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Differentiation means distinction. Differentiating pulses refers to distinguishing the names of various pulse types. "Method" refers to the location, frequency (beats per respiration), and shape of various pulses; some are similar, while others are opposite, and each has its specific method for differentiation. Pulse names include those such as Floating (Fu, 浮), Deep (Chen, 沉), Slow (Chi, 迟), Rapid (Shu, 数), Slippery (Hua, 滑), and Choppy (Se, 涩). Location refers to positions such as Superficial (Fu, 浮), Middle (Zhong, 中), Deep (Chen, 沉), Upper (Shang, 上), and Lower (Xia, 下). Frequency refers to counts such as three beats per respiration for Slow (Chi, 迟) and six beats per respiration for Rapid (Shu, 数). Shape refers to characteristics such as smooth flow for Slippery (Hua, 滑) and stagnation for Choppy (Se, 塞). Similarity includes pairs like Wiry (Xian, 弦) and Taut (Jin, 紧), or Slippery (Hua, 滑) and Agitated (Dong, 动). Opposition includes pairs like Floating (Fu, 浮) and Deep (Chen, 沉), or Deficient (Xu, 虚) and Excess (Shi, 实). Pulses obtained by palpating the skin are called Floating (Fu, 浮); those obtained by palpating the sinews and bones are called Deep (Chen, 沉). These are named according to their vertical location; thus, all pulses named by location are categorized under Floating (Fu, 浮) and Deep (Chen, 沉). For instance, a Floating (Fu, 浮) pulse that is forceless is called Soft (Ruo, 濡); a Deep (Chen, 沉) pulse that is forceless is called Weak (Ruo, 弱); a Floating (Fu, 浮) pulse that is extremely forceful is called Drum-skin (Ge, 革); a Deep (Chen, 沉) pulse that is extremely forceful is called Firm (Lao, 牢); a pulse that is forceful at Superficial (Fu, 浮), Middle (Zhong, 中), and Deep (Chen, 沉) levels, and appears large upon pressure, is called Excess (Shi, 实); a pulse that is forceless at all three levels and appears large upon pressure is called Deficient (Xu, 虚); a pulse that is extremely forceless at all three levels, appears small, and seems present yet absent, is called Fine (Wei, 微); a pulse that is extremely forceless at all three levels, appears large, and is scattered and uncollected, is called Scattered (San, 散); a pulse that is forceful at Superficial (Fu, 浮) and Deep (Chen, 沉) levels but forceless at the Middle (Zhong, 中) level is called Scallion-stalk (Kou, 芤); a pulse that can only be felt by pressing to the bone and requires pushing to locate is called Deep/Hidden (Fu, 伏). These are named based on location combined with opposing shapes. Three beats per respiration are called Slow (Chi, 迟); six beats per respiration are called Rapid (Shu, 数). These are named by frequency; thus, all pulses named by frequency are categorized under Slow (Chi, 迟) and Rapid (Shu, 数). For example, four beats per respiration are called Moderate (Huan, 缓); seven beats per respiration are called Hasty (Ji, 疾); a Rapid (Shu, 数) pulse that occasionally stops is called Interrupted (Cuo, 促); a Moderate (Huan, 缓) pulse that occasionally stops is called Intermittent (Jie, 结); a pulse with regular frequency that stops during movement, cannot recover spontaneously, and resumes after a moment is called Replacement (Dai, 代). These are named by frequency combined with similarity. Smoothness like pearls is called Slippery (Hua, 滑); difficulty in advance and retreat with stagnation is called Choppy (Se, 涩). These are named by shape; thus, all pulses named by shape are categorized under Slippery (Hua, 滑) and Choppy (Se, 涩). A pulse with a coarse and large form is called Large (Da, 大); a pulse with a fine and small form is called Small (Xiao, 小); a pulse that extends long in both arrival and departure is called Long (Chang, 长); a pulse that is short in both arrival and departure is called Short (Duan, 短); a pulse that arrives vigorously and depares weakly is called Surging (Hong, 洪); a pulse shaped like a bean, trembling without moving, is called Agitated (Dong, 动); a pulse resembling a bowstring, straight and tense upon pressure, is called Wiry (Xian, 弦); a pulse coarser than Wiry (Xian, 弦), which rebounds against the fingers from side to side upon pressure, is called Taut (Jin, 紧). These are named by shape combined with similarity and opposition. This is the general principle of differentiating pulses. If practitioners can examine these in detail and expand their knowledge, they will master the methods. Now, we take Floating (Fu, 浮), Deep (Chen, 沉), Slow (Chi, 迟), Rapid (Shu, 数), Slippery (Hua, 滑), and Choppy (Se, 涩) as the main categories (Gang); and differentiate using Large (Da, 大), Small (Xiao, 小), Deficient (Xu, 虚), and Excess (Shi, 实) as sub-categories (Mu). This ensures that Yin-Yang, root and branch, deficiency-excess, and cold-heat are clearly understood in the mind, leading to accurate finger diagnosis, harmonious mind-hand coordination, and error-free syndrome differentiation and prescription.

Question: What does it mean that pulses have Yin and Yang? Answer: Pulses that are Large (Da, 大), Floating (Fu, 浮), Rapid (Shu, 数), Agitated (Dong, 动), and Slippery (Hua, 滑) are named Yang pulses. Pulses that are Deep (Chen, 沉), Choppy (Se, 涩), Weak (Ruo, 弱), Wiry (Xian, 弦), and Fine (Wei, 微) are named Yin pulses. In Yin diseases, the appearance of Yang pulses indicates survival; in Yang diseases, the appearance of Yin pulses indicates death.

[Annotation]
This section uses the Yin-Yang nature of pulses to determine the Yin-Yang prognosis of life and death in diseases. Floating (Fu, 浮), Large (Da, 大), Rapid (Shu, 数), Agitated (Dong, 动), and Slippery (Hua, 滑) are considered surplus compared to other pulses; since the Yang path involves surplus, they are called Yang. Deep (Chen, 沉), Choppy (Se, 涩), Weak (Ruo, 弱), Wiry (Xian, 弦), and Fine (Wei, 微) are considered deficient compared to other pulses; since the Yin path involves deficiency, they are called Yin. Yin disease refers to Yin-cold disease. Seeing Yang pulses means seeing Yang-heat pulses, i.e., Floating (Fu, 浮), Large (Da, 大), Rapid (Shu, 数), Agitated (Dong, 动), Slippery (Hua, 滑). If Yin disease presents with Yin pulses, the symptoms and pulse correspond, indicating inevitable death. If Yin disease presents with Yang pulses, it is like winter ending and spring arriving; although things do not immediately grow, vitality increases daily, hence survival. Yang disease refers to Yang-heat disease. Seeing Yin pulses means seeing Yin-cold pulses, i.e., Deep (Chen, 沉), Choppy (Se, 涩), Weak (Ruo, 弱), Wiry (Xian, 弦), Fine (Wei, 微). If Yang disease presents with Yang pulses, symptoms and pulse correspond, indicating survival. If Yang disease presents with Yin pulses, it is like summer leaving and autumn arriving; although things do not immediately die, they approach death daily, hence death. The principle of Heaven and humanity is one; Spring and Summer are Yang, Autumn and Winter are Yin; Yang governs generation, Yin governs destruction.

[Collected Annotations]
Fang Youzhi said: Yin and Yang here refer generally to Zang-Fu organs, Qi and Blood, Exterior and Interior, Deficiency and Excess, Wind-Cold, and Cold-Heat.
Cheng Zhi said: Yin disease presenting with Yang pulses leads to survival because the pathogenic factor moves from Interior to Exterior, seeking resolution through sweating. Yang disease presenting with Yin pulses leads to death because the pathogenic factor moves from Exterior to Interior, with righteous Qi deficient and pathogenic factor exuberant. Thus, when righteous Qi is substantial, Yang pulses are common; when righteous Qi is deficient, Yin pulses are common.

A pulse that is Moderate (Huan, 缓) and occasionally stops before returning is called Intermittent (Jie, 结); a pulse that is Rapid (Shu, 数) and occasionally stops before returning is called Interrupted (Cuo, 促). Exuberance of Yang causes Interrupted (Cuo, 促); exuberance of Yin causes Intermittent (Jie, 结). These are all pathological pulses.

[Annotation]
Moderate (Huan, 缓) refers to a pulse of four beats per respiration; an Intermittent (Jie, 结) pulse is one that is Moderate (Huan, 缓) and occasionally stops before returning. Rapid (Shu, 数) refers to a pulse of six beats per respiration; an Interrupted (Cuo, 促) pulse is one that is Rapid (Shu, 数) and occasionally stops before returning. Exuberance of Yang causes Interrupted (Cuo, 促); exuberance of Yin causes Intermittent (Jie, 结). Imbalance of Yin and Yang leads to disease, hence these are all pathological pulses.

A pulse that feels Moderate (Huan, 缓) upon pressure and occasionally stops before returning is called Yin Intermittent (Jie Yin, 结阴); furthermore, a pulse that stops during movement, returns slightly faster, and has a rebounding motion is also called Yin Intermittent (Jie Yin, 结阴); a pulse that stops during movement, cannot recover spontaneously, and then resumes is called Yin Replacement (Dai Yin, 代阴). Patients with these pulses will certainly be difficult to treat.

[Commentary]
The phrase "pulse feels Moderate (Huan, 缓) upon pressure, occasionally stops, named Yin Intermittent (Jie Yin, 结阴)" is grammatically awkward, and since the pulses of Cuo and Jie were already clarified earlier, this is likely a textual error or interpolation.

[Annotation]
A pulse with regular frequency that stops, cannot recover spontaneously, and then resumes is called Replacement (Dai, 代). This occurs because one Zang organ lacks Qi and seeks another Zang organ to substitute and continue the function. Any disease presenting with a Replacement (Dai, 代) pulse is difficult to treat. The stops in Cuo (Cuo, 促) and Jie (Jie, 结) pulses are like stumbling while walking fast; although they stop, they recover immediately, unlike the Replacement (Dai, 代) pulse.

When Yin and Yang contend, it is called Agitated (Dong, 动). Yang agitation causes sweating; Yin agitation causes fever. If the body is cold and the patient fears cold, this indicates injury to the Sanjiao (Triple Burner). If a Rapid (Shu, 数) pulse appears at the Guan (Middle) position, without head or tail above or below, about the size of a bean, trembling firmly, it is called Agitated (Dong, 动).

[Commentary]
The *Su Wen* states: "Yang added to Yin is called sweat." How can there be sweating if Yang is added to Yang? Therefore, "sweating" in "Yang agitation causes sweating" should be "fever"; and "fever" in "Yin agitation causes fever" should be "sweating".

[Annotation]
"Dong" (Agitated) means restless, referring to Yin and Yang mutually stimulating each other without peace. Dong is a Yang pulse. The Cun (Inch) position is Yang; when Yang attacks Yang, Yang agitation causes fever. The Chi (Cubit) position is Yin; when Yin attacks Yin, Yin agitation causes sweating. The Guan (Middle) position lies between Yin and Yang, so Yin and Yang mutually attack, causing both fever and sweating. This describes a Dong pulse that is forceful, indicating Yang exuberance. If it does not bulge upon pressure, it indicates Yang deficiency, manifesting as cold body without fever, and sweating with aversion to cold. This is not the Dong of Yang exuberance due to contention, but the Dong of Yang deficiency due to disturbance. Injury to the Yang Qi of the Sanjiao (Triple Burner) prevents external warming of the muscle layer, resulting in these symptoms. The shape of the Agitated (Dong, 动) pulse resembles the Rapid (Shu, 数) pulse, but lacks head and tail, is bean-sized, and trembles firmly, hence the name. "Jue jue" describes a trembling motion that seems rooted and immobile, unlike the flowing, non-abiding motion of the Slippery (Hua, 滑) pulse.

[Collected Annotations]
Fang Youzhi said: The Yin and Yang in "Yin and Yang contend" refers to the two Qi; the Yin and Yang in "Yang agitation" and "Yin agitation" refer to locations. The following text describes the fixed location and shape of the Agitated (Dong, 动) pulse, with "jue jue" describing the manner of emergence.
Cheng Zhi said: Yang rises and Yin descends, communicating above and below, moving between Chi (Cubit) and Cun (Inch) positions, resulting in harmony and tranquility. If Yang desires to rise but Yin is insufficient to harmonize and descend them, they contend. The pulse becomes Rapid (Shu, 数), and firm trembling appears at the Guan (Middle) position.

A pulse that is Floating (Fu, 浮) and Taut (Jin, 紧) is called Wiry (Xian, 弦). The Wiry (Xian, 弦) pulse resembles a bowstring and remains immovable upon pressure. The Taut (Jin, 紧) pulse resembles a twisting rope that changes constantly.

[Annotation]
A pulse that is Floating (Fu, 浮) and Taut (Jin, 紧) is called Wiry (Xian, 弦). This does not mean that Floating-Taut is exactly the Wiry pulse, but rather that Floating and tense/tight constitutes the state of Wiry. Wiry and Taut are similar; to prevent confusion between them, they are presented together for comparison. Wiry resembles a bowstring, immovable upon pressure, i.e., straight. Taut resembles a twisting rope, i.e., not straight. Straightness precludes twisting; twisting precludes straightness. However, both are tense and urgent, hence they are similar.

[Collected Annotations]
Fang Youzhi said: This clarifies the distinction between Wiry and Taut. "Immovable upon pressure" means like a string stretched on a bow, fixed and unmovable. "Twisting rope changing constantly" means rotating left and right without constraint.
Cheng Zhi said: Taut indicates exuberant cold pathogens; it has a sense of rotation and urgency within its straightness and thinness, hence likened to a twisting rope.
Zhang Xiju said: The distinction between Wiry and Taut lies in whether it moves or not!

A pulse that is Wiry (Xian, 弦) and Large (Da, 大): Wiry indicates reduction; Large indicates Empty (Kou, 芤). Reduction indicates Cold; Empty indicates Deficiency. Cold and Deficiency contend, this is called Drum-skin (Ge, 革). In women, it indicates spontaneous abortion and continuous bleeding; in men, it indicates loss of blood and essence.

[Annotation]
A pulse form that is coarse and large with force is called Large (Da, 大). A pulse that is forceful at Floating (Fu, 浮) and Deep (Chen, 沉) levels but forceless at the Middle (Zhong, 中) level, resembling a scallion stalk, is called Empty (Kou, 芤). A pulse that is Deep (Chen, 沉) and large, forceful and tense upon pressure, is called Firm (Lao, 牢). A pulse that is Floating (Fu, 浮) and large, forceful and tense upon light pressure, is called Drum-skin (Ge, 革). Drum-skin is named after a drum cover, representing an exterior tense and interior hollow image. Wiry implies tension; reducing the tension at the middle level creates the exterior tense image. Large implies solidity; reducing the solidity at the middle level creates the interior hollow image. This uses the Wiry-reduction and Empty-deficiency pulses to describe the Drum-skin pulse. Women presenting with this pulse suffer spontaneous abortion and leakage; men suffer blood loss and essence depletion, due to the contention of Cold and Deficiency.

[Collected Annotations]
Cheng Zhi said: This describes a Wiry and vacuously Large pulse. Wiry indicates reduction, meaning Yang Qi is reduced leading to Cold. Large indicates Empty, meaning it resembles the hollow center of a Drum-skin pulse and is Deficient. Contention of Deficiency and Cold causes leakage of essence and blood, hence the Drum-skin image.

Question: What are the "Mutilating and Robbing" (Can Zei) pulses? Master said: There are Wiry (Xian, 弦), Taut (Jin, 紧), Floating (Fu, 浮), Slippery (Hua, 滑), Deep (Chen, 沉), and Choppy (Se, 涩) pulses. These six pulses are called Mutilating and Robbing (Can Zei), as they can cause pathology in other pulses.

[Annotation]
The following sections discuss diagnoses where Mutilating and Robbing pulses cause disease. Pulses of mutual overcoming indicate deficient righteous Qi, where the pathogen attacks the deficient area. Mutilating and Robbing pulses indicate excess pathogenic Qi, where the strong pathogen tyrannizes. These six pulses are called Mutilating and Robbing; "Mutilating" implies open injury, "Robbing" implies secret invasion. Their presence in the pulse indicates excess pathogenic factors. Regardless of the position, if any of these pulses appear alongside the primary pulse, one must guard against the arrival of pathogens.

[Collected Annotations]
Fang Youzhi said: "Other pulses" refers to pulses at various positions. "Zuo" means arise. It means that if these six appear within the pulses of various positions, they can all initiate pathology in those positions.
Zhang Xiju said: "Can" means mutilation; "Zei" means robbery/harm. It means these six pulses can secretly harm the meridians, Qi, and Blood, like a robber harming someone unnoticed, hence they can cause pathology in other pulses.

When Cun Kou pulses are both Yin and Yang Tight (Jin, 紧), the method dictates that Clear Pathogens invade the Upper Jiao, and Turbid Pathogens invade the Lower Jiao. Clear pathogens invading above are called Clean (Jie, 洁); Turbid pathogens invading below are called Muddy (Hun, 浑). When Yin is invaded by pathogens, internal shivering occurs; because Exterior Qi is slightly deficient and Interior Qi does not hold, pathogens invade Yin. When Yang is invaded by pathogens, fever, headache, neck stiffness, cervical spasm, lower back pain, and leg soreness occur. This is known as Yang being invaded by mist and dew, hence Clear Pathogens invade above. Turbid pathogens invading below cause Yin Qi to shiver, cold feet and knees, and inappropriate urination/defecation. Exterior Qi is slightly deficient, Interior Qi is slightly urgent, Sanjiao is confused, Interior and Exterior are blocked. Upper Jiao is stagnant, Zang Qi薰 (smokes/fumes), causing mouth ulcers and gum erosion. Middle Jiao fails to regulate, Stomach Qi rushes upward, Spleen Qi fails to transform, the Stomach becomes turbid, Ying and Wei do not communicate, and Blood congeals and fails to flow. If Wei Qi communicates first, urine becomes red and yellow; contending with Heat, acting as a vehicle for Heat, it wanders through meridians, entering and exiting Zang-Fu organs. Where Heat passes, abscesses and pus form. If Yin Qi communicates first, Yang Qi is severely deficient, Yin has no use, external pathogens enter internally, sneezing expels them, voice is hoarse, throat is blocked, Cold and Reversal press each other,擁 (surrounded) by Heat, Blood congeals and flows out from below, resembling pig liver. Both Yin and Yang are reversed, Spleen Qi is isolated and weak, Five Fluids pour downward, Lower Jiao fails to close, clear stool feels heavy, frequent and difficult defecation occurs, umbilical colic and shallow pain arise, life is hard to preserve.

[Annotation]
"Cun Kou Yin and Yang both Tight" means all six pulses are Tight at both Floating and Deep levels. Floating-Tight indicates Mist-Dew pathogens invading the Upper Jiao; Deep-Tight indicates Cold pathogens invading the Lower Jiao. Upper Jiao refers to the Taiyang channel; Lower Jiao refers to the Shaoyin channel. Mist-Dew pathogens, called Clean/Clear, invade above, causing fever, headache, neck stiffness, cervical spasm, lower back pain, and leg soreness, indicating Mist-Dew pathogens invading the Taiyang Exterior. Cold pathogens, called Muddy/Turbid, invade below, causing Yin Qi shivering, cold calves, and inappropriate urination/defecation, indicating Cold pathogens invading the Shaoyin Interior. The Classics state: Deficient pathogens cannot injure alone; they must encounter bodily deficiency to lodge. Generally, because Exterior Qi is deficient and Interior Qi is insecure, Clear and Turbid pathogens injure Above and Below, confusing Sanjiao, blocking Interior and Exterior. This leads to improper circulation of Clear Qi in the Upper Jiao, pathogenic stagnation, fuming with Zang Qi, causing mouth ulcers and gum erosion. Middle Jiao fails to regulate; Stomach Qi should descend but rushes up; Spleen Qi should transport but fails to turn; Middle Jiao becomes turbid, Ying and Wei do not communicate, and Blood congeals and fails to circulate. If Righteous Qi overcomes Pathogenic Qi, and Wei Qi communicates first, urine becomes red and yellow; Heat-injured meridians cause blood coagulation and flesh rot, emerging externally as abscesses and pus. If Ying Qi communicates first, sneezing, hoarseness, and throat blockage occur; Heat-surrounded congealed blood flows out from below, resembling pig liver. If Righteous Qi fails to overcome Pathogenic Qi, Yin and Yang are both reversed, Ying and Wei do not communicate, Spleen Qi is isolated and weak, failing to scatter essence, Five Fluids pour downward, Lower Jiao fails to close, abdominal urgency and dragging pain occur, frequent and窘迫 (urgent/difficult) defecation arises, life is hard to preserve.

[Collected Annotations]
Shen Liangchen said: In Typhoid disorders, turning to Heat is auspicious; thus, Shaoyin and Jueyin recover with fever. Downward discharge of pus/blood and external abscesses are not fatal. If Yin and Yang are both reversed, reversal leads to diarrhea; thus, Five Fluids pour downward, Lower Jiao fails to close, and life is hard to preserve.
Fang Youzhi said: Clear refers to Wind, Turbid refers to Cold; Clean and Muddy refer to biased Qi of Heaven and Earth. From "Yin invaded by pathogens" to "Turbid pathogens invade below" explains that Yin is Lower Jiao and Yang is Upper Jiao. From "Yin Qi shivers" to "Blood congeals and fails to flow" describes symptoms. From "If Wei Qi communicates first" explains the cause of abscess formation. From "If Yin Qi communicates first" explains the cause of pus-blood diarrhea. Wei Qi is Yang Qi; Ying Qi is Yin Qi, continuing from "Ying and Wei do not communicate," revealing why Clear and Turbid cause disease. From "Yin and Yang are both reversed" describes symptoms worsening in the Interior, hence "life is hard to preserve."

When Yin and Yang pulses are both Tight, leading to vomiting and diarrhea, if the pulse alone does not resolve, and the Tightness disappears and the person is at ease, this indicates impending resolution. If the pulse becomes Slow until the sixth or seventh day, and the person does not desire food, this is late onset, due to Water retention, indicating unresolved condition. If food desire returns, it indicates impending resolution.

[Commentary]
"Tightness disappears, person is at ease" - the character "Ru" (Enter) should be "Ren" (Person). "Person at ease" means no vomiting or diarrhea; this is likely a transcription error. The sentences "This is late onset, due to Water retention" do not fit the context and are likely interpolations.

[Annotation]
This elaborates on the meaning of Yin and Yang pulses both Tight, indicating severe Cold in Interior and Exterior, leading to vomiting and diarrhea, and whether they resolve. If the pulse remains Tight after vomiting and diarrhea, it indicates incomplete expulsion of pathogens and unresolved condition. If Tightness disappears and the pulse becomes Moderate, it indicates complete expulsion of pathogens, person is at ease, and resolution is impending. If Tightness disappears and the pulse becomes Slow, and until the sixth or seventh day the person does not desire food, the Stomach is not harmonized, indicating unresolved condition. If the person desires food, the Stomach is harmonized, and even with a Slow pulse, resolution is impending.

[Collected Annotations]
Cheng Wuji said: Yin and Yang pulses both Tight indicate severe Cold above and below. After vomiting and diarrhea, if the Tight pulse persists, the pulse alone does not resolve. If Tightness disappears, the person is at ease, indicating impending resolution.

At Cun Kou, if the pulse is Floating and Large: Floating indicates Deficiency, Large indicates Excess. At the Chi (Cubit) position, it is Guan (Obstruction); at the Cun (Inch) position, it is Ge (Rejection). Guan means inability to urinate; Ge means vomiting and regurgitation.

[Annotation]
Standard pulse diagnosis uses Interior/Exterior to assess Guan and Ge; this text uses Cun/Chi positions to assess Guan and Ge. From this, we infer that extreme Excess of Yin and Yang all lead to Guan Ge disease, not necessarily limited to Interior/Exterior or Cun/Chi. At Cun Kou, Floating and Large: Floating indicates deficient Righteous Qi, Large indicates exuberant Pathogenic Qi. At Chi, Yin Pathogen is Excess, obstructing Righteous Qi from circulating, named Guan (Obstruction), leading to inability to urinate. At Cun, Yang Pathogen is Excess, rejecting Righteous Qi from transforming, named Ge (Rejection), leading to vomiting and regurgitation.

[Collected Annotations]