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The pulse presenting various sunken (Chen, 沉) qualities indicates the presence of water retention. A floating (Fu, 浮) pulse is often associated with Qi stagnation and Wind pathogen. A sunken and solid (Shi, 实) pulse, or a sunken-heat (Chen-Shu, 沉数) pulse at the interior level, belongs to Yang syndrome; a sunken-slow (Chen-Chi, 沉迟) pulse belongs to Yin syndrome. A floating and large (Da, 大) pulse suggests critical illness with impending disaster; a deficient and small (Xu-Xiao, 虚小) pulse is alarming. This passage elucidates the principles of pulses and symptoms in Water Disease (Shui Bing, 水病).

Water-Qi disease is divided into four types: Qi Water (Qi Shui, 气水), Feng Water (Feng Shui, 风水), Shi Water (Shi Shui, 石水), and Li Water (Li Shui, 里水). Although the varieties of water disease are numerous, whenever the pulse presents as sunken, it invariably carries the quality of sunkenness. Even for Qi Water and Feng Water located at the exterior, where the pulse should theoretically be floating, there must inevitably be a tendency towards sunkenness. This is because "sunken" reflects the nature of water. In terms of morphology, "floating" refers to the position. If the pulse is sunken and rapid (Shu, 数), it constitutes a Yang Water syndrome, necessarily accompanied by Yang heat; if the pulse is sunken and slow (Chi, 迟), it constitutes a Yin Water syndrome, necessarily accompanied by Yin cold. A floating and large pulse in water disease indicates the dispersion of water qi and the emergence of disaster; a deficient and small pulse indicates the decline of righteous Qi and the persistence of pathogenic factors, which is indeed alarming.

In distension-fullness disease, a wiry (Xian, 弦) pulse indicates Wood overacting on Earth (Spleen/Stomach constrained by Liver); a rapid and surging (Hong, 洪) pulse indicates damp-heat; a slow and weak (Ruo, 弱) pulse indicates Yin-cold; a floating pulse indicates deficiency-type fullness; a tight (Jin, 紧) pulse indicates excess in the middle jiao. A floating and large pulse is treatable; a deficient and small pulse is critically dangerous. This passage elucidates the principles of pulses and symptoms in Distension-Fullness (Zhang Man, 胀满).

"Distension" (Zhang, 胀) refers to swelling on the exterior; "fullness" (Man, 满) refers to stuffiness within the interior. This condition displaces the Zang-Fu organs, expands the chest and hypochondrium, tenses the skin, exposes the sinews, protrudes the umbilicus, rounds the waist, and causes the abdomen to swell like a drum. It is a disease of the chest and abdomen. Generally, this disease arises from irregular diet, improper daily routine, excessive sexual activity and fatigue, and unending worry and thought, leading to Qi congestion and stasis in the middle jiao, gradually giving rise to distension-fullness. Therefore, excess patterns are few while deficiency patterns are many; heat patterns are few while cold patterns are many, all resulting from Spleen and Stomach dysfunction. The Spleen and Stomach belong to Earth, reside in the center, and irrigate the four other Zang organs. If a wiry pulse is seen, it indicates Wood invading Earth, which is particularly inauspicious. If a rapid and surging pulse is seen, it must be due to damp-heat stagnation. If a slow and weak pulse is seen, it is caused by Yin-cold coagulation. A floating pulse indicates Qi dispersion; although the exterior appears full, the interior is definitely deficient. A tight pulse indicates Qi contraction; although the exterior appears firm and solid, the interior is even more excess. A floating and large pulse indicates the revitalization of Yuan Qi, harmonious with the pathological form, hence it is said to be treatable. A deficient and small pulse indicates the decline of Yuan Qi, contrary to the pathological form, hence it is said to be critically dangerous.

Accumulation (Ji, 积) originates in the Five Zang organs; Gathering (Ju, 聚) originates in the Six Fu organs. A strong and robust pulse indicates survival; a sunken and fine pulse indicates death. This passage elucidates the life-and-death prognosis in Accumulation-Gathering diseases. (*Nan Jing*, Chapter 55 states:) "Accumulation" is caused by Yin Qi; "Gathering" is caused by Yang Qi. Yin pulses are sunken and hidden; Yang pulses are floating and moving. It further states: "Accumulations" arise from the Five Zang organs; "Gatherings" are formed by the Six Fu organs. There are five types of Accumulation: The accumulation of the Liver is named Fei Qi (Fei Qi, 肥气); the accumulation of the Heart is named Fu Liang (Fu Liang, 伏梁); the accumulation of the Spleen is named Pi Qi (Pi Qi, 痞气); the accumulation of the Lung is named Xi Ben (Xi Ben, 息贲); the accumulation of the Kidney is named Ben Tun (Ben Tun, 奔豚). Their diseases each have five manifestations, and their pain has fixed locations. Gatherings in the Six Fu organs move and flow freely, with pain having no fixed location. Yue Ren (Yue Ren, 越人, i.e., Bian Que) distinguished Zang and Fu using Yin and Yang, hence the names five and six. The reason for discussing Accumulation and Gathering in relation to Zang and Fu is simply that those which are sunken, hidden, stationary, and immobile belong to Yin, and Yin corresponds to Zang; those which are floating, gathering, scattering, and irregular belong to Yang, and Yang corresponds to Fu. A strong and robust pulse is a Yang pulse, indicating both the struggle between pathogenic and righteous Qi and the robustness of the original constitution. Since it follows Fu and Yang, it indicates survival. A sunken and fine pulse is a Yin pulse, indicating both the deep invasion of pathogenic Qi and the decline of the original constitution. Since it follows Zang and Yin, it indicates death.