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Chapter 3 states: There are pulse conditions of excess (Tai Guo), deficiency (Bu Ji), mutual overcoming between Yin and Yang, Fu (inverted) pulses, Yi (overflowing) pulses, Guan (closed) and Ge (blocking) patterns. What does this mean?

The excess and deficiency mentioned here refer to pathological pulses. When Yin overcomes Yang, it means Yin is in excess and invades Yang, resulting in Yang deficiency; when Yang overcomes Yin, it means Yang is in excess and invades Yin, resulting in Yin deficiency. If the mutual overcoming is severe, it forms Fu and Yi pulses, leading to the Guan-Ge syndrome (a critical condition characterized by the separation of Yin and Yang and obstruction of upper and lower communication).

However, the area anterior to the Guan (barrier) position is where Yang moves; the pulse should appear at a length of nine fen and be superficial (Fu). Exceeding this standard is termed "excess" (Tai Guo), while falling short is termed "deficiency" (Bu Ji).

Anterior to the Guan belongs to Yang, which is the location of the Cun (inch) pulse. A pulse appearing at nine fen and superficial is normal for a Yang pulse, as nine is a Yang number and the Cun position naturally presents with a superficial quality. "Excess" refers to exceeding the original position or normal pulse characteristics; "deficiency" refers to failing to reach the original position or normal pulse characteristics. Both are pathological pulses.

If the pulse extends straight up to the thenar eminence (Yu Ji), it is called "Yi" (Overflowing). This manifests as external closure and internal blocking, representing a pulse of Yin overcoming Yang.

"Sui" means moving directly forward. "Yu" refers to the thenar eminence. "Yi" implies overflowing like water spilling out. When Yang Qi is excessively strong, Yin Qi cannot interact harmoniously with it, hence termed "Guan" (Closed); when Yin Qi is excessively strong, Yang Qi cannot interact harmoniously with it, hence termed "Ge" (Blocking). This occurs when Yin overcomes the Yang position, causing the pulse to overflow into the thenar region, forming the external Guan and internal Ge pattern.

The area posterior to the Guan is where Yin moves; the pulse should appear at a length of one cun and be deep (Chen). Exceeding this standard is termed "excess" (Tai Guo), while falling short is termed "deficiency" (Bu Ji).

Posterior to the Guan belongs to Yin, which is the location of the Chi (cubit) pulse. A pulse appearing at one cun and deep is normal for a Yin pulse, as one cun corresponds to Yin numbers and the Chi position naturally presents with a deep quality. "Excess" refers to exceeding the original position or normal pulse characteristics; "deficiency" refers to failing to reach the original position or normal pulse characteristics. Both are pathological pulses.

If the pulse sinks deeply into the Chi region, it is called "Fu" (Inverted/Overturned). This manifests as internal closure and external blocking, representing a pulse of Yang overcoming Yin.

"Fu" implies overturning like a collapsing wall. The classics state: When Yang Qi is excessively strong, Yin Qi cannot interact harmoniously with it. Because Yin cannot nourish Yang, Yang sinks and covers the Chi region. This is a pulse of Yang overcoming Yin, forming the internal Guan and external Ge pattern.

Therefore, it is said that Fu and Yi pulses are Zang-Zang pulses (pulses revealing the true state of organ qi). Even if the patient shows no obvious disease symptoms, death will occur.

Fu and Yi pulses are signs of the separation and rupture of Yin and Yang. If the Fu and Yi manifestations are mild, although they represent severe Guan-Ge syndromes, they may not yet be critical. However, if Fu and Yi manifestations are severe, they constitute Zang-Zang pulses. "Zang-Zang" means the organ qi has been exhausted. The true form of the organ qi appears independently on the surface; regardless of whether there are specific disease symptoms, certain death can be predicted.

Commentary: The pulse is the Qi within the blood, also known as Ying Qi (Nutritive Qi). Western medicine posits that after food enters the stomach, its essence rises to the neck, passes through the lungs to the heart, transforms into red blood, and circulates in the vessels according to respiration. This aligns with the *Ling Shu · Ying Qi Chapter*: "The path of Ying Qi treasures the grain entering the stomach. It transmits to the lungs, flows internally, spreads externally, and its purest part travels through the meridians, circulating endlessly." Generally, organ qi cannot reach the Hand-Taiyin Lung meridian's Cun Kou point on its own; it must rely on the driving force of Wei Qi (Stomach Qi) to arrive there. Thus, although the left and right Cun Kou points belong to the Lung, they are energized by the Yangming Stomach Qi. Therefore, the Stomach is the root of the pulse, and the Lung is the trunk. The *Su Wen · Mai Yao Jing Wei Lun* states: "When Yin and Yang do not correspond, the disease is named Guan-Ge." The *Su Wen · Liu Jie Zang Xiang Lun* describes Ge-Yang (Blocking-Yang) when the Ren Ying pulse (carotid) is one to four times larger than the Cun Kou pulse, and Guan-Yin (Closing-Yin) when the Cun Kou pulse is one to four times larger than the Ren Ying pulse. Similarly, chapters in the *Ling Shu* such as *Zhong Shi* and *Jin Fu* name a Ren Ying pulse four times larger, vigorous and rapid, as "Yi-Yang" (Overflowing-Yang), which constitutes external Ge. A Pulse Kou (Cun Kou) pulse four times larger, vigorous and rapid, is named "Yi-Yin" (Overflowing-Yin), constituting internal Guan blockage, which is untreatable and fatal. When both Ren Ying and Taiyin Pulse Kou (Cun Kou) are more than four times larger, it is named Guan-Ge. Guan-Ge indicates a short life expectancy. Here, "Ren Ying" refers to the pulse beside the larynx, and "Cun Kou" refers to the pulse between Tai Yuan and Jing Qu. Since Yue Ren (Bian Que) exclusively took the Cun Kou pulse and did not examine the twelve meridian arteries, there was no need to examine the Ren Ying at the larynx. Inferring the meaning of naming Yi-Yang as external Ge and Yi-Yin as internal Guan, we understand that Ren Ying is the root of the Cun Kou Lung pulse, and Cun Kou is the trunk of the Ren Ying Stomach pulse. If the Ren Ying pulse is one, two, three, or four times larger, it invariably manifests at the Qi Kou (Cun Kou), because if the root is large, the trunk is also large. If the Ren Ying pulse exceeds four times, indicating an external Ge syndrome, the Cun Kou pulse will also overflow above the thenar eminence as an Yi-Yang pulse, corresponding to the Qi of the Ren Ying. Since the root and trunk are connected, the Qi of the Ren Ying can be observed from the Cun Kou upwards, making examination of the Ren Ying beside the larynx unnecessary. This explains why Yue Ren exclusively used the Cun Kou to differentiate Fu/Yi and Guan/Ge pulse patterns using the Cun and Chi positions. Later commentators on the *Nan Jing* failed to grasp Yue Ren's intent, often adhering to the theory that one pulse has four names, or insisting that Ren Ying must be examined at the larynx, dying due to rigid adherence to textual phrasing. These are misunderstandings. They fail to realize that the main purport of this section is to diagnose the patterns of Yin-Yang mutual overcoming by examining the Cun and Chi pulses to identify Guan-Ge diseases. His question asks: Ancient pulse theorists spoke of excess, deficiency, Yin-Yang mutual overcoming, Fu/Yi, and Guan/Ge; do these terms differ? The answer begins by listing anterior and posterior to the Guan to clarify Yin-Yang positions, explaining excess and deficiency as pulse dynamics via "overstepping" and "falling short," and explaining Fu and Yi as pulse morphology via "ascending to the thenar" and "descending into the Chi." It concludes that these constitute the formation of Guan-Ge disease. Zhang Zhongjing’s *Ping Mai Pian* states: "A Cun Kou pulse that is floating and large: floating indicates deficiency, large indicates excess. At the Chi position, it is Guan; at the Cun position, it is Ge. Guan results in inability to urinate; Ge results in vomiting and reflux." This elaborates on the syndromes based on this section. Why were commentators so negligent in observing this?