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(For) pulse patterns that are neither excess nor deficiency, this is the method of meridian therapy; all three therapies (herbal medicine, moxibustion, and acupuncture) should be applied. (Note: In *Jia Yi Jing*, "yi yue" is written as "yi yong".)

When the pulse is tense, it causes traction and stiffness. (Traction means pulling. If the Cun Kou pulse is tense, needle manipulation and Dao Yin can be used to harmonize it.) When the pulse is intermittent and weak, tranquility is desired, avoiding exertion. (A declining, intermittent pulse with a weak return indicates a desire for stillness; such individuals should remain quiet and at ease, avoiding self-inflicted strain. Note: In *Ling Shu*, "dai" [intermittent] is written as "da" [large]. *Jia Yi Jing* omits the characters "yi ruo".)

Lei Gong asked: How do we distinguish between worsening conditions and recovering conditions? (Inquiring about whether the condition is worsening or improving based on pulse diagnosis.) Huang Di replied: Both exterior and interior factors are involved. (Both the exterior Fu organs and interior Zang organs exhibit changes of worsening or recovery, hence it is said they are both present.)

Palpating the Mai Kou (Cun Kou), if the pulse is slippery, small, tight, and deep, the disease will worsen, located internally; (Mai Kou is a Yin position. Slippery is a Yang pulse. Small, tight, and deep are all Yin pulses. Palpating the Mai Kou reveals one Yang and three Yin pulses, indicating Yin overacting on Yang, thus the disease worsens. Since the disease is in the five Zang organs, it is said to be internal.) If the Ren Ying pulse is large, tight, and floating, the disease will worsen, located externally. (Ren Ying is a Yang position. Tight is a Yin pulse. Large and floating are Yang pulses. Two Yang and one Yin pulse indicate Yang overacting on Yin, thus the disease worsens. Since the disease is in the six Fu organs, it is said to be external.) If the Mai Kou pulse is slippery and floating, the disease will diminish daily; (Slippery and floating are both Yang pulses; obtaining two Yang pulses in a Yin position indicates harmonious Qi, so the disease heals daily. Note: In *Ling Shu*, "hua er fu" is written as "fu hua".) If the Ren Ying pulse is deep and slippery, the disease will diminish daily; (One Yin and one Yang pulse in a Yang position allows Qi to harmonize easily, so the disease diminishes.) If the Mai Kou pulse is slippery and deep, the disease will progress daily, located internally; (One Yin and one Yang pulse in a Yin position leads to daily progression, involving the five Zang organs.) If the Ren Ying pulse is slippery, vigorous, and floating, the disease will progress daily, located externally. (Slippery, vigorous, and floating are all Yang pulses; appearing in a Yang position signifies excess, leading to disease increase in the six Fu organs.) If the floating/sinking nature of the pulse and the magnitude of Qi in Ren Ying and Cun Kou are equal, the disease is difficult to cure. (When pulse floating/sinking and the size of Qi in Ren Ying and Cun Kou are uniform, Yin and Yang cannot incline towards each other, making the disease difficult to resolve. Note: In the commentary, "xiang qing" is written as "xiang gu" in Yuan edition.) If the disease is in the Zang organs, a deep and large pulse indicates easy recovery, while a small pulse is adverse; (Palpating Ren Ying and Cun Kou reveals disease in the internal five Zang organs. A deep and large pulse indicates harmonious Yin and Yang Qi, facilitating recovery even if diseased. A deep and small pulse is purely Yin, making it adverse and difficult to cure.) If the disease is in the Fu organs, a floating and large pulse indicates easy recovery. (Palpation reveals disease in the external six Fu organs; a floating and large pulse aligns with the season, facilitating recovery.) A Ren Ying pulse that is vigorous and tight indicates injury by Cold; (Ren Ying vigor is Yang, tightness is Yin, referring to Winter cold invading the interstices, named Cold Injury, which may transform into Warm Disease in Spring. Note: In *Ling Shu*, "sheng jin" is written as "sheng jian", same below.) A Mai Kou pulse that is vigorous and tight indicates injury from food and drink. (Vigor is Yin. A vigorous and tight Mai Kou results from eating too much after hunger, damaging the Zang organs. Note: *Ling Shu* and *Jia Yi Jing* omit the character "yin".)

In one day and night, Qi circulates fifty circuits (Ying) to nourish the essence of the five Zang organs. Failure to meet this number is called "Kuang Sheng" (premature death). The term "fifty circuits" means the five Zang organs all receive Qi. (Wei Qi circulates fifty times around the body in a day and night, managing the essence and Qi of the five Zang organs to sustain life. If it does not reach fifty circuits, the five Zang lack essence; although alive, lifespan is short, hence "Kuang Sheng".) Holding the patient's Mai Kou and counting the beats, if there are fifty beats without an intermittent pulse (Dai Mai), the five Zang organs have received Qi; (Mai Kou is also known as Cun Kou or Qi Kou. Fifty beats correspond to ten beats per organ: Kidney first, Liver second, Spleen third, Heart fourth, Lung fifth. Thus, fifty beats mean all five Zang have received Qi. The method involves first establishing a standard count from a healthy person's Mai Kou, then applying it to the patient. This should be done in the early morning when Yin Qi has not dispersed and Yang Qi has not moved.) If there is one intermittent beat in forty beats, one Zang lacks Qi; (If an intermittent beat occurs between the 40th and 41st beat, the count is short by five, indicating the first Zang, the Kidney, lacks Qi.) If there is one intermittent beat in thirty beats, two Zang lack Qi; (If an intermittent beat occurs between the 30th and 31st beat, the count is short by ten, indicating the second Zang, the Liver, lacks Qi.) If there is one intermittent beat in twenty beats, three Zang lack Qi; (If an intermittent beat occurs between the 20th and 21st beat, the count is short by fifteen, indicating the third Zang, the Spleen, lacks Qi.) If there is one intermittent beat in ten beats, four Zang lack Qi; (If an intermittent beat occurs between the 10th and 11th beat, the count is short by twenty, indicating the fourth Zang, the Heart, lacks Qi.) If there is an intermittent beat before ten beats, five Zang lack Qi; (If an intermittent beat occurs within fewer than ten beats, the count is short by twenty-five, indicating the fifth Zang, the Lung, lacks Qi.) Give them a prognosis of death. (The Lung governs the Qi of the five Zang; since Lung Qi is absent, Qi of all five Zang fails to arrive, hence a death prognosis is given. Note: In *Jia Yi Jing*, "yu" is written as "yu" [give], same below; Yuan edition mistakenly writes "zi".) The key lies in Zhong Shi (Ends and Beginnings). The rule of fifty beats without an intermittent pulse serves as the norm, (Fifty beats without an intermittent pulse represents the normal cycle of the five Zang, the essential principle of Zhong Shi,) allowing us to know the timeframe of the five Zang. Those given a death prognosis exhibit irregular rhythms (Zhuo Shu Zhu Shu). (Giving a death prognosis refers to five Zang pulses being irregularly fast and slow, failing to meet the fifty-beat count, thus allowing prediction of death.)

Huang Di asked: Why does Qi Kou alone serve as the master of the five Zang Qi? (Why does Qi Kou alone govern the Qi of the five Zang, six Fu, and twelve meridians, while the nine palpations assess each?) Qi Bo replied: The Stomach is the Sea of Water and Grain, the great source of the six Fu. Flavors enter the mouth, are stored in the Stomach to nourish the five Qi, and Qi Kou belongs to the Tai Yin channel. Therefore, the Qi and flavors of the five Zang and six Fu all originate from the Stomach and manifest at Qi Kou. (The Stomach is the sea of water and grain, the head of the six Fu, releasing flavors to nourish the Zang and Fu. Blood, Qi, and Wei Qi travel via the Hand Tai Yin channel to Qi Kou. The good or bad state of the five Zang and six Fu is carried by Wei Qi, converging at Hand Tai Yin and manifesting at Qi Kou, hence "manifesting". Note: In *Su Wen* and *Jia Yi Jing*, "da" has "yuan" [source] after it; "wu qi" is written as "wu zang qi".) Thus, the Qi of the five Zang enters the nose, is stored in the Heart and Lung. If the Heart and Lung are diseased, the nose becomes obstructed. (Food enters the Stomach to nourish the five Zang, steaming upwards into the nose, stored in the Heart and Lung. The nose is the orifice of the Lung; thus, Heart and Lung disease causes nasal obstruction.) Therefore it is said: In treating any disease, one must observe the upper and lower parts, adapt to the pulse signs, observe the patient's mental state, and their ability to cooperate. One who is bound by superstition regarding ghosts and spirits cannot be taught the highest principles of healing. (The essence of treatment requires observing Ren Ying above and Cun Kou below, adapting to pulse signs. Observing mental state is crucial; those lacking intent cannot receive high-level treatment. Observing the patient's attitude towards illness is also necessary. If a patient attributes wind-cold-summer-dampness illness to ghosts, they cannot be discussed with regarding medical theory. Note: *Su Wen* writes "cha qi xia" [observe the lower] instead of "cha qi shang xia"; no "hou" after "mai"; no "neng" after "bing". Yuan edition mistakes "neng" for "tai". *Su Wen* Xin Zheng Jiao Yun states: "According to *Tai Su*, it reads 'bi cha qi shang xia, shi qi mai hou, guan qi zhi yi, yu qi bing neng', which matches this." Also, "zhi zhi" in *Su Wen* is written as "zhi de".) One who dislikes needles and stones cannot be taught sophisticated techniques. If a patient refuses treatment, the disease may not be cured, and treatment will be ineffective. (Pi is a type of needle. If a patient dislikes needles despite needing them, even Qi Bo and Huang Di cannot succeed. If a patient could be treated but refuses, even Cang Fei cannot succeed. Note: Original manuscript writes "pi" as "jing"; according to commentary, it should be "pi". *Su Wen* writes "zhen".)

The principles of acupuncture are completed in the Zhong Shi chapter. Understanding Zhong Shi, taking the five Zang as the guideline, Yin and Yang are determined. (The essence of acupuncture requires understanding the ends and beginnings of Yin and Yang Qi. Human Yin and Yang Qi are based on the five Zang as the guideline, as the Zang store the Spirit and reside in the body, thus becoming the guideline for Yin and Yang Qi, determining Yin and Yang.) Yin governs storage, Yang governs transformation. (Yin Qi governs the five Zang, residing internally; Yang Qi governs the six Fu, residing externally.) Yang receives Qi from the four extremities, Yin receives Qi from the five Zang. (Clear Yang fills the four limbs, Turbid Yin travels to the six Fu, so Yang receives Qi from the extremities. Clear Yin originates in the five Zang, Turbid Yang manages the four limbs, so Yin receives Qi from the Zang. Note: In *Jia Yi Jing*, "mo" is written as "zhi".) Therefore, for reducing methods, one meets the Qi (Ying); for tonifying methods, one follows the Qi (Sui). Knowing Ying and Sui allows Qi to harmonize. The method to harmonize Qi must connect Yin and Yang. (Thus, in tonification and reduction: for excess arriving Qi, reduce by meeting it; for deficiency departing Qi, tonify by following it. Understanding these essentials harmonizes Yin and Yang Qi, curing disease.) Five Zang are Yin, six Fu are Yang. Pass this down to future generations, sworn in blood. Respect it and prosper; neglect it and perish. Acting unrighteously for selfish gain brings premature death. (Respect the transmitted methods, abide by the Way, and abandon selfishness. Note: In *Ling Shu*, "hou dai" is written as "hou shi". *Jia Yi Jing* omits the last six sentences starting from "chuan zhi hou dai".) Reverently obeying the Heavenly Dao, I request to speak of Zhong Shi. (Having received the admonition, I request to discuss the guideline of the five Zang's Zhong Shi.) Zhong Shi takes the meridians as the guideline. Holding the Mai Kou and Ren Ying, one knows the excess or deficiency, peace or imbalance of Yin and Yang, completing the Heavenly Dao. (The guideline of five Zang Zhong Shi is the meridians. To understand meridians as Zhong Shi, palpate the Mai Kou and Ren Ying arteries to know the excess or deficiency of Yin and Yang Qi in the twelve meridians.)

The so-called "Ping Ren" (healthy person) does not get sick. A healthy person's Mai Kou and Ren Ying correspond to the four seasons. (In Spring and Summer, Ren Ying is slightly larger than Cun Kou; in Autumn and Winter, Cun Kou is slightly larger than Ren Ying, corresponding to the four seasons. Note: Commentary originally wrote "hou" [after] for both "wei" [slight], corrected to "wei" based on context.) Upper and lower correspond and move together (Ju Wang Ju Lai). (Ren Ying is at the sides of the Adam's apple, hence "upper". Cun Kou is at the radial artery of the wrists, hence "lower". Though distinct, both move due to respiration, hence moving together. "Wang" means Yang exiting, "Lai" means Yin entering. Though different, they move simultaneously, hence "Ju". Note: In *Ling Shu* and *Jia Yi Jing*, "ju" is omitted before "lai".) The six channels' pulses do not knot or stagnate. (When Yin and Yang pulses move together, the three Yin and three Yang meridians move without knotting.) The origin and end maintain their respective cold and warmth. (Spring and Summer are governed by Yang, warm in time, Ren Ying is the origin. Autumn and Winter are governed by Yin, cold in time, Mai Kou is the origin. The two pulses do not invade each other but guard their positions, hence "maintaining duties". Note: In *Ling Shu*, "wen" has "zhi" after it. *Jia Yi Jing* writes "ben mo xiang guo", omitting "zhi".) Form, flesh, and blood Qi must be proportional; this is called a healthy person. (Form refers to bone, muscle, and complexion. Flesh refers to skin, muscle, and blood Qi. Proportionality indicates health. If the previous five aspects are favorable, it is a healthy person. Note: Commentary missing a character after "blood Qi"; original top part is "si". "Shuai lao", "lao" is corrected to "rong" in original notes.)

Those with "Shao Qi" (deficient Qi) have Mai Kou and Ren Ying both weak and disproportionate to the Cun and Chi positions, indicating insufficiency of both Yin and Yang. (Mai Kou is Cun Kou. Cun position has 9 fen movement, Chi position has 1 cun movement. In Autumn/Winter, Cun Kou is smaller than Ren Ying, meaning Cun Kou is disproportionate. In Spring/Summer, Ren Ying is smaller than Cun Kou, meaning Ren Ying is disproportionate. Such examination reveals insufficiency of Yin and Yang Qi in Zang and Fu. Note: Commentary "kan" is mistakenly printed as "shen" in Yuan edition.) Tonifying Yang will exhaust Yin; reducing Yin will cause Yang to collapse. For such cases, sweet medicines can be used. If ineffective, administer precise doses. (If Yang is excess and Yin deficient, reduce Yang and tonify Yin; if Yin is excess and Yang deficient, reduce Yin and tonify Yang. Now, both Yin and Yang are deficient. Tonifying Yang further exhausts Yin; reducing deficient Yin leaves Yang without support, causing collapse. Thus, needles and stones are unsuitable; sweet decoctions should be used to support. If not cured, proceed to precise dosing. Note: *Ling Shu* and *Jia Yi Jing* omit "yu"; "qi" is written as "ji". Commentary "gan shan" is mistakenly printed as "gan yao" in Yuan edition.) Such cases will not heal without moxibustion; using reduction therapy would damage the five Zang Qi. (Such cases are both deficient; they can be supplemented with decoctions and heal gradually, hence "not healed quickly". If not handled thus, using needle reduction will damage five Zang Qi. Moxibustion is inappropriate here; "jiu" likely implies "jiu" [long time].)

If Ren Ying is one-fold greater, the disease is in Foot Shaoyang; if one-fold greater and restless, it is in Hand Shaoyang. (Disease in Foot Shaoyang. Foot Shaoyang disease is double that of Foot Jueyin, so Ren Ying is double Cun Kou. One-fold greater and restless indicates Hand Shaoyang.) If Ren Ying is two-fold greater, the disease is in Foot Taiyang; if two-fold greater and restless, it is in Hand Taiyang. (Restless means disturbing. Yang Qi gradually increases in Foot Taiyang. Foot Taiyang disease is double Foot Shaoyin, so Ren Ying is double Cun Kou.) If Ren Ying is three-fold greater, the disease is in Foot Yangming; if three-fold greater and restless, it is in Hand Yangming. (Yang Qi is more vigorous in Foot Yangming. Foot Yangming disease is triple Foot Taiyin, so Ren Ying is triple Cun Kou. Note: Commentary originally wrote "Yang" for "Yin" in "Foot Taiyin", corrected to "Yin".) If Ren Ying is four-fold greater, large and rapid, it is called "Yi Yang" (Overflowing Yang), which is "Wai Ge" (External Grid). (Ren Ying is four times greater, large and rapid. Yang Qi overflows externally, blocking Yin Qi from exiting, hence "External Grid". Note: *Su Wen* writes "si sheng yi shang wei Ge Yang".) If Mai Kou is one-fold greater, the disease is in Foot Jueyin; if one-fold greater and restless, it is in Hand Jueyin (Pericardium). (Foot Jueyin excess disease is double Foot Shaoyang, so Mai Kou is double Ren Ying.) If Mai Kou is two-fold greater, the disease is in Foot Shaoyin; if two-fold greater and restless, it is in Hand Shaoyin. (Foot Shaoyin excess disease is double Foot Taiyang, so Mai Kou is double Ren Ying.) If Mai Kou is three-fold greater, the disease is in Foot Taiyin; if three-fold greater and restless, it is in Hand Taiyin. (Foot Taiyin excess disease is triple Foot Yangming, so Mai Kou is triple Ren Ying. Note: Hand Shaoyin in *Ling Shu* and *Jia Yi Jing* is written as Hand Taiyin; based on text, it should be Taiyin, likely a transcription error.) If Mai Kou is four-fold greater, large and rapid, it is called "Yi Yin" (Overflowing Yin), which is "Nei Guan" (Internal Closure). Nei Guan is untreatable and fatal. (Yin Qi is four times greater than Yang. Mai Kou is large and rapid. Yin Qi overflows internally, closing off Yang Qi from re-entering, named "Internal Closure", untreatable.) If Ren Ying and Tai Yin Mai Kou are both four times greater or more, it is called "Guan Ge" (Closure and Grid). Guan Ge patients are given a death prognosis. (Mai Kou is Cun Kou. Yang excess four times blocks without closing; Yin excess four times closes without blocking. Both give death prognosis. Ren Ying and Mai Kou both four times greater is Guan Ge, near death, hence death prognosis. Mentioning Ren Ying and Tai Yin Mai Kou implies Hand Tai Yin has no Ren Ying. Note: "Guan" is mistakenly printed as "kai" in Yuan edition.)

If Ren Ying is one-fold greater, reduce Foot Shaoyang and tonify Foot Jueyin. (Ren Ying one-fold greater than Mai Kou indicates Shaoyang one-fold greater than Jueyin, hence reduce Foot Shaoyang, tonify Foot Jueyin. Others follow this pattern.) Two reductions, one tonification. (Tonification/reduction method: Yang excess/Yin deficiency, two reductions on Yang, one tonification on Yin. Yin excess/Yang deficiency, one reduction on Yin, two tonifications on Yang. Thus, Yang excess gets two reductions, Yang deficiency gets two tonifications, Yin excess gets one reduction, Yin deficiency gets one tonification. Why treat Yang more? Yin Qi is slow, so tonification/reduction is gradual; Yang Qi is rapid, so tonification/reduction is immediate, doubling the treatment for Yang. Others follow this. Note: Commentary "fang ci", "fang" originally "gu", corrected to "fang"; Yuan edition writes "zuo".) Treat once daily. (One treatment is one session of tonification/reduction. Foot Taiyang excess/Foot Shaoyin deficiency, Foot Shaoyin excess/Foot Taiyang deficiency: these two meridians have least Qi/Blood, so treat every two days. Foot Shaoyang excess/Foot Jueyin deficiency, Foot Jueyin excess/Foot Shaoyang deficiency: these have secondary Qi/Blood, so treat daily. Foot Yangming excess/Foot Taiyin deficiency, Foot Taiyin excess/Foot Yangming deficiency: these have richest Qi/Blood, so treat twice daily as example. Jueyin has least Qi/Blood, Shaoyin secondary, Taiyin most. Here Shaoyin is every two days, Jueyin daily, Taiyin twice daily; possibly a textual error.) Must palpate and verify. Must palpate Ren Ying and Mai Kou to verify. If restless, treat the upper points. (Ren Ying restlessness moves upward, all in Hand meridians, hence "treat upper". "Treat" means selecting points from these meridians. Note: "Zao" in *Ling Shu* and *Jia Yi Jing* is written as "shu", same below.) Stop when Qi harmonizes. (Reduce excess, tonify deficiency, stop when Yin and Yang Qi harmonize, also an example.)

If Ren Ying is two-fold greater, reduce Foot Taiyang and tonify Foot Shaoyin. Two reductions, one tonification. Treat every two days. Must palpate and verify. If restless, treat the upper points. Stop when Qi harmonizes. If Ren Ying is three-fold greater, reduce Foot Yangming and tonify Foot Taiyin. Two reductions, one tonification. Treat twice daily. Must palpate and verify. If restless, treat the upper points. Stop when Qi harmonizes. If Mai Kou is one-fold greater, reduce Foot Jueyin and tonify Foot Shaoyang. Two tonifications, one reduction. Treat once daily. Must palpate and verify. If restless, treat the upper points. Stop when Qi harmonizes. If Mai Kou is two-fold greater, reduce Foot Shaoyin and tonify Foot Taiyang. Two tonifications, one reduction. Treat every two days. Must palpate and verify. If restless, treat the upper points. Stop when Qi harmonizes. If Mai Kou is three-fold greater, reduce Foot Taiyin and tonify Foot Yangming. Two tonifications, one reduction. Treat twice daily. Must palpate and verify. If restless, treat the upper points. Stop when Qi harmonizes. The reason for treating twice daily is that Taiyin governs the Stomach, which is rich in Grain Qi, hence treated twice daily. (Explains why these two meridians are treated frequently. Note: In *Ling Shu*, "Taiyin zhu Wei" is written as "Yangming zhu Wei". *Jia Yi Jing* omits "qi" after "gu".)

If Ren Ying and Mai Kou are both three times greater or more, it is called "Yin Yang Ju Yi" (Both Yin and Yang Overflowing). If not opened/drained, blood vessels close, Qi has nowhere to flow, leaking internally, injuring the five Zang. Such cases, if treated with moxibustion, will change into other diseases. (Ren Ying and Mai Kou both three times greater, not yet four times. Both Yin and Yang are overflowing. At this time, needles must be used to open and drain. If not opened...)