Lecture 1: The Study of Pulse in the Golden Chamber
Summary: The current edition of the “Essentials of the Golden Chamber” contains a total of 398 articles, of which 134 are related to pulse diagnosis. Therefore, this lecture aims to help us analyze the meanings of these articles more accurately; secondly, to serve clinical practice, not only to explain theories through pulse; and thirdly, to inspire students to explore difficult articles (this lecture aims to clarify various pulse types, but there are still some articles that are unclear, such as the “Pulse of Water and Qi” section’s “cun kou mai chen er qian,” which Wu openly admits he does not understand, and encourages students to explore and verify).
1. The Role of Pulse Diagnosis
(1) It can determine the cause of the disease (establishing the etiology and pathogenesis).
For example, a floating pulse often indicates wind (also blood deficiency, such as in men with blood loss, but mostly it is a hollow pulse), a slow and tight pulse often indicates cold, a moist pulse is usually soft and slow, a phlegm pulse is often slippery and string-like, and a stasis pulse is often rough, etc. Specific explanations are as follows.
1. In the “Wind Stroke” section, Article 2 states: “The cun kou pulse is floating and tight; tight indicates cold, floating indicates deficiency, cold and deficiency intertwine, and the pathogen is in the skin. Floating indicates blood deficiency, the collaterals are empty, and the evil does not disperse, either left or right; the evil qi is counteracting the righteous qi, the righteous qi leads the evil, and the evil does not follow. If the evil is in the collaterals, the skin and muscles are numb; if the evil is in the channels, it is heavy and unmanageable; if the evil enters the bowels, the person cannot recognize others; if the evil enters the organs, the tongue cannot speak, and saliva is expelled.” Wu analyzes this pulse pathology as blood deficiency being harmed by wind and cold, which corresponds to the wind stroke disease at that time, such as when the meridians are affected, often seen as facial paralysis or hemiplegia without disturbance of consciousness, and the tongue is pale, the coating is thin and white, and the pulse is floating and weak, for which Xiao Xuming Decoction can be used.
For instance, treating an elderly cadre with wind-induced facial paralysis with several doses of Xiao Xuming Decoction was effective, as was treating an elderly woman with facial paralysis, both cases were tightly linked to exposure to wind (either from a vehicle or air conditioning).
2. In the “Wind Stroke” section, Article 4 states: “The cun kou pulse is deep and weak; deep indicates the bones, weak indicates the tendons, deep indicates the kidneys, and weak indicates the liver. Sweating enters the water, as water injures the heart, and the yellow sweat emerges from the joints, hence it is called ‘joints’.” This indicates that the patient has insufficient liver and kidney yin blood, making it easier for wind, dampness, and heat evils to invade the bones, joints, and tendons governed by the liver and kidneys (wherever the evil gathers, its qi must be deficient), leading to joint diseases.
Wu mentioned a case of a director’s daughter who had been suffering from fever since the age of 4. Initially, she consulted Mr. Yao Hesheng, who then referred her to Wu for treatment.
Patient Zhang, female, 20 years old, first diagnosed on September 2, 1980. The patient had been experiencing fever since the age of 4, accompanied by joint pain. The condition had persisted for nearly 16 years, and she had been diagnosed with “collagen disease” at multiple military hospitals. She was treated with “prednisone”; taking 6 tablets daily would prevent fever and reduce joint pain, but reducing the dosage would lead to fever, and stopping completely would cause her temperature to rise to 40°C or higher. Therefore, multiple attempts to reduce the prednisone dosage failed, leading her to transfer to Jiangxi University of Traditional Chinese Medicine.
At the time of consultation, the patient had reduced the steroid to 4 tablets daily, with a temperature of around 38.5°C and joint pain, especially in the small joints, which were notably red, swollen, and hot, with slight thirst. Wu tried various herbal formulas without success (including Chai Hu Decoction, Bai Hu Jia Gui Zhi Decoction, Gui Zhi Sha Zhi Mu Decoction, Ma Xing Yi Gan Decoction, Gan Cao Fu Zi Decoction, etc.).
After three months of ineffective treatment, he advised stopping the steroids and using only herbal medicine. After stopping the steroids, the patient experienced cold followed by fever reaching 40°C every afternoon, with sweating at night leading to a reduction in fever, accompanied by joint redness, swelling, pain, slight thirst, emaciation, weakness, scant menstruation, and normal bowel movements, with pale urine and a floating, wiry pulse.
Wu analyzed three points: first, chronic illness often leads to deficiency; second, the cun kou pulse is deep and weak, indicating liver and kidney qi and blood deficiency; third, the effectiveness of prednisone (warming kidney yang) indicates kidney yang deficiency. Therefore, he used a pure tonifying approach, taking Ren Shen (Ginseng) and Lu Rong (Deer Antler) as powder, administered daily, and within two weeks, the patient was stable and fully recovered without relapse.
3. Many sections use pulse diagnosis to discuss pathogenesis or suggest treatment methods.
For example, in chest obstruction: “The pulse should be taken as too much or too little; if the yang is weak and the yin is string-like, it indicates chest obstruction and pain. This is because of extreme deficiency. Now, if the yang deficiency is in the upper jiao, it leads to chest obstruction and heart pain due to the yin being string-like.”
For abdominal fullness: “The fu yang pulse is slightly string-like; the method should be for abdominal fullness; if not full, there must be difficulty in defecation, and pain in both groins, indicating that cold from deficiency is rising from below, and warming herbs should be used.”
For food retention: “When asked: How can one differentiate food retention? The teacher said: The cun kou pulse is floating and large; pressing it feels rough, and the chi pulse is also slightly rough, hence it is known to be food retention; Da Cheng Qi Decoction is the main treatment for it.”
For water and qi diseases: “The teacher said: There are diseases of wind water, skin water, righteous water, stone water, and yellow sweat. Wind water has a floating pulse, with external symptoms of joint pain and aversion to wind; skin water also has a floating pulse, with external symptoms of swelling, pressing it sinks, and does not aversion to wind, with a distended abdomen and no thirst, should induce sweating; righteous water has a deep and slow pulse, with external symptoms of shortness of breath; stone water has a deep pulse, with external symptoms of abdominal fullness and no shortness of breath; yellow sweat has a deep and slow pulse, with body heat, chest fullness, swelling of limbs and face, and if not cured for a long time, it will lead to pus and abscesses.”
For jaundice: “The cun kou pulse is floating and slow; floating indicates wind, and slow indicates obstruction. Obstruction is not wind. The limbs are troubled and the spleen must be yellow, with stasis heat circulating.” Also, “The jaundice obtained from dampness should not be treated with excessive fluids to avoid promoting dampness.”
(2) It can distinguish the eight principles (location and nature of the disease).
For example, floating and deep can determine exterior and interior; for difficult and miscellaneous diseases, or recurrent cases, pulse diagnosis is particularly important, as many diseases are caused by treating the disease without addressing the exterior; slow and rapid can determine cold and heat, of course, dampness, righteous deficiency, and other factors can also lead to slow or rapid pulses; strong or weak can distinguish deficiency and excess, but one must also pay attention to the authenticity of deficiency and excess.
1. In the “Cough and Lung Abscess” section, Article 8 states: “If the cough pulse is floating, then use Hou Po Ma Huang Decoction.” This condition indicates exterior cold and interior heat combined with water retention, and this formula is a variation of Ma Xing Shi Gan Decoction (removing licorice and adding Hou Po, Ban Xia, Xi Xin, Gan Jiang, and Wu Wei Zi). Wu mentioned that this condition often presents as paroxysmal cough, with a tight cough sound, worsening when lying down, with thin phlegm, accompanied by body pain, chest tightness, and nausea; while Article 9 states: “If the pulse is deep, then use Ze Qi Decoction,” indicating purely an interior condition, with water retention being more pronounced, and interior deficiency being more evident. Wu mentioned that this formula often treats lung failure and cough caused by pulmonary heart disease, but for various reasons, he had not used this formula, hence he cited a case to deepen understanding:
A male patient with lung cancer, aged 53, had been ill for more than two years, with prominent symptoms of poor appetite and severe cough, causing pain in both sides of the ribs, preventing him from sleeping. The patient was emaciated, only able to eat small amounts of thin rice porridge and noodles, and lacked the strength to eat, with dry and hard stools. His tongue was red with a yellow coating, his face was pale and dull, and his pulse was floating and rapid. He requested treatment for his cough, and the prescription was: Ze Qi 100g, Sheng Ban Xia 20g, Zi Yuan 15g, Bai Qian 15g, Sheng Shen 25g, Huang Qin 20g, Gan Cao 20g, Gui Zhi 20g, Sheng Jiang 20g, for three doses.
Three days later, he returned for a follow-up, with no significant improvement, feeling slightly relieved from coughing. The prescription was adjusted to: Ze Qi 120g, Sheng Ban Xia 30g, Zi Yuan 15g, Bai Qian 15g, Sheng Shen 30g, Huang Qin 20g, Gan Cao 20g, Gui Zhi 20g, Bai Shao 30g, Sheng Jiang 20g, for two doses. He was instructed to soak in warm water for 60 minutes, boil on high heat, and simmer for 30 minutes, dividing into five doses. After finishing the two doses, the patient came back with his wife and child, giving a thumbs up and saying: “Amazing, after one dose, I slept for nine hours without coughing at all!” His wife joked that he slept so soundly that she thought he had “passed away”. After waking up, he immediately wanted to eat, finishing a bowl of noodles, and when he went to the toilet, he had a particularly smooth bowel movement. After that, he coughed a couple of times, which was the best treatment he had received in two years. Experts in Beijing had said that at this stage of lung cancer, Chinese medicine would be ineffective, and had they known the efficacy would be so good, they would have sought treatment earlier to avoid so much suffering.
During the third consultation, he continued with the second prescription for 20 doses, with the same preparation method.
By the time he had taken 10 doses, the patient and his son specifically came to the clinic to express their gratitude. The patient’s complexion was rosy, a stark contrast to his previous pale and dull appearance, and his appetite and bowel movements had returned to normal. Occasionally, he would cough a few times during the day, but otherwise, he was no different from a healthy person. He could walk in the community, and when he experienced chest tightness, he would sit down and quickly recover. Recently, during continuous rainy weather, his cough slightly worsened, but it did not affect his normal life.
Comment: The treatment of this patient relied heavily on the large doses of Ze Qi, Sheng Ban Xia, and Bai Shao. I often add She Gan and Bai Shao to Ze Qi Decoction because many patients with severe cough also experience spasms and discomfort in the throat. Adding She Gan and Bai Shao not only alleviates the spasms in the upper respiratory tract but also eliminates the itchiness and discomfort in the throat that causes coughing. Ze Qi Decoction can be considered a specialized formula for lung cancer, but some lung cancer patients do not respond well to it, which requires adjustments to enhance the effectiveness of cough relief, phlegm resolution, and asthma alleviation.
2. The pulse can suggest treatment methods (treating the disease according to the situation).
For example, in the “Cold Damage” section: “After cold damage, if there is a subsequent fever, Xiao Chai Hu Decoction is the main treatment; if the pulse is floating, it should be resolved with sweating; if the pulse is deep and solid, it should be resolved with purging.” (Article 394)
Additionally, in the Golden Chamber: “If the patient’s pulse is floating in the front, the disease is in the exterior; if floating in the back, the disease is in the interior. If there is low back pain and stiffness, it must be accompanied by shortness of breath and extreme fatigue.” This is known as treating the upper with the upper and the lower with the lower, and treatment should follow the situation.
For instance, when Pu Fuzhou treated a patient with high fever and delirium, abdominal distension, and constipation, while the pulse was slippery and flowing, other doctors suggested immediate treatment, but Pu Fuzhou argued that the slippery pulse was not in the Yangming organ but in the Yangming channel, and thus used Bai Hu Decoction, effectively countering the majority’s opinion (Wu stated that Pu Fuzhou was a true TCM practitioner). In the “Cold Damage” section, there is also a statement in Article 219: “In the case of three Yang diseases, with abdominal fullness and heaviness, difficulty in turning, numbness of the mouth, facial dirtiness, delirium, and urinary incontinence, if sweating occurs, delirium will ensue; if purged, sweating will occur on the forehead, and the hands and feet will be cold. If there is spontaneous sweating, Bai Hu Decoction is the main treatment.” Zhang Xichun often used Bai Hu Decoction or alone with Shi Gao to treat fever and constipation, and after taking the medicine, the fever would subside, and the patient would pass hard black stools. The key lies in the combination of abdominal diagnosis (whether there is distension and hardness) and pulse diagnosis (whether the pulse is deep and solid or floating and slippery).
3. The rapid pulse indicates the main disease (rapid indicates heat, rapid indicates deficiency).
For example, with tachycardia, it can indicate heat evil stirring or heart qi deficiency, and in the case of a solid pulse, an example is given of a child with a flushed face, a shiny complexion, a thirst for cold water, profuse sweating, and a rapid and strong pulse. Taking Zhu Ye Shi Gao Decoction for several doses would stabilize the condition. Another example is an elderly woman with palpitations, a thick tongue coating, a sticky mouth, and a slippery and rapid pulse. Initially treated with Wen Dan Decoction without effect, but after adding Huang Lian and Zhi Zi, it was effective.
Also referenced in Article 7: “A rapid pulse indicates lung atrophy, while a solid pulse indicates lung abscess.”
4. Malaria (and similar conditions) also emphasizes pulse.
For example, in the “Malaria” section, Article 1 states: “The pulse of malaria is string-like; a string-like and rapid pulse indicates much heat, while a string-like and slow pulse indicates much cold. A small and tight string indicates poor treatment; a string-like and slow pulse can be warmed; a tight string can be induced to sweat; a large floating pulse can be purged; a string-like and rapid pulse indicates wind-induced.”
Referring to a case of pancreatitis, the patient had a high fever, with symptoms of chills followed by fever in the afternoon, and at night the fever would subside, with frequent belching, nausea, and a burning sensation in the stomach, a thick and greasy tongue coating, and a string-like and rapid pulse. After using Da Chai Hu Decoction, the symptoms did not improve, and diarrhea persisted (indicating damp heat was not resolved), so using Hao Qing Qing Dan Decoction with added Zhi Zi and Hou Po was effective.
(3) It can determine the transition of the disease mechanism.
1. Severity of symptoms.
For example, in the “Vomiting and Diarrhea” section, Article 25 states: “If there is diarrhea, and the pulse is deep and string-like, it indicates heaviness; if the pulse is large, it indicates it has not stopped (the disease is severe and will further develop); if the pulse is weak and rapid, it indicates it is about to stop (the disease is mild and will overcome the evil), even if there is fever, it will not be fatal.” This is similar to what is stated in the “Inner Canon”: “A large pulse indicates disease progression, while a small pulse indicates disease retreat.”
2. Direction of disease progression.
Generally speaking, a deficiency disease will have a deficiency pulse, and the prognosis will not be too poor. If a deficiency disease presents with a solid pulse, the prognosis is generally poor. For example, in the case of a tuberculosis patient, after Western medical treatment, the symptoms stabilized, and the hospital claimed the rescue was successful. However, upon pulse examination, the pulse was large and solid, indicating the stomach qi was about to collapse, and thus he predicted a poor prognosis, advising the medical staff to strengthen monitoring, but no one paid attention, resulting in the patient dying from a hemorrhage the day after discharge.
Another example is in the “Cough with Phlegm” section, Article 24 states: “If a cough persists for several years, and the pulse is weak, it can be treated; if it is large and rapid, it indicates death…” Another example is a heart failure patient, after anti-infection treatment, the symptoms stabilized, and the hospital claimed the rescue was successful, but upon pulse examination, the pulse was large and solid. Although he advised careful monitoring, no one listened (and even mocked Wu for being overly cautious), and that night the patient died.
3. Transmission of symptoms.
For example, in the “Cold Damage” section, Article 4 states: “If a cold is contracted for one day, and the pulse is quiet, it indicates no transmission; if there is agitation and the pulse is rapid, it indicates transmission.” Generally speaking, if the initial symptoms of the disease are not obvious, and the pulse is slow but becomes rapid, it indicates that symptoms will soon become prominent, such as a fever about to develop. Additionally, if there are accompanying symptoms, it can be inferred that the disease will undergo a transmission change (or have accompanying conditions). However, one cannot solely rely on pulse diagnosis; pulse and symptoms must be combined, as the ability to combine color and pulse can ensure comprehensive understanding.
2. Some Rules of Pulse Diagnosis
(1) Pay attention to the differences in meanings of cun kou and the three positions.
If the cun kou, guan shang, and chi zhong are combined or appear simultaneously, it indicates a single pulse representing cun, guan, and chi. For example, in blood stasis: “The cun kou and guan shang are slightly weak, and the chi is small and tight.” If only the cun kou pulse appears or appears simultaneously with the fu yang pulse or shao yin pulse, it indicates that the three positions are being taken together.
(2) Pay attention to the relative and absolute differences in pulse.
1. For example, if the pulse is floating, with difficulty in urination, slight fever, and thirst, one should promote urination and induce sweating; Wu Ling San is the main treatment. This is an absolute floating pulse, as there is an exterior pathogen present.
Example: A woman underwent a sterilization surgery two days after her menstrual period ended, during which she caught a cold, leading to persistent vomiting for three months, with both Western and Chinese medicine being ineffective. Wu, after trying various formulas without success, noted that she had persistent thirst and was drinking water continuously. Although she would vomit occasionally, the reaction was worse after drinking water, and she had slight fever. Observing her pale tongue with a white coating, he used Wu Ling San as the original formula, and after two doses, she was stable, which can be considered a responsive treatment.
However, if the pulse is floating with fever, thirst, and difficulty in urination, Zhu Ling Decoction is the main treatment. This is a relative floating pulse, as the disease does not have an exterior pathogen but is due to lower jiao damp-heat injuring yin, leading to a chi pulse that is deep and a cun kou pulse that is floating.
Example: Treating a patient with neurosis, who had insomnia, irritability, dizziness, and thirst. His appetite was acceptable, but he experienced a burning sensation during urination, and his tongue coating was particularly thick. He was treated with Zhu Ling Decoction and stabilized.
Note: There are also several scattered pulse diagnoses.
For food retention, the cun kou pulse is floating and large, pressing it feels rough, and the chi pulse is also slightly rough, which is due to the chi pulse being deep and rough, hence the cun pulse is relatively floating.
For diarrhea (dysentery), the chi pulse is deep and rough, while the cun pulse is slightly floating, indicating that heat evil has harmed the lower jiao blood level, hence the cun pulse is floating and rapid, while the chi pulse is rough, indicating pus and blood in the stool.
For chest obstruction, the pulse is floating and slippery, emphasizing the slippery pulse, which is caused by phlegm-heat stirring the pulse, also because the guan pulse is deep while the cun pulse is strong.
For chest obstruction, the guan pulse is deep (indicating the disease is in the middle jiao), while the cun pulse is relatively floating.
(3) The ancient and modern views on pulse diagnosis.
Wu stated that the “Golden Chamber” was written in an earlier era, and although it places great importance on pulse diagnosis, due to the era’s limitations, some concepts of pulse diagnosis were not yet mature, and some differ from modern concepts. This is a natural situation when a new technique is beginning to develop and has not yet been standardized.
1. Large pulse.
(1) The “Yangming pulse is large” in the “Cold Damage” section, or the “Cough and Shortness of Breath, this is lung distension, the person is wheezing, with eyes appearing to be protruding, and a floating and large pulse indicates that the formula of “Yue Bi Jia Ban Xia Decoction” is the main treatment.” This indicates a large pulse, which is similar to the modern meaning but not entirely the same.
(2) The pulse of dampness is large and the mouth is dry, as stated in the “Dampness Disease” section: “Dampness disease causes body pain, fever, yellow face, wheezing, headache, nasal congestion, and irritability; the pulse is large, and one can still eat and drink, and the abdomen is harmonious without disease, indicating that the disease is in the head due to cold dampness, hence nasal medication will cure it.” This indicates that cold dampness obstructing the upper jiao leads to acute rhinitis, and the cun pulse should be strong.
(3) A large pulse indicates labor, with a strong and not soft pulse, or even a leather-like pulse, such as “Shortness of breath (difficulty breathing and wheezing) with facial swelling, shoulder breathing (heart and lung qi deficiency), and a floating and large pulse (indicating that the large qi is about to collapse, and the yang qi is difficult to conceal). If untreated, it will worsen.” Wu emphasized that what Zhang Zhongjing said is true, and he recounted a case of his wife’s brother, who had heart failure, shoulder breathing, and leg swelling, with a deep and weak pulse. He frankly stated that there was no immediate danger to life, but after four years, the pulse gradually became large, and treatment became difficult, leading to his eventual death.
2. String and tight pulses are interchangeable (the former is left and right, while the latter is up and down, both indicating a higher tension pulse).
For example, a tight pulse feels tight like a string, moving up and down (wind excess causing cramps), which emphasizes the string pulse; in the case of cold and solid evil, the pulse is tight and string-like, indicating the presence of cold evil.
There is also a mention of deficiency labor, stating: “The pulse is string-like and large. String indicates reduction. Large indicates hollow. Reduction indicates cold. Hollow indicates deficiency. Cold and deficiency are intertwined. This is called leather. For women, it indicates postpartum bleeding. For men, it indicates blood loss and loss of essence.” The so-called string indicates reduction, which actually means that the string indicates tightness (Li Jinyong also verified this), referring to the pulse being slightly tight, indicating deficiency and cold. It is also mentioned that if a young boy shows significant memory decline, it often indicates loss of essence, hence Wu advises young men to practice moderation.
Note: A single pulse can indicate multiple diseases; for example, a string pulse can indicate malaria, abdominal fullness, cold hernia, phlegm retention, etc.; and multiple pulses can also indicate multiple conditions; for example, wind water edema can have a floating pulse when mild, and a deep pulse when severe; food retention in new diseases can have a deep and rough pulse, and when it transforms into heat, it can have a slippery and rapid pulse, indicating a struggle between righteousness and evil, leading to a tight pulse like a twisted rope.
3. Rapid does not necessarily indicate a fast pulse rate.
In the “Golden Chamber,” a rapid pulse sometimes does not refer to the speed of the pulse but to the dynamics of the pulse, such as in the “Chest Obstruction and Heart Pain” section: “In the case of chest obstruction, wheezing, coughing, and spitting, chest and back pain, shortness of breath, the cun kou pulse is deep and slow, while the guan pulse is small and tight and rapid; Guo Wei Xie Bai Jiu Jiu Decoction is the main treatment.” In this section, the rapid pulse is not meant to indicate a fast pulse rate but rather the dynamics of the pulse, indicating a state of agitation, as the pulse becomes rapid during a chest obstruction attack, which aligns with the explanation in the “Golden Chamber Translation”: “Here, the slow and rapid pulse refers to the dynamics of the pulse’s speed, as the upper jiao yang is deficient, leading to a weak and unresponsive cun kou pulse, while phlegm and fluids obstruct the flow of yang qi, causing the guan pulse to appear agitated and restless.” This interpretation aligns with Zhang Zhongjing’s original intent.
4. The weak pulse has two meanings.
The character “weak” in the “Golden Chamber” sometimes refers to a weak pulse, while at other times it is an adjective, which should be distinguished. In the “Blood Stasis and Deficiency Labor” section, it states: “In the case of essence loss, the lower abdomen is string-like and tight, the head is cold, the eyes are string-like and falling, the pulse is extremely weak and hollow and slow, indicating loss of blood and essence. The pulse is slightly tight, indicating deficiency of yang qi, and one should needle to invigorate yang qi, allowing the pulse to harmonize and tighten to achieve recovery.” In this case, “the pulse is slightly tight” should be interpreted as a pulse diagnosis, indicating yang deficiency, which should not be overlooked.
Conversely, in some articles, “weak” refers to the pulse, such as in the “Blood Stasis and Deficiency Labor” section: “When asked: How does one contract blood stasis? The teacher said: Those who are honored have weak bones and abundant skin, and due to fatigue and sweating, they do not move at the right time, and are exposed to a slight breeze, thus contracting it. However, the pulse is weak and wet, in the cun kou and guan shang, indicating that one should needle to invigorate yang qi, allowing the pulse to harmonize and tighten to achieve recovery.” Here, “the pulse is weak” refers to the pulse diagnosis, indicating yang deficiency, which should not be overlooked.
5. Zhang Zhongjing’s four pulse diagnosis methods.
These are cun kou (generally used for exterior diseases), shao yin (possibly Tai Xi pulse or Yong Quan pulse), shao yang (pulsation in front and back of the ear), and fu yang pulse (dorsalis pedis artery, related to the spleen and stomach). Apart from the cun kou and fu yang pulses being used more frequently, for example, in the “Ma Zi Ren Wan” case in the “Cold Damage” section, the fu yang pulse is floating and rough, and in the case of cold hernia, the fu yang pulse is slightly string-like, while in the case of stomach reflux, the fu yang pulse is weak and floating.
In the jaundice disease, both the cun kou pulse is floating and slow, and the fu yang pulse is tight and rapid. The cun kou pulse emphasizes the exterior sensation of damp-heat, while the fu yang pulse emphasizes the internally generated damp-heat, which can ultimately lead to damp-heat steaming the blood level, causing stasis heat to circulate, leading to bile leakage and resulting in jaundice. Based on this analysis, one can use Gan Lu Xiao Du Dan combined with Chi Shao to treat jaundice. Wu also emphasized that one should not think that only warming yang and dispersing cold herbs can accelerate heart rate; if one sees a slow pulse with a slow heart rate, one should consider Fu Zi and Gan Jiang, as damp-heat can also easily lead to bradycardia (which can be treated with Yin Ma Xuan Bi).
For example, in a 90-year-old patient with obstructive jaundice, the pulse was slow and strong, with over 40 beats per minute. After fluid treatment, the jaundice did not improve, and the pulse became even slower. With abdominal distension and poor appetite, using Long Dan Xie Gan Decoction combined with Yin Chen Hao and Jin Qian Cao for seven packets resulted in the resolution of jaundice.
For certain complex diseases, when diagnosing multiple pulse types, such as in the “Water and Qi Disease” section: “The cun kou pulse is deep and slow; slow indicates… the fu yang pulse is hidden, water and grains do not… the shao yang pulse is low, and the shao yin pulse is thin… this is called blood level.” This is because the formation of edema is closely related to the functions of the lungs, spleen, and kidneys, and also involves the dysfunction of the three jiaos. Therefore, when explaining the formation of edema, the methods of combining cun kou, fu yang, shao yin, and shao yang pulses are used to illustrate this complex mechanism. If the disease enters the stomach or is a long-term mixed disease, one often takes both cun kou and fu yang together. In the “Diabetes” section, it states: “The cun kou pulse is floating and slow; floating indicates deficiency, slow indicates labor; deficiency indicates insufficient wei qi, and labor indicates depleted ying qi. The fu yang pulse is floating and rapid; floating indicates qi, rapid indicates excessive consumption of grains, leading to frequent urination and hard stools, indicating diabetes.” Here, the cun kou and fu yang pulses are combined to explain the mechanism of diabetes, which falls under the category of long-term mixed diseases.
6. For diseases with upper and lower obstruction, one should carefully differentiate the cun, guan, and chi pulses.
In the “Five Organs Wind Cold Accumulation Disease” section, it states: “For all accumulations, the pulse is fine and attached to the bone, indicating accumulation. The mouth indicates accumulation in the chest, slightly emerging from the cun kou; accumulation in the throat is indicated by the guan shang; accumulation in the lower abdomen is indicated by the chi; and the upper guan indicates accumulation in the heart, while the lower guan indicates accumulation in the lower abdomen, and the chi indicates accumulation in the qi level.” (Wu openly stated that Zhang Zhongjing’s pulse diagnosis skills are truly high.) The “Cold Damage” section states: “When asked: What is the condition of a patient with chest obstruction? The answer is: Pressing it causes pain; the cun pulse is floating, and the guan pulse is deep, indicating chest obstruction. What is the condition of hidden obstruction? It resembles chest obstruction, with food intake being difficult, and frequent diarrhea; the cun pulse is floating, and the guan pulse is small, fine, deep, and tight, indicating hidden obstruction…” From this, it is not difficult to see that Zhang Zhongjing often differentiates the upper and lower obstructions by examining the cun, guan, and chi pulses.
Wu’s sayings:
