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Difficulty 9 states: How can one distinguish and know the diseases of the Zang (Yin) and Fu (Yang) organs? The answer is: A rapid pulse (Shu Mai, 数脉) belongs to the Fu organs, while a slow pulse (Chi Mai, 迟脉) belongs to the Zang organs. A rapid pulse indicates Heat, and a slow pulse indicates Cold. All Yang meridians are associated with Heat, and all Yin meridians are associated with Cold; thus, by distinguishing these, one can identify whether the disease resides in the Zang or Fu organs.

Difficulty 10 states: What is meant by "one pulse transforming into ten variations"? The answer is: This refers to the interaction of Gang (Yang/Hard) and Rou (Yin/Soft) pathogens among the Five Evils (Wu Xie, 五邪). For example, if the Heart pulse is severely tense (Ji Mai, 急脉), it indicates Liver Evil invading the Heart; if the Heart pulse is slightly tense, it indicates Gallbladder Evil invading the Small Intestine. If the Heart pulse is severely large (Da Mai, 大脉), it indicates Heart Evil self-invading the Heart; if slightly large, it indicates Small Intestine Evil self-invading the Small Intestine. If the Heart pulse is severely relaxed/slow (Huan Mai, 缓脉), it indicates Spleen Evil invading the Heart; if slightly relaxed, it indicates Stomach Evil invading the Small Intestine. If the Heart pulse is severely choppy (Se Mai, 涩脉), it indicates Lung Evil invading the Heart; if slightly choppy, it indicates Large Intestine Evil invading the Small Intestine. If the Heart pulse is severely deep (Chen Mai, 沉脉), it indicates Kidney Evil invading the Heart; if slightly deep, it indicates Bladder Evil invading the Small Intestine. Since each of the Five Zang organs has Gang and Rou evils that invade one another, a single pulse position often manifests ten variations.

Difficulty 11 states: The Classics say that if the pulse stops after fewer than fifty beats, it indicates that Qi is absent in one organ. Which organ lacks Qi? The answer is: When inhaling, Qi follows Yin pathways inward; when exhaling, Qi exits via Yang pathways. Currently, inhalation cannot reach the Kidneys but returns upon reaching the Livers. Therefore, knowing that one organ lacks Qi, we conclude that Kidney Qi is exhausted first.

Difficulty 12 states: The Classics say that when the pulses of the Five Zang organs are already extinct internally, practitioners mistakenly tonify the exterior; when the pulses are already extinct externally, they mistakenly tonify the interior. How does one distinguish between internal extinction and external extinction? The answer is: When the pulses of the Five Zang organs are extinct internally, it means Kidney and Liver Qi are extinct internally, yet physicians mistakenly tonify the Heart and Lungs. When the pulses of the Five Zang organs are extinct externally, it means Heart and Lung pulses are extinct externally, yet physicians mistakenly tonify the Kidneys and Livers. Tonifying Yin when Yang is extinct, and tonifying Yang when Yin is extinct, constitutes "making the Excess more Excess and the Deficiency more Deficient" (Shi Shi Xu Xu, 实实虚虚). This damages what is insufficient and augments what is excessive. Death resulting from such actions is effectively murder by the physician.

Difficulty 13 states: The Classics say that if one observes the complexion but fails to find the corresponding pulse, and instead finds a mutually overcoming (Xiang Sheng, 相胜) pulse, death ensues; if a mutually generating (Xiang Sheng, 相生) pulse is found, the disease will resolve spontaneously. How should the complexion and pulse be correlated?
The answer is: The Five Zang organs correspond to five colors, which manifest on the face and should also correspond with the pulses at Cun Kou (Inch Position) and Chi Nei (Cubit Position). For instance, if the complexion is Green (Qing, 青), the pulse should be Tense (Xian Mai, 弦脉) and rapid; if Red (Chi, 赤), the pulse should be Floating (Fu Mai, 浮脉), Large, and Scattered; if Yellow (Huang, 黄), the pulse should be Moderate, Relaxed, and Large; if White (Bai, 白), the pulse should be Floating, Choppy, and Short; if Black (Hei, 黑), the pulse should be Deep (Chen Mai, 沉脉), Soft (Ru Mai, 濡脉), and Slippery (Hua Mai, 滑脉). This is what is meant by the correlation of the five colors and the pulses.
If the pulse is Rapid, the skin at the Chi position is also warm/restless; if the pulse is Tense, the skin at the Chi position is also tight; if the pulse is Relaxed, the skin at the Chi position is also loose; if the pulse is Choppy, the skin at the Chi position is also rough; if the pulse is Slippery, the skin at the Chi position is also smooth.
Each of the Five Zang organs has specific sounds, colors, odors, and tastes that should correspond with the pulses at Cun Kou and Chi Nei. Lack of correspondence indicates disease. For example, if the complexion is Green, the pulse should be Tense and rapid. If a Floating, Choppy, and Short pulse is seen, or a Large and Relaxed pulse, this represents an Overcoming (Ke, 克) relationship. If a Floating, Large, and Scattered pulse, or a Small and Slippery pulse is seen, this represents a Generating (Sheng, 生) relationship.
The Classics state: Knowing only one aspect makes one a Lower-grade practitioner (Xia Gong, 下工); knowing two aspects makes one a Middle-grade practitioner (Zhong Gong, 中工); knowing three aspects makes one an Upper-grade practitioner (Shang Gong, 上工). An Upper-grade practitioner cures nine out of ten cases; a Middle-grade practitioner cures seven out of ten; a Lower-grade practitioner cures six out of ten. This is the principle described here.