Library

Cannot penetrate. It is like a ruler who cannot extend benevolence far and wide, and the spring-like compassion of Heaven and Earth, which acts as parents, appears particularly thin here; therefore it is called "Ren Bu" (Inhumanity/Lack of Penetration). Thus, not only can the heaviness and stagnation of Bi syndrome (Obstruction Syndrome) not be used to name this condition, but even cases that seem similar to numbness cannot replace it. This is because the heaviness and stagnation of Bi syndrome, as well as numbness, are diseases originating from the limbs themselves. Therefore, speaking from the perspective of the diseased part, the skin of the hands and feet itself has no pathology. This discussion focuses on the aspect of Heart Yang failing to penetrate. The ancients described the subtleties of disease in such detail.

Article 20: If the pulse is rapid and tight, it is a Xian pulse (Wiry Pulse), resembling the string of a bow, and does not shift when pressed. For a rapid and wiry pulse, cold should be purged using a draining method. For a tight, large, and slow pulse, there must be hardness in the Xin Xia (epigastric region/sub-xiphoid area). For a large and tight pulse, there is Yin within Yang, and a draining method may be used.

If a patient suffers from Shan (Hernia/Colic), and upon examining the Mai Yang (Stomach Meridian) pulse, lifting reveals a rapid pulse, while pressing reveals tension at both ends and tightness, this is a Xian pulse. Although named similarly to Jin (Tight), it is not like a twisting rope. The Xian pulse resembles a bowstring; pressing down does not cause it to move, presenting an image of tension at both ends, hence also referred to as Jin. In reality, it is Rapid and Wiry. The two instances of "Jin" in the following text share the same meaning. The Jin pulse resembling a twisting rope represents true Yin-Cold, a sign of fading Yang about to extinguish, requiring strong warming and moxibustion, with only one chance of survival out of nine; how could one dare to use purging? Whenever "Xian Jin" or "Jin Xian" is mentioned, it refers to urgent tightness, specifically the vigorous and swift nature of the Xian pulse. The so-called Rapid-Wiry pulse arises because Yin-Cold Shan rises to attack Yang positions, persisting for a long time, causing weak Yang to lose its function of descending and transforming, leading to constipation. On one hand, false heat accumulates; on the other, Stomach fluids dry up, resulting in a rapid pulse. Furthermore, Xian belongs to the Liver meridian. A Xian pulse like a bowstring that resists pressure indicates Wood becoming rigid due to Cold. For conditions with Heat and fluid depletion, purging is indicated. However, for pathogenic Yin-Cold rising to become rigid and urgent, it is necessary to combine warm herbs to purge the cold. The subsequent pulses expand upon the Rapid-Wiry theme. Generally, if the Mai Yang pulse is solidly Wiry and seemingly Tight, yet Large and Slow, Wiry-Tight indicates Liver Qi attacking upward; Large indicates emptiness in the center and shortness of fluids; Slow indicates sluggish beating and Yang deficiency. Xin Xia is the Wan (pylorus/upper stomach); if both Yin and Yang in the Stomach are deficient, and Liver Wood attacks via Cold-Shan, how can it not result in hardness in the epigastrium? Additionally, Large is the fundamental pulse of the Yang-Fu (Stomach). Pressing and finding Solid-Wiry-Simulating-Tight indicates obvious pathogenic Qi from a Yin-Zang (Liver) invading a Yang-Fu. Saying "Ke Xia" (can be purged) means all these cases can be treated by using warm herbs to purge the cold.

Article 21: Question: How can one distinguish Su Shi (Retained Food)? The Master said: If the Cun Kou (Radial artery at the wrist) pulse is Floating and Large, but feels Slippery (Se) upon pressing, and the Chi position is also faint and Slippery, then one knows there is retained food. Da Cheng Qi Tang (Major Order the Qi Decoction) is the primary formula.

These three articles follow Article 13 regarding abdominal fullness that does not decrease, setting up a Q&A to elaborate further on the pulse and symptoms indicating internal excess suitable for purging. The Stomach is the Sea of Water and Grain; its transformed fluids ascend via the Spleen to nourish the Lungs and descend via the Lungs to irrigate the Liver and Kidneys. Cun Kou corresponds to the Heart and Lungs. If the pulse is Floating and Large upon lifting, and Slippery upon pressing: Floating indicates Qi mechanism depression upward; Large is the fundamental pulse of Yang Ming; Slippery indicates lack of fluid nourishment. Moreover, Floating implies voidness at the base, and Large implies hollowing in the center. The opposite of Floating-Large coincides with the fluid-deficient Slippery pulse. This means Yang Ming Qi fails to descend smoothly and instead depresses in the empty spaces between the Heart and Lungs, without the response of Stomach fluids ascending to nourish. Chi corresponds to the Liver and Kidneys. Faint upon lifting and Slippery upon pressing indicates that Wei Zhong (Stomach) lacks Hao Qi (Pivotal Qi/Hao-Gas) to fill downward, hence Faint; it lacks Jing Zhi (Essential Fluids) to moisten downward, hence Slippery. This aligns with the Classic's statement: "When Er Yang (Yang Ming/Stomach and Intestines) disease occurs, there is inability to express hidden concerns [emotional/excretory blockage], and women experience amenorrhea." At Cun Kou, rebellious Heat floats while Earth fluids do not steam; at Chi, Hao Qi declines and Essential Fluids do not irrigate. Could this dry, floating, void, and dry pulse be anything other than Su Shi internally knotted in the Stomach Fu, leaving Yang fluids too busy saving themselves? This infers the indication for Da Cheng Qi Tang from the upper and lower extremes of the Stomach—this is point one.

Article 22: A Rapid and Slippery pulse indicates Excess. This signifies retained food; purging is appropriate, preferably with Da Cheng Qi Tang.

Not specifying the location but simply saying "pulse," it generally refers to Yang Ming. The final two mentions of "Jin" have the same meaning. Rapid indicates disease in the Fu organs, and Rapid also indicates Heat. Slippery indicates grain Qi self-aggregating and failing to irrigate the surroundings. Since there is Heat in the Fu and grain Qi self-aggregates, is this not Wei Shi (Stomach Excess)? This infers the indication for Da Cheng Qi Tang from the fundamental position of the Stomach—this is another point. Saying "Excess" and then "retained food" is not redundant. "Excess" describes the symptom, while "retained food" answers the question.

Article 23: Diarrhea accompanied by loss of appetite indicates retained food; purging is required, preferably with Da Cheng Qi Tang.

This closely follows the previous sentence regarding the Rapid and Slippery pulse. If the pulse were not Rapid and Slippery, diarrhea with loss of appetite could not be diagnosed as caused by retained food. It refers to the Yang Ming pulse being Rapid and Slippery. If diarrhea occurs despite this, Rapid indicates excessive Stomach Fire, and Slippery indicates the return of grain Qi; one should normally be able to eat. Now, since there is no desire to eat, it is because retained food occupies the Stomach sector. The reason for diarrhea is Qi stagnation causing peripheral flow. That is, as long as there is no desire to eat, even if diarrhea has occurred, one cannot interpret the Rapid-Slippery pulse as a loose/purging pulse. This infers the indication for Da Cheng Qi Tang from observing dietary intake—this is another point.

Article 24: Retained food in the Shang Wan (Upper Stomach) should be expelled via vomiting; Gua Di San (Melon Tip Powder) is appropriate.

Gua Di San Formula: Gua Di (Melon Tip, 1 fen, roasted), Chi Xiao Dou (Red Adzuki Bean, 1 fen, boiled).
Grind the above two ingredients into powder. Boil Xiang Chi (Black Soybean Paste, 7 he) to extract juice. Mix with one qian bi of the powder and take warm. If vomiting does not occur, increase the dose slightly. Stop when vomiting is thorough. Contraindicated in patients with blood loss and various deficiency patterns.

Wan refers to the tube of the Stomach, extending from the throat to the Stomach, divided into three parts, hence Upper, Middle, and Lower Wan. Li Shi referenced Ren Mai acupoints to annotate this, which is incorrect. If retained food is in the Shang Wan of the Stomach and has not entered the Stomach Fu, using Da Cheng Qi Tang to purge would mean the food is high while the purgative medicine is low and cannot reach it, merely injuring Stomach Qi unnecessarily. It is more convenient to induce vomiting. Gua Di grows on vines, has a bitter and cold taste, and its nature tends upward, resisting downward descent. Vining growth allows it to traverse Stomach collaterals; bitterness causes the Stomach ligaments to contract and curl. All cold-natured substances are disliked by the Stomach. Its upward tendency prevents downward descent, thus forcing Stomach Qi upward to induce vomiting. However, vomiting damages Yin, causing Fire Qi to float upward, inevitably leading to irritability and restlessness (Ao Nao) in those who vomit. Xiang Chi nourishes Yin and descends Qi; boiling it to mix with the powder serves as a preventive measure to counterbalance this bias.

Article 25: A pulse that is Tight like a twisting rope and variable indicates retained food.

Jin (Tight) indicates Cold. Tight like a twisting rope suggests the rope's firm contraction and shortening during rotation. In the Yang Ming Stomach Fu, if firm contraction and shortening appear due to Cold constriction, is this not retained food?

Article 26: Tight pulse, headache, aversion to wind and cold, indicate retained food in the abdomen that is not digesting.

The Tight pulse continues from the previous description of twisting. Headache is the response to knotted Qi in the Stomach rushing upward. Aversion to wind and cold occurs because there is no Hao Qi (vigorous Qi) to circulate as Wei Qi (Defensive Qi). Thus, one knows there is undigested retained food. Both this article and the previous one require focusing on the word "Tight" in the pulse, especially the Tight pulse in the Yang Ming region. Tight like a twisting rope indicates Yang deficiency and Cold in the Stomach, failing to transform and transport, leading to stagnant retained food. This differs greatly from the purging indications in Articles 21-23. Therefore, the previous articles merely stated "retained food," and this one states "undigested retained food," providing no formulas. The implication is that warming Stomach Yang to aid self-digestion is preferred over attacking with purges. Even if purging is不得已 (unavoidable), warm herbs like Da Huang (Rhubarb) and Fu Zi (Aconite) should be used. Furthermore, the pulse and symptoms here resemble Tai Yang Shang Han (Cold Damage), yet they are distinctly diagnosed as undigested retained food because the Tight pulse is specific to the Yang Ming region, and external symptoms like headache and aversion to wind/cold are absent in typical Yang Ming Wind-Cold patterns. Observing the intersection of meridians and Fu organs reveals that the exterior is not Tai Yang Cold Damage, but the interior is Yang Ming retained food pulse. Hence, emphasis is placed on the Tight pulse, particularly in the Yang Ming region.