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[Original Text] The pulse is soft and weak (Ru and Ruo). The weak pulse appears at the Guan position, while the soft pulse appears at the superficial level (Dian). The faint pulse appears at the Cun position (Upper), and the choppy pulse appears at the Chi position (Lower). Faintness indicates insufficiency of Yang Qi; choppy indicates lack of Blood. If Yang Qi is weak, wind-stroke with sweating occurs, accompanied by restlessness and vexation. Choppy pulse indicates lack of Blood, leading to cold extremities and chills. Applying diaphoresis to a condition of faint Yang Qi causes restlessness and insomnia.

[Annotation] A superficial pulse that is forceless is the Soft Pulse (Rumai). A deep pulse that is forceless is the Weak Pulse (Ruomai). A pulse that is forceless at superficial, middle, and deep levels, seeming to exist yet not, is the Faint Pulse (Weimai). A pulse that is stagnant and unsmooth is the Choppy Pulse (Semai). "Dian" refers to superficial palpation; "Upper" refers to the Cun position; "Lower" refers to the Chi position. "Pulse soft and weak, weak at Guan, soft at superficial, faint at Upper, choppy at Lower" means the Guan pulse is soft on superficial palpation and weak on deep palpation; the Cun pulse is faint, and the Chi pulse is choppy. Yang deficiency leads to a faint Cun pulse; Blood deficiency leads to a choppy Chi pulse. This is the pulse pattern of Yang deficiency and Blood deficiency, where diaphoresis is contraindicated. Yang deficiency typically presents with sweating and aversion to cold; Blood deficiency typically presents with mental vexation and fever. This is the symptom pattern of Yang deficiency and Blood deficiency, where diaphoresis is contraindicated. If mistakenly diagnosed as Taiyang Wind-Stroke and treated with diaphoresis, it will inevitably cause Yin and Yang to lose their connection and perish, resulting in restlessness, insomnia, cold extremities, and chills.

[Original Text] The pulse is soft and weak, with the weak pulse at the Guan position and the soft pulse at the superficial level. The wiry pulse appears at the Upper (Cun), and the faint pulse appears at the Lower (Chi). Wiry indicates Yang movement [here referring to Shaoyang heat or qi stagnation]; faint indicates Yin cold. Upper excess and Lower deficiency, with a desire for warmth. A faint and wiry pulse indicates deficiency; diaphoresis is contraindicated. Diaphoresis will cause shivering, and the body will not recover.

[Annotation] This refers to the Guan pulse being soft on superficial palpation and weak on deep palpation, the Cun pulse being wiry, and the Chi pulse being faint. Wiry is the pulse of Shaoyang Heat Pathogen; faint is the pulse of Shaoyin Cold Pathogen, hence "Upper excess and Lower deficiency." However, when faint and wiry pulses appear together, deficiency and excess are hard to distinguish. Only by observing if the patient desires warmth can we determine that this is not aversion to cold from the exterior, but fear of cold from the interior; thus, diaphoresis is contraindicated. If mistakenly induced to sweat, Yin becomes more abundant causing shivering, and Yang becomes more depleted, preventing self-recovery.

[Original Text] In various pulse patterns, if there is rapidity and agitation but also weakness and faintness upon pressure, diaphoresis is contraindicated. Diaphoresis will lead to difficult defecation, dryness in the abdomen, dry stomach, and mental vexation. The symptoms may appear similar, but the root causes are different.

[Annotation] Generally, diseases presenting with rapid and agitated pulses indicate an Excess syndrome, which may be treated with diaphoresis. However, if these pulses feel weak and faint upon pressure, it indicates false Excess on the outside and true Deficiency on the inside; diaphoresis is contraindicated. Mistaken diaphoresis damages Body Fluids, leading to abdominal dryness, difficult defecation, dry stomach, and vexation. Although the presentation resembles Yangming Fu-Excess Heat Binding, its root cause is actually Jinchu (Fluid Depletion) and Xu Zao (Deficiency Dryness) caused by sweating a deficient patient. Hence, "the appearance is similar, but the origin is different."

[Ji Zhu - Collected Annotations] Cheng Zhi states: Agitation and rapidity indicate Heat; weakness and faintness indicate Deficiency. Sweating disturbs Body Fluids, leading to difficult defecation, abdominal dryness, and gastric dryness with vexation. Compared to Yangming Interior Heat syndrome, although the appearance is similar, the roots differ between Excess and Deficiency.

Zhang Zhicong states: Rapid and agitated pulses are Yang pulses; weak and faint pulses are Yin pulses. When various pulses show rapidity/agitation but feel weak/faint upon pressure, regardless of whether it is left or right, three positions, diaphoresis is contraindicated. Sweating depletes internal fluids, causing difficult defecation; external leakage of water qi causes abdominal dryness; fire-heat steaming upward causes gastric dryness and vexation. The similarity in appearance refers to identical dryness syndromes post-sweating. The difference in origin refers to rapid/agitated pulses belonging to Yang, and weak/faint pulses belonging to Yin, encompassing Yin, Yang, Deficiency, and Excess.

[Original Text] Cold extremities with a tight pulse: diaphoresis is contraindicated. Diaphoresis will cause voice disorder and hoarseness, tongue flaccidity, and inability to speak.

[Annotation] A pulse suitable for diaphoresis must be tightly bound on both Yin and Yang levels (Taiyang Cold Damage). Here, cold extremities with a tight pulse indicate a Shaoyin tight pulse, not a Taiyang one. Diaphoresis will damage Shaoyin Qi, leading to voice disorder, hoarseness, tongue flaccidity, and speech impairment.

[Ji Zhu - Collected Annotations] Cheng Wuji states: Cold extremities with a tight pulse indicate Shaoyin Cold Damage. The treatment should warm the interior; mistakenly using diaphoresis damages Shaoyin Qi. The pulse qi cannot enter the Lung, follow the throat, and attach to the tongue base, resulting in voice disorder, hoarseness, tongue flaccidity, weak voice, and inability to speak loudly.

Wei Litong states: This section discusses the pulse of Jue syndromes to show that Yang deficiency prohibits diaphoresis, clarifying the errors of various counter-productive sweating methods. Jue syndromes include Cold Jue, Heat Jue, Roundworm Jue, and Jue from alternating Cold and Heat. Whenever a tight pulse is seen, regardless of the type of Jue, the disease is in the Yin channels. Diaphoresis attacks Yang, scattering Qi and exhausting Blood. The tongue is rooted in the Kidney; voice originates from the Lung. Voice disorder and hoarseness indicate impending Lung Qi exhaustion. Tongue flaccidity means loss of function. Inability to speak indicates failure of original Qi. All result from diaphoresis dispersing the True Qi of the Kidney and Lung.

[Original Text] Pulsation in the Right abdomen: diaphoresis is contraindicated. Diaphoresis causes epistaxis, thirst, severe mental vexation, and vomiting water immediately after drinking. Pulsation in the Left abdomen: diaphoresis is contraindicated. Diaphoresis causes dizziness, incessant sweating, and muscle twitching. Pulsation above the umbilicus: diaphoresis is contraindicated. Diaphoresis causes Qi rushing upward, centered at the heart region. Pulsation below the umbilicus: diaphoresis is contraindicated. Diaphoresis causes absence of sweat, severe mental vexation, painful joints, dizziness, aversion to cold, vomiting after eating, and food failing to descend.

[Annotation] "Dong Qi" (Pulsation) refers to the sensation of throbbing Qi. The areas above, below, left, and right of the umbilicus correspond to the Four Viscera. The Qi of these four viscera does not remain in its proper position, hence the pulsation. Because the organ has long been occupied by exogenous pathogens, its own Qi has lost its defense, relying only on the Middle Jiao Stomach Qi as the master. Even if there is an exterior pathogen, diaphoresis is contraindicated, lest the Qi and Fluids of the Stomach be damaged, leaving the primary organ un-nourished, allowing the conquering pathogen to invade simultaneously.
If pulsation is on the Right, Lung Qi is disordered, and Heart fails to maintain its virtue. Mistaken diaphoresis increases Heart Heat, boiling blood vessels, causing epistaxis, thirst, and vexation; Lung loses regulation, failing to regulate water passages, causing immediate vomiting of water.
If pulsation is on the Left, Liver Qi is disordered, and Lung fails to maintain its virtue. Mistaken diaphoresis causes Liver deficiency and failure to ascend, leading to dizziness; incessant sweating deprives muscles/tendons of fluids, causing twitching.
If pulsation is Above, Heart Qi is disordered, and Kidney fails to maintain its virtue. Mistaken diaphoresis causes Heart Qi deficiency, leading to Kidney Qi rushing upward to the heart region.
If pulsation is Below, Kidney Qi is disordered, and Spleen fails to maintain its virtue. Mistaken diaphoresis exhausts Kidney Water, causing bone pain, aversion to cold, no sweat, vexation, and dizziness; Spleen Earth becomes overly dry, failing normal transformation, causing vomiting after eating and food refusal.

[Ji Zhu - Collected Annotations] Cheng Zhi states: This explains that Dong Qi prohibits diaphoresis. Internal Zheng Qi deficiency and disordered Zang Qi cause throbbing pulsation. Dong Qi indicates interior deficiency, so diaphoresis is contraindicated.

Cheng Yingmao states: Zang Qi not remaining in position causes pulsation. Originally occupied by pathogens, the primary organ's Qi is attached to the root and easily deviates. It relies entirely on Stomach Qi for stability. Diaphoresis depletes Stomach Qi, leaving the Four Zang un-nourished and attacked by pathogens, showing signs of deviation. Though location varies, the violation of the principle of "Jian Zhong" (Strengthening the Center) is the same.

[Original Text] Throat obstruction: diaphoresis is contraindicated. Diaphoresis causes hematemesis, faint breath nearing extinction, cold hands and feet, a desire to curl up, and inability to self-warm.

[Annotation] The Shaoyin meridian follows the throat and attaches to the tongue base. Throat obstruction indicates Shaoyin Qi failing to ascend. Forcing diaphoresis in Shaoyin, where Yang is too weak to produce sweat, will disturb Blood, causing hematemesis, faint breath, curled posture, cold extremities, and inability to self-warm.

[Ji Zhu - Collected Annotations] Cheng Zhi states: Throat obstruction prohibits diaphoresis due to盛 (abundance) of Yin Pathogen. Forcing sweat disturbs Blood. Hematemesis and near-extinction of breath indicate even the slight Yang of the Kidney cannot sustain itself, leading to cold extremities, curled posture, and inability to self-warm. "Lower Jue and Upper Exhaustion," curled posture and cold extremities are critical Shaoyin syndromes.

Cheng Yingmao states: Diaphoretics are Yang in nature; applying them to Yin meridians is counter-productive. Throat obstruction results from Shaoyin fluid deficiency and Kidney Qi failing to ascend. Forcing Shaoyin sweat causes Lower Jue and Upper Exhaustion, leading to these manifestations.

[Original Text] Severe cough with frequent spitting of saliva and foam, dry throat, difficult urination, mental hunger/vexation, intermittent发作 (attacks), resembling malaria but with chills only and no fever, indicating deficiency and chills. Cough with diaphoresis leads to curled posture, fullness/distress, and abdominal hardness.

[Annotation] Severe cough indicates severity. Frequent spitting of saliva/foam indicates Lung injury and fluid depletion, causing dry throat, difficult urination, and mental hunger/vexation. "Intermittent" refers to an attack once per day/cycle. Resembling malaria but with chills only indicates interior deficiency generating chills. Mistakenly treating this "cold-form" cough with diaphoresis injures both Lung Qi and Wei Yang. Dual Yang injury fails to warm the Middle/Lower Jiao; Yin Qi condenses internally and externally, causing curled posture, distress from fullness, and abdominal hardness.

[Ji Zhu - Collected Annotations] Cheng Zhi states: Following the discussion of Ru/Ruo/Xian/Wei pulses, if cough is present, the disease is severe and diaphoresis is prohibited. Cough with frequent saliva/foam implies dry throat and difficult urination; Middle Jiao Yang deficiency causes mental hunger/vexation. Wei Qi circulates 50 times daily; Yang deficiency fails to protect the exterior, causing intermittent chills like malaria (chills only). Diaphoresis here further depletes Yang and increases Yin-Cold, leading to curled posture, fullness, and abdominal hardness.

[Original Text] Cough with free urination, or urinary incontinence: diaphoresis is contraindicated. Diaphoresis leads to cold extremities reversing upwards.

[Annotation] Cough often involves fluid retention, where urination should be difficult. If urination is free, there is no fluid retention. Cough with urinary incontinence indicates not only absence of fluid retention but also Lower Jiao Yang deficiency and Bladder insecurity. Thus, diaphoresis is contraindicated; sweating further depletes Yang, causing reverse cold in extremities.

[Ji Zhu - Collected Annotations] Cheng Zhi states: *Neijing* says prolonged Kidney Cough affects the Bladder. Bladder Cough presents with coughing and enuresis. Thus, cough with free urination. If incontinence occurs, it indicates Kidney Yang deficiency. Diaphoresis further depletes Yang, causing cold reversal.

[Original Text] Various counter-productive diaphoresis: mild cases are difficult to cure; severe cases involve delirium and dizziness, leading to death, with life barely salvageable.

[Annotation] Diaphoresis when inappropriate, or excessive diaphoresis when appropriate, all lead to "Ni" (counter-productive/rebellious) conditions. Mild counter-productive cases are hard to cure; severe cases result in death. Severe cases involve Yang collapse (seeing ghosts/delirium) and Yin collapse (blindness/dizziness).

[Ji Zhu - Collected Annotations] Cheng Yingmao states: Most "Ni" cases belong to Shaoyin, indicating extreme Yin-Cold. Diaphoresis heavily夺 (seizes) Yang. Whether mild or severe, it concerns death, highlighting that Yang is the root of life.

[Original Text] Cold damage headache, moderate fever (Xi Xi Fa Re), resembling wind-stroke, with constant slight sweating and spontaneous vomiting: Misusing purgatives increases vexation and mental restlessness/hunger-like feeling; Diaphoresis causes Spasm (Jing), stiff body difficult to flex/extend; Moxibustion/Fumigation causes Jaundice and urinary retention; Moxibustion causes cough and expectoration.

[Annotation] Headache, moderate fever, sweating, vomiting, resembling wind-stroke, should be treated with Guizhi Tang to resolve the muscle layer. Purging worsens it to chest binding/stiffness (severe) or increased mental vexation/restlessness (mild). Using Mahuang Tang instead of Guizhi Tang for diaphoresis in this exterior-deficient state invites wind, causing Spasm (stiffness). Fumigation forces sweat, leading to urinary retention and Jaundice (heat transforming with dampness). Moxibustion injures Lung with Fire, causing persistent cough and expectoration.

[Ji Zhu - Collected Annotations] Cheng Wuji states: Purging allows evil heat to flow into the chest as empty vexation (Ao Nu). Diaphoresis leaves the exterior empty; heat enters collaterals, generating wind, causing stiffness/spasm. Fumigation combines fire/heat, consuming fluids, causing urinary difficulty and jaundice. Lung fears fire; moxibustion injures Lung, causing cough/expectoration.

Gao Shizong states: Diaphoresis, purging, and fumigation differ in method but equally damage Zheng Qi; thus they are discussed together.

Wei Litong states: This clarifies that even with exterior signs requiring sweating, contraindications must be carefully observed. Headache/moderate fever resembling wind-stroke is a Guizhi Tang pattern. Vomiting indicates internal fluid retention. Mistaken purging increases vexation/restlessness, implying pre-existing vexation. Mistaken diaphoresis leaves exterior empty, inviting wind (stiffness). Fumigation forces heat inward, blocking urination. Jaundice implies urine blockage by dampness and consumption by heat. Moxibustion sends heat upward, causing cough and purulent sputum.