典藏书目

Tian: For warm diseases occurring in spring, if the course of illness is less than three days, administer two doses of Xingxing San first. If after four or five days the condition remains unresolved with symptoms of irritability, thirst, and vomiting, use Baizhu San. If there is spontaneous sweating and dry mouth, use Zhi Baihu Tang. By the sixth or seventh day, if stool is dry and constipated, use Sishun Yinzi to purge; if there is severe abdominal fullness and distension, use Niuhuang Tongge Wan to purge. At the initial stage, if one suspects sores and rashes, only use Gegen Shengma Tang to resolve the muscle layer.

Question: What is meant by yin and yang pulses?
Answer: Pulses that are large (Da), floating (Fu), rapid (Shu), moving (Dong), and slippery (Hua) are called yang pulses. Pulses that are deep (Chen), choppy (Se), weak (Ruo), wiry (Xian), and minute (Wei) are called yin pulses. In yin syndromes, the appearance of a yang pulse indicates survival; in yang syndromes, the appearance of a yin pulse indicates death.

Cheng Wuji: The way of yang is usually abundant; the five pulse qualities—large, floating, rapid, moving, and slippery—are excessive compared to the normal pulse (Ping Mai), hence they are called yang. The way of yin is usually deficient; the five pulse qualities—deep, choppy, weak, wiry, and minute—are insufficient compared to the normal pulse, hence they are called yin. In cold damage (Shanghan), when pathogenic factors are at the exterior, yang pulses appear; when pathogenic factors are at the interior, yin pulses appear. A yin syndrome presenting with a yang pulse suggests survival because the pathogen moves from the interior to the exterior, seeking resolution through sweating. For example, in Jueyin wind strike, a slightly floating pulse indicates impending recovery, while a non-floating pulse indicates no recovery. Conversely, a yang syndrome presenting with a yin pulse suggests death because the pathogen moves from the exterior to the interior, with righteous qi being deficient and pathogenic qi being excess. For instance, delirious speech combined with a deep, fine pulse indicates death. Generally, one should judge based on stillness or restlessness; after purgation, stillness indicates survival, while restlessness indicates death. One should not rigidly adhere to the idea that "yin syndrome with yang pulse" means pathogen dispersing outward, or "yang syndrome with yin pulse" means pathogen entering due to deficiency.

Danbo Yuanjian: According to the Classics, large, floating, rapid, moving, long, and slippery pulses are yang; deep, choppy, weak, wiry, short, and minute pulses are yin. The discussion omits "long" and "short," why? Does cold damage lack long and short pulses? Zhang Zhongjing's writings mention them frequently. Wang Shuhe's *Mai Jing* lists twenty-four pulse shapes but excludes long and short; why? The character "see" (Jian) might be interpreted as "obtain" (De), meaning an exterior syndrome obtains an interior pulse, or an interior syndrome obtains an exterior pulse. Interpreting it as pathogen moving from exterior to interior may cause confusion. Taiyang disease unresolved gradually transmits to Yangming and Shaoyang. If the three yang meridians remain unresolved, they gradually transmit to the fu organs; these are curable conditions. Some cases do not transmit nor involve alien pathogens; after seven days, transmission proceeds gradually from Taiyang to Yangming and Shaoyang, representing self-healing conditions rather than pathogen moving from exterior to interior. Initially, there is no death, which causes my doubt. Examining the treatise, yang syndrome obtaining yin pulse can arise from the original disease or iatrogenic causes. Zhang Zhongjing details treatments extensively. For example, Taiyang disease lasting eight or nine days resembling malaria, with fever and aversion to cold, more heat than cold, no vomiting, normal bowel movements, desiring self-recovery, occurring two or three times daily with a slightly slow pulse, indicates impending recovery. If the pulse is slight and there is aversion to heat, this indicates deficiency of both yin and yang, prohibiting further sweating, purgation, or emesis. Is Taiyang disease resembling malaria with fever and aversion to cold not a yang syndrome? Is a slight pulse not a yin pulse? Furthermore, in cold damage after five or six days, with head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, lack of appetite, hard stool, and fine pulse, this is yang slight binding, having both exterior and interior signs. Sweating indicates yang slightness; pure yin binding would not have exterior signs and would be entirely interior, termed half-interior half-exterior. Although the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease because yin syndromes do not sweat; head sweating confirms it is not Shaoyin. Xiao Chaihu Tang may be administered. Was using Xiao Chaihu Tang not treating a yang syndrome? Were slight and deep pulses not yin pulses? These are all instances of yang syndrome obtaining yin pulse, describing the yin-yang nature of accompanying symptoms. There are many such examples. Reflecting on the treatise's intent, it seeks yin and yang through pulse diagnosis to distinguish life and death. Those writing about disease transmission must expand upon ancient wisdom to guide later learners. Without clarifying the yin-yang nature of symptoms and merely correlating pulse and disease, how can learners find direction? This reinforces my doubts.

Zhang Yuansu: Some say the Classics state large, floating, rapid, moving, and slippery are yang, while deep, choppy, weak, wiry, and minute are yin. Gao Yangsheng included the wiry pulse in the Seven Superficial tables as yang. Why? The wiry pulse is a pulse of deficiency, indicating post-sweating status between exterior and interior. Thus, "wiry implies reduction," making it yin. Gao Yangsheng classified wiry as yang because Zhang Zhongjing stated, "Floating and tight pulse is named wiry." Wiry feels like a bowstring, unyielding to pressure. Due to the "floating" aspect, it was placed in superficial pulses. However, floating and wiry indicate the pathogen remains at the exterior. Before sweating, it is tight; after sweating, it becomes wiry. This is a fixed rule, similar to tight but differing in timing. If one uses pre- and post-sweating states as criteria, errors can be avoided.

Xu Shumi: Zhang Zhongjing considers wiry as yin when combined with other pulses. Floating and large are yang; combined with choppy, weak, wiry, and minute, they become yin. Deep-micro-wiry, deep-choppy-wiry, and deep-fine-wiry are all yin syndrome pulses. Shaoyang pulse is wiry; Zhang Zhongjing discusses it singly. Shaoyang energy corresponds to spring; spring pulse is wiry, corresponding to spring yang seasonality, thus it can be considered yang. Floating-large-wiry, surging-long-wiry, floating-slippery-wiry, and floating-rapid-wiry are all yang. Zhang Zhongjing divides wiry into yin and yang applications with subtle reasoning. Wang Shuhe classified wiry as yang without mentioning yin, focusing on single-pulse analysis for miscellaneous diseases. Thus, Zhang Zhongjing's pulse methodology differs from that used for miscellaneous diseases.

Question: How to distinguish yang binding and yin binding pulses?
Answer: Floating and rapid pulse with ability to eat but constipation is excess syndrome, named yang binding, expected to worsen on the 17th day. Deep and slow pulse with inability to eat, heavy body, and hard stool is named yin binding, expected to worsen on the 14th day.

Cheng Wuji: Binding refers to qi stagnation where yin and yang fail to mix. Yin contains yang, yang contains yin; their mixture creates harmony, while separation creates binding. Floating and rapid are yang pulses; eating but constipation indicates stomach excess, yang qi binding preventing yin mixing, named yang binding. Deep and slow are yin pulses; inability to eat and heaviness indicate yin syndrome. Yin syndrome with yin pulse usually leads to diarrhea; hard stool here indicates yin qi binding preventing yang mixing, named yin binding. Cold damage transmits daily: Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang, Day 4 Taiyin, Day 5 Shaoyin, Day 6 Jueyin. Transmission completes on Day 6; recovery expected on Day 7. Failure to recover by Day 7 is "re-transmission." Re-transmission completes on Day 12; recovery expected on Day 13. Failure by Day 13 is "passing the meridian." Yang binding belongs to fire; by Day 17 it transmits to Shaoyin water, which controls fire, leading to recovery. Yin binding belongs to water; by Day 14 it transmits to Yangming earth, which controls water, leading to recovery. If pathogenic binding is severe, water cannot control fire, nor earth control water, leading to worsening. The *Neijing* states: After one pentad, disease persists; after two, it worsens; after three, it becomes critical. ○ One pentad is five days; initial pathogen invasion shows bias in chills and fever.

Question: What causes alternating chills and fever?
Answer: Insufficient yin pulse allows yang to follow; insufficient yang pulse allows yin to invade. What is yang insufficiency? Answer: If the cun position pulse is slight, it is yang insufficiency. Yin qi enters yang, causing chills. What is yin insufficiency? Answer: If the chi position pulse is weak, it is yin insufficiency. Yang qi sinks into yin, causing fever.

Cheng Wuji: One yin and one yang constitute the Dao; biased yin or yang constitutes disease. Yin deficiency allows yang to dominate; yang deficiency allows yin to invade. Yang deficiency leads to yin qi entering yang, causing chills (yin excess generates cold). Yin deficiency allows yang qi to sink into yin, causing fever (yang excess generates heat). ○ Yang pulse insufficiency causes chills; yin pulse insufficiency causes fever.

Danbo Yuanjian: The *Neijing* states cold injury causes heat disease because cold lodges in meridians, stifling yang qi and generating heat, causing fever. Cold injuring Ying blood causes chills, belonging to Taiyang syndrome. It also says "fever and chills originate from yang." Combining these, although the body is hot, chills persist, requiring exterior resolution via Mahuang Qinglong decoctions. However, "chills followed by fever" suggests alternating chills and fever. Exterior cases suit Xiao Chaihu Tang; interior cases suit Da Chaihu Tang; post-sweat/purgation cases suit Guizhi Ganjiang Tang. Regarding equal alternating chills and fever in three yang syndromes, treatment depends on severity. The text states yin insufficiency leads to yang excess heat, and yang insufficiency leads to yin excess cold, with yang following yin and yin invading yang. This resembles Qi Bo's description of malaria qi alternating excess and deficiency, aligning with the text's meaning of yang/yin excess. Whether this applies to cold damage or malaria remains unclear.

Zhang Yuansu: Some interpret "yin insufficiency, yang follows; yang insufficiency, yin invades" as referring to weak yang pulses causing chills and fever. Also, "strong pulse with cold body" indicates cold damage. Exterior cold damage always presents with floating-strong pulses; weak pulses indicate yang syndrome with yin pulse. Both explanations have merit. This chapter explains the underlying mechanism, not just external symptoms. All cold damage arises from Ying-Wei deficiency, resulting in weak Chi-Cun pulses, allowing external pathogens to invade and cause yin-yang mutual invasion, leading to chills and fever. Existing disease pulses differ: Wind invading Wei makes Wei excess and Ying deficiency, hence Guizhi syndrome has floating-yang and weak-yin pulses. Wind-cold invading Ying-Wei makes both pulses floating-strong, hence Mahuang syndrome requires sweating. Zhang Zhongjing's works have specific references beyond shallow understanding.

Yang pulse floating, yin pulse weak indicates blood deficiency; blood deficiency leads to tendon tension.

Cheng Wuji: Yang represents qi, yin represents blood. Floating yang pulse indicates strong Wei qi. Weak yin pulse indicates weak Ying blood. The *Nan Jing* states qi warms and blood moistens. Blood deficiency fails to moisten tendons, causing tension.

Deep pulse indicates weak Ying qi.

Cheng Wuji: The *Neijing* states vessels are the residence of blood. Full vessel means full blood; empty vessel means empty blood. Deep pulse indicates internal deficiency of Ying blood.

Floating pulse with profuse sweating like beads indicates Wei qi decline.

Cheng Wuji: The *Ling Shu* states Wei qi warms muscles, fills skin, plumps pores, and controls opening/closing. Floating pulse with bead-like sweating indicates loose pores and failed control, signifying external Wei qi decline. Floating monitors Wei, deep monitors Ying; distinguishing decline via floating/deep is logical. However, decline is worse than deficiency; thus Ying is described as "micro" and Wei as "decline" because bead-like sweating signifies external loss of yang qi, making Wei pathology worse than Ying.

Weak Ying qi aggravated by burning needle causes stagnant blood flow, increased fever, and restlessness.

Cheng Wuji: Wei is yang, Ying is yin. Burning needle increases yang but damages yin. Weak Ying qi implies yin deficiency. The *Neijing* states yin deficiency causes internal heat. Adding burning needle to supplement yang combines two heats, stopping Ying blood flow, causing external fever and internal restlessness.

Pulse vast like a chariot canopy is named yang binding.

Cheng Wuji: Vast like a chariot canopy is large yet gentle. It indicates yang qi bound externally, failing to harmonize with yin. Like the previous floating-rapid yang binding.

Pulse continuous like touching a long bamboo pole is named yin binding.

Cheng Wuji: Continuous like touching a long bamboo pole is stiff and straight. It indicates yin qi bound internally, failing to harmonize with yang. Long bamboo implies tight/wiry, corresponding to the previous deep-slow yin binding.

Pulse fleeting like fat on soup indicates weak yang qi.

Cheng Wuji: Lightly floating and indicates weakness.

Pulse winding like a spider thread indicates declining yang qi.

Cheng Wuji: Winding implies stagnation. Spider thread implies extreme thinness. Micro indicates slight yang; fine indicates declining yang. The *Mai Yao* states micro indicates qi blockage, not yet decline. The *Neijing* states fine indicates little qi. Extreme fineness indicates declining yang. *Shuo Wen* defines "ying" as rolling up, implying rotation.

Pulse continuous like pouring lacquer stopping abruptly indicates blood loss.

Cheng Wuji: Continuous implies soft continuity. Pouring lacquer stopping abruptly implies initially large then fine. The *Zheng Li Lun* states heaven-earth development, essence movement, qi change, yin-yang intersection, stomach harmony, and pulse generation. Yang qi arrives first, yin qi last; pulse front is yang, back is yin. Large front, fine back indicates yang excess and yin deficiency, known as blood loss. Pouring lacquer stops suddenly; blood loss pulse is similar.

Pulse slow with intermittent stop is named knotting (Jie). Pulse rapid with intermittent stop is named urging (Cu). Yang excess causes urging; yin excess causes knotting. These are pathological pulses.

Knotting, urging, and intermission all involve stopped beating. Self-returning stop is knotting/urging; non-self-returning is intermission. Irregular interval is knotting/urging; regular interval is intermission. Knotting/urging are pathological; intermission is fatal. Miscellaneous disease knotting/urging often results from phlegm-fluid or blood stasis blocking channels; otherwise, difficult to treat. Taiyang disease after purgation with urging pulse and no chest binding indicates resolution, not necessarily fatal. Shaoyin disease with cold limbs and urging pulse suits moxibustion, not necessarily yang excess.

Yin-yang struggle is named moving (Dong). Yang moving causes sweating; yin moving causes fever. Cold body and aversion to cold indicate Sanjiao injury. If rapid pulse appears at Guan, lacking head/tail, bean-sized, trembling, it is named moving.

Yang rises, yin descends; their communication within Cun-Chi is peaceful. Movement occurs when yang desires descent but yin opposes, or yin desires ascent but yang opposes. Struggle prevents smooth movement, creating a bulge, forming the moving pulse. Why at Guan? Cun is yang, Chi is yin, Guan is middle. Yang exits, yin enters, Guan is the boundary. Thus, movement manifests at Guan. *Neijing* states strong hand-Shaoyin pulse indicates pregnancy; this refers to Shenmen point pulsation, not the moving pulse. Moving pulse terminology starts with Zhang Zhongjing. Pang Anchang states Guan occupies six parts: anterior three yang, posterior three yin. Yang Cun moving with quiet Yin suggests sweating resolution (*Suwen*: "Yang added to Yin is sweat"). Yin Chi moving with quiet Yang suggests fever (*Suwen*: "Thick Chi indicates internal heat"). Post-sweat cold body/chills indicates Sanjiao injury and death. Calm yin-yang qi is solid; agitated is deficient. Yang moving indicates yang deficiency, failing to protect skin, causing sweating. Yin moving indicates yin deficiency, failing to nourish muscles, causing fever. Zhang Zhongjing states slight yang causes chills, weak yin causes fever. Trembling independently distinguishes it from other pulses. Later interpretations describing moving pulse as faint on pressure and disappearing on lift contradict Zhang Zhongjing.

Yang pulse floating-large-soft, yin pulse floating-large-soft, equal yin and yang pulses, is named slow (Huan).

Slow implies slowness and harmony. Independent yin or yang does not produce slow. Slow involves both yin and yang. Harmony creates the name. When yin-yang mix harmoniously, complexion is yellow, face bright, voice metallic, hair long, overflowing vital qi. Disease manifestation includes deficiency, bi-syndrome, or qi rebellion. Dai Shi states slow pulse in middle/lower positions, soft and slow, smaller than deep, indicates pathogen presence (insufficient slow). Yin-yang harmony, Cun-Chi equal floating-large-soft without bias indicates health (harmonious slow). Slow resembles delayed (Chi); Chi is three breaths per cycle, Slow is four.

Floating-tight pulse is named wiry (Xian). Wiry feels like a bowstring, unyielding. Tight pulse feels like twisting cord.

Why is wiry associated with Liver? Liver is wood. Days: Jia (beginning), Yi (still bending). Meridians: Shaoyang (young yang), Jueyin (end yin). Seasons: Spring (birth without growth). *Suwen* states soft-light-vacant-smooth, straight-and-long is wiry, containing yang within yin. Here, floating-tight is wiry. Floating is yang, tight is yin. Yang not separated from yin. *Mai Jue* lists it as yang; Zhang Zhongjing lists it as yin. Dai Shi considers it half-yin half-yang. "Floating" should be understood via soft-light-vacant. *Mai Jue* mistakenly says insufficient on pressure, excess on lift, implying only floating-wiry exists. Classics state deep-wiry indicates suspended fluid pain; thus deep wiry exists. Wiry and tight resemble pulled rope. To distinguish, wiry is unyielding like bowstring; tight is variable like twisting cord. Straight-and-long is wiry; twisting is tight. Soft-wiry is easy to treat; hard-wiry is difficult. Zhang Zhongjing states twisting pulse indicates death due to lack of Stomach qi. Distinguish carefully.

Wiry-large pulse: Wiry implies reduction, large implies hollow (Kou). Reduction implies cold, hollow implies deficiency. Cold-deficiency struggle is named leather (Ge). Women: miscarriage/bleeding; Men: blood loss/semen emission.

*Yijing* states Ge means removing old. Pulse normally充盈 (full) via digestion and circulation. Chronic deficiency-cold alters this, causing wasting. Wiry-large reflects this. Wiry-reduction indicates yang deficiency/cold. Large-hollow indicates yin-blood deficiency/vacuity. Cold-deficiency struggle changes qi-blood, named Ge. Women get miscarriage/bleeding; men get blood/semen loss. Many pulses exist, but Ge specifically implies chronic alteration. Acute changes may also show Ge but can heal spontaneously. Classics state Ge pulse in chronic disease indicates death; in acute disease, survival. *Mai Jue* describes Ge as absent on light pressure, present on deep pressure, locating position but missing form. Classics say it resembles deep/submerged. Solid-long-slightly-wiry is its shape. Essentially large, wiry, resembling long, involving deep/submerged/solid/long, giving it firm (Lao) quality. Sun Simiao equates Ge with Lao. Some texts list Lao but not Ge, or vice versa, due to this confusion.

Question: Why does battle with sweating lead to resolution?
Answer: Floating-tight pulse, hollow on pressure, indicates root deficiency, causing battle and sweating. Root deficiency causes battle; floating pulse allows sweating resolution. If floating-rapid, not hollow, root is not deficient; resolution comes via sweating without battle. Question: Why resolution without battle or sweating? Answer: Self-micro pulse, due to prior sweating/vomiting/purgation/blood loss, lacking fluids. Yin-yang self-harmony leads to self-recovery without battle or sweating.

When pathogen exits, root deficiency causes pathogen-righteous struggle, leading to battle, then sweating resolution. No deficiency means no struggle, hence sweating without battle. Deficiency distinguished by hollow pulse. Hollow resembles green onion tube: present on light/deep pressure, absent on medium. Classics state Ying flows in vessels, indicating blood loss. "Pressure" here means "seeking" (Xun) between lifting and pressing. If pathogen weak and righteous weak, pulse is micro, resolving without battle/sweating. Micro pulse originates from vomiting/purgation/blood loss. Yang micro prohibits sweating; yin micro prohibits purgation, due to yin-yang deficiency. Question: When to assess these pulses? Answer: Assess beginning for releasing pulses; observe cessation for resolving pulses. E.g., Chaihu Tang syndrome, six-seven days...