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According to the *Ling Shu: Jing Mai Pian* (Spiritual Pivot: Chapter on the Meridians), discussing the meridians of Hand and Foot Taiyin and Yangming: The Hand Taiyin Lung Meridian (Hand Taiyin Fei Jing, 手太阴肺经) originates in the chest, travels outward to the hand where it connects with the Hand Yangming Large Intestine Meridian (Hand Yangming Da Chang Jing, 手阳明大肠经); from the Hand Yangming, it ascends to the head where it connects with the Foot Yangming Stomach Meridian (Foot Yangming Wei Jing, 足阳明胃经); from the Foot Yangming, it descends to the foot where it connects with the Foot Taiyin Spleen Meridian (Foot Taiyin Pi Jing, 足太阴脾经); from the Foot Taiyin, it ascends to the abdomen. This circulation from the upper body to the lower body, traversing Yin, Yang, Exterior, and Interior for one cycle, forms the first major circular loop of Hand and Foot Yin-Yang. Since both pulse diagnosis sites, "Cunkou" (Radial Artery, Cun Kou, 寸口) and "Renying" (Carotid Artery, Ren Ying, 人迎), are located on this first Yin-Yang loop, diseases affecting the Hand and Foot Taiyin and Yangming meridians result in direct sensory responses from Yin and Yang pulses. Therefore, a pulse three times stronger than normal is used to diagnose diseases of the Taiyin and Yangming meridians.

2. Discussion on the meridians of Hand and Foot Shaoyin and Taiyang: The Hand Shaoyin Heart Meridian (Hand Shaoyin Xin Jing, 手少阴心经) originates in the heart, travels outward to the hand where it connects with the Hand Taiyang Small Intestine Meridian (Hand Taiyang Xiao Chang Jing, 手太阳小肠经); from the Hand Taiyang, it ascends to the head where it connects with the Foot Taiyang Bladder Meridian (Foot Taiyang Pang Guang Jing, 足太阳膀胱经); from the Foot Taiyang, it descends to the foot where it connects with the Foot Shaoyin Kidney Meridian (Foot Shaoyin Shen Jing, 足少阴肾经); from the Foot Shaoyin, it ascends to the abdomen. This circulation from the upper body to the lower body, traversing Yin, Yang, Exterior, and Interior for one cycle, forms the second major circular loop of Hand and Foot Yin-Yang. Since the pulse diagnosis site is on the first Yin-Yang loop, diseases affecting the Hand and Foot Shaoyin and Taiyang meridians result in indirect sensory responses from Yin and Yang pulses. Therefore, a pulse two times stronger than normal is used to diagnose diseases of the Shaoyin and Taiyang meridians.

3. Discussion on the meridians of Hand Jueyin and Shaoyang: The Hand Jueyin Pericardium Meridian (Hand Jueyin Xin Bao Luo Jing, 手厥阴心包络经) originates in the chest, travels outward to the hand where it connects with the Hand Shaoyang Sanjiao Meridian (Hand Shaoyang San Jiao Jing, 手少阳三焦经); from the Hand Shaoyang, it descends to the head where it connects with the Foot Shaoyang Gallbladder Meridian (Foot Shaoyang Dan Jing, 足少阳胆经); from the Foot Shaoyang, it ascends to the foot where it connects with the Foot Jueyin Liver Meridian (Foot Jueyin Gan Jing, 足厥阴肝经); from the Foot Jueyin, it ascends to the abdomen. This circulation from the upper body to the lower body, traversing Yin, Yang, Exterior, and Interior for one cycle, forms the third major circular loop of Hand and Foot Yin-Yang. Because the pulse diagnosis site is on the first Yin-Yang loop, separated by the second Yin-Yang loop, the pulse wave transmission is further away. Thus, diseases affecting the Hand and Foot Jueyin and Shaoyang meridians result in isolated indirect sensory responses from Yin and Yang pulses. Therefore, a pulse one time stronger than normal is used to diagnose diseases of the Jueyin and Shaoyang meridians.

Regarding the connection between these three major circular movements, it relies on three branch meridians:

1. Foot Taiyin Spleen Meridian: "Its branch returns from the stomach, passes through the diaphragm, and enters the heart."

2. Foot Shaoyin Kidney Meridian: "Its branch emerges from the lung, connects with the heart, and enters the chest."

3. Foot Jueyin Liver Meridian: "Its branch returns from the liver, pierces through the diaphragm, and ascends to the lung."

The Ying Qi (Nutritive Qi, Ying Qi, 营气) and Wei Qi (Defensive Qi, Wei Qi, 卫气) of the human body circulate through these three major Yin-Yang loops, moving through Yin twenty-five cycles and through Yang twenty-five cycles, ending and restarting, circulating endlessly.

Table of Excess and Deficiency of Hand and Foot Twelve Meridians

Taiyin (Hand Lung, Foot Spleen)
Excess: Cunkou pulse is three times larger than Renying pulse.
Deficiency: Cunkou pulse is smaller than Renying pulse.

Shaoyin (Hand Heart, Foot Kidney)
Excess: Cunkou pulse is two times larger than Renying pulse.
Deficiency: Cunkou pulse is smaller than Renying pulse.

Jueyin (Hand Pericardium, Foot Liver)
Excess: Cunkou pulse is one time larger than Renying pulse.
Deficiency: Cunkou pulse is smaller than Renying pulse.

Yangming (Hand Large Intestine, Foot Stomach)
Excess: Renying pulse is three times larger than Cunkou pulse.
Deficiency: Renying pulse is smaller than Cunkou pulse.

Taiyang (Hand Small Intestine, Foot Bladder)
Excess: Renying pulse is two times larger than Cunkou pulse.
Deficiency: Renying pulse is smaller than Cunkou pulse.

Shaoyang (Hand Sanjiao, Foot Gallbladder)
Excess: Renying pulse is one time larger than Cunkou pulse.
Deficiency: Renying pulse is smaller than Cunkou pulse.

(II) Understanding of Yin-Yang Arteries and Advantages of Dual Yin-Yang Pulse Diagnosis

The *Ling Shu: Jing Mai Pian* states: "Meridians are usually invisible; their deficiency or excess can be known via the Qi Kou (Cunkou)." The positive and negative motor functions of the "Twelve Meridians" are formless and imageless. How can physicians examine the coming and going, deficiency and excess of Yin and Yang pulses to confirm the Yin-Yang abundance or scarcity of the "Twelve Meridians"? Even the arterial pulse at the "Taixi Acupoint" (Taixi Xue, 太溪穴) on both feet can be seen pulsating. If the "Twelve Meridians" are formless and invisible, how can they be touched and seen? It is because the energy of the opposing Yin-Yang movement of the formless "Twelve Meridians" stirs the tangible "Qi and Blood" of the human body, thereby forming the visible manifestation of the Yin-Yang arterial "pulse wave." Thus, physicians can touch and see them. This is like the East, South, West, and North winds blowing over the earth; although these winds are "formless" energy and hard to see, they can be detected through tangible objects on the earth, such as "swaying trees" and "waves on water." Therefore, examining the "Mai Kou (Cunkou) and Renying" arteries is equivalent to examining the "Qi and Blood pulse waves" promoted by the positive and negative movements of the Three Yin and Three Yang. Hence, the abundance or scarcity of Yin-Yang arteries and the Twelve Meridians share the same source and interact mutually.

Regarding the manifestation of this "Qi and Blood pulse wave" within the human body, past sages created many pulse studies works with differing views and complex theories on "pulse images," each having their own theoretical insights. Based on my study of the *Ling Shu*, I believe that ultimately there are only "two categories": the nature of "Normal" (Ping, 平) and "Abnormal" (Bu Ping, 不平). The *Ling Shu: Zhong Shi Pian* says: "What is called a healthy person is one who is not ill. A non-ill person has Cunkou and Renying pulses corresponding to the Four Seasons, with upper and lower parts responding to each other and flowing together, without knotting or intermission in the Six Meridian pulses, with cold and heat at the root and end being regulated, and shape, flesh, blood, and qi being proportional." If various pulse images correspond normally as above, they can be summarized as the "Peace Formula" of the Twelve Meridians. Furthermore, the *Ling Shu: Zhong Shi Pian* states: "Renying one-fold excess indicates disease in Foot Shaoyang; one-fold excess with agitation indicates disease in Hand Shaoyang. Renying two-fold excess indicates disease in Foot Taiyang; two-fold excess with agitation indicates disease in Hand Taiyang. Renying three-fold excess indicates disease in Foot Yangming; three-fold excess with agitation indicates disease in Hand Yangming. Renying four-fold excess, large and rapid, is named Overflowing Yang, which leads to External Grid. Cunkou one-fold excess indicates disease in Foot Jueyin; one-fold excess with agitation indicates disease in Hand Jueyin (Heart Master). Cunkou two-fold excess indicates disease in Foot Shaoyin; two-fold excess with agitation indicates disease in Hand Shaoyin. Cunkou three-fold excess indicates disease in Foot Taiyin; three-fold excess with agitation indicates disease in Hand Taiyin. Cunkou four-fold excess, large and rapid, is named Overflowing Yin, which leads to Internal Close." If various pulse images show differences in Yin-Yang abundance and scarcity as above, they can be summarized as the "Unpeaceful Formula" of the Twelve Meridians.

The *Ling Shu: Zhong Shi Pian* says: "Hold the Cunkou and Renying to know the surplus and deficiency of Yin and Yang, and whether they are normal or abnormal; thus the Way of Heaven is complete." Examining the "Mai Kou" artery on both hands belongs to Yin, akin to the Earthly Way; examining the "Renying" artery on both sides of the neck belongs to Yang, akin to the Heavenly Way. Thus, dual diagnosis of Yin and Yang arteries obtains the complete Way of Heaven and Earth.

However, later pulse studies only discussed examining the "Cunkou artery" on both hands, stating: "The left hand artery is Renying; the right hand artery is Mai Kou." Consequently, this theory likely led to the loss of true "Renying pulse diagnosis." I consider this theory unfounded. Because the Five Zang Organs and Six Fu Organs each have two meridians, one on the left and one on the right, the "Cunkou artery" sites on both hands belong entirely to the pathway of the Hand Taiyin Lung Meridian. Thus, the "Cunkou arteries" of both hands can only represent the Yin aspect (left, right, positive, negative) of the Five Zang Organs. The fluctuating pulse cannot represent the Yang aspect "Renying artery" of the Stomach Meridian on both sides of the neck.

Based on my years of experience, following ancient methods to examine "both Mai Kous and both Renying arteries" constitutes a comprehensive examination of Yin and Yang natures in all four directions (left, right, etc.). If only examining the Yin aspect "Cunkou artery," especially during extreme polarization of Yin-Yang movement, the manifestations at "Mai Kou" and "Renying" acupoints become special—either hidden in the bright surface or hidden in the Yang surface. If examining the interior Yin of the Five Zang via Mai Kou and the exterior Yang of the Six Fu via Renying, pulse images hidden in the Yin aspect must manifest in the Yang aspect, and vice versa. By dual-diagnosing the excess and deficiency of Yin-Yang meridian Qi in this manner, distinctions become clear and easy to identify, accurate with few errors, simple and clear, leading to definite syndrome differentiation and good therapeutic efficacy.

Physicians should use this "concise diagnostic method" to examine the abundance and scarcity of Yin and Yang pulses, determine methods to adjust Yin and Yang, and promote the "Twelve Meridians" to return to a state of "restored peace."

Why was this straightforward Yin-Yang pulse diagnosis abandoned? I believe that although the *Ling Shu* did not detail the principles of the "Twelve Meridians" in writing, there must have been mind-to-mind transmission and oral instruction among ancient sages and disciples. For example, Lei Gong, Shao Shi, and Gao Bo in the *Huang Di Nei Jing* were inheritors. It is likely that due to conservative medical practices or changes in times, truth was lost through generations of inheritance.

The classic states: "Hold the Cunkou and Renying to know the surplus and deficiency of Yin and Yang." Therefore, we cannot blindly discard diagnostic methods advocated in "ancient sage classics." We should inherit them while combining modern new understandings to elevate them. This will bring Traditional Chinese Medicine into a new field and lead to new discoveries of the supreme medical principles and skills contained in ancient medical culture. By gradually summarizing experiences, these methods can be accurately applied clinically. How could we not worry about our TCM level surpassing world medical standards?

Since the unclear principles of the "Twelve Meridians" block the path of TCM progress, I, despite limited knowledge and poor writing skills, presumptuously wrote this book to contribute my insights on studying the "Twelve Meridians" for colleagues who love TCM to reference and verify, encouraging mutual progress. I sincerely hope TCM colleagues will proceed from reality and use a scientific attitude to verify the superiority of this "Dual Yin-Yang Pulse Diagnosis."

(III) Methods for Diagnosing the Renying Pulse

In later ages, few people diagnosed the "Renying artery" on both sides of the neck; only Saint Physician Zhang Zhongjing mentioned it. Thus, no diagnostic methods for the "Renying pulse" appear in various "Pulse Studies" books. Therefore, to verify and implement the principles of the "Twelve Meridians," after years of exploration and repeated verification, I have now determined the diagnostic sites and methods for the "two Renying arteries." I provide this here for TCM colleagues to test in clinical practice.

1. Diagnostic Site of the "Renying Artery": At the highest protrusion of the laryngeal cartilage on the front of the neck (below the Lianquan Acupoint), moving backward to where the Renying artery pulses, this is the Guan position. Above the Guan position is the Cun position, and below the Guan position is the Chi position.

2. Method for Diagnosing the "Renying Artery": Physicians can adopt two diagnostic forms.
1. Have the patient sit; the physician stands behind the patient. The pulse-taking action is the same as diagnosing the "Cunkou" arteries on both hands: place three fingers aligned. First, place the middle finger (when the tip touches the high laryngeal cartilage, move back to the "Renying artery" site) at the "Guan position"; then place the index finger at the "Cun position" above Guan; finally, place the ring finger at the "Chi position" below Guan. Use the right hand to diagnose the patient's "Right Renying Artery" and the left hand to diagnose the patient's "Left Renying Artery."
2. The physician stands on the patient's left side, using the left hand to diagnose the patient's "Right Renying Artery"; the physician moves to stand on the patient's right side, using the right hand to diagnose the patient's "Left Renying Artery."

Pulse Diagnosis Rule: First diagnose the Cunkou artery to inspect the interior Yin of the Five Zang Organs, then diagnose the Renying artery to inspect the exterior Yang of the Six Fu Organs. This yields the Yin, Yang, Exterior, and Interior aspects of the Eight Principles Syndrome Differentiation. The *Ling Shu: Jin Fu Pian* says: "Cunkou governs interior, Renying governs exterior." The *Ling Shu: Wu Se Pian* says: "Renying full and firm indicates injury from Cold; Qikou (Cunkou) full and firm indicates injury from food." This fully explains that the "Mai Kou" on both hands belongs to the Yin of the Five Zang Organs and governs the interior; the "Renying" on both sides of the neck belongs to the Yang of the Six Fu Organs and governs the exterior. Clearly distinguishing Yin, Yang, Exterior, and Interior allows for combined differentiation of the six pulses: Slow (Huan, 缓), Urgent/Tight (Ji, 急), Large (Da, 大), Small (Xiao, 小), Slippery (Hua, 滑), and Choppy (Se, 涩), further integrating Floating (Fu, 浮), Deep (Chen, 沉), Slow (Chi, 迟), and Rapid (Shu, 数) for diagnosis. This can also diagnose the four syndromes of Cold, Heat, Deficiency, and Excess. Although simple, this method utilizes the Eight Principles (Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency, Excess) for diagnosis. The *Ling Shu* advocates two concise diagnostic schemes for pulse diagnosis:

1. Discussing Correspondence, Overcoming, and Generating between Color and Pulse. The *Ling Shu: Xie Qi Zang Fu Bing Xing Pian* says: "Those with green color have wiry (Xian, 弦) pulses; red color has hook-like (Gou, 钩) pulses; yellow color has substituted (Dai, 代) pulses; white color has hair-like (Mao, 毛) pulses; black color has stone-like (Shi, 石) pulses. Seeing the color but not getting the corresponding pulse, but instead getting an overcoming pulse, indicates death; getting a generating pulse indicates recovery." This explains that if Liver Wood is diseased, its color should be green, and its pulse should be wiry, which is the normal phenomenon of color-pulse correspondence. Recovery can be achieved by balancing Yin-Yang abundance and scarcity. If Liver Wood is diseased, showing green face color, but diagnosing a light and hair-like Lung Metal pulse, this is Metal overcoming Wood, indicating bad prognosis. If Liver Wood is diseased, showing green face color, but diagnosing a deep and stone-like Kidney Water pulse, this is Water generating Wood, a auspicious sign, so Liver disease heals easily. The same logic applies to Heart Fire, Spleen Earth, Lung Metal, and Kidney Water.

2. In pulse diagnosis, distinguishing the six pulse images of Slow, Urgent, Large, Small, Slippery, and Choppy to diagnose Cold, Heat, Deficiency, Excess, and Qi-Blood abundance/scarcity. The *Ling Shu: Xie Qi Zang Fu Bing Xing Pian* says: "All Urgent (Tight) pulses indicate much Cold; Slow pulses indicate much Heat; Large pulses indicate much Qi and little Blood; Small pulses indicate little Qi and Blood; Slippery pulses indicate abundant Yang Qi with slight Heat; Choppy pulses indicate much Blood and little Qi with slight Cold." This sufficiently shows that diagnosing these six pulses allows diagnosis of internal Cold/Heat, Deficiency/Excess, and Qi/Blood levels.

Appendix: Story of the Slow Pulse

Speaking of the Slow Pulse, I will share my story of misunderstanding the "Slow Pulse." Though ignorant and laughable, perhaps referencing real physics may benefit pulse theory.

When I first studied medicine, working in agriculture, I often studied during breaks from plowing and hoeing. Having not attended medical school nor taken a master, and with limited cultural knowledge, my misunderstanding of diagnosing the "Slow Pulse" in the *Ling Shu* was only clarified while plowing fields. In pulse studies, the Slow pulse (Chi, 迟) with three beats per breath indicates Cold, and the Rapid pulse (Shu, 数) with six beats per breath indicates Heat; the principles of these two opposite pulses are clear. The *Ling Shu* states: "Slow pulses indicate much Heat." As a beginner with shallow understanding, I assumed the "Slow" (Huan, 缓) of Slow pulse was synonymous with the "Slow" (Chi, 迟) of Chi pulse. Why would Chi indicate Cold while Huan indicates Heat? This question remained in my mind, unsolved day and night.

One day, after finishing autumn plowing, I left my tools in the field and led the ox home. That night, heavy rain fell with wind and storms. The next day was sunny, and I took the ox to plow again. Putting the ox in the yoke rope, I found the thick rope had shortened by seven or eight inches (due to cold and wet rain absorption). I casually lengthened the rope by seven or eight inches and drove the ox, paying no mind to this daily occurrence.

Near noon, the sun was high and temperature rose. Seeing the ox struggle greatly while plowing, I realized the rain on the thick rope had dried in the sun, making the rope loose and extended.

At the moment of stopping the ox and gathering the rope, I suddenly understood the reason for "Slow pulses indicate much Heat, Urgent pulses indicate much Cold" in the *Ling Shu*: it is the principle of thermal expansion and cold contraction. This profound inspiration became the basis for my later diagnosis of Cold and Heat in treating diseases.

Since many cases of Cold and Heat present pulses neither slow nor rapid, Tight and Slow pulse images are needed to distinguish Cold and Heat, allowing definite syndrome differentiation. I narrate this process here, hoping colleagues may also benefit.

(IV) Understanding of the Six Pulses: Slow, Urgent, Large, Small, Slippery, and Choppy

The *Su Wen* and *Ling Shu* are the outlines established by ancient sages, while later medicine branched out from these outlines. Fearing complexity and seeking simplicity, I believe the diagnosis of the six pathological pulses—Slow, Urgent, Large, Small, Slippery, and Choppy—in the *Ling Shu* is very concise. My understanding of these six pulses is as follows:

1. Regarding the Slow Pulse: The classic says, "Slow pulses indicate much Heat." Any Slow pulse appearing relaxed indicates warm Yang Qi stored in the body. In normal people, if the arteries in the Cun, Guan, and Chi positions of both Yin and Yang sides are uniform and show a Slow image, it indicates sufficient Yang and complete spirit, truly a pulse of Yin-Yang harmony, health, and longevity. If the Slow pulse is uneven in left/right, Yin/Yang, Cun/Chi, it is a pathological pulse. Slow pulse in the Chi position indicates Heat in the Lower Jiao; in the Guan position, Heat stagnates in the Middle Jiao; in the Cun position, Heat flares in the Upper Jiao; at the Mai Kou, it governs Zang organs; at the Renying, it governs Fu organs; on the left, it belongs to the left; on the right, it belongs to the right. The diagnosis of the six pulses follows this analogy. Thus, as described above: if various diseases manifest a "Slow pulse," it proves there is sunlight shining within the body. Hence, "Slow pulses indicate much Heat."

2. Regarding the Tight/Urgent Pulse: The classic says, "Urgent pulses indicate much Cold." Diagnosing an urgent pulse indicates injury from Cold pathogens. Generally, Cold pathogens first invade the exterior. "Cold governs contraction and pulling," which is the principle of thermal expansion and cold contraction. If the body feels Cold, the pulse will appear tight. Hence, "Tight pulses indicate much Cold."

3. Regarding the Large Pulse: The classic says, "Large pulses indicate much Qi and little Blood." A pulse appearing coarse and large indicates surplus Qi in the body. If Qi and Blood in the body are balanced and appropriate, the pulse will appear moderate, neither large nor small. Therefore, a large pulse means Blood is insufficient to support the Qi transport, hence "Large pulses indicate much Qi and little Blood."