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Huangdi asked: How can one determine life and death? (This means to predict life or death in advance based on the patient's physical appearance, symptoms, pulse, and respiration.) Qibo replied: If the body is robust but the pulse is fine and thin, and there is shortness of breath insufficient for respiration, the condition is critical. (A robust body with a fine pulse and shortness of breath indicates apparent excess externally but deficiency internally, like abundant branches and leaves but a weak root; thus, death is near.) If the body is emaciated but the pulse is large, and there is a sensation of excessive Qi in the chest, it is a fatal sign. (Emaciation with a contrary large pulse and excessive Qi in the chest indicates Yin deficiency and Yang excess. Since the Yin form has collapsed, solitary Yang cannot survive alone; thus, death ensues.) If the Form and Qi are harmonious, the patient will live. (Physical appearance is "Form," belonging to Yin; physiological activity is "Qi," belonging to Yang. Yin is static, and without Yang, Yin cannot form; Yang is active, and without Yin, Yang cannot generate. Thus, Form houses Qi, and Qi moves Form; Yin and Yang must be harmonious and not lose each other. For example, a robust body with a large pulse, or an emaciated body with a fine pulse, are both considered "harmonious." Harmonious means life; contrary means critical.) If the pulses are irregular and uncoordinated, it is a disease. (Referring to three and five pulses for comparison and classification, termed "uncoordinated." Any pulse that varies in size or speed, coming and going without regularity, is a pathological pulse.) If all Nine Pulses (Sanbu Jiuhou) are disordered, death occurs. (The meaning of Sanbu Jiuhou is seen in Part 5 earlier. "All disordered" means losing normal rhythm, such as intermittent rapidity/slowness, loss of timing, Zang-Fu pulses, flesh wasting, and the Seven Diagnoses mentioned below; thus, death ensues.) If the pulses above, below, left, and right respond to each other like the pounding of a mortar, the disease is severe. If they are disordered and uncountable, death occurs. ("Above, below, left, right" refers to the left and right pulses at each of the Three Regions. "Pounding" refers to a large, forceful pulse like a pestle striking, indicating extreme Yang; thus, the disease is severe. If even the respiratory rate and pulse rate are disordered and uncountable, death occurs. Pulse theory states: Two beats per exhalation and two per inhalation is normal; three beats is deviation from the channel; four beats is essence depletion; five beats is death; six beats is end of life. Now, if disordered and uncountable, exceeding five or six beats, death is certain. Chong, pronounced like "chong." Shuo, pronounced with rising tone.) If the Middle Region pulse is individually coordinated but disordered relative to other Zang-Fu organs (Head and Foot regions), death occurs. If the Middle Region pulse is weaker than the Upper and Lower regions, death occurs. (The Three Regions' pulses are located at the Head (Upper), Hand (Middle), and Foot (Lower). Here, although the hand pulse is coordinated, if the head and foot pulses are abnormal, death is expected. If the hand pulse is weaker than the upper and lower, it indicates severe decline of Middle Qi; thus, death ensues.) Sunken eyes indicate death. (Essence-Qi of the Five Zang and Six Fu organs ascends to the eyes to form the spirit. Sunken eyes indicate the exhaustion of Yang Essence; thus, death is inevitable.) Press with the left hand five cun above the ankle on the patient's leg, and while doing so, flick the ankle area with the right hand. (Collaterals of hands and feet can be tested here. Above the wrist, it is the Luo-connecting vessel of the Hand Taiyin Lung Channel. Above the ankle, it is the Luo-connecting vessel of the Foot Taiyin Spleen Channel. The Lung stores Qi and governs regulation; the Spleen belongs to Earth and governs irrigation; thus, this site can be used to observe auspicious or inauspicious signs. Huai, pronounced like "han.") If the vibration response exceeds five cun and feels smooth and uniform (like worms moving), there is no disease. If the response is rapid and feels turbid/muddled to the touch, there is disease. If the response is slow, there is disease. If the response does not reach five cun, or if flicking produces no response, death occurs. (Ying refers to movement. Response exceeding five cun indicates abundant Qi and vessels. Ruru describes a worm-like motion, indicating smooth and harmonious pulse, which is non-pathological. Ji means rapid. Hunhun means turbid/disordered. Xuxu means slow. Failure to reach five cun indicates weak Qi/vessels. No response indicates exhausted Qi/vessels. Thus, slight weakness is disease, extreme weakness is death. Ru, pronounced like "ru".) Therefore, if muscles have wasted away but the body can still move, death occurs. (Spleen and Stomach exhaustion leads to muscle wasting; Liver and Kidney failure leads to bone/tendon fatigue. Wasted muscles and heavy body indicate approaching death. "Bu qu" means inability to move/walk.) Intermittent rapidity and slowness in the Middle Region pulse indicates death. (Middle Region refers to the pulses of both hands. Intermittent rapidity/slowness is a sign of chaotic Qi/vessel collapse; thus, death ensues.) A pulse that is alternating (Dai) and hook-shaped (Gou) indicates disease in the Collaterals. (Dai and Gou correspond to Summer Qi, which resides in the Collaterals.) The Nine Pulses should correspond, being uniform above and below, without disorder. ("Uniform above and below" means size and speed should be peaceful/harmonious.) One region delayed indicates disease; two regions delayed indicates severe disease; three regions delayed indicates critical illness. "Delayed" refers to prolonged intervals between beats. (Ying bu ju means losing normal rhythm, lacking order in reversal and compliance.) By observing the Zang-Fu organs, one can know the time of death. (The time of death can be known by observing the cycles of generation and restriction among the Five Elements.) One must first know the Normal Pulse (Jing Mai) before knowing the Disease Pulse. (Normal pulse is constant; disease pulse is variable. Without knowing the constant, one cannot understand the variable.) Appearance of True Zang Pulses indicates death when encountering the controlling element. (Meaning of True Zang Pulses is seen later. "Sheng Si" means dying when meeting the element that controls it, e.g., Liver appearing on Geng/Xin days, Spleen on Jia/Yi days.) Exhaustion of Foot Taiyang Qi causes inability to flex/extend the legs, and death with upward staring eyes. (Foot Taiyang channel descends to join the popliteal fossa, passes through the calf, exits behind the lateral malleolus; ascends from the inner canthus. There is a pathway entering the brain connected to the eye base, called the Eye System. Thus, Taiyang Qi exhaustion causes blood dryness and tendon tension, leg immobility, and death with Daiyan. Daiyan means eyes fixed upward. Zhuan, sound Zhuan. Deng, Cao Geng qie.) Huangdi asked: What about Winter Yin and Summer Yang? (Referring to time of death.) Qibo replied: If all Nine Pulses are deep, fine, and suspended/extinct, it is Yin, governing Winter, so death occurs at midnight. If pulses are盛大 (sheng), restless, panting, and rapid, it is Yang, governing Summer, so death occurs at noon. (Midnight is Winter of the day. Yin ends, Yang generates; thus, extreme Yin dies. Noon is Summer of the day; Yang ends, Yin generates; thus, extreme Yang dies.) Therefore, patients with Cold-Heat diseases die at dawn. (Dawn is Spring of the day, half Yin and half Yang. Thus, Cold-Heat patients die during the transition of Yin and Yang.) Patients with Heat-in-the-Middle or Heat diseases die at noon. (Yang aids Yang, exhausting True Yin.) Patients with Wind diseases die at dusk. (Dusk is Autumn of the day. Wind shares affinity with Wood; it dies upon encountering Metal.) Patients with Water diseases die at midnight. (Hai/Zi hours water is prosperous; pathogenic factor is extremely strong.) Pulses that are intermittently sparse/rapid or slow/fast die during the Four Seasons (Chen/Xu/Chou/Wei hours). (Irregular pulses indicate central emptiness and lack of mastery. Four Seasons refer to Chen, Xu, Chou, Wei hours. These hours are the graveyards of the Five Elements; thus, exhausted organs die then.) If flesh and muscles have wasted away, death occurs even if the Nine Pulses are coordinated. (Spleen governs muscles and is the root of Five Zang. No one survives Spleen Qi exhaustion; thus, even coordinated Nine Pulses cannot prevent death.) Although the Seven Diagnoses appear, if the Nine Pulses comply (follow seasonal norms), death does not occur. (Seven Diagnoses meaning is in Chapter 6 earlier. Cong means compliance. If pulses follow seasonal commands and channel bodies, even if some are unusually large/small, death does not ensue.) The statement "does not die" refers to Wind diseases and menstrual conditions, which resemble Seven Diagnoses but are not true Seven Diagnoses, hence "no death." (Wind is Yang disease. Occasional wind exposure may cause Yang branch pulses to be large or rapid. Menstruation is a regular period. During blood loss, Yin branch pulses may be small, slow, or sunken. These resemble Seven Diagnoses but are not real; thus, they do not indicate death. However, if Seven Diagnosis pulses appear without external wind or menstruation, it is not an auspicious sign.) If Seven Diagnosis diseases are present AND the pulse condition is also exhausted, death occurs, accompanied by hiccupping and belching. (Continuing from above: Wind/menstrual conditions are not Seven Diagnoses; if truly exhausted pulses/symptoms exist, it is not "no death." Death involves hiccups/belching. Hiccups originate from Stomach, indicating Earth Qi failure. Belching originates from Heart, indicating Yin evil excess. Yue, Yu Jue qie, hiccup. Yi, Yi Fang/Ai sounds, belching.) One must carefully ask about the initial onset and current symptoms, then palpate pulses separately, observing the floating/sinking of meridians to trace upward/downward reversals/compliance. (Diagnosis requires asking about onset to find causes, and current symptoms to assess present state. Once origin and end are clear, palpate pulses to integrate meridian/collateral status, floating/sinking, and directional flow, treating accordingly.) Rapid pulses indicate no disease; slow pulses indicate disease; absent pulses indicate death; skin adhering to bone indicates death. (Ji implies strength and spirit. Chi implies Qi deficiency. Absent pulses mean Yin/Yang exhaustion. Skin adhering to bone means blood exhaustion, i.e., withered skin clinging to bone.) Huangdi asked: What about treatable cases? Qibo replied: Treat Jing-channel diseases by needling the Jing channels. (Jing channels are interior; branching transversely are Luos. Treating Jing means needling directly into the channel.) Treat Sunluo diseases by bleeding the Sunluo. (Small Luos are Sunluo, distinct Luos floating on skin. *Jingmai* chapter says: Acute needling of Luos to drain evil and release blood; retention causes Bi syndrome. Thus, treat the blood.) Blood diseases with body pain are treated by needling the Jing and Luo channels. (Blood disease with pain involves not just Sunluo but also Jing channel stagnation; needle along the channels.) Diseases caused by Odd Evil (Qi Xie) are treated with Miu Ci (lateral needling). (Odd Evil enters Luos, not Jing. Evil in Large Luos shifts left/right unpredictably; thus, use Miu Ci. See Needling Category 30.) Chronic wasting diseases with fixed locations are treated by needling at joints. (Liu means stagnation; Shou means emaciation; Bu yi means fixed. Long-standing pathogens stagnate in the Eight Valleys of limbs; seek and needle at joint intersections to resolve.) Upper Excess and Lower Deficiency: palpate and follow the channel, seek obstructed Luo vessels, bleed them to restore flow. (Upper Excess/Lower Deficiency implies blockage; palpate to locate, follow channels to extract, seek obstructed Luos, bleed to remove obstruction and restore patency.) High pupils (Tongzi Gao) indicate Taiyang deficiency; Daiyan indicates Taiyang exhaustion. This is key to determining life/death and must be examined carefully. (Tongzi Gao means upward gaze. Daiyan means severe upward fixation. This reiterates Foot Taiyang signs, distinguishing severity for prognosis.) Retain needles in fingers, lateral malleolus of hand, and five fingers. (This section seems disconnected; previous part only mentioned Taiyang. Likely missing text in ancient version.)