All lessons Module 5: Going deeper Lesson 5
The classical pulse texts and prognosis
What do the classical pulse texts say, and how do you read a prognosis from them that you can use responsibly today?
After this lesson you know the four classical pulse texts and what each contributed, you read Stomach-Qi, Shen and root as a measure of reserve, you know when a pulse fits the disease and when it does not, you recognise the true organ pulses, and you know that today they are a reason to refer and not to predict.
Know by heart
- Four texts. Su Wen: Stomach-Qi and the death pulses. Nan Jing: only the pulse at the wrist, depths and root. Mai Jing (Wang Shuhe, 3rd century): 24 pulses, in pairs that resemble each other. Bin Hu Mai Xue (Li Shizhen, 1564): 27 pulses in verses on form, look-alikes and disease; mnemonic: first the stomach, then the place, then the names, then the verses.
- Stomach-Qi as the measure. A seasonal pulse with Stomach-Qi is healthy; more season than Stomach-Qi is sick; season alone without Stomach-Qi is the death pulse (Su Wen 18, Nan Jing 15); mnemonic: a pinch of spice makes the soup, too much spoils it, spice alone is no soup.
- Three signs of reserve. Stomach-Qi: calm, supple, even. Shen: strength and regularity. Root: felt on deep pressure and at chi; a tree with roots sprouts again (Nan Jing 14); mnemonic: stomach, spirit, root.
- Does the pulse fit the disease? Fever with a rapid, full pulse fits; fever with a quiet pulse does not. After blood loss or diarrhoea a small, soft pulse fits; a big, full one does not (Su Wen 19, Nan Jing 17). If it does not fit, the picture is more serious than it looks; mnemonic: the pulse must follow the story.
- The true organ pulses. Without Stomach-Qi, Shen or root: sharp as a knife or a freshly strung bowstring, tapping like a stone, dripping like a leaking roof, pecking like a sparrow, coming apart like an unravelling rope, light as a feather in the wind; mnemonic: knife, stone, roof, sparrow, rope, feather.
- Rate and rhythm as the limit. Much faster or slower than four to five per breath, alternating fast and slow, or absent: fatal in the classics (Su Wen 18, Nan Jing 14). Today: ECG or emergency.
- What you do with it. A true organ pulse, or a pulse that does not fit a serious disease, is today a reason to refer, often the same day or to emergency services (112 in Europe, 999 in the UK, 911 in North America). No prediction, and no treatment instead of care.
The rest of this lesson is reference.
Three practice questions from this lesson
According to Su Wen 18 and Nan Jing 15: in spring you feel a pulse that is clearly wiry, with little Stomach-Qi. What is it?
- Sick: more season than Stomach-Qi, the Liver
- Healthy: wiry belongs to spring
- Fatal: every wiry pulse without Stomach-Qi
Answer: Sick: more season than Stomach-Qi, the Liver. Slightly wiry with Stomach-Qi is healthy, more wiry than Stomach-Qi is sick, wiry alone without Stomach-Qi is the death pulse. Mnemonic: a pinch of spice makes the soup, too much spoils it.
Which text was the first to choose a single place, the cun kou, for feeling the pulse?
- The Nan Jing
- The Bin Hu Mai Xue
- The Mai Jing
Answer: The Nan Jing. Nan Jing 1: the cun kou only, where the vessels meet. The Su Wen still has nine measuring points (chapter 20).
How many pulses do the Mai Jing and the Bin Hu Mai Xue describe?
- 24 and 27
- 28 and 28
- 12 and 24
Answer: 24 and 27. Wang Shuhe described 24, Li Shizhen 27 in 1564; Li Zhongzi later added the 28th.
The rest of this lesson
In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 17 case-based practice questions, 19 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 5: Going deeper.