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​一 脈 變 為 二 病 one pulse change may indicate two diseases

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22nd difficult issue explains development of disease from pulse changes to change of qi, later blood and development od disease itself. This difficulty is linked to difficulty 48 about triple excess and triple deficiency
人 有 三 虛 三 實 ,man has triple deficiency and triple excess
Rén yǒu sān xū sān shí
何 謂 也 ? 然 : how does it happen? Explanation
Hé wèi yě? Rán
有 脈 之 虛 實,may be deficiency and excess of pulse
Yǒu mài zhī xū shí
有 病 之 虛 實 , may be deficiency and excess of disease
Yǒu bìng zhī xū shí
有 診 之 虛 實 也 。 may be deficiency and excess of appearance
Yǒu zhěn zhī xū shí yě
22nd difficult issue also is linked to 77th difficulty which explains strategy of treatment and prevention of disease before it became a disease. It is a chapter about highest doctor and mediocre doctor. 
 二 十 二 難 22nd difficult issue
Èr shí' èr nán
論 一 脈 變 為 二 病  theory of one pulse’s change shows two diseases
Lùn yī mài biàn wéi èr bìng
二 十 二 難 曰 :22nd difficult issue says
Èr shí'èr nán yuē
經 言 : treatises say
Jīng yán:
脈 有 是 動 , pulse changes it’s movement
Mài yǒu shì dòng
有 所 生 病 。 when disease appears
一 脈 變為 二 病 者 ,one pulse change shows two diseases
Yī mài biàn wéi èr bìng zhě
何 也 ? 然 : How explain that? explanation
Hé yě? Rán:
​經 言 是 動 者 ,treatises say that there is a movement 
Jīng yán shì dòng zhě
氣 也 ;of qi
Qì yě
所 生 病 者 ,in the place where disease started
Suǒ shēngbìng zhě
血 也 。of blood
Xuè yě
邪 在 氣 ,evil situated in qi
Xié zài qì
氣 為 是 動 ; qi produces  movement
Qì wéi shì dòng
邪 在 血 , evil situated in blood
Xié zài xuè
血 為 所 生 病 。blood produces disease
Xuè wéi suǒ shēng bìng
氣 主呴 之 ,qi manage breath
Qì zhǔ xǔ zhī
血 主 濡 之 。blood manage moisture
Xiě zhǔ rú zhī
氣 留 而 不 行 者 , qi stays and doesn’t move
Qì liú ér bùxíng zhě
為 氣 先 病 也 ; so qi first becomes sick
Wéi qì xiān bìng yě
血 壅 而不 濡 者 , blood is blocked and doesn’t moisten
Xuè yōng ér bù rú zhě
為 血 後 病 也 。 so blood second becomes sick
Wèi xuè hòu bìng yě
故 先 為 是 動 , so first appears movement
Gù xiān wéi shì dòng
後 所 生 也 。afterwards appears disease
Hòu suǒ shēng yě

Practitioner of archaic acupuncture treat the pulse, so primary concern is to treat disease when it is only change of the pulse, before change of blood happened and disease become a disease. Practice of archaic acupuncture requires movement of disease to shen cycle of development as it is explained in difficulty 77. It prevents movement of disease into ko cycle and it's development.
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