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Huangdi asked: The spring pulse is like a string. What kind of pulse is called a string? Qibo replied: The spring pulse corresponds to the Liver, which belongs to Wood in the East. It is the season when all things begin to grow. Therefore, its qi comes weak, light, void, and slippery, straight and long; thus it is called a string. If it is contrary to this, it indicates disease. Huangdi asked: What kind of pulse is considered contrary? Qibo said: If the qi comes solid and strong, this is called Excess (Tai Guo), and the disease is in the exterior; if the qi comes not solid but faint, this is called Deficiency (Bu Ji), and the disease is in the interior. Huangdi asked: Regarding the Excess and Deficiency of the spring pulse, what are their respective symptoms? Qibo said: Excess causes forgetfulness, dizziness, vertigo, and diseases of the vertex; Deficiency causes chest pain radiating to the back, and distension in the hypochondrium below. Huangdi said: Excellent. The summer pulse is like a hook. What kind of pulse is called a hook? Qibo said: The summer pulse corresponds to the Heart, which belongs to Fire in the South. It is the season when all things flourish and grow. Therefore, its qi comes vigorous and departs declining; thus it is called a hook. If it is contrary to this, it indicates disease. Huangdi asked: What kind of pulse is considered contrary? Qibo said: If the qi comes vigorous and departs also vigorous, this is called Excess, and the disease is in the exterior; if the qi comes not vigorous but departs vigorously, this is called Deficiency, and the disease is in the interior. Huangdi asked: Regarding the Excess and Deficiency of the summer pulse, what are their respective symptoms? Qibo said: Excess causes fever and skin pain, leading to impetigo (Im Yin); Deficiency causes vexation, coughing and expectoration above, and Qi leakage below. Huangdi said: Excellent. The autumn pulse is like floating. What kind of pulse is called floating? Qibo said: The autumn pulse corresponds to the Lung, which belongs to Metal in the West. It is the season when all things are harvested. Therefore, its qi comes light, void, and floating, coming swiftly and dispersing slowly; thus it is called floating. If it is contrary to this, it indicates disease. Huangdi asked: What kind of pulse is considered contrary? Qibo said: If the qi comes like a feather but firm in the center and empty on both sides, this is called Excess, and the disease is in the exterior; if the qi comes like a feather but faint, this is called Deficiency, and the disease is in the interior. Huangdi asked: Regarding the Excess and Deficiency of the autumn pulse, what are their respective symptoms? Qibo said: Excess causes rebellious Qi and back pain with a feeling of oppression; Deficiency causes panting, shortness of breath, cough, hemoptysis above, and pathological sounds below. Huangdi said: Excellent. The winter pulse is like Ying (deeply stored). What kind of pulse is called Ying? Qibo said: The winter pulse corresponds to the Kidney, which belongs to Water in the North. It is the season when all things are hidden and stored. Therefore, its qi comes deep and firm; thus it is called Ying. If it is contrary to this, it indicates disease. Huangdi asked: What kind of pulse is considered contrary? Qibo said: If the qi comes like a flicking stone, this is called Excess, and the disease is in the exterior; if it departs rapidly and frequent, this is called Deficiency, and the disease is in the interior. Huangdi asked: Regarding the Excess and Deficiency of the winter pulse, what are their respective symptoms? Qibo said: Excess causes flaccidity, pain in the spinal meridians, shortness of breath, and reluctance to speak; Deficiency causes a feeling of emptiness in the heart as if hungry, coldness in the epigastrium, pain in the spine, fullness in the lower abdomen, and changes in urination. Huangdi said: Excellent.

Huangdi asked: The order of the four seasons has variations of compliance and opposition, but what governs the Spleen pulse alone? Qibo said: The Spleen pulse belongs to Earth. It is the solitary Zang organ that irrigates the four directions. Huangdi asked: Then can the good or bad condition of the Spleen be seen? Qibo said: The good cannot be seen, but the bad can be seen. Huangdi asked: How can the bad be seen? Qibo said: If it comes like flowing water, this is called Excess, and the disease is in the exterior; if it comes like the beak of a bird, this is called Deficiency, and the disease is in the interior. Huangdi asked: You stated that the Spleen is the solitary organ, central Earth irrigating the four directions. What are the symptoms of its Excess and Deficiency? Qibo said: Excess causes inability to move the limbs; Deficiency causes obstruction of the nine orifices, named Zhong Qiang (Heavy Stiffness). Huangdi rose startled, bowed twice, and kowtowed saying: Excellent. I have obtained the great essence of pulse diagnosis, the supreme numbers of the world, the changes of the five colors and pulses, measuring the normal and the abnormal. The Dao lies in one thing: Shen (Spirit) turns without returning. If it returns, it does not turn, and the opportunity is lost. The essence of these supreme numbers is close and subtle. It is recorded on jade tablets and stored in the Zang organs, read every morning, named "Yu Ji" (Jade Machine).

The Qi of the five Zang organs is received from the organ that generates it, transmitted to the organ it overcomes, stays at the organ that generates it, and dies when it reaches the organ it cannot overcome. When death is imminent, the disease must first transmit to the organ it cannot overcome, and then death occurs. This refers to the retrograde flow of Qi, hence death. The Liver receives Qi from the Heart, transmits it to the Spleen, the Qi stays at the Kidney, and dies when reaching the Lung. The Heart receives Qi from the Spleen, transmits it to the Lung, the Qi stays at the Liver, and dies when reaching the Kidney. The Spleen receives Qi from the Lung, transmits it to the Kidney, the Qi stays at the Heart, and dies when reaching the Liver. The Lung receives Qi from the Kidney, transmits it to the Liver, the Qi stays at the Spleen, and dies when reaching the Heart. The Kidney receives Qi from the Liver, transmits it to the Heart, the Qi stays at the Lung, and dies when reaching the Spleen. These are all deaths due to retrograde transmission. Dividing a day and night into five parts allows one to predict the early or late time of death. Huangdi said: The five Zang organs are interconnected, and shifts occur in sequence. When the five Zang organs are diseased, they transmit to the organ they overcome. If untreated, according to the method, within three months or six months, or three days or six days, after transmitting through the five Zang organs, death ensues. This is the sequential transmission to the overcome organs. Thus it is said: Distinguishing Yang reveals the origin of the disease; distinguishing Yin reveals the period of life and death. This means knowing that death occurs when the disease reaches the organ that confines it. Therefore, Wind is the leader of a hundred diseases. Now, if Wind-Cold invades humans, causing all hair follicles to stand erect and skin pores to close resulting in heat, at this time, sweating can induce release. Or if Bi syndrome causes numbness, swelling, and pain, at this time, herbal baths, hot compresses, moxibustion, and acupuncture can remove it. If untreated, the disease enters and stays in the Lung, named Fei Bi (Lung Bi), manifesting as cough and rebellious Qi. If untreated, the Lung disease transmits to the Liver, named Gan Bi (Liver Bi), also known as Jue, with symptoms of hypochondriac pain and vomiting food; at this time, massage or ear acupuncture can be used. If untreated, Liver disease transmits to the Spleen, named Pi Feng (Spleen Wind), manifesting as Jaundice, heat in the abdomen, vexation, and discharge of yellow fluid; at this time, massage, herbs, or baths can be used. If untreated, Spleen disease transmits to the Kidney, named Shan Jia (Hernia Mass), with heat and pain in the lower abdomen and discharge of white matter, also known as Gu; at this time, massage or herbs can be used. If untreated, Kidney disease transmits to the Heart, causing spasmodic contraction of sinews and vessels, named Chou Yu (Convulsion); at this time, moxibustion or herbs can be used. If untreated, after ten days, death is expected by law. After Kidney disease transmits to the Heart, the Heart may reverse and transmit to the Lung, manifesting as chills and fever, with death expected after three years; this is the sequence of disease transmission. However, sudden onset diseases need not wait for transmission to treat, or if their transformation does not follow the sequence, entering irregularly due to emotions like worry, fear, sorrow, joy, or anger, preventing regular transmission, thus causing severe illness. Excessive joy leads to Heart Qi deficiency, allowing Kidney Qi to invade; anger leads to Liver Qi invading; sorrow leads to Lung Qi invading; fear leads to Spleen Qi invading; excessive worry leads to Heart Qi invading. This is the principle. There are five types of diseases, leading to twenty-five transformations and their transmissions. Transmission is the name for invasion by excess.

If the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult, and movement exacerbates the condition, death is expected in six months. If Zhen Zang Mai (True Organ Pulse) appears, a specific date of death is given. If the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult, internal pain radiates to the shoulders and neck, death is expected in one month. If Zhen Zang Mai appears, a specific date of death is given. If the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult, internal pain radiates to the shoulders and neck, body heat, muscle wasting, and skin breakdown appear, if Zhen Zang Mai appears, death occurs within ten months. If the large bones are withered and the large muscles are sunken, marrow in the shoulders dissipates internally, movement declines further, and Zhen Zang Mai appears, death is expected in one year. When Zhen Zang Mai appears, a specific date of death is given. If the large bones are withered and the large muscles are sunken, the chest is full of Qi, abdominal pain, mental discomfort, shoulder/neck/body heat, muscle wasting, sunken eye sockets, and Zhen Zang Mai appear, and the patient cannot see people, death is immediate; if they can see people, death occurs at the time corresponding to the organ they cannot overcome. If sudden extreme deficiency strikes the body, the five Zang organs close off, meridians are blocked, and Qi ceases to circulate, similar to falling or drowning, making prediction impossible. If the pulse stops, or if one breath cycle sees five to six beats, even if flesh is not wasted and Zhen Zang Mai is not seen, it is still fatal.

When True Liver Pulse appears, it is tense inside and out, sharp like touching a blade, tight like pressing a lute string, complexion is cyan-white without luster, hair breaks, and death follows. When True Heart Pulse appears, it is hard and beating, grainy like touching coix seeds, complexion is red-black without luster, hair breaks, and death follows. When True Lung Pulse appears, it is large and void, like feathers piercing human skin, complexion is white-red without luster, hair breaks, and death follows. When True Kidney Pulse appears, it is beating and abrupt, like fingers flicking stones, complexion is black-yellow without luster, hair breaks, and death follows. When True Spleen Pulse appears, it is weak and intermittently rapid and slow, complexion is yellow-cyan without luster, hair breaks, and death follows. All appearances of Zhen Zang Mai indicate untreatable death. Huangdi asked: Why does seeing Zhen Zang Mai mean death? Qibo said: The five Zang organs all derive Qi from the Stomach; the Stomach is the root of the five Zang organs. Zang Qi cannot reach the Hand Taiyin (Lung Meridian) on its own; it must rely on Stomach Qi to reach the Hand Taiyin. Thus, each Zang organ arrives at the Hand Taiyin in its respective season carrying its own Qi. Therefore, when pathogenic Qi prevails, essential Qi declines. In severe disease, Stomach Qi cannot accompany Zang Qi to the Hand Taiyin, so only Zhen Zang Qi appears alone. Appearance alone means pathogenic Qi overwhelms the Zang Qi, hence death. Huangdi said: Excellent.

Huangdi said: In treating any disease, observe the form, Qi, color, and luster, the flourishing or declining state of the pulse, and whether the disease is new or old, then treat without delaying the appropriate time. If form and Qi are harmonious, it is treatable; if color and luster are bright and floating, it is easily cured; if the pulse conforms to the four seasons, it is treatable; if the pulse is weak and slippery, indicating Stomach Qi, it is named easy to treat, provided treatment is timely. If form and Qi are discordant, it is difficult to treat; if color is dull and lacks luster, it is difficult to cure; if the pulse is solid and hard, the condition worsens; if the pulse opposes the four seasons, it is untreatable. One must examine these four difficulties and clearly inform the patient. Opposing the four seasons refers to: obtaining Lung pulse in Spring, Kidney pulse in Summer, Heart pulse in Autumn, and Spleen pulse in Winter, where the pulses are all suspended, isolated, deep, and choppy, named opposing the four seasons. Without corresponding Zang manifestations, if pulses are deep and choppy in Spring and Summer, or floating and large in Autumn and Winter, this is also named opposing the four seasons. Heat disease with quiet pulse, diarrhea with large pulse, blood loss with solid pulse, interior disease with solid/firm pulse, exterior disease with non-solid/non-firm pulse, are all difficult to treat. Huangdi said: I have heard that Deficiency and Excess determine life and death; I wish to hear the details. Qibo said: Five Excesses lead to death, Five Deficiencies lead to death. Huangdi said: I wish to hear about the Five Excesses and Five Deficiencies. Qibo said: Full pulse, hot skin, abdominal distension, blockage of front and back (urination and defecation), and chest oppression/dizziness are called Five Excesses. Fine pulse, cold skin, shortness of breath, diarrhea of front and back, and inability to eat are called Five Deficiencies. Huangdi asked: Under what circumstances can they survive? Qibo said: If porridge and gruel enter the Stomach and diarrhea stops, the deficient patient lives; if sweat appears and bowels/bladder open, the excess patient lives. These are the signs.