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[The *Nan Jing*] There are diseases of the regular meridians originating from within (Zhengjing Zibing), and injuries caused by the Five Evils (Wu Xie). How can they be distinguished? The classics state: Worry and overthinking damage the Heart; exposure to cold and consumption of cold drinks damage the Lungs; anger with Qi rebelling upward and failing to descend damages the Liver; improper diet and fatigue damage the Spleen; sitting long in damp places or forcing oneself into water damages the Kidneys. These constitute diseases of the regular meridians originating from within. What are the Five Evils? They are Wind Strike (Zhong Feng), Summerheat Injury (Shang Shu), Diet and Fatigue (Yinshi Laojuan), Cold Damage (Shang Han), and Dampness Strike (Zhong Shi). This is what is meant by the Five Evils. Suppose a Heart disease occurs; how do we know it was caused by Wind Strike? The answer is that the complexion should be red. Why? The Liver governs colors. Its own color entering the Liver is green; entering the Heart is red; entering the Spleen is yellow; entering the Lungs is white; entering the Kidneys is black. Since the Liver acts as the "evil" (pathogenic factor) for the Heart, we know the complexion should be red. The symptoms include fever, fullness and pain in the hypochondrium, and a pulse that is floating, large, and wiry (Xian). How do we know it was caused by Summerheat Injury? The answer is that there should be aversion to odors. Why? The Heart governs odors. Its own odor entering the Heart is scorched; entering the Spleen is fragrant; entering the Liver is fishy/sour; entering the Kidneys is putrid; entering the Lungs is fishy. Thus, knowing the Heart disease is due to Summerheat Injury, there should be aversion to odors. The symptoms include fever and vexation, heart pain, and a pulse that is floating, large, and scattered (San). How do we know it was caused by Diet and Fatigue? The answer is that there should be a preference for bitter taste. Deficiency leads to anorexia, while excess leads to appetite. Why? The Spleen governs tastes. Entering the Liver is sour; entering the Heart is bitter; entering the Lungs is pungent; entering the Kidneys is salty; its own taste entering the Spleen is sweet. Therefore, when Spleen evil enters the Heart, it manifests as a preference for bitter taste. The symptoms include fever, heavy body, lethargy, flaccidity of the four limbs, and a pulse that is floating, large, and moderate (Huan). How do we know it was caused by Cold Damage? The answer is that there should be delirious speech. Why? The Lungs govern sounds. Its own sound entering the Lungs is crying; entering the Liver is calling out; entering the Heart is speaking; entering the Spleen is singing; entering the Kidneys is groaning. Thus, when Lung evil enters the Heart, it manifests as delirious speech. The symptoms include fever, chills, and severe coughing and wheezing, with a pulse that is floating, large, and choppy (Se). How do we know it was caused by Dampness Strike? The answer is that there should be spontaneous sweating that cannot stop. Why? The Kidneys govern fluids. Its own fluid entering the Kidneys is saliva; entering the Liver is tears; entering the Spleen is drool; entering the Lungs is nasal mucus. Thus, when Kidney evil enters the Heart, it manifests as unstoppable sweating. The symptoms include fever and pain in the Small Intestine, cold and reversal in the calves, and a pulse that is deep, soggy (Ru), and large. This is the method for distinguishing the Five Evils. (*Nan Jing*, Chapter 49)

The Liver governs colors, the Heart governs odors, the Spleen governs tastes, the Lungs govern sounds, and the Kidneys govern fluids. The Liver's color is green, its odor is fishy/sour, its taste is sour, its sound is calling out, its fluid is tears. The Heart's color is red, its odor is scorched, its taste is bitter, its sound is speaking, its fluid is sweat. The Spleen's color is yellow, its odor is fragrant, its taste is sweet, its sound is singing, its fluid is drool. The Lungs' color is white, its odor is fishy, its taste is pungent, its sound is crying, its fluid is nasal mucus. The Kidneys' color is black, its odor is putrid, its taste is salty, its sound is groaning, its fluid is saliva.

Diseases include Deficiency Evil (Xu Xie), Excess Evil (Shi Xie), Thief Evil (Ze Xie), Minor Evil (Wei Xie), and Regular Evil (Zheng Xie). How are they distinguished? Evil coming from the mother organ is Deficiency Evil; evil coming from the child organ is Excess Evil; evil coming from the organ that overcomes me is Thief Evil; evil coming from the organ I overcome is Minor Evil; and disease originating from the organ itself is Regular Evil. Why? Suppose a Heart disease occurs: Wind Strike (Wood generates Fire, Mother affecting Child) is Deficiency Evil; Summerheat Injury (Self-qi disease) is Regular Evil; Diet and Fatigue (Fire generates Earth, Child affecting Mother) is Excess Evil; Cold Damage (Water overcomes Fire, Overcomer attacking) is Minor Evil; Dampness Strike (Earth overcomes Water, here classified as Thief Evil per text logic) is Thief Evil. (*Nan Jing*, Chapter 50)

What does it mean for one pulse to transform into ten variations? It refers to the interaction of the Five Evils through Gang (Yang) and Rou (Yin) channels. For example, if the Heart pulse is extremely rapid/tight (Ji), it is Liver evil invading the Heart. If slightly rapid, it is Gallbladder evil invading the Small Intestine. If extremely large, it is Heart evil self-invading the Heart. If slightly large, it is Small Intestine evil self-invading the Small Intestine. If extremely moderate (Huan), it is Spleen evil invading the Heart. If slightly moderate, it is Stomach evil invading the Small Intestine. If extremely choppy (Se), it is Lung evil invading the Heart. If slightly choppy, it is Large Intestine evil invading the Small Intestine. If extremely deep (Chen), it is Kidney evil invading the Heart. If slightly deep, it is Bladder evil invading the Small Intestine. Each of the five Zang organs has Gang and Rou evils, thus causing one pulse to vary into ten types. (*Nan Jing*, Chapter 10)

[The *Ling Shu*] Huangdi asked: Please explain the pathological manifestations of the pulse qualities: Huan (moderate/relaxed), Ji (rapid/tight), Da (large), Xiao (small), Hua (slippery), and Se (choppy). Qibo replied: Allow me to discuss the pathological changes of the five Zang organs. An extremely Ji Heart pulse indicates convulsions (Yu Chu); a slightly Ji pulse indicates heart pain radiating to the back and inability to eat. (This refers to a red complexion with a hook-like and Ji pulse; other pulses follow this pattern). An extremely Huan Heart pulse indicates manic laughter; a slightly Huan pulse indicates Fu Liang disease (a mass below the heart moving up and down) with occasional hemoptysis. An extremely Da Heart pulse indicates throat obstruction (Hou Bi); a slightly Da pulse indicates Heart Bi with radiation to the back and excessive tearing. An extremely Xiao Heart pulse indicates frequent hiccups; a slightly Xiao pulse indicates Xiao Dan (wasting-thirst disease). An extremely Hua Heart pulse indicates excessive thirst; a slightly Hua pulse indicates Xin Han (heart hernia) radiating to the umbilicus with abdominal borborygmi. An extremely Se Heart pulse indicates aphonia; a slightly Se pulse indicates blood extravasation, limb reversal, tinnitus, and epilepsy.

An extremely Ji Lung pulse indicates epilepsy; a slightly Ji pulse indicates Lung cold-heat alternation, lethargy, coughing with blood, radiation to the lower back and chest, and nasal polyps obstructing airflow. (This refers to a white complexion with a hair-like and Ji pulse; other pulses follow this pattern). An extremely Huan Lung pulse indicates excessive sweating; a slightly Huan pulse indicates Wei Bi (flaccidity) and hemiplegia, with unstoppable sweating below the head. An extremely Da Lung pulse indicates calf swelling; a slightly Da pulse indicates Lung Bi radiating to the chest and back, with aversion to sunlight. An extremely Xiao Lung pulse indicates diarrhea; a slightly Xiao pulse indicates Xiao Dan. An extremely Hua Lung pulse indicates asthma and rebellious Qi; a slightly Hua pulse indicates bleeding from above and below. An extremely Se Lung pulse indicates hematemesis; a slightly Se pulse indicates Shu Liu (rat abscesses) in the neck and axilla, weakness of the lower limbs, and a sensation of sourness.

An extremely Ji Liver pulse indicates abusive speech; a slightly Ji pulse indicates Fei Qi disease in the hypochondrium, resembling an inverted cup. (This refers to a green complexion with a string-taut and Ji pulse; other pulses follow this pattern). An extremely Huan Liver pulse indicates frequent vomiting; a slightly Huan pulse indicates Shui Jia Bi (water accumulation bi syndrome). An extremely Da Liver pulse indicates internal abscesses with frequent vomiting and epistaxis; a slightly Da pulse indicates Gan Bi with genital retraction and cough radiating to the lower abdomen. An extremely Xiao Liver pulse indicates polydipsia; a slightly Xiao pulse indicates Xiao Dan. An extremely Hua Liver pulse indicates Shan Hernia; a slightly Hua pulse indicates enuresis. An extremely Se Liver pulse indicates Yi Yin (overflowing drinking/water retention); a slightly Se pulse indicates Jin Bi (tendon bi) with spasms.

An extremely Ji Spleen pulse indicates convulsions; a slightly Ji pulse indicates Ge Zhong disease, where food and drink are vomited immediately after ingestion, accompanied by foamy stools. An extremely Huan Spleen pulse indicates Wei Jue (flaccidity and cold limbs); a slightly Huan pulse indicates Feng Wei, with paralysis of the four limbs but a clear mind. An extremely Da Spleen pulse indicates sudden collapse; a slightly Da pulse indicates Hernia Qi with large amounts of pus and blood in the abdomen outside the intestines. An extremely Xiao Spleen pulse indicates alternating cold and heat; a slightly Xiao pulse indicates Xiao Dan. An extremely Hua Spleen pulse indicates Lin (difficulty/painful urination); a slightly Hua pulse indicates insect toxin or scorpion sting causing abdominal heat. An extremely Se Spleen pulse indicates Chang Pi (dysentery); a slightly Se pulse indicates Nei Yong (internal carbuncle) with purulent bloody stools.

An extremely Ji Kidney pulse indicates Gu Dian Ji (bone epilepsy); a slightly Ji pulse indicates Chen Jue Ben Tun (deep reversal and running piglet), inability to hold the feet, and urinary/fecal retention. (This refers to a black complexion with a stone-like and Ji pulse; other pulses follow this pattern). An extremely Huan Kidney pulse feels like a broken spine; a slightly Huan pulse indicates Dong Xie (hole diarrhea), where food is not digested and regurgitated upon swallowing. An extremely Da Kidney pulse indicates impotence; a slightly Da pulse indicates Shi Shui (stone water edema), swelling from the navel down to the lower abdomen extending to the stomach, which is fatal. An extremely Xiao Kidney pulse indicates Dong Xie; a slightly Xiao pulse indicates Xiao Dan. An extremely Hua Kidney pulse indicates Lin (urinary obstruction); a slightly Hua pulse indicates Gu Wei (bone flaccidity), difficulty sitting or standing, and blindness upon standing. An extremely Se Kidney pulse indicates large carbuncles; a slightly Se pulse indicates amenorrhea and chronic hemorrhoids. Huangdi asked: How should acupuncture treat these six variations of disease? Qibo answered: Ji pulses usually indicate cold; Huan pulses usually indicate heat; Da pulses usually indicate excess Qi and deficient Blood; Xiao pulses indicate deficiency of both Qi and Blood; Hua pulses indicate excess Yang Qi with slight heat; Se pulses indicate excess Blood and deficient Qi with slight cold. Therefore, for Ji pulses, needle deeply and retain for a long time. For Huan pulses, needle shallowly and withdraw quickly to dispel heat. For Da pulses, mildly drain Qi without releasing blood. For Hua pulses, withdraw quickly and needle shallowly to drain Yang Qi and heat. For Se pulses, ensure accurate penetration of the vessel, retain the needle for a long time following the flow direction, massage the area beforehand, and press the puncture site firmly after withdrawal to prevent bleeding and harmonize the pulse. For Xiao pulses, indicating deficiency of Yin-Yang, Form, and Qi, do not use needles but regulate with sweet medicines. (Note: Initially, Hua pulse was analyzed as excess Yin, but now stated as excess Yang; Se pulse as excess Yang, now stated as deficient Qi and excess Blood. These may interact and require further study. All above from *Ling Shu · Xie Qi Zang Fu Bing Xian*).

[Li Dongyuan] Suppose Liver disease presents as Excess Evil, with Wind and Heat combining. Wind is swift, Fire shakes and rotates the flame. The pulse is wiry, tight, and surging. Wind-Heat causing mania should be treated with Xiong Huang Tang.
Qiang Huo, Chuan Xiong, Da Huang (each 1 liang), Gan Cao (0.5 liang).
Cut into pieces. Take 0.5 liang per dose, boil in 2 cups of water until reduced to 0.6 cup, strain, and take warm.

For Deficiency Evil with Wind-Cold combining, Wood fears Water, leading to stiffness, spontaneous sweating, and a wiry, tight, deep pulse. Zhang Zhongjing states: Wind affecting the Taiyang channel transferring to Shaoyin is treated with Gui Zhi Jia Fu Zi Tang. For Thief Evil with Wind-Dryness combining, blood deficiency causes tendon contraction and skin cracking, with a wiry, floating, choppy pulse. Zhang Zhongjing states: Blood deficiency with tendon tension is treated with Gui Zhi Jia Gua Lou Tang. For Minor Evil with Wind-Dampness combining, heavy body and joint pain, visceral diarrhea, with a wiry, long, moderate pulse. Zhang Zhongjing states: Body pain with clear watery diarrhea requires urgent interior rescue with Si Ni Tang. For Regular Evil Wind Strike, dizziness, heavy head, inability to shout or rage, with a wiry, tight, long pulse. Zhang Zhongjing states: Severe cases resembling epilepsy/spasm should use Qiang Huo Tang. Materia Medica states: Qiang Huo treats epilepsy/spasm, with Fang Feng and Huang Qin as assistants.
Children suffer epilepsy; adults suffer spasm.

Suppose Heart disease presents as Excess Evil, with Heat and Dampness combining, causing mental confusion, vexation, steaming heat, and insomnia. The Spleen meridian connects to the Heart, and the Heart meridian originates from the Spleen; their connection creates Heat-Dampness. The pulse is floating, large, and moderate. The Foot Taiyin manifestation appears in the Hand Taiyang channel. Treat with Zhi Chi Tang. Add Hou Po and Zhi Shi for palpitations. For Deficiency Evil with Heat-Wind combining, hallucinations and auditory illusions, wind noise in ears, involving the Gallbladder and San Jiao meridians emerging from the ear. *Tong Ren* states: Bleed Guan Chong, drain Zhi Gou. Pulse floating, large, and wiry. Initially use Xiao Chai Hu Tang, then Da Chai Hu Tang. This is a Taiyang-Shaoyang combined disease, former pathogen and current host. For Thief Evil with Heat-Cold combining, timidity, heart hanging like hunger, fearfulness, involving Foot Shaoyin and Hand Jueyin connection, Water overcoming Heart Fire, causing spiritual fear. Pulse large, deep, and soggy, also in the Taiyang channel. *Nei Jing* states: Heart deficiency retains heat internally; treat with Huang Lian Fu Zi Xie Xin Tang. Treatment principle: If heat exceeds cold, use heat herbs as assistants; if cold exceeds heat, add Fu Zi and Gan Jiang as assistants. For Minor Evil with Heat-Dryness combining, excessive drinking and singing, actual heat-dryness (colloquially "joyful drinking"). Patient speaks of joy, which is vocal singing. "Meaning paste" implies silent singing. Pulse large, surging, and choppy. Treat with Bai Hu Tang. Add Ren Shen for asthma. For Regular Evil Heat, Yang depletion seeing ghosts, restlessness and madness, pulse surging and solid, 4 beats per breath (8 beats total). Treat with Xiao Cheng Qi Tang, assuming the abdomen is not hard or distended.

Suppose Lung disease presents as Excess Evil, with Dryness and Cold combining, piloerection, cool skin, frequent clear urination, short, choppy, deep pulse. In autumn/winter, use Ba Wei Wan; in spring/summer, use Di Huang Wan. For Deficiency Evil with Dryness-Dampness combining, mild asthma and palpitations, difficult defecation with phlegm, floating, choppy, moderate pulse. Treat with Zhi Shi Li Zhong Tang. Add Ren Shen for severe asthma; add Mu Xiang and Bing Lang (0.5 qian each, fine powder) with Li Zhong Wan for difficult defecation. For Thief Evil with Dryness-Heat combining, nasal congestion, rhinorrhea, epistaxis, pulse choppy and floating-large. Severe cases: Tao Ren Cheng Qi Tang; mild cases: Xi Jiao Di Huang Tang. Extreme cases: Di Dang Tang; mild cases: Di Dang Wan. For Minor Evil with Dryness-Wind combining, dry skin, brittle nails, blood and Qi deficiency, both organs deficient. Tonify blood first, then Qi. Pulse floating, choppy, wiry, and large. Use blood and Qi tonics. For Regular Evil Dryness self-disease, Qi stagnation belongs to the Lungs. Various dryness symptoms with sound, pulse floating, choppy, and short. Select various cough remedies.

Suppose Kidney disease presents as Excess Evil, Cold-Wind combining, failure to store, resulting in pure clear diarrhea, pulse deep, slippery, and wiry. Zhang Zhongjing states: Shaoyin syndrome with dry mouth/throat and pure clear diarrhea is treated with Da Cheng Qi Tang. Pulse deep, wiry, and slow with cold limbs: use Si Ni Tang etc. For Deficiency Evil with Cold-Clear combining, coughing with much phlegm/groaning, shivering cold insomnia, dryness transforming to clear, pulse deep, solid, and choppy. Treat with Suan Zao Ren Tang. For Thief Evil with Cold-Dampness combining, Kidney as the Gate of the Stomach, failure to control water overflow, water in Stomach causes edema, in Lungs causes asthma, and various syndromes. Pulse deep, moderate, and large. Zhang Zhongjing states: Post-illness edema below the waist is treated with Mu Li Ze Xie Tang. For Minor Evil with Cold-Heat combining, Bladder heat stagnation, dry fluids, pulse deep, soggy, and large. *Nei Jing* states: Water scarcity leads to dryness. Treat with Zhu Ling Tang. For Regular Evil Cold self-disease, Cold anger storing, Hei Bi Jing Chen, pulse deep, soggy, and slippery. Use Hei Bi Tian Ma Wan. If symptoms match but pulse differs, mild is Fu disease, severe is Zang disease.

Suppose Spleen disease presents as Excess Evil, Damp-Dryness combining, dry feces in Stomach, abdominal fullness and hard pain, moderate, long, choppy pulse. This is Zheng Yang Yangming syndrome. Treat with Tiao Wei Cheng Qi Tang. For Deficiency Evil with Heat-Dampness combining, heat sinking into Stomach, intestinal bleeding, moderate, large pulse. Treat with Huang Lian Jie Du Tang. For Thief Evil with Damp-Wind combining, vomiting, rib pain, alternating cold/heat, moderate, wiry, long pulse. Treat with Xiao Chai Hu Tang. For Minor Evil with Damp-Cold combining, cold seeking damp, jaundice without heat, heavy body without thirst, called Cold-Damp. Pulse moderate, deep, and slippery. Treat with Shu Fu Tang. Add Fu Ling for difficult urination. For Regular Evil Damp self-disease, abdominal fullness and intermittent pain, warm extremities, deep, choppy, long pulse. Deficiency pain: Gui Zhi Jia Shao Yao Tang; Excess pain: Gui Zhi Jia Da Huang Tang.

The Stomach is the Sea of the Twelve Meridians; all meridians receive Qi and Blood to nourish the body. The Spleen receives from the Stomach to circulate Qi and Blood. If Spleen-Stomach is deficient, evils from the Twelve Meridians emerge differently. If unable to eat and muscles waste, this is the root disease. Right Guan pulse is moderate and weak, the local pulse. If local pulse shows wiry quality, or limb fullness/closure, dysuria, or tetany, this is Liver affecting Spleen-Stomach. Add wind-dispelling herbs to local formulas. If local pulse shows surging-large quality, or muscle heat/vexation/red face/anorexia/muscle wasting, this is Heart affecting Spleen-Stomach. Add fire-draining herbs. If local pulse shows floating-choppy quality, or shortness of breath/rebellious Qi/cough/phlegm/dry skin, this is Lung affecting Spleen-Stomach. Drain Lung evil and tonify Qi. If local pulse shows deep-fine quality, or fearfulness/yawning, this is Kidney affecting Spleen-Stomach. Drain floating Kidney Water and hidden Yin Fire.

Wiry pulse (Wind evil): Gan Cao, Shao Yao, Huang Qi Jian Zhong Tang, or sweet-sour agents.
Surging pulse (Heat evil): San Huang Wan, Xie Huang San, Tiao Wei Cheng Qi Tang, or sweet-cold agents.
Moderate pulse at Right Guan (Spleen-Stomach) (Excess local, Damp evil): Ping Wei San + Bai Zhu, Fu Ling; Wu Ling San; or damp-draining agents.
Choppy pulse (Dryness evil): Yi Gong San + Dang Gui; Si Jun Zi Tang + Shu Di Huang; or sweet-warm/sweet-moist agents.
Deep-fine pulse (Cold evil): Yi Huang San, Yang Pi Wan, Li Zhong Tang. If severe cold, add Fu Zi (sweet-hot agents).
These are standard prescriptions; modify if conditions change.

Spleen-Stomach deficiency differs from other organs due to lack of fixed form. Treating Liver, Heart, Lung, Kidney excess/deficiency via tonification/draining is less direct than benefiting Spleen-Stomach. Classics state: "Arriving but not arriving" is insufficiency. The overcoming element acts recklessly, the generated element suffers, the overcoming element invades. "Arriving but not arriving" refers to Deficiency Evil from later (Mother/Subsequent) organs: Heart and Small Intestine invading Spleen-Stomach. Pulse floating-large and wiry. Symptoms: vexation/confusion, limb heat, bitter taste, dry tongue/throat. Heart governs Fire, Small Intestine governs Heat. Fire-Heat invading Earth creates Heat-Dampness, causing vexation. Limbs belong to Spleen-Stomach; Fire invasion causes limb heat. Improper diet/labor damages Spleen-Stomach, affecting Blood generation and fluid transport, causing dry mouth/throat. Patients feel thirsty; doctors using Wu Ling San to stop thirst may worsen it by depleting fluids further, leading to danger. Classics say: "Deficiency tonifies the Mother." Tonify Spleen-Stomach roots via Heart/Small Intestion. Use sweet-warm as Sovereign, bitter-cold as Envoy, sour as Ministers/Assistants. Heart dislikes laxity; sour astringes. Heart Fire excess harms Lung Metal; sour tonifies Metal. Then use sweet-warm/cold in Spleen-Stomach to drain Heart Fire excess, treating the root. "Overcoming element acting recklessly" means Heart Fire excess makes Mother (Liver Wood) solid. Liver Wood excess carries Fire, acting recklessly, harming Spleen first. Symptoms: heavy body, migrating pain (Heat-Damp friction, Wind-Heat depression attaching to form). Anger (Wind-Heat sinking). Eye cataracts (Spleen wraps blood, Stomach governs blood, Heart governs vessels/blood house; Liver opens to eyes). Hallucinations, bad dreams, limb fullness/tetany: all Liver Wood-Fire excess. Flaccidity, Bi, Jue, Wind Stroke, sores, Kidney flaccidity, upper heat/lower cold: all Wind-Heat failure to grow, Wood-Fire suppression in form. "Generated element suffering" means Lung suffers Earth/Fire/Wood evils, damaging clear-descending Qi. Chest fullness/shortness of breath (Lung governs Qi, all Zang Qi deficient, Yang pathway blocked). Cough/cold-heat (Heat-Damp invading internally). "Overcoming element invading" means Water follows Wood's reckless action, insulting Earth. Kidney Fire rises, stimulating Du, Ren, Chong meridians. Fire boils Water, invading Spleen-Lung, causing salivation. Downward: Yin sweat, cold external genitals, leg weakness, foot pain. Upward with Wood: dry eyes, discharge, cold tears. All due to Lung Metal deficiency and lack of restraint. Spleen-Stomach deficiency is Fire failing to generate Earth, leading to resistance. This "arriving but not arriving" is insufficiency.

Bai Zhu (Sovereign), Ren Shen (Minister), Gan Cao (Assistant), Shao Yao (Assistant), Huang Lian (Envoy), Huang Qin (Minister), Sang Bai Pi (Assistant).
All wind herbs disperse dampness; all sweet-warm herbs work too.
Heart Fire excess invading Spleen-Stomach position is also "arriving but not arriving," i.e., insufficiency.