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The great collateral of the Stomach is named Xuli (虚里, Ventricle Li), located three cun below the left nipple. If its pulsation is faint and invisible, it indicates "insufficiency," signifying that Zong Qi (宗气, Pectoral Qi) is internally deficient. If the pulsation is vigorous enough to shake the clothes, it indicates "excess," signifying that Zong Qi is leaking externally. If the pulse beats three or four times before a pause, or five or six times before a pause, it primarily indicates the presence of accumulations (Ji Ju, masses or stagnations). If no pulsation can be felt at all, the condition is critical. The classics state: Death occurs if there is no arterial pulsation at Xuli. (From *Xin Fa*)

Humans rely on Stomach Qi as their foundation; therefore, observing the pulsation of Xuli allows one to distinguish the severity of the pathogenesis. If palpation yields a soft sensation, with pulsation that is neither tense nor urgent, but rather slow and relaxed, it indicates that Zong Qi is accumulated in the Danzhong (膻中, Chest Center) region, which is the normal physiological state. If the pulsation is surging and large, snapping against the fingers, or if there is absolutely no pulsation, both indicate the exhaustion of Stomach Qi. (From *Yangshan Yuanwen*)

In healthy individuals, stillness in the Danzhong area is auspicious. Xuli represents the Zong Qi of the pulses. It should not be visible to the naked eye; gentle palpation reveals a gradual pulsation, feeling present yet elusive, which is a favorable sign. If the Yang Qi in the chest is declining, and the pulsation rises above the breast, extending to Zhongfu (LU-1) and Yunmen (LU-2), the prognosis is ominous. In cases of deficiency consumption (Xu Lao) and tuberculous disease (Lao Zhai), if the pulsation remains high daily, it is incurable. (Annotation by Taizhou)

The pulsation of Xuli corresponds with the Cun Kou pulse (Radial Pulse). If Xuli pulsation is high, the Cun Kou pulse is also high; if the Cun Kou pulse exhibits Jie Dai (irregular rhythm), Xuli will also exhibit irregularity. (From *Zhen Bing Qi*)

High pulsation at Xuli is an adverse sign and is most taboo for pregnant women. However, if this occurs postpartum during a critical illness, or in cases of yellow edema (Huang Pan Bing), fright, rage, or after strenuous physical exertion, even if Xuli pulsation is high, there is no danger. This distinction must not be overlooked. (Annotation by Nanyang)

When treating children, regardless of the syndrome, one should first palpate the Xuli acupoint. If the pulsation is excessively vigorous, invasive or draining treatments should not be used, due to the child's congenital insufficiency. Pediatricians who follow this advice will bring boundless benefit. This is a secret unshared for millennia; cherish it. (From *Liuzhou Yi Hua*)

Children's pulse signs are difficult to rely upon; only by palpating Xuli is there reliable evidence. This method is equally applicable to adults. (Annotation by Wang Mengying)

The chest and abdomen are the palaces of the five Zang and six Fu organs, and the sources of Yin-Yang and Qi-Blood. To understand the state of the organs, nothing compares to diagnosing the chest and abdomen. (From *Dui Shi Lun*)

Examination of the chest and abdomen should involve multiple palpations and caresses, varying between deep and shallow pressure, to assess hardness or softness, and whether the area resists pressure, thereby distinguishing deficiency from excess. (From *Zhen Bing Qi*)

Palpating the Upper, Middle, and Lower Wan (epigastric regions) with fingers: if smooth and without friction, it indicates Stomach harmony without deficiency or stagnation. If pressing the Middle Wan feels obstructed and hard but not like stone, it indicates Yin Pi (water retention forming masses). (From *Zhen Bing Qi*)

There are three manifestations of pulsation at Xuli: felt lightly but lost with deep pressure indicates Qi deficiency; felt surging and large lightly but empty and fine with heavy pressure indicates Blood deficiency; a tangible mass accompanied by pulsation indicates accumulation. (From *Gai Bing Qi*, likely referring to *Zhen Bing Qi Chu*)

Diagnosing the chest and abdomen involves light stropping from Jiwei (CV-15) to below the umbilicus to perceive skin moisture or dryness, distinguishing cold from heat. Medium-pressure searching while asking about pain detects the presence of pathogens. Heavy pushing and pressing while asking about pain assesses organ deficiency/excess and sedimentation, analogous to the floating, middle, and sinking methods of pulse diagnosis. (From *Dui Shi Lun*)

The key to abdominal diagnosis begins with the umbilicus. The human umbilicus is like the North Star in the sky, hence named Tianshu (Heavenly Pivot) and Shenshu (Spirit Pivot). It is the acupoint of divine Qi and the root of life preservation. Gentle pressure yielding strength and responsive Qi indicates internal guarding by divine Qi. Lack of response indicates loss of normal guarding. (Annotation by Yangshan)

To diagnose the moving Qi between the Kidneys, place three fingers of the right or left hand closely together over the umbilicus. A gentle, strong, two-beats-per-breath pulsation filling the area around the umbilicus indicates abundant Kidney Qi. Five to six beats per breath indicates Heat. Cold and weak hands with deep, faint pulsation indicate Mingmen (Gate of Life) insufficiency. Hot, dry hands with fine, rapid pulsation extending upward to Zhongwan (CV-12) indicate Yin deficiency. Dispersed feeling upon pressure, with only one beat per breath, indicates collapse of Yuan Qi (Original Qi). (From *Zhen Bing Qi*)

Abdominal diagnosis may start with the umbilicus. Strong response to pressure indicates health. Weak response, feeling like a finger or ash in incense, indicates incurability. (Annotation by Shou'an)

Normal is when the umbilicus does not move when pushed up, down, left, or right. However, in those with weak Qi, pushing causes displacement to one side. Displacement to the right indicates left meridian exhaustion; displacement to the left indicates right meridian exhaustion; similar logic applies vertically. This is called "Umbilical Exhaustion." Its appearance in patients indicates incurability, except in the elderly. (From *Nan Ming*)

The umbilicus connects to the five Zang organs and is the gate where true Spirit enters and exits, hence named Shenshu. It opposes the 14th thoracic vertebra on the spine, like the North and South Poles. A deep, large, firm umbilicus that does not move when pushed in any direction, with well-constrained wheels (folds of abdominal skin) and rims (base resembling a small wine cup), indicates safe True Spirit. Even severe diseases may be treatable, except acute illnesses. (From *Taizhou Yuanwen*)

Constant nodules on either side of the lower abdomen indicate stored Blood (Xu Xue). If painful, it is not food stagnation or worm accumulation, but stored Blood potentially developing into hernia. (From *Taizhou Yuanwen*)

Dry stool in the lower abdomen is usually near the transverse bone. Lumpy formations on the left, slightly elongated, non-tender upon pressure, if full on the left, will extend to the right. (From *Taizhou Yuanwen*)

Manifestation of the Ren Mai (Conception Vessel) above and below the umbilicus, swollen like chopsticks, indicates Spleen and Kidney deficiency. Appearance in healthy people predicts illness; in patients, it indicates difficulty in treatment. Common in labor injury, Yin deficiency with Fire hyperactivity, and Qi stagnation (harmless). Physicians must observe carefully. (Annotation by Baizhu)

In chronic illness, if the abdominal skin adheres tightly to the back, with hard, immovable knots above and below the umbilicus, these are the spinous processes themselves. (From *Taizhou Yuanwen*)

Liver disease causes pain under the costal margins radiating to the lower abdomen; thus, Liver disease requires examining the hypochondrium. Full, solid, and strong hypochondrial flesh indicates Liver harmony. Empty and weak hypochondrial flesh indicates Liver deficiency and syndromes of wind-stroke and tendon disorders. Masses in the left hypochondrium of men indicate Qi hernia; masses in the right hypochondrium of women indicate Blood stasis. (From *Taizhou Yuanwen*)

Syndromes such as Pi accumulation and Hernia are easier to treat on the left and harder on the right, because Left belongs to Yang and Right belongs to Yin. (Annotation by Liangwu)

Low pulsation at Jiwei (CV-15) indicates Wind-Cold or Evil Heat; high pulsation at Jiwei indicates Smallpox. Vigorous arterial pulsation in the palm also indicates Smallpox. Cessation of pulsation after eruption is normal; continued pulsation after eruption indicates intense Smallpox toxin, which is critically dangerous. (From *Nan Ming*)

Treating Smallpox requires distinguishing Cold and Heat via abdominal diagnosis, focusing on the Ren Mai. True Cold: although sides of the abdomen are hot, prolonged pressure on Ren Mai reveals coldness; despite thirst, rapid pulse, and red-purple spots, this is False Heat. True Heat: pressure on Ren Mai reveals heat; despite chills, teeth grinding, pale spots, and diarrhea, this is False Cold. (From *Zong Liu*)

Distinguishing Cold and Heat is done above the Shuifen point (CV-9) on the Ren Mai; prolonged manual pressure clarifies the nature. Distinguishing Deficiency and Excess is done below the umbilicus, left or right. Low pulsation indicates mild toxin; high pulsation indicates severe toxin. Vigorous pulsation at Xuli indicates a critical condition. (From *Zhen Bing Qi*)

There are three signs in abdominal diagnosis: 1. Hard, cord-like coagulation that moves when pressed firmly, shifting locations randomly (large abdomen, beside umbilicus, or lower abdomen). 2. Gentle pressure for a longer time reveals movement like an earthworm under the skin, audible gurgling in the abdomen floor. 3. Undulating contours like fields; deep pressure reveals rising, falling, gathering, scattering, and emerging movements. (Annotation by Xuan)

In edema and distension, if pressing reaches the umbilicus and it shifts sideways, and heavy pressure lifts it off the spine, losing the umbilical root, death is certain. (From *Yangshan Yuanwen*)

Pulse shows Heat but abdomen feels cool indicates Exterior Heat, which is easily resolved. Abdomen feeling hot like a burning palm upon pressure indicates Hidden Heat, which is difficult to resolve. In sudden high fever in children, severity is hard to judge by pulse alone, but abdominal diagnosis decides it. Heat at the epigastrium that burns the hand is particularly significant. (Annotation by Nanyang)

Pain at Burong (ST-19) and Chengman (ST-20), worsening with pressure, radiating to chest/abdomen, with gurgling sounds and vomiting water that relieves pain, indicates Water Sac (fluid retention). Use warming herbs and reduce diet. (Annotation by Taizhou)

Abdominal pain types: Food/Worm pain; pain in the epigastrium suggests food stagnation; Blood stasis pain is in the lower abdomen beside the umbilicus, with palpable masses; Intestinal Abscess pain presents with right leg stiffness and dysuria; Phlegm-Fluid pain migrates without fixed location. (Annotation by Dongguo)

Protruding abdomen in children is called Heart Protrusion or Lung Distension, indicating Lung exhaustion. (Annotation by Zhou Yufan)

Large belly with visible blue veins, sleeping rigidly bound, indicates incurability. (From *Ji Cheng*)

The abdomen is the Sea of Water and Grain. Wide and thick abdominal skin indicates abundant nourishment and longevity. (Annotation by Chen Feixia)

The umbilicus is the center of the abdomen, housing the Large Intestine. Periumbilical pain indicates dry stool stuck in the intestines, wanting to exit but unable to. (Annotation by Zhanglingshao)

If the lower abdomen is not hard or painful, the pathogen is in the Exterior; if hard and painful, the pathogen has entered the Interior. (Annotation by Zhou Yufan)

Lower abdominal pain with deep, slow pulse indicates Yin-Cold; treat with warming methods. (Annotation by Zhou Yufan)

Abdominal distension with borborygmi, cold limbs with diarrhea, fever, emaciation, and a large pulse indicates death. (Annotation by Zhou Yufan)

Commentary: The Chest distributes Yin and Yang; the Abdomen is the Ultimate Yin within Yin. Food stagnation, Phlegm obstruction, and Blood stasis are distinguished by resistance or acceptance to pressure, revealing deficiency or excess. This is the standard interpretation. However, verifying the Chest via Xuli and the Abdomen via Shenshu is the precise key to syndrome differentiation. Rare among practitioners, this adds a fifth method beyond Observation, Listening/Smelling, Inquiry, and Palpation, making diagnosis more refined. (Annotation by Tilizi)