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If panting and urgency are accompanied by shrugging of the shoulders, and the pulse is floating (Fu, superficial) and slippery (Hua, smooth), it is a favorable condition (Shun). If the pulse is deep (Chen, profound) and choppy (Se, rough), with cold limbs, or if a scattered (San, dispersed) pulse appears, it is an unfavorable condition (Ni). This passage explains that the pulses and syndromes of panting and urgency should be distinguished. Rapid breathing is called "panting" (Chuan); shortness of breath is called "urgency" (Ji). Because respiration is obstructed, the shoulders rise accordingly. A floating pulse belongs to Yang, indicates the Exterior, and relates to Wind; a slippery pulse belongs to Yang and relates to Phlegm and Food Stagnation. Generally, external pathogens obstruct the chest and diaphragm, causing stagnation and leading to panting and shoulder shrugging. If the pathogenic factors can be dissipated and the stagnation cleared, it is termed favorable. A deep and choppy pulse: deep indicates Yin and the Interior; choppy indicates Yin and Deficiency. This signifies that Yuan Qi (Original Qi) cannot connect continuously, resulting in cold limbs. If a scattered pulse is also seen, the True Yuan Qi will dissipate along with the panting, inevitably leading to death; thus, it is termed an unfavorable syndrome.

In cases of heat disease with Fire manifestations, if the pulse is surging (Hong, full) and rapid (Shu, fast), it is treatable; if the pulse is deep and minute (Wei, faint), without Fire signs and rootless, it is critical. This passage discusses diseases caused by Fire and Heat. When heat disease presents with Fire symptoms, it is a Fire disease, and the pulse should be surging and rapid.

Bone-steaming fever with a rapid but deficient pulse is manageable; however, if fever is accompanied by a choppy and small pulse, death is inevitable. This passage explains that the pulses and syndromes of bone-steaming fever should be distinguished. Bone-steaming fever refers to the heat arising from internal injury and deficiency consumption. A rapid and deficient pulse is its natural presentation. However, if bone-steaming fever presents with choppy and small pulses, a choppy pulse indicates scarcity of Essence and Blood, and a small pulse indicates decline of Yuan Qi. As True Yin is daily depleted, death will inevitably occur.

Exhaustion due to overwork (Lao Ji) and various deficiencies present with floating, soft, minute, and weak pulses, indicating the failure of Earth (Spleen/Stomach); double wiry (Xian, string-like) pulses indicate the failure of Earth due to excessive Wood (Liver); urgent and rapid pulses indicate blazing Fire (Heart/Liver). This passage discusses the syndromes of Lao Ji combined with other pulse patterns. "Lao Ji" refers to the Five Labors and Six Extremities. According to *Chao Yuanfang's Treatise on Disease Sources*: Lung Labor manifests as shortness of breath, facial edema, and loss of smell; Liver Labor manifests as dry and dark complexion, bitter taste, mental unrest, fearfulness, inability to sleep alone, and blurred vision; Heart Labor manifests as mental confusion, forgetfulness, difficult defecation or loose stools resembling duck droppings, and oral ulcers; Spleen Labor manifests as tongue stiffness and difficulty swallowing saliva; Kidney Labor manifests as back stiffness preventing bending and stretching, dysuria, reddish-yellow urine with dribbling, pain inside the penis, dampness in the genitalia, sores on the scrotum, and fullness/urgency in the lower abdomen. These five labors correspond to the five Zang organs. The Six Extremities are: 1. Qi Extremity, 2. Blood Extremity, 3. Sinew Extremity, 4. Bone Extremity, 5. Flesh Extremity, 6. Essence Extremity. These are diseases associated with the five Zang organs, representing deficiency damage reaching the extreme. The Kidney has one additional category, Essence Extremity, hence there are six extremities. Lao Ji damages Qi and Blood, causing daily depletion and gradual physical decline. The observed pulses reflect the disease state, such as floating like emptiness, soft like lack of strength, minute like about to vanish, and weak without power. Although these are pathological pulses, they are relatively appropriate. However, double wiry pulses indicate the failure of Earth (due to excessive Liver Wood attacking weakened Spleen Earth); urgent and rapid pulses indicate blazing Fire. Wiry pulses belong to Liver Wood; double wiry pulses indicate excessive Wood overcoming long-standing diseased Earth, indicating inevitable failure. Urgent and rapid pulses are restless and forceful, indicating flourishing pathogenic Fire and extinction of True Yin; both conditions are untreatable.