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(Addition)
Huangdi said: "The Cun Kou (Cun Kou, pulse position at the wrist, reflecting interior conditions) primarily governs internal diseases, while the Ren Ying (Ren Ying, pulse position at the neck, reflecting exterior conditions) primarily governs external diseases. The two should correspond to each other, moving together and arriving together, equal in size, like a drawn rope." It is also said: "The three Yang meridians are located at the head, and the three Yin meridians are located at the hands." The *Ling Shu* states: "The Qi Kou (Qi Kou, synonymous with Cun Kou, reflecting Yin conditions) observes Yin, and the Ren Ying observes Yang. (Cun Kou is Qi Kou; it is the pulse of the Hand Taiyin Lung Meridian, thus governing diseases within. The Ren Ying pulse is located 1.5 cun on both sides of the laryngeal prominence; it is the pulse of the Foot Yangming Stomach Meridian, thus governing diseases outside. Generally, the Taiyin meridian circulates Qi among the three Yin meridians, and the Yangming meridian circulates Qi among the three Yang meridians; therefore, the Qi of the three Yang meridians is diagnosed at the Ren Ying, and the Qi of the three Yin meridians is diagnosed at the Qi Kou. What is meant by 'correspondence' is that the coming and going, large and small, are as precise as a straightened rope. Thus, Pang Anchang stated that Ren Ying and Qi Kou have the meaning of a rope drawn from the throat to the hand. Because the *Mai Jing* (Pulse Classic) designated the left side as Ren Ying and the right side as Qi Kou, it completely disregarded the Foot Yangming Stomach Meridian, which greatly contradicts the intent of the classics. Moreover, the saying 'three Yang at the head, three Yin at the hands' is also erroneous. Ren Ying refers to the pulse of the Foot Yangming Meridian; it is evident that this cannot be referred to as a hand pulse. However, there were three diagnostic methods in ancient times: one was to take the Three Regions and Nine Pulses to diagnose the pulses of the whole body; another was to take the Taiyin and Yangming pulses to diagnose Yin and Yang pulses; and the third was to take the left and right Qi Kou pulses to diagnose the Qi of the Zang-Fu organs. Zhang Jiebin said, 'When I first saw the *Mai Jing* stating that the left is Ren Ying and the right is Qi Kou, I was confused and dared not immediately refute it. Upon seeing the explanation of Ren Ying and Qi Kou in the *Ben Cao Gang Mu*, it also stated that Ren Ying is located on both sides of the laryngeal prominence and is the pulse of the Foot Yangming Stomach Meridian. I also saw Pang Anchang discuss pulses, asking, "What is Ren Ying?" and answering, "It is taken beside the throat." Recently, I saw Xu Donggao state that the *Mai Jing*'s designation of the front one-fen of the left Guan position as Ren Ying is incorrect. Seeing these views made me feel that I was a forerunner. I hereby cite them to correct this. Alas! A single error in words can mislead for a thousand years. If passed down in this manner, when will it ever be corrected? Those who establish doctrines must not fail to examine and verify details carefully. It would be better, without drawbacks, to follow Wu Caolu's practice of naming both hands as Qi Kou. Therefore, the *Nei Jing* says, "The essence and qi of the five Zang and six Fu organs all originate from the Stomach and manifest in the Qi Kou." Qi Kou is Cun Kou. It is clear that the prosperity and decline of the Zang-Fu organs and Yin-Yang cannot but be evidenced through this.') In spring and summer, the Ren Ying pulse is slightly larger; in autumn and winter, the Qi Kou pulse is slightly larger. Such a person is called a healthy individual. (Spring and summer are governed by Yang, hence the Yang pulse of Ren Ying is slightly larger; autumn and winter are governed by Yin, hence the Yin pulse of Qi Kou is slightly larger. "Slightly larger" means somewhat larger.) Leigong asked: "How do we distinguish between the worsening of a disease and its initial remission?" Huangdi replied: "Both interior and exterior must be considered. (This means both exterior and interior should be carefully examined.) If the Mai Kou (Mai Kou, synonymous with Qi Kou/Cun Kou) pulse is slippery, small, tight, and deep, the disease is worsening internally; if the Ren Ying pulse is large, tight, and floating, the disease is worsening externally. ('Yi shen' means the disease is progressing. Mai Kou is the Taiyin Qi Kou, thus called 'internal' and governing Zang diseases. Ren Ying is the Yangming Fu pulse, thus called 'external' and governing Fu diseases. A slippery, small, tight, and deep Mai Kou indicates pathogenic factors in the Yin aspect. A large, tight, and floating Ren Ying indicates pathogenic factors in the Yang aspect. Thus, both indicate daily progression of the disease.) If the Mai Kou pulse is floating and slippery, the disease progresses daily; if the Ren Ying pulse is deep and slippery, the disease diminishes daily (The Mai Kou is Yin; floating and slippery indicates Yang pathogen superimposed on Yin, hence the disease progresses daily. The Ren Ying is Yang; deep and slippery indicates the gradual retreat of Yang pathogen, hence the disease diminishes daily and gradually subsides.) If the Mai Kou pulse is slippery and deep, the disease progresses internally; if the Ren Ying pulse is slippery, vigorous, and floating, the disease progresses externally. (Mai Kou and Ren Ying correspond to the exterior and interior of the meridians; thus, whether the disease progresses due to slippery/deep or slippery/floating pulses distinguishes between internal and external locations.) If the floating and deep qualities of the pulse, as well as the sizes of the Ren Ying and Cun Kou pulses, are equal, the disease is difficult to cure. When the Ren Ying and Qi Kou pulses are equal in floating, deep, large, and small qualities, it indicates either Yang excess or Yin excess, hence the disease is difficult to cure.
[Commentary] The *Jin Fu Pian* chapter states: 'In spring and summer, the Ren Ying pulse is slightly larger; in autumn and winter, the Cun Kou pulse is slightly larger. Such a person is called a healthy individual.' The principle here can be understood. For diseases in the Zang organs, a deep and large pulse indicates easy recovery, while a small pulse indicates an adverse prognosis. For diseases in the Fu organs, a floating and large pulse indicates easy recovery. (Diseases in the Zang are Yin; Yin diseases should naturally present with a deep pulse, and a large pulse indicates sufficient Yang Qi, hence easy recovery. If a small pulse appears, it indicates depletion of True Yin, which is adverse. Diseases in the Fu are Yang; Yang diseases presenting with Yang pulses are favorable, hence a floating and large pulse indicates easy recovery. Thus, it is said: 'Yin syndromes presenting with Yang pulses survive; Yang syndromes presenting with Yin pulses die.') A Ren Ying pulse that is vigorous and firm indicates injury from Cold; a Qi Kou pulse that is vigorous and firm indicates injury from food. (Ren Ying governs the exterior; vigor and firmness indicate exogenous Cold damage. Qi Kou governs the interior; vigor and firmness indicates endogenous dietary injury. This is the ancient method. Currently, only the Cun Kou diagnostic method is used, which is not bad, but originally there was no rationale for distinguishing interior and exterior by left and right. Since Wang Shuhe began designating the left as Ren Ying and the right as Qi Kou, the loss of the meaning of exterior and interior has persisted for a long time.)