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Ping Mai (Normal Pulse) refers to the pulse of a healthy person without disease. Examples include pulses that conform to the four seasons, normal pulses of the five Zang organs, and pulses where Yin and Yang are balanced. Once a person becomes ill, the pulse loses its equilibrium. This includes pulses that are excessive or deficient according to the four seasons, pulses resulting from mutual over-restriction (Xiang Cheng) or counter-restriction (Xiang Wu) among Yin/Yang and Zang/Fu organs, as well as abnormal pulses indicating life or death amidst various diseases. The term "Ping" (Normal/Level) also implies a standard or criterion. It means that if a practitioner can use various normal pulses as standards to evaluate abnormal pulses, then any deviations due to excess or deficiency, or discrepancies in respiration and Cun/Guan/Chi positions, will be clearly understood both mentally and tactilely, leaving no room for error. Only then can one use the pulse patterns of Shanghan (Cold Damage) to evaluate Huai Bing (complicated/deteriorated conditions), or use the pulses of Huai Bing to evaluate Shanghan. This is indeed what is meant by mastering the principles comprehensively without omission.

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Question: The pulse has three positions (Cun, Guan, Chi), with Yin and Yang influencing each other. Ying (Nutrient) and Wei (Defensive) Qi and Blood exist within the body, moving up and down through inhalation and exhalation, circulating via breath, allowing fluids to flow smoothly. They change constantly, presenting different forms: String-like in Spring, Floating in Autumn, Deep in Winter, and Large/Hong in Summer. Observing complexion and pulse reveals differences in size. Within a short time, changes are unpredictable; Cun and Chi may vary, being short or long, with upper and lower parts misaligned, appearing or disappearing. Conditions change constantly, advancing or retreating, causing confusion and loss of direction. Please explain thoroughly so I may distinguish them clearly. Master said: Your question touches upon the root of medical Dao. The pulse is divided into three positions: Cun, Guan, and Chi. Ying and Wei Qi circulate without losing balance. Kidney pulse is Deep (Chen), Heart pulse is Large/Hong (Hong), Lung pulse is Floating (Fu), Liver pulse is String-like (Xian). These are the constant norms, accurate to the finest detail. Qi moves in and out, rising and falling, completing a cycle every two ke (approx. 48 minutes), returning to Cun Kou, where Deficiency (Xu) and Excess (Shi) become apparent. Changes interact, and Yin and Yang interfere. Wind causes Floating and Empty (Xu) pulses; Cold causes Firm (Lao) and Solid (Jian) pulses; Water retention causes Deep and Stagnant pulses; Branchal Fluid Retention (Zhi Yin) causes Rapid-Tight (Ji Xian) pulses; Moving (Dong) pulse indicates pain; Rapid (Shuo) pulse indicates heat and restlessness. If symptoms do not match, understand the cause of variation. Different pulses in the three positions indicate different pathologies. Excess is startling, but Deficiency is equally significant. Pathogenic factors do not appear randomly; there is always an underlying evil. Examine Exterior and Interior, differentiate the San Jiao (Triple Burner), identify the location of the pathogen, carefully diagnose, and predict Zang organ status. With insight as sharp as a deity, I record this for you to pass on to worthy successors.

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Master said: Respiration is the source of the pulse.

[Annotation]
In a healthy person, the pulse beats twice during one exhalation and twice during one inhalation. During the pause between breaths (Ding Xi), it beats four times. This is the Moderate (Huan) pulse of a healthy person. Occasionally, due to a deep sigh, it may beat five times, which is also considered a normal pulse. One cannot determine pulse frequency without reference to respiration. Pulse taking must begin with observing respiration; hence, "Respiration is the source of the pulse."

[Collected Annotations]
Fang Youzhi stated: Exhalation is the exit of Qi and the arrival of the pulse; Inhalation is the entry of Qi and the departure of the pulse. "Head" refers to the origin. Although pulse names and shapes vary, respiration is their source. However, there are two contexts for pulse: here referring to Cun Kou, if referring to the whole body, circulation is endless and continuous, having no head or tail. Students should recognize this.

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When initially palpating, if the pulse arrives quickly but departs slowly (Out-Quick, In-Slow), it is named "Nei Xu Wai Shi" (Interior Deficiency, Exterior Excess). When initially palpating, if the pulse arrives slowly but departs quickly (Out-Slow, In-Quick), it is named "Nei Shi Wai Xu" (Interior Excess, Exterior Deficiency).

[Annotation]
This describes the method of diagnosing Exterior/Interior and Deficiency/Excess based on the speed of the pulse's arrival and departure. "Arrival" (Lai) refers to the pulse emerging, associated with Yang, thus indicating the Exterior. "Departure" (Qu) refers to the pulse receding, associated with Yin, thus indicating the Interior. "Quick" (Ji) indicates rapidity and excess, thus indicating Excess. "Slow" (Chi) indicates slowness and insufficiency, thus indicating Deficiency. Therefore, an Out-Quick/In-Slow pulse indicates Exterior Excess and Interior Deficiency, hence "Interior Deficiency, Exterior Excess." An Out-Slow/In-Quick pulse indicates Exterior Deficiency and Interior Excess, hence "Interior Excess, Exterior Deficiency."

[Collected Annotations]
Fang Youzhi stated: "Arrival" moves from the muscle/bone layer to the skin surface, representing ascending Qi. "Departure" moves from the skin surface back to the muscle/bone layer, representing descending Qi. Exit corresponds to exhalation and arrival; Entry corresponds to inhalation and departure. The Classics state: Arrival is Yang, Departure is Yin. Quickness is Yang excess; Slowness is Yin deficiency. Interior Deficiency/Exterior Excess is Yin deficiency and Yang excess; Interior Excess/Exterior Deficiency is Yang deficiency and Yin excess. Thus, arrival/departure and interior/exterior are the key principles of pulse diagnosis and disease differentiation. Knowing the Yin/Yang of interior/exterior and distinguishing deficiency/excess is crucial for practitioners.

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Suppose the pulse is微弱 (Wei/Micro) on arrival and large on departure; this is called "Fan" (Reverse), indicating disease in the Interior. Suppose the pulse head is small and the root is large; this is called "Fu" (Covered), indicating disease in the Exterior. If the upper part (Cun) is micro/small-headed, sweating occurs. If the lower part (Chi) is micro/large-rooted, it indicates Guan Ge syndrome (obstruction), leading to inability to urinate. If the head has no sweat, it is treatable; if there is sweat, it is fatal.

[Commentary]
"Pulse head small, root large" should likely be "Pulse large on arrival, small on departure." "Upper micro/small-headed" should be "Upper micro indicates Yin Excess." "Lower micro/large-rooted" should be "Lower micro indicates Yang Excess." This aligns better with the logic of upper/lower.

[Annotation]
The previous section used arrival/departure speed to diagnose interior/exterior deficiency/excess; this section uses arrival/departure magnitude to diagnose exterior/interior excess/deficiency. A pulse that is micro on arrival and large on departure resembles reversal, hence "Fan Mai" (Reverse Pulse). A pulse that is larger on arrival and micro on departure resembles covering, hence "Fu Mai" (Covered Pulse). Fan indicates Interior disease with Yin Excess; Fu indicates Exterior disease with Yang Excess. Yang Excess leads to Ge (blocking); Yin Excess leads to Guan (closing). Extreme excess of Yin and Yang prevents communication, resulting in Guan Ge syndrome. No sweat on the head indicates Yang has not separated from Yin, so it is treatable. Sweat indicates Yang has fled upward, hence fatal.

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At Cun Kou, Excess of Wei Qi is named "Gao" (High); Excess of Ying Qi is named "Zhang" (Clear/Distinct). When Gao and Zhang combine, it is named "Gang" (Outline/General). Weakness of Wei Qi is named "Die" (Trepidation); Weakness of Ying Qi is named "Bei" (Low/Abased). When Die and Bei combine, it is named "Sun" (Damage/Loss). Harmony of Wei Qi is named "Huan" (Moderate); Harmony of Ying Qi is named "Chi" (Slow). When Huan and Chi combine, it is named "Chen" (Deep/Sunken - *Note: Text suggests this should be "Qiang" Strong*).

[Commentary]
The character "Chen" (Deep) in "Named Chen" should likely be "Qiang" (Strong), as inferred from the following text.

[Annotation]
This details the states of pulse strength and weakness. Cun Kou generally refers to Cun, Guan, and Chi. Wei governs Qi (Yang) to indicate the Exterior; Ying governs Blood (Yin) to indicate the Interior. If the pulse rises strongly under the finger, Wei Qi is excessive, called "Gao" (High/Long). If the pulse descends strongly under the finger, Ying Qi is excessive, called "Zhang" (Clear/Distinct). Gao implies long-lasting excess; Zhang implies clarity. Their combination is "Gang," implying total abundance of Ying and Wei. If the pulse rises weakly, Wei Qi is deficient, called "Die" (Trepidation/Unsteady). If the pulse descends weakly, Ying Qi is deficient, called "Bei" (Low/Shrinking). Their combination is "Sun," implying total deficiency of Ying and Wei. If Gao/Zhang or Die/Bei pulses appear alongside non-rapid/non-slow Moderate/Slow pulses, it indicates balance (neither too excessive nor too deficient), known as Harmonious Pulse. The "Strong" mentioned here refers to the condition described next.

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Cun Kou pulse is Moderate (Huan) and Slow (Chi). Huan indicates growth of Yang Qi, resulting in fresh complexion, radiant face, clear voice, and long hair. Chi indicates abundance of Yin Qi, resulting in marrow generation, full blood vessels, and tight muscles. [Text corruption here]. When Yin and Yang embrace, Ying and Wei circulate together, and Rigidity and Flexibility harmonize, it is named "Qiang" (Strong).

[Commentary]
"The characters 'Bo Xian □' do not form a sentence and are likely interpolations; they should be deleted."

[Annotation]
This explains the meaning of "Qiang" (Strong) following the previous section. Generally, those with abundant Yang Qi exhibit Gao/Zhang characteristics; those with abundant Yin Qi exhibit Die/Bei characteristics. This is normal. However, only when Huan and Chi normal pulses are present simultaneously does it signify Yin-Yang harmony and Ying-Wei balance, truly earning the name "Qiang." Qiang refers to fresh complexion, radiant face, full blood, and tight flesh.

[Collected Annotations]
Fang Youzhi stated: Huan diagnoses the Stomach; Chi diagnoses the Spleen. Growth of Yang Qi means sufficient Stomach Qi. Complexion, voice, and hair belong to Yang. Fresh means beautiful; Radiant means shining; Shang (clear) means clear; Long means fine. This describes surplus Stomach Yang. Abundance of Yin Qi means sufficient Spleen Qi. Marrow generation, full blood, tight muscles—all belong to Yin, describing sufficient Spleen Yin. Embrace means harmony; Circulate together means flowing throughout; Combine means unity. This emphasizes that peace between the two energies results from Spleen/Stomach surplus, ensuring robust health, hence "Qiang."

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Master said: For obese individuals, one should investigate Floating pulses; for thin individuals, one should investigate Deep pulses. Obese people should have Deep pulses; if they instead have Floating pulses, pathology is suspected. Thin people should have Floating pulses; if they instead have Deep pulses, pathology is suspected.

[Annotation]
The previous section used pulse strength to assess physical constitution; this section uses pulse depth (Floating/Middle/Deep) to differentiate skin, vessels, muscle, tendon, and bone, thereby diagnosing the Five Zang organs. Heart and Lung pulses are Floating; Liver and Kidney pulses are Deep. Skin and vessel superficiality distinguish Heart/Lung floating; tendon and bone depth distinguish Liver/Kidney deepness. Spleen governs muscle, situated between floating and deep, so it is diagnosed at the Middle level. Obese people have thick skin/flesh, so their pulse should be Deep; thin people have thin skin/flesh, so their pulse should be Floating. If an obese person has a Floating pulse or a thin person has a Deep pulse, one must investigate which Zang organ is affected.

[Collected Annotations]
Fang Youzhi stated: "Ze" (Investigate/Blame) means to seek. Obese people should have Deep pulses because their flesh is thick and the pulse is deep; thus, we look for pathology in the Floating aspect. Thin people should have Floating pulses because their flesh is thin and the pulse is shallow; thus, we look for pathology in the Deep aspect.

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Question: The Classics mention applying pressure equivalent to three or six beans (Shu). Is this valid? Master said: When pressing the pulse, a weight equivalent to three beans indicates Lung Qi; six beans indicates Heart Qi; nine beans indicates Spleen Qi; twelve beans indicates Liver Qi; pressing to the bone indicates Kidney Qi. Suppose a patient has diarrhea, and no pulse is felt at Cun, Guan, or Chi. However, if the Chi position occasionally shows a small pulse that re-emerges upon lifting, this indicates remaining Kidney Qi. If a Sun (Damaged) pulse appears, it is difficult to treat.

[Annotation]
This elaborates on the previous section regarding skin, vessels, muscle, tendon, and bone corresponding to the Five Zang organs. "Shu" means bean, used here to approximate weight, not literal beans. The *Nan Jing* states: Three beans' weight touching the skin corresponds to the Lung; six beans' weight touching the blood vessels corresponds to the Heart; nine beans' weight equal to muscle corresponds to the Spleen; twelve beans' weight equal to tendon corresponds to the Liver; pressing to the bone with a quick rebound corresponds to the Kidney. Each position corresponds to specific Zang Qi. Regarding Cun, Guan, and Chi: Left Cun is Heart, Right Cun is Lung, Left Guan is Liver, Right Guan is Spleen, Chi is Kidney. Here, the Kidney example illustrates the rest. Severe diarrhea depletes Yuan Qi; if no pulse is found anywhere, death is expected. Survival depends on the occasional small pulse at Chi. "Re-emerging" means beating four times per breath cycle (two per inhale, two per exhale). Four beats at Chi indicate the source of Vital Qi in the Kidneys is not exhausted; even if diarrhea persists, it is treatable. Two beats per breath is a Sun (Damaged) pulse, indicating Qi decline and lack of Stomach Qi, making it difficult to treat.

[Collected Annotations]
Cheng Zhi stated: The *Nan Jing*'s discussion of three/six beans refers to varying pressure depths to diagnose Five Zang Qi. Diarrhea with absent pulses at all positions indicates exhaustion of Stomach Yang Qi. The *Nan Jing* considers the Sun pulse as downward collapse of Yang Qi, hence difficult to treat.

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Cun Kou pulse: Floating indicates Exterior; Deep indicates Interior; Rapid indicates Fu (Organs); Slow indicates Zang (Viscera). Suppose the pulse is Slow; this indicates disease in the Zang.

[Annotation]
"Cun Kou" refers to the three positions collectively. This section uses Floating/Deep and Slow/Rapid to diagnose Exterior/Interior and Zang/Fu. Floating is felt at the skin level, indicating Exterior. Deep is felt at the bone/muscle level, indicating Interior. Rapid is six beats per breath, associated with Yang and Fu organs. Slow is three beats per breath, associated with Yin and Zang organs. A Slow pulse specifically points to Zang pathology, serving as an example for others.

[Collected Annotations]
Cheng Zhi stated: Outside the body, Ying/Wei constitute the Exterior; inside, Zang/Fu constitute the Interior, distinguished by Floating/Deep. While Yang generally relates to Fu and Yin to Zang, Slow/Rapid provides further distinction. Note that in Shanghan transmission, Rapid pulses can enter Zang, and Slow pulses can enter Fu; careful study of the classics will clarify this.

Zhang Lu stated: This uses Floating/Deep/Slow/Rapid to define Exterior/Interior/Zang/Fu, emphasizing "Slow indicates Zang." If a Floating-Slow pulse appears despite Exterior signs, one should use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) to harmonize, rather than Ma Huang Tang or Qing Long Tang, because the Zang Qi is inherently deficient.

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Yang pulse is Floating, Large, and Soft (Ru); Yin pulse is Floating, Large, and Soft (Ru). When Yin and Yang pulses are equal, it is named "Huan" (Moderate).

[Annotation]
This explains the Harmonious Moderate pulse through the equality of Yin and Yang. "Yang pulse" and "Yin pulse" refer to the pulse felt at Floating, Middle, and Deep pressures being equal. "Huan" refers to the Harmonious pulse. There are two meanings of Huan: 1. Shape: The pulse is forceful yet soft, neither too large nor too small, indicating harmony of Qi. 2. Frequency: The pulse beats four times per breath, leisurely and steady, indicating harmony of Stomach Qi.

[Collected Annotations]
Fang Youzhi stated: Huan has two meanings; here it refers to combined qualities, signifying peaceful Qi and Blood.

Cheng Zhi stated: Huan implies harmony and relaxation, similar to Floating/Large, but distinct from Slow. Hence the text says "Floating, Large, and Soft," not "Floating, Large, and Slow." Slow/Rapid refers to frequency; Huan/Tight refers to shape.

Zhang Lu stated: If the pulse is Floating, Large, and Soft but disappears completely upon heavy pressure, it is a Deficient (Xu) pulse, not a Huan pulse.

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Question: What does the Liver pulse of the East resemble? Master said: The Liver belongs to Wood, named Jue Yin. Its pulse is slightly String-like (Xian), Soft (Ru), Weak (Ruo), and Long. This is the Liver pulse. If a Liver disease patient presents with Ru/Ruo characteristics, they will recover. If a pure String-like pulse appears, death ensues. Why? Because the pulse is rigid like a string, indicating severe Liver damage.

[Annotation]
This section covers normal, pathological, and terminal pulses for the Five Zang organs across the four seasons. Liver corresponds to Wood and Spring wind. Its normal pulse should be String-like. A pulse that is slightly String-like, Soft, Weak, and Long indicates the presence of Stomach Qi (Wei Qi), representing a normal Liver pulse; recovery is likely. A pulse that is String-like and Long but lacks Soft/Weak moderation indicates "String-like with little Stomach Qi," a pathological Liver pulse. A pure, rigid String-like pulse lacking any Soft/Weak moderation indicates "Only String-like, no Stomach Qi," a terminal Liver pulse. The same logic applies to other organs (Heart, Lung, Kidney), though the text omits explicit mentions of "Pure Hong/Floating/Deep" for brevity.

[Collected Annotations]
Fang Youzhi stated: "Wei" (Micro) is not a pulse name itself but implies a slight String-like quality with Stomach Qi.

Wei Litong stated: Slightly String-like, accompanied by Soft/Weak, and combined with Long, reflects the gentle and elongated nature of Wood. This is the fundamental Liver pulse. If seen, even minor illness will heal. A pure String-like pulse resembles a dying tree—dry and hard—indicating death.

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Question: Why is it said that obtaining a Mao (Feather/Floating) pulse in the second month (Spring) predicts death in Autumn? Master said: In the second month, the pulse should be Ru (Soft) and Ruo (Weak). Obtaining a Mao (Floating) pulse instead indicates death in Autumn. The second month is governed by the Liver (Wood). The pulse should be Ru/Ruo. A Mao pulse belongs to the Lung (Metal). Metal overcomes Wood. Hence, death is predicted in Autumn. Apply this logic to other cases.

[Annotation]
The second month is Spring; Mao/Floating is an Autumn pulse. Obtaining an Autumn pulse in Spring predicts death in Autumn. In Spring, Liver Wood is prosperous; in Autumn, Lung Metal is prosperous. If a Lung (Metal) pulse appears when Liver (Wood) is strong, the Wood is already weakened. By Autumn, Metal becomes even stronger, overcoming the already weak Wood, leading to extinction. Hence, death is predicted. This logic applies to other Zang organs.

[Collected Annotations]
Fang Youzhi stated: This illustrates the principle of predicting life/death based on the Five Elements' interactions with seasonal pulse energies, providing a key diagnostic method.

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Question: What does the Heart pulse of the South resemble? Master said: The Heart belongs to Fire, named Shao Yin. Its pulse is Large/Hong (Hong), Large (Da), and Long. This is the Heart pulse. If a Heart disease patient presents with Hong characteristics, they will recover.