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[Annotation]
The South belongs to Fire, governing the heat of summer. In Heaven it is Fire, in Earth it is Heat, and in Man it corresponds to the Heart. Thus it is said: The Heart belongs to Fire, named the Hand Shaoyin Meridian, and its pulse should be洪 (Hong, flooding). If the pulse is 洪大 (Hongda, large and flooding) yet harmonious and slow (hehuan), this indicates that while there is flooding, there is also Stomach Qi (Wei Qi, indicating healthy digestive function). This is the Ping Mai (Ping Pulse, normal/healthy pulse) of the Heart. Even if there is Heart disease, it will easily heal. If the pulse is 洪大 (Hongda) but lacks harmony and slowness, this indicates much flooding but little Stomach Qi; this is the Bing Mai (Bing Pulse, pathological pulse) of the Heart. If the pulse is 洪大 (Hongda) without any harmony or slowness, this indicates flooding without Stomach Qi; this is the Si Mai (Si Pulse, death pulse) of the Heart.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: The pulse is Hongda (large and flooding) and long, corresponding to the image of all things flourishing and growing.

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At the beginning of Summer (Lixia), a Hongda (large and flooding) pulse appears, which is its proper position. If the patient suffers from body pain and heaviness, sweating therapy must be used. If the next day the body pain and heaviness cease, sweating is no longer necessary. If the patient sweats continuously (jiejie), the illness will resolve the next day. Why? Because obtaining a Hongda pulse at Lixia is the pulse corresponding to the season, hence the result. The same logic applies to the other four seasons.

[Annotation]
For illnesses in all four seasons, one should judge them according to the pulse patterns of those seasons. "Judging" here means predicting whether recovery will occur. On the day of Lixia, a Hongda pulse appears, which is the pulse expected for its proper position. If the patient suffers from body pain and heaviness, sweating is required. If the next day the pain and heaviness cease, even if the pulse remains Hongda, it is certainly not an evil pulse, but rather the seasonal pulse; no further sweating is needed, indicating resolution. Suppose on that day the patient sweats continuously; this shows the sign of resolution has appeared. Although the pulse is Hongda, sweating is unnecessary, and it will resolve naturally the next day. Why? Because obtaining a Hongda pulse at Lixia means obtaining the seasonal pulse. The same applies to other seasons.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: This states that when the pulse flourishes in accordance with the season, the illness has a time for resolution. Taking Summer as an example to illustrate the rest, it shows people how to deduce and emulate.
Cheng Zhi says: Spring pulses are Xian (String-like), Summer pulses are Hong (Flooding), Autumn pulses are Mao (Feather-like/Float), Winter pulses are Shi (Stone-like/Sink). Obtaining these during their respective seasons constitutes Ping Mai (Normal Pulses). Even with external cold pathogenic invasion, slight sweating leads to self-healing. Severe cases require treatment; mild cases do not. As the *Neijing* states: "Pulses that follow the four seasons." This refers to that.
Cheng Yingmao says: Hongda (Large and Flooding) is both the pulse of Summer and the pulse of excess evil. When ill, it follows the evil; when well, it follows the season. Whether resolved or not does not need separate differentiation.

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What does the pulse of the Lung in the West resemble? The Master said: The Lung belongs to Metal, named Taiyin, and its pulse is Maofu (Floating like a feather). If Lung disease naturally presents this pulse, and it becomes Huanchi (Slow and Moderate), healing occurs. If it becomes Shu (Rapid), the condition worsens. How do we know? Shu (Rapid) belongs to Southern Fire. Fire overcomes Western Metal. According to medical principles, carbuncles and swellings should arise, making it difficult to treat.

[Annotation]
The West belongs to Metal, governing the dryness of Autumn. In Heaven it is Dryness, in Earth it is Metal, and in Man it corresponds to the Lung. Thus it is said: The Lung belongs to Metal, named the Hand Taiyin Meridian, and its pulse should be Fu (Floating). If the pulse is Maofu (Floating like a feather) with Huanchi (Slowness and Moderation), this indicates floating with Stomach Qi; this is the Ping Mai (Normal Pulse) of the Lung. Even with Lung disease, it heals easily. If the pulse is Maofu but lacks Huanchi, this indicates much floating but little Stomach Qi; this is the Bing Mai (Pathological Pulse) of the Lung. If the pulse is Maofu without Huanchi, this indicates floating without Stomach Qi; this is the Si Mai (Death Pulse) of the Lung. If the pulse is Maofu and Shu (Rapid), the illness is severe. How do we know? Shu (Rapid) belongs to Southern Fire. Fire overcomes Western Metal. According to medical principles, carbuncles and swellings should arise, making it difficult to treat.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: The Lung governs skin and hair and sits high like a canopy, hence the pulse is Maofu (Floating like a feather). Huanchi (Slowness and Moderation) is the pulse of Spleen Earth. Obtaining Huanchi leads to healing because Lung Metal receives birth from Earth. Carbuncle and pus formation occurs because Metal transforms under Fire.

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What does the pulse of the Kidney in the North resemble? The Master said: The Kidney belongs to Water, named Shaoyin, and its pulse is Chenhua (Deep and Slippery); this is the Kidney pulse. If Kidney disease naturally presents a Chenhua (Deep and Slippery) pulse that is also Ru (Soft), healing occurs.

[Commentary]
There is text for the Southeast and West, but only the North is missing. It is supplemented here emulating the classic text.

[Annotation]
The North belongs to Water, governing the cold of Winter. In Heaven it is Cold, in Earth it is Water, and in Man it corresponds to the Kidney. Thus it is said: The Kidney belongs to Water, named the Foot Shaoyin Meridian, and its pulse should be Chen (Deep). If the pulse is Chenhua (Deep and Slippery) and Ru (Soft), this indicates deep with Stomach Qi; this is the Ping Mai (Normal Pulse) of the Kidney. Even with Kidney disease, it heals easily. If the pulse is Chenhua (Deep and Slippery) but lacks Ru (Softness and Harmony), this indicates much deepness but little Stomach Qi; this is the Bing Mai (Pathological Pulse) of the Kidney. If the pulse is Chen (Deep) without Huaru (Slippery and Soft), this indicates deep without Stomach Qi; this is the Si Mai (Death Pulse) of the Kidney.

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Question: The pulse gathers suddenly and then sinks, called Hua Mai (Slippery Pulse). What does this mean? The Master said: Sinking represents Pure Yin; gathering (floating) represents Correct Yang. When Yin and Yang harmonize and combine, the pulse becomes slippery, and the Guan and Chi positions are balanced. The Yangming pulse is slightly sinking, and digestion is normal. The Shaoyin pulse is slightly slippery. Slippery is the floating name of Tight. This constitutes Yin Excess. The person will surely have sweat in the inner thighs and dampness below the genitals.

[Commentary]
"Slippery is the floating name of Tight." The two sentences "This constitutes Yin Excess" do not fit the context above and below; they are likely misplaced bamboo slips.

[Annotation]
This describes the Ping Mai (Normal Pulse) of winter. If the Yangming Guan pulse is slightly sinking but not slippery, it loses Correct Yang, causing Stomach disharmony, so the patient's diet is merely adequate. If the Shaoyin Chi pulse is slightly slippery but not soft, it loses Pure Yin, causing Kidney disharmony, so the patient sweats and has dampness below the genitals.

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Question: There is mutual overcoming (Cheng) in pulses, including Zong (Vertical/Unrestrained), Heng (Horizontal/Rebellious), Ni (Reverse), and Shun (Smooth). What does this mean? The Master said: Water overcoming Fire, and Metal overcoming Wood, is called Zong (Vertical/Unrestrained); Fire overcoming Water, and Wood overcoming Metal, is called Heng (Horizontal/Rebellious); Water overcoming Metal, and Fire overcoming Wood, is called Ni (Reverse); Metal overcoming Water, and Wood overcoming Fire, is called Shun (Smooth).

[Annotation]
This uses the five pulses of humans to diagnose the imbalance of the five Zang organs. The five Zang organs correspond to the Five Elements of Heaven: Liver Wood, Heart Fire, Spleen Earth, Lung Metal, and Kidney Water. This is mutual generation. Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal generates Water, Water generates Wood. This is mutual overcoming. Wood overcomes Earth, Earth overcomes Water, Water overcomes Fire, Fire overcomes Metal, Metal overcomes Wood. Those who generate lead to life; those who overcome lead to death (or control). Human organ qi is the same, hence pulses have Cheng (overcoming), Zong, Heng, Ni, and Shun. Water overcoming Fire, Metal overcoming Wood, is overcoming what one controls (Sheng), which is mutual overcoming, called Zong. Fire overcoming Water, Wood overcoming Metal, is overcoming what controls one (Bu Sheng), which is reverse usurpation, called Heng. Water overcoming Metal, Fire overcoming Wood, is child overcoming mother, which is inverted application, called Ni. Metal overcoming Water, Wood overcoming Fire, is mother overcoming child, which is related to generation, called Shun. The pulses of the five Zang organs are: Liver Xian (String-like), Heart Hong (Flooding), Spleen Huan (Moderate), Lung Fu (Floating), Kidney Chen (Deep). If each Zang shows its own pulse, there is no disease. If other pulses appear, deduce accordingly: Zong indicates severe illness, Heng indicates mild illness, Ni indicates deficiency illness, Shun indicates excess illness.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: Cheng means riding like a boat or cart. Zong means straight. Heng is the opposite of Zong. Shun means following. Ni is the opposite of Shun.
Cheng Zhi says: Obtaining these out of season constitutes Cheng (Overcoming). Zong and Heng cause the heaviest harm; Ni and Shun cause relatively little harm.

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Question: How do we know it is Cheng Fu (Overcoming the Fu organs)? How do we know it is Zang (Overcoming the Zang organs)? The Master said: All Yang pulses that are Floating and Rapid indicate Cheng Fu; all Yin pulses that are Slow and Choppy indicate Cheng Zang.

[Annotation]
The previous paragraph elucidated the pulses of Zang mutual overcoming, Zong, Heng, Ni, and Shun. This paragraph elucidates Yin-Yang mutual overcoming, each following its kind. Fu organs are Yang; Floating and Rapid are Yang. Zang organs are Yin; Slow and Choppy are Yin. Yang overcoming Yang, Yin overcoming Yin, each follows its kind to overcome. If Yin evil overcomes Yang, or Yang evil overcomes Yin; Fu evil overcomes Zang, or Zang evil overcomes Fu, one can deduce by synthesizing pulse and symptoms.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: Floating and Rapid are Yang. Seeing Yang pulses in Yang positions indicates Cheng Fu. Slow and Choppy are Yin. Seeing Yin pulses in Yin positions indicates Cheng Zang.

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Question: Why do Ru Ruo (Soft and Weak) pulses adapt to the "Eleven Heads"? The Master said: Because the five Zang and six Fu organs mutually overcome, thus becoming eleven.

[Annotation]
This continues the previous paragraph, elucidating the pulses of imbalance and mutual overcoming among the five Zang and six Fu organs. "Shi" means arriving; "Tou" means count. If one sees Ru Ruo (Soft and Weak) pulses with mutual overcoming, it is because one's deficiency allows the other to overcome. Yue Ren (Bian Que) only said one pulse changes ten times, why does it reach eleven? Yue Ren omitted Pericardium and San Jiao, so it was ten. Now, with five Zang and six Fu organs mutually overcoming, it is eleven. However, Yin overcoming Yang, Yang overcoming Yin, Fu overcoming Zang, Zang overcoming Fu, mixed and synthesized, how could it be only eleven!

[Ji Zhu - Collected Annotations]
Cheng Zhi says: This summarizes the main points of pulses, stating that obtaining Ru Ruo (Soft and Weak) pulses allows harmony with the five Zang and six Fu organs. The Classics say: Respiration is the head of the pulse. Ru Ruo is soft, harmonious, and slippery, which the *Neijing* calls having Stomach Qi. The evils of the five Zang and six Fu organs cannot fail to overcome each other, such as Metal evil overcoming Wood, Wood evil overcoming Fire, etc. Only among these mutual overcomings, if there is a sense of softness, harmony, and slipperiness, it is easy to heal. Thus, Ru Ruo can harmonize the pulse qi of the eleven organs.

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Question: Why does a patient shiver with aversion to cold and then have fever? Answer: When Yin pulses are deficient, Yang goes to follow it; when Yang pulses are deficient, Yin goes to overcome it. Question: What is meant by Yang deficiency? Answer: For example, if the Cun Kou (Cun position) pulse is Wei (Micro), it is called Yang deficiency. Yin Qi enters Yang, causing shivering and aversion to cold. Question: What is meant by Yin deficiency? Answer: If the Chi position pulse is Ruo (Weak), it is called Yin deficiency. Yang Qi sinks into Yin, causing fever.

[Annotation]
This uses Cun and Chi positions to elucidate the pulses of illness caused by Yin-Yang mutual overcoming. If the pulse is Tight with no sweat, shivering with aversion to cold and fever, it is Shang Han (Cold Damage). If the pulse is Slow with sweat, shivering with aversion to cold and fever, it is Feng Zhong (Wind Strike). Now, Cun pulse is Micro, shivering with aversion to cold: this is Yang deficiency, Yin Qi surges upward, entering Yang. Chi pulse is Weak, fever: this is Yin deficiency, Yang Qi sinks downward, entering Yin. This is internal injury and deficiency, Yin-Yang mutual overcoming, with paroxysmal aversion to cold and fever. It differs from external excess, where Wind-Cold injures Ying and Wei, causing non-paroxysmal aversion to cold and fever.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: Yang falls into Yin first, hence "follows," a euphemism. Yin follows Yang upward, hence "overcomes," implying injury. Aversion to cold occurs because Yang is insufficient to overcome Yin, transforming together with Yin. Fever occurs because Yin is insufficient to overcome Yang, transforming with Yang.
Cheng Zhi says: This differentiates the pulses of Yin-Yang mutual overcoming. Alternating implies Yin and Yang qi wax and wane. Yin merging causes cold; Yang merging causes heat. This applies to all pulses of malaria and alternating chills and fever.

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Question: There are Yang Jie (Yang Knotting) and Yin Jie (Yin Knotting) in pulses. How to distinguish them? Answer: If the pulse is Floating and Rapid, the patient can eat, but has constipation, this is Excess, called Yang Jie. Expect worsening on the 17th day. If the pulse is Sinking and Slow, the patient cannot eat, body feels heavy, and stool is loose, this is Yin Jie. Expect worsening on the 14th day.

[Annotation]
The previous paragraph distinguished Yin-Yang deficiency via weak Cun and Chi pulses. This paragraph distinguishes Yin-Yang Excess/Knotting via strong Floating and Sinking pulses. A pulse that is Large, Floating, and Rapid, appearing vast like a chariot canopy, is the Yang Jie solid pulse. A pulse that is Stone-like, Sinking, and Slow, appearing continuous like tracing a long bamboo pole, is the Yin Jie solid pulse. Pulses can distinguish Yin-Yang knotting, but one must also synthesize Yin/Yang Jie symptoms with Yin/Yang Jie pulses. Yang Jie symptoms: light body, able to eat (Yang can digest grain), constipation. Expected worsening on the 17th day because Yang nature is ultimately dry, hence three days later. Yin Jie symptoms: heavy body, unable to eat (Yin cannot digest grain), constipation. Expected worsening on the 14th day because Yin nature is ultimately moist/damp, hence three days earlier. "Worsening" refers to constipation, tenesmus, fullness, and pain. One should not wait; treat early. Either moisten orifices to guide, or soften hardness to purge. Otherwise, hard stool becomes huge, difficult to pass, causing extreme distress. Patients after illness often suffer fluid damage and have this syndrome. Experienced practitioners know this well.

[Ji Zhu - Collected Annotations]
Cheng Yingmao says: It says "pulse has" not "illness has," indicating the two Qi endowments have bias. Yang Jie is biased toward Yang without Yin to generate fluids. Yin Jie is biased toward Yin without Yang to transform fluids. These are distinguished by Floating/Rapid vs. Sinking/Slow pulses.

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If Yang pulse is Floating and Yin pulse is Weak, there is Blood Deficiency. Blood Deficiency leads to tendon tension. If the pulse is Sinking, Ying Qi is faint. If the pulse is Floating and sweat flows like beads, Wei Qi is declining.

[Commentary]
In "Yang pulse is Floating," the second "Floating" should be "Ru" (Soft). If it were "Floating," it would not align with the meaning of Wei decline and bead-like sweat. In "Pulse is Sinking," the "Sinking" should be "Ruo" (Weak). If it were "Sinking," it would not align with Blood deficiency and faint Ying Qi.

[Annotation]
This uses Floating and Sinking to differentiate illness caused by Yin-Yang deficiency. Yang pulse Ru is Floating but forceless. Yin pulse Ruo is Sinking but forceless. Pulse Ruo indicates faint Ying Qi. Faint Ying leads to Blood Deficiency, so besides fever, there is tendon tension. Pulse Ru indicates declining Wei Qi. Declining Wei leads to insecure exterior, so besides aversion to cold, there is sweat flowing like beads.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: Sinking examines the interior; Ying moves within vessels, so faintness is known. Floating examines the exterior; Wei moves outside vessels. Sweat like beads indicates insecure exterior, so decline is known.

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A pulse vast like a chariot canopy is called Yang Jie.

[Annotation]
"Vast like a chariot canopy" describes a pulse that is Floating, Large, and Forceful, i.e., the previously mentioned Yang Jie Floating-Rapid pulse. Because it is forceful and vigorous, it is called Yang Jie.

[Ji Zhu - Collected Annotations]
Cheng Yingmao says: "Vast like a chariot canopy" describes a sensation of upward pressure within the Floating-Rapid quality.

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A pulse continuous like tracing a long bamboo pole is called Yin Jie.

[Annotation]
"Continuous like tracing a long bamboo pole" describes a pulse that is Sinking, Stone-like, and Forceful, i.e., the previously mentioned Yin Jie Sinking-Slow pulse. Because it is forceful and vigorous, it is called Yin Jie.

[Ji Zhu - Collected Annotations]
Cheng Zhi says: "Continuous like tracing a long bamboo pole" depicts a straight, pulling, stiff appearance, indicating Yin Qi firmly knotted, preventing Yang from harmonizing it. Previously mentioning Yin Jie and Yang Jie referred to constipation; here it specifically refers to pulse morphology.

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A pulse flickering like fat floating on soup indicates微弱 Yang Qi.

[Annotation]
"Flickering like fat floating on soup" describes a pulse that is Floating but Forceless, i.e., the previously mentioned Wei Qi decline Ru pulse. Hence it is said: Yang Qi is微弱 (weak/faint).

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A pulse continuous like lacquer pouring out thinning at the end indicates loss of Blood.

[Annotation]
"Continuous like lacquer pouring out thinning at the end" describes a pulse that is Sinking but Forceless, i.e., the previously mentioned Ying Qi faint Ruo pulse. Hence it is said: Loss of Blood.

[Ji Zhu - Collected Annotations]
Cheng Wuji says: "Mianmian" means continuous. "Like lacquer pouring out thinning at the end" means large initially and fine subsequently.

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A pulse winding like a spider's silk indicates Yang Qi decline.

[Annotation]
"Winding like a spider's silk" describes a pulse that is Fine and Small, difficult to locate, appearing present yet absent in Floating, Middle, and Deep positions. This is the previously mentioned Wei pulse of Yang deficiency. Hence it is said: Yang Qi declines.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: "Winding like spider silk" depicts a state of entanglement, swirling, extremely fine and nearly extinct.

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The Master said: If the Cun pulse does not reach down to the Guan position, it is Yang Jue (Extinction). If the Chi pulse does not reach up to the Guan position, it is Yin Jue (Extinction). These are untreatable and indicate death. To calculate the remaining lifespan, use the monthly solar terms' overcoming relationships.

[Annotation]
The above section elucidated Ping Mai (Normal Pulses); the following sections describe Si Hou (Death Signs) pulses. The upper and lower aspects of the Cun, Guan, and Chi positions examine the ascending and descending of Yin-Yang and the Five Zang. Cun is upper, examining Heart and Lung Yang, governing ascent. Ascent reaches its peak and descends; if it does not descend to Guan, it is Lone Yang. Hence: Cun pulse not reaching Guan is Yang Jue. Chi is lower, examining Liver and Kidney Yin, governing descent. Descent reaches its peak and ascends; if it does not ascend to Guan, it is Lone Yin. Hence: Chi pulse not reaching Guan is Yin Jue. Guan is middle, examining Spleen, situated between Cun and Chi, serving as the pivot for ascending, descending, exiting, and entering. Now, upper and lower do not reach Guan, meaning ascending, descending, exiting, and entering have ceased. Hence: These are untreatable, definitely death. If Yin and Yang have separated but Stomach Qi is not yet extinct, one can calculate the remaining life span using monthly solar term overcoming. As the Classics say: Yin excess leads to Yang extinction, capable of enduring Summer but not Winter. Yang excess leads to Yin extinction, capable of enduring Winter but not Summer. Liver dies in Autumn, Heart in Winter, Spleen in Spring, Lung in Summer, Kidney in Late Summer. The same applies to days and hours.

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Also, unknown which Zang, Yin and Yang extinguish first. If Yang Qi extinguishes first and Yin Qi exhausts later, the person dies, and body color will be Green. If Yin Qi extinguishes first and Yang Qi exhausts later, the person dies, and body color will be Red, with warmth in the axilla and heat in the epigastrium.

[Annotation]
The Classics say: Humans have two deaths but no dual births. "Two deaths" means both Yin and Yang can die. "No dual births" means Yin and Yang cannot survive independently. Thus, if Yang extinguishes first and Yin exhausts later, death brings green body and coldness. If Yin extinguishes first and Yang exhausts later, death brings red body and warmth.

[Ji Zhu - Collected Annotations]
Cheng Wuji says: Yang governs heat and Red color; Yin governs cold and Green color. After death, if the body is Green, Yin has not left the body, so Yin exhausts later. If the body is Red, axilla is warm, epigastrium is hot, Yang has not left the body, so Yang exhausts later.
Cheng Zhi says: Yang extinguishing first indicates Cold disease; Yin extinguishing first indicates Heat disease. If the treatment for Cold and Heat is mistaken once, even death leaves signs, truly to be feared.

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The Master said: Pulse abnormal, person normal, is called "Walking Corpse" (Xing Shi), lacking Wang Qi (Prosperous Qi). Sudden dizziness and collapse, unaware of others, short life leads to death. Person abnormal, pulse normal, is called "Internal Deficiency" (Nei Xu), lacking Gu Shen (Grain Spirit). Though distressed, there is no harm.

[Annotation]
Pulse is the root of man. Pulse abnormal, person normal, means the exterior appears healthy, but True Zang disease pulses are seen. Internally, life is already extinct; though alive, it is like dead. It is merely residual Qi residing in a corpse! Hence called "Walking Corpse." Residual Qi refers to the remaining vitality of the five Zang organs before exhaustion. Once Prosperous Qi retreats, sudden dizziness, collapse, and death occur. If a skilled physician plans treatment before Prosperous Qi retreats, there may be benefit. Person abnormal, pulse normal, means the exterior is emaciated like illness, but the pulse is harmonious. The root is still firm; it is merely insufficient Grain Qi. Called "Internal Deficiency," incomparable to Walking Corpse. Though distressed, there is no harm. When Stomach Qi recovers and Grain Qi fills, peace returns naturally. Gu Shen is Grain Qi.

[Ji Zhu - Collected Annotations]
Fang Youzhi says: Zhou Shi said: Within the form, one feels haggard, spirit is confused, food is unappetizing, yet the pulse follows the four seasons...