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There is no excess or deficiency bias; this indicates that the person is diseased while the pulse remains normal. The physical form is peaceful and harmonious, yet the pulse fluctuates—sometimes large, sometimes small, sometimes rapid, sometimes slow, varying between wiry and tight, floating and slippery, or deep and choppy. These variations damage the harmonious Qi. This signifies that the pulse does not correspond to the physical condition, representing a state where the pulse is abnormal but the person shows no obvious signs of illness.

Zhang Xiju stated: "Grain Spirit" (Gu Shen) refers to the vital essence derived from food and drink, which humans rely upon for sustenance. If the interior is deficient and food intake is scant, Grain Qi fails to fill the body, resulting in the loss of Grain Spirit. Therefore, it is said to be "harmless"; however, without the inherent Stomach Spirit (Wei Shen), how can it be considered harmless?

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Furthermore, one must not know which Zang organ suffers first. If sweating occurs with wet hair, accompanied by unceasing panting, this indicates the premature failure of the Lung.

[Annotation]
This elaborates on the previous section regarding which Zang organ fails first, detailing its manifestations. The Lung governs the skin and hair; when Lung Qi fails, sweat flows uncontrollably, causing the hair to become wet. The Lung governs Qi; when Lung Qi fails, the mouth opens to exhale air, which cannot be retracted. Hence, it is stated: "This indicates the premature failure of the Lung."

[Collected Notes]
Cheng Wuji stated: "The Lung is the master of Qi and the commander of Body Fluids. Wet hair after sweating indicates the depletion of Body Fluids; unceasing panting indicates the depletion of Qi."

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A pulse that is floating and surging, combined with sweat like oil on the body, unceasing panting, inability to take in fluids or food, insensitivity of the physical form, and alternating states of calmness and chaos, indicates the termination of life.

[Annotation]
Sweat like oil indicates the external loss of fluids; unceasing panting indicates the upward collapse of Qi; inability to ingest food and water indicates the extinction of Stomach Qi; insensitivity of the form indicates the ruin of Ying and Wei (Nutritive and Defensive) Qi; and alternating calmness and chaos indicate the scattering of Spirit. All these are signs of life's end. From this, we deduce that although the pulse may appear floating and surging, it will inevitably lack root. This is the diagnosis of solitary Yang flying away in the context of True Zang Pulse.

[Collected Notes]
Wang Kentang stated: "When fire is about to extinguish, it must shine brightly. A pulse that comes floating, surging, and vigorous is a sign that the person is about to depart from the body. However, one must also observe one or two of the following symptoms before concluding that life has ended."

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Yang Qi remains alone, the body feels hot as if smoked, with fixed staring eyes and head shaking; this indicates the failure of the Heart.

[Annotation]
When Heart Yin is exhausted, only Yang remains alone, causing severe body heat and a form resembling smoke exposure, transforming according to Fire. The Heart stores Spirit; fixed staring eyes indicate the departure of Spirit. The Head belongs to Yang; when Yang has no foundation, the head shakes.

[Collected Notes]
Cheng Wuji stated: "The Heart meridian runs alongside the throat and connects to the eyes. Fixed staring eyes indicate the exhaustion of the Heart Meridian. The Head is the meeting point of all Yang meridians; head shaking indicates Yin exhaustion and Yang lacking a root."

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The lips and corners of the mouth turn green, and the limbs twitch and tremble; this indicates the failure of the Liver.

[Annotation]
The color of the lips should be red and yellow; seeing green instead indicates Wood overcoming Earth. Profuse sweating from the limbs without cessation indicates Liver failure.

[Collected Notes]
Cheng Wuji stated: "The lips are the external indicator of the Spleen. The Liver's color is green; when the Liver fails, its true color appears in the area it overcomes (the Spleen). The limbs are governed by the Spleen, while the Liver governs the sinews. When the Liver fails, the sinews and vessels contract, manifesting in the area it overcomes."

Fang Youzhi stated: "The edges of the mouth are called 'wen'. Limbs refer to hands and feet. [Character missing], describes sweating. 'Xi' means birds flying repeatedly. It means the hands and feet tremble and shake as if birds are practicing flight, flapping continuously."

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The area around the mouth turns dark and blackish, with soft sweat and yellow discoloration; this indicates the failure of the Spleen.

[Annotation]
The Spleen's brilliance manifests in the four white areas around the mouth. Dark blackness around the mouth indicates the withering of its brilliance. Cold sweat and dull yellow color both indicate Spleen failure.

[Collected Notes]
Fang Youzhi stated: "The mouth is the orifice of the Spleen. Blackish darkness is a smoky yellow turning dark, the color of failing Earth. Soft sweat is commonly known as cold sweat."

Zhang Xiju stated: "The Spleen governs the four white areas. Dark blackness around the mouth indicates Earth failing and being bullied by Water. Soft sweat is soft and sticky, representing the true fluid of the Spleen; yellow is the true color of the Spleen. When true fluid leaks and true color appears, it indicates Spleen failure."

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Incontinence of urine and feces, delirious speech, and eyes rolling back with fixed staring; this indicates the failure of the Kidney.

[Annotation]
The Kidney controls the opening and closing of the lower orifices. Incontinence indicates Kidney failure. The Kidney stores Essence and Will. Delirious speech and fixed staring indicate the failure of both Essence and Will.

[Collected Notes]
Fang Youzhi stated: "'Sou bian' refers to urinary incontinence. The Kidney controls opening and closing; when these functions fail, both urine and feces lose control. The Classics state: 'The Kidney stores Will.' Delirious speech indicates loss of Will; loss of Will leads to death. The Kidney governs bones, and the essence of bones manifests in the pupils. Eyes rolling back with fixed staring indicate that the bone's essence fails to nourish the pupils, preventing movement."

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Question: An expert physician knows through observation, an average physician through inquiry, and a poor physician through pulse diagnosis. I wish to hear the explanation. Master said: If the patient's family reports that the patient suffers from fever and body pain, and the patient lies down voluntarily, and upon the physician's arrival, the pulse is found to be deep and slow, knowing that recovery is imminent, why is this so? If there were exterior pathology, the pulse should be floating and large. Now that the pulse is instead deep and slow, we know recovery is near.

[Annotation]
The following sections detail methods of knowing through observation and inquiry. Observation involves examining the prosperity or decline of the form and the depth or lightness of the complexion. Inquiry involves asking about the patient's suffering and desires, and the root cause of the disease. Pulse diagnosis involves examining the Yin and Yang of the pulse to see if it matches the form and complexion. Suppose the patient's family requests help, reporting fever and body pain. Upon arrival, the patient lies down voluntarily. If the pulse is deep and slow, we know improvement is occurring. Why? Exterior diseases typically present with floating and large pulses. The current deep and slow pulse, lacking exterior signs, indicates recovery.

[Collected Notes]
Zhang Xiju stated: "If there is fever and body pain, yet the pulse is deep and slow, this is a Yang disease presenting with a Yin pulse. How can recovery be predicted? The answer is: One must observe a tranquil desire to sleep and inquire about the relief of heat and lightness of the body, then combine this with the pulse to conclude recovery."

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Suppose the patient complains of sudden abdominal pain and sits voluntarily. Upon the physician's arrival, the pulse is floating and large, indicating recovery. Why? If there were interior pathology, the pulse should be deep and fine. Now that the pulse is floating and large, we know recovery is near.

[Annotation]
The patient's family requests help, reporting sudden abdominal pain. Upon the physician's arrival, the patient sits voluntarily without expressions of distress. The pulse is floating and large, indicating improvement. Why? Interior diseases typically present with deep and fine pulses. The current floating and large pulse, lacking interior signs, indicates recovery.

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Master said: If the patient's family reports extreme fever and irritability, and the next day the physician arrives to find the patient lying facing the wall, this indicates the heat has subsided. Even if the pulse is not perfectly harmonious, one may say the patient has recovered.

[Commentary]
"Not harmonious" should likely be "naturally harmonious"; otherwise, how can recovery be claimed?

[Annotation]
This supplements the meaning of the previous two sections. If the family reports extreme fever and irritability, and the next day the patient lies quietly facing the wall, this indicates the heat has gone, signaling improvement. If the pulse is not slow and harmonious, recovery cannot be declared; it must be harmonious before concluding recovery. This logic applies similarly to abdominal pain. As stated at the beginning of this chapter: "If findings do not match, carefully deliberate and examine." Deliberation means today's observation differs from yesterday's inquiry and listening.

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If the patient lies facing the wall, and upon hearing the physician's arrival, does not startle up but glances sideways, speaks with pauses, and swallows saliva during pulse diagnosis, this is feigned illness. If the pulse is naturally harmonious, the physician should say the illness is severe, requiring emetic and purgative medicines, and dozens or hundreds of acupuncture points need treatment for recovery.

[Annotation]
This prescribes a method for treating feigned illness. Zhang Zhongjing did not wish for people to deceive, nor for physicians to be deceived into erroneous treatment. By studying and reflecting on this, patients will dare not deceive, and physicians will not treat rashly.

[Collected Notes]
Cheng Zhi stated: "They feign illness, and we treat with feigned methods; only a skilled physician can possess such ingenuity."

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When the physician holds the pulse, if the patient yawns, there is no disease. If the patient groans during pulse diagnosis, there is disease. If speech is slow, it indicates Wind. If the head shakes while speaking, it indicates interior pain. If walking is slow, it indicates exterior stiffness. If sitting with the body bent forward, it indicates shortness of breath. If sitting with one leg extended, it indicates waist pain. If guarding the abdomen due to interior excess, as if holding an egg, it indicates heart pain.

[Annotation]
Yawning occurs due to the mutual attraction of Yin and Yang; inhaling first then exhaling constitutes yawning. Lack of mutual attraction indicates disease; attraction indicates harmony. Thus, yawning implies no disease. Groaning during diagnosis indicates suffering from disease. Slow speech indicates language impediment due to Wind. Head-shaking while speaking indicates severe pain making vocalization difficult, using head movement to signal relief, indicating interior pain. Slow walking indicates Wind disease causing poor meridian circulation, indicating exterior stiffness. Sitting bent forward indicates Qi cannot connect, indicating shortness of breath. Those with waist pain cannot sit comfortably; even slight sitting requires extending the leg for support, hence sitting with one leg extended indicates waist pain. Those with heart pain hunch over to guard the painful area, hence guarding the abdomen as if holding an object indicates heart pain.

[Collected Notes]
Fang Youzhi stated: "Tongue stiffness causes slow speech; meridian tension causes tongue stiffness. Sinew spasm causes meridian constriction. The Liver belongs to Wood, governs sinews, and rules Wind. The Head belongs to Yang, the Interior to Yin. Head shaking indicates Yin failing to harmonize with Yang. Shortness of breath indicates interior insufficiency. These eight items are all matters of knowing through observation."

Zhang Zhicong stated: "Holding the pulse here implies the physician observes without asking. These eight items involve observing spirit and demeanor to understand pathogenesis, which is knowing through observation."

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Question: What is the pulse shape when a person is terrified? Master said: The pulse resembles feeling along threads, linked one after another, and the face is pale and loses color.

[Annotation]
Fear and terror indicate insufficient Yang Spirit. Insufficient Yang leads to fear; insufficient Spirit leads to terror. Fear causes blood to follow Qi downward, resulting in a pale, lusterless face. Terror causes Qi to scatter with the Spirit, resulting in a pulse that feels like threads linked together yet chaotic.

[Collected Notes]
Fang Youzhi stated: "Terror implies alarm. 'Xun' means to smooth or manage. 'Si' means thin. 'Leilei' means connected. 'Tuose' means losing color. Inner Qi deficiency leads to external loss of complexion, causing sudden changes."

Cheng Yingmao stated: "This demonstrates the method of combining complexion and pulse observation. Fear causes Qi to descend and Spirit to be seized, resulting in a thin and unstable pulse, and a pale, washed-out face."

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Question: What is the pulse like when a person does not drink water? Master said: The pulse is naturally choppy, and the lips and mouth are dry.

[Annotation]
Scanty Body Fluids lead to a choppy pulse, causing dry lips and mouth. This results from not drinking, not the other way around.

[Collected Notes]
Cheng Yingmao stated: "Not drinking is like refusing food and water after a dispute for two or three days. The Lung loses the ability to circulate essential Qi and fluids, resulting in a choppy pulse and dry lips and mouth."

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Question: What is the pulse like when a person feels ashamed? Master said: The pulse is floating, and the complexion alternates between white and red.

[Annotation]
Shame causes the Spirit and complexion to fluctuate unpredictably, leading to a floating pulse and alternating pallor and flush. These are cases of knowing through combining complexion and pulse observation with mental deliberation.

[Collected Notes]
Cheng Yingmao stated: "In the above cases, regardless of disease, any internal guilt manifests in the complexion and pulse. From this, one can deliberate mentally to verify internal conditions through external signs for all diseases."

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Question: What is meant by 'disaster and strangeness' in pulses? Master said: Suppose a person is ill, presenting with a Taiyang pulse corresponding to their symptoms, and a decoction is prepared accordingly. Before returning with the medicine, within the time it takes to eat a meal, the patient suddenly vomits severely or experiences diarrhea with abdominal pain. The physician says: 'I did not see these symptoms earlier; now they have changed strangely. This is called disaster and strangeness.' Asked: 'What causes this vomiting and diarrhea?' Answered: 'Perhaps old medication taken previously is now taking effect; hence it is called disaster and strangeness.'

[Annotation]
'Disaster and strangeness' refers to adverse reactions caused by medication. Suppose a person has Taiyang disease with matching Taiyang pulse and symptoms, and Taiyang decoction is administered. Upon return, within a meal's time, the patient vomits or has diarrhea with pain. The physician asks: 'I saw no such symptoms earlier; why this strange change?' The patient answers: 'Perhaps old medication taken previously is now acting, causing this disaster.' Observation and inquiry are physicians' duties, but require patients to be completely honest to maximize medical efficacy. Zhang Zhongjing included this clause because patients often fail to inform physicians of prior medication, serving as a warning.

[Collected Notes]
Cheng Wuji stated: "When the physician matches pulse and symptoms with appropriate medicine, but unexpected changes occur as a disaster, it is named 'disaster and strangeness'."

Zhang Zhicong stated: "Pulse matching Taiyang and symptoms, such as floating pulse, stiff neck, headache, and aversion to cold, represents correspondence. If old medication taken previously acts now, it means within the short time of delivering the new medicine, the new dose hasn't fully circulated through the meridians; thus, it must be the effect of the old medication."