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I once read Jiegu's various discussions on exterior and interior pulse patterns. Every sentence was reasonable, every word meticulous, deeply grasping the essence of Wang Shuhe. However, these discussions were implicit and profound, difficult to understand clearly. Each time I wanted to interpret them, I found myself at a loss when picking up my pen.偶然ly, in the markets of Guangling, I obtained a handwritten copy. Upon reading it, I realized it was an explanation of Jiegu's discussions on exterior and interior pulses. Although the author's surname is lost and their identity unknown, their line-by-line commentary was worthy of appreciation. Yet, they lacked the discernment to identify textual errors caused by copying mistakes (such as "Lu Yu Hai Shi" errors). For instance, in the "Discussion on Examples of Interchange of Seven Exterior Pulses," it states: "Regarding the root and branch, Taiyin has the transformation numbers of root and branch." One must know that the character "Yin" in "Taiyin" here is a printing error for "Yang" in "Taiyang." The explainer, even if hesitant to alter the words of former sages for correction, should not have forced an interpretation that would mislead later scholars. Moreover, this does not align with the theory of root and branch in the *Neijing*, and instead incorrectly attributes Ministerial Fire to Taiyang and claims Taiyin has cold as its branch and heat as its root, which is extremely absurd. Nevertheless, the painstaking effort of the annotator cannot be erased. I shall preserve it for now, taking its strengths while overlooking its weaknesses. As for analyzing principles item by item and providing detailed annotations, I leave this hope to future scholars.

The so-called Seven Exterior Pulses refer to Floating (Fu), Knifelike (Kou), Slippery (Hua), Full/Excess (Shi), Wiry (Xian), Tight (Jin), and Surging (Hong). The so-called Eight Interior Pulses refer to Faint (Wei), Deep (Chen), Slow (Huan), Choppy (Se), Delayed (Chi), Hidden (Fu), Soft (Ru), and Weak (Ruo).

Odd numbers are numbers of Yang. The seven exterior pulses all belong to Yang. When pathogenic factors invade from the front towards the outside, it is called Excess Pathogen (Shi Xie), and treatment primarily uses dispersing methods to expel them. If the pulse initially appears externally and gradually transmits inward, starting with Floating, Tight, or Surging pulses, after dispersing, one might see Wiry, Slippery, or Full pulses. If the person is constitutionally weak or has internal injury, their Renying (ST9) pulse will likely be Knifelike. These all belong to Yang pulses.

Even numbers are numbers of Yin. The eight interior pulses all belong to Yin. When pathogenic factors enter from the back into the interior, or enter from the medial malleolus, it is called Deficient Pathogen (Xu Xie), requiring treatment with warming the middle and regulating the middle methods. Thus, within Deep pulses, one may see Delayed, Hidden, Slow, Choppy, Soft, or Weak pulses. If only Faint or Slow pulses are seen alone, this indicates deficiency in both exterior and interior.

Note: To examine the Seven Exterior Pulses, one first determines the exterior using the Floating pulse; the remaining six types appear within the floating assessment. To examine the Eight Interior Pulses, one first determines the interior using the Deep pulse; the remaining seven types appear within the deep assessment.

The Seven Exterior Pulses are Yang; the Eight Interior Pulses are Yin. Exterior pulses are more commonly seen on the left hand, where Guest pulses change according to Host pulses. (Guest pulses refer to inappropriate pulses.) Pathogens outside constitute an Exterior Syndrome, belonging to Yang and External Guest Pathogens. A Guest disease is changed by the Host channel; it is a pulse inappropriate for the original channel. Because healthy Qi recovers, pathogenic Qi retreats naturally, and the channel pulse returns to normal, hence it is said that "Guest follows Host change."

Interior pulses are more commonly seen on the right hand, where Host pulses change according to Guest pulses. (Host pulse refers to the normal pulse of the Zang organ.) Pathogens inside constitute an Interior Syndrome, belonging to Yin and Primary Disease. The primary disease is altered by Guest pathogens; it is a pulse appropriate for the original channel. Because pathogens transmit to the interior, Healthy Qi is constrained by pathogens, and the original channel exhibits inappropriate pulse changes, hence it is said that "Host follows Guest change."

Note: The Host channel possesses its own Host pulse. It cannot be invaded by Host or Guest pathogens. If the Healthy Qi of the original channel is not affected by pathogens, the Guest disease will recede. This means the Host can change the Guest.

The three positions on the left hand mainly govern Warmth, Wind, and Cold diseases. Warmth, Wind, and Cold diseases arise from external contraction.

Warmth, Wind, and Cold are the seasonal qi of heaven and earth. Sometimes Warmth qi flows, sometimes Wind evil spreads, sometimes severe qi condenses into cold. These are all external pathogens entering from the surface. Are they not diseases acquired externally?

Note: Warmth, Wind, and Cold belong to the severe qi of heaven and earth, contracted from outside, circulating according to the Five Movements of Heaven. Are they not acquired externally?

The three positions on the right hand mainly govern Dryness, Dampness, and Summerheat diseases. Dryness, Dampness, and Summerheat diseases originate internally.

Dryness, Dampness, and Summerheat: Yangming Dry Metal generates Fire, Taiyin Damp Earth generates Dampness. Summerheat is Heat Pathogen. After heaven and earth interact, excessive Yang hides, and Yin Earth dampness steams, forming Summerheat. Yangming, steamed by Damp Earth, also becomes Summerheat-Heat. Are they not diseases located internally?

This is the general principle of pulse methodology and their mutual variations. Or exterior pulses appear on the right, or interior pulses appear on the left; or Yin and Yang mutually overcome each other, or mutually subdue each other; or one pulse undergoes ten transformations. (One represents Yang, Ten represents Yin.) Pulse principles are subtle and profound, not exhaustible by a single statement. However, the key lies nowhere else but Yin and Yang and the Five Elements.

This is the general principle of pulse methodology, continuing from the previous text, showing that the exterior and interior three positions govern Warmth, Wind, Cold, Dryness, Dampness, and Summerheat, interacting with each other. Or Seven Exterior syndromes show Eight Interior pulses, Eight Interior syndromes show Seven Exterior pulses; this is their mutual variation, naturally Host following Guest change, Guest following Host change. Or pathogens are abundant, and Healthy Qi is overcome by pathogens; Healthy Qi prevails, and pathogens are subdued by Healthy Qi. Or Yin syndromes transform into Yang, or Yang syndromes transform into Yin, changing mutually due to Yin and Yang mutually subduing each other. As stated: "Heaven generates Water with One, Earth generates Fire with Two; Heaven Three is Shaoyang, Earth Four is Shaoyin, Heaven Five is Yangming, Earth Six is Jueyin, Heaven Seven is Taiyang, Earth Eight is Taiyin. Heaven Nine reaches extreme Yang and generates Yin, with Three Yins hiding inside; Earth Ten reaches extreme Yin and generates Yang, with One Yang moving initially." Hence it is said "one pulse undergoes ten transformations." The principles of heaven and earth Yin and Yang are the qi of two forces, generating life endlessly, changing infinitely. Thus Yin and Yang mutually overcome and subdue, interweaving and transforming. Variation forms the system of heaven and earth Yin-Yang overcoming and subduing; transformation embodies the harmony of Yin-Yang and Five Elements. The Classic says: "Pulse principles are subtle and profound, not exhaustible by a single statement," which is exactly what this means.

Note: Mutual variation refers to the different transmissions between exterior and interior pulses. Or the left hand obtains the right hand's pulse, or the right hand obtains the left hand's pulse. In short, Yang and Yin qi interact. In Yin syndromes, Yang pulses appear; in Yang syndromes, Yin pulses appear. Due to Yin and Yang mutually overcoming and subduing to generate changes, it is said "one pulse becomes ten transformations." This is not a theory that one category of pulse transforms into ten categories, but a generalization. When treating clinically, classify and deduce; one pulse does not necessarily correspond to only one pulse type, allowing the completion of syndrome analysis.

There are seven exterior pulses and eight interior pulses, totaling fifteen pulses. Divided by the Five Elements, each element gets three pulses; 3 times 5 equals 15. The Five Zang organs belong to the Five Elements: Metal, Wood, Water, Fire, Earth. Each Zang has three pulse positions: Floating, Middle, and Deep. Floating examines the exterior, Deep examines the interior, and Middle serves as the gateway between interior and exterior, examining the principles of exterior-interior, Yin-Yang, and deficiency-excess. Each Zang obtains three pulses; the Five Zangs together make fifteen pulses. See below for details.

Floating, Choppy, and Weak belong to Metal; Wiry, Tight, and Hidden belong to Wood; Slippery, Deep, and Soft belong to Water; Knifelike, Full, and Surging belong to Fire; Faint, Slow, and Delayed belong to Earth. Each position has distinctions of light and heavy pressure. The Five Elements should be balanced; if there is any imbalance, Guest pathogens will appear.

This discusses the Host pulses of each Zang. Each Zang pulse shape has three aspects to distinguish deficiency and excess. Lung pulse naturally floats; Full is Choppy, Deficient is Weak. Liver pulse naturally wiry; Full is Tight, Deficient is Hidden. Kidney pulse naturally deep; Full is Slippery, Deficient is Soft. Heart pulse naturally surging; Full is Full, Deficient is Knifelike. Spleen pulse naturally slow; Full is Faint, Deficient is Delayed. (It should be said Full is Delayed, Deficient is Faint.) Thus, distinguishing light and heavy pressure is distinguishing deficiency and excess. If the Five Elements each possess their natural balanced pulse, there is no disease. Once light/heavy differences appear, disease arises.

Note: The commentary states that the fifteen exterior-interior pulses, when divided by the Five Elements, explain Metal, Wood, Water, Fire, and Earth. The annotation distinguishes Zang deficiency and excess through light and heavy pressures. The normal pulse of the specific Zang is the Host. But if an inappropriate pulse appears, it indicates disease. Each position must be distinguished; careful examination is required during clinical diagnosis.

Some say internal injury is fine, but ask if external contraction lacks proper treatment? Little do they know that within heaven and earth, the Six Qi are based on the Five Movements. The human body is a small heaven and earth. External pathogens contracted manifest from within. Suppose external contraction of Wind-Damp (also Warmth), then Wood and Fire are excessive, while Earth and Metal are insufficient, and Water cannot control Fire. External contraction is caused by external pathogens, leading to imbalance in the Five Elements.

Internal injury merely involves damage to the five viscera; the five Zangs recognize their gain and loss. A skilled practitioner finds it easy to treat. However, if internal injury is accompanied by external contraction, it is difficult to manage. How can one know to examine internally which Five Elements are deficient, and externally observe the Wind, Warmth, and Cold pathogens contracted? By detailing the syndrome location in specific meridians and Zang-Fu organs, nothing remains unseen. The Classic states that external contraction of Wind-Warmth pathogens leads to excess Wood and Fire. With Liver pathogen prevailing, Spleen and Lung meridians are controlled. Metal within Earth is overcome by Wood. Without Earth's source to generate Water, Wood qi attacks upward, and Ministerial Fire flourishes accordingly. The water source in the Kidneys cannot ascend.

Generally, four Zangs mutually overcome each other, damaging two of the Five Elements. How can peace and balance be achieved?

Note: The commentary says, "Or speak of internal injury," meaning that discussing Five Element differentiation makes internal injury diseases easier to deduce. If external contraction occurs, one fears Guest pulse manifestations appearing as either Seven Exterior or Eight Interior pulses, making deduction difficult. Regarding the deficiency/excess of the normal Host pulse, asking if there is no proper treatment? This view suggests that for external contraction syndromes, as hypothetically stated in the text, by basing deductions on the five Zang Host pulses and classifying them, one understands the principles of Metal, Water, Wood, Fire, and Earth. Then clarify the pathogens of Excess, Deficiency, Overcoming, Minor, and Normal types. Furthermore, examine Wiry, Surging, Choppy, Slow, and Deep as Host pulses. If the Zang does not exhibit Wiry, Surging, Choppy, Slow, or Deep, but shows inappropriate pulses for that position, these are Guest pathogen marker diseases, not the primary Host pulse disease. Deducing thus, how could confusion arise?

Internal injury is self-damage to the five viscera, causing the Five Elements to lose balance.

The five inner organs are Heart, Liver, Spleen, Lung, and Kidney. Internal injury refers to Zang deficiency, caused by emotional disturbances (Seven Emotions) or desires (Six Desires). The Five Elements Metal, Wood, Water, Fire, Earth mutually overcome and harm each other, unable to maintain peace and balance.

First clarify the principles of Metal, Water, Wood, Fire, and Earth; then inspect pathogens of Excess, Deficiency, Overcoming, Minor, and Normal; further differentiate the positions of Floating, Middle, and Deep; and carefully examine the combination of Host and Guest pulses. What is Host? Wiry (Liver), Surging (Heart), Choppy (Lung), Slow (Spleen), Deep (Kidney). What is Guest? Any inappropriate pulse in that position is a Guest pulse. By doing so, for internal and external injuries, Host/Guest and Root/Branch diseases, correct judgments are made, errors avoided.

Heaven and Earth Five Elements generate each other: Metal generates Water, Water generates Wood, Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal generates Water endlessly. Thus heaven and earth find their places, and all things are nurtured. If anything deviates, Yin and Yang become disordered, and the Five Elements inevitably result in imbalance of deficiency and excess. Or one is affected by the three pathogens of Overcoming, Minor, and Normal. For example, Metal overcomes Wood, Wood overcomes Earth, Earth overcomes Water, Water overcomes Fire, Fire overcomes Metal; these are all Overcoming Pathogens (Ze Xie). As for Minor and Normal pathogens, such as husband overcoming wife, child supporting mother, mother suppressing child, etc., these can be examined and deduced. One must use the method of examining Floating, Middle, and Deep, knowing the appropriate pulse for that position is the Host pulse. If inappropriate pulses appear, they are Guest pulses. One must examine and clarify this. Then, knowing which Zang is injured internally, which is deficient, which is excessive, and how two Zangs interact, overcome, suppress, or support each other, one understands the degree of severity. External contraction involves Overcoming Pathogens; Excess, Minor, and Normal pathogens may be at the Branch or Root. Thus right and wrong are immediately visible, clear under the fingers, leaving no room for error.