Library

Pulse diagnosis for Shanghan (Cold Damage) and Rebing (Heat Disease) should be treated with equal importance. The pulse is full, penetrating the three passes, vast (Hong) and forceful like a beating drum. It emerges from the Fengmen point and traverses the Taiyang meridian. If within one day, signs of "Tuo E" (a critical turning point or resolution of pathogenic factors) appear.

When the pulse crosses the passes, it may appear slightly slow and leisurely. One must carefully seek its characteristics until the evening hours.

Zhang Shixian stated: Cold is the qi of winter. In winter, when it is bitterly cold, all things hide deeply. A gentleman maintains strict defense and does not suffer from cold. Those who are exposed to and offended by cold are said to have contracted Shanghan. If one contracts cold pathogens but does not fall ill immediately, the cold toxicity hides within the skin and muscles. Before the Summer Solstice, this transforms into Wenbing (Warm Disease); after the Summer Solstice, it transforms into Rebing (Heat Disease). However, their onset is caused by Shanghan. Therefore, the method of pulse diagnosis is the same. "Hong Paipa" refers to the Hong (Vast) pulse, also known as "Hong Jing." The transmission of Shanghan follows a daily pattern: on the first day, it affects the Juyang (Taiyang) meridian; on the second day, Yangming; on the third day, Shaoyang; on the fourth day, Taiyin; on the fifth day, Shaoyin; and on the sixth day, Jueyin. After six days, the transmission through the meridians is complete, and the disease should heal. If it does not heal on the seventh day, the pathogen should transmit again. At this stage, the pulse is vast and large, passing through the three passes, emerging from the Fengmen point, and crossing over the Taiyang meridian. The pathogen is about to scatter, and within one day, sweating should occur leading to recovery. If the pulse crossing the passes shows a slight slowness, it indicates that the pathogen reaches the Taiyang meridian slowly. If there is no sweating during the day, one must wait until the evening time for sweating to occur. "Fushi" refers to the time before sleep, in contrast to midday.

The pulse qi wanders remotely and diffusely within the palm; conditions such as dryness, post-illness weakness, pain, and ding sores are often not accurately diagnosed. (These two lines are absent in other editions.) Generally, one must inquire about the duration of the illness on the current day and carefully deliberate upon the pulse qualities of Chi (Slow), Shu (Rapid), Hong (Vast), and Wei (Fine).

Zhang Shixian stated: For Shanghan and Rebing before sweating, the pulse must be Floating and Vast; after sweating, the pulse should be calm and quiet. A diffuse and rootless pulse suggests that although recovery might seem imminent without medication, one cannot fully guarantee that the patient has completely returned to health. I opine that Shanghan is considered a major disease, distinct from miscellaneous diseases. It undergoes numerous transformations and presents various ambiguous symptoms. Students must dedicate substantial time and effort, study the works of Zhang Zhongjing with deep concentration, familiarize themselves with the discussions of Jie'an (Li Zhongzi), consult contemporary experts, and adhere to specialized knowledge. Only then will they live up to their responsibility as physicians saving lives. Are the 397 methods and 113 prescriptions established by the ancients really less convenient than those of modern practitioners? Regrettably, many modern physicians do not read Zhang Zhongjing’s books nor adopt the theories of previous sages. Relying only on slick phrases and rigid formulas, they claim to treat Shanghan. Yet, when facing clinical cases, they are at a loss and forcibly apply treatments for miscellaneous diseases. Thus, they fail to induce sweating when necessary, induce sweating when inappropriate, fail to purge when needed, and purge when unnecessary. How could such errors not cause significant harm? Even evaluating ancient figures, there are strengths and weaknesses. Shanghan is Zhang Zhongjing’s specialty, not Wang Shuhe’s. Confucius did not lack knowledge of music, but his hearing was not as acute as Shi Kuang’s; Confucius did not lack skill in archery, but his accuracy was not as divine as Yang Youji’s; Wang Shuhe did not lack understanding of Shanghan, but his sagacity was not as profound as Zhang Zhongjing’s. Therefore, Wang Shuhe’s discussions on Shanghan are not entirely clear, possibly due to textual corruption from long ages past. There is no need to conceal these faults for Wang Shuhe. Thus, I dare not provide interpretations for this verse here, but rather preserve it, awaiting future scholars of high caliber to refine it.