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The general classification of pulse types comprises twenty-six kinds, which serve as the outline for diagnostic observation. Analyzed in detail, even a minute discrepancy can lead to treatment deviating significantly from the correct path. In summary, it boils down to reversal and compliance, deficiency and excess, yin and yang. By deliberating on these two aspects, one grasps the essential points, carefully extracting the core principles from various schools of pulse diagnosis, deleting redundancies, and recording the refined meanings.

**Floating Pulse (Fu Mai):** The pulse is felt floating under the fingers; pressure reveals insufficiency, while light touch reveals abundance. Repeated searching shows an excessive quality, appearing suddenly between the skin and hair. It indicates exterior syndromes, wind pathogens, or deficiency. A floating, large, and scattered pulse corresponds to the Heart; a floating, short, and choppy pulse corresponds to the Lung; a floating and rapid pulse indicates heat. While a floating-rapid pulse should be accompanied by fever, if there is no fever but rather aversion to cold, it signifies carbuncles and sores (Chuang Ju).

**Surging Pulse (Hong Mai):** The pulse seems floating and large; upon both pressing and lifting, it feels broadly filling all three positions (Cun, Guan, Chi). Its appearance is like a torrent of water or rising waves. It indicates blood excess and accumulated heat leading to swelling and sores. The treatise states: A surging-large pulse indicates the progression of carbuncles and sores. If pus has formed but not yet abscessed, purgation is appropriate. After rupture, if the pulse remains surging-large, it is difficult to treat. If spontaneous diarrhea occurs, it is incurable.

**Slippery Pulse (Hua Mai):** The pulse is full, large, and slippery, flowing smoothly like pearls rolling. Pressing reveals a continuous slippery sensation. It indicates heat or deficiency, belonging to yang pulses. For carbuncles and sores, before rupture, internal resolution is suitable; after rupture, supporting the interior is suitable. This reflects the transition from initial heat to subsequent deficiency.

**Rapid Pulse (Shu Mai):** Upon pressing, the pulse beats six times or more per respiration cycle. It resembles a slippery pulse but is faster. Floating and rapid indicates exterior heat; sinking and rapid indicates interior heat. Generally, rapid pulses indicate heat. Zhang Zhongjing stated: Intermittent rapid pulses indicate the development of malignant sores. Also: A lung pulse that is surging and rapid indicates sore formation. In diagnosing sores, a surging-rapid pulse suggests impending pus accumulation.

**Scattered Pulse (San Mai):** The pulse seems floating and rapid, but upon pressing, it scatters and fades; upon lifting, it is large and forceless. It indicates qi excess and blood deficiency, with pathology involving both exterior and interior. After rupture of a sore with lingering pain, a surging-slippy-rough-scattered pulse is difficult to treat due to deficient healthy qi and excess pathogenic factors. Additionally: Heavy body combined with a large, floating-scattered lung pulse indicates death.

**Gourd Kernel Pulse (Kou Mai):** The pulse seems floating and soft; pressing reveals emptiness in the center and solidity at the edges. It indicates blood deficiency or hemorrhage. In sores, a gourd kernel pulse after rupture indicates easy treatment because the pulse matches the condition.

**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, this pulse suggests sweating will resolve the condition. A long and moderate pulse is the stomach pulse, indicating recovery from various diseases ("Long implies harmonious qi").

**Firm Pulse (Lao Mai):** Pressing reveals a solid, large, and wiry pulse, deep yet firm. In cases of scrofula or nodular swelling, a firm pulse contraindicates internal resolution methods.

**Excess Pulse (Shi Mai):** Forceful upon both light and heavy pressure, resembling a knotted pulse. Classics state: Excess indicates strong pathogens; chronic illness indicates deficiency. Obtaining an excess pulse is generally unfavorable. In carbuncles and sores, urgent purgation is needed because both pathogens and organs are in an excess state.

**Wiry Pulse (Xian Mai):** Pressing reveals tightness and wiriness, distinct from tightness by its static nature like a string, whereas tightness moves like a rope. Spring pulses are floating and wiry and considered normal; otherwise, they indicate fluid retention or pain, cold, or deficiency. In sores: Wiry and surging pulses together indicate external tightness and internal heat, signaling impending carbuncle/sores.

**Tight Pulse (Jin Mai):** Similar to wiry but tighter, feeling like cutting a rotating rope. It indicates sharp pain and accumulations. In sores, it indicates stagnant qi and blood and pain.

**Choppy Pulse (Se Mai):** Pressing reveals scattering and returning; lifting reveals thinness and insufficiency. Choppy pulse indicates stagnant qi and blood deficiency in sores. It is acceptable after rupture.

**Short Pulse (Duan Mai):** Light and heavy pressure do not reach the normal position. *Neijing* states: Short pulse indicates qi disease due to lack of stomach qi. Short pulse in any disease is difficult to treat; in sores, it indicates depletion of true qi.

**Fine Pulse (Xi Mai):** Pressing feels like a spider's thread about to break; lifting feels non-existent yet present. It is fine and subtle, indicating collapse of yang. In sores, a fine, sinking, straight pulse indicates interior deficiency and impending transformation.

**Micro Pulse (Wei Mai):** Pressing reveals a soft, small, and extremely faint pulse. It indicates deficiency. Recovery of true qi brings life; dominance of pathogens brings danger. After sore rupture, a micro and uniform pulse indicates improvement.

**Slow Pulse (Chi Mai):** Coming slowly upon lifting and pressing, beating only three times per respiration cycle. It resembles a moderate pulse but slower. In chronic diseases, it is favorable; in acute diseases, it indicates exhausted healthy qi. In sores, it indicates self-healing after rupture.

**Moderate Pulse (Huan Mai):** Feels slightly faster than slow. Zhang Zhongjing defined moderate pulse via specific combinations of yin/yang positions. Long and moderate pulses indicate healing of hundred diseases. After sore rupture, choppy-slow-moderate pulses indicate easy recovery due to matching pulse-condition and presence of stomach qi.

**Sinking Pulse (Chen Mai):** Insufficient upon lifting, visible only upon pressing, feeling like rotten cotton. It indicates pathogens in the zang organs. Water pathogens cause rebellion; it is a yin pulse. In sores, it indicates deep-seated pathogens.

**Hidden Pulse (Fu Mai):** Deeper than sinking; invisible upon lifting, felt only when pressing to the bone. Pathogens are deeper than in sinking pulse.

**Deficient Pulse (Xu Mai):** Insufficient upon pressing, slow, large, and soft; lifting feels hollow. Classics state: Deficient pulse indicates blood deficiency, cold generation, and insufficient yang qi. In sores, support the interior, harmonize qi, and nourish blood.

**Soft Pulse (Ruan Mai):** Feels like silk in water, extremely soft and thin, also called Ru pulse. It indicates weak stomach qi. In sores, tonify deficiency, drain pus, and support the interior.

**Weak Pulse (Ruo Mai):** Similar to soft but extremely faint, slow, and seemingly present. Zhang Zhongjing described it as continuous like leaking lacquer. It indicates dual deficiency of qi and blood, lacking form and spirit. Generally, sores with sinking-slow-soft-weak pulses require interior support.

**Hasty Pulse (Cu Mai):** Rapid upon pressing, with occasional stops. Zhang Zhongjing stated: Yang excess causes hasty pulse, indicating heat accumulation in the interior; purgation harmonizes it. In sores, urgent purgation is indicated.

**Knotted Pulse (Jie Mai):** Slow upon pressing, with occasional stops. Zhang Zhongjing stated: Yin excess causes knotted pulse. Classics state: Hasty and knotted pulses indicate survival; substituted pulse indicates death.

**Substituted Pulse (Dai Mai):** Regular rhythm with fixed intervals of stopping, unable to recover immediately. E.g., one stop every ten beats. It indicates qi decline and is inauspicious in all diseases. In sores, hasty and knotted pulses are difficult to treat; substituted pulse is even worse.

**Moving Pulse (Dong Mai):** Felt at the Guan position, bean-sized, trembling without head or tail. *Mai Jing* states: Interaction of yin and yang creates moving pulse. Movement in yang indicates yang deficiency and syncope; movement in yin indicates yin deficiency and fever. Differentiation is crucial.

*Mai Jue* states: Sinking-choppy-tight pulse with body pain signals impending carbuncles/sores. Fever with floating-rapid pulse but aversion to cold signals early-stage carbuncles/sores.

Zhang Zhongjing stated: Intermittent rapid pulses indicate malignant sores. Lung pulses being rapid indicates sore formation. Large-excess-surging pulses indicate disease progression initially, or unresolved pathogens after rupture. Sinking-solid/hidden pulses indicate deep pathogens initially (hard to cure) or residual toxins after rupture. Gourd-kernel/choppy/slow/moderate pulses match conditions after rupture (acceptable); short-fine pulses indicate transformation (better after rupture, bad initially). Floating-large/floating-rapid pulses indicate pathogen-host struggle initially (good); hasty/knotted pulses are inauspicious initially (bad after rupture).

Zhu Danxi stated: Rapid pulse indicates heat, often with excess (yang syndrome); if combined with deficiency, it sinks into yin. Slow pulse indicates cold, often with yin syndrome; if combined with excess, it returns to yang.

Weng Kentang stated: Sinking-solid pulse with fever/restlessness but no external redness/pain indicates deep interior pathogens; clear pathways first. Floating-large-rapid pulse with external swelling requires supporting the interior to prevent inward invasion. Non-sinking/non-floating pulse with no internal/external symptoms indicates meridian involvement; harmonize Ying and Wei. Rapid pulse without fever indicates internal abscess. Rapid pulse with aversion to cold and pain indicates impending abscess. Intermittent rapid pulses indicate malignant sores.

Regarding Sores (Zhongyang/Ulkus):
- **Floating:** Initial stage indicates deficiency/wind; ulcerated stage indicates deficiency requiring tonification.
- **Surging:** Initial stage indicates deficiency/excessive heat (clear heat/detoxify; purge if young/strong); ulcerated stage indicates excess pathogens (hard to treat if unresponsive).
- **Slippery:** Initial stage indicates heat; ulcerated stage indicates heat/deficiency/unresolved pathogens.
- **Rapid:** Initial stage indicates disease retreat/heat (surging-rapid indicates pus formation); ulcerated stage indicates difficulty healing (severe rapidity is hard to treat).
- **Scattered:** Initial stage indicates qi dispersion; ulcerated stage indicates lingering pain (surging-slippy-large-scattered is hard to treat).
- **Gourd Kernel:** Initial stage indicates blood deficiency; ulcerated stage matches condition.
- **Long:** Initial stage suitable for resolution; ulcerated stage indicates easy healing ("Long implies harmonious qi").
- **Firm:** Initial stage indicates excess pathogens/impending pus; ulcerated stage indicates unresolved pathogens.
- **Excess:** Initial stage indicates extreme excess; ulcerated stage indicates unresolved pathogens (excess type) or deficiency (if loose/large).
- **Wiry:** Initial stage indicates pain/impending pus (wiry-surging indicates external tightness/internal heat/carbuncle); ulcerated stage indicates blood deficiency/pain.
- **Tight:** Initial stage floating-tight with fever/aversion to pain indicates abscess; ulcerated stage indicates stagnant qi/blood/pain/exterior cold.
- **Choppy:** Initial stage indicates qi excess/stagnation; ulcerated stage indicates blood deficiency/matching condition.
- **Short:** Initial stage indicates insufficient primal qi; ulcerated stage indicates severe deficiency requiring tonification.
- **Micro:** Initial stage indicates deficiency (improves with medication); ulcerated stage indicates deficiency (micro-uniform matches condition).
- **Slow:** Initial stage indicates cold/deficiency (Chi position slow indicates low blood); ulcerated stage indicates deficiency/inability to nourish sores/exterior cold.
- **Moderate:** Initial stage indicates treatability (large-moderate indicates deficiency); ulcerated stage slow-choppy indicates healing (matching condition/stomach qi).
- **Sinking:** Initial stage indicates deep pathogens; ulcerated stage indicates retained toxins (Cun position sinking indicates phlegm in chest).
- **Hidden:** Initial stage indicates hidden yang pathogens in yin; ulcerated stage indicates yang hidden in yin/internal erosion/metastatic infiltration (hard to treat).
- **Deficient:** Initial stage suitable for tonification/support; ulcerated stage after pus drainage requires major blood/qi tonification.
- **Weak:** Initial stage indicates insufficient primal qi (internal support needed).
- **Knotted:** Initial stage indicates pathogen knotting; ulcerated stage regularizes then heals, irregularity indicates danger.
- **Hasty:** Initial stage indicates heat/progression; ulcerated stage persistent heat leads to death, retreating heat leads to life.
- **Substituted:** Initial stage indicates blood/qi destruction/primal qi damage; ulcerated stage indicates primal qi exhaustion.

Xue Lizhai stated: Pulse diagnosis is the manifestation of bodily vitality and disease mechanisms, serving as the physician's standard. Acupoints Taixi and Chongyang are vital for determining life and death. All twelve meridians connect to vital qi, the root of humanity. If Cun Kou pulse is normal but death occurs, vital qi is internally severed. *Nan Jing* states: Upper pulse present, lower absent, with inability to vomit, indicates death. Upper absent, lower present, indicates difficulty but not necessarily fatal harm, showing pulse roots and yuan qi. Humans receive qi from grain, transmitted to organs; clear becomes Ying (Nutrient), turbid becomes Wei (Defensive). Ying circulates in vessels, Wei outside. Yin and Yang interconnect like a circle. Disruption indicates disease. Severe disease disrupts pulse channels. Treating "Sparrow Pecking" or "House Leaking" pulses caused by harsh drugs requires immediate use of Ginseng, Angelica, Atractylodes, Ginger, and Aconite decoctions, often resulting in recovery. Do not abandon treatment.

Also stated: If carbuncles/sores have not ruptured but the pulse is already weak, how can healing occur?