White Pulse Disease—cited from the "Chinese Medical Encyclopedia—Tibetan Medicine"

　　In Tibetan medicine, the “Jiangma” meridian is said to originate from the brain and connect to it. The meridians primarily composed of the “Lung” substance—those responsible for regulating bodily development and activity—are called the “White Meridians,” also known as the “Water Meridians.” In modern medical terms, these correspond to nerves. There are 19 major Water Meridians in the human body. When these Water Meridians become diseased due to factors such as infectious epidemics, poisoning, or invasion by pathogenic heat, they cause excruciating pain and movement disorders, a condition known as “White Meridian Disease.”

　　The White Pulse is the first set of meridians to emerge in the human body during the embryonic stage; it is also the network through which the embryo receives nutrients during development. After birth, these meridians continue to play a crucial role by absorbing the essence of food and drink while expelling waste products, thereby ensuring the smooth circulation of the three factors and seven substances. If the function of these meridians declines, the Three Factors will be impaired, leading to the onset of various diseases. Thus, the body’s state of health—whether thriving or declining—and its life or death largely depend on the condition of these meridians.

　　The meridians are classified into two types: the black meridian and the white meridian. The black meridian, which originates from the life-giving pulse and connects with the "Ruma" pulse, is a channel through which blood-based substances flow; it resembles the branching structure of tree limbs as it spreads upward throughout the body. The white meridian, which arises from the brain and connects with the "Jiangma" pulse, is a channel through which "lung" (long) -based substances flow; it resembles the root system of a tree as it spreads downward throughout the body. The white meridian further divides into inner and outer branches. The inner white meridian, resembling silk threads hanging down, consists of 13 main channels that run deep within the body, connecting to the internal organs. Thus, if the head suffers injury, it can affect the internal organs, causing symptoms such as facial and ocular deviation, urinary incontinence, and constipation or obstruction of both bowel movements. The outer white meridian originates from the brain-heart region and runs along the superficial layers of the body, connecting with muscles, bones, tendons, and other tissues. When this outer white meridian is injured, it can lead to symptoms such as swelling, atrophy, paralysis, and stiffness throughout the body. In general, those meridians that project outward are called vital meridians. These vital meridians are distributed all over the body, and when they are damaged, various symptoms manifest. Any condition caused by intense physical activity leading to heat accumulation, or pathogenic factors such as epidemics, poisoning, or febrile conditions entering the meridians, or injuries caused by sharp objects like arrows or spears, or blunt-force trauma from stones or clubs—all these can disrupt the function of lung and blood, damaging the white meridian and giving rise to white meridian disease. Symptoms include headaches and upper-body pain, facial and ocular deviation, confusion, memory loss, inability to squat or sit comfortably, insomnia, vomiting, aphasia, impaired or disordered organ functions, skin itching, difficulty concentrating in noisy environments, tremors in the limbs, numbness in the hands and feet, and limited mobility. Clinically, this disease is categorized into two types: heat-type and cold-type. According to the duration of the illness, it is divided into acute and chronic forms. Based on the affected area, it can be further classified as upper-body white meridian disease or limb white meridian disease. By the Three Factors classification, it is subdivided into white meridian disease caused by lung, white meridian disease caused by bile, white meridian disease caused by phlegm, and white meridian disease caused by the aggregation of these three factors. Heat-type white meridian disease results from heat accumulation due to weapons or other injuries, infectious diseases, or poisoning, which disrupts the balance of blood and bile, allowing pathogenic heat to invade the meridians and cause severe body heat and pain. Cold-type white meridian disease arises from disruptions in lung and phlegm, allowing cold pathogens to invade the meridians and produce symptoms such as swelling, mild fever, and clouded consciousness. Aggregated white meridian disease occurs when lung, bile, phlegm, and blood are simultaneously disrupted and invade the meridians, resulting in all the aforementioned symptoms. Upper-body white meridian disease manifests as excessive talking accompanied by body tremors, frequent stretching, a stiff, dry, and emaciated physique, intense thirst after trembling, half-body swelling or numbness, urinary incontinence or difficulty controlling bowel movements, body heat resembling fire or coldness akin to stone, a bent waist like a bow, head tilted back like a horn or stiffened like wood, coarse speech, and other abnormal symptoms. Limb white meridian disease presents as numbness and weakness in the limbs, swelling, loss of sensation, edema or wasting, rigidity or contracture, and a state of being wrapped in a shroud—especially in cases where the injury was caused by weapons. The injured meridians may shift left, right, up, or down, accompanied by swelling. Severe injuries are difficult to treat, while moderate cases often respond well to intensive treatment, and mild cases are relatively easy to cure.

　　Treatment is divided into general treatment and syndrome-specific treatment.

　　General treatment

　　Guided by the principle of regulating qi, activating blood circulation, and unblocking the meridians, the appropriate medication is the Sare Thirteen-Flavor Pengniao Pill. For heat-type conditions, take the pill with boiling water; for cold-type conditions, take it with wine. Continue taking the pill several times in succession to ensure a continuous medicinal effect until the pathogenic factors are completely eliminated. Alternatively, you may choose either the Ruyi Zhenbao Pill or the Seventy-Flavor Zhenbao Pill. Externally apply the Fifteen-Flavor Tibetan Acorus Powder and the Anning External Application Powder. Subsequently, internally administer the Pili Weili Pill combined with powdered licorice and pearl oyster shell to clear and drain excess pathogenic factors. To prevent recurrence, the purgative therapy (see the entry on purgative therapy), hot spring baths, and the Five-Flavor Sweet Dew Bath are highly effective for treating White Pulse Disease.

　　For the treatment of hot-type self-pulse disorders, when the heat is severe, use formulas such as “Renqin Duozi E,” the Fifteen-Flavor Bezoar Powder, or the Twenty-Five-Flavor Pearl Pill from the “Secrets Section.” In terms of diet, it is advisable to consume nutritious and nourishing foods like fresh butter and meat, as well as barley porridge and cheese. For external treatments, for pain in the upper body, perform venesection at the枕辫脉 (zhuan bian mai) and the枕骨脉 (zhen gu mai); for pain in the lower body, perform venesection at the踝脉 (tai mai) and the“Zhou Guo”脉 (zhou guo mai) in appropriate amounts. After the heat subsides, drinking brown sugar wine has a similar effect to sweet dew. For external application, prepare a fourteen-ingredient anti-inflammatory ointment by grinding together tumor-shaped silicomagnesite, goethite, calamine, magnetite, kyanite, asbestos, and serpentine into a fine powder. Once the pulse and urine patterns show signs of cold predominance on the body surface, take internally the Five-Peng Powder combined with ground cloves, Tibetan cat’s milk, and Wankin Teng—three herbs—or the Five-Peng Powder supplemented with a larger dose of ground cloves; this has a similar effect to sweet dew or the Nine-Flavor Rhinoceros Horn Ash Powder and the Nine-Flavor Musk Powder. If conditions permit, take internally the Northern-style Shen Zhuo Powder. Apply moxibustion to the sixth and seventh vertebral points and the膻中穴 (tan zhong xue). However, avoid bloodletting. The diet should consist of warm, nutrient-rich foods, such as red sugar cubes and wine; take internally the “Ba San” medicinal oil pills. In the early stages of white pulse disease, after body temperature drops, take internally the Five-Peng Powder supplemented with a higher dose of ground cloves, or take the “Qiong Ou Qu Da Er” formula—namely, the Five-Peng Powder combined with one-third of the total dosage of ground cloves, Tibetan cat’s milk, and Wankin Teng. For cold-type white pulse disease, use the Five-Roots Medicine combined with heated sheep dung for warm compresses. For chronic pulse diseases, first focus on consolidating the pathogenic factors, then employ purgative methods, and finally use tonifying therapies. Begin by taking internally in the morning and evening a consolidating formula such as small-leaved rhododendron powder mixed with honey; the best effect for consolidating pathogenic factors is achieved by applying a warm compress made from deer dung wine. For patients with severe self-pulse disorders, use purgative and pulse-discharging methods to thoroughly clear the pulse disease. Finally, take internally the “Ba San” medicinal oil pills for tonification. For white pulse disease originating outside the brain, apply a warm compress made from deer dung wine, and perform moxibustion at the two sides of the大椎 (da zhui), the posterior fontanelle, and the two occipital hair whorls; if bloodletting is necessary, determine the amount based on the degree of heat. For white pulse disease originating within the brain, use the Shi San formula: for heat-type cases, add white sugar;For cold-type cases, add red sugar and take it internally. Apply moxibustion to the Baihui point, the Tan Zhong point, the sixth thoracic vertebra point, the tips of the four ring fingers (toes), the scapular region, and the palms and soles of the hands and feet. For localized numbness, immobility, and chills, apply moxibustion to the three apexes (Baihui, navel, and perineum). For stiffness on one side of the body, apply moxibustion only to the stiff side. For those with hoarseness, apply moxibustion to the lower ends of both cheeks and the tips of the twenty fingers. For those with facial and ocular asymmetry, apply moxibustion to the hair whorl on the affected side. For those with meningial pulse damage, symptoms such as head heaviness will appear; treat these cases using the nasal drainage method described in the “Subsequent Section.” For those with pulse channels dilated by heat, combine purgative and pulse-discharging methods for treatment. For white pulse disease caused by Long disorder, use a nasal medicine prepared with safflower and licorice for nasal drops. For white pulse disease originating outside the body, apply a warm compress made from deer dung wine, take a hot spring bath, and perform moxibustion at the affected area.

　　For leucoderma originating from body cavities, apply moxibustion to the Baihui point, the posterior fontanelle, the sixth thoracic vertebra point, the膻中 point, the supraclavicular fossa, both sides of the Dazhui point, the TianTu point, and the center of the scapulae. Administer the Nineteen-Flavor Golden Ash Pills with a decoction of Terminalia chebula, and apply warm compresses made from deer dung heated in wine. For those suffering from the condition for a long time, alternate between the aforementioned purgative and pulse-dispelling therapies, using the Nineteen-Flavor Golden Ash Pills as the basic formula and adding or subtracting specific herbs tailored to the affected organ according to the methods described in the "Secrets Section." For external treatments, adjust according to the disease's thermal or cold nature and the site of onset. Select appropriate acupoints for bloodletting or moxibustion. For leucoderma affecting the limbs, use the above-mentioned Small-leaved Rhododendron Powder as the base formula; for heat-type conditions, add borneol and camphor; for cold-type conditions, add Piper longum, and form pills about the size of a thumb. Administer these pills with goat's milk. For heat-type conditions, bathe with the Five-Flavor Sweet Dew herbal bath; for cold-type conditions, rub the entire body with a filtered decoction of deer dung boiled in wine, and perform moderate bloodletting at the pulse pathways corresponding to the affected areas on the upper and lower body as well as the internal organs. For chronic cases of leucoderma, employ the pulse-dispelling method outlined in the "Subsequent Section" for purging. For patients whose hand and foot muscles have become thin and dry, take a bath infused with the Five-Flavor Sweet Dew herbal bath, and orally take three-fruit medicinal oil pills combined with Six Good Herbs.

　　When the White Pulse Disorder invades the tendons and sinews, internally administer astringent formulas such as the Small-Leaf Rhododendron Powder. In particular, apply topical treatments containing mineral-based ingredients like cinnabar. Long-term use of a small spoonful of Polygonatum Powder taken with wine or hot water can help relieve tendon and sinew stiffness. Alternatively, soaking in hot springs for half a month, regularly drinking aged wine and red sugar liquor, and applying warm compresses made from oil residues can also be effective. For patients with lower-limb paralysis, apply moxibustion to the 14th thoracic vertebra point, the two black pulse points located one cun lateral to it, the hip bone kidney pulse point, the groin eye point, the inner and outer aspects of the knee joint, and the soles of the feet. For those with upper-limb paralysis, moxibustion should be applied to the supraclavicular fossa, the two shoulder paralysis points, the inner and outer aspects of the shoulder joint, the two precious pulse points, and both palms. In cases of excessive White Pulse Disorder, perform moxibustion at the Dazhui and Baihui acupoints and consume nutritious foods. When the Red Fire Disorder predominates in the White Pulse Disorder, treat it using the purgative and pulse-dispelling methods described in the "Subsequent Section." If the Earth Element Disorder prevails in the White Pulse Disorder, soak in natural hot springs or the Five-Flavor Sweet Dew medicinal bath, followed by a combined purgative and pulse-dispelling treatment to completely eradicate the disorder. For complex White Pulse Disorders involving multiple syndromes, employ the above-mentioned treatment methods accordingly. In general, for patients experiencing severe pain due to the White Pulse Disorder, alternate between taking the aforementioned calming formulas and the Wupeng Powder for pain relief. If the White Pulse Disorder is accompanied by asthma and inability to move the hands due to concurrent Blood and Earth Disorders, alternate between the above-mentioned calming formulas and remedies for Blood and Earth Disorders, such as the Fifteen-Flavor Agarwood Powder. Afterwards, apply moxibustion to the 6th and 7th thoracic vertebrae points, the膻中 (Tan Zhong) point, the anterior fontanelle, and the A-shi points. As stated in the "Four Medical Classics": "Misdiagnosing the White Pulse Disorder as possession by evil spirits is actually the fault of incompetent physicians who lack proper medical knowledge."

　　Therefore, for leucodermia, it is essential to carefully observe the pulse and urine characteristics and make an accurate diagnosis. Treatment should be administered using the aforementioned prescriptions and therapies. These therapeutic approaches are not only effective for leucodermia but also uniquely beneficial in completely curing various types of trauma. They can also serve as adjunctive therapies to prevent disease recurrence and treat complications. In terms of diet and daily routines, it is advisable to consume warm, nutritious foods such as alcohol and meat, live in a warm environment, and engage in moderate physical activity. It is important to avoid cold and cooling foods and beverages like tea, as well as strenuous physical activities and exposure to loud noises from musical instruments, water, or wind. Prolonged stays in cold, damp, and windy environments should be strictly avoided, as should any factors that might trigger the onset of leucodermia, such as excessive hunger or excessive sleep.

　　(Prepared by the Qinghai Provincial Health Department, translated by Carlo, and edited by Xing Quanzhang)