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The so-called "Water Qi" (Shui Qi, pathogenic water energy) does not necessarily refer to visible fluid accumulation. It may result from external contraction of Wind-Cold (Feng Han), internal injury from diet, or emotional disturbances (Seven Emotions: Joy, Anger, Worry, Thought, Sorrow, Fear, Fright), leading to imbalance in the deficiency and excess of Zang-Fu Qi, causing mutual overacting or insulting among organs; all these constitute Water Qi. All five Zang organs can suffer from Cold invasion, but invasion into the Heart is the most urgent, as discussed by ancient physicians. There are also cases where Spleen Yang is insufficient, and Cold is excessive in the Lower Jiao, naturally causing Heart Qi to sink and Kidney Qi to ascend and overwhelm the Heart. This is unrelated to external Wind-Cold invasion; it belongs to Internal Deficiency patterns, with a slower onset but a deeper root. Additionally, consuming cold food and indigestible substances, combined with sedentary behavior, can obstruct Middle Jiao Qi, damaging Spleen Yang, thereby causing Water-Drink to overflow above the Diaphragm. Consequently, Heart Qi cannot ascend, leading to sudden severe palpitations, anxiety and restlessness (Zheng Chong), epigastric discomfort, violent vomiting, internal rise of Yin-Cold, frequent and involuntary urination and defecation, coma, and loss of consciousness. Or, one may inexplicably feel desolate and unhappy, or suddenly experience chest tightness and breathlessness, feeling desperate and helpless, crying out for help, accompanied by profuse sweating, headache as if splitting. These are manifestations of Heart Fire failing to flourish and being suppressed by Water pathogens. The *Nei Jing* states: "Violating the Qi of Summer leads to Malaria in Autumn, with severe illness at Winter Solstice," which implies that Heart Deficiency fears Water. Xu Shi's interpretation of *Mang Yan* (Oyster Malaria) in the *Jin Gui Yao Lue* aligns with this view. The *Mai Jing* records: "Pulses tremble in the three positions, each different; contracting disease in Mid-Summer leads to death when peach blossoms fall." This indicates Heart Qi injury; when the time comes for Heart Qi to flourish in the following year, there is a fear of inability to overcome the deficit due to lack of support. Generally, Wind carrying Cold invading from outside has fierce and rapid Qi; Dampness carrying Cold attacking from below has deep and sharp Qi. Shi Zaizhi once stated: "For diseases where Cold-Water attacks the Heart, even if cured, longevity is not guaranteed." This is a major disease in human life that urgently requires clarification. If pulse diagnosis reveals trembling pulses that are weak upon pressure, and the patient appears pale and listless, it is an ominous sign. The contents described by Shi are listed below item by item:

When Water Evil attacks Heart Qi, use Cinnamon Twig Decoction (Guizhi Tang) and Ginger (Jiang) to strengthen Heart Qi to overcome it. If the patient speaks deliriously, has fever, bone and joint pain, red face, eyes protruding as if pulled out, and head feeling as if detached, and the Heart Pulse is firm and long, they should suffer from tongue retraction and inability to speak. Whenever a pulse trembles, it is due to pathogenic invasion; when Ghost Qi (severe pathogen) overwhelms healthy Qi, trembling occurs. Trembling of the Heart Pulse is caused by Kidney Evil invading. Tongue retraction and inability to speak occur because the tongue corresponds to the Heart, and the root of the tongue is where the Shaoyin Meridian distributes. The treatment method involves not only cooling the Heart but also warming and moving the Kidney. (Here, "cooling" is interpreted as "draining"; draining means attacking.)

If the Heart Pulse is large and slippery, and the Kidney Pulse is deep, since sweat is the fluid of the Heart, a large and slippery Heart Pulse indicates Water invasion causing movement, thus resulting in sweating. (This is because Heart Qi was previously restrained by Cold-Water and gradually penetrated through heavy Yin, hence the pulse moves with strength. Shi Zaizhi had a discussion on Kidney Cold causing asthma: "Six pulses are heavy, turbid, and革 (ge-like/restrained), as if controlled by something; this indicates excessive Kidney Cold." The phrase "as if controlled by something" vividly describes the spirit of the Trembling Pulse.)

A Heart Pulse that is trembling, slippery, and rapid indicates Heart Hernia (Xin Shan); a small, rapid pulse without full beating indicates Mass Accumulation (Jia). Therefore, it is said that if the Heart Pulse is found to be urgent, the disease is named Heart Hernia, and there should be tangible signs in the lower abdomen. This is due to Heart Qi deficiency and Blood invasion by Cold Evil. (Whenever pulses are slippery and trembling, it is due to the stagnation and knotting of Body Fluids.)

If Yuan Qi is weak, Kidney Qi is insufficient, Bladder Qi is deficient, and the Chong and Ren meridians are empty, men may suffer from Hernia, and women from urinary retention. The pulse presents as all six positions trembling, fine, rapid, and lightly wiry; the Kidney pulse beats slightly and is deep; the Bladder pulse is choppy and short. (These two sections describe long-standing knotting of Cold-Dampness, gradually suppressing Heart Qi.)

If Yuan Qi is exhausted, and Kidney Water is extremely cold, chills and shaking fever may occur, with spontaneous cold sweat, and the six pulses become minute, fine, and deep.

When Cold Evil invades the Heart, the Kidney pulse must beat and be deep, with severe unrest and palpitation in the epigastrium, potentially leading to collapse. One should first warm the Kidney and then protect the Heart. (This is a case of sudden attack due to Heart Qi deficiency. The *Nei Jing* states: "Pulse is rapid and firm, accumulated Qi is in the middle, occasionally hindering eating; this is called Heart Bi (Obstruction). Acquired from external illness and mental worry leading to Heart Deficiency, so pathogens follow." Thus, those who overwork their minds have depleted Heart Fire, making them susceptible to Water invasion.)

When Dampness and Cold prevail and jointly invade the Heart, Heart Qi fails to ascend, resulting in urinary obstruction.

When Kidney Water prevails and overwhelms the Heart, the classics state: "Heart Qi fails to ascend, pain remains between the eyebrows and vertex, extending to the chest in severe cases, causing headache and pain in the Naohu region." Warm the Kidney.

When Cold Evil invades the Heart, internal changes occur in Qi and Blood, damaging the Middle Jiao, leading to downward discharge of dysentery with blood and mucus. This disease is rare in the world, representing extreme damage to the human body. Symptoms include high fever like fire, pain in the head and body, complexion resembling purple grass, secretions resembling glue or tea dregs. Without urgent treatment, death follows swiftly. While toxic dysentery harms people in various ways, Water Evil attacking the Heart is the most severe. When a person initially suffers from dysentery, starting with chills, fever, and headache, it indicates Cold Evil attacking the Heart. (This specifically analyzes dysentery, referring to the so-called 'diarrhea/dysentery with body heat'.)

The aforementioned syndromes vary in speed and severity, with pulses ranging from minute to wiry-tight or large-trembling-slippery. Generally, if the pathogen is shallow, invading the area of Heart Qi circulation and affecting the Heart internally, initially the pathogen is in the Qi level, presenting a wiry-slippery pulse; after a long time, if the pathogen enters the Blood level, the pulse becomes fine and tight. If a major pathogen directly strikes the Heart's primary meridian and invades the Zang internally, attacking due to Heart Deficiency, the pulse is often fine and choppy; if Heart Qi is strong and forcefully resists, the pulse is often large, trembling, and slippery. The detailed listing of syndromes omits "sadness and unhappiness"; sadness and unhappiness belong to mild pathogens of Cold and Dryness.