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Zhou Yu Zai said: In summer, heat and dampness steam and mix together, and people are prone to heatstroke. The symptoms resemble those of febrile diseases (Re Bing), so one must first differentiate them by pulse. The pulse in febrile disease is necessarily vigorous (Sheng), whereas the pulse in heatstroke is necessarily deficient (Xu). This is because cold damages the form but not Qi, hence the pulse is vigorous; heat damages Qi but not the form, hence the pulse is deficient. However, why do pulses such as cord-like (Xian), fine (Xi), hollow (Kou), and slow (Chi) appear? During the hot months, people sweat profusely; excessive sweating leads to a deficient pulse, which is the normal state. Liu Shou Zhen said: Heat is the supreme Yang within Yang. When heat damages Qi, spontaneous sweating occurs. Although the disease is due to heat, the pulse cannot be full but is instead weak and deficient. If wind strikes while sweating, closing the sweat pores, wind and dampness from sweat remain stagnant in the muscle interstices (Ji Cou), causing the pulse to become cord-like and fine. Or, if deficiency-wind does not arise but latent heat accumulates, and the exterior deficiency still causes spontaneous sweating, the pulse will necessarily be hollow and slow. Generally speaking, it is called "deficient"; specifically, it is cord-like, fine, hollow, or slow. One should not confuse floating and large pulses with deficient pulses, thereby misidentifying them as the pulse of heat disease.

Zhang Feng Kui said: Liu Fu Zhen (Liu Shou Zhen) stated: The pulse of heat is deficient and faint, powerless upon pressure. Also, the pulse may be hidden/submerged (Yin Fu), or cord-like, fine, hollow, and slow; all these are pulses of heat. A deficient pulse with body heat results from injury by heat (Shang Shu); a pulse that is deficient and faint is indicative of this. Cold diseases transmit through meridians, so the pulse changes daily; warm-heat diseases do not transmit through meridians, so the pulse remains unchanged. In cold diseases, a floating and surging pulse with strength is easy to treat; a hollow and fine pulse without strength is difficult to treat; an absent pulse is untreatable. However, warm-heat diseases are different. In warm disease, there may be no pulse in one or two positions; in heatstroke, there may be no pulse in three or four positions. This is because the pulse is forced into hiding by fire/heat pathogens, not because it is truly absent. This poses no harm to the condition, and attacking the pathogen is relatively easy. Physicians often panic and fail to understand this. If one prescribes acrid-cold herbs according to the classic texts, the fire dissipates, the pulse rises, and the disease cures. What benefit is there in mere terror? The key lies in detailed differentiation. Warm-heat diseases originate in one or two meridians and remain confined to them, not transmitting to others. The pulse in these affected meridians may be surging and rapid, while the pulse in other meridians is weak and submerged. By regulating according to the meridians, the surging pulse becomes balanced, and the submerged pulse rises, indicating recovery.

In the third month of Ding Wei year during the Wanli era, I resided in the capital, holding a minor post in the Ministry of Revenue (Tai Cang Ku). Suddenly, my fellow official from Li Bu, Liu Puting, rode over reporting a critical illness and seeking help. I went to his residence, where colleagues from the Ministry of Personnel were gathered around, having already prepared funeral arrangements. The patient was delirious (Chan Yu), picking at clothes, and had not slept for seven or eight days. Wu Si Quan, a famous physician from the Imperial Medical Academy (Yu Yi Yuan), treated him along with several other doctors. I palpated his pulse and found only the Guan position to be surging and large, while the rest were submerged. I then prescribed Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction). The gentlemen were astonished, saying, "Dr. Wu has already decocted Fu Zi Li Zhong Tang (Aconite Root and Magnolia Bark Decoction). Why is your approach so contrary?" I questioned them. Dr. Wu said, "Yang syndrome presenting with Yin pulse necessitates the use of Aconite." I replied, "The bilateral Guan pulses are surging and large; this is a Yang pulse. The pulses in the other positions are suppressed by fire/heat, not Yin pulses." Dr. Wu argued loudly, but I stood firm with a serious demeanor. The gentlemen followed my advice. After just one dose, the delirium ceased, and he slept for a short while. I checked his pulse again: the previously surging pulse had softened, and the submerged pulses had risen. The gentlemen looked at each other and said, "This is truly Zhang Zhong Jing reborn!" Subsequently, he recovered after being regulated with acrid-cool medicines. When pulse and symptoms correspond, diagnosis is easy; when they contradict, it is difficult. Only when the pulse is clear can one differentiate the syndrome; only when the syndrome is true can one administer medicine. One must observe with an open mind and carefully, not adhering stubbornly to preconceived notions and experimenting with various drugs, risking life in the blink of an eye. Be cautious, be cautious.