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Chuan Shi (a contagious, consumptive chronic deficiency disease, similar to modern tuberculosis) does not form through transmission from one household to another. It arises because the person's blood and qi are weak, the zang-fu organs are deficient and emaciated, they are attacked by "ghost qi" (pathogenic factors), thereby sensing this evil, and finally developing the disease. Its manifestations include: persistent cough; chest and diaphragm oppression and stuffiness; limb pain; emaciation of skin and flesh; inability to take in food; irregular vomiting and diarrhea; expectoration of pus and blood; craving for water and fluids; fondness for singing and chanting; predisposition to sadness and sorrow; alternating episodes of epilepsy or mania; difficulty in urination and defecation. The disease may be contracted after encountering pathogens following alcohol consumption or meals; due to wind and rain invasion; by visiting patients or attending funerals; or by chance encounters during morning walks or evening strolls. It may result from qi stagnation or abnormal blood circulation; from sleeping exposed in fields; or from accidental gatherings in gardens. One contracts this qi of death and illness, becomes infected, and thus develops the disease, hence it is called "Chuan Shi". The treatment formulas are detailed at the end of this chapter.

The deficiency, excess, cold, and heat of the five zang and six fu organs, as well as their life-and-death and reversal-and-smooth states, are all manifested in physical signs and pulse/qi characteristics. Without diagnosis and examination, these cannot be recognized. For deficiency syndromes, use tonification; for excess syndromes, use purgation; for cold syndromes, use warming; for heat syndromes, use cooling. For syndromes that are neither deficient nor excess, regulate via the meridians. This is the fundamental principle of a skilled physician. Specific pulse patterns and clinical manifestations are detailed at the end of this chapter.

The Liver and Gallbladder are exterior-interiorly related. Their respective meridians are the Foot Jueyin Liver Meridian and the Foot Shaoyang Gallbladder Meridian. The Liver qi prospers in Spring. Spring is the beginning of the generation of all things; its qi is tender, soft, empty, and expansive. Therefore, the pulse is Xian (Wiry). If the pulse is soft, sweating therapy should not be used; if weak, purgative therapy should not be used. A Xian and long pulse indicates normality; deviation from this indicates pathology. A pulse that is deficient yet Xian is termed "Excessive" (Tai Guo), indicating an external disease. Excessiveness causes forgetfulness, mental confusion, dizziness, and vertigo. A pulse that is excess yet fine/thin is termed "Deficient" (Bu Ji), indicating an internal disease. Deficiency causes chest pain radiating to both hypochondriac regions, distension, and fullness. Generally, Liver excess causes pain radiating from both hypochondriac regions downward to the lower abdomen, leading to irritability and anger. Liver deficiency manifests as a sensation of being hunted or pursued. When Liver qi rebels upward, symptoms include headache, deafness, and red cheeks (or swelling). The pulse, when pressed deeply, is rapid/tense; superficially, it is also so. This primarily indicates hypochondriac fullness, difficult urination, headache, and dizziness. An extremely rapid/tense pulse indicates aversion to speech; slightly rapid/tense indicates qi stagnation in the chest and hypochondrium; extremely slack indicates vomiting and reflux; slightly slack indicates Water Bi (water-dampness obstruction). Extremely large indicates internal abscess with hematemesis; slightly large indicates Sinew Bi; very small indicates polydipsia; slightly large (original text says small) indicates Xiao Dan (wasting-thirst); slightly slippery indicates Tui Shan (scrotal hernia); very slippery indicates enuresis; very choppy indicates Liu Yin (flowing fluid retention); slightly choppy indicates spasms/cramping. Additionally, accumulated Qi in the Liver resides in the hypochondrium; if unmanifested for a long time, it causes cough and rebellion of Qi, or Malaria. Liver deficiency leads to dreams of lush grass and flowers; Liver excess leads to dreams of dense forests and mountains. In Liver diseases, the patient feels better in the morning (or lucid), worse in the evening, and quiet at night. Liver disease presents with headache and hypochondriac pain, dizziness, limb fullness, retraction of the scrotum, and urinary retention (or incontinence); death occurs within ten days. Furthermore, if there is body heat, aversion to cold, and immobility of the four limbs, the pulse should be Xian, long, and rapid. If it is instead short and choppy, this represents Metal overcoming Wood (Jin Ke Mu), which is incurable with a mortality rate of ten out of ten. Regarding Cold invading the Liver: bilateral arm pain preventing lifting, dryness at the root of the tongue, frequent sighing, chest pain, and inability to turn sideways. The pulse is slow and choppy at the Left Guan position, indicating Cold in the Liver. Regarding Heat invading the Liver: panting, fullness, irritability, eye pain, abdominal distension, anorexia, erratic behavior, nocturnal palpitations, red eyes, and blurred vision. The pulse is Yin-excess at the Left Guan position, indicating Heat in the Liver. Regarding Liver Deficiency-Cold: hardness and pain under the hypochondrium, blindness, arm pain, chills and fever resembling malaria, anorexia; in women, amenorrhea, and急促 breathing. The pulse is deep and weak at the Left Guan position, indicating Deficiency-Cold in the Liver.