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[Note] When the pulse is extremely weak at superficial (Fu), middle (Zhong), and deep (Chen) levels, small upon pressure, and seems to be there but not really there, it is called Wei Mai (Micro Pulse).

23. If the pulse at all three positions (Cun, Guan, Chi) is weak, large upon pressure, and scattered and loose without restraint, it can be identified as San Mai (Scattered Pulse).

[Note] When the pulse is extremely weak at superficial, middle, and deep levels, large upon pressure, and scattered and loose without restraint, it is called San Mai (Scattered Pulse).

24. If only the middle position is weak, it is named Kou Mai (Rind Pulse); if one must push the tendons to the bone to feel it, Fu Mai (Hidden Pulse) can be sought.

[Note] When the pulse is forceful at superficial and deep levels but weak at the middle level, it is called Kou Mai (Rind Pulse). When one must push the tendons to the bone to feel it, it is called Fu Mai (Hidden Pulse). The above ten types of pulses are named according to their depth/position, so they are all categorized under Superficial (Fu) and Deep (Chen).

25. Three beats per respiratory cycle constitute Chi Mai (Slow Pulse); six beats per respiratory cycle constitute Shu Mai (Rapid Pulse).

[Note] One complete respiration is called one "Xi" (respiratory cycle). Three beats per Xi constitute Chi Mai (Slow Pulse). Six beats per Xi constitute Shu Mai (Rapid Pulse). These are named according to the frequency (Zhi Shu) of the pulse. All pulses named by frequency are categorized under Slow (Chi) and Rapid (Shu).

26. Four beats per Xi constitute Huan Mai (Moderate Pulse); seven beats per Xi constitute Ji Mai (Very Rapid Pulse). Four beats per Xi are called Huan Mai (Moderate Pulse); seven beats per Xi are called Ji Mai (Very Rapid Pulse).

27. A Huan Mai (Moderate Pulse) with intermittent pauses is called Jie Mai (Intermittent Pulse); a Shu Mai (Rapid Pulse) with intermittent pauses is called Cu Mai (Hastened Pulse). All these diagnoses are governed by pulse frequency. If the pulse stops during movement and cannot recover on its own, but the overall rhythm remains regular, Dai Mai (Replacement Pulse) indicates a difficult prognosis.

[Note] A Huan Mai (Moderate Pulse) that occasionally has a pause is called Jie Mai (Intermittent Pulse). A Shu Mai (Rapid Pulse) that occasionally has a pause is called Cu Mai (Hastened Pulse). In Jie and Cu pulses, although the pulse stops, it recovers on its own. If the pulse stops and does not recover immediately, resuming after a moment, or stopping every ten beats or thirty beats while maintaining a regular interval, it is called Dai Mai (Replacement Pulse). "Difficult to cure" refers to a pulse that stops before fifty beats, consistent with the fatal pulses described in classics. The above five types of pulses are named by frequency, so they are all categorized under Slow (Chi) and Rapid (Shu).

28. The shape is like a bead, slippery and unstable. If the flow is rough and obstructed, Se Mai (Choppy Pulse) is confirmed.

[Note] A shape like a bead, slippery and unstable, is called Hua Mai (Slippery Pulse). Difficulty in advancing and retreating, with rough and obstructed flow, is called Se Mai (Choppy Pulse). These are named by the shape of the pulse. All pulses named by shape are categorized under Slippery (Hua) and Choppy (Se).

29. Thin, straight, and tense is Xian Mai (String-taut Pulse). Jin Mai (Tight Pulse) is thicker than Xian, with tension radiating to both sides.

[Note] Resembling a bowstring, thin and straight, and tense upon pressure, it is called Xian Mai (String-taut Pulse). Thicker than Xian, tense upon pressure, and bouncing against the fingers from side to side, it is called Jin Mai (Tight Pulse).

30. Strong arrival and weak departure reveal Hong Mai (Surging Pulse). Large implies breadth, small implies fineness.

[Note] Strong upon arrival and weakening upon departure is called Hong Mai (Surging Pulse). A broad and coarse pulse shape is called Da Mai (Large Pulse). A fine pulse shape like a thread is called Xiao Mai (Small Pulse), which is also Xi Mai (Fine Pulse).

31. Moving chaotically like a bean, yet staying in place. Long pulses stretch far, short pulses shrink back.

[Note] A shape like a bean, moving chaotically yet remaining in one spot, is called Dong Mai (Pulsating Pulse). Arriving and departing with a long reach is called Chang Mai (Long Pulse). Arriving and departing with a short reach is called Duan Mai (Short Pulse). The above eight types of pulses are named by shape, so they are all categorized under Slippery (Hua) and Choppy (Se).

32. Floating pulses belong to Yang and govern the Exterior; Wind pathogens invade the Six Qi. Forceful indicates Exterior Excess, weak indicates Exterior Deficiency. Floating-Slow indicates Cold in the Exterior; Floating-Moderate indicates Wind-Dampness; Floating-Soft indicates Summerheat injury; Floating-Scattered indicates Extreme Deficiency; Floating-Surging indicates Yang Excess; Floating-Large indicates Yang Excess Solidity; Floating-Fine indicates Qi deficiency; Floating-Choppy indicates Blood deficiency; Floating-Rapid indicates Wind-Heat; Floating-Tight indicates Wind-Cold; Floating-String-taut indicates Wind-Fluid retention; Floating-Slippery indicates Wind-Phlegm.

[Note] Floating pulses are Yang pulses governing the Exterior. Diseases caused by Wind pathogens and the Six External Factors enter from the exterior, hence they belong here. Floating and forceful indicates Exterior Excess Wind disease; floating and weak indicates Exterior Deficiency Wind disease. Slow is a Cold pulse, hence Exterior Cold. Moderate is a Dampness pulse, hence Wind-Dampness. Soft is a Qi-deficiency pulse; Qi deficiency leads to Summerheat injury, hence Floating-Soft indicates Summerheat injury. Scattered is a Qi-scattering pulse; Qi scattering leads to extreme deficiency, hence Floating-Scattered indicates extreme deficiency. Floating-Surging is a Yang-excess pulse, hence Yang Excess. Floating-Large is a Yang-excess solid pulse, hence Yang Excess Solidity. Fine is a Qi-deficient pulse; insufficient Qi fills the vessel, hence Qi deficiency. Choppy is a Blood-deficient pulse; blood deficiency causes stagnation, hence Blood deficiency. Rapid is a Heat pulse, hence Wind-Heat. Tight is a Cold pulse, hence Wind-Cold. String-taut is a Fluid-retention pulse, hence Wind-Fluid retention. Slippery is a Phlegm pulse, hence Wind-Phlegm.

33. Deep pulses belong to Yin and govern the Interior; involving Seven Emotions, Qi stagnation, and Food retention. Deep-Large indicates Interior Excess; Deep-Small indicates Interior Deficiency; Deep-Slow indicates Interior Cold; Deep-Moderate indicates Interior Dampness; Deep-Tight indicates Cold Pain; Deep-Rapid indicates Extreme Heat; Deep-Choppy indicates Bi Syndrome due to Qi stagnation; Deep-Slippery indicates Phlegm and Food retention; Deep-Hidden indicates Obstruction and Depression; Deep-String-taut indicates Fluid diseases.

[Note] Deep pulses are Yin pulses governing the Interior. Internal diseases caused by Seven Emotions, Qi stagnation, and Food retention arise from the interior, hence they belong here. Large is a pulse of excess, hence Interior Excess. Small is a pulse of insufficiency, hence Interior Deficiency. Slow is a Cold pulse, hence Interior Cold. Moderate is a Dampness pulse, hence Interior Dampness. Tight is a Cold pulse, hence Cold Pain. Rapid is a Heat pulse, hence Extreme Heat. Choppy is a Blood-stagnation pulse, hence Bi Syndrome due to Qi stagnation. Slippery is a Phlegm-Food pulse, hence Phlegm and Food retention. Hidden is a pulse for severe pain where vomiting and diarrhea are impossible, hence Obstruction and Depression. String-taut is a Fluid-retention pulse, hence Fluid diseases.

34. Rou Mai (Soft Pulse) governs Yang Deficiency diseases; Ruo Mai (Weak Pulse) governs Yin Deficiency ailments; Wei Mai (Micro Pulse) governs various deficiencies; San Mai (Scattered Pulse) indicates critical deficiency.

[Note] Rou Mai (Soft Pulse) is a pulse of weakness in the Yang aspect, hence it governs various Yang Deficiency diseases. Ruo Mai (Weak Pulse) is a pulse of weakness in the Yin aspect, hence it governs various Yin Deficiency diseases. Wei Mai (Micro Pulse) is a pulse of insufficiency in Yin-Yang, Qi, and Blood, hence it governs various deficiencies. San Mai (Scattered Pulse) is a pulse of scattered Yuan Qi (Primal Qi), hence it indicates critical deficiency.

35. Ge Mai (Leather Pulse) indicates injury to Essence and Blood, seen in miscarriage, leukorrhea, and metrorrhagia. Lao Mai (Firm Pulse) indicates Hernia and Masses, and cold pain in the heart and abdomen.

[Note] Ge Mai (Leather Pulse) is a pulse that is empty inside, hence it governs blood loss and essence injury in men, and miscarriage, metrorrhagia, and leukorrhea in women. Lao Mai (Firm Pulse) is a pulse that is firm inside, hence it governs various hernias, masses (Zheng Jia), and cold pain in the heart and abdomen.

36. Xu Mai (Deficient Pulse) governs various deficiencies; Shi Mai (Excess Pulse) governs various excesses; Kou Mai (Rind Pulse) governs blood loss; this can be known by observation.

[Note] Xu Mai (Deficient Pulse) is a pulse weak at all three positions, hence it governs various deficiencies. Shi Mai (Excess Pulse) is a pulse forceful at all three positions, hence it governs various excesses. Kou Mai (Rind Pulse) is a pulse of empty Ying (Nutritive) Blood, hence it governs blood loss. However, these three pulses indicate internal/external and upper/lower pathologies depending on the position felt.

37. Chi Mai (Slow Pulse) governs Cold and Zang organs; Yin Cold interferes. Forceful indicates Cold Pain; weak indicates Deficient Cold.

[Note] Chi Mai (Slow Pulse) is a Yin pulse; Zang organs belong to Yin, hence it governs them. All Yin Cold diseases belong here. Forceful indicates Cold Excess pain; weak indicates Cold Deficiency pain.

38. Shu Mai (Rapid Pulse) governs Heat and Fu organs; Rapid and Fine indicates Yin injury. Forceful indicates Excess Heat; weak indicates Deficient Sores.

[Note] Shu Mai (Rapid Pulse) is a Yang pulse; Fu organs belong to Yang, hence it governs them. All Yang diseases belong here. Rapid indicates Yang excess; Fine indicates insufficiency, hence Yin injury. Forceful indicates Excess Heat; weak indicates Deficient Heat. Rapid pulses also govern sores, hence Deficient Sores.

39. Huan Mai (Moderate Pulse) governs Dampness in Spleen and Stomach; firm and large indicates Dampness obstruction. Cu Mai (Hastened Pulse) is Yang depression; Jie Mai (Intermittent Pulse) is Yin coagulation.

[Note] Huan Mai (Moderate Pulse) is the pulse of the Spleen and Stomach and also governs Dampness pathogens, hence it governs Dampness diseases of the Spleen and Stomach. If it beats firmly and is large, it indicates Dampness obstruction and distension. Cu Mai (Hastened Pulse) is a pulse of Yang excess and depression; Jie Mai (Intermittent Pulse) is a pulse of Yin excess and coagulation.

40. Dai Mai (Replacement Pulse) indicates Qi exhaustion; seen in trauma with suffocation, Qi depletion from acute illness or painful sores, or in early pregnancy (three months).

[Note] Dai Mai (Replacement Pulse) is a pulse seeking replacement due to exhaustion of True Qi. If not caused by trauma with suffocation, acute illness depleting Qi, painful sores injuring Qi, or fetal Qi obstruction, seeing it spontaneously indicates certain death.

41. Hua Mai (Slippery Pulse) governs Phlegm diseases; Guan position governs Food and Wind; Cun position observes vomiting and reversal; Chi position observes bloody and purulent stool.

[Note] Hua Mai (Slippery Pulse) is a Yang pulse; Yang excess generates Phlegm, hence it governs Phlegm diseases. Right Guan observes the Stomach, hence it governs Phlegm and Food. Left Guan observes the Liver, hence it governs Wind-Phlegm. Cun observes the Upper Jiao, hence it governs vomiting and reversal. Chi observes the Lower Jiao, hence it governs bloody and purulent stool.

42. Se Mai (Choppy Pulse) governs Deficiency, Dampness, and Bi Syndrome; Chi position governs Essence and Blood injury; Cun position governs sweat and fluid exhaustion; Guan position governs dysphagia and fluid loss.

[Note] Se Mai (Choppy Pulse) is a pulse of blood insufficiency and stagnation. Seen in all six positions, it governs Ying deficiency with Dampness-Bi syndrome. Seen in both Chi positions, it governs Essence and Blood injury. Seen in both Cun positions, it governs excessive sweating and fluid injury. Seen in both Guan positions, it governs dysphagia, regurgitation, and fluid loss with intestinal dryness.

43. Xian Mai (String-taut Pulse) at Guan governs Fluid retention; Wood insults Spleen Meridian; Xian at Cun governs headache; Xian at Chi governs abdominal pain.

[Note] Xian Mai (String-taut Pulse) is a Yin pulse; Yin excess generates Fluid retention. It is also a Wood pulse; Wood excess insults Earth (Spleen), Earth deficiency fails to control Dampness, hence Fluid diseases arise. Xian at Cun is Yin invading Yang, hence headache. Xian at Chi is Yin invading Yin, hence abdominal pain.

44. Jin Mai (Tight Pulse) governs Cold Pain; Hong Mai (Surging Pulse) indicates Fire injury. Dong Mai (Pulsating Pulse) governs Pain and Heat, metrorrhagia, sweating, fright, and mania.

[Note] Jin Mai (Tight Pulse) is a Cold-Excess pulse, hence Cold Pain. Hong Mai (Surging Pulse) is a Heat-Excess pulse, hence Fire injury. Dong Mai (Pulsating Pulse) is a Yang pulse of Yin-Yang conflict, hence various pains; Yang Dong governs fever, fright, and mania; Yin Dong governs sweating and metrorrhagia.

45. Chang Mai (Long Pulse) indicates regulated Qi; Duan Mai (Short Pulse) indicates diseased Qi; Xi Mai (Fine Pulse) indicates declining Qi; Da Mai (Large Pulse) indicates progressing disease.

[Note] Long indicates smooth Qi, hence regulated Qi. Short indicates contracted Qi, hence diseased Qi. Small indicates decline of Righteous Qi. Large indicates progression of Pathogenic factors.

46. Pulses governing diseases have suitability and unsuitability; Yin-Yang compliance or opposition allows deduction of auspiciousness or ominousness.

[Note] Diseases have Yin and Yang; pulses also have Yin and Yang. Compliance brings good fortune; opposition brings misfortune. From this point to "predicting death," twenty-seven sections detail which pulse is auspicious or ominous for which disease.

47. For Zhong Feng (Wind Stroke), Floating-Slow is favorable; Firm, Large, and Rapid are ominous.

[Note] For Deficient Wind Stroke, seeing Deficient pulses is appropriate, with Floating-Slow being compliant. Seeing Firm, Large, and Rapid is non-compliant and indicates no hope for life.

48. For Shang Han (Cold Damage) and Febrile Diseases, Floating-Surging pulses are favorable; Deep, Micro, Choppy, and Small are ominous due to contradiction. After sweating, if the pulse calms and body temperature drops, safety is assured; if the pulse is restless and heat persists, recovery is difficult. Yang Syndrome seeing Yin pulses indicates critical danger; Yin Syndrome seeing Yang pulses, though difficult, poses no threat to life.

[Note] This section discusses compliance and non-compliance in Shang Han. Shang Han febrile diseases transmitting to the interior involve Heat; Floating-Surging (Yang pulses) are auspicious. Seeing Deep, Micro, Choppy, Small (Yin pulses) contradicts the syndrome, hence ominous. After sweating, if pathogens resolve, the pulse should calm and body cool. If restless and hot, it is "not subsiding with sweat," named Yang-Yin Intersection, difficult to treat. Yang Syndrome seeing Deep, Choppy, Fine, Micro, Weak, Slow (Yin pulses) contradicts pulse and syndrome, indicating critical danger. Yin Syndrome seeing Floating, Large, Rapid, Pulsating, Surging, Slippery (Yang pulses) contradicts pulse and syndrome; while forbidden in other diseases, in Shang Han it indicates Yin pathogen returning to Yang and resolving; though critical, it does not threaten life.

49. Fatigue injuring the Spleen requires Weak pulses; spontaneous sweating with restless pulses indicates inevitable death.

[Note] Fatigue injuring the Spleen should present Weak pulses, which is compliant. If spontaneous sweating occurs with restless pulses, it is non-compliant. How can death be avoided?

50. Nu Mai (Malaria) pulses are naturally String-taut; String-taut-Slow indicates more Cold; String-taut-Rapid indicates more Heat; Replacement and Scattered indicate difficulty.

[Note] Malaria is a Cold-Heat disease; String-taut is the Shaoyang pulse. Shaoyang governs alternating Cold and Heat. Most Cold-Heat diseases belong to the Shaoyang Half-Exterior Half-Interior boundary, hence Malaria pulses should naturally be String-taut. Slow indicates more Cold; Rapid indicates more Heat, which is natural logic. Seeing Replacement or Scattered pulses means pathogens are unresolved and Righteous Qi is depleted, making survival difficult.

51. For Diarrhea and Dysentery, Deep, Small, Slippery, and Weak are favorable; Excess, Large, Floating, and Rapid with fever are ominous.

[Note] Diarrhea and dysentery involve Interior Deficiency; Deep, Small, Slippery, and Weak pulses are compliant. Seeing Excess, Large, Floating, Rapid pulses instead leads to fever and ominous signs.

52. For Vomiting and Regurgitation, Floating-Slippery pulses indicate prosperity; Deep, Rapid, Fine, and Choppy pulses with intestinal dryness indicate death.

[Note] Vomiting and regurgitation involve Spleen Deficiency with Phlegm. Floating indicates Deficiency; Slippery indicates Phlegm; this is a compliant pulse, hence prosperity. Deep, Rapid, Fine, and Choppy indicate Qi insufficiency and fluid exhaustion, leading to intestinal dryness with sheep-dung-like feces, which is incurable.

53. In Huo Luan (Cholera-like disorder), do not be surprised by Dai Mai (Replacement Pulse); Tongue curling and testicular retraction with hidden pulses and cold limbs are lamentable.

[Note] For Huo Luan diagnosis, Yang pulses are good. If Dai Mai is seen, it is due to temporary confusion of Clear and Turbid Qi, causing pulse discontinuity, not necessarily a death sign. If pulses are hidden, limbs are cold, tongue curls, and testicles retract, it indicates severe Yin Cold, leading to lamentable changes.

54. Cough pulses are often Floating; Floating-Soft is easy to treat; Deep, Hidden, and Tight indicate approaching death.

[Note] Cough is a Lung disease; Floating pulses are suitable. Combined with Soft, the disease will recede. Deep, Hidden, and Tight are contrary and indicate deep disease. Why wait for death?

55. For panting with raised shoulders, Floating-Slippery is compliant; Deep-Choppy with cold limbs is non-compliant.

[Note] Yang panting is mostly Excess, due to Wind and Phlegm, hence Floating-Slippery is compliant. Yin panting is mostly Deficiency, due to Cold and Deficiency, hence Deep-Choppy with cold limbs are untreatable non-compliant signs.

56. For Fire-Heat syndromes, Surging-Rapid pulses are suitable; Weak and faint without spirit indicates separation of the root.

[Note] Heat syndromes presenting Surging-Rapid pulses are correct. Seeing Weak and faint pulses contradicts the syndrome, indicating separation of the root; medication cannot be applied.

57. For Bone-steaming Fever, Rapid and Deficient pulses are expected; Heat with Choppy-Small pulses will surely cause death.

[Note] Bone-steaming is due to Kidney Water insufficiency and vigorous Fire usurping upward; Deficient and Rapid pulses are the correct image. Choppy-Small pulses indicate "fever with quiet pulse," which is incurable.

58. For extreme fatigue and various deficiencies, Floating-Soft, Weak, and Faint are expected; Earth failure presents Double String-taut; Fire flaring presents Fine-Rapid.

[Note] Deficiency syndromes should show Deficient pulses. If both Guan pulses are String-taut, it is called Double String-taut. String-taut is the Liver pulse; seeing it at Right Guan indicates Liver Wood insulting Spleen, hence Earth failure. For fatigue syndromes, Fine-Rapid pulses indicate Yin Deficiency with Fire excess insulting Lung Metal, which is incurable.

59. For blood loss syndromes, Kou Mai (Rind Pulse) must appear; Slow and Small are pleasing; Rapid within is worrying.

[Note] Kou Mai has an empty center, suitable for blood loss. Slow and Small are also Deficient pulses, compliant and pleasing. If Rapid and Large, it indicates pathogen excess, hence worrying.

60. For Blood stasis in the middle, Firm and Large pulses are suitable; Deep, Choppy, and Micro indicate few quick recoveries.

[Note] Blood stasis is a tangible Excess syndrome; Firm and Large pulses match the syndrome. If Deep, Choppy, and Micro, it involves Deficiency. Unable to move blood naturally and difficult to use harsh agents, how can quick recovery be expected?

61. For San Xiao (Three Wasting-Thirst) pulses, Rapid and Large indicate life; Fine, Small, Short, and Choppy are alarming.

[Note] Thirst with excessive drinking is Upper Xiao; consuming food quickly with hunger is Middle Xiao; thirst with frequent urination is Lower Xiao. All Three Xiao involve excessive Dryness-Heat; only Rapid and Large pulses are auspicious. Fine, Small, Short, and Choppy are incurable.

62. For stranguria and urinary retention, nasal color must be yellow; Excess and Large are treatable; Choppy and Small indicate death.

[Note] Yellow nose tip indicates difficulty in urination. If all six pulses are Excess and Large, using attacking agents will cure it. If Choppy and Small, Jing-Qi fails to transform, and death is imminent.

63. Dian (Catatonia) is Heavy Yin; Kuang (Mania) is Heavy Yang; Floating-Surging is auspicious; Deep-Rapid is ominous.

[Note] Both Dian and Kuang syndromes favor Floating-Surging pulses, indicating shallow disease. If Deep and Rapid, disease has entered the bones; even with Bian Que and Cang Gong, it cannot be saved.

64. For Epilepsy, Floating-Moderate is suitable; Deep, Small, Rapid, and Solid indicate deep disease; String-taut without Stomach Qi indicates certain death.

[Note] Epilepsy originates from Wind-Phlegm; Floating-Moderate pulses are natural. Deep, Small, Rapid, and Solid indicate deep disease. Or String-taut without Stomach Qi indicates the True Organ pulse of the Liver appearing; how can life be expected?

65. For Heart and Abdominal Pain, there are nine types; Fine and Slow indicate quick recovery; Floating and Large indicate prolonged duration.

[Note] Nine types of heart and abdominal pain should present Slow and Fine pulses, making treatment easy. If Floating and Large, it indicates Central Deficiency and Pathogen Excess, preventing quick results.

66. Hernia belongs to Liver disease; pulses must be String-taut and Rapid. Firm and Rapid indicate life; Weak and Rapid indicate death.

[Note] Liver governs tendons; Hernia involves tendon tension, hence belonging to Liver. Liver pulses are naturally String-taut and Rapid. Hernia is due to Yin Cold; Firm pulses govern Interior Cold, which is also normal. If Weak and Rapid, there is a threat to life.

67. For Jaundice due to Damp-Heat, Surging-Rapid is suitable; Floating and Large are acceptable; Micro and Choppy are difficult to treat.

[Note] Damp steaming and Heat stasis generate Jaundice; Surging-Rapid and Floating-Large are suitable. Seeing Micro and Choppy indicates severe deficiency, likely with poor appetite and frequent diarrhea, with no medicine available to cure.