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Difficulty 40: The Liver governs complexion (Se, facial color), the Heart governs odor (Chou, smell), the Spleen governs taste (Wei, flavor), the Lungs govern voice (Sheng, sound), and the Kidneys govern fluids (Ye, body fluids). The meaning of this is difficult to understand. I propose to provide an exposition stating that: when Qi is contained and reserved, it manifests externally as complexion; when it is released and penetrates outward, it becomes odor; when it strikes and bursts forth, it produces sound; when it gathers and flows, it forms fluids. Yang Qi ascends in the East; ascending is the beginning of Yang. At this stage, it is still obscured by Yin and cannot emerge immediately. It remains contained within, manifesting internally and externally, thus becoming complexion. The East corresponds to the Liver, therefore the Liver governs complexion. Yang Qi reaches its peak in the South; peaking implies the release of Yang. When abundant Yang fills the body and releases upward, it becomes odor. The South corresponds to the Heart, therefore the Heart governs odor. Yang Qi declines in the West; as Yang wanes, Yin grows. Yang fails to overcome Yin and is instead scorched by it, causing agitation and unrest, thereby producing sound. The West corresponds to the Lungs, therefore the Lungs govern sound. Yang Qi lies dormant in the North; lying dormant means gathering without dispersing. Through fermentation and steaming, fluids are generated. The North corresponds to the Kidneys, therefore the Kidneys govern fluids. Yang Qi harmonizes in the Center; harmony implies a balance of Yin and Yang. Yang governs Qi, and Yin governs substance. When Qi and substance combine, taste is produced. The Center corresponds to the Spleen, therefore the Spleen governs taste. This is the principle behind these five governances.

The term "Zhong Shi" (Double Excess) refers to a severe heat disease where pathogenic Qi is excess and the pulse is full and robust. This is called Double Excess.
The Chi skin (skin on the inner forearm below the elbow) can observe the cold and heat of the whole body. Since it is stated as a severe heat disease, the firmness of the Chi skin can be inferred. Therefore, the following section on "Zhong Xu" (Double Deficiency) uses deficient Chi skin for contrast.
When both the Channels (Jing) and Collaterals (Luo) present excess patterns, it means the pulse at the Cun Kou (radial artery site) is rapid/tight while the Chi skin is relaxed/soft.
In current editions, "pulse tight" is written as "Cun pulse tight". Examining Wang Bing's commentary, "pulse tight" refers to the tightness of the Cun Kou, indicating that Wang's original text lacked the character "Cun". "Pulse" here refers to the Cun Kou, encompassing all three positions (Cun, Guan, Chi). "Chi" refers to the Chi skin. Observing Channel disorders is done at the Cun Kou, while observing Collateral disorders is done at the Chi skin. Later scholars mistakenly interpreted "Chi soft" as a palpation technique, leading them to interpret "pulse tight" specifically as "Cun pulse tight," thereby adding the character "Cun". If the original text had included this character, the commentary would not have omitted it.
When Luo Qi is deficient and Jing Qi is excessive, the Cun Kou is hot and the Chi skin is cold. This is contrary (Ni) in Autumn and Winter, but compliant (Cong) in Spring and Summer. When Jing Qi is deficient and Luo Qi is excessive, the Chi skin is hot and full while the Cun Kou is cold and choppy. In this case, death occurs in Spring and Summer, while survival is possible in Autumn and Winter.
In current editions, the characters "Kou" appear after "Mai" in "Mai Re" and "Mai Han Se". These were likely added erroneously due to the commentary mentioning "Mai Kou Re" and "Mai Kou Han". They have been corrected by removing them based on the *Mai Jing* (Pulse Classic). Similarly, the earlier phrase "Mai Ji Er Chi Huan" also lacks the character "Kou".

What is "Zhong Xu" (Double Deficiency)? It refers to a deficient pulse, deficient Qi, and deficient Chi skin. This is called Double Deficiency.
Current editions read "Mai Qi Shang Xu" for "Mai Xu" and "Qi Xu". We follow the correction by Lin Yi et al. Examining this, Zhong Xu is the opposite of Zhong Shi; thus, the symptoms should also be opposite. A deficient pulse contrasts with the full pulse mentioned earlier; deficient Qi contrasts with the excess Qi mentioned earlier; deficient Chi skin contrasts with the severe heat disease mentioned earlier, as deficient Chi skin indicates the absence of severe heat. Wang Bing's commentary states that both Cun and Chi positions are deficient. Analyzing his wording, he is explaining Mai Xu and Chi Xu, so Wang's original text was not erroneous.

The term "Qi Xu" (Qi Deficiency) refers to irregular manifestations.
Commentary: Deficiency at the Cun position causes irregular pulse movement. The character "Cun" is an error for "Qi". Qi refers to pulse Qi. Clarifying that the "Mai" in "Mai Xu" specifically refers to the Cun Kou, and the "Chi" in "Chi Xu" specifically refers to the Chi skin, while the "Qi" in "Qi Xu" generally refers to the circulating Qi of both Cun and Chi positions, provides a profound and appropriate meaning. Yang Shangshan explained Qi Xu as insufficiency of the Dan Zhong (Conception Vessel area), which is not as precise as Wang Bing's explanation. This commentary corroborates the previous one regarding deficiency in both Cun and Chi, encouraging mutual inference to grasp the meaning. A scribe mistakenly wrote "Cun" instead of "Qi", making the text unintelligible. Changing one character clarifies the meaning.

Chi Xu presents as unsteady gait.
Unsteady gait describes a state of shivering from cold and inability to support oneself. Since Chi skin observes the whole body, Chi Xu必然 leads to body coldness, opposing the severe heat of the earlier Zhong Shi. Because the text uses descriptive language rather than explicit statements, superficial readers fail to understand. Now, because the commentary is brief, we supplement this clarification.

Mai Xu does not resemble Tai Yin patterns.
Commentary: It does not resemble the signs of Tai Yin. Why? The Cun Kou is the meeting point of pulses, representing the movement of the Hand Taiyin Lung Meridian. Examining Wang Bing's intent, he reads "Xiang" as "Like/Appearance". The *I Ching* says: "Xiang means resembling this."

When Cold Qi suddenly rises, the pulse is full and excess. If the excess pulse is slippery, there is life; if the excess pulse is reversed/disordered, there is death.
"Excess" here refers to Qi excess. Sudden rising of Cold Qi implies deficient Chi skin. The previous sections on Zhong Shi and Zhong Xu discussed each of the three factors (Chi, Qi, Pulse) reaching an extreme bias individually. This section discusses the two factors, Qi and Pulse, similar to the earlier Zhong Shi where only the Chi differed.

If the pulse is full and excess, with cold hands and feet but a hot head, survival is possible in Spring and Autumn, while death occurs in Winter and Summer.
This section follows up on the full/excess pulse to discuss the coexistence of cold and heat.

When the physical form is completely full/distended, the pulse is rapid, large, and hard, while the Chi skin is choppy and unresponsive. In such cases, compliance leads to life, and contrariness leads to death. Compliance refers to warm hands and feet. Contrariness refers to cold hands and feet.
This describes a situation of Excess Qi but Deficient Pulse and Deficient Chi Skin. The text explicitly mentions choppy Chi skin yet discusses both compliance and contrariness, proving that choppy Chi skin can also present with warm hands and feet. This confirms that the cold hands and feet mentioned earlier were due to Qi deficiency, not Chi skin deficiency; whereas the full/excess pulse and hot head indicate Excess Pulse and Excess Chi Skin.

In Xiao Dan (Wasting-Thirst Disease), if the pulse is large and excess, and the disease has persisted for a long time, it is incurable. If the pulse is suspended, small, and hard, and the disease has persisted for a long time, it is incurable.
Current editions lack the character "Bu" (not) after "Mai Shi Da Bing Jiu". Detailed examination of the commentary states: "In chronic illness, Qi and Blood decline; the pulse should not be large and excess, hence it is incurable." This indicates Wang Bing's original text included the character "Bu". Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states: "For Xiao Dan, a solid, firm, and large pulse indicates death; a fine, small, and floating pulse also indicates death." Chao's theory is based on this classic. Given he mentions solid/firm/large and fine/small/floating, the character "Jian" (hard) in the text must originally precede "Da" (large). Furthermore, since the Emperor asked about Excess and Deficiency in Xiao Dan, Qibo should have clearly responded with Excess and Deficient pulses. Solid, hard, and large constitute Excess; suspended and small constitute Deficiency, matching the question and answer. Placing "Jian" after "Xuan Xiao" confuses Excess and Deficiency. "Fu" (floating) is equivalent to "Xuan" (suspended), and "Lao" (firm) is equivalent to "Jian" (hard).