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Chapter 1 states: All twelve meridians have pulsating arteries. Why is the Cun Kou (Cun-kou, pulse at the wrist) alone selected as the method to determine the life and death, auspiciousness and inauspiciousness of the Zang-Fu organs?

This initiates the first difficulty, asking why, given that all twelve hand and foot meridians have pulsating arteries, only the Cun Kou is taken to determine life and death, thereby setting up the meaning for the following text.

Commentary: The Qi of the five Zang and six Fu organs circulates day and night without cessation, starting from the Lung and ending at the Lung. Thus, the Lung is the master of Qi in the body, and the Cun Kou is the pulsating artery of the Lung. Located between the Taiyuan (LU9) and Jingqu (LU8) acupoints, it is the great gathering point of pulses. Therefore, Yue Ren (Bian Que) exclusively selects this location to observe the Qi of the five Zang and six Fu organs. However, the pulsating arteries of other meridians must not be unknown; otherwise, palpating only the wrist and neglecting the feet would inevitably incur the reprimand of Zhang Zhongjing (Changsha Taishou). The pulsating artery of the Hand-Yangming Large Intestine meridian is at Hegu (LI4), (located between the metacarpals of the thumb and index finger.) The pulsating artery of the Hand-Shaoyin Heart meridian is at Jiquan (HT1), (located in the tendon space under the axilla on the medial arm.) The pulsating artery of the Hand-Taiyang Small Intestine meridian is at Tianchuang (SI16), (located in the large tendon space on the side of the neck, below the angle of the jaw.) The pulsating artery of the Hand-Shaoyang Sanjiao meridian is at He'liao (TE22), (located in the depression anterior to the ear within the hairline.) The pulsating artery of the Hand-Jueyin Pericardium meridian is at Laogong (PC8), (located in the center of the palm, at the tip of the middle and ring fingers when flexed.) The pulsating artery of the Foot-Taiyang Bladder meridian is at Weizhong (BL40), (located in the transverse crease of the popliteal fossa.) The pulsating artery of the Foot-Shaoyin Kidney meridian is at Taixi (KI3), (located above the calcaneus behind the medial malleolus.) The pulsating artery of the Foot-Taiyin Spleen meridian is at Chongmen (SP15), (located beside Qugu, three cun five fen using the body-cun measurement.) The pulsating artery of the Foot-Yangming Stomach meridian is at Chongyang (ST42), (located in the depression between the first and second toes; Neiting (ST44) is here, and Chongyang is five cun above Neiting using the body-cun measurement.) The pulsating artery of the Foot-Jueyin Liver meridian is at Taichong (LR3), (located posterior to the first metatarsophalangeal joint, two cun using the body-cun measurement.) The pulsating artery of the Foot-Shaoyang Gallbladder meridian is at Tinghui (GB2). (Located in the depression anterior to the ear.) Consulting texts such as *Mingtang Acupuncture and Moxibustion Diagrams* and *Jia Yi Jing*, there are over twenty acupoints referred to as "arteries." Among these, only about ten can be used for diagnosis, and among these ten, the pulses at Taixi (KI3), Chongyang (ST42), and Taichong (LR3) on the feet are the most crucial.

Response: The Cun Kou is the great gathering point of pulses and is the pulsating artery of the Hand-Taiyin Lung meridian.

"Ran" is a particle indicating a response. "Hui" means gathering. The Hand-Taiyin is the meridian of the Lung. It is said that the Lung governs Qi, and the pulsations of the twelve meridians are all driven by Lung Qi. Therefore, it is said that the Lung faces all vessels, and the Qi gathers at the Cun Kou. The Cun Kou refers to the meaning in *Su Wen: Chapter on Distinguishing Meridians* that "the Qi-kou becomes Cun, to decide life and death," hence it is called Cun Kou. The Cun Kou is divided into three positions: Yuji (LU10) is the Cun position, the high bone at Taiyuan (LU9) is the Guan position, and Jingqu (LU8) is the Chi position. This is the pulsating artery of the Hand-Taiyin Lung meridian. When food enters the stomach, its clear Qi ascends to the Lung to coordinate with respiration and govern pulse dynamics. The intent of Yue Ren's question lies in exclusively taking the Cun Kou, a method revered by later generations as an unchangeable standard. Chapter 45 of *Nan Jing* mentions "Pulse meets at Taiyuan," which shares this same principle.

In one exhalation, the pulse moves three Cun; in one inhalation, the pulse moves three Cun. At the pause between breaths (Ding Xi), the pulse moves six Cun. In one day and night, there are thirteen thousand five hundred breaths, during which the pulse circulates fifty times around the body. Over the time it takes for water to drip one hundred marks (Ke), Ying Qi (Nutritive Qi) travels twenty-five times through the Yang aspects and twenty-five times through the Yin aspects, constituting one complete cycle. Thus, after fifty cycles, it reunites at the Hand-Taiyin Lung meridian. The Cun Kou is the beginning and end of the Qi of the five Zang and six Fu organs; therefore, the diagnostic method takes its standard from the Cun Kou.

This passage continues from the previous discussion, referring to a "Ping Ren" (healthy person), who does not suffer from disease and has regular breathing. *Ling Shu: Chapter on Fifty Circulations* records: Over the time of one hundred water marks, dividing day and night, in one exhalation the pulse beats twice, and Qi moves three Cun; in one inhalation the pulse also beats twice, and Qi moves three Cun. At the pause between breaths, Qi moves six Cun. In ten breaths, Qi moves six Chi; in two hundred and seventy breaths, Qi moves sixteen Zhang and two Chi, completing one circulation around the body, corresponding to two water marks; in two thousand seven hundred breaths, Qi completes ten circulations around the body, corresponding to twenty water marks; in thirteen thousand five hundred breaths, Qi completes fifty circulations around the body, corresponding to one hundred water marks, totaling eight hundred and ten Zhang. *Ying Wei Hui Hui Chapter* states: Humans derive Qi from grain. Grain enters the stomach and is transmitted to the Lung. Its clear portion becomes Ying Qi (Nutritive Qi), and its turbid portion becomes Wei Qi (Defensive Qi). Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels. Ying Qi circulates endlessly, meeting again after fifty cycles. Wei Qi and Ying Qi both travel twenty-five times through the Yang aspects and twenty-five times through the Yin aspects, forming one cycle. Thus, they also meet again at the Hand-Taiyin Lung meridian after fifty cycles. *Su Wen: Chapter on Normal Pulse Phenomena* states: In one exhalation the pulse beats twice, in one inhalation it beats twice. At the pause between breaths, the pulse beats five times, occasionally supplemented by a deep sigh (Tai Xi), which is defined as a healthy person. This pulse reflects Ying Qi. Ying Qi circulates through the meridians fifty times a day. Today at dawn, it starts at the Cun Kou of the Hand-Taiyin Lung meridian; tomorrow at dawn, it will meet again at the Cun Kou of the Hand-Taiyin Lung meridian. Since this is the beginning and end of the Qi of the five Zang and six Fu organs, the diagnostic method takes its standard from the Cun Kou.

Commentary: The pulse is the Qi within the blood. The term "Ying Qi" in the classics implies its operation within the vessels. Western medicine posits that after food enters the stomach and small intestine, micro-vessels absorb its essence. This fluid ascends to the jugular confluence, passes through the lungs, and enters the left atrium of the heart. (The heart is hollow internally, with rough, concave, or convex walls. A septum divides it into left and right atria; further horizontal partitions divide them into upper and lower sections. Fibrous strands connect these parts, allowing automatic opening and closing to respond to respiration.) The fluid transforms into red blood, which corresponds to the "clear portion becoming Ying Qi." Blood flows from the left atrium to the left ventricle, enters the main arterial vessel, runs along the spinal muscles, and circulates through the meridians fifty times a day and night, traversing eight hundred and ten Zhang of vascular pathways, responding to respiration. The "dripping water" refers to Ying Qi. As for Wei Qi, it implies protection on the exterior. The Qi and blood within the meridians exit from the ends of the vessels into the Qi Gates, entering the micro-vessels (referred to as Sun Luo in classics). Here, they combine with the fierce Qi of the Yangming meridian. (Food consists of five flavors; how can it be non-toxic? Western medicine calls this "carbon gas," referring to this phenomenon.) This mixture spreads throughout the skin and interstices, filling the skin, warming the flesh, and permeating the hair follicles. This corresponds to the "turbid portion becoming Wei Qi." Once the red blood in the main vessels enters the micro-vessels and combines with the fierce Qi of Yangming, its color gradually turns purple. Western medicine considers this toxic and calls it "carbon gas." Spreading throughout the body, these vessels merge and thicken, connecting to the tails of the venous vessels (referred to as Luo Mai in classics). Blood enters the veins, circulating internally to the Zang-Fu organs and externally to the meridians and arteries, moving in alternating directions. Those traveling outside the main meridians have Yin and Yang distinctions: one branch floats above the muscle layers, and another sinks between the muscle fibers. That is, Yang Luo circulates on the surface of the skin, and Yin Luo circulates beneath the skin, both moving alongside the main vessels. This aligns with the classic statement that Ying Qi moves within the vessels and Wei Qi moves outside. After circulating extensively inside and outside the veins, blood enters the main venous trunk, reaches the right atrium, falls into the right ventricle, and is delivered to the lungs. It exhales the fierce Qi and inhales vital Qi, transforming back into red blood, entering the left atrium. The mutual connection of Yin and Yang, like a circle without beginning or end, is what is meant here. However, Qi contains Blood, and Blood contains Qi; they cannot be separated for a moment. This is the natural principle of Yin and Yang rooting each other. The Qi and blood operating within the meridians, circulating fifty times day and night, move swiftly like the moon influencing water flowing through the earth. The Qi and blood exiting the Qi Gates, combining with the fierce Qi of Yangming, and spreading throughout the body, circulate once day and night, moving slowly like the sun following the celestial path around the earth. Thus, humans correspond to Heaven and Earth. The movement through Yin and Yang refers to the Qi and blood in the Yin and Yang Luo meridians accompanying the Wei Qi along the meridians. Regarding external pathogens attacking the body, heat injures Qi, and cold injures Blood; one should investigate the Wei Qi spread via the Sun Luo throughout the body. For latent Qi erupting internally, one should investigate the Wei Qi within the Luo meridians. Those floating outside the vessels can be treated with acupuncture to drain the Qi; those sinking inside the vessels require urgent attack to eliminate toxicity. When diagnosing pulses to examine disease, one should investigate the Ying Qi operating within the main vessels. Because blood entering the upper atrium, falling to the lower atrium, and passing through the main vessel involves opening and closing sounds corresponding to respiration, the pulse rate can be observed. Western medicine listens to sounds to diagnose heart diseases, adopting this same principle.