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Question: Regarding the pulse, when the fingers first press down, it appears floating and large, but after prolonged pressing, it feels empty and lacking substance; or when the fingers first press down, it feels soft and soggy, but after prolonged pressing, it beats forcefully against the fingers; or when the fingers first press down, it is slightly wiry, but after prolonged pressing, it feels harmonious and moderate. What is the reason for this?

Answer: When diagnosing external pathogenic factors causing acute sudden diseases, a floating pulse upon initial palpation can confirm the condition. However, when palpating patients with deficiency and emaciation suffering from chronic long-term diseases, one must take the root qi (fundamental energy) as the basis. For instance, a pulse that is floating and large upon initial touch but empty and lacking substance upon prolonged pressing indicates a severe deficiency of righteous qi (vital energy). Regardless of whether it is an acute sudden disease or a chronic long-term disease, even if symptoms manifest as obvious burning heat and restlessness, these are all signs of righteous qi failing to maintain autonomy, leading to deficient yang revealing itself externally. A pulse that feels soft and soggy upon initial touch but beats forcefully against the fingers upon prolonged pressing indicates internal pathology with harmonious exterior qi. This is not due to injury to zang-organ qi, but rather implies hidden firm accumulations internally; one should not mistake a deep pulse for deficiency-cold. A pulse that is slightly wiry upon initial touch but becomes harmonious and moderate upon prolonged pressing indicates a long-term disease tending towards recovery. Although qi and blood may be critically depleted, the zang-organ qi has not yet failed. However, clinically, there are often cases where symptoms change in various ways, while the pulse gradually becomes smaller and weaker, feeling slightly harmonious under the fingers, seemingly indicating a chance of recovery. This actually signifies that both yuan qi (original qi) and pathogenic qi have detached, resulting in no pathological manifestations appearing; this is a sign where the pulse does not correspond to the disease, rather than indicating that a small pulse means the disease is receding. Generally speaking, for a patient's pulse, if it initially feels weak or wiry and irregular under the fingers, but gradually becomes harmonious after about ten beats, treatment will likely succeed. If the pulse seems harmonious initially but becomes slightly choppy and fails to respond upon prolonged pressing, or gradually feels wiry and stiff, treatment will likely fail. Assuming the disease is lingering, but diet gradually increases and urination/defecation naturally regulate, this is also a sign of gradual recovery of stomach qi. The Classics state: "Those who can eat have stomach qi." When gruel and porridge enter the stomach, the deficient person survives. This is such a manifestation.

Question: There are cases where diseases are the same but pulses differ, diseases differ but pulses are the same, diseases are the same but treatments differ, and diseases differ but treatments are the same. What is the reason?

Answer: Regarding "same disease, different pulse," humans live within the intersection of heaven and earth qi, contracting the six excesses (wind, cold, summerheat, dampness, dryness, fire) and seven emotions, as well as eight winds and nine qi variations. Sudden illnesses at any given time are generally similar. Thus, observed symptoms are also mostly similar. However, each person's constitution varies in excess and deficiency, and there are differences in internal damage to spirit/mind and external strain on limbs. How can pulses be identical? For example, in blood-loss syndromes, pulses may be floating, large, and hollow (Kou pulse), or small, weak, and rapid, differing based on whether the stomach or zang-organs are injured. In qi-deficiency syndromes, pulses at the Qi Kou position may be deficient, large, and choppy, or small, thin, and weak, differing based on the nature of labor injury or depletion.

Regarding "different diseases, same pulse," this refers to internal injuries complicated by external contractions, yang syndromes complicated by yin-cold, deficiency with solid knots, new pathogens carrying old pathogens, and interlaced interior-exterior issues. Pathologies vary, but the manifested pulse always revolves around the mechanisms of yin-yang, cold-heat, and deficiency-excess. How can subtle symptom details fully reveal themselves under the fingers? For instance, Taiyang wind-strike presenting with paralysis and numbness shows a floating-slow pulse; one is an acute external contraction, the other a chronic deficiency disease. Consumption with bone-steaming fever and malaria chills/fevers show wiry-tight pulses at Guan and Chi positions; one is kidney yang deficiency, the other Shaoyang pathogen excess. Can one ignore correlating pulse and symptoms and treat indiscriminately?

Regarding "same disease, different treatment," conditions like wind-pathogen diseases, seasonal epidemic diseases, malaria/dysentery diseases, and internal injury consumption diseases often present with similar initial symptoms. However, constitutions vary in resilience and fragility, and individuals may have tendencies toward excessive fire, phlegm, or qi. Since baseline constitutions differ, treatments during illness must differ. For example, in *Jin Gui Yao Lue*, shortness of breath with slight fluid retention is treated by promoting urination using Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction); Shen Qi Wan (Kidney Qi Pill) is also used. For thirst with difficult urination, Pu Hui San (Cattail Pollen Powder) is used; Hua Shi Bai Yu San (Talcum, White Fish, and Powder Decoction) and Fu Ling Rong Yan Tang (Poria, Tallow Tree Salt, and Decoction) are also used. If treating disease without seeking its root, ignoring the true or false appearance of pulse and symptoms, and merely treating the disease name, one severely deviates from the principles of counteracting and correcting deviations.

Regarding "different diseases, same treatment," although observed symptoms differ, they ultimately revolve around the deficiency and excess of pathogens and righteous qi. For example, Ying qi insufficiency due to slow pulse at Chi position in Shang Han (Cold Damage), abdominal pain due to inward collapse of yang pathogen, palpitations, epistaxis, and seminal emission due to internal tension in Xiao Lao (Consumption) are all suitable for Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Febrile diseases due to latent pathogen郁发 (stagnation and eruption), and Yue Bing (Heatstroke) due to Taiyang heat are all suitable for Bai Hu Tang (White Tiger Decoction). Abdominal and hypochondriac urgency due to Han Shan (Cold Colic), and abdominal pain postpartum are all suitable for Dang Gui Sheng Jiang Yang Rou Tang (Angelica Sinensis, Fresh Ginger, and Mutton Decoction). How can one assume one formula treats only one disease, failing to understand the application of flexibility and adaptation?