Library

This chapter differentiates syndromes based on pulse diagnosis, which is indeed a key point for physicians. However, the content is not yet detailed and complete; it should be consulted with chapters such as *Ping Ren Qi Xiang Lun* (Treatise on the Pulse of a Healthy Person) and *Yu Ji Zhen Zang Lun* (Treatise on the Jade Machine and True Viscera). Those chapters discuss normal conditions, whereas this one focuses on abnormalities, hence the title "Da Qi" (Great Anomalies).

When the pulses of the Liver, Kidney, and Lung are full and excess, swelling occurs. ("Full" refers to the pulse qi being full and excess. Swelling refers to carbuncles and swellings. When the qi of the zang organs is full and excessive, it manifests in this way. Note: The *Yin Yang Ying Xiang Da Lun* states: "Excess heat leads to swelling." Since the pulses of these three meridians are both full and excess, this is undoubtedly an excess-heat disease.)

Lung qi stagnation causes panting and fullness in both axillae. (The Lung stores qi and externally governs respiration. Its meridian branch emerges horizontally from the lung system to the axilla; therefore, panting and axillary fullness occur. Note: "Yong" is synonymous with "Yong" (stagnation/obstruction). Only when qi is obstructed does panting and fullness arise. Wang Bing failed to explain the reason, and the *Jia Yi Jing* erroneously wrote "carbuncle".) Liver qi stagnation causes fullness in both axillae, startle upon sleeping, and inability to urinate. (Note: The Liver dislikes depression/stagnation; obstruction represents extreme stagnation. " " refers to the axilla. The axilla is the area governed by the Liver, so obstruction causes bilateral axillary fullness. When lying down, qi converges; if the Liver is already obstructed and one lies supine, the qi desires to flow but cannot, causing startle. The Liver meridian circles the genitalia, so Liver qi obstruction leads to difficult urination. Wang's commentary indiscriminately cites meridians and is very superficial.) Kidney qi stagnation causes fullness from the lower back to the lower abdomen. (Note: The lower part of the waist is governed by the Kidney, so Kidney qi stagnation causes fullness below. The original text says "feet", but "foot" should be corrected to " ". If written as "foot", it implies upward movement from below, contradicting "down to". This is now corrected.) There may be disparity in calf size, thick thighs, limping, or predisposition to hemiplegia. (Note: This also concerns the lower body and is a Kidney disease. It means that once Kidney qi is stagnant, not only is there the affliction of abdominal distension, but also diseases of the legs such as limping or hemiplegia. The Kidney is the source of vital qi; thus, stagnation leads to qi coagulation and blood stasis, resulting in such diseases. Above the knee is the thigh, below the knee is the shin/calf; the tibia and calf are similar. "Large and small" means unequal. "Limping" means uneven foot placement. "Yi" means change, indicating no fixed side for left or right. This is called hemiplegia syndrome, caused by Kidney qi stagnation. "Bi" sounds like 'bei'. " " sounds like 'hang'. "Bo" sounds like 'bo' rising tone.)

Heart pulse full and large leads to epilepsy, convulsions, and tendon spasms. Liver pulse small and rapid also leads to epilepsy, convulsions, and tendon spasms. (Note: Heart and Liver are different organs; one has a full-large pulse, the other a small-rapid pulse, yet the disease is the same. Why? The Heart belongs to Fire and generates blood; a full-large pulse indicates fire excess drying the blood. The Liver stores blood and governs tendons; a small-rapid pulse indicates cold qi and congealed blood. Both can cause epilepsy and convulsions, fundamentally due to blood failing to nourish the tendons—the Heart condition is due to heat, the Liver condition due to cold. Epilepsy refers to dianxian. "Chong" sounds like 'chi', referring to convulsions/twitching.) Liver pulse chaotic and galloping indicates sudden fright/shock. (Note: "Wu" means horses running wildly. A chaotic liver pulse indicates turbulent qi, necessarily caused by some fright/shock.) If the pulse is absent or the patient is aphasic, it will heal spontaneously without treatment. (Note: "Absent" means the pulse body is deep and hidden. "Yin" means inability to speak. Extreme fright/shock causes the pulse to hide and speech loss; once the fright subsides, health returns, requiring no treatment.)

Kidney pulse small and rapid, Liver pulse small and rapid, Heart pulse small and rapid, with weak beating, all indicate Jia masses. (Note: Small indicates deficiency of both qi and blood; rapid indicates cold. "Not drumming/beating strongly" means the pulse lacks force and cannot propel. "Jia" means false; deficiency of qi and blood with cold causes stagnation and immobility, resembling accumulation/masses.)

Kidney and Liver pulses both deep indicate Shi Shui (Stone Water). (Note: Kidney is Shaoyin. Liver is Jueyin. Both zang organs belong to Yin; if their pulses are both deep, it indicates untransformed yin-cold and condensed water qi, named Shi Shui. For example, patients with abdominal distension that feels hard upon pressure.) Both floating indicate Feng Shui (Wind Water). (Note: The Kidney governs water, and the Liver governs wind. If their pulses are both floating, the disease originates from external contraction, manifesting as flaccid edema/swelling.) Both deficient indicate death. (The Kidney is the master of the five zang organs, and the Liver is the master of generation. Deficiency in both means the sources of life are extremely weak, leading to death.) Both small and wiry indicate impending fright. (Note: Small indicates deficiency, wiry indicates pathogen. Deficiency with pathogen suggests fear of impending fright. "Impending" means it has not yet occurred.)

Kidney pulse large, rapid, and deep; Liver pulse large, rapid, and deep, both indicate Shan (Hernia). (Shan is caused by the aggregation of cold qi. Note: Kidney rapid/deep indicates water cold and qi stagnation; Liver rapid/deep indicates tendon tension and blood coagulation. Aggregation forms mass, unbearable pain, constituting Shan.)

Heart pulse slippery, rapid, and forceful indicates Xin Shan (Heart Hernia); Lung pulse deep and forceful indicates Fei Shan (Lung Hernia). (Note: The Heart and Lung can also have Shan, but Bo Gao did not describe the symptoms, only the pulse. Thus, these two types of Shan exist only in name in the world, without true understanding. The commentary states they are caused by cold invading the zang organs, which is correct.)

San Yang (Three Yang) pulses rapid indicate Jia masses; San Yin (Three Yin) pulses rapid indicate Shan. (Taiyang cold contraction causes blood stasis forming Jia; Taiyin cold contraction causes qi aggregation forming Shan.) Er Yin (Two Yin) pulses rapid indicate Epileptic Convulsion; Er Yang (Two Yang) pulses rapid indicate Fright. (Er Yin refers to Shaoyin. Er Yang refers to Yangming. Note: "Rapid" means the pulse strikes the finger. Epileptic convulsions often belong to wind-phlegm; Shaoyin rapidity indicates phlegm entering Heart and Kidney. Fright diseases are half-excess, half-deficient; Yangming rapidity indicates stomach fire conflict.)

Spleen pulse externally pulsating and internally deep indicates Chang Pi (Intestinal Dysentery), which heals itself after a long time. (External pulsation means beating on the outside of the arm. Note: Chang Pi refers to dysentery. Dysentery pulses are often deep due to accumulation. If accompanied by external pulsation, qi is not stagnant, and accumulation is easily cleared; thus, it heals even if prolonged. External pulsation implies floating; the commentary's "beating on the arm" is too rigid.) Liver pulse small and slow indicates Chang Pi, easy to treat. (Note: Liver pulses should avoid strong/rigid and deep/rapid qualities. Seeing small and slow here indicates weakness but presence of Stomach qi, hence easy to treat.) Kidney pulse small, forceful, and deep indicates Chang Pi with bloody stool. (Small indicates insufficient yin qi; forceful indicates yang qi attacking; heat in the lower jiao causes bloody stool.) If the blood is warm and the body hot, death ensues. (Warm blood and body heat indicate failure of yin qi, hence death.) Heart and Liver [pulses] also involve bloody stool; simultaneous disease of these two zang organs is treatable. (Liver stores blood, Heart nourishes blood, so both involve bloody stool. Simultaneous disease implies Wood generating Fire, hence treatable.) Pulse small, deep, and choppy indicates Chang Pi; if the body is hot, death ensues, dying within seven days of fever appearance. (...Heart and Liver pulses small, deep, and choppy indicate Chang Pi. Intestinal dysentery with body heat indicates internal extinction of fire qi, leaving the Heart and returning to the exterior, hence death. Seven is the completion number of Fire, hence death in seven days. Note: The *Tong Ping Xu Shi Lun* states: "Chang Pi with body heat dies, with cold lives." Here it says Chang Pi with body heat dies, dying in seven days. This likely refers to dysentery with pus and blood where internal accumulation is heavy, compounded by external wind-pathogen causing body heat. To release the exterior leaves the interior accumulation uncleared; to purge the interior allows the exterior pathogen to enter deeper, making treatment most difficult, hence "death". The commentary's explanation of fire qi extinguishing internally and floating outward, using seven as the fire number, is erroneous. Diseases have specific syndromes and combined syndromes; specific syndromes are easier to treat, combined ones harder. Chang Pi results from mental strain and overwork damaging diet, leading to dysentery. As dysentery develops, middle qi is deficient, allowing wind-pathogen entry; occasional wind-cold causes body heat, representing internal injury combined with external contraction. Generally, internal injury with external contraction is hard to treat but not always fatal. However, this specific case differs: spleen/stomach disease progressing to dysentery with pus/blood indicates extreme deficiency; contracting wind-pathogen means Earth cannot withstand Metal punishment, hence death, justifying the scripture's prognosis. I pondered this section of the Neijing repeatedly without understanding until treating patients. I realized that for this syndrome, one must first raise and release the exterior pathogen, then treat the dysentery. Whether dysentery is severe with mild fever, or dysentery with alternating chills and fever like malaria, or malaria-dysentery combination with chest fullness/vomiting, or severe dysentery with slight fever unrecognized—treating only dysentery drives the pathogen deeper, causing internal collapse without external heat, leading to intractable urgency, continuous pus/blood, and death. I commonly use Chai Hu (Bupleuri Radix), Jie Geng (Platycodonis Radix), Huang Qin (Scutellariae Radix), Shao Yao (Paeoniae Radix), Ren Shen (Ginseng Radix), Dang Gui (Angelicae Sinensis Radix), Guang Pi (Citri Reticulatae Pericarpium), and Gan Cao (Glycyrrhizae Radix et Rhizoma) to support healthy qi and expel exterior pathogen, preventing Wood from injuring Earth. Once exterior pathogen is gone, internal dysentery reduces. Even with severe condition, 50-60% recover. This is my painstaking effort in treating combined syndromes, borrowing Dong Yuan's method of internal injury with external contraction. Those interested in this path must know this.)

Pulse striking forcefully, with nasal hemorrhage and body heat, indicates death. (...Nasal hemorrhage indicates deficiency; the pulse should not be striking. Forceful pulse here indicates extreme qi exhaustion, hence death.)

Pulse arriving in clusters (Fu He), resembling a rapid pulse, exceeding ten beats per respiration cycle, indicates insufficiency of Jing Qi (Meridian Qi); slight manifestation leads to death in ninety days. (Like waves merging, latter waves overtaking former, moving rapidly without constant pattern. Note: One inhalation and exhalation is one respiration cycle (Xi). Over ten beats per Xi is the extreme of rapidity. "Fu He" describes its floating nature without root. Who provides this insufficiency of pulse? It is likely due to the scattering and rootlessness of meridian qi.) Pulse like burning firewood indicates deprivation of Heart Essence; death occurs when grass dries. (Firewood burning implies flickering flames, unstable form before cessation.) Pulse like scattered leaves indicates deficiency of Liver Qi; death occurs when tree leaves fall. (Like leaves drifting with wind, changing constantly.) Pulse like a visiting guest (Sheng Ke), where Sheng Ke means pulse blocked yet pulsating, indicates insufficiency of Kidney Qi; death occurs when jujube flowers bloom. (Blocked yet pulsating means appearing briefly then disappearing.) Pulse like a mud pellet indicates insufficiency of Stomach Essence; death occurs when elm seeds fall. (Rolling like a pearl is called mud pellet.) Pulse like a horizontal bar indicates insufficiency of Gallbladder Qi; death occurs when grains ripen. (Long and firm pulse, like a horizontal wood under fingers.) Pulse like a silk thread indicates insufficiency of Bao (Uterus/Microcosm) Essence; patient speaks excessively, dies at frost; if silent, treatable. (Bao meridian connects to Kidney; Kidney meridian accompanies tongue base. Insufficient qi usually prevents speech. Excessive speech here indicates internal extinction of true qi, leaving Kidney and returning to tongue, hence death.) Pulse like mixing lacquer (Jiao Qi), meaning coming from sides left and right, slight manifestation leads to death in thirty days. (Coming from sides left and right resembles dripping lacquer crossing over.) Pulse like a spring gushing, floating and beating in muscles, indicates insufficiency of Taiyang Qi; lacking smell/appetite, dies when leeks flower. (Like water spring moving, exiting but not entering.) Pulse like crumbling earth, unobtainable upon pressure, indicates insufficiency of Muscle Qi; black and white colors appear first, dies during thunder storms. (Crumbling earth means large and vacuous upon floating, empty upon pressing. Note: "Lei Fa" should be "Thunder Eruption"; thunder erupts in Spring, implying spleen/stomach disease dies when Wood is prosperous.) Pulse like the uvula (Xuan Yong), where floating and pressing makes it larger, indicates insufficiency of Twelve Shu points; dies when water freezes. (Like the uvula in the throat.) Pulse like an inverted knife, where floating is small and rapid, pressing is firm, large, and rapid, indicates accumulation and heat in Five Zang organs, with cold-heat combining exclusively in Kidney; such person cannot sit, dies at Start of Spring. (Wen means accumulation. Shu means heat.) Pulse like smooth pills slipping from hand, unobtainable upon pressing, indicates insufficiency of Large Intestine Qi; dies when jujube leaves grow. Pulse like flowers causes fearfulness, reluctance to sit/lie, walking/standing while listening constantly, indicates insufficiency of Small Intestine Qi; dies in late autumn. (Pulse like flowers implies weak and indistinct. Small Intestine meridian enters ear, hence constant listening. Note: The above pulse descriptions, starting from Fu He, total fifteen cases, meanings largely obscure. Dare not force interpretation; recorded according to commentary, preserving doubts.)