Dificultate 3

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Vessel Movements & Diagnostic Significance, contd.

(Difficult Issues 1-22, here, 14-16).
THE FOURTEENTH DIFFICULT ISSUE

Overview: Introduction of the concepts of "injured" (i.e., slower than usual) and "arriving" (i.e.,
faster than usual) movements in the vessels; also, discussion of the significance of the presence of a
movement in the vessels at the inch-section when no movement can be perceived at the foot-section,
and vice versa.
The fourteenth difficult issue: (1) The [movement in the] vessels may be "injured" or "arriving."
What does that mean?
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(2) It is like this. An "arriving" [movement in the] vessel [implies the following. If during a period of]
one exhalation two [movements] arrive, that is called "normal. " (3) If three arrive, that is called
"departure from the regular." (4) If four arrive, that is called "loss of essence." (5) If five arrive, that
is called "death." (6) If six arrive, that is called "severance of fate." (7) These are the arriving1
[movements in the] vessels.
(8) What does "injured" [movement in the] vessels
mean?
(9) If one [movement] arrives [during the period of]
one exhalation, that is called "departure from the
regular." (10) One arrival during two exhalations is
called "loss of essence." (11) One arrival during three
exhalations is called "death." (12) One arrival during
four exhalations is called "severance of fate." (13)
These are injured [movements in the] vessels. (14) In
case of arriving [movements in the] vessels, [the
illness] proceeds from the lower [depots] to the upper
[depots]; in case of injured [movements in the]
vessels, [the illness] proceeds from the upper [depots]
to the lower [depots].
(15) What [course of an] illness is signalled by injured
[movements in the] vessels?
(16) It is like this. The first [stage of an] injured
[movement in the vessels corresponds to an] injury of
the skin [and of its] hair. The skin contracts and the
hair falls out. (17) The second [stage of an] injured
[movement in the vessels corresponds to an] injury of
the blood vessels. Hence, the blood vessels have little
or no contents which could circulate through the
[body's] five depots and six palaces. (18) The third
[stage of an] injured [movement in the vessels
corresponds to an] injury of the flesh. The flesh
grows lean; food and drink can no longer create flesh
and skin.
(19) The fourth [stage of an] injured [movement in the vessels corresponds to an] injury of the
muscles. The muscles relax and are unable to support one's stature. (20) The fifth [stage of an]
injured [movement in the vessels corresponds to an] injury of the bones. The bones become
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powerless, and [one is] no longer able to rise from bed. (21) Opposite to this is the [course of an]
illness [corresponding to] arriving [movements in the vessels].2 (22) Thus, if [the illness, as happens
in case of an injured movement,] proceeds from the upper [depots] to the lower [depots, the patient
will] die when the bones have become powerless so that he is unable to rise from bed. (23) If,
however, [the illness] proceeds from the lower [depots] to the upper [depots, as happens in case of
an arriving movement in the vessels, the patient] will die when the skin contracts and when the hair
falls out.
(24) What methods exist to treat injury?
(25) It is like this. If the injury has affected the respective [patient's] lung, supplement his influences.
(26) If the injury has affected his heart, balance his protective and constructive [influences]. (27) If
the injury has affected his spleen, balance his food and drink, and see to it that [his exposure to] cold
and warmth is appropriate. (28) If the injury has affected his liver, relax his center. (29) If the injury
has affected his kidneys, supplement his essence. (30) These are the methods to treat injury.
(31) [Consider the following situations. The movement in the] vessels arrives twice during one
exhalation and twice during one inhalation; (32) it arrives three times during one exhalation and three
times during one inhalation; (33) it arrives four times during one exhalation and four times during one
inhalation; (34) it arrives five times during one exhalation and five times during one inhalation; (35) it
arrives six times during one exhalation and six times during one inhalation. (36) Or it arrives once
during one exhalation and once during one inhalation; (37) it arrives once during two exhalations and
once during two inhalations; (38) or it arrives twice during exhalation and inhalation. (39) If the
[movement in the] vessels comes like any of these [situations], how can the respective illnesses be
distinguished?
(40) It is like this. If the [movement in the] vessels comes in such a way that it arrives twice during
one exhalation and twice during one inhalation, and if it is neither strong nor minor, that is called
"normal." (41) Three arrivals during one exhalation and three arrivals during one inhalation indicate
that one just happens to contract an illness. (42) If the [movement in the vessels is felt to be] strong in
front [of the gate and] minor behind [the gate, that is accompanied by] headache and dizziness. (43) If
the [movement in the vessels is felt to be] minor in front [of the gate] and strong behind [the gate, that
is accompanied by a perception of] fullness in one's chest and by short breath. (44) Four arrivals
during one exhalation and four arrivals during one inhalation indicate that the illness tends to become
serious. (45) If the [movement in the] vessels is vast and strong, one suffers from uneasiness and has
[a perception of ] fullness [in one's chest]. (46) If the [movement in the] vessels is deep and fine, one
suffers from abdominal pain. (47) A smooth [movement indicates] harm due to heat. (48) A rough
[movement indicates] mist and dew in one's center. (49) Five arrivals during one exhalation and five
arrivals during one inhalation indicate that the [situation of that] person is critical. (50) If [in this case
the movement in the] vessels is deep, and fine, [the seriousness of the illness] will increase during the
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night. (51) If it is at the surface and strong, [the seriousness of the illness] will increase during the
day. (52) If it is neither strong nor minor, [the illness] can be cured, although [the situation of the
patient] is critical. [If the movement is] either strong or minor, a cure will be difficult. (52) Six
arrivals during one exhalation and six arrivals during one inhalation indicate a deadly [movement in
the] vessels. (53) If it is deep and fine, death will occur during the night. (54) If it is at the surface
and strong, death will occur during the day. (55) One arrival during one exhalation and one arrival
during one inhalation is called "injury." (56) The [afflicted] person may still be able to walk, but
should stay in bed. (57) The reason for such [a condition] lies in a depletion of blood and of
[protective] influences. (58) One arrival during two exhalations [and one arrival during two
inhalations] or two arrivals during exhalation and inhalation are called "absence of hun."3 (59) If
one's hun is absent, one must die. (60) The [afflicted] person may still be able to walk, but one
speaks here of a "walking corpse." (61) If [a movement in the] vessels is [perceivable] in the upper
section, while no [movement in the] vessels is [perceivable] in the lower section, the respective
person should vomit; if he does not vomit, he will die. (62) If no [movement in the] vessels is
[perceivable] in the upper section, while [a movement in the vessels is perceivable] in the lower
section, the [respective person] will not suffer any harm, although [his situation] is critical. (63) The
reason for this lies in the fact that just as a person has feet, a tree has roots. Even though branches
and leaves may wither, the roots can lived by themselves. (64) [Similarly,] the vessels have their
root, [and that is where] man has his primordial influences. Hence, one knows that [the respective
patient] will not die.4
Unschulds Footnotes
1. The text says ssu mai ("deadly movement in the vessels"). All editions consulted, except for the
Nan-ching chi-chu, have replaced the character ssu, by chih ("arriving"). In analogy to sentence 13,
such a correction seems justified, so I have adopted it in my rendering.
2. The characters y shou, appear to be superfluous here: see the commentaries.
3. The term hun, may have been used here in an ancient metaphysical sense, referring to a hun soul
which enters the body some time after its birth and leaves it upon its death (also during
unconsciousness). In the context of the medicine of systematic correspondence, this concept was
modified and the hun was considered to be one of several spirit-influences stored in the body's
depots.
4. The tenth difficult issue discussed the transmission of illnesses, (i.e. evil influences) from one
depot to the next in the context of the Five Phases doctrine. As outlined there, evil influences can
develop in a depot and cause it itself to be ill, or they may be transmittedin accordance with the
orders of mutual generation and of mutual destructionfrom child phase to mother phase, from
mother to child, from inferior phase to superior phase, and from superior phase to inferior phase.
Here in the fourteenth difficult issue, a different mode of transmission is introduced which is not
recorded in the Nei-ching, together with a method for diagnosing the resulting illnesses. The Nanching points out that illnesses may descend from the lungvia the heart, spleen, and liverto the
kidneys; or they may be transmitted from the kidneys upwardvia the liver, spleen, and heartto
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the lung. The first of these two courses of transmission is considered to be paralleled byand thus
perceivable througha decreasing frequency of the movement in the vessels, while the second course
is supposed to be accompanied by an increasing frequency of this movement. The author(s) of this
difficult issue introduced two new terms to denote these innovative conceptsnamely, "injury" for
the transmission downward, and "arrival" for the transmission upward. The discussion of this
difficult issue by the commentators followed the usual path; some adopted the new ideas and
attempted to reconcile them as best as they could with other concepts of systematic correspondence,
while the conservatives ridiculed any innovation and focused their comments on contradictions with
terms and concepts recorded by the Nei-ching.
THE FIFTEENTH DIFFICULT ISSUE
Overview: Elucidation of the changes in the movements in the vessels in accordance with the passing
of the four seasons.
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The fifteenth difficult issue: (1) In spring the [movement in the] vessels is stringy; in summer the
[movement in the] vessels is hook-like; in autumn the [movement in the] vessels is hairy; in winter
the [movement in the] vessels is stony. Do these [movements in the] vessels [indicate the normal
presence of the] governing [influences of the respective seasons], or do these [movements in the]
vessels [indicate] illness?
(2) It is like this. Stringy, hook-like, hairy, and stony [movements in the] vessels are [those in
accordance with] the four seasons. (3) In spring [the movement in] the vessels is stringy because [it
corresponds to] the liver, the eastern region, [and to the phase of] wood. [During that season] all
things come to life; [trees] have no branches or leaves yet. Hence, the respective [movement in the]
vessels is soft, weak, and extended. Hence, it is called "stringy."
(4) In summer the [movement in
the] vessels is hook-like
because [it corresponds to] the
heart, the southern region, [and
to the phase of] fire. [During
that season] all things flourish;
the branches and the leaves are
spread out, and they all point
downward and are curved like
hooks. Hence, the [respective
movement in the] vessels comes
swiftly and goes slowly.
Hence, it is called "hook-like."
(5) In autumn [the movement
in] the vessels is hairy because
[it corresponds to] the lung, the
western region, [and to the
phase of ] metal. [During that
season] all things come to an
end. All the blossoms and
leaves of herbs and trees fall in
autumn. Only the branches
remain, resembling fine hair.
Hence, [the movement in] the
vessels comes light, depleted,
and is at the surface. Hence, it
is called "hairy."
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(6) In winter [the movement in] the vessels is stony because [it corresponds to] the kidneys, the
northern region, [and to the phase of] water. [During that season] all things are stored. When winter
is at its peak, the water congeals to resemble stones. Hence, [the movement in] the vessels comes in
the depth, is soft, and smooth. Hence, it is called "stony." (7) These are the [movements in the]
vessels [in accordance with] the four seasons.
(8) What about variations?
(9) It is like this. In spring the [normal movement in the] vessels is stringy. [A movement] contrary
[to this] indicates illness.
(10) What does "contrary" mean?
(11) It is like this. If the influences come replete and vigorous, that is called "greatly excessive"; [in
this case] an illness is located in the external [sections of the organism]. (12) If the influences come
depleted and slight, that is called "insufficient"; [in this case] an illness is located in the internal
[sections of the organism]. (13) If the influences come serene and whispering, as if they followed
[the movement of] elm-leaves [in a spring breeze], that implies a normal state. (14) [If they come]
increasingly replete, as if they followed [the movement of] long canes, that implies illness. (15) [If
the influences come] tense and are unyielding and increasingly vigorous, like a new bowstring, that
implies death. (16) [If the movement in] the vessels in spring is slightly stringy, that implies a normal
state; if it is mostly stringy, and if few influences of the stomach are present, that implies illness. (17)
But if it is stringy in the absence of influences of the stomach, that implies death. (18) In spring [the
organism needs] the influences of the stomach as its basis.
(19) In summer the [normal movement in the] vessels is hook-like. [A movement] contrary [to this]
indicates illness. What does "contrary" mean [in this case]?
[sections of the organism]. (22) [If the influences in] the vessels come tied together like rings, or as if
they were following [in their movement a chain of] lang-kan stones, that implies a normal state. (23)
[If they come] in increasing frequency, resembling chickens lifting their feet, that implies illness. (24)
[If the movement is felt to be] curved in front [of the gate and] settled behind [the gate], like a hook
holding a belt, that means death. (25) [If the movement in] the vessels in summer is slightly
hook-like, that implies a normal state. (26) If it is mostly hook-like, and if few influences of the
stomach are present, that implies illness. (27) But if it is hook-like in the absence of influences of the
stomach, that implies death, [because in] summer [the organism needs] the influences of the stomach
as its basis.
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(28) In autumn the [normal movement in the] vessels is hairy. [A movement] contrary [to this]
[sections of the organism]. (31) [If the influences in] the vessels come luxuriously, resembling the
canopy on a carriage, and if their strength increases under pressure, that implies a normal state. (32)
[If the influences remain] neither above nor below [the gate, but flap up and down] as if they
followed [the movement of ] chicken wings, that implies illness. (33) If under pressure [the
movement feels like] a loose rope, resembling hair blown by the wind, that implies death. (34) [If the
movement in] the vessels in autumn is slightly hairy, that implies a normal state. (35) If it is mostly
hairy, and if few influences of the stomach are present, that implies illness. (36) But if it is hairy in
the absence of influences of the stomach, that implies death, [because in] autumn [the organism
needs] the influences of the stomach as its basis.
(37) In winter the [normal movement in the] vessels is stony. [A movement] contrary [to this]
[sections of the organism]. (40) [If the influences in] the vessels come strongly above [the gate and]
sharply below [the gate], and if they are soft and smooth, resembling a bird's beak, that implies a
normal state. (41) [If the movement in the vessels resembles] continuous pecking, and if it is slightly
curved in between, that implies illness. (42) [If the movement in the vessels] comes like a loose rope,
and if it goes like a stone ball, that implies death. (43) [If the movement in] the vessels in winter is
slightly stony, that implies a normal state. (44) If it is mostly stony, and if few influences of the
stomach are present, that implies illness. (45) But if it is stony in the absence of influences of the
stomach, that implies death, [because in] winter [the organism needs] the influences of the stomach as
its basis. (46) The stomach is the sea of water and grains; it is responsible for supplying [the depots
during all] four seasons. Hence, the influences of the stomach constitute the basis for all [the depots].
(47) This is [what is] meant by variations [in the movements in the vessels] and by illnesses related to
the four seasons; these are the essential criteria [for recognizing a person's impending] death or
survival. (48) The spleen is the central region. Its balanced and normal state cannot be recognized
[through feeling the movement in the vessels. Only its] exhaustion can be recognized. [In this case,
the movement in the vessels] comes like the pecking of birds, like the dripping of water. This is how
one may recognize exhaustion of the spleen.1
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Unschulds Footnotes
1. In this difficult issue, the author of the Nan-ching once again modified the meaning of certain terms
and concepts of the Nei-ching in order to introduce innovative diagnostic criteria. As the
commentators pointed out, the Nei-ching treatises thus "misused" were the two Su-wen treatises,
"P'ing-jen ch'i-hsiang lun and "Yu-chi chen-tsang lun". Two basic concepts are presented in this
difficult issue. The first is the idea of normal changes in the movement in the vessels in accordance
with the changing dominant influences during the four seasons, and the idea of the diagnostic
significance of aberrations from this pattern. This first concept was somewhat modified by a second,
which emphasized the importance of the stomach influences as accompanying the proper influences of
the respective depots. A diagnostic pattern is offered, outlining guidelines for diagnosing the partial or
complete absence of stomach influences and for drawing the appropriate prognostic conclusions. The
entire scheme is clear and logical if regarded in its own right, but conservative commentators
evaluated its contents against the contents of the Su-wen. They obviously failed to appreciate the
attempt of the Nan-ching author(s) to replace the often incoherent and contradictory presentation of
concepts in the Nei-ching with a set of ideas designed to serve as a concise and coherent guide to
practice (a function which the Nei-ching could hardly fulfil). The correspondences alluded to in this
difficult issue and by later commentators can be put into tabular form for easier reference as follows:
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THE SIXTEENTH DIFFICULT ISSUE
Overview: Discussion of various methods to diagnose illnesses by taking internal and external
evidence into account.
The sixteenth difficult issue: (1) The [movement in

the] vessels can be [examined at the] three sections
and nine indicator [-levels], (2) as well as through
its yin or yang [nature]. (3) [One may, further,
examine it by exerting] light or heavy [pressure,
(4) or by taking into regard the] sixty informants,
(5) or one single [movement in the] vessels as it
varies in accordance with the four seasons. (6) The
distance from the sages is long and far. (7)
[Today,] everybody [selects but one of these
methods and] considers his [choice] to be correct.
How can one distinguish [what are correct and
incorrect diagnostic techniques]?
(8) It is like this. Any verification of an illness
should be based on the presence of certain internal
and external evidence.
(9) What kind of [evidence] do illnesses create?
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(10) It is like this. Consider feeling a [movement in the] vessels [that is associated with an illness in
the] liver. (11) External evidence of such [an illness includes] a tendency towards tidy appearance, a
virid face, and an inclination to become angry. (12) Internal evidence of such [an illness is the
presence of] moving influences to the left of the navel which, if pressed, respond with firmness and
pain. (13) The illness, as perceived by the [patient], consists of swollen and stiff limbs, (14) dripping
urine and difficult stools, as well as twisted muscles. (15) If this [evidence] is present, the liver is
[afflicted]. If it is not present, [the liver] is not [afflicted]. (16) Consider feeling a [movement in the]
vessels [that is associated with an illness in the] heart. (17) External evidence of such [an illness
includes] a red face, a dry mouth, and a tendency to laugh. (18) Internal evidence of such [an illness
is the presence of] moving influences above the navel which, if pressed, respond with firmness and
pain. (19) The illness, as perceived by the [patient], consists of uneasiness of the heart and of
heartache. The center of the palms is hot, and dry vomiting occurs. (20) If this [evidence] is present,
the heart is [afflicted]. If it is not present, [the heart] is not [afflicted]. (21) Consider feeling a
[movement in the] vessels [that is associated with an illness in the] spleen. (22) External evidence of
such [an illness includes] a yellow face, a tendency to belch, a tendency to ponder, and a fondness of
tasty [food]. (23) Internal evidence of such [an illness is the presence of] moving influences right at
the navel which, if pressed, respond with firmness and pain. (24) The illness, as perceived by the
[patient], consists of a swollen and full abdomen; his food is not digested; his body feels heavy and
the joints ache. He is tired and weary, desires to lie down, and is unable to pull his four limbs
together. (25) If this [evidence] is present, the spleen is [afflicted]. If it is not present, [the spleen] is
not [afflicted]. (26) Consider feeling a [movement in the] vessels [that is associated with an illness in
the] lung. (27) External evidence of such [an illness includes] a white face, a tendency to sneeze,
grief without joy, and an inclination to cry. (28) Internal evidence of such [an illness is the presence
of] moving influences to the right of the navel which, if pressed, respond with firmness and pain.
(29) The illness, as perceived by the [patient], consists of panting and coughing, and of shivering
from [fits of ] cold and heat. (30) If this [evidence] is present, the lung is [afflicted]. If it is not
present, [the lung] is not [afflicted]. (31) Consider feeling a [movement in the] vessels [that is
associated with an illness in the] kidneys. (32) External evidence of such [an illness includes] a black
face and a tendency to be fearful, as well as yawning. (33) Internal evidence of such [an illness is the
presence of ] moving influences below the navel which, if pressed, respond with firmness and pain.
(34) The illness, as perceived by the [patient], consists of influences moving contrary to their proper
course, tensions and pain in the lower abdomen, and diarrhea [linked with a feeling] as if something
heavy was moving down, as well as [a feeling] of cold and reversed [moving influences] in the feet
and shinbones. (35) If this [evidence] is present, the kidneys are [afflicted]. If this [evidence] is not
present, [the kidneys] are not [afflicted].1
Unschulds Footnotes
1. Various commentators have argued that the question voiced in sentences 1 through to 7 is unrelated
to the answer given in sentences 10 through 35, and they have reached the conclusion that the text of
this difficult issue is corrupt. This may be so, but one could also support a different interpretation. In
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the preceding difficult issues, several diagnostic patterns have been outlined which, although based
on the same fundamental paradigms of yinyang and of the Five Phases, cannot be reconciled entirely
with each other. The quest for one general, coherent system, supposedly encompassing all
acknowledged facts and concepts, has characterized Western science for centuries. Yet such an allembracing system may be elusive to the human mind, at least for the time being. As developments in
modern physics demonstrate (for instance, the renewed recognition of cotemporaneous phenomena
and of the singularity of certain events), man's desire for knowledge may have to be satisfied with a
series of rather distinct explanatory models, often linked only by a common acknowledgment of some
basic paradigms of science. Such was also the case with the knowledge in the medicine of systematic
correspondence. Evidence obtained through experience and insights derived from theoretical
conclusions appear to have suggested various distinct explanatory models for an understanding of
illnesses and their symptoms. The question raised in sentences 1 through 7 may express the concern
that individuals would select one or another of these models and proclaim that their choice alone
represents the truth, while neglecting or even denouncing the other models. The response to this
complaint avoids a decision as to which of the diagnostic patterns mentioned is "correct," because
there is no point in making such a decision. Instead, a general survey is given which considers the
examination of the movement in the vesselsregardless of which pattern one relies on to determine
itas but one facet of a comprehensive assessment of the patient's state. Such a comprehensive
assessment, it is pointed out, has to take into account much more than the condition of the influences
in the conduits. The "holistic" schema of diagnosis actually outlined in this difficult issue appears,
however, merely as a hint; the scope is pointed out, but only a few selected details are offered. For a
tabular illustration of this schema see the following table.
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Vessel Movements & Diagnostic Significance, contd.

THE FOURTEENTH DIFFICULT ISSUE

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The sixteenth difficult issue: (1) The [movement in

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