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The *Qibing Lun* (Treatise on Rare Diseases) states: "Dan" refers to heat. The use of the character "Shi" (Dampness) at the beginning of this chapter is incorrect. The *Han Shu* (Book of Han), in the biography of Yan Zhu, records: "In the south, there is summer dampness and near summer 'dan' heat." (Yan Shigu's commentary states: "'Dan' is jaundice. This is an error.)

Wang Chong in *Lunheng* (Discourses Weighed in the Balance) states: "A human body is seven chi long, containing the Five Constants (referring to normal physiological structures). If one suffers from 'dan' heat disease, even if one deeply blames oneself, it still cannot be cured." He further states: "Just as heaven and earth have moisture ('Zhan'), how do we know it is not like humans having water disease? Just as there is drought, how do we know it is not like humans having 'dan' disease?" The *Zuo Zhuan* (Commentary of Zuo) records: "Xun Yan suffered from 'dan' carbuncle." (3rd year of Duke Ai). The *Shiji* (Records of the Grand Historian) records: "Wind 'dan', lung 'xiaodian' (wasting-thirst due to heat), as well as 'xiaodian' and 'dan nue' (malaria with high fever) mentioned in the *Neijing*, all singly denote the meaning of heat. Xiong's phonetic annotation: 'Dan' is pronounced 'duoman fan'. It is colloquially written as 'Dan' (Jaundice), referring to yellow disease. This is also an error.

Jue Qi (Rebellious Qi) ascending becomes a disease of the vertex. Wu Kun states: "'Dian' (Vertex) is identical to 'Dian' (Epilepsy/Insanity), used interchangeably in ancient times. When Qi rebels upward and does not cease, the upper becomes excess and the lower becomes deficient, causing sudden collapse and falling. This is what is now called the five types of epilepsy (Wuxian). Zhang Jingyue states: "It may manifest as pain, or as dizziness and collapse, thereby forming a disease of the vertex." Another view holds: "Qi rebellion causes mental confusion, leading to mania and epilepsy; this interpretation is also valid." Commentary notes: Yang Xuancao, annotating the *Nanjing* (Classic of Difficult Issues), states: "'Dian' means vertex. Upon onset, the patient stiffens and falls to the ground, hence the term 'Dianjue' (Epileptic fall). Lou Shi's *Gangmu* states: "Because the disease is located at the head vertex, it is called 'Dianji' (Disease of the Vertex)." From this, we know that the 'Dian' in 'Dianxian' (Epilepsy) and the 'Dian' in "Jue Cheng Dianji" (Jue Qi becoming vertex disease) and "Xuanmao Dianji" (Vertigo and vertex disease) refer to the same disease. Wang Bing erroneously divided 'Dian' into two diseases; only Sun Simiao began to unify them. Although Lou Shi was correct in equating 'Dian' and 'Dian' as one disease, his interpretation that 'Dian' solely refers to the anatomical vertex is unacceptable. The *Wuzang Shengcheng Pian* (Chapter on the Generation of the Five Viscera) states: "Headache and vertex disease, lower deficiency and upper excess." The *Qibing Lun* states: "Those born with vertex disease." The *Fang Sheng Shuai Lun* states: "Qi rises but does not descend, causing headache and vertex disease." These all refer to epilepsy/manic disorders, and Wu Kun's annotation should be followed.

Prolonged wind leads to undigested food diarrhea (Sungxie). Zhang Zhicong states: "Wind belongs to Wood pathogen. Over time, it internally damages Spleen Earth, resulting in Sungxie." Thus it is said: "If injured by wind in spring, the pathogen lingers, eventually becoming Dongxie (profuse watery diarrhea)."

Sinew changes and bone pain. The character "Bian" (Change) is written as "Luan" (Spasm/Cramp) in most editions and should be corrected. Zhang Jingyue states: "This refers to various abscesses and swellings accompanied by sinew spasms and bone pain. Previous commentators interpreted abscesses, sinew spasms, and bone pain as three separate syndromes, which greatly misses the intent of the classic. Looking at the following text: 'This is swelling caused by cold pathogen,' it is clear that the inquiry focuses on 'swelling,' revealing the meaning."

Swelling caused by cold pathogen and changes from the Eight Winds. Zhang Jingyue states: "Only changes from wind and cold affect the meridians, thus accompanying bone and sinew pain. Currently, diseases such as Big Head Plague and Mumps involve either abscesses of the head, neck, and throat, or swelling of the muscles; these are precisely of this category." Gao Shishi states: "'Swelling of cold pathogen' means abscesses arising from cold. 'Changes of the Eight Winds' means sinew spasms and bone pain arising from wind." This clarifies that the origin of the disease is its manifestation.

Cure it by treating with the overcoming element. Zhang Zhicong states: "Cure it by using the overcoming properties of the Five Elements and their flavors. For example, if cold invades internally, treat with sweet and hot substances. For instance, the East generates Wind; Wind generates Wood; Wood generates Sour flavor; Pungent flavor overcomes Sour flavor, and so on."

Verify the pulse. Wu Kun states: "'Zheng' means to verify or test."

Complexion is cyan-red. Zhang Jingyue states: "Cyan color is the color of Liver and Kidney, blackish-green. Red color is the color of Heart Fire; the Heart governs Blood. If the pulse is wiry and deep, and the complexion is cyan-red, it indicates pathology in sinews, bones, blood, and vessels; thus, there must be trauma/injury." Commentary notes: In *Shuowen Jiezi*, "Cang" refers to grass color, blackish-green. The basis for this is unclear.

Dampness resembles being struck by water. Zhang Jingyue states: "For any injury to sinews and bones, whether bleeding occurs or not, the blood will surely stagnate, and the meridians will surely be obstructed. Stagnation of Qi and blood causes the body to swell. It may resemble dampness in the meridians, appearing similar to being struck by water." Gao Shishi states: "Injury to sinews and bones should not involve bleeding. If bleeding has occurred, the Heart Qi is also damaged, similar to sweating and then feeling damp, as if struck by water. Water enters through sweat pores and damages Heart Qi." In Wu Kun's edition, the twenty-five characters starting from "Liver and Kidney" are moved below "Ren Mai Bo Jian Er Chang... until it never recovers." The annotation states: "When Liver and Kidney pulses arrive together, they are firm and long, and also deep and stone-like. The complexion should be cyan-black. Seeing cyan-red now indicates it is not a Liver/Kidney disease, but rather trauma without bleeding. Likely, sinew injury manifests as cyan color, vessel injury as red color. If bleeding has occurred, the pulse is firm and long." Or it presents as damp-fluid retention with a deep, sinking pulse; or it presents as water disease. Commentary notes: This section does not connect smoothly with the context above and below; there is suspected textual loss or error.

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The inner sides of the Chi area correspond to the hypochondrium. Commentary notes: Wang Bing annotates: "Chi Nei refers to the interior of the Chi Ze acupoint." This is the location for diagnosing the skin of the forearm (Chifu). The *Pingren Qixiang Lun* (Chapter on Normal People and Pulse Images) states: "Rough Chifu with slippery pulse, cold Chifu with fine pulse." Wang Bing also annotates: "Refers to Chifu." The *Xiéqì Zàngfǔ Bìngxíng Piān* (Chapter on Pathogenic Factors and Zang-Fu Diseases) states: "One who is skilled in regulating Chifu does not need to wait for the Cun pulse." It also states: "The correspondence between facial color, pulse, and Chifu is like the striking of a drum or the shadow following the form." The *Lun Ji Zhen Chi Pian* (Chapter on Discussing Diseases by Diagnosing Chifu) states: "Moist Chifu," and also: "Weak flesh at Chifu." *Nanjing* Chapter 13 states: "If the pulse is rapid, the skin of Chifu is also rapid; if the pulse is tight, the skin of Chifu is also tight." The *Shiji* Biography of Cang Gong also states: "Palpate the pulse, trace the Chifu." Zhang Zhongjing states: "Palpating Cun without reaching Chi." All these illustrate this concept. As for why it is called "Chi," *Shuowen Jiezi* states: "Chi is ten Cun." The arterial pulse at the wrist, ten Cun backward from the tip of the thumb, is called Cun Kou. Ten Cun constitutes Chi. Chi is used to indicate standards/rules. The character consists of 'Shi' (Corpse/Body) and 'Yi' (Mark). In Zhou dynasty systems, measures like Cun, Chi, Zhi, Xun, and Ren were all based on human body dimensions. Xu Kai states: "*Kongzi Jiayu* says: Spreading fingers knows one Chi; extending the arm knows one Xun. (*Da Dai Liji* says: Spreading fingers knows one Cun; spreading hand knows one Chi; extending arm knows one Xun.)" Clearly, "Chi" here refers to the one-Chi segment of the inner arm, absolutely not the "Chi" position in the Cun-Guan-Chi three positions. The Cun Kou is divided into Cun, Guan, and Chi. In the *Nanjing*, scholars like Ma Shi and Zhang Jingyue interpreted "Chi" using the Cun-Guan-Chi system, which deviates significantly from the original intent of the classic. Based on Wang Bing's interpretation and the text, looking at the left side of the diagram.

Used to observe the abdomen. Zhang Zhicong and Gao Shishi both attach the character "Zhong" (Middle) to the following sentence, reading it as "Wei Zhong Fu Shang" (Attach to the middle), which is correct.

Left exterior observes Liver; interior observes Diaphragm. He Mengyao in *Yiquan* states: "Heart, Lung, Liver, Kidney are Zang organs. They are observed externally; the thoracic diaphragm wraps these organs. Observing internally seems to be a transcription error. It should be analogized to Stomach external/Spleen internal, swapping positions would be correct." Commentary notes: This argument has merit. However, whether the old text was indeed so is hard to confirm.

Anterior observes anterior; posterior observes posterior. Commentary notes: Anterior refers to the Yin meridian aspect of the arm. Posterior refers to the Yang meridian aspect of the arm. The *Lun Ji Zhen Chi Pian* states: "Heat exclusively at the front of the elbow indicates heat in the chest/front; heat exclusively at the back of the elbow indicates heat in the shoulder/back." This illustrates the point. Wang Bing considered Left as Anterior and Right as Posterior; subsequent commentators followed him, which is incorrect.

Upper attachment, right exterior observes Stomach. In the Song edition, "Stomach" is written as "Lung"; all other editions agree, but it should be corrected to Stomach.

Matters of the knee, shin, and foot. The *Jiayi Jing* lacks the character "Foot".

Pulse is coarse and large. Commentary notes: Below this, the pulse image is used to observe the excess or deficiency of Yin/Yang, Evil, and Righteous Qi, which differs naturally from the meaning of Chifu.

Arrival is rapid, departure is slow. Shou Shou in *Zhenjia Shuyao* states: "Arrival" is from the depth of muscle/bone emerging to the surface of the skin, representing the rising of Qi. "Departure" is from the surface of the skin returning to the depth of muscle/bone, representing the descending of Qi. Commentary notes: Wu Kun and Zhang Jingyue follow Shou Shou's explanation.

Upper excess, lower deficiency. Wu Kun states: "Pulse rising from Chi position to Cun Kou is 'Up'; descending from Cun Kou to Chi position is 'Down'." Commentary notes: The distinction of Cun and Chi is a post-*Nanjing* concept and should not be adopted here.

Jue leading to vertex disease. Ma Yin states: "The disease should be Jue disease, and also vertex disease." Wu Kun states: "It is Jue Ni (rebellious Qi) and epileptic collapse disease." Gao Shishi states: "Qi only rebels upward and does not descend, thus becoming vertex disease." Similar to the previous statement "Jue becomes vertex disease."

Due to aversion to wind, thus those struck by evil wind. Wu Kun states: "Yin excess and Yang deficiency cannot withstand wind and cold, thus causing aversion." Zhang Jingyue states: "'Wu' (Aversion/Hate) is read with the departing tone (4th tone); the second 'Wu' is read with the entering tone (entering sound)." Zhang Zhicong states: "Wind is a Yang pathogen, damaging Yang Qi in the skin. Severe wind enters directly from Yang into Interior Yin. Therefore, the lower is excess, the upper is deficient; Yang deficiency and Yin excess cause aversion to wind." Gao Shishi states: "'Wu Feng' refers to Leprosy (Li Feng)." Commentary notes: Both instances of "Wu" are read with the entering tone; Zhang Zhicong's annotation is correct.

Shaoyin Jue. Zhang Jingyue states: "Deep and fine is the pulse characteristic of the Kidney. Accompanied by rapidity indicates heat, Fire within Yin. Thus it becomes Shaoyin Yang Jue."

Chills and fever. Gao Shishi states: "Heat has Yin and Yang aspects. Clarifying that a deep, fine, and scattered rapid pulse is not the excessive Yang heat of a coarse/large pulse, but rather chills and fever due to Yin excess and Yang deficiency." Commentary notes: This is also deficiency-labor chills and fever. Gao's annotation is correct. However, in cases of Yin deficiency with fire hyperactivity, the pulse may also be deep, fine, rapid, and scattered; one must not adhere rigidly to one view.

All floating pulses but not restless. Zhang Jingyue states: "Floating pulse belongs to Yang; restlessness is Yang within Yang. Therefore, floating without restlessness belongs to Yang pulses and inevitably involves heat. If floating and restless, it represents extreme Yang. Thus, the disease is in the Hand meridians. 'Hand' refers to Yang within Yang, i.e., the Three Yang Meridians of the Hand." This is consistent with the *Zhongshi Pian* (Chapter on End and Beginning): "Renying pulse one-fold excess, disease in Foot Shaoyang; one-fold excess and restless, disease in Hand Shaoyang."

All fine and deep pulses. Zhang Jingyue states: "Deep and fine belongs to Yin; stillness is Yin within Yin. Therefore, a pulse that is merely deep and fine indicates disease in the Yin division, likely bone pain. If deep, fine, and still, it represents extreme Yin. Thus, the disease is in the Foot meridians. 'Foot' refers to Yin within Yin, i.e., the Three Yin Meridians of the Foot."

Rapid, moving, and intermittent pulse. Wu Kun states: "Rapid is a Yang pulse. Yin is solidified externally, Yang battles internally, causing the pulse to tremble violently, named 'Dong' (Moving). If the pulse stops once after five beats, or once after seven beats, without further change, it is named 'Dai' (Intermittent). This is Yang knotting. Thus the disease manifests as slippery diarrhea/dysentery, and also bloody stool/pus." Wang Ang states: "'Shu' (Rapid) is read with the departing tone. Annotation notes: Ma's annotation reads 'Shu' with the entering tone. 'Shu' means heat, thus causing bloody stool; this is incorrect." Zhang Zhicong states: "Yang heat in the meridians causes rapid/moving pulse. Heat damages the Blood division, causing bloody stool/pus. Blood loss downward causes the intermittent pulse."

All abnormal pulses. Wu Kun states: "'Guo' means the pulse has lost its normal rhythm."

Yin and Yang both in excess. Ma Yin states: "If Slippery and Choppy pulses appear together, and both Yin and Yang are in excess, then Yang excess causes no sweat, and Yin excess causes cold body. Both symptoms should appear simultaneously." Commentary notes: Slippery and Choppy pulses are opposite; how can both appear simultaneously?

Push outward but not inward; push inward but not outward. Zhang Jingyue states: "Below discusses the method of examining disease. One must deduce via the pulse to resolve doubts. If the disease is in the Exterior, one seeks it in the Exterior; however, if the pulse is deep, slow, and not floating, it is in the Interior, not the Exterior. Thus, one knows there is accumulation in the Heart and Abdomen. 'Tui' (Push/Deduce) is pronounced 'Chui'. Interpreting it as 'pushing forward/expanding' is incorrect." Commentary notes: Wu Kun, Ma Shi, and others follow Wang Bing, interpreting 'Tui' as expanding. Wang Ji subsequently treated 'Tui' as a specific pulse diagnosis method (seen in *Maijue Kanwu* appendix). This is unacceptable.

Push inward but not outward; push outward but not inward. Zhang Jingyue states: "If the disease is in the Interior, one seeks it in the Interior; however, if the pulse is floating, rapid, and not deep, it is in the Exterior, not the Interior. Thus, one knows there is heat in the body."

Push upward but not downward; push downward but not upward. Zhang Jingyue states: "When seeking in the Upper part, if the pulse is only visible in the Upper, while the Lower is weak, this is due to ascending without descending, upper excess and lower deficiency, causing coldness in the waist and feet."

Push downward but not upward; push upward but not downward. Zhang Jingyue states: "When seeking in the Lower part, if the pulse is only visible in the Lower, while the Upper is deficient, this is due to descending without ascending, Clear Yang cannot reach the top, causing headache and neck pain." Note: In the *Jiayi Jing*, the phrases "Upward but not downward" and "Downward but not upward" are swapped compared to the main text, making them seem more parallel. However, if it is "downward but not upward," why would the waist and feet be cold if Qi/Pulse is in the lower? Furthermore, the first two sections of the classic speak inversely, while the latter two speak directly. One inverse, one direct, both capture the meaning. The main text should prevail. Commentary notes: Zhang Jingyue's annotations for these four sections are comprehensive; we follow him. Zhang Zhicong states: "'Tui' means detailed examination. Detailed examination of the bias of Qi pulse towards exterior/interior/up/down." This is also based on Zhang Jingyue's view.

Press to the bone, pulse Qi is scanty. Gao Shishi states: "If pressing to the bone yields no response to the finger, and pulse Qi is scanty, this is Yin excess and Yang deficiency. The generating Yang Qi cannot ascend upward. There should be lumbar/spinal pain and Bi syndrome in the body." This follows the discussion of diseases in up/down/out/in to explain that pulse diagnosis also has methods regarding exterior/interior/up/down. This answers the Emperor's question about diseases fluctuating between interior and exterior. Thus.