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Chapter 9 asks: How can one distinguish and know the diseases of the Zang (Solid) and Fu (Hollow) organs?

The response states: A rapid pulse (Shu Mai, fast pulse) indicates a Fu organ disease, while a slow pulse (Chi Mai, slow pulse) indicates a Zang organ disease. A rapid pulse signifies Heat, and a slow pulse signifies Cold. All Yang-related conditions manifest as Heat, and all Yin-related conditions manifest as Cold. Therefore, one distinguishes and knows Zang and Fu diseases through the slowness or rapidity of the pulse.

This section differentiates diseases of the Zang and Fu organs. One inhalation and exhalation constitute one "Xi" (respiration cycle), and the pulse corresponds to it. Within one Xi, the pulse beats four times; if accompanied by a deep sigh (Tai Xi), it beats five times. This is termed a "Ping Ren" (healthy person). A healthy person is defined by having a pulse without disease; any increase or decrease in frequency indicates pathology. Three beats per Xi is called Chi Mai (slow pulse), representing an insufficient pulse. Six beats per Xi is called Shu Mai (rapid pulse), representing an excessive pulse. The Zang organs belong to Yin, and the Fu organs belong to Yang. A rapid pulse belongs to the Fu organs, corresponding to Yang and Heat; a slow pulse belongs to the Zang organs, corresponding to Yin and Cold. Furthermore, it deduces the rationale for why rapid pulses belong to Fu organs and slow pulses to Zang organs, stating that all Yang relates to Heat and all Yin to Cold. However, this only describes the general principles of Yin and Yang and should not be applied rigidly.

Commentary: Fu organ diseases may also present with a slow pulse, and Zang organ diseases may also present with a rapid pulse. It is indeed inflexible to distinguish solely between Zang and Fu based on slowness or rapidity. Similarly, distinguishing Cold and Heat solely based on these two pulse qualities is not entirely accurate. The Chi Mai (slow pulse) is a Yin pulse. When the physician completes one respiration cycle and the patient's pulse beats three times, moving very slowly, this is the Chi Mai. Diseases associated with the Chi Mai are often caused by internal injury from consuming cold, raw, or cooling foods, or external exposure to icy, wet, and Yin-cold qi. These pathogens mostly affect the Zang organs, sometimes the Fu organs, or penetrate into the Cou Li (skin texture and interstitial spaces), causing Qi and Blood to stagnate and fail to circulate freely. Thus, it primarily indicates deficiency of Yang Qi, stagnation of Qi and Blood, and a pattern of Excess Yin and Deficient Yang. By observing the degree of slowness, one can discern the depth of the Cold pathogen; this is the normal rule. However, if the Chi Mai is forceful and additionally choppy (Se), feeling so upon both light and heavy pressure, it indicates Heat pathogen accumulation and obstruction of the meridians, deviating from the norm, thus presenting a seemingly slow pulse. One must not jump to conclusions but must verify with clinical signs. For instance, if there is fullness and oppression in the chest and epigastrium, constipation, and dark urine, then it is a Chi Mai indicating Heat. As Zhang Jingyue stated: After the initial resolution of Shang Han (Cold Damage), residual heat may remain unclarified, meridians may not yet be filled, and Stomach Qi may not have recovered; the pulse will necessarily be Chi-Hua (slow and slippery) or appear Chi-Huan (slow and moderate). Liu Hejian stated: Excessive sweating due to intense Heat, or extreme vomiting and diarrhea leading to depletion of Qi and Body Fluids, can result in a slow pulse that fails to become rapid. This occurs when Ying Qi (Nutritive Qi) is deficient and further damaged by Heat, unable to move the Heat pathogen, which instead obstructs it, losing its transport mechanism, thus resulting in a slow pulse. If the pulse is slow and not smooth, it is Se Mai (choppy pulse); if slow with intermittent pauses, it is Jie Mai (knotted pulse); if slow, soggy, floating, large, and moderate, it is Xu Mai (deficiency pulse). These are similar yet distinct, requiring careful differentiation.

The Shu Mai (rapid pulse) belongs to Yang. When the physician completes one respiration cycle and the patient's pulse beats six or seven times, this is the Shu Mai. The Shu Mai primarily indicates Heat, signifying disease progression, where Yin cannot overcome Yang, resulting in an excessive pulse rate.

The response adds: It can also indicate Cold. If the pulse is floating and rapid, large but forceless, and feels hollow upon deep pressure, being minute and nearly imperceptible, this indicates Yin-Cold excess at the lower body forcing Yang Qi to float upward. The deficient Yang floats outward, manifesting as feverish sensation, red face, and Dai Yang (floating false yang with facial flushing like makeup). Consequently, the pulse appears rapid, soft, large, and lacking spirit. Zhu Danxi stated: A pulse that is rapid and vigorous, yet choppy upon deep pressure, accompanied by external Heat symptoms, is named Zhong Han (internal Cold). This is because Cold flows into the blood vessels; although external symptoms show Heat, the pulse becomes rapid, following this same principle. Yue Ren (Bian Que) only discussed the normal patterns and did not address the variations. The classic texts are concise and profound, containing many such generalized statements. Students must comprehend them carefully and avoid applying them rigidly like marking a boat to find a lost sword.