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The *Ling Shu* (Spiritual Pivot) determines pathological changes based on the six pulse qualities: slow and rapid (Huanji), large and small (Daxiao), slippery and rough (Huase). This can be regarded as the general outline of all pulses. The *Su Wen* (Basic Questions) states: large, small, slippery, rough... [text omitted]. The *Nan Jing* (Classic of Difficult Issues) states: floating, deep, long, short, slippery, rough. Zhang Zhongjing states: wiry, tight, floating, deep, slippery, rough. These six are named "can zai" (harmful pathogens capable of inducing various pathological pulses) and can cause diseases manifesting in various pulses. Hua Borun stated: Generally speaking, the essence of the pulse outline does not exceed the six pulses of floating, deep, slow, rapid, slippery, and rough. The reason for saying "does not exceed" is that these six are sufficient to govern diseases related to exterior-interior, yin-yang, deficiency-excess, cold-heat, wind-cold-dampness-dryness, zang-fu organs, blood, and qi. Floating represents yang and the exterior; corresponding syndromes include wind and deficiency. Deep represents yin and the interior; corresponding syndromes include dampness and excess. Slow indicates involvement of the Zang organs, representing cold and chill. Rapid indicates involvement of the Fu organs, representing dryness and heat. Slippery indicates an excess of blood; rough indicates stagnation of Qi alone. Although the wording of these various theories differs slightly, their underlying meaning is actually consistent. In my opinion, they ultimately do not go beyond the six categories of exterior, interior, deficiency, excess, cold, and heat. For instance, since floating indicates the exterior, San Mai (Scattering Pulse), Da Mai (Large Pulse), and Kou Mai (Hollow Pulse) can be classified accordingly. Since deep indicates the interior, Xi Mai (Fine Pulse), Xiao Mai (Small Pulse), and Fu Mai (Hidden Pulse) can be classified accordingly. Since rapid indicates heat, Hong Mai (Surging Pulse), Hua Mai (Slippery Pulse), Ji Mai (Rapid Pulse), and Cu Mai (Intermittent Pulse) belong to this category. Since slow indicates cold, Se Mai (Rough Pulse), Jie Mai (Knotted Pulse), Dai Mai (Tied Pulse), and Huan Mai (Moderate Pulse) belong to this category. Since deficiency indicates insufficiency, Duan Mai (Short Pulse), Ruo Mai (Weak Pulse), Ru Mai (Soggy Pulse), and Wei Mai (Minute Pulse) belong to this category. Since excess indicates surplus, Xian Mai (Wiry Pulse), Jin Mai (Tight Pulse), Dong Mai (Moving Pulse), and Ge Mai (Leather Pulse) belong to this category. However, among these six, there are significant distinctions that must not be overlooked. Floating indicates the exterior, but in cases of Yin deficiency, the pulse is necessarily floating yet forceless; thus, floating cannot be universally equated with the exterior, nor should dispersing methods be indiscriminately used. Deep indicates the interior, but when pathogenic factors initially invade severely, with Yin-cold binding the skin and Yang Qi unable to reach the exterior, the pulse will first appear deep and tight; thus, deep cannot be universally equated with the interior, nor should internal attacking methods be indiscriminately used. Most rapid pulses indicate heat, but in cases of Yin deficiency where both Yin and Yang are deficient and Blood and Qi are chaotic, the pulse will necessarily be urgent and rapid; the more rapid, the more deficient, and the more deficient, the more rapid; thus, rapid cannot be universally equated with heat, nor should cooling methods be indiscriminately used. Wei Mai (Minute Pulse) and Xi Mai (Fine Pulse) resemble deficiency, but in cases of extreme pain and blockage, the pulse often hides; thus, Fu Mai (Hidden Pulse) cannot be universally equated with deficiency, nor should tonification be administered abruptly. Xian Mai (Wiry Pulse) and Shu Mai (Rapid Pulse) resemble excess, but in cases of severe depletion of True Yin, the pulse may become abnormally prominent (Guan Ge Bei Chang); thus, wiry cannot be universally equated with excess, nor should reducing or purging methods be indiscriminately used. In this way, within the general outline, a higher-level outline exists. If one does not integrate the four diagnostic methods (Four Examinations) for reference, but acts rashly and arbitrarily, there is no case where the patient will not be harmed in an instant. This is why pulse diagnosis is difficult to articulate and why every minute detail must be distinguished carefully.