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The pulse is injured by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), manifesting as distinct variations of the Nine Qi (Qi Rising, Qi Slackening, Qi Knotting, Qi Consuming, Qi Descending, Qi Disorder, Qi Contracting, Qi Leaking, Qi Exhaustion): Anger injures the Liver, resulting in a rapid and surging pulse with Qi rushing upward; Fright injures the Gallbladder, causing chaotic pulse Qi with twitching and jerking; Excessive Joy injures the Heart, leading to a scattered pulse with slackened Qi; Excessive Pensiveness injures the Spleen, resulting in a short pulse with knotted Qi; Sorrow injures the Lung, causing a choppy pulse with sinking Qi; Fear injures the Kidney, leading to a deep pulse with timid Qi; Injury by Cold results in a slow pulse with contracted Qi; Injury by Heat results in a rapid pulse with leaking Qi. Therefore, a rapid pulse indicates consumption of Qi due to sorrow causing tethering and pulling of the Heart system.

Generally, people's pulses may be inherently large or small, inherently Yin or Yang, which are endowments from congenital origins. If the pulse changes due to pathogenic factors, appearing suddenly slow or fast, advancing or retreating abruptly, this indicates the sudden arrival of disease, where the pulse manifests according to Qi dynamics. Thus, whoever examines the pulse must first recognize the normal pulses of the Zang organs before discerning pathological pulses; one must first understand normal pulses before identifying altered pulses. From normal pulses, one can observe an individual's constitutional framework and longevity; from altered pulses, one can assess disease conditions and life-and-death prognoses.

It is stated that floating pulses indicate exterior syndromes, deep pulses indicate interior syndromes, rapid pulses indicate heat, slow pulses indicate cold, wiry and forceful pulses indicate excess syndromes, and minute and fine pulses indicate deficiency syndromes; this is indeed correct. However, amidst similarities and ambiguities, true distinctions must be made and carefully examined. For instance, while floating pulses generally indicate the exterior, in cases of Yin deficiency and blood insufficiency, or middle Qi depletion, the pulse will necessarily be floating but weak; thus, a floating pulse cannot be universally categorized as an exterior syndrome. While deep pulses generally indicate the interior, in initial exterior pathogen invasion where Cold binds the skin and hair pores preventing pulse Qi from reaching the surface, the pulse will necessarily be deep and tight; thus, a deep pulse cannot be universally categorized as an interior syndrome. Although rapid pulses indicate heat, true heat syndromes do not always present with rapid pulses; in deficiency consumptive diseases where both Yin and Yang are exhausted, severe deficiency leads to severe rapidity; thus, a rapid pulse cannot be universally categorized as heat. Although slow pulses indicate cold, after the initial retreat of Cold Damage with residual heat remaining, the pulse is often slow and slippery; thus, a slow pulse cannot be universally categorized as cold. Wiry and forceful pulses resemble excess, but in cases of true Yin deficiency, severe stomach Qi depletion, or Yin-Yang separation syndromes, the pulse will necessarily be expansive and wiry-forceful; thus, wiry-forcefulness cannot be universally categorized as excess. Minute and fine pulses resemble deficiency, but in cases of extreme pain, Qi closure blocking Ying and Wei, and stagnation obstructing flow, the pulse will necessarily be hidden and concealed; thus, minute-fineness cannot be universally categorized as deficiency. Among all types of pulses, there are similarities and ambiguities, as well as true distinctions; the key principle for pulse diagnosticians is to first recognize these principles.