Library

The profundity and subtlety of pulse diagnosis cannot be grasped unless one comprehends the mechanism of divine transformation, thereby enabling the mind and spirit to converge, allowing one to perceive the significant from the minute. It is by no means merely distinguishing symptoms through the indications of floating (Fu), deep (Chen), slow (Chi), rapid (Shu), large (Da), small (Xiao), slippery (Hua), and choppy (Se) pulses. One can say that this exhausts the capabilities of examination and captures the essence of pulse theory. However, for beginners, it is impossible to skip the initial signs and immediately discuss the realm of transformation (mastery/integration). Only by examining the truth and observing the connections can one achieve the wonder of ease and proficiency; being rigidly attached to the established theories of the ancients is inappropriate. Therefore, medical scholars throughout history, who diagnosed syndromes based on pulses, have been extremely detailed. Those who merely described the physical traces sometimes lost in rigidity; those who talked high about metaphysical principles sometimes lost in speculation. Moreover, some doctrines inherited since ancient times and long settled as conclusions, when checked against actual conditions, often fail to fit the pathogenesis. This is because idealistic language is too dogmatic, and practitioners do not realize its impracticality. If one were to analyze and debate in detail, seeking statements that are valid upon sitting and actions that are feasible upon standing, it would inevitably be obstructed and difficult to conclude, wasting words. This cannot be fully elaborated without a dedicated book. Shouyi (the author's self-reference), presuming his own ignorance and lack of talent, has compiled an article titled "Correct Meaning of Pulse Studies" (Mai Xue Zheng Yi), which can still elucidate a few points to supplement what the ancients missed. However, these are generally discussed in the context of internal medicine and do not cover external sores (Wai Yang). Now, considering the field of external surgery (Yang Ke), where manifestations appear externally while pulses reflect internally, there is indeed a principle of mutual correspondence that has been verified without error. I will briefly examine various pulse images relevant to external sores, detailing their forms, tracing their origins, determining auspiciousness or inauspiciousness, and distinguishing between similar and distinct conditions. It seems that many existing books on treating external sores may not have fully clarified their underlying principles. Although this compilation is somewhat haphazard and may have omissions, it may contain some unique insights. I present what I know to share with fellow enthusiasts.

Floating and deep refer to the depth of the pulse. When the pulse appears superficially and can be felt with light pressure, it is called Floating Pulse (Fu Mai). When the pulse is hidden deeply and requires heavy pressure to be felt, it is called Deep Pulse (Chen Mai). From the perspective of constitution, individuals with robust constitutions and abundant Qi and Blood have a surplus pulse that is easily detected with light pressure, resembling a Floating Pulse; those with weak constitutions and deficient Qi and Blood have an insufficient pulse that is not visible with light touch, resembling a Deep Pulse. From the perspective of physique, thin individuals with little flesh and atrophic Cun Kou (inch position at the radial artery) have exposed pulse channels, and their pulses are fine and soft, tending towards Deep. From the perspective of seasons, spring growth and summer expansion cause Qi to vent outward, making the pulse float and manifest; autumn harvest and winter storage cause Qi to gather inward, making the pulse sink and settle. From the perspective of human activities, after strenuous labor or running, or consuming strong wine, Qi and Blood surge, and the pulse invariably floats and exposes itself; during silence and immobility, or sitting quietly at home, with a calm state of mind, the pulse invariably sinks and settles. These are constant pulse images, shifting according to each person's Qi-Blood dynamics and activity levels. I believe that none of the twenty-eight types of pulse images should be viewed otherwise; one cannot hastily place fingers and immediately know which pulse corresponds to which disease. Taking pathological pulses belonging to floating and deep as examples, predecessors often stated that Floating Pulse governs exterior, belongs to Fu organs, and is Yang; Deep Pulse governs interior, belongs to Zang organs, and is Yin. Reading this roughly, few would not consider this classification by exterior-interior, inside-outside, Yin-Yang to be perfectly appropriate. Yet, knowing that "Floating governs exterior and Deep governs interior" is still an idealistic judgment and a generalization that fails to precisely hit the condition and align with reality. Furthermore, saying Floating Pulse belongs to Yang and Deep Pulse to Yin, Floating Pulse governs Fu organs and Deep Pulse governs Zang organs, contains logical flaws and should not be rigidly adhered to. Generally, Floating Pulse can diagnose exterior diseases only when exterior pathogens are most vigorous; mild external contractions will not result in a floating pulse. As for diseases with severe fever, the pulse must be洪大 (Hong Da, Large and Surging) and 滑数 (Hua Shu, Slippery and Rapid) because the heat is flourishing, thus also showing a floating image. This is due to both Qi and Fire being excessive and detectable with light pressure; although it resembles Floating Pulse, it is not the true essence of Floating Pulse. Patients with this condition have heat in both exterior and interior; one must not assume it is solely an exterior disease just because the pulse floats. Additionally, external contraction of Wind-Heat results in a floating pulse, which is evidence that Floating Pulse governs the exterior. However, when Liver Yang acts recklessly, causing dizziness and headache, the rising of Qi and Fire also results in a floating pulse. This indicates the root cause is internal, not an exterior syndrome. Saying Floating Pulse belongs to Yang and Deep Pulse to Yin applies only to normal states. If Yin is excessive internally and Yang is repelled externally, the pulse may be large and floating, but rootless upon heavy pressure; how can this be generally called a Yang syndrome? Again, if Heat knots in the interior and Qi pathways are blocked, the pulse may be deep, stagnant, and sluggish; how can this be generally considered a Yin syndrome? Regarding the claim that Floating governs Fu organ diseases and Deep governs Zang organ diseases, this view did not exist before the Song and Jin dynasties. Since the Ming Dynasty, it was included in the Four-Character Pulse Rhymes (Si Yan Mai Jue), read by almost everyone. (The Four-Character Pulse Rhyme was originally authored by Cui Shi of the Song Dynasty, but Ming dynasty scholars made many revisions; the idea that Floating Pulse governs exterior and belongs to Fu organs was not in Cui Shi's original work.) Zang and Fu are relative; Zang is Yin, Fu is Yang; Zang is interior, Fu is exterior, but this is a relative exterior compared to the Zang. Speaking of the whole body, Fu organs are also deeply hidden within the interior; how can it be erroneously thought they are in the exterior? How can one mistake this character "exterior" to mean that diseases in Fu organs should have a floating pulse? If Fu organ diseases could be treated as exterior diseases resulting in a floating pulse, then what about diseases of the meridians, muscles, and skin/hair? Their pulses would have to be... This logic is untenable and factually impossible. However, current physicians, having read the pulse rhymes, certainly know the eight characters: "Floating Pulse governs exterior, belongs to Fu, belongs to Yang." This shows how much vulgar books mislead people. Ultimately, saying Floating Pulse governs exterior and Deep Pulse governs interior is vague and perhaps acceptable; but insisting that Floating governs Fu organ diseases and Deep governs Zang organ diseases is too dogmatic and completely illogical.

Shouyi believes that in ancient and modern pulse books, claims that "a certain pulse governs a certain disease" all have pros and cons, gains and losses. Students must possess their own insights and penetrate the truth to avoid being fooled by the ancients.

Here, I briefly elaborate on the topic of Floating and Deep pulses to serve as a basis for inferring other cases. My intention is merely to correct common secular errors, not to engage in pointless disputes with the ancients. Considering Floating and Deep pulses in the context of external sores: a Floating Pulse in a swelling sore (Zhong Yang, un-ulcerated abscess) occurs only in upper jiao Wind-Heat syndromes. For example, parotitis (Fa Yi), mumps (Sa Yong), and abscesses around the ear gate and dental alveolus originate in the exterior and involve Wind-Evil and Heat-Toxin accumulating in the upper part; their pulses are invariably Floating, Rapid, Slippery, and Quick. If there is phlegm, it should be drained; if there is heat, it should be cleared. One must not, because the pulse is Floating and belongs to the exterior, merely use methods to disperse Wind and release the exterior, which would instead cause Qi and Fire to float further, exacerbating the sore. If seasonal evils invade the meridians causing Liu Zhu (flowing deposits), with alternating chills and high fever, when exterior pathogens are fully vigorous, the pulse will also be Floating and Rapid. In this case, releasing the exterior and reducing swelling proceed together; once the exterior evil is expelled, the swelling sore resolves naturally. If the sore has formed pus, with full toxicity but not yet discharged, the pulse responds with Floating and Rapid, or Slippery and Large; draining the pus and toxin will cause the pulse to calm. If the pulse remains Floating after ulceration and pus discharge, unless the external contraction is not fully resolved, one must guard against secondary pus formation. If the pathogenic factor has transformed, the sore does not recur, yet the pulse remains Floating, it indicates dispersion and consumption of Righteous Qi, which is not an auspicious sign. A Deep Pulse in a swelling sore occurs occasionally in cases like Bone-Attached Major Abscess (Fu Gu Da Ju) or abdominal masses (Jia Pi Ji Ju), caused by Cold coagulation, meridian obstruction, and Qi-Blood stagnation. The toxin is very deep, the condition is consolidated, and the pulse is Deep, stagnant, and indistinct; this is definitely not a mild ailment. If not urgently treated with circulation-promoting methods to dissipate the condensation, it will be difficult to cure. Ordinary muscle abscesses and meridian sores will never show a Deep pulse. Once a carbuncle or malignant sore has ulcerated, pus and toxin are discharged, and Qi and Blood are unblocked, there is no reason for the pulse to be Deep. If it is, it means Qi is still knotted and Blood is still congealed, which is not a good sign. In summary, sores are diseases of the muscles. Although "pain implies blockage," the pulse should not be excessively floating. However, if stagnation is not resolved and knots are not opened, the pulse often remains Deep and Choppy without rising, and if treatment fails, the harm would be severe.