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Those pulse qualities that are exclusively small, exclusively rapid, exclusively slow, exclusively cold, exclusively hot, or exclusively sunken (sinking and unrising), all indicate the location of disease. "Exclusively cold" and "exclusively hot" refer to pathogenic qi being either in the upper part, lower part, exterior, or interior. "Sunken" refers to the pulse sinking and failing to rise. This situation is difficult to explain using the Three Regions and Nine Locations method, so it should be applied by analogy at the Qi Kou (radial artery) position.)

There are ten measures for diagnosis: measuring the pulse measure, organ measure, flesh measure, tendon measure, and acupoint measure. (The ten measures refer to the five measures of pulse, organs, flesh, tendons, and acupoints, one on each side, two times five equals ten. The character "duo" in "measuring people" is pronounced like "duo".) When Yin and Yang qi are exhausted, the person's diseases will naturally manifest. (All these ten measures encompass the principles of Yin and Yang in the human body. Therefore, human diseases are all reflected herein.) Pulse movement has no constant form; when Yin qi scatters, the pulse resembles Yang; when pulse qi escapes, normal pulse characteristics cannot be maintained, and diagnostic methods lose their fixed course. ("Pulse movement has no constant form" means the pulse has no fixed morphology. "Scattering Yin resembles Yang" means when Yin qi scatters, the pulse resembles Yang. A floating and large pulse indicates excess Qi and deficient Blood. A floating pulse without root indicates death; having exterior but lacking interior indicates death. When True Yin scatters and solitary Yang remains, the pulse resembles Yang but lacks root; this is not a true Yang pulse. This indicates the pulse is biased and Yin-Yang are incomplete. Diagnosing this requires deviating from the standard methods of Yin and Yang.")

Diagnosis must consider both upper and lower, and assess the differences between commoners and nobles. (Status, seniority, work-rest patterns differ; diets of rich foods versus coarse grains differ in constitution and temperament. Therefore, one must assess the differences between people and rulers, distinguishing upper and lower levels for diagnosis.) If one learns medicine from a teacher but fails to investigate the principles of reversal and compliance, abandoning Yin to follow Yang, diagnosis will inevitably remain unclear. ("Zu" means complete. When Yin and Yang separate and resolve, spirit perishes. Thus, a skilled diagnostician, upon observing Yin, must examine Yang, and upon observing Yang, must examine Yin. Without understanding the principles of Yin-Yang reversal and compliance, how can diagnosis be clear?) Extreme Yin deficiency leads to the severance of Heaven Qi; extreme Yang excess leads to insufficiency of Earth Qi. ("Extreme Yin" and "Extreme Yang" refer to the Dao of Heaven and Earth. Extreme Yin deficiency means Earth Qi declines and fails to ascend; without ascending, it cannot descend, thus Heaven Qi is severed. Extreme Yang excess means Heaven Qi becomes hyperactive and fails to descend; without descending, it cannot ascend, thus Earth Qi is insufficient. Yin and Yang Qi hide roots within each other and utilize each other; neither can be neglected. This borrows the natural Dao of Heaven and Earth to illustrate that human Yin and Yang value harmony.) Yin and Yang interacting together is practiced by the Perfect Person. ("Interacting together" means Yin and Yang do not lose each other and achieve peace. This subtle regulation can only be practiced by the Perfect Person.)

When Yin and Yang interact together, Yang arrives first, and Yin arrives later. Therefore, mastering the Dao of diagnosis involves holding to Yin and Yang in their sequence. (In the Dao of Yin and Yang: Yang moves, Yin is still; Yang is firm, Yin is soft; Yang initiates, Yin follows; Yang acts, Yin receives; Yang ascends, Yin descends; Yang precedes, Yin follows; Yang is above, Yin is below; Yang is left, Yin is right; number is Yang, slowness is Yin; exterior is Yang, interior is Yin; arrival is Yang, departure is Yin; advancement is Yang, retreat is Yin; generation is Yang, storage is Yin. Yang moves fast, Yin moves slow. Thus, when Yin and Yang interact, Yang arrives first and Yin later. The diagnostician observes the sequence of Yin and Yang to deduce their essence.) The patterns of the extraordinary and the ordinary consist of sixty chapters. Diagnosis combines subtle matters, traces changes in Yin and Yang, clarifies the conditions of the Five Zang, grasps the essentials of deficiency and excess, determines the affairs of the five measures, and understanding these is sufficient for diagnosis. ("Qi" means extraordinary. "Heng" means ordinary. Sixty chapters refer to the meaning of the sixty chapters of *Nine Needles*, which are now lost. "Combining subtle matters in diagnosis" means integrating the subtleties of diagnostic methods. "Tracing changes in Yin and Yang" means seeking variations in Yin-Yang prosperity and decline. "Zhang" means clarify. "Wu Zhong" refers to the Five Zang. "Five measures" refer to the aforementioned ten measures. Mastering these allows one to discuss diagnosis.)

Therefore, palpating Yin without obtaining Yang leads to the disappearance of diagnosis; obtaining Yang without Yin results in shallow learning; knowing the left but not the right, knowing the right but not the left, knowing the upper but not the lower, knowing the prior but not the posterior—thus treatment cannot be sustained. ("Palpating Yin without obtaining Yang, diagnosis disappears" means knowing only of Yin and Yang but not their mutual rooting and mutual use, nor the way of Yin-Ping and Yang-Mi. "Zhan" means clear. Partially adhering to learning ultimately remains unclear. Left-right, upper-lower, prior-posterior are all principles of Yin and Yang. Not knowing left-right means not understanding ascending-descending; not knowing upper-lower means not understanding clearing-turbid; not knowing prior-posterior means not knowing urgency-slowness. How can one expect to treat effectively and sustainably?)" Knowing ugliness and beauty, knowing disease and health, knowing high and low, knowing sitting and rising, knowing walking and stopping—if applied with order, the Dao of diagnosis is complete, enduring for ten thousand generations without peril. (All these have reciprocal principles. A difference of a hair's breadth leads to an error of a thousand miles. Thus, the good and evil of disease, the movement and stillness of form, must be distinguished. Understanding this and applying it with order makes the Dao of diagnosis complete, ensuring safety for ten thousand generations. "Ji" means order. "Dai" means peril.) Rising implies excess; knowing what is lacking. ("Qi" means rising. To treat excess, one must observe deficiency. Pathogenic Qi is often in excess, while Healthy Qi is often deficient. Knowing only excess and forgetting deficiency is the path to failure. This warns people to be cautious of the root.) Assessing matters of upper and lower, pulse matters are thereby comprehended. (If one can assess the height and depth of physical conditions, pulse matters can be understood through investigation.)

Therefore, weak form and deficient Qi lead to death; (Both interior and exterior are ruined.) Excess form and Qi but deficient pulse Qi lead to death; (Externally normal, but internal organ Qi is damaged.) Excess pulse Qi but deficient form and Qi lead to survival. (If organ Qi is undamaged, weak form is harmless because the root is primary. If flesh and muscles are wasted, even if the nine pulses are harmonious, death occurs. Wasting differs from deficiency; once flesh is wasted, Spleen Yuan is severed, so even harmonious pulse Qi cannot be treated. Comparing this clarifies the meaning.)

Thus, diagnosis has great principles, and sitting/standing have constants. ("Da Fang" means great law. Constant sitting/standing ensures proper conduct, rectifying the self first. Rectifying the body externally aligns the mind. Thus, the great principle of diagnosis begins here.) Entry and exit involve virtue, transforming spirit. ("Xing" means virtue. The physician's heart is to save lives. In entry and exit, thoughts are true and respectful. Virtue moves Heaven, sincerity penetrates the heart, allowing divine transformation in all actions. "Xing" is pronounced with the departing tone.) Must be clear and pure, observing above and below. (Clarity and purity focus the mind and reveal spirit. Observe above to inspect spirit, color, voice, and sound; observe below to inspect form, body, reversal, and compliance.) Monitor the eight correct evils, distinguish the five central regions. ("Si" means monitor. "Bie" means examine. Monitor the correctness and evil of the eight solar terms and winds to inspect the exterior; examine the locations of the five Zang and five forms to inspect the interior.) Press pulse movement and stillness, follow the meanings of sliding, rough, cold, and warm. (Pressing pulse movement/stillness distinguishes Yin/Yang; sliding/rough/cold/warm reveals deficiency/excess. If the pulse is sliding, the skin of the Chi position is also sliding; if rough, then rough; if cold, then cold; if warm, then warm. Thus, following the Chi reveals this. "Xun" means to feel out.) Observe size, combining with disease conditions. ("Size" refers to urination and defecation. These are the gates of constraint. If gates are loose, granaries leak. Retention brings life, loss brings death. Observing size helps understand disease conditions. "Neng" means condition/state.) Reversal and compliance are obtained, then disease names are known. (Reversal is contrary, compliance is smooth. Obtaining reversal/compliance and knowing disease names ensures certainty without error.) Diagnosis can be perfect, not losing human circumstances. (Following the above methods, diagnosis can be perfect, especially regarding human circumstances.) Observe breath and intent, not losing regulation. ("Shi Xi" is observing breath to view Qi; "Shi Yi" is observing form/color to view emotion, thus maintaining regulation.) Not knowing this Dao loses classics and severs principles. Speaking without basis and making false predictions is called losing the Dao. (Not knowing this Dao leads to baseless speech and false predictions, inevitably perilous.) Outside all things, within the six directions, changes of Heaven and Earth, responses of Yin and Yang. The warmth of spring becomes the heat of summer; the anger of autumn becomes the rage of winter. Movements of the four seasons cause pulses to rise and fall. (Things are within Heaven, Heaven envelops things outside. Heaven, Earth, and all things share one Qi. Changes of Heaven and Earth are responses of Yin and Yang. Spring warmth gradually becomes Summer heat; Autumn anger gradually becomes Winter rage. Spring generation, Summer growth, Autumn harvest, Winter storage are the movements of Yin-Yang four changes, and pulses follow accordingly.) Spring corresponds to the compass. (The compass draws circles. Spring Qi generates, round and active, corresponding to the compass; human pulse responds, becoming round and active.) Summer corresponds to the square. (The square draws rectangles. Summer Qi flourishes, reaching peak and stopping, corresponding to the square; human pulse responds, becoming grand, large, upright, and方正.) Autumn corresponds to the balance. (Balance means level. Autumn Qi completes all treasures level on the ground, corresponding to the balance; human pulse responds, appearing floating and fine on the surface.) Winter corresponds to the weight. (Weight is a plumb bob. Winter Qi stores and hides, corresponding to the weight; human pulse responds, sinking heavy and hiding inside. All these compass, square, balance, and weight elucidate the principles of Yin-Yang ascending/descending, conforming to seasonal pulse changes.)

Therefore, forty-five days after Winter Solstice, Yang Qi slightly ascends, Yin Qi slightly descends; forty-five days after Summer Solstice, Yin Qi slightly ascends, Yang Qi slightly descends. Yin and Yang have their times, setting periods for pulses. If periods are missed, it matches pulse divisions. Divisions have timing, thus knowing the time of death. (Winter Solstice generates one Yang. Forty-five days after WS to Start of Spring, Yang Qi gradually ascends slightly; as Yang ascends, Yin descends. Summer Solstice generates one Yin. Forty-five days after SS to Start of Autumn, Yin Qi gradually ascends slightly; as Yin ascends, Yang descends. This is "Yin and Yang have their times." Setting periods for pulses means pulses change with time. Missing periods means Spring Compass, Summer Square, Autumn Balance, Winter Weight do not match degrees. Matching pulse divisions means each Zang pulse has its domain. Divisions have timing means decline/prosperity have their times. Knowing this knows the time of life and death.)

Subtlety lies in the pulse, must not fail to observe. Observation has order, starting from Yin and Yang. Starting has classics, born from Five Elements. Birth has limits, suitable for four seasons. (Pulse subtlety relies on Yin-Yang and Five Elements as order. Yin-Yang and Five Elements birth have limits: Yang births at Winter Solstice, Yin at Summer Solstice, Wood at Hai, Fire at Yin, Metal at Si, Earth/Water at Shen. Four seasons birth/prosperity have suitability. "Ji" means discipline. "Jing" means constant. i.e., major outline and minor discipline.) Tonification and drainage must not be lost, matching Heaven and Earth as one. (Heaven and Earth's Dao reduces excess and supplements deficiency. Correct tonification/drainage matches Heaven and Earth's Dao.) Grasping the essence of One, knowing life and death. (Essence of One is the subtlety of Heaven-Human unity. Heaven-Earth Dao: Yang governs movement, Yin governs stillness. Yang coming brings life, Yang going brings death. Knowing Heaven's non-stop Dao knows human life/death.) Thus sound matches Five Tones, color matches Five Elements, pulse matches Yin and Yang. (Sound matches Gong-Shang-Jue-Zhi-Yu, color matches Wood-Fire-Water-Metal-Earth, pulse matches Four Seasons Yin-Yang. Though three seem divided, principle is one.) Holding pulse has Dao, emptiness and stillness are guarantee. (Holding pulse requires sincere thought, avoiding disturbance. Empty heart and quiet will, without gap, complete the diagnostic Dao. "Bao" means not losing.) Spring pulse floats, like fish swimming in waves. (Spring pulse gets Spring Qi, floating but not fully out, like fish in waves.) Summer pulse at skin, abundant like all things. (Summer pulse gets Summer Qi, grand and external, abundant like all things.) Autumn pulse below skin, hibernating insects about to leave. (Autumn pulse gets Autumn Qi, grandness gathers, like insects preparing to hibernate.) Winter pulse in bone, hibernating insects secure, gentleman in room. (Winter pulse gets Winter Qi, sinking in bone, like secure hibernating insects. Gentleman at this time should embody Heaven-Earth storage and stay indoors.) Thus, knowing interior presses and records; knowing exterior ends and begins. These six are the great methods of holding pulse. ("Interior" refers to Organ Qi, with positions, so can be pressed and recorded; "Exterior" refers to Meridian Qi, with order, so can be ended and begun. These are the methods of four seasons and interior/exterior.)

Spring pulse is like a bowstring. Spring pulse is Liver, Eastern Wood, where all things begin. Its Qi comes weak, light, empty, and slippery, straight and long, thus called Bowstring. Opposite of this is disease. (Bowstring is straight and long, strong like a bowstring, but weak/light/empty/slippery contains harmony. Liver governs this.) How is it opposite? Qi comes solid and strong, called Excess, disease in Exterior; Qi comes not solid and slight, called Deficiency, disease in Interior. (Solid/strong is excess of Bowstring; not solid/slight is deficiency of Bowstring. Both are opposites of Bowstring. Excess disease is in Exterior, Deficiency disease is in Interior. Exterior diseases often have excess, Interior diseases often have deficiency.) Excess causes forgetfulness, dizziness, and vertex disease; Deficiency causes chest pain radiating to back, and fullness in both hypochondria. ("Wang" should be "Nu" (anger). Liver Qi deficiency causes fear, excess causes anger. "Hu Hu" means confused/unpleasant. "Mao" means stifled. "Dian Ji" is disease at the vertex. Foot Jueyin Meridian meets at vertex, passes diaphragm, spreads to hypochondria, hence these symptoms. , pronunciation qu, armpit/hypochondrium.)

Summer pulse is like a hook. Summer pulse is Heart, Southern Fire, where all things flourish and grow. Its Qi comes vigorous and departs declining, thus called Hook. Opposite of this is disease. (Hook: lifting finger comes vigorous, departing seems declining. Pulse vigorous externally, departing powerless, Yang prosperity. Heart governs this.) How is it opposite? Qi comes vigorous and departs vigorous, called Excess, disease in Exterior; Qi comes not vigorous and departs vigorously, called Deficiency, disease in Interior. (Vigorous-come/vigorous-depart is excess of Hook; Not-vigorous-come/vigorous-depart is deficiency of Hook. Both are opposites of Hook. "Departing vigorously" does not mean strong. Pulse coming from bone/flesh to skin is "Come"; returning from skin to bone/flesh is "Depart". Not-vigorous-come/vigorous-depart means Come is deficient, Depart is excessive, i.e., consuming more than growing. Thus Bian Que considered Spring Liver, Summer Heart, Autumn Lung, Winter Kidney: solid/strong is Excess, disease in Exterior; weak/slight is Deficiency, disease in Interior. Words differ, meaning same.) Excess causes body heat and skin pain, spreading erosion; Deficiency causes vexation, coughing/spitting above, and Qi leakage below. (Summer pulse Excess: Yang excess, disease in Exterior, causing body heat, skin pain, spreading erosion. Deficiency: Ministerial Fire decline, disease in Interior, causing Heart Qi deficiency/vexation, Deficient Yang invading Lung/coughing, instability/Qi leakage. Meridian starts in Heart, connects Heart system, passes diaphragm, connects Small Intestine, returns to Lung.)

Autumn pulse is like floating. Autumn pulse is Lung, Western Metal, where all things harvest. Its Qi comes light, empty, and floating, urgent come and scattered depart, thus called Floating. Opposite of this is disease. (Floating means light/empty. Urgent come/scattered depart: Autumn Yang Qi still in skin/hair. Lung governs this.) How is it opposite? Qi comes hairy with center firm and sides empty, called Excess, disease in Exterior; Qi comes hairy and slight, called Deficiency, disease in Interior. (Center firm means floating with firm center. Floating Excess/Floating Deficiency are opposites of Floating, disease in Exterior/Interior same as before.) Excess causes reverse Qi and back pain with sorrowful feeling; Deficiency causes panting, shortness of breath, cough, upper Qi with blood, lower hearing disease sounds. (Lung Meridian starts Middle Jiao, connects Large Intestine, returns to stomach, passes diaphragm, belongs to Lung, attaches to back. Excess causes reverse Qi obstruction/back pain. "Yun Yun" is sorrowful appearance. Deficiency causes panting/cough/shortness of breath; Qi not returning origin causes upper Qi; Yin deficiency/internal damage causes blood. Lower hearing disease sound means throat sound during panting.)

Winter pulse is like Ying (camp). Winter pulse is Kidney, Northern Water, where all things store. Its Qi comes sinking and firm, thus called Ying. Opposite of this is disease. (Ying means camp, like soldiers gathering, not scattering, also meaning sinking stone. Kidney governs this.) How is it opposite? Qi comes like flicking stones, called Excess, disease in Exterior; Qi departs like rapid count, called Deficiency, disease in Interior. (Coming like flicking stones: will is very strong, Ying Excess. Departing like rapid count: movement stops quickly, Ying Deficiency. Rapid count usually belongs to Heat, but this True Yin deficiency pulse must also be tight/rapid. The more deficient, the more rapid, originally not Yang-strong real heat rapid count, hence "like rapid", deep analysis. One mistake here, disaster is easy. Excess disease in Exterior, Deficiency disease in Interior.) Excess causes relaxation of sinews, spine pain, shortness of breath, unwilling to speak; Deficiency causes heart hanging like hungry illness, middle cold, spine pain, lower abdomen fullness, urine changes. (Winter pulse Excess: Yin Evil wins. Yin Evil wins damages Kidney Qi, True Yang deficiency, causing limb relaxation, poor movement, called Relaxation. Spine pain: Kidney Meridian reaches there. Kidney stores Essence, Essence damage means no Qi, hence shortness of breath/unwilling to speak, all Exterior disease. Deficiency: True Yin deficiency, Heart-Kidney not communicating, heart hanging/fear like hunger. "Zhong" is soft area under lateral ribs, beside Kidney. Kidney Meridian passes spine, belongs to Kidney, connects Bladder, hence spine pain, abdominal fullness, urine changes. Changes: yellow, red, enuresis, strangury, due to Kidney Water deficiency, all Interior disease. , pronunciation ji.)

Spleen pulse is Earth, the solitary Organ irrigating the four sides. (Spleen belongs to Earth, Earth is root of all things, transporting water/grain, transforming fluids, irrigating Liver, Heart, Lung, Kidney. Earth has no fixed position, rules four seasons, thus called Solitary Organ.) Good state cannot be seen, bad state can be seen. (When Spleen healthy, irrigation complete, four Zang safe, unaware of Spleen power, thus good state unseen; Spleen diseased, four Zang follow disease, thus bad signs seen.) Coming like flowing water, this is...