典藏书目

Kou Zongshi said: Whenever diagnosing women's diseases, one must first ask about the menstrual period upon entering. Zhang Zihe said: Whenever diagnosing gynecological diseases, one should first ask about pregnancy. He also said: When treating women's diseases, one must not lightly use herbs that break qi and move blood, for fear that the patient might be in a suspected state of pregnancy. Peng Yongxian said: Whenever diagnosing postpartum diseases, one must inquire about the amount and presence of lochia. This is the essential principle of gynecology. Shen Qianlü said: The viscera qi of infants is not yet fully developed and cannot withstand the force of medicine. Within the first year of life, unless it is a severe illness, one should not easily administer medication; treatment must be carefully considered. Even within two to three years of age, the physical form and righteous qi are essentially tender and weak; medication should not be too harsh. Harsh purgation or harsh tonification will instead cause the patient to suffer from the drugs. This is the essential principle of pediatrics. Wang Hongxu said: Carbuncle (Yong) and gangrene (Ju) are two completely different paths. Redness and swelling indicate Carbuncle, which should be treated with cooling and resolving methods; white depression indicates Gangrene, which should be treated with warming and dissipating methods. He also said: Only Ding sores (hard, deep-seated infections) can be treated with acupuncture; for all others, knives and needles should not be used lightly, and herbs that cause pain and ulceration should be prohibited. This is the essential principle of surgery.

The general outlines of the Six Channels in Shanghan Lun (Treatise on Cold Pathogenic Diseases) are largely based on inquiry. For instance, symptoms such as bitter taste in the mouth, dry throat, and vertigo in Shaoyang disease (Lesser Yang Disease), as well as alternating chills and fever, fullness and distension in the chest and hypochondrium, silence and lack of desire for food, mental irritability, and a tendency to vomit in Xiao Chai Hu Tang syndrome, are all known through inquiry. This is why Sun Simiao emphasized "inquiring before diagnosing."

The pulse of the Large Intestine is observed at the left Cun position, and the pulse of the Small Intestine is observed at the right Cun position; this is the statement in Mai Jue (Pulse Classic). Since Hua Bolin observed the pulses of the Large and Small Intestines at both Chi positions, Li Shicai praised this as a "unique insight of the ages," and later generations came to believe it. I examined Wang Shishan's Mai Jue Kan Wu (Correction of Errors in Pulse Classic), which corrects many of Wang Shuhe's statements, but did not object to the view that "the left Cun observes the Heart and Small Intestine, and the right Cun observes the Lung and Large Intestine." He stated that matching Fu organs to Zang organs, since these two meridians connect, they are observed at the same position. Additionally, Huang Kunzai (courtesy name Yuanyu) from Changyi argued that where pulse qi ascends, disease manifests above; where pulse qi descends, disease manifests below. The three Hand Yang meridians travel from the hand to the head. Although the Large and Small Intestines are located at the lowest part of the body, their pulse qi travels upward; therefore, they are observed together with the Heart and Lung at the two Cun positions. His theory is also profound and can correct the error in Hua's theory. Yang Renzhai stated that pulse qualities such as Chen Xi (Deep and Fine), Chen Chi (Deep and Slow), Chen Xiao (Deep and Small), Chen Se (Deep and Choppy), and Chen Wei (Deep and Minute) all belong to Yin; whereas Chen Hua (Deep and Slippery), Chen Shuo (Deep and Rapid), Chen Shi (Deep and Excess), and Chen Da (Deep and Large) all belong to Yang. A mistake in application could lead to death or life instantly. I believe there are exceptions. According to Ming Yi Lei An (Classified Cases of Famous Physicians) under the section on Heat Fire, Hu Xianweng treated unresolved wind-heat with both hands' pulses being Fu (Hidden). At that time, an epidemic was prevalent. Other physicians believed that a Yang syndrome presenting with Yin pulses was incurable and wanted to use Yang Du Sheng Ma Tang (Yang Toxin Ephra Twig Decoction) to raise and lift. Hu Xianweng said: This is extreme wind-heat; excessive fire causes the pulse to hide; it is not an epidemic. Raising it would cause death. He administered Lian Qiao Liang Ge San (Forsythia Cooling Chest Powder), and the condition resolved after one dose. Also, according to Mai Jue songs, if a cold injury presents with a Fu pulse in one hand, it is called Dan Fu (Single Hidden); if in both hands, it is called Shuang Fu (Double Hidden). One should not diagnose it as incurable just because a Yang syndrome shows Yin pulses. It is due to fire pathogen internal stagnation, unable to vent outward; extreme Yang resembles Yin, hence the pulse is hidden. There must be profuse sweating for resolution. Such pulses are not uncommon in epidemic conditions; practitioners should examine them carefully and not solely rely on Yang's theory.

In Zhang Zhongjing's Shanghan Lun, Jie Xiong Re Shi (Chest Binding Heat Excess) presents with a Chen Jin (Deep and Tight) pulse, pain below the heart, hardness like stone upon palpation, and is treated with Da Xian Xiong Tang (Major Expel Thorax Decoction). In Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet), Shan Qi (Hernia) with periumbilical pain, discharge of white fluid during attacks, cold limbs, and a Chen Jin pulse is treated with Da Wu Tou Jian (Major Aconite Decoction). The same Chen Jin pulse indicates heat in one case and cold in another. Thus, how can clinicians rely solely on the pulse?

Shanghai County Annals, Art Section, records that Yao Meng was skilled in medicine, especially proficient in Tai Su Mai (Primordial Pulse diagnosis). Governor Zou Laixue summoned him to treat an illness. Yao Meng said: Your Lordship's constitution has an aperture leaking sweat. Zou Laixue was greatly surprised and said: This is my secret ailment; how do you know? Yao Meng said: I deduced it from the pulse. The Guan position on the left is Slippery and Slow; there is a leak in the fourth lobe of the Liver connecting downwards. Zou Laixue requested medicine. Yao Meng said: No medicine is needed; you will recover upon reaching Nanjing. Using his hand to estimate, he said: Today is the 7th; you should arrive around the 12th. Zou Laixue departed immediately and indeed arrived in Nanjing on the morning of the 12th, then passed away. Predicting the time of death is possible for those with profound pulse theory, but knowing of a downward leak from the Slippery and Slow Guan pulse is likely impossible. Local chronicles often use exaggerated language, and this is typical.

Li Dongbi's Qi Jing Kao (Study of Extraordinary Vessels) states: The Eight Extraordinary Vessels are not constrained by the Twelve Regular Meridians and have no exterior-interior pairing, thus they are called Extraordinary. Generally, the Regular Meridians are like ditches, and the Extraordinary Vessels are like lakes and marshes. When the pulse qi of the Regular Meridians is abundant, it overflows into the Extraordinary Vessels. Thus, Qin Yueren compared it to rain falling from the sky; when ditches overflow, water flows wildly into the lakes and marshes. According to this, the character "Qi" (Extraordinary) should be pronounced as in Qi Ou (Odd/Even) (indicating no exterior-interior pairing). Some pronounce it as in Qi Zheng (Odd/Correct), which is incorrect.

Between Deficiency and Excess pulse qualities, it is most difficult to examine accurately. Ye Silan's medical case of a postpartum woman states: Whenever encountering extremely Large or extremely Minute pulses during diagnosis, one must be most cautious. If the pulse is extremely Large but powerless, one must guard against Yang qi floating externally. If the pulse is extremely Minute, found only after prolonged searching, and feels increasingly firm when pressing to the bone with slight additional force, it should not be mistaken for Deficiency-Cold. In this case, there is no pulse in the six positions, but behind the Chi position, the pulse is Excess, Rapid, and powerful. This is what is called Fu Ni Mai (Hidden and Concealed Pulse). Yang qi is concealed below, hyperactive to the extreme. How can one stick to the prohibition of using Cold-Cooling herbs in postpartum cases? His differentiation of pulse qualities is extremely precise; practitioners should study and repeat his words.

Pulses caused by demonic influence fluctuate between large and small, rapid and slow. Pulses caused by parasites vary suddenly in size. These lack a fixed form. Regarding Qi Stagnation syndromes, often due to obstructed pulse channels, resulting in irregular speed, careful examination is essential. Deficient pulses may also have irregular rhythm. Wang Shishan Yi An (Medical Cases of Wang Shishan) records a man suffering from seminal emission, whose pulse was sometimes Floating and Soft with rapidity, and sometimes Deep and Weak with slowness. Wang said: The inconsistency of the pulse is due to deficiency. He used Ren Shen (Ginseng Root) as the chief herb... [text incomplete in source] ...until the pulse showed six Yin characteristics... [text incomplete]. There are also Fan Guan Mai (Reverse Passage Pulses); diagnosticians should examine carefully. A physician in Wu Commandery was famous at the time. A high official's newly acquired concubine suddenly suffered from Heart disease with phlegm surging and hand-Jueyin contraction. This physician diagnosed no pulse in both hands and declined treatment. Another physician diagnosed the pulse, identified it as Fan Guan Mai, and cured her with one dose. This physician's reputation dropped instantly.

Ming Dynasty Wang Wenge Gong's Zhenze Chang Yu states: When Xu Wending Gong served as Hanshi (Director of the Palace Library), he went to Suzhou City and heard that Wang Shimian was a renowned physician. He asked Wang to diagnose him. Wang Shimian noticed pauses in the Duke's pulse but dared not speak. The Duke said: My pulse has always been abnormal. Wang Shimian said: In this case, it is not concerning. Thus, there are cases of pulse pauses that are not pathological; can clinicians fail to examine carefully? (Qiantang Liang's Yusheng Pie Ji mentions someone recently who had a pulse in only one hand and none in the other; this principle is particularly hard to understand, yet it is something clinicians should know.)

Wang Shishan Yi An records: Lady Wang, after bathing postpartum, developed fever, nausea, thirst for cold water and fruits, delirium resembling madness, and loss of appetite. Her physique was robust and she could not tolerate tonification. Physicians used Cooling herbs, and the fever intensified. Wang Shishan diagnosed Floating, Large, Surging, and Rapid pulses in all six positions, stating: Postpartum sudden damage to Qi and Blood causes solitary Yang to float externally; internally true Cold, externally false Heat. It requires major tonification of Qi and Blood. He prescribed Ba Zhen Tang (Eight Treasures Decoction) with Pao Jiang (Prepared Ginger Root) 8 fen. The fever reduced by more than half. The patient knew she usually did not tolerate Ren Shen (Ginseng Root) and refused further doses. After a day, the fever returned fiercely. He gave the previous prescription again, secretly adding Ren Shen, [missing herb], and Pao Jiang. After two or three doses, the fever subsided, the body cooled, and she recovered. In this clinical presentation and pulse image, there was no reason to use Warming-Tonification initially; how could the doctor not use Cooling herbs? Only after the Cooling herbs worsened the fever did they realize Warming-Tonification was necessary. However, without Wang's courage and insight, one could not have resolutely used it. Furthermore, although the pulse was Floating, Large, Surging, and Rapid, it was powerless upon pressure, consistent with Ye Silan's statement (see above). This can be inferred beyond the explicit words.

Jiang Genting (courtesy name Sheng) of Yuanhe in Lunyu Si Zhi states: Confucius, being sage and all-knowing, could not possibly not know medicine. Holding the patient's hand through the window, he felt the pulse. Having felt the pulse and knowing the disease was incurable, he said: Perished, it is fate. Although his explanation does not directly address human affairs, the Commentary on Li Ji contains sayings of Confucius on pulse diagnosis, so Jiang's theory has its basis. Moreover, disease is something sons take seriously; how could they casually entrust it to doctors without investigating the principles? Some ask: If Confucius knew medicine, why did he say "Wei Da" (not understood/not tried) when Minister Kang offered medicine? I answer: The medicine was likely pills or powders; he did not know what it was. Even if he knew, he could not judge its quality. Thus, Wei Shu · Shu Yi Lie Zhuan records: Emperor Xianzhu wanted to test Xu Jian's abilities, placed patients in a tent, and let Xu Jian feel their pulses from outside. He grasped the disease deeply and knew the complexion signs. Later, when Emperor Xiaozu was critically ill, Xu Jian invited effective doctors and received generous rewards. An edict stated: "Sincerity and skill both delivered; loyalty and subtlety both arrived." His art was indeed exquisite. However, when Empress Dowager Wen Zhao carried Emperor Shizong, she dreamed of being chased by the sun, transforming into a dragon circling the Empress. Upon waking, she was startled and developed Heart disease. Wang Xian diagnosed the pulse and said: It is not Heart disease; it is a sign of pregnancy with a male child. But Xu Jian said it was mild wind invading the viscera and recommended decoctions and acupuncture. As the saying goes, even the wise make mistakes in a thousand deliberations; the Way of Medicine is truly not easy to discuss.

A pulse that is Rapid but stops occasionally is Cu Mai (Surging Pulse). Cu primarily indicates Heat, but it can also be caused by Cold, such as in Cold Injury where the pulse is Cu with cold limbs, treatable with moxibustion. Commentators explain that the Qi naturally moves, but forced by Cold, it becomes Rapid and Surging. A pulse that is Slow but stops occasionally is Jie Mai (Knotted Pulse). Jie primarily indicates Cold, but it can also be caused by Heat, such as in Taiyang Disease with yellow skin, Deep Knotted pulse, hard lower abdomen, free urination, and restlessness like madness; this is a definitive Blood stasis pattern, treated with Di Dang Tang (Di Dang Decoction). Commentators explain that Damp-Heat struggle makes the Slow pulse indicative of Dampness; thus, interior Dampness pulses present as Deep and Knotted. Observing this, we further know that clinicians cannot rely solely on the pulse.