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(Below, at the lower abdomen, is the location of the Kidney.) Its diseases: rebellious Qi (rebellious Qi), (when the Qi below fails to store, it rebels upward.) acute pain in the lower abdomen, (the Kidney governs the lower part, so the disease manifests in the lower abdomen.) diarrhea with a sensation of heaviness and bearing down (bearing down sensation), (Mr. Hua said: "Ru" reads as "er". The Kidney governs the two yin orifices; bearing down indicates Qi sinking and failing to hold.) coldness and reversal coldness in the feet and shins. (The *Ling Shu · Jing Mai Chapter* states that the Foot Shaoyin Kidney meridian "follows behind the medial malleolus, branches into the heel, and goes up internally", hence the disease presents thus. Having these signs indicates Kidney disease; not having them indicates otherwise.)

Chapter 17 says: The classics state that some diseases lead to death, some heal without treatment, and some persist for years. (This is also a misquotation of the classic text, not the full original text.) Can one know life and death, survival and demise, by palpating the pulse?

It is replied: One can know it completely. If a patient closes their eyes and does not wish to see people, (this is a presenting syndrome of Liver disease; the Liver and Gallbladder are interior-exterior partners; Liver disease leads to deficient Gallbladder Qi, hence closing eyes and avoiding people.) the pulse should present as a Liver pulse, strong, tight, and long, (this is the intrinsic pulse of the Liver.) but if instead a Lung pulse, floating, short, and choppy, is found, death will occur. (The syndrome belongs to Wood, the pulse to Metal; Metal overacts on Wood, constituting a destructive relationship.) If a patient opens their eyes and feels thirsty, with a firm obstruction in the heart region, (this is a presenting syndrome of Heart disease; the Heart governs heat; excessive heat causes open eyes and thirst.) the pulse should be tight, solid, and rapid, (this is the intrinsic pulse of the Heart.) but if instead a deep, choppy (or soggy), and faint pulse is found, death will occur. (This is the intrinsic pulse of the Kidney. The syndrome belongs to Fire, the pulse to Water; Water overacts on Fire, constituting a destructive relationship.) If a patient vomits blood and also suffers from epistaxis or oral bleeding, the pulse should be deep and fine, but if instead a floating, large, and firm pulse is found, death will occur. (This is another principle, not discussed in terms of generation and restriction, but rather "deficient disease with excess pulse," which leads to death. The *Ling Shu · Yu Ban Chapter* says: "Epistaxis that does not stop, with a large pulse, this is the third adverse sign," which is the same meaning here.) If a patient speaks deliriously and妄语 (makes nonsensical statements), the body should have heat, and the pulse should be洪大 (surging and large), but if instead the hands and feet are cold, and the pulse is deep, fine, and faint, death will occur. (This is an excess disease with a deficient pulse. Cold hands and feet are mentioned as a concurrent symptom.) If a patient has abdominal distension and diarrhea, the pulse should be faint, fine, and choppy, but if instead a tight, large, and slippery pulse is found, death will occur. (This is also a deficient disease with an excess pulse. The *Ling Shu · Yu Ban Chapter* says: "Borborygmus and fullness, cold limbs, diarrhea, with a large pulse, this is the second adverse sign.")

Chapter 18 says: There are three positions in the pulse, each position having four meridians, (The three positions are Cun, Guan, Chi. The four meridians refer to each Cun, Guan, and Chi position on both hands corresponding to one Zang organ and one Fu organ.) the Hand meridians include Taiyin and Yangming, (Hand Taiyin belongs to the Lung, Hand Yangming belongs to the Large Intestine, both are diagnosed at Right Cun.) the Foot meridians include Taiyang and Shaoyin, (Foot Taiyang belongs to the Bladder, Foot Shaoyin belongs to the Kidney, both are diagnosed at Left Chi.) these are called the upper and lower parts. What does this mean?

It is replied: Hand Taiyin and Yangming belong to Metal; Foot Shaoyin and Taiyang belong to Water. Metal generates Water; water flows downward and cannot go up, hence they are in the lower part. (This discusses the cyclic generation between left and right hands.) Foot Jueyin and Shaoyang belong to Wood, (Foot Jueyin belongs to the Liver, Shaoyang belongs to the Gallbladder, both are diagnosed at Left Guan.) Wood generates Hand Taiyang and Shaoyin Fire, (Hand Taiyang belongs to the Small Intestine, Hand Shaoyin belongs to the Heart, both are diagnosed at Left Cun. Fire flares upward and cannot descend, hence they are in the upper part. Hand Jueyin Pericardium and Hand Shaoyang also belong to Fire, (Hand Jueyin is the Pericardium of the Heart. Hand Shaoyang belongs to the Sanjiao. Based on the context, they should be diagnosed at Right Chi.) generating Foot Taiyin and Yangming Earth, (Foot Taiyin belongs to the Spleen, Foot Yangming belongs to the Stomach, both are diagnosed at Right Guan.) Earth governs the Central Palace, hence they are in the middle part. These are all the mutual generation and nourishment of the Five Elements through mother-son relationships. (The above explains the meaning of the upper and lower divisions of the three positions and four meridians; the following text discusses the diseases governed by them.) The pulse has three positions and nine inspections. What does each govern?

It is replied: The three positions are Cun, Guan, and Chi. The nine inspections are Floating, Middle, and Deep. (Each of the three positions has Floating, Middle, and Deep, hence nine.) The upper part models Heaven and governs diseases from the chest up to the head; (This is stated by body part, not by meridian.) the middle part models Humanity and governs diseases from below the diaphragm to the navel; the lower part models Earth, (these four characters appear in some versions as "Chi is the lower part, modeling and responding to Earth.") governing diseases from below the navel to the feet. (This corresponds to what is said in the *Su Wen · Mai Yao Jing Wei Lun*: "Shang Jing Shang refers to matters of the chest and throat. Xia Jing Xia refers to matters of the lower abdomen, waist, thighs, knees, shins, and feet." "However, its pulse diagnosis method differs slightly from this.") One must examine carefully before applying acupuncture. (Meaning: examine the upper and lower locations of the disease and needle accordingly, so as not to apply needles erroneously. Xie Shi in the *Ben Yi* believes "this section should be the answer to Chapter 16," which does not connect well with the following text; his view is close to being correct.)

Can one know chronic stagnation and long-standing accumulations by palpating the pulse?

It is replied: When diagnosing, if there is accumulated Qi in the right hypochondrium, (Accumulated Qi refers to the Qi of accumulation,) the Lung pulse presents as Jie (knotted). (The right hypochondrium is the area of the Lung. Jie pulse is the pulse of accumulation. The *Su Wen · Ping Ren Qi Xiang Lun* says: "Jie and horizontal indicates accumulation.") If the Jie pulse is severe, the accumulation is severe; if slight, the accumulation is slight. If the Lung pulse is not obtained, but there is accumulated Qi in the right hypochondrium, why is this?

It is replied: Although the Lung pulse is not seen, the Right Hand pulse should be Fu (hidden/deep) and Chen (deep). (Chen and Fu pulses are also pulses of accumulated Qi. "Right hand" generally refers to the three positions, so the Lung pulse is included within it. Also, the Qi Kou pulse on the right hand is used to diagnose interior conditions.) Is the method for external stubborn diseases the same? Or is it different? (Stubborn diseases refer to any illness lingering in muscles, sinews, bones, and joints for a long time; because it is not in the Zang-Fu organs, it is called external.)

It is replied: Jie means the pulse comes and goes with occasional stops, without a fixed number, (No fixed number is the image of the Jie pulse. If there is a fixed number, such as stopping every forty beats or every thirty beats, it is a Dai pulse, indicating death, not just accumulation. The reason for the Jie pulse is that there is accumulation inside, blocking the pulse channels, hence the pulse presents thus.) it is named Jie. Fu means the pulse runs beneath the sinews. Floating means the pulse runs above the flesh. This applies to left and right, exterior and interior. (Meaning: Jie and Fu indicate disease in the interior; Jie and Floating indicate disease in the exterior; Jie on the right indicates disease on the right; Jie on the left indicates disease on the left. By inferring from this, for internal/external, left/right accumulations and stubborn diseases, the Jie pulse is the same, but Floating/Fu differ, hence "the method is the same.") If the pulse is Jie and Fu, but there is no internal accumulation; if the pulse is Floating and Jie, but there is no external stubborn disease; if there is accumulation but the pulse is not Jie and Fu; if there is stubborn disease but the pulse is not Floating and Jie, this is pulse not corresponding to disease, and disease not corresponding to pulse, which is a fatal condition. (When disease and pulse do not correspond, it means the True Qi has dissipated and the blood vessels are no longer connected, hence it is called fatal.)

Chapter 19 says: The classics state that pulses have Ni (reverse) and Shun (smooth), and men and women have constant patterns, but what does it mean when they are reversed? (Obtaining the appropriate pulse is Shun; not obtaining it is Ni. Heng means constant, referring to fixed methods. Fan means reverse, referring to the opposition of strength above and below, as described below. The original text is lost.)

It is replied: Men are born in Yin, Yin is Wood, Yang. Women are born in Shen, Shen is Metal, Yin. (This traces the principles of heaven and earth giving birth to men and women to explain why pulses differ.)

It is replied: If a man obtains a woman's pulse (Yin pulse), it indicates insufficiency, and the disease is internal, (If a man obtains a Yin pulse, Yang sinks into Yin, hence insufficiency. Internal refers to inside the heart and abdomen. When Yang enters Yin, the disease manifests in Yin positions.) if obtained on the left, the disease is on the left; if on the right, the disease is on the right, following the pulse position. (This uses the left/right of the pulse to verify the left/right of the disease.) If a woman obtains a man's pulse (Yang pulse), it indicates excess, and the disease is in the four limbs, (If a woman obtains a Yang pulse, Yin exceeds into Yang, hence excess. The four limbs belong to Yang; when Yin follows Yang, the disease manifests in Yang positions.) if obtained on the left, the disease is on the left; if on the right, the disease is on the right, following the pulse position. This is called it. (The Way of Yang is complete, the Way of Yin is half; hence Yang obtaining Yin pulse is insufficiency, Yin obtaining Yang pulse is excess.)

Chapter 20 says: The classics state that pulses have Fu Ni (hidden and concealed). In which Zang organ is Fu Ni discussed? (The cited classic text is lost. Fu Ni means the pulse is not seen in its proper position but hides and appears in other positions.)

It is replied: It refers to Yin and Yang mutually overacting and mutually hiding. (Meaning it is not confined to one Zang organ.) If the pulse is in the Yin position (Chi), but Yang pulses appear, this is Yang overacting on Yin; (Yang pulse refers to the floating, slippery, and long pulse mentioned below.) although the pulse is sometimes deep, choppy, and short, this is Yin hidden within Yang. (Meaning although Yang overacts on Yin, Yin still hides within Yang.) If the pulse is in the Yang position (Cun), but Yin pulses appear, this is Yin overacting on Yang; (Yin pulse refers to the deep, choppy, and short pulse mentioned above.) although the pulse is sometimes floating, slippery, and long, this is Yang hidden within Yin. Extreme Yang leads to Mania (Kuang); extreme Yin leads to Catatonia (Dian). (This further elaborates on the extremes of Yin/Yang hiding. Extreme Yang/Yin means not just hiding, but Yin fully transforming to Yang, and Yang fully transforming to Yin. Kuang is a Yang disease, Dian is a Yin disease; when pathogenic Qi is excessive, it damages the Spirit, hence the disease presents thus. The *Su Wen · Bing Neng Lun* says: "Those who suffer from anger and mania... arise from Yang.") Those who lose Yang see ghosts; those who lose Yin go blind. (This follows from extreme Yin/Yang. Ghosts belong to Yin; if Yang is lost, it is purely Yin, hence seeing ghosts. Eyes see only when nourished by Blood; if Yin is lost, Blood does not nourish the eyes, hence blindness. This is the reverse of extreme Yin/Yang.)

Chapter 21 says: The classics state that if the body is diseased but the pulse is not, it is life; if the pulse is diseased but the body is not, it is death. What does this mean?

It is replied: Body diseased, pulse not diseased, does not mean the pulse is truly not diseased, (but refers to the respiration rate not matching the pulse rate.) (Meaning the pulse is not truly healthy. Generally, diagnosis uses normal respiration to adjust observation of the patient: two beats per exhalation, two beats per inhalation is the normal pulse rate. If the person is sick, respiration may be irregular and not match the pulse rate; or the pulse may be slow while respiration is appropriately slow, or pulse fast while respiration is appropriately rapid. If the doctor cannot examine this carefully, they assume no disease, but this is incorrect. Alternatively, if the doctor's own respiration is not regulated and matches the patient's, they cannot distinguish slow/fast, mistakenly thinking there is no disease; this interpretation is also plausible, though the original text is lost.) This is the general principle.

Chapter 22 says: The classics state that pulses have "Shi Dong" (is moving) and "Suo Sheng Bing" (diseases generated by it); how does one meridian become two diseases? (This is also not the full original text, but a summary of classic phrases. The word "pulse" here refers to the meridians. "Shi Dong" and "Suo Sheng Bing" are found in the *Ling Shu · Jing Mai Chapter*. The two diseases refer to the diseases listed under "Shi Dong" and those listed under "Suo Sheng Bing," which have distinct differences.)

It is replied: The classics say "Shi Dong" relates to Qi; "Suo Sheng Bing" relates to Blood. (Meaning the movement of the pulse is caused by Qi, while the diseases generated are caused by Blood.) Pathogen in Qi causes "Shi Dong"; pathogen in Blood causes "Suo Sheng Bing". (This again explains that Qi and Blood diseases arise due to pathogens.) Qi primarily provides warmth (Xu); Blood primarily provides nourishment (Ru). (Warmth implies steaming/heating. Ru implies moistening/nourishing.) If Qi stays and does not flow, (failing to warm,) it is Qi disease first; if Blood is obstructed (or stagnant) and does not nourish, (Obstruction means stagnation,) it is Blood disease later. Hence, first "Shi Dong," then "Suo Sheng." (Meaning when pathogens invade, they first injure Qi causing Qi disease, then affect Blood causing Blood disease, hence one meridian becomes two diseases.)

Chapter 23 says: Can the lengths of the Hand and Foot Three Yin and Three Yang meridians be explained?

It is replied: The Hand Three Yang meridians, (Three Yang, written as "Six Yang" in *Ling Shu · Mai Du Chapter*.) run from hand to head, (Hand Three Yang meridians start from finger tips and end at the head.) five chi long; multiplied by six (two hands times three meridians), totaling three zhang. (Five and six refers to combining both hands.) The Hand Three Yin meridians run from hand to chest center, (Hand Three Yin meridians also start from finger tips and reach the chest center.) three chi five cun long; three times six is one zhang eight chi, plus five chi for both hands, totaling two zhang one chi. The Foot Three Yang meridians run from foot to head, (Foot Three Yang start from toe tips to head.) eight chi long; six times eight is four zhang eight chi. The Foot Three Yin meridians run from foot to chest, (Foot Three Yin start from toe tips/soles to chest.) six chi five cun long; six times six is three zhang six chi, plus five chi for both hands, totaling three zhang nine chi. The two Foot Qiao meridians of a person run from foot to eye, seven chi five cun long; two times seven is one zhang four chi, plus five chi for both hands, totaling one zhang five chi. (Qiao meridians belong to the Extraordinary Vessels.)

It is replied: The meridians circulate Qi and Blood, connect Yin and Yang, and nourish the body. They begin at the Middle Jiao, injecting into Hand Taiyin and Yangming; (Nourishment originates from the Middle Jiao, hence the pulse starts there.) Yangming injects into Foot Yangming and Taiyin; Taiyin injects into Hand Shaoyin and Taiyang; Taiyang injects into Foot Taiyang and Shaoyin; Shaoyin injects into Hand Jueyin Pericardium and Shaoyang; Shaoyang injects into Foot Shaoyang and Jueyin; Jueyin returns to inject into Hand Taiyin.

The fifteen Collateral Vessels all originate from the Yuan Source points, (Where Qi gathers is the Yuan source. The *Ling Shu · Jiu Zhen Shi Er Yuan Chapter* says: "...The Yuan source is where the Five Zang organs receive the Qi and flavors of the three hundred sixty-five solar terms." Basically, the Qi of the Five Zang organs converges here, and the Qi of the collateral vessels depends on this.) like a ring without end, irrigating each other, gathering at Cun Kou and Ren Ying, (Cun Kou, see Chapter 1. Ren Ying is the Cun Kou pulse on the left hand. Chao, like paying court, means gathering here to receive Qi again and exit.) to treat all diseases and determine life and death. (Chu means to estimate/judge, i.e., the meaning in Chapter 1 of taking only Cun Kou to determine life and death.) The classic says: Knowing the beginning and end, Yin and Yang are determined. What does this mean? (Seen in *Ling Shu · Zhong Shi Chapter*.)

It is replied: Beginning and End are the discipline of the pulse. (The *Zhong Shi Chapter* says: "Beginning and End, the meridians are the discipline.") Cun Kou and Ren Ying, the Qi of Yin and Yang, communicate through court and envoy, (Chao, see above. Shi means mutual use. Cun Kou is Yin, Ren Ying is Yang.) like a ring without end, hence called Beginning. End means the meridians of Three Yin and Three Yang are severed; severance means death. Death has various forms, (Forms of death, see next Chapter 24.) hence called End.

Chapter 24 says: How can we know the signs when the Qi of the Hand and Foot Three Yin and Three Yang meridians is severed? (Hou means to verify with symptoms.) Can we know auspiciousness or inauspiciousness?

It is replied: When the Qi of Foot Shaoyin severs, bones wither. (Below describes the signs. The *Su Wen · Liu Jie Zang Xiang Lun* says: The Kidney "fills the bones".) Shaoyin is the Winter pulse, running deep and warming the marrow. (Kidney pulse corresponds to Winter; its Qi stores inward.) Thus, if marrow is not warmed, flesh does not adhere to bone; if flesh and bone are not intimate, flesh becomes flaccid and retracts; (Ru means stagnation. The text writes "soft and retracts." Que means retract.) Flesh flaccid and retracting causes teeth to appear long and withered, (Withered, the text writes "dirty/filthy." When gum flesh retracts, gums recede, making teeth appear long. Withered means lacking luster. Teeth are the surplus of bone, hence verified by this.) hair loses luster; (The *Liu Jie Zang Xiang Lun* says: The Kidney "flourishes in the hair".) Losing luster means bone dies first. Disease worsens on Wu days, dies on Ji days. Lips are the root of muscle. (The *Liu Jie Zang Xiang Lun* says: The Spleen "flourishes in the lips and white surrounding area, fills the muscles".) If pulse does not nourish, muscles are not smooth/lustrous; if muscles are not smooth/lustrous, muscles swell; if muscles swell, lips evert; (Man means edema/swelling. If flesh swells, lips also swell and evert outward.)
Lips everting means flesh dies first. Disease worsens on Jia days, dies on Yi days. (The text has "Wood overacts on Earth" four characters.) When the Qi of Foot Jueyin severs, sinews contract, pulling the testicles and tongue. (Yin means pull. The *Jing Mai Chapter* says the Jueyin meridian "follows the genitalia," also says, "follows behind the throat," also says, "circles the inside of the lips." The *Liu Jie Zang Xiang Lun* says: The Liver "flourishes in the nails, fills the sinews".) Jueyin is the Liver meridian. The Liver is the convergence of sinews. Sinews gather at the genitalia and connect to the root of the tongue. (The *Su Wen · Jue Lun*: "The anterior yin is the gathering place of the Zong sinews".) Thus, if pulse does not nourish, sinews contract and tighten; sinews contracting and tightening pulls testicles and tongue, hence tongue curls and testicles retract; this is sinew dying first. Disease worsens on Geng days, dies on Xin days. (The text has "Metal overacts on Wood" four characters.) When the Qi of Hand Taiyin severs, skin and hair become dry/brittle. (The *Liu Jie Zang Xiang Lun* says: The Lung "flourishes in hair, fills the skin".) Taiyin is the Lung, circulating Qi to warm skin and hair. If Qi does not nourish, skin and hair become brittle; if skin and hair become brittle, fluids depart; if fluids depart, skin joints are injured; if skin joints are injured, skin withers and hair breaks; (Skin withering, the text writes "nails". Zhe means wither/break.) Hair breaking means hair dies first. Disease worsens on Bing days, dies on Ding days. (The text has "Fire overacts on Metal" four characters.) When the Qi of Hand Shaoyin severs, pulses do not flow; if pulses do not flow, Blood does not circulate; (The *Liu Jie Zang Xiang Lun*: The Heart "flourishes in the face, fills the blood vessels".) If Blood does not circulate, luster disappears, hence facial color is black like charcoal, (Li means black-yellow.) this is Blood dying first. Disease worsens on Ren days, dies on Gui days. (The text has "Water overacts on Fire" four characters.) When the Qi of all Three Yin meridians severs, dizziness and spinning occur, eyes close, (The *Ling Shu · Da Huo Lun* says: "The essence of the Five Zang and Six Fu organs all ascend to the eyes to form the pupil," Chapter 20 said: "Those who lose Yin go blind," which is the same meaning. Xuan, the text writes "xi".)

Chapter 25 says: There are twelve meridians, but Five Zang and Six Fu organs total eleven. Which meridian is the extra one? (The *Ling Shu · Jiu Zhen Lun*: "Five Zang: Heart stores Shen, Lung stores Po, Liver stores Hun, Spleen stores Yi, Kidney stores Jing and Zhi." Six Fu organs: Small Intestine, Large Intestine, Stomach, Gallbladder, Bladder, Sanjiao, mainly receiving and discharging food and fluids, like storehouses managing entry and exit, hence called Fu.)

It is replied: The extra one is the separate pulse of Hand Shaoyin and the Heart Master (Pericardium). The Heart Master and Sanjiao are interior-exterior partners, (The *Ling Shu · Jiu Zhen Lun*: "Foot Yangming and Taiyin are interior-exterior, Shaoyang and Jueyin are interior-exterior, Taiyang and Shaoyin are interior-exterior... Hand Yangming and Taiyin are interior-exterior, Shaoyang and Heart Master are interior-exterior, Taiyang and Shaoyin are interior-exterior". Separate pulse means the Heart Master is originally the palace city of the Heart, should be interior-exterior with the Heart, but instead is separately interior-exterior with the Sanjiao, forming a separate meridian, hence becoming twelve meridians. Sanjiao refers to Upper, Middle, and Lower Jiao.) Both have names but no substantial form, hence it is said there are twelve meridians.