Library

Taiyang (Greater Yang) pulse resembles Shaoyin (Lesser Yin), and Shaoyin symptoms resemble Taiyang. Although they appear similar, the treatment methods differ.

A deep pulse accompanied by fever is a common manifestation in both conditions. If headache is present, it is designated as Taiyang disease. Yang syndromes typically present with a floating pulse; however, if the pulse is deep rather than floating, it indicates internal deficiency-cold. With body pain, the priority should be to treat the interior deficiency, strengthening the healthy qi internally to expel pathogenic factors outward. Ganjiang Sheng Fuzi Decoction (Dried Ginger and Raw Aconite Decoction) may be used to resolve the condition through sweating. If there is no internal deficiency-cold, the pulse will necessarily be floating, which corresponds to the Mahuang Tang (Ephedra Decoction) syndrome of Taiyang.

A deep pulse accompanied by fever is also a shared feature. If headache is absent, it is designated as Shaoyin disease. Yin syndromes typically do not involve fever; thus, the presence of fever suggests that cold pathogens remain at the exterior and have not yet transmitted inward. The fever arises merely from the stagnation and closure of the skin pores. If heat were located within the interior, there would be no external fever. In this scenario, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Prepared Aconite, and Asarum Decoction) is indicated. Mahuang (Ephedrae Herba) releases the exterior slightly, while Fuzi (Aconiti Lateralis Radix Preparata) warms the Shaoyin meridians. Conversely, if cold pathogens are located in the interior, there will certainly be no external fever, and symptoms such as vomiting, diarrhea, and cold extremities (Jue Ni) will appear, corresponding to the Sini Tang (Recovery Decoction) syndrome of Shaoyin. Generally speaking, for Shaoyin exterior pathogens that are superficial, the presence of fever is considered a milder condition; whereas for Taiyang disease where healthy qi is significantly depleted, a deep pulse is considered a more severe condition. Shu Fuzi (Prepared Aconite) combined with Mahuang provides tonification amidst release; Sheng Fuzi (Raw Aconite) combined with Ganjiang provides release amidst tonification. This reflects the profound intent of Zhang Zhongjing.

A floating pulse indicates an exterior condition, for which diaphoresis (sweating) is the appropriate treatment. However, if the pulse is large and floating, accompanied by hardness and heat in the epigastrium (Xin Xia), indicating excess in the zang organs, purgation should be employed, and diaphoresis avoided. A deep pulse indicates an interior condition, for which purgation is the appropriate treatment. If Shaoyin disease presents initially with fever and a deep pulse, Ma Huang Fu Zi Xi Xin Tang should be used to induce slight sweating. An accelerated pulse (Cu Mai) generally indicates yang, for which clearing heat is the appropriate treatment. However, if an accelerated pulse is accompanied by cold extremities, moxibustion or warming methods should be used. This contradicts the theory that an accelerated pulse always signifies yang excess. A slow pulse (Chi Mai) indicates cold, for which warming is the appropriate treatment. However, in Yangming disease, if the pulse is slow but there is no aversion to cold and the body sweats, Da Cheng Qi Tang (Major Order the Qi Decoction) should be used for purgation. This contradicts the theory that a slow pulse always signifies yin-cold. These four scenarios illustrate prioritizing symptoms over pulses.

Exterior syndromes typically require diaphoresis, which is the standard approach. However, if there is fever and headache with a deep pulse and body pain, the interior must be treated first using Sini Tang (Recovery Decoction). Interior syndromes typically require purgation, which is the standard approach. Fever occurring during the You hour (17:00–19:00) belongs to Yangming; if the pulse is floating, diaphoresis with Guizhi Tang (Cinnamon Twig Decoction) is appropriate. If Jie Xiong (Chest Binding) syndrome is fully manifested, Xian Xiong Tang (Sinking Chest Decoction) is indicated for purgation. However, if the pulse is large and floating, purgation is contraindicated as it may lead to death; instead, the exterior should be treated. For body pain, Guizhi Mahuang Ge Ban Tang (Decoction of Half Dosage of Cinnamon Twig and Ephedra) is suitable for resolution. However, if the radial pulse at the cun position is slow, diaphoresis is contraindicated due to insufficient Ying blood (Nutritive Blood); instead, the Ying blood should be regulated. These four scenarios illustrate prioritizing pulses over symptoms.