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Origin of the Pulse

The pulse is like a curtain; it is as if one outside the curtain wishes to know what is happening inside. (Zhu Danxi)

Ying Qi (Nutrient Qi) circulates within the vessels, while Wei Qi (Defensive Qi) circulates outside the vessels. The vessel serves to govern Ying and Wei Qi, and its function cannot be neglected for even a moment. The character "Mai" (Pulse) consists of "Yue" (Moon/Flesh radical) and "Yong" (Eternal), implying that this can last through the ages. The ancient form of the character "Mai" consisted of "Xue" (Blood) and "Chen", indicating that it enables Qi and Blood to follow their respective distributions and circulate through the meridians. ○ Even if one arm is broken or one eye is blinded, death does not ensue immediately; however, if the pulse changes slightly, the patient's symptoms will follow. Can one not be cautious? (*Medical Beginner*)

The pulse is the channel of blood, the precursor of Qi and Blood, and the tunnel through which blood flows, with breath corresponding within it. Its image resembles the earth; it is the mansion of blood, associated with the Heart, and a region of the skin. It originates from the Kidney and is nourished by the Stomach. It is Yin within Yang, rooted in Ying and Wei Qi. Ying Qi is Yin Blood, and Wei Qi is Yang Qi. Ying Qi moves within the vessels, while Wei Qi moves outside. The vessels do not move on their own but follow the Qi. When Qi moves, the pulse responds. This illustrates the principle of Yin and Yang. Qi is like a bellows, and blood is like waves; the pulse, blood, and breath circulate endlessly up and down. (Cui Zixu)

The meridians are the pathways of the pulse. The visible pulsation is the sign of the pulse. It is the essence of Ying Qi, circulating exclusively within the meridian tunnels and regulating the interior and exterior. Blood and Qi differ in form but become unified through the pulse; Wei Qi and Ying Qi move separately but correspond through the pulse. Thus, within the pulse, Yin and Yang are integrated. Therefore, although the pulse, blood, and Qi can be divided into three, they can also be considered one; one may say that Ying Qi is the pulse. (Zou Danyuan)

The movement of the pulse is not the movement of tendons. It is the movement of Qi and Blood traveling along the meridians, clearing the path and flowing continuously, hence such movement. Physicians of the world mistakenly believe that pulse movement is tendon movement, which is a significant error. For example, the Deep Pulse (Fu Mai) lies beneath the tendons; one must push aside the tendons with fingers to palpate it, which proves that the pulse is not the tendon. (Wang Yingu)

Methods of Diagnosis

Diagnosis is usually performed at dawn, when Yin Qi has not yet stirred, Yang Qi has not dispersed, food and drink have not been taken, the meridians are not yet full, the collaterals are balanced, and Qi and Blood are not chaotic. Only then can pathological pulses be diagnosed. ○ The way of holding the pulse requires emptiness and stillness as the safeguard. (*Suwen*)

One should feel as if standing at the edge of an abyss and looking at floating clouds; the mind is clear, but the sensation under the fingers is hard to describe. (Bian Que)

When initially palpating the pulse, ask the patient to extend their palm upward. The prominent bone behind the palm is called Guan (Gate). Anterior to Guan is Yang, and posterior to Guan is Yin. Yang corresponds to Cun (Inch), and Yin corresponds to Chi (Cubit); search sequentially. (Cui Zixu)

For beginners learning pulse diagnosis, spread herbs in a grid pattern on silk. The teacher places a lute string underneath to verify the Wiry Pulse (Xian Mai); use small millet grains to verify the Slippery Pulse (Hua Mai); use scraped bamboo marks to verify the Choppy Pulse (Se Mai); use cut scallion tubes to verify the Hollow Pulse (Kou Mai); and use rotten cotton to verify the Soggy Pulse (Ru Mai). Instruct the student to press lightly and heavily, carefully seeking and understanding the finger techniques. With time, accuracy will naturally develop. (Han Feixia)

Human bodies vary, so the coming and going of the pulse also differs. One cannot apply a single theory to all conditions. For tall people, finger placement should be wider; for short people, it should be closer. People from the North often have strong, solid pulses; people from the South often have weak, soft pulses. Young and vigorous individuals often have large pulses; elderly individuals often have deficient pulses. Pulses after drinking are often constant; pulses after eating are often surging. Virgins and nuns often have soggy and weak pulses; infants often have seven beats per respiration. Thus, the *Classic* states: Those whose form and Qi match survive; those whose patterns are irregular die. (Wu Hegao)

In general pulse examination, one must understand six characters: Up, Down, Coming, Going, Arrival, and Stop. Without understanding these six, one cannot distinguish Yin and Yang or Deficiency and Excess. Up is Yang, Coming is Yang, Arrival is Yang; Down is Yin, Going is Yin, Stop is Yin. Up refers to the pulse moving from Chi (Cubit) to Cun (Inch), where Yang arises from Yin; Down refers to the pulse moving from Cun to Chi, where Yin arises from Yang. Coming refers to the pulse rising from the deep flesh/bone level to the skin surface, representing the ascent of Qi; Going refers to the pulse returning from the skin surface to the deep flesh/bone level, representing the descent of Qi. Arrival corresponds to the heartbeat, Stop corresponds to the breath. ○ The method of diagnosing the pulse requires adjusting one's own breathing. For men, check the left hand first; for women, the right hand first. Use the middle finger to locate the Guan position, then place the index and ring fingers simultaneously. Initially press lightly to sense, then moderately, then deeply. Then examine each section from Cun to Guan to Chi. Four beats per respiration is the standard; occasional extra beats due to a deep sigh constitute a Normal Pulse (Ping Mai). Any excess or deficiency constitutes a Pathological Pulse. Determine the pathology based on the specific section. ○ During diagnosis, if the patient's arm is long, space the fingers widely; if short, place them closely. Within the three sections, if Large/Small, Floating/Sinking, Slow/Rapid are equal, and Chi/Cun, Yin/Yang, High/Low correspond, and Male/Female, Left/Right, Strong/Weak align, and the four-seasonal pulses do not contradict, the person is healthy (Ping Ren). Any deviation indicates disease. ○ The principles of taking the pulse vary, and shapes are diverse. A pulse never arrives alone; for example, Floating and Wiry, Floating and Rapid, Sinking and Tight, Sinking and Fine. How to distinguish them? Generally, they fall into the Six Pulses: Floating, Sinking, Slow, Rapid, Slippery, and Choppy. Floating and Sinking are determined by light and heavy pressure; Slow and Rapid are determined by the examiner's respiration; Slippery and Choppy are determined by the shape of the flow. Floating is Yang, obtained with light pressure, including Hollow, Surging, Scattered, Large, Long, Soggy, and Wiry. Sinking is Yin, obtained with heavy pressure, including Hidden, Stone, Short, Fine, Firm, and Solid. Slow is two beats per respiration, including Moderate, Knotted, Faint, and Weak. Some say Slippery resembles Rapid, and Choppy resembles Slow, but although similar, the principles differ. Slow and Rapid are judged by counting beats via respiration; Slippery and Choppy are judged by the shape of flow. Rapid indicates Heat, Slow indicates Cold, Slippery indicates abundant blood, Choppy indicates scant blood. The outline does not exceed these six characters. ○ The three essentials of holding the pulse are Ju (Lift), An (Press), and Xun (Seek). Lightly touching is Ju; pressing heavily is An; neither light nor heavy, seeking gently, is Xun. ○ Initially, press with all three fingers together to observe the general outline (Yin/Yang, Interior/Exterior, Up/Down, etc.). Then press each finger individually to observe specific sections. Upon placing fingers, first determine the meridian and seasonal pulses to assess Stomach Qi. Differentiate Interior/Exterior, Cold/Heat, Deficiency/Excess, Qi/Blood levels, Yin/Yang excess/deficiency, and organ associations. Use Floating, Middle, and Deep palpation to analyze. If a section differs from others, disease resides there; judge severity to decide. (Hua Borren)

Diagnostic methods are numerous, relying entirely on agile finger techniques. Since the middle finger's upper two segments are longer than those of the ring and index fingers, alignment is uneven. If spacing is too wide for Chi, it exceeds the 1.9 cun limit; if too close, it fails to cover Cun, Guan, and Chi boundaries. Aligning the three fingers causes the middle finger to protrude, ensuring joints rotate freely. This distinguishes left/right, interior/exterior, and applies five layers of pressure for Floating, Middle, and Deep palpation. Aligning the middle finger with the index finger removes the ring finger; aligning with the ring finger removes the index finger, ensuring joint rotation. This balances Cun, weighs Chi, aligns up/down, and pushes up/down/back/forth using two fingers. Regarding Left Renying and Right Qikou for locating twelve organs: e.g., right index on left Cun diagnoses Heart (organ) and Small Intestine (hollow organ); right middle on left Guan diagnoses Liver/Gallbladder; right ring on left Chi diagnoses Kidney/Bladder. Left index on right Cun diagnoses Lung/Large Intestine; left middle on right Guan diagnoses Spleen/Stomach; left ring on right Chi diagnoses Mingmen/Triple Burner (following ancient methods, except for Cun which follows previous texts). Using fingertip lifting and pressing for specific organs is Single Finger Method. While three fingers together provide location, single-finger pressing yields true results without interference. The index finger is thin and agile; the middle is thicker; the ring is thickest and dull. The ridge-like tip of the finger is called "Finger Eye" (Zhi Mu), used to press the spine of the pulse. Whether Surging, Large, Wiry, or Taut, or fine threads, all have a spine. Like eyes seeing beauty or ugliness, ancients called pulse diagnosis "looking at the pulse." Those who protect long nails and use fleshy parts or joints below the tips for diagnosis are like having eyes on their neck or armpits. ○ Pulse shapes are diverse, relying on diagnostic methods. Ten categories serve as the outline. For form, Large/Small are the main headings: Fat, Surging, Scattered, Horizontal, Wiry, Taut are Large; Weak, Thin, Fine, Faint, Spider-silk-like are Small. For rate, Slow/Rapid are main headings: Urgent,疾 (Ji), Tight, Beating, Restless, Panting, Frequent, Moving, Unrestrained are Rapid; Moderate, Escaping, Short of Breath, Not Advancing, Stop, Pause, Halt, Intermitting, Knotted, Like pouring lacquer stopping abruptly are Slow. For flow, Slippery/Choppy are main headings: Smooth, Nutritious, Pecking, Opening/Closing, Chapter, String of Pearls, Continuous are Slippery; Tight, Stagnant, Slow-moving, Unresponsive, Irregular, Difficult and scattered, Like rain sinking in sand, Like scraping bamboo with a sharp knife are Choppy. For position, Long/Short are main headings: Rising, High, Surging, Straight, Flowing, Reaching the fish area (Yi) are Long; Depressed, Low, Below finger, Entering Chi (Fu) are Short. For pressure, Floating/Sinking are main headings: Abundant, Hair-like, Floating, Hollow, Like falling elm seeds, Flesh moving up, Occasionally floating, Like wood floating in water, Fleeting like fat on soup are Floating; Hidden, Hard, Deep, Excessive, Reduced, Sunken, Solely sunken, Occasionally sunken, Like sand wrapped in cotton, Like stone thrown in water are Sinking. (Lu Ziyou)

In antiquity, Three Sections and Nine Locations were used to determine life and death (comprehensive method); Renying, Cun Kou, and Duyang were used to distinguish auspicious and ominous (key method). Since the *Nanjing* advocated solely taking Cun Kou, Renying and Duyang were excluded. The general principles of pulse theory do not exceed ten types of Yin and Yang. Yin-Yang pairing shows five aspects: Floating is pulse body, Large/Weak are pulse momentum, Slippery/Choppy are pulse Qi, Moving/Wiry are pulse shape, Rapid/Slow are pulse breath. They cannot all be viewed merely as pulse images. There are comparative views, direct views, reverse views, normal views, variable views, and thorough views. Where there is Floating, there is Sinking; where there is Large, there is Weak. Combined with diseases: Floating indicates Exterior, Sinking indicates Interior; Large indicates Excess, Weak indicates Deficiency; Slippery indicates abundant blood, Choppy indicates scant Qi; Moving indicates beating Yang, Wiry indicates beating Yin; Rapid indicates Hollow Organ, Slow indicates Solid Organ. This is the Comparative View. Floating, Large, Moving, Rapid, Slippery are Excess pulses named Yang; Sinking, Choppy, Weak, Wiry, Slow are Deficient pulses named Yin. This is the Direct View. One must understand the mechanism of Yin-Yang victory and recovery. As Yin-Yang rotates, excess is followed by deficiency, and deficiency by excess. Initially, it may be Floating, Large, Rapid, Moving, Slippery; subsequently, it reverses to Sinking, Weak, Wiry, Choppy, Slow. This is the mechanism of Yang declining and Yin growing. Initially Sinking, Weak, Wiry, Choppy, Slow; subsequently, it becomes slightly Floating, Large, Rapid, Moving, Slippery. This is the mechanism of Yang advancing and Yin retreating. Both indicate the disease is healing. This is the Reverse View. If Floating is accompanied by Large, Moving, Slippery, Rapid (Yang pulses), it is Pure Yang, indicating Yang Excess and Yin Deficiency. If Sinking is accompanied by Weak, Choppy, Wiry, Slow (Yin pulses), it is Heavy Yin, indicating Yin Excess and Yang Deficiency. This is the Normal View. If Floating is combined with Weak, Choppy, Wiry, Slow, this is Yin within Yang, indicating Yang Deficiency with Yin hiding within Yang, risking Yang collapse; supporting Yang is urgent. If Sinking is combined with Large, Moving, Slippery, Rapid, this is Yang within Yin, indicating Yin Deficiency with Yang pathogen sinking into Yin, risking Yin exhaustion; preserving Yin is critical. This is the Variable View. For Five Yang pulses, if strength remains unchanged but goes from strong to weak/faint, Yang is about to perish. For Five Yin pulses, if they suddenly transform into Five Yang appearances, it is Extreme Yin resembling Yang; this reflection does not grow, and embers extinguish easily. This is the Thorough View. Furthermore, there are True Yin and True Yang views: Yin diseases showing Yang signs survive; Yang diseases showing Yin signs die. Cheng's commentary only cites Shanghan, but the word "Fan" (all/every) implies pulse methods are not exclusive to Shanghan. Pulse refers to the True Yang of the Stomach region (Twenty-Five Yangs mentioned in the Classic). Yin disease showing Yang pulse means Stomach Qi is unharmed, thus survival (distinguishing Yang reveals onset). Yin pulse refers to True Yin of the Five Zang organs. If Stomach Yang does not reach Hand Taiyin, True Yin appears, meaning no Stomach Qi; thus Yin signs indicate death (distinguishing Yin reveals time of death). Note that Sinking, Choppy, Weak, Wiry, Slow are pathological, not necessarily fatal, and appear most in Yang diseases. Unceasing Floating, Large, Moving, Rapid, Slippery in Yang diseases are fatal. Yin diseases showing these pulses often show Extreme Yin resembling Yang, not necessarily a sign of survival. If True Zang pulses arrive—Liver pulse tight outside and inside, Heart pulse firm and beating, Lung pulse floating and large, Kidney pulse like bouncing stones, Spleen pulse like a bird's beak—they all show excessive signs, how can they be named Yang? The Classic states: Evil Qi comes tight and rapid; Grain Qi comes slow and harmonious. Thus, one cannot judge Yin/Yang solely by Slow/Rapid. (Ke Yunbo)

Locations

Inside Chi, on both sides, are the hypochondrium. Outside Chi observes the Kidney; Inside Chi observes the abdomen. Midway attaching above, Left Outside observes the Liver; Inside observes the Diaphragm. Right Outside observes the Stomach; Inside observes the Spleen. Upper attaching above, Right Outside observes the Lung; Inside observes the Chest Center. Left Outside observes the Heart; Inside observes the Shanzhong (Chest). Front observes anterior; Back observes posterior. End of Upper concerns chest and throat; End of Lower concerns lower abdomen, waist, thighs, knees, shins, and feet. (*Suwen*)

Regarding "Interior/Exterior" in this chapter, annotations say medial/lateral. To speak of medial/lateral sides, the pulse must be flat/broad or double-stranded. If referring to the examiner's finger sides, the text discusses pulse body. Moreover, examiner's Left Outside would correspond to patient's Right Hand, which should observe Stomach, not Liver, making it illogical. Observing I Ching hexagrams, lines drawn bottom to top: upper three are Outer Trigram, lower three are Inner Trigram, clarifying Up/Down and Interior/Exterior meanings. Also, Floating palpation as Exterior and Deep palpation as Interior is also logical. (*Leijing*)

Heart and Liver are on the Left; Spleen and Lung are on the Right; Kidney and Mingmen are in the two Chi positions. Cun observes above chest; Guan observes below diaphragm; Chi observes from umbilicus to ankle. Left observes Left side; Right observes Right side. Disease follows location; non-diseased areas are negative. (Cui Zixu)

Palpating the pulse requires focusing the spirit, like learning archery by first learning not to blink. Self-cultivation leads to mastery; it cannot be achieved instantly. However, finger placement must be clear, breaking through confusion, proceeding calmly without doubt, leading to sudden enlightenment. Otherwise, merely pressing three fingers perfunctorily is despicable. Some diagnose Heart and Small Intestine together, Lung and Large Intestine together. Experts criticize this, not realizing it discusses disease mechanisms (e.g., Heart heat transferring to Small Intestine), not locations. Small Intestine should be observed at Right Chi (Fire following Fire); Large Intestine at Left Chi (Metal following Water). Triple Burner belongs to Fire, also at Right Chi; Bladder belongs to Water, also at Left Chi. One Chi divides Water and Fire; one Zang associates with four Fu organs. This is the natural, unchangeable supreme Dao. If the Two Intestines, being the most turbid Yin, are listed with Heart and Lung, mixing hell with heaven, is this acceptable? Can turbid Qi disturbing the Triple Burner still be called a healthy person? (Yu Wuting)

Renying

Emperor asked: Why does Foot Yangming move? Qibo answered: Stomach Qi ascends to the Lung. Its fierce Qi rushes upward to the head, follows the throat to empty orifices, follows the eye system, enters the brain network, exits, descends to Key Master (ST5), follows the jaw, merges with Yangming, and descends together to Renying. This is Stomach Qi branching to Yangming. (*Lingshu*)

Two inches lateral to the Renmai is the Foot Yangming Stomach Meridian. The acupoint in the neck is called Renying, located 1.5 cun lateral to the Adam's apple, being the second row of vessels in the abdomen. (Ma Yuantai)

The pulses of Renying and Qikou are originally scriptural teachings. However, Renying is Foot Yangming, so it cannot refer to the hand; Qikou generally refers to Hand Taiyin, so it cannot be divided left/right. Chapters like *Dongshu*, *Benshu*, *Jingmai* clearly point to Renying as the arterial pulse of the Stomach Meridian beside the Adam's apple. Ancient diagnostic methods had three: 1. Three Sections and Nine Locations to diagnose whole-body pulses; 2. Taiyin and Yangming to diagnose the root of Yin/Yang; 3. Left and Right Qikou to diagnose Zang-Fu Qi. Thus, Renying has its own location. *Mai Jing* wrongly placed Renying on the left hand and Qikou on the right hand, without basis. I was initially confused until seeing *Gangmu* explain: Renying is beside the Adam's apple, Foot Yangming pulse. Also Pang Anchang's *On Pulse*: What is Renying? Take it beside the throat. Recently Xu Donggao said: *Mai Jing* claiming Left Guan minus one part is Renying is wrong. These scholars already awakened my prior awareness. (*Leijing*)

Qikou Cun Kou

Emperor asked: Why does Qikou alone govern the Five Zang? Qibo answered: The Stomach is the sea of water and grain, the great source of the Six Fu. Flavors enter the mouth, store in the Stomach, to nourish Five Zang Qi. Qikou is also Taiyin. Thus, the Qi and flavor of Five Zang and Six Fu all originate from the Stomach and manifest in Qikou. (*Suwen*)

*Nan Jing* First Difficulty states: Among twelve meridians, all have arterial points. Why take only Cun Kou to determine life/death and fortune/misfortune of Five Zang and Six Fu? Answer: Cun Kou is the great gathering of pulses, the arterial point of Hand Taiyin. (*Nanjing*)

Examining the meanings of Cun Kou, Qikou, and Maikou through scriptures, they refer to both hands collectively, not just the two Cun positions. Right hand is Qikou; Lung governs all Qi, so Qi's prosperity/decline appears here, hence Qikou. Lung faces hundred vessels, so the great gathering of pulses is here, hence Maikou. Pulse emerges from Taiyuan, length 1.9 cun, hence Cun Kou. Is