CHAPTER ONE

辨脈法

SH CH1

The right page top: Shang-han Lun Volume One

The second line: In the Han Dynasty, Zhang Zhong-jing followed the predecessors(shu)

[Shinjiro’s Explanatory Notes]

1) I broke the text into sections and numbered them following the Japanese standard text, the Nippon Kanpo Kyokai Edition.

2) The words in [] are Shinjiro’s notes, not in the original text.

3) The words in () are added by Shinjiro to facilitate comprehension in English.

4) The words in {} are notes in small characters in the original texts.
Shinjiro's Note
As Zhu Jie Shang-han Lun (Notes and Explanations on Shang-han Lun) by Cheng Wu-ji, 1144  Southern Song Dynasty omitted Chapter One and Two, the TCM and Kanpo versions Shang-han Lun, which based on the Cheng version, also omitted these chapters. It is obvious to me the pulse diagnosis in these chapters are the bases of the pulse diagnosis in the contents of Song Text Shang-han Lun. 

Song-ban Shang-han Lun Volume One

Zhong-jing Complete Books Volume One

 

Shang-han Lun Volume One:

[Credits]   

In the Han Dynasty, Zhang Zhong-jing followed the predecessors1.    

In the Jing Dynasty, Wan Shu-he Compiled.

In the Song Dynasty, Lin Yi Proofread.

In the Ming Dynasty, Zao Kai-mei Proofr

                     and published.

        Chen Lin also proofread.

  1. followed the predecessors (述 shu): The word "shu" means to state, to express one's idea writing it, and to follow the predecessors. Mori Risshi2 thinks "the compilers stated here that Zhong-jing followed the predecessors' ideas and did not create any new idea." In the Chinese ancient culture, one's creation was not appreciated than the predecessors'.

  2. Mori Risshi (also known as Ryushi or Tatsuyuki; 1807-85): Sho-kan-ron Ko-chu (Examination Notes of the Shang-han Lun),1868? Not accomplished. Recently published in a digital format in China.

The First Chapter1

The Way to Discriminate2 Pulses

The Second Chapter

The Way to Review 3 Pulses

  1. According to Taki Genkan (Motoyasu, 1755 – 1810: His son's name is Gen-ken, and also a Shang-han Lunist), author of the Shokan Shugi (Collections of Explanations on the Shang-han Lun, 1822 hereinafter the Genkan), “Three sections of the way to discriminate pulses, the way to review pulses and the example of Shang-han are added by Wan Shu-he, compiler of the Shang-han Lun and the Pulse Classic, who collected from many books and added his own opinion. There are some Zhong-jing’s theories in them, but they are far out from his three hundred ninety seven methods.”

    The most of the Shang-han Lunists agree including Cheng’s Notated with Explanations Shang-han Lun (Zhu-jie Shang-han Lun), and did not hesitate to omit these sections in the volume one. In Wan’s Pulse Classic, there is the chapter on Zhong-jing’s pulse theory in the beginning of the volume five and its contents are same as the beginning of the Way to Review Pulses in the Shang-han Lun. The Pulse Classic is composed by ten volumes and only 44 descriptions are same as the Shang-han Lun Chapter One. It is hard to consider that Wan Shu-he added this chapter to the Shang-han Lun.

    As each chapter of the six warps (jing) illness sections of the Shang-han Lun is entitled as “Discriminating Pulse Evidences of, such as Tai-yang Illness, and Its Treatments, “ it is very important to know pulses in order to understand the Shang-han Lun. It is reasonable to consider that there were chapters on the explanations of  pulses in the “original” Shang-han Lun.

  2. Bian: to discriminate: By the way TCM translates "Bian Zheng" as "Dialectics," but it is wrong. A Japanese philosopher translated "dialectics" of Hegel (Georg F W, 1770-1831) as "bian zheng (ben-sho in Japanese)" in the early 20th century, and the Japanese communists used it to translate works of  Marx (Karl H, 1818-83) and Engels (Friedrich, 1820-95). Hegel and Marx are nothing to do with the Shang-han Lun.

  3. The Way to Review Pulses (ping mai fa): Some translates “Healthy Pulse Technique,” but I do not agree. Here “ping” is a verb as “bian (discriminate)” in “bian mai fa.” In Shuo-wen Xi-jie, (Explanations and Resolutions of Characters in the Sentences) the oldest Chinese character dictionary, by Xu Shen in the first cenctury, "Ping is to state (shu)."  According to Mori Risshi, the letter "ping" is used to express "to review."  

    Those two pulse palpation techniques could be from the Bian-que Pulse Methods.

The First Chapter

The Way to Discriminate Pulses

1: One asks (his master), “There are Yin and Yang in pulses. What are they talking about?”

(Master) answers saying1, “Generally Large (da), Floating (fu), Frequent (shu)2, Moving (dong) and Smooth (hua)3 pulses are called Yang pulses. Sinking (chen), Weak (ruo), Faltering (se)4, String (xian)5, and Minute (wei) pulses are called Yin pulses. Generally in the Yin diseases, when Yang pulses come up, the patient will live, but when Yin pulses come up, the patient shall die.”

  1. Here, according to the master’s answer, Yin and Yang are qualities of the pulse, not reflecting the areas of the body, i.e. the Yin equals Zang organs and the Yang equals Fu viscera.

    The Pulse Classic Chapter 9 Section 6 “Generally Large is Yang, Floating is Yang, Frequent is Yang, Moving is Yang, Long is Yang, and Slippery is Yang. Sinking is Yin, Faltering is Yin, Weak is Yin, String is Yin, and Short is Yin, and Minute is Yin. These compose three Yin and three Yang (pulses). When a Yin pulse appears in a Yang disease is adverse, and rules death. When a Yang pulse appears in a Yin disease is favorable, and rules life.”

  2. Frequent (shu): Generally this pulse is translated “Rapid." The word “shu” means "number” and “frequent.”

    3.

  3. Smooth (hua): Generally this pulse is translated as “slippery.” The word “hua” has the meaning of “slippery” indeed, but in the Pulse Classic, it says, “Hua mai comes, goes, advances and retreats flowing smoothly.” So, I prefer to translate the “smooth pulse.”

    4.

  4. Falter (se): It is very difficult to translate the word “se” in English. Generally this pulse is translated as “choppy” or “hesitant.” It is obvious the “choppy pulse” is mistranslation, because it lets us imagine choppy waves in the sea and this image is wrong. Unschuld, Wiseman and Bensky (Eastland Press) all translate “se mai” as “rough pulse.”

    The oldest dictionary, Shuo-wen Xi-jie, says “se” is “bu hua (not smooth).” Kang-xi Zi-dian says that in Run-nan-zi Yao-rue, it says “se ji-fu (not smooth skin).” Even though, I do not think the word “se” contains any meaning of “roughness” in a sense of the English word. “Not smooth” does not necessarily mean “rough.” Shuo-wen Xi-jie, adds a note, “Not smooth, but when the evil qi attacks ni-zhong (reversed center), it is like ‘knotted (jie) se.’ This ‘se’ is “jie-sai (knotted and blocked).” If we need to express “roughness”, we have the word “huang�� or “cu.” Rough pulse is called “zao mai.”

    If we unwillingly pay the bill, we can use the word “se” to express this attitude, in this case the word “se” means “hesitant.” When traffic is jammed and slow, it is “se.” In this case in English, maybe you could use the word “hesitant” describing the movement, but the word “hesitant” expects unwillingness of the subject and traffic itself does not have any will to cause a jammed situation, as in the case of the pulse.

    In the Pulse Classic, it describes the “se” pulse as “Thin and Delayed. Traffic is difficult and scattered, stopping once in a while and comes back.” I prefer to translate Falter pulse.

    5.

  5. String (xian): Generally this pulse is translated as “Wiry,” but the word “xian” means a “string” as in a “bow string,” or a “string quartet.

2: One asks (his master), “There are pulses (specific to cases) of Yang-jie (knotted) and Yin-jie (knotted)*. How could we differentiate them?”

(Master) answers saying, “When the pulse (of a patient) is Floating (fu) as well as Frequent (shu), and the patient has appetite but does not evacuate the bowels, this is called Yang-jie. On the seventeenth day1, (the condition) becomes most intense. When the pulse (of a patient) is Sinking (chen) as well as Slow (chi), and the patient does not eat well, weighing heavy with stools being hard, contrarily to our expectation,  this is called Yin-jie. On the fourteenth day2, (the condition) becomes intense.”

  1. Yang-jie (knotted) and Yin-jie (knotted) are the health conditions, not the qualities of pulses (See Section 5). Jie (knotted) means the flow of Qi is knotted and occluded. Yang-jie means "no Water," Yin-jie means "no Fire."  If constipation is due to Stomach Repletion (wei shi) as the case of the Yang-ming Illness, the pulse is Sinking (chen) and Repletion (shi). Constipation due to Yang-jie (knotted) and Yin-jie (knotted), we do not purge, but smoothen out the Jie (knot).

  2.  17 days and 14 days: Cheng Wu-ji explains this as the followings, “The Shang-han illness attacks Tai-yang on the first day, Yang-ming on the second day, Shao-yang on the third day, Tai-yn on the fourth day, Shao-yin on the fifth day, and Jue-yin on the sixth day. When the patient does not recover from the illness on the seventh day, then the illness goes back to Tai-yang again. When the patient does not recover on the thirteenth day at the end of the second round, the illness goes into the third round. At the seventeenth day (in the third round), the illness attacks Shao-yin Water. Water controls Fire, and the Fire evil will be dissipated. At the fourteenth day, the illness attacks Yang-ming Earth. Earth controls Water and the Water evil will be dissipated.”  Even though, the text says, “it will be severe, not “healed.”

    According to Mori Risshi "the Yang type person gets worse after Yang number days, 2x8 days, and the Yin type person gets worse after Yin number days, 2x7 days."

3. One asks (his master), “In some disease, one feels shivering chills1, and also becomes feverish. What is this?”

(Master) answers saying, “When Yin pulses are insufficient (bu zu), Yang (Qi) goes down and follows Yin2. When Yang pulses are insufficient, Yin Qi goes up and rides over Yang Qi.”

One asks [his master], “What is Yang Insufficiency (bu zu)?”

[Master] answers, “For example, when the Cun distal pulse3 is Minute (wei), it is called Yang insufficiency. Yin Qi goes up and gets inside of Yang. There for, it gives shivering chills.”

One questions, “What is Yin insufficiency?”

[Master] answers, “When the Chi proximal pulse4 is Weak (ruo), it is called Yin insufficiency. Yang Qi goes down and gets inside of Yin. There for, (it causes) fervescence(fa re)5.

  1. shivering (sa-xi) chills: The word “sha” means “pouring,” and “xi” means “dreary sounds of waters and rains.” In Tai-ping Sheng-hui Fang (978), these words are “sa-xi,” but the meaning is the same.

  2.  Yang (Qi) goes along and follows this (Yang wang cong zhi): In Tai-ping Sheng-hui Fang, “cheng (ride over)” instead of “cong (follow),”  and it makes more sense. Yang (pulse) is located at the Cun distal position.

  3. Cun: The distal position in the three radial wrist pulse positions. The word “cun” is an old unit of the length such as an “inch.” The full name is Cun-kou (one inch from the mouth). If the palm is a mouth, this position is one inch from the mouth.

    4.

  4. Chi: The proximal position in the three radial wrist positions. The word “chi��� is an old unit of the length such as a “foot.” The full name of this pulse is Chi-zhong (foot center).

    There is an expression “chi fu,” which means the palmar side skin of the forearm.

    The theory of three-pulse-positions appears first time in Nan-jing (Eighty-one Difficulty Classic) and some believe Nan-jing was written by Bian-que. Then, Bian-que could not be the inventor of the pulse diagnosis, because there are theories of the pulse diagnosis, which we find in Su-wen precursor to Nan-jing.

  5. fa re:  In the Shang-han Lun, the moment of starting to elevate body temperature is very important. Western and conventional medicine do not care. I translate this moment as Fervescence.
4. When Yang pulses1 are Floating (fu) {one book says Minute (wei)} and Yin pulses are Weak (ruo), it is because Blood is Void (xue xu)2. When Blood (xue) is Void (xu), muscles cramp. When the pulse is Sinking (chen), Prosperous (rong) Qi3 is minute. When the pulse is Floating (fu) and sweating is like a stream of gem balls, Guarding (wei) Qi4 has been withered (shuai).  When the patient’s Prosperous (rong) Qi is minute, treating with a searing needle (shao zhen)5 may stop Blood from circulating (xing) and (patient become) fervescence (fa re), causing them to be manic (zao)and anguished (fan). 

  1. In Section 4, unlike Section 1, Yang pulses are the Cun (distal) pulses and Yin pulses are Chi (proximal) pulses. According to the Difficulty  Classic (nan jing), The Second Difficulty (Chapter 2), the Yang condition is palpated by the Cun (distal) position, and the Yin condition is palpated by the Chi (proximal) position. Also, in the Fourth Difficulty (Chapter 4), it says “the Floating (fu) pulse is Yang and the Sinking (chen) pulse is Yin.” In this case, “Floating (fu)” means the surface of the wrist and “Sinking (chen)” means the position palpated deep on the wrist. Thus, those positions can be alternated in the sense of Yin and Yang conditions.

  2.  Xue xu: Habitually translated as Blood Deficiency.

    Void (xu): Generally this word is translated as “depletion (Unshuld),” “deficiency (Bensky)” and “vacuity (Weisman).” The oldest dictionary, Shuo-wen Xi-jie, says “xu is a big hill. The Kun-lun Hills are called Kun-lun Xu.” Its note says, “Big hills mean the empty space (surrounded by the hills, a basin), and stretching its meaning to emptiness.” Thus, originally the word “xu” contained the meaning of emptiness of a space. It is obvious that the time Shuo-wen Xi-jie was written, the medical term “xu” was not popularly used.

    In another hand, “shi,” which is generally translated as “excess (Bensky)” or “repletion (Unshuld, Weisman).” In Shuo-wen Xi-jie “Shi is wealth. The bottom part of this character means goods.” Its note says, “stretching its meaning to the fruit of grass and tree. Goods under the roof create shi.” Thus, originally the word “shi” contained a meaning of “filling the space.”

    I prefer to translate “xu” as “Void” and “shi” as “Repletion.”

    I am sure the Shag-han Lun followed the concepts of “xu” and “shi” as Su-wen defined. In Chapter 28, Qi-bo says, “When Evil Qi (xie qi) is thriving, it is “shi,” and when Essential Qi (jing qi) is not invigorated, it is “xu.”

    Su-wen tells us that the states “xu” and “shi” are not balanced nor healthy. Thus, when Essencial Qi is replete, it would not be described as “shi” because it is a healthy state. Instead, the classics describe this state as “cheng (thriving).”

  3. Rong Qi: 榮気Habitually translated as “Nourishing Qi” or "nutritious qi." with the character “ying:營" which means to surround the house (like a parapet)” in Shuo-wen Xi-jie (the first Chinese dictionary in the first century) but here the character “rong: 榮" is different, meaning “prosperous.” In Shuo-wen Xi-jie, "rong 榮" means "paulownia" and "decorations (made with paulownia) on the roof top which signify prosperous."
    Both "ying 營" and "rong 榮" originated from the letter "ying 熒," which means a bonfire. In Chinese classic books, this kind of character changes happens lots, because in ancient days, books were copied by hand writing. When the Japanese government in the early 20 century had to translate a European concept "nutrition," it used a word “rong-yang” which means "to nourish Rong Qi." Thus it is not appropriate to use the word "nourish" for the translation of the classics.

  4. Guarding (wei) Qi: Generally this qi is translated as “protective qi (Unshuld, Bensky)” and “defense qi (Weisman).” The word “wei-bing” means a “guard soldier” and “shou wei,” “a guardman.

  5. searing needle: A needling technique using a hot-red needle and burn the skin. Manaka Yoshio MD reported in his book, Shinkyu no Riron to Kangaekata,  p.154, 1971.

5.    When the pulse is protuberant (ai ai) like a roof of a cart1, it is called Yang-jie2 {one book says Autumn pulse}3.

When the pulse is connecting (lei lei) like a straight long bamboo pole4, it is called Yin-jie {one book says Summer pulse}.

When the pulse is glittering and glaring (pie pie) like fat floating on soup, Yang Qi is minute (wei).

When the pulse is entangled and entwined (ying ying) like a thread of a spider web, Yang Qi is declined {one book says Yin Qi}5.

When the pulse is continuous (mian mian) like a drop of lacquer leaving a trail6, it is Lost Blood (wang xue).

  1. The pulse like a roof of a cart: A Floating (fu), Large (da) and strong pulse.

  2. Yang-jie:  Here the text is talking about the pulse, but generally the word “Yang-jie��� means constipation under the Yang predominant state.

  3. [one book says Minute]: In the actual text, this phrase is written in smaller letters. When it is translated as [one book says] here after, all the same. These notes could be written by Lin, et al.

  4. The pulse like a straight long bamboo pole: A pulse has a short peak with long intervals before and after. In Su-wen Chapter 18, it says "The healthy Liver pulse comes fully Replete and Smooth, if it comes like a straight long bamboo pole, it is a Liver disease." It is almost same in Nan-jing the 15th Dificulty.

    In Su-wen Chapter 18, "the healthy heart pulse come like connecting (lei lei) gem balls and as if it is a pearl like gem stone (lang-gan)." In Nan-jing 15th Difficulty, it says "the Summer pulse comes like connecting (lei lei) gem balls, and as if it is a pearl like gem stone." 

  5. The pulse like a thread of a spider web: The pulse is very fine and entangled: In Mai Jing Volume 4 Chapter 1, it says "When Cun distal pulse is stretched quickly like a spider thread, Yin Qi is withered." According to this, the note is correct.

  6. The pulse like a drop of lacquer leaving a tail: The beginning of the pulse is rather thick, but it ends very thin continuing as if it never ends.

    Otsuka Keisetsu believes all those pulses are Death pulses.

6. When the pulse arrives Gently (huan)1, stopping once and coming again, it is called Knotted (jie).

When the pulse arrives Frequently (shu), stopping once and comes again, it is called Urging (cu) {one writes Vertical (zong)2}.

When the pulse is Yang Thriving (cheng)3, it is Hastening (cu)4.

When the pulse is Yin Thriving (cheng), it is Knotted (jie). Both are diseased pulses.

  1. Huan pulse: Habitually translated as Leisury pulse. The opposite word of Huan in Chinese is Ji (hastened), thus I chose the word, “gentle” as a gentle flow of a river or a slope which is not steep.

  2. Vertical (zong): According to Mori Risshi, the "Vertical (zong)" pulse means one pulse not coming (skipping). This name comes from a long interval. Thus, it is same as Cu (Hasting) pulse.

  3. Yang Thriving (cheng) means Yang Qi being thriving. Yin Thriving (cheng) means Yin Qi being thriving. Some translates Thriving (cheng) as “excess,” but the word “cheng” means “a thing in at its best,” not “overly done.” Most of English translators do not translate this word as a noun. In Japanese acupuncture and Kanpo (Japanese style classic Chinese herbal medicine) theories, this word is always treated as a noun meaning “thriving.”

  4. Hasting (cu): Could be “quickened” or “accelerated.”

7. When Yin pulses and Yang pulses beat together (xiang bo), it is called Moving (dong)1. Yang Moving (dong) pulse means sweat comes out, and Yin Moving (dong) pulse means fervescence (fa re). When the body is cold and the patient feels chills, it means San Jiao (three scorchers)2 is injured. If Frequent (shu) pulse appears in Guan-shang (middle position)3, and the upper and lower pulses4 are without heads, being the size of soy beans, and meandering and rolling, this pulse is called Moving (dong).

  1. dong: In case of the pulse figure, I chose "moving."

  2. San Jiao: Habitually translated as “Triple Burner,” or “Triple Energizer.” The word “jiao” means “to scorch.” The word “jiao-dian (literally scorching point)” is a “focus.”

  3. Guan-shang: Literally it means “upper checkpoint.” (The lower “guan” is located on the upper portion of the knee joint.) The center of the three wrist pulse positions. 

  4. Upper and lower pulses: In the Chinese classic anatomical position, the hands are up. Thus, the Cun distal position locates upper, and Chi proximal position lower.
8. When Yang pulses are Floating (fu), Large (da) and Calm (ru)1, and Yin pulses are Floating (fu), Large (da) and Calm (ru), [that is] Yin pulses and Yang pulses are equal, (and) it is called Gentle (huan).

  1. Ru:濡: Calm (pulse): The character means “wet” with a “left hand radical “water.” Without this “left hand radical,” the character is “ruan,” meaning “wet.” The sound “ruan” is the same as the character “soft.” In some Chinese classics, the character “ru (wet)” means “soft.” Thus, some translate this pulse as a “soft pulse.” Even so, the character “ru” has a meaning of “calmness.”  We have "soft pulse" with the character "rou."    

9. When the pulse is Floating (fu) and Tense (jin), it is called String (xian). The figure of String (xian) pulse is like a bowstring, and when it is palpated, it does not shift. Tense (jin) pulse is just like a rolling rope and it is not steady.
10.    When the pulse is String (xian) and Large (da), String (xian) means a diminishing (jian) (state), and Large (da) means Leek (kou)1. A diminishing (jian) (state) means Cold, and Leek (kou) means Void (xu). When Cold and Void beat together, it is called Hide (ge)2. (This pulse could mean in the case of) a woman, delivering a baby half way, or vaginal bleeding (lou-xia), (in the case of) a man, lost Blood (wang xue), or lacking semen (shi jing).

  1. kou: leek: The character means a grass, which has a tube like leaf like a leek.

    The character for the leek is “cong.” This character ���kou” is the old character for the leek.

  2. ge: Hide: This character also means the leather-covered musical instruments, thus some translate “Leather” or “Drum,” which might cause misunderstanding of the pulse figure. The actual meaning of “ge�� is the tight surface with the empty bottom.

11. One asks (his master), “There is a disease where the patient shivers (zhan) and sweats, and then he gets healed. What is it?”

(Master) answers saying, “When the pulse is Floating (fu) and Tense (jie), but when (you) palpate (deeper), it is Leek (kou), then this pulse originally was Void (xu), (and that is why) the patient shivers and sweats. When the patient is originally Void (xu), he will shiver. When the pulse is Floating (fu) and the patient sweats, then he has to be healed. If the pulse is Floating (fu) and Frequent (shu), and when (you) palpate (deeper), it is Leek (kou), then this patient cannot be originally Void (xu). (So when) the disease is going to be healed by itself, only sweat will come out, and no shivering happens.

12. One asks (his master), “There is a disease not causing shivering, and sweating heals it. Why is it so?"

(Master) answers saying, “When the pulse is Large (da), Floating (fu) and Frequent (shu), we know no shivering but (only) sweating will heal it.”

13. One asks (his master), “There is a disease not causing shivering and sweating, and it is healed [by itself]. What is this?”

(Master) answers saying, “The pulse must be Minute (wei) by itself. It is because the patient had been sweated, vomited, purged, or lost Blood in the past, which resulted in having no Body fluids (jin ye) in the Inside (nei) (of the body). If Yin and Yang harmonize themselves, then (the patient) will be healed by himself without fail. That is why (there can be cases with) no shivering and no sweating, and (the patient) is healed.   

14. One asks (his master), “The patient is three days with the Shang-han (harmful Cold) disease, and the pulse is Floating (fu), Frequent (shu), and Minute (wei). The patient feels cool and harmonized. Why?”

(Master) answers saying, “That is because the disease is going to be cured. The relief from the disease is in the midnight. When the pulse is Floating (fu) and the patient is going to be healed, then the sweat will come out quietly (ji ran). When the pulse is Frequent (shu) and the patient is going to be healed, then the patient eats well without fail. When the pulse is Minute (wei) and the patient is going to be healed, then the sweat comes out profusely.

15. One asks (his master), “The pulse is diseased, and I would like to know if it will be healed or not healed. How can I distinguish it?”

(Master) answers saying, “When three locations of Cun-kou (distal position), Guan-shang (middle position), and Chi-zhong (proximal position), are all equal in size, Floating (fu) or Sinking (chen), and Slow (qi) or Frequent (shu), then even  if the patient’s cold or fever is not relieved yet, the pulses’ Yin and Yang are harmonized and even if the disease is severe, it will be healed.

16. Master said, “In the Beginning of Summer (li xia)1 the pulse becomes Flooded (hong) {One book says Floating (fu)}, and Large (da) pulse. This is natural. The people who suffer from body pain and heaviness, they all have to be sweated. If the next day, the person does not have pain and heaviness, do not sweat. If the sweat drips drop by drop (ji ji) by itself, the next day the illness will be cleared.”

“Why do you say that?”

“The pulse of the Beginning of Summer is Flooded (hong) and Large (da). This is the seasonal pulse. Thus, I say that. The other seasons are the same way."

  1. li-xia: One of 24 Seasonal Qi. In Gregorian Calendar, it is around May 5 or 6.

17.  One asks (his master), “I would like to know when we will get illness and when it will be cleared.”

(Master) answers saying, “For instance, when you get illness in the mid night, you will be fine in the mid day of the next day. When you get illness in the mid day, you will be fine in the mid night.”

“Why do you say that?”

“The person who gets illness in the mid day and is going to be fine in the mid night, acquires Yin with Yang. That is why the illness will be

cleared.”
18.    “When Cun (distal) pulse is Floating (fu), (the evil) exists on the Surface (biao)*, and when it is Sinking (chen), (the evil) exists in the Rear  (li)1. When the Cun pulse is Frequent (shu), (the evil) exists in the Fu viscera, and when it is Slow (chi), it exists in the Zang organs. Even if the pulse is Slow (chi), (the evil) exists in the Zang organs.”

    1. biao: Surface: This character also means “outside.” Commonly translated as “Exterior.” According to Wiseman, “biao” is “the outer part of the body as opposed to the interior; includes the fleshy exterior (i.e. the skin and exterior muscles of the head, limbs and trunk) and bowels, which are the organs of the exterior.”

      li: Rear: This character also means “inside.” Commonly translated as “Interior.” As the modern Chinese character, this letter is same as the character expresses the unit of distance, thus it lost its original meaning. According to Wiseman, “The bone marrow, the bowels and viscera, etc. are consider as interior.”

      There are another couple of the Chinese words expressing the areas of the body, “nei” and “wai.” According to Wiseman, “nei” is “the inner part of the body; synonymous with interior,” and “wai” is “the outer part of the body, the exterior.” 

      In Kanpo (Japanese style classic Chinese herbal therapy), “biao-li” and “nei-wai” are considered to express different areas of the body. According to the Introduction to Kampo – Japanese Traditional Medicine by the Japanese Society for Oriental Medicine, 2005, they are translated as “superficies (biao),” “interior (li),” “external (wai)” and “internal (nei).” “In Kampo, surface areas of the body such as skin, muscles, joints, and nerves are definesd as “superficies” and deeper areas and viscera form the “interior.” Moreover, organs located near to the diaphragm such as the lungs and liver are considered “mesodermal.” Here, “mesodermal” means “half biao (surface) and half wai (outside)” in Shang-han Lun. Shang-han Lun text never says “half biao and half li.” “External and internal is another indicator similar to superficies and interior. While external and internal are relative concepts, superficies and interior are concepts of fixed organs such as muscles and skin (superficies) and viscera (interior).”  

19. “When the Fu-yang1 (ST 42) pulse is Slow (chi) and Faltering (se), and the Shao-yin pulse2 (KD3) is usual, the illness exists in the Spleen, and the protocol is to purge.”

“How can you know it?”

“If the pulse is Floating (fu) and Large (da), Qi is Replete (shi) and Blood is Void (xu). Now, the Fu-yang (ST42) pulse is Floating (fu) and Faltering (se), so (you know) Spleen Qi is insufficient (bu zu) and Stomach Qi is Void (xu).

The Shao-yin pulse (KD3) is String (xian) and Floating (fu) {one book says Sinking (chen)} (but the Floating (fu) quality) appears (only) slightly. It means the pulse is harmonized. That is why it says “as usual.” If, in contrast, (in case the pulse is) Gentle (hua) and Frequent (shu), then (you know) the patient must have stools {The Gem Box3 makes this letter “urine.”} with pus.

  1. Fu-yang (ST 42) Pulse: Actually the acupuncture point Fu-yang is BL59, and ST42 is called Chong-yang, but the Fu-yang pulse is palpated at ST 42.

  2. Shao-yin Pulse (KD3): In the Su Wen, Chapter 20, the Three Section Nine Indication (san bu chu hou) Theory, KD3 (da xi) is the pulse of Kidney.

  3. Gem Box (yu han): Jing-gui Yu-han Jing (Golden Casket Gem Box Classic), a variant copy of Shang-han Lun existed in the Tang Dynasty (618-907). 

20. When Cun distal pulse is Floating (fu) and Tight (jing), it is Floating (fu) because of Wind (feng), and it is Tight (jing) because of Cold (han). Wind harms (shang) Guarding Qi (wei qi), and Cold harms (shang) Prosperous Qi (rong qi). When Guarding (wei) and Prosperous (rong) Qi both suffer, then bones and joints start to be uncomfortable and ache. The patient shall be sweated.

21.    “When the Fu-yang (ST42) pulse is Slow (chi) and Gentle (hua), Stomach Qi is flowing, as the classics say. When the Fu-yang (ST42) pulse is Floating (fu) and Frequent (shu), it is Floating (fu) because Stomach is harmed (shang), and it is Frequent (shu) because Spleen (pi) is affected (dong). This is originally not a disease, but because the doctor deliberately purged this patient. When Guarding and Prosperous (wei & rong) Qi sink inside (nei), Frequent (shu) pulse becomes Minute (wei) first. Contrarily, if the pulse becomes Floating (fu), then the patient has hard stools without fail and belching relieves (the patient).”

"How can you say that?"

“Originally Frequent (shu) pulse moved Spleen. (As) Frequent (shu) pulse became Minute (wei) first, (we) know that Spleen Qi is not cured, because there are hard stools and belching relieves (the patient).  Now, the pulse is Floating (fu) (against our expectation) and the Frequent (quality) transforms into Minute (wei) (quality), (we know) Evil (xie) Qi is still staying (inside). (Thus, even though) the Heart feels hunger, Evil Fever (xie re) does not digest food. Tidal fever(chao re) begins and (the patient feels) thirst. Frequent (shu) pulse must (transform into) Slow (chi) and Gentle (hua), (and then) the quality of pulse before and after the illness becomes as the law.  The patient will feel hunger (and be able to eat).  If Frequent (shu) pulse continues timelessly, then a malignant boil (wu chuang) will form.  
22. Master says, “When the pulse of the diseased person is Minute (wei) and Faltering (se), it is a disease the doctor created. As (the doctor) sweats the patient profusely, and in many cases, he purges the patient strongly, the patient loses his Blood (wang xu). The disease causes Chills (wu hang), and later fervescence (fa re). (Fever) will not stop any time. Even in the summer and the midst of the heat, the patient wants to wear multiple layers of clothes. Even in the winter and the midst of the cold, the patient wants to be naked. That is because Yang is minute and causing Chills (wu hang), and Yin is weak, which causes fervescence (fa re). This is due to the doctor letting the patient sweat, and making Yang Qi minute. Also, (this is due to the doctor) purging strongly and weakening Yin Qi. In the month of May, Yang Qi stays in the Surface (biao), and (the doctor) cools the middle of the stomach (wei zhong) and Yang Qi becomes minute in the Inside (nei). Thus, (Yang Qi) is unable to win over coolness (leng), and the patient wants to wear multiple layers of clothes. In the month of November, Yang Qi stays in the Rear (li), and the middle of the stomach heats up. Yin Qi is minute in the Inside (nei), and it cannot win over the Heat (re), thus the patient wants to be naked. Also, the Yin pulses are Slow (chi) and Faltering (se); thus we know (the patient) has lost Blood (wang xue).
23. When the pulse is Floating (fu) and Large (da), and the epigastric area (shin xia) is Hard (ge)(against our expectation), there is fever (and the illness) belongs to organs (zang), (we have to) attack (by purging the patient) not sweating. When (the illness) belongs to the Viscera (fu), (we have) to not let (the patient) urinate frequently. If (the patient) urinates frequently, it hardens the stools. If (the patient) sweats a lot, then the fever subsides, but if (he patient) sweats less, (it causes) difficult defecation. If the pulse is Slow (chi), then (we should) not attack (by purging the patient) yet.
24.     When the pulse is Floating (fu) and Flooding (hua), sweat is like oil on the body, (there is) wheezing without a break, and being unable to swallow water,  (while) the body is not functioning (bu ren), being quiet sometimes and violent sometimes, then the life (of the patient) is going to be terminated. Also, even if you do not know yet which organ is affected first from a misfortune, if the patient sweats and wets his/her hair and wheezes without a break, this means the Lung is going to be terminated (jue) first. When Yang Qi stays alone (against our expectation), and the body looks as if it is smoked, while gazing straight ahead and swaying the head, this means the Heart is going to be terminated. When lips are blue (against our expectation), and four limbs are trembling always, this means the Liver is going to be terminated. When the area around the mouth is yellowish black, and (the patient is) sweating cold sweats, while being yellow, this means the Spleen is going to be terminated. If the patient defecates and urinates without control, while uttering crazy words and gazing straight ahead (against our expectation), this means the Kidney is going to be terminated. Also even if you do not know yet which organ’s Yin and Yang is terminated first, if Yang Qi is terminated first, and Yin Qi is exhausted later, then the patient will die with the body color blue without fail. When Yin Qi is terminated first, and Yang Qi is exhausted later, then the patient dies with red body color, warm armpits and a feverish epigastrium (shin xia).
25.    When Cun distal pulse is Floating (fu) and Large (da), and the doctor purges the patient (against our expectation), this causes the Great Reverse (da ni). The Floating (fu) means no Blood (xue), and the Large (da) means Cold (han). Coldness (han) and Qi fight each other and cause borborygmus. If the doctor does not realizes it and let the patient drink cold water [against our expectation], then the patient sweats cold and sweats profusely. When Water (sui) meets Cold (han) Qi and both fight each other, the patient will be choked.
26: When Fu-yang (ST42) pulse is Floating (fu), it is Floating (fu) because it is Void (xu). Thus, the Floating (fu) and Void (xu) fight each other, and the fight chokes the Qi. This is called Stomach Qi Void (wei qi xu). If the pulse is Smooth (hua), it causes hiccups. This is due to the doctor’s fault. He attacked the Void (xu) (condition) as the Repletion (shi) (condition), keeping the Emptiness (kong) and approaching the Blood (xue). If the pulse is Floating (fu) and the inner (zhong) nose of the patient dries, then he/she shall have nosebleeds.
27: When all pulses are Floating (fu) and Frequent (shu), it means (the patient has) fervescence (fare). If the patient has severe chills and pain somewhere, but drinks and eats as usual, then pus is accumulating somewhere.
28: When the pulse is Floating (fu) and Slow (chi), and the face is hot and reddish with tremor, (the disease) will be resolved after sweating in 6 or 7 days. If the patient has fever (against our expectation), healing is delayed. It delays because the patient has no Yang Qi, and is unable to sweat. The body shall be itching.

29:  When both Yin and Yang of Cun Guo (wrist) Pulse1 are Tense (jin), as a rule, Clear Evil2 (qing ye) is hitting the Upper Jiao (scorcher) and Cloudy Evil3 (zhuo ye) is hitting the Lower Jiao (scorcher). Clear Evil (qing ye) hitting the Upper is called Clean (jie) and Cloudy Evil (zhuo ye) hitting the Lower (xia) is called Cloudiness (hun).

When Yin is hit by Evil (ye), the Inside (nei) shall shudder (li). Because the Surface (biao) Qi is minute and Void (xu), Rear (li) Qi does not protect. Thus, (Rear (li) Qi) lets Evil (ye) strike (zhong) Yin. When Yang is struck by Evil4 (ye), (it shall cause) fervescence (fa re), and headache. The nape stiffens and the neck contracts. The low back gets pain, and the calves become tender.  When Yang Qi is hit by Misty Dew (wu lu) Qi, it is called Clear Evil (qing ye) strikes the Upper (shang)(body).

When Cloudy Evil (zhuo ye) strikes the Lower (xia)(body), Yin Qi shivers. Feet and knees become adversely cool. (The person will) defecate and urinate profusely. Surface (biao) Qi becomes slightly Void (xu), and Rear (li) Qi becomes slightly Contracting (ji). San Jiao (three scorchers) become confused (hun) towards each other. The Inside (nei) and the Outside (wai) do not communicate. Upper Jiao (scorcher) becomes depressed (fu yu). Organ (zang) Qis smolder and smudge each other. The mouth becomes sore and unable to eat food. When Middle Jiao (scorcher) is not healed, then Stomach Qi thrusts up (shang chong), and Spleen Qi cannot transform (what’s in Stomach), thus inside of Stomach becomes turbid. Prosperous (rong) Qi does not communicate, Blood is clogged and does not flow.

If Guarding (wei) Qi passes ahead, then urine becomes reddish yellow. Guarding (wei) Qi fights with Fever (re) and lets Fever (re) idly go into Warps (jing) and Choroids (ruo)5, then in and out of Zang organs and Fu viscera6.  Wherever Fever (re) passes, it creates abscesses and pus.

If Yin Qi passes ahead, as Yang Counter-flow (jue) is minute, and Yin cannot utilize it, Foreign Evil (ke ye) comes into the Inside (nei). Thus snivel will come out, voice will be choked, and the throat will be blocked. Cold (han) and Counter-flow (jue) chase each other and this shuts Fever (re) in, causing Blood to congeal and go down by itself. It looks like a pig’s liver.

When Yin and Yang both Counter-flow, then Spleen Qi alone becomes weak, thus Five Fluids6 pour down, but Lower Jiao (scorcher) cannot cover them. Stools go down a few times, trying to be defecated frequently and with difficulty, and the navel goes up and down with pain. It is difficult to survive.

  1. Cun Guo (wrist) Pulse: Not the Cun distal pulse, but the wrist radial pulse.

  2. Clear Evil(qing ye): Clear Evil (qing ye): = Misty Dew (wu lu) Qi: Not serious pernicious influence.

  3. Cloudy Evil(zhuo ye): Clear Evil (qing ye): = Misty Dew (wu lu) Qi: Not serious pernicious influence.

  4. Luo: Choroid: Commonly translated as “network (vessel).”

  5. Five Fluids: Digested Five Tastes

  6. zang fu: Mori Risshi thinks "zang" means "inside of the stomach" and "fu" means outside of the stomach, i.e. San Jiao.
30: When Yin and Yang pulses are both Tense (jin), from inside of mouth Qi comes out1. Lips and the mouth are dried. Patient lies down with bent knees and cold feet. From the nose, snivel comes out. On the tongue, the moss becomes slippery. Then, you should not treat the patient indiscriminately. After more than seven days, if the person starts to have fever minutely, and hands and feet become warm, then it means (the patient) is going to heal. Or if after eight days, the person starts to have big fever, it is hard to treat. If the body feels chills (wu han), then the person shall vomit, without a doubt. If inside of the abdomen aches, then the person shall have diarrhea.

  1. kou zhong qi chu: from inside of mouth, Qi comes out: When the nose is clogged, the person breathes through the mouth.

31:  When Yin and Yang pulses both are Tense (jin), (and the person) comes to have vomiting and diarrhea (which clears the problem), only the pulses are (still) not healed. If the Tense (jin) pulse goes away, (the person shall) feel peaceful, and is going to be healed. If the pulse has been Slow (chi) and six to seven days have passed, and there is no appetite, it is Late Start (yan fa), due to Water Stagnation (sui ting). It is not healed yet. If the person can eat, then it is going to be healed. If it has been six to seven days of illness, and all three part pulses in hands and feet1 are balanced, (even though) the person is greatly anguished, shutting his/her mouth, being unable to speak, and this person is depressed and agitated, this (person) is going to be healed without fails. If the pulses are balanced, and the person is greatly anguished, with a feeling of heaviness in the eyes, and the insides of eyelids are yellow, it is going to be healed.

  1. all three part pulses (san bu mai) in hands and feet: Could be St 9, Wrist 3 positions, and Foot St 42. But, Mori Risshi says these pulses are 1) wrist Cun, Guan and Chi, 2) Foot Fu-yang (St 42), and 3) Low leg Shao-yin (Kd 3), because in the Shang-han Lun, the Ren-yin (St 9) pulse appears in the author's preface but never checked in the text.

32: When the pulse is Floating (fu) and Frequent (shu), it is Floating (fu) due to Wind (feng), and it is Frequent (shu) due to being Void (xue). Wind (feng) causes Fever (re), and Void (xu) causes Cold (han). Wind (feng) and Void (xue) fight each other, and will cause shivering Chills (wu hang). 
33: When the pulse is Floating (fu) and Smooth (hua), it is Floating (fu) due to Yang, and it is Smooth (hua) due to Repletion (shi). Yang and Repletion (shi) fight each other, and will make the pulse Frequent (shu) and Nimble (ji)1. Then Guarding (wei) Qi will lose its composure (duo). When Floating (fu) and Smooth (hua) pulse becomes Frequent (shu) and Nimble (ji) with fervescence (fa re) and (it causes) sweating, then it is incurable.

  1.  ji: Nimble: It means running in extreme speed.
34: In case of Shang-han (harmful Cold) disease, if the person coughs severely and exhibits flushing1 (shang Qi), with Scattered2 (san) pulse, the person is going to die, because the body is damaged3.

  1. shang qi: Severe coughing turns one’s face red.

  2. san pulse: The shape of the pulse is poorly formed and desultory.

  3. sun: Damaging.

[Vol. 1 Chapter 1 END]  

No part of this site may be reproduced or transmitted in any form without the prior written consent of the publisher. Mail Address: shinjiro@shanghanlun.us