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*The Nan Jing (Classic of Difficult Issues), Chapter 13, states: When the pulse is present in the upper portion (Cun position) but absent in the lower portion (Chi position), the patient should vomit; if they do not vomit, death ensues. If the pulse is absent in the upper portion but present in the lower portion, although the condition is critical, it poses no fatal threat. The reason for this is that the Chi pulse is like the root of a tree; even if the branches and leaves wither and die, as long as the root remains, life will naturally regenerate. Since the pulse has its root, and the person has their Yuan Qi (Primordial Qi), we know they will not die.

This refers to Bian Que (Yue Ren) discussing how the pulse originates from the Stomach Qi in the Middle Jiao, where the Cun pulse arises from the Chi pulse, and Yang pulses arise from Yin pulses. The Qi of the Zang organs cannot reach the Hand-Taiyin Lung Meridian on its own; it must rely on the Stomach Qi to arrive at the Hand-Taiyin Lung Meridian. The Chi position is the root of the pulse; therefore, one who is skilled in regulating the Chi pulse does not need to wait for the Cun pulse [to appear]. Thus, when there is a pulse in the upper portion but none in the lower portion, it indicates that the Middle Jiao Stomach Qi has been damaged by vomiting, resulting in this pulse presentation. If this pulse appears without prior vomiting, it means the Sheng Qi (Vital Qi) within has already severed, which is what is meant by "the Cun Kou pulse appears normal yet the patient dies." Therefore, when the upper portion lacks a pulse but the lower portion has one, it is like a tree having roots; although the patient is debilitated, there is no fatal danger. The context and meaning flow as a single, coherent breath.

Zhang’s diagrammatic annotation states: Whenever a person’s pulse shows presence in the upper portion and absence in the lower portion, it signifies that pathogenic factors are excess and located in the upper region, preventing the free circulation of Vital Qi. Therefore, one should employ the Vomiting Method (Fa Han/Vomit) to expel the pathogen and ascend the Qi; otherwise, the source becomes blocked, indicating certain death. Zhang divided this continuous passage into two separate parts, treating the first section as discussing Pathogens and the second as discussing Zheng Qi (Upright Qi). Furthermore, if pathogens obstruct the upper region, preventing the lower Qi from dispersing, the lower pulse would necessarily be forceful, deep, and tight; there is no scenario where Qi stagnation occurs in the lower region resulting in an absent pulse. To apply the Vomiting Method to a rootless pulse would only hasten death. I have once diagnosed the pulse of Huoluan (Cholera-like disease), where both the Cun and Chi positions were absent. If the pulse returns, the patient lives; if it does not return, the patient dies. One must understand that at the onset of vomiting, the lower pulse disappears first; by the time the physician arrives to diagnose, the upper pulse has also vanished.

When Bian Que annotated Chapter 81 of *The Nan Jing*, he extracted content from *Huang Di Nei Jing (The Yellow Emperor's Inner Canon)* to set up dialectical questions. Although the principles are clear, there are errors within. To add further erroneous annotations would make one a sinner against Bian Que. Alas! Writing original works is difficult, and annotating them is equally challenging.