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Bian Que said: What are the diseases caused by the pulse of depletion (Sun Mai)? The first degree of depletion affects the skin and hair, manifesting as wrinkled skin and falling hair; the second degree affects the blood vessels, where blood deficiency fails to nourish the Zang organs; the third degree affects the muscles, resulting in emaciation where food intake cannot transform into muscle tissue; the fourth degree affects the sinews, causing flaccidity and inability to control movement; the fifth degree affects the bones, leading to bone atrophy and inability to rise from bed. Conversely, if the disease progresses upwards, it is termed "Zhi Mai" (Pulse of Arrival).

If the disease progresses from top to bottom, bone atrophy with inability to rise from bed indicates a fatal prognosis; if it progresses from bottom to top, wrinkled skin and falling hair indicate a fatal prognosis.

Bian Que said: A pulse rate of two beats per exhalation or one beat per exhalation is called "Depletion" (Sun). Although the patient can still walk, they have not yet become bedridden, indicating that both Qi and Blood are deficient. If it worsens to one beat per exhalation and one beat per inhalation, it is called "Soulless" (Wu Hun), and such patients will die. Although the patient can still walk, this state is akin to a "walking corpse."

Bian Que said: What is the method for treating depletion? For lung depletion, benefit its Qi; for heart depletion, harmonize Ying and Wei (Nutritive and Defensive Qi); for spleen depletion, regulate diet and adapt to cold and warmth; for liver depletion, soothe the middle Jiao; for kidney depletion, benefit Essence and Qi.

Wang Shishan said: I treated a patient in his twenties who suffered from cough, hematemesis, night sweats, borborygmus with diarrhea, and afternoon fever. His pulse was fine, rapid, and irregular. I told him: The *Nan Jing* states that "Seven Transmissions" refers to counter-clockwise transmission along the meridians. Initially, due to the exhaustion of Kidney Water, this is a Kidney disease. Kidney pathogenic factors transmit to the Heart, causing fever worse at night; Heart pathogenic factors transmit to the Lung, causing cough and sweating; Lung pathogenic factors transmit to the Liver, causing hypochondriac pain and Qi stagnation; Liver pathogenic factors transmit to the Spleen, causing borborygmus and diarrhea; Spleen pathogenic factors transmit back to the Kidney, but the Kidney can no longer accept the pathogen. Since the disease involves all these aspects, death will occur within ten days, which indeed happened. The term "pathogen" here refers to the extreme self-disease invading upwards because the body cannot maintain internal stability. (The *Suibi Chengzhi Shenghua Lun* notes: When weakness allows others to exploit it, the trend is smooth; when extreme illness allows the body to attack others, the trend is contrary, which applies here.)

The Classics state: Death occurs with muscle wasting and severe heat; death occurs with worsening cough and sweating; death occurs with cough accompanied by diarrhea and upper asthma (wheezing/shortness of breath). Cough with inability to lie on the left side indicates Liver Distension; cough with inability to lie on the right side indicates Lung Distension; both are fatal signs. (Note: Distension above the ribs near the armpit belongs to the Lung; distension below the ribs near the waist belongs to the Liver. Distension in both upper and lower regions indicates Qi and Blood... The *Ling Shu* states: In Skin Cold-Heat, the body cannot rest on the mat, hair is scorched, the nose is dry and shriveled, and there is no sweat like in mid-winter; treat by taking the collaterals of the Three Yang meridians and supplementing the Hand Taiyang meridian. In Muscle Cold-Heat, muscle and hair are scorched, lips are dry, and there is no sweat like in mid-winter; treat by taking points on the lower Three Yang meridians to remove blood stasis, and supplement the Foot Taiyin meridian to induce sweating. In Bone Cold-Heat, the patient is restless with continuous profuse sweating; if teeth are not yet dry/shriveled, take the collateral of the Foot Shaoyin meridian in the inner thigh; if teeth are already dry/shriveled, it is untreatable and fatal, belonging to Jue syndrome.)

Liu Hejian said: Diseases of deficiency-depletion arise from feeling cold or heat due to deficiency. Feeling cold damages Yang; Yang deficiency leads to Yin excess, and damage proceeds from top to bottom, treated with acrid, sweet, and bland herbs; if damage exceeds the Stomach, it is untreatable. Feeling heat damages Yin; Yin deficiency leads to Yang excess, so damage proceeds from bottom to top, treated with bitter, sour, and salty herbs; if damage exceeds the Spleen, it is untreatable. Top-to-bottom progression goes from Lung to Heart to Stomach; bottom-to-top progression goes from Kidney to Liver to Spleen. It is stated: Damage to Heart and Lung causes sallow complexion; damage to Kidney and Liver causes physical atrophy. Failure to transform grain indicates Spleen damage; deep infiltration results in Deficiency Labor (Xu Lao).