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Written by Cui Jiayan of Nankang, Song Dynasty.

The pulse is the channel of blood flow and the precursor of Qi and Blood; it is the tunnel for blood, responding to the movement of Qi. Its form mimics the earth, serving as the residence of blood, harmonizing with the Heart, and being the domain of the skin.

Nourishment begins in the Kidney and is generated by the Stomach. It belongs to Yin within Yang, rooted in Ying (Nutritive Qi) and Wei (Defensive Qi). Ying flows within the vessels, while Wei flows outside the vessels.

Vessels do not move on their own but follow Qi; when Qi moves, the pulse responds, illustrating the relationship of Yin and Yang. Qi acts like a bellows, and blood like waves; blood vessels circulate up and down following the breath.

In the twelve regular meridians, there are arterial pulses, but only the Cun Kou (Cun-Port) point on the Hand-Taiyin Lung Meridian is decisive for diagnosis. This meridian belongs to the Lung, connects upward to the throat, serves as the great assembly of pulses, and governs the entry and exit of breath.

One exhalation and one inhalation constitute one respiratory cycle (Xi), during which the pulse beats four times. There are 13,500 cycles per day and night. In each cycle, Qi moves six cun, totaling 810 zhang per day and night as the standard.

When initially palpating the pulse, ask the patient to hold their palm upward. The prominent bone behind the palm is defined as the Guan (Gate) position. The area before the Guan is Yang (Cun), and the area after is Yin (Chi). Following the order of Yang-Cun and Yin-Chi, search sequentially.

The Heart and Liver are located on the left; the Lung and Spleen on the right; the Kidneys and Mingmen (Gate of Life) are at both Chi positions. Hun (Ethereal Soul), Po (Corporeal Soul), and Gushen (Grain God) are all visible at the Cun Kou. The left side governs the Zang organs (officials), and the right side governs the Fu organs.

A larger pulse on the left is favorable for men; a larger pulse on the right is favorable for women. According to destiny and life force, men favor the left and women the right. One fen before the Guan is the master of human life. The left is the Renying (Human Welcome) pulse, and the right is the Qikou (Qi Port) pulse.

Shenmen is located behind both Guans. If a person lacks these two pulses, death from illness will be incurable. Male and female pulses are generally the same, except for the Chi position. If Yang is weak and Yin is abundant, or vice versa, disease arises.

There are seven diagnostic methods: Floating, Middle, and Deep pressure techniques, along with Upper, Lower, Left, and Right locations, requiring careful exploration. There are also nine inspections, using light lifting and heavy pressing to examine five movements in the three positions (Cun, Guan, Chi) of floating and sinking.

The Cun position examines the chest and above; Guan examines below the diaphragm; Chi examines from the navel down to the heels and ankles. The left pulse examines the left side of the body, and the right pulse examines the right side. Disease manifests according to location; absence of disease means this does not apply.

Floating pulses indicate the Heart and Lung; sinking pulses indicate the Kidney and Liver. The Spleen and Stomach occupy the central region, with pulses between floating and sinking. A Heart pulse that is floating is large and scattered; a Lung pulse that is floating is choppy and short.

A Liver pulse that is sinking is long and wiry; a Kidney pulse that is sinking is solid and soft. The Spleen and Stomach belong to Earth, so their pulse should be harmonious and relaxed. The Mingmen represents Ministerial Fire, diagnosed similarly to the left Cun.

Spring pulses are wiry; Summer pulses are surging; Autumn pulses are feathery (floating); Winter pulses are stone-like (deep). Harmonious pulses in the four seasons are called Normal Pulses. Excessive strength indicates external disease; deficiency and weakness indicate internal disease.

If an Autumn pulse appears in Spring, death occurs on Metal days; the Five Zang organs follow this principle without error. For diseases of the four seasons, Stomach Qi is the root. The pulse must possess Shen (Spirit); this must be examined carefully.

Regulate your own breathing; based on respiratory cycles, four to five beats per cycle is the standard for peace. Three beats per cycle is Slow (Chi), indicating Cold. Six beats per cycle is Rapid (Shu), indicating Heat.

Slower means colder; faster means hotter. Once Slow and Rapid are understood, distinguish Floating and Sinking. Floating, Sinking, Slow, and Rapid differentiate internal and external causes. External causes stem from weather; internal causes stem from human emotions.

Heaven has Yin-Yang, wind-rain, darkness-brightness; humans have joy-anger, worry-thought, sorrow-fear-surprise. An external cause causing a Floating pulse indicates Exterior Syndrome. Sinking, Interior, Slow, and Yin indicate excess Yang if Rapid.

An internal cause causing a Floating pulse results from deficient Wind; Sinking indicates Qi stagnation, Slow indicates Cold, and Rapid indicates Heat without doubt. Floating-Rapid indicates Exterior Heat; Sinking-Rapid indicates Interior Heat; Floating-Slow indicates Exterior Deficiency; Sinking-Slow indicates Cold accumulation.

Differentiating Exterior/Interior, Yin/Yang, Wind/Cold/Heat helps identify internal and external causes. Pulse and symptoms must be cross-referenced. Although pulse theory is vast, it is summarized in four-character verses. Having grasped the outline, extend through analogy.

Floating pulses mimic Heaven; they are accessible with light touch, floating above like wood on water. With force, they are Surging (Hong), coming strongly and going leisurely; without force, they are Deficient (Xu), large, slow, and soft.

Extreme deficiency leads to Scattered (San) pulses, loose and unrestrained; having edges but no center is called Knife-edge (Kou) pulse. Small and floating is Soft (Ru), lying softly on the water surface; extreme softness becomes Minute (Wei), resisting palpation.

Sinking pulses mimic Earth; near tendons and bones, deep within. Extreme sinking is Hidden (Fu). With force, they are Firm (Lao), solid, large, wiry, and long; extreme firmness becomes Solid (Shi), strong.

Without force, they are Weak (Ruo), soft and small like cotton; extreme weakness becomes Fine (Xi), like a spider's thread. Slow pulses belong to Yin, beating three times per cycle. Smaller than Slow and slower than four beats per cycle indicates Damage (Sun) or Failure (Bai), incurable diseases. Two cycles per beat depletes Essence; the pulse has lost Qi.

Floating, large, deficient, and scattered, or appearing as Knife-edge or Leathery (Ge) pulses; small, floating, soft, minute, sinking, small, fine, and weak. Slow and fine is Choppy (Se), difficult to move, easily scattering with occasional pauses returning later. Knotted (Jie) pulses come slowly with pauses then return; Intermittent (Dai) pulses come slowly with pauses that do not return.

Rapid pulses belong to Yang, beating six times per cycle; seven is Hasty (Ji), eight is Extreme (Ji), nine is Depleted (Tuo). Large and floating is Surging (Hong); large, firm, and solid, flowing smoothly is Slippery (Hua).

With force, it is Tight (Jin), snapping like a turning rope; if Rapid at Cun Kou with pauses, it is Urgent (Cu); if Rapid at Guan, the Arterial (Dong) pulse can be observed, trembling like a small bean.

Long pulses indicate regulated Qi, extending beyond its normal position; long and straight corresponds to the Wiry (Xian) pulse. Short pulses indicate Qi disease, failing to fill the position, not visible at Guan, only at Cun and Chi.

Each pulse shape has its corresponding disease. Combined pulses manifest various syndromes. Floating pulses govern the Exterior, implying Interior insufficiency; with force indicates Wind-Heat, without force indicates Blood deficiency.

Floating-Slow indicates Wind-Deficiency; Floating-Rapid indicates Wind-Heat; Floating-Tight indicates Wind-Cold; Floating-Relaxed indicates Wind-Dampness; Floating-Deficient indicates Summerheat injury; Floating-Knife-edge indicates Blood loss; Floating-Surging indicates Deficient Fire; Floating-Minute indicates Exhaustion.

Floating-Soft indicates Yin Deficiency; Floating-Scattered indicates severe deficiency; Floating-Wiry indicates Phlegm-Fluid; Floating-Slippery indicates Phlegm-Heat. Sinking pulses govern the Interior, Cold, and Accumulation; with force indicates Phlegm-Food retention, without force indicates Qi stagnation.

Sinking-Slow indicates Deficient Cold; Sinking-Rapid indicates Hidden Heat; Sinking-Tight indicates Cold Pain; Sinking-Relaxed indicates Water retention; Sinking-Firm indicates Chronic Cold; Sinking-Solid indicates Extreme Heat; Sinking-Weak indicates Yin Deficiency; Sinking-Fine indicates Bi-Dampness.

Sinking-Wiry indicates Fluid-Pain; Sinking-Slippery indicates Retained Food; Sinking-Hidden indicates Vomiting/Diarrhea; Yin-Toxin accumulation. Slow pulses govern Zang organs, where Yang Qi is hidden; with force indicates Pain, without force indicates Deficient Cold.

Rapid pulses govern Fu organs, vomiting, and mania; with force indicates Heat, without force indicates Sores. Slippery pulses govern Phlegm or Food injury; downward indicates Blood stasis, upward indicates Vomiting/Reflux.

Choppy pulses indicate Blood deficiency or Cold-Damp invasion; leading to reverse regurgitation, colon constipation, spontaneous sweating, or cold limbs. Wiry pulses govern Fluids, belonging to Gallbladder and Liver; Wiry-Rapid indicates much Heat, Wiry-Slow indicates much Cold.

Floating-Wiry indicates Branch Fluids; Sinking-Wiry indicates Suspended Pain; Yang-Wiry indicates Headache; Yin-Wiry indicates Abdominal Pain. Tight pulses govern Cold and various pains; Floating-Tight indicates Exterior Cold, Sinking-Tight indicates Interior Pain.

Long pulses indicate balanced Qi; Short pulses indicate Qi disease; Fine indicates little Qi; Large indicates disease progression. Floating-Long indicates Epilepsy; Sinking-Short indicates Retained Food. Blood deficiency yields deficient pulses; Qi excess yields excess pulses.

Surging pulses indicate Heat, implying Yin deficiency; Fine pulses indicate Dampness, implying Blood deficiency. Relaxed-Large indicates Wind; Relaxed-Fine indicates Dampness; Relaxed-Choppy indicates little Blood; Relaxed-Slippery indicates Internal Heat.

Soft-Small indicates Yin Deficiency; Weak-Small indicates Yang exhaustion. Yang exhaustion causes aversion to cold; Yin deficiency causes fever. Yang Micro indicates aversion to cold; Yin Micro indicates fever. Men with Micro pulses suffer deficiency; Women with Micro pulses suffer bleeding.

Yang Movement causes sweating; Yin Movement causes fever, pain, and fright, metrorrhagia, and blood loss. Deficient Cold combining is named Leathery (Ge) pulse. Men lose essence; women lose blood.

Yang excess leads to Urgent (Cu) pulses, Lung Abscess, Yang Toxin; Yin excess leads to Knotted (Jie) pulses, Hernia, Masses, and stagnation. Intermittent (Dai) pulses indicate Qi decline, or discharge of pus/blood. In Cold Damage with palpitations, or three months pregnant women, Dai pulses appear.

Pulses governing diseases have suitability and unsuitability; Yin-Yang reversal predicts auspiciousness or inauspiciousness. Stroke with Floating-Relaxed pulses is good; Rapid-Solid is contraindicated. Floating-Slippery indicates Phlegm obstruction; Sinking-Slow indicates Qi obstruction.

Corpse fainting with Sinking-Slippery pulses involves sudden unconsciousness. Entering Zang causes cold body; entering Fu causes warm body. Wind injuring Wei leads to Floating-Relaxed with sweat; Cold injuring Ying leads to Floating-Tight without sweat.

Summerheat injuring Qi leads to Deficient pulse and hot body; Dampness injuring Blood leads to Relaxed-Fine-Choppy pulse. Cold Damage and heat diseases prefer Surging-Floating pulses; Sinking-Micro-Choppy-Small pulses indicate adverse conditions.

After sweating, if the pulse calms and body cools, safety is assured; if the pulse agitates and heat persists, difficulty is certain. Yang disease showing Yin pulses indicates danger; Yin disease showing Yang pulses, though difficult, poses no harm.

Pulse not reaching Guan indicates Yin Qi extinction; not reaching Guan from below indicates Yang Qi exhaustion. Intermittent (Dai) pulses with pauses indicate Zang failure and peril; Scattered (San) pulses without root indicate形体 damage and incurability.

Internal injury from food/diet leads to urgent-slippery Qi Kou pulse; internal injury from fatigue leads to large-weak Spleen pulse. To know this Qi, press deeply; extreme sinking becomes Hidden, choppy-weak indicates deep chronic condition.

Six Stagnations often show Sinking pulses; Slippery for Phlegm, Tight for Food, Choppy for Qi/Blood, Rapid for Fire, Fine for Dampness. Slippery governs much Phlegm; Wiry governs retained fluids; Heat makes them Slippery-Rapid; Cold makes them Wiry-Tight.

Floating-Slippery combines with Wind; Sinking-Slippery combines with Qi; Food injury shows Short-Rapid; Dampness retention shows Soft-Fine. Malaria pulses are naturally Wiry; Wiry-Rapid indicates Heat; Wiry-Slow indicates Cold; Dai-Scattered indicates mortality.

Diarrhea and dysentery show Sinking-Small-Slippery-Weak pulses; Solid-Large-Floating-Surging pulses with fever are ominous. Vomiting and reflux with Floating-Slippery pulses are favorable; Wiry-Rapid-Tight-Choppy pulses with colon constipation indicate death.

After Cholera, Dai pulses need not surprise; Cold-Limb inversion with Slow-Minute pulses is terrifying. Coughs are mostly Floating, gathering at Lung/Guan/Stomach; Sinking-Tight-Small are critical; Floating-Soft are easy to treat.

Wheezing with shoulder breathing, Floating-Slippery pulses are smooth; Sinking-Choppy with cold limbs, Scattered pulses are adverse. Fever with fire, Surging-Rapid pulses are treatable; Sinking-Micro without fire, rootless pulses are critical.

Bone-steaming fever, Rapid-Deficient pulses; Heat with Choppy-Small pulses, body destruction is certain. Extreme fatigue and various deficiencies show Floating-Weak-Micro pulses; Earth failure shows Double Wiry; Fire flare-up shows Rapid-Numerous.

All diseases with blood loss show Knife-edge (Kou) pulses; Slow-Small are pleasing; Rapid-Large are worrying. Internal blood stasis prefers Solid-Large pulses; Sinking-Small-Choppy-Minute pulses become harmful.

Spermatorrhea and white turbidity show Micro-Choppy-Weak pulses; Fire excess and Yin deficiency show Kou-Soft-Surging-Rapid pulses. Sanxiao (Three Consumptions) pulses: Floating-Large indicate life; Small-Fine-Micro-Choppy with emaciation are alarming.

Dysuria and retention, yellow nose tip; Choppy-Small without blood, Rapid-Large are acceptable. Dry stool constipation requires distinguishing Qi/Blood; Yang is Rapid-Solid, Yin is Slow-Choppy.

Mania is Heavy Yin; Delirium is Heavy Yang; Floating-Surging are auspicious; Sinking-Urgent are inauspicious. Epilepsy pulses should be Deficient; Solid-Urgent are bad. Floating is Yang, Sinking is Yin; Slippery is Phlegm, Rapid is Heat.

Throat bi pulses: Rapid-Heat, Slow-Cold; Swallowing horse (severe throat swelling), Micro-Hidden is difficult. Various wind vertigo, with Fire or Phlegm; Left Choppy indicates dead blood, Right Large indicates deficiency.

Headaches are mostly Wiry; Floating-Wind, Tight-Cold, Heat-Surging, Damp-Fine, Relaxed-Slippery indicate Phlegm-Cold. Qi deficiency is Wiry; Blood deficiency is Micro-Choppy; Kidney Jue is Wiry-Firm; True pain is Short-Choppy.

Heart/abdominal pain has nine types; Fine-Slow is auspicious, Floating-Large prolongs. Hernia is Wiry-Urgent; Accumulations are interior; Firm-Urgent indicates life, Weak-Urgent indicates death.

Lower back pain pulses are mostly Sinking-Wiry; Combined Floating indicates Wind, Combined Tight indicates Cold. Wiry-Slippery indicates Phlegm-Fluid; Soft-Fine indicates Kidney fixation; Large indicates Kidney deficiency; Sinking-Solid indicates sprain.

Podagra has four types: Slow-Cold, Rapid-Heat, Floating-Slippery indicates Wind, Soft-Fine indicates Dampness. Atrophy due to Lung deficiency shows Micro-Relaxed pulses; or Choppy, Tight, Fine, or Soft.

Wind-Cold-Dampness combine to form Bi syndrome; Floating-Choppy-Tight, these three pulses complete it. Five Jaundices are Excess-Heat, pulses must be Surging-Rapid; Choppy-Micro indicate Deficiency, avoid thirst induction.

Pulses obtaining all Sinking indicate water retention; Floating Qi and Wind, Sinking Stone or Interior. Sinking-Rapid is Yang, Sinking-Slow is Yin; Floating-Large escapes disaster, Small-Deficient causes alarm.

Distension with Wiry pulses, Earth controlled by Wood; Damp-Heat shows Rapid-Surging, Yin-Cold shows Slow-Weak. Floating indicates empty distension, Tight indicates solid middle; Floating-Large is treatable, Small-Deficient is critically dangerous.

Five Zang form Accumulations (Ji); Six Fu form Gatherings (Ju); Solid-Strong indicates life, Sinking-Fine indicates death. Sudden evil abdominal distension, Tight-Fine indicates life; if Floating-Large, pathogen is deep.

Abscesses/Furuncles show Floating-Rapid, aversion to cold and fever; if painful, it is the site of abscess. Rapid pulse, fever, and pain indicate Yang sore; non-rapid, non-fever, non-pain indicate Yin sore.

Unruptured abscesses fear not Large pulses; Ruptured abscesses fear Large pulses. Lung Abscess formed, Cun is Rapid-Solid; Lung萎 (Atrophy) form, Rapid but without force.

Lung Abscess color white, pulse should be Short-Choppy, not Floating-Large; spitting paste/vomit blood. Intestinal Abscess is Excess-Heat, known by Slippery-Rapid; Rapid but no heat, Guan pulse is Kou-Deficient.

Micro-Choppy-Tight, before suppuration, purge; Tight-Rapid with suppuration, never purge. Women's pulses are based on Blood; Blood abundance facilitates conception, Qi abundance hinders it.

Shaoyin movement vigorous indicates pregnancy; Chi pulse slippery and smooth indicates pleasant pregnancy. Slippery-Rapid without scattering indicates three months gestation; merely Rapid without scattering distinguishes five months.

Left Rapid indicates male, Right Rapid indicates female; Female abdomen like basket, Male abdomen like pot. Labor pulses deviate from regular pattern; water breaking precedes birth, do not panic if not yet broken.

Postpartum pulses, Slow-Slippery are auspicious; Solid-Large-Wiry-Firm with symptoms is adverse. Children's pulses, seven beats per cycle are normal; further observe color/symptoms and tiger-mouth lines.

Extraordinary Eight Vessels have different diagnoses; Straight up/down, Floating indicates Du vessel, Firm indicates Chong vessel, Tight indicates Ren vessel. Left/Right pulsation at Cun decides Yang Qiao; Left/Right pulsation at Chi decides Yin Qiao; Left/Right pulsation at Guan decides Dai vessel.

Chi outward slanting to Cun indicates Yin Wei; Chi inward slanting to Cun indicates Yang Wei. Du vessel disease: stiff spine, epilepsy; Ren vessel disease: seven hernias, masses; Chong vessel disease: rebellious Qi, abdominal urgency; Dai governs leukorrhea, umbilical pain, essence loss.

Yang Wei: chills/fever, dizziness, collapse; Yin Wei: heart pain, chest/hypochondriac stabbing. Yang Qiao disease: Yin slack, Yang tense; Yin Qiao disease: Yang slack, Yin tense.

Epilepsy convulsions, chills/fever, confusion; Eight Vessel pulse-syndromes each have their domain. Healthy people without pulse may have it shifted to collateral vessels; brother occupying elder's place, Yangxi/Lieque points.

Once disease pulses are clear, auspiciousness/infortune is distinguished; beyond regular meridians, there are True Pulses. Liver extinction pulse: razor-sharp; Heart extinction pulse: moving beans, restless/rapid.

Spleen: sparrow pecking, like roof leak, like water flow, like overturned cup. Lung extinction: like hair, rootless and desolate, like hemp seeds shaking, like floating waves meeting.

Kidney pulse nearing extinction: like visiting guest, coming like striking stone, going like untying rope. Life pulse nearing extinction: shrimp swimming, fish gliding, like gushing spring, extinct in Bladder.

Once True Pulses appear, Stomach Qi is gone; observe color and symptoms, judge by intuition.