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It is possible to separately seek the normal pulse of Spleen Earth. However, when the Spleen declines, manifestations such as the Sparrow-pecking pulse (Quezhuo Mai) or the Leaking pulse (Xialou Mai) become visible.

Chapter 16 states: "The pulse has three regions and nine positions, possesses Yin and Yang attributes, involves light and heavy pressure, comprises sixty categories, and one pulse type transforms across the four seasons. Since the time of the Sages has passed long ago, each practitioner adheres to their own views and establishes their own methods. How can one distinguish right from wrong?" The response is: This depends on whether the disease presents with external and internal signs.

Here, Yue Ren (Bian Que) points out that since the era of Xuanyuan (Yellow Emperor) and Qibo has passed for a long time, physicians hold divergent views and establish independent methods. How then can one discern correctness? Pulse diagnosis is divided into three regions, and pulses transform according to the four seasons; these are all established methods. It is unnecessary to debate which method is correct or incorrect. By using the external and internal signs of diseases described below to verify the correctness of pulse diagnosis, the principles of Xuanyuan and Qibo can be substantiated in every statement. From this, it is evident that among texts following the Yellow Emperor, this work stands as the most pivotal pillar. "Sixty Chapters" refers to an ancient medical classic.

What are the conditions of the disease? The response is: Suppose one obtains the Liver pulse. Its external signs include a preference for cleanliness, a bluish complexion, and irritability. Its internal signs include pulsation at the left side of the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as fullness and obstruction in the four limbs, dysuria with dribbling, difficult defecation, and tendon spasms. If these signs are present, it is a Liver disease; if absent, it is not.

This describes the diagnostic pulse for Liver pathology. The Liver organ is pure and clear, hence the patient's preference for cleanliness. A bluish complexion corresponds to the color of the Liver. Irritability corresponds to the emotional association of the Liver. As the Liver belongs to Wood and is associated with the left direction, pulsation occurs at the left side of the umbilicus. "Firm" indicates hardness. In Liver disease, Liver Qi fails to circulate, leading to fullness and obstruction in the four limbs. "Lin Sou" refers to painful, incomplete urination; "Bian Nan" refers to difficult defecation; "Zhuan Jin" refers to tendon cramping. The presence of Liver colors and identification of Liver signs confirm the Liver pulse. The following organs follow this pattern.

Suppose one obtains the Heart pulse. Its external signs include a reddish complexion, dry mouth, and excessive laughter. Its internal signs include pulsation above the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as vexation, heart pain, and heat in the palms accompanied by a sensation of choking (Ye). If these signs are present, it is a Heart disease; if absent, it is not.

This describes the color, disease, and pulse of the Heart. The Heart resides superiorly, hence the pulsation is felt superiorly. "Ye" sounds like "Yan"; Zhang's annotation explains it as having sound but no substance. Due to heat in the heart, this choking sensation arises, which should be verified through pulse diagnosis pending further correction.

Suppose one obtains the Spleen pulse. Its external signs include a yellowish complexion, frequent belching (Yi), excessive thinking, and heightened taste sensitivity. Its internal signs include pulsation directly above the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as abdominal distension, indigestion, heaviness of the body, joint pain, lethargy, drowsiness, and inability to control the four limbs. If these signs are present, it is a Spleen disease; if absent, it is not.

This describes the color, pulse, and disease of the Spleen. The Spleen occupies the central position, hence the pulsation is felt at the umbilicus.

Suppose one obtains the Lung pulse. Its external signs include a pale complexion, frequent sneezing, sorrow, unhappiness, and a desire to cry. Its internal signs include pulsation at the right side of the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as wheezing and coughing, and alternating chills and fever. If these signs are present, it is a Lung disease; if absent, it is not.

This describes the color, pulse, and disease of the Lung. The right side corresponds to the Lung, hence the pulsation is felt on the right. The Lung governs the skin and hair, hence the occurrence of chills and fever.

Suppose one obtains the Kidney pulse. Its external signs include a blackish complexion, fearfulness, and frequent yawning. Its internal signs include pulsation below the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as rebellious Qi, acute pain in the lower abdomen, diarrhea with a sensation of heaviness/tenesmus (Xie Ru Xia Zhong), and coldness with reversal in the calves and shins. If these signs are present, it is a Kidney disease; if absent, it is not.

This describes the color, pulse, and disease of the Kidney. The Kidney resides inferiorly, hence the pulsation is felt inferiorly. Yawning is caused by the drawing of Qi. "Diarrhea with heaviness" refers to the sinking sensation and distress in the waist during defecation. The above five paragraphs describe the fixed patterns of the Five Zang pulses, colors, and diseases. The characters "sign" (Zheng) and "disease" (Bing) both encompass internal and external meanings.

Chapter 17 states: "Medical classics say that some diseases lead to death, some heal without treatment, and some persist for years. Can the life and death, survival and demise, be known by palpating the pulse?" The response is: "It can be fully understood."

The mention of "some diseases lead to death" refers to the mutually overcoming pulses mentioned below. "Healing without treatment" refers to the mutually generating pulses in Chapter 13. "Persisting for years" refers to the corresponding pulses for accumulation diseases in Chapter 55. Thus, it is said that it can be fully understood.

If a patient closes their eyes and does not wish to see people, the pulse should correspond to the Liver pulse—wiry, rapid, and long. If instead, the Lung pulse is obtained—floating, choppy, and short—it indicates death. (Deficient condition with Excess pulse.)

This section discusses the Metal overcoming Wood pulse. The following four sections also consider the relationship between Excess/Deficient conditions and pulses.

If a patient opens their eyes, feels thirsty, and has a firm mass in the epigastrium, the pulse should be tight, solid, and rapid. If instead, a deep, choppy, and faint pulse is obtained, it indicates death. (Excess condition with Deficient pulse.)

These are diseases of the Liver and Heart meridians, which should present with tight, solid, and rapid Liver and Heart pulses. Instead, obtaining deep, soft, and faint Kidney and Lung pulses means Metal and Water overcome Wood and Fire, indicating death.

If a patient vomits blood and suffers from epistaxis, the pulse should be deep and fine. If instead, a floating, large, and firm pulse is obtained, it indicates death. (Deficient condition with Excess pulse.)

The Lung governs Qi, and Blood is coordinated by Qi. Vomiting and nasal bleeding must originate from the Lung and injure Qi; thus, the pulse should be deep and fine to be favorable. Obtaining a floating, large, and firm Fire pulse instead means Fire overcomes Metal, indicating death.

If a patient speaks deliriously and hallucinates, the body should have fever, and the pulse should be surging and large. If instead, the hands and feet are cold, and the pulse is deep, fine, and faint, it indicates death. (Excess condition with Deficient pulse.)

The condition belongs to Yang and should present with a surging, large Fire pulse to be favorable. Obtaining a deep, fine Water pulse instead means Water overcomes Fire, indicating death. This is the same principle as "Yang disease presenting with Yin pulse leads to death."

If a patient has a large abdomen and diarrhea, the pulse should be faint, fine, and choppy. If instead, a tight, large, and slippery pulse is obtained, it indicates death. (Deficient condition with Excess pulse.)

In Spleen disease, Earth is deficient, and the pulse should be faint, fine, and choppy. Faint, fine, and choppy are pulses of the Heart and Lung; Fire generates Earth, and Earth generates Metal, which is auspicious. Obtaining a tight, large, and slippery pulse instead implies pulses of the Liver and Kidneys; Wood overcomes Earth, and Water overcomes Fire, indicating death. The above discusses death due to overcoming, leading into the meaning of Guan Ge (Obstruction and Rejection) overcoming in the next chapter.

Chapter 18 (erroneously listed as Chapter 3) states: "The pulse has excess (Tai Guo) and deficiency (Bu Ji), mutual overcoming of Yin and Yang, Fu (Reversal) and Yi (Overflow), Guan (Barrier) and Ge (Rejection). What do these mean?" The response is: "Anterior to the Guan (Cun) position is the realm of Yang movement. The pulse should be nine fen deep and floating. Exceeding this depth is termed 'Excess' by law; falling short is termed 'Deficiency' by law. If it rises to the Yuji point, it is called 'Yi' (Overflow), constituting External Barrier and Internal Rejection. This is the pulse of Yin overcoming Yang."

"Posterior to the Guan position is the realm of Yin movement. The pulse should be one cun deep and sunken. Exceeding this depth is termed 'Excess'; falling short is termed 'Deficiency'. If it sinks into the Chi position, it is called 'Fu' (Reversal), constituting Internal Barrier and External Rejection. This is the pulse of Yang overcoming Yin." (Chapter 37 elaborates on this and should be consulted.)

The core meaning of this chapter focuses on "Guan Ge." Terms like Excess, Deficiency, mutual overcoming of Yin and Yang, Fu, and Yi are all annotations of Guan Ge. First, the Yin-Yang nature of pulse positions is discussed: Cun is Yang, Chi is Yin. Second, the Yin-Yang nature of pulse bodies is discussed: Floating is Yang, Sunken is Yin. If a floating, large pulse is found at the Cun position and extends down to the Chi position, it is Yang Excess. Extending to the very end of the Chi position is called Ge (Rejection); Yang pulse is Yang overcoming Yin. If a deep, solid pulse is found at the Chi position and extends up to the Cun position, it is Yin Excess. Extending to the very end of the Cun position is called Guan (Barrier); Yin pulse is Yin overcoming Yang. "Deficiency" refers to a sunken pulse at the Cun position (Yang Deficiency) and a floating pulse at the Chi position (Yin Deficiency). Furthermore, "Guan" means Yin is too abundant, preventing Yang from communicating. "Ge" means Yang is too abundant, preventing Yin from penetrating. These are hard pulses of pure Yin or pure Yang without harmonious Qi. If obtained in one hand, floating and large is Ge, deep and solid is Guan. If obtained in both hands, it is called Guan Ge, i.e., the True Zang pulse mentioned below, leading to death even without illness. Floating is Yang; exceeding the float naturally moves from Cun downward, passing the Guan position by one or two fen. If floating and harmonious, it is not a pathological pulse; if not harmonious, it indicates Yang abundance, termed Excess (Yang Tai Guo). "Deficiency" means the Cun position, nine fen anterior to Guan, should be floating but is instead sunken, termed Deficiency (Yang Bu Ji). If sunken past the Guan position to the Yuji point, it is External Barrier/Internal Rejection, where Chi Yin pulse occupies the Cun Yang position. Sunken is Yin; exceeding the sink naturally moves from Chi upward, passing the Guan position by one or two fen. If sunken and harmonious, it is not pathological; if not harmonious, it indicates Yin abundance, termed Excess (Yin Tai Guo). "Deficiency" means the position one cun posterior to Guan should be sunken but is instead floating, termed Deficiency (Yin Bu Ji). If floating past the Guan position to the interior of the Chi position, it is Internal Barrier/External Rejection, where Cun Yang pulse occupies the Chi Yin position. In summary, the meaning of Guan Ge lies solely in the harm caused by the mutual overcoming of Yin and Yang.

Therefore, Fu and Yi are True Zang pulses; a person may die without prior illness.

Fu resembles Internal Barrier/External Rejection, like water flowing down from above. Yi resembles External Barrier/Internal Rejection, like water overflowing upward from below. These are isolated Yin or solitary Yang, representing True Zang pulses without Stomach Qi to harmonize them. "Dying without illness" means rapid death without prolonged illness. Both hands showing extremely floating and large pulses is Fu; both hands showing extremely deep and solid pulses is Yi. This is Guan Ge appearing together, a pulse of certain death. Fu is Ge Yang; Yi is Guan Yin, discussed here based on the Yin-Yang of Cun and Chi. If discussed based on both hands, Left and Right represent Yin and Yang respectively. Ge Yang on the right is Yang overcoming Yin; Guan Yin on the left is Yin overcoming Yang. Thus, obtaining this in both hands constitutes the Guan Ge pulse.

Chapter 19 states: "There are contrary and compliant pulses. Men and women have constant patterns that sometimes reverse. What does this mean?" The response is: "Men are born in Yin (Tiger), which is Wood and Yang. Women are born in Shen (Monkey), which is Metal and Yin. Therefore, men's pulses are prominent above the Guan, and women's pulses are prominent below the Guan. Hence, men's Chi pulses are typically weak, and women's Chi pulses are typically strong. This is the norm. The reverse is when men obtain women's pulses and women obtain men's pulses."

This chapter discusses male and female pulses in accordance with Yin-Yang theory to distinguish the norms of weakness and strength. Wood number is three, so male Yang is born in Yin. Metal number is four, so female Yin is born in Shen. Men should have vigorous Yang, prominent in the Cun Yang position, hence "above Guan." Women should have vigorous Yin, prominent in the Chi Yin position, hence "below Guan." If men have weak Cun pulses or women have strong Cun pulses, it indicates disease, as explained below. Later interpretations claiming men are born in Yin and women in Shen refer to fetal origin, arising from literal reading of the characters.

What are the resulting diseases? The response is: "When a man obtains a woman's pulse, it indicates insufficiency, and the disease is internal. If found on the left, the disease is on the left; if on the right, the disease is on the right, depending on the pulse location."

"When a woman obtains a man's pulse, it indicates excess, and the disease is in the four limbs. If found on the left, the disease is on the left; if on the right, the disease is on the right, depending on the pulse location. This is what is meant."

This discusses abnormally reversed Yin-Yang pulses. A man obtaining a woman's pulse indicates insufficiency because the Cun pulse is weak, signifying insufficient Yang internally, hence internal disease. Weak left Cun pulse indicates disease on the left; weak right Cun pulse indicates disease on the right. A woman obtaining a man's pulse indicates excess because the Cun pulse is strong, signifying surplus Yang externally, hence disease in the four limbs. Strong left Cun pulse indicates disease on the left; strong right Cun pulse indicates disease on the right. Why does this chapter discuss only Cun pulses and not Chi pulses? The Chi pulse is like the root of a tree; it should be robust and cannot be otherwise. If a man obtaining a woman's pulse implies a strong Chi pulse, how can it be called insufficiency? If a woman obtaining a man's pulse implies a weak Chi pulse, how can it be called excess? Old annotations equating male pulses with Spring/Summer and female pulses with Autumn/Winter are irrelevant to this text.

Chapter 20 states: "Medical classics say the pulse has 'Fu Ni' (Hidden/Lodged). In which Zang organ does it lodge, and why is it called hidden?" The response is: "It refers to the mutual overcoming and mutual hiding of Yin and Yang. When the pulse is in the Yin region (Chi) but Yang pulses appear, it is Yang overcoming Yin. Although the pulse is sometimes deep, choppy, and short, this is called 'Yin Hidden within Yang.' When the pulse is in the Yang region (Cun) but Yin pulses appear, it is Yin overcoming Yang. Although the pulse is sometimes floating, slippery, and long, this is called 'Yang Hidden within Yin.'"

This chapter discusses the meaning of mutual hiding within mutual overcoming. For example, if floating, slippery, and long pulses appear in the Chi region, it is Yang overcoming Yin. Within these floating, slippery, and long pulses, if deep, choppy, and short pulses occasionally appear, it is called "Yin Hidden within Yang." If deep, choppy, and short pulses appear in the Cun region, it is Yin overcoming Yang. Within these deep, choppy, and short pulses, if floating, slippery, and long pulses occasionally appear, it is called "Yang Hidden within Yin." This is the most subtle aspect of pulse diagnosis. The commentary provides the general outline; readers should comprehend and expand upon it.

"Double Yang leads to mania; Double Yin leads to depression. Loss of Yang leads to seeing ghosts; Loss of Yin leads to blindness."

This follows the previous discussion. If Yang pulses appear in the Yang region, it is appropriate. If Yin regions also show Yang pulses, it is called Double Yang. If Yin pulses appear in the Yin region, it is appropriate. If Yang regions also show Yin pulses, it is called Double Yin. Double Yang causes the Yin region to lose its moistening function, allowing Yang pathogens to fly away, resulting in mania. Double Yin causes the Yang region to lose its ventilating and harmonizing command, causing Yin pathogens to stagnate, resulting in depression. Extreme imbalance of Yin and Yang in the body leads to extreme pathology, reaching pure Yin or pure Yang without any hidden mechanism. This inevitably leads to Loss of Yang (seeing ghosts) and Loss of Yin (blindness).

Chapter 21 states: "Medical classics say: If the body is diseased but the pulse is healthy, it indicates life; if the pulse is diseased but the body is healthy, it indicates death. What does this mean?" The response is: "When the body is diseased but the pulse appears healthy, it is not that the pulse is truly healthy, but rather that the respiratory rate does not correspond to the pulse rate. This is the general principle."

This chapter elucidates the principle of Qi and Blood being affected sequentially, leading into the next chapter. "Body diseased, pulse healthy" does not mean the pulse is truly healthy. It means the patient's respiratory rate does not match the pulse rate. If pathogenic factors enter the Qi level, Qi belongs to Yang and corresponds to the exterior. The body becomes diseased first, and respiration becomes disordered first. The pulse will subsequently respond; it is not that the pulse remains unaffected, but rather that the body is diseased first while the respiratory rate does not match the pulse rate. If pathogenic factors enter the Blood level, Blood belongs to Yin and hides in the interior. The body becomes diseased later, and respiration becomes disordered later. However, the pulse is already diseased; it is not that the body remains unaffected, but rather that the pulse is diseased first while the pulse rate does not match the respiratory rate. This is the general principle of sequential affliction of Qi and Blood. "Life" indicates disease in the Exterior and Fu organs. "Death" indicates disease in the Interior and Zang organs. Folk editions claim: "Physicians cannot adjust their breathing to match the patient's pulse rate," which is absurd nonsense.

Chapter 22 states: "Medical classics say the pulse has 'Shi Dong' (Is Moving) diseases and 'Suo Sheng Bing' (So Generates Disease) conditions. Why does one pulse transform into two diseases?" The response is: "The classics state that 'Shi Dong' relates to Qi, and 'Suo Sheng Bing' relates to Blood. When evil is in Qi, Qi moves ('Shi Dong'). When evil is in Blood, Blood generates disease ('Suo Sheng Bing')."

This chapter discusses how Blood diseases necessarily stem from Qi diseases. Qi is the commander of Blood, and the pulse is filled by Qi. Qi diseases occur first, and the pulse responds immediately; thus, the classics say "Shi Dong" relates to Qi. Blood diseases occur later, and the pathology is verifiable; thus, "Suo Sheng Bing" relates to Blood. Evil in Qi manifests in the pulse; evil in Blood manifests in symptoms. Hence the question of one pulse becoming two diseases. The following text details why Qi is affected before Blood.

"Qi primarily warms; Blood primarily nourishes. Qi stagnating and failing to circulate is Qi disease first. Blood stagnating and failing to nourish is Blood disease second. Hence, first comes 'Shi Dong', then 'Suo Sheng'."

"Warmth" (Xu) means warming, like steaming. "Nourish" (Ru) means moistening. Qi stagnates first and fails to circulate, then Blood stagnates and fails to nourish. Thus, Qi first manifests as 'Shi Dong' in the pulse, and Blood subsequently manifests as 'Suo Sheng' in disease.

Chapter 23 states: "Can the lengths and measures of the Hand and Foot Three Yin and Three Yang meridians be explained?" The response is: "The Hand Three Yang meridians run from hand to head, totaling three zhang. The Hand Three Yin meridians run from hand to the chest center, totaling two zhang and one chi. The Foot Three Yang meridians run from foot posterior to head, totaling four zhang and eight chi. The Foot Three Yin meridians run from foot to chest, totaling three zhang and nine chi. The two Foot Qiao meridians run from foot to eye, totaling one zhang and five chi. The Du and Ren meridians are each four chi and five cun, totaling nine chi. All meridians combined total sixteen zhang and two chi. This is the count of meridian lengths."

This chapter discusses the starting points and lengths of meridians, consistent with Chapter 1's concept of 270 breaths per cycle, where the pulse travels one degree, totaling sixteen zhang and two chi for one circuit. In one day and night, there are 13,500 breaths, and the pulse completes 50 circuits, which is the same meaning.

"The Twelve Meridians and Fifteen Collaterals: Where do they start and where do they end?" The response is: "Meridians and collaterals transport Qi and Blood, connect Yin and Yang, and nourish the body. They begin at the Middle Jiao, injecting into the Hand Taiyin and Hand Yangming. Yangming injects into Foot Yangming and Foot Taiyin. Taiyin injects into Hand Shaoyin and Hand Taiyang. Taiyang injects into Foot Taiyang and Foot Shaoyin. Shaoyin injects into Hand Jueyin and Hand Shaoyang. Shaoyang injects into Foot Shaoyang and Foot Jueyin. Jueyin returns to inject into Hand Taiyin. The fifteen collateral vessels follow their source points, forming a circle without end, irrigating each other, and converging at the Cun Kou and Ren Ying pulses to diagnose hundred diseases and determine life and death."

This section corresponds to Chapter 1's description of Ying Qi traveling 25 cycles in Yang and 25 cycles in Yin, starting from the Lung and ending at the Liver, completing one cycle in a day and night. The fifteen collaterals do not travel straight to the Zang-Fu organs like the twelve meridians but branch off from the Yuan-Source points of the twelve meridians, running alongside them, circulating through various acupoints endlessly, and converging at the Cun Kou and Ren Ying pulses to judge the fortune and misfortune of diseases. The terms "Hand" and "Foot" apply to the following pairs: Hand Taiyin/Yangming refers to Hand Taiyin and Hand Yangming; Foot Yangming/Taiyin refers to Foot Yangming and Foot Taiyin. Details of the acupoints are found in Chapter 66.

"The Classics say: Knowing the beginning and end, Yin and Yang are determined. What does this mean?" The response is: "'Beginning and End' are the chronicles of the pulse. Cun Kou and Ren Ying allow Yin and Yang Qi to communicate freely (like ministers moving without obstruction), forming a circle without end, hence 'Beginning'. 'End' refers to the cessation of the Three Yin and Three Yang meridians. Cessation leads to death, and death has distinct forms, hence 'End'."

This section continues the theme of determining life and death, asking about the beginning and end of the pulse to introduce the forms of pulse cessation in the next chapter. Generally, "beginning and end" refers to the chronicle of the pulse. Here, discussing the beginning and end of life and death refers to the left and right Ren Ying and Cun Kou pulses, where Yin and Yang Qi circulate endlessly. Human vitality begins here, hence "Beginning". The cessation of the Three Yin and Three Yang meridians marks the end of human vitality, hence "End". However, the cessation of the Three Yin and Three Yang meridians presents different forms, as explained in the next chapter.

Chapter 24 states: "What are the signs when the Qi of the Hand and Foot Three Yin and Three Yang meridians ceases? Can good or bad omens be known?" The response is: "When the Qi of Foot Shaoyin ceases (Qi cessation means pulse cessation, following this pattern), the bones become withered. Shaoyin is the Winter pulse, lying dormant and warming the marrow. If the marrow is not warmed, the flesh does not adhere to the bone, and bone and flesh lose intimacy. The flesh shrinks and recedes. Consequently, the teeth appear long and withered, and the hair loses luster. Lack of luster indicates Bone Qi has died first. The condition worsens on Wu days and dies on Ji days."

This chapter discusses the meaning of pulse cessation. Foot Shaoyin belongs to the North Kidney. The Kidney governs Winter, and Qi should store and conceal. Thus, the pulse should lie dormant against the bone. "Lying dormant" means moving secretly. Hence, diagnosing the Kidney pulse requires pressing to the bone. Kidney belongs to Water; Wu and Ji belong to Earth. Earth overcomes Water, hence death.

"When the Qi of Foot Taiyin ceases, the pulse fails to nourish the lips. The lips are the root of the muscles. If the pulse fails to nourish, the muscles lose smoothness. If the muscles lose smoothness, they become rotten. Rotten muscles cause the lips to invert. Lip inversion indicates Muscle Qi has died first. The condition worsens on Jia days and dies on Yi days."

Foot Taiyin is the Spleen, which governs muscles. Diagnosing the Spleen pulse correlates with muscle condition. Spleen belongs to Earth; Jia and Yi belong to Wood. Wood overcomes Earth, hence death.

"When the Qi of Foot Jueyin ceases, the tendons contract, pulling the testicles and tongue inward. Jueyin is the Liver pulse. The Liver is the convergence of tendons. Tendons gather at the genitalia and connect to the base of the tongue."