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The pulse at the Cun Kou (Cun position of the radial artery) being faint indicates the loss of Yang Qi. A choppy pulse indicates the depletion of Yin Blood. A weak pulse with fever indicates deficiency of Zheng Qi (Upright Qi). A tight pulse indicates the invasion of Cold Evil. When Cold Evil takes advantage of deficiency, it leads to Jue syndrome (cold extremities), stagnation of Stomach Qi, and numbness of the body. This is because the Stomach lacks the Qi derived from food and drink, and the Spleen's transport function is sluggish, causing Qi obstruction. This results in stiffness of the mouth and inability to speak, along with shivering and trembling.

Stiffness of the mouth and inability to speak occur because the Blood stored in the Spleen is insufficient to ascend and connect with the Heart Qi.

If the pulse at the Cun Kou is faint and the Chi pulse (distal radial pulse) is tight, the person suffers from deficiency and exhaustion with profuse sweating. This indicates that Yin Qi is prevalent while Yang Qi is absent, as no Yang pulse is seen.

When Yang Qi is weak and Yin Qi prevails, compounded by profuse sweating, the Yang Qi becomes even more deficient.

When the Shao Yin pulse (radial pulse at the Shao Yin position or deep pulse indicating Kidney condition) is absent, it signifies that Kidney Qi is weak and Essence-Blood is scant. The rushing Qi (Ben Teng Qi) rushes upward into the chest and diaphragm, causing Zong Qi (Pectoral Qi) to stagnate and blood to congeal below the heart. Yang Qi retreats downward, and heat returns to the inner thighs. The interaction between Yin and Yang causes numbness of the body. This is called "Corpse Jue" (Shi Jue), and one should puncture the Qimen (LR14) and Juque (CV14) acupoints.

When the True Yang Qi in the Kidneys cannot govern the whole body, Yin Qi presses upward into the Yang regions. Consequently, Zong Qi stagnates and blood congeals. The Yang Qi below the heart fails to extend, sinking into the deepest Yin areas. With only Yin and no Yang throughout the body, numbness and Jue syndrome ensue. Treatment involves puncturing Qimen to break up congealed blood and Juque to promote the movement of Zong Qi. Once Zong Qi circulates, Yang Qi naturally recovers, and Jue subsides.

If the pulse at Cun Kou is floating and large: Floating indicates deficiency; Large indicates excess. If seen at the Chi position, it is called Guan (Obstruction); if seen at the Cun position, it is called Ge (Rebellion). Guan leads to inability to urinate; Ge leads to vomiting and reflux.

If the Fu Yang pulse (pulse at the dorsum of the foot) is hidden (Fu) and choppy (Se): Hidden indicates vomiting and reflux with undigested food and water; Choppy indicates difficulty in swallowing food. This is termed Guan Ge (Obstruction and Rebellion).

The previous passage discusses Guan Ge characterized by a pulse significantly larger than normal due to deficiency and excess. Guan is seen at the Chi position, and Ge at the Cun Kou. Thus, when "Cun Kou" is mentioned, it generally refers to all three positions (Cun, Guan, Chi). The next passage discusses Guan Ge characterized by an abnormal hidden and choppy pulse at the Guan position. Hidden pulse indicates Qi stagnation; Choppy pulse indicates Cold in the Blood. The former case represents a terminal stage of righteous Qi decline and evil excess, which is untreatable. The latter case involves Cold Evil blocking and rejecting, which is treatable. These must be carefully distinguished.

If the Fu Yang pulse is imperceptible, it indicates that Spleen Qi cannot distribute upwards and downwards, leading to cold body and hard skin.

A cold body indicates that Stomach Qi fails to warm; hard skin indicates that Ying Blood fails to moisten. Due to the decline of Ying and Wei (Defensive) Qi, the Fu Yang pulse becomes imperceptible, Spleen Qi fails to distribute, and finally, Zang Jue (Visceral Cold Extremities) develops.

If the Cun pulse does not reach down to the Guan position, it is called Yang Jue (Yang Termination). If the Chi pulse does not reach up to the Guan position, it is called Yin Jue (Yin Termination). Both are untreatable.

The Guan position is the junction of Yin and Yang. If the pulse at Guan is absent, it signifies the separation of Yin and Yang, hence untreatable.

If the Yin and Yang pulses at Cun Kou are both tight, according to the principles, Clear Evil (misty dew) attacks the Upper Jiao, and Turbid Evil (cold-dampness) attacks the Lower Jiao. Invasion by Yin Evil causes internal shivering. Slight deficiency of Exterior Qi and failure of Interior Qi to guard allow the Evil to invade the Yin aspects. Invasion by Yang Evil causes fever, headache, neck stiffness, calf cramping, lower back pain, and leg soreness. This is referred to as Yang being attacked by misty dew. Hence, Clear Evil attacks the Upper Jiao, and Turbid Evil attacks the Lower Jiao. Yin Evil causes shivering, manifested as cold feet and knees, and involuntary urination and defecation. Slight deficiency of Exterior Qi and slight urgency of Interior Qi cause chaos in the Three Jiao and blockage of interior-exterior communication. Stagnation in the Upper Jiao causes organ Qi to harass each other, leading to oral ulcers and difficulty swallowing. Failure of the Middle Jiao leads to rebellious Stomach Qi, stagnant Spleen Qi, turbidity in the Stomach, blocked Ying-Wei circulation, and stagnant blood flow. If Wei Qi flows first, urine becomes dark yellow, clashing with Heat to create abscesses and pus where Heat passes through the meridians and organs. If Yin Qi flows first, Yang Qi is weak and Yin has no anchor, allowing Guest Evil to enter internally. Sneezing occurs, followed by hoarseness and throat blockage. Cold Jue and Heat chase each other, suppressed by Heat, causing blood to coagulate and pass spontaneously, resembling pig liver. Simultaneous Jue of Yin and Yang leads to isolated and weak Spleen Qi, leakage of the Five Fluids, and lower Jiao failing to close, resulting in frequent, difficult defecation with heavy sensation and umbilical pain, threatening life.

The following five passages discuss mixed Yin-Yang evils. "Chaos in the Three Jiao and blockage of interior-exterior" is the general principle for epidemic febrile diseases. Complicated cases of Shang Han (Cold Damage), Warm Diseases with Yin involvement, often feature combined interior-exterior evils. This passage states that simultaneous tightness of Yin and Yang pulses at Cun Kou indicates Evil initially attacking the Middle Jiao due to deficiency, injuring both interior and exterior without yet becoming Excess. Floating and tight Cun pulse indicates Clear Yang (misty dew) injuring Yang aspects (Clear Evil attacks Upper Jiao). Deep and tight Chi pulse indicates Turbid Yin (cold-damp) injuring Yin aspects (Turbid Evil attacks Lower Jiao). Clear Evil attacking Upper Jiao causes exterior symptoms like fever, headache, neck stiffness, and leg cramps. Turbid Evil attacking Lower Jiao causes Yin shivering, manifesting as internal palpitations without external shivering, and cold feet/knees, indicating Evil in Yin meridians. Now, signs of deficient Exterior Qi allow Yang to enter inward; signs of urgent Interior Qi allow Yin Evil to rebel upward, causing Three Jiao chaos and blockage. Stagnation in Upper Jiao damages gums and chewing; Middle Jiao failure prevents digestion; blocked Ying-Wei leads to blood stasis. If Yang Qi opens first, Bladder Evil disperses, causing dark yellow urine; Heat wandering meridians causes abscesses. If Yin Qi opens first, Yang is weak, Cold invades Lungs, causing sneezing and hoarseness. Cold refers to External Evil; Jue refers to Internal Evil. Combined evils clash, suppressed by Heat, causing spontaneous bloody discharge. Simultaneous Yin-Yang Jue means Spleen-Stomach Qi fail to connect; Stomach Yang fails to distribute, causing cold extremities; Spleen Yin is weak, failing to control Lower Jiao, causing fluid leakage and difficult, heavy defecation. Umbilicus is the source of vital Qi; umbilical pain indicates impending death of vital Qi. Evil injures Middle Jiao, mixing Clear and Turbid, affecting all Three Jiao. Both sweating and purging methods are difficult; slight timing errors lead to myriad complications.

With simultaneous tightness of Yin and Yang pulses, coarse breath, dry lips/mouth, curled posture, cold feet, runny nose, and slippery tongue coating, do not treat rashly. By the seventh day, if mild fever and warm hands/feet appear, resolution is imminent. If after the eighth day high fever returns, it is difficult to treat. Chills imply impending vomiting; abdominal pain implies impending diarrhea.

Given this confusing mix of Yin-Yang and interior-exterior, avoid rash medication. Wait patiently. If after seven days mild fever and warm extremities appear, Evil resolves spontaneously. If after eight days unresolved high fever persists, it is a counter-indication and untreatable. However, Zhang Zhongjing says "difficult to treat," not "untreatable." Subsequently, if Cun pulse is floating-tight with chills, vomiting occurs (Clear Evil overflowing Upper Jiao); if Chi pulse is deep-tight with abdominal pain, diarrhea occurs (Turbid Evil moving to Lower Jiao). Once Evil dissipates via upper/lower pathways, treatment can follow the momentum.

With simultaneous tightness of Yin and Yang pulses, if vomiting/diarrhea occur but the tight pulse remains, and the patient feels better, resolution is imminent. If the pulse becomes slow, and by day 6-7 there is anorexia, it is a late onset due to water retention, indicating non-resolution. Normal appetite indicates resolution.

Simultaneous tightness of Yin and Yang pulses indicates Evil inside and out. After vomiting/diarrhea, Evil is expelled, and the tight pulse should disappear. If the tight pulse persists post-vomit/diarrhea with anorexia, it indicates Spleen-Stomach Qi deficiency and water-fluid retention, a late complication. By day 7, if the tight pulse fades, the patient feels well and eats, resolution is confirmed.

In Shang Han, with simultaneous tightness of Yin and Yang pulses, chills, and fever, the pulse exhibits "Jue" characteristics: initially large, then gradually smaller, then gradually larger again. Severe chills cause sweating, sore throat; severe heat causes red eyes and dull vision. Re-sweating damages the throat; re-purging closes the eyes. Severe cold causes undigested stool; severe heat causes bloody/purulent stool. Moxibustion causes jaundice; ironing causes dry throat. Favorable prognosis if urination is free; critical if difficult.

"Pulse Jue" resembles alternating cold and heat. Initially large indicates Evil agitation; shrinking indicates Righteous Qi injury; enlarging again indicates Evil resurgence. Due to inherent Righteous Qi deficiency, the pulse follows the Evil's advance and retreat. Classics state: "Unchanged size, though severe, is treatable; varying sizes are difficult." Severe chills lead to sweating and sore throat (Shao Yin channel connects to throat). Severe heat leads to red eyes (Tai Yang channel originates in eyes). Sweating drives Shao Yin Heat upward, damaging the throat. Purging allows Tai Yang Evil to sink inward, closing the eyes. Yin Evil descending causes cold undigested stool; Yang Evil descending causes heat bloody stool. Moxibustion burns the exterior causing jaundice; ironing forces Fire inward causing dry throat. Free urination indicates fluids remain (treatable); difficult urination indicates fluid exhaustion (critical).

Shang Han fever with bubbling breath, headache, yellow eyes, uncontrollable epistaxis, desire to drink indicates vomiting (Yin deficiency, Evil in Upper Jiao). Aversion to water indicates Jue (Yang deficiency, Evil in Middle Jiao). Incorrect purging causes throat sores. If hands/feet are warm, tenesmus and bloody stool occur. Headache/yellow eyes worsen with purging (Eye closure). Desire to drink + purging causes Pulse Jue, hoarseness, throat blockage. Sweating causes Yin-Yang deficiency and shivering. Aversion to water + purging causes interior cold, anorexia, undigested stool. Sweating causes oral lesions, white tongue coating, irritability. If yellow eyes, rinsing mouth without swallowing, constipation for 6-7 days, hematochezia occurs. Sweating causes free urination (Sun Tai Yang stasis-heat in Bladder causing biased urination). Stasis-blood, being Yin Evil, does not consume fluids, hence free urination. ("Purging" added from Yu Han Jing).

Ruo (Soggy) and Ruo (Weak) pulses: Weak at Guan, Ruo at Cun, Xian (Wiry) at Upper, Wei (Faint) at Lower. Xian indicates Yang operation issues; Wei indicates Yin Cold. Upper Excess, Lower Deficiency, desire for warmth. Wei-Xian indicates deficiency; do not sweat. Sweating causes shivering and immobility. Coughing worsens with salivation, dry throat, dysuria, hunger, irritability, malaria-like symptoms (chills only). Continuous sweating causes curling, fullness, hard abdomen.

Ruo and Ruo pulses: Weak at Guan, Ruo at Cun, Xian at Upper, Wei at Lower. Xian indicates Yang issues; Wei indicates Yin Cold. Upper Excess, Lower Deficiency, desire for warmth. Wei-Xian indicates deficiency; do not purge. Wei indicates cough with salivation. Purging stops cough but causes endless diarrhea, chest discomfort, regurgitation of porridge, dysuria, hypochondriac tension, dyspnea, neck/back traction, arm numbness. Extreme cold with sweating, ice-cold body, dull eyes, incessant speech, excessive food intake indicates Chu Zhong (False Appetite). Mouth wants to speak, tongue cannot protrude.

These two passages warn against sweating/purging when Chi pulse is weak/faint. "Desire for warmth" reveals the pathology. First passage: Cun shows Xian with severe cough/salivation, indicating Spleen-Stomach deficiency with Cold-Fluid. Warmth is needed. Sweating injures Stomach Yang, consolidating Evil. Continuous sweating causes curling, fullness, hard abdomen (Yin-Fluid stagnation). Second passage: Similar Spleen-Stomach deficiency. Purging/vomiting causes endless diarrhea, empty stomach, false appetite (Chu Zhong). Shaoyin Cold with cold sweat indicates exterior collapse. Tongue atrophy indicates death. Second case is worse than the first.

Ruo and Ruo pulses: Weak at Guan, Ruo at Cun, Wei at Upper, Se (Choppy) at Lower. Wei indicates Yang insufficiency; Se indicates Blood deficiency. Yang Wei, Wind-Strike with sweating and irritability. Se indicates Blood deficiency, Jue with cold. Yang Wei, sweating causes irritability and insomnia.

Ruo and Ruo pulses: Weak at Guan, Ruo at Cun, Wei at Upper, Se at Lower. Wei indicates Yang insufficiency; Se indicates Blood deficiency. Yang Wei, Wind-Strike with sweating and irritability. Se indicates Blood deficiency, Jue with cold. Yang Wei, do not purge. Purging causes Epigastric fullness/hardness.

These two passages warn against sweating/purging when Chi pulse is Se. Yang Wei and Yin Se indicate Qi-Blood dual deficiency, with Guan weakness indicating Spleen decline. Both sweating and purging are contraindicated. Sweating Yang Wei with Yang drugs injures Yang further (irritability/insomnia). Purging Yang Wei with Yin drugs sinks Yang (epigastric fullness).

Ruo and Ruo pulses: Weak at Guan, Ruo at Cun, Fu (Floating) at Upper, Shu (Rapid) at Lower. Fu indicates Yang deficiency; Shu indicates Epistaxis. Fu indicates Deficiency; Shu indicates Heat. Fu-Deficiency causes sweating and aversion to cold; Shu-Pain indicates hidden Cold and shivering. Weakness at Guan causes chest urgency, panting, breathing pain in hypochondrium, malaria-like chill-heat. Incorrect purging causes rapid pulse, fever, mania, hallucinations, urinary dribbling, lower abdominal hardness, hematuria.

Cun Fu-Ruo, Guan Weak, Chi Rapid indicates Yang deficiency with Sunken Yang in Yin. Incorrect purging injures Blood, causing mania, fullness, hematuria. Ruo and Jin (Tight) pulses: Ruo indicates Yang micro; Jin indicates Ying Cold. Yang Micro/Wind strikes exterior (fever/chills); Ying Firm/Stomach Cold causes interior mild vomiting and vexation. Doctor mistakes exterior heat for interior heat, induces sweating, causing Yang loss, deficiency vexation, epigastric hardness. Interior-Exterior exhaustion causes dizziness upon rising. Guest heat on skin causes restlessness. Ignoring Stomach Cold and Guan Yuan Cold, using cold water irrigation extinguishes guest heat but triggers severe chills. Heavy blankets cause head sweating, tremors, difficult urination. Water-induced Cold causes undigested stool, vomiting, prolapse, restlessness, cold extremities, interior vexation. Late rescue is impossible.

Ruo-Jin pulse indicates Yang micro and Ying Cold. Yang micro/Wind causes exterior fever/chills; Ying Jin/Stomach Cold causes interior vomiting/vexation. Doctor treating exterior heat with sweating exhausts interior-exterior. Guest heat is superficial; Cold is deep at Guan Yuan. Irrigation fails to save.

Fu (Floating) and Da (Large) pulse: Fu indicates Qi Excess; Da indicates Blood Deficiency. Blood deficiency means Yin absence, solitary Yang sinking into Yin parts. Urine should be red/difficult, bladder empty. Instead, urine is free and sweating is profuse. Wei Qi should be weak, but appears strong. Fluids scatter everywhere, Ying empties, Blood exhausts, dryness/vexation/insomnia, thin flesh/blood loss, sudden fluid leakage. Doctor uses toxic drugs to attack Stomach, causing double deficiency. Guest Yang departs, leading to death with sludge-like stool.

Fu-Da pulse indicates Qi Excess/Blood Deficiency. If Yin parts show insufficiency but urine is free and sweating profuse, it falsely suggests Excess. If Wei Qi remains strong, pulse weakens after sweating/urination, allowing safety. If Yang pulse strengthens, Yang dominates externally, Yin perishes internally. Free urine/profuse sweating indicates fluid scattering, Ying/Blood exhaustion, dryness/vexation/insomnia, flesh wasting. At this critical juncture, stabilizing Stomach and securing fluids is urgent. Using toxic drugs increases pressure, leading to double deficiency and death with sludge-like stool.

Master says: Patient with Wei (Faint) and Se (Choppy) pulse is iatrogenic. Profuse sweating and repeated purging caused Blood loss. Initially chills, then unremitting fever. In summer heat, desires heavy clothes; in winter cold, desires nakedness. Yang Wei causes chills; Yin Weak causes fever. Sweating weakened Yang; purging weakened Yin. In May (Summer), Yang is in Exterior, Stomach is cold/deficient; internal Yang cannot overcome cold, hence desiring warmth. In November (Winter), Yang is in Interior, Stomach is hot; internal Yin cannot overcome heat, hence desiring coolness. Slow-Choppy Yin pulse confirms Blood loss.

Wang Kentang notes: Profuse sweating injures Yang (Wei pulse, chills); repeated purging injures Yin (Se pulse, fever). Yin-Yang dual injury damages Qi-Blood. Why focus on Blood loss? Purging injures Yin implicitly; sweating also affects Blood. In internal deficiency, Summer Yang in Exterior leaves Interior Yang-deficient (cannot bear cold). Winter Yang in Interior leaves Interior Yin-deficient (cannot bear heat flare). Generally, Xian (Wiry)-Xi (Fine)-Se (Choppy) pulses with forcelessness cause chills/shivering or irritability/heat like sitting in a steamer, relieved by cooling. This is not limited to seasonal chills/heat but illustrates the principle.

Hong Da (Surging-Large) pulse at Start of Summer is the normal seasonal pulse. Body ache/heaviness requires sweating. If ache/heaviness resolve next day, no sweating needed. Spontaneous sweating resolves it next day. Hong Da at Start of Summer is the root pulse of Wen Bing (Warm Disease). Body ache/heaviness indicates Heat stagnating in muscle surface. Acrid-cool/bitter-cold herbs vent Heat. If symptoms resolve next day, Ying-Wei harmonize, spontaneous sweating resolves it without medicine.

Pulse Strong/Body Cold indicates Shang Han; Pulse Weak/Body Hot indicates Shang Shu (Summerheat). Cold injures Form (Pulse Strong, Body Cold then Fever); Summerheat injures Qi (Pulse Weak, Body Hot, slight back chills).

Q: Why does battle with sweating resolve disease? A: Floating-Tight pulse, hollow on pressure indicates Root Deficiency. Battle occurs due to deficiency; sweating resolves due to Floating pulse.

Q: Why does non-battle sweating resolve disease? A: Large-Floating-Rapid pulse indicates no battle, resolution by sweating. Floating-Rapid, not hollow indicates no root deficiency; simple sweating resolves without battle.

Q: Why does non-battle, non-sweating resolve disease? A: Self-micro pulse indicates prior sweating/vomiting/purging/Blood loss, lacking fluids. Yin-Yang self-harmony leads to spontaneous recovery without battle or sweating.

Q: Shang Han day 3, Floating-Rapid-Micro pulse, cool/even body, what? A: Resolution imminent. Resolves at midnight. Floating pulse resolves with slight sweating. Rapid pulse resolves with appetite return; Micro pulse resolves with profuse sweating.

Previous micro pulse resolution lacked battle/sweating due to prior injury (Qi/Yin deficiency). Current micro pulse resolution involves battle/sweating because no prior injury (Qi/Blood intact, Strong Righteous/Evil). Dong Yuan clarifies: Battle+sweating = Tai Yang; No battle+sweating = Yang Ming; No battle/no sweat = Shao Yang. Prior treatment alters this.

Q: How to distinguish recovery? A: Cun, Guan, Chi positions equal in size, depth, rate. Even with lingering cold/heat, balanced Yin-Yang pulse indicates recovery despite severity.

Day 6-7, all three pulses present, severe vexation, locked jaw, inability to speak, restlessness indicates impending resolution.