Yīnyáng Mài Sǐhòu 陰陽脈死候
Signs of Death in the Yin and Yang Vessels
Anonymous (Mawangdui tomb 3 manuscript corpus, sealed 168 BCE)
About the work
The Yīnyáng Mài Sǐhòu 陰陽脈死候 (“Signs of Death in the Yin and Yang Vessels”) is the shortest of the medical texts from the Mawangdui 馬王堆 tomb 3 silk manuscript cache, sealed 168 BCE at Changsha, Hunan. In approximately 120 characters it presents a clinical scheme for distinguishing fatal from non-fatal vessel pathologies in the three yang and three yin vessel groups, and enumerates five specific external signs that signal the progressive death of the body’s constituent substances (flesh, bone, qi, blood, and sinew). The title is a modern editorial designation.
Abstract
The Yīnyáng Mài Sǐhòu was excavated in 1973 from Mawangdui tomb 3 and first published in 馬王堆漢墓帛書整理小組, 《馬王堆漢墓帛書》 (文物出版社, 1985); it received its definitive critical edition in 裘錫圭 et al. (eds.), 《長沙馬王堆漢墓簡帛集成》, 7 vols. (中華書局, 2014).
The text opens with a cosmological differentiation: “凡三陽，天氣殹” (“All three yang [vessels] are heavenly qi”) and “凡三陰，地氣殹” (“All three yin [vessels] are earthly qi”). For the three yang vessels, the only fatal condition is “折骨列膚” (“broken bone and split skin”) — that is, fatal yang-vessel pathology requires severe physical injury. For the three yin vessels, the condition “陰病而亂，則不過十日而死” (“when yin disease is chaotic, death within ten days”) represents the threshold of lethality.
The text then specifies five sequential external signs (wǔ sǐ 五死, “five deaths”) by which the practitioner can assess which substance is dying first:
- 唇反人盈 (lips curled outward, mouth open) — flesh (ròu 肉) dies first
- 齦瘠齒長 (gums wasted, teeth appearing long) — bone (gǔ 骨) dies first
- 面黑，目環視衺 (face blackened, eyes rolling sideways) — qi (qì 氣) dies first
- 汗出如絲，傅而不流 (sweat flowing like threads, adhering without dripping) — blood (xuè 血) dies first
- 舌掐卷 (tongue contracted and curled) — sinew (jīn 筋) dies first
The conclusion states: “五者扁有，則不沽矣” — “if all five are present, [the patient] cannot be saved.” The character 沽 is taken by editors as a tōngjiǎ for 活 (huó, “alive/to survive”).
This five-substance scheme (flesh, bone, qi, blood, sinew) represents an archaic conceptual framework distinct from both the five-phase (wǔxíng 五行) system of classical cosmology and the five-viscera (wǔzàng 五臟) system of mature medical theory. Its presence alongside the vessel texts confirms that multiple organizational frameworks coexisted in early Han medical thought. Donald Harper identifies this text as closely linked to the Màifǎ 脈法 KR2p0091 and the broader group of Mawangdui vessel manuscripts.
Translations and research
- Harper, Donald. Early Chinese Medical Literature: The Mawangdui Medical Manuscripts. London: Kegan Paul International, 1998. — Translation and commentary; pp. 208–212.
- 馬王堆漢墓帛書整理小組 (ed.). 《馬王堆漢墓帛書》, vol. 4. 北京: 文物出版社, 1985.
- 裘錫圭 et al. (eds.). 《長沙馬王堆漢墓簡帛集成》, 7 vols. 北京: 中華書局, 2014.
- Hinrichs, T.J., and Linda L. Barnes (eds.). Chinese Medicine and Healing: An Illustrated History. Cambridge, MA: Harvard University Press, 2013.
Other points of interest
The text shares its final prognosis section (the five death signs) with a structurally parallel section at the end of the Zúbì Shíyī Mài Jiǔjīng KR2p0090, suggesting that these prognosis materials circulated as a discrete unit that was appended to multiple vessel texts. The relationship between the two texts — whether one excerpted the other, or whether both drew from a common source — remains debated.