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The upper section discussed the manifestations of Jue (reversal) in the six meridians, but the principles of "Bing Neng" (disease functions and mechanisms) were not fully elucidated; therefore, further discussion is presented. The twelve primary meridians derive their Qi from the Stomach. Thus, the discussion begins with Carbuncle of the Epigastrium (Stomach Abscess), followed by cases of Jue syndrome, Neck Carbuncle, Manic Delirium due to anger, and Jiufeng (Wine Wind). These conditions, where pathogenic Qi aligns with the Four Seasons, are all categorized under Bing Neng.

Huangdi asked: When a person suffers from Carbuncle of the Epigastrium, what should the pulse diagnosis reveal?

Since the twelve primary meridians derive their Qi from the Stomach, if a person suffers from Carbuncle of the Epigastrium, how should the pulse of the meridians be diagnosed?

Qibo replied: To diagnose this condition, one must observe the Stomach Pulse. The pulse should be Deep and Fine (Chen Xi). A Deep and Fine pulse indicates Rebellious Qi. When Qi is rebellious, the Renying (Human Welcome) pulse becomes extremely full. An extremely full Renying pulse indicates Heat. The Renying pulse reflects the Stomach Meridian. When Qi is rebellious and full, Heat accumulates at the stomach opening without circulating, resulting in a Carbuncle of the Epigastrium.

Because there is a carbuncle in the epigastrium, diagnosing this requires observing the Stomach Pulse. Since the disease is in the Stomach, the pulse should be Deep and Fine. The Deep and Fine quality arises from the rebellion of Healthy Qi. When Qi rebels, the meridians become disharmonious; thus, rebellion causes the Renying pulse to be extremely full, indicating Stomach Heat. It is clarified here that the Renying pulse refers to the Stomach artery located on both sides of the laryngeal prominence. Now, with rebellious Qi and excessive Heat, Heat accumulates at the stomach opening and fails to circulate. Due to this lack of circulation, a carbuncle forms in the epigastrium.

Regarding the fine pulse felt deeply: when pressing with the middle finger, it feels as fine and deep as a needle. Palpating and pressing the affected area, if there is a sense of aggregation, it indicates the hardness of the carbuncle; if the pulsation is broad and diffuse, it indicates a large carbuncle.

In older editions, this passage appeared after "taking medicine before meals"; it is now corrected here. "Zhong" (middle finger) is pronounced with the departing tone. "Shen" means deep. "Bo" means diffuse. As stated earlier, the pulse should be Deep and Fine. The "fine pulse felt deeply" refers to the sensation of being extremely fine and deep, like a needle, when pressed by the middle finger. For a carbuncle in the epigastrium, the exterior should be palpated and pressed. If aggregation is felt during palpation and pressing, it signifies the hardness of the carbuncle. If there is no aggregation but rather a diffuse spread, it signifies the largeness of the carbuncle.

Huangdi said: Excellent. Why do some people feel uneasy when lying down?

Having understood the diagnosis of Stomach Carbuncle through the Renying pulse, Huangdi praised this insight. Disharmony of the Stomach leads to restlessness during sleep; hence, this question was raised.

Qibo said: When the Zang organs are injured, and Jing (Essence) is lost or scattered, if Wei Qi (Stomach Qi) can reside and harmonize, then peace is achieved. Therefore, one cannot isolate the disease from this physiological connection.

The Qi of the five Zang organs returns to the Spleen-Stomach Earth. Restlessness during sleep occurs due to injury to Zang Qi and the loss of Yin Essence. "Zhi" means departure or loss. Injury to Zang Qi and loss of Essence lead to unrest during sleep. Since the Qi of all Zang organs returns to the Stomach, and Stomach Earth Qi resides within the Zang organs, mutual residence and harmony bring peace. Without this residence, there is unrest. Thus, one cannot view the pathology in isolation.

Huangdi asked: Why can some people not lie flat on their backs?

"Yanwo" refers to lying flat on the back. The *Ping Re Lun* (Discourse on Fever Evaluation) states that inability to lie flat is due to disharmony in the Stomach. Hence, this question is raised again.

Qibo said: The Lung is the canopy of the Zang organs. When Lung Qi is excessive, the pulse becomes large. A large pulse prevents lying flat. This theory is found in the *Qi Heng Yin Yang* chapter.

The Lung resides in a high position, acting as a canopy covering the other Zang organs. Like the sky covering above, its Qi should descend. Currently, if Lung Qi is excessive, it ascends and does not descend. Ascending without descending causes the pulse associated with the Lung to become large. A large pulse makes lying flat impossible. This violates the normal balance of Yin and Yang, hence it is discussed in the *Qi Heng Yin Yang* chapter. "Qi Heng Yin Yang" refers to what follows below.

The *Shang Jing* (Upper Classic) discusses the communication of Qi with Heaven. The *Xia Jing* (Lower Classic) discusses the changes of diseases. The *Jin Gui* (Golden Cabinet) determines life and death. The *Kui Du* (Measure and Estimate) involves palpating and estimating. The *Qi Heng* (Extraordinary and Constant) discusses extraordinary diseases. "Qi" (extraordinary) means such diseases do not die according to the four seasons' norms. "Heng" (constant) means ordinary diseases die according to the four seasons' norms. "Kui" means to square and seek, referring to carefully investigating the pulse mechanism. "Du" means to locate the disease site and estimate it according to the four seasons.

In older editions, this was at the end of the chapter; it is listed here now. "Du" is pronounced with the entering tone. "Chu" is pronounced with the departing tone. The *Shi Cong Rong* discourse says, "Please recite the Upper and Lower sections of the *Mai Jing*." The *Mai Jing* is suspected to be the *Ling Shu Jing*. Here, the *Shang Jing* and *Xia Jing* refer to the upper and lower sections of the *Mai Jing*. The *Shang Jing* discusses the way of Qi transformation, so it speaks of human Qi communicating with Heaven. The *Xia Jing* discusses the generation of diseases, so it speaks of the changes in people's illnesses. The *Ling Shu* mentions inscribing on jade plates and storing in orchid chambers, which is equivalent to storing in the Golden Cabinet. The "Golden Cabinet" is used to determine life and death. The *Shu Wu Guo Lun* states: "Shang Jing, Xia Jing, Kui Du Yin Yang, Qi Heng Wu Zhong, decided by Ming Tang." Thus, reiterating "Kui Du" means palpating the pulse to estimate the condition. "Qi Heng" refers to unusual, extraordinary diseases. Reiterating "Qi," it means extraordinary diseases do not follow the seasonal pattern of death. "Heng" means they do follow the seasonal pattern. Reiterating "Kui," it means to square and seek, i.e., carefully investigate the pulse logic. "Du" means finding the disease location and estimating it via the Yin-Yang of the four seasons. In this way, one understands the communication of Qi with Heaven and the changes of disease, thereby determining life and death.

Huangdi asked: In cases of Jue syndrome, if the right pulse is Deep and Tight, and the left pulse is Floating and Slow, but if this is not the case, where is the primary disease located?

Continuing the theme of carefully investigating pulse logic to locate the disease, he asks about Jue syndrome. Yang Qi failing to ascend results in a Right pulse that is Deep and Tight. Yin Qi failing to descend results in a Left pulse that is Floating and Slow. In Jue syndrome, Yin and Yang Qi fail to connect smoothly, resulting in such pulses. If one has Jue syndrome but the pulse is different, where is the primary disease?

Qibo said: Diagnose each side separately. The Right pulse should naturally be Deep and Tight; this corresponds to the Four Seasons. The Left pulse being Floating and Slow contradicts the Four Seasons. On the left, the disease primarily resides in the Kidney, significantly involving the Lung, and should manifest as lower back pain.

Investigating pulse logic to locate the disease requires estimation based on the Yin-Yang of the Four Seasons: Spring generates, Summer grows, Autumn harvests, Winter stores. If diagnosed in Winter, the Right pulse should naturally be Deep and Tight; this is the Winter pulse corresponding to the seasons. However, the Left pulse being Floating and Slow contradicts the seasonal pattern. Floating and Slow on the left primarily indicates disease in the Kidney. This is because the Kidney pulse resides in the Left Chi position. The Kidney connects upward to the Lung; thus, it significantly involves the Lung. Disease in the Kidney involving the Lung manifests as lower back pain.

Huangdi asked: Why do you say so?

Why does Kidney disease involve the Lung? Why does Lung involvement cause lower back pain?

Qibo said: The Shaoyin Meridian passes through the Kidney and links to the Lung. Now, obtaining the Lung pulse indicates the Kidney is diseased. Therefore, the Kidney is the source of the lower back pain.

Shaoyin refers to the Kidney pulse. The Shaoyin meridian passes through the Kidney and links to the Lung, hence Kidney disease involves the Lung. Floating and Slow is the characteristic of the Lung pulse. Obtaining the Floating and Slow Lung pulse while the Kidney is the root of the illness: since the waist is the mansion of the Kidney, the Kidney becomes the source of the lower back pain.

Huangdi said: Excellent. Some suffer from Neck Carbuncle. Some are treated with stone needles (bian shi), others with acupuncture, and all recover. What is the truth behind this?

Having discussed Jue syndrome and winter pulses corresponding to the seasons, Huangdi praised this. Jue corresponds to Winter, Neck Carbuncle to Spring, Manic Delirium to Summer, and Wine Wind to Autumn. Thus, questions follow sequentially.

Qibo said: These share the same name but belong to different categories.

"Deng" means category. Although named Neck Carbuncle, they differ in whether the pathology lies in Qi or Blood.

If the carbuncle is caused by stagnant Qi, it is suitable to use needles to open and remove it. If it is caused by excessive Qi and aggregated Blood, it is suitable to use stone needles to drain it. This is called "treating the same disease differently."

"Xi" means stagnation or cessation. If the Neck Carbuncle is due to Qi stagnation, the disease is in the Qi level. Needles should be used to unblock Qi and remove the pathogen. This is the true method for carbuncles formed by Qi stagnation using acupuncture. If the Neck Carbuncle is due to excessive Qi and aggregated Blood, the disease is in the Blood level. Stone needles should be used to pierce and bleed to drain the pathogen. This is the true method for carbuncles formed by Blood aggregation using stone therapy. This explains why treating the same-named disease differently leads to recovery in both cases.

Huangdi asked: Some suffer from Manic Delirium due to anger. How does this disease arise?

Neck Carbuncle corresponds to Spring; Manic Delirium corresponds to Summer. Hence, this is asked next.

Qibo said: It arises from Yang.

Excessive Yang Qi leads to mania. This type of manic delirium arises from Yang.

Huangdi asked: How does Yang cause mania?

Yang refers to Healthy Qi. How does it cause mania?

Qibo said: Yang Qi, when suddenly frustrated and difficult to resolve, leads to frequent anger. This disease is named Yang Jue (Yang Reversal).

Yang Qi flows freely and should not be suppressed. When Yang Qi is suddenly frustrated and difficult to dissipate ("Jue" implies dissipation/resolution), it leads to anger and mania. This results from the reversal of Yang Qi, hence named Yang Jue.

Huangdi asked: How do we know this?

How do we identify Yang Jue?

Qibo said: The Yangming pulse is constantly active. The Taiyang and Shaoyang pulses are normally inactive. If the normally inactive pulses become active and rapid, this is the sign of Yang Jue.

Taiyang and Shaoyang combine to form Yangming. Yangming possesses the Yang of Shaoyang and the Yang of Taiyang, so the Yangming pulse is constantly active. Juyang (Taiyang) is the extreme of Yang. At the extreme, its Qi becomes weak. Shaoyang is the beginning of Yang. At the beginning, its Qi is quiet. Thus, Taiyang and Shaoyang pulses are normally inactive. If they become active and rapid, this is the sign of Yang Jue.

Huangdi asked: How should it be treated?

Unfamiliar with the treatment method, he asks again.

Qibo said: Depriving them of food will cure it. Food enters the Yin and nourishes/grows Yang. Therefore, depriving them of food cures it. Have them drink Sheng Tie Luo (Iron Filings Decoction). Sheng Tie Luo rapidly descends Qi.

"Zhang" is pronounced with the rising tone. "Luo" is synonymous with "Lao." Yangming belongs to the Stomach. The Stomach is the gathering place of Yang Qi. With excess Yang Qi, restricting food intake is necessary for recovery. Food enters the Stomach, generating Yin Essence. Thus, food enters Yin; sufficient Yin Essence strengthens Yang, thereby "growing" Yang. Restricting food reduces the hyperactivity of Yangming Earth Qi, so restriction cures it. "Duo" means to diminish. Additionally, have them drink Sheng Tie Lao (Iron Filings Drink). Iron belongs to Metal. Metal controls Wood, regulating Shaoyang Qi. "Lao Yin" (drinking the red-hot iron quenched liquid) turns red to black. Red turning to black can calm Juyang Qi, hence it is said to rapidly descend Qi.

Huangdi said: Excellent. Some suffer from body heat, flaccidity, sweating profusely as if bathing, aversion to wind, and shortness of breath. What disease is this?

"E" is pronounced with the departing tone. Having established treatment for Yang Jue, Yin Jue should also have treatment. Huangdi grasped the implication and praised it, then asked about the disease characterized by heat, sweating, aversion to wind, and shortness of breath.

Qibo said: This disease is named Jiufeng (Wine Wind).

Wine Qi acts first on the skin and fills the collaterals, causing body heat, sweating, and aversion to wind. It does not distribute essence through the central Earth (Spleen/Stomach), leading to flaccidity and shortness of breath. Qibo calls this Jiufeng, likely an autumn disease.

Huangdi asked: How should it be treated?

Qibo said: Use Ze Xie (Alisma Rhizome) and Bai Zhu (Atractylodes Macrocephala Rhizome) each in 10 parts, and Mi Xian (Elsholtzia Spica) in 5 parts. Mix and take three fingers' worth as a dose, taken before meals.

"Fen" is pronounced with the departing tone. Jiufeng disease involves deficiency in the central Earth. Ze Xie and Bai Zhu, each 10 parts, serve as the Sovereign herbs to tonify Spleen Earth. Mi Xian, 5 parts, serves as the Minister herb to dispel wind pathogens. Mix these and take a dose held between three fingers. Take the medicine first, tonify the center, dispel wind pathogens, and then eat, to benefit Stomach Qi. Combining Carbuncle of the Epigastrium, Jue syndrome, Neck Carbuncle, Manic Delirium, and Wine Wind illustrates "Bing Neng" and the principles of "Kui Du Qi Heng." Since the主旨 (main purport) was not fully expounded, the following text discusses Extraordinary Diseases and Great Extraordinary Diseases.