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Preface Cui Zixu's "Four-Character Pulse Resolution" has been in circulation for a long time. Li Yuechi revised and supplemented it, renaming it "Four-Character Essentials". I selected these two versions, making additions and deletions, either elaborate or concise, aiming only to conform to medical principles. How dare I claim to be a merit-maker for Cui and Li?

The pulse is the blood vessel, the precursor of Qi and Blood; it is the tunnel through which Blood flows, with Respiration responding within it.

Is the pulse Qi? But Qi belongs to Wei Qi (Defensive Qi), which circulates outside the vessels; thus, we know the pulse is not Qi. Is the pulse Blood? But Blood belongs to Ying Qi (Nutritive Qi), which circulates inside the vessels; thus, we know the pulse is not Blood. Is the pulse the Jing-Luo (Meridian-Vessel) system? But there are many such systems; thus, we know the pulse is not merely the Meridian-Vessel system. Hua Yuanhua said well: "The pulse is the precursor of Qi and Blood." Generally, the human body consists of Essence (Jing), Qi, and Spirit (Shen). Essence and Qi are Blood and Qi; as the precursor of Blood and Qi, if not Shen, then what? Without Shen, humans cannot govern Qi and Blood, maintain Taihe (Great Harmony), circulate through the San Jiao (Triple Burner), and irrigate the entire skeleton. Therefore, the pulse is nothing other than another name for Shen. Understanding this, Qi and Blood can be analyzed both holistically and distinctly; as it is said, "Qi is like a bellows, Blood like waves," rising and falling to perform their functions, thereby establishing the Pulse Dao (Way of the Pulse).

Originating from the Kidney, nourished by the Stomach; Blood vessels and Respiration cycle up and down continuously.

Before the body forms, the Kidneys exist first, providing a foundation for Qi and Blood. Shen relies on Qi, Qi relies on Blood, and Blood is nourished by Grain, whose root lies in the Stomach. Thus, when Stomach Qi is sufficient, Blood is abundant; when Blood is abundant, Qi is strong; when Qi is strong, Shen is prosperous. Hence it is said: "The root of Pre-Heaven lies in the Kidney, and the root of Post-Heaven lies in the Spleen." (The Spleen and Stomach are mutually related, like husband and wife.) The prosperity or decline of Shen is signaled by the pulse. In the movement of the pulse, Qi moves and Blood follows, circulating throughout, rising and falling, meeting and intersecting, nourishing and guarding, each fulfilling its duty.

Among the Twelve Meridians, all have pulsating points; only the Cun Kou (Inch Port) of the Hand-Taiyin Lung Meridian determines the diagnosis.

"Nan Jing · First Difficulty" states: "All twelve meridians have pulsating points, why take only the Cun Kou?" Bian Que answered: "Cun Kou is the great assembly of pulses, the pulsating point of the Hand-Taiyin Lung Meridian." Because the Lung is the canopy of the five Zang and six Fu organs, distributing Yin and Yang throughout the body, occupying the highest position, while all other organs are below it. The Lung connects upwards to the throat and pharynx to facilitate respiration. The Lung governs the Qi of the whole body; Qi cannot move without respiration, and the pulse cannot distribute without Lung Qi. However, "Su Wen · Treatise on the Distinctions of the Five Zang Organs" says: "The Yellow Emperor asked: 'Why can the Qi Kou (Air Port) alone serve as the master of the five Zang organs?' Qibo replied: 'The Stomach is the sea of water and grain, the great source of the six Fu organs. Flavors enter the mouth and are stored in the Stomach to nourish the Qi of the five Zang organs. The Qi Kou also belongs to Taiyin. Therefore, the Qi and flavor of the five Zang and six Fu organs all originate from the Stomach and manifest at the Qi Kou.'" Here, the emphasis is again on the Stomach. Upon careful reflection, the principle is consistent. The Qi Kou originally belongs to the Taiyin (Lung), but saying it "also belongs to Taiyin" implies that while the Qi Kou belongs to the Lung (Hand-Taiyin), the distribution of Stomach Qi lies in the Spleen (Foot-Taiyin). According to "Ling Shu · Chapter on the Generation and Meeting of Ying and Wei": "Grain enters the Stomach, transmits to the Lung, and the five Zang and six Fu organs all receive its Qi." "Jue Lun" states: "The Spleen transports the fluids for the Stomach." "Su Wen · Treatise on the Divergent Meridians" says: "Drinks enter the Stomach, their essence floats up, is transported to the Spleen, the Spleen scatters the essence, and it returns upward to the Lung." The Spleen's essence must return to the Lung before circulating to the Zang-Fu and Ying-Wei. Thus, although the Qi Kou is the Hand-Taiyin, it is actually the convergence of the Foot-Taiyin, hence "the Qi Kou also belongs to Taiyin." It is known that the Qi and flavor of the five Zang and six Fu organs go from the Stomach to the Spleen, and from the Spleen to the Lung; this is the earthy path going low yet ascending. From the Lung, they distribute to the Zang-Fu; this is the heavenly path descending and shining. Earth is central and the mother of Metal, serving as the root of all pulses; the Lung is high and symbolizes the ruler, issuing commands for all pulses. Hence, "The Lung faces all pulses, and Cun Kou is their great assembly," just as water gathers in the ocean. Further research shows Qi Kou is Cun Kou. The Lung governs all Qi, and the abundance or deficiency of Qi manifests here, hence called Qi Kou. The pulse emerges from Tai Yuan acupoint, totaling one inch and nine fen, hence called Cun Kou. Since the Lung faces all pulses and they assemble here, it is also called Mai Kou (Pulse Port). They are essentially the same. Wu Caolu said: "Doctors who name the Cun, Guan, and Chi positions as the Heart, Lung, Liver, Spleen, and Kidney pulses respectively are incorrect. There are twelve meridians in the five Zang and six Fu organs. The Cun, Guan, and Chi of both hands are merely one pulse of the Hand-Taiyin Lung Metal. The positions are divided to observe the Qi of other organs. Pulse movement starts at the Lung, ends at the Liver, and returns to the Lung. The Lung is the portal for Qi entry and exit, hence named Qi Kou, and serves as the great assembly of pulses to assess the whole body." Li Shizhen said: "The six positions of both hands are all Lung meridians; they are taken specifically to observe the Qi of the five Zang and six Fu organs, not where the organs reside." "Ling Shu", "Su Wen", and "Nan Jing" record that among the twelve meridians, some travel to the hand but do not pass through the three positions. For example, the Hand-Yangming Large Intestine Meridian starts at the tip of the index finger, passes through Hegu between the thumb and index finger, goes along the upper aspect of the arm, enters the elbow, ascends the shoulder, and ends at Yingxiang, connecting to the Foot-Yangming Stomach Meridian. This has no connection with the Right Cun. The Foot-Yangming Stomach Meridian starts near the nose, descends to connect with the Stomach, links to the Large Intestine, reaches the foot, and ends at Lidui (tip of the second toe), connecting to the Foot-Taiyin Spleen Meridian. This has no connection with the Right Guan. The Foot-Taiyin Spleen Meridian starts at the tip of the big toe, ascends the knee and thigh, enters the abdomen, and connects to the Hand-Shaoyin Heart Meridian. This has no connection with the Right Guan. The Hand-Shaoyin Heart Meridian starts in the heart, descends to link to the Small Intestine; its branch follows the axilla, down the inner posterior aspect of the elbow to the little finger, ending at Shaochong (tip of the little finger), connecting to the Hand-Taiyang Small Intestine Meridian. This has no connection with the Left Cun. The Hand-Taiyang Small Intestine Meridian starts at the tip of the little finger, follows the lateral aspect of the arm, crosses both shoulders, descends to the Small Intestine, ascends to the head, links to the cheekbone, and ends in the ear at Tinggong, connecting to the Foot-Taiyang Bladder Meridian. This has no connection with the Left Cun. The Foot-Taiyang Bladder Meridian starts at the inner canthus, descends to link to the Kidney, connects to the Bladder, and ends at the little toe (Zhiyin), connecting to the Foot-Shaoyin Kidney Meridian. This has no connection with the Left Chi. The Foot-Shaoyin Kidney Meridian starts at the little toe, ascends along the throat, flanks the tongue root, pours into Danzhong, and connects to the Hand-Jueyin Pericardium Meridian. This has no connection with the Left Chi. The Hand-Jueyin Pericardium Meridian starts in the chest, connects to the pericardium below the heart, enters Quze in the elbow, runs between the two tendons of the arm, enters the palm, follows the middle finger to its end, and connects to the Hand-Shaoyang Sanjiao Meridian. The pulse travels along the middle finger, having no connection with the Left Chi. The Hand-Shaoyang Sanjiao Meridian starts at the tip of the ring finger, runs between the two bones of the outer arm, descends to link to the Bladder; its branch stops at the ear from Danzhong, ends at Sizhukong, and connects to the Foot-Shaoyang Gallbladder Meridian. The little finger path also has no connection with the Right Chi. The Foot-Shaoyang Gallbladder Meridian starts at the outer canthus, descends through the chest, links to the Liver and connects to the Gallbladder, enters between the fourth and fifth toes; its branch exits from the dorsum of the foot to the tip of the big toe, connecting to the Foot-Jueyin Liver Meridian. The Foot-Jueyin Liver Meridian starts at the hairline of the big toe, follows the genitalia, connects to the Liver and Gallbladder, pierces the diaphragm, follows behind the throat, ascends to the nasopharynx, connects to the eye system, emerges at the forehead; its branch descends from the eye system to Zhongwan, connecting to the Hand-Taiyin Lung Meridian. Thus, the Foot-Shaoyang and Foot-Jueyin do not travel to the hand. Only the Lung Meridian starts in the Middle Jiao, follows the inner arm, ascends to the Thenar eminence, and ends at the tip of the big toe (Shaoshang); its branch emerges from behind the wrist to the tip of the index finger, connecting to the Large Intestine Meridian. Knowing this, this meridian correctly belongs to Cun Kou, the location of the Lung's pulsating point. As for the pulsating points of other meridians, each is at its respective location. Hand-Yangming Large Intestine pulse beats at Hegu (between the metacarpals of the thumb and index finger); Hand-Shaoyin Heart pulse beats at Jiquan (in the axilla between tendons); Hand-Taiyang Small Intestine pulse beats at Tianchuang (in the neck between large tendons below the jaw); Hand-Shaoyang Sanjiao pulse beats at Heliao (in front of the ear); Hand-Jueyin Pericardium pulse beats at Laogong (in the palm where the middle and ring fingers bend); Foot-Taiyang Bladder pulse beats at Weizhong (in the popliteal crease); Foot-Shaoyin Kidney pulse beats at Taixi (behind the medial malleolus on the calcaneus); Foot-Taiyin Spleen pulse beats at Chongmen (below Qimen, 1.5 cun down); Foot-Yangming Stomach pulse beats at Chongyang (in the depression between the first and second metatarsal bones, 5 cun above Neiting); Foot-Jueyin Liver pulse beats at Taichong (2 cun proximal to the base of the big toe); Foot-Shaoyang Gallbladder pulse beats at Tinghui (in the depression in front of the ear). The movements of these meridians are all different, let alone whether they pass through the three positions. Why are the false resolutions so indiscriminate? Although "Nan Jing · Second Difficulty" discusses Cun and Chi, its intent uses Guan as the boundary. From Guan to Yuji is one inch, defined as Yang, obtaining nine fen within the inch; from Guan to Chize is one chi, defined as Yin, obtaining one inch within the chi. This speaks of Yin and Yang, not distinguishing meridians. Then how are the Zang-Fu diagnosed? Does not the classic say, "Exhalation involves the Heart and Lung, inhalation involves the Kidney and Liver. Between breaths, the Spleen receives the flavors of grain." The abundance and deficiency of the pulse are rooted in the Stomach; entry and exit depend on the Lung. Stomach Qi is like the weight of an object; Lung Qi is like the beam of a scale balancing that weight. If one follows the false resolution assigning specific meridians to specific positions, it is too arbitrary.

The pulse traveling through the twelve meridians refers to the Three Yin and Three Yang meridians of the hand and foot. "Nan Jing · Twenty-third Difficulty" states: "There are twelve Jing-Mai (Main Meridians) and fifteen Luo-Mai (Connecting Vessels). Where do they start and where do they end? Answer: The Jing-Mai transport Qi and Blood, connect Yin and Yang, and nourish the whole body. It starts in the Middle Jiao, injects into the Hand-Taiyin Lung; Hand-Taiyin Lung injects into Hand-Yangming Large Intestine; Hand-Yangming Large Intestine injects into Foot-Yangming Stomach; Foot-Yangming Stomach injects into Foot-Taiyin Spleen; Foot-Taiyin Spleen injects into Hand-Shaoyin Heart; Hand-Shaoyin Heart injects into Hand-Taiyang Small Intestine; Hand-Taiyang Small Intestine injects into Foot-Taiyang Bladder; Foot-Taiyang Bladder injects into Foot-Shaoyin Kidney; Foot-Shaoyin Kidney injects into Hand-Jueyin Pericardium; Hand-Jueyin Pericardium injects into Hand-Shaoyang Sanjiao; Hand-Shaoyang Sanjiao injects into Foot-Shaoyang Gallbladder; Foot-Shaoyang Gallbladder injects into Foot-Jueyin Liver; Foot-Jueyin Liver returns to inject into Hand-Taiyin. This is called one cycle."

Within the body, there is Ying Qi (Nutritive Qi), Wei Qi (Defensive Qi), Zong Qi (Gathering Qi), Zang-Fu Qi, and Jing-Luo Qi, each distinct. What unifies the Zang-Fu, Jing-Luo, Ying-Wei, filling them without gap and circulating endlessly throughout the body, is entirely dependent on the Da Qi (Great Qi) in the chest to preside over it. The concept of Da Qi has been mentioned once. "Su Wen · Treatise on the Five Movements and Six Operations" says: "The Yellow Emperor asked if the Earth is below. Qibo replied: 'Earth is below humans, within the Great Void.' Asked: 'What supports it?' Replied: 'The Great Qi lifts it.' Thus, the Great Void is vast, yet fills and encompasses the entire Earth, all due to Qi. Therefore, when the four directions are empty, the Qi of Cold, Heat, Dryness, Dampness, Wind, and Fire enters the Earth and generates transformations. If not for the Great Qi enveloping the Earth externally, the Earth would collapse and shake, how could it stand majestically in the center and perpetuate generation? The human body is the same. The five Zang and six Fu organs, major and minor collaterals, circulate day and night without rest, relying on the Great Qi in the chest to rotate them. If the Great Qi declines, entry and exit cease, and ascent and descent stop. The Shen Ji (Spirit Mechanism) perishes, leading immediately to danger. Some say Da Qi is the Qi of Danzhong, so Danzhong is the Master of the Heart, issuing orders, the official of ministers and messengers. However, observing celestial movements, Danzhong as a minister can only handle the six intruding Qi of Cold, Heat, Dryness, Dampness, Wind, and Fire. It must be like the Great Void, solemn and formless, encompassing the terrain, permanently stabilizing the center, to be called Da Qi. Since Danzhong is called a minister with duties, it cannot be called Da Qi. Others say Da Qi is another name for Zong Qi. Zong means respected and master; the twelve meridians respect it as their master. How can one know that Zong Qi, Ying Qi, and Wei Qi are divided into three tunnels? Since there are tunnels, they are similar to the Qi entering the Earth from the six directions, not comparable to the Great Void. The diagnosis of Danzhong is the Pericardium; the diagnosis of Zong Qi is under the left breast. Originally, they are not mixed in diagnosis. So how is Da Qi diagnosed? "Nei Jing" clearly indicates it, but readers fail to notice. When it says 'Upper attaches, right exterior observes the Lung, interior observes the Chest,' this is precisely its diagnostic method. The Lung governs the Qi of the whole body, and regulation follows. The Qi that encompasses everything in the body comes solely from the Lung in the chest. Therefore, its diagnosis is divided into the Heaven Position (upper part) of the Right Hand governing Qi, facing all pulses and called the Great Assembly.

The great assembly of the pulse, the entry and exit of respiration; one exhalation and one inhalation, four beats constitute one Xi (breath/respiration cycle).

The physician regulates their breath. With one exhalation, the pulse arrives twice; with one inhalation, the pulse arrives twice. Between respiration, if the pulse arrives four times steadily, it is a Ping Mai (Normal Pulse). Occasionally, five beats may occur, but disease cannot be determined solely on this. Human respiration varies in length. Every three breaths, there is one longer breath; every five breaths, there is one longer breath, called Tai Xi (Sigh); similar to the calendar intercalating every three years and twice every five years. Saying the pulse must have four beats to be normal, five beats is excessive. Only during a true Tai Xi is it considered no illness; this longer breath is not due to rapid pulse. If not Tai Xi, it strictly matches four beats.

Respiration established, combined as one Xi; ten thousand three hundred and fifty per day and night.

Exhalation comes from Yang, inhalation enters Yin. One exhalation pulse two beats, one inhalation pulse two beats, combining four beats as one Xi. Totaling day and night, approximately ten thousand three hundred and fifty Xi.

Between respiration, the pulse travels six cun; eight hundred and ten zhang, standard for day and night.

Calculating one exhalation and one inhalation: exhalation travels three cun, inhalation travels three cun. With respiration established, pulse Qi travels six cun. Calculated over ten thousand three hundred and fifty Xi, totaling eight hundred and ten zhang. Converted using the total pulse length of sixteen zhang and two chi, it should circulate the body fifty times. This is the standard degree measure for pulse circulation day and night. According to Yue Ren's "Nan Jing · Twenty-third Difficulty": The total pulse length is sixteen zhang and two chi, including Ren Mai, Du Mai, and the two Qiao Mai. Calculating six cun per Xi, over ten thousand three hundred and fifty Xi daily, totaling eight hundred and ten zhang. Circulating the body, it achieves fifty cycles. Later it says: Starting from Middle Jiao injecting into Hand-Taiyin, ending at Foot-Jueyin, Foot-Jueyin returns to inject into Hand-Taiyin. Called a circle without beginning or end. It is unknown where the two Qiao Mai, Ren, and Du connect. Do they attach to Foot-Shaoyin and Foot-Taiyang? If attached, they cannot be within the cyclic injection. This awaits clarification by experts.

When diagnosing disease pulses, use dawn as the standard; remain empty, quiet, concentrate spirit, regulate breath, and examine carefully.

Dawn is the intersection of Yin and Yang. Yang governs day, Yin governs night; Yang governs exterior, Yin governs interior. "Ling Shu · Chapter on Ying and Wei" says: "At dawn, Yin ends and Yang receives Qi. At noon, Yang peaks. At sunset, Yang declines; when sun sets, Yang ends and Yin receives Qi." "Ling Shu · Chapter on Mouth Questions" says: "When Yang Qi ends and Yin Qi is abundant, eyes close. When Yin Qi ends and Yang Qi is abundant, one wakes." Therefore, diagnosis should be done at dawn upon waking, when Yin Qi is balanced and unmoved, Yang Qi is about to become abundant but not scattered, food has not been consumed, Grain Qi has not circulated, so meridians are not yet full, collaterals are even, Qi and Blood are not disturbed, and pulse form has not changed. Only then can pathological pulses be diagnosed. Furthermore, pulse taking requires sincerity and precision, avoiding disturbance. Thus, the mind must be empty without delusions, the body still without movement or speech, to grasp the subtleties of the pulse.

To diagnose another's pulse, have them extend their palm; the high bone behind the palm is named Guan. Once position is confirmed, place fingers; spacing should be appropriate, length not lost.

For pulse diagnosis, have the person extend their hand, the physician covers it to diagnose. The level corresponding to the high bone behind the palm is called Guan. After confirming the position, slowly place the middle finger on Guan, then the index finger on Cun, then the ring finger on Chi. For tall people, finger placement should be sparse; for short people, dense. Fingernails should not be kept long; if long, fingertips cannot align, making pulse observation difficult. Moreover, during deep pressing, long nails leave deep marks, which is particularly inconvenient for women in seclusion.

Finger pressure varies; methods are Ju (Lift), An (Press), and Xun (Search), proceeding calmly.

Observing the pulse depends on skillful finger technique. The general rule: light touch along the surface is Ju (Lift); heavy touch to obtain is An (Press); neither light nor heavy, seeking thoroughly is Xun (Search). Careful embodiment is required. For example, lifting must precede pressing, and pressing must precede lifting, as lifting an object goes from bottom to top, pressing goes from top to bottom. Thus, lifting contains pressing, pressing contains lifting, alternating and repeating, revealing the meaning of Search.

"Nan Jing · Fifth Difficulty" states: "Pulses have different weights. What does this mean? Answer: Initially holding the pulse, with the weight of three beans, touching the skin and hair, is the Lung region. With the weight of six beans, touching the blood vessels, is the Heart region. With the weight of nine beans, touching muscle and bone, is the Spleen region. With the weight of twelve beans, level with tendons, is the Liver region. Pressing to the bone, lifting the finger quickly reveals the Kidney region." This describes six regions with different weights. Shu means bean. The number of beans varies due to light or heavy lifting/pressing. Those holding the pulse must understand lifting and pressing: first lightly lift to feel superficial, then heavily press to feel deep. Lung pulse is very superficial and felt first, hence the text adds "initially holding the pulse" before describing Heart, Spleen, Liver, and Kidney pulses, each heavier than the last. Lung governs skin and hair, Heart governs blood vessels, Spleen governs muscles, Liver governs tendons, Kidney governs bones. "Touching appropriately" means finding the portion governed by each and thus obtaining the pulse of that region. The Kidney region does not mention fifteen beans but says "to the bone" because reaching the bone clarifies the weight of fifteen beans.

Anterior to Guan is Yang, posterior to Guan is Yin; Yang is Cun, Yin is Chi, push and search sequentially.

From Yuji to the high bone is one inch, hence named Cun. From Chize to the high bone is one chi, hence named Chi. Between Cun and Chi is named Guan. Anterior to Guan, Cun is Yang; posterior to Guan, Chi is Yin. Guan is centered as the boundary of Yin and Yang, yet Yin and Yang actually intersect here. Cun observes Upper Jiao, Guan observes Middle Jiao, Chi observes Lower Jiao. One must sequentially and finely push and search, deducing deficiency and excess, searching for the pulse image.

For men, a larger pulse on the left is favorable; for women, a larger pulse on the right is favorable.

Zhu Danxi said: "Pulses are assigned to left and right hands. Heart, Small Intestine, Liver, Gallbladder, Kidney, Bladder on the left govern Blood; Lung, Large Intestine, Spleen, Stomach, Ming Men on the right govern Qi. Men prioritize Qi..."