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If the Gu Shen (Spleen-Stomach Qi, the foundation of acquired constitution) fails to transport and transform, the death forms of the Five Elements will manifest according to their respective Zang organs. The time of death can be calculated and determined by days.

The pulse of Heart Qi exhaustion resembles holding a leather belt with a hook, or turning beans—short, solid, rigid, restless, and rapid—with danger within one day.
The *Suwen: Pingren Qixiang Lun* states: "When the dying Heart pulse arrives, it is curved at the beginning and rigid at the end, like holding a leather belt with a hook; this is called Heart death." By "curved at the beginning," it means that upon light palpation, it feels hard and unyielding rather than soft; by "rigid at the end," it means that upon heavy palpation, it feels firm and immobile. It is like holding the hook part of a leather belt, completely losing the harmonious and gentle Qi. Having only the Hook aspect without Stomach Qi is why it is called Heart death. The "turning bean" pulse refers to what is described in the *Suwen: Yuji Zhenzang Lun* as "resembling touching Coicis Semen (Job's tears), linked continuously," describing its short, solid, and rigid nature, which is the True Zang pulse. It further states: "Heart Qi exhaustion leads to death in one day." And: "Condition worsens on Ren days, death occurs on Gui days. Death happens during Hai or Zi hours because Water overcomes Fire."

The pulse of Liver Qi exhaustion feels like sliding along a blade—sharp and urgent; or like a newly strung bowstring—tight and taut, leading to death in eight days.
The *Suwen: Yuji Zhenzang Lun* states: "The true Liver pulse arrives, urgent inside and out, like sliding along a knife edge." The *Suwen: Pingren Qixiang Lun* states: "The pulse arrives urgently and becomes even more forceful, like a newly strung bowstring; this is called Liver death." It further states: "Liver Qi exhaustion leads to death in eight days." And: "Condition worsens on Geng days, death occurs on Xin days. Death happens during Shen or You hours because Metal overcomes Wood."

The pulse of Spleen Qi exhaustion resembles the pecking of a sparrow, or the dripping of a leaking roof; it is also like flowing water, or an overturned cup pouring out.
The *Suwen: Pingren Qixiang Lun* states: "The dying Spleen pulse arrives, sharp and hard like a crow's beak, like a leaking roof, or like flowing water." This means the pulse pauses and then returns, like a crow pecking, describing its hardness. Or it beats once after a long interval, like a leaking roof, describing the inability of the pulse qi to connect continuously. As for flowing water or an overturned cup, this indicates that Jing-Qi has already escaped, going forth without returning, tipping over without support; how can life be sustained? It further states: "Spleen Qi exhaustion leads to death in four days." And: "Condition worsens on Jia days, death occurs on Yi days. Death happens during Yin or Mao hours because Wood overcomes Earth."

What does Lung Qi exhaustion look like? It is like wind blowing feathers—scattered and rootless; or like feathers piercing the skin—floating and weak, leading to wailing death in three days.
The *Suwen: Pingren Qixiang Lun* states: "The dying Lung pulse arrives like wind blowing feathers; this is called Lung death." The *Suwen: Yuji Zhenzang Lun* states: "The true Lung pulse arrives like feathers piercing human skin." Both describe its scattered and disordered nature, having only the Feather aspect without Stomach Qi. It further states: "Lung Qi exhaustion leads to death in three days." And: "Condition worsens on Bing days, death occurs on Ding days. Death happens during Wu or Wei hours because Fire overcomes Metal."

What does Kidney Qi exhaustion look like? The pulse is like two people struggling for a rope—tense and strong; or like stones being struck—hard and rigid, leading to onset of death in four days.
The *Suwen: Pingren Qixiang Lun* states: "The dying Kidney pulse arrives like two people struggling for a rope, sounding like striking stones; this is called Kidney death." When ropes struggle against each other, their tension must be extreme; when striking stones, their hardness must be extreme. It further states: "Kidney Qi exhaustion leads to death in four days." And: "Condition worsens on Wu days, death occurs on Ji days. Death happens during Chen, Xu, Chou, or Wei hours because Earth overcomes Water."

When the Life Pulse is about to exhaust, it resembles a fish gliding—seemingly present yet absent; or a shrimp swimming—a sudden leap amidst stillness; it is like a gushing spring, uncontrollable and irretrievable.
Upon floating palpation, it suddenly sinks, akin to a fish gliding where presence seems uncertain; upon sinking palpation, it suddenly floats, akin to a shrimp leaping amidst stillness; the form resembles a gushing spring, floating and rapid above the muscles, violating the natural tendency of water to flow downward; if Shen (Spirit) is about to escape, what reliance allows survival? Generally speaking, if this pulse appears in the Heart region, it shows curvature at the start and rigidity at the end, lacking all softness and smoothness, resembling restless turning beans; thus, the Stomach Qi pulse described as "linked like pearls, like sliding along agate" is absent. If it appears in the Liver region, it is strong, tense, and string-like, cutting into the finger upon pressure, like sliding along a blade; thus, the Stomach Qi pulse described as "soft, weak, light, void, smooth, straight, and long" is absent. If it appears in the Spleen region, it is hard, sharp, and continuous like sparrow pecks, beating once after a long delay, fluctuating between rapid and slow, like a leaking roof, departing without return, like flowing water, stopping without rising, like an overturned cup; thus, the Stomach Qi pulse described as "harmonious and soft, separated like a chicken stepping on ground" is absent. If it appears in the Lung region, the upper part is faint and the lower part severed, rootless and desolate; thus, the Stomach Qi pulse described as "gentle and slight, like falling elm seeds" is absent. If it appears in the Kidney region, it disperses and departs, wanting to store but having nowhere to enter, leaving like untying a rope, arriving like striking stones, with all stored essence expelled, arriving like striking stones; thus, the Stomach Qi pulse described as "panting and linked like a hook, firm upon pressure" is absent. In the Mingmen, Right Kidney, and Left Kidney, it is similar, but containing Ministerial Fire, so upon exhaustion, there is a sudden leap amidst stillness, like a shrimp swimming or a fish gliding, representing the image of fire about to extinguish but flaring up momentarily. In the Bladder, it floods and cannot contain itself, like a gushing spring, because it stores body fluids and serves as the Officer of the Capital; hence its exhausted form is such. Essentially, the harmony and appropriateness of the pulse are due to the accompanying Stomach Qi. If Stomach Qi is diminished, disease has already formed; how much more so if it is absent? Then the root of generation is first cut off, and how can the Five Zang organs endure? By observing complexion and symptoms to decide, the principle should not fail. Seeing the True Zang pulse allows for determining the short-term prognosis of death. However, the *Suwen: Yuji Zhenzang Lun* states: "When acute deficiency evil strikes suddenly, the Five Zang organs close, the pulse channels do not communicate, Qi does not go back and forth, resembling falling into drowning; one cannot predict based on standard timeframes. If the pulse ceases completely, or if a person breathes five to six times per respiration, and the flesh has not wasted away, even if the True Zang pulse is not seen, it is still death." From this, we know that acute illnesses may lead to death without showing True Zang pulses; how can one be bound by fixed days and times!

According to the *Nanjing: Fifteenth Difficulty*, the normal and dying pulses recorded differ from those in this text in some aspects. For example, "gentle and slight, like sliding along elm leaves" is considered a Spring normal pulse; "like a chicken lifting its feet" is a Summer pathological pulse; "abundant like a chariot canopy, becoming larger upon pressure" is an Autumn normal pulse; "feeling desolate upon pressure, like wind blowing feathers" is an Autumn dying pulse; "large above, narrow below, moist and smooth like a sparrow pecking" is a Winter normal pulse; "pecking continuously, slightly curved in the middle" is a Winter pathological pulse; "arriving like untying a rope, departing like striking stones" is a Winter dying pulse; these all differ from this text. As for pulses like "pulling vines," "struggling for a rope," "crow's beak," "bird's claw," "soft and swaying like holding the tip of a long bamboo pole," and "panting and linked like a hook while firm," these are not recorded in the *Nanjing*. The meaning of the *Nanjing* originally comes from this treatise, yet differs thus; it is likely that errors exist.

Physicians examining pulses aim to determine life and death. They ponder repeatedly, striving for precision. They search extensively and collect widely, calming their Qi and focusing their spirit. Mastering the technique brings benefit to future generations. Encourage yourselves, colleagues, to achieve success together. Read diligently and think deeply, as if meeting ancient masters.
Human life is of utmost importance; therefore, a physician must be entrusted only to those benevolent and loving, employed only by those intelligent, and trusted only by those honest and good. Ancient physicians had to understand the Heavenly Dao above, mastering the principles of change, stagnation, and recovery in the Five Movements and Six Qi without exception; they examined the human body in the middle, understanding the fourteen meridians, the profound depths of the internal Five Zang and Six Fu organs, and the connections of the external limbs and bones without omission; they understood physical laws below, comprehending the natures and flavors of insects and plants without hindrance. Upon diagnosis, they cleared desires, maintaining emptiness, brightness, and vitality, penetrating subtleties and reaching obscurities, not missing details. Their intelligence could explain complex matters thoroughly, and their virtue practiced benevolence and universal love. Yet they dared not rest on their laurels, carefully observing and thinking deeply, striving for balance, never presumptuous even in haste. Students who sincerely seek improvement will master skills like catching cicadas or wielding axes, entering the halls of Qi Bo and Huang Di (Traditional Chinese Medicine). Let us encourage each other's aspirations to achieve great success.