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Here, we will use the pulse diagnosis from “Shang Han Za Bing Lun” as a standard to explain the diagnostic application of pulse methods based on disease pulse syndrome treatment.
1. Pulse Diagnosis in “Shang Han Lun”
Floating pulse indicates that the disease is on the surface; it can be felt with light pressure, indicating that Yang Qi is floating outward. Various pulse conditions are the result of the struggle between the righteous and the evil.
Pulse Diagnosis of Tai Yang Disease
1. Floating and relaxed pulse: Floating indicates a disease on the surface, and relaxed indicates deficiency. A relaxed pulse is slower than a normal pulse; a floating and relaxed pulse is termed as wind stroke. Wind is a deficiency evil, thus floating indicates deficiency. Wind is also a Yang evil, floating is a Yang pulse, while Yin indicates closure and Yang indicates opening. Wind evil harms the surface, and the struggle between the righteous and the evil leads to Wei Qi deficiency and Ying Qi weakness. Wei Yang floats outward, and the pores are widely open; if the external defense is not solid, then Yin is weak, leading to spontaneous sweating. Therefore, the pulse is floating and relaxed, belonging to the Gui Zhi Tang syndrome.
2. Floating and tight pulse: Floating indicates the surface, and tight indicates cold. A tight pulse is difficult to distinguish, resembling a twisted rope, so much so that it is hard to count. “If both Yin and Yang pulses are tight, it is called Shang Han”; a tight pulse indicates an urgent condition. There is pain all over the body, aversion to cold and panting, and no sweating, which is the Ma Huang Tang syndrome. This is due to the epidemic cold poison harming the body, resulting in the struggle between the righteous and the evil, and the pulse appears urgent. In normal times without the spread of epidemic Qi, there is no such urgent sign. Generally, a common cold due to wind-cold may also have symptoms like headache, aversion to wind, aversion to cold, sweating, or no sweating, but they are relatively mild, and the pulse will not show a tight and urgent condition. Generally, it can self-resolve in six to seven days. A mild cold usually does not cause fever; if there is fever, the condition must be severe. The recovery period is also six to seven days, and if severe, it may take half a month.
Shang Han pulse is tight; tight indicates cold, and cold indicates a solid evil, which is a Yin evil. Yin evil indicates blockage, and cold evil enters the body, blocking the pores and directly pressing on the Yang heat of the righteous Qi, causing it to contract inward. Where cold evil reaches, there is unbearable pain; the great Qi cannot circulate and disperse outward, hence no sweating; Yang heat is forced inward, leading to panting. It is necessary to use the strong Ma Huang Tang to induce sweating, open the surface, disperse the Qi, and drive away the evil.
The pulse is rapid and urgent, indicating that the evil Qi is strong, and the righteous Qi is deficient; the person is agitated. A relaxed pulse indicates calmness, suggesting that the evil Qi has retreated, indicating a desire to recover. A breath rate of 9-10 times is considered a rapid pulse.
The pulse is hurried. A hurried pulse indicates deficiency; hurried means urgent, with urgency mixed with relaxation. A hurried pulse has more relaxation and less urgency, indicating a pulse that is hurried, which is an irregular heartbeat, sometimes fast and sometimes slow, also caused by insufficient heart strength. What causes a hurried pulse?
One is from “Shang Han Lun” Article 22, “After the Tai Yang disease, the pulse is hurried and the chest is full; Gui Zhi removes Shao Yao Tang is the treatment.” This is due to the deficiency of the stomach after purging, with surface evil accumulating in the chest and ribs, the heart lacking nourishment, heart Qi being deficient, and the heart being in a critical state, causing the pulse to be hurried. Sometimes it is relaxed; after the heart beats rapidly, Qi declines, and the pulse becomes relaxed, then hurried again.
Two, a person may also have a hurried pulse after intense exercise, but this hurried pulse will slow down afterward and will not remain hurried.
Three, a person with a long-term illness and deficiency may also have a hurried pulse. It is sometimes urgent and sometimes relaxed, the body is extremely weak, the heart is restless, and the Qi is uneven, indicating severe illness and exhaustion, leading to a hurried pulse due to insufficient heart strength.
Pure Yin is water, pure Yang is fire; when fire is in water, the pulse appears urgent and hurried. Gui Zhi removes Shao Yao Tang is a pure Yang formula, treating the pure Yin blockage of the three jiao.
The pulse is floating and large, indicating both Qi and blood deficiency; floating indicates wind, and large indicates deficiency. Wind can cause mild heat, and deficiency can lead to cramping in both legs. A floating and large pulse feels weak upon pressure. This pulse is seen in Tai Yang disease and also in wind-damp arthritis. A floating and large pulse indicates wind, which harms the blood vessels and transforms into heat, causing fever and spontaneous sweating, frequent urination, and the three jiao fluids being robbed. Yin does not nourish Yang, leading to agitation in the heart, mild aversion to cold, and fluids not nourishing the blood, causing the blood to dry up and not nourish the tendons. With both Qi and blood deficiency, the legs are tense and cannot sweat; heavy use of Shao Yao (60 grams) and Gan Cao (30 grams) is needed to relieve the leg tension.
The pulse is surging and large; a surging and large pulse can be either deficient or solid. A surging and large pulse without heat symptoms indicates a deficiency syndrome, which is the Gui Zhi syndrome; a surging and large pulse with vexation and thirst indicates a solid syndrome, which is the Bai Hu Tang syndrome. Gui Zhi Tang and Bai Hu Tang are formulas that correspond to the duality of Yin and Yang, cold and heat.
Surging indicates heat, and large indicates deficiency. There is deficiency within the solid, so Bai Hu adds Ren Shen Tang to treat it.
The inch pulse is floating and rapid, while the wrist pulse is weak; this indicates internal deficiency, and sweating should not be induced. It is necessary to wait for the surface and internal to be solid, and the fluids to harmonize, leading to spontaneous sweating and recovery.
The inch pulse is floating and tight, while the wrist pulse is slow; this indicates insufficient Ying Qi and blood, and sweating should not be induced.
The pulse is floating and rapid, without vexation or thirst symptoms; Ma Huang Tang can be used to induce sweating.
The pulse is weak and fine, indicating both internal and external deficiency; fine indicates Yang deficiency, and weak indicates blood deficiency. A weak pulse with aversion to cold indicates both Yin and Yang deficiency.
The pulse is deep and weak, with no significant heat but slight heat; this indicates Yang Qi deficiency, treated with Gan Jiang and Fu Zi Tang.
The pulse is deep and slow, with body aches; deep indicates internal, and slow indicates cold, treated with Gui Zhi plus Ren Shen Tang.
The pulse is deep and tight, indicating cold evil entering internally, with fullness and water retention under the heart, causing dizziness when standing and peace when lying down; this is treated with Ling Gui Zhu Gan Tang.
Fever and headache with a deep pulse indicates the need to rescue the interior; Si Ni Tang.
Both Yin and Yang pulses are stagnant; upon careful palpation, the Yang pulse emerges first, sweating will resolve it, and the Yin pulse emerges first, purging will cure it. Sweating must be vigorous, and the pulse must be vigorous. The Yang pulse emerging first indicates both internal and external deficiency, while the Yin pulse emerging first indicates food accumulation in the interior, suitable for adjusting the stomach with Cheng Qi Tang.
The Yang pulse is rough, and the Yin pulse is wiry; this indicates the liver wood overcoming the earth. The rough Yang pulse indicates Qi and blood deficiency, with evil accumulating in the chest, while the wiry Yin pulse indicates that the evil Qi has entered the organs, leading to urgent abdominal pain. This type of pulse generally belongs to liver disease. A weak Yang pulse and a wiry Yin pulse, or a deep Yang pulse and a wiry Yin pulse, all indicate the liver wood overcoming the earth, where Yang Qi is weak and cannot control water, and cold Qi is strong, causing water to accumulate.
The inch pulse is floating and tight; this indicates the liver invading the spleen, with strong liver Qi, treated with a needle at the Qimen point.
Presenting symptoms of Shang Han with a floating and weak pulse; the weak pulse indicates thirst, fever, and inability to use pungent warming to resolve the surface, suitable for a small dose of Bai Hu Ren Shen Tang with Xuan Shen and Mai Dong.
The pulse is weak and rapid, indicating internal heat; the pulse is floating and weak, and the pulse is weak and rapid; these two pulse methods are very important in clinical practice, as they represent the pulse condition where cold and heat are difficult to distinguish; it is essential to remember these two pulse methods.
The pulse is rapid, indicating heat; those who eat a lot and get hungry quickly have a strong appetite, indicating solid heat. If there is poor digestion, the stomach is cold and weak, leading to vomiting, indicating deficiency heat, which is used to diagnose the rapid pulse’s deficiency or solidity.
The inch pulse is floating, while the guan pulse is deep; this is called chest obstruction. The neck is stiff, resembling a soft spasm; purging will harmonize it, treated with Da Xian Xiong Wan.
The inch pulse is floating, while the guan pulse is small, fine, and tight; this is called organ obstruction. Organ obstruction without Yang symptoms does not alternate between cold and heat; the person is quiet, and if there is a coating on the tongue, it is difficult to treat and should not be attacked.
The pulse is floating and moving rapidly; floating indicates wind, rapid indicates heat, and moving indicates pain. A breath rate of six indicates rapid movement; the pulse is like a bean, difficult to press, indicating the accumulation of evil Qi, with shortness of breath and agitation in the chest, leading to a hard heart, indicating chest obstruction, treated with Da Xian Xiong Tang.
Wind-cold evil Qi enters the Shao Yang San Jiao; the Shao Yang San Jiao governs Qi and blood, either in Qi or blood, or in both Qi and blood, leading to chest obstruction, with many variable symptoms. A floating pulse indicates chest obstruction; a tight pulse indicates throat pain; a wiry pulse indicates tightness in both sides; a fine and rapid pulse indicates a headache that has not stopped. A deep and tight pulse indicates a desire to vomit; a deep and slippery pulse indicates heat and benefit; a floating and slippery pulse indicates blood loss.
Chest obstruction syndrome is the beginning of wind-cold evil Qi entering the interior, and whether it is chest obstruction or not is evidence of transformation into mixed symptoms.
If there is no chest obstruction, internal deficiency with a hurried pulse indicates that the evil Qi has entered the earth and transformed, indicating a desire to recover. If chest obstruction symptoms appear, the evil Qi penetrates the three jiao, and the Shao Yang connects to the organs, leading to complex and variable symptoms. A floating pulse indicates the surface, indicating the upper jiao; thus, a floating pulse must indicate chest obstruction. A tight pulse indicates internal entry, with Qi rising, leading to throat pain. A wiry pulse indicates the evil entering the Shao Yang, with the Shao Yang pulse being wiry, leading to tightness in both sides, with Shao Yang Qi stagnating, liver Qi not flowing, leading to sweating and yellowing of the body.
The pulse is fine and rapid, indicating blood deficiency; rapid indicates heat in the stomach, with the disease in Yang Ming, Qi rushing into the brain, leading to a headache that has not stopped. The pulse is deep and tight, indicating internal cold; tight indicates cold evil in the liver and stomach, leading to a desire to vomit; the pulse is deep and slippery, indicating internal presence, while slippery indicates accumulation.
Slippery pulse indicates solid symptoms; a deep and slippery pulse indicates heat and benefit, while cold evil entering the interior transforms into heat, further blocking stomach heat and leading to diarrhea; this is heat and benefit. A floating and slippery pulse indicates wind, with wind evil harming blood and transforming into heat, leading to heat entering the blood and harming it, resulting in a slippery pulse. If there is chest obstruction, Xiao Xian Xiong Tang is the treatment. If there is no chest obstruction, Bai Hu Tang is the treatment.
The pulse is knotted and alternates, indicating Qi and blood stagnation, with insufficient Qi and blood, with the pulse moving slowly and stopping intermittently; if the stop has a fixed number, it is called knotted; if the stop has no fixed number, it is called alternating, collectively referred to as knotted and alternating pulse. Knotted and alternating pulse indicates Qi and blood deficiency and stagnation, treated with Fu Mai Tang.
Pulse Diagnosis in “Jin Kui Yao Lue”
The pulse is double wiry and slow, indicating hardness under the heart; a large and tight pulse indicates Yin within Yang, suitable for purging, treated with Da Cheng Qi Tang.
Malaria pulse is self-wiry; a wiry and rapid pulse indicates much heat, while a wiry and slow pulse indicates much cold; a wiry and small tight pulse indicates poor treatment.
A wiry and slow pulse can be warmed; a wiry and tight pulse can induce sweating; a floating and large pulse can be purged; a wiry and rapid pulse indicates wind, treated with dietary adjustments; if able to eat, it indicates wind stroke; if unable to eat, it indicates cold stroke.
Pulse Diagnosis for Wind Stroke
The pulse of wind stroke is weak and rapid, indicating the effect of wind stroke. A weak and rapid pulse indicates heat in the blood.
The inch pulse is floating and tight; tight indicates cold, floating indicates deficiency, with cold and deficiency clashing, indicating evil in the skin. Floating indicates blood deficiency, with the vessels being empty (evil enters through deficiency), with the evil Qi not being released, either left or right, with the evil Qi being slow, while the righteous Qi is urgent. The righteous Qi draws the evil, leading to obstruction.
The evil is in the vessels, with the skin being numb; if the evil is in the meridians, it is heavy and unbearable; if the evil enters the organs, the tongue becomes difficult to speak, and saliva is produced.
The inch pulse is slow and relaxed; slow indicates cold, relaxed indicates deficiency, with the Wei Qi being relaxed leading to blood loss, while the Wei Qi being relaxed leads to wind stroke, with the evil Qi entering the meridians, causing itching and rashes. Insufficient heart Qi leads to evil Qi entering the interior, causing fullness and shortness of breath.
Blood stasis and deficiency
A man’s pulse is weak and rough, indicating infertility, with clear and cold essence.
If a man loses essence, the lower abdomen is wiry and urgent, with cold in the head, dizziness, and hair loss, with a rapid and weak pulse.
The pulse has various wiry movements; for men losing essence, it indicates a dream of intercourse.
A weak and fine pulse indicates excessive sweating.
The pulse is wiry and large; wiry indicates reduction, large indicates roughness, reduction indicates cold, and roughness indicates deficiency, with deficiency and cold clashing, known as the leather pulse. For women, it indicates postpartum bleeding; for men, it indicates blood loss and loss of essence.
Pulmonary distension and lung abscess
Coughing indicates a dull pain in the heart, with a rapid and slippery pulse, indicating lung abscess.
The inch pulse is weak and rapid. Weak indicates wind, rapid indicates heat; weak indicates sweating, rapid indicates aversion to cold. Wind harms the Wei, while heat harms the Ying, with excessive heat leading to blood stagnation. If it is in the early stages, it can be saved; if it becomes pus, it will lead to death.
The pulse should be taken to determine excess and deficiency. Weak Yang and wiry Yin indicate chest obstruction and pain. Weak Yang leads to Qi deficiency, causing the Qi to sink, leading to chest obstruction and pain, with the disease being attributed to deficiency. Now, Yang deficiency is known to be in the upper jiao, so chest obstruction and heart pain occur due to the Yin wiry Qi rising.
The pulse is flat, with no cold or heat. Shortness of breath indicates fullness, which should be purged.
Abdominal fullness and cold hernia
The stomach pulse is weak and wiry, indicating abdominal fullness. If it is not full, there will be difficulty in defecation. Pain on both sides indicates that this is a deficiency cold rising from below, treated with warming herbs.
The patient has abdominal fullness; if pressing does not cause pain, it indicates deficiency; if it causes pain, it indicates excess. Excess can be purged, while deficiency will reduce abdominal fullness temporarily, returning to normal, indicating cold, which should be treated with warming herbs.
The inch pulse is wiry, indicating tightness and pain under the ribs, with the person feeling cold.
Abdominal pain with a wiry and tight pulse indicates that the Wei Qi is not circulating, leading to aversion to cold, while tightness indicates a lack of appetite, with the evil and righteous clashing, indicating cold hernia.
Periumbilical pain, with white sweating upon onset, and cold hands and feet. The pulse is deep and wiry, treated with Da Wu Tou Jian.
The pulse is rapid and tight, resembling a bowstring, pressing down without moving. A wiry and rapid pulse indicates that cold should be purged. A large and tight pulse indicates hardness under the heart, which can be purged.
The pulse is rapid and slippery, indicating excess. If there is retained food, purging will lead to recovery, suitable for Da Cheng Qi Tang.
The pulse is tight like a twisted rope, indicating irregularities, with retained food.
The pulse is tight with a headache, indicating retained food in the abdomen.
True pulses of the five organs
The lung true pulse is floating and weak, pressing down weakly, like scallion leaves, indicating death without roots.
The liver true pulse is floating and weak, pressing down like a rope, like a guitar string, like a knife edge, not showing a count, or curving like a snake indicates death.
The heart true pulse is floating and solid like a broad bean, pressing down and becoming agitated indicates death. The evil cries out, the soul is restless, and blood and Qi are few. Heart Qi deficiency leads to fear; Yin Qi disease leads to mania, while Yang Qi disease leads to madness.
The spleen true pulse is floating and large and firm, pressing down like an overturned cup, clean and shaking, indicating death.
The foot Yang pulse is floating and rough; floating indicates strong stomach Qi, while rough indicates frequent urination. Floating and rough clashing leads to hard stools; the spleen is contracted, treated with Ma Zi Ren Wan.
The kidney true pulse is floating and firm, pressing down chaotically like a rolling ball, indicating death if it is weak.
The three jiao are exhausted. The upper jiao receives Qi from the middle jiao, which is not harmonized, leading to inability to circulate and digest food, hence belching. The lower jiao Qi is exhausted, leading to urinary incontinence and loss of bowel control, with the Qi not harmonizing with the middle jiao, leading to inability to self-regulate. No treatment is needed; it will recover over time. Heat in the upper jiao leads to cough and lung atrophy; heat in the middle jiao leads to hardness; heat in the lower jiao leads to blood in urine. It can also lead to dysuria or constipation. Cold in the large intestine leads to frequent loose stools; heat leads to phlegm and saliva; cold in the small intestine leads to heavy blood in the stool; heat leads to hemorrhoids.
Various accumulations and major methods
Accumulation indicates organ disease, which does not change; tightness indicates bowel disease, which has times of onset, with pain moving around, indicating it can be treated.
Various accumulations and major methods, the pulse comes fine and attached to the bone, indicating accumulation. The inch pulse accumulates in the chest, slightly emerging from the inch pulse; accumulation in the throat, the guan pulse is on the side of the navel, the upper guan pulse is under the heart, slightly below the guan pulse is in the lower abdomen, the wrist pulse is in the Qi rush. If the pulse emerges on the left, the accumulation is on the left; if it emerges on the right, the accumulation is on the right; if the pulse emerges in two places, the accumulation is in the center, treated according to its location.
Phlegm and cough
The pulse is double wiry, indicating cold; a偏 wiry pulse indicates fluid; a floating and fine slippery pulse indicates fluid damage.
A wiry and rapid pulse indicates cold fluid, which should be purged. A deep and wiry pulse indicates internal pain from suspended fluid, treated with Shi Zao Tang.
Diabetes and urinary difficulties
The inch pulse is floating and slow; floating indicates deficiency, while slow indicates consumption. Deficiency indicates insufficient Wei Qi, while consumption indicates exhausted Ying Qi. This indicates a pulse condition based on the disease. Generally, floating indicates a disease on the surface, while the wrist indicates cold. Now, floating indicates deficiency, while slow indicates consumption, indicating deficiency consumption. If the deficiency is severe, wind and cold can harm it, leading to invasion by wind and cold, indicating that the pulse is floating and slow, indicating cold evil on the surface, with floating indicating deficiency and slow indicating cold, indicating a transformation of the pulse method.
The pulse is floating, with urinary difficulties, slight heat, and thirst; it is suitable for inducing urination and sweating, treated with Wu Ling San. The pulse is floating with urinary difficulties and slight heat, indicating a group of symptoms of diabetes, indicating dryness in the stomach, with Yin not nourishing Yang, leading to floating pulse. This indicates dryness in the stomach, with urinary difficulties, suitable for inducing urination and sweating, and after taking the medicine, drink plenty of water, leading to recovery.
Water Qi Disease
Wind water has a floating pulse, with joint pain and aversion to wind. Skin water has a floating pulse, with external symptoms of swelling, pressing down without fingers, with no aversion to wind, and a distended abdomen, treated with sweating; true 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, with yellow sweating, deep and slow pulse, body heat, chest fullness, and swelling of the limbs and face.
The pulse is floating and surging; floating indicates wind, while surging indicates Qi, with wind and Qi clashing. If the wind is strong, it leads to hidden rashes; if the Qi is strong, it leads to water retention, making it difficult to bend and stretch.
The inch pulse is deep and slippery, indicating internal water Qi, with facial swelling.
The inch pulse is wiry and tight; wiry indicates that the Wei Qi is not circulating, leading to aversion to cold.
The Shao Yin pulse is tight and deep; tight indicates pain, while deep indicates water.
The pulse is deep, indicating water.
Various floating and rapid pulses indicate heat; various deep and slow pulses indicate internal organs.
The inch pulse indicates various floating conditions on the surface, while various deep conditions indicate internal conditions; various rapid conditions indicate bowel conditions, while various slow conditions indicate organ conditions.
The kidney pulse is deep, the liver pulse is wiry, the heart pulse is surging, and the lung pulse is floating.
There are six types of pulse thieves: wiry, tight, floating, slippery, deep, and rough, known as residual thieves, which can cause various pulse diseases.
The pulse methods in “Shang Han Lun” integrate disease pulse syndrome treatment into a comprehensive pulse theory. Its meaning is accurate, with precise wording and appropriate usage, to prevent future learners from falling into confusion.
The above content includes my annotations. The author attempts to present personal insights on some traditionally debated points, such as the hurried pulse.
As long as we grasp the pulse methods in the discussion, we can understand the changes in cold and heat, deficiency and excess during diagnosis, laying a solid foundation for disease pulse syndrome treatment.
The application of the three jiao in “Shang Han Lun”
The human body is composed of the Qi of the three jiao and the blood of the organs. When the Qi of the Ying and Wei harmonizes, there is no disease; when the Qi of the Ying and Wei is disharmonious, there is disease.
What is the three jiao? Regarding the origin, formation, and distribution of the three jiao, there is a relatively detailed description in Tang Rongchuan’s “Complete Book of Medicine.” He mentions in the preface of “Shang Han Lun” that the three jiao is the oil membrane of the human body, known in Western medicine as the network, which is the pathway for water. The “Nei Jing” states, “The three jiao is the gate of drainage, where the water path emerges.” The pathway of water is entirely within the oil membrane of the three jiao. When a person drinks water, the stomach has fine tubes that disperse the water, leading into the oil membrane. The ability to disperse is due to the lung Qi, hence the lung is the source of water. Water disperses into the oil membrane, leading into the bladder; all water in the network is vaporized by fire into Qi. If the vaporization is insufficient, it seeps into the bladder.
This is a general overview of the pathway of the three jiao. The application of the three jiao in “Shang Han Lun” involves the surface and interior, upper, middle, and lower. To discuss the three jiao, we must also start from the blood. The circulation of blood in the human body is adjusted through the functions of the five organs, output through arterial blood vessels, and returned through venous blood vessels, entering the five organs for continuous circulation. Blood vessels change from thick to thin, down to capillaries, meaning that blood is transported through the functions of the five organs and blood vessels, nourishing the skin, hair, meridians, and organs to maintain various functions of the human body.
Thus, the way blood circulates in the human body is through a tubular, dense network, delivering blood throughout the body. The characteristic of blood circulation is to store and not leak; therefore, when blood is diseased, it is a stagnation syndrome, accumulating and not dispersing, treated with invigorating blood, resolving stasis, dispersing knots, and acupuncture to release it.
Now let us look at the three jiao. Besides the five organ blood vessels, there is the three jiao. The three jiao includes the six fu organs, nine orifices, muscles, skin, membranes, and the membranes between blood vessels, joints, and skin hairs; all of these belong to the scope of the three jiao. Mr. Hao Wanshan stated in his “Lectures on Shang Han Lun”: “The human body has three jiao everywhere; there is no place in the human body that is not three jiao.” In the “Suwen: Discussion on Yin and Yang Correspondences,” it states: “The nine orifices are the gates of water Qi.” The nine orifices are the gates for distributing water Qi, and the Qi transformation function of the three jiao is to leak and not store. When a person drinks water into the stomach, it enters the three jiao for transformation, emerging from the pores and nine orifices, hence it is called leaking and not storing. When the three jiao is diseased, the treatment methods are to release the surface, induce sweating, and promote water; its disease is easy to recover, as it follows the trend and guides it.
The transformation of the three jiao is governed by Qi. The transformation of the three jiao relies on the heat energy of the stomach’s function to transform water and liquid. The three jiao has the functions of transformation, metabolism, and conversion. The fluids in the stomach are transformed through the three jiao, emerging as sweat, entering the fu as fluids, and entering the organs as blood.
Water cannot be treated without Qi, and blood cannot circulate without Qi. The transformation of the three jiao governs all functions of the human body. Water and Qi are mutually convertible; water can transform into Qi, and Qi can transform into water. Water and Qi are the transformation of the same entity, and the driving force for this transformation is the heat energy in the stomach. If the heat energy in the stomach is weak, the water pathway of the three jiao cannot be treated. “If the upper jiao is not treated, water will overflow the plateau (lung Qi); if the middle jiao is not treated, water will remain in the middle (abdominal distension); if the lower jiao is not treated, water will disrupt the two excretions.”
The three jiao treats water, leaking and not storing. This means that the function of the three jiao in transforming water and liquid is to continuously absorb and regulate the water and liquid to emerge from the pores and nine orifices. The three jiao is precisely through this method of leaking and not storing to nourish, protect, maintain, and repair various functions of human life. In addition, the function of the three jiao’s transformation can also be expressed through the relationship between sweat and blood.
Sweat emerges from the transformation of the three jiao, while blood is derived from the organs and vessels. Sweat and blood originate from the same source, originating from the fluids in the stomach, and can mutually supplement each other through the function of the Shao Yang pivot. When blood decreases, the fluids can supplement blood through the transformation of the three jiao; when fluids are lacking, the water in the blood can also supplement the fluids. Blood and fluids have a complementary and supportive relationship. The three jiao and the organs have a cooperative relationship of mutual regulation. Therefore, when drinking water into the stomach, it can supplement both fluids and blood.
The entire text of “Shang Han Lun” runs through the transformation and operation of the three jiao. From the perspective of dialectical treatment, the three Yang and three jiao represent the surface and interior, while the three Yin and three jiao represent the upper, middle, and lower, establishing laws, dialectics, and prescriptions. The entire text has 380 articles based on the laws of the operation of the three jiao (surface and interior), from the Qi division to the blood division reaching the organs. This is also the pathway of evil Qi entering the body. Therefore, the six meridians are divided into righteous transmission and evil transmission. The six meridians are divided into three Yang and three Yin. When evil Qi enters Yang, it flows into the meridians; when it enters Yin, it flows into the organs. The three jiao Qi division is Yang, while the five organs blood division is Yin. The texts from Gui Zhi Tang, Ma Huang Tang to Ge Gen Tang are examples of entering Yang and flowing in the meridians. From Xiao Chai Hu Tang to Da Chai Hu Tang, Xiao Jian Zhong Tang, etc., they are examples of entering Yin and flowing in the organs.
Xiao Chai Hu Tang is the pivot and harmonious formula for the transformation of evil Qi from the three jiao Qi division into the five organs blood division. It best represents the function of the three jiao and Shao Yang harmonious pivot.
Now let us look at the original text of Xiao Chai Hu Tang syndrome. “After five or six days of Shang Han, wind stroke, alternating cold and heat”; our predecessors annotated it as such, Shang Han is like this, and wind stroke is also like this, or annotated it as regardless of whether it is Shang Han or wind stroke. These two annotations are largely similar. However, this is incorrect.
Whether it is wind stroke or Shang Han, the key issue is that wind stroke and Shang Han are both three jiao Qi division syndromes, with the evil in the Yang. The text of Xiao Chai Hu Tang indicates that the evil is in the Yin; this is a fundamental issue of the text’s pivot, the essence of this article.
They have erased the five or six days, believing that in the text of Xiao Chai Hu Tang, five or six days, six or seven days, four or five days are unimportant; however, this is not the case. The five or six days of Shang Han indicates that the evil has transmitted to another meridian, which is the basis for transformation, indicating that the disease has transmitted to the Yin.
Now let us annotate the original text: the five or six days of Shang Han indicates that the evil Qi has transmitted through the six meridians, nearing its end, and also indicates that the evil Qi has entered the Jue Yin. According to normal people, after five or six days, the evil Qi should have weakened, and the righteous Qi should recover. On the seventh day, when Yang Qi returns, the disease will recover. However, today, this five or six days of Shang Han is different, as it is a dual sensation of wind stroke, alternating cold and heat. Why is it a dual sensation of wind stroke? The following Article 97 explains it clearly as an annotation to Article 96. Article 97 states that blood is weak and Qi is exhausted, with the pores open, allowing the evil Qi to enter. This means that the patient is physically weak, with both Yin and Yang being deficient, leading to a struggle between the righteous and the evil, with the righteous unable to overcome the evil, blood weak and Qi exhausted, with the virus carrying the evil. The three jiao Yang Wei is not solid, the pores are open, allowing the evil Qi to enter, leading to wind stroke in five or six days, in the three Yin meridian.
The five or six days of wind stroke in the Jue Yin leads to the Shao Yang, clashing with the righteous Qi, accumulating in the ribs. With the righteous and evil in conflict, alternating cold and heat occurs; when the righteous Qi comes, there is fever, and when the evil Qi comes, there is aversion to cold. The alternating cold and heat is the result of the evil accumulating in the Shao Yang, resembling malaria. It is not the Jue Yin syndrome of alternating cold and heat, which is endless; the alternating cold and heat is also a special manifestation of the three jiao, Shao Yang, Qi transformation function, and the result of the struggle between the righteous and the evil, and the cold and heat.
The five or six days of Shang Han, wind stroke in the three Yin, with the evil Qi clashing with the righteous Qi, accumulating in the ribs of the Shao Yang, with the righteous and evil in conflict, alternating cold and heat, with fullness in the chest and ribs, indicating that the disease is in the Jue Yin, with the organs connected, leading to pain below. If the evil is in the Shao Yang, it leads to agitation and a desire to vomit, or fullness in the chest without vomiting, or thirst in the stomach, or abdominal pain in the middle jiao, or hardness in the ribs, or the three jiao failing to treat water, with palpitations under the heart, or urinary difficulties, or three jiao Qi deficiency with no thirst, with slight heat in the body, or damage to the upper jiao lung Qi leading to cough. The three jiao Shao Yang, Qi, blood, and fluids, with various changes, involve the surface, blood, and internal organs. Surface and interior, the changes in the three jiao Shao Yang correspond to Xiao Chai Hu Tang.
Xiao Chai Hu Tang is a harmonizing formula, a formula for the transformation of Qi and blood in the three jiao Shao Yang, with both surface and interior symptoms, both Qi diseases and blood diseases, both three jiao Qi transformation symptoms and Shao Yang organ blood symptoms, covering a wide range. Shang Han wind stroke has the Chai Hu syndrome, but only one symptom is seen, and it is not necessary to have all symptoms.
The transformation of the three jiao is to leak and not store. The five organs store blood and do not leak. When the three jiao is diseased, the symptoms are divided into surface and interior, with sweating, no sweating, fever, aversion to cold, etc., for dialectical treatment. The characteristics of the three jiao being diseased are that the three jiao cannot transform water and liquid, leading to leakage of water and liquid and water retention in the surface symptoms. Leakage of water and liquid leads to spontaneous sweating, treated with Gui Zhi Tang; water and liquid being stored leads to no sweating, treated with Ma Huang Tang; water retention in the Ying Wei, with heat in the stomach, treated with Da Qing Long Tang; water retention under the heart, with both cold and heat, treated with Xiao Qing Long Tang, Ling Gui Zhu Gan Tang; water retention in the lower jiao, indicating internal symptoms, treated with Wu Ling San, Fu Ling Gan Cao Tang, etc. The treatment is mainly through inducing sweating and promoting water to release evil Qi and disperse righteous Qi.
The five organs store blood and do not leak, so when the blood in the five organs is diseased, it stores and does not leak, often leading to accumulation symptoms, with chest obstruction, organ obstruction, and lower abdomen urgent obstruction, also divided by the three jiao, into upper, middle, and lower three jiao. In treatment, there are acupuncture bleeding, spontaneous bleeding, and self-healing; if the disease is in the upper jiao, it is treated with Xiao and Da Chai Hu Tang, and Da Xian Xiong Tang; if the disease is in the middle jiao, it is treated with San Cheng Qi Tang; if the disease is in the lower jiao, it is treated with Tao Ren Cheng Qi Tang, Da Cheng Qi Tang, Wu Ling San, etc.
The three jiao Shao Yang Qi and blood heat syndrome can be treated with Bai Hu Tang, Ma Xing Shi Gan Tang, and Zhu Ye Shi Gao Tang, focusing on clearing heat from the Qi and blood divisions, using formulas for treating warm diseases (the characteristic of warm diseases is that Qi and blood are both diseased, leading to fever and heaviness in the body).
The text of “Shang Han Lun” can be discussed from a macro perspective, with treatment prescriptions divided into three major categories: one is the three jiao Qi division, surface and interior, with formulas for inducing sweating and promoting water; two is the organ and blood division, with methods for breaking down and dispersing accumulations; three is the combined disease of Qi and blood, with methods for clearing heat and removing solid accumulations.
Using the three Yin and three Yang six diseases as the framework, with methods for sweating, purging, and warming, establishing a framework for dialectical treatment and a model for establishing laws, methods, and prescriptions.
Overview of the Six Meridians
The six meridians run throughout “Shang Han Lun.” “Shang Han Lun” combines the disease symptoms of the six meridians with pulse methods and treatment methods, forming a holistic theory of disease, pulse, syndrome, and treatment, opening up a medical path for future generations, becoming a medical guideline for practitioners in treating diseases.
The six meridians are divided into three Yang and three Yin. Tai Yang, Yang Ming, and Shao Yang are the three Yang meridians, while Tai Yin, Shao Yin, and Jue Yin are the three Yin meridians. The operation of the six meridians in the human body can be summarized as follows: the three Yang governs the Qi division of the three jiao, while the three Yin governs the blood division of the three jiao and the five organs.
The six meridians bear the responsibility of circulating Qi and blood, repairing, maintaining, and nourishing the five organs and six fu, as well as the overall functions of the human body. This cycle continues day and night, endlessly.
The six meridians are divided into righteous transmission and evil transmission. Righteous transmission circulates endlessly, while evil transmission has one transmission, two transmissions, and no three transmissions. One transmission lasts for six days, two transmissions for twelve days, and thirteen days indicates passing through the meridians. The tenth article of the text states: “If the wind family resolves on the surface and does not resolve, it will recover in twelve days,” indicating that the disease has two transmissions and no three transmissions. If it does not recover after thirteen days, it will no longer pass through the meridians, but will enter the organs, or enter the fu, or accumulate Qi and blood in one place.
Some say that the disease does not follow the meridians in order; the text also mentions direct entry, combined diseases, and associated diseases, but people do not understand the reasons. The evil Qi originally transmits through the six meridians in order, but why is it not one day of Tai Yang disease, two days of Yang Ming disease, three days of Shao Yang disease…? The reason has two aspects: one is that each of the six meridians has its own deficiency and excess; the second is that the evil Qi enters through deficiency, which is its nature. The six meridians, whichever is deficient, that meridian will be diseased. The meridians with sufficient Yang Qi will not be diseased; not being diseased does not mean that the evil Qi has not passed through this meridian. The passage in the Shao Yang section states: “After three days of Shang Han, the three Yang will be exhausted, and the three Yin will receive the evil; the person can eat but does not vomit, indicating that the three Yin does not receive the evil,” which tells us that the evil Qi transmits through the six meridians in order, but now the three Yin does not receive the evil, which does not mean that the evil Qi has not passed through the three Yin meridians.
Regarding direct entry, combined diseases, and associated diseases, these are caused by viral transmission and dual sensations of wind and cold, such as wind family, cough family, and pre-existing symptoms. In strong and healthy individuals, if the evil Qi does not break through the first barrier of Tai Yang Wei Qi, it cannot harm other meridians.
Each of the six meridians has its own responsibilities, and they are used together. The Tai Yang meridian governs the Wei Qi of the entire body, governs the Yang Qi of the six meridians, and governs the Qi transformation of the three jiao, serving as the external defense of the human body, the first barrier against external evils, hence Tai Yang is the surface, and its disease is on the surface.
The Yang Ming meridian is responsible for transporting and disseminating the heat energy from the stomach, combining with the Wei Qi of Tai Yang, and also governing the operation of the Qi transformation of the three jiao. The stomach governs harmony, harmonizing Qi and blood, harmonizing Yin and Yang, with the function of leaking and not storing, governing the metabolism of the overall functions of the human body. Yang Ming is the fu, and the stomach governs the interior, with its disease being internal. Tai Yang and Yang Ming are the surface and interior of the three jiao Qi division.
The Shao Yang meridian governs the pivot, pivoting the Qi division of the three jiao, pivoting the fluids into the blood division, providing blood and various nutrients to the five organs. The Shao Yang meridian has a powerful transformation function, allowing Qi and blood to complement each other, seizing the opportunities of Yin and Yang transformation, promoting the balance of Yin and Yang. When evil enters the Shao Yang, it transforms from the Qi division of the three jiao into the blood division of the Shao Yang, and transmits to the organs, hence the disease of the Shao Yang is highly variable, either in the three Yin upper, middle, and lower, or in the three Yang surface and interior.
The Tai Yin meridian, although belonging to the spleen, also belongs to the lung, which is related to the Qi of the meridians. (Foot Tai Yin Spleen Meridian, Hand Tai Yin Lung Meridian) The lung governs Qi, governs the skin and hair, and governs descent. The spleen governs essence and governs ascent. One ascends and one descends, externally combining the two Qi of Tai Yang and Yang Ming, forming the Qi of the six meridians. The Qi of Tai Yang, Yang Ming, and lung Qi combine to form the great Qi of the human body, circulating throughout the body. The Tai Yin lung Qi internally combines with the Yang Ming stomach Qi to generate fluids and transform liquids, providing various nutrients such as essence, Qi, and blood to the five organs and six fu; externally combining with the Tai Yang Wei Qi, forming the great Qi that protects the entire body, becoming the first barrier for defending and resisting diseases.
This surface and interior, Yin and Yang harmonizing, Ying and Wei communicating, great Qi circulating, and the six meridians communicating, form a complete, living, organic whole. The Tai Yin meridian distributes the water pathway, governing the water pathway of the three jiao. Tai Yin disease indicates obstruction of the water pathway of the three jiao, leading to “abdominal fullness and vomiting, inability to eat, and self-benefiting greatly, with abdominal pain at times,” indicating damage to the middle Yang Qi, leading to water retention in the three jiao.
The Tai Yin is the true Yin; true Yin without Yang leads to Tai Yin disease, resulting in self-benefit without thirst.
The Shao Yin meridian governs the pivot, pivoting the interaction of water and fire between the heart and kidney, harmonizing Yin and Yang, leading to peace in the body. The Shao Yin heart is the root of Yang; if the heart fire does not extinguish, the spirit remains. The Shao Yin heart governs Qi and blood; when Qi and blood flow smoothly, the heart is peaceful. The Shao Yin kidney harmonizes Yin and Yang; when Yin and Yang harmonize, essence and Qi are generated, leading to peace in the heart and kidney.
During the Shao Yin period, Yang is generated; when Yang is generated, Yin grows, leading to spirit. “The disease of Shao Yin is a fine and weak pulse, with a desire to sleep,” indicating that the middle Yang is injured, and Yin Qi remains. In Shao Yin disease, Yang is precious; if there is Yang, it determines progress and retreat. During the Shao Yin period, when Yang Qi is generated, self-benefit and thirst belong to Shao Yin.
The Jue Yin meridian belongs to the liver meridian; the liver governs blood vessels and also governs tendons. The Jue Yin meridian is the extreme of Yin; when Yin is exhausted, Yang is born, representing the great path of Yin and Yang circulation. The liver and gallbladder are connected, with the organs linked; the liver and gallbladder illuminate each other, with Yin and Yang traveling together, forming the path of Yin and Yang connection. When Yin is exhausted, Yang is born; the connection of Yin and Yang occurs in the liver meridian (at the points where the ten fingers and toes connect Yin and Yang).
The disease of Jue Yin indicates liver and gallbladder disease, with Yin and Yang clashing, with cold and heat intertwined. “Jue deep heat is deep, Jue mild heat is mild.” Jue cold leads to diarrhea, while fever leads to cessation of diarrhea; when Yin and Yang connect, the disease self-heals. The disease of Jue Yin indicates the struggle between Yin and Yang, leading to self-benefit and thirst.
The three Yin diseases all harm the stomach, leading to diarrhea and abdominal pain. In three Yin diseases, Yang is precious; having Yang or not determines progress and retreat.
The above four items are important content that must be mastered before learning and applying “Shang Han Lun.”
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