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[Ping An]: This section is incomplete from "Xing Qi Xiang De Zhe Sheng" (Those whose form and qi are in harmony survive) onwards. The Yuan edition supplemented it based on *Su Wen: San Bu Jiu Hou Lun* (Plain Questions: Treatise on the Three Regions and Nine Positions), inserting content from Huangdi's question "Yu Wen Jiu Zhen Yu Fu Zi" (I have heard of the nine needles from you, Master) to "Xiong Zhong Duo Qi Zhe Si" (Excess qi in the chest indicates death). Checking the original text of *Su Wen*, the passage from "Shang Bu Tian" (Upper Region Heaven) to "Xia Bu Ren Zu Tai Yin Ye" (Lower Region Human, Foot Taiyin Meridian) appears in detail at the end of this book; this was inserted by Lin Yi et al., Song dynasty officials. Examining the *Xin Zheng Xiao* (New Corrections) of *Su Wen* clarifies this. If this section were supplemented according to the beginning of *Su Wen*, the passage from "Shang Bu Tian" to "Xia Bu Ren Zu Tai Yin Ye" would be repetitive. Therefore, we now supplement it based on the content following "Di Yue Jue Si Sheng Nai He" (The Emperor said: How to determine life and death?) in *Su Wen* and *Jia Yi Jing*, corroborated by the *Xin Zheng Xiao* stating that Quan Yuanqi's edition named this section "Jue Si Sheng" (Determining Life and Death), which aligns with the meaning. From "Zi Xing Yi Xiang De Yi Xia" (From those whose form and meaning are in harmony downwards), it is found in *Su Wen* Volume 6, Chapter 20 *San Bu Jiu Hou Lun*, and also in *Jia Yi Jing* Volume 4, Chapter 3 *San Bu Jiu Hou*.

The Emperor asked: How can one determine life and death?
Qibo replied: When the physical form is robust but the pulse is thin, and there is insufficient breath to sustain respiration, the condition is critical; when the physical form is emaciated but the pulse is large, and there is excessive qi in the chest, death ensues; (The above two points are supplemented from *Su Wen: San Bu Jiu Hou Lun* and *Jia Yi Jing: San Bu Jiu Hou*.) When the form and qi are in harmony, survival is indicated; (When the form is robust, qi is robust; when the form is emaciated, qi is fine; such harmony leads to survival, this is the third case.) When the pulses are irregular and uncoordinated (Can Wu Bu Tiao), disease exists; (This refers to a person whose form and qi are sometimes harmonious and sometimes not, appearing chaotic and unregulated, indicating disease, this is the fourth case.) If the pulses at all three regions and nine positions are disordered, death ensues; (The three regions and nine positions fail to align uniformly, each differing, leading to death due to disorder, this is the fifth case. Ping An: *Su Wen* and *Jia Yi Jing* lack the character 'Yi'.) When the pulses above and below, left and right respond like a pestle pounding rice (Can Chong), the disease is severe; (The pulses at the three regions and nine positions move as if pulling a rope, front and back corresponding. Now, the three regions at the head constitute the Upper Region, the three regions at the feet constitute the Lower Region, the three regions of the left hand constitute the Left Region, and the three regions of the right hand constitute the Right Region. The pulses respond with a pounding motion, rising and resting alternately above and below, left and right, with qi coming and going, like a mortar and pestle failing to align uniformly (Chong, pulsation moving up and down, Dong Gong fan), thus the disease is severe, this is the sixth case. Ping An: *Su Wen* and *Jia Yi Jing* have 'Ru' before 'Can'.) When the pulses above and below, left and right are disordered and uncountable, death ensues; (The pulsations above and below, left and right lack sequence, making the rapid pulses uncountable; pulse chaos leads to death, this is the seventh case.) If the pulse at the Middle Region is independently harmonious but disordered relative to the other organs, death ensues; (The lungs, heart, and chest constitute the Middle Region. Diagnosing the Hand Taiyin, Hand Yangming, and Hand Shaoyin meridians, if the three pulses are harmonious during respiration but do not accord with the pulses of the upper and lower regions' organs, death results, this is the eighth case. Ping An: 'Zhong' (many) is written as 'Zhu' (various) in the Yuan edition.) If the pulse at the Middle Region diminishes, death ensues; (At the Middle Region, the Hand Taiyin, Hand Yangming, and Hand Shaoyin pulses vary in number, one more and one less, lacking uniformity, resulting in death, this is the ninth case.) Sunken eyes indicate death. (The essence of the five zang organs resides in the eyes; thus, when the five zang organs fail, the eyes sink first, indicating death. The above ten signs determine life and death.)

The Emperor asked: How does one know where the disease is located? (The location of the disease lies in determining life or death, which is not easy. Since determination has many aspects, I ask again.)
Qibo answered: Examine the nine positions. A pulse that is exclusively small indicates disease; exclusively large indicates disease; exclusively rapid indicates disease; exclusively slow indicates disease; exclusively hot indicates disease; exclusively cold indicates disease; a pulse that is exclusively sunken indicates disease; (Following sequentially, there are eighteen more signs; exclusively small or large constitutes seven signs. The nine-position pulses, above and below, left and right, should be uniform and identical; thus, any exclusive deviation indicates disease. Ping An: *Su Wen* and *Jia Yi Jing* lack 'Qi' after 'Cha'.) Press with the left hand five cun above the ankle, and strike with the right hand at the ankle. If the response extends more than five cun upwards with a gentle trembling sensation (Hu Hu Ran), there is no disease; (The pulse is harmonious. Above the medial malleolus, the Foot Taiyin meridian appears, ascending eight cun above the ankle, crossing behind Jueyin, conveying Stomach Qi to the five zang organs. Thus, pressing five cun above the ankle with the left hand and striking the ankle with the right hand, if the left hand feels a gentle tremor, the person is healthy, constituting the eighth sign. Hu Hu, weak movement. Hu, Mian fan. Ping An: *Su Wen* adds 'Zu' (foot) after 'Left Hand'; *Jia Yi Jing* adds 'Yu Zuo Zu' (on the left foot). Checking *Su Wen*, there is no 'Er' before 'Zhi', but 'Shu' after. *Jia Yi Jing* adds 'Zu' after 'Right Hand'. Hu in *Su Wen* and *Jia Yi Jing* is written as 'Ru Ru'. Also, checking *Su Wen*, Song official Lin Yi cites Quan Yuanqi's commentary: "Above the medial malleolus, Yinjiao emerges, connecting to the Bladder and Kidney. The Kidney is the Gate of Vitality, hence this point is taken to clarify auspiciousness and inauspiciousness. The current text lacks one 'Er' character, and has extra 'Shu' and 'Zu' characters. Wang Bing's interpretation taking both hands and feet is forced. One should follow the old version of Quan Yuanqi's commentary and *Jia Yi Jing* as correct.") If the response is rapid and feels turbulent (Hun Hun) under the fingers, disease exists; (Striking causes the area below the left hand to feel turbulent and uncoordinated, indicating disease, this is the ninth sign.) If it feels slow (Xu Xu) under the fingers, disease exists; if the response cannot reach five cun upwards, or if there is no response to striking, death ensues; (Foot Taiyin blood and qi are weak; a slow response indicates disease; failure to reach five cun or no response indicates death, this is the tenth sign. Ping An: *Su Wen* and *Jia Yi Jing* add 'Ran' after 'Xu Xu'.) Emaciation with inability to move the body indicates death; ('Qu' means movement. Severe emaciation and weakness preventing walking indicates death, this is the eleventh sign. Ping An: The original manuscript lacks 'Bu'; based on notes, both *Su Wen* and *Jia Yi Jing* read 'Bu Qu' (not moving), so it is supplemented here.) Fluctuating frequency in the middle region (Zha Shu Zha Shu) indicates death; (Middle region refers to Hand Taiyin, Hand Yangming, and Hand Shaoyin; fluctuating frequency indicates death, this is the twelfth sign.) A pulse that is intermittent and hooked (Dai Er Gou) indicates disease in the collateral vessels; (The middle region pulses: Hand Taiyin is the Autumn pulse; Hand Shaoyin is the Summer pulse. When the Autumn pulse is dominant, receiving the Spleen pulse, Earth overcomes Metal, termed Deficient Evil, causing disease. When the Summer pulse is dominant, receiving the Spleen pulse, Earth overcomes Fire, termed Excess Evil, causing disease. Diseases of the Summer pulse reside in the collateral vessels; pricking to release blood treats them, this is the thirteenth sign. Ping An: *Jia Yi Jing* writes 'Dai Mai' instead of 'Mai Dai'.) The nine positions should correspond, upper and lower as one, without losing alignment. If one position lags, disease exists; if two lag, disease is severe; if three lag, the condition is critical. 'Lagging' means failing to move simultaneously. Examine the diseased zang organ to know the time of death; (The nine-position arterial pulses should correspond as one, without losing alignment. Suddenly, eight positions move together while one lags, representing one loss, hence disease. Two lagging represent two losses, hence severe disease. Three lagging represent three losses, hence critical condition. For disease caused by three lagging positions, examine each to identify which zang organ is affected, knowing the severity and time of death. Three lagging positions constitute three losses, this is the sixteenth sign. Ping An: *Su Wen* and *Jia Yi Jing* write 'Fu Zang' instead of 'Bing Zang'.) One must first understand the regular meridians, then the pathological pulses. Appearance of True Zang Pulses with excess indicates death; (To diagnose via nine positions, one must first know the pathways of the twelve regular meridians and various collaterals, then examine the nine positions for pathological pulses. Presence of True Zang Pulses, lacking the softness of Stomach Qi, with exclusive excess, inevitably leads to death, this is the seventeenth sign. Ping An: *Su Wen* writes 'Zhe Si' instead of 'Sheng Zhe Si'; *Jia Yi Jing* writes 'Zhe Xie Sheng Si Ye' (five characters). Note: 'Wu' (no) in 'No Stomach Qi' was mistakenly printed as 'Jian' (see) in the Yuan edition.) Absence of Foot Taiyang Qi results in inability to flex or extend the legs; death involves upward staring of the eyes (Dai Yan). (Foot Taiyang meridian runs from the eye, through the head, to the foot. Its absence causes leg immobility and upward staring at death, this is the eighteenth sign.)

The Emperor asked: What about Winter Yin and Summer Yang? (Pulses at all nine positions being deep, thin, and faint are Yin; reaching extremity in Winter, hence Winter Yin. Pulses being vigorous, restless, panting, and rapid are Yang; reaching extremity in Summer, hence Summer Yang. Please explain the principle.)
Qibo answered: When pulses at all nine positions are deep, thin, and suspended/cut off (Xuan Jue), this is Yin, governing Winter, leading to death at midnight; (Deep upon pressure is 'Shen'. Movement like a drawn thread is 'Xi'. Coming like a broken rope is 'Xuan Jue'. All nine positions being like this indicates Yin Qi excess. Yang Qi is externally cut off, Yin Qi moves alone, having interior but no exterior, dying in Winter at the time of extreme Yin. Midnight death corresponds to extreme Yin. This is the first diagnosis.) Vigorous, restless, panting, and rapid pulses are Yang, governing Summer, leading to death at noon; (Voluminous qi is 'Sheng'. Rapid movement is 'Zao'. Due to panting and rapidity, it is called 'Chuan Shu'. All nine positions being like this indicates Yang Qi excess. Yin Qi is internally cut off, Yang Qi moves alone, having exterior but no interior, dying in Summer at the time of extreme Yang. Noon death corresponds to extreme Yang. This is the second diagnosis.) Therefore, those with alternating cold and heat die at dawn (Ping Dan); (Spleen disease with cold and heat dies at dawn. Dawn is Wood; Wood overcomes Earth, hence Spleen disease dies at dawn, this is the third diagnosis. Ping An: The nine characters "Shi Gu Han Re Zhe Yi Ping Dan Si" were originally in small print under Note 2, mixed into the note. They should be treated as scripture based on *Su Wen* and *Jia Yi Jing* to match the meaning of the third diagnosis note. Yuan edition added 'Bing' (disease) based on *Su Wen*/*Jia Yi Jing*, made it large print, connected it to "Yi Ri Zhong Si", and kept the nine characters in the note under Diagnosis 2, which is redundant and inaccurate. Here, changing the small print under Note 2 to large print as scripture clarifies Notes 2 and 3. Also, *Su Wen* and *Jia Yi Jing* add 'Bing' after 'Han Re'. *Jia Yi Jing* lacks 'Shi Gu' before 'Han Re'.) Those with internal heat and heat diseases die at noon; (Heat in the Lungs and cold-induced heat diseases are all Yang diseases, hence dying at noon during extreme Yang, this is the fourth diagnosis. Ping An: *Su Wen* and *Jia Yi Jing* add 'Zhe' after 'Bing'. Yuan edition repeats 'Ri Zhong' and omits 'Shi' after 'Ji'.) Wind diseases die at dusk (Ri Xi); (Wind relates to Liver disease. You hour is Metal; Metal overcomes Wood, hence death at dusk, this is the fifth diagnosis. Ping An: *Su Wen* and *Jia Yi Jing* write 'Bing Feng' instead of 'Feng Bing'.) Water diseases die at midnight; (Water disease is Yin disease. Midnight Zi hour is extreme Yin, hence death, this is the sixth diagnosis.) Pulses that are intermittently sparse and rapid, intermittently slow and fast, die during the transition periods of the four seasons (Ri Cheng Si Ji); (Spleen is Earth, dominant in the four seasons. In peace, the pulse is in the Central Palace, quiet and unseen. When diseased, it appears as intermittent sparsity and rapidity, hence dying during the seasonal transitions, this is the seventh diagnosis. Ping An: *Su Wen* adds 'Zhe' after 'Ji', lacks 'Yi'; *Jia Yi Jing* has 'Zhe'.) When flesh and muscle have wasted away, even if the nine positions are harmonious, death ensues. (Earth represents flesh; flesh is the master of the body. Thus, even if the pulse is harmonious, wasting flesh leads to death, this is the seventh diagnosis. Ping An: *Jia Yi Jing* adds 'Zhe' after 'Tiao'.) Even if the seven diagnostic signs appear, if the nine positions are compliant, death does not occur. The term 'non-death' refers to wind/qi diseases and inter-meridian diseases, which resemble the seven diagnostic signs but are not true ones, hence stated as non-lethal. If the seven diagnostic signs are present AND the pulse qualities are also failed/degenerated, death occurs, accompanied by hiccups and belching. (Although the seven signs of death exist, if the nine-position pulses comply with the four seasons, it is called non-lethal. Regarding the seven signs appearing with compliant pulses indicating life: wind and qi diseases, and mild diseases within the meridians, show signs resembling the seven signs but are not true seven signs, hence compliance allows survival. If the seven signs are present and pulses degenerate, survival is impossible. The five zang organs fail first, and the person will surely die from hiccups. Ping An: *Su Wen* writes 'Cong' instead of 'Shun'. *Su Wen* and *Jia Yi Jing* write 'Jing Yue' instead of 'Jian Jian'.) One must carefully inquire into the cause, the onset, the current disease, and the impending illness; (Key to diagnosing disease has four aspects: 1. Observing color to know, called 'Shen' (Divine); 2. Listening to voice to know, called 'Ming' (Bright); 3. Asking questions to know, called 'Gong' (Skillful); 4. Palpating pulse to know, called 'Qiao' (Clever). There are three types of inquiry: 1. Ask for the origin of disease (when in the four seasons, diet, sexual activity, etc.); 2. Ask about the disease symptoms (cold, heat, pain, itching, etc.); 3. Ask about impending illness (what strange changes are occurring now). Ping An: *Su Wen* and *Jia Yi Jing* write "Qi Suo Shi Bing" instead of "Qi Gu, Suo Shi, Suo Bing".) Then palpate and trace the pulses; (First ask the cause of disease, then palpate and trace the pulses to ensure accuracy. 'Qie' means cutting/pressing with hand to divide fortune/misfortune; 'Xun' means tracing pulse movement with heart and hand, hence 'Qie Xun Qi Mai'. Ping An: *Su Wen* adds 'Ge' before 'Qie'. Yuan edition writes 'Fen Bie' instead of 'Fen Ge' in the note.) Observe the floating and sinking of the meridians; (Meridians refer to the Twelve Regular and Eight Extraordinary Vessels. Collaterals refer to the Fifteen Major Collaterals and various Sun Collaterals. The method of palpation involves observing floating/sinking of meridians and collaterals. Sinking is Yin, Floating is Yang, used to determine cold/warmth of disease.) Follow the upward/downward and reverse/compliant flow. Rapid pulses indicate no disease; slow pulses indicate disease; pulses that do not come and go indicate death; skin adhering tightly to bone indicates death. (Up refers to Upper Region; Down refers to Lower Region. Also, Up refers to left/right of throat; Down refers to left/right of hands. Cun Kou pulse starting from organs and going towards limbs is Compliant (Shun); pulse starting from limbs and going towards organs is Reverse (Ni). Palpating compliant/reverse pulses: rapid response means no disease; loss of sequence and slow response means disease. Hand Three Yin go out, Three Yang come in; Foot Three Yang go out, Three Yin come in. If none come or go, it is death. Harmonious Qi separates skin and flesh; extreme stiffness and adherence indicate death. Ping An: *Su Wen* and *Jia Yi Jing* write 'Cong' instead of 'Shun'. *Jia Yi Jing* adds 'Bu' after 'Xia'.)

The Emperor asked: How are treatable cases managed? (The previous statements by the Emperor mentioned many fatal signs, hence asking about treatable diseases, this is the third question.)
Qibo answered: Disease of the meridians is treated by treating the meridians; disease of the Sun Collaterals is treated by treating the Sun Collaterals; (Below discusses treatable diseases. Pathogen in meridians takes the meridians; pathogen in Sun Collaterals takes Sun Collaterals. Ping An: *Su Wen* writes "Zhi Qi Sun Luo Xue"; *Jia Yi Jing* lacks two 'Sun' characters.) Blood disease with body pain is treated by treating the meridians and collaterals. (Major meridians and collaterals jointly cause blood disease; body pain indicates treating both major meridians and large collaterals. Ping An: *Jia Yi Jing* lacks 'Xue Bing'. Yuan edition mistakes 'Bing' for 'Tong'.) True disease located in Odd Collaterals (Qi Xie) is treated by Diagonal Needling (Miu Ci). (True means regular. When an organ receives pathogen directly, not transmitted, it is called Regular Disease. Qi Xie refers to large odd collaterals on major meridians. Diagonal needling should be performed, taking points horizontally across left and right. Ping An: *Su Wen* and *Jia Yi Jing* write "Qi Bing" instead of "Zhen Bing".) Chronic emaciation with immobility is treated by regulated needling. ('Liu' means long-standing. For chronically emaciated patients, sudden heavy needling is contraindicated; needling should be regulated/modulated. Ping An: *Su Wen* and *Jia Yi Jing* add 'Zhi' after 'Ci'.) Upper Excess and Lower Deficiency: palpate and follow the flow, locate the meridian pulses, prick to release blood to unblock. (For Upper Excess/Lower Deficiency, trace meridian pulses; prick abundant blood to unblock and balance. Ping An: *Su Wen* and *Jia Yi Jing* lack 'Zhe' before 'Qie', add 'Er' after 'Qie'. *Su Wen* writes 'Cong' for 'Shun'. *Su Wen* writes "Yi Jian Tong Zhi"; *Jia Yi Jing* writes "Yi Tong Qi".) High pupils indicate Taiyang deficiency; upward staring (Dai Yan) indicates Taiyang exhaustion. These are key to determining life and death and must not be overlooked. (Taiyang meridian is the upper lid governor. When Taiyang pulse is sufficient, eyes function normally; when Qi is deficient, it pulls essence urgently, causing high pupils; when pulse exhausts, eyelid essence sags, causing upward staring. These are major keys to determining life and death, must not be ignored.) Retain needle in fingers and between fingers five cun above the lateral malleolus of the hand. (Previous Taiyang deficiency and Foot Taiyang exhaustion relate to Foot Taiyang meridian; this treatment relates to Hand Taiyang meridian. Because Hand Taiyang connects above and below to the inner eye, take Hand Taiyang to treat high pupils and upward staring. Take the tip of the little finger and between the little finger and hand five cun above the lateral malleolus [Note: Text likely contains error regarding anatomical location, traditionally Hand Taiyang points are on arm/hand]. Ping An: *Su Wen* lacks 'Jian' before 'Liu'. This section in *Su Wen* note is considered misplaced bamboo slips.) Upper Region Heaven: Arteries at both temples. Upper Region Earth: Arteries at both cheeks. Upper Region Human: Arteries in front of both ears. (Upper Heaven: Pulsations of Foot Shaoyang and Yangming at temples, inspecting Head/Horn Qi. Upper Earth: Pulsation of Foot Yangming at Daying on cheeks, inspecting Mouth/Teeth Qi. Upper Human: Pulsations of Hand Taiyang, Hand Shaoyang, and Foot Shaoyang at Hegu in front of ears, inspecting Ear/Eye Qi.) Middle Region Heaven: Hand Taiyin. Middle Region Earth: Hand Yangming. Middle Region Human: Hand Shaoyin. (Middle Heaven: Hand Taiyin pulse moves at Zhongfu, Tianfu, Xiabai, Chize, inspecting Lung Qi. Middle Earth: Hand Yangming pulse, checking classics shows no specific movement point; Lu Guang's commentary on *Nan Jing* says it moves at the mouth corner, inspecting Large Intestine Qi. Middle Human: Hand Shaoyin moves at Jiquan and Shaohai, inspecting Heart Qi.) Lower Region Heaven: Foot Jueyin. Lower Region Earth: Foot Shaoyin. Lower Region Human: Foot Taiyin. (Lower Heaven: Foot Jueyin pulse moves at Qugu, Xingjian, Chongmen, inspecting Liver Qi. Lower Earth: Foot Shaoyin pulse moves at Taixi, inspecting Kidney Qi. Lower Human: Foot Taiyin pulse moves at Zhongfu, Jimen, Wuli, Yinguang, Chongmen, Yunmen [Note: Some point names may vary in transcription], inspecting Spleen Qi. Of the twelve meridians, Pericardium (Hand Jueyin) has no separate Heart organ representation and does not enter the nine positions. Hand Taiyang, Hand Shaoyang, Foot Taiyang, Foot Shaoyang, Foot Yangming are the six exterior meridians of the five zang organs. Inspecting zang knows exterior, hence they do not exceed the nine positions. Ping An: From "Shang Bu Tian" to "Xia Bu Ren Zu Tai Yin Ye", *Su Wen* Xin Zheng Xiao reorders based on *Jia Yi Jing*.)