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The pulse is wiry (Xian) and large. Wiry indicates a decline [in yang], and large indicates a hollow [like the Kou pulse]. A decline implies cold, and hollow implies deficiency. The interplay of cold and deficiency is named "Ge" (Leather). In women, this leads to miscarriage or metrorrhagia; in men, it leads to blood loss or seminal emission.

The pulse is wiry and large. Wiry indicates insufficient yang qi, resulting in cold; large [hollow] indicates insufficient yin blood, resulting in deficiency. The interplay of cold and deficiency is named "Ge". The "Ge" pulse feels like the skin of a drum: firm on the outside and empty on the inside.

Wei Qi (Defensive Qi) is governed by the Lung, and Ying Blood (Nutritive Blood) is stored in the Liver. When Wei Qi declines, the exterior becomes deficient; when Ying Blood declines, the interior becomes hollow. "Decline" refers to cold qi due to Wei Qi deficiency; "Hollow" refers to blood deficiency due to Ying Blood deficiency. With both Qi and Blood being deficient and cold, the pulse resembles leather. Women presenting this pulse suffer from miscarriage and metrorrhagia; men presenting this pulse suffer from blood loss and seminal emission. This occurs because the Middle Qi has collapsed and cannot harmonize Water and Fire. Kidney Water sinks with cold while Heart Fire rises with heat; Water and Wood sink downward, causing internal deficiency-cold; Fire and Metal reverse upward, causing external wiriness. Metal and Water fail to store, while Wood and Fire tend to leak, thus leading to fetal abortion and menstrual leakage, blood depletion and sperm loss. (Metrorrhagia refers to bleeding outside the menstrual period; the sudden gushing is like a breached dike flooding violently, while the continuous dripping is like water leaking from a clepsydra.)

At the Cun Kou (Radial Artery), the pulse is faint (Wei) and choppy (Se). Faint indicates the decline of Wei Qi; choppy indicates the insufficiency of Ying Qi. Decline of Wei Qi manifests as a sallow complexion; insufficiency of Ying Qi manifests as a bluish complexion. Ying is the root, and Wei is the leaf. If both Ying and Wei are minute, the roots and leaves wither, leading to chills, coughing with counterflow qi, spitting of foul-smelling saliva, and froth.

At the Cun Kou, the pulse is faint and choppy. Faint indicates the decline of Wei Qi; choppy indicates the insufficiency of Ying Qi. Wei Qi originates in the Stomach; its decline causes Wu Earth (Stomach) to be deficient, manifesting as a sallow complexion. Ying Blood is stored in the Liver; its insufficiency causes Yi Wood (Liver) to wither, manifesting as a bluish complexion. Ying is the root of Wei, and Wei is the leaf of Ying. If both Ying and Wei are minute, the roots and leaves wither, giving rise to chills, coughing with counterflow qi, and spitting of foul saliva and froth. These symptoms arise because Spleen Earth fails to generate Lung Metal.

At the Cun Kou, the pulse is faint and slow. Faint indicates the dispersion of Wei Qi, making the skin pores open and loose; slow indicates the fullness of Stomach Qi, which digests grain and transforms it into fluids. Grain entering the Stomach allows the pulse channels to flow; fluids entering the meridians allow blood to form. If Ying Blood becomes excessive, the skin must become loose. If the San Jiao (Triple Burner) meridians are severed, it is called "Blood Collapse" (Menorrhagia/Hemorrhage).

At the Cun Kou, the pulse is faint and slow. Faint indicates the dispersion of Wei Qi, making the skin loose and not dense; slow indicates the fullness of Stomach Qi, which digests grain and transforms it into fluids. (In *Ling Shu: Five Fluids*, it is stated: Heat in the stomach digests grain, filling and expanding the intestines and stomach, hence the pulse appears slow.) Blood vessels are transformed from the essence of water and grain. Grain enters the Stomach, spreads outward, and the pulse channels flow; water enters the meridians, changes to red, and blood is formed. After grain is digested and water is transformed, entering the blood vessels, Ying Qi is established. The Lung governs Qi; when Qi is abundant, it is cool and astringent. The Liver governs Blood; when Blood is abundant, it is warm and dispersing. When Ying and Wei Qi are harmonious, Ying does not dominate alone. If Ying Blood dominates alone, the blood becomes warmer and more dispersing, while Qi fails to be cool and astringent. The sweat pores open and leak, so the skin becomes loose. Once loose, the blood in the San Jiao and meridians is entirely transformed into sweat and excreted through the hair follicles, hence it is called "Blood Collapse." This is what is meant by "Do not bleed those who have lost sweat, do not sweat those who have lost blood," for sweat is the fermented product of blood.