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Patients should not conceal their illness, and physicians should not hide their shortcomings. One must investigate the origin and details of the condition to avoid confusion in treatment methods.

Those who were once noble but later fell into obscurity, although not affected by external pathogens, develop internal diseases known as *Tuoying* (depletion of Ying-nutrient due to mental depression). Those who were once wealthy but later became poor are said to suffer from *Shijing* (loss of Jing-essence due to excessive worry). One must inquire about the patient's diet and living conditions, as well as sudden shifts in emotion such as abrupt joy or sorrow, or starting with joy and ending with sorrow; all these factors can damage the Jing-essence.

This section discusses inquiring about the causes of disease. The method of inquiry is not limited to this; one should deduce and expand upon it to achieve comprehensiveness.

In diagnosing, one must understand the beginning and end of the disease and be aware of accompanying symptoms. When taking the pulse and asking for the name, one must consider the differences between men and women.

This paragraph summarizes the methods of observation and inquiry. "Understanding the beginning and end" means knowing the onset of the disease and its final manifestations, allowing for a complete assessment. "Knowing the remaining threads" refers to identifying minor accompanying symptoms that must also be examined to distinguish severe from mild conditions, thereby determining whether to treat them together or separately. By combining pulse diagnosis with inquiries about identity, one can determine the primary name of the disease and avoid errors. Since men and women differ physiologically and pathologically, considering their specific conditions ensures accuracy. This detailed approach to inquiry requires careful study. Appendix Chen Xiuyuan's *Song of Questioning Symptoms* states: First ask about chills and fever, second about sweating, third about head and body, fourth about excretion, fifth about diet, sixth about chest discomfort, seventh about deafness, eighth about thirst—all must be distinguished. Ninth asks about past illnesses, tenth about causes; add medication history to reference changes. For women, menstruation must be asked about; delays, rapidity, amenorrhea, or metrorrhagia can all be verified. Add a few phrases for pediatrics: smallpox and measles are fully diagnosed by this method.

Diagnosing disease through pulse observation is extremely refined. However, both the *Neijing* (Inner Canon) and Zhang Zhongjing's works advocate combined diagnosis using the Renying and Fuyang pulses. Currently, only the Cun Kou (inch position) pulse is taken, likely to simplify and grasp the essence. The annotations cited here refer exclusively to the Cun Kou method.

All twelve meridians have arterial pulsations. Why does taking only the Cun Kou pulse allow one to determine the life and death of the five zang and six fu organs? What is the rationale?

Cun Kou refers to the area behind the palm where the pulse is currently felt. This question originates from the *Nanjing* (Classic of Difficult Issues) to introduce subsequent theories. Modern Western medicine, unfamiliar with pulse diagnosis, attempts to refute it by arguing that since arteries exist throughout the body, why rely solely on the wrist's Cun Kou? They likely do not realize that ancient Chinese creators of pulse methodology anticipated such objections. The statement that "all twelve meridians have arterial pulsations" was already addressed and refuted long ago. Since Western medicine lacks understanding of pulse theory, their discussions remain speculative.

However, Cun Kou is the convergence point of pulses and an arterial branch of the Hand Taiyin Lung Meridian. With each exhalation, pulse qi travels three cun; with each inhalation, it also travels three cun. In one breath cycle (one xi), pulse qi travels six cun. Over a day and night, a person breathes 13,500 times, and pulse qi circulates fifty times around the body. Ying-nutrient and Wei-defensive qi each travel twenty-five cycles in Yang and twenty-five in Yin, completing one full circuit, finally converging at the Hand Taiyin Lung Meridian. Cun Kou is where the qi of the five zang and six fu organs begins and ends; thus, diagnostic methods utilize Cun Kou.

Recent theories suggest that the Lung governs all vessels and acts as the canopy (highest organ); the qi of all zang and fu organs ascends to nourish the Lung. Therefore, observing the Lung meridian's Cun Kou pulse allows diagnosis of various organs. While plausible, this overlooks the fundamental principle that the convergence of Ying and Wei qi marks the beginning and end of zang-fu qi. Thus, Yue Ren (author of *Nanjing*) established this precise method. Western medicine understands blood circulation but not Wei-defensive qi movement. They state that blood exits the heart, circulates, turns purple due to carbon absorption, returns via pulmonary veins, is oxygenated by exhaled air, and re-enters the heart. This aligns with the *Neijing*'s concept of Ying-nutrient circulating the body. Every moment sees blood exiting the left atrium and returning to the right atrium. However, calculating the time for blood to return takes a full day and night. Unlike Wei-defensive qi, which completes a full cycle before returning to the Lung to meet Ying-nutrient (a minor convergence), Ying-nutrient flows continuously every moment. Wei-defensive qi moves during the day in Yang (keeping one awake) and at night in Yin (inducing sleep), completing twenty-five cycles each to return to the Lung for a major convergence with Ying-nutrient. Hence, Ying-nutrient is described as "circulating the body," while Wei-defensive qi is described as "returning to converge at Hand Taiyin." These distinctions are clear and should not be confused. Since Ying-nutrient circulates internally and externally within zang-fu organs and converges at the Lung, examining the Cun pulse alone suffices to diagnose internal and external diseases. According to the *Lingshu*, human meridians span sixteen zhang two chi around the body. One cycle equals one degree. Over 13,500 breaths daily, qi travels fifty degrees. Details on meridian lengths and qi pathways are found in the *Neijing* (e.g., *Mai Du* and *Ying Qi* chapters). Observing pulse movement versus qi movement reveals that pulse follows Ying-blood. Daytime movement outside Ying is Yang (twenty-five cycles); nighttime movement inside Ying is Yin (twenty-five cycles). The *Neijing* notes elderly insomnia results from deficient Ying-blood preventing Wei-yang from entering Yin. This illustrates the interdependence of Ying and Wei. Ying-nutrient returns to the Lung-heart every moment; Wei-defensive qi returns after one full cycle. The fifty cycles represent the completion of Yin-Yang numbers before returning to the Lung for major convergence, marking the start and end of zang-fu qi. Because it converges at the Lung, the Lung pulse diagnoses all zang-fu diseases. Western medicine, unaware of Ying-Wei convergence and viewing pulses merely as blood vessels, fails to grasp Chinese pulse diagnosis, revealing their superficial understanding.

From Guan to Chi represents the realm of Yin within Chi. From Guan to Yuji represents the governance of Yang at Cun Kou.

Guan is the boundary between Cun and Chi, referred to in pulse rhymes as the "high bone." Below Guan is Chi, governing Liver and Kidney, deep in nature, hence Yin. Above Guan is Cun, governing Heart and Lung, floating in nature, hence Yang.

Western medicine denies pulse theory, claiming all body vessels originate from the heart's beating, so how can five zang organs be judged solely by vessels? They argue the wrist pulse is a single vessel, questioning the division into Cun, Guan, and Chi. This view is superficially logical but fundamentally flawed. Careful examination shows the pulse disappears above Yuji and below Chize. Although one continuous vessel, it has divisions of dispersion, convergence, visibility, and invisibility. Cun Kou is the major convergence point, crucial for Ying-Wei interaction, making it suitable for diagnosing various conditions. Inside the vessel belongs to Blood aspect; outside belongs to Qi aspect. Slowness and speed relate to contents within the vessel; floating and sinking relate to positions outside the vessel. Regarding anterior-posterior positioning, Cun is Yang, Chi is Yin. As the hand pulse is the convergence of all pulses, it naturally has regional distinctions. Yang outside, Yin inside reflects immutable heavenly principles. Superficial/upper/qi-related (Yang) are diagnosed at Cun; deep/internal/blood/lower-related (Yin) are diagnosed at Chi.

The Upper section corresponds to Heaven, governing diseases from the chest to the head. The Middle section corresponds to Humanity, governing diseases from below the diaphragm to the navel. The Lower section corresponds to Earth, governing diseases from below the navel to the feet.

This aligns with the *Neijing*: "Upper reaches upper" concerns chest and throat; "Lower reaches lower" concerns lower abdomen, waist, and feet. Heavenly principles favor the upper; earthly principles favor the lower, following affinity. Thus, Left Cun corresponds to Heart (upper); Right Cun to Lung (upper); Left Guan to Liver (middle); Right Guan to Spleen (middle); Left Chi to Kidney (lower); Right Chi to Mingmen (lower). This divides upper, middle, and lower. Left-right differentiation follows elemental theory: Water (Heaven 1) pairs Left; Fire (Earth 2) pairs Right. Water generates Wood, Wood generates Fire; thus Heart and Liver are on the Left. Fire generates Earth, Earth generates Metal; thus Spleen and Lung are on the Right. This follows affinity. Six Fu organs follow similar pairing logic. Large Intestine (Fu of Lung) pairs with Right Guan-Chi or Right Cun, reflecting Lung-Large Intestine unity. Stomach pairs with Right Guan (following Spleen). Sanjiao pairs with Right Chi (following Mingmen). Bladder pairs with Left Chi (following Kidney). Gallbladder pairs with Left Guan (following Liver). Small Intestine pairs with Left Cun (following Heart) or Left Chi, depending on positional hierarchy. Once zang-fu positions are clear, they extend to physical regions: throat, tongue, head, face, chest, shoulders diagnose at Cun; armpits, abdomen, waist diagnose at Guan; lower abdomen, perineum, thighs, calves, knees, feet diagnose at Chi. This *Neijing* method of "reaching up and down" reflects the I Ching's principle of affinity. Differentiation requires regional focus; diagnosis requires integrating three regions. Understanding these principles is essential for pulse diagnosis, which Western medicine lacks.

Older rhyme books list positions: Left Heart, Danzhong, Liver/Gallbladder, Kidney, Small Intestine; Right Lung, Chest, Spleen/Stomach, Mingmen, Large Intestine. Zhou Mengjue's *Three Finger Zen Pulse Method* lists: Left Heart, Small Intestine, Liver/Gallbladder, Kidney, Bladder; Right Lung, Large Intestine, Spleen/Stomach, Kidney, Mingmen. However, this is incomplete. It should be divided as: Left Cun: Heart, Danzhong, Small Intestine; Left Guan: Liver/Gallbladder; Left Chi: Kidney, Bladder, Small Intestine. Right Cun: Lung, Chest, Large Intestine; Right Guan: Spleen/Stomach; Right Chi: Mingmen, Sanjiao, Large Intestine. Small Intestine may attach to Lung (interior-exterior relation) or Chi (lower position). Danzhong is Pericardium; Chest is Lung covering. Ancient methods did not diagnose Sanjiao due to ignorance of its root in Kidney system; now pairing it with Right Chi completes the theory.

Pulse has Three Regions and Nine Probes. Three Regions are Cun, Guan, Chi. Nine Probes are Floating, Middle, Deep.

This differs from the *Neijing*'s head-hand-foot comprehensive probing. Since that method is obsolete, we follow *Nanjing*: Cun, Guan, Chi as Three Regions, each with Floating, Middle, Deep probes, forming Nine Probes.

Exhalation relates to Heart and Lung; inhalation relates to Kidney and Liver; the interval relates to Spleen. Spleen's pulse is in the Middle. Floating is Yang. Heart and Lung pulses float: large and scattered indicates Heart; short and choppy indicates Lung. Sinking is Yin. Liver and Kidney pulses sink: firm and long indicates Liver; soft yet solid upon lifting indicates Kidney. Spleen resides in the Central Province, so its pulse is in the Middle. This is the Yin-Yang method.

The previous section differentiated zang by location; this section differentiates by respiration and depth. Heart/Lung are upper, associated with exhalation (two beats per exhale). Kidney/Liver are lower, associated with inhalation (two beats per inhale). Between breaths, Spleen governs the center (one beat). Total five beats per breath cycle indicate health. Extra beats indicate excess; fewer indicate deficiency. This measures pulse rate. Below, Middle probe differentiates zang. Pulse in muscle: light pressure reveals Floating (Yang, Heart/Lung). Large/scattered = Heart; short/choppy = Lung. Heavy pressure reveals Sinking (Yin, Kidney/Liver). Firm/long = String-like (Liver); soft/solid = Slippery (Kidney). Spleen is central/middle, representing balanced Yin-Yang. This uses Sinking for Kidney/Liver, Floating for Heart/Lung, Middle for Spleen, offering multiple correspondences.

Spring pulse is Wiry; Summer is Hook (Surging); Autumn is Hairy (Floating); Winter is Stone (Sinking). All seasons prioritize Stomach Qi. Seasonal variations and disease prognosis depend on this.

Hook equals Surging; Hairy equals Floating; Stone equals Sinking. Stomach Qi appears as a harmonious, moderate quality. Wiry, Hook, Hairy, Stone pulses must show harmony to possess Stomach Qi. Excess or deficiency without Stomach Qi indicates disease. This details seasonal main pulses, rooting them in Stomach Qi. Recent *Three Finger Zen* rhymes use Moderate pulse as the guideline, emphasizing Stomach Qi as the foundation.

Rapid pulse belongs to Fu; Slow pulse belongs to Zang. All Yang is Heat; All Yin is Cold. Rapid indicates Heat; Slow indicates Cold.

Fu is Yang, so Rapid pulse corresponds to Fu. Zang is Yin, so Slow pulse corresponds to Zang. Rapid=Heat (Yang/Qi); Slow=Cold (Yin/Qi). Differentiating Zang/Fu by speed is not entirely accurate, but Rapid=Heat and Slow=Cold are invariant principles. Pulse beats stem from Heart Blood fluctuations within vessels. Heart governs Fire; deficient Blood/Fire slows the pulse; abundant Blood/Fire speeds it. Vessel thickness/voidness relates to vessel content, judged alongside speed. Pulse diagnosis distinguishes Blood aspect (inside vessel) from Qi aspect (outside vessel), ensuring precise medical consultation.

Floating, Slippery, Long are Yang; Sinking, Short, Choppy are Yin. Based on meridian locations, one determines favorable/unfavorable signs.

Floating/Slippery/Long are Yang; Sinking/Short/Choppy are Yin. This grasps the essence. Further differentiation by meridian determines favorability. E.g., Kidney pulse should be Sinking but is Floating (Unfavorable); Heart pulse should be Floating but is Sinking (Unfavorable). Beyond fixed pulse images, pulses vary by meridian. This fine method highlights that Western medicine views pulses only as blood vessels, ignoring Qi adhering to pulses. Western "pulse sheath" membranes with pores resemble channels for adhering Qi. Though one vessel moves together (no positional difference in speed), Qi varies in depth (positional difference in floating/sinking). Extending this to separate Qi/Blood vessel diagnosis reveals hidden pulse truths. Reading Western texts confirms ancient sages' profundity; I hope Western medicine studies ancient texts to fill gaps.

This diagnostic method derives from *Nanjing*. After Yue Ren changed the *Neijing*'s head-foot comprehensive method, simplicity prevailed. Later pulse rhymes originated here, being highly refined. One should follow this and consult other pulse texts to master its mysteries.