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Pulse floating and tight with aversion to cold is termed Cold Damage (Shanghan); pulse rapid with less cold sensation and more heat sensation is termed Warm Disease (Wenbing); pulse slow with aversion to wind is termed Wind Injury (Shangfeng); pulse full and vigorous with high fever is termed Heat Disease (Rebing); pulse deficient with body heat is termed Summerheat Injury (Shangshu). Physicians must not fail to distinguish these.

Regarding the pulse of Warm Disease, it is neither floating nor sunken; at medium pressure, it appears surging (Hong), long, slippery, and rapid. The right-hand pulse is often fuller than the left-hand pulse. This is generally due to stifling heat (Fure) stagnating, causing the pulse qi to knot in the middle. If the left-hand pulse is full, or floating and tight, it is naturally a disease of contracting wind-cold, not Warm Disease.

Regarding the pulse of Warm Disease, stifling heat resides internally, mostly manifesting in the muscle layer, without being particularly superficial. If heat stagnates in the Shaoyin channel, the pulse becomes sunken, faint, and nearly imperceptible; this is not a true Yin pulse, but rather Yang pathogenic factors closing off the pulse vessels.

Cold Damage originates from the exterior moving inward, entering through the Qi level. Initially, it presents with fever and aversion to cold, without irritability or thirst within one or two days. The pulse is mostly floating and tight, does not transmit to the Three Yin channels, and the pulse does not appear sunken. Warm Disease originates from the interior reaching the exterior, emerging from the Blood level. Initially, there is no aversion to cold but rather fever; as soon as fever occurs, there is dry mouth and throat with thirst. (Yang Ruhou stated: This discusses latent Qi [Fuqi]. If it is an externally contracted Warm Disease, there may also be slight aversion to cold.) The pulse is mostly surging and slippery, and in severe cases, even sunken. This explains the difference between releasing the exterior and clearing the interior treatments.

When floating and medium palpation reveal a pulse that is large and forceful, or long and forceful, if a patient with Cold Damage has such a pulse, sweating therapy should naturally be employed; this indicates indications for Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction). However, at the onset of Warm Disease, even if such a pulse exists, sweating must absolutely not be used; this indicates indications for Baihu Tang (White Tiger Decoction) or Xiexin Tang (Drain the Epigastrium Decoction). The critical juncture of life and death lies entirely in this distinction.

In Warm Disease, when there is heat both internally and externally, the pulse may be sunken and faint, neither surging nor rapid, but feeling sunken, small, and urgent under the fingers. It must absolutely not be mistaken for deficiency-cold. Using acrid-warm herbs will only exacerbate the heat. Therefore, Cold Damage diagnosis relies more on the pulse, while Warm Disease diagnosis relies more on symptoms. This is because Cold Damage involves wind-cold entering from outside and transmitting along the meridians, whereas Warm Disease involves stifling heat blazing internally and overflowing into the meridians.

If Cold Damage begins in the Taiyang stage with fever and headache, but the pulse is unexpectedly sunken, although it is called Taiyang, it actually reveals a Shaoyin pulse. Thus, Sini Tang (Frigid Extremities Decoction) is used to warm it. If Warm Disease begins with fever and headache, but the pulse is sunken, choppy, small, and urgent, this indicates latent heat toxin stagnating in the Shaoyin channel, unable to emerge into the Yang level. Consequently, the body is very hot while the four limbs are cold; this is termed Jue (Cold Extremities), caused by miscellaneous Qi stagnation and fire pathogen closing the pulse vessels, causing them to hide. One must urgently use salty-cold and bitter-cold substances to clear and purge vigorously. One must absolutely not mistake this for early-stage Taiyang Cold Damage presenting with a sunken Shaoyin pulse and use Sini Tang to warm it. Warming it will lead to disastrous complications. Nor should it be mistaken for Yang Jue in Cold Damage where purgatives are contraindicated and Sini San (Frigid Extremities Powder) is used to harmonize. Harmonizing it will worsen the disease. This is because heat stagnation is hyperactive and closed, preventing Yang Qi from connecting to the four limbs, resulting in a sunken and choppy pulse, or even all six pulses disappearing; this is Pulse Jue. When hands and feet are cold, or even the whole body is ice-cold, this is Body Jue. This corresponds to Zhang Zhongjing's description of Yang Jue: shallow Jue means shallow heat, deep Jue means deep heat. Purgative therapy must not be delayed. Only those with true insight, firm principles, and the ability to adapt flexibly can discuss this matter. (Wu Xihuang said: Wang Shizhong stated: A sunken and fine pulse can also result from heat pathogen blockage. In cases with substantial physical symptoms, purgation can save the patient; one cannot assume death simply upon seeing a Yin pulse. Whenever heat pathogen obstructs, the pulse is often fine, solid, slow, and choppy. Clearing and resolving according to symptoms will naturally make the pulse surging and slippery, unlike internal injury diseases where taking cooling herbs causes the pulse rate to increase indicating deficiency. Additionally, Ma Yuanyi stated: There are also cases in Yangming/Yang channels where the pulse is weak and unarisen, because heat pathogen suppresses it, preventing external release. Once heat is cleared, the pulse rises naturally; do not attribute it to Yang Qi decline and weak pulse. Both gentlemen's discussions on pulse align with Li Shan's previous statements, representing understanding gained from long experience that is accurate and unchangeable. Physicians must remember this well.)

Regarding the pulse of Warm Disease, if medium palpation reveals surging, long, slippery, and rapid qualities, the condition is mild; in severe cases, the pulse is sunken; in extreme cases, the pulse is closed and absent. This is the key principle for distinguishing different treatments based on floating versus sunken pulses in Warm Disease versus Cold Damage.

Regarding the pulse of Warm Disease, if surging, long, slippery, and rapid are accompanied by slow, it is easy to treat; if accompanied by wiry (Xian), it is difficult to treat.

Regarding the pulse of Warm Disease, if sunken, choppy, small, and urgent, with cold extremities and a body like ice, the condition is critical.

Regarding the pulse of Warm Disease, if both hands' pulses are closed/absent, or one hand's pulse is closed/absent, the condition is critical.

Regarding the pulse of Warm Disease, if sunken, choppy, and faint, resembling drops from a leaking roof, the prognosis is fatal.

Regarding the pulse of Warm Disease, if floating, large, and scattered, resembling boiling water in a cauldron, the prognosis is fatal.

Note: For both Cold Damage and Warm Disease, treatment must be administered based on pulse diagnosis. When pulse and symptoms correspond, identification is easy. When they do not correspond, one must examine the urgency, deciding whether to follow the pulse or the symptoms, ensuring both are considered. For example, if exterior syndrome presents without a floating pulse, it can be resolved by sweating; if interior syndrome presents without a sunken pulse, it can be resolved by purgation. This is because the pathogenic factor is weak and cannot restrain the righteous Qi, so the pulse does not correspond. In diarrhea, a solid pulse may indicate recovery; if symptoms subside and a solid pulse returns, it is a natural longevity pulse. Furthermore, regarding pulse differentiation, surging and slippery are Yang and Excess, while weak and faint are Yin and Deficiency, which is self-evident. However, Zhang Zhongjing stated: If the pulse is floating and large, it indicates Qi excess and Blood deficiency. The *Neijing* states: If the pulse is more than four times normal size, it is called Guan-Ge (Obstruction and Repletion). These represent true deficiency. Tao stated: Regardless of floating/sunken or large/small, if the pulse feels powerless under the fingers and vanishes completely upon heavy pressure, it is a Yin pulse. This shows that surging/slipping are not necessarily always Yang/Excess. Jingyue stated: If the pulse seems present yet absent, visible only when pressed to the bone, appearing sunken, faint, fine, and depleted, it is a sign of Yin-Yang lying dormant and blocked. Tao stated: Whenever there is heat internally and externally, if the pulse is sunken and hidden, neither surging nor slippery, but feeling sunken, choppy, small, and urgent under the fingers, it is latent heat. This shows that weak/faint are not necessarily always Yin/Deficiency.