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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The chest and abdomen are the outer enclosures of the zang-fu organs. Examining their locations and layers: the upper part of the chest belongs to the Lung; the area between the chest and sternum belongs to the Heart; below this lies a horizontal diaphragm, surrounding the ribs in a circle; below the diaphragm belongs to the Stomach; the large abdomen and umbilicus belong to the Spleen; the circumference around the umbilicus belongs to the Small Intestine; the two loins below the umbilicus belong to the Kidney; beside the two kidneys and below the umbilicus belongs to the Large Intestine; the Bladder is also located below the umbilicus, so the area below the umbilicus also belongs to the Bladder. The Blood Chamber (Xueshi, related to the uterus and menstrual function) is governed by the Liver. The Blood Chamber is larger than the Bladder, so the sides of the lower abdomen are called Shaofu (Lesser Abdomen), which is the margin of the Blood Chamber and belongs to the Liver. Shaofu connects upward to the hypochondrium (Jixie), which also belongs to the Liver; the hypochondrium connects upward to the ribs, which belong to the Gallbladder.

The chest and abdomen are traditionally divided into three sections (Ting): The upper section is named Chest, located above the diaphragm, where the Heart, Lung, and Pericardium reside; this is the Upper Jiao (Upper Burner). Below the diaphragm is the Stomach, curved horizontally like a bag; below the stomach are the Small and Large Intestines; on both sides are the Liver and Gallbladder on one side, and the Spleen on the other; this is the Middle Section, or Middle Jiao. Below the umbilicus is the Lower Section, containing the Bladder, Chong Mai (Penetrating Vessel), Ren Mai (Conception Vessel), rectum; males have external kidneys (testes), females have the uterus; this is the Lower Jiao.

Therefore, the chest and abdomen are the palaces of the five zang and six fu organs, and the source of yin-yang and qi-blood. If one wishes to know the condition of the zang-fu organs, there is no better method than palpating the chest and abdomen, known as abdominal diagnosis (Fuzhen). The diagnostic method involves massaging several times, with techniques varying from light to heavy, tapping or pressing, to observe the hardness or softness of the chest and abdomen, whether they reject pressure, and whether they are hot or cold, specifically if they burn upon touch, thereby determining the cold-heat and deficiency-excess nature of the disease. For example, using light hands to stroke from the upper chest to below the umbilicus allows one to perceive the moisture or dryness of the skin, distinguishing cold from heat. Using medium pressure to seek and feel, while asking about pain, helps detect the presence of pathogenic factors. Using heavy pressure to push and press, observing for hardness, and further asking about pain, helps distinguish the deficiency-excess of the zang-fu and the extent of pathological accumulation; this corresponds to the floating, middle, and deep pulse palpation methods. Among these, the Xu Li pulse (located at the left breast) and the Chong-Ren pulses (at the umbilicus) are most critical for life and death. Thus, beyond the four diagnostic methods of inspection, auscultation/olfaction, inquiry, and palpation, this method is added and promoted as the fourth essential key of diagnosis.

First, palpate the chest, diaphragm, and hypochondrium: Palpation revealing chest stuffiness indicates dampness obstructing qi mechanism or liver qi rebelling upward. Palpation causing chest pain indicates water-fluid retention in the qi level or lung qi obstructed upward. Palpation revealing qi stagnation in the diaphragm suggests either gallfire invading the pericardium or latent pathogens lodged in the membrane source. Palpation of the hypochondrium revealing distending pain suggests either phlegm-heat binding with qi or retained fluid clashing with qi. A protruding chest with panting upon palpation indicates Lung Distension. A protrusion between the diaphragms that is solid and hard upon palpation indicates Turtle Chest. In cases of liver disease, palpating both hypochondria is necessary: fullness and solidity with strength indicate normal liver qi; pain in the lower hypochondria radiating to the lower abdomen indicates liver depression; masses in the left hypochondrium in men indicate hernia; masses in the right hypochondrium in women indicate blood stasis; emptiness in both hypochondria with weakness upon palpation indicates liver deficiency; distending pain in both hypochondria intolerable to touch indicates liver abscess. However, in summer cases of Huoluan (cholera-like disorder) or Shazhang (sha-toxin swelling), there is often a mixture of water, food, and blood binding with pathogens in the chest and hypochondria. Water-binding in the chest causes pain on palpation and splashing sounds on pushing; food-binding causes fullness and pain on palpation and belching of rotten smells on rubbing; blood-binding causes pain intolerable to touch and occasional syncope. Although etiologies differ, the characteristics of binding pain and rejection of pressure are the same.

Next, palpate the entire abdomen: When Zhang Zhongjing refers to "Wei Jia" (Stomach family), he refers to the Upper and Middle Wan (epigastric regions). Palpation revealing stuffiness and hardness indicates Wei Jia Excess. Palpating the Middle Wan revealing stuffiness and hardness but producing splashing sounds when rubbed indicates Yin Pi (fluid retention). If the Upper, Middle, and Lower Wan are smooth and free of obstruction when stroked by fingers, it indicates a harmonious stomach without retained food. Generally, abdominal fullness/pain relieved by pressure indicates deficiency; rejected by pressure indicates excess; preferred with warm hands indicates cold; preferred with cold objects indicates heat. Abdominal heat burning upon touch that intensifies with pressing indicates latent heat; abdominal heat searing the hand with unbearable pain indicates internal abscess. Pain below the heart down to the umbilicus, hard and painful rejecting pressure, worsening with pressing, indicates food stagnation. Pain near the umbilicus in the lower abdomen with palpable masses indicates blood stasis. Abdominal pain radiating to both hypochondria, softening upon pressure, and relieved by vomiting water indicates water qi. Regarding intestinal parasites, there are three signs upon abdominal palpation: 1. Hard nodules like sinews that shift location when pressed firmly for a long time, moving unpredictably in the abdomen, umbilicus, or lower abdomen. 2. Gentle pressure for a longer period reveals a sensation of movement like earthworms wriggling under the fingers. 3. Uneven surface resembling fields; firm pressure reveals rising, falling, gathering, scattering, and moving up, down, floating, and sinking. Pain around the umbilicus with granular hardness indicates dry stool bound in the intestines, wanting to exit but unable. In edema and distension, pressing to the umbilicus causes it to move sideways; heavy pressing near the spine with loss of umbilical root support indicates certain death. This is the general method of chest and abdominal diagnosis.

However, when palpating the chest, one must first palpate the Xu Li point. (Located three cun below the left nipple, representing the Zong Qi [Pectoral Qi], corresponding to the apex of the left ventricle connecting to the aorta.) Weak pulsation unresponsive to touch indicates internal deficiency of Zong Qi; vigorous pulsation responding by moving the clothes indicates leakage of Zong Qi outward. Responsive pulsation that is not tight, slow, and urgent indicates Zong Qi accumulating in the Danzhong (Chest Center); this is normal. Pulsation that bounces off the finger, surging and forceful, or absent/unresponsive, indicates exhaustion of heart and stomach qi, making the disease untreatable. Absence of arterial pulsation at Xu Li indicates death. Even high pulsation at Xu Li is an ominous sign. It is strictly contraindicated in pregnancy and postpartum "Three Rushing" syndromes. In consumptive tuberculosis, daily increasing height of pulsation is strictly contraindicated. Only after sudden fright, running, anger, or strenuous exercise, where high pulsation returns to normal after a while, is it not contraindicated. In summary, Xu Li represents Zong Qi, corresponding to the six positions of the Cun Kou (Radial) pulse. High Xu Li pulse correlates with high Cun Kou pulse; knotted Xu Li pulse correlates with knotted Cun Kou pulse. When pulse diagnosis is unreliable, Xu Li palpation provides definite evidence. Although often indicating yin deficiency with fire hyperactivity or blood deficiency with wind stirring, even during yin exhaustion and yang collapse, there are three patterns upon palpation: Obtained superficially but not deeply indicates qi deficiency; Surging superficially but deficient/thin deeply indicates blood deficiency; Tangible with intermittent pulse (every 3-4 beats or 5-6 beats stopping) indicates accumulation/masses.

The key to abdominal palpation starts with the umbilicus. The dynamic qi at the umbilicus is the Chong-Ren pulse, located above, below, left, and right of the umbilicus. The *Neijing* states: Dynamic qi on the right prohibits sweating; sweating causes epistaxis, thirst, irritability, and vomiting upon drinking. Dynamic qi on the left prohibits sweating; sweating causes vertigo, continuous sweating, muscle twitching. Dynamic qi above prohibits sweating; sweating causes qi rushing upward to the heart center. Dynamic qi below prohibits sweating; sweating causes absence of sweat, severe cardiac irritability, bone-joint pain, vertigo, vomiting upon eating, and tongue stiffness. Furthermore: Dynamic qi on the right prohibits purgation; purgation depletes body fluids, causing dry throat/nose, vertigo, and palpitations. Dynamic qi on the left prohibits purgation; purgation causes abdominal cramping, inability to eat, exacerbated dynamic qi, curling up despite fever. Dynamic qi above prohibits purgation; purgation causes hot palms, floating sweat, desire for self-irrigation. Dynamic qi below prohibits purgation; purgation causes abdominal fullness, vertigo, undigested stool in feces, and epigastric stuffiness. Emesis is also prohibited, as it causes qi rebellion and syncope. Tonification is prohibited, as it causes qi rushing upward leading to vertigo and spasms. Therefore, the umbilicus is named Shenque (Spirit Pivot), the acupoint of spirit qi and root of preserving life.

When diagnosing umbilical arterial pulsation, place three fingers tightly on the right or left to palpate above, below, left, and right of the umbilicus. Harmonious, strong pulsation, two breaths per cycle, filling the umbilicus indicates sufficient kidney qi. Five to six breaths per cycle indicates latent heat in Chong-Ren pulses. Cold and empty palpation with deep/weak pulsation indicates Mingmen (Gate of Life) insufficiency. Hot/dry palpation with thin/rapid pulsation extending to Zhongwan indicates yin deficiency with qi rushing. Scattered pulsation, one breath per cycle, indicates exhaustion of primordial qi. No pulsation, feeling like fingers entering ash, indicates depletion of Chong-Ren pulses. This also distinguishes false cold/heat: If Chong-Ren pulsation is hot and burning, despite symptoms of chattering teeth, cold limbs, and diarrhea, it is true heat with false cold. If the sides of the abdomen feel hot, but prolonged palpation of Chong-Ren pulses reveals no heat/cold, despite red face, thirst, rapid pulse, and red tongue, it is true cold with false heat. In summary, Chong-Ren pulsation indicates latent heat injuring yin and yin deficiency with fire stirring. In healthy people, this leads to illness; in patients, it is difficult to treat. Those with chronic liver heat may have this without major harm. However, those with maternal qi stagnation contracting warm-heat with food stagnation will have intestinal accumulated heat. Heat abundance causes Chong-Ren pulsation: low pulsation indicates mild heat; high pulsation indicates severe heat. Combined with vigorous Xu Li pulsation indicates death. If accumulated heat gradually descends, Chong-Ren pulsation becomes faint, and stops after purgation, survival is likely. If Chong-Ren pulsation vibrates against the hand in chronic diarrhea/dysentery, it indicates yin exhaustion from excessive downward flow, and the disease is incurable.

[Commentary] Xu Li and Chong-Ren originate from the *Neijing*. The Canon states: The great collateral of the stomach is named Xu Li; vigorous pulsation moving the clothes indicates leakage of Zong Qi. Absence of arterial pulsation at Xu Li indicates death. It also states: Chong is the Sea of Blood and Street of Qi; its vessel originates in the lower abdomen within the Baozhong (uterus/womb), ascends flanking the umbilicus, runs alongside the Foot-Yangming Stomach channel, disperses in the chest, and ascends flanking the throat. Ren governs conception; its vessel originates in the lower abdomen below the Bao Shi (womb), emerges at Huiyin, ascends past the pubic hair, follows the center of the umbilicus to Danzhong, ascends through the throat, circles the lips, ending at Chengjiang below the lower lip, intersecting with the Du Mai. Li Zhirui stated: Food enters the stomach, juices turn red, ascend via Ying and Wei to the heart, distribute heavy juices to Chong Mai to form blood, and essence juices to Ren Mai to form essence. Chong is the main blood vessel of the body; Ren is the main essence vessel. Yu’s method of palpating the chest to diagnose Xu Li and the abdomen to diagnose Chong-Ren is more reliable than diagnuring Taixi and Duyang pulses. Thus, abdominal diagnosis is essential in clinical practice.