Library

The "Wu Jie" (Five Knots) pulse is Yin. When palpated with the fingers, the pulse may flow forward or backward; it gathers and then returns, which is called the Knot pulse (Jie Mai). It primarily indicates Qi stagnation in the four limbs, accompanied by intermittent pain.

The Knot pulse belongs to Yin and corresponds to the Dui trigram (Lake). Dui represents water/lake; rain descends only after Yin and Yang harmonize. Now, when palpating the pulse, the vessel flows sometimes forward and sometimes backward, gathering and then returning. This indicates that Yin is exclusively abundant while Yang cannot enter. As stated in the *Mai Jing* (Pulse Classic), a pulse that is slow and occasionally stops before resuming beating is called the Knot pulse. This signifies blood stasis without movement and Qi stagnation without dispersion, resembling a dragon coiling but not raining. The four limbs belong to Yang. If blood remains stagnant and does not circulate, and Qi is obstructed and does not disperse, then Yin and Yang cannot sustain each other, resulting in Qi stagnation in the four limbs. "Intermittent pain" refers to the large intestine pain mentioned later.

According to the *Mai Jing*: The Knot pulse comes and goes slowly, occasionally stopping and then resuming. When pressed, if the pulse is slow and occasionally stops, it is named Knot Yang (Jie Yang); if upon initial arrival it stops, and upon resuming beats slightly faster but cannot return to normal on its own, and rises when lifted, it is named Knot Yin (Jie Yin).

Furthermore, Liu Shouzhen said: The Knot pulse is slow and occasional stopping, belonging to Yin. It primarily indicates excessive Yin causing restlessness, irritability, fullness, and distension. This is due to extreme Yang reversal, leading to cold body and a pulse that is faint, nearly imperceptible, slow, and weak. Occasional stopping also causes chest irritability. This stopping is due to extreme heat, not cold. Both must be clarified by distinguishing root and branch.

Accumulated Qi arises beside the Spleen organ, causing paroxysmal large intestine pain that is unbearable. Gradually understand that slightly purging the Fire of the Sanjiao (Triple Burner) is sufficient; do not arbitrarily establish multiple treatment protocols.

Why does a Knot pulse indicate accumulated Qi? Generally, the left side of the human body belongs to the Liver and governs Blood, while the right side belongs to the Lung and governs Qi. The Knot pulse image corresponds to the Dui trigram. Dui resides in the West, corresponding to the right side of the human body. One should know that accumulated Qi arises beside the Spleen organ, specifically on the right side of the abdomen. However, why does accumulated Qi arise beside the Spleen? The *Ying Wei Sheng Hui Pian* states: Grain Qi enters the Stomach and transmits to the Lung; all Zang and Fu organs receive this Qi. The *Ying Qi Pian* further states: Grain enters the Stomach, transmits to the Lung, overflows internally, and spreads externally. The refined essence travels through the meridians and collaterals, circulating endlessly, beginning and ending again, which is the law of Heaven and Earth. Thus, Qi emerges from the Hand Taiyin Lung Meridian and pours into the Hand Yangming Large Intestine Meridian. Now, if the pulse presents as Knot, it is like a person walking with difficulty and stumbling again. This means the Qi of the Spleen and Stomach cannot transport to the Lung, and the Lung cannot transmit to the Large Intestine. Therefore, it stagnates beside the Spleen organ, forming accumulated Qi.

However, why does a Knot pulse indicate large intestine pain? Why does Xin Metal not suffer disease while Geng Metal suffers? Xin combines with Bing to transform into Water, governed by Cold Qi. Geng combines with Yi to transform into Metal, governed by Dryness Qi. Xin Metal is Yin Metal, which is the Lung Metal. Geng Metal is Yang Metal, which is the Large Intestine. Because the Dryness Qi of Yang Metal stagnates in the Large Intestine, paroxysmal pain occurs.

But why purge the Fire of the Sanjiao for large intestine pain? Because Dryness Qi is close to Fire, and Metal fears Fire. Yin Metal is controlled by the Zang organs, and Yang Metal is controlled by the Fu organs, following their respective categories. The Large Intestine is a Fu organ, thus controlled by the Sanjiao. Treatment should involve purging the Fire of the Sanjiao so as not to assist the Dryness Metal Qi. Then pain will naturally subside, and the disease will heal. However, the Knot pulse ultimately belongs to the extreme of Yin pulses. One must not use harsh bitter-cold herbs severely, nor attack hastily. Only slight purging of the Sanjiao Fire is appropriate. There is a fear that later generations, due to abdominal pain, might mistakenly administer acrid-hot substances, causing fluid exhaustion and worsening dryness, making cure difficult. Hence, repeated warnings are given: Do not arbitrarily establish multiple treatment protocols.

Referencing Li Dongyuan's *Lan Shi Mi Cang*, the Seven-Sage Pill treats unbearable large intestine pain, fully quoting this verse. The formula for the Seven-Sage Pill is attached: Qiang Huo (Notopterygii Rhizoma et Radix) 1 liang, Yu Li Ren (Prunus japonica Seed) soaked in water, skin removed, ground separately 1.5 liang, Da Huang (Rhei Radix et Rhizoma) 8 qian, Wei Bin Lang (Arecae Semen preparatum), Gui Pi (Cinnamomi Cortex), Mu Xiang (Aucklandiae Radix), Chuan Xiong (Chuanxiong Rhizoma), each of the above 5 qian. Except for Yu Li Ren which is ground separately and added, all are made into fine powder, mixed with refined honey to form pills the size of paulownia seeds. Take 30-50 pills per dose, washed down with warm water, before meals, aiming for mild bowel movement. One dose cures. Strictly forbid excessive bowel purging, as pain will intensify.

Additionally, referencing Liu Shouzhen's *Zhi Ji Lun*: The Hand Yangming Large Intestine is named "Hai Fei". The *Liu Yuan Zheng Ji Lun* regarding Yangming also states: "Si Sha Fu" is the Large Intestine, saying "Hai Fei" refers to Metal, which can harm five types of worms. It also says: "Si Sha Fu" means Metal governs killing. Given these two names, how can it generate worms itself? It is likely because the Ministerial Fire of the Sanjiao is prosperous and can control Yangming Metal, so Wood Qi comes to insult. The *Nei Jing* states: Insult means overcoming what one previously feared. Wood governs the generation of five worms. He Suhe said: "Wind arises beside the Spleen, large intestine pain is paroxysmal and hard to bear; gradually feel slight purging of Sanjiao heat; do not arbitrarily establish protocols." This refers to excessive drinking and eating hot foods, causing the Spleen to generate Fire and Heat, thereby assisting the prosperity of Sanjiao Qi. Fire generates Earth. One should purge the Sanjiao Fire. Once heat recedes, Metal receives Qi and reverses to control Wood. When Wood is controlled, the five worms do not generate, and the disease heals naturally.