Diseases that are hot and have a calm pulse; those that leak and have a large pulse; those that lose blood and have a solid pulse; those that are sick in the middle and have a solid pulse; those that are sick in the outside and have a weak pulse are all difficult to treat. "- Yellow Emperor's Inner Canon, Su Wen, Yu Ji Zhen Gan Lun, Chapter 19
Today, we will continue to explain the 19th chapter of the Yellow Emperor's Inner Canon, Su Wen, and Yu Ji Zhen Cang Lun. Let's first take a look at the original text: "When the disease is hot, the pulse is calm; when there is leakage, the pulse is large; when there is blood loss, the pulse is solid; when the disease is in the middle, the pulse is solid; when the disease is outside, the pulse is not solid, it is difficult to treat." This paragraph is not so difficult to understand literally. Let me first take you through the overall meaning.
The first sentence is called 'Disease Heat Pulse Tranquility'. Fever is a febrile disease. What should be done for febrile diseases? The pulse should be strong. Generally speaking, when we see external diseases caused by wind, cold, heat, dampness, dryness, and fire, fever is the main symptom. Once these diseases are diagnosed, the pulse of the patient will jump faster, and the pulse will be relatively floating and heavy, which indicates that the disease is on the surface and is very intense in progress. At this point, the method we should use is to conduct syndrome differentiation and treatment, distinguish between cold and heat deficiency and excess, and adjust medication accordingly. But in this place, there was a pulse stillness, which means that after contracting a fever, he did not have a large pulse. On the contrary, this pulse was very quiet, relatively thin, and relatively late, which means slow. This indicates that his illness and syndrome are opposite, as the ancients said, the pulse syndrome is opposite. This situation is a difficult to treat disease. So in the end, even a single sentence is difficult to cure, and this is the first situation. There are four types of conditions in the future: large pulse due to leakage, solid pulse due to loss of blood, moderate disease, and external disease.
Looking back, 'ejaculation with large pulse' refers to diarrhea. In this case, the person should be weak, and the pulse should be fine or heavy, weak, or moist, indicating insufficient spleen and stomach qi, spleen deficiency, or spleen cold. Diarrhea often occurs when the spleen and stomach are cold or deficient. There are also some foreign diseases, such as cholera, and some infectious diseases that can easily cause diarrhea. But remember that after diarrhea, the pulse of most people should be small, which means fine, weak, heavy, and subtle. These pulses are all small. On the contrary, this situation did not occur. Instead, there was a very large pulse, which is explained in some books as' Hongda 'or' Fuda '. This pulse is particularly large, and if you give it a hand, it beats very fast and counts, and the pulse is still very strong. It indicates that his pulse does not match his symptoms, which is called the opposite of pulse syndrome. This is the second scenario, there are a total of five scenarios.
The third situation is called 'blood loss and pulse consolidation', what does it mean? This person has already lost blood, such as massive bleeding or internal organ bleeding, which all belong to bloodletting. Generally speaking, the use of the word 'Tuo' in traditional Chinese medicine indicates that the disease is relatively severe, indicating that it has reached a certain degree of deficiency, or that the qi and blood have been removed. In this case, it is already very weak, even more severe than this deficiency, and it is a symptom of detachment. At this point, the blood loss is already very severe, or the blood deficit is very severe, and the pulse should be weak. When you take a pulse, it is very weak, only the weak ones are correct, but the pulse appears to be particularly strong. This situation is exactly the opposite, that is, the symptoms of this patient are exactly opposite to his pulse. This is the third situation.
The fourth situation is called 'disease in the middle, strong pulse'. We have all learned it before, and we know that in "The Theory of Pingren Meteorology", it is said that the disease lies in the deficiency of the central vein, and the disease lies in the hardness and astringency of the external veins. The theory of "Pingren Meteorology" is not about the opposite of symptoms, but about the opposite of pulse symptoms. It is about the normal state, and in this place, it is exactly the opposite. Being sick in the middle means that our internal organs are diseased. At this time, the pulse should be weak, and the five organs' qi should be weak, either due to deficiency, qi deficiency, or blood deficiency. For example, weak spleen and stomach, and weak pulse. If the liver qi is weak, there will be no vitality in the pulse. If it is kidney deficiency and the ulnar pulse is sinking and weak. This indicates that once the internal organs weaken, the pulse symptoms also weaken. Therefore, in the "Treatise on the Meteorology of Ordinary People", it is said that the disease lies in the deficiency of the midrib, and the disease is generally weak inside. On the contrary, at this time, the pulse appears solid and firm, which means that when the disease is inside, the pulse appears solid and firm, which is exactly the opposite of this pulse syndrome.
Is there such a disease? We also encounter some people in clinical practice, such as those with dysfunction of the spleen and stomach in the middle burner. I often give examples to illustrate that dysfunction of the spleen and stomach in the middle burner. After the spleen and stomach in the middle burner become blocked, the heat in the upper part cannot be lowered, and the cold in the lower part cannot be lifted, which means that water cannot be lifted and fire cannot be released. The spleen in the middle burner is blocked here, so this person experiences upper heat and lower cold, and the middle burner is blocked. The upper teeth are also on fire, the eyes, nose, and ears are on fire, and the tip of the tongue is on fire. The mouth is also prone to ulceration, which is caused by heat. Cold below, cold feet, cold legs, and diarrhea in the stomach, this is called cold below. Where is the middle coke stuck? The middle burner is blocked in the spleen and stomach. Eating something causes bloating in the stomach, either due to bloating or bloating.
Stomach bloating has another word called 'pi bloating', what is pi? It's just a disease box, a 'no'. What does' pi 'represent? Not being able to connect up and down is called a hooligan. We all know that there is a hexagram in the sixty-four hexagrams called the 'No hexagram'. The 'No hexagram' has fire on top, which is heaven, and water on the bottom, which is Kun. Above is Qian, below is Kun. This hexagram separates water and fire. The fire in the top of the Qian hexagram is burning upwards, while the Kun hexagram below belongs to Yin. It moves downwards, and in the middle, it no longer communicates. This is the negative hexagram. Normally, it should be the Tai hexagram, which means that when the body is healthy, the top should be cool, and the earth should be above the Kun hexagram. The Qian hexagram belongs to the water and the earth are both harmonious because the fire is burning upwards, and the Kun hexagram belongs to the water and the earth are both harmonious. In the Tai hexagram, we correspond to the body. A normal person's body should have very cool eyes, nose, ears, and upper orifices. The mind is also very calm, not hot or annoyed, and there is no fire in the heart, so the upper burner is clear. Lower Jiao is warm, and warmth represents the Qian hexagram below. What is warmth? Dantian is warm, feet are warm, legs are warm, waist is strong, this is the strength below, this is the yang energy below, it is suitable for warmth. Zhongjiao Yitong, there is no bloating in the spleen and stomach of Zhongjiao. Eating food can also be digested and absorbed, completely transforming into water, grain, essence, and micro essence, which can be transported and transformed into qi and blood throughout the body. The strong ability of the spleen and stomach in the middle burner indicates good physical health. No is precisely unhealthy.
So where does bloating represent? It represents the position from the chest to the middle of the stomach. The Huangting Jing calls it the Middle Palace, and Taoism also calls it the Middle Yellow. Yellow represents soil, and soil represents the spleen and stomach. Therefore, in traditional Chinese medicine, once the area of Zhongjiao becomes blocked, it is referred to as' pi sai guan '. What should we do at this point when Zhang Zhongjing directly calls himself a 'lower level ruffian'? We should open up the middle burner. After the middle burner is activated, the fire above comes down and the water below goes up. Water and fire can be reconciled, the dantian becomes warm, the feet become warm, and the fire on the teeth, eyes, ears, and nose all subside. Why? These flames should be in their rightful place, it's not right to ignite them in that area, the flames are floating up. So after the middle burner is activated, the fire can automatically return to its original position and warm up when it returns to the Dantian Gate of Life. The acupoint behind the waist is called the Gate of Life.
After the Ming Dynasty, Zhao Xianke, Sun Yikui, and Zhang Jingyue all conducted academic discussions on the attributes of the Gate of Destiny. Some believed it was kidney yang, while others believed it was true yin and true yang. In summary, the gate of destiny should be associated with the kidneys and belong to the lower burner. So once the fire of the gate of destiny returns, the gate of destiny becomes hot, that is, when the gate of destiny becomes hot and the waist becomes hot, the feet naturally become warm, and the qi of the spleen and stomach naturally becomes sufficient. After being full of qi, we digest the essence of water and grain and digest it well, so the spleen and kidney are combined. This means that after spleen yang deficiency, the kidney yang will definitely be insufficient, and after the decline of the fire in the gate of life, the spleen and stomach yang qi will definitely be insufficient. Therefore, they are related. That's why traditional Chinese medicine places great emphasis on the middle burner.
We just talked about that when the disease is in the middle, the pulse is solid and firm. Originally, when the disease is in the middle, the pulse is weak, but it turns out to be solid and firm, which indicates the opposite. On the other hand, if the disease is external and the pulse is not firm, what does it represent when the disease is external? It represents not internal organs, but rather issues with meridians, bones, skin, and so on. At this time, the pulse should be red, floating, or solid. On the contrary, if the pulse is not solid and firm, it indicates that the pulse is weak. If the disease is external, the pulse should be solid. If the pulse is weak, it indicates that the syndrome is opposite to the pulse. The above five situations all belong to the category of very difficult to treat diseases, which are the five major categories.
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