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Further observation of classical medical texts reveals that the Spleen and Stomach are often confused with the intestines. Ancient sayings state that "the large abdomen belongs to the Spleen," yet what is stored within the large abdomen is precisely the Large Intestine and Small Intestine. Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage Diseases) states: "The Yangming disease is characterized by excess in the stomach house." The main symptom is internal accumulation of dry feces, and the treatment method should be purgation. Based on evidence and treatment principles, this pertains to treating intestinal diseases by addressing the intestines, rather than treating stomach diseases by addressing the stomach. The text explicitly mentions "dry feces in the stomach," which actually means "dry feces in the intestines"; this is common sense and requires no further debate.

In summary, the diagnostic location for the Large Intestine is at the right Guan pulse position, and for the Small Intestine at the left Guan pulse position; this is beyond doubt.

Three Topics on Pulse Diagnosis

I. Personal Experience with Double Wiry Pulses

The Wiry pulse (Xian Mai, a pulse feeling like a guitar string) is the primary pulse of the Liver channel. As the Liver belongs to Wood and its Qi tends to spread horizontally, it easily invades other Zang-Fu organs, leading to various pathologies. Thus, Wei Zhixiu once said, "The Liver is the thief of ten thousand diseases." In clinical practice, Wiry pulses or pulses with Wiry characteristics are commonly seen. Mastering the examination methods and diagnostic significance of the Wiry pulse is both extremely necessary and important. The Wiry pulse is divided into Single Wiry and Double Wiry. What is commonly referred to as the Wiry pulse is actually the Single Wiry pulse. This means that regardless of the left or right hand, only one channel exhibiting a Wiry image is seen in one hand, which is the usual Wiry pulse. There is another type, the Double Wiry pulse, which is less frequently seen but, when it appears, often indicates severe, chronic, or complex conditions. At such times, if one cannot grasp the pathogenesis and make decisive decisions, errors of significant magnitude are inevitable; thus, it remains worthy of study. In the 1960s, I suffered from a serious illness, feeling extremely debilitated. My pulse presented as Double Wiry and stiff/tough. I visited many renowned physicians, yet none could identify this pulse pattern and correlate it with the syndrome. The prescribed formulas were not only ineffective but also aggravated my condition. Recalling this incident still gives me palpitations. Now, based on my personal experience, I briefly describe the Double Wiry pulse for the readers' benefit.

Regarding the physical manifestation of the Double Wiry pulse, ancient experts held two views:

One view holds that among the left and right hands, seeing it in one hand is Single Wiry, while seeing it in both hands is Double Wiry, meaning simultaneous Wiry pulses in both hands constitute Double Wiry. For example, *Sizhen Juwei* (Refining the Four Diagnostic Methods) quotes *Maijian*: "Wiry pulses in both hands are Double; Wiry pulse in one hand is Single." Dai Tongfu further stated, "Wiry pulses at both Guan positions are called Double Wiry." Although slightly different, these belong to the same category.

Another view argues that the Double Wiry pulse should present as two Wiry channels within the Cun Kou pulse of one hand, either in the left or right hand. If seen in both hands, it would be four Wiry channels (two in each hand). For instance, the Japanese scholar Tanba Genkan, in *Maixue Jiyao* (Essentials of Pulse Learning), quotes Wu Shanfu: "Double Wiry means the pulse comes like two drawn lines... If Single Wiry, there is only one line." Similarly, Xu Zhongke in *Jingui Yaolue Lunzhu* (Commentary on the Essential Prescriptions of the Golden Cabinet) said: "Having two pulses in one hand is also called Double Wiry."

Among these two opinions, I believe the latter is correct. The former describes ordinary Wiry pulses, whether seen in one hand or simultaneously in both, which is the commonly known "Single Wiry pulse." During my illness, I manifested two thin, stiff, and tough Wiry channels in each hand, running parallel, slightly rapid, and unyielding upon pressure. Some have observed that the two Wiry channels in one hand of a patient may not be parallel but appear uneven and prominent. This reasoning is also plausible, though I have not witnessed it personally; I leave this for future experts to verify.

Secondly, the diseases indicated by the Double Wiry pulse fall within the scope of diseases indicated by the Wiry pulse. Previous discussions can be summarized in three points: First, the saying in *Maijing* (Classic of Pulse): "Double Wiry implies stiffness and pain under the hypochondrium." Hua Bolin and Wu Shanfu agreed with this. Second, "Double Wiry indicates cold stagnation." Zhang Luyu (*Zhenzong Sanwei*), Xu Huixi (*Maijue Qiwu Zhushi*), and Li Yangan (*Maijue Huibian*) shared this view. Third, Double Wiry indicates deficiency. Xu Zhongke stated in *Jingui Yaolue Lunzhu*: "This pulse is often seen in people with weak Yuan Qi; it also indicates deficiency. It is suitable to use warming and tonifying methods for the Middle Jiao combined with resolving phlegm, resulting in quick recovery."

Regarding my condition at that time (see the first half of "Calming the Liver and Washing Phlegm to Treat Mania"), it was caused by Phlegm-Heat disturbing the Heart and Liver, combined with Yin deficiency and Qi stagnation. Mr. Chao Nianzu treated me with clearing the Liver, washing away Phlegm, nourishing Yin, and calming the Spirit, which proved effective. Among the symptoms then, the most prominent was abdominal distension and pain radiating to the hypochondrium, corresponding to the first point mentioned above. Deficiency was indeed present, but warming and tonification were not appropriate. The key difference lay in the nature of heat versus cold: previous theories emphasized cold stagnation, whereas mine was Liver Heat. This does not imply an error in ancient texts; one must remember that pulse diagnosis is the last of the Four Examinations and must be integrated with Inspection, Auscultation/Olfaction, and Inquiry to be accurate. Relying solely on the pulse ignores concurrent signs. One should also examine the Deep (Chen) position, where the true nature of the main pulse is often hidden. If it were cold stagnation, the Double Wiry pulse would be accompanied by Deep, Slow, Tight, or Choppy images. My Phlegm-Heat manifested as a Double Wiry pulse that was stiff, thin, forceful, and slippery-rapid, unyielding upon pressure. Careful observation in such details yields unexpected insights. With prolonged practice, one can achieve remarkable results.

II. Seeking the Truth about the Hollow Pulse

The morphology of the Hollow pulse (Kou Mai, floating and large but empty in the middle, like pressing a green onion) has been compared to green onions by ancients. Due to this figurative description, interpretations vary. Two main views exist in ancient texts: One view states that the pulse is felt at the Floating (Fu) and Deep (Chen) levels but is empty at the Middle (Zhong) level. *Maijue Huibian* says: "The shape is like a hollow reed, similar to an onion. If using fingers to feel an onion, the Floating level touches the outer skin; the Middle level feels the hollow center; the Deep level touches the inner skin." Another view emphasizes that the sides are full while the center is empty. *Maijing* states: "The Hollow pulse is floating, large, and soft; pressing the center feels empty." *Sizhen Juwei* adds: "The Hollow pulse is large and soft like an onion; pressing the sides feels solid while the center is empty."

These two views are similar yet distinct: both use the onion analogy, one focusing on left/right and the other on up/down. The resulting mental image differs slightly but lacks essential distinction. Modern author Xiao Tongwu in *Xiao Tongwu Maijue Ji Mai'an* combines them: "The main feature of the Hollow pulse is that the periphery is floating and large, while the center is empty. It is not that it exists at Floating/Deep but not Middle, but rather that Middle extraction reveals emptiness."

I agree with Hehu's (Wang Shuhe) view in *Maijing*. The Hollow pulse is rarely seen clinically and is difficult to verify empirically. I once encountered a theory comparing the pulse to a small, soft, elastic rubber tube. After massive hemorrhage, blood volume drops sharply, but the vessel wall has not yet constricted due to lack of strength or tension. The vessel contains more Qi and less blood, making it feel soft upon pressure, similar to a gas-filled rubber tube. Pressing a rubber tube: Floating level feels soft and large; Middle level feels softer in the center than the Floating level, while the sides feel slightly fuller and firmer. A Deficient pulse would feel equally soft throughout and relatively wide. Deep pressing makes it hard to distinguish the bottom of the tube. Generally, vascular tension is uniform. At the Floating level, only upper tension is felt. At the Middle level, compression increases tension on the sides, creating a sensation of "solid sides." At the Deep level, upper tension plus blood flow force exceeds bottom tension, so one does not feel "touching the bottom onion skin" as described earlier. While this description seems imaginative, it aligns with clinical reality.

Regarding diseases indicated by the Hollow pulse, all agree it indicates massive hemorrhage. However, *Maijue* attributes it to Blood stasis and abscesses/pus, a view rejected by many. *Binhu Maixue* quotes *Maijue*, facing criticism. Actually, both are valid indications. Massive hemorrhage, though localized initially, rapidly affects the whole body, becoming a systemic issue. Thus, the Hollow pulse appears in all three positions (Cun, Guan, Chi). Its duration is short; after bleeding stops, vessels fill less, tension decreases, and the pulse transforms into Thin, Wiry-Thin, or Choppy types, no longer appearing Hollow. Hence, it is uncommon in routine practice.

For Blood stasis and abscesses, the pulse presence is longer-lasting, not transient like in acute hemorrhage. I hypothesize this arises from obstructed Qi and Blood flow. "The pulse is the pathway of Blood, preceding Qi and Blood." Pulse beats reflect the body's Qi-Blood dynamics. When healthy, flow is smooth, and the corresponding pulse site shows normal rhythms. When local stasis or pus forms on one side of an organ/tissue, the other side still flows but is restricted, reducing area and causing obstruction. The pulse site shows one channel, appearing Thin and Choppy. If stasis/pus blocks the center, Qi-Blood flows around the sides, generating two thin, choppy channels on the pulse site, which seems logical. Regarding fire signs, abscesses imply郁热 (stagnant heat); long-standing stasis generates heat ("hidden Yang in hardened masses"). Medical texts mention Hollow pulse indicating stasis. Sun Dongsu's *Shengshengzi Yi'an* records a case of hypochondriac pain diagnosed as Phlegm-Fire, noting: "If Blood stasis, the pulse must be Deep-Hidden, or Hollow, or Choppy." Equating Hollow with Choppy and Deep-Hidden for stasis. *Chen Xunzhai Yixue Biji* records: "Deficient persons with stasis may have a Hollow pulse, often with a Wiry segment. Tonify while removing stasis; use Taohé Chengqi Tang plus 5 qian Ginseng, divided into three doses for slow attack, saving 20-30%." This shows the dual nature of the Hollow pulse: indicating both blood loss and stasis. Blood loss indication is limited to the initial phase; prolonged bleeding changes the pulse. For stasis, the Hollow pulse is forceful, possibly combined with Wiry, Choppy, or Deep-Hidden images.

III. Realizing the Scattered Form by Observing Rain

Regarding the morphology of the Scattered pulse (San Mai, floating and scattered without root), *Maijing* states: "The Scattered pulse is large and scattered." Later physicians followed Wang Shuhe, elaborating but staying within his scope. Descriptions include "floating, large, and unrestrained," "rootless," or "like willow catkins drifting aimlessly." But what exactly is its form? How to perceive it under the fingers? What does "unrestrained" mean? What does "rootless" mean? What does "drifting like catkins" mean? Pulse diagnosis is a practical skill; unclear morphology hinders examination. I pondered this repeatedly during consultations, finding it hard to grasp. The key to the Scattered pulse lies in "scattering," yet the essence of "scatter" was elusive. One summer day, sitting by the window, thunder rumbled, followed by heavy rain. Puddles formed in the garden. Raindrops hit the water, creating bubbles. As rain fell chaotically, bubbles rose and popped, forming a chaotic, disordered pattern. I suddenly realized the shape of "scatter" resembled this perfectly.

Of the twenty-seven pulses, except for the Scattered pulse, all others retain a linear shape, even if prominent in one section (like the Surging pulse, bean-like and rapid). Even searching other sections reveals linear continuity. The Scattered pulse lacks linear continuity. On the Cun Kou skin surface, countless scattered跳动 points appear, rising and falling, with no fixed location or rhythm. Ancients compared it to drifting catkins, just as I observed bubbles rising and vanishing. This is the "Scatter" in *Maijing*: no fixed point, irregular birth and death, hence "chaos." Only then did I understand the Scattered pulse's form. Since then, applying this understanding in clinic has never failed. However, Scattered pulses are rare; I mostly see them in patients with atrial fibrillation, especially those with AF and asthma.

Reflections on Clearing Yellow-Brown Thick Greasy Coatings

Yellow-brown thick greasy coatings are occasionally seen clinically. Pathologically, they usually indicate internal accumulation of Phlegm-Heat, suggesting excess rather than deficiency. Physicians, combining pulse and symptoms, typically use methods to clear heat and resolve phlegm, sometimes adding bowel-opening agents. Prescriptions tailored to symptoms often yield good results. However, Dampness is lingering and sticky, hard to transform. Through repeated clinical reflection, I realized that long-standing Phlegm-Heat damages Body Fluids. Although Phlegm forms from Dampness, its blockage prevents fluid distribution, causing local dryness and tightening the Phlegm-Damp adhesion. Moistening helps remove this adhesion. Cooling phlegm-resolving herbs cannot replace heat-clearing drugs. Since Phlegm-Damp binds with Heat, appropriate heat-clearing agents must be added. For deficiency, use Sweet-Cold; for excess, use Bitter-Cold. Phlegm forms from Heat frying Damp turbidity; if Heat isn't resolved, Phlegm hardens. In later years, for stubborn yellow-brown coatings, I incorporated moistening-drying and heat-draining herbs into phlegm-resolving formulas, achieving success. Three examples follow.

Retired cadre Mr. Wang had esophageal cancer. Left Guan pulse was large and forceful; Right pulse was small. Tongue was pale with central fissure, coating thick, greasy, yellow-black, with patchy peeling. Added Gua Lou, Yu Jin, Zhu Ru, and Zhu Li to anti-cancer formula. After six doses, coating remained unchanged. Modified formula included Sha Shen, Shi Hu, Gua Lou, Shi Jue Ming, Ju Hua, Zhu Ru, and Shan Zhi. After three doses, coating completely dissolved, revealing red tongue body with thin, clean coating. Patient was excited, recalling two instances of yellow-black thick coatings. Once at age thirty with hepatitis, Chinese medicine didn't clear it until a family doctor cleared it after dozens of doses. This black coating lasted over two years before cancer diagnosis; clearing it quickly amazed him. Surgery followed, but he died unexpectedly, a regrettable outcome.

Middle-aged Ms. Wang had carcinoma in the posterior basal segment of the right lower lung lobe, with obstructive inflammation and carinal involvement. Metastasis to T9 vertebra, visible egg-sized subcutaneous mass, lower limb paralysis. Pulse was small-slippery; tongue center had gray-black thick greasy coating. Combined anti-cancer formula with Simiao Wan. After two doses, four episodes of black, foul-smelling diarrhea occurred, stopping on the third day. Appetite improved, T9 swelling subsided. Tongue became light red with thin white clean coating.

Another case involved a lung cancer patient, primary peripheral squamous cell carcinoma of the right upper lobe, metastasized to the right fourth rib. Elderly, frail, tongue pale, coating sticky with a yellow-black strip in the center. Liver Qi stagnation and Spleen deficiency made her intolerant to fluids-generating and Bitter-Cold herbs (poor appetite, fatigue, lethargy). Only Sweet-Cold phlegm-resolving and heat-clearing herbs were added cautiously for slow treatment. After over a month, coating gradually cleared, exposing stagnant heat. Tongue became bright red without coating. Quickly administered Yin-nourishing, fluid-generating, and anti-toxin herbs. Symptoms temporarily receded, condition improved.

All three cases featured yellow-black thick greasy coatings. Cao Bingzhang's *Caitu Bianshe Zhinan* states: "Yellow-black, floating-slippery, sticky coating indicates Taiyin Damp-Heat binding internally; promote diuresis and clear heat." Beijing University of Chinese Medicine's *TCM Tongue Diagnosis* notes for "Yellow-edged Black Greasy Coating": "Yellow coating on edges and tip, gray-black in center indicates internal Damp-Heat accumulation." Clinical yellow-sticky coatings with gray-black centers usually indicate Damp-Heat binding, consistent with these cases. However, Cases 1 and 3 involved prolonged illness, fluid depletion, and heat binding. Though Damp-Heat existed, fluid dryness prevented lubrication, making Phlegm-Damp hard to resolve. Without fluid, Heat persists. Thus, flexible treatment was needed: first generate fluids and moisten dryness, combined with clearing heat and draining dampness. This achieved efficiency. Like wet mud on a wall, easy to scrape off; if semi-dry, scraping damages the wall. Wetting it first makes removal easy. Physics and pathology often intersect; observing things leads to knowledge. This represents flexible differentiation and treatment, requiring careful consideration by physicians. Sharing these shallow insights, not keeping them secret.

Additional Remarks on Tongue Examination

Fissured tongue (Lie Wen She) is a common clinical sign, frequent in chronic diseases. Generally indicating Yin deficiency and fluid exhaustion, it cannot be generalized. *Bianshe Zhinan* discusses this extensively, e.g., "Pale white tongue with widespread cracks indicates Spleen deficiency with Damp invasion." Fluid exhaustion (dry) vs. Damp excess (wet) are vastly different. Besides pathological causes, physiological fissures exist. I once treated a young clerk, Mr. Bu, with hepatitis. Aside from the tongue, all four examinations were normal. His tongue was light red, full, filling the mouth, with a fine crack from tip to root, and symmetrical fine cracks on sides. Near the root on the sides, cracks angled toward the tip, resembling leaf veins. Coating was thin white. Prescribed Liver-soothing, Qi-regulating, Spleen-strengthening, and Damp-resolving herbs. Hepatitis improved, but tongue appearance remained. Asking about the cause, he didn't know. I prescribed a hundred doses to treat the fissure and correct potential fluid deficiency. Two weeks later, he reported asking his mother, who said his tongue had always looked like that. It was physiological. I was astonished and blamed myself.