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[Ping An]: This section, from the beginning of the chapter to "named contrary to the four seasons," is found in *Suwen* (Basic Questions), Volume 6, Chapter 19, "Yuji Zhenzang Lun" (Treatise on the True Viscera and the Jade Machine), and also in *Jiaying Jing* (A-B Classic), Volume 4, "Jingmai" (Meridians), Part 1, Lower Section. From "Huangdi asked Qibo: How do pulses move with the four seasons..." to "the great method of holding pulses," it is found in *Suwen*, Volume 5, Chapter 17, "Maiyao Jingwei Lun" (Treatise on the Essence and Subtlety of Pulses), and *Jiaying Jing* is the same. Also, from "Therefore, when Yin is excessive, one dreams of wading through great water..." to "...when Lung Qi is excessive, one dreams of sorrow," it is found in *Jiaying Jing*, Volume 6, Chapter 8, "Zhengxie Xi Nei Sheng Meng Da Lun" (Great Treatise on Righteous Evil Invading Internally and Generating Dreams). From "Spring pulse of Autumn..." to the end, it is found in *Suwen*, Volume 7, Chapter 23, "Xuanming Wuqi Pian" (Chapter on Manifesting the Five Qi), and also in *Jiaying Jing*, Volume 4, "Jingmai" (Meridians), Part 1, Middle Section.

In all cases of treating disease, one must observe the patient's form, Qi, color, and luster; the excess or deficiency of the pulse; and whether the disease is new or old. Then treatment is administered without delaying the appropriate time. (The fatness or thinness of the form, the strength or weakness of Qi, the freshness or witheredness of color, the excess or deficiency of the pulse, and the newness or chronicity of the disease—these five diagnostic aspects are used by those who treat diseases. If the diagnosis is accurate, it conforms to the time; if not, it misses the time.) When form and Qi are harmonious, it is called treatable. (When the form is thin but Qi is abundant, or the form is fat but Qi is deficient, they are disharmonious; when the form is fat and Qi is abundant, or the form is thin and Qi is deficient, they are harmonious.) When the pulse, color, and luster appear floating, it is called easy to recover. (If the patient's complexion is floating, light, and lustrous, the disease will be easily resolved. Ping An: The character "pulse" is absent in *Suwen*.) When the pulse conforms to the four seasons, it is called treatable. (The ruling pulses of the four seasons all contain Stomach Qi [Wei Qi, a sign of healthy digestive function and vitality] and are not overcome by other elements, hence called conforming to the season. Ping An: "Conform" is written as "Follow" in *Suwen*.) When the pulse is weak and slippery, it indicates the presence of Stomach Qi [Wei Qi], and is named easy to treat; act promptly according to the timing. (When the pulses of all four seasons are weak and slippery, this is called Stomach Qi [Wei Qi]. Treating based on this is considered conforming to the time. Ping An: "Act promptly according to the time" is written as "Take it according to the time" in *Suwen*, and as "Treat it and hasten it, do not delay the time" in *Jiaying Jing*.) When form and Qi are disharmonious, it is called difficult to treat; when the complexion is withered and lacks luster, it is called difficult to heal; when the pulse is solid and hard, it indicates the condition is worsening; when the pulse contradicts the four seasons, it is called untreatable. One must carefully examine these four difficulties and clearly inform the patient, and not act hastily according to the seasonal timing. (These four diagnostic signs are difficult to manage appropriately; one should clearly inform the patient and adopt flexible treatment methods rather than rigidly adhering to standard seasonal treatments. Ping An: "Called untreatable" is written as "is untreatable" in *Suwen*, lacking the phrase "do not act hastily according to the time." *Jiaying Jing* lacks the twelve characters following "must examine the four difficulties".) What is meant by contradicting the four seasons is: finding the Lung pulse in Spring, the Kidney pulse in Summer, the Heart pulse in Autumn, and the Spleen pulse in Winter, where the pulses are all hanging, isolated, deep, and choppy. This is named contradicting the four seasons. Even without visible signs of visceral pathology, (When all four seasons show the pulse that overcomes one's own element, and one's own pulse is hanging, isolated, deep, and choppy, losing the harmonious pulse of the four seasons, although there are no visible forms of diseased viscera, it cannot be treated. Ping An: "Named" is written as "Called" in *Jiaying Jing*.) In Spring and Summer, the pulse is deep and choppy; in Autumn and Winter, the pulse is floating and large. (This pulse contradicts the four seasons. Ping An: *Suwen* and *Jiaying Jing* have the character "at" before "Spring." Below "floating and large," *Suwen* has six characters: "named contradicting the four seasons.") In febrile disease, the pulse is quiet. (In heat disease, the pulse should be hot and restless; now it is cold and quiet. , means cold. Ping An: The character is absent in *Suwen* and *Jiaying Jing*.) In diarrhea, the pulse is large. (In human diarrhea, the pulse should be small and fine; now it is洪大 [large and expansive].) In blood loss, the pulse is solid, and the disease is internal. (In blood loss, the pulse should be weak; now it is strong and solid, indicating the disease is internal.) With a solid and hard pulse, the disease is external. (In blood loss, a solid and hard pulse indicates the disease is external.) But if the pulse is not solid and hard, it is difficult to treat, named contradicting the four seasons. (In blood loss, if the pulse is not solid and hard, it is difficult to treat. The above seven diagnostics all contradict the four seasons. Ping An: "Difficult to treat" is written as "all difficult to treat" in *Suwen*. Additionally, according to the New Correction in *Suwen*: "According to 'Pingren Qixiang Lun' [Treatise on Normal People's Pulse and Phenomena], it says for disease inside the pulse is empty, for disease outside the pulse is choppy and hard, which is opposite to this. This scripture has an error, while that treatise is correct. From 'without visceral form' to 'Spring and Summer here,' it overlaps with 'Pingren Qixiang Lun'; the explanatory meaning is fully contained therein.")

Huangdi asked Qibo: How do we know how pulses move with the four seasons? How do we know the location of the disease? How do we know the changes of the disease? How do we know if the disease is suddenly internal? How do we know if the disease is suddenly external? I ask about these six points; may I hear them? (Six refers to six questions. There are only five questions here; one question is likely missing. Ping An: *Suwen* lacks the character "know" after "please," and writes "five" instead of "six." Based on the text below "these six are the great method of holding pulses," it should be "six." Yang Shangshan notes that a question is likely missing, which fits the logic.) Qibo replied: Let me speak of its connection with Heaven's rotation. (Considering the answer below, the text should have six items, hence "six unions." The human body corresponds to Heaven, so let me explain the way the human body's Qi connects with Heaven's rotation. Ping An: "With Heaven's rotation" is written as "With Heaven's rotation great" in *Suwen*.)

Outside all things, within the Six Directions [North, South, East, West, Up, Down], are the changes of Heaven and Earth and the responses of Yin and Yang. (Each thing receives a specific form. Outside this form of all things, encompassed within the Six Directions, Heaven and Earth act as parents, creating change and birth. Thus, all things correspond and combine with the Qi of Heaven and Earth. Ping An: *Suwen* lacks the character "Fu." *Jiaying Jing* lacks the five characters "Fu Wanwu zhi wai".) That spring warmth becomes summer heat. (Spring and Summer are the beginning and end of Yang Qi. The three months of Spring are the start of Yang Qi, with gentle air and warm days. The three months of Summer see abundant Yang Qi and intense heat, formed by the growth of spring warmth. Ping An: The note says "end of Yin Qi"; "Yin" is likely a typo for "Yang".) That autumn urgency becomes winter severity. (Autumn and Winter are the beginning and end of Yin Qi. The three months of Autumn are the start of Yin Qi, with high wind and sharp air, hence named urgency. The three months of Winter see severe Yin Qi, formed by the growth of autumn coolness. Ping An: "Urgency" is written as "Anger" in *Suwen* and *Jiaying Jing*; Wang Bing notes: Anger is alternatively Urgency. The note says "Qi Qie"; "Qie" is likely a typo for "Jin" [strong/tough].) The movement of the four changes causes the pulse to rise and fall. (Warmth, heat, urgency, and severity are the movements of Heaven causing changes in the four Qi. Human meridians change up and down similarly to these four Qi. In Spring and Summer, the Renying pulse is larger than the Cunkou pulse, hence "up"; Cunkou is smaller than Renying, hence "down." In Autumn and Winter, Cunkou is larger than Renying, hence "up"; Renying is smaller than Cunkou, hence "down." This defines up and down by excess and deficiency. This answers the first question. Ping An: The five sentences from "Renmai of Autumn and Winter" to "hence down" were omitted in Yuan's edition; inserted here based on the original manuscript.) Spring corresponds to the compass [Gui, representing roundness/circle]; Summer corresponds to the square [Ju, representing right angles/square]. (In the three months of Spring, Shaoyang Qi [Lesser Yang] is active; all things begin to grow but are not yet upright, hence corresponding to the compass. In the three months of Summer, Taiyang Qi [Greater Yang] is active; all things grow upright, hence corresponding to the square.) Autumn corresponds to the balance [Heng, representing weighing/balance]; Winter corresponds to the plumb bob/weight [Quan, representing weight/heaviness]. (In the three months of Autumn, Shaoyin Qi [Lesser Yin] is active; all things reach their peak of growth, hence corresponding to the balance. In the three months of Winter, Taiyin Qi [Greater Yin] is active; all things return to the root, hence corresponding to the weight. Ping An: "Heng" was originally written as "Chong" in the manuscript; corrected to "Heng" based on *Suwen* and *Jiaying Jing*.) Therefore, forty-five days after the Winter Solstice, Yang Qi rises slightly, and Yin Qi descends slightly. (After the Winter Solstice, Yang Qi gradually grows, hence "slightly rises"; Yin Qi gradually declines, hence "slightly descends.") Forty-five days after the Summer Solstice, Yang Qi descends slightly, and Yin Qi rises slightly. (After the Summer Solstice, Yin Qi gradually grows, hence "slightly rises"; Yang Qi gradually declines, hence "slightly descends.") Yin and Yang have their times, and the pulse has its period. If the period passes and the pulse deviates, one can know the division of the pulse. Since the divisions have periods, one can know the time of death. (Yin and Yang follow the four seasons; the four seasons set the period for the pulse. By observing the gains and losses relative to the four seasons, one knows the pulse's division into the four seasons. Since the pulse's division into the four seasons has a limit, the time of life and death can be known. This answers the second question, "location of disease." Ping An: "Know the pulse's division"; "Know" was originally "He"; corrected to "Know" based on *Suwen*, *Jiaying Jing*, and the note.) The subtlety lies in the pulse, which must not be ignored. Examination has principles, starting with Yin and Yang. (To know life and death, nothing is more subtle than examination. The principle of examining the pulse must take Yin and Yang as the foundation. Ping An: *Suwen* and *Jiaying Jing* lack the character "also".) The beginning has meridians, generated from the Five Elements [Wu Xing]. (The origin of Yin and Yang has the Twelve Meridians [Twelve Primary Channels]. The meridians of the twelve months are generated from the Five Elements.) Generation has rules, measured by the four seasons. (The Five Elements generate the Twelve Meridians, each with its rules. Pulses are generated from the Five Elements: Wood generates two meridians: Foot Jueyin and Foot Shaoyang. Fire generates four meridians: Hand Shaoyin, Hand Taiyang, Hand Jueyin, Hand Shaoyang. Earth generates two meridians: Foot Taiyin and Foot Yangming. Metal generates two meridians: Hand Taiyin and Hand Yangming. Water generates two meridians: Foot Shaoyin and Foot Taiyang. This is the Five Elements generating the Twelve Meridians. Regarding rules: Spring has two meridians, Summer has four, Late Summer has two, Autumn has two, Winter has two. Thus, the Twelve Meridians are counted by the four seasons. Ping An: *Suwen* writes "Shu" as "Yi"; New Correction says: According to *Tai Su*, "Yi" should be "Shu".) Follow the rules without error, align with Heaven and Earth, attain sincerity, and know life and death. (Among the Cun, Guan, and Chi positions, following the Twelve Meridians' pulses, obtaining the Four Seasons' Qi of String [Xian], Hook [Gou], Floating [Fu], and Nourishing [Ying] without error, becoming one with the suitability of Heaven and Earth, thus one can understand the time of life and death. Ping An: "Follow the number" is written as "Tonify and Reduce" in *Suwen*; "Sincerity" as "Emotion/Qing". From "The beginning has meridians" to "know life and death," these eight sentences are absent in *Jiaying Jing*.) Therefore, sound matches the Five Tones [Wu Yin], color matches the Five Elements [Wu Xing], and pulse matches Yin and Yang. (Human voice matches the Five Tones; human form and color match the Five Elements; human pulse Qi matches Yin and Yang. This answers the third question, "knowing disease changes." Ping An: The note says "Zhi Bing"; "Zhi" was originally "Zhi" [of]; corrected to "Zhi" [know] based on the preceding text.) Therefore, when Yin is excessive, one dreams of wading through great water and feeling fear; when Yang is excessive, one dreams of great fire burning; when both Yin and Yang are excessive, one dreams of killing and injuring each other; when Upper [Jueyin/Taiyang] is excessive, one dreams of flying upward; (Ping An: *Suwen* and *Jiaying Jing* lack the character "Yang".) when Lower [Shaoyin/Shao Yang] is excessive, one dreams of falling; (Ping An: *Suwen* and *Jiaying Jing* lack the character "Zhui".) when very full, one dreams of giving; when very hungry, one dreams of taking; when Liver Qi is excessive, one dreams of anger; when Lung Qi is excessive, one dreams of sorrow and crying; (Ping An: "Shen" [excessive/severe] is written as "Sheng" [abundant/excessive] in *Suwen* and *Jiaying Jing*. *Suwen* writes "Ai" as "Ku" [cry]; *Jiaying Jing* writes "Kuqi Kongju Feiyang" [crying, fear, flying].) when many short worms [small intestinal parasites] exist, one dreams of crowds; when many long worms [large intestinal parasites] exist, one dreams of fighting and injury. (There are three types of dreams: omens where good or bad fortune appears first in the dream, called Omen Dreams; dreams arising from deep thoughts, called Thought Dreams; and dreams arising from existing illness, called Illness Dreams. These eleven types of dreams are all Illness Dreams, caused by the excess or deficiency of Yin and Yang Qi, internal hunger or fullness, excess of Liver and Lung Qi, and abundance of short or long worms. This is dreaming due to injury/illness, using dreams for diagnosis, called Dream Diagnosis, which can serve as a supplement to the fourth question. Ping An: *Jiaying Jing* lacks the last two sentences. *Suwen* New Correction says: Upon detail, these two sentences should not appear here; they are likely fragments from another classic's bamboo slips.) Therefore, holding the pulse has a Way; emptiness and stillness are the guarantee. (The Way of holding the pulse requires an empty mind free from other thoughts, concentrating spirit and calming thoughts for self-preservation, so as to perceive the pulse's floating/sinking and Qi's internal/external. Ping An: *Jiaying Jing* lacks "Therefore"; "Bao" is written as "Bao" [treasure].) Spring pulse floats, like a fish swimming in the skin; Summer pulse is in the flesh, heavy and abundant like all things. (In Spring, Yang Qi initially opens; the pulse flows from Marrow into Meridians, rising to the skin, like a fish swimming in water, unable to spread widely. In Summer, Yang Qi is lush and abundant; the pulse overflows from Meridians into Sun-Luo [minute collaterals] and flesh, like water overflowing, heavy and growing, just as all things are lush and abundant. This answers the fifth question, "disease external." Ping An: "Pi" [skin] is written as "Bo" [wave] in *Suwen* and *Jiaying Jing*.) Autumn pulse goes down to the skin, like hibernating insects preparing to leave; Winter pulse is in the bone, like hibernating insects sealed tightly, and gentlemen stay indoors. (In Autumn, Yang Qi gradually retreats inward from the skin, hence "down to the skin." Hibernating insects seek warmth and enter holes, hence "preparing to leave." At this time, Yin Qi emerges from within to the skin, and pores are about to open. In Winter, Yang Qi is hidden internally; hibernating insects seal doors tightly; gentlemen leave halls to stay indoors. Human pulse Qi travels in the bones, so the examiner must press deeply to feel it. This answers the sixth question, "disease suddenly internal." Ping An: "Gu" [solid] is written as "Zhou" [complete/circular] in *Suwen* and *Jiaying Jing*.) Thus it is said: To know the internal, press to find the structure; to know the external, follow from end to beginning. (Autumn and Winter pulse Qi is Yin and internal, so pressing reveals the structure; Spring and Summer pulse Qi is Yang and external, so following reveals the beginning and end. Spring and Summer pulses are the end of Autumn and Winter pulses, i.e., the beginning of Yang.) These six points are the great method of holding pulses. (As the great method of pulse diagnosis.)

Finding the Autumn pulse in Spring, the Winter pulse in Summer, the Spring pulse in Autumn, and the Summer pulse in Winter; Yin emerging to Yang, Yang disease prone to anger and untreatable, is called the Five Evils [Wu Xie], all sharing the same fate of death and untreatability. (Finding Autumn pulse in Spring and Winter pulse in Summer are attacks by Zai Xie [Thieving/Overcoming Evils]. Finding Spring pulse in Autumn and Summer pulse in Winter, though slight evils attacking, occur in Autumn/Winter where Yin emerges to Yang and struggles, making it untreatable. Ping An: *Suwen* adds five characters "Late Summer gets Spring pulse" after "Summer gets Winter pulse"; "Autumn gets Spring pulse" is written as "Autumn gets Summer pulse"; "Winter gets Summer pulse" as "Winter gets Late Summer pulse"; "Yin Chu" has two characters "Ming Yue" [named] before it; *Jiaying Jing* is the same. Also, *Jiaying Jing* lacks the character "Ming" before "Si Bu Zhi" [death untreatable].)