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The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft (Ru) pulse appears at the Cun position (top). The faint (Wei) pulse appears in the upper part, and the choppy (Se) pulse appears in the lower part. A faint pulse indicates insufficiency of Yang Qi; a choppy pulse indicates absence of Blood. If Yang Qi is faint, and after contracting wind-stroke with sweating, restlessness and vexation occur instead; if the choppy pulse indicates absence of Blood, cold limbs and coldness will ensue. When Yang Qi is faint, purgation must not be used. If purgation is wrongly applied, epigastric fullness and hardness will result.

If there is pulsation around the navel on the right side, purgation must not be used. Wrong purgation leads to exhaustion of internal body fluids, causing dry throat, dry nose, dizziness, and palpitations.
If there is pulsation around the navel on the left side, purgation must not be used. Wrong purgation leads to abdominal cramping and tightness, inability to eat, and intensified pulsation around the navel. Even if there is body heat, the patient desires to lie curled up.
If there is pulsation around the navel above, purgation must not be used. Wrong purgation leads to hot and vexed palms, alternating sensations of cold and heat on the body, spontaneous sweating, and a desire to drink water and pour it over oneself.
If there is pulsation around the navel below, purgation must not be used. Wrong purgation leads to abdominal distension, dizziness upon sudden rising, undigested food in stool after eating, and epigastric stuffiness.

A sensation of obstruction in the throat requires that purgation must not be used. Wrong purgation leads to a feeling of lightness above and heaviness below, inability to swallow liquids, desire to curl up when lying down, abdominal pain, and diarrhea occurring dozens of times a day.
In cases of exterior excess syndromes, purgation must not be used. Wrong purgation induces slight fever.
In cases where the pulse is lost and cold limbs occur, warmth should be applied by holding the area around the umbilicus.
In all deficiency syndromes, purgation must not be used. Wrong purgation leads to intense thirst for water. Thirst for water indicates an easier condition to cure; aversion to water indicates a severe condition.

The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft (Ru) pulse appears at the Cun position. The wiry (Xian) pulse appears in the upper part, and the faint (Wei) pulse appears in the lower part. A wiry pulse relates to Yang movement; a faint pulse relates to Yin cold. Upper excess and lower deficiency indicate a desire for warmth. Faint and wiry indicate deficiency; deficiency syndromes must not be treated with purgation.
If a faint pulse causes coughing, leading to expectoration of saliva, wrong purgation may stop the cough but will cause unceasing diarrhea. Unceasing diarrhea feels like insect bites in the chest; drinking gruel causes vomiting; urination is difficult; hypochondriac regions are tight and painful; breathing is labored; neck and back are drawn together; arms are numb. In extreme cold conditions with spontaneous sweating and icy cold body, eyes are dim, speech is incessant, yet grain qi intake is high; this is called "Chu Zhong" (Eliminating Middle), also known as Xiao Zhong. Although the mouth wants to speak, the tongue cannot extend forward.

The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft (Ru) pulse appears at the Cun position. The floating (Fu) pulse appears in the upper part, and the rapid (Shu) pulse appears in the lower part. A floating pulse indicates Yang deficiency; a rapid pulse indicates absence of Blood. Floating indicates deficiency; rapid generates heat. Floating with deficiency causes spontaneous sweating and aversion to cold; rapid indicates pain, trembling, and chills. Weakness at the Guan position causes urgency below the chest, panting, sweating, and difficulty breathing; pain occurs in the hypochondrium during respiration; trembling colds clash, resembling malaria. If the physician wrongly uses purgation, it results in a rapid pulse, fever, running wildly, seeing ghosts, epigastric stuffiness, dribbling urination, extreme hardness in the lower abdomen, and hematuria.

The pulse is soft and tight; soft indicates weak Wei Qi (Defensive Qi); tight indicates Cold in Ying Blood (Nutritive Blood). Weak Wei Qi allows wind-stroke, causing fever and aversion to cold; tight Ying Blood causes cold Stomach Qi, slight vomiting, and internal vexation. If the physician mistakes this for excessive heat and uses diaphoresis to release the muscle layer, it leads to loss of Yang, deficiency-induced restlessness, and bitter epigastric stuffiness and hardness. With both interior and exterior exhausted, sudden rising causes dizziness. External heat remains on the skin, causing discomfort and insomnia, unaware that Stomach Qi is cold. Tight cold at the Guan Yuan point renders medical skills useless. Pouring cold water on the body makes external heat cease quickly, but causes shivering and trembling cold. Covering with heavy quilts still results in coldness; sweating reaches the crown; body trembles; urination becomes slightly difficult. Cold Qi triggers undigested stool due to water, vomiting, and intestinal prolapse, causing restlessness. Cold limbs and slight reversal occur; body is cold with internal vexation. How can rescue from behind recover what has passed?

The pulse is floating and large; floating indicates Qi excess, large indicates Blood deficiency. Blood deficiency means lack of Yin, leaving solitary Yang alone. If evil descends to the Yin region, urine should be red and difficult, and the Bladder cavity should be empty. Instead, urination is free and sweating is profuse. According to principles, Wei Qi should be weak, but now it is excess, causing fluids to scatter. Ying Blood is exhausted, Blood is depleted, leading to dryness, vexation, and insomnia. Thin blood and wasting flesh result in acute disease (or black fluid). If the physician uses toxic drugs to attack the Stomach again, this is double deficiency. The departure of external Yang has a deadline; death will come with stool like mud.

The pulse is floating and tight; floating indicates Wind, tight indicates Cold. Wind injures Wei Qi, Cold injures Ying Blood. Both Wei and Ying are diseased, causing bone and joint pain. Sweating should be induced, not purgation.
At the Foot-Yang position, a slow and moderate pulse indicates normal Stomach Qi. A floating and rapid pulse at the Foot-Yang position: floating injures the Stomach, rapid moves the Spleen. This is not the original disease but caused by the physician's erroneous purgation. Ying and Wei sink inward; the rapid pulse first becomes faint. The pulse reverses to only floating; the person will likely have hard stool, belching, and Chu Zhong. Why? Originally, the rapid pulse moved the Spleen; since the rapid pulse became faint, we know Spleen Qi is disordered, causing hard stool, belching, and Chu Zhong. Now the pulse is floating, and the rapid has become faint; evil Qi remains alone. The heart feels hungry, but evil heat cannot digest grain, causing tidal fever and thirst. A rapid pulse should be slow and moderate. If the pulse degrees follow the rules before and after, the patient feels hungry. If the rapid pulse is irregular, sores may arise.
A rapid pulse lasting long without stopping indicates evil knotting. When it stops, Zheng Qi cannot recover; Zheng Qi retreats and knots in the Zang organs, so evil Qi floats to the skin and hair. Rapid pulses must not be purged; purgation causes vexation and unceasing diarrhea.

In Shao Yin disease, if the pulse is faint, sweating should not be induced to avoid loss of Yang. If Yang is already deficient and the Chi position shows weak and choppy pulses, purgation must not be used.
If the pulse is floating and large, sweating should be induced. If the physician wrongly purges, this is a major error.
If the pulse is floating and large, but the epigastrium is hard with heat belonging to the Zang, attack it without inducing sweat; if belonging to the Fu, do not induce frequent urination. Frequent urination makes stool hard; profuse sweating increases heat; little sweating makes stool difficult. If the pulse is slow, attack is not yet possible.
When Tai Yang and Yang Ming diseases combine: if Tai Yang was just contracted and sweating was induced but not thorough, it transfers to Yang Ming, continuing with slight sweating and no aversion to cold. If Tai Yang symptoms persist, purgation must not be used; this is adverse.
In Jie Xiong (Chest Binding) syndrome, if the pulse is floating and large, purgation must not be used; purgation leads to death.
In combined Tai Yang and Yang Ming disease with wheezing and chest fullness, purgation must not be used.
In combined Tai Yang and Shao Yang disease with epigastric hardness, stiff neck, and dizziness, purgation must not be used.
In all cases of Ni Jue (Reversal Cold), purgation must not be used. This applies equally to those with deficiency constitutions.
If the patient desires to vomit, purgation must not be used.
In Tai Yang disease, if exterior symptoms are unresolved, purgation must not be used; this is adverse.
If disease originates from Yang and is wrongly purged, heat enters and forms Jie Xiong; if originating from Yin and wrongly purged, Pi (Stagnation) forms.
If the disease pulse is floating and tight, and purgation is wrongly applied, the tightness enters the interior forming Pi.
Diseases with much Yang present involve heat; purgation causes hardness. If originally deficient and heat is attacked, hiccups will occur. Without Yang, with Yin excess and hard stool, purgation causes undigested stool and abdominal fullness.

Tai Yin disease manifests as abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and periodic abdominal pain. Purgation causes hardness below the chest.
Jue Yin disease manifests as thirst, Qi rushing upward hitting the heart, burning pain in the heart, hunger without desire to eat, vomiting roundworms after eating, and unceasing diarrhea if purged.
In Shao Yin disease, if food entering the mouth causes vomiting, and there is a desire to vomit from the heart but inability to do so, with cold hands and feet at onset and a wiry-slow pulse, this indicates excess in the chest; purgation must not be used.
After five or six days of Shang Han, if there is no Jie Xiong, the abdomen is soft, the pulse is weak, and cold limbs recur, purgation must not be used; this indicates loss of Blood, and purgation leads to death.
In Shang Han with fever, headache, and slight sweating, inducing sweating causes delirium; moxibustion causes wheezing and inability to urinate; purgation causes shortness of breath, difficult urination, headache, and stiff back; adding warm needle therapy causes nosebleeds.
In Shang Han, if Yin and Yang pulses are both tight, with aversion to cold and fever, the pulse tends to reverse. Reversal means the pulse starts large, gradually becomes small, then larger again. In such cases, severe aversion to cold, slight sweating, and sore throat occur. If heat is predominant, eyes are red and vision unclear. If the physician induces sweating again, the throat is injured. If purgation is wrongly applied, both eyes close. Cold predominance causes undigested stool; heat predominance causes pus and blood in stool. Moxibustion causes jaundice; ironing causes dry throat. If urination is free, rescue is possible; if difficult, the condition is critical.

In Shang Han with fever, bubbling breath from the mouth, headache, yellow eyes, uncontrollable nosebleeds, craving water leads to vomiting; aversion to water leads to cold limbs. If purged, sores form in the throat. If hands and feet are warm, there is heaviness in the rectum and pus/blood in stool. If head/eyes are yellow and purged, eyes close. If craving water and purged, the pulse becomes reversed, voice is hoarse, and throat is blocked. If sweated, chills occur, and Yin/Yang are both deficient. If aversive to water and purged, interior cold occurs, appetite is lost, and undigested stool passes. If sweated, mouth injuries and white tongue coating occur. Vexation, solid rapid pulse, and constipation for six-seven days lead to bloody stool. If sweated, urination becomes free.
On the second or third day of illness, if the pulse is weak, without Tai Yang or Chai Hu symptoms, but with vexation and epigastric stuffiness: by the fourth day, even if able to eat, give a small amount of Cheng Qi Tang to mildly harmonize and bring slight relief. By the sixth day, give one sheng of Cheng Qi Tang. If no bowel movement for six-seven days but urination is scant, although no bowel movement, only the head is hard, stool will later be loose. Do not attack until hardness is certain. Wait for free urination and confirmed hard stool before attacking.
Zang Jie (Knotting in Zang) without Yang symptoms, no alternating cold and heat, quiet patient, and slippery tongue coating: do not attack.
In Shang Han, if there is much vomiting, even with Yang Ming symptoms, attack must not be used.
In Yang Ming disease, with tidal fever and slightly hard stool, Da Cheng Qi Tang may be given; if not hard, do not give. If no bowel movement for six-seven days and suspecting dry stool, give a small amount of Xiao Cheng Qi Tang. If gas passes after ingestion, dry stool exists, and attack is possible. If no gas passes, only the head is hard and stool is loose later; do not attack. Attacking causes distension and inability to eat. Giving water to one desiring it causes hiccups. Subsequent fever leads to harder, less stool; use Xiao Cheng Qi Tang to harmonize. If no gas passes, strictly do not attack.
In Shang Han Zhong Feng, if wrongly purged, daily diarrhea of dozens of times occurs with undigested food, borborygmus, epigastric hardness/fullness, dry heaves, and vexation preventing peace. Seeing epigastric stuffiness, the physician thinks disease remains and purges again, worsening stuffiness. This is not accumulated heat but Stomach deficiency with rebellious Qi, causing hardness. (Gan Cao Xie Xin Tang)
Diarrhea with a large pulse indicates deficiency caused by strong purgation. If the pulse is floating and thin (Ge), accompanied by borborygmus, (Dang Gui Si Ni Tang) is indicated.
In Yang Ming disease, if the whole body is red, do not attack; it will cause fever and yellowing with difficult urination.
In Yang Ming disease, if the epigastrium is hard and full, do not attack. If attacked and diarrhea continues unceasingly, death ensues; if it stops, recovery occurs.
In Yang Ming disease, with spontaneous sweating, or induced sweating, and free urination, this indicates exhaustion of internal fluids. Even if stool is hard, do not attack. Wait for the desire to defecate and use Honey Suppository to guide passage. Melon root or pig bile can also be used as guides.

Yun: Non-Yang Ming primary diseases must not be purged. Yang Ming primary disease is Stomach Excess. Non-Pi, Fullness, Dryness, and Excess must not be purged. Non-Tidal Fever and Thirst must not be purged. Non-Abusive behavior towards relatives/strangers must not be purged. Non-Sunken-Rapid pulse must not be purged. Non-Discarding clothes, climbing roofs, singing, and seeing ghosts must not be purged.
Huo: Floating pulse: do not purge. Weak pulse: do not purge. Aversion to cold: do not purge. Vomiting: do not purge. Loss of flatus: do not purge (passing gas indicates downward discharge). Clear urine: do not purge. Hard stool with frequent urination: do not use Cheng Qi Tang (this is Pi Yue Wan syndrome). Hard stool with scant urination: do not attack yet. Yang Ming disease with spontaneous sweating, induced sweating, and free urination: do not purge (use Honey Suppository).
Wu: Cases with aversion to wind/cold, abdominal fullness that reduces sometimes, distension that can be rubbed/massed, soft deficiency, Yin deficiency, fatigue, cold extremities, weak Chi pulse, superficial pulse, sunken-ineffective pulse, weak pressure, blood loss, deficiency constitutions, women with regular/interrupted menstruation, Heat entering Blood Chamber, pre/post-natal bleeding, frequent clear urination, and constipation: all must not be purged.
Dai: Although Yang Ming purge indications are present, if the patient has wheezing/cough or slight aversion to cold (Tai Yang-Yang Ming), or alternating cold/heat (Shao Yang-Yang Ming), and Tai Yang/Shao Yang symptoms persist within Yang Ming syndrome, this is not true Yang Ming. Be cautious about immediate purgation. Ancient notes mention three types of Yang Ming; one must recognize this.