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Pulse diagnosis is typically performed at dawn, when Yin qi has not yet stirred, Yang qi has not yet dispersed, food and drink have not been ingested, the meridians are not yet full, the collaterals are harmonious and even, and Qi and Blood are not yet chaotic. Only then can abnormal pulses be diagnosed. (Dawn is the time of transition between Yin and Yang. Yang governs the day, Yin governs the night; Yang governs the exterior, Yin governs the interior. The Ying-Wei Qi (Nutritive and Defensive Qi) of the human body circulates fifty times through the body in a day and night. During the day, it travels through the Yang aspects; at night, through the Yin aspects. By dawn, it converges again at the Cun Kou (Inch Port). The Cun Kou is the great assembly of pulses, the beginning and end of the Zang-Fu organs of the five Zang and six Fu. The pulse is the precursor of Qi and Blood. When abundant, the pulse is abundant; when deficient, the pulse is deficient; when hot, the pulse is rapid; when cold, the pulse is slow; when faint, the pulse is weak; when balanced, the pulse is harmonious. Tall people have long pulses, short people have short pulses; those with an irritable temperament have tense pulses, those with a calm temperament have relaxed pulses. These are all normal. Deviations indicate abnormal pulses.) Palpate the movement and stillness of the pulse, observe the clarity of the eyes, examine the five colors, inspect the five Zang organs, assess excess and deficiency, the strength and weakness of the six Fu organs, and the flourishing or declining state of the physique. By synthesizing these observations, one can determine the boundary between life and death. ("Palpate" refers to pressing and exploring with fingers. Palpating the pulse's movement and stillness diagnoses Yin and Yang. Observing the clarity of the eyes diagnoses Shen Qi (Spirit Qi). Examining the changes in the five colors diagnoses the generation and restriction cycles, pathogens, and righteous Qi. Inspecting the deficiency and excess of the Zang-Fu diagnoses internal conditions; distinguishing the flourishing or declining appearance diagnoses external conditions. Therefore, any physician diagnosing illness must combine pulse and color, seeking truth through internal and external synthesis. Thus, the conditions of Yin/Yang, interior/exterior, excess/deficiency, and cold/heat will be revealed, and treatments regarding priority, urgency, authenticity, and deviation will be error-free. Hence, one can determine life and death, let alone disease. "Can Wu" means comparing three things is "Can," and classifying five things is "Wu." It involves searching for the hidden and subtle, understanding changes, and exhausting numerical principles.) The inner side of the Chi position corresponds to the Ji Xie (hypochondriac region). (The "Chi Nei" refers to the area behind the Guan. The area before the Guan is called Cun, and behind is called Chi, hence "Chi Nei." Ji Xie refers to the lower ribs, located on both sides below the hypochondrium, close to the Kidneys. Thus, everything below the Ji Xie is governed by the Chi position. Relative to the Cun, although there are many arterial points in the body, only this Qi Kou, consisting of three positions totaling one cun and nine fen, is collectively called "Cun Kou." Separately, the outer part is the Cun position, and the inner part is the Chi position. The outer is Yang, so the Cun takes nine fen, which is a Yang number. The inner is Yin, so the Chi takes one cun, which is a Yin number. The front of the Guan is "Cun," the back is "Chi." The front of the Cun is "Yu Ji," and the back of the Chi is "Chi Ze." The Guan itself lies between the Cun and Chi, serving as the boundary between Yin and Yang, located exactly at the high bone behind the palm. Therefore, nine fen are taken within the Cun, and one cun within the Chi, conforming to the numbers of Yang Nine and Yin Ten.) The outer aspect of the Chi position候 (observes/diagnoses) the Kidney, and the inner aspect of the Chi position observes the abdomen. (Chi Wai refers to the anterior half of the Chi pulse. Chi Li refers to the posterior half of the Chi pulse. The anterior observes Yang, and the posterior observes Yin. The back of the body is Yang, and the Kidneys attach to the back, so the outer aspect observes the Kidneys. The abdomen is Yin, so the inner aspect observes the abdomen. The term "abdomen" here includes the Large Intestine, Small Intestine, Bladder, and Ming Men (Gate of Vitality). Other positions distinguish left and right, but this one does not because both Chi positions govern the Kidneys.) Moving up from the middle attachment, the left outer aspect observes the Liver, and the inner aspect observes the Diaphragm. ("Zhong Fu Shang" refers to the position attached above the Chi and situated in the middle, i.e., the Guan pulse. Left Wai refers to the anterior half of the left Guan, and Nei refers to the posterior half. The Liver is a Zang organ that is Yin within but Yang in nature, and it is also near the back, so the outer aspect observes the Liver and the inner aspect observes the Diaphragm. Mentioning the Diaphragm encompasses the diaphragmatic membrane and the Gallbladder in the Middle Jiao.) The right outer aspect observes the Stomach, and the inner aspect observes the Spleen. (The anterior part of the right Guan observes the Stomach, and the posterior part observes the Spleen. The Spleen and Stomach are officials of the Central Plain. In terms of exterior-interior relationship, the Stomach is Yang and the Spleen is Yin, so the outer aspect observes the Stomach and the inner aspect observes the Spleen. The Cun Kou belongs to the Hand Taiyin Lung Meridian. Taiyin distributes Qi to the Three Yin meridians and governs the Five Zang organs via the hand. The Stomach is also a Fu organ. Its mention here implies that the Qi and flavor of all Zang and Fu organs originate from the Stomach and manifest at the Qi Kou, leaving nothing unseen.) Moving up further, the right outer aspect observes the Lungs, and the inner aspect observes the Chest Center. ("Shang Fu Shang" refers to moving up again, i.e., the Cun pulse. Among the Five Zang organs, the Lung is the highest. Thus, the anterior part of the right Cun observes the Lungs, and the posterior part observes the Chest Center. The Chest Center refers to everything above the diaphragm.) The left outer aspect observes the Heart, and the inner aspect observes the Tan Zhong (Chest Center/Epicenter). (Both the Heart and Lungs reside above the diaphragm. Thus, the anterior part of the left Cun observes the Heart, and the posterior part observes the Tan Zhong. Tan Zhong is located between the two breasts, known as the Sea of Qi, corresponding to the residence of the Pericardium. The anterior observes the anterior, and the posterior observes the posterior. This reiterates and clarifies the meanings of upper/lower and interior/exterior. Generally speaking, Cun is anterior and Chi is posterior; specifically, the upper half is anterior and the lower half is posterior. This indicates observing the upper with the upper and the lower with the lower.) The end of the Cun pulse extending upwards relates to matters of the chest and throat; the end of the Chi pulse extending downwards relates to matters of the lower abdomen, waist, thighs, knees, shins, and feet. ("Jing" means end. Extending upwards to the end corresponds to the Yu Ji point in the pulse and the chest/throat in the body. Extending downwards to the end corresponds to the Chi position in the pulse and the lower abdomen/feet in the body. This describes the upper and lower pulse observations. First, the Chi Nei is mentioned, then the Zhong Fu Shang becomes the Guan, and finally the Shang Fu Shang becomes the Cun. All proceed from inside to outside. Because the Taiyin meridian travels from the chest to the hand, using Chi as the root and Cun as the branches. Therefore, a person's pulse may have roots without branches, but should not have branches without roots. By examining the slackness/tightness, floating/sinking, slippery/choppy nature of the Chi pulse, and the firmness/brittleness of the flesh, the pathology is determined. This emphasizes the root. Again, "Shang Jing Shang" refers to chest/throat matters, and "Xia Jing Xia" refers to lower abdomen/foot/knee matters. Clearly, upper observes upper, lower observes lower. This is an unchangeable principle. Later pulse classics offer confused and forced explanations, which are very erroneous.) One exhalation causes the pulse to beat twice, and one inhalation also causes it to beat twice. At the pause between breaths, the pulse beats five times. Occasionally, a longer sigh-like breath occurs, termed "Ping Ren" (Normal Person). A Ping Ren is someone who is not ill. (Exhaling is Hu, inhaling is Xi. Together, one Hu and one Xi are called Xi. "Dong" means beat. "Zai Dong" means two beats. The normal pulse beats twice per exhalation and twice per inhalation. "Hu Xi Ding Xi" refers to the moment when one breath ends and the next has not yet begun. The pulse beats once more, hence five beats. "Run" means surplus, like a leap month. It means that besides normal breathing, there is occasionally a particularly long breath, causing the pulse to exceed five beats. This is the standard for a healthy, non-ill person. Counting the pauses and long breaths, approximately six beats occur per breath cycle, and during the pause, the pulse moves six cun, meaning one beat equals one cun.) Usually, the pulse of the healthy is used to calibrate the patient. Since the doctor is healthy, they use their own steady breath to calibrate the patient's pulse as a method. (Those who are not ill have even breathing; those who are ill have irregular breathing. The doctor, being healthy, can use their even breath to calibrate the patient. This is the method of calibration.) If one exhalation causes the pulse to beat once, and one inhalation causes it to beat once, it is called "Shao Qi" (Deficient Qi). (The pulse is the pathway for Blood and Qi, and its operation depends on Qi. If the pulse beats once per exhalation and once per inhalation, it is two beats per breath, half the normal rate. This indicates exhaustion of Righteous Qi, hence "Shao Qi," also called "Li Jing" (Departure from the Classic norm).) If one exhalation causes the pulse to beat three times, and one inhalation also three times, and it is restless, with heat in the Chi position, it is a Warm Disease. If the Chi is not hot but the pulse is slippery, it is a Wind Disease. If the pulse is choppy, it is Bi Syndrome. (If not due to pauses or long breaths, three beats per exhalation and inhalation mean six beats per breath, also called "Li Jing." "Zao" means rapid and urgent. "Chi Re" means heat in the Chi area near the arm, implying whole-body heat. Rapid, restless pulse with body heat indicates Warm Disease. Rapid, slippery pulse without Chi heat indicates excess Yang pathogen, indicating Wind Disease. However, Wind pathogens vary and are not limited to the surface, hence no Chi heat. Choppy pulse indicates disordered Blood, indicating Bi Syndrome. Slippery means not choppy, flowing smoothly; choppy means not slippery, like rain soaking sand. Slippery indicates excess Blood and stagnant Qi; choppy indicates stagnant Qi and deficient Blood.) If one exhalation causes the pulse to beat four times or more, it indicates death. If the pulse ceases completely, it indicates death. If the pulse is intermittently slow and fast, it indicates death. (Four beats per exhalation mean eight beats per breath, and more than that. This is called "Duo Jing" (Depletion of Essence). Four beats indicate depletion of essence, five indicate death, six indicate the end of life. All are four beats per exhalation or more, hence death. Complete cessation of the pulse indicates exhaustion of Yuan Qi (Original Qi). Intermittent slowness and speed indicate chaos and loss of control in Yin and Yang. Both are death pulses.) In one day and night, the Qi circulates fifty times to nourish the essence of the Five Zang organs. Those who do not conform to this number are called "Kuang Sheng" (Madly Born/Unstable Life). ("Ying" means to operate/circulate. The meridians circulate fifty times in a day and night to nourish the essence of the Five Zang organs. The total length of the twenty-eight meridians throughout the body is sixteen zhang and two chi. Zong Qi (Gathering Qi) accumulates in the chest, governing respiration and moving through the vessel tunnels. One exhalation moves three cun, one inhalation moves three cun, and at the pause, six cun. Based on six cun per breath, in one day and night (13,500 breaths), the Qi circulates fifty times, covering 810 zhang. Those whose circulation is excessive or insufficient and does not match this number are called "Kuang Sheng." Kuang is like delusion; although alive, longevity is uncertain.) The so-called fifty circuits mean the Five Zang organs all receive Qi. Holding the pulse at the Kou, count the beats. (These fifty circuits represent the Qi received by the Five Zang organs. By holding the pulse at the Kou and counting the beats, the decline or prosperity of Zang Qi can be known.) If there are fifty beats without a single Dai pulse (intermittent pulse), the Five Zang organs are nourished. ("Dai" means substitution/change. It refers to a sudden weakness in a normal pulse, or alternating speed, or stopping and restarting. This happens when a Zang organ is damaged and Qi is deficient, causing such changes. Any such change is called Dai. If there are fifty beats without a Dai pulse, the Five Zang organs are fully nourished, representing a harmonious pulse.) If there is one Dai pulse in forty beats, one Zang organ lacks Qi. (One Dai pulse in forty beats indicates deficiency in one of the Five Zang organs. "One Zang lacks Qi" specifically refers to the Kidney Qi being exhausted first. Thus, harmonious Zang organs have long pulses, while diseased ones have short pulses. Seeing one Zang lack Qi starts with the Kidney. For two, three, four, or five Zang organs lacking Qi, the progression goes from distant to near, becoming shorter in sequence: from Kidney to Liver, Liver to Spleen, Spleen to Heart, Heart to Lung. Therefore, critically ill patients often breathe rapidly like asthma, confined to a few inches in the chest, because True Yin is exhausted below and Lone Yang floats above. This is the extreme of shortness of breath. If a doctor tries to treat this with calming or dispersing methods, death is inevitable.) Thirty beats with one Dai pulse indicate two Zang organs lack Qi. Twenty beats with one Dai pulse indicate three Zang organs lack Qi. Ten beats with one Dai pulse indicate four Zang organs lack Qi. Fewer than ten beats with one Dai pulse indicate five Zang organs lack Qi. Give them a short-term prognosis (death date), focusing on the beginning and end. ("Yu" is the same as "give." "Duan Qi" is the death date. Saying five Zang organs lack Qi means a death date can be given. "Zhong Shi" refers to the termination of the Twelve Meridians.) The so-called fifty beats without a Dai pulse serve as the norm. From this, one knows the lifespan of the Five Zang organs. To give a short-term prognosis, look for intermittent slowness and speed. (Serving as the norm means the normal pulse should be like this, allowing observation of Zang Qi. To know the death date, focus on intermittent slowness and speed. This phase change differs from normal Dai pulses because Zang Qi is failing and losing control, leading to this失常 (abnormality). Hence, "intermittent slowness and speed" indicates death. A beat stops, cannot return on its own, and then resumes; the Classics call this "Dai." Also, if the pulse beats five times and stops, without further change, it indicates death. If it beats seven times (half a breath cycle) and stops, without further change, it is also called "Dai," and death is certain. Later generations grouped Jie, Cu, and Dai together as "stopping pulses," which fails to capture their true meaning. Slow with one stop is Jie; rapid with one stop is Cu. The stops may vary (every 3rd, 5th, 7th, or 8th beat), but the rhythm is clear, and the start/stop is forceful. Diseases caused include Qi rebellion/phlegm obstruction, Blood/Qi deficiency/collapse, or constitutional sluggishness. These are Jie and Cu. Dai pulse differentiation is different. Fifty beats without Dai is "numerical Dai." If the pulse is normally even but suddenly strong or weak, it is "physical Dai." If the Spleen governs the four seasons and changes accordingly, it is "climatic Dai." Pulses with no fixed pattern and frequent changes are all called Dai. One must observe the changes to understand the condition. If a healthy person has a Dai pulse every forty beats, one Zang lacks Qi, and they will die in four years when spring grass grows. Every thirty beats, two Zang lack Qi, dying in three years when wheat ripens. Every twenty beats, three Zang lack Qi, dying in two years when mulberries turn red. Every ten beats, four Zang lack Qi, dying within the year. Five beats with one stop, five Zang lack Qi, dying in five days. Predicting danger from health is logical, but only masters can do it. Do not dismiss this as later invention.) The supreme numbers of Heaven and Earth begin with One and end with Nine. (Numbers begin with One and end with Nine, the natural numbers of Heaven and Earth. Regarding Heaven: a year has four seasons, each season ninety days, making nine. Regarding Earth: the Luoshu arrangement has Nine at the top, One at the bottom, Three on the left, Seven on the right, Two and Four as shoulders, Six and Eight as feet, Five in the center. Regarding Humans: the Huangzhong pitch pipe number starts with Nine. Nine squared is eighty-one, the basis of all things. Beyond Nine is Ten, which reverts to One. Hence, "The supreme numbers of Heaven and Earth begin with One and end with Nine.") One is Heaven, Two is Earth, Three is Human. Tripling Three gives Nine, corresponding to the Nine Fields. (One is odd, corresponding to Heaven. Two is even, corresponding to Earth. Three is the combination, corresponding to Human. Heaven opened at Zi, Earth formed at Chou, Human born at Yin. This is the Three Powers. Tripling Three corresponds to the Nine Fields. Nine Fields refer to the Nine Palaces of the Luoshu and the Nine Provinces of the Yugong.) Thus, humans have Three Positions (Bu), each with Three Observations (Hou), to decide life and death, treat diseases, regulate excess and deficiency, and eliminate pathogens. (Heaven, Earth, Human are the Three Powers. Upper, Middle, Lower are the Three Positions. Dividing each Position into three creates the Three Observations. Three times three is Nine Positions and Nine Observations (San Bu Jiu Hou). Through these, the entire network of meridians enters and exits, allowing determination of life/death, treatment of diseases, regulation of excess/deficiency, and elimination of pathogens. San Bu Jiu Hou is not just about the Cun Kou. For example, Zhang Zhongjing's pulse method uses Cun Kou above and Zu Yang (Dazu) below, illustrating the principle.) Upper Position Heaven: Artery at both temples. (Temple artery, at the Heyan point, where the Foot Shaoyang Gallbladder Meridian Qi travels.) Upper Position Earth: Artery at both cheeks. (Cheek artery, at Dicang and Daying points, where the Foot Yangming Stomach Meridian Qi travels.) Upper Position Human: Artery in front of the ears. (Ear-front artery, at Heliao point, where the Hand Shaoyang Sanjiao Meridian Qi travels.) Middle Position Heaven: Hand Taiyin (Lung). (Artery at Cun Kou behind the palm, next to Jingqu, where the Lung Meridian Qi travels.) Middle Position Earth: Hand Yangming (Large Intestine). (Artery between the metacarpal bones of the thumb and index finger, next to Hegu, where the Large Intestine Meridian Qi travels.) Middle Position Human: Hand Shaoyin (Heart). (Artery below the sharp bone behind the palm, next to Shenmen, where the Heart Meridian Qi travels.) Lower Position Heaven: Foot Jueyin (Liver). (Artery three cun below Qichong, at Wuli point, where the Liver Meridian Qi travels. Take while lying down. For women, take Taichong, two cun behind the base of the big toe in the depression.) Lower Position Earth: Foot Shaoyin (Kidney). (Artery behind the medial malleolus next to the calcaneus, at Taixi point, where the Kidney Meridian Qi travels.) Lower Position Human: Foot Taiyin (Spleen). (Artery above the fish belly crossing the tendon, directly below Wuli at Jimen point. Press deeply to feel it. Where the Spleen Meridian Qi travels. To observe Stomach Qi, take Chongyang on the dorsum of the foot.) Thus, Lower Position Heaven observes the Liver (Foot Jueyin Meridian). Earth observes the Kidney (Foot Shaoyin Meridian). Human observes the Qi of the Spleen and Stomach (Foot Taiyin Meridian; Spleen and Stomach are connected by membranes, so this observes both). Middle Position Heaven observes the Lungs (Hand Taiyin Meridian). Earth observes the Qi of the Chest Center (Hand Yangming Large Intestine Meridian; Large and Small Intestines belong to the Stomach, and the Stomach connects to the Chest Center). Human observes the Heart (Hand Shaoyin Meridian). Upper Position Heaven observes the Qi of the head and horns/temples (Temple arteries). Earth observes the Qi of the mouth and teeth (Cheek arteries). Human observes the Qi of the ears and eyes (Ear-front arteries). The Three Positions each have Heaven, Earth, and Human. Three Heavens, Three Earths, Three Humans. (This is San Bu Jiu Hou.) Three times three combines to nine. Nine divided is Nine Fields, Nine Fields are Nine Zang. Thus, there are Five Spirit Zang and Four Form Zang, combining to Nine Zang. (Nine Zang refers to the Nine Observations. Five Spirit Zang: Liver stores Hun, Heart stores Shen, Lungs store Po, Spleen stores Yi, Kidneys store Zhi. Four Form Zang: Head/temples, ears/eyes, mouth/teeth, chest center. Total nine. This refers to the human Nine Zang, corresponding to the Earth's Nine Fields, aligning with the supreme numbers of Heaven and Earth.) If the Five Zang organs are failing, their complexion will be dull and lifeless (Tian). Tian inevitably leads to death. (Color is the banner of Shen; Zang is the residence of Shen. Dull color means Shen has departed; departed Shen means Zang is failing, hence death. Tian means dry, dark, lusterless, and abnormal color.) First, measure the fatness or thinness of the body to determine the deficiency or excess of Qi. Deficiency requires tonification; Excess requires purging. ("Hou" is diagnosing the condition; "Duo" is measuring deficiency/excess. Body fatness/thickness determines needle depth; disease deficiency/excess determines tonification/purging treatment. Although stated for acupuncture, herbal medicine follows the same principle.) Must first remove blood stasis in the vessels before regulating. (If there is blood stasis causing blockage in the vessels, one must first puncture to remove the stagnation before regulating deficiency and excess.) Regardless of the disease, aim for balance. (For severe illnesses, achieving results is difficult. Do not ask about the speed of efficacy; simply aim for the harmony of Qi and Blood.) To know the location of the disease, one must understand the Seven Diagnoses and observe the Nine Positions: Unusually large indicates disease, unusually small indicates disease, unusually rapid indicates disease, unusually slow indicates disease, unusually cold indicates disease, unusually hot indicates disease, unusually sunken indicates disease. (This states that within the Nine Positions, there is a method of Seven Diagnoses. It means the pulse loses its normal character and is uniquely large...)