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San Yang (Triple-Heater/Yang Brightness/Greater Yang channels) serves as the main trunk of the meridians, Er Yang (Yang Brightness channel) serves as the maintaining vessel, and Yi Yang (Shaoyang/Gallbladder channel) serves as the wandering part. San Yang refers to Taiyang (Greater Yang), where the pulse reaches the Hand-Taiyin Lung meridian; it is wiry, floating but not sinking, judged by standards, observed with the mind, and aligned with Yin-Yang theory. Er Yang refers to Yangming (Yang Brightness), where the pulse reaches the Hand-Taiyin Lung meridian; it is wiry, deep, rapid, and lacks vigorous beating (weak impulse); if heat arrives excessively, it indicates a fatal condition. Yi Yang refers to Shaoyang (Lesser Yang), where the pulse reaches the Hand-Taiyin Lung meridian and connects upward to the Renying point (ST 9); it is wiry, rapid, and suspended like an unbroken thread; this is a disease of the Shaoyang channel, and if it combats with Yin pulses, it indicates death.

San Yin (Three Yin channels) are the masters of the Six Meridians, intersecting with Taiyin; the pulse is deep, beating without floating, and its qi ascends to the heart. Er Yin (Shao Yin) reaches the lungs, its qi returns to the Bladder, and externally connects to the Spleen and Stomach. Yi Yin (Jue Yin) alone arrives; the meridian qi is severed, floating without beating, with a hook-like and slippery quality. These six pulses alternate between Yin and Yang, interweaving and merging, intricately connecting the Five Zang organs, and harmonizing with Yin and Yang. The one arriving first is the "Master," and the one arriving later is the "Guest." San Yang is like a father, Er Yang like a guard, Yi Yang like a discipline; San Yin is like a mother, Er Yin like a female, Yi Yin like a solitary messenger.

When Er Yang (Yangming) and Yi Yin (Jueyin) coexist, if Yangming dominates and the Spleen is diseased, unable to restrain Yi Yin, the pulse becomes soft and moving, causing all nine orifices to sink and obstruct. When San Yang (Taiyang) and Yi Yin (Jueyin) coexist, if the Taiyang pulse prevails and Yi Yin cannot stop it, internal chaos ensues in the Five Zang organs, and externally there is fright and terror. When Er Yin (Shaoyin) and Er Yang (Yangming) coexist, the disease is in the Lungs; if the Shaoyang (or Shaoyin per variant) pulse is deep and prevails, damaging the Lungs and Spleen, the extremities are injured externally. When Er Yin and Er Yang pulses both arrive intermixed, the disease is in the Kidneys; the patient curses and acts wildly, developing Mania (Dian Kuang). When Er Yin and Yi Yang coexist, the disease originates from the Kidneys; Yin Qi lodges in the Heart, blocking the empty spaces below the epigastrium, leading to separation and weakness of the four limbs. When Yi Yin and Yi Yang show intermittent absence (Dai Jue), Yin Qi reaches the Heart; the pulse varies unpredictably, entering and exiting without awareness, with dry throat and pharynx; the disease is in the Earthly Spleen.

When Er Yang and San Yin coexist, the Zhì Yin (Ultimate Yin) qi is present; if Yin cannot overcome Yang, and Yang cannot restrain Yin, and both Yin and Yang pulses cease, a floating pulse indicates Blood Mass (Xue Jia), while a deep pulse indicates Abscess (Nong Yu). When San Yang pulses arrive exclusively, it means the three Yang meridians merge; their arrival is like wind and rain, causing Mania above and bleeding leakage below. San Yang is the Ultimate Yang; accumulation and merging cause fright; the disease arises like wind and thunder, blocking all nine orifices, with overflowing Yang Qi, dry throat, and blocked pharynx. If merging into Yin, the pulse varies unpredictably, pressing into the intestines causing Dysentery (Chang Pi). This is called San Yang directly affecting the Heart; the patient cannot sit up or lie down comfortably, feeling heavy-bodied; this is a disease of San Yang.

The Yellow Emperor asked: How do pulses move according to the four seasons? Qibo replied: Within the six directions, changes of heaven and earth, responses of Yin and Yang—the warmth of spring becomes the heat of summer; the severity of autumn becomes the anger of winter. The movement of these four changes causes the pulse to rise and fall accordingly. Spring corresponds to the Compass (Gui - round and soft); Summer corresponds to the Square (Ju - large and forceful); Autumn corresponds to the Balance (Heng - light and level); Winter corresponds to the Weight (Quan - deep and heavy). Thus, forty-five days after the Winter Solstice, Yang Qi slightly ascends, and Yin Qi slightly descends; forty-five days after the Summer Solstice, Yin Qi slightly ascends, and Yang Qi slightly descends. Yin and Yang have their times, matching the pulse cycle. If they miss the timing, based on the pulse's division, one can know the time of death. The subtlety lies in the pulse; it must be examined. Examination has principles, starting from Yin and Yang. Thus, sound matches the Five Tones, color matches the Five Elements, and pulse matches Yin and Yang. There is a way to hold the pulse; emptiness and stillness are precious.

In spring, the pulse floats like a fish swimming in waves; in summer, it is at the skin surface, abundant like all things growing; in autumn, it sinks to the skin, like insects preparing to hibernate; in winter, it is in the bones, like insects tightly wrapped, and gentlemen stay indoors. Therefore, those who understand the interior press and record; those who understand the exterior conclude and begin. These six points are the great methods of pulse diagnosis.

When a Red pulse arrives, rapid and firm, it is diagnosed as accumulated Qi in the middle, occasionally harming digestion, named Heart Bi (Obstruction). It arises from external pathogens due to excessive worry causing Heart deficiency, allowing evil to enter.

When a White pulse arrives, rapid and floating, with upper deficiency and lower excess, accompanied by fright, it indicates accumulated Qi in the chest, with panting and deficiency, named Lung Bi, accompanied by chills and fever, arising from intercourse while drunk.

When a Yellow pulse arrives, large and deficient, with accumulated Qi in the abdomen and rebellious Qi, named Jue Shan (Rebellious Hernia), following the same pattern for women, arising from strenuous limb activity with sweating exposed to wind.

When a Green pulse arrives, long and wiry, vibrating left and right, with accumulated Qi supporting under the heart, named Liver Bi, arising from cold-dampness, sharing the method with Hernia, accompanied by lower back pain, cold feet, and headache (variant: tight head pulse).

When a Black pulse arrives, firm and large above, with accumulated Qi in the lower abdomen and yin region, named Kidney Bi, arising from bathing and sleeping after washing with cold water.

If Form-Qi is sufficient but Pulse-Qi is insufficient, death occurs; if Pulse-Qi is sufficient but Form-Qi is insufficient, life persists; if Form and Qi match, it is treatable. A weak and slippery pulse indicates Stomach Qi, termed easy to treat; treat promptly without delay. If Form and Qi mismatch, it is difficult to treat; if complexion is dull and lusterless, it is difficult to cure; if the pulse is solid and hard, it indicates worsening; if the pulse contradicts the four seasons, it is untreatable. Contradicting the four seasons means: Lung pulse in spring, Kidney pulse in summer, Heart pulse in autumn, Spleen pulse in winter, all hanging, extreme, deep, and choppy—this is contradicting the four seasons. Without organ signs, if the pulse is deep and choppy in spring/summer, or floating and large in autumn/winter; if heat disease has a quiet pulse, diarrhea has a large pulse, blood loss has a solid pulse, internal disease has a solid/firm pulse, external disease has a non-solid/non-firm pulse—all are difficult to treat, termed contradicting the four seasons.

Asked: What is the essence of Deficiency and Excess? Answer: Qi Excess with Form Excess, Qi Deficiency with Form Deficiency—this is normal; reversal indicates disease. Grain abundance leads to Qi abundance, grain scarcity leads to Qi scarcity—this is normal; reversal indicates disease. Pulse Excess with Blood Excess, Pulse Deficiency with Blood Deficiency—this is normal; reversal indicates disease. Qi Excess with Body Cold, Qi Deficiency with Body Heat—called reversal. Eating much but having little Qi—called reversal. Not eating but having much Qi—called reversal. Pulse Excess with Blood Deficiency—called reversal. Pulse Deficiency with Blood Excess—called reversal. Qi Excess with Body Cold arises from Cold Injury; Qi Deficiency with Body Heat arises from Summerheat Injury. Eating much but having little Qi arises from blood loss with dampness below; eating little but having much Qi arises from evil in the Stomach and Lungs. Pulse Deficiency with Blood Excess arises from heat in the drinker; Pulse Large with Blood Deficiency arises from Wind Qi in the pulse with no fluid intake—this is called reversal. Excess is Qi entering; Deficiency is Qi leaving. Qi Excess brings heat; Qi Deficiency brings cold. To tonify Excess, open the needle hole with the left hand; to tonify Deficiency, close the needle hole with the left hand.

Small pulse without color change indicates new disease; pulse not changed but color changed indicates old disease; both pulse and five colors changed indicate old disease; neither pulse nor five colors changed indicates new disease. Liver and Kidney pulses arriving together with pale-red complexion indicates injury/trauma; if no blood was seen, or if blood was seen, it may be dampness or water poisoning. The inner side of the Chi position flanks the hypochondrium; the outer Chi probes the Kidneys; the inner Chi probes the abdominal cavity. Above that, the left outer probes the Liver, inner probes the Diaphragm; the right outer probes the Stomach, inner probes the Spleen. Further up, the right outer probes the Lungs, inner probes the Chest Middle; the left outer probes the Heart, inner probes the Danzhong. Front probes the front, back probes the back. The end of the upper section probes the chest and throat; the end of the lower section probes the lower abdomen, waist, thighs, knees, and shins. Coarse/large pulse indicates Yin deficiency and Yang excess, resulting in Heat in the Middle.

Abdominal distension, body heat, and large pulse (variant: small) is the First Reversal. Abdominal rumbling and fullness, cold extremities, diarrhea, and large pulse is the Second Reversal. Unstopping nasal hemorrhage and large pulse is the Third Reversal. Coughing, hematuria, emaciation, and small/tense pulse is the Fourth Reversal. Coughing, emaciation, body heat, and small/rapid pulse is the Fifth Reversal. Such cases die within fifteen days. Abdominal distension, cold extremities, emaciation, severe diarrhea is the First Reversal; abdominal distension, hematochezia, large pulse with intermittent cessation is the Second Reversal; coughing/hematuria, emaciation, panting is the Third Reversal; vomiting blood, chest fullness radiating to back, small/rapid pulse is the Fourth Reversal; coughing/vomiting, abdominal distension, undigested stool diarrhea, absent pulse is the Fifth Reversal. Such cases die within less than one hour. Physicians who fail to observe this and apply acupuncture commit malpractice (Reverse Treatment).

Treating Heat Disease: Quiet pulse after sweating, yet pulse is large and restless is the First Reversal; diarrhea with洪大 (Hong Da/Large) pulse is the Second Reversal; fixed Bi with muscle wasting, body heat, and unilateral absent pulse is the Third Reversal; pathogenic depletion of form, body heat, sallow-white complexion, followed by hematochezia, severe condition is the Fourth Reversal; cold/heat depletion of form, firm/pounding pulse is the Fifth Reversal.

Five Excesses lead to death; Five Deficiencies lead to death. Large pulse, hot skin, abdominal distension, blockage of urination/defecation, chest oppression/dizziness—these are Five Excesses. Small pulse, cold skin, shortness of breath, diarrhea of urine/stool, inability to eat—these are Five Deficiencies. If gruel enters the stomach and diarrhea stops, the deficient patient lives; if sweat appears and bowels/bladder open, the excess patient lives. These are their signs.

Full-large Heart pulse indicates Epilepsy and tendon cramping. Small-rapid Liver pulse indicates Epilepsy and tendon cramping. Muddled/oppressed Liver pulse due to fright, absent pulse or aphonia—is untreatable. Deep Liver/Kidney pulses indicate Stone Water; Floating indicate Wind Water; Empty indicate Death; Small-wiry indicate impending Fright. Pounding-slippery-rapid Heart pulse indicates Heart Hernia. Deep-pounding Lung pulse indicates Lung Hernia. Rapid San Yang pulse indicates Mass (Zha). Rapid Er Yin pulse indicates Epileptic Convulsion (variant: Hernia). ... (Text fragment missing) ... Body heat indicates death. Heart/Liver ... also hematochezia; dual organ disease is treatable; small-deep-choppy pulse indicates Intestinal Dysentery; body heat indicates death; severe heat leads to death in seven days. Deep-beating-choppy Stomach pulse, externally large, small-firm-rapid Heart pulse—all indicate Hemiplegia (Ge Pian Ju). Left onset in men, right in women. No aphonia, tongue moves: treatable, recovery in 30 days. Aphonia: recovery in 3 years. Under 20 years old: death in 3 years. Pounding pulse with hematemesis/nasal bleed and body heat: death. Hanging-hook-floating pulse indicates Heat (variant: Normal Pulse). Pounding pulse named Sudden Syncope (Bao Jue); the syncope patient cannot speak. Rapid pulse causes sudden fright; self-recovers in 3-4 days.

Floating-combining pulse, resembling rapid, over ten beats per breath: Jing Qi insufficiency; slight appearance leads to death in 90 days. Pulse like burning firewood: Heart Essence deprivation; death when grass dries. Pulse like thorny bushes (variant: scattered leaves): Liver Qi deficiency; death when leaves fall. Pulse like a visiting official: pulse cold/blockage as before; Kidney Qi insufficiency; death when jujube flowers hang/fall. Pulse like a mud pellet: Stomach Essence insufficiency; death when elm pods fall. Pulse like a horizontal bar: Gallbladder Qi insufficiency; death when grain ripens. Pulse like string threads: Bao (Uterus) Essence insufficiency; talkative: death at frost; silent: treatable. Pulse like crossing thorns (variant: lacquer): coming from sides; slight appearance leads to death in 30 days. Pulse like a gushing spring, floating/beating in muscles: Taiyang Qi insufficiency; faint smell; death when leek flowers bloom. Pulse like collapsed earth, yielding to pressure: Muscle Qi insufficiency; black/white colors appear; recurrent attacks lead to death. Pulse like a uvula; uvula: floating/pounding/chopping makes it larger; Twelve Shu Qi insufficiency; death when water freezes. Pulse like an inverted knife; inverted knife: floating small-rapid, pressing firm-large; Five Zang cold-heat (variant: stagnated heat); cold-heat merging in Kidneys; patient cannot sit; death at Start of Spring. Pulse like a pill, smooth not sticking to hand (variant: not straight); pill-smooth not sticking: unobtainable on pressure; Large Intestine Qi insufficiency; death when jujube leaves grow. Pulse like pounding mortar: causes fear, unwillingness to sit/lie, listening while standing/walking; Small Intestine Qi insufficiency; death in Late Autumn.