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The principle of pulse diagnosis is the most difficult skill for physicians to master. Unless one studies diligently under the lamp, memorizes frequently, consults teachers, and discusses with friends, day and night without rest, and keeps this in mind even during hasty or turbulent times, as well as in sleep and waking, how can one understand the subtleties of sage-like medical arts? The ancients said: "Palpating the pulse to know the disease is called 'Shen' (Divine), to comprehend the mystery of exploring profound truths." It is also said: "Cutting the pulse to treat the disease is called 'Qiao' (Skillful), to clarify the merit of finger discrimination." The distance between three fingers is merely a hair's breadth, yet the diseases they indicate are as far apart as a thousand miles. Observing the merit of finger discrimination, people naturally consider it difficult; calling it 'Shen', how could it be easily attained!

Frequently consulting classics, the pulse has three positions: Cun (Inch), Guan (Bar), and Chi (Cubit). From the Yuji point (LU10) to the high bone (radial styloid process), moving backward one cun is called 'Cun'; one fen forward from Cun is 'Yuji'; from Cun to Chize (LU5) is 'Chi'; behind Cun and before Chi is 'Guan'. Front of Guan is Yang, which is the Cun position; behind Guan is Yin, which is the Chi pulse. Yang emerges outward, Yin enters inward, with Guan as the boundary. Cun governs the Upper Jiao (Upper Burner), corresponding to the head, hands, skin, and hair; Guan governs the Middle Jiao (Middle Burner), corresponding to the abdomen and waist; Chi governs the Lower Jiao (Lower Burner), corresponding to the lower abdomen and feet. This is the general scope governed by the three positions. There are also left and right hands, each with three positions, making six pulses. Additionally, there are Yingc (Renying), Kou (Qikou), and Shenmen, each governing differently. Generally, the front of Guan on the left hand is Yingc, the front of Guan on the right hand is Qikou, and one fen behind both Guans is Shenmen. Thus, the *Mai Fa* praises: "Liver and Heart govern the left, Lung and Spleen govern the right, Kidney and Mingmen (Gate of Life) appear in the Chi position; Hun (Ethereal Soul), Po (Corporeal Soul), and Gu Shen (Grain Spirit) all manifest at Cun." Specifically, the front of Guan on the left hand is the Heart's domain; its meridian is Hand Shaoyin Heart Meridian and Hand Taiyang Small Intestine Meridian, which are exterior-interior pairs, with Small Intestine forming the Fu organ; the Guan position on the left hand is the Liver's domain; its meridian is Foot Jueyin Liver Meridian and Foot Shaoyang Gallbladder Meridian, exterior-interior pairs, with Gallbladder forming the Fu organ; the rear of Guan on the left hand is the Kidney's domain; its meridian is Foot Shaoyin Kidney Meridian and Foot Taiyang Bladder Meridian, exterior-interior pairs, with Bladder forming the Fu organ; the front of Guan on the right hand is the Lung's domain; its meridian is Hand Taiyin Lung Meridian and Hand Yangming Large Intestine Meridian, exterior-interior pairs, with Large Intestine forming the Fu organ; the Guan position on the right hand is the Spleen's domain; its meridian is Foot Taiyin Spleen Meridian and Foot Yangming Stomach Meridian, exterior-interior pairs, with Stomach forming the Fu organ; the rear of Guan on the right hand is the Mingmen domain; its meridian is Hand Jueyin Pericardium Meridian and Hand Shaoyang Sanjiao Meridian, exterior-interior pairs, with Sanjiao forming the Fu organ. This refers to the Zang-Fu organs governed by the six positions and the meaning of the Twelve Meridians.

Furthermore, the *Su Wen: Mai Yao Jing Wei Lun* states: "The inner sides of Chi correspond to the hypochondrium; the outer side of Chi observes the Kidneys, the inner side observes the abdomen; the middle part extending upward, the outer side of the left observes the Liver, the inner side observes the Diaphragm; the outer side of the right observes the Stomach, the inner side observes the Spleen; extending further up, the outer side of the right observes the Lungs, the inner side observes the Chest; the outer side of the left observes the Heart, the inner side observes the Danzhong (Chest Center). The anterior part observes the anterior body, the posterior part observes the posterior body. The end of Chi extending upward corresponds to matters of the chest and throat; extending downward corresponds to matters of the lower abdomen, waist, thighs, knees, calves, and feet. A coarse pulse indicates Yin deficiency and Yang excess, constituting Heat Zhong (Heat in the Middle). A pulse coming swiftly and departing slowly indicates Upper Excess and Lower Deficiency, constituting Jue Ni (Reversal Cold) or Dian Ji (Epilepsy); a pulse coming slowly and departing swiftly indicates Upper Deficiency and Lower Excess, constituting Aversion to Wind. Therefore, Zhong Feng (Wind Stroke) is caused by Yang Qi receiving pathogenic factors. If pulses are all deep, fine, and rapid, it is Shao Yin Jue Ni (Shaoyin Reversal); if deep, fine, rapid, and scattered, it is Cold-Heat; if floating and scattered, it is Pu Dao (Collapse). All floating and rapid pulses belong to Yang and indicate Heat; if accompanied by agitation, the disease is in the Hand meridians. All fine and deep pulses belong to Yin, causing Bone Pain; if accompanied by stillness, the disease is in the Foot meridians. A pulse that is rapid, moving, and intermittent indicates disease in the Yang pulse, manifesting as diarrhea and pus-blood in stool. All abnormal pulses must be palpated; a Se pulse indicates Yang Qi excess, a Hua (Slippery) pulse indicates Yin Qi excess; Yang Qi excess manifests as body heat and no sweat, Yin Qi excess as profuse sweating and cold body, both Yang and Yin excess as no sweat and cold body. Pushing the pulse outward, if internal but not external, there is accumulation in the heart and abdomen; pushing inward, if external but not internal, there is body heat; pushing upward, if ascending but not descending, there is pain in the waist and feet; pushing downward, if descending but not ascending, there is pain in the head and neck; pressing to the bone, if pulse Qi is weak, there is pain in the waist and spine and Bi Syndrome (Obstruction) in the body. For the above diseases, unless one clearly understands them, how can one achieve subtlety?

Furthermore, the *Su Wen: Ping Ren Qi Xiang Lun* states: "With one exhalation, the pulse moves twice; with one inhalation, the pulse also moves twice. Between breaths, the pulse moves five times, called Da Xi (Great Breath). Not large nor small, not long nor short, not slippery nor choppy, not floating nor sunken, not slow nor rapid, this is called a Ping Ren (Normal Person). A Ping Ren is one who is not diseased. Generally, the normal Qi of a Ping Ren is derived from the Stomach. Stomach Qi is the normal Qi of a Ping Ren. Since humans constantly derive Qi from the Stomach, the pulse takes Stomach Qi as its root. The *Zheng Li Lun* states: "When food enters the Stomach, the pulse channels then flow." The *Ling Shu* states: "The Stomach is the Sea of Water and Grain." It also says: "Pulses responding to the Four Seasons are called Ping Pulses. The pulses of the Four Seasons all take Stomach Qi as their root. Spring is Xian (Wiry), Summer is Hong (Surging), Autumn is Mao (Feather-like/Float), Winter is Shi (Stone-like/Deep). A Spring pulse slightly wiry is called Ping; others follow this pattern. Violating the Four Seasons leads to disease.

When diagnosing women's pulses, if pregnant, one must be cautious and not indiscriminately administer decoctions or powders. Diagnosing women's pulses, if the Shao Yin pulse beats vigorously, pregnancy exists. It is also said: "Yin pulse striking Yang indicates pregnancy." It is also said: "Sweating body without pulse indicates pregnancy." Generally, for pregnant women, inquire about menstruation, observe physique, but do not neglect primary treatment.

Furthermore, classics state: "Observe complexion and palpate pulse, first distinguish Yin and Yang." Yin and Yang are the Way of Heaven and Earth. Therefore, treating diseases requires seeking the root, which lies in Yin-Yang, Cold-Heat, Four Seasons, and the roots of the Five Zang Organs. In terms of pulse, this refers to Floating and Sunken. In terms of position, this refers to Cun and Chi. Thus, classics say: "Pulse is the method of Yin-Yang, responding to the Five Zang Organs. Exhalation relates to Heart and Lung, inhalation relates to Kidney and Liver. Between breaths, the Spleen receives grain essence, its flavor is in the center." Discussing Floating and Sunken: Floating is Yang, Sunken is Yin. Corresponding to Zang-Fu, a Floating, large, and scattered pulse corresponds to the Heart; a Floating, short, and choppy pulse corresponds to the Lung; thus, Heart and Lung pulses are both Floating. Firm and long corresponds to the Liver; pressing feels large, lifting feels solid corresponds to the Kidney; thus, Liver and Kidney pulses are both Sunken. Slow, delayed, and long corresponds to the Spleen. The Spleen is in the Central Province (Middle Jiao), so the pulse is in the middle. Zhang Zhongjing said: "Large, Floating, Rapid, Moving, Slippery are all Yang pulses; Deep, Choppy, Weak, Wiry, Micro are all Yin pulses. Yang represents Heat, Yin represents Cold. Therefore, Cold presents with Deep and Slow pulses, Heat presents with Floating and Rapid pulses. Thus, 'All Rapid pulses indicate Heat, all Slow pulses indicate Cold,' there is no more accurate verification than this.

The *Mai Jing* states: "All Floating pulses indicate Wind, all Tight pulses indicate Pain, all Hidden pulses indicate Accumulation, all Wiry pulses indicate Fluid Retention, Khong (Hollow) pulses indicate Blood Loss, Long pulses indicate Qi Regulation, Short pulses indicate Qi Disease, Choppy pulses indicate Vexing Heart, Large pulses indicate Disease Progression, Floating indicates Exterior, Sunken indicates Interior, Slow indicates Zang Disease, Rapid indicates Fu Disease. Furthermore, robust form with thin pulse, shortness of breath, is critical; emaciated form with large pulse, excessive Qi in chest, is fatal. Form and Qi matching leads to life, irregularity of three and five leads to death, loss of harmony in Three Positions and Nine Hopes leads to death. This is the great method of pulse diagnosis by ancient sages. Thus, it is said: 'In treating diseases, observe form, Qi, color, and luster to treat, do not wait for specific times.' Therefore, matching form and Qi leads to life, floating luster indicates easy recovery, pulses following Four Seasons are treatable, weak and seemingly slippery pulses indicate presence of Stomach Qi, all these are easy to treat. If form and Qi mismatch, or color is dull and lusterless, or pulses violate Four Seasons, or pulses become harder, all are untreatable. Classics say one must examine four difficulties and inform clearly. Also, heat disease with quiet pulse, diarrhea with large pulse, blood loss with solid pulse, post-sweating restless pulse, all are difficult to treat. For carbuncles and ulcers, with massive pus and blood discharge, slippery and rapid pulses are difficult to treat. If pus is abundant or like clear rice water, pulse is slippery, large, and scattered, with chills, fever, and thirst, treatment is futile. If suffering from Lung Abscess, coughing pus and blood, pulse appears Hong and Slippery, treatment is hard to cure. Generally, seeing Floating and Rapid pulses should indicate fever, but if aversion to cold occurs instead, although with stiff head and neck, vexing pain in limbs, or trembling and severe thirst, if there is a fixed painful area, it indicates impending carbuncle swelling."