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Lung abscess (a purulent disease of the lung) presenting with a rapid and excess pulse at the Cun position indicates that pus has already formed. Withering and drying of the lung lobes is caused by fire invading metal (lung), hence the pulse is rapid but weak. Once lung abscess occurs, Lung Qi becomes deficient; white is the true color of the West (Metal/Lung). It is said that when one Zang organ is deficient, its true color appears. A short and choppy pulse represents the natural constitution of Autumn Metal; if it instead presents as floating and large, this signifies fire attacking metal. The element that conquers me is called "robber evil" (Zei Xie), representing a critical condition of corrupted blood and Qi. Intestinal abscess (a purulent disease of the intestine): Excess pulse indicates an Excess syndrome; Deep and fine pulse indicates a Deficiency syndrome. When the syndrome is Excess but the pulse is Deficient, death is imminent.

For throat obstruction (Hou Bi - painful swelling and difficulty swallowing in the throat), a slow or rapid pulse is normal; however, for severe conditions like "Coiling Throat Wind" (Chan Hou Feng) or "Running Horse Cancre" (Zou Ma Gan), a faint and hidden pulse indicates a difficult prognosis.

The Twelve Primary Meridians and their Branches mostly pass through this area (the radial artery/Cun Kou); even if not so, they are located anteriorly, posteriorly, laterally, or medially to it. The pulses here are mostly Rapid because Rapidness indicates Heat. Occasionally, a Slow pulse may be seen; this occurs when external pathogens invade the meridians, causing meridian Qi to stagnate and obstruct at the passage points, thus forming a Bi syndrome. A Slow pulse arriving can also correspond to the disease. In cases of Coiling Throat Wind characterized by swelling, pain, numbness, and itching, or Running Horse Cancre which can cause sudden closure and death, both are Fire combined with Wind, fierce and violent. The pulse should be Floating, Large, Surging, and Rapid. If instead a Faint and Hidden pulse is seen, it indicates that Righteous Qi is declining while Pathogenic Evil is flourishing. Neither tonification nor purgation can be effectively applied; is this not difficult to treat?

Signs of poisoning present with Rapid and Tight pulses at both Cun and Chi positions. A Fine and Minute pulse indicates danger, with death imminent within days.

A Rapid and Tight pulse occurs because toxic vapors are coiled and stagnant, striking against the vessel walls. Once a Fine and Minute pulse is observed, it is known that Righteous Qi has become deficient and toxic pathogens have penetrated deeply; how long can the patient survive?

For traumatic wounds with bleeding, the pulse is mostly Empty and Fine. If it suddenly becomes Urgent, Excess, Large, and Rapid, it indicates impending collapse and is untreatable.

After significant trauma and blood loss, an Empty pulse naturally tends toward Deep and Fine. If it instead becomes Urgent and Rapid, Yin Blood is about to be exhausted; what use is treatment?

In women, the pulse is based on Blood. Abundant Blood facilitates conception, while abundant Qi makes pregnancy difficult. Hyperactivity of the Shao Yin pulse indicates pregnancy. A Slippery and free-flowing pulse at the Chi position is auspicious for pregnancy. A Slippery and Rapid pulse that does not scatter suggests a three-month gestation. A merely Rapid pulse without scattering allows differentiation by the fifth month. A Rapid pulse on the Left indicates a male fetus; on the Right, a female fetus. A female-shaped abdomen resembles a winnowing basket (Ji); a male-shaped abdomen resembles a cauldron (Fu).

This describes the pulse before pregnancy in women. Women belong to Yin, and Yin governs Blood; therefore, women's constitution is based on Blood. When the root (Blood) is sufficient, conception is easy. If Qi is abundant, Blood may become deficient, meaning the root is insufficient. No one who violates normal physiological laws can conceive. "Hyperactivity of Shao Yin" refers to the pronounced movement of the Hand-Shao Yin Heart Meridian. The Heart governs Blood; pronounced movement indicates abundant Blood, facilitating conception, hence "having a child." This aligns with the *Su Wen: Ping Ren Qi Xiang Lun*: "When the Hand-Shao Yin pulse moves vigorously in women, she is pregnant." The Heart governs Blood, so fetal formation causes vigorous movement, implying smooth and fluid flow, not the bean-like throbbing of a distinct arterial pulse. The Chi pulse corresponds to the Kidneys on both sides. The Kidney is the Water of Tian Yi, governing the uterus and holding the Bao (womb), serving as the root of gestation. A Slippery and free-flowing pulse indicates fullness rather than dryness, containing the image of substance, hence auspicious for pregnancy. This matches the *Su Wen: Yin Yang Bie Lun*: "When Yin pulses beat distinctly different from Yang, it indicates pregnancy." Cun is Yang, Chi is Yin; this means the Yin pulse at Chi beats distinctly against the finger, clearly differing from the Yang pulse at Cun. Regarding this Slippery pulse, if it feels Slippery upon pressure but does not scatter, Slipperiness indicates rapid blood flow, while non-scattering indicates the gathering and condensation of blood, signifying three months of pregnancy. If it is merely Rapid without scattering, it progresses from Deficiency to Excess, from soft to firm, as blood condenses and transforms into form, losing its slipperiness; this is the pulse of five months' pregnancy. If the Rapidness is greater on the Left than the Right, it indicates a male fetus, as males belong to Yang and reside on the Left, with fetal Qi concentrating in Yang. If greater on the Right, it indicates a female fetus, as females belong to Yin and reside on the Right, with fetal Qi concentrating in Yin. "Greater" refers to degree, not that the Right is absent. Observing the abdomen: basket-shaped indicates a female fetus; cauldron-shaped indicates a male fetus. Generally, in utero, females face the mother's abdomen, and males face the mother's back. While mimicking parental forms, this reflects the principle of Yin-Yang embracing. Females facing the abdomen have knees pressing against it, making the lower part larger and upper smaller, resembling a basket. Males facing the back have their spine pressing against it, making the shape round like a cauldron.

Regarding gender differentiation, He Huanzhi in the *Mai Jing* stated: "Rapid Left indicates male, Rapid Right indicates female." Also: "Deep and Solid Left indicates male, Floating and Large Right indicates female." Also: "Chi pulse larger on the Left indicates male, larger on the Right indicates female." Also: "Obtaining Tai Yin pulse indicates male, obtaining Tai Yang pulse indicates female. Tai Yin pulse is Deep. Tai Yang pulse is Floating." Since then, all discussions on pregnancy pulses have generally adhered to these. Hua Bolin later stated: "Large and Surging Left Chi indicates male, Deep and Solid Right indicates female." Xu Donggao of recent times stated: "To distinguish male and female, one must examine Yin and Yang. If the Right pulse is strong, showing more Yin characteristics, it indicates a girl. If the Left Chi is strong, showing more Yang characteristics, it indicates a boy." Examining all these theories is thorough; however, they often contradict each other and are hard to rely upon. The unchanging principle lies in the words "Yin and Yang." Dividing by left and right, Left is Yang, Right is Yin. Dividing by pulse quality, pounding and deep-solid are Yang; empty, floating, deep-choppy are Yin. All Yang-Excess cases indicate males; all Yin-Deficiency cases indicate females. This is the definitive theory. One must also observe the pregnant woman's strength, age, habitual left/right bias, and inherent strength/weakness of the Cun and Chi positions to fully master the method.

The pulse before delivery is Scattered and deviates from the regular meridian pattern. The pulse after new delivery should be Small and Slow; if it is Excess, Large, Wiry, or Firm, the prognosis is ominous.

This discusses the pulse during childbirth, which differs suddenly from the usual ten-month pregnancy pulse. For example, if the pulse was usually Floating, it suddenly becomes Deep at labor; if usually Slow, it suddenly becomes Rapid. Whether Large, Small, Slippery, or Choppy, all change suddenly at labor. For ten months, fetal Qi is stable; once delivery begins, Qi and Blood surge, the fetal sac ruptures, and everything deviates from the norm, so the pulse changes from its usual appearance. After delivery, Qi and Blood are both deficient, so the pulse should be Slow and Slippery. Slow indicates relaxation, not urgency due to Qi depletion; Slippery indicates fluidity, not dryness due to blood loss. Both are auspicious signs. If the pulse is Excess, Large, Wiry, or Firm, it is unsuitable for postpartum Qi and Blood deficiency. Excess indicates pathogenic excess; Large indicates pathogenic progression; Wiry indicates Yin constriction preventing distribution; Firm indicates solidity with unresolved stasis. These are contrary pulses. If external symptoms exist, how can the condition be favorable?

Pediatric pulses rely entirely on the Tiger Mouth (finger veins on the index finger). The Wind, Qi, and Life gates must be carefully analyzed.

The Tiger Mouth is the area where the inner side of the index finger connects with the thumb, forming a tiger-mouth shape. The skin is thin, and vein colors are clear. This is the end point of the Hand-Taiyin Lung Meridian and a major convergence point for pulses. Although there are no Five Zones, there are Three Gates. The first phalanx is the Wind Gate; the second is the Qi Gate; the third is the Life Gate. Observe the left hand for boys and the right for girls. Veins visible only at the Wind Gate indicate mild illness; progressing to the Qi Gate indicates severity; penetrating straight to the Life Gate indicates critical illness, possibly fatal. This progression shows wind pathogens affecting righteous Qi, which fails to overcome them, forcing the pathogen toward life-threatening levels.

What are the colors? Red indicates Heat (pulse Rapid); White indicates Cold (pulse Slow); Yellow indicates accumulation (pulse Slow); Blue-Black indicates pain (pulse Deep and Wiry).

Children under three are pure Yang bodies with small frames; their pulse circulates quickly and feels rapid. Using the adult standard of seven beats per breath as normal, more than seven is Rapid (Heat), and less is Slow (Cold). This is the general rule. However, 7-8 beats per breath are too fast to count accurately, making it hard to assess the condition precisely. Regarding facial diagnosis, organs correspond to specific areas: Left cheek-Liver, Right cheek-Lung, Forehead-Heart, Nose-Spleen, Chin-Kidney. Similarly, pathogens manifest specific colors at the Three Gates as listed above. Understanding the source and synthesizing observations depends on the physician's skill.

Purple indicates Heat and Shang Han (Cold Damage). Blue indicates Convulsions (Jing Feng). White indicates Guan Disease (malnutrition/worms). Yellow indicates Spleen distress. Black often indicates bloody dysentery; if mixed with purple, thirst will increase. Chaotic veins at the Tiger Mouth indicate disharmonious Qi. Hidden red and yellow are normal; a healthy color is most desirable. Changes occur due to severe disease. Progression: Yellow becomes Red, Red becomes Purple, Purple becomes Blue, Blue becomes Black. If Black appears without mixing, medicine cannot help!

This combines color with disease diagnosis.

For children over three, pulse diagnosis can be used. Use one finger to palpate the three positions. Six to seven beats per breath is normal. Increase indicates Heat; decrease indicates Cold. Floating and Rapid pulse indicates infantile convulsion due to Wind-Heat. Empty and Soft indicates Convulsion. Tight and Solid indicates Wind-Convulsion. Wiry and Tight indicates abdominal pain. Wiry and Urgent indicates rebellious Qi. Firm and Solid indicates constipation. Deep and Fine indicates Cold. Fluctuating size indicates strange/pathological pulses. Deep or Slippery indicates retained food. Chaotic pulse with fever, sweating, anorexia, and immediate vomiting after eating indicates Bian Zheng (physiological growth fever). Floating indicates Wind. Hidden indicates accumulated matter. Single and Fine indicates Guan consumption. Shortness of breath with intermittent pulse indicates critical state. Scattered and disordered pulses are most taboo; survival is rare.

For children over three, pulse diagnosis determines the syndrome. Children are pure Yang; Yang abundance leads to rapidity, so 6-7 beats is normal. Pediatric pulse positions are narrow, so one finger is used.

All terminal syndromes are incurable: Red vessels on the eyes extending down to the pupil.

Red vessels belong to the Heart; pupils belong to the Kidney. This indicates Heart Fire overcoming Kidney Water. When water dries, it cannot generate Wood, leading to exhaustion of both Kidney and Liver.

Fontanelle swelling, accompanied by sinking (depression).

The cranial fontanelle is the gate of spirit and qi. Qi solidifies closes it; Qi deficiency opens it. All Yang converges at the head. External wind pathogens attack Yang, causing swelling. Wind attacking Yang leads to extreme Yang dispersal and exhaustion. Hence, depression indicates death.

Dry, black, and scaly nose.

The nose is the opening of the Lung. Dry Lung Metal cannot generate Kidney Water. Thus, a dry, black, and scaly nose indicates death.

Distended abdomen with visible blue veins.

Earth is overcome by Wood, leading to Spleen deficiency and impending exhaustion. Distension with visible blue veins indicates death.

Eyes staring straight ahead, unable to move.

Upward gazing (Dai Yan) indicates essence failing to rotate and looking back. This signifies exhaustion of the Tai Yang meridian.

Blue-black fingernails.

The Liver governs tendons; its bloom is in the nails. Nails are the flower of the Liver. Liver exhaustion prevents nourishment, resulting in black color.

Sudden crow-like voice.

Speech originates from the Lung (Metal), which resonates. When Lung Metal exhausts, speech becomes incoherent, sounding like a crow's caw.

Flaccid tongue retracting to the mouth floor.

The tongue is the sprout of the Heart. Heart Qi exhaustion causes the tongue to relax and fail to return.

Teeth grinding or biting.

Teeth are the surplus of bone. Kidneys store essence and govern bone. Kidney Qi exhaustion leads to teeth grinding. Heart is Yang, Kidney is Yin. Separation of Yin and Yang leads to death.

Fish-mouth breathing, gasping, crying without sound.

Fish-mouth refers to open mouth unable to close, indicating Spleen exhaustion. Gasping and silent crying indicate Lung exhaustion.

If roundworms appear, the patient is dead.

Roundworms live in the stomach, feeding on grain. When Stomach Qi exhausts and food intake stops, worms emerge.

According to the *Su Wen: Tong Ping Xu Shi Lun*: "The Emperor asked: 'An infant has heat disease, and the pulse is suspended and small. What happens?' Qibo replied: 'If hands and feet are warm, the patient lives; if cold, the patient dies.' (This summarizes internal and external signs in infants. Heat disease with suspended-small pulse is a Yang syndrome with Yin pulse, generally forbidden. But small-slow indicates mild Yang, easy recovery; small-urgent indicates severe pathogen, concerning. Small pulse with warm limbs means Yang remains in the four extremities, so life; cold limbs mean pathogen overcomes righteousness, Yuan Yang departs, so death.) The Emperor asked: 'Infant contracts wind-heat, with wheezing and shoulder-lifting respiration. What is the pulse?' Qibo replied: 'Wheezing and shoulder-lifting respiration present a Large and Solid pulse. Slow indicates life; urgent indicates death.' (This discusses external contraction in infants. Wind-heat in Yang aspect causes wheezing/shoulder-lifting; pulse should be Large/Solid. Large/slow means Stomach Qi remains, pathogen recedes, so life; Solid/urgent means True Organ pulse appears, disease advances, so death.)"

These two passages show that ancient physicians valued pulse diagnosis in infants, even immediately after birth. Why do later pediatric texts like *Shui Jing Jue* and *Quan You Xin Jian* propose observing the Three Gates? A review of the *Nei Jing* finds no such name. Only the *Ling Shu: Jing Mai Pian* mentions observing the color of the hand fish (thenar eminence), which is similar but a general diagnostic method, not exclusive to infants. Thus, the Three Gates theory is a later alias. Furthermore, these gates are superficial collaterals of the Hand-Yangming, insufficient for assessing Zang-Fu Qi. Moreover, in children, regardless of health, these veins are always purple-white mixed with blue-red. Though shades vary, the four colors are always present. How can one distinguish purple as wind, red as cold, blue as fright, white as guan? And how to distinguish thunder fright, human fright, water fright, beast fright? This theory is flawed. However, I have seen wealthy families with delicate children who cry violently upon seeing a doctor, resisting examination, sweating profusely. Parents, fearing harm from crying, look on anxiously. Recently, the habit of only checking the Tiger Mouth has become common, leading patients to view pulse diagnosis as outdated. In essence, major pediatric diseases like smallpox and measles, or miscellaneous conditions like vomiting, diarrhea, fright, and guan, always present obvious physical signs before treatment. Pulse diagnosis is unnecessary, and herbal prescriptions do not vary greatly. Thus, the Tiger Mouth method can be borrowed, regardless of ancient or modern times. I record this Tiger Mouth theory here to illustrate alternative diagnostic approaches.

The pulse's indication determines fortune or misfortune beforehand; yet flexibility and active judgment are required. Follow the syndrome and discard the pulse, or follow the pulse and discard the syndrome; if clearly distinguished, medication will be effective.

Pulse matching syndrome is the norm. However, exceptions must be known, especially in Shang Han. Floating pulse indicates Exterior; sweating is the norm. Yet sometimes purgation is indicated. Zhang Zhongjing said: "If pulse is Floating and Large, epigastric hardness, and heat, belonging to the Zang, purge it, do not sweat." This is correct. Deep pulse indicates Interior; purgation is the norm. Yet sometimes sweating is indicated. "Shao Yin disease, just acquired, with fever and Deep pulse, use Mahuang Fuzi Xixin Tang to induce slight sweating." This is correct. Cramped pulse indicates Yang; Ge Gen Qin Lian Decoction should clear it. But if Cramped pulse with cold limbs indicates collapse, moxibustion and warming are essential; this is not a Yang-excess Cramped pulse. Slow pulse indicates Cold; Gan Jiang Fu Zi Tang should warm it. But Yang Ming Slow pulse, without aversion to cold, with body sweating, requires Da Cheng Qi Tang. This is not a Yin-Cold Slow pulse. These four cases follow the syndrome, not the pulse. Those who palpate pulse without asking symptoms commit grave errors! Sweating for Exterior syndrome is the norm. Zhang Zhongjing said: "Fever, headache, Reverse Deep pulse, body pain, save the Interior with Si Ni Tang." This follows the Deep pulse. Purgation for Interior syndrome is the norm. "Afternoon fever, belongs to Yang Ming, Floating and Empty pulse, sweat with Gui Zhi Tang." This follows the Floating pulse. Fullness syndrome requires Da/Xiao Xian Xiong Tang purgation. "Floating and Large pulse, do not purge, purging leads to death." This follows the pulse to treat the Exterior. Body pain requires Gui Zhi/Ma Huang release. But "Slow Chi pulse, do not sweat, due to insufficient Ying Blood." This follows the pulse to regulate Ying. These cases follow the pulse, not the syndrome. Those who ask symptoms but ignore the pulse are sinners against Zhang Zhongjing!