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The pulses at the three positions of the hands (Cun, Guan, Chi) are all palpable, meaning the magnitude of the pulses in the three positions is equal. Nowadays, people only know that when a disease is about to resolve through "Zhan Han" (shivering sweat, where righteous Qi fights pathogenic factors), the pulse may become hidden. They do not realize that if the pulses in all three positions are full and solid, accompanied by irritability and lockjaw, this is also a sign that sweating is imminent. Therefore, Zhang Zhongjing reiterates this point to clarify it.

If the pulse is harmonious, the patient is extremely irritable, eyelids are heavy, and the inner canthus appears yellow, this indicates that the disease is about to resolve.

When the patient is extremely irritable, eyelids are heavy, the inner canthus is yellow, and the pulse is harmonious, it signifies that the color of the Spleen Earth (yellow) appears in its proper position, allowing damp-heat to dissipate outwardly.

If a patient has fever and body pain but lies quietly, and upon examination by the physician, the pulse is deep and slow, it can be known that the disease is recovering. Why is this known? Because for exterior diseases, the pulse should typically be floating and large; since the pulse is now instead deep and slow, it is known that recovery is occurring.

Originally having fever and body pain, now with heat subsiding, quiet lying down, and a deep and slow pulse, it is known that the pathogen has dispersed and the disease will not transmit. If an exterior syndrome is mistakenly treated with purgatives, causing the pulse to become deep and slow, this indicates the formation of "Jie Xiong" (chest binding) and the transmission of the pathogen inward.

Suppose a patient complains of sudden abdominal pain and sits quietly. Upon examination, if the pulse is floating and large, it is known that the disease is recovering. Why? Because interior diseases typically present with deep and fine pulses; the reversal to floating and large indicates recovery.

Abdominal cold causes pain, so the pulse should theoretically be deep and fine. The change to a floating and large pulse indicates the retreat of Yin-cold and the restoration of Yang, signifying recovery. However, if sudden pain presents immediately with a floating and large pulse, this represents a mismatch between pulse and syndrome.

The physician states: Family members request medical attention, reporting the patient had extreme fever and irritability. When the physician arrives the next day, seeing the patient facing the wall indicates the heat has subsided. Even if the pulse is not perfectly harmonious, it is considered cured.

With heat subsiding, body cooling, and calmness, even if the pulse is not harmonious, it is because the pathogen has just retreated and full recovery has not yet occurred. One should not apply the rule of "pulse mismatching patient comfort" in this context.

Q: How does one determine when a disease was contracted and when it will resolve? A: For example, if contracted at midnight, it resolves at noon the next day; if contracted at noon, it resolves at midnight. Why? Resolution at noon from a midnight onset occurs because Yang obtains Yin to resolve; resolution at midnight from a noon onset occurs because Yin obtains Yang to resolve.

Q: What is meant by "Zai Guai" (disaster anomaly) in pulses? A: Suppose a patient presents with Taiyang pulse matching the symptoms, and decoction is prepared. Before the medicine is consumed, within the time of a meal, the patient suddenly vomits severely or experiences diarrhea and abdominal pain. The physician says, "I did not see these symptoms earlier; their sudden appearance is called Zai Guai." Q: What causes this vomiting and diarrhea? A: It may be due to medication taken previously that is now taking effect, hence termed Zai Guai.

Floating and surging pulse, sweating like oil, continuous panting, inability to take fluids, numbness of the body, alternating periods of calmness and confusion—this indicates the end of life. It is unknown which Zang organ fails first: Sweating with wet hair and continuous panting indicates Lung failure first; Yang remains alone (isolated Yang hyperactivity), body color like smoke, fixed gaze, and head shaking indicate Heart failure first; lips and mouth turning cyanotic, limb tremors and spasms indicate Liver failure first; blackening around the mouth, cold sweat, and yellowish complexion indicate Spleen failure first; incontinence of urine and feces, delirious speech, and fixed upward gaze indicate Kidney failure first.

Yang remaining alone signifies isolated Yang hyperactivity and prior exhaustion of Yin. Limb tremors and spasms indicate restlessness. Cold sweat refers to soft sweat. Regarding the causes of death in Five Zang failure syndromes: some die due to overcoming by hostile pathogens, some due to hyperactivity of Wood (Liver) pathogens, some due to excessive Child Qi exhausting the Mother Qi, some due to衰竭 of the original Zang Qi, and some due to simultaneous failure of Zang and Fu organs; these cannot be generalized.

It is unknown whether Yin or Yang of the original Zang fails first: If Yang fails first and Yin follows, the corpse color will be green; if Yin fails first and Yang follows, the corpse color will be red, with warm axillae and hot epigastrium.

In Shanghan (Cold Damage) with cough, rebellious Qi rising, and a scattered pulse, death is indicated because the physical essence is damaged. If both Yin and Yang pulses are excessively large and sweating does not resolve the condition, death is indicated. If both Yin and Yang pulses are deficient and fever persists, death is indicated. If the pulse alternates between slow and rapid, death is indicated. If the pulse feels like a turning rope, death occurs on that day. Delirium and妄语 (wild speech) with slight fever, floating and large pulse, and warm hands and feet indicate survival; cold hands and feet with deep and fine pulse indicate death within one day.

Shanghan with cough and rebellious Qi rising is a Lung disease. An excessively large Mao (Hair-like) pulse that becomes scattered indicates Lung failure. Excessively large Yin and Yang pulses with unresolved sweating indicate "Yin Yang Jiao" (intermingling of Yin and Yang). Deficient Yin and Yang pulses with persistent fever indicate exhaustion of Jin Ye (Body Fluids). Alternating slow and rapid pulses indicate death; variable pulse sizes indicate difficult treatment. A pulse like a turning rope indicates pure pathogenic pulse where Zheng Qi (Righteous Qi) cannot prevail. Delirium with slight fever and warm extremities matches the pulse, indicating survival; delirium with high fever and cold extremities contradicts the pulse, indicating death.