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When a warm epidemic disease presents with interior excess syndrome, the patient's spirit and complexion remain intact, speech and movement are normal, and there are no other bizarre symptoms. Suddenly, the six pulses become thread-like, deep, fine, and soft, or even imperceptible; both hands may lack a pulse, or one hand's pulse may vanish first. Observing that the person should not naturally have this pulse, its appearance here is due to the failure to use purgation when indicated. Internal accumulation and blockage cause Ying Qi (nutritive energy) to reverse internally, unable to reach the four extremities. This is called "Pulse Jue" (Pulse Collapse). It also often occurs from the overuse of cold agents such as Huanglian (Coptis Rhizome) and Shigao (Gypsum Fibrosum), which forcibly suppress heat, causing the pathogen to bind more tightly and the pulse to flow even less smoothly. Physicians seeing a faint, nearly absent pulse may consider it an exterior Yang condition presenting with interior Yin pulse—a sign of untreatability—and abandon treatment, thus harming many people. If Ren Shen (Ginseng Radix) or Sheng Mai San (Generate the Pulse Powder) are then administered, disaster will follow immediately. The appropriate treatment is to slowly purge using Chengqi Tang (Gut-Regulating Decoction), after which the six pulses will naturally recover.

In the exterior stage, if the pulse does not float, sweating can be used to resolve the condition because the pathogen is slight and cannot draw out the Zheng Qi (healthy energy), resulting in atypical pulse presentation. In the interior stage, if the pulse does not sink, purgation can be used to resolve the condition because the pathogen is slight and cannot depress the Zheng Qi, again resulting in atypical pulse presentation. When a Yang condition presents with a Yin pulse, survival is possible if the spirit and complexion are intact and speech/movement are normal; this indicates the patient's constitutive pulse. Further inquiry reveals whether this pulse was present previously; if not, it is "Pulse Jue." After purgation, if the pulse becomes full and forceful, recovery is also possible; provided symptoms subside and a full pulse returns, this is the normal pulse of longevity. Pulse diagnosis must not rely on a single criterion; one must correlate spirit, qi, physical appearance, and clinical signs to determine prognosis accurately.

Zhang Kunyuanzheng, aged sixty, suffered from dysentery. He experienced tenesmus and urgency, defecating thirty to forty times daily. His pulse frequently skipped beats. Other physicians identified this as Quezhuo Mai (Sparrow Pecking Pulse), a sign of certain death, and refused to prescribe medicine. Upon my examination, his pulse was irregular (Canwu Bu Tiao), sometimes two beats followed by a pause, or three beats followed by a pause, then resuming. This is a Se Mai (Choppy Pulse). Given his advanced age, weak blood, and dysentery with pus and blood, his short and choppy six pulses suggested he could not tolerate strong treatment. However, his diet remained unchanged, his complexion unaltered, his voice robust, and his speech normal, indicating this was not a critical condition. I prescribed Shaoyao Tang (Peony Decoction) with an addition of 3 qian of Dahuang (Rhubarb Root and Rhizome). He passed approximately two bowls of pure, clotted pus. He felt relieved, his pulse qi gradually resumed continuity, and the dysentery ceased. Several years later, he contracted wind-cold, suffering from cough and profuse phlegm. Examination revealed the same previous pulse pattern. Two doses of Xingjie Tang (Apricot Seed and Forsythia Decoction) stopped the cough and regulated the pulse. I later observed his wife, who exhibited this same pulse pattern whenever ill. Generally, in treating diseases, one must carefully cross-reference physical appearance, pulse, and symptoms to avoid missing the overall picture, thereby correctly determining auspicious or ominous outcomes.