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Question: What is meant by "disaster and strangeness" (Zaiguai) in pulse diagnosis?

The Master said: Suppose a person is ill, the pulse presents as Taiyang disease, and the clinical manifestations correspond to the pulse. A decoction is prescribed accordingly. However, shortly after the medicine is delivered (about the time it takes to eat a meal), the patient suddenly experiences severe vomiting, diarrhea, and abdominal pain. The Master said: "When I examined the patient earlier, these symptoms were not present. Now the condition has changed abruptly; this is called 'disaster and strangeness'."

Question: Why does such vomiting and diarrhea occur?

Answer: It may be due to medication taken previously that is now taking effect, thus causing this seemingly strange occurrence.

Although the pulse and symptoms initially showed no discrepancy, the sudden onset of vomiting and diarrhea is indeed peculiar. Generally, this may arise because different people handle the preparation of the medicine differently; or it could be due to malicious acts, such as poisoning by maids, relatives from the wife's family, or enemies, which are unpredictable.

Taiyang governs with Cold-Water qi and commands the Six Meridians. The Bladder is the Fu organ of Taiyang, and the Taiyang Meridian is the meridian of the Bladder. In the sequence of the Six Meridians, the Three Yin meridians are interior, and the Three Yang meridians are exterior. Taiyang governs the skin and hair layer. Its sequence follows: first Taiyang, then Yangming, then Shaoyang, then Taiyin, Shaoyin, and Jueyin. Overall, Taiyang serves as the primary commander.

Yang qi is abundant at the exterior; the exterior yang is called Wei Qi (Defensive Qi). "Wei" means to guard, providing consolidation and protection of the exterior. Internally, Wei Qi transforms into Ying Qi (Nutritive Blood). "Ying" means to circulate continuously. Ying Qi is governed by the Liver, serving as the root of Wei Qi; Wei Qi is governed by the Lung, serving as the leaf of Ying Qi. Ying and Wei Qi are transformed in the Middle Jiao (Spleen and Stomach). Food enters the Stomach, its essence floats and overflows, transmitting through the collaterals. The purest part travels within the vessels and is named Ying Qi; the fierce and rapid part travels outside the vessels and is named Wei Qi.

Ying and Wei Qi are distributed among Metal (Lung) and Wood (Liver) but are unified under Taiyang. Therefore, Taiyang meridian diseases differ between injuring Wei and injuring Ying. Wei Qi is Yang, and Ying Blood is Yin. However, blood ascends to transform into Hun and Po (Soul and Spirit); this is Yin containing Yang. Thus, Liver Blood is warm and ascending/dispersing. Qi descends to transform into Jing and Po (Essence and Spirit); this is Yang containing Yin. Thus, Lung Qi is cool and descending/converging.

Human sweat pores close in winter and open in summer because the Liver and Heart govern Ying, and Wood-Fire qi is prosperous in Spring and Summer, causing Ying Blood to be warm and dispersing, opening the pores. The Lung and Kidney govern Wei, and Metal-Water qi is prosperous in Autumn and Winter, causing Wei Qi to be cool and converging, closing the pores.

If cold departs and warmth arrives, but Wood-Fire qi cannot vent, Wei Qi converges and closes, so the pores remain often closed. If attacked by Wind Qi while wanting to converge but unable to, the injury is to Wei Qi. If heat recedes and coolness arises, but Metal-Water qi cannot store, Ying Blood disperses, so the pores remain often open. If invaded by Cold while wanting to disperse but unable to, the injury is to Ying Blood.

Wind injuring Wei Qi occurs because cool weather causes pore closure. Cold injuring Ying Blood occurs because warm weather causes pore opening. When pores are open in Spring and Summer, one contracts Cold disease rather than Wind disease. When pores are closed in Autumn and Winter, one contracts Wind disease rather than Cold disease. Thus, even when Cold is prevalent in Autumn and Winter, Wind can still strike; even when Wind is frequent in Spring and Summer, Cold can still injure. The *Lingshu* chapter "Sui Lu" states that the Eight Winds of the four seasons enter humans, resulting in Cold and Heat distinctions. Cold makes the skin tight and pores close; Heat makes the skin loose and pores open. Because they enter when open, the invasion is deep, and the illness is sudden and violent. Because they enter when closed, the invasion is shallow, and the illness is slow and delayed.

Opening leads to injury of Ying (deep); closing leads to injury of Wei (superficial). Wind nature is dispersing; Cold nature is obstructing. Qi nature is converging; Blood nature is expanding. Wei Qi converges and pores close. In Wind Strike (Zhong Feng), Qi wants to converge but Wind disperses it, leading to sweating. The more Wind disperses, the more Qi tries to converge, thereby internally restraining Ying Blood and generating interior Heat. Ying disperses and pores open. In Cold Damage (Shang Han), Blood wants to disperse but Cold binds it, leading to no sweating. The more Cold binds, the more Blood tries to disperse, thereby externally closing Wei Qi and generating exterior Cold.

If human fundamental Qi is not stagnant, it does not become excessively strong. Stagnation causes those with Yang deficiency to have excess internal Yin Cold, manifesting as Cold syndromes; those with Yin deficiency have excessive external Yang Heat, manifesting as Heat syndromes. This is the origin of transmission to Fu or Zang organs. Pathogens entering Fu or Zang must first affect the skin and hair; thus, all Six Meridian diseases originate in Taiyang because it is the most exterior and injured first.

Pathogens in Ying and Wei, if not resolved, may enter Fu or Zang depending on the patient's interior Qi. Yang decline leads to Taiyin Cold syndrome; Yin decline leads to Yangming Heat syndrome. There is no alternative path. It is crucial to treat early during the initial stage of Ying-Wei disease. If not cured then, subsequent complications will not arise.

Wei Qi moves outside the vessels and interacts internally with Ying Qi; Ying Qi moves inside the vessels and interacts externally with Wei Qi. Harmonious Ying and Wei constitute a healthy person. Cold injuring Ying binds Ying Blood, which in turn constrains Wei Qi, causing Wei stagnation and exterior Cold. Wind injuring Wei blocks Wei Qi, which in turn restrains Ying Blood, causing Ying stagnation and interior Heat. Exterior emission of Ying and Wei resolves the disease; interior collapse of Ying and Wei advances the disease. Collapse and failure lead to death. Death from Shang Han or Zhong Feng is due to the collapse of Ying and Wei.

The exterior emission of Wei Qi relies on the prosperity of Yang Qi within the meridians; the exterior emission of Ying Blood relies on the prosperity of Yin Qi within the zang-fu. Yang is commanded by Yangming; Yin is commanded by Taiyin. When Yangming meridian Qi is prosperous, Wei Qi emits externally and sweating occurs. If Yang is deficient, Wei Qi desires to emit but cannot, leading to trembling and shivering before sweating. If further deficient, there is cold shivering without sweating; this is Yang failing to overcome Yin, with Wei Qi about to collapse. One should drain Yin and support Yang, open the skin and hair, and emit Wei Qi.

When Taiyin meridian Qi is prosperous, Ying Qi emits externally and sweating occurs. If Yin is deficient, Ying Qi desires to emit but cannot, leading to irritability and oppression before sweating. If further deficient, there is restlessness and stifling without sweating; this is Yin failing to overcome Yang, with Ying Qi about to collapse. One should drain Yang and support Yin, open the muscle surface, and emit Ying Blood.

Yang is prosperous in Fu organs; Yin is prosperous in Zang organs. The collapse of Wei Qi is due to excessive Zang Yin and interior Cold. The collapse of Ying Blood is due to excessive Fu Yang and interior Heat. Taiyang is the head of the Six Meridians, commanding both Ying and Wei. When Ying and Wei are initially diseased, if the exterior meridians are resolved and interior zang-fu are regulated, preventing interior Cold from moving and interior Heat from arising, there will be no future risk of entering Zang or Fu. This is the skillful treatment of Taiyang disease.

Taiyang meridian diseases involve only Wind and Cold. For Wind, Guizhi Tang is used; for Cold, Mahuang Tang is used. If Wind combines with Cold or Cold combines with Wind, Guizhi Mahuang Gemi Tang is used. If Wind combines with Fire stagnation or Cold combines with Water retention, Da Qinglong Tang or Xiao Qinglong Tang are employed. If Wind-Cold is resolved but interior dryness remains, Baihu Tang clears Metal. If Wind-Cold is not fully penetrated but interior dampness exists, Wuling San promotes urination. If Wind-Cold scatters externally but Blood Heat stagnates internally, Taohe Chengqi Tang or Didang Tang/Pills are set. These are fixed methods for treating the primary diseases of Taiyang Wind-Cold.

If human fundamental Qi is unbalanced, Yang stagnation does not reach extreme Heat, and Yin stagnation does not reach extreme Cold. Slight imbalance leads to Yin excess causing Cold or Yang excess causing Heat. Using warming, cooling, tonifying, and draining methods to restore the balance of Qi transformation allows recovery with appropriate herbs. Without misdiagnosis and mistreatment, it certainly will not become a complicated disease. Familiarity with Zhang Zhongjing's principles regarding Taiyang primary diseases ensures that Wind-Cold syndromes are resolved in the Taiyang meridian without becoming complicated diseases.