Library

If the pulse exceeds the normal level by more than four times, it indicates that Qi circulation is obstructed; pathogenic factors overflow and flow backward, damaging the five Zang organs internally, and moxibustion should not be used at this time. (Ping An: "Exceeds by three times" in *Jia Yi Jing* is written as "exceeds by four times"; the annotation states: *Ling Shu* writes "three times". The annotation implies this is correct, and the character "Er" was erroneously printed as "Zhen" in Yuan's edition.)

In general, the principle of acupuncture is to stop when Qi is harmonized. Tonifying Yin and draining Yang: draining Yin is easy, while tonifying Yin is difficult; tonifying Yang is easy, while draining Yang is difficult. In acupuncture methods, if Yin and Yang are harmonized through tonifying Yin and draining Yang, the procedure may be stopped. (Ping An: In the annotation "Drain Yin", the character "Yin" was erroneously printed as "Yang" in Yuan's edition.)

When voice and breath are both clear and resonant, and hearing and vision are acute, the opposite condition indicates that Blood and Qi do not circulate smoothly within the body. (Harmony of Yin and Yang manifests as clear voice and smooth respiration, hence termed "Bing Zhang" [mutually manifest]. With the seven orifices open, hearing and vision become acute; the opposite is considered adverse, thus Blood and Qi fail to circulate. Ping An: "Yin Qi Bing Zhang" in *Ling Shu* is written as "Yin Qi Yi Zhang", and in *Jia Yi Jing* as "Sheng Yin Yi Zhang". *Ling Shu* and *Jia Yi Jing* lack the characters "Shen Zhong". In the annotation, "Wei Ni" [is adverse] was erroneously printed as "Zuo Zhe Ni" in Yuan's edition.)

The phrase "Qi arrives and there is efficacy" refers to (after inserting the needle into the skin and flesh, rotating it to await Qi arrival, performing tonification or reduction upon Qi arrival, and obtaining verification, this is called efficacy. Ping An: "Xiao" [efficacy] in *Jia Yi Jing* is the same).

After reduction (draining), deficiency increases; in a deficient state, the pulse may be large as before but not firm. If the pulse remains large and firm, although the patient feels comfortable after removing the needle, the disease has not been eliminated. (Because there is excess, reduction is required to further damage the excess. When the excess is damaged, the pulse is large like before but not firm inside, indicating the excess has been reduced. If after reduction the pulse is still large and firm inside, even if the patient reports feeling better after needle removal, the disease persists.)

After tonification, fullness increases; in an excessive state, the pulse may be large as before but becomes firmer. If the pulse is large but not firm, although the patient feels comfortable, the disease has not been eliminated. (Because there is deficiency, tonification is required to fill the deficiency and increase fullness. When fullness is achieved, the pulse is large like before and firm inside, indicating success. If after tonification the pulse is large but not firm inside, even if the patient feels comfortable after needle removal, the disease is not cured.)

Therefore, tonification makes the deficient solid, and reduction makes the excessive empty. Although pain may not cease immediately with the needle, the disease will certainly recede. (Thus, tonification makes the deficient solid, and reduction makes the excessive empty. If tonification and reduction are not performed thoroughly, even if the patient says they feel better after needle removal, the disease is not removed; if tonification and reduction follow proper principles, even if pain does not disappear immediately with the needle, the disease will surely recede. Ping An: *Jia Yi Jing* has the character "Jian" [reduce] under "Zhen Xia" [under the needle].)

One must first understand the diseases occurring in the twelve meridians, and only then can one grasp their transmission from beginning to end. (The origin of diseases in the twelve meridians lies in knowing the initial stage of various pathogenic invasions, and also knowing the final outcome of the cure for all diseases; thus, one can transmit knowledge of disease beginnings and endings to future generations. Ping An: *Jia Yi Jing* lacks the character "Mai" [pulse] after "Jing" [meridian], and lacks the character "De" [obtain] before "Chuan" [transmit].)

Therefore, when Yin and Yang do not shift, and deficiency and excess do not incline, treatment should select the corresponding meridians. (Therefore, students must know that for conditions where Yin/Yang and Deficiency/Excess do not shift or incline, one can apply tonification and reduction to the twelve meridians. Ping An: "Qing" [inclined] was erroneously printed as "Qi" in Yuan's edition, and the annotation is the same.)

Huang Di asked Qi Bo: If a person suffers from a carbuncle in the stomach region, how should the pulse be diagnosed? Qi Bo replied: Diagnosing this condition requires finding the Stomach pulse, which should be deep and fine. A deep and fine pulse indicates rebellious Qi. Rebellious Qi causes the Ren Ying pulse (Stomach Meridian pulse at the neck) to be very vigorous. Vigor indicates heat. The Ren Ying pulse belongs to the Stomach meridian; when Qi is rebellious and vigorous, heat gathers at the stomach opening without circulating, thus causing a carbuncle in the stomach region.

Huang Di said: Excellent. (A carbuncle in the stomach region means heat at the stomach opening causes a carbuncle in the stomach tube. Finding the Stomach pulse refers to the Cun Kou pulse. Cun Kou is the great convergence of pulses, belonging to the movement of the Hand Taiyin Lung meridian, and thus is the termination and beginning of the five Zang and six Fu organs and the twelve meridians. In a healthy person, the Stomach pulse at the Cun Kou typically appears floating and large. Now, diagnosing a deep and fine pulse at the Cun Kou indicates cold damage and rebellious Qi in the Stomach; therefore, the Cun Kou pulse is deep and fine, while the upper Ren Ying pulse is surging and vigorous. The upper Ren Ying pulse is located on both sides of the throat and is the pulse of the Foot Yangming Stomach meridian. When Stomach Qi is rebellious, the hand's Cun Kou pulse is deep and fine, and the Ren Ying pulse at the side of the throat is vigorous; thus, we know heat gathers at the stomach opening and fails to circulate, forming a carbuncle. Yu Gong fan qie [phonetic transcription], meaning swelling. Ping An: *Su Wen* and *Jia Yi Jing* write "Wei Guan" as "Wei Wan". *Jia Yi Jing* writes "Shen Xi" [deep and fine] as "Shen Se" [deep and choppy]; *Su Wen* Xin Jiao Zheng states: *Tai Su* writes "Shen Xi".)

Lethargy, yellow and red urine, and a small and choppy pulse indicate a lack of appetite. (Lethargy, yellow and red urine, small and choppy pulse are signs of Spleen disease, hence the lack of appetite. Ping An: "Se" [choppy] in *Ling Shu* is the same.)

When a person is ill, if the size and floating/sinking characteristics of their Cun Kou pulse and Ren Ying pulse are equal, the disease is difficult to cure. (Cun Kou is the Mai Kou. When ill, the Cun Kou pulse floats in autumn and sinks in winter; the Ren Ying pulse is small in spring and large in summer. Even if ill, it is easy to cure; if the size and floating/sinking are identical across all four seasons, the four-season pulses are chaotic, hence difficult to cure. Ping An: *Ling Shu* writes "Xiao Da Deng" [small, large, equal] instead of "Da Xiao" [large, small].)