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Huangdi asked: "How is pulse diagnosis conducted?" Qibo replied: "Pulse diagnosis is usually performed in the early morning (Pingdan). At this time, Yin Qi has not yet stirred, Yang Qi has not yet dispersed, food and drink have not been ingested, the Jing Mai (Meridian Vessels) are not yet full, the Luo Mai (Collateral Vessels) are harmonious and uniform, and the Ying Qi (Nutritive Qi) and Xue (Blood) are not yet chaotic. Therefore, abnormal pulses can be diagnosed."

The Mai (Pulse) is the precursor manifestation of Ying Qi and Xue. When Ying Qi and Xue deviate from normality, phenomena appear in the pulse. Only when Yin and Yang Qi are undisturbed and undispersed in the early morning, without dietary assistance to Qi, and with harmonious Qi in the Jing Mai and Luo Mai, can one determine the location of the disease by palpating the pulse and distinguish between longevity and premature death.

By palpating the dynamic changes of the pulse, observing the clarity of the eyes (Shi Jing Ming), examining the five colors of the face, and assessing the excess or deficiency of the Zang Organs, the strength or weakness of the Fu Organs, and the flourishing or declining state of the body form, these factors are cross-referenced (Can Wu) to determine the boundary between life and death.

"Palpating the dynamic changes of the pulse" refers to characteristics such as Floating (Fu), Sinking (Chen), Slow (Chi), and Rapid (Shu). "Observing the clarity of the eyes and examining the five colors" means that human spirit gathers in the eyes, and the luster of Qi and blood manifests on the face. Observing the exterior allows one to know the strength or weakness of the interior Zang Organs; seeing the form allows one to know the flourishing or declining state of the body. For instance, a robust form with a weak pulse indicates root deficiency, while a frail form with a strong pulse indicates pathogenic excess. By deducing the principles of the reversal or smoothness of Yin and Yang, and the generation and restriction of the Five Elements, and cross-referencing them, one decides the division of life and death. Further details follow.

The Mai (Pulse) is the residence (Fu) of Xue (Blood). A long pulse indicates regulated Qi; a short pulse indicates diseased Qi; a rapid pulse indicates vexation of the heart; a large pulse indicates advancing disease; excess at the upper part indicates high Qi (Qi rising); excess at the lower part indicates abdominal distension due to Qi stagnation; a Dai Pulse (Intermittent Pulse) indicates Qi decline; a fine pulse indicates scanty Qi; a choppy pulse indicates heart pain. If the pulse is chaotic and rapid like surging springs, the disease advances and the complexion deteriorates. If the pulse fades away slowly like a broken string, it indicates death.

This is the method of distinguishing disease through the pulse and deciding life and death. Wei Qi (Defensive Qi) moves outside the vessels and governs Qi; Ying Qi (Nutritive Qi) moves inside the vessels and governs Xue. Thus, the vessel is the residence of Xue, yet it can also be used to verify Qi. Why? Because Xue primarily moistens, and Qi primarily warms. Xue follows Qi in its movement, and Qi gathers through Xue. Indeed, Yin and Yang, Xue, and Qi are mutually rooted and cannot be separated. Therefore, a long pulse shape indicates regulated and smooth Qi and health; a short pulse shape indicates stagnant Qi and disease; a rapid pulse may result from pathogenic stagnation transforming into fire, or from Kidney Water deficiency leading to Heart Fire hyperactivity, both causing heart vexation. If an external contraction presents with a gradually enlarging pulse, it indicates pathogenic excess; if an internal injury presents with a surprisingly large pulse, it indicates insecurity of the Yuan Qi (Original Qi). Both indicate advancing disease. If the pulse force overflows upward and the Cun position is particularly vigorous, Qi is excessive above, and respiration must be labored. If the pulse force sinks downward and the Chi position is relatively large, Qi sinks below, and the abdomen must be distended. The Dai pulse involves pauses, indicating Qi decline, though it can also occur due to stagnation of Zang-Fu Qi and Xue. A fine pulse indicates scanty Qi, though it can also result from external dampness invasion; generally, it is due to deficient Yang Qi and is still treatable. However, if a Dai pulse appears without stagnation, it indicates collapse of the Yuan Qi and is difficult to treat. A choppy pulse indicates Qi stagnation and Blood stasis. Since the Heart governs the vessels and blood, heart pain occurs. A chaotic, rapid pulse like surging springs, where light pressure yields indistinguishable beats resembling leather, and heavy pressure feels like boiling springs, indicates scattered Yuan Qi and disorderly ascending/descending and exiting/entering of Yin and Yang, leading to advancing disease and deteriorated complexion. Yet, there is still a pulsating momentum. If there is no forceful pulsation, and the pulse fades slowly like water flowing downhill or like a zither string suddenly breaking without trace, it is like a dying lamp extinguishing, thus indicating death.