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The Earth element, receiving the harmonious Qi of Heaven and Earth, nourishes all things and governs the four seasons; correspondingly, the human Stomach aligns with it. In a healthy individual, Qi is derived from grain. Once grain enters the Stomach, the Five Zang and Six Fu organs all receive its Qi. Thus, the Stomach is the root of the Zang and Fu organs. This Stomach Qi (Wei Qi) is essentially the normal Qi of a healthy person and cannot be absent for even a day; its absence constitutes a reversal (Ni), which leads to death.

Regarding the manifestation of Stomach Qi in the pulse, as stated in *Su Wen: Yu Ji Zhen Zang Lun*: "A pulse that is weak and slippery indicates the presence of Stomach Qi." The *Zhong Shi Pian* states: "When pathogenic Qi arrives, the pulse is tight and rapid; when Grain Qi (Gu Qi) arrives, the pulse is slow and harmonious." These both refer to Stomach Qi. Therefore, each season has its own seasonal pulse and seasonal diseases. However, since Earth irrigates the four directions, despite various pathological manifestations, one must rely on Stomach Qi as the mechanism for survival. For instance, in Spring, Wood Qi is prosperous, and the pulse should be Wiry (Xian). It should be slightly wiry but not excessive, indicating the harmonious nature of Spring's Stomach Qi. If the pulse is excessively wiry, it signifies the excess of Liver Pathogen (Gan Xie) and the decline of Stomach Qi, revealing Liver disease. If the pulse is merely wiry and urgent, completely lacking harmony, it means the Stomach Qi of Spring is exhausted, and the True Organ Pulse (Zhen Zang Mai) of the Liver appears, indicating a critical condition. The Hook (Gou/Autumn), Hair (Mao/Winter), and Stone (Shi/Winter) pulses follow this same principle. By observing the abundance or absence of Stomach Qi, the severity and prognosis of the disease become clear. Cai Shi said: "A pulse that is neither large nor small, neither long nor short, neither slippery nor choppy, neither rapid nor slow, feeling moderate upon touch, with a spirit of vitality, leisurely and graceful, difficult to describe in words, is the Stomach Qi pulse." Li Dongyuan said: "In pathological pulses, one must seek the 'Shen' (Spirit). A pulse rate of six beats per respiration or extremely rapid indicates Heat. If there is strength within the pulse, there is Shen. Treatment should vent the Heat. A pulse rate of three beats per respiration or failing indicates Cold. If there is strength within the pulse, there is Shen. Treatment should dispel the Cold. If the pulse is both extremely rapid and failing, and lacks strength, there is no Shen. To hastily vent heat or dispel cold would leave the Shen without foundation! Thus, the Classics state: 'The pulse is the precursor of Qi and Blood; Qi and Blood are the Shen of humanity.'" According to Wang Zongzheng's method of pulse diagnosis, the Heart and Lung pulses are superficial (Fu), the Liver and Kidney pulses are deep (Chen), and the Spleen pulse is in the middle region (Zhong Zhou). Even adhering to Wang's theory, we can understand that Li Dongyuan's reference to "strength in the middle" refers to the Central Wu-Ji Earth, located at the Middle Modality (Zhong Hou). As long as Stomach Qi has not dissipated, even if the pulse is extremely rapid or extremely slow/failing, recovery is still possible. Thus, Li Dongyuan's concept of "having Shen" is equivalent to the *Nei Jing*'s concept of "having Stomach Qi".

Three beats per respiration constitute a Slow (Chi) pulse, which indicates Cold; six beats per respiration constitute a Rapid (Shu) pulse, which indicates Heat.
If the pulse beats only three times during one respiration cycle, it is Slow and deficient. Slow pulses indicate Cold diseases. If the pulse beats six times during one respiration cycle, it is Rapid and excessive. Rapid pulses indicate Heat diseases. If the pulse beats only twice, or even once, per respiration, it becomes increasingly Slow and Cold. If it beats seven times, or even eight or nine times, it becomes increasingly Rapid and Hot. Any pulse beating once or twice, or eight or nine times, per respiration is a Death Pulse.

Once Slow and Rapid are clarified, Superficial and Deep must be distinguished.
Slow indicates Cold, and Rapid indicates Heat; this is a fixed principle. To determine the location of Cold and Heat, one must distinguish between Superficial (Fu) and Deep (Chen) pulses.

Using Superficial, Deep, Slow, and Rapid to differentiate Internal and External Causes.
There are two types of causes, which must be distinguished as internal and external.
External causes originate from Heaven (Nature); Internal causes originate from Humans (Emotions).
External contraction of the Six Evils (Liu Yin) arises from Heaven. Internal injury of the Seven Emotions (Qi Qing) arises from Humans.
Heaven has Yin and Yang, wind, rain, darkness, and brightness; Humans have joy, anger, worry, thought, grief, fear, and shock.
Yi He in *Zuo Zhuan* stated: "Excess Yin induces Cold diseases, Excess Yang induces Heat diseases, Excess Wind induces diseases of the extremities, Excess Rain induces abdominal diseases, Excess Darkness induces confused diseases, Excess Brightness induces Heart diseases." "Yin" here refers to excessive deviation that persists. Excess Yin leads to excessive coldness, preventing Yang Qi from governing, resulting in Cold diseases such as Jue Ni (reversal of cold in limbs) and chills inside and out. Excess Yang leads to excessive heat, preventing Yin Qi from governing, resulting in Heat diseases such as mania, delirium, thirst, bleeding, and hematemesis. Excess Wind leads to excessive movement, causing diseases in the extremities, such as limb paralysis, hair loss, dizziness, and convulsions. Excess Rain leads to excessive dampness, causing diseases in the intestines and abdomen, such as abdominal distension, swelling, borborygmus, and loose stools. Excess Darkness leads to excessive gloom, suppressing sunlight internally, causing confused diseases like Bai He Bing (Lily Disease) and Hu Huo Bing, and dryness in the Zang organs. Excess Brightness leads to excessive exposure, scattering sunlight externally, causing Heart diseases like mental confusion, palpitations, and loss of spirit. The Seven Emotions are Joy, Anger, Worry, Thought, Grief, Fear, and Shock, also known as the Seven Qi. Joy relaxes Qi, Anger raises Qi, Worry scatters Qi, Thought knots Qi, Grief consumes Qi, Fear sinks Qi, and Shock scatters Qi. Joy relaxes Qi because joy harmonizes Qi and unblocks Ying and Wei, thus relaxing Qi. Anger raises Qi because anger causes Qi to rebel; severely, it causes vomiting blood and food, thus raising Qi. Worry scatters Qi because worry causes depression and unresolved stagnation, thus scattering Qi. Thought knots Qi because thought fixes the mind and body, causing Qi to stagnate and not move, thus knotting Qi. Grief consumes Qi because grief tightens the Heart connection and lifts the Lung leaves, blocking the Upper Jiao, preventing Ying and Wei from dispersing, thus consuming Qi. Fear sinks Qi because fear causes Essence to retreat; retreating Essence blocks the Upper Jiao, causing Qi to return; returning Qi causes distension in the Lower Jiao, thus sinking Qi. Shock causes the Heart to have no support, the Shen to have no return, and thoughts to have no stability, thus scattering Qi.

The elderly and weak differ; wind and soil vary; having understood the ultimate principle, one must value flexibility.
The decline and vigor of the elderly and weak change with time. The rigidity and softness of local customs change with geography. For example, the elderly and weak should have Slow and Weak pulses; if overly vigorous, it is pathological. The young and strong should have Full pulses; if overly weak, it is pathological. In the extreme East, where all seasons resemble Spring, the climate is warm and harmonious, and people's pulses are often Slow. In the extreme South, where all seasons resemble Summer, the climate is hot and steaming, and people's pulses are often Soft. In the extreme West, where all seasons resemble Autumn, the climate is clear and austere, and people's pulses are often Firm. In the extreme North, where all seasons resemble Winter, the climate is biting cold, and people's pulses are often Stone-like. However, there are nuances. An elderly person with a vigorous and restless pulse has thick congenital endowment and is a long-lived elder, called a Longevity Pulse; if the pulse is restless and rapid with exterior but no interior, it is Lone Yang, and death is near. A strong person with a fine, harmonious, and slow pulse, equal in all three positions, has a quiet congenital endowment and is an elegant scholar, called a Yin Pulse; if the pulse is fine, small, firm, and unequal front-to-back, can it last long? Southeastern lowlands are damp, with Soft and Slow pulses; living in high peaks, the pulse resembles that of the Northwest. Northwestern highlands are dry, with Firm pulses; living in marshes, the pulse resembles that of the Southeast. Southerners with Northern pulses take Qi that is necessarily rigid. Northerners with Southern pulses take Qi that is necessarily soft. Eastern and Western pulses are uneven and can be analyzed by analogy. Furthermore, those who live long have thick congenital endowment, so when examining symptoms, even if the disease is terminal, the pulse may not cease. Those who die young have thin congenital endowment, so when examining symptoms, the pulse may cease before the disease does. How can one be rigid? *Zuo Zhuan* says: "Where soil is rich and water deep, residence does not lead to illness." *Huainanzi* says: "People in hard soil are rigid; people in soft soil are fat; people in Lu soil (black earth) are tall; people in sandy soil are thin; people in fertile soil are beautiful; people in barren soil are ugly. Mountain Qi produces more males; Marsh Qi produces more females; Water Qi causes aphonia; Wind Qi causes deafness; Forest Qi causes strangury; Wood Qi causes kyphosis; Damp Qi causes edema; Stone Qi gives strength; Yin Qi causes goiter; Summer Qi causes premature death; Cold Qi promotes longevity; Valley Qi causes Bi syndrome; Hill Qi causes madness; Wild Qi causes benevolence; Mound Qi causes greed. Light soil makes people agile; Heavy soil makes people sluggish; Clear water produces small sounds; Turbid water produces loud sounds; Swift water makes people light; Slow water makes people heavy; Central soil produces sages." All these are established theories. However, in one place, people may differ in beauty, ugliness, longevity, and early death. Although life stems from the Qi of water and soil, the bias, completeness, thickness, and thinness vary individually.