典藏书目

(Continuing from the previous text) The pulse becomes faint; this is because the patient has previously undergone sweating or purging, leading to a deficiency of body fluids and yin fluids. Since the yin fluids have harmonized themselves, there is no chattering of teeth (rigors), nor does the disease resolve through sweating. These three pulse patterns are all observed at the time when the disease is about to resolve. (Haizang said: Resolution after rigors indicates Taiyang disease; resolution without rigors but with sweating indicates Yangming disease; resolution without rigors and without sweating indicates Shaoyang disease.)

Question: In cold damage occurring on the third day, if the pulse is floating, rapid, and faint, and the patient's body feels 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 faint and the disease resolves, it will be accompanied by profuse sweating.

Cheng Wuji's commentary: On the third day of cold damage, yang qi leaves and enters yin. If the patient has fever, and the pulse is floating, rapid, and large, it indicates the transmission of pathogenic factors into the interior. If the body is cool and peaceful, and the pulse is floating, rapid, and faint, it indicates that the pathogenic factors are not transmitting but are about to resolve. Resolution at midnight occurs because yang qi arises at Zi hour (midnight). A floating pulse indicates resolution through spontaneous sweating, meaning pathogens disperse from the exterior. A rapid pulse indicates resolution through the ability to eat, signifying harmony of stomach qi. A faint pulse indicates resolution through profuse sweating, signifying weak pathogens. The earlier text states that a faint pulse leads to resolution without sweating, while here it states that a faint pulse leads to resolution with profuse sweating. Why do these two statements seem contradictory? The answer is: The former refers to cases where vomiting and purging caused blood loss, weakening both pathogenic factors and healthy qi, preventing sweating for resolution. The latter refers to cases where no sweating or purging occurred, so qi and blood were undamaged, healthy qi was strong, and pathogens were weak, leading to resolution via profuse sweating. These two statements are not contradictory.

Question: Regarding pulses and diseases, how can one distinguish between recovery and non-recovery? Answer: If the pulses at Cun Kou (radial artery proximal crease), Guan (middle position), and Chi (distal position) are equal in magnitude, depth (floating/sinking), and rate (slow/rapid), even if symptoms of cold and heat persist, this indicates a state of yin-yang harmony in the pulse. 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, internal injury and external contraction present different pulses, making the Qi Kou (radial) and Ren Ying (carotid) pulses unequal. Differences in upper/lower excess/deficiency make the floating/middle/sinking and size positions unequal. How much more so in cold damage? Now, since the pulses at Cun, Guan, and Chi are all equal, it indicates yin-yang harmony and spontaneous recovery. The *Needle Classic: Prohibited Service Chapter* states: When the Cun Kou and Ren Ying pulses correspond, being as tight and equal as a drawn rope, it is called a "Ping Ren" (healthy person). This means the Cun Kou pulse on the hand and the Ren Ying pulse beside the throat being equal indicates health. Another passage states: If the six pulses' yin and yang both stop, the patient must first shiver and sweat to resolve. Some say: Cun, Guan, and Chi each have their own principal pulse positions, as described in the previous chapter regarding pressure depth. Spring, summer, autumn, and winter have ascending/descending and floating/sinking characteristics, each having its proper position without exceeding its rank, hence "equal," indicating recovery. If interpreted like Cheng Wuji's note, where Cun is floating and Chi is floating, Chi floating would be abnormal. How can this be considered recovery?

During Lixia (Start of Summer), a洪大 (Hóng Dà, surging and large) pulse is the seasonal normal pulse. If a person suffers from body pain and heaviness, sweating should be induced. If the next day the pain and heaviness cease, sweating is unnecessary. If sweat appears spontaneously, the disease resolves the next day. Why? Because obtaining a Hóng Dà pulse during Lixia aligns with the season, thus facilitating resolution. This logic applies to the four seasons.

This section discusses cold damage that does not manifest immediately. Spring pulses should be Xian (String-like), Summer Hong (Surging), Autumn Mao (Feather-like/Floating), Winter Shi (Stone-like/Sinking). Obtaining these pulses in their respective seasons indicates normal pulses, resolving without treatment. Obtaining them out of season indicates pathological pulses, requiring treatment based on symptoms for recovery. If a Hong pulse appears in summer alongside body pain and heaviness, it indicates pathogenic invasion, requiring treatment for resolution. By analogy, if String, Feather, or Stone pulses appear in Spring, Autumn, or Winter respectively, accompanied by corresponding symptoms, treatment is required for recovery.

Question: For any illness, how can one determine when it started and when it will recover? Answer: For example, if contracted at midnight, it recovers at noon the next day; if contracted at noon, it recovers at midnight. Why? Noon contraction resolving at midnight occurs because Yang obtains Yin to resolve. Midnight contraction resolving at noon occurs because Yin obtains Yang to resolve.

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). Diseases of the Three Yin meridians often resolve at night.

A floating pulse at Cun Kou indicates an exterior syndrome; sinking indicates interior; rapid indicates Fu organ involvement; slow indicates Zang organ involvement. A slow pulse, therefore, indicates a Zang organ disease.

Previously stated: Floating, Large, Rapid, Moving, Slippery pulses are Yang pulses; Sinking, Choppy, Weak, Wiry, Faint pulses are Yin pulses. *Nan Jing* Chapter 9 asks: How to distinguish Zang and Fu diseases? Answer: Rapid indicates Fu disease; Slow indicates Zang disease. 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 serves as a general principle for classifying cold damage into Three Yang and Three Yin syndromes. However, for miscellaneous diseases, Zang organs can have Heat despite rapid pulses, and Fu organs can have Cold despite slow pulses; one should not adhere rigidly to this rule.

The Fu Yang pulse is Floating and Choppy, while the Shao Yin pulse follows the regular pattern. The pathology lies in the Spleen, legally presenting with diarrhea. How do we know? If the pulse is Floating and Large, it indicates Excess Qi and Deficient Blood. Currently, the Fu Yang pulse is Floating and Choppy, indicating Spleen Qi insufficiency and Stomach Qi deficiency. The Shao Yin pulse is Wiry and Floating, which is considered a harmonious pulse, hence "following the regular pattern." If it instead becomes Slippery and Rapid, pus in the stool is predicted.

The Fu Yang pulse, also known as Hui Yuan or Chong Yang, is located three cun above the Xian Gu point on the dorsum of the foot, marking the arterial movement of the Foot-Yangming Stomach Meridian. The Stomach is the Sea of Water and Grain, the leader of the Five Zang and Six Fu organs. If Stomach Qi is exhausted, water and grain intake ceases, the Grain Spirit departs, and the organs lose nourishment, leading to death when the pulse ceases. Thus, examining the Fu Yang pulse assesses Stomach Qi. Pulse palpation uses light and heavy pressure to differentiate Qi and Blood. A Floating and Large pulse, excessive upon light pressure but deficient upon heavy pressure, indicates Excess Qi and Deficient Blood. If light pressure reveals a pulse that is neither large nor smooth, it indicates insufficient Spleen and Stomach Qi. Insufficient Spleen and Stomach Qi leads to failure in transportation and transformation, resulting in diarrhea. Diarrhea belongs to Shaoyin syndromes, hence the statement "Shao Yin pulse follows the regular pattern." The Shaoyin pulse is normally Fine, Small, Sinking, and Tight; here, Wiry and Floating is considered harmonious, requiring flexible interpretation. Normally, one expects Wiry and Floating; finding Slippery and Rapid indicates impending pus in the stool, a case for Tao Hua Tang (Peach Kernel Decoction). The Shao Yin arterial pulse is named Tai Xi, located behind the medial malleolus above the calcaneus.

Cun Kou pulse is 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, causing bone and joint discomfort, sweating should be induced.

Wind is a Yang pathogen, residing externally, affecting Wei Qi, moving lightly upward, hence the Floating pulse. Cold is a Yin pathogen, residing internally, injuring Ying Qi, causing tension and contraction, hence the Tight pulse. With Ying and Wei diseased and bone/joint pain, the pores should be opened to expel pathogens; thus, Ma Huang Tang (Ephedra Decoction) is used to induce sweating.

Fu Yang pulse is Slow and Relaxed, indicating normal Stomach Qi. If Fu Yang pulse is Floating and Rapid, Floating injures the Stomach, and Rapid agitates the Spleen. This is not the original disease but results from improper purging by the physician. Ying and Wei sink inward. The Rapid pulse first becomes Faint, then only Floating remains. The patient will likely have hard stools and belching followed by relief. Why? Originally, the Rapid pulse agitated the Spleen. As the Rapid pulse fades, Spleen Qi dysfunction is evident, causing hard stools and belching. Now, the pulse is Floating, and the Rapid pulse has faded to Faint, leaving pathogenic factors solely in the Spleen. Hunger arises because the Stomach is empty; heat cannot digest food, leading to tidal fever and thirst. If the Rapid pulse returns to Normal/Slow rhythm, hunger occurs but digestion proceeds normally. If the Rapid pulse persists irregularly, skin ulcers may develop.

The normal Stomach pulse is Slow and Relaxed. Floating and Rapid indicates pathology. Injury to Stomach Qi causes Deficiency (Floating); agitation of Spleen Qi causes Restlessness (Rapid). This confirms error from purging. Ying/Wei and Spleen/Stomach Qi are linked. Stomach injury and Spleen agitation lead to internal deficiency, allowing Ying/Wei pathogens to sink. The Rapid pulse retreats first, leaving only Floating. Hard stools and belching occur. Originally, Rapid pulse agitated Spleen, but Spleen restlessness is unsustainable, so Rapid fades to Faint, indicating Spleen Qi failure. Without Spleen function, fluids decrease, Stomach dries, and stools harden. Spleen disease causes belching, relieved by passing gas/stool. Floating pulse injures Stomach; Stomach injury stops at injury, so Floating remains alone. Pathogens remain in Spleen, not Stomach. Empty Stomach causes hunger. Stomach receives food, but Spleen fails to transform it. Spleen's true fire digests food; pathogenic heat cannot. Undigested food increases Stomach heat, causing tidal fever and thirst (Treat with Tiao Wei Cheng Qi Tang / Regulate the Stomach Purge Decoction). If Rapid changes to Slow/Normal, recovery ensues. If Rapid persists irregularly, Spleen restlessness causes skin ulcers.

The Master said: A patient with Faint and Choppy pulses suffered medical error. Profuse sweating and repeated purging caused blood loss. The patient experiences chills followed by fever without cessation. In summer heat, they desire heavy clothing; in winter cold, they desire to be naked. Why? Yang deficiency causes chills; Yin weakness causes fever. Sweating depleted Yang; purging depleted Yin. In May, Yang is at the exterior, Stomach is cold internally. Internal Yang deficiency cannot overcome cold, hence desire for warm clothes. In November, Yang is at the interior, Stomach is hot internally. Internal Yin deficiency cannot withstand Yang heat, hence desire to remove clothes. Yin pulse is Slow and Choppy, confirming blood loss.

Profuse sweating injures Yang (Faint pulse, chills). Repeated purging injures Yin (Choppy pulse, fever). Both Yin and Yang injured, Qi and Blood damaged. Why mention only blood loss? Purging depletes Yin; sweating also relates to blood. In internal deficiency, summer Yang at exterior leaves interior Yang deficient, unable to resist cold. Winter Yang at interior leaves interior Yin deficient, unable to resist heat. Generally, Wiry, Fine, Choppy, forceless pulses cause chills. If accompanied by uncontrollable shivering, irritability, steaming heat like sitting in a steamer, requiring cooling measures, it is not strictly seasonal. This establishes a theoretical principle. Haizang said: In June's intense heat, contracting severe cold makes breathing difficult, body cool, pulse slow. Treatment? Disease has Root (Ben) and Branch (Biao). Heat is Root, Cold is Branch. Cooling follows season but misses Root; Heating follows Root but misses season. Treat via "Middle": Warmth. But warmth cannot treat severe cold; Ginger and Aconite are needed. Using them reduces cold severity by half, pulse normalizes, other symptoms resolve. This is Middle treatment, effectively Warmth. Zhang Hezi and Zhu Yanxiu treated June chills with cooling herbs successfully; do not rigidly follow Haizang. Herb temperature depends on pulse rate. Here, slow pulse indicates Stomach cold, so Haizang's view is cited. Yin deficiency causes fever; winter fever requires Yin tonification (e.g., Fu Ling Bu Xin Tang). Misusing cooling herbs causes fire to rise, irritability, desire to sit in wells; treat with warming herbs.

Pulse Floating and Large, yet epigastric region is hard with heat. If belonging to Zang (solid accumulation), purge it; do not induce sweating. If belonging to Fu (urinary issue), do not allow frequent urination. Frequent urination hardens stools; excessive sweating worsens heat; less sweating makes stools difficult. Slow pulse indicates purging is premature.

The text states Floating/Large pulses require sweating; purging is contraindicated. Here, epigastric hardness with heat indicates interior transmission, so prioritize symptoms over pulse. "Zang" implies fecal retention; "Fu" implies urinary difficulty. Purging clears internal heat; diuresis wastes fluids. For cold damage with urinary difficulty, Wu Ling San is used only after sweating with floating pulse and thirst. Other methods include warming, purging, harmonizing, draining damp-heat, securing lower jiao, dispersing cold, warming meridians, resolving complex pathogens, or clearing transmitted heat. Rarely is diuresis used lightly. Not inducing sweating or diuresis prevents fluid loss and complications.

Slow indicates Yin, Cold, Zang. Kidney is the Ultimate Yin Zang. Disease attributed to Kidney Deficiency. Aggressive purging risks draining Kidney Qi. Even with indications for purging, wait and observe if the pulse is Slow. Question: Text says Jie Xiong (Chest Binding) with Floating/Large pulse cannot be purged, or death ensues, yet here purging is suggested. Contradiction? Answer: Epigastric hardness differs from Jie Xiong, which differs from Pi (Glomus). Exterior pathogen + purging = Jie Xiong (painful). Interior pathogen + purging = Pi (painless, less severe). Pi lacks the prohibition against purging seen in Jie Xiong. Taiyang disease post-purging with soft epigastric glomus and Guan-floating pulse uses Da Huang Huang Lian Xie Xin Tang. Hard epigastric region without prior purging indicates need for purging. However, Yangming disease with hard/full epigastric region must not be purged, or fatal diarrhea ensues. Careful examination is essential.

Pulse Floating and Surging, sweat like oil, continuous panting, inability to take fluids, insensibility, alternating calmness and chaos indicate death.

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

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

Yang remains alone, body like smoke, fixed gaze, head shaking indicates Heart failure. Heart corresponds to Li trigram (Yang outside, Yin inside). Yang remaining alone means Heart Blood exhausted, leaving floating fire. Classic: Heart failure leads to death in 1 day. Identified by shoulder breathing, backward gaze. Alternative: Fixed eyes, death in 2 days.

Lips/tongue blue, limb twitching indicates Liver failure. Liver meridian connects to eyes, jaw, lips. Classic: Liver failure leads to death in 8 days. Identified by blue face, desire to curl up, blind sweating. Alternative: Death in 2 days.

Black around mouth, soft yellow sweat indicates Spleen failure. Spleen manifests in lips. Black around mouth indicates waning manifestation. Classic: Spleen failure leads to death in 12 days. Identified by cold mouth, swollen feet, abdominal heat/bloating, uncontrolled diarrhea. Alternative: Death in 5 days.

Incontinence, delirium, reversed staring eyes indicates Kidney failure. Classic: Kidney failure leads to death in 4 days. Identified by sudden tooth withering, black face, yellow eyes, breaking back sensation, flowing sweat. Alternative: 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 body; Yang exhaustion = red/warm body. 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 correspond to Zang/Fu.

Cun Kou pulse Floating/Large, improperly purged: Major error. Floating indicates blood deficiency; Large indicates Cold. Cold clashes causing borborygmus. Physician drinks cold water to induce sweat. Water meets cold, clashes causing KT (hiccup/choking).

Fu Yang pulse Floating indicates Deficiency. Floating/Deficiency clash causes Qi KT (choking/hiccups), indicating Stomach Qi exhaustion. Slippery pulse indicates Yue (hiccups). This is physician's fault. Treating deficiency as excess, forcing empty vessels. Floating pulse with dry nose predicts epistaxis.

"Pulse large, disease hot, yet called cold" refers to pathogenic factor. Later text "water meets cold" suggests Stomach deficiency-cold. True cold vs. pathogenic heat? Large pulse? Clash of pathogen/cold involves Qi (Floating pulse). Cause of Floating pulse? Clash of pulse and cause? Unresolved. Cheng Shi accepted this without doubt. KT connects to Ye; Yue is hiccup. Li Dongyuan/Zhang Hezi equate Yue with dry retching; Chen Wuyue equates Yue with cough-hiccup. *Ling Shu*: Treat Yue by tickling nose to sneeze, holding breath, pulling head back, startling. Modern hiccups respond to these. Dry retching does not. Vomiting has its own section; adding this seems redundant. Ancient "Ke" equals modern "Sou" (cough) and hiccup, unrelated. KT and Yue arise from improper purging + cold water sweating, causing middle Jiao Qi rebellion. Light = KT, Heavy = Yue. Fu Yang pulse: Floating = KT, Slippery = Yue. KT is throat blockage, wide eyes, mute (Dongyuan). Yue is Qi rushing from umbilicus to mouth, repetitive sound. Excess (treatable); Deficient (hard, 1 hiccups/0.5 hr). 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/irritation. Text: Floating pulse, fever, dry mouth/nose, able to eat -> Epistaxis, treat with Huang Qin Tang.

All Floating/Rapid pulses accompany fever and aversion to cold. If painful area with normal appetite, pus accumulation is suspected.

Cold damage texts list four similar conditions: Gangrene, Phlegm-fluid, Food stagnation, Deficiency irritability. Abscesses/carbuncles with chills/high fever mimic cold damage. Zhang Zhongjing discussed this, later ignored sadly. People feel local pain/swelling. This section 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 without thirst, foul sputum, long-term pus like rice gruel -> Lung Abscess. Lower abdominal heaviness/pain on pressure, frequent urination like strangury, sweating, aversion to cold, rough skin, tense abdomen, Slippery/Rapid pulse -> Intestinal Abscess. Hidden epigastric pain, tenderness, Sinking/Fine Stomach pulse, Surpassing Ren Ying pulse -> Gastric Abscess. Differentiate internal/external injury via Ren Ying/Qi Kou. Internal injury: Ren Ping; Gastric Abscess: Ren Ying Surpassing. Often mistaken for cold damage; distinguish early. Example: Qian family daughter, intestinal abscess fever, misdiagnosed as cold damage, starved, died after purging pus. Alas! Must read Zhang Zhongjing!

Pulse Floating/Slow, facial redness with shivering: Should resolve with sweat by day 6-7. Fever instead delays resolution. Slow indicates Yang deficiency, inability to sweat, causing itching.

Floating/Slow pulse: Yang deficiency causes Slowness. Qi stagnation causes facial redness. Struggle between Healthy Qi and Pathogen causes shivering. Like humid weather forming rain, sweating is possible, but Yang deficiency prevents it. At day 6-7 (end of transmission cycle), instead of sweating, fever and itching occur. Classic: "All itching is deficiency." Text: Taiyang disease like malaria, micro-pulse, chills, facial redness, itching -> Gui Zhi Ma Huang Ge Ban Tang (small dose).

Cun Kou pulse Yin/Yang both Tight: Clear pathogen attacks Upper Jiao; Turbid pathogen attacks Lower Jiao. Clear attacking Upper = Jie (Pure); Turbid attacking Lower = Hun (Muddy). Yin attacked by pathogen causes internal trembling. Exterior Qi slightly deficient, Interior Qi unguarded, allowing pathogen to enter Yin. Yang attacked by pathogen causes fever, headache, stiff neck/back, waist/leg pain. Caused by fog/dew (Clear pathogen attacking Upper, Turbid attacking Lower). Yin trembling causes cold feet/knees, erratic urination/defecation. Exterior Qi slightly deficient, Interior Qi slightly urgent, Three Jiao confused, interior/exterior blocked. Upper Jiao stagnation, Zang Qi薰 (fumes) causing mouth/gum ulcers. Middle Jiao dysfunction, Stomach Qi rebels, Spleen Qi fails to rotate, Stomach becomes Turbid, Ying/Wei blocked, Blood coagulates. If Wei Qi flows forward first: Urine dark yellow, clashes with Heat, travels meridians/organs, causes abscesses/pus. If Yin Qi flows forward first: Yang Qi declines, Yin has no outlet, external pathogen enters, sneezing, throat blockage, cold reversal clashing with heat, Blood coagulates downward like pig liver. Both Yin/Yang reverse, Spleen Qi weak, five fluids pour down, Lower Jiao closes poorly, clear stool heavy/frequent/difficult, umbilical cramping pain, life endangered.