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The *Suwen: Treatise on the Six Micro Principles* states: "If exit and entry cease, the spirit mechanism perishes; if ascent and descent halt, qi standing becomes isolated and perilous." I have often remarked that the discussion of meridian transmission in the *Shanghan Lun* (Treatise on Cold Damage) embodies the profound essence of exit and entry. Generally, the exit and entry of righteous qi proceed from Jueyin to Shaoyin, then Taiyin, Shaoyang, Yangming, and finally to Taiyang, cycling repeatedly. In contrast, pathogenic factors of the six excesses (wind, cold, summerheat, dampness, dryness, fire) enter via the Taiyang channel, retreating step by step until they reach Jueyin as their extreme. This represents the advance of pathogenic qi and the retreat of righteous qi, no longer communicating with external qi. Ling Shao Zhang referred to this as "reverse transmission," while Yang Kui Zhao called it "depression syndrome"; both terms convey this same meaning. Thus, opening, closing, and pivoting constitute the key principles. Discussed separately, they are termed exit/entry and ascent/descent; discussed collectively, they ultimately amount to nothing more than one qi. Observing Li Dongyuan's diagram of floating/sinking and tonifying/reducing in his *Pi Wei Lun* (Treatise on the Spleen and Stomach), which uses Mao and You as pathways and emphasizes the qi of the vast heaven, we can examine his prescribed formulas. Methods using Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Lingpi (Poria), and Zexie (Alismatis Rhizoma) actually originate from the concepts of Gegen (Puerariae Lobatae Radix), Chaihu, and Wuling San (Five-Ingredient Powder with Poria) discussed by Changsha (Zhang Zhongjing), extended and elaborated upon. It is said, "Ascend to the highest heavens, descend to the deepest earth." Although internal injury and external contraction belong to different categories, regarding the ascent, descent, exit, and entry of qi, there is essentially no difference. Master Wang stated: "All orifices oriented horizontally possess qi of exit, entry, and mutual flow; all orifices oriented vertically possess qi of yin/yang ascent and descent." Essentially, humans exist within qi just as fish exist within water; humans cannot see qi, just as fish cannot see water. The nine orifices above and below, along with the eighty-four thousand pores outside, serve as its gates. Qi circulates and distributes throughout the body, so that even severe wind or toxic pathogens cannot cause harm. Therefore, "Where pathogenic factors gather, righteous qi must be deficient." Diseases sinking inward involve entry without exit; diseases sinking downward involve descent without ascent. These four characters—ascension, descent, exit, and entry—are the bellows (tuo yue) of life and the general outline of all diseases.

A detailed examination of the tight pulse at the Cun Kou (radial artery at the wrist) and the tight pulse at the Fu Yang (dorsalis pedis artery) in the *Shanghan Lun* reveals that although both are termed "tight," their meanings differ. A tight pulse appearing at Cun Kou indicates a disease caused by exogenous pathogens. A tight pulse appearing at the Fu Yang pulse, which is the primary pulse of the stomach, requires specific interpretation. The *Ping Mai Pian* (Chapter on Pulse Diagnosis) states: "If the Dizhong pulse is faint and tight, tightness indicates cold." It also states: "If the Dizhong pulse is deep and rapid, deepness indicates excess, rapidity consumes grain, but if tight, the disease is difficult to treat." Tightness indicates cold, and rapidity indicates heat. If it is described as rapid and also as tight, does this not confuse cold and heat? Lu Youyou, in his commentary, explained: "Tightness indicates cold" because one might fear it implies a lack of yang. Here, the character "cold" does not refer to cold pathogenic factors, but rather contrasts with the character "yang," describing the state of lacking yang. Lacking yang means lacking the yang of the epigastrium, which corresponds to the saying, "Knowing that yin remains constant, never seeing yang." Referring to the Chi pulse (wrist position), this denotes kidney yang; referring here to the Fu Yang pulse, it denotes stomach yang. Humans rely on stomach qi as their foundation. Therefore, when diagnosing the Fu Yang pulse, one should recognize the slow and moderate qualities; when diagnosing the Cun Kou pulse, one should seek the soft and weak qualities. Both are manifestations of stomach yang distributing throughout the body, aligning with the essential principle in the Classics: "Absence of stomach qi signifies death." As for the Cun Kou pulse being floating and tight, or the Cun Kou pulse showing tightness in both yin and yang positions, this "tightness" refers to cold pathogenic factors. Upon careful analysis, there must inherently be soft and weak qualities present. This corresponds to the saying, "How can soft and weak [pulses] correspond to the eleven heads?" Serving as the master of the five zang and six fu organs, and the framework of the pulses, this condition must not be conflated with the tightness of the Fu Yang pulse.