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Chapter 73: Pulse and Symptom Patterns of Zhong'e (Sudden Attack by Malignant Qi)

If the pulse is tight and fine, the prognosis is good; if the pulse is floating and large, it indicates that the pathogenic qi has penetrated deeply. This passage elucidates the meaning of the pulse patterns associated with Zhong'e. "E" refers to malevolent influences that stealthily invade, causing sudden collapse or fainting. Symptoms may include cold extremities or delirious speech, varying in manifestation. These conditions often arise from wading through water, climbing mountains, or entering tombs and temples, leading to sudden attacks by external pathogens such as Ke Wu (Guest Hostility), Cu Jue (Sudden Syncope), Gui Ji (Ghost Strike), or Fei Shi (Flying Corpse). When struck by external pathogens, the healthy qi cannot reach the exterior, causing the mechanism of qi to become constrained and stagnant, inevitably resulting in abdominal distension. If medicinal force assists the healthy qi, the qi will surely expand and strengthen; the tight pulse will relax, and the fine pulse will fill out, indicating a favorable outcome. However, if the pulse is floating and large, it signifies the dispersion of healthy qi and deep penetration of pathogens, making treatment extremely difficult.

Chapter 74: Pulse and Symptom Patterns of Carbuncles and Ulcers

In the early stages of carbuncles and ulcers, a floating and rapid pulse accompanied by aversion to cold and fever, along with localized pain, indicates the onset of these conditions. A rapid pulse, fever, and pain indicate a Yang pattern (whereas non-rapid, non-feverish, and non-painful conditions suggest Yin patterns); for unruptured Yin sores, a洪大 (large and surging) pulse is not necessarily alarming. For ruptured carbuncles and ulcers, a洪大 pulse is dangerous. "Yong" (Carbuncle) implies obstruction, while "Ju" (Ulcer) implies blockage. These are caused by the stagnation and blockage of Ying and Wei qi and blood, leading to郁热 (stagnant heat) and pus formation. Carbuncles are typically broad but superficial, whereas ulcers are smaller but deeper. Superficial lesions follow the Fu organs and Yang nature, making them easier to resolve and rupture; deep lesions follow the Zang organs and Yin nature, making them harder to resolve and rupture. Those that rupture easily allow toxins to discharge externally; those that do not rupture easily cause toxins to sink inward. This distinction determines the severity and prognosis.

A floating and rapid pulse occurs because blood flow becomes sluggish while qi follows suit; the struggle between pathogenic and healthy qi generates heat, resulting in a rapid pulse. Since the pathology is at the surface and in the Yang level, the pulse floats. The struggle between healthy and pathogenic qi causes aversion to cold and fever. Localized pain combined with a rapid pulse indicates heat accumulation and pus formation at the site of the carbuncle or ulcer. If the pulse is floating, rapid, and accompanied by fever, it suggests accumulated pus, classified as Yang Toxin. Conversely, if the pulse is not rapid, there is no fever, and no pain, it indicates pathogenic invasion of the Yin level, often leading to internal sinking of toxins. However, this must be accompanied by symptoms such as restlessness, nausea, and vomiting; otherwise, without fever, pain, or a rapid pulse, the heat cannot vent, characterizing a Yin sore, which may be more severe than Yang conditions.

Before rupture, when heat toxins are stagnant and not vented externally, a surging and洪大 pulse is expected. After rupture, as heat dissipates and pathogens resolve, the洪大 pulse should diminish. If the pulse remains洪大 after rupture, it indicates persistent pathogenic heat, which is highly alarming.

Chapter 75: Pulse and Symptom Patterns of Lung Abscess and Lung Withering

For established Lung Abscess, the Cun (inch) position pulse is rapid and excess; for Lung Withering, the pulse is rapid but deficient. In Lung Abscess, the complexion is white, the pulse should be short and choppy rather than floating and large, and the patient expectorates pus-like sputum resembling rice paste and vomits blood. This section distinguishes the pulse and symptom patterns of Lung Abscess from Lung Withering.

Lung Abscess is characterized by wheezing, upward reversal of qi, chest fullness, dull pain, coughing up pus and blood, and a rapid, excess pulse at the Cun position. Lung Withering is characterized by frequent spitting of saliva, urinary incontinence or frequency, or cough without thirst, and a rapid, deficient pulse at the Cun position. Generally, both Lung Abscess and Lung Withering result from stagnant heat in the Upper Jiao.

The statement "established Lung Abscess presents with a rapid and excess Cun pulse" corresponds to the *Jin Gui Yao Lue* saying "a rapid and excess pulse indicates Lung Abscess." The statement "Lung Withering presents with a rapid but deficient pulse" corresponds to the *Jin Gui Yao Lue* saying "a rapid and deficient pulse indicates Lung Withering." Examination focuses on the Cun position because the Lung resides at the highest point of the body. In Lung Abscess, a white complexion and a short, choppy pulse are appropriate, as white is the color of the Lung and short/choppy is its typical pulse; thus, the color, pulse, and symptoms align. However, a floating and large pulse indicates flaming fire rising upward. Expectoration of rice-paste-like material and vomiting of pus and blood indicate Fire insulting Metal, damaging the Lung organ, which is highly unfavorable.