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In all phlegm syndromes, when the pulse presents forms such as shrimp swimming (Xia You), sparrow pecking (Que Zhuo), or intermittent stopping (Dai Zhi), one must understand that this is due to phlegm coagulation and Qi stagnation, causing obstruction of Guan Ge (gateways and restrictions), resulting in irregular pulse movements. Some pulses move chaotically across multiple positions, some disappear intermittently, some are present at the Cun position but absent at the Chi position, or invisible at the Guan position, some beat intermittently with varying magnitude, some occur suddenly in previously healthy individuals, some occur intermittently in those with a chronic predisposition to phlegm diseases, and some result from sudden collapse or acute strike. None of these are death pulses; they are indeed caused by phlegm.

Pulse diagnosis involves opposite viewing (Dui Kan), correct viewing (Zheng Kan), reverse viewing (Fan Kan), balanced viewing (Ping Kan), oblique viewing (Ze Kan), and thorough viewing (Di Tao Kan). For instance, where there is a floating pulse (Fu Mai), there is also a deep pulse (Chen Mai); where there is a large pulse (Da Mai), there is also a weak pulse (Ruo Mai); where there is a slippery pulse (Hua Mai), there is also a choppy pulse (Se Mai); where there is a rapid pulse (Shu Mai), there is a slow pulse (Chi Mai). Correlating with disease: floating indicates exterior syndrome, deep indicates interior syndrome; large indicates excess, weak indicates deficiency; slippery indicates abundant blood, choppy indicates deficient Qi; moving indicates agitation in Yang, wiry indicates agitation in Yin; rapid indicates Fu organ disease, slow indicates Zang organ disease. This is opposite viewing. Pulses such as floating, large, slippery, moving, and rapid indicate excess Qi, named Yang; one should recognize the mechanism of Yin disease with Yang predominance within them. Pulses such as deep, weak, choppy, wiry, and slow indicate deficient Qi, named Yin; one should recognize the mechanism of Yin predominance with Yang disease within them. This is correct viewing. Yin and Yang exist in heaven and earth; where there is excess, deficiency follows; where there is deficiency, excess accompanies. Understanding following and accompanying allows prediction of Qi changes. Thus, if initially presenting as floating, large, slippery, moving, rapid, and subsequently reversing to deep, weak, choppy, wiry, slow, this is the mechanism of Yang declining and Yin growing, indicating disease progression. If initially presenting as deep, weak, choppy, wiry, slow, and subsequently showing slight floating, large, slippery, moving, rapid, this is the mechanism of Yang advancing and Yin retreating, indicating recovery. This is reverse viewing. Floating is Yang; if accompanied by large, moving, slippery, rapid Yang pulses, it is pure Yang, necessarily indicating Yang excess and Yin deficiency disease. Deep is Yin; if accompanied by weak, choppy, wiry, slow Yin pulses, it is double Yin, necessarily indicating Yin excess and Yang deficiency disease. This is balanced viewing. Floating with weak, choppy, wiry, or slow characteristics indicates Yin within Yang; the person has Yang deficiency with Yin Qi hiding within Yang pulses, portending Yang collapse, requiring urgent support of Yang. Deep with large, slippery, or rapid characteristics indicates Yang within Yin; the person has Yin deficiency with Yang pathogenic factors sinking into Yin pulses, portending Yin deficiency complications, requiring careful preservation of Yin. This is oblique viewing. If the five Yang pulse bodies remain unchanged, starting as strong Yang with force and ending as weak Yang without force, one knows Yang is about to perish. Although five Yin pulses may transform into Yang, if they appear suddenly, this is extreme Yin resembling Yang; knowing the reflected light will not last long and embers extinguish easily, this is thorough viewing. There is also viewing of True Yin and True Yang. What is called Yang is the Yang of the stomach region; if the pulse has Stomach Qi, death is avoided. What is called Yin is the pulse of the True Zang organs; seeing True Zang pulses indicates death. However, pathogenic Qi arrives tight and rapid, while grain Qi arrives slow and harmonious; thus, Yin and Yang cannot be determined solely by slow or rapid rates. Among the ten pulses, floating and deep are pulse bodies, large and weak are pulse momentum, slippery and choppy are pulse Qi, moving and wiry are pulse shapes, slow and rapid are pulse rhythm; all are disease pulses, not normal pulses. Ancients said: floating with weakness is Yang deficiency, deep with weakness is Yin deficiency. This states the norm. However, Yin deficiency necessarily manifests Yin pulses, so the more Yang is deficient, the deeper the pulse. If extremely deep then suddenly floating, this is a sign of slight Yang about to escape; if medication causes gradual floating reaching moderate depth, it is auspicious. If suddenly floating, with shortness and chopiness, it is the True Zang pulse of the Lung appearing; if floating, scattered, and large, it is the True Zang pulse of the Heart appearing. Yang pulses are the reverse for Yin deficiency, but the more Yin is deficient, the more floating the pulse becomes. If extremely floating then suddenly deep, this is a sign of True Yin already perished. If tonifying agents cause gradual deepening reaching moderate depth, it is auspicious. If suddenly deepening, or deep with scattering and chopiness, or continuous and about to cease, it cannot be treated further. This is the pulse method of Yin-Yang reversal.