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Li Dongyuan said: For the pulse of a person without disease, there is no need to deliberately seek "Shen" (Spirit/Vitality), yet "Shen" naturally exists within it; however, for the pulse of a person with disease, one must examine the presence or absence of "Shen". For instance, a Shu Mai (Rapid Pulse, beating more than six times per respiration) or Ji Mai (Extremely Rapid Pulse, beating seven times per respiration) indicates Re Syndrome (Heat Pattern). If the pulse is You Li (Forceful) at the Fu, Zhong, and Chen levels (indicating the presence of Wei Qi/Stomach Qi), it possesses "Shen", and treatment should involve releasing heat through methods such as sweating. Conversely, a Chi Mai (Slow Pulse, beating less than four times per respiration) or Bai Mai (Declining/Weak Pulse) indicates Han Syndrome (Cold Pattern). If the pulse is You Li (Forceful) at these levels, it possesses "Shen", and treatment should focus on dispelling cold. However, if in pulses that are extremely rapid or slow/weak, there is no longer any forcefulness, this indicates a lack of "Shen"; upon what basis can life be sustained? If one does not understand this principle and hastily applies purgative or cold-dispelling methods, upon what will "Shen" rely as its master? Therefore, the Classics state: The pulse is the precursor of Qi and Xue (Blood); Qi and Xue are the Shen (Spirit) of humans. How true this is!

Fu Mai (Floating Pulse) is not Chen (Deep). It feels insufficient under light pressure but abundant under heavy pressure, filling the fingers at a superficial level. It is a sign of Wind-Xu (Wind-Deficiency) agitation, indicating distension, Wind pathogen, Pi (Glomus/blockage), abdominal fullness with anorexia, exterior Heat, wheezing, and cough. A Fu Da (Floating and Large) pulse indicates Shang Feng (Wind-Cold injury) with nasal congestion. A Fu Hua Ji (Floating, Slippery, and Rapid) pulse indicates Su Shi (Retained Food). A Fu Hua (Floating and Slippery) pulse indicates Yin (Phlegm-Fluids). At the Left Cun position, a Fu pulse indicates Shang Feng Fa Re (Wind-Cold injury with fever), headache, dizziness, and Feng Tan (Wind-Phlegm); if Fu Er Xu Chi (Floating, Deficient, and Slow), it indicates Xin Qi Bu Zu (Heart Qi Deficiency) and Xin Shen Bu An (Restless Heart Spirit); if Fu San (Floating and Scattered), it indicates Xin Qi Hao (Consumption of Heart Qi) and Xu Fan (Deficient Irritability); if Fu Er Hong Shu (Floating, Surging, and Rapid), it indicates Xin Jing Re (Heat in the Heart Meridian). At the Right Guan position, a Fu pulse indicates Fu Zhang (Abdominal Distension); if Fu Er Shu (Floating and Rapid), it indicates Feng Re Ru Gan Jing (Wind-Heat entering the Liver Meridian); if Fu Er Cu (Floating and Interrupted), it indicates Nu Qi Shang Gan Gan (Anger injuring the Liver), chest and heart reverse fullness; if Fu Da (Floating and Large), it indicates chest and hypochondriac distension; at the Chi position, a Fu pulse indicates Bladder Wind-Heat with red, scanty urination; if Fu Er Da Kou (Floating, Large, and Hollow), men present with hematuria, women with Beng Dai (Metrorrhagia and Leukorrhea); if Fu Er Chi (Floating and Slow), it indicates Leng Shan (Cold Hernia) and pain below the umbilicus. At the Right Cun position, a Fu pulse indicates Lung affected by Wind-Cold, with cough, wheezing, clear rhinorrhea, spontaneous sweating, and fatigue; if Fu Er Hong (Floating and Surging), it indicates Lung Heat with cough; if Fu Er Chi (Floating and Slow), it indicates Lung Cold with wheezing and cough. At the Right Guan position, a Fu pulse indicates Pi Xu Zhong Man Bu Shi (Spleen Deficiency with central fullness and anorexia); if Fu Er Da Se (Floating, Large, and Choppy), it indicates Su Shi (Retained Food); if Fu Er Chi (Floating and Slow), it indicates Pi Wei Xu (Spleen-Stomach Deficiency); at the Chi position, a Fu pulse indicates Wind-Evil lodging in the Lower Jiao with constipation; if Fu Er Xu (Floating and Deficient), it indicates Yuan Qi Bu Zu (Insufficiency of Primal Qi); if Fu Er Shu (Floating and Rapid), it indicates Lower Jiao Wind-Heat with constipation.

Chen Mai (Deep Pulse) is not Fu (Floating). It is invisible to light pressure but palpable only with heavy pressure. It signifies Yin Rebellion and Yang Depression, indicating Excess patterns, Cold patterns, Qi stagnation, Water retention, Phlegm-Fluids accumulation, Zha (Masses), hypochondriac distension, Jue Ni (Reversal Cold), and Dong Xie (Watery Diarrhea). Chen Xi (Deep and Fine) indicates Shao Qi (Shortness of Breath); Chen Chi (Deep and Slow) indicates Gu Leng (Chronic Cold); Chen Hua (Deep and Slippery) indicates Su Shi (Retained Food); Chen Fu (Deep and Hidden) indicates Huo Luan (Vomiting and Diarrhea syndrome). Chen Er Shu (Deep and Rapid) indicates Internal Heat; Chen Er Chi (Deep and Slow) indicates Internal Cold; Chen Er Xian (Deep and Wiry) indicates Cold Pain in the Heart and Abdomen. At the Left Cun position, a Chen pulse indicates Cold Evil in the Heart causing pain, and Cold Fluids in the chest causing hypochondriac pain; at the Right Guan position, a Chen Fu pulse indicates Cold in the meridians causing stabbing pain in both hypochondria; a Chen Xian pulse indicates Nei Tong from Pi Ji (Accumulations); at the Chi position, a Chen pulse indicates Kidney Cold causing cold pain in the waist and back, turbid and frequent urination; in men, it indicates Jing Leng (Cold Sperm); in women, it indicates Xue Jie (Blood Stasis). A Chen Er Xi (Deep and Fine) pulse indicates leg soreness, genital itching, and dribbling after urination. At the Right Cun position, a Chen pulse indicates Lung Cold with stagnant Cold Phlegm, deficiency wheezing, and shortness of breath; a Chen Er Jin Hua (Deep, Tight, and Slippery) pulse indicates cough; a Chen Xi Er Hua (Deep, Fine, and Slippery) pulse indicates Bone-steaming Fever and dry, scorched skin/hair. At the Right Guan position, a Chen pulse indicates Stomach Cold Accumulation with central fullness and acid regurgitation; a Chen Jin (Deep and Tight) pulse indicates Xuan Yin (Hanging Fluids); at the Chi position, a Chen pulse indicates Edema with waist and leg pain; a Chen Xi (Deep and Fine) pulse indicates diarrhea and slippery urination with cold pain below the umbilicus.

Chi Mai (Slow Pulse) is "Bu Ji" (Insufficient). In terms of frequency, during one respiration cycle, the pulse beats only three times, one beat less than the normal pulse. It signifies Yin Excess and Yang Deficiency, indicating Cold patterns and Deficiency. Fu Er Chi (Floating and Slow) indicates Exterior Cold; Chen Er Chi (Deep and Slow) indicates Interior Cold. If found at the Cun position, it indicates Qi Deficiency; if at the Chi position, it indicates Blood Deficiency. Cold Qi causes contraction; Cold Blood causes coagulation. At the Left Cun position, a Chi pulse indicates Cold in the Heart with a gloomy spirit; at the Right Guan position, a Chi pulse indicates Cold in the tendons causing stiffness, cold hands and feet, and hypogastric pain; at the Chi position, a Chi pulse indicates Kidney Deficiency with turbid urine, and in women, Amenorrhea. At the Right Cun position, a Chi pulse indicates Lung Cold with Cold Phlegm and shortness of breath; at the Right Guan position, a Chi pulse indicates Middle Jiao Cold and Spleen-Stomach damage from cold foods, anorexia; if Chen Chi (Deep and Slow), it indicates Accumulation; at the Chi position, a Chi pulse indicates Zang Cold with diarrhea, cold pain in the lower abdomen, and heavy waist and legs.

Shu Mai (Rapid Pulse) is "Tai Guo" (Excessive). It beats six times per respiration, two beats more than the normal pulse. It indicates irritability and fullness. Upper appearance indicates headache and Upper Heat; Middle appearance indicates Spleen Heat with bad breath, Stomach irritability, and vomiting/regurgitation; Right appearance indicates cheek heat and red eyes; Lower Left appearance indicates yellow-red urine and constipation. Fu Shu (Floating and Rapid) indicates Exterior Heat; Chen Shu (Deep and Rapid) indicates Interior Heat.

Xu Mai (Deficient Pulse) is "Bu Shi" (Not Excess). It is scattered, large, and soft; upon lifting and pressing, it feels hollow and cannot sustain itself. This is a diagnosis of joint Qi and Blood Deficiency. It indicates Summerheat, Xu Fan (Deficient Irritability), excessive sweating, trance-like states, fright, and Infantile Convulsions.

Shi Mai (Excess Pulse) is "Bu Xu" (Not Deficient). Upon lifting and pressing, it is unceasing, strong and long, moving with force, neither fast nor slow. It is a sign of Fullness of Qi in the Three Jiao, indicating vomiting, pain, Qi blockage, Food Retention, Qi Aggregation, Dysentery, and latent Yang inside. At the Left Cun position, a Shi pulse indicates Accumulated Heat in the Heart with mouth/tongue sores and sore throat; if Shi combined with Tai Tou Mian Re Feng (Large Head/Face Wind-Heat), it indicates irritability, body pain, and red face; at the Right Guan position, a Shi pulse indicates abdominal and hypochondriac pain; if Man Shi Er Fu Da (Full, Excess, Floating, and Large), it indicates Liver Excess with dim vision and red eye pain; at the Chi position, a Shi pulse indicates lower abdominal pain and scanty urination; if Shi Er Hua (Excess and Slippery), it indicates strangury, penile pain, and red urine; if Shi Da (Excess and Large), it indicates Bladder Heat with difficult urination; if Shi Er Jin (Excess and Tight), it indicates lower back pain. At the Right Cun position, a Shi pulse indicates Heat in the Chest with phlegm-cough, irritability, and fullness; if Shi Er Fu (Excess and Floating), it indicates Lung Heat with dry/sore throat, wheezing, cough, and Qi oppression; at the Right Guan position, a Shi pulse indicates latent Yang steaming internally, Spleen Deficiency with poor appetite, and Stomach Qi stagnation; if Shi Er Fu (Excess and Floating), it indicates Pi Re Xiao Zhong (Spleen Heat with Consuming-Thirst), polyphagia, dry mouth, and fatigue; at the Chi position, a Shi pulse indicates pain below the umbilicus, difficult defecation, or occasional dysentery.

Hong Mai (Surging Pulse) is Da Er Shi (Large and Excess). Upon lifting and pressing, there is surplus; it arrives large and departs long, filling the fingers upward. It signifies Great Heat in the Ying Collaterals and blazing Qi/Blood, indicating Heat in both Exterior and Interior, irritability, dry throat, and obstruction of urination and defecation. At the Left Cun position, a Hong pulse indicates Accumulated Heat in the Heart Red Meridian with red eyes, mouth sores, headache, and internal irritability; at the Right Guan position, a Hong pulse indicates Liver Heat with body pain and floating heat in the four limbs; at the Chi position, a Hong pulse indicates Bladder Heat with red, scanty urination. At the Right Cun position, a Hong pulse indicates Lung Heat with scorched hair, sticky saliva, and dry throat; if Hong Er Jin (Surging and Tight), it indicates urgent wheezing; at the Right Guan position, a Hong pulse indicates Stomach Heat with fan wei (reverse vomiting), vomiting, and dry mouth; if Hong Er Jin (Surging and Tight), it indicates distension; at the Chi position, a Hong pulse indicates abdominal fullness, difficult defecation, or bleeding.

Wei Mai (Micropulse) is "Bu Xian" (Not Manifest). It is faint, light, and fine, seeming to exist and not exist. It signifies joint Qi and Blood Deficiency, indicating weakness, diarrhea, spontaneous sweating, unstoppable Beng Lou (Metrorrhagia/Metrostaxis due to failed blood), and shortness of breath. Fu Er Wei (Floating and Micropulse) indicates Yang Insufficiency,必然 (necessarily) accompanied by aversion to cold; Chen Er Wei (Deep and Micropulse) indicates Yin Insufficiency, primarily Zang Cold with diarrhea. At the Left Cun position, a Wei pulse indicates Heart Deficiency with worry/fright and insufficiency of Ying Blood; at the Right Guan position, a Wei pulse indicates aversion to cold and stiffness in the four limbs; at the Chi position, a Wei pulse indicates unstoppable failed blood; in men, Jing Shang Niao Xue (Kidney Injury with Hematuria); in women, Beng Dai (Metrorrhagia and Leukorrhea). At the Right Cun position, a Wei pulse indicates Upper Jiao Cold Pi (Glomus), undissipated Cold Phlegm, Middle Cold with shortness of breath; at the Right Guan position, a Wei pulse indicates Stomach Cold with Qi distension, indigestion, Spleen Deficiency with belching, and cold pain in heart/abdomen; at the Chi position, a Wei pulse indicates Zang Cold with diarrhea and cold pain below the umbilicus.

Xian Mai (Wiry Pulse) does not shift when pressed, responds to lifting, straight like a silk string. It signifies Qi/Blood convergence, Yin hidden within Yang, or Cold invading the meridians. It indicates pain, malaria, stiffness, alternating cold/fever, Blood Deficiency with night sweats, Cold coagulation with Qi knotting, Cold Bi (Obstruction), hernia, Phlegm-Fluids, and fatigue. Xian Shu (Wiry and Rapid) indicates Lao Nie (Chronic Malaria); Shuang Xian (Double Wiry) indicates urgent hypochondriac pain; Xian Chang (Wiry and Long) indicates Ji Ju (Accumulations). At the Left Cun position, a Xian pulse indicates headache, palpitations, fatigue, night sweats, and weakness; at the Right Guan position, a Xian pulse indicates hypochondriac pain and Pi Ji (Accumulations); if Xian Jin (Wiry and Tight), it indicates Shan Xia (Hernia/Masses) and Yu Xue (Blood Stasis); if Xian Xiao (Wiry and Small), it indicates Han Pi (Cold Accumulation); at the Chi position, a Xian pulse indicates lower abdominal pain; if Xian Hua (Wiry and Slippery), it indicates waist/leg pain. At the Right Cun position, a Xian pulse indicates Lung Cold with cough and Cold Phlegm in the chest; at the Right Guan position, a Xian pulse indicates Spleen-Stomach damage from cold, undigested food, cold pain in heart/abdomen, and Phlegm-Fluids; at the Chi position, a Xian pulse indicates urgent pain below the umbilicus and Water retention in the Lower Jiao.

Huan Mai (Moderate/Relaxed Pulse) is "Bu Dai" (Not Arriving/Tardy). It moves slowly and leisurely with respiration because Qi and Blood are declining, making the pulse body slow. It indicates Wind, Deficiency, Bi Syndrome, Weakness, and pain. Appearing upper, it indicates neck stiffness; appearing lower, it indicates weak legs. Fu Huan (Floating and Moderate) indicates Wind; Chen Huan (Deep and Moderate) indicates Qi/Blood Deficiency. At the Left Cun position, a Huan pulse indicates Heart Qi Deficiency with palpitations and forgetfulness, also Neck/Back stiffness/pain; at the Right Guan position, a Huan pulse indicates Wind-Deficiency with vertigo and Qi knotting in abdomen/hypochondria; at the Chi position, a Huan pulse indicates Kidney Cold with frequent urination, and in women, Menorrhagia. At the Right Cun position, a Huan pulse indicates Floating Lung Qi with short speech; at the Right Guan position, a Huan pulse indicates Stomach Weakness/Qi Deficiency, while Fu Huan (Floating and Moderate) indicates Spleen Qi Deficiency. Non-floating, non-deep, calm, and moderate is the Ben Mai (Root Pulse) of the Spleen; at the Chi position, a Huan pulse indicates Lower Cold with weak legs and Qi stagnation; Fu Huan (Floating and Moderate) indicates Chang Feng Xie Xie (Intestinal Wind Diarrhea); Chen Huan (Deep and Moderate) indicates Cold invasion of the lower abdomen.

Hua Mai (Slippery Pulse) is "Bu Se" (Not Choppy). It flows smoothly like pearls rolling on a plate, neither advancing nor retreating excessively. It signifies Blood Excess and Qi Stagnation, where Blood cannot overcome Qi. It indicates vomiting, Phlegm-Rebellion, retained food, and amenorrhea. If Hua Mai is continuous, menstruation is not closed; if interrupted, menstruation is closed. Upper appearance indicates vomiting/regurgitation; lower appearance indicates Qi knotting; Hua Shu (Slippery and Rapid) indicates Knotting Heat. At the Left Cun position, a Hua pulse indicates Heart Heat; if Hua Er Shi Da (Slippery, Excess, and Large), it indicates Heart Fright and stiff tongue; at the Right Guan position, a Hua pulse indicates Liver Heat affecting head/eyes; at the Chi position, a Hua pulse indicates strangury, red urine, and penile pain. At the Right Cun position, a Hua pulse indicates Phlegm-Fluids with vomiting/regurgitation; if Hua Er Shi (Slippery and Excess), it indicates Lung Heat with scorched hair, diaphragm obstruction, dry throat, phlegm-cough, dizziness, and sticky discharge; at the Right Guan position, a Hua pulse indicates Spleen Heat with bad breath and undigested food/vomiting; if Hua Shi (Slippery and Excess), it indicates Stomach Heat; at the Chi position, a Hua pulse indicates excessive drinking due to Minister Fire flaring, cold umbilicus with borborygmus, or occasional diarrhea; in women, it signifies Blood Excess and Qi Stagnation with amenorrhea; if He Hua (Harmonious and Slippery), it indicates Pregnancy.

Se Mai (Choppy Pulse) is "Bu Hua" (Not Slippery). It is deficient, fine, and slow, moving with extreme difficulty, irregular like rain soaking sand or a light knife scraping bamboo. It signifies Excess Qi and Deficient Blood, indicating Blood Deficiency, loss of sweat, Blood Bi pain, Jing Injury; in pregnant women, it indicates Tai Tong (Fetal Pain); in non-pregnant women, it indicates Bai Xue Bing (Failed Blood Disease). At the Left Cun position, a Se pulse indicates Heart Spirit deficiency/unrest and Cold Qi Heart Pain; at the Right Guan position, a Se pulse indicates Liver Blood Deficiency with scattering, rib/flank distension, and body pain; at the Chi position, a Se pulse indicates Jing Injury and Hernia in men, and menstrual failure in women; if pregnant, it indicates Tai Lou (Fetal Leakage). At the Right Cun position, a Se pulse indicates Ying-Wei Disharmony, Upper Jiao Cold Pi, shortness of breath, and arm pain; at the Right Guan position, a Se pulse indicates Spleen Weakness with anorexia and Cold Stomach with vomiting; at the Chi position, a Se pulse indicates difficult defecation, fluid insufficiency, lower abdominal cold, and cold lower legs/shins. (The Classics state: Slippy pulses injure with Heat; Choppy pulses are struck by Fog, Dew, Metal, and Leather.)

Chang Mai (Long Pulse) is "Bu Duan" (Not Short). It feels abundant under the finger, extending beyond its original position, indicating surplus of both Qi and Blood. It indicates internal accumulation of Yang Toxin, irritation/stagnation in the Three Jiao, and high fever.

Duan Mai (Short Pulse) is "Bu Chang" (Not Long). It lacks extremities but has a middle, failing to reach its original position, indicating Qi insufficiency to guide Blood. It indicates Yang hidden within Yin, Qi stagnation in the Three Jiao, and undigested retained food.

Da Mai (Large Pulse) is "Bu Xiao" (Not Small). Superficially it resembles Hong (Surging) and Fu (Floating); deeply it is large but forceless. It indicates Blood Deficiency where Qi cannot enter. The Classics state: Da Mai indicates disease progression.

Xiao Mai (Small Pulse) is "Bu Da" (Not Large). Both superficial and deep palpation reveal diminution. In Yang positions, it indicates Yang Insufficiency; in Yin positions, it indicates Yin Insufficiency; Front Large Back Small indicates headache and dizziness; Front Small Back Large indicates chest fullness and shortness of breath.

Jin Mai (Tight Pulse) is You Li (Forceful) but not Huan (Relaxed). It comes with vigor and urgency, feeling long when pressed, and resembling a twisted rope when lifted. It signifies Evil Wind struggling and lodging between Ying and Wei, indicating pain and Cold. Fu Jin (Floating and Tight) indicates Shang Han (Cold Damage) with body pain; Chen Jin (Deep and Tight) indicates Cold in the abdomen and Feng Xian (Wind Epilepsy). At the Left Cun position, a Jin pulse indicates Head Heat, Eye Pain, and Neck Stiffness; if Jin Er Chen (Tight and Deep), it indicates Reverse Cold Pain in the Heart; at the Right Guan position, a Jin pulse indicates Heart/Abdominal Fullness/Pain, Hypochondriac Pain/Rib Stiffness; if Jin Er Sheng (Tight and Vigorous), it indicates Whole Body Pain from Cold Damage; if Jin Er Shi (Tight and Excess), it indicates Pi Ji (Accumulations); at the Chi position, a Jin pulse indicates Waist/Leg/Umbilical Pain and difficult urination. At the Right Cun position, a Jin pulse indicates Nasal Congestion and Diaphragm Obstruction; if Jin Er Chen Hua (Tight, Deep, and Slippery), it indicates Lung Excess with Cough; at the Right Guan position, a Jin pulse indicates Abdominal Pain and Vomiting; if Jin Sheng (Tight and Vigorous), it indicates Abdominal Distension from Food Injury; at the Chi position, a Jin pulse indicates Lower Jiao Beating Pain.

Ruo Mai (Weak Pulse) is "Bu Sheng" (Not Vigorous). It is extremely deep, fine, and soft, reluctant to advance; pressing feels near cessation but not quite, lifting makes it disappear. Due to Jing-Qi insufficiency, the pulse is atrophic and weak. It indicates Yuan Qi Consumption, atrophy/weakness, chronic cold, false heat, spermatorrhea, and spontaneous sweating. Obtained by the elderly, it is favorable; obtained by the vigorous, it is adverse. At the Left Cun position, a Ruo pulse indicates Yang Deficiency with palpitations and spontaneous sweating; at the Right Guan position, a Ruo pulse indicates tendon atrophy/weakness, and in women, Postpartum External Wind with facial swelling; at the Chi position, a Ruo pulse indicates frequent urination, Kidney Deficiency with deafness, and bone/muscle soreness. At the Right Cun position, a Ruo pulse indicates cold body with aversion to cold and shortness of breath in the chest; at the Right Guan position, a Ruo pulse indicates Spleen-Stomach Deficiency with indigestion; at the Chi position, a Ruo pulse indicates Lower Jiao Cold Pain and slippery stool.

Dong Mai (Moving Pulse) resembles a soybean trembling in place; it is felt upon searching but disappears upon lifting; it does not move forward or backward, staying in its place, mostly seen at the Guan position. It indicates pain, fright, deficiency-fatigue with body pain, Beng Tuo (Collapse), and diarrhea/dysentery. Yang Dong indicates sweating; Yin Dong indicates fever.

Fu Mai (Hidden Pulse) is "Bu Jian" (Not Visible). Light pressure reveals nothing; heavy pressure finds it adhering to the bone. It signifies Yin/Yang hiding, Guan Ge (Diaphragm) obstruction, indicating accumulations, hernias, indigestion, Huo Luan, Water Qi, and Ying-Wei closure leading to Jue Ni. Found before the Guan, it is Yang Fu; found after the Guan, it is Yin Fu. At the Left Cun position, a Fu pulse indicates Heart Qi Deficiency, Spirit not guarding normally, and depression; at the Right Guan position, a Fu pulse indicates Cold Blood, waist/leg pain, and Cold Qi in hypochondria; at the Chi position, a Fu pulse indicates Kidney Cold with Essence Deficiency and Cold Pain from Hernia/Masses. At the Right Cun position, a Fu pulse indicates Qi Stagnation in the Chest and Cold Phlegm/Accumulation; at the Right Guan position, a Fu pulse indicates Masses in Zhong Wan causing pain and Spleen Stagnation; at the Chi position, a Fu pulse indicates Cold Pain below the umbilicus, Lower Jiao Deficiency-Cold, and chronic Cold in the abdomen.

Cu Mai (Interrupted Pulse) is the extreme of Yang Pulses. The pulse is rapid, occasionally stopping and then resuming. It signifies Yang Excess alone unable to harmonize with Yin, or anger causing Qi rebellion. It indicates surging Qi, mania/oppression, Blood Stasis causing mania, and stagnation of Qi, Blood, Fluids, Food, or Phlegm. Generally, prior conditions of Qi Heat and Rapid Pulse (five types) with one type of stagnation cause Cu Mai. It is not necessarily a malignant pulse; although severe cases lead to death, improvement leads to survival, thus it is formidable!

Jie Mai (Knotted Pulse) is the extreme of Yin Pulses. The pulse is slow, occasionally stopping and then resuming. It signifies Yin Excess alone unable to admit Yang. It indicates Yin Knotting, Accumulations, and Seven Emotions Depression. Fu Jie (Floating and Knotted) indicates Cold Evil stagnating in meridians; Chen Jie (Deep and Knotted) indicates accumulated Qi inside, and stagnation of Qi, Blood, Fluids, or Phlegm. Generally, prior conditions of Qi Cold and Slow Pulse (five types) with one type of stagnation cause Jie Mai. Thus, Zhang Changsha stated that Jie and Cu are both pathological pulses.

Kou Mai (Hollow Pulse) is Fu Er Da Ruan (Floating, Large, and Soft); searching reveals empty center and solid sides, with substance on the sides but void in the middle. Diagnosed between light lifting and heavy pressing, it signifies Blood Loss. Generally, it indicates Qi Excess and Blood Deficiency, where Blood cannot control Qi, resulting in a large, hollow shape like a reed stem. At the Left Cun position, a Kou pulse indicates Wild Flow of Heart Blood, manifesting as vomiting or epistaxis; at the Right Guan position, a Kou pulse indicates Blood-Qi pain in hypochondria or abdominal Blood Stasis, also vomiting and dim vision; at the Chi position, a Kou pulse indicates hematuria and menstrual disorders in women. At the Right Cun position, a Kou pulse indicates Accumulated Blood in the Chest, manifesting as epistaxis or vomiting; at the Right Guan position, a Kou pulse indicates Intestinal Abscess, Blood Stasis, vomiting blood, and anorexia; at the Chi position, a Kou pulse indicates hematochezia. It is also said: Front Large Back Thin indicates Blood Loss; how could it not be Kou Mai?

Ge Mai (Leather Pulse) is Chen Fu Shi Da (Deep, Hidden, Excess, and Large), feeling like pressing a drumhead. It signifies Qi/Blood Deficiency-Cold and deviation from normal pulse qualities. In women, it indicates miscarriage and spotting; in men, it indicates Blood Loss and Essence Loss, also serving as a diagnosis for Wind Stroke and Cold-Dampness.

Ru Mai (Soggy Pulse) is "Wu Li" (Forceless). It is deficient, soft, and forceless, responding as scattered and fine, like cotton floating in water; light pressure brings it, heavy pressure makes it go. It signifies joint Qi and Blood Insufficiency, indicating shortness of breath, Blood Deficiency, exhaustion, spontaneous sweating, Lower Cold, and Bi Syndrome. At the Left Cun position, a Ru pulse indicates Heart Deficiency with easy fright, night sweats, and shortness of breath; at the Right Guan position, a Ru pulse indicates Ying-Wei Disharmony, scattered spirit, and physical weakness; at the Chi position, a Ru pulse indicates Jing Injury in men, Blood Loss in women, frequent urination, and excessive sweating. At the Right Cun position, a Ru pulse indicates Guan Heat with aversion to cold, Qi乏 (Lack), and physical weakness; at the Right Guan position, a Ru pulse indicates Spleen Softness with indigestion and Stomach Deficiency with inability to eat; at the Chi position, a Ru pulse indicates Lower Origin Cold/Exhaustion and Intestinal Deficiency with diarrhea.

Lao Mai (Firm Pulse) is "Jian Lao" (Solid and Firm). It is deep and forceful, moving without shifting. It indicates Interior Excess and Exterior Deficiency, Qi urgency in the middle, and extreme fatigue/atrophy from overwork. Generally, this pulse approaches having no Wei Qi, so all schools consider it a critical pulse. It also indicates pain between bones, with Qi residing in the exterior.

Ji Mai (Racing Pulse) is "Sheng" (Vigorous). Faster than Shu (Rapid), it beats seven times per respiration, indicating Extreme Heat. In Yang positions, it is acceptable; in Yin positions, it is adverse.

Xi Mai (Fine Pulse) is "Wei Miao" (Subtle). Searching under the finger, it moves subtly and finely like a thread. This is due to Cold Blood and Deficient Qi failing to fill the vessels. It indicates Yuan Qi Deficiency, fatigue/lack of essence, internal/external cold, atrophy/watery diarrhea, excessive worry/work, Dampness Injury, Accumulations, and pain in the interior/lower body.

Dai Mai (Intermittent Pulse) is "Geng Dai" (Replacing). It moves, stops, cannot return on its own, resumes movement, stops again; after searching for a long time, it rises strongly again. It indicates emaciation and inability to speak. If not due to disease but the person is emaciated with a Dai Mai stop, it means one Zang lacks Qi and other Zangs compensate, signaling true danger/death. If due to disease with sudden Qi/Blood loss leading to Yuan Qi discontinuity, or in Wind/Pain cases showing stops/interruptions, it is merely a disease pulse. Thus, Shang Han practitioners also see Dai pulses with palpitations, and abdominal pain cases show irregular Jie/Se stops; do not regard them as ominous. Generally, pulses in pain cases are not reliable standards. Additionally, pregnancy may present with a Dai Mai, likely indicating a fetus of over three months, which requires no worry.

San Mai (Scattered Pulse) is "Bu Ju" (Not Gathering). It has Yang but no Yin; pressing fills the fingers, but it scatters without gathering, coming and going unclearly, with no root. It signifies Qi/Blood dissipation and Zang-Fu Qi exhaustion. In disease pulses, it indicates Floating Yang failing to consolidate and Heart Qi Deficiency; generally, it is not a favorable pulse.