Library

(Cunkou, also known as Qikou [Pulse Gate], internally comprises three positions: Cun [Inch], Guan [Bar], and Chi [Cubit]. Explanations are provided below.)

The *Suwen* (Basic Questions) chapter "Maiyao Jingwei Lun" (Treatise on the Essential Subtleties of Pulse Diagnosis) states: "On both sides inside the Chi position corresponds to the Ji Xie [lower ribs]." (Ji Xie refers to the lower ribs. The Zang-Fu organs governed by the Chi position correspond to the lateral aspects of the body, specifically the Ji Xie. Since the Liver is inspected at the Guan position and governs the hypochondrium, the Kidney, inspected at the Chi position, should govern the Ji Xie.) The outer aspect of the Chi position inspects the Kidneys, (Outer refers to superficial palpation/Floating pulse technique.) while the inner aspect inspects the abdomen. (Inner refers to deep palpation/Sinking pulse technique. The terms inner and outer follow this pattern in subsequent texts.) The middle part connects upwards, (Referring to connecting above the Chi position and occupying the center, i.e., the Guan position.) the left hand's (Left Guan) outer aspect inspects the Liver, and the inner aspect inspects the Diaphragm (Diaphragm is defined as the area between the chest and the abdomen.); the right hand's (Right Guan) outer aspect inspects the Stomach, and the inner aspect inspects the Spleen. The upper part connects upwards, (Referring to connecting above the middle part and occupying the top, i.e., the Cun position.) the right hand's (Right Cun) outer aspect inspects the Lungs, and the inner aspect inspects the Chest Center; the left hand's (Left Cun) outer aspect inspects the Heart, and the inner aspect inspects the Dan Zhong [Sea of Qi/Pericardium region] (Dan Zhong is the Pericardium, located between the two breasts, also called Qi Hai. According to the text, the Heart, Lungs, Liver, and Kidneys are Zang organs but are inspected on the outer aspect; the Chest Center, Dan Zhong, Diaphragm, and Abdomen are areas enclosing these Zang organs but are inspected on the inner aspect. This may be a transcription error. It should follow the example of 'Stomach outer, Spleen inner,' swapping their positions for correctness.) The anterior aspect (referring to Cun) inspects the front of the body, (Front refers to the face/anterior body.) while the posterior aspect (referring to Chi) inspects the back of the body. (Back refers to the dorsal body. This divides the inspection of the body's anterior and posterior surfaces. Subsequent divisions regarding upper and lower body parts refer to the physical trunk, contrasting with the previous division regarding Zang-Fu organs.) "Upper reaching the extreme" (Jing means extremity/end), refers to matters in the chest and throat, (Head and face conditions can be inferred from this.) while "lower reaching the extreme" refers to matters in the lower abdomen, waist, thighs, shins, and feet. (This implies that the Cun position does not exclusively inspect the chest, nor does the Chi position exclusively inspect the abdomen.)

According to the *Neijing*, meridians run deeply within the muscle intervals and are invisible; what is commonly seen are the collateral vessels. Only the meridian of the Hand-Taiyin Lung emerges externally at the Cunkou, which is the reason for exclusively diagnosing the Cunkou. Later generations followed this principle, seeking pulse information solely from the Cunkou. The ancient diagnostic method dividing the body into three regions and nine locations is no longer practiced.

"Cunkou" is named by combining the Cun, Guan, and Chi positions. What are Cun, Guan, and Chi? The answer is: From the transverse crease at the elbow to the transverse crease at the Yuji point, the length is one chi and one cun. However, the actual area used for pulse diagnosis is only 1.9 cun long. It falls short of the Yuji transverse crease by one fen at the front and falls short of the elbow transverse crease by nine cun at the back. Ancient people divided this 1.9 cun into three sections. The lower section lies within the chi range, hence named Chi; the upper section lies within the cun range, hence named Cun; the middle section is the junction of upper and lower, the place where Yin and Yang enter and exit, hence named Guan. Why is Cunkou also called Qikou? Because it is the location of the Lung Meridian, and the Lung is the master of Qi, thus it is called Qikou [Qi Gate], also known as Maikou [Pulse Gate]. Question: The human body has Zang and Fu organs. Why do we only inspect the five Zang organs here, while the six Fu organs are only represented by the Stomach? Answer: The *Neijing* originally used the Renying point to inspect Yang and the Qikou to inspect Yin. Fu organs belong to Yang and Zang organs to Yin; therefore, these five Zang organs are inspected at the Qikou. The reason for additionally inspecting the Stomach is that the Qi of the five Zang organs is derived from the Stomach. The Qi of the Zang organs cannot reach the Hand-Taiyin Lung meridian on its own; it must arrive via Stomach Qi. Therefore, Stomach Qi must be examined concurrently.

Question: Where should the Gallbladder, Bladder, Large Intestine, Small Intestine, Mingmen [Gate of Life], and Sanjiao [Triple Burner] be inspected? Answer: The *Neijing* provides no explicit text, leading to varied theories among later scholars. Some argue that the Small Intestine, being interior-exterior related to the Heart, follows the Heart and is inspected at the Left Cun; the Large Intestine, interior-exterior related to the Lungs, follows the Lungs and is inspected at the Right Cun. (This theory comes from the *Nanjing*, not Gao Yangsheng.) Others state that the Small Intestine is inspected at the Left Chi and the Large Intestine at the Right Chi. Still others argue that the Small Intestine belongs to Bing Fire and should be inspected at the Right Chi following the Fire of Mingmen; the Large Intestine belongs to Geng Metal, and since the mother hides in the child's womb, it should be inspected at the Left Chi following the Water of the Left Kidney. These three theories differ, but most modern practitioners follow the latter two. Since the Small and Large Intestines are in the abdomen and positioned very low, and the *Neijing* states that the inner Chi inspects the abdomen, they should be inspected at the Chi position, not at the Cun position along with the high-positioned Heart and Lungs. I believe that Zang and Fu organs can influence each other (e.g., Heart heat transferring to the Small Intestine causing red urine and constipation, which obstructs Lung Qi). Since they are interconnected above and below, inspecting them at the Cun position is also acceptable. Moreover, although the two intestines are located low, their meridians ascend. Thus, inspecting the meridians at the Cun and the Fu organs at the Chi, the first theory should not be discarded. For instance, when the Bladder Fu is in the lower abdomen but Cold damages the Taiyang meridian, all six pulses become Floating; how could it be limited to the Left Chi alone? When the Stomach Fu is central but pathogenic factors are in the Yangming meridian, all six pulses become Large; how could it be limited to the Right Guan alone? How can one be so rigid? Among the latter two theories, assigning the Small Intestine to the Left and Large Intestine to the Right is correct. This is because Zang-Fu pairing is based on meridian connection; connection leads to pairing, and pairing gives rise to designations like Geng Metal and Bing Fire. Names should match reality, so one should follow the actual connections and pairings for left-right assignment.

The Gallbladder is inspected at the Left Guan together with the Liver, and the Bladder at the Left Chi together with the Left Kidney, without any dissent. However, there are conflicting views on what the Right Chi inspects. Some claim that the Sanjiao, Mingmen, and Right Kidney are distinct entities all inspected at the Right Chi. Others argue that the Right Kidney is the Mingmen and they are inspected together. Opinions vary widely. (The *Nanjing* states there are two kidneys: the left is the Kidney belonging to Water, and the right is the Mingmen belonging to Fire. Later scholars criticized this, arguing that the left kidney is Form-Water and the right is Qi-Water, both belonging to Water, and the Mingmen is located between the two kidneys. Although these two views differ, both acknowledge that the Kidneys contain both Water and Fire, and the fire-tonifying herbs used are similar, so distinction is unnecessary.) I believe that the Right Chi needs only to inspect the Mingmen, without needing to separately list the Sanjiao or Right Kidney. Why? If Sanjiao is considered in terms of location, it corresponds to the Chest Middle, Diaphragm Middle, and Abdomen Middle mentioned in the classics. If considered in terms of Yuan Qi [Original Qi], it is simply the True Fire of the Mingmen. This fire resides in the Mingmen and spreads through the Sanjiao, taking different names depending on the organ it activates. Are there really two fires? Thus, speaking of the Chest, Diaphragm, and Abdomen is speaking of the Sanjiao's locations; speaking of the Mingmen is speaking of the Sanjiao's Original Yang. The name Sanjiao becomes redundant. Since both kidneys belong to Water, they should be unified under the Left Kidney, making the name Right Kidney unnecessary. Furthermore, Mingmen represents Fire Qi, centered and leaning right. Yang generates Yin, and Qi transforms Water. Inspecting the Fire Qi of the Mingmen is equivalent to inspecting the Water Source of the Right Kidney, further rendering the name Right Kidney unnecessary. Essentially, the Left Chi inspects the Pre-Heaven True Yin, and the Right Chi inspects the Pre-Heaven True Yang. All rivers return to one sea; a thousand lamps share one flame. Why establish multiple names to cause confusion?

Question: What are the positional relationships of the Zang and Fu organs? Answer: Fu organs are Yang and Zang organs are Yin. Yang pulses float and Yin pulses sink; this is an immutable principle. The *Nanjing* states that a weight of three beans corresponds to the Lung pulse; therefore, inspecting the Chest Center requires less pressure than three beans. A weight of six beans corresponds to the Heart pulse; therefore, inspecting the Dan Zhong requires less pressure than six beans. A weight of nine beans corresponds to the Spleen pulse; therefore, inspecting the Stomach requires less pressure than nine beans. Additionally, the Chest Center and Dan Zhong both belong to the Upper Jiao and are inspected at both Cun positions; the Abdomen belongs to the Lower Jiao and is inspected at both Chi positions; therefore, the Diaphragm Middle, belonging to the Middle Jiao, should be inspected at both Guan positions. However, this is merely theoretical. In practice, how can one be so rigid? Although positions are divided, Qi and pulses are actually continuous. The three positions of the Cunkou span only about one cun. Apart from differences in floating/sinking and large/small qualities, other pulse characteristics like slow/fast are generally similar. One never sees a Slow pulse at Cun and Fast at Guan, or Slippery at Cun and Choppy at Chi. If all six pulses are Fast, can one conclude that all Zang and Fu organs are hot? One must instead rely on the principles that Heart and Lung pulses are Floating, Liver and Kidney pulses are Sinking, and Spleen and Stomach pulses are intermediate, to determine which specific Zang or Fu organ is affected. (See detailed explanations in the section on Pulse Correspondence with Four Seasons and Five Zang Organs.) If the manual pressure is slightly off, one might mistake Fu for Zang or Zang for Fu. Even if accurate, a Floating pulse indicates exterior disease but also interior deficiency; a Sinking pulse indicates internal pathogens but also sinking of Yang. Whether it is Deficiency Heat or Excess Heat, internal or external etiology, how can one distinguish finely without integrating the Four Diagnostic Methods? Relying solely on these limited positional distinctions is akin to gluing the bridge of a zither before playing it. (For example, if cold food stagnates in the Stomach, all six pulses may be Slow; if the Lung is scorched by Fire, all six pulses may be Fast. Limiting findings strictly to Right Guan or Right Cun and demanding strict boundaries is overly rigid.) Question: You stated that if the six pulses are Fast, they are all Fast; if Slow, they are all Slow. But the Classics mention the Seven Diagnoses, stating that isolated Smallness, Isolated Largeness, Isolated Speed [Fast], Isolated Slowness, Isolated Heat, Isolated Cold, and Isolated Depression [Sinking/Unrising] indicate disease. Is this statement incorrect? Answer: This refers to the Three Regions and Nine Locations method, not the Cunkou method. (Note: Even applying this to Cunkou is valid; e.g., if a Fast pulse is found accompanied by Floating quality localized at the Cun position, it is called Cun-Fast. The distinction becomes clear when reviewing the section on distinguishing Heart and Lung Floating pulses.)