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Chapter 19 states: The classic texts mention that pulses have distinctions of compliance (Shun) and non-compliance (Ni), and there are constant norms for men and women. What is meant by a reversal?

"Heng" refers to constancy or normality. "Fan" refers to the reversal between upper (Cun) and lower (Chi) positions. This refers to the pulse patterns of men and women, which follow certain fixed and constant laws. Adhering to these pulse patterns is considered compliant (Shun), while deviating from them is considered non-compliant (Ni). If the strength and weakness are reversed, what disease does this indicate?

The response is: Men are associated with Yin (the third earthly branch), which corresponds to Wood and Yang. Women are associated with Shen (the ninth earthly branch), which corresponds to Metal and Yin. Therefore, in men, the pulse manifestation is primarily above the Guan (barrier) position (i.e., Cun), while in women, it is primarily below the Guan position (i.e., Chi). Consequently, the Chi pulse in men is typically weak, whereas the Chi pulse in women is typically strong; this is the norm.

This explanation traces back to the origin of life to discuss the Yin-Yang of men and women. Yang Shi stated: Yuan Qi (Original Qi) begins at Zi. From Zi, counting forward, men move leftward for thirty years to reach Si; women move rightward for twenty years to reach Si, at which point they marry and conceive. In ancient times, men married at thirty and women at twenty, based on this principle. After ten months of gestation, a male fetus moves leftward from Si for ten months to reach Yin; thus, the male age cycle begins at Bing Yin. A female fetus moves rightward from Si for ten months to reach Shen; thus, the female age cycle begins at Ren Shen. This explains why it is said that men are born at Yin and women at Shen. Xie Shi stated: Yin represents Yang Wood, and Wood generates Fire. Fire originates at Yin, possessing an upward-flaring nature; hence, the male pulse manifests above the Guan. Shen represents Yin Metal, and Metal generates Water. Water originates at Shen, possessing a downward-flowing nature; hence, the female pulse manifests below the Guan. Men possess abundant Yang Qi, so their Chi pulse is weak; women possess abundant Yin Qi, so their Cun pulse is weak. This constitutes the normal state for men and women.

A "reversal" occurs when a man exhibits a woman's pulse pattern, or a woman exhibits a man's pulse pattern. What diseases result from this?

When a man exhibits a woman's pulse or a woman exhibits a man's pulse, it deviates from the norm and is termed a "reversal." But what kind of pathology does this reversal entail? This question is posed to introduce the subsequent discussion.

The response is: When a man exhibits a woman's pulse, it indicates Deficiency (Bu Zu), with the pathology located internally. If found on the left side, the disease is on the left side of the body; if found on the right, the disease is on the right. This interpretation follows the positional indication of the pulse. When a woman exhibits a man's pulse, it indicates Excess (Tai Guo), with the pathology located in the four limbs. If found on the left, the disease is on the left; if found on the right, the disease is on the right. This is what is meant by interpreting based on pulse position.

In a man exhibiting a woman's pulse, the Cun pulse should be strong but is instead weak, and the Chi pulse should be weak but is instead strong. This signifies an abundance of Yin Qi and the sinking of Yang Qi into Yin, hence termed Deficiency. Since Yin governs the interior, the disease is internal. Yang Qi entering Yin results in symptoms manifesting in Yin positions (interior/lower). In a woman exhibiting a man's pulse, the Cun pulse should be weak but is instead strong, and the Chi pulse should be strong but is instead weak. This signifies an abundance of Yang Qi and the transgression of Yin Qi into Yang, hence termed Excess. The four limbs belong to Yang; when Yin Qi follows Yang, symptoms manifest in Yang positions (limbs/exterior). The left and right sides refer to using the left and right pulse positions to verify the location of the disease on the corresponding sides of the body. Xu Shi stated: The Path of Yang is complete, while the Path of Yin is half. Thus, Yang receiving a Yin pulse indicates Deficiency, and Yin receiving a Yang pulse indicates Excess.

Commentary: Ding Jin stated: The Chi pulse in humans is like the roots of a tree; it should be robust, not weak. If a man exhibits a woman's pulse characterized by a strong Chi pulse, how can this be called Deficiency? If a woman exhibits a man's pulse characterized by a weak Chi pulse, how can this be called Excess? Presumably, when a man exhibits a woman's pulse and is termed Deficient, it is because the Cun pulse is weak, indicating insufficient Yang Qi internally, hence the disease is internal. When a woman exhibits a man's pulse and is termed Excessive, it is because the Cun pulse is strong, indicating excessive Yang Qi externally, hence the disease is in the limbs. This argument seems reasonable but should not be applied rigidly. It is true that the Chi pulse, as the root of the pulse, should be strong rather than weak. However, in cases of Yin Deficiency with Fire Hyperactivity, both Chi pulses may be洪大 (Hongda, flooding and forceful); is this not Deficiency? When Fire flares upward, both Cun pulses may be洪大 and forceful; is this not Excess? Furthermore, there are cases where both Cun pulses are vast and empty without force, requiring major tonification; or both Chi pulses are vast and empty without force, requiring raising Yang and dispersing fire. If the Cun pulse is larger than the Chi pulse and both are forceful, it indicates Yin Deficiency with Yang Excess, suitable for purgation. If the Chi pulse is larger than the Cun pulse and both are forceful, it indicates Yang Deficiency with Yin Excess, suitable for diaphoresis. However, the variations in pulse cannot be exhausted in a single statement. How can one treat it rigidly like a fixed bridge on a se (zither)? Yue Ren (Bian Que) demonstrated the Yin-Yang constitutions of men and women, and the variations of internal/external deficiency and excess, intending for students to infer other cases from one example. Learners should examine this carefully.