《黃帝八十一難經纂圖句解》Vol. 3

This passage explains ancient pulse diagnosis methods and manifestations of abnormal liver pulse. Pulse examination involves three positions (cun, guan, chi) and nine pulse qualities (each position having superficial, middle, and deep levels), collectively called the "three positions and nine indicators." Pulse manifestations are distinguished by Yin-Yang principles: the cun pulse belongs to Yang, appearing at the surface; the chi pulse belongs to Yin, lying deep. Pulses also vary in intensity—Yang pulses are light and floating, while Yin pulses are heavy and deep.

Ancient physicians identified sixty fundamental pulse patterns that change according to seasonal variations. Given the antiquity of these methods and their inherent complexity, diagnosis requires correlating both external and internal symptoms.

Take abnormal liver pulse as an example: A healthy liver pulse should resemble a plucked zither string—soft yet elongated. When liver disease is present, external symptoms include obsessive cleanliness (as the gallbladder, its paired organ, governs purity), a greenish facial complexion (the color associated with liver), and proneness to anger (since liver governs the emotion of rage). Internal symptoms manifest as hardened masses in the left abdomen that are painful upon pressure (called "exuberant qi," indicating liver stagnation), potentially accompanied by swollen limbs and difficult urination.

The term "dysuria" (difficult urination) mentioned here occurs because the liver meridian passes through the genital region, so liver dysfunction can impair urinary flow.

This scripture primarily explains how to diagnose diseases of the liver, heart, spleen and other internal organs through pulse patterns and symptoms.

When the liver and kidneys exhibit problems in the lower body, the flow of Qi becomes obstructed and counterflowing, leading to symptoms such as difficulty in bowel movements and muscle spasms. Since the liver is responsible for storing blood to nourish the sinews, liver disorders will cause convulsions in the tendons. The presence of these symptoms indicates liver disease; their absence suggests otherwise.

If a heart pulse pattern is detected (floating, large, and scattered), the external manifestations include a reddish complexion (the heart governs the color red), dry mouth (the heart channel passes beneath the tongue, and heart heat causes dryness), and a tendency to laugh (the heart corresponds to laughter among the five vocal expressions). Internally, there may be a hard mass above the navel that is painful upon pressure (known as "Fu Liang," an accumulation in the heart channel), along with restlessness, heart pain, heat and dryness in the palms, and retching. The pericardium channel emerges at the tip of the middle finger and descends into the palm; pressing the point below the ring finger (Laogong point) will reveal heat and retching if the pericardium is affected. The presence of these symptoms confirms heart disease; their absence indicates otherwise.

If a spleen pulse pattern is detected (moderate, relaxed, and large), the external manifestations include a yellowish complexion (the spleen governs the color yellow), frequent belching (the spleen’s pathological change manifests as belching), and heightened sensitivity to taste (the spleen governs sweetness). Internally, there may be a hard mass at the navel that is painful upon pressure (known as "Pi Qi," an accumulation in the spleen channel), along with abdominal distension, indigestion (dampness causes bloating, while insufficient Yang Qi makes food difficult to digest), heaviness in the body with joint pain, fatigue and drowsiness, and weakness in the limbs. The presence of these symptoms confirms spleen disease; their absence indicates otherwise.

These diagnostic methods rely on observing pulse patterns and symptoms to determine which organ is affected, embodying the traditional Chinese medical principle of "inferring the internal from the external."

If these symptoms are not present during diagnosis, then it is not a disorder of the spleen.

Suppose the lung pulse (the pulse manifestation of the lungs) is diagnosed as floating and short. The external manifestations include a pale complexion, as the lungs correspond to white, hence the pallor. Frequent sneezing occurs because the nose is the passage for clear Qi (vital energy), and the nose is associated with the lungs. When the lungs are affected by wind-cold, it manifests as frequent sneezing through the nose. Emotionally, there is a tendency toward sorrow and melancholy, as grief is the emotional expression of the lungs. The lungs govern autumn, a season prone to melancholy. The spleen belongs to earth, while the lungs belong to metal. The spleen is the "mother" of the lungs, and the spleen governs singing. When the lungs are diseased, the spleen, as the mother, becomes concerned, hence the manifestation of autumnal sorrow and melancholy. There is also a desire to cry—vocalizing this emotion results in weeping. The internal symptom is a sensation of moving Qi to the right of the navel, which feels hard and painful upon palpation. This is the lung accumulation disorder called "Xi Ben," located to the right of the navel, presenting as hardness and pain when pressed. The condition manifests as panting and coughing because the lungs are the "canopy" (protective shield) of the five organs, favoring purity and clarity. When the lungs are affected by wind-cold, the Qi pathways become obstructed, leading to panting and coughing. The body alternates between chills and fever—lung deficiency causes aversion to cold, while lung excess results in fever and chest tightness. If these symptoms are present, it is a lung disorder; if not, it is not.

Suppose the kidney pulse (the pulse manifestation of the kidneys) is diagnosed as deep, short, and solid. The external manifestations include a dark complexion, as the kidneys correspond to black, hence the darkening of the face. There is a tendency toward fear, as fear is the emotional expression of the kidneys. Frequent yawning is a sign of Taiyang channel Qi deficiency. The internal symptom is a sensation of moving Qi below the navel, which feels hard and slightly painful upon palpation. This is the kidney accumulation disorder called "Ben Tun," located below the navel, presenting as slight pain when pressed. The condition manifests as rebellious Qi (counterflow Qi) because kidney Qi deficiency damages the Chong vessel, causing Qi to rise upward. There is acute pain in the lower abdomen, as the foot Shaoyin kidney channel passes through the lower abdomen, intersecting with the foot Jueyin liver channel and the foot Taiyin spleen channel—the three Yin channels converge below the navel. Kidney disorder thus causes lower abdominal pain. Diarrhea with a sensation of prolapse is called "Chi Jia Xie," characterized by tenesmus (urgency without relief), frequent but unproductive bowel movements, and penile pain. The calves feel cold and chilled, as the foot Shaoyin kidney channel’s artery is located five cun above the inner ankle, hence the coldness in the calves. If these symptoms are present, it is a kidney disorder; if not, it is not.

The 17th Difficulty states: Medical classics say that some diseases lead to death, while others may resolve on their own without treatment.

Some illnesses resolve spontaneously without treatment, while others persist for months or even years without improvement. These life-and-death situations can indeed be discerned through pulse diagnosis.

When examining a patient, if they keep their eyes closed and avoid looking at others, this indicates liver disease. A healthy liver pulse should be soft and elongated like a taut string, but if the pulse becomes hard and rapid, it signifies liver pathology. If a lung pulse (floating, short, and rough) appears instead, the prognosis is dire—this represents the Metal phase (lung) overcoming the Wood phase (liver), marking a fatal pattern.

Patients who stare with wide-open eyes while experiencing thirst and rigidity in the cardiac region suffer from heart disease. The expected pulse here should be tense, solid, and rapid. However, if a kidney pulse (deep, soggy, and faint) emerges instead, it signifies Water (kidney) overcoming Fire (heart)—a yang disease exhibiting yin pulses, another fatal indication.

Hemoptysis, epistaxis, or blood-streaked nasal discharge all point to lung disease. The corresponding pulse should be deep and thin (as blood belongs to yin). But if a floating, large, and firm heart pulse appears instead, it shows Fire (heart) overcoming Metal (lung)—a contradiction between disease and pulse that signals impending death.

When patients deliriously rant, their bodies should exhibit heat with corresponding surging pulses. But if their limbs turn cold while pulses become deep, thin, and faint, this yang syndrome displaying yin pulses—another mismatch—similarly foretells death.

Abdominal distension with diarrhea indicates spleen deficiency failing to retain fluids due to excessive dampness. Here the pulse should be faint and rough.

This passage explains the correspondence between pulse diagnosis in traditional Chinese medicine and the relationships among the internal organs. It first mentions that if symptoms of spleen disease appear while the pulse instead shows the tight, large, and slippery characteristics of a liver pulse (where liver Wood overacts on spleen Earth), this contradiction between pulse and symptoms would lead to a fatal prognosis.

The Eighteenth Difficulty describes how pulse diagnosis divides into three positions—cun, guan, and chi—each corresponding to four meridians (a simplified representation of the twelve primary meridians). Specifically:

The hand meridians include the Taiyin Lung and Yangming Large Intestine meridians (associated with Metal), while the foot meridians comprise the Taiyang Bladder and Shaoyin Kidney meridians (associated with Water). Lung Metal in the upper body generates Kidney Water, and since Water's nature is to descend, the Kidneys correspond to the lower body.

The foot also contains the Jueyin Liver and Shaoyang Gallbladder meridians (associated with Wood). Wood generates Fire, corresponding to the hand's Taiyang Heart and Shaoyin Small Intestine meridians (associated with Fire). As Fire's nature is to flare upward, the Heart resides in the upper body.

The hand's Pericardium (Heart Protector) and Shaoyang Triple Burner meridians (associated with ministerial Fire) generate the foot's Taiyin Spleen and Yangming Stomach meridians (associated with Earth). Earth occupies the center, placing the Spleen and Stomach in the middle position.

These relationships follow the Five Phase mutual generation principle (Metal generates Water, Water generates Wood, Wood generates Fire, Fire generates Earth) to illustrate how the zang-fu organs nourish one another. The distribution of meridians in the body's upper and lower regions correlates with their Five Phase attributes: Water's descending nature places the Kidneys below, Fire's ascending nature situates the Heart above, while Earth's central position keeps the Spleen and Stomach in the middle.

This passage explains the theoretical framework of pulse diagnosis in traditional Chinese medicine, divided into three main components:

During pulse examination, the radial artery is divided into three positions: the inch (cun), the bar (guan), and the cubit (chi). The inch position corresponds to Yang, the bar position marks the boundary between Yin and Yang, while the cubit position corresponds to Yin. Each position further manifests three pulse depths - superficial, middle, and deep - collectively termed the "three positions and nine indicators." The superficial pulse represents Yang Qi, the deep pulse signifies Yin Qi, and the middle pulse reflects the condition of stomach Qi. Superficial pulses correspond to the six hollow organs (liufu), deep pulses relate to the five solid organs (wuzang), while the middle pulse indicates the state of the middle burner (the region between chest and abdomen).

The specific correspondences are: the upper position (inch pulse) corresponds to Heaven and governs disorders from the chest upward to the head. On the left hand, the outer inch pulse relates to the head while the inner portion connects to the chest. The middle position (bar pulse) corresponds to humanity and governs conditions from the diaphragm down to above the navel - the front segment of the bar pulse indicates below the diaphragm while the rear segment relates to above the navel. The lower position (cubit pulse) corresponds to Earth and governs disorders from below the navel down to the feet, with the front segment indicating below the navel and the rear segment connecting to the feet.

Regarding diagnosis of accumulation disorders (similar to modern concepts of masses or tumors): if a patient has accumulated Qi in the right hypochondrium, the lung pulse (right inch position) will manifest a knotted pulse (irregular rhythm). The more pronounced the knotted quality, the more severe the accumulation; a subtle knotted pulse indicates mild Qi stagnation. Even if the lung pulse doesn't show knotted characteristics when right hypochondrium accumulation exists, this occurs because the right hand pulse has submerged - though the lung pulse isn't evident, the accumulated Qi persists.

The "mother-child generation" principle mentioned here refers to the Five Phase (wuxing) generative cycle: the right inch (lung metal) generates the left cubit (kidney water), kidney water generates the left bar (liver wood), liver wood generates the left inch (heart fire), heart fire generates the right cubit (ministerial fire), and ministerial fire generates the right bar (spleen earth), forming a continuous cyclical relationship of mutual nourishment.

This passage primarily discusses methods for diagnosing illnesses through pulse reading, and the correspondence between pulse patterns and disease manifestations.

Regarding pulse diagnosis: A knotted pulse (Jiemai) refers to an irregular heartbeat that occasionally skips without pattern. A deep-hidden pulse (Fumai) is concealed beneath the tendons, requiring firm pressure down to the bone to detect. A floating pulse (Fumai) beats near the surface of the muscles—barely noticeable with light touch but more pronounced when fingers are lifted.

Diagnostic approach: The pulse readings from both hypochondriac regions (below the ribs on either side) determine disease conditions. The surface pulse (floating type) examines fu-organ disorders (digestive system and hollow organs), while the deep pulse (hidden type) reveals zang-organ (heart, liver, spleen, lungs, kidneys) pathologies.

Key diagnostic principle: Pulse patterns and symptoms must correspond. Dangerous signs appear when:

1. Knotted or deep-hidden pulses appear without corresponding internal accumulations

2. Floating or knotted pulses manifest without corresponding stubborn surface ailments

3. Accumulation diseases exist without knotted/deep-hidden pulses

4. Stubborn illnesses occur without floating/knotted pulses

Such pulse-symptom mismatches all indicate critical conditions.

Supplementary note from the 19th Difficulty: Gender differences exist in normal versus abnormal pulses. Male pulses belong to Yang—like growing trees, primordial Qi (Yuanqi) circulates from the Zi hour (midnight), passing through thirty time-periods to the Si hour (9-11am), then from Si to Yin hour (3-5am), completing ten months that mirror human gestation. Here, the celestial stems-earthly branches (Tiangan Dizhi) and Yin-Yang theory explain physiological rhythms.

In traditional Chinese pulse diagnosis theory, there exists a fundamental distinction between male and female pulse manifestations. Males belong to Yang, corresponding to the Wood phase (Jia-Yi in the Five Phases system, Yang in nature), with pulse characteristics prominently displayed at the cun position (radial artery near the wrist crease). Females belong to Yin, corresponding to the Metal phase (Geng-Xin in the Five Phases system, Yin in nature), with pulse characteristics predominantly manifested at the chi position (distal radial artery).

The male pulse pattern follows this progression: Yang Qi begins its development from the Shaoyin stage, reaching its peak at the Taiyang stage. During Shaoyin (corresponding to the Fu hexagram, representing initial Yang growth), the pulse appears intermittently large and small. At the Yangming stage (corresponding to the Lin hexagram, with two Yang lines growing), the pulse becomes floating, broad yet short. In the Taiyang phase (corresponding to the Tai hexagram, with three strong Yang lines), the pulse manifests as surging, expansive and prolonged. Since Yang Qi grows upward from below, males exhibit strong cun pulses with relatively weak chi pulses.

Female pulse patterns display the opposite dynamic: Yin Qi originates from Taiyin, culminating at the Jueyin stage. During Taiyin (corresponding to the Gou hexagram, representing initial Yin emergence), the pulse appears tense, broad and long. At Shaoyin (corresponding to the Dun hexagram, with two Yin lines developing), the pulse becomes tight, thin and subtle. In the Jueyin phase (corresponding to the Pi hexagram, with three strong Yin lines), the pulse turns deep, short and substantial. As Yin Qi descends from above, females demonstrate calm cun pulses with vigorous chi pulses.

Abnormal pulse manifestations carry diagnostic significance: when males display female-characteristic strong chi pulses, or females exhibit male-characteristic weak chi pulses, these indicate health disturbances. Male pulses showing feminine patterns suggest Yang deficiency with internal disorders. Abnormalities in the left hand indicate left-side pathologies, while right-hand irregularities point to right-side conditions, with specific diagnoses requiring comprehensive pulse analysis.

(Note: The referenced hexagrams—Fu, Lin, etc.—belong to the 64 hexagrams of the Yi Jing (Classic of Changes), anciently used to analogize different phases of Yin-Yang transformation. "Three Yang growing from earth" and "Three Yin descending from heaven" describe the fundamental patterns of Yang Qi ascending from below and Yin Qi descending from above.)

This medical classic passage discusses diagnostic methods through pulse examination. When a woman exhibits a masculine pulse pattern, this indicates an "excess condition" (yang qi hyperactivity). Normally, the chi pulse position (on the inner wrist near the elbow) should be relatively floating in women. If the cun pulse position (on the outer wrist near the thumb) also shows a floating quality, this signifies excessive yang qi manifesting as disorders in the limbs. A masculine pulse detected on the left hand indicates left-sided symptoms, while appearing on the right hand points to right-sided manifestations.

The Twentieth Difficulty examines "hidden pulse patterns" where yin and yang pulse qualities transform and influence each other: yin pulses may appear in yang positions (like the cun pulse area), and yang pulses in yin positions (like the chi pulse area). Specific manifestations include:

• Yang pulses in yin positions (e.g., floating-slippery-long pulse at chi position) show yang qi invading yin regions
• Yin pulses in yang positions (e.g., deep-choppy-short pulse at cun position) indicate yin qi penetrating yang regions
• Yin qualities concealed within yang pulses (deep-short-choppy cun/guan pulses with floating-slippery-long chi pulse)
• Yang qualities concealed within yin pulses (deep-choppy-short cun/guan pulses with floating-slippery-long chi pulse)

Two critical conditions receive special attention:

"Double yang" (extreme yang excess) manifests as manic behavior: floating-slippery-long rapid pulses accompanied by incoherent speech, grandiosity, and even disrobing or climbing heights.

"Double yin" (extreme yin excess) presents as depressive mental disorders (dian illness). This represents classic pulse diagnosis for psychiatric conditions through yin-yang pulse transformations.

The two passages from The Illustrated Verse Commentary on the Yellow Emperor's Classic of Eighty-One Difficulties primarily discuss the relationship between pulse manifestations and diseases, as well as the pathological manifestations of Qi (vital energy) and blood disorders.

When the Chi pulse (the pulse position on the inner wrist near the elbow) exhibits deep, short, rough, and excessively strong characteristics, this is called "double Yin." The patient will suddenly collapse unconscious with closed eyes and loss of awareness. This occurs when Yin energy reaches its extreme and Yang energy begins to recover, and the patient will only awaken after a prolonged period. This condition is termed "epilepsy."

"Yang collapse" refers to complete depletion of Yang energy, where the Cun pulse (the pulse position near the palm on the wrist) becomes extremely faint. The patient may experience hallucinations, as if seeing ghosts. "Yin collapse," on the other hand, indicates exhaustion of Jing (essence), where the Qi of the five viscera fails to nourish the eyes, resulting in blindness. In this case, the Chi pulse becomes exceptionally weak.

The twenty-first difficulty states that if a person appears severely ill but has normal pulse manifestations, this is called "physical illness without pulse illness," and the patient can still survive. Conversely, abnormal pulse manifestations with no apparent external symptoms is termed "pulse illness without physical illness." Even if there are no immediate symptoms, the patient will eventually die. This is because pulse manifestations reflect the fundamental state of Qi and blood circulation; abnormal pulses indicate internal Qi-blood imbalance.

The twenty-second difficulty explains that abnormal pulse manifestations fall into two categories: "active disorders" and "resultant illnesses." "Active disorders" refer to pulse changes caused by pathogenic factors affecting Yang Qi, belonging to Qi-level disorders. "Resultant illnesses" occur when pathogens progress from the Qi level to the blood level, causing blood circulation obstructions that lead to disease. Qi acts as the warm motivating force ("breathing upon") that propels blood circulation. When Qi is first affected by pathogens, it causes pulse changes; subsequently affecting the blood gives rise to illness.

This scripture primarily discusses the patterns of Qi-blood circulation in the human body and measurement methods for meridian lengths.

Regarding Qi-blood circulation:

"Breath regulation" (referring to inhalation and exhalation) flows back and forth like blowing air, with Qi governing the body's continuous cyclical movement. The function of blood is to nourish and moisten, keeping the body hydrated and preventing dryness. When Qi stagnates and fails to circulate, it indicates a primary Qi disorder. When Qi-blood is affected by pathogenic heat, it becomes chaotic and overflows—this resembles encountering "thief wind" (referring to external pathogenic invasion). If Qi-blood becomes obstructed, it stagnates; when blood congeals and fails to nourish, this indicates a secondary blood disorder. Initially, Qi undergoes abnormal changes in the meridians, subsequently affecting blood circulation. Thus, the progression of disease follows the sequence of Qi disorder first, then blood disorder.

Regarding meridian lengths:

The 23rd Difficulty discusses the measurement of the three Yin and three Yang meridians in the hands and feet. The lengths of the three Yin hand meridians (Hand-Taiyin Lung Meridian, Hand-Shaoyin Heart Meridian, Hand-Jueyin Pericardium Meridian) and three Yang hand meridians (Hand-Taiyang Small Intestine Meridian, Hand-Yangming Large Intestine Meridian, Hand-Shaoyang Triple Burner Meridian), as well as the three Yin and three Yang foot meridians, can be precisely measured.

Specific measurement data:

The three Yang hand meridians collectively measure five chi from hand to head, totaling three zhang (approximately 9 meters) for both sides. Among them:

• The Hand-Taiyang Small Intestine Meridian runs from the little finger tip along the arm to the front of the ear—five chi per side, totaling one zhang for both sides.
• The Hand-Yangming Large Intestine Meridian ascends from the index finger side to the wings of the nose where it crosses—five chi per side, totaling one zhang for both sides.
• The Hand-Shaoyang Triple Burner Meridian ascends from the ring finger tip to the front of the ear—five chi per side, totaling one zhang for both sides.

The three Yin hand meridians collectively measure three chi five cun from hand to chest, totaling two zhang one chi (approximately 6.3 meters) for both sides. Among them:

• The Hand-Shaoyin Heart Meridian descends from the heart to connect with the small intestine, then ascends to the lung meridian at the armpit and continues along the arm to the little finger tip—three chi five cun per side, totaling seven chi for both sides.
• The Hand-Taiyin Lung Meridian originates from the middle burner (spleen-stomach region), descends to connect with the large intestine, returns to the stomach to link with the lungs, then passes through the armpit and elbow to the thumb tip—three chi five cun per side, totaling seven chi for both sides.
• The Hand-Jueyin Pericardium Meridian emerges from the chest to connect with the pericardium and triple burner, then passes through the armpit along the upper arm to the middle finger tip—three chi five cun per side, totaling seven chi for both sides.

This scripture provides a detailed account of the pathways and lengths of the six primary meridians in the human feet. The foot region contains three yang meridians (Taiyang, Yangming, Shaoyang) and three yin meridians (Taiyin, Jueyin, Shaoyin), along with two qiao vessels (Yinqiao and Yangqiao).

The three yang meridians collectively measure four zhang eight chi (approximately 14.4 meters) from feet to head. Specifically: the Foot Taiyang meridian originates from the lateral side of the little toe, ascends along the posterior leg to the inner canthus of the eye, measuring eight chi (about 2.4 meters) per side, totaling one zhang six chi for both sides. The Foot Yangming meridian begins beside the big toe, travels up the lower leg to the hairline at the forehead's corner, with identical length. The Foot Shaoyang meridian starts near the little toe, ascends the lateral leg to the outer canthus, maintaining the same measurement.

The three yin meridians span three zhang nine chi (roughly 11.7 meters) from feet to chest. The Foot Taiyin meridian commences at the medial side of the big toe, climbing the inner leg to connect with the spleen and stomach in the abdomen, measuring seven chi five cun (about 2.25 meters) per side. The Foot Jueyin meridian begins at the big toe, passes through the abdomen to link with the liver and gallbladder, extending six chi five cun (approximately 1.95 meters). The Foot Shaoyin meridian originates below the little toe, traversing the kidneys to connect with the bladder, matching the Jueyin's length.

Additionally, there are two special qiao vessels: the Yangqiao runs from the heel along the outer ankle to the Fengchi point at the occiput, while the Yinqiao also starts at the heel, connects with the Foot Shaoyin meridian, and ascends the inner ankle. Each qiao vessel measures seven chi five cun, totaling one zhang five chi (about 4.5 meters) for all four vessels. These meridian pathways and dimensional relationships represent ancient physicians' fundamental understanding of the body's qi-blood circulation channels.

This passage provides a detailed explanation of the pathways and lengths of the human meridian system. It first describes the routes of the Governing Vessel (Du Mai, the central channel along the spine) and Conception Vessel (Ren Mai, the central channel along the front torso): starting from the inner ankle, ascending through the inner thigh into the perineum, continuing upward along the abdomen to the chest, passing through the supraclavicular fossa, traversing the front of the neck, and entering the inner corner of the eye where it converges with the Taiyang meridian.

The text specifies the precise lengths of each meridian: both the Governing and Conception Vessels measure four chi five cun (approximately 4.5 Chinese feet) each, totaling nine chi. The twelve primary meridians (three hand Yang, three hand Yin, three foot Yang, and three foot Yin) combined span sixteen zhang two chi (about 162 Chinese feet). Adding the two Qiao vessels (Yin Qiao and Yang Qiao) measuring one zhang five chi (15 Chinese feet) and the nine chi of the Du-Ren vessels, the entire meridian system totals sixteen zhang two chi in length.

The passage then explains the functions of meridians: they serve as pathways for circulating Qi (vital energy) and blood, facilitating communication between Yin and Yang to nourish the entire body. This cyclical movement begins at the middle burner (the Danzhong point between the breasts, also called the Sea of Qi) in the chest, following a specific sequence through the internal organs: starting with the lungs and large intestine, progressing successively to the stomach-spleen, heart-small intestine, bladder-kidneys, pericardium-triple burner, and finally the liver-gallbladder to complete one cycle.

The "fifteen collateral vessels" mentioned refer to the twelve primary meridians each having one collateral vessel, plus the Yang collateral, Yin collateral, and the major spleen collateral, totaling fifteen. This meridian system operates in an endless cycle without beginning or end, sustaining the vital functions of the human body.

The circulation of the Jueyin channel's qi returns again to the Hand Taiyin Lung Channel. After completing a full cycle through the liver, the qi and blood begin anew their flow from the Lung Channel at dawn.

The human body has fifteen collateral pathways (branching channels), all interconnected with the twelve primary channels as their fundamental source. The channel circulation forms an endless loop without beginning or end, with qi and blood flowing through like irrigation. The channel qi ultimately converges at the "qi opening" on the wrist's cunkou pulse position (diagnostic site), where examination can determine the prognosis of all diseases.

Cunkou serves as the grand meeting point of channel qi, where the pulsation of the Hand Taiyin Lung Channel manifests. Pathological changes in all five zang and six fu organs reflect at this qi opening, enabling life-and-death determinations. Just as yin-yang qi converges at the solar term of Beginning of Spring, or day and night transition at dawn, the defensive and nutritive qi complete their daily cycle by converging at the Taiyin Channel.

Channel circulation follows natural rhythms, completing 13,500 respirations in one day-night cycle. While the original text mentions the convergence point as "cunkou renying" (carotid artery pulse), "cunkou qi opening" proves more accurate here.

Understanding the cyclical nature of channel beginnings and endings reveals the patterns of yin-yang transformation. Yin-yang qi originates from the Lung Channel and terminates at the Liver Channel. By discerning yang channel changes, we trace disease origins; through yin channel variations, we predict life-and-death timelines.

This cyclical termination and renewal constitutes the fundamental principle of channel theory. During pulse diagnosis, careful observation of yin-yang fluctuations is essential, for the pulse's essential pattern lies precisely in this cyclical movement of yin-yang qi. At dawn, yin and yang qi converge at cunkou like an endless revolving ring.

The so-called "termination" refers to manifestations of qi exhaustion in the three yin and three yang channels - when qi is exhausted, death follows, with each channel exhibiting distinctive signs: when Foot Shaoyin qi terminates, teeth elongate and wither while muscles atrophy; when Foot Taiyin qi terminates, abdominal distension occurs with lips curling outward; when Foot Jueyin qi terminates, the tongue retracts and testicles ascend; when Hand Taiyin qi terminates...

This passage describes the fatal signs manifested when the Qi (vital energy) in the body's meridians becomes exhausted. When the primordial Qi of the Hand Shaoyin Meridian (Heart Meridian) is completely depleted, the skin becomes withered, body hair breaks off, and the complexion turns dark like a pear. When the Qi of the Three Yin Meridians (Taiyin, Shaoyin, and Jueyin) is cut off, symptoms such as dizziness, blurred vision, and swollen eyes appear. When the Qi of the Six Yang Meridians (Taiyang, Yangming, Shaoyang, etc.) is exhausted, cold sweat pours out like rolling beads. Thus, different meridian systems exhibit distinct fatal signs when their energy fails, and once these symptoms emerge, life is nearing its end.

This constitutes crucial diagnostic criteria for determining life and death from the Huangdi Bashiyi Nanjing (The Yellow Emperor's Classic of Eighty-One Difficult Issues). By observing the external manifestations of meridian Qi exhaustion, ancient physicians could assess the severity of critical conditions. Traditional Chinese medicine holds that meridians serve as pathways for the circulation of Qi and blood, with each meridian corresponding to specific organ functions. Consequently, their failure presents unique characteristic signs.