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*From the "Ling Shu: Pathogenic Qi, Zang-Fu Organs, Disease Manifestations and Pulse Chapter"*

Huang Di asked Qi Bo, saying, "I have heard that observing the complexion to know the disease is called 'Ming' (Clear); palpating the pulse to know the disease is called 'Shen' (Divine); asking about the disease to know its location is called 'Gong' (Skilled). I wish to hear how one can achieve knowing through observation, obtaining through palpation, and exhausting knowledge through inquiry. How should this be done?" (Observing color refers to inspecting the five colors of the face: cyan, red, yellow, white, and black. Palpating the pulse refers to feeling the yin and yang at the Cun Kou [radial artery] site. Asking about the disease refers inquiring into the causes of the illness. Mastering these three methods leads to the states of Ming, Shen, and Gong, completing the diagnostic methods. The *Nan Jing*, Chapter 61, states: 'Knowing through inspection is called Shen; knowing through listening/smelling is called Sheng; knowing through questioning is called Gong; knowing through pulse-taking is called Qiao.' This constitutes the 'Shen, Sheng, Gong, Qiao,' which originates from here.)

Qi Bo replied, "The correspondence between facial color, pulse characteristics, and the skin of the Chi area [the forearm skin from elbow to wrist] is like the response of a drumstick to a drum or an image to its object; they must not diverge. This is also the manifestation of the relationship between roots and branches, or trunk and leaves; thus, if the root dies, the leaves wither. Facial color, pulse, and form/flesh must not contradict each other. Therefore, mastering one aspect makes one a 'Gong'; mastering two makes one 'Shen'; mastering all three makes one both 'Shen' and 'Ming'." (This passage emphasizes that facial color, pulse, and form/flesh should all be carefully examined. Color is observed via inspection; pulse is felt via palpation; form and flesh are verified via the Chi skin. Since the Chi skin is always visible during examination, the prosperity or decline of form and flesh can be generally understood by verifying this area. What exists internally must manifest externally. Thus, color corresponds to pulse, and pulse corresponds to form/flesh, just as a drumstick corresponds to the drum sound, or an image to its shape, like the signs of roots/branches and trunk/leaves, without deviation. These three aspects should be combined for analysis; therefore, mastering all three achieves both Shen and Ming. Fu [drumstick] is struck with a mallet, pronounced Fu or Fu.)

Huang Di said, "I wish to hear this completely."

Qi Bo replied, "When the complexion is cyan, the pulse is Xian [wiry]; when red, the pulse is Gou [hook-like]; when yellow, the pulse is Dai [moderate/rhythmic pause]; when white, the pulse is Mao [feather-like/light]; when black, the pulse is Shi [stone-like/deep]." (The Liver governs Wood, its color is cyan, and its pulse is Xian. The Heart governs Fire, its color is red, and its pulse is Gou. The Spleen governs Earth, its color is yellow, and its pulse is Dai. The Lungs govern Metal, its color is white, and its pulse is Mao. The Kidneys govern Water, its color is black, and its pulse is Shi. The meanings of the five pulses are seen in Chapter 11 previously.) If one sees the color but does not find the corresponding pulse, but instead finds a pulse that overcomes it [via the Five Elements overcoming cycle], death will occur; if one finds a pulse that generates it [via the Five Elements generating cycle], the disease will resolve. (Not finding the correct pulse means failing to find the normal pulse harmonious with the color. A 'Ke' [overcoming] pulse, such as seeing a Mao pulse with a cyan color, occurs because Metal overcomes Wood. A 'Sheng' [generating] pulse, such as seeing a Shi pulse with a cyan color, occurs because Water generates Wood.)

Huang Di asked Qi Bo, "What are the disease manifestations resulting from the generation and changes of the Zang organs?"

Qi Bo replied, "First determine the correspondence of the five colors and five pulses, then the diseases can be distinguished."

Huang Di said, "Once the color and pulse are determined, how do we distinguish them?"

Qi Bo said, "By regulating [examining] the pulse's Huan [slow/relaxed], Ji [rapid/tense], Xiao [small], Da [large], Hua [slippery], and Se [choppy] qualities, the nature of the pathological change is determined." (Huan and Ji refer to the rate of the pulse. Xiao, Da, Hua, and Se refer to the morphology of the pulse. Hua means not Se; it flows smoothly, like pearls rolling in a plate. Se means not Hua; it is deficient, thin, and slow, difficult to move, like rain soaking sand or a knife scraping bamboo. These six types are mutually contrasting. By examining these six, the pathological changes can be determined. My commentary notes: This section determines pathology through Huan, Ji, Xiao, Da, Hua, and Se, serving as a general outline of all pulses. However, the *Su Wen: Treatise on the Generation of the Five Viscera* mentions Xiao, Da, Hua, Se, Fu, and Chen. Later generations had different views. For example, the *Nan Jing* says: Fu, Chen, Chang, Duan, Hua, Se. Zhang Zhongjing says: Pulses include Xian, Jin, Fu, Chen, Hua, Se; these six are named 'Can Zei' [harmful agents] and can cause various pulse pathologies. Hua Borun says: Generally, the key outlines do not exceed the six pulses of Fu, Chen, Chi, Shu, Hua, and Se. The reason they do not exceed these six is that they suffice to encompass exterior-interior, yin-yang, deficiency-excess, cold-heat, wind-cold-dampness-dryness, and Zang-Fu/Blood-Qi diseases. Fu is Yang and Exterior, diagnosing Wind and Deficiency; Chen is Yin and Interior, diagnosing Dampness and Excess. Chi indicates Zang involvement, Cold, and Chill; Shu indicates Fu involvement, Heat, and Dryness. Hua indicates excess Blood; Se indicates stagnant Qi alone. Although these theories differ slightly in wording, their principles are interconnected. From my perspective, it essentially boils down to distinguishing the six categories of Exterior-Interior, Cold-Heat, and Deficiency-Excess. For instance, Fu indicates Exterior, so San, Da, and Kou pulses can be classified here; Chen indicates Interior, so Xi, Xiao, and Fu pulses can be classified here; Chi indicates Cold, so Xu, Huan, Se, and Jie pulses can be classified here; Shu indicates Heat, so Hong, Hua, Ji, and Cu pulses can be classified here; Xu indicates insufficiency, so Duan, Ru, Wei, and Ruo pulses can be classified here; Shi indicates excess, so Xian, Jin, Dong, and Ge pulses can be classified here. These are generally known facts; however, within these six, there are critical distinctions that many fail to recognize. For example, although Fu indicates Exterior, patients with Yin deficiency often have a Fu pulse that is forceless; thus, Fu cannot universally indicate Exterior, nor can dispersing methods be used indiscriminately? Although Chen indicates Interior, in severe initial external contractions where Yin-Cold binds the skin/hair and Yang Qi cannot reach the exterior, the pulse may first appear Chen-Jin; thus, Chen cannot universally indicate Interior, nor can purgative methods be used indiscriminately? Although Chi indicates Cold, after the retreat of Shang Han [cold damage], if residual heat remains, the pulse is often Chi-Hua; thus, Chi cannot universally indicate Cold, nor can warming methods be used indiscriminately? Although Shu indicates Heat, in cases of deficiency damage where both Yin and Yang are depleted and Blood-Qi are chaotic, the pulse becomes urgent and Shu; the more Shu, the more deficient, and the more deficient, the more Shu; thus, Shu cannot universally indicate Heat, nor can cooling methods be used indiscriminately? Micro and Thin pulses resemble Deficiency, but in cases of extreme pain and blockage, the pulse may be Fu-Ni [hidden]; thus, Fu cannot universally indicate Deficiency, nor can sudden tonification be used? Hong and Xian pulses resemble Excess, but in cases of severe True Yin depletion, Guan-Ge [obstruction/regurgitation] phenomena may double; thus, strong pulses cannot universally indicate Excess, nor can reducing methods be used indiscriminately? In such cases, within the outline, there exists a higher-level outline. If one does not combine the Four Diagnostic Methods and acts rashly, disaster will inevitably follow quickly. This is why the Dao of the pulse is difficult to explain and requires meticulous distinction of even the slightest differences.)

Huang Di said, "How do we examine [regulate] them?"

Qi Bo replied, "When the pulse is Ji [tense], the skin of the Chi area is also tense; when the pulse is Huan [relaxed], the skin of the Chi area is also relaxed; when the pulse is Xiao [small], the skin of the Chi area is diminished and lacks Qi; when the pulse is Da [large], the skin of the Chi area is bulging and raised; when the pulse is Hua [slippery], the skin of the Chi area is also slippery; when the pulse is Se [choppy], the skin of the Chi area is also rough. All these variations have degrees of mildness and severity." (Tiao means to examine. This precisely describes the correspondence between the pulse and the Chi skin, like a drumstick to a drum or an image to its object, with variations having degrees of mildness or severity. Generally, severe variation indicates deep disease, while mild variation indicates superficial disease. The *Ling Shu: Chapter on Diagnosing Diseases by Inspecting the Chi* states: 'Carefully examine the Huan, Ji, Xiao, Da, Hua, Se of the Chi skin, and the firmness or fragility of the flesh, to determine the disease manifestation.' The principle is identical to this. See the next chapter. Ben, pronounced Fen or Ben, means large or boiling up.)

Therefore, those skilled in examining the Chi skin need not wait for the Cun [radial] pulse; those skilled in examining the pulse need not wait for the facial color. Those who can integrate and practice all three can be considered Shang Gong [Master Physicians], achieving a nine-in-ten success rate; those practicing two are Zhong Gong [Intermediate Physicians], achieving a seven-in-ten success rate; those practicing only one are Xia Gong [Junior Physicians], achieving a six-in-ten success rate." (This reaffirms the principle of roots and branches. Regarding Cun and Chi, Chi is the root, and Cun is the branch. Regarding pulse and color, the pulse is the root, and color is the branch. Thus, those skilled in Chi need not look at Cun; those skilled in pulse need not look at color. However, one must integrate all three and practice them together to master both root and branch, ensuring no errors, thereby qualifying as a Shang Gong with a 90% cure rate. Those knowing only two or one are merely intermediate or junior talents, curing only 60-70%. Mentioning six or seven implies easier tasks come first; mentioning eight or nine implies the hardest tasks come last. What is easy has no difficulty? How can the difficult be spoken of lightly! Although these levels are divided into upper and lower, the gap in success, failure, virtue, and worthlessness between them is as vast as heaven and earth.)