Qian Jin Fang: Traditional Chinese Medicine Pulse Diagnosis Guide for Predicting Life and Death

This prescription is from “Qian Jin Fang”, written by Sun Simiao during the Tang Dynasty. It focuses on pulse diagnosis in Traditional Chinese Medicine (TCM) to predict the life or death of patients with various illnesses. By examining pulse patterns—such as speed, strength, and depth—TCM practitioners determine the severity of diseases and guide treatment decisions. The text highlights the holistic approach of TCM, where the pulse is seen as a vital indicator of internal health conditions.

Pulse Diagnosis for Determining Life and Death in Diseases
(Author: Sun Simiao, from “Qian Jin Fang”)

When diagnosing the pulse, observe the patient’s physical size, temperament, and nature. A pulse that matches the person’s physical condition in terms of speed, size, and length is a positive sign. If the pulse is contrary to the person’s natural state, it is a bad sign.

Cold Damage (Shanghan) Fevers:

In severe cold damage fevers, if the pulse is floating and large, the patient will survive; if it is deep and small, the patient is in danger.
If a patient with cold damage begins to sweat and the pulse becomes deep and small, they will recover. However, if the pulse is floating and large after sweating, death is likely.

Warm Disease (Wenbing):

If the pulse is large and rapid within the first three or four days, the patient will survive; if the pulse is fine and weak, the condition is terminal.
In epidemic diseases with high fever, a fine and small pulse is fatal.
If warm disease causes diarrhea and severe abdominal pain, the condition is untreatable and fatal.
A patient with warm disease who sweats but the sweat doesn’t reach the feet is in danger of death.

Reversal Cold (Jue) Symptoms:

Sweating with a firm and rapid pulse indicates survival, but a weak and slow pulse suggests death.
In hot diseases, if the pulse is rapid and the patient has abdominal distention, headaches, and still eats normally, a fast pulse indicates death within eight days.
If by the fourth or fifth day, the patient experiences headaches, abdominal pain, vomiting, and the pulse is fine and strong, death is likely within twelve days.
After eight or nine days, if the headaches, body pain, and eye redness subside, but diarrhea appears, and the pulse becomes large, slow, and unresponsive, death is expected in seventeen days.

Prognosis Based on Pulse:

A firm, large, and rapid pulse in a hot disease suggests a poor outcome, especially when no sweating occurs.
A large, rapid pulse that persists even after sweating indicates extreme yang energy and an untreatable condition.
If sweating has occurred but the pulse remains overactive, it suggests extreme yin energy, and the prognosis is fatal.
If a hot disease has been sweating, but the fever remains and the pulse is weak and rapid, avoid needling treatment.

Pulse Patterns in Specific Diseases:

In cold-damage-induced paralysis or weakness, a weak pulse indicates survival, while a strong, rapid pulse indicates death.
In epilepsy, a weak pulse suggests treatability, while a strong and firm pulse suggests the patient will not survive.
In abdominal distention with blood in the stool and a large pulse that intermittently stops, the condition is dangerous.
A fine and weak pulse in a patient with persistent cough suggests a worse prognosis, while a floating pulse signals survival.

Critical Conditions:

For conditions like severe vomiting of blood, coughing with chest pain, or severe abdominal pain, a small and weak pulse indicates survival, while a large and rapid pulse points to death.
In cases of severe trauma with excessive blood loss, a weak pulse suggests recovery, but a strong, rapid pulse signals imminent death.