The Diagnosis
This is a pretty difficult section to work with, largely because of all the technical terms relating to traditional Chinese medicine. Let’s see what we can do with it.
My Translation
The doctor went inside after that, and Jia Rong went with him. “Is this your esteemed wife,” the doctor asked Jia Rong after they entered the room and saw Qin Keqing.
“It is,” replied Jia Rong. “Please take a seat, doctor, and allow me to explain her symptoms. We can then proceed with the examination. Is that okay?”
“In my humble opinion,” replied the doctor, “it would be best to examine her first, and then discuss the origin of her illness. Since this is my first visit to your honored household, I am naturally unaware of the circumstances. However, Mr. Feng insisted that I come see her, and so I had no choice but to come.
“Once I’ve measured her pulse, you can see if what I say is accurate or not. Then we can discuss how her condition has progressed recently. We can then all discuss a possible prescription and see if it would be suitable or not. At that point, sir, you can make the final decision.”
“You are truly wise, sir,” replied Jia Rong. “Now I regret that we didn’t meet you sooner. Please, proceed with the examination, and see if she can be treated or not. This will ease my parents’ concerns.”
With that, some of the maids in the household got a large pillow for Qin Keqing to rest on. They helped her lean against the large pillow, pulled back her sleeve, and exposed her wrist. The doctor extended his fingers and placed them on the veins in her right hand. He quieted down his breathing to count her heartbeats for quite some time, concentrating very hard. He repeated the process on her left wrist.
When his diagnosis was complete he said, “Let’s go outside and discuss.”
Jia Rong went outside with the doctor, where they sat down. An older maid brought in some tea. “Please have some tea, sir,” said Jia Rong.
After they had finished their tea, Jia Rong asked him, “Based on your observation of her pulse, sir, is her condition treatable?”
“I see your honorable wife’s diagnosis like this,” replied the doctor. “Her left distal pulse is deep and rapid; her left medial pulse is deep and hidden. Her right distal pulse is thready and has no force; her right medial pulse is deficient and lacks vitality.
“The deep and rapid pulse at the left distal position indicates a deficiency of the energy of her heart, giving rise to fire. The deep and hidden pulse at the left medial position indicates the stagnation of the energy of her liver and that her blood is insufficient.
“The thready and forceless pulse at the right distal position indicates a severe deficiency of energy in her lung channel. The deficient and lifeless pulse at the right medial position indicates that the earth element of her spleen is being subdued by the wood element of her liver.
“The condition of deficiency of the energy of her heart would manifest itself as an irregular menstrual cycle and insomnia at night. The insufficiency of blood in the liver and stagnation of its energy would lead to distending pain below her ribs, a delayed menstrual cycle, and a sense of feverishness in her chest.
“The severe deficiency of energy in the lung channel would cause frequent dizziness and blurred vision, spontaneous sweating between 3 and 7 AM, and a feeling of unsteadiness as if she were aboard a boat. And the earth element of her spleen being subdued by the wood element of her liver would certainly result in a loss of appetite, listlessness, and soreness and weakness of the limbs.
“Based on my reading of her pulse, these should be the corresponding symptoms. If anybody were to think this pulse indicated pregnancy, I am afraid I could not possibly agree with their view.”
Translation Critique
Hawkes
大迎枕 is not a very clear term, and can be difficult to understand. David Hawkes translates it as “a large arm-rest of the kind used in consultations,” which is kind of helpful but still not entirely clear. My understanding is that it was a large pillow.
I’ve relied on Hawkes’ translations of “distal pulse” and “median pulse” for 寸 and 關, due largely to my lack of understanding of technical terms in traditional Chinese medicine.
The Chinese original refers several times to 氣 or “qi,” which we usually leave just as the vague “qi” in English translation. Hawkes translates this as “humour,” which is probably a pretty good representation. “Humour” in this sense refers to the fluids within the body.
Yang
The Yangs simply render 大迎枕 as “a pillow.” I actually think this translation is more technically correct than the Hawkes translation, though his explains that this is a special kind of pillow used in these kind of medical visits.
The Yangs also use the phrases “distal pulse” and “median pulse.” I’ve mentioned this before, but I think I ought to mention again that it’s likely that they used the Hawkes translation as a guide here.
Chinese Text
於是賈蓉同了進去。到了內室，見了秦氏，向賈蓉說道：「這就是尊夫人了？」賈蓉道：「正是。請先生坐下，讓我把賤內的病症說一說，再看脈，如何？」那先生道：「依小弟的意思，竟先看脈，再請教病源為是。我初造尊府，本也不知道什麼，但我們馮大爺務必叫小弟過來看看，小弟所以不得不來。如今看了脈息，看小弟說得是不是，再將這些日子的病勢講一講，大家斟酌一個方兒，可用不可用，那時大爺再定奪就是了。」賈蓉道：「先生實在高明。如今恨相見之晚。就請先生看一看脈息，可治不可治，得以使家父母放心。」於是家下媳婦們捧過大迎枕來，一面給秦氏靠著，一面拉著袖口露出手腕來。這先生方伸手按在右手脈上，調息了至數，凝神細診了半刻工夫，換過左手，亦復如是。診畢了，說道：「我們外邊坐罷。」
賈蓉於是同先生到外邊屋裡炕上坐了。一個婆子端了茶來。賈蓉道：「先生請茶。」茶畢，問道：「先生看這脈息還治得治不得？」先生道：「看得尊夫人脈息：左寸沉數，左關沉伏；右寸細而無力，右關虛而無神。其左寸沉數者，乃心氣虛而生火；左關沉伏者，乃肝家氣滯血虧。右寸細而無力者，乃肺經氣分太虛；右關虛而無神者，乃脾土被肝木剋制。心氣虛而生火者，應現今經期不調，夜間不寐；肝家血虧氣滯者，應脅下痛脹，月信過期，心中發熱；肺經氣分太虛者，頭目不時眩暈，寅卯間必然自汗，如坐舟中；脾土被肝木剋制者，必定不思飲食，精神倦怠，四肢痠軟。據我看這脈，當有這些症候才對。或以這個脈為喜脈，則小弟不敢從其教也。」
Translation Notes
賤內 is a humble phrase that refers to your own wife.
小弟 means “younger brother” and is a humble way that Dr. Zhang is using to refer to himself. He’s almost certainly not younger than Jia Rong, the person he’s speaking with.
斟酌 means to discuss, talk over, or deliberate over
方兒 here means a medical prescription
定奪 means to make a decision or a determination
大迎枕 is a specific type of pillow used to support a patient during medical examinations.
Notice the discussion of 調息 here, or pranayama. The doctor was able to calm down his own breathing to listen more carefully to her heartbeat.
寸 seems to refer to taking the pulse at the distal position and 關 to taking the pulse at the middle position.