素问·玉机真藏论 Treatise on the Jade Mechanism and the True Viscera

Huangdi asked: The spring pulse is like a bowstring — in what way is it like a bowstring? Qibo replied: The spring pulse corresponds to the liver, to wood of the east, the direction by which the myriad things begin to be born. Therefore its qi comes soft and weak, light and empty, yet smooth, straight and upright, and long — hence it is called "bowstring-like." Anything contrary to this is disease. Huangdi said: What is meant by contrary to this? Qibo said: If the qi comes full and forceful, this is called excess, and the disease is on the outside; if the qi comes insubstantial and faint, this is called insufficiency, and the disease is on the inside. Huangdi said: In excess and insufficiency of the spring pulse, what are the diseases like in each case? Qibo said: In excess, it makes a person forgetful, dazed and dizzy, with disorders of the crown of the head; in insufficiency, it makes the chest ache, drawing into the back, and below causes fullness in both flanks and the sides beneath the ribs. Huangdi said: Good.

The summer pulse is like a hook — in what way is it like a hook? Qibo said: The summer pulse corresponds to the heart, to fire of the south, the direction by which the myriad things flourish and grow. Therefore its qi comes abundant and departs in decline — hence it is called "hook-like." Anything contrary to this is disease. Huangdi said: What is meant by contrary to this? Qibo said: If the qi comes abundant and also departs abundant, this is called excess, and the disease is on the outside; if the qi comes not abundant but departs abundant instead, this is called insufficiency, and the disease is on the inside. Huangdi said: In excess and insufficiency of the summer pulse, what are the diseases like in each case? Qibo said: In excess, it makes the body hot and the skin ache, producing spreading sores; in insufficiency, it makes the heart vexed, with coughing and spitting appearing above, and an outflow of qi below. Huangdi said: Good.

The autumn pulse is like a floating pulse — in what way is it floating? Qibo said: The autumn pulse corresponds to the lung, to metal of the west, the direction by which the myriad things are gathered in and brought to completion. Therefore its qi comes light, empty, and floating, arriving quickly and dispersing as it leaves — hence it is called "floating." Anything contrary to this is disease. Huangdi said: What is meant by contrary to this? Qibo said: If the qi comes feather-like yet firm at the center and empty on both sides, this is called excess, and the disease is on the outside; if the qi comes feather-like and faint, this is called insufficiency, and the disease is on the inside. Huangdi said: In excess and insufficiency of the autumn pulse, what are the diseases like in each case? Qibo said: In excess, it makes the qi rebel upward and the back ache, with a stifled, brooding feeling; in insufficiency, it makes a person pant, breathe with insufficient qi, and cough, with blood appearing when qi rises, and an abnormal sound heard below. Huangdi said: Good.

The winter pulse is like the "ying" [entrenched] pulse — in what way is it entrenched? Qibo said: The winter pulse corresponds to the kidney, to water of the north, the direction by which the myriad things are gathered together and stored away. Therefore its qi comes deep and beats hard — hence it is called "entrenched." Anything contrary to this is disease. Huangdi said: What is meant by contrary to this? Qibo said: If the qi comes like a stone flicked by the finger, this is called excess, and the disease is on the outside; if it departs in a hurried, racing manner, this is called insufficiency, and the disease is on the inside. Huangdi said: In excess and insufficiency of the winter pulse, what are the diseases like in each case? Qibo said: In excess, it makes a person listless and weak, with pain along the spine and shortness of qi so that one does not wish to speak; in insufficiency, it makes the heart feel suspended as if famished, coldness in the region below the ribs, pain in the spine, fullness in the lower abdomen, and abnormal urination. Huangdi said: Good.

Huangdi said: The order of the four seasons and the changes of compliance and rebellion follow this pattern — but what alone governs the spleen pulse? Qibo said: The spleen pulse corresponds to earth, the solitary viscus that irrigates the four surrounding [viscera]. Huangdi said: Then can the good and the ill of the spleen be observed? Qibo said: The good cannot be seen; the ill can be seen. Huangdi said: In what way can the ill be seen? Qibo said: If it comes like flowing water, this is called excess, and the disease is on the outside; if it is like the beak of a bird, this is called insufficiency, and the disease is on the inside. Huangdi said: Master, you say the spleen is the solitary viscus, earth at the center that irrigates the four surrounding [viscera] — what are the diseases of its excess and insufficiency like? Qibo said: In excess, it makes the four limbs unable to be raised; in insufficiency, it makes the nine orifices fail to be free, called "doubled stiffness." Huangdi rose in astonishment, bowed twice, touched his head to the ground, and said: Excellent. I have grasped the great essentials of the pulse, the utmost calculations of the world, the transformations of the five colors and the pulse, the estimation of the ordinary and the extraordinary. The Way lies in unity: the spirit turns without reversing; if it reverses, it no longer turns, and then the pivotal moment is lost. The essentials of these utmost calculations are close at hand yet subtle. Let them be inscribed on jade tablets and stored in the treasury of the viscera and bowels, to be read every morning — this is called "the Jade Mechanism."

Each viscus receives qi from the viscus that generates it, transmits it to the viscus it overcomes, and its qi lodges in the viscus that generates it, but death occurs at the viscus that cannot overcome it. When a disease is about to bring death, it must first be transmitted onward until it reaches the viscus that cannot overcome it, and only then does death occur. This describes the reverse movement of qi, and hence death results. The liver receives qi from the heart, transmits it to the spleen, and its qi lodges in the kidney; death occurs at the lung. The heart receives qi from the spleen, transmits it to the lung, and its qi lodges in the liver; death occurs at the kidney. The spleen receives qi from the lung, transmits it to the kidney, and its qi lodges in the heart; death occurs at the liver. The lung receives qi from the kidney, transmits it to the liver, and its qi lodges in the spleen; death occurs at the heart. The kidney receives qi from the liver, transmits it to the heart, and its qi lodges in the lung; death occurs at the spleen. These are all cases of death from reverse transmission. Dividing a day and night into five parts allows one to divine the early or late hour of death.

Huangdi said: The five viscera communicate with one another, and their transmission always follows a sequence. When one of the five viscera has disease, it transmits the disease to the one it overcomes. If left untreated, the rule is that in three months or six months, or in three days or six days, the disease will have been transmitted through the five viscera and death will occur — this is the sequence of transmission following the order of overcoming. Hence it is said: by distinguishing what pertains to yang, one knows whence the disease has come; by distinguishing what pertains to yin, one knows the time of death or survival. This means knowing that the patient dies upon reaching the viscus that constrains him.

Therefore wind is the chief of the hundred diseases. Now when wind and cold lodge in a person, they make the fine body hairs stand erect, close the skin, and produce heat; at this time, one may induce sweating to release it, or, if there is numbness, insensitivity, swelling and pain, one may use hot decoctions, fomentation, moxibustion, or needling to remove it. If left untreated, the disease enters and lodges in the lung, called "lung bi [impediment]," bringing on cough and rising qi. If left untreated, the lung then transmits it onward to the liver, and the disease is called "liver bi," also called "reversal," with rib-side pain and the bringing up of food; at this time, one may treat by pressing or by needling. If left untreated, the liver transmits it to the spleen, and the disease is called "spleen wind," bringing on jaundice, heat in the abdomen, a vexed heart, and yellow discharge; at this time, one may treat by pressing, by medicine, or by bathing. If left untreated, the spleen transmits it to the kidney, and the disease is called "mounting-conglomeration," with oppressive heat and pain in the lower abdomen and a whitish discharge, also called "gu [parasitic] disease"; at this time, one may treat by pressing or by medicine. If left untreated, the kidney transmits it to the heart, and the sinews and vessels pull against one another and grow tense — the disease is called "convulsion"; at this time, one may treat by moxibustion or by medicine. If left untreated, when ten full days have passed, by rule death should occur. Alternatively, the kidney may transmit it to the heart, and the heart in turn transmits it back to the lung, bringing on chills and fever, and by rule death should occur within three years — this is the sequence of the disease.

However, when a disease breaks out suddenly, it need not follow this order of transmission; or its transmission and transformation may fail to follow the sequence — when it does not enter in sequence, it is because worry, fear, sorrow, joy, and anger prevent it from following its proper order, and so a person develops serious illness. Thus, if joy causes great depletion, then kidney qi will take advantage of the weakness; anger causes liver qi to take advantage; sorrow causes lung qi to take advantage; fear causes spleen qi to take advantage; worry causes heart qi to take advantage — this is the principle involved. Hence there are five types of disease, and five times five makes twenty-five variations, along with their transmissions and transformations. "Transmission" here is another name for "taking advantage of weakness."

When the great bones become withered, the great flesh sinks and falls away, qi fills the chest, breathing becomes labored, and this disturbance of qi is visible in the body's movement, death is expected within six months; when the true visceral pulse appears, then the day can be predicted. When the great bones become withered, the great flesh sinks and falls away, qi fills the chest, breathing becomes labored, and there is internal pain drawing into the shoulders and neck, death is expected within one month; when the true viscus pulse appears, then the day can be predicted. When the great bones become withered, the great flesh sinks and falls away, qi fills the chest, breathing becomes labored, and there is internal pain drawing into the shoulders and neck, death is expected within one month; when the true viscus pulse appears, then the day can be predicted. When the great bones become withered, the great flesh sinks and falls away, qi fills the chest, breathing becomes labored, there is internal pain drawing into the shoulders and neck, the body is hot, the flesh wastes and the muscle masses break down, when the true viscus pulse appears, death occurs within ten months. When the great bones become withered, the great flesh sinks and falls away, the marrow within the shoulder wastes away, movement grows ever more feeble, when the true viscus pulse comes and appears, death is expected within one year; once the true viscus pulse is seen, then the day can be predicted. When the great bones become withered, the great flesh sinks and falls away, qi fills the chest, there is pain within the abdomen, discomfort in the heart region, heat in the shoulders, neck and body, the muscle masses break down and the flesh wastes, the eye sockets sink in, when the true viscus pulse appears and the eyes no longer recognize people, death is immediate; if the eyes still recognize people, death occurs when the season arrives that the affected viscus cannot overcome. In cases of urgent depletion where collapse strikes the body suddenly, the five viscera become sealed and closed off, the pathways of the pulse are blocked, and qi no longer comes and goes — this is like falling and drowning, and no fixed time of death can be given. When the pulse is cut off and does not come, or when a person's breath produces five or six beats of the pulse in a single respiration, yet the flesh and muscle have not wasted away, then even though the true visceral pulse does not appear, death will still occur. When the true liver pulse arrives, it is tense both within and without, like running one's finger along the edge of a blade, hard and unyielding, like pressing on the strings of a zither or lute; the complexion is greenish-white and without luster, the body hair breaks off — then death occurs. When the true heart pulse arrives, it is hard and pounding, like fingering the beads of Job's-tears seed strung one after another; the complexion is reddish-black and without luster, the body hair breaks off — then death occurs. When the true lung pulse arrives, it is large and empty, like feathers brushing against a person's skin; the complexion is whitish-red and without luster, the body hair breaks off — then death occurs. When the true kidney pulse arrives, it pounds and then breaks off, like a finger flicking a stone, hard and abrupt; the complexion is blackish-yellow and without luster, the body hair breaks off — then death occurs. When the true spleen pulse arrives, it is weak, now rapid and now sparse; the complexion is yellowish-green and without luster, the body hair breaks off — then death occurs. Whenever any of the true visceral pulses appear, death follows in every case, and there is no treating it. Huangdi said: Why is it said that the appearance of the true visceral pulse means death? Qibo said: All five viscera receive their qi from the stomach; the stomach is the root of the five viscera. The qi of the viscera cannot reach the Hand Taiyin channel by itself — it must rely on the qi of the stomach in order to reach the Hand Taiyin. Hence each of the five viscera, at its proper season, arrives of itself at the Hand Taiyin only by means of stomach qi. Therefore, when pathogenic qi prevails, the essential qi declines; and when a disease is severe, the stomach qi cannot accompany the visceral qi in reaching the Hand Taiyin together — so the qi of the true viscus appears alone. When it appears alone, the disease has overcome the viscus, and hence death is said to follow. Huangdi said: Good.

Huangdi said: Whenever treating disease, one must examine the body's physique and qi, the complexion and its luster, the strength or weakness of the pulse, and whether the disease is new or old, and then treat it without letting the proper moment pass. When physique and qi correspond to each other, this is called treatable; when the complexion has a floating luster, this is called easily cured; when the pulse follows the pattern of the four seasons, this is called treatable; when the pulse is weak yet smooth, this indicates the presence of stomach qi, called easily treated, and one should select the treatment according to the season. When physique and qi fail to correspond, this is called difficult to treat; when the complexion is withered and without luster, this is called difficult to cure; when the pulse is full and hard, this is called worsening; when the pulse runs contrary to the four seasons, this is called untreatable. One must examine these four difficulties and state them clearly. What is meant by "running contrary to the four seasons" is: in spring obtaining the lung pulse, in summer obtaining the kidney pulse, in autumn obtaining the heart pulse, in winter obtaining the spleen pulse — when these arrive suspended, cut off, sunken, and rough, this is called running contrary to the four seasons. Even when there is not yet a visible visceral form of disease, if in spring and summer the pulse is sunken and rough, or in autumn and winter the pulse is floating and large, this too is called running contrary to the four seasons. When there is heat disease yet the pulse is calm; when there is diarrhea yet the pulse is large; when blood has been lost yet the pulse is full; when the disease is internal yet the pulse is full and hard; when the disease is external yet the pulse is not full and hard — in all these cases, the disease is difficult to treat.

Huangdi said: I have heard that deficiency and excess are used to determine death and survival; I would like to hear the particulars. Qibo said: The five excesses bring death, and the five deficiencies bring death. Huangdi said: I would like to hear of the five excesses and five deficiencies. Qibo said: A full pulse, hot skin, a distended abdomen, blockage of both the front and back passages, and oppression with clouded vision — these are called the five excesses. A fine pulse, cold skin, insufficient qi, diarrhea and incontinence of both front and back passages, and inability to take in food and drink — these are called the five deficiencies. Huangdi said: Yet sometimes at such times a person survives — why is that? Qibo said: If thin gruel enters the stomach and the diarrhea stops, then even one with deficiency will live; if the body sweats and the bowels move freely afterward, then even one with excess will live. These are the signs that indicate survival.