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The *Suwen · Pingren Qixiang Lun* states: If the pulse conforms to Yin and Yang, the disease is easy to cure; if the pulse goes against Yin and Yang, the disease is difficult to cure. If the pulse follows the smooth progression of the Four Seasons, it indicates no other complications in the disease; if the pulse contradicts the Four Seasons, or involves "non-intervening Zang" transmission, the disease is difficult to cure. Death occurs if the Liver presents with True Zang Pulse (True Visceral Pulse) on Geng-Xin days (Metal prosperous days), the Heart on Ren-Gui days (Water prosperous days), the Spleen on Jia-Yi days (Wood prosperous days), the Lung on Bing-Ding days (Fire prosperous days), and the Kidney on Wu-Ji days (Earth prosperous days). This is called the manifestation of True Zang Pulses, all indicating death.

Pulse conforming to Yin and Yang refers to situations such as the Heart and Lung pulses being floating, the Liver and Kidney pulses being deep, the Fu-organ pulses being floating and large, and the Zang-organ pulses being deep and small. Obtaining the smoothness of the Four Seasons refers to Spring presenting with Wiry (Xian) pulse, Summer with Hook (Gou) pulse, Autumn with Hairy (Mao) pulse, and Winter with Stone (Shi) pulse, accompanied by a harmonious Stomach Qi (Wei Qi). In such cases, even if diseased, recovery is easy. Pulse going against Yin and Yang is opposite to the pulse images described above as conforming to Yin and Yang. Contradicting the Four Seasons refers to, for example, seeing Hairy pulse (Autumn pulse) in Spring, which is Metal overcoming Wood; seeing Stone pulse (Winter pulse) in Summer, which is Water overcoming Fire; seeing Hook pulse (Summer pulse) in Autumn, which is Fire overcoming Metal; and seeing Intermitting pulse (Dai pulse, often associated with Earth/Long Summer) in Winter, which is Earth overcoming Water. "Non-intervening Zang" refers to disease transmission via mutual overcoming, such as Liver transmitting to Spleen (Wood overcomes Earth); Spleen transmitting to Kidney (Earth overcomes Water); Kidney transmitting to Heart (Water overcomes Fire); Heart transmitting to Lung (Fire overcomes Metal); and Lung transmitting to Liver (Metal overcomes Wood). In such cases, the disease is difficult to cure. "Intervening Zang" refers to transmission via mutual generation, such as Liver transmitting to Heart (Wood generates Fire), intervening through the Lung, so Wood does not overcome Earth [Note: Textual logic implies avoiding direct overcoming path]; Heart transmitting to Spleen (Fire generates Earth), intervening through the Kidney, so Fire does not overcome Metal; Spleen transmitting to Lung (Earth generates Metal), intervening through the Liver, so Earth does not overcome Water; Lung transmitting to Kidney (Metal generates Water), intervening through the Heart, so Metal does not overcome Wood; and Kidney transmitting to Liver (Water generates Wood), intervening through the Spleen, so Water does not overcome Fire. In such cases, the disease is easy to cure. Those involving overcoming transmission lead to death, as stated in the scripture regarding Liver seeing Geng-Xin, etc. This is the True Zang Pulse without Stomach Qi, consistent with the principle stated in the previous chapter that "Wiry pulse without Stomach Qi indicates death."

Pulses have categories of contrary and compliant. If the characteristic pulse shape of the specific Zang organ is absent during the Four Seasons, and the pulse is thin/small in Spring and Summer, or floating and large in Autumn and Winter, this is called contradicting the Four Seasons. Wind-Heat presenting with a quiet pulse, diarrhea or blood loss presenting with a full/excess pulse, internal disease presenting with a deficient pulse, and external disease presenting with choppy/firm pulse are all difficult to treat, and are called contrary to the Four Seasons.

This further elucidates the principles of contrary and compliant. If the characteristic pulses of Wiry, Hook, Hairy, and Stone are absent during the Four Seasons, and in Spring and Summer when Yang Qi is prosperous and ascending, the pulse is instead thin and small, it indicates the pulse does not correspond to the Qi, revealing internal deficiency. In Autumn and Winter when Yang Qi descends and stores, if the pulse is instead floating, large, and empty, it indicates the root Yuan Qi is insecure, known as contradicting the Four Seasons. Furthermore, if Wind-Heat presents with a quiet pulse, it is a Yang disease showing Yin pulse, meaning righteous Qi cannot resist pathogenic factors. Diarrhea or blood loss injures both Yin and Yang; the pulse should be deep and weak, but if it is instead full/excess, it is the True Zang Pulse without Stomach Qi. Internal disease with accumulation presenting with a deficient pulse indicates already depleted Yuan Qi, making it impossible to attack the accumulation. External contraction presenting with choppy/firm pulse indicates a lack of harmonious Yang Qi, making it impossible to unblock Ying and Wei (Nutritive and Defensive Qi) to expel pathogens. Therefore, these are all difficult-to-treat diseases, called contrary to the Four Seasons, opposing the Qi transformation of Heaven and Earth.

To know excess and deficiency at the Cun Kou (Inch Port): If the Cun Kou pulse feels short upon palpation, it indicates Headache; if long, it indicates pain in the lower legs/shins; if rapid and striking upward, it indicates Shoulder and Back pain. Deep and firm Cun Kou pulse indicates disease in the interior (Zhong); Floating and vigorous Cun Kou pulse indicates disease in the exterior. Deep and weak Cun Kou pulse indicates Cold-Heat disorders, Hernia masses (Han Jia), and Lower Abdominal pain. Deep and transverse/horizontal Cun Kou pulse indicates accumulation under the hypochondrium and horizontal accumulation pain in the abdomen. Deep and panting/rushing Cun Kou pulse indicates Cold-Heat.

The scripture states: The Qi Kou forms the Cun pulse to determine life and death. Thus, Cun Kou, Qi Kou, or Mai Kou all refer to the pulses of both hands. Ren Ying (Carotid artery) primarily reflects the Yang of the Six Fu organs, while Cun Kou primarily reflects the Yin of the Five Zang organs, as detailed in the Guan Ge disease chapter. Old annotations dividing Cun, Guan, and Chi are not only forced but also contrary to the scriptural intent. Why? Because the scripture already has sections specifically clarifying Cun, Guan, and Chi to locate Zang and Fu organs, and sections specifying how Heart pulse manifests certain diseases, Liver pulse manifests certain diseases, etc. The passages in this chapter specifically explain the pathology of the overall pulse image of both hands. For instance, in external contractions, both hand pulses are floating; in Fire pathogen diseases, both hand pulses are rapid. How can one divide by location? Since the practitioner has already clarified Zang and Fu locations, they can naturally assess the disease site according to time. Thus, this scripture only discusses the principle of general pulse pathology. "Pulse middle hand" refers to the pulse felt at the superficial level upon initial palpation. Shortness indicates surface Yang stagnation transforming into Fire, causing headache, as all Yang meridians converge at the head. Length indicates excess Yang; excess Yang means insufficient Yin to nourish meridians; the lower part belongs to Yin, hence lower leg pain. Rapidity and upward striking indicate Yang Qi rebelling in the chest and lungs, causing shoulder and back pain. Both hands deep and firm indicate tangible pathogenic stagnation, hence disease in the interior. Floating and vigorous indicate Qi moving at the surface, implying external contraction. Deep and weak indicate deficiency in both surface and interior. Surface Yang deficiency leads to insecure Cou Li (pores/skin texture) and frequent Cold-Heat episodes. Interior Yang deficiency allows Yin pathogens to knot in the Yin divisions, causing Hernia masses and lower abdominal pain. Deep and transverse/horizontal means the pulse presses firmly against the finger, deviating from the normal course, indicating hypochondriac accumulation and abdominal horizontal accumulation pain. Deep and panting/rushing means the pulse beats rapidly and irregularly, indicating pathogenic closure of Ying and Wei and blockage between surface and interior, thus deep pulse with Cold-Heat. Additionally, since the pulse governs the Qi of the whole body, Lung Qi obstruction causing panting may also result in deep pulse. The character "Chuan" (panting/rushing) has a double meaning here, and one must simultaneously examine external symptoms.