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The Five Zang organs are the guardians within. If the middle Jiao (Middle Burner) organs are filled with excess pathogens, and Qi is hyperactive damaging the Kidney's will (Fear), the voice will sound muffled as if speaking from inside a room; this indicates dampness obstructing the Middle Qi. If speech is faint and one can only speak again after a long time, this indicates depletion of Qi. If one does not dress or cover oneself properly, and speaks without distinguishing between good and bad or close and distant relatives, this indicates chaos of the Shen (Spirit). If the granaries (Stomach and Intestines) cannot store contents, it means the gates (pylorus and anus) have lost their control. If urine flows incessantly, it means the Bladder cannot store urine. Those who retain these functions live; those who lose them die.

The Five Zang organs are the strength of the body. The head is the mansion of clear Yang and spirit. If the head droops and eyes are sunken, the spirit is about to be depleted. The back is the mansion of the chest. If the back is curved and shoulders sag, the mansion of the chest is about to collapse. The waist is the mansion of the Kidneys. If turning and shaking is difficult, the Kidneys are about to fail. The knees are the mansion of the sinews. If flexion and extension are impossible, and walking requires bending over and leaning on something, the sinews are about to fail. The bones are the mansion of the marrow. If one cannot stand for long, and walking causes trembling, the bones are about to fail. Those who maintain strength live; those who lose strength die. (From *Su Wen: Treatise on the Essentials of Pulse Diagnosis*)

If in one exhalation the pulse beats four times or more, it is called death. If the pulse ceases and does not return, it is called death. If the pulse is intermittently slow and rapid, it is called death.

If a person lacks Stomach Qi, it is a reversal, and reversal leads to death. If the pulse follows Yin and Yang principles, the disease is easy to cure; if the pulse reverses Yin and Yang, the disease is hard to cure. If the pulse conforms to the four seasons, it is said that there are no other complications. If it reverses the four seasons, or involves transmission between non-adjacent organs (interfering with the generating cycle), it is said to be hard to cure.

If the pulse is thin in Spring and Summer, and floating and large in Autumn and Winter, it is called reversing the four seasons. If wind-heat presents with a quiet pulse, or diarrhea and blood loss present with a full pulse, the disease is internal. If the pulse is empty, the disease is external. Pulses that are choppy and firm are all difficult to treat; this is called reversing the four seasons. Water and grain are the root; therefore, if a person cuts off water and grain, they die. If the pulse lacks Stomach Qi, they also die. What is meant by lacking Stomach Qi is that only the True Zang pulse is seen, without the gentle Stomach Qi.

A normal Heart pulse comes continuously like linked pearls, smooth like touching jade; this is a peaceful Heart pulse. Summer relies on Stomach Qi as the root. When Lung and Heart pulses come, rapid and connected, but with a slight gentleness, this is a peaceful Lung pulse. Autumn relies on Stomach Qi as the root. A diseased Lung pulse comes neither up nor down, feeling like touching a chicken feather; this is Lung disease. A dying Lung pulse floats like an object on water, or scatters like hair blown by the wind; this is Lung death. A normal Liver pulse comes soft and continuous, like holding the tip of a long bamboo pole; this is a peaceful Liver pulse. Spring relies on Stomach Qi as the root. A diseased Liver pulse comes full, solid, and slippery, like touching a long pole; this is Liver disease. A dying Liver pulse comes urgent and strong, like a newly drawn bowstring; this is Liver death. A normal Spleen pulse comes harmonious and soft, distinct like a chicken stepping on the ground; this is a peaceful Spleen pulse. Late Summer relies on Stomach Qi as the root. A diseased Spleen pulse comes solid, full, and rapid, like a chicken lifting its foot; this is Spleen disease. A dying Spleen pulse is sharp and firm like a bird's beak, or claw, or like water leaking from a roof, or flowing away; this is Spleen death. A normal Kidney pulse comes rapid and continuous like a hook, firm upon pressure; this is a peaceful Kidney pulse. Winter relies on Stomach Qi as the root. A diseased Kidney pulse feels like pulling a vine, becoming firmer upon pressure; this is Kidney disease. A dying Kidney pulse feels like two people pulling a rope against each other, or like stones being flicked; this is Kidney death. (From *Su Wen: Treatise on the Phenomena of Normal People*)

When form and Qi are in harmony, it is called treatable. When complexion is bright and floating, it is called easily curable. When the pulse follows the four seasons, it is called treatable. When the pulse is weak and slippery, it indicates the presence of Stomach Qi, named easy to treat, and treatment should be timed appropriately. When form and Qi are discordant, it is called difficult to treat. When the color is dull and lacks luster, it is called difficult to cure. When the pulse is full and hard, it indicates worsening. When the pulse reverses the four seasons, it is untreatable. Reversing the four seasons refers to: Spring presenting with Lung pulse, Summer with Kidney pulse, Autumn with Heart pulse, Winter with Spleen pulse; if these pulses are suspended, extreme, deep, and choppy, it is named reversing the four seasons.

Five Excess conditions lead to death; Five Deficiency conditions lead to death. Full pulse, hot skin, abdominal distension, blockage of front and back (urination and defecation), and stifling dizziness constitute Five Excess. Thin pulse, cold skin, shortness of breath, leakage of front and back (incontinence), and inability to eat constitute Five Deficiency. If gruel enters the stomach and diarrhea stops, the deficient patient lives. If sweat appears and bowels/urine become free, the excess patient lives. (From *Su Wen: Treatise on the True Hidden Zang Pulses*)

Full form but thin pulse, with insufficient Qi to breathe, is critical. Thin form but large pulse, with excessive Qi in the chest, is fatal. Harmonious form and Qi indicate life; chaotic and uncoordinated form and Qi indicate disease. If all three parts and nine positions of the pulse are discordant, death ensues. If pulses above and below, left and right, respond to each other like pounding grain, the disease is severe; if they are discordant and uncountable, death ensues. If the central pulse alone is harmonious but discordant with the other viscera, death ensues. If the central pulse diminishes, death ensues. Sunken eyes indicate death. Emaciation with limbs still moving indicates death. Appearance of True Zang pulses indicates death.

If all nine positions of the pulse are deep, thin, and suspended/extreme, this is Yin ruling Winter, so death occurs at midnight. If the pulse is full, restless, panting, and rapid, this is Yang ruling Summer, so death occurs at noon.

Patients with cold-heat diseases die at dawn. Patients with heat-in-the-middle and heat diseases die at noon. Patients with wind diseases die at dusk. Patients with edema die at midnight. Those whose pulse is intermittently slow and rapid, or intermittent and fast, die during the transition periods of the four seasons (Chen, Xu, Chou, Wei hours). If flesh and muscle are already depleted, even if the nine positions are harmonious, death ensues. If the seven diagnostic signs appear but the nine positions follow the seasons, death does not ensue. Absence of pulse flow indicates death. Skin adhering tightly to bone indicates death.

Elevated pupils indicate insufficiency of the Taiyang channel. Fixed upward gaze indicates exhaustion of the Taiyang channel; this is key to determining life and death. (From *Su Wen: Treatise on Three Parts and Nine Positions*)

For infants with heat disease, if the pulse is suspended and small, warmth of hands and feet indicates life, coldness indicates death. For infants with wind-heat, wheezing, and shoulder breathing, if the pulse is full and large, slowness indicates life, urgency indicates death. For intestinal bleeding, fever indicates death, absence of fever indicates life. For passage of white foam from the rectum, deep pulse indicates life, floating pulse indicates death. For pus and blood from the intestines, suspended/extreme pulse indicates death, slippery and large pulse indicates life. For intestinal disorders, if there is no fever and the pulse is not suspended/extreme, slippery and large indicates life, suspended and choppy indicates death. (From *Su Wen: Treatise on Comprehensive Evaluation of Excess and Deficiency*)

Yang rises from the left, Yin descends from the right. For the elderly, disease proceeds from top to bottom; for the young, from bottom to top. Thus, following Yang in Spring and Summer leads to life, following Yin in Autumn and Winter leads to death; reversing this, following Autumn/Winter leads to death, following Spring/Summer leads to life. In Cold-Jue reaching the knees, the young die in Autumn/Winter, the elderly survive in Autumn/Winter.

Weak form and deficient Qi lead to death. Full form and Qi but deficient pulse Qi lead to death. Full pulse Qi but deficient form and Qi lead to survival. (From *Su Wen: Treatise on Fullness and Emptiness*)

Those who retain their guarding function live; those who lose it die. Those who possess Shen prosper; those who lose Shen perish. (From *Su Wen: Treatise on Basic Disease*)

In healthy people, Qi exceeding Form indicates longevity. In sick people, if flesh and muscle are depleted, Qi exceeding Form indicates death; Form exceeding Qi indicates danger. (From *Ling Shu: Treatise on Longevity and Shortness of Life*)

In heat disease lasting 7-8 days, if the pulse is minute, the patient urinates blood, and the mouth is dry, death occurs in one and a half days. If the pulse is Intermitting (Dai), death occurs in one day.

After heat disease has sweated, if the pulse remains restless, panting occurs, and fever returns, severe panting leads to death.

In heat disease lasting 7-8 days, if the pulse is not restless, or restless but not rapid, and sweating occurs within the next three days, but no sweating occurs after three days, death occurs on the fourth day.

If the patient with heat disease does not know where the pain is, is deaf, cannot control their limbs, has a dry mouth, extreme Yang heat, yet significant Yin cold, the heat is in the marrow; this is incurable and fatal.

If heat disease has sweated but the pulse remains full and restless, this is the extreme of Yin pulses, leading to death. If sweating results in a calm pulse, life ensues. If heat disease presents with full, restless pulse but no sweating, this is the extreme of Yang pulses, leading to death. If the full, restless pulse becomes calm after sweating, life ensues.

There are nine types of heat disease that should not be treated with acupuncture: 1. No sweat, red cheeks, and hiccups lead to death. 2. Diarrhea with full abdominal distension leads to death. 3. Blindness... [text missing] ...leads to death. 7. Coughing with epistaxis, no sweat, or sweat not reaching the feet leads to death. 8. Marrow heat leads to death. 9. Heat with spasms leads to death. This includes opisthotonos, convulsions, and lockjaw. All nine are untreatable by acupuncture. (From *Su Wen: Treatise on Heat Disease*)

Heat disease with calm pulse, which becomes full and restless after sweating, is the first reversal. Diarrhea with洪大 (Hong Da / Surging) pulse is the second reversal. Fixed Bi syndrome without migration, muscle wasting, fever, emaciation, and firm/pounding pulse is the fifth reversal.

One exhalation with two beats is Ping (Normal); three beats is Li Jing (Departing from the Channel); four beats is Duo Jing (Depleting Essence); five beats is Si (Death); six beats is Ming Jue (Life Extinction). These are Zhi (Rapid) pulses. One exhalation with one beat is Li Jing; two exhalations for one beat is Duo Jing; three exhalations for one beat is Si; four exhalations for one beat is Jue Ming (Extinction of Life). These are Sun (Damaged/Slow) pulses. Disease of Sun damage: First damage affects skin and hair, causing wrinkled skin and falling hair. Second damage affects blood vessels, causing deficiency unable to nourish the Zang-Fu. Third damage affects muscles, causing emaciation. Conversely, disease of Zhi pulses: Progressing from top to bottom, bone痿 (Wei / Atrophy) preventing getting out of bed leads to death. Progressing from bottom to top, wrinkled skin and falling hair leads to death. Palpating pulse: Two beats per inhalation/exhalation, neither large nor small, is Ping. Three beats per inhalation/exhalation indicates recent onset. Anterior large/posterior small causes headache and vertigo; anterior small/posterior large causes chest fullness and shortness of breath. Four beats per inhalation/exhalation indicates worsening; Hong Da pulse causes vexation and fullness; Chen Xi (Deep and Fine) pulse causes abdominal pain. Hua (Slippery) pulse indicates heat injury; Se (Choppy) pulse indicates mist/dampness injury. Five beats per inhalation/exhalation indicates fatigue; Chen Xi worsens at night, Fu Da (Floating and Large) worsens by day; neither large nor small is treatable despite fatigue; varying sizes are difficult to treat. Six beats per inhalation/exhalation is a Death Pulse; Chen Xi dies at night, Fu Da dies by day. One beat per inhalation/exhalation is named Sun; although the person can walk, they must lie in bed because Qi and Blood are insufficient. Two exhalations/inhalations for one beat is named Wu Hun (No Soul); such persons should die, though they may walk, they are called "walking corpses." Upper pulse present, lower absent, indicates vomiting; if no vomiting, death ensues. Upper absent, lower present, though difficult, poses no major threat because the Chi position is like tree roots; even if branches wither, roots regenerate. Pulse has roots, person has Yuan Qi, thus knowing they will not die.

Bian Que said: Sinew exhaustion is untreatable, death occurs in nine days. Signs include green-black fingernails/toenails, shouting and cursing incessantly.