Library

Ancient physicians distinguished between external injuries (external pathogenic factors) and internal injuries by comparing the Renying pulse (pulse at the carotid artery, representing Yang/exterior) and the Qikou pulse (radial pulse at the cun position, representing Yin/interior). If the Renying pulse is greater than the Qikou pulse, it indicates an external injury; if the Qikou pulse is greater than the Renying pulse, it indicates an internal injury. This distinction is indeed correct, but its explanation is not exhaustive.

External contraction of wind-cold constitutes a syndrome of excess, arising from invading pathogenic factors. The pathology must manifest on the left hand. The left hand governs the exterior and corresponds to the circulation of Yang for twenty-five degrees. Internal injury due to diet, irregular eating habits, or excessive labor constitutes a syndrome of deficiency. The pathology must manifest on the right hand. The right hand governs the interior and corresponds to the circulation of Yin for twenty-five degrees.

Therefore, when contracting cold pathogens externally, only the left Cun position of the Renying pulse appears floating and tight; upon heavy pressure, it becomes surging (Hong). "Tight" (Jin) is more urgent than "wiry" (Xian), which is the pulse of the Foot-Taiyang Bladder channel (Cold Water). Upon heavy pressure, it feels surging and forceful, revealing characteristics of the Hand-Shaoyin Heart channel (Fire). Due to the combination of Ding (Fire) and Ren (Water), a surging pulse manifests internally; this is the pulse of Shanghan (Cold Damage).

If contracting wind pathogens externally, the Renying pulse is moderate (Huan) and one, two, or three times greater than the Qikou pulse.

In cases of internal injury from diet, the right Cun position of the Qikou pulse is one time greater than the Renying pulse. In severe cases involving the Shaoyin channel, it is two times greater; in cases involving the Taiyin channel, it is three times greater. This is the pulse pattern of internal injury from diet.

In cases of irregular diet and excessive labor, the Heart pulse changes manifest at the Qikou position. This represents Heart Fire insulting Lung Metal (Heart Fire punishing the Lungs). The Liver Wood, carrying the momentum of Heart Fire, also attacks the Lungs. As the classics state: "Insulting what should not be insulted, because of lacking fear," refers to this mechanism. Thus, the Qikou pulse appears urgent, surging, choppy (Se), and rapid (Shu), occasionally presenting with a intermittent pulse (Dai) accompanied by choppieness. "Choppy" is the intrinsic pulse of the Lung; "Intermittent" indicates that Yuan Qi (Original Qi) fails to connect continuously.

If the Spleen and Stomach are deficient, and the pulse is surging and rapid, it is because the Heart pulse insults the Lungs. If the pulse is urgent, it is because Liver Wood, carrying Heart Fire, counter-attacks Lung Metal.

If the labor is not severe, only the right Guan position (Spleen pulse) appears surging and rapid, being uniquely greater than the other five positions. Within the rapid quality, a moderate quality may appear, occasionally showing an intermittent pulse.

If there is irregular diet and improper regulation of cold and heat, the right Guan position (Stomach pulse) first becomes damaged and weak. In severe cases, it may become hidden and invisible, revealing only the intrinsic Spleen pulse, which is surging, rapid, slightly moderate, and occasionally intermittent.

If food stagnation is not digested, only the right Guan pulse appears deep (Chen) and slippery (Hua). The classics state: "A slippery pulse indicates food stagnation."

By using these methods for differentiation, is it not clear and easy to see? However, fearing that in remote areas there might suddenly be no physician available for diagnosis, I further describe the symptoms to aid in differentiation.