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*Suwen: Treatise on the Distinctions of the Five Zang Organs*

The Yellow Emperor asked: Why can the Qi Kou (Crest of Breath, radial artery pulse) alone serve as the master for diagnosing the five Zang organs? (Regarding the meaning of "Qi Kou," there are three names: it is the pulse of the Hand Taiyin Lung Meridian; since the Lung governs all Qi, the prosperity and decline of Qi manifest here, hence called Qi Kou; the Lung meets with all vessels, and the great assembly of pulses gathers here, hence called Mai Kou (Pulse Crest); the pulse emerges from Taiyuan (LU-9), measuring one cun and nine fen in length, hence called Cun Kou (Inch Crest). Although the names are three, they are actually one. The essence and flavor of the five Zang and six Fu organs all originate from the Stomach, and their changes manifest at the Qi Kou, thus making it the master of the five Zang organs. The detailed reasoning is seen in the following text. My commentary states: The concepts of Qi Kou, Cun Kou, and Mai Kou refer collectively to both hands, not specifically to the right hand as Qi Kou. For instance, the *Meridians Chapter* states: "The Hand Taiyin meridian enters the Cun Kou and ascends along the Yuji." It also says: "The meridians themselves are usually invisible; their deficiency or excess is known through the Qi Kou." The *Meridian Sinew Chapter* states: "The sinews of the Hand Taiyin knot behind the大鱼际 (Yuji), running on the lateral side of the Cun Kou." The *Treatise on Distinctions of Meridians* states: "When balanced, the Qi Kou forms the Inch impression, used to determine life and death." The *Chapter on Normal People's Pulse and Qi Phenomena* states: "To know if the Cun Kou pulse is excessive or insufficient." The *Small Needle Explanation* states: "If the Qi Kou pulse is deficient, tonify; if full, sedate." This chapter asks: "Why does the Qi Kou alone serve as the master of the five Zang organs?" The *Nan Jing (Classic of Difficult Issues)* states: "All twelve meridians have pulsating arteries, yet only the Cun Kou is taken to determine the life, death, auspiciousness, and inauspiciousness of the five Zang and six Fu organs. What is the reason?" It answers: "The Cun Kou is the great assembly of pulses, the beginning and end of the five Zang and six Fu organs, therefore the method is derived from the Cun Kou." Such instances clearly do not refer solely to the right hand. However, Wang Shuhe failed to thoroughly understand the classic intent, abruptly claiming that the left hand is Ren Ying (Human Welcome) and the right hand is Qi Kou, and proposing theories such as "the Cun Kou before Ren Ying on the left hand" and "the Cun Kou before Qi Kou on the right hand." From the Jin Dynasty to the present, errors have been passed down erroneously, impossible to rectify; even going so far as to claim the left pulse diagnoses exterior syndromes and the right pulse diagnoses interior syndromes. This baseless talk is extremely erroneous. The Liver and Heart reside on the left; could they not be used to diagnose interior syndromes? The Intestines and Stomach reside on the right; could they not be used to diagnose exterior syndromes? Zhang Zhongjing, revered as the ancestor of Cold Damage studies, stated only that pulses that are Large, Floating, Rapid, Slippery, or Surging are named Yang; those that are Deep, Choppy, Weak, String-taut, or Micro are named Yin. He also said: When there is disease in the exterior, the pulse should be Floating and Large; when there is disease in the interior, the pulse should be Deep and Fine. Furthermore, taking the Cun Kou above refers to the Taiyin pulse; taking the Duzhong (Foot Yangming) below refers to the Yangming pulse. These all discuss Yin-Yang and Exterior-Interior relationships. There was never a mention of using the left hand as Ren Ying to diagnose the exterior and the right hand as Qi Kou to diagnose the interior. Even I myself was confused by the theory of left-exterior and right-interior in my early years. Only after gaining extensive experience and firm understanding did I realize that pulse bodies naturally possess Yin-Yang, and all meridians contain both Exterior and Interior aspects. Those who currently practice these erroneous teachings see a strong left pulse and immediately say it is an external contraction attacking the exterior; they see a vigorous right pulse and immediately say it is an internal injury attacking the interior. How can they know that Zang Qi may be uneven, and pulse conditions vary by constitution? Some may naturally have a larger left pulse than the right, or vice versa. Which is normal? Which is abnormal? Or, within a relatively weak pulse, slight strength indicates hidden Deficiency transforming into Excess; within a relatively strong pulse, slight lack of spirit indicates Excess transforming into Deficiency. If one does not understand this but rigidly divides Exterior and Interior by left and right, does the left have no Interior and the right have no Exterior? Thus, they often cause unnecessary attack and depletion, reversing Yin and Yang. This not only greatly deviates from the classic intent but also causes significant harm to people. No wonder pulse diagnosis has become increasingly difficult to master; it is necessary to clarify these points. Further analysis: The positions of Ren Ying and Qi Kou were originally defined by the classics. However, Ren Ying is the pulse of the Foot Yangming Stomach Meridian and cannot be applied to the hand; Qi Kou generally refers to the Hand Taiyin Lung Meridian and cannot be divided into left and right. As clearly pointed out in chapters like *Dongshu*, *Benshu*, and *Jingmai*, Ren Ying is located at the arterial pulse of the Stomach Meridian beside the laryngeal prominence. I once examined the *Sishi Qi Chapter*, which states: "Qi Kou diagnoses Yin, Ren Ying diagnoses Yang." The *Wuse Chapter* states: "A Ren Ying pulse that is full and firm indicates injury by Cold; a Qi Kou pulse that is full and firm indicates injury by food." The *Jinfu Chapter* states: "Cun Kou governs interior diseases, Ren Ying governs exterior diseases." The *Jingmai* and *Zhongshi Chapters* discuss the meanings of Ren Ying being one, two, or three times stronger, and the Mai Kou (Qi Kou) being one, two, or three times stronger. All state that Ren Ying is the Yangming Fu pulse, thus governing the Exterior; Mai Kou is the Taiyin Zang pulse, thus governing the Interior. As the *Taiyin Yangming Lun* states: "Taiyin circulates Qi among the three Yin meridians, Yangming circulates Qi among the three Yang meridians." The *Yinyang Bie Lun* states "Three Yang are at the head," correctly referring to Ren Ying circulating Qi among the three Yang meridians; "Three Yin are at the hand," correctly referring to Mai Kou circulating Qi among the three Yin meridians. Ancient diagnostic methods had three types: one was taking Three Parts and Nine Positions to diagnose whole-body pulses; another was taking Taiyin and Yangming to diagnose the root of Yin and Yang; the third was taking the left and right Qi Kou to diagnose Zang-Fu Qi. Therefore, Ren Ying has its own specific location. The *Mai Jing (Pulse Classic)* incorrectly places Ren Ying on the left hand and divides Qi Kou to the right hand. On what basis or insight is this claimed? I was initially confused and dared not argue immediately. Later, seeing the explanation in *Gangmu* stating: "Ren Ying is on both sides of the laryngeal prominence, the pulse of the Foot Yangming Meridian." And seeing Pang Anchang discuss pulses saying: "What is Ren Ying? Take it at the side of the throat." Recently, seeing Xu Donggao state: "The *Mai Jing* calling the point one division before the Guan on the left hand as Ren Ying is wrong." With these gentlemen, I feel I am not the first to awaken. Here I specifically cite them to correct the error. Alas! A single erroneous statement misleads for millennia. With fixed minds passing down traditions, when will it be corrected? Those who establish doctrines must be cautious.)

Qibo replied: The Stomach is the Sea of Water and Grain, the great source of the six Fu organs. The flavors of the five foods enter the mouth, are stored in the Stomach to nourish the Qi of the five Zang organs, and the Qi Kou also belongs to Taiyin. Therefore, the essence and flavor of the five Zang and six Fu organs all originate from the Stomach and manifest at the Qi Kou. (Humans have four Seas, and the Stomach is one of them, called the Sea of Water and Grain. Among Zang and Fu, Yang is Fu and Yin is Zang. The Stomach belongs to Yang and is the root of the six Fu organs, hence called the great source of the six Fu organs. However, since the five flavors enter the mouth and are stored in the Stomach to nourish the Qi of the five Zang organs, it is also said that the Stomach is the Sea of the five Zang and six Fu organs. The Qi Kou originally belongs to Taiyin Lung; why is it said "also Taiyin"? Because the Qi Kou belongs to the Lung, the Hand Taiyin; while distributing Stomach Qi lies with the Spleen, the Foot Taiyin. According to the *Yingwei Shenghui Chapter*: "Food enters the Stomach, transmits to the Lung, and the five Zang and six Fu all receive Qi." The *Juelun* states: "The Spleen primarily transports fluids for the Stomach." The *Jingmai Bie Lun* states: "Drinks enter the Stomach, overflowing with essence and Qi, transported upward to the Spleen; the Spleen scatters essence, returning upward to the Lung." Thus, Stomach Qi must return to the Spleen, and Spleen Qi must return to the Lung, before circulating to the Zang-Fu and Ying-Wei. Therefore, although the Qi Kou is the Hand Taiyin, it is essentially the convergence of the Foot Taiyin, hence called "Qi Kou also belongs to Taiyin." Thus, the essence and flavor of the five Zang and six Fu organs all originate from the Stomach and manifest at the Qi Kou, making the Stomach the great source of the Zang-Fu organs, though none bypass the Spleen reaching the Lung. See pronunciation Xian.)

Therefore, the five Qi enter through the nose, are stored in the Heart and Lung; if the Heart and Lung have disease, the nose becomes obstructed. (The transformation of Qi and Flavor: in Heaven it is Qi, in Earth it is Flavor. The previous text discussed flavors entering the mouth and storing in the Stomach, referring to Flavor as Yin; this text discusses five Qi entering the nose and storing in the Heart and Lung, referring to Qi as Yang. The nose is the orifice of the Lung, so when the Heart and Lung have disease, the nose becomes obstructed. Observing these two sections, one discussing Flavor and one discussing Qi, both originate from the Stomach and reach the Lung. Having reached the Lung, they must also manifest at the Qi Kou; thus, the Qi Kou alone serves as the master of the five Zang organs.)

Generally, in treating disease, one must examine defecation and urination, assess the pulse, observe the patient's aspirations and mental state, and analyze the disease itself. (These are the four essentials of treatment. "Lower" refers to the two Yin orifices. The two Yin orifices are the aperture of the Kidney and the gate of the Stomach. The *Maiyao Jingwei Lun* states: "If the granary cannot store, it is because the gates fail to guard." Those who maintain control live; those who lose control die. Thus, defecation and urination are the locks of Stomach Qi, relating to the safety of the body's primal Qi; therefore, the lower orifices must not be neglected. "Shi" means to measure. The pulse is the precursor of Qi and Blood, so only the Cun Kou is taken to determine omens of auspiciousness or inauspiciousness. As the *Pingren Qixiang Lun* states: "Humans without Stomach Qi are considered Ni (Rebellious/Reverse), and Ni leads to death. Pulses without Stomach Qi also lead to death." Thus, the pulse must not be neglected. Aspirations and mental state: as the *Ben Cang* chapter states: "When aspirations are harmonious, spirit is focused and upright, Hun and Po do not scatter, regret and anger do not arise, and the five Zang are not invaded by pathogenic factors." Aspirations relate to Spirit and Qi survival; thus, aspirations must not be neglected. Diseases have Root and Branch; failing to seek the Root loses the essence. Diseases have True and False; failing to understand Reverse and Follow leads to disaster. Thus, the etiology must not be neglected. Combining these four aspects for observation, the subtleties of treatment leave no method unexplored.)

Those constrained by ghosts and spirits cannot be spoken to regarding the highest virtue. The spiritual aspect of Yang is called Shen (Spirit/God); the spiritual aspect of Yin is called Gui (Ghost/Spirit). Master Zhang said: Ghosts and spirits are the excellent capabilities of the two Qi (Yin and Yang). Master Cheng said: Ghosts and spirits are merely creation itself. Heaven is high, Earth is low, Qian and Kun are established; thunder drums, wind and rain moisten—this is it. Thus, ghosts and spirits are the spirituality of Heaven and Earth. Fortune and misfortune have causes, created by humans themselves. Heaven and Earth are impartial; how can ghosts and spirits obscure them? Those ignorant of principles do not know that ghosts and spirits cannot be flattered, yet they advocate emptiness and void, seeking no practical benefit. What good is this? For such people, even discussing the highest virtues of Heaven and Humanity, they will not believe. What is there worth speaking to them about? Hence it is said: Believing in shamans but not in physicians is the first case of untreatable illness. This is what is meant.)

Those who detest needles and stones cannot be spoken to regarding supreme skill. The way of needles and stones follows the Three Powers (Heaven, Earth, Human) to regulate Yin and Yang, harmonize Qi and Blood, and unblock meridians. Hence it is said: "One who knows the way of subtle mechanisms cannot be delayed by a hair," indicating its utmost precision and subtlety. For those who detest needles and stones, it is indeed impossible to speak of supreme skill.)

Patients who do not permit treatment will certainly not be cured, and treatment will yield no merit. (Treating disease before it arises is the way of the sages. Those who already have disease but still do not permit treatment usually suffer from unclear biases and weak conviction, similar to those constrained by ghosts/spirits or detesting needles/stones. Since they do not believe, treatment will inevitably be hindered. Forcing treatment cannot succeed. Even if some recover due to treatment, they will still deny it, counting it altogether as no merit.)