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[From *Nan Jing* (Classic of Difficult Issues)] The classic states: "To know through observation is called 'Shen' (Divine); to know through listening and smelling is called 'Sheng' (Sage); to know through questioning is called 'Gong' (Skilled artisan); to know through palpating the pulse is called 'Qiao' (Dexterous). What does this mean?" To know through observation means observing the Five Colors (Green, Red, Yellow, White, Black) to infer the disease. To know through listening and smelling means hearing the Five Tones (Jue, Zhi, Gong, Shang, Yu) to distinguish the disease. To know through questioning means asking about the patient's preference for the Five Flavors (Sour, Bitter, Sweet, Pungent, Salty) to know the origin and location of the disease. To know through palpating the pulse means diagnosing at the Cun Kou (Radial Artery), observing its deficiency or excess, to know which Zang-Fu organ is affected. The statement in the classic that "knowing from external signs is Sheng, knowing from internal mechanisms is Shen" refers to this.

[From *Su Wen* (Basic Questions)] Pulse diagnosis should be performed at dawn, when Yin Qi has not yet moved, Yang Qi has not yet dispersed, food and drink have not been taken, the Jing Mai (Regular Meridians) are not yet full, the Luo Mai (Connecting Vessels) are harmonious, and the Qi and pulse are not yet chaotic. Thus, abnormal pulses can be diagnosed. By feeling the movement and stillness of the pulse, observing the clarity of the eyes, examining the five colors of the face, and assessing the excess or deficiency of the Zang organs, the strength or weakness of the Fu organs, and the flourishing or declining state of the body form, these factors are cross-referenced to determine the division between life and death. (From *Mai Yao Jing Wei Lun*)

[Zhu Danxi] The classic says: "The way of pulse diagnosis lies in observing a person's courage or timidity, as well as their muscles and skin, to understand their condition and establish diagnostic methods." Generally, tall stature differs from short, large from small, and fat from thin. Pale complexion differs from dark, tender skin from rough, and thin subcutaneous tissue from thick. Moreover, fat people tend to have more Dampness, while thin people tend to have more Fire. Those with pale complexions have deficient Lung Qi; those with dark complexions have sufficient Kidney Qi. Since physical appearance and color differ, the functions of the Zang-Fu organs also differ. Even if external symptoms are the same, treatment methods are vastly different. Therefore, for fat people, a floating pulse requires investigation; for thin people, a deep pulse requires investigation; for restless people, a slow pulse requires investigation; for sluggish people, a rapid/agitated pulse requires investigation. One cannot generalize.

Zhang Zhongjing said: "For fat people, the pulse should be deep; if it is now floating, investigate. For thin people, the pulse should be floating; if it is now deep, investigate."

[From *Su Wen*] A skilled diagnostician observes the complexion and palpates the pulse, first distinguishing Yin and Yang; examines the clarity or turbidity of the complexion to know the location of the lesion; observes breathing and listens to voice sounds to know where the suffering lies; observes the balance, rules, circle, and square (metaphors for pulse variations) to know the main aspect of the disease; palpates the Chi and Cun positions, observing floating, deep, slippery, and choppy qualities to know the origin of the disease. In this way, treatment will have no errors, and diagnosis will be flawless. (From *Yin Yang Ying Xiang Da Lun*)

Close the doors and windows, focus on the patient, ask repeatedly about their emotional state and desires, and follow their intentions. Those who possess Shen (Spirit) prosper; those who lose Shen perish. (From *Yi Jing Bian Qi Lun*) You must carefully inquire about the initial onset of the disease and the current symptoms, then palpate each pulse, observing the floating or deep nature of the meridians, and trace them according to the principles of upward/downward and reverse/compliant movements. (From *San Bu Jiu Hou Lun*) Before diagnosing any illness, one must ask if the patient was formerly noble but became humble. Even without external pathogenic invasion, disease may arise internally, named "Tuo Rong" (Loss of Glory). If the patient was formerly rich but became poor, it is named "Shi Jing" (Loss of Essence). The Qi of the Five Zang organs may linger and affect each other, causing diseases to combine. When physicians diagnose, they may find the disease is not in the Zang-Fu, nor has the body shape changed. They diagnose with doubt, unaware of the disease name. The body wastes away daily, Qi becomes empty and Essence depleted, the disease is deep with exhausted Qi, and the patient feels chilly and startled frequently. This is because the pathogen externally depletes Wei Qi and internally robs Ying Blood. A competent physician who misses this fails to understand the condition. (From *Shu Wu Guo Lun*)

[Li Dongyuan] Various diseases that worsen during the day and quiet at night indicate Excess of Yang disease, meaning Qi is diseased while Blood is not. Diseases that worsen at night and quiet during the day indicate Excess of Yin disease, meaning Blood is diseased while Qi is not. Fever during the day with quietness at night indicates Yang Qi flourishing in the Yang divisions. Quietness during the day with fever and irritability at night indicates Yang Qi sinking into the Yin divisions, named "Re Ru Xue Shi" (Heat Entering the Blood Chamber). Fever and irritability both day and night indicate Double Yang without Yin; one must urgently drain Yang and vigorously tonify Yin. Chills at night with quietness during the day indicate Yin Blood flourishing in the Yin divisions. Quietness at night with chills during the day indicates Yin Qi overflowing into the Yang divisions. Chills both day and night indicate Double Yin without Yang; one must urgently drain Yin and vigorously tonify Yang. Chills during the day with irritability at night, inability to eat or drink, is named "Yin Yang Jiao Cuo" (Intermingling of Yin and Yang) and is fatal.

[Zhu Danxi] The Lung governs Qi, and its pulse is located at the Right Cun. The Spleen, Stomach, Ming Men, and San Jiao all rely on Qi for transformation and function, so they are associated with it. The Heart governs Blood, and its pulse is located at the Left Cun. The Liver, Gallbladder, Kidney, and Bladder are all channels and stores for Essence and Blood, so they are associated with it. Men conceive via Qi, so Qi is primary. Women carry fetus via Blood, so Blood is primary. In men, if the Right pulse is fuller than the Left, there is Stomach Qi; even if the disease is severe, it is treatable. In women, if the Left pulse is fuller than the Right, there is Stomach Qi; even if the disease is severe, it is treatable. The opposite indicates extreme deficiency.

[From *Su Wen*] Pulses have Yin and Yang aspects. Knowing Yang allows one to know Yin; knowing Yin allows one to know Yang. There are five types of Yang pulses, totaling twenty-five Yang manifestations. The so-called Yin pulses refer to the True Zang pulses; their appearance indicates failure, and failure leads to death. The so-called Yang pulses refer to the Yang of the Stomach cavity (Stomach Qi). Distinguishing Yang allows one to know the location of the disease; distinguishing Yin allows one to know the time of death. The Three Yang pulses are found at the head (Ren Ying), and the Three Yin pulses are found at the hand (Qi Kou); this is referred to as "One." Distinguishing Yang allows one to know the contraindicated times for disease; distinguishing Yin allows one to know the time of death. (From *Yin Yang Bie Lun*. Wang Bing's commentary: Head refers to Ren Ying pulse, 1.5 cun lateral to the Adam's apple; Hand refers to Qi Kou pulse, 1 cun posterior to the thenar eminence. The two correspond, moving together, equal in size like a drawn rope, indicating a healthy person, hence "referred to as One.") Distinguishing Yang allows one to know the origin of the disease; distinguishing Yin allows one to know the time of death. (From *Yu Ji Zhen Zang Lun*)

[From *Ling Shu*] Qi Kou diagnoses Yin; Ren Ying diagnoses Yang. (From *Si Shi Qi Lun*)

[From *Su Wen*] Carefully master Yin and Yang, do not consult with others. The so-called Yin and Yang: departing is Yin, arriving is Yang; stillness is Yin, motion is Yang; slowness is Yin, speed is Yang. (From *Yin Yang Bie Lun*)

All floating pulses without agitation belong to Yang, manifesting as Heat. If there is agitation, the disease is in the Hand Yang pulses. Only floating without agitation indicates disease in the Foot Yang pulses; if there is agitation, it is in the Hand Yang pulses. All fine and deep pulses belong to Yin, manifesting as bone pain. If there is stillness, it is in the Foot. (From *Mai Yao Jing Wei Lun*. Fine, deep, and agitated indicates disease in the Hand Yin pulses; stillness indicates disease in the Foot Yin pulses.)

[Wang Shuhe *Mai Jing*] [Chen Wuyue] Floating pulse: insufficient upon pressing, abundant upon lifting. Deep pulse: insufficient upon lifting, abundant upon pressing. Slow pulse: three beats per respiration, very slow. Rapid pulse: fast and urgent. (Six to seven beats per respiration.) Deficient pulse: slow, large, and soft; insufficient upon pressing, feeling hollow under the fingers. Excess pulse: large and long, slightly strong; firm upon pressing (or forceful upon both lifting and pressing). Moderate pulse: slow, slightly faster than slow (or floating, large, and soft). Tight pulse: rapid like cutting a rope (or like a twisting cord). Surging pulse: very large under the finger. Fine pulse: very small, seeming to exist but barely. Slippery pulse: fluent and rolling back and forth, similar to rapid (or gurgling like slipping off. Zhang Zhongjing said: Xi and An Chen constitute Slippery; Chen is pure Yin, Xi is positive Yang, their harmony is Slippery. Xu Xueshi said: These three characters by Zhang Zhongjing accurately describe Slippery pulse. Xi means closing, opening then closing. An Chen means suddenly descending. Just as it closes, it suddenly descends; An refers to the instant. Zhang Zhongjing's description of Slippery pulse is precise.). Choppy pulse: fine and slow, difficult and scattered to move, or stopping occasionally (or short and stopping. *Mai Jue* says: like a knife scraping bamboo marks. Chen Wuyue says: like rain soaking sand.). String-taut pulse: weak upon lifting, like a bowstring upon pressing (String-taut but not large is String-taut; string-taut and large is Leathery.). Leathery pulse: seems deep and hidden, actually large and long, slightly string-taut (Chen Wuyue says: like pressing a drum skin. Zhang Zhongjing says: String-taut and large.). Soft pulse: extremely soft, floating, and fine (Soft, also written as Ru.). Weak pulse: extremely soft, deep, and fine, nearly imperceptible upon pressing. Knotted pulse: slow with occasional stops (Zhang Zhongjing said: Pulse moves then stops, returns quickly, then moves again, named Jie, Yin type. Pulse moves then stops, cannot return immediately, then moves again, named Dai, Yin type; difficult to treat.). Urgent pulse: rapid with occasional stops. Scallion-stalk pulse: floating, large, and soft; empty in the center, solid on the sides. Minute pulse: extremely fine and soft, sometimes nearly absent, seeming to exist but not. Pulsating pulse: seen at Guan, no head or tail, size of a bean, quivering. Hidden pulse: requires extreme pressure, felt only against the bone. Dispersed pulse: large and scattered; indicates Qi excess and Blood deficiency, exterior without interior. Alternating pulse: rapid with stops, cannot return immediately, then moves again (Knotted pulse survives; Alternating pulse dies).

The above opposing pulse shapes are arranged according to Wang's classic. As Chen's *San Yin Fang* states: Pulses are paired. Floating and Deep oppose; Floating indicates Exterior/Yang disease, Deep indicates Interior/Yin disease. Slow and Rapid oppose; Slow indicates Cold/deficient Yang, Rapid indicates Heat/deficient Blood. Excess and Deficient oppose; Deficient indicates Blood/Qi deficiency, Excess indicates Blood/Qi excess. Large and Fine oppose; Large indicates abundant Blood/Qi, Fine indicates scarce Blood/Qi. Slippery and Choppy oppose; Slippery indicates Blood excess/Qi deficiency, Choppy indicates Qi excess/Blood deficiency. Moderate and Tight oppose; Heat causes relaxation (Moderate), Cold causes contraction (Tight). Strong/Leathery oppose Soft/Weak; Strong/Leathery indicate Deficient Cold, Soft/Weak indicate Deficient Heat, deduced similarly to Moderate/Tight. Knotted and Urgent oppose; Knotted indicates Yin excess, Urgent indicates Yang excess. Floating, Rapid, Excess, Tight, Large, Slippery, Strong, Leathery, Scallion-stalk, Dispersed belong to Yang. Deep, Slow, Deficient, Moderate, Fine, Choppy, Soft, Weak, Knotted, Minute, Pulsating, Hidden, Alternating belong to Yin. Later scholars divided Yang pulses into Seven Tables and Yin pulses into Eight Li.

Floating resembles Scallion-stalk; String-taut resembles Tight; Slippery resembles Rapid; Leathery resembles Excess; Deep resembles Hidden; Minute resembles Choppy; Soft resembles Weak; Moderate resembles Slow.

[Zhang Congzheng (Hai Zang)] Qi disorders involve thirst for water; Blood disorders do not. Qi disease causes numbness; Blood disease causes pain. No Yang leads to cold limbs; No Yin leads to vomiting. Yin disorder: body still, whispering, difficult breathing, unclear vision, breath unable to exit nose/inlet mouth, cold air from mouth/nose, inability to swallow, incontinence or retention of urine/feces, aversion to cold like skin scraping. Yang disorder: body active, loud speech, clear vision, smooth breathing, hot air from mouth/nose.

[From *Mai Jue*] Both hands' pulses show Yang upon floating and Yin upon deepening; both Yin and Yang are full and vigorous; this is the Chong and Du Mai. Chong and Du Mai are the pathways of the Twelve Regular Meridians. When Chong and Du are active, the Twelve Meridians no longer converge at Cun Kou. Such patients suffer from恍惚 (trance/madness); otherwise, they are indecisive with dual minds. Both hands' Yang pulses are floating, fine, and continuous; Yin pulses are also fine and continuous; this is Yin Qiao and Yang Qiao Mai. These patients previously had demon-wind illness, died in agony and trance, causing harm from the deceased. Chi and Cun pulses both floating, straight up and down; this is Du Mai, causing stiff back and waist, inability to bend or extend, adult epilepsy, infant wind-colic. Chi and Cun pulses both firm (or scallion-stalk), straight up and down; this is Chong Mai, indicating cold hernia in the chest.

[From *Nan Jing*] How do the diseases of the Extraordinary Vessels present? Answer: Yang Wei maintains Yang, Yin Wei maintains Yin. If Yin and Yang cannot maintain each other, the patient feels lost and despondent, unable to control themselves. Yin Qiao disease: Yang side relaxed, Yin side tense. Yang Qiao disease: Yin side relaxed, Yang side tense. Chong disease: rebellious Qi and abdominal urgency. Du disease: stiff spine and cold limbs (Su Wen says "stiff spine and opisthotonos"). Ren disease: internal knotting, seven types of hernia in men, masses in women. Dai disease: abdominal fullness and limp waist as if sitting in water. Yang Wei disease: aversion to cold and heat. Yin Wei disease: heart pain. These are the diseases of the Eight Extraordinary Vessels. (From *Nan Jing 29*)

[Zhu Danxi] Discussion on Yang Stagnation in Yin and Yin Stagnation in Yang. *Jing Yao* states: Yang stagnation in Yin presents with Floating, Surging, String-taut, or Rapid pulses. Yin stagnation in Yang presents with Deep, Fine, Weak, or Choppy pulses. Yang stagnation is treated with Cold; Yin stagnation with Heat. I scrutinize this intent: Yang/Yin stagnation should be read as Heat/Cold stagnation. Seeking Heat/Cold allows discussion of Yin/Yang, distinguishing Qi/Blood. Heat stagnating in Qi is clear, but what of Cold stagnation? Cold stagnating in Blood is clear, but what of Heat stagnation? Why can Cold not injure Qi, and Heat not injure Blood? I believe: Qi is Yang, moving outside the vessels; Blood is Yin, moving inside. They circulate together, never stopping, forming the pulse. In one exhalation, pulse moves 3 cun; in one inhalation, 3 cun. Total 6 cun per breath. Body length 7 chi 5 cun, total travel 810 zhang. Heat makes it fast (excess); Cold makes it slow (deficiency). Imbalance of Five Flavors and Seven Emotions causes Qi stagnation, thickens fluids, leading to Phlegm/Dampness entering vessels, disturbing Blood, causing turbidity, stasis, or boiling. This is Yin stagnating in Yang, i.e., Blood stagnating in Qi. Qi disease worsened by drugs aiding evil, Blood disease increases, leaking out of vessels, blocking channels, hindering ascent/descent, disrupting transformation. This is Yang stagnating in Yin, i.e., Qi stagnating in Blood. Disease differentiation into Cold/Heat depends on constitutional bias and mixed pathogens, not solely assigning Yang=Heat and Yin=Cold. Floating/Surging/String-taut/Rapid are Qi disease pulses, not necessarily Heat. Deep/Fine/Weak/Choppy are Blood disease pulses, not necessarily Cold. This is the root of ten thousand diseases, not just sores and ulcers. Please evaluate. ("Qi", pronounced Hu Gu, means blockage.)

[From *Su Wen*] Cun Kou pulse deep and firm indicates disease in the Interior; Cun Kou pulse floating and vigorous indicates disease in the Exterior. (From *Ping Ren Qi Xiang Lun*. Hai Zang says: Floating pulse indicates Exterior. If floating is large and firm, deep is diminished, it is Exterior. If floating is large and firm, and deep is also large and firm, it is not Exterior; pathogen has entered deeply.) Pulse vigorous, slippery, and firm indicates Exterior disease; pulse small, solid, and firm indicates Interior disease.

[From *Ling Shu*] Qi Kou governs Interior; Ren Ying governs Exterior. (From *Jin Fu Pian*). Ren Ying vigorous and firm indicates injury by Cold; Qi Kou vigorous and firm indicates injury by Food. (From *Wu Se Pian*)

Qi Kou refers to the pulse of the Hand Taiyin Lung Meridian behind the wrist. Ren Ying refers to the pulse of the Foot Yangming Stomach Meridian beside the throat.

[Zhang Congzheng (Hai)] Differentiating External vs. Internal Injury: Wind injury causes coarse nasal breathing, mouth closed, as Lung Qi connects to Heaven/Earth. Food injury causes loss of taste, lack of saliva, uniform nasal breathing, as Spleen Qi connects to Earth. External injury causes whole-body heat, starting in Taiyang, entering from outside (formless). Internal injury causes limb disharmony and bilateral hypochondriac heat, starting in Shaoyang, emerging from inside (formed). Both external and internal injury: Ren Ying and Qi Kou both vigorous, or forceful upon lifting/pressing; exterior fever with aversion to cold, abdominal discomfort with thirst. This is combined external/internal injury. Diagnosis: palpate palms and backs of hands. Palm heat indicates internal injury; back-of-hand heat indicates external injury. Then differentiate by pulse.

[From *Nan Jing*] Pulse has Three Parts and Nine Probes, each governing specific areas. Answer: Three Parts are Cun, Guan, Chi. Nine Probes are Floating, Middle, Deep. Upper part models Heaven, governing diseases from chest to head. Middle part models Humanity, governing diseases from diaphragm to umbilicus. Lower part models Earth, governing diseases from umbilicus to feet. Acupuncture should be applied carefully. (From *Nan Jing 18*)

[Zhu Gong *Huo Ren Shu*] Upon placing fingers, first use the middle finger to locate Guan. The high bone behind the palm is Guan. Place index and ring fingers before and after Guan for the Three Parts. Index is Cun, Ring is Chi. Long arms require wider spacing; short arms require closer spacing. If diagnosing Cun first, lightly press to assess, then moderately, then heavily. Assess upper and lower limits, and push fingers outward and inward. Diagnose only when breath is calm. One respiration (one exhale + one inhale) is one Xi. Four or five beats per Xi, neither too large nor small, corresponding to the season and location, is a Harmonious Pulse. More than this is "Zhi" (Excess); less is "Sun" (Deficiency). *Nan Jing* details Sun and Zhi pulses.

Zhang Zhongjing said: Rapid inhalation indicates Excess in Middle Jiao; purgation heals, deficiency is untreatable. Rapid inhalation in Upper Jiao; slow/deep inhalation in Lower Jiao; both are difficult to treat. Trembling during respiration is untreatable.

[From *Su Wen*] Disharmony of the Five Zang arises from obstruction of the Six Fu. (From *Tong Ping Xu Shi Lun*)

[From *Nan Jing*] How to distinguish Zang and Fu diseases? Answer: Rapid pulses belong to Fu, Slow pulses to Zang. Rapid indicates Heat, Slow indicates Cold. All Yang is Heat, all Yin is Cold. Thus, one distinguishes Zang and Fu diseases. (From *Nan Jing 9*). Diseases may desire warmth, cold, company, or solitude. Where is the disease? Desire cold and company indicates Fu disease. Desire warmth and solitude indicates Zang disease. Why? Fu is Yang; Yang diseases desire cold and company. Zang is Yin; Yin diseases desire warmth and solitude, avoiding noise. Thus, one distinguishes Zang and Fu diseases. (From *Nan Jing 51*). Do Zang and Fu diseases originate equally? No. Zang diseases are stationary and localized. Fu diseases are migratory and fluctuating. (From *Nan Jing 52*)

[From *Su Wen*] Huang Di said: All diseases arise from Wind, Cold, Summer-heat, Dampness, Dryness, and Fire, transforming and changing. The classic says: Drain the Excess, Tonify the Deficiency. I gave you medical arts, but practitioners are not always perfect. I wish for the essential Dao to work effectively, like a drumstick hitting a drum, pulling thorns, or washing dirt. Can you explain? Qi Bo said: Examine the disease mechanism, do not miss the Qi suitability. This is it. Huang Di asked about the disease mechanism. Qi Bo said: All wind-induced tremors and dizziness belong to the Liver. All cold-induced contraction and pulling belong to the Kidney. All Qi-related depression and stagnation belong to the Lung. All dampness-induced swelling and fullness belong to the Spleen. All heat-induced confusion and convulsions belong to Fire. All pain, itching, and sores belong to the Heart. All reversal, constipation, and incontinence belong to the Lower Jiao. All wasting, wheezing, and vomiting belong to the Upper Jiao. All locking, shivering, and loss of spiritual control belong to Fire. All spasms and neck stiffness belong to Dampness. All rebellious Qi rushing upward,