Library

The *Classic of Internal Medicine* states: The method of pulse diagnosis involves observing a person's courage or timidity, as well as the condition of their muscles and skin, to understand the pathology and establish diagnostic methods. Generally speaking, in terms of body shape, the tall are not inferior to the short, the large are not inferior to the small, and the fat are not inferior to the thin. In terms of complexion, white is not inferior to black, tender is not inferior to dark/rustic, and thin is not inferior to dense. Moreover, fat people tend to have more dampness, while thin people tend to have more fire; those with white complexions have deficient Lung Qi, while those with black complexions have sufficient Kidney Qi. Since physical appearances differ, the internal organs also vary. Although external symptoms may be identical, treatment methods are radically different. Therefore, for fat people, a floating pulse is preferred; for thin people, a deep pulse is preferred. A restless person with a slow pulse raises suspicion, just as a sluggish person with a rapid pulse does, because conditions cannot be generalized. I will briefly present two cases to illustrate how one can infer others from these examples.

Mr. Chen from Dongyang had visible subcutaneous veins (exposed sinews) and was slightly tall. He suffered from deficiency and exhaustion, accompanied by headache, to the extent that he spoke words of farewell. Upon examining his pulse, I found it wiry, large, and rapid. I used *Ren Shen* (Ginseng Radix) and *Bai Zhu* (Atractylodis Macrocephalae Rhizoma) as the sovereign drugs, and *Chuan Xiong* (Ligusticum Chuanxiong Rhizome) and *Chen Pi* (Citri Reticulatae Pericarpium) as ministering drugs. After five or six days, there was no improvement, and everyone was surprised, believing the prescription did not match the syndrome. I said, "The medicinal action requires time; wait another night or two, and you will recover." Suddenly, his younger brother came to ask, "Why didn't you add some Huang Qi?" I smiled and did not answer. After another night, Mr. Chen suddenly declared that his illness had abruptly resolved. Upon re-examining his pulse, I felt it was slightly stronger under my fingers. Half a day later, the patient complained of fullness above the diaphragm and loss of appetite. Observing that his abdominal striae had already faded, I asked, "Did you add Huang Qi to the medicine last night?" He replied, "Yes." Only three doses had been given. Consequently, I quickly prescribed *Er Chen Tang* (Two-Cured Decoction) augmented with *Hou Po* (Magnoliae Officinalis Cortex), *Zhi Ke* (Aurantii Fructus Immaturus), and *Huang Lian* (Coptidis Rhizoma) to drain the Wei level (Defensive Level). After three doses, he recovered.

Another case involved Mr. Zheng from Yimen, Pujiang, who was in his early twenties. In autumn, he suffered from high fever, thirst, delirious speech, and visual hallucinations, appearing as if possessed by evil spirits. Seven or eight days later, he summoned me for treatment. Palpating both wrists, the pulse was surging, rapid, and excess. His body was fat, his face red with a whitish hue, yet he exhibited exposed veins. The pulse was originally not truly excess; this state was caused by the administration of cooling medicines. This illness resulted from fatigue and overwork, which should be treated with warming and tonifying medicines to restore peace. He stated, "I have already taken seven or eight doses of *Chai Hu* (Bupleuri Radix)." I prepared *Huang Qi Fuzi Tang* (Astragalus and Prepared Aconite Decoction) and administered it cold. After three doses, he became drowsy, slept with snoring, and recovered through slight sweating. His pulse became slightly softer. Subsequently, I prescribed *Huang Qi Bai Zhu Tang* (Astragalus and Atractylodes Decoction). By the tenth day, his pulse gradually converged and became smaller. With continued treatment, he recovered after half a month.

Huang Qi (Astragali Radix) is a Qi-tonifying herb. These two patients were different: one had Qi deficiency, the other had Qi excess. Thus, there are indications and contraindications. Can one fail to examine carefully?