The Yellow Emperor’s Inquiry: The Art of Pulse Diagnosis

The Yellow Emperor asked: “What is the method for diagnosing pulses?”

Qi Bo responded: “The best time to diagnose pulses is early in the morning when the person hasn’t yet engaged in daily activities. At this time, Yin energy has not been disturbed, Yang energy has not yet dispersed, no food has been consumed, and the energy in the meridians is still balanced and undisturbed, allowing for an accurate assessment of the pulse. While examining the pulse’s movement, one should also observe the eyes’ brightness to gauge the spirit, and examine the five colors to assess the organs’ strength and weakness, combining these observations to judge the prognosis.”

The pulse is where the blood gathers. A long pulse indicates smooth and harmonious Qi and blood, thus representing healthy Qi; a short pulse indicates insufficient Qi, thus a Qi deficiency; a rapid pulse indicates heat, which causes restlessness; a large pulse indicates an ongoing pathogenic development; a strong upper pulse shows obstruction above, leading to rapid breathing and fullness; a strong lower pulse indicates stagnation below, causing fullness and distension; an intermittent pulse indicates weakened vitality; a thin pulse indicates diminished true Qi; a rough pulse indicates less blood and Qi stagnation, often associated with heart pain. A large and rapid pulse like gushing water indicates a progressing and dangerous condition; an indistinct and weak pulse, or one that breaks like a snapped bowstring, signifies depleted Qi and blood and imminent death.”

The eyes’ brightness and the face’s colors reflect the internal organs’ essence. Red should be like silk wrapped in cinnabar, radiant yet not exposed, unlike dull reddish-purple hematite. White should be like bright goose feathers, not grayish like salt. Green should be like lustrous jade, not dull blue. Yellow should be like silk wrapped in realgar, bright and vibrant, not like dull yellow earth. Black should be like rich lacquer, glossy, not like dark dust. If the organs’ true colors are exposed externally, it indicates a depletion of vital energy, shortening one’s lifespan. The eyes’ brightness allows for the observation of things, the distinction between black and white, and the judgment of length and shortness; if these abilities fail, it indicates a depletion of essence.”

Each of the five organs holds the spirit and has its duties within. If pathogenic Qi is abundant in the abdomen, causing fullness, it leads to breathlessness and fear. Speaking becomes heavy and unclear, as if speaking from within a room, indicating a loss of central Qi due to dampness. Weak and discontinuous speech reflects robbed true Qi. Inability to cover oneself properly, inability to discern good from evil, and inability to distinguish relationships signify a confused spirit. Uncontrolled leakage of water and food from the stomach is due to a loss of central Qi control over the anus. Uncontrolled urination is due to the bladder’s inability to store fluids. Healthy organ function means life; failure to secure the organs’ essence means death. Adequate essence in the organs is the foundation of strong health.”

Qi Bo said: “Pulse Qi opposes the seasonal Yin and Yang Qi: when opposing forms show excess, it indicates pathogenic Qi overpowering healthy Qi; when showing deficiency, it indicates diminished blood and Qi. Seasonal changes should align with excess organ Qi and corresponding pulse Qi; if instead showing deficiency, it indicates pathogenic Qi prevailing over healthy Qi. Misalignment between Yin and Yang, and mismatched Qi and blood flow, result in diseases known as ‘Guan Ge.’

The Yellow Emperor asked: “How do pulse patterns respond to seasonal changes? How can one determine the illness’s location, progression, and sudden onset internally or externally through pulse diagnosis? Can you explain these five questions?”

Qi Bo replied: “Let me explain the body’s Yin and Yang ascent and descent in harmony with the celestial cycles. All things outside the six directions and within the universe follow the seasonal changes of Yin and Yang. Warm spring evolves into hot summer, autumn’s brisk energy into winter’s cold, and the human pulse follows these seasonal ups and downs. Spring pulses are round like a compass; summer pulses are square like a carpenter’s square; autumn pulses are balanced like scales; winter pulses are weighted like a balance weight. Seasonal Yin and Yang shifts have specific times and patterns: during the 45 days from winter solstice to spring, Yang rises slightly, Yin descends slightly; during the 45 days from summer solstice to autumn, Yin rises slightly, Yang descends slightly. Pulses aligning with these patterns indicate health; misalignment indicates disease. Abnormal pulse variations reveal which organ is affected, and understanding the organ’s state and seasonal peak allows prediction of disease and death timelines. These subtle seasonal changes reflect in the pulse, so careful observation is essential.”

“Diagnosing pulses begins with distinguishing Yin and Yang, analyzing the twelve meridians according to the five elements and their regenerative cycle. Observing the regenerative cycle’s measure uses seasonal Yin and Yang as the standard. Following these changes ensures balance and unity with celestial Yin and Yang, understanding this harmony predicts life and death outcomes. Five sounds correspond with five tones, five colors with five elements, and pulse patterns with Yin and Yang.”

“Excessive Yin dreams of crossing vast waters with fear; excessive Yang dreams of burning fires; excessive Yin and Yang dreams of mutual destruction; upper excess dreams of flying, lower excess dreams of falling; overeating dreams of giving food to others, hunger dreams of receiving food; excessive liver Qi dreams of anger, excessive lung Qi dreams of sorrow; many short abdominal worms indicate dreams of crowds, many long worms indicate dreams of fighting.”

“Pulse diagnosis requires a calm mind and focused energy for accuracy. Spring pulses should be floating like fish swimming in water; summer pulses are large, floating, and ample like summer’s growth; autumn pulses are beneath the skin like hibernating insects; winter pulses are deep in the bones like hidden hibernating insects. Thus, the internal state is discernible through the pulse; the external meridian state is ascertainable through their paths. These six aspects – spring, summer, autumn, winter, internal, and external – constitute the grand method of pulse diagnosis.”

“The heart pulse, firm and long, indicates excessive heart Qi, leading to a rolled tongue and speechlessness; a soft, dispersed pulse indicates thirst and spontaneous recovery upon returning stomach Qi. A firm, long lung pulse, hitting the fingers, indicates lung fire causing blood in sputum; a soft, dispersed lung pulse indicates deficiency, causing continuous sweating and contraindicating dispersing treatments. A firm, long liver pulse, with a normal face color, suggests an external injury or blood stasis under the ribs, obstructing lung Qi and causing breathlessness; a soft, dispersed liver pulse with a bright complexion suggests overflow disease, excessive thirst, and water not transforming into Qi, easily infiltrating tissues and skin. A firm, long stomach pulse with a red face indicates thigh pain; a soft, dispersed pulse indicates insufficient stomach Qi, causing food stagnation. A firm, long spleen pulse with a yellow face indicates poor spleen Qi, causing shortness of breath; a soft, dispersed pulse indicates spleen deficiency, causing edema.”

“The kidney pulse, firm and long with a yellowish-red face, indicates excess heart and spleen Qi attacking the kidneys, causing severe back pain; a soft, dispersed pulse indicates deficient essence and blood, impairing health recovery.”

The Yellow Emperor asked: “What does a tense, rapid heart pulse indicate? What are its symptoms?”

Qi Bo replied: “This condition is called heart hernia, with signs in the lower abdomen.”

The Yellow Emperor asked: “What does a diseased stomach pulse indicate?”

Qi Bo answered: “An excessive stomach pulse shows Qi accumulation causing abdominal distension; a deficient stomach pulse indicates insufficient Qi causing diarrhea.”

The Yellow Emperor inquired about disease formation and development. Qi Bo explained: “Wind pathogens cause cold and heat diseases; persistent itching heat leads to wasting disease; upward rebelling Qi causes epilepsy; enduring liver wind damages the earth, causing chronic diarrhea; lodged wind in the vessels causes stubborn wind diseases; disease evolution is complex.”

The Yellow Emperor asked about abscesses, muscle spasms, and bone pain. Qi Bo attributed these to cold accumulation and wind invasions.

The Yellow Emperor asked about treatment. Qi Bo suggested treating seasonal excesses with five-element overcoming principles for recovery.”

The Yellow Emperor inquired about distinguishing old and new diseases from pulse and color changes. Qi Bo explained: “Small pulse with normal color indicates new disease; normal pulse with abnormal color or both abnormal indicates chronic disease; both normal indicates new disease. Sunken, wiry pulses with a blue-red face indicate blood stasis, with blocked meridians and swelling resembling dampness.”

Examining the inner sides of the forearms checks the flanks and kidneys, the middle for the abdomen. The inner side of the forearms checks the diaphragm and liver; the outer for the stomach and spleen. The upper section checks the lungs and heart; the inner for the pericardium.

Large pulses indicate deficient Yin and excess Yang, causing internal heat. Rapid, slow pulses indicate upper excess and lower deficiency, leading to convulsive diseases. Slow, rapid pulses indicate upper deficiency and lower excess, causing chronic wind diseases. Weak Yang fails to resist pathogens, causing disease. Sunken, thin rapid pulses indicate deficient Yin causing chronic feverish diseases. Floating, scattered pulses indicate dizziness and fainting.

Accurate pulse diagnosis requires correlating pulse patterns with Yin-Yang balance, assessing changes to predict disease locations and progression.