Library

The syndrome of "Dongqi" (Pulsating Qi) manifests exclusively above, below, to the left, and to the right of the umbilicus. Hence it is termed "Umbilical Pulsating Qi". However, in Zhang Zhongjing's treatise on the Six Meridians' syndromes and treatments, not a single word is mentioned regarding this condition. It appears solely in Wang Shuhe's *Zhuke Yu Buke* (Various Conditions Suitable and Unsuitable for Treatment). Why is this? It is presumed that Zhang Zhongjing originally had no such term; it was Wang Shuhe who first established this theory. The so-called "Dongqi" refers to what Zhang Zhongjing called "Xin Xia Ji" (Palpitations in the Epigastrium), "Qi Xia Ji" (Palpitations Below the Umbilicus), and "Qi Pang Ji" (Palpitations Beside the Umbilicus). "Xin Xia" and "Qi Xia" correspond to above and below the umbilicus; "Qi Pang" corresponds to the left and right sides of the umbilicus. "Ji" (Palpitation) refers to the sensation of thumping or pounding movement. It is conjectured that Wang Shuhe renamed and defined this concept based on Zhang's work, making the term "Dongqi" seem more explicit and easier to understand than "Ji". However, a notable deficiency is that while prohibitions against sweating (Fa Han) and purging (Xia) are stated, along with the complications arising from their misuse, the underlying reasons are not clearly explained, nor are specific treatment methods established. This leaves later practitioners helpless when encountering such cases. Instead of elucidating Zhang Zhongjing's intent, this obscurity buries his methods, leaving students with no clues to follow. This can be described as being not only unhelpful but also harmful. Can this truly be considered sound legislative practice?

In my private opinion, within Zhang Zhongjing's writings, there are several examples of treating palpitations: *Xiao Jianzhong Tang* (Minor Construct the Middle Decoction) for palpitations accompanied by irritability; *Zhi Gancao Tang* (Honey-Fried Licorice Decoction) for knotted and intermittent pulse with heart palpitations; *Guizhi Gancao Tang* (Cinnamon Twig and Licorice Decoction) for palpitations after excessive sweating, where the patient crosses their hands over the heart; *Zhenwu Tang* (True Warrior Decoction) for dizziness, body tremors, a desire to fall to the ground, fever, and epigastric palpitations; and *Fuling Guizhi Gancao Dazao Tang* (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) for the sensation of *Ben Tun* (Rushing Pig) and palpitations below the umbilicus following sweating. All these forms of palpitation are caused by deficient pathogenic factors resulting from mismanagement of Taiyang disease. Furthermore, in Taiyang disease, if urination is clear and profuse, it indicates the absence of heat pathogens in the interior. If there is no heat in the Stomach but excessive water intake occurs, water stagnates in the epigastrium causing palpitations. In the Shaoyang meridian, cold damage presenting with a string-taut and thin pulse, headache, and fever already indicates Shaoyang involvement, precluding the use of sweating. If sweating is induced, the pathogen enters the Stomach causing delirious speech, because stomach disharmony leads to irritability and palpitation; this is palpitation due to erroneous sweating. In Shaoyang wind-strike, with deafness, red eyes, chest fullness, and irritability, vomiting and purging are prohibited. If erroneously employed, they cause palpitations and fright; this is palpitation due to erroneous vomiting or purging. Regarding the Three Yin meridians, palpitations arise from Yin excess and Yang deficiency. Only the Yangming meridian presents with excess-heat syndromes, hence palpitations are absent here. Thus, we know that "Dongqi" belongs to deficient pathogenic factors and is difficult to treat with sweating or purging. Moreover, at the initial stage requiring sweating, Dongqi should never appear. By the time Dongqi manifests, considerable time has passed, and the pathogen is in the interior; how can one induce sweating again? Only if the tongue coating is yellow, black, dry, and thick, and tenderness persists upon pressing from the epigastrium to the abdomen, might purging be considered despite the presence of Dongqi. However, if the pulsation is severe, the pathogen is firmly entrenched, the body is emaciated, and Yuan Qi (Original Qi) is exhausted, it is an untreatable condition. If the symptoms are mild and treatable, even after recovery, when diet and physique gradually return to normal, if Dongqi remains, it highlights that the umbilicus is the "Life Root" of the human body. The acupoint at the umbilicus is named Shenque (CV8). Above it lie acupoints such as Shuifen (CV9), Jianli (CV11), and Zhongwan (CV12), which are the residence of the Post-Heaven Spleen and Stomach and the passageway for dietary transformation. Below lie Yinjiao (RN7), Shimen (RN5), Guanyuan (RN4), and Qihai (RN6), the storage sites of Pre-Heaven True Yang and the root of ascending-descending and respiration. To the left and right are Tianshu (ST25). The *Suwen: Zhi Zhen Yao Da Lun* states: "Above the midpoint of the body, the Qi is divided into three, belonging to Heaven, governed by Heavenly Qi. Below the midpoint, the Qi is divided into three, belonging to Earth, governed by Earthly Qi." Naming Qi by its designation and location by its Qi, the midpoint is referred to as Tianshu. When superior pathology affects the inferior, it is named by Earth; when inferior pathology affects the superior, it is named by Heaven. These distinctions identify the winning and retaliatory energies of Heaven and Earth Yin-Yang, as well as the six Qi's yielding and responding patterns. Observing this, the significance of the umbilicus is profound. How can one allow pathogenic factors to invade it, injuring Zang Qi, obstructing the ascending-descending flow of Qi, and causing thumping palpitations? Although not a minor condition, it is not necessarily untreatable; treatment severity should match symptom severity.

In Wang Shuhe's *Zhuke Yu Buke*, under the "Unsuable for Sweating" section, it states: "If Dongqi is on the right, do not sweat. Sweating causes nasal bleeding, thirst, mental distress, and vomiting water upon drinking." I argue that by the time Dongqi appears, considerable time has passed, indicating interior deficiency. There is no rationale for sweating. Sweating causes deficient Yang to rebel upward, leading to nasal bleeding, thirst, and mental distress. Furthermore, post-sweating loss of Yang damages Stomach Yang, chilling the Middle Qi, causing immediate vomiting of ingested water. A treatment for "vomiting upon drinking" should be devised. It also states: "If Dongqi is on the left, do not sweat. Sweating causes dizziness, continuous sweating, muscle twitching, and fasciculation." This too indicates interior pathogen not requiring exterior attack. Sweating merely injures Wei Qi (Defensive Qi), leading to collapse of True Yang and dizziness. Unsecured Wei Qi causes continuous sweating. Without Yang to nourish the sinews, Yin-cold pervades the body, causing twitching. Treatment should refer to managing "tremors desiring to fall" or errors involving *Da Qinglong Tang* (Major Green Dragon Decoction). It further states: "If Dongqi is above, do not sweat. Sweating causes Qi rushing upward, centered at the heart." Although the area above the umbilicus belongs to Heavenly Yang, the appearance of Dongqi indicates the pathogen has entered the Fu organs. Sweating severely depletes Yang, allowing Lower Jiao Yin to counterflow and rush to the Heart. This should not be treated as simple "Qi rushing up" but rather using methods for "impending Ben Tun," possibly adding warming meridian herbs. Finally: "If Dongqi is below, do not sweat. Sweating results in no sweat, extreme mental烦躁 (restlessness), painful bone joints, dizziness, aversion to cold, vomiting food, and inability to digest grain." Since Dongqi is below the umbilicus, the pathogen is not only interior but in the Yin. Sweating is impossible. Sweat requires Yang to mobilize Yin fluids. With pathogen in Yin and insufficient Yang to vaporize fluids, sweating fails. Mental restlessness and dizziness indicate rebellious deficient Yang; joint pain and aversion to cold indicate Yang deficiency and Yin-cold excess; vomiting indicates Cold-Stomach deficiency. These are all variations of Yang loss due to erroneous sweating.

Under the "Unsuitable for Purging" section: "If Dongqi is on the right, do not purge. Purging exhausts internal fluids, causing dry throat and nose, dizziness, and palpitations." Without yellow/black coating or epigastric/umbilical hardness, purging is contraindicated. Erroneous purging in deficiency exhausts Stomach fluids, causing deficient Fire to flare, leading to dryness and dizziness. It states: "If Dongqi is on the left, do not purge. Purging causes abdominal tension, inability to eat, worsened Dongqi. Despite body heat, the patient desires to curl up." Left-sided Dongqi involves Shaoyang/Jueyin without excess pathogen. Purging damages Stomach Yang, creating Cold in the Middle Jiao, causing tension and worsening Dongqi. External body heat reflects floating deficient Yang, while curling up mimics Shaoyin syndrome. It states: "If Dongqi is above, do not purge. Purging causes hot palms and irritability, cold floating skin, spontaneous hot sweating, and desire for cold water irrigation." If Dongqi is near the Stomach and accompanied by thick yellow coating and hardness, purging may be appropriate. However, purging an empty Stomach injures Yang. Since limbs derive Qi from the Stomach, erroneous purging causes sudden Yang rebellion, hot palms, yet cold limbs and body. Desperate solitary Yang leads to hot sweating and desire for cold baths. This is True Cold-False Heat and Yang collapse. People know erroneous sweating loses Yang, but erroneous purging is even more destructive. It states: "If Dongqi is below, do not purge. Purging causes abdominal fullness, dizziness upon rising, undigested food in stool, and epigastric stuffiness." Dongqi below indicates Three Yin involvement. Erroneous purging damages Stomach Yang and Spleen Cold, causing fullness and dizziness due to severe Yuan Qi deficiency. Three Yin diarrhea with undigested food is treated with *Sini Tang* (Counterflow Decoction) due to Yang injury. Zhang Zhongjing noted in the deficiency-fullness section: "This is not heat binding, but Stomach deficiency causing hostile Qi to counterflow, creating hardness." These eight scenarios describe complications of erroneous sweating/purging in Dongqi. Whether from ancient masters or Wang Shuhe's speculation, I tentatively interpret them here.

Regarding the pulse description: "Ru (Soft) and Ruo (Weak) pulses, Weak reversed at Guan, Soft reversed at Dian, Micropulse reversed above, Choppy reversed below." This ultimately points to Yang insufficiency, Jue syndrome with cold, a variation of erroneous sweating in Yin meridians. Why use four "reversed" characters instead of simply stating Ru, Ruo, Micropulse, and Choppy Yin pulses? Why use obscure terms like "at Guan," "at Dian," "above," "below"? The meaning of "Dian" is particularly confusing. Does it mean the vertex of the head? The upper pulse position? Or the Cun Kou (Radial Artery)? Such cryptic language is unfit for instructing future generations. Later phrases like "similar form, different origin," "vomiting food, unable to digest," "mouth wants to speak, tongue cannot advance," "tongue atrophy, voice cannot advance," and "late rescue, impossible to追回 (retrieve)" are vulgar and logically flawed, certainly not the style of the Changsha Master (Zhang Zhongjing). Therefore, they are excluded. Readers should discern this.