十四难曰∶脉有损至，何谓也？
然∶至之脉，一呼再至曰平，三至曰离经，四至曰夺精，五至
曰死，六至曰命绝，此至之脉也。何谓损？一呼一至曰离经，二呼一至曰夺精，三呼一至曰死，四
呼一至曰命绝，此损之脉也。至脉从下上，损脉从上下也。
平人之脉，一呼再至，一吸再至，呼吸定息四至。闰以太息脉五至，加之为过曰至，不及为
减曰损。至脉从下而逆上，由肾而至肺也；损脉从上而行下，由肺而之肾也。离经者，脉呼吸
六至，已离其经常之度也。一呼四至，一吸四至，则一息八九至，乃阳气乱，故脉数，数则气
为热耗，耗则精竭，故曰夺精也。五至死之渐，六至其命绝矣。然数脉一息十至十二三至，迟脉
四呼始见一至，皆仅见之脉也。
损脉之为病奈何？
然∶一损损于皮毛，皮聚而毛落；二损损于血脉，血脉虚少，不能荣于五
脏六腑也；三损损于肌肉，肌肉消瘦，饮食不为肌肤；四损损于筋，筋缓不能自收持也；五损损于骨，
骨痿不能起于床。反此者，至于收病也。从上下者，骨痿不能起于床者死∶从下上者，皮聚而毛落者死。
此推究损脉病证也。一损损肺，肺主皮毛，肺损故皮聚而毛落也。二损损心，心主血脉，心
损则血虚，故不能荣养脏腑也。三损损脾，脾纳五味而主肌肉，脾损失其运化之权，故肌肉消瘦也。
四损损肝，肝主筋，肝损不克充其筋，故纵缓不能收持也。五损损肾，肾主骨，肾损故骨痿不能起
于床也。从上下者，从肺损至肾，五脏俱尽，故死，肺在上也。从下上者，从肾损至肺，亦复五脏
俱尽，故死、肾在下也。于收，滑氏云∶当作“脉之”二字，愚意尤不若丁氏之“反此者，至之脉病也”为是。
治损之法奈何？
然∶损其肺者，益其气；损其心者，调其荣卫；损其脾者，调其饮食，适其寒
温；损其肝者，缓其中；损其肾者，益其精。此治损之法也。
肺主气，肺损者，宜益其气。心主血脉，心损者，宜调其营卫，使血脉有所资也。脾受谷味
而主肌肉，脾损者，宜调其饮食，适其寒温，俾健运不失其职。肝藏血而主怒，怒则伤肝，肝损者，
宜缓其中，即经所谓肝苦急，急食甘以缓之之义。肾藏精而主骨，肾损者，宜益其精。盖病在何脏，
则各随其所在而治之也。
脉有一呼再至，一吸再至；有一呼三至，一吸三至；有一呼四至，一吸四至；
有一呼五至，一吸五至；有一呼六至，一吸六至；有一呼一至，一吸一至，有再呼一至、再吸一至；
有呼吸不至。脉来如此，何以别知其病也？
上文统言五脏受病之次序，此再举损至之脉以求其病形也。滑氏曰∶前之损至，以五脏自病，
得之于内者而言。此则以经络血气，为邪所中之微甚，自外得之者而言也。其曰呼吸再至，即一呼
一至，一吸一至之谓，疑衍文也。
然∶脉来一呼再至，一吸再至，不大不小曰平。一呼三至，一吸三至，为适得病。前大后小，
即头痛目眩；前小后大，即胸满短气。一呼四至，一吸四至，病欲甚，脉洪大者，苦烦满；沉细者，
腹中痛；滑者伤热；涩者中雾露。一呼五至，一吸五至，其人当困，沉细夜加，浮大昼加，不大不
小，虽困可治。其有大小者，为难治。一呼六至，一吸六至，为死脉也，沉细夜死，浮大昼死。一
呼一至，一吸一至，名曰损，人虽能行，犹当着床，所以然者，血气皆不足故也。再呼一至，再吸
一至，名曰无魂。无魂者，当死也。人虽能行，名曰行尸。
一息四至，闰以太息五至。是为平脉。一呼三至，一吸三至，是一息之间有六七至，比之平人
较多两至，适得病而未甚，即上文离经之义也。前为寸，后谓尺，寸大尺小，病气在阳，为浊气上
逆之候，故头痛目眩也。寸小尺大，病气在阴，为清气下陷，脾肝不升，肺胃不降，故胸满短气也。
一呼四至，一吸四至，是一息之间有八九至，故病欲甚，即上文夺精之义也。脉洪大者，阳邪外越，
为胆上逆而火升，故苦烦满也。沉细者，阴邪内陷，为肝脾下陷而土贼，
故腹中痛也。滑乃血实，故为热，涩为伤湿，故曰中雾露，此又于病之微甚间分别言之，欲令学人取
所现脉象，以别其病，而推展其义也。一呼五至，一吸五至，是一息之间，脉来十外至，则其人沉困，
近于死矣。夜为阴，昼为阳，沉细阴盛，故加于夜，浮大阳盛，故加于昼。大即浮大，小即沉细，若
不大不小，则昼夜不至有加，阴阳相等，故可治。若更参差不伦，则难治矣。一呼一至，一吸一至，
是一息之间，脉来二三至为损，以气血皆亏，虽能行步，久当不起于床也。若再呼一至，再吸一至，
迟之极矣，则其人魂气已离，生道已绝，如尸之行，故曰行尸。
上部有脉，下部无脉，其人当吐，不吐者死。上部无脉，下部有脉，虽困无能为害。所以然者，
人之有尺，譬如树之有根，枝叶虽枯槁，根本将自生。脉有根本，人有元气，故知不死。
上部寸口，下部尺中。上部有脉，下部无脉者，邪实于上，阳遏不降，吐则气逆于上，故脉亦从
而上，则下部之无脉，乃因吐而然，非真离其根也。若无吐证，为上无邪而下气竭，故曰当死。上部
无脉，下部有脉，虽困无害者，盖脉者根乎元气以营运者也，元气未伤，则脉自能渐生，其所以上
部之无脉者，特因气血之偶有滞耳，病去则自复，故曰人之有尺，譬如树之有根也。此越人又因上文
损至之义引申之，以见无脉之故，亦有两端，不可概定为死也。
按∶损脉者，迟脉也，至脉者，数脉也，曷不云乎迟数，而言损至者何也？盖迟数之脉，统
摄寒热表里虚实，所包者广，越人恐后学之误会，故以一息四至，终于十二三至为至，始于一息二至，终
于两息一至为损，明损脉从上而下，由肺气虚而及于肾阳竭，至脉从下而上，由肾阴虚而及于肺气尽。然
损脉之本原，病起于肺，若失冶必递及于心脾肝肾，其损脉必反而为至脉，因肾虚火燥，复由肾而递及肝
脾心肺而死。故曰∶反此者，至脉之病也。尝见虚寒之证，末传而现躁急之脉者，为不明治损之法，扶阳
不早，延及阴气亦竭也。夫扶阳者，扶持胃脘之阳，更察五脏之损以益之，非徒执姜桂乌附之谓也。更有
进者，近世医家，每以虚劳两字为怯病通称，不知虚损病自上而下。痨瘵病自下而上，以痨瘵法治虚损，
多转泄泻，以虚损法治痨瘵，必致喘促，于此泾渭不分，能免于南辕北辙之相左乎？此皆不明损至之义也。
越人既以损至之脉，明虚损痨瘵之治，恐急证无脉，后人不察，混入损脉，故又申明上部有脉，下部无脉，
上部无脉，下部有脉之旨，而复归重于元气，以结此章之义。学人于此、尤宜三致意焉。
第十四难说：脉象有“损”和“至”，这是什么意思呢？
回答说：“至”脉，一呼脉搏跳动两次为平脉，三次为离经（偏离正常常度），四次为夺精（精气被剥夺），五次为死脉，六次为命绝（生命终结），这就是“至”脉。什么是“损”脉？一呼脉搏跳动一次为离经，两呼脉搏跳动一次为夺精，三呼脉搏跳动一次为死脉，四呼脉搏跳动一次为命绝，这就是“损”脉。“至”脉的病势是从下往上发展，“损”脉的病势是从上往下发展。
健康人的脉象，一呼跳动两次，一吸跳动两次，一呼一吸定息共跳动四次。如果遇到长息（深呼吸）则跳动五次，超过这个次数称为“至”，不足这个次数称为“减”即“损”。“至”脉的病势从下而上逆行，由肾传至肺；“损”脉的病势从上而下顺行，由肺传至肾。“离经”是指脉搏在一呼一吸间跳动六次，已经脱离了正常的常度。如果一呼跳动四次，一吸跳动四次，那么一息之间就跳动八九次，这是阳气紊乱，所以脉数（快），数脉则气被热邪消耗，消耗则精气枯竭，所以称为“夺精”。五次跳动是死亡的征兆，六次跳动则是生命终结。然而，一息跳动十到十二三次的是极数的脉，四呼才见到一次跳动的是极迟的脉，这些都是极少见的脉象。
“损”脉导致的疾病是怎样的呢？
回答说：一损损伤皮毛，表现为皮肤聚缩而毛发脱落；二损损伤血脉，血脉虚少，不能滋养五脏六腑；三损损伤肌肉，肌肉消瘦，饮食无法转化为肌肤营养；四损损伤筋，筋脉弛缓不能自我收持；五损损伤骨，骨痿软不能起床。与此相反的情况，则是“至”脉的疾病。病势从上往下发展的，出现骨痿不能起床的会死亡；病势从下往上发展的，出现皮肤聚缩毛发脱落的会死亡。这是在推究“损”脉的病证。一损损伤肺，肺主皮毛，肺受损故皮肤聚缩而毛发脱落。二损损伤心，心主血脉，心受损则血虚，故不能荣养脏腑。三损损伤脾，脾受纳五味而主肌肉，脾受损失去运化之权，故肌肉消瘦。四损损伤肝，肝主筋，肝受损不能充养筋脉，故纵缓不能收持。五损损伤肾，肾主骨，肾受损故骨痿不能起床。病势从上往下，是从肺损及于肾，五脏都衰竭了，所以死亡，因为肺在上部。病势从下往上，是从肾损及于肺，也是五脏都衰竭了，所以死亡，因为肾在下部。关于“反此者，至于收病也”一句，滑寿认为应当作“脉之”二字，我认为不如丁氏所说的“反此者，至之脉病也”更为恰当。
治疗“损”脉的方法是怎样的呢？
回答说：损肺的，补益其气；损心的，调和其营卫；损脾的，调节饮食，适应寒温；损肝的，舒缓其中焦之气；损肾的，补益其精。这就是治疗“损”脉的方法。
肺主气，肺受损的，宜补益其气。心主血脉，心受损的，宜调和其营卫，使血脉有所资生。脾受纳谷味而主肌肉，脾受损的，宜调节饮食，适应寒温，使其健运不失职。肝藏血而主怒，怒则伤肝，肝受损的，宜舒缓其中焦之气，即《内经》所谓“肝苦急，急食甘以缓之”的意思。肾藏精而主骨，肾受损的，宜补益其精。大概病在哪个脏，就根据其所处的位置进行针对性治疗。
脉象有一呼两次、一吸两次；有一呼三次、一吸三次；有一呼四次、一吸四次；有一呼五次、一吸五次；有一呼六次、一吸六次；有一呼一次、一吸一次；有再呼一次、再吸一次；还有呼吸间无脉搏跳动的。脉象如此变化，如何辨别其疾病呢？
上文总述五脏受病的次序，这里再次列举“损”和“至”的脉象来探求病形。滑寿说：前面的“损”和“至”，是以五脏自病，得之于内而言。这里则是以经络气血，被邪气所中的轻重，得之于外而言。文中说的“呼吸再至”，即一呼一至、一吸一至的意思，怀疑是衍文（多余的文字）。
回答说：脉来一呼两次，一吸两次，不大不小为平脉。一呼三次，一吸三次，为刚刚得病。前大后小（寸大尺小），即头痛目眩；前小后大（寸小尺大），即胸满短气。一呼四次，一吸四次，病情将要加重，脉洪大的，苦于烦闷胀满；脉沉细的，腹中疼痛；脉滑的，为热邪所伤；脉涩的，为雾露湿邪所伤。一呼五次，一吸五次，其人应当困顿，脉沉细的夜间加重，脉浮大的白天加重，脉不大不小的，虽然困顿但可治愈。如果脉象大小不一，则难治。一呼六次，一吸六次，为死脉，脉沉细的夜间死亡，脉浮大的白天死亡。一呼一次，一吸一次，名为“损”，人虽然能行走，但也应当卧床，之所以这样，是因为气血都不足。再呼一次，再吸一次，名为“无魂”。无魂的人，应当死亡。人虽然能行走，名为“行尸”。
一息四至，遇到长息五至，这是平脉。一呼三次，一吸三次，是一息之间有六七至，比平人多出两至，刚刚得病而未严重，即上文“离经”的意思。前指寸口，后指尺中，寸大尺小，病气在阳，为浊气上逆的征候，所以头痛目眩。寸小尺大，病气在阴，为清气下陷，脾肝不升，肺胃不降，所以胸满短气。一呼四次，一吸四次，是一息之间有八九至，所以病情加重，即上文“夺精”的意思。脉洪大的，阳邪外越，为胆气上逆而火升，所以苦于烦闷。脉沉细的，阴邪内陷，为肝脾下陷而土贼（脾胃受损），所以腹中疼痛。滑脉乃血实，故为热；涩脉为伤湿，故曰中雾露，这又是在病情的轻重之间分别论述，意在让学习者根据现存的脉象来辨别疾病，并推展其义理。一呼五次，一吸五次，是一息之间脉来十多次，则其人沉困，接近死亡。夜为阴，昼为阳，沉细属阴盛，故夜间加重；浮大属阳盛，故白天加重。大即浮大，小即沉细，若不大不小，则昼夜不会加重，阴阳相等，故可治。如果更参差不齐，则难治。一呼一次，一吸一次，是一息之间脉来二三至为“损”，因气血皆亏，虽能行走，久当不起床。若再呼一次，再吸一次，迟到了极点，则其人魂气已离，生道已绝，如尸体行走，故曰“行尸”。
上部有脉，下部无脉，其人应当呕吐，若不呕吐则死亡。上部无脉，下部有脉，虽然困顿但无大害。之所以这样，是因为人有尺脉，就像树有根一样，枝叶虽然枯槁，根本尚存就会自己生长。脉有根本，人有元气，所以知道不死。
上部寸口，下部尺中。上部有脉，下部无脉，是邪气实于上部，阳气遏阻不能下降，呕吐则气逆于上，所以脉也随之上行，则下部的无脉，是因为呕吐所致，并非真正脱离根本。如果没有呕吐症状，则是上部无邪而下部气竭，所以说应当死亡。上部无脉，下部有脉，虽然困顿却无害，这是因为脉依靠元气来营运，元气未伤，则脉自然能逐渐生成，其上部的无脉，特因气血偶有阻滞罢了，病去则自然恢复，所以说人有尺脉，就像树有根一样。这是越人（扁鹊）又因上文“损”和“至”的意义引申出来，以说明无脉的原因也有两种情况，不可一概定为死亡。
按语：“损”脉就是迟脉，“至”脉就是数脉，为什么不直接说迟数，而说损至呢？大概迟数之脉，统摄寒热表里虚实，所包含的范围很广，越人恐怕后世学者误解，所以以一息四至，终于十二三次为“至”，始于一息二至，终于两息一次为“损”，明确“损”脉从上而下，由肺气虚而及于肾阳竭，“至”脉从下而上，由肾阴虚而及于肺气尽。然而“损”脉的本原，病起于肺，若失治必递及于心脾肝肾，其“损”脉必反而转为“至”脉，因肾虚火燥，复由肾而递及肝脾心肺而死。所以说：与此相反的情况，是“至”脉的疾病。我曾见过虚寒之证，末期传变而出现躁急之脉的，是因为不明白治疗“损”脉的方法，扶阳不及时，延及阴气也枯竭了。所谓扶阳，是扶持胃脘之阳，更要察辨五脏的亏损加以补益，并非仅仅执着于姜、桂、乌头、附子等药物。更有进言者，近代医家，每以“虚劳”二字作为怯病的通称，不知道虚损病自上而下，痨瘵病自下而上，用治疗痨瘵的方法治疗虚损，多转为泄泻；用治疗虚损的方法治疗痨瘵，必致喘促，于此泾渭不分，能免于南辕北辙的错误吗？这都是不明白“损”和“至”的意义。越人既然以“损”和“至”的脉象，阐明虚损和痨瘵的治疗，恐怕急证无脉，后人不明察，混入“损”脉，所以又申明上部有脉下部无脉、上部无脉下部有脉的宗旨，而复归于重视元气，以总结本章的意义。学习的人对此，尤其应该再三留意。
Chapter 14 states: "There are 'Sun' (Loss) and 'Zhi' (Increase) pulses. What does this mean?"
The answer is: For the 'Zhi' pulse, two beats per exhalation indicate a normal pulse; three beats per exhalation indicate deviation from the standard (Li Jing); four beats per exhalation indicate depletion of essence (Duo Jing); five beats per exhalation indicate death; six beats per exhalation indicate termination of life. This constitutes the 'Zhi' pulse. What is the 'Sun' pulse? One beat per exhalation indicates deviation from the standard; one beat per two exhalations indicates depletion of essence; one beat per three exhalations indicates death; one beat per four exhalations indicates termination of life. This constitutes the 'Sun' pulse. The pathology of the 'Zhi' pulse progresses upward from below, whereas the pathology of the 'Sun' pulse progresses downward from above.
In a healthy person, the pulse beats twice per exhalation and twice per inhalation, totaling four beats per respiratory cycle. In cases of deep breathing (Tai Xi), it may beat five times. Exceeding this frequency is termed 'Zhi' (Increase), while falling short is termed 'Jian' (Decrease) or 'Sun' (Loss). The pathology of the 'Zhi' pulse moves upward against the normal flow, originating from the Kidney and reaching the Lung; the pathology of the 'Sun' pulse moves downward with the flow, originating from the Lung and reaching the Kidney. 'Deviation from the standard' refers to a pulse rate of six beats per respiratory cycle, which has already departed from the normal constant degree. If there are four beats per exhalation and four beats per inhalation, the total is eight or nine beats per cycle. This indicates chaotic Yang Qi, resulting in a rapid pulse (Shu Mai). A rapid pulse consumes Qi through heat; consumption leads to exhaustion of essence, hence termed 'Depletion of Essence'. Five beats per cycle is the onset of death; six beats per cycle signifies the end of life. However, a pulse rate of ten to twelve or thirteen beats per cycle represents an extremely rapid pulse, and one beat appearing only after four exhalations represents an extremely slow pulse; both are rare occurrences.
What diseases are caused by the 'Sun' pulse?
The answer is: First-degree loss affects the skin and hair, manifesting as contracted skin and fallen hair; second-degree loss affects the blood vessels, causing them to become deficient and unable to nourish the Zang and Fu organs; third-degree loss affects the muscles, causing emaciation where food intake fails to generate flesh; fourth-degree loss affects the sinews, causing flaccidity and inability to maintain posture; fifth-degree loss affects the bones, causing bone atrophy and inability to rise from bed. Conversely, these conditions pertain to the pathology of the 'Zhi' pulse. In cases progressing downward, bone atrophy preventing rising from bed leads to death; in cases progressing upward, contracted skin and fallen hair lead to death. This elaborates on the syndromes of the 'Sun' pulse. First-degree loss damages the Lung, which governs skin and hair; thus, Lung damage causes contracted skin and fallen hair. Second-degree loss damages the Heart, which governs blood vessels; thus, Heart damage causes blood deficiency and failure to nourish the organs. Third-degree loss damages the Spleen, which receives the five flavors and governs muscles; thus, Spleen damage results in loss of transformation and transportation, leading to muscle emaciation. Fourth-degree loss damages the Liver, which governs sinews; thus, Liver damage fails to fill the sinews, leading to flaccidity and inability to hold position. Fifth-degree loss damages the Kidney, which governs bones; thus, Kidney damage causes bone atrophy and inability to rise from bed. Progression from top to bottom implies damage spreading from the Lung to the Kidney, exhausting all five Zang organs, leading to death, as the Lung is superior. Progression from bottom to top implies damage spreading from the Kidney to the Lung, also exhausting all five Zang organs, leading to death, as the Kidney is inferior. Regarding the phrase "fan ci zhe, zhi yu shou bing," Hua Shi suggested it should read "mai zhi" (pulse of), but I believe Ding's interpretation "fan ci zhe, zhi zhi mai bing ye" (the opposite pertains to the disease of the Zhi pulse) is more accurate.
What is the treatment method for 'Sun' pulse conditions?
The answer is: For Lung loss, tonify its Qi; for Heart loss, regulate Ying and Wei; for Spleen loss, adjust diet and adapt to cold and warmth; for Liver loss, soothe the interior; for Kidney loss, benefit the essence. These are the methods for treating 'Sun' pulse conditions.
The Lung governs Qi; for Lung loss, it is appropriate to tonify Qi. The Heart governs blood vessels; for Heart loss, it is appropriate to regulate Ying and Wei so that blood vessels have sufficient resources. The Spleen receives grain flavors and governs muscles; for Spleen loss, it is appropriate to adjust diet and adapt to temperature changes to ensure robust transportation functions. The Liver stores blood and governs anger; anger injures the Liver. For Liver loss, it is appropriate to soothe the interior, consistent with the Classic saying "The Liver suffers from tension; eat sweet foods to relieve tension." The Kidney stores essence and governs bones; for Kidney loss, it is appropriate to benefit the essence. Generally, if the disease lies in a specific Zang organ, treatment should follow its location.
Pulses may present as two beats per exhalation and two per inhalation; three beats per exhalation and three per inhalation; four beats per exhalation and four per inhalation; five beats per exhalation and five per inhalation; six beats per exhalation and six per inhalation; one beat per exhalation and one per inhalation; one beat per two exhalations and one per two inhalations; or no beats during respiration. Given such variations, how can one distinguish the disease?
The preceding text generally described the sequence of Zang organ pathology; here, the 'Sun' and 'Zhi' pulses are listed again to seek the pathological form. Hua Shi stated: The previous 'Sun' and 'Zhi' referred to internal diseases originating from the Zang organs themselves. This section refers to external pathogens affecting meridians, blood, and Qi, varying in severity. The phrase "respiration twice" refers to one beat per exhalation and one per inhalation, likely a redundant text.
The answer is: A pulse of two beats per exhalation and two per inhalation, neither large nor small, is normal. Three beats per exhalation and three per inhalation indicate recent illness. If the front (Cun) is large and the back (Chi) is small, there is headache and dizziness; if the front is small and the back is large, there is chest fullness and shortness of breath. Four beats per exhalation and four per inhalation indicate worsening disease. If the pulse is洪大 (Hong Da / Surging and Large), the patient suffers from irritability and fullness; if 沉细 (Chen Xi / Deep and Fine), there is abdominal pain; if 滑 (Hua / Slippery), it indicates heat injury; if 涩 (Se / Choppy), it indicates injury from fog and dew. Five beats per exhalation and five per inhalation indicate the person is exhausted. If 沉细, symptoms worsen at night; if 浮大, symptoms worsen during the day. If neither large nor small, although exhausted, it is treatable. If the pulse sizes are inconsistent, it is difficult to treat. Six beats per exhalation and six per inhalation constitute a dying pulse; if 沉细, death occurs at night; if 浮大, death occurs during the day. One beat per exhalation and one per inhalation is named 'Sun' (Loss). Although the person can walk, they should be bedridden because Qi and Blood are both insufficient. One beat per two exhalations and one per two inhalations is named 'Wu Hun' (No Soul). Those with 'No Soul' will die. Although the person can walk, they are called a 'Walking Corpse'.
Four beats per cycle, or five with deep breathing, constitute a normal pulse. Three beats per exhalation and three per inhalation result in six or seven beats per cycle, two beats more than normal, indicating recent illness without severity, corresponding to the earlier concept of 'Deviation from Standard'. 'Front' refers to Cun, 'Back' refers to Chi. Cun large and Chi small indicate pathogenic Qi in Yang, representing turbid Qi ascending, causing headache and dizziness. Cun small and Chi large indicate pathogenic Qi in Yin, representing clear Qi sinking, failure of Spleen and Liver to ascend, and failure of Lung and Stomach to descend, causing chest fullness and shortness of breath. Four beats per exhalation and four per inhalation result in eight or nine beats per cycle, indicating worsening disease, corresponding to 'Depletion of Essence'. A surging and large pulse indicates Yang pathogen escaping outward, Gallbladder Qi reversing upward, and Fire rising, causing irritability. A deep and fine pulse indicates Yin pathogen sinking inward, Liver and Spleen sinking, and Earth being attacked, causing abdominal pain. A slippery pulse indicates blood excess and heat; a choppy pulse indicates dampness injury, hence 'injury from fog and dew'. This distinguishes disease severity based on pulse images, guiding students to differentiate diseases and expand their understanding. Five beats per exhalation and five per inhalation result in over ten beats per cycle, indicating severe exhaustion nearing death. Night is Yin, Day is Yang. Deep and fine pulses indicate Yin excess, worsening at night; floating and large pulses indicate Yang excess, worsening during the day. 'Large' means floating and large; 'Small' means deep and fine. If neither large nor small, symptoms do not worsen day or night, Yin and Yang are balanced, and it is treatable. If irregular, it is difficult to treat. One beat per exhalation and one per inhalation results in two or three beats per cycle, classified as 'Sun' due to Qi and Blood deficiency. Although able to walk, prolonged cases will remain bedridden. One beat per two exhalations and one per two inhalations is extremely slow; the soul has departed, life is severed, resembling a walking corpse, hence 'Walking Corpse'.
If there is pulse in the upper part but none in the lower part, the person should vomit; if they do not vomit, they will die. If there is no pulse in the upper part but pulse in the lower part, although exhausted, there is no major harm. This is because having a Chi pulse is like a tree having roots; even if branches and leaves wither, the root will sustain new growth. Pulses have roots; humans have Yuan Qi (Primary Qi), so death is avoided.
Upper part refers to Cun Kou; lower part refers to Chi Zhong. Upper pulse present, lower absent, indicates pathogenic excess in the upper Jiao, blocking Yang Qi from descending. Vomiting causes Qi to reverse upward, so the pulse rises, making the lower absence due to vomiting, not true root loss. Without vomiting, it indicates no pathogen above but Qi exhaustion below, hence death. Upper pulse absent, lower present, though exhausting, is harmless because pulses rely on Yuan Qi for circulation. If Yuan Qi is intact, pulses regenerate. Upper absence is merely temporary Qi and Blood stagnation; upon recovery, pulses return. Thus, having a Chi pulse is like a tree having roots. Yue Ren (Bian Que) extended the meaning of 'Sun' and 'Zhi' to show that absent pulses have two causes and cannot be uniformly deemed fatal.
Commentary: 'Sun' pulse is a slow pulse; 'Zhi' pulse is a rapid pulse. Why use 'Sun' and 'Zhi' instead of 'Slow' and 'Rapid'? Slow and Rapid pulses encompass Cold/Heat, Exterior/Interior, Deficiency/Excess broadly. Yue Ren feared misunderstanding, so he defined 'Zhi' as four to twelve/thirteen beats per cycle, and 'Sun' as two beats per cycle down to one beat per two cycles. He clarified that 'Sun' pathology proceeds downward from Lung Qi deficiency to Kidney Yang exhaustion, while 'Zhi' pathology proceeds upward from Kidney Yin deficiency to Lung Qi exhaustion. However, the origin of 'Sun' pathology begins in the Lung; if untreated, it spreads to Heart, Spleen, Liver, and Kidney. The 'Sun' pulse may reverse into a 'Zhi' pulse due to Kidney deficiency and fire dryness, spreading from Kidney to Liver, Spleen, Heart, and Lung, leading to death. Hence, "the opposite pertains to the disease of the Zhi pulse." I have seen deficiency-cold conditions presenting with restless rapid pulses in late stages due to failure to apply 'Sun' treatment methods and delayed Yang support, leading to Yin exhaustion. Supporting Yang means supporting Stomach Yang and benefiting damaged Zang organs, not merely using Ginger, Cinnamon Twig, Aconite, or Typha. Furthermore, modern physicians often use 'Xu Lao' (Deficiency Consumption) as a general term for weakness, unaware that Xu Sun (Deficiency Loss) progresses downward, while Lao Zhai (Tuberculosis/Consumption) progresses upward. Treating Xu Sun with Lao Zhai methods often causes diarrhea; treating Lao Zhai with Xu Sun methods causes panting. Failing to distinguish these leads to contradictory treatments. This stems from ignorance of 'Sun' and 'Zhi'. Yue Ren used 'Sun' and 'Zhi' pulses to clarify treatments for Xu Sun and Lao Zhai. Fearing that later generations might confuse acute absent pulses with 'Sun' pulses, he clarified upper/lower pulse differences and emphasized Yuan Qi to conclude this chapter. Students should pay close attention to this.