Library

Tian stated: For warm diseases occurring in spring, if the course of illness is less than three days, administer two doses of Xingxing San first. If after four to five days the condition remains unresolved with symptoms of irritability, thirst, and vomiting, use Baizhu San. If spontaneous sweating and dry mouth are present, use Zhi Baihu Tang. By the sixth or seventh day, if there is dry fecal impaction, use Sishun Yinzi to purge; if there is severe fullness and distension in the heart and abdomen, use Niuhuang Tongge Wan to purge. At the initial stage, if one suspects carbuncles or rashes, only use Gegen Shengma Tang to resolve the muscle layer.

A question was asked: What does it mean that pulses have yin and yang? The answer is: Pulses that are large (Da), floating (Fu), rapid (Shu), moving (Dong), and slippery (Hua) are named yang. Pulses that are deep (Chen), choppy (Se), weak (Ruo), wiry (Xian), and fine (Wei) are named yin. Generally, if a yin disease presents with a yang pulse, the patient will survive; if a yang disease presents with a yin pulse, the patient will die.

Cheng Wuji stated: The way of yang is usually abundant; the five pulses—large, floating, rapid, moving, and slippery—are excessive compared to the normal pulse (Ping Mai), hence they are called yang. The way of yin is usually deficient; the five pulses—deep, choppy, weak, wiry, and fine—are insufficient compared to the normal pulse, hence they are called yin. In cold damage (Shanghan) diseases, when the pathogen is at the exterior, yang pulses appear; when the pathogen is at the interior, yin pulses appear. If a yin disease presents with a yang pulse indicating survival, it means the pathogen moves from the interior to the exterior, desiring to be resolved through sweating. For example, in Jueyin wind strike, a slightly floating pulse indicates impending recovery, while a non-floating pulse indicates no recovery. If a yang disease presents with a yin pulse indicating death, it means the pathogen moves from the exterior to the interior, with righteous qi deficient and pathogenic qi victorious. For instance, delirious speech and a deep, fine pulse indicate death. The general principle should be judged by stillness versus restlessness: those who are still after purgation survive, those who are restless die. One cannot rigidly adhere to the idea that "yin disease with yang pulse" means pathogenic qi disperses outward, or "yang disease with yin pulse" means pathogenic qi enters due to deficiency.

Danbo Yuanjian respectfully notes: The classics state that large, floating, rapid, moving, long (Chang), and slippery pulses are yang, while deep, choppy, weak, wiry, short (Duan), and fine pulses are yin. The discussion omits the "long" and "short" pulses. What is the intent? Is it said that cold damage diseases lack long and short pulses? Zhang Zhongjing's writings mention long and short pulses frequently. Wang Shuhe's *Mai Jing* (Pulse Classic) lists twenty-four pulse shapes but excludes long and short. Why? The character "see" (Jian) might be intended as "obtain/get" (De), meaning an exterior disease obtains an interior pulse, or an interior disease obtains an exterior pulse. If interpreted as pathogen moving from exterior to interior, is there any obstruction? When Taiyang disease is not resolved, it gradually transmits to Yangming and Shaoyang. Diseases of the Three Yang meridians, if not resolved, gradually transmit to the Fu organs. These are all curable conditions. There are also cases where transmission does not occur and no alien qi is added; after seven days, it naturally transmits from Taiyang to Yangming and Shaoyang, similar to the Three Yang meridians, representing self-healing conditions without pathogen moving from exterior to interior. Initially, there is no death. This is why I have doubts. Examining the discourse, yang disease obtaining yin pulse can arise from the original disease itself or result from medical intervention. Zhang Zhongjing detailed treatment methods extensively. For example, Taiyang disease lasting eight or nine days, resembling malaria with fever and aversion to cold, more heat than cold, no vomiting, normal urination and defecation, desiring self-recovery, occurring two or three times a day with a slightly slow pulse, indicates impending recovery. If the pulse is slight and there is aversion to heat, this indicates both yin and yang are deficient; do not induce sweating, purgation, or emesis again. Taiyang disease resembling malaria with fever and aversion to cold—is this not a yang disease? Is a slight pulse not a yin pulse? Furthermore, in cold damage after five or six days, with head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, desire not to eat, hard stool, and a fine pulse, this is Yang Wei Jie (Yang slight binding), having both exterior and interior signs. Sweating indicates Yang Wei. If it were pure Yin Jie, there would be no exterior signs, all entering the interior, named half-interior half-exterior. Although the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease because yin conditions should not have sweating. Since there is head sweating, we know it is not Shaoyin. Xiao Chaihu Tang may be given. Did Zhang Zhongjing use Xiao Chaihu Tang for a yang disease? Are slight and deep pulses not yin pulses? These are all instances of yang disease obtaining yin pulse, describing the yin and yang of syndromes. Such examples are numerous and cannot be listed here. Reflecting on the intent, it is indeed to examine the pulse based on the disease, seeking the so-called yin and yang to distinguish life and death. Those writing about meridian transmission must deduce the intentions of sages to guide later learners. If one does not clarify the yin and yang of syndromes but merely compares pulse and disease, how will later learners find their way? This is why I have further doubts.

Zhang stated: Some say the classics state that large, floating, rapid, moving, and slippery pulses are yang, while deep, choppy, weak, wiry, and fine pulses are yin. Gao Yangsheng included the wiry pulse in the Seven Tables (Biao) as yang. Why? The wiry pulse is a pulse of deficiency, a sign of disease in the exterior and interior after sweating. Hence it is said "wiry implies reduction," thus belonging to yin. Gao Yangsheng classified wiry as yang because Zhang Zhongjing said, "A pulse that is floating and tight is named wiry." Wiry feels like a bowstring, unyielding to pressure. Because of the word "floating," it was included in exterior pulses. However, a floating and wiry pulse indicates the disease is still in the exterior. Before sweating, it is tight; after sweating, it becomes wiry. This is a fixed rule, generally similar to tight but differing in timing. As long as the pulse indication is subtle, using whether sweating has occurred as the criterion avoids error.

Xu stated: Zhang Zhongjing considers the wiry pulse as yin when combined with other pulses. Floating and large are yang; combined with choppy, weak, wiry, and fine, how can it not be yin? Deep and slight with wiry, deep and choppy with wiry, deep and fine with wiry are all yin syndrome pulses. Generally, Shaoyang pulse is wiry; Zhang Zhongjing speaks of a single pulse. However, Shaoyang qi connects with spring; spring pulse is wiry to correspond to the spring yang seasonal pulse, so how can it not be yang? Floating-large and wiry,洪-long and wiry, floating-slippery and wiry, floating-rapid and wiry are all yang. Zhang Zhongjing uses wiry pulse to distinguish yin and yang applications; its meaning is subtle. Wang Shuhe considered wiry as yang but did not say wiry is yin because he referred to a single pulse for miscellaneous diseases. Thus, Zhang Zhongjing's pulse theory cannot be compared to miscellaneous diseases.

A question was asked: How to distinguish yang binding (Jie) and yin binding in pulses? The answer is: A pulse that is floating and rapid, with ability to eat but inability to defecate, is excess syndrome, named yang binding. It is expected to worsen on the seventeenth day. A pulse that is deep and slow, with inability to eat, heavy body, and hard stool, is named yin binding. It is expected to worsen on the fourteenth day.

Cheng Wuji stated: Binding refers to qi binding firmly, preventing yin and yang from mixing. Yin contains yang, yang contains yin; harmony arises from mixing, binding arises from non-mixing. Floating and rapid are yang pulses; eating but not defecating indicates stomach excess. Yang qi binds firmly, preventing yin from mixing, hence named yang binding. Deep and slow are yin pulses; inability to eat and heavy body indicate yin disease. Yin disease with yin pulse should lead to diarrhea. Now, hard stool indicates yin qi binds firmly, preventing yang from mixing, hence named yin binding. Cold damage disease: Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang, Day 4 Taiyin, Day 5 Shaoyin, Day 6 Jueyin. By Day 6, transmission is complete; Day 7 should see recovery. If not recovered by Day 7, it is called "Re-Jing" (Second Cycle). Re-Jing means transmitting again from Taiyang to Day 12, reaching Jueyin again for completion; Day 13 should see recovery. If not recovered by Day 13, it is called "Guo-Jing" (Passing the Meridian). Transmitting again through Taiyang sequentially. Yang binding belongs to fire; by Day 17, it transmits to Shaoyin water. Water controls fire; fire pathogen dissipates, leading to recovery. Yin binding belongs to water; by Day 14, it transmits to Yangming earth. Earth controls water; water pathogen dissipates, leading to recovery. If pathogen binding is severe, water cannot control fire, and earth cannot control water, so the condition worsens. *Neijing* states: After one Hou (5 days), disease worsens; after two Hous, disease is severe; after three Hous, disease is critical. ○ One Hou is five days. At the beginning of pathogen invasion, aversion to cold and fever have biases, hence the following text.

A question was asked: What causes chills (Saxi) followed by fever? The answer is: Insufficient yin pulse leads yang to follow; insufficient yang pulse allows yin to invade. Question: What is insufficient yang? Answer: If Cun Kou pulse is slight, it is named insufficient yang. Yin qi enters yang, causing chills. Question: What is insufficient yin? Answer: If Chi pulse is weak, it is named insufficient yin. Yang qi sinks into yin, causing fever.

Cheng Wuji stated: One yin and one yang is called Dao; biased yin or biased yang is called disease. If yin is insufficient, yang follows; if yang is insufficient, yin invades. Yang insufficiency leads yin qi to enter yang, causing aversion to cold, because yin excess brings cold. Yin insufficiency leads yang qi to sink into yin, causing fever, because yang excess brings heat. ○ Insufficient yang pulse causes aversion to cold; insufficient yin pulse causes fever.

Danbo Yuanjian notes: The classics state that injury by cold results in heat disease. Cold lodges in meridians, obstructing yang qi, generating heat, hence fever. Cold injures Ying blood; since blood is injured, there is aversion to cold, belonging to Taiyang syndrome. It is also said: "Fever and aversion to cold originate from yang." Combining these, clearly the body is hot yet feels cold, requiring exterior resolution, primarily using Mahuang Tang or Qinglong Tang. Now, "chills followed by fever" suggests alternating chills and fever. Exterior cases suit Xiao Chaihu Tang; interior cases suit Da Chaihu Tang; post-sweat or post-purgation cases suit Guizhi Ganjiang Tang. This discusses equal alternating chills and fever in Three Yang syndromes. Variations in severity require adjusted treatment. Now, "insufficient yin leads yang excess and heat; insufficient yang leads yin excess and cold," and "yang follows yin, yin invades yang," suggests yang merging into yin and yin merging into yang. Qibo said: Malaria qi alternates between excess and deficiency, aligning with the classic's meaning of yang excess and yin excess. Is this discussing cold damage or malaria? Who is correct?

Zhang stated: Some say the classics state insufficient yin pulse allows yang to follow; insufficient yang pulse allows yin to invade. "Insufficient" refers to weak yang pulse, causing chills and fever. It is also said: "Full pulse, cold body, results from cold damage." Cold damage is exterior disease; pulse is rarely not floating and full. If weak, it is yang disease with yin pulse. These two explanations differ but must have rationale. This chapter discusses the underlying reason, not the external manifestation. All cold damage diseases arise from Ying-Wei deficiency, making Cun-Chi pulses weak, allowing external pathogens to invade and cause yin-yang interaction, resulting in chills and fever. Existing disease pulses differ: Wind merging with Wei makes Wei excess and Ying deficiency, hence Guizhi syndrome has floating yang and weak yin pulse. Wind-cold merging with Ying-Wei makes both pulses floating and full, hence Mahuang syndrome requires sweating. Zhang Zhongjing's works have specific references unknown to shallow understanding.

Yang pulse floating, yin pulse weak, indicates blood deficiency. Blood deficiency leads to tendon tension.

Cheng Wuji stated: Yang is Qi, Yin is Blood. Floating yang pulse indicates strong Wei Qi; weak yin pulse indicates weak Ying Blood. *Nanjing* states: Qi warms, Blood moistens. Blood deficiency fails to moisten tendons, causing tension.

Deep pulse indicates weak Ying Qi.

Cheng Wuji stated: *Neijing* says pulse is the mansion of blood. Pulse full means blood full; pulse empty means blood empty. This is the norm. Deep pulse indicates internal weakness of Ying Blood.

Floating pulse with sweat like flowing pearls indicates Wei Qi decline.

Cheng Wuji stated: *Zhenjing* says: Wei Qi warms muscles, fills skin/hair, thickens pores, controls opening/closing. Floating pulse with sweat like pearls indicates loose pores and loss of opening/closing control, showing external decline of Wei Qi. Floating monitors Wei, Deep monitors Ying; distinguishing Ying-Wei decline by floating/deep is logical. However, decline is worse than weakness. Hence Ying is called weak and Wei is called declined, because sweat like pearls indicates external escape of yang qi, so Wei disease is worse than Ying.

In weak Ying Qi, adding burning needle causes blood flow stagnation, further fever, and irritability.

Cheng Wuji stated: Wei is Yang, Ying is Yin. Burning needle benefits Yang but harms Yin. Weak Ying Qi implies yin deficiency. *Neijing* states: Yin deficiency leads to internal heat. Adding burning needle to supplement yang during internal heat combines two heats, stopping Ying blood flow, causing external fever and internal irritability.

Pulse like a chariot canopy is named Yang Binding.

Cheng Wuji stated: Like a chariot canopy means large and gentle. Yang qi binds externally, not harmonizing with yin. Charriot canopy implies floating and large, i.e., previous floating-rapid yang binding.

Pulse like touching a long bamboo pole is named Yin Binding.

Cheng Wuji stated: Like touching a long pole means continuous and stiff. Yin qi binds internally, not harmonizing with yang. Long pole implies tight and wiry, i.e., previous deep-slow yin binding.

Pulse like fat floating on soup indicates weak Yang Qi.

Cheng Wuji stated: Lightly floating and indicates weakness.

Pulse like a spider's thread indicates declining Yang Qi.

Cheng Wuji stated: Yingying means stagnant. Like a spider's thread is extremely fine. Fine indicates weak yang, very fine indicates declining yang. *Mai Yao* says: Fine indicates qi blockage, not yet decline. *Neijing* says: Fine indicates little qi. Considering extremely fine as declining yang is appropriate. *Shuowen* defines Ying as rolling up, implying rotation.

Pulse continuous like pouring lacquer stopping abruptly indicates loss of blood.

Cheng Wuji stated: Continuous means soft and lingering. Like pouring lacquer stopping means initially large then fine. *Zheng Lilun* states: Tiankai develops, essence moves, qi changes, yin-yang meets, stomach harmonizes, pulse generates. Yang qi arrives first, yin qi arrives last. Pulse initially large then fine indicates yang excess and yin deficiency, known as blood loss. Pouring lacquer stops suddenly; blood loss pulse is like this.

Pulse slow, stopping occasionally then returning, is named Knot Pulse (Jie Mai). Pulse rapid, stopping occasionally then returning, is named Urgent Pulse (Cu Mai). Yang excess causes Cu, Yin excess causes Jie. These are pathological pulses.

Jie, Cu, and Dai all stop during movement. Jie and Cu return automatically; Dai does not. Irregular interval is Jie/Cu; regular interval is Dai. Jie/Cu are pathological; Dai is fatal. Must distinguish. Miscellaneous disease Jie/Cu often caused by phlegm-fluids or blood stasis blocking tunnels; otherwise, disease is hard to treat. Taiyang disease after purgation with Cu pulse and no chest binding indicates resolving, not necessarily fatal. Shaoyin disease with cold limbs and Cu pulse should be moxibusted, not necessarily yang excess.

Yin and Yang interacting is named Moving (Dong). Yang moving causes sweating; Yin moving causes fever. Cold body and aversion to cold indicate Sanjiao injury. If rapid pulse appears at Guan, without head/tail, like a bean, trembling, it is named Moving.

Yang rises, Yin descends; they communicate within Cun-Chi. Peaceful and harmonious, how can one see "Moving"? Only when Yang desires to descend but Yin opposes, and Yin desires to rise but Yang opposes, they clash, unable to move up/down, creating a bulging shape of Moving pulse. Why at Guan? Cun is Yang, Chi is Yin, Guan is middle of Yin-Yang. Thus, Yang exits, Yin enters, Guan is the boundary, the position of Yin-Yang ascent/descent. Hence, interaction occurs here. *Neijing* says strong pulse at Hand-Shaoyin indicates pregnancy; this refers to Shenmen point, not "Moving" pulse. "Moving" pulse starts with Zhang Zhongjing. Pang Anchang said: Guan occupies six parts, front three Yang, back three Yin. If Cun moves and Chi is still, sweating should resolve (*Suwen*: Yang adds to Yin is sweat). If Chi moves and Cun is still, fever occurs (*Suwen*: Rough Chi indicates heat in middle). Post-large sweat with cold body and aversion to cold indicates Sanjiao injury, a fatal sign. Calm yin-yang qi is solid; agitated is deficient. Yang moving causes yang deficiency, failing to protect skin/pores, causing sweat. Yin moving causes yin deficiency, failing to moisten muscles, causing fever. Zhang Zhongjing said: Slight yang causes aversion to cold; weak yin causes fever. Trembling independently, not mixing with three positions, like a person apart from a crowd, is called "Juejue." Later pulse scholars describe Moving as feeling present when pressing, disappearing when lifting, repeatedly searching without coming/going, contradicting Zhang Zhongjing.

Yang pulse floating-large and soft, Yin pulse floating-large and soft, equal in both, is named Slow (Huan).

Huan has meanings of slow and harmonious. Exclusive yin or exclusive yang cannot produce Huan. Huan is not just yin, it has yang; not just yang, it has yin. Both combine to form Huan. When yin-yang mix to harmonize, color is yellow, face bright, sound Shang, hair long, overflowing with Chun Qi. If disease manifests, it is deficiency, bi, or Qi Dai. Dai Shi said: Soft and slow in middle/lower positions, smaller than deep pulse, soft on pressure, indicates邪 (pathogen), deficiency-type Huan. Yin-yang harmony, Cun-Yang Chi-Yin, both float-large and soft equally, no bias, indicates no disease, yin-yang harmonious Huan. Huan resembles Chi. Chi is three breaths per cycle; Huan is four breaths per cycle.

Pulse floating and tight is named Wiry (Xian). Wiry feels like a bowstring, unyielding. Tight pulse feels like twisting rope, irregular.

Why is Wiry liver pulse? Liver is Wood. Day: Jia is beginning, Yi is bending. Meridian: Shaoyang is young Yang, Jueyin is end of Yin. Season: Spring is birth of things. *Suwen* says: Soft, light, void, smooth, straight, long is Wiry, containing yang within yin. Here, floating-tight is Wiry. Floating is Yang, Tight is Yin, Yang not separated from Yin. Hence *Mai Jue* lists it as Yang, Zhang Zhongjing as Yin. Dai Shi calls it half-yin half-yang. "Floating" should be understood via soft, light, void. *Mai Jue* mistakenly says: feel weak when pressing, strong when lifting, implying only floating-wiry, no deep-wiry. Classics say: Deep-wiry indicates suspended fluid and internal pain, so deep also has wiry. Wiry and Tight both resemble pulling rope. To distinguish, Wiry is unyielding like bowstring; Tight is irregular like twisting rope. Straight and long is Wiry; twisting is Tight. Straight is constant; twisting is irregular. Wiry-soft is easy to treat; Wiry-hard is difficult. Zhang Zhongjing said: Pulse like twisting rope indicates death, due to urgency and lack of Stomach Qi. Twisting has life/death distinctions; must differentiate carefully.

Pulse wiry and large: Wiry implies reduction, Large implies Hollow (Kou). Reduction implies cold, Hollow implies deficiency. Cold and deficiency interact, named Leathery (Ge). In women, miscarriage and bleeding; in men, blood loss and essence loss.

*I Ching* says: Ge means removing the old. Ge means changing old to new. Normal pulse circulates nutrients, filling body without change. If deficiency-cold lingers, former fullness changes to exhaustion. Pulse wiry and large is its form. Wiry-reduction means yang deficiency causing cold; Large-Hollow means yin-blood deficiency causing deficiency. Cold-deficiency interaction changes qi-blood, named Ge. Women get miscarriage/bleeding; men get blood/essence loss. Many pulses exist, but Ge is named so because of long-term change. Even sudden changes named Ge may heal without medicine. Classics say: Ge pulse in chronic disease indicates death; in acute disease, life. *Mai Jue* says: Absent when pressing, present when pushing, describes position, not shape. Classics say resembles deep/hidden (position). Solid, long, slightly wiry is shape. Basically solid-like, wiry, long-like,不离 (not leaving) wiry and large. Mixing with deep/hidden/solid/long gives firm (Lao) meaning. Classics compare Ge to Solid; Sun Simiao equates Ge with Lao. Some books have Lao but no Ge, or vice versa.

Question: Why does shivering then sweating resolve disease? Answer: Floating-tight pulse, hollow on pressure, indicates root deficiency, causing shivering then sweating. Root deficiency causes shivering; floating pulse allows sweating to resolve. If floating-rapid, not hollow, root is not deficient; only sweating resolves, no shivering. Question: Why does non-shivering sweating resolve disease? Answer: Large-floating-rapid pulse indicates no shivering, sweating resolves. Question: Why does non-shivering non-sweating resolve disease? Answer: Self-micro pulse, due to prior sweat/vomit/purgation/blood loss, lacking fluids. Yin-yang self-harmony leads to self-recovery, hence no shivering/sweating.

Pathogen exiting, root deficient, pathogen fights righteous qi, causing shivering. After shivering, sweating resolves. Non-deficient root, pathogen cannot fight, no shivering, sweating resolves. Deficiency distinguished by hollow pulse. Hollow is like onion tube in skin: light/heavy touch present, medium touch absent. Classics: Ying runs in vessels, sign of blood loss. "Press" means "Seek" (Xun), between floating/lifting and deep-pressing. If pathogen weak and righteous qi weak, micro pulse, no shivering/sweating resolves. Micro pulse originally for vomit/purgation/blood loss. Yang micro forbids sweating; Yin micro forbids purgation, due to yin-yang deficiency. Question: When to check these pulses? Answer: Check at start for releasing exterior; observe end for resolving. E.g., Chaihu Tang syndrome, six-seven days...