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When the Kidney pulse is firm and long, it indicates that pathogenic factors are excessive in the Kidney; if the complexion is yellow with a reddish hue, it signifies that Earth (Spleen) controls Water (Kidney), and Water fails to overcome Fire; although the pulse body is solid, the healthy Qi is deficient, therefore one should suffer from "Zhe Yao" (waist injury/impairment), as the waist is the external manifestation of the Kidney. If the pulse is soft and scattered, it indicates a lack of communication between the Heart and Kidney, therefore one should suffer from blood deficiency; when both Water and Fire are deficient, it can even lead to exhaustion of blood that cannot be restored.

The Yellow Emperor said: Upon diagnosing an urgent Heart pulse, what disease is this? What are the clinical manifestations?
Diseases originate internally but manifest externally. By reiterating the urgency of the Heart pulse, we probe the specific form of the disease.

Qibo said: The disease is named "Xin Shan" (Heart Hernia), and there should be palpable masses in the lower abdomen.
Because the Heart pulse is urgent, it is named Heart Hernia. In cases of Heart Hernia, there should be palpable masses in the lower abdomen.

The Yellow Emperor said: Why do you say so?
Why does Heart Hernia often present with palpable masses in the abdomen?

Qibo said: The Heart is a Yang organ (Mu Zang), and the Small Intestine acts as its envoy; therefore, it is said that there should be palpable masses in the lower abdomen.
"Envoy" is pronounced with the departing tone. The Heart, located in the upper yang, is thus called a Yang organ. The Heart meridians connect to the Small Intestine, so the Small Intestine serves as its envoy. In Heart Hernia, the Small Intestine ceases to function as an envoy; hence, it is said that palpable masses appear in the lower abdomen. By citing the relationship between the Heart and Small Intestine, for any pulse corresponding to paired Zang-Fu organs, one can infer that disease in the Zang affects the Fu.

The Yellow Emperor said: Upon diagnosing a diseased Stomach pulse, what are the clinical manifestations?
Among the Five Zang organs, the Heart is the ruler; among the Six Fu organs, the Stomach is the primary receiver. Upon diagnosing a diseased Stomach pulse, what are the manifestations?

Qibo said: An excess Stomach pulse leads to distension; a deficient Stomach pulse leads to diarrhea.
An abundant and solid Stomach pulse causes abdominal distension. Distension refers to abdominal bloating, which is a disease of Spleen excess. A deficient and weak Stomach pulse causes loose stools. Diarrhea refers to watery stools, which is a disease of Spleen deficiency.
By citing the relationship between the Stomach and Spleen, for any pulse corresponding to paired Fu-Zang organs, one can infer that disease in the Fu affects the Zang. This answers the Yellow Emperor's inquiry regarding the location of diseases, as described above.

The Yellow Emperor said: What is meant by changes after a disease has formed?
Proceeding in order, we must discuss the transformations of diseases; thus, I ask this question.

Qibo said: Wind lingering becomes cold-heat disorders; Dan heat becomes Xiao Zhong (middle consumption); Jue reversal becomes Dian Ji (diseases of the vertex); prolonged wind becomes Sun Xie (undigested food diarrhea); wind in the vessels becomes Li disease (leprosy/malignant ulcers). The transformations of diseases are countless.
"Sheng" is pronounced with the level tone; "Shu" is pronounced with the rising tone. Wind is the leader of all diseases, agile in movement and changeable; thus, once wind forms, it may transform into cold or heat. Dan is a fire-heat disease. Once Dan forms, internal fluids are exhausted, leading to Xiao Zhong (middle consumption). Jue refers to cold extremities. Once Jue forms, Yin and Yang are disharmonious, with Qi ascending but not descending, leading to headache and Dian Ji (vertex diseases). Injury by wind in spring transforms into Sun Xie (diarrhea with undigested food) by summer; thus, prolonged wind causes Sun Xie. Wind damaging the vessels transforms into leprosy-like ulcers; thus, wind in the vessels leads to Li disease. All these are pathological changes; upon investigation, the transformations of diseases are indeed countless.

The Yellow Emperor said: Various abscesses, tendon spasms, and bone pain—how are these generated?
Transformations caused by wind arise internally and manifest externally. Regarding various abscesses, tendon spasms, and bone pain, the disease has already manifested externally; thus, I ask how these are generated.

Qibo said: These are swellings caused by Cold Qi and variations due to the Eight Winds.
"Swellings of Cold Qi" refers to abscesses arising from cold pathogens. "Variations of the Eight Winds" refers to tendon spasms and bone pain arising from wind pathogens. This clarifies that the origin of the disease is also its transformation.

The Yellow Emperor said: How should they be treated?
What is the method for treating cold and wind pathogens?

Qibo said: These are diseases caused by abnormal qi of the four seasons; they can be cured by using the controlling element to treat them.
Cold wind is the abnormal pathogen of the four seasons. The treatment method should seek the element that controls it to effect a cure. For example, if cold invades internally, treat with sweet-hot herbs; if wind invades internally, treat with pungent-cool herbs. This is the principle.

The Yellow Emperor said: If there is a pre-existing disease where the Five Zang organs activate, thereby affecting the pulse and complexion, how can one distinguish whether it is a chronic condition or an acute onset?
Diseases in the human body vary between chronic and acute. There are old diseases of the Five Zang organs activating externally, affecting the pulse and complexion. These are not sudden changes occurring at one moment. How can one distinguish between chronic and acute diseases?

Qibo said: Your question is very thorough! If the pulse is small and the complexion is unimpaired, it is a new disease; if the pulse is unimpaired but the complexion is impaired, it is a chronic disease; if both the pulse and the five colors are impaired, it is a chronic disease; if both the pulse and the five colors are unimpaired, it is a new disease.
Discussing disease transformations involving chronic and acute conditions reveals no hidden details; your question is indeed thorough. When a disease erupts, a small pulse with unimpaired complexion is a sign of a new disease; an unimpaired pulse with impaired complexion is a sign of a chronic disease; both pulse and complexion impaired are signs of a chronic disease; both pulse and complexion unimpaired are signs of a new disease. This is how observing color and pulse reveals whether a disease is chronic or acute.

If the Liver and Kidney pulses arrive simultaneously, and the complexion is cyan-red, one should suffer from trauma; whether bleeding has occurred or not, accompanied by dampness or water retention.
"Dang" and "Zhong" are pronounced with the departing tone. This cites acute trauma to supplement the previous text. Simultaneous arrival of Liver and Kidney pulses: the Liver governs tendons, the Kidney governs bones; cyan-red complexion: Liver color is cyan, Heart color is red; "should suffer" refers to acute illness; "trauma" refers to injury of tendons and bones. Trauma to tendons and bones should ideally show no blood; if blood is present, the Heart Qi is also injured, similar to sweating followed by body dampness, as if struck by water, where water enters through sweat pores and damages Heart Qi. One should suffer from trauma, which explains why the Liver and Kidney pulses arrive simultaneously. Blood presence explains the cyan-red complexion. This answers the Yellow Emperor's inquiry regarding disease transformations, as described above.

The inner side of the Chi position corresponds to the hypochondrium; the outer side of Chi observes the Kidney, and the inner side observes the abdomen.
Internal and external diseases follow the meridians; thus, pulse positions are cited to clarify this. "Chi Nei" means within the Chi section; "Liang Pang" means left and right. The pulses at the Chi position on both hands correspond to the hypochondrium of the body. The hypochondrium is the end of the ribs. The waist is outside the hypochondrium; therefore, the outer side of the Chi pulse on both hands observes the Kidney. The abdomen is inside the hypochondrium; therefore, the inner side of the Chi pulse on both hands observes the abdomen. Pulse Qi moves from bottom to top; thus, we first discuss the left-right and inner-outer aspects of the Chi position.

At the Guan position (mid-level attached): the left outer side observes the Liver, and the inner side observes the Diaphragm; the right outer side observes the Stomach, and the inner side observes the Spleen.
"Guan Shang Fu" refers to extending from the Chi position to the Guan position. Left outer observes Liver, inner observes Diaphragm: the outer side of the left Guan position observes the Liver pulse; the inner side of the Guan position observes the Diaphragm pulse. Right outer observes Stomach, inner observes Spleen: the outer side of the right Guan position observes the Stomach pulse; the inner side of the Guan position observes the Spleen pulse. Pulse Qi moves from bottom to middle; thus, we next discuss the left-right and inner-outer aspects of the Guan position.

At the Cun position (upper level attached): the right outer side observes the Lung, and the inner side observes the Chest Middle; the left outer side observes the Heart, and the inner side observes the Dan Zhong.
"Cun Shang Fu" refers to extending from the Guan position to the Cun position. Right outer observes Lung, inner observes Chest Middle: the outer side of the right Cun position observes the Lung pulse; the inner side observes the Chest Middle pulse. Left outer observes Heart, inner observes Dan Zhong: the left Cun pulse observes the Heart pulse; the inner side of the Cun position observes the Dan Zhong pulse of the Pericardium.
Pulse Qi moves from middle to top; thus, we finally discuss the left-right and inner-outer aspects of the Cun position.

The anterior part observes the anterior body, and the posterior part observes the posterior body.
Pulses have inner and outer aspects, as well as anterior and posterior. Anterior observes anterior: the anterior parts of Chi, Guan, and Cun observe the front of the body; posterior observes posterior: the posterior parts of Cun, Guan, and Chi observe the back of the body.

"Shang Jing Shang" (extending to the top of the Cun) concerns the chest and throat; "Xia Jing Xia" (extending to the bottom of the Chi) concerns the lower abdomen, waist, thigh, knee, shin, and foot.
Pulses have inner, outer, anterior, and posterior, as well as upper and lower, constituting the six harmonies of the pulse body. "Shang Jing Shang" extends from the Cun position up to the Yu Ji area. The throat governs heavenly Qi and is located in the upper chest; thus, it concerns the chest and throat, representing "upper observing upper." "Xia Jing Xia" extends from the Chi position down to the elbow. Feet tread on the ground; thighs, knees, shins, and feet are below the waist and lower abdomen; thus, they concern the lower abdomen, waist, thigh, knee, shin, and foot, representing "lower observing lower."

A coarse and large pulse indicates Yin deficiency and Yang excess, resulting in Re Zhong (internal heat). A pulse that comes rapidly and departs slowly indicates upper excess and lower deficiency, resulting in Jue (reversal cold) and Dian Ji (vertex disease); a pulse that departs rapidly and comes slowly indicates upper deficiency and lower excess, resulting in E Feng (aversion to wind).
The previous section used pulse positions to observe Zang-Fu and body locations; this section uses pulse qualities to observe Yin-Yang and upper-lower diseases. A coarse and large pulse indicates insufficient Yin Qi and excessive Yang Qi, hence Re Zhong disease. Re Zhong means Yang abundance internally. A pulse coming rapidly and departing slowly means strong arrival and weak departure. Rapid arrival indicates upper excess; slow departure indicates lower deficiency. Upper excess and lower deficiency cause Qi to reverse upward only, disrupting Yin-Yang harmony, leading to Jue (cold extremities); Qi reversing upward without descending leads to Dian Ji, echoing "Jue becomes Dian Ji." A pulse departing rapidly and coming slowly means weak arrival and strong departure. Slow arrival indicates upper deficiency; rapid departure indicates lower excess. Upper deficiency and lower excess disrupt meridian harmony, leading to E Feng. E Feng refers to Leprosy wind.

Therefore, contracting evil wind implies the Yang Qi was affected. If pulses are both deep, fine, and rapid, it indicates Shao Yin Jue; if deep, fine, rapid, and scattered, it indicates cold-heat disorder; if floating and scattered, it indicates collapse (Pu Dao).
"Zhong" is pronounced with the departing tone. "Shun" is identical to "Shun," following this pattern in other chapters. Here, the pulse signs for evil wind, Jue, heat, and Dian Ji are reiterated to show their differences, supplementing the previous text. Evil wind damages meridians, entering from the exterior; thus, contracting evil wind begins with the invasion of Yang Qi. Jue has Yin and Yang types: a soft, fine, and rapid pulse is not Yang Qi reversing upward, but Shao Yin Jue. Heat has Yin and Yang types: a soft, fine, rapid, and scattered pulse is not coarse and excessive Yang heat, but cold-heat disorder due to Yin excess and Yang deficiency. Dian Ji also has Yin and Yang types: excess is surplus, deficiency is lack; a floating and scattered pulse is not upper-excess Dian Ji, but collapse due to interior deficiency.

All floating pulses without agitation belong to Yang, indicating heat; if agitated, it involves the Hand meridians. All fine and deep pulses belong to Yin, indicating bone pain; if quiet, it involves the Foot meridians. A pulse that is rapid, active, and intermittent indicates disease in the Yang pulse, manifesting as diarrhea and pus/blood in stool. All abnormal pulses must be palpated; a choppy pulse indicates Yang excess, while a slippery pulse indicates Yin excess. Yang excess manifests as body heat and absence of sweat; Yin excess manifests as profuse sweating and cold body; if both Yin and Yang are excessive, there is absence of sweat and cold body.
Here, floating, deep, intermittent, choppy, and slippery pulses are used to clarify Yin-Yang and internal-external diseases. If all three positions on left and right are floating without agitation, the disease is in Yang, causing external heat. If floating and agitated, it involves the Hand meridians (Yang). If fine and deep, the disease is in Yin, causing internal bone pain. If fine, deep, and quiet, it involves the Foot meridians (Yin). Pulses that are rapid, active, and intermittent: rapid activity belongs to Yang, so the disease is in the Yang pulse. Rapid activity with intermittency means Yin within Yang, leading to diarrhea and pus/blood in stool. All abnormal pulses require palpation to ascertain truth. Choppy pulses indicate insufficient internal Yin blood; insufficient Yin blood leads to excessive external Yang Qi. Slippery pulses indicate Yang Qi entering Yin; Yang entering Yin leads to excessive internal Yin Qi. Excessive Yang Qi places disease in Yang, lacking Yin to harmonize it, causing body heat and no sweat. Excessive Yin Qi places disease in Yin, lacking Yang heat to assist it, causing profuse sweat and cold body. If both Yin and Yang are excessive, Yang abundance causes no sweat, Yin abundance causes cold body, resulting in no sweat and cold body.

Pushing outward, if the pulse remains internal and does not reach the exterior, there is accumulation in the heart and abdomen. Pushing inward, if the pulse reaches the exterior but not the interior, there is heat in the body. Pushing upward, if the pulse ascends but does not descend, the waist and feet are cold. Pushing downward, if the pulse descends but does not ascend, there is pain in the head and neck. Pressing to the bone, if pulse Qi is weak, there is pain in the waist and spine with bi syndrome in the body.
"Push" is pronounced with the level tone. Continuing from the discussion of upper/lower and outer/inner diseases, diagnosis also employs methods of pushing outward/inward and upward/downward. "Pushing outward" means pressing with fingers toward the exterior. If the pulse is predominantly internal and does not reach the exterior, there is accumulation in the heart and abdomen. "Pushing inward" means pressing fingers toward the interior. If the pulse is predominantly external and does not reach the interior, there is pathogenic heat in the body. "Pushing upward" means pressing toward the upper Cun/Guan/Chi positions. If the pulse responds by ascending but not descending, this is upper excess and lower deficiency, causing cold waist and feet. "Pushing downward" means pressing toward the lower Cun/Guan/Chi positions. If the pulse responds by descending but not ascending, this is lower excess and upper deficiency, causing stiff and painful head and neck. If pressing to the bone yields little pulse response, this is Yin excess and Yang deficiency, where vital Yang Qi cannot ascend, leading to waist/spine pain and body bi syndrome. Continuing from the discussion of upper/lower and outer/inner diseases, diagnosis employs methods of pushing outward/inward and upward/downward. This answers the Yellow Emperor's inquiry regarding diseases fluctuating between internal and external locations, as described above.
This section addresses the five questions mentioned previously, answering each in turn, illustrating the essence of pulse diagnosis.