Subsequently, being Yin, it is inevitable to distinguish them by floating and sinking pulses. However, when the ancients spoke of "Cunkou" (Inlet Pulse), they often referred to both the Guan (Bar) and Chi (Root) positions as well. For instance, as stated in the *Nan Jing* (Classic of Difficult Issues) and later in this chapter: "When water drops two marks, the circulation completes one cycle and returns to Cunkou, where deficiency and excess manifest." This all refers to the Jing-Stream point Jingqu (LU8) of the Hand-Taiyin Lung Meridian. Understanding this, there is no need for forced or overly elaborate explanations, thereby avoiding the error of diagnosing disorders of the Lower Jiao at the Cun position. The pathogenic factor mentioned here seems to be Dampness, likely referring to the moisture, mist, dew, and rain from the sky. Heaven is based on Qi; thus, this type of dampness mostly affects the Middle and Upper Jiao, the exterior, and the meridians. Earth is based on Form; thus, ground dampness like mud and water mostly affects the Middle and Lower Jiao, the interior, and the sinews and bones. Since it has been clearly stated that Clear Pathogens are mist and dew, then what is meant by Turbid Pathogens—if not the dampness of the earth—must be... As stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "Wind pathogens affect the upper part first; Dampness pathogens affect the lower part first." It also says: "Cold and damp earthy qi injuring humans must start from the feet." If the Turbid Pathogen were Cold, the Foot-Taiyang Bladder Meridian should be affected first, and it should not only affect the Lower Jiao presenting with symptoms such as coldness and reversal of the feet and knees, and incontinence of urine and feces. Someone might ask: If so, how does this differ from the pulse and symptoms of Damp Bi (Dampness Arthralgia)? I reply: Damp Bi is severe, whereas this condition is mild. Only when the condition is severe does Dampness flow inward and tend downward, resulting in a sinking and fine pulse, with symptoms of painful and irritable joints, and a body color resembling smoked yellow. Only when the condition is mild is the injury caused merely by Yin-cold Qi, resulting in a tight pulse, with symptoms of headache, neck stiffness, and lower back pain, similar to Shanghan (Cold Damage). Only when the Turbid Pathogen attacks the Lower Jiao does it differ from Shanghan, because it directly invades the Zang-Fu organs, sinews, bones, muscles, and flesh, rather than being limited to the meridians. Feeling chills in the ears, the body does not tremble, but the heart feels fearful and anxious. The *Nan Jing* discusses the Five Pathogens, considering Dampness invasion as a Kidney Pathogen, with symptoms of coldness and reversal in the lower legs and feet. Thus, the mention of coldness and reversal of the feet and knees here clearly indicates Dampness Pathogen in the Kidney. Regarding the incontinence of urine and feces, this is what Liu Hejian described as pathogenic factors lodging in the Kidney region and the Foot-Shaoyin and Foot-Jueyin meridians, causing extreme stagnation in the anterior orifice, preventing the free flow of Qi and Blood, leading to flaccidity and numbness, loss of spiritual function, so that body fluids seep into the Bladder, resulting in involuntary urination that cannot be controlled. So, how should it be treated? I reply: To treat Heavenly Dampness (airborne moisture), one should follow the method of Si Tian (Sovereign Qi): "When Dampness is excessive and accompanied by Heat, treat it with Pungent-Warm herbs, assisted by Sweet-Pungent herbs, aiming for sweating as the effect, stopping once sweat occurs." This should be selected from the treatment methods of Shanghan. To treat Earthly Dampness (ground moisture), one should follow the method of Zai Quan: "When Dampness overflows internally, treat it with Bitter-Hot herbs, assisted by Sour-Light herbs, using Bitter to dry Dampness and Light to drain Dampness." Formulas such as Sini Tang (Four Reversal Decoction) and Bainong Tang (White Through Decoction) can also be used. The San Jiao (Triple Burner) is the special envoy of Yuan Qi (Source Qi), primarily responsible for circulating the Qi of the Upper, Middle, and Lower Jiao, passing through the Five Zang and Six Fu organs. Circulating the Three Qi is what Ji Shi referred to as the Lower Jiao receiving True Yuan Qi, which is also Yuan Qi. It ascends to the Middle Jiao, where the Middle Jiao receives the refined essence of food and drink, transforming it into Ying (Nutritive) Qi and Wei (Defensive) Qi. Ying and Wei Qi, along with True Yuan Qi, circulate and reach the Upper Jiao. When the San Jiao is unobstructed, the upper, lower, interior, and exterior, left and right, are all unobstructed. Now, if Exterior Qi is slightly deficient and Interior Qi is slightly urgent, the San Jiao becomes confused and mixed, leading to obstruction between the interior and exterior. Disease in the Upper Jiao causes stagnant Heat to erupt internally, resulting in mouth ulcers and gingival erosion. Disease in the Middle Jiao impairs the Spleen's ability to transform and transport the food ingested by the Stomach, causing turbidity in the Stomach. Stomach turbidity means there is no essence of food and drink to serve as Ying Qi, nor is there the fierce Qi of food and drink to serve as Wei Qi; thus, how can Ying and Wei Qi circulate freely? If Ying and Wei Qi do not circulate, blood coagulates and freezes, failing to flow. Human life depends on Ying and Wei Qi. Can one survive long if Ying and Wei Qi do not circulate? Ying circulates within the vessels, and Wei circulates outside the vessels; they cannot become unobstructed simultaneously but must have a sequence. To know whether Ying or Wei Qi becomes unobstructed first, where can we verify it? If Wei Qi becomes unobstructed first, there will first be dark yellow urine, followed by the emergence of carbuncles and pus. If Ying Qi becomes unobstructed first, there will first be sneezing and throat blockage, followed by bloody stool resembling pig liver. The *Neijing* states: "The San Jiao is the official of dredging, through which water passages flow smoothly; the Bladder is the official of the reservoir, storing body fluids, which can be excreted only after Qi transformation." Does this not solely depend on the Qi transformation of the Lower Jiao Bladder? The Lungs govern the regulation of water passages, transporting them downward to the Bladder. In cases of Spleen disease, the nine orifices are obstructed, and urination is difficult, indicating that urination also depends on the Qi transformation of the Upper and Middle Jiao. Therefore, when Wei Qi is unobstructed, urine becomes dark yellow. The *Neijing* discusses sneezing: sometimes due to Cold Qi descending and Heart Qi ascending; sometimes due to Heat Qi descending and Lung Qi ascending. Li Dongyuan said: "When Yang Qi cannot exit, it is called Obstruction (Se); when Yin Qi cannot descend, it is called Dysphagia (Ye)." He further stated: "Obstruction is governed by the Five Zang, belonging to Yin and Blood; Dysphagia is governed by the Six Fu, belonging to Yang and Qi." Both arise from Yang hidden within Yin. From this perspective, sneezing and nasal obstruction are signs of the struggle between Yin-Yang and Cold-Heat. Therefore, it is said that when Cold Jue chase each other and are overwhelmed by Heat, blood coagulates and flows downward, resembling pig liver. Wei Qi warms the muscle intervals, fills the skin, thickens the interstices, and controls opening and closing; thus, its unobstruction manifests as the discharge of pus. Ying Qi pours its fluids into the vessels, transforms them into blood, nourishes the four extremities, and irrigates the Five Zang and Six Fu organs; thus, its unobstruction manifests as bloody stool. If Ying and Wei Qi ultimately remain obstructed, both Yin and Yang become Jue (reversal/cold), the Spleen Qi becomes isolated and weak, unable to scatter essence and ascend it to the Lungs to regulate water passages. Consequently, the fluids of the Five Zang pour downward, the Lower Jiao fails to close, frequent trips to the toilet occur with difficulty in excretion, because there is no Qi to push it out. The area around the navel feels tense and painful like pounding, because the Moving Qi between the Kidneys is about to fail. Therefore, it is said that life is difficult to preserve.

When the Yin and Yang pulses are both tight, with breath issuing from the mouth, dry lips and mouth, curling up while lying down, cold feet, runny nose, and a slippery coating on the tongue, do not treat recklessly. After seven days, if the patient has slight fever and warm hands and feet, this indicates the disease is about to resolve. Or, if after eight days or more, there is instead high fever, this is difficult to treat. If there is aversion to cold, vomiting is certain; if there is abdominal pain, diarrhea is certain. With this pulse and these symptoms, where the interior and exterior, Yin and Yang are confused and uncertain, do not administer medicine rashly; wait patiently. If beyond the seventh day, signs of resolution appear—slight fever and warm hands and feet—this means the pathogenic factor is resolving and the patient will heal spontaneously. If after eight days or more, resolution does not occur, but high fever develops instead, this is a contrary syndrome and is untreatable.

When the Yin and Yang pulses are both tight, continuing through vomiting and diarrhea, if the pulse remains tight and does not relieve, the person can only find peace when the tightness disappears; this indicates resolution. If the pulse is slow, reaching six or seven days without desire for food, this is a late onset due to water retention, indicating the disease is not resolved. If appetite returns naturally, it indicates resolution.

Cheng Wuji's Commentary: Tight Yin and Yang pulses indicate severe Cold above and below. Even after vomiting and diarrhea, if the tight pulse persists, it means the pulse alone has not relieved. When the tightness disappears, the person finds peace, indicating resolution. If the pulse is slow, reaching six or seven days without desire for food, it is because the Spleen and Stomach are greatly deficient after vomiting and diarrhea. The *Neijing* states: "Fluids enter the Stomach, their essence floats and overflows, is transported upward to the Spleen, the Spleen scatters the essence upward to the Lungs, regulates the water passages, transports downward to the Bladder, water essence distributes in four directions, and runs through the five meridians." If Spleen and Stomach Qi is strong, it can transport and scatter fluid-dampness; if Spleen and Stomach Qi is deficient, fluid-dampness stays inside. What is called "late onset" refers to subsequent illness. If by six or seven days the patient desires food, the Spleen and Stomach have harmonized and Cold pathogens have dispersed, hence it is said to be resolving. ○ The tight pulse in this disease should be viewed in three sections.

After six or seven days of illness, if the pulses at the hand and foot三部 (three positions) are all present (forceful), accompanied by great irritability, jaw clenching, inability to speak, and internal restlessness, the disease will surely resolve.

Cheng Wuji's Commentary: Irritability and heat. During the transmission of meridians, if the patient has severe bodily irritability, jaw clenching, inability to speak, and internal restlessness, it signifies a struggle between Yin and Yang. If the pulses at the three positions of the hands and feet are all present, it indicates that Righteous Qi prevails, Pathogenic Qi is weak, Yang Qi recovers, and Cold disperses, so the disease will surely resolve.

If the pulse is harmonious, and although the patient is greatly irritable, the inner aspect of the eyelids shows yellow, this indicates resolution.

Cheng Wuji's Commentary: The *Mai Jing* (Pulse Classic) states: "If yellow appears in the eyes of the patient, the disease is about to heal." Diagnosis relies primarily on the pulse. If there is yellowing of the eyes, great irritability, and an inharmonious pulse, Pathogenic Qi prevails, and the disease progresses. If there is yellowing of the eyes, great irritability, but a harmonious pulse, Righteous Qi has harmonized, hence it is said to be resolving.

A floating and rapid pulse. Floating indicates Wind; Rapid indicates Deficiency. Wind relates to Heat; Deficiency relates to Cold. The combination of Wind and Deficiency leads to shivering and aversion to cold.

Cheng Wuji's Commentary: The *Neijing* states: "Presence implies Excess, absence implies Deficiency." When Qi combines, Blood is absent; when Blood combines, Qi is absent. Wind injures Wei (Defensive) Qi; Rapid pulse indicates Blood deficiency. A floating and rapid pulse suggests Wind pathogens combining with Wei Qi, making Wei Qi superior and Ying (Nutritive) Qi deficient. Wei is Yang; Wind combats Wei, hence Heat. Ying is Yin; Ying Qi is deficient, hence Cold. Wind combining with Wei results in both fever and aversion to cold.

Zhang Jingyue's Commentary: Ancient and modern practitioners regard the rapid pulse as Heat. Why does Zhongjing regard it as Deficient Cold? Rapid indicates Deficiency, which is the principle of Yin-Yang imbalance, not exclusively Cold or Heat. Floating is Yang; floating-rapid indicates Yang deficiency. Sinking is Yin; sinking-rapid indicates Yin deficiency. Yang deficiency causes aversion to cold; treat with Warm-Hot herbs to suppress Yin and support Yang. Yin deficiency causes fever; treat with Cold-Cool herbs to suppress Yang and support Yin. Balance the two Qi, and the disease heals itself. For example, if the disease is in the Exterior with a floating-rapid pulse, it indicates Yin excess and Yang deficiency; sweating cures it, purgation kills it. If the disease is in the Interior with a sinking-rapid pulse, it indicates Yang excess and Yin deficiency; purgation cures it, sweating kills it. The classics are clear, with no difference.

A floating and slippery pulse. Floating is Yang; Slippery is Excess. Yang and Excess combat each other, resulting in a rapid and hurried pulse, with Wei Qi losing its regulation. A floating-slippery pulse, rapid and hurried, with fever and sweating, indicates an untreatable condition.

Cheng Wuji's Commentary: Floating indicates Pathogenic Qi combining with Wei Qi, making Wei Qi superior. Slippery indicates Pathogenic Qi combining with Ying Qi, making Ying Qi excessive. When Pathogenic Qi is superior and excessive, congesting Ying and Wei, Ying and Wei move quickly, hence the pulse is rapid and hurried. Six beats per breath is called Rapid. A healthy person has four beats per breath, with Wei Qi moving three cun. Now, with six beats per breath, Wei Qi moves nine cun, exceeding half the normal distance. Thus, a rapid and hurried pulse indicates Wei Qi has lost its normal degree. With a floating-slippery-rapid-hurried pulse, fever, and sweating, the disease should resolve. If it does not resolve, Essence and Qi are depleted, and it is definitely untreatable. The Classics state: "If Yin and Yang pulses are both full and large, and sweating does not resolve the condition, death ensues."

Shanghan with cough, counterflow Qi, and upward gas, if the pulse is scattered, indicates death, because the form is damaged.

Cheng Wuji's Commentary: The *Qianjin Fang* regards panting and cough as counterflow Qi and upward gas, which is a Lung disease. A scattered pulse is a Heart pulse. This represents Heart Fire punishing Lung Metal. The *Neijing* states: "Heart affecting Lung is called Dead Yin. Those belonging to Dead Yin die within three days." This is evident from the damage to the form. This is an internal injury.

Question: Pulses have three positions, Yin and Yang interact, Ying and Wei, Blood and Qi reside in the human body. Respiration enters and exits, moving up and down within. Through breath, they circulate, fluids flow smoothly, acting according to time, showing effects and forms. Spring pulses are wiry, Autumn pulses float, Winter pulses sink, Summer pulses are洪 (Surging). Observing color and pulses, sizes differ. Within a moment, changes have no fixed pattern. Cun and Chi vary, sometimes short, sometimes long, upper and lower disordered, existing or absent. Diseases change, advancing or retreating. One may be confused and lose the guiding principles. Please explain fully so I may understand clearly. Master said: Your question touches the root of the Dao. Pulses have three positions: Cun, Chi, and Guan.

Cheng Wuji's Commentary: Cun is the Upper position, Guan is the Middle, Chi is the Lower. Below this, later authors attributed it to Wang Shuhe. However, checking the *Mai Jing*, Zhang Zhongjing's discussion on pulses ends with this single passage, indicating it was not written by Shuhe himself.

Ying and Wei circulate freely, not losing the balance of weight and measure.

Cheng Wuji's Commentary: Heng and Quan refer to scales, used to weigh lightness and heaviness. The *Neijing* states: "Spring corresponds to the compass, Summer to the square, Autumn to the balance, Winter to the steelyard." Ying circulates within the vessels, Wei circulates outside. Ying and Wei follow the vessels, corresponding to the four seasons, maintaining their normal degree.

Kidney pulses sink, Heart pulses surge, Lung pulses float, Liver pulses are wiry. These are the constant laws, not deviating by a hair's breadth.

Cheng Wuji's Commentary: Kidney is Water of the North, flourishing in Winter, hence sinking pulses. Heart is Fire of the South, flourishing in Summer, hence surging pulses. Lung is Metal of the West, flourishing in Autumn, hence floating pulses. Liver is Wood of the East, flourishing in Spring, hence wiry pulses. These are the constant laws, not deviating by even a tiny fraction.

Entering and exiting, rising and descending, cycles with the clepsydra, water drops two marks, one complete cycle.

Cheng Wuji's Commentary: The vessels in the human body total sixteen zhang and two chi. One exhalation moves the pulse three cun; one inhalation moves it three cun. One exhalation and inhalation constitute one breath, moving the pulse six cun. In one day and night, the clepsydra drops one hundred marks, the person takes thirteen thousand five hundred breaths, the pulse travels eight hundred ten zhang, completing fifty cycles around the body. Thus, in one mark of time, the person takes 135 breaths, the pulse travels eight zhang and one chi. When water drops two marks, the person takes 270 breaths, the pulse travels sixteen zhang and two chi, completing one cycle around the body. The movement of the pulse ends and begins again, like a circle without end.

Returning to Cunkou, deficiency and excess manifest.

Cheng Wuji's Commentary: The origin of the meridians starts from the Middle Jiao, injecting into the Hand-Taiyin Cunkou. In 270 breaths, the pulse completes one cycle around the body and returns to Cunkou. Cunkou is the starting point of the pulse, hence used to diagnose deficiency and excess. The Classics state: "Deficiency and excess are the key to life and death, all manifesting in Cunkou."

Changes multiply, Yin and Yang interfere. Wind results in floating and deficient; Cold results in firm and hard. Sinking and submerged indicate water accumulation; branch-fluid results in urgent and wiry. Movement indicates pain; Rapid indicates heat and irritability.

Cheng Wuji's Commentary: Wind injures Yang, hence floating and deficient pulses. Cold injures Yin, hence firm and hard pulses. Accumulated internally is called water accumulation, hence sinking and submerged pulses. Dispersed externally is called branch-fluid, hence urgent and wiry pulses. Movement indicates Yin-Yang struggling; struggle generates pain. Rapid is Yang; pathogenic Qi prevails, Yang prevails generates Heat and irritability.

Even if there are inconsistencies, know the cause of the change. The three positions differ, diseases have different origins.

Cheng Wuji's Commentary: When pulse and disease do not correspond, it must be due to transmission and change. The three positions observe the Qi of the Five Zang; inspect deficiency and excess according to the position.

Excess is strange, deficiency is also so. Pathogens do not appear empty; there must be treachery within. Examine the interior and exterior, distinguish the San Jiao. Know where they lodge, observe and diagnose, estimate the Zang-Fu, seeing uniquely as if divine. Record these items for you, to pass on to worthy men.

Cheng Wuji's Commentary: Excessive and deficient pulses both involve pathogens interfering with Righteous Qi. Examine whether it is in the exterior or interior, entering Fu or Zang, and treat according to where they lodge.

Master said: Respiration is the head of the pulse.

Cheng Wuji's Commentary: The *Nan Jing* states: "One exhalation moves the pulse three cun; one inhalation moves it three cun." Because the pulse follows respiration, it is called the head of the pulse. This is the essential method for entering pulse diagnosis.

Initially holding the pulse, coming fast and going slow, this comes fast and enters slow, named Internal Excess and External Deficiency.

Cheng Wuji's Commentary: Exterior is Yang, Interior is Yin. The *Neijing* states: "Coming is Yang, Going is Yin." Coming observes the exterior, Going observes the interior. Fast indicates surplus, surplus implies Excess. Slow indicates insufficiency, insufficiency implies Deficiency. Coming fast and going slow indicates Yang surplus and Yin deficiency, hence named Internal Deficiency and External Excess (Note: The text says "Internal Excess External Deficiency", but logically "Lai Ji Qu Chi" usually implies Yang Excess/Wind attacking Wei, leading to Ying deficiency. However, strictly translating the provided text: "named Internal Excess External Deficiency"). *Correction*: The source text says "名曰内实外虚也" (Named Internal Excess External Deficiency). But "Lai" (Coming) is Yang/Exterior, "Qu" (Going) is Yin/Interior. Lai Ji (Fast) = Yang Excess (External Excess). Qu Chi (Slow) = Yin Deficiency (Internal Deficiency). So it should be External Excess Internal Deficiency. The text provided says "Internal Excess External Deficiency". This is likely a typo in the source text provided by the user or a specific interpretation. I will translate faithfully to the source text provided: "named Internal Excess and External Deficiency," though medically this contradicts standard theory for "Lai Ji Qu Chi". *Self-Correction*: Actually, looking at Cheng Wuji's commentary immediately following: "Lai Ji Qu Chi zhe, Yang You Yu er Yin Bu Zu, gu yue Nei Xu Wai Shi" (Coming fast going slow, Yang has surplus and Yin lacks, therefore called Internal Deficiency External Excess). Wait, Cheng Wuji's commentary says "Nei Xu Wai Shi" (Internal Deficiency External Excess). But the main text says "Nei Shi Wai Xu" (Internal Excess External Deficiency). There is a contradiction in the provided text between the main text and the commentary. I will translate the main text as written: "named Internal Excess and External Deficiency."

Question: The expert physician knows by observation, the average physician by inquiry, the inferior physician by pulse. I wish to hear your explanation. Master said: The patient's family reports: "The patient suffers from fever and body pain, and lies down voluntarily." When the master arrives and palpates the pulse, finding it sinking and slow, he knows the patient will recover. Why do I know this? When there is disease in the exterior, the pulse should be floating and large. Now the pulse is contrary, sinking and slow, hence I know recovery.

Cheng Wuji's Commentary: Observation views form and symptoms; inquiry learns of suffering; pulse distinguishes interior and exterior. Fever and body pain indicate pathogen in the exterior. One should lie down uncomfortably with a floating-rapid pulse. Now the patient lies down voluntarily with a sinking-slow pulse, indicating exterior pathogen is slack. Having interior pulse signs but no exterior symptoms, one knows the exterior pathogen will heal.

Suppose the patient says: "Sudden abdominal pain," and sits up voluntarily. When the master arrives and palpates, finding a floating and large pulse, he knows recovery. Why do I know this? If there is disease in the interior, the pulse should be sinking and thin. Now the pulse is floating and large, hence recovery.

Cheng Wuji's Commentary: Abdominal pain indicates interior Cold. Severe pain prevents rising and results in a sinking-thin pulse. Now the patient sits up voluntarily with a floating-large pulse, indicating interior Cold has dispersed. Having exterior pulse signs but no interior symptoms, one knows the interior pathogen will heal. Thus, observing symptoms, asking about illness, and cutting the pulse are three aspects combined to achieve perfect medical skill. The *Needle Classic* states: "Knowing one is superior, knowing two is divine, knowing three is enlightened."

Master said: The patient's family comes requesting: "The patient has high fever and extreme irritability." The next day, when the master arrives, the patient lies facing the wall. This heat has gone. The pulse has harmonized, hence it is said to be healed. High fever and extreme irritability prevent quiet lying. Now lying quietly facing the wall, one knows the heat has gone.

If lying facing the wall, upon hearing the master arrive, does not startle up but looks around, speaks haltingly (three words, three pauses), and swallows saliva when palpating the throat, this is feigned illness. Suppose the pulse is naturally harmonious, yet claims the disease is severe, requiring emetic and purgative medicines, and dozens or hundreds of acupuncture points, before healing.

Cheng Wuji's Commentary: Feigned illness is performed by those not virtuous. By frightening them with words, causing fear, they heal. The physician uses intuition. Is this correct? This is not a true treatment method. Setting up a framework for feigned illness, they feign, and the physician treats as feigned.

The master holds the pulse; if the patient yawns, there is no disease.

Cheng Wuji's Commentary: The *Needle Classic* states: "Yang draws upward, Yin draws downward; Yin and Yang draw each other, hence yawning." If Yin and Yang do not draw each other, there is disease; if they draw each other, there is harmony. Thus, yawning indicates no disease.

Palpating a groaning patient indicates disease.

Cheng Wuji's Commentary: Groaning is the sound of moaning. The body suffers, hence this occurs.

Speaking slowly indicates Wind.

Cheng Wuji's Commentary: Wind lodges internally, causing meridians and collaterals to tighten, tongue stiffness, and difficult articulation.

Shaking the head while speaking indicates interior pain.

Cheng Wuji's Commentary: Disease in the interior causes the head to tremble when speaking.

Walking slowly indicates exterior stiffness.

Cheng Wuji's Commentary: Exterior stiffness, due to tendon and collateral tension, makes walking difficult.

Sitting and leaning forward indicates shortness of breath.

Cheng Wuji's Commentary: Shortness of breath indicates interior disharmony. Hence sitting and preferring to lean forward.

Sitting with one leg extended indicates lower back pain.

Cheng Wuji's Commentary: The *Neijing* states: "The waist is the major joint of the body." Lower back pain causes dysfunction of the major joint, hence inability to sit straight. Extending one leg relieves the pain in the waist.

Interior Excess, protecting the abdomen as if holding an egg, indicates Heart pain.

Cheng Wuji's Commentary: Heart pain prevents extending and lying flat; protecting the abdomen presses the pain.

Master said: Disease of latent Qi is anticipated by intent. Within this month, latent Qi is expected. Suppose there is old latent Qi; one must palpate. If the pulse is weak and faint, there should be throat pain, resembling injury but not Hou Bi (throat bi). The patient claims real throat pain, and now also desires diarrhea.

Cheng Wuji's Commentary: Contracting Cold in Winter, hiding in the meridians without immediate onset, is called Latent Qi. By the Spring Equinox, latent Cold desires to emerge, hence "within this month, latent Qi is expected." Suppose latent Qi has emerged; one must palpate to determine the meridian. Finding a weak and faint pulse indicates the pathogen is in the Shaoyin. The Shaoyin meridian follows the throat; Cold lodging there必然 causes throat pain. The Kidney governs opening and closing; Shaoyin manages the Lower Jiao. Severe internal Cold disrupts opening and closing, Lower Jiao fails to constrain, inevitably leading to diarrhea. Hence, although there is throat pain, there is also desire for diarrhea.

Question: When a person suffers from terror, what is the pulse shape? Master said: The pulse shape resembles tracing threads continuously, and the face is pale and loses color.

Cheng Wuji's Commentary: The *Neijing* states: "Blood and Qi are the spirit of man." Terror indicates insufficient Blood and Qi and weak Spirit Qi. Pulse shape resembling continuous threads, pale face losing color: The *Needle Classic* states: "When Blood is depleted, the complexion is dull and lusterless, and the pulse is empty." Thus, terror indicates insufficient Blood and Qi.

Question: When a person does not drink, what is the pulse like? Master said: The pulse is naturally choppy, and lips and mouth are dry.

Cheng Wuji's Commentary: Choppy is Yin; although it mainly governs loss of body fluids, dry lips and mouth, dominated by Yin internally, lead to lack of drinking. This section likely has missing text.

Question: When a person feels ashamed, what is the pulse like? Master said: The pulse is floating, and the face alternates between white and red.

Cheng Wuji's Commentary: Shame causes timid Spirit Qi, hence floating pulse and changing facial color.

Question: The Classics say pulses have weights of three beans and six beans. What does this mean? Master said: When pressing the pulse with fingers, pressure equivalent to three beans indicates Lung Qi; six beans indicates Heart Qi; nine beans indicates Spleen Qi; twelve beans indicates Liver Qi; pressing to the bone indicates Kidney Qi.

Cheng Wuji's Commentary: Dou refers to beans. The *Nan Jing* states: "Pressure of three beans, touching skin and hair, is Lung position; six beans, touching blood vessels, is Heart position; nine beans, touching muscles, is Spleen position; twelve beans, level with sinews, is Liver position; pressing to bone, lifting finger rapidly, is Kidney position." Each corresponds to its respective division to observe Zang Qi.

Suppose diarrhea, where Cun, Guan, and Chi pulses are all invisible. However, if Chi occasionally shows a small pulse, and the pulse lifts twice (two heads), this is Kidney Qi. If the pulse shows deterioration, it is difficult to treat.

Cheng Wuji's Commentary: The *Mai Jing* states: "Cold Qi in the Stomach causes pulse obstruction. Diarrhea without visible pulse indicates Cold Qi lodging in Spleen and Stomach. Occasional small pulse in Chi indicates Spleen deficiency and Kidney Qi encroaching. Pulse lifting twice indicates Spleen being overcome by Kidney. If Chi pulse diminishes further, Kidney Qi also declines, Spleen overcomes it again, Ghost and Thief contend, hence difficult to treat. This is Spleen overcoming at an inappropriate time."

Question: Pulses have mutual overcoming, Vertical (Zong), Horizontal (Heng), Counter (Ni), and Smooth (Shun). What does this mean? Master said: Water overcoming Fire, Metal overcoming Wood is called Vertical (Zong); Fire overcoming Water, Wood overcoming Metal is called Horizontal (Heng); Water overcoming Metal, Fire overcoming Wood is called Counter (Ni); Metal overcoming Water, Wood overcoming Fire is called Smooth (Shun).

Cheng Wuji's Commentary: Metal overcoming Wood, Water overcoming Fire: Zong means allowing Qi to overcome what it conquers. Heng means Qi acts horizontally and reversely, overcoming what it does not conquer. Zong and Heng share meanings with indulgence and arrogance. Water is Metal's child; Fire is Wood's child. Child overcoming Mother is Counter (Ni); Mother overcoming Child is Smooth (Shun).

Question: Pulses have "Can Zei" (Mutilating Bandits). What does this mean? Master said: Pulses that are Wiry, Tight, Floating, Slippery, Sinking, and Choppy—these six are called Mutilating Bandits, capable of causing disease in all other pulses.

Cheng Wuji's Commentary: Eight Evils cause disease. Wind, Cold, Summerheat, Dampness injure externally; Hunger, Fullness, Labor, Rest injure internally. Meridians are Ying and Wei; Ying and Wei are Yin and Yang. For them to cause disease in various meridians, it must be due to Wind, Cold, Summerheat, Dampness injuring Ying and Wei, lodging in Yin and Yang. Wind causes floating pulse; Cold causes tight pulse; Summerheat causes slippery pulse; Dampness causes choppy pulse; Injury to Yin causes sinking pulse; Injury to Yang causes floating pulse. They are called Mutilating Bandits because harming goodness is "Can" (mutilate), harming goodness is "Ze" (bandit), as they harm Righteous Qi.

Question: Pulses have "Zai Guai" (Disaster Monster). What does this mean? Master said: Suppose a patient has a Taiyang pulse, corresponding to form and symptoms, and decoction is administered. Shortly after taking the medicine, the patient suddenly vomits severely, or has diarrhea with abdominal pain. The master says: "I did not see these symptoms before; now they have changed, this is called Disaster Monster." Asked: "What causes this vomiting and diarrhea?" Answer: "Perhaps old medication taken previously is now acting, hence called Disaster Monster."

Cheng Wuji's Commentary: When the physician matches pulse and symptoms with medicine, but changes occur unexpectedly, causing disaster and strangeness, it is called Disaster Monster. From the three-bean and six-bean weights to the Disaster Monster pulse, these five sections are all methods for consulting physicians.