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Difficulty 1 states: All twelve meridians have pulsating arteries. Why is it that by taking only the Cun Kou (Inch Port) pulse, one can determine the life and death, fortune and misfortune of the five Zang organs and six Fu organs?

Regarding the fact that all twelve meridians have arteries: for example, the hand Taiyin Lung meridian has pulses at Zhongfu (LU-1), Yunmen (LU-2), Tianfu (LU-3), and Xiabai (LU-4); the hand Yangming Large Intestine meridian has pulses at Hegu (LI-4) and Yangxi (LI-5); the hand Shaoyin Heart meridian has a pulse at Jiquan (HT-1); the hand Taiyang Small Intestine meridian has a pulse at Tianchuang (SI-16); the hand Jueyin Pericardium meridian has a pulse at Laogong (PC-8); the hand Shaoyang Sanjiao meridian has a pulse at Heliao (TE-17); the foot Taiyin Spleen meridian has pulses at Jimen (SP-11) and Chongmen (SP-12); the foot Yangming Stomach meridian has pulses at Chongyang (ST-42), Daying (ST-5), Renying (ST-9), and Qichong (ST-30); the foot Shaoyin Kidney meridian has pulses at Taixi (KI-3) and Yinggu (KI-10); the foot Taiyang Bladder meridian has a pulse at Weizhong (BL-40); the foot Jueyin Liver meridian has pulses at Taichong (LR-3), Wuli (LR-11), and Yinlian (LR-9); the foot Shaoyang Gallbladder meridian has pulses at Xiaguan (ST-7) and Tinghui (GB-2), and so on. The term "Jing" (Meridian/Vessel) refers to the continuous flow of Ying (Nutrient) and Wei (Defensive) Qi; the term "Mai" (Pulse/Vessel) refers to the branching network through which blood flows in the body. Thus, "Jing" implies a direct path, while "Mai" implies a crosswise network. Yué Rén's (Qin Yueren) meaning is likely this: although all twelve meridians have arteries as mentioned above, why are these other points discarded and only the Cun Kou pulse taken to judge the fate of the Zang and Fu organs?

The answer is: Cun Kou is the great convergence of pulses, specifically the pulsating point of the hand Taiyin Lung meridian. ("Ran" is an affirmative particle used in response; others follow this pattern.)

Cun Kou is also called Qi Kou. It is located one cun posterior to the大鱼际 (Thenar eminence) of the hand Taiyin meridian. Below Qi Kou are Guan (Gate) and Chi (Depth). Ying and Wei Qi circulate twenty-five cycles in the Yang aspects and twenty-five cycles in the Yin aspects. Entering and exiting Yin and Yang, they intersect and intermingle without any interruption. After fifty cycles, exactly one hundred ke (water clock units) have elapsed, marking the end of a day and night cycle and the arrival of dawn the next day. At this time, the Qi converges again at the hand Taiyin meridian. This is why Cun Kou serves as the beginning and end of the Qi of the five Zang and six Fu organs, and thus diagnostic methods are derived from it. One inhalation and exhalation constitute one Xi (breath/respiration). There are 135 Xi per ke. Each Shi (two-hour period) has eight ke, totaling 1,080 Xi. Twelve Shi make up ninety-six ke, totaling 12,960 Xi. Adding the fractional parts of the ke yields 540 Xi, bringing the total to 13,500 Xi per day. In each Xi, the pulse travels six cun. In two ke (270 Xi), the pulse travels sixteen zhang and two chi. In one Shi (eight ke), the pulse travels sixty-four zhang and eight chi. Ying and Wei Qi circulate around the body once every twelve Shi (ninety-six ke), traveling seven hundred seventy-seven zhang and six chi, equivalent to forty-eight full circuits of the body. Adding the fractional parts allows for two more circuits, covering thirty-two zhang and four chi. In total, over fifty circuits of the body, the pulse travels eight hundred ten zhang. This details the rhythm of respiration, the number of pulse travels, the degree of bodily circulation, and the precise measurement of the hundred ke of day and night. "Traveling Yang and Yin" refers to traveling during the day and night respectively.

Difficulty 7 states: The classics say that when Shao Yang arrives, the pulse is suddenly large, suddenly small, suddenly short, and suddenly long; when Yang Ming arrives, it is floating, large, and short; when Tai Yang arrives, it is surging, large, and long; when Tai Yin arrives, it is tight, large, and long; when Shao Yin arrives, it is tight, fine, and faint; when Jue Yin arrives, it is deep, short, and rapid. Are these six types Ping Mai (Normal Pulses) or Bing Mai (Pathological Pulses)? The answer is: they are Wang Mai (Wang/Prosperous Pulses, i.e., pulses corresponding to the season).

The explanation of the Wang status of these six pulses is found below.

Which month does each govern for how many days? The answer is: After the Winter Solstice, upon encountering a Jia Zi day, Shao Yang governs; upon encountering another Jia Zi day, Yang Ming governs; then Tai Yang; then Tai Yin; then Shao Yin; then Jue Yin. Each governs for sixty days. Six times sixty equals three hundred sixty days, completing one year. This is the general rule for the timing of the Wang periods of the Three Yang and Three Yin.

The previous text discussed the Wang pulses of the Three Yang and Three Yin; this text discusses their Wang times. When the time arrives, the corresponding pulse appears.

Liu Wenshu said: In *Su Wen: Zhi Zhen Yao Da Lun*, it is stated: When Jue Yin arrives, the pulse is Xian (String-like); when Shao Yin arrives, the pulse is Gou (Hook-like); when Tai Yin arrives, the pulse is Chen (Deep); when Shao Yang arrives, it is large and floating; when Yang Ming arrives, it is short and Se (Choppy); when Tai Yang arrives, it is large and long. This also follows the expansion and contraction of Heaven and Earth Qi. Just as Spring is Xian, Summer is Hong (Surging), Autumn is Mao (Feather-like), and Winter is Shi (Stone-like), the Five Movements and Six Qi correspond to the four seasons and manifest in the pulse. Referring to *Ping Ren Qi Xiang Lun*, Tai Yang pulse is surging, large, and long; Shao Yang pulse is suddenly rapid, suddenly sparse, suddenly short, suddenly long; Yang Ming pulse is floating, large, and short. *Nan Jing* cites these to discuss the pulses of the Three Yin and Three Yang, speaking from the perspective of the depth of the initial generation of Yin and Yang.

Difficulty 12 states: The classics say that if the pulse of the five Zang organs is exhausted internally, the acupuncturist erroneously tonifies the exterior; if the pulse of the five Zang organs is exhausted externally, the acupuncturist erroneously tonifies the interior. How are internal and external exhaustion distinguished? The answer is: Internal exhaustion of the five Zang pulse means the Qi of the Kidney and Liver is exhausted internally, yet the physician erroneously tonifies the Heart and Lung. External exhaustion means the pulse of the Heart and Lung is exhausted externally, yet the physician erroneously tonifies the Kidney and Liver. Tonifying Yin when Yang is exhausted, and tonifying Yang when Yin is exhausted, is called "making the excess more excessive and the deficiency more deficient," damaging what is insufficient and benefiting what is already sufficient. Death resulting from such treatment is effectively murder by the physician.

*Ling Shu* states: Whenever using acupuncture, one must first diagnose the pulse to assess the severity and ease of the condition before treating. It also states: "Exhaustion of Zang Qi internally" means the pulse at the Kou (Gate) position does not reach internally. If one erroneously treats external disease sites and combines them with He-Sea points of Yang meridians, retaining the needle to draw in Yang Qi, the arrival of Yang Qi will cause double exhaustion internally, leading to death. Such death is characterized by stillness because there is no Qi to move. "Exhaustion of Zang Qi externally" means the pulse at the Kou position does not reach externally. If one erroneously treats Shu points of the four limbs, retaining the needle to draw in Yin Qi, the arrival of Yin Qi causes Yang Qi to retreat inward. Retreating inward leads to rebellion/negation, causing death. Such death is characterized by restlessness because Yin Qi is in excess. *Ling Shu* uses the internal and external aspects of the pulse Kou to distinguish Yin and Yang. Yué Rén distinguishes Yin and Yang by placing Heart/Lung externally and Kidney/Liver internally, but the principle remains the same.

Difficulty 22 states: The classics mention "Shi Dong" (Is Moving) diseases and "Suo Sheng Bing" (So Producing Disease) conditions. How does one meridian give rise to two types of disease? The answer is: The classics state that "Shi Dong" relates to Qi, and "Suo Sheng Bing" relates to Blood. Pathogen in Qi causes Shi Dong disease; pathogen in Blood causes Suo Sheng Bing. Qi provides warmth (Xu), and Blood provides nourishment (Ru). If Qi stagnates and fails to circulate, it is a Qi disease occurring first; if Blood becomes obstructed and fails to nourish, it is a Blood disease occurring later. Hence, Shi Dong comes first, followed by Suo Sheng Bing.

Difficulty 35 states: Each of the five Zang organs has a paired Fu organ, and they are generally close to each other. Why are the Heart and Lung far from the Large and Small Intestines? The answer is: The classics state that the Heart governs Ying and the Lung governs Wei, circulating Yang Qi, hence they reside in the upper body. The Large and Small Intestines transmit Yin Qi downward, hence they reside in the lower body. This is why they are distant from each other.

Difficulty 40 states: The classics say the Liver governs color, the Heart governs smell, the Spleen governs taste, the Lung governs sound, and the Kidney governs fluids. The nose is the opening of the Lung, yet it perceives smells; the ear is the opening of the Kidney, yet it hears sounds. What is the rationale? The answer is: The Lung belongs to Metal in the West. Metal is born in Si (Snake), which belongs to Fire in the South. Fire corresponds to the Heart, which governs smell. Therefore, the nose can perceive smells. The Kidney belongs to Water in the North. Water is born in Shen (Monkey), which belongs to Metal in the West. Metal corresponds to the Lung, which governs sound. Therefore, the ear can hear sounds.

Chen of Siming said: Smell is governed by the Heart, and the nose is the opening of the Lung. The Heart meridian ascends to the Lung, enabling the nose to perceive smells. Sound is governed by the Lung, and the ear is the opening of the Kidney. The Kidney meridian ascends to the Lung, enabling the ear to hear sounds. I believe Yué Rén's statement relies on the principle of mutual generation among the Five Elements, demonstrating their interdependent function.

Difficulty 43 states: Why do people die after seven days without food or water? The answer is: The human stomach normally contains two dou of grain and one dou five sheng of water. A healthy person defecates twice daily, passing two and a half sheng each time, totaling five sheng per day. Over seven days, this amounts to three dou five sheng. Thus, when water and grain are exhausted, death occurs.

When water is gone, Ying Qi scatters; when grain is consumed, Wei Qi perishes. With Ying scattering and Wei perishing, Shen (Spirit) has no foundation, leading to death.

Difficulty 46 states: Why do elderly people lie down but cannot sleep, while young and strong people sleep deeply and do not wake easily? The answer is: The classics state that young people have abundant Qi and Blood, smooth muscles, and unobstructed Qi channels. Their Ying and Wei circulation is normal, so they are energetic during the day and sleep soundly at night. Elderly people have declining Qi and Blood, rough muscles, and sluggish Ying and Wei pathways. Thus, they lack energy during the day and cannot sleep at night.

Elderly insomnia and youthful deep sleep depend on the abundance or deficiency of Ying, Wei, Qi, and Blood.

Difficulty 47 states: Why is the face uniquely able to resist cold? The answer is: The head is the convergence of all Yang meridians. All Yin meridians ascend only to the neck and chest before returning, whereas all Yang meridians ascend to the head and ears. This allows the face to resist cold.

Difficulty 49 states: There are diseases caused by the meridians themselves (Zheng Jing Zi Bing) and those caused by the Five Evils (Wu Xie). How are they distinguished? The answer is: Worry and overthinking injure the Heart; exposure to cold and consumption of cold drinks injure the Lung; anger with reversed Qi rising upward injures the Liver; improper diet and fatigue injure the Spleen; sitting long in damp places or forcing oneself into cold water injures the Kidney. What are the Five Evils? They are Wind Strike (Zhong Feng), Summerheat Injury (Shang Shu), Diet and Fatigue (Yin Shi Lao Juan), Cold Damage (Shang Han), and Dampness Strike (Zhong Shi).

Xie Shi said: Diet and fatigue are distinct. Diseases from diet arise from irregular eating habits (hunger/fullness imbalance), which is an external evil injury. Diseases from fatigue arise from physical exertion leading to exhaustion, which is a self-injury of the proper meridian.

For example, regarding Heart disease: How do we know it is caused by Wind Strike? The complexion should be red. Why? The Liver governs color. Green enters the Liver, Red enters the Heart, Yellow enters the Spleen, White enters the Lung, Black enters the Kidney. Thus, Liver evil entering the Heart manifests as redness. Symptoms include fever, fullness and pain under the ribs, with a floating, large, and string-like pulse.

How do we know it is caused by Summerheat Injury? The patient should dislike odors. Why? The Heart governs smell. Scorched odor enters the Heart, fragrant odor enters the Spleen, fishy odor enters the Liver, putrid odor enters the Kidney, raw/fishy odor enters the Lung. Thus, Heart disease involves aversion to odors. Symptoms include fever, irritability, heart pain, with a floating, large, and scattered pulse.

How do we know it is caused by Diet and Fatigue? The patient should crave bitter taste. Deficiency leads to anorexia; excess leads to voracious appetite. Why? The Spleen governs taste. Sour enters the Liver, Bitter enters the Heart, Pungent enters the Lung, Salty enters the Kidney, Sweet enters the Spleen itself. Thus, Spleen evil entering the Heart manifests as craving bitter taste. Symptoms include fever, heavy body, lethargy, limp limbs, with a floating, large, and slow pulse.

How do we know it is caused by Cold Damage? The patient should speak deliriously. Why? The Lung governs sound. Crying enters the Liver, Speaking enters the Heart, Singing enters the Spleen, Moaning enters the Kidney, Weeping enters the Lung itself. Thus, Lung evil entering the Heart manifests as delirious speech. Symptoms include fever, chills, severe coughing and wheezing, with a floating, large, and choppy pulse.

How do we know it is caused by Dampness Strike? The patient should have uncontrollable sweating. Why? The Kidney governs dampness. Tears enter the Liver, Sweat enters the Heart, Saliva enters the Spleen, Mucus enters the Lung, Spittle enters the Kidney itself. Thus, Kidney evil entering the Heart manifests as uncontrollable sweating. Symptoms include fever, lower abdominal pain, cold legs and feet, with a deep, soggy, and large pulse. These are the methods for diagnosing the Five Evils.

In this chapter, Yué Rén discusses the partial deficiency and excess of Yin/Yang, Zang/Fu, and meridians. Due to partial excess, internal evils arise; due to partial deficiency, external evils invade.

Difficulty 50 states: Diseases include Xu Xie (Empty Evil), Shi Xie (Solid Evil), Wei Xie (Minor Evil), Zei Xie (Thief Evil), and Zheng Xie (Proper Evil). How are they distinguished? The answer is: Coming from behind is Xu Xie; coming from ahead is Shi Xie; coming from the element that does not overcome me is Zei Xie; coming from the element that I overcome is Wei Xie; originating from the meridian itself is Zheng Xie.

(Note: In the Five Elements, the element that generates me is "Xiu" (Resting), its Qi is weak, coming from behind as evil, hence Xu Xie. The element I generate is "Xiang" (Assistant), its Qi is strong, coming from ahead as evil, hence Shi Xie. Zheng Xie is the disease of the meridian itself.)

Why? For example, in Heart disease: Wind Strike is Xu Xie; Summerheat Injury is Zheng Xie; Diet and Fatigue is Shi Xie; Cold Damage is Wei Xie; Dampness Strike is Zei Xie.

Difficulty 51 states: Some patients desire warmth, some desire cold, some wish to see people, some do not. These differ in pathology. Which Zang or Fu organ is affected? The answer is: Desire for cold and wanting to see people indicates disease in the Fu organs. Desire for warmth and not wanting to see people indicates disease in the Zang organs.

Why? Fu organs belong to Yang. Yang diseases desire cold and social interaction. Zang organs belong to Yin. Yin diseases desire warmth and isolation, closing doors and avoiding voices. Thus, we distinguish Zang and Fu diseases by these preferences.

Difficulty 52 states: Is the root of Zang and Fu diseases equal? The answer is: No. How are they unequal? Zang diseases are stationary and immobile, remaining in their original location. Fu diseases are like rushing waters, moving up and down, with no fixed location. Thus, the fundamental nature of Zang and Fu diseases differs.

Difficulty 55 states: Diseases include Ji (Accumulation) and Ju (Gathering). How are they distinguished? Ji is Yin Qi; Ju is Yang Qi. Yin is still and hidden; Yang is active and floating. Where Qi accumulates, it is called Ji; where Qi gathers, it is called Ju. Ji arises from the five Zang organs; Ju forms from the six Fu organs. Ji is Yin Qi; it starts at a fixed location, pain remains in that area, with definite upper/lower and left/right boundaries. Ju is Yang Qi; it has no fixed origin, moves freely without stopping, and pain has no fixed location. Thus, Ji and Ju are distinguished by these characteristics.

Difficulty 56 states: Do the five Zang accumulations have specific names? On what months and days do they form? The answer is: The Liver accumulation is named Fei Qi (Abundant Qi). It is located under the left hypochondrium, resembling an inverted cup with a head and feet. If untreated, it causes coughing, asthma, and malaria persisting for years. It forms on Wu/Ji days in late summer (Ji Xia). Why? Lung disease transmits to the Liver. The Liver should transmit to the Spleen. However, the Spleen is prosperous in late summer and rejects the evil. The Liver tries to return the evil to the Lung, but the Lung refuses. Thus, it stagnates and forms an accumulation. Hence, Fei Qi forms on Wu/Ji days in late summer.

The Heart accumulation is named Fu Liang (Hidden Beam). It starts above the umbilicus, as thick as an arm, extending up to the epigastrium. If untreated, it causes mental agitation. It forms on Geng/Xin days in autumn. Why? Kidney disease transmits to the Heart. The Heart should transmit to the Lung. The Lung is prosperous in autumn and rejects the evil. The Heart tries to return the evil to the Kidney, but the Kidney refuses. Thus, it stagnates and forms an accumulation. Hence, Fu Liang forms on Geng/Xin days in autumn.

The Spleen accumulation is named Pi Qi (Obstruction Qi). It is in the epigastrium, large as a plate. If untreated, it causes limb weakness, jaundice, and failure of food to nourish the body. It forms on Ren/Gui days in winter. Why? Liver disease transmits to the Spleen. The Spleen should transmit to the Kidney. The Kidney is prosperous in winter and rejects the evil. The Spleen tries to return the evil to the Liver, but the Liver refuses. Thus, it stagnates and forms an accumulation. Hence, Pi Qi forms on Ren/Gui days in winter.

The Lung accumulation is named Xi Ben (Breathing Rush). It is under the right hypochondrium, covering an area large as a cup. If untreated, it causes chills, fever, cough, and lung abscess. It forms on Jia/Yi days in spring. Why? Heart disease transmits to the Lung. The Lung should transmit to the Liver. The Liver is prosperous in spring and rejects the evil. The Lung tries to return the evil to the Heart, but the Heart refuses. Thus, it stagnates and forms an accumulation. Hence, Xi Ben forms on Jia/Yi days in spring.

The Kidney accumulation is named Ben Tun (Rushing Pig). It originates in the lower abdomen and extends up to the epigastrium, resembling a pig. The Kidney should transmit to the Heart. The Heart is prosperous in summer and rejects the evil. The Kidney tries to return the evil to the Spleen, but the Spleen refuses. Thus, it stagnates and forms an accumulation. Hence, Ben Tun forms on Bing/Ding days in summer. These are the essential rules for the five accumulations.

Difficulty 59 states: How are Kuang (Mania) and Dian (Epilepsy/Melancholia) distinguished? The answer is: Kuang begins with little sleep, lack of hunger, arrogance, self-perceived wisdom, self-perceived nobility, inappropriate laughter, singing, joy, and incessant erratic behavior. Dian begins with unhappiness, sudden collapse, staring straight ahead, and a pulse that is excessively strong in both Yin and Yang positions across the three levels.

Difficulty 60 states: Head and Heart diseases include Jue Tong (Rebellious Pain) and Zhen Tong (True Pain). What is the difference? The answer is: When the three hand-Yang meridians are invaded by wind and cold, which linger and do not depart, it is called Jue Tou Tong (Rebellious Headache). If the pathogen penetrates and connects to the brain, it is called Zhen Tou Tong (True Headache). When the Qi of the five Zang organs interferes with each other, it is called Jue Xin Tong (Rebellious Heart Pain). If the pain is extreme, localized solely in the heart, and accompanied by cyanosis of the hands and feet, it is called Zhen Xin Tong (True Heart Pain). True Headache and True Heart Pain are fatal: if onset is in the morning, death occurs in the evening; if onset is in the evening, death occurs in the morning.

Difficulty 61 states: The classics say: Diagnosing by observation is called Divine; diagnosing by listening/smelling is called Sage; diagnosing by questioning is called Skilled; diagnosing by palpation is called Clever. What does this mean? The answer is: Diagnosing by observation involves seeing the five complexions to identify the disease.

*Suu Wen: Wu Zang Sheng Cheng Pian* states: Complexions like dead grass (green), dried orange peel (yellow), coal dust (black), clotted blood (red), and dry bone (white) indicate death. Complexions like kingfisher feathers (green), chicken comb (red), crab belly (yellow), pig fat (white), and crow feathers (black) indicate life. *Ling Shu* states: Green/black indicates pain; yellow/red indicates heat; white indicates cold. It also states: Red appearing on the cheeks, size of a thumb, indicates imminent death even if symptoms seem mild. Black appearing on the forehead (Ting), size of a thumb, indicates sudden death. Regarding pulse diagnosis: Many red indicates heat; many green indicates pain; many black indicates chronic bi-syndrome; mixed black, red, and green indicates alternating chills and fever with body pain. Slight yellow complexion, yellow dental plaque, and yellow nails indicate jaundice. In obstetrics: Red face and blue tongue indicate living mother and dead fetus; blue face and red tongue with foam indicate dead mother and living fetus; blue lips and mouth indicate death of both.

Diagnosing by listening/smelling involves distinguishing disease by the five vocal tones.

Chen of Siming said: The five Zang produce sounds, which correspond to musical tones. Liver sound is calling, tone Jue (Wood), clear and straight; harmony indicates health, discord indicates Liver disease. Heart sound is laughing, tone Zhi (Fire), harmonious and long; harmony indicates health, discord indicates Heart disease. Spleen sound is singing, tone Gong (Earth), broad and harmonious; harmony indicates health, discord indicates Spleen disease. Lung sound is crying, tone Shang (Metal), light and vigorous; harmony indicates health, discord indicates Lung disease. Kidney sound is moaning, tone Yu (Water), deep and沉; harmony indicates health, discord indicates Kidney disease.

Diagnosing by questioning involves asking about the desired flavors to determine the origin and location of the disease.

*Ling Shu* states: The five flavors enter the mouth and travel to specific tissues, causing disease in those areas. Sour travels to sinews; excessive intake causes urinary retention. Salty travels to blood; excessive intake causes thirst. Pungent travels to Qi; excessive intake causes hollow heart sensation. Pungent moves with Qi, so pungent enters the Heart and exits with sweat. Bitter travels to bones; excessive intake causes vomiting. Sweet travels to flesh; excessive intake causes chest oppression. From this, we know that asking about desired flavors reveals the disease's origin and location.