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The *Tribes and Nine Observations Treatise* states: There are the lower, middle, and upper regions. Each region has three observations (pulse positions). These three observations correspond to Heaven, Earth, and Humanity. The Heaven of the upper region refers to the arteries on both sides of the forehead; (located on both sides of the forehead, pulsating and palpable, this is where the Qi of the Foot-Shaoyang Gallbladder Meridian flows.) The Earth of the upper region refers to the arteries on both cheeks; (located below and on both sides of the nostrils, near the Yingxiang point, pulsating and palpable, this is where the Qi of the Foot-Yangming Stomach Meridian flows.) The Humanity of the upper region refers to the artery in front of the ear; (located in the depression in front of the ear, pulsating and palpable, this is where the Qi of the Foot-Shaoyang Gallbladder Meridian originates.) The Heaven of the middle region is the Hand-Taiyin Lung Meridian; that is, the Lung pulse. It is located at the Cun Kou point behind the wrist crease, named Jingqu, pulsating and palpable.) The Earth of the middle region is the Hand-Yangming Large Intestine Meridian; (that is, the Large Intestine pulse. Located between the metacarpal bones of the thumb and index finger, at the Hegu point, pulsating and palpable.) The Humanity of the middle region is the Hand-Shaoyin Heart Meridian. (That is, the Heart pulse. Located at the end of the styloid process of the ulna, at the Shenmen point, pulsating and palpable.) The Heaven of the lower region is the Hand-Jueyin Pericardium Meridian; (Note: The original text annotation here incorrectly identifies it as the Liver meridian; anatomically and traditionally in this context, it often refers to the Foot-Jueyin Liver Meridian or specific points like Wuli. Located outside the pubic hairline, one and a half cun below the Yangshi point, in the depression, at the Wuli point. The patient should be supine when taking the pulse, pulsating and palpable. For women, the Taichong point is taken, located two cun posterior to the first metatarsophalangeal joint, in the depression.) The Earth of the lower region is the Foot-Shaoyin Kidney Meridian; (That is, the Kidney pulse. Located in the depression posterior to the medial malleolus and superior to the calcaneus, at the Taixi point, pulsating and palpable.) The Humanity of the lower region is the Foot-Taiyin Spleen Meridian. (That is, the Spleen pulse. Located above the fleshy part of the foot, passing through the tendons, directly below the Wuli point, at the Jimen point. One must loosen clothing and press deeply to feel it, and it pulsates and is palpable. To observe Stomach Qi, one should take the Chongyang point on the dorsum of the foot.) Therefore, the Heaven of the lower region is used to observe the Liver, (the Foot-Jueyin Liver Meridian runs through this area.) the Earth to observe the Kidneys, (the Foot-Shaoyin Kidney Meridian runs through this area.) and the Humanity to observe the Qi of the Spleen and Stomach. (the Foot-Taiyin Spleen Meridian runs through this area.) How are the observations of the middle region? They also have Heaven, Earth, and Humanity. Heaven is used to observe the Lungs, (the Hand-Taiyin Lung Meridian passes through this location.) Earth to observe the Qi of the Chest, (the Hand-Yangming Large Intestine Meridian passes through this location. The Classic states: The intestines and stomach share observation, thus it is used to observe the chest.) and Humanity to observe the Heart, (the Hand-Shaoyin Heart Meridian passes through this location.) What is used to observe the upper region? It also has Heaven, Earth, and Humanity. Heaven is used to observe the Qi of the head and horns (temples), (located at the temples, thus used to observe the Qi of the head and temples.) Earth to observe the Qi of the mouth and teeth, (located near the throat and teeth, thus used to observe them.) and Humanity to observe the Qi of the ears and eyes. (Because the location corresponds to the front of the ear, and the meridian reaches the outer canthus of the eye, thus used to observe them.) In the three regions, each has Heaven, Earth, and Humanity. Three constitute Heaven, (detailing how three constitute Heaven, up to combining into nine Zang organs.) three constitute Earth, three constitute Humanity. Divided into three parts, they combine to form nine. The number nine multiplied by nine divides into nine fields (Jiu Ye), and the nine fields correspond to the nine Zang organs. (This corresponds to the numbers of Heaven and Earth.) Thus, there are five Spirit Zang (Shen Zang) and four Form Zang (Xing Zang), totaling nine Zang organs. (The Spirit Zang are those where the Liver stores Hun, the Heart stores Shen, the Spleen stores Yi, the Lungs store Po, and the Kidneys store Zhi. Because these organs are inhabited by spiritual Qi, they are called the five Spirit Zang. The Form Zang are like vessels that expand outward, are hollow, and do not bend, capable of containing objects, thus called Form Zang. These are: 1. Head and temples, 2. Ears and eyes, 3. Mouth and teeth, 4. Chest.) If the essence of the five Zang organs fails, the complexion will inevitably become dull and lifeless (Yao). A dull complexion indicates death. (Yao refers to the color of death, an abnormal appearance. Complexion is the flag of the Spirit, and Zang organs are the residence of the Spirit. Thus, when the Spirit departs, the Zang organs fail, and when the Zang organs fail, abnormal signs of death appear in the complexion.) If the body is robust but the pulse is thin, and there is shortness of breath insufficient for respiration, the condition is critical. (When form and Qi are harmonious, it is treatable. Now, if Qi is insufficient while the form is excessive, the syndrome does not support the healthy Qi, hence it is dangerous.) If the body is emaciated but the pulse is large, and there is excess Qi in the chest, death ensues. (This means form and Qi are insufficient, while pulse Qi is excessive. Emaciation with a large pulse and excess chest Qi indicates injury to the Form Zang, hence death. All such cases represent disharmony between form and Qi.) When form and Qi are harmonious, life prevails; when the pulse is irregular and uncoordinated, disease exists. (Can refers to comparison/verification. Wu refers to classification/grouping. Irregularity in verification and classification means deviation from normalcy, which constitutes disease.) If the pulses of all three regions and nine observations are lost/disordered, death ensues. (Loss refers to the pulse observations being dissimilar. There are seven types of "lost" pulse observations, described as follows.) If the pulses above, below, left, and right correspond to each other, surging like a pestle pounding grain, the disease is severe. If the pulses above, below, left, and right are disordered and cannot be counted, death ensues. (There are eighteen pulse-taking sites in the three regions and nine observations, including above, below, left, and right. "Cun Chong" (pounding grain) refers to a large and forceful pulse, moving up and down like a pestle. A large pulse indicates disease progression, hence severity. "Cannot be counted" refers to more than ten beats per respiration. Death.) If the pulses of the middle region are individually harmonious but disassociated from the other Zang organs, death ensues. If the pulses of the middle region are diminished, death ensues. (There are six pulse sites in the middle region, left and right. If the upper and lower regions are already disassociated, and only the middle region is harmonious, this is not sustainable; if the middle region is diminished, it also indicates Qi decline, hence death. Diminished means relatively weak.) If the eyeballs are sunken, death ensues. (The Foot-Taiyang Bladder Meridian originates from the inner canthus of the eye. Sunken eyeballs indicate the exhaustion of the Taiyang channel. Hence death. Taiyang is mentioned specifically because it governs the Qi of all Yang channels.) If the flesh and muscles have wasted away, even if the nine observations are harmonious, death ensues. (This also signifies disharmony between form and Qi. The Classic states: Excess pulse Qi with deficient form Qi leads to life; here, "deficient" has not yet reached total wasting. If the large muscles are completely gone, since the Spleen governs muscles, muscle wasting indicates Spleen exhaustion. Even if the nine observations are balanced, death is inevitable.) Observe the nine observations: if one is exclusively small, it is disease; if exclusively large, disease; if exclusively rapid, disease; if exclusively slow, disease; if exclusively hot, disease; if exclusively cold, disease; if exclusively depressed/sunken, disease. (These are the seven types of disordered observations mentioned earlier. The appearance of these seven pulse diagnoses indicates irregularity and discordance. Based on their unique abnormalities, the disease is identified. This describes applying the method of seven diagnoses within the nine observations.) If the body is emaciated and unable to walk, death ensues. (External decline of Grain Qi leads to complete muscle wasting; internal exhaustion of True Yuan causes inability to walk. With both True Yuan and Grain Qi exhausted, death is imminent. "Qu" refers to walking away.) If the pulses of all nine observations are deep, fine, wiry, and nearly absent, this belongs to Yin governing Winter, so death occurs at midnight. If the pulses are vigorous, restless, panting, and rapid, this belongs to Yang governing Summer, so death occurs at noon. (Positions are not fixed; extremes reverse. The principle of Qian and Kun: when Yin reaches its extreme, dragons fight in the wild; when Yang reaches its extreme, the arrogant dragon has regrets. Thus, extreme Yin and Yang pulses lead to death at midnight and noon, respectively.) Patients with cold-heat diseases die at dawn (Ping Dan). (This is also due to the reversal at extremes. At dawn, Wood Qi is prosperous, transforming into Wind. Thus, patients with cold-heat diseases die when Wood Qi is strongest.) Patients with interior heat or heat diseases die at noon. (This is the peak of Yang.) Patients with wind diseases die at dusk. (This corresponds to the clash of Mao and You hours.) Patients with water diseases (edema) die at midnight. (Water Qi is prosperous.) Those whose pulses are intermittently sparse, rapid, slow, or quick are said to die during the transition of the four seasons (Cheng Si Ji). (At Chen, Xu, Chou, and Wei hours, Earth Qi is寄旺 [parasitically prosperous]. Internal exhaustion of Spleen Qi leads to death termed "riding the four seasons." This details the timing of death for various diseases.)