleen, moving towards impending death.
A normal pulse pattern of the kidney is regular and robust like that of the
heart, but forceful to the touch. Since weiqi is dominant in winter, a sick renal
pulse is like a climbing vine that hangs loosely yet is resistant to touch. A
moribund renal pulse rises abruptly like cracking a shot of pebble; it is taut
like a highly-strung cord. This indicates a failing kidney, moving towards
impending death.
Explanatory Notes
This section is a vivid description of the genuine zang-organ specific pulse
patterns with respect to the presence or absence of weiqi. It reinforces the
message from the previous section in which the pulse is either excessive or
inadequate. In this section, the pulse is described as normal, sick or moribund.
Neijing.indb 98 2010/2/26 6:58:15 PM

Perhaps this difference in presentation suggests that the authors of these two
chapters were different persons or from different schools. It is important to be
able to recognise the typical pulse patterns. Suwen Chapter 18 is quoted three
times in this chapter.
Footnotes
[1] cock’s feather: The Chinese word here is yu 羽 (quill or feather). The quill
feather has barbs held in place by small hooks. When stroking it against the
grain, one feels its abrasive touch. This is a mild form of hesitant pulse. See
ibid. 4-7-4 for a comparison.
[2] As with treating the centre as a direction, a long summer is allocated to the
spleen, in order to fit it into the five elements framework. Long summer is
the last part of summer when it is still warm, like an Indian summer.

Pulse-taking
《素問．脈要精微論》曰：夫脈者，血之府也。長則氣治，短則氣病，數則
煩心，大則病進；上盛則氣高，下盛則氣脹；化則氣衰，細則氣少，濇則
心痛；渾渾革（革），至如涌泉，病進而色弊，綿綿其去如弦絕，死。
Blood is housed in the conduits [1]. If the pulse lasts a long time, there is
plentiful qi in circulation. If the pulse lasts only a short while, the circulation
of qi is in trouble. If the pulse rate is too quick, one feels fretful and annoyed.
If the pulse is too strong, it indicates that the disease is worsening. If the pulse
at the cun site is too strong, qi is congested in the upper part of the body [2].
If the pulse at the chi site is too strong, qi is congested in the lower part of the
body. An intermittent pulse pattern is a sign of weakening qi, while a weak
pulse is due to a deficiency of qi. Hesitant pulses will cause pain in the heart. If
the pulse rises like a turbulent flow gushing out from a spring, the disease is
rapidly advancing and it should show up in a sickly countenance. If the pulse
declines gradually, like a lax bowstring losing its tautness, this means
impending death.
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Explanatory Notes
This is the fourth excerpt from Suwen Chapter 17. It is a short paragraph
describing the six common abnormal pulse patterns, viz. long, short (peak
time), strong, weak (referring to amplitude), intermittent and hesitant
(arrhythmia). Taking into account the nuances of the descriptive language,
“long” and “short” correspond to “slow” and “quick” because a longer peak
time means a slower pulse rate. By the same token, “strong”and “weak” corre-
spond to “floating” and “sinking” because a strong pulse (large amplitude) is
easy to detect, hence “floating”. A hesitant pulse is the same as intermittent
pulse, which is the reverse of the smooth pulse, but an intermittent pulse has
in addition irregular missed beats. As if doing justice to these six basic pulse
patterns, Lingshu Chapter 4: Pathological Manifestation of Evil Qi in Visceral
Organs (邪氣藏府病形) gives a detailed description of the six basic pulse
patterns. This long paragraph may be simplified in a tabular form as follows:
Zang- Pulse Pathological Manifestations

Organ Condition Exceedingly Slightly
Heart Quick clonic convulsion of limbs heart pain radiated to the
back, dysphagia
Moderate laughing deliriously cardiac oedema,
haematemesis
Strong sensation of obstruction in numbness of heart radiated
throat to the back, tears
Weak belching, retching diabetes mellitus
Smooth polydipsia ischaemic pain in heart
radiating to the navel
Hesitant aphonia haemorrhage
Lung Quick epilepsy listless, coughing,
haematemesis
Moderate hyperhidrosis fistula, profuse sweating all
over body
Strong oedema with swollen shins dermal neuritis at the back,
photophobia
Weak diarrhoea diabetes mellitus
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Smooth lung congestion, asthmatic bleeding in upper and lower

breathing orifices
Hesitant haematemensis fistula at neck/armpit, weak
legs
Liver Quick abrasive language liver aggregation
(behaviour)
Moderate nausea hydrops under chest, dysuria
Strong ulcer, haemoptysis cirrhotic liver, retraction of
testicles
Weak polydipsia diabetes mellitus
Smooth hernia enuresis
Hesitant polydipsia with oedematous cramping, retraction of
limbs tendons
Spleen Quick clonic convulsion of limbs regurgitating food then
foaming at mouth
Moderate atrophic debility and cold paralytic limbs but alert
limbs mind
Strong loss of consciousness abdominal mass, internal
bleeding
Weak chills and tremor diabetes mellitus
Smooth swollen testicles and dysuria internal parasites
Hesitant intestinal ulcer internal ulcer leading to pus
in faeces
Kidney Quick deep-seated mania heavy legs, panting, anuria,
constipation
Moderate pain in back like broken diarrhoea passing undigested
spine food
Strong impotence ascites, incurable until death
Weak torrential diarrhoea diabetes mellitus
Smooth swollen testicles and dysuria bone atrophy, postural
hypotension
Hesitant ulcer amenorrhoea, intractable
haemorrhoids
Note: There is a certain inconsistency in the naming of the six common
abnormal pulse patterns, although in essence they mean the same. The
following table is a summary of the terms used:
Neijing.indb 101 2010/2/26 6:58:16 PM

Reference Amplitude Frequency Slope Tension

Suwen Ch. 20 大小遲疾熱（滑）— — 寒（緊）
Suwen Ch. 17 大細長短（數）（代）澀 — —
Lingshu Ch. 4 大小緩急滑澀 — —
Nanjing Q. 4 浮沉長短滑澀 — —
Zhang Zhong-jing 浮沉 — — 滑澀弦緊
Hua Shou/current 浮沉遲數滑澀 — —
Further to this paragraph, Huangdi asks Qibo how to treat these different
pulse patterns with acupuncture and Qibo gives a general outline of the char-
acteristic pulse pattern as follows:
“All quick pulse patterns are caused by coldness, moderate patterns by
fever, strong patterns are due to yangqi (qi, inotropic force) prevailing over
yinqi (consistency of the blood, blood volume), weak patterns are due to inad-
equacy of both qi and blood, smooth patterns are due to exuberant yangqi and
a low fever and hesitant patterns are due to weak yangqi (heart beat) and
diminished blood (volume) together with light chills.”
Qibo then suggests different ways of needle manipulation to redress the
abnormal pulse pattern.
Footnotes
[1] conduits: This statement leaves no doubt that Neijing recognised the blood
vessels. The fact that qi also flows in the blood vessels is actually a reference
to the pulsatile force of the heartbeat.
[2] upper part of the body: This statement is usually taken to mean the cun and
chi sites respectively, because they are upper (shang 上) and lower (xia 下)
with respect to the guan site in the middle. However, Tamba (Taki) Genkan
(1755–1810) struck a point. The differentiation into the three sites only
occurs in Nanjing, which served to explain Neijing, and it is therefore unfair
to use a later view and imposed it upon a previous statement. According to
Tamba, “upper” and “lower” simply refer to a pulse taken at the upper part
(neck) and the lower part (foot) according to the classic “three regions and
nine sites” mode of pulse-taking. However, in Section 4.1 of this chapter, the
three separate sites were implied, though not named (ibid. 4-1-2). It is
understandable that both modes of pulse-taking (i.e. “ three regions” versus
“cunkou only”) might coexist for some time before “cunkou only” was finally
Neijing.indb 102 2010/2/26 6:58:17 PM

adopted as the sole method and the three sites were named. So it is possible
that both modes are described in the same chapter. After all, it was Wang
Bing who rearranged the chapters into their present form; these two para-
graphs (4.1 and 4.9) may have come from two different sources.
[Section 4.10] Suwen Chapter 48: On Some Severe Rare

Diseases
《素問．大奇論》曰：脈至浮合，浮合如數，一息十至以上，是經氣予不足
也。微見九、十日死。
脈至如火薪然（燃），是心精之予奪也。草乾而死。
脈至如散葉，是肝氣予虛也，木葉落而死。
脈至如省客─省客者，脈塞而鼓，是腎氣予不足也，懸去棗華而死。
脈至如泥丸，是胃精予不足也，榆莢落而死。
脈至如橫格，是膽（氣）予不足也，禾熟而死。
脈至如弦縷，是胞精予不足也，病善言，下霜而死；不言，可治。
脈至如交漆─交漆者，左右傍至也，微見三十日死。
脈至如涌泉，浮鼓肌中，太陽氣予不足也，少氣，味韭英而死。
脈至如頹土之狀，按之不得，是肌氣予不足也，五色先見黑，白虆發
死。
脈至如懸雍─懸雍者，浮揣切之益大，是十二俞之予不足也，水凝
而死。
脈至如偃刀─偃刀者，浮之小急，按之堅大急，五藏菀熱，寒熱獨
並於腎也。如此其人不得坐，立春而死。
脈至如丸滑不直手 ─不直手者，按之不可得也，是大腸氣予不足
也，棗葉生而死。
脈至如華者，令人善恐，不欲坐卧，行立常聽，是小腸氣予不足也，
季秋而死。
The pulses are readily detectable under the skin surface without a discernible
pattern; they are now and then clustered or dispersed. This kind of floating
and irregular pattern looks like a quick pulse pattern, with ten beats in
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one breath; in fact it is not. The reason behind this particular pulse pattern
is that the qi [force] driving the pulse in the conduits has been insufficient
[1] for some time. Nine to ten days after its first appearance, the patient will
die.
The pulses are like blazing firewood, [fierce but short-lived]. This is
because the essence of the heart is already depleted. The patient will die when
the grass is dry [in late autumn].
The pulses are scattered like falling leaves. This is because the liver has
been malfunctioning for some time. The patient will die when the leaves fall
from the trees.
The pulses are irregular like a random visitor. This means the pulse is
momentarily undetectable but it suddenly reappears. This is because
the kidney has been malfunctioning for some time. The patient will die at
the time when the jujube flowers are blooming and dropping [in early
summer].
The pulses are like clay slugs [short and round but not smooth]. This is
because the essence of the stomach has been inadequate for some time. The
patient will die when elm pods fall to the ground [in late spring].
The pulses are like a solid rung of a ladder [long and hard that leads to
nowhere]. This is because the gallbladder has been malfunctioning for some
time. The patient will die when the rice crop [2] is ripe [in autumn].
The pulses are thin and taut like a bow string or musical cord. This is
because the essence of the pericardium has been malfunctioning for some
time. In this case, a loquacious patient will die when frost deposits [on
ground] while a taciturn patient may survive [with appropriate treatment].
The pulses are large but indistinct like lacquer sap [3] oozing out of
twisting gauze; they can be felt at both sides of the fingertip. Thirty days from
their first appearance, the patient will die.
The pulses are felt like water gushing incessantly out of a spring; it
rebounds at the body’s surface. This is because the urinary bladder [4] has not
been working well for some time. There is also shortness of breath. The
patient will die when the scent of chive flowers appears in the air.
The pulses feel like crumbled soil; they are not detectable upon pressing
[the wrist]. This is because the muscles [5] have been wasted for some time. If
the healthy countenance gives way to a dark colour first, the patient will die
when the white (downy) vine [6] sprouts [in spring].
The pulses have the consistency of the uvula [7]. This means that when
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taking the pulse in the floating mode [8], the pulses seem even stronger [but it
is actually not so]. This is because all the twelve regular conduits [9] have had
insufficient qi in circulation for some time. The patient will die when water
begins to freeze [in winter].
The pulses feel like touching [the sharp edge of] a knife lying on its back.
They are sensitive to the touch; upon pressing [the wrist], they feel hard and
quick [10]. The five zang-organs are congested with heat because both the cold
and hot evil qi are afflicting the kidney. Such a patient finds it difficult to sit
up and will die by the time spring commences (ibid. 1-3-1).
The pulses feel like rolling marbles that are hard to keep under the
fingertip. This means that the pulses are elusive and hard to define. This is
because the large intestine has been malfunctioning for some time. The
patient will die when the leaves of the jujube tree are spreading [in early
summer].
If the pulses are light like flowers, the patient is always in fear of some-
thing and cannot sit still or lie quiet. Even when walking, the patient often
freezes in his movement in order to catch an imaginary voice. This is because
the small intestine has been malfunctioning for some time. The patient will
die in autumn.
Explanatory Notes
Suwen Chapter 48, entitled On Some Severe Rare Diseases (Da Qi Lun 大奇論)
is the sequel to Chapter 47: On Some Rare Diseases (Qi Bing Lun 奇病論). The
latter describes diseases like nutritional dropsy (fuliang 伏梁, swelling of the
lower limbs with pain around the navel) and diabetes mellitus (xiaoke 消渴,
literally “polydipsia and emaciation”). Chapter 48 describes some particular
cases such as hemiplegia and hernia. But the main part of this short chapter
deals with the pulse patterns of some moribund situations due to organ
failure. The six common abnormal pulse patterns can be expanded to describe
a total of 28 commonly occurring abnormal pulse patterns with discernable
characteristics. In addition to these, there are ten “queer” or “death pulse”
patterns that are rare but readily distinguishable; they announce imminent
death. This excerpt does not discuss any of these pulse patterns. It focuses
rather on a special feature of the pulse pattern associated with the failure of a
particular organ and visualises it vividly as a social or natural phenomenon.
Chronobiology, the study of cyclic and seasonal natural phenomena,
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(wuhou 物候) is deeply ingrained in Chinese culture.5 Many Chinese literary

expressions can testify to this, for instance “a falling leaf announces autumn”
(yiye zhiqiu 一葉知秋). In the context of medical practice, this predicts the
time of death, as described in this section. There are many examples of
chronobiology in Neijing that describe the diurnal rhythm (Lingshu Chapter
44: Shunqi yire fen sishi 順氣一日分四時 (Diurnal Variation of Diseases), the
mensual rhythm (Suwen Chapter 28: Bazheng shenming lun 八正神明論 (An
Overall View on Diseases of Excess and Deficiency), and the annual rhythm
(Suwen Chapter 22: Zangqi fashi lun 藏氣法時論 (On Seasonal Changes of
Visceral Organ Functions). The influence of these time cycles on disease
development was well documented. Perhaps the most common quotation in
this respect concerns diurnal rhythm: “[A disease] is fine in the morning,
stable during the day, turns bad in the evening and worsens into the night.”6
This progression is heavily influenced by the rise and fall in levels of regula-
tory molecules (autacoids) in the blood. For example, cortisol rises to its
highest level in the pre-dawn hours. In due consideration of these diurnal
changes, it is accepted that medication should change accordingly while
treating a disease. In Chinese medicine, the timing of drug administration is
more binding than simply taking pills in the morning or evening, or before or
after meals. Qin Bo-wei (ref. 2) quotes some clinical examples to illustrate this
point.
In the third quotation, the annual rhythm was superimposed on the
diurnal rhythm.
Footnotes
[1] conduit is insufficient: This is taken to imply organ failure; it employs the
terms qi 氣 or jing 精 (“essence”), or none at all to qualify the malfunction
of the visceral organ. In each case, these substances or functions have been
either depleted or insufficient for some time.
[2] rice crop: The Chinese word he 禾 is usually translated as “rice plant”. But
there is more than one word for rice in the Chinese language, e.g. dao 稻 (“rice
crop”), gu 穀 (“rice grain”), mi 米 (“decorticated rice grain”) and fan 飯
(“cooked rice”). By the same token, several cereal plants resembling rice are
5
A typical example is found in Shijing where the month of the year was dated by
representative agricultural events, i.e.《詩．豳風．七月》.
6
Lingshu Chapter 44: 旦慧、晝安、夕加、夜甚 (“dan hui, zhou an, xi jia, ye shen.”)
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also called “he”, e.g. millet (shu 黍, su 粟). But taller plant crops like maize
and sorghum cannot be called he. The rice crop is basically grown in the
south, requiring flooded fields. But in the time of Neijing, there were small
areas with a mild climate as far north as Qinling 秦嶺 that could grow rice.
That was the epicentre of Chinese culture at the time of Neijing.
[3] lacquer: The lacquer plant (qishu 漆樹, Rhus verniciflua) was widely culti-
vated in China. Zhuangzi 莊子 was superintendent of a lacquer tree planta-
tion (qiyuan li 漆園吏, qi 漆, lacquer, originally qi 桼, the lacquer tree). Sap
was harvested from incisions made in the tree trunk, in the same way that
rubber is collected. The sap is viscous and turns black upon exposure to air,
hence the term for “jetblack” is qihei 漆黑 in Chinese. The crude sap contains
a group of phenolic compounds that tend to polymerise, and thus to thicken.
Filtered through gauze to remove the debris, the partially polymerised sap
oozes out in thick streams. This is what the text describes. Lacquer played an
important role in the making of various utensils in ancient times, very much
like plastic today. Its use was a notable feature of Chu 楚 culture.
[4] urinary bladder: The text mentions tai-yang qi 太陽氣 (or qi flowing in the
tai-yang conduit). There are two tai-yang conduits, viz. the cheirogenic tai-
yang small intestine conduit, which runs into the podotelic tai-yang urinary
bladder conduit. According to the symptoms described, Li Zhong-zi assigned
this to the urinary conduit.
[5] muscles: The text mentions ji qi 肌氣 (“qi supporting the muscles”). Because
the spleen nourishes the muscles, this is assigned to the podogenic tai-yin
spleenic conduit.
[6] white vine: The text mentions a white vine (bailei 白虆, “white hanging
plants”). The white colour may refer to the downy young shoots of Pueraria
hirsuita (P. lobata), which was a popular plant source of fibre and starch and
a long-standing item in the herbal pharmacy at the time of Neijing. A multi-
purpose economic and medicinal plant called ge 葛, it has been extensively
cultivated in China and other Asian countries since antiquity. It is also
known by the Japanese name of kudzu, meaning “wild ge”. There are several
references to ge and the use of its fibre in Shijing.7
[7] uvula: The Chinese term xuanyong 懸雍 refers to the uvula, the “little
tongue” which hangs down at the back of the oral cavity. An extension and
7
《詩》︰〈王風．葛藟〉，〈王風．采葛〉，〈魏風．葛屨〉，〈唐風．葛生〉。
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free-hanging flap of the soft palate, it can retract when touched. Perhaps this
is the image used to visualise this pulse pattern; it looks large but shrinks to
nothing when touched.
[8] floating mode: In the new version of “three regions and nine sites”, the three
regions (the upper, middle and lower parts of the body) become the three
sites, viz. cun, guan and chi. At each site, the pulse is taken with a light touch
(fuqu 浮取, “floating mode”), a hard press (chenqu 沉取, “sinking mode”)
and mid-way in-between these two, searching for the pulse with medium
pressure, the medium mode (zhongqu 中取).
[9] twelve regular conduits: The text mentions “shi-er shu” 十二俞 ( “twelve shu
acupoints”). Shu 俞 is a homonym of shu 輸 (“transmit, transport, deliver,
drain”) and when it refers to an acupoint (shuxue 俞穴), it is written 腧.
There are five kinds of special acupoints (wu shuxue 五輸穴) in each of the
twelve regular conduits, viz. jing 井 (well), ying 滎 (brooklet), shu 俞
(draining into), jing 經 (flux, “course of flow”) and he 合 (confluence). One
can readily glean from these approximate translations that they are referring
to the momentum of flow of the qi passing through these acupoints, which
are located on the limbs distal to the elbows and knees. Since there is only
one representative shuxue 輸穴 in each of the twelve regular conduits, which
in turn governs one particular visceral zang- or fu-organ, “shi-er shu” 十二俞
is taken to mean the twelve regular conduits. If all regular conduits have
insufficient qi, i.e. all the visceral organs are failing, the patient could not
possibly survive a harsh winter (when water freezes). For clear discussions of
this subject, see Lu and Needham (ref. 50, pp. 62–63) and Sun Wai-zhu (2004,
pp. 102–103, ibid. 4-4).
[10] hard and quick: The original text used the term “quick” (ji 急, “quick,
urgent”) to describe the feeling of touching a sharp edge. Touching lightly,
the fingers recoil quickly (xiao ji 小急). When pressed hard and starting to
hurt, the fingers recoil brusquely (da ji 大急). So the quickness is a reference
to the rapidity of withdrawing the fingers, not the pulse rate. For a knife
lying on its back, the Chinese word yan 偃 is appropriate. Yan means “to
stop, to quieten, to lie down, particularly face upwards”. Confucius said: “The
virtue of a gentleman is like the wind. The virtue of a commoner is like the
grass. When wind blows over grass, it bends to the ground.”8 This means that
a virtuous lord needs to set an example himself and his subjects will follow.
8
《論語．顏淵》
：「草，上之風，必偃。」
（ The Analects of Confucius, 21:19 ）.
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[Section 4.11] Suwen Chapter 20: On the Different Sites of

Pulse-taking
《素問．三部九候論》曰：形盛脈細、少氣不足息者，死；形瘦脈大、胸中
多氣者，死；形氣相得者，生；參伍不調者，病；三部九候皆相失者，
死；形肉已脫，九候雖調，猶死；七診雖見，九候皆從者，不死。
When the body is strong but the pulse is feeble and the patient feels short of
breath, death is certain. When the body is thin but the pulse is strong and the
patient feels plenty of qi [congested] inside the chest, death is certain. When
the physique agrees with the [plenitude of] qi, the patient will live. On the
contrary, if the physique does not agree with the [plenitude of] qi, the patient
is sick. When all the nine signals from the three sites (of pulse-taking) are in
total disagreement, death is certain. Even when the nine signals are agreeable
if the physique has deteriorated and the muscles are emaciated [1], death is
still unavoidable. When the seven unique pulse patterns [2] (ibid. 4-4-1) are
evident but the nine signals are in agreement, the patient will live.
Explanatory Notes
Pulse-taking is no doubt the most sophisticated method of diagnosis in
Chinese medicine, but Neijing never fails to emphasise the importance of
considering it alongside other diagnostic methods. There are many passages in
Neijing where integration of the four diagnostic methods (si zhen he can 四診
合參) is repeatedly expounded. The signals from the different diagnostic
methods should agree with each other “like beating a drum with a drumstick”
(fu gu xiang ying 桴鼓相應, i.e. a reliable causal effect) (Lingshu Chapter 4). If
the other symptoms agree with the pulse pattern, the prognosis is favourable
(shun 順, “smooth, going along with the grain or current”). If not, it is unfa-
vourable (ni 逆 , “going against the grain or current”). This integrative
approach is extended to cover disease management where other environ-
mental and social factors are considered (Suwen Chapter 77). Without
digressing to a discussion of integrative diagnostic methods, it is sufficient to
learn from this chapter, that it is the agreement, or otherwise, between the
physique (xing 形, “body form, constitution”) and qi 氣 (“heart performance”)
that determines the prognosis. Even in pulse-taking, all the signals from
different sites should corroborate each other (see Section 4.4). Today, there are
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many indiscreet clinicians who go straight to pulse-taking (zu chi cun kou 卒
持寸口. See Section 4.14, below). There are also demanding patients who bare
their wrists for pulse-taking without uttering a word, so as to test whether the
clinician can pick up the symptoms. All these moves are counter-productive
and against the teaching of Neijing.
Footnotes
[1] muscles emaciated: When the muscles are emaciated, it is a sign that the
spleen is no longer functioning. Without nourishment, the patient will not
live. Normal functioning of the spleen is the basis of a normal pulse pattern
full of weiqi (stomach qi).
[2] unique pulse pattern: This refers to the seven singular pulse patterns
described in Section 4.4. Besides seeking an agreement between the signals
from all four diagnostic methods, even the signals from different sites of
pulse-taking must agree with each other. If a signal from one of these sites,
which indicates its visceral organ affiliation, is particularly strong, weak etc.,
this organ is probably malfunctioning.
[Section 4.12] Suwen Chapter 7: On Yin and Yang Types of

Disease
《素問．陰陽別論》曰：凡持真藏之脈者，肝至懸絕急，十八日死；心至懸
絕，九日死；肺至懸絕，十二日死；腎至懸絕，七日死；脾至懸絕，四日
死。
Whenever reading the genuine pulse pattern of the visceral organs [1], if the
pulse of the liver is taut, like a weight-bearing string near its breaking point [2],
the patient will die in 18 days. By the same token, for the heart pulse, 9 days;
the lung pulse, 12 days; the kidney pulse, 7 days and the spleen pulse, 4 days.
Explanatory Notes
This section echoes the previous section on the prognostic significance of
moribund pulse patterns. The spleen and stomach system supplies the energy
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for a normal heart beat, so the stomach qi (weiqi) is the dominant feature of
all pulse patterns (Section 4.8, above). The information generated by a pulse
(mai 脉) can be separated into two components, viz. the yang mai, which is
the relative abundance of stomach qi (amplitude, regularity) and the yin mai
(the genuine organ-specific pulse devoid of stomach qi). This chapter
discusses the relative abundance of the yang versus the yin component, and
the correlation to different types of diseases. Depending on how the yang mai
is modulated by the yin mai, the clinician will be able to tell where the disease
lies (in what visceral organ). By reading the yin mai in the absence of yang
mai, the clinician will be able to predict the time of impending death. This is
the essence of this section quoted by Li Zhong-zi, who explained the number
of days as the result of permutations of the five elements. Without going into
detail, suffice it to note that when the numbers of days are arranged in an
increasing order, they fall into an inhibitory (suppressive) relationship (xiangke
相剋), viz. 4 (spleen—earth) → 7 (kidney—water) → 9 (heart—fire) → 12
(lung—metal) → 18 (liver—wood).
Footnotes
[1] genuine pulse pattern of the visceral organs: The text uses the clumsy term
“the genuine pulse of the visceral organ(-specific) pulse” (zhen mai zhi zang
mai 真脉之臟脉), which is in fact the genuine (organ-specific) pulse (zhen
zang mai 真臟脉), or in other words, the moribund pulse (si mai 死脉).
“When the genuine pulse is showing up, death is inevitable” (zhen zang mai
jian, si bu zhi 真臟脉見，死不治). This is a quotation from Suwen Chapter
19: On a Comparison between Normal Pulse Patterns and Critical/Moribund
Pulse Patterns, of which a long passage was quoted in Section 4.7.
[2] breaking point: This is a vivid description of impending systolic arrest.
《素問．平人氣象論》
：婦人手少陰脈動甚者，任子也。
When the cheirotelic shao-yin cardiac conduit is very active [1] in a woman,
she is pregnant.
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Suwen Chapter 7: On Yin and Yang Types of Disease
〈又〉
《陰陽別論》曰：陰搏陽別，謂之有子。
[In women] when the yin mai [2] [at the chi site] shows a strong pulse that is
different from the yang mai [2] [at the cun site], this indicates pregnancy.
Explanatory Notes
This is a very special statement indicating that pulse diagnosis had been used
for early detection of pregnancy since the times of Neijing. Since then all expe-
rienced clinicians claim that they can detect pregnancy before the first missed
period, some can even tell the sex of the foetus (by timing the first appearance
of the smooth pulse pattern). Anecdotal examples are many, but unfortunately
no data from controlled trials are available. It is generally agreed that a strong
and smooth pulse is indicative of pregnancy, if the patient is otherwise healthy
and the clinician is familiar with her usual pulse pattern from previous visits.
This is explained clearly in Suwen Chapter 40: On Abdominal Diseases.
Huangdi asks Qibo: “How can one tell when a pregnant woman is near term?”
Qibo replies: “There are signs of sickness [abnormal physiology, obviously
amenorrhoea] but no evil [pathological] pulse pattern.” Today, we know that
as soon as implantation takes place, the chorionic villi of the budding placenta
are already producing chorionic gonadotrophin. This powerful hormone
supports the development of the corpus luteum that suppresses the
on-coming period, and at the same time, together with other placental
hormones, stimulates a series of physiological activities ready for gestation.
This elevated level of activity is the basis of a strong and smooth pulse.
The short paragraph from Suwen Chapter 7 (quoted in Section 4.12) was
lumped together in Section 4.13 as a special topic on detection of pregnancy.
While the passage from Suwen Chapter 18 regards the pulse pattern of preg-
nancy as a variation of a normal pulse pattern, the passage from Chapter 7
regards the disagreement between yin mai and yang mai as a sign of sickness,
unless it is due to pregnancy. The quotation from Suwen Chapter 18 appears
verbatim in Lingshu Chapter 74.
Footnotes
[1] cardiac conduit very active: The text says simply “very active”, but all later
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interpretations have considered this heightened activity to be strong and

smooth-flowing pulses. This is the combined result of an increase in blood
volume and heartbeat under the effect of placental hormones. There is no
doubt that the cardiac conduit is the brachial artery.
[2] yin mai and yang mai: The fact that the idea of yin-yang is only relative is
absolutely true. Any two things or events put together will reveal which one
is relatively more yin or yang than the other: left is yang, for example, and
right is yin. In pulse-taking, the chi site is yin as compared to the cun site
which is regarded as yang. If the chi site is much stronger than the cun site, it
means the kidney is particularly active. In Chinese medicine, the kidney
system produces regulatory molecules like adrenalin, corticosteroids and
renin (which in turn leads to the production of angiotensin) that are
cardiotonic.
Yin-yang categorisation can also apply to pulse patterns. A floating pulse
is yang while a sinking pulse is yin. When the chi pulse is strong only when
reading at the sinking mode, as compared to an easily detectable cun pulse
(meaning the kidney is active), this is not normal except in pregnancy.
In his concluding remarks on this chapter, Li Zhong-zi further qualified
the yin-yang component of a pulse. He quotes Hua Shou 滑壽 (1304–1386)
an expert on sphygmology, who said: “There are six words to describe a pulse
in the context of yin-yang. They are upper (shang 上), coming (lai 來) and
arriving (zhi 至); these are yang qualities. On the contrary, lower (xia 下),
leaving (qu 去) and arresting (zhi 止) are yin qualities.” “Upper”(shang)
means the pulse felt at the cun site when the chi site is compressed; it is a
measure of the systolic pressure (yang) that can go beyond the compressed
point (yin) (yang sheng yu yin 陽生於陰). “Lower” (xia) means the pulse felt
at the chi site (yang) when the cun site is compressed (yin); it is a measure of
the diastolic pressure (yin) that remains when the pulse cannot propel
forward (yin sheng yu yang 陰生於陽). “Coming” (lai) means the pulse is
rising from the depth of the bones and muscles, i.e. the rising slope of the
pulse curve, with pressure increasing. “Leaving” (qu) means the pulse is
returning to the depth of the bones and muscles, i.e. the sinking slope of the
pulse curve, with pressure decreasing. “Arriving” (zhi) is the moment the
peak force bounces off the fingertip. “Arresting” (zhi) is the refractory period
between two pulses. Hence an expert clinician can read the pulse like an
oscilloscope, taking into consideration all the phases of a pulse and its rela-
tion to each other in the rise and fall of a pulse. If people think that pulse-
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taking is mystified beyond credibility, it is because they are ignorant of these

nuances in sphygmology.
[Section 4.14] Suwen Chapter 78: On Four Kinds of

Malpractice
《素問．徵四失論》曰：診病不問其始、憂患飲食之失節、起居之過度、或
傷於毒，不先言此，卒持寸口，何病能中？！妄言作名，為粗所窮。
During a consultation, if the clinician does not enquire a priori about the
history of the disease, what worries the patient, his/her food habits, any excess
in his/her life style, or whether he/she has been exposed to toxic [harmful]
elements, but instead goes straight to take the pulse at the wrist, how can the
clinician arrive at a correct diagnosis? Furthermore, the clinician may make
matters worse by inventing a disease that does not exist; this malpractice will
have a long-lasting deleterious effect on the patient.
Explanatory Notes
Volume 23 of Neijing contains four chapters on medical ethics. Unlike most
chapters, where Huangdi humbly asks Qibo to enlighten him, these chapters
are records of Huangdi admonishing Leigong 雷公 (the minister of health
who specialised in drugs) on matters of medical ethics. Chapters 75 and 76
describe how Huangdi tells Leigong that he should learn the profession seri-
ously and treat it with the utmost respect. Chapters 77 and 78 deal with “the
five misconducts and four malpractices” (wu guo si de 五過四德, literally “five
faults and four missed virtues”). The five faults, or misconducts, are actually
oversights that lead to wrong diagnosis or prognosis. The four malpractices
(lack of virtue) are more serious misconduct by a clinician who does not
observe the established rules of the profession.
According to the four conventional diagnostic methods, the clinician
undertakes inspection and olfaction and/or auscultation on his/her own initi-
ative. This is followed by interrogation that requires the participation of the
patient. This can provide answers to what the clinician has observed. Diag-
nosis by pulse-taking comes last, only to confirm or to modify the information
derived from the three previous steps. Zhang Jie-bin, expert clinician and
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great authority on Neijing, composed a mnemonic verse in rhyme on the

protocol of interrogation. Later, Chen Xiu-yuan 陳修園 (ca. 1753–1823) elab-
orated on the original version and it became known as the “Song of Ten
Questions” (shi wen ge 十問歌) (ref. 53, p. 210). No matter how comprehen-
sive the diagnosis procedure may become, it is ultimately patient-oriented.
Suwen Chapter 80: On the Normal Practice of Diagnosis ends with a fair piece
of advice: “Diagnosis can be all-inclusive, but it must bear a relationship to the
personal particulars of the patient.”9
With the importance of pulse-taking having now been explained, this is a
fitting end to an important chapter on the subject that puts diagnosis by
pulse-taking in its proper perspective. To put it briefly, it is useful—but only
as part of an integrative diagnostic protocol.
9
《素問．方盛衰論》
：「診可十全，不失人情。」(zhen ke shi quan, bu shi ren
qing).
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Huangdi Neijing

Published by The Chinese University of Hong Kong Press

For additional information about this book

Diagnosis by pulse-taking is one of the four principal methods of diag-

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hesitant) further subdivide into 28 recognizable patterns and an infinite

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Whilst pulse-taking is a unique method of diagnosis in Chinese medi-

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7. Prognosis based on the discordance between pulse dynamics

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[Section 4.1] Suwen Chapter 17: On the Finer Points of

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Sub-site Right SITE Left

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and even Li Zhong-zi had contributed minor variations. In current practice,

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yingqi 營 氣 (nourishing qi) and that of weiqi 衛 氣 (defensive qi), each

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[Section 4.2] Suwen Chapter 18: On Normal Pulse Patterns

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medicine was first established on an institutional basis among the populace,

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spasmodic diseases such as epilepsy (yangxian feng 羊 癇 瘋／風). Very often,

[Section 4.3] Lingshu Chapter 5: Source and Terminal Points

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fewer beats than usual, this indicates a moribund state.

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[Section 4.4] Suwen Chapter 20: On the Different Sites of

Region/site Conduit/location Indicated organ/

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[Section 4.5] Suwen Chapter 80: On the Normal Practice of

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[Section 4.6] Suwen Chapter 17: On the Finer Points of

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concerns the differentiation of colour in visual inspection. The second excerpt

[1] gentleman: The Chinese term is junzi 君 子. It is first mentioned in [ibid.

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[Section 4.7] Suwen Chapter 19: On a Comparison between

秋 脈 者，肺 也。西 方，金 也，萬 物 之 所 以 收 成 也。故 其 氣 來 輕 虛 以

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The pulse pattern prevalent in summer is under the influence of the

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[Section 4.8] Suwen Chapter 18: On Normal Pulse Patterns

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[Section 4.9] Suwen Chapter 17: On the Finer Points of

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Zang- Pulse Pathological Manifestations

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Smooth lung congestion, asthmatic bleeding in upper and lower

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Reference Amplitude Frequency Slope Tension

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[Section 4.10] Suwen Chapter 48: On Some Severe Rare

yingqi 營氣 (nourishing qi) and that of weiqi 衛氣 (defensive qi), each

spasmodic diseases such as epilepsy (yangxian feng 羊癇瘋／風). Very often,

[1] gentleman: The Chinese term is junzi 君子. It is first mentioned in [ibid.

秋脈者，肺也。西方，金也，萬物之所以收成也。故其氣來輕虛以

(wuhou 物候) is deeply ingrained in Chinese culture.5 Many Chinese literary