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Chapter 14 states: "There are 'Sun' (Loss) and 'Zhi' (Increase) pulses. What does this mean?"

The answer is: For the 'Zhi' pulse, two beats per exhalation indicate a normal pulse; three beats per exhalation indicate deviation from the standard (Li Jing); four beats per exhalation indicate depletion of essence (Duo Jing); five beats per exhalation indicate death; six beats per exhalation indicate termination of life. This constitutes the 'Zhi' pulse. What is the 'Sun' pulse? One beat per exhalation indicates deviation from the standard; one beat per two exhalations indicates depletion of essence; one beat per three exhalations indicates death; one beat per four exhalations indicates termination of life. This constitutes the 'Sun' pulse. The pathology of the 'Zhi' pulse progresses upward from below, whereas the pathology of the 'Sun' pulse progresses downward from above.

In a healthy person, the pulse beats twice per exhalation and twice per inhalation, totaling four beats per respiratory cycle. In cases of deep breathing (Tai Xi), it may beat five times. Exceeding this frequency is termed 'Zhi' (Increase), while falling short is termed 'Jian' (Decrease) or 'Sun' (Loss). The pathology of the 'Zhi' pulse moves upward against the normal flow, originating from the Kidney and reaching the Lung; the pathology of the 'Sun' pulse moves downward with the flow, originating from the Lung and reaching the Kidney. 'Deviation from the standard' refers to a pulse rate of six beats per respiratory cycle, which has already departed from the normal constant degree. If there are four beats per exhalation and four beats per inhalation, the total is eight or nine beats per cycle. This indicates chaotic Yang Qi, resulting in a rapid pulse (Shu Mai). A rapid pulse consumes Qi through heat; consumption leads to exhaustion of essence, hence termed 'Depletion of Essence'. Five beats per cycle is the onset of death; six beats per cycle signifies the end of life. However, a pulse rate of ten to twelve or thirteen beats per cycle represents an extremely rapid pulse, and one beat appearing only after four exhalations represents an extremely slow pulse; both are rare occurrences.

What diseases are caused by the 'Sun' pulse?

The answer is: First-degree loss affects the skin and hair, manifesting as contracted skin and fallen hair; second-degree loss affects the blood vessels, causing them to become deficient and unable to nourish the Zang and Fu organs; third-degree loss affects the muscles, causing emaciation where food intake fails to generate flesh; fourth-degree loss affects the sinews, causing flaccidity and inability to maintain posture; fifth-degree loss affects the bones, causing bone atrophy and inability to rise from bed. Conversely, these conditions pertain to the pathology of the 'Zhi' pulse. In cases progressing downward, bone atrophy preventing rising from bed leads to death; in cases progressing upward, contracted skin and fallen hair lead to death. This elaborates on the syndromes of the 'Sun' pulse. First-degree loss damages the Lung, which governs skin and hair; thus, Lung damage causes contracted skin and fallen hair. Second-degree loss damages the Heart, which governs blood vessels; thus, Heart damage causes blood deficiency and failure to nourish the organs. Third-degree loss damages the Spleen, which receives the five flavors and governs muscles; thus, Spleen damage results in loss of transformation and transportation, leading to muscle emaciation. Fourth-degree loss damages the Liver, which governs sinews; thus, Liver damage fails to fill the sinews, leading to flaccidity and inability to hold position. Fifth-degree loss damages the Kidney, which governs bones; thus, Kidney damage causes bone atrophy and inability to rise from bed. Progression from top to bottom implies damage spreading from the Lung to the Kidney, exhausting all five Zang organs, leading to death, as the Lung is superior. Progression from bottom to top implies damage spreading from the Kidney to the Lung, also exhausting all five Zang organs, leading to death, as the Kidney is inferior. Regarding the phrase "fan ci zhe, zhi yu shou bing," Hua Shi suggested it should read "mai zhi" (pulse of), but I believe Ding's interpretation "fan ci zhe, zhi zhi mai bing ye" (the opposite pertains to the disease of the Zhi pulse) is more accurate.

What is the treatment method for 'Sun' pulse conditions?

The answer is: For Lung loss, tonify its Qi; for Heart loss, regulate Ying and Wei; for Spleen loss, adjust diet and adapt to cold and warmth; for Liver loss, soothe the interior; for Kidney loss, benefit the essence. These are the methods for treating 'Sun' pulse conditions.

The Lung governs Qi; for Lung loss, it is appropriate to tonify Qi. The Heart governs blood vessels; for Heart loss, it is appropriate to regulate Ying and Wei so that blood vessels have sufficient resources. The Spleen receives grain flavors and governs muscles; for Spleen loss, it is appropriate to adjust diet and adapt to temperature changes to ensure robust transportation functions. The Liver stores blood and governs anger; anger injures the Liver. For Liver loss, it is appropriate to soothe the interior, consistent with the Classic saying "The Liver suffers from tension; eat sweet foods to relieve tension." The Kidney stores essence and governs bones; for Kidney loss, it is appropriate to benefit the essence. Generally, if the disease lies in a specific Zang organ, treatment should follow its location.

Pulses may present as two beats per exhalation and two per inhalation; three beats per exhalation and three per inhalation; four beats per exhalation and four per inhalation; five beats per exhalation and five per inhalation; six beats per exhalation and six per inhalation; one beat per exhalation and one per inhalation; one beat per two exhalations and one per two inhalations; or no beats during respiration. Given such variations, how can one distinguish the disease?

The preceding text generally described the sequence of Zang organ pathology; here, the 'Sun' and 'Zhi' pulses are listed again to seek the pathological form. Hua Shi stated: The previous 'Sun' and 'Zhi' referred to internal diseases originating from the Zang organs themselves. This section refers to external pathogens affecting meridians, blood, and Qi, varying in severity. The phrase "respiration twice" refers to one beat per exhalation and one per inhalation, likely a redundant text.

The answer is: A pulse of two beats per exhalation and two per inhalation, neither large nor small, is normal. Three beats per exhalation and three per inhalation indicate recent illness. If the front (Cun) is large and the back (Chi) is small, there is headache and dizziness; if the front is small and the back is large, there is chest fullness and shortness of breath. Four beats per exhalation and four per inhalation indicate worsening disease. If the pulse is洪大 (Hong Da / Surging and Large), the patient suffers from irritability and fullness; if 沉细 (Chen Xi / Deep and Fine), there is abdominal pain; if 滑 (Hua / Slippery), it indicates heat injury; if 涩 (Se / Choppy), it indicates injury from fog and dew. Five beats per exhalation and five per inhalation indicate the person is exhausted. If 沉细, symptoms worsen at night; if 浮大, symptoms worsen during the day. If neither large nor small, although exhausted, it is treatable. If the pulse sizes are inconsistent, it is difficult to treat. Six beats per exhalation and six per inhalation constitute a dying pulse; if 沉细, death occurs at night; if 浮大, death occurs during the day. One beat per exhalation and one per inhalation is named 'Sun' (Loss). Although the person can walk, they should be bedridden because Qi and Blood are both insufficient. One beat per two exhalations and one per two inhalations is named 'Wu Hun' (No Soul). Those with 'No Soul' will die. Although the person can walk, they are called a 'Walking Corpse'.

Four beats per cycle, or five with deep breathing, constitute a normal pulse. Three beats per exhalation and three per inhalation result in six or seven beats per cycle, two beats more than normal, indicating recent illness without severity, corresponding to the earlier concept of 'Deviation from Standard'. 'Front' refers to Cun, 'Back' refers to Chi. Cun large and Chi small indicate pathogenic Qi in Yang, representing turbid Qi ascending, causing headache and dizziness. Cun small and Chi large indicate pathogenic Qi in Yin, representing clear Qi sinking, failure of Spleen and Liver to ascend, and failure of Lung and Stomach to descend, causing chest fullness and shortness of breath. Four beats per exhalation and four per inhalation result in eight or nine beats per cycle, indicating worsening disease, corresponding to 'Depletion of Essence'. A surging and large pulse indicates Yang pathogen escaping outward, Gallbladder Qi reversing upward, and Fire rising, causing irritability. A deep and fine pulse indicates Yin pathogen sinking inward, Liver and Spleen sinking, and Earth being attacked, causing abdominal pain. A slippery pulse indicates blood excess and heat; a choppy pulse indicates dampness injury, hence 'injury from fog and dew'. This distinguishes disease severity based on pulse images, guiding students to differentiate diseases and expand their understanding. Five beats per exhalation and five per inhalation result in over ten beats per cycle, indicating severe exhaustion nearing death. Night is Yin, Day is Yang. Deep and fine pulses indicate Yin excess, worsening at night; floating and large pulses indicate Yang excess, worsening during the day. 'Large' means floating and large; 'Small' means deep and fine. If neither large nor small, symptoms do not worsen day or night, Yin and Yang are balanced, and it is treatable. If irregular, it is difficult to treat. One beat per exhalation and one per inhalation results in two or three beats per cycle, classified as 'Sun' due to Qi and Blood deficiency. Although able to walk, prolonged cases will remain bedridden. One beat per two exhalations and one per two inhalations is extremely slow; the soul has departed, life is severed, resembling a walking corpse, hence 'Walking Corpse'.

If there is pulse in the upper part but none in the lower part, the person should vomit; if they do not vomit, they will die. If there is no pulse in the upper part but pulse in the lower part, although exhausted, there is no major harm. This is because having a Chi pulse is like a tree having roots; even if branches and leaves wither, the root will sustain new growth. Pulses have roots; humans have Yuan Qi (Primary Qi), so death is avoided.

Upper part refers to Cun Kou; lower part refers to Chi Zhong. Upper pulse present, lower absent, indicates pathogenic excess in the upper Jiao, blocking Yang Qi from descending. Vomiting causes Qi to reverse upward, so the pulse rises, making the lower absence due to vomiting, not true root loss. Without vomiting, it indicates no pathogen above but Qi exhaustion below, hence death. Upper pulse absent, lower present, though exhausting, is harmless because pulses rely on Yuan Qi for circulation. If Yuan Qi is intact, pulses regenerate. Upper absence is merely temporary Qi and Blood stagnation; upon recovery, pulses return. Thus, having a Chi pulse is like a tree having roots. Yue Ren (Bian Que) extended the meaning of 'Sun' and 'Zhi' to show that absent pulses have two causes and cannot be uniformly deemed fatal.

Commentary: 'Sun' pulse is a slow pulse; 'Zhi' pulse is a rapid pulse. Why use 'Sun' and 'Zhi' instead of 'Slow' and 'Rapid'? Slow and Rapid pulses encompass Cold/Heat, Exterior/Interior, Deficiency/Excess broadly. Yue Ren feared misunderstanding, so he defined 'Zhi' as four to twelve/thirteen beats per cycle, and 'Sun' as two beats per cycle down to one beat per two cycles. He clarified that 'Sun' pathology proceeds downward from Lung Qi deficiency to Kidney Yang exhaustion, while 'Zhi' pathology proceeds upward from Kidney Yin deficiency to Lung Qi exhaustion. However, the origin of 'Sun' pathology begins in the Lung; if untreated, it spreads to Heart, Spleen, Liver, and Kidney. The 'Sun' pulse may reverse into a 'Zhi' pulse due to Kidney deficiency and fire dryness, spreading from Kidney to Liver, Spleen, Heart, and Lung, leading to death. Hence, "the opposite pertains to the disease of the Zhi pulse." I have seen deficiency-cold conditions presenting with restless rapid pulses in late stages due to failure to apply 'Sun' treatment methods and delayed Yang support, leading to Yin exhaustion. Supporting Yang means supporting Stomach Yang and benefiting damaged Zang organs, not merely using Ginger, Cinnamon Twig, Aconite, or Typha. Furthermore, modern physicians often use 'Xu Lao' (Deficiency Consumption) as a general term for weakness, unaware that Xu Sun (Deficiency Loss) progresses downward, while Lao Zhai (Tuberculosis/Consumption) progresses upward. Treating Xu Sun with Lao Zhai methods often causes diarrhea; treating Lao Zhai with Xu Sun methods causes panting. Failing to distinguish these leads to contradictory treatments. This stems from ignorance of 'Sun' and 'Zhi'. Yue Ren used 'Sun' and 'Zhi' pulses to clarify treatments for Xu Sun and Lao Zhai. Fearing that later generations might confuse acute absent pulses with 'Sun' pulses, he clarified upper/lower pulse differences and emphasized Yuan Qi to conclude this chapter. Students should pay close attention to this.