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Injury. The Qi of Geng Metal and Xin Metal are both exhausted. What the current rhyme says, "when floating and slippery pulses combine," indicates that a floating pulse signifies Wind, and a slippery pulse signifies Phlegm. When Wind and Phlegm attack upwards, obstructing the airway, removing the Wind and Phlegm will naturally calm the rebellious Qi. If the pulse is fine and minute (Wei Xi), it means the Yuan Yang Qi is depleted below, and rootless Qi rebels above; saving such a case would be difficult.

Malignant Qi invasion causing abdominal distension: a tight and fine pulse indicates survival; if a floating and large pulse appears, life is in imminent danger.
Chao Yuanfang stated: Malignant Qi invasion occurs when a person's spirit is weak and is suddenly attacked by demonic or ghostly Qi. When Yin and Yang are harmonious, Ying and Wei (Nutritive and Defensive Qi) are balanced, and the Spirit remains guarded, the body is strong, and pathogenic factors cannot invade healthy Qi. However, if care is neglected leading to spiritual weakness, one may be struck by toxic Qi from ghosts or poisons. The symptoms include sudden stabbing pain in the heart and abdomen, severe confusion resembling death. In cases of sudden malignant Qi invasion with abdominal distension and fullness, if the pulse is tight, large, and floating, the prognosis is poor (death); if it is tight, fine, and minute, the prognosis is good (survival). Additionally, in malignant Qi invasion with several shengs of hematemesis, a deep, rapid, and fine pulse indicates poor prognosis (death), while a floating, large, and rapid pulse indicates good prognosis (survival). *Mai Jing* states: In sudden malignant Qi invasion with several shengs of hematemesis, a deep, rapid, and fine pulse indicates poor prognosis (death), while a floating, large, and rapid pulse indicates good prognosis (survival). It also states: In sudden malignant Qi invasion with abdominal distension and fullness of the four limbs, a large and slow pulse indicates survival; a tight, large, and floating pulse indicates death; a tight, fine, and minute pulse also indicates survival. My commentary suggests that malignant Qi invasion involves Yin pathogenic Qi. The interior belongs to Yin, and Blood belongs to Yin; the pathogen enters the interior first and damages Blood, following the principle of like attracting like. Thus, the classics state: In malignant Qi invasion with several shengs of hematemesis, a deep, rapid, and fine pulse indicates poor prognosis (death). Having received demonic toxic Qi, once Yin Blood is damaged, the pathogen should exit through the orifices. However, if the pulse is instead deep, fine, and rapid, it indicates that Yin is severely damaged (deep and fine) and the toxin remains inside (rapid), hence the prognosis is poor (death). If the pulse is floating, large, and rapid, it indicates the pathogen has exited and no residue remains internally, hence the prognosis is good (survival). The classics further state: In sudden malignant Qi invasion with abdominal distension and fullness of the four limbs, a large and slow pulse indicates survival; a tight, large, and floating pulse indicates death; a tight, fine, and minute pulse also indicates survival. This aligns perfectly with this rhyme. When malignant Qi invasion leads to abdominal distension, the pathogen is already in the interior. If the pulse is tight and fine, the toxin is not severe, hence survival. If the pulse is floating and large, it damages both Yin and Yang, leading to imminent danger. One might ask: The text previously stated that a floating, large, and rapid pulse indicates survival, but later said a tight, large, and floating pulse indicates death. Why the contradiction? The former refers to hematemesis where toxic vapors exit via orifices, so a floating, large, and rapid pulse is appropriate. The latter refers to abdominal distension and limb fullness where the toxin is internal; here, a tight, large, and floating pulse indicates damage to both Yin and Yang (death), whereas a tight, fine, and minute pulse indicates Yin and Yang are not severely compromised (survival).

Metal wounds with excessive bleeding: a void and fine pulse indicates survival; an urgent, rapid, large, and numerous pulse endangers life.
In cases of metal wounds, one must assess whether blood loss is excessive. If blood loss is not excessive, the pulse need not necessarily be void and fine. Zhang Shixian stated: Metal wounds are injuries caused by blades. "Excessive blood" refers to significant blood loss. After significant blood loss, the pulse should be void and fine. If it instead becomes urgent, rapid, large, and numerous, it indicates Wind-Heat invading due to deficiency, endangering the body.
According to the classics: In metal wounds with excessive bleeding, a void and fine pulse indicates survival, while a solid, rapid, and large pulse indicates death. Also: In metal wound bleeding, a deep and small pulse indicates survival, while a floating and large pulse indicates death. Also: For chop wounds losing one or two shengs of blood, a large pulse predicts death within twenty days. Also: For combined chop and stab wounds with continuous bleeding, death occurs within seven days; however, a slippery and fine pulse indicates survival. I further note that metal wounds are critical. Consider two people fighting, one cutting their own throat; life hangs in the balance. Saving them brings great merit. There are many formulas for metal wounds, but few guarantee complete safety. Quack doctors, lacking guidance, often apply live chicken skin, which is ineffective. I later obtained a formula that proved effective repeatedly: applying the medicine stops pain and bleeding immediately. It is a miraculous formula using common, easy-to-make ingredients. For example, if someone cuts their throat severing the windpipe, suture it with silk thread, apply the powder, wrap with soft silk, and they can recover after a few applications. I dare not hoard this heavenly treasure and share it with colleagues. The formula uses six liang of raw Pine Resin powder and four liang of raw Pinellia Rhizome powder, ground together again for use. Minor metal wounds need not be discussed.

When the Cun and Chi pulses are tight and numerous, resembling a straight hairpin, and vomiting increases. This Gu Poison requires urgent rescue; seeking divine medicine may stop death.
The character "Gu" consists of "insect" and "vessel," referring to collecting insects and snakes in a vessel to let them devour each other until only one survives, named Gu. It transforms into poison to harm humans. Those who practice Gu use it to harm others, often through food or drink. Victims suffer heart pain as if struck, sometimes with clear-yellow complexion changes. The poison first affects the upper Jiao, causing hematemesis, then consumes the five Zang organs, resulting in dark, clotted lower blood resembling rotten chicken liver. Without urgent treatment, consumption of all Zang organs leads to death. Diagnosis shows tight and numerous pulses at Cun and Chi positions. In the morning, before eating, have the patient spit into well water. If the saliva sinks straight down like a pillar, it is Gu Poison; if it scatters and does not sink, it is Grass Poison. Treatments include Decayed Drum Bark, Pomegranate Bark, Bitter Bottle Gourd Rind, Coriander Root, Axle Grease, Tribulus Fruit Skin, Tree Peony Root, Coriander Seed, Earthworms, etc., prescribed according to the formula. Some may survive. Zhang Shixian interpreted "hairpin straight" as resembling a turning cord, indicating Liver Qi excess; "vomiting increases" indicates Spleen Qi decline. Wood excess leads to Spleen extinction, ensuring death. This interpretation is likely incorrect.
The classics state: If the three positions' pulses are firm and numerous, like a silver hairpin, Gu Poison is fatal; if numerous and soft, Gu Poison allows survival.

Poisoning with a洪大 (Surging-Large) pulse indicates survival; a fine and minute pulse indicates peril. Unstoppable hematemesis means life cannot return, recovery is impossible.
Xiong Zongli incorrectly linked this verse to the previous one. The first four lines discuss Gu Poison; these four lines discuss poisoning from food or herbs. The meaning is: In general poisoning, if the pulse is Surging-Large, the patient's Yuan Qi can still overcome the toxin, indicating survival. If deep and fine, Yuan Qi cannot overcome the toxin, indicating peril. If hematemesis is unstoppable, regardless of whether the pulse is Surging-Large or deep/fine, the prognosis is death. Why? The Heart is the Sovereign, governing Blood vessels. If poisoned but without visible blood, the toxin is in the Stomach and Intestines, relatively mild, resolvable via vomiting or purging. If hematemesis is unstoppable, the toxin directly attacks the Heart Sovereign, ensuring death. Dai Shi claimed that for other conditions involving blood loss, a deep/fine pulse indicates survival, but for poisoned hematemesis, a Surging-Large pulse indicates survival; this is a significant error. (Note: The classics state: For poisoning by various medicines, a floating, choppy, and rapid pulse indicates survival; a fine and minute pulse indicates death; a Surging-Large and slow pulse indicates survival.)