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Human life relies solely on the triad of Jing (Essence), Qi (Vital Energy), and Shen (Spirit). Jing-Qi is synonymous with Blood-Qi, while Shen is difficult to perceive directly. Without Shen, there can be no mastery over Blood-Qi; thus, the pulse is nothing other than an alias for Shen. However, Shen is rooted in Qi, Qi is rooted in Blood, Blood is nourished by Grain (Nutrients), and Grain originates from the Stomach. Therefore, the *Huangdi Neijing* (Yellow Emperor's Inner Canon) states regarding pulse diagnosis: "With Stomach Qi, there is life; without Stomach Qi, there is death." Li Dongyuan stated: "The pulse values having Shen." This precisely refers to Stomach Qi. From this, we know that when Stomach Qi is abundant, Blood is vigorous; when Blood is vigorous, Qi is strong; when Qi is strong, Shen flourishes. Thus, whether Shen flourishes or not is indicated by the pulse.

From the Yuji point (L10, Large Intestine Meridian) behind the thumb to the high bone (styloid process/radial styloid area contextually referring to wrist anatomy), there is a distance of one cun, hence named "Cun" (Inch). From the Chize point (LU5, Lung Meridian) at the inner elbow to the same high bone, there is a distance of one chi, hence named "Chi" (Foot). The section between Cun and Chi is named "Guan" (Gate). The Cun position governs the Upper Jiao (Upper Burner), the Guan position governs the Middle Jiao (Middle Burner), and the Chi position governs the Lower Jiao (Lower Burner).

The Three Positions (San Bu) refer to Cun, Guan, and Chi. When diagnosing the pulse, one first places the middle finger to fixate the Guan position, then places the index and ring fingers on the Cun and Chi positions respectively. The prominent bone behind the palm is the Guan position. If the patient is tall, the fingers should be spaced wider; if short, closer together. One first palpates the Cun position, then the Guan position, and finally the Chi position.

The Nine Probes (Jiu Hou) refer to Floating (Fu), Moderate (Zhong), and Deep (Chen) pressures. Floating pressure involves lightly placing fingers on the skin and hair level to probe the Fu-organ pulses, representing the Exterior (Biao). Moderate pressure involves slightly heavier placement on the muscle level to observe Stomach Qi, representing the Half-Exterior Half-Interior (Ban Biao Ban Li). Deep pressure involves heavy placement on the bone and tendon level to examine Zang-organ pulses, representing the Interior (Li). Each of the three positions has three probes (Floating, Moderate, Deep); combined with the three positions, this totals nine probes.

Pulse Qi does not travel through the Cun Kou (Radial Artery at the wrist) normally but enters via the Lieque point (LU7) into the arm posteriorly, connecting to the Hand-Yangming Large Intestine Meridian. Because it does not run normally over the Guan position, it is called "Fan Guan" (Reverse Gate). In such cases, the hand must be turned over to diagnose the pulse. The method of pulse diagnosis requires first regulating one's own breath. Between one exhalation and one inhalation, four pulse beats are considered normal. If the patient sighs, five beats may also be considered normal; this is due to the lengthened respiration, not a rapid pulse. Any excess or deficiency constitutes a pathological pulse, judged according to the specific position.

Pulse diagnosis values grasping the outline. For example: Left hand is Yang, Right hand is Yin; Rapid/Restless is Yang, Slow is Yin; Superficial touch is Yang, Deep touch is Yin; Forceful is Yang, Weak is Yin; Long/Large is Yang, Short/Small is Yin. Understanding these establishes the general outline of the pulse. Thus it is said: Briefly speaking, merely knowing Floating, Deep, Slow, and Rapid reveals the gist. The Classics state: "He who knows the essentials needs only one word to conclude; he who does not know them wanders infinitely." This is what is meant.

The pulse values having Shen. For instance, six or seven beats per respiration cycle indicates Heat, but if the pulse is forceful within, it has Shen, indicating the need to drain the Heat. Three or two beats per cycle indicates Cold, but if forceful within, it has Shen, indicating the need to dispel the Cold. If the pulse is both rapid/extreme or slow/degenerate, losing forcefulness, it lacks Shen. Hastily draining or warming in such cases leaves Shen without foundation.

One fen anterior to the Guan position is the master of human life. The left side is Ren Ying (Person Welcome), used to inspect external causes. Thus: "Ren Ying full and firm indicates injury by Cold." The right side is Qi Kou (Qi Portal), used to inspect internal causes. Thus: "Qi Kou full and firm indicates injury by Food." Since Cun, Guan, and Chi each occupy three fen, totaling the Cun Kou, the "one fen anterior to Guan" refers precisely to that segment. All mechanisms of life and death, fortune and misfortune, are deduced here. The Liver and Gallbladder govern the spring ascending energy of heaven and earth, the beginning of all things; thus, if Ren Ying deviates, the root of generation is depleted. The Spleen and Stomach receive the harmonious qi of heaven and earth, nurturing all things; thus, if Qi Kou is disrupted, the source of nourishment fails. Hence, they are the masters of life.

"Pulse without Root" has two interpretations: One considers the Chi position as the root. A rooted pulse is like a tree with roots; even if branches and leaves wither, the root regenerates. The two Chi positions belong to Kidney Water, which is the primal origin of Heaven One, the congenital root of life. The *Nan Jing* (Classic of Difficult Issues) states: "If there is no pulse above but pulse below, although distressed, there is no harm." Wang Shuhe stated: "Even if Cun and Guan lack pulse, if Chi remains unceasing, why worry about demise?" This signifies having a root. If only the Kidney pulse degenerates, there is no root. The second interpretation considers Deep pressure as the root. The Classics state: "All floating pulses without root lead to death," meaning Exterior without Interior, or Solitary Yang cannot grow. Yin and Yang are mutual roots; if Yin is severed, can Solitary Yang survive? Though these two views seem different, they are consistent. The two Chi positions represent the Kidney region. Wang Zongzheng stated: "In pulse diagnosis, Heart and Lung float, Liver and Kidney sink, Spleen is in the Central Region." Thus, the six pulses in deep pressure reflect this. Therefore, lack of root in the two Chi positions and lack of root in deep pressure both signify the extinction of Kidney Water.

The *Nan Jing* states: "The text says the pulse stops after fewer than fifty beats; this means one Zang lacks Qi." Which Zang? Inhalation follows Yin inward, exhalation follows Yang outward. Now, if inhalation cannot reach the Kidney but returns at the Liver, we know the Zang lacking Qi is the Kidney, whose Qi fails first. Thus, when Five Zangs harmonize, Qi and pulse are long; when diseased, they are short. Observing one Zang lacking Qi starts with the Kidney. As described later for two, three, four, or five Zangs lacking Qi, the progression is from distant to near, shortening sequentially: from Kidney to Liver, Liver to Spleen, Spleen to Heart, Heart to Lung. Therefore, in critical illness, breathing becomes rapid and pant-like, confined to a few inches in the chest. This is because True Yin is exhausted below, and Solitary Yang floats above—the extreme of shortness of breath. At this stage, any attempt to calm or disperse will result in immediate collapse, which is truly lamentable.

Among Floating, Deep, Slow, Rapid, Slippery, and Choppy pulses, there are crucial distinctions. Floating indicates Exterior, but in Yin Deficiency, the pulse is Floating and weak; thus, Floating cannot universally indicate Exterior, nor should dispersing methods be used indiscriminately. Deep indicates Interior, but in severe initial exterior pathogen invasion where Yin-Cold binds the skin and pores, blocking Yang from reaching the exterior, the pulse may appear Deep and Tight; thus, Deep cannot universally indicate Interior, nor should purgative methods be used. Slow indicates Cold, but in Yangming Disease of Cold Damage, the pulse is Slow without aversion to cold but with fever, heaviness, abdominal fullness, panting, and sweating on hands and feet; this indicates a condition requiring purgation of the Interior; thus, Slow cannot universally indicate Cold, nor should warming methods be used. Rapid indicates Heat, but in consumptive diseases with dual deficiency of Yin and Yang and chaotic Blood-Qi, the pulse is urgent and rapid; the more rapid, the more deficient; the more deficient, the more rapid. This requires tonifying the Master of Water (Kidney Yin); thus, Rapid cannot universally indicate Heat, nor should cooling methods be used. Fine and Thin resemble Deficiency, but in extreme pain with obstruction, the pulse may be Hidden (Fu); thus, Fine/Thin cannot universally indicate Deficiency, nor should sudden tonification be used. Surging and Wiry resemble Excess, but in severe True Yin deficiency, the pulse shows Guan Ge (Excessive strength, four times normal); thus, Wiry cannot universally indicate Excess, nor should reducing/draining methods be used. Within the general principles, there are overarching principles; skilled diagnosticians must observe these carefully.

There are cases following symptoms over pulse, e.g., Yangming Disease with Slow pulse but presenting indications for purgation, treated with Chengqi Tang. There are cases following pulse over symptoms, e.g., Jie Xiong (Chest Binding) syndrome present, normally requiring purgation to open the binding; however, if the pulse is Floating and Large, the exterior pathogen is not yet resolved. Purgation would cause binding upon binding, leading to death. Here, one must follow the pulse and treat the exterior pathogen. This example can be extrapolated.

Pulses have "Hyperactivity and Restraint." The Classics state: "Hyperactivity causes harm; restraint follows." Hyperactivity means exceeding upward limits without descending. Restraint means receiving/control. Extreme hyperactivity leads to being controlled. Fire normally controls Metal; excessive control is hyperactivity. Metal's child is Water, which can control Fire. Taking advantage of Fire's weakness to avenge its mother (Metal), Fire is instead controlled. In Yang Excess, the pulse is Surging and Large; at the extreme of Yang Excess, the pulse becomes Hidden, appearing Yin-like (Yang extreme mimics Yin). In Yin Excess, the pulse is Fine and Minute; at the extreme of Yin Excess, the pulse becomes Dry and Rapid, appearing Yang-like (Yin extreme mimics Yang). Everything at extremes reverses to mimic its controlling element.

Wealthy people often have central deficiency and delicate constitutions, with insufficient pulses. Poor/common people often have solid centers and strong constitutions, with surplus pulses. Fat individuals have Qi residing in the exterior, with Floating/Surging pulses. Thin individuals have Qi gathered internally, with Deep/Rapid pulses. Irritable temperaments require five beats per respiration for a normal pulse; calm temperaments may show heat signs with four beats. Northern people often show strong pulses; Southern people often show weak pulses. Youthful/strong pulses tend to be large; elderly/frail pulses tend to be deficient. Post-alcohol pulses are often Rapid; post-meal pulses are often Surging. After long travel, pulses are necessarily fast; after prolonged fasting, pulses are necessarily deficient. Virgins and nuns, possessing solitary Yin without Yang, have Deep/Weak pulses. Infants, possessing pure Yang without Yin, have pulses around seven beats. These variations in form and Qi necessitate adaptability in diagnosis.

For men, a larger Left pulse is favorable (Left is Yang); for women, a larger Right pulse is favorable (Right is Yin). Men's Chi pulses are constantly deficient, resembling the empty center of the Li trigram (Fire). Women's Chi pulses are constantly full, resembling the full center of the Kan trigram (Water).

Elderly pulses should be weak; excessive strength indicates disease. Strong/adult pulses should be substantial; weakness indicates disease. However, if an elderly person's pulse is strong but not restless, it indicates robust constitution and longevity. If restless with Exterior but no Interior, it is Solitary Yang, signaling imminent death. An adult's pulse should be fine, harmonious, and slow, equal in all three positions, indicating quiet constitution and stable cultivation. If fine, wiry, and unequal front-to-back, death is near.

Spring presents Wiry pulses, Summer Surging, Autumn Hairy (Choppy), Winter Stone (Deep). These appearing according to seasons are normal. If Spring shows Surging, death comes in Summer; if Choppy, death in Autumn; if Deep, death in Winter. This indicates premature leakage of the True Zang Qi. The image appears out of season and vanishes when the season arrives.

Six pulses with Exterior but no Interior, such as Ru (Soggy) pulse, are named "Depletion of Yin." Six pulses with Interior but no Exterior, such as Ruo (Weak) pulse, are named "Depletion of Yang." Sudden cessation of all six pulses indicates depletion of both Yin and Yang. Depletion of Yang causes blindness; Depletion of Yin causes hallucinations (seeing ghosts); both indicate death.

The Classics state: Ren Ying (lateral to Adam's apple, Yangming Exterior pulse) inspects Yang; Qi Kou (the six positions, Taiyin Interior pulse) inspects Yin. Thus, if Ren Ying alone is excessively strong (four times normal), it is an extreme Yang pulse, leading to depletion of Yin in the Six Fu organs, called Ge Yang (Gridlock Yang). If Qi Kou alone is excessively strong (four times normal), it is an extreme Yin pulse, leading to depletion of Yin in the Five Zang organs, called Guan Yin (Closing Yin). If both Ren Ying and Qi Kou are excessively strong (four times normal), it is extreme Yang and Yin, leading to depletion of Yin in both Zang and Fu organs, called Guan Ge (Gridlock and Closing). All are termed Yin Depletion because extreme pulse strength implies lack of Yin; without Yin, there is no root, and Solitary Yang floats externally. Those suffering this will undoubtedly die. I have seen patients with extremely hard/full pulses, increasing daily dyspnea, and vibrating pulses throughout the body and neck, caused by sexual excess and alcohol damaging Essence, ultimately untreatable. Thus, the Classics state: "The Five Zang store Essence; do not injure them. Injury leads to loss of control and Yin Deficiency. Yin Deficiency leads to lack of Qi. Lack of Qi leads to death!" This refers to Guan Yin and Ge Yang.

Examining the *Neijing*, there is no mention of the "Three Gates" (San Guan). Later pediatric examination of the Three Gates is a heterodox theory and unreliable. Treating children requires observing the Qi Kou pulse, facial color, and respiratory sound. Pediatric pulse diagnosis focuses only on Size, Slowness/Rapidity, and Deficiency/Excess among the six categories; no further complexity is needed.

Pediatric pulse method: Use one finger to assess Cun, Guan, and Chi. Six beats per respiration is peaceful; seven beats is Heat; four or five beats is Cold.

Chong Yang (also known as Fu Yang) is the Stomach pulse. Located on the dorsum of the foot, between the big toe, in the depression between the fifth metatarsal bones. In critical illness, one must check Chong Yang. If Chong Yang ceases, death is incurable; the root of nourishment is gone.

Tai Xi is the Kidney pulse. Located behind the medial malleolus, in the depression above the heel bone. In critical illness, one must check Tai Xi. If Tai Xi ceases, death is incurable; the root of initiation is gone.