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(This condition) does not belong to the category of inevitable death. However, if the patient dies, it will inevitably be accompanied by hiccups (eh-ni, hiccupping/reflux of stomach qi) and belching (ai-qi, belching/eructation). Hiccups originate from the Stomach, indicating the failure of Earth Qi; belching originates from the Heart, indicating the excess of Yin pathogenic factors. (Hiccups, pronounced "jue," refer to the symptom of qi rebelling upward, i.e., hiccupping. Belching, pronounced "yi" or "ai," refers to the sound emitted when gas rises from the stomach through the throat after a full meal.) One must carefully inquire about the initial onset of the disease and the symptoms currently manifesting, then palpate their pulses individually, observing the floating and sinking changes in the meridians and collaterals, thereby deducing the direction and compliance of the pathogenic qi from top to bottom. (The method of diagnosing diseases requires asking about the initial cause to investigate the origin of the illness, and seeking current symptoms to assess the present diagnostic picture. Once the root and branch are clear, one then palpates the pulse, integrating whether the pathogen is in the Jing-mai or Luo-collaterals, whether the pulse is floating or sinking, and the upward/downward rebellion or compliance of the qi, treating each according to its sequence.) A rapid and forceful pulse does not necessarily indicate disease; a slow and sluggish pulse indicates disease; a pulse that ceases to flow indicates death; skin that withers and adheres tightly to the bones also indicates death. (Rapid and forceful indicates strong Yuan Qi and spiritual presence; slow and sluggish indicates Qi deficiency and insufficiency. If the pulse ceases to flow, it means both Yin and Yang Qi have exhausted. Skin withering and adhering to bones indicates blood depletion, where the skin is dry, atrophied, and attached to the bone.) For diseases of the Jing-mai (Primary Meridians), treat the Jing-mai; (Jing-mai are deep, while branching horizontal vessels are called Luo-collaterals. Treating the Jing-mai means needling directly along the meridian.) For diseases of the Sun-luo (Branch Collaterals), treat the blood of the Sun-luo. (Small collaterals are called Sun-luo, which are branches of the Luo-collaterals floating on the skin surface. When needling collaterals, one should quickly select points to drain pathogenic factors and release blood; retaining needles too long may lead to Bi-syndrome, hence "treating the blood.") For blood diseases accompanied by body pain, treat the Jing-mai and Luo-collaterals. (Blood diseases causing body pain are not limited to Sun-luo but also involve stagnation in the Jing-mai. One should needle along the respective meridians.) For diseases caused by Qi-xie (Abnormal Pathogens), where the pulse is abnormal, apply Miao-stimulation (Mirrored Needling). (Qi-xie refers to pathogens that do not enter the Jing-mai but affect the Luo-collaterals. Pathogens lodging in large collaterals shift from left to right and right to left, with no fixed location, thus requiring Miao-stimulation.) For lingering emaciation where the disease site does not move, needle at the joints. (Lingering refers to pathogenic stagnation; emaciation refers to physical wasting; non-moving refers to a fixed location. For pathogens lingering for a long time without moving, there is likely accumulation between the eight溪 (valleys/creeks) of the four limbs; thus, one should seek and needle at the joint intersections to expect recovery.) For upper excess and lower deficiency, palpate the pulse and follow the meridian qi to locate, find obstructed collaterals, needle them to release blood, thereby restoring circulation. (Upper excess and lower deficiency indicate an obstruction; thus, one must palpate the pulse to find the cause, follow the meridian to select points, locate obstructed collaterals, needle them to release blood, and once the obstruction is removed, patency will be restored.) High gaze (eyes looking upward and unable to look down) indicates Taiyang insufficiency; Dai-yan (eyes staring straight up and fixed) indicates Taiyang exhaustion. This is the key to determining life and death and must be carefully examined. (High gaze refers to eyes looking upward. Dai-yan refers to extreme upward gazing that is fixed and immobile. This reiterates the symptoms of Foot-Taiyang Bladder Meridian and distinguishes their severity to determine prognosis.) Pulses have Yin and Yang aspects; knowing Yang allows one to know Yin, and knowing Yin allows one to know Yang. (Understanding the nature of Yang pulses enables the observation of Yin pulses, and vice versa. Yang contains Yin, appearing Yang but not purely Yang; Yin contains Yang, appearing Yin but not purely Yin. Detailed differentiation is required; misjudgment can be fatal.) Generally, there are five Yang pulses, and five times five make twenty-five Yang pulses. (Yang refers to the Yang of the Wei-wan (epigastrium), i.e., Stomach Qi. Five refers to the pulses of the Five Zang organs: Liver [Xian/String-like], Heart [Gou/Hook-like], Spleen [Dai/Alternating], Lung [Mao/Feather-like], Kidney [Shi/Stone-like]. Each Zang organ exhibiting five pulse qualities constitutes mutual visibility among the Five Zang, termed twenty-five pulses. However, all Zang pulses must possess Stomach Qi; hence "Five Yangs," and the twenty-five pulses are the twenty-five Yangs.) The so-called Yin pulse refers to the Zhen-Zang pulse (True Organ Pulse); its appearance indicates organ failure, and failure leads to death. (Yin means the absence of Yang. Absence of Yang means the absence of Yangming Stomach Qi, leaving only the isolated Yin pulse of the primary organ, such as exclusively Xian or exclusively Gou pulses. This is called Zhen-Zang pulse, indicating Stomach Qi failure, hence death.) The so-called Yang pulse refers to the Yang of the Wei-wan. (The Stomach belongs to the Yangming channel. The Yang of the Wei-wan refers to the warm Yang Qi within the Stomach, i.e., Stomach Qi, which serves as the foundation for the Five Zang organs. Thus, humans without Stomach Qi are said to have Ni-reversal, and reversal leads to death; similarly, pulses lacking Stomach Qi also indicate death.) Differentiating Yang allows one to know the location of the disease; differentiating Yin allows one to know the timing of death. (Being able to differentiate the harmonious Stomach Qi reveals the disease location upon any disharmony; being able to differentiate the pure Yin Zhen-Zang pulse reveals the timing of death based on generative and controlling cycles.) The Three Yang meridians are located at the head, and the Three Yin meridians are located at the hand; this is referred to as unity. (Three Yang at the head refers to the Renying point. Three Yin at the hand refers to the Qikou point. The previous section discussed Yin and Yang via Zhen-Zang and Stomach Qi; this section discusses them via Renying and Qikou. The former concerns pulse quality, the latter pulse position; they corroborate each other, hence "unity.") Differentiating Yang allows one to know the contraindicated times for the disease; differentiating Yin allows one to know the timing of death. (This is slightly similar to the previous section but restated because the former used Zhen-Zang and Stomach Qi, while this uses Yin-Yang and Exterior-Interior. Both meanings are related and indispensable. Contraindicated times refer to the waxing and waning of Qi and specific times when the disease is aggravated.) Carefully master the principles of Yin and Yang, and do not consult with others. (The principles of Yin and Yang must be mastered thoroughly, hence "carefully"; unique insight is unknown to the masses, hence "do not consult.") The so-called Yin and Yang in pulses: departure is Yin, arrival is Yang; stillness is Yin, movement is Yang; slowness is Yin, frequency is Yang. (The Yin and Yang of pulses are summarized thus. Obtaining Yang pulses indicates life; obtaining Yin pulses indicates death; this is the essence.)

Great bones withered, great muscles sunken, chest full of Qi, difficult breathing, movements causing the body to tremble, expected death in six months; if Zhen-Zang pulses appear, assign a specific date of death. (Great bones and great muscles refer to the whole body: shoulder, spine, waist, knees are great bones; forearm skin and buttock muscles are great muscles. Drooping shoulders, tilted neck, heavy waist, failing knees indicate withered great bones; thinned forearm skin and withered buttocks indicate sunken great muscles. Kidneys govern bones; bone withering means Kidney failure. Spleen governs flesh; muscle sunken means Spleen failure. Lungs govern Qi; chest fullness and panting mean Lung failure. Qi fails to return to its source, body trembles, solitary Yang floats externally while True Yin is deficient. Deficiency of Three Yin leads to death within six months. Six months represents the cycle of Yin-Yang transformation in a year. If Zhen-Zang pulses have already appeared, the six-month rule does not apply; death can be predicted based on days of elemental overcoming.)

Great bones withered, great muscles sunken, chest full of Qi, difficult breathing, internal pain radiating to shoulders and neck, expected death in one month; if Zhen-Zang pulses appear, assign a specific date of death. (Internal pain radiating to shoulders and neck indicates the disease has affected the Heart meridian, which is more severe than before, leading to death in one month. One month corresponds to the shift of the Dipper star and change of Qi.) Great bones withered, great muscles sunken, chest full of Qi, difficult breathing, internal pain radiating to shoulders and neck, body heat, flesh shedding, skin cracking revealing bones, Zhen-Zang pulses appear, death within ten days. (Body heat indicates Yin Qi departure; flesh shedding indicates complete muscle loss; skin cracking revealing bones indicates prolonged recumbency leading to bone exposure and muscle decay. This indicates injury to all Five Zang organs with Zhen-Zang pulses, leading to death within ten days. Ten days correspond to the completion of the Heavenly Stems and change of the ten-day period. Cou-li refers to areas where muscles and sinews gather, such as lumps behind elbows and knees.)

Great bones withered, great muscles sunken, marrow internally consumed, motor function increasingly declining, Zhen-Zang pulses not yet seen, expected death in one year; if Zhen-Zang pulses appear, assign a specific date of death. (Bone withering and muscle sunken indicate Spleen and Kidney deficiency; combined with internal marrow consumption and declining motor function, although not all signs are present and Zhen-Zang pulses are absent, the signs of collapse are evident. It can only support one year until the year ends and new Qi arises, unable to recover. If Zhen-Zang pulses appear, death can be definitively predicted.) Great bones withered, great muscles sunken, chest full of Qi, abdominal pain, heart discomfort, shoulder/neck/body heat, skin cracking, flesh shedding, eye sockets sunken, Zhen-Zang pulses appear, eyes cannot see people, immediate death; if eyes can still see people, death occurs at the time of elemental overcoming. (All signs of Zang organ failure are present, eye sockets are sunken, Zhen-Zang pulses appear, and eyes cannot see people, indicating Shen-spirit has departed, hence immediate death. If eyes can still see people, Shen-spirit remains, so death waits for the overcoming time.) Sudden invasion of Ji-Xu (Acute Deficiency), where the body is struck abruptly, Five Zang orifices close, pulse channels block, Qi ceases to flow, resembling falling or drowning, making prediction impossible. If the pulse cuts off completely, or if the pulse beats five to six times per breath, even if flesh is not shed and Zhen-Zang pulses are not seen, it is still death. (Ji-Xu refers to sudden severe injury to Yuan Qi, so pathogens strike abruptly like falling or drowning, unpredictable. Pulse cessation or excessive rate (5-6 beats per breath) indicates Zang Qi exhaustion and impending death, regardless of flesh condition or Zhen-Zang pulses.)

True Liver pulse arrives, tense inside and out, like touching a knife edge, sharp and piercing, like pressing a zither string, complexion blue-white and dull, hair breaks before death; (Below describes Zhen-Zang pulses. The True Liver pulse like a knife edge or zither string indicates thin, tense, and firm quality, not the normal mild String pulse. Blue is Wood color; accompanying white and dullness indicates Metal overcoming Wood. All Zang organs typically die when hair breaks, as skin/hair depend on Blood/Qi; hair breaking indicates Essence depletion.) True Heart pulse arrives, hard and beating, like touching Coix seeds, grain-like, complexion red-black and dull, hair breaks before death; (Hard and beating like Coix seeds indicates short, solid, and firm quality, not the normal mild Hook pulse, constituting the True Heart pulse. Red is Fire color; accompanying black and dullness indicates Water overcoming Fire, hence death.) True Lung pulse arrives, large and empty, like feathers brushing human skin, complexion white-red and dull, hair breaks before death; (Large and empty like feathers brushing skin indicates extreme floating and weakness, not the normal mild Feather pulse, constituting the True Lung pulse. White is Metal color; accompanying red and dullness indicates Fire overcoming Metal, hence death.) True Kidney pulse arrives, beating strongly and seemingly cutting off, like fingers snapping stones, crackling, complexion black-yellow and dull, hair breaks before death. (Beating strongly and seemingly cutting off indicates intense pulsation, like snapping stones, crackling, deep and firm, not the normal mild Stone pulse, constituting the True Kidney pulse. Black is Water color; accompanying yellow and dullness indicates Earth overcoming Water, hence death.) True Spleen pulse arrives, weak and intermittently fast and slow, complexion yellow-green and dull, hair breaks before death. (Weak and intermittent fast/slow lacks all harmony, not the normal mild Alternating pulse, constituting the True Spleen pulse. Yellow is Earth color; accompanying green and dullness indicates Wood overcoming Earth, hence death.) All appearances of Zhen-Zang pulses indicate death and incurability. (Absence of Stomach Qi is named Zhen-Zang; all are incurable pulses.) The Five Zang organs all derive Qi from the Stomach; the Stomach is the root of the Five Zang. Zang Qi cannot reach the Hand-Taiyin Lung meridian on its own; it must rely on Stomach Qi to arrive at the Hand-Taiyin. (Food enters the Stomach and transmits to the Lung; all Five Zang and Six Fu organs receive Qi from it. Thus, Zang Qi must rely on Stomach Qi to reach the Hand-Taiyin, where the pulse manifests at the Qikou. This is why Zang pulses rely on Stomach Qi as their master.) Therefore, the Five Zang organs manifest themselves in their respective seasons and reach the Hand-Taiyin. (Manifesting in their respective seasons, e.g., Spring showing only String pulse, Summer showing only Hook pulse, indicates the Five Zang operating without Stomach Qi, i.e., appearance of Zhen-Zang pulses.) Therefore, when pathogenic factors prevail, Essence-Qi declines. In severe illness, Stomach Qi cannot accompany Zang Qi to the Hand-Taiyin, so Zhen-Zang Qi appears alone. Alone appearance means disease overcomes the Zang, hence death. (When pathogens are strong and Zheng Qi is exhausted, disease overcomes the Zang, so Zhen-Zang pathogens appear alone. Zhen-Zang appearing alone means Stomach Qi has failed and cannot accompany Zang Qi to the Hand-Taiyin; thus, Stomach Qi is absent from the pulse, marking a critical sign.)

For those holding Zhen pulses of the Zang organs: Liver pulse hanging and extremely tense, death in eighteen days; (Zhen pulse of the Zang organ is the Zhen-Zang pulse. Hanging and extremely tense means complete loss of harmony and abnormal String-beat. Eighteen days is the remainder of the Metal-Wood completion numbers; Metal overcomes Wood, leading to death. Death periods below follow the He Tu numerology, using either generating or completion numbers.) Heart pulse hanging, death in nine days; (Nine days is the remainder of the Fire-Water generating/completion numbers; Water overcomes Fire.) Lung pulse hanging, death in twelve days; (Twelve days is the remainder of the Metal-Fire generating/completion numbers; Fire overcomes Metal.) Kidney pulse hanging, death in seven days; (Seven days is the remainder of the Water-Earth generating numbers; Earth overcomes Water.) Spleen pulse hanging, death in four days. (Four days is the remainder of the Wood generating number; Wood overcomes Earth. These cases cannot withstand the overcoming Qi, so Zhen-Zang appears alone, Qi fails, and danger ensues.) Liver pulse appears on Geng/Xin days, death; (Geng/Xin belong to Metal, attacking Liver Wood.) Heart pulse appears on Ren/Gui days, death; (Ren/Gui belong to Water, extinguishing Heart Fire.) Spleen pulse appears on Jia/Yi days, death; (Jia/Yi belong to Wood, overcoming Spleen Earth.) Lung pulse appears on Bing/Ding days, death; (Bing/Ding belong to Fire, smelting Lung Metal.) Kidney pulse appears on Wu/Ji days, death; (Wu/Ji belong to Earth, injuring Kidney Water.) This is called Zhen-Zang appearance, all result in death.

Yin and Yang both deficient, suffering from Chang-Pi (Intestinal Dysentery), death. (Yin and Yang both deficient means Cun and Chi pulses are both weak. Chang-Pi refers to dysentery with pus and blood. Stomach Qi does not retain, Pormen (anus) loses control, and Yin/Yang deficiency indicates Zang Qi exhaustion, hence death. Slippery and large pulses indicate life; hanging and choppy pulses indicate death.) Yang added to Yin is called Sweat. (Yang refers to pulse quality, Yin refers to pulse position. Sweat fluid belongs to Yin; Yang added to Yin causes Yin Qi to leak, so Yin pulses with Yang characteristics indicate sweating.) Yin deficient, Yang pounding is called Beng (Metrorrhagia/Metrorrhea). (Yin deficient means insufficient deep pressure. Yang pounding means excessive superficial pressure. Yang excess and Yin deficiency lead to internal bleeding disorders.) Three Yin pulses all beating, death at midnight on the twentieth day; (Three Yin refers to Hand-Taiyin Lung and Foot-Taiyin Spleen. Beating refers to Zhen-Zang striking. Twenty days is the remainder of Spleen-Lung completion numbers; midnight is extreme Yin and end of Qi, hence death.) Two Yin pulses all beating, death at dusk on the thirteenth day; (Two Yin refers to Hand-Shaoyin Heart and Foot-Shaoyin Kidney. Thirteen days is the completion number of Heart-Kidney. Dusk is when Yin and Yang are equal, a time of Water-Fire conflict.) One Yin pulse all beating, death at dawn on the tenth day; (One Yin refers to Hand-Jueyin Pericardium and Foot-Jueyin Liver. Ten days is the generating number of Liver-Heart. Dawn is when Wood-Fire peak and pathogens worsen, hence death.) Three Yang pulses all beating and鼓 (drumming/pulsating), death in three days; (Three Yang refers to Hand-Taiyang Small Intestine and Foot-Taiyang Bladder. Water is 1, Fire is 2, hence death in three days. Rapid death is due to beating and drumming indicating extreme Yang pathogen excess.) Three Yin and Three Yang pulses all beating, abdominal distension fully developed, inability to pass urine/feces, death in five days; (Three Yin and Three Yang refer to Spleen, Lung, Small Intestine, Bladder. Four Zang organs beating means pathology above and below. Above: heart/abdominal distension to extreme (Fa-Jin). Below: inability to pass urine/feces, Yin pathway blocked. Four Zang diseased relies on Stomach Qi; Earth number is five; five completes, hence death.) Two Yang pulses all beating, suffering from Wen-bing (Warm Disease), incurable, death within ten days. (Two Yang refers to Hand-Mingyang Large Intestine and Foot-Mingyang Stomach. Ten days is the remainder of Gastrointestinal generating numbers. Not mentioning One Yang is not for comparison with One Yin, but likely a missing slip.)

Jing-Ming (Spiritual Clarity) and Five Colors are the splendor of Qi. (Jing-Ming is seen in the eyes; Five Colors manifest on the face; all are the essence of Five Qi. Palpating pulse dynamics, observing Jing-Ming, examining Five Colors, and cross-referencing determines the boundary of life and death.) Red desires to be like white silk wrapping cinnabar, not like hematite; (White silk wrapping cinnabar implies hidden ruddiness without exposure. Hematite is square and purple. This describes the good and bad of Fire color.) White desires to be like goose feathers, not like salt; (Goose feathers are white and bright; salt is white and dim. This describes the good and bad of Metal color.) Green desires to be like the luster of dark jade, not like indigo; (Dark jade luster is green and bright/moist; indigo is green and deep/dull. This describes the good and bad of Wood color.) Yellow desires to be like raw silk wrapping realgar, not like yellow earth; (Raw silk wrapping realgar is glossy and hidden; yellow earth color is stagnant and spiritless. This describes the good and bad of Earth color.) Black desires to be like double-lacquered color, not like earthy cyan. (Double-lacquered color is radiant and moist; earthy cyan is withered and dark like dust. This describes the good and bad of Water color.) These are all images of the subtle essence of Five Colors; ominous signs appear, lifespan is near its end. Jing-Ming is used to view all things, distinguish black and white, judge long and short. If long is seen as short, and white as black, Jing is depleted. (Essence of all Five Zang and Six Fu organs ascends to the eyes to form Jing-Ming; thus, Jing gathers and Shen is whole. If inverted and confused, Jing is depleted and Shen is weak, certainly not a sign of long-term stability!) Acupuncture has Five Orifices and Five Views to observe Five Qi. Five Qi are the messengers of the Five Zang, and the counterparts of the Five Seasons. (Acupuncture methods require knowing Zang Qi; to know Zang Qi, one must observe the Five Orifices and Five Views. View refers to external signs. Messenger refers to what is dispatched. Counterpart refers to correspondence.) Five Orifices are the windows of the Five Zang. (Five Zang are stored internally; Five Orifices manifest externally; interior and exterior correspond, hence they are windows of the Five Zang.) Pulses emerge from Qikou; colors appear at Ming-Tang (Nose). Five Colors alternate to correspond to Five Seasons, each following its norm. When Jing Qi enters the Zang, treatment must focus on the Interior. (Norms are standard practices. Zang pulses are observed at Qikou; Zang colors at Ming-Tang. Ming-Tang is the nose. Colors corresponding to seasons are normal. However, color appearing externally while disease is internal indicates Essence entering the Zang, so treatment must focus on the Interior.) Five Orifices distinguished, Que-Ting (glabella and forehead) spread open, thus establishing Ming-Tang. Ming-Tang is broad, Fan-Bi (cheek sides and ear gates) visible externally, walls high and bases firm,垂 (hanging parts) prominent outside. (This states that all parts of the Five Orifices must be detailed, not just color at Ming-Tang. Que is glabella. Ting is forehead. Zhang is spread. Fan is cheek side. Bi is ear gate. Wall is wall. Base is bone structure. Prominent outside means clearly open. This discusses the prominence of部位 (locations) beyond Five Colors.) Five Colors regulated, flat, broad, and vast, lifespan reaches one hundred years. (Excellent shape and color constitute longevity, hence suitable for living to a hundred. Regulated means orderly. Suitable means capable. Seeing such people, acupuncture will surely cure. Such people have abundant Blood-Qi and firm muscles, so they can endure bitter acupuncture (strong stimulation). (Such people have substantial Blood-Qi and firm shape/color, so acupuncture cures and strong stimulation is tolerated. Conversely, internal Blood-Qi deficiency and external shape/color weakness are unsuitable for acupuncture, and likewise for herbs. Zhi means dense/firm.) Nose is the official organ of the Lung; Eye is the official organ of the Liver; Mouth/Lips are the official organ of the Spleen; Tongue is the official organ of the Heart; Ear is the official organ of the Kidney. (Nose is Lung orifice, Eye is Liver orifice, Lips are Spleen orifice, Tongue is Heart orifice, Ear is Kidney orifice. Official refers to duty, governing respiration, distinguishing colors, accepting food/water, tasting flavors, hearing sounds. Five Zang and Five Orifices,)