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There are generally twenty-six major types of pulses, which serve as the outline for pulse diagnosis. Analyzed in detail, a slight deviation can lead to significantly different treatments. In summary, they fall into two categories: deficiency and excess, yin and yang. By discussing these two, one grasps the essence. From various pulse methods, we extract the key points, discard the superfluous, and record the core principles.

**Floating Pulse (Fu Mai):** The pulse is felt superficially under the fingers; pressure reveals insufficiency, while light touch reveals abundance. Repeated searching shows a sensation of excessive fullness. It appears suddenly between the skin and hair. It indicates exterior syndromes, wind pathogens, or deficiency. A floating and large/diffuse pulse indicates Heart pathology; a floating and short/choppy pulse indicates Lung pathology. A floating and rapid pulse indicates Heat. While a floating-rapid pulse should present with fever, if there is no fever but instead aversion to cold, it signifies carbuncles and sores (Chuang Ju).

**Surging Pulse (Hong Mai):** The pulse seems floating and large; upon pressing or lifting, it feels broadly filling all three positions (cun, guan, chi), resembling a torrent of water or rising waves. It indicates Blood excess. *Treatise on Carbuncles and Sores* states: "A surging-large pulse indicates the progression of carbuncle and sore diseases." If pus has not yet formed in a carbuncle/sore, purgation is appropriate. However, if pus has drained and the pulse remains surging-large, treatment is difficult; if accompanied by spontaneous diarrhea, it is incurable.

**Slippery Pulse (Hua Mai):** The pulse is solid and large, flowing smoothly like rolling pearls; pressing reveals a continuous slippery quality. It indicates either Heat or deficiency, belonging to Yang pulses. For carbuncles and sores, if pus has not ulcerated, internal resolution is suitable; after ulceration, supporting the interior is suitable. This reflects the transition from initial Heat to final deficiency.

**Rapid Pulse (Shu Mai):** Upon pressing, the pulse beats six times per respiration cycle, appearing slippery and fast. Floating and rapid indicates Exterior Heat; sinking and rapid indicates Interior Heat. It is said that all rapid pulses indicate Heat. Zhang Zhongjing stated: "If a rapid pulse appears intermittently, malignant sores will arise." He also said: "A Lung pulse that is surging and rapid leads to sores." Diagnosing various sores, a surging-rapid pulse suggests impending suppuration.

**Scattered Pulse (San Mai):** The pulse seems floating and scattered; pressing causes it to disperse and fade, while lifting reveals a large but forceless pulse. It indicates Qi excess and Blood deficiency, having an exterior without an interior. After carbuncles/sores ulcerate, if pain and irritability persist, a surging-slippery-rough-scattered pulse indicates a difficult prognosis due to deficient healthy Qi and excess pathogenic factors. Additionally, heavy limbs combined with a large (floating/scattered) Lung pulse indicate fatal outcomes.

**Gourd Seed Pulse (Kou Mai):** The pulse seems floating and soft; pressing reveals emptiness in the center and solidity on the sides. It indicates Blood deficiency or conditions involving blood loss/carbuncles. Obtaining a gourd seed pulse after pus drainage indicates ease of treatment because the pulse matches the disease state.

**Long Pulse (Chang Mai):** Pressing reveals a surging, large, and long pulse extending beyond its normal position. It indicates excess Yang Qi. In Cold Damage (Shang Han), this pulse suggests sweating will resolve the condition. A long and slow pulse is the Stomach pulse, indicating recovery from all diseases, termed "long means Qi is regulated."

**Firm Pulse (Lao Mai):** Pressing reveals a solid, large, and wiry pulse, both sinking and floating, with a firm and hard quality, resembling scrofula nodules. Obtaining a firm pulse contraindicates internal resolution therapies.

**Excess Pulse (Shi Mai):** Forceful upon both light and deep pressure, similar to a knotted pulse, is called Excess. Classics state: "Pathogen dominance makes the pulse excess; chronic illness makes it deficient." This pulse is most feared. In carbuncle patients, urgent purgation is required because both pathogen and Zang-Fu organs are excess.

**Wiry Pulse (Xian Mai):** Pressing reveals tightness and wiriness. Unlike the tight pulse which rotates like a rope, the wiry pulse feels like pressing a string without movement. A floating-wiry pulse that appears intermittently indicates fluid retention or pain, ruling Cold and deficiency. *Carbuncle Treatise* states: "Wiry and surging pulses interacting indicate exterior tightness and interior heat, heralding carbuncles."

**Tight Pulse (Jin Mai):** Similar to wiry but tighter, feeling like cutting a rotating rope. It indicates sharp pain or accumulations. In carbuncles, it indicates stagnant and sluggish Qi and Blood, also ruling pain.

**Choppy Pulse (Se Mai):** Pressing reveals dispersion then return; lifting reveals thinness and insufficiency. Choppy pulses indicate Qi stagnation and Blood deficiency. In post-ulceration carbuncles, it is not harmful.

**Short Pulse (Duan Mai):** Light and deep pressure fail to reach the normal position. *Neijing* states: "Short pulses indicate Qi pathology due to lack of Stomach Qi." Short pulses in any disease are difficult to treat; in carbuncles, it indicates depletion of True Qi.

**Fine Pulse (Xi Mai):** Pressing reveals a thread-like pulse like a spider's silk about to break; lifting feels non-existent yet present. Fine and minute pulses indicate decline of Primordial Yang. In carbuncles, a fine and sinking pulse with straight/unyielding qualities indicates interior deficiency and potential transformation of the disease.

**Minute Pulse (Wei Mai):** Pressing reveals a soft, small, and extremely minute pulse. It indicates deficiency. Recovery of True Qi brings life; dominance of pathogens brings danger. In carbuncles, a minute and even pulse after ulceration indicates natural healing.

**Slow Pulse (Chi Mai):** Light and deep pressure reveal a slow rate, beating only three times per respiration cycle, appearing slightly slower than a moderate pulse. In chronic diseases, it is favorable; in acute diseases, it indicates exhausted healthy Qi. In carbuncles, it indicates self-healing after ulceration.

**Moderate Pulse (Huan Mai):** Similar to slow but slightly faster. Zhang Zhongjing stated: "Yang pulse floating-large and moist, Yin pulse floating-large and choppy, equalized Yin and Yang constitutes Moderate." Long-moderate pulses heal all diseases; post-ulceration carbuncles with choppy-moderate pulses heal easily due to corresponding pulse signs and presence of Stomach Qi.

**Sinking Pulse (Chen Mai):** Insufficient on light pressure, visible only on deep pressure, feeling like rotten cotton. It indicates pathogens in the Zang organs. Water pathogens cause rebellion with this Yin pulse; in carbuncles, it indicates deep-seated pathogens.

**Hidden Pulse (Fu Mai):** Deeper than sinking; invisible on light pressure, felt only at the bone level. Similar to sinking but indicates deeper pathogens.

**Deficient Pulse (Xu Mai):** Insufficient on pressure, slow, large, and soft; light lifting feels hollow. Classics state: "Deficient pulse indicates Blood deficiency." Blood deficiency generates Cold and Yang Qi insufficiency. In carbuncles with deficient pulses, therapy should support the interior, harmonize Qi, and nourish Blood.

**Soft Pulse (Ruan Mai / Ru Mai):** Pressing feels like silk in water, extremely soft, sinking, and fine, also called Ru (Damp) pulse. It indicates weak Stomach Qi. In carbuncles, it requires tonifying deficiency, draining pus, and supporting the interior.

**Weak Pulse (Ruo Mai):** Similar to soft but extremely minute, slow, and faint. Zhang Zhongjing described weak-minute pulses as continuous like leaking lacquer. It indicates dual deficiency of Qi and Blood, and insufficiency of form and spirit. Generally, carbuncle presentations with sinking, slow, soft, or weak pulses all require supporting the interior.

**Racing Pulse (Cu Mai):** Pressing reveals rapid coming and going with occasional pauses followed by resumption. Zhang Zhongjing stated: "Yang excess causes racing pulses, indicating Heat accumulation in the interior; purgation brings harmony." In carbuncles, racing pulses also warrant urgent purgation.

**Knotted Pulse (Jie Mai):** Pressing reveals slow, intermittent pulses with pauses followed by resumption. Zhang Zhongjing stated: "Yin excess causes knotted pulses." Classics state: Racing and knotted pulses allow for survival, whereas Dai pulses indicate death.

**Intermittent Pulse (Dai Mai):** Pressing reveals pulses that stop and cannot resume immediately, then move again. Dai pulses indicate Qi scattering; seeing them in any disease is inauspicious. In carbuncles, racing or knotted pulses are difficult to treat, let alone Dai pulses.

**Moving Pulse (Dong Mai):** Seen at the Guan position, headless and tailless, bean-sized, quivering and shaking. *Mai Jing* states: "Interaction of Yin and Yang is called Moving." Movement in Yang indicates Yang Qi deficiency and syncope; movement in Yin indicates Yin Qi deficiency and fever. Yang originates at Chi and moves to Cun; Yin originates at Cun and moves to Chi. This distinction must not be overlooked.