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When the Ge pulse (Leather Pulse) arrives, it feels hard and urgent like leather; Yongquan describes its abundant and full momentum. Those presenting this pulse suffer from progressively worsening disease with a sallow and lusterless complexion. (If the pulse becomes threadlike and weak then suddenly cuts off, it indicates the complete loss of Stomach Qi, the appearance of the Zang-Fu True Pulses, hence death ensues).

The *Da Qi Lun* states: When the pulse arrives resembling floating waves merging (Fuhe Pulse), appearing rapid, beating more than ten times per respiration, this indicates severe insufficiency of Jing-Qi. If seen even slightly for the first time, death will occur within ninety days (The following all specify fixed periods until death. "Fuhe" resembles floating waves converging, with rear waves urging front waves, chaotic and unmeasured. "Appearing rapid but not truly rapid" indicates blood corruption; "Fuhe" indicates Qi corruption. More than ten beats per respiration implies imminent death. The mention of ninety days here is erroneous; the character "ten" is a superfluous duplication. "Wei jian" means first seen. Upon first seeing this pulse, death occurs in nine days). When the pulse arrives as fierce as burning firewood, this indicates the depletion of Heart Essence and Qi; death will occur when grass and trees dry up (A pulse like burning fire indicates extreme excess of Fire, signifying that the Essence and Qi of the Heart Meridian are exhausted. In summer when Fire is prosperous, one may barely sustain life; in the Water season when grass dries, Yang is exhausted and death follows). When the pulse arrives like scattered leaves, this indicates deficiency of Liver Qi; death will occur when tree leaves fall (Scattered leaves refer to floating and rootless qualities, indicating extreme deficiency of Liver Qi. When wood leaves fall, Metal is prosperous and Wood is cut off, making death appropriate at that time). When the pulse arrives like a visitor coming and going (Shengke Pulse), meaning a guest who asks questions, appearing and disappearing intermittently. "Se" refers to roughness and intermittent pauses (Dai pulse); "Gu" refers to firmness and forceful beating. Roughness and Dai indicate corruption of Essence and Blood; firmness and force indicate scanty Stomach Qi. By the time dates flowers bloom, Earth is prosperous and Water declines, leading to immediate demise. When the pulse arrives like a clay pellet (Niwan Pulse), this indicates insufficiency of Stomach Essence and Qi; death will occur when elm seeds fall (Niwan resembles a clay pellet, a short pulse. It signifies insufficiency of Stomach Essence and Qi. Elm seeds fall in late spring when Wood is prosperous, causing Earth to fail). When the pulse arrives like a horizontal grid (Hengge Pulse), this indicates insufficiency of Gallbladder Qi; death will occur when grain ripens (Hengge refers to a long, large, firm, and strong pulse, which is the True Pulse of Wood, indicating failure of the Gallbladder. Grain ripens in autumn when Metal is prosperous and Wood is cut off). When the pulse arrives like intertwined strings (Xianlv Pulse), this indicates insufficiency of Baojing (Uterine/Pericardium Essence). The patient speaks excessively; death will occur when frost falls; if they do not speak excessively, the condition is treatable ("Xian"喻劲急, "Lv"喻细小. "Bao" refers to the Pericardium Meridian. The tongue is the sprout of the Heart; Fire moving causes excessive speech. Frost in winter represents Water overcoming Fire, leading to death. Lack of excessive speech implies lesser injury, thus salvageable). When the pulse arrives like mixing lacquer (Jiaoqi Pulse), meaning reaching from both sides laterally, death will occur thirty days after first being seen (Jiaoqi is blurred and large, akin to pouring lacquer. Lateral reach indicates vastness. "Wei" means initial. As the monthly order changes, the period of death arrives). When the pulse arrives like a gushing spring, floating and beating within the muscles, this indicates insufficiency of Taiyang Qi, shortness of breath, and death upon consuming leek flowers (Yongquan resembles a gushing spring, rising only without descending, floating and beating between muscle surfaces, indicating insufficiency of Foot-Taiyang Bladder Qi. The Bladder belongs to Three-Yang and governs the exterior; now exterior is excess and interior is deficient, hence shortness of breath. Jiu Ying is leek flower. Emerging in Long Summer, Earth overcomes Water, leading to death). When the pulse arrives like a collapsing earth mound, undetectable upon pressure, this indicates insufficiency of Muscle Qi. If black color appears on the face first, death will occur if white appears in spring (Deficiency above and below leads to collapse. A pulse that is empty and large, undetectable upon pressure, is a sign of lower deficiency. Spleen governs muscles; Muscle Qi is Spleen Qi. Black is the color of Water; when Earth fails, Wood insults it. Lei is similar to "Lei" (bud). Lotus buds have five colors; white appears in spring when Wood is prosperous, leaving Earth extinct). When the pulse arrives like the uvula (Xuanyong Pulse), where palpating lightly makes it larger, this indicates insufficiency of the Twelve Shu points' Qi; death will occur when water freezes (Xuanyong is the fleshy projection in the throat, commonly called throat flower. Palpating lightly yields a larger pulse, indicating Yang without Yin, isolated Yang hyperactive upwards. The Twelve Shu are the transport points of the twelve Zang-Fu meridians. Death by water freezing indicates盛 Yin and extinction of isolated Yang). When the pulse arrives like an inverted knife (Yandao Pulse), where superficial palpation is small and urgent, deep palpation is firm, large, and urgent, this indicates heat stagnation in the Five Zang organs, with cold-heat pathogens exclusively combining in the Kidney. Such a person cannot sit upright; death will occur at Lichun (Inverted knife lies flat. Superficial small/urgent resembles the blade edge; deep firm/large/urgent resembles the blade back. Deep pressure corresponds to the Kidney. Kidney deficiency leads to Yin consumption and heat in all Five Zang. Although there is stagnant heat causing cold-heat symptoms, the root lies in the Kidney. Due to Kidney deficiency, waist and spine ache, preventing sitting or standing. In winter when Water is prosperous, collapse is delayed until spring). When the pulse arrives like a slippery bead but does not respond to the hand, meaning it is undetectable upon pressure, this indicates insufficiency of Large Intestine Qi; death will occur when jujube leaves grow (Resembling beads indicates smoothness, a Slippery Pulse. Not responding to the hand means slipping away upon pressure. The Large Intestine and Lung Metal are exterior-interior partners. Jujube leaves grow in early summer; excessive Fire cuts off Metal, leading to death). When the pulse arrives like a flower, causing fearfulness, reluctance to sit or lie down, and constant listening while walking or standing, this indicates insufficiency of Small Intestine Qi; death will occur in late autumn (Like a flower indicates fullness and lightness. The Small Intestine and Heart are exterior-interior partners; Small Intestine deficiency leads to Heart deficiency, causing fear and restlessness. Constant listening reflects fear and suspicion. Bing Fire enters the tomb at Xu, hence death in late autumn).

The *San Bu Jiu Hou Lun* states: If the body is robust but the pulse is thin, with insufficient Qi to breathe, death ensues (Robust body should have a robust pulse. Thin pulse mismatching the body, especially with shortness of breath, indicates imminent death). If the body is emaciated but the pulse is large, with much Qi in the chest, death ensues (Emaciated body should have a small pulse. Large pulse mismatching the body, especially with rebellious Qi in the chest, indicates Yin failure and isolated Yang; death is inevitable). If form and Qi are harmonious, life is sustained (Form and pulse match, e.g., small form/small pulse, large form/large pulse). If pulses are irregular and discordant (Can Wu), disease exists (Comparing three and classifying five. Discordance refers to variations in size, speed, or texture not conforming to norms, all indicating pathological pulses). If all Nine Hounds are lost/disordered, death ensues (Three Parts refer to Upper, Middle, Lower, corresponding to Heaven, Earth, Human, and Chest/Abdomen. Nine Hounds refer to Floating, Middle, Deep at each part. Loss refers to mismatches, e.g., expected large/superficial but found small/deep, violating measurement standards).

If flesh and muscles are already depleted, even if the Nine Hounds are harmonious, death ensues (Spleen governs muscles and is the root of Zang organs. Muscle depletion signifies Spleen extinction; harmonious pulses are useless). If the Seven Diagnoses are present but the Nine Hounds follow [seasonal norms], death does not ensue (Seven Diagnoses refer to exclusively large, small, rapid, slow, hot, cold, or sunken. "Follow" means compliant. Pulses complying with seasonal orders and meridian structures, despite showing Seven Diagnosis signs, do not lead to death).

The *Yin Yang Bie Lun* states: Regarding True Zang Pulses, if the Liver pulse hangs isolated (Xuanjue), death occurs in eighteen days (Xuanjue indicates True Zang pulse appearance, no Stomach Qi, hanging and about to sever. Eighteen days relates to the remainder of Wood/Metal completion numbers; Metal overcomes Wood leading to death). If the Heart pulse hangs isolated, death occurs in nine days (Nine days relates to Fire/Water generation numbers; Water overcomes). If the Lung pulse hangs isolated, death occurs in twelve days (Twelve days relates to Metal/Fire generation numbers; Fire overcomes Metal). If the Kidney pulse hangs isolated, death occurs in seven days (Seven days relates to Water/Earth generation numbers; Earth overcomes Water). If the Spleen pulse hangs isolated, death occurs in four days (Four days relates to Wood generation number; Wood overcomes Earth).

The *Ping Ren Qi Xiang Lun* states: If the Hand-Shaoyin pulse moves vigorously in women, it indicates pregnancy (Hand-Shaoyin is the Heart pulse. Vigorous movement, smooth and slippery, indicates abundant blood, hence pregnancy).

The *Yin Yang Bie Lun* states: Yin pulsing distinctly different from Yang is called having a child (Yin pulsing distinct from Yang. Yin/Yang covers broad concepts: Left is Yang, Right is Yin; Cun is Yang, Chi is Yin; Floating is Yang, Deep is Yin. Old theories consider full Chi pulse as Yin distinct from Yang, yet Hand-Shaoyin vigor is also at Cun. Thus, integrating various Yin/Yang theories is necessary for judgment).

The *Zheng Si Shi Lun* states: Diagnosing illness without asking about its onset, worries, dietary irregularities, excessive lifestyle, or toxic injuries, and immediately palpating the Cun Kou without prior inquiry, how can one accurately diagnose? Making arbitrary names results in being trapped by coarseness (Physicians must first investigate etiology before correlating with pulses to avoid confusion of Yin/Yang and Deficiency/Excess. Ignoring onset ignores the source. Worries/diet are internal causes; lifestyle excesses are external; toxins are neither-internal-nor-external. Rushing to pulse diagnosis without inquiry claims pulse divinity but misses truth/reversal. Accurate diagnosis requires thorough inquiry; otherwise, errors harm life and virtue).

My commentary: Pulses are omens of Qi and Blood. With myriad pathological states, measuring changes with three fingers requires supreme skill. Xu Shuwei said: Pulse principles are profound and hard to clarify; what I understand internally cannot be fully expressed verbally. What can be transmitted via writing or speech are merely coarse traces.

Nevertheless, without mastering the coarse, how can the refined emerge? Analytically, twenty-four characters seem brief; summarily, Floating, Deep, Slow, and Rapid grasp the outline. Without distinguishing Yin and Yang, investigation leads only to confusion. Yin-Yang principles were discussed under "Yin Pulsing Distinct from Yang." Additionally, Hua Bo-ren stated: Examining pulses requires distinguishing Up, Down, Coming, Going, Arriving, and Stopping. Without understanding these six characters, Yin and Yang cannot be distinguished. Up is Yang, Coming is Yang, Arriving is Yang; Down is Yin, Going is Yin, Stopping is Yin. Up moves from Chi to Cun, Yang born from Yin. Down moves from Cun to Chi, Yin born from Yang. Coming emerges from bone/flesh to skin, Qi ascending. Going returns from skin to bone/flesh, Qi descending. Response is Arriving, Breath is Stopping. This principle is simple yet vital; travel far starting near, climb high starting low; please practice these words.