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When Earth is affected by Wood pathogen, the pulse becomes tense and dynamic. The Qi of the nine orifices is governed by the Yangming channel; if Yangming disease occurs, Stomach Qi fails to circulate, causing stagnation and obstruction in all nine orifices.) When Three Yang and One Yin are involved simultaneously, the Taiyang pulse prevails, and One Yin (Liver) cannot restrain it, leading to internal chaos of the five Zang organs and external manifestations of fright and alarm; (Simultaneous involvement of Three Yang and One Yin refers to the combined disease of the Bladder and Liver channels. Liver Wood generates Heart Fire, but Bladder Cold Water insults Liver Wood, causing the Taiyang pulse to prevail. Although One Yin Liver Qi is strong, it cannot prevent this pathological change; thus, Wind-Cold combine to disrupt the five Zang internally and injure Liver Qi, resulting in diseases of fright and alarm.) When Two Yin and Two Yang are involved simultaneously, the disease is in the Lung, the Shaoyin pulse is deep, prevailing over and injuring the Lung and Spleen, affecting the limbs externally; (Two Yin refers to the Hand-Shaoyin Heart channel. Two Yang refers to the Foot-Yangming Stomach channel. Shaoyin is the organ of Heart Fire; Fire pathogen injures Metal (Lung), so the disease is in the Lung. Yangming is the mansion of Stomach Earth; Earth pathogen inevitably injures Water (Kidney), so the Foot-Shaoyin pulse is deep. "Deep" signifies weak and unvigorous Qi. However, the Stomach is the Fu organ of the Spleen, and the Spleen governs the limbs. Since Fire prevails over the Lung and the Stomach affects the Spleen, Spleen disease leads to limb disease.) When Two Yin and Two Yang arrive together, the disease is in the Kidney, characterized by cursing, erratic behavior, and mania arising from head disorders; (Arrival of Two Yin indicates pathogen in the Kidney. Arrival of Two Yang indicates pathogen in the Stomach. When Water and Earth pathogens combine, Earth prevails and Water declines. Water decline means Yin cannot control Yang, so the disease is in the Kidney; Earth prevalence means Yangming pathogen is excess, causing cursing, erratic behavior, and mania from head disorders.) When Two Yin and One Yin are involved simultaneously, the disease originates from the Kidney. Yin Qi lodges in the cardiac epigastrium, obstructing the lower orifices like a dam, causing blockage, and a sensation of separation in the limbs; (Two Yin refers to the Kidney. One Yang refers to the Sanjiao. Combined disease of Kidney and Sanjiao causes Ministerial Fire to be controlled by Water, so the disease originates from the Kidney. A branch of the Kidney meridian emerges from the Lung, connects with the Heart, and enters the chest; thus, when Yin Qi is excessive, it lodges in the cardiac epigastrium. Yin pathogen rises from below while Yang Qi fails to descend, causing the lower orifices to be blocked as if by a dam. Clear Yang nourishes the limbs; Yang deficiency renders the limbs useless, creating a sensation as if they are separated from the body.) When One Yin and One Yang show intermittent interruption, this indicates Yin Qi reaching the Heart, with irregular movement up and down and unknown entry and exit, dry throat and pharynx, with the disease located in the Earth-Spleen; (One Yin refers to the Foot-Jueyin Liver channel. One Yang refers to the Foot-Shaoyang Gallbladder channel. Intermittent interruption signifies injury to the Qi of these two organs, causing chaotic pulses. Both Liver and Gallbladder belong to Wood, which naturally generates Heart Fire. Due to Yang deficiency, Yin Qi reaches the Heart. However, Wood diseases follow Wind, moving swiftly and changing frequently, hence appearing up or down without fixed location, entering or exiting without clear cause. The dry throat and pharynx occur because the pharynx is the envoy of Liver and Gallbladder, and the Spleen meridian knots at the pharynx; thus, the disease is in the Earth-Spleen, precisely because Wind-Wood pathogen must overcome Earth.) When Two Yang, Three Yin, and Zhiyin (Spleen) are all present, Yin does not communicate with Yang, Yang cannot restrain Yin, both Yin and Yang are severed, floating pulse indicates blood mass, deep pulse indicates abscess, and if both Yin and Yang are hyperactive, the disease extends to the genitalia. (Two Yang refers to the Stomach. Three Yin refers to the Lung. Zhiyin refers to the Spleen. "All present" means all are diseased. Spleen and Stomach are exterior-interior pairs; disease here impairs digestion. Lung distributes Qi to the Zang-Fu; disease here impairs regulatory function. Thus, Yin fails to communicate with Yang, remaining solely Yin and not entering Yang aspects; Yang fails to restrain Yin, remaining solely Yang and not staying in Yin aspects. In such cases, there is no further communication, and both Yin and Yang are severed. Therefore, a floating pulse indicates an external disease manifesting as a blood mass, while a deep pulse indicates an internal disease manifesting as an abscess. This reversal of pulse and symptoms occurs because Yin-Yang and exterior-interior do not communicate. If both Yin and Yang are hyperactive, they become harmful due to excess, either as isolated Yin or isolated Yang. The disease extends to the genitalia: men have Yang pathways, women have Yin organs; dysfunction in these hidden areas constitutes major illness.) Aligning with the obvious, failing to grasp the obscure, diagnosing the timing of life and death leads to the beginning of the year. (The obvious is visible, the obscure is measurable, governed by the Way of Yin and Yang. To determine the timing of life and death, one must seek the beginning of the year. For example, in Jia and Ji years, Bing-Yin marks the start, followed by Ding-Mao in the second month, Wu-Chen in the third; in Zi and Wu years, with Sovereign Fire presiding, the first Qi is Taiyang, the second Qi is Jueyin, etc. Calculating sequentially allows one to determine the periods of waxing and waning of the Five Phases and their favorable or unfavorable timing.)
Yin-Yang, exterior-interior, above-below, male-female correspond and transmit to each other. If Three Yang arrive alone, it means the Three Yang converge. Their convergence is like wind and rain, causing head disorders above and leakage diseases below. (Three Yang arriving alone refers primarily to the Foot-Taiyang, though it includes Hand-Taiyang. Foot-Taiyang is the leader of the Three Yang; thus, when Taiyang pathogen arrives alone, the Qi of all Three Yang converges and follows. Yang pathogen arrives swiftly and unpredictably, like wind and rain. Foot-Taiyang meridian ascends to the vertex, enters the brain, descends to connect with the Kidney, and belongs to the Bladder. Hand-Taiyang meridian ascends along the neck and cheek, descends to the Stomach, and belongs to the Small Intestine. Hence, it causes vertex disorders above and leakage diseases below. Leakage diseases refer to the inability of the Two Yin to restrain, encompassing water, grain essence, and blood.) There are no external signs to anticipate, no internal names to define, deviating from standard meridians, diagnosis lacks upper-lower distinction. (With the sudden convergence of Three Yang like wind and rain, there are no external evidence to predict nor internal names to define. The progression of disease deviates from standard principles, so its manifestations lack fixed upper-lower rules.) Three Yang represents Extreme Yang. Accumulation and convergence cause fright; the disease arises like a sudden gale, becoming severe like whetstones, blocking all nine orifices, with Yang Qi overflowing, drying the throat and causing obstruction. (Taiyang is the most vigorous Yang, hence called "Extreme Yang." If various Yang energies accumulate and converge, Yang excess reaches its peak, injuring the Yin Qi of the Heart. The Yin of Hand-Taiyang is the Heart; the Yin of Foot-Taiyang is the Kidney. Injury to Heart Spirit and Kidney Will results in fright, sudden gales, and severity like whetstones—all denoting rapid violence. The dryness and obstruction of the nine orifices and throat occur because the meridians of Hand-Taiyang and Hand/Foot-Shaoyin all traverse the throat.) When merging with Yin, movements become irregular, and thinning leads to intestinal [dysentery]. (Yin refers to the Zang organs. When Yang pathogen enters from the exterior into the Zang and gathers in Yin, it moves up or down without fixed diagnosis. If it lingers and thins in the Lower Jiao, it causes intestinal dysentery.) This is referred to as Three Yang directly striking the Heart; those who cannot sit up or lie down fully exhibit Three Yang disease. (Directly striking the Heart means pathogen rushes straight to the heart diaphragm. Hand-Taiyang meridian runs along the outer arm, winds around the scapula, crosses the shoulder, enters the supraclavicular fossa, and connects with the Heart. Foot-Taiyang meridian flanks the spine, passes through the buttocks, enters the popliteal fossa; its branches scatter to the Kidney, run along the back muscles, and enter the center corresponding to the Heart. Thus, any disease where pathogen strikes the Heart directly, or where one cannot rise from sitting or lie down from rising, involves the full spectrum of Three Yang disease. Note that Three Yang pathogens mostly enter from outside; thus, Shanghan practitioners often see direct Heart strikes and inability to sit/lie. Physicians diagnosing external contractions must observe this carefully.) Disease injures the five Zang, causing bones and sinews to waste away. (Pathogen merging with Yang causes Yang disease; merging with Yin causes Yin disease. With both Yin and Yang diseased, the five Zang are injured. Internal Zang injury leads to external wasting of bones and sinews.) Kidney Qi approaches exhaustion; sorrowful until dusk, unable to move calmly, human affairs become neglected. (Kidney and Foot-Taiyang are exterior-interior, belonging to the extreme Yin organ. If Three Yang converge and injure the five Zang, essence becomes deficient and Qi exhausted, leading to wasting of bones and sinews. Furthermore, Taiyang transmitting inward must reach Shaoyin, injuring Kidney Qi and depleting True Yin. Thus, one feels perpetual sorrow and worry throughout the day, appropriately unable to move calmly and neglecting daily affairs. Therefore, when Yang pathogen arrives, harm inevitably returns to Yin; when five Zang are severely injured, it ultimately reaches the Kidney. This is what is meant by the correspondence between Yin-Yang, exterior-interior, above-below, and male-female.)
Spleen deficiency presents as floating resembling Lung; Kidney slight floating resembles Spleen; Liver tension with deep scattered pulse resembles Kidney. These are often confused by physicians. (Spleen normally has a slightly soft pulse; when diseased and deficient-floating, it resembles Lung. Kidney normally has a slightly deep pulse; when diseased and slightly floating, it resembles Spleen. Liver normally has a slightly wiry pulse; when diseased with tense, deep, and scattered qualities, it resembles Kidney. Pulses are interrelated; inability to distinguish them leads to confusion, mistaking one for another. Floating and slow indicates Spleen; floating and short indicates Lung; slightly floating and slippery indicates Heart; tense, tight, and scattered indicates Liver; forceful, deep, and slippery indicates Kidney. The pulse characteristics of the five Zang must be clearly understood.) Here is a person with headache, tendon cramping, heavy bones, timidity with shortness of breath, hiccups and belching, abdominal fullness, occasional fright, insomnia, with a floating and wiry pulse that feels hard like stone upon palpation. To understand this, for the elderly, seek the Fu organs; for the young, seek the meridians; for the vigorous adult, seek the Zang organs. (This describes the ambiguity of Kidney disease. Floating pulse resembles Lung, wiry pulse resembles Liver, stone-hard pulse resembles Kidney; differentiation is required. Elderly people often have dietary indiscretions; since the Six Fu organs receive substances, investigate the Fu organs to check for faults. Young people often suffer from Wind-Cold and fatigue; since injuries affect the meridians, investigate the meridians to check for damage. Vigorous adults often indulge in sexual desires; since the five Zang store essence, investigate the Zang organs to check for deficiency or excess.) A floating and wiry pulse indicates Kidney insufficiency. (Kidney pulse should be deep; floating indicates Yin deficiency. Water generates Wood; wiry indicates Qi leakage, hence Kidney insufficiency.) A deep and stone-like pulse indicates Kidney Qi stagnating internally. (Deep and stone-like means extremely deep and hard. Without Yang within Yin, Kidney Qi cannot penetrate, thus stagnating internally.) Timidity and shortness of breath indicate failure of water pathways and consumption of form and Qi. (Essence forms the body and transforms into Qi. Failure of water pathways leads to consumption of form and Qi, causing timidity and shortness of breath.) Coughing and distress indicate rebellious Kidney Qi. (Empty Water organ fails to nourish the mother organ of the upper orifices, causing cough and distress, indicating rebellious Kidney Qi ascending.) The Qi of one person is diseased in one Zang organ. (In this case, the disease is in the single Kidney Zang. For instance, headache is due to Water deficiency and Fire flaming; tendon cramping is because Kidney Water cannot nourish sinews; heavy bones are because Kidney governs bones; hiccups and belching are due to Kidney Qi penetrating upward through Liver diaphragm with rebellious Yin Qi; abdominal fullness is due to Water pathogen insulting Earth; occasional fright is because Kidney stores Will, and loss of Will causes fright; insomnia is due to Yin deficiency preventing eye closure. All diseases originate from the Kidney.) Here is a person with flaccid limbs, wheezing cough, and bloody discharge. Diagnosis considers Lung injury. Palpation reveals a large, floating, and tight pulse. An incompetent physician using acupuncture and stone therapy cures the disease, causing significant bleeding; once bleeding stops, the body feels light. To understand this, a large and floating-deficient pulse indicates Spleen Qi severing externally from the Stomach and returning outward to Yangming. (This describes the ambiguity of Spleen disease. Spleen is Yin, interior to Stomach; Stomach is Yang, exterior to Spleen. A large, floating, and deficient pulse indicates excess externally and deficiency internally, meaning Spleen Qi is severed externally from the Stomach. Having left the Stomach, Qi returns to Yangming, producing such a pulse. Yangming typically has abundant Qi and Blood; curing via acupuncture by an incompetent physician works precisely by draining the excess pathogen in Yangming.) When Two Fires cannot overcome Three Waters, the pulse becomes chaotic and irregular. (Two Fires refer to the Two Yang Zang organs, Heart and Lung, located above the diaphragm. Three Waters refer to the Three Yin Zang organs, Liver, Spleen, and Kidney, located below the diaphragm. This image of the five Zang shows Yin exceeding Yang, hence "Two Fires cannot overcome Three Waters." Since Spleen is Yin Earth, it relies on Fire for generation. Now, Spleen Qi leaves the Stomach and severs externally from Yangming; thus, the chaotic and irregular pulse is due to the absence of Stomach Qi in the Spleen.) Flaccid limbs indicate the failure of Spleen Essence to circulate. (Spleen governs the limbs.) Wheezing and coughing indicate Water Qi merging with Yangming. (Spleen disease fails to control Water; Water pathogen overflows and merges with the Stomach Fu, obstructing the airway, causing wheezing and coughing. Indeed, all six Fu and five Zang can cause cough.) Bloody discharge with a tense pulse indicates blood having nowhere to flow. (Meridians transport Qi and Blood to nourish Yin and Yang. Rapid pulse results from Qi chaos; Qi chaos leads to Blood chaos, causing leakage into bowels with no proper circulation. Blood failing to stay central is governed by the Spleen.) If considered Lung injury, it is due to error and madness. Failing to draw analogies indicates unclear understanding. (Madness implies absurdity. Failing to draw analogies, attributing wheezing and cough to Lung injury reflects unclear understanding. If pulse and symptoms are integrated and investigated, the disease is in the Spleen, not the Lung, which can be discerned by analogy.) Regarding Lung injury: Spleen Qi fails to guard, Stomach Qi fails to clear, Meridian Qi fails to serve, True Zang is damaged and ruptured, meridians are abandoned peripherally, five Zang leak, resulting in either nasal hemorrhage or vomiting. These two conditions are not similar. (This clarifies the presentation of Lung injury. Lung Metal injury steals its Mother's Qi, so Spleen cannot guard. Humans receive Qi from grain; grain enters the Stomach and transmits to the Lung. Lung disease prevents grain Qi from circulating, so Stomach cannot clear. Lung transports Ying and Wei, connecting Yin and Yang; Lung injury causes both Ying and Wei diseases, so Meridian Qi fails to serve. "True Zang" refers to the Lung. Damage to the Lung impedes regulatory function, causing meridians to be abandoned peripherally and the Qi of all five Zang to lose their guard, leading to leakage. Thus, either nasal hemorrhage or vomiting occurs. Since the root in Spleen differs from the root in Lung, these two are not similar. Note that Heart, Lung, Liver, Spleen, and Kidney are all Yin. The explanation of Three Yin disease omits Heart and Liver because Heart is the Monarch, invulnerable to pathogen (injury means death); Liver is the General, inherently strong, so its disease is not detailed. Only Kidney is the root of storing essence, Lung the root of storing Qi, Spleen the root of grain and water. Water disease affects Lung, Metal disease affects Spleen, stealing Mother Qi; Earth disease ruins all Zang, losing the source of transformation. Any violation involving Three Yin deficiency falls under these "Three Roots." If all three roots are injured, few can escape.) Clearly drawing analogies and calmly diagnosing is called the Way. (Clearly citing symptoms and signs, measuring similarities and differences, and diagnosing according to method achieves this.)