Library

The pulse qualities of large (Da), floating (Fu), rapid (Shu), slippery (Hua), and surging (Dong) belong to Yang pulses. If Yin diseases present with Yang pulses, it indicates life potential and a favorable prognosis; conversely, if Yang diseases present with Yin pulses—specifically deep (Chen), choppy (Se), wiry (Xian), thready (Wei), or weak (Ruo)—it indicates a poor prognosis and potential death. The interaction between Yin and Yang pulses is most profound and subtle, yet becomes clear through the method of palpating at superficial (Fu), middle (Zhong), and deep (Chen) levels.

When both Yin and Yang pulses exhibit five distinct qualities, it is because the pulse follows the generation cycle of the Five Elements (Wu Xing). When pathogenic factors are in the exterior, Yang pulses appear; when they are in the interior, Yin pulses appear. If a Yin disease presents with Yang pulses, it signifies survival, as the pathogen moves from the interior to the exterior, aiming for resolution through sweating. For example, in Jueyin wind-stroke, a slightly floating pulse indicates impending recovery, while a non-floating pulse indicates no recovery. If a Yang disease presents with Yin pulses, it signifies death, as the pathogen moves from the exterior to the interior, causing the righteous Qi to collapse and sink; for instance, delirium accompanied by a deep pulse exemplifies this. The *Huoren Shu* (Book of Vitality) claims that the pulses of miscellaneous diseases differ from those of cold damage syndromes, but in reality, they are the same. Moreover, cold damage syndromes often contain elements of miscellaneous diseases, and vice versa. The Yin-Yang nature of pulses in both cold damage and miscellaneous diseases is fundamentally identical. Since the *Baizheng Ge* summarized the general principles and Zhu Danxi elucidated their subtleties, it has been understood that pulse diagnosis should follow Zhang Zhongjing and Wang Shuhe's *Mai Jing* (Classic of Pulse Diagnosis), rather than adhering rigidly to Gao Yangsheng's *Mai Jue* (Pulse Rhymes).

The floating pulse assesses deficiency and excess in the exterior. In treating cold damage syndromes, one must first differentiate the Renying pulse (carotid artery, reflecting Yang), and after transmission and transformation, differentiate the pulses of the various meridians.
If the Cun, Guan, and Chi positions all present a floating pulse, it is a Taiyang exterior syndrome; a pulse that is floating and tight/choppy indicates cold damage; a pulse that is floating and rapid indicates significant heat.
If the Cun, Guan, and Chi pulses are all floating, forceful, and possess Shen (spirit/vitality), diaphoresis (sweating method) may be used; if the pulse is slow, diaphoresis is contraindicated.
A pulse that is floating and moderate/relaxed indicates wind injury; muscle-releasing methods should be used, not strong diaphoresis.
A pulse that is floating, large, and forceful makes the heat easy to identify; a pulse that is floating and long/large corresponds to the Yangming meridian; a pulse that is floating and wiry/large corresponds to the Shaoyang meridian.
Palpating the middle position assesses the Yangming and Shaoyang meridians. If the Cun, Guan, and Chi positions all present a long pulse, it is a Yangming disease; if the pulse is floating and long with force, combined with Taiyang exterior signs, and there is no sweat, diaphoresis is appropriate.
A pulse that is long, large, and forceful indicates severe heat; muscle-releasing methods should be employed.
A pulse that is long, rapid, and forceful suggests the heat can be pacified; a pulse that is long, slippery, solid, and large indicates the need for purgation/drainage. If the Cun, Guan, and Chi positions all present a wiry pulse, it belongs to the Shaoyang meridian.
Generally, wiry pulses should only be treated with harmonizing methods.
If the pulse is floating and wiry with exterior signs, sweating may be determined as the treatment; if the pulse is wiry-slow, wiry-small, or wiry-thready/weak and deficient, it indicates internal cold and requires warming methods.
A pulse that is wiry-large, wiry-long, or slippery-rapid indicates excessive heat; when heat is severe, resolving methods should be used.

The deep pulse assesses deficiency and excess in the interior. If the Cun, Guan, and Chi positions all present a deep and thready pulse, it belongs to the Taiyin meridian; a deep and thready pulse belongs to the Shaoyin meridian; a micro-slow pulse belongs to the Jueyin meridian; a deep, slow, and forceless pulse indicates profound Yin qi.
A pulse that is deep, micro, thready, slow, or hidden and forceless lacks Shen, indicating Yin excess and Yang deficiency; immediate use of Shengmai Huayang (Generate Pulse and Return Yang) methods is required.
A pulse that is deep, rapid, and forceful indicates heat-excess; nourishing Yin to retreat Yang prevents pathogenic invasion.
A pulse that is deep, rapid, slippery, or solid and forceful possesses Shen, indicating heat-excess, Yang excess, and Yin deficiency; immediate nourishment of Yin to retreat Yang is required. Generally, the method of deep palpation is the most critical key point, used to decide on Yin/Yang and cold/heat treatments. Life and death hang in the balance, so careful observation is indispensable. A pulse with force indicates Shen and is treatable; a pulse without force indicates lack of Shen and is difficult to treat.

Furthermore, the discussion of cold damage pulses is not limited to one type: if both Yin and Yang aspects present with tight and choppy pulses, it is cold damage; however, if previous cold damage left stagnant heat uncleaned, and cold is contracted again, it transforms into warm malaria. If the Yang pulse is floating and the Yin pulse is weak, it is wind injury; however, if previous wind injury left accumulated heat unresolved, and wind is contracted again, it transforms into wind-warmth. If the Yang pulse is soggy and the Yin pulse is urgent, it indicates dampness injured first and summer-heat second during summer, which is the pulse of damp-warmth. If the Yang pulse is floating and the Yin pulse is soggy, it indicates warm qi injured first and wind contracted second during spring, which is the pulse of wind-warmth. If the Yang pulse is洪 (Hong/surging) and rapid, and the Yin pulse is solid and large, it is the pulse of warm toxin. Contracting heat in spring/summer and encountering damp-heat results in two heats combining, causing warm toxin to manifest as macules. If the Yang pulse is soggy and weak, and the Yin pulse is wiry and tight, it is the pulse of damp-warmth. In late summer, dampness is injured first and summer-heat second, with both Yin and Yang flourishing, resulting in the pulse of warm malaria. This occurs when wind-cold is initially injured, residual heat remains uncleaned, and cold is contracted again. If the pulse shows both Yin and Yang as deep, yet symptoms resemble Taiyang disease, it is due to warm weather in winter allowing warm qi to invade. There may be same-disease-different-names or same-pulse-different-meridians scenarios. These diseases all originate from the damp earth of the Middle Jiao and resemble cold damage; they must not fail to be differentiated.