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The "reverse-guan pulse" (Fǎn Guān Mài) mentioned by the ancients merely refers to an abnormal pulse position. It does not clarify whether the observed pulse can be inferred to be similar to that of ordinary people, or if there are other differences. The answer is: All reverse-guan pulses are caused by obstruction in the pulse channel, leading to a displacement in position. Consequently, they cannot flow smoothly and freely like normal pulses. The causes of the reverse-guan pulse vary, and its manifestations are diverse. Some result from fright or falls during fetal development; some arise from binding injuries in infancy; some stem from falls damaging meridians in childhood; some are due to infantile malnutrition (Gān Jī, 疳积) excessively injuring the Liver, causing ptosis (Mù Lián, 目连) and a smaller-than-normal pulse on the left hand, resembling a reverse-guan pulse; some occur after severe fright causing loss of spirit and revival from apparent death; some affect only one hand; some affect both hands; some deviate obliquely from the Guan position to the Cun position; some appear on the medial side, ascending near the Daling (LI4) acupoint; in some cases, all six positions have threads-like pulses, yet at Yangxi (LI5) and Lieque (LU7), another pulse larger than the standard position exists; in some, no pulse is felt in standard or lateral positions but is obtained when the hand is turned over; in others, no pulse is found in the standard position due to illness, but is detected upon turning the hand over. These are all manifestations of Yin and Yang hiding within. For instance, in cold damage (Shāng Hán, 伤寒) where battle-sweat is about to occur, a hidden pulse may be mistaken for a reverse-guan pulse. Generally, reverse-guan pulses are deep and fine, accounting for eight or nine out of ten cases; those that are strong and excessive account for only two or three out of ten. Achieving a moderate balance is difficult. In some cases, all positions show small and weak pulses, except for one bead-like pulse, indicating meridian blockage at that site. Thus, a pulse finer than normal is common for reverse-guan pulses, while one larger than normal is rare. This should not be considered a bizarre variation under the fingers, nor labeled as a strange pulse (Guài Mài, 怪脉). Whenever encountering such unusual pulses, detailed inquiry is necessary. If slightly larger than usual, it indicates excess pathogenic factors; if smaller than usual, it indicates deficiency of Qi. These findings must be correlated with other clinical signs.

A disciple asked: The Renying (人迎) pulse governs the exterior, and the Qikou (气口) pulse governs the interior. Li Dongyuan discussed this in detail in his *Differentiation of Internal Injury*. However, Shengqidong further stated that the prognosis of new diseases depends on the Guan pulse of the right hand, while the prognosis of chronic diseases depends on the Guan and Chi pulses of the left hand. I do not fully understand this concept and wish to hear the rationale. The response was: Diseases have new and old stages, and syndromes have favorable and unfavorable courses. In new diseases, grain Qi remains intact, so the Stomach pulse should naturally be harmonious and slow. Even if enlarged by pathogens or reduced by deficiency, the rate and rhythm must be distinct, forceful upon palpation, and not turbid or chaotic. Additionally, clear speech and good appetite indicate unharmed Stomach Qi; even severe cases can be treated. If the pulse is turbid, rhythm unclear, consciousness clouded, speech disordered, and disease Qi restless, this indicates loss of mental mastery. Unless it is a detoxification reaction (Míng Xuàn, 瞑眩) from strong pathogens, such signs are inappropriate. The Classics state: A floating and slippery pulse indicates a new disease; a small and choppy pulse indicates a long-standing disease. Therefore, sudden collapse of form in a new disease leads to death; muteness also indicates death. Open mouth, closed eyes, relaxed hands, panting, sweating, and urinary incontinence are untreatable. If in a new disease, pulses in all positions vanish but the middle position remains, this signifies preserved Stomach Qi, and treatment will surely succeed. In chronic diseases, if the left Guan and Chi pulses are weak but spirited upon palpation, it suggests essence and blood are not yet exhausted. Although other positions are critical, recovery is possible. If the Chi pulse is wiry, tight, rapid, and pounding against the fingers, or thread-like and nearly absent, the condition is untreatable. This is because Stomach Qi declines in long-standing diseases, and one must then examine the Chi pulse, which represents the root Qi of congenital constitution. Shengqidong also said: When detecting a floating pulse, strength in the Chi position indicates reliable congenital Kidney Water, ensuring safety in releasing the exterior. When detecting a sunken pulse, strength in the right Guan position indicates reliable postnatal Spleen and Stomach, ensuring safety in purging downward. These statements complement each other; though the wording differs, the principle is the same.