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The Master said: When a patient's pulse is floating at the anterior part of the Guan position (the anterior part of the Guan is considered Yang), the disease is in the Exterior. When the pulse is floating at the posterior part of the Guan position (the posterior part of the Guan is considered Yin), the disease is in the Interior. (However, although the posterior Guan belongs to the Interior region, a floating pulse is not the typical pulse for an Interior syndrome; it merely indicates that the Exterior pathogen has affected the Interior, rather than being a true Interior condition. Therefore, the disease is not located in the abdomen or hypogastrium, but manifests as) lower back pain, stiffness of the back, (and inability to walk due to) knee and calf issues. (If physical injury persists untreated, it will inevitably affect Qi. In cases where the pulse floats at the posterior Guan, one can infer that there will inevitably be shortness of breath, reaching the extreme of these symptoms.)

The floating pulse originally indicates the Exterior. Here, distinguishing between Exterior and Interior within the floating pulse aims to make practitioners understand the variations of the floating pulse. By extension, the deep pulse originally indicates the Interior, yet one can also distinguish between Exterior and Interior within the deep pulse; the slow pulse originally indicates Cold, and the rapid pulse originally indicates Heat, so it is equally valid to distinguish between Cold and Heat within slow and rapid pulses. This is also a matter of inferring three aspects from observing one corner (using induction).

Question: The classics state, "Jue Yang travels alone." What does this mean? The Master said: (When Yin and Yang move together, it is smooth/harmonious.) This refers to having Yang without Yin, hence called Jue Yang. ("Jue" means rebellion/reversal. Yin and Yang moving independently implies reversal and lack of harmony.)

This dialogue on Jue Yang serves to illustrate that Yin and Yang cannot be neglected. The *Neijing* states: "When Yin is peaceful and Yang is firm, spirit thrives; when Yin and Yang separate, spirit perishes." The Way of Yin and Yang is truly great! You Zaijing stated: "In Jue Yang traveling alone, it refers to solitary Yang Qi rebelling and ascending. When Yang loses its Yin constraint, it scatters outward, just as a man without a wife may become dissolute." The *Qianjin Fang* states: "When Yin pulses relax, blood scatters and flow obstructs; Zheng Yang rebels, and Yin fails to follow. This is the essence of Jue Yang traveling alone."

Question: (The Cun pulse of both hands) represents the locations of the Heart and Lung. It does not appear floating, but rather deep, large, and slippery. A deep pulse indicates Blood excess (meaning excess of Blood). A slippery pulse indicates Qi excess (meaning excess of Qi). When Excess (of Blood) and Qi (excess) contend with each other, if Blood and Qi enter the Zang organs, death ensues; if they enter the Fu organs, recovery occurs. This is named sudden syncope (Zuì Jué) (distinguishing life and death based on Zang and Fu). What does this mean? The Master said: (Zang organs are like treasuries, implying deep storage; once excess pathogens enter, they cannot exit. Thus,) bluish lips and cold body indicate entry into the Zang organs, leading to death. (Fu organs are like external offices, originally responsible for intake and discharge; excess pathogens can enter and exit.) If the body is warm and sweat occurs spontaneously, it indicates entry into the Fu organs, leading to recovery.

This passage discusses life and death outcomes when pathogens are excessive (Excess syndromes). You Zaijing stated: "Excess refers to Blood excess, and Qi refers to Qi excess. When Excess and Qi contend, Blood and Qi gather together in an excess state. The Five Zang organs store essence and do not drain; if Blood and Qi enter, they suddenly cannot return. Spirit departs, mechanisms cease, resulting in death with bluish lips and cold body. The Six Fu organs transmit transformations and do not store; if Blood and Qi enter, they fill and empty intermittently. When Qi returns and Blood flows, the body becomes warm and sweating occurs, leading to recovery." The classics state: "When Blood and Qi rush upward together, it causes Great Syncope. Syncope leads to sudden death; if Qi returns, life is preserved; if it does not return, death occurs." This refers to such cases.

Question: (Pathogens becoming excessive constitutes Excess; loss of healthy Qi constitutes Deficiency. For instance, a large and slippery pulse indicates strong and powerful excess pathogens, which the Zang organs naturally cannot withstand. However, in sudden syncope, the pathological pulse is not large but small, not slippery but choppy, completely shedding the appearance of large and slippery. Hence, it is distinguished as) Pulse Transformation (here, "Tuo/Transformation" means change/transformation, not dispersion/collapse. Since the pulse has transformed, the disparity between Excess and Deficiency is significant, and the prognosis of entering Zang or Fu should also change, yet we still adhere to the theory that) entry into Zang leads to death, and entry into Fu leads to recovery. What does this mean? The Master said: (The main idea of this statement is that emerging to Yang is shallow, while transmitting to Yin is deep.) This is not specific to (sudden syncope) alone. (For all) diseases (entering Zang or Fu), this principle applies. For example, in impetigo-like sores, if they start from the mouth and flow to the limbs, they are treatable; if they start from the limbs and flow back to the mouth, they are untreatable. (Because the mouth belongs to Yin, and limbs belong to Yang. Yin and Yang correspond to Zang and Fu respectively. The terms Zang and Fu are obscure and difficult to fathom, whereas Superficial and Interior are comprehensive and easy to understand. I specifically warn you: Any) disease remaining in the Exterior is treatable; entering the Interior leads to death.

This section discusses life and death outcomes when healthy Qi is depleted (Deficiency syndromes). This reasoning extends from sudden syncope to all diseases. The term "Pulse Transformation" has been misunderstood by various commentators. Li Weixi stated: "The sentences 'Disease in the Exterior' generally refer to all diseases, meaning the same applies to hundreds of diseases. 'Entering Interior leads to death' includes conditions like Bi-Qi entering the abdomen or gout attacking the heart."

Question: There are eighteen types of Yang diseases. What are they? The Master said: (The Qi of the Three Yang channels governs the exterior of the body shell, such as) headache, neck/back/waist/spine/arm/leg pulling pain. (Although these six involve upper and lower parts, because they are outside the body shell, they are called Yang diseases. Diseases in the Exterior have distinctions among Ying-Nutrient disease, Wei-Defensive disease, and combined Ying-Wei disease. Thus, one disease type has three variations. Three multiplied by six equals eighteen diseases.) Question: There are eighteen types of Yin diseases. What are they? The Master said: (The Qi of the Three Yin channels governs the interior of the body shell, such as) cough, asthma/wheezing, hiccups, throat pain, borborygmus, distension/fullness, heart pain, and spasms/tightness. (Although these nine involve Zang and Fu, because they are inside the body shell, they are called Yin diseases. Diseases in the Interior have differences between Deficiency and Excess. Thus, one disease type has two variations. Nine multiplied by two equals eighteen diseases. However, the transmission of the Six Qi (Three Yin and Three Yang) is formless, whereas the diseases of the Five Zang and Six Fu organs are有形 (form-based). When Zang and Fu are invaded by the Six Pathogenic Factors (Wind, Cold, Summerheat, Dampness, Dryness, Fire), they further involve Qi level, Blood level, or combined Qi-Blood involvement—three categories. Six multiplied by three equals eighteen.) Each of the Five Zang organs has eighteen diseases, totaling ninety diseases. Humans also have diseases of the Six Fu organs, which are slightly milder, amounting to eighteen diseases, totaling one hundred and eight diseases. (These numbers are orderly and distinct. As for prolonged vision damaging Blood, prolonged lying damaging Qi, prolonged sitting damaging Flesh, prolonged standing damaging Bone, and prolonged walking damaging Sinew, these are named) Five Exhaustions. (Overeating damages Spleen, intense anger causing Qi rebellion damages Liver, heavy lifting while sitting on damp ground damages Kidney, cold exposure and drinking cold beverages damage Lung, sorrow and worry damaging Heart, wind/rain/cold/summerheat damaging Form, and intense anger/fear/immoderation damaging Will/Zhi, these are named) Seven Damages. (Extreme exhaustion of Qi, Blood, Sinew/Bone, Muscle, and Essence, these are named) Six Extremes. Women have (Twelve Masses, Nine Pains, Seven Harms, Five Damages, and Three Causes, totaling) Thirty-Six Diseases. (These are not caused by the Six External Pathogens and are thus) not included in the above classifications. (Students should discuss them separately. Although, the aforementioned Yin/Yang and Zang/Fu syndromes are categorized based on pathogen invasion in the human body, naming them without exploring the attribution of pathogens and their underlying causes. Generally, Light/Clear) pathogens reside superiorly. (Heavy/Turbid) pathogens reside inferiorly. (Those derived from Heaven constitute) Major Pathogens affecting the Exterior. (Those derived from Human activities constitute) Minor Pathogens affecting the Interior. Dietary pathogens entering via the mouth (constitute) retained food. The Five Pathogens invading humans (follow similar categories.) each having its own rules. Wind (being Yang category) attacks before noon. Cold (being Yin category) attacks in the evening. Dampness (being heavy/turbid) injures the lower body. Fog/Mist (being light/clear) injures the upper body. (Verifying this on the whole body:) Wind (being Yang pathogen) makes the pulse (slow and) floating. Cold (being Yin pathogen) makes the pulse (tight and) rapid. Mist (light/clear pathogen) injures skin and pores. Dampness (heavy/turbid pathogen) flows into joints. (Retained) food (only) damages Spleen and Stomach. (Without involving meridians and pores.) Extreme Cold (causes Yang to hide internally and fail to protect the exterior, so diseases mostly) damage meridians. Extreme Heat (causes Yang to float externally, combining with summerheat; sweating damages collaterals, so diseases mostly) damage collaterals. (In summary, this is nothing but the principle of similarity attracting similarity.)

This section covers the division, combination, differences, and similarities of Yin/Yang, Zang/Fu, and Five Pathogens; the origins and timing of Jing-Qi circulation; what ought to happen as described, and why it happens as explained. Those who study should comprehend this beyond the text itself. Appendix: Thirty-Six Diseases of Women from *Qianjin Fang*, for reference. Twelve Masses (Xia): discharge resembling 1. green mud, 2. green blood, 3. purple juice, 4. red skin, 5. pus crust, 6. bean soup, 7. okra soup, 8. clotted blood, 9. green blood like water, 10. rice water, 11. menstrual wash, 12. irregular menstruation cycle. Nine Pains: 1. pain in yin organ injury, 2. painful dripping in yin organ, 3. immediate pain upon urination, 4. cold pain, 5. abdominal pain during menstruation, 6. fullness/pain from Qi stagnation, 7. pain in yin organ like insect bite after sweating, 8. hypochondriac pain, 9. lower back pain. Seven Harms: 1. harm from food, 2. harm from Qi, 3. harm from cold, 4. harm from labor, 5. harm from sexual activity, 6. harm from pregnancy, 7. harm from sleep. Five Damages: 1. orifice pain, 2. alternating cold/heat pain, 3. urgent/stiff small intestine pain, 4. numbness of Zang organs, 5. abnormal cervical opening. Three Causes: 1. amenorrhea/blockage, 2. infertility/miscarriage, 3. emaciation/lack of muscle growth. Also, *Kangxi Dictionary* annotation says: "Read as 'Xin' (fragrant)." Physician Tang Lisan of Wu states: "Ren refers to the degree of cooking raw and cooked food. Thus, the 'Ren' sentence refers to stopping/stagnation caused by overeating delicious, fragrant food."

Question: In diseases, there are urgent cases requiring rescue of the Interior or rescue of the Exterior. What does this mean? The Master said: If a disease (is mistakenly treated with purgatives by the physician), followed by continuous diarrhea with undigested food. (The Interior syndrome is extremely urgent, while) body pain exists. (Both conditions require attention, but weighing them,) urgently rescue (the Interior first, specifically the) diarrhea with undigested food. (Temporarily defer treating the Exterior) body pain. (If after medication) bowel movements normalize (while body pain persists,) urgently rescue the Exterior.

This explains that syndromes differ in Exterior/Interior nature, and treatments differ in urgency. This is detailed in the *Shanghan Lun*; no need for further elaboration.

Regarding diseases, (there are chronic) entrenched diseases. (Added to) acute/sudden diseases. (Acute diseases are easier to attack; entrenched diseases are hard to eradicate. Assessing the sequence.) One should first treat the acute disease, then treat the entrenched disease.

The previous section discussed differences in Exterior/Interior, where treatment prioritizes urgency. This section discusses differences in New/Old diseases, where treatment prioritizes difficulty/ease.

The Master said: Diseases of the Five Zang organs heal when they obtain favorable conditions. (Favorable conditions include emotional counteraction, e.g., anger damages Liver, healed by grief, as grief conquers anger; temporal favorability, e.g., Liver disease heals in Summer, benefiting from Zi/Water element controlling Wood; dietary favorability, e.g., Liver color is Green, suitable for Sweet taste; Heart color is Red, suitable for Sour taste; Lung color is White, suitable for Bitter taste; Spleen color is Yellow, suitable for Sour taste; Kidney color is Black, suitable for Pungent taste; positional favorability, e.g., Liver disease heals on Bing/Ding days, starts on Jia/Yi days; Heart disease heals on Wu/Ji days, starts on Bing/Ding days; Spleen disease heals on Geng/Xin days, starts on Wu/Ji days; Lung disease heals on Ren/Gui days, starts on Geng/Xin days; Kidney disease heals on Jia/Yi days, starts on Ren/Gui days.) Diseases of the Five Zang organs each have aversions. (Heart dislikes Heat, Lung dislikes Cold, Liver dislikes Wind, Spleen dislikes Dampness, Kidney dislikes Dryness. Moreover,) each develops pathology according to what it dislikes. (Why call it dislike? It is opposite to what is favorable, not just limited to what is abhorred. Taking one aspect of what is disliked as an example:) Patients may crave foods they normally shouldn't eat. (This indicates Zang Qi has been altered by pathogens, and eating such foods aids the pathogenic Qi.) It will definitely cause fever. (Note: The method for thirst and desire for water in Cold Damage syndromes is not included here.)

This section emphasizes that disease is rooted in Zang Qi. Healing through obtaining favorable conditions means obtaining what is suitable, stabilizing Zang Qi, and repelling pathogenic Qi. Having aversions and developing pathology based on dislikes means losing suitability, offending Zang Qi, and aiding pathogens. The word "Suò" (that which) in "Suo De" (what is obtained), "Suo E" (what is abhorred), and "Suo Bu Xi" (what is disliked) encompasses a broad range.

For all diseases located in the Zang organs, the method should ideally be purgation. However, when Yangming enters the Fu organs, it does not transmit further; treating Fu like Zang is applicable. If there is actual accumulation in the intestines and stomach, even if ten days pass without defecation, there is no distress, indicating urgent purgation is not suitable. Only in Yangming and Shaoyin are there indications for urgent purgation. Urgent purgation seems to imply direct attack without doubt. However, the method of attack is most subtle. If) intending to attack, one should attack according to what is uniquely obtained (within the commonality). (Yangming has three urgent purgation indications: 1. After six or seven days, eyes are unclear and pupils are unresponsive; 2. Yangming disease with fever and profuse sweating; 3. Failure to resolve after sweating, with abdominal fullness and pain. These urgently prevent vigorous Qi from becoming excessive and Yin from perishing. Shaoyin has three urgent purgation indications: 1. Shaoyin disease for two or three days with dry mouth and tongue; 2. Shaoyin disease with spontaneous diarrhea of clear water, pure green color, pain in the epigastrium, and dry mouth; 3. Shaoyin disease for six or seven days with abdominal distension and constipation. These urgently prevent fire from raging and self-immolation.) If (the obtained factor is not in the category for purgation, but only presents with) thirst. (As mentioned in the Treatise: Shaoyin disease with diarrhea for six or seven days, cough, vomiting, thirst, irritability, and insomnia; or Yangming disease with floating pulse, fever, desire to drink water, and dysuria. Both cases) administer Zhu Ling Tang. (Nurturing Yin within diuresis allows heat to exit via urine, stopping thirst. This is complementary to the purgation method.) Others follow this pattern.

This section states that pathogens in Zang organs should be attacked, and the subtlety of attack lies in the four characters "following what is obtained." Xu Zhongke merely expanded on the text without insight; You Zaijing added extraneous elements like water, blood, phlegm, and food. Neither understood the core intent.