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In the "Ping Ren Qi Xiang Lun" (Treatise on the Pulse and Manifestations of a Healthy Person) of the *Su Wen* (Basic Questions), Qibo stated: When a person exhales, the pulse beats twice; when they inhale, the pulse also beats twice. At the pause between breaths (Ding Xi), it beats five times in total. If we account for occasional deep sighs (Tai Xi), this is called a Ping Ren (Healthy Person). A Ping Ren is one who is not diseased. Typically, one uses the pulse of a healthy person to adjust for that of a patient. Since the physician is healthy, the method is to regulate one's own breathing to diagnose the patient. If upon one exhalation the pulse beats once, and upon one inhalation it beats once, this is called Shao Qi (Deficient Qi). If upon one exhalation the pulse beats three times, and upon one inhalation it beats three times with a restless quality, and the skin at the chi position is hot, this indicates Wen Bing (Warm Disease); if the chi skin is not hot but the pulse is slippery, this indicates Feng Bing (Wind Disease); if the pulse is choppy, this indicates Bi Syndrome (Obstruction). If upon one exhalation the pulse beats four or more times, or if the pulse ceases completely, or if the pulse rhythm is intermittently slow and rapid, these all indicate death. The normal qi of a healthy person is derived from the Stomach; the Stomach is the source of normal qi. If a person lacks Stomach Qi, it is termed Ni (Rebellious/Contrary), and Ni leads to death.

The movement of the pulse reflects the ascending, descending, exiting, and entering of Yin-Yang, Qi, and Blood. The root of this Qi lies in respiration; therefore, Zhang Zhongjing stated that respiration is the key to observing the pulse. One exhalation and one inhalation constitute one Xi (Breath Cycle). Among three breath cycles, there must be one longer breath, similar to a leap month in a year, called Tai Xi. In one breath cycle, the pulse beats four times. Including the long breath, among three cycles there are three extra beats; averaged out, each cycle has five beats, called Wu Zhi (Five Beats). This represents a healthy, disease-free state. By combining the respiration rate of a healthy person with the beat count of a pathological pulse, one can discern whether the pulse is Chi (Slow) or Shu (Rapid). For instance, if the pulse stops or beats only once per exhalation, and beats once per inhalation, this is a Chi Pulse, indicating deficient Yang Qi. If the pulse beats three times per exhalation and three times per inhalation, this is a Shu Pulse. If accompanied by restlessness and heat at the chi skin, it is a Warm Disease; if the chi skin is not hot but the pulse is slippery, it indicates internal Wind-Phlegm, such as in Stroke; if the pulse is choppy, it indicates pathogenic obstruction of the meridians. If the pulse beats four or more times per exhalation, it means Qi exits but does not enter, indicating the external collapse of the Yuan Qi (Original Qi). If the pulse ceases completely, it indicates exhaustion of Qi and Blood. If the pulse rhythm is intermittently sparse and rapid, it indicates scattered Original Qi. Thus, all these indicate death. The Stomach is the sea of the Zang-Fu organs; all Zang-Fu organs rely on the Grain Qi from the Stomach for nourishment. Therefore, if a person lacks Stomach Qi, their condition is contrary, which is a sign of death.

The Tai Yang (Greater Yang) pulse is Hong Da (Surging and Large) and Chang (Long). The Shao Yang (Lesser Yang) pulse is intermittently rapid and sparse, intermittently short and long. The Yang Ming (Bright Yang) pulse is Fu Da (Floating and Large) and Duan (Short).

These manifestations reflect the generation, prosperity, opening, and closing of Yang Qi. Tai Yang governs Opening; since Yang Qi is prosperous, the pulse is surging, large, and long. Shao Yang governs the Pivot; since Yang Qi has just begun to generate and cannot yet flow smoothly, the pulse is intermittently rapid and sparse, intermittently long and short. This is distinctly different from the intermittent sparsity and rapidity caused by scattered and weak Qi mentioned in the previous section, a distinction one must know. Two Yangs combining to form brightness is called Yang Ming; when Yang Qi reaches its peak, the Qi closes. Thus, a floating and large pulse is a sign of Yang, and a short pulse is a sign of closing. Using this to verify the generation, prosperity, exit, and entry of the Three Yang Qi aligns with the laws of Heaven and Earth. For example, in summer, when Yang Qi is at its peak and Yin Qi begins to generate, the short pulse of Yang Ming is a precursor to the floating, short, and choppy pulses of autumn. The same applies to the Opening, Closing, and Pivot of the Three Yin meridians. Thus, the *Nan Jing* states: The arrival of Tai Yin presents as Jin Da Er Chang (Tight, Large, and Long). This is because Yin Qi is prosperous, so Tai Yin governs Opening. It further states: The arrival of Shao Yin presents as Jin Xi Er Wei (Tight, Fine, and Minute). This is because Yin Qi has just begun to generate, so Shao Yin governs the Pivot. It also states: The arrival of Jue Yin presents as Chen Xi Er Dun (Deep, Fine, and Solid). This is because Yin Qi has reached its extreme, so Jue Yin governs Closing. The *Nan Jing* names these prosperous pulses according to the Three Yin and Three Yang, asserting they conform to the generative and prosperous Qi of Heaven and Earth. However, the *Nan Jing* says that after the Winter Solstice, upon obtaining the Jia Zi day, Shao Yang becomes prosperous; upon obtaining another Jia Zi day, Yang Ming becomes prosperous; upon obtaining another Jia Zi day, Tai Yang becomes prosperous. This refers only to the generation and prosperity of Heavenly Yang Qi. The *Nei Jing*'s discussion of Opening, Closing, and Pivot refers to the circulation of Human Meridian Qi, possessing different principles. Furthermore, the *Su Wen·Zhi Zhen Yao Da Lun* states: The arrival of Jue Yin presents as Xian (Wiry); the arrival of Shao Yin presents as Gou (Hooked); the arrival of Tai Yin presents as Chen (Deep); the arrival of Shao Yang presents as Da Er Fu (Large and Floating); the arrival of Yang Ming presents as Duan Er Se (Short and Choppy); the arrival of Tai Yang presents as Da Er Chang (Large and Long). This discusses the circulation of Guest Qi responding to pulse manifestations, differing again from the previous meanings. Therefore, the sage classics discuss Yin and Yang with thousands of transformations, each having its primary principle, which must not be confused. Hence the scripture says: Those who understand the essence need only one word to conclude; those who do not understand the essence scatter infinitely. This is why Li Shicai’s previous annotations of pulse manifestations based on subjective views led to confusion regarding Zang-Fu locations and Yin-Yang.

In Spring, a pulse with slight Xian (Wiry) qualities and Stomach Qi is Ping (Normal); if Xian qualities are excessive and Stomach Qi is deficient, it indicates Liver Disease; if there is only Xian without Stomach Qi, it indicates Death; if Stomach Qi is present with Mao (Feather-like/Floating) qualities, illness will occur in Autumn; if Mao qualities are severe, illness occurs immediately. The Zhen Zhen (True Essence) Qi scatters into the Liver, which stores the Qi of the sinews/fascia.

The Five Zang organs possess the nature of the Five Elements, so their pulse forms differ and harmonize with the Qi transformation of the Five Seasons. However, the basis is always the mild and moderate image of Stomach Qi. Thus, in the five seasons, if the pulse merely slightly manifests the shape of its corresponding Zang organ, it is auspicious. For instance, Liver Wood prospers in Spring, and both wrists show a Xian pulse. Xian is characterized by being slender, long, and smooth-flowing. It must be primarily governed by mild Stomach Qi, with a slight Xian image, to be considered Ping (Normal/Healthy). If Xian is excessive and Stomach Qi is deficient, Liver Qi rebels horizontally causing disease. If there is only Xian without Stomach Qi, the True Zang Pulse appears, leading to death. If the pulse is Xian-Huan (Wiry and Moderate) combined with Mao (Feather-like) qualities—where Mao is floating, short, and choppy, the native pulse of the Lung governing Autumn—excessive Xian indicates Liver Qi excess, while the presence of Mao indicates Liver Qi deficiency. When Autumn Metal Qi prospers, Liver Wood suffers further depletion, causing disease. If Mao is severe, seeing an Autumn pulse in Spring indicates the exhaustion of Sheng Qi (Generating Qi), resulting in immediate illness. The innate True Yuan Qi distributes into the Liver. The Liver corresponds to Zhen (Thunder), where post-natal Yang begins to generate fascia. Thus, the Qi of fascia is stored in the Liver, and the Liver governs the sinews.

In Summer, a pulse with slight Gou (Hooked) qualities and Stomach Qi is Ping; if Gou is excessive and Stomach Qi is deficient, it indicates Heart Disease; if there is only Gou without Stomach Qi, it indicates Death; if Stomach Qi is present with Shi (Stone-like/Deep) qualities, illness will occur in Winter; if Shi qualities are severe, illness occurs immediately. The Zhen Zhen Qi connects to the Heart, which stores the Qi of the blood vessels.

Heart Fire prospers in Summer, and both wrists show a Gou pulse. Gou is curved downward like a hook, round and active at the top, and floating. It must be primarily governed by mild Stomach Qi, with a slight Gou image, to be considered Ping. If Gou is excessive and Stomach Qi is deficient, Heart Fire rebels hyperactively causing disease. If there is only Gou without Stomach Qi, the pulse becomes hard and unyielding, the True Zang Pulse appears, leading to death. If the pulse is Gou-Huan combined with Shi qualities—where Shi is deep, solid, soft, and slippery, the native pulse of the Kidney governing Winter—this indicates insufficient Heart Fire. When Winter Water Qi prospers, Heart Qi becomes more depleted, causing disease. If Shi is severe, Yin is excessive and Yang is deficient, resulting in immediate illness. True Yuan Qi connects to the Heart to generate blood vessels, which are stored in the Heart; thus, the Heart governs the blood vessels.

In Late Summer, a pulse with slight Ruo Ruo (Weak and Soft) qualities and Stomach Qi is Ping; if Ruo Ruo is excessive and Stomach Qi is deficient, it indicates Spleen Disease; if there is only Dai (Intermittent) without Stomach Qi, it indicates Death; if Ruo Ruo is present with Shi qualities, illness will occur in Winter; if Shi qualities are severe, illness occurs immediately. The Zhen Zhen Qi moistens the Spleen, which stores the Qi of the muscles.

Spleen Earth prospers in the Four Seasons and governs the Wei Month of Late Summer, as Earth is central and Wei is the middle of the year. The Spleen directs drumming and transport, acting on behalf of the Qi of all Zang organs throughout the body; thus, its native pulse is named Dai (Intermittent). Ruo Ruo is the soft image of Yin Earth. The Stomach is Yang Earth, with rigid Qi. Rigidity and softness complement each other to achieve neutral harmony; thus, a slight Ruo Ruo image is Ping. If Ruo Ruo is excessive, Yang Qi is deficient, the Spleen lacks drumming power, and disease occurs. If there is only Dai without Stomach Qi, the True Zang Pulse appears, leading to death. Ruo Ruo with Shi indicates Winter illness; severe Shi indicates immediate illness, identical to Heart disease. This is because Fire and Earth share a source, and Heart Fire remains prosperous in Late Summer. True Yuan Qi steams fluids to moisten the Spleen to nourish muscles; thus, the Qi of muscles is stored in the Spleen, and the Spleen governs the muscles.

In Autumn, a pulse with slight Mao (Feather-like) qualities and Stomach Qi is Ping; if Mao is excessive and Stomach Qi is deficient, it indicates Lung Disease; if there is only Mao without Stomach Qi, it indicates Death; if Mao is present with Xian qualities, illness will occur in Spring; if Xian qualities are severe, illness occurs immediately. The Zhen Zhen Qi rises above the Lung to circulate Ying and Wei Qi.

Lung Metal prospers in Autumn, and both wrists show a Mao pulse. Mao is floating, short, and choppy, representing the initial descent of Yang Qi transforming into Yin. It must be primarily governed by mild Stomach Qi, with a slight Mao image, to be considered Ping. If Mao is excessive and Stomach Qi is deficient, Lung Qi fails to regulate, causing disease. If there is only Mao without Stomach Qi, the True Zang Pulse appears, leading to death. If Mao is present with Xian qualities, the contracting and肃 (solemn) seasonal command manifests a generating pulse; Yang fails to consolidate. In Spring, emission becomes more severe, causing disease. If Xian is severe, it reverses the Qi transformation seasonal order, causing immediate illness. The Lung is the Canopy, located highest. True Yuan Qi ascends to the Lung, weighing and measuring the Qi of the whole body to circulate Ying, Wei, Yin, Yang, Exterior, and Interior.

In Winter, a pulse with slight Shi (Stone-like) qualities and Stomach Qi is Ping; if Shi is excessive and Stomach Qi is deficient, it indicates Kidney Disease; if there is only Shi without Stomach Qi, it indicates Death; if Shi is present with Gou qualities, illness will occur in Summer; if Gou qualities are severe, illness occurs immediately. The Zhen Zhen Qi descends to the Kidney, which stores the Qi of the marrow and bones.

Kidney Water prospers in Winter, and both wrists show a Shi pulse. Shi is deep, solid, soft, and slippery, representing the storage of Yang Qi. It must be primarily governed by mild Stomach Qi, with a slight Shi image, to be considered Ping. If Shi is excessive and Stomach Qi is deficient, Kidney Yang declines, Yin-Cold is excessive, and disease occurs. If there is only Shi without Stomach Qi, the True Zang Pulse appears, leading to death. If Shi is present with Gou qualities, the storage command manifests a rising and floating pulse; Yang reveals itself prematurely. By Summer, water dries up, inevitably causing Heat disease. If Gou is severe, it reverses the storage command, causing immediate illness. True Yuan Qi roots downward in the Kidney. Marrow is formed from Essence and stored in the Kidney; thus, the Kidney governs the bones.