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Deficiency and cold combine, this is named Ge pulse (Cymbal Pulse). In men, it manifests as loss of essence; in women, as loss of blood.

The *Shanghan Lun* (Treatise on Cold Damage Diseases), Chapter on Differentiating Pulses, states: "The pulse is wiry and large. Wiry indicates reduction; large indicates hollow (Kou). Reduction implies cold; hollow implies deficiency." Deficiency and cold combining is what is called the Ge pulse. In women, it leads to spontaneous abortion or continuous uterine bleeding, for which tonifying blood is indicated. In men, it leads to hemorrhage or loss of essence, for which replenishing essence is indicated. This section serves as a commentary on the Ge pulse. Essentially, the Ge pulse feels like leather, tight and full under the fingers. To say the pulse is wiry and large—if not the Ge pulse, then what? These four characters suffice to describe the morphology of the Ge pulse completely. The following text explains the cause of the Ge pulse and how it gives rise to disease. A wiry pulse body is wiry, tense, fine, and constricted, indicating a reduction of Yang Qi. When it changes from fine/constricted to large, the wiry/tense nature remains. Wiry/tense signifies Yang reduction; becoming large signifies central hollowing (Kou). Yang reduction creates cold; central hollowing creates deficiency. Both deficient and cold, it presents as Ge externally but is empty internally. In women, this manifests as spontaneous abortion and metrorrhagia; in men, as hemorrhage and seminal emission. All these are signs of internal emptiness.

Yang excess leads to Cu pulse (Surging/Intermittent Pulse), associated with Lung abscess and Yang toxin. Yin excess leads to Jie pulse (Knotted/Intermittent Pulse), associated with hernia, mass, and accumulation/stagnation.

A rapid pulse that occasionally stops is named Cu pulse. Rapidness indicates heat and Yang excess, primarily pointing to heat aggregation in the Upper Jiao forming toxins, or heat aggregating in the lungs forming a lung abscess. (For Yang toxin, clearing and dispersing is suitable, using herbs such as Huangqin [Scutellariae Radix], Huafen [Trichosanthis Radix], Lianqiao [Forsythiae Fructus], Zhike [Aurantii Fructus], Jingjie [Schizonepetae Herba], Fangfeng [Saposhnikoviae Radix]. For lung abscess, clearing and resolving is suitable, such as Zhongjing's Jiegeng Tang [Platycodon Decoction].) The flow of pulse qi is obstructed, hence the occasional stop. If the pulse is not rapid but slow, occasionally stopping, it is named Jie pulse. This indicates Yin excess, primarily suggesting hernias or stubborn masses in the Yin aspect or abdomen. (Formulas such as Yuanrong Wanbing Ziwan Wan or Baojian Chenxiang Guifu Wan are suitable.) Long-term accumulation leads to stagnation; Qi becomes hard and knotted without dispersing. When pulse qi reaches this point, it is also obstructed, hence the occasional stop. The *Nan Jing* (Classic of Difficult Issues), Difficulty 18, states: "Severe knotting indicates severe accumulation; slight knotting indicates slight accumulation." Therefore, one must examine the frequency of pauses to judge the severity of the disease.