Chapter 73 The Liang Method of Pulse Diagnosis

A quiet evening gives way to a lesson in fundamentals.

Evan had completed the system's task, but he couldn't feel excited. There was even a faint sadness. After Simon Liu came to say goodbye, Evan had been subdued all day.

Clara and Ben both noticed he wasn't himself. Neither dared disturb him.

When work ended, Evan gathered his things and went home.

He ate a little dinner, then sat staring into space. He rarely did that. He always thought the time would be better spent reading medical books or studying more case records.

Yet now he sat there for more than half an hour, his mind completely empty. Not a thought passed through it. He seemed to have gone blank.

He really was just sitting there, doing nothing.

As he slowly came back to himself, wistfulness settled over his face. He gave a small sigh.

He got up and washed his face, then returned to his seat. He let out several long breaths and pulled himself together before opening the system to use his reward.

The scene before his eyes changed. He was back in the familiar clinical training room, where Dr. Cheng had taught him acupuncture last time.

He had trained day and night, oblivious to heat and cold, pushing himself to the point of mental collapse over and over before finally bringing his acupuncture skills up to the level of a provincial expert.

Now he was back. Two other people stood in the room, but Dr. Cheng wasn't one of them.

The expressionless simulated patient was still there.

And the other man…

“Hello, Comrade Xu. My name is Liang Xiuqing. I'll be teaching you the basics of the Liang method of pulse diagnosis. You may call me Teacher Liang.”

This time, Evan wasn't quite so surprised. It wasn't that Dr. Liang's pulse diagnosis was unimpressive. The system always arranged instruction of the highest caliber. Once he knew he would be learning pulse examination, Evan had guessed that it would probably be the Liang method.

Dr. Liang truly understood the essence of pulse diagnosis in Chinese medicine. He practiced the Liang method handed down in his family. Nine generations of the Liangs had been physicians, with a wealth of knowledge passed down through the family. Doctors with an inherited tradition like that were formidable.

There was an old saying: “Don't take a doctor's medicine unless his family has practiced for three generations.” Without those three generations behind a doctor, patients wouldn't feel safe taking his medicines. A family with nine generations was more impressive still, and the Liangs were best known for their pulse diagnosis.^[1]

Before examining a patient, Dr. Liang would sketch the body's five zang and six fu organ systems in a notebook. As he felt the pulse, he would add a few brief marks to the drawing.^[2]

He never allowed the patient to speak first. He took the pulse, then asked whether the patient had the symptoms he named. He had never been wrong.

Above all, he had absolute confidence in his pulse examination. People who knew him said he had X-ray eyes. No illness could hide from him.

Dr. Liang was famous for treating cancer. From the pulse alone, he could tell where a patient's tumor was growing, roughly how large it was, and whether it was benign or malignant.

Ordinarily, that kind of diagnosis required biomedical tests: CT scans and other equipment to locate and measure the tumor, then a tissue sample to determine whether it was benign or malignant.

Dr. Liang could do it with just a few fingers. Every patient who came to him was astonished.^[3]

One eminent doctor of Chinese medicine had said that Dr. Liang's prescribing wasn't of the very highest order. But when it came to pulse diagnosis, no one disputed his mastery.

…

Chinese medicine had four diagnostic methods: inspection, listening and smelling, inquiry, and palpation. The first three could all yield misleading signs.

Sometimes a patient had a cold pattern but showed signs of a heat pattern. Even tongue findings weren't always accurate. The only thing that was accurate, that never lied, was the pulse.^[4]

It was a lighthouse in the dark, a blade that could cut through layer after layer of fog.

Sun Simiao had said, “The pulse is a physician's great undertaking. If you do not study it in depth, how can you be a physician?”

The Neijing also said, “Bring complexion and pulse together, and you can achieve complete success.”^[5]

That was why truly skilled clinicians made pulse diagnosis their foundation, then consulted the findings of the other methods, checking one against another. They integrated all four methods to identify the pattern and treat accordingly.

As Wu Jutong had said, “Of the four diagnostic methods, the pulse is the hardest, but it is also the most reliable.” Pulse examination was the hardest to master, yet it was the central basis of diagnosis in Chinese medicine.

Dr. Liang was just such a true physician of Chinese medicine: he knew the root of a patient's illness before the patient spoke.

Even if he was only learning the basics, Evan was excited to study the renowned Liang method.

Dr. Liang began by having Evan examine the simulated patient's pulse. As soon as Evan put his fingers down, Dr. Liang shook his head. “Your foundations are very weak.”

Evan looked a little embarrassed. He had learned his basics at university. How much of a foundation could that be? Later, during his years with Dr. Qian inside the system, he had gradually developed his pulse skills.

By now they were just about adequate for treating patients. When he combined all four methods, he rarely misdiagnosed a case. That wasn't because of any great skill in his fingertips. It was because he was sufficiently careful and thorough.

But those modest abilities amounted to very little beside Dr. Liang, who could understand an entire case without the patient saying a word.

Dr. Liang smiled reassuringly. “Don't worry. We have plenty of time. We can build your foundations gradually. The Liang method of pulse diagnosis has no other secret. Its one secret is the basics.

“How firmly you establish those foundations will determine how far you can go. You have the best possible conditions here. I hope you can bear the solitude and settle your mind.

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“Let's start at the very beginning. The Nanjing says: ‘When first taking the pulse, apply pressure equal to the weight of three beans, reaching the skin and hair: this is the Lung level. With the weight of six beans, reaching the blood vessels: this is the Heart level.

“‘With the weight of nine beans, reaching the flesh: this is the Spleen level. With the weight of twelve beans, level with the sinews: this is the Liver level. Press down to the bone; when the pulse comes swiftly as you lift your finger, this is the Kidney level.’^[6]

“To learn pulse examination, you must begin by practicing with beans. Once you can control the pressure of your fingers accurately, you'll know what you're feeling when you examine a pulse.

“On an exhalation, the pulse travels three cun; on an inhalation, it travels three cun. One complete breath carries it six cun. Over a day and a night, a person takes 13,500 breaths, and the pulse makes fifty circuits of the body.^[7]

“Six cun for every breath in and out. Once your finger pressure is precise enough, and you've learned to gauge and calculate the pulse's course by the breath, examining it through one complete circuit will make the patient's illnesses clear beneath your fingers. You'll know what you're dealing with.

“So you must take great care when feeling a pulse. You can't give it a cursory examination, as some doctors do, and leave it at that. A cursory examination is quick, of course. A careful one takes longer.

“It sounds simple. Doing it is anything but. The Liang method is based on the pulse diagnosis of the Nanjing. Remember: never underestimate the four great classics of Chinese medicine. They are its true foundation.

“This is a basic course. I'll teach you only the fundamentals, not how to distinguish pulse findings and the patterns they indicate. There are three things for you to learn: control of finger pressure, gauging the pulse's course, and the normal pulses of the four seasons.^[8]

“We'll begin with finger pressure.”

As Dr. Liang finished speaking, a handful of evenly sized beans and a balance appeared on the table.

Dr. Liang put three beans on one pan and motioned for Evan to press the other with his finger. He smiled. “These instruments make things convenient now. In our day, we learned entirely by picking up beans with our fingers. It was far from easy.”

Evan let out a breath. This was a lesson in the basics. He couldn't expect to reach Dr. Liang's almost uncanny skill, but if he built a sufficiently firm foundation, his pulse examination would improve enormously.

That would greatly reduce the chance of a wrong diagnosis when he treated patients. Misdiagnosis was what a doctor feared most.

Evan quieted his mind and gently pressed down with his finger. Yet achieving a true balance was extremely difficult. Only now did he discover how hard it was to control his own strength with precision.

“Teacher Liang, may I ask how long it took you to learn that exercise with the beans?”

Dr. Liang smiled. “Three years just practicing with the beans. A lifetime reinforcing what I'd learned.”

Reader Notes

Reader Notes

1. ↩︎ A family tradition of medicine. The saying about three generations appears in the Liji, or Book of Rites, in “Qu Li II.” Here the narrator reads it as a mark of trust in knowledge accumulated within a medical family. It is a historical maxim, not a modern licensing requirement or a rule that skill is inherited biologically. The Liang family's nine generations and the teacher's reputation are the novel's account; the classical saying does not independently establish those biographical claims. Source: Chinese Text Project — Liji, Qu Li II, section 114 (in Chinese).
2. ↩︎ Five zang and six fu. These are traditional groupings of organ systems, a distinction introduced earlier in the serial. Their names overlap with anatomical organs, but the traditional categories also organize functions and relationships. The capital letters used for Heart, Liver, Spleen, Lung, and Kidney mark this traditional sense in the translation. Dr. Liang's notebook sketch is described as part of his diagnostic routine; it does not represent a modern anatomical scan. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 55–56.
3. ↩︎ Pulse diagnosis and tumors. The claims of unfailing accuracy and of identifying a tumor's location, size, and malignancy by touch are part of the novel's portrayal of Dr. Liang. “X-ray eyes” is a metaphor for that reputation. In biomedical diagnosis, imaging can help locate a suspected tumor, while examination of sampled tissue is often needed to establish cancer. The National Cancer Institute describes different tests for different circumstances, rather than one fixed sequence for every tumor. Its account does not establish the pulse-only abilities described in the story. Source: National Cancer Institute — How Cancer Is Diagnosed, Imaging tests and Biopsy.
4. ↩︎ Four methods and misleading appearances. Inspection includes the tongue; listening and smelling are grouped together; inquiry draws on the patient's account; palpation includes feeling the pulse. Traditional cold and heat patterns describe groups of findings. “True cold with false heat” names a pattern whose outward heat signs are interpreted as misleading. This passage places particular confidence in the pulse when appearances conflict. That ranking, including the statement that the pulse never lies, is the narrator's position. The general framework calls for assessing findings together; naming the four methods does not establish infallibility. Sources: Hong Kong Department of Health — Diagnostic Methods and Features, diagnostic methods and holistic assessment; WHO — International standard terminologies, entries 938 and 998.
5. ↩︎ Classical voices on diagnosis. Sun Simiao's statement about studying the pulse appears in the Qianjin Yaofang's section on pulse methods. The Neijing is the medical classic also known as the Yellow Emperor's Inner Canon; “complexion” here means the patient's observable coloring. Its passage connects visual findings with touch. The quotations in this chapter are translated from the Chinese manuscript, retaining its attributions, including the later quotation assigned to Wu Jutong. They express a medical tradition's ideals and arguments; their emphatic language is not a measured guarantee of diagnostic success. Sources: Qianjin Yaofang — Book 28, General principles of the normal pulse (in Chinese); Suwen — Chapter 10, Generation of the five zang (in Chinese).
6. ↩︎ The Nanjing and bean weights. The Nanjing, or Classic of Difficult Issues, presents medical questions and answers. Its fifth difficulty describes successively heavier finger pressure by comparison with three, six, nine, and twelve shu, beans used as a weight comparison, followed by pressure down to the bone. These are traditional descriptions of palpation depth and its associations, not instructions to press directly on the internal organs. The novel turns that comparison into a training exercise using beans and a balance. No exact bean species, gram conversion, or modern instrument specification is supplied. Source: Nanjing Benyi — Difficulty Five (in Chinese).
7. ↩︎ Breaths, cun, and circuits. The figures of three cun per inhalation or exhalation, six per complete breath, 13,500 breaths, and fifty circuits in a day and night appear in the Nanjing's first difficulty. They belong to a classical account of circulation through the body's channel system. Cun is a traditional length unit; it is retained here without converting the passage into inches or centimeters. A circuit means a complete course in that model, not a single heartbeat. The teacher's application of these figures to his examination belongs to the novel. Source: Nanjing Benyi — Difficulty One and commentary (in Chinese).
8. ↩︎ Normal pulses of the seasons. “Normal” here translates ping: the expected baseline, against which a practitioner interprets a change. Classical pulse theory describes seasonal differences as part of that baseline. It does not mean diagnosing four separate pulses in one patient. The Nanjing discusses these correspondences in its fifteenth difficulty. Dr. Liang lists this as one of three subjects he will teach; the chapter has not yet shown Evan learning it. His reference to four great classics likewise names a traditional core of study without listing the four books here. Source: Nanjing Benyi — Difficulty Fifteen (in Chinese).