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The method of pulse diagnosis is a skill that physicians find difficult to master. Unless one studies diligently by lamplight, memorizes constantly, consults teachers, visits friends day and night without rest, and keeps this in mind during hasty situations, turbulent times, waking or sleeping, how can one know the subtleties of divine medicine? The ancients said: "Pressing the pulse and knowing the disease is called 'Shen' (Divine), which reflects the wonder of exploring profound mysteries." It is also said: "Palpating the pulse and treating the disease is called 'Qiao' (Skillful), demonstrating the efficacy of finger differentiation." The distance between the three fingers is merely a hair's breadth, yet the diseases they indicate are as far apart as a thousand miles. Observing the efficacy of finger differentiation, people naturally consider it difficult; calling it 'Shen', how could it be easily attained?

It is commonly observed that the meridians are divided into three positions: Cun (Inch), Guan (Bar), and Chi (Cubit). One cun backward from the radial styloid process (Gao Gu) towards the fish际 (Yu Ji) is called Cun. From Cun forward one fen is Yu Ji. From Cun to Chi Ze is Chi. The area before Guan and after Cun is Guan. Anterior to Guan is Yang, known as the Cun Kou (Inch Port); posterior to Guan is Yin, known as the Chi Mai (Cubit Pulse). Yin enters and Yang exits with Guan as the boundary. The Cun position primarily governs the Upper Jiao (Upper Burner), including the head, face, and skin/hair. The Guan position primarily governs the Middle Jiao (Middle Burner), including the hypochondrium, abdomen, and waist. The Chi position primarily governs the Lower Jiao (Lower Burner), including the lower abdomen and feet. This is the general overview of what the three positions govern. On the left hand, anterior to Guan is the Heart position; at Guan is the Liver position; posterior to Guan is the Kidney position. On the right hand, anterior to Guan is the Lung position; at Guan is the Spleen position; posterior to Guan is also the Kidney position. (These six positions originally matched the Zang-Fu pairing in *Mai Jue*, but now following the diagnostic principles of *Nei Jing*, the Fu organ pairings have been deleted.) If the pulses of the six positions each possess Stomach Qi (Wei Qi, the vital energy derived from digestion indicating health) according to the four seasons, they are called "Ping Ren" (Normal Person), meaning a person who is not ill. Generally, the normal Qi of a healthy person is derived from the Stomach; the Stomach is the source of normal Qi for a healthy person. Therefore, humans constantly derive Qi from the Stomach, so the pulse is rooted in Stomach Qi. Cai Xishan said: A pulse with Stomach Qi is neither large nor small, neither long nor short, neither slippery nor choppy, neither floating nor sunken, neither slow nor rapid; it appears vibrant and lively, difficult to describe in words. This is a pulse with Stomach Qi. Anything contrary to this indicates disease. The Classics state: "Observe the complexion and palpate the pulse, first distinguishing Yin and Yang." Yin and Yang are the way of Heaven and Earth. Therefore, those who treat diseases must seek their root. The root lies in Yin-Yang, the four seasons, cold and heat, and the five Zang organs. In terms of pulse characteristics, this refers to Floating (Fu) and Sunken (Chen); in terms of positions, it refers to Cun and Chi. Thus, the Classics say: "Pulse is the law of Yin and Yang, corresponding to the five Zang organs. Exhalation corresponds to the Qi of the Heart and Lungs; inhalation corresponds to the Qi of the Kidneys and Liver. Between breaths, the Spleen receives grain essence, and its pulse is located in the middle." Discussing by Floating and Sunken: Floating is Yang, Sunken is Yin. Regarding Zang organs: A pulse that is Floating, Large, and Scattered belongs to the Heart; a pulse that is Floating, Short, and Choppy belongs to the Lung. Thus, both Heart and Lung pulses manifest as Floating. A pulse that is Firm (Lao) and Long belongs to the Liver; a pulse that is solid upon pressure and strong upon lifting belongs to the Kidney. Thus, both Liver and Kidney pulses manifest as Sunken. A pulse that is Slow (Chi) and Long belongs to the Spleen. Since the Spleen resides in the Central Region (Zhong Zhou), its pulse is located in the middle. Zhang Zhongjing said: "Floating, Rapid (Shuo), Moving (Dong), and Slippery (Hua) pulses are all Yang; Sunken, Choppy (Se), Weak (Ruo), Wiry (Xian), and Minute (Wei) pulses are all Yin." Yang represents Heat, and Yin represents Cold. Therefore, in Cold conditions, the pulse comes slowly and sunken; in Heat conditions, the pulse comes floating and rapid. Thus it is said: "Many rapid pulses indicate Heat; many slow pulses indicate Cold." There is no more accurate verification than this. *Mai Jing* states: "All Floating pulses indicate Wind; all Tight (Jin) pulses indicate Pain; all Deep/Fixed (Fu) pulses indicate Accumulation; all Wiry pulses indicate Fluid Retention (Yin); a Knotted/Empty (Kou) pulse indicates Blood Loss. A Long pulse indicates regulated Qi; a Short pulse indicates diseased Qi; a Rapid pulse indicates vexation of the Heart; a Large pulse indicates advancing disease. Floating indicates exterior location; Sunken indicates interior location; Slow indicates various Cold patterns; Rapid indicates various Heat patterns. If the body is robust but the pulse is thin, and there is shortness of breath insufficient for respiration, the condition is critical. If the body is emaciated but the pulse is large, and there is excessive Qi in the chest, death ensues. If Form and Qi are harmonious, life prevails; if the three positions and nine examinations are discordant, disease exists; if all three positions and nine examinations are lost/disordered, death occurs. This is the great method of pulse diagnosis of the ancient sages. Therefore, it is said: 'When treating any disease, observe the form, Qi, complexion, and color; do not miss the appropriate time for treatment.' Thus, if Form and Qi are harmonious, life prevails; if the complexion is floating/lustrous, the disease is easy to cure. If the pulse conforms to the four seasons, it is treatable; if the pulse is weak and slippery, it possesses Stomach Qi; these are all easy to treat. However, if Form and Color are discordant, and the complexion lacks luster, or if the pulse contradicts the four seasons, or if the pulse is Excessively Solid and even firmer, they are untreatable. This is what is meant by 'must examine the four difficulties and clearly inform [the patient].' Furthermore, if a patient has Heat but the pulse is quiet; diarrhea but the pulse is large; blood loss but the pulse is Excess; or post-sweating agitation of the pulse, these are all difficult to treat. If a patient with carbuncles/furuncles has severe discharge of pus and blood, and the pulse is Slippery and Rapid, it is difficult to treat. If suffering from Lung Abscess (Fei Yong) with wheezing, coughing, and pus-blood, and the pulse appears Large and Slippery, recovery is difficult. If the pulse is Large and Rapid, fever should occur, but instead there is aversion to cold; stiffness and tension in the head and neck; irritability and pain in the four limbs; or recurrent chills and severe thirst, where there is only a painful area, a carbuncle or swelling will inevitably develop." (From *Jing Yi*)