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The pulse beats frequently but with a regular rhythm. However, the *Neijing* (Classic of Internal Medicine) elaborates on this in greater detail and completeness. It states that "intercalation relies on deep sighs" (Run Yi Tai Xi). Here, "intercalation" refers to the regulation between excess qi (Qi Ying) and deficient qi (Shuo Xu); "deep sigh" (Tai Xi) occurs within the interval of respiration. This is analogous to a leap month in a year; it does not mean adding an extra breath outside of one exhalation and inhalation.

A "deep sigh" means that at the moment of respiratory transition (Ding Xi), within the breathing cycle, the pulse beats one additional time, thus completing the count of five beats. This is similar to how during exhalation, the Qi of the Heart and Lungs moves outward, and during inhalation, the Qi of the Kidneys and Liver moves inward, while the Spleen receives Grain Qi in the Middle Jiao, operating precisely between exhalation and inhalation.

Three beats per respiration indicate a Slow Pulse (Chi Mai), signifying deficiency-cold, critical condition, and distress. Six beats indicate a Rapid Pulse (Shu Mai), seven beats indicate Extreme Rapidness, signifying excessive heat and numerous illnesses. Eight beats indicate Devastation (Tuo), nine beats indicate Death (Si), and ten beats indicate Tomb (Mu). Eleven and twelve beats indicate Soul Severance (Hun Chai), signaling a critical state.
[Three beats is Slow; one or two beats is Deficient/Broken] (One beat per respiration, pulse sinking to the bed, causes great harm.) Two respirations for one beat is a death pulse, which is not strange.
Slow and Broken pulses were discussed earlier; their re-appearance here serves to illustrate the general principles, as the following text discusses "Damage Pulses" (Sun Mai) regarding two respirations per beat. The *Nanjing* (Classic of Difficult Issues) asks: What is Damage?
One beat per exhalation is called "Leaving the Channel" (Li Jing); two beats per exhalation is called "Snatching Essence" (Duo Jing); three beats per exhalation is called "Death"; four beats per exhalation is called "Life Extinction". Damage pulses progress from lower to higher levels, evolving from one beat per exhalation to four beats per exhalation. However, if it reaches Li Jing or Duo Jing, death is inevitable; why wait for three or four beats per exhalation? Thus, the *Maijue* (Pulse Rhymes) states death at two respirations per beat. Zhang Zhongjing said: With four damages, death occurs in three days. A normal person has four beats per respiration, while a patient has one beat. With five damages, death occurs in one day. A normal person has five beats per respiration, while a patient has one beat. With six damages, death occurs in one shichen (two hours). A normal person has six beats per respiration, while a patient has one beat. Zhang Zhongjing added five and six damages to the four damages, setting death periods of one day or one shichen.

Slow pulses indicate cold, rapid pulses indicate heat; this understanding is consistent throughout ancient and modern times. The *Nanjing*, specifically the Yue Du chapter, records this clearly.
Accumulated heat generates wind; accumulated cold agitates Qi. [Pay careful attention under the fingers and remember.]
How can heat directly generate wind? It is the accumulation of heat that produces wind-like symptoms. How can cold directly generate Qi movement? It is the accumulation of cold that causes Qi agitation. However, both heat and cold can disturb Blood and cause disease; one must not be dogmatic.

Spring pulses are Wiry (Xian); Summer pulses are Surging/Hooked (Hong/Gou); Autumn pulses are Floating like hair (Mao); Winter pulses are Deep like stones (Shi). These are based on the classics according to solar terms.
The *Suwen* says: Spring pulses are like wires; their Qi comes weak, light, void, and slippery, straight and long, hence called Wire. Summer pulses are like hooks; their Qi comes abundant and departs declining, hence called Hook. Autumn pulses are floating; their Qi comes light, void, and floating, urgent in arrival and scattered in departure. Winter pulses are like camps (stones); their Qi comes deep and firm, hence called Camp. The *Nanjing* says: Wire pulse, coming gently and softly, like touching elm leaves (should be corrected according to *Suwen* to "weak, attracting like lifting the end of a long pole"), is a Healthy Pulse. More solid and slippery, like touching a long pole, is a Diseased Pulse. Urgent and strong, like a new bowstring, is a Dead Pulse. Summer Hook pulse, coming continuously like a ring, like touching lapis lazuli, is Healthy. Coming more rapidly like a chicken lifting its foot is Diseased. Bent front and stiff back, like holding a belt hook, is Dead. Autumn Hair pulse, coming abundant like a chariot canopy, enlarging upon pressure (corrected according to *Suwen* to "gently softly like falling elm leaves"), is Healthy. Neither up nor down, like touching chicken feathers, is Diseased. Disappearing upon pressure like wind blowing through hair is Dead. Winter Stone pulse, large above and sharp below, like a sparrow pecking, is Healthy. Pecking continuously, slightly curved within, is Diseased. Coming like untying a rope, departing like flicking a stone, is Dead. Examining the four seasonal pulses, they all take imagery from the *Nanjing*. The Summer pulse should not be changed to Surging (Hong).

Pulses soft and slow like spring willows indicate the Spleen Earth residing in the four seasons.
At the end of each season, Earth prospers for eighteen days, which is the fundamental position of Spleen Earth. However, the climate of the four seasons and the pulses of the four Zang organs all rely on Spleen Earth and Stomach Qi as the root. The *Nanjing* says: The Spleen is the Central Plain; its peaceful Qi cannot be seen; only when declining does it appear. Pulses coming like sparrow pecks or dripping water indicate the decline of the Spleen home. The *Maijing* says: In the sixth month, late summer, corresponding to the Wei branch and the Kun trigram, the position of Earth, when the Spleen prospers. Its pulse comes soft and slow, named a Healthy Pulse. The current *Maijue* adds "spring willows" as imagery. Cai Shi said: Any pulse that is neither large nor small, long nor short, floating nor sunken, slippery nor choppy, feels neutral and harmonious, with a joyful spirit, difficult to name, is Stomach Qi. This is also considered good description. Examining the *Nanjing*, the healthy pulses of the four seasons are those with Stomach Qi. Diseased pulses have more of the seasonal pulse and less Stomach Qi. Dead pulses have only the seasonal pulse and no Stomach Qi. Thus, the pulse of Stomach Qi resides within the seasonal pulse of the time, manifesting as a healthy pulse, invisible and indescribable. The phrase "soft and slow" specifically refers to what is observed during the eighteen days of each season.

Focus your mind and observe the subtle details; the *Lingshu* explains these profound mysteries.

Floating (Fu), Knife-edge (Kou), Slippery (Hua), Solid (Shi), Wiry (Xian), Tight (Jin), and Surging (Hong) are the [Seven Surfaces] (Yang Pulses), originally belonging to the same category. Fine (Wei), Sunken (Chen), Slow (Huan), Choppy (Se), Delayed (Chi), Hidden (Fu), Soft (Ru), and Weak (Ruo) combined are the [Eight Interior] (Yin Pulses).
Pulses cannot be named by Exterior/Interior. Only Floating and Sunken pulses can be discussed in terms of Exterior and Interior. Huang Di, Qi Bo, Yue Ren (Qin Yueren), Zhongjing, and Shuhe did not speak of Exterior/Interior. The *Maijing* was written by Wang Shuhe and has no names of Seven Surfaces, Eight Interiors, or Nine Channels. The current *Maijue* falsely attributes itself to Shuhe, yet its pulse theory contradicts the *Maijing*. Since the Six Dynasties, people have been confused by the Seven Surfaces, Eight Interiors, and Nine Channels, with no one pointing out the error. Wang Shang wrote *Chanwei Lun*, arguing that *Maijue* discusses Exterior but neglects Interior, greatly illuminating pulse shapes, but still did not correct the Exterior/Interior concept, instead rigidly adding Rapid and Long pulses to make Nine Surfaces, and Short and Fine pulses to make Ten Interiors, using nine and ten as the extremes of Yin and Yang numbers. Alas! Pulse changes indeed arise from Yin and Yang, but how can they be constrained by numbers? Historically, some classified Floating, Sunken, Long, Short, Slippery, and Choppy as Three Yin and Three Yang; some distinguished them by Size, Slipperiness, Choppy-ness, Floating, and Sunken; some classified Large, Floating, Rapid, Moving, and Slippery as Yang, and Sunken, Choppy, Weak, Wiry, and Fine as Yin; some diagnosed by pressing Cun and Chi, observing Floating, Sunken, Slippery, and Choppy to know the disease origin. All these pair Yin and Yang mutually, never mentioning Seven Surfaces, Eight Interiors, or Nine Channels. Can these categories exhaust the number of pulses? The *Neijing* mentions Drumming, Beating, Panting, Horizontal, Urgent, and Agitated pulses. Zhongjing mentions Bei, Rong, Zhang, Gang, Sun, and Vertical/Horizontal, Reverse/Smooth patterns. Do Seven Surfaces, Eight Interiors, and Nine Channels exhaust them? Although names differ, they essentially fall within Yin and Yang. Therefore, pulses should be examined by form through Yin and Yang, not named by Exterior/Interior. The *Neijing* says pulses conform to Yin and Yang, and skilled diagnosticians first distinguish Yin and Yang by observing color and feeling pulses. Pulses appearing due to Floating are called Exterior, not limited to Seven Surfaces. Pulses appearing due to Sunken are called Interior, not limited to Eight Interiors. Sunken and Slippery is also Interior; Floating and Choppy is also Exterior. Detailed distinctions are found under individual pulse sections.

Blood, Ying (Nutrient), Qi, and Wei (Defensive) have fixed respiration counts, totaling thirteen thousand five hundred passages.
The *Suwen* says: Ying is the essence of Water and Grain, harmonized in the Five Zang, distributed to the Six Fu, entering the vessels. Thus, it circulates up and down the vessels, penetrating the Five Zang, and connecting the Six Fu. Wei is the fierce Qi of Water and Grain, swift and slippery, unable to enter the vessels. Thus, it circulates among the skin and muscles (outside the vessels), steaming the Hui membranes, and dispersing in the chest and abdomen. The *Lingshu* says: Humans receive Qi from grain. Grain enters the Stomach and transmits to the Lung; the Five Zang and Six Fu all receive Qi. The clear part becomes Ying, the turbid part becomes Wei. Ying travels within the vessels, Wei travels outside. Ying circulates without rest, meeting every fifty cycles. It is also said: Once Grain Qi and Body Fluids circulate, Ying and Wei flow freely, turning into dregs, transmitted downwards. Also: Grain enters the Stomach; its fine essence first emerges from the two Jiaos of the Stomach to irrigate the Five Zang, separating into two paths of Ying and Wei. The condensed atmospheric Qi that does not circulate accumulates in the chest, named Sea of Qi, emerging from the Lung, following the throat, exiting on exhalation, entering on inhalation. Also: The floating Qi not following channels is Wei Qi; the fine essence traveling in channels is Ying Qi. Also: When five grains enter the Stomach, their dregs, fluids, and Zong (Gathering) Qi divide into three groups. Thus, Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart and Lung, and governs respiration. Ying Qi secretes body fluids, injects them into vessels, transforms them into Blood, nourishes the four extremities, and internally notes the Five Zang and Six Fu, responding to time units. Wei Qi releases its fierce swiftness, moving first in the four extremities, muscles, and skin, without rest. Ying and Wei are both flows of body fluids. Also: Ying and Wei are Essence Qi; Blood is Spirit Qi. Thus, Blood and Qi have different names but are of the same category. Also: Ying emerges from the Middle Jiao, Wei emerges from the Upper Jiao. Also: The Upper Jiao opens and develops, distributing the flavors of five grains, steaming the skin, filling the body, moistening hair, like mist and dew irrigation; this is called Qi. The Middle Jiao receives Qi, extracts juice, transforms it red; this is called Blood. Also: Vessels are used to move Blood and Qi, nourish Yin and Yang, moisten sinews and bones, and benefit joints. Wei Qi warms muscles, fills skin, plumps interstices, and controls opening and closing. The *Lingshu* says: Human vessels total sixteen zhang and two chi around the body. Water drips one hundred ke (time units) dividing day and night. One exhalation, pulse moves twice, Qi moves three cun. One inhalation, pulse moves twice, Qi moves three cun. At respiratory transition, Qi moves six cun. Ten respirations, Qi moves six chi. Two hundred seventy respirations, Qi moves sixteen zhang and two chi, completing one circuit around the body, water dropping two ke. Two thousand seven hundred respirations, Qi moves ten circuits, water drops twenty ke. Thirteen thousand five hundred respirations, Qi moves fifty circuits, water drops one hundred ke. Thus, Fifty Circuits prepare for the longevity of Heaven and Earth, traveling eight hundred ten zhang. Also: Wei Qi travels fifty circuits around the body in one day and night. Daytime travels Yang twenty-five circuits, nighttime travels Yin twenty-five circuits, circling the Five Zang. Thus, at dawn, Yin ends, Yang Qi emerges from the eyes. Eyes open, Qi moves up to the head, follows the neck, descends Foot Taiyang, follows the back, to the tip of the little toe. Scattered parts diverge from the outer canthus, descend Hand Taiyang, to the lateral side between hand little fingers. Scattered parts diverge from the outer canthus, descend Foot Shaoyang, note between the fourth and fifth toes, follow Hand Shaoyang laterally, to the hand little finger. Divergent parts go up to before the ear, merge with mandibular pulse, note Foot Yangming, descend to the dorsum of the foot, enter between five toes. Scattered parts go down from the ear, descend Hand Yangming, enter between the thumb and index, enter the palm. Reaching the foot, it enters the sole, exits the medial malleolus, descends Yin branches, and merges back at the eye, thus completing one circuit. Thus, as the sun moves one she (station), human Qi moves one circuit around the body, with 8/10th part. Entering Yin, it usually starts from Foot Shaoyin noting the Kidney. Kidney notes Heart, Heart notes Lung, Lung notes Liver, Liver notes Spleen, Spleen returns to Kidney, completing a circuit. Thus, as the moon moves one she, human Qi moves one circuit in Yin Zang, with 8/10th part of Zang, also twenty-five circuits like Yang, returning to meet at the eye. (See *Lingshu·Wei Qi Xing* Chapter 76). This is the fifty circuits of Wei Qi. Daytime travels Yang twenty-five degrees, nighttime travels Yin twenty-five degrees, meeting at dawn after fifty circuits, with Ying and Wei respiration counts being the same. Starting from Middle Jiao noting Hand Taiyin and Yangming, Yangming notes Foot Yangming and Taiyin, Taiyin notes Hand Shaoyin and Taiyang, Taiyang notes Foot Taiyang and Shaoyin, Shaoyin notes Hand Jueyin (Pericardium) and Shaoyang, Shaoyang notes Foot Shaoyang and Jueyin, Jueyin returns to note Hand Taiyin. This is the beginning and end of vessel circulation, different from Wei Qi travel. *Sanyin Fang* says: Blood is the pulse, Qi is the respiration. One exhalation, one inhalation, one transition, pulse moves six cun. Two hundred seventy respirations, traveling sixteen zhang two chi, is the pulse of Blood. Qi respiration is slower than pulse; eight respirations, 3.333... cun, move one cun. Thirteen thousand five hundred respirations, finally traveling sixteen zhang two chi. Now examining the classic: Qi accumulates in the Stomach to connect Ying and Wei, each following its path. Zong Qi flows into the Sea, downward notes Qichong, upward walks the respiratory tract. Thus Ying and Wei follow different paths, as stated in the *Lingshu*: Ying is essence of Water and Grain, emerging from Middle Jiao, transforming red, entering vessels, responding to respiration counts. Wei is fierce Qi of Water and Grain, emerging from Upper Jiao, traveling outside vessels, warming muscles, filling skin, controlling opening/closing, not traveling with vessels, not sharing the Dao with Ying, not responding to respiration counts with Ying and Wei. Their difference is such. However, traveling around the body, day and night fifty circuits, Ying and Wei are one. *Sanyin* takes Blood as pulse referring to Ying, and Qi as respiration referring to Wei, stating Ying-Blood pulses circulate fifty times day and night, while Wei Qi respiration circulates once day and night. On what basis is this, differing so much from ancient classics? Also examining *Nanjing*: Ying Qi travel often accompanies Wei Qi up and down. Wei moves by respiration. Chao Yuanfang said Qi moves then Blood moves, Qi stops then Blood stops; all suspect transmission errors. Wang Bing said needling collaterals to open Ying and Wei, shouldn't mention Wei in collaterals. *Lingshu·Wei Qi Xing* says: Wei Qi travel, daytime Yang, eyes open and awake; nighttime Yin, eyes closed and asleep. Carefully examining this section: Dawn Yang Qi emerges from eyes, descending to Hand and Foot Three Yang channels, all diverging simultaneously, not sequential. The end of this chapter says: Water drops one ke, Qi is in Taiyang; two ke, Shaoyang; three ke, Yangming; four ke, Yin branch. This implies descending Taiyang completely, then Shaoyang, then Yangming, then ascending Yin branch, contradicting this section, likely interpolations. Also examining this section: Combining the number of Yang Qi circuits and water ke drops mentioned below, it seems to be interpolated text. Why? Daytime water drops fifty ke. Daytime Yang Qi travels twenty-five circuits. Matching water ke to Yang circuits, one Yang circuit matches two water ke. Matching two water ke to one Yang circuit, Yang Qi from dawn emerging from eyes and diverging to Hand/Foot Three Yang matches one water ke. From sole exiting medial malleolus, ascending Yin branch, merging at eye, also matches one water ke, constituting one circuit. Thus, at one ke drop, Qi should be in Three Yang; at two ke drop, Qi should be in Yin branch, completing one circuit. At three ke drop, Qi again in Three Yang; at four ke drop, Qi again in Yin branch, completing one circuit. Cycling Three Yang and Yin branch until fifty ke drops, obtaining twenty-five circuits, matching the start of daytime Yang travel. But the end of this chapter says: One ke Taiyang, two ke Shaoyang, three ke Yangming, four ke Yin branch. This means four ke drops match one circuit; eight ke drops match two circuits; fifty ke drops match twelve and a half circuits, contradicting the twenty-five daytime Yang circuits at the start. Is this the original intent? Ying Qi travel starts from Hand Taiyin, ends at Foot Jueyin, one circuit around the body. Detailing one circuit, externally to limbs, internally to Five Zang and Six Fu, all covered. Thus its fifty circuits have no Yin/Yang or day/night distinction. Wei Qi travel is different: Daytime only circles Yang, outside limbs, not inside Zang/Fu; Nighttime only circles Yin, inside Zang/Fu, not outside limbs. Thus must complete fifty circuits, reaching dawn, to meet Ying at Lung Hand Taiyin.