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The *Jingmai Bie Lun* (Treatise on the Divergent Meridians) chapter of the *Huangdi Neijing* states: When food enters the stomach, its refined essence is dispersed to the Liver (*Gan*), nourishing the sinews. When food enters the stomach, its turbid qi returns to the Heart (*Xin*), and its refined essence is infused into the vessels. The qi in the vessels flows through the meridians, and the meridian qi converges in the Lung (*Fei*). The Lung receives all vessels and transmits refined essence to the skin and hair. The essence of the skin and vessels combines, circulating qi through the Fu organs. The bright spirit of the Fu organs remains in the Zang organs, and the qi reaches a state of balance and equilibrium. Through this balance, the Cun Kou (Cunkou pulse) forms its inch position, allowing for the determination of life and death. (Here, "Qi Kou" refers generally to the pulses of both hands, not solely the right hand.) When drink enters the stomach, its clear and turbid essences overflow and are transported upward to the Spleen (*Pi*). The Spleen disperses refined essence, sending it upward to return to the Lung, which regulates the water passages and transports fluids downward to the Bladder (*Pangguang*). Water essence is distributed throughout the body, and the five meridians run in parallel, harmonizing with the four seasons and the Yin-Yang of the five Zang organs, establishing this as the normal physiological pattern.

[Diagram of the Formation of the Cun Position from the Qi of the Five Zang and Six Fu Organs]

In the *Sanbu Jiuhou Lun* (Treatise on the Three Regions and Nine Locations Pulse Diagnosis) chapter, the Yellow Emperor asked: I wish to hear about the supreme numbers of Heaven and Earth, how they correspond to human form and blood-q i, and how they can be used to determine life and death. What should be done? Qibo replied: The supreme numbers of Heaven and Earth begin with one and end with nine. One represents Heaven, two represents Earth, and three represents Humanity. Multiplying by three, we get nine, corresponding to the Nine Fields (Nine Provinces). Thus, humans have three regions (Sanbu), each containing three locations (Jiuhou), used to determine life and death, treat various diseases, regulate deficiency and excess, and eliminate pathogenic factors. The Yellow Emperor asked: What are the three regions? Qibo said: There are the Upper Region, Middle Region, and Lower Region, each having three locations. These three locations correspond to Heaven, Earth, and Humanity. One must point them out and guide the understanding to grasp the truth. The Heaven location of the Upper Region is the arterial pulse at both temples; Wang Bing’s commentary notes it is on both sides of the forehead, pulsating under the fingers. The Earth location of the Upper Region is the arterial pulse at both cheeks (located beside the nostrils, near the Juliao acupoint, pulsating under the fingers). The Human location of the Upper Region is the arterial pulse in front of the ears (located in the depression in front of the ear, pulsating under the fingers). The Heaven location of the Middle Region is the Hand-Taiyin Lung Meridian (located at the Cun Kou behind the wrist, known as Jingqu acupoint, pulsating under the fingers). The Earth location of the Middle Region is the Hand-Yangming Large Intestine Meridian (located between the bones separating the thumb and index finger, at Hegu acupoint, pulsating under the fingers). The Human location of the Middle Region is the Hand-Shaoyin Heart Meridian (located at the end of the styloid process of the ulna, at Shenmen acupoint, pulsating under the fingers). The Heaven location of the Lower Region is the Foot-Jueyin Liver Meridian (located in the depression two cun distal to the base of the big toe, at Taichong acupoint). The Earth location of the Lower Region is the Foot-Shaoyin Kidney Meridian (located in the depression behind the medial malleolus and above the calcaneus, at Taixi acupoint, pulsating under the fingers). The Human location of the Lower Region is the Foot-Taiyin Spleen Meridian (located between the muscles over the fish belly tendon, directly opposite Wuli and Jimen acupoints, pulsating under deep pressure. To palpate Stomach qi, one should take the Chongyang acupoint on the dorsum of the foot, which pulsates under the fingers). Therefore, the Heaven location of the Lower Region observes the Liver, the Earth location observes the Kidney, and the Human location observes the Spleen and Stomach qi. The Heaven location of the Middle Region observes the Lung, the Earth location observes the qi of the chest, and the Human location observes the Heart. The Heaven location of the Upper Region observes the qi of the head and horns, the Earth location observes the qi of the mouth and teeth, and the Human location observes the qi of the eyes and ears.

The correspondence among the nine locations should be consistent; upper and lower should be uniform and not deviate. If one location lags (is absent or weak), disease occurs; if two lag, the disease is severe; if three lag, the condition is critical. "Lagging" means the pulses do not respond simultaneously.

The *Maiyao Jingwei Lun* (Treatise on the Essential subtleties of Pulse Diagnosis) chapter states: The inner lateral side of the Chi area corresponds to the hypochondrium (the hypochondrium is one cun eight fen below the costal margin above the Dai Mai belt vessel, which is its diagnostic site). The outer Chi area observes the Kidney, and the inner Chi area observes the abdomen (both Chi pulses; the outer aspect of both Chi pulses observes the Kidney region, while the inner aspect observes the interior of the abdomen, where the Large Intestine, Small Intestine, and Bladder are located centrally). Above this is the Guan area (both Guan positions); the left outer aspect observes the Liver, and the inner aspect observes the Diaphragm (the classic text states: The Diaphragm is the Middle Jiao, the source of blood). The right outer aspect observes the Stomach, and the inner aspect observes the Spleen. Above that is the Cun area (both Cun positions); the right outer aspect observes the Lung, and the inner aspect observes the chest (the classic text states: The chest is the Upper Jiao, the source of qi). The left outer aspect observes the Heart, and the inner aspect observes the Danzhong (the classic text states: Danzhong is the Official of the Envoy, from which joy and pleasure emerge; this is the Sea of Qi). The anterior part observes anterior pathology, and the posterior part observes posterior pathology. Pulse qi reaching the extreme upper (above the Cun) relates to matters of the chest and throat; pulse qi reaching the extreme lower (below the Chi) relates to matters of the lower abdomen, waist, thighs, knees, and feet. (This summarizes the preceding text.) This method of observing the Cun, Guan, and Chi three regions from the *Neijing* was altered in the *Nanjing* and *Maijue*, assigning the Large and Small Intestines to the Lung and Heart respectively, yet few today thoroughly investigate this. So, which standard for the three regions is accurate? While modern practitioners correctly identify the three regions of the pulse, their methods for internal/external observation would remain unknown without Mr. Xin Gu's work *Zhiyi*. *Zhiyi* states: Each internal and external portion has anterior and posterior halves. Pulse qi rising up corresponds to the anterior half, belonging to the exterior and Yang; pulse qi sinking down corresponds to the posterior half, belonging to the interior and Yin. Rising up moves from back to front, as Yang arises from Yin. Sinking down moves from front to back, as Yin arises from Yang. Generally speaking, Zang organs located near the back (Yang position) are observed via the anterior half, while those near the abdomen (Yin position) are observed via the posterior half. Specifically, the junctions of the inner/outer and anterior/posterior aspects of both Chi areas resemble the boundary of the hypochondrium dividing the waist and abdomen. The anterior half of both Chi areas observes the Kidney attached to the lumbar spine (Yang position), while the posterior half observes the abdominal interior (Yin position). From Chi to Guan is the Guan section; on the left, the anterior half observes the Liver (located in the left hypochondrium near the back, a Yang position), and the posterior half observes the Diaphragm (at the stomach opening, a Yin position); on the right, the anterior half observes the Stomach (near the spine, a Yang position), and the posterior half observes the Spleen (located in the right hypochondrium near the abdomen, a Yin position). From Guan to Cun is the Cun section; on the right, the Lung occupies the upper right Yang position, and the chest occupies the Yin position above the Danzhong acupoint. Thus, these areas are observed separately anteriorly and posteriorly. The phrase "anterior observes anterior, posterior observes posterior" reiterates the general meaning. Overflowing from Guan to Cun observes matters from the chest to the head; extending from Guan to the end of Chi observes matters from the navel to the feet, expanding upon the previous meaning. This constitutes the observation method for the anterior/posterior and internal/external aspects of Cun and Chi. Why do the Heart, Liver, Spleen, and Lung each have one observation site, while only the Kidney occupies both Chi sites? This follows the principle of Yang being one and Yin being two. The Heart, Liver, Spleen, and Lung reside above the diaphragm in Yang positions, with odd numbers, thus having one form and one observation site. Only the Kidney resides below the diaphragm in a Yin position, with an even number, shaped like two kidney beans, attached to the lumbar spine on left and right, hence observing both Chi sites; this follows the principle of water flowing downward. The *Maijing* and *Kanwu* both observe the Kidney at both Chi sites, grasping this intent. However, the *Nanjing* and *Maijue* incorrectly assign the left Chi to the Kidney (Water) and the right Chi to the Hand-Jueyin Pericardium paired with Mingmen and Shaoyang Sanjiao Ministerial Fire. Mingmen, according to the *Tongren* manual, is an acupoint below the 14th thoracic vertebra on the spine. Based on this, there is no proper Zang organ internally nor a proper Meridian externally, so how can it be assigned to a pulse region? Furthermore, the naming of the Hand-Jueyin organ is inconsistent: some say Pericardium, some say "small heart beside the seven segments," some say it substitutes for the Heart's master role, and some say it refers to the static water and moving fire of the two Kidneys; all are groundless claims. Examining the *Jinkui Zhenyan Lun*, it states: The five Zang organs—Liver, Heart, Spleen, Lung, Kidney—are Yin; the six Fu organs—Gallbladder, Stomach, Large Intestine, Small Intestine, Bladder, Sanjiao—are Yang. This pairs eleven Zang organs with twelve meridians, leaving the Hand-Jueyin meridian without a matching Zang organ. Examining the *Linglan Midian Lun*, Qibo answers the Yellow Emperor regarding the twelve Zang organs: The Heart is the Sovereign Official, from whom spirit emerges. The Lung is the Official of Transmission, from whom regulation emerges. The Liver is the General Official, from whom strategy emerges. The Gallbladder is the Official of Integrity, from whom decision emerges. Danzhong is the Official of the Envoy, from which joy and pleasure emerge. The Spleen and Stomach are the Officials of the Granary, from which the five flavors emerge. The Large Intestine is the Official of Conduction, from whom transformation emerges. The Small Intestine is the Official of Reception, from whom refinement emerges. The Kidney is the Official of Strength, from whom skill emerges. The Sanjiao is the Official of Drainage, from whom water passages emerge. The Bladder is the Official of the Metropolis, storing fluid essence; when qi transforms, it can exit. Observing this, Danzhong completes the count of twelve Zang organs to prepare for the twelve officials. Therefore, does not the Hand-Jueyin meridian pair with Danzhong? Indeed, Danzhong is the empty space before the Heart, sharing the Heart's nature of joy. Joyful laughter is governed by Fire, indicating it serves as the correspondent to the Heart's Sovereign Fire. It constantly stores ethereal qi, called Zongqi (Gathering Qi) or Sea of Qi in the *Lingshu*. Its residual qi permeates the Upper Jiao of the chest, spreads throughout the body via the Lung, serving as the continuous operation of life; the classic text says "Minor Fire generates Qi." If this function fails, external heat and internal fever scorch the Zang organs, termed Ministerial Fire or Dragon Fire; the classic text says "Major Fire consumes Qi." Thus, Danzhong is the Zang organ of the Hand-Jueyin Heart Master Ministerial Fire. Hence, this text pairs it with the Heart's Sovereign Fire, distinguishing internal/external but observing both at the Left Cun, following the principle of fire flaming upward. Tracing the Hand-Jueyin Meridian, it originates in the chest, connects to the Sanjiao, ascends via the axilla along the medial arm to the middle finger. Since both the meridian and organ are in the upper body, they should be observed at the Cun; can they be observed at the Right Chi? Additionally, the Sanjiao is the Fu organ of the Hand-Shaoyin, connecting upper and lower. The *Lingshu* states: The Upper Jiao is like mist, the Middle Jiao like foam, the Lower Jiao like a ditch. Here, the chest is the Upper Jiao, source of qi; the diaphragm is the Middle Jiao, source of blood; the abdomen is the Lower Jiao, source of water. Their positions differ, and so do their treatments; this explains why the text distinguishes observations for the chest, diaphragm, and abdomen. Tracing the Hand-Shaoyang Sanjiao Meridian, it starts at the tip of the ring finger, travels along the lateral elbow and arm, over the shoulder to the head, with a branch descending to connect with Danzhong and belong to the Sanjiao of the chest, diaphragm, and abdomen. It cannot be exclusively owned by the Lower Jiao; can it be exclusively observed at the Right Chi? As for why the Gallbladder is omitted from the Fu organs, it is entrusted to the Liver. Why are the Small, Large Intestines, and Bladder omitted? They are unified under the abdomen. Moreover, these three Fu organs reside in the lower abdomen, appropriately observed at the posterior halves of both Chi sites, divided left and right. The Small Intestine follows the Heart on the left, the Large Intestine follows the Lung on the right, and the Bladder communicates with the Small Intestine sharing the same observation is correct. The *Nanjing* and other books ignore the vertical positions of Zang and Fu, rigidly adhering to exterior-interior meridian relationships, observing the Heart and Small Intestine at the Left Cun and the Lung and Large Intestine at the Right Cun, which is incorrect. Texts like *Shuyao* often assign the Left Chi to diseases of the Small Intestine, Bladder, and anterior orifice, and the Right Chi to diseases of the Large Intestine and posterior orifice. Now, speaking of the method of anterior/posterior and internal/external observation: In a single pulse region, if the rising and falling pulses are soft, smooth, timely, and fit the position, it is called the Harmonious Pulse, indicating health. If the rising and falling pulses show excess or deficiency, mistiming, or reversal of position, it is called the Abnormal Pulse, indicating disease. One must examine whether the rising and falling pulse qualities are similar or different to assign their observational domains, largely based on the Five Elements. Qi of the same nature rises together; only Water descends. Qi of different natures has both ascending and descending movements, distinguishing Yin and Yang. Therefore, if rising and falling are the same, judge by unity: pathology at Cun/Guan is in the anterior observation, pathology at both Chi is in the posterior observation. If rising and falling are different, judge by affiliation: rising pathology is in the anterior observation, sinking pathology is in the posterior observation. If rising and falling appear harmonious and discordant, harmony indicates health, discordance indicates disease. If rising and falling are identical but contain differences, the differing aspect indicates pathology. If rising and falling are identical but vary in strength, the more pronounced aspect indicates pathology. This applies to the eight pulse types: Choppy, Slippery, Long, Short, Surging, Fine, Hollow, and Slow. The general rule involves unity and affiliation, additionally examining Floating/Sinking, Deficiency/Excess, and Yin/Yang overflow/reversal. Floating observes the Exterior, generally governing the skin, hair, meridians, head, neck, waist, spine, limbs, joints, and muscles. Sinking observes the Interior, generally governing the Zang-Fu organs, bone marrow, throat, and urination/defecation. Deficiency indicates insufficiency, manifesting as itching, numbness, flaccidity, and diarrhea. Excess indicates superfluity, manifesting as distension, obstruction, pain, and constipation. Rising is Yang, observing ascending pathology. Sinking is Yin, observing descending pathology. Rising beyond the region is Overflow; sinking beyond the region is Reversal, with observations as previously stated. Taking the Choppy pulse (insufficiency) as an example:

At the anterior rising aspect of both Chi sites, which observes the Kidney: A Floating-Choppy pulse indicates deafness. The Kidney stores essence and opens into the ears; the ears receive Kidney essence rising to nourish them, enabling hearing. Now, Floating-Choppy indicates Kidney insufficiency, unable to nourish the ears, resulting in deafness. A Sinking-Choppy pulse indicates lower back pain. The Kidney attaches to the spine and manifests externally in the waist; the waist receives Kidney essence nourishing it internally, enabling movement. Now, Sinking-Choppy indicates Kidney insufficiency, unable to nourish the waist internally, resulting in lower back pain.

At the posterior sinking aspect of the Left Chi, which observes the abdomen, Small Intestine, and Bladder: A Floating-Choppy pulse indicates coldness and numbness in the feet and knees. This is the location of the Lower Jiao in the abdomen; insufficient Yang qi cannot warm the feet and knees externally, causing coldness and numbness. A Sinking-Choppy pulse indicates seminal emission in men and leukorrhea in women, observing the water-essence of the abdomen. Insufficient Yang qi cannot secure the anterior orifice internally, causing essence and discharge to slip downward.

At the posterior sinking aspect of the Right Chi, which observes the Large Intestine in the abdomen: A Floating-Choppy pulse is diagnosed similarly to the left. A Sinking-Choppy pulse indicates difficulty defecating. The abdomen is the origin of the Large Intestine; the Large Intestine is naturally rich in qi and blood. Now, Sinking-Choppy indicates insufficiency of qi and blood in the Large Intestine, leading to qi stagnation and blood dryness, causing difficult defecation.

At the anterior rising aspect of the Left Guan, observing the Liver: A Floating-Choppy pulse indicates blurred vision due to Liver blood failing to nourish the head upwards. A Sinking-Choppy pulse indicates flank distension due to Liver qi internal stagnation.

At the posterior sinking aspect of the Left Guan, observing the Diaphragm: A Floating-Choppy pulse indicates dampness from the Central Palace seeping into the scrotum, causing unilateral testicular enlargement accompanied by acute pain. A Sinking-Choppy pulse indicates that Middle Jiao qi cannot nourish the essence to the Heart and Lung, causing stagnation in the diaphragm leading to distension, or severe pain.

At the anterior rising aspect of the Right Guan: A Floating-Choppy pulse indicates aversion to vomiting; a Sinking-Choppy pulse indicates poor appetite. This observes Stomach Yang, which governs reception.

At the posterior sinking aspect of the Right Guan: A Floating-Choppy pulse indicates aversion to cold in the four limbs; a Sinking-Choppy pulse indicates difficulty digesting food. This observes Spleen Yin, which governs transformation and transportation.

At the anterior rising aspect of the Right Cun, observing the Lung: A Floating-Choppy pulse indicates headache. The Lung is the organ transmitting qi; its qi should be full, not deficient. Now, Floating combined with Choppy indicates Lung qi insufficiency, unable to ascend to nourish the head, resulting in empty headache. A Sinking-Choppy pulse indicates phlegm stagnation. The Lung is the organ ventilating qi; its qi should be free-flowing, not stagnant. Now, Sinking combined with Choppy indicates Lung qi obstruction, stagnating into phlegm, possibly obstructing lung orifices causing cough.

At the posterior sinking aspect of the Right Cun, observing the chest: A Floating-Choppy pulse indicates stabbing pain in both pectorals. Both pectorals are beside the chest. Now, Sinking combined with Choppy indicates insufficiency of chest qi, unable to fill the pectorals externally, causing qi stagnation and stabbing pain. A Sinking-Choppy pulse indicates shortness of breath. The chest is the source of qi in the Upper Jiao. Now, Sinking combined with Choppy indicates insufficiency of chest qi, unable to supply the Lung's transmission, resulting in discontinuous shortness of breath.

Observing the Heart at the anterior rising aspect of the Left Cun: A Floating-Choppy pulse indicates dizziness, as Heart blood cannot nourish the head externally, causing Fire to flare up and induce dizziness. A Sinking-Choppy pulse indicates spontaneous sweating, as Heart blood insufficiency causes Fire to steam internally, producing sweat.

Observing Danzhong at the posterior sinking aspect of the Left Cun: A Floating-Choppy pulse indicates aversion to cold in both axillae. The axillae are the passage of the Hand-Jueyin Meridian. Insufficient exterior meridian qi leads to loss of defensive protection at the pores, allowing pathogens to invade externally, causing aversion to cold near the axillae. A Sinking-Choppy pulse indicates fright. Danzhong is the organ of Zongqi. Insufficient Danzhong qi causes Fire to consume Heart blood, and Spirit fails to remain inward, resulting in palpitations and restlessness. This uses the Choppy pulse as an example; the rest can be inferred analogously.