Course-Handout-Shanghan-Lun-Pulse-Diagnosis.pdf

8/07/2024 Canonical Chinese Medicine® Training www.iceam.org Shanghan Lun Sequence Shanghan Lun Pulse Diagnosis © Arnaud Versulys, PhD, MD (China), LAc 1 ...

8/07/2024 Canonical Chinese Medicine® Training www.iceam.org Shanghan Lun Sequence Shanghan Lun Pulse Diagnosis © Arnaud Versulys, PhD, MD (China), LAc 1  8/07/2024 Legal Disclaimer By participating in this seminar, you irrevocably accept the following: Participant acknowledges that all information provided during this continuing education course training series is proprietary information and shall continue to be the exclusive property of Dr. Arnaud Versluys and ICEAM, LLC. Participant agrees not to disclose the proprietary information, directly or indirectly, under any circumstances or by any means, to any third person without the express written consent of Dr. Arnaud Versluys. Participant may use the proprietary information for their own personal practice, but shall not copy, transmit, teach, reproduce, summarize, quote, or make any commercial use whatsoever of proprietary information, with or without financial gain, without the express written consent of Dr. Arnaud Versluys. Participant agrees to not make any recordings, of any nature, digital or otherwise, of the seminar, without express written consent of Dr. Arnaud Versluys Tian Lineage Shanghan Lun Pulse Methods 田氏傷寒論脈法 2  8/07/2024 Zhang Zhongjing and Pulse Diagnosis Brief History of Pulse Diagnosis 素文, 扁雀 Chapter on Methods for Pulse Differentiation 辨脉法 Chapter on Methods for Pulse Assessment 平脉法 Human Physiology and Pulses: Pulses and Elemental Organs 腎沉心洪，肺浮肝弦，此自經常，不失銖分。 A kidney [pulse] is deep, heart [pulse] is flooding, lung [pulse] is floating, liver [pulse] is wiry; for these are spontaneously regular, and their qualities certain. 3  8/07/2024 Human Physiology and Pulses: Directions, Pulses and Qualities 問曰：東方肝脈，其形何似？師曰：肝者，木也，名 厥陰。其 脈微弦濡弱而長，是肝脈也。肝病自得濡弱者，愈也；假令得純 弦脈者，死。何以知之？以其脈 如弦直，是肝藏傷，故知死也 。 Question: What is the form of the liver pulse of the east? The master says: The liver is wood, and is called jueyin. Its pulse is mildly wiry with a soft roll, weak and long, for this is the liver pulse. When liver disease spontaneously manifests a soft rolling and weak [quality], [this indicates] curation. If it manifests a pure wiry pulse, death [will occur]. How does one know this? Because if the pulse is straight [and taut] like a string, it indicates damage to the liver zang, so one knows there will be death. Human Physiology and Pulses: Directions, Pulses and Qualities 南方心脈，其形何似？師曰：心者，火也，名少陰。其 脈洪大而長，是心脈也。心病自得洪大者，愈也。假令 脈來微去大，故名反，病在裏也。脈來頭小本大者，故 名覆，病在表也。 What is the form of the heart pulse of the south? The master says: The heart is fire, and is called shaoyin. Its pulse is flooding big and long, for this is the heart pulse. When heart disease spontaneously manifests a flooding big pulse, [there will be] curation. If the pulse comes faintly, but leaves big, it is called adversity, for the disease is in the interior. If the pulse has a small head but a big base, it is called reversal, and the disease is on the surface. 4  8/07/2024 Human Physiology and Pulses: Directions, Pulses and Qualities 西方肺脈，其形何似？師曰：肺者，金也，名太陰。其 脈毛浮也，肺病自得此脈。若得緩遲者，皆愈；若得數 者，則劇。何以知之？數者南方火，火克西方金，法當 癰腫，為難治也。 What is the form of the lung pulse of the west? The master says: The lung is metal, and is called taiyin. Its pulse is hair- like floating and lung diseases spontaneously manifest this pulse. If the pulse manifests as moderate slow, it always indicates curation. But if it manifests rapid, [the disease] will aggravate. How does one know this? Rapid is the fire of the south, for fire controls metal, and accordingly there will be abscesses and swelling, which is difficult to treat. Human Physiology and Pulses: Directions, Pulses and Qualities 北方腎脈，其形何似？師曰：腎者，水也，［名太阳］。 其脈沉而石，腎病自得此脈者，愈。若得實大者，則劇。 何以知之？實大者，長夏土王，土克北方水，水藏立涸 也。 What is the form of the kidney pulse of the north? The master says: The kidney is water, and is called taiyang. Its pulse is deep and stone-like, for when kidney disease spontaneously manifests this pulse, there will be curation. But if the pulse manifests as solid and big, then [the disease] will aggravate. How does one know this? Solid big indicates the rule of earth in late summer, for earth damages the water of the north, and the water zang will dry up instantaneously. 5  8/07/2024 Yin and Yang Pulses The Yin and Yang Qualities of Pulses 問曰：脈有陰陽者，何謂也？荅曰：凡脈大、浮、 數、動、滑，此名陽也；脈沉、濇、弱、弦、微， 此名陰也。 Question: There are Yin and Yang pulses, what does this mean? Answer: All big, floating, rapid, stirring, and slippery pulses are called Yang. All deep, unsmooth, weak, wiry, and faint are called Yin. Internal and External Indications of Pulses Interior and Exterior Indications of Pulses 寸口脈，浮為在表，沉為在裏，數為在府，遲為在藏。假令脈遲，此為在 藏也。 Cun pulses, when floating indicates at the surface, deep indicates in the interior; rapid indicates in the hollow organs, slow indicates in the solid organs. If the pulse is slow, it indicates [that the disease is] in the solid organs. 問曰：何以知乘腑？何以知乘藏？師曰：諸陽浮數為乘腑，諸陰遲濇為乘 藏也。 Question: How does one know [the disease] has invaded the hollow organs? How does one know [the disease] has invaded the solid organs? The master says: All yang floating and rapid [pulses] indicate [the diseases] has invaded the hollow organs; all yin slow and unsmooth [pulses] indicate [the disease] has invaded the solid organs. 表有病者，脈當浮大…若裏有病者，脈當沉而細。 If the exterior is diseased, the pulse will be floating and big… if the interior is diseased, the pulse will be deep and thin. 6  8/07/2024 Climactic Qi and Pulses Pulses and Seasons 隨時動作，效象形容，春弦秋浮，冬沉夏洪。 The pulse moves along with time, in mimicking fashion, for in springtime wiry, autumn floating, winter deep and summer flooding. Six Qi and Pulses 師曰：六氣所傷，各有法度。 The master says: When the six [climatic] qi damage, they each have their patterns 風令脈浮，寒令脈緊，又令脈急； Wind causes the pulse to be floating; cold causes the pulse to be tight, and also causes it to be urgent [contracted]. 暑則浮虛，濕則濡澀； Summer heat causes the pulse to be floating and vacuous; dampness causes the pulse to be soggy and unsmooth. 燥短以促，火躁而數； Dryness causes the pulse to be short, making it hasty; fire causes it to be restless and rapid. 7  8/07/2024 Six Qi and Pulses Fire disease: all pulses flooding Wind disease: all pulses wiry Water disease: all pulses deep Dryness disease: all pulses unsmooth Dampness disease: all pulses moderate Human Pathology and Pulses Pulse Divisions 師曰：平脈□□，脈分三部。浮部分經，以候皮膚經絡之氣；沉部分經，以候五 臟之氣；中部分經，以候六腑之氣。 The master says: [When] assessing the pulse --, the pulse is divided in three divisions. For in the superficial division, one assesses the qi in channels and collaterals in the skin. In the deep division, one assesses the qi of the five solid organs. In the middle division, one assesses the qi of the six hollow organs. 師曰：脈分寸關尺，寸脈分經以候陽，陽者氣之統也； The master says: The pulse is [also] divided in cun, guan and chi, for the cun division is used to assess yang, and yang is the controller of qi. 尺脈分經以候陰，陰者血之注也；故曰陰陽。 The chi division is used to assess yin, for yin is the infuser of blood. Thus these are [both] called yin and yang. 關上陰陽交界，應氣血升降，分經以候中州之氣。 The guan division is the realm where yin and yang communicate, and resonates with the ascending and descending of qi and blood, for this division is used to assess the qi of the middle continent. 8  8/07/2024 Human Pathology and Pulses Main Locations and Sub-Locations 諸積之脈，沉細附骨在寸口，積 在胸中；微出寸口，積在喉中； The pulse for accumulations, when deep thin and [as if] attached to the [radial] bone on the cun position, the accumulation is in the chest; when it mildly exceeds the cun position, the accumulation is in the throat. 在關者，積在臍旁；上關上，積在心下；微出下關，積在少腹。 When on the guan position, the accumulation is besides the umbilicus; when above the guan position, the accumulation is under the heart; when mildly below the guan position, the accumulation is in the lower abdomen. 在尺中，積在氣沖；脈出左，積在左；脈出右，積在右；脈左右俱出，積 在中央；各以其部處之。 When on the chi position, the accumulation is at Qichong [ST-30]; when the pulse exceeds to the left, the accumulation is on the left; when the pulse exceeds to the right, the accumulation is on the right; when it exceeds both left and right, the accumulation is in the middle; for all are located based on the proper divisions. Five Phase Dynamics [five evils] and Pulses 問曰：脈有相乘，有縱有橫，有逆有順，何也？師曰：水行乘火， 金行乘木，名曰縱；火行乘水，木行乘金，名曰橫；水行乘金， 火行乘木，名曰逆；金行乘水，木行乘火，名曰順也。 Question: Of mutual invasion of pulses, there is lengthwise, crosswise, retrogressive, and progressive, what does this mean? The master says: When the water movement invades fire, when the metal movement invades wood, this is called lengthwise [invasion]. When the fire phase invades water, when the wood phase invades metal, this is called crosswise [invasion]. When the water phase invades metal, when the fire phase invades wood, this is called retrogressive [invasion]. When the metal phase invades water, when the wood phase invades fire, this is called progressive [invasion]. 9  8/07/2024 Pulses and Disease Conditions Pulses and Prognosis 表有病者，脈當浮大，今脈反沉遲，故知愈也。 When the exterior is diseased, the pulse is supposed to be floating and big, but now the pulse is contrarily deep and slow, so one knows there will be curation. 若裏有病者，脈當沉而細，今脈浮大，故知愈也。 When the interior is diseased, the pulse is supposed to be deep and thin, but now the pulse is floating and big, so one knows there will be curation. 凡陰病見陽脈者生，陰病見陰脈者死。 When yin diseases show a yang pulse, there will be life; when yin diseases show a yin pulse, there will be death. Pulses and Disease Conditions Conditions of Qi and Blood 問曰：脈何以知氣血臟腑之診也？師曰： 脈乃氣血先見，氣血有盛衰，臟腑有偏勝。 Question: How does one diagnose [the condition] of qi, blood, solid and hollow organs from the pulse? The master says: The pulse will first tell you about qi and blood, for qi and blood can be abundant or weak, [and] solid and hollow organs can be dominant. 氣血俱盛，脈陰陽俱盛；氣血俱衰，脈陰陽俱衰。 When qi and blood are both abundant, the yin and yang of the pulses are both abundant; when qi and blood are both weak, the yin and yang of the pulses are both weak. 氣獨勝者，則脈強；血獨盛者，則脈滑； When only qi dominates, then the pulse is strong; when only blood is abundant, the pulse is slippery. 氣偏衰者，則脈微；血偏衰者，則脈澀； When qi tends to be weak, the pulse is faint; when blood tends to be weak, the pulse is unsmooth. 氣血和者，則脈緩；氣血平者，則脈平； When qi and blood are peaceful, the pulse is moderate; when qi and blood are balanced, the pulses are balanced. 氣血亂者，則脈亂；氣血脫者，則脈絕； When qi and blood are chaotic, the pulse is chaotic; when qi and blood are in demise, the pulse will expire. 陽迫氣血，則脈數；陰阻氣血，則脈遲； When yang forces qi and blood, the pulse is rapid; when yin obstructs qi and blood, the pulse is slow. 10  8/07/2024 Pathological Pulses 問曰：脈有殘賊，何謂也？師曰：脈有弦、緊、浮、滑、 沉、濇，此六者名曰殘賊，能為諸脈作病也。 Question: There are damaging and wicked pulses, what does this mean? The master says: There are wiry, tight, floating, slippery, deep and unsmooth pulses, for these six are called damaging and wicked, since they can indicate disease in the pulses. Pulse Descriptions Knotted Pulse [jie mai] 脈來緩，時一止複來者，名曰結。脈來數，時一止複來 者，名曰促。脈陽盛則促，陰盛則結，此皆病脈。 When the pulse comes in slow moderate fashion, and occasionally stops and comes again, this is called knotted [jie]. When the pulse comes rapidly, and occasionally stops and comes again, this is called hasty [cu]. When yang is abundant, the pulse will be hasty; when yin is abundant, the pulse will be knotted, for these are both pathological pulses. 11  8/07/2024 Pulse Descriptions Stirring Pulse [dong mai] 陰陽相搏，名曰動。陽動則汗出，陰動則發熱。形冷惡寒者，此 三焦傷也。 When yin and yang mutually clash, this is called stirring [dong]. For when yang stirs, sweat leaves [the body]; when yin stirs, heat is effused. When the body is cold and there is aversion to cold, this is damage to the triple burner. 若數脈見於關上，上下無頭尾，如豆大，厥厥動搖者，名曰動也。 When a rapid pulse is seen on the guan [position], [but] above and below without head or tail, as the size of a bean, probing and wavering, this is called stirring [dong]. Pulse Descriptions Moderate Pulse [huan mai] 陽脈浮大而濡，陰脈浮大而濡，陰脈與陽脈同等者，名 曰緩也。 When yang pulses are floating big and soft rolling (aka soggy), and when yin pulses are floating big and soft rolling, when yin pulses and yang pulses are equivalent, this is called moderate. 12  8/07/2024 Pulse Descriptions Wiry Pulse [xian mai] 脈浮而緊者，名曰弦也。弦者狀如弓弦，按之不移也。 脈緊者，如轉索無常也。 A floating and tight pulse is called wiry. For wiry is like the shape of a bow-string, which does not move when pressed upon. A tight pulse is like a wrung rope. Pulse Descriptions Hide-like Pulse [ge mai] 脈弦大而，弦則為減，大則為芤。減則為寒，芤則為虛。 寒虛相搏，此名為革。婦人則半產漏下，男子則亡血失 精。 When the pulse is wiry and big, for wiry indicates decrease, big indicates hollow. Decrease indicates cold, hollow indicates deficiency. When cold and deficiency clash, this is called hide-like. For in women there can be downward leakage mid-gestation, and for men there can be demise of blood with loss of semen. 13  8/07/2024 Pulse Descriptions Slow Pulse [chi mai] 寸口脈弱而遲，弱者衛氣微，遲者榮中寒。榮為血…衛 為氣… When the cun position is weak and slow, weak indicates faint protective, and slow indicates cold invasion of the nutritive. For nutritive is blood… and protective is qi… Pulse Descriptions Weak Pulse [ruo mai] 寸口脈弱而緩，弱者陽氣不足，緩者胃氣有餘。 When the cun position is weak and moderate, weak indicates insufficiency of yang, [and] moderate indicates surplus of stomach qi. 少陰脈弱而濇，弱者微煩，濇者厥逆。 When the shaoyin pulse is weak and unsmooth, weak indicates mild vexation, [while] unsmooth [indicates] fainting and adverse flow. 14  8/07/2024 Pulse Descriptions Faint Pulse [wei mai] 寸口脈微，尺脈緊，其人虛損多汗，知陰常在，絕不見陽也。 When the cun position is faint, and the chi is tight, the person is damaged by deficiency and has copious sweating, for one then knows than yin is present as normal, but there is absolutely no yang to be seen. 寸口諸微亡陽，諸濡亡血，諸弱發熱，諸緊為寒。 All faint pulses at the cun position indicate demise of yang; all soft rolling [soggy] indicate demise of blood; all weak [pulses] indicate fever; [and] all tight [pulses] indicate cold. Pulses and Various Pathological Conditions 風則浮虛，寒則牢堅；沉潛水畜，支飲急弦；動則為痛， 數則熱煩。 Wind makes the pulse floating and vacuous, cold [makes it] firm and solid; deep sunken indicates water accumulation, urgent and wiry indicates poking rheum; stirring is pain, and rapid is heat vexation. 15  8/07/2024 Pulses and Various Pathological Conditions Protective and Nutritive 其脈沉者，榮氣微也。 When the pulse is deep, the nutritive is faint. 其脈浮，而汗出如流珠者，衛氣衰也。 When the pulse is floating, and there is sweating like running pearls, the protective is weak. 寸口脈微而濇，微者衛氣衰，濇者榮氣不足。 When the cun pulse is faint and unsmooth, faint indicates that protective qi is weak, [while] unsmooth indicates that nutritive qi is insufficient. 寸口脈弱而遲，弱者衛氣微，遲者榮中寒。榮為血…衛為氣… When the cun pulse is weak and slow, weak indicates that protective qi is faint, [while] slow indicates that cold has invaded the blood. For nutritive is blood… and protective is qi… Pulses and Various Pathological Conditions Blood Deficiency Pulse 陽脈浮，陰脈弱者，則血虛。血虛則筋急也。 When yang pulses are floating, and yin pulses are weak, this indicates blood deficiency. For blood deficiency will cause tightness of the tendons. 16  8/07/2024 Six Conformation Diseases and Pulse Differentiation 尺寸俱浮者，太陽受病也，當一二日發。 When chi to cun pulses are floating, Taiyang has received the illness, for it must have started since one or two days. 尺寸俱長者，陽明受病也，當二三日發。 When chi to cun pulses are long, Yangming has received the illness, for it must have started since two or three days. 尺寸俱弦者，少陽受病也，當三四日發。 When chi to cun pulses are wiry, Shaoyang has received the illness, for it must have started since three or four days. 尺寸俱沉濡者，太陰受病也，當四五日發。 When chi to cun pulses are deep and soggy, Taiyin has received the illness, for it must have started since four or five days. 尺寸俱沉細者，少陰受病也，當五六日發。 When chi to cun pulses are deep and thin, Shaoyin has received the illness, for it must have started since five or six days. 尺寸俱弦微者，厥陰受病也，當六七日發。 When chi to cun pulses are wiry and faint, Jueyin has received the illness, for it must have started since six or seven days. Left Hand Yang Channels Cun Guan Chi (inch) (bar) (cubit) Upper third Taiyang Small Shaoyang Taiyang Channel Intestine Gallbladder Bladder Middle third Small Gallbladder Bladder Hollow Organ Intestine Lower third Heart Liver Kidney Solid Organ 17  8/07/2024 Right Hand Yang Channels Cun Guan Chi (inch) (bar) (cubit) Upper third Yangming Yangming Shaoyang Channel Large Intestine Stomach Triple Burner Middle third Large Stomach Triple Burner Hollow Organ Intestine Lower third Lung Spleen Pericardium Solid Organ Left Hand Yin Channels Cun Guan Chi (inch) (bar) (cubit) Upper third Shaoyin Jueyin Shaoyin Channel Heart Liver Kidney Middle third Small Gallbladder Bladder Hollow Organ Intestine Lower third Heart Liver Kidney Solid Organ 18  8/07/2024 Right Hand Yin Channels Cun Guan Chi (inch) (bar) (cubit) Upper third Taiyin Taiyin Jueyin Channel Lung Spleen Pericardium Middle third Large Stomach Triple Burner Hollow Organ Intestine Lower third Lung Spleen Pericardium Solid Organ Radial Pulse Diagnosis: Yang Conformations “Taiyang Conformation of the Cold Water of the North” Foot Taiyang Hand Taiyang Bladder Small Intestine Ren 壬 Water Bing 丙 Fire Left Chi Left Cun 19  8/07/2024 Radial Pulse Diagnosis: Yang Conformations “Yangming Conformation of the Dry Metal of the West” Foot Yangming Hand Yangming Stomach Large Intestine Wu 戊 Earth Geng 庚 Metal Right Guan Right Cun Radial Pulse Diagnosis: Yang Conformations “Shaoyang Conformation of the Ministerial Fire” Foot Shaoyang Hand Shaoyang Gallbladder Triple Burner Jia 甲 Wood Ministerial Fire Left Guan Right Chi 20  8/07/2024 Radial Pulse Diagnosis: Yin Conformations “Taiyin Conformation of the Damp Earth of the Center” Foot Taiyin Hand Taiyin Spleen Lung Ji 己 Earth Xin 辛 Metal Right Guan Right Cun Radial Pulse Diagnosis: Yin Conformations “Shaoyin Conformation of the Imperial Fire of the South” Foot Shaoyin Hand Shaoyin Kidney Heart Kui 癸 Water Ding 丁 Fire Left Chi Left Cun 21  8/07/2024 Radial Pulse Diagnosis: Yin Conformations “Jueyin Conformation of the Wind Wood of the East” Foot Jueyin Hand Jueyin Liver Pericardium Yi 乙 Wood Ministerial Fire Left Guan Right Chi Basic Rule for Pulse Diagnostic Location: Cold Damage Invades the Foot Channels First Taiyang Foot Channel: left chi Yangming foot channel: right guan Shaoyang foot channel: left guan Taiyin foot channel: right guan Shaoyin foot channel: left chi Jueyin foot channel: left guan 22  8/07/2024 Exceptions to the Basic Rule for Diagnostic Pulse Locations Per Biao-Ben-Zhongqi Conformation Biao Location Zhong Ben Location (by hand Location (by channel) element) Taiyang Left Cun Shaoyin Fire Left Chi Cold Taiyang Hand within Taiyang Water within Channel (SI/HT) Taiyang Taiyin Right Cun Yangming Right Guan Taiyin Hand Dryness within Damp Earth Channel Taiyin within Taiyin (LUSP) Shaoyin Left Cun Taiyang Water Left Cun Fire Shaoyin Hand within Shaoyin within Shaoyin Channel (KDHT) 23  8/07/2024 Diagnostic Location Summary for Cold Damage Taiyang Disease: left chi, or left cun Yangming Disease: right guan Shaoyang Disease: left guan Taiyin Disease: right guan, right cun Shaoyin Disease: left chi, left cun Jueyin Disease: left guan Archetypical Herb-Pulse Allocations Taiyang Conformation Left Cun Guizhi Wind Strike Floating Soft Left Cun Mahuang Cold Damage Floating Tight Left Cun Zhizi Small Intestine Damp Mid-depth Slippery Heat Left Chi Fuling Bladder Water Mid-depth Wiry Accumulation 24  8/07/2024 Archetypical Herb-Pulse Allocations Yangming Conformation Right Guan Gegen Taiyang-Yangming Floating Slippery, Shigao Yangming Channel Floating Rapid, Zhuye Late-stage Yangming Flooding Right Guan Huanglian Stomach Domain Mid-depth slippery, Dahuang Excess Deep slippery Archetypical Herb-Pulse Allocations Shaoyang Conformation Left Guan Chaihu Shaoyang Channel Thin Wiry Congestion Left Guan Huangqin Shaoyang Slippery Wiry Ministerial Fire Congestion 25  8/07/2024 Archetypical Herb-Pulse Allocations Taiyin Conformation Right Guan Renshen Earth Insufficiency (all) Deep Weak Right Guan Renshen Center Vacuity Dong or Big Right Guan Banxia Earth Damp (all) Deep Soggy Right Guan Baishao Earth Weakness with Wood Thin Wiry Overacting Right Cun Mahuang Cold Lung Closure Floating Tight Right Cun Shengjiang Taiyin Cold Contraction Mid-depth Tight Ganjiang Archetypical Herb-Pulse Allocations Shaoyin Conformation Left Cun Fuzi Lack of Imperial Fire (all) Deep Left Chi Fuzi Kidney Cold (all) Deep Tight Left Chi Fuling Shaoyin with Cold Water Deep Wiry Stagnation Left Chi Egg Yolk/E Jiao Shaoyin Blood (all) Deep Thin Wiry Insufficiency Left Chi Zhuling Shaoyin with Hot Water Deep Thin Slippery/Soggy Stagnation 26  8/07/2024 Archetypical Herb-Pulse Allocations Jueyin Conformation Left Guan Danggui Blood Expiration Deep Thin Expiring Left Guan Danggui Blood Stagnation Deep Thin Wiry or Knotted Left Guan Wumei Internal Wind Big (Wiry) Empty Left Guan Wuzhuyu Liver Cold Deep Wiry Tight Archetypical Herb-Pulse Allocations Summary Left Floating Soft Guizhi Right Floating Tight Mahuang Cun Floating Tight Mahuang Cun Mid-depth Tight Sheng/Ganjiang Mid-depth Slippery Zhizi (all) Deep Fuzi Left Thin Wiry Chaihu Right Floating Slippery, Gegen, Shigao, Guan Slippery Wiry Huangqin Guan Floating Rapid, Zhuye Flooding Deep Thin Expiring Danggui Mid-depth Slippery, Huanglian Deep Thin Wiry Danggui Deep Slippery Dahuang Big (Wiry) Empty Wumei Deep Wiry Tight Wuzhuyu (all) Deep Weak Renshen Dong or Big Renshen (all) Deep Soggy Banxia Thin Wiry Baishao Left Mid-depth Wiry Fuling Right Chi Chi (all) Deep Tight Fuzi Deep Wiry Fuling (all) Deep Thin Wiry Egg Yolk/E Jiao Deep Thin Slippery Zhuling 27  8/07/2024 Formula-Pulse Patterns: Taiyang 1) Guizhi Tang Pulse Pattern 桂枝湯 Left cun floating and moderate 左寸浮緩 1.1) Guizhi Jia Shaoyao Tang 桂枝加芍藥湯 Left cun floating and moderate, right guan wiry 左寸浮緩，右關弦 1.2) Guizhi Jia Dahuang Tang 桂枝加大黃湯 Left cun floating, right guan slippery 左寸浮，右關滑 Formula-Pulse Patterns: Taiyang 1.3) Guizhi Jia Fuzi Tang 桂枝加附子湯 Primary pulse: Left cun floating and moderate, chi deep or weak, or left chi fails to lift the fingers 左寸浮緩，尺沈或弱，左尺不起指 Secondary pulse: Left cun floating, left chi tight 左寸浮，左尺緊 28  8/07/2024 Formula-Pulse Patterns: Taiyang 1.4) Guizhi Fuzi Tang 桂枝附子湯 Primary Pulse: Left cun tight, right fails to lift the fingers 左寸緊，右不起指 Secondary pulse: Both cun fail to lift the fingers, both chi deep tight 兩寸不起指，兩尺沈緊 Formula-Pulse Patterns: Taiyang 1.5) Guizhi Jia Gui Tang 桂枝加桂湯 Primary pulse: Left cun floating but unable to lift fingers 左寸浮不起指 Secondary pulse: Left cun and guan floating weak, chi wiry or wiry tight 左寸關浮弱兼尺弦或弦緊 1.6) Guizhi Qu Shaoyao Tang 桂枝去芍藥湯 Left cun floating hasty 左寸浮促 29  8/07/2024 Formula-Pulse Patterns: Taiyang 1.7) Guizhi Jiuni Tang 桂枝救逆湯 Primary Pulse: Left cun and chi not communicating 左寸尺不交 Secondary Pulses: Left cun and chi not communicating, right guan big Left cun superficial slippery, left chi deep/faint, right guan big Left cun and guan superficial, left chi deep tight, right guan big Formula-Pulse Patterns: Taiyang 1.8) Guizhi Gancao Longgu Muli Tang 桂枝甘草龍骨牡 蠣湯 Primary Pulse: Left cun superficial slippery 左寸浮數 Secondary Pulse: Left cun and chi not communicating 左寸尺不交 30  8/07/2024 Formula-Pulse Patterns: Taiyang 1.9）Guizhi Jia Gegen Tang 桂枝加葛根湯 Left cun floating weak, right guan slippery or big Formula-Pulse Patterns: Taiyang 1.10) Zhigancao Tang 炙甘草湯 Primary Pulse: Left cun superficial weak, knotted Secondary Pulse: Left cun big 31  8/07/2024 Formula-Pulse Patterns: Taiyang 2）Mahuang Tang 麻黃湯 Primary Pulses: Left cun floating tight (Cold Damage) 左寸浮緊（傷寒） Secondary Pulses: Left cun deep tight (Cold Dampness) 左寸沈緊（寒濕） Left and right cun floating tight Formula-Pulse Patterns: Taiyang 2.1）Gegen Tang 葛根湯 Primary Pulse: Left floating wiry, right guan slippery or wiry (eye pain or dry nose) 左浮弦，右關獨滑（滑或弦：目痛鼻幹） Secondary Pulse: Left floating wiry, right guan slippery, or wiry, or big; right cun tight 32  8/07/2024 Formula-Pulse Patterns: Taiyang 2.2）Xiao Qinglong Tang 小青龍湯 Left cun floating, guan and chi thin wiry tight 左寸浮，關尺細弦緊 Left thin wiry tight 左細弦緊 Modification 加減： Right guan slippery, add Shigao. 右關滑＝加石膏 Formula-Pulse Patterns: Taiyang 3）Wuling San 五苓散 Primary pulse: Left chi tight (failure of taiyang to transform water) 左尺緊（太陽水氣不化） Secondary pulses: Chi wiry and tight 尺弦緊 Deep moderate 沈緩 Both cun fail to rise, both chi deep and tight 兩寸不起，兩尺沈緊 Left cun fails to rise, guan and chi tight 左寸不起，關尺緊 Right cun tight, left chi wiry tight 右寸緊，左尺弦緊 Left cun tight, both chi deep and unsmooth 左寸緊，兩尺沈澀 Left cun flooding big rolling over the whole hand (water qi) 左寸洪大滿手溜（水氣） 33  8/07/2024 Formula-Pulse Patterns: Taiyang 4）Ling Gui Zhu Gan Tang 苓桂術甘湯 Primary pulse: Left cun and guan fail to rise (when yang fails to rise, water and damp are not being expelled) 左寸關不起（陽不起， 水濕不利） Secondary pulses: Both hands deep and wiry 兩手沉弦 Both cun fail to rise, both guan wiry 兩寸不起，兩關弦 Formula-Pulse Patterns: Taiyang 5) Taohe Chengqi Tang 桃核承氣湯 Primary pulse: Both chi deep thin slippery (blood stasis below) 兩手尺沉細滑 Secondary pulses: Left cun thin slippery (blood stasis with jaundice) 左寸細滑 Left chi thin slippery (female blood stasis with lower abdominal pain) 左尺細滑 Both chi deep unsmooth (external trauma blood stasis) 兩手尺沉澀 34  8/07/2024 Formula-Pulse Patterns: Yangming 1) Baihu Tang 白虎湯 Primary pulse: Both hands flooding and big 兩手洪大 Secondary pulse: Both guan thin and slippery 兩關細滑 Formula-Pulse Patterns: Yangming 2) Da Chengqi Tang 大承氣湯 Primary pulse: Big thin slippery, wiry slippery 大細滑，弦滑 Secondary pulses: Left thin slippery 左細滑 Solely right guan deep, but when pressed thin and slippery (food stagnation) 獨右關沈，推出細滑（宿食） 35  8/07/2024 Formula-Pulse Patterns: Yangming 3) Xiao Chengqi Tang 小承氣湯 Primary pulse: Solely right guan thin slippery, others normal 獨右關細滑，餘如常 Secondary pulse: Both hands slippery or wiry 兩手滑或弦 Formula-Pulse Patterns: Yangming 4) Maziren Wan 痲子仁丸 Right guan slippery or deep thin slippery, unable to push out left pulses 右關滑或沈細滑，左脈推不起 36  8/07/2024 Formula-Pulse Patterns: Shaoyang 1) Xiao Chaihu Tang 小柴胡湯 Left guan wiry, wiry tight, thin wiry 左關弦，弦緊，細弦 Formula-Pulse Patterns: Shaoyang 2) Huangqin Tang 黃芩湯 Below left guan wiry and slippery 左關下弦滑 37  8/07/2024 Formula-Pulse Patterns: Shaoyang 3) Sini San 四逆散 Primary pulse: Solely left guan wiry, other positions fail to rise 獨左關弦，餘不起 Secondary pulses: Both guan wiry, chi fails to rise (lower back pain) 兩關弦，尺不起（腰痛） Left guan wiry, below guan dong 左關弦，關下動 Formula-Pulse Patterns: Shaoyang-Yangming 4) Da Chaihu Tang 大柴胡湯 Primary pulse: Both guan wiry, or wiry big 兩關弦，弦大 Secondary pulse: Both guan wiry, left pulses long 兩關弦，左脈長 38  8/07/2024 Formula-Pulse Patterns: Shaoyang-Yangming 5) Banxia Xiexin Tang 半夏瀉心湯 Left guan chi wiry 左關尺弦 Both guan wiry 兩關弦 6) Shengjiang Xiexin Tang 生薑瀉心湯 Both guan wiry 兩關弦 Left guan wiry, right cun tight 左關弦右寸緊 7) Gancao Xiexin Tang 甘草瀉心湯 Both guan wiry, with only left guan also stirring [dong] 兩關弦，獨左關兼動 Formula-Pulse Patterns: Shaoyang-Yangming 8) Chaihu Jia Longgu Muli Tang 柴胡龍骨牡蠣湯 Primary pulses: Both guan wiry with right guan wiry big 兩關弦兼右關弦大 Left guan thin wiry with right guan wiry big 左關細弦兼右關弦大 Secondary pulse: Left guan wiry slippery 左關弦滑 39  8/07/2024 Formula-Pulse Patterns: Taiyin 1）Lizhong Wan 理中丸 Right guan deep and wiry (weak spleen) 右關沈弦（脾弱） Both hands deep and thin 兩手沈細 Formula-Pulse Patterns: Taiyin 1.1) Guizhi Renshen Tang 桂枝人參湯 Left cun floating moderate with right guan deep wiry or deep thin 左寸浮緩兼右關沈弦或沈細 Left cun floating weak, right guan dong or big 左寸浮弱，右關動或大 Dong above left guan, right guan dong or big 左關上動，右關動或大 40  8/07/2024 Formula-Pulse Patterns: Taiyin 1）Shaoyao Gancao Tang 芍藥甘草湯 Right guan wiry and slippery 右關弦滑 Both hands all pulses wiry 兩手俱弦 Formula-Pulse Patterns: Taiyin 3）Xiao Jianzhong Tang 小建中湯 Primary Pulse: Yang pulse (left cun) unsmooth, yin pulse (right guan) wiry 左寸（太陽）澀右關（太陰）弦 Secondary Pulse: Left cun floating weak, right guan big 41  8/07/2024 Formula-Pulse Patterns: Shaoyin 1）Sini Tang 四逆湯 Primary pulse: Both hands severely thin and faint 兩手細微甚 Secondary pulses: Unable to raise the pulse by pressing (sadness in the heart) 推不起（心裏難過） Slow (cold solid organs) 遲（藏寒） Big but forceless 大而無力 Deep and soggy (cold dampness) 沈濡（寒濕） Formula-Pulse Patterns: Shaoyin 2）Zhenwu Tang 真武湯 Primary Pulse: Deep thin tight, all six pulses fail to lift the fingers 沈細緊，六脈不起指 Secondary Pulses: Both cun deep, both guan wiry, all weak or faint Right cun tight, rolling up; left all weak or faint, or deep wiry tight 42  8/07/2024 Formula-Pulse Patterns: Shaoyin 3）Mahuang Xixin Fuzi Tang 麻黃細辛附子湯 Primary Pulse: Both hands tight deep thin 兩手緊沈細 Secondary Pulses: Both hands deep weak, faint and thin 兩手沈弱微細 Left all deep faint, right cun tight Left chi deep faint tight, right cun tight Formula-Pulse Patterns: Shaoyin 4）Huanglian Ejiao Tang 黃連阿膠湯 Deep thin rapid 沈細數 43  8/07/2024 Formula-Pulse Patterns: Shaoyin 5) Zhuling Tang 豬苓湯 Deep thin slippery or soggy 沈細滑或濡 Formula-Pulse Patterns: Jueyin 2) Danggui Sini Tang 當歸四逆湯 Thin wiry, deep thin wiry 細弦，沈細弦 Deep thin with tendency towards expiring 沈細欲絕 44  8/07/2024 Formula-Pulse Patterns: Jueyin 3) Wuzhuyu Tang 吳茱萸湯 Primary Pulse: Left guan wiry, thin wiry or deep thin wiry 左關弦，細弦或沈細弦 Secondary Pulses: Left guan wiry tight, right cun tight Dong above left guan, right guan dong or big, right cun tight Formula-Pulse Patterns: Jueyin 4) Wumei Wan 烏梅圓 Left guan big wiry hollow 45  8/07/2024 Thank you! 46