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This is the third method of pulse diagnosis from ancient times. Determining deficiency and excess, and judging life and death, all depend on an overall observation. Therefore, I have integrated the essential meanings of the classics into a song, citing one-tenth of them as evidence. Practitioners may read it together with the smaller text annotations.

The pulse gathers at the Taiyin meridian to determine life and death; the Cun, Guan, and Chi positions contain the conditions of Yin and Yang.
The *Nan Jing* (Classic of Difficult Issues) states: "Cunkou is the great assembly of pulses, the moving artery of the Hand-Taiyin Lung Meridian." Cunkou refers to the Cun, Guan, and Chi positions, which are the beginning and end of the Qi and Blood of the Zang and Fu organs. Others, such as Chongyang (Yuan-Source point of Foot-Yangming Stomach Meridian), specifically correspond to the Stomach; Taichong (Yuan-Source point of Foot-Jueyin Liver Meridian), specifically corresponds to the Liver; Taixi (Yuan-Source point of Foot-Shaoyin Kidney Meridian), specifically corresponds to the Kidney. How can they comprehensively reflect the twelve meridians? Therefore, the method selects Cunkou. Pulse originates from Yin and Yang, but Yang Qi arises from the Chi position and manifests at the Cun position, while Yin Qi arises from the Cun position and manifests at the Chi position. The Guan position represents half Yin and half Yang, situated between the two. Yang pulses are typically floating and rapid, indicating disease in the head, eyes, chest, and diaphragm; Yin pulses are typically deep and slow, indicating disease in the umbilical region, abdomen, waist, and legs; the middle pulse floats and sinks with time, indicating disease in the abdomen, hypochondrium, and epigastrium. Yin and Yang should harmonize with each other and not prevail excessively. If Yang Qi alone prevails upwards and exceeds the Yuji boundary (edge of the thenar eminence), it is called "Overflow" (Yi); if Yin Qi alone prevails downwards and penetrates deeply into the Chize area (cubital fossa), it is called "Inversion" (Fu). If the Cun pulse does not reach down to the Guan position, it is "Yang Extinction"; if the Chi pulse does not reach up to the Guan position, it is "Yin Extinction." These are True Zang pulses without the moderating presence of Middle Qi. If students can comprehend this, within the span of one inch and nine fen of the Cunkou, the conditions of excessive or insufficient Yin and Yang throughout the body will be revealed. Shuhe said: "A wiry Yang pulse definitely indicates headache; where does a wiry Yin pulse go? It indicates abdominal pain." A rapid Yang pulse indicates vomiting accompanied by headache; a minute Yin pulse indicates diarrhea with roaring in the umbilicus. Yang excess indicates facial redness and wind; Yin deficiency indicates night sweats and consumptive disease. Yang excess, large and slippery indicates stiff tongue; Yin rapid indicates Spleen heat and bad breath. Yang minute, floating, and weak indicates Heart cold; Yin slippery indicates food stagnation and Spleen fault. Distinguishing Yin and Yang before and after the Guan allows one to inspect the root of the disease imperishably. All floating and restless pulses belong to Yang; all deep and fine pulses belong to Yin. Generally, pulses conforming to Yin and Yang are easy to cure; those opposing Yin and Yang are difficult to cure.

Using the Floating, Middle, and Deep methods, one knows Slow and Rapid pulses; Reverse/Smooth and Deficient/Excess correspond to the Five Elements.
When initially palpating, feeling the pulse between the skin is called Floating. Floating and large/scattered belongs to the Heart; Floating and short/astringent belongs to the Lung. Pressing to below the muscle layer is called Deep. Deep and wiry/long belongs to the Liver; Deep and soft/slipping belongs to the Kidney. Neither light nor heavy, just touching the muscle, belongs to the Spleen. There are often combinations of pathogens from the four Zang organs, so within the harmonious and moderate quality, there must also be combined features of floating, deep, slipping, astringent, long, short, wiry, and large. Each pulse type has its characteristics. For example, a Deep-Slippery pulse is favorable at the Left Chi but unfavorable at the Left Cun; a Floating-Astringent pulse is favorable at the Right Cun but unfavorable at the left half. The Cunkou pulse should be floating; if it appears diminished and small instead, it indicates Yang deficiency with Yin invasion. Sometimes it is floating, slippery, and long, called "Yang Hidden within Yin." The Chi position pulse should be deep; if it appears solid and large instead, it indicates Yin deficiency with Yang invasion. Sometimes it is deep, soft, and short, called "Yin Hidden within Yang." If the Chi position is originally deep and becomes even deeper, it is called "Double Yin"; if the Cun position is originally floating and becomes even more floating, it is called "Double Yang"; if both Cun and Chi are extremely minute, it is called "Extinction of Yang and Yin." This is nothing but the partiality or completeness of the generation and restriction of the Five Elements, and whether the pulses of the four seasons and five Zang organs correspond to their respective positions, used to determine reverse/smooth and deficient/excess. Floating, deep, slow, and rapid (see song above).

Extreme confusion requires consulting the Nine Palpations and Ten Transformations, which are none other than the flowing forms of Zang and Fu organs.
Nine Palpations: Upper Heaven, Foot-Shaoyang Gallbladder Meridian, observes the temples; Upper Human, Hand-Shaoyang Sanjiao Meridian, observes the ears and eyes; Upper Earth, Foot-Yangming Stomach Meridian, observes the mouth and teeth. Middle Heaven, observes the Lung; Middle Human, observes the Heart; Middle Earth, observes the Qi in the chest. Lower Heaven, observes the Liver; Lower Human, observes the Qi of the Spleen and Stomach; Lower Earth, observes the Kidney. Outer Left Chi observes the Kidney; Inner Left Chi observes the abdomen. Outer Left Guan observes the Liver; Inner Left Guan observes the diaphragm. Outer Right Guan observes the Spleen; Inner Right Guan observes the epigastrium. Outer Right Cun observes the Lung; Inner Right Cun observes the chest. Outer Left Guan observes the Heart; Inner Left Guan observes the Danzhong. Anterior observes the anterior body; Posterior observes the posterior body. Reaching the upper extreme concerns the chest and throat; reaching the lower extreme concerns the lower abdomen, waist, thighs, knees, shins, and feet. If the pulses of the three positions and nine palpations are all discordant, death ensues; if the nine palpations are harmonious but the muscles are wasted, death ensues. This is the wonder of Yin-Yang interlacing, and the five correct evils of deficiency, excess, subtle, and treacherous are distinguished thereby. Ten Transformations: If the Heart pulse is extremely wiry, it is Liver pathogen invading the Heart; slightly wiry, it is Gallbladder pathogen invading the Small Intestine, known as Empty Evil from behind; if the Heart pulse is extremely large, it is Heart pathogen self-invading the Heart; slightly large, it is Small Intestine pathogen self-invading the Small Intestine, known as Correct Evil; if the Heart pulse is extremely slack, it is Spleen pathogen invading the Heart; slightly slack, it is Stomach pathogen invading the Small Intestine, known as Full Evil from ahead; if the Heart pulse is extremely choppy, it is Lung pathogen invading the Heart; slightly choppy, it is Large Intestine pathogen invading the Small Intestine, known as Subtle Evil from the conquered; if the Heart pulse is extremely deep, it is Kidney pathogen invading the Heart; slightly deep, it is Bladder pathogen invading the Small Intestine, known as Treacherous Evil from the unconquered. Each Zang organ has rigid and soft pathogens, causing one pulse to transform into ten types. Saying nine or ten seems complex but is simple, derived naturally from floating, middle, and deep. Thus, rapid pulses belong to Fu organs; slow pulses belong to Zang organs, allowing differentiation of Zang and Fu diseases. Later generations analyzed too much, forgetting the interlacing of Yin and Yang and the shared Qi of Zang and Fu.

The three-position pulse is fully understood and easily recognized.
If the three positions are unobstructed, the six pulses are complete, and floating, deep, slow, and rapid are equal, the pulse is easy to recognize and the disease easy to cure. The song says: Three positions all floating indicate Wind in the Lung organ, aversion to wind, fever, and runny nose; three positions deep and slow indicate Cold accumulation, withered skin, and exhausted Yuan Qi; three Guan positions all slack indicate Heat in the Spleen, bad breath, swollen gums, and frequent regurgitation; three positions all wiry indicate Liver anger, eye cataracts, tearing, pain, and many accumulations; three positions all rapid indicate Heart heat and mania, mouth/tongue ulcers, and broken lips; three positions deficient, soft, minute, choppy, and hidden indicate inevitable death in chronic disease or sudden onset in acute disease; three positions floating, slippery, knotted, wiry, and rapid are suitable for acute disease but disastrous for chronic disease.
There are also cases where all six positions have the same pulse. Ancient saying: Double wiry pulse indicates Earth deficiency; double floating pulse indicates Water deficiency. One can infer the rest. Generally, if the three positions are slippery but minute, the disease is in the Lung; tight below and empty above, the disease is in the Spleen; long and wiry, the disease is in the Liver; small pulse with little blood, the disease is in the Heart, and solid indicates Heart labor; large and tight, the disease is in the Kidney; slack and slippery, heat is in the Stomach; slow, slack, and choppy, there is Cold and knotting in the Stomach; solid and tight pulse, there is Cold in the Stomach, suffering inability to eat, and frequent spontaneous diarrhea is difficult to treat. Pulses coming like beads strung together, not reaching the Cun, indicate Wind-Cold in the Large Intestine, lingering and not departing; pulses coming like beads but stopping, not reaching the Cun and being soft, indicate Knotting Heat in the Small Intestine, lingering and not departing; pulsus alternans (Dai) and hooked indicates disease in the collaterals, Hooked is the Summer pulse. If both channels and collaterals are solid, the Cun pulse is urgent and the Chi pulse is slack; if collateral Qi is insufficient and channel Qi is excessive, the Cun pulse is hot and the Chi pulse is cold; if channel is deficient and collateral is full, the Chi is hot and full while the Cun is cold and choppy.

Or pulses arriving or not arriving are harder to rely upon.
If the Cun pulse is large and strong but the Chi is absent, this is Yin prevailing over Yang, suffering from backache, leg pain, and cold shins. If the Chi pulse is floating and large but the Cun is absent, this is Yang prevailing over Yin, the person is deficient, loses much sweat, or has lower abdominal fullness/pain and inability to urinate, with pain in the yin during urination, and similarly in defecation. If both Cun and Chi pulses are firm and long but the Guan is absent, this is Yin and Yang interfering with each other. If both Cun and Chi are absent but the Guan is present, this is Yin and Yang Qi returning to the center. The Left Guan tests Wind-Cold, or the rise and fall of Wind and Fire; the Right Guan tests the Seven Emotions, or internal injury from fatigue and diet. If the three positions have pulses arriving or not arriving, Cold Qi is in the Spleen, causing blocked pulses. If there is pulse above but none below, Food Retention fills the chest; the person should vomit, and if not, death ensues. If there is no pulse above but pulse below, although distressed, it causes no harm. Why? Like a tree having roots. Thus, if the Cunkou is flat and death occurs, it is because Kidney Qi first failed internally.

Observing Up/Down and Come/Go preserves the message.
Up refers to rising from the Chi to the Cun, Yang born from Yin, representing Exterior; Down refers to descending from the Cun to the Chi, Yin born from Yang, representing Interior. Come refers to emerging from the bone/muscle division to the skin surface, Qi ascending, representing Exterior; Go refers to returning from the skin surface to the bone/muscle division, Qi descending, representing Interior. Up/Down and Come/Go are the messages of Yin-Yang waxing and waning. Speaking of Up/Down: Excess above leads to high Qi (shortness of breath); excess below leads to distension. Short and urgent indicates disease above; long and slack indicates disease below. Excess tends to overflow upward; insufficiency tends to fall downward. Speaking of Come/Go: Rapid come and slow go indicates Excess above and Deficiency below, leading to Jue or Epilepsy; slow come and rapid go indicates Deficiency above and Excess below, leading to aversion to wind. If the pulse is lost but has a thread-like continuity, it is treatable; if the pulse is complete but lacks continuity, death ensues. If pulses up/down/left/right correspond but are irregular, the disease is severe; if they are discordant and cannot be counted, death ensues.
Furthermore, Disharmony of the Left pulse indicates disease in the Exterior, governing the limbs; Disharmony of the Right pulse indicates disease in the Interior, governing the abdominal organs. There are cases with Exterior but no Interior, and cases with Interior but no Exterior.

Pushing method requires vertical and horizontal examination.
For hidden pulses, the pushing method is used. The Classics say: Push outward, it belongs to Fu organs; if inward but not outward, there are abdominal masses. Push inward, it belongs to Zang organs; if outward but not inward, the body has heat. Push up to before the Guan, if going up but not down, the waist and feet are cold. Push down to after the Guan, if going down but not up, there is disease in the head. Pressing to the bone with little pulse Qi indicates backache and Bi syndrome. Since pulses have hidden and manifest aspects, all due to intricate changes of Yin and Yang, one must view them horizontally and vertically to exhaust their variations.

Only the Tianhe pulse does not respond.
The song says: Tianhe pulse only discusses the Three Yin; Southern Heaven is high, Northern Spring is deep; Taiyin specifically governs the Right Cun/Chi; Jueyin is sunken at the Left Cun/Chi; Shaoyin at both Cun/Chi does not respond; intersection and opposition signal impending death. Tianhe refers to the Normal Pulse. All Yang pulses are floating; all Yin pulses are deep, hence the Three Yang Si Tian/Zai Quan are not mentioned. Nan Zheng (Southern Administration) speaks of Heavenly Dao: In years of Jia and Ji, Cun is South and Chi is North. When Three Yin Si Tian, both Cun do not respond; Taiyin Si Tian, Right Cun does not respond; Shaoyin Si Tian, both Cun do not respond; Jueyin Si Tian, Left Cun does not respond. When Three Yin Zai Quan, both Chi do not respond; Taiyin Zai Quan, Right Chi does not respond; Shaoyin Zai Quan, both Chi do not respond; Jueyin Zai Quan, Left Chi does not respond. Bei Zheng (Northern Administration) speaks of Earthly Dao: In years of Yi, Bing, Ding, Wu, Geng, Xin, Ren, Gui, Cun is North and Chi is South. When Three Yin Si Tian, both Chi do not respond; Taiyin Si Tian, Right Chi does not respond; Shaoyin Si Tian, both Chi do not respond; Jueyin Si Tian, Left Chi does not respond. When Three Yin Zai Quan, both Cun do not respond; Taiyin Zai Quan, Right Cun does not respond; Shaoyin Zai Quan, both Cun do not respond; Jueyin Zai Quan, Left Cun does not respond. "Not responding" means the pulse is deep and fine, not felt by the hand. The *Ganzhu Jing* says: The Minister Fire of the Five Elements does not take command. Thus, in Nan Zheng, when Shaoyin Si Tian, Minister Fire is above, so both Cun do not respond; when Zai Quan, Minister Fire is below, so both Chi do not respond. When Jueyin Si Tian, Minister Fire is on the left, so Left Cun does not respond; when Zai Quan, Left Chi does not respond. When Taiyin Si Tian, Minister Fire is on the right, so Right Cun does not respond; when Zai Quan, Right Chi does not respond. In Bei Zheng, when Shaoyin Si Tian, Minister Fire is above, so both Chi do not respond; when Zai Quan, Minister Fire is below, so both Cun do not respond. When Jueyin Si Tian, Minister Fire is on the left, so Left Chi does not respond; when Zai Quan, Left Cun does not respond. When Taiyin Si Tian, Minister Fire is on the right, so Right Chi does not respond; when Zai Quan, Right Cun does not respond. All "not responding" pulses are deep and fine, failing to resonate to the touch. Conversely, deep becomes floating, and fine becomes large. If the year dictates Minister Fire at the Cun, but the deep response resonates at the Chi; if the year dictates Minister Fire at the Chi, but the deep response resonates at the Cun, the Classics say: "Reverse Cun and Chi leads to death." If the year dictates Minister Fire on the left, but the deep response resonates on the right; if the year dictates Minister Fire on the right, but the deep response resonates on the left, the Classics say: "Exchange of Yin and Yang leads to death." It is also said: "Those who learn diagnosis must first know the annual Qi, for good reason!" This differs from Zhang Zhongjing and Danxi, but the discussion deeply captures the intent of the *Su Wen* regarding Minister Fire retreating, so we follow it.

Sudden plucking and irregularity characterize the Extraordinary Vessels.
The song says: Du and Chong vessels show hesitation, madness, or foolishness; both hands are solid, floating, and deep equally; if both Cun and Chi are floating and firm, they go straight up and straight down similarly; Ren vessel is tight, thin, and long, stopping at the Guan, with cutting pain in the yin radiating to the abdomen and umbilicus. Pulsating at the anterior left and right indicates Yang Qiao vessel, epilepsy, Bi, skin/muscle issues; pulsating at the posterior indicates Yin Qiao vessel, interior urgency, Yin hernia, and metrorrhagia are critical; pulsating at the middle indicates Dai vessel, spermatorrhea, amenorrhea, fear of infertility. Slanting from Shaoyin to Taiyang indicates Yang Wei, falling from height, baa-ing like a sheep; slanting from Shaoyang to Jueyin indicates Yin Wei, itching, Bi, aversion to wind. Coming large then small indicates Yin Collateral, flesh Bi spontaneously occurring; coming small then large indicates Yang Collateral, skin insensitivity and dripping sweat. According to the *Mai Jing*, if both hands' pulses are equally floating, deep, solid, and vigorous, it is the Chong and Du vessels. It indicates hesitation and dual-mindedness, or severe madness/confusion. If both Cun and Chi are floating, going straight up and down, or only Guan is floating, going straight up and down, it is the Du vessel. It indicates stiff back/waist, adult epilepsy, pediatric seizures. If both Cun and Chi are firm, going straight up and down, or only Guan is solid, it is the Chong vessel. It indicates Cold in the chest, uterine masses, sterility in women. Tight, thin, solid, and long pulse indicates the Ren vessel. Suffering lower abdominal pain radiating to the umbilicus, cutting pain in the yin. Pulsating at the anterior left and right indicates Yang Qiao vessel. Suffering epilepsy, aversion to wind, hemiplegia, falling stiffly, baa-ing, body stiffness/Bi. Pulsating at the posterior left and right indicates Yin Qiao vessel. Suffering lower abdominal pain, interior urgency, radiating pain in the yin; men have hernias, women have metrorrhagia. Pulsating at the middle left and right indicates Dai vessel. Suffering lower abdominal pain radiating to the waist; men have spermatorrhea, women have amenorrhea, causing infertility. Slanting from Shaoyin to Taiyang is Yang Wei. Falling from height, baa-ing, or loss of voice. Slanting from Shaoyang to Jueyin is Yin Wei. Suffering epilepsy, muscle itching/Bi, sweating, aversion to wind. Yin Collateral coming large then small suffers flesh Bi spontaneously arising, body shivering; Yang Collateral coming small then large has skin insensitivity and pain, sweating and cold. Whenever extraordinary vessel diseases appear, followed by extraordinary vessel pulses, see the preceding meridian chapters for detailed symptoms.

One pulse transforming twice is particularly strange.
The Dong (Pulsating) pulse is the struggle of Yin and Yang Qi. When Yin and Yang are harmonious, the pulse does not move. Now, if Qi is first invaded by pathogens, Qi becomes active. Once Qi is affected, Blood also fails to flow, giving rise to disease. Thus, the movement of one pulse transforms into both Qi and Blood diseases, not just Left for Blood and Right for Qi. Furthermore, the Hong (Surging) pulse: forceful and solid indicates severe Heat; weak and empty indicates severe Deficiency. The Wei Se (Minute and Choppy) pulse: weak and short is indeed Deficiency, but can latent Heat, Phlegm, and Qi stagnation be generally viewed as Deficiency? Thus, we know pulse changes are not restricted thus. Hence, some discard symptoms to follow the pulse, some discard the pulse to follow symptoms. Some follow one part pulse and two parts symptoms; some follow one part symptom and two parts pulse. There are noble people with no pulse in both hands; there are Left small/Right large or Left large/Right small; there are Fan Guan (Reversed Gate) pulses; there are those with broken arms or damaged pulse channels. Can one not follow the symptoms? Those skilled in diagnosis should realize this.

Do not be surprised by Men/Yin and Women/Shen.
Heaven's Yang is South and Yin is North. Men face South and are born in Yin, so both Cun are South and obtain Yang; Cun pulse surging and Chi pulse weak is normal. Earth's Yang is North and Yin is South. Women face North and are born in Shen, so both Chi are North and obtain Yin; Cun pulse weak and Chi pulse surging is normal. Yang strong means Yin weak, this is the Way of Heaven; reversing this causes disease. Man obtaining Woman's pulse indicates insufficiency; Woman obtaining Man's pulse indicates excess. Obtaining on the left indicates disease on the left; obtaining on the right indicates disease on the right. Man Left/Woman Right is the fixed position of Earth. Since humans stand on Earth, they transform according to Earth. Chu people value Left, which is the way of barbarians. Thus, Men have strong Left pulse and weak Right pulse; Women have strong Right pulse and weak Left pulse. Heaven uses Yin, so human left ears/eyes are sharper than right. Earth uses Yang, so human right hands/feet are stronger than left. Yin and Yang use each other, this is not reversal. Generally, when diagnosing men, extend the Left hand first; when diagnosing women, extend the Right hand first. Men obtain more Yang Qi, so Left pulse is vigorous; Women obtain more Yin Qi, so Right pulse is vigorous. Men regard Left Chi as the House of Essence; Women regard Right Chi as the Sea of Blood. This is the divine transformation of Heaven and Earth, distinguishing men and women, judging life and death. Shuhe said: "Women reverse this, look backwards; the third Chi pulse diagnoses disease similarly." Or those who do not know this Yin-Yang, with inverted Zang organs, are incorrect.

Da Yan Fifty is the Ultimate Number, Master Position reveals Spirit from Pre-Heaven.
Pulse is primarily determined by breath count. Blood is the pulse, Qi is the breath. Response is called "Zhi", Breath is called "Zhi". Breathing is the bellows of Qi; movement/response is the waves of Blood. In one exhalation, pulse moves 3 cun; in one inhalation, pulse moves 3 cun. At the pause of breathing, pulse moves 6 cun. In one day and night, there are 13,500 breaths. Pulse moves 50 cycles around the body, water clock drops 100 marks. Ying and Wei travel Yang 25 cycles, travel Yin 25 cycles, making one cycle. Thus, after 50 cycles, they meet again at the Hand-Taiyin. The method counts one exhalation and one inhalation as one breath. Between one breath, if the pulse comes 4-5 times, harmonious and smooth, it is Normal. 6 rapid, 7 extreme, indicates severe Heat. 3 slow, 2 sluggish, indicates Cold critical condition. One beat per two breaths, or 80-90+ beats per breath, does not constitute a proper breath. Generally, many beats is "Zhi" (Arrival), few beats is "Sun" (Damage). Sun pulse starts from top damaging Lung and goes down to Kidney; Zhi pulse starts from bottom damaging Kidney and goes up to Lung. *Kuaijie Fangshi* says: Damage from top down dies later; Zhi pulse mostly from bottom damage up, but this is the number of Xiao Yan. Da Yan takes 50 as the ultimate. If three positions are average, reaching 50 beats before one stop, or no stop, there is no disease. If one feels the Kidney pulse suddenly sink, counting from the Kidney position, stopping before 50 beats, one Zang has no Qi. Exhaling reaches Heart and Lung, one beat Lung, one beat Heart; Inhaling reaches Kidney and Liver, one beat Liver, one beat Kidney; Between breaths, one beat Spleen. Now, if inhalation cannot reach Liver and Kidney and returns, activating Lung pulse again, then stopping after 40 beats, Kidney failed first, Liver compensates, expected death in spring when grass grows. Counting from Liver position, stopping after 30 beats, Liver and Kidney have no Qi, Heart compensates, expected death at Grain Rain three years later. Counting from Heart position, stopping after 20 beats, Kidney, Liver, Heart have no Qi, Spleen compensates, expected death in two years when mulberry leaves turn red. Counting from Spleen position, stopping after 15 beats, Kidney, Liver, Heart, Spleen have no Qi, Lung compensates, expected death in one year when grass withers. As for stopping after two beats, or three/four beats, death is judged by days. Thus, we know pulse deficiency/excess and life/death are all within the breath count. Why do current diagnosticians only study various pulse shapes and neglect the count? And those who know to check the count but lack the skill of hand-heart correspondence, counting more intricately loses the truth. Alas! Breaking an arm or blinding one eye does not cause premature death, but slight pulse variation follows the patient. When people ask about illness, they always ask "How is the pulse?" Doctors fail to understand this. Students must practice regularly...