一、仲景之书。精入无伦。非善读。未免滞于语下。诸家论述。各有发明。而聊摄成氏引经析义。尤称详洽。虽
牾附会。间或时有。然诸家莫能胜之。初学不能舍此索途也。悉依旧本。不敢去取。
一、诸家善发仲景之义者。无过南阳。外此如叔维、潜善、洁古、安常、东垣、丹溪、安道。近代如三阳、宇泰诸
君子。单词短语。虽不尽拘长沙辙迹。实深得长沙精义。急为采入。以补六经未发之旨也。
一、是书仲景自序原为十六卷。至叔和次为三十六卷。今坊本仅得十卷。而七八卷又合两为一十卷。仅次遗方。先
后详略。非复仲景叔和之旧矣。今根据辨平脉法为第一卷。自伤寒大例及六经。次第。不复。妄有诠次。止以先后匀适。
约为六卷。其遗方并入论集。便于简阅。大抵因三阳王氏义例云。
问曰。脉有阴阳者。何谓也。答曰。凡脉大、浮、数、动、滑。此名阳也。脉沉、
涩、弱、弦、微。此名阴也。凡阴病见阳脉者生。阳病见阴脉者死。
内经曰。微妙在脉。不可不察。察之有纪。从阴阳始。始之有经。从五行生。兹
首论曰。脉之阴阳者。以脉从阴阳始故也。阳脉有五。阴脉有五。以脉从五行生故也。
阳道常饶。大浮数动滑五者。比之平脉也有余。故谓之阳。阴道常乏。沉涩弱弦
微五者。比之平脉也不及。故谓之阴。伤寒之为病。邪在表。则见阳脉。邪在里。则
见阴脉。阴病见阳脉而主生者。则邪气自里之表。欲汗而解也。如厥阴中风。脉微浮为
欲愈。不浮为未愈者是也。阳病见阴脉而主死者。则邪气自表入里。正虚邪胜。如谵
言妄语。脉沉细者死是也。金匮要略曰。诸病在外者可治。入里者即死。此之谓也。
王三阳云。阴病见阳脉。邪气虽盛。而元气未脱也。阳病见阴脉。邪气既盛。而元
气已脱也。此皆初起便是阴症。便是阳症。固非后来自里之表。自表之里也。何也。
若邪既传里。难得复之表而发汗。况邪气自表入里。此又阳症传阴之常。岂可便断为
死乎。惟阳症脉沉。则阴脉见矣。沉又不数而反见微弱。方是死脉。然则此非元气脱
而何。故成引厥阴中风谵言妄语二条。是自里之表自表之里二句。不能无疑也。
问曰。脉有阳结阴结者。何以别之。答曰。其脉浮而数。能食。不大便者。此为
实。名曰阳结也。期十七日当剧。其脉沉而迟。不能食。身体重。大便反硬名曰阴结
也。期十
四日当剧。
结者。气偏结固。阴阳之气。不得而杂之。阴中有阳。阳中有阴。阴阳相杂以为和。
不相杂以为结。浮、数、阳脉也。能食而不大便。里实也。为阳气结固。阴不得而杂之。
是名阳结。沉、迟、阴脉也。不能食。身体重。阴病也。阴病见阴脉。则当下利。今大
便硬者。为阴气结固。阳不得而杂之。是名阴结。论其数者。伤寒之病。一日太阳。二
日阳明。三日少阳。四日太阴。五日少阴。六日厥阴。至六日为传经尽。七日当愈。七
日不愈者。谓之再传。经言再传经者。再自太阳而传。至十二日再至厥阴。为传经尽。
十三日当愈。十三日不愈者。谓之过经。言再传过太阳之经。亦以次而传之也。阳结
为火。至十七日传少阴水。水能制火。火邪解散则愈。阴结属水。至十四日传阳明土。
土能制水。水邪解散则愈。彼邪气结甚。水又不能制火。土又不能制水。故当剧。内经
曰。一候后则病。二候后则病甚。三候后则病危也。
王文禄云。伤寒传经。阳三日。阴
三日。结者。阴阳偏剧。阳剧于参天。故十七日。阴剧于两地。故十四日。
问曰。病有洒淅恶寒而复发热者何。答曰。阴脉不足。阳往从之。阳脉不足。阴往
乘
之。曰何谓阳不足。答曰。假令寸口脉微。名曰阳不足。阴气上入阳中。则洒淅恶寒
也。曰何谓阴不足。答曰。假令尺脉弱。名曰阴不足。阳气下陷入阴中。则发热也。
一阴一阳谓之道。偏阴偏阳谓之疾。阴偏不足。则阳得而从之。阳偏不足。则阴
得而乘之。阳不足。则阴气上入阳中。为恶寒者。阴胜则寒矣。阴不足。则阳气下陷
入阴中。为发热者。阳胜则热矣。
张兼善云。此章论所以然之理。非病已发于外而言也。凡病伤寒者。皆因荣卫不
足。是以尺寸之脉皆微弱。外邪因得相袭。使阴阳相乘。故洒淅恶寒而复发热也。
阳脉浮。阴脉弱者。则血虚。血虚。则筋急也。
阳为气。阴为血。阳脉浮者。卫气强也。阴脉弱者。荣血弱也。难经曰。气主 之。
血主濡之。血虚则不能濡润经络。故筋急也。
张卿子云。论中卫强荣弱。强字往往失解。
其脉沉者。荣气微也。
内经云。脉者。血之府也。脉实则血实。脉虚则血虚。此其常也。脉沉者。知荣
血内
微也。
其脉浮而汗出如流珠者。卫气衰也。
针经云。卫气者。所以温分肉。充皮毛。肥腠理。司开阖者也。脉浮。汗出如流
珠者。腠理不密。开阖不司。为卫气外衰也。浮主候卫。沉主候荣。以浮沉别荣卫之衰
微。理固然矣。然而衰甚于微。所以于荣言微。而卫言衰者。以其汗出如流珠。为阳
气外脱。所以卫病甚于荣也。
荣气微者。加烧针。则血流不行。更发热而躁烦也。
卫、阳也。荣、阴也。烧针益阳而损阴。荣气微者。谓阴虚也。内经曰。阴虚而内
热。方其内热。又加烧针以补阳。不惟两热相合。而荣血不行。必更外发热。而内躁烦
也。
唐不岩云。流、或作留。非。方其始也。虽微而不得不流者。烧针以迫之也。及其
既也。已衰而不得复行者。烧针以竭之也。
脉蔼蔼如车盖者。名曰阳结也。
蔼蔼如车盖者。大而厌厌聂聂也。为阳气郁结于外。不与阴气和杂也。
王宇泰云。按车盖言浮大。即前浮数之阳结也。
脉累累如循长竿者。名曰阴结也。
累累如循长竿者。连连而强直也。为阴气郁结于内。不与阳气和杂也。
王宇泰云。按长竿者。紧弦也。即前沉迟之阴结也。
脉瞥瞥如羹上肥者。阳气微也。
轻浮而阳微也。
脉萦萦如蜘蛛丝者。阳气衰也。
萦萦、滞也。若萦萦惹惹之不利也。如蜘蛛丝者。至细也。微为阳微。细为阳衰。脉
要曰。微为气微是未至于衰。内经曰。细则气少。以至细为阳衰宜矣。
脉绵绵如泻漆之绝者。亡其血也。
绵绵者。连绵而软也。如泻漆之绝者。前大而后细也。正理论曰。天枢开发。精移
气变。阴阳交会。胃和脉生。脉复生也。阳气前至。阴气后至。则脉前为阳气。后为
阴气。脉来前大后细。为阳气有余而阴气不足。是知亡血。
脉来缓。时一止复来者。名曰结。脉来数。时一止复来者。名曰促。脉阳盛则促。
阴盛
则结。此皆病脉。
脉一息四至曰平。一息三至曰迟。小快于迟曰缓。一息六至曰数。时有一止者。
阴阳之气。不得相续也。阳行也速。阴行也缓。缓以候阴。若阴气胜而阳不能相续。
则脉来缓而时一止。数以候阳。若阳气胜而阴不能相续。则脉来数而时一止。伤寒有
结代之脉。动而中止。不能自还。为死脉。此结促之脉。止是阴阳偏胜而时有一止。即
非脱绝而止。云此皆病脉。
王宇泰云。结、促、代、皆动而中止。但自还为结促。不能自还为代。无常数为
结促。
有常数为代。结促为病脉。代为死脉。不可不辨。
阴阳相搏名曰动。阳动则汗出。阴动则发热。形冷恶寒者。此三焦伤也。
动为阴阳相搏。方其阴阳相搏。而虚者则动。阳动为阳虚故汗出。阴动为阴虚。故
发热也如不汗出发热。而反形冷恶寒者。三焦伤也。三焦者。原气之别使。主行气于阳。
三焦既伤。则阳气不通而微。致身冷而恶寒也。金匮要略曰。阳气不通即身冷。经曰
阳微则恶寒。
若数脉见于关上。上下无头尾。如豆大。厥厥动摇者。名曰动也。
脉经云。阳出阴入。以关为界。关为阴阳之中也。若数脉见于关上。上下无头尾。
如豆大。厥厥动摇者。是阴阳之气相搏也。故名曰动。
王宇泰云。阳升阴降。二者交通。上下往来于尺寸之内。方且冲和安静。焉睹所谓
动者哉。惟夫阳欲升而阴逆之。阴欲降而阳逆之。两者相搏。不得上下。击鼓之势。陇
然高起。而动脉之形着矣。
阳脉浮大而濡。阴脉浮大而濡。阴脉与阳脉同等者。名曰缓也。
阳脉。寸口也。阴脉。尺中也。上下同等。无有偏胜者。是阴阳之气和缓也。非若
迟缓之有邪也。阴阳偏胜者为结为促。阴阳相搏者为动。阴阳气和者为缓。学人不可不
知也。
脉浮而紧者。名曰弦也。弦者。状如弓弦。按之不移也。脉紧者。如转索无常也。
脉经云。弦与紧相类。以弦为虚。故虽紧如弦。而按之不移。不移。则不足也。经曰。
弦则为减。以紧为实。是切之如转索无常而不散。金匮要略曰。脉紧如转索无常者。有
宿食也。
许叔微云。少阳之气通于春。春脉弦者。以应春阳时令之脉也。如浮大而弦。洪
长而弦。浮滑而弦。浮数而弦者。皆为阳也。若夫沉微而弦。沉涩而弦。沉细而弦。
皆为阴症之脉也。仲景以弦脉分阴阳二用之理。其义微矣。
脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。寒虚相搏。此名为革。
妇人则半产漏下。男子则亡血失精。
弦则为减。减则为寒。寒者。谓阳气少也。大则为芤。芤则为虚。虚者。谓血少
不足也。所谓革者。言其既寒且虚。则气血改革。不循常度。男子得之。为真阳减而不
能内固。故主亡血失精。妇人得之。为阴血虚而不能滋养。故主半产漏下。
问曰。病有战而汗出。因得解者。何也。答曰。脉浮而紧。按之反芤。此为本虚。
故当战而汗出也。其人本虚。是以发战。以脉浮。故当汗出而解也。
浮为阳。紧为阴。芤为虚。阴阳争则战。邪气将出。邪与正争。其人本虚。是以发
战。正气胜则战。战已。复发热而大汗解也。
若脉浮而数。按之不芤。此人本不虚。若欲自解。但汗出耳。不发战也。
浮、数、阳也。本实阳胜。邪不能与正争。故不发战也。
问曰。病有不战而汗出解者。何也。答曰。脉大而浮数。故知不战汗出而解也。
阳胜则热。阴胜则寒。阴阳争则战。脉大而浮数。皆阳也。阳气全胜。阴无所争。何
战之有。
问曰。病有不战不汗出而解者。何也。答曰。其脉自微。此以曾经发汗。若吐若下。若
亡血。以内无津液。此阴阳自和。必自愈。故不战不汗出而解也。
脉微者。邪气微也。邪气已微。正气又弱。脉所以微。既经发汗、吐下、亡阳、亡
血。内无津液。则不能作汗。得阴阳气和而自愈也。
王宇泰云。此三脉。皆于病将解之时而候之也。
问曰。伤寒三日。脉浮数而微。病患身凉和者。何也。答曰。此为欲解也。解以夜
半。脉浮而解者。 然汗出也。脉数而解者。必能食也。脉微而解者。必大汗出也。
伤寒三日。阳去入阴之时。病患身热。脉浮数而大。邪气传也。若身凉和。脉浮数
而微者。则邪气不传而欲解也。解以夜半者。阳生于子也。脉浮。主 然汗出而解者。
邪从外散也。脉数。主能食而解者。胃气和也。脉微。主大汗出而解者。邪气微也。
王宇泰云。上言脉微。故不汗出而解。此言脉微而解。必大汗出。上以曾经吐下
亡血。邪正俱衰。不能作汗而解。此以未经汗下。血气未伤。正盛邪衰。故大汗出而解。
问曰。脉病欲知愈未愈者。何以别之。答曰。寸口关上尺中三处。大小浮沉迟数同
等。虽有寒热不解者。此脉阴阳为和平。虽剧当愈。
三部脉均等。即正气已和。虽有余邪。何害之有。王三阳云。三处浮沉迟数同等者。
非如成云均等也。各照本部应得脉看。如肺脉当浮。肾脉当沉之谓也。
立夏得洪大脉。
是其本位。其人病。身体苦疼重者。须发其汗。若明日身不疼不重者。不须发汗。若汗
自出者。明日便解矣。何以言之。立夏得洪大脉。是其时脉。故使然也。四时仿此。
脉来应时。为正气内固。虽外感邪气。但微自汗出而亦解尔。内经曰。脉得四时之
顺者。病无他。
问曰。凡病欲知何时得。何时愈。答曰。假令夜半得病。明日日中愈。日中得病。
夜半愈。何以言之。日中得病。夜半愈者。以阳得阴则解也。夜半得病。明日日中愈者。
以阴得阳则解也。
日中得病者。阳受之。夜半得病者。阴受之。阳不和。得阴则和。是解以夜半。阴
不和。得阳则和。是解以日中。经曰。用阳和阴。用阴和阳。
寸口脉浮为在表。沉为在里。数为在腑。迟为在脏。假令脉迟。此为在脏也。
经曰。诸阳浮数为乘腑。诸阴迟涩为乘脏。
趺阳脉浮而涩。少阴脉如经也。其病在脾。法当下利。何以知之。若脉浮大者。气
实血虚也。今趺阳脉浮而涩。故知脾气不足。胃气虚也。以少阴脉弦而浮。才见此为调脉。
故称如经也。若反滑而数者。故知当屎脓也。
趺阳者。胃之脉。诊得浮而涩者。脾胃不足也。浮者以为气实。涩者以为血虚者。
1. Zhang Zhongjing's writings are exquisitely profound, unparalleled. If one is not adept at reading them, one may easily become stuck on the literal words. Various commentaries have their own innovations, but Cheng Wuji from Liaocheng, by citing classics to analyze meanings, is particularly praised for being detailed and accurate. Although there are occasional instances of contradiction or forced interpretation, no other school can surpass him. Beginners cannot abandon this text to find a path. Therefore, I have retained the old editions entirely, daring not to make any deletions or additions.
2. Among various schools, none excels in elucidating Zhang Zhongjing's principles more than Nanyang (referring to Zhang Zhongjing). Besides him, such figures as Shuwei, Qianshan, Jiegu, Anchang, Dongyuan, Danxi, and Andao, and in recent times, scholars like Sanyang and Yutai, though their concise phrases do not strictly adhere to Changsha's (Zhang Zhongjing) footsteps, actually deeply grasp his essence. I hasten to collect them to supplement the unelucidated aspects of the Six Channels.
3. In Zhang Zhongjing's preface, the original work consisted of sixteen volumes. Later, Wang Shuhe reorganized it into thirty-six volumes. Current printed editions only contain ten volumes, with volumes seven and eight merged, leaving only residual prescriptions. The sequence and detail differ significantly from the originals of Zhang Zhongjing and Wang Shuhe. Now, based on "Differentiating Normal Pulse Methods" as Volume One, covering general principles of Cold Damage and the sequence of the Six Channels, without arbitrary rearrangement, but arranging them logically and appropriately, I have condensed it into approximately six volumes. Residual prescriptions are incorporated into the discussions for easier reference. This generally follows the principles of Mr. Wang Sanyang.
Question: What does it mean that pulses have Yin and Yang?
Answer: Pulses that are large, floating, rapid, moving, and slippery are named Yang pulses. Pulses that are deep, choppy, weak, string-taut, and minute are named Yin pulses. Generally, if a Yin disease presents with a Yang pulse, survival is indicated; if a Yang disease presents with a Yin pulse, death is indicated.
The *Neijing* states: The subtlety lies in the pulse, which must not be overlooked. Examination has its guidelines, starting with Yin and Yang. Guidelines have their classics, originating from the Five Elements. Here, we first discuss the Yin and Yang of pulses because pulses begin with Yin and Yang. There are five Yang pulses and five Yin pulses, reflecting the generation from the Five Elements. The Way of Yang is usually abundant; the five pulses—large, floating, rapid, moving, slippery—are surplus compared to the normal pulse, hence called Yang. The Way of Yin is usually deficient; the five pulses—deep, choppy, weak, string-taut, minute—are insufficient compared to the normal pulse, hence called Yin. In Cold Damage disease, when pathogens are in the exterior, Yang pulses appear; when pathogens are in the interior, Yin pulses appear. When a Yin disease presents with a Yang pulse indicating survival, it means pathogens are moving from interior to exterior, seeking resolution through sweating. For example, in Jueyin wind strike, a slightly floating pulse indicates impending recovery, while a non-floating pulse indicates no recovery. Conversely, when a Yang disease presents with a Yin pulse indicating death, it means pathogens move from exterior to interior, with righteous Qi deficient and pathogens victorious. For instance, delirious speech and a deep, fine pulse indicate death. The *Jingui Yaolue* states: Diseases where pathogens remain in the exterior are treatable; those entering the interior are fatal. This refers to this principle.
Wang Sanyang says: When a Yin disease presents with a Yang pulse, although pathogens are vigorous, the primal Qi has not collapsed. When a Yang disease presents with a Yin pulse, pathogens are vigorous, and primal Qi has collapsed. These refer to conditions that are Yin or Yang syndromes from the onset, not necessarily shifting from interior to exterior or vice versa later. Why? Once pathogens transmit to the interior, it is difficult to return them to the exterior for sweating. Moreover, pathogens moving from exterior to interior is the normal progression of Yang syndrome transmitting to Yin. How can one immediately declare death? Only if a Yang syndrome presents with a deep pulse, revealing a Yin pulse, and if the deep pulse is neither rapid but instead weak and minute, is it a death pulse. Thus, isn't this a collapse of primal Qi? Therefore, I have doubts about Cheng Wuji's citation of the two cases of Jueyin wind strike and delirious speech regarding "moving from interior to exterior" and "from exterior to interior."
Question: How to distinguish between Yang Jie (binding/knotting) and Yin Jie?
Answer: If the pulse is floating and rapid, the patient can eat but has no bowel movement, this is excess, named Yang Jie. It is expected to worsen on the seventeenth day. If the pulse is deep and slow, the patient cannot eat, feels heavy, and has hard stool, this is named Yin Jie. It is expected to worsen on the fourteenth day.
Jie refers to qi binding firmly, where Yin and Yang qi do not mix. Yin contains Yang, Yang contains Yin; harmony arises from their mixture, while binding arises from lack thereof. Floating and rapid are Yang pulses; ability to eat but no bowel movement indicates interior excess. Due to Yang qi binding firmly, Yin qi cannot mix, hence Yang Jie. Deep and slow are Yin pulses; inability to eat and heaviness indicate Yin disease. A Yin disease presenting with a Yin pulse should typically result in diarrhea; however, hard stool here indicates Yin qi binding firmly, preventing Yang qi from mixing, hence Yin Jie. Regarding the days: In Cold Damage, Day 1 is Taiyang, Day 2 Yangming, Day 3 Shaoyang, Day 4 Taiyin, Day 5 Shaoyin, Day 6 Jueyin. Transmission completes on Day 6. Recovery is expected on Day 7. If not recovered by Day 7, it is called "re-transmission," restarting from Taiyang to Jueyin by Day 12. Recovery is expected on Day 13. If not recovered by Day 13, it is called "passing the meridian," continuing transmission past Taiyang. Yang Jie belongs to Fire; by Day 17, it transmits to Shaoyin Water, which controls Fire, leading to resolution. Yin Jie belongs to Water; by Day 14, it transmits to Yangming Earth, which controls Water, leading to resolution. If pathogens bind severely, Water cannot control Fire, nor Earth control Water, so the condition worsens. The *Neijing* states: After one pentad, illness occurs; after two pentads, illness worsens; after three pentads, illness becomes critical.
Wang Wenlu says: In Cold Damage transmission, Yang takes three days, Yin takes three days. Binding implies extreme imbalance. Yang extreme corresponds to "Can Tian" (high heaven), hence seventeen days; Yin extreme corresponds to "Di Li" (earthly places), hence fourteen days.
Question: Why does a patient experience chills followed by fever?
Answer: When Yin pulse is deficient, Yang qi moves to join it; when Yang pulse is deficient, Yin qi moves to invade it. What is Yang deficiency? If the Cun (inch) pulse is minute, it is called Yang deficiency. Yin qi ascending into the Yang region causes chills. What is Yin deficiency? If the Chi (cubit) pulse is weak, it is called Yin deficiency. Yang qi sinking into the Yin region causes fever.
One Yin and one Yang constitute the Dao; partial Yin or partial Yang constitutes disease. If Yin is partially deficient, Yang can join it; if Yang is partially deficient, Yin can invade it. Yang deficiency leads to Yin qi entering the Yang region, causing chills (Yin excess brings cold). Yin deficiency leads to Yang qi sinking into the Yin region, causing fever (Yang excess brings heat).
Zhang Jianshan says: This chapter discusses the underlying mechanism, not just external symptoms. All Cold Damage cases stem from deficiency of Ying and Wei, resulting in weak Cun and Chi pulses. External pathogens exploit this, causing Yin and Yang to invade each other, leading to chills and fever.
If Yang pulse is floating and Yin pulse is weak, blood is deficient. Blood deficiency leads to tendon tension.
Yang represents Qi, Yin represents Blood. A floating Yang pulse indicates strong Wei Qi. A weak Yin pulse indicates weak Ying Blood. The *Nanjing* states: Qi warms, Blood moistens. Blood deficiency fails to moisten meridians, causing tendon tension.
Zhang Qingzi notes: In discussions of strong Wei and weak Ying, the character "strong" is often misunderstood.
A deep pulse indicates weak Ying Qi.
The *Neijing* states: The pulse is the residence of Blood. Full pulse means full Blood; empty pulse means deficient Blood. This is the norm. A deep pulse indicates internal deficiency of Ying Blood.
A floating pulse with sweat beads flowing like pearls indicates declining Wei Qi.
The *Zhenjing* states: Wei Qi warms muscles, fills skin, thickens pores, and controls opening/closing. A floating pulse with profuse sweating indicates loose pores and failed control, signifying external decline of Wei Qi. Floating monitors Wei, Deep monitors Ying; using floating/deep to distinguish Ying/Wei decline is logical. However, decline is more severe than weakness. Hence, Ying is described as "weak" and Wei as "declining," because profuse sweating indicates external collapse of Yang Qi, making Wei pathology more severe than Ying.
In cases of weak Ying Qi, applying moxibustion (burning needle) impedes blood flow, causing further fever and restlessness.
Wei is Yang, Ying is Yin. Moxibustion boosts Yang but damages Yin. Weak Ying Qi implies Yin deficiency. The *Neijing* states: Yin deficiency generates internal heat. Adding moxibustion to boost Yang during internal heat combines heat sources, impeding Ying Blood, causing external fever and internal restlessness.
Tang Buyan clarifies: "Flowing" should not be read as "staying." Initially, despite weakness, flow is compelled by moxibustion. Later, having declined, flow ceases due to exhaustion by moxibustion.
A pulse resembling a chariot canopy is named Yang Jie.
Resembling a chariot canopy, it is large yet gentle, indicating Yang qi bound externally, failing to harmonize with Yin.
Wang Yutai notes: Describing a chariot canopy implies floating and large, corresponding to the previously mentioned floating/rapid Yang Jie.
A pulse resembling touching a long bamboo pole is named Yin Jie.
Resembling a long bamboo pole, it is continuous and rigid, indicating Yin qi bound internally, failing to harmonize with Yang.
Wang Yutai notes: Long bamboo implies tight and string-taut, corresponding to the previously mentioned deep/slow Yin Jie.
A pulse resembling fat floating on soup indicates weak Yang Qi.
Lightly floating and Yang-deficient.
A pulse resembling a spider's silk indicates declining Yang Qi.
"Yingying" implies sluggishness. Like a spider's silk, it is extremely thin. Minute indicates weak Yang; thin indicates declining Yang. The *Mai Yao* states: Minute indicates weak Qi, not yet declined. The *Neijing* states: Thin indicates little Qi. Thus, extreme thinness signifies declining Yang.
A pulse continuous like the end of pouring lacquer indicates loss of Blood.
Continuous and soft. Like the end of pouring lacquer, it is large initially then thin. The *Zheng Li Lun* states: Heavenly pivot opens, essence shifts, Qi changes, Yin-Yang meets, Stomach harmonizes, Pulse generates. Pulse regeneration involves Yang Qi arriving first, Yin Qi later. Pulse large initially then thin indicates Yang excess and Yin deficiency, confirming blood loss.
A slow pulse with intermittent stops is named Jie (knotted). A rapid pulse with intermittent stops is named Cu (hasty). Yang excess causes Cu; Yin excess causes Jie. These are pathological pulses.
Four breaths per cycle is normal. Three breaths is slow. Slightly faster than slow is緩 (slow/gentle). Six breaths is rapid. Intermittent stops indicate failure of Yin and Yang Qi to succeed each other. Yang moves fast, Yin moves slow. Monitoring Yin via slowness: if Yin excess prevents Yang succession, the pulse is slow with stops. Monitoring Yang via speed: if Yang excess prevents Yin succession, the pulse is rapid with stops. Cold Damage features Jie and Dai pulses, stopping and failing to return, indicating death. Jie and Cu pulses stop due to Yin/Yang imbalance but return, unlike Dai which fails to return. Hence, they are pathological, not terminal.
Wang Yutai clarifies: Jie, Cu, and Dai all stop intermittently. Returning is Jie/Cu; not returning is Dai. Irregular intervals are Jie/Cu; regular intervals are Dai. Jie/Cu are pathological; Dai is terminal. Distinction is crucial.
Interaction of Yin and Yang is named Dong (moving). Yang Dong causes sweating; Yin Dong causes fever. Cold body and aversion to cold indicate Sanjiao injury.
Dong results from Yin-Yang interaction. Deficiency causes movement. Yang Dong (Yang deficiency) causes sweating. Yin Dong (Yin deficiency) causes fever. If no sweating/fever but cold body/aversion, it is Sanjiao injury. Sanjiao is the envoy of Yuan Qi, governing Qi movement in Yang. Injury blocks Yang Qi, causing cold and aversion. The *Jingui Yaolue* states: Blocked Yang Qi causes cold. Scripture states: Minute Yang causes aversion.
If a rapid pulse appears at Guan (barrier), without head or tail, bean-sized, trembling, it is named Dong.
The *Mai Jing* states: Yang exits, Yin enters, bounded by Guan. Guan is the center of Yin/Yang. Rapid pulse at Guan, bean-sized, trembling, indicates Yin-Yang interaction, hence Dong.
Wang Yutai explains: Yang rises, Yin descends, communicating within Cun and Chi. In harmony, no movement is seen. When Yang seeks to rise but Yin opposes, and Yin seeks to descend but Yang opposes, they clash, unable to move up/down, creating a drum-beat effect, manifesting as Dong.
If Yang pulse is floating, large, and soft, and Yin pulse is floating, large, and soft, equal in magnitude, it is named Huan (relaxed/slow).
Yang pulse is Cun; Yin pulse is Chi. Equal magnitude without excess indicates harmonious Yin-Yang Qi, unlike Chi/Huan which involve pathogens. Excess Yin/Yang causes Jie/Cu; interaction causes Dong; harmony causes Huan. Scholars must know this.
Floating and tight pulse is named Xian (string-taut). Xian resembles a bowstring, firm upon pressure. Tight pulse resembles twisting cords.
The *Mai Jing* states: Xian and Jin are similar. Xian is deficiency; though tight like a string, it remains firm, indicating insufficiency. Scripture: Xian implies reduction. Jin is excess; feels like twisting cords without scattering. *Jingui Yaolue*: Tight pulse like twisting cords indicates food retention.
Xu Shimicro says: Shaoyang Qi connects to Spring. Spring pulse is Xian, responding to Spring Yang season. Floating-large-Xian, surging-long-Xian, floating-slippery-Xian, floating-rapid-Xian are all Yang. Deep-micro-Xian, deep-choppy-Xian, deep-thin-Xian are all Yin syndrome pulses. Zhang Zhongjing's differentiation of Xian into Yin/Yang uses is subtle.
Xian and large pulse: Xian implies reduction (cold); Large implies Kou (hollow) (deficiency). Reduction implies cold; Kou implies deficiency. Cold and deficiency combine, named Ge (leather) pulse. In women, it indicates miscarriage or bleeding; in men, blood loss or essence depletion.
Xian implies reduction (cold), meaning low Yang Qi. Large implies Kou (hollow), meaning low Blood Qi. Ge pulse indicates both cold and deficiency, altering Qi/Blood norms. Men get it due to true Yang deficiency failing to secure interior, causing blood/essence loss. Women get it due to Yin Blood deficiency failing to nourish, causing miscarriage/bleeding.
Question: Why does a patient shiver then sweat to resolve?
Answer: Floating-tight pulse, hollow upon pressure, indicates root deficiency. Hence, shivering and sweating occur. Root deficiency causes shivering. Floating pulse indicates resolution via sweating.
Floating is Yang, Tight is Yin, Kou is deficiency. Yin-Yang struggle causes shivering. Pathogens exiting struggle with Righteous Qi. Root deficiency causes shivering. Victory of Righteous Qi leads to shivering, then fever, then profuse sweating for resolution.
If floating-rapid pulse, not hollow upon pressure, root is not deficient. Resolution comes via simple sweating, no shivering.
Floating/Rapid are Yang. Root excess, Yang victory, pathogens cannot struggle with Righteous Qi, hence no shivering.
Question: Why does a patient resolve via sweating without shivering?
Answer: Large-floating-rapid pulse indicates resolution without shivering.
Yang excess brings heat; Yin excess brings cold. Yin-Yang struggle causes shivering. Large-floating-rapid are all Yang. Complete Yang victory leaves no room for Yin struggle, hence no shivering.
Question: Why does a patient resolve without shivering or sweating?
Answer: Micro pulse indicates prior sweating, vomiting, purging, or blood loss, leading to internal fluid depletion. Yin-Yang self-harmonization ensures spontaneous recovery. Hence, no shivering or sweating.
Micro pulse indicates weak pathogens. Pathogens weak, Righteous Qi also weak, hence micro pulse. After sweating/vomiting/purging/blood loss, internal fluids are depleted, preventing sweating. Harmony of Yin-Yang Qi leads to recovery.
Wang Yutai notes: These three pulses are observed when illness is about to resolve.
Question: On Day 3 of Cold Damage, pulse is floating-rapid-micro, body is cool and harmonious. Why?
Answer: This indicates impending resolution, occurring at midnight. Floating pulse resolves with slight sweating. Rapid pulse resolves with appetite return. Micro pulse resolves with profuse sweating.
Day 3 is transition from Yang to Yin. Fever with floating-rapid-large pulse indicates transmission. Cool body with floating-rapid-micro pulse indicates no transmission, impending resolution. Midnight resolution aligns with Yang birth at Zi hour. Floating pulse indicates external dispersion via sweating. Rapid pulse indicates Stomach Qi harmony via appetite. Micro pulse indicates pathogen weakness via profuse sweating.
Wang Yutai clarifies: Previously, micro pulse meant no sweating resolution due to prior treatments depleting Qi/Blood. Here, micro pulse with resolution implies profuse sweating because no prior treatments harmed Qi/Blood; Righteous Qi is strong, pathogens weak.
Question: How to distinguish recovery from non-recovery in pulse disease?
Answer: If Cun, Guan, and Chi pulses are equal in size, floating/deep, slow/rapid, even if fever/chill persists, Yin-Yang are peaceful. Severe illness will recover.
Equal三部 (Three Positions) indicate harmonized Righteous Qi. Residual pathogens pose no threat. Wang Sanyang clarifies: Equality does not mean identical pulses everywhere. Each position should reflect its organ's normal pulse (e.g., Lung floating, Kidney deep).
Obtaining a洪大 (Surging-Large) pulse at Start of Summer is its proper seasonal pulse. If patient suffers body pain/heaviness, induce sweating. If pain/heaviness cease next day, no sweating needed. If spontaneous sweating occurs, recovery follows next day. Why? Surging-Large at Start of Summer is the seasonal pulse, facilitating this. Seasons follow this pattern.
Pulse matching seasons indicates internal Righteous Qi stability. Even with external pathogens, mild sweating suffices for resolution. *Neijing*: Pulse following Four Seasons' order means no other complications.
Question: How to determine onset and recovery time?
Answer: Illness starting at midnight recovers at noon. Illness starting at noon recovers at midnight. Why? Noon onset (Yang) recovers at midnight (Yin) as Yang gains Yin harmony. Midnight onset (Yin) recovers at noon (Yang) as Yin gains Yang harmony.
Noon onset affects Yang; Midnight onset affects Yin. Yang disharmony resolves with Yin (midnight recovery). Yin disharmony resolves with Yang (noon recovery). Scripture: Use Yang to harmonize Yin, use Yin to harmonize Yang.
Cun pulse floating indicates Exterior; Deep indicates Interior; Rapid indicates Fu organs; Slow indicates Zang organs. Slow pulse indicates Zang involvement.
Scripture: All Yang floating-rapid indicates Fu invasion; All Yin slow-choppy indicates Zang invasion.
Fu Yang pulse floating-choppy, Shao Yin pulse normal. Disease in Spleen, likely diarrhea. Why? Floating-large indicates Qi excess/Blood deficiency. Current Fu Yang floating-choppy indicates Spleen Qi deficiency and Stomach Qi weakness. Shao Yin pulse string-taut-floating is considered normal/tuned. If slippery-rapid instead, pus in stool is expected.
Fu Yang is Stomach pulse. Floating-choppy indicates Spleen/Stomach deficiency. Floating interpreted as Qi excess, Choppy as Blood deficiency.