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In ancient times, life and death were determined by the "Three Regions and Nine Locations" (a comprehensive method of palpating arteries throughout the body), which was a method of exhaustive investigation; comparing the Renying (Jiachezhen, ST8), Cunkou (Radial artery at wrist), and Duyang (Dorsalis pedis artery) pulses to distinguish auspicious from inauspicious signs was a method of grasping the essentials. Since the theory of exclusively taking the Cunkou pulse propagated by the *Nan Jing* (Classic of Difficult Issues), the Renying and Duyang pulses were no longer consulted together. The Qi Kou (Cunkou) forms the Cun position, serving as the great convergence of pulses, with life and death, auspiciousness and inauspiciousness depending upon it; what is transmitted today is only this one method. Since the publication of the *Mai Jing* (Pulse Classic) by Wang Shuhe, various schools have risen successively, each striving for distinction through unique pulse names, resulting in generalizations that are not incisive and lack clear direction. In diagnostic methods, simplicity is sought, yet in pulse nomenclature, complexity is pursued; this is precisely what Zhang Zhongjing referred to as "racing after superficial glamour without consolidating the root."

Zhang Zhongjing established his principles by deducing from the "Ti" (substance/structure) and "Yong" (function/application) of the pulse, rather than differentiating based on pulse names. Therefore, if Yin and Yang constitute the Ti, then Floating (Fu), Large (Da), Agitated (Dong), Slippery (Hua), and Rapid (Shu) represent the Yong of Yang; whereas Deep (Chen), Choppy (Se), Weak (Ruo), Wiry (Xian), and Slow (Chi) represent the Yong of Yin. If Exterior and Interior constitute the Ti, then Floating represents the Yong of Exterior, and Deep represents the Yong of Interior. If Zang and Fu organs constitute the Ti, then Rapid represents the Yong of Fu organs, and Slow represents the Yong of Zang organs. For instance, if Floating and Deep constitute the Ti, then within both Floating and Deep, there exist the Yong of Slow and Rapid. If Floating constitutes the Ti, then Large, Agitated, Slippery, and Rapid are the normal manifestations of Yong, while Choppy, Weak, Wiry, and Slow are the variable manifestations of Yong; if Deep constitutes the Ti, then Choppy, Weak, Wiry, and Slow are the normal manifestations of Yong, while Large, Agitated, Slippery, and Rapid are the variable manifestations of Yong. Between Ti and Yong, changes in the pulse can be observed, and consequently, the causes of disease, the deficiency or excess of the pathological condition, and the shift in pathogenesis also become apparent. This entirely depends on the dexterity of the practitioner's finger technique and the subtlety of their observation.

Although pulse theory is vast and complex, the general outline does not exceed ten types named as Yang or Yin. When divided into Yin and Yang, they naturally form a confrontation; when paired, they manifest in five aspects: Floating and Deep are the pulse body (Ti); Large and Weak are the pulse momentum (Shi); Slippery and Choppy are the pulse Qi (Qi); Agitated and Wiry are the pulse shape (Xing); Slow and Rapid are the pulse rate (Xi). These cannot simply be viewed as pulse images.

Pulse diagnosis involves viewing methods: comparative (Dui), orthodox (Zheng), reverse (Fan), balanced (Ping), lateral (Ce), and thorough (Chedi). Where there is Floating, there is Deep; where there is Large, there is Weak; where there is Slippery, there is Choppy; where there is Rapid, there is Slow. Correlating with symptoms, Floating indicates pathology in the Exterior, Deep indicates pathology in the Interior, Large indicates Excess, Weak indicates Deficiency, Slippery indicates abundant Blood, Choppy indicates deficient Qi, Agitated indicates pulsation in the Yang aspect, Wiry indicates pulsation in the Yin aspect, Rapid indicates pathology in the Fu organs, and Slow indicates pathology in the Zang organs. This is the Comparative View.

If Floating, Large, Agitated, Rapid, and Slippery pulses indicate an abundance of pulse Qi belonging to Yang, one must understand the mechanism of Yang prevailing over Yin pathology; if Deep, Choppy, Weak, Wiry, and Slow pulses indicate a deficiency of pulse Qi belonging to Yin, one must understand the mechanism of Yin prevailing over Yang pathology. This is the Orthodox View.

The rotation of Yin and Yang implies that where there is excess, deficiency follows; where there is deficiency, excess follows. Thus, initially presenting as Floating, Large, Slippery, Agitated, or Rapid, followed by a reversal to Deep, Weak, Choppy, Wiry, or Slow, indicates the mechanism of Yang declining and Yin growing, meaning the disease is progressing. Conversely, initially presenting as Deep, Weak, Choppy, Wiry, or Slow, followed by a subtle appearance of Floating, Large, Slippery, Agitated, or Rapid, indicates the mechanism of Yang advancing and Yin retreating, meaning the disease is about to heal. This is the Reverse View.

Floating belongs to Yang; if accompanied by other Yang pulses like Large, Agitated, Slippery, or Rapid, it is termed Pure Yang, indicating a disease of Yang Excess and Yin Deficiency. Deep belongs to Yin; if accompanied by other Yin pulses like Weak, Choppy, Wiry, or Slow, it is termed Heavy Yin, indicating a disease of Yin Excess and Yang Deficiency. This is the Balanced View.

If the pulse is Floating but also Weak, Choppy, Wiry, or Slow, this is Yang containing Yin. The person has deficient Yang, with Yin pulses潜伏 (latent) within the Yang pulse, predisposing them to a collapse of Yang; thus, supporting Yang becomes the urgent priority. If the pulse is Deep but also Large, Slippery, Agitated, or Rapid, this is Yin containing Yang. The person has deficient Yin, with Yang pathogens sinking into the Yin pulse, predisposing them to exhaustion of Yin; thus, preserving Yin requires deep concern. This is the Lateral View.

If the pulse body remains Floating, Large, Agitated, Slippery, or Rapid, starting as strong Yang strength but ending as weak Yang power, it indicates that Yang is about to perish. If the pulse is Deep, Choppy, Weak, Wiry, or Slow, but suddenly presents with Floating, Large, Agitated, Slippery, or Rapid characteristics, this is Extreme Yin resembling Yang, indicating that residual Yang is like dying embers easily extinguished. This is the Thorough View.

Furthermore, there is the view of True Yin and True Yang: generally, Yin diseases presenting with Yang pulses indicate survival, while Yang diseases presenting with Yin pulses indicate death. Cheng Wuji’s commentary only speaks based on Cold Damage (*Shanghan*), but the use of the word "generally" (Fan) shows that pulse methodology is not exclusive to Cold Damage, nor merely an extension of the preceding text, but rather expands upon Zhang Zhongjing’s flexible methods.

The pulse relies on Stomach Qi (Wei Qi) as its root. Observing these pulse states named as Yin or Yang reveals they are merely names, not the substance of Yin and Yang. Because slight deficiency in Stomach Qi leads to bias in Yin and Yang, compared to the Ping Pulse (Normal Pulse) where excess is named Yang and deficiency is named Yin. Here, Yang disease refers to external injury by the Six Qi (pathogens), and Yin disease refers to internal injury of Essence and Qi. If referring specifically to Yin and Yang syndromes of Cold Damage, it would be too shallow. Yang pulse refers to the True Yang of the Stomach and Intestines, as mentioned in the *Nei Jing* (Inner Canon) as the "Twenty-Five Yangs." When a Yin disease presents with a Yang pulse, it signifies the recovery of Stomach Qi and the emergence of the harmonious Qi of the Five Zang organs, hence indicating survival; as the *Nei Jing* states, "Distinguishing Yang allows one to know the onset of the disease." Yin pulse refers to the True Yin of the Five Zang organs. Because the Yang of the Stomach and Intestines does not reach the Hand-Taiyin Lung meridian, the True Yin of the Five Zang organs emerges. When a Yang disease presents with a Yin pulse, it signifies the absence of Stomach Qi in the pulse, hence indicating death; as the *Nei Jing* states, "Distinguishing Yin allows one to know the time of death or survival."

It must be understood that Deep, Choppy, Weak, Wiry, and Slow are pathological pulses, not necessarily death pulses, and they appear most frequently in Yang diseases. A Yang disease presenting with incessant Floating, Large, Agitated, Rapid, or Slippery pulses is a death pulse. A Yin disease presenting with Floating, Large, Agitated, Rapid, or Slippery pulses is mostly Extreme Yin resembling Yang and may not necessarily be a sign of recovery. If True Zang pulses arrive, such as the Liver pulse being urgent inside and out, the Heart pulse being firm and beating hard, the Lung pulse being floating and large, the Kidney pulse feeling like throwing stones, or the Spleen pulse resembling a bird's beak, all showing abnormal excess, how can these be called Yang pulses? The Classics say: "When evil Qi arrives, the pulse is tight and rapid; when Grain Qi (Stomach Qi) arrives, the pulse is slow and harmonious." Thus, one cannot judge Yin and Yang solely by Slowness and Rapidity.

Zhang Zhongjing’s method for Exterior/Interior and Zang/Fu takes Floating, Deep, Slow, and Rapid as the general outline. Floating and Deep examine the rise and fall of the pulse position; Slow and Rapid observe the frequency. Within Floating and Deep, Slow and Rapid are embedded. Any pulse that is neither floating nor deep but intermediate, and neither slow nor rapid but beating five times per breath, is called a Ping Pulse (Normal Pulse), indicating the presence of Stomach Qi. It can be apprehended by spirit/intuition, not by image. Once an image of Floating, Deep, Slow, or Rapid appears, it becomes a pathological pulse. Floating, Deep, Slow, and Rapid are not originally divided by Exterior/Interior or Zang/Fu; now that they have Yin/Yang names, we use Yang for Exterior and Fu, and Yin for Interior and Zang to determine the location of the disease.

Observe that a Floating pulse indicates pathology in the Exterior, and symptoms should also be in the Exterior. However, a Floating pulse can also accompany Interior symptoms, either because Exterior pathogens have just sunk inward, or Interior pathogens are attempting to emerge outward. Ultimately, it does not leave the Exterior, so Exterior is taken as the general rule. Deep indicates pathology in the Interior, and symptoms should also be in the Interior. However, a Deep pulse can also accompany Exterior symptoms, either because a Yang disease presents with Yin signs leading to danger, or a Yin disease emerges to Yang leading to healing. Ultimately, the root of the disease is in the Interior, so Interior is taken as the general rule.

Rapid pulses belong to Yang and govern Heat. Rapid pulses have Floating and Deep variations: Floating-Rapid corresponds to Exterior Heat, Deep-Rapid corresponds to Interior Heat. Although Rapid pulses often indicate pathology in the Zang organs, the origin must come from the Fu organs, because the Six Fu organs belong to Yang, and Yang pulses surround the Fu organs; thus, Fu is taken as the general rule. Slow pulses belong to Yin and govern Cold. Slow pulses have Floating and Deep variations: Floating-Slow corresponds to Exterior Cold, Deep-Slow corresponds to Interior Cold. Although Slow pulses often indicate pathology in the Fu organs, the root must come from the Zang organs, because the Five Zang organs belong to Yin, and Yin pulses surround the Zang organs; thus, Zang is taken as the general rule. Various pulse conditions are summarized in Floating, Deep, Slow, and Rapid. Among these four, the solitary appearance serves as the criterion. Whichever position shows the solitary pulse determines the location of the Exterior/Interior and Zang/Fu, leaving no hidden pathology.

However, the Ten Pulses of Yin/Yang and the Four Examinations of Exterior/Interior/Zang/Fu refer to the Ti and Yong of the pulse. The Ti and Yong of diagnostic methods, however, take Disease as the Ti and Pulse as the Yong. Let us discuss the Floating pulse as an example, and others can be inferred similarly. If the pulse is Floating, the disease is in the Exterior, and there must be Exterior symptoms like Fever and Aversion to Cold. However, Floating varies. There is simple Floating, identical in all three positions (Cun, Guan, Chi), without variation in breath count or speed, appearing Slippery, Choppy, Agitated, Wiry, Large, or Small. This is the pulse body of Taiyang disease. Because Wind-Cold is in the Exterior, the Yang Qi within the pulse resists it, and internally there is no excess or deficiency, so this image appears. This is a Normal Pulse within a pathological state, so Mahuang Tang (Ephedra Decoction) can be used to induce sweating and resolve vexation, though such pulses are rare. Therefore, fever has its corresponding pulse image, and aversion to cold has its corresponding pulse image.

For example, if the Cunkou pulse is Floating and Tight, Floating is the image of Wind, and Tight is the image of Cold. This is Yang containing Yin, a variation of Yang. However, if Cold does not combine with Wind, the Xuan Fu (pores) do not open, and Cold remains in the skin and hair. Wei Qi (Defensive Qi) is sufficient to protect the exterior and maintain solidity; although affected by Cold, it is not injured, and once the Cold leaves, the body harmonizes itself. If Wind does not carry Cold, it only agitates Wei Qi, preventing the closure of Yuan Fu, causing the skin to receive pathogens and Lung Qi to become unclear, but it cannot penetrate deeply into Ying Qi (Nutritive Qi). This results in fever, aversion to cold, and pain in the head, neck, and joints. Only when Wind carries Cold does the condition become severe. In this case, Wind injures Wei Qi, and Cold injures Ying Qi; initially, there is no dual meaning. Wei Qi fails to protect the exterior and instead disturbs Ying Qi internally, causing vexation; Ying Qi fails to circulate freely and presses inward against the joints, causing pain. With both Ying and Wei diseased, fever arises.

If the pulse is Floating and Rapid, it is Yang seeing Yang, the correct configuration of Yang pulses. However, one must not consider this as Yang excess; it is actually due to insufficient Yang Qi, presenting an image of excess. The pulse is the house of Blood, driven by Qi. Long Qi indicates healthy Qi; Short Qi indicates diseased Qi. The Wiry pulse resembles Long; the Rapid pulse resembles Short. Because the Rapid pulse stems from insufficient Qi, Rapidness indicates deficiency. Wind is a Yang pathogen, so Wind generates Heat; Deficiency is a Yin pathogen, so Deficiency generates Cold. The struggle between Deficiency and Cold in Ying and Wei, where Wei Qi is insufficient to resist, gives rise to aversion to cold. The previous clause discussed Yang containing Yin but manifested as fever; this clause discusses Yang seeing Yang but manifests as aversion to cold. This is a literary device (inter-textual meaning) to reveal the principle. Both clauses require sweating therapy, but differ from simple Floating. Hence it says: "If the pulse is Floating and Tight, bodily pain is expected according to the law, and sweating should be used to resolve it. If the Chi position pulse is Slow, sweating must not be used, because Ying Qi is insufficient and Blood is scarce." This shows that using Mahuang Tang is not exclusively for Cold injuring Ying; this is Zhang Zhongjing’s method. It also says: "If the pulse is Floating and Rapid, sweating should normally lead to recovery. If the Chi position pulse is Micro, this indicates Interior Deficiency, and sweating must not be used." This further shows that for Floating-Rapid pulses, Mahuang Tang cannot be blindly used. It also says: "After Cold Damage resolves for half a day, if vexation recurs and the pulse is Floating and Rapid, sweating may be administered again, preferably Guizhi Tang (Cinnamon Twig Decoction)." Thus, the statement that "when Exterior and Interior are solid and Fluids are harmonized, spontaneous sweating occurs and recovery follows" is demonstrated by drinking warm millet gruel.

The Chi pulse of a person is like the root of a tree. Regardless of whether it is Floating-Rapid or Floating-Tight, the Chi pulse is relied upon to assess Deficiency and Excess. This is another annotation by Zhang Zhongjing for "Floating indicates Exterior."

Among the Ten Pulses, Tight is absent; Tight is a rotation of Wiry. One must understand that pressing without moving is the stillness of Yin as Ti; rotating unpredictably is movement of Yang as Yong. Therefore, Tight found in a Floating pulse relates to Wind Strike (Zhong Feng), differing from the simultaneous Tightness of Yin and Yang in Cold Damage. Tight resembles Rapid, but Tight is seen in morphology (Fa Xiang), while Rapid is seen in frequency (Zhi Shu). However, because Tight comes with long Qi, it paradoxically becomes a Real pulse of Yang within Yin; because Rapid comes with short Qi, it paradoxically becomes a Deficient pulse of Yin within Yang.

If the pulse is Floating and Large, it is Yang seeing Yang, a pulse of Two Yangs combining brightness. However, the pulse does not immediately become Large; it becomes Large only after three or four days. This is a pulse of Interior Heat of Yangming revealing itself externally. At this point, Floating can no longer be considered Exterior. One must understand that Large indicates disease progression; thus, hardness below the heart appears, requiring purgation rather than sweating. If the pulse is Floating and Slow, with facial heat/redness and trembling, this is Yang seeing Yin. Thus, the face shows false heat, while the body shows true cold. Because Slow indicates pathology in the Zang, there is no Yang to generate sweat; because Floating indicates pathology in the Exterior, one should use the method of bathing the body in warm water to induce sweat. Slow following Floating derives from the Exterior; Floating following Large derives from the Interior. Floating without Rapidness turns Deficient; Tight entering Floating becomes Excess. Thus, among Exterior/Interior, Zang/Fu, Yin/Yang, and Deficiency/Excess, everything belongs to indeterminate methods.