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The meridians refer to citing the Lung meridian passage to explain this principle. Yang states: The pulse comes and goes slowly, occasionally stopping and then resuming, is called Jie (Knotted) pulse. In cases of severe Jie pulse, this refers to the condition during pulse diagnosis. "Severe Jie" here interprets "Jie" as accumulation, meaning that if the pulse is severely knotted, the internal accumulation is severe; if the pulse accumulation is slight, the internal accumulation is slight. This statement is somewhat implicit. Yu states: Jie pulse indicates the presence of mass-like accumulations in the body. The pulse beats but stops intermittently, with a slightly rapid rate and a returning sensation, hence it is called Jie pulse. The size of the accumulation varies according to the diagnostic findings. Yang states: Although the typical floating, short, and choppy characteristics of the Lung pulse are not detected, the right-hand pulse should be deep and hidden (Fu), indicating the presence of stagnant Qi in the right hypochondrium. This is because the Lung's governance is located on the right. It requires heavy pressure to reach the bone to be felt, thus it is called Fu (Hidden) pulse.

Regarding external chronic diseases, is the treatment method the same or different? The answer is affirmative. Jie pulse refers to the pulse stopping occasionally during its coming and going without a fixed pattern, named Jie pulse. Fu pulse refers to the pulse traveling beneath the tendons. Floating pulse refers to the pulse traveling above the flesh. The principles for left/right and superficial/deep are all like this. For instance, if the pulse is Jie and Fu, but there is no internal accumulation; or if the pulse is Floating and Jie, but there is no external chronic disease; or if there is an accumulation but the pulse is not Jie/Fu, or there is a chronic disease but the pulse is not Floating/Jie, this constitutes a mismatch between pulse and disease, and disease and pulse, which indicates a fatal condition.

Ding states: When the heart harbors thoughts or yearnings, the pulse may also present as Jie. If the heart has no thoughts and there is no internal or external illness, yet the pulse presents as Fu and Jie, this is a case where the form is healthy but the pulse is diseased, thus indicating a fatal prognosis. Yang states: A mismatch between pulse and disease is considered a counter-flow (Ni) pattern, which is difficult to treat, hence it is said to be a fatal disease.

Old commentaries state: The Pericardium Meridian of Hand-Jueyin and the Sanjiao Meridian of Hand-Shaoyang combine to form the middle position of the left hand. The Spleen Meridian of Foot-Taiyin and the Stomach Meridian of Foot-Yangming combine to form the middle position of the right hand. This classic makes such distinctions. If one follows the *Mai Jing* (Pulse Classic) to assign the three positions, it differs from this. (This is precisely Yang's annotation from the previous section on Hand-Jueyin and Shaoyang. It is cited again in detail in the following section, repeated here redundantly, but retained here based on the original text.)

The old classic contains this content, which contradicts the previous annotations. This diagram is listed to correct the text. Yang states: The Pericardium Meridian of Hand-Jueyin and the Sanjiao Meridian of Hand-Shaoyang combine to form the upper position of the left hand. The Spleen Meridian of Foot-Taiyin and the Stomach Meridian of Foot-Yangming combine to form the middle position of the right hand. This classic makes such distinctions. If one follows the *Mai Jing* to assign the three positions, it differs from this. Yang failed to clarify the rationale behind this method, hence stating they differ. The Master inverted the three positions to correspond with the Five Elements and Six Qi. The Master referred to this inversion of Cun and Chi, and asked what each of the three positions governs. The classic states: The upper position corresponds to Heaven, governing diseases from the chest upwards to the head. The middle position corresponds to Humanity, governing diseases from below the diaphragm to above the navel. The lower position corresponds to Earth, governing diseases from below the navel to the feet. Hence it says to examine and arrange them in order. Additionally, Wang Shuhe described it in reverse order starting from the left Cun: Left corresponds to Heart, Small Intestine, Liver, Gallbladder, Kidney; Right corresponds to Lung, Large Intestine, Spleen, Stomach, Mingmen. Women are the reverse, viewed from the back. The third Chi pulse diagnoses similarly. Generally, the inverted two Chi pulses jointly govern diseases from below the navel to the feet. Thus Bian Que said to examine and arrange them in order, and Wang Shuhe said to use careful attention to find the trend.

[Image]
Hand Taiyang and Shaoyin (Fire): Fire flares upward and cannot descend to generate Hand Jueyin and Shaoyang (Fire). Foot Jueyin and Shaoyang (Wood): Wood generates Fire.
Hand Taiyang and Shaoyin (Ministerial Fire).
Foot Taiyang and Shaoyin (Water): Water flows downward and cannot ascend to generate Foot Jueyin and Shaoyang (Wood).
Hand Jueyin and Shaoyang (Ministerial Fire) generates Foot Taiyin and Yangming (Earth). Earth regenerates Metal. Foot Taiyin and Yangming (Earth) generates Hand Taiyin and Yangming (Metal).
Hand Taiyin and Yangming (Metal) generates Water.
Foot Taiyang and Shaoyin (Water).

Difficulty 19 states: The classics say pulses have contrary and compliant patterns. Men and women have normal patterns that may be reversed. What does this mean? The response is: Men are born in Yin; Yin represents Wood and Yang. Women are born in Shen; Shen represents Metal and Yin.
Yang states: Yuan Qi originates at Zi, which is the root of human birth. Men travel thirty years from Zi moving left to arrive at Si. (Note: These two characters are suspected to be interpolations.) Women travel twenty years from Zi moving right to arrive at Si, at which point husband and wife conceive. In ancient times, men married at thirty and women at twenty, following this law. Ten months later, a male child is born; moving left from Si to Yin takes ten months, so the male's annual cycle begins at Bing Yin. Women move right from Si to Shen, taking ten months, so the female's annual cycle begins at Ren Shen. Therefore, men are born in Yin, and women in Shen.
Yu states: The classics saying men are born in Yin and women in Shen refers to the convergence of their parents' years at Si. Men travel left for ten months to be born in Yin; women travel right for ten months to be born in Shen. According to Xiao Yun theory: Men start age one at Bing Yin, women at Ren Shen. The *Nan Jing* uses "born" rather than "start," implying one year old after birth. Bing and Ren represent Water and Fire, the parents of all things. Yin and Shen represent Metal and Wood, the beginning and end of biological maturation. The womb of Wood is in Shen, the womb of Metal is in Yin. The two Qi pair from their wombs, hence Yin and Shen are used. Metal is born at Si, and Si combines with Shen, so women take Shen. Wood is born at Hai, and Hai combines with Yin, so men take Yin. Thus, at age ten, men proceed forward to Hai; women proceed backward to Hai. At age sixteen, Tian Gui arrives for men, moving left to Si, which is the vital energy position of Shen. At age fourteen, Tian Gui arrives for women, moving right also to Si. (Note: Based on this reasoning, women at fourteen should be at Wei, not Si; this sentence is erroneous.) They occupy the vital energy position of their respective palaces in the same year. Yin and Yang combine to establish the way of marriage, hence there are men and women. *Shanggu Tianzhen Lun* states: At age sixteen (2x8), Tian Gui arrives for men, essence overflows, Yin and Yang harmonize, thus procreation is possible. Yang stated that men marry at thirty when their annual cycle reaches Si, which is incorrect. At age fourteen (2x7), Tian Gui arrives for women, Ren Mai opens, Chong Mai flourishes, menstruation occurs regularly, thus procreation is possible. Yang stated that women marry at twenty when their cycle reaches Si moving right, which contradicts this principle. Yang's words only align with ancient ritual laws of marriage but contradict the numbers of Tian Gui in this classic. Moreover, in Difficulty 19, the Sage discusses the way of male-female pairing, the intersection of Yin and Yang, and the timing of Tian Gui arrival, knowing pulse abundance or deficiency above and below, inferring strength or weakness, and diagnosing excess or insufficiency. If one only speaks of marrying at thirty and twenty, on what basis does this relate to the medical principles of this classic?

Therefore, the male pulse is above Guan, and the female pulse is below Guan. Consequently, the Chi pulse in men is consistently weak, while in women it is consistently strong; this is the norm.
Ding states: The mention of Chi pulses in men and women refers to the root of Yin and Yang. Compliance and contrariety refer to Yang embracing Yin to generate, and Yin embracing Yang to generate. Three Yang begin at Lichun, establishing Yin, hence it is said men are born in Yin, Wood being Yang. Three Yin begin at Liqiu, the seventh month establishing Shen, hence it is said women are born in Shen, Metal being Yin. Male Qi begins with Shaoyang and peaks with Taiyang, so the male Chi pulse is consistently weak and the Cun pulse is Yang. (Note: This character "Yang" is suspected to mean "Strong".) Female Qi begins with Taiyin and peaks with Jueyin; the female Chi pulse is floating and the Cun pulse is sunken, hence it is said the male pulse is above Guan and the female pulse is below Guan. This represents the compliance and contrariety of men and women.
Yang states: Men have abundant Yang Qi, so the Chi pulse is weak. Women have abundant Yin Qi, so the Chi pulse is strong. This is their natural nature.
Contrary patterns refer to men receiving female pulses and women receiving male pulses. What are the pathologies? The response is: When a man receives a female pulse, it indicates insufficiency, with disease internal. If found on the left, the disease is on the left; if on the right, the disease is on the right, depending on the pulse. When a woman receives a male pulse, it indicates excess, with disease in the four limbs. If found on the left, the disease is on the left; if on the right, the disease is on the right, depending on the pulse. This is what is meant.
Ding states: Saying a man receiving a female pulse indicates insufficiency means Yin insufficiency, allowing Yang to invade. Thus, Yang is not seen at Cun Kou but appears in Chi. Yin Qi governs the interior; insufficiency implies disease is internal. When a woman receives a male pulse indicating excess, disease is in the four limbs, because the female Chi pulse is naturally floating; if it additionally appears at Cun, it is called excess. Yang governs the exterior, so disease is in the four limbs. Depending on the left or right pulse: left finding implies left disease, right finding implies right disease.
Yang states: A man receiving a female pulse indicates abundant Yin Qi, which governs the interior, so disease is internal. A woman receiving a male pulse indicates abundant Yang Qi. (Note: The character "Yang" seems missing here.) Yang governs the four limbs, so disease is in the four limbs.
Yu states: Cun Kou is Yang. Men operate using Yang; seeing a Yin pulse now is contrary to heavenly norms, so disease arises internally. Women operate using Yin; seeing a Yang pulse at Cun Kou now is also contrary to heavenly norms, so disease is in the four limbs. *Su Wen* states: The four limbs are the root of all Yang.