典藏书目

Taiyang disease (disease of the Taiyang channel) resolving with sweating without shivering; Yangming disease (disease of the Yangming channel) resolving without sweating without shivering; Shaoyang disease (disease of the Shaoyang channel)...

Question: In a case of Shanghan (Cold Damage) on the third day, the pulse is floating, rapid, and fine. The patient's body is cool and peaceful. What is the reason? Answer: This indicates that the disease is about to resolve. The resolution typically occurs at midnight. If the pulse is floating and the disease resolves, it is due to spontaneous sweating. If the pulse is rapid and the disease resolves, the patient will be able to eat. If the pulse is fine and the disease resolves, it is due to profuse sweating.

Cheng Wuji’s Commentary: On the third day of Shanghan, it is the time when Yang qi moves from the exterior to the interior. If the patient has fever, and the pulse is floating, rapid, and large, it indicates that the pathogenic factor is transmitting inward. If the body is cool and peaceful, and the pulse is floating, rapid, but fine, it indicates that the pathogenic factor is not transmitting but is about to resolve. Resolution at midnight occurs because Yang qi arises at Zi hour (midnight). A floating pulse indicates resolution through spontaneous sweating, meaning the pathogen disperses from the exterior. A rapid pulse indicates resolution through the ability to eat, signifying harmonized Stomach Qi. A fine pulse indicates resolution through profuse sweating, signifying that the pathogen is weak. The earlier text states that a fine pulse leads to resolution without sweating, while this text states that a fine pulse leading to resolution involves profuse sweating. These two statements seem contradictory. Why? The answer is: The earlier statement refers to cases where vomiting, purging, or blood loss have occurred, causing both healthy Qi and the pathogen to be deficient, unable to produce sweat for resolution. This statement refers to cases where no sweating or purging methods were used, Qi and Blood are unharmed, Healthy Qi is strong, and the pathogen is weak, thus resolving through profuse sweating. These two statements are not contradictory.

Question: When the pulse indicates disease, how can one determine if the condition is improving or not? Answer: If the pulses at the Cun (inch), Guan (bar), and Chi (cubit) positions are equal in magnitude, depth (floating/sinking), and rate (slow/rapid), even if chills and fever persist, this indicates that Yin and Yang pulses are becoming harmonious. Although the condition may be severe, recovery is expected.

When Yin and Yang are imbalanced, disease occurs; when balanced, health prevails. Therefore, in miscellaneous diseases, different pulses arise from internal injury versus external contraction, leading to inequality between the Qi Kou (radial artery) and Ren Ying (carotid artery). Differences in upper/lower excess/deficiency lead to inequalities among Floating/Middle/Sinking depths and Cun/Guan/Chi positions, let alone in Shanghan. Now, since the pulses at Cun, Guan, and Chi are all equal, it is said that Yin and Yang are harmonious, and self-recovery will occur. The *Needle Classic · Forbidden Service Chapter* states: "The Cun Kou and Ren Ying pulses correspond to each other, equal in size like a taut rope, this is called a healthy person." This means equality between the hand's Cun Kou pulse and the throat's Ren Ying pulse indicates health. Another passage states: "If the six pulses of Yin and Yang both stop, the patient must first shiver and sweat to resolve." Some say: Cun, Guan, and Chi each have their respective primary pulses. As mentioned in previous chapters regarding weight pressure (like the weight of beans), the rising/floating and sinking/descending characteristics vary by season (Spring, Summer, Autumn, Winter), each having its proper position without exceeding its grade. Thus, "equal" implies the disease should resolve. If interpreted according to Cheng Wuji’s note, where Cun floats and Chi also floats, Chi floating would be an abnormal equality. How can this be considered recovery?

During Lixia (Start of Summer), a洪大 (Huge-Large) pulse appears, which is the pulse appropriate for the season. If this person is ill with body pain and heaviness, sweating therapy should be induced. If the next day the body pain and heaviness cease, sweating therapy is unnecessary. If sweat comes out spontaneously, recovery will occur the next day. Why? Because obtaining a Huge-Large pulse during Lixia conforms to the seasonal pulse pattern, hence the result. Other seasons follow this principle.

This discussion concerns "non-immediate" Shanghan (latent warm disease). Spring pulses are Wiry (Xian), Summer pulses are Huge (Hong), Autumn pulses are Feather-like (Mao/Floating), and Winter pulses are Stone-like (Shi/Sunken). Obtaining these pulses during their respective seasons constitutes normal pulses, resolving without treatment. Obtaining them out of season constitutes pathological pulses, requiring treatment based on symptoms for recovery. In Summer, obtaining a Huge pulse while the patient suffers body pain and heaviness indicates pathogenic retention, requiring treatment for resolution. By analogy, obtaining Wiry pulses in Spring, Feather-like in Autumn, or Stone-like in Winter, accompanied by corresponding symptoms, requires treatment for recovery.

Question: Regarding any disease, how does one know when it was contracted and when it will resolve? Answer: For example, if contracted at midnight, it resolves at noon the next day; if contracted at noon, it resolves at midnight. Why is it said that contracting at noon resolves at midnight? Because Yang resolves with Yin. Contracting at midnight resolves at noon the next day because Yin resolves with Yang.

Taiyang disease fails to resolve between Si and Wei hours (9 AM – 3 PM); Yangming disease resolves between Shen and Xu hours (3 PM – 9 PM); Shaoyang disease resolves between Yin and Chen hours (3 AM – 9 AM); Taiyin disease resolves between Hai and Chou hours (9 PM – 3 AM); Shaoyin disease resolves between Zi and Yin hours (11 PM – 5 AM); Jueyin disease resolves between Chou and Mao hours (1 AM – 7 AM). Three-Yin diseases often resolve at night.

Cun Kou pulse floating indicates disease in the Exterior; sinking indicates Interior; rapid indicates Fu organs; slow indicates Zang organs. If the pulse is slow, the disease is in the Zang organs.

Earlier it was stated: All pulses that are Floating, Large, Rapid, Active, or Slippery are named Yang pulses; Sinking, Choppy, Weak, Wiry, or Fine pulses are named Yin pulses. *Nan Jing · Chapter 9* asks: How to distinguish Zang and Fu diseases? It answers: Rapid is Fu, Slow is Zang. Rapid indicates Heat, Slow indicates Cold. All Yang pulses relate to Heat, all Yin pulses relate to Cold, thus distinguishing Zang and Fu diseases. This is likely the general principle for dividing Shanghan into Three-Yang and Three-Yin syndromes. However, in miscellaneous diseases, Zang organs can have Heat even with rapid pulses, and Fu organs can have Cold even with slow pulses. One should not rigidly adhere to this.

Fu Yang pulse (pulse at the dorsum pedis) is Floating and Choppy, while Shao Yin pulse is normal. The disease is in the Spleen, and diarrhea is the expected outcome. How do we know? If the pulse is Floating and Large, it indicates Excess Qi and Deficient Blood. Since the current Fu Yang pulse is Floating and Choppy, we know Spleen Qi is insufficient and Stomach Qi is weak. The Shao Yin pulse is Wiry and Floating; seeing this as a harmonious pulse, it is called "normal." If it instead appears Slippery and Rapid, we know pus and blood will appear in the stool.

Fu Yang pulse, also known as Hui Yuan or Chong Yang, is located three cun above Xian Gu on the dorsum of the foot, where the pulse beats. It is the arterial pulse of the Foot-Yangming Stomach Channel. The Stomach is the Sea of Water and Grain, the leader of the Five Zang and Six Fu organs. If Stomach Qi becomes exhausted, water and grain do not enter, the Grain Spirit departs, and the organs receive no nourishment, the pulse ceases, and death ensues. Therefore, one must examine the Fu Yang pulse to observe Stomach Qi. In pulse diagnosis, light and heavy pressure distinguish Qi and Blood. A Floating and Large pulse, excessive on light pressure but deficient on heavy pressure, indicates Excess Qi and Deficient Blood. If light pressure reveals a pulse that is neither large nor smooth, but choppy, it indicates insufficiency of Spleen and Stomach Qi. Insufficiency of Spleen and Stomach Qi leads to failure of transportation and transformation, resulting in diarrhea. Diarrhea belongs to Shao Yin syndrome, hence it is said the Shao Yin pulse is normal. The Shao Yin pulse is typically Fine, Small, Sinking, and Tight, whereas here it is Wiry and Floating, termed harmonious, requiring flexible interpretation. Normally, one should see Wiry and Floating; finding Slippery and Rapid instead indicates pus and blood in the stool, indicating a Tao Hua Tang (Peach Kernel Decoction) syndrome. The Shao Yin arterial pulse is named Tai Xi, located behind the medial malleolus on the calcaneus.

Cun Kou pulse Floating and Tight: Floating indicates Wind, Tight indicates Cold. Wind injures Wei (Defensive) Qi, Cold injures Ying (Nutritive) Qi. With both Ying and Wei diseased, bone joints ache painfully, necessitating sweating therapy.

Wind is a Yang pathogen, residing externally, affecting Wei Qi, moving lightly upward, hence the pulse is necessarily Floating. Cold is a Yin pathogen, residing internally, injuring Ying Qi, causing contraction and constriction, hence the pulse is necessarily Tight. With Ying and Wei diseased and joint pain, one must open the pores to expel the pathogen, thus using Ma Huang Tang (Ephedra Decoction) to induce sweating.

Fu Yang pulse Slow and Moderate indicates normal Stomach Qi. Fu Yang pulse Floating and Rapid: Floating injures the Stomach, Rapid agitates the Spleen. This is not the original disease but results from the physician's erroneous purgation. Ying and Wei sink inward. The Rapid pulse first becomes Fine, leaving only the Floating pulse. The patient will likely have hard stools and belching followed by relief. Why? Originally, the Rapid pulse agitated the Spleen. Since the Rapid pulse first became Fine, we know Spleen Qi is dysfunctional, causing hard stools and belching with relief. Now the pulse is Floating, and the Rapid pulse has changed to Fine. Pathogen remains alone. The heart feels hungry, but pathogenic Heat cannot digest food, leading to tidal fever and thirst. A Rapid pulse should become Moderate. If the pulse degrees before and after conform to the standard (four beats per breath), the patient will feel hungry, eat, and digest properly without issue. If the Rapid pulse does not change, nor does the Fine pulse, appearing out of season, Spleen Qi agitates continuously. Since the Spleen governs muscles, carbuncles will arise.

Stomach pulses are normally Slow and Moderate. Floating and Rapid indicate pathology. Injury to Stomach Qi causes deficiency, leading to Floating; agitation of Spleen Qi causes restlessness, leading to Rapid. This confirms error from purgation. Ying/Wei and Spleen/Stomach Qi are interconnected. Stomach injury and Spleen agitation allow internal pathogens to sink. The Floating and Rapid pulses show the Rapid pulse retreating first, leaving only Floating. Hard stools and belching with relief occur. Originally, the Rapid pulse agitated the Spleen, but it could not sustain agitation, so the Rapid pulse changed to Fine. Knowing Spleen Qi is dysfunctional, who transforms fluids? Fluid deficiency dries the Stomach, causing hard stools. Spleen disease causes belching, relieved by passing gas/stool. Originally, Floating pulse injured the Stomach, stopping at injury, so only Floating remains. Pathogen stays in Spleen, not Stomach. Empty Stomach causes hunger. Stomach accepts but Spleen cannot transform, so food is not digested. Only true Fire in the Spleen can digest food; pathogenic Heat cannot. Undigested food increases Stomach Heat, inevitably causing tidal fever and thirst. (Tiao Wei Cheng Qi Tang may be used). If the Rapid pulse changes to Moderate, and the disease recovers to four beats per breath, hunger and digestion proceed normally. If the Rapid pulse persists, or changes abnormally out of season, Spleen Qi agitates, causing carbuncles.

The Master said: If the patient's pulse is Fine and Choppy, this is iatrogenic injury. Profuse sweating depletes Yang; repeated purgation depletes Yin. The patient loses Blood. Initially, there is aversion to cold, followed by fever without cessation. In summer heat, the patient desires heavy clothing; in winter cold, the patient desires to be naked. Why? Yang deficiency causes aversion to cold; Yin weakness causes fever. Sweating made Yang Qi weak; purgation made Yin Qi weak. In May, Yang Qi is in the Exterior, making the Stomach cold internally. Weak internal Yang cannot overcome cold, hence desire for heavy clothing. In November, Yang Qi is in the Interior, causing internal heat. Weak internal Yin cannot withstand Yang scorching, hence desire to be naked. Additionally, Yin pulse is Slow and Choppy, confirming blood loss.

Profuse sweating injures Yang, causing Fine pulse and aversion to cold. Repeated purgation injures Yin, causing Choppy pulse and fever. Both Yin and Yang are injured, Qi and Blood damaged. Why mention only blood loss? Purgation depletes Yin; sweating also relates to Blood. In internal deficiency, summer Yang in Exterior leaves interior empty of Yang, unable to withstand winter cold. Winter Yang in Interior leaves interior Yin deficient, unable to withstand Yang heat. However, Wiry, Fine, and Choppy pulses, weak on pressure, often present with aversion to cold. If shivering persists, or irritability arises, feeling hot like sitting in a steamer, removing clothes or drinking cold water brings relief. Shivering returns; it is not exclusively summer cold or winter heat. This establishes a principle. Wang Haizang said: In June, great heat, yet suffering great cold, difficult breathing, cool body, slow pulse. How to treat? Disease has Root and Branch. Heat is Root, Cold is Branch. Cooling follows season but misses Root; heating follows Root but misses season. Thus, treat via the Middle. Middle treatment uses Warmth. But Warmth cannot treat Great Cold; Ginger and Aconite are needed. Using them seems contrary to "Warm" treatment. However, reducing cold intensity until pulse reaches four beats suffices. Using Ginger/Aconite is still Middle treatment, i.e., Warm. Zhang Zihe and Zhu Yanxiu treated summer chills with cold herbs successfully. Do not rigidly follow Wang Haizang. Herb temperature depends entirely on pulse rate. This text cites Wang Haizang due to slow pulse/cold Stomach. Yin deficiency causes fever; winter fever requires tonifying Yin to support Yang. Examples include Fu Ling Bu Xin Tang. Misusing cold herbs causes fire to rise uncontrollably, causing irritability and desire to sit in wells; warm herbs are indicated.

Pulse Floating and Large, epigastric hardness with Heat. If belonging to Zang, purge it; do not induce sweating. If belonging to Fu, do not cause frequent urination. Frequent urination hardens stool; profuse sweating increases heat; little sweating makes stool difficult. Slow pulse indicates purging is not yet appropriate.

The Treatise says Floating/Large pulses should induce sweating; purging is contraindicated. Here, epigastric hardness with Heat indicates transmission to Interior, so we follow symptoms over pulse. "Belonging to Zang" implies retained feces in Zang; "Belonging to Fu" implies urinary difficulty. Purging stool removes internal heat; purging urine does not, merely wasting fluids. In Shanghan, diuretics like Wu Ling San are only used after sweating with Floating pulse, irritability, and thirst. Other treatments include warming, purging, harmonizing, draining damp-heat, securing lower jiao, dispelling cold, warming channels, resolving complex pathogens, or clearing transmitted Yin heat. Diuresis is rarely used lightly. Not inducing sweating or diuresis prevents fluid loss and complications.

Slow indicates Yin, Cold, Zang. Kidney is the Ultimate Yin Zang. Disease manifests as Kidney Deficiency. Rushing to purge risks leaking Kidney Qi. Even if purging indications exist, wait and observe. Some ask: The Treatise says Jie Xiong (Chest Binding) with Floating/Large pulse cannot be purged, or death ensues. Why does this text suggest purging? Epigastric hardness differs from Jie Xiong, which differs from Pi (Glomus). Yang disease purged becomes Jie Xiong; Yin disease purged becomes Pi. Jie Xiong is painful; Pi is not. "Yin disease" means interior pathogen present but incomplete purging indication, leading to Pi upon purging, lighter than Jie Xiong. Since Pi and Jie Xiong differ in Yin/Yang and severity, Jie Xiong prohibitions do not apply to Pi. Thus, Taiyang disease purged incorrectly causing Pi with soft palpation and Floating Guan pulse is treated with Da Huang Huang Lian Xie Xin Tang. If hard and unpurged, purging is indicated. However, Yangming disease with epigastric fullness/hardness cannot be purged; purging leads to intractable diarrhea and death. Careful examination is essential.

Pulse Floating and Huge, sweat like oil, continuous panting, inability to swallow liquids, insensate body, alternating calmness and chaos. This is Death of Life (Ming Jue).

As fire dies, brightness flares. Pulse Floating/Huge/Surging indicates departure of life. Combined with specific signs, death is confirmed.

Which Zang fails first? Sweat with sticky hair, continuous panting: Lung failure first. Lung governs Qi and skin/hair. Classics: Lung failure leads to death in 3 days. Identified by mouth open, air exiting but not returning.

Yang remains alone, body smoke-colored, staring eyes, head shaking: Heart failure. Heart is Li trigram, Yang outside, Yin inside. Yang remaining alone means Heart Blood exhausted, only floating fire remains. Classics: Heart failure leads to death in 1 day. Identified by shoulder breathing, fixed gaze, immediate death. Or eyes fixed, death in 2 days.

Lips/mouth green, limb spasms: Liver failure. Liver channel connects to eye system, jaw, lips. Classics: Liver failure leads to death in 8 days. Identified by green face, desire to lie curled, blind, watery sweat. Or death in 2 days.

Black around mouth, soft yellow sweat: Spleen failure. Spleen manifests in lips. Black around mouth shows waning manifestation. Classics: Spleen failure leads to death in 12 days. Identified by cold mouth, swollen feet, abdominal heat/bloating, involuntary diarrhea. Or death in 5 days.

Incontinence, delirium, eyes rolling back: Kidney failure. Classics: Kidney failure leads to death in 4 days. Identified by sudden tooth decay, black face, yellow eyes, broken waist, flowing sweat. Or death in 7 days.

Unknown which Zang's Yin/Yang fails first. Yang fails first, Yin later: Body turns blue. Yin fails first, Yang later: Body turns red, warm armpits, hot epigastrium.

*Ling Shu*: Two deaths, no dual life. Yin exhaustion = blue/cold; Yang exhaustion = red/warm. Five Yin exhaustion = eye rotation, vision loss, Zhi (Will) dies first, death in 1.5 days. Six Yang exhaustion = Yin/Yang separation, pores open, absolute sweat, death morning/evening. Yin/Yang here refers to Zang/Fu.

Cun Kou pulse Floating/Large, erroneously purged: Major error. Floating indicates Blood deficiency; Large indicates Cold. Cold/Qi collision causes borborygmus. Physician drinks cold water to induce sweat. Water/Cold collide, causing KT (hiccup/choking).

Fu Yang pulse Floating indicates Deficiency. Floating/Deficiency collision causes Qi KT (choking). Indicates Stomach Qi exhaustion. Slippery pulse indicates Yue (hiccups). This is physician's fault. Treating deficiency as excess, pressing emptiness. Floating pulse with dry nose indicates epistaxis.

"Pulse Large, disease Hot but called Cold" refers to pathogen. Later "Water/Cold collide" suggests Stomach deficiency-cold. If true Cold, why Large pulse? Pathogen/Cold colliding... Qi is what? Floating pulse. Cause of Floating pulse? How do Pulse and Cause collide? I cannot explain. Cheng Shi explains similarly without doubt. KT connects to Ye. Yue is hiccup. Li Dongyuan/Wang Haizang equate Yue with dry heave; Chen Wuyue equates Yue with cough-hiccup. All incorrect. *Ling Shu*: Hiccup treated by tickling nose or holding breath. Modern hiccup stops instantly. Dry heave does not. Vomiting has its own section; adding this is redundant. Ancient "Ke" is modern "Sou" (cough), unrelated to hiccup. KT and Yue arise from erroneous purging + cold water sweating, causing chest Qi reversal. Light = KT, Heavy = Yue. Fu Yang pulse: Floating = KT, Slippery = Yue. KT is throat blockage, mouth open, eyes staring, silent. Yue is Qi rushing from umbilicus to mouth, making sound. Excess is treatable; half-hour intervals indicate Deficiency, hard to treat. KT treated with Xiao Qing Long Tang minus Ma Huang plus Fu Zi to disperse Water-Cold. Yue caused by Heat stagnation blocking Qi. Mild: Harmonize; Severe: Purge. Heat disease with Yue is extreme, unlike mild thirst/irritability. Treatise: Floating pulse, fever, dry mouth/nose, able to eat → Epistaxis, treated with Huang Qin Tang.

All Floating/Rapid pulses indicate Fever and chills. If painful area, normal diet: Pus accumulation.

Shanghan texts list four mimics: Hong Jiao (Beriberi), Tan Yin (Phlegm-Fluid), Shang Shi (Food Injury), Xu Fan (Deficiency Irritability). Carbuncles/abscesses with chills/high fever mimic Shanghan. Zhang Zhongjing discussed this, later ignored sadly. People feel pain/swelling. This text implies internal abscess ("accumulated pus"). *Su Wen*: Liver/Kidney/Lung fullness/excess causes swelling. Wang Bing notes: Fullness = pulse Qi excess; Swelling = abscess. Cough, hidden chest pain, rough chest skin, chills, rapid pulse, dry throat, no thirst, foul sputum, long-term pus like rice porridge: Lung Abscess. Lower abdominal heaviness/pain on pressure, frequent urination like strangury, sweating, chills, rough skin, urgent abdomen, Slippery/Rapid pulse: Intestinal Abscess. Hidden epigastric pain, tender to touch, Sinking/Fine Stomach pulse, Surging Ren Ying pulse: Gastric Abscess. Internal/External injuries distinguished by Ren Ying/Qi Kou. Internal injury: Ren Ping (flat). Gastric Abscess: Ren Ying Surging. Often mistaken for Shanghan. Distinguish early. Example: Qian family daughter with intestinal abscess fever treated as Shanghan, starved, died, discharged pus. Alas! Must read Zhang Zhongjing!

Pulse Floating/Slow, face red/shivering: Should resolve with sweat by day 6-7. If fever persists, resolution delayed. Slow indicates Yang deficiency, unable to sweat, body itches.

Floating/Slow pulse: Yang deficiency causes Slow. Qi stagnation causes red face. Struggle with pathogen causes shivering. Like humid weather forming rain, sweat should occur. But weak Yang prevents it. At day 6-7, transmission ends, should sweat. Instead, fever and itch. Classics: All itching is Deficiency. Treatise: Taiyang like malaria, Micro pulse, chills, red face, itch → Gui Zhi Ma Huang Ge Ban Tang (small dose).

Cun Kou Yin/Yang both Tight: Clear pathogen attacks Upper Jiao, Turbid pathogen attacks Lower Jiao. Clear attacking Upper = Jie (Pure); Turbid attacking Lower = Hun (Turbid). Yin attacked by pathogen → internal shivering. Exterior Qi weak, Interior Qi unguarded → pathogen enters Yin. Yang attacked by pathogen → fever, headache, stiff neck/back, leg pain. Caused by fog/dew (Clear pathogen). Yin shivering → cold feet/knees, erratic urination. Exterior weak, Interior urgent → Three Jiao confused, internal/external blocked. Upper Jiao stagnant → organ Qi熏 (fumes) → mouth/gum ulcers. Middle Jiao dysfunction → Stomach Qi rebels, Spleen Qi doesn't rotate → Stomach turbid, Ying/Wei blocked, Blood coagulates. If Wei Qi passes first → dark yellow urine, Heat collision → abscesses. If Yin Qi passes first → Yang collapse, Yin unsupported, external pathogen enters → sneezing, throat block, cold reversal, Heat oppression, bloody stool like pig liver. Both Yin/Yang collapsed → Spleen weak, five fluids pour down, Lower Jiao closes poorly → heavy sensation, difficult defecation, umbilical pain, near death.

Cheng Shi notes: Floating/Sinking distinguishes Yin/Yang. Taiyang/Shao Yin both have Tight pulses. Floating/Tight = Taiyang; Sinking/Tight = Shao Yin. Text mentions only Cun Kou, so cannot define Guan front as Yang...