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Pulse is soft and weak; the weak pulse appears at the Guan position, the soft pulse appears at the superficial level (Dian), the faint pulse appears at the Cun position (Upper), and the choppy pulse appears at the Chi position (Lower). Faintness indicates insufficiency of Yang Qi; choppyness indicates lack of Blood. If Yang Qi is already faint, and Wind-Strike occurs with sweating, restlessness and vexation may arise. Due to lack of Blood and choppy pulse, there will be cold limbs and aversion to cold. If sweating is induced in a patient with faint Yang Qi, it leads to restlessness and insomnia.

[Annotation]
A pulse that is forceless on superficial palpation is the Soft Pulse (Ru Mai). A pulse that is forceless on deep palpation is the Weak Pulse (Ruo Mai). A pulse that is forceless on superficial, middle, and deep palpation, appearing as if present or absent, is the Faint Pulse (Wei Mai). A pulse that is stagnant and unsmooth is the Choppy Pulse (Se Mai). "Dian" refers to superficial palpation; "Upper" refers to the Cun position; "Lower" refers to the Chi position. The description "pulse soft and weak, weak at Guan, soft at Dian, faint at Upper, choppy at Lower" means the Guan pulse is soft on superficial palpation and weak on deep palpation; the Cun pulse is faint, and the Chi pulse is choppy. Yang deficiency manifests as a faint Cun pulse; Blood deficiency manifests as a choppy Chi pulse. This constitutes the pulse pattern of Yang deficiency and Blood deficiency, which contraindicates diaphoresis (sweating therapy). Yang deficiency typically presents with sweating and aversion to cold; Blood deficiency typically presents with mental vexation and fever. These are the clinical manifestations of Yang deficiency and Blood deficiency, which contraindicate diaphoresis. If mistakenly diagnosed as Taiyang Wind-Strike and treated with diaphoresis, it will inevitably cause loss and depletion of both Yin and Yang, resulting in restlessness, insomnia, cold limbs, and aversion to cold.

The pulse is soft and weak; the weak pulse appears at the Guan position, the soft pulse appears at the superficial level, the wiry pulse appears at the Cun position (Upper), and the faint pulse appears at the Chi position (Lower). Wiryness indicates Yang movement (or Heat pathogen); faintness indicates Yin Cold. There is excess in the Upper and deficiency in the Lower; the patient desires warmth. The combination of faint and wiry pulses indicates deficiency; diaphoresis is contraindicated. Inducing sweating will cause shivering from cold, and the body will not recover.

[Annotation]
This describes the Guan pulse as soft on superficial palpation and weak on deep palpation, the Cun pulse as wiry, and the Chi pulse as faint. Wiryness is the pulse diagnosis for Shaoyang Heat pathogen; faintness is the pulse diagnosis for Shaoyin Cold pathogen; hence, it is said that there is excess in the Upper and deficiency in the Lower. However, when faint and wiry pulses appear together, the distinction between deficiency and excess is unclear. Only by observing whether the patient desires warmth can one determine that this is not exterior aversion to cold, but interior fear of cold. Therefore, diaphoresis is contraindicated. If mistakenly induced, Yin will become more abundant, causing shivering from cold, and Yang will become more depleted, preventing recovery.

In various pulse patterns, if the pulse is rapid and beating but becomes faint and weak upon pressure, diaphoresis is contraindicated. Inducing sweating will lead to difficult defecation, dry abdomen, dry stomach with vexation. Although the symptoms may appear similar, the root causes are different.

[Annotation]
Generally, diseases presenting with a rapid and beating pulse indicate an Excess syndrome, where diaphoresis may be appropriate. However, if the pulse feels faint and weak upon pressure, it indicates false Excess on the exterior and true Deficiency on the interior. Diaphoresis is contraindicated. If mistakenly induced, it damages Body Fluids, leading to a dry abdomen and difficult defecation, dry stomach, and vexation. The symptoms resemble those of Yangming Fu-Excess Heat accumulation, but fundamentally, they result from inducing sweating in a deficient patient, leading to fluid exhaustion and vacuous dryness in the Yangming channel. Thus, it is said: "The symptoms appear similar, but the roots are different."

[Collected Annotations]
Cheng Zhi stated: Rapid and beating pulses indicate Heat; faint and weak pulses indicate Deficiency. Sweating depletes Body Fluids, causing difficult defecation, dry abdomen, dry stomach, and vexation. Compared to Yangming Interior Heat syndromes, although the symptoms are similar, the fundamental nature differs between Deficiency and Excess.
Zhang Zhicong stated: Rapid and beating pulses are Yang pulses; faint and weak pulses are Yin pulses. When various pulses show rapidity and beating but feel faint and weak upon pressure, regardless of whether it is on the left or right three positions, diaphoresis is contraindicated. Sweating depletes internal Body Fluids, causing difficult defecation; external leakage of Water Qi causes dry abdomen; Fire-Heat steaming upward causes dry stomach and vexation. "Symptoms appear similar" refers to the similarity of dryness syndromes after sweating. "Roots are different" refers to the fact that rapid/beating pulses belong to Yang, while faint/weak pulses belong to Yin, encompassing Yin, Yang, Deficiency, and Excess.

When there are cold limbs and a tight pulse, diaphoresis is contraindicated. Inducing sweating will cause hoarseness, throat spasms, tongue flaccidity, and inability to speak clearly.

[Annotation]
A pulse suitable for diaphoresis must be tightly bound on both Yin and Yang levels. Now, with cold limbs and a tight pulse, this is the tight pulse of Shaoyin, not Taiyang. If sweating is induced, it injures Shaoyin Qi, leading to symptoms such as hoarseness, throat spasms, tongue flaccidity, and inability to produce sound.

[Collected Annotations]
Cheng Wuji stated: Cold limbs with a tight pulse indicate Shaoyin Cold Damage. The method should be to warm the Interior. Inducing sweating instead damages Shaoyin Qi. The pulse Qi cannot enter the Lung, follow the throat, and attach to the base of the tongue, resulting in hoarseness, throat spasms, tongue flaccidity, weak voice, and inability to speak loudly.
Wei Litong stated: This section discusses the pulse in relation to Jue syndromes, indicating that Yang deficiency prohibits sweating, thereby clarifying the errors caused by inducing sweating in various adverse conditions. Jue syndromes include Cold Jue, Heat Jue, Roundworm Jue, and Jue due to competing Cold and Heat. Whenever a tight pulse is seen, regardless of the type of Jue, the disease resides in the Yin aspect. Inducing sweating attacks Yang, scattering Qi and exhausting Blood. The tongue is rooted in the Kidney; voice originates from the Lung. Hoarseness and throat spasms indicate impending Lung Qi failure. Tongue flaccidity means the tongue is useless. Inability to speak indicates failure of original Qi. All these result from sweating dispersing and destroying the True Qi of the Kidney and Lung organs.

If there is pulsating Qi on the Right side, diaphoresis is contraindicated. Inducing sweating will cause epistaxis, thirst, mental vexation, and vomiting water immediately after drinking. If there is pulsating Qi on the Left side, diaphoresis is contraindicated. Inducing sweating will cause dizziness, incessant sweating, and muscle twitching. If there is pulsating Qi above, diaphoresis is contraindicated. Inducing sweating will cause Qi rushing upward, striking directly at the heart region. If there is pulsating Qi below, diaphoresis is contraindicated. Inducing sweating will cause absence of sweat, severe mental vexation, painful bone joints, dizziness, aversion to cold, regurgitation of food after eating, and inability of food to pass down.

[Annotation]
"Pulsating Qi" refers to the sensation of Qi throbbing vigorously. The areas above, below, left, and right of the umbilicus correspond to the locations of the four Zang organs. The Qi of these four organs is unsettled in its proper position, hence the pulsation. Because the organ has long been occupied by exogenous pathogens, the organ's own Qi has lost its guardianship, relying solely on the Stomach Qi in the Middle Jiao as the master. Even if there are exterior pathogens, diaphoresis is contraindicated, lest the Qi and Fluids of the Stomach be injured, causing the organ to lose nourishment, allowing the conquering pathogen to cause simultaneous disease.
Pulsating Qi on the Right indicates Lung Qi dysfunction and Heart failing to maintain its virtue. Mistaken sweating increases Heart Heat, boiling blood vessels, causing epistaxis, thirst, and vexation; Lung fails to regulate and diffuse, unable to control water passages, causing vomiting of water after drinking.
Pulsating Qi on the Left indicates Liver Qi dysfunction and Lung failing to maintain its virtue. Mistaken sweating causes Liver deficiency and failure to ascend, leading to dizziness; incessant sweating deprives muscles and tendons of Fluid nourishment, causing twitching.
Pulsating Qi above indicates Heart Qi dysfunction and Kidney failing to maintain its virtue. Mistaken sweating causes Heart Qi deficiency, leading to Kidney Qi rushing upward to the heart region.
Pulsating Qi below indicates Kidney Qi dysfunction and Spleen failing to maintain its virtue. Mistaken sweating exhausts Kidney Water, causing bone pain, aversion to cold, absence of sweat, mental vexation, and dizziness; Spleen Earth becomes overly dry, failing to maintain normal transformation, causing regurgitation of food and inability of food to pass down.

[Collected Annotations]
Cheng Zhi stated: This explains that pulsating Qi contraindicates sweating. Internal deficiency of Zheng Qi and dysfunction of Zang Qi cause vigorous pulsation. Pulsating Qi indicates Interior Deficiency, hence sweating is contraindicated.
Cheng Yingmao stated: Zang Qi unsettled in its position causes pulsation. Due to prior pathogen occupation, the organ's Qi is precarious and prone to deviating from its channel. Reliance is placed entirely on Stomach Qi for stability. Sweating depletes Stomach Qi, causing the four Zang organs to lose nourishment and be attacked by pathogens, each showing signs of deviation. Although the location varies (left, right, upper, lower), the principle of losing the supportive function of the Middle Jiao remains the same.

If there is closure and cold in the throat, diaphoresis is contraindicated. Inducing sweating will cause hematemesis, faint Qi, cold limbs, desire to curl up, and inability to self-warm.

[Annotation]
The Shaoyin meridian follows the throat and attaches to the base of the tongue. Throat closure indicates Shaoyin Qi cannot ascend. Forcing sweating in Shaoyin, where Yang is faint and cannot generate sweat, will disturb Blood, causing hematemesis, faint Qi, curled posture, cold limbs, and inability to self-warm.

[Collected Annotations]
Cheng Zhi stated: Throat closure contraindicates sweating because Yin pathogen is abundant. Forcing sweating disturbs Blood. Hematemesis and impending Qi failure indicate even the faint Yang in the Kidney cannot sustain itself, leading to cold limbs, desire to curl up, and inability to self-warm. Lower Jue and Upper Exhaustion, curled posture and cold limbs, are critical Shaoyin syndromes.
Cheng Yingmao stated: Sweating agents are Yang in nature; applying them to Yin meridians is adverse. Throat closure is due to scant Shaoyin Fluids and Kidney Qi failing to ascend. Inducing sweating in Shaoyin causes Lower Jue and Upper Exhaustion, resulting in such manifestations.

If coughing is severe, frequent expectoration of saliva and foam occurs, the throat is necessarily dry, urination is difficult, there is hunger-like vexation in the heart, occurring once every 24 hours, resembling malaria with chills but no fever, vacuity with cold shivers. Coughing accompanied by sweating leads to curling up, distressing fullness, and abdominal hardness.

[Annotation]
Severe coughing with frequent expectoration of saliva and foam indicates Lung injury and fluid consumption. Hence, dry throat, difficult urination, and hunger-like vexation occur. "Zui Shi" refers to a full day cycle, meaning an episode once every 24 hours. Resembling malaria with chills but no fever indicates Interior Vacuity generating cold shivers. Mistakenly treating this as exterior cold-induced cough and inducing sweating will further damage Lung Qi and Wei Yang. Dual injury of Yang Qi fails to warm the Middle and Lower Jiao; Yin Qi condenses internally and externally, leading to curling up, distressing fullness, and abdominal hardness.

[Collected Annotations]
Cheng Zhi stated: Continuing from the previous discussion on soft, weak, wiry, and faint pulses, if coughing is present, the disease is severe and sweating is contraindicated. Coughing with frequent expectoration of saliva and foam implies dry throat and difficult urination. Yang deficiency in the Diaphragm causes hunger-like vexation. Wei Qi circulates 50 times through the body in a day and night; Yang deficiency fails to protect the exterior, causing chills resembling malaria once daily, with only chills and no fever. Inducing sweating here further depletes Yang and intensifies Yin Cold, leading to curling up, distressing fullness, and hardening of the abdomen.

If coughing is accompanied by free urination or urinary incontinence, diaphoresis is contraindicated. Inducing sweating will cause cold limbs and reversal.

[Annotation]
Coughing often involves Phlegm-Fluid retention, where urination should be difficult. If urination is free, it indicates no Phlegm-Fluid. Now, coughing with urinary incontinence indicates not only absence of Phlegm-Fluid but also Lower Jiao Yang deficiency and Bladder insecurity. Thus, diaphoresis is contraindicated; sweating will further deplete Yang Qi, causing cold limbs.

[Collected Annotations]
Cheng Zhi stated: *Neijing* states that persistent Kidney Cough transmits to the Bladder; Bladder Cough presents with coughing and enuresis. Therefore, coughing with free urination or incontinence indicates Kidney Yang deficiency. Sweating further depletes Yang, causing cold limbs.

For any adverse condition, inducing sweating makes mild cases difficult to cure. Severe cases result in confused speech; those with dizziness die, and life will be hard to save.

[Annotation]
Sweating when inappropriate, or excessive sweating when indicated, all lead to adverse reactions, hence "any adverse condition." For diseases made adverse by sweating, mild cases are difficult to cure, while severe cases result in death. Severe cases refer to Yang collapse seeing hallucinations (confused speech) and Yin collapse causing blindness (dizziness).

[Collected Annotations]
Cheng Yingmao stated: Most adverse conditions belong to Shaoyin, where Yin Cold is extreme. Sweating severely夺 (seizes/deprives) Yang. Whether mild or severe, all relate to death, clarifying that Yang is the root of human life.

In Cold Damage, headache, slight fever, resembling Wind-Strike, frequent slight sweating, and spontaneous vomiting: purgation increases vexation and mental agitation like hunger. Inducing sweating leads to spasms, stiff body, and difficulty bending/extending. Moxibustion/fumigation leads to jaundice and inability to urinate. Moxa induces coughing and expectoration.

[Annotation]
Headache, slight fever, sweating, vomiting, resembling Wind-Strike, should be treated with Guizhi Tang (Cinnamon Twig Decoction) to resolve the muscle layer. Purgation may lead to severe Jie Xiong (Constraint in the Chest) or Pi Man (Stagnation), or mild mental vexation and agitation like hunger. Using Mahuang Tang (Ephedra Decoction) to induce sweating instead of Guizhi Tang for exterior deficiency allows Wind invasion, causing spasms, stiff body, and difficulty moving. Fumigation/moxa forcing sweat prevents urination; Heat combines with Dampness to cause jaundice. Moxa injures Lung with Fire pathogen, causing persistent coughing and expectoration.

[Collected Annotations]
Cheng Wuji stated: Purgation allows Evil Heat to flow into the Chest due to deficiency, causing mental agitation like hunger. Sweating on a deficient exterior sends Heat into the collaterals; intense Heat generates Wind, causing stiffness and spasms. Fumigation combines Fire and Heat, consuming Fluids, causing difficult urination and jaundice. Lung dislikes Fire; moxa injures Lung with Fire, causing cough and expectoration.
Gao Shizong stated: Sweating, purgation, and fumigation differ in treatment but equally damage Righteous Qi; thus, purgation and fumigation are discussed alongside sweating.
Wei Litong stated: This clarifies that even with exterior syndromes suitable for sweating, contraindications must be carefully observed. Headache, slight fever resembling Wind-Strike is a Guizhi Tang syndrome. Vomiting indicates internal Phlegm-Fluid retention. Mistaken purgation increases vexation and agitation, implying pre-existing vexation worsened. Further mistaken sweating on deficient exterior allows Wind invasion, causing stiffness. Fumigation forces Heat inward, preventing urination. Jaundice occurs when urination is obstructed by Dampness and consumed by Heat. Moxa drives Heat upward, causing coughing and expectoration of pus and blood.