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The pulse counts for the Liver, Heart, Lung, and Kidney total forty-six. Adding four for the Spleen, they combine to form the fifty pulses of the Great Expansion (Dayan). When the five Zang organs complete ten cycles, the count ends at "Heaven Five," which belongs to Earth and internally corresponds to the Spleen. Therefore, it is known that if Spleen Qi has exhausted, the patient will die on a Jia or Yi day. The *Mai Jue* (Pulse Classic) states: "If the pulse does not stop within fifty beats, the body has no disease; if there are stops within the count, the condition is determined." This is also based on this principle.

In the *Mai Yao Jing Wei Pian* (Chapter on Essential Secrets of Pulse Diagnosis), Qibo said: Pulses that contradict the Four Seasons show "excess" as Jing (advancement/increase) and "deficiency" as Xiao (depletion/decrease).
"Jing" means advancement; "Xiao" means depletion. Pulses reflect the excess and deficiency of Yin and Yang corresponding to the Four Seasons, specifically through the Renying (Human Welcome) and Qikou (Qi Mouth) pulses.
When the pulse should be excessive but appears insufficient, it is called Jing (advancement); when it should be insufficient but appears excessive, it is called Xiao (depletion). If Yin and Yang pulses do not correspond, the disease is named Guan Ge (Obstruction and Reflux).
When the pulse should be large but is fine, or should be fine but is large, this is called contradicting the Four Seasons. When the response should be insufficient but is excessive, it is Jing; when the response should be excessive but is insufficient, it is Xiao. This represents Jing reaching excess and Xiao reaching insufficiency. In Spring and Summer, Yin Qi depletes; the Cunkou (Cun Mouth) pulse governs Yin and should appear insufficient. If the response is instead excessive, what was originally insufficient advances. In Spring and Summer, Yang Qi advances; the Renying pulse governs Yang and should appear excessive. If the response is instead insufficient, what was originally excessive depletes. Thus, it is said: when insufficiency responds with excess, it is Xiao. If Yin and Yang do not correspond—specifically, if the Yang pulse of Renying responds insufficiently and the Yin pulse of Qikou responds excessively—it is said: Yin and Yang do not correspond, and the disease is named Guan Ge. Guan primarily refers to the inability to urinate or defecate, while Ge primarily refers to vomiting and reflux.

In the *Liu Jie Zang Xiang Pian* (Chapter on Six Sections and Visceral Manifestations): It states: If the Renying pulse is one-fold stronger (one times stronger than the Cunkou), the disease is in the Shaoyang channel; two-fold stronger, in the Taiyang channel; three-fold stronger, in the Yangming channel; and four-fold or more stronger indicates Ge Yang (Reflux of Yang).
Renying is the arterial pulse of the Foot-Yangming Stomach channel, located on both sides of the laryngeal prominence. Compared to the Renying pulse, if the Cunkou pulse is one-fold stronger, the disease is in the Shaoyang channel; two-fold stronger, in the Taiyang channel; three-fold stronger, in the Yangming channel; and four-fold or more stronger indicates extreme Yang excess, causing rejection where food cannot enter. This is what is meant by Ge, i.e., vomiting and reflux.
If the Cunkou pulse is one-fold stronger, the disease is in the Jueyin channel; two-fold stronger, in the Shaoyin channel; three-fold stronger, in the Taiyin channel; and four-fold or more stronger indicates Guan Yin (Obstruction of Yin).
Cunkou is the arterial pulse of the Hand-Taiyin Lung channel, emerging from the Jingqu acupoint. Compared to the Renying pulse, if the Cunkou pulse is one-fold stronger, the disease is in the Jueyin channel; two-fold stronger, in the Shaoyin channel; three-fold stronger, in the Taiyin channel; and four-fold or more stronger indicates extreme Yin excess, causing closure where urine cannot pass smoothly.
If both the Renying and Qikou pulses are four-fold or more stronger, it is called Guan Ge. The Guan Ge pulse is emaciated; if it cannot reach the limit of Heaven and Earth's essence and Qi, death ensues.
Not reaching the limit of Heaven and Earth's essence and Qi means failing to attain the central and correct balance of Heaven and Earth Yin and Yang, similar to being at the North Pole; thus it is called "extreme."

In the *Zhi Zhen Yao Da Lun Pian* (Chapter on the Essential and Most Important Discussion of Truth): It asks: What about cases where the pulse follows the disease but the symptoms are contrary? Qibo replied: The pulse seems to follow, but upon deep pressure, it does not throb; this applies to all Yang conditions. Asked: What about the contrary cases of all Yin conditions? Reply: The pulse seems to follow, but upon deep pressure, it throbs strongly and becomes prominent.
This refers to heat diseases where the pulse is defective; pressing deeply reveals no throbbing, caused by Yin excess repelling Yang, indicating false heat, which applies to all Yang conditions. For cold diseases, if the pulse throbs strongly under pressure, it is caused by Yang excess rejecting Yin, indicating false cold.

In the *Mai Yao Jing Wei Pian*: A coarse pulse indicates Yin insufficiency and Yang excess, constituting Heat Zhong (Heat in the Middle). A pulse coming swiftly and departing slowly indicates Upper Excess and Lower Deficiency, leading to Jue Dian Ji (Jue syndrome and epilepsy); a pulse coming slowly and departing swiftly indicates Upper Deficiency and Lower Excess, leading to E Feng (aversion to wind). Thus, those suffering from aversion to wind have affected Yang Qi. If the pulse is uniformly deep, fine, and rapid, it indicates Shaoyin Jue (Shaoyin reversal); if deep, fine, rapid, and scattered, it indicates Cold-Heat disorders; if floating and scattered, it leads to Pu Dao (falling/collapsing). (Floating indicates deficiency, scattered indicates insufficiency, hence dizziness and collapsing.) All floating pulses without agitation indicate Yang locations, thus heat; if agitation is present, it is in the hands (heat in the Three Yang channels of the hand). All fine and deep pulses indicate Yin locations, thus bone pain; if stillness is present, it is in the feet (disease in the Three Yin channels of the foot).
Regarding various abnormal pulses, a Se (choppy) pulse indicates Yang excess (due to Yang excess, blood is scanty). A Hua (slippery) pulse indicates Yin excess (due to Yin excess, blood is abundant). Yang excess manifests as body heat and anhidrosis; Yin excess manifests as hyperhidrosis and cold body; excess of both Yin and Yang results in anhidrosis and cold body.
Pushing outward, if the pulse moves inward rather than outward, there is accumulation in the chest and abdomen. Pushing inward, if the pulse moves outward rather than inward, the body has heat. Pushing upward, if the pulse rises but does not descend, the waist and feet are cold. Pushing downward, if the pulse sinks but does not rise, there is headache and neck pain. Pressing to the bone, if the pulse Qi is weak, there is lower back and spine pain accompanied by Bi syndrome.

In the *Ping Ren Qi Xiang Pian* (Chapter on Normal People and Pulse Phenomena): It states: Heat disease with a quiet pulse, diarrhea with a large pulse, blood loss with a solid pulse, internal disease with a deficient pulse, and external disease with a choppy and firm pulse are all difficult to treat.
These are cases where the disease and pulse contradict each other in terms of deficiency and excess, termed difficult to treat.
A pulse that is vigorous, slippery, and firm indicates disease in the exterior. A pulse that is small, solid, and firm indicates disease in the interior.
Vigorous and slippery belong to Yang, indicating exterior disease; small and solid belong to Yin, indicating interior disease.
A small, weak, and choppy pulse indicates chronic disease. A slippery, floating, and rapid pulse indicates acute disease.
Small, weak, and choppy indicate blood and Qi deficiency, hence chronic disease. Floating, slippery, and rapid indicate sufficient Yang Qi, hence acute disease.

In the *San Bu Jiu Hou Pian* (Chapter on Three Regions and Nine Positions): The Emperor asked: How to determine life and death? Qibo replied: A robust physique with a fine pulse, shortness of breath, and inability to catch one's breath indicates danger. A emaciated physique with a large pulse and excessive Qi in the chest indicates death. When form and Qi are harmonious, there is life. When the pulses are irregular and uncoordinated, there is disease. When all Nine Positions are discordant, there is death. If the pulses above and below, left and right respond like the pounding of a mortar, the disease is severe. If they are discordant and uncountable, there is death.
These statements refer to abnormal pulse signs indicating disease; discordance and uncountability indicate death, representing the extreme of numerical deviation.
Even if the Middle Position pulse is independently harmonious, if it is discordant with the other Zang organs, there is death. If the Middle Position pulse diminishes, there is death. Sunken eyes indicate death.
"Independently harmonious" means uniform rhythm. "Discordant with other Zang organs" means none correspond. "Diminishes" means less than the upper and lower positions, indicating partial deficiency.
The Emperor asked: How to know the location of the disease? Qibo replied: Observe the Nine Positions; the one that is uniquely small, large, rapid, slow, hot, cold, or sunken indicates disease.
These discordant pulses constitute the Seven Diagnoses. Irregularity and lack of coordination, depending on the unique anomaly, indicate disease.
Place the left hand on the patient's left foot, five cun above the ankle, and press. Then, with the right hand, tap the right foot at the ankle. If the response travels more than five cun upward and feels soft and continuous, there is no disease. If the response is rapid and feels chaotic to the touch, there is disease; if it feels slow and steady, there is disease; if the response does not reach five cun upward, or if tapping produces no response, there is death.
This discusses diagnosing life and death via the Chongyang pulse of the Foot-Yangming Stomach channel. Placing the left hand five cun above the ankle refers to using one's own hand to diagnose the foot pulse. "Shu" means sequence/next, referring to using the right hand to diagnose the right foot. Tapping involves pressing to move the pulse, seeking its presence or absence. If the response does not reach five cun upward, death ensues. Wang Bing's commentary stating that arteries exist above and below the ankles on both hands and feet is likely erroneous.
One must first understand the Jing Mai (Meridian-Vessel) pulses before understanding pathological pulses.
Jing Mai pulses refer to those possessing the Stomach Qi of the Four Seasons. In all pulse diagnoses, one must first examine Stomach Qi, then examine pathological pulses.
Emaciation with immobility indicates death.
Severe muscle wasting with inability to move the body indicates death.
If muscles and flesh are wasted, even if the Nine Positions are harmonious, there is death; if the Seven Diagnoses appear, but the Nine Positions follow the seasonal norms, there is no death.
Muscle wasting leads to death even if the Nine Positions are harmonious. However, if the Qi of the Four Seasons is smooth, the Seven Diagnoses appearing together does not necessarily mean death.
One must carefully examine the initial cause of the disease and the current manifestation, then palpate the respective pulses, observing the floating and sinking of the meridians, and tracing their upward/downward and reverse/compliant movements. Rapid pulses indicate no disease; slow pulses indicate disease. Pulses that do not flow indicate death, signifying the departure of Spirit and exhaustion of Stomach Qi. Skin adhering tightly to the bones indicates death, signifying dry and withered bones.

In the *Tong Ping Xu Shi Lun* (Chapter on General Evaluation of Deficiency and Excess): It asks: What about a full and solid pulse with cold hands and feet and a hot head? Qibo replied: Survival in Spring and Autumn; death in Winter and Summer.
In Spring and Autumn, the Three Yang govern the Heaven phase, corresponding to the Three Yang channels of the head, which belong to Yang and govern heat. The Three Yin govern the Earth phase, corresponding to the Yin channels of the hands and feet, which should receive Yin Qi and feel cold. A full and solid pulse indicates excess of Yang pathogen, ideally manifesting as whole-body high fever matching the Yang syndrome, which is compliant. Currently, with a hot head and cold hands/feet, this complies with the season in Spring and Autumn. In Winter and Summer, the Three Yin govern the Heaven phase, and the Three Yang govern the Earth phase; the head should be cold and hands/feet hot. Thus, Winter and Summer are non-compliant, indicating death.
This is similar to the Northern and Southern Polarity theory: when the year's Qi has Three Yang governing Heaven and Three Yin governing Earth, the Cun pulse should be large and Chi pulse fine; when Three Yin govern Heaven and Three Yang govern Earth, the Cun pulse should be small and Chi pulse large. This follows the same principle.