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Lei Gong asked, "The chapter 'Wai Chuai' states that the myriad phenomena are 'condensed into one,' but I do not understand what this means. May I ask how to summarize it?" The Yellow Emperor replied, "The Cun Kou (Cun Kou pulse, located at the radial artery of the wrist) primarily reflects the interior (Zang organs), while the Ren Ying (Ren Ying pulse, located at the carotid artery) primarily reflects the exterior (Yang meridians). The two should correspond with each other, moving together as if they were a single taut rope, equal in size. 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 Ping Ren (healthy person). If the Ren Ying pulse is one times larger than the Cun Kou pulse, the disease is in the Shaoyang (Lesser Yang) meridian; two times larger, in the Taiyang (Greater Yang) meridian; three times larger, in the Yangming (Bright Yang) meridian. A full pulse indicates heat; a deficient pulse indicates cold; a tight pulse indicates painful obstruction (Tong Bi); a choppy or intermittent pulse (Dai Mai) indicates fluctuating severity. For a full pulse, use draining (Xie); for a deficient pulse, use tonifying (Bu). For a tight pulse, treat at the muscle spaces (Fen Rou); for a choppy pulse, treat at the blood collaterals (Xue Luo) and administer herbal medicine. For a sunken pulse, apply moxibustion. For neither full nor deficient pulses, treat by selecting points on the affected meridian directly, which is called Jing Ci (Meridian Needling). If the Ren Ying pulse is four times larger, it is called Wai Ge (External Grid). Wai Ge presents with a large and rapid pulse. This indicates death and is incurable. One must carefully examine the root and branch, observe cold and heat, to verify the diseases of the Zang and Fu organs. If the Cun Kou pulse is one time larger than the Ren Ying pulse, the disease is in the Jueyin (Terminal Yin) meridian; two times larger, in the Shaoyin (Lesser Yin) meridian. A full pulse causes distension and fullness; a cold pulse causes indigestion; a deficient pulse causes internal heat, vomiting of eroded material, shortness of breath, and changes in urine color. A tight pulse indicates painful obstruction; a choppy pulse indicates alternating cold and heat, with heat below and cold above (Tai Su records: 'a choppy pulse indicates alternating pain and cessation'). For a full pulse, use draining; for a deficient pulse, use tonifying. For a tight pulse, needle first then apply moxibustion; for a choppy pulse, puncture blood collaterals then regulate (Tai Su records: 'drain') them. For sunken pulses, apply moxibustion. Sunken pulses indicate blood stasis in the middle jiao; since blood stagnation leads to cold, moxibustion is appropriate. For neither full nor deficient pulses, treat by selecting points on the affected meridian directly. If the Cun Kou pulse is four times larger, it is called Nei Guan (Internal Closure). Nei Guan presents with a large and rapid pulse, indicating death and incurability. One must carefully examine the root and branch, observe cold and heat, to verify the diseases of the Zang and Fu organs, unblock the Ying-Spring and Shu-Stream acupoints, and thereby grasp the general principles. A large pulse indicates excess, so drain; a small pulse indicates deficiency, so tonify. A tight pulse requires moxibustion and needling, along with herbal medicine. A sunken pulse requires moxibustion. Neither full nor deficient pulses require direct meridian treatment. This so-called 'Jing Zhi' (Meridian Treatment) involves herbal medicine, moxibustion, and needling. An urgent pulse requires drawing out tension; a choppy pulse (or another version: large and weak) requires quietude, avoiding exertion.

The Yellow Emperor asked, "How can we distinguish between worsening conditions and gradually declining conditions?" Qi Bo replied, "Both occur internally and externally. If the Cun Kou pulse is slippery, small, tight, and deep, the disease is worsening and located in the interior; if the Ren Ying pulse is large, tight, and floating, the disease is worsening and located in the exterior. If the Cun Kou pulse is floating and slippery, the disease progresses daily; if the Ren Ying pulse is deep and slippery, the disease improves daily. If the Cun Kou pulse is slippery and deep, the disease progresses internally; if the Ren Ying pulse is slippery, full, and floating, the disease progresses externally. If the floating/sinking nature of the pulse and the sizes of the Ren Ying and Cun Kou pulses are equal, the disease is difficult to cure. For diseases in the Zang organs, a deep and large pulse indicates easy recovery, while a small pulse is adverse. For diseases in the Fu organs, a floating and large pulse indicates easy recovery. A full and tight Ren Ying pulse indicates injury from cold; a full and tight Cun Kou pulse indicates injury from food. A slippery, large, choppy, and long pulse indicates disease coming from outside. Visual perceptions and mental fixations indicate the merging of Yang qi, which can be altered. Question: What defines a healthy person? Answer: When a person exhales, the pulse beats twice; when they inhale, the pulse beats twice. During the pause between breaths, the pulse beats five times, occasionally beating six times due to a deep sigh (Tai Xi). This is called a healthy person. A healthy person is one without disease. We often use the pulse of a healthy person to calibrate the patient's pulse. Since the physician is healthy, they use their own calm breathing to measure the patient. If the pulse beats once per exhalation and once per inhalation, it is called Shao Qi (Deficient Qi). If the pulse beats three times per exhalation and is rapid, with heat in the Chi area (wrist), it is a Wen Bing (Warm Disease); if the Chi area is not hot but the pulse is slippery, it is a Feng Bing (Wind Disease) (Su Wen records: 'a涩 [rough] pulse indicates Bi Syndrome'). If the pulse beats more than four times per exhalation, it indicates death; if the pulse ceases completely, it indicates death; if the pulse is irregularly slow and fast, it indicates death. Humans derive Qi from the Stomach; the pulse is rooted in Stomach Qi. Without Stomach Qi, it is Ni (Rebellious), and Ni leads to death. Holding the Cun Kou pulse and counting its beats: fifty beats without a single choppy beat indicate that all five Zang organs have received Qi. Forty beats with one choppy beat indicate one Zang organ lacks Qi; thirty beats with one choppy beat indicate two Zang organs lack Qi; twenty beats with one choppy beat indicate three Zang organs lack Qi; ten beats with one choppy beat indicate four Zang organs lack Qi; less than ten beats with one choppy beat indicate all five Zang organs lack Qi. This allows us to predict the short-term prognosis. The key lies in the beginning and end. Fifty beats with one choppy beat is considered normal, used to determine the lifespan of the Zang organs. Predicting a short life involves an irregularly slow and fast pulse.

The Liver pulse is Xian (String-like); the Heart pulse is Gou (Hook-like); the Spleen pulse is Dai (Intermittent); the Lung pulse is Mao (Feather-like); the Kidney pulse is Shi (Stone-like).

When the Heart pulse arrives, it comes continuously like pearls, smooth like touching Langgan jade; this is a Ping Pulse (Normal Pulse). If it comes continuously but curves slightly within, it is a Disease Pulse. If it hooks forward and stays fixed backward, like holding a belt hook, it is a Death Pulse.

When the Lung pulse arrives, it is gentle and light, like touching elm leaves; this is a Ping Pulse. If it is neither rising nor falling, like touching chicken feathers, it is a Disease Pulse. If it floats like an object or blows like wind-blown feathers, it is a Death Pulse.

When the Liver pulse arrives, it is soft and swaying, like the tip of a long bamboo pole held aloft; this is a Ping Pulse. If it is full, solid, and slippery, like touching the length of a bamboo pole, it is a Disease Pulse. If it is rapid and stiff, like a newly strung bowstring, it is a Death Pulse.

When the Spleen pulse arrives, it is harmonious and distinct, like the foot of a chicken stepping on the ground; this is a Ping Pulse. If it is solid, full, and rapid, like a chicken lifting its foot, it is a Disease Pulse. If it is sharp and hard like a bird's beak or claws, or like water leaking from a roof or flowing away, it is a Death Pulse.

When the Kidney pulse arrives, it comes rapidly and continuously like a Hook pulse, firm upon pressure; this is a Ping Pulse. If it arrives like pulling on a vine and becomes firmer upon pressure, it is a Disease Pulse. If it feels like ropes being pulled apart, or crackles like stones being struck, it is a Death Pulse.

A deficient and floating Spleen pulse resembles the Lung pulse; a small and floating Kidney pulse resembles the Spleen pulse; a rapid, deep, and scattered Liver pulse resembles the Kidney pulse.

Question: Why does seeing the True Zang Pulse indicate death? Answer: The five Zang organs all derive Qi from the Stomach; the Stomach is the root of the five Zang organs. Zang Qi cannot reach the Hand-Taiyin (Lung) meridian on its own; it must rely on Stomach Qi to arrive there. Thus, each Zang organ, in its respective season, relies on Stomach Qi to reach the Hand-Taiyin. When pathogenic factors prevail, essential Qi declines. In severe disease, Stomach Qi cannot accompany the Zang Qi to the Hand-Taiyin, so the True Zang Qi appears alone. Appearance of isolated True Zang Qi means the disease has overcome the Zang organ, hence death.

Spring pulse corresponds to the Liver, East Wood, the time when all things begin to grow. Its Qi is soft, light, empty, slippery, straight, and long, hence called Xian (String-like). Deviation from this indicates disease. If the Qi arrives solid and strong, this is Excess (Tai Guo), disease in the exterior; if the Qi arrives not solid and weak, this is Deficiency (Bu Ji), disease in the interior. Excess causes forgetfulness, dizziness, vertigo, and epilepsy; Deficiency causes chest fullness (or pain) radiating to the back, and below, hypochondriac fullness.

Summer pulse corresponds to the Heart, South Fire, the time when all things flourish and grow. Its Qi arrives strong and departs weak, hence called Gou (Hook-like). Deviation from this indicates disease. If the Qi arrives strong and departs strong, this is Excess, disease in the exterior; if the Qi arrives weak but departs strong, this is Deficiency, disease in the interior. Excess causes body heat and bone pain (or skin pain), leading to spreading sores; Deficiency causes vexation, coughing and spitting upwards, and gas leakage downwards.

Autumn pulse corresponds to the Lung, West Metal, the time when all things are harvested. Its Qi is light, empty, and floating, arriving rapidly and dispersing, hence called Fu (Floating). Deviation from this indicates disease. If it arrives feather-like but is firm in the center and empty on the sides, this is Excess, disease in the exterior; if the Qi is feather-like but weak, this is Deficiency, disease in the interior. Excess causes rebellious Qi and back pain, with a sense of oppression; Deficiency causes panting, shortness of breath, cough, hemoptysis upwards, and pathological sounds heard downwards.

Winter pulse corresponds to the Kidney, North Water, the time when all things are stored. Its Qi is deep and moist (Su Wen records: 'pulsating'), hence called Ying (Nourishing/Internal). Deviation from this indicates disease. If the Qi arrives like striking stones, this is Excess, disease in the exterior; if it departs like a rapid pulse, this is Deficiency, disease in the interior. Excess causes flaccidity, spinal pain, shortness of breath, and reluctance to speak; Deficiency causes a feeling of emptiness in the heart as if hungry. (Su Wen adds below: coldness in the abdomen, spinal pain, lower abdominal fullness, and reddish-yellow urine).

The Spleen pulse belongs to Earth, the solitary Zang organ, which irrigates the four surrounding organs. Its healthy manifestation is not visible; only its pathological manifestations are visible. If the pulse flows like water, this is Excess, disease in the exterior; if it is like a bird's beak, this is Deficiency, disease in the interior. Excess causes inability to lift the limbs; Deficiency causes obstruction of the nine orifices, named Chong Qiang (Heavy Rigidity).