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The pulse of the human body is rooted in Ying (Nutritive Qi) and Wei (Defensive Qi). Ying is Yin Blood, while Wei is Yang Qi. Ying circulates within the vessels, and Wei circulates outside the vessels. The vessels do not beat on their own; they move with the Qi. Qi moves, and the pulse responds, embodying the principle of Yin and Yang.

Qi is like a bellows, and blood is like waves. The Qi of the blood vessels circulates up and down continuously. In the twelve meridians, there are arterial pulses, but the pulse of the Hand-Taiyin Lung Meridian can be examined through respiration. This meridian belongs to the Lung and connects upward to the throat. The great convergence of the pulse corresponds to the inhalation and exhalation of breath.

When initially examining the pulse, instruct the patient to hold their palm upward. The high bone behind the wrist is called the Guan (Cuff/Bar). The area anterior to the Guan is Yang (Cun/Inch), and the area posterior to the Guan is Yin (Chi/Cubit). The Yang position corresponds to Cun, and the Yin position corresponds to Chi; they are distinguished by sequential palpation. The Cun, Guan, and Chi positions are present in both hands. After locating the high bone, palpate above, below, and to the sides. The pulse characteristics are generally the same for men and women, except for the Chi position. If Yang is weak and Yin is excessive, or vice versa, it indicates disease.

During pulse diagnosis, regulate your own breathing. A normal, healthy pulse beats four to five times per complete respiratory cycle (one Xi). Three beats per cycle constitute a Chi (Slow) pulse, which indicates Cold syndromes. Six beats per cycle constitute a Shu (Rapid) pulse, which indicates Heat syndromes. The slower the pulse, the colder the condition; the faster the pulse, the hotter the condition. This requires careful observation and differentiation by the practitioner.

Once Slow or Rapid is determined, differentiate between Fu (Floating) and Chen (Sinking) pulses. Fu indicates Exterior syndromes, while Chen indicates Interior syndromes; their depth must be assessed carefully. A Fu-Shu pulse indicates Exterior Heat; a Chi-Shu pulse indicates Interior Heat; a Fu-Chi pulse indicates Exterior Deficiency; a Chen-Chi pulse indicates Cold accumulation. Observe the six pulse positions to locate the pathology precisely.

Each position corresponds to two meridians, one Zang organ, and one Fu organ. The Left Cun position belongs to the Heart and pairs with the Small Intestine; the Guan position belongs to the Liver and Gallbladder; the Chi position belongs to the Kidney and Bladder. The Right Cun position governs the Lung and pairs with the Large Intestine; the Guan position belongs to the Spleen and Stomach; the Chi position belongs to the Mingmen (Gate of Life) and Sanjiao (Triple Burner).

Beyond organs, different body parts also correspond to pulse positions. The body is divided into Upper, Middle, and Lower sections, corresponding to Cun, Guan, and Chi respectively. The Cun position diagnoses the chest and above; the Guan position diagnoses from below the diaphragm to the abdomen; the Chi position diagnoses from the umbilicus down to the heels and ankles. The Left pulse primarily reflects the left side of the body, and the Right pulse primarily reflects the right side. Pathological changes occur where the disease resides, while unaffected areas remain normal.

The Fu, Chen, Chi, and Shu pulses have both External and Internal causes. External causes stem from nature, including Yin-Yang dynamics, wind, rain, darkness, and brightness. Internal causes stem from human emotions, specifically the Seven Emotions: joy, anger, worry, thought, sadness, fear, and fright.

An External cause manifesting as a Fu pulse indicates an Exterior syndrome; a Chen pulse indicates Interior pathology; a Chi pulse indicates Cold; a Shu pulse indicates Excessive Heat. An Internal cause manifesting as a Fu pulse is often due to Deficient Wind; a Chen pulse indicates Qi stagnation; a Chi pulse indicates Cold; a Shu pulse indicates restlessness. To distinguish between External and Internal causes, and to identify patterns such as Exterior/Interior, Cold/Heat, Wind, Cold, and Dryness, one must reference both pulse and symptoms.

Fu and Chen pulses also have specific organ associations. Fu pulses mainly correspond to the Heart and Lung; Chen pulses mainly correspond to the Kidney and Liver. The Spleen resides in the Middle Earth (central region) and lies between Fu and Chen depths. When palpating, light pressure equivalent to three bean weights feels the Lung pulse at the skin level; moderate pressure equivalent to six bean weights feels the Heart pulse in the blood vessels; heavier pressure equivalent to nine bean weights feels the Spleen pulse in the muscles; deep pressure equivalent to twelve bean weights feels the Liver pulse in the tendons. Only the Kidney pulse sinks to the extreme, requiring palpation down to the bone, where it responds swiftly upon lifting the finger.

Although pulse theory is vast, it can be summarized into four basic types. Chapters 6 and 7 of the *Nan Jing* (Classic of Difficult Issues) elaborate on these meanings. Subdivided, there are Seven Superficial (Biao), Eight Interior (Li), and Nine Distinct types, covering all names.

A Fu pulse that is forceless is called Kou (Hollow); if forceful, it is Hong (Surging), recognizable by its shape. A Chen pulse that is forceful is Shi (Full); if forceless and weak, it is Fu (Hidden), which is the extreme of sinking. A Chi pulse that is forceful and smooth is Hua (Slippery); if forceless, slow, and choppy, it falls into the category of Tui (Retreating/Sluggish). A Shu pulse that is forceful is Jin (Tight); small and tight is Xian (Wiry); similar appearances require careful scrutiny.

Combining these yields four basics; separating them yields seven or eight variations. These are secrets of heaven and divine teachings. A pulse that feels abundant when lifted but deficient when pressed is Fu. It floats superficially, like wood drifting on water. What does the Kou pulse resemble? Like a green onion stalk; under the fingers, it feels hollow, with edges but no center. The Hua pulse resembles a bead, rolling back and forth. Abundant upon both lifting and pressing characterizes the Shi pulse.

Xian resembles a drawn bowstring; Jin resembles a thin thread. Hong is larger and stronger than Fu. Faint and elusive, difficult to find, absent on lifting but present on pressing defines the Chen pulse. Slower than Chi but not quite Chi is Huan (Lax). Choppy and short, like rain soaking into sand, is Se (Choppy). Chi is extremely slow; Fu is pressed to the bone. Ru (Soggy) is soft; Ruo (Weak) is fleeting. Having understood the Seven Superficial and Eight Interior pulses, one must memorize the shapes of the Nine Distinct types.

Various schools differ in selecting among the Nine Distinct types; none should be entirely discarded, yet they may complement each other. Extending beyond the standard position with mutual traction is Chang (Long); falling short is Duan (Short). Irregular coming and going with large form but weak force indicates Deficiency. Cu (Hasty) and Jie (Knotted) pulses both feature pauses. Cu is rapid with pauses; Jie is slow with pauses; Dai (Intermittent) pauses are different and difficult to recover from. All three feature pauses, requiring meticulous examination. Lao (Firm) is harder and stronger than Xian and Jin. Dong (Agitated) pulses shake and are unstable. Xi (Fine) is like a single thread, small but forceful. Ge (Leather) is large, empty, and hollow. San (Scattered) pulses are diffuse and uncollected. Rapid and swift is Shu. Pulse diagnosis is straightforward; identifying disease through pulse reveals all pathologies.

Referencing disease alongside pulse allows judgment of life and death. However, some pulses match the disease, while others do not; this must be studied carefully and not applied rigidly. "Person healthy, pulse diseased" is called "Walking Corpse"; "Person diseased, pulse harmonious" guarantees safety without danger.

Stroke (Zhong Feng) presents with a Fu pulse; combined with Hua indicates Phlegm-Qi. If Chen-Hua, do not treat as Wind. Whether Fu or Chen, if Micro and Weak, rescue the critical state by warming and resolving Phlegm; do not lightly disperse Wind. Cold invading the Taiyang meridian presents with Fu-Jin-Se pulses. Upon transmission and transformation, symptoms vary widely. Yangming meridian pulses are Long; Shaoyang are Xian; Taiyin entering the interior combines Chi and Chen. Entering Shaoyin, the pulse becomes Jin. In Jueyin with deep heat, the pulse is Fu with cold extremities.

For Exterior conditions, induce sweating; then promote urination. If the Exterior is resolved but Interior pathology remains with a Shi-Jian pulse, this is a general guideline. For major principles, rely on Zhang Zhongjing. There are five types of Shanghan (Cold Damage), with diverse pulses. Yin and Yang both excess with Jin-Se indicates Cold; Yang Fu-Hua and Yin Ru-Ruo indicates Zhong Feng (Wind Strike); avoid Cold-natured herbs. Yang Ru-Ruo and Yin Xiao-Ji indicates not Wind-Cold, but Shi Wen (Damp-Warmth).

Yin and Yang both excess indicates extreme Heat. Fu-Hua and Chen-San-Se indicates only Warm Disease (Wen Bing), where pulses scatter across meridians according to location, making specific naming difficult. Summerheat injures Qi, resulting in a Xu (Deficient) pulse. Xian, Xi, Kou, and Chi cover various forms. Se, Xi, Ru, or Huan all indicate Dampness invasion.

Malaria pulses are naturally Xian; Xian-Chi indicates more Cold; Xian-Shu indicates more Heat, changing with time. Wind, Cold, and Dampness combining create Bi (Obstruction) syndromes, presenting with Fu-Se-Jin pulses. Foot Qi (Hong Kong Jiao) has four presentations: Fu-Xian for Wind, Ru-Ruo for Dampness, Chi-Se for Cold, Hong-Shu for Heat郁 (Stagnation).

Wind treated with sweating; Dampness with warming; Heat with purging; Cold with moxibustion/warming. Waist pain pulses are generally Chen-Xian. Combined Fu indicates Wind; combined Jin indicates Cold; Ru-Xi indicates Dampness; Shi indicates sprain/trauma. Clear finger identification ensures accurate treatment.

Weak Chi pulses with Huan-Se-Jin indicate foot pain or Wei (Atrophy) syndromes. Se indicates Blood deficiency with severe Cold reversal. Micro Chi indicates Yin deficiency, leading to dysentery and cold extremities. Heat reversal presents with Fu pulses, occasionally Shu. Constipation is difficult to treat; errors are dangerous. Hernia pulses are Xian-Ji, indicating internal accumulation. Lao-Ji indicates survival; Ruo-Ji indicates death. Chen-Chi-Fu-Se indicates Hernia-Zha (masses) and Cold pain. Severe pain leads to Fu pulses, or Xi/Dong.

Wind, Cold, Summerheat, and Dampness causing Qi stagnation and Saliva-Phlegm, with lower Deficiency and upper Excess, lead to dizziness and vertigo. Wind presents Fu; Cold presents Jin; Dampness presents Xi; Summerheat presents Xu; Saliva-Phlegm presents Xian-Hua; Deficiency presents empty pulses. Treating vertigo requires careful scrutiny: first resolve Phlegm-Qi, then treat symptoms. Hua-Shu indicates vomiting; Dai indicates Huoluan (Colic/Vomiting-Diarrhea). Micro-Hua indicates survival; Se-Shu indicates凶 (ominous/death). Pian Xian indicates Fluid retention (Yin); Chen-Xian-Hua, Jie, or Fu also indicate Phlegm-Fluid affecting cough.

Exterior Wind presents Fu; Cold presents Jin; Heat presents Shu; Dampness presents Xi. Sexual exhaustion presents Se-difficulty. Right Guan Ru indicates dietary injury to the Spleen. Left Guan Xian-Duan indicates liver exhaustion from fatigue. Fu-Duan indicates Lung injury, necessitating cough treatment. Coughs of the five Zang organs depend on their respective positions. Fu-Jin-Xu-Cold; Chen-Shu-Shi-Heat. Hong-Hua indicates much Phlegm; Xian-Se indicates little Blood. Robust body with fine pulse unable to sustain breath, or Chen-Shao/Fu-Ni, are all Death pulses. Only Fu-Da with cough indicates survival. Correlate external signs with internal pulses.

Deep pulse indicates Qi disorder. Extreme Deep is Fu; Se-Ruo is hard to treat. Chen-Hua indicates Qi combined with Phlegm-Fluid. Chen-Xian-Xi-Dong all indicate Qi-Pain syndromes. Heart pain at Cun; Abdominal pain at Guan; Lower body pain at Chi. Palpitations always show Dai-Jie pulses. Dietary palpitations show Chen-Fu-Dong-Hua. Epilepsy pulses are Fu-Hong-Da-Chang. Hua-Da-Jian-Ji indicates Phlegm accumulating in the Heart causing madness. Fluctuating size/length indicates Evil pulses and mental confusion. Sweating shows Fu-Xu, or Se/Ru. Soft-Scattered-Hong-Da with thirst indicates fluid loss. Nocturnal emission and white turbidity are verified at Chi. Jie-Kou-Dong-Jin confirm these two conditions. Yellow nose tip indicates difficult urination. Fu-Xian-Se indicates urinary retention. Hematochezia shows Kou; Shu indicates red/yellow urine. Shi pulse indicates strangury with Heat in the Bladder. All hemorrhagic conditions show Kou pulses; check upper/lower to locate bleeding. Generally, for hemorrhage, Shen-Xi (Deep-Fine) is precious. Fu-Da suggests difficult treatment later.

Edema has Yin and Yang types. Observe pulse, color, and symptoms in detail. Yin Edema: Chen-Chi pulse, blue-white complexion, no thirst, diarrhea, clear/difficult urination. Yang Edema: Chen-Shu pulse, red-yellow complexion, dry stool, red urine, accompanied by thirst. Distension with Xian pulse indicates Liver controlling Spleen. Hong-Shu indicates Heat distension; Chi-Ruo indicates Cold distension. Fu indicates false fullness; Jin indicates solid interior. Fu is treatable; Xu is critical. Chest oppression with Hua pulse indicates Phlegm knotting. Xian-Fu also indicates oppression; Se indicates poor Qi.

Liver accumulation (Fei Qi) is Xian-Xi with blue color. Heart accumulation (Fu Liang) is Chen-Kou with red color. Spleen accumulation (Pi Qi) is Fu-Da-Chang, yellow earth color. Lung accumulation (Xi Ben) is Fu-Mao with white color. Ben Tun belongs to Kidney, showing Chen-Ji pulse with black face. Five Zang accumulations are Ji; Six Fu aggregations are Ju. Ji stays in fixed locations; Ju moves. Jin-Fu-Lao-Xiao-Chen-Shi, or Jie-Fu, indicate Ju or Ji. Strong/Shi indicates survival; Small/Chen indicates death. Same disease, different pulses determine life/death.

Qikou (Radial artery at wrist) tight/excessive indicates food injury. Undigested food shows Fu-Hua-Ji. Uneven Hua indicates vomiting/diarrhea, Huoluan syndrome. Dai pulse is not alarming. Summer diarrhea matches Summerheat-Dampness: Hong pulse with frequent urination, extremely Xu pulse. Treat Summerheat-Damp diarrhea by separating fluids via urination. For collapse, secure intestines; recovery is certain. Dysentery without [specific symptom]: pulse should be Hua-Da. Fu-Xian-Ji indicates death; Chen-Xi is harmless. Five Jaundices with Excess-Heat show Hong-Shu pulses. Micro-Se indicates weakness. Bone-steaming consumption shows Shu-Xu pulse. Heat with Se-Xiao indicates death. Sweat plus cough cannot be cured by medicine alone.

Headache with Yang Xian: Fu for Wind, Jin for Cold. Wind-Heat shows Hong-Shu; Warmth shows Xi-Jian. Qi-deficiency headache is Xian-Se even if Xian. Phlegm-Jue shows Hua; Kidney-Jue shows Jian-Shi. Carbuncles/Furuncles show Fu-Shu with chills/fever. Painful location indicates carbuncle origin. Shu pulse with fever and pain indicates Yang sore; non-Shu/non-hot/painless indicates Yin sore. Carbuncle onset shows Xian-Hong interacting; Fine-Chen-Hua indicates Lung/Liver Shu. Cun-Shu-Shi indicates Lung Abscess formed; Cun-Shu-Xu-Se indicates Lung Withering. Lung Abscess color white, pulse should be Duan-Se. Death shows Fu-Da; not white but red indicates severity. Intestinal abscess is hard to know; Hua-Shu can deduce it. Shu without heat confirms intestinal abscess. Chi-Jin before pus formation requires purging; Hong-Shu after pus formation advises against purging.

Yin pulsates below, Yang differs above; harmonious Blood-Qi indicates pregnancy. Hand-Shaoyin pulse moves strongly. Uninterrupted Chi Chen indicates pregnancy. Shaoyin belongs to Heart, which governs Blood-Vessels. Bones are the womb gate; pulse responds at Chi. If Cun is Micro, Guan is Hua, Chi is Shu, flowing smoothly like a sparrow pecking. Or examine three positions: Fu/Chen pause once. Or Ping/Xu, ask about menstruation. Gender distinction by left/right: Left rapid is Male, Right rapid is Female. Chen-Shi on Right, Fu-Da on Right. Right Female, Left Male, can be relied upon.

Li Jing (departing from normal) six beats, Chen-Xi-Hua with labor pains connecting to waist indicates imminent delivery. Blood mass (Xia) is Xian-Ji; large indicates survival. Xu-Xiao-Ruo indicates death form. Miscarriage and leakage dominated by Ge pulse. Ruo indicates Blood depletion, immediate danger.

Pediatric pulse diagnosis prioritizes Fu/Chen. Fu indicates Exterior, Chen indicates Interior, revealing the source. Size, Hua/Se, Xu/Shi, Chi/Shu allow assessment based on pulse form. Generally, women and infants follow adult rules, except for female pregnancy/birth/blood issues, and pediatric convulsions/rickets/developmental fevers, which have distinct methods differing from males. Knowing women and children requires recognizing symptom forms. Detailed inquiry is primary; pulse alone is insufficient. Inspection, Auscultation/Olfaction, Inquiry, and Palpation constitute the Divine, Profound, Skillful, and Ingenious arts. The foolish see only pulses; the wise understand clearly. This covers the basics of disease-pulse diagnosis.

Regarding holding the pulse, one must know: Spring is Xian (Wiry); Summer is Gou (Hook); Autumn is Mao (Feather); Winter is Shi (Stone). Excessive strength indicates Exterior disease; Deficiency indicates Interior disease. These four pulses vary by season, all rooted in Stomach Qi. What is Stomach Qi? It is the harmony and balance of the pulse. Excess or deficiency is deviation.

Spring governs Liver Wood; Summer governs Heart Fire. Spleen Earth peaks in Late Summer. Autumn governs Lung Metal; Winter governs Kidney Water. Five Zang pulses correspond to the Five Movements. Liver pulse is Xian-Chang, gentle and soft; seeking under fingers feels like touching elm leaves. Hardening and smoothing like touching a long pole indicates Excess. Liver disease: tight like a bowstring, cutting like a knife, pressing like a zither. Liver death pulse: Fu-Da like scattered fibers. Heart health: peaceful and safe, round like a ring, smooth like jade. Heart disease: increasingly rapid, like a chicken lifting its feet. Heart death: hook-like, squatting rear, bent front.

Lung pulse: Fu-Se-Duan, light like a canopy. Normal lung pulse is smooth. Pressing makes it larger. Disease feels like touching feathers, neither rising nor falling. Death pulse: fading like blowing hair. Kidney pulse: Chen-Ru-Hua, large top/small bottom. Disease pulse: pecking like a sparrow, continuous but slightly curved. Death pulse: unraveling rope, shooting stone. Recognize these states.

Spleen is Central Earth, peaceful and unseen, but observable. Large middle and slow, coming like sparrow pecking or dripping water, indicates Spleen decline. Body types matter: fat/slim, tall/short. Fat pulses sink; slim pulses float. Short pulses are rapid; long pulses are sparse. Diagnosis varies by type, not uniform. Intent is hard to exhaust; principles are hard to穷 (reach). Grasped in heart, responded by fingers. Encourage students to recite daily. The mystery of the Dao.