TCM Pulse Diagnosis: Emperor Huang’s Wisdom on Root & Branch Diseases

Emperor Huang sat calmly and summoned Lei Gong, asking, “You study medical arts, reciting texts and(extensively reading) various books. Can you draw analogies and integrate medical principles? Share your expertise with me. The five viscera, six bowels, gallbladder, stomach, large and small intestines, spleen, uterus, bladder, brain marrow, mucus, saliva, tears from weeping—all are governed by the five body fluids. These are essential for human survival and prone to errors in treatment. You must comprehend them thoroughly to ensure comprehensive healing when treating illnesses. Failure to do so leads to mistakes and public complaints.” Lei Gong replied, “I’ve memorized much of the ‘Pulse Classic’ , but I’m not fully adept at discerning differences, drawing analogies, or integrating principles. How can I claim complete understanding?”

Emperor Huang said, “Use theories beyond the ‘Pulse Classic’ to explain diseases of the five viscera, disharmonies of the six bowels, failures of acupuncture and stone therapy, appropriate use of toxic drugs, and aspects of decoctions and flavors. Describe symptoms in detail and answer thoroughly. If you’re uncertain, ask me.” Lei Gong said, “Liver deficiency, kidney deficiency, and spleen deficiency can all cause bodily heaviness and restlessness. After treating with toxic drugs, acupuncture, stone therapy, and decoctions, some recover while others don’t. How should this be explained?” Emperor Huang said, “You’re quite old—why such a naive question? My fault for prompting such a reply. I intended to ask about profound principles, but you cited the ‘Pulse Classic’. Why? The spleen pulse should be soft but is now floating and empty, resembling the lung pulse. The kidney pulse should be sinking but is now slightly floating, resembling the spleen pulse. The liver pulse should be taut but is now urgent, sinking, and scattered, resembling the kidney pulse. These are common diagnostic confusions, yet discernible with careful examination. The spleen, liver, and kidneys belong to earth, wood, and water, all located below the diaphragm. Even children know this—what’s the point of asking?”

Lei Gong said, “Here’s a patient with headache, muscle cramps, heavy joints, timidity, shortness of breath, belching, abdominal fullness, frequent fright, and inability to lie down. Which organ’s disease is this? The pulse is floating and taut, hard as stone upon pressure. I’m unsure how to interpret this, hence I ask about the three organs to learn how to classify and analyze.” Emperor Huang said, “Analyze calmly. Generally, elderly diseases stem from the six bowels; youth diseases from meridians; adults from viscera. You only discuss pulse symptoms, not causes like external wind-heat, internal organ decay, or sequential pathogen transmission, losing comprehensive understanding. A floating and taut pulse indicates kidney qi deficiency. A sinking, stone-hard pulse shows kidney qi stagnation. Timidity and shortness of breath result from impaired water pathways and dissipated vital energy. Coughing and restlessness are due to kidney qi reversal. This is a single person’s qi issue, the disease lies in the kidneys. Claiming all three organs are diseased contradicts diagnostic rules.”

Lei Gong asked, “Here’s a patient with limb weakness, wheezing cough, and bloody diarrhea. I diagnosed lung injury, found a floating, large, and tight pulse, and hesitated to treat. A reckless doctor used stone therapy, the disease improved, but bleeding was excessive. After stopping, the body felt light. What is this disease?” Emperor Huang said, “You’ve treated and known many diseases, but misdiagnosed this one. Medical principles are profound, like wild geese flying high but not reaching the sky’s edge. Sages treat diseases by following rules, drawing analogies, and grasping changes in the unknown. They observe the whole, not just the parts. Now, a floating, large, and empty pulse indicates spleen qi external depletion, leaving the stomach for the Yangming meridian. Since two fires can’t overcome three waters, the pulse is chaotic. Limb weakness is due to spleen essence failure. Wheezing cough is from water qi overwhelming the stomach. Bloody diarrhea results from urgent pulses disrupting blood flow. Diagnosing this as lung injury is a wild claim. Failing to draw analogies shows poor understanding. If lung qi is injured, spleen qi can’t (guard/retain) internally, causing stomach qi turbidity, meridian qi disfunction, lung damage disrupting regulation, and partial meridian blockage. All five viscera’s qi leak—no nosebleeds mean vomiting blood. Lung and spleen diseases are distinct. If you can’t differentiate, it’s like seeking form in the sky, order in the earth, or confusing black and white—too far off. This mistake is mine; I thought you knew, so I didn’t tell you. Diagnosis must draw analogies to align with the ‘Composed Chapter’ ( Composed Chapter), hence called the True Classic, the essence of truth.”