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The Heart governs Shen Ming (Spirit/Mind) and is generally not easily invaded by pathogenic factors. Therefore, when a disease transmits from the Kidney to the Heart, the Heart will reverse-transmit it to the Lung, causing Lung pathology and manifesting as aversion to cold and fever. Since the disease originates internally, according to the pattern, death should occur within three years. The reason for death after three years lies in the sequence of transmission following the "mutual overcoming" (Ke) cycle: The Kidney transmits to the Heart, representing Water overcoming Fire; the Heart then transmits to the Lung, representing Fire overcoming Metal; in the first year, Metal overcomes Wood; in the second year, Wood overcomes Earth; and in the third year, Earth overcomes Water. Once transmitted through all five Zang organs, death ensues. The earlier statement that "the five Zang organs are interconnected, and shifts have their sequence" refers to the sequence of mutual generation (Sheng). The sequence of disease transmission here, however, follows the sequence of mutual overcoming.

However, if the disease manifests suddenly, one need not treat based on its transmission pattern. Or, if the transmission does not follow a fixed order, it is because emotional factors such as worry, fear, grief, joy, and anger prevent the disease from developing sequentially, leading to severe illness. If excessive joy leads to internal deficiency of Heart Qi, Kidney Qi will invade the Heart. If excessive anger causes Liver Qi to rebel upward, Liver Qi will invade the Spleen. If excessive grief causes Lung Qi to stagnate, Lung Qi will invade the Liver. If excessive fear causes Spleen Qi to become deficient, Spleen Qi will invade the Kidney. If excessive worry causes Heart Qi to be insufficient, Heart Qi will invade the Lung. This is the principle involved. Thus, there are five types of diseases, and each organ has transmissions involving the other five organs, resulting in twenty-five variations concerning disease transmission. "Transmission" (Chuan) is synonymous with "invading/overcoming" (Cheng).

"Cu" (sudden) is pronounced like "Cu". The same applies below. Lung disease manifests as aversion to cold and fever. However, if these symptoms appear suddenly, it is due to a violent attack by external pathogens, and one need not treat based on transmission patterns. This means one should not use the method for treating Heart transmitting to the Lung. The earlier mention of Kidney transmitting to Heart and Heart transmitting to Lung represents the normal sequence of disease. If transmission does not follow this sequence, it is because the internal injury of the Five Emotions prevents sequential development, leading to severe disease. For instance, excessive joy causes internal deficiency of Heart Qi, allowing Kidney Qi to invade the Heart. Excessive anger causes internal rebellion of Liver Qi, allowing Liver Qi to invade the Spleen. Excessive grief causes internal stagnation of Lung Qi, allowing Lung Qi to invade the Liver. Excessive fear causes internal deficiency of Kidney Qi, allowing Spleen Qi to invade the Kidney. Excessive worry causes internal deficiency of Lung Qi, allowing Heart Qi to invade the Lung. This is the pathway of transmission caused by the movement of the Five Emotions. The Five Emotions correspond to the Five Zang organs; thus, there are five diseases, and each organ involves transmission from the other five, resulting in twenty-five variations. "Transmission" refers to Kidney Qi invading, Liver Qi invading, Lung Qi invading, Spleen Qi invading, and Heart Qi invading; hence, "transmission" is named "invading." The text does not separately discuss the emotion of the Spleen because Spleen Earth is distributed among the other four organs. Mentioning grief as the emotion of the Lung indicates that not only does excess Liver anger cause its own Qi to invade other organs, but even deficiency of Lung grief causes its own Qi to invade other organs.

If the large bones are withered and atrophic, the large muscles are sunken, the chest is distended with Qi, breathing is difficult and labored, and the breath causes the body to tremble, death is expected in six months. If the Zhen Zang Mai (True Organ Pulse) appears, a specific date of death can be given.

"Pian" is read as a level tone. "Xian" sounds like "Xian" (appear). "Yu" is interchangeable with "Yu" (give). The following examples follow this rule. "Large bones and large muscles" refer to the flesh and bone of the arms and thighs. Withered large bones indicate Kidney disease. Sunken large muscles indicate Spleen disease. Chest fullness and difficult breathing indicate Lung disease. "Pian" means smooth or unobstructed. The repetition below follows this meaning. "Qi moving the form" means that due to difficult breathing, the movement of Qi is obstructed, causing the physical body to tremble. Death in six months implies an inability to survive the summer if one survives winter, or vice versa, leading to death in half a year. The appearance of the Zhen Zang Mai refers to the description later in the text, such as feeling like touching a knife edge. Giving the date of death refers to statements in the *Ping Ren Qi Xiang Lun* (Treatise on the Normal Person's Phenomena), such as Liver appearing on Geng/Xin days leading to death. When the True Qi of the five Zang organs flows without returning, and the Zhen Zang Mai appears, it returns but does not flow, leading to death.

If the large bones are withered, 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 the Zhen Zang Mai appears, a specific date of death can be given.

Continuing from the previous discussion of Kidney, Spleen, and Lung diseases, if internal pain radiates to the shoulders and neck, it indicates the disease has followed the meridians to the Fengfu point, hence death is expected in one month. Generally, the Wei Qi (Defensive Qi) circulates through the meridians, gathering at the Fengfu point once every day and night, descending one section daily. After twenty-one days, it reaches the Futu point; after thirty days, it emerges from the Quepen point. If it cannot gather again at the Fengfu point, death occurs. If the Zhen Zang Mai appears, a date of death is given.

If the large bones are withered, the large muscles are sunken, the chest is full of Qi, breathing is difficult, internal pain radiates to the shoulders and neck, the body is hot, muscles waste away, and the skin cracks, and the Zhen Zang Mai appears, death is expected within ten months.

Muscle tissue is called "Rou," and fat is called "Peng." Continuing from the previous discussion of Kidney, Spleen, Lung, and Fengfu diseases, the addition of body heat, muscle wasting, and cracked skin indicates deficiency of Yin blood and failure of the Middle Jiao (Spleen/Stomach). If the Zhen Zang Mai appears, death occurs within ten days. The generative number of Earth is five, and the completed number is ten. Death within ten days does not exceed the completed number of Earth.

If the large bones are withered, the large muscles are sunken, the marrow of the shoulders dissipates internally, movements become increasingly weak, and the Zhen Zang Mai has not yet appeared, death is expected in one year. If the Zhen Zang Mai appears, a specific date of death can be given.

"Wei" was erroneously printed as "Lai" in old editions and is corrected here. Dissipation of shoulder marrow and increasing weakness of movement mean that initially, pain radiated to the shoulders and neck, but now the shoulder marrow is dissipated. Initially, muscles wasted and movements were weak, but now movements are increasingly weak, indicating progression from the previous context. If the Zhen Zang Mai has not appeared, death is expected upon the completion of a one-year cycle. If the Zhen Zang Mai is seen, a date of death is given.

If the large bones are withered, the large muscles are sunken, the chest is full of Qi, there is abdominal pain, discomfort in the heart region, heat in the shoulders, neck, and body, muscle wasting, and sunken eye sockets, and the Zhen Zang Mai appears, if the person cannot see others, they will die immediately. If they can still see others, they will die during the time element that overcomes them.

The pronunciation of "Jian" (see) is as written. Kidney disease causes bone withering, Spleen disease causes muscle sinking, and Lung disease causes Qi fullness. Liver Wood invading Spleen Earth causes abdominal pain. Internal deficiency of Shen Qi causes discomfort in the heart region. This continues the previous theme, stating that all five Zang organs are diseased. "Shoulders and neck" refers to pain radiating to them. Heat in the shoulders, neck, and body, along with muscle wasting, also continues the previous context. Sunken eye sockets indicate the exhaustion of Yangming Stomach Qi. If the Zhen Zang Mai appears and the person cannot see others, Shen Qi perishes first, leading to immediate death. If they can still see others, Shen Qi has not perished, and they will die during the time element that overcomes them. A "time element" refers to the twelve two-hour periods of the day.

Acute deficiency, sudden invasion by pathogens, and abrupt onset lead to the closure and blockage of the five Zang organs, obstruction of the pulse channels, and cessation of Qi circulation. This is like falling into water or drowning, making prognosis impossible. If the pulse ceases completely, or if the pulse beats five to six times per breath in a healthy person, even if the flesh and form are not wasted and the Zhen Zang Mai is not visible, death will still occur.

"Zhong" is pronounced with a departing tone. Continuing the previous meaning, acute diseases can kill quickly, making pulse diagnosis difficult for prognosis. "Ji Xu" (acute deficiency) refers to a sudden, temporary collapse of Zheng Qi (Upright Qi). "Shen Zhong" refers to external pathogens suddenly striking the body. "Cu Zhi" refers to guest pathogens abruptly reaching the Zang organs. These diseases affect the divine mechanism of the Zang Yuan (True Yuan) rather than the tangible meridians. Thus, the Qi of the five Zang organs closes temporarily, and the pulse channels throughout the body become blocked. The circular circulation of Qi stops temporarily. Such sudden diseases cause death in an instant, like falling or drowning, making prediction impossible. In cases of acute deficiency, if the pulse collapses inward, it ceases completely. If it collapses outward, the pulse may beat five to six times per breath. Even if the flesh is not wasted and the Zhen Zang Mai is not visible, death will still occur. This illustrates sudden death where prognosis is impossible, noting that the Zhen Zang Mai does not necessarily need to appear, thereby supplementing the previous incomplete meaning.

When the True Liver Pulse arrives, it is tense inside and out, sounding like rubbing a knife edge (Ze Ze Ran), or pressing a lute string. The complexion is blue-white and dull. When the hair follicles break, death occurs. When the True Heart Pulse arrives, it is firm and beating, like rolling hemp seeds (Lei Lei Ran). The complexion is red-black and dull. When the hair follicles break, death occurs. When the True Lung Pulse arrives, it is large and empty, like a feather brushing against the skin. The complexion is white-red and dull. When the hair follicles break, death occurs. When the True Kidney Pulse arrives, it is beating and severed, like fingers snapping stones (Pi Pi Ran). The complexion is black-yellow and dull. When the hair follicles break, death occurs. When the True Spleen Pulse arrives, it is weak and intermittent (alternating between rapid and slow). The complexion is yellow-blue and dull. When the hair follicles break, death occurs. All appearances of the Zhen Zang Mai indicate incurable death.

"Zhe" sounds like "She". "Zhong" in "Zhong Ren" is a departing tone. "Dan" is a level tone. "Shuo" sounds like "Shuo". The so-called appearance of the Zhen Zang Mai: When the True Liver Pulse arrives, it is tense inside and out. This tension is like rubbing a knife edge, indicating stagnant flow. Like pressing a lute string, it feels like a single line, lacking softness. An absolute pulse must be accompanied by an absolute complexion. Thus, the complexion is blue-white and dull. Blue is the color of the Liver; white indicates Metal overcoming Wood. Since pulse Qi travels from inside to outside, the appearance of the Zhen Zang Mai must be accompanied by the breaking of hair follicles before death, because both root and branch are exhausted. When the True Heart Pulse arrives, it is firm and beating. Firm means solid; beating means striking. Like rolling hemp seeds, it indicates rigidity without root. Red-black dull complexion indicates Water overcoming Fire. Hair follicle breaking precedes death. When the True Lung Pulse arrives, it is large and empty, indicating lack of root. Like a feather brushing the skin, it indicates lack of branch. White-red dull complexion indicates Fire overcoming Metal. Hair follicle breaking precedes death. When the True Kidney Pulse arrives, it is beating and severed. Beating resembles twisting a rope; severed means the rope seems broken. Like fingers snapping stones, it is hard and rigid, lacking Stomach Qi. Black-yellow dull complexion indicates Earth overcoming Water. Hair follicle breaking precedes death. When the True Spleen Pulse arrives, the organ Qi is deficient, so the pulse is weak and cannot reach the four other organs, hence intermittent. Yellow-blue dull complexion indicates Wood overcoming Earth. Hair follicle breaking precedes death. This clarifies that the Zhen Zang pulse image requires both root and branch to be exhausted before death, supplementing the previous incomplete meaning.

Huangdi said: Seeing the Zhen Zang Mai indicates death. Why?

The Zhen Zang Mai is hidden; when it appears, death is certain. Having explained this repeatedly, Huangdi wishes to deduce the reason for death and asks Qibo to elucidate.

Qibo said: The five Zang organs all receive Qi from the Stomach. The Stomach is the root of the five Zang organs. The Qi of the Zang organs cannot reach the Hand Taiyin (Lung Meridian) on its own; it must rely on Stomach Qi to reach the Hand Taiyin. Therefore, each of the five Zang organs manifests its pulse at its respective season and reaches the Hand Taiyin. When pathogenic factors prevail, Jing Qi (Essence Qi) declines. In severe disease, Stomach Qi cannot accompany the Zang Qi to reach the Hand Taiyin. Thus, the Qi of the Zhen Zang appears alone. Appearing alone means the disease Qi overcomes the Organ Qi, hence death. Huangdi said: Excellent.

The Zhen Zang Mai is a pulse devoid of Stomach Qi. The five Zang organs all receive Qi from the Stomach; thus, the Stomach is the root of the five Zang organs. The Lungs govern all pulses, presided over by the Hand Taiyin. However, Zang Qi cannot reach the Hand Taiyin independently; it relies on Stomach Qi. Thus, the Liver, Heart, Spleen, Lung, and Kidney each manifest their respective pulse qualities (Wiry, Hook, Floating, Stone) at their seasons and reach the Hand Taiyin. When pathogens prevail, it is due to the decline of Zang Jing Qi. In severe disease, Stomach Qi cannot accompany Zang Qi to the Hand Taiyin. Devoid of Stomach Qi, the Zhen Zang Qi appears alone in the pulse. Appearing alone means Disease Qi overcomes Organ Qi. Disease Qi overcoming Organ Qi leads to death. This aligns with the principle that "returning without turning results in loss of opportunity." Hence, Huangdi said: Excellent. This section, Huangdi reiterates the meaning of Yu Ji regarding the Zhen Zang Mai.

Huangdi said: In treating any disease, observe the patient's form, Qi, color, and luster, the flourishing or declining state of the pulse, and whether the disease is new or old, then treat accordingly, without delaying the appropriate time.

Having clarified the meaning of Yu Ji and Zhen Zang, and recognizing that form, Qi, color, and pulse all possess the Divine Mechanism, Huangdi reiterates: In treating disease, one must observe the form and Qi, the luster of the color, the strength of the pulse, and the novelty of the disease, then establish treatment methods, ensuring not to miss the opportune moment.

If form and Qi are harmonious, it is called treatable. If the color is floating and lustrous, it is called easily curable. If the pulse conforms to the four seasons, it is called treatable. A pulse that is weak and slippery indicates the presence of Stomach Qi and is named easily treated; seize the timing for treatment.

"Yi" is pronounced with a departing tone. Considering favorable conditions of form, Qi, color, and pulse: Harmonious form and Qi indicate treatability. Floating and lustrous facial color indicates easy recovery. Wiry in Spring, Hook in Summer, Floating in Autumn, and Stone in Winter—pulses conforming to the four seasons indicate treatability. A weak and slippery pulse indicates Stomach Qi and easy treatment. If form, Qi, color, and pulse are all favorable, even chronic diseases are treatable. Treating without delay is called seizing the timing.

If form and Qi are discordant, it is called difficult to treat. If the complexion is sallow and unclear, it is called difficult to cure. If the pulse is excess and hard, the condition worsens. If the pulse contradicts the four seasons, it is untreatable. One must examine these four difficulties and clearly inform the patient.

The "four difficulties" refer to form, Qi, color, and pulse. Considering unfavorable conditions: Form weak with Qi strong, or form strong with Qi weak, indicates discordance and difficulty in treatment. A sallow, dull complexion without luster indicates difficulty in curing. An excess and hard pulse indicates lack of Stomach Qi and worsening condition. A pulse contradicting the four seasons indicates Zang Qi being overcome and untreatability. If form, Qi, color, and pulse are all contradictory, even new diseases are untreatable. Informing without delay requires examining the four difficulties clearly. There is no room for hesitation.

What is meant by contradicting the four seasons? It is obtaining the Lung pulse in Spring, the Kidney pulse in Summer, the Heart pulse in Autumn, and the Spleen pulse in Winter. If these pulses are suspended, absent, deep, and choppy, it is called contradicting the four seasons. Without the typical pulse shape of the organ, having a deep and choppy pulse in Spring and Summer, or a floating and large pulse in Autumn and Winter, is also called contradicting the four seasons.

Elaborating on contradicting the four seasons: Lung pulse in Spring indicates Metal overcoming Wood. Kidney pulse in Summer indicates Water overcoming Fire. Heart pulse in Autumn indicates Fire overcoming Metal. Spleen pulse in Winter indicates Earth overcoming Water. Pulses that are suspended, rootless, deep, or choppy indicate lack of Stomach Qi and are called contradicting the four seasons. "Without typical pulse shape" means failing to show Wiry/Hook pulses in Spring/Summer or Floating/Stone pulses in Autumn/Winter. Spring generates and Summer grows; deep/choppy pulses in Spring/Summer contradict this. Autumn harvests and Winter stores; floating/large pulses in Autumn/Winter contradict this, also called contradicting the four seasons.

Heat disease with a quiet pulse, diarrhea with a large pulse, blood loss with a solid pulse, interior disease with a solid pulse, exterior disease with a non-solid pulse—all are difficult to treat.

Pulse and disease contrary to each other is also called contradiction. Heat disease implies disharmony of Qi and Blood; a quiet pulse in heat disease is contradictory. Diarrhea implies internal deficiency of Earth Qi; a large pulse in diarrhea is contradictory. Blood loss implies downward leakage of Yin fluids; a solid pulse in blood loss is contradictory. Interior disease implies deficiency of Righteous Qi; a solid/hard pulse in interior disease is contradictory. Exterior disease implies excess of Pathogenic Qi; a non-solid/non-hard pulse in exterior disease is contradictory. These contradictions between pulse and disease, akin to contradicting the four seasons, make them all difficult to treat.

Huangdi said: I have heard that determining excess and deficiency allows one to decide life and death. I wish to hear the details.

Having understood the essentials of form, Qi, color, and pulse, and recognizing their variations in excess and deficiency leading to life or death, Huangdi asks Qibo to clarify.

Qibo said: Five Excesses lead to death; Five Deficiencies lead to death.

Five Excesses refer to excess pathogenic Qi in the five Zang organs. Five Deficiencies refer to deficiency of righteous Qi in the five Zang organs. Disease affecting Zang Qi can lead to death regardless of excess or deficiency.

Huangdi said: Please explain the Five Excesses and Five Deficiencies. Qibo said: A surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and chest oppression with dizziness constitute the Five Excesses. A fine pulse, cold skin, shortness of breath, diarrhea and incontinence of urine and feces, and inability to eat or drink constitute the Five Deficiencies.

"Mao" is pronounced "Mao", same as in other chapters. The pulse is governed by the Heart. Pathogens invading the Heart cause a surging pulse. Skin is governed by the Lung. Pathogens invading the Lung cause hot skin. The abdomen is governed by the Spleen. Pathogens invading the Spleen cause abdominal distension. The Kidneys open into the anterior and posterior orifices. Pathogens invading the Kidneys cause obstruction of urination and defecation. The Liver opens into the eyes. Pathogens invading the Liver cause oppression and dizziness ("Mao" means depression; "Mu" means blurred vision). This constitutes the Five Excesses. Deficiency of Heart Qi causes a fine pulse. Deficiency of Lung Qi causes cold skin. Deficiency of Liver Qi causes shortness of breath. Deficiency of Kidney Qi causes diarrhea and incontinence. Deficiency of Spleen Qi causes inability to eat or drink. This constitutes the Five Deficiencies.

Huangdi said: Under what circumstances can there be survival? Qibo said: If gruel and porridge enter the stomach and diarrhea stops, the deficient patient lives. If the body sweats and urination/defecation becomes free, the excess patient lives. These are the signs.

The Qi of the five Zang organs is generated by Stomach Earth and governed by the San Jiao. If Stomach Earth is harmonious, gruel enters the stomach, and diarrhea stops, allowing the deficient patient to live. If the San Jiao is unobstructed externally, the body sweats; if unobstructed internally, urination and defecation become free, allowing the excess patient to live. These are the signs of life and death in excess and deficiency.

This section concludes the discussion on form, Qi, color, pulse, excess, deficiency, life, and death, finalizing the meaning of the *Yu Ji Zhen Zang Lun*.