Library

[Body and Image]
The Lao pulse (Firm Pulse) is located in the deep (Chen, 沉) level; its form is large, wiry (Xian, 弦), and solid (Shi, 实). It cannot be detected at all in the superficial (Fu, 浮) and middle (Zhong, 中) levels.
This represents an image of residing deeply within. Therefore, trees are called "lao" (firm/deep-rooted) because their roots go deep into the earth; prisons are called "lao" because they imprison people deep inside. Zhang Zhongjing said: "Cold causes firmness." Here it also carries the meaning of solidity.

[Primary Diseases]
The Lao pulse primarily indicates hard accumulations (Jian Ji, 坚积), with the pathology located internally. If the Lao pulse appears at the Left Cun position, it indicates the disease of Fu Liang (Voluminous Beam). If the Lao pulse appears at the Left Guan position, it indicates blood accumulation in the Liver. If the Lao pulse is obtained at the Left Chi position, it portends Ben Tun (Running Piglet).
If the Lao pulse appears at the Right Cun position, it confirms Xi Fen (Breath Accumulation). If the Lao pulse appears at the Right Guan position, it indicates Pi Pi (Epigastric Mass) caused by Yin cold. If the Lao pulse is obtained at the Right Chi position, it indicates severe pain from Shan Jia (Hernia and Masses).
The syndromes indicated by the Lao pulse, because it is in the deep level, all belong to Yin Cold; because its form is wiry and solid, all are hard accumulations. The formation of accumulations occurs due to deficiency of healthy Qi (Zheng Qi, 正气) and the deep, firm penetration of pathogenic factors. The accumulation of the Heart is named Fu Liang; the accumulation of the Liver is named Fei Qi (Fat Qi); the accumulation of the Kidney is named Ben Tun; the accumulation of the Lung is named Xi Fen; the accumulation of the Spleen is named Pi Qi.
And those that feel responsive upon palpation are called "Ji" (Fixed Accumulation); those formed by borrowing material shape (intermittent masses) are called "Jia" (Wandering Mass); those appearing between muscles are called "Zheng" (Solid Mass); those knotted in hidden areas are called "Pi" (Hidden Mass). The Classics state: "Accumulations begin to generate when they receive Cold, and become fixed when Qi rebels." Thus, the Lao pulse governs all these conditions. However, for persons who have lost blood or exhausted essence, internal deficiency should present with a Ge pulse (Leather Pulse), which would be the correct image; if instead a Lao pulse is obtained, this is a contradiction between pulse and syndrome, indicating a short life expectancy.

[Commentary]
Mr. Shen said: "Resembling both Chen and Fu pulses is the position of the Lao pulse. Solid, large, wiry, and long is the body of the Lao pulse. The Lao pulse must not be confused with the Chen pulse or the Fu pulse; careful differentiation is required. The Chen pulse is like sand wrapped in cotton, rigid inside and soft outside, but it does not necessarily combine largeness and wiriness. The Fu pulse is invisible unless pushed to the bone. In contrast, with the Lao pulse, since it is solid and large, as soon as moderate pressure is applied, strength fills the fingers; this is how they are distinguished." Wang Shuhe said: "Resembling both Chen and Fu pulses cannot be treated as a uniform conclusion." Wu Caolu said: "Lao indicates Cold-Excess, while Ge indicates Deficiency-Cold; how can they be confused?" The Pseudo-Mantra states: "Sought lightly, it is absent; pressed, it is present." This is merely vague and does not describe the solid, large, wiry, and long image; it describes a Chen pulse, not a Lao pulse. It further states: "The pulse enters the skin, making respiration difficult to distinguish," and even more erroneously treats the Lao pulse as a pulse of death. How numerous are such fallacies!