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The movement of the pulse is like using Qi (vital energy) to blow through the water inside a scallion leaf, causing it to flow. The pulse presents as Floating or Sinking, Slow or Rapid, Choppy or Slippery.

Floating Pulse: The ancients divided the human body into Three Regions and Nine Probes (San Bu Jiu Hou), while later practitioners also divided the Cun Kou (radial artery) pulse into Three Regions and Nine Probes. The Cun, Guan, and Chi positions constitute the Three Regions; each region has three probing depths: Superficial (Fu), Middle (Zhong), and Deep (Chen). Three times three equals nine probes. Therefore, a pulse obtained immediately with light pressure on the skin surface is called the Floating Pulse; a pulse obtained only with heavy pressure between the tendons and bones is called the Sinking Pulse; and a pulse obtained in the middle of the muscle layer, below the skin but above the tendons and bones, is called the Middle Pulse.

Sinking Pulse: When the Sinking Pulse is extremely deep, it is called the Hidden Pulse (Fu Mai).

Rapid Pulse: It is swift and restless. If the pulse beats six times per respiratory cycle (one exhalation and one inhalation), and is accompanied by a jumping sensation, it is called the Moving Pulse (Dong Mai).

Slow Pulse: Opposite to the Rapid Pulse, it beats three times per respiratory cycle.

The *Nei Jing* (Inner Canon) states that for every exhalation, the pulse moves twice; for every inhalation, the pulse moves twice. At the end of a full breath cycle (Ding Xi - the moment after one cycle ends and before the next begins), the pulse moves five times. This includes occasional longer breaths (Tai Xi - great sighs, analogous to leap months in a calendar). A healthy person (Ping Ren) is defined by this rhythm. In clinical practice, one should observe a healthy individual regulating their breathing, silently counting ten breath cycles, during which the pulse beats forty-five times; this is considered the Normal Pulse (Ping Mai). If the pulse beats once per exhalation and once per inhalation (two beats per cycle), this is an extreme slowness called "Shortness of Qi" (Shao Qi). If the pulse beats three times per exhalation and three times per inhalation (six beats per cycle, i.e., Rapid), accompanied by restlessness and heat in the Chi area (inner aspect of the forearm), it is called Warm Disease (Wen Bing). If the pulse beats four times or more per exhalation (eight times or more per cycle), it indicates death. If the pulse ceases completely, it indicates death. If the pulse alternates between sparse (slow) and rapid, it indicates death.

Slippery Pulse: "Slippery" implies smoothness and slickness, describing a fluent and smooth flow. In a normal pulse, it indicates abundant blood; in a pathological pulse, it indicates blood heat driving the pulse or the flow of phlegm-dampness.

Choppy Pulse: Rough and obstructed. Opposite to the Slippery Pulse, a pulse that flows with stickiness and obstruction is Choppy.

The presence of Floating or Sinking pulses can be determined by innate constitution. Arrogant individuals often have a Floating pulse, while calm and profound individuals often have a Sinking pulse. (Additionally, obese people tend to have Sinking pulses, and thin people tend to have Floating pulses.) They can also vary with seasonal changes: in Spring and Summer, when Qi ascends, the pulse is Floating; in Autumn and Winter, when Qi descends, the pulse is Sinking. When caused by disease, if the pathology is located in the Upper part, Exterior, or Fu organs, the pulse is Floating. (Upper, Exterior, and Fu are all Yang; the Floating pulse is also Yang; thus, Yang diseases present with Yang pulses.) If the pathology is located in the Lower part, Interior, or Zang organs, the pulse is Sinking.

Question: Does a Floating pulse indicate that there is pulse activity externally but not internally, signifying Interior Deficiency? Does a Sinking pulse indicate that there is pulse activity internally but not externally, signifying Exterior Deficiency? Is this correct?

Answer: If the Floating or Sinking pulse appears without cause from constitution, season, external pathogens, or internal injury, it can be termed Deficiency, interpreted as Yin failing to hold or Yang sinking inward. However, if there is a specific cause, this interpretation is invalid. For instance, in any season, a healthy person's pulse is harmonious and typically found at the Middle probe level; would we then diagnose them with simultaneous Exterior and Interior Deficiency? Furthermore, the ancients stated that the Floating pulse indicates Interior Deficiency, yet also described it as "abundant upon lifting, insufficient upon pressing." Is this contradictory? I say: To call a Floating pulse "Deficient," it must exhibit signs of Deficiency alongside the Floating quality; merely being Floating does not make it Deficient. To say a Floating pulse indicates Interior Deficiency requires evidence of actual Interior Deficiency; it does not mean a Floating pulse inherently causes Interior Deficiency. The substance of the pulse as Deficient or Excess does not change due to Floating or Sinking. An Excess pulse is forceful in both Floating and Sinking probes; a Deficient pulse is weak in both. The difference lies in the sensation of light versus heavy pressure. An Excess pulse feels harder upon deeper pressure because the suppression highlights its vigorous beating; a Deficient pulse feels weaker upon deeper pressure because it lacks the strength to beat against the pressure. Thus, "abundant upon lifting, insufficient upon pressing" applies only to Floating pulses that are Deficient, not to those that are Excess. Some might ask: If a Floating-Excess pulse becomes harder upon pressing, showing characteristics in all three probes, why is it still called Floating? Answer: The nature of the pulse is fundamentally Floating; it only appears Sinking when pressed. Without pressure, it remains Floating, hence the name. Another question: Why do some Floating pulses indicate Exterior Deficiency? Answer: Excessive sweating from external contraction, or excessive spontaneous sweating from internal injury, leads to Deficiency of Exterior Yang and the outward floating of Qi, resulting in a Floating pulse.

The Slowness or Rapidity of the pulse can depend on innate constitution: irritable temperaments tend toward Rapid pulses, while relaxed temperaments tend toward Slow pulses. Seasonal variations also apply: warm weather makes the pulse restless, while cold weather makes it quiet. Regarding disease correlation, the same principles apply. Zhang Zhongjing associated Slow pulses with Cold in the Zang organs and Rapid pulses with Heat in the Fu organs; however, one should not rigidly adhere to this, as Fu organs can also have Cold and Zang organs can have Heat.

Do Slipperiness and Choppy qualities also depend on innate constitution? Yes. Noble individuals, whose Shen (spirit) and Qi flow freely, have smooth pulses; poor individuals, whose Shen and Qi are suppressed, have obstructed pulses. This aligns with the *Tai Su* concept of judging fortune and misfortune through the slipperiness or choppy nature of the pulse. Regarding seasons, the Liver pulse belongs to Spring and is slightly Slippery; the Lung pulse belongs to Autumn and is slightly Choppy. In terms of disease manifestation, these qualities fundamentally reflect the obstruction or free flow of Qi and Blood.