Library

[Physical Characteristics] The Lao pulse (Firm Pulse) is located at the deep level; its form is large, wiry, and solid. It cannot be detected at all at the superficial and middle levels.

[Main Diseases] The Lao pulse indicates firm accumulations within the interior. A Lao pulse at the left Cun position indicates Fuliang disease (abdominal mass). A Lao pulse at the right Cun position indicates Xifen disease (lung accumulation). A Lao pulse at the left Guan position indicates blood stasis and accumulation in the Liver.
A Lao pulse at the right Guan position indicates cold-induced epigastric masses or癖积 (fixed lumps). A Lao pulse at the left Chi position indicates Ben Tun disease (Qi rushing upward from the lower abdomen to the chest). A Lao pulse at the right Chi position indicates severe pain from hernia and Jia masses (abdominal tumors).

[Commentary] The term "Lao" has two meanings: one refers to being firm and solid, and the other refers to being deeply situated within. Therefore, trees are described as having a "firm" root because they are deeply rooted underground. Prisons are called "Lao" because prisoners are deeply confined inside. Zhang Zhongjing said, "Cold makes things firm," implying another meaning of solidity. Shen Shi said, "Resembling Chen (Deep) and Fu (Hidden), this is the positional characteristic of Lao; Solid, Large, Wiry, and Long, this is the physical characteristic of Lao." Regarding the diseases indicated by the Lao pulse: because it is located at the deep level, all such conditions belong to Yin-Cold syndromes; because its shape is wiry and solid, all such conditions represent firm accumulations. For individuals who have lost blood or essence, the interior is deficient, and they should present with a Ge pulse (Leather Pulse), which would be the correct image; if they instead present with a Lao pulse, the pulse contradicts the symptoms, indicating that death is imminent. A spurious prescription states, "Absent when searching lightly, present when pressing heavily," describing only a vague presence without mentioning the solid, large, wiry, and long characteristics; this describes a Chen pulse, not a Lao pulse. It further states, "The pulse enters the skin, making breath differentiation difficult," treating Lao as a pulse of death; how can such errors be enumerated? Wang Shuhe's *Mai Jing* (Pulse Classic) states, "The Lao pulse resembles Chen and Fu, is solid, large, long, and slightly wiry," which describes its morphology comprehensively. As for the Fu pulse (Hidden Pulse), even with heavy pressure, it is invisible; one must push the tendons to the bone to see its form. However, since the Lao pulse is already solid, large, wiry, and long, it feels full and powerful upon slight heavy pressure; how can it be described as "resembling Fu"? The principles of pulse diagnosis are profound and difficult to understand. Without scrutinizing every word and examining them repeatedly, how can the doubts left for future generations be resolved?

[Physical Characteristics] The San pulse (Scattered Pulse) is floating and chaotic, existing only on the surface without a root in the interior. At the middle level, it gradually becomes empty; upon heavy pressure, it disappears completely.

[Main Diseases] The San pulse indicates damage to the fundamental Qi; its appearance signifies critical danger. A San pulse at the left Cun position indicates palpitations (Zhengchong) and insomnia. A San pulse at the right Cun position indicates profuse spontaneous sweating. A San pulse at the left Guan position suggests Yi Yin disease (water retention in the limbs and skin).
A San pulse at the right Guan position indicates abdominal distension and Gu disease (ascites with emaciation). A San pulse at the left Chi position indicates exhaustion of Kidney Water. A San pulse at the right Chi position indicates the extinction of Yang and the end of life.

[Commentary] The term "San" has two meanings: one is the image of gradually fading away, and the other is the image of being scattered and disordered. When felt at the superficial level, it appears grand and distinct as a pulse; however, at the middle level, it suddenly feels weak, reducing by seventy to eighty percent; at the deep level, it is imperceptible. With increasing pressure, it gradually vanishes; with decreasing pressure, it gradually reappears. Understanding these eight characters clarifies the meaning of "San" and firmly establishes the morphology of the San pulse. Thus, Wang Shuhe stated, "The San pulse is large and scattered, having a surface but no interior," words carefully chosen without negligence. Cui Shi said, "Dispersed and unrestrained," where "dispersed" implies floating and large, and "unrestrained" implies lacking a root; although he grasped the general idea, his description was not precise enough. Liu Shi said, "Without order, without constraint, irregular in rhythm, sometimes coming more and going less, sometimes going more and coming less, scattered and unrestrained, like willow catkins drifting aimlessly." Willow catkins drifting aimlessly refers to being light-floating and rootless. His mention of irregular rhythms and varying quantities describes a scattered and unrigorous image. This supplements the incomplete points in Wang Shuhe's work and captures the essence of the San pulse. Dai Tongfu said, "Heart pulse floating, large, and scattered; Lung pulse short, choppy, and scattered; these are normal pulses (Ping Mai). Heart pulse soft, scattered, accompanied by palpitations; Lung pulse soft, scattered, accompanied by sweating; Liver pulse soft, scattered, accompanied by Yi Yin; Spleen pulse soft, scattered, accompanied by edema; these are pathological pulses. Kidney pulse soft and scattered; any pathological pulse appearing as scattered is a death pulse." Ancients considered the simultaneous appearance of Dai (Intermittent) and San pulses as a sign of certain death. Generally, the San pulse is a sign of Kidney failure, while the Dai pulse is a sign of Spleen exhaustion. The Kidney pulse is naturally deep, but the San pulse is imperceptible upon pressure, indicating the severance of the congenital foundation. The Spleen pulse governs regularity, but the Dai pulse shows intermittent beats without missing their cycle, indicating the severance of the acquired foundation. Therefore, the independent appearance of either pulse is a critical sign; their simultaneous appearance is an even stronger omen of certain death.