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Cheng Zhi stated: Diarrhea caused by food and water belongs to the Spleen and Stomach, whereas diarrhea with pus and blood belongs to the Kidney. This can be differentiated by diagnosing the Duzhong pulse (foot dorsalis pedis artery, reflecting Stomach Qi) and the Taixi pulse (posterior tibial artery, reflecting Kidney Qi).

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If the Duzhong pulse is deep-hidden (Fu) and choppy (Se), a deep-hidden pulse indicates vomiting and regurgitation with undigested food; a choppy pulse indicates inability to ingest food. This condition is named Guan Ge (a severe syndrome characterized by upper vomiting and lower urinary retention).
[Commentary]
The character "hua" (transform/digest) in "undigested food" should likely be "ru" (enter). If it were "digest," it would imply the ability to eat, so how could it be called "Ge" (blocking/rejection)? The inability to ingest food should refer to the inability to urinate. If urination were possible, the water passages would be open, so how could it be called "Guan" (closing/blockage)? This must be a transcription error.
[Annotation]
Previous discussions used floating/sinking and cun/chin positions to diagnose Guan Ge; here, the Duzhong pulse is used for this diagnosis. Duzhong refers to the Stomach pulse. A deep-hidden and choppy pulse implies that the ascending and descending of Yin and Yang at the cun and chin positions are stagnant, and the Yuan Qi (Original Qi) of the San Jiao (Triple Burner) does not circulate freely. Due to the lack of ascending, descending, circulating, and flowing, there is vomiting and regurgitation above, and inability to urinate below. This disease is named Guan Ge.

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If the Duzhong pulse is slippery (Hua) and tight (Jin), slipperiness indicates excess Stomach Qi, and tightness indicates strong Spleen Qi. When excess attacks strength, pain arises and injures the self, similar to holding a blade and cutting oneself, resulting in sores.
[Annotation]
The Duzhong pulse diagnoses the Spleen and Stomach; the pulse should be harmonious and relaxed. Now, it is slippery and tight. Slipperiness indicates excess Stomach Qi; tightness indicates strong Spleen Qi. The coexistence of slippery and tight pulses is like an attack of excess on strength, thus indicating acute pain, which in turn injures the Spleen and Stomach. Just as holding a blade causes sores, it is like wielding a blade to cut oneself, thereby bringing harm.
[Collected Notes]
Fang Youzhi said: Slipperiness indicates food retention; thus, in the Stomach, it signifies excess grain Qi. Tightness indicates cold; thus, in the Spleen, it signifies strong pathogenic Qi. "Holding excess to attack strength" means that excess in the Stomach and strength in the Spleen fight each other, causing disease. It is like holding a blade and injuring oneself, implying that the disease does not arise from transmission between Zang-Fu organs.

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If the Duzhong pulse is deep (Chen) and rapid (Shu), deep indicates excess, and rapid indicates consumption of grain (polyphagia). If tightness is also present, the disease is difficult to treat.
[Annotation]
A Stomach pulse that is deep and rapid: deep indicates interior, rapid indicates heat. Deep and rapid indicates interior excess-heat, leading to polyphagia. For interior diseases presenting with this pulse, treatment is generally easy. However, if the pulse is deep and tight rather than deep and rapid, deep-tight indicates interior cold. This is a sign of damaging Stomach Qi, hence it is said to be difficult to treat.
[Collected Notes]
Fang Youzhi said: Deep is used to diagnose the interior; thus, in the Spleen and Stomach, it represents Earth excess, i.e., excess grain Qi. Rapid indicates heat, which is Yang; tight indicates cold, which is Yin. This means that Duzhong governs the Spleen and Stomach, which govern grain intake. If the pulse is rapid and Yang heat prevails, Yang can transform grain, so illness is not harmful. If the pulse is tight and Yin cold prevails, Yin cannot transform grain, making it difficult to treat.
Cheng Zhi said: This refers to the disease of polyphagia due to deep and rapid Duzhong pulse. Deep indicates excess and interior location; rapid indicates heat and polyphagia. Excessive tightness indicates pathogenic dominance, hence it is difficult to treat.

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If the Duzhong pulse is large (Da) and tight (Jin), diarrhea will immediately occur, which is difficult to treat.
[Annotation]
Diarrhea, whether cold or heat type, is a disease of Middle Jiao deficiency. Therefore, the pulse should be small and slow. When the disease and pulse match, it is easy to treat. Now, the Duzhong pulse is large and tight, representing a deficient disease with an excess pulse, which is mismatched, hence it is difficult to treat.
[Collected Notes]
Cheng Wuji said: Large indicates deficiency, tight indicates cold. Deficient-cold in the Stomach leads to immediate diarrhea. Diarrhea pulses should be minute and small; now they are large and tight, indicating pathogenic excess, hence difficult to treat. The Classic states: In diarrhea, a large pulse indicates the disease has not ceased.
Zhang Lu said: A tight Duzhong pulse indicates cold pathogen injuring the Stomach, necessitating diarrhea. A large pulse in diarrhea indicates pathogenic excess, hence difficult to treat.

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If the Duzhong pulse is faint (Wei) and tight (Jin), tight indicates cold, faint indicates deficiency. The combination of faint and tight leads to shortness of breath.
[Annotation]
A pulse that is faint on the surface and tight on deep pressure indicates deficiency-cold. The Duzhong Stomach pulse appearing indistinct suggests Yang deficiency; deep pressure revealing tightness suggests interior cold. Deficient-cold of Stomach Yang results in shortness of breath. Although the tight pulse usually indicates pain, in this case, because tightness combines with faintness, it is not forceful, hence no pain occurs.
[Collected Notes]
Cheng Zhi said: This refers to the syndrome of shortness of breath caused by deficiency-cold of the Middle Qi due to faint and tight Duzhong pulse.

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If the Duzhong pulse is absent, the Spleen fails to transport upward and downward, resulting in cold body and numb skin.
[Annotation]
If the Duzhong pulse is hidden and absent, it indicates deficiency of Middle Jiao Yang. The Spleen and Stomach fail to transport and distribute essence upwards and downwards, and Wei Qi (Defensive Qi) does not circulate. Thus, the disease manifests as whole-body coldness and skin numbness.
[Collected Notes]
Cheng Zhi said: Body coldness is due to Wei Qi failing to warm; skin numbness is due to Ying Qi (Nutritive Blood) failing to moisten.

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If the Duzhong pulse is floating (Fu) and hollow (Kou), floating indicates decline of Wei Qi, and hollow indicates injury to Ying Qi. The body becomes emaciated, and muscles show crisscross scaling (like fish scales). The interaction of floating and hollow pulses leads to decline of Zong Qi (Pectoral Qi), severing the connection of the four tissues (skin, flesh, fat, marrow).
[Annotation]
A Stomach pulse that is floating and hollow: floating indicates declining Stomach pulse; hollow indicates injured Ying Qi. Decline of Wei Qi causes emaciation; injury to Ying Qi causes muscle scaling. The interplay of floating and hollow pulses over time leads to decline of Zong Qi and reduced vital energy. "Severing of the four tissues" refers to the exhaustion of skin, flesh, fat, and marrow, causing the whole body to become withered and lose nourishment.
[Collected Notes]
Cheng Yingmao said: Wei relies on Ying as its root, and Ying relies on Wei for protection. The integration of Ying and Wei under Zong Qi further relies on Duzhong Stomach Qi as its foundation.

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If the Duzhong pulse is tight and floating, floating indicates Qi stagnation, tight indicates Cold congealing. Floating causes abdominal fullness, tight causes colic. The interaction of floating and tight pulses causes borborygmus and peristalsis; movement generates Qi dynamics, allowing Qi in the diaphragm to descend. If the Shaoyin pulse is absent, the genitalia will swell and hurt.
[Commentary]
The character "xu" (deficiency/empty) in "swollen and empty genitalia" should be "tong" (pain). This can be understood upon careful reading.
[Annotation]
In external contraction, six pulses are floating and tight, with cold pathogen on the exterior, causing bone and joint soreness. In internal injury, the Stomach pulse is floating and tight, with cold pathogen inside, causing abdominal fullness and colic. The interaction of cold pathogens causes borborygmus and peristalsis; movement directs cold Qi in the diaphragm downward, leading to profuse diarrhea. If the Shaoyin pulse floats but does not emerge, it indicates deficiency of Lower Jiao Yang. Cold Qi gathers in the genitalia without venting, causing hernia with swelling and pain of the penis/scrotum.
[Collected Notes]
Fang Youzhi said: When the Earth of Duzhong fails, Shaoyin loses its control.

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When the Shaoyin pulse is weaker than the Duzhong pulse, it is a favorable sign (Shun).
[Annotation]
This is the main principle of Shaoyin being subordinate to Duzhong. Shaoyin Kidney belongs to Water, and Duzhong Stomach belongs to Earth. In miscellaneous diseases, Earth overcoming Water is feared. However, in Shaoyin disease of Shanghan (Cold Damage), one fears only that Earth cannot control Water. Once Water overflows, vomiting and diarrhea occur indiscriminately. If the Duzhong pulse is harmonious, Stomach Earth has authority, Water is controlled, and thus a weaker Shaoyin pulse is considered favorable. Favorable means Earth is not insulted by Water.
[Collected Notes]
Fang Youzhi said: All things derive life from Earth, and all bones rely on the Stomach for nourishment. When Earth and Water are balanced, resources abound and people are safe. Is this not the greatest favorability? Since ancient times, it has been said that those with a Duzhong pulse do not die, which is well-founded!
Wang Hu said: The Duzhong pulse, originally named Chongyang pulse in the *Tu Jing*, is located at the end of the middle toe on the foot dorsum, ascending five cun, three cun away from Xangu acupoint. It is where the Foot-Yangming Meridian passes and serves as the Yuan-Source point, hence also called Huiyuan. In diagnosis, palpating it in severe cases determines life or death. Shanghan takes Stomach Qi as the root. If the Duzhong pulse does not weaken, it indicates Stomach Qi remains; even if the disease is critical, it is still treatable.

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If the Shaoyin pulse is weak and choppy, weakness indicates slight irritability, and choppyness indicates cold extremities (Jue Ni).
[Annotation]
A Shaoyin pulse that is weak and choppy: weakness indicates Kidney Yin deficiency, causing slight irritability; choppyness indicates stagnation of the pulse vessels, causing cold limbs.
[Collected Notes]
Fang Youzhi said: Weakness is a pulse of deficiency and insufficiency. Yin deficiency generates internal heat, causing irritability; however, since it is deficiency-related irritability, it is slight. Choppyness indicates scant blood and lack of smoothness, preventing upward connection with Yang, thus causing cold extremities.
Cheng Zhi said: This refers to the disease of faint and choppy Kidney pulse. The Shaoyin Kidney artery is located in the depression behind the medial malleolus of the foot.

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If the Shaoyin pulse is absent, Kidney Qi is faint, and Essence-Blood is scarce. Rushing Qi presses urgently, entering the chest and diaphragm. Zong Qi accumulates inversely, Blood knots below the heart. Yang Qi retreats downward, Heat returns to the inner thighs. Interacting with Yin, this renders the body insensible. This is Corpse-Jue (Shi Jue), and one should puncture Qimen and Juque.
[Annotation]
An absent Shaoyin pulse indicates衰微 (decline/faintness) of Kidney Qi and scarcity of Essence-Blood. The Kidney stores Yang within Yin. When Kidney Yin is exhausted, it cannot contain Yang. Yang Qi rushes upward, pressing the chest and diaphragm. Zong Qi is obstructed and accumulates without moving. Blood knots below the heart. Having rushed upward, Yang Qi must eventually retreat downward. Upon retreating, heat appears in the inner thighs, interacting with Yin. This inevitably causes mental obscurity and bodily insensibility, yet death does not ensue. This is called Shi Jue (Corpse-Jue). One should puncture Qimen to unblock knotted blood and Juque to move Zong Qi, so that the Jue state reverses and revival occurs.
Phonetic Notations
Zhe: Zhishè qiē. Die: Yīn dié. Shū: Yīn shū. Ài: Yú gài qiē. Piē: Pǐ miè qiē. Yíng: Yú róng qiē. Luǎn: Lú guǎn qiē. Hùn: Hú kùn qiē. Yín: Yú jīn qiē. Tì: Yīn dì. Jiǎo: Zǐ yóu qiē. Zhěn: Zhī rěn qiē. Jiā: Yīn jiā. Lài: Lì dài qiē.