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The Fuyang pulse is deep and rapid. Deep indicates interior excess, and rapid indicates the ability to digest food (xiao gu). This represents the flourishing of Stomach Yang. If accompanied by a tight pulse, the disease is difficult to treat. The tight pulse occurs because Yang Qi is constrained by pathogenic factors and cannot flow freely (external constraint of Wind-Cold causes the Jia Wood to be depressed and pressured, thus presenting a tight image).

The Fuyang pulse is large and tight; there should immediately be diarrhea, which is difficult to treat. A large and tight Fuyang pulse indicates that Stomach Yang is constrained by the Gallbladder channel, unable to accommodate food and fluids, leading to immediate diarrhea. This is difficult to treat (In the chapter "Indications and Contraindications for Sweating and Purging," it states that a large and tight pulse indicates Yin within Yang, requiring purgation, suitable for Da Cheng Qi Tang, referring to this condition).

When both the Yin (Chi) and Yang (Cun) positions of the Cun Kou pulse are tight, according to the principle, clear pathogens attack the Upper Jiao, and turbid pathogens attack the Lower Jiao. Clear pathogens attacking the upper part are called "Jie" (pure/clear), and turbid pathogens attacking the lower part are called "Hun" (turbid/muddy). When the Yin aspect is attacked by pathogens, internal shivering must occur. Because the exterior Qi is slightly deficient and the interior Qi fails to maintain its post, pathogens invade the Yin aspect. When the Yang aspect is attacked by pathogens, fever, headache, stiffness of the neck and occiput, cervical spasms, lower back pain, and soreness of the calves will occur. This is referred to as the Yang aspect being affected by mist and dew. Thus, it is said that clear pathogens attack the upper, and turbid pathogens attack the lower.

When the Yin aspect is attacked and shivers, the feet and knees become cold, and urination and defecation may occur involuntarily. This is because the exterior Qi is slightly deficient and the interior Qi is slightly urgent, causing the Three Jiao to become mixed and confused, with no communication between inside and outside. The Upper Jiao becomes stifled, and organ Qi steams each other, leading to oral ulcers and rotting gums. The Middle Jiao loses regulation; Stomach Qi rebels upward, Spleen Qi fails to transform, and the stomach becomes filled with turbidity. Ying and Wei Qi do not circulate, and blood coagulates and stagnates.

If Wei Qi flows first, urine will be dark yellow. It clashes with heat, driven by heat to act as an agent, wandering through the meridians and entering/exiting the Zang-Fu organs. Wherever the hot Qi passes, carbuncles and pus form. If Yin Qi flows first, Yang Qi becomes inverted and weak, leaving Yin without direction. Guest Qi enters internally, causing sneezing and expulsion of sound, hoarseness, and throat obstruction. Cold inversion chases each other, blocked by heat. Coagulated blood descends spontaneously, resembling pig liver. Both Yin and Yang experience inversion; Spleen Qi becomes isolated and weak. The five fluids pour downward, and the Lower Jiao fails to close. Clear stool feels heavy in the anus, frequent but difficult defecation occurs, and there is pounding pain in the umbilical region. Life is difficult to preserve.

When both the Cun and Chi positions of the Cun Kou pulse are tight, this is due to external pathogenic constraint. A tight Cun pulse indicates clear pathogens attacking the Upper Jiao; a tight Chi pulse indicates turbid pathogens attacking the Lower Jiao. Clear pathogens are pure, called "Jie"; turbid pathogens are muddy, called "Hun." When the Lower Jiao Yin is attacked, interior Yang deficiency leads to shivering. This is because the exterior Qi is slightly deficient and the interior Qi fails to guard, allowing pathogens to invade the Yin regions. When the Upper Jiao Yang is attacked, fever, headache, neck stiffness, cervical spasms, lower back pain, and calf soreness occur, known as the Yang aspect being affected by mist and dew. Thus, clear pathogens attack the upper, and turbid pathogens attack the lower. Since similar things attract each other, as stated in *Jin Gui Yao Lue*, mist injures the upper, and dampness injures the lower, which is exactly this meaning.

Clear pathogens attacking the upper cause interior heat; turbid pathogens attacking the lower cause interior cold. Upper heat and lower cold mean both Yin and Yang are diseased, but Yang disease is lighter and Yin disease is heavier, due to the difference in the clarity or turbidity of the pathogens. Now speaking of turbid pathogens attacking the lower: Yin is attacked, causing interior cold and shivering; Yang cannot descend, leading to cold feet and knees, failure of cold Qi to control, and involuntary urination and defecation. This is because the exterior Qi is slightly deficient, allowing external pathogens to invade without being contained; the interior Qi is also slightly constrained, causing fullness and urgency, so the Three Jiao become chaotic with no internal-external communication. All three Jiao are diseased, with distinct symptoms.

The stifling of the Upper Jiao involves heat steaming the organs, where organ Qi steams each other, causing oral ulcers and rotting gums. This is because the Upper Jiao has external exterior pathogen sensation and internal lower cold pressure, trapping fire in the upper, hence these symptoms. The dysfunction of the Middle Jiao involves rebellious Stomach Qi rushing upward and depressed Spleen Qi failing to transform. The stomach is filled with turbid Qi, blocking Ying and Wei circulation, causing blood coagulation and stagnation. Since Ying and Wei circulation depends on the movement of Middle Qi, if Middle Qi does not move, Qi and Blood are obstructed.

If Wei Yang flows first to the lower, Qi descends into water, resulting in dark yellow urine. As Wei Qi attempts to flow but is not yet free, it becomes constrained and generates heat. Wei Qi combines with heat in the organs; wherever Wei Qi goes, heat follows, acting through heat. Wei and heat wander through meridians, entering/exiting Zang-Fu organs. Wherever hot Qi passes, it steams and rots, forming carbuncles and pus. This is Wei Yang flowing while heat injures the interior.

If Li Yin flows first to the upper, Yang Qi is cold and weak, unable to generate heat, leaving Yin without direction. Guest Qi from the Lower Jiao enters the chest and diaphragm, stirring Lung Qi upward, causing sneezing and expulsion of sound, followed by hoarseness and throat obstruction. Lower Jiao cold inversion attacks upward, blocked by upper heat. Cold and heat clash, and previous coagulated blood descends spontaneously, resembling pig liver. Both Yin and Yang reach inversion; turbid Qi does not descend, clear Qi does not ascend. Spleen Qi becomes isolated and weak, unable to control the essence and fluids of the five Zang organs. The five fluids rush downward and泄 out. This is Li Yin flowing while cold injures the interior.

The Lower Jiao fails to close, causing a feeling of heaviness in the anus with frequent but difficult defecation, and pounding pain above the navel. This is because clear Qi sinks, causing heaviness and frequency, while cold coagulation and Qi stagnation prevent smooth descent, making defecation difficult and causing abdominal pain. Thus, life is difficult to preserve.