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Shang Han Lun · Treatise on Cold Damage
20. Contraindications to Purging · Pulses, Signs and Treatment
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The pulse is yielding and weak: weakness is instead at the guan, yielding at the uppermost position, faintness above and roughness below. Faintness means insufficient yang qi; roughness means absence of blood. Yang qi is unexpectedly faint, and wind-strike with sweating instead produces restlessness and agitation. Roughness means absence of blood, with reversal cold and chill. Faint yang forbids purging: purging causes focal obstruction and hardness below the Heart.
Stirring qi on the right forbids purging. Purging exhausts fluids internally, causing dry throat, dry nose, dizziness and palpitations.
Stirring qi on the left forbids purging. Purging causes internal abdominal contraction, inability to take food and more severe stirring qi. Even with bodily heat, the person wishes to curl up when lying down.
Stirring qi above forbids purging. Purging produces distressing heat in the palms, floating cold on the body, spontaneous hot sweating and a wish to pour water over oneself.
Stirring qi below forbids purging. Purging causes abdominal distention and fullness, dizziness on rising suddenly, passage of undigested grain after eating and focal obstruction below the Heart.
Cold blockage in the throat forbids purging. Purging makes the upper region light and lower region heavy; water and gruel cannot descend, the person wishes to curl up when lying down, the body is tense and painful, and diarrhea occurs dozens of times daily.
Exterior repletion forbids purging. Purging produces slight fever. If the pulse disappears and reversal cold occurs, heat should be felt at the navel.
Deficiency conditions forbid purging. Purging produces great thirst. Those who ask for water recover easily; aversion to water indicates severity.
The pulse is yielding and weak: weakness is instead at the guan, yielding at the uppermost position, wiriness above and faintness below. Wiriness signifies yang movement, faintness yin cold. Repletion above and deficiency below produce a wish for warmth. Faintness and wiriness indicate deficiency; deficiency forbids purging.
Faintness produces cough, and cough produces vomiting of thin saliva. Purging stops the cough but causes unceasing diarrhea. The chest then feels as if bitten by insects; gruel comes out as soon as it enters. Urination is difficult, both flanks contract, breathing is labored, and the neck and back pull against each other. The arms are numb. Extreme cold unexpectedly produces sweating; the body is cold as ice, the eyes lack clarity and speech does not cease, yet much grain qi enters. This is elimination of the middle. Although the mouth wishes to speak, the tongue cannot come forward.
The pulse is yielding and weak: weakness is instead at the guan, yielding at the uppermost position, floating above and rapidity below. Floating means yang deficiency; rapidity absence of blood. Floating means deficiency; rapidity heat. Floating deficiency gives spontaneous sweating and aversion to cold. Rapidity also signifies pain, with shaking chills and trembling. Faintness and weakness at the guan cause tension below the chest, panting and sweating with difficulty breathing, and flank pain during breathing. Shaking and cold contend, resembling nüe fever. If the physician instead purges, the pulse becomes rapid, fever develops, and the person runs about manically seeing spirits. Focal obstruction below the Heart, dribbling urination, a very hard lower abdomen and bloody urine follow.
A yielding, tight pulse: yielding means faint defensive qi, tightness cold in the nutritive aspect. With faint yang and wind in the defensive aspect, fever and aversion to cold occur. Tight nutritive qi means cold Stomach qi, slight vomiting and internal vexation. The physician takes this for great heat and releases the muscle layer by sweating, causing loss of yang, deficient agitation and restlessness, and distressing hard focal obstruction below the Heart. Exterior and interior are both exhausted; sudden rising causes dizziness. Guest heat is in the skin, with distress and inability to sleep, but the physician does not recognize cold Stomach qi and tight cold at Guanyuan.
With no skill left to apply, he draws water and pours it over the body. Guest heat immediately ceases, but shivering and shaking chills arise. Heavy covers are placed over the person; sweat emerges with clouded oppression reaching the head. The body twitches and shakes, and urination becomes slightly difficult. Water has stirred cold qi, and undigested grain passes without respite. Vomiting changes, with the bowel turning out; the person tosses without peace. Hands and feet are slightly reversely cold, the body cold but internally agitated. To seek rescue only afterward is too late: how could the course be brought back?
A floating, large pulse: floating means replete qi and largeness deficient blood. Deficient blood means absence of yin. Solitary yang descends alone into the yin region; urine should be red and difficult, and the Bladder empty. Yet urination is instead free and profuse sweating occurs. Defensive qi should ordinarily be faint, but is instead still more replete. Fluids shoot in all directions, nutritive qi is exhausted and blood spent, with dry agitation and inability to sleep. Blood thins, flesh wastes and sudden fluid loss develops. If the physician again attacks the Stomach with toxic medicine, this compounds deficiency. Guest yang has its time of departure; a discharge like dirty mud must precede death.
With a rapid pulse, prolonged rapidity does not stop. If it stops, harmful influence binds and proper qi cannot recover; proper qi instead binds in the viscera, while harmful qi floats outward and joins the skin and hair. A rapid pulse forbids purging. Purging must cause agitation and unceasing diarrhea.
A floating, large pulse calls for sweating. If the physician instead purges, this is a major contrary treatment.
With much vomiting, attacking treatment is forbidden even if a Yangming presentation is present.
Taiyang illness with unresolved exterior signs must not be purged. Purging is contrary treatment.
Illness with much yang has heat. Purging then produces hardness.
With no yang, strong yin and hard stool, purging must cause passage of undigested grain and abdominal fullness.
In cold damage with fever, headache and slight sweating, inducing sweat causes failure to recognize people. Fumigation causes panting, inability to urinate and fullness of the Heart region and abdomen. Purging causes shortness of qi, difficult urination, headache and a stiff back. Added warm-needling causes nosebleeding.
In cold damage with tight pulses in both yin and yang, aversion to cold and fever, the pulse tends toward reversal. In reversal, it initially arrives large, gradually becomes small, then returns gradually larger: this is its form. Such a person has aversion to cold; in severe cases gently moist sweating and throat pain occur. Predominant heat produces red eyes, an abundant pulse and unclear vision. If the physician again induces sweating, the throat is injured. Repeated purging closes both eyes: predominant cold causes passage of undigested grain, predominant heat passage of pus and blood. Fumigation makes the body yellow; hot compresses dry the throat. Free urination permits rescue; difficult urination indicates grave danger.
In cold damage with fever, forcefully emerging breath from the mouth, headache, yellow eyes and uncontrollable nosebleeding, craving water must lead to vomiting; aversion to water to reversal cold. Purging causes throat sores. Even if the hands and feet are warm, downward heaviness and passage of pus and blood must occur. Purging someone with headache and yellow eyes closes both eyes. In someone craving water, the pulse must reverse, the voice becomes faint and the throat blocked. Induced sweating causes shaking and trembling, with deficiency of both yin and yang. In someone averse to water, purging produces internal cold, no desire for food and passage of whole grain. Sweating causes mouth injury, a white tongue coating, agitation, restlessness, a rapid, replete pulse and no bowel movement; blood must be passed six or seven days later. The passage adds that induced sweating makes urination naturally free.
In diarrhea, a large pulse signifies deficiency due to forced purging. If the pulse is floating and drumskin-like, with persistent intestinal rumbling, Danggui Sini Tang governs.
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