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[Ping An]: This chapter, from the beginning to "those who lose their spirit perish," is found in *Suwen* (Treatise on Changing Spirit and Qi), Volume 4, Chapter 13. From "Huangdi said: I have heard of Kui Du and Qi Heng" to "the essentials of diagnosis are complete," it is found in *Suwen* (Discourse on the Jade Tablet), Volume 4, Chapter 15. From "The beginning of diagnosing disease" to the end, it is found in *Suwen* (Generation of the Five Zang Organs), Volume 3, Chapter 10, and also in *Jiaying Jing* (Essential Prescriptions of the Golden Casket), Volume 6, Chapter 9 (Great Discourse on the Suitability of Five Flavors and Diseases of the Five Zang Organs), and Volume 4, Part 1, Lower Section.

Huangdi asked Qibo: "I wish to face patients, observe life and death, resolve doubts, and grasp the essentials, as clearly as the light of the sun and moon. May I hear about this?" (This refers to asking for the essentials of determining life and death. Ping An: The phrase "Huangdi asked Qibo" is absent in *Suwen*. Note: The character 'Jue' (decide) is mistakenly printed as 'Ci' (next) in Yuan's edition.) Qibo replied: "Color and pulse are esteemed by the Supreme Emperor (Shangdi) and transmitted by ancient masters. In ancient times, Dai Ji was tasked with regulating color and pulse to achieve understanding of the divine spirit, integrating them with Metal, Wood, Water, Fire, Earth, the Four Seasons, Yin and Yang, the Eight Winds, and the Six Directions, without deviating from their norms. Observing their mutual changes allows one to perceive their subtleties and understand their essentials." (Supreme Emperor refers to ancient kings. Dai Ji refers to an ancient immortal. The Supreme Emperor instructed Dai Ji to regulate human color and pulse to connect with the divine spirit, aligning externally with the constant laws of change in the Five Elements, Four Seasons, Yin-Yang, Eight Winds, and Six Directions, deeply observing the mysteries of these natural laws to understand the profound utility of color and pulse.)

(Ping An: The words "zhi shi" (of that time) are missing after "Shanggu" in *Suwen*, and the character "Jiu" precedes "Dai". The character "Liu" in "Liuhe" was originally missing and has been supplemented according to *Suwen*.) To know the essentials, one must focus on color and pulse.

(The essential principle for preserving health before illness arises lies in nothing other than color and pulse, hence they are termed the essence. Ping An: The character 'Jia' (add) in the note is printed as 'Ru' (like) in Yuan's edition.) Complexion corresponds to the Sun, and pulse corresponds to the Moon. If the Sovereign seeks the essence, he finds it here. (Physical complexion appearing outwardly is Yang, thus corresponding to the Sun. Pulse and blood manifesting inwardly are Yin, thus corresponding to the Moon. The Sun corresponds to 360 days, and the Moon to 12 months; therefore, knowing color and pulse serves as the essential guide. Ping An: In *Suwen*, "Di qiu" (Emperor seeks) is written as "Chang qiu" (Constantly seeks), and "Yao yi" (Essence is here) as "Yao ye" (It is the essence).) The variations of color and pulse correspond to the overcoming cycles of the Four Seasons. This is what the Supreme Emperor values, aligning with the divine spirit, thereby distancing oneself from death and approaching life. (The harmonious energy of the Four Seasons represents victory; ancient emperors valued the Way of the Sovereign, aligning with the divine spirit to cherish life, thus avoiding death and achieving longevity. Ping An: In *Suwen*, there is no "Mai" (pulse) after "Se" (color), and "Zhi Sheng" (of victory) is written as "Zhi Mai" (of pulse).) Following the Great Dao leads to long life, and such a person is called a Sage King. (The Supreme Emperor regulates color and pulse, connects with the divine spirit, and aligns with the constant Dao; those who achieve longevity are called Sage Kings. Ping An: "Shang Dao" (Upper Dao) in *Suwen* is written as "Sheng Dao" (Dao of Life).)

In middle antiquity, when treating diseases, decoctions were used upon the arrival of illness, administered for ten days to eliminate diseases caused by the Eight Winds and Five Bi syndromes. (When latent illnesses manifest, decoctions are taken; since the pathology is mild, the disease resolves in ten days. Ping An: The character "Bing" (disease) is not repeated in *Suwen*.) If not cured after ten days, treatment involves herbal roots, stems, and branches. The roots and extremities of these herbs are subtle; once the root and branch aspects are grasped, the pathogenic qi is subdued. ( , pronounced 'lai', refers to herbal roots and stems. Miao, pronounced 'wang shao', indicates subtlety. Herbal roots and stems are key to curing disease. If decoctions fail after ten days, one may use herbal roots, stems, leaves, and branches prepared as pills, powders, or fermented wines. Having addressed both the root cause and symptoms, all pathogenic qi is suppressed. Ping An: In *Suwen*, the first character is 'Su', and "Wei Miao" is written as "Wei Zhu".) In later generations, treatment differs. Therapy does not follow the Four Seasons, ignores the rhythms of the sun and moon, fails to assess reversibility and normalcy, and only acts after the pathological form has fully developed, attempting to treat the exterior with fine needles and the interior with decoctions. (The previous mention of ancient and middle antiquity implies that Huangdi's era is considered "later generation." The subsequent text where Huangdi mentions "ancient, middle, and current times" confirms this. Treating disease means treating established illness. Later-generation treatment differs from antiquity in five ways: first, ignorance of tracing therapies to the Four Seasons; second, lack of understanding of how color and pulse relate to solar and lunar patterns; third, failure to assess disease reversibility; fourth, inability to distinguish between developing and established disease; fifth, ignorance of appropriate therapeutic formulas. Thus, they resort to fine needles and decoctions to treat already established conditions. Ping An: In *Suwen*, "Mu Dai" is written as "Mu Shi", and "Ni Shun" as "Ni Cong".) Crude practitioners act recklessly, believing aggressive attack is necessary; old diseases remain unresolved, and new ones arise. (Xiong, pronounced 'xu rong', denotes fierce aggression. Using fine needles and small amounts of liquid to attack established disease adds further ailments; acting rashly without skill is termed 'Xiong'. Ping An: One character is missing after "Xiong"; it should be repeated as in *Suwen*. Yuan's edition does not repeat it. "Jiu Bing" (Old disease) in *Suwen* is written as "Gu Bing" (Former disease).) Huangdi said: "I wish to hear the essential principles." Qibo said: "The ultimate goal of treatment is not to neglect color and pulse. Applying them without confusion constitutes the great principle of therapy. Reversing the order of normal and abnormal, failing to match root and branch, leads to loss of spirit and state. Abandoning the old for the new allows one to attain the status of a True Person." (This means losing knowledge of color and pulse results in ignorance of benefit and harm. Ping An: "Ni Shun Dao Xing" in *Suwen* is written as "Ni Cong Dao Xing".) Huangdi said: "I have heard the essentials from my teacher, who stated that treatment never departs from color and pulse. Color and pulse are what I already know." (Ping An: In *Suwen*, "Mai Se" is written as "Se Mai" and is not repeated.) Qibo said: "The pinnacle of treatment lies in 'One'." Huangdi asked: "What is meant by 'One'?" Qibo replied: "One is achieved through attaining [the patient's mind/spirit]." Huangdi asked: "How so?" Qibo said: "Close the doors and windows, focus entirely on the patient, inquire repeatedly into their condition, and accommodate their intentions. Those who retain their spirit prosper; those who lose their spirit perish." Huangdi said: "Excellent." ('One' refers to retaining the spirit. Retaining the spirit means obtaining the patient's cooperation through inquiry. Obtaining cooperation allows needle and drug therapies to transform death into life, hence 'prosper'. Ping An: In *Suwen*, "Shun" is written as "Cong".)

Huangdi said: "I have heard that Kui Du and Qi Heng refer to different concepts. How should they be applied?" Qibo said: "Kui Du measures the depth and superficiality of disease. Qi Heng distinguishes between extraordinary and ordinary diseases. (By thoroughly investigating the disease, locating its site, and determining its depth, it is called Kui Du. 'Qi' (extraordinary) refers to diseases that do not follow the seasonal timing of death. 'Heng' (ordinary) refers to diseases that follow the seasonal timing of death, adhering to normal patterns. Ping An: 'Yan Qi Heng Bing' in *Suwen* is written as 'Yan Qi Bing Ye'.) Please allow me to explain the highest principles of the Dao. The variations of the five colors and pulses, and the application of Kui Du and Qi Heng, all reside in 'One'. The Spirit turns and does not reverse; if it reverses, it ceases to turn, and the opportunity is lost. (Shu means principle. I request to explain the highest principle of the Dao. This highest principle concerns the variations of the five colors and five pulses, and the mechanism of Kui Du and Qi Heng. The Dao resides in One, which is the turning of the Spirit. Turning of the Spirit refers to clear consciousness and dynamic activity. If the mirror of consciousness remains static, it cannot comprehend changes in things, thus losing the opportunity. Ping An: Xin Zheng Xiao notes that Quan Yuanqi's version reads 'Wei' instead of 'Qing'. 'Hui' in *Suwen* is written as 'Hui'.) The essence of these highest principles is close and subtle; inscribed on jade tablets, it is named 'Harmony with the Mechanism of Life'. (The principle of spiritual movement is close to the subtleties of all things' mechanisms; thus, it is written on jade tablets and named Harmony with the Mechanism of Nourishing Life. Ping An: 'Sheng Ji' in *Suwen* is written as 'Yu Ji'. Note: The character 'Yang' in 'Yang Sheng' is mistakenly printed as 'Yi' in Yuan's edition.) Guest colors appear in the upper, lower, left, and right positions, each at its critical point. (When the ruling color of the five seasons appears, accompanied by the overacting color, it is called a guest color. If guest colors appear in specific locations relative to the normal ruling color, it indicates disease. Ping An: 'Ke Se' in *Suwen* is written as 'Rong Se'; Xin Zheng Xiao notes Quan Yuanqi's version uses 'Ke'.) When the color appears shallow, decoction therapy is indicated, and recovery occurs in ten days. When it appears deep, compound prescriptions are required, with recovery in twenty-one days. When it appears very deep, fermented wine therapy is used, with recovery in one hundred days. If the color is dull and the face is emaciated, treatment is futile. (Each of the five colors has two types: one is a vital color, e.g., red like a chicken comb; the other is a death color, e.g., red like coagulated blood. If the red hue is light and pale, unlike a chicken comb, it indicates mild disease, treated with decoctions for ten days. If deeper but still not like a chicken comb, the disease is moderately mild, requiring twenty-one days of decoction. If very deep, resembling coagulated blood, the disease is severe, requiring one hundred days of medicinal wine. If the red is like coagulated blood and the face is sharp/emaciated, the disease is fatal and untreatable. 'Dui' means sharp/small, referring to a thin, fleshless face. Ping An: In *Suwen*, 'Qi' is missing before 'Se Yao', and 'Wei' is missing before 'Zhi'. 'Dui' is written as 'Tuo' in *Suwen*. 'Yao' is printed as 'Chi' in Yuan's edition.) Even if treated for a hundred days, if the pulse is short and qi is exhausted, death ensues; this is especially true for warm diseases with extreme severity. (If the color is very deep and, after a hundred days of treatment, the pulse becomes short and qi exhausts, death occurs. Warm diseases with short pulse and exhausted qi also result in death. Ping An: In *Suwen, 'Ran' is missing after 'Yi', and 'Zui' is written as 'Xu'.) Colors appearing in the upper, lower, left, and right positions indicate prognosis: upper is adverse, lower is favorable. For women, the right side is adverse, the left is favorable; for men, the left side is adverse, the right is favorable. (The 'critical point' refers to the location of disease manifestation within the facial color zones (upper, lower, left, right). Upper refers to the upper zone, lower to the lower zone, etc. When a controlling color appears in the upper zone, it is adverse; in the lower zone, it is favorable. For women, appearance in the right zone (controlling) is adverse; in the left (non-controlling), it is favorable. For men, appearance in the left zone (controlling) is adverse; in the right (non-controlling), it is favorable. Ping An: 'Shun' in *Suwen* is written as 'Cong'.) Ease leads to death from double Yang or double Yin. If Yin and Yang are reversed, treatment requires balancing and exchanging excess and deficiency, which falls under Qi Heng matters. Recognizing the reversal of Yin and Yang is a matter of Kui Du. (Yin excess reversing Yang causes disease; Yang excess reversing Yin causes disease. Treatment uses Yin and Yang to balance deficiency and excess, employing tonification and drainage. This is a Qi Heng matter. Simply recognizing the reversal of Yin and Yang is a Kui Du matter. Ping An: The four characters 'Yin Yang Fan Ta' are missing before 'Kui Du' in *Suwen*.) Clashing pulses indicate Bi obstruction and alternating cold and heat. (When pulses beat together, attached and unable to separate, this is Bi obstruction disease, caused by the clashing of cold and heat energies. Ping An: 'Pi' in *Suwen* is written as ' '.) An isolated pulse indicates Xiao (wasting-thirst). (When Yin or Yang pulses appear exclusively alone, it is called isolated. For example, if the Foot Shaoyang pulse appears alone without Jueyin, the disease is Xiao Dan. Ping An: Note 'Xiao Dan' is printed as 'Xiao Bi' in Yuan's edition.) A deficient pulse indicates Xi (diarrhea) and Duo Xue (blood loss). (In cases of diarrhea and blood loss, the pulse is deficient. Ping An: 'Xu Wei Xi' in *Suwen* is written as 'Qi Xu Xi'.) Isolation is adverse; deficiency is favorable. (When Yin and Yang pulses appear exclusively, if the excessive one appears, it is adverse; if the deficient one appears, the qi is easily harmonized, hence favorable.) To practice the method of Qi Heng, begin with Taiyin. Acting against what one cannot overcome is adverse and leads to death; acting against what one can overcome is favorable and leads to survival. (Taiyin refers to the Hand Taiyin Lung meridian, which governs Qi. To apply tonification, drainage, and balancing methods, start with the Qi of Taiyin and the Five Elements. Acting on what one cannot overcome (being controlled) leads to adverse death; acting on what one overcomes leads to favorable survival. For instance, in Liver disease, using Metal therapy acts against what one cannot overcome; using Earth therapy acts against what one overcomes. Ping An: In *Suwen*, 'Wei' is missing after 'Taiyin', and 'Shun' is written as 'Cong'.) The victory of the Eight Winds and Four Seasons ends and begins again. (The Eight Winds overcome, and the Four Seasons succeed each other; peace marks the cycle.) If one reverses the cycle even once, it is counted as one transgression; a second transgression leads to death, so it is not counted further. The essentials of diagnosis are now complete. (Following the victory of the Eight Winds and Four Seasons is the normal course. Reversing one step is one transgression. A second transgression leads to death, so it is not counted. For example, in Liver disease, if Lung Qi attacks, it is one transgression; a second attack leads to death, so it does not reach the count. This is the ultimate principle of diagnostic essentials, hence 'complete'. Ping An: In *Suwen*, 'Ke' appears before 'Shu'. Note 'Fei Qi' is printed as 'Fei Mai' in Yuan's edition.)

At the beginning of diagnosis, the Five Determinations serve as the guideline. To grasp the beginning, one must first establish the Mother. The so-called Five Determinations refer to the five pulses. (Diagnosing the pulses of the five Zang organs reveals the disease, hence they are called the Mother. Mother means root. Ping An: In *Suwen*, 'De' is written as 'Zhi'.) Therefore, headache and epilepsy, characterized by deficiency below and excess above, involve the Shaoyin and Juyang meridians; severely, they enter the Kidney. (The Kidney meridian, Foot Shaoyin, is interior and Zang; the Bladder meridian, Foot Taiyang, is exterior and Fu. Shaoyin is below the tongue root, Taiyang is at the head, hence 'above'. Shaoyin deficiency and Taiyang excess cause headache and epilepsy. If these two meridians become overly盛, they enter the Zang. Ping An: 'Zu' (Foot) appears before 'Shaoyin' in *Suwen* and *Jiaying Jing*. 'Juyang' in *Jiaying Jing* is written as 'Taiyang'. Note 'Shaoyin Xu' prints 'Yin' as 'Yang'.) Dizziness, vertigo, trembling eyes, and deafness, characterized by excess below and deficiency above, involve the Shaoyang and Jueyin meridians; severely, they enter the Liver. (Xun Meng refers to dizziness and vertigo. Zhao You refers to trembling eyes and shaking head. You is pronounced 'you'. The pathology is Shaoyang deficiency and Jueyin excess. Ping An: 'HT' is unclear; *Suwen* writes 'Ming', *Jiaying Jing* writes 'Ming', likely a transcription error for 'Ming'. 'Zu' appears before 'Shaoyang' in *Suwen* and *Jiaying Jing*. Also, Xin Zheng Xiao notes: 'Wang注 describes Xun Meng as sudden blindness, which is not very clear. Xun Meng refers to rapid blinking and dim vision.') Abdominal fullness and distension, rib-side constraint, lower coldness with upper oppression, involve the Foot Taiyin and Yangming meridians. (Diseases of the Spleen Zang and Stomach Fu meridians. Ping An: 'Zhi Ge ' in *Jiaying Jing* is written as 'Zhi Man Yi Xie', and in *Suwen* as 'Zhi Ge Yi Xie'. Yuan edition prints ' '.) Cough and rebellious Qi, with rebellion in the chest, involve the Hand Yangming and Taiyin meridians. (Diseases of the Lung Zang and Large Intestine Fu meridians. Ping An: 'Jue' in *Jiaying Jing* is written as 'Bing', noting that *Suwen* uses 'Jue'.) Heart vexation and headache, with disease in the diaphragm, involve the Hand Juyang and Shaoyin meridians. (Hand Taiyang ascends to the head, causing headache. Diseases of the Heart Zang and Small Intestine Fu meridians. The following three pulse sections all mention entry into Zang, but are briefly omitted here. Ping An: This paragraph in *Jiaying Jing* reads: 'Pain in the chest, fullness in the ribs, pain radiating to the waist and spine, involving Hand Shaoyin and Taiyang.' The note cites *Suwen* consistent with this book.) The smallness, largeness, slippery, rough, floating, and sinking qualities of pulses can be distinguished by touch. (The forms of the six pulses at the Cun Kou are perceived under the fingers, hence called 'distinguished by touch'.) The manifestations of the five Zang organs can be inferred by analogy. (Skin, flesh, sinews, vessels, and bones are the external forms of the five Zang organs, hence called 'manifestations'. The five pulses are categories of these five manifestations; inferring from pulses allows knowledge. Ping An: Note 'Wu Xiang' is printed as 'Wu Zang'.) The superior physician observes voice, which can be understood consciously; the subtle diagnosis of five colors can be observed visually. Combining pulse and color diagnosis ensures complete accuracy. (Listening to the five tones and observing the five colors, combined with pulse assessment, these three methods for evaluating disease ensure comprehensive accuracy. Ping An: 'Shang Yi' in *Suwen* is written as 'Wu Zang'.) When the Red Pulse arrives, it is panting and firm; diagnosis reveals accumulated Qi in the center, occasionally hindering food intake, named Xin Bi (Heart Obstruction). (The Heart pulse, Hand Shaoyin, belongs to Fire and is red, hence Red Pulse. Red Pulse is the Summer pulse. Summer pulse is like a hook, coming strong and going weak, indicating health. Now, if it moves like panting and is firm, it indicates accumulated Qi in the chest, causing fullness and hindering eating, named Heart Bi. Accumulation is Yin Qi, gathering is Yang Qi; accumulation arises from Zang, gathering from Fu; accumulation has a fixed location, while gathering has no root and stops nowhere. Ping An: 'Zhen Zhi' in *Suwen* and *Jiaying Jing* is written as 'Zhen Yue'.) It is acquired from external stress and mental worry leading to Heart deficiency, allowing pathogens to enter. (Acquired from urgent mental worry about external affairs, exhausting the Heart and causing deficiency, pathogens invade externally rather than transmitting internally, forming Bi. Ping An: Note 'Xin Xu', the character 'Xin' was originally missing and has been added based on the text.) When the White Pulse arrives, it is panting and floating, with deficiency above and excess below, fright, accumulated Qi in the chest, panting and deficiency, named Fei Bi (Lung Obstruction), with cold and heat sensations. (The Lung pulse, Hand Taiyin, belongs to Metal and is white, hence White Pulse. White Pulse is the Autumn pulse. Autumn pulse is like floating, coming light and floating, urgent and scattering, indicating health. Now, although it floats, if it moves like panting, it indicates Lung Qi combining with Heart; Heart excess causes fright, Lung deficiency causes accumulated Qi in the chest, frequent sighing, named Lung Bi. Due to Lung deficiency, cold and heat diseases occur. Ping An: In 'Jing You', the character 'You' in *Jiaying Jing* is written as 'Wei'.) It is acquired from drunkenness and sexual intercourse. (Caused by sexual activity while drunk, leading to panting and Lung injury.) When the Yellow Pulse arrives, it is large and deficient, with accumulated Qi in the abdomen and rebellious Qi, named Jue Shan (Rebellious Hernia), applying equally to women. (The Spleen pulse, Foot Taiyin, belongs to Earth and is yellow, hence Yellow Pulse. A good Yellow Pulse is intermittent and not visible; a bad one appears large and deficient, indicating accumulated Qi in the abdomen and rebellious Qi, named Jue Shan, affecting both men and women. Ping An: The 'Yellow Pulse' section in *Suwen* follows the 'Green Pulse' section. Note 'Tong Bing' prints 'Tong' as 'Nei'.) It is acquired from strenuous limb exertion with sweating exposed to wind. (Spleen governs the limbs; urgent effort causes limb sweating and wind invasion.) When the Green Pulse arrives, it is long and pulsates left and right, with accumulated Qi beneath the heart causing rib constraint, named Gan Bi (Liver Obstruction). (The Liver pulse, Foot Jueyin, belongs to Wood and is green, hence Green Pulse. Green Pulse is the Spring pulse. Spring pulse is like a string, coming soft, weak, tender, deficient, slippery, straight and long, indicating health. Now, if the Green Pulse arrives, long and pulsating left and right, it indicates accumulated Qi beneath the heart causing rib constraint and hindrance, named Liver Bi. Ping An: 'Xian' (string-like) appears before 'Zuo' in *Jiaying Jing*. Note 'Fang' has 'Shi' (food) added in Yuan's edition.) It is acquired from cold-dampness, treated similarly to hernia, with lower back pain, cold feet, and headache. (Acquired from cold-dampness, cold feet ascending to cause disease, similar to hernia. The Foot Jueyin meridian runs from the foot along the lower abdomen to the head, hence lower back, foot, and head pain. Ping An: *Jiaying Jing* note says: Another version states the head pulse is tight.) When the Black Pulse arrives, it is firm and large upwards, with accumulated Qi in the abdomen and genitals, named Shen Bi (Kidney Obstruction). (The Kidney pulse, Foot Shaoyin, belongs to Water and is black, hence Black Pulse. Black Pulse is the Winter pulse. Winter pulse is like a camp, coming deep and forceful, indicating health. Now, if the Black Pulse arrives, firm and large upwards, it indicates accumulated Qi in the abdomen and genitals, named Kidney Bi. Ping An: 'Fu Zhong' in *Suwen* is written as 'Xiao Fu', and in *Jiaying Jing* as 'Shao Fu'.) It is acquired from bathing in cold water and lying down. (Caused by washing hair and body in cold water and then lying down.) Generally, observing the unusual pulses of the five colors: if the face is yellow with eyes green, red, white, or black, none will die. (Observing the five unusual colors and pulses, prioritizing the face: if the face shows yellow, regardless of whether the eye color is green, red, white, or black, Earth is the root, so all survive. Ping An: Note 'Yi Tu Wei Ben' prints 'Tu' as 'Shang'.) Face green, eyes red: Liver disease with Heart overacting, named Excess Evil. Face red, eyes white: Heart disease with Lung overacting, named Minor Evil. Face green, eyes black: Liver disease with Kidney overacting, named Deficiency Evil. Face black, eyes white: Kidney disease with Lung overacting, also named Deficiency Evil. Face red, eyes green: Heart disease with Liver overacting, named Deficiency Evil. Ping