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The *Tribune and Nine Observations Chapter* (Sanbu Jiuhou Lun) states: The human body is divided into the Lower, Middle, and Upper regions. Each region has three observations (Heaven, Earth, Human). These three observations refer to Heaven, Earth, and Human.

The "Heaven" of the Upper region refers to the arterial pulse on both sides of the forehead; (located on both sides of the forehead, palpable to the touch, where the Qi of the Foot-Shaoyang Gallbladder Meridian flows.)
The "Earth" of the Upper region refers to the arterial pulse on both cheeks; (located on both sides below the nostrils, near the Yingxiang point, palpable to the touch, where the Qi of the Foot-Yangming Stomach Meridian flows.)
The "Human" of the Upper region refers to the arterial pulse in front of the ears. (Located in the depression in front of the ear, palpable to the touch, where the Qi of the Hand-Shaoyang Sanjiao Meridian flows.)

The "Heaven" of the Middle region refers to the Hand-Taiyin Lung Meridian; (i.e., the Lung pulse. Located at the Cun Kou point behind the wrist, named Jingqu, palpable to the touch.)
The "Earth" of the Middle region refers to the Hand-Yangming Large Intestine Meridian; (i.e., the Large Intestine pulse. Located between the metacarpal bones of the thumb and index finger, at the Hegu point, palpable to the touch.)
The "Human" of the Middle region refers to the Hand-Shaoyin Heart Meridian. (i.e., the Heart pulse. Located at the end of the styloid process of the ulna, at the Shenmen point, palpable to the touch.)

The "Heaven" of the Lower region refers to the Foot-Jueyin Liver Meridian; (i.e., the Liver pulse. Located 1.5 cun below the Wuli point outside the pubic hairline, in a depression; the patient should be supine for palpation, palpable to the touch. For women, the Taichong point is taken, located in a depression 2 cun distal to the metatarsophalangeal joint of the great toe.)
The "Earth" of the Lower region refers to the Foot-Shaoyin Kidney Meridian; (i.e., the Kidney pulse. Located in the depression posterior to the medial malleolus and superior to the calcaneus, at the Taixi point, palpable to the touch.)
The "Human" of the Lower region refers to the Foot-Taiyin Spleen Meridian. (i.e., the Spleen pulse. Located above the fleshy part of the foot, crossing the tendons, directly below the Wuli point, at the Jimen point; clothing should be loosened, and deep pressure applied to feel it, palpable to the touch. To observe Stomach Qi, one should take the Chongyang point on the dorsum of the foot.)

Thus, the "Heaven" of the Lower region observes the Liver (the Foot-Jueyin Liver Meridian runs through this area), the "Earth" observes the Kidney (the Foot-Shaoyin Kidney Meridian runs through this area), and the "Human" observes the Qi of the Spleen and Stomach (the Foot-Taiyin Spleen Meridian runs through this area).

How are the observations of the Middle region conducted? There is also Heaven, Earth, and Human.
"Heaven" observes the Lungs (the Hand-Taiyin Lung Meridian corresponds to this location);
"Earth" observes the Qi of the Chest (the Hand-Yangming Large Intestine Meridian corresponds to this location. The classic states: The Intestines and Stomach share observation, thus it is used to observe the Chest);
"Human" observes the Heart (the Hand-Shaoyin Heart Meridian corresponds to this location).

How is the Upper region observed? There is also Heaven, Earth, and Human.
"Heaven" observes the Qi of the Head Corners (located at the head corners, thus observing the Qi of the head corners);
"Earth" observes the Qi of the Mouth and Teeth (located near the mouth and teeth, thus observing them);
"Human" observes the Qi of the Ears and Eyes (positioned corresponding to the front of the ear, with the meridian reaching the outer canthus, thus observing them).

These three regions each have Heaven, Earth, and Human. Three constitute Heaven (detailed explanation from "Three become Heaven" to "Combined into Nine Viscera"), three constitute Earth, and three constitute Human. Three divided into three parts combine to form nine; these nine divisions correspond to the Nine Fields, and the Nine Fields correspond to the Nine Viscera. (This aligns with the supreme numbers of Heaven and Earth.)

Therefore, there are five Spirit Viscera and four Form Viscera, totaling nine viscera.
The Spirit Viscera refer to: the Liver storing Hun (Ethereal Soul), the Heart storing Shen (Spirit), the Spleen storing Yi (Intellect), the Lung storing Po (Corporeal Soul), and the Kidney storing Zhi (Will). Because these viscera house spiritual energy, they are called the Five Spirit Viscera.
The Form Viscera are like vessels that expand outward, hollow yet unyielding, capable of containing objects, hence called Form Viscera. Specifically: 1. Head Corners, 2. Ears and Eyes, 3. Mouth and Teeth, 4. Chest.

If the essence of the Five Viscera fails, the complexion will inevitably appear withered and lifeless (Yao). A withered complexion indicates death. (Yao refers to the color of death, an abnormal sign. Complexion is the banner of the Spirit, and viscera are the residence of the Spirit; thus, when the Spirit departs, the viscera fail. When viscera fail, abnormal colors appear, which is a sign of death.)

If the body is robust but the pulse is thin, and there is shortness of breath insufficient for respiration, the condition is critical. (When Form and Qi are harmonious, it is treatable. Now, Qi is insufficient while Form is excessive, and the syndrome does not support the healthy Qi, hence danger.)

If the body is emaciated but the pulse is large, and there is excess Qi in the chest, death ensues. (This indicates that Form and Qi are insufficient while Pulse Qi is excessive. Emaciation with a large pulse and excess chest Qi means the Form Viscera are injured, leading to death. All such cases represent a disharmony between Form and Qi.)

If Form and Qi are harmonious, life prevails; if they are irregular and discordant (Can Wu Bu Tiao), disease occurs. (Can refers to comparison/verification; Wu refers to grouping/classification. Irregularity in verification and grouping, deviating from normal patterns, constitutes disease.)

If the pulses of all three regions and nine observations are lost/disordered, death ensues. (Loss refers to dissimilar pulse qualities. There are seven types of disordered observations, as described below.)

If the pulses of the upper/lower and left/right correspond rhythmically like pounding grain (Can Chong), the disease is severe. If the pulses of upper/lower and left/right are disordered and uncountable, death ensues. (There are eighteen diagnostic points across the three regions, upper/lower, and left/right. Can Chong refers to a large, forceful pulse, like the up-and-down motion of a pestle. A large pulse indicates disease progression, hence severity. Uncountable refers to more than ten beats per respiration, indicating death.)

If the Middle region's pulse is independently harmonious but disconnected from the other viscera, death ensues. If the Middle region's pulse is diminished, death ensues. (The Middle region has six diagnostic points on the left and right. If the upper and lower regions are already unresponsive, and only the Middle region is harmonious, it cannot last long. If the Middle region is diminished compared to the upper and lower, it also indicates Qi decline, both leading to death. Diminished means relatively weak.)

If the eyes are sunken, death ensues. (The Bladder Taiyang Meridian originates at the inner canthus. Sunken eyes indicate the exhaustion of Taiyang Qi, hence death. Taiyang is mentioned specifically because it governs the Qi of all Yang meridians.)

If the flesh and muscles have completely wasted away, even if the nine observations are harmonious, death ensues. (This also indicates disharmony between Form and Qi. The classic states: Excess pulse Qi with deficient Form Qi leads to survival. Here, "deficient" has not reached total wasting; "wasting" means the large muscles are entirely gone. The Spleen governs muscles; muscle wasting indicates Spleen exhaustion. Even if the nine observations are balanced, death is inevitable.)

Observing the nine observations: if one is exclusively small, it is disease; exclusively large, disease; exclusively rapid (Ji), disease; exclusively slow (Chi), disease; exclusively hot, disease; exclusively cold, disease; exclusively depressed/sunken, disease. (These are the seven types of disordered observations mentioned earlier. However, the appearance of seven diagnostic signs refers to irregularity and discordance, identifying disease based on unique differences. This describes applying the Seven Diagnostic method within the Nine Observations.)

If the body is emaciated and immobile, death ensues. (External depletion of Grain Qi leads to complete muscle wasting; internal exhaustion of True Qi prevents movement. Both True Qi and Grain Qi are depleted, marking the extremity of death. "Qu" implies movement/walking.)

If the pulses of all nine observations are deep, thin, and suspended/extinct (Xuan Jue), this is Yin, governing Winter, so death occurs at midnight (Ye Ban). If the pulses are full, restless, with panting and rapid breathing, this is Yang, governing Summer, so death occurs at noon (Ri Zhong). (Pulse positions have no fixed abode; extremes reverse. The principle of Qian and Kun dictates that at Yin extreme, dragons fight in the wild; at Yang extreme, the arrogant dragon brings regret. Thus, extreme Yin and Yang pulses lead to death at midnight and noon, respectively.)

Patients with Cold-Heat diseases die at dawn (Ping Dan). (Also due to extremity transformation; at dawn, Wood Qi is prosperous, transforming into Wind, so Cold-Heat patients die during the time of prosperous Wood.)

Patients with Heat-in-the-Middle or Heat diseases die at noon. (This is the extreme of Yang.)

Patients with Wind diseases die at dusk (Ri Xi). (Time of Mao and You opposition.)

Patients with Water diseases die at midnight. (Time of prosperous Water.)

Patients whose pulses are intermittently sparse, rapid, slow, or quick die during the Four Seasons' transition times (Chen, Xu, Chou, Wei hours). (At Chen, Xu, Chou, Wei, Earth Qi is prosperous; if Spleen Qi internally fails, the pulse becomes irregular, leading to death during these Earth-dominant periods. This details the timing of death for various diseases.)