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(If the pathogenic factor) is extinguished in the exterior, yet the physician instead tonifies the Kidney and Liver. (The Kidney and Liver govern the interior; the Heart and Lung govern the exterior. "Tonify" here refers to the tonification method of acupuncture.) To tonify Yin when Yang is exhausted, or to tonify Yang when Yin is exhausted, (The Heart and Lung belong to Yang; the Kidney and Liver belong to Yin,) this is called making the excess more excessive and the deficiency more deficient, damaging what is insufficient and benefiting what is already in surplus. (What is termed "exhausted" is deficiency, i.e., insufficiency; what is termed "not exhausted" is excess, i.e., surplus. Tonifying what should not be tonified will make the exhausted state even more perilous.) Death resulting from such circumstances is caused by the physician killing the patient. (This means the disease does not necessarily lead to death, but the physician's mismanagement causes it.)

Chapter 13 states: The classic says that if one observes the facial color but fails to obtain the corresponding pulse, and instead obtains a pulse that overcomes (Sheng) the color, death will ensue; if a pulse that generates (Sheng) the color is obtained, the disease will resolve spontaneously. Facial color and pulse should correspond with each other; how should this be done? (This passage appears in *Ling Shu: Pathogenic Factors and Zang-Fu Manifestations*. The meanings of overcoming and generating are explained below.)

The response is: The Five Zang organs have five colors, all manifested on the face, which should also correspond with the Cun Kou pulse and the skin of the Chi area. (The manifestation of the five colors is described below, indicating that whichever Zang organ is diseased will manifest its corresponding color. "Cun Kou" refers to the pulse, while "Chi Nei" refers to the skin of the Chi area, as clarified in the subsequent text.)

For example, if the facial color is green (Qing), the pulse should be Wiry (Xian) and rapid (Ji); if red (Chi), the pulse should be Floating (Fu), Large (Da), and Scattered (San); if yellow (Huang), the pulse should be Moderate (Zhong), Slow (Huan), and Large (Da); if white (Bai), the pulse should be Floating (Fu), Choppy (Se), and Short (Duan); if black (Hei), the pulse should be Deep (Chen), Soft (Ru), and Slippery (Hua). This is what is meant by the correspondence between the five colors and the pulses. (*Ling Shu: Five Colors* states: "Green belongs to the Liver, Red to the Heart, White to the Lung, Yellow to the Spleen, Black to the Kidney." Wiry, rapid, floating, large, and scattered are the fundamental pulses of the Five Zang organs. *Ling Shu: Pathogenic Factors and Zang-Fu Manifestations* states: "Those with green faces have wiry pulses; those with red faces have hook-like pulses; those with yellow faces have intermittent pulses; those with white faces have hair-like pulses; those with black faces have stone-like pulses." This can be cross-referenced with the above.) If the pulse is Rapid (Shu), the skin of the Chi area also feels hot (Shu); if the pulse is Urgent (Ji), the skin of the Chi area is also tense (Ji); if the pulse is Slow (Huan), the skin of the Chi area is also relaxed (Huan); if the pulse is Choppy (Se), the skin of the Chi area is also rough (Se); if the pulse is Slippery (Hua), the skin of the Chi area is also smooth (Hua). (This is what is meant by correspondence with the Chi area skin.)

The Five Zang organs each have associated sounds, colors, odors, and tastes, which should correspond with the Cun Kou pulse and the Chi area skin. If there is no correspondence, it indicates disease.

For example, if the facial color is green, the pulse should be Wiry and rapid. If a Floating, Choppy, and Short pulse is seen, or a Large and Slow pulse, this indicates an Overcoming (Xiang Sheng/Ke) relationship. If a Floating, Large, and Scattered pulse is seen, or a Small and Slippery pulse, this indicates a Generating (Xiang Sheng) relationship. (Green color belongs to the Liver; a Floating, Choppy, and Short pulse is a Lung pulse, where the pulse overcomes the color, hence "Overcoming"; a Large and Slow pulse is a Spleen pulse, where the color overcomes the pulse, hence also "Overcoming". A Floating, Large, and Scattered pulse is a Heart pulse, where the color generates the pulse; a Small and Slippery pulse is a Kidney pulse, where the pulse generates the color, hence "Generating".)

The classic states that knowing one aspect makes one a Lower-grade practitioner (Xia Gong), knowing two makes one a Middle-grade practitioner (Zhong Gong), and knowing three makes one an Upper-grade practitioner (Shang Gong). An Upper-grade practitioner cures nine out of ten cases, a Middle-grade practitioner eight out of ten, and a Lower-grade practitioner six out of ten. This is what is meant. (Knowing one refers to being able to clarify one among color, pulse, and Chi skin. "Quan" refers to avoiding mismanagement and curing the disease.)

Chapter 14 states: Pulses include Sun (Damaging) and Zhi (Increasing) types. What does this mean? (Few beats are termed Sun; many beats are termed Zhi.)

The response is: In Zhi pulses, two beats per exhalation indicate a Normal Pulse (Ping); three beats per exhalation indicate Li Jing (Departing from the Standard); four beats per exhalation indicate Duo Jing (Depletion of Essence); five beats per exhalation indicate Si (Death); six beats per exhalation indicate Ming Jue (Extinction of Life). These are Zhi pulses. What are Sun pulses? One beat per exhalation indicates Li Jing; two breaths for one beat indicate Duo Jing; three breaths for one beat indicate Si; four breaths for one beat indicate Ming Jue. These are Sun pulses. (Normal refers to adhering to regularity. Li Jing means departing from normal physiological patterns. Duo Jing means essence has been depleted. Si indicates inevitable death. Ming Jue means vital energy is extinct, leaving only pulse movement, which will soon cease with respiration.)

Zhi pulses progress from bottom to top; Sun pulses progress from top to bottom. (Heart and Lung are upper; Kidney and Liver are lower.) How do diseases caused by Sun pulses manifest?

The response is: First-degree Sun damages the skin and hair, causing skin contraction and hair loss; Second-degree Sun damages the blood vessels, causing vessel deficiency and inability to nourish the Five Zang and Six Fu organs; Third-degree Sun damages the muscles, causing muscle emaciation and inability of food to transform into flesh; Fourth-degree Sun damages the sinews, causing flaccidity and inability to self-control; Fifth-degree Sun damages the bones, causing bone atrophy and inability to rise from bed. The reverse of this applies to Zhi pulses. (Regarding the characters "Yu Shou", Master Hua noted they likely should be "Mai Zhi". *Ling Shu: Nine Needles* states the Lung governs skin, Heart governs vessels, Spleen governs muscles, Liver governs sinews, and Kidney governs bones. Skin contraction refers to withering and shrinking. Among the Zang organs, the Lung is highest and the Kidney lowest; moving from Lung to Kidney is what is meant by "from top to bottom". The reverse describes Zhi pulse diseases, moving from Kidney to Lung, i.e., "from bottom to top".) For those progressing from top to bottom (Sun pulses), bone atrophy preventing rising from bed indicates death; for those progressing from bottom to top (Zhi pulses), skin contraction and hair loss indicate death. (This judges the time of death for Zhi and Sun pulses. Generally, Sun corresponds to Slow (Chi) pulses, which belong to Cold, thus affecting the exterior first. Zhi corresponds to Rapid (Shuo) pulses, which belong to Heat, thus affecting the interior first. After prolonged transmission, both interior/exterior and surface/deep levels become diseased, rendering treatment impossible.) How should Sun diseases be treated?

The response is: For Lung damage, benefit its Qi; for Heart damage, regulate Ying and Wei; for Spleen damage, adjust diet and adapt to cold/warmth; for Liver damage, soothe its center; for Kidney damage, benefit its Essence. This is the method for treating Sun diseases. (The Lung governs Qi, so benefit its Qi. Ying and Wei are filled by blood. Diet and temperature regulation are the sources of muscle formation. "Soothing the center" follows the classic principle: "The Liver dislikes constraint; eat sweet foods to soothe it." Essence is stored by the Kidney. Generally, treat according to the affected Zang organ.)

The response continues: Two beats per exhalation and two per inhalation, neither large nor small, is a Normal Pulse. Three beats per exhalation and three per inhalation indicate recent onset of disease (Shi De Bing, meaning Li Jing, merely having a disease pulse). If the front (Cun) is large and the back (Chi) is small, headache and dizziness occur; if the front is small and the back is large, chest fullness and shortness of breath occur. (Front refers to Cun, back to Chi. Front large/back small indicates pathogenic Qi in Yang, causing headache/dizziness. Front small/back large indicates pathogenic Qi in Yin, causing chest fullness/shortness of breath.) Four beats per exhalation and four per inhalation indicate worsening disease (Bing Yu Shen, meaning Duo Jing, disease deepening). If the pulse is Surging (Hong) and Large (Da), there is vexation and fullness; if Deep (Chen) and Fine (Xi), there is abdominal pain; if Slippery (Hua), heat injury occurs; if Choppy (Se), mist/dew dampness invades. (Surging/Large indicates Yang pathogen escaping outward, causing vexation/fullness. Deep/Fine indicates Yin pathogen sinking inward, causing abdominal pain. Slippery indicates blood excess, hence heat. Choppy indicates dampness injury, hence mist/dew invasion. This distinguishes diseases within four beats per breath, serving as an example; readers should deduce further based on observed pulse qualities.) Five beats per exhalation and five per inhalation indicate the person is distressed (Kun, near death). If Deep/Fine, symptoms worsen at night; if Floating/Large, symptoms worsen during the day. If neither large nor small, though distressed, it is treatable; if varying in size, it is difficult to treat. (Deep/Fine belongs to Yin, worsening at night. Floating/Large belongs to Yang, worsening during the day. Large refers to Floating/Large; Small refers to Deep/Fine. If neither large nor small, symptoms do not worsen diurnally/nocturnally, hence treatable. If varying, symptoms progress throughout day and night, hence difficult. "Neither large nor small" corresponds to *Ling Shu: Forbidden Regulations*: "like a rope of equal thickness"; if uneven, it is difficult to treat.) Six beats per exhalation and six per inhalation are Death Pulses (Si Mai). If Deep/Fine, death occurs at night; if Floating/Large, death occurs during the day. (Death pulse is synonymous with Ming Jue.) One beat per exhalation and one per inhalation is named Sun Pulse. Though the person can walk, they will eventually need to stay in bed, because Qi and Blood are both insufficient. (Though able to walk, they will ultimately not rise. Insufficient Qi/Blood explains the cause of the Sun pulse.) Two breaths for one beat is named Wu Hun (No Soul). Those with No Soul will die. Though able to walk, they are called "Walking Corpses". (No Soul means the soul qi has departed. Walking Corpse means life is extinguished, like a corpse walking.) 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. (Vomiting causes Qi rebellion upward, so the pulse rises accordingly; lower pulse absence is due to vomiting, not true root loss. If no vomiting and no lower pulse, the pulse is truly absent, not due to Qi rebellion, hence death.) If there is no pulse in the upper part but pulse in the lower part, though distressed, it is harmless. Why? It is like a tree having roots; even if branches and leaves wither, the root survives. Pulses have roots; humans have Yuan Qi (Primal Qi), so death is avoided.

Chapter 15 states: The classic says Spring pulse is Wiry (Xian), Summer is Hook-like (Gou), Autumn is Hair-like (Mao), Winter is Stone-like (Shi). Are these Wang (Prosperous) pulses or Bing (Disease) pulses? (Passage found in *Su Wen: Plain Person Meteorological Theory* and *Jade Machine True Viscera Theory*.)

The response is: Wiry, Hook, Hair, and Stone are the pulses of the Four Seasons. (Four Season pulses refer to pulses responding to the seasons, i.e., Prosperous pulses.) Spring pulse is Wiry because the Liver belongs to East Wood. When things begin to grow, without branches or leaves, the pulse comes soft-weak and long, hence Wiry. (Soft-weak and long is the correct image of Wiry; otherwise, it is Excess or Deficient.) Summer pulse is Hook-like because the Heart belongs to South Fire. When things flourish, branches hang down like hooks, so the pulse comes rapidly and departs slowly, hence Hook-like. (Coming rapidly means slightly urgent and strong; departing slowly means slightly slow and weak, i.e., bending down like a hook.) Autumn pulse is Hair-like because the Lung belongs to West Metal. When things end, flowers and leaves fall in autumn, leaving only branches like hairs, so the pulse comes light, empty, and floating, hence Hair-like. (Only branches remaining, like hairs, means no support on four sides and very light body.) Winter pulse is Stone-like because the Kidney belongs to North Water. When things are stored, in deep winter water freezes like stone, so the pulse comes deep, soft, and slippery, hence Stone-like. These are the Four Season pulses. (Winter Qi gathers, so it is deep and slippery, the image of water. Regarding Zang organs and Five Elements, each has specific associations, but Spring/Summer/Autumn pulses use Wood as metaphor because Wood changes with seasons.) What if there are abnormalities? (Abnormality means deviation from norm.)

The response is: Spring pulse is Wiry; reversal indicates disease. What is reversal?

The response is: If Qi comes solid and strong, it is called Excess (Tai Guo), disease in the Exterior; if Qi comes empty and slight, it is called Deficiency (Bu Ji), disease in the Interior. (Excess belongs to Yang, manifesting in the exterior. Deficiency belongs to Yin, timid in the interior.) If Qi comes faintly and softly, like touching elm leaves, it is Normal; (Faintly, Wang Bing's commentary on *Su Wen* considers it floating, thin, and empty.) if more solid and slippery, like touching a long bamboo pole, it is Disease; (These are images of Wiry Excess.) if urgent, strong, and rigid, like a newly strung bowstring, it is Death. (This is the extreme of Wiry, i.e., True Viscera Pulse.) Spring pulse slightly Wiry is Normal; much Wiry with little Stomach Qi is Disease; purely Wiry without Stomach Qi is Death. Spring takes Stomach Qi as the root. Summer pulse is Hook-like; reversal indicates disease. What is reversal?

The response is: If Qi comes solid and strong, it is Excess, disease in Exterior; if Qi comes empty and slight, it is Deficiency, disease in Interior. If pulse comes continuously like a ring, like touching Lang Gan (jade-like stone), it is Normal; (Like a ring, *Su Wen* says "like linked pearls," indicating fullness. Lang Gan is a jade-like stone.) if coming more rapidly, like a chicken lifting its foot, it is Disease; (Indicates solid and strong.) if front curved and back straight, like holding a belt hook, it is Death. (Straight/Zhu, Wang Bing notes: "immovable". Belt hook is curved and hard.) Summer pulse slightly Hook-like is Normal; much Hook-like with little Stomach Qi is Disease; purely Hook-like without Stomach Qi is Death. Summer takes Stomach Qi as the root. Autumn pulse is Hair-like; reversal indicates disease. What is reversal?

The response is: If Qi comes solid and strong, it is Excess, disease in Exterior; if Qi comes empty and slight, it is Deficiency, disease in Interior. If pulse comes abundant like a chariot canopy, pressing makes it larger, it is Normal; (Chariot canopy, indicating floating, large, and empty.) neither up nor down, like touching chicken feathers, it is Disease; (Wang Bing notes: "firm in center, empty on sides.") pressing reveals desolation, like wind blowing feathers, it is Death. (*Su Wen* says: like floating object, like wind blowing feathers, is Lung Death. "Wang Bing says: like floating object, flickering; like wind blowing feathers, chaotic. 'Generally implies light, empty, and chaotic meaning'.") Autumn pulse slightly Hair-like is Normal; much Hair-like with little Stomach Qi is Disease; purely Hair-like without Stomach Qi is Death. Autumn takes Stomach Qi as the root. Winter pulse is Stone-like; reversal indicates disease. What is reversal?

The response is: If Qi comes solid and strong, it is Excess, disease in Exterior; if Qi comes empty and slight, it is Deficiency, disease in Interior. If pulse comes large above and sharp below, soft and slippery like a sparrow pecking, it is Normal; (Sparrow pecking, large above and sharp tip.) pecking continuously, slightly curved in middle, it is Disease, (Pecking continuously, beating hand and frequent. Slightly curved in middle, resembling Hook.) coming like untying a rope, departing like flicking stone, it is Death. (Untying rope, tight and scattered; flicking stone, rapid and hard. *Su Wen* says: "Hair like seizing rope, crackling like flicking stone, is Kidney Death".) Winter pulse slightly Stone-like is Normal; much Stone-like with little Stomach Qi is Disease; purely Stone-like without Stomach Qi is Death. Winter takes Stomach Qi as the root. The Stomach is the Sea of Water and Grain, (Water and grain gather in Stomach, like sea gathering waters.) governing provision for the Four Seasons, (Stomach belongs to Earth, Earth prospers in four seasons, hence governing provision for four seasons.) all taking Stomach Qi as the root. This is called the variable diseases of the Four Seasons, the key to life and death. The Spleen is the Central Region (Zhong Zhou). Its peaceful state cannot be seen; (Central Region means among the four Zang organs; when four Zang are peaceful, Spleen pulse is included, hence unseen.) it is seen only when declining. Coming like sparrow pecking, like water leaking down, is the manifestation of Spleen decline. (Sparrow pecking, firm and sharp. Water leaking, intermittent and irregular.)

Chapter 16 states: Pulses have Three Parts and Nine Locations, Yin and Yang, Light and Heavy, Sixty Heads, one pulse changing into Four Seasons. (Three Parts/Nine Locations detailed in *Su Wen: Three Parts Nine Locations*. Yin/Yang in Chapter 4. Light/Heavy in Chapter 5. Sixty Heads in *Su Wen: Abundance and Decline*, Wang Bing notes meaning lost, or refers to sixty days prosperity. One pulse changing into Four Seasons in Chapter 15. But subsequent questions lack explanation, suspecting omission/error.) Distance from Sages is long, each insists on their methods, how to distinguish?

The response is: Because diseases have Exterior and Interior manifestations. (Injuries causing disease are verified by manifestations; disease combines while manifestations differentiate.) What are the diseases?

The response is: For example, obtaining Liver pulse (Five Zang pulse bodies detailed in Chapter 13). Exterior manifestations: Love cleanliness, (Liver pairs with Gallbladder, Gallbladder is clear/pure fu, hence love cleanliness.) Green face, prone to anger; (*Su Wen: Yin-Yang Ying Xiang Da Lun*: Liver "color is blue/green", "emotion is anger".) Interior manifestations: Moving Qi at left of umbilicus, firm and painful upon pressure; (*Su Wen: Acupuncture Taboos*: "Liver born on left", left of umbilicus is Liver position. Moving Qi is true Qi failing to store and manifest externally. Firm means Qi knotting and hard. Pain means Qi stagnating.) Disease: Limb fullness/blockage, (Fullness means blockage. Limbs belong to Liver, *Zuo Zhuan*: "Wind induces terminal diseases".) Urinary obstruction/dysuria, difficult urination, (*Ling Shu: Meridians*: Foot Jueyin Liver meridian runs along inner thigh, knots at genitalia, hence urinary issues.) Tendon cramping. (*Ling Shu: Nine Needles*: "Liver governs tendons", hence tendon disease.) Having these indicates Liver disease; lacking them indicates non-Liver disease. (These refer to above symptoms. Without these, even with Liver pulse, disease is not in Liver.) For example, obtaining Heart pulse. Exterior manifestations: Red face, (*Su Wen*: Heart "color is red".) Dry mouth, (Heart Qi connects to tongue, Fire flaming upward causes dryness.) Laughter; (*Su Wen*: Heart "sound is laughter".) Interior manifestations: Moving Qi above umbilicus, (Above umbilicus is Heart position.) firm and painful upon pressure; Disease: Vexed heart, Heart pain, (Disease in the Zang itself.) Hot palms and hiccups/vomiting. (*Ling Shu: Meridians*: Hand Shaoyin Heart meridian "enters palm", hence hot palms. Hiccups/vomiting. *Su Wen: Supreme Essentials*: "All rebellious upward movements belong to Fire".) Having these indicates Heart disease; lacking them indicates non-Heart disease. For example, obtaining Spleen pulse. Exterior manifestations: Yellow face, (*Su Wen*: Spleen "color is yellow".) Frequent belching, (Yi is belching. *Ling Shu: Mouth Questions*: "Cold qi lodges in Stomach, Rebellious Qi scatters upward from below, exits Stomach again, hence belching." Spleen pairs with Stomach, hence same disease.) Frequent thinking, (*Su Wen*: Spleen "emotion is thought".) Keen taste; (*Su Wen*: Spleen "orifice is mouth", hence governs taste.) Interior manifestations: Moving Qi at umbilicus, firm and painful upon pressure; (At umbilicus, Spleen is central.) Disease: Abdominal fullness, (*Su Wen: Golden Cabinet True Meanings*: "Abdomen is Yin, Yin among Yin is Spleen." Hence disease in abdomen.) Food indigestion, (Spleen grinds food.) Heavy body, (Spleen governs muscles.) Joint pain, (*Su Wen: Flaccidity Syndrome*: Yangming "binds bones and facilitates joints", Spleen pairs with Stomach, hence also governs joints.) Lethargy and desire to sleep, (Fatigue also belongs to Spleen.) Limbs unable to hold/restrain. (Spleen governs limbs.) Having these indicates Spleen disease; lacking them indicates non-Spleen disease. For example, obtaining Lung pulse. Exterior manifestations: White face, (*Su Wen*: Lung "color is white".) Frequent sneezing, (*Ling Shu: Mouth Questions*: "Yang Qi harmonious and beneficial, fills Heart, exits Nose. Hence sneezing. Lung Qi connects to Nose, hence sneezing.") Sadness, sorrow, unhappiness, desire to cry; (*Su Wen*: Lung "emotion is grief", "sound is crying".) Interior manifestations: Moving Qi at right of umbilicus, firm and painful upon pressure; (*Su Wen: Acupuncture Taboos*: "Lung stored on right", right of umbilicus is Lung position.) Disease: Asthma and cough, (Lung governs Qi, Qi rebellion causes asthma/cough.) Chills and fever. (Lung governs skin/hair.) Having these indicates Lung disease; lacking them indicates non-Lung disease. For example, obtaining Kidney pulse. Exterior manifestations: Black face, (*Su Wen*: Kidney "color is black".) (Fear. *Su Wen*: "Emotion is fear".) Yawning; (*Ling Shu: Mouth Questions*: "Yin Qi accumulates below, Yang Qi not exhausted, Yang pulls upward, Yin pulls downward, Yin-Yang pull each other, hence frequent yawning." Also: "Kidney governs yawning".) Interior manifestations: Moving Qi below umbilicus, firm and painful upon pressure; (Kidney resides lowest)