Library

In human illness, it is no more than the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) and Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire). How does a physician know the differences in severity and life-and-death prognosis? One must inquire about the symptoms and palpate the pulse before knowing. However, symptoms and pulses vary. There are cases where symptoms are extremely clear but not visible in the pulse; there are cases where the pulse is very clear but not visible in the symptoms. In some cases, one should follow the symptoms; in others, one should follow the pulse. There must be a definite reason for this. If examined truly and accurately, the disease condition cannot escape detection; otherwise, one will be misled either by the symptoms or by the pulse. Therefore, in cases suitable for following symptoms, even if the pulse is extremely smooth, if the symptoms are critical, death is certain. In cases suitable for following the pulse, even if the symptoms are extremely dangerous, if the pulse is harmonious, survival is certain. For example, a person who has lost a large amount of blood may appear like a corpse, with danger imminent, but if the six pulses (Cun, Guan, Chi positions on both hands) have root qi, they will not die. This is a case of following the pulse rather than the symptoms. For example, a person with Tan Jue (Phlegm-Jue, sudden coma due to phlegm obstruction) may have a rapid or absent pulse, but will recover once the phlegm descends. This is a case of following the symptoms rather than the pulse. In Yin deficiency cough, diet and daily activities may be normal, but the six pulses are fine and rapid; over time, death is inevitable. This is a case of following the pulse rather than the symptoms. In Ye Ge Fan Wei (Dysphagia and regurgitation), the pulse may resemble that of a healthy person, but over time, stomach qi fails and the pulse changes suddenly, resulting in almost no survivors. This is another case of following the symptoms rather than the pulse. There are many such examples, which cannot be enumerated. In short, observing the pulse and symptoms separately makes neither reliable for determining auspiciousness or misfortune. Observing them together allows one to determine prognosis based on which symptoms contraindicate which pulses, and vice versa. For example, Lung diseases contraindicate a rapid pulse. The Lung belongs to Metal, and rapidity belongs to Fire; this is Fire punishing Metal. The rest can be inferred analogously, all governed by the principles of the Five Elements (Wood, Fire, Earth, Metal, Water) generation and restriction. Nowadays, people do not examine symptoms but only discuss the pulse; the more detailed their discussion, the further they stray from the truth. As for the entirety of pulse theory, it has been detailed in the *Nei Jing* and other texts.

Symptoms are the manifestations of disease. If the disease pathogen is Heat, symptoms manifest as Heat; if Cold, symptoms manifest as Cold. This is an immutable principle. However, symptoms sometimes contradict the nature of the disease, leading to easy misdiagnosis and mistreatment, which must be known. For instance, a disease caused by exposure to Cold may present with body heat and aversion to heat; a disease caused by Summerheat injury may present with body coldness and aversion to cold; a case of Shang Shi (Food Stagnation) may present with increased appetite and ability to eat; a case of Shang Yin (Fluid Retention) may present with extreme thirst and dry mouth. Such diseases require careful examination. A single error in treating based on symptoms can determine life or death. There are reasons for these contradictions. Sometimes the disease trend is not yet fixed; for example, in Shang Han (Cold Damage), fever is expected, but if it has not yet appeared, it will likely appear later. This is a difference in sequence. Sometimes internal and external conditions differ, such as external cold but internal heat. Sometimes there is name without substance, such as desiring good food and drink but stopping after slight intake, and difficulty digesting afterwards. Sometimes other symptoms are mixed in, leading to misidentifying one symptom pattern as another. Sometimes a patient has a pre-existing condition, and a new condition emerges, causing old symptoms to reappear. Regarding contradictory pulses, variations also exist. Some individuals have constitutions different from the norm. Mild diseases may not manifest in the pulse. Phlegm and Qi obstruction may hinder Ying Qi (Nutritive Qi) flow, causing the pulse to deviate from its normal course. Temporary closure by pathogens may make the pulse appear dangerous, but it returns to normal once Qi flows freely. Some patients retain the pulse of a pre-existing condition despite new symptoms. These situations are numerous and cannot be fully listed. One must deeply contemplate and recognize the true nature of the condition to avoid confusion by symptoms and pulses. Otherwise, adhering rigidly to one aspect leads to greater errors in treatment. Unless one is extremely precise in syndrome differentiation and well-versed in pulse theory, confusion is inevitable.