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The meridians begin at the Lung meridian and end at the Liver meridian, circulating continuously with a regular measure. If affected by fright, anger, or labor, leading to panting, sweating, and illness, causing the Qi of the Zang organs to become excessively dominant and deviating from the normal measure, this is referred to as the variation of the meridians (Jingmai). Knowing the normal state allows one to know the variations; therefore, the text discusses the normal distribution of food and drink. Knowing the variations allows one to seek the normal state; therefore, the text discusses the structure of Yin-Yang and Zang-Xiang (Visceral Manifestations), elaborating on it repeatedly.

Huangdi asked: Do the pulses also change according to a person's living environment, activity level, and courage or timidity?

Pulse refers to the Meridians. The circulation of human meridians follows a constant measure. For instance, regarding the dynamics of living environments and the strength of effort, do the meridians also change accordingly? Huangdi's inquiry into pulse changes aims to explain the variations of the meridians.

Qibo replied: Any fright, anger, labor, activity, or rest in humans will cause changes.

Not only do the dynamics of living environments and the strength of effort cause changes, but any fright, anger, labor, activity, or rest that leads to meridian dysfunction constitutes a change in the pulse.

Therefore, walking at night causes panting originating from the Kidney, with pathogenic Qi invading and damaging the Lung; falling and fear cause panting originating from the Liver, with pathogenic Qi invading and harming the Spleen; fright and terror cause panting originating from the Lung, with pathogenic Qi invading and damaging the Heart; wading through water and falling cause panting originating from the Kidney and bones.

In a healthy person, Qi harmonizes within the meridians. Labor-induced panting indicates meridian dysfunction. Thus, labor at night prevents Qi from storing properly, causing panting to originate from the Kidney. The Kidney is the root, and the Lung is the branch; thus, pathogenic Qi invades and damages the Lung, losing its normal state. Falling accompanied by internal fear injures the sinews, which are governed by the Liver; thus, panting originates from the Liver. Liver Wood overacts on the Spleen, so pathogenic Qi harms the Spleen, losing its normal state. Fright involves internal fear; fright disrupts internal Qi mechanism. Since the Lung governs Qi, panting originates from the Lung. The Lung covers the Heart, so pathogenic Qi damages the Heart, losing its normal state. Wading and falling involve both injury and shock, more severe than night walking; thus, panting originates from the Kidney and bones. Qi cannot ascend to combine with the Lung, and pathogenic Qi harms the bones, hence "and bones," further losing the normal state. These cases of panting due to Zang organ pathology result from meridian dysfunction, constituting variations of the meridians.

At such times, courageous individuals have sufficient Qi flow, and the condition resolves; timid individuals retain the pathogen and develop disease. Therefore, it is said that the method of pulse diagnosis involves observing a person's courage or timidity, as well as their bone, muscle, and skin conditions, to understand the nature of the illness, serving as a diagnostic method.

Continuing from the above, during night walking, falling, fear, or shock and falls, courageous individuals have surplus Qi in their meridians and do not fall ill, so Qi flows freely and the condition resolves. Timid individuals suffer meridian injury, retaining the pathogen and developing disease as described above. Since the courageous recover and the timid fall ill, it is said that the method of pulse diagnosis involves observing courage or timidity, and bone, muscle, and skin, to understand internal and external, superficial and deep conditions, forming a diagnostic method.

Thus, excessive fullness from food causes sweat from the Stomach; shock depleting Essence causes sweat from the Heart; carrying heavy loads and traveling far causes sweat from the Kidney; running fast and fearing causes sweat from the Liver; bodily shaking and hard labor cause sweat from the Spleen. Therefore, illnesses arising from Yin-Yang imbalance in the four seasons all stem from overexertion, which is the norm.

Qi disharmony leads to panting; meridian disharmony leads to sweating. Sweating is cited to illustrate this. Excessive eating disrupts Stomach collaterals, causing sweat from the Stomach; shock depleting Essence disrupts Heart vessels, causing sweat from the Heart; carrying heavy loads and traveling far injures the bones governed by the Kidney, causing sweat from the Kidney; running fast and fearing injures the sinews governed by the Liver, causing sweat from the Liver; bodily shaking and hard labor injure the muscles governed by the Spleen, causing sweat from the Spleen. The Lung is not mentioned because sweat emerges from the skin governed by the Lung. The Qi of the five Zang organs harmonizes with the four seasons; thus, illnesses caused by Yin-Yang disharmony in the four seasons all arise from overexertion. Overexertion includes excessive eating, depleting Essence, long travel, fear, and hard labor. This is considered the norm, meaning treating overexertion as routine leads to deviation from the normal course of the meridians.

When food enters the Stomach, its essence is dispersed to the Liver, nourishing the sinews. When food enters the Stomach, turbid Qi returns to the Heart, infusing essence into the vessels. Vessel Qi flows through the meridians, and meridian Qi returns to the Lung. The Lung receives all vessels and distributes essence to the skin and hair. Skin and vessel essence combine, moving Qi to the Fu organs. The clarity of Fu organ essence remains in the four Zang organs, and Qi returns to equilibrium. When balanced, the radial artery (Cunkou) forms an inch-length pulse, used to determine life and death.

The Stomach is the foundation of the five Zang organs and the great source of the six Fu organs. Food entering the Stomach aids the ascending Wood Qi of the East, dispersing essence to the Liver, which then nourishes the sinews. "Yin" means irrigation. Food entering the Stomach aids the Shen Qi of Ministerial Fire, where turbid Qi returns to the Heart, infusing essence into the vessels. The Liver receives essence and irrigates Qi; the Heart receives Qi and infuses essence. Thus, the essence of food is its Qi, and the Qi of food is its essence. Vessel Qi remaining in the meridians refers to formless vessel Qi flowing into formed meridians. Meridian Qi returning to the Lung occurs because the Lung is superior, receiving meridian fluid Qi. The Lung receiving all vessels means the Lung accepts the convergence of all vessels. Distributing essence to skin and hair means the skin and hair receive the distribution of Lung essence. Skin and vessel essence combining, moving Qi to Fu organs, means skin and all vessels combine Lung-distributed essence to move Qi to the six Fu organs. The clarity of Fu organ essence remaining in the four Zang organs means Fu organ essence combines with Heart Shen to remain in the Lung, Liver, Spleen, and Kidney. External and internal correspondence among skin, vessels, Fu, and Zang organs means excess or deficiency can cause disease; thus, Qi returns to balance. Balance implies weighing to achieve equilibrium. When balanced, the Cunkou pulse forms. Cunkou refers to the radial pulse at both wrists, specifically the Cun position. The major convergence of pulses is at the Cunkou. Diagnosing the Cunkou pulse determines life and death. This describes the normal distribution and transport of food entering the Stomach, representing the correct course of the meridians.

When drink enters the Stomach, its essence overflows and ascends to the Spleen. The Spleen disperses essence, sending it upward to the Lung. The Lung regulates water passages, descending them to the Bladder. Water essence spreads everywhere, and the five meridians run together, harmonizing with the four seasons and the Yin-Yang of the five Zang organs, measured as the norm.

"Duo" is pronounced with entering tone. The previous section discussed food; this discusses drink. Drink entering the Stomach differs from food; it overflows Stomach essence and ascends to the Spleen. The Spleen disperses Stomach essence upward to the Lung. Lung represents Heaven; Spleen represents Earth. Spleen dispersing essence raises Earth Qi, regulating water passages. Ascending to the Lung lowers Heaven Qi, descending to the Bladder. Regulated water passages allow water essence to spread everywhere and descend to the Bladder, allowing the five meridians to run together. Spreading everywhere harmonizes with Heaven's four seasons; five meridians harmonize with Human five Zang organs. Thus, harmonizing with four seasons and five Zang organs, the Yin-Yang of four seasons equals the Yin-Yang of five Zang organs, and vice versa. Yin-Yang measurement achieves unity of Heaven and Man, serving as the norm for human meridians. This describes the normal distribution and transport of drink entering the Stomach, representing the correct course of the meridians.

This section discusses abnormal panting and sweating to illustrate meridian variations; food and drink distribution illustrates meridian correctness. Knowing variations requires knowing correctness; knowing correctness reveals variations.

Taiyang Zang Qi exclusively arriving manifests as Jue cold, panting, and reverse defluxion of deficient Qi. This indicates insufficient Yin and excess Yang. Both exterior and interior should be drained, selecting lower Shu points.

Twelve meridians combine hand and foot San Yang and San Yin. Thus, the constancy and variation of San Yang and San Yin are discussed. San Yang governs the six Fu organs; Fu organs storing substances are also called Zang. Taiyang Zang Qi exclusively arriving means Yang Qi does not harmonize with Yin, resulting in exclusive dominance of Taiyang Zang Qi. Jue panting refers to lower extremity cold and upper body panting. Reverse defluxion of deficient Qi refers to panting accompanying Jue, indicating upward defluxion of deficient Qi. Jue, panting, and reverse Qi indicate true Yin insufficiency and Taiyang exclusive arrival, signifying excess Yang heat. Taiyang Qi originates from the Water Palace (Kidney) and connects to skin and hair; thus, exterior and interior should be drained. Taiyang meridian begins at Zhiyin (BL67) on the little toe; thus, lower Shu points should be selected. Shu refers to Shu points.

Yangming Zang Qi exclusively arriving signifies heavy accumulation of Yang Qi. One should drain Yang and tonify Yin, selecting lower Shu points.

"Zhong" is pronounced with level tone. Heavy accumulation means Taiyang and Shaoyang Qi both accumulate in Yangming. Thus, one should drain excess Yang and tonify deficient Yin. Yangming meridian begins at Lidui (ST45) on the second toe; thus, lower Shu points should be selected.

Shaoyang Zang Qi exclusively arriving signifies Jue Qi. Suddenly large before the Qiao vessel, select lower Shu points.

"Cu" is pronounced like "cu". Shaoyang is initial Yang, born from Jueyin. Exclusive arrival of Shaoyang means Yang Qi is not yet vigorous, representing Yin Jue Qi. Initial Yang fails to ascend, causing sudden enlargement before the Qiao vessel. Shaoyang meridian is anterior to the Yang Qiao vessel. Shaoyang begins at Qiaoyin (GB44) on the second toe; thus, lower Shu points should be selected.

Exclusive arrival of Shaoyang is the fault of One Yang.

Taiyang is Three Yang, Yangming is Two Yang, Shaoyang is One Yang. Thus, exclusive arrival of Shaoyang is the fault of One Yang. "Guo" means error. Inferring from Shaoyang, exclusive arrival of Yangming is the fault of Two Yang; exclusive arrival of Taiyang is the fault of Three Yang.

Taibin Zang pulsation requires careful examination of true Qi. Five vessel Qi is scant, Stomach Qi is unbalanced, belonging to Three Yin. Treat lower Shu points, tonify Yang and drain Yin.

Taibin Zang pulsation refers to the interaction between Foot Taibin (Spleen) and Hand Taibin (Lung) Qi. Carefully examining true Qi applies whether the disease is in the foot or hand. Lung receives all vessels; scant five vessel Qi relates to Hand Taibin. Spleen and Stomach are connected; unbalanced Stomach Qi relates to Foot Taibin. This scant and unbalanced Qi, though divided into hand and foot, belongs to Taibin, hence called Three Yin. Disease in Three Yin should be treated at lower Shu points. Yin Qi interaction leads to Yang insufficiency; thus, tonify Yang and drain Yin.

One Yang whistling exclusively is Shaoyang Jue. Yang accumulates upward, four vessels compete and expand, Qi returns to the Kidney. Treat meridians and collaterals, drain Yang and tonify Yin.

One Yang refers to Shaoyang. Shaoyang refers to San Jiao. *Ling Shu: Ben Shu Lun* states: Shaoyang belongs to the Kidney. Discussing One Yang mentions the Kidney. Exclusive whistling of One Yang means Upper Jiao Qi erupts exclusively upward. Exclusive eruption of Upper Jiao causes Lower Jiao Qi to reverse downward, hence Shaoyang Jue. Exclusive whistling of One Yang means Yang accumulates upward. Shaoyang Jue means four vessels compete and expand. Four vessels refer to Liver, Spleen, Heart, and Lung. Competition and expansion mean disharmony. Disharmony of four vessels stems from Kidney Qi failure to reach, so Qi returns to the Kidney, attributing vessel competition to Kidney deficiency. Meridians connect internally to five Zang organs; thus, treat meridians and collaterals. Drain exclusive whistling of Upper Jiao, tonify Kidney Jue of Lower Jiao; hence drain Yang and tonify Yin.

One Yin arriving is the treatment of Jueyin. True deficiency and false symptoms, worry, Jue Qi lingering and thinning, manifest as white sweat. Harmonize diet and medicine, treat lower Shu points.

One Yin refers to Jueyin. Not saying "exclusive arrival" but "arriving" implies Yin contains Yang, hence Jueyin treatment. "Zhen Xu" means true and false. "You" means worry. Judging the truth and falsity of Jueyin treatment requires careful consideration, similar to Taibin's careful examination. Jueyin is the end of meridians, reconnecting to the Lung. Lingering and thinning Jue Qi means Jueyin Qi lingers in the Liver and thins against the Lung. Thinning against the Lung manifests as white sweat.

This Jueyin treatment is not a Jueyin disease but requires harmonizing diet and medicine to treat sweat, and treating lower Shu points to consolidate Yin.

Huangdi asked: What is the image of Taiyang Zang?

Continuing from Zang Qi disharmony, detailing the inherent pulse image.

Qibo replied: The image resembles Three Yang and is floating.

Its inherent pulse image resembles Three Yang and floats externally.

Huangdi asked: What is the image of Shaoyang Zang? Qibo replied: It resembles One Yang. One Yang Zang is slippery but not solid.

Its inherent pulse image resembles the birth of One Yang, slippery but not solid. Slippery is floating tightness. Slippery but not solid indicates gradual rise of generating Yang.

Huangdi asked: What is the image of Yangming Zang? Qibo replied: It resembles large and floating.

Two Yangs combined brighten, called Yangming; thus, its inherent pulse image resembles large and floating.

Taibin Zang pulsation speaks of hidden drumming.

Huangdi asked about Three Yang Zang images, and Qibo replied with Three Yin. The pulse image of Taibin Zang pulsation is the mutual stimulation of Heaven and Earth, Spleen and Lung Qi, described as hidden drumming. Hidden drumming implies rising from below to above, from Earth to Heaven.

Er Yin pulsating to the Kidney is sunken and not floating.

Er Yin pulsation is Heart-Kidney interaction. The pulse image of Heart-Kidney interaction pulsates to the Kidney, sunken and not floating. Sunken and not floating implies descending from above to below, from Heart to Kidney, meaning Shaoyang Jue and Qi returning to the Kidney. Er Yin Jue pulsation is omitted because it involves Jueyin treatment.

This shares the same meaning as the previous section. Exclusive Zang Qi illustrates meridian variations. Zang Xiang ontology illustrates meridian correctness. Knowing variations requires knowing correctness; knowing correctness enhances understanding of variations.