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When the pulse is full, slippery, and firm, it indicates that the disease is in the exterior; when the pulse is small, solid, and firm, it indicates that the disease is in the interior. When the pulse is small, weak, and choppy, it is called a chronic disease; when the pulse is slippery, floating, and rapid, it is called an acute disease.

When the pulse is tense, it is called Shan-Jia (abdominal masses), accompanied by pain in the lower abdomen; when the pulse is slippery, it indicates Wind disease; when the pulse is choppy, it indicates Bi syndrome (impediment syndrome caused by obstruction of Qi and Blood); when the pulse is slow and slippery, it indicates Heat in the Middle Jiao; when the pulse is full and tight, it indicates distension.

This also discusses the pathological manifestations reflected by the pulses of both hands. A pulse that is full, slippery, and firm means that upon light pressure, the pulse force is full and slippery, but upon heavy pressure, it feels firm. This indicates that external pathogens are abundant, causing the Qi of the Zang-Fu organs to fail to spread and harmonize, resulting in a firm pulse, thus indicating that the disease is in the exterior. If the pulse is small, lacking strength upon light pressure but feeling solid and firm upon heavy pressure, this indicates that the pathogen is inside the Zang-Fu organs, thus indicating that the disease is in the interior; this is Yin pathogens knotting in the Yin divisions. When the pulse is small, weak, and choppy, it signifies injury to both Qi and Blood, so we know it is a chronic disease. However, compared to a small, solid, and firm pulse, this is considered auspicious. Whenever the pulse becomes hard and firm, it is either a difficult-to-treat stubborn disease or a severe illness damaging the Yuan Qi. If the pulse is slippery, floating, and rapid, this indicates external contracted pathogenic heat with undamaged Yuan Qi, so we know it is an acute disease. A tense pulse lacks a soft and harmonious quality, indicating Yin condensing pathogens, hence the diseases of Shan-Jia and lower abdominal pain. A slippery pulse indicating Wind disease refers to internal Wind carrying Phlegm; if it were external Wind, the pulse would necessarily be floating. A choppy pulse indicates Cold-Dampness stagnating in the blood vessels forming Bi syndrome. A slow and slippery pulse indicates Heat pathogens injuring the Middle Jiao; thus the pulse is relaxed and slippery. If forceful, it is a Heat disease; if forceless, it is Wei syndrome (flaccidity syndrome). A full and tight pulse indicates Yin pathogens accumulating and stagnating in the middle, inevitably leading to distension.

The *Su Wen: Mai Yao Jing Wei Lun* states: "If the Heart pulse beats firmly and long, one should expect tongue retraction and inability to speak; if it is soft and scattered, it will resolve on its own."

Firm and long beating refers to a string-tight, strong, and forceful pulse, where Liver pathology invades the Heart. The Heart governs Blood, the Liver stores Blood, and the tongue is the sprout of the Heart. The Liver governs sinews; when Blood is deficient, sinews become tense. The *Jing Jin Pian* states that if the Hand Shaoyang sinew twists, it causes tongue retraction, hence the disease of tongue retraction and inability to speak. If the pulse is soft and scattered, it indicates injury to Blood and depletion of Qi. The term "Xiao Huan" likely contains an error; the *Jia Yi Jing* reads "Xiao Ke zi yi" (Wasting-thirst will resolve on its own). Likely, due to Blood injury and Qi depletion, Body Fluids are not generated, leading to Xiao Ke (Wasting-thirst). However, since the pulse is soft and scattered, Heart Fire has already diminished, and recovery can occur through quiet nourishment.

If the Lung pulse beats firmly and long, one should expect spitting of blood; if it is soft and scattered, one should expect profuse sweating, which cannot be stopped.

The Lung governs Qi, and the Liver stores Blood. A firm and long Lung pulse indicates Liver pathology invading the Lung horizontally, causing Blood to rise with Qi and be spat out. If the pulse is soft and scattered, Lung Qi is severely damaged, and the Cou Li (pores) are open, leading to profuse sweating like water pouring over the body, unable to recover, because Jing Qi and Yang Qi are dispersing outward.

If the Liver pulse beats firmly and long, but the complexion is not green, it indicates injury from falling or striking, with blood stasis knotting in the hypochondrium, causing panting and rebellious Qi. If the pulse is soft and scattered, but the complexion is lustrous, it indicates Yi Yin (overflowing fluid) disease. Yi Yin is characterized by sudden thirst and excessive drinking, where fluids easily enter outside the muscles, skin, and intestines.

A firm and long Liver pulse indicates a string-hard and forceful pulse. Liver pathology is abundant, so the complexion should be green; the fact that it is not green indicates injury from falling or striking, causing blood stasis to knot in the hypochondrium. The hypochondrium is the region of the Liver; blood stasis causes Qi rebellion in the Middle Jiao, disrupting ascending and descending, hence panting and rebellious Qi. If the pulse is soft and scattered, it indicates injury to both Qi and Blood, and the complexion should be withered and dull. The fact that it is now lustrous and bright indicates overflowing fluids, where Jing Qi does not follow its normal course, hence the soft and scattered pulse. Due to sudden excessive drinking during thirst, fluids easily enter the muscles and overflow outside the intestines, potentially leading to swelling. The upper compilation states: "A slightly slow Liver pulse indicates Water Shan-Jia Bi; a very choppy pulse also indicates Yi Yin." Generally, slightly slow, choppy, and soft/scattered pulses are all weak pulses. Observing the complexion, if it is withered and dull, it is not a disease of overflowing water.

If the Stomach pulse beats firmly and long, and the complexion is red, one should expect pain in the thigh (Bi) as if broken. If the pulse is soft and scattered, one should expect Shi Bi (food impediment).

Heart and Liver Fire pathogens attacking the Stomach cause the Stomach pulse to beat firmly and long, hence the red complexion. The Bi (thigh) is the area traversed by the Stomach meridian; Fire pathogens flowing into the meridian cause Bi pain as if broken. If the pulse is soft and scattered, Stomach Qi is injured, food cannot be digested, and emaciation worsens; this disease is named Shi Bi.

If the Spleen pulse beats firmly and long, and the complexion is yellow, one should expect shortness of Qi. If the pulse is soft and scattered, and the complexion lacks luster, one should expect foot swelling resembling edema.

The Spleen pulse should naturally be soft and slow. If it beats firmly and long, it indicates Wood pathology overcoming Earth, hence the yellow face. With no power to drive transformation, Shortness of Qi occurs. If the pulse is soft and scattered and the face lacks color/luster, it indicates Spleen Earth decline and sinking Qi, hence foot swelling resembling water, though it is not true water disease. If it were water pathology, the complexion would be lustrous and bright. One must strongly tonify Spleen Earth for the swelling to gradually subside.

If the Kidney pulse beats firmly and long, and the complexion is yellowish-red, one should expect lower back pain as if broken. If the pulse is soft and scattered, one should expect deficiency of Blood, unable to recover.

The Kidney stores Tian Yi True Water; its pulse should be deep, solid, soft, and slippery. A firm and long pulse indicates Kidney Water deficiency failing to nourish Liver Wood. Liver Wood becomes abundant and Fire blazes; Fire generates Earth, making Earth prosperous, hence the yellow-red complexion. Earth controls Water. The waist is the mansion of the Kidney. Extreme Kidney Water deficiency causes lower back pain as if broken. If the pulse is soft and scattered, it indicates deficiency of Essence and Blood and depletion of Qi, hence the soft and scattered pulse, unable to recover Yuan Qi.

The Yellow Emperor said: "I diagnose a tense Heart pulse. What is this disease? What are the symptoms?" Qibo said: "The disease is named Xin Han (Heart Hernia), and there should be a palpable mass in the lower abdomen." The Yellow Emperor asked: "Why do you say so?" Qibo replied: "The Heart is a Yang organ (Mu Zang), and the Small Intestine is its envoy (Fu). Therefore, there should be a palpable mass in the lower abdomen."

Han (Hernia) is commonly known as Small Intestine Qi. Mu refers to Yang. The Small Intestine is the Fu of the Heart, connected by meridians, forming interior-exterior pairs. Cold pathogens lodging in the Small Intestine cause the Heart pulse to appear tense. Since the Heart is a Yang organ and the Small Intestine is its envoy, the disease manifestation appears in the lower abdomen, the location of the Small Intestine.

The Yellow Emperor asked: "I diagnose the Stomach pulse. What are the symptoms?" Qibo said: "A full Stomach pulse indicates distension; a deficient Stomach pulse indicates diarrhea." The Yellow Emperor asked: "What is meant by changes after disease formation?" Qibo said: "Wind becomes Cold-Heat; Dan (fever/heat) becomes Xiao Zhong (Middle Wasting); Jue (reversal) becomes Dian Bing (head disease); chronic Wind becomes Sun Xie (undigested stool diarrhea); Wind in the pulse becomes Li Feng (leprosy). The changes of disease are countless."

The Stomach governs receiving grain and digestion to generate Qi and Blood. A full pulse indicates pathogen accumulation and indigestion, hence epigastric distension. A deficient pulse indicates Qi deficiency and sinking, leading to diarrhea; these are two diseases of excess and deficiency. Regarding pathological changes: if Wind lodges in the exterior, Ying and Wei become disharmonious, forming Cold-Heat disease, because Wei Qi is generated by the Stomach. Internal entrapment of pathogenic Fire forms Dan. Dan is characterized by good appetite but emaciation, named Zhong Xiao (Middle Wasting-Thirst). Stomach Qi prefers descending. The Stomach belongs to Yangming. Yangming circulates Qi among the Three Yang channels. If pathogenic factors obstruct, causing reversal of Qi in the Three Yang channels, it forms headache at the vertex, i.e., the previously mentioned Upper Excess Lower Deficiency forming Jue Dian Ji. If Wind pathogens lodge in the Stomach, their nature is dispersing and rapid, causing food to pass down undigested, named Sun Xie. If Wind pathogens enter the blood vessels, blocking and generating heat, and since the Stomach is the Sea of Water and Grain and governs muscles, pathogenic heat steams and corrupts the blood vessels, gradually causing muscle ulceration with pain and itching, named Li Feng (commonly Leprosy/Great Wind), the most malignant disease. Thus, disease changes are countless, depending on understanding Yin-Yang, Five Elements generation/transformation, Eight Winds, and the reality/deficiency of pathogens.

The *Su Wen: Da Qi Lun* states: "If the Kidney pulse is small and urgent, the Liver pulse is small and urgent, and the Heart pulse is small and urgent, and does not beat forcefully upon pressure, all indicate Jia (masses)."

The Heart, Liver, and Kidney all govern Ying Blood. If any of the three positions presents a small and urgent pulse, it indicates Ying Blood knotting internally, forming tangible Jia masses. Ying flows within the vessels; due to blockage, the pulse is small and cannot beat forcefully; upon pressure, it feels urgent, strong, and unharmonious.

If the Kidney and Liver pulses are both deep, it is Shi Shui (Stone Water); if both are floating, it is Feng Shui (Wind Water); if both are deficient, it indicates death; if both are small and string-tight, it indicates impending fright.

The Kidney governs Cold Water, and the Liver governs Wind Wood. If both Kidney and Liver pulses are deep, Wood sinks in Water, named Shi Shui. Pressing the lower abdomen reveals hardness; this is Yang decline, lack of Qi in Water, and Yin condensation like stone without transformation. If both Kidney and Liver pulses are floating, Wind prevails and Water follows Wind to surge, named Feng Shui. If both Kidney and Liver pulses are deficient, Water dries up and Wood withers, vital Qi is exhausted, hence death. If both Kidney and Liver pulses are small and string-tight, Kidney Water deficiency fails to nourish Liver Wood, internal defunct Wind moves causing fright, because the Liver governs fright.

If the Kidney pulse is large, urgent, and deep, and the Liver pulse is large, urgent, and deep, both indicate Han (Hernia). If the Heart pulse is slippery and urgent, it indicates Xin Han (Heart Hernia); if the Lung pulse is deep and beating forcefully, it indicates Fei Han (Lung Hernia).

Han may be caused by Cold-Wind or Damp-Heat, spreading from Fu to Zang, involving sinews. The Liver governs sinews, so it always involves Liver pathology. Since Liver and Kidney share the same source, the pulse images are similar. Here, urgent pulses indicate mostly Cold-Wind causing colic pain. The [obscured] Han refers to numbness without pain, caused by Damp-Heat pathogens, detailed in various medical texts. Now, since the Kidney, Liver, Heart, and Lung pulses all beat urgently (urgent, strong, and unharmonious), it indicates Cold-Wind pathogens. Although locations differ, the pathogen is the same, hence the disease is similar. However, Xin Han is a Small Intestine disease; as stated above, Fei Han must therefore be a Large Intestine disease.

Urgent pulses in the Three Yang channels produce Jia masses; urgent pulses in the Three Yin channels produce Han; urgent pulses in the Two Yin channels produce Xian Jue (epileptic convulsions and fainting); urgent pulses in the Two Yang channels produce Jing (fright).

Three Yang refers to Taiyang; Three Yin refers to Taiyin. Jia masses take shape from false entities. Urgent pulses indicate pathogen closure and knotting. Knotting in Yang produces Jia; knotting in Yin produces Han; the pathogen is the same, but the disease differs. Two Yin refers to Shaoyin. Urgent pulses indicate Cold-Wind pathogens attacking Heart and Kidney, producing Xian Jue (convulsions, fainting, loss of consciousness). Two Yang refers to Yangming. Urgent pulses indicate Wood pathology attacking the Stomach, i.e., being startled by the sound of wood.