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The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft pulse appears at the Cun position (tip). The faint pulse appears in the upper part, and the choppy pulse appears in the lower part. A faint pulse indicates insufficient Yang Qi, while a choppy pulse indicates lack of Blood. If Yang Qi is faint, and after contracting wind-stroke with sweating, restlessness and irritability occur instead; a choppy pulse signifies lack of Blood, leading to cold limbs and cold sensations.

When Yang Qi is faint, purgation must not be used. If purgation is mistakenly applied, it results in epigastric fullness and hardness. If pulsations around the umbilicus are on the right, purgation must not be used; if mistakenly applied, it depletes internal fluids, causing dry throat, dry nose, dizziness, and palpitations. If pulsations around the umbilicus are on the left, purgation must not be used; if mistakenly applied, it causes abdominal cramping, difficulty eating, worsening of umbilical pulsations, and even if there is body heat, the patient desires to curl up. If pulsations around the umbilicus are above, purgation must not be used; if mistakenly applied, it causes hot and irritable palms, alternating hot and cold sensations on the body, spontaneous sweating, and a desire to drink water and pour it over oneself. If pulsations around the umbilicus are below, purgation must not be used; if mistakenly applied, it causes abdominal distension, dizziness upon sudden rising, undigested food in stool, and epigastric fullness.

If there is a sensation of blockage in the throat, purgation must not be used; if mistakenly applied, it leads to a feeling of lightness in the upper body and heaviness in the lower, inability to swallow liquids or solids, desire to curl up when lying down, severe pain, and diarrhea occurring dozens of times a day. In cases of exterior excess syndromes, purgation must not be used; if mistakenly applied, it triggers slight fever. In cases of Yang collapse with cold limbs, warmth should be applied to the navel area. In deficiency syndromes, purgation must not be used; if mistakenly applied, those with intense thirst for water may recover easily, while those who dislike water will suffer severely.

The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft pulse appears at the Cun position. The wiry pulse appears in the upper part, and the faint pulse appears in the lower part. A wiry pulse indicates Yang movement, while a faint pulse indicates Yin cold. Upper excess and lower deficiency indicate a desire for warmth. Faint and wiry indicate deficiency; deficiency syndromes must not be treated with purgation. A faint pulse brings coughing and expectoration of saliva; if purgation is mistakenly applied, the cough stops but diarrhea persists. Persistent diarrhea causes a sensation like insect bites in the chest, regurgitation of ingested porridge, difficult urination, hypochondriac cramping, difficult breathing, neck and back traction, and arm numbness. Extreme cold with sweating, cold body like ice, dull eyes, incessant speech despite high grain intake, is called "Chu Zhong" (also known as Xiao Zhong). Although the mouth wants to speak, the tongue cannot extend forward.

The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft pulse appears at the Cun position. The floating pulse appears in the upper part, and the rapid pulse appears in the lower part. A floating pulse indicates Yang deficiency, while a rapid pulse indicates lack of Blood. Floating indicates deficiency, spontaneous sweating, and aversion to cold; rapid indicates pain, shivering, and chills. Weakness at the Guan position causes urgency below the chest, panting, sweating, and difficulty breathing, with pain in the hypochondrium during respiration. Shivering and cold sensations resemble malaria. If the physician mistakenly uses purgation, it causes a rapid pulse, fever,狂走 (running wildly), hallucinations of ghosts, epigastric fullness, dribbling urine, extreme hardness in the lower abdomen, and hematuria.

The pulse is soft and tight; soft indicates weak Wei Qi, while tight indicates cold in Ying. Weak Wei Qi with wind-stroke causes fever and aversion to cold; tight Ying with cold Stomach Qi causes slight vomiting and internal irritability. If the physician mistakes this for excessive heat and uses diaphoresis to release the muscle layer, it leads to Yang collapse, deficiency-induced irritability, and bitter epigastric fullness and hardness. With both interior and exterior depleted, sudden rising causes dizziness. External heat on the skin causes discomfort and insomnia, unaware of the cold Stomach Qi. Tight cold at the Guan Yuan point renders medical skills useless. Pouring cold water on the body stops the external heat but causes shivering and chills. Even under heavy blankets, sweating occurs at the crown, with tremors and slight difficulty urinating. Cold Qi triggered by water causes undigested food, intolerable intervals, vomiting, evisceration, restlessness, slight reversal of hands and feet, cold body, and internal irritability. How can rescue from behind now retrieve what has passed?

Pulse floating and large: floating indicates Qi excess, large indicates Blood deficiency. Blood deficiency means no Yin, leaving solitary Yang alone. If pathogenic factors descend into the Yin organs, urine should be red and difficult, and the bladder cavity should be empty. Now, however, urine is clear and profuse, accompanied by heavy sweating. According to principles, Wei Qi should be weak, but now it is stronger, causing fluids to scatter. Ying depletion and Blood exhaustion lead to dryness, irritability, and insomnia. Thin Blood and wasting flesh result in acute illness (or black fluid). If the physician again uses toxic drugs to attack the Stomach, this is double deficiency. The departure of exogenous Yang has a deadline; death will come with stools like mud.

Pulse floating and tight: floating indicates Wind, tight indicates Cold. Wind injures Wei, Cold injures Ying. Both Ying and Wei are diseased, causing bone and joint soreness. Sweating should be induced, not purged.

Fu Yang pulse slow and moderate indicates normal Stomach Qi. Fu Yang pulse floating and rapid: floating injures Stomach, rapid moves Spleen. This is not the original disease but caused by physician's mistaken purgation. Ying and Wei sink inward; the rapidity first becomes faint, and the pulse reverses to only floating. The person will likely have hard stool, belching, and Chu Zhong. Why? Originally, the rapid pulse moved the Spleen; its initial faintness indicated Spleen Qi dysfunction, hard stool, belching, and Chu Zhong. Now the pulse reverses to floating, and rapidity changes to faint. Pathogenic factors remain alone, causing hunger, inability of exogenous heat to digest grain, tidal fever, and thirst. A rapid pulse should be slow and moderate. If pulse degrees before and after are standard, the patient feels hungry; if the rapid pulse is irregular, sores may arise.

A persistent rapid pulse that does not stop indicates pathogenic knotting where Zheng Qi cannot recover. As Zheng Qi retreats and knots in the Zang organs, pathogenic factors float and associate with skin and hair. Rapid pulses must not be purged; purging causes irritability and unceasing diarrhea.

In Shaoyin disease, a faint pulse contraindicates sweating due to risk of Yang collapse. If Yang is already deficient and Chi position shows weak and choppy pulses, purgation is also contraindicated.

A floating and large pulse should induce sweating; if the physician mistakenly purges, it is a major error. If the pulse is floating and large, but the epigastrium is hard with heat belonging to Zang organs, attack it without inducing sweating. If belonging to Fu organs, do not cause frequent urination. Frequent urination makes stool hard; heavy sweating increases heat; little sweating makes stool difficult. A slow pulse is not yet suitable for attack.

In Taiyang and Yangming concurrent disease, if sweating was initiated early but incomplete, it transfers to Yangming with continued slight sweating and no aversion to cold. If Taiyang symptoms persist, purgation is contraindicated and considered adverse.

In Jie Xiong syndrome, a floating and large pulse contraindicates purgation; purging leads to death.

In Taiyang and Yangming concurrent disease with wheezing and chest fullness, purgation is contraindicated.

In Taiyang and Shaoyang concurrent disease with epigastric hardness, neck stiffness, and dizziness, purgation is contraindicated.

In various cases of Ni Jue (reversal cold), purgation is contraindicated. This applies equally to patients with deficiency constitutions.

If the patient desires to vomit, purgation is contraindicated.

In Taiyang disease, if exterior symptoms are unresolved, purgation is contraindicated and considered adverse.

If disease originates in Yang and is mistakenly purged, heat enters and forms Jie Xiong. If disease originates in Yin and is mistakenly purged, it forms Pi (fullness).

If the disease pulse is floating and tight, and purgation is subsequently applied, the tightness enters the interior forming Pi.

Diseases with abundant Yang present heat; purging causes hardness. In cases of original deficiency attacking heat, hiccups will occur. In cases without Yang but strong Yin with hard stool, purging causes undigested food and abdominal fullness.

Taiyin disease presents as abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and periodic abdominal pain. Purging causes hardness below the chest.

Jueyin disease presents as excessive thirst, Qi rushing upward hitting the heart, burning pain in the heart, hunger without desire to eat, vomiting roundworms upon eating, and unceasing diarrhea if purged.

In Shaoyin disease, if food entering the mouth causes vomiting, and there is a desire to vomit from the heart but inability to do so, accompanied by cold extremities and a wiry-slow pulse at onset, this indicates excess in the chest; purgation is contraindicated.

In Shanghan after five or six days, if there is no Jie Xiong, the abdomen is soft, the pulse is weak, and cold limbs recur, purgation is contraindicated; this indicates blood loss, and purging leads to death.

In Shanghan with fever, headache, and slight sweating, inducing sweating causes confusion. Moxibustion causes wheezing and inability to urinate. Purgation causes shortness of breath, difficult urination, headache, and back stiffness. Adding warm needles causes epistaxis.

In Shanghan with Yin-Yang pulses both tight, aversion to cold and fever occur, and the pulse attempts to reverse. Reversal means the pulse starts large, gradually becomes small, then grows large again. In such cases, severe aversion to cold, slight sweating, and sore throat occur. If heat predominates, eyes become red and vision unclear. If the physician induces sweating again, the throat is injured. If purging is applied, both eyes close. Cold predominance causes undigested stool; heat predominance causes pus and blood in stool. Moxibustion causes jaundice; hot ironing causes dry throat. If urination is easy, rescue is possible; if difficult, the condition is critical.

In Shanghan with fever, forceful breath from the mouth, headache, yellow eyes, uncontrollable epistaxis, craving water causes vomiting, and aversion to water causes cold limbs. If purged, sores form in the throat. If hands and feet are warm, there is heaviness in defecation and pus/blood in stool. If headache and yellow eyes are present and purged, eyes close. If craving water is purged, the pulse becomes reversed, voice hoarse, and throat blocked. If sweating is induced, chills occur, and Yin-Yang are both deficient. If aversion to water is purged, interior cold occurs, appetite loss, and undigested stool. If sweating is induced, mouth injury and white coating on tongue occur. Irritability with a rapid-solid pulse and constipation for six-seven days leads to bloody stool. If sweating is induced, urination becomes free.

On the second or third day of illness, if the pulse is weak, without Taiyang or Chai Hu symptoms, but with irritability and epigastric fullness, by the fourth day, even if able to eat, give a small amount of Cheng Qi Tang to mildly harmonize and bring slight relief. By the sixth day, give one sheng of Cheng Qi Tang. If no bowel movement for six-seven days but urination is scant, although no bowel movement, only the head of the stool is hard, the rest will be loose. Do not attack until you confirm hardness. Only when urination is sufficient and stool is definitely hard can you attack.

Zang Jie without Yang symptoms, no alternating cold and heat, calm demeanor, and slippery tongue coating contraindicate attack.

In Shanghan, if there is much vomiting, even with Yangming symptoms, attack is contraindicated.

In Yangming disease, with tidal fever and slightly hard stool, Da Cheng Qi Tang may be given; if not hard, do not give it. If no bowel movement for six-seven days and suspecting dry stool, give a small amount of Xiao Cheng Qi Tang. If gas passes after ingestion, dry stool exists, and attack is permissible. If no gas passes, only the beginning is hard and the end loose; do not attack. Attacking causes distension and inability to eat. If desiring water and given water, hiccups occur. Subsequent fever indicates stool becomes hard again but less; use Xiao Cheng Qi Tang to harmonize. If no gas passes, strictly avoid attack.

In Shanghan wind-strike, if the physician mistakenly purges, the patient suffers diarrhea dozens of times daily with undigested food, borborygmus, epigastric fullness and hardness, dry heaves, and irritability preventing peace. Seeing epigastric fullness, the physician thinks the disease is not exhausted and purges again, worsening the fullness. This is not accumulated heat but stomach deficiency with rebellious Qi, causing hardness. (Gan Cao Xie Xin Tang)

Diarrhea with a large pulse indicates deficiency caused by strong purging. If the pulse is floating and革 (leather-like), accompanied by borborygmus, (Dang Gui Si Ni Tang) is indicated.

In Yangming disease, if the body has a reddish hue, attack is contraindicated; otherwise, fever and jaundice with difficult urination will occur.

In Yangming disease, if the epigastrium is hard and full, attack is contraindicated. If attacked and diarrhea continues unceasingly, death ensues; if it stops, recovery occurs.

In Yangming disease, with spontaneous sweating, or if sweating is induced and urination is free, this indicates internal depletion of fluids. Even if stool is hard, do not attack. Wait for the natural urge to defecate and use honey suppositories to guide passage. Melon root and pig bile can also be used as guides.

Yun states: Non-Yangming primary diseases must not be purged. Yangming primary disease is "Wei Jia Shi" (Stomach House Excess). Therefore, non-fullness, dryness, and excess must not be purged. Non-tidal fever and thirst must not be purged. Non-verbal abuse of relatives and strangers must not be purged. Non-deep-rapid pulse must not be purged. Non-discarding clothes, climbing heights, singing, and seeing ghosts must not be purged.

Huo states: Floating pulse, weak pulse, aversion to cold, vomiting, passing flatus (note: turning flatus refers to downward discharge), clear urine, hard stool with frequent urination (Pi Yue Wan syndrome), and hard stool with scant urine are all contraindications for purging. In Yangming disease with spontaneous sweating, induced sweating, and free urination, purging is contraindicated (use honey suppositories).

Wu states: Any case with aversion to wind/cold, abdominal fullness that reduces intermittently, distension that can be massaged, soft/deficient Yin, fatigue, cold extremities, weak Chi pulse, superficial pulse, deep-ineffective pulse, weak pressure, blood loss, deficiency constitution, women with regular or interrupted menstruation, heat entering the blood chamber, pre/post-natal hemorrhage, frequent urination, clear urine with constipation, etc., must not be purged.

Dai states: Even if Yangming purge indications are complete, if the patient has wheezing/cough or slight aversion to cold (Taiyang-Yangming), or alternating cold/heat (Shaoyang-Yangming), and Taiyang/Shaoyang symptoms have not resolved within Yangming syndrome, this is not true Yangming. Caution is advised against hasty purging. Ancient notes mention three types of Yangming; one must recognize this.