Library

The methods for treating diseases include cases where one should discard symptoms and follow the pulse, as well as cases where one should discard the pulse and follow the symptoms. This is because pulses have true and false manifestations, and symptoms also have true and false distinctions. Whenever pulse and symptom findings are inconsistent, it implies that one aspect is true and the other is false hidden within. Thus, there are Yang syndromes (Yang Zheng) presenting with Yin pulses (Yin Mai), Yin syndromes presenting with Yang pulses, deficiency syndromes (Xu Zheng) presenting with excess pulses (Shi Mai), and excess syndromes presenting with deficiency pulses. In such cases of contradiction between Yin and Yang, or deficiency and excess, which one should be followed?

I have carefully observed this: If an excess syndrome presents with a deficiency pulse, the symptoms must be falsely excessive; if an excess pulse presents with deficiency symptoms, the pulse must be falsely excessive. How do we know this? For instance, although the exterior shows vexation and heat, if the pulse is weak and faint, it indicates Fire Deficiency (Huoxu, deficiency of Heart-Kidney Yang); although the abdomen is distended and full, if the pulse is weak and faint, it indicates Stomach Deficiency (Weixu). Given these are deficient fire and deficient distension, how can purgative methods be used? In such cases, one should follow the deficiency indicated by the pulse rather than the apparent excess in symptoms.

Conversely, if there is no original vexation or heat, yet the pulse is surging and rapid, this is not due to Fire Pathogens (Huoxie); if there is no original distension or stagnation, yet the pulse is wiry and strong, this is not internal excess accumulation. Since there is no heat or distension, how can draining methods be applied? In such cases, one should follow the deficiency indicated by the symptoms rather than the apparent excess in the pulse. Generally speaking, excess conditions can have false manifestations, whereas deficiency conditions do not have false manifestations. Falsely excess conditions often involve变幻 (changes/deceptions) in pathology, which is why they are "false"; deficiency conditions reveal loss and depletion clearly, which is why they are "true." Therefore, whenever pulse and symptoms are inconsistent, there is likely deception involved. One must first examine deficiency to seek the root cause; this is an unchangeable essential principle.

However, true excess with false deficiency is not impossible. For example, internal injury from Cold pathogens, or food retention with Qi stagnation, causing acute pain in the heart and abdomen, may result in a pulse that is extremely deep and hidden, or hurried, or knotted. This is caused by pathogenic closure of the meridians. Although the pulse appears deficient, there are symptoms like pain and distension to rely upon; this is indeed a false deficiency pulse, but essentially not a deficiency condition. Similarly, if there are cold limbs or aversion to wind and cold, yet the pulse is slippery and rapid, this is due to extreme heat generating cold. Although the exterior appears deficient/cold, there are internal signs like vexation, heat, and constipation to rely upon; this is indeed a false deficiency disease, but essentially not a deficiency condition. Furthermore, if there is an excess pulse without corresponding excess symptoms, it is a false excess pulse; if there are excess symptoms without corresponding excess pulse, it is a false excess syndrome. Knowing what is false and what is true allows one to know what to follow and what to discard.

There is also a method of choosing between following the pulse or the symptoms based on the severity of the illness. If the disease is originally mild and superficial, with no other critical signs, one may treat the branch (acute symptoms) based on current presentations. If the disease involves Zang-Fu Qi (Zangfu zhi qi) and presents some difficulty in differentiation, one must carefully distinguish between deficiency and excess, prescribing medication based on solid evidence to be appropriate. Thus, for mild cases, following symptoms accounts for only one or two out of ten; for severe cases, following the pulse accounts for eight or nine out of ten. Therefore, although pulses are said to have true and false aspects, this is actually due to human observation lacking clarity. Do pulses themselves ever have true and false distinctions?