Chen Chaozu: Pulse diagnosis, also known as “diagnosing the pulse,” is a method used by practitioners to assess changes in the pulse by pressing their fingers on the radial artery at the wrist. This allows them to discern the pulse’s characteristics, such as floating or sinking, slow or rapid, large or small, relaxed or tense, slippery or rough, and to evaluate the functional state of the organs, as well as the conditions of qi, blood, and body fluids. A normal pulse is characterized by a pulse felt in all three positions (cun, guan, chi), not floating or sinking, not slow or rapid, calm and gentle, soft yet strong, smooth and even, with a consistent rhythm, beating four to five times per breath, referred to as a “ping mai” (normal pulse).Pulse diagnosis has been documented since ancient texts such as the “Suwen: Essentials of Jade Tablet” and “Suwen: Subtle Pulse Theory,” and has been refined over 3000 years, detailing the correlation between specific conditions and pulse types. However, the intrinsic connection between symptoms and pulse characteristics has not been clearly defined, leading to a situation where scholars understand the phenomena but not the underlying reasons.The intrinsic connection between pulse and symptoms can be summarized as follows:When qi, blood, and body fluids are deficient or stagnantand the functions of the five organs fluctuateor when the meridians exhibit abnormalities, different pulse patterns will emerge.Only by clarifying the relationship between the generation, transformation, and distribution of qi, blood, and body fluids and the functions of the five organs can we connect the symptoms of deficiency or stagnation of qi, blood, and body fluids with the pulse characteristics, thus understanding how pulse diagnosis can reveal changes in the five organs.The formation of different pulse patterns is closely related to the heart, vessels, and the conditions of qi, blood, and body fluids. The variations in pulse patterns reflect changes in the strength of the heart, the tension of the vessels, and the stagnation of qi, blood, and body fluids. Since qi, blood, and body fluids require the cooperation of the five organs to complete their generation and distribution, the stagnation of qi, blood, and body fluids also reflects the functional state of the five organs, which is then manifested in the pulse, resulting in different pulse patterns.The essence of pulse changesis rooted in the strength of the heart’s pulsation and the tension of the vessels. A strong heart pulsation will result in different pulse patterns such as flooding, large, slippery, or rapid; a weak pulsation will often present as slow, thin, or weak pulses.The pulsation of the heart and the fluctuations of the pulse reflect the alternating contraction and relaxation of the liver’s membrane and vessels. If the blood vessels are relaxed, the pulse will be soft and slow; if tense, it will be tight and string-like; if in spasm, it will present as knotty or intermittent. Only by analyzing the fixed heart pulse and the flowing qi, blood, and body fluids together can we reveal the essence of pulse changes, providing a rational basis for understanding which pulse corresponds to which condition.Changes in the deficiency or stagnation of qi, blood, and body fluids can reflect different pulse patterns.From the perspective of qi stagnation:Qi is the driving force behind the heart’s pulsation; heart qi is derived from the kidney‘s essence, the spleen‘s essence is transformed from food, and the lungs draw in clear qi, which together energizes the heart’s activity. If the functions of the spleen and kidneys decline, heart qi will also weaken, leading to a pulse that is slow or weak. If we reverse this chain reaction,a weak pulse is due to insufficient heart qi, and insufficient heart qi results from the decline of the spleen and kidney’s ability to transform qi. In the nourishing pulse, the defensive pulse is external; when the nourishing and defensive systems are balanced, the pulse will neither float nor sink, neither be slow nor rapid. If wind-cold binds the exterior, the pores contract, and the vessels become tense; if the defensive qi is abundant at the surface, the pulse will float, presenting as a floating tight pulse.If the defensive qi retreats due to cold and returns to the organs, it will present as a heavy pulse that is only felt with firm pressure; if the qi is deficient due to prolonged illness, the pulse will be deep and weak. If yang qi is deficient, it will be unable to assist the heart in circulating blood, resulting in a slow and weak pulse.If wind-cold binds the exterior or wind-heat invades the lungs, qi stagnation transforms into heat, and heart yang becomes excessive, the pulse will respond with a large and rapid pulse. If qi stagnation causes pulse conduction obstruction, the pulse will respond with a rough pulse. If qi stagnation causes the vessels to be unyielding, the pulse will respond with a string-like pulse. Thus, it is evident that the floating, sinking, slow, and rapid nature of the pulse, as well as its strength or weakness, are all related to qi deficiency and stagnation.From the perspective of blood stagnation:Blood flows through the vessels, and only when it is abundant and smooth can a normal pulse be felt. If there is insufficient blood production due to a lack of transformation, blood deficiency will occur, leading to a gradual thinning of the pulse, resulting in a thin and weak pulse. If there is a sudden loss of a large amount of blood, the vessels may remain unchanged, but the pulse will be empty, resembling a hollow pulse.If there is blood stagnation or blood stasis, the conduction of the pulse will be obstructed, presenting as a rough pulse, which feels like a light knife scraping bamboo, with large waves accompanied by fine ripples under the fingers.From the perspective of fluid stagnation:The shape of the pulse is also related to body fluids. When there is a deficiency of fluids in the blood, the pulse will lose its moisture and become thin. Fluid deficiency often results from nourishing yin being consumed or from heat diseases damaging fluids, often accompanied by heat signs, thus the pulse associated with yin deficiency is often thin and rapid and is seen alongside a red tongue with little coating.If the pulse is externally deficient in fluids and internally deficient in fluids simultaneously, the pulse will lose its moisture and present as a string-like pulse. The above pulse patterns are due to liver and kidney yin deficiency.If due to spleen and kidney yang deficiency, qi transformation is abnormal, and water retention occurs, the pulse may present as a string-like pulse due to excess fluids in the blood vessels, although the string-like pulse may differ in terms of cold, heat, deficiency, or excess.In summary, all pulse patterns are a comprehensive reflection of the strength of the heart, the tension of the vessels, and the stagnation of qi, blood, and body fluids; changes in the heart, vessels, qi, blood, and body fluids are also related to pathological changes in the five organs, thus pulse diagnosis can reveal the functional state of the five organs.When I first studied medicine, I sought guidance on pulse diagnosis from my cousin Chongxian. He said, “To differentiate conditions, one must consider all four examinations together; one cannot rely solely on pulse diagnosis to avoid misdiagnosis. The pulse diagnosis in the “Binhuh Pulse Study” discusses twenty-eight pulse types, and while the discussions are detailed, many pulse patterns are quite similar and difficult to distinguish. This is not only challenging for beginners but even for those with years of experience, leading to the lament that while one understands it in their heart, it is difficult to clarify under the fingers. My brother only needs to remember the floating and sinking to differentiate between exterior and interior, the slow and rapid to determine cold and heat, the large and small, slippery and rough, strong and weak to distinguish between deficiency and excess, then the outline is grasped, and the essential points are not cumbersome. Of course, the above only discusses the common cases and does not cover the variations, as even weak pulses can lead to this; knowing the common cases and understanding the variations is the essence of pulse diagnosis!” Today, I present this advice to readers as a reference.Pulse diagnosis is only one of the four examinations; some pathological changes cannot be diagnosed solely by pulse diagnosis. One should consider all four examinations together and combine them with modern diagnostic methods to gain a comprehensive understanding of diseases. If one emphasizes that pulse diagnosis alone can reveal the location of disease changes, it will mislead scholars. The forms of the pulse are numerous, making them difficult to master. Below is a brief description of common pathological pulse patterns.[Floating Pulse]Wind-cold binding the exterior→ Defensive qi resists the invasion of pathogens, filling the skin surface →The pulse floats with the qi at the surface→Light pressure yields afloating tight pulse.Eight principles of differentiation: belongs toexterior syndrome, deficiency syndrome, excess syndrome.[Sinking Pulse]Pathology in the organs→ The pulse is deeply hidden,insufficient when lifted, excessive when pressed→referred to as sinking pulse.Strong indicates excess, weak indicates deficiency.Eight principles of differentiation: belongs tointerior syndrome, cold syndrome, deficiency syndrome, excess syndrome.[Slow Pulse]Yin excess and yang deficiency→ Heart function declines, pulsation slows →Three beats per breath, very slow→ referred to asslow pulse. Yin excess indicates cold, yang deficiency indicates deficiency. Eight principles of differentiation: belongs tocold syndrome, deficiency syndrome.[Rapid Pulse](1) Exterior defensive qi is obstructed,qi stagnation transforms into heat, or (pathogenic qi) enters the blood, causing both qi and blood to be heated →Heart beats rapidly→Six beats per breath, more than the normal pulse→ referred to as rapid pulse.(2) There is alsodeficiency of heart qi→ Weak pulsation → Each beat has insufficient blood output,the heart beats faster to compensate→ becomesrapid deficiency pulse.Eight principles of differentiation: belongs toheat syndrome, deficiency syndrome, excess syndrome.[String-like Pulse](1) Liver and kidney yin deficiency→ Loss of body fluids, pulse loses moisture →The vessels become tense→ The pulse appears straight and long, like pressing a string → referred to as string-like pulse.(2) Shaoyin yang deficiency, qi transformation is abnormal →Water retention in the three jiao,filling the vessels and their layers→ The vessels become tense, feeling like pressing a string → referred to as string-like pulse.(3) Liver and gallbladder qi stagnation → The pulse is bound by qi,unable to relax→ Like pressing a string → can also become a string-like pulse.Eight principles of differentiation: belongs toexcess syndrome, deficiency syndrome.[Tight Pulse](1) Wind-cold binding the exterior→ The vessels contract →The pulse appears like a rope, easily felt with light pressure→ referred to asfloating tight pulse; (2) Cold in the three yin →The vessels contract+ its shape is like a rope,only felt with heavy pressure→ referred to assinking tight pulse.Eight principles of differentiation: belongs toexterior syndrome, interior syndrome, cold syndrome, excess syndrome.[Thin Pulse]Qi and blood deficiency, with a predominance of yin deficiency→Qi deficiency leads to less output→ Coupled with blood deficiency, the pulse loses blood filling, thusthe pulse is thin as a thread→ referred to asthin pulse.Eight principles of differentiation: belongs todeficiency syndrome.[Soft Pulse](1) Water dampness obstructing → The pulse becomes relaxed due to dampness →Feels weak, like silk in water, easily pressed, and has no resistance→ referred to assoft pulse.(2) Qi, blood, yin, and yang deficiency →the pulse lacks blood filling→ also presents assoft pulse.Eight principles of differentiation: belongs toexcess syndrome, deficiency syndrome.[Weak Pulse]Qi and blood deficiency→ Qi deficiency cannot stimulate blood flow, blood deficiency cannot fill the vessels →extremely soft, sinking, and thin,only felt with pressure, difficult to find with light touch→ referred to asweak pulse.Eight principles of differentiation: belongs todeficiency syndrome.[Excess Pulse]Three jiao excess heat or obstruction of the qi in the bowels→ Heart beats rapidly →the pulse is strong→ referred to asexcess pulse.Eight principles of differentiation: belongs toexcess syndrome.[Flooding Pulse]Qi stagnation transforms into heat, qi heat is excessive→ Heart function becomes excessive →the pulse is large and strong→ referred to asflooding pulse. Iflarge and weak, it indicates that the heart qi is already deficient.Eight principles of differentiation: belongs toexcess syndrome, deficiency syndrome.[Slippery Pulse]Phlegm, food stagnation, pregnancy, obstructing the meridians→ The obstructed area causes the vessels to become tense →Blood flow is obstructed→gathering like beads, flowing within the pulse→flowing smoothly, like beads rolling, referred to as slippery pulse.Eight principles of differentiation: belongs toexcess syndrome.[Rough Pulse]Qi stagnation, blood stasis, phlegm coagulation→ The conduction of the pulse is obstructed,slightly spasmodic→blood flow is not smooth→the pulse feels like a light knife scraping bamboo→ referred to asrough pulse.Eight principles of differentiation: belongs toexcess syndrome.[Hollow Pulse]Sudden loss of a large amount of blood→ The pulse loses blood filling →shaped like a scallion tube, feeling hollow when pressed→ referred to ashollow pulse.Eight principles of differentiation: belongs todeficiency syndrome.[Knotty Pulse]Heart system yin and yang deficiency→ The vessels are spasmodic →conduction obstruction→ The pulse rhythm is irregular, sometimes stopping → referred to asknotty pulse.Slow and periodic stoppingis referred to asintermittent pulse. There may also beqi obstruction→ The vessels are slightly spasmodic → formingknotty pulse.Eight principles of differentiation: belongs todeficiency syndrome.Appendix:1. Wang Xingfu discusses Zhang Zhongjing’s pulse methodPerhaps due to the demands of the times, modern TCM practitioners are very familiar with biochemical tests, MRI, CT, and ultrasound technologies. Although the traditional four examinations and eight principles are emphasized, there are fewer practitioners who can truly follow Zhang Zhongjing’s principle of “observing the pulse and symptoms to know the nature of the disease and treating according to the symptoms,” especially in pulse diagnosis, where most focus on how many beats per minute, and even struggle to distinguish between floating and sinking. It is no wonder that such an important aspect of TCM, which concerns its future, has reportedly received less than 20 hours of teaching in the five years of TCM education, and even the two most critical chapters on Zhang Zhongjing’s pulse method, “Differentiating Pulse Method” and “Normal Pulse Method,” have been deleted from the standardized textbook “Lecture on Cold Damage.”Ancient scholars have long noted the difficulty of learning pulse diagnosis: “It is easy to understand in the heart, but difficult to clarify under the fingers.” It is not easy to master in a lifetime, so how can one learn it well in just 20 hours? Moreover, most instructors themselves do not understand it, often teaching from the book without depth, leading to the criticism from Mr. Guo Boxin that this phenomenon is “using one’s own confusion to confuse others!” As a result, some have published articles in the “Health News” claiming that “TCM cannot be limited to three fingers and a pillow,” and even some who pride themselves on being staunch TCM practitioners believe that pulse diagnosis, being the last of the four examinations, can be abandoned, which seems reasonable but is actually misleading and undermines the foundation of TCM.In the 11th issue of the 2008 TCM magazine, a paper titled “Establishing a Pulse Diagnosis Teaching Model Based on the Characteristics of Miniature Pigs” was published, using the posterior tibial artery pulse of pigs and the axillary artery pulse of the forelimbs to collect pulse diagrams as a teaching model for pulse diagnosis. This pulse diagnosis teaching method was surprisingly a key project of the National Natural Science Foundation and the National “Eleventh Five-Year Plan” Science and Technology Support Project. In fact, pulse diagnosis is not only a characteristic of classical TCM but also reflects the level of syndrome differentiation and treatment in modern TCM. A good TCM practitioner must be proficient in pulse diagnosis; in other words, only by mastering pulse diagnosis can one become a good TCM practitioner. Since one claims to be a TCM practitioner, one must adhere to the characteristics of TCM. Although Zhang Zhongjing also believed that “the best practitioners know by observation, the intermediate ones know by inquiry, and the lower ones know by pulse,” he did not possess supernatural abilities, but through effort, one can certainly become a good intermediate or lower practitioner, improving clinical skills and mastering the four examinations and eight principles is very important. Today, we emphasize revisiting the classics and learning classical formulas, and we should also trace back to the source, solidifying the foundation for applying classical formulas. Mastering pulse diagnosis is of utmost importance in applying classical formulas.The “Treatise on Cold Damage and Miscellaneous Diseases” includes both the “Treatise on Cold Damage” and the “Essentials of the Golden Chamber,” both titled “Differentiating Disease, Pulse, and Symptoms and Treatment” and “Pulse and Symptoms and Treatment,” indicating that pulse diagnosis is the essence of syndrome differentiation and treatment. The “Treatise on Cold Damage” consists of 22 chapters, covering 398 clauses and 113 formulas. Among them, 135 clauses mention both pulse and symptoms, describing 60 types of pulse patterns. The opening chapters of the “Treatise on Cold Damage” discuss “Differentiating Pulse Method” and “Normal Pulse Method,” elaborating on the subtleties of pulse diagnosis and its application rules, serving as a guiding framework for the entire book. The “Essentials of the Golden Chamber” consists of 25 chapters, with 21 chapters mentioning both pulse and symptoms, starting with “The First Chapter on the Disease and Pulse of the Organs and Meridians,” which also emphasizes the necessity of correlating pulse and symptoms. Thus, it is evident how important it is to learn Zhang Zhongjing’s pulse method in the process of studying classical formulas. The last three chapters of the “Essentials of the Golden Chamber” are “Miscellaneous Treatment Methods,” “Prohibitions and Treatments for Animals, Fish, and Insects,” and “Prohibitions and Treatments for Fruits and Vegetables,” which are collections of folk remedies and secret prescriptions, advocating for specialized treatment, making them the ancestors of folk remedies, among which many contain superstitious elements, and it is difficult to determine whether they belong to the original text, which requires separate discussion, and modern practitioners also rarely follow them. The “Treatise on Cold Damage and Miscellaneous Diseases” is a summary of pre-Qin medicine. In the preface, Zhang Zhongjing states: “Reflecting on the past losses and the inability to save the dying, I diligently seek ancient teachings, drawing from various sources, compiling the “Suwen,” “Nine Volumes,” “Eighty-One Difficulties,” “Yin-Yang Great Theory,” and “Fetal Medicine and Drug Records,” and relying on pulse diagnosis for differentiation, creating the “Treatise on Cold Damage and Miscellaneous Diseases” in sixteen volumes.” He also emphasizes: “Although I cannot cure all diseases, I hope to help people understand the source of their ailments. If I can find the remaining teachings, I will have achieved more than half of my goal.” Viewed from today’s medical standards, Zhang Zhongjing’s statement is not an exaggeration. Later generations studying classical formulas and researching Zhang Zhongjing’s teachings have claimed over a thousand schools, and related works are numerous, leading some to comment that everyone has their own Zhang Zhongjing, and every school has its own interpretation of cold damage. For example, the Fuyang school is a distinctive branch of the cold damage school, and the theories of the Four Great Masters of the Jin and Yuan dynasties, as well as the formation of the warm disease school, are inseparable from Zhang Zhongjing’s cold damage teachings. Only through inheritance can there be innovation, and only through innovation can there be development. Innovation without inheritance is like water without a source, a tree without roots, and applying classical formulas without discussing pulse methods is akin to dreaming in vain.1. Key Points in Learning Zhang Zhongjing’s Pulse Method1. First, differentiate yin and yangThe theory of yin and yang is the soul of TCM. The “Suwen: Great Theory of Yin and Yang” states: “A good diagnostician observes color and presses the pulse, first distinguishing yin and yang, examining clarity and turbidity to understand the parts; observing breathing, listening to sounds to know the suffering; observing weight and balance to know the main disease; pressing the three positions, observing floating, sinking, slippery, and rough to know the origin of the disease. To know without error, one must not miss in diagnosis.” Therefore, the most important aspect of Zhang Zhongjing’s pulse method is to first differentiate yin and yang. The theory of yin and yang is not only the general principle of syndrome differentiation but also the general principle of pulse differentiation. The opening of the “Treatise on Cold Damage: Differentiating Pulse Method” states: “Question: The pulse has yin and yang; what does this mean? Answer: A pulse that is large, floating, rapid, moving, and slippery is called yang; a pulse that is sinking, rough, weak, string-like, and minute is called yin. If a yin disease shows a yang pulse, it indicates life; if a yang disease shows a yin pulse, it indicates death.” Therefore, the role of pulse diagnosis is to discern yin and yang, and from the changes in yin and yang, infer the deficiency or excess of the organs, thus understanding the origin and severity of the disease. Li Yangbo believes that TCM is a medicine of symbols and numbers, “things are born and have forms, forms are born and have numbers.” The ancients observed celestial phenomena and measured their own bodies, summarizing life phenomena with yin and yang, which is undoubtedly a great invention. To this day, who can escape the natural law of the opposition and unity of yin and yang? Practitioners of the Fuyang school use yin and yang as a framework to differentiate all diseases, establishing the Fuyang theory, which has achieved good clinical results.Methods for Differentiating Yin and Yang in Zhang Zhongjing’s Pulse Method(1) Differentiating yin and yang by pulse characteristics: For example, floating, large, moving, rapid, slippery, etc., are excessive and abundant blood pulse manifestations belonging to yang; sinking, rough, weak, string-like, minute, etc., are insufficient and deficient blood pulse manifestations belonging to yin. For example, the descriptions of knotty and rapid pulses: “A pulse that comes slowly, sometimes stops and then comes again is called knotty. A pulse that comes rapidly, sometimes stops and then comes again is called rapid. A strong pulse indicates yang excess, while a weak pulse indicates yin excess; both are pathological pulses.”(2) Differentiating yin and yang from pulse tension: Pulse diagnosis uses floating and sinking to differentiate yin and yang. For example: “If the pulse is floating and rapid, the patient can eat but does not have a bowel movement, this indicates excess, called yang knot… If the pulse is sinking and slow, the patient cannot eat, feels heavy, and has hard stools, this indicates yin knot…”(3) Differentiating yin and yang from pulse positions: For example, the cun pulse method diagnoses the pulse at three positions: cun, guan, and chi. “If the cun pulse is minute, it indicates yang deficiency.” “If the chi pulse is weak, it indicates yin deficiency.” In addition to the cun pulse method, there are also the fu yang pulse method, shaoyin pulse method, cun fu yang pulse method, fu yang shaoyin pulse method, and chi pulse fu yang pulse method. The cun pulse method is the most basic pulse diagnosis method in Zhang Zhongjing’s pulse method.In summary, Zhang Zhongjing’s pulse method is based on yin and yang, comprehensively employing various pulse methods to differentiate the disease’s location, whether it is in the exterior or interior, in qi or blood, in the upper, middle, or lower jiao, in the organs or bowels, focusing on syndrome differentiation as the main approach, with disease differentiation as a supplementary method, correlating pulse and symptoms, and providing a basis for establishing treatment principles.2. Correlating pulse and symptomsThe “Treatise on Cold Damage” uses the format of “Differentiating Disease, Pulse, and Symptoms and Treatment” and the “Essentials of the Golden Chamber” uses the format of “Disease, Pulse, and Symptoms and Treatment” to list the causes, symptoms, pulse patterns, and treatment methods, allowing for mutual verification and comparison, and through pulse diagnosis, one can know the symptoms clearly, enabling precise understanding of the disease mechanism and deep exploration of the formula rules, achieving the learning effect that Zhang Zhongjing mentioned in the preface of the “Treatise on Cold Damage”: “Although I cannot cure all diseases, I hope to help people understand the source of their ailments. If I can find the remaining teachings, I will have achieved more than half of my goal.”(1) Knowing symptoms through pulse diagnosis: This refers to the method of determining the disease through specific pulse patterns. The changes in the disease mechanism have certain regularities, and the corresponding symptoms also follow certain rules. Knowing symptoms through pulse diagnosis, correlating pulse and symptoms, can simplify complex situations, mainly used for identifying the main symptoms of the six meridian diseases and the causes of certain miscellaneous diseases.For example, the identification of the main symptoms of the six meridian diseases in the “Treatise on Cold Damage”:“For the disease of the Taiyang, the pulse is floating, and there is stiffness and pain in the head and neck, with aversion to cold.”“After three days of cold damage, the pulse of Yangming is large.”“The pulse of cold damage is string-like and thin, with headache and fever, belonging to Shaoyang.”“The pulse of cold damage is floating and slow, with warm hands and feet, indicating Taiyin.”“For the disease of Shaoyin, the pulse is minute and thin, with a desire to sleep.”“The pulse of cold damage is minute and has a tendency to collapse, with cold skin after seven or eight days, and the person is restless, with no time to rest, indicating organ collapse.”For example, the identification of causes in the “Essentials of the Golden Chamber: Coughing and Phlegm Disease, Pulse, Symptoms, and Treatment”:“The pulse is floating and thin, indicating injury from drinking.”“The pulse is string-like and rapid, indicating cold drinking, difficult to treat in winter and summer.”“The pulse is sinking and string-like, indicating internal abscess from suspended drinking.”In the above cases, the main pulse and main symptoms have an intrinsic connection, and both must be determined by a certain disease mechanism. Of course, there are also cases where the pulse and symptoms do not match, but the tongue appearance, urination, and other diagnostic methods can help differentiate. For example:“In the case of Taiyang wind, the yang is floating and the yin is weak; the floating indicates heat, while the weak indicates sweating.”“The pulse of the fu yang is floating and rough; the floating indicates strong stomach qi, while the rough indicates frequent urination; the floating and rough interact, leading to hard stools, indicating spleen deficiency, treated with Ma Zi Ren Wan.”This type of pulse-symptom correspondence is common in the “Treatise on Cold Damage,” where pulse patterns are mentioned to illustrate disease mechanisms, indicating that there must be corresponding symptoms for every pulse. This method of pulse diagnosis can directly establish treatment principles, providing a very convenient method for selecting formulas and medicines, such as:“In the case of cold damage, if the pulse is slippery and there is collapse, there is heat in the interior, treated with Bai Hu Tang.”“In the case of blood bi with both yin and yang weak, the pulse at the cun and guan is weak, and the pulse at the chi is slightly tight; the external symptoms are numbness in the body, resembling wind bi, treated with Huang Qi Gui Zhi Wu Wu Tang.”The method of knowing symptoms through pulse diagnosis can also be used to guide treatment and assess prognosis, such as: whether to warm, whether to tonify, whether to purge, whether to moxibust, whether to sweat, whether to purge, whether to clear, and whether to differentiate transmission, whether to determine recovery, and whether to assess life and death, etc.(2) Using symptoms to measure pulse: This refers to the method of inferring pulse patterns through a series of symptoms of the disease. What is within must manifest externally; there must be corresponding pulse patterns for specific symptoms. The method of using symptoms to measure pulse can help confirm diagnoses and identify disease mechanisms. For example:“In the case of Taiyang disease, with fever, sweating, aversion to wind, and a slow pulse, it is called wind.”“In the case of Taiyang disease, whether there is fever or not, there must be aversion to cold, body pain, and vomiting; if the pulse is tight in both yin and yang, it is called cold damage.”“In the case of wind-dampness, the pulse is tight in both yin and yang.”The key to using the method of using symptoms to measure pulse lies in the correspondence between disease, symptoms, and pulse; none can be missing, like shadow and echo, each corresponding to the other, and there must be a pulse for every symptom.The greatest feature of Zhang Zhongjing’s pulse method is that it correlates pulse with symptoms, establishing treatment based on the pulse. Knowing symptoms through pulse, measuring pulse through symptoms, and correlating pulse and symptoms can ensure accurate differentiation, allowing for true differentiation and treatment. Therefore, the correspondence between formulas and symptoms is the basic principle of applying classical formulas.2. Classification of Zhang Zhongjing’s Pulse MethodThe classification of Zhang Zhongjing’s pulse method mainly has two types: one is the cun pulse method, and the other is the fu yang pulse method.1. Cun Pulse MethodThe cun pulse diagnosis method originates from the “Suwen,” as the essence and flavor of the five organs and six bowels all emerge from the stomach, manifesting in the qi mouth. The so-called “food qi enters the stomach, turbid qi returns to the heart, and the essence flows through the pulse; the pulse qi flows through, and the qi returns to the lungs; the lungs connect to the hundred pulses, delivering essence to the skin and hair, where the hair pulses combine with essence, circulating qi in the bowels; the spirit resides in the four stores, and qi returns to balance; balance leads to the formation of the cun, determining life and death” (from the “Differentiation of Meridians”). This means that the changes in the essence and qi of the five organs and six bowels can all be reflected in the pulse patterns at the cun, allowing for the assessment of disease states. Its application is also reflected in the texts of the “Nanjing”; in the “Treatise on Cold Damage: Normal Pulse Method,” there is a very insightful discussion: “Question: The pulse has three parts, yin and yang intermingled, and the flow of qi and blood in the body. Breathing in and out, moving up and down, is influenced by the breath, and body fluids circulate. The pulse changes with the seasons, appearing string-like in spring, floating in autumn, sinking in winter, and flooding in summer. Observing color and pulse, the sizes differ, and there are no constants at any given time. The three positions vary, either short or long, up and down, or existing or absent. Diseases change, rising and falling, the heart is confused, and movement loses its order. I wish to clarify this for you, so it becomes clear. The teacher said: What you ask is the root of the way. The pulse has three parts, cun, guan, and chi, and the flow of qi and blood does not lose balance. The kidney is sinking, the heart is flooding, the lung is floating, and the liver is string-like; this is the norm, not losing balance. The flow of qi and blood rises and falls, circulating in a cycle. When returning to the cun, the deficiency and excess can be seen, and the changes interrelate, yin and yang are interconnected. Wind causes floating deficiency, cold causes tightness; sinking leads to water retention, and urgent tension leads to pain. If there is movement, it causes pain; if it is rapid, it indicates heat and restlessness; if there is no response, it indicates the cause of change. The three parts differ, and the diseases are each unique; if excessive, it is strange; if insufficient, it is the same. Evil cannot be seen empty; there must be a hidden cause, examining the exterior and interior, differentiating the three jiao. Knowing what to discard, observing the diagnosis, estimating the organs, one can see as if by divine insight.”It can be seen that the cun pulse method encompasses the qi and essence changes and disease information of the five organs and six bowels, and the late master Chen Ruichun once statistically noted that the original text of the “Treatise on Cold Damage” contains 146 clauses related to pulse diagnosis, accounting for more than one-third of the entire text. The pulse method involves more than twenty pulse patterns and over fifty combined pulses, the vast majority of which are related to the cun pulse method’s three parts. The cun pulse method matches the cun, guan, and chi with the upper, middle, and lower jiao, where the upper jiao governs above the chest, the middle jiao governs the abdomen, and the lower jiao governs below the navel. The classification of pulse patterns is based solely on yin and yang differentiation. The “Nanjing: Eighteen Difficulties” also has a matching method of three parts and nine conditions: “The pulse has three parts and nine conditions; what do they govern? The three parts are cun, guan, and chi; the nine conditions are floating, middle, and sinking. The upper part corresponds to heaven, governing diseases above the chest to the head. The middle part corresponds to humanity, governing diseases below the diaphragm to the abdomen. The lower part corresponds to earth, governing diseases below the abdomen to the feet.” Modern classical formula experts, such as Hu Xishu, have conducted related analyses of Zhang Zhongjing’s pulse method, as seen in the attached table:Excessive Pulse (Yang Pulse) Insufficient Pulse (Yin Pulse)Pulse Name Main Disease Pulse Name Main DiseaseFloating Governs the exterior, governs heat, also governs deficiency Sinking Governs the interior, governs deficiency cold, also governs water retentionRapid Governs heat, but in chronic illness, a rapid pulse often indicates deficiency, thus also governs deficiency Slow Governs cold, governs deficiency, but in cases of extreme interior excess, the pulse may also be slowExcess Governs excess, often belongs to conditions that can be attacked Deficiency Governs deficiencyMoving Governs pain, governs shock; shock causes chest and abdomen to tremble, thus also governs movement Knotty Governs deficiency, governs blood stasis, excess conditionsRapid Governs the exterior, often seen in excess above and deficiency below, also governs knotty chest Intermittent Governs deficiency, often seen in chronic illnessLong Governs excess, those with thick endowments often have long pulses, not based on disease Short Governs deficiency, often seen in loss of fluids and blood, difficult to treatLarge Governs heat, governs excess, governs deficiency fatigue Thin Governs deficiency, insufficient bloodString-like Governs pain, muscle tension, governs excess, water retention, deficiency of blood Weak Governs deficiency, governs insufficient blood, spontaneous sweating, night sweatingTight Governs excess, governs pain, governs food retention, also governs water retention Slow Governs insufficient bloodSlippery Governs excess, governs heat, governs excessive pathogens Rough Governs deficiency, insufficient bloodFlooding Governs excessive heat, excessive heat conditions often present as flooding Minute Governs both qi and blood deficiencyUrgent Initial illness indicates excessive pathogens, chronic illness often indicates danger Hidden Governs deficiency cold, water retention, internal obstruction Hollow Governs deficiency fatigue, insufficient blood Abnormal Governs blood loss, women’s leakage, men’s loss of essence2. Xu Ruqi discusses Zhang Zhongjing’s pulse methodI have studied the “Treatise on Cold Damage and Miscellaneous Diseases” for decades and have taken many detours. Since meeting my mentor Chen Ruichun in 1997, I realized that to be a doctor who can treat diseases, one must read the “Treatise on Cold Damage” and the “Essentials of the Golden Chamber” well. However, during the reading process, I had many doubts and felt that the study of cold damage was too difficult.However, four years ago, when I obtained the People’s Health Publishing House’s edition of the Song version of the “Treatise on Cold Damage” and “Essentials of the Golden Chamber,” I discovered that my entry into the study of cold damage was through a small door, narrow and limited, and my efforts could only squeeze in a little. After flipping through this set of books, I suddenly realized that the “Treatise on Cold Damage and Miscellaneous Diseases” is composed of several parts: first, the differentiation of the six meridians, which dates back to ancient times; second, the application of cold damage and miscellaneous diseases, which is the promotion of Zhang Zhongjing; third, the dialogues between teacher and student, which are clinical records; fourth, the insights of Shuhe in compiling this book; and fifth, the experiences of Tang and Song practitioners. Although there are still some unresolved issues, I feel that classical formulas are not as difficult to learn as I imagined. Tonight, I would like to share some of my insights on learning Zhang Zhongjing’s academic thoughts with everyone.1. Understanding the differences between the Song version of the “Treatise on Cold Damage” and “Essentials of the Golden Chamber” and the versions passed down through later generationsThe “Treatise on Cold Damage and Miscellaneous Diseases” was completed during the chaotic times of the late Eastern Han dynasty, and shortly after its completion, it became disorganized. The “Treatise on Cold Damage and Miscellaneous Diseases” has been compiled and passed down for over two thousand years by Wang Shuhe, the Taiyi Ling of the Wei and Jin dynasties. Although the original work of Zhang Zhongjing is no longer available, even the compiled version by Wang Shuhe is also not available. During the Tang and Song dynasties, it was re-edited by medical practitioners such as Sun Simiao, Sun Qi, and Lin Yi, and even so, the Tang and Song editions are still invaluable today. Understanding the source and flow of the “Treatise on Cold Damage and Miscellaneous Diseases” is an important way to correctly interpret Zhang Zhongjing’s academic thoughts. The preface of the Song version of the “Treatise on Cold Damage” states: “The ‘Treatise on Cold Damage’ is a summary of the great sage’s intentions, and no other school can compare. Therefore, the preface of the Jin dynasty’s Huangfu Mi’s ‘Jia Yi Needle Classic’ states: ‘Yi Yin, with the talent of the original sage, compiled the ‘Shennong’s Materia Medica’ to create ‘Tang Liquid.’ Han Zhang Zhongjing discussed the broad ‘Tang Liquid,’ which consists of ten volumes, and has been widely tested. In recent times, the Taiyi Ling Wang Shuhe has compiled and organized Zhang Zhongjing’s remaining theories very well, all of which can be applied.“This indicates that Zhang Zhongjing’s methods are based on Yi Yin’s methods, which in turn are based on the teachings of Shennong, and cannot be said to be a summary of the great sage’s intentions? … Since Zhang Zhongjing, over eight hundred years have passed, and only Wang Shuhe can learn from him.” This passage helps us understand the origins of the “Treatise on Cold Damage” and guides later generations in correctly interpreting Zhang Zhongjing’s academic thoughts, leading them to seek out Wang Shuhe. Because “since Zhang Zhongjing, over eight hundred years have passed, and only Wang Shuhe can learn from him.” So what did Wang Shuhe say? The preface of the “Pulse Classic” states: “The principles of pulse are subtle, and their essence is difficult to discern. String-like, tight, floating, hollow, they are all similar. It is easy to understand in the heart, but difficult to clarify under the fingers. If one mistakes sinking for hidden, the treatment will be forever wrong; if one mistakes slow for delayed, danger will come immediately. Moreover, there are many conditions that appear together, and different diseases can have the same pulse! Medical treatment is for use, and life is at stake. Even the most exquisite methods require thought; Zhang Zhongjing’s methods are also based on observing forms and symptoms. If there is any doubt, one must verify and seek evidence. Therefore, there are warnings against excessive purging in cold damage and questions about vomiting and purging in the lower jiao.“This passage has very guiding significance for interpreting the “Treatise on Cold Damage and Miscellaneous Diseases” and analyzing Zhang Zhongjing’s academic thoughts, indicating that Zhang Zhongjing had very advanced pulse diagnosis techniques. Reading his works should start from pulse patterns, but one must correlate pulse and symptoms, repeatedly verify from pulse and symptoms, and focus on differentiation. Only with precise differentiation can one achieve accurate diagnosis. Opening the “Pulse Classic,” one can see the section “Volume Five: Zhang Zhongjing Discusses Pulse First,” and upon examining Volume Eight, the title is “Normal XX Pulse and Symptoms,” which is similar to certain chapters in the “Treatise on Cold Damage and Miscellaneous Diseases.” Zhang Zhongjing emphasizes the application of pulse diagnosis, which can be seen from his criticism in the preface of the “Treatise on Cold Damage,” where he states: “Observing today’s doctors, they do not seek the essence of the classics, but rather perform what they know; each follows their family techniques, adhering to the old ways, asking about diseases and ailments, focusing on verbal prescriptions; in a moment, they dispense decoctions; pressing the cun does not reach the chi, holding the hand does not reach the foot; the ren and fu yang pulses are not correlated; movement and rapidity do not exceed fifty; short-term unknown diagnoses, the nine conditions have no resemblance; the Ming Hall and the courtyard are not observed, merely peering through a tube. To view life and death is truly difficult!” Therefore, to study TCM, one must have the determination, perseverance, and will to become a staunch TCM practitioner, arming oneself with the secret weapons of TCM, striving to achieve accuracy in every pulse diagnosis. This secret weapon is Zhang Zhongjing’s pulse method.Attached are four clinical cases from my practice:Case 1: Dong xx, Male, 75 years old, Wentiankuang family2009.2.10 Left cun floating, slippery and strong, guan slippery, slightly string-like, chi sinking. Right pulse guan string-like, cun and chi slightly slippery. Tongue pale red, white and slippery coating, with tooth marks on the edges. Reports a history of hypertension, diabetes, gout, and prostatitis, with a sudden episode of dizziness and fainting requiring hospitalization a few years ago. Currently feels blurred vision, soft stools, and frequent urination at night. Blood pressure 180/68 mmHg.Gegen 90, Chuanxiong 30, Huai Niuxi 15, Chrysanthemum 15, Fangji 15, Zexie 15, Shichangpu 10, Yujin 15, Baizhu 15, Fupian 30, Cheqianzi 10, Tu Fuling 30, Cizhi 15, Baishao 15, Rougui 10, Cao Jue Ming 30, Shajiang 30, 7 doses.2009.2.18 Left pulse sinking, thin and slippery, right pulse guan string-like, cun and chi sinking, thin and string-like. Tongue pale tender with tooth marks, white coating, reports vision still blurred, other symptoms improved, two bowel movements daily, soft consistency. Urination frequency increased, slightly short. Blood pressure 150/80 mmHg.2009/3/3 Pulse sinking, string-like, slightly slippery, tongue red and moist, reports impotence for four to five years.Fupian 30, Baishao 15, Baizhu 12, Fuling 15, Gancao 10, Zexie 5, Rougui 10, Wuzhuyu 6, Danshen 15, Cao Jue Ming 30, Cizhi 10, Tusi 30, Shaiyu 10, Cheqianzi 10, Xianlingpi 30, Qingzangzi 5, Wulingzhi 10, Gegen 90, Huai Niuxi 10, 7 doses.2009/3/11 Pulse sinking, thin and string-like, chi weak, tongue pale red, slightly blue. Hand tremors. Night urination still requires three to four times. Blood pressure 130/78 mm.Fupian 30, Baishao 15, Baizhu 12, Zexie 15, Gancao 10, Rougui 10, Cao Jue Ming 30, Cizhi 10, Tusi 30, Cheqianzi 10, Shaiyu 15, Qingzangzi 10, Xianlingpi 30, Huai Niuxi 10, Gegen 60, Zhi Nanshen 15, Shanzhuyu 15, Wulingzhi 10, Buguzi 15, Muli 50, 7 doses.2009/3/20 Pulse sinking, string-like and slippery, tongue pale red, tender, slightly blue, blood pressure 120/76. Hand tremors resolved, night urination frequency reduced, no need for further prescriptions. 7 doses.Case 2: Guo xx, Male, 57 years old, Wanhe Copper Wall Group2009.2.21 Pulse sinking, thin, slippery, rapid, right cun slightly tight. Left guan chi slightly string-like. Tongue tip red, white and light yellow coating. Reports coughing blood since last April, diagnosed with right lower lung central lung cancer at the provincial hospital, underwent chemotherapy six times at the county TCM hospital, and has been hospitalized for coughing with blood-streaked yellow phlegm, still has cough, shortness of breath, palpitations, dry mouth, prefers warm drinks, and occasional left-sided chest tightness.Lugen 60, Taoren 15, Yimi 30, Xingren 15, Yuxingcao 30, Xianhecao 30, Nansharen 20, Gancao 10, Tiandong 15, Pugongying 30, Maozhu 10, Jinguolan 10, Zhebei 15, Muli 30, Hanlianhua 30, Shengbanxia 15, Wulingzhi 15, Shigang 15, Ziwang 15, 5 doses daily.2009.2.26 Left cun guan sinking, thin, chi string-like, right sinking, thin, tongue pale red, white and greasy coating. Reports blood has stopped, cough and chest tightness have reduced, spirit is uplifted. Continue with the above formula, adding Fuling 15, 7 doses, three times daily.2009.3.8 Wife reports still has cold and nasal congestion, other symptoms have improved.Lugen 60, Taoren 15, Yimi 30, Xingren 15, Yuxingcao 30, Xianhecao 30, Nansharen 20, Gancao 10, Tiandong 15, Pugongying 30, Maozhu 10, Jinguolan 10, Zhebei 15, Muli 30, Hanlianhua 30, Shengbanxia 15, Wulingzhi 15, Shigang 15, Ziwang 15, 5 doses daily.2009.3.16 Left cun sinking, thin, chi string-like, right sinking, thin, chi string-like, tongue pale red, slightly blue, reports right-sided chest pain, cold has resolved, appetite is good, spirit is good, bowel and bladder are normal.Lugen 60, Taoren 15, Yimi 30, Xingren 15, Wuxingxian 30, Nansharen 15, Huangqin 30, Jinguolan 30, Shengbanxia 30, Wulingzhi 15, Zhebei 15, Muli 30, 7 doses.2009.3.24 Left chi string-like, slightly hard, cun chi thin string-like, right cun floating, rapid, guan chi string-like, chi string-like, tongue pale blue, white coating. Reports right chest pain, cough, phlegm is thick and yellow, occasionally with fresh blood, appetite is good, bowel and bladder are normal.Lugen 60, Yimi 30, Taoren 15, Xingren 15, Wuxingxian 30, Nansharen 15, Huangqin 30, Jinguolan 30, Shengbanxia 30, Wulingzhi 15, Zhebei 15, Muli 30, 7 doses.2009.4.3 Coughing blood has decreased.Continue with the above formula, 7 doses.2009.4.11 Reports chest pain, cough, phlegm is white, no blood, appetite is good, bowel and bladder are normal, easily catches colds. Pulse left chi string-like, slightly hard, cun chi thin string-like, right sinking, thin string-like. Tongue pale blue, yellow coating.Lugen 60, Yimi 30, Dongguo 30, Taoren 15, Xingren 15, Wuxingxian 30, Nansharen 15, Huangqin 30, Jinguolan 30, Shengbanxia 30, Wulingzhi 15, Zhebei 15, Muli 30, 7 doses.2009.4.20 Reports still has chest pain, cough, phlegm is thick and yellow, slightly dry mouth, appetite is good but lacks flavor, bowel and bladder are normal. Pulse left guan cun sinking, slippery, chi string-like, right cun sinking, string-like, chi string-like, tongue pale red, slightly blue.Lugen 60, Yimi 30, Dongguo 30, Taoren 15, Xingren 15, Wuxingxian 30, Nansharen 15, Huangqin 30, Jinguolan 30, Shengbanxia 30, Wulingzhi 15, Zhebei 15, Muli 30, 7 doses.Case 3: Liu xx, Male, 45 years old, Shangmo Laoju Eight Group2009.1.15 Reports irregular twitching pain in the upper right corner of the head, no other obvious discomfort. Appetite is good, bowel and bladder are normal, tongue red and swollen with thin white coating, tooth marks on the edges. The sublingual vessels are blue and thick. Left cun sinking, guan slippery, chi string-like, slightly tight; right pulse is short, cun sinking, guan floating, chi slightly weak. MRI examination at Nanjing University First Affiliated Hospital: An irregularly shaped long T1 and T2 signal cyst is seen in the right cerebellopontine angle, extending upward into the prepontine cistern, with clear boundaries, and the inversion recovery sequence shows slightly low signal, with deformation of the right pons pushing to the left, and no obvious abnormal signals in the brain parenchyma, with no significant enlargement of the ventricular system, and no displacement of the midline structure. Diagnosis: 1. Abnormal signal in the right cerebellopontine angle, likely epidermoid cyst. (December 13, 2002, MRI: Consider right cerebellopontine angle epidermoid cyst. April 20, 2008, Jiangsu University Second Affiliated Hospital MRI: 1. Right cerebellopontine angle cholesteatoma, approximately 1.6CM*3.7CM 2. Multiple small ischemic lesions in the brain parenchyma.)Lingstone 30g, Dahuang 15g, Zhi Shi 10g, Sheng Banxia 30g, Sheng Nanshen 30g, Fuling 60g, Zexie 10g, Baijiezi 30g, Huai Niuxi 15g, Xuan Shen 15g, Zhebei 10g, Huangqi 30g, Baizhu 15g, Foshou 10g, Xixin 6g, Chuanxiong 30g, Wuzhuyu 6g, Dazhu 1 piece, Tianlong 10g, Quanxie 10g, Dilong 15g, Jiangcan 30g, Pao Shanjia 6g, Gancao 10g, Shengjiang 30g, Shexiang 0.3g, Zhenzhu 30g, Artificial Niu Huang 3g, Sheng Shouwu 30g, 5 doses.2009.2.19 Left pulse thin and string-like, right pulse cun floating, guan chi sinking. Tongue dark red, reports right head tremors, cold sweat, night sweats.Wuzhuyu 10, Chuanxiong 30, Gegen 15, Zhi Nanshen 30, Guizhi 15, Gancao 10, Baishao 15, Honghua 15, Jiangcan 15, Dilong 15, Tubi 10, Shengjiang 60, Huangqi 30, Artificial Niu Huang 6, Danggui 15, Xixin 10, Muxiang 10, Huai Niuxi 10 (Quan Chong 10, Hailong 10, Haima 10) powdered separately. 7 doses.2009.2.28 Left pulse sinking, thin and string-like, right pulse floating, thin and string-like, tongue pale blue. Reports neck and back pain, still has night sweats.Wuzhuyu 10, Fupian 15, Chuanxiong 30, Gegen 50, Baishao 15, Huai Niuxi 10, Zhi Nanshen 30, Fuling 30, Jiangcan 15, Dilong 15, Tubi 10, Xixin 10, Guizhi 15, Danggui 15, Gancao 10, Artificial Niu Huang 6, Tianma 30, Baizhu 15, 7 doses.2009.3.12 Reports night sweats, right shoulder pain, right-sided forehead pain, occasional swelling, left cun sinking, guan chi string-like, left sinking, guan chi string-like, tongue tender.Wuzhuyu 10, Chuanxiong 15, Gegen 60, Baishao 15, Huai Niuxi 10, Wuzhuyu 3 pieces, Jiangcan 15, Dilong 15, Tubi 10, Zhi Nanshen 30, Xixin 10, Danggui 15, Gancao 10, Muli 50, Guizhi 30, Fupian 15, Baizhu 12, Fuling 60, Quan Chong 10, 7 doses.2009.3.26 Pulse string-like and slow, tongue red and tender, reports head pain is not obvious, right shoulder pain, bleeding has stopped, waist is sore, bowel and bladder are still normal.Continue with the above formula, adding Jianghuang 15, Weilingxian 30. 7 doses.2009/4/8 Pulse string-like and slow, chi string-like, tongue pale red and tender. Reports no obvious head pain, shoulder pain, bleeding has stopped, waist is sore, bowel and bladder are still normal.Wuzhuyu 10, Chuanxiong 15, Gegen 60, Baishao 15, Huai Niuxi 10, Wuzhuyu 3 pieces, Jiangcan 15, Dilong 15, Tubi 10, Zhi Nanshen 30, Xixin 10, Danggui 15, Gancao 10, Muli 50, Guizhi 30, Fupian 15, Baizhu 12, Fuling 60, Quan Chong 10, 7 doses.Case 4: Yu xx, Female, 19 years old, Fuzhou Fuzhou City2009.3.10 Left pulse guan sinking, chi sinking, right pulse guan cun short and slippery, chi slightly weak, tongue pale red. Reports depression, extreme moodiness, insomnia, many dreams, poor appetite, sticky stools, menstrual period is still regular, with lower abdominal distension and pain during each menstrual period, and more irritability.Floating wheat 30, Gancao 10, Dazao 30, Zhi Zi 15, Dahuang 15, Chuanlian 15, Zhuye 10, Yujin 15, Shichangpu 10, Lingstone 30, Shengbanxia 30, Xianlingpi 30, Fuling 30, Mai Dong 15, He Huan Pi 15, Zhenzhu 30, 7 doses.2009.3.17 Pulse guan string-like, chi sinking, slightly hard, tongue red. Reports that the mother says the appetite is small, continue with the formula from March 10, removing Xianlingpi, adding Baizhi 10, Sheng Shouwu 15, Yuanzhi 15, Xuan Shen 30, 7 doses.2009.3.24 Pulse right cun string-like and rapid, guan chi string-like, left string-like, tongue red. Bowel movements are slightly tight.Dahuang 30, Mangxiao 20, Houpian 15, Zhi Shi 10, Longdancao 10, Huanglian 10, Kushi 15, Shengbanxia 30, Gancao 10, Lingstone 30, 7 doses.2009.4.2 Pulse cun guan string-like, chi slightly sinking, tongue dark red, thin coating. Reports that after taking the above medicine, diarrhea occurs three to four times a day. Sleep quality has improved, and spirit is good, wanting to return to class.Dahuang 30, Houpian 15, Zhi Shi 10, Longdancao 10, Huanglian 10, Kushi 15, Shengbanxia 30, Gancao 10, Lingstone 30, 7 doses.Defending TCM, diligently seeking ancient teachings, and promoting national essence, drawing from various sources to establish a comprehensive TCM system.Let us encourage each other, thank you all!See attached table:Excessive Pulse (Yang Pulse) Insufficient Pulse (Yin Pulse)Pulse Name Main Disease Pulse Name Main DiseaseFloating Governs the exterior, governs heat, also governs deficiency Sinking Governs the interior, governs deficiency cold, also governs water retentionRapid Governs heat, but in chronic illness, a rapid pulse often indicates deficiency, thus also governs deficiency Slow Governs cold, governs deficiency, but in cases of extreme interior excess, the pulse may also be slowExcess Governs excess, often belongs to conditions that can be attacked Deficiency Governs deficiencyMoving Governs pain, governs shock; shock causes chest and abdomen to tremble, thus also governs movement Knotty Governs deficiency, governs blood stasis, excess conditionsRapid Governs the exterior, often seen in excess above and deficiency below, also governs knotty chest Intermittent Governs deficiency, often seen in chronic illnessLong Governs excess, those with thick endowments often have long pulses, not based on disease Short Governs deficiency, often seen in loss of fluids and blood, difficult to treatLarge Governs heat, governs excess, governs deficiency fatigue Thin Governs deficiency, insufficient bloodString-like Governs pain, muscle tension, governs excess, water retention, deficiency of blood Weak Governs deficiency, governs insufficient blood, spontaneous sweating, night sweatingTight Governs excess, governs pain, governs food retention, also governs water retention Slow Governs insufficient bloodSlippery Governs excess, governs heat, governs excessive pathogens Rough Governs deficiency, insufficient bloodFlooding Governs excessive heat, excessive heat conditions often present as flooding Minute Governs both qi and blood deficiencyUrgent Initial illness indicates excessive pathogens, chronic illness often indicates danger Hidden Governs deficiency cold, water retention, internal obstruction Hollow Governs deficiency fatigue, insufficient blood Abnormal Governs blood loss, women’s leakage, men’s loss of essence
