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Having been completed, Earth can again generate Metal. Metal can again generate Water. Thus, generation continues in succession. All of this relies on the power of supplementing Water. This is the meaning of "Heaven generates One and Water." If one does not understand this, it is as the Classic says: "If one cannot treat deficiency, why ask about the rest?"

Difficulty Thirteen states: The Classic says, "When you see the complexion but do not find the corresponding pulse, and instead find a pulse that overcomes (controls) [the organ corresponding to the complexion], death ensues. If you find a pulse that generates [the organ corresponding to the complexion], the disease will resolve itself." The complexion and the pulse should correspond when examined together. How should this be done?

This raises the issue of complexion and pulse. The following text details the meaning of the correspondence among complexion, pulse, skin, voice, and odor. However, the Five Zang organs have five complexions, all of which appear on the face, and they should also correspond with the pulse at Cun, Guan, and Chi positions. For example, if the complexion is green (Liver color), the pulse should be wiry and rapid (Liver pulse). If the complexion is red (Heart color), the pulse should be floating, large, and scattered (Heart pulse). If the complexion is yellow (Spleen color), the pulse should be moderate, slow, and large (Spleen pulse). If the complexion is white (Lung color), the pulse should be floating, choppy, and short (Lung pulse). If the complexion is black (Kidney color), the pulse should be deep, soft, and slippery (Kidney pulse). This is called the correspondence between the five complexions and the pulses. (This generally lists the complexions and pulses of the Five Zang organs. Regarding the significance of auspicious and inauspicious signs related to clothing and artifacts, mastering this section thoroughly will make the principles of pulse generation and overcoming clear.) When the pulse is rapid (heat), the skin at the Chi position also feels hot. When the pulse is tight, the skin at the Chi position also feels tense. When the pulse is relaxed (harmonious), the skin at the Chi position also feels soft. When the pulse is choppy, the skin at the Chi position also feels dry. When the pulse is slippery, the skin at the Chi position also feels smooth.

This explains the principle of correspondence between the pulse and the skin at Cun, Guan, and Chi. "Rapid" should be interpreted as "heat." "Tight" should be interpreted as "tight." "Relaxed" should be interpreted as "harmonious." "Choppy" refers to dryness. "Slippery" refers to smoothness. Here, only the Chi position is mentioned because it encompasses the entire arm.

Each of the Five Zang organs has its own voice, complexion, odor, and taste, which should correspond with the pulse at Cun, Guan, and Chi. If they do not correspond, it indicates disease.

This states that each of the Five Zang organs has relationships of generation and overcoming, which should be judged by combining voice, complexion, odor, and taste. For instance, a calling voice, green complexion, fishy odor, and sour taste indicate the Liver. A laughing voice, red complexion, scorched odor, and bitter taste indicate the Heart. A singing voice, yellow complexion, fragrant odor, and sweet taste indicate the Spleen. A crying voice, white complexion, fishy odor, and pungent taste indicate the Lung. A groaning voice, black complexion, putrid odor, and salty taste indicate the Kidney. By observing their voice, complexion, odor, and taste, and combining them with the generation and overcoming relationships of the pulse, one can determine the life or death prognosis of the disease. For example, if the complexion is white, there is much crying, and a preference for pungent and fishy odors, but the pulse is wiry and rapid, this represents the voice, complexion, odor, and taste of the Lung, yet the Liver pulse is seen. This is an overcoming relationship, so death ensues. If the Spleen pulse is seen, this is a generating relationship, and the disease will resolve itself. If the voice, complexion, odor, and taste of the Liver are observed, but the Spleen pulse is obtained, death also ensues.

For example, if the complexion is green (Liver color), but the pulse is floating, choppy, and short (Lung pulse), this is overcoming. If the pulse is large and slow (Spleen pulse), this is overcoming. If the pulse is floating, large, and scattered (Heart pulse), or small and slippery (Kidney pulse), this is generation.

This clarifies the meaning of generation and overcoming, using the Liver as an example. Green is the color of Liver Wood. Floating, choppy, and short is the pulse of Lung Metal; this is pulse overcoming complexion. Large and slow is the pulse of Spleen Earth; this is complexion overcoming pulse. Floating, large, and scattered is the pulse of Heart Fire; this is complexion generating pulse. Small and slippery is the pulse of Kidney Water; this is pulse generating complexion. The other organs follow this pattern.

The Classic says: "Knowing one aspect makes one a lower physician; knowing two aspects makes one a middle physician; knowing three aspects makes one an upper physician." An upper physician cures nine out of ten cases; a middle physician cures eight out of ten; a lower physician cures six out of ten. This is what is meant.

This summarizes the principles of complexion and pulse generation and overcoming mentioned above; none can be omitted. Knowing one means knowing only the complexion. Knowing two means knowing both complexion and pulse. Knowing three means knowing the generation and overcoming relationships among pulse, voice, complexion, odor, and taste.

Difficulty Fourteen states: There are Sun (diminished) pulses and Zhi (increased) pulses. What does this mean? Answer: In Zhi pulses, two beats per exhalation is considered normal (four beats per respiration). Three beats per exhalation is Li Jing (departing from the standard) (six beats per respiration). Four beats per exhalation is Duo Jing (depletion of essence) (eight beats per respiration). Five beats per exhalation is Si (death) (ten beats per respiration). Six beats per exhalation is Ming Jue (life extinction) (twelve beats per respiration).

These are the Zhi pulses. What are the Sun pulses? One beat per exhalation is Li Jing (two beats per respiration). One beat per two exhalations is Duo Jing (one beat per respiration). One beat per three exhalations is Si (one beat per 1.5 respirations). One beat per four exhalations is Ming Jue. These are the Sun pulses. Zhi pulses develop from below upwards; Sun pulses develop from above downwards.

To diagnose Sun and Zhi pulses, use the physician's breath count to determine the patient's pulse count. Zhi pulses developing from below upwards refer to progression from the Kidney upwards. Sun pulses developing from above downwards refer to progression from the Lung downwards. This outlines the general principles of Sun and Zhi pulses. How do diseases caused by Sun pulses manifest? Answer: First degree Sun damages the skin and hair; the skin gathers and hair falls out. Second degree Sun damages the blood vessels; the vessels become deficient and scant, unable to nourish the Five Zang and Six Fu organs. Third degree Sun damages the muscles; the muscles emaciate, and food cannot transform into flesh. Fourth degree Sun damages the sinews; the sinews relax and cannot hold themselves. Fifth degree Sun damages the bones; the bones become weak, and the patient cannot rise from bed. The opposite conditions describe Zhi pulse diseases. From above downwards (Sun pulse disease), bone weakness preventing rising from bed leads to death. From below upwards (Zhi pulse disease), skin gathering and hair falling out leads to death.

This section points out that Sun and Zhi pulses originate from chronic diseases of the root. First degree Sun affecting skin and hair is superficial; fifth degree Sun affecting bones is deep. However, if damage proceeds from bones back to affect skin and hair, death is certain. Therefore, deficiency consumption with a rapid pulse is untreatable.

How should Sun pulses be treated? Answer: For Lung damage, benefit the Qi. For Heart damage, harmonize Ying and Wei. For Spleen damage, regulate diet and adapt to cold and warmth. For Liver damage, soothe the interior. For Kidney damage, benefit the Essence. These are the methods for treating Sun pulses.

The terms "benefit," "harmonize," "adapt," and "soothe" encompass all methods. Formulas are implied without being explicitly stated. Here, only Sun pulses are discussed, not Zhi pulses, because once Zhi pulses appear, there is no treatment. Can one not be cautious?

There are pulses with two beats per exhalation and two per inhalation; three per exhalation and three per inhalation; four per exhalation and four per inhalation; five per exhalation and five per inhalation; six per exhalation and six per inhalation; one per exhalation and one per inhalation; one per two exhalations and one per two inhalations; and even no pulse during respiration. Given such pulse presentations, how can one distinguish the disease?

This reiterates Zhi and Sun pulses as questions, referring to recent illnesses to introduce the following text. However, a pulse with two beats per exhalation and two per inhalation, neither large nor small, is normal.

This refers to the normal pulse of four beats per respiration. "Neither large nor small" means neither flooding nor deep and fine. Three beats per exhalation and three per inhalation indicate the onset of disease. If the front (Cun) is large and the back (Chi) is small, there is headache and dizziness. If the front is small and the back is large, there is chest fullness and shortness of breath.

This refers to the pulse of six beats per respiration. "Shi" means initial. It indicates the beginning of illness. Front refers to Cun pulse; back refers to Chi pulse. Cun large and Chi small indicates pathogen in the exterior. Cun small and Chi large indicates pathogen in the interior.

Four beats per exhalation and four per inhalation indicate the disease is worsening. If the pulse is flooding, the patient suffers from vexation and fullness. If the pulse is deep and fine, there is abdominal pain. If the pulse is slippery and rapid, heat injury has occurred. If the pulse is choppy, mist and dew dampness have penetrated.

This refers to the rapid pulse of eight beats per respiration. "Yu shen" means approaching severity. Flooding and rapid indicates pathogen in the chest and diaphragm. Deep, fine, and rapid indicates pathogen in the abdomen. Slippery and rapid indicates heat pathogen injury. Choppy and rapid indicates damp pathogen penetration.

Five beats per exhalation and five per inhalation indicate the person should be distressed. Deep and fine pulses worsen at night; floating and large pulses worsen during the day. If the pulse is neither large nor small, although distressed, it is treatable. If the pulse varies in size, it is difficult to treat.

This refers to the critical pulse of ten beats per respiration. "Kun" means severe illness. Deep and fine indicates Yin exhaustion, worsening at night. Floating and large indicates Yang exhaustion, worsening during the day. Therefore, if not floating and large or deep and fine, although severe, it is treatable.

Six beats per exhalation and six per inhalation constitute a death pulse. Deep and fine leads to death at night; floating and large leads to death during the day.

This is the death pulse of twelve beats per respiration. The above four sections all refer to recent illnesses.

One beat per exhalation and one per inhalation is named Sun. Although the person can walk, they must eventually lie in bed. The reason is that both Blood and Qi are insufficient.

This is the pulse of two beats per respiration. That the person can walk refers to the initial stage of Lung damage, where walking is still possible. Because they can walk and are not treated, the condition gradually spreads to the Heart, Liver, Spleen, and Kidneys. Blood and Qi are all damaged, leading to bedridden status.

One beat per two exhalations and one per two inhalations is named Wu Hun (Loss of Soul). Those with Wu Hun should die. Although the person can walk, they are called "walking corpses."

This is the pulse of one beat per respiration. Hun belongs to True Yang Qi. When Yang Qi fails and perishes, death is inevitable even if walking is possible. Hence, "walking corpse." These two sections reiterate Sun pulses, clarifying that Sun pulses do not arise overnight. Perhaps in early stages, a pulse resembling Sun but not quite Sun appears, to prevent misidentification, hence the following summary.

Pulse present in the upper part but absent in the lower part indicates the person should vomit. If they do not vomit, death ensues. Pulse absent in the upper part but present in the lower part, although distressing, causes no harm. The reason is like a person having a Chi pulse, just as a tree has roots. Even if branches and leaves wither, the root will naturally sustain growth. Pulses have roots; humans have Yuan Qi. Therefore, death is avoided.

This refers to the pulse absent during respiration. Upper present, lower absent means Cun present, Chi absent. Due to sudden obstruction by substantial pathogens blocking vital energy, vomiting disperses the pathogen and raises the Qi. Failure to vomit leads to death. Yue Ren fears this might be mistaken for Sun pulses, so he clarifies it earnestly. Sun pulses are slow pulses; Zhi pulses are rapid pulses. Not speaking of slow and rapid, but of Sun and Zhi, implies that slow and rapid pulses comprehensively cover deficiency/excess and exterior/interior patterns, serving as a general term for all possibilities. As stated in the first section, Zhi pulses range from four to twelve beats per respiration; Sun pulses range from two beats down to one beat per two respirations. This discusses the outline of root syndromes. Zhi pulses develop from below upwards, indicating Kidney Yin deficiency progressing to Lung Qi exhaustion. Sun pulses develop from above downwards, indicating Lung Qi deficiency and cold progressing to Kidney Yang exhaustion. The second section clarifies that Sun pulse root syndromes originate in the Lung; if untreated, they progress to Heart, Spleen, Liver, and Kidneys. The Sun pulse may reverse into a Zhi pulse due to Kidney deficiency and fire dryness, progressing from Kidney to Liver, Spleen, Heart, and Lung, causing death. Hence, "the opposite indicates Zhi pulse disease." The third section clarifies treatment methods for root syndromes. Treating Lung damage involves benefiting Qi. Damaging the Lung damages Qi. Qi is the True Qi of the Mingmen. When True Qi is damaged, skin wrinkles and hair withers, hence "skin gathers and hair falls." Treatment should benefit Qi. "Benefit" means tonify. Qi deficiency is Yang deficiency. Tonifying Yang Qi fills the skin and hair. Without formulas like Lizhong Tang or Guizhi Fuzi, how can Yang be tonified? Mild cases may use Buzhong Yiqi Tang. If one does not understand the meaning of Sun pulses, how can one clearly treat them? Only when rapid pulse, asthma, cough, and afternoon fever appear, labeling it Lung deficiency, and then tonifying Lung and preserving Qi, is there no effect. This is actually Sun pulse mismanagement turning into untreatable Zhi pulse manifestations. Furthermore, treating Heart damage involves harmonizing Ying and Wei. Damaging the Heart damages Blood. The Heart is the source of Ying Blood; the Lung is the root of Wei Qi. Having damaged the Lung and then the Heart, Blood and Qi cannot nourish the Five Zang and Six Fu organs. Harmonization is required. "Harmonize" implies balancing, involving considering multiple aspects, unlike the direct action of "benefiting." Formulas like Guipi Tang, Yigong San, Bazhen Tang, Shiquan Dabu Tang, or Liuwei Wan, Bawei Wan, adjusted according to the condition, are effective. If one does not understand treating Sun pulses, waiting until rapid pulse, vexation, dry throat, insomnia, etc., label it Heart deficiency, and then administer warm tonics, they will be rejected. Nourishing tonics hinder the Spleen. This is also Sun pulse mismanagement turning into untreatable Zhi pulse manifestations. Furthermore, treating Spleen damage involves regulating diet and adapting to cold/warmth. The Spleen governs the Middle Jiao and muscles. Emaciation leads to loose interstices, making one susceptible to pathogens regardless of temperature. Hence, "adapt to cold/warmth." If the Middle Jiao fails, transportation and transformation lose power, leading to diarrhea or stagnation. Not only herbs like Renshen and Lingzhu tonify the Spleen, but diet must also be regulated regarding hunger/fullness and suitability. Hence, "regulate diet." If one does not understand Zhi/Sun meanings, waiting until inability to eat despite hunger, shortness of breath, distension, and double-string-like rapid pulse, labeling it Spleen deficiency, and using Renshen increases distension, while Guizhi/Fuzi increases deficiency vexation. This is also Sun pulse mismanagement turning into untreatable Zhi pulse manifestations. Furthermore, treating Liver damage involves soothing the interior. The Liver governs sinews, which rely on Blood. Blood deficiency leads to Liver dryness and sinew flaccidity. Greatly tonifying Heart and Spleen allows the Heart to generate Blood and the Spleen to control Blood. Early administration of Guipi or Yangrong tangs is appropriate. If one does not understand Zhi/Sun meanings, waiting until blood depletion, rapid pulse, and difficulty moving limbs, labeling it Liver deficiency, before discussing previous formulas, it is too late. Furthermore, treating Kidney damage involves benefiting Essence. Bones belong to the Kidney. Essence deficiency leads to marrow depletion and bone weakness. Benefiting Essence naturally replenishes marrow. The Classic says: "Where Essence is insufficient, tonify with flavor." Flavor refers to rich animal and meat substances. Such as Lurong (Deer Antler), combined with Dihuang, Renshen, Gouqi, all benefit Essence. If one does not understand Zhi/Sun meanings, waiting until True Yin exhaustion, defying fire steaming, rapid pulse, vexation, inability to rise from bed, and finding that yin-nourishing causes diarrhea and yang-nourishing causes dryness, these are failures to comprehend the essence of this chapter.

The fourth section raises Zhi and Sun pulses separately to distinguish five pathogens and exterior/interior symptoms from root syndromes. The fifth section describes non-flooding, non-deep/fine pulses as normal. The sixth section describes large Cun and deep/small Chi as exterior/interior syndromes. The seventh section describes large Cun and Chi, or deep/small Cun and Chi, as exterior heat and interior heat syndromes. It further states that flooding and slippery indicates heat injury; deep/small and choppy indicates damp-heat penetration. The eighth section states deep/small Cun and Chi indicate interior heat worsening at night; floating/large Cun and Chi indicate exterior heat worsening during the day. It also states that neither large nor small, although distressed, is treatable due to the potential for pathogen retreat and symptom relief. If increasingly floating/large or deep/small, the disease progresses and is difficult to treat. This corresponds to the ninth section's death at night for deep/small and day for floating/large. Sections four through nine focus on Zhi pulses to clarify exterior/interior excess pathogens. The tenth section reiterates that Sun pulses must not be left untreated. Even if the person can walk with a two-beats-per-respiration pulse, early treatment is necessary. Neglecting treatment due to ability to walk leads to bedridden status due to Blood and Qi insufficiency. The eleventh section states that neglecting two-beats-per-respiration leads to one-beat-per-respiration, which is untreatable. Walking capability becomes merely "walking corpse." The final section clarifies the meaning of urgent conditions with absent pulses to prevent confusion with Sun pulses. Absent Chi pulse below indicates sudden obstruction by substantial pathogens, treatable by vomiting. Absent Cun pulse above may indicate accidental exposure to formless deficient pathogens; although distressing, it causes no harm. Returning emphasis to Yuan Qi summarizes the chapter's meaning. Zhongfeng said: Reading this theory reveals that ancient physicians treated root syndromes differently from modern ones. Ancients treated treatable Sun pulses; moderns treat untreatable Zhi pulses. How lamentable!

Difficulty Fifteen states: The Classic says, Spring pulse is wiry, Summer pulse is hooked, Autumn pulse is hairy, Winter pulse is stone-like. Are these Wang (prosperous) pulses or Bing (disease) pulses? Answer: Wiry, hooked, hairy, and stone-like are the pulses of the four seasons. Spring pulse is wiry because the Liver belongs to Eastern Wood. When things begin to grow, there are no branches or leaves yet, so the pulse comes soft, weak, and long, hence "wiry." Summer pulse is hooked because the Heart belongs to Southern Fire. When things flourish, branches hang and leaves spread, curving downwards like hooks, so the pulse comes rapidly and departs slowly, hence "hooked." Autumn pulse is hairy because the Lung belongs to Western Metal. When things conclude, flowers and leaves fall after autumn, leaving only branches like hairs, so the pulse comes light, empty, and floating, hence "hairy." Winter pulse is stone-like because the Kidney belongs to Northern Water. When things are stored, in extreme winter, water freezes like stone, so the pulse comes deep, soft, and slippery, hence "stone-like." These are the pulses of the four seasons.

This chapter discusses the pulses of the four seasons to introduce the concepts of Ping (normal), Bing (disease), and Si (death) pulses.

What if there are changes? Answer: Spring pulse is wiry; reversal indicates disease. What is reversal? Answer: If the Qi comes solid and strong, it is called Taigu (excess), indicating disease in the exterior. If the Qi comes deficient and slight, it is called Buji (deficiency), indicating disease in the interior. If the pulse feels gentle and fluttering, like touching elm leaves, it is Ping (normal). If it becomes more solid and slippery, like touching a long bamboo pole, it is Bing (disease). If it is rapid, forceful, and increasingly strong, like a drawn bowstring, it is Si (death). A slightly wiry Spring pulse is Ping. More wiry than Stomach Qi is Bing. Only wiry without Stomach Qi is Si. Spring relies on Stomach Qi as the foundation.

From this section onwards, all describe the spirit of the pulse, requiring personal comprehension. This is the thousand-hands-thousand-eyes method of pulse diagnosis. Later generations wrote thousands of words of rhymes, yet likely failed to explain even a fraction. Pulse follows Qi; when Qi comes, the pulse comes. The following imitates this.

Summer pulse is hooked; reversal indicates disease. What is reversal? Answer: If the Qi comes solid and strong, it is Taigu, disease in the exterior. If the Qi comes deficient and slight, it is Buji, disease in the interior. If the pulse comes continuously like a ring, like touching lapis lazuli, it is Ping. If it comes increasingly rapid, like a chicken lifting its feet, it is Bing. If it curves forward and stays fixed backward, like holding a belt hook, it is Si. A slightly hooked Summer pulse is Ping. More hooked than Stomach Qi is Bing. Only hooked without Stomach Qi is Si. Summer relies on Stomach Qi as the foundation.

Autumn pulse is hairy; reversal indicates disease. What is reversal? Answer: If the Qi comes solid and strong, it is Taigu, disease in the exterior. If the Qi comes deficient and slight, it is Buji, disease in the interior. If the pulse comes abundant like a chariot canopy, increasing in size upon pressure, it is Ping. If it neither rises nor falls, like touching a chicken feather, it is Bing. If it feels desolate upon pressure, like wind blowing feathers, it is Si. A slightly hairy Autumn pulse is Ping. More hairy than Stomach Qi is Bing. Only hairy without Stomach Qi is Si. Autumn relies on Stomach Qi as the foundation.

Winter pulse is stone-like; reversal indicates disease. What is reversal? Answer: If the Qi comes solid and strong, it is Taigu, disease in the exterior. If the Qi comes deficient and slight, it is Buji, disease in the interior. If the pulse comes large above and small below, soft and slippery like a sparrow pecking, it is Ping. If it pecks continuously with slight curvature inside, it is Bing. If it comes like untying a rope and departs like flicking a stone, it is Si. A slightly stony Winter pulse is Ping. More stony than Stomach Qi is Bing. Only stony without Stomach Qi is Si. Winter relies on Stomach Qi as the foundation.

The normal pulses of the four seasons above are those with Stomach Qi. Disease pulses have less Stomach Qi. Death pulses have no Stomach Qi. To understand the profound meaning of pulse spirit, one must contemplate within the normal pulses.

The Stomach is the sea of water and grain, governing the four seasons, all relying on Stomach Qi as the foundation. This is the key intersection of seasonal variations, disease, and life/death.

This states that seasonal variations, disease, and life/death all depend primarily on Stomach Qi.

The Spleen is the Central Plain. Its peaceful state is invisible; only decline is visible. Coming like a sparrow pecking, or water leaking downwards, is the manifestation of Spleen decline.

This summarizes the pulses of the four seasons above, integrating the Five Zang organs. The Spleen belongs to Earth and prospers in each of the four seasons. Therefore, the normal pulses of the four seasons all belong to the Spleen, hence...