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[Suwen] In treating any disease, one must observe the patient's physical constitution and Zhengqi (vital energy), facial luster, pulse strength and fullness, as well as the novelty or chronicity of the disease, before initiating treatment, without delaying the opportune moment. If the physical constitution and Zhengqi are harmonious, it is termed treatable. If the facial color is bright and lustrous, it is termed easily curable. If the pulse conforms to the four seasons, it is termed treatable. A weak and slippery pulse indicates the presence of Stomach Qi (the vital energy derived from food and drink that sustains life), named easily treated, and treatment should be timed appropriately. If the physical constitution and Zhengqi are discordant, it is termed difficult to treat. If the complexion is dull and lacks luster, it is termed difficult to cure. A solid and hard pulse indicates worsening condition. A pulse that violates the laws of the four seasons is termed untreatable; one must carefully examine these four difficult conditions and clearly inform the patient. What is meant by violating the four seasons is: obtaining a Lung Pulse (Hairy/Mao pulse) in Spring, a Kidney Pulse (Stone/Shi pulse) in Summer, a Heart Pulse (Hook/Gou pulse) in Autumn, and a Spleen Pulse (Wavy/Dai pulse) in Winter. If these pulses are all suspended, extreme, deep, and choppy, they are called violating the four seasons (from *Yu Ji Zhen Zang Lun*). When Zhengqi is excess, the body is robust; when Zhengqi is deficient, the body is emaciated; this is the norm. The opposite indicates disease. Abundant food intake leads to abundant Zhengqi; scant food intake leads to scant Zhengqi; this is the norm. The opposite indicates disease. A full pulse corresponds to abundant blood; a deficient pulse corresponds to deficient blood; this is the norm. The opposite indicates disease (from *Ci Zhi Lun*). Deficient Zhengqi with body heat is called contrary. Abundant food intake but scant Zhengqi is called contrary. Scant food intake but abundant Zhengqi is called contrary. Full pulse but scant blood is called contrary. Weak pulse but abundant blood is called contrary. Excess Zhengqi with cold body is caused by Cold Injury (Shang Han). Deficient Zhengqi with body heat is caused by Summerheat Injury (Shang Shu). Abundant food intake but scant Zhengqi is caused by blood loss or dampness residing in the lower jiao. Scant food intake but abundant Zhengqi is caused by pathogenic factors in the Stomach and Lungs. Weak pulse but abundant blood is caused by internal heat from drinking. Full pulse but scant blood is caused by wind pathogen in the vessels and inability to ingest fluids, as described above (ibid.). Robust physique with fine pulse, shortness of breath insufficient for respiration, is critical. Emaciated physique with large pulse, excessive qi in the chest, is death. Harmonious physique and Zhengqi indicate life; discordant interplay indicates disease; loss of harmony in all three positions and nine inspections indicates death. Pulses at upper, lower, left, and right corresponding rhythmically like pestle pounding indicate severe disease; pulses at upper, lower, left, and right being discordant and uncountable indicate death. Although the central pulse alone may be harmonious, if it is discordant with the other zang organs, it indicates death. Diminution of the central pulse indicates death. Sunken eyes indicate death (full text see previous sections on upper and lower lines, same below). Even if the nine pulses are harmonious after muscle wasting has occurred, death ensues.

[Ling Shu] In heat diseases, if the pulse is quiet, but becomes盛大 and restless after sweating, this is the first reversal (Ni). In diarrhea, if the pulse is洪大 (Hongda/large and forceful), this is the second reversal. In fixed Bi syndrome with immobility, muscle erosion, body heat, and unilateral pulse absence, this is the third reversal. In depletion due to excessive pathogens with emaciation, body heat, pale and dull complexion, followed by heavy bloody stool, this is called the fourth reversal. In emaciation due to alternating cold and heat with a firm and beating pulse, this is called the fifth reversal. (From *Wu Jin Pian*. "Cheng" is pronounced 'qu sun', referring to flesh masses behind elbows and knees).

Abdominal distension, body heat, and large pulse constitute the first reversal. Abdominal borborygmi and fullness, cold extremities with diarrhea, and large pulse constitute the second reversal. Unstopping epistaxis with large pulse constitutes the third reversal. Coughing with hematuria, emaciation, and small yet vigorous pulse constitute the fourth reversal. Coughing with emaciation, body heat, and small yet rapid pulse constitute the fifth reversal. Such cases result in death within fifteen days. Abdominal distension, cold extremities, emaciation, and severe diarrhea constitute the first reversal. Abdominal distension with hematochezia, large pulse, and intermittent absence constitute the second reversal. Coughing with hematuria, muscle wasting, and beating pulse constitute the third reversal. Hematemesis with chest fullness radiating to the back, and small yet rapid pulse constitute the fourth reversal. Coughing, vomiting, abdominal distension, and undigested stool diarrhea with absent pulse constitute the fifth reversal. Such cases result in death within less than one shichen (two hours). If physicians fail to observe these and apply acupuncture, it is called reverse treatment. (From *Yu Ban Pian*. "Bo" is pronounced 'pu gu').

[Suwen] Heat with quiet pulse, diarrhea with blood loss, full pulse indicating interior disease, empty pulse indicating exterior disease, and firm-choppy pulse indicating difficulty in treatment are all noted. (From *Ping Ren Qi Xiang Lun*)

[Zhang Zhongjing] The pulse states: When the pulse shows pathology but the person does not, it is called "Walking Corpse" due to lack of vigorous Qi. Sudden dizziness and collapse with unconsciousness indicates short lifespan and death. When the person is ill but the pulse is normal, it is called "Interior Deficiency"; because there is righteous Qi, although distressed, there is no suffering. Left-sided pathology causing right-sided pain, right-sided pathology causing left-sided pain, lower pathology causing upper pain, upper pathology causing lower pain, this is called Reverse; Reverse means death, untreatable. In obese persons, a pulse fine as silk and nearly absent indicates death. In emaciated persons, a restless pulse indicates death. In persons feeling rough/stagnant but with a smooth pulse flow, death occurs. In small persons with a large pulse flow, death occurs. In large persons with a small pulse flow, death occurs. In short persons with a long pulse flow, death occurs. In tall persons with a short pulse flow, death occurs. In smooth persons with a choppy pulse flow, death occurs.

[Suwen] The Five Zang organs are the guardians within. If the middle jiao is full and stagnant, with Qi excess injuring fearfulness, speech sounding muffled as if from inside a room, this is dampness obstructing Middle Qi. Speech that is faint, repeating only after a whole day, indicates Qi depletion. Inability to dress warmly or coolly appropriately, and speech lacking discrimination between good/evil or kin/stranger, indicates confusion of Shen Ming (Spirit-Mind). Inability of the Granary (Spleen/Stomach) to store indicates failure of the gates (sphincters) to control. Unceasing urination indicates Bladder failure to store. Those who maintain guardianship live; those who lose it die. (From *Mai Yao Jing Wei Lun*). The Five Zang organs are the strength of the body. The head is the mansion of Spirit; head drooping and deep-set eyes indicate Spirit depletion. The back is the mansion of the Chest; curved back and drooping shoulders indicate mansion destruction. The waist is the mansion of the Kidney; inability to twist and turn indicates Kidney exhaustion. The knees are the mansion of Sinews; inability to flex and extend, stooping while walking, indicates Sinew exhaustion. The bones are the mansion of Marrow; inability to stand long, trembling while walking, indicates Bone exhaustion. Those who retain strength live; those who lose strength die. (Ibid.). Regarding colors manifesting from Zang Qi: Green like dead grass indicates death; Yellow like Fructus Aurantii Immaturus indicates death; Black like soot indicates death; Red like clotted blood indicates death; White like dry bone indicates death; these are the death signs of the five colors. (From *Wu Zang Sheng Cheng Pian*. "Tai" is pronounced 'fang bei', meaning clotted blood). Green like kingfisher feathers indicates life; Red like chicken comb indicates life; Yellow like crab belly indicates life; White like pig fat indicates life; Black like crow feathers indicates life; these are the life signs of the five colors. (Ibid.). Life in the Heart resembles white silk wrapping cinnabar; Life in the Lung resembles white silk wrapping red; Life in the Liver resembles white silk wrapping cyan; Life in the Spleen resembles white silk wrapping Trichosanthes fruit; Life in the Kidney resembles white silk wrapping purple; these are the external glory generated by the Five Zang. (Ibid.). Brightness and five colors are the splendor of Qi. Red should resemble white silk wrapping cinnabar, not ochre. White should resemble goose feathers, not salt. Green should resemble the luster of dark jade, not indigo. Yellow should resemble silk wrapping realgar, not yellow earth. Black should resemble double-lacquered color, not earthy gray. (From *Mai Yao Jing Wei Lun*).

Hua Tuo stated: If the patient's face and eyes show uniform coloration, they will not die.

[Suwen] Face yellow with eye green, face yellow with eye red, face yellow with eye white, face yellow with eye black—all do not die. Face green with eye red, face red with eye white, face green with eye black, face black with eye white, face red with eye green—all die. (Wang Bing notes: Any color showing yellow indicates Stomach Qi, thus not dying. The Five Zang take the Stomach as root; thus, absence of yellow leads to self-death. From *Wu Zang Sheng Cheng Pian*).

Hua Tuo stated: Patient with green face and white eyes dies. Patient with green face and yellow eyes dies in five days. Patient bedridden with heart pain and shortness of breath, Spleen exhaustion and internal injury, recovers after one hundred days. If able to rise and pace, then sit on ground, stand leaning on bed, such cases can be cured by divine skill. Patient with red face and white eyes dies in ten days; due to worry and anxiety, Heart Qi is internally depleted, yet facial color appears good; prepare coffin immediately. Patient with red face and green eyes dies in six days. Patient with black face and white eyes dies in eight days; Kidney Qi internally injured, pathogen retained. Patient with black face, staring eyes, and aversion to wind dies. Patient with white face and black eyes dies; this signifies loss of glory and emptiness of blood vessels. Red appearing on both cheekbones, size of a thumb, indicates that even if the disease slightly improves, sudden death will follow. (Full text see Sudden Death section. Quan refers to cheekbone. Dong Yuan said: *Mai Jue* states face red like makeup implies short life. Redness appears on cheeks like rouge, round. Disease reaching this state cannot last long. Like roots exhausted but branches not yet withered, red like rosy clouds filling the sky).

[Bian Que, Hua Tuo] Patient with red ears, eyes, and cheekbones dies within five days. Black appearing in the Tian Ting (center of forehead), size of a thumb, indicates non-disease sudden death. (Full text see Sudden Death. Ting is center of forehead). Black appearing from hairline on forehead, straight down to nose bridge and above cheekbones, also dies within five days. Black Qi appearing from Tian Zhong (Yintang), descending to Nian Shang (tip of nose) and above cheekbones, indicates death. Patient or healthy person with black or white color entering eyes, nose, or mouth dies within three days. Black appearing in ears, eyes, nose, mouth entering the mouth indicates inevitable death. Patient with black face, fullness under both hypochondria, inability to turn over, dies. Patient with black face and blue lips dies. Patient with green face and black lips dies. Patient or healthy person with sudden liver-colored face, looking green from afar, black scorched up close, dies. Patient with face lacking luster, earthy color, unable to eat, dies in four days. Patient with eyes lacking luster and black teeth is incurable.

[Suwen] The five pathological pulses seen are: Autumn pulse in Spring, Winter pulse in Summer, Spring pulse in Late Summer, Summer pulse in Autumn, Late Summer pulse in Winter; these are called Five Evils, all leading to death and untreatable. (From *Xuan Ming Wu Qi Pian*. Zhongjing said: Why say death in autumn if Mao pulse is obtained in February? Answer: In February, pulse should be soft and weak; obtaining floating Mao pulse indicates death in autumn. February governs Liver Wood; Liver pulse should be soft/weak. Obtaining Mao pulse (Lung/Metal) indicates Metal overcoming Wood, hence death). Spring pulse slightly wiry with Stomach Qi is Ping (Normal); Wiry exceeding Stomach Qi indicates Liver disease; Only wiry without Stomach Qi indicates death. Stomach Qi with Mao pulse indicates Autumn disease; Excessive Mao pulse indicates current disease. True Zang Qi scatters to Liver, which stores Sinew-Vessel Qi. Normal Liver pulse comes soft and waving, like holding the tip of a long pole, called Liver Ping, Spring relies on Stomach Qi. Diseased Liver pulse comes full, solid, and slippery, like tracing a long pole, called Liver disease, death. Liver pulse coming urgent and strong, like a newly strung bowstring, called Liver death.

Summer pulse slightly hook-shaped with Stomach Qi is Ping; Hook exceeding Stomach Qi indicates Heart disease; Only hook without Stomach Qi indicates death. Stomach Qi with Shi (Stone/Kidney) pulse indicates Winter disease; Excessive Shi pulse indicates current disease. True Zang Qi connects to Heart, which stores Blood-Vessel Qi. Normal Heart pulse comes continuous like pearls, like tracing Langgan jade, called Heart Ping, Summer relies on Stomach Qi. Diseased Heart pulse comes panting and connected, slightly curved inside, called Heart disease. Dead Heart pulse comes curved front and rigid back, like handling a belt hook, called Heart death.

Autumn pulse slightly hairy with Stomach Qi is Ping; Hairy exceeding Stomach Qi indicates Lung disease; Only hairy without Stomach Qi indicates death. Mao pulse with Wiriness indicates Spring disease; Excessive Wiriness indicates current disease. True Zang Qi rises high in Lung to circulate Ying and Wei, Yin and Yang. Normal Lung pulse comes gentle and fluttering, like falling elm seeds, called Lung Ping, Autumn relies on Stomach Qi. Diseased Lung pulse comes neither rising nor falling, like tracing chicken feather, called Lung disease. Dead Lung pulse comes floating like an object, like wind blowing hair, called Lung death.

Winter pulse slightly stone-like with Stomach Qi is Ping; Stone exceeding Stomach Qi indicates Kidney disease; Only stone without Stomach Qi indicates death. Shi pulse with Hook indicates Summer disease; Excessive Hook indicates current disease. True Zang Qi descends to Kidney, which stores Marrow-Bone Qi. Normal Kidney pulse comes continuous like a hook, firm upon pressure, called Kidney Ping, Winter relies on Stomach Qi. Diseased Kidney pulse comes like pulling vines, firmer upon pressure, called Kidney disease. Dead Kidney pulse comes like seizing a rope, cracking like striking stone, called Kidney death.

Late Summer pulse slightly weak with Stomach Qi is Ping; Weak exceeding Stomach Qi indicates Spleen disease; Only Dai (Intermittent) without Stomach Qi indicates death. Weak pulse with Stone indicates Winter disease; Excessive Weak indicates current disease. True Zang Qi moistens Spleen, which stores Muscle Qi. Normal Spleen pulse comes harmonious and distinct, like chicken stepping on ground, called Spleen Ping, Late Summer relies on Stomach Qi. Diseased Spleen pulse comes solid, full, and rapid, like chicken lifting foot, called Spleen disease. Dead Spleen pulse comes sharp and hard like bird pecking, like bird claw, like roof leak, like flowing water, called Spleen death. (All above from *Ping Ren Qi Xiang Lun*).

True Liver pulse arrives tense inside and out. Like tracing knife edge, crisp, like pressing lute strings, color cyan-white without luster, hair falls off then death. (Zhongjing said: Liver death organ, superficially weak, pressing like a cord not returning, or curved like snake shape indicates death). True Heart pulse arrives firm and beating, like tracing Coix seeds continuously, color red-black without luster, hair falls off then death. (Zhongjing said: Heart death organ, superficially solid like bean/hemp hitting hand, pressing increasingly restless indicates death). True Lung pulse arrives large and empty, like feather penetrating skin, color white-red without luster, hair falls off then death. (Zhongjing said: Lung death organ, superficially empty, pressing weak like scallion leaf without root indicates death). True Kidney pulse arrives beating and severed, like finger striking stone cracking, color black-yellow without luster, hair falls off then death. (Zhongjing said: Kidney death organ, superficially firm, pressing chaotic like rolling ball, sinking into Chi position indicates death). True Spleen pulse arrives weak and intermittently sparse/rapid, color yellow-cyan without luster, hair falls off then death. (Zhongjing said: Spleen death organ, superficially large/firm, pressing inside like inverted cup, clean/shaking indicates death). All True Zang pulses appearing indicate death untreatable. Yellow帝 asked: Seeing True Zang means death, why? Qi Bo answered: Five Zang all receive Qi from Stomach; Stomach is root of Five Zang. Zang Qi cannot reach Hand Taiyin independently; it must rely on Stomach Qi to reach Hand Taiyin. Thus, each Zang naturally reaches Hand Taiyin at its respective season. Therefore, when Pathogenic Qi wins, Essence Qi declines. In severe disease, Stomach Qi cannot accompany Zang Qi to Hand Taiyin, so True Zang Qi appears alone. Appearing alone means disease overwhelms Zang, hence death. (Above from *Yu Ji Zhen Zang Pian*). Humans rely on Water and Grain as root; thus, humans cut off from Water and Grain die. Pulse without Stomach Qi also dies; what is called no Stomach Qi is obtaining only True Zang pulse without Stomach Qi (*Ping Ren Qi Xiang Lun*). What is called Yin is True Zang; appearing indicates ruin, ruin means death. What is called Yang is the Yang of Stomach Fu (*Yin Yang Bie Lun*). Generally, holding True Pulse of Zang: Liver suspension extreme urgent, dies in 18 days. Heart suspension extreme, dies in 9 days. Lung suspension extreme, dies in 12 days. Kidney suspension extreme, dies in 7 days. Spleen suspension extreme, dies in 4 days. (Ibid.)

[Zhang Zhongjing] Cun pulse not reaching Guan below is Yang Absolute; Chi pulse not reaching Guan above is Yin Absolute; these are all untreatable, determining death. If calculating remaining life span, use Month/Jie overcoming. (Wang note: Yang Absolute dies in Spring/Summer, Yin Absolute dies in Autumn/Winter, this statement is very appropriate).

[Ling Shu] What is called Fifty Prosperity: Five Zang all receive Qi. Hold Mai Kou, count beats. Fifty beats without one interruption: Five Zang all receive Qi. Forty beats with one interruption: One Zang has no Qi. (*Mai Jing* says: Dies four years later when spring grass grows). Thirty beats with one interruption: Two Zang have no Qi. (*Mai Jing* says: Dies three years later when wheat ripens). Twenty beats with one interruption: Three Zang have no Qi. (*Mai Jing* says: Dies two years later when mulberry berries turn red). Ten beats with one interruption: Four Zang have no Qi. (*Mai Jing* says: Dies within year, still during Qingming, far not beyond Guyu). Less than ten beats with one interruption: Five Zang have no Qi. (*Mai Jing* says: Dies five days later). Giving short-term prognosis lies in beginning and end. Fifty beats without interruption is normal. Knowing Five Zang periods, giving short-term prognosis involves rapid and slow irregularities. (From *Gen Jie Pian*).

[Nan Jing] states: Pulse stops once before fifty beats, one Zang has no Qi, which Zang? Reply: Inhalation follows Yin entering; exhalation follows Yang exiting. Now inhalation cannot reach Kidney, returns at Liver; thus knowing one Zang has no Qi, Kidney Qi is exhausted first.

[Zhang Zhongjing] Pulse coming slow with occasional stop then return is named Jie (Knot), Yin. Pulse coming moving then stopping, returning slightly faster, with intermediate return and movement, named Cu (Urgency), Yang. Pulse coming moving then stopping, unable to return itself, stopping then returning as before, named Dai (Replacement), Yin. Obtaining this pulse indicates difficult treatment.

Returning itself: Moving then stopping then returning, frequency higher than previous movement. Unable to return itself: Moving then stopping, returning as before, movement same but not frequent.

[Huo Ren Shu] Has Jie pulse, Cu pulse, Dai pulse. Jie is Yin, Yin excess causes Jie, pulse slow, occasional stop then return, main chest fullness and irritability. Cu is Yang, Yang excess causes Cu, pulse rapid, occasional stop then return, main accumulation and Qi痞 (blockage), formed by worry/thought. Generally Jie/Cu pulses, though occasionally stopping, are disease pulses, not death pulses. Only Dai pulse is true death. Slow movement, stopping unable to return itself, then moving again, named Dai; Dai means death. Zhongjing's Cold Damage pulse Jie Dai, Heart palpitation, Zhi Gan Cao Tang governs.

[Mai Jing] Heat disease pulse four beats, dies in three days. Four beats means normal person one beat, patient four beats. Heat disease pulse five beats, dies in one day. Occasionally large beat, dies in half day. Suddenly confused/disturbed, dies. Heat disease pulse six beats, dies in half day. Suddenly rapid large beat, dies shortly after. Heat disease pulse four losses, dies in three days. Four losses means normal person four beats, patient one beat, named four losses. Heat disease pulse five losses, dies in one day. Five losses means normal person five beats, patient one beat, named five losses. Heat disease pulse six losses, dies in one shichen. Six losses means normal person six beats, patient one beat, named six losses. If absolutely absent, arriving after long time, immediate death.

[Mai Jing] Healthy person not ill, pulse like leaking roof or sparrow pecking, dies (This is Spleen True Zang pulse. Wang note: Leaking roof, arrival ceases then stops, occasionally rises again not connecting. Sparrow pecking, like pecking rice very frequently). Pulse like striking stone, departing like untying cord, dies (This is Kidney True Zang pulse. Wang note: Striking stone, cracking urgent. Untying cord, moving rapid then scattered disorderly without order). Patient pulse like shrimp swimming, like fish gliding, dies. (Wang note: Shrimp swimming, slowly rising then retreating disappearing unknown where, long time then rising again, rising slow retreating fast. Fish gliding, like fish not moving, but tail wagging head shaking body swaying staying long). Pulse like turning bean, dies. Pulse like inverted knife, dies. Pulse surging not leaving, dies. Pulse suddenly leaving suddenly coming temporarily stopping then returning, dies. Pulse dividing absolute