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This passage expounds on the core principles of pulse diagnosis and treatment for the five Zang organs. The profound meaning within the chapter is divided into eight sections: The first section discusses the pulse patterns and pathological manifestations of the five Zang organs, highlighting that the Spleen is the "solitary Zang organ," a concept with subtle implications; the second section outlines the sequence of disease transmission among the five Zang organs, specifically death occurring when the disease reaches the organ that overcomes it (Sheng Ke cycle); the third section explains that most diseases originate from Wind pathogen, transmitting sequentially with infinite variations; the fourth section discusses the varying timeframes to death indicated by the appearance of True Visceral Pulses (Zhen Zang Mai); the fifth section describes the specific characteristics of True Visceral Pulses; the sixth section elucidates why True Visceral Pulses appear exclusively, which is the key theoretical point of this chapter; the seventh section details diagnostic methods; and the final section discusses the subtleties of seeking life amidst death in cases of Five Excesses (Wu Shi) and Five Deficiencies (Wu Xu). Although each section differs, the title emphasizes "True Visceral" because these pulses are crucial for distinguishing life from death, a primary duty of physicians. The term "Yu Ji" (Jade Machine), similar to the naming convention in the *Jin Gui* chapters, signifies reverence and importance.

The Yellow Emperor asked: "The spring pulse resembles a bowstring. What constitutes a bowstring pulse?" Qi Bo replied: "The spring pulse corresponds to the Liver, which belongs to Wood in the East. It is the season when all things begin to grow. Therefore, its qi arrives soft, light, empty, slippery, straight, and long, hence called 'bowstring' (Xian). If it is contrary to this, it indicates disease." (Commentary: Bian Que stated, "When all things first begin to grow, before branches and leaves appear, the pulse arrives moist, weak, and long. Generally, only 'long' makes it a bowstring pulse; only when 'moist and weak' does the bowstring pulse become relaxed. A relaxed bowstring pulse indicates health; deviation indicates disease. The following sections follow this logic.) The Emperor asked: "What constitutes the contrary state?" Qi Bo said: "If the qi arrives solid and strong, this is called 'Excess' (Tai Guo), indicating disease in the exterior; if the qi arrives insubstantial and faint, this is called 'Deficiency' (Bu Ji), indicating disease in the interior." (Excess qi leads to exterior disease; deficient qi leads to interior disease. Commentary: Lu Guang said, "Solid and strong indicates flourishing Yang qi. The Shaoyang pulse should be faint; now it is solid and strong, termed Excess. Yang resides at the exterior, causing exterior disease. Jueyin qi nourishes the sinews, and its pulse is bowstring; now it is deficient and faint, termed Deficiency. Yin resides in the interior, causing interior disease.")

The Emperor asked: "For spring pulse Excess and Deficiency, what are the respective symptoms?" Qi Bo said: "Excess causes irritability (Note: Original text says 'forgetfulness,' corrected to 'irritability' based on commentary), dizziness, vertigo, and head disorders; Deficiency causes chest pain radiating to the back, and distension in both hypochondriac regions." The Emperor said: "Excellent!" ('Huhu' refers to mental confusion. 'Xuan' refers to vertigo, feeling as if spinning. 'Xie' refers to the hypochondriac region under the armpit. 'Wang' is likely a typo for 'Nu' (anger). Commentary: Old texts read 'Wang,' but annotations correct it to 'Nu.' Since the Liver governs anger, Liver excess leads to irritability. Liver belongs to Wood and governs Wind, causing vertigo. Liver meridians ascend to the forehead and meet the Du vessel at the vertex, causing head disorders. Liver meridians distribute to the hypochondrium, causing distension; even Liver deficiency can cause distension, so distension should not immediately be diagnosed as Excess. 'Xie' sounds like 'Qu'.)

The summer pulse resembles a hook. What constitutes a hook pulse? Qi Bo replied: "The summer pulse corresponds to the Heart, which belongs to Fire in the South. It is the season when all things flourish and grow. Therefore, its qi arrives vigorous and deploys weakly, hence called 'hook' (Gou). If it is contrary to this, it indicates disease." (Commentary: Bian Que said, "Summer pulse hook, due to Southern Fire, where all things flourish. Branches and leaves hang down and curve like hooks, so the pulse arrives fast and deploys slow. The image of a hook represents the normal summer pulse. The Jingmai interprets it via vigor and weakness, resembling a pathological pulse. Bian Que's interpretation of fast arrival and slow departure is logically sound. However, Bian Que only mentioned 'vigorous,' while the Jing mentions 'flourishing and growing.' Flourishing inherently implies growing.) The Emperor asked: "What constitutes the contrary state?" Qi Bo said: "If the qi arrives vigorous and deploys vigorously, this is called 'Excess,' indicating disease in the exterior; (Arriving and departing vigorously indicates excessive Yang, surplus Heart qi, i.e., Excess.) if the qi arrives insubstantial but deploys vigorously, this is called 'Deficiency,' indicating disease in the interior." (Commentary: Xin Zheng Jiao notes, "Examining Bian Que's descriptions of Liver, Heart, Lung, and Kidney pulses, he defines Excess as solid/strong and Deficiency as weak/faint, differing from the Su Wen.") The Emperor asked: "For summer pulse Excess and Deficiency, what are the respective symptoms?" Qi Bo said: "Excess causes fever and skin pain, developing into spreading sores (Jin Yin); Deficiency causes vexation, upper symptoms of coughing and expectoration, and lower symptoms of flatus." The Emperor said: "Excellent!" (Commentary: The Heart is a Yang organ governing Fire. Excess leads to fiery pathology. Fever and skin pain result from fire burning externally. Jin Yin refers to sweating, forced out by fire pressing on the Lungs. Heart deficiency leads to fire agitation and vexation; fire agitates and flares upward to the Lungs causing cough, and descends into the Large Intestine, exiting via the anal sphincter as gas. Why does Heart disease affect the Lungs? Because uncontrolled fire attacks Metal.)

The autumn pulse resembles floating. What constitutes a floating pulse? Qi Bo replied: "The autumn pulse corresponds to the Lung, which belongs to Metal in the West. It is the season of harvest. Therefore, its qi arrives light, empty, and floating, arriving swiftly and dispersing slowly, hence called 'floating' (Fu). If it is contrary to this, it indicates disease." (Commentary: Bian Que said, "Autumn pulse Mao (feather-like), due to Western Metal, where all things conclude. Grass and tree flowers and leaves fall in autumn, leaving only branches, like hairs. Thus, the pulse arrives light, empty, and floating, hence called 'Mao.' Nothing is lighter than hair, and the autumn pulse is light and floating, hence the name. The lightness and floating nature arise because autumn follows humid heat, clearing away turbidity to become clear and light. Clear leads to light, light leads to floating. Autumn pulse is sometimes called Mao, here called Fu; the principle is identical.) The Emperor asked: "What constitutes the contrary state?" Qi Bo said: "If the pulse feels like hair but is firm in the center and hollow on the sides, this is called 'Excess,' indicating disease in the exterior; if the pulse feels like hair but is faint, this is called 'Deficiency,' indicating disease in the interior." The Emperor asked: "For autumn pulse Excess and Deficiency, what are the respective symptoms?" Qi Bo said: "Excess causes rebellious qi and back pain, with a feeling of oppression; Deficiency causes asthma, shortness of breath, cough, hemoptysis (upper symptom), and audible respiratory or intestinal sounds (lower symptom)." The Emperor said: "Excellent!" (Commentary: Hollow sides and firm center indicate internal Excess. Internal Lung Excess implies pathogenic factors or fire, causing rebellious qi and back pain. The back is Yang; excess qi merges with Yang. Yunyun denotes stagnant qi. Lung deficiency leads to scattered, rapid qi, causing asthma and cough. While Lung deficiency causes asthma/cough, treating it solely as Excess is incorrect. Hemoptysis results from floating qi moving blood. 'Bing Yin' annotated as asthma is incorrect; it refers to lower expulsion of gas.)

The winter pulse resembles Ying (deep/stony). What constitutes a Ying pulse? Qi Bo replied: "The winter pulse corresponds to the Kidney, which belongs to Water in the North. It is the season of storage. Therefore, its qi arrives deep and soft, hence called 'Ying'." (Commentary: Wang Bing's edition reads 'deep and striking.' The *Jia Yi Jing* corrects 'striking' to 'soft' (Ru), an ancient variant of 'ruan' (soft), representing the balanced winter pulse. Deep and striking against the fingers indicates Winter Pulse Excess. This correction is adopted. Other chapters mention Kidney pulse as 'Stone'; here it is 'Ying.' 'Ying' refers to a military camp, implying solidity and density, consistent with 'Stone'.) The Emperor asked: "What constitutes the contrary state?" Qi Bo said: "If the qi arrives like bouncing stones, this is called 'Excess,' indicating disease in the exterior; if it deploys like a rapid pulse (Shu), this is called 'Deficiency,' indicating disease in the interior." (Commentary: Kidney pulse should resemble stone; bouncing stones is excessive. A normal Kidney pulse is deep, fine, and slow. Departing rapidly indicates Yin deficiency.) The Emperor asked: "For winter pulse Excess and Deficiency, what are the respective symptoms?" Qi Bo said: "Excess causes lethargy, spinal pain, shortness of breath, and reluctance to speak; Deficiency causes a sensation of hunger with an empty heart, coldness in the epigastrium, spinal pain, abdominal fullness, and abnormal urination." The Emperor said: "Excellent!" (Commentary: 'Jie Chi' was analyzed previously. Although Excess pulse suggests excess pathology, the symptoms here indicate deficiency. Why? Zhu Danxi stated, "Yin is often deficient." After birth, Fire moves daily, Water declines daily. The apparent 'Excess' is merely the striking quality of the pulse, reflecting Water deficiency and Fire agitation, not true Kidney Qi excess. Thus, the pulse seems Excess, but symptoms are Deficient. Hunger sensation is Water failing to control Fire. Epigastric cold is Kidney deficiency causing cold. Abdominal fullness is Kidney Qi overflowing and failing to store. Abnormal urination (yellow/red urine) occurs when Water is depleted and becomes turbid. Treating this as Heat with Cold herbs is incorrect.)

The Emperor asked: "Regarding the order of the four seasons and their variations of compliance and rebellion, what does the Spleen pulse alone govern?" Qi Bo replied: "The Spleen pulse belongs to Earth, the solitary Zang organ, responsible for irrigating the four directions (other Zang organs)." (It accepts food and water, transforms fluids, and irrigates the Heart, Liver, Lung, and Kidney. It does not govern a specific season, hence 'solitary.' Commentary: The four Zang organs occupy specific quarters; the Spleen centers and responds to all four, not governing a season but being revered by all seasons.) The Emperor asked: "Can the auspicious and inauspicious states of the Spleen be seen?" Qi Bo replied: "The auspicious state cannot be seen; the inauspicious state can be seen." (Commentary: Earth prospers in all four seasons, turning with time. Without disease, it is merely ordinary. Once afflicted, it manifests in the pulse and symptoms.) The Emperor asked: "How can the inauspicious state be seen?" Qi Bo said: "If the qi flows like water, this is called 'Excess,' indicating disease in the exterior; if it resembles a bird's beak, this is called 'Deficiency,' indicating disease in the interior." (Commentary: Spleen Excess compared to flowing water suggests a Floating-Hong pulse. Bird's beak refers to the dying Spleen pulse; here labeled Deficiency, readers should grasp the general idea.) The Emperor asked: "You stated the Spleen is the solitary Zang, Central Earth irrigating the four directions. What are the symptoms of its Excess and Deficiency?" Qi Bo said: "Excess causes inability to lift the limbs; (Commentary: Spleen belongs to Earth and governs the limbs. Dampness excess causes heaviness and immobility. Although Spleen is damp Earth, it dislikes dampness.) Deficiency causes obstruction of the nine orifices, named 'Chong Qiang' (Heavy Rigidity)." (...Since the Spleen irrigates the four directions, disease here causes disharmony among the five Zang, leading to orifice obstruction. *Nan Jing* Chapter 81 states, "Disharmony of the five Zang leads to obstruction of the nine orifices." Chong means overlapping Zang qi; Qiang means discordant qi.)

The five Zang receive qi from the organ that generates them, transmit it to the organ they overcome, retain it in the organ that generates them, and die when it reaches the organ that overcomes them... This describes reverse qi movement, leading to death. (The sequence of reversal is as follows.) Liver receives qi from Heart, transmits to Spleen, retains in Kidney, and dies upon reaching Lung. Heart receives qi from Spleen, transmits to Lung, retains in Liver, and dies upon reaching Kidney. Spleen receives qi from Lung, transmits to Kidney, retains in Heart, and dies upon reaching Liver. Lung receives qi from Kidney, transmits to Liver, retains in Spleen, and dies upon reaching Heart. Kidney receives qi from Liver, transmits to Heart, retains in Lung, and dies upon reaching Spleen. These are all reverse deaths. Dividing day and night into five parts allows prediction of whether death occurs in the morning or evening. (...Morning governs Jia/Yi, Day governs Bing/Ding, End-of-Season governs Wu/Ji, Evening governs Geng/Xin, Night governs Ren/Gui. From this, the timing of death can be known. Commentary: This is the fixed rule of Five Elements generation and overcoming. Wang Bing's text reads 'timing of life and death'; *Jia Yi Jing* reads 'predicting timing of death.' Detailed examination shows the text discusses reverse death timing, so *Jia Yi Jing* is preferred.)

Therefore, Wind is the chief of all diseases. (Commentary: *Sheng Qi Tong Tian Lun* says "Wind is the beginning of all diseases," meaning all diseases start from Wind. Here "chief" means Wind is the most prominent among pathogens. Though wording differs, meaning is the same.) When Wind-Cold invades the body, causing hair to stand erect and skin pores to close, generating heat, at this stage, diaphoresis (sweating) can be used. (Commentary: *Yin Yang Ying Xiang Da Lun* states, "The skilled healer treats the skin and hair." This refers to that principle.) If Bi syndrome, numbness, swelling, and pain occur, at this stage, hot compresses, moxibustion, and acupuncture can remove the pathogen. (Heat stagnating blood and qi causes Bi and numbness. Cold damaging form causes swelling and pain.) If untreated, the pathogen enters and settles in the Lung, named Lung Bi, manifesting as cough and rebellious qi. (Commentary: *Xuan Ming Wu Qi Lun* states, "Pathogen entering Yang causes mania; entering Yin causes Bi." Lung changes manifest as cough; cough involves rebellious qi, hence 'rebellious qi'.) If untreated, the Lung transmits to the Liver, named Liver Bi, also called Jue, with hypochondriac pain and vomiting. (Lung Metal attacks Wood; qi descends into Liver, hence 'if untreated, transmits to Liver.' Liver qi connects to Gallbladder, which is prone to anger; anger causes rebellious qi, hence 'Jue.' Liver meridians distribute to the hypochondrium, causing pain. Commentary: 'Chu Shi' (vomiting food) is unclear in annotations. Likely, pathogen in Liver causes Wood excess attacking Stomach, leading to vomiting.) At this stage, massage or ear pricking/bloodletting can be used. If untreated, Liver transmits to Spleen, named Pi Feng (Spleen Wind), manifesting as jaundice, abdominal heat, vexation, and yellow discharge. (Liver corresponds to Wind-Wood, overcoming Spleen-Earth. Earth receiving Wind qi is named Spleen Wind, named after Wind connecting to Liver. Spleen disease easily produces yellow jaundice. Spleen branch meridians ascend through diaphragm to Heart, causing abdominal heat and vexation, discharging yellow matter in stool. Commentary: 'Chu Huang' annotated only as stool is partial. Yellow is Spleen color; Spleen disease manifests externally as yellow complexion/jaundice.) At this stage, massage, herbs, or bathing can be used. If untreated, Spleen transmits to Kidney, named Shan Jia (Hernia/Mass), with painful heat in the lower abdomen resembling grievance, and white discharge, also named Gu. (Commentary: Pathogen entering Kidney gathers into form, creating Hernia/Mass. Kidney's fu organ is Bladder, located in lower abdomen. Heat binding Bladder prevents qi exit, feeling like grievance, hence 'painful heat resembling grievance.' Only heat in Bladder causes white urinary discharge. Named Gu, annotation explains: "Internal binding of grievous heat consumes flesh like insects eating, causing daily wasting, hence Gu.") At this stage, massage and herbs can be used. If untreated, Kidney transmits to Heart, causing sinew and vessel contraction and spasm, named Yuan (convulsion/twitching). (Kidney deficiency fails to generate Water; lack of Water causes dry, tight sinews, leading to contraction. Inner Yin is weak, Outer Yang burns; sinews/vessels受热 cause twitching, hence Yuan. Commentary: Yuan sounds like 'Chi', referring to sinew spasms.) At this stage, moxibustion and herbs can be used. If untreated, after ten days, death is expected according to protocol. (Qi reaches extremity at Heart, thus such outcome. If transmission continues, see below.) Kidney transmitting to Heart, Heart then reverses-transmits to Lung, manifesting chills and fever, expected death in three years. (Reverse transmission to Lung Metal, Lung injured twice, hence chills/fever. Three years: Lung to Kidney one year, Kidney to Liver one year, Liver to Heart one year, Fire then attacks Lung again, hence 'three years death.') This is the sequence of disease transmission. However, sudden onset diseases need not follow transmission rules. (Commentary: Transmission by overcoming has a sequence. Sudden onset, whether acute external invasion or collapse of primordial Qi, though having a cause, is not transmitted sequentially, e.g., direct strike in Cold Damage, fainting in Stroke, or reversal in miscellaneous diseases. One should investigate the cause, not rigidly apply transmission sequences.) Or transmission may not follow sequence. Non-sequential entry is caused by Worry, Fear, Sadness, Joy, Anger, disrupting order, leading to severe disease. (Emotions arise unpredictably upon trigger, causing disease qi to arise non-sequentially. Commentary: This explains sudden onset. Five Zhi injuries accumulate and suddenly erupt, not sequentially, hence non-sequential disease.)

Although many sudden diseases exist, the Jing mentions only the Five Zhi because human disease, unless rooted in Seven Emotions internal injury, will not be fatal despite severity. Excessive Joy causes extreme Heart Qi deficiency, allowing Kidney Qi to invade. (Commentary: Joy is Heart's emotion. Excessive Joy depletes Heart Qi; Heart deficiency weakens Fire, allowing Water pathogen to invade.) Anger allows Liver Qi to invade. (Commentary: Anger is Liver's emotion. Extreme Anger strengthens Liver Qi excessively, inevitably invading Spleen.) Sadness allows Lung Qi to invade. (Commentary: Sadness is Lung's emotion. Sadness makes Metal qi urgent, inevitably attacking Wood. Note: Annotation mistakenly wrote Liver; corrected here.) Fear allows Spleen Qi to invade. (Commentary: Fear is Kidney's emotion. Extreme Fear weakens Kidney; Kidney weakness leads to Water deficiency, allowing Earth to control Water.) Worry allows Heart Qi to invade. (Commentary: Lung's emotion is also Worry. Excessive Worry damages Lung; Lung damage weakens Metal, allowing Fire to invade. These five describe sudden disease. However, observing closely, they differ: Essence and Qi gathering and becoming excessive, thereby overcoming the controlled organ, applies to Liver and Lung. Overworking Qi to extreme deficiency, thereby being invaded by the controlling organ, applies to Heart, Kidney, and Lung. Annotations are vague; scholars must distinguish carefully.) This is the principle. There are five diseases, five times five making twenty-five transformations, and their transmission. "Transmission" is the name for "Overcoming" (Cheng). (Five Zang combining and multiplying by five, then overcoming, yields twenty-five transformations. Changes vary widely, transmitting without sequence. Commentary: Top overriding bottom, strong bullying weak is Cheng. Pathogen transmission is precisely overcoming the controlled and insulting it, transmitting only when strength allows overcoming.)

Great bones withered, great muscles sunken, chest full of qi, difficult breathing, body movements disturbing the form, expected death in six months. Appearance of True Visceral Pulse confirms the date. (This is the True Visceral Pulse of the Lung.) Great bones withered, great muscles sunken, chest full of qi, difficult breathing, internal pain radiating to shoulder and neck, expected death in one month. Appearance of True Visceral Pulse confirms the date. (This is the True Visceral Pulse of the Heart.) Great bones withered, great muscles sunken, chest full of qi, difficult breathing, internal pain radiating to shoulder and neck, body heat, muscle wasting, skin cracking, True Visceral Pulse appears, death within ten months. (Skin cracking/muscle wasting indicates Spleen, as Spleen governs flesh.) Great bones withered, great muscles sunken, shoulder marrow internally consumed, movements increasingly frail, True Visceral Pulse not yet appeared, expected death in one year. Appearance of True Visceral Pulse confirms the date. (Shoulder marrow consumption refers to hollowed supraclavicular fossa. Frail movements refer to decreased sexual activity. This is the True Visceral Pulse of the Kidney. Commentary: Wang Bing includes 'appeared'; Quan Yuanqi and *Jia Yi Jing* say 'not appeared,' which is more accurate. Adopted here.) Great bones withered, great muscles sunken, chest full of qi, abdominal pain, heart discomfort, shoulder/neck/body heat, skin cracking/muscle wasting, eye sockets sunken, True Visceral Pulse appears, eyes unable to see person, immediate death. If able to see person, death occurs at the time of the organ it cannot overcome. (Liver governs eyes; sunken sockets and blindness indicate immediate death. Time of overcoming refers to Geng/Xin months, i.e., Autumn. This is the True Visceral Pulse of the Liver.) Acute deficiency, sudden bodily collapse, five Zang closure, meridian blockage, qi stagnation, akin to falling or drowning, no specific timeframe can be predicted. (Commentary: Life depends on this breath of Qi. Harmonious Qi brings safety; discordant Qi brings disease. If primordial Qi collapses, disease strikes suddenly, causing fainting/reversal and unconsciousness, due to exhaustion of Zang Qi, closing nine orifices and blocking meridians. Blocked meridians stop Qi flow, leading to death. This is most sudden, like accidental drowning.) If pulse is absent, or if pulse beats five to six times per breath, even if form/flesh is intact and True Visceral Pulse not seen, death still occurs. (Commentary: Absent pulse means no pulse. Five-six beats per breath is extreme rapidity. No pulse means True Qi exhausted; extreme rapidity means root depleted. Both signs lead to immediate death,无需 waiting for flesh/pulse changes for verification. Annotation states...)