Library

Li Dongyuan stated: The northwest regions are extremely cold, with a severe and desiccating qi; thus, those suffering from Shanghan (Cold Damage) are numerous. The southeast regions are mild and warm, so cases of Shanghan are few. The Classics state: "Where pathogenic factors gather, the body's qi must be deficient." For diseases caused by internal injury, Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used, modified according to the syndromes observed in the Six Channels. In cases of severe qi deficiency, a small amount of Fuzi (Prepared Aconite Root) is added to facilitate the efficacy of Renshen (Ginseng Root). In the north, where internal injuries are rare, the methods of Zhang Zhongjing are employed.

The *Suwen* states: "If the Cun Kou (Radial Artery at the wrist) pulse is floating and vigorous, the disease is external. 'External' refers to the exterior. If the Cun Kou pulse is deep and tight, it indicates disease in the interior. 'Interior' refers to the inside."

Zhang Zhongjing stated: "A floating pulse indicates disease in the exterior, for which diaphoresis (sweating therapy) may be applied." He also said: "When there is disease in the exterior, the pulse should be floating." Regarding Jie Xiong syndrome (Chest Binding), if the pulse is floating, purgation (downward-draining therapy) is contraindicated; thus, it is certain that a floating pulse belongs to Yang syndromes.

The *Nanjing* states: "In Shanghan, the pulses of both Yin and Yang are vigorous, tight, and choppy."

The *Shanghan Lun* (Treatise on Cold Damage) states: "When both Yin and Yang pulses are tight, it is named Shanghan. If the Cun Kou pulse is floating and tight, floating indicates Wind, and tight indicates Cold. Floating, choppy, and tight together indicate Shanghan."

The *Mai Jing* (Pulse Classic) states: "Choppy and tight indicate Cold. A pulse that is floating in the Yang position and weak in the Yin position is named Shangfeng (Wind Injury). A tight pulse without sweat is named Shanghan. When both Yin and Yang pulses are vigorous, and upon re-exposure to Cold they become tight and choppy, it transforms into Wen Nue (Warm Malaria). Tight and vigorous Yin and Yang pulses characterize Shanghan; this occurs when the heat of a previous illness has not yet subsided, and Cold is contracted again. A pulse that is floating and slippery in the Yang position and soft and weak in the Yin position, upon encountering Wind, transforms into Feng Wen (Wind-Warmth). A pulse that is surging and rapid in the Yang position and excessive and large in the Yin position, representing the combination of Warmth and Heat, transforms into Wen Du (Warm Toxin). A pulse that is soft and weak in the Yang position and wiry and tight in the Yin position, upon encountering Warm Qi, transforms into Wen Yi (Plague). If a patient presents with fever and a deep, fine pulse, involving the Taiyang channel, it is named [text missing] disease. If one suffers Taiyang joint pain accompanied by vexation and a deep, fine pulse, it is named Shi Bi (Dampness Bi). If one suffers Taiyang body pain with a faint, weak, wiry, or hollow pulse, it is named [text missing]. If the pulse is deep, fine, and rapid, with a cool body, cold limbs, vexation, aversion to drinking water, mania, and oppression, it is named Yang Jue Shanghan (Yang Reversal Cold Damage). If heat is intense and the pulse is large, survival is possible; if the pulse is deep and fine, death ensues. After sweating, if the pulse is deep and small, survival is possible; if floating and large, death ensues.

The *Baoming Ji* states: "A floating and tight pulse indicates Exterior Excess, suitable for sweating. (Ma Huang Tang is the primary formula.) A floating and slow pulse indicates Exterior Deficiency, suitable for consolidating the exterior and dispelling Cold. (Gui Zhi Tang is the primary formula.) A deep and rapid pulse, or rapid and slippery, or deep, solid, and forceful, all indicate Interior Excess; if accompanied by dry stool, purgation may be used. (Da Cheng Qi Tang is the primary formula.) A deep and fine pulse, or faint and slow, feeling weak upon pressure, with a weak Chi position, all indicate Interior Deficiency. To rescue Interior Deficiency with unregulated bowels/bladder, or cold hands and feet, Si Ni Tang is the primary formula. Deep and fine pulses are not suitable for sweating; slow Chi pulses are not suitable for sweating. Floating and rapid indicates Exterior Excess, requiring sweating. (Formulas like Ma Huang Tang.) Floating and slow indicates Exterior Deficiency, suitable for consolidating the exterior. (Formulas like Gui Zhi Tang.) Neither floating nor deep, but rapid at the middle position, indicates Excess Heat in the Middle Jiao. (Formulas like Tiao Wei Cheng Qi Tang.) If accompanied by headache and aversion to cold, Xiao Chai Hu Tang or Da Chai Hu Tang should be used judiciously. Neither floating nor deep, but slow, faint, or fine at the middle position, indicates Middle Qi Deficiency. (Formulas like Jian Zhong Li Zhong Tang.) Deep and rapid indicates Interior Excess, requiring purgation. (Formulas like Da Cheng Qi Tang.) Deep and slow indicates Interior Deficiency, requiring warming. (Herbs like Sheng Jiang and Fu Zi.)

Tao Jie'an stated: "For Shanghan pulses, one specifically distinguishes Yin/Yang, Cold/Heat, and Exterior/Interior/Excess/Deficiency through floating, mid-level, deep, slow, and rapid qualities. All floating pulses relate to the exterior; obtained with light pressure, it is called Floating. Slightly heavier pressure, between skin and muscle, where Yin and Yang are equal, relates to half-exterior/half-interior, called Mid-level. Deep relates to the interior; heavy pressure below muscle and between sinews and bones, called Deep. All slow pulses indicate Cold; all rapid pulses indicate Heat. Yin/Yang, Cold/Heat, Excess/Deficiency are distinguished by forcefulness. Forceful indicates Yang, Heat, Excess; forceless indicates Yin, Cold, Deficiency. In miscellaneous diseases, Wiry is Yang; in Shanghan, Wiry is Yin. In miscellaneous diseases, Slow is Weak; in Shanghan, Slow is Harmonious. In Shanghan, Large indicates disease progression; Slow indicates pathogen retreat. Slow is the Stomach pulse; having Stomach Qi means life, lacking it means death. A pulse with Shen (Spirit) in Shanghan means life; Shen is the precursor of Qi and Blood. Absence of pulse in both hands is Double Hidden; absence in one hand is Single Hidden; normal sweating will certainly occur. If the Cun position (Yang) shows deep/fine but forceless, it is Yin hidden within Yang. If the Chi position (Yin) shows deep/rapid, it is Yang hidden within Yin. Rapid, large, and forceful at Cun is Heavy Yang; deep, fine, and forceless at Chi is Heavy Yin. Fine as a thread at Cun is Yang Collapse; forceless at Chi is Yin Collapse. Floating and forceful at Cun indicates Cold Pathogen in Exterior Excess, suitable for sweating; floating and forceless indicates Wind Pathogen in Exterior Deficiency, suitable for consolidating. Deep and forceful at Chi indicates Yang Pathogen in Interior Excess, suitable for purgation; forceless indicates Yin Pathogen in Interior Deficiency, suitable for warming. Weak and forceless Cun pulse strictly forbids emesis; weak and forceless Chi pulse strictly forbids purgation. Initially, fast departure and slow return is named Internal Deficiency/External Excess; fast return and slow departure is named Internal Excess/External Deficiency. Uniform Cun and Chi pulses are named Slow/Harmonious, indicating harmony and generation. After sweating/purgation, a quiet pulse indicates life; restless, chaotic, with body heat indicates death, due to pathogen victory. After treating Warm diseases, if the pulse has intermittent stops, it indicates collapse of righteous Qi without recovery. A purely Wiry pulse is named Fu (Burden/Negative), indicating death. A pulse feeling like unraveling silk upon pressure is named Yin-Yang Separation, indicating death. Yin diseases showing Yang pulses indicate life; Yang diseases showing Yin pulses indicate death."