Library

The terms "Xu Lao" (Deficiency and Labor) are generally used loosely by the world, without knowing that symptoms differ and treatments may be contradictory. In my early years, upon first hearing the teachings of Mr. Shen Rou, I was told: "Sun Bing" (Damage Disease) transmits from top to bottom, while "Lao Bing" (Labor Disease) transmits from bottom to top; Damage diseases transmitting to the Spleen and Kidney are incurable. Labor diseases transmitting to the Spleen and Lung are also incurable. Using the treatment for Labor disease on Damage disease often leads to diarrhea; using the treatment for Damage disease on Labor disease inevitably causes panting and shortness of breath. If one is ignorant of this clear distinction and confuses them as mere timidity or weakness, how can one avoid going in the opposite direction? Zhu Danxi established the principle of Ministerial Fire, focusing solely on nourishing Yin with Si Wu Tang (Four Substance Decoction), causing Yin and Yang to remain obscure and blocked for a long time. The principle of benefiting Fire and strengthening Water in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), and treating them separately, is not done out of a desire for unnecessary complexity. During the Jiajing and Longqing reigns, Mr. Xue Lizhai emerged, bringing about the first transformation of medicine based on Zhu Danxi's theories; subsequently, Mr. Shenzhai emerged, bringing about a second transformation. It was I, Shen Rou, who collected the methods of former sages and the lineage of transmission, strictly dividing Xu Sun (Deficiency Damage) and Lao Zhai (Labor Consumption) into two separate categories, thereby adding another torch to the brilliance of the medical profession. Recently, a book titled *Yuan Qi Lun* (Treatise on Original Qi) distinguished Yin and Yang based on Pre-heaven and Post-heaven, establishing treatment methods accordingly. I privately believe that although Pre-heaven can have damage, if it is not caused by Post-heaven malnutrition, disease will not arise. Once Post-heaven is damaged, how can Pre-heaven remain undamaged? Treating Pre-heaven is essentially treating Post-heaven. How can one abandon Post-heaven to treat Pre-heaven? The more profound and abstruse the theory, the more it seems the author lacks genuine clinical experience; what benefit is there in speaking of profundity? Simplicity and completeness, clarity and precision—these should be found in this compilation.

The *Mai Jing* (Classic of Pulse Diagnosis) states: A soft pulse indicates Deficiency; a slow pulse indicates Deficiency; a minute pulse indicates Deficiency; a weak pulse indicates Deficiency; a string-like pulse indicates Deficiency; a fine and minute pulse indicates both Qi and Blood Deficiency; a small pulse indicates both Qi and Blood are scant.
Zhang Zhongjing's *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: A knotted pulse indicates Blood Deficiency; a deep and slow pulse indicates Qi loss. It also states: Blood Deficiency presents with a large pulse, hollow like a scallion stalk. It further states: A large and knotted pulse indicates blood loss.
Mr. Shenzhai said: A floating and large pulse appearing at the Right Chi position indicates False Fire; False Fire should be treated according to internal injury principles.
Generally, a rapid pulse in Damage disease indicates insufficient Stomach Qi. If it transforms into a slow and weak pulse, it is a sign of the generation of Stomach Qi. If the Left pulses are minute and fine and do not rise, while the Right Chi pulse is rapid or floating and large, treatment will take two to three years to cure.
A tight and rapid pulse indicates Deficiency in both Exterior and Interior; Tightness indicates Cold injuring Wei Qi (Defensive Qi), and Rapidity indicates Blood insufficiency. A tight Lung pulse indicates insufficient Lung Qi, unable to protect the skin and hair, leading to wind aversion; a rapid pulse indicates Yin Deficiency with moving Fire. A tight pulse still retains Stomach Qi, whereas a rapid pulse indicates no Stomach Qi. (To consider a tight pulse as retaining Stomach Qi is a true insight, but one must also examine whether there is hidden Yang within; if the pulse is tight and isolated, it is ominous.)
Internal injury causing diarrhea, accompanied by a spacious and large Lung pulse, is difficult to treat.
In chronic illness, if the pulse is string-like, recovery occurs only after transforming into Malaria; if the pulse is slow, recovery occurs only after transforming into Dysentery. This is because prolonged illness allows Qi and Blood to become active, thus changing the nature of the disease. If the pulse is rapid and sweating does not occur, recovery happens only after the emergence of sores and toxins.
If the pulses at both Chi positions are absent, it indicates Turbid Yin rising to the upper body, phlegm coagulation and Qi closure, Lung Qi failing to descend, Metal failing to generate Water, resulting in Phlegm Syncope. (This is what I refer to as difficulty in inhalation, Lung Qi closing upwards, similar to Wang Qixuan's description: filling a hollow tube, pinching the top upside down, yet water drops cannot leak from the bottom.) The Classic states: If there is a pulse above but none below, the person should vomit. Vomiting expels turbid phlegm, unblocking the upper body, allowing Lung Qi to descend to the Kidney, and Sha Yin (Lesser Yin) Qi to rise to the crown, restoring the mechanism of generation.
Zhang Zhongjing said: When Yang pulses are choppy and Yin pulses are string-like, there should be urgent pain in the abdomen. The Chi represents Yin, and the Cun represents Yang. String-like Yin pulses indicate Water borrowing Wood's force to insult Earth. Choppy Yang pulses indicate excess Qi, meaning latent Fire in the Qi aspect. Fire stagnating above and Water abundant below cause abdominal urgency and pain.
If the Cun Kou pulse is minute and the Chi pulse is tight, the person suffers from deficiency damage and profuse sweating; this is Yang weakness. Weak Wei Qi is named Bei; weak Ying Qi (Nutritive Qi) is also named Bei.
If the Cun Kou pulse is minute and choppy, minuteness indicates Wei Qi decline, and choppy indicates Ying Qi insufficiency. Wei Qi decline leads to a yellow complexion; Ying Qi decline leads to a greenish complexion. Ying is the root, Wei is the leaf; when leaves and branches wither, there is chills, coughing, and counterflow Qi, spitting foul-smelling saliva and froth.
If the Zu Yang pulse is floating and knotted, floating indicates Wei Qi decline, and knotted indicates Ying Qi injury. The body becomes emaciated, muscles show crisscross patterns (like fish scales). Floating and knotted interacting indicates decline of Zong Qi (Gathering Qi) and severance of the four limbs.
If the Cun Kou pulse is minute and slow, minuteness indicates Wei Qi laxity, leading to empty skin; slowness indicates Stomach fullness, where food digests and water transforms. Food entering Wei Qi allows the pulse channels to flow; water entering the meridians forms Blood. If Ying Qi becomes excessive, the skin becomes loose; if the Three Burners cut off their meridians, it is named Blood Flooding.
If the Zu Yang pulse is minute and tight, tightness indicates Cold, minuteness indicates Deficiency. Minute and tight interacting leads to shortness of breath. (The minute pulses mentioned in the above several items all refer to being short and small in起伏 [rise and fall], not necessarily thin in shape or weak in force. Thus, they primarily reflect Wei Qi.)
If the Shao Yin pulse is weak and choppy, weakness brings slight irritability, and choppyness brings cold extremities.
If the Zu Yang pulse is absent, the Spleen fails to move up and down, leading to cold body and hard skin.
If the Shao Yin pulse is absent, Kidney Qi is faint, Jing and Blood are scant. Rushing Qi presses urgently, entering the chest and diaphragm; Zong Qi gathers inversely, Blood knots under the heart. Yang Qi retreats downward, Heat returns to the inner thighs, interacting with Yin, causing numbness of the body. This is Corpse Syncope, requiring acupuncture at Qimen (LR14) and Juxue (CV14).
If the pulse appears short and rapid, there is no Stomach Qi; fine and rapid, or tight and rapid, are both inauspicious signs.
A洪大 (Vigorous and Large) pulse that sinks upon pressure is a pulse of deficiency damage. (Note: "Xia Xia" likely contains an omitted character.)
Generally, in deficiency damage pulses, Mingmen Fire is vigorous, Kidney Water is insufficient, Heart Fire insults Metal, Wood is dry and Earth is parched, Five Fires blaze together. Using Zhi Mu (Anemarrhena Rhizome) and Huang Bai (Phellodendron Bark) to descend Fire is like pouring a cup of water onto a red-hot dry pot; it merely provokes the fire, causing immediate cracking. If the pulse carries a slowness, Stomach Qi is not exhausted, and regulation is possible. Use Si Jun Zi Tang (Four Gentlemen Decoction) plus Shan Yao (Dioscorea Rhizome) to guide into the Spleen Meridian, singly tonifying Spleen Yin, then treating according to accompanying symptoms. Earth generates Metal, Metal generates Water. In deficiency damage, if the Lung pulse is rapid and large, one must guard against diarrhea.
Jiang Huangnan said: Those who contract this disease through excessive sexual activity have a knotted and rapid pulse, indicating True Yin damage and internal heat generation. A slow and weak pulse indicates severe injury from bitter-cold agents.
Wang Shishan said: Whenever a rapid pulse is seen, it is difficult to treat; a rapid pulse in chronic illness is especially unfavorable. Pulses may be floating, choppy, and rapid, or deep, weak, and slow; the irregularity of the pulse is due to Deficiency. In deficiency damage, if it transforms into tidal fever and diarrhea, and the pulse is short and rapid, it is incurable.