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The pulse changes caused by the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) are primarily due to internal injury of the Five Zhi (emotional activities governed by the Heart, Liver, Spleen, Lung, and Kidney). Joy leads to a slow and dispersed pulse; sorrow results in a short pulse; worry causes a choppy pulse; excessive thought leads to a knotted pulse; fear produces a deep pulse; fright causes a agitated pulse; anger results in a rapid and tense pulse. These seven types of pulses should be carefully examined first before treatment is administered.

During pregnancy, the pulse is typically tight and slippery. If this appears at the Right Guan position (Spleen/Stomach pulse position), it may indicate vomiting or fetal damage; other positions must be consulted for comprehensive diagnosis. When examining the Left pulses, if one or two positions show surging and slippery qualities; or if all six positions are equal, with the Chi position being vigorous, or the Zhongchong vessel being long and flowing, these are signs of pregnancy. To distinguish between male and female fetuses, Yin and Yang attributes must be assessed. A surging Cun position on the Right (Lung pulse) with more Yin characteristics generally indicates a female fetus (Nongwa); a surging Chi position on the Left (Kidney pulse) with more Yang characteristics generally indicates a male fetus (Nongzhang). A weak and rapid Right Guan pulse suggests potential fetal damage; if spontaneous vaginal bleeding during pregnancy (Tai Lou) is accompanied by a Ge pulse (Cushion-like pulse, often indicating blood loss or miscarriage), miscarriage is likely, causing great distress. Near delivery, the pulse may show intermittent stops, appearing either surging or fine; if the Right Guan pulse is weak at the time of birth, tonifying decoctions should be applied.

When the pulse and symptoms are contradictory, the condition is difficult to treat. In Spring and Summer, the pulse should be floating but not choppy; in Autumn and Winter, it should be floating and large but not excessive. For the elderly, an excessive pulse indicates disease; for the young and strong, an insufficient pulse indicates disease. Conditions such as Heart pain, Spleen pain, hemorrhage, and dysentery become critical if accompanied by contrary pulses. For Zhong E (sudden attack by turbid pathogens) and Jin Chuang (knife/arrow wounds), a floating and surging pulse is contraindicated. In Shanghan (Cold Damage) and febrile diseases with abdominal fullness, or in Shui Qi (water retention) diseases, contrary pulses are ominous. In poisoning with mania, a deep and fine pulse is inauspicious. After childbirth, with ulcerating carbuncles, a surging and solid pulse is undesirable. Coughing with a deep and hidden pulse, or deficiency pain with a forceful pulse (beating against the finger), indicates severity. Asthma and urgency with a fine and minute pulse, or Wei Bi (flaccidity and numbness) with a tense pulse, are serious. Internal diseases with firm pulses, external diseases with choppy pulses, sweating with a surging pulse, and headache with a short and choppy pulse are all adverse signs. Deficiency consumption with a rapid Heart pulse, and Wind disorders with a Spleen pulse that is slow and weak, are problematic. Huo Luan (cholera-like vomiting and diarrhea) with a minute and choppy pulse, thin body with a large pulse and panting, or robust body with a minute pulse and shortness of breath, are unfavorable. Additionally, in Shanghan Yang diseases presenting with Yin pulses, or after two weeks where the Cun pulse is depressed, with Jue Ni (cold extremities) and Li (diarrhea) and no pulse, these are critical. Minute pulse with cold extremities and irritability, or slow pulse with apparent ability to digest food, are paradoxical signs.

Pulses and symptoms may seem contradictory but are not entirely so, meaning the progression of the disease may not cause severe harm. An excess condition presenting with emaciated signs, such as Cold-Dampness with a deep and fine pulse, requires careful differentiation. A deficiency condition presenting with excess signs, where the deficiency pulse is large and variable, must be analyzed. If the disease is deficient with a fine pulse, but becomes forceful after taking cold-natured herbs, this indicates reaction to medication. If Yin deficiency with sweating occurs, and Ginseng is mistakenly taken leading to a strong pulse, this is iatrogenic. In Shanghan with constipation, a slow pulse with Stomach excess indicates suitability for purgation. Gout complicated by constipation is manageable.

When the pulse does not correspond to the illness, rely on symptom analysis. If a person is ill but has no critical symptoms, and the pulse is harmonious, the outcome will be auspicious. If a person appears healthy but has malignant pulses, the disease has penetrated to the Gaohuang (deep vital areas), indicating a grave prognosis.

For unsuitable pulses in various positions, seek the cause in the corresponding Zang organs. A floating and choppy Left Guan pulse, and a deep and minute Left Chi pulse, indicate specific organ imbalances. A surging and rapid Right Cun pulse, and a slow and delayed Chi position, suggest heat or deficiency. A string-tight and urgent Right Guan pulse is pathological and inappropriate.