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The *Zhi Zhen Yao Da Lun* (Great Treatise on the Most Essential Principles) states: What is the manifestation of Yin pulses at the Cun Kou (Cun position, radial artery pulse point reflecting upper jiao and heart/lung qi)? (The term "Ying" refers to a pulse that is deep and imperceptible.) By observing whether the year's governing Qi is North or South, this can be known.

In years of Northern Governance, when Shao Yin (Ministerial Fire) is in Quan (ruling the second half of the year), the Cun Kou pulses are deep and imperceptible; (Wood, Fire, Metal, and Water undergo four cycles of transformation, receiving Qi facing North. For any Qi located in Quan, its pulse often remains hidden and unseen, while the pulses of other Qi on the left and right may be visible. When the Qi in Quan is harmonious, the pulse is not seen; when it is pathogenic, it is visible. Diseases are named based on the excess of Guest Qi or Host-Guest interactions. The same applies to Qi in Si Tian.) When Jue Yin (Wind Wood) is in Quan, the right Cun Kou pulse is deep and imperceptible; (Because Shao Yin is on the right.) When Tai Yin (Damp Earth) is in Quan, the left Cun Kou pulse is deep and imperceptible. (Because Tai Yin is on the left.)

In years of Southern Governance, when Shao Yin (Ministerial Fire) is in Si Tian (ruling the first half of the year), the Cun Kou pulses are deep and imperceptible; (In years of Earth Cycle, commanding facing South, so when Shao Yin is in Si Tian, both hands' Cun Kou pulses are deep and imperceptible.) When Jue Yin (Wind Wood) is in Si Tian, the right Cun Kou pulse is deep and imperceptible; when Tai Yin (Damp Earth) is in Si Tian, the left Cun Kou pulse is deep and imperceptible. (This also follows the principle of left-right correspondence.)

All instances of "Ying" (imperceptibility) become visible if the diagnostic method is reversed (e.g., by applying deeper pressure or changing posture). (The term "Ying" refers to deep pulses; when pressing down, the pulse feels deep, but upon releasing or adjusting the hand, a deep pulse may appear superficial, and a fine pulse may appear coarse.)

The Yellow Emperor asked: How do the Chi positions (Chi position, distal radial artery pulse point reflecting lower jiao and kidney/mandate qi) manifest? The Master replied: In years of Northern Governance, when the Three Yin meridians are below (in Quan), the Cun Kou pulses are deep and imperceptible; when the Three Yin meridians are above (in Si Tian), the Chi pulses are deep and imperceptible. (Si Tian is referred to as "above," and Quan as "below.") In years of Southern Governance, when the Three Yin meridians are in Si Tian, the Cun Kou pulses are deep and imperceptible; when the Three Yin meridians are in Quan, the Chi pulses are deep and imperceptible. The situation is the same for the left and right sides. (Whether Chi or Cun is imperceptible, it is identical on both sides. This explains that for Northern and Southern governance, the Si Tian and Quan positions have specific locations where the Cun and Chi pulses are imperceptible.)

How does the internal excess of Heaven and Earth Qi cause disease?

In years where Jue Yin (Wind Wood) is in Quan, with Wind excess prevailing, the ground atmosphere becomes obscure, plains are shrouded in mist, and grasses flower early. The people suffer from chills and trembling, frequent groaning and yawning, heart pain with limb fullness, tightness in the hypochondrium, difficulty swallowing food, obstruction in the diaphragm and throat, vomiting after eating, abdominal distension with frequent belching. After defecation or passing gas, symptoms temporarily alleviate, but the body feels heavy. (This refers to Yin-Shen years. Chills, groaning, and yawning indicate Stomach disease. Vomiting, distension, belching, relief after bowel movement, and heaviness indicate Spleen disease. Difficulty swallowing and throat obstruction indicate pathogen in the stomach cavity. Since Jue Yin is in Quan, Wood Qi is strong and overacts on the Spleen and Stomach, causing these symptoms.)

In years where Shao Yin (Ministerial Fire) is in Quan, with Heat excess prevailing, rivers and marshes appear to boil like flames, and dark places seem bright. The people suffer from borborygmus (abdominal rumbling), Qi rushing up to the chest, asthma unable to stand for long, alternating chills and fever with skin pain, eye closure with toothache and swelling, chills and fever resembling malaria, lower abdominal pain and distension, and hibernating insects failing to hide. (This refers to Mao-You years. Toothache and swelling indicate Large Intestine disease. Borborygmus, Qi rushing to chest, and asthma indicate pathogen in the Large Intestine. Since Shao Yin is in Quan, Fire overacts on Metal, causing Large Intestine disease.)

In years where Tai Yin (Damp Earth) is in Quan, grasses flourish early. With Dampness excess prevailing, valleys and rocks are obscured by dust, yellow color appears black, marking the intersection of Extreme Yin. The people suffer from fluid accumulation, heart pain, deafness with muffled hearing, sore throat and obstruction, bleeding from lower orifices, lower abdominal pain and swelling, inability to urinate, severe headache as if bursting, eyes feeling as if protruding, neck feeling stiff as if pulled, waist feeling as if broken, thighs unable to move, popliteal fossa feeling bound, and calf muscles feeling torn. (This refers to Chen-Xu years. Tai Yin is Earth; its color should be yellow in the central sky, but instead appears in the northern black region. Water and Earth colors appearing together is called the intersection of Extreme Yin. Severe headache refers to pain in the back of the head and between eyebrows. Popliteal fossa is the bend behind the knee. Calf muscle is the soft flesh behind the leg. Deafness and sore throat indicate San Jiao disease. Headache, eye protrusion sensation, neck stiffness, waist breakage, thigh immobility, bound popliteal fossa, and torn calves indicate Bladder Foot-Taiyang meridian disease. Lower abdominal pain and urinary retention indicate pathogen in the San Jiao. Since Tai Yin is in Quan, Earth Qi overacts on Taiyang, causing these symptoms.)

In years where Shao Yang (Ministerial Fire) is in Quan, with Fire excess prevailing, the suburbs shine brightly, and cold and heat alternate. The people suffer from dysentery with red and white discharge, lower abdominal pain, red urine, and in severe cases, bloody stools. The pulse presentation is the same as in Shao Yin in Quan. (This refers to Si-Hai years. During cold periods, heat replaces it; after heat passes, cold returns, hence "alternating." Other symptoms are the same as Shao Yin in Quan.)

In years where Yang Ming (Dryness Metal) is in Quan, with Dryness excess prevailing, fog is dim and unclear. The people suffer from frequent vomiting with bitter taste, frequent sighing, heart and hypochondriac pain preventing turning over, severe dry throat, dusty complexion, lack of skin luster, and heat on the outer foot. (This refers to Zi-Wu years. Dim fog obscures shapes and brings slight cold. Heart-hypochondriac pain refers to pain beside the heart in the ribs. Dusty complexion means the face looks covered in dust. Bitter vomiting, sighing, pain preventing turning, dusty face, lack of luster, and foot heat indicate Gallbladder disease. Dry throat and dusty face indicate Liver disease. Since Yang Ming is in Quan, Metal Qi overacts on Wood, causing these symptoms.)

In years where Tai Yang (Cold Water) is in Quan, with Cold excess prevailing, the environment becomes condensed, solemn, and chilling. The people suffer from lower abdominal pain radiating to the testicles, pulling into the lumbar spine and shooting up to the heart with pain, bleeding, sore throat, and submandibular swelling. (This refers to Chou-Wei years. Condensed solemnity means cold air fills the sky, stagnant and motionless, making all things still. Chilling means extreme cold. "Kong" means radiating/pulling. "Gao" means testicle. "Han" is below the jawline near the teeth. Sore throat and submandibular swelling indicate Small Intestine disease. Lower abdominal pain radiating to testicles, pulling to waist, and shooting to heart/lungs indicates pathogen in the Small Intestine. Since Tai Yang is in Quan, Water overacts on Fire, causing these symptoms.)

For various Qi in Quan, if Wind excesses internally, treat with Pungent-Cold herbs, assist with Bitter-Sweet herbs, use Sweet to relax tension, and use Pungent to disperse. If Heat excesses internally, treat with Salty-Cold herbs, assist with Sweet-Bitter herbs, use Sour to astringe, and use Bitter to disperse. If Dampness excesses internally, treat with Bitter-Hot herbs, assist with Sour-Light herbs, use Bitter to dry dampness, and use Light to drain. If Fire excesses internally, treat with Salty-Cold herbs, assist with Bitter-Pungent herbs, use Sour to astringe, and use Bitter to disperse. If Dryness excesses internally, treat with Bitter-Warm herbs, assist with Sweet-Pungent herbs, use Bitter to purge. If Cold excesses internally, treat with Sweet-Hot herbs, assist with Bitter-Pungent herbs, use Salty to purge, use Pungent to moisten, and use Bitter to consolidate. (This describes the treatment methods for diseases caused by the excess of the Six Qi in Quan.)

How do changes in Heaven's Qi manifest?

When Jue Yin (Wind Wood) is in Si Tian, with Wind excess prevailing, the sky becomes dusty and obscure, clouds and objects are disturbed, cold generates spring-like Qi, and flowing water does not freeze. The people suffer from epigastric pain at the heart center, upward support to the hypochondrium, obstruction in the diaphragm and throat, difficulty swallowing, stiff tongue root, vomiting after eating, cold diarrhea, abdominal distension, loose stools, masses, and fluid retention. Hibernating insects do not emerge. The disease originates in the Spleen. (This refers to Si-Hai years. Wind comes from heaven, raising dust. Wind movement disturbs clouds. "Ai" is green dust. Obscuring distant objects is "Ai Hun." Earth disease tends toward diarrhea. If water pathology occurs, urine stops. If severe diarrhea occurs, menstruation stops. Stiff tongue, vomiting, distension, loose stools, and masses indicate Spleen disease. Epigastric pain, hypochondriac support, throat obstruction, and swallowing difficulty indicate Stomach disease. Since Jue Yin is in Si Tian, Wood overacts on Earth, causing these symptoms.) If the Chong Yang pulse vanishes, death is incurable. (Chong Yang is on the dorsum of the foot where the artery beats, representing Stomach Qi. A weak Chong Yang pulse reduces intake; a vanished pulse prevents ingestion or causes immediate regurgitation. If attack fails and nourishment fails, evil grows strong while true Qi perishes internally, leading to death.)

When Shao Yin (Ministerial Fire) is in Si Tian, with Heat excess prevailing, stifling heat arrives, and Fire exercises its administration. The people suffer from chest irritability and heat, dry throat, right hypochondriac fullness, skin pain, chills/fever, cough, and asthma. Heavy rain approaches. Hemoptysis, hematochezia, epistaxis, sneezing, vomiting, and urine color changes occur. In severe cases, sores swell, shoulder/back/arm/clavicle pain, heart pain, lung distension, abdominal fullness, bloating, cough, and asthma occur. The disease originates in the Lung. (This refers to Zi-Wu years. Stifling heat indicates Fire's dominance. Disease concentrates on the right because the Small Intestine connects to the Heart. Disease arises from the Lung, hence "originates in Lung." Since Shao Yin is in Si Tian, Fire overacts on Metal, causing these symptoms.) If the Chi Ze pulse vanishes, death is incurable. (Chi Ze is in the elbow crease where the artery beats, representing Lung Qi. Fire burns Metal, fulfilling heavenly mandate; internal Metal Qi perishes, leading to critical danger.)

When Tai Yin (Damp Earth) is in Si Tian, with Dampness excess prevailing, deep Yin spreads, rain causes withering. Edema, bone pain, and Yin Bi (deep pain unresponsive to pressure) occur. Yin Bi involves pain in the waist, spine, head, and neck, dizziness, difficult defecation, impotence, hunger without desire to eat, blood in sputum, and a sensation of the heart hanging empty. The disease originates in the Kidney. (This refers to Chou-Wei years. "Chen" means long-lasting. Kidney Qi is pathogenic, Water cannot moisten, lower Jiao dries, causing constipation. Hunger without appetite, bloody sputum, and hanging heart sensation indicate Kidney disease. Pathogen in Kidney causes bone pain, Yin Bi, abdominal distension, back pain, constipation, neck stiffness, and dizziness. Since Tai Yin is in Si Tian, Earth overacts on Water, causing these symptoms.) If the Tai Xi pulse vanishes, death is incurable. (Tai Xi is behind the medial malleolus where the artery beats, representing Kidney Qi. Earth evil overcomes Water, and Kidney Qi perishes internally.)

When Shao Yang (Ministerial Fire) is in Si Tian, with Fire excess prevailing, warm Qi flows freely, and Metal's administration is uneven. The people suffer from headache, fever/chills resembling malaria, heat rising causing skin pain, yellow-red complexion changes, progression to edema, facial/body swelling, abdominal fullness with仰息 (breathing with head tilted back), dysentery with red/white discharge, sores, bloody sputum,心烦 (vexation) and chest heat, and severe epistaxis. The disease originates in the Lung. (This refers to Yin-Shen years. Fire dominance injures Metal, so "Metal administration is uneven." Fire flares up, injuring Metal/Lung; guest heat burns internally, Water cannot save. Since Shao Yang is in Si Tian, Fire overacts on Metal, causing these symptoms.) If the Tian Fu pulse vanishes, death is incurable. (Tian Fu is two cun below the axilla on the inner arm where the artery beats, representing Lung Qi. Fire dominance causes Metal/Lung perishing, leading to death.)

When Yang Ming (Dryness Metal) is in Si Tian, with Dryness excess prevailing, trees bloom late, grasses grow late, bones and sinews undergo internal changes. The people suffer from left hypochondriac pain, coldness in the middle, malaria upon contraction, drastic cooling altering seasons, cough, borborygmus, loose dysentery, trees敛 (contracting), vitality stagnating below, grasses withering above, sudden heart/hypochondriac pain preventing turning, dry throat, dusty face, back pain, hernia in men, lower abdominal pain in women, visual impairment, sores/acne/abscesses, and emergence of hibernating insects. The disease originates in the Liver. (This refers to Mao-You years. Metal dominance causes late blooming. Corresponding to the body, bones/sinews fail. Drastic cooling alters seasons, causing internal cold/malaria. Large Intestine is on the right, connected to Lung Qi; now Lung Qi invades internally, Liver is on the left/bottom, causing left hypochondriac stabbing pain. If people have diarrhea, there is no excess disease. Drastic cooling is secondary to cold. Extreme cold stops Yang Qi, so Wood contracts and grasses delay. Rising Sheng Qi lacks Yang distribution, stagnating below. In the body, pain Qi resides in the lower abdomen. Sores, back pain, hernia, female abdominal pain, dusty face, chest fullness, and洞泄 (profuse diarrhea) indicate Liver disease. Heart/hypochondriac pain, eye corner pain, clavicle/armpit swelling, chills/malaria indicate Gallbladder disease. Since Yang Ming is in Si Tian, Metal overacts on Wood, causing these symptoms.) If the Tai Chong pulse vanishes, death is incurable. (Tai Chong is two cun proximal to the big toe joint where the pulse beats, representing Liver Qi. Metal attacks Wood, Liver Qi perishes internally, True Qi cannot overcome evil, leading to death.)

When Tai Yang (Cold Water) is in Si Tian, with Cold excess prevailing, cold Qi returns abnormally, water freezes, blood changes internally, causing abscesses. The people suffer from Jue Xin Tong (cold heart pain), hematemesis, hematochezia, epistaxis, sadness, dizziness, and fainting. If the annual cycle has intense Fire, violent rain forms hail. Chest/abdominal fullness, hot hands, elbow spasms, armpit swelling, palpitations, chest/hypochondriac/epigastric discomfort, red face, yellow eyes, belching, dry throat, and in severe cases, black complexion and thirst with desire to drink occur. The disease originates in the Heart. (This refers to Chen-Xu years. Tai Yang Si Tian spreads Cold, freezing water and coagulating blood in skin, causing abscesses via Wei Qi stagnation. If Fire cycle is intense, it battles Water, forming hail. Disease concentrates in heart/hypochondrium. Internal Yang stagnation steams Warm Qi, causing cold heart pain, bleeding, red/yellow face, belching, hot hands, spasms, swelling, dry throat. Severe Cold overcomes Yang, Water overacts on Fire, internal Fire stagnation causes thirst. Disease starts in Heart, Yin invading, hence "originates in Heart." Since Tai Yang is in Si Tian, Water overacts on Fire, causing these symptoms.) If the Shen Men pulse vanishes, death is incurable. (Shen Men is at the end of the transverse wrist crease where the artery beats, representing True Heart Qi. Water overcomes Fire, Heart Qi perishes internally, Spirit departs, death is inevitable.)

The presence of moving Qi allows one to know which Zang organ is affected. (Why do we diagnose death? Because these are the moving Qi of the Zang meridians, revealing the survival or demise of the Spirit Zangs.)

For Qi in Si Tian: If Wind excesses, level with Pungent-Cold, assist with Bitter-Sweet, use Sweet to relax, use Sour to purge. If Heat excesses, level with Salty-Cold, assist with Bitter-Sweet, use Sour to astringe. If Dampness excesses, level with Bitter-Hot, assist with Sour-Pungent, use Bitter to dry, use Light to drain. If Dampness is severe above with Heat, treat with Bitter-Warm, assist with Sweet-Pungent, stop when sweating occurs. If Fire excesses, level with Acid-Cold, assist with Bitter-Sweet, use Sour to astringe, use Bitter to disperse, use Sour to restore. Heat excess follows the same. If Dryness excesses, level with Bitter-Warm, assist with Acid-Pungent, use Bitter to purge. If Cold excesses, level with Pungent-Hot, assist with Bitter-Sweet, use Salty to purge. (This describes treatment for Six Qi in Si Tian causing excess diseases.)

To treat all Victory and Repayment (Sheng Fu) patterns: Cold is treated with Heat, Heat with Cold, Warm with Cool, Cool with Warm, Scattered with Astringent, Suppressed with Dispersing, Dry with Moistening, Urgent with Relieving, Hard with Softening, Fragile with Firming, Deficient with Tonifying, Excess with Purging. Calm each Qi, ensure clarity and stillness, then disease Qi declines and returns to its source. This is the general principle of treatment. (Tai Yang is Cold, Shao Yin/Shao Yang are Hot, Jue Yin is Warm, Yang Ming is Clear/Cool, Tai Yin is Damp. With Sheng Fu, double the respective Qi to regulate, achieving balance. "Zong" means belonging. Proper regulation returns residual Qi to its source. After Sheng Fu subsides, nourish and calm. Clarity and stillness prevent interference, allowing Six Qi circulation and Five Spirits peace. Treating climatic heat/cold returns them to their Si Tian/Quan sources. This summarizes the general principle of treating Sheng Fu.)

Above the midpoint of the body, there are three Qi, belonging to Heaven, governed by Heaven Qi. Below the midpoint, there are three Qi, belonging to Earth, governed by Earth Qi. Name the Qi by its designation, designate the location by the Qi, and discuss the disease. The midpoint refers to the Tianshu acupoint. (The body's midpoint is the umbilicus. Some say the waist, but measuring from raised arm to extended foot aligns with the umbilicus, hence "midpoint" or Tianshu. Si Tian has three Qi, Di (Earth) has three Qi, so upper body has three Qi, lower body has three Qi. Naming Qi by name, location by Qi, cold/heat by Qi location determines disease signs. To know diagnosis, follow Qi location: Yin areas attract Cold diseases, Yang areas attract Heat diseases. Thus, discussing Sheng Fu begins with cold/heat based on this physics. *Liu Wei Zhi Da Lun* states: Above Tianshu, Heaven Qi governs. Below Tianshu, Earth Qi governs. At the Qi intersection, Human Qi follows.)

Regarding Qi Victory: Minor victories are followed; major victories are controlled. Regarding Qi Repayment: Harmonious repays are leveled; violent repays are deprived. All follow the Victory Qi, pacify the suppressed, regardless of number, aiming for harmony. This is the Dao. (Follow means to soothe. Control means to stop. Level means to balance. Deprive means to take away Victory Qi. Treatment depends on Qi harmony, not numbers. This explains the treatment for Repayment causing reverse disease.)

High is suppressed, low is lifted, excess is reduced, deficient is tonified. Assist with beneficial agents, harmonize with appropriate ones. Secure the Host and Guest, adapt to cold/heat. Same Qi is treated inversely, different Qi is treated conformingly. (Suppress high to control victory. Lift low to aid weakness. Reduce excess to blunt sharpness. Tonify deficient to preserve Qi. Though controlling victory and aiding weakness, Host/Guest must be secured. One Qi out of place causes internal invasion and external merging, leading to crisis. "Same" means harmonious Cold/Heat/Warm/Cool. "Different" means non-harmonious Water/Fire/Wood/Metal/Earth. If Qi agrees, treat inversely against the victorious Qi. If Qi disagrees, treat conformingly to the non-victorious Qi. This is the general principle of treating Host/Guest.)

Qi has high and low; disease has far and near; symptoms have interior and exterior; treatment has light and heavy. Adapt to reach the target. (Zang positions have height/depth; Fu Qi has distance; symptoms have exterior/interior; medicines have potency. Adjust quantity and speed so medicinal Qi reaches the disease site, avoiding excess or deficiency.) The *Da Yao* states: One Sovereign, two Ministers, is the Odd Formula system; Two Sovereigns, four Ministers, is the Even Formula system; Two Sovereigns, three Ministers, is the Odd Formula system; Three Sovereigns, six Ministers, is the Even Formula system. (Odd refers to ancient single-agent formulas; Even refers to compound formulas. Both have sizes. Odd formulas: 1-2, 2-3. Even formulas: 2-4, 3-6. Diseases vary in size, Qi in distance, treatment in weight/appropriateness, hence "systems.") Therefore: Near diseases use Odd formulas; Far diseases use Even formulas. Sweating does not use Odd formulas; Purging does not use Even formulas. Tonifying upper/treating upper uses Slow formulas; Tonifying lower/treating lower uses Rapid formulas. Rapid formulas have strong flavor/odor; Slow formulas have weak flavor/odor. Reach the target appropriately. This is correctness. (Sweating with Even formulas causes excessive outward dispersal. Purging with Odd formulas causes toxic over-attack. Upper treatment with Rapid formulas fails to stay upper. Lower treatment with Slow formulas gets stuck in transit and loses power. Making Rapid formulas weak makes them equal to Slow. Making Slow formulas strong makes them equal to Rapid. This results in neither truly slow nor rapid, neither strong nor weak. Size is not system, weight is not measure. Deficiency/excess, cold/heat, Zang/Fu become chaotic.)