肝心肺肾已共四十六数，加脾四数，共合五十大衍之数，五脏十周终数而止为天五，属土
内应乎脾，故知脾气已绝，甲乙日干死之期也。《脉诀》云∶五十不止身无病，数内有止皆知定，
亦此义也。
脉要精微篇 岐伯曰∶反四时者，有余为精，不足为消。
精，增进也。消，消灭也。脉有阴阳盛衰四时有余不足之应人迎气口是也。
应太过，不及为精；应不足，有余为消。阴阳不相应，病名曰关格。
当大而细，当细而大，谓之反四时。当不足响应有余为精，当有余响应不足为消。此则为
精至于有余，为消至于不足者也。春夏阴气消灭，寸口主阴，当应不足，而响应之太过，是不及
者，反为精进也。春夏阳气增进，人迎主阳，当应有余，而响应之不足，是有余者，反为消灭也。
故曰∶应不足，有余为消。阴阳不相应，即人迎之阳脉而响应之不足，气口之阴脉而响应之有余，
故曰∶阴阳不相应，病名曰关格。关主不得便溺，格主吐逆是也。
六节藏象篇 曰∶人迎一盛，（一倍也。）病在少阳，二盛病在太阳，三盛病在阳明，
四盛以上为格阳。
人迎为足阳明胃脉，动在结喉两旁。比之寸口盛一倍者，病在少阳；盛二倍者，病在太阳；
盛三倍者，病在阳明，四倍以上，阳盛之极，故格拒而食不得入。所谓格，则吐逆者是也。
寸口一盛病在厥阴，二盛病在少阴，三盛病在太阴，四盛以上为关阴。
寸口为手太阴肺经动脉，穴出经渠，比之人迎盛一倍者，病在厥阴；盛二倍者，病在少阴；
盛三倍者，病在太阴；四盛以上，阴盛之极，故关闭而溲不得通也。
人迎与气口俱盛四倍以上为关格，关格之脉羸，不能极于天地之精气，则死矣。
不能极于天地之精气，不得天地阴阳之中正也，如北极之处乎中，故曰极也。
至真要大论篇 曰∶脉从而病反者，其诊何如？岐伯对曰∶脉至而从，按之不鼓，
诸阳皆然。曰∶诸阴之反，其脉何如？曰∶脉至而从，按之鼓甚而盛也。
此言病热而脉敝，按之不鼓手，乃阴盛格阳而致之，非热也，诸阳然也。病寒，脉按之鼓
击手下而盛者，乃阳盛拒阴而然，非寒也。
脉要精微篇 曰∶粗大者，阴不足阳有余，为热中也。来疾去徐，上实下虚，为厥颠
疾；来徐去疾，上虚下实，为恶风也。故中恶风者，阳气受也。有脉俱沉细数者，少阴厥也；沉
细数散者，寒热也；浮而散者，为 仆。（浮为虚，散为不足，故头眩而仆倒也。）诸浮不躁者
皆在阳，则为热；其有躁者在手。（热在手之三阳也。）诸细而沉者皆在阴，则为骨痛；其有静
者在足。（病在足之三阴经。）
诸过者切之，涩者阳气有余也，（阳有余，故血少。）滑者阴气有余也。（阴有余，故血多。）
阳气有余为身热无汗，阴气有余为多汗身寒，阴阳有余则无汗而寒。
推而外之，内而不外，有心腹积也。（内外脉经之两旁，内而不外，侵外也。）推而内之，
外而不内，身有热也。（脉侵外为阳气有余，故身热。）推而上之，上而不下，腰足清也。（脉
涌上出，为阳气在上，故足冷也。）推而下之，下而不上，头项痛也。（脉在下，是阴气有余，
故头痛。）按之至骨，脉气少者，腰脊痛而身有痹也。
平人气象篇 曰∶病热而脉静，泄而脉大，脱血而脉实，病在中脉虚，病在外脉涩坚者，皆难治。
此病脉虚实相反者，曰难治。
脉盛滑坚者，曰病在外。脉小实而坚者，病在内。
盛滑为阳，病在外；小实为阴，病在内。
脉小弱以涩，谓之久病。脉滑浮而疾者，谓新病。
小弱以涩为血气虚，故为久病。浮滑而疾为阳气足，故为新病。
三部九候篇 帝曰∶决死生奈何？岐伯曰∶形盛脉细，少气不足以息者危。形瘦脉大，
胸中多气者死。形气相得者生。参伍不调者病。三部九候皆相失者死。上下左右之脉相应如参舂
者病甚。上下左右相失不可数者死。
此皆言失常候者病，相失不可数者死，数之极也。
中部之候虽独调，与众脏相失者死。中部之候相减者死。目内陷者死。
独调，至数匀也。众脏相失，言皆不应也。相减者，减于上下，谓其偏少也。
帝曰∶何以知病之所在？岐伯曰∶察九候独小者病，独大者病，独疾者病，独迟者病，独热
者病，独寒者病，独陷下者病。
相失之候，凡有七诊者，此也。参伍不调，随其独异者，言病耳。
以左手足上，上去踝五寸按之，庶右手足当踝而弹之，其应过五寸以上，蠕蠕然者不病。其
应疾，中手浑浑然者病，中手徐徐然者病，其应上不能至五寸，弹之不应者死。
此言足阳明胃经冲阳之脉，诊之以决生死。以左手足上，上去踝五寸按之，谓以自手而诊足
上之脉也。庶，次也。次以右手诊其右足。弹之，按而动移也，寻其脉之有无也，其应手上不能
至五寸者死。王注∶手足踝上皆有动脉，盖差误也。
必先知经脉，然后知病脉。
经脉，四时胃气之脉。凡诊必先察胃气，然后察病脉。
脱肉身不去者死。
形肉瘦脱，身体不能动移者，主死。
形肉已脱，九候虽调，犹死；七诊虽见，九候皆从者不死。
形肉脱瘦，九候调亦死也。然四时之气顺，七诊互见不死。
必审其所始病，与今之所方病，而后各切循其脉，视其经络浮沉，以上下逆从循之。其脉疾
者不病，其脉迟者病。脉不往来者死，精神去，胃气绝。皮肤着者死。骨枯干也。
通评虚实论 曰∶脉实满，手足寒，头热，何如？岐伯曰∶春秋则生，冬夏则死。
春秋月建为三阳司天，而应头之三阳经，属阳而主热也。三阴在泉，而应手足阴经，宜得
阴气而寒也。脉实满为阳邪之实，宜通身壮热，阳证相应斯为顺也。今头热而手足寒者，其在春
秋亦应时为顺也。冬夏月建三阴司天，而三阳在泉，当头寒而手足热，故冬、夏为逆，则主死也。
亦如南北政，岁当三阳司天，三阴在泉，宜寸大而尺细；岁当三阴司天，三阳在泉，宜寸小而尺
大。亦此义也。
肝、心、肺、肾四脏的脉象总数已为四十六，加上脾脏的四数，合共五十大衍之数。五脏脉象循环十周后终结于“天五”之数，此数属土，内应于脾脏。因此可知，若脾气已绝，患者将在甲日或乙日干支之日死亡。《脉诀》中说：“脉搏五十次不停止则身体无病，次数中有停顿则知病情确定”，也是这个意思。
《脉要精微篇》中岐伯说：违背四时变化的脉象，有余表现为“精”，不足表现为“消”。
“精”，意为增进；“消”，意为消灭。脉象有阴阳盛衰及对应四时有余不足的反映，即人迎脉与气口脉是也。
应当脉象太过，却显得不及，这叫“精”（精进）；应当脉象不足，却显得有余，这叫“消”（消灭）。阴阳脉象不相呼应，病症名叫“关格”。
应当脉大却细，应当脉细却大，这叫做违背四时。应当脉象不足而响应反而有余，这叫“精”；应当脉象有余而响应反而不足，这叫“消”。这就是所谓的“精”至于有余，“消”至于不足。春夏季节阴气消灭，寸口脉主阴，应当表现为不足，如果响应反而太过，这是本应不及反而精进。春夏季节阳气增进，人迎脉主阳，应当表现为有余，如果响应反而不足，这是本应有余反而消灭。所以说：应当不足而有余叫“消”。阴阳不相呼应，即人迎的阳脉响应不足，气口的阴脉响应有余，所以说：阴阳不相呼应，病症名叫“关格”。“关”主要指大小便不通，“格”主要指呕吐逆阻。
《六节藏象篇》说：人迎脉盛大一倍（即一倍于寸口），病在少阳经；盛大两倍，病在太阳经；盛大三倍，病在阳明经；盛大四倍以上为“格阳”。
人迎脉是足阳明胃经的动脉，跳动在结喉两旁。与人迎脉相比，寸口脉盛大一倍的，病在少阳经；盛大两倍的，病在太阳经；盛大三倍的，病在阳明经；盛大四倍以上，是阳气极盛，所以产生格拒，导致食物无法进入。所谓“格”，就是呕吐逆阻的意思。
寸口脉盛大一倍，病在厥阴经；盛大两倍，病在少阴经；盛大三倍，病在太阴经；盛大四倍以上为“关阴”。
寸口脉是手太阴肺经的动脉，穴位出自经渠穴。与人迎脉相比，寸口脉盛大一倍的，病在厥阴经；盛大两倍的，病在少阴经；盛大三倍的，病在太阴经；盛大四倍以上，是阴气极盛，所以产生关闭，导致小便不通畅。
人迎脉与气口脉都盛大四倍以上，称为“关格”。关格之脉羸弱，不能达到天地精气的极限，就会死亡。
不能达到天地精气的极限，是因为得不到天地阴阳的中正之气，就像处于北极的位置一样偏颇，所以称为“极”。
《至真要大论篇》说：脉象顺从病情但症状相反，诊断是怎样的？岐伯回答说：脉象看似顺从，但重按之下不鼓动，所有阳证都是这样。问：所有阴证的反常情况，脉象是怎样的？答：脉象看似顺从，但重按之下鼓动非常强劲且盛大。
这里说的是患热病而脉象败坏，重按不鼓动手指，乃是阴盛格阳所致，并非真热，所有阳证皆如此。患寒病，脉象重按鼓击手下且盛大的，乃是阳盛拒阴所致，并非真寒。
《脉要精微篇》说：脉象粗大的，是阴不足阳有余，属于热中病。脉来急去缓的，是上实下虚，属于厥逆颠疾；脉来缓去急的，是上虚下实，属于恶风病。所以患恶风病的，是阳气受邪。如果有脉象都沉细数的，是少阴经厥逆；沉细数而散的，是寒热病；浮而散的，会导致仆倒。（浮脉主虚，散脉主不足，所以头晕目眩而仆倒。）所有浮脉而不躁动的，病都在阳分，则为热病；其中伴有躁动的，病在手部。（热病在手之三阳经）。所有细而沉的脉，病都在阴分，则为骨痛；其中伴有静象的，病在足部。（病在足之三阴经）。
对于各种异常脉象进行切诊，涩脉表示阳气有余（因为阳有余，所以血少）。滑脉表示阴气有余（因为阴有余，所以血多）。阳气有余表现为身体发热无汗，阴气有余表现为多汗身体寒冷，阴阳都有余则无汗且身体寒冷。
推脉向外，脉象向内而不外显的，有心腹积聚病。（内外脉经的两旁，脉象向内侵扰外部）。推脉向内，脉象向外而不内显的，身体有热病。（脉象侵扰外部为阳气有余，所以身体发热）。推脉向上，脉象向上不下行的，腰脚清冷。（脉气涌向上出，为阳气在上，所以脚冷）。推脉向下，脉象向下不上升的，头项疼痛。（脉在下，是阴气有余，所以头痛）。按脉至骨，脉气微少的，腰脊痛且身体有痹症。
《平人气象篇》说：患热病而脉象平静，泄泻而脉象盛大，失血而脉象坚实，病在体内而脉象虚弱，病在体表而脉象涩坚的，都难治。
这是病与脉虚实相反的情况，叫做难治。
脉象盛大滑利坚实的，病在体表。脉象小实而坚硬的，病在体内。
盛大滑利属阳，病在体表；小实属阴，病在体内。
脉象小弱而涩的，称为久病。脉象滑浮而疾快的，称为新病。
小弱而涩是因为气血虚弱，所以是久病。浮滑而疾快是因为阳气充足，所以是新病。
《三部九候篇》黄帝问：如何决断生死？岐伯说：形体壮盛而脉象细微，气息短少不足以呼吸的，危险。形体消瘦而脉象盛大，胸中气多的，死亡。形与气相得的，生存。参伍不调的，生病。三部九候脉象都失常的，死亡。上下左右脉象相应如舂米般的，病重。上下左右脉象失调无法计数的，死亡。
这些都是说失常的脉候会生病，脉象失调无法计数的会死亡，这是数目的极点。
中部脉候虽然单独调和，但与其余各脏脉象失调的，死亡。中部脉候减弱的，死亡。眼睛内陷的，死亡。
“独调”，指至数均匀。“众脏相失”，指都不相应。“相减”，指比上下脉候减少，谓其偏少。
黄帝问：如何知道病在哪里？岐伯说：观察九候脉象，唯独小的有病，唯独大的有病，唯独疾快的有病，唯独迟缓的有病，唯独热的有病，唯独冷的有病，唯独下陷的有病。
这些失常的脉候，共有七种诊法，就是上述情况。参伍不调，随着其独特差异的，说明有病。
用左手在患者左足上方，距离脚踝五寸处按住，然后用右手在患者右足踝部弹击，如果反应超过五寸以上，蠕蠕然柔和的，没有病。如果反应急促，手感浑浑然的，有病；手感徐徐然的，有病；反应向上不能到达五寸，弹击无反应的，死亡。
这里说的是足阳明胃经冲阳脉，通过诊察来判断生死。用左手在足上，距离脚踝五寸处按住，是指用自己的手来诊察足上的脉象。庶，是次序的意思。接着用右手诊察右足。弹击，是按动使脉移，寻找脉象的有无。如果应手向上不能到达五寸的，死亡。王冰注解说：手足踝上都有动脉，大概是错误的。
必须先知经脉，然后才知道病脉。
经脉，是指带有四时胃气的脉象。凡诊脉必须先察胃气，然后察病脉。
脱肉且身体不能移动的，死亡。
形体肌肉瘦脱，身体不能动移的，主死。
形体肌肉已经脱瘦，九候脉象虽然调和，仍然死亡；七诊脉象虽然出现，但九候脉象都顺从四时的，不死。
形体肌肉脱瘦，九候脉象调和也会死亡。但如果四时之气顺遂，七诊脉象互见而不死。
必须审察最初发病的原因，以及现在正在发生的病症，然后分别切循其脉，观察其经络的浮沉，顺着上下逆从的关系去推究。脉象疾快的不病，脉象迟缓的有病。脉象不来往的死亡，精神离去，胃气绝断。皮肤枯着于骨的死亡。骨骼枯干。
《通评虚实论》说：脉象实满，手足寒冷，头部发热，怎么样？岐伯说：春秋季节可生，冬夏季节则死。
春秋月份建三阳司天，而应头部三阳经，属阳而主热。三阴在泉，而应手足阴经，宜得阴气而寒。脉实满是阳邪之实，宜全身壮热，阳证相应这才算顺。现在头部热而手足寒的，其在春秋季节也应合时令为顺。冬夏月份建三阴司天，而三阳在泉，应当头部寒而手足热，所以冬、夏季节为逆，则主死。
也像南北政一样，岁运当三阳司天，三阴在泉，宜寸脉大而尺脉细；岁运当三阴司天，三阳在泉，宜寸脉小而尺脉大。也是这个意思。
The pulse counts for the Liver, Heart, Lung, and Kidney total forty-six. Adding four for the Spleen, they combine to form the fifty pulses of the Great Expansion (Dayan). When the five Zang organs complete ten cycles, the count ends at "Heaven Five," which belongs to Earth and internally corresponds to the Spleen. Therefore, it is known that if Spleen Qi has exhausted, the patient will die on a Jia or Yi day. The *Mai Jue* (Pulse Classic) states: "If the pulse does not stop within fifty beats, the body has no disease; if there are stops within the count, the condition is determined." This is also based on this principle.
In the *Mai Yao Jing Wei Pian* (Chapter on Essential Secrets of Pulse Diagnosis), Qibo said: Pulses that contradict the Four Seasons show "excess" as Jing (advancement/increase) and "deficiency" as Xiao (depletion/decrease).
"Jing" means advancement; "Xiao" means depletion. Pulses reflect the excess and deficiency of Yin and Yang corresponding to the Four Seasons, specifically through the Renying (Human Welcome) and Qikou (Qi Mouth) pulses.
When the pulse should be excessive but appears insufficient, it is called Jing (advancement); when it should be insufficient but appears excessive, it is called Xiao (depletion). If Yin and Yang pulses do not correspond, the disease is named Guan Ge (Obstruction and Reflux).
When the pulse should be large but is fine, or should be fine but is large, this is called contradicting the Four Seasons. When the response should be insufficient but is excessive, it is Jing; when the response should be excessive but is insufficient, it is Xiao. This represents Jing reaching excess and Xiao reaching insufficiency. In Spring and Summer, Yin Qi depletes; the Cunkou (Cun Mouth) pulse governs Yin and should appear insufficient. If the response is instead excessive, what was originally insufficient advances. In Spring and Summer, Yang Qi advances; the Renying pulse governs Yang and should appear excessive. If the response is instead insufficient, what was originally excessive depletes. Thus, it is said: when insufficiency responds with excess, it is Xiao. If Yin and Yang do not correspond—specifically, if the Yang pulse of Renying responds insufficiently and the Yin pulse of Qikou responds excessively—it is said: Yin and Yang do not correspond, and the disease is named Guan Ge. Guan primarily refers to the inability to urinate or defecate, while Ge primarily refers to vomiting and reflux.
In the *Liu Jie Zang Xiang Pian* (Chapter on Six Sections and Visceral Manifestations): It states: If the Renying pulse is one-fold stronger (one times stronger than the Cunkou), the disease is in the Shaoyang channel; two-fold stronger, in the Taiyang channel; three-fold stronger, in the Yangming channel; and four-fold or more stronger indicates Ge Yang (Reflux of Yang).
Renying is the arterial pulse of the Foot-Yangming Stomach channel, located on both sides of the laryngeal prominence. Compared to the Renying pulse, if the Cunkou pulse is one-fold stronger, the disease is in the Shaoyang channel; two-fold stronger, in the Taiyang channel; three-fold stronger, in the Yangming channel; and four-fold or more stronger indicates extreme Yang excess, causing rejection where food cannot enter. This is what is meant by Ge, i.e., vomiting and reflux.
If the Cunkou pulse is one-fold stronger, the disease is in the Jueyin channel; two-fold stronger, in the Shaoyin channel; three-fold stronger, in the Taiyin channel; and four-fold or more stronger indicates Guan Yin (Obstruction of Yin).
Cunkou is the arterial pulse of the Hand-Taiyin Lung channel, emerging from the Jingqu acupoint. Compared to the Renying pulse, if the Cunkou pulse is one-fold stronger, the disease is in the Jueyin channel; two-fold stronger, in the Shaoyin channel; three-fold stronger, in the Taiyin channel; and four-fold or more stronger indicates extreme Yin excess, causing closure where urine cannot pass smoothly.
If both the Renying and Qikou pulses are four-fold or more stronger, it is called Guan Ge. The Guan Ge pulse is emaciated; if it cannot reach the limit of Heaven and Earth's essence and Qi, death ensues.
Not reaching the limit of Heaven and Earth's essence and Qi means failing to attain the central and correct balance of Heaven and Earth Yin and Yang, similar to being at the North Pole; thus it is called "extreme."
In the *Zhi Zhen Yao Da Lun Pian* (Chapter on the Essential and Most Important Discussion of Truth): It asks: What about cases where the pulse follows the disease but the symptoms are contrary? Qibo replied: The pulse seems to follow, but upon deep pressure, it does not throb; this applies to all Yang conditions. Asked: What about the contrary cases of all Yin conditions? Reply: The pulse seems to follow, but upon deep pressure, it throbs strongly and becomes prominent.
This refers to heat diseases where the pulse is defective; pressing deeply reveals no throbbing, caused by Yin excess repelling Yang, indicating false heat, which applies to all Yang conditions. For cold diseases, if the pulse throbs strongly under pressure, it is caused by Yang excess rejecting Yin, indicating false cold.
In the *Mai Yao Jing Wei Pian*: A coarse pulse indicates Yin insufficiency and Yang excess, constituting Heat Zhong (Heat in the Middle). A pulse coming swiftly and departing slowly indicates Upper Excess and Lower Deficiency, leading to Jue Dian Ji (Jue syndrome and epilepsy); a pulse coming slowly and departing swiftly indicates Upper Deficiency and Lower Excess, leading to E Feng (aversion to wind). Thus, those suffering from aversion to wind have affected Yang Qi. If the pulse is uniformly deep, fine, and rapid, it indicates Shaoyin Jue (Shaoyin reversal); if deep, fine, rapid, and scattered, it indicates Cold-Heat disorders; if floating and scattered, it leads to Pu Dao (falling/collapsing). (Floating indicates deficiency, scattered indicates insufficiency, hence dizziness and collapsing.) All floating pulses without agitation indicate Yang locations, thus heat; if agitation is present, it is in the hands (heat in the Three Yang channels of the hand). All fine and deep pulses indicate Yin locations, thus bone pain; if stillness is present, it is in the feet (disease in the Three Yin channels of the foot).
Regarding various abnormal pulses, a Se (choppy) pulse indicates Yang excess (due to Yang excess, blood is scanty). A Hua (slippery) pulse indicates Yin excess (due to Yin excess, blood is abundant). Yang excess manifests as body heat and anhidrosis; Yin excess manifests as hyperhidrosis and cold body; excess of both Yin and Yang results in anhidrosis and cold body.
Pushing outward, if the pulse moves inward rather than outward, there is accumulation in the chest and abdomen. Pushing inward, if the pulse moves outward rather than inward, the body has heat. Pushing upward, if the pulse rises but does not descend, the waist and feet are cold. Pushing downward, if the pulse sinks but does not rise, there is headache and neck pain. Pressing to the bone, if the pulse Qi is weak, there is lower back and spine pain accompanied by Bi syndrome.
In the *Ping Ren Qi Xiang Pian* (Chapter on Normal People and Pulse Phenomena): It states: Heat disease with a quiet pulse, diarrhea with a large pulse, blood loss with a solid pulse, internal disease with a deficient pulse, and external disease with a choppy and firm pulse are all difficult to treat.
These are cases where the disease and pulse contradict each other in terms of deficiency and excess, termed difficult to treat.
A pulse that is vigorous, slippery, and firm indicates disease in the exterior. A pulse that is small, solid, and firm indicates disease in the interior.
Vigorous and slippery belong to Yang, indicating exterior disease; small and solid belong to Yin, indicating interior disease.
A small, weak, and choppy pulse indicates chronic disease. A slippery, floating, and rapid pulse indicates acute disease.
Small, weak, and choppy indicate blood and Qi deficiency, hence chronic disease. Floating, slippery, and rapid indicate sufficient Yang Qi, hence acute disease.
In the *San Bu Jiu Hou Pian* (Chapter on Three Regions and Nine Positions): The Emperor asked: How to determine life and death? Qibo replied: A robust physique with a fine pulse, shortness of breath, and inability to catch one's breath indicates danger. A emaciated physique with a large pulse and excessive Qi in the chest indicates death. When form and Qi are harmonious, there is life. When the pulses are irregular and uncoordinated, there is disease. When all Nine Positions are discordant, there is death. If the pulses above and below, left and right respond like the pounding of a mortar, the disease is severe. If they are discordant and uncountable, there is death.
These statements refer to abnormal pulse signs indicating disease; discordance and uncountability indicate death, representing the extreme of numerical deviation.
Even if the Middle Position pulse is independently harmonious, if it is discordant with the other Zang organs, there is death. If the Middle Position pulse diminishes, there is death. Sunken eyes indicate death.
"Independently harmonious" means uniform rhythm. "Discordant with other Zang organs" means none correspond. "Diminishes" means less than the upper and lower positions, indicating partial deficiency.
The Emperor asked: How to know the location of the disease? Qibo replied: Observe the Nine Positions; the one that is uniquely small, large, rapid, slow, hot, cold, or sunken indicates disease.
These discordant pulses constitute the Seven Diagnoses. Irregularity and lack of coordination, depending on the unique anomaly, indicate disease.
Place the left hand on the patient's left foot, five cun above the ankle, and press. Then, with the right hand, tap the right foot at the ankle. If the response travels more than five cun upward and feels soft and continuous, there is no disease. If the response is rapid and feels chaotic to the touch, there is disease; if it feels slow and steady, there is disease; if the response does not reach five cun upward, or if tapping produces no response, there is death.
This discusses diagnosing life and death via the Chongyang pulse of the Foot-Yangming Stomach channel. Placing the left hand five cun above the ankle refers to using one's own hand to diagnose the foot pulse. "Shu" means sequence/next, referring to using the right hand to diagnose the right foot. Tapping involves pressing to move the pulse, seeking its presence or absence. If the response does not reach five cun upward, death ensues. Wang Bing's commentary stating that arteries exist above and below the ankles on both hands and feet is likely erroneous.
One must first understand the Jing Mai (Meridian-Vessel) pulses before understanding pathological pulses.
Jing Mai pulses refer to those possessing the Stomach Qi of the Four Seasons. In all pulse diagnoses, one must first examine Stomach Qi, then examine pathological pulses.
Emaciation with immobility indicates death.
Severe muscle wasting with inability to move the body indicates death.
If muscles and flesh are wasted, even if the Nine Positions are harmonious, there is death; if the Seven Diagnoses appear, but the Nine Positions follow the seasonal norms, there is no death.
Muscle wasting leads to death even if the Nine Positions are harmonious. However, if the Qi of the Four Seasons is smooth, the Seven Diagnoses appearing together does not necessarily mean death.
One must carefully examine the initial cause of the disease and the current manifestation, then palpate the respective pulses, observing the floating and sinking of the meridians, and tracing their upward/downward and reverse/compliant movements. Rapid pulses indicate no disease; slow pulses indicate disease. Pulses that do not flow indicate death, signifying the departure of Spirit and exhaustion of Stomach Qi. Skin adhering tightly to the bones indicates death, signifying dry and withered bones.
In the *Tong Ping Xu Shi Lun* (Chapter on General Evaluation of Deficiency and Excess): It asks: What about a full and solid pulse with cold hands and feet and a hot head? Qibo replied: Survival in Spring and Autumn; death in Winter and Summer.
In Spring and Autumn, the Three Yang govern the Heaven phase, corresponding to the Three Yang channels of the head, which belong to Yang and govern heat. The Three Yin govern the Earth phase, corresponding to the Yin channels of the hands and feet, which should receive Yin Qi and feel cold. A full and solid pulse indicates excess of Yang pathogen, ideally manifesting as whole-body high fever matching the Yang syndrome, which is compliant. Currently, with a hot head and cold hands/feet, this complies with the season in Spring and Autumn. In Winter and Summer, the Three Yin govern the Heaven phase, and the Three Yang govern the Earth phase; the head should be cold and hands/feet hot. Thus, Winter and Summer are non-compliant, indicating death.
This is similar to the Northern and Southern Polarity theory: when the year's Qi has Three Yang governing Heaven and Three Yin governing Earth, the Cun pulse should be large and Chi pulse fine; when Three Yin govern Heaven and Three Yang govern Earth, the Cun pulse should be small and Chi pulse large. This follows the same principle.