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Xu Chunfu cautiously remarks: The four characters of Wang (Observation), Wen (Listening and Smelling), Wen (Inquiry), and Qie (Palpation) are indeed the guiding principles of medicine. If one grasps the essence of these four, one can be said to have reached the pinnacle of medical knowledge. Nowadays, people only focus on Inquiry, while their understanding of Observation and Listening/Smelling is superficial. As for Palpation, it is often considered inferior to the other three and thus neglected; consequently, few people become proficient in pulse diagnosis. Those who occasionally discuss pulse diagnosis merely refer to the theory that the Heart and Small Intestine are exteriorly-interiorly related. Without distinguishing the positions of the meridians, how can one discern the critical signs of deficiency, excess, life, and death? It is unknown to many that the key to the four diagnostic methods lies in the efficacy of Palpation. Observation, Listening/Smelling, and Inquiry first provide clues to the patient's condition, after which palpating the Cun Kou (Radial Artery at the wrist) allows one to accurately determine the original source of the disease. In current practice, to determine which Zang-Fu organ or meridian is affected, whether the condition is deficient or excess, and whether the prognosis is life or death, prescribing treatment relies heavily on pulse diagnosis to achieve therapeutic effectiveness. This sequence—initially observing and listening/smelling, then inquiring and palpating—is an unchangeable principle. Can Palpation truly be neglected? Therefore, I have revised this topic for the reference of knowledgeable practitioners.

The Yellow Emperor asked Qibo: I have heard that recognizing a disease by observing facial color is called "Ming" (Clear); recognizing a disease by feeling the pulse is called "Shen" (Divine); recognizing the location of a disease by inquiry is called "Gong" (Skilled). I wish to know how to achieve knowledge through observation, acquisition through palpation, and thoroughness through inquiry. How should this be done? Qibo replied: The correspondence between facial color, pulse, and Chi Fu (forearm skin) pulse is like the response of a drumstick to a drum or the echo to a sound; they must not be disconnected. This is also the manifestation of the root and branches, or trunk and leaves; if the root dies, the leaves wither. Facial color, pulse, body form, and flesh must not lose their correspondence. Knowing one aspect leads to knowing two; knowing two aspects leads to the state of Shen (Divine); knowing all three aspects results in being both Shen and Ming.

It is also said: Recognizing disease through Observation is called "Shen" (Divine); recognizing disease through Listening/Smelling is called "Sheng" (Sage); recognizing disease through Inquiry is called "Gong" (Skilled); recognizing disease through Palpation is called "Qiao" (Skillful).

Chapter 61 of the Nan Jing (Classic of Difficult Issues) states: One who knows disease through Observation sees the five colors and thereby knows the location of the disease; one who knows disease through Listening/Smelling hears the five tones and thereby distinguishes the origin of the disease; one who knows disease through Inquiry asks about desires for the five flavors (sour, bitter, sweet, pungent, salty) and thereby knows the cause and location of the disease; one who knows disease through Palpation examines the Cun Kou (Radial Pulse) and observes its deficiency or excess to know which Zang-Fu organ is diseased.