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Pulse diagnosis can determine the critical path of life and death. The judgment mainly relies on the *Zhi* pulse (pulse with intermittent pauses), *Dai* pulse (intermittent pulse), and *Se* pulse (choppy pulse).

The *Neijing* (Classic of Internal Medicine) states: By feeling the dynamics of the pulse, observing the spirit in the eyes (*Jingming*), examining the five colors of the complexion, assessing the excess or deficiency of the Zang organs, and the strength or weakness of the Fu organs, as well as the flourishing or declining state of the body, one can decide upon life and death.

Examining the *Se* pulse and the *Zhi/Dai* pulses provides a general indication of the time of death. The *Se* pulse implies that there are obvious external symptoms present; therefore, it cannot be immediately concluded that death is imminent. However, if there are no external symptoms but a *Dai* pulse appears, the situation is different.

The *Suwen* (Basic Questions) refers to "Dai," while the *Nanjing* (Classic of Difficult Issues) refers to "Zhi"; these two terms share the same meaning. The pulse should not exhibit pauses. If it beats fifty times without showing a *Dai* pattern, the Qi of the five Zang organs can circulate freely without exhaustion. If the pulse reaches the Kidney and then returns to the Liver, it indicates that Kidney Qi has been exhausted first. Life depends on the presence of Qi in the five Zang organs, and death occurs when Qi is absent. The *Se* pulse is fine, slow, difficult to move, and occasionally pauses; this is a sign of insufficiency of Essence and Blood. It resembles the *Dai* pulse. However, obtaining a *Se* pulse with Stomach Qi during autumn is considered a normal pulse for that season. A floating, short, and *Se* pulse at the Cun Kou point on the right hand is the correct pulse for the Lung; it is neither a death pulse nor a disease pulse. If both the Chi and Cun positions show floating and *Se* pulses, external symptoms such as fever, aversion to cold, headache, stiffness of the neck and back, lower back pain, and even pain throughout all bone joints will likely appear. This indicates Taiyang channel Cold Damage (Shanghan), which can be cured by inducing sweating. These examples demonstrate that the *Se* pulse cannot be universally categorized as a death pulse. Thus, saying "it implies external symptomatic manifestations" makes the meaning very clear. Students of medicine should reflect deeply on this. Regarding the Chi pulse, it is the root of human life. Humans do not die because they possess Yuan Qi (Original Qi). The *Se* pulse signifies insufficiency of Essence and Blood; if it appears exclusively in the Chi position, it is a sign of certain death. Hence, it is said to be "similar to the Dai pulse."

To know how to predict the time of death, ancient sages deduced five types of Earth elements. For Yang Earth days, one must know they do not exceed Yin Earth days; for Yin Earth days encountering Yang days, careful calculation is required. The Wu and Ji Earths of the central seasons are identical.

These five Earths refer to climatic conditions. The Five Elements of the human body correspond to Heaven and Earth. By understanding Heaven and Earth, one can understand the human body. Since Heaven, Earth, and Humanity (the Three Powers) can be understood, changes in climate can also be discerned.

Metal generates Water; thus, in late autumn, Metal is in a state of Rest (Xiu) and transitions into Winter Water. Water generates Wood; thus, in late winter, Water is in a state of Rest and transitions into Spring Wood. This illustrates that Earth exists within the four seasons. In Heaven, there are five stars, with Zhenxing (Saturn) in the center; on Earth, there are five great mountains, with Songshan in the center; in Humanity, there are five Zang organs, with the Spleen governing the Central Region. Since the five Earths are all central, it is known that among all things, the four seasons, and the seventy-two pentads, Earth is the primary element. If Heaven loses Earth, phenomena lose order and cannot cover from above; if Earth loses Earth, things lose change and cannot support from below; if Humanity loses Earth, endowment is incomplete. Based on these principles, it is known that Heaven, Earth, and all things regard Earth as essential. However, there are Yang Earth and Yin Earth. The Gen trigram represents Yang Earth, and the Kun trigram represents Yin Earth. Gen is the trigram of the Northeast, corresponding to the transition between the twelfth and first months, where things complete their cycle and begin anew. Kun is the trigram of the Southwest, corresponding to the transition between the sixth and seventh months, where things reach peak abundance, and primal Qi returns to hidden Spirit. One Yang arises in the Zi month, six Yangs peak in the Wu month, and six Yins peak in the Hai month. The fourth month is Yang Earth, nurturing and generating all things, where everything flourishes, yet the power of Earth is already declining; hence, it is said that Yang Earth must not exceed Yin Earth. The tenth month is Yin Earth, storing all things; here, growth ceases, but the power of Earth is about to flourish; hence, it is said that Yin Earth encountering Yang requires careful calculation. The *Neijing* states: Yin and Yang are the Way of Heaven and Earth. Laozi stated: All things carry Yin and embrace Yang, harmonizing through the interaction of Qi. The *Xici* (Commentary on the Appended Statements) says: One Yin and one Yang is called the Dao. Generally, Yin cannot generate without Yang, and Yang cannot grow without Yin. When Yin and Yang combine, the principle of generation and transformation is inexhaustible. If Yin and Yang separate, the principle of generation and transformation is cut off. Mencius said: An old man without a wife is called Guan; an old woman without a husband is called Gua. Isolated Yang and severed Yin are analogous to the meanings of widowers and widows.

For example, in the year of Shen, if the Kidney pulse shows Zhi or Dai, ten beats correspond to one year, clearly indicating the ruler. If the Chi position loses its ruler and the Ghost Thief pulse prevails, the person may die in the summer of the Zi year.

The number of Old Yang peaks at nine, and the number of Old Yin peaks at ten. Ten beats corresponding to one Zang organ means the numbers of Yin and Yang are complete. Carefully calculated, if the Qi of the five Zang organs is sufficient, but the Ghost Thief pulse appears, death will occur within the year. This matter is widely recognized. In spring, obtaining the Lung pulse leads to death on Geng or Xin days. Fools mistakenly complain that the medicine is incorrect. Shuhe's *Maiking* discusses these subtleties.

Pulses of the four seasons that accord with the season are favorable (Cong); those that overcome the season are unfavorable (Ni). The *Neijing* states: Pulse following the four seasons is treatable; pulse opposing the four seasons is untreatable.

A Chi pulse that is deep and hidden is like a tree without roots. Yin toxicity and Yang cold belong to the same category. After applying moxibustion to restore Yang, one must still examine; if the bones feel lifeless, tears may flow.

The *Nanjing* states: Having a Chi pulse in humans is like a tree having roots. Because humans have Original Qi, they do not die. If the Chi pulse is deep and immobile, it is like a tree without roots.

If the six pulses of a person are trembling, one must fear the absence of Stomach Qi.

The *Neijing* states: The four seasons all take Stomach Qi as the foundation. Thus, it is said: Without Stomach Qi in the six pulses, life cannot be sustained. For instance, the Xian (Bowstring) pulse belongs to Wood and corresponds to the Liver, occurring in the season of Spring. It possesses Spirit. It contains Earth.

The Wulou (House Leaking) and Quezhuo (Sparrow Pecking) patterns are abhorrent when seen in the Spleen; seeing them in other positions is not feared. There are many ways to determine the time of death. Danshi (Finger Striking Stone) and Jiesuo (Untying Rope) require detailed discussion. This condition does not exceed one quarter. Fire is two, Wood is three, measure accordingly.

The *Neijing* says: The Spleen is Earth, the solitary Zang organ that irrigates the four directions. Its good manifestations are invisible; its bad manifestations appear immediately, like a sparrow pecking or water dripping. Qi is exhausted.

Earth prospers for eighteen days in each season; this method has never failed since ancient times. Huangdi's method divides into quarters of three; another method says thirty days, varying according to proximity.

Earth has no fixed movement but prospers in the four seasons. Therefore, after the Start of Spring solar term, Liver Wood prospers for seventy-two days; after the Start of Summer, Heart Fire prospers for seventy-two days; after the Start of Autumn...

Only Cold Damage (Shanghan) is most unpredictable. After sweating, vomiting, or purging, the pulse must become calm. If it suddenly reverses, it is difficult to treat; externally, deviation from physical signs is particularly feared.

Cold Damage was called a major disease in antiquity; survival or death depends on periods of ten days. This disease, if contracted from the back, enters the Taiyang channel or the Shaoyin channel.

The pulse may be minimal, cold, deficient, and exhausted, or maximal, hot, and congested; neither is strange. Tonifying deficiency and draining excess restores the previous state; seeing this clearly allows verification.

When the pulse comes twice per exhalation and twice per inhalation, neither large nor small, Yin and Yang each occupy their proper portion without overcoming each other. This is called a healthy person. Reduction...

The superior physician must master four aspects: pulse, disease, syndrome, and treatment. They must be cross-referenced. If one deviates, handling becomes difficult; this is extremely hard to treat.

The way of learning medicine requires mastering the four aspects of pulse, disease, syndrome, and treatment. The *Nanjing* states: Knowing one makes a junior practitioner; knowing two makes a mid-level practitioner; knowing three makes a senior practitioner. A senior practitioner achieves ten successes...

There are also chronic and acute diseases; major discussions must be thorough. Chronic disease pulse changes may not align; signs of death should be identified early. Acute disease pulse changes are also diverse.

The *Mai Yao Jingwei Lun* states: With pre-existing diseases, the five Zang organs activate, damaging the pulse and complexion. How can one distinguish long-standing from sudden illnesses? If the pulse is minute and the complexion is not depleted...

Front is Yang Guan, Back is Yin; for women, this is reversed like a hairpin. Overwhelming and overflowing invade each other; harmonizing Ying and Wei involves deeper principles.

Guan is the boundary of Yin and Yang. Front Guan is Yang, named Cun Kou; Back Guan is Yin, named Chi Ze. Men are Yang, born from Yin. First generated... Women... Said this emerges as Ge, actually then called Guan.

To identify virgins, the secret lies in Cun, Guan, and Chi. Naturally tight and rapid, clearly distinct, due to undispersed essence and Qi.

Men and women differ in Yin-Yang constitution; Tian Gui and semen forms also differ. Yin heaven fills and causes blood loss; Yang moves and Yin combines to release essence. Thus women two... Harmonious. Of what.

Diseases of the main channels are hardest to treat; no matter how long treated, when will recovery come?

The *Nanjing* states: Worry and thought damage the Heart; cold form and cold drinks damage the Lungs; anger and qi rebellion damage the Liver; diet and fatigue damage the Spleen; sitting long in dampness...

Form is primarily Yin; thus, regarding the Lung, cold form and cold drinks are mentioned; regarding the Kidney, sitting long in dampness and forcing entry into water are mentioned. The regular channels have fixed rules, so the body can be divided.

Then Qi is vast. Speaking and moving, inter-Zang transmission and seven-transmission have no external signs; forcibly using pills and powders to support...

The *Nanjing* states: Seven-transmission is what overcomes; Inter-Zang transmission transmits to the son. For example, Heart disease transmits to Lung, Lung to Liver, Liver to Spleen, Spleen to Kidney, Kidney... Heart.

Cold Damage and Wind Strike are naturally hard to see; meeting them under the fingers, the pulse is chaotic. Combining vomiting and diarrhea is not good; when the sweat pulse appears, sweating is required. Although sweat is obtained, the shape is like beads.

Cold Damage was called a major disease in antiquity. Wind is the chief of hundred diseases. The initial pulse is also hard to see. Moreover, Cold Damage and Wind Strike have many external signs. Undiagnosed, suitable for purging, it is said...

Dripping. Sweat is the liquid of true Qi and extreme Yang. If sweat comes out like beads, sticking to the body without flowing, Essence is exhausted. Exhaustion of Essence means Qi dies first. Exhaustion of Qi means upper and lower...

There are many kinds of death pulses; the *Nanjing* explains them in detail, how can they be forgotten? Damage from top to bottom delays death; death pulses often arise from bottom damage to top. Continuously obtaining five Zang death diseases...

The *Nanjing* states: Pulses have Sun and Zhi. Regarding Zhi pulses: two beats per breath is Ping (normal); three beats is Li Jing (departing from the channel); four beats is Duo Jing (exhaustion of essence); five beats is Si (death); six beats... Exhaustion and not Lung disease, symptom and pulse status mostly taken in the middle.

To know generally the gate of medicine. If one deviates, it is incorrect. Only look at the strong as the master.

Pulse is the forefront of the medical gate; its principles are subtle and hard to research. Generally, asking to know observes the exterior; cutting to know examines the interior. Syndrome and pulse...

Furthermore, chronic diseases are harder to see; sometimes the pulse resembles that of a healthy person. Suddenly adding beats, the pulse changes; if pulse and disease do not match, it is good to buy a coffin.

The *Neijing* states: Excess in Form and Qi, deficiency in Pulse Qi leads to death. Excess in Pulse Qi, deficiency in Form and Qi leads to life. Pulse is the precursor of Qi and Blood; when Qi and Blood are abundant...

If encountering Wind Disease and Labor Disease, the wonderful method of viewing is like Di Sheng. Wind Disease with slow Spleen is futile effort; Labor Disease with rapid Heart is hard to survive. Wind Disease should not let the pulse arrive slowly.

Distinction between life and death pulses in Wind and Labor diseases; if realizing the mystery, it is like Di Sheng. Wind evil attacking humans, its appearance is sudden,善于 changing locations, sudden attack... Distinguish. If Spleen pulse is slow and powerless, it is hardest to treat. Wind likes to return to Liver; Liver Wood overcomes Spleen, causing loose stools. Qianjin Fang says: Wind strike big... Wind excessive... Restore and Central State.

Cold Damage and Wind Strike obtaining death pulses; only give true medicine to the disease gate. If medicine is effective, disease retreats, pulse must harmonize; if pulse remains the same, disease is hard to save.

Cold Damage and Wind Strike are originally major afflictions; seeing death pulses, ten cases yield none alive. If following Zhang Zhongjing's methods, treating according to syndrome, then Righteous Qi defeats Evil, occasionally there is survival... Disease.

Thus determining the time of life and death can serve as the handle for medical practitioners. If one can realize the mystery under the fingers, it is like hanging a bright mirror on the spiritual platform.

Wang Shuhe said: Pulse principles are subtle and cannot be transmitted by words. Clear in mind, difficult under fingers. Later generations who can suddenly realize the mystery will have minds clear as if hanging a bright mirror.