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Difficulty 1 states: Among the twelve meridians, there are all pulsating arteries (The twelve meridians refer to the three Yin and three Yang meridians of the hands and feet. Pulsating artery refers to the pulse beating manifesting externally, such as at Tianfu or Yunmen points of the Hand-Taiyin Lung Meridian; pressing these areas makes the movement felt by the finger.), yet we exclusively select the Cun-Kou pulse (Cun-Kou refers to the area of Taiyuan and Jingqu points, encompassing the upper, middle, and lower sections of both wrists) to determine the life, death, auspiciousness, and inauspiciousness of the Zang and Fu organs. What is the reason for this?

It is answered: The Cun-Kou is the great gathering point of pulses, where the Hand-Taiyin Lung Meridian moves. ("Gathering" means convergence. The Hand-Taiyin is the meridian of the Lung. As stated in *Ling Shu: Dong Shu*: "The Stomach is the sea of the five Zang and six Fu organs; its clear Qi ascends to the Lung. Lung Qi travels along the Taiyin meridian... it moves with respiration." This is the meaning. Furthermore, *Ling Shu: Jing Mai* states that the Hand-Taiyin meridian "follows the Thenar eminence and emerges at the tip of the thumb.") In one exhalation, the pulse Qi travels three cun; in one inhalation, it travels three cun. Between a full breath cycle, the pulse Qi travels six cun. A person breathes 13,500 times in a day and night, and the pulse Qi circulates fifty times around the body. ("Exhalation" is breathing out. "Inhalation" is breathing in. *Ling Shu: Wu Shi Ying* states: "The human body has twenty-eight meridians up, down, left, right, front, and back, encircling the body with a length of 16 zhang 2 chi... between breath cycles, Qi travels six cun... after 270 breaths, Qi travels 16 zhang 2 chi... completing one circuit around the body... after 13,500 breaths, Qi completes fifty circuits." "Du" means to pass through, i.e., to go through once. The actual number of twenty-eight meridians is detailed in *Ling Shu: Mai Du*.)

Over one hundred ke (water clock units) (According to *Sui Shu*, water clocks originated from the Yellow Emperor. A day and night are divided into one hundred ke. An arrow floats in a pot, and as water drains, the marks indicate the passage of time, distinguishing day and night lengths.), Ying (Nutritive) and Wei (Defensive) Qi travel twenty-five circuits in the Yang aspects and twenty-five circuits in the Yin aspects, making one complete cycle. (Ying and Wei: *Ling Shu: Ying Wei Sheng Hui* states: "Humans receive Qi from grain. Grain enters the Stomach and transmits to the Lung. All five Zang and six Fu organs receive Qi. The clear part becomes Ying Qi, residing within the vessels; the turbid part becomes Wei Qi, residing outside the vessels." This is the meaning. When speaking of pulses collectively, Ying and Wei are included. Daytime Qi travels in Yang, nighttime Qi travels in Yin. Twenty-five circuits each for day and night make fifty circuits for one cycle. Since day and night vary in length, this describes the average. The methods of traveling in Yang/Yin and their starting/ending points are detailed in *Ling Shu: Wei Qi Xing*.)

Therefore, after fifty circuits, the Qi reconvenes at the Hand-Taiyin. The Cun-Kou is the beginning and end of the Qi of the five Zang and six Fu organs; thus, the method selects the Cun-Kou. (Starting and ending at the Hand-Taiyin, hence called "Zhong Shi". The Qi of the five Zang and six Fu organs manifests here, so selecting Cun-Kou can determine life/death and fortune/misfortune. *Ling Shu: Ying Wei Sheng Hui* states: "Ying Qi originates from the Middle Jiao, Wei Qi originates from the Lower Jiao. The Yellow Emperor asked about the origins of the Three Jiao. Qibo said: The Upper Jiao exits the upper opening of the Stomach, passes through the pharynx and diaphragm... follows the Taiyin division, returns to the Yangming, ascends to the tongue, descends to the Foot-Yangming, and always travels with Ying Qi for twenty-five circuits in Yang and twenty-five in Yin, constituting one cycle. Thus, after fifty circuits, they meet again at the Hand-Taiyin." This is the normal regulation of Ying and Wei.)

Difficulty 2 states: There are Cun and Chi in the pulse. What does this mean?

It is answered: Cun and Chi are the major convergence points of the pulse. (Details on Cun and Chi follow. "Yao Hui" refers to the critical location and gathering place.) From the Guan (Bar) point to the Chi (Cubit) position is the Chi interior, governed by Yin; from the Guan point to the Yuji (Fish Border) is the Cun (Inch) interior, governed by Yang. (The Guan point is the boundary between Cun and Chi, known as the high bone mentioned in *Mai Jue*. Below Guan is Chi, governing Kidney and Liver, with a deep pulse, thus belonging to Yin. Yuji is the white flesh named "Fish" on the medial side of the first metacarpophalangeal joint; the border between red and white flesh is Yuji. Above Guan is Cun-Kou, governing Heart and Lung, with a floating pulse, thus belonging to Yang.)

Therefore, dividing Cun creates Chi, and dividing Chi creates Cun. (These two sentences explain "Cun" and "Chi" clearly. It means taking one cun away from above Guan leaves Chi; taking one chi away from below Guan leaves Cun. This explains the naming.) Thus, Yin occupies one cun in the Chi section, and Yang occupies nine fen in the Cun section. (This divides the length within Cun and Chi to align with Yin-Yang numbers. One cun is an even number, nine fen is an odd number. Generally, from Guan down to Chize is called Chi, but pulse diagnosis only checks one cun below Guan. From Guan up to Yuji is called Cun, but pulse diagnosis only checks nine fen above Guan. Hence, "one cun in Chi, nine fen in Cun".) The total length of Cun and Chi from start to finish is one cun and nine fen, hence called Cun-Chi. (This combines the numbers of Cun and Chi. However, obtaining one cun is not called just "Cun", and nine fen is not called just "Fen", because they are within the Chi section and Cun section respectively.)

Difficulty 3 states: There are pulses of excess (Tai Guo), deficiency (Bu Ji), Yin overcoming Yang, Fu (covering/reversing), Yi (overflowing), Guan (closing), and Ge (blocking). What does this mean? (Tai Guo and Bu Ji are pathological pulses. Yin overcoming Yang means Yin exceeds and invades Yang; Yang overcoming Yin means Yang exceeds and invades Yin, representing severe excess/deficiency. Fu, Yi, Guan, and Ge represent severe overcoming.)

It is answered: Before the Guan point is the movement of Yang; the pulse should appear nine fen and be floating. (Before Guan is Yang. Floating is the image of Yang.) Exceeding this standard is termed Tai Guo (Excess); falling short is termed Bu Ji (Deficiency). If the pulse rises to the Yuji, it is called Yi (Overflowing) (Exceeding means floating beyond nine fen. Falling short means floating less than nine fen. Yuji is the Fish Border. Rising to Yuji indicates extreme excess. Yi means full and overflowing outwards). This is called Wai Guan Nei Ge (External Closing, Internal Blocking), which is a pulse of Yin overcoming. (Regarding Guan-Ge, Difficulty 37 states: If Yang Qi is too excessive, Yin cannot interact, called Guan; if Yin Qi is too excessive, Yang cannot interact, called Ge. Here, External Guan means Yang excess surges outward; Internal Ge means Yin excess blocks inward. Yin overcoming means Yin Qi ascends to the Yang position.) After the Guan point is the movement of Yin; the pulse should appear one cun and be deep. (After Guan is Yin. Deep is the image of Yin.) Exceeding this is Tai Guo; falling short is Bu Ji. If the pulse sinks into the Chi, it is called Fu (Covering/Reversing) (Exceeding means sinking beyond one cun. Falling short means sinking less than one cun. Chi is the section after one cun. Fu means reversing/tipping over). This is called Nei Guan Wai Ge (Internal Closing, External Blocking), which is a pulse of Yang overcoming. (Internal Guan means Yang reverses to the lower position, occupying Yin's place; External Ge means Yin reverses upward, occupying Yang's place. Yang overcoming means Yang Qi descends into Yin.) Therefore, it is called Fu and Yi. These are True Zang pulses; a person may die without apparent disease. (True Zang pulse means Zang Qi is exhausted. Its true form appears alone externally; death can be predicted regardless of other diseases. This should be read together with Difficulty 37.)

Difficulty 4 states: There is a method of Yin and Yang in pulses. What does this mean? (Yin and Yang refer to pulses belonging to Yin or Yang.)

It is answered: Exhalation involves the Heart and Lung; inhalation involves the Kidney and Liver. Between breaths, the Spleen receives the essence of grain. (Heart and Lung are superior, so exhalation comes from them, belonging to Yang. Kidney and Liver are inferior, so inhalation returns to them, belonging to Yin. Spleen governs the Central Palace, managing the interval of entry and exit. Receiving grain essence implies receiving Stomach Qi to reach the Hand-Taiyin.) Their pulse is in the middle. (In the middle, between Yin and Yang. Floating is Yang, Deep is Yin, hence Yin and Yang.) (Floating is exterior, thus Yang. Deep is interior, thus Yin.)

Both Heart and Lung pulses are floating; how to distinguish them? (Exhalation from Heart/Lung makes both float. Distinguish means to differentiate.)

It is answered: Floating, large, and scattered is the Heart pulse; floating, short, and choppy is the Lung pulse. (Heart belongs to Fire, so its image is large and scattered; Lung belongs to Metal, so its image is short and choppy. These are the fundamental pulses of Heart and Lung, while floating is their common trait.)

Both Kidney and Liver pulses are deep; how to distinguish them? (Inhalation to Kidney/Liver makes both deep.)

It is answered: Firm and long is the Liver pulse; soft upon pressure but firm when lifting the finger is the Kidney pulse. (Liver belongs to Wood, so its image is firm and long. Kidney belongs to Water, so its image is soft yet firm internally. Water is soft outside but hard inside.)

Spleen is in the Central Province, so its pulse is in the middle. This is the method of Yin and Yang. (In the middle, neither deep nor floating. The above explains Yin-Yang clearly; the following discusses interaction within Yin-Yang.)

There are pulses of one Yin one Yang, one Yin two Yang, one Yin three Yang; one Yang one Yin, one Yang two Yin, one Yang three Yin. Does this mean six pulses move simultaneously at Cun-Kou? (Simultaneous movement means all three Yin and three Yang are visible.)

It is answered: This does not mean six pulses move simultaneously, but refers to Floating, Deep, Long, Short, Slippery, and Choppy. (These are the so-called six pulses. Floating is upper, Deep is lower, Long exceeds the position, Short falls short of the position, Slippery is fluent, Choppy is stagnant. Floating, Deep, Long, Short describe shape; Slippery, Choppy describe texture.)

Floating is Yang, Slippery is Yang, Long is Yang; Deep is Yin, Short is Yin, Choppy is Yin. (These are the three Yin and three Yang.) So-called "One Yin One Yang" means the pulse comes Deep and Slippery; "One Yin Two Yang" means Deep, Slippery, and Long; "One Yin Three Yang" means Floating, Slippery, and Long, occasionally appearing Deep. "One Yang One Yin" means Floating and Choppy; "One Yang Two Yin" means Long, Deep, and Choppy; "One Yang Three Yin" means Deep, Choppy, and Short, occasionally appearing Floating. (These are images of mixed pulses. This is an example; they interweave and are not fixed. Note that Floating and Deep can combine, but Slippery/Choppy and Long/Short cannot coexist.) Based on the meridian involved, name the disease as Ni (Reverse) or Shun (Smooth). (The previous text discussed pulse forms without judging fortune; this discusses judgment. The meridians are the hand and foot three Yin and three Yang. Reverse/Smooth: e.g., Heart pulse should be Floating, Kidney pulse should be Deep for Smooth; if Heart is Deep and Kidney is Floating, it is Reverse. This shows pulses have no fixed form and depend on the meridian for judgment.)

Difficulty 5 states: There is lightness and heaviness in pulses. What does this mean? (Light is floating and weak; Heavy is deep and strong.)

It is answered: Initially holding the pulse with the weight of three beans, touching the skin and hair, is the Lung pulse. (Holding the pulse means pressing. Bean is a general term for legumes. Weight of three beans means force equivalent to three beans. Touching skin/hair means floating to the skin level. Lung pulse is lightest, hence this image.) With the weight of six beans, touching the blood vessels, is the Heart pulse. With the weight of nine beans, touching the muscles, is the Spleen pulse. With the weight of twelve beans, level with the tendons, is the Liver pulse. Pressing to the bone, with a quick response upon lifting the finger, is the Kidney pulse. (Blood vessels, muscles, tendons, bones descend in depth, so pulse lightness/heaviness is based on this. Lung is highest, then Heart, Spleen, Liver, Kidney lowest. To the bone is the deepest press. Quick response means strong and urgent, same meaning as "firm upon lifting" in Difficulty 4.)

Difficulty 6 states: There is Yin Excess Yang Deficiency, and Yang Excess Yin Deficiency. What does this mean? (This differs from the Yin-Yang method above. The above discussed pulses belonging to Yin/Yang as normal; this discusses pathological excess/deficiency in Yin/Yang branches.)

It is answered: If Floating pulse is damaged/small and Deep pulse is solid/large, it is called Yin Excess Yang Deficiency. If Deep pulse is damaged/small and Floating pulse is solid/large, it is called Yang Excess Yin Deficiency. (Floating pulse governs Yang, Deep pulse governs Yin. Damaged/small means Qi/Blood decline; Solid/large means Qi/Blood abundance.) This is the meaning of Yin-Yang Deficiency-Excess.

Difficulty 7 states: The Classics say: Shaoyang to the peak, pulses suddenly large, suddenly small, suddenly short, suddenly long; Yangming to the peak, pulses Floating, Large, and Short; Taiyang to the peak, pulses洪 (Vast/Surging), Large, and Long; (Shaoyang Yang Qi is still slight, close to Yin, so pulse is不定 (variable). Yangming Yang is already abundant but not extreme, so Floating, Large, Short. Taiyang Yang is extremely abundant, so Vast, Large, Long. "To the peak" means Qi arrives and pulse responds.) TAIyin to the peak, pulses Tight, Large, and Long; Shaoyin to the peak, pulses Tight, Fine, and Micro; Jueyin to the peak, pulses Deep, Short, and敦 (Solid/Round). (Taiyin is start of Yin, so has Tight image but still has Long/Large Yang pulse. Shaoyin Yin gradually increases, so Tight, Fine, Micro. Jueyin is extreme of Yin, so Deep, Short, Solid, extreme of Yin pulse.) Are these six normal pulses or pathological pulses? (Normal pulse is natural; Pathological pulse is excessive.)

It is answered: They are Wang (Dominant/Seasonal) pulses. (Wang pulse means Qi corresponds to the season of dominance.) In which month, and for how many days does each dominate?

It is answered: After Winter Solstice, when Jiazi day arrives, Shaoyang dominates. (Ancient calendars start from Winter Solstice, which must be Jiazi. However, a year is 365.25 days, causing drift, so Solstice isn't always Jiazi. "Jiazi after Solstice" refers to when Solstice is Jiazi. On Jiazi Solstice, after 15 days post-Lichun (Spring Start), a Jiazi cycle completes, Wood Qi begins to flourish, hence Shaoyang dominates. If Solstice is not Jiazi, Shaoyang dominance lasts roughly 60 days, not limited by Jiazi.) When Jiazi day arrives again, Yangming dominates; again, Taiyang; again, Taiyin; again, Shaoyin; again, Jueyin. (Shaoyang Yang is slight. Yangming Yang is abundant. Taiyang Yang is extreme; extreme generates Yin, so Taiyin acts. Taiyin Yin is slight; Shaoyin Yin is abundant; Jueyin Yin is extreme; extreme generates Yang. This cycle continues endlessly.) Each dominates for sixty days. (From Jiazi to next Jiazi is sixty days, one cycle.) Six times sixty is 360 days, forming a year. This is the general rule of Three Yang and Three Yin dominance periods. (Month refers to time, Days refers to duration, answering the previous question.)

Difficulty 8 states: Cun-Kou pulse is peaceful, yet the person dies. What is the reason? (Peaceful means pulse is not diseased.)

It is answered: All twelve meridians are connected to the Source of Life Qi. The Source of Life Qi is the root of the twelve meridians, also known as the Moving Qi between the Kidneys. (Twelve meridians seen above. Connected means linked. Qi of twelve meridians originates here, hence root. Between Kidneys is the space between the two kidneys. Moving Qi is where Qi opens/closes/exits/enters, i.e., Mingmen. Detailed in Difficulty 36.) This is the root of five Zang and six Fu organs, the root of twelve meridians, the gate of respiration, and the source of Sanjiao. Also called the Spirit guarding against Evil. (Inhalation to Kidney/Liver makes it the gate of respiration, i.e., Moving Qi. Sanjiao matches Kidney, Kidney is Lower Jiao, so it is source of Sanjiao. Guarding Evil is unclear. Some say sufficient Yuan Qi prevents evil invasion, hence "Guarding Evil". Uncertain.) Thus, Qi is the root of humans; if the root perishes, stems and leaves wither. (Qi is Yuan Qi. Yuan Qi in humans is like roots in plants; if roots perish, stems/leaves wither; human Yuan Qi is the same.) Cun-Kou pulse is peaceful yet death occurs because the Life Qi is uniquely severed internally. (Meaning internal Life Qi is exhausted; even if external pulse is peaceful, death is inevitable.)

Difficulty 9 states: How to distinguish Zang and Fu diseases?

It is answered: Rapid pulses belong to Fu, Slow pulses belong to Zang. (Fu is Yang, Zang is Yin.) Rapid indicates Heat, Slow indicates Cold. (Explains why Slow/Rapid.) All Yang pulses indicate Heat, all Yin pulses indicate Cold. (Further explains why Rapid belongs to Fu and Slow to Zang. All Yin/Yang extends the reasoning. Thus, to distinguish Zang/Fu diseases.)

Difficulty 10 states: One pulse changes ten times. What does this mean? (One pulse ten changes means one Zang pulse has ten variations, as described below.)

It is answered: (This refers to the meeting of Five Evils with Gang-Rou. Five Evils are evils of five Zang and five Fu. Gang-Rou: Five Zang are Rou (Soft), Five Fu are Gang (Hard). Meeting means Zang evil invading Zang, Fu evil invading Fu. Detailed below.) For example, if Heart pulse is extremely Urgent, it is Liver evil invading Heart; if Heart pulse is slightly Urgent, it is Gallbladder evil invading Small Intestine; if Heart pulse is extremely Large, it is Heart evil invading Heart; if Heart pulse is slightly Large, it is Small Intestine evil invading Small Intestine; if Heart pulse is extremely Relaxed, it is Spleen evil invading Heart; if Heart pulse is slightly Relaxed, it is Stomach evil invading Small Intestine; if Heart pulse is extremely Choppy, it is Lung evil invading Heart; if Heart pulse is slightly Choppy, it is Large Intestine evil invading Small Intestine; if Heart pulse is extremely Deep, it is Kidney evil invading Heart; if Heart pulse is slightly Deep, it is Bladder evil invading Small Intestine. (This is the ten changes. Zang invading Zang makes pulse significant; Fu invading Fu makes pulse slight. Urgent, Large, Relaxed, Choppy, Deep are fundamental pulses of five Zangs. Seeing which pulse indicates which Zang is invading. Observing Small Intestine via Heart pulse is because *Su Wen: Xue Qi Xing Zhi* says: "Hand-Taiyang and Hand-Shaoyin are exterior-interior." Other pairings follow this.) Each Zang has Gang-Rou evils, causing one pulse to change ten times. (These two sentences generalize, using Heart as example, so all Zangs are the same, hence "each has" and "changes".)

Difficulty 11 states: The Classics say the pulse stops before fifty beats, indicating one Zang has no Qi. What does this mean? (*Ling Shu: Gen Jie* states: "Fifty beats without interruption means five Zangs receive Qi. Forty beats with one interruption means one Zang has no Qi... Ten beats with one interruption means four Zangs have no Qi. Less than ten beats with one interruption means five Zangs have no Qi." This cites and summarizes the Classic. No Qi means Qi is exhausted, so pulse flow breaks here.)

It is answered: Inhalation follows Yin entering; Exhalation follows Yang exiting. (Inhalation to Kidney/Liver, so follows Yin. Exhalation from Heart/Lung, so follows Yang.) Now inhalation cannot reach the Kidney, returning at the Liver. (One exhalation two beats, one inhalation two beats. Speaking of respiration relates to pulse movement. Pulse stops before completion, knowing inhalation doesn't reach Kidney.) Thus, knowing one Zang has no Qi, it is Kidney Qi that is exhausted first. (Cannot reach Kidney, so Kidney Qi is exhausted.)

Difficulty 12 states: The Classics say if Five Zang pulses are exhausted internally, acupuncturists mistakenly tonify externally; if Five Zang pulses are exhausted externally, acupuncturists mistakenly tonify internally. How to distinguish internal and external exhaustion? (Classic cited from *Ling Shu: Jiu Zhen Shi Er Yuan*.)

It is answered: Five Zang pulses exhausted internally means Kidney and Liver pulses are exhausted internally, yet doctors mistakenly tonify Heart and Lung; Five Zang pulses exhausted externally means Heart and Lung pulses