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(The pulse) has already manifested, therefore the disease will resolve spontaneously without treatment. (Wu, pronounced Wu.) The Kidney pulse is small, rapid, and urgent; the Liver pulse is small, rapid, and urgent; the Heart pulse is small, rapid, and urgent, and does not beat vigorously (lacks a drumming sensation); these are all Jia masses (abdominal masses). These three pulses are small and rapid, completely lacking any sense of being large and vigorous, indicating that Yin pathogens are gathering in the Yin divisions; thus, Jia masses should form according to the locations of these three meridians.) When both the Kidney and Liver pulses are deep, it is Shishi water retention (Stone Water); when both are floating, it is Fengshui wind-water edema. (This discusses the Yin and Yang aspects of water diseases. The Kidney and Liver are located in the lower part; the Liver governs Wind, and the Kidney governs Water. If both Kidney and Liver pulses are deep, it is a Yin-within-Yin disease, leading to Shishi water retention. Shishi water retention refers to coagulation in the lower abdomen, heavy and hard in the lower part. If both Kidney and Liver pulses are floating, it is a Yang-within-Yin disease, leading to Fengshui edema. Fengshui edema wanders through the four limbs and floats superficially in the upper part.) If both the Kidney and Liver pulses are deficient, it is a death sign. (The Kidney is the root of the five Zang organs, and the Liver is the master of generation. With an empty root, there is exterior without interior, hence death.) If both the Kidney and Liver pulses are small and wiry, the patient desires to be startled. (Small pulses in the Kidney and Liver indicate deficiency of True Yin. Smallness combined with wiriness indicates Wood pathogen excess. Qi deficiency leads to gallbladder timidity, hence the desire to be startled.) Large, rapid, and deep pulses in the Kidney, and large, rapid, and deep pulses in the Liver, are all Han diseases (Hernias). (Han disease is caused by cold pathogen aggregation. A rapid pulse indicates involvement of the Liver pathogen; a deep pulse indicates the disease is in the Yin division. Deep, rapid, and large pulses indicate excessive Yin pathogen. The Kidney and Liver meridians connect to the lower abdomen and knot at the genitalia; where cold pathogen resides, Han disease occurs. Note: Han disease is a syndrome of cold clamping the Liver pathogen, which may knot in the lower abdomen, testicles, or around them, causing tendon urgency and colic pain. Pulses are often rapid and forceful because cold pathogen aggregates in the Yin division and clamps the Wind-Wood qi. For example, Lung Wind-Han and Spleen Wind-Han both contain the character "Wind," indicating they must involve the Liver pathogen. Gao, pronounced Gao, refers to the scrotum.) A Heart pulse that is slippery, rapid, and urgent indicates Heart Han; a Lung pulse that is deep and forceful indicates Lung Han. (In Han disease, a slippery, rapid, and urgent Heart pulse means cold clamping the Liver pathogen invades the Heart; a deep and forceful Lung pulse means cold clamping the Liver pathogen invades the Lung.) Urgent pulses in the Three Yang meridians indicate Jia masses; urgent pulses in the Three Yin meridians indicate Han disease. (Three Yang refers to the Hand and Foot Taiyang meridians. Three Yin refers to the Hand and Foot Taiyin meridians. Pathogens aggregating in the Three Yang form Jia masses; pathogens aggregating in the Three Yin form Han Qi. Whenever pulses are urgent, it indicates pathogen excess. The previous text mentioned Liver, Kidney, Heart, and Lung; this one mentions the Spleen meridian, showing that all five Zang organs can have Han disease.) Urgent pulses in the Two Yin meridians (Shaoyin) indicate Epileptic Convulsion (Xianjue); urgent pulses in the Two Yang meridians (Yangming) indicate Fright (Jing). (Two Yin refers to Shaoyin. Two Yang refers to Yangming. Urgent pulses are due to Wind-Cold; pathogens invading Heart and Kidney cause Epilepsy and Convulsion. Wood pathogen invading Stomach causes Fright, as Earth fears Wood.) An external beating but internal deep Spleen pulse indicates Changpi (Intestinal Dysentery), which will resolve on its own after a long time. (Deep indicates disease in the interior; combined with external beating, the pathogen is not deep. Although it is Changpi, it will resolve on its own. Changpi refers to dysentery. All Zang organs—Heart, Liver, Spleen, Kidney—govern the Yin division. Whether injured by Cold-Damp or Heat, blood flows from the large intestine, all called Changpi. Pi, pronounced Pi.) A small and slow Liver pulse indicates Changpi, which is easy to treat. (If the Liver pulse is rapid and large, the pathogen is excess and difficult to cure; now the pulse is small and slow, indicating light pathogen, hence easy to treat.) A small, forceful, and deep Kidney pulse indicates Changpi with bloody stool. If the blood is warm and the body is hot, it is a death sign. (The Kidney is in the lower part, so its pulse is naturally deep. If small and forceful, it indicates insufficient Yin Qi allowing Yang pathogen to invade, causing Changpi with bloody stool. If the blood is warm and the body hot, it indicates excess pathogenic fire and loss of True Yin, hence death.) Bleeding from the collaterals of the Heart and Liver also involves bloody stool; if these two Zang organs are diseased together, it is treatable. (The Heart generates blood, and the Liver stores blood, so their collaterals bleed, not just the Kidney. However, Heart and Liver share the same Qi (Wood and Fire), so simultaneous disease is favorable and treatable; if Liver and Spleen are diseased together, it is Earth failing and Wood attacking, which is clearly difficult to treat.) A small, deep, and choppy pulse indicates Changpi. If the body is hot, it is a death sign; death occurs if heat persists for seven days. (Small, deep, and choppy Heart and Liver pulses indicate Yin insufficiency and blood injury, causing Changpi. However, a deep and fine pulse should not present with heat. Now, a small pulse with body heat is adverse, hence death. Death on the seventh day of heat indicates the exhaustion of the Six Yin energies.) A Stomach pulse that is deep, beating, and choppy; a Stomach pulse that beats externally and is large; and a Heart pulse that is small, firm, and urgent—all indicate Ge obstruction and Pianku hemiplegia. (Deep, beating, and choppy indicates insufficient Yang. External beating and large indicates injured Yin. Small, firm, and urgent indicates excessive Yin pathogen. The Stomach is the sea of water and grain; the Heart is the master of blood vessels. With injured Stomach Qi and diseased blood vessels, upper and lower blockage and hemiplegia result.) In men, onset on the left; in women, onset on the right. If there is no aphasia and the tongue moves, it is treatable, recovering in thirty days. (For men, left is adverse, right is favorable; for women, right is adverse, left is favorable. Hemiplegia starting on the left in men and right in women is an adverse syndrome. If voice is clear and tongue moves, although meridians are adverse, the Zang organs are not severely damaged, so it is treatable and recovery occurs within one month. If hemiplegia is accompanied by aphasia, it is due to internal exhaustion of Kidney Qi, and the disease is severe. For example, internal depletion and厥 lead to aphasia and paralysis, which is Kidney deficiency, as the Kidney meridian passes through the throat and surrounds the tongue base.) Those who are favorable but have aphasia recover in three years. (If men develop symptoms on the right and not left, and women on the left and not right, it is called favorable. Favorable means compliant. However, if the syndrome is favorable but the voice is hoarse, it is mild externally but severe internally, requiring three years for recovery.) Those under twenty years old die within three years. (At an age when Qi and Blood are robust, seeing hemiplegia and disability indicates insufficient congenital endowment and signs of premature decline; death occurs within three years.) A pulse that is pounding, accompanied by nasal bleeding and body heat, is a death sign. A pulse that is suspended, hooked, and floating is a normal pulse. (Pounding pulses are wiry and strong, most taboo for Yin deficiency. In all diseases involving blood loss and nasal bleeding, if the pulse is pounding and the body is hot, it indicates collapse of True Yin, hence death. However, blood loss syndromes often involve Yin deficiency, and Yin deficiency pulses are often floating and large. Thus, suspended, hooked, and floating is the normal pulse for such cases, not a cause for worry. Suspended means neither high nor low, neither floating nor deep, like an object hanging in space, indicating that although the pulse is floating and hooked, it has not lost the harmonious Qi.) A pulse that comes like panting is named Baojue (Sudden Fainting). Patients with Baojue do not know how to speak to others. (Panting refers to急促 breath, indicating urgency. Baojue refers to sudden厥逆 and loss of consciousness.) A pulse that appears rapid causes sudden fright in the person; it resolves on its own in three to four days. (Rapid pulses govern Heat, but a pulse appearing rapid is not truly rapid. It is likely due to sudden stirring of Liver and Heart Fire, causing sudden fright. Since the pulse is not truly rapid, it self-resolves as the Qi subsides in three to four days.)

A pulse that is floating and merging (Fuhe), resembling a rapid pulse, with more than ten beats per respiration, indicates insufficiency of Jing Qi. If seen slightly, death occurs in ninety days; (The following all discuss the timing of death. Fuhe resembles merging waves, one urging the other, fluctuating unpredictably. More than ten beats per respiration looks like a rapid pulse but is not actually a Heat-rapid pulse; it indicates exhaustion of Jing Qi. Wei jian means first seen. Seeing this pulse initially predicts death in ninety days; if seen for a long time, death may occur sooner. The ninety-day period accounts for seasonal changes, Heavenly Dao variations, and human Qi adaptation. Yu is synonymous with Yu, meaning alliance/support.) A pulse like burning firewood indicates deprivation of Heart Essence; death occurs when grass dries. (Like burning firewood, coming sharp like flame and going fast like extinction, this is a rootless pulse of the Fire organ, indicating deprivation of Heart Jing Qi. Summer Fire prosperity can still support it, but death occurs when grass dries, marking the exhaustion of Yang.) A pulse like scattered leaves indicates deficiency of Liver Qi; death occurs when tree leaves fall. (Scattered leaves mean floating and rootless, indicating severe Liver Qi deficiency with no convergence. Leaf falling represents Metal overcoming Wood failure, the time of Liver death.) A pulse like a visiting guest (Shengke), where the pulse is blocked yet beating, indicates insufficiency of Kidney Qi; death occurs when jujube flowers bloom and fall. (Shengke resembles a visiting guest, coming and going. Blocked means stopping; beating means pulsating. This indicates unstable Kidney origin without mastery. After jujube flowers is early summer. Xuan refers to blooming, Qu refers to falling. At the time of jujube flower bloom and fall, Fire is prosperous and Water fails; those with Kidney deficiency die.) A pulse like pill-shaped mud indicates insufficiency of Stomach Essence; death occurs when elm pods fall. (Pill-shaped mud implies hardness, shortness, and roughness, indicating insufficiency of Stomach Jing and Middle Qi. Elm pods are elm seeds. They fall in late spring when Wood is prosperous; Earth failure leads to death.) A pulse like a horizontal grid indicates insufficiency of Gallbladder Qi; death occurs when grains ripen. (Horizontal grid resembles a crossbar, long and firm under the finger, representing the true Zang pulse of Wood and insufficiency of Gallbladder Qi. Grains ripen in autumn when Metal commands; Wood failure leads to death.) A pulse like a string and thread indicates insufficiency of Bao (Uterus) Essence. The patient speaks excessively; death occurs at frost, but if silent, it is treatable. (String and thread resemble the urgency of a string and fineness of a thread, a pulse of True Yuan depletion. Bao refers to the uterus. Mingmen gathers Yuan Yang. The Bao meridian connects to the Kidney, and the Kidney meridian connects to the tongue base. Bao Qi insufficiency should result in silence and stillness. Excessive speech indicates Yin not storing and Deficient Yang revealing externally. At frost, Deficient Yang collapses and death occurs. Silence indicates Kidney Qi is still, so it is treatable.) A pulse like pouring lacquer (Jiaoqi), moving from left and right sides, indicates slight appearance; death occurs in thirty days. (Jiaoqi resembles intersecting poured lacquer. Left and right movement is tangled and unclear. Wei jian means first seen. Thirty days marks the change of the lunar month; Yin-Yang partial collapse lasts no more than one month.) A pulse like a gushing spring, floating and beating in the muscles, indicates insufficiency of Taiyang Qi, shortness of breath, and death when eating chive flowers. (Gushing spring rises without descending, floating and beating in muscles, indicating insufficiency of Foot Taiyang Bladder Qi. Bladder belongs to Three Yang and governs the exterior. Now exterior is solid and interior is empty, Yin Essence is insufficient, causing shortness of breath. Death occurs when eating chive flowers because winter ends and spring begins, and Water Qi gradually declines.) A pulse like crumbling earth, unobtainable upon pressure, indicates insufficiency of Muscle Qi; if black color appears first and white Lei erupts, death occurs. (Crumbling earth is void, large, and weak, unobtainable on pressure. Muscle Qi is Spleen Qi, as Spleen governs muscles. Black is the color of Water; extreme Earth failure allows Water to overcome it, hence death. Lei is synonymous with Feng. There are five types of Lei; White Lei erupts in Spring when Wood is prosperous, and Earth should fail.) A pulse like a uvula (Xuanyong), floating and pressing, becoming larger upon palpation, indicates insufficiency of the Twelve Shu points; death occurs when water freezes. (Uvula is the fleshy pendant in the throat. Floating and pressing, becoming larger, indicates floating, short, isolated, having up but no down. Shu points are on the back, connected to the Qi of the Twelve Meridians and Zang organs. Death when water freezes indicates excessive Yin and isolation of Yang. Chuai means striking water. Shu, pronounced Shu.) A pulse like a recumbent knife (Yandao), where superficial palpation is small and urgent, and deep palpation is firm, large, and urgent, indicates Five Zang stagnation heat, with Cold-Heat combining exclusively in the Kidney. Such a person cannot sit; death occurs at Lichun (Start of Spring). (Recumbent knife: superficial feels like the blade edge, deep feels like the blade back. Five Zang stagnation heat causes Cold-Heat. Yang prosperity consumes Yin, so it combines exclusively in the Kidney. The waist is the mansion of the Kidney; with Kidney Yin deficiency, one cannot rise or sit. At Lichun, Yang is prosperous and Yin declines daily, hence death.) A pulse like a pill, slippery and not straight to the hand (unobtainable upon pressure), indicates insufficiency of Large Intestine Qi; death occurs when jujube leaves grow. (Like a pill, short and small. Zhi means appropriate. Slippery, small, and rootless cannot withstand pressure. Large Intestine corresponds to Geng Metal. Jujube leaves grow in early summer when Fire is prosperous and Metal declines, hence death.) A pulse like a flower causes fear, unwillingness to sit or lie, walking and standing while listening constantly, indicating insufficiency of Small Intestine Qi; death occurs in late autumn. (Like a flower, light, floating, and weak. Small Intestine belongs to Bing Fire, exterior-interior with Heart. Small Intestine insufficiency allows Qi to connect to Heart. Fear and restlessness indicate Heart Qi timidity. Constant listening while moving indicates fear generating doubt. Bing Fire enters the tomb at Xu, hence death in late autumn.)

Form full but pulse thin, with shortness of breath insufficient for respiration, is critical. (Full form with thin pulse and shortness of breath indicates excess outside and deficiency inside, lush branches but empty root, hence near death.) Form emaciated but pulse large, with much Qi in the chest, is death. (Emaciated form with large pulse and excess Qi in chest indicates Yin deficiency and Yang excess. With Yin form destroyed, solitary Yang cannot remain alone, hence death.) When Form and Qi are compatible, life prevails. (Appearance is Form, Yin; operation is Qi, Yang. Yin governs stillness, Yang cannot exist without Yin. Yang governs movement, Yin cannot generate without Yang. Injury resides in Qi, Qi moves Form. Yin and Yang should harmonize and not lose each other. Full form with large pulse, emaciated form with thin pulse are both compatible. Compatibility brings life; the opposite brings danger.) Sanwu irregularity indicates disease. (San refers to comparing three, Wu refers to classifying five, called irregular. Any pulse varying in size or speed, coming and going without constant measure, is a disease pulse.) If all Nine Palpations are inconsistent, death occurs. (Nine Palpations losing their norm leads to death.) If pulses above, below, left, and right correspond like pestle pounding, disease is severe; if they are inconsistent and uncountable, death occurs. (Above, below, left, right refer to the Nine Palpations with left and right sides. Pestle pounding means numerous and beating, like a pestle, an extreme Yang pulse, hence "severe disease." Even more so, if breath and pulse counts are lost and uncountable, death is certain. One exhalation with two beats, one inhalation with two beats is "normal"; three beats is "departed from meridian"; four beats is "essence depletion"; five beats is "death"; six beats is "life end." Now inconsistency and uncountability exceed five or six beats, inevitably fatal. Chong, pronounced Chong.) If the Middle Pulse is uniquely regular but inconsistent with other Zang organs, death occurs; if the Middle Pulse decreases, death occurs. (Three parts: Head (Upper), Hand (Middle), Foot (Lower). If Middle pulse is regular but Head and Foot pulses are abnormal, death occurs. If Middle pulse is weaker than Upper and Lower, Middle Qi is greatly declined, also fatal.) Eyes sunken inward indicate death. (Essence of Five Zang and Six Fu organs ascends to the eyes. Sunken eyes indicate collapse of Yang Essence, hence fatal.) Press with the left hand five cun above the ankle, and strike the right foot at the ankle. (Collaterals of hands and feet can be tested. Above hand ankle is Hand Taiyin Lung collateral; above foot ankle is Foot Taiyin Spleen collateral. Lung stores Qi and governs regulation; Spleen belongs to Earth and governs irrigation, so they can be used to observe auspiciousness and inauspiciousness.) If the response exceeds five cun and feels like creeping insects (Ruru), there is no disease. If the response is rapid and feels turbid (Hunhun) in the hand, there is disease. If it feels slow (Xuxu), there is disease. If the response does not reach five cun, or striking elicits no response, death occurs. (Response means movement. Response exceeding five cun indicates abundant Qi and pulse. Ruru describes insect-like motion, smooth and harmonious, a non-disease pulse. Ji means rapid. Hunhun means turbid and chaotic. Xuxu means slow. Not reaching five cun indicates declining Qi and pulse; no response indicates exhausted Qi and pulse. Mild is disease, severe is death. Ru, pronounced Ru.) Therefore, flesh-shedding with heavy body unable to move indicates death. (Spleen and Stomach exhaustion causes muscle wasting; Liver and Kidney failure causes bone and tendon fatigue. Flesh shedding and heaviness mark the approach of death. Bu qu zhi means inability to move.) Irregularly sparse and rapid pulses in the Middle indicate death. (Middle refers to pulses of both hands. Irregular sparsity and rapidity indicate collapse and chaos of Qi and pulse, hence death.) A Dai (intermittent) and Gou (hooked) pulse indicates disease in the Collateral vessels. (Dai and Gou correspond to Summer Qi, and Summer Qi resides in the collaterals.) The correspondence of the Nine Palpations should be uniform, upper and lower not losing each other. (Uniformity means size and speed should be peaceful.) One palpation lagging indicates disease; two lagging indicates severe disease; three lagging indicates critical disease. "Lagging" means responses are not simultaneous. (Non-simultaneous response means pulse loses norm, disorderly and unnatural.) Observe the Zang and Fu organs to know the timing of death and life. (Timing is known by observing overcoming, harming, generating, and prospering.) One must first know the Jing (Meridian) pulses, then know the Disease pulses. (Jing are normal pulses; Disease are changed pulses. Without knowing the normal, one cannot know the changed.) Appearance of True Zang pulses leads to death at the time of their overcoming element. (Death by overcoming means dying at the time when the element overcomes the diseased organ, e.g., Liver appearing on Geng/Xin days, Spleen on Jia/Yi days.) Exhaustion of Foot Taiyang Qi causes inability to flex or extend the legs; death presents with upward staring eyes (Daiyan). (Foot Taiyang meridian goes down to popliteal fossa, penetrates inner leg, exits behind lateral malleolus; goes up from inner canthus, with a branch entering brain, connecting to eye roots, named "Eye System". Thus, Taiyang Qi exhaustion causes blood dryness and tendon urgency, leg immobility, and upward staring eyes. Daiyan means eyes looking up and staring. Zhuan, pronounced Zhuan. Deng, pronounced Deng.) If all Nine Palpations are deep, thin, suspended, and cut off, it is Yin, governing Winter, so death occurs at midnight. If they are surging, restless, panting, and rapid, it is Yang, governing Summer, so death occurs at noon. (Midnight is Winter of the day, Yin ends and Yang generates, so extreme Yin dies. Noon is Summer of the day, Yang ends and Yin generates, so extreme Yang dies.) Therefore, patients with Cold-Heat diseases die at dawn. (Dawn is Spring of the day, half Yin and half Yang, so Cold-Heat patients die during the transition of Yin and Yang.) Patients with Heat-in-the-Middle and Heat diseases die at noon. (Yang assists Yang, exhausting True Yin.) Patients with Wind diseases die at dusk. (Dusk is Autumn of the day. Wind and Wood share Qi, dying when Metal arrives.) Patients with Water diseases die at midnight. (Hai and Zi generate Wang, pathogen reaches extremity.) Pulses that are alternately sparse and rapid, slow and quick, indicate death during the Four Seasons of the Day. (Irregular pulses indicate central emptiness and lack of mastery. The Four Seasons of the Day are Chen, Xu, Chou, Wei. These are tombs of the Five Elements, so failing organs die when encountered.) If flesh and form are already shed, even if Nine Palpations are regular, death occurs. (Spleen governs muscles and is the root of Five Zang. No one survives Spleen Qi exhaustion, so even regular Nine Palpations lead to death.) If Seven Diagnoses are seen but Nine Palpations are compliant, death does not occur. (Compliant means following the seasons and meridian norms. Even with unique large or small pulses, it is not fatal.) The said non-death conditions apply to Wind diseases and Menstrual diseases, which resemble Seven Diagnosis diseases but are not, hence declared non-fatal. (Wind is Yang disease; occasional wind invasion makes Yang branch pulses large or rapid. Menstruation is a regular cycle; blood loss makes Yin branch pulses small, slow, or depressed. These resemble Seven Diagnosis pulses but are not, so death is not predicted. However, non-exterior contraction or menstrual diseases presenting Seven Diagnosis pulses are not auspicious.) If there are Seven Diagnosis diseases and the pulse condition also fails, death occurs,必定发哕噫 (must experience hiccups and belching). (Wind and Menstrual diseases are not of the Seven Diagnosis type; if the pulse and symptom condition truly fails...)