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The pathogenesis is profound and mysterious, the principles of pulse diagnosis are subtle and deep. Although they are fully recorded in the sacred classics, without oral transmission and mental instruction from a teacher, one cannot truly understand them. (The pivot of disease and the profound principles of pulses are fully recorded in *Suwen* and *Maijing*. If beginners do not receive oral transmission and mental instruction from a teacher, how can they exhaust their underlying essence?) To diagnose hundreds of diseases and determine life and death, one must explore the principles of Yin and Yang pulse conditions. (Pulses contain the principles of Yin and Yang, thus enabling the diagnosis of hundreds of diseases and the determination of life and death.) When formulating the Seven Forms (Da, Xiao, Huan, Ji, Qi, Ou, Fu) and administering medicines, one should deduce the patient's physical and emotional states of pleasure or suffering. (The Seven Forms refer to Da, Xiao, Huan, Ji, Qi, Ou, and Fu. Formulas are formulated according to the disease; people differ in whether their form and spirit are pleasurable or suffering, or if they suffer frequent fright. One must know these principles when prescribing.) Where evil pathogens reside, the Biao (Branch/Symptom) and Ben (Root/Cause) cannot escape the influence of the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire). (Residing refers to external evil pathogens residing in the body. The initial onset is Biao, the root cause is Ben. However, the Biao and Ben of residing evils are nothing but constituted by Wind, Cold, Summer-heat, Dampness, Dryness, and Fire.) The origin of diseases does not exceed the Four Causes. (The Classics state: Some originate from Qi movement causing internal formations, such as accumulations, masses, goiters, tubercles, epilepsy, etc. Some originate from Qi movement causing external formations, such as carbuncles, sores, ulcers, hemorrhoids, scrofula, tremors, edema, red eyes, rashes, pain, and itching, etc. Diseases arising internally without Qi movement include retained fluids, food stagnation, hunger/fullness imbalance, overwork, old food, cholera, sorrow/fright/anger/joy, longing/worry/knotting, etc. Diseases arising externally without Qi movement include miasma, evil spirits, insects/snakes, gu poison, flying corpse ghost strikes, Wind-Cold-Summerheat-Dampness, falls/cuts/shots/stabs/beats, etc. These four are the causes of all diseases.) First distinguish complexion, second distinguish voice; this is the divine and sage-like妙用 (wonderful application) of physicians. (The Classics say: Knowing through observation is called Shen (Divine), knowing through listening/smelling is called Sheng (Sage). Observating the Five Colors and distinguishing the Five Tones to know the master of the disease—what else could it be but Divine and Sage?) Third, "three broken arms" (extensive clinical experience), fourth, "nine broken arms" (long-term illness experience); originally due to the patient's felt condition. (*Zuo Zhuan*: Duke Ding's third year, Gao Guo of Qi said: "Three broken arms make a good doctor." *Chu Ci*: "Nine broken arms make a doctor; I now know this is true!" If doctors can achieve this, they can understand the patient's condition.) If one can exhaust the mysteries of the eight pulses: Floating, Sinking, Slow, Rapid, Slippery, Choppy, Large, and Moderate, (These eight are the mysteries of pulses.) then one will know the names of the Eight Essentials: Exterior, Interior, Deficiency, Excess, Cold, Heat, Evil, and Zheng (Upright). (Exterior means disease is not inside; Interior means disease is not outside. Deficiency refers to the Five Deficiencies. Excess refers to the Five Excesses. Cold refers to accumulated cold in Zang-Fu. Heat refers to accumulated heat in Zang-Fu. Evil refers to non-Zang-Fu proper diseases. Zheng refers to non-external evil invasion. The Classics say: Diseases have eight essentials; if not examined carefully, the disease cannot be removed. It is not that the disease cannot be removed, but that there is no method to remove it. If one studies the principles of the eight pulses thoroughly, the eight essentials will naturally be known.) The eight pulses are the guidelines for all pulses. (Guideline refers to the net rope; collar refers to the garment collar. Mastering these eight pulses allows deduction of other pulses, just like holding the main rope and collar, where details naturally fall into place.) The eight essentials are the balance scale for all diseases. (Weight refers to the steelyard weight; Balance refers to the beam. Weighing objects to achieve balance, taking the middle at any time, thus measuring weight; therefore, measuring various diseases relies on these eight essentials.) Choppy pulse indicates blood deficiency and essence injury, moving with a rough, obstructed sensation, like a knife scraping bamboo; Slippery pulse indicates excessive phlegm and abundant Qi, feeling round and smooth under the finger, like rolling pearls. (The shape of the Choppy pulse is like a knife scraping bamboo, rough and obstructed, indicating injury to essence and loss of blood. The shape of the Slippery pulse is like a rolling pearl, smooth and fluent, indicating abundant Qi and excessive phlegm. These two pulses can probe the condition of Qi and Blood deficiency/excess.) Slow indicates Cold, Rapid indicates Heat, recording the number of beats per breath. (Normal pulse beats four times per breath. Less than this is Slow, three beats per breath. More than this is Rapid, six beats per breath. The Classics say: Rapid implies Heat, Slow implies Cold. These two pulses distinguish Cold and Heat.) Floating indicates Exterior, Sinking indicates Interior, depending on the lightness or heaviness of lifting and pressing. (Light lifting finds it on the skin, heavy pressing makes it disappear, floating like water, called Floating. Heavy pressing reaches tendons and bones to find it, called Sinking. The Classics say: Floating is in the Exterior, Sinking is in the Interior. These two pulses distinguish Exterior and Interior.) Moderate indicates recovery of Zheng Qi, gentle like willow dancing in spring wind; Large indicates disease progression, vigorous like autumn tide rising. (Moderate pulse is the Stomach pulse, fluent and moderate without urgency. *Maijue* says: "Ah, moderate like spring willows." Moderate indicates Stomach Qi recovery, so evil retreats and Zheng recovers. Large pulse comes grand and large. The Classics say: Pulse coming turbulent and革革 like a gushing spring indicates disease progression and danger. Thus, like surging autumn tides describes the Large pulse. Zhang Zhongjing said: Large indicates disease progression, Moderate indicates disease retreat.) If the six pulses are equal, rejoice that medicine may not be needed. (Zhang Zhongjing said: If the six pulses—Large, Small, Floating, Sinking, Slow, Rapid—are equal, the disease heals without treatment. Just as in the *I Ching*, a disease of "No Falsehood" heals without medicine, bringing joy.) If the six pulses are unevenly strong, worry about "firewood gathering" (metaphor for severe illness). (*Maijing* says: If the six pulses—Floating, Sinking, Slippery, Choppy, Slow, Rapid—are unevenly strong, named "Can Zei Pulses," they can dominate the meridians, hence the worry of firewood gathering.) Exterior syndromes should be resolved by sweating; Interior syndromes should be pacified by purging. (Evil in the Exterior requires sweating. Evil in the Interior requires purging. This is the treatment for Exterior Excess and Interior Excess.) To rescue Exterior Deficiency use Guizhi Tang (Cinnamon Twig Decoction), Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix); to rescue Interior Deficiency use Ganjiang (Dried Ginger), Fuzi (Aconiti Lateralis Radix Preparata), Renshen (Ginseng Radix et Rhizoma), Fuling (Poria). (Guizhi, Huangqi, Shaoyao rescue Exterior Deficiency. Rougui (Cinnamomi Cortex), Fuzi, Ganjiang, Renshen, Fuling rescue Interior Deficiency.) Diseases differ in Deficiency and Excess; Deficiency is tonified, Excess is purged. (There is disease Deficiency/Excess and constitutional Deficiency/Excess, so Deficiency is tonified, Excess is purged; one must clearly distinguish between tonification and purgation.) Evils differ in Cold and Heat; Cold is warmed, Heat is cleared. (When Cold dominates, use Acrid-Warm herbs. When Heat dominates, use Cold-Clear herbs.) External evils are those residing from Wind, Cold, Summer-heat, Dampness, Dryness, and Fire. (These Six Evils enter from outside, hence called "External Evils.") Internal evils are the mutual overcoming of Deficiency, Excess, Thief, Minor, and Zheng evils. (*Nanjing* says: Coming from the preceding is Deficiency Evil. Coming from the following is Excess Evil. Coming from what one controls is Minor Evil. Coming from what controls one is Thief Evil. Disease originating from the same organ is Zheng Evil. These are evils of mutual overcoming among the Five Zang, hence called "Internal Evils.") Zheng Qi is the True Qi of the Stomach, excellent like a loyal minister of the state. (Human Stomach Qi is like a loyal minister in the state; then evil flatterers cannot act arbitrarily and cause harm, Zheng defeats Evil.) Driving out evil is like chasing bandits; one must attack urgently and eradicate completely. (Evil invading the body is like bandits in a nation; if not urgently attacked and eradicated, the harm is significant, so evil must be attacked.) Nourishing Zheng Qi is like dealing with petty people; it lies in self-cultivation and rectifying the mind. (Protecting the body is like dealing with petty people; if one rectifies the mind and cultivates oneself, evil cannot interfere. If Zheng Qi is insufficient, evil gathers, so Zheng must be nourished.) Soil fertility varies, investigating constitutional excess or deficiency. (Northwest soil is fertile, constitution is thick. Southeast soil is thin, constitution is thin. Excess and deficiency are visible.) Luck and Rebound (Yunqi) deduce the prevalence of Excess and Deficiency. (Five Yun and Six Qi govern the annual command; Yang years are Excess, Yin years are Deficiency. Their prevalence, rebound, depression, and eruption disasters exist. Good practitioners deduce annual disasters and adjust accordingly. Hence: Mind precedes annual Qi, do not violate Heavenly Harmony.) Once pulse and disease methods are mastered, why worry about ineffective medication? (Once pulse principles are clear, treatment methods are prudent. Thus, how can prescriptions and medications fail?)

Originally, Stroke (Zhong Feng) should be distinguished as True or False. (True Stroke is caused by external invasion. False Stroke is not caused by external invasion.) True Stroke presents Six Meridian syndromes, divided into Middle Zang, Middle Fu, and Middle Collaterals/Vessels. (Wind evil invades humans with varying depth. Wind in the Exterior presents Six Meridian syndromes: Taiyang, headache and stiff spine; Shaoyang, chest fullness, alternating chills and fever; Yangming, body heat, eye pain, and irritability; Shaoyin, thirst and occasional cold limbs; Taiyin, spontaneous diarrhea, abdominal pain, or difficulty defecating; Jueyin, testicular retraction, urinary incontinence, cold limbs. Middle Fu is shallow, Middle Zang is deep, Middle Collaterals/Vessels are half-Exterior half-Interior; this division distinguishes depth.) False Stroke follows the elaborations of the Three Masters (Hejian, Dongyuan, Danxi), attributed to Dampness, Fire, or Qi Deficiency. (Hejian cited extreme emotions generating Fire leading to apoplexy, emphasizing Fire. Dongyuan argued original Qi deficiency allows evil to gather, causing sudden collapse resembling wind, emphasizing Qi Deficiency. Danxi noted the warm and damp climate of the Southeast, stating wind diseases are not wind but Phlegm generated from Dampness, Heat generated from Phlegm, and Wind generated from Heat, emphasizing Dampness. Since the Three Masters' elaborations are not external wind, they are called False.) Middle Zang endangers life. (Middle Zang often blocks the nine orifices, presenting symptoms like slack lips, loss of speech, deafness, blindness, nasal congestion, difficulty defecating. Those with open mouth, closed eyes, letting go of hands, urinary incontinence, and snoring sleep are untreatable. This deep invasion of Zang is why life is endangered.) Middle Fu leads to limb paralysis. (Middle Fu affects the four limbs; since wind evil invasion is shallow, limbs become useless.) In Collaterals, facial deviation occurs; in Vessels, hemiplegia occurs. (Evil in Collaterals/Vessels is neither Exterior nor Interior, has no fixed location, affecting left or right, lacking interior/exterior signs, hence facial deviation and hemiplegia, with warnings against sweating and purging.) Sudden collapse requires decoctions for tonification. (Sudden collapse is Qi Deficiency, treated with Renshen and Huangqi.) Phlegm-Qi obstruction can be treated with emetics. (Phlegm-Qi obstructing the chest and diaphragm must be resolved by vomiting.) Twitching of hands and feet is called Chu. (Twitching refers to muscle spasms. Relaxation refers to tendon laxity. Spasms and convulsions of hands and feet indicate Chu.) Back and neck hyperextension is called Chi. (Stiffness and opisthotonos indicate Chi syndrome. Without sweat is Gang Chi, with much sweat is Rou Chi. Initially caused by stroke or Cold-Damp invasion.) It may manifest as Feng Fei or Pian Ku, or transform into Feng Bi or Feng Yi. (Feng Fei: body painless, limbs unresponsive. Pian Ku: hemiplegia. Feng Bi: numbness and insensitivity. Feng Yi: sudden unconsciousness. These four are transformations of Wind.) Tan, Huan, Wei, Yi involve flaccid limbs and insensitivity. (Left immobility is Tan, right immobility is Huan. Wei refers to weak calves unable to support the body, weak bones unable to rise. Danxi said: Lung Heat scorches leaves, affecting the Five Zang, leading to Wei Jue. Yi means transformation. These three are diseases of rich diet, belonging to Earth, hence flaccid limbs and insensitivity resemble Wind but are not Wind.) Wind, Dampness, and Cold combine to form Bi Syndrome. (Classics say: Wind, Dampness, and Cold mixing together form Bi. Wind dominance is Xing Bi, Dampness dominance is Zhuo Bi, Cold dominance is Tong Bi.) Although unpredictable in its changing nature, it is all caused by Wood excess and Wind pervasion. (Wind changes rapidly and moves quickly, unpredictable. All above diseases are variations of Liver Wood Wind pervasion. *Zuo Zhuan* says: Wind pervasion causes terminal diseases, this is what is meant.) Snow and frost biting cold are always Cold Evil. (Snow is Cold condensation. Frost is肃杀 (severe killing) Qi. Biting cold is Cold majesty. All three are Cold transformations, hence Cold Evil. Zhang Zhongjing said: Winter severe cold forms the most lethal Qi.) Scorching sun and steaming heat are all Summer-heat category. (Scorching is fierce. Heat is fire power. Steaming is hot air vaporizing. Thus in Heaven it is Sun, on Earth it is Summer-heat, in Humans it corresponds to Heart. All these are Summer-heat.) Cold Injury presents tight pulse and cold body; Summer-heat Injury presents deficient pulse and intense heat. (Zhang Zhongjing said: Full pulse and cold body result from Cold Injury; deficient pulse and hot body result from Summer-heat Injury.) Summer-heat should be astringed, tonified, and cleared; Cold can be warmed and dispersed. (Summer-heat injures Qi, causing much sweat, suitable for astringing sweat and tonifying deficiency, e.g., Qingshu Yiqi Tang. Cold injures Ying, causing no sweat, requiring releasing exterior to disperse evil, e.g., Mahuang Tang.) Various spasms and stiffness, heavy body and edema arise from mountain/marsh wind/rain/damp steam. (Classics say: Various spasms/stiffness, retained fluid/blockage/fullness, cholera/heavy body/edema all belong to Dampness. Dampness is wind/rain attacking deficiency, mountain/marsh vapor.) Various choppy/dry/withered states, hard skin and cracking all belong to Heaven/Earth solemn Dryness Qi. (Classics say: Various choppy/dry/withered, hard skin/cracking all belong to Dryness. Dryness is Yang Qi descending, Yin Qi rising, Heaven/Earth solemn and desolate, strong wind Qi.) Dampness harms flesh and skin; Dryness dries intestines and stomach. (Classics say: Earth's Dampness Qi, when contracted, harms flesh, skin, and tendons/bones. Dryness is transformation of Yangming Dry Metal; Stomach and Large Intestine belong to Yangming, thus contracting by similarity. Intestines/Stomach receiving evil leads to dry/choppy/constipated diseases.) Northwest high wind and dry soil often suffer thirst, constipation, and abscesses. (Northwest is high and cold, prone to Dry diseases, hence thirst, constipation, abscesses are common.) Southeast low land and wet water often contract jaundice, edema, and dysentery. (Southeast is low and wet, prone to Damp diseases, hence jaundice, edema, dysentery are common.) Evils have "Shang" (Injury) and "Zhong" (Strike); Shang is shallow, Zhong is deep. (For Wind, Cold, Summer-heat, Dampness, there is Shang and Zhong. Shang injures Qi/Blood layers and skin pores, progressing slowly from shallow to deep, entering Interior, hence slow and shallow. Zhong enters directly inward, hence urgent and deep.) In humans, there are Strong and Weak; thus Strong move it away, Weak suffer severely. (Strong ones have sufficient Yuan Qi and dense pores, evil cannot invade; even if struck, Qi moves and disperses, causing no harm. Weak ones have Qi deficiency and loose interiors, evil easily injures; weak Qi cannot move, thus disease occurs. Zhang Zhongjing said: Evil toxin enters pores, transmits between Ying and Wei; Strong ones' Qi moves, causing no harm; Weak ones' Qi stays, becoming disease. This is what is meant.) Heaven/Human Seven Fires: Jun (Monarch) and Xiang (Minister) fires, and Five Emotions. (Jun/Xiang fires are Heaven-made. Five Emotion fires are Human-made. Hence Heaven/Human Seven Fires.) Practitioners who understand direct suppression and following nature can achieve divine skill. (Jun Fire is Yang Fire, can be directly suppressed with ice/cold herbs. Xiang Fire is Yin Fire, cannot be treated directly, must follow its nature to subdue it. This is the wonderful method of treating Fire; understanding this mystery makes skill divine.) Good physicians who understand counter-treatment and seeking the root can cure all diseases. (Good practitioners treat Heat with Heat, Cold with Cold, e.g., using Cold for Heat, Heat for Cold, so evil easily follows. Classics say: If cold medicine causes heat, or hot medicine causes cold, seek the root to reduce it. If Heat persists, blame Water deficiency; if Cold persists, blame Fire deficiency. Strengthening Water to aid Fire is called "Seeking Root." Strengthening Water source to calm Sunlight; strengthening Fire master to eliminate Yin shadow. Knowing this, no disease is incurable.) Deficient Fire and Excess Fire require appropriate tonification and purgation. (Danxi said: Deficient Fire can be tonified, Excess Fire can be purged.) Damp-Heat and Depressed-Heat require different attacking and releasing agents. (Severe Damp-Heat is attacked. Severe Depressed-Heat is released. Agents differ.) Having understood the mechanism of Six Qi, one can leave a thousand-year reputation. (Understanding the pathogenesis of Wind, Cold, Summer-heat, Dampness, Dryness, Fire can bring fame.)

It is heard that Blood belongs to Yin; insufficiency generates Heat, this is Hejian's firm theory; Qi belongs to Yang; excess is Fire, wear Danxi's maxim. (Yin deficiency leads to Fire prosperity, Qi prosperity generates Fire. These two sages revealed what predecessors had not. Detailed discussions exist, not repeated here.) Qi Excess manifests as panting/urgency, distension/fullness, blockage; accompanying Fire descent stops it naturally. (Panting is Qi ascending. Distension is Qi not soothing. Blockage is Qi not flowing. Though Qi excess, all are caused by Fire. Not treating Qi but descending Fire treats the Root; Qi is Branch, Fire is Root.) Blood Deficiency manifests as hematemesis/epistaxis, vexation/steaming, consumptive disease; difficult to heal without clearing Heat. (Hematemesis/epistaxis: Fire carries Blood upward. Vexation/steaming: Fire Qi steaming. Consumptive disease: Yin deficiency with Fire stirring. Though all Blood Deficiency signs, constant activity boils True Yin, making Blood more deficient.) Lizhong Tang treats Spleen/Stomach Deficiency-Cold. (Lizhong Tang tonifies Spleen/Stomach, expels Cold.) Runxia Wan transforms Chest/Diaphragm Phlegm-Saliva. (Abundant Phlegm-Saliva arises from Fire flaming upward, Water rising to save Fire, failing to descend, making Kidney more deficient and Fire more blazing. Danxi made this drug to descend Fire, so Water returns to source and descends moistening, hence the name.) Sudden vomiting/reversal is caused by Cold. (Sudden Cold in Stomach causes vomiting/reversal. Hejian said: Vomiting immediately after eating indicates No Fire.) Chronic cough/hemoptysis is Fire's fault. (Chronic cough/hemoptysis: Fire flaming and conquering Lung Metal.) Pingwei San treats Damp-Excess causing persistent soft diarrhea. (Soft diarrhea: much water passed, Dampness is severe, hence Pingwei San to leach Dampness.) Yirong Tang treats palpitations, trance, insomnia. (Palpitations: heart palpitation. Trance: like being hunted, fearful state. All Ying-Blood deficiency causing Heart-Mind unrest, hence insomnia, Yirong Tang governs.) Zhike San and Dasheng San help pregnant women bind fetus and facilitate birth. (Rich people over-nourish, becoming fat; over-rest, Qi does not move, often difficult birth. These two drugs reduce Qi and bind fetus, facilitating birth. Da means lamb. Lambs give birth without difficulty, *Shi Jing* says: "First born like a lamb," taking this meaning, hence Dasheng San.) Maren Wan and Runchang Wan treat elderly with little Blood and difficult defecation. (Elderly with little Blood lack nourishment/moisture to Large Intestine, hence constipation, cannot purge harshly. These two drugs nourish Blood, moisten Dryness, stool passes naturally.) Calming fright/palpitations requires Niuhuang (Calculus Bovis), Pearl, Polyrimnia. (Sedating agents, thus calming fright.) Resolving parasite accumulation relies on Heshi (Chrysanthemi Indici Flos) and Leiwanz (Wormwood Fruit). (Humans with parasites use these to resolve.) Unblocking closure uses Malva and Spinach, taking slipperiness to nourish orifices. (Dairen used this to moisten dryness in elderly/weak, taking slipperiness.) Reducing goiter uses Kunbu (Laminariae Thallus) and Haizao (Sargassum), because Salty softens hardness. (Danxi took Salty-Cold agents to soften hardened goiter.) These are secrets of former sages, alas, transmitted to later generations.

It is said: Summer injury by Summer-heat, Autumn must manifest as Malaria. Close and sudden cases heal in real-time; distant and lingering cases occur every three days. (Classics say: Summer heat without sweating becomes...)