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Chapter 16 states: Pulse diagnosis involves three positions (Sanbu) and nine inspections (Jiuhou), distinctions of Yin and Yang, variations in pressure depth (Qingzhong), and sixty pulse categories. A single pulse type changes according to the four seasons. However, as time has passed since the Sage, each school adheres to its own methods. How can one distinguish between their correctness and errors?

The response is: This depends on whether the disease presents with external and internal signs (Zheng).

Regarding the three positions and nine inspections of the pulse, see Chapter 18. The details of Yin and Yang are explained in Chapter 4. The details of pressure depth are explained in Chapter 5. The sixty pulse categories are found in *Suwen: Fang Sheng Shuai Lun*. Wang Bing's commentary refers to them as "Qiheng Sixty Categories," which are no longer extant in the world today. Some believe this refers to the concept that each organ governs for sixty days. "A single pulse changing according to the four seasons" refers to the spring chord-like pulse (Xian), summer hook-like pulse (Gou), autumn feather-like pulse (Mao), and winter stone-like pulse (Shi) mentioned in Chapter 15.

Since pulse methods vary and have been distant from the Sage for a long time, with each school adhering to its own methods, how can one distinguish their merits and flaws? It lies in the fact that diseases present with external and internal signs. This means that for any disease, by verifying through external and internal signs, one will naturally grasp the truth, without being constrained by various pulse methods.

How exactly does this manifest?

The response is: Suppose one obtains the Liver pulse (Gan Mai). Its external signs include a preference for cleanliness, a bluish complexion, and irritability. Its internal signs include pulsation at the left side of the umbilicus, which feels firm and painful upon palpation. The symptoms include fullness in the four limbs, urinary obstruction or dribbling, difficulty in urination, and tendon spasms. If these signs are present, it is a Liver disease; if not, it is not.

Obtaining the Liver pulse means diagnosing a Chord-like pulse (Xian Mai). The Liver and Gallbladder are interior-exteriorly related, and the Gallbladder is considered a clear and pure organ, hence the patient's preference for cleanliness. Blue/Green corresponds to Wood, and the Liver belongs to Wood, hence the bluish complexion. The Liver governs anger in the emotions, hence the irritability. These are the external signs regarding color, pulse, and emotional disposition. The left side of the umbilicus is the region where Liver Wood Qi ascends. Pulsation occurs because the True Qi cannot be stored internally and manifests externally. "Firm" (Lao) indicates Qi stagnation and solidity; "pain" indicates Qi depression and obstruction; "fullness" indicates blockage. Tendon tension leads to fullness in the four limbs; as stated in *Zuo Zhuan*, "wind pathogen causing disorders in the extremities." The Jueyin meridian circulates around the genitalia, so Liver disease causes difficulty in urination. Tendon spasms occur because the Liver governs tendons, so the pathology affects the tendons. These are the internal signs regarding location and associated diseases.

Suppose one obtains the Heart pulse (Xin Mai). Its external signs include a red complexion, dry mouth, and a tendency to laugh. Its internal signs include pulsation above the umbilicus, which feels firm and painful upon palpation. The symptoms include vexation, heart pain, heat in the palms, and dry heaving (Gan Ou). If these signs are present, it is a Heart disease; if not, it is not.

Obtaining the Heart pulse means diagnosing a Hook-like pulse (Gou Mai). The Heart corresponds to Red in colors, hence the red complexion. Heart Qi connects to the tongue, and Heart Fire flares upward, hence the dry mouth. The Heart corresponds to laughter in sounds, hence the tendency to laugh. These are the external signs regarding color, pulse, and emotional disposition. The area above the umbilicus is the region of the Heart. Pulsation with firmness and pain upon palpation, along with vexation, actually indicates pathogen affecting the Pericardium (Xin Bao Luo), rather than true Heart disease. If it were true Heart disease, death would occur within half a day (morning diagnosed, evening dies; evening diagnosed, morning dies). The Hand Jueyin Pericardium meridian runs through the palm, hence heat in the palms. Dry heaving is due to excessive Heart Fire. These are the internal signs regarding location and associated diseases.

Suppose one obtains the Spleen pulse (Pi Mai). Its external signs include a yellow complexion, frequent belching (Yi), excessive thinking, and heightened taste sensitivity. Its internal signs include pulsation at the center of the umbilicus, which feels firm and painful upon palpation. The symptoms include abdominal fullness, indigestion, heavy body with joint pain, lethargy and desire to lie down, and weakness in the four limbs. If these signs are present, it is a Spleen disease; if not, it is not.

Obtaining the Spleen pulse means diagnosing a Slow/Relaxed pulse (Huan Mai). The Spleen belongs to Earth and corresponds to Yellow in colors, hence the yellow complexion. Belching (Yi) is eructation. *Ling Shu: Kou Wen* states: "Cold pathogen lodging in the Stomach causes rebellious Qi to rise from below, disperse, and exit the Stomach again, resulting in belching." The Spleen and Stomach are interior-exteriorly related, so they often suffer together. The Spleen governs thought in the emotions, hence excessive thinking. The Spleen opens into the mouth, hence heightened taste sensitivity. These are the external signs regarding color, pulse, and emotional disposition. The Spleen resides in the Middle Jiao, hence pulsation at the umbilicus with firmness and pain upon palpation. The Spleen governs transport and transformation; if this function is impaired, abdominal fullness and indigestion occur. The Spleen governs muscles, hence heaviness of the body. The Yangming meridian binds bones and facilitates joints; since the Spleen and Stomach are related, joint pain is relevant. Fatigue damaging the Spleen, or dampness overwhelming and depressing the Spleen, both lead to lethargy and desire to lie down. The Spleen governs the four limbs, hence weakness and inability to hold the limbs. These are the internal signs regarding location and associated diseases.

Suppose one obtains the Lung pulse (Fei Mai). Its external signs include a white complexion, frequent sneezing, sadness and sorrow, unhappiness, and a desire to cry. Its internal signs include pulsation at the right side of the umbilicus, which feels firm and painful upon palpation. The symptoms include wheezing and coughing, and chills and fever resembling a sprinkling sensation (Sa Xi). If these signs are present, it is a Lung disease; if not, it is not.

Obtaining the Lung pulse means diagnosing a Feather-like pulse (Mao Mai). The Lung corresponds to White in colors, hence the white complexion. *Ling Shu: Kou Wen* states: "When Yang Qi is harmonious and smooth, filling the Heart and exiting through the nose, sneezing occurs." Lung Qi connects to the nose, hence frequent sneezing. The Lung governs sorrow/worry in the emotions, hence sadness and unhappiness. The Lung corresponds to crying in sounds, hence the desire to cry. These are the external signs regarding color, pulse, and emotional disposition. The right side of the umbilicus is the region where Lung Metal Qi descends. Pulsation with firmness and pain upon palpation indicates Lung Qi stagnation. The Lung governs Qi; when Qi rebels, wheezing and coughing result. The Lung governs the skin and hair, hence chills and fever resembling a sprinkling sensation. These are the internal signs regarding location and associated diseases.

Suppose one obtains the Kidney pulse (Shen Mai). Its external signs include a black complexion, fearfulness, and frequent yawning. Its internal signs include pulsation below the umbilicus, which feels firm and painful upon palpation. The symptoms include rebellious Qi, acute pain in the lower abdomen, diarrhea with a sensation of rectal tenesmus (heavy feeling), and coldness with inversion in the feet and calves. If these signs are present, it is a Kidney disease; if not, it is not.

Obtaining the Kidney pulse means diagnosing a Stone-like pulse (Shi Mai). The Kidney corresponds to Black in colors, hence the black complexion. The Kidney governs fear in the emotions, hence fearfulness. *Ling Shu: Kou Wen* states: "When Yin Qi accumulates below and Yang Qi is not yet exhausted, Yang pulls upward and Yin pulls downward, resulting in frequent yawning." This explains why the Kidney governs yawning. These are the external signs regarding color, pulse, and emotional disposition. The Kidney resides at the lowest position; below the umbilicus is the location of the Kidney. Kidney Qi stagnation causes pulsation with firmness and pain upon palpation. Insufficient Kidney Qi damages the Chong Mai, resulting in rebellious Qi. The Shaoyin meridian circulates around the lower abdomen, hence acute pain in the lower abdomen. The Kidney is the gate of the Stomach; now, due to Qi deficiency, there is diarrhea with rectal tenesmus, meaning the urge to defecate immediately after eating. *Ling Shu: Jing Mai* states: "The Foot Shaoyin Kidney meridian circulates behind the medial malleolus, branches into the heel, and ascends into the gastrocnemius muscle," hence coldness and inversion in the feet and calves. These are the internal signs regarding location and associated diseases. Regarding the phrase "diarrhea with a sensation like heaviness" (Xie ru xia zhong), Mr. Hua Shou changed the character "ru" (like) to "er" (and), which is very correct.