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Huangdi asked, "How should pulse diagnosis be conducted?" Qibo replied, "Pulse diagnosis is usually performed at dawn. At this time, Yin Qi has not yet stirred, Yang Qi has not yet dispersed, food and drink have not been ingested, the Jingmai (Primary Meridians) are not yet full, the Luomai (Collaterals) are harmonious and even, and Qi and Blood are not yet chaotic. Therefore, it is possible to diagnose abnormal pulses. By palpating the movement and stillness of the pulse, observing the clarity of the eyes (Jingming), examining the five colors of the face, and assessing the excess or deficiency of the Zang organs, the strength or weakness of the Fu organs, and the flourishing or declining state of the body, these aspects are compared and integrated to determine the boundary between life and death.

The pulse is the residence of Blood (Xue zhi fu). A long pulse indicates regulated Qi; a short pulse indicates diseased Qi; a rapid pulse indicates mental restlessness; a large pulse indicates advancing disease; excess in the upper part indicates Qi rebellion upward; excess in the lower part indicates Qi distension; an intermittent pulse (Dai Mai) indicates Qi decline; a thin pulse indicates Qi deficiency; a choppy pulse indicates heart pain. If the pulse comes turbid and rapid like surging springs, with worsening disease and deteriorated complexion, it is serious. If the pulse goes slowly and weakly like a broken string, it indicates death.

The clarity of the eyes and the five colors of the face are the splendor of Qi. Red should resemble white silk wrapping cinnabar (ru bai guo zhu), not like jasper (zhe); white should resemble goose feathers (e yu), not like salt (yan); green should resemble the luster of dark jade (cang bi), not like indigo (lan); yellow should resemble silk wrapping realgar (luo guo xiong huang), not like yellow earth (huang tu); black should resemble heavy lacquer (zhong qi se), not like dark earth (di cang). If the subtle essence of the five colors appears openly, the lifespan will not be long.

The clarity of the eyes allows one to see all things, distinguish black from white, and judge length and shortness. If one perceives long as short and white as black, it indicates that Essence (Jing) has declined.

The Zang organs are the guardians within. If there is excess in the middle leading to organ fullness, and Qi excess injures the Will (Zhi) causing fear, speech may sound as if coming from a room, indicating dampness in Middle Qi. If speech is faint and only repeated after a whole day, this is Qi depletion. If clothing is disheveled, speech is inappropriate regardless of good or bad, and kinship or distance is ignored, this is confusion of the Spirit (Shen Ming). If the Granary (Spleen/Stomach) cannot store, it is because the gates (Yuanmen/Lanmen) do not secure. If urine flows incessantly, it is because the Bladder cannot store. Retaining the guardians leads to life; losing them leads to death.

The Zang organs are also the strength of the body. The head is the residence of Jingming; if the head droops and eyes are deep-set, Spirit is about to be depleted. The back is the residence of the Chest (Heart and Lungs); if the back is curved and shoulders sag, the residence is about to fail. The waist is the residence of the Kidney; if turning and shaking are difficult, the Kidney is about to be exhausted. The knees are the residence of the Sinews (Jin); if flexion and extension are impossible, and walking requires stooping and leaning, the Sinews are about to be exhausted. The bones are the residence of Marrow (Sui); if standing for long periods is impossible, and walking causes trembling, the Bones are about to be exhausted. Maintaining strength leads to life; losing strength leads to death.

Qibo said: Those who go against the Four Seasons, where excess manifests as 'Jing' (abnormal fullness) and deficiency manifests as 'Xiao' (consumption), correspond to excessive conditions showing deficiency as 'Jing', and deficient conditions showing excess as 'Xiao'. When Yin and Yang do not correspond, the disease is named Guan Ge (Interception and Constraint).

Huangdi asked, "How does the pulse move with the four seasons? How can we know the location of the disease? How can we know the transformation of the disease? How can we know when the disease suddenly arises internally? How can we know when the disease suddenly arises externally? Please explain these five points." Qibo replied, "Let me speak of its correspondence with the great rotation of Heaven. Outside all things and within the Six Directions, changes in Heaven and Earth respond to Yin and Yang. The warmth of spring becomes the heat of summer; the severity of autumn becomes the anger of winter. The movements of the four transformations cause the pulse to rise and fall accordingly. Spring corresponds to the Circle (Gui), Summer to the Square (Ju), Autumn to the Balance (Heng), and Winter to the Weight (Quan). Thus, forty-five days after the Winter Solstice, Yang Qi rises slightly and Yin Qi descends slightly; forty-five days after the Summer Solstice, Yin Qi rises slightly and Yang Qi descends slightly. Yin and Yang have their times, corresponding to the pulse cycle. If the period passes and the pulse deviates, knowing the division of the pulse and its timing allows one to know the time of death.

The subtlety lies in the pulse, which must not be neglected. Examination has a discipline, starting from Yin and Yang; initiation has classics, arising from the Five Elements; generation has measure, suitable for the four seasons. Do not miss tonification or sedation, align with Heaven and Earth, grasp this principle, and you will know life and death. Thus, sound matches the Five Tones, color matches the Five Elements, and pulse matches Yin and Yang. It is known that excess Yin dreams of crossing large waters in fear; excess Yang dreams of fire burning; excess Yin and Yang dream of killing and injury; excess above dreams of flying; excess below dreams of falling; being very full dreams of giving; being very hungry dreams of taking; Liver Qi excess dreams of anger; Lung Qi excess dreams of crying; many small parasites dream of gathering crowds; many long parasites dream of fighting and injury. Therefore, holding the pulse has a way, and emptiness and stillness are the guarantee. In spring, the pulse floats like fish swimming in waves; in summer, it is on the skin, abundant like all things; in autumn, it descends to the skin, like insects preparing to hibernate; in winter, it is in the bone, like insects tightly hidden, and gentlemen stay indoors. Thus, those who understand the interior record by pressing; those who understand the exterior conclude and begin. These six points are the great methods of pulse diagnosis.

If the Heart pulse is firm and long, one should expect tongue curling and inability to speak; if soft and scattered, the disease around Huantiao will resolve itself. If the Lung pulse is firm and long, one should expect spitting blood; if soft and scattered, one should expect profuse sweating that does not stop. If the Liver pulse is firm and long but the complexion is not green, one should expect trauma from falling or beating, with blood stasis under the ribs causing wheezing and rebellious Qi; if soft and scattered with lustrous color, one should expect Yi Yin (Overflowing Drink), characterized by sudden thirst and excessive drinking, with water entering muscles, skin, and outside the intestines and stomach. If the Stomach pulse is firm and long and the complexion is red, one should expect hip fracture (Zhe Bi); if soft and scattered, one should expect Shi Bi (Food Obstruction). If the Spleen pulse is firm and long and the complexion is yellow, one should expect shortness of Qi; if soft and scattered with dull color, one should expect edema of the legs, resembling water disease. If the Kidney pulse is firm and long and the complexion is yellow and red, one should expect lower back pain (Zhe Yao); if soft and scattered, one should expect blood deficiency that does not recover.

Huangdi asked, "If the Heart pulse is urgent, what is the disease? What are the symptoms?" Qibo replied, "The disease name is Xin Shan (Heart Hernia), and there should be a mass in the lower abdomen." Huangdi asked, "Why do you say so?" Qibo replied, "The Heart is a Yang Zang, and the Small Intestine serves it; therefore, there should be a mass in the lower abdomen." Huangdi asked, "If the Stomach pulse is diagnosed, what are the symptoms?" Qibo replied, "Excess in the Stomach pulse causes distension; deficiency causes diarrhea." Huangdi asked, "What is meant by the transformation of formed diseases?" Qibo replied, "Wind becoming cold and heat; Dan becoming Xiao Zhong (Middle Consumption); Jue becoming Dian Ji (Dian Disease of the vertex); long-term wind becoming Sun Xie (undigested stool in diarrhea); Mai Feng becoming Li (Leprosy). The transformations of diseases are countless." Huangdi asked, "Where do various abscesses, sinew spasms, and bone pain arise?" Qibo replied, "These are swellings caused by Cold Qi and changes from the Eight Winds." Huangdi asked, "How to treat them?" Qibo replied, "These are diseases of the four seasons; treating them with the overcoming method leads to recovery.

Huangdi asked, "If there is an old disease, and the Zang organs activate, injuring the pulse and color, how can each be distinguished as new or sudden versus long-standing?" Qibo replied, "Excellent question! If the pulse is small but the color is undisturbed, it is a new disease; if the pulse is undisturbed but the color is disturbed, it is a long-standing disease; if both pulse and five colors are disturbed, it is a long-standing disease; if both pulse and five colors are undisturbed, it is a new disease. If the Liver and Kidney pulses arrive together and the color is cyan and red, one should expect trauma without visible bleeding, or already bleeding, or dampness akin to water poisoning. The inner side of the Chi position flanks the hypochondrium; the outer Chi probes the Kidney, and the inner Chi probes the abdominal cavity. Above the Chi (Fu Shang), the left outer probes the Liver, and the inner probes the Diaphragm; the right outer probes the Stomach, and the inner probes the Spleen. Above that (Shang Fu Shang), the right outer probes the Lung, and the inner probes the Chest Center; the left outer probes the Heart, and the inner probes the Tan Zhong. The front probes the anterior, and the rear probes the posterior. The end of Cun upwards probes the chest and throat; the end of Chi downwards probes the lower abdomen, waist, thighs, knees, shins, and feet. Coarse and large indicates Yin deficiency and Yang excess, leading to Heat in the Middle. Rapid arrival and slow departure indicate Upper Excess and Lower Deficiency, leading to Jue and Dian Ji; slow arrival and rapid departure indicate Upper Deficiency and Lower Excess, leading to aversion to wind. Thus, suffering from evil wind means Yang Qi is affected. Pulses that are all deep, fine, and rapid indicate Shaoyin Jue; deep, fine, rapid, and scattered indicate cold-heat disorders; floating and scattered indicate collapse. All floating but not restless indicate Yang, thus heat; if restless, it is in the Hand meridians. All fine and deep indicate Yin, thus bone pain; if quiet, it is in the Foot meridians. Rapid, moving, and intermittent indicate disease in Yang pulses, involving diarrhea and pus-blood in stool. For erroneous pulses, choppy indicates Yang Qi excess; slippery indicates Yin Qi excess. Yang excess presents as body heat and no sweat; Yin excess presents as excessive sweat and cold body; Yin and Yang excess present as no sweat and cold. Pushing outward, if internal but not external, there is accumulation in the Heart and Abdomen. Pushing inward, if external but not internal, there is heat in the body. Pushing upward, if upward but not downward, the waist and feet are cold. Pushing downward, if downward but not upward, there is headache and neck pain. Pressing to the bone, if pulse Qi is scarce, there is lower back and spine pain with body Bi syndrome."