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To clearly understand the pulse, one must distinguish between four characters: Exterior (Biao), Interior (Li), Deficiency (Xu), and Excess (Shi). The Exterior refers to Yang and the Fu organs. Any pathogenic factors of the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) that invade the meridians but have not yet entered the Stomach Fu or the Zang organs all belong to the Exterior. The Interior refers to Yin and the Zang organs. Any Qi stagnation caused by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) that is depressed within the heart and abdomen and cannot dissipate, as well as injuries from diet that remain between the Fu and Zang organs and cannot be unblocked and discharged, all belong to the Interior. Deficiency refers to the self-deficiency of Yuan Qi (Original Qi), with dissipation of spirit and exhaustion of qi and strength. Excess refers to the excess of pathogenic factors, which arises because the healthy qi was originally deficient, allowing pathogens to take advantage; it is not a self-excess of Yuan Qi. Therefore, for deficiency, one tonifies the healthy qi; for excess, one drains the pathogenic factors. The Classics state: "When pathogenic factors are abundant, it is Excess; when essential essence is depleted, it is Deficiency." This is the general principle.

Li Dongyuan said: In the pulse of a person without disease, one does not need to seek for Shen (Spirit); it is inherently present everywhere. In the pulse of a person with disease, one must examine whether Shen is present or absent. For instance, if the pulse is rapid (6-7 beats per breath) or extremely rapid, it indicates Heat. If there is force within the pulse, it possesses Shen, and one should drain the Heat. If the pulse is slow (2-3 beats per breath) or failing, it indicates Cold. If there is force within the pulse, it possesses Shen, and one should dispel the Cold. However, if in pulses that are rapid, extremely rapid, slow, or failing, there is no longer any force, this indicates an absence of Shen; upon what can one rely? If one does not understand this and proceeds to drain or dispel, upon what will Shen rely as its master? Thus, the Classics state: "The pulse is the precursor of Blood and Qi; Blood and Qi are the Shen of man." How true this is!

The pulse originates from Ying (Nutritive) Qi and Wei (Defensive) Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels. If the Zang and Fu organs are harmonious and Ying and Wei Qi are smooth and regulated, then the pulse has no specific shape to be discussed. However, if the Six Evils attack externally or the Seven Emotions injure internally, leading to disharmony of the Zang and Fu organs and deviation of Ying and Wei Qi, then the names and forms of the Twenty-Four Pulses will emerge layer upon layer. Therefore, Wind, Cold, Summerheat, Dampness, Dryness, and Fire constitute the Six Evils. Regarding the pulses of external injury by the Six Evils: Floating (Fu) indicates Wind, Tight (Jin) indicates Cold, Empty (Xu) indicates Summerheat, Fine (Xi) indicates Dampness, Rapid (Shu) indicates Dryness, and Full (Hong) indicates Fire. All of these allow one to distinguish external pathogenic factors through the pulse. Joy, Anger, Worry, Pensiveness, Sorrow, Fear, and Fright constitute the Seven Emotions. Regarding the pulses of internal injury by the Seven Emotions: Joy injures the Heart, resulting in a Slow/Relaxed (Huan) pulse; Anger injures the Liver, resulting in a Wiry/Tense (Ji) pulse; Fear injures the Kidney, resulting in a Deep (Chen) pulse; Sorrow consumes Qi, resulting in a Short (Duan) pulse; Fright causes Qi chaos, resulting in a Startled/Moving (Dong) pulse. All of these allow one to differentiate internal injuries through the pulse. However, this merely cites the normal patterns where the pulse corresponds to the disease.

If discussing variations, there are cases where the pulse does not correspond to the disease, or the disease does not correspond to the pulse, with hundreds of variations arising, making it difficult to rely solely on the pulse. Let us cite a few examples. Zhang Zhongjing stated: "A floating and large pulse indicates the pathogen is at the Exterior, and sweating is indicated." But if the pulse is floating and large, accompanied by hardness below the heart and heat belonging to the Zang organs, purgation is indicated, not sweating; this is not a pulse indicating exterior pathogen suitable for sweating. He also stated: "A Cuo (Surging/Irregular) pulse indicates Yang Excess, and Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) is appropriate." But if the pulse is Cuo accompanied by cold limbs, it indicates collapse of Deficiency, requiring moxibustion and warming; this is not a pulse indicating Yang Excess. Furthermore: "Slow pulse indicates Cold, Deep pulse indicates Interior." But if the Yangming channel presents a Slow pulse, without aversion to cold, and with sweating of the body, Da Chengqi Tang (Major Order the Qi Decoction) is used; this shows not all Slow pulses indicate Cold. If Shaoyin disease begins with fever and a Deep pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is used for sweating; this shows not all Deep pulses indicate Interior. These are clear proofs that the pulse cannot be relied upon exclusively. If one relies only on the pulse without asking about symptoms, one may mistake Cold for Heat, Exterior for Interior, and Yin for Yang, leading to confusion and premature death. Thus, ancient physicians did not rely solely on the pulse but combined it with careful examination of symptoms, which is justified.

Alas, people today do not understand this. Often, they hide their illness and do not speak of it, testing the doctor's ability solely through pulse diagnosis. If the doctor's pulse reading happens to hit the mark, they regard him as a good doctor and entrust themselves completely, revealing nothing about the root cause of the disease and examining neither the appropriateness of the medication. They simply submit to the doctor's orders, delaying until death, yet still fail to realize this, which is truly pitiable. It is no wonder that vulgar people, who never loved learning, act this way. However, it is regrettable that scholars and officials in recent times also succumb to this habit, which is even more laughable. Stability, tranquility, peace, deliberation, investigating things to extend knowledge—these are the primary principles of the first chapter of *The Great Learning*. "Deliberation" means considering matters with precision; "Investigating things" means exhausting the principles of affairs; "Extending knowledge" means pushing one's understanding to the limit. Students of medicine must devote themselves to these aspects. Former sages also said that sons must know medicine; leaving a sickbed patient to a quack is worse than being unfilial. Observation, Listening/Smelling, Inquiry, and Palpation are the major procedures of medicine. If, when facing a patient, one considers only palpation as skillful and neglects the other three, how can one claim to know medicine? How can one claim to handle matters precisely? How can one claim to exhaust principles and extend knowledge?

Moreover, a good physician is not defined solely by skill in pulse diagnosis. One must have regular conduct, proper demeanor, a loyal and sincere mind, pure and honest speech, detailed and prudent observation of disease, and precise and dedicated prescription. Only by combining these qualities can one be called a good physician. Although inferring symptoms from the pulse may sometimes be slightly inaccurate, since one pulse type does not correspond to only one disease, the inference may not always be exact. To discard a physician because of this would be like discarding a general defending the state over two eggs; such thinking cannot be shared with the wise. Taking the Floating pulse as an example, the *Mai Jing* (Pulse Classic) states that Floating indicates Wind, Deficiency, Qi rebellion, vomiting, syncope,痞 (Pi - stuffiness), distension, fullness with loss of appetite, Heat, internal binding, etc., covering dozens of diseases. If a Floating pulse is diagnosed, how can one determine the specific disease? Without combining Observation, Listening/Smelling, and Inquiry, attempting to identify the disease accurately is extremely difficult. The ancients placed Palpation after Observation, Listening/Smelling, and Inquiry because the condition was already understood during those steps; palpation was merely to verify if the pulse matched the condition. If the pulse matches the disease, the prognosis is good and treatment is easy; if the pulse contradicts the disease, the prognosis is poor and treatment is difficult. The purpose of using the pulse to cross-reference the disease is thus clear; why elevate pulse diagnosis alone as the supreme method? The *Mai Jing* earnestly teaches diagnostic methods, yet opens with observing form and color, comparing them to decide life and death. This shows that Observation, Listening/Smelling, Inquiry, and Palpation are indispensable. Alas! The world claims Wang Shuhe excelled most in pulse diagnosis, yet he still relied on cross-referencing. How much more so for those inferior to him! Therefore, relying solely on palpation to diagnose disease inevitably leads to error; how can such a person be a good physician?

Furthermore, some people use *Tai Su Mai* (Great Origin Pulse) to predict nobility, poverty, success, or failure. This is extremely absurd. I have examined its meaning. "Tai" means beginning or origin, as in Taiji or Taiyi. "Su" means substance or origin, as in "white silk follows painted patterns." This supposedly refers to the pulse of initial essence. What kind of pulse is this? It must refer to Yuan Qi. Li Dongyuan said: Yuan Qi is another name for Stomach Qi. The pulse of Stomach Qi, as described by Cai Xishan, is neither too long nor short, neither sparse nor rapid, neither large nor small, feeling harmonious and moderate, with a sense of vitality, indescribable in words. Healthy people possess this pulse. Using it to detect health or disease is acceptable, but using it to determine wealth or status is not. Why? Because the Stomach Qi pulse is indescribable; what basis is there for diagnosing status? Observing the book, although named *Tai Su*, the text never mentions the meaning of "Tai Su." The rhymes are mostly vulgar and lack logical interest. Its original intent was likely just a pretext for profit. Later generations, unaware, copied it, and no one corrected it. Some argue: "Tai Su" refers to destiny determined at birth, but the pulse itself is not named Tai Su. I say: True, but the pulse diagnosed by Tai Su practitioners must fall within the Twenty-Four Pulses. Since all Twenty-Four Pulses indicate disease, seeing one pulse indicates one disease; how can wealth or status be detected? If it is a Floating pulse, diagnosed as Wind, would a Tai Su practitioner say it is Wind or say it indicates status? They cannot do both. If they say it is Wind, they only know disease. If they ignore disease to talk of status, they cannot even know the disease close to the body, let alone distant matters. Status and fortune are external to the body and unrelated to blood and qi; how can they be known by pulse? Moreover, pulses change constantly, and seasons vary, so pulses differ by season and are not static. A pulse found today may differ tomorrow; a spring pulse may differ in summer. Tai Su practitioners judge a lifetime's fortune based on a moment's palpation, which is unreasonable. Even if they guess correctly occasionally, it is grasping at shadows, vague and uncertain. Alas! If one cannot even accurately diagnose disease through pulse, let alone know other things. Pulse studies originated with Qibo and Huangdi, developed by Qin Yueren, and detailed by Wang Shuhe. Examining *Suwen*, *Nanjing*, and *Mai Jing*, there is not a single word on this. It is not hidden; it is simply factually impossible. Chao Yuanfang said: Tai Su practitioners were skilled physiognomists who borrowed the name "Tai Su" to mystify their art. This is true and dispels worldly confusion. Others who spy and probe to deceive are even lower and unworthy of discussion.

Although humans are born with varying degrees of clarity and turbidity from Heaven and Earth, those with clear constitution have clear blood and qi, and thus a clear pulse: round, clean, and distinct in rhythm. Diagnosing this, I can only infer wealth and status, but cannot know specific years of promotion or wealth. Those with turbid constitution have turbid blood and qi, and thus a turbid pulse: unclear form and chaotic rhythm. Diagnosing this, I can only infer poverty and low status, but cannot know specific years of misfortune. There are those with turbid form but clear pulse (clarity within turbidity) and clear form but turbid pulse (turbidity within clarity). There are also those whose form is neither very clear nor very turbid, with pulse positions and sizes balanced, indicating stability without great gain or loss. Other details are left for students to deduce. My understanding of people is based ten percent on reason; I dare not fabricate stories to deceive. I wrote this treatise because everyone praises *Tai Su Mai*, unable to analyze it logically, and even praising it falsely. Even if wrong, they cover for it, misleading themselves and others. What benefit is there? Also, patients often do not state their suffering, remaining silent even when asked, hiding secret ailments that confuse the doctor. The doctor is confused, and the patient suffers. These are common faults. I discuss them in detail to awaken the ignorant. Mencius said: "Do I enjoy debating? I am compelled to do so."