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Ping Ren (Normal Person) refers to an individual without disease. The pulse has a constant rhythm; deviation from this norm indicates illness. The manifestation of Qi and pulse naturally differs between the sick and the healthy.

Huangdi asked: What characterizes a Ping Ren? Qibo replied: In a normal person, the pulse beats twice during one exhalation and twice during one inhalation. During the pause between breaths (Ding Xi), it beats once more, totaling five beats per respiratory cycle. Occasionally, a deep sigh (Tai Xi) occurs, which is still considered a Ping Ren.

A Ping Ren is one who is free from disease. Typically, the condition of a patient is assessed by comparing their pulse to that of a healthy individual. Since the physician is healthy, they use their own calm breathing rate as a standard to examine the patient. (The meridians circulate Qi throughout the body, with a total length of 16 zhang and 2 chi. With two beats per exhalation and two per inhalation, plus one beat at the pause, there are five beats. After 270 pauses, Qi completes one circuit. For fifty circuits, totaling 13,500 pauses, Qi travels 810 zhang. This aligns with the celestial constants, ensuring the pulse Qi is neither deficient nor excessive, resulting in a harmonious state, hence termed Ping Ren. Note: Human pulses correspond to heavenly measures; thus, calculations in thousands or tens of thousands, measured in chi or zhang, are theoretically sound. However, applying these numbers directly for treatment may be impractical; literal interpretation is more precise. "Two beats" means two pulsations. Two beats per exhalation and two per inhalation make four beats. The fifth beat occurs during the brief pause in respiration. "Run Tai Xi" (Leap Deep Sigh) implies that just as leap months account for accumulated time, a deep sigh accounts for residual Qi. "Tai Xi" is half a breath. When the pulse has beaten five times but feels lingering and vibrant under the fingers, it indicates "Shen" (Spirit) in the pulse. Such a state signifies health; otherwise, illness exists, allowing for treatment.)

If the pulse beats once per exhalation and once per inhalation, it is called Shao Qi (Deficient Qi). (This is half the frequency of a normal pulse. Note: The pulse is the essence of Qi and Blood. If Qi is weak and Blood is deficient, the pulse cannot fill adequately. Stating "Shao Qi" implies "Shao Xue" (Deficient Blood) as well.) If the pulse beats three times per exhalation and three times per inhalation, and is rapid and restless, with heat in the Chi (Cun Kou) area, it indicates Wen Bing (Warm Disease). If the Chi area is not hot but the pulse is Slippery (Hua), it indicates Feng Bing (Wind Disease). If the pulse is Choppy (Se), it indicates Bi Syndrome (Obstruction). (Three beats per breath exceed the normal rate by half. The Chi position corresponds to Yin, while the Cun position corresponds to Yang. Heat in both Yin and Yang indicates Warm Disease. Restlessness in Yang alone indicates Wind invading Yang. A Slippery pulse indicates Excess Yang, hence Wind Disease. A Choppy pulse indicates lack of Blood, hence Bi Syndrome. "Restless" refers to agitation. Note: Three beats per breath equals six pulsations, the extreme of rapidity. "Chi" here refers to the skin over the radial artery at the wrist, not the measurement term "Cun-Chi," making the latter interpretation erroneous. It means if the pulse is rapid (six beats) and the skin in the Chi area is scorched-hot, it is undoubtedly a Warm-Heat disease. If the Chi skin is not hot, but the pulse is rapid and slippery, Fire is intensified by Wind, originating from Wind. If the Chi skin is not hot and the pulse is neither slippery nor merely rapid, but rapid and choppy, Fire is Excessive and dries the Blood, causing Bi Syndrome with numbness. Slipperiness and Choppy nature are based on rapidity; Choppy nature is also based on non-heat in the Chi. The text distinguishes pulse from Chi skin; why did Wang Bing fail to observe this?) If the pulse beats four times or more per exhalation/inhalation, it is a sign of Death. If the pulse ceases entirely, it is a sign of Death. If the pulse is irregularly slow and fast, it is a sign of Death. (Four beats per breath double the normal rate. In 270 breaths, Qi would travel 32 zhang 4 chi, let alone exceeding this. Pulse laws state: "Four beats indicate Essence depletion; five beats indicate Death." Four beats or more approaches five, hence death. Complete cessation indicates loss of Tian Zhen (Innate) Qi. Irregularity indicates failure of Wei Gu (Stomach Grain) Essence. Both are signs of death.)

The normal Qi of a Ping Ren is derived from the Stomach; the Stomach is the source of normal Qi. (Normal, peaceful Qi is generated by the Stomach. The Ling Shu states: "The Stomach is the Sea of Water and Grain.") If a person lacks Stomach Qi, it is called Ni (Rebellion/Contrary), and such persons die. (Note: Humans cannot survive without food and drink.) In Spring, a pulse that is slightly Wiry (Xian) yet contains Stomach Qi (Huan/Slack) is Normal. (Note: Wiry is the Liver pulse; Liver belongs to Wood and prospers in Spring. Slightly wiry means wiry yet slack, the normal Liver pulse, called "Spring Stomach." This is because Stomach Qi manifests as slackness. The same applies subsequently.) If Wiry exceeds Slack, it indicates Liver Disease. If there is only Wiry without Slack, it indicates Death. (Note: Excessive wiriness is tense and unslack, indicating pathology. Pure wiriness without slackness lacks harmony, revealing the True Zang pulse, which is fatal.) If the Spring pulse shows Mao (Floating/Autumnal) qualities, disease will occur in Autumn. If Mao qualities are strong, disease occurs immediately. (Note: Mao is the Autumn pulse, associated with Metal. Seeing Mao in Spring means Wood is punished by Metal. Even with Stomach Qi, disease will arise when Metal prospers. If Metal pathogen is extreme, disease erupts immediately as Wood cannot overcome it.) The Zhen Zhen (True Visceral Qi) disperses into the Liver, which stores the Qi of the sinews and fascia. (Note: The definition of Zhen Zhen in commentaries is unclear. Since all Zang organs rely on Stomach Qi as their root, the Stomach is the True Qi of the Five Zang. In a healthy person, the Stomach is peaceful, and its Qi transforms according to the Zang. Entering the Liver, it facilitates dispersion, nourishing the sinews with peace, preventing tension. If the Zang pulses themselves were Zhen Zhen, pure Wiry or Hook pulses would be fatal, unable to store sinews or blood, and would be True Zang rather than Zhen Zang. Furthermore, the meanings of Disperse, Connect, Moisten, High, and Low would remain unexplained.)

In Summer, a pulse that is slightly Gou (Hook/Crimson/Surging) yet contains Stomach Qi is Normal. If Gou exceeds Slack, it indicates Heart Disease. If there is only Gou without Slack, it indicates Death. If the Summer pulse shows Shi (Stone/Kidney/Winter) qualities, disease will occur in Winter. If Shi qualities are strong, disease occurs immediately. (Note: Summer Fire fears Water; thus, disease arises when Water prospers. If Water pathogen is extreme, disease erupts immediately.) The Zhen Zhen connects to the Heart, which stores the Qi of the blood vessels. (Note: In the Heart, as the Master of the Five Zang, Qi connects everywhere. The Heart receives peaceful Qi, containing blood vessels without obstruction.)

In Late Summer, a pulse that is slightly Ruo (Weak) yet contains Stomach Qi is Normal. If Ruo exceeds Slack, it indicates Spleen Disease. If there is only Dai (Intermittent) without Stomach Qi, it indicates Death. (Note: The Spleen and Stomach value peace above all; too strong or too weak causes disease. Slightly weak implies weakness without excess. If too weak, transport and transformation fail, causing Spleen disease. Spring Wiry, Summer Surging, Autumn Floating, Winter Stone change sequentially, called Dai (Alternating). Earth rules the four seasons, so Wiry, Surging, Floating, and Stone pulses should carry Huan (Slack/Stomach) quality. If reversed, it is "Only Dai without Stomach Qi," a fatal pulse. Diseases often manifest in what one cannot overcome. Thus, Liver and Heart suffer from Mao/Shi (Metal/Water), while Spleen, Lung, and Kidney suffer from what they overcome. Why? Zang Qi is variable. When strong, it resists what overcomes it; when weak, it is bullied by what it overcomes. Spleen is Earth; Earth is overcome by Wood and overcomes Water. If Wood is weak but Water is strong, the pulse appears Shi (Winter/Water). Water fears Earth, but if Spleen Earth is weak, Water has no fear. In Winter, Water prospers further, harming Spleen. If Water is extreme, Earth cannot control it, and disease occurs before Winter, hence "Shi strong means immediate disease." Some ask: Liver and Heart are controlled by what overcomes them but not bullied by what they overcome; Spleen, Lung, Kidney are bullied by what they overcome but not controlled by what overcomes them? Answer: Being controlled by what overcomes is the Norm; being bullied by what one overcomes is the Variation. Heaven and Earth have both. Qibo illustrates both, using Liver/Heart for Norm and Spleen/Lung/Kidney for Variation. Readers should not be bound by literalism. Knowing Earth is bullied by Water allows inferring Metal/Water bullied by Wood/Fire.) If Shi qualities are strong, disease occurs immediately. (Note: Wang's edition reads "Ruo strong," which is incorrect. Jia Yi Jing reads "Shi strong," which is correct. Follow this.) The Zhen Zhen moistens the Spleen, which stores the Qi of muscles. (Note: Spleen is Wet Earth, transporting grain internally and nourishing muscles externally. Peaceful Qi roots in the Spleen. Without upper constraint or lower bullying, Spleen moistens itself, nourishing all Qi in the body.)

In Autumn, a pulse that is slightly Mao (Floating) yet contains Stomach Qi is Normal. If Mao exceeds Slack, it indicates Lung Disease. If there is only Mao without Slack, it indicates Death. If the Autumn pulse shows Xian (Wiry/Spring) qualities, disease will occur in Spring. If Xian qualities are strong, disease occurs immediately. The Zhen Zhen is High in the Lung, distributing Ying (Nutrient) and Wei (Defensive) Qi and Yin-Yang. (Lung is in the Upper Jiao, hence Zhen Zhen is high. From the Lung, it distributes Ying, Wei, and Yin-Yang.)

In Winter, a pulse that is slightly Shi (Stone/Kidney) yet contains Stomach Qi is Normal. If Shi exceeds Slack, it indicates Kidney Disease. If there is only Shi without Slack, it indicates Death. If the Winter pulse shows Gou (Hook/Summer) qualities, disease will occur in Summer. If Gou qualities are strong, disease occurs immediately. The Zhen Zhen descends to the Kidney, which stores the Qi of bones and marrow. (Kidney governs the Lower Jiao, hence Zhen Zhen descends. Note: Kidney is the root of the Five Zang, located below. If healthy, peaceful Qi connects both kidneys. Kidney governs bone; bone stores marrow. If the root is solid, Essence generates and form flourishes.)

The Great Luo vessel of the Stomach is named Xu Li. It penetrates the diaphragm, connects to the Lung, and emerges below the left breast. Its movement is visible through clothing; this is the Mai Zong Qi (Ancestral Qi of the Pulse). (...Zong means Respect or Master, referring to the master of the twelve meridians. Note: The Stomach's Great Luo is the Ancestor of the twelve meridians because the Stomach is the Sea of Water and Grain, sustaining life and nourishing Qi and Blood.)

To know if the Cun Kou pulse is Excessive or Deficient: If the Cun Kou pulse feels short upon palpation, it indicates Headache. (Short indicates insufficient Yang Qi, hence disease in the head.) If the Cun Kou pulse feels long upon palpation, it indicates Pain in the lower legs. (Long indicates Excessive Yin Qi, hence disease in the feet. Note: "Zhong Shou" means responding to pressure.)

If the Cun Kou pulse feels hurried and strikes upward, it indicates Shoulder and Back Pain. (Note: Hurried and striking upward indicates a Surging, Large, Rapid, and Frequent pulse, a sign of Yang Excess and Blazing Fire. The back is Yang; Excessive Yang Fire causes shoulder and back pain.)

If the Cun Kou pulse is Deep and Firm, it indicates Disease Inside. (Deep and Firm is Yin, hence internal disease.) If the Cun Kou pulse is Floating and Exuberant, it indicates Disease Outside. (Floating and Exuberant is Yang, hence external disease.)

If the Cun Kou pulse is Deep and Horizontal, it indicates Accumulation under the hypochondrium and horizontal accumulation pain in the abdomen. (Also indicates internal binding of Yin Qi. Note: Pulse channels are straight; horizontality indicates hidden accumulations.) Although only "horizontal" is mentioned, strength is implied. Zhang Zhongjing said: "Accumulation (Ji) is Zang disease, fixed and immovable; Gathering (Ju) is Fu disease, intermittent, shifting pain, treatable... General principles for Accumulations: Pulse fine and adhering to bone indicates Accumulation. At Cun Kou, accumulation is in the chest; slightly beyond Cun Kou, in the throat. At Guan, beside the navel; above Guan, below the heart; slightly below Guan, in the lower abdomen. At Chi, at Qi Chong. Pulse emerging on the left indicates accumulation on the left; on the right, on the right; on both, in the center. Judge according to the location."

If the Cun Kou pulse is Deep and Panting (Chuan), it indicates Alternating Cold and Fever. (Panting is Yang inhaling; Deep is Yin struggling. Struggle and inhalation clash, causing cold and fever. Note: Rapid breathing is called panting; why is the pulse called panting? It means the pulse comes rapidly, like panting air. Cold and fever may alternate. Deep indicates cold; Rapid indicates fever.)

If the pulse is Exuberant, Slippery, and Firm, it indicates Disease Outside. (Exuberant and Slippery is Yang.) If the pulse is Small, Solid, and Firm, it indicates Disease Inside. (Small and Solid is Yin; Yin disease is internal, Yang disease is external.)

If the pulse is Small, Weak, and Choppy, it indicates Chronic Disease. (Small indicates Qi deficiency; Choppy indicates Blood deficiency. Weak Qi and Blood imply long-standing disease.) If the pulse is Slippery, Floating, and Rapid, it indicates Acute Disease. (Slippery and Floating indicates sufficient Yang; Rapid indicates complete Qi. Sufficient Yang and complete Qi imply new, superficial disease.)

If the pulse is Tense (Ji), it indicates Shan Jia (Hernia/Mass) and pain in the lower abdomen. (Note: Shan is Cold coagulation; Jia is Qi accumulation. Cold coagulation causes lower abdominal pain. Why? Cold makes the pulse tense.)

If the pulse is Slippery, it indicates Wind Disease. If the pulse is Choppy, it indicates Bi Syndrome. (Slippery is Yang; Yang disease is Wind. Choppy is Yin; Yin disease is Bi.)

If the pulse is Slack and Slippery, it indicates Heat in the Middle. (Slack here means relaxed/lax, not slow. Yang Excess in the middle causes Slippery and Slack pulse.) If the pulse is Exuberant and Tight, it indicates Distension. (Cold Qi stagnation causes fullness, hence Exuberant and Tight pulse.)

If the pulse follows Yin-Yang (matches the disease), the illness is easy to cure. If the pulse opposes Yin-Yang, the illness is difficult to cure. If the pulse follows the four seasons' order, the illness has no complications. If the pulse opposes the four seasons or involves transmission between non-mother/child organs (Bu Jian Zang), it is difficult to cure. (Note: Following/Opposing refers to pulse-disease correspondence. Opposing seasons: Spring getting Autumn pulse, etc., is opposing seasons. Bu Jian Zang lacks explanation. If Wood disease does not affect Fire, stopping at Liver, it is easy. If Liver disease affects Heart (Mother and Child both diseased), it is hardest, called Bu Jian Zang. Zhang Jingyue says it is transmission to what one overcomes (Ghost Thief punishment), which should be fatal, not just difficult. Jian is pronounced with departing tone.)

Many blue veins on the arm indicate Blood Loss. (Note: Liver is Wood, color Green, governs sinews, stores Blood. Arm is like tree branches. Empty Liver Blood shows externally as Blue Veins.)

If the Chi pulse is Slack and Choppy, it is called Xie Ji (Lethargy/Weakness). (Chi indicates Yin region, governed by Abdomen/Kidney. Slack indicates Heat in Middle; Choppy indicates Blood deficiency. Heat without Blood causes Xie Ji. However, not cold, not hot, not weak, not strong, it is indescribable, called Xie Ji. Note: Xie Ji appears only in Su Wen. Wang Bing's commentary is suspicious, yet unchallenged by later sages. Saying Chi is Yin/Kidney and Choppy is Blood deficiency is correct. But saying Slack is Heat in Middle is wrong. Slack has two meanings: 1. Harmonious (Stomach Qi); 2. Slack/Weak (Qi deficiency, pulse unable to fill). Thus, Choppy is Blood deficiency, Slack is Qi deficiency. Chi is the root. Slack and Choppy Chi indicates Qi and Blood deficiency, root damaged. Xie should be Xie (Relaxed/Lethargic), meaning lethargic and weak. Ji (亦) combined with Xie implies Qi and Blood deficiency, leaving only the form, merely a human shell. Wang Bing's view of Xie Ji as an indescribable strange disease due to Kidney pulse is unlikely.)

If one lies down peacefully but the pulse is Exuberant, it indicates Blood Loss. (Exuberant means rapid, urgent, and large/throbbing. Note: Exuberant pulse usually means Excess Pathogen, causing restlessness. Peaceful lying contradicts this, suggesting it is not Yang Excess. Day is for activity; Night is for rest. Peaceful lying implies quiet Qi. Pulse is the house of Blood; rapid pulse indicates moving Blood. Thus, peaceful lying with exuberant pulse indicates Blood Loss. After Blood Loss, lying is usually uneasy due to Yin deficiency.)

If Chi skin is Choppy/Dry and Chi pulse is Slippery, it indicates Profuse Sweating. (Dry Chi skin indicates dried-up Ying Blood. Slippery Chi pulse indicates remaining Yang Qi inside. Dried Blood with remaining Yang Qi causes profuse sweating with this pulse.)

If Chi skin is Cold and pulse is Fine, it indicates Diarrhea (Hou Xie). (Chi governs Lower Jiao/intestines. Cold skin and fine pulse indicate diarrhea. Note: Stomach controls bowel/bladder. Kidney deficiency and Cold cause diarrhea (Kidney Diarrhea). Using Ginseng and Atractylodes to tonify Yang in such cases worsens diarrhea, which is lamentable.)

If the Chi pulse is Coarse/Rough and constantly Hot, it indicates Heat in the Middle. (Note: Coarse Chi pulse and dry-hot Chi skin indicate Yin deficiency and Yang Excess, causing internal heat.)

Liver pulse appearing on Geng/Xin days leads to Death. (Geng/Xin are Metal, chopping Liver Wood.) Heart pulse appearing on Ren/Gui days leads to Death. (Ren/Gui are Water, extinguishing Heart Fire.) Spleen pulse appearing on Jia/Yi days leads to Death. (Jia/Yi are Wood, overcoming Spleen Earth.) Lung pulse appearing on Bing/Ding days leads to Death. (Bing/Ding are Fire, melting Lung Metal.) Kidney pulse appearing on Wu/Ji days leads to Death. (Wu/Ji are Earth, punishing Kidney Water.) This is called True Zang appearance, all indicating Death. (Note: Death occurs due to what overcomes the organ. This is also called True Zang, not just "Only Dai without Stomach Qi".)

If the neck pulse throbs, accompanied by rapid panting and cough, it indicates Water Disease. (Note: Water entering the Lung causes panting and cough; rising Qi causes neck pulse throbbing.) If the inner eye lid swells slightly, resembling a silkworm, it indicates Water Disease. (Ping Re Bing Lun states: "Water is Yin; under-eye is Yin; abdomen is Supreme Yin. Water in abdomen causes under-eye swelling.") If urine is yellow-red and the person lies peacefully, it indicates Jaundice. (Kidney labor and bladder heat cause yellow-red urine. Zheng Li Lun calls it Lao Dan, obtained from female labor.) If one feels hungry after eating, it indicates Stomach Dan (Jaundice). (This is Stomach Heat. Heat consumes grain, causing hunger after eating.) If the eyes are yellow, it indicates Jaundice. (Yang trapped above, heat accumulating in chest, Yang Qi flaming upward causes yellow eyes.) Facial swelling indicates Wind Disease. (Note: Head is chief of all Yang; face is Yang within Yang. Yin pathogens cannot enter; only Yang pathogens invade, causing swelling. Wind is Yang pathogen.) Lower leg swelling indicates Water Disease. (Note: Dampness rises from below. Feet are lower Yin; Water is Yin pathogen. Water entering lower part causes leg swelling. Note: Wang's edition places "Yellow eyes indicate Jaundice" below, but moved it up due to context.)

If the Hand Shaoyin pulse moves vigorously in women, it indicates pregnancy. (...Note: Quan Yuanqi's edition says Foot/Hand Yin, but this says Hand Shaoyin. Both are valid. Hand Shaoyin is Heart; Foot Shaoyin is Kidney. Kidney governs Essence; Heart governs Blood. Essence and Blood combine for conception. Thus, vigorous Shaoyin pulse indicates pregnancy. "Move" means Slippery and Rapid.)

Humans rely on Water and Grain; thus, cutting off Water and Grain leads to death, and pulse lacking Stomach Qi also leads to death. Lack of Stomach Qi means obtaining only True Zang pulse, without Stomach Qi. Pulse lacking Stomach Qi means Liver is not Wiry, Kidney is not Stone. (Note: Stomach stores grain, leading the twelve meridians, showing its importance. Pulse without Stomach Qi reveals True Zang; it should say "Liver only Wiry, Kidney only Stone," but says "Not Wiry, Not Stone." Why only Liver/Kidney, not Heart/Lung/Spleen? Harmonious pulse is Stomach Qi. Wiry/Stone must be harmonious to be called Wiry/Stone. Pure Wiry/Stone without harmony is True Zang, not even Wiry/Stone. Hence "Not Wiry, Not Stone." Wiry/Stone implies Hook/Mao/Dai are present; this is ellipsis.)

Taiyang pulse arrives: Surging, Large, and Long. (Qi is Excess. Note: Lu Guang says "Taiyang rules May/June, Qi is great," hence this.) Shaoyang pulse arrives: Sometimes Rapid, sometimes Slow; sometimes Short, sometimes Long. (Qi is not fully smooth. Note: Lu Guang says "Shaoyang rules Jan/Feb, Qi is slight, hence pulse fluctuates.") Yangming pulse arrives: Floating, Large, and Short. (Grain Qi is full. Note: Lu Guang says "Yangming rules Mar/Apr, Qi is budding/not full," hence this. New Correction says: