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Pulse is the pathway of blood, the precursor of Qi and Blood. It is the tunnel through which blood flows, and the movement of Qi responds within it. Its form mimics the earth; it is the mansion where blood gathers, harmonized with the Heart, and externally connected to the skin.

Its origin begins in the Kidney, and its nourishment depends on the Stomach. It belongs to Yin within Yang, rooted in Ying (Nutritive) Qi and Wei (Defensive) Qi. Ying is Yin Blood, while Wei is Yang Qi; Ying circulates within the vessels, whereas Wei circulates outside the vessels. The vessels cannot beat on their own but move following the propulsion of Qi. When Qi moves, the pulse responds, illustrating the intimate relationship between Yin and Yang. Qi is like a bellows, and Blood is like waves; the circulation of blood vessels and Qi moves up and down continuously. In the twelve meridians, there are pulsating arteries, yet only the Cunkou (Inch Position) of the Hand-Taiyin Lung Meridian serves as the basis for diagnosis. This meridian belongs to the Lung, connects upward to the throat, and is the great assembly of all pulses, governing the entry and exit of respiration. One exhalation and one inhalation constitute one "Xi" (respiratory cycle); the pulse beats four times per Xi. In a day and night, there are 13,500 Xis. With each Xi, Qi moves six cun, totaling 810 zhang in a day and night, which serves as the standard.

When initially palpating the pulse, instruct the patient to hold their palm upward. The prominent bone at the back of the wrist is called the Guan (Bar). The area anterior to the Guan is Yang, known as Cun (Inch); the area posterior to the Guan is Yin, known as Chi (Cubit). By sequentially pushing and searching the Cun, Guan, and Chi positions, one diagnoses. The Heart and Liver reside on the left, the Lung and Spleen on the right, and the Kidneys and Mingmen (Gate of Life) occupy both Chi positions. Hun (Ethereal Soul), Po (Corporeal Soul), and Gushen (Grain God) are all reflected in the Cunkou pulse. The left side primarily observes the Zang organs (Officer), and the right side primarily observes the Fu organs (Functionary). A larger pulse on the left is favorable for men, and a larger pulse on the right is favorable for women. The influence of Benming (Life Destiny) and Mingmen differs by gender: left for men, right for women. One fen anterior to the Guan is the master of human life. The position anterior to the Guan on the left is Renying (Human Welcome), and on the right is Qikou (Qi Gate). Shenmen (Spirit Gate) is located bilaterally posterior to the Guan. If these two pulses are absent, the condition is critical and difficult to cure. Men and women generally have similar pulses, except for the Chi position. If Yang is weak and Yin is excessive, or conversely if Yin is weak and Yang is excessive, these are pathological states.

There are seven diagnostic techniques: Floating (Fu), Middle (Zhong), and Deep (Chen) pressures, applied to Upper, Lower, Left, and Right positions, requiring careful inquiry. There are also nine inspections, using light lifting and heavy pressing to examine the three positions (Cun, Guan, Chi) for floating and deep qualities, observing five movements in each. The Cun position examines the chest and above; the Guan position examines below the diaphragm; the Chi position examines the navel, extending down to the heels and ankles. The left pulse primarily reflects the left side of the body, and the right pulse primarily reflects the right side; disease manifests according to location, while health does not follow this rule.

Floating pulse corresponds to the Heart and Lung; Deep pulse corresponds to the Kidney and Liver; the Spleen and Stomach are in the central region, with pulses intermediate between floating and deep. The Heart's floating pulse is large, floating, and scattered; the Lung's floating pulse is floating, choppy, and short; the Liver's deep pulse is deep, wiry, and long; the Kidney's deep pulse is deep, solid, and soft. The Spleen and Stomach belong to Earth, and their pulse should be harmonious and relaxed. The Mingmen represents Ministerial Fire, and the left Cun pulse can be interpreted similarly. Spring pulses are wiry, Summer pulses are surging, Autumn pulses are feathery (floating), Winter pulses are stone-like (deep), and pulses during the last month of each season are harmonious; this is called the Ping Pulse (Normal Pulse). Excessive, solid, and strong pulses indicate disease originating externally; insufficient, deficient, and minute pulses indicate disease originating internally. If an Autumn (feathery) pulse appears in Spring, death occurs on a Metal day; this principle applies to the five Zang organs without error. For diseases across the four seasons, Stomach Qi is fundamental. The pulse must possess Shen (Spirit); this must be examined carefully.

Regulate breathing; one respiratory cycle constitutes one Xi. Four to five beats per Xi is the standard for harmony. Three beats per Xi is Chi (Slow) pulse, indicating Cold. Six beats per Xi is Shu (Rapid) pulse, indicating Heat. The slower, the colder; the faster, the hotter. Once Slow and Rapid are understood, distinguish Floating and Deep. Floating, Deep, Slow, and Rapid help differentiate external and internal causes. External causes stem from heaven; internal causes stem from humanity. Heaven has Yin/Yang, wind/rain, darkness/brightness; humans have joy/anger, worry, thought, sorrow, fear, fright. External Floating indicates Exterior Syndrome. Deep interior, Slow Yin, and Rapid Yang excess are patterns. Internal Floating results from deficient wind; Deep indicates Qi stagnation, Slow indicates Cold, and Rapid indicates Heat without doubt. Floating-Rapid indicates Exterior Heat; Deep-Rapid indicates Interior Heat; Floating-Slow indicates Exterior Deficiency; Deep-Slow indicates Cold accumulation. Differentiate Exterior/Interior, Yin/Yang, Wind/Cold-Heat to identify causes. Correlate pulse and symptoms; although pulse theory is vast, it summarizes into four categories. Having grasped the outline, one can extend and apply it analogously.

Floating pulse mimics heaven; it is accessible with light pressure, superficial like wood floating on water. Forceful and large with vigorous onset and leisurely decline is Hong (Surging) pulse. Weak and large with slow and soft quality is Xu (Deficient) pulse. Extremely deficient leads to San (Scattered) pulse, which is diffuse and uncontained. Having edges but no center is Kou (Hollow) pulse. Small and floating is Ru (Soggy) pulse, soft and floating on water surface. Extremely soggy leads to Wei (Minute) pulse, which cannot withstand pressure.

Deep pulse mimics earth; it is near tendons and bones, deeply situated. Extremely deep is Fu (Hidden) pulse. Forceful, large, wiry, and long is Lao (Tight/Firm) pulse. Extremely firm becomes Shi (Excess) pulse, strong and hard. Weak and small like cotton is Ruo (Weak) pulse. Extremely weak becomes Xi (Fine) pulse, like a spider's thread.

Chi (Slow) pulse belongs to Yin, beating three times per Xi. Huan (Moderate) pulse is slightly faster than Slow but less than four beats. Two beats per Xi is Sun (Damage) pulse; one beat per Xi is Bai (Decay) pulse, untreatable. One beat every two Xi indicates loss of Jing (Essence) and absence of Qi. If Floating, Large, Deficient, Scattered, or Kou/Ger pulses appear; or Floating-Small, Ru, Wei, Deep-Small, Xi, Ruo pulses, these are critical signs. Slow and Fine is Se (Choppy) pulse, extremely difficult to flow. Easy to scatter with occasional pauses that return is Jie (Knotted) pulse. Slow with pauses that do not return is Dai (Intermittent) pulse.

Shu (Rapid) pulse belongs to Yang, beating six times per Xi. Seven beats is Ji (Fast) pulse; eight beats is Ji (Extreme) pulse; nine beats is Tuo (Depleted) pulse. Floating and large is Hong (Surging) pulse. Deep, large, firm, and solid with smooth flow is Hua (Slippery) pulse. Forceful and snapping like a turning rope is Jin (Tight) pulse. Rapid pulse at Cun with occasional pauses is Cu (Hasty) pulse. Rapid pulse at Guan with quivering motion like a small bean is Dong (Moving) pulse.

Chang (Long) pulse indicates regulated Qi, extending beyond its normal position. Long and straight, responding to the finger, is Xian (Wiry) pulse. Duan (Short) pulse indicates Qi pathology, failing to fill the position, absent at Guan, visible only at Cun and Chi. Each pulse shape has specific disease associations. Combined rapid pulses present various syndromes.

Floating pulse governs Exterior; Interior must be deficient. Forceful indicates Wind-Heat; weak indicates Blood deficiency. Floating-Slow indicates Wind-Deficiency; Floating-Rapid indicates Wind-Heat; Floating-Tight indicates Wind-Cold; Floating-Moderate indicates Wind-Dampness; Floating-Deficient indicates Summerheat injury; Floating-Hollow indicates Blood loss; Floating-Surging indicates Deficient Fire; Floating-Minute indicates Extreme Fatigue; Floating-Soggy indicates Yin Deficiency; Floating-Scattered indicates Severe Deficiency; Floating-Wiry indicates Phlegm-Fluid; Floating-Slippery indicates Phlegm-Heat.

Deep pulse governs Interior, Cold, and Accumulation. Forceful indicates Phlegm-Food; weak indicates Qi stagnation. Deep-Slow indicates Deficient-Cold; Deep-Rapid indicates Hidden Heat; Deep-Tight indicates Cold Pain; Deep-Moderate indicates Water retention; Deep-Firm indicates Chronic Cold; Deep-Solid indicates Extreme Heat; Deep-Weak indicates Yin Deficiency; Deep-Fine indicates Bi-Dampness; Deep-Wiry indicates Fluid-Pain; Deep-Slippery indicates Retained Food; Deep-Hidden indicates Vomiting/Diarrhea, Yin Toxin accumulation.

Chi (Slow) pulse governs Zang organs, with latent Yang Qi. Forceful indicates Pain; weak indicates Deficient-Cold.

Shu (Rapid) pulse governs Fu organs, vomiting, and mania. Forceful indicates Heat; weak indicates Sores/Ulcers.

Hua (Slippery) pulse governs Phlegm or food injury. Downward indicates Blood stasis; upward indicates vomiting/regurgitation.

Se (Choppy) pulse indicates Blood deficiency or Cold-Dampness invasion, leading to reverse regurgitation, colon constipation, spontaneous sweating, and cold limbs.

Xian (Wiry) pulse governs Fluid retention, belonging to Gallbladder and Liver. Wiry-Rapid indicates Heat; Wiry-Slow indicates Cold. Floating-Wiry indicates Branch Fluid; Deep-Wiry indicates Suspended Pain; Yang-Wiry indicates Headache; Yin-Wiry indicates Abdominal Pain.

Jin (Tight) pulse governs Cold and various pains. Floating-Tight indicates Exterior Cold; Deep-Tight indicates Interior Pain.

Chang (Long) pulse indicates balanced Qi; Duan (Short) pulse indicates Qi pathology. Fine indicates little Qi; Large indicates disease progression. Floating-Long indicates Epilepsy; Deep-Short indicates Retained Food. Blood deficiency yields Deficient pulse; Qi excess yields Excess pulse.

Hong (Surging) pulse indicates Heat, with Yin deficiency. Xi (Fine) pulse indicates Dampness, with Blood deficiency. Moderate-Large indicates Wind; Moderate-Fine indicates Dampness; Moderate-Choppy indicates Blood shortage; Moderate-Slippery indicates Internal Heat. Ru-Small indicates Yin Deficiency; Ruo-Weak indicates Yang exhaustion. Yang exhaustion causes aversion to cold; Yin deficiency causes fever. Yang micro indicates aversion to cold; Yin micro indicates fever. Male micro indicates deficiency damage; female micro indicates bleeding. Yang moving causes sweating; Yin moving causes fever, pain, fright, metrorrhagia, and blood loss.

Deficient-Cold interacting is named Ger (Leather) pulse. Men lose essence; women lose blood.

Yang excess yields Cu (Hasty) pulse, governing Lung Abscess and Yang Toxin. Yin excess yields Jie (Knotted) pulse, governing Hernia, Masses, and stagnation. Dai (Intermittent) pulse indicates Qi decline, or pus/blood discharge. In Shanghan (Cold Damage) palpitations, or three-month pregnancy, Dai pulse appears.

Pulse governing diseases has appropriate and inappropriate patterns; Yin/Yang compliance determines auspiciousness or peril. Zhongfeng (Wind Stroke) shows Floating-Moderate; Rapid/Solid is contraindicated. Floating-Slippery indicates Phlegm obstruction; Deep-Slow indicates Qi obstruction. Shijue (Corpse Fainting) shows Deep-Slippery, sudden unconsciousness. Entering Zang causes cold body; entering Fu causes warm body. Wind injuring Wei shows Floating-Moderate with sweat; Cold injuring Ying shows Floating-Tight without sweat. Summerheat injuring Qi shows Deficient pulse with fever; Dampness injuring Blood shows Moderate-Fine-Choppy pulse.

In Shanghan febrile diseases, Floating-Surging is favorable. Deep-Micro-Choppy-Small pulses contradict symptoms and indicate peril. Post-sweat quiet pulse and cool body indicate safety; post-sweat restless pulse and severe heat indicate difficulty. Yang disease showing Yin pulse is critical; Yin disease showing Yang pulse is manageable despite severity. Pulse not reaching Guan indicates Yin exhaustion; pulse not reaching Guan from below indicates Yang exhaustion. Dai pulse with pauses indicates Zang failure and peril; San (Scattered) pulse without root indicates physical damage and incurability.

Dietary injury shows Urgent-Slippery Qi Kou pulse. Labor/fatigue injury shows Large-Weak Spleen pulse. To identify Qi issues, press deeply; pulse becomes Deep, eventually Hidden, Choppy, and Weak over time. Fire depression often shows Deep pulse; Slippery indicates Phlegm, Tight indicates Food, Qi Choppy, Blood Hollow, Rapid indicates Fire, Fine indicates Dampness. Slippery indicates much Phlegm; Wiry indicates retained fluid. Heat yields Slippery-Rapid; Cold yields Wiry-Tight. Floating-Slippery combines Wind; Deep-Slippery combines Qi. Food injury yields Short-Rapid pulse; Dampness retention yields Ru-Fine pulse.

Malaria pulse is naturally Wiry. Wiry-Rapid indicates Heat; Wiry-Slow indicates Cold. Dai-Scattered indicates death. Diarrhea/dysentery shows Deep-Small-Slippery-Weak pulse; if Solid-Large-Floating-Surging with fever, it is ominous. Vomiting/regurgitation shows auspicious Floating-Slippery pulse; Wiry-Rapid-Tight-Choppy indicates colon constipation and death. Huoluan (Cholera) shows Dai pulse (do not be surprised); JueNi (Reversal Cold) with Slow-Micro pulse is terrifying.

Cough is mostly Floating, gathering at Lung, Guan, Stomach. Deep-Tight-Small is dangerous; Floating-Ru is easy to treat. Panting with shoulder breathing shows Smooth-Shun (favorable) Floating-Slippery pulse; Deep-Choppy with cold limbs shows Reverse San (Scattered) pulse. Fever with fire shows curable Surging-Rapid pulse; Deep-Micro without fire shows dangerous rootless pulse. Bone-steaming fever shows Rapid-Deficient pulse; fever with Choppy-Small pulse leads to death. Extreme fatigue and deficiencies show Floating-Soft-Weak pulse. Earth failure shows Double Wiry pulse; Fire flare shows Rapid pulse. All blood loss diseases show Kou (Hollow) pulse; Moderate-Small is pleasing, Rapid-Large is worrying. Internal blood stasis should show Firm-Large pulse; Deep-Small-Choppy-Micro is harmful. Spermatorrhea/cloudy urine shows Micro-Choppy-Weak pulse; Fire excess/Yin deficiency shows Kou-Ru-Surging-Rapid pulse. Sanxiao (Three Wasting-Thirst) pulse: Floating-Large indicates survival; Small-Micro-Choppy with physical depletion is alarming. Lin (Strangury) with yellow nose tip shows Choppy-Small without blood; Rapid-Large is acceptable. Dry stool requires distinguishing Qi/Blood: Yang is Rapid-Solid, Yin is Slow-Choppy.

Dian (Depression) is Heavy Yin; Kuang (Mania) is Heavy Yang. Floating-Surging is auspicious; Deep-Urgent is disastrous. Xian (Epilepsy) pulse should be Deficient; Solid-Urgent is bad. Floating is Yang, Deep is Yin; Slippery is Phlegm, Rapid is Heat. Houbi (Throat Obstruction) pulse: Rapid is Heat, Slow is Cold. Chanhou Zouma (Rapid Throat Swelling) with Micro-Hidden pulse is difficult.

Wind vertigo involves Fire or Phlegm. Left Choppy indicates Dead Blood; Right Large indicates Deficiency. Headache is mostly Wiry; Floating is Wind, Tight is Cold, Surging is Heat, Fine is Dampness, Moderate-Slippery indicates Phlegm. Qi deficiency shows Soft-Wiry; Blood deficiency shows Micro-Choppy. Kidney Jue shows Firm-Wiry; True Pain shows Short-Choppy.

Heart/Abdominal pain has nine types. Fine-Slow is auspicious; Floating-Large prolongs illness. Hernia is Urgent-Wiry; Accumulation is internal. Firm-Urgent indicates survival; Weak-Urgent indicates death.

Lumbar pain pulse is mostly Deep-Wiry. Combined Floating is Wind; combined Tight is Cold; Wiry-Slippery is Phlegm-Fluid; Ru-Fine is Kidney Dampness. Large indicates Kidney Deficiency; Deep-Solid indicates Sprain.

Hongjiao (Gout/Leg Disease) has four types: Slow-Cold, Rapid-Heat, Floating-Slippery-Wind, Ru-Fine-Dampness. Wei Bing (Flaccidity) due to Lung Deficiency shows Micro-Moderate, or Choppy/Tight/Fine/Ru pulses. Wind-Cold-Dampness combine to form Bi syndrome, showing Floating-Choppy-Tight pulses.

Five Jaundices are Excess-Heat, showing Surging-Rapid pulses; Choppy-Micro indicates Deficiency, avoid thirst. Deep pulses suggest Water retention. Floating indicates Qi/Wind; Deep-Stone indicates Interior. Deep-Rapid is Yang; Deep-Slow is Yin. Floating-Large escapes danger; Deficient-Small is alarming. Distension shows Wiry pulse, Wood controlling Earth. Damp-Heat shows Surging-Rapid; Yin-Cold shows Slow-Heat. Floating indicates Empty Distension; Tight indicates Solid Interior. Floating-Large is treatable; Deficient-Small is critical.

Zang masses are Ji (Accumulation); Fu masses are Ju (Gathering). Solid-Strong indicates survival; Deep-Fine indicates death. Zhong'e (Evil Qi) abdominal distension: Tight-Fine indicates survival; Floating-Large indicates deep pathogen.

Yongju (Carbuncle/Ulcer) shows Floating-Scattered with chills/fever. Pain indicates Carbuncle development. Rapid pulse, fever, and pain indicate Yang sore; non-rapid, non-fever, non-pain indicates Yin sore. Unulcerated carbuncles fear not Surging-Large pulse; ulcerated carbuncles fear Surging-Large pulse. Lung Abscess formed shows Rapid-Solid Cun pulse. Lung萎 (Withering) shows Rapid-Weak pulse. Lung Abscess white color prefers Short-Choppy pulse, not Floating-Large. Spitting paste/blood indicates Intestinal Abscess Excess-Heat, known by Slippery-Rapid pulse. Rapid without fever, Hollow-Weak Guan pulse, Micro-Choppy-Tight indicates pus formation before drainage; if Tight-Rapid, pus is formed, do not drain.

Women's pulse is based on Blood. Abundant Blood facilitates conception; Abundant Qi hinders it. Strong Shaoyin pulse indicates pregnancy. Slippery-Smooth Chi pulse indicates favorable pregnancy. Slippery-Rapid without dispersion indicates three months gestation; Rapid without dispersion indicates five months. Left Rapid indicates Male fetus; Right Rapid indicates Female fetus. Female abdomen like basket; Male abdomen like pot. Pre-labor pulse changes to Li Jing (Departing from Standard). Delivery follows water breaking; do not panic before delivery. Post-partum pulse: Smooth-Slow is auspicious; Solid-Large-Wiry-Firm with symptoms is adverse.

Children's pulse: Seven beats per Xi is normal. Observe complexion, symptoms, and Tiger Mouth lines.

Extraordinary Vessels have distinct diagnostics. Straight up-down Floating is Du Mai; Firm is Chong Mai; Tight is Ren Mai. Left-right pulsation at Cun resolves Yang Qiao; at Chi resolves Yin Qiao; at Guan resolves Dai Mai. Diagonal up from outer Chi to Cun identifies Yin Wei; diagonal up from inner Chi to Cun identifies Yang Wei.

Du Mai disease: Stiff spine, epilepsy. Ren Mai disease: Seven hernias, masses. Chong Mai disease: Counterflow Qi, abdominal urgency. Dai Mai governs leukorrhea, umbilical pain, essence loss. Yang Wei: Chills/fever, dizziness, collapse. Yin Wei: Heart pain, chest/hypochondriac stabbing. Yang Qiao disease: Yang laxity, Yin tension. Yin Qiao disease: Yin laxity, Yang tension. Epilepsy convulsions, chills/fever, confusion. Eight Extraordinary Vessels have specific pulse-symptom associations.

Healthy people may lack pulses in main channels, shifting to collateral vessels (Brother occupying Elder's position). Pulses at Yangxi and Lieque points can be observed.

Once pathological pulses are clear, distinguish auspiciousness/peril. Beyond regular pulses are True Pulses (Extinction Pulses). Liver extinction: Razor-sharp. Heart extinction: Bean-like, restless/fast. Spleen: Sparrow pecking, roof leak, water flow, overturned cup. Lung: Feathery, rootless, desolate, sesame shaking, wave merging. Kidney nearing extinction: Guest visiting, striking stone onset, untied cord decline. Life pulse nearing extinction: Shrimp swimming, fish gliding, spring gushing, bladder extinction. Once True Pulses appear, Stomach Qi is gone. Correlate with complexion and symptoms to judge.