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Ju (Distance), refers to a pulse that is hard, sharp, and not flexible. Wulou (House Leak), refers to a pulse that drops drop by drop without rhythm. Shuili (Water Flow), refers to a pulse that departs and does not return. These are all manifestations of the strangeness pulses appearing due to the exhaustion of Spleen Qi, representing only the meaning of Dai Pulse (Intermittent Pulse) lacking Stomach Qi; therefore, it is said "Spleen Death". (Ju, pronounced as Quanyu, refers to the spur on a chicken's foot.)

The Ping Kidney Pulse (Normal Kidney Pulse) comes with a rapid, continuous rhythm like a hook, and feels firm upon deep pressure; this is called Kidney Ping. (Winter pulses should be sunken and stone-like, hence feeling firm upon deep pressure. If it is too stone-like, it becomes sunken and stagnant without vitality. Therefore, it must be rapid and continuous, resembling the Heart's hook-like quality, harboring Yang within Yin and obtaining the meaning of slight stone-ness; this is the Normal Kidney Pulse.)

Winter is based on Stomach Qi. (i.e., Stone pulse but harmonious). The Bing Kidney Pulse (Diseased Kidney Pulse) comes like pulling a vine, becoming harder upon pressure; this is called Kidney Disease. (The pulse resembles pulling a vine, firm and pulsating with connection. Becoming harder upon pressure indicates excessive Stone-ness and disharmony. This also signifies more Stone than Stomach Qi, hence "Kidney Disease.") The Si Kidney Pulse (Dead Kidney Pulse) comes like ropes being pulled in contention, or crackling like stones being struck; this is called Kidney Death. (If ropes contend, their tension must be severe. Crackling like stones indicates extreme hardness. This represents having only Stone pulse without Stomach Qi, hence "Kidney Death".)

When Taiyang Pulse arrives, it is surging, large, and long. (This speaks of human pulse Qi rolling and expanding according to the changes of Heaven and Earth Yin-Yang. Taiyang Qi dominates for sixty days after Guyu (Grain Rain); at this time, Yang Qi is excessive, so its pulse is surging, large, and long.) When Shaoyang Pulse arrives, it is suddenly rapid and suddenly slow, suddenly short and suddenly long. (Shaoyang Qi dominates for sixty days after Dongzhi (Winter Solstice); at this time, Yang Qi is still weak, and Yin Qi has not retreated, so length and rapidity represent Yang, while sparsity and shortness represent Yin, indicating indecision in advance and retreat.) When Yangming Pulse arrives, it is floating, large, and short. (Yangming Qi dominates for sixty days after Yushui (Rain Water); at this time, Yang Qi is not yet strong, and Yin Qi still exists, so the pulse is floating and large but still accompanied by shortness. Here, only the Three Yang pulses are mentioned without the Three Yin pulses, because Nan Jing states: "Taiyin arrival is tight, large, and long; Shaoyin arrival is tight, fine, and minute; Jueyin arrival is sunken, short, and solid," which already supplements this omission.)

When Taiyang Zang (Organ) alone arrives (hyperactivity), there is Jue Ni (Reversal Cold/Convulsion), panting, and reverse flow of empty Qi; this indicates Yin deficiency and Yang excess. Both Exterior and Interior should be drained, selecting the Lower-Shu points. (This speaks of Zang Qi disharmony where one Zang is excessive; Qi necessarily arrives alone, presenting different symptoms requiring different acupuncture treatments. Taiyang refers to the Bladder Meridian. Taiyang arriving alone causes Jue Ni, panting, and reverse flow of empty Qi upwards. Since Bladder and Kidney are Exterior-Interior pairs and both are Water Zang, if Water Zang has exclusive Yang arrival, it means Yang excess and Yin deficiency. One should select the Lower-Shu points of both meridians. The Lower-Shu of Bladder is named Shugu (BL65), and the Shu point of Kidney is named Taixi (KI3). Even though Kidney Yin is deficient, it is also drained because Yang pathogens are abundant; thus, simultaneous draining of Exterior and Interior is necessary to curb the momentum.)

When Yangming Zang alone arrives, it is Heavy Combination of Yang Qi. One should drain Yang and tonify Yin, selecting the Lower-Shu points. (Yangming refers to the Foot-Yangming Stomach Meridian. Yangming is the Sea of the Twelve Meridians and circulates Qi among the Three Yangs. If it arrives alone, Yang Qi heavily combines with the Zang due to pathogens; thus, one should drain Stomach Yang, tonify Spleen Yin, and select the Lower-Shu points. The Lower-Shu of Yangming is named Xangu (ST41), and the Shu point of Taiyin is named Taibai (SP3).)

When Shaoyang Zang alone arrives, it is Jue Qi (Reversal Qi). The front of the Qiao vessel suddenly becomes large; select the Lower-Shu point. (Shaoyang refers to the Foot-Shaoyang Gallbladder Meridian. Gallbladder disease connects to the Liver; its Qi tends to reverse. Thus, Shaoyang arriving alone is Jue Qi. However, Jue Qi must start from below the feet; therefore, observe the front of the Qiao vessel. Qiao refers to Yang Qiao, belonging to Shenmai (BL62) of the Foot-Taiyang Meridian. The area anterior to Yang Qiao is where the Shaoyang Meridian lies. When Shaoyang Qi is abundant, the front of Qiao suddenly enlarges; thus, one should select the Lower-Shu point of Shaoyang, named Linqi (GB41). Zu and Cu are synonymous. Qiao has five pronunciations: Qiao, Jiao, Qiao, Jiao, and also reads Ji Nüe Qie.)

Shaoyang arriving alone is the fault of One Yang. (This explains the meaning of "arriving alone" as the excess of one Zang. Taking Shaoyang as an example, the arriving alone of Taiyang and Yangming implies the excess of Three Yang and Two Yang respectively. One Yang refers to Shaoyang.)

When Taiyain Zang Bo (Pulsates strongly), one must carefully examine the True Zang pulse. The Qi of the Five Pulses is scant, Stomach Qi is unbalanced; this is a matter of Three Yin (Tiyain). It is suitable to treat the Lower-Shu points, tonifying Yang and draining Yin. (Tiyain refers to the Foot-Ta iyain Spleen Meridian. Bo means firm and strong, i.e., Fugu (Hidden Drum). The Tiyain Spleen pulse values harmony and slowness; now seeing drumming beating resembles the True Zang pulse. If the True Zang pulse truly appears, it is incurable; thus, one must carefully examine if it is indeed the True Zang pulse. Now, Tiyain Zang Bo is the arriving alone of Tiyain; Tiyain arriving alone means the Qi of the Five Zangs is scant and Stomach Qi is unbalanced, constituting the excess of Three Yin. Thus, it is suitable to treat the Lower-Shu points, tonifying Xangu (ST41) of Foot-Yangming and draining Taibai (SP3) of Foot-Ta iyain.)

Er Yin (Two Yin) Du Xiao (Howls Alone/Blazes Alone) is Shaoyin Jue Qi. Yang combines with the Upper, Four Pulses compete and expand, and Qi returns to the Kidney. It is suitable to treat the Meridians and Collaterals, draining Yang and tonifying Yin. (Er Yin refers to the Foot-Shaoyin Kidney Meridian. Du Xiao means blazing alone; Xiao is emitted by Yang Qi. Yang emerging from Yin, with Minister Fire flaming upward, results in Shaoyin Heat Jue Ni, with Yang combining above. Thus, the pulses of Heart, Liver, Spleen, and Lung compete and expand, while Qi returns to the Kidney. Hence "Du Xiao"; it is suitable to treat the Exterior-Interior meridians, draining Foot-Taiyang and tonifying Foot-Shaoyin. The Jing-Well point of Taiyang is Kunlun (BL60), the Luo-Connecting point is Feiyang (BL58); the Jing-River point of Shaoyin is Fuliu (KI7), the Luo-Connecting point is Dazhong (KI4).)

Yi Yin (One Yin) arrives; this is the treatment of Jueyin. True Qi is deficient, Heart hurts. Jue Qi remains and binds, causing White Sweat. Regulate diet and medicine, treating at the Lower-Shu point. (Yi Yin refers to the Foot-Jueyin Liver Meridian. Arrives means arriving alone. Treatment means governing. When Liver Pathogen arrives alone, True Qi must be deficient; Wood and Fire interfere, causing Heart pain. Jue Qi is Reverse Qi. If Reverse Qi does not dissipate, it remains and binds in the meridians; if Qi is deficient and insecure, White Sweat appears on the surface. Regulating food and medicine aims for appropriateness; using acupuncture treats at the Lower-Shu. The Lower-Shu of Jueyin is named Taichong (LR3). Note: Regulating diet and medicine applies not just to one meridian; ancient classics are often brief, so one must grasp the intent. Yuan, sound Yuan, means sour pain.)

Taiyang Zang manifests the image of Three Yang and is floating; Shaoyang Zang manifests the image of One Yang; One Yang Zang is slippery but not solid; Yangming Zang manifests large and floating. (Taiyang manifesting Three Yang images is because Yang travels on the Exterior, being the extreme of Yang, so the pulse floats externally. Shaoyang manifesting One Yang image is because Shaoyang is the interior of Yang and exterior of Yin, known as Half-Exterior Half-Interior, being slight Yang; thus, although slippery, it is not solid. Yangming, although interior to Taiyang, is exterior to Shaoyang; compared to slippery-but-not-solid, it appears large and floating. Zhongjing said: If Cun and Chi are both floating, Taiyang is affected; if Cun and Chi are both long, Yangming is affected; if Cun and Chi are both string-taut, Shaoyang is affected.)

Tiyain Zang Bo speaks of Fugu (Hidden Drum). (Fugu means sunken/stagnant and drumming, i.e., firm pulsation. Zhongjing said: If Cun and Chi are both sunken and fine, Tiyain is affected.)

Er Yin Bo Zhi (Two Yin Pulsates Arriving) means Kidney is sunken and does not float. (Er Yin refers to Shaoyin Kidney Meridian. Er Yin pulsating and arriving alone means Kidney is only sunken and not floating. Zhongjing said: If Cun and Chi are both sunken, Shaoyin is affected; if Cun and Chi are both minute and slow, Jueyin is affected.)

To know whether the Cun Kou (Inch Port) pulse is Excessive or Insufficient: If the Cun Kou pulse feels short upon pressing, it is Headache. (Cun Kou is Qi Kou. Shortness indicates Yang insufficiency; when Yang is insufficient, Yin gathers, causing headache. Short means short at the lower part. If the pulse is short below, pathogens combine above, causing headache. Zhong is pronounced with the departing tone.)

If the Cun Kou pulse feels long upon pressing, it is Pain in the Legs and Calves. (Length indicates Yin insufficiency; when Yin is insufficient, Yang gathers, causing leg and calf pain.)

If the Cun Kou pulse feels urgent and strikes the upper hand upon pressing, it is Shoulder and Back Pain. (A pulse coming urgently and striking the upper hand indicates Yang pathogens are abundant above, causing shoulder and back pain.)

If the Cun Kou pulse is sunken and firm, the disease is in the Middle (Interior). (Sunken indicates Interior; firm indicates Yin Excess, so the disease is in the Middle.)

If the Cun Kou pulse is floating and vigorous, the disease is in the Exterior. (Floating indicates Exterior; vigorous indicates Strong Yang, so the disease is in the Exterior.)

If the Cun Kou pulse is sunken and weak, it indicates Alternating Chills and Fever, Hernia Masses, and Lower Abdominal Pain. (Sunken indicates Yang Deficiency; weak indicates Yin Deficiency. Yang deficiency leads to external cold; Yin deficiency leads to internal heat, hence alternating chills and fever. However, sunken-weak pulses have much Yin and little Yang; Yin-Cold is below, causing Hernia and Masses, and Lower Abdominal Pain. Xia refers to accumulations.)

If the Cun Kou pulse is sunken and transverse (rapid/tight), there is accumulation under the ribs and horizontal accumulation pain in the abdomen. (Transverse means rapid/tight. Sunken governs the interior; Transverse governs accumulation, hence accumulation and pain in the hypochondrium and abdomen. Zhongjing said: Accumulation is Zang disease, never moving; Gathering is Fu disease, occurring at times, shifting pain, and is treatable. The general rule for accumulations: A pulse that is fine and adheres to the bone indicates accumulation. At Cun Kou, accumulation is in the chest; slightly out of Cun Kou, in the throat; at Guan, beside the navel; above Guan, below the heart; slightly below Guan, in the lower abdomen; at Chi, in Qichong. Pulse appearing on the left indicates accumulation on the left; on the right, on the right; appearing on both, in the center. Treat each according to its location.)

If the Cun Kou pulse is sunken and panting (rapid), it indicates Alternating Chills and Fever. (Panting means rapid. Sunken and rapid pulse indicates Heat in the interior. Heat in the interior causing chills and fever corresponds to "All spasms, shivering, and trembling belong to Fire".)

Vigorous, slippery, and firm pulses indicate disease in the Exterior. (Yang pulse and firm, so disease in the Exterior.)

Small, solid, and firm pulses indicate disease in the Interior. (Yin pulse and firm, so disease in the Interior.)

Small, weak, and choppy pulses indicate Long-standing Disease. (Small and weak indicate Qi deficiency; choppy indicates Blood deficiency. Qi and Blood deficiency result from long-standing disease.)

Slippery, floating, and rapid pulses indicate New Disease. (Slippery and floating are Yang pulses. Yang pulse and rapid indicates Pathogen abundance. Pathogen abundance and vigor signify new disease.)

Urgent pulses indicate Hernia Masses and Lower Abdominal Pain. (String-taut and urgent indicate Yin Pathogen abundance, causing hernia and lower abdominal disease.)

Slippery pulses indicate Wind. (Slippery pulse is smooth and belongs to Yang; Wind nature is movement, also Yang; thus, slippery pulse indicates Wind.)

Choppy pulses indicate Bi Syndrome. (Choppy is a Yin pulse, indicating Blood deficiency, hence Bi syndrome.)

Slow and slippery pulses indicate Heat in the Middle. (Slowness is due to Stomach Heat; slipperiness strengthens Yang, causing Heat in the Middle. Slowness here refers to relaxation, not delayed movement.)

Vigorous and tight pulses indicate Distension. (Vigorous means Middle Qi stagnation; tight means Pathogen excess, causing distension.)

Many blue veins on the arm indicate Blood Loss. (Blood loss leads to Qi departure; Qi departure leads to cold coagulation; coagulation leads to cyanosis/blackness, hence blue color on the arm. Mentioning the arm implies other areas too.)

Chi pulse slow and choppy indicates Xie Xi (Laxity/Fatigue). (Chi governs the Yin aspect; slow indicates Qi decline; choppy indicates Blood scarcity, hence Xie Xi. Xie Xi is a name for difficult-to-describe fatigue.)

Resting with a vigorous pulse indicates Blood Loss. (Whenever pulse is vigorous, Pathogen must be abundant; when Pathogen is abundant, rest must be uneasy. Now, pulse is vigorous but rest is peaceful, knowing it is not Qi/Yang Pathogen, but Yin Deficiency and Blood Loss. This also follows the Chi pulse; whenever Chi pulse is vigorous, it is mostly Yin Deficiency, hence Blood Loss.)

Chi choppy and pulse slippery indicates Profuse Sweating. (Refers to Chi skin being choppy and Chi pulse being slippery. Choppy Chi skin indicates scarce Ying Blood; slippery Chi pulse indicates abundant Yin Fire. Yang excess and Yin deficiency cause profuse sweating.)

Chi cold and pulse fine indicates Posterior Diarrhea. (Cold Chi skin indicates Spleen Yang decline, as Spleen governs muscles and limbs. Fine Chi pulse indicates Kidney Yang decline, as Kidney governs the lower orifices. Spleen and Kidney deficiency-cold cause posterior diarrhea.)

Rough and constantly hot Chi pulse indicates Heat in the Middle. (Rough Chi indicates True Yin deficiency; constant heat indicates abundant Yin Fire, hence Heat in the Middle.)

Seeing the complexion and knowing the disease is called Ming (Bright); palpating the pulse and knowing the disease is called Shen (Divine); asking about the disease and knowing its location is called Gong (Skillful). (Seeing complexion involves observing the five colors of appearance; palpating pulse involves cutting the Yin-Yang of Cun Kou; asking disease involves inquiring into the causes. Knowing these three makes one Ming, Shen, and Gong, exhausting diagnostic methods.)

The correspondence between Color, Pulse, and Chi is like the response of a drumstick to a drum or shadow to form; they cannot be lost. This is also the manifestation of roots, branches, trunks, and leaves; thus, if the root dies, the leaves wither. Color, Pulse, Form, and Flesh must not be discordant. Knowing one makes one Gong, knowing two makes one Shen, knowing three makes one Shen and Ming. (This says Color, Pulse, Form, and Flesh should be examined in detail. Color can be observed, Pulse can be palpated, and Form/Flesh should be verified on the Chi skin. Since Chi skin is always visible during diagnosis, verifying here allows knowing the prosperity/decline of Form/Flesh. What is inside must manifest outside; thus, Color and Pulse, Pulse and Form/Flesh correspond like drumstick-drum or shadow-form, and root-branch signs do not mismatch. All three should be combined; knowing three makes one Shen and Ming. Fu is a drumstick. Fu reads Fu or Fu.)

Green complexion corresponds to String-taut pulse; Red to Hook pulse; Yellow to Dai (Moderate) pulse; White to Hair (Light) pulse; Black to Stone (Heavy) pulse. Seeing the color but not getting the corresponding pulse, but instead getting the mutually overcoming pulse, indicates death; getting the mutually generating pulse indicates recovery. (Not getting the pulse means not getting the correct pulse matching the color. Mutually overcoming pulse: e.g., Green color getting Hair pulse, Metal overcoming Wood. Mutually generating pulse: e.g., Green color getting Stone pulse, Water generating Wood.)

For diseases generated by the Five Zangs and their changing forms, first determine the correspondence of the Five Colors and Five Pulses, then the diseases can be distinguished. Once Color and Pulse are determined, regulating the Pulse's Slow, Urgent, Large, Small, Slippery, and Choppy qualities will fix the disease variation. (Slow/Urgent refer to frequency; Small/Large/Slippery/Choppy refer to shape. Slippery means not choppy, flowing smoothly like pearls in a plate; Choppy means not slippery, void, fine, and slow, difficult to move like rain soaking sand or knife scraping bamboo. These six oppose each other; regulating these six fixes disease variation. This uses Slow, Urgent, Large, Small, Slippery, Choppy to determine disease variation, serving as the general outline of all pulses. Later physicians may differ slightly, but must reference Yue Ren and Zhongjing. Floating is Yang/Exterior, diagnosing Wind/Deficiency; Sunken is Yin/Interior, diagnosing Dampness/Excess; Slow is in Zang, Cold/Cool; Rapid is in Fu, Heat/Dryness; Slippery is Blood excess, Choppy is Qi stagnation; this seems correct. However, one does not realize that Floating being Exterior includes Scattered, Large, and Kong pulses; Sunken being Interior includes Fine, Small, and Hidden pulses; Slow being Cold includes Slow, Relaxed, Choppy, and Intermittent pulses; Rapid being Heat includes Surging, Slippery, Rapid, and Interrupted pulses; Deficiency includes Short, Soft, Minute, and Weak pulses; Excess includes String-taut, Tight, Moving, and革 (Leather) pulses. This is the general knowledge. Among these six, there are crucial distinctions that many fail to recognize. Although Floating is Exterior, Yin Deficiency pulses are floating but forceless; thus, Floating cannot generally mean Exterior, nor can it be lifted/dispersed? Although Sunken is Interior, severe initial Exterior contraction by Yin-Cold prevents Yang from reaching the exterior, showing Sunken-Tight pulse first; thus, Sunken cannot generally mean Interior, nor can it be purged internally? Although Slow is Cold, after early-stage Cold damage recedes with residual heat, pulses are often Slow-Slippery; thus, Slow cannot generally mean Cold, nor can it be warmed internally? Although Rapid is Heat, in deficiency patterns with Yin-Yang depletion and Qi-Blood chaos, pulses are urgent-rapid; the more rapid, the more deficient; thus, Rapid cannot generally mean Heat, nor can it be cooled? Minute and Fine resemble Deficiency, but extreme pain obstruction shows Hidden pulses; thus, Hidden cannot generally mean Deficiency, nor can it be abruptly tonified? Surging and String-taut resemble Excess, but severe True Yin deficiency shows Guan Ge (Obstruction/Regurgitation) exceeding normal; thus, Strong cannot generally mean Excess, nor can it be reduced/drained? In such cases, within the outline, there is a super-outline. If one cannot combine the Four Diagnoses and acts rashly, one will surely overturn the patient instantly. This is why Pulse Dao is hard to explain; every hair's breadth must be distinguished.)

If the pulse is urgent, the Chi skin is also urgent; if the pulse is slow, the Chi skin is also slow; if the pulse is small, the Chi skin is diminished and lacks Qi; if the pulse is large, the Chi skin bulges and rises; if the pulse is slippery, the Chi skin is also slippery; if the pulse is choppy, the Chi skin is also choppy. All these variations have minor and severe degrees. Thus, one skilled in adjusting Chi need not wait for Cun; one skilled in adjusting Pulse need not wait for Color. One who can combine and practice them can be a Shang Gong (Superior Physician), achieving nine successes out of ten. Practicing two makes one Zhong Gong (Middle Physician), achieving seven successes out of ten. Practicing one makes one Xia Gong (Inferior Physician), achieving six successes out of ten. (This is the meaning of Root/Branch and Trunk/Leaf. Regarding Cun-Chi, Chi is the root, Cun is the branch; regarding Pulse-Color, Pulse is the root, Color is the branch. Thus, skilled in Chi need not wait for Cun; skilled in Pulse need not wait for Color. But one must combine all three to ensure no errors, worthy of being called Shang Gong, saving nine out of ten. Those knowing only two or one are middle/inferior talent, saving only six or seven.)

Adjust the Chi, speak of the disease, knowing the interior from the exterior. Examine the Chi's Slow, Urgent, Large, Small, Slippery, Choppy qualities, and the flesh's Firm/Brittle nature, and the disease form is fixed. (Cun Kou pulse extends from Chi to Cun; thus, diagnosing only the Chi pulse reveals the interior. The whole body is hard to see fully, but flesh prosperity/decline manifests at the wrist; thus, observing only Chi flesh reveals the exterior. Hence, adjusting only Chi fixes the disease form.)

Observing a person's eye sockets having slight swelling, like newly risen after lying down, neck vessels pulsating, occasional coughing, and pressing the hands/feet leaving an indentation that does not rise immediately, indicates Feng Shui Skin Distension. (Eye socket is the area under the eyes, like a silkworm. Yong means blockage, i.e., new slight swelling. Neck vessel is Renying pulse. Indentation not rising means a pit forms upon pressing. These are external signs of Feng Shui Skin Distension. Ke means cavity. Yong, departing tone. Yao, sound Yao.)

Chi skin slippery and glossy indicates Wind. (Yang receives Wind Qi; thus, Wind patients have slippery and glossy Chi skin.)

Weak Chi flesh indicates Xie Xi and desire to rest; Emaciated flesh indicates untreatable Alternating Chills and Fever. (Weak Chi flesh means muscles must emaciate. Emaciated flesh indicates Yin Deficiency, leading to Xie Xi. Xie Xi means body fatigue, hence desiring rest. No pathogen but emaciation with chills/fever indicates True Yin collapse, hence untreatable.)

Chi skin slippery and oily indicates Wind. (Oily refers to previous glossiness. Wind is Yang Qi; Yang in skin/flesh makes it slippery and oily.)

Chi skin choppy indicates Wind Bi. (Choppy Chi skin indicates Blood scarcity; Blood cannot nourish, hence Wind Bi.)

Chi skin rough like dried fish scales indicates Water Retention. (Like dried fish scales means extreme dryness/choppiness. Due to Spleen Earth decline and muscle wasting, Water takes advantage, causing Water Retention. Yi and Yi are the same.)

Extremely hot Chi skin and vigorous/restless pulse indicates Warm Disease; if the pulse is vigorous and slippery, the disease is about to exit. (Hot Chi skin, its...)