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All distension and fullness symptoms belong to the Earth element. The Wei (Micro) pulse represents Yin Earth, indicating deficiency of Earth function. When the Wei pulse appears at the Guan position (palpation site for Spleen/Stomach), it signifies Spleen Qi deficiency, leading to distension and fullness. One should refer to the section on the Wei pulse for further understanding.

When a Chen (Deep) pulse is present above the diaphragm accompanied by acid regurgitation, and the Se (Choppy) pulse is observed, it should be regarded as a deficiency syndrome; however, the Chen pulse must be interpreted as an excess syndrome.

The text previously stated "Chen pulse above the diaphragm with acid regurgitation," and later stated "Chen pulse must be viewed as excess." Does this not imply one pulse corresponding to two syndromes? It is unknown that the "Chen pulse above the diaphragm with acid regurgitation" mentioned earlier refers to retained food stagnation in the Stomach causing acid regurgitation. There is a fear that later practitioners might mistake a Chen pulse at the Guan position for Spleen deficiency and use tonifying formulas, thereby committing the error of "treating excess with tonification" (exacerbating the pathogen). Therefore, it is repeatedly emphasized: the Se pulse should be viewed as deficiency. Since Ying (Nutritive) Qi originates from the Middle Jiao, a Se pulse at the Guan position indicates insufficiency of Ying and Blood, thus appropriately termed deficiency. As for the Chen pulse, it should not be viewed as deficiency but as excess, and digestive-resolving formulas should be used to eliminate stagnation. Once the stagnation is removed, Yang Qi will naturally ascend, and the pulse will no longer be deep.

Heaviness in the lower body stems from the Ru (Soggy) pulse; Nuwei San can treat this urgently.

The Ru pulse indicates deficiency and exhaustion, a sign of insufficient Qi and Blood. The Guan position governs the Spleen and Stomach; seeing a Ru pulse here indicates decline of Yuan (Original) Qi and sinking of Zhong (Middle) Qi, resulting in a sensation of heaviness below the waist and difficulty walking. The formula Nuwei San is lost; its verification awaits future research. (The human body is like an egg; Spleen Qi is like the yolk, and Original Qi is like the white. Eggs boiled before the Qingming Festival have the yolk in the center because the clear Qi is sufficient. Eggs boiled after Qingming have the yolk shifted downward because the clear Qi is insufficient. The same applies to Middle Qi in the human body. If Middle Qi is sufficient, there is no deviation; if insufficient, it sinks and deviates.)

Water retention due to latent pathogens is relieved by the purgative action of Qianniu Tang.

Ying Qi originates from the Middle Jiao; when the Middle Jiao functions correctly, the pulse channels are open, and Qi and Blood flow smoothly. Now, a Fu (Hidden) pulse at the Guan position indicates that Earth is obscured by Water, blocking the pulse channels. As stated in the *Wu Chang Zheng Da Lun*: "The governance of the Zang organs is distributed, preventing them from being suppressed." Treatment should employ Qianniu Tang to thoroughly purge the Water, allowing the Spleen Earth to emerge naturally and the pulse channels to unblock. This corresponds to the statement in the *Yu Gong* chapter of the *Shangshu*: "The soils of Yun and Meng were made arable."

Regarding a Hua (Slippery) pulse in the Chi (Cunimal) position, it is certain that female menstruation is irregular. In men, this pulse indicates difficulty in resolving abdominal masses.

The Hua pulse indicates excessive stagnation. Irregular menstruation in women and difficult urination in men are both conditions of stagnation. According to the classics: "Chi pulse slippery indicates excess of Qi and Blood; women suffer from irregular menstruation, men from hematuria."

A Fu pulse in the Chi position indicates inability to digest grains.

Why does a Fu pulse in the Chi position relate to indigestion? Generally, food entering the Stomach fails to transform and remains in the Middle Jiao, obstructing Ying and Wei Qi. Wei Qi originates from the Lower Jiao; if it cannot circulate freely, the Wood Qi of the Jueyin channel fails to ascend, causing the Chi pulse to become hidden. Treatment should involve inducing vomiting to expel pathogens and raising Qi, allowing Jueyin Qi to ascend so the Chi pulse may reappear. Refer to the section on Fu pulses in the Chi position under the Eight Pulse categories for more details.

A Wei pulse indicates abdominal pain without sweat.

The Wei pulse indicates Yang deficiency and Yin excess. A Wei pulse in the Chi position means Yin pathology presenting with Yin pulses. All Yin pulses indicate Cold; hence, the classics state: "Chi pulse Wei indicates cold extremities, spasmodic pain in the lower abdomen with Cold."

A Ruo (Weak) pulse in the Chi position relates to Heat accumulation in the Stomach rising upward.

Why does a Ruo pulse in the Chi position relate to Stomach Heat rising? Generally, excess above leads to deficiency below; Heat accumulates at the Stomach opening, causing the Chi pulse to appear weak.

A Chi (Slow) pulse indicates Cold in the Lower Jiao.

All Chi pulses indicate Cold. The Chi position is used to inspect the Lower Jiao; a Chi pulse here indicates Cold in the Lower Jiao.

Cold Stomach with retching is indicated by a Se pulse.

The human body is like a steamer; the Stomach is the upper vessel (Zeng), the Spleen is the pot (Fu), and the Mingmen (Gate of Life) in the Lower Jiao is the firewood beneath. If Mingmen Fire is vigorous, it steams the Spleen Earth, facilitating digestion in the Stomach. Moreover, the Kidney is the gate of the Stomach. A Se pulse in the Chi position indicates insufficiency of Essence and Blood and decline of True Fire, failing to steam the Spleen Earth and rot/ripen food. Thus, Cold Stomach leads to retching. This aligns with Wang Tai Pu's saying: "Food eaten long ago comes back up; this is because the Stomach lacks Fire."

Abdominal distension and Yin hernias are indicated by Xian (Wiry) and Lao (Firm) pulses.

The classics state: "Chi pulse Xian and small indicates abdominal pain and cramping in the legs; Jianzhong Tang is suitable, and Qihai acupoint should be needled with reducing method." Also: "Chi pulse Lao indicates abdominal fullness and urgency in the genital region; Tinglizi Zhuyu Wan is suitable, and Dantian, Guanyuan, and Zhongji acupoints should be needled." These acupoints (Qihai, Dantian, Guanyuan, Zhongji) all belong to the Ren Mai (Conception Vessel). The Ren Mai treats seven types of hernias in men and masses/leukorrhea in women. However, since hernias have various types, why attribute them solely to the Ren Mai? The Ren Mai is the root of hernia diseases, while other meridians are branches. A Xian and Lao pulse in the Chi position, characterized by strength and immobility, indicates stagnation of Foot Jueyin Qi, leading to abdominal distension and Yin hernias. Luo Qianfu said: "In Yin syndromes, the Foot Jueyin meridian circles the genitals and reaches the lower abdomen. Pain due to Kidney deficiency and depletion of Cold Water should be treated by draining pathogens and tonifying the Liver with Jili Tang."

A Jin (Tight) pulse indicates pain in the abdomen.

All Jin pulses indicate Cold. When seen in the Chi position, it indicates Cold in the Lower Jiao, as stated in the classics: "Chi pulse Jin indicates pain below the umbilicus."

A Chen pulse indicates disease in the waist.

The waist is the mansion of the Kidneys. A bilateral Chen pulse in the Chi position, representing Yin Water and lack of mutual interaction between Fire and Water, indicates disease in the waist. See the section on Chen pulses in the Chi position under the Eight Pulse categories.

Ru, Shu, Fu, and Kou pulses all indicate red and scanty urination. Carefully examining such signs, where can they escape?

Ru combined with Shu (Rapid) indicates Fire within Yin. Fire within Yin causes red and scanty urination; cool-tonifying herbs should be used to nourish Yin. Fu combined with Kou (Hollow) indicates Fire within Yang. Fire within Yang also causes red and scanty urination; cold-purging formulas should be used to drain Fire. However, note that Ru-Shu and Fu-Kou are paired pulse combinations, not four separate types.

If asking about pregnancy in women, a continuous pulse in the Chi position is the true sign of fetal pulse.

Women are primarily governed by the Chi pulse. "Continuous" means smooth and flowing circulation. As stated in the *Neijing*: "When Yin pulses beat distinctly different from Yang, it signifies pregnancy." This means the Chi pulse beats vigorously under the fingers, distinct from the pulses at the Cun and Guan positions.

Hong (Full) pulse in Taiyin suggests a female fetus; Da (Large) pulse in Taiyang suggests a male fetus.

This refers to the Right Cun and Guan pulses being Chen and Hong, while the Left Cun and Chi pulses are Hong and Da. Women are Yin, and their path favors the Right side; Taiyin (Lung/Spleen) resides in the Right Cun/Guan. Taiyin is Zang, best felt in the Chen depth. Diagnosing Right Lung/Spleen pulses as Chen and Hong indicates a female fetus. Men are Yang, and their path favors the Left; Taiyang (Small Intestine/Bladder) resides on the Left. Taiyang is Fu, best felt in the Fu depth. Diagnosing Left Small Intestine/Bladder pulses as Hong and Da indicates a male fetus.

If both sides show Hong pulses, twins may be expected; this method is as accurate as divine inspiration. Gestational age is determined by specific positions. For instance, movement in Zhongchong indicates approaching three months.

In pregnant women, except for the Heart and Small Intestine (Heart is the Monarch, Small Intestine is its envoy), other organs nourish the fetus monthly: Month 1 Liver, Month 2 Gallbladder, Month 3 Pericardium, Month 4 Sanjiao, Month 5 Spleen, Month 6 Stomach, Month 7 Lung, Month 8 Large Intestine, Month 9 Kidney, Month 10 Bladder. After ten months, birth occurs. Ten days constitute a xun (decade); nine xun equals three months. Zhongchong is the Jing-Well point of the Pericardium; thus, its pulse moves at three months. (Zhongchong is located on the medial tip of the middle finger.)

To determine if a patient is near death, one must carefully observe pauses in the pulse.

A healthy person's pulse beats twice per exhalation and twice per inhalation, totaling five beats including occasional deep sighs, circulating endlessly. Fifty beats without pause represent the number of Great Expansion, indicating all five Zang organs receive Qi. If there is a pause mid-beat, it indicates one Zang organ lacks Qi, and the time of death can be predicted based on that organ.

Danshi (Stone-Tapping) pulse sounds crisp and rapid; Jielsuo (Unbound Cord) pulse is scattered and disorganized.

"Danshi" should be read with a level tone, not a departing tone. Danshi pulse feels like tapping on stone, crisp and hard. Misreading it as "projectile" loses the meaning of crispness. Jielsuo pulse resembles a rotten rope, untied and disordered. Interpreting it as "untying knots" is incorrect. The *Neijing* states: "Coming like striking stone, going like an unbound cord—death." Also: "The dying Kidney pulse comes like pulling a cord, crisp like striking stone—Kidney death." (Note: Danshi implies rapidity; Jielsuo implies scattered disorder.)

Quezhuo (Sparrow-Pecking) pulse comes abruptly then stops; Wulou (House-Leak) pulse nearly ceases then restarts.

Sparrows peck continuously, occasionally looking back fearing capture. Similarly, abnormal pulses come rapidly with intermittent pauses, resembling sparrow pecking. Also described as very rapid with sudden stops. Wulou pulse comes, stops, and rarely restarts, disconnected. The classics state: "Dying Spleen pulse is sharp and firm, like a bird pecking, like a bird's claw, like a leaking roof, like flowing water—Spleen death."

Xiayou (Shrimp-Traveling) pulse rises faintly, hard to trace.

The rhyme says: "Shrimp travel resembles frog swimming, soul departs, corpse worries." Xiayou pulse rises faintly; upon close inspection, the pulse location is lost, then reappears slowly and vanishes quickly, indicating slow arrival and fast departure.

According to the classics: "Patients with confused pulses, like shrimp swimming or fish gliding, die." Commentary notes: "Xiayou rises faintly, retreats, disappears, reappears slowly, vanishes quickly." Yuxiang (Fish-Swimming) pulse resembles a fish not moving forward but wagging its tail and head, swaying and lingering.

Yuyue (Fish-Leaping) pulse is clear, hesitating with tail wagging.

Yuyue is synonymous with Yuxiang. Hesitating tail-wagging means the head is still while the tail shakes, a sudden jerk. Another rhyme says: "Tail wags, head doesn't move; Yuxiang indicates Kidney exhaustion is imminent." Xiayou refers to vertical movement (hidden/reappearing); Yuxiang refers to horizontal movement (jerking).

Alas! Encountering these signs, recovery is impossible. Even with pills and elixirs, it is fate.

There are cases of severe lethargy and weak voice. Although Cun and Guan pulses are absent, the Chi pulse remains uninterrupted, with regular breath rhythm, and the pulse at the ankle does not cease. Such cases need not fear death. The classics record: "A tree without leaves but with roots survives; a person in such distress, though near death, may still be treated."

"Lethargic" refers to mental cloudiness; "weak" refers to shortness of breath. Although Cun/Guan pulses are absent, the Chi pulse continues, breath is regular, and the Taixi artery (on the posterior medial malleolus) flows smoothly. Like branches withering but roots remaining, there is still potential for regeneration. Why fear death? *Nanjing* Chapter 8 asks: "Why does death occur when Cun Kou pulse is normal?" The answer: "All twelve meridians connect to the Source of Vital Qi, known as the Root of the Twelve Meridians, or the Moving Qi between the Kidneys. This is the root of the six Fu and five Zang organs, the foundation of the twelve meridians, the gate of respiration, and the source of Sanjiao, also called the 'God guarding against pathogens.' Qi is the root of life. If the root perishes, branches wither. If Cun Kou pulse is normal but death occurs, it is because Qi alone is severed internally." The *Mai Fu* states that even if branches are gone, if the root remains, there is hope. *Nanjing* states that if the root is destroyed, even if branches remain, there is no hope. Viewing them together enhances understanding.

According to the *Mai Jing*: "If there is pulse above but none below, and the patient should vomit but cannot, death ensues. If there is no pulse above but pulse below, although distressed, there is no suffering." This is because, like feet for humans or roots for trees, even if branches wither, death does not follow unless the root rots.