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Chapter 11 states: The classic texts say that if the pulse beats fewer than fifty times before there is one pause, it indicates that one Zang organ lacks Qi. Which Zang organ is it?
The response is: When a person inhales, Qi follows the Yin meridians into the interior; when exhaling, Qi exits via the Yang meridians. Now, if inhalation cannot reach the Kidney and returns only upon reaching the Liver, we know that the Zang organ lacking Qi is the Kidney, as its Qi has been exhausted first.
The *Ling Shu · Gen Jie* chapter says:
In one day and night, a person circulates Qi fifty times (Ying cycles) to nourish the essence of the five Zang organs. If this number is not met, it is called "Kuang Sheng" (a state of critical vitality or abnormality). The so-called fifty Ying cycles mean that all five Zang organs receive Qi. By holding the Cun Kou pulse point and counting the beats: if there are fifty beats without any intermission, all five Zang organs have received Qi; if there is one intermission in forty beats, one Zang organ lacks Qi; if there is one intermission in thirty beats, two Zang organs lack Qi; if there is one intermission in twenty beats, three Zang organs lack Qi; if there is one intermission in ten beats, four Zang organs lack Qi; if there is an intermission in fewer than ten beats, all five Zang organs lack Qi, indicating a short life expectancy (impending death). A "Zhi" (stop) pulse is similar to a "Dai" (intermittent) pulse. This passage cites the classic text and summarizes it. Inhalation involves Yang following Yin into the interior; exhalation involves Yin exiting due to Yang. Now, if inhalation cannot reach the Kidney and returns only at the Liver, it is because the Kidney is located lowest, making the distance for inhalation longer. If the pulse shows an intermission before fifty beats, it indicates that Kidney Qi has failed and cannot ascend along with the Qi of the other Zang organs.

Chapter 12 states: The classic texts say that if the pulses of the five Zang organs are already extinct internally, the acupuncturist instead tonifies the exterior; if the pulses of the five Zang organs are already extinct externally, the acupuncturist instead tonifies the interior. How can one distinguish between internal and external extinction?
The response is: When the pulses of the five Zang organs are extinct internally, it refers to the pulses of the Liver and Kidney being extinct internally, yet the physician erroneously tonifies the Heart and Lung. When the pulses of the five Zang organs are extinct externally, it refers to the pulses of the Heart and Lung being extinct externally, yet the physician erroneously tonifies the Liver and Kidney. Tonifying Yin when Yang is extinct, and tonifying Yang when Yin is extinct, is termed "Shi Shi Xu Xu" (making the excess more excessive and the deficiency more deficient), damaging what is insufficient and augmenting what is already in excess. Death resulting from such actions is considered murder by the physician.
The *Ling Shu · Jiu Zhen Er Shi Yuan* chapter says: Whenever one intends to use acupuncture, one must first diagnose the pulse, observe the severity and ease of the Qi condition, and then proceed with treatment. If the Qi of the five Zang organs is already extinct internally, but the acupuncturist instead tonifies the exterior, this is called "Chong Jie" (double exhaustion). Chong Jie leads to death, and the deceased appears quiet. The practitioner who treats this wrongly reverses the Qi, selecting points in the axilla and chest. If the Qi of the five Zang organs is already extinct externally, but the acupuncturist instead tonifies the interior, this is called "Ni Jue" (reverse cold syndrome). Ni Jue leads to death, and the deceased appears restless. The practitioner who treats this wrongly selects the extremities. Internal exhaustion is Yin deficiency, so one tonifies the axilla and chest, as these are where Zang Qi emerges. External extinction is Yang deficiency, so one tonifies the extremities, as these are the roots of all Yang meridians. The *Xiao Zhen Jie* explains: The so-called extinction of Zang Qi internally means the Qi at the Cun Kou pulse point does not reach internally. Instead, taking external disease sites and the He-Sea points of Yang meridians, and retaining the needle to draw in Yang Qi, causes the Yang Qi to arrive, leading to double internal exhaustion. Double internal exhaustion leads to death; since there is no Qi to move, the body is quiet. The so-called extinction of Zang Qi externally means the Qi at the Cun Kou pulse point does not reach externally. Instead, taking the Shu points of the extremities and retaining the needle to draw in Yin Qi, causes the Yin Qi to arrive, forcing Yang Qi to enter inward. Inward entry leads to reversal, and reversal leads to death; since there is excess Yin Qi, the body is restless. This discusses Yin-Yang, interior-exterior, and deficiency-excess based on the interior and exterior of the Cun Kou pulse, which must not be mistaken. Yué Rén (Bian Que) distinguishes Yin and Yang using the Heart/Lung and Liver/Kidney because the Heart and Lung are above the diaphragm, connecting with Heaven's Qi; the Heart governs the vessels and constitutes Ying Qi, while the Lung governs Qi and constitutes Wei Qi. Ying and Wei Qi float within the skin and blood vessels, hence they are said to be "external." The Liver and Kidney are below the diaphragm, connecting with Earth's Qi; they store essence and blood to nourish bone marrow, hence they are said to be "internal." Feng Shi stated that this chapter should be grouped with those on acupuncture tonification and reduction, likely placed after Chapter 60 for thematic consistency. His view is also correct.