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When a person exhales, the pulse beats twice; when they inhale, the pulse also beats twice. At the moment of rest between breaths (Dingxi), the pulse beats five times in total. Occasionally, due to a deep sigh (Taixi), it may beat one extra time. This is called a "Ping Ren" (Healthy Person). A Ping Ren is one who is free from disease.
(Note: Hu refers to exhalation; Xi refers to inhalation; Dingxi refers to the interval just before the next breath begins; Runyu refers to the occasional extra beat.)

If a person's pulse beats only once per exhalation and once per inhalation, this is called "Shao Qi" (Deficiency of Qi). The *Nan Jing* (Chapter 14) considers this a Li Jing Mai (Departing Vessel Pulse), indicating the decline of righteous Qi.
If a person's pulse beats three times per exhalation and three times per inhalation, with a rapid and restless quality, and the skin at the Chi position (Cun-Knee area) is hot (indicating body heat), this is called "Wen Bing" (Warm Disease).
If the skin at the Chi position is not hot, but the pulse is slippery (Hua), this is called "Feng Bing" (Wind Disease), indicating an excess of pathogenic Qi.
If the pulse is choppy or rough (Se), this is called "Bi Syndrome" (Obstruction Syndrome), indicating a deficiency of Blood.
If a person's pulse beats four or more times per exhalation, this indicates death (Four beats per exhalation is termed Tuo Jing, or Essence Depletion).
If the pulse ceases and does not return, this indicates death (Yuan Qi has been exhausted).
If the pulse is irregular, alternating between slow and rapid, this indicates death (Disorder of Yin and Yang).

The Spring pulse corresponds to the Liver, located in the East, belonging to Wood, the season when all things begin to grow. Therefore, its Qi comes forth soft, weak, light, void, yet smooth, straight and long, hence it is called the "Xian Pulse" (Bowstring Pulse). (Xian means upright.) Deviation from this indicates disease. If the Qi comes forth solid and strong, this is called "Tai Guo" (Excess), with disease in the exterior. If the Qi comes forth insubstantial and faint, this is called "Bu Ji" (Deficiency), with disease in the interior. (Exterior diseases often involve excess; interior diseases often involve deficiency.)
Excess leads to irritability, sudden dizziness and vertigo (Xuan Mao), and even epilepsy.
Deficiency leads to chest pain radiating to the back, and fullness in the hypochondrium below. (Wu's commentary notes this as pain.)

The Summer pulse corresponds to the Heart, located in the South, belonging to Fire, the season when all things flourish and grow. Therefore, its Qi comes forth abundant and goes forth declining, hence it is called the "Gou Pulse" (Hook Pulse). (The meaning of Gou is like a hanging branch, i.e., the Hong Pulse.) Deviation from this indicates disease. If the Qi comes forth abundant and goes forth abundant, this is "Tai Guo" (Excess), with disease in the exterior. If the Qi comes forth not abundant but goes forth abundantly, this is "Bu Ji" (Deficiency), with disease in the interior. (Qi coming out from the deep bone/muscle level to the skin surface is called "Lai"; returning from the skin surface to the bone/muscle level is called "Qu".)
Excess leads to body heat and skin pain (heat cannot vent), resulting in Jin Yin sores (damp-heat soaking and steaming continuously).
Deficiency leads to vexation in the heart, coughing and spitting above, and Qi leakage below (such as incontinence). (Heart Qi deficiency causes vexation; deficient Yang invading the Lung causes cough; invading the Spleen causes spitting; sinking downward causes loss of Qi control at the lower orifices.)

The Autumn pulse corresponds to the Lungs, located in the West, belonging to Metal, the season when all things are harvested. Therefore, its Qi comes forth light, void, and floating, coming rapidly and scattering upon departure, hence it is called the "Fu Pulse" (Floating/Mao Pulse). (Not reaching the deep Chen level, it comes rapidly and scatters upon departure, which is the Mao Pulse.) Deviation from this indicates disease. If the Qi feels like hair (Mao) but is firm in the center and empty on the sides, this is "Tai Guo" (Excess), with disease in the exterior. If the Qi feels like hair but is faint, this is "Bu Ji" (Deficiency), with disease in the interior.
Excess leads to rebellious Qi and back pain, with a melancholic demeanor (Yun Yun Ran).
Deficiency leads to panting, shortness of breath, and coughing, upward rebellious Qi manifesting as blood, and audible pathological sounds (wheezing sounds in the throat). (Old texts read "hear pathological sounds below," now corrected by Wu to "and.")

The Winter pulse corresponds to the Kidneys, located in the North, belonging to Water, the season when all things store and hide. Therefore, its Qi comes forth deep and pounding, hence it is called the "Ying Pulse." (Pounding indicates the pulse is hidden yet vigorous; deep and hidden yet vigorous signifies Ying Qi guarding within, thus named Ying. Bian Que said: In deep winter, water freezes like stone; the pulse comes forth deep, soft, and smooth, hence also called Shi [Stone] Pulse.) Deviation from this indicates disease. If the Qi comes forth like bouncing stones (a sign of hardness), this is "Tai Guo" (Excess), with disease in the exterior. If the Qi departs resembling a Shu Pulse (rapid), this is "Bu Ji" (Deficiency), with disease in the interior.
Excess leads to flaccidity of the four limbs, pain in the spinal vessels, shortness of Qi, and unwillingness to speak (injury to Kidney Essence and Qi).
Deficiency leads to a feeling of emptiness in the heart as if hungry (Kidney Water failing to nourish Heart Fire), coldness in the diaphragm, pain in the spine, fullness in the lower abdomen, and abnormal urination.

The Spleen pulse corresponds to Earth. It is the solitary organ that irrigates the four surrounding organs. (The Spleen resides in the Center, connecting the Liver, Heart, Lungs, and Kidneys.) Its healthy state is difficult to perceive; only its pathological state is visible. (When the Spleen is healthy, irrigation is complete and the four Zang organs are peaceful, so the healthy pulse is invisible; the pathological pulse is what becomes visible.)
If the pulse flows like water, scattered without trace, this is "Tai Guo" (Excess), with disease in the exterior. If the pulse resembles a bird's beak (sharp and hard, lacking harmony), this is "Bu Ji" (Deficiency), with disease in the interior. (Beak/Hui sound is hui.)
Excess leads to inability to lift the four limbs (excess Dampness). Deficiency leads to obstruction of the nine orifices, named "Zhong Qiang" (where all Zang Qi are disharmonious).

A pulse that follows the four seasons is called treatable (following the seasonal order).
A pulse that is weak yet smooth indicates the presence of Wei Qi (Stomach Qi); this is called easy to treat, provided treatment is timed correctly (aligning with the seasons).
If form and Qi are discordant, it is called difficult to treat (excess leads to destructive over-control).
If the complexion is dull and lacks luster, it is called difficult to cure (both Qi and Blood are damaged).
A pulse that is solid and hard indicates worsening condition (pathogenic Qi is excessive).
A pulse that contradicts the four seasons is called untreatable.
Contradicting the four seasons means: finding the Lung pulse in Spring, the Kidney pulse in Summer, the Heart pulse in Autumn, and the Spleen pulse in Winter. These pulses arrive as Xuan Jue (suspended and severed), deep and Se (choppy), and are called contradicting the four seasons. (Xuan means the pulse arrives suspended and severed, Yin and Yang are unbalanced, lacking harmonious Qi, showing only True Zang pulses. Deep indicates severance of Yang; Se indicates severance of Yin. In autumn/winter, when Qi should store, a floating/large pulse contradicts the seasons, also called contradicting the four seasons.)
Heat disease with a quiet pulse (Yang syndrome with Yin pulse), diarrhea with a large pulse (Righteous Qi declines, Pathogenic Qi advances), internal disease with a solid/firm pulse (should be deficient but is solid/firm, indicating True Zang shape), external disease with a non-firm pulse (should be excess but is not solid/firm, indicating insufficient True Yang to drive), are all difficult to treat.

Pulse vigorous (Heart Excess), skin hot (Lung), abdominal distension (Spleen), blockage of front and rear (Kidney), mental confusion/obscuration (Liver), this is called "Wu Shi" (Five Excesses). (Mao sounds wu or mao.)
Pulse fine/thin (Heart Deficiency), skin cold (Lung), shortness of Qi (Liver), diarrhea/incontinence of front and rear (Kidney), inability to eat/drink (Spleen), this is called "Wu Xu" (Five Deficiencies).
If after consuming fermented bean paste and porridge, the diarrhea stops, the deficient patient will survive (Earth Qi remains, deficiency can recover).
If sweat appears (exterior pathogens resolve) and bowels/bladder open (interior pathogens exit), the excess patient will survive.