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Question: The twelve meridians of the hand and foot, consisting of three Yin and three Yang meridians, all have arterial pulses. Why is only the Cun Kou (Inch Port) pulse selected for diagnosis? Bian Que replied: In a full day and night, the clepsydra (water clock) drips one hundred ke (time units). Each ke consists of 135 breaths (xi). Ten ke amount to 1,350 breaths, and one hundred ke amount to 13,500 breaths. The pulse circulates fifty times throughout the body during this period. As the water drips one hundred ke, Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) circulate twenty-five times in the Yang aspects and twenty-five times in the Yin aspects, totaling fifty cycles to complete one great revolution, finally converging again at the Hand Taiyin Lung Meridian. The Hand Taiyin Lung Meridian corresponds to the Cun Kou; the Cun Kou is the beginning and end of the Qi and Blood of the Zang and Fu organs. Therefore, the method of diagnosis selects the Cun Kou pulse.

Regarding the pulse positions of Cun, Guan, and Chi: From the Guan position to the Chi position is the "Chi Nei" (Inner Chi), which is governed by Yin Qi. From the Guan position to the Yu Ji (Fish Border) is the "Cun Nei" (Inner Cun), which is governed by Yang Qi. The Cun Kou position measures eight fen, the area above the Guan measures three fen, and the Chi Zhong position measures eight fen, totaling one cun and nine fen across the three positions. The Cun and Guan positions belong to Yang; Yang pulses are typically floating and rapid. The Chi position belongs to Yin; Yin pulses are typically deep and slow.

When initially palpating the pulse, with a light pressure equivalent to the weight of three beans, feeling it correspond to the skin and hair indicates the Lung pulse. With a slightly heavier pressure equivalent to six beans, feeling it correspond to the blood vessels indicates the Heart pulse. With further increased pressure equivalent to nine beans, feeling it correspond to the muscles indicates the Spleen pulse...

In general, when diagnosing the pulse, one must observe the patient's body size, height, length, and whether their temperament is rapid or leisurely. If the pulse matches the person's physical constitution and temperament, it is auspicious; if the pulse clashes with their inherent nature, it is ominous. Why? If a large-bodied person has a thin pulse, or a small-bodied person has a large pulse; if a person who is joyful has a solid pulse, or a suffering person has a deficient pulse; if a person with an irritable temperament has a slow pulse, or a leisurely person has a restless pulse; if a robust person has a thin pulse, or a emaciated person has a large pulse—these are all considered "Ni" (Rebellious/Adverse) patterns, which are difficult to treat. Conversely, these are "Shun" (Smooth/Favorable) patterns, which are easy to treat.

Generally, women's pulses tend to be soft and weak, weaker than those of men. Children aged four or five naturally have rapid pulses, beating eight times per respiration cycle.

Spring pulses are fine, wiry, and long. Summer pulses are surging, floating, and long, arriving rapidly and departing slowly. Autumn pulses are slightly floating and scattered. Winter pulses are deep, slippery, and solid. Late Summer pulses are surging and slow.

The pulses of the Heart and Lungs are generally both floating. How to distinguish them? A floating and large pulse is the Heart pulse; a floating and short pulse is the Lung pulse. The pulses of the Liver and Kidneys are both deep. How to distinguish them? A firm and long pulse is the Liver pulse; one that feels soft upon pressing but solid upon lifting is the Kidney pulse; a slow, moderate, and long pulse is the Spleen pulse.

Humans receive Qi from grain, which is processed in the Stomach and transmitted to the Zang and Fu organs. All Zang and Fu organs receive Qi from the Stomach. The clear and light part becomes Ying Qi, while the turbid and heavy part becomes Wei Qi. Ying Qi circulates within the vessels, and Wei Qi circulates outside the vessels. Yin and Yang interconnect like a circle without end. Thus, the Stomach is the Sea of Water and Grain, governing the four directions, with Stomach Qi as the root.

If a patient appears normal but the pulse is abnormal, it is called "Nei Xu" (Internal Deficiency). If the pulse appears normal but the patient exhibits severe symptoms, it is called "Xing Shi" (Walking Corpse); this condition leads to death and is untreatable.

A balanced, normal pulse is neither slow nor rapid, neither choppy nor slippery, neither present nor absent, neither long nor short, neither high nor low, neither vertical nor horizontal. This is a Ping Pulse (Normal Pulse), indicating no disease. The Chi pulse should be moderately sized, the Guan pulse slightly solid. An elderly person's pulse should be faint, with Yang slightly weaker than Yin; this is also considered normal.

If pressing reveals insufficiency but lifting reveals excess, it is called a Floating Pulse (Fu Mai). Floating belongs to Yang.

If pressing reveals a rapid and hurried movement, it is called a Rapid Pulse (Shu Mai). Rapid belongs to Yang.

If pressing feels like a lute string, consistent across all three positions, stiff and unyielding, it is called a Wiry Pulse (Xian Mai). Wiry belongs to Yang. (According to *Wang Han Jing*, Wiry is Yin.)

If pressing feels like rolling pearls, it is called a Slippery Pulse (Hua Mai). Slippery belongs to Yang.

If pressing feels solid and strong, resembling a deep and hidden pulse, it is called a Firm Pulse (Lao Mai). Firm belongs to Yang.

If pressing feels large and full under the fingers, it is called a Surging Pulse (Hong Mai). Surging belongs to Yang.

If pressing feels surging, large, firm, and strong, sinking into the fingers, it is called a Solid Pulse (Shi Mai). Solid belongs to Yang.

If the pulse appears at the Guan position, without head or tail, large like a bean, trembling vigorously, it is called a Moving Pulse (Dong Mai). Moving belongs to Yang.

The above eight types are all Yang pulses.

If pressing reveals excess but lifting reveals insufficiency, it is called a Deep Pulse (Chen Mai). Deep belongs to Yin.

If pressing feels empty but lifting reveals the pulse coming, with solidity on both sides and emptiness in the center, it is called a Scallion Stem Pulse (Kou Mai). Scallion Stem belongs to Yin.

If pressing feels slow and fine, it is called a Fine Pulse (Xi Mai). Fine belongs to Yin.

If pressing feels short, solid, and rapid, resembling the cutting of a rope, it is called a Tight Pulse (Jin Mai). Tight belongs to Yin.

If pressing feels compliant and slow, it is called a Moderate Pulse (Huan Mai). Moderate belongs to Yin.

If pressing feels large and slow, it is called a Deficient Pulse (Xu Mai). Deficient belongs to Yin.

If pressing feels short and small, wavering as if present or absent, or alternatively floating, thin, and rapid, obtainable with light pressure but not with heavy pressure, it is called a Minute Pulse (Wei Mai). Minute belongs to Yin.

If the pulse is felt only upon pressing and disappears upon lifting, being soft and fine, it is called a Weak Pulse (Ruo Mai). Weak belongs to Yin.

If pressing finds it completely firm, disappearing upon lifting, neither advancing nor retreating, only exiting without entering, moving like a fish taking food in water, it is called a Slow Pulse (Chi Mai). Slow belongs to Yin.

If pressing feels empty but lifting reveals excess, or feels like silk cloth in water, soft and corresponding to the muscle with light pressure, it is called a Soft Pulse (Ru Mai). Soft belongs to Yin.

If pressing feels hurried, rapid, floating, and short, like scraping bamboo skin, obtainable with light pressure but staying put with heavy pressure, or entering more than exiting, it is called a Choppy Pulse (Se Mai). Choppy belongs to Yin.

If pressing feels hurried and rapid, stopping occasionally, it is called a Hasty Pulse (Cu Mai). Hasty belongs to Yin.

If the pulse beats and then stops, but upon pressing recovers within a slight rapidity, and moves upon lifting, it is called a Knotted Pulse (Jie Mai). Knotted belongs to Yin and indicates survival.

If the pulse beats and stops, cannot recover spontaneously, and thus moves again, it is called a Intermittent Pulse (Dai Mai). Intermittent belongs to Yin and indicates death.

The above fourteen types are all Yin pulses.

Pulses may clash. If the Cun Kou pulse is minute while the Chi Zhong pulse is wiry, this is clashing. Even if only the Cun Kou is minute and wiry, it is still considered clashing.

Deep and Hidden pulses are similar; Soft and Weak pulses are similar; Wiry and Tight pulses are similar;
Floating and Scallion Stem pulses are similar; Firm and Solid pulses are similar; Minute and Choppy pulses are similar;
Slow and Moderate pulses are similar; Slippery and Rapid pulses are similar.

Generally, pulses emerging outward are Yang, and those entering inward are Yin. The movement between incoming and outgoing relates to the Spleen.

Generally, floating, slippery, and long pulses are Yang; deep, choppy, and short pulses are Yin.

A pulse with one Yin and one Yang element arrives deep and slippery. One Yin and two Yang elements arrive deep, slippery, and long. One Yin and three Yang elements arrive floating, slippery, and long, occasionally sinking. One Yang and one Yin element arrive floating and choppy. One Yang and two Yin elements arrive long, deep, and choppy. One Yang and three Yin elements arrive deep, choppy, and short, occasionally floating.

Pulses may have hidden or concealed characteristics, referring to Yin and Yang mutually overcoming and hiding. If a pulse located in the Yin sector (Chi) unexpectedly shows Yang pulses, this is Yang overcoming Yin. Although Yang pulses appear, if they are sometimes deep, choppy, and short, this is Yin hidden within Yang. If a pulse located in the Yang sector (Cun) unexpectedly shows Yin pulses, this is Yin overcoming Yang. Although Yin pulses appear, if they are sometimes floating, slippery, and long, this is Yang hidden within Yin. Therefore, excessive Yin leads to Mania (Dian), and excessive Yang leads to Hyperactivity (Kuang).

Pulses may be excessive or deficient, involving mutual overcoming, covering (Fu), overflowing (Yi), blocking (Guan), and repelling (Ge). Before the Guan position is the movement of Yang. The pulse should manifest nine fen and float. Exceeding this is termed Excessive; reducing it is termed Deficient. If it extends up to the Fish Border, it is called an Overflowing Pulse (Yi Mai), representing external blockage and internal repulsion, a pulse of Yin overcoming Yang. Behind the Guan position is the movement of Yin. The pulse should manifest one cun and sink. Exceeding this is Excessive; reducing it is Deficient. If it sinks into the Chi region, it is called a Covering Pulse (Fu Mai), representing internal blockage and external repulsion, a pulse of Yang overcoming Yang. This manifests the True Zang pulses. Obtaining such pulses means the person will die even without illness. If the Cun pulse does not reach the Guan below, it is Yang Extinction. If the Chi pulse does not reach the Guan above, it is Yin Extinction. These are all fatal and untreatable. To determine life and death, one must refer to the lunar months and solar terms.

Pulses involve mutual overcoming, with Vertical (Zong), Horizontal (Heng), Rebellious (Ni), and Smooth (Shun) dynamics. How to know them? Water overcoming Fire, and Metal overcoming Wood, is called Vertical. Fire overcoming Water, and Wood overcoming Metal, is called Horizontal. Water overcoming Metal, and Fire overcoming Wood, is called Rebellious. Metal overcoming Water, and Wood overcoming Fire, is called Smooth.

To know if a patient's illness will heal, diagnose the three positions of the pulse. If the Cun, Guan, and Chi are equal in size, slowness/rapidity, and depth/floating, even if cold and heat symptoms persist, knowing that Yin and Yang are balanced indicates healing.

If a patient has fever and body pain, this is an exterior disease, and the pulse should be floating and large. If the pulse is instead deep and slow, one knows healing is imminent. If a patient suddenly has abdominal urgency and pain, this is an interior disease, and the pulse should be deep and fine. If the pulse is instead floating and large, one knows healing is imminent. However, in these two cases, if the patient does not heal immediately, they will surely die, because... (Text cuts off here).

The pulse is the mansion of Blood. Long indicates regulated Qi; short indicates diseased Qi; rapid indicates vexation in the heart; large indicates progressing disease. Upper excess causes Qi rising; lower excess causes Qi distension. Intermittent pulses indicate Qi decline; fine pulses indicate Qi scarcity. Short and rapid pulses indicate disease in the upper body; long and moderate pulses indicate disease in the lower body; wiry and deep pulses indicate disease in the interior; floating and surging pulses indicate disease in the exterior. Solid pulses indicate interior disease; deficient pulses indicate exterior disease. Slippery and slightly floating pulses indicate Lung disease; hardness below and deficiency above indicate Spleen and Stomach disease; long and wiry pulses indicate Liver disease; small pulses with scant blood indicate Heart disease; large and tight pulses indicate Kidney disease.

Generally, Fu organs are Yang and govern heat; Zang organs are Yin and govern cold. Yang micro-pulse causes spontaneous sweating; Yin floating pulse causes downward discharge. Yang rapid pulse causes mouth ulcers; Yin rapid pulse causes aversion to cold. Yang rapid pulse causes bleeding; Yin choppy pulse causes bloody stool. When the pulse corresponds well with the muscle texture, holding it for a long time until the rate allows, purgative methods may be used.

There are three pulse positions. Yin and Yang overcome each other. Ying and Wei, Qi and Blood follow the human body. Through respiration entering and exiting, they move up and down within. Driven by breath, they circulate, distributing fluids smoothly. They act according to the time, forming images and descriptions: Spring is wiry, Autumn is floating, Winter is deep, Summer is surging. Observing color and viewing the pulse, sizes differ. Within a moment, changes are constant. Cun and Chi vary, sometimes short, sometimes long. Up and down are disordered, sometimes present, sometimes absent. Illness alters constantly. Advancing and retreating, rising and falling, cause confusion and bewilderment, losing discipline. I wish to state this fully to clarify. The Master said: What you ask is the root of the Dao. There are three pulse positions: Cun, Chi, and Guan. Ying and Wei flow without losing balance. Kidney is deep, Heart is surging, Lung is floating, Liver is wiry. This is the constant principle, accurate to the smallest fraction. Entering and exiting, ascending and descending, rotate with the clepsydra. Under the dripping water of one hundred ke, one cycle completes, returning to the Cun Kou. Deficiency and Excess become visible. Changes overcome each other; Yin and Yang interact. Wind causes floating and deficient pulses; Cold causes firm and hard pulses. Deep and submerged [water retention]; Phlegm-fluids cause urgent wiry pulses. Moving pulses indicate pain; Rapid pulses indicate heat and vexation. If there is discrepancy, know there is a cause. The three positions differ; diseases have different origins. Excess is strange; deficiency is so too. Evil does not appear empty; there is always a culprit. Examine the exterior and interior; differentiate the Triple Burner. Know where the pathogen resides. Carefully observe and judge. Estimate the Zang and Fu. See clearly as if divine. I record this for you to pass on to worthy persons.

In treating illness, one must observe the form, Qi, color, and luster; the prosperity and decline of the pulse; and the newness or oldness of the disease, before treatment can begin. If form and Qi match, color is bright, and the pulse follows the four seasons, it is easy to treat. If form and Qi mismatch, color is dull and lusterless, and the pulse is excessively solid and hard, violating the four seasons, it is difficult to treat.

If the form is robust but the pulse is fine, with insufficient Qi to breathe, it is critical. If the form is emaciated but the pulse is large, with much Qi in the chest, it is fatal. If form and Qi match, there is life; if the three [form, Qi, pulse] are discordant, there is disease.

Before the Guan is Yang; behind the Guan is Yin. Yang exits and Yin enters, with the Guan as the boundary. Yang rapid pulse causes vomiting; Yin rapid pulse causes diarrhea. Yang wiry pulse causes headache; Yin wiry pulse causes abdominal pain.