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The pathogenesis is profound and mysterious, and the principles of pulse diagnosis are subtle and deep. Although they are fully recorded in the sacred classics, without direct instruction from a teacher, one cannot truly understand them. To treat a hundred diseases and determine life and death, one must explore the pulse signs of Yin and Yang; to formulate the "Seven Forms" (Da, Xiao, Huan, Ji, Qi, Ou, Fu - Large, Small, Slow, Urgent, Odd, Even, Compound) for administering medicine, one should deduce the patient's emotional state of suffering or joy and their physical form. Wherever evil qi resides, the root and branch cannot escape the influence of the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire). The origin of disease lies within the four categories of etiology. First, distinguish the complexion; second, distinguish the voice; these are the miraculous applications of a sage physician. Third, as the saying goes, "Three fractures of the arm make an expert bone-setter," meaning that long-term patients often best understand their own condition. If one can exhaustively understand the mysteries of the eight basic pulses—Floating (Fu), Sinking (Chen), Slow (Chi), Rapid (Shu), Slippery (Hua), Choppy (Se), Large (Da), and Moderate (Huan)—one will know the names of the eight essentials: Exterior (Biao), Interior (Li), Deficiency (Xu), Excess (Shi), Cold (Han), Heat (Re), Evil (Xie), and Righteous (Zheng). The eight pulses are the guidelines for all pulses, and the eight essentials are the standards for weighing various diseases.

A Choppy pulse indicates deficiency of blood and essence; it feels obstructed and hesitant under the fingers, like a knife scraping bamboo. A Slippery pulse indicates excessive phlegm and abundant qi; it feels round and smooth under the fingers, like a rolling pearl. Slow pulses indicate Cold, Rapid pulses indicate Heat, recording the frequency of beats. Floating pulses indicate the Exterior, Sinking pulses indicate the Interior, depending on the lightness or heaviness of the pressing technique. A Moderate pulse signifies the recovery of righteous qi, gentle as willow branches dancing in the spring breeze; a Large pulse signifies the progression of disease, vigorous like the rising tide of autumn water. If the six positions of the pulse are equally moderate, it is auspicious that no medicine is needed; if the six positions are excessively strong, one should worry about the patient's debility. Exterior syndromes are suitable for resolution through sweating; Interior syndromes are treated with purgation. To rescue the Exterior, Guizhi Tang (Cinnamon Twig Decoction) with Shaoyao (Paeonia Root) may be used; to rescue the Interior, Ganjiang (Dried Ginger), Fuzi (Prepared Aconite Root), Renshen (Ginseng Root), and Fuling (Poria) may be used. Diseases differ in Deficiency and Excess; Deficient conditions are tonified, while Excess conditions are drained. Pathogens differ in Cold and Heat; Cold conditions are warmed, while Heat conditions are cleared. External pathogens are Wind, Cold, Summer-heat, Dampness, and Dryness; internal pathogens involve the mutual overacting of Deficiency, Excess, Thief, Micro, and Zheng factors. Zheng qi is the true qi of the Stomach, akin to a loyal minister in the state. Driving out evil is like expelling bandits; it requires urgent attack and total eradication. Nourishing Zheng qi is like dealing with petty people; it requires self-cultivation and rectifying the mind.

The fertility of the soil reflects innate endowment of excess or deficiency. The victory and reversal of climatic cycles deduce the prevalence of excess or insufficiency. Once the heart-method of pulse diagnosis is mastered, why worry about the ineffectiveness of medication? Regarding Zhongfeng (Stroke), one must distinguish between true and false forms. True Zhongfeng presents with manifestations of the Six Channels, involving the Zang organs, Fu organs, meridians, and vessels. False Zhongfeng, based on the theories of Liu Wansu, Li Dongyuan, and Zhu Zhenheng, is attributed to Dampness, Fire, or Qi deficiency. Involvement of the Zang organs is critical and life-threatening; involvement of the Fu organs leads to limb paralysis. In the meridians, there is deviation of the mouth and eyes; in the vessels, there is hemiplegia. Sudden collapse requires tonic decoctions; obstruction by phlegm and qi may be treated with emetics. Twitching of the hands and feet is called Chu (Twitching); rigidity and opisthotonos of the back and neck is called Chi (Spasm). It may become Fengfei (Wind Paralysis) or Piangu (Hemiplegia), or transform into Fengbi (Wind Bi Syndrome) or Fengyi (Wind Imbalance), resulting in flaccid paralysis where limbs are relaxed and insensitive. When Wind, Dampness, and Cold combine, they form Bi Syndrome. Although its mobility and changes are unpredictable, it is caused by Wood excess and Wind hyperactivity.

Bitter frost and snow are always Cold pathogens; scorching sun and heat are Summer-heat types. Shanghan (Cold Damage) presents with tight pulses and cold body; Zhongshu (Heat Stroke) presents with deficient pulses and intense heat. Summer-heat should be resolved by astringing, tonifying, and clearing; Cold can be dispersed by warming. Various spasms and rigidity, heavy body and edema, arise from wind, rain, and damp steaming in mountains and marshes. Various obstructions, dryness, and cracked skin result from the肃 (solemn/drying) Qi of Dryness in nature. Dampness harms the skin and flesh; Dryness depletes the intestines and stomach. In the Northwest, high winds and dry soil cause thirst, constipation, and sores; in the Southeast, low land and damp water lead to jaundice, edema, diarrhea, and dysentery. Pathogens have "Shang" (injury) and "Zhong" (strike); Shang is shallow, Zhong is deep. People vary in strength and weakness; thus, the strong suffer lightly, while the weak suffer severely.

The Seven Fires of Heaven and Earth, and the Five Emotions governing Jun and Xiang fires: if physicians understand the principles of directly subduing and conforming to nature, their skills can reach divine levels. Good physicians understand the way of using contrary methods to find the root cause, and then no disease is incurable. For Deficient and Excess Fire, tonification and draining must be appropriate; for Damp-Heat and Fire, attacking and dispersing must differ in formulation. Having understood the mechanism of the Six Qi, one may achieve eternal fame.

It is said that Blood belongs to Yin; when insufficient, it generates Heat. This is the definitive theory of Hejian (Liu Wansu). Qi belongs to Yang; when in excess, it becomes Fire. This is the maxim of Danxi (Zhu Zhenheng). Excess Qi causes panting, distension, and fullness; lowering fire is essential. Blood deficiency causes vomiting of blood, consumption fever, and vexatious steaming; clearing heat is difficult to avoid for recovery. Lizhong Tang (Regulate the Middle Decoction) treats Spleen and Stomach deficiency-cold; Runxia Wan (Moisten and Purge Pill) transforms phlegm-saliva in the chest and diaphragm. Sudden vomiting and regurgitation are caused by Cold; chronic cough with hemoptysis is due to Fire. Pingwei San (Peace the Stomach Powder) treats persistent loose stools due to Dampness excess. Yirong Tang (Nourish Prosperity Decoction) treats palpitations,恍惚 (mental confusion), and insomnia. Zhike San (Immature Bitter Orange Powder) and Dasheng San (Promote Life Powder) help pregnant women bind the fetus and facilitate birth. Maren Wan (Hemp Seed Pill) and Runchang Wan (Moisten Intestine Pill) treat constipation in the elderly due to blood deficiency. To calm fright and palpitations, seek Niuhuang (Calculus Bovis) and Hupo (Fossilized Wood); to eliminate parasites, use Shijunzi (Quinine Tree Seed), Heshi (Crab Louse), and Leiwan (Oligoloma Fruit). To unblock obstructions, use Kuicai (Malva Verticillata) and Bo Cai (Spinach), utilizing their slipperiness to benefit orifices; to reduce goiter, use Kunbu (Kelp) and Haizao (Sargassum), utilizing their saltiness to soften hardness. These are the secrets of the ancestors, inspiring future generations.

It is said: "Summer injury by Summer-heat leads to Malaria in Autumn." Acute cases resolve quickly; delayed cases occur every three days. For Dan Malaria (Hot Malaria), only clear the muscle layer; do not use antimalarial drugs in the Yin level. Renshen Yangwei Tang (Ginseng Nourish Stomach Decoction) treats cases with more Cold than Heat and deficiency; Chaihu Qingspi Tang (Bupleurum Clear Spleen Decoction) regulates cases with more Heat than Cold and thirst. Spontaneous sweating is due to Yang deficiency; night sweats are due to Yin weakness. Cough without sound but with phlegm indicates Spleen invasion by Dampness; cough with sound but without phlegm indicates Lung burning by Fire. Huoluan (Colic and Vomiting-Diarrhea) has Cold and Heat types; why does the Ju Fang discuss only acrid-warmth? Jiji (Accumulation and Gathering) has Deficiency and Excess types; how can the secular world bias towards harsh purging? Know that Wood stagnation can be resolved by vomiting; Metal stagnation by draining, Earth stagnation by overcoming, Water stagnation by restraining, and Fire stagnation by dispersing. Draining and dispersing refer to sweating and purging; restraining and overcoming refer to attacking and suppressing. Daocanglin (Emptying the Granary/Catharsis) removes old accumulation, cleansing the Central Jiao; Kaigui Men (Open Ghost Gate/Sweating) and Jingjifu (Cleanse the Bladder/Urination) are excellent methods for upper and lower dispersion. Such Mingxuan (dizziness/reaction) responses can reverse life and death in a moment; a single mistake leads to regret too late, and further reversal brings shame to incomplete prescriptions.

Generally, acute diseases are not Heat, and chronic diseases are not Cold. Carbuncles on the buttocks and back are caused by accumulated Heat; sudden pain in the heart and abdomen is caused by sudden Cold. Wu Xie (Five Diarrheas) and Wu Dan (Five Jaundices) are due to Damp-Heat, prioritizing promoting urination; San Xiao (Three Wastes) and San Nu (Three Hemorrhages) are due to Dryness-Fire, resolving with Yin nourishment. Vomiting and coughing/regurgitation blame the Stomach; Yin Hernia and Masses belong to the Liver. Fluids return to the Heart to form sweat; astringing them uses Huangbo (Phellodendron Bark) and Liuyi San (Six-to-One Powder). Internal blazing Heat causing rashes is cleared by Ren Shen Hua Ban Tang (Ginseng Transforming Spot Decoction). Body unrest is Zao (Restlessness); Heart unrest is Fan (Vexation). Sudden stiffening with goosebumps and coma is named Shijue (Corporeal Syncope); sudden falling with foaming at the mouth, waking intermittently, is called Dianxian (Epilepsy). Abdominal fullness and acid regurgitation indicate retained fluids in the Stomach. Chest distension and belching stem from phlegm retention above the diaphragm. To restore the power of spring, one must prepare the elixir of resurrection.

I assert that Yin and Yang syndromes require different treatments; internal and external injuries require careful distinction. Internal vs. External injury is distinguished by breathing through nose and mouth; Yin vs. Yang syndrome is observed by the pulse at Cun and Chi positions. Once Internal/External and Yin/Yang are clarified, one knows Deficiency/Excess and Cold/Heat. Turbid discharge and leukorrhea have red and white colors, possibly due to Phlegm or Fire. White relates to Qi, Red to Blood; originally there is no distinction of Cold/Heat, only Deficiency/Excess, and Dysentery is the same. Stagnant Heat-Dampness should not be treated with bland diuretics or astringents; instead, sweating, purging, cooling, warming, vomiting, and draining may be used. Daochi San (Guide Out Red Powder) unblocks urinary retention; Wenbai Wan (Warm White Pill) resolves large intestine pain and binding; Digupi San (Diget Bark Powder) is suitable for treating consumption fever; Qingmengshi Wan (Green Stone Pill) rapidly transforms consolidated phlegm. For Fire stagnation, palpate the skin; for dead fetus, examine the tongue. Yanhusuo (Corydalis Rhizome) and Kulian (Melia Azedarach Bark) treat cold hernia radiating pain in Erwan; Danggui (Angelica Sinensis) and Longdan (Gentiana Root) drain damp-heat pain attacking the hypochondrium. Understanding the feelings of Yin/Yang and Deficiency/Excess is the mysterious secret of physicians. Generally, all pain is Excess, all itching is Deficiency. Deficiency means insufficiency of essence and Qi; Excess means surplus of pathogenic Qi.

Diarrhea with intestinal mucus or loose stools: if slipping and uncontrolled, astringents are appropriate. Abdominal pain with food stagnation and stagnant heat: if Cold-Yin, Ganjiang and Fuzi may be applied. Jue Xin Tong (Jue-Chest Pain) is caused by invading Cold affecting the Stomach; if hands and feet are warm, warming and dispersing will suffice. Zhen Toutong (True Headache) penetrates to the brain; if fingernails turn black, it is critical and hard to cure. Jieyang (Binding Yang) leads to predictable limb swelling; Jieyin (Binding Yin) leads to certain hematochezia. Weakness in foot and knee joints is called Hongjiujiao (Hongji Foot/Gout); swelling and pain indicate much Dampness and severe Heat. Unrelenting lower back pain is Kidney Deficiency; sprain involves Qi stagnation and Blood stasis. Severe pain at the vertex respects Gaoben (Ligusticum Wallichii Rhizome); non-stop Biyuan (Nasal Sinusitis) selects Xinyi (Magnolia Flower). Hand numbness involves Damp-Phlegm and Dead Blood; hand stiffness stems from Wind-Dampness and Qi deficiency; dribbling urine with difficulty indicates Qi deficiency, treated by Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction). Hematochezia: examine if blood precedes or follows stool. Yin Binding uses Pingwei San plus Diyü (Sanguisorba Root). It is heard that difficult urination is called Lei, inability to eat is called Ge, due to Yin/Yang imbalance, causing pulse overflow. Coughing blood differs from vomiting blood; coughing blood rises with cough, vomiting blood comes upward with reflux. Swallowing acid differs from spitting acid; swallowing acid pierces the heart, spitting acid gushes out. Water stopping below the Heart is Yin (Fluid Retention); water accumulating under the ribs is Pi (Mass). Promoting water flow uses Zexie (Alisma Rhizome) and Fuling (Poria); attacking Pi uses Yuanhua (Kadua Flower) and Daji (Euphorbia Lathyris Root). Kongxian Dan (Control Saliva Pill) is harsh but can drive out hidden phlegm; Baohe Wan (Preserve Harmony Pill) is mild and warm, able to digest food stagnation. Hematuria without pain is bleeding; with pain is Red Lin (Dysuria). Shortness of breath is difficulty in distributing Qi; coarse breathing is panting. Epigastric pain centered on the heart must distinguish between Guest Heat and Guest Cold; generalized joint pain must distinguish between Wind and Dampness. Tongsheng San (Universal Salvation Powder) specifically treats various Winds; Yueju Wan (Resolve Depression Pill) opens the Six Depressions. Weakness causing dizziness and vertigo also stems from Phlegm-Fire; Damp-Heat causing seminal emission and dreams may result from excessive thinking. Since miscellaneous diseases are complex and lack clear evidence, and their mechanisms are hard to clarify (unlike Shanghan which has meridian basis and recognizable signs), if one thinks thrice before treating, medication will never fail. I briefly list the beginnings of many diseases to serve as a model for later learners.