Chapter 74 Normal Pulses of the Four Seasons

A lesson in pulse diagnosis begins with learning what is normal.

On the street outside a restaurant behind the Chinese medicine hospital, a young man was making a drunken scene.

“Bastard! The man's a complete bastard!” Alex Xu cursed at everything around him.

The people beside him hurried to hold him back.

His face red with drink, Alex ranted in a thick voice. “I can't accept it. I can't stand it. Why should this happen? Dr. Liu is such a good man. He's worked hard at that hospital for decades. So skilled, and so conscientious.

“Such a good man, but he never knew how to cultivate connections. That's why he's only getting a deputy's post now. Otherwise, he'd have been running the department years ago. Just when things were finally looking up, someone comes along and talks him into this nonsense.^[1]

“Who the hell does that kid think he is? What's wrong with integrating Chinese and Western medicine? What gives him the right to say that? Even the famous doctors of Chinese medicine wouldn't dare say such a thing!

“Has someone put a curse on my teacher? How did that kid fool him so completely? It makes me furious!”

Someone beside him tried to calm him down. “All right, don't get so worked up. You're in public.”

“Why shouldn't I be angry?” Alex shouted drunkenly. “I'm going to find that bastard and fight him!”

He staggered into a run.

The others hurried to stop him again.

…

Meanwhile, Evan was still practicing pulse examination inside the system. He had no idea how much time had passed. Thank goodness he was in the clinical training room. Outside it, this much practice really might have driven him mad.

No wonder the Neijing said that anyone examining a pulse must prize a quiet, undistracted mind. Without settling his mind, how could he refine his skill? How could he feel the pulse as it truly was?^[2]

He couldn't have said how long he practiced before controlling his strength became both easy and precise.

Only then was Dr. Liang satisfied with his grasp of the first fundamental.

Next came gauging the pulse by the breath and determining its position along a complete circuit. Another unknown stretch of time passed before Evan met the standard for that second fundamental.^[3]

The last subject was examining the normal pulses of the four seasons. Ordinarily, a normal pulse meant there was no illness. But each season had particular pulse qualities that might indicate illness at other times yet be normal in that season.

These were wiry in spring, surging in summer, featherlike—a floating pulse—in autumn, and stonelike—a deep pulse—in winter.^[4]

“In their own season, these qualities need not indicate illness,” Dr. Liang said. “But an illness affecting the same area can produce the same pulse. So you must learn the normal pulses of the four seasons and understand what they convey before you can learn to recognize diseased pulses.

“We live between heaven and earth, within the natural world. Illness comes from either internal causes or external influences. The six external pathogenic influences are all ways in which the natural world makes people ill.

“When nature causes illness, its remedy is also hidden in nature. That is why Chinese medicinal substances have properties that lean one way or another. One tendency corrects another. This is the most fundamental principle behind treatment in Chinese medicine.^[5]

“To learn the normal pulses of the four seasons, you must understand the seasons themselves and the natural world. When I was young and learning pulse examination, my father wouldn't let me take anyone's pulse. He made me feel river water first.

“In spring, he fixed a rope in the river. The river was like a person's pulse. He had me put my hand into the spring water and feel the rope, to understand the wiry quality of spring.

“In summer, I stood beneath the blazing sun in the fierce heat and reached into the powerful current, to understand the surging quality of summer. In autumn, I held a sparrow in my hand and gently stroked its neck and back, to understand the movement of the featherlike autumn pulse. In winter, I broke the ice and felt the stones in the river, to understand the stonelike quality of winter.”

Dr. Liang sighed softly. “A pulse has its outward qualities, but its spirit matters more. You must never judge a pulse from a textbook alone. Take the rapid pulse, which indicates a heat pattern: six beats in one breath, 90–100 beats per minute. But if it goes far beyond 100, even to 200, and the person's complexion is dark and dull, it becomes a sign of extreme cold, with yang on the verge of total collapse.

“A slow pulse indicates a cold pattern. Yet extreme heat can also produce a slow pulse when it causes guange, a blockage above and below. A floating pulse indicates an exterior pattern. Yet it can also appear when yang qi is dispersing outward. If you try to release the exterior then, you'll cause serious trouble.^[6]

“Pulse qualities can mislead you too. Only when you truly understand how to examine the normal pulses of the seasons can you learn to recognize diseased pulses, get to the root of the illness, and avoid being trapped by misleading appearances.

“I practiced through several summers and winters before I grasped what the seasonal pulses conveyed. Only then did my father allow me to examine people. After that, I could catch the pulse's moment-to-moment changes in the body. I knew what my fingers were feeling and understood it in my mind. This is why I've never misdiagnosed a case in my life.”

Evan couldn't help admiring him. Never a wrong diagnosis in a lifetime. How difficult was that? Even an old horse could stumble. Who dared claim never to have made a diagnostic mistake? Evan was extremely cautious and rarely misdiagnosed a case, but it had happened.

There were minor diagnostic errors and major ones. As the Neijing said, “A skilled diagnostician observes the complexion and feels the pulse, first distinguishing yin from yang.” As long as that distinction was correct—using yang medicines for a yin illness and yin medicines for a yang illness—even a wrong diagnosis would at worst leave the medicine ineffective, or slow to take effect.^[7]

But if even yin and yang were mistaken, it would be like Simon Liu's two misdiagnoses. Both times, he had identified a yin illness as yang, then used a yin treatment for it. The more he treated it, the worse it became.

A source check points to NovelPhoenix: the author publishes this story there, while this copy was taken without permission. Readers there help.

“Only when you can examine the normal pulses of the four seasons have you truly entered the world of pulse diagnosis,” Dr. Liang continued. “You're still outside the door. Let's begin. Spring: the wiry pulse.”

As he finished speaking, the surroundings changed.

A broad river flowed past Evan in the lingering chill of early spring. He stood on its bank. A rope had been secured in the water.

…

Evan opened his eyes to a terrible headache, an aftereffect of entering the clinical training room. Traveling back in time to study under a teacher was easier on him. He lived through those days one by one, so even returning wasn't too painful.

But in the training room he practiced day and night without stopping. Coming back to reality all at once made his head feel as if it would burst.

He leaned back on the bed and rested for a long time before his aching head began to clear. He let out a long breath. The process had been painful, but he had gained a great deal.

He had now crossed the threshold into pulse diagnosis.

A satisfied smile came over his face. The further he went along the path of practicing Chinese medicine on its own, the wider the way ahead seemed to become.

…

At the county Chinese medicine hospital, Alex was seeing outpatients. He tapped his aching head. He was hungover and vaguely remembered making a drunken scene the night before.

He sighed and shook his head, visibly irritable. Everything that had happened with his teacher lately had left him upset and angry too.

He took several heavy breaths, then clicked the button on his computer to call the next patient.

A middle-aged couple soon came in. The husband kept coughing.

Alex looked up at the patient, puzzled.

The wife spoke with a slight accent. “Doctor, you're Dr. Xu, aren't you?”

Alex nodded. “Yes, I'm Dr. Xu.”

The couple relaxed. “Dr. Xu, my husband's been coughing for months. No one's been able to get rid of it. Would you have a look at him?”

“How many months? Any phlegm?”

“Two months. No phlegm, just a dry cough.”

Alex recorded the main complaint, asked a few more questions, then said, “Let's get a CT scan first, to see whether there's an infection in the lungs. And a complete blood count, all right?”

The couple looked taken aback.

“We've already had those tests,” the wife said. “They didn't find anything.”

Alex frowned. “Have them done again. His condition may have changed. If you're being treated at our hospital, you need to have the tests done here. That way, they're more accurate.”

“But aren't you a doctor of Chinese medicine?” she asked, puzzled.

His frown deepened, and impatience showed on his face. “Chinese medicine doctors need those tests too. How can I prescribe without seeing the results? Would you dare take what I prescribed?”

“But… when Evie was sick, didn't you just feel her pulse and prescribe a few doses? And she got better.”

Alex was even more confused. “Evie? Who?”

“Our neighbors' little girl. Evie. A year and a half old. She was just discharged from here. She had that adeno… what was it?”

“Adenovirus pneumonia,” her husband managed between coughs.

“Yes, yes, that's it. Adenovirus pneumonia. Her parents said it was very serious. She nearly had to go into intensive care. It was frightening. But she took your medicine, and after just a few doses she was better. They said you were very good, so we made a point of booking an appointment with you.”

Alex was livid. What the hell was this?

Reader Notes

Reader Notes

1. ↩︎ A deputy's post. The hospital has both professional ranks and department management posts. Earlier chapters established that Simon already held the rank of associate chief physician and was about to become deputy head of his department. Alex's complaint follows that distinction: the delayed promotion here is a department post. His claim that connections held Simon back is his own explanation, not an independently established account of the hospital's appointments. Source: Beijing municipal government — Medical professional title structure, section III(1), item 1 (in Chinese).
2. ↩︎ A quiet mind at the pulse. The Neijing, or Yellow Emperor's Inner Canon, is a foundational medical classic. Its Suwen section, Chapter 17, calls for an undistracted, still mind when examining the pulse. Evan's reflection concerns the examiner's attention and ability to perceive subtle differences through touch. “Empty” describes freedom from distracting thoughts, not unconsciousness. The line is a traditional statement about the practitioner's approach; it does not explain the fictional system's control of time or mental strain. Source: Shanghai University of Traditional Chinese Medicine — Classical passages for the Level I examination, Neijing, Unit Eight, item 5 (in Chinese).
3. ↩︎ Gauging by the breath. This continues the lesson introduced in Chapter 73. The Nanjing describes the pulse's course through a traditional circulation model, with a complete circuit meaning a course around the body. It is not one heartbeat. The novel's training method uses the examiner's breath to judge that course; no modern blood-flow measurement is implied. Source: Nanjing Benyi — Difficulty One (in Chinese).
4. ↩︎ The seasonal baseline. Chapter 73 introduced the idea of normal seasonal pulses. Here the individual qualities matter: wiry suggests a stretched string; surging suggests a strong incoming wave; featherlike emphasizes a light, superficial sensation; stonelike emphasizes depth. These are comparisons for touch, not objects inside an artery. The Nanjing's fifteenth difficulty uses “hooked” for summer, while the manuscript here uses “surging”; the translation preserves that choice. A seasonal tendency does not make every pronounced example normal. Dr. Liang's point is to distinguish a normal variation from a similar quality caused by illness. Source: Nanjing Benyi — Difficulty Fifteen and commentary (in Chinese).
5. ↩︎ External influences and medicinal properties. The six influences are wind, cold, summer-heat, dampness, dryness, and fire, traditional categories for interpreting illness. They are not six types of microbe. A medicine's “tendency” means a characteristic within that framework, such as warming or cooling, rather than necessarily the temperature at which it is taken. Dr. Liang connects those properties with correcting a patient's imbalance. His wider claim that nature contains the remedy for the illnesses it causes remains his explanation in the story. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 281, 2635, and 2638–2639.
6. ↩︎ Reading the whole pulse. Rapid and slow concern rate; floating and deep concern response to finger pressure. A pulse's “spirit” means its perceived vitality, not a separate being. Cold, heat, the exterior, and yang collapse are traditional pattern terms. The teacher gives exceptions to simple associations. Here guange describes blockage above and below; no modern obstructive disease is assigned. Six beats per breath and 90–100 per minute reproduce the manuscript's figures; their conversion depends on breathing rate. The extreme-rate example remains a narrative teaching claim, not a universal rule for diagnosing cold or yang collapse. Sources: WHO — International standard terminologies, entries 414 and 888–892; Hong Kong Department of Health — Diagnostic methods and comprehensive assessment.
7. ↩︎ Yin, yang, and treatment direction. This passage returns to the traditional distinction used in Simon's earlier cases. “Yang medicines” and “yin medicines” describe opposing medicinal tendencies, not drugs that literally contain yin or yang. The Neijing quotation puts distinguishing the pattern before treatment. The narrator's following assurance—that other diagnostic errors would at worst make treatment ineffective or slow—is broader than the quotation and remains the novel's assertion. The cited passage does not establish that an incorrect treatment is harmless, or verify Dr. Liang's lifetime record of never misdiagnosing a case. Source: Suwen — Chapter 5, Great discussion of the correspondences of yin and yang (in Chinese).