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In the *Suwen: Treatise on the Essential Subtleties of Pulse Diagnosis*, Qibo stated: Beyond all things and within the six directions (Heaven, Earth, and the four cardinal directions), amidst the changes of Heaven and Earth and their correspondence with Yin and Yang, just as the warmth of spring evolves into the heat of summer, and the severity of autumn transforms into the wrath of winter, the movements of the four seasonal changes are mirrored in the pulse. In spring, the pulse should correspond to the compass (Gui, indicating a round and smooth quality); in summer, to the square (Ju, indicating a broad and upright quality); in autumn, to the balance beam (Heng, indicating a light and balanced quality); and in winter, to the weight (Quan, indicating a deep and solid quality).

This explains that the pulse image should respond to the Qi transformation of Yin and Yang across the four seasons. Cold belongs to Yin, and heat belongs to Yang. The circulation of these two Qi energies progresses from subtle to vigorous. Thus, from warmth to heat, extreme heat generates coolness, which is Yang reaching its extremum and generating Yin; extreme cold generates warmth, which is Yin reaching its extremum and generating Yang. As the four seasons rotate, the Yin and Yang Qi of the human body advances and retreats accordingly, manifesting in the pulse like the compass, square, balance, and weight—responding to each other above and below, accurately and with measure. If the pulse does not accord with the climate, exhibiting excess or deficiency, or abnormal generation and restriction relationships, one can distinguish the severity and prognosis of the disease.

Therefore, forty-five days after the Winter Solstice, Yang Qi subtly ascends while Yin Qi subtly descends; forty-five days after the Summer Solstice, Yin Qi subtly ascends while Yang Qi subtly descends. Yin and Yang have their specific times, and the pulse has its corresponding cycle. If they miss this timing, one can identify the classification of the pulse; since the classification has its period, one can know the time of death.

This further clarifies the meaning of the preceding text. Forty-five days after the Winter Solstice marks the Beginning of Spring (Lichun). Yang Qi subtly emerges above the ground, and Yin Qi subtly sinks below it. The vital energy of all things begins to stir, and the pulse changes from the "Stone" (Shi) pulse to the "Bowstring" (Xian) pulse to accord with the Qi of Spring Yang. Forty-five days after the Summer Solstice marks the Beginning of Autumn (Liqiu). Yin Qi subtly emerges above the ground, and Yang Qi subtly sinks below it. All things grow fully and become substantial. The pulse changes from the "Hook" (Gou) pulse to the "Feather" (Mao) pulse to accord with the Qi of Autumn Harvest. As Yang Qi grows from subtle to vigorous, the Bowstring pulse changes to the Hook pulse; the Hook pulse refers to a floating and surging quality. As Yin Qi grows from subtle to vigorous, the Feather pulse changes to the Stone pulse; the Stone pulse refers to a deep and solid quality. This is the principle of Yin and Yang ascending and descending, circulating, and transforming all things. Hence, there are different seasonal climates and pulses that correspond to them at the appointed times. If the pulse does not correspond when the time arrives, it indicates that the pulse Qi has separated from the Heaven and Earth Qi transformation, hence failing to correspond. By observing whether this separation follows a pattern or involves abnormal generation and restriction, one can determine the day and time of life or death. For example, seeing an Autumn pulse in Spring represents Metal restricting Wood, indicating death; seeing a Winter pulse in Spring represents Water generating Wood, indicating survival.

The subtlety lies in the pulse; it must not be neglected. Examination must have discipline, starting with Yin and Yang. The beginning must follow classics, deriving from the generation of the Five Elements. Generation has its limits, suited to the four seasons. Tonification and sedation must not be missed, aligning with Heaven and Earth as one. Grasping this essence allows one to know life and death. Therefore, sounds harmonize with the Five Tones, complexions harmonize with the Five Elements, and pulses harmonize with Yin and Yang.

This discusses the subtle principles of disease, life, and death, which reside entirely in examining the pulse. Examination must have rules and cannot rely on speculation. It must begin with the principles of Yin-Yang transformation. Knowing the beginning reveals constant changes derived from the Five Elements. For instance, Yang arises at the Winter Solstice, Yin arises at the Summer Solstice; Wood is prosperous in Spring, Fire in Summer, Metal in Autumn, Water in Winter, and Earth in the transitional periods of the four seasons. This is the standard measure of Yin, Yang, and the four seasons. If Yin and Yang exhibit excessive dominance, the Five Elements undergo generation and restriction, leading to pathological changes. Therefore, regulation is necessary, adhering to the suitability of the four seasons, applying tonification or sedation without error, aligning with the transformative principles of Heaven and Earth. Mastering this unified essence allows one to understand the path of reversal, compliance, life, and death. Since voice emanates from Qi, complexion manifests from Qi, and Qi roots in the Zang organs, which possess the nature of the Five Elements, and the pulse is the precursor manifestation of Blood and Qi, therefore, voice, complexion, and pulse must all conform to the transformative principles of the Five Elements and Yin-Yang. Deviation leads to disease; signs of collapse indicate death.

Opposing the four seasons, excess manifests as refined essence (overabundance), while deficiency manifests as consumption. Responding to excess but showing deficiency indicates injury to essence and failure of Qi to grow; responding to deficiency but showing excess indicates the depletion of the root origin and the false appearance of deficient Yang emerging. Thus it is said: When Yin and Yang do not correspond, the disease is named Guan Ge (Obstruction and Repletion). Guan Ge is a fatal condition that cannot be treated. This section of the classic originally likely appeared before the "Beyond all things" paragraph. After carefully analyzing the logic above and below, I believe it was a bamboo slip error, so I have specifically moved it here for logical coherence.

Therefore, holding the pulse requires a method, with emptiness and stillness as the safeguard. In spring, the pulse floats, like fish swimming in waves; in summer, it is at the skin level, abundant like flourishing all things; in autumn, it sinks below the skin, like hibernating insects preparing to leave; in winter, it reaches the bone, like hibernating insects tightly concealed, and gentlemen stay indoors. Thus it is said: To know what is internal, press and record the pulse; to know what is external, observe the cycle of end and beginning. These six points are the great methods of pulse diagnosis.

This explains the essential way of palpating the pulse. The physician must be empty-minded and calm; if the physician is empty-minded, observation is clear. The patient must have calm Qi; if the patient's Qi is calm, the pulse is accurate, ensuring no errors. The subtlety of pulse theory is hard to express in words. Metaphors such as fish swimming and insects hibernating describe the phenomena of Qi and Blood circulation and entry/exit, which also imply the meanings of Xian, Gou, Mao, and Shi pulses. One must ponder deeply and investigate silently to comprehend the spiritual principles, allowing the fingers to perceive clearly. Thus, those who understand internal Qi transformation analyze and record based on pulse images, Yin-Yang, and the Five Elements, revealing the principles naturally. Those who understand external Qi transformation observe the flow of time and the way of beginning and end, finding no disconnect with the human body, thereby clearly distinguishing internal injuries and external infections. Integrating the Qi transformation of the four seasons with the internal and external aspects of the human body, these six points constitute the major outline of pulse diagnosis. This concludes the purport of the previous sections; the following will detail the locations for pulse diagnosis.