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When the pulse feels like boiling water surging under the fingers, if observed in the morning, death is certain by evening. If the tail of the pulse trembles and shakes without moving steadily, this is the "Fish Swimming" (Yuxiang) pulse, indicating Kidney Qi exhaustion and an approaching death. When the pulse departs rapidly but arrives slowly, with a forceful momentum like splitting wood, this is the "Life-Extinguishing" pulse, arriving hard like a flicking stone. When the Gu Qi (Grain Qi) of the Three Yang channels has been empty for a long time, and the Stomach Qi is distinct yet dripping like a leaking roof drop by drop, or scattered and chaotic like untied ropes, these are signs of Marrow Exhaustion and Bone Withering, seen in the Two Chi pulses.

The "Shrimp Swimming" (Xiayou) pulse resembles a toad swimming; it indicates the departure of the Soul and the state of a walking corpse, bringing definite sorrow. The "Sparrow Pecking" (Quezhao) pulse comes in rapid, continuous pecks; this indicates Spleen lacks Grain Qi and life is difficult to retain. To know the conditions of Heart Exhaustion and Ying Blood Exhaustion, one must seek them by pressing firmly as if with a knife and pushing carefully. Furthermore, Lung Withering and Stomach Deficiency present with a pulse like hemp seeds—fine, constrained, and rapid without rest. Under the fingers, it feels completely uniform like rolling beans, indicating that the Zheng Qi (Upright Qi) of the Three Lights has already drifted away.

Master Dongxu said: The pulses of Shrimp Swimming, Sparrow Pecking, and Dai (Intermittent) stop are named "Death Syndromes." One must know that patients with Phlegm-Qi Guan Ge (Obstruction and Reversal) may occasionally exhibit such pulses. Unless one is experienced and well-traveled in practice, one might blindly follow classical texts to diagnose diseases, thereby becoming a laughingstock among experts. Generally, when the disease process has consumed almost all vitality, the Qi cannot continue sequentially, resembling shrimp swimming in water or drops from a leaking roof without regularity; this is a Death Pulse. However, if there is Phlegm coagulation and Qi stagnation causing Guan Ge obstruction, the pulse may naturally remain still at times, move chaotically in two or three channels, appear and disappear intermittently, or be absent at the Cun and Chi positions. There may be cases where the Guan pulse is absent and bone visibility is prominent, or where the pulse beats irregularly in size. These can occur suddenly in healthy individuals, sporadically in those prone to Phlegm disorders, or after sudden collapse and stroke. None of these are Death Pulses.

Fifty beats without any pause indicate the body is free of disease. Any pause within fifty beats signifies a fatal prognosis.
Here, "pause" is similar to the Dai pulse. If the pulse beats fifty times without seeing a single pause, there is no disease. The number fifty corresponds to the numbers of Heaven and Earth's creation. The *Xi Ci* commentary on the *I Ching* states: "The Great Expansion Number is fifty." Fifty represents completeness. One is the beginning of numbers, ten is the limit. Human respiration and pulse circulation day and night; each beat of the Five Zang pulses corresponds to one organ. Five beats cycle through the five organs. After fifty beats, this constitutes ten cycles of five. When the cycle is complete, the numbers reach their limit. Without pauses, the Five Zang are balanced, hence no disease.

A pause after forty-one beats (one pause in forty beats) indicates one Zang is exhausted, leading to death after four years. A pause after thirty-one beats (one pause in thirty beats) indicates death in three years. A pause after twenty-one beats (one pause in twenty beats) indicates death in two years. A pause after fifteen beats (one pause in fifteen beats) indicates death in one year.
For pauses below this threshold, one must examine whether it is an acute illness.

Seeing one pause in forty beats means one Zang lacks the extreme number of arterial movement, indicating one Zang is exhausted. It begins with the Kidney channel. Why? Because Heaven generates Water, and the Kidney belongs to Water, corresponding to the generative number one. The Five Zangs are born from the Kidney first. Kidney Water governs the Liver pulse; Liver Wood generates Heart Fire; Mingmen Fire generates Spleen Earth; Spleen Earth generates Lung Metal. Thus, the Kidney exhausts first, with a predicted death in four years. Seeing a pause in thirty beats means two Zangs lack the extreme number, indicating Qi deficiency in both Kidney and Liver channels, with predicted death in three years. Seeing a pause in twenty beats means three Zangs lack the extreme number, indicating Qi deficiency in Kidney, Liver, and Heart, with predicted death in two years. Seeing one pause in fifteen beats indicates Qi deficiency in four Zangs: Kidney, Spleen, Liver, and Heart, with predicted death in one year.

New annotation says: Regarding the above discussion of pulse beats and pauses, it is unclear which position was palpated for evidence. According to the *Su Wen* and *Nan Jing*, one should typically diagnose during Yin hour at dawn, before sunrise and before eating, when blood and Qi are undisturbed. The physician should concentrate spirit and intent, keeping the mind from wandering externally, and diagnose under the fingers. The Right Hand Cun Kou (Inch Port), also known as the Qi Kou (Qi Port), allows silent counting of pulse beats to determine pauses. The *Nei Jing* asks: Why does the Qi Kou alone serve as the master of the Five Zangs? Qibo answers: The Stomach is the Sea of Water and Grain, the great source of the Six Fu organs. Flavors enter the mouth, are stored in the Stomach, and manifest in the Qi Kou. It is also stated: "Pulses converge at Taiyuan"; Cun Kou is the Taiyuan acupoint. Therefore, Cun Kou is the gathering place of pulses and can determine the life and death, auspiciousness and inauspiciousness of the Five Zang and Six Fu organs.