Formulas · Text · Donguibogam 東醫寶鑑

Pulse Diagnosis

Jinmaek

한글 진맥 · Pinyin Zhen Mai

The pulse must have spirit, the pulse must have stomach — and the ten strange pulses that mean death

診脉

The fourth of the introductory chapters of the Miscellaneous Disorders, and the one that tells a physician what to make of what the fingers find. It is not a catalogue of pulses — that is the Pulse chapter of the Inner Landscape — but a chapter about judgement: what a pulse means, when a pulse lies, and which pulses cannot be argued with. Two ideas run through it. The pulse must have spirit, which the Haejang defines as force — a rapid pulse with force is heat and can be drained, a rapid pulse without force is nothing to drain and the draining kills. And the pulse must have stomach, which the Immun defines as the quality that cannot be named: not large, not fine, not long, not short, meeting the finger in harmony. Where either is absent the chapter turns to prognosis, and it is exact about it — how many beats a stopping pulse skips and how many years or days that leaves, which pulse in a fat man and which in a thin one means death, and why a level pulse at the wrist can still be found in a dying patient if the artery at the ankle has gone. It ends with the ten strange pulses, each named for the thing it resembles — a boiling pot, a fish swimming, a stone flicked, a rope unravelling, a roof leaking, a shrimp darting, a sparrow pecking, a knife's edge, a spinning bean, a scatter of hemp seed — and each with its count of days.

4.1 The Six Pulses in Harmony with Heaven 天和六脉

4.1.1

Source원문

內經曰, 必先歲氣, 毋伐天和. 註曰, 歲有六氣分主, 有南面北面之政, 先知此六氣所在, 人脉至尺寸應之. 太陰所在, 其脉沈, 少陰所在, 其脉鉤, 厥陰所在, 其脉弦, 太陽所在, 其脉大而長, 陽明所在, 其脉短而澁, 少陽所在, 其脉大而浮. 如是六脉則謂天和, 不識不知, 呼爲寒熱. 攻寒令熱, 脉不變而熱疾已生, 制熱令寒, 脉如故而寒病又起. 夭枉之來, 率由於此也. 《內經》

Translation영역

The Neijing says: first know the qi of the year, and do not cut down the harmony of heaven. The commentary says: the year has six qi that govern in turn, and there is a south-facing and a north-facing administration; first know where these six qi lie, and the person's pulse at cubit and inch answers to them. Where the greater yin lies, the pulse is sunken; the lesser yin, hooked; the reverting yin, stringlike; the greater yang, large and long; the yang brightness, short and rough; the lesser yang, large and floating. Six pulses of this kind are called the harmony of heaven. Not recognizing and not knowing them, one calls them cold or heat; attacking cold to make heat, the pulse does not change and a heat disease has already arisen; checking heat to make cold, the pulse is as before and a cold disease arises again. Early and wrongful death comes, as a rule, from this.

Clinical note임상 주석

The chapter opens with a warning rather than a method: some pulses are seasonal and not diseased, and treating them as diseased kills. The six correspond to the six climatic qi of the year, and the passage sends the reader to the Five Movements chapter for the calendar. 毋伐天和 — do not cut down the harmony of heaven — is the Medicine-Use chapter's 5.10 as well, and the two chapters share the premise that a physician's first duty is to know what not to treat.

Naegyeong 內經

4.2 The Pulse Must Have Spirit 脉當有神

4.2.1

Source원문

脉之不病, 其神不言當自有也. 脉之旣病, 當求其神之有與無焉. 謂如六數七極, 熱也, 脉中有力, 卽有神也. 三遲二敗, 寒也, 脉中有力, 卽有神也. 熱而有神, 當泄其熱, 則神在焉. 寒而有神, 當去其寒, 則神在焉. 寒熱之脉, 無力無神, 將何藥而泄熱去寒乎. 苟不知此, 而遽泄去之, 將何依以生. 所以十亡八九矣. 《海藏》

Translation영역

In a pulse that is not diseased the spirit need not be spoken of — it is there of itself. Once the pulse is diseased, one must seek whether its spirit is present or absent. Six beats is rapid and seven is extreme — that is heat; if there is force within the pulse, there is spirit. Three is slow and two is failing — that is cold; if there is force within the pulse, there is spirit. Hot with spirit, drain the heat and the spirit remains. Cold with spirit, remove the cold and the spirit remains. But a pulse of cold or heat without force and without spirit — with what medicine will one drain the heat or remove the cold? Not knowing this and draining or removing at once, on what will the patient depend to live? That is why eight or nine in ten die.

Clinical note임상 주석

The chapter's first principle and its most usable: 神 is force, and force is what licenses treatment. A rapid pulse with force is heat and may be drained; a rapid pulse without force is not heat but exhaustion, and draining it is fatal. 十亡八九 — eight or nine in ten die — is the Haejang's estimate of what happens when the distinction is missed. The Fire chapter's 5.7 and the Internal Damage chapter's 1.16 are built on the same test.

Haejang 海藏

4.2.2

Source원문

氣血食積痰飮, 一有留滯於其間, 脉必因之而止節矣. 但當求其有神, 何害之有. 夫有神者, 卽經所謂有中氣也. 卽脉有力也. 《樞要》

Translation영역

Where qi, blood, food accumulation or phlegm rheum — any one of them — lodges and stagnates in between, the pulse will surely stop and be checked because of it. Only seek whether it has spirit, and what harm is there? Having spirit is what the classic calls having the centre qi; that is, the pulse having force.

Clinical note임상 주석

A stopping pulse from obstruction is not the stopping pulse of 4.8. The difference is force — a pulse that pauses but beats with strength between pauses is blocked, not failing.

Churyo 樞要

4.3 The Pulse Takes Stomach Qi as Its Root 脉以胃氣爲本

4.3.1

Source원문

胃氣者, 中氣也. 不大不細, 不長不短, 不浮不沈, 不滑不濇. 應手冲和, 難以名狀者, 爲胃氣. 有胃氣則有力, 有力則有神. 無胃氣則無力, 無力則無神. 有神則生, 無神則死. 《入門》

Translation영역

Stomach qi is the centre qi. Not large and not fine, not long and not short, not floating and not sunken, not slippery and not rough — meeting the finger in harmony, hard to name or describe: this is stomach qi. Where there is stomach qi there is force; where there is force there is spirit. Where there is no stomach qi there is no force; where there is no force there is no spirit. With spirit, life; without spirit, death.

Clinical note임상 주석

Stomach qi defined by what it is not. Eight negations and then 難以名狀 — hard to name — which is the honest position: the healthy pulse has no quality that stands out, and that absence of any dominant quality is what the physician is feeling for. The chain from stomach to force to spirit to life makes 4.2 and 4.3 one argument.

Immun 入門

4.3.2

Source원문

人以水穀爲本, 故人絶水穀則死, 脉無胃氣亦死. 所謂無胃氣者, 但得眞藏脉, 不得胃氣也. 《內經》

Translation영역

A person takes water and grain as the root; hence a person cut off from water and grain dies, and a pulse without stomach qi also dies. What is called being without stomach qi means getting only the true visceral pulse and not getting the stomach qi.

Naegyeong 內經

4.4 The True Visceral Pulses 眞臟脉

4.4.1

Source원문

眞肝脉至, 中外急如循刀刃, 責責然如按琴瑟絃. 眞心脉至, 堅而搏, 如循薏苡子累累然. 眞肺脉至, 大而虛, 如以毛羽中人膚. 眞腎脉至, 搏而絶, 如指彈石辟辟然. 眞脾脉至, 弱而乍數乍疏. 諸眞藏脉見, 皆死不治也. 《內經》

Translation영역

When the true liver pulse arrives, it is tight within and without like running the finger along a knife's edge, taut like pressing the strings of a lute. When the true heart pulse arrives, it is hard and beats like running the finger over a string of coix seeds. When the true lung pulse arrives, it is large and empty like a feather touching the skin. When the true kidney pulse arrives, it beats and breaks off like a finger flicking a stone. When the true spleen pulse arrives, it is weak and now rapid, now sparse. Where any of the true visceral pulses appears, all die and are not treated.

Clinical note임상 주석

Five pulses each described by touch — a knife's edge, coix seeds, a feather, a flicked stone, an irregular weakness — and each is the pulse of one organ with nothing moderating it. The next passage says what 'nothing moderating it' means.

Naegyeong 內經

4.4.2

Source원문

楊上善云, 無餘物和雜, 故名曰眞也. 如弦, 是肝脉也, 微弦爲平和. 微弦, 謂二分胃氣一分弦氣俱動爲微弦. 三分幷是弦而無胃氣, 爲見眞藏. 餘四藏準此. 《太素》

Translation영역

Yang Shangshan says: nothing else is mixed in with it, and so it is called true. Take stringlike, which is the liver pulse: slightly stringlike is level and harmonious. Slightly stringlike means two parts stomach qi and one part string qi moving together. All three parts stringlike with no stomach qi is the appearance of the true viscus. The other four viscera follow this.

Clinical note임상 주석

The proportion is stated: two parts stomach to one part organ is health, three parts organ and no stomach is death. That is the whole of 4.3 and 4.4 in a ratio, and it makes the judgement quantitative rather than impressionistic.

Taeso 太素

4.4.3

Source원문

黃帝曰, 見眞藏曰死, 何謂也. 岐伯曰, 五藏者, 皆稟氣於胃, 胃者, 五藏之本也. 藏氣者, 不能自致于手太陰, 必因於胃氣, 乃至于手太陰也. 故五藏各以其時自爲, 而至于手太陰也. 邪氣勝者, 精氣衰也, 病甚者, 胃氣不能與之俱至于手太陰, 故眞藏之氣獨見. 獨見者, 病勝藏也. 故曰死. 《內經》

Translation영역

The Yellow Emperor said: seeing the true viscus is called death — what does this mean? Qi Bo said: the five viscera all receive qi from the stomach; the stomach is the root of the five viscera. The qi of a viscus cannot reach the hand greater yin of itself; it must depend on the stomach qi to arrive at the hand greater yin. So each of the five viscera, in its own season, acts of itself and arrives at the hand greater yin. Where the evil qi prevails, the essential qi declines; where the disease is severe, the stomach qi cannot arrive together with it at the hand greater yin, and so the qi of the true viscus appears alone. Appearing alone means the disease has overcome the viscus. Therefore it is called death.

Clinical note임상 주석

The mechanism: the wrist pulse is the hand greater yin, the lung channel, and an organ's qi reaches it only carried by the stomach's. When the organ's quality shows at the wrist unaccompanied, the stomach has failed to carry it — and it is the stomach's failure that the death sentence rests on.

Naegyeong 內經

4.5 The Deficient and Excessive Pulses 損至脉

4.5.1

Source원문

脉有損至, 何謂也. 然, 至之脉, 一呼再至曰平, 三至曰離經, 四至曰奪精, 五至曰死, 六至曰命絶. 此至之脉也. 何謂損, 一呼一至曰離經, 二呼一至曰奪精, 三呼一至曰死, 四呼一至曰命絶. 此損之脉也. 至脉從下上, 損脉從上下. 《難經》

Translation영역

The pulse has deficiency and excess — what does this mean? Well: of the excessive pulse, two beats to one exhalation is level; three is leaving the norm; four is essence seized; five is death; six is life cut off. These are the excessive pulses. What is deficiency? One beat to one exhalation is leaving the norm; one beat to two exhalations is essence seized; one to three is death; one to four is life cut off. These are the deficient pulses. The excessive pulse proceeds from below upward; the deficient pulse from above downward.

Clinical note임상 주석

The Nanjing's scale, and it is a rate table. Two beats per exhalation — about four per full breath — is normal; each step faster or slower has a name and a prognosis. Six per exhalation is roughly 180 a minute; one per four exhalations is about 8. The names are the same in both directions — leaving the norm, essence seized, death, life cut off — which makes the point that too fast and too slow are equally grave.

Nangyeong 難經

4.5.2

Source원문

脉來一呼再至, 一吸再至, 不大不小曰平. 一呼三至, 一吸三至, 爲得病. 一呼四至, 一吸四至, 病欲甚. 一呼五至, 一吸五至, 其人當困. 脉有大小則難治. 一呼六至, 一吸六至, 爲死脉. 沈細夜死, 浮大晝死. 《難經》

Translation영역

A pulse coming twice to an exhalation and twice to an inhalation, neither large nor small, is level. Three to an exhalation and three to an inhalation means illness contracted. Four and four, the illness is about to grow severe. Five and five, the person will be exhausted; if the pulse varies in size, it is hard to treat. Six and six is a death pulse — sunken and fine, death at night; floating and large, death by day.

Nangyeong 難經

4.5.3

Source원문

一呼一至, 一吸一至, 名曰損. 人雖能行, 猶當着床, 盖血氣皆不足也. 再呼一至, 再吸一至, 名曰無魂. 無魂者, 當死. 人雖能行, 名曰行屍. 《難經》

Translation영역

One beat to an exhalation and one to an inhalation is called deficient; though the person can walk, they should keep to the bed, for blood and qi are both insufficient. One beat to two exhalations and one to two inhalations is called soulless; the soulless will die, and though they can walk, they are called a walking corpse.

Clinical note임상 주석

行屍, the walking corpse — a person on their feet whose pulse says they are already dead. The Nanjing uses the phrase for extreme bradycardia, and the Fire chapter borrows it at 5.24 for the pulse of a patient with no stomach qi. A pulse of one beat to two breaths is a rate of about 8, which is complete heart block. The patient may indeed still be walking.

Nangyeong 難經

4.5.4

Source원문

上部有脉, 下部無脉, 其人當吐, 不吐者死. 上部無脉, 下部有脉, 雖困無能爲害. 所以然者, 人之有足, 比如樹之有根, 枝葉雖枯槁, 根本將自生. 脉有根本, 人有元氣, 故知不死. 《難經》

Translation영역

Where there is a pulse in the upper position and none in the lower, that person should vomit, and if they do not vomit they die. Where there is no pulse in the upper position and a pulse in the lower, though they are exhausted no harm can come. The reason is that a person's having feet is like a tree's having roots; though the branches and leaves wither, the root will bring forth of itself. Where the pulse has a root, the person has origin qi, and so it is known they will not die.

Clinical note임상 주석

The passage the Vomiting chapter takes as its foundation at To 6.11 and the Internal Damage chapter cites at 1.37.1. A pulse present at the wrist and gone at the cubit means the root has been cut — and a pulse gone at the wrist but present at the cubit means the root survives. The tree image is the chapter's clearest statement of what the cubit position means: it is where the reserve is felt.

Nangyeong 難經

4.6 The Pulse Leaving the Norm 離經脉

4.6.1

Source원문

一呼六至, 曰離經, 一呼一至, 亦曰離經. 經者, 常也. 經脉周而復始, 從初起之經再起. 今因胎墜, 胃脉已離常絡之處, 不從所起之經再起, 故曰離經. 《入門》

Translation영역

Six beats to an exhalation is called leaving the norm, and one beat to an exhalation is also called leaving the norm. The norm is the constant. The channel pulse goes round and begins again, rising again from the channel where it first rose. Now because the foetus has descended, the stomach pulse has already left its constant network and does not rise again from the channel where it rose, and so it is called leaving the norm.

Immun 入門

4.6.2

Source원문

一呼一至曰損脉離經, 一呼六至曰至脉離經. 離經二脉, 惟將産婦及陰陽易病有之. 《活人》

Translation영역

One beat to an exhalation is the deficient pulse leaving the norm; six beats to an exhalation is the excessive pulse leaving the norm. These two pulses of leaving the norm are found only in a woman about to give birth and in the disease of yin-yang exchange.

Clinical note임상 주석

The pulse of imminent labour, which the Women chapter uses at 1.18.1 and gives its twelve-hour timing. Here it is defined: a rate that has left its constant in either direction, and found in only two conditions. 陰陽易, yin-yang exchange, is the Shanghan tradition's name for a relapse contracted by intercourse during recovery from a fever.

Hwarinseo 活人

4.7 The Pulses of the Southern and Northern Administrations 南北政脉

4.7.1

Source원문

詳見運氣.

Translation영역

Treated in fuller detail in the Five Movements and Six Qi chapter.

Clinical note임상 주석

The calendrical scheme that 4.1 depends on — in certain years the cubit pulses read reversed, and a physician who does not know which year it is misreads them. The Bogam keeps the heading here and sends the reader to the chapter that has the tables.

Donguibogam · Jinmaek

4.8 The Stopping and Intermittent Pulses Fix the Time of Death 止代脉定死期

4.8.1

Source원문

所謂五十營者, 五藏皆受氣. 持其寸口, 數其至也. 五十動而不一代者, 五藏皆受氣也. 四十動一代者, 一藏無氣, 三十動一代者, 二藏無氣, 二十動一代者, 三藏無氣, 十動一代者, 四藏無氣, 不滿十動一代者, 五藏無氣, 予之短期. 《靈樞》

Translation영역

What is called the fifty circuits means the five viscera all receiving qi. Hold the inch opening and count its beats. Fifty beats without one intermission means all five viscera receive qi. Forty beats and one intermission means one viscus without qi; thirty and one, two viscera without qi; twenty and one, three viscera; ten and one, four viscera; fewer than ten and one, all five viscera without qi — and a short term is given.

Clinical note임상 주석

The Lingshu's rule, and it is a counting method: fifty beats without a skip is health, and each ten fewer before the skip means one more organ has failed. The section that follows converts the count into years. What is being counted is the frequency of dropped beats, and the observation that more frequent dropping is graver holds. The organ-by-organ assignment does not.

Yeongchu 靈樞

4.8.2

Source원문

人吸者隨陰入, 呼者因陽出. 今吸不能至腎, 至肝而還, 故知一藏無氣者, 腎氣先盡也. 《靈樞》

Translation영역

A person's inhalation follows the yin inward; exhalation goes out by the yang. Now where the inhalation cannot reach the kidney but reaches the liver and returns, it is known that the one viscus without qi is the kidney, whose qi is exhausted first.

Yeongchu 靈樞

4.8.3

Source원문

太衍以五十數爲極. 滿五十動而一止, 或不止者, 無病也. 四十動後一止者, 是腎先絶, 四年而死. 三十動後一止, 腎肝無氣, 三年而死. 二十動後一止, 腎肝心無氣, 二年而死. 十五動後一止, 腎肝心脾無氣, 一年而死. 《入門》

Translation영역

The great expansion takes fifty as its limit. A full fifty beats and one stop, or no stop at all, is no disease. A stop after forty beats means the kidney is cut off first — death in four years. After thirty, kidney and liver without qi — three years. After twenty, kidney, liver and heart — two years. After fifteen, kidney, liver, heart and spleen — one year.

Clinical note임상 주석

太衍, the great expansion, is the Yi's number fifty, and the whole scheme rests on it. Forty beats to a skip gives four years, thirty gives three, and so down — the years are the tens. The prognosis is numerological and should not be applied. What the chapter is recording is that intermittent pulses were watched over years, and that the interval between skips was held to shorten as the patient declined.

Immun 入門

4.8.4

Source원문

一動一止, 兩日死, 兩動一止, 四日死, 三動一止, 六日死, 四動一止, 八日死, 五動一止, 十日死, 十動一止, 一年死. 《入門》

Translation영역

One beat and a stop, death in two days; two beats and a stop, four days; three and a stop, six days; four and a stop, eight days; five and a stop, ten days; ten and a stop, one year.

Clinical note임상 주석

The lower end of the same scale, where the intermission comes every few beats and the count is in days. A pulse that stops every second beat is bigeminy, and in a dying patient it does mean days rather than years.

Immun 入門

4.8.5

Source원문

代者, 止也. 一藏絶, 他藏代至, 眞死脉也. 《三因》

Translation영역

Intermittent means stopping. One viscus cut off and another viscus arriving in its place — this is a true death pulse.

Samin 三因

4.8.6

Source원문

促結二脉, 爲邪碍而歇止也. 脉促手足厥逆者, 可灸之. 脉乍結手足厥冷者, 當吐之, 宜瓜蔕散方見吐門. 灸之吐之, 所以逐去其邪也. 《仲景》

Translation영역

The skipping and bound pulses are the evil obstructing so that the pulse pauses. Where the pulse skips and the hands and feet are reverse-cold, moxa may be used. Where the pulse is suddenly bound and the hands and feet are cold, ejecting should be used — Melon Stalk Powder formula in the Vomiting chapter. Moxa and ejecting are the means of driving off the evil.

Clinical note임상 주석

Two pausing pulses that are not death pulses, and the distinction 4.9 will draw in full. A pause from obstruction is treated by removing the obstruction — moxa or vomiting — because the force between pauses shows the spirit is still there.

Junggyeong 仲景

4.8.7

Source원문

其促有五, 一曰氣, 二曰血, 三曰飮, 四曰食, 五曰痰. 但藏熱則脉促, 以氣血痰飮留滯不行故也. 促結, 非惡脉也. 《三因》

Translation영역

The skipping pulse is of five kinds: the first is qi, the second blood, the third rheum, the fourth food, the fifth phlegm. Where the viscera are hot the pulse skips, because qi, blood, phlegm or rheum are lodged and do not move. Skipping and bound are not evil pulses.

Clinical note임상 주석

促結, 非惡脉也 — skipping and bound are not evil pulses. The section's most important sentence, set against the rest: a pause with five ordinary causes is a pause to be treated, not a death to be counted.

Samin 三因

4.8.8

Source원문

不因病而羸瘦, 脉有止曰代. 其脉往來緩, 動而中止, 不能自還, 因而復動, 名曰代. 代, 眞死脉也. 《活人》

Translation영역

Wasting and thinness without illness, with a pulse that stops — this is called intermittent. The pulse comes and goes slowly, beats and stops midway, cannot return of itself, and then beats again; this is called intermittent. Intermittent is a true death pulse.

Clinical note임상 주석

不能自還 — cannot return of itself — is what separates 代 from 促 and 結. The other two pause and recover; this one pauses and the next beat comes only after a delay, as though from somewhere else. The Samin's 4.8.5 says the same: another viscus arriving in its place. A pause that the pulse cannot recover from on its own is an escape rhythm, and the chapter's description of it is exact.

Hwarinseo 活人

4.8.9

Source원문

代者, 脾絶之脉. 脾脉者, 平和不可得見, 衰乃見耳. 如雀之啄, 如屋漏水之下滴, 是脾之衰見也. 《難經》

Translation영역

Intermittent is the pulse of the spleen cut off. The spleen pulse in health cannot be seen; only in decline does it appear. Like a sparrow pecking, like the drip of water from a leaking roof — this is the spleen's decline appearing.

Clinical note임상 주석

The sparrow and the roof are two of the ten strange pulses at 4.25, and the Nanjing gives them here as the signs of the spleen failing. The spleen's healthy pulse is invisible because it is the stomach qi of 4.3 — the quality that cannot be named — and it shows only when it goes.

Nangyeong 難經

4.8.10

Source원문

傷寒脉結代, 心動悸, 灸甘草湯主之方見下. 若暴損氣血, 以至元氣不續而止, 可治之以人參黃芪湯方見脉部. 《脉訣》

Translation영역

In cold damage with a bound and intermittent pulse and the heart stirring with palpitation, Mix-Fried Licorice Decoction governs it formula below. Where qi and blood are suddenly detrimented so that the origin qi does not continue and stops, it may be treated with Ginseng and Astragalus Decoction formula in the Pulse chapter.

Clinical note임상 주석

Zhongjing's formula for the irregular pulse with palpitation — Jagamcho-tang, the tradition's standing prescription for arrhythmia — and the section closes on it rather than on a death count. Not every intermittent pulse is fatal; some are treated.

Maekgyeol 脉訣

4.9 The Rough, Skipping, Bound and Intermittent Pulses All Stop Midway 濇促結代脉皆中止

4.9.1

Source원문

濇脉, 細而遲, 往來難, 時一止. 然三秋診得濇, 爲秋正脉. 右手寸口浮短而濇, 爲肺正脉, 非病脉也. 《脉訣》

Translation영역

The rough pulse is fine and slow, difficult in its coming and going, stopping once from time to time. But a rough pulse found in the three months of autumn is the proper pulse of autumn; and at the right inch opening a pulse floating, short and rough is the proper pulse of the lung, not a diseased pulse.

Clinical note임상 주석

Four pulses that all pause, sorted. The rough pulse pauses irregularly and is normal in autumn and at the lung position — 4.1's warning about seasonal pulses applied to a specific case.

Maekgyeol 脉訣

4.9.2

Source원문

脉來緩時一止復來, 名曰結. 脉來數時一止復來, 名曰促. 陽盛則促, 陰盛則結, 此皆病脉. 《仲景》

Translation영역

A pulse coming slowly that stops once and comes again is called bound. A pulse coming rapidly that stops once and comes again is called skipping. Where yang is exuberant it skips; where yin is exuberant it is bound. These are both diseased pulses.

Clinical note임상 주석

The definition the tradition uses: a slow pulse with a pause is 結, a fast pulse with a pause is 促. Both recover — 復來, comes again — which is what separates them from the intermittent pulse of 4.8, which cannot. Four pulses, then, on a scale: the rough pauses and is normal; bound and skipping pause and recover and are disease; intermittent pauses and does not recover and is death.

Junggyeong 仲景

4.10 Yin and Yang Pulses 陰陽脉

4.10.1

Source원문

凡脉大浮數動滑, 此名陽也. 沈濇弱弦微, 此名陰也. 凡陰病見陽脉者, 生, 陽病見陰脉者, 死. 《仲景》

Translation영역

Large, floating, rapid, stirring and slippery — these are called yang. Sunken, rough, weak, stringlike and faint — these are called yin. Where a yin disease shows a yang pulse, life; where a yang disease shows a yin pulse, death.

Clinical note임상 주석

Ten pulses sorted into two, and a rule of prognosis: the pulse should match the disease, and a mismatch that shows the yang holding up is good while one that shows it failing is not. The Cold Damage chapter applies this throughout.

Junggyeong 仲景

4.11 The Ravaging Pulses 殘賊脉

4.11.1

Source원문

脉有殘賊, 何謂也. 師曰, 脉有弦緊浮滑沈濇, 此六者, 名曰殘賊, 能爲諸經作病也. 《仲景》

Translation영역

The pulse has ravagers — what does this mean? The master said: the pulse has stringlike, tight, floating, slippery, sunken and rough; these six are called ravagers, and can make disease in all the channels.

Junggyeong 仲景

4.12 The Crossed Pulse 互脉

4.12.1

Source원문

人有寸關尺三部之脉, 按之絶無形跡, 而移於手陽明經陽谿與合谷之地動者何歟. 曰手太陰肺與手陽明大腸, 一藏一府相爲表裏, 其列缺穴乃二經之絡脉, 故脉從絡而出於陽明之經. 此爲妻乘夫位, 地天交泰生成, 無病之脉. 名曰互脉. 《正傳》

Translation영역

Some people have no trace at all of a pulse at the three positions of inch, bar and cubit, and instead it beats moved to the ground of Yanggye (陽谿, LI5) and Hapgok (合谷, LI4) on the hand yang brightness channel — how is this? The answer: the hand greater yin lung and the hand yang brightness large intestine are one viscus and one bowel, exterior and interior to each other, and the point Yeolgyeol (列缺, LU7) is the network vessel of the two channels; so the pulse follows the network and comes out on the yang brightness channel. This is the wife riding the husband's seat, earth and heaven intercoursing in peace and engendering — a pulse of no disease. It is called the crossed pulse.

Clinical note임상 주석

The radial artery running on the back of the wrist rather than the front — an anatomical variant the tradition called the reversed-bar pulse, and which is real. The chapter's explanation, that it has crossed from the lung channel to the large intestine channel by their connecting point, follows the channel map exactly. 無病之脉 — a pulse of no disease. The chapter is careful to say that a pulse in the wrong place is not a pulse that is wrong.

Jeongjeon 正傳

4.13 The Refined and Eminent Without a Pulse 淸高無脉

4.13.1

Source원문

淸高貴人, 有兩手俱無脉者, 有左小右大, 左大右小者, 有反關脉者, 當審辨之. 《入門》

Translation영역

Among the refined, eminent and noble there are some with no pulse at either hand, some with the left small and the right large or the left large and the right small, and some with the reversed-bar pulse; these must be examined and distinguished.

Clinical note임상 주석

The same variants as 4.12 listed for a class of patient the physician would meet at court and could not afford to misread. The point is practical: absence at the usual place is sometimes anatomy, and the physician who declares a healthy man dying will not keep his post.

Immun 入門

4.14 In Any Grave Illness, Taegye and Chungyang Must Be Examined 凡病革必診太谿衝陽

4.14.1

Source원문

傷寒賦云, 有根有本, 必診太谿衝陽. 盖太谿, 是足少陰腎之經. 男子以右腎爲命門, 女子以左腎爲命門, 主生死之要. 病人有命門脉卽活, 無卽死.

Translation영역

The Cold Damage Rhapsody says: having root and having origin — Taegye and Chungyang must be examined. Taegye is the channel of the foot lesser yin kidney; a man takes the right kidney as the gate of life and a woman the left, and it governs the essentials of life and death. Where the patient has the gate-of-life pulse he lives; where it is absent he dies.

Clinical note임상 주석

Taegye (太谿, KI3) is behind the inner ankle, where the posterior tibial artery is felt, and Chungyang (衝陽, ST42) is on the top of the foot over the dorsalis pedis. The section says that in a grave illness these two must be examined regardless of what the wrist shows. Peripheral pulses at the foot are what fail first in circulatory collapse, and a physician who checked them would have caught a shock that the wrist still concealed. This is the chapter's most directly useful instruction.

Hwarinseo 活人

4.14.2

Source원문

衝陽, 是足陽明胃之經. 人受氣於穀, 穀入於胃, 乃傳與五藏六府. 藏府皆受氣於胃. 胃爲水穀之海, 主稟四時, 皆以胃氣爲本. 是謂四時之變病, 生死之要會, 故必診之, 以察胃之有無也. 《活人》

Translation영역

Chungyang is the channel of the foot yang brightness stomach. A person receives qi from grain; grain enters the stomach and is passed on to the five viscera and six bowels. The viscera and bowels all receive qi from the stomach; the stomach is the sea of water and grain, governs what the four seasons provide, and everything takes stomach qi as its root. This is what is called the changing disease of the four seasons and the essential meeting of life and death; therefore it must be examined, to see whether the stomach is present or absent.

Clinical note임상 주석

The two ankle pulses divided between the two roots the chapter has named: Taegye for the kidney and origin qi, Chungyang for the stomach and grain qi. 4.16 says what to conclude when the wrist is level and these are gone.

Hwarinseo 活人

4.15 A Large Pulse Means the Disease Advances 脉大病進

4.15.1

Source원문

內經曰, 大則病進. 盖大者, 洪之別名, 火之象也. 其病得之於內傷者, 陰虛爲陽所乘, 故脉大當作陰虛治之. 其病得之於外傷者, 邪客於經絡亦大, 當作邪勝治之. 合二者而觀, 則皆病證方長之勢也. 謂之病進, 不亦宜乎. 《東垣》

Translation영역

The Neijing says: large means the disease advances. Large is another name for surging, and it is the image of fire. Where the disease is got from internal damage, the yin is vacuous and ridden by the yang, and so a large pulse should be treated as yin vacuity. Where the disease is got from external damage, the evil lodged in the channels also makes it large, and it should be treated as the evil prevailing. Looking at the two together, both are the disease pattern in the momentum of its growing. To call it the disease advancing — is that not fitting?

Clinical note임상 주석

A large pulse is a bad sign whatever its cause, and Dongwon gives the two causes and the two treatments. The Women chapter's 1.30 applies this to the postpartum pulse, where a large pulse in a woman who should be depleted is the sign that something is wrong.

Dongwon 東垣

4.16 The Inch-Opening Pulse Level and Yet Death 寸口脉平猶死

4.16.1

Source원문

難經曰, 寸口脉平而死者, 何謂也. 然十二經脉者, 皆係於生氣之原. 所謂生氣之原者, 謂十二經脉之根本也. 謂腎間動氣也. 此五藏六府之本, 十二經脉之根, 呼吸之門, 三焦之原, 一名守邪之神. 故氣者, 人之根本也. 根絶則莖葉枯矣. 寸口脉平而死者, 生氣獨絶於內也.

Translation영역

The Nanjing says: the inch-opening pulse level and yet death — what does this mean? Well: the twelve channels are all bound to the origin of engendering qi. What is called the origin of engendering qi means the root of the twelve channels — the stirring qi between the kidneys. This is the root of the five viscera and six bowels, the root of the twelve channels, the gate of breathing, the origin of the three burners, also called the spirit that guards against evil. Hence qi is a person's root; where the root is cut off the stem and leaves wither. The inch-opening pulse level and yet death is the engendering qi alone cut off within.

Nangyeong 難經

4.16.2

Source원문

腎間動氣, 謂臍下氣海丹田之地也. 丹田氣海與腎脉相通, 爲腎之根也. 或曰, 寸口旣平, 奚疑其死乎. 曰此爲病劇形脫者論耳. 內經曰, 形肉已脫, 九候雖調猶死. 凡人病劇, 大肉已脫, 雖六脉平和, 尤當診候足陽明之衝陽ㆍ足少陰之太谿. 二脉或絶, 更候臍下腎間之動氣, 其或動氣未絶, 猶有可生之理. 動氣已絶, 雖三部脉平和, 其死無疑矣. 《正傳》

Translation영역

The stirring qi between the kidneys means the ground of the sea of qi and the cinnabar field below the navel. The cinnabar field and sea of qi communicate with the kidney vessel and are the kidney's root. Someone asks: if the inch opening is already level, why suspect death? The answer: this is spoken of the gravely ill whose form has deserted. The Neijing says: where the form and flesh have already deserted, though the nine indicators be in order it is still death. Wherever a person is gravely ill and the great flesh has already deserted, though the six pulses be level and harmonious, one must the more examine Chungyang of the foot yang brightness and Taegye of the foot lesser yin. If these two pulses have gone, examine further the stirring qi between the kidneys below the navel; if that stirring qi has not yet gone, there is still a principle by which they may live. Where the stirring qi has already gone, though the pulse at all three positions be level and harmonious, death is beyond doubt.

Clinical note임상 주석

A protocol for the patient whose wrist pulse is misleading: look at the body first — if the flesh has wasted, the wrist is not to be trusted — then the ankle pulses, then the abdominal aorta below the navel. Only when all three are gone is the level wrist pulse overruled. The order is right. A cachectic patient can keep a radial pulse while the peripheral and central circulation are failing, and the chapter says to look further before believing the wrist.

Jeongjeon 正傳

4.17 The Pulse Agrees but the Disease Is Contrary 脉從病反

4.17.1

Source원문

黃帝曰, 脉從而病反者, 其診何如. 岐伯曰, 脉至而從, 按之不鼓, 諸陽皆然. 註曰, 病熱而脉數, 按之不動, 乃寒盛格陽而致之, 非熱也.

Translation영역

The Yellow Emperor said: where the pulse agrees but the disease is contrary, how is it examined? Qi Bo said: the pulse arrives and agrees, but pressing it there is no drumming — all the yang are so. The commentary says: the disease is hot and the pulse rapid, but on pressing it does not move; this is cold exuberant and blocking the yang, and it is not heat.

Naegyeong 內經

4.17.2

Source원문

帝曰, 諸陰之反, 其脉何如. 岐伯曰, 脉至而從, 按之鼓甚而盛也. 註曰, 形證是寒, 按之而脉氣鼓擊於指下盛者, 此謂熱盛拒陰而生病, 非寒也. 《內經》

Translation영역

The Emperor said: the contrariness of all the yin — how is its pulse? Qi Bo said: the pulse arrives and agrees, but pressing it there is strong drumming and exuberance. The commentary says: the form and pattern are cold, but on pressing the pulse qi drums and strikes strongly under the finger; this is heat exuberant and repelling the yin so that disease arises, and it is not cold.

Clinical note임상 주석

The test is pressure. A hot patient with a fast pulse that collapses under the finger is cold underneath; a cold patient with a pulse that beats harder under pressure is hot underneath. The Fire chapter's 5.15 and 5.16 — fire at its extreme resembling water — are the clinical face of this, and the pulse is how they are told apart. Two grades of pressure, light and heavy, and the difference between them is the finding. That is the same method the Fire chapter uses at 5.4 to locate heat by depth.

Naegyeong 內經

4.18 The Pulse Cut Off and Not Seen 脉絶不見

4.18.1

Source원문

脉絶者, 陽入于地中也. 脉者, 如地中溝渠也. 通達諸經, 灌漑一體. 陽氣鼓舞而行之, 陽不行則脉不動矣. 是乃陰離而不守, 故大小便皆爲之不禁. 內溫之外灸之, 幷行而不可緩. 溫之四逆湯輩方見寒門, 灸之臍下氣海穴, 是也. 《海藏》

Translation영역

The pulse cut off is the yang entered into the ground. The pulse is like the ditches and channels in the ground, reaching through all the channels and irrigating the whole body. The yang qi drums and rouses it to move; where the yang does not move the pulse does not beat. This is the yin parted and not keeping guard, and so stool and urine both escape uncontrolled. Warm within and moxa without, both together and without delay — warming with Four Counterflows Decoction formula in the Cold Damage chapter and its kind, and moxa at Gihae (氣海, CV6) below the navel. That is it.

Clinical note임상 주석

A pulse that has stopped with incontinence is circulatory collapse, and the chapter's response is the right kind — warm and stimulate, both at once, without delay. Sayeok-tang is aconite, dry ginger and licorice, the tradition's standing remedy for cold collapse. **Absence of pulse with loss of sphincter control is cardiac arrest or profound shock and requires immediate resuscitation.**

Haejang 海藏

4.18.2

Source원문

病人或無脉, 若有痛處, 當知痛甚者, 脉必伏, 如無痛證而脉不來者, 死. 傷寒陰證無脉, 薑酒半盞服之. 《入門》

Translation영역

Where a patient has no pulse, if there is a place of pain, it should be known that where the pain is severe the pulse will surely be hidden; but where there is no painful pattern and the pulse does not come, death. In the yin pattern of cold damage without a pulse, half a cup of ginger wine is taken.

Clinical note임상 주석

Severe pain hides the pulse and is not death. The distinction matters because a patient in agony may be pulseless from the pain alone, and a physician who reads it as collapse treats the wrong thing.

Immun 入門

4.18.3

Source원문

一手無脉, 謂之單伏. 兩手無脉, 謂之雙伏. 雜病得之則危. 傷寒脉伏, 因寒邪鬱閉其脉. 冬月, 麻黃湯, 三時, 羌活冲和湯以汗之. 不可誤爲陽得陰脉. 《入門》

Translation영역

No pulse at one hand is called single hiding; no pulse at both hands is called double hiding. Got in miscellaneous disease, it is critical. A hidden pulse in cold damage is the cold evil depressing and shutting the pulse; in winter, Ephedra Decoction, and in the other three seasons, Notopterygium Harmonize the Centre Decoction, to sweat it. It must not be mistaken for a yang disease getting a yin pulse.

Clinical note임상 주석

A third pulseless state that is not collapse: cold locking the surface in an acute fever, treated by sweating. The section thus has three causes for an absent pulse — collapse, pain, and cold — and three opposite treatments, and the last line warns against mistaking the third for the first.

Immun 入門

4.19 Examination Has Light and Heavy 診有輕重

4.19.1

Source원문

凡診脉, 以指按之, 如三菽之重, 與皮膚相得者, 肺氣也. 如六菽之重, 與血脉相得者, 心氣也. 如九菽之重, 與肌肉相得者, 脾氣也. 如十二菽之重, 與筋平者, 肝氣也. 如十五菽之重, 按之至骨者, 腎氣也. 《仲景》

Translation영역

In examining the pulse, pressing with the finger at the weight of three beans, meeting the skin, is the lung qi; at the weight of six beans, meeting the blood vessels, the heart qi; at nine beans, meeting the flesh, the spleen qi; at twelve beans, level with the sinews, the liver qi; at fifteen beans, pressing to the bone, the kidney qi.

Clinical note임상 주석

Five depths of pressure measured in beans, each finding one organ. The same scheme the Fire chapter applies to heat at 5.4 — skin for the lung, just under it for the heart, mid-flesh for the spleen, deep for the liver, at the bone for the kidney — and here it is the examining finger's own gradation. The bean is a unit of pressure the tradition took literally: a pea's weight, then two, then three. Whatever the calibration, the practice of feeling at graded depths is the whole technique.

Junggyeong 仲景

4.20 The Pulses of Old and Young, Men and Women Differ 老少男女異脉

4.20.1

Source원문

老者之脉, 陽羸陰强爲順, 陰弱陽强爲逆, 陰陽謂左右也. 《直指》

Translation영역

In the pulse of the old, the yang weak and the yin strong is favourable; the yin weak and the yang strong is contrary. Yin and yang mean left and right.

Jikji 直指

4.20.2

Source원문

大人得小兒脉, 不治. 《直指》

Translation영역

An adult with a child's pulse is not treated.

Jikji 直指

4.20.3

Source원문

小兒之脉, 一息六七至爲平和, 八九至爲熱, 四五至爲寒. 《丹心》

Translation영역

In a child's pulse, six or seven beats to a breath is level and harmonious, eight or nine is heat, four or five is cold.

Clinical note임상 주석

A child's normal rate is faster than an adult's — six or seven per breath against the adult's four — and the chapter says so. An adult with a child's rate is therefore tachycardic, and 4.20.2 calls that untreatable. The observation is correct: resting heart rate falls through childhood, and a sustained adult rate of 100 or more is a sign of illness.

Dansim 丹心

4.20.4

Source원문

男左女右者, 地之定位也. 盖人立形於地, 故從地化也. 男子左脉强而右脉弱, 女子右脉强而左脉弱. 男子得陽氣多, 故左脉盛, 女子得陰氣多, 故右脉盛. 男以左尺爲精府, 女以右尺爲血海, 此天地之神化也. 《入門》

Translation영역

Left for a man and right for a woman is the fixed position of earth; a person establishes their form on the earth and so follows the earth's transformation. A man's left pulse is strong and the right weak; a woman's right pulse is strong and the left weak. A man receives more yang qi and so the left pulse is exuberant; a woman receives more yin qi and so the right pulse is exuberant. A man takes the left cubit as the mansion of essence, a woman the right cubit as the sea of blood — this is the spirit-like transformation of heaven and earth.

Clinical note임상 주석

The left-male right-female rule that the Women chapter's sex-prediction tests at 1.9 rest on. Here it is stated as a general fact of the pulse, and the Women chapter's 1.9.1.5 is Danxi doubting it.

Immun 入門

4.20.5

Source원문

肺主氣居右. 男以氣爲主, 男子病右脉充於左者, 有胃氣也. 病雖重可治. 心主血居左. 女以血爲主, 女子病左脉充於右者, 有胃氣也, 病雖重可治. 《丹心》

Translation영역

The lung governs qi and dwells on the right; a man takes qi as his mainstay, and where a sick man's right pulse is fuller than his left, there is stomach qi, and though the disease be heavy it can be treated. The heart governs blood and dwells on the left; a woman takes blood as her mainstay, and where a sick woman's left pulse is fuller than her right, there is stomach qi, and though the disease be heavy it can be treated.

Clinical note임상 주석

Danxi turns the rule to prognosis and, characteristically, reverses it: a man whose right pulse is the stronger is doing well, because the right is the lung and qi and qi is what a man depends on. The healthy side is the one that is not supposed to be strong.

Dansim 丹心

4.20.6

Source원문

室女尼冠, 脉當濡而弱. 《東垣》

Translation영역

In an unmarried girl, a nun or a priestess, the pulse should be soggy and weak.

Clinical note임상 주석

The pulse of the celibate given as a norm, and the Women chapter's 1.36 treats the diseases of the same women. Dongwon's point is that a soft pulse in such a patient is not a finding.

Dongwon 東垣

4.21 The Pulses of Fat and Thin, Tall and Short Differ 肥瘦長短異脉

4.21.1

Source원문

凡脉肥人責浮, 瘦人責沈. 肥人當沈今反浮, 瘦人當浮今反沈, 故責之. 盖肥人肌膚厚故脉沈, 瘦人肌膚薄故脉浮. 《仲景》

Translation영역

In the pulse, a fat person is faulted for floating and a thin person for sinking. A fat person should be sunken, and is now floating instead; a thin person should be floating, and is now sunken instead — that is why they are faulted. For a fat person's flesh is thick and so the pulse is sunken; a thin person's flesh is thin and so the pulse is floating.

Clinical note임상 주석

The finding depends on the body it is found in. A floating pulse is normal in a thin wrist and abnormal in a fat one, because the artery lies at different depths under different thicknesses of flesh — and that is the plain anatomical reason the chapter gives.

Junggyeong 仲景

4.21.2

Source원문

肥人肉厚, 脉宜沈結, 瘦人肉薄, 脉宜浮長. 《入門》

Translation영역

A fat person's flesh is thick and the pulse should be sunken and bound; a thin person's flesh is thin and the pulse should be floating and long.

Immun 入門

4.21.3

Source원문

人形短脉亦短, 形長脉亦長. 反此則凶. 《入門》

Translation영역

A short person's pulse is also short; a tall person's pulse is also long. The reverse is inauspicious.

Immun 入門

4.21.4

Source원문

人性緩脉亦緩, 性急脉亦急. 反則病. 《正傳》

Translation영역

A person of slow temper has a slow pulse; one of quick temper a quick pulse. The reverse is disease.

Clinical note임상 주석

Four lines that say one thing: the pulse is read against the person, not against a standard. Build, height, temperament — each shifts what counts as normal, and 4.20 added age and sex. A physician who has not looked at the patient cannot read their wrist.

Jeongjeon 正傳

4.22 The Guiding Principles of All the Pulses 諸脉綱領

4.22.1

Source원문

凡脉, 博之則二十七種. 約之則浮沈遲數滑澁細大爲八要. 又約之則爲浮沈遲數, 又至約則爲浮中沈. 是知浮沈遲數四脉, 眞千古要妙也. 《入門》

Translation영역

The pulses, broadly taken, are twenty-seven kinds. Summarized, floating, sunken, slow, rapid, slippery, rough, fine and large are the eight essentials. Summarized further, they are floating, sunken, slow and rapid; and at the utmost summary, floating, middle and sunken. From this it is known that the four pulses floating, sunken, slow and rapid are truly the essential subtlety of all ages.

Clinical note임상 주석

Twenty-seven pulses reduced to eight, to four, to three. The four — depth and rate — are what the chapter has actually been using: 4.5 is rate, 4.19 is depth, 4.17 is depth under pressure. The catalogue of twenty-seven is in the Pulse chapter; this chapter works with the four.

Immun 入門

4.23 The Disease Patterns of All the Pulses 諸脉病證

4.23.1

Source원문

內經曰, 脉者, 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, 代則氣衰, 細則氣少, 濇則心痛.

Translation영역

The Neijing says: the pulse is the mansion of the blood. Long, the qi is in order; short, the qi is diseased. Rapid, the heart is vexed; large, the disease advances. Exuberant above, the qi is high; exuberant below, the qi is distended; intermittent, the qi declines; fine, the qi is scant; rough, the heart pains.

Naegyeong 內經

4.23.2

Source원문

麄大者, 陰不足陽有餘, 爲熱中也. 《內經》

Translation영역

Coarse and large is the yin insufficient and the yang in surplus — heat in the centre.

Naegyeong 內經

4.23.3

Source원문

風熱而脉靜, 泄而脫血脉實, 病在中脉虛, 病在外脉濇堅者, 皆難治. 《內經》

Translation영역

Wind heat with a quiet pulse; diarrhoea and blood loss with a replete pulse; disease in the centre with a vacuous pulse; disease without with a rough and hard pulse — all are hard to treat.

Clinical note임상 주석

Four mismatches between disease and pulse, each hard to treat because the pulse is going the wrong way. The rule of 4.10 — that the pulse should match the disease — given in its four commonest failures.

Naegyeong 內經

4.23.4

Source원문

寸口脉沈而堅者, 曰病在中, 浮而盛者, 曰病在外. 脉盛滑堅者, 病在外, 脉小實而堅者, 病在內. 《內經》

Translation영역

The inch-opening pulse sunken and hard is called disease in the centre; floating and exuberant is called disease without. A pulse exuberant, slippery and hard is disease without; small, replete and hard is disease within.

Naegyeong 內經

4.23.5

Source원문

靈樞曰, 血脫者, 脉空虛. 氣虛則脉弦, 血虛則脉大.

Translation영역

The Lingshu says: where blood has been lost the pulse is empty and vacuous. Where qi is vacuous the pulse is stringlike; where blood is vacuous the pulse is large.

Clinical note임상 주석

血虛則脉大 — where blood is vacuous the pulse is large. The counterintuitive one, and it is the basis of Dongwon's Danggwibohyeol-tang: a large surging pulse in a patient who is actually empty, because the vessels are open and there is nothing in them to slow the flow.

Yeongchu 靈樞

4.23.6

Source원문

脉病人不病, 名曰行尸. 以無正氣, 卒眩仆不識人, 短命則死. 人病脉不病, 名曰內虛. 以有正氣, 雖困無苦. 《仲景》

Translation영역

The pulse diseased and the person not diseased is called the walking corpse; with no right qi, they suddenly fall dizzy and know no one, and being short-lived they die. The person diseased and the pulse not diseased is called internal vacuity; with right qi present, though they are exhausted they suffer no harm.

Clinical note임상 주석

The walking corpse again, now defined against its opposite. A bad pulse in a well-looking person is worse than a bad-looking person with a good pulse, because the pulse is the reserve and the appearance is only the surface.

Junggyeong 仲景

4.23.7

Source원문

寸口脉諸微亡陽, 諸濡亡血. 緊則爲寒, 浮則爲風, 數則爲熱, 動則爲痛. 《仲景》

Translation영역

At the inch opening, all faint pulses are yang lost and all soggy pulses are blood lost. Tight is cold, floating is wind, rapid is heat, stirring is pain.

Junggyeong 仲景

4.23.8

Source원문

風則浮虛, 寒則牢堅, 沈潛水蓄, 支飮急弦, 動則爲痛, 數則熱煩. 《仲景》

Translation영역

Wind is floating and vacuous; cold is firm and hard; sunken and submerged is water amassed; propping rheum is urgent and stringlike; stirring is pain; rapid is heat and vexation.

Junggyeong 仲景

4.23.9

Source원문

脉大而堅者, 血氣俱實, 脉小者, 血氣俱虛, 脉大者, 血氣俱多, 脉細微者, 血氣俱虛. 《脉經》

Translation영역

A pulse large and hard is blood and qi both replete; small, both vacuous; large, both abundant; fine and faint, both vacuous.

Maekgyeong 脉經

4.23.10

Source원문

寸口脉瞥瞥如羹上肌者, 陽氣微言浮而無力也. 縈縈如蜘蛛絲者, 陰氣衰言細而無力也. 綿綿如瀉漆之絶者, 亡其血也. 《脉經》

Translation영역

An inch-opening pulse fleeting like the skin on broth is the yang qi faint meaning floating and without force. Wavering like a spider's thread is the yin qi declined meaning fine and without force. Trailing like the last drip of poured lacquer is the blood lost.

Clinical note임상 주석

Three images for three failing pulses, and the glosses say what each means in the chapter's own terms — floating without force, fine without force. The skin on broth and the spider's thread are the two most-quoted pulse images in the tradition.

Maekgyeong 脉經

4.23.11

Source원문

寸口脉微而濇, 微者, 衛氣不足, 濇者, 榮血不足. 脉滑者, 多血少氣, 脉濇者, 少血多氣. 《脉經》

Translation영역

An inch-opening pulse faint and rough: faint is the defence qi insufficient, rough is the construction blood insufficient. A slippery pulse is much blood and little qi; a rough pulse is little blood and much qi.

Maekgyeong 脉經

4.23.12

Source원문

緊則傷寒, 虛因傷暑. 濇因傷燥, 細緩傷濕, 浮則傷風, 弱爲傷火. 《醫鑑》

Translation영역

Tight is cold damage; vacuous is from summerheat damage; rough is from dryness damage; fine and moderate is damp damage; floating is wind damage; weak is fire damage.

Clinical note임상 주석

The six climatic evils each assigned a pulse, and the list closes the section as a reference. Twelve passages from four sources, and what they share is the habit of reading one quality as one meaning — which 4.20 and 4.21 have just said must be adjusted for the patient.

Uigam 醫鑑

4.24 All the Death Pulses 諸死脉

4.24.1

Source원문

內經曰, 人一呼脉四動以上曰死. 脉絶不至曰死. 乍疏乍數曰死. 人一呼五六至, 其形肉不脫, 眞藏雖不見, 猶死也. 《內經》

Translation영역

The Neijing says: a pulse beating four times or more to one exhalation is called death. A pulse cut off and not arriving is called death. Now sparse and now rapid is called death. A pulse of five or six beats to one exhalation, though the form and flesh have not deserted and the true viscus is not seen, is still death.

Clinical note임상 주석

Four death pulses from the Neijing, and three of them are rhythm disorders — too fast, absent, and chaotically irregular. Four beats per exhalation is about 120 a minute at rest; five or six is 150 to 180. 乍疏乍數, now sparse and now rapid, is atrial fibrillation with a fast ventricular response, and the chapter calls it death without qualification.

Naegyeong 內經

4.24.2

Source원문

脉不往來者, 死. 《內經》

Translation영역

A pulse that does not come and go is death.

Naegyeong 內經

4.24.3

Source원문

肥人脉細小如絲, 欲絶者, 死. 羸人脉躁者, 死. 諸浮脉無根者, 皆死. 《仲景》

Translation영역

A fat person with a pulse fine and small as a thread, about to break off, is death. A wasted person with an agitated pulse is death. All floating pulses without root are death.

Clinical note임상 주석

4.21's rule inverted: the fat should be sunken and the thin floating, and here each has the opposite at its extreme. A thread pulse in a fat man and a racing pulse in a wasted one are both the body's reserve exhausted. 浮脉無根 — floating without root — is the pulse that has nothing beneath it when pressed, which is the chapter's constant sign of failure.

Junggyeong 仲景

4.24.4

Source원문

寸脉下不至關爲陽絶, 尺脉上不至關爲陰絶, 皆決死. 《仲景》

Translation영역

Where the inch pulse does not reach down to the bar it is the yang cut off; where the cubit pulse does not reach up to the bar it is the yin cut off; both decide death.

Junggyeong 仲景

4.24.5

Source원문

脉四損, 三日死. 平人四至, 病人脉一至, 名曰四損脉. 五損, 一日死. 平人五至, 病人脉一至, 名曰五損脉. 六損, 一時死. 平人六至, 病人脉一至, 名曰六損也. 四藏氣絶, 脉爲四損. 五藏氣絶, 脉爲五損. 五藏六府俱絶, 脉爲六損也. 《仲景》

Translation영역

A pulse of four deficiencies, death in three days: where a healthy person's pulse beats four times and the patient's beats once, it is called the four-deficiency pulse. Five deficiencies, death in one day: the healthy five and the patient's one. Six deficiencies, death within the hour: the healthy six and the patient's one. Four viscera cut off makes the four-deficiency pulse; five viscera, five; five viscera and six bowels all cut off, six.

Clinical note임상 주석

The deficient pulse of 4.5 measured against a bystander's rather than against the breath — the physician counts his own pulse and the patient's together. One beat to the healthy person's four is a rate of about 18, and the chapter's three days is generous.

Junggyeong 仲景

4.24.6

Source원문

病人脉絶, 口張足腫, 五日死. 《扁鵲》

Translation영역

A patient whose pulse is cut off, with the mouth open and the feet swollen, dies in five days.

Pyeonjak 扁鵲

4.25 The Ten Strange Pulses 十怪脉

4.25.1

Source원문

十怪脉者, 一曰釜沸, 二曰魚翔, 三曰彈石, 四曰解索, 五曰屋漏, 六曰鰕遊, 七曰雀啄, 八曰偃刀, 九曰轉豆, 十曰麻促. 《得效》

Translation영역

The ten strange pulses: the first is the boiling pot, the second the swimming fish, the third the flicked stone, the fourth the unravelling rope, the fifth the leaking roof, the sixth the darting shrimp, the seventh the pecking sparrow, the eighth the knife's edge, the ninth the spinning bean, the tenth the scattered hemp seed.

Clinical note임상 주석

The chapter's closing list, and the tradition's most vivid. Each pulse is named for the thing it feels like, and the ten subsections give the depth at which each is found, what it means, and how many days remain. Read as a set they are the terminal rhythms — the racing pulse that never falls, the pulse that flutters at the surface, the hard irregular beat, the chaotic beat, the slow irregular drip, the beat that comes and goes, the run of beats and a pause, the pulse with no rhythm at all, the fast tiny beat, the fine chaotic one. Several correspond to rhythms that are now named on a monitor.

Deukhyo 得效

4.25.1 The Boiling Pot 釜沸

4.25.1.1

Source원문

脉在皮肉, 有出無入, 如湯涌沸, 息數俱無. 乃三陽數極, 無陰之候. 朝見夕死, 夕見朝死. 《得效》

Translation영역

The pulse lies in the skin and flesh, going out and not coming in, like broth surging at the boil, with neither pause nor count. This is the three yang at the extreme of rapidity, the sign of no yin. Seen in the morning, death by evening; seen in the evening, death by morning.

Clinical note임상 주석

A pulse so fast it has no countable beats — 息數俱無, neither pause nor count. That is a ventricular tachycardia or a fibrillation at the wrist, and the chapter's prognosis of hours is right. **A pulse too rapid to count is a life-threatening arrhythmia.**

Deukhyo 得效

4.25.2 The Swimming Fish 魚翔

4.25.2.1

Source원문

脉在皮膚, 頭定而尾搖, 浮浮泛泛. 三陰數極, 又曰亡陽. 當以死斷.

Translation영역

The pulse lies in the skin, the head still and the tail waving, floating and drifting. This is the three yin at the extreme of rapidity, also called yang lost. It should be judged as death.

Deukhyo 得效

4.25.2.2

Source원문

魚翔脉, 似有似無. 《得效》

Translation영역

The swimming-fish pulse seems present and seems absent.

Clinical note임상 주석

頭定而尾搖 — the head still and the tail waving — is how a fish holds place in a stream, and the pulse it names is one felt only at the surface, with no body beneath it, seeming to be there and not there. It is the floating pulse without root of 4.24.3 at its last.

Deukhyo 得效

4.25.3 The Flicked Stone 彈石

4.25.3.1

Source원문

脉在筋肉間, 辟辟湊指, 急促而堅. 乃腎經眞藏脉見, 遇戊己日則不治.

Translation영역

The pulse lies between sinew and flesh, tapping against the finger, urgent, hurried and hard. This is the true visceral pulse of the kidney channel appearing; meeting a mu or gi day, it is not treated.

Deukhyo 得效

4.25.3.2

Source원문

彈石硬來, 尋卽散. 《得效》

Translation영역

The flicked stone comes hard, and is scattered as soon as it is sought.

Clinical note임상 주석

The true kidney pulse of 4.4.1 — 如指彈石, like a finger flicking a stone — given its own entry. Hard, sudden and gone, with nothing between the taps. 戊己 are the earth stems, and earth overcomes water; the kidney's death is fixed to the days of its conqueror.

Deukhyo 得效

4.25.4 The Unravelling Rope 解索

4.25.4.1

Source원문

脉如解亂繩之狀, 散散無序. 腎與命門之氣皆亡, 戊己日篤, 辰巳日不治. 《得效》

Translation영역

The pulse is like a tangled rope coming undone, scattered and without order. The qi of the kidney and the gate of life are both lost; on mu and gi days it grows grave, and on jin and sa days it is not treated.

Clinical note임상 주석

散散無序 — scattered and without order. A pulse with no pattern at all, which is fibrillation, and the image of a rope unravelling into separate strands is as good a description of it as the tradition has.

Deukhyo 得效

4.25.5 The Leaking Roof 屋漏

4.25.5.1

Source원문

脉在筋肉間, 如殘霤之下, 良久一滴濺起無力.

Translation영역

The pulse lies between sinew and flesh, like the last drip from the eaves — after a long while one drop, splashing up without force.

Deukhyo 得效

4.25.5.2

Source원문

如水滴濺地貌, 胃氣榮衛俱絶, 七八日死. 《得效》

Translation영역

Like water dripping and splashing on the ground: the stomach qi and the construction and defence are all cut off, and death in seven or eight days.

Clinical note임상 주석

A slow, irregular, weak beat with long gaps — the drip from eaves after the rain has stopped. It is the intermittent pulse of 4.8 at its slowest, and the Nanjing at 4.8.11 named it as the spleen's failing. Seven or eight days is the longest term among the ten.

Deukhyo 得效

4.25.6 The Darting Shrimp 鰕遊

4.25.6.1

Source원문

脉在皮膚, 如鰕遊水面, 杳然不見, 須臾又來, 隱隱然不動, 依前又去. 醒者七日死, 困者三日死. 《得效》

Translation영역

The pulse lies in the skin, like a shrimp darting on the water's surface — vanishing from sight, in a moment come again, faintly still, then gone as before. The alert die in seven days, the exhausted in three.

Clinical note임상 주석

A pulse that appears, holds still, and vanishes, over and over. The shrimp's dart and pause is the image, and the two prognoses — seven days if the patient is still alert, three if not — make the mental state the second finding.

Deukhyo 得效

4.25.7 The Pecking Sparrow 雀啄

4.25.7.1

Source원문

脉在筋肉間, 連連湊指, 忽然頓無, 如雀啄食之狀, 盖來三而去一也. 脾元穀氣已絶於內, 醒者十二日死, 困者六七日亡. 《得效》

Translation영역

The pulse lies between sinew and flesh, tapping the finger in a run and then suddenly nothing, like a sparrow pecking at food — it comes three times and goes once. The spleen's origin and the grain qi are already cut off within; the alert die in twelve days, the exhausted in six or seven.

Clinical note임상 주석

來三而去一 — three beats and a pause — is the pattern, and it is a fixed-ratio block or a run of beats with a compensatory pause. The sparrow pecks in quick bursts and stops, and the image gives the rhythm exactly. The Nanjing at 4.8.11 pairs this with the leaking roof as the two pulses of spleen failure, and the Deukhyo gives it the longest term of the ten in the alert patient.

Deukhyo 得效

4.25.8 The Knife's Edge 偃刀

4.25.8.1

Source원문

脉如手循刀刃, 無進無退, 其數無准. 由心元血枯, 衛氣獨居, 無所歸宿, 見之四日難療. 《得效》

Translation영역

The pulse is like running the hand along a knife's edge, neither advancing nor retreating, its count without standard. It comes of the heart's origin blood withered and the defence qi dwelling alone with nowhere to return to; seen, in four days it is hard to treat.

Clinical note임상 주석

The true liver pulse of 4.4.1 — 如循刀刃, like running the finger along a blade — as a strange pulse. Thin, hard, and with no rhythm that can be counted. The Deukhyo attributes it to the heart rather than the liver, reading the hardness as vessels with no blood to fill them.

Deukhyo 得效

4.25.9 The Spinning Bean 轉豆

4.25.9.1

Source원문

脉形如豆, 周旋展轉, 幷無息數. 藏府空虛, 正氣飄散, 象曰行尸, 其死可立待也. 《得效》

Translation영역

The pulse is shaped like a bean, turning and rolling round and round, with no pause and no count. The viscera and bowels are empty and the right qi drifts and scatters; it is called the walking corpse, and its death may be awaited standing.

Clinical note임상 주석

A small, fast, rolling pulse with no countable rhythm — the boiling pot's counterpart at a lower amplitude. 其死可立待 — death may be awaited standing — is the chapter's shortest prognosis, and 行尸, the walking corpse, returns for the third time.

Deukhyo 得效

4.25.10 The Scattered Hemp Seed 麻促

4.25.10.1

Source원문

脉如麻子之紛亂, 細微至甚. 盖衛枯榮血獨澁. 輕者三日死, 重者一日殂矣. 《得效》

Translation영역

The pulse is like hemp seeds in disorder, fine and faint to the utmost. The defence has withered and the construction blood alone is rough. The light die in three days, the heavy in one.

Clinical note임상 주석

The last of the ten and the finest — a scatter of tiny beats with no order, which is fibrillation at a thread's amplitude. The unravelling rope of 4.25.4 was the same chaos at a larger scale; this is it at the end. Ten pulses, and the chapter has given each a texture under the finger, a depth, a cause, and a count of days. What survives of it is the habit of naming a rhythm by what it feels like, and several of the names are still apt.

Deukhyo 得效

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 1, Pulse Diagnosis chapter. The Chinese text is collated against the public-domain Wikisource transcription and a printed edition; original character forms (脉, 人參) are retained. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.