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The left Cun position corresponds to the Heart, and its signs reflect the condition of the Heart and the Pericardium (Pericardium). The Heart receives the Qi of the Ministerial Fire of the South; Spleen Earth is generated by it, and Lung Metal is controlled by it. The Heart primarily governs the clarity or turbidity of the Spirit (Shen).

The right Cun position corresponds to the Lung, and its signs reflect the condition of the Lung and the Shanzhong (Chest Center/Pericardium area). The Lung receives the Qi of Dryness-Metal of the West; Kidney Water is generated by it, and Liver Wood is controlled by it. The Lung primarily governs the goodness or badness of emotions.

The left and right Cun positions are referred to as "upper reflects upper"; therefore, any diseases of the head, face, throat, teeth, neck, shoulders, and back can be diagnosed through these two positions.

The left Guan position corresponds to the Liver, and its signs reflect the condition of the Liver and Gallbladder. The Liver receives the Qi of Wind-Wood of the East; Heart Fire is generated by it, and Spleen Earth is controlled by it. The Liver primarily governs official rank and nobility (Note: This reflects ancient physiognomy or fortune-telling concepts rather than pure medical diagnosis).

The right Guan position corresponds to the Spleen, and its signs reflect the condition of the Spleen and Stomach. The Spleen receives the Qi of Damp-Earth of the Center; Lung Metal is generated by it, and Kidney Water is controlled by it. The Spleen primarily governs the thickness or thinness of wealth (Note: Same as above, belonging to ancient fortune-telling concepts).

The left and right Guan positions are located in the middle, so they are used to diagnose the Middle Jiao; therefore, any diseases of the hypochondrium, abdomen, and back can be diagnosed through these two positions.

The left Chi position corresponds to the Kidney, and its signs reflect the condition of the Kidney, Bladder, and Large Intestine. The Kidney receives the Qi of Cold-Water of the North; Liver Wood is generated by it, and Heart Fire is controlled by it. The Kidney primarily governs the longevity of Yin Qi.

The right Chi position corresponds to the Sanjiao (Triple Burner), and its signs reflect the condition of the Kidney, Sanjiao, Mingmen (Gate of Vitality), and Small Intestine. The right Chi receives the Qi of Heavenly One Ministerial Fire of the North; Spleen Earth is generated by it, and Lung Metal is controlled by it. The right Chi primarily governs the longevity of Yang Qi.

The left and right Chi positions are referred to as "lower reflects lower"; therefore, any diseases of the waist, abdomen, vagina, and legs/knees can be diagnosed through these two positions. Commentary: The *Neijing* states: "Upper Jing Shang refers to matters of the chest and throat; Lower Jing Xia refers to matters of the lower abdomen, waist, thighs, knees, and shins." Thus, pulse manifestations appearing in the upper part diagnose upper lesions, and those appearing in the lower part diagnose lower lesions; this is the natural order. Since Wang Shuhe stated that "the Heart and Small Intestine combine at the left Cun, and the Lung and Large Intestine combine at the right Cun," later generations adopted the view that the left Cun diagnoses the Heart and Small Intestine, and the right Cun diagnoses the Lung and Large Intestine. This error is very serious. The Small and Large Intestines are Fu organs of the lower part and should naturally correspond to the two Chi positions. However, regarding the pulse at the two Chi positions, the left is the Water position, the residence of True Yin; the right is the Fire position, the root of Primordial Yang. The Small Intestine belongs to Fire, and Fire resides in the Fire position, so it should be paired with the lower right; the Large Intestine belongs to Metal, and Metal follows Water, so it should be paired with the lower left. This is also logical. But since the two intestines connect to the Stomach, their Qi is inherently continuous. Therefore, the *Neijing* does not specify fixed locations for them but states that both the Large and Small Intestines belong to the Stomach, allowing one to observe the Qi of the two intestines within the Stomach Qi. Nevertheless, all Zang-Fu organs in the Lower Jiao possess Yin and Yang. If one wishes to diagnose Yang in the lower part, one should focus on the right Chi; if diagnosing Yin in the lower part, one should focus on the left Chi. This grasps the essence. Someone asks: Why is the right Chi considered Yang and associated with Fire? The answer is: The Chi position is the realm of Xuanwu (Black Tortoise), and the firmness of Earth resides in the northwest. Therefore, the right side of the human body is stronger than the left, which embodies the principle of Left-Yin Right-Yang. There is a detailed discussion in this chapter, recorded in *Lei Jing · Qiu Zheng Lu*, which should be consulted.

The Sixteen Standard Pulses (Floating, Deep, Slow, Rapid, Surging, Fine, Slippery, Choppy, Bowstring, Scallion-Stalk, Tight, Moderate, Knotted, Hidden, Deficient, Excess)

**Floating Pulse (Fu Mai):** Abundant upon light palpation, insufficient upon heavy pressure. The Floating pulse is Yang. Pulses such as Surging, Large, Scallion-Stalk, and革 (Leather) belong to this category. It indicates deficiency of Middle Qi, insufficiency of Yin, Wind, Summerheat, distension and fullness, anorexia, exterior heat, and rapid breathing. A Floating-Large pulse indicates Wind-Strike; Floating-Tight indicates Cold-Strike; Floating-Slippery indicates retained food; Floating-Moderate indicates dampness stagnation; Floating-Scallion-Stalk indicates blood loss; Floating-Rapid indicates Wind-Heat; Floating-Surging indicates mania and restlessness. Although it is said that the Floating pulse indicates an exterior syndrome, in cases of true Exterior Wind-Cold invasion, the pulse may actually not be Floating, but rather Tight and Rapid with a slight Floating quality. This indicates exterior pathogenic factors, accompanied by fever without sweat or body aches. If the pulse is Floating and accompanied by Moderateness, it is not an exterior syndrome. Generally, a Floating pulse that is Forceful and Spirit-filled indicates excess Yang; excess Yang implies accompanying Fire, leading to phlegm in the middle or Qi stagnation in the upper regions, which can be inferred similarly. A Floating pulse that is Weak and Empty indicates Yin insufficiency, implying water deficiency, inability of Blood to nourish the Heart, or Essence failing to transform into Qi, indicating Middle Qi deficiency. Treating such pulses as exterior syndromes would be extremely harmful. If the pulse is Floating, Large, Bowstring, and Hard to an extreme degree, even more than four times normal, the *Neijing* calls this Guan-Ge (Obstruction and Repletion). This is not a pulse with Spirit, but indicates extreme depletion of True Yin and unrooted Yang hyperactivity, a sign of great misfortune. For any pulse appearing in a specific position, one must examine the corresponding syndrome according to that position; this applies to all pulses.

**Deep Pulse (Chen Mai):** Not visible with light touch, obtained only with heavy pressure. The Deep pulse is Yin. Pulses such as Fine, Hidden, and Reverse Guan belong to this category. It indicates Yang depression. It signifies Cold, Water retention, Qi stagnation, depression, retained fluid, mass formations (Jia), abdominal distension and fullness, cold limbs, and profuse diarrhea. A Deep-Fine pulse indicates shortness of breath, desire for cold, cold stomach, pain in the waist and feet, and Pi masses. A Deep-Slow pulse indicates chronic cold and cold essence. A Deep-Slippery pulse indicates retained food and hidden phlegm. A Deep-Hidden pulse indicates cholera and chest/abdominal pain. A Deep-Rapid pulse indicates internal heat. A Deep-Bowstring or Deep-Tight pulse indicates heart, abdominal, or small intestinal pain. Although the Deep pulse belongs to the Interior, one must examine whether it is Forceful or Weak to distinguish between Excess and Deficiency. A Deep and Solid pulse indicates much stagnation and Qi blockage, hence the saying "if the pulse is deep upon first touch, know it is Qi disease." For Qi stagnation and accumulation, resolution and purgation are appropriate. A Deep and Deficient pulse indicates Yang failure to reach and Qi failure to circulate. For Yang deficiency and Qi sinking, warming and tonification are appropriate. In cases of Exterior Cold invasion where Yang is obscured by Yin, presenting with a Deep-Tight and Rapid pulse along with headache and fever, the pathogen is still in the Exterior; one must not mistake the Deep pulse for an Interior syndrome.

**Slow Pulse (Chi Mai):** Any pulse with fewer than four beats per respiration is a Slow pulse. The Slow pulse is Yin. Pulses such as Dai (Intermittent), Huan (Moderate), Jie (Knotted), and Se (Choppy) are similar. It indicates Yin excess and Yang deficiency. It signifies Cold and deficiency. A Floating-Slow pulse indicates interior Qi deficiency; a Deep-Slow pulse indicates exterior Qi deficiency. If the Slow pulse is in the Upper Jiao, Qi fails to transform Essence; if in the Lower Jiao, Essence fails to transform into Qi. Cold Qi fails to move; Cold Blood stagnates. If the Slow pulse is accompanied by Slippery and Large qualities, it often indicates wind-phlegm and stubborn bi-syndrome; if accompanied by Fine and Small qualities, it indicates deficiency of True Yang. If Yin-Cold accumulates in the middle, it causes diarrhea and pain; if Yuan Qi fails to nourish the exterior, it causes chills and spasms. Generally, a slow pulse always results from insufficient Yuan Qi; one must not recklessly use attacking methods.

**Rapid Pulse (Shu Mai):** Five to six beats or more per respiration. Pulses such as Urgent, Fast, and Cu (Surging-intermittent) belong to this category. It signifies cold-heat fluctuations, consumption disorders, exterior pathogens, and abscesses. Slippery-Rapid and Surging-Rapid pulses indicate Heat; Choppy-Rapid and Fine-Rapid pulses indicate Cold. Sudden onset of Rapid pulse indicates exterior pathogens; prolonged Rapid pulse indicates deficiency. The Rapid pulse has both Yin and Yang aspects. Later generations have transmitted that Rapid pulse indicates Heat, but a careful examination of the *Neijing* reveals statements like: "All urgent pulses tend toward Cold; moderate pulses tend toward Heat; slippery pulses indicate abundant Yang Qi with slight heat." It also says: "Coarse and large pulses indicate Yin insufficiency and Yang excess, resulting in internal heat." And: "Moderate and slippery pulses indicate internal heat." Aside from these, there is no mention of Rapid pulse indicating Heat. The theory "Slow is Cold, Rapid is Heat" originated from the *Nanjing* stating "Rapid means Heat, Slow means Cold," which is now universally accepted. However, the idea that Rapid pulse always indicates Heat is greatly erroneous. How do I know this? From my clinical experience, in cases of internal heat and latent fire, the pulse is often not Rapid, but rather Surging, Slippery, and Forceful, as described in the classics. Regarding the differentiation of Rapid pulse, there are roughly seven types, and the distortion of this meaning has caused immeasurable harm through transmission. I list the key points below; other未尽 cases can be inferred. 1. Exterior pathogens can present with Rapid pulse. In Exterior Cold invasion, the pulse suddenly becomes Tight and Rapid. However, if it is Rapid from the initial infection, the pathogen has not yet transformed into heat via channel transmission; thus, warming and dispersing are indicated. Even if transmission has occurred over time, only if the pulse is Rapid, Slippery, and Solid can it be considered Heat; if Rapid and Weak, it remains a Yin syndrome, requiring warming of the middle. Thus, not all Rapid pulses in exterior conditions indicate Heat. Using cold-cooling herbs indiscriminately will kill patients. 2. Consumption disorders can present with Rapid pulse. In Yang deficiency with Rapid pulse, the pulse is Rapid and Weak, or Fine, with symptoms of deficiency-cold; warming is urgently needed, let alone treating as Heat. In Yin deficiency with Rapid pulse, the pulse is Rapid, Bowstring, and Slippery; despite symptoms of vexation and heat, cold-cooling herbs must be used cautiously. Purely clearing fire will lead to spleen diarrhea and deterioration. Moreover, patients with consumption almost always have a Rapid pulse; among diseases with Rapid pulse, consumption is most common. The more deficient, the more Rapid; the more Rapid, the more critical. Does Rapid pulse always mean Heat disease? Mistaking deficiency-Rapid for heat-Rapid leads to inevitable failure. 3. Malaria can present with Rapid pulse. During malaria attacks, the pulse is Tight and Rapid; when it stops, the pulse is Moderate and Slow. Does attack imply fire and cessation imply no fire? Fire in the body either exists continuously or not at all; it does not stop and start. What starts and stops is the advance and retreat of Cold pathogens. True fire and true heat do not behave this way. Thus, the Rapid pulse in malaria cannot be entirely attributed to Heat. 4. Dysentery can present with Rapid pulse. Dysentery usually arises from internal injury by Cold-Dampness, damaging Spleen and Kidney. Therefore, a Rapid pulse accompanied by Bowstring, Choppy, Fine, and Weak qualities indicates deficiency-Rapid, not heat-Rapid. All cases should be treated with warming and tonifying the Mingmen, with high success rates. Only in robust individuals with clear heat signs and a Surging, Slippery, Solid, and Rapid pulse should it be treated as heat-Rapid. 5. Abscesses and ulcers can present with Rapid pulse. If the pulse is Rapid but the body has no fever and instead feels aversion to cold, or if eating/drinking is normal, or if there is fever but sweating does not resolve it, this indicates carbuncles and sores. However, sores and ulcers can be Yin or Yang, treatable by attacking or tonifying; one cannot assume all Rapid pulses indicate Heat syndromes. 6. Smallpox and rashes can present with Rapid pulse because the pathogenic toxin has not yet reached the surface; once reached, the pulse ceases to be Rapid. One must differentiate Yin and Yang based on deficiency/excess and size, not assuming Rapid equals Heat. 7. Pi masses (accumulations) can present with Rapid pulse. If there is a disk-like mass under the hypochondrium or abdomen due to stagnation, the pulse will be Rapid. If long-standing stagnation leads to childhood malnutrition (Gan), Yangming congestion, causing bad breath, gum rot, and fever, then clearing Stomach heat and fire is appropriate. If there are no heat signs but the pulse is Fine and Rapid, it must not be recognized as Heat. 8. Pregnancy can present with Rapid pulse due to obstruction of Chong and Ren vessel Qi; this is not Fire. One must differentiate cold/heat based on strength, not blindly using Huangqin (Scutellaria) as a holy medicine. Commentary: Among the above Rapid pulse syndromes, those with strong pathogens often show Rapid pulse, and those with severe deficiency especially so. Thus, whether it is Heat or not can be known.

**Surging Pulse (Hong Mai):** Large and Solid, abundant upon both light and heavy palpation. The Surging pulse is Yang. Pulses such as Floating, Scallion-Stalk, Solid, and Large belong to this category. It indicates burning blood and Qi, a sign of major Heat. Floating-Surging indicates exterior Heat; Deep-Surging indicates interior Heat. It signifies distension and fullness, vexation and thirst, mania and restlessness, macules and rashes, headache and facial heat, dry throat and sore throat, mouth ulcers and swelling, obstruction of urination and defecation, and bleeding. This is a sign of Yang excess and Yin deficiency, Qi excess and Blood deficiency. If Surging and Large to an extreme, exceeding four times normal, it is the pulse of separation of Yin and Yang, Guan-Ge, which is untreatable.

**Fine Pulse (Wei Mai):** Fine and thread-like, lacking Spirit, extremely weak. This is a Yin pulse. Pulses such as Fine, Small, Deficient, and Soft belong to this category. It indicates dual deficiency of Blood and Qi. It signifies fear of cold, fearfulness, timidity, shortness of breath, interior Cold, distension and fullness, vomiting and hiccuping, diarrhea, spontaneous sweating, indigestion, waist and abdominal pain, injury to Essence and blood loss, dizziness, vertigo, and cold limbs. Although this is dual deficiency of Blood and Qi, it particularly indicates loss of Primordial Yang and is a sign of severe Yin-Cold.

**Slippery Pulse (Hua Mai):** Smooth and fluent in movement, like pearls rolling in a plate. Pulses such as Surging, Large, Scallion-Stalk, and Solid belong to this category. It indicates Qi excess and Blood congestion. It signifies rebellious Phlegm, food stagnation, vomiting, and fullness. Slippery-Large and Slippery-Rapid indicate internal Heat: upper Heat in Heart/Lung, head, eyes, and throat; lower Heat in Small Intestine, Bladder, and urination/defecation. In women, a Slippery-Rapid pulse with amenorrhea indicates pregnancy. In healthy individuals, a Slippery and Moderate pulse indicates sufficient Ying and Wei, a good omen; if excessively Slippery and Large, it indicates pathogenic Heat. Patients with consumption often have Bowstring-Slippery pulses, indicating Yin deficiency; those with diarrhea/dysentery also often have Bowstring-Slippery pulses, indicating Spleen/Kidney injury. These should not be generally attributed to Fire.

**Choppy Pulse (Se Mai):** Movement is difficult and choppy, not fluent, like rain falling on sand or a knife scraping bamboo, describing its image. The Choppy pulse is Yin. Pulses such as Deficient, Fine, Micro, and Slow belong to this category. It indicates dual deficiency of Blood and Qi. It signifies shortness of breath, worry and vexation, bi-pain, spasms, numbness, absence of sweat, Spleen Cold with poor appetite, Stomach Cold with frequent vomiting, irregular urination/defecation, and cold limbs. In men, it indicates injury to Essence; in women, blood loss, infertility, and irregular menstruation. Choppy and stagnant pulses are mostly due to unresolved Seven Emotions, depletion of Ying and Wei, lack of Blood to fill vessels, and lack of Qi to circulate freely. In the Upper Jiao, it causes discomfort; in the Lower Jiao, it causes poor transport; on the exterior, it causes bone/tendon fatigue; in the interior, it causes mental/spiritual shortage. All these belong to Yang deficiency. Various schools claim Qi is abundant and Blood is scarce, but how can Qi be abundant if the pulse is unfavorable?

**Bowstring Pulse (Xian Mai):** Firm upon pressure, hard like a bowstring. Pulses such as Slippery, Large, and Firm belong to this category. It indicates Yin hidden within Yang, disharmony of Blood and Qi, rebellious Qi, pathogenic victory, Liver excess, Spleen weakness, cold-heat, phlegm-fluid, retained food, accumulations, distension, consumption, pain, spasms, malaria-dysentery, hernia-bi, and chest/hypochondriac pain. The *Chuang Ju Lun* states: "Bowstring and Surging interacting, exterior tight and interior heat, indicates impending carbuncle/sore." Bowstring transforms from Wood, connecting Qi to the Liver; it can be Yin or Yang. However, Bowstring-Large with Slippery indicates Yang pathogen; Bowstring-Tight with Fine indicates Yin pathogen. Wherever Stomach Qi reaches among the Zang-Fu, the five Zang organs are peaceful; where Liver pathogen invades, the five Zang organs become diseased. Why? Because Wood grows from Water and is nurtured by Earth. If Wood Qi is too strong, it consumes Water and damages Earth; Water depletion leads to Kidney deficiency, Earth damage leads to Stomach injury. The Kidney is the root of Essence and Blood; the Stomach is the root of grain and water. Damage to the roots destroys the generating Qi, so Wood should not be too strong. Furthermore, a person without Stomach Qi dies; thus, a Moderate pulse is auspicious, while a Bowstring and Strong pulse under the fingers is ominous. Liver pathogen conflicting with Stomach Qi creates opposition between Moderate and Bowstring-Strong. Extreme Bowstring leads to Earth failure; seeing this in various diseases is generally inauspicious.

**Scallion-Stalk Pulse (Kou Mai):** Floating and Large but empty in the center, feeling like a scallion stalk upon pressure. The Scallion-Stalk pulse is Yang. Pulses such as Floating, Empty, Bowstring, and Surging are similar. It indicates isolated Yang and detached Yin. It signifies blood loss and depletion, Qi having nowhere to return, Yang having nowhere to attach, Yin deficiency with fever, dizziness and vertigo, palpitations and fright, rapid breathing, and night sweats. Although Scallion-Stalk is a Yang pulse, the Yang is rootless, representing a major deficiency syndrome.

**Tight Pulse (Jin Mai):** Urgent, forceful, firm against the finger, resembling twisting rope. Pulses such as Bowstring and Rapid are similar. The Tight pulse has more Yin than Yang, indicating激荡 (agitation/clashing) of Yin pathogens. It signifies pain and Cold. Tight-Rapid in the Exterior indicates Cold-Strike with fever, whole-body bone/muscle pain, headache and stiff neck, cough and nasal congestion, miasma, and malaria. Deep-Tight in the Interior indicates heart/hypochondriac pain, chest/abdominal distension, interior Cold with cold limbs, vomiting/regurgitation, wind-epilepsy with opisthotonos, Pi masses, diarrhea/dysentery, and Yin hernia. In women, it indicates rebellious Qi and stagnant menses; in children, it indicates convulsions from fright.

**Moderate Pulse (Huan Mai):** Moderate and not Tight. The Moderate pulse has Yin and Yang aspects, with three meanings: 1. Calm, moderate, balanced in floating and sinking is the normal pulse of a healthy person. 2. Moderate with Slippery and Large qualities indicates excess Heat, as stated in the *Neijing*. 3. Moderate with Slow and Fine qualities indicates deficiency Cold, as stated by various schools. Excess Heat presents as Moderate, Large, and Forceful, often with vexation, bad breath, abdominal fullness, abscesses, or difficulty in urination/defecation, or residual heat after recovery from Cold-Strike/Warm Malaria. Deficiency Cold presents as Moderate, Slow, and Fine, indicating Yang deficiency, fear of cold, timid Qi, pain, dizziness, bi-weakness, flaccidity/cold limbs, palpitations/amnesia, indigestion, loose stools/watery diarrhea, cold essence/kidney, frequent urination. In women, it indicates delayed menses and scant blood, or bleeding. For external sores/poisons, stroke, or postpartum conditions, obtaining a Moderate pulse indicates easy recovery.

**Knotted Pulse (Jie Mai):** The pulse suddenly stops, then resumes; this is collectively called Jie. Old theories state: Rapid pulse with intermittent stop is Cu (Surging-intermittent), indicating Heat and extreme Yang; Slow pulse with intermittent stop is Jie, indicating Cold and extreme Yin. It is generally attributed to Qi/Blood stasis, food/phlegm, accumulations, Jia masses, or Seven Emotions depression. Floating Jie indicates Cold pathogen in channels; Deep Jie indicates internal accumulation. This is the old theory of Jie and Cu. However, based on my verification, Cu resembles Rapid but is not necessarily Heat; Jie resembles Slow but is not necessarily Cold. Any pulse with interruption is a Jie pulse. It is mostly due to gradual decline of Blood/Qi and exhaustion of energy, causing intermittent stopping and restarting. It is common in chronic diseases, consumption, or after mistaken use of attacking/dissolving treatments. Slow-Jie indicates Yang deficiency; Rapid-Jie indicates Yin deficiency. Slow is manageable; Rapid is more severe. The severity of Jie pulse clearly reflects the waxing and waning of Yuan Qi. Diseases like stagnation and depression may also present this pulse, but only if the constitution is strong and Qi is solid with forceful palpation, indicating stagnation. Some people have a lifelong Knotted pulse without disease, due to innate abnormality, which is not strange. Except for these, if a patient's illness persists and the pulse gradually becomes Knotted, it indicates residual Blood/Qi deficiency and discontinuity of vitality. One must quickly tonify the root and not mistakenly attribute it to stagnation.

**Hidden Pulse (Fu Mai):** As if present but not, felt only against the bone. This indicates hidden Yin and Yang, obstruction, and closure. It can be caused by Fire closure, Cold closure, or Qi closure. It signifies extreme pain, cholera, hernia/masses, obstruction, rebellious Qi, food stagnation, anger, cold limbs, and edema. Although Hidden pulse resembles Deep, Fine, Micro, and Depleted pulses, it is different. Hidden pulse appears as if non-existent due to temporary concealment. Cases include severe chest/abdominal pain causing hiding, Qi rebellion blocking pulse channels, or sudden Qi depletion causing discontinuity. These occur in acute severe illnesses; regulating Qi restores the pulse. Outside these cases, if chronic illness leads to a pulse becoming gradually Fine and Hidden, it is a sign of imminent death ("embers about to extinguish"), not merely "hidden." Common physicians often diagnose this as Hidden pulse regardless of duration or deficiency/excess, arbitrarily using Qi-breaking and phlegm-resolving agents. This is akin to delaying travel and then rushing the messenger. My observations suggest this does not happen frequently.

**Deficient Pulse (Xu Mai):** Deficiency of righteous Qi, Weakness, Lack of Spirit. It has Yin and Yang aspects. Floating and Weak indicates Blood deficiency; Deep and Weak indicates Qi deficiency; Rapid and Weak indicates Yin deficiency; Slow and Weak indicates Yang deficiency. Although Micro, Soft, Slow, and Choppy pulses belong to deficiency categories, regardless of the pulse type, if it lacks Spirit under the fingers, it is always Deficient.