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(Original) Previously, this syndrome was not seen; now it has changed, which is called "Zai Guai" (Disaster and Wonder). Another question asked: What is the reason for this vomiting and diarrhea? The answer is: Perhaps there was medication taken in the past, which is now taking effect, hence it is named "Zai Guai".
Cheng Wuji's Commentary: When a physician matches pulse and symptoms with a prescription but encounters unexpected variations, it is considered strange and wondrous, thus termed "Zai Guai". From the depth of three beans to six beans down to the pulse of Zai Guai, there are five sections in total, all pertaining to the methods of consulting physicians.

(Original) Question: What does the liver pulse of the East look like? Master said: The Liver is Wood, named Jueyin. Its pulse is slightly wiry, soft, weak, and long. This is the liver pulse. If a patient with liver disease naturally presents with a soft and weak pulse, they will recover.
Cheng Wuji's Commentary: *Nan Jing* states: The spring pulse is wiry because the Liver belongs to the East and Wood. When all things begin to grow, they have not yet developed branches and leaves, so the pulse comes in as soft, weak, and long; therefore, it is called wiry. This is the normal pulse of the Liver. If a patient with liver disease presents with this pulse, it indicates that the Liver Qi has harmonized.

(Original) Suppose one obtains a purely wiry pulse, death ensues. How do we know this? Because the pulse is straight like a string, indicating injury to the Liver organ, hence we know death will occur.
Cheng Wuji's Commentary: A purely wiry pulse refers to a pulse that is straight like a string without flexibility. This indicates the absence of Stomach Qi and represents the True Visceral Pulse. *Nei Jing* states: The dying liver pulse arrives urgently and forcefully, like a newly drawn bowstring.

(Original) Question: What does the heart pulse of the South look like? Master said: The Heart is Fire, named Shaoyin. Its pulse is surging, large, and long. This is the heart pulse. If a patient with heart disease naturally presents with a surging and large pulse, they will recover.
Cheng Wuji's Commentary: The Heart governs Summer. In Summer, Yang Qi prevails externally, causing Qi and Blood to surge and overflow; thus, the pulse arrives surging, large, and long.

(Original) Suppose the pulse arrives slightly and departs largely; this is called "Fan" (Reverse), and the disease is in the interior. If the pulse head is small and the root is large, this is called "Fu" (Cover), and the disease is in the exterior. If the upper part is slight and the head small, sweating occurs. If the lower part is slight and the root large, it is "Guan Ge" (Obstruction and Rejection), leading to inability to urinate. If the head has no sweat, it is treatable; if the head has sweat, death ensues.
Cheng Wuji's Commentary: A heart pulse arriving vigorously and departing weakly is a normal pulse. Arriving weakly and departing largely is "Fan," indicating interior disease. *Nei Jing* states: Large indicates pathogenic Qi, small indicates peace, slight indicates healthy Qi deficiency, and large indicates pathogenic abundance. Observing the "arrival" assesses the exterior; a slight arrival indicates exterior harmony. Observing the "departure" assesses the interior; a large departure indicates interior disease. *Nei Jing* states: If the heart pulse does not arrive strongly but departs strongly, this is "Bu Ji" (Insufficiency), and the disease is in the center. "Head small, root large" means anterior small and posterior large. Small represents healthy Qi, large represents pathogenic Qi. Since pathogenic Qi was initially in the interior and now returns to the exterior, it is called "Fu." The text mentions only "arrival" to indicate the disease is in the exterior. *Mai Jing* states: Upper is exterior, lower is interior. Sweat is the fluid of the Heart. An upper slight pulse, felt lightly as slight, and a small head (anterior small) indicate deficiency of Qi in the exterior, hence governing sweating. A lower slight pulse, felt heavily as slight, and a large root (posterior large) indicate heaviness in the interior, where large signifies disease progression. *Nei Jing* states: The Heart is a Yang Zang, and the Small Intestine is its envoy. Now, pathogenic Qi is severe and moves downward, obstructing the Small Intestine, preventing the smooth flow of healthy Qi, hence the inability to urinate, termed "Guan Ge." *Mai Jing* states: When Yang Qi floats upward, sweat appears on the head. Now, with Guan Ge blocking healthy Qi, plus sweating on the head, it indicates Yang Qi cannot descend and instead escapes upward. If there is no sweat, although suffering from Guan Ge, Yang Qi has not yet declined, and it is still treatable.

(Original) Question: What does the lung pulse of the West look like? Master said: The Lung is Metal, named Taiyin. Its pulse is floating like hair. If a patient with lung disease naturally presents with this pulse, or a slow and delayed pulse, they will recover. If they present with a rapid pulse, the condition will worsen. How do we know? Rapid is associated with the South and Fire. Fire overcomes Metal in the West. According to the method, this should lead to carbuncles and be difficult to treat.
Cheng Wuji's Commentary: Light, void, and floating is called "Mao" (Hair), which is the normal pulse of the Lung. Slow and delayed is the pulse of the Spleen. As the Mother of the Lung, through the mutual generation of mother and child, recovery is indicated. Rapid is the pulse of the Heart. Fire overcoming Metal constitutes "Gui Zei" (Ghost Thief) punishment, hence the worsening. The Lung governs skin and hair. Rapid indicates heat. Heat lodging in the skin and remaining causes carbuncles and ulcers. The classic states: If a rapid pulse occurs intermittently, malignant sores will arise.

(Original) Question: Why is it said that obtaining a Mao-Floating pulse in the second month predicts death by autumn? Master said: In the second month, the pulse should be soft and weak. Obtaining a Mao-Floating pulse instead indicates death by autumn. In the second month, the Liver is active. The Liver pulse belongs to Wood and should be soft and weak. Obtaining a Mao-Floating pulse instead indicates the Lung pulse. The Lung belongs to Metal, and Metal overcomes Wood; hence, death by autumn is predicted. Other cases follow this pattern.
Cheng Wuji's Commentary: Seeing an Autumn pulse during Spring indicates Metal Qi coming to overcome Wood. The Lung (Metal) overcomes the Liver (Wood), seizing the vigorous pulse. By Autumn, when the Lung is prosperous and Liver Qi exhausted, death occurs. Other scenarios follow this logic.

(Original) Master said: For obese people, the pulse should be deep; for thin people, the pulse should be deep [Note: Text says 'shen' twice, likely error in source or context implies shallow/floating for thin]. Obese people should have a deep pulse; now it is floating. Thin people should have a floating pulse; now it is deep. Therefore, we investigate this anomaly.
Cheng Wuji's Commentary: Obese individuals have thick skin and flesh, so their pulse should be deep. Thin individuals have thin skin, so their pulse should be floating. Now, the obese person's pulse is unexpectedly floating, and the thin person's pulse is unexpectedly deep. There must be pathogenic interference causing this abnormality, so the cause must be investigated.

(Original) Master said: If the Cun pulse does not reach the Guan position downwards, it is Yang Extinction. If the Chi pulse does not reach the Guan position upwards, it is Yin Extinction. Both are untreatable and certain death. If calculating the remaining lifespan and time of death, it is determined by the monthly solar terms overcoming each other.
Cheng Wuji's Commentary: *Mai Jing* states: Yang originates at Cun and moves at Chi; Yin originates at Chi and moves at Cun. If the Cun pulse does not extend down to Guan, Yang is extinct and cannot resonate with Chi. If the Chi pulse does not extend up to Guan, Yin is extinct and cannot resonate with Cun. *Nei Jing* states: When Yin and Yang separate, Essence and Qi perish. Here, Yin and Yang are partially extinct, hence certain death. The timing of death is calculated based on the overcoming relationship of monthly solar terms. For example, Yang Extinction leads to death in Spring/Summer, and Yin Extinction in Autumn/Winter.

(Original) Master said: When the pulse fits the disease but the body does not show signs of illness, it is called "Xing Shi" (Walking Corpse) due to the lack of vigorous Qi. Sudden dizziness, collapse, and unconsciousness indicate short life and death. When the body shows disease but the pulse does not, it is called "Nei Xu" (Internal Deficiency) because there is "Gu Shen" (Grain Spirit). Although distressed, there is no suffering.
Cheng Wuji's Commentary: The pulse is the root of human life. When the pulse contradicts the disease state (pulse normal while patient is critical), the internal root is severed. Although the form may temporarily appear strong, sudden Qi depletion leads to dizziness, collapse, and death—hence "Walking Corpse." When a person is ill but the pulse remains normal, the internal root is solid. Though the form is emaciated, it is merely internal deficiency. "Gu Shen" refers to Grain Qi. Once Grain Qi is sufficient, one is naturally at peace. *Nei Jing* states: Excess Form/Qi with deficient Pulse Qi leads to death; excess Pulse Qi with deficient Form Qi leads to survival.

(Original) Question: What is meant by "Xi Yan Chen" being called "Hua" (Slippery)? Answer: Chen (Deep) is Pure Yin, Xi (Surface/Closing) is Correct Yang. The harmony of Yin and Yang creates the Slippery pulse. The Guan and Chi positions are naturally balanced. If the Yangming pulse is slightly deep, food and drink are manageable. If the Shaoyin pulse is slightly slippery, "Hua" is the floating name of "Jin" (Tight). This is Yin Solidity. The person will surely have sweat inside the thighs and dampness below the yin.
Cheng Wuji's Commentary: A pulse that is large and vigorous, gathering and deepening, is called "Xi Yan Chen," resembling rolling pearls. Deep represents Visceral Qi, hence Pure Yin. Xi represents Fu Qi, hence Correct Yang. Slipperiness indicates Yin and Yang Qi do not overpower each other. Guan and Chi are balanced. A slightly deep Yangming pulse suggests Yin predominance in the Yang region, meaning Yang insufficiency. In the Stomach (Yangming), excessive Yin allows for normal appetite. A slightly slippery Shaoyin pulse suggests Yang predominance in the Yin region, meaning Yin insufficiency. Yang approaching Yin is called "Yin Shi" (Yin Solidity). The thigh and yin area belong to Shaoyin. Now, Yang-Heat approaches Yin, steaming fluids outward, causing thigh sweating and genital dampness.

Xu Shuzhong's Commentary: Deep is Pure Yin, Xi is Correct Yang; their harmony makes it Slippery. Ancients described the Slippery pulse as flowing smoothly back and forth, similar to a Rapid pulse. However, Zhang Zhongjing's three words suffice. "Xi Yan Chen" best describes "Hua." "Xi" means combining; "Yan" means suddenly. When Qi gathers and becomes vigorous, it suddenly sinks away—this is Slippery. Zhang Zhongjing feared people would mistake Slippery for Deep, so he added: "Hua is the floating name of Jin." Saying Deep and Floating seems different but is the same; wisdom is required. Looking at "Jin is like turning cords unpredictably," we know this "Floating" is unpredictable, not the light-touch constant floating. This "Deep" is the Xi-Yan Deep, not the heavy-touch fixed Deep. Zhang's wording is precise like a historian's brush; do not read carelessly. Zhao Sizhen said: "Modern people fail to read it as Qin-Han texts; this is truly reading Zhongjing well."

(Original) Question: I have been challenged by others: Where does the Tight pulse come from? Master said: Suppose there is loss of sweat or vomiting due to Cold in the Lung interior, causing a Tight pulse. Suppose coughing results from drinking cold water, causing a Tight pulse. Suppose diarrhea results from deficiency-cold in the Stomach, causing a Tight pulse.
Yang relaxes, Yin contracts and tightens; Yin transforms into Cold, contracting Qi and Blood firmly, making the pulse urgent. How can it not be urgent? The Classic states: The Tight pulse carries Rapidness, like cutting a rope, or like turning cords unpredictably. Thus, Cold presents with Tightness.
Cun Kou Wei Qi Excess is named "Gao" (High).
"Cun Kou" refers to the whole pulse area. "Gao" means the pulse arrives floating and forceful. Wei Qi governs the exterior; floating pulse assesses it. Its nature is upper. Now, floating and middle-layer palpation show forcefulness, indicating Wei Qi excess. Being upper, it is called High, implying rising without descending.
Ying Qi Excess is named "Zhang" (Manifest/Clear).
Zhang means clear and orderly. Coming and going distinctly with order. The current Slippery pulse as a diagnosis of Blood Excess is close to this.
Gao and Zhang interacting is named "Gang" (Net/Ridgepole).
Gang means summary. Since both Ying and Wei are excess, it is called Summary.
Wei Qi Weakness is named ... (Text missing character, likely 'Ruo' or similar).
Lifting reveals soft, weak, and vague qualities, hence named ...
Ying Qi Weakness is named "Bei" (Low/Humble).
Ying governs Blood and is Yin; pressing assesses it. The pulse is deep and powerless, hence named Bei.
Bei interacting is named "Sun" (Damage/Loss).
Bei interaction means both Yin and Yang are deficient, collectively called Sun. Lifting and pressing are both powerless.
Wei Qi Harmony is named "Huan" (Slow/Relaxed).
Huan is the Stomach pulse; Stomach combines with Wei Qi. Wei Qi harmony shows Huan pulse.
Ying Qi Harmony is named "Chi" (Delayed/Slow).
Chi is the Spleen pulse; Spleen combines with Ying Qi. Ying Qi harmony shows Chi pulse.
Huan and Chi interacting is named "Qiang" (Strong).
Since Ying and Wei are both harmonious, Huan and Chi interact; is this not Strong?
Cun Kou pulse is Huan and Chi. Chi means Yang Qi grows. Complexion is fresh, face radiant, voice sounds like Shang, hair grows long. Chi means Yin Qi prospers, marrow generates, blood fills, muscles become tight, thin, fresh, and hard. Yin and Yang embrace, Ying and Wei move together, Hard and Soft interact, named "Qiang" (Strong).
This explains the previous sentence. This is a Normal Pulse, not a Disease Pulse.

Cheng Wuji's Commentary: Tight pulse carries Rapidness, like cutting a rope, or like turning cords unpredictably. Thus, Cold presents with Tightness.
Wei Qi Excess at Cun Kou is named "Gao." "Gao" refers to the pulse arriving floating and forceful. Wei Qi governs the exterior; floating pulse assesses it. Its location is upper. Now, floating and middle palpation are forceful, indicating Wei Qi excess. Being upper, it is called High, implying rising without descending.
Ying Qi Excess is named "Zhang." Zhang means clear and orderly. Coming and going distinctly with order. The current Slippery pulse as a diagnosis of Blood Excess is close to this.
Gao and Zhang interacting is named "Gang." Gang means summary. Since both Ying and Wei are excess, it is called Summary.
Wei Qi Weakness is named ... (Text missing). Lifting reveals soft, weak, and vague qualities, hence named ...
Ying Qi Weakness is named "Bei." Ying governs Blood and is Yin; pressing assesses it. The pulse is deep and powerless, hence named Bei.
Bei interacting is named "Sun." Bei interaction means both Yin and Yang are deficient, collectively called Sun. Lifting and pressing are both powerless.
Wei Qi Harmony is named "Huan." Huan is the Stomach pulse; Stomach combines with Wei Qi. Wei Qi harmony shows Huan pulse.
Ying Qi Harmony is named "Chi." Chi is the Spleen pulse; Spleen combines with Ying Qi. Ying Qi harmony shows Chi pulse.
Huan and Chi interacting is named "Qiang." Since Ying and Wei are both harmonious, Huan and Chi interact; is this not Strong?
Cun Kou pulse is Huan and Chi. Chi means Yang Qi grows. Complexion is fresh, face radiant, voice sounds like Shang, hair grows long. Chi means Yin Qi prospers, marrow generates, blood fills, muscles become tight, thin, fresh, and hard. Yin and Yang embrace, Ying and Wei move together, Hard and Soft interact, named "Qiang."
This explains the previous sentence. This is a Normal Pulse, not a Disease Pulse.