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The floating pulse (Fú Mài, Floating Pulse) belongs to Yang and indicates exterior syndromes; the slow pulse (Chí Mài, Slow Pulse) indicates wind or cold pathogens, the rapid pulse (Shuò Mài, Rapid Pulse) indicates heat, and the tight pulse (Jǐn Mài, Tight Pulse) indicates cold constraint. A floating pulse that is forceful often indicates wind-heat, while a floating pulse that is forceless indicates blood deficiency.

When the pulse is felt above the skin, it is called the floating pulse, which corresponds to Yang and the Metal element in the Five Phases. The disease location is in the exterior. In thin individuals, if the floating pulse is consistent between both hands, it is due to thin muscle tissue. In obese individuals, the appearance of this pulse invariably indicates illness.

The deep pulse (Chén Mài, Deep Pulse) belongs to Yin, submerging like accumulated water; the rapid pulse indicates heat, the slow pulse indicates cold, the slippery pulse (Huá Mài, Slippery Pulse) indicates phlegm-fluids, a deep pulse that is forceless indicates deficiency and Qi deficiency, and a deep pulse that is forceful indicates cold accumulation combined with excess pathogens.

When the pulse is felt below the muscle layer, it is called the deep pulse, which corresponds to Yin and the Water element in the Five Phases. The disease location is in the interior. In Taiyang disease (Exterior Syndrome), if both hands present a deep and choppy pulse, it is difficult to treat. If a healthy person presents a deep and choppy pulse, it indicates a lack of Yang Qi, leading to a short lifespan and infertility.

The slow pulse primarily indicates Zang organ diseases or phlegm-turbidity stagnation; one must carefully examine for chronic conditions or mass formations. A slow pulse that is forceful indicates cold pain, while a slow pulse that is forceless definitively indicates deficiency-cold.

During one exhalation and inhalation of the physician, if the pulse beats three times, it is termed the slow pulse. It belongs to Yin, indicating Yang deficiency and cold patterns. If it beats two or once, it is even slower and indicates an untreatable condition. Irregular alternations of slow and rapid rates indicate deficient fire.

The rapid pulse belongs to Yang, which is self-evident, but one must further deduce the excess or deficiency within it. A rapid and deep-small pulse suggests damage to the Spleen and Kidney; for Lung diseases in late autumn, a rapid pulse is also unfavorable.

During one exhalation and inhalation of the physician, if the pulse beats six times, it is termed the rapid pulse. It belongs to Yang, indicating Yin deficiency and heat patterns. If it beats seven or eight times, it is even more rapid and indicates an untreatable condition. However, in infants with pure Yang Qi, a rate of seven to eight beats per respiration is a normal pulse and not considered pathological.

The slippery pulse is often caused by declining Stomach Qi; internal generation of phlegm-dampness and food stagnation can all lead to this pulse. Upper Jiao manifestations include vomiting and regurgitation, while lower Jiao manifestations include blood retention. In women, if no other discomfort is present, this pulse often predicts pregnancy.

A pulse that comes round, smooth, and forceful, rotating like a pearl and slipping away, is called the slippery pulse. It belongs to Yin within Yang and corresponds to the Earth element. It indicates excess patterns, accumulation of essence, and decline of Yang Qi. If the slippery pulse contracts and the pulse shape is clear, it indicates excess (excess pathogen); if the slippery pulse is irregular (three or five beats out of rhythm) and the pulse shape is turbid, it indicates phlegm-dampness. For women, a slippery pulse requires consideration of pregnancy; if only one hand presents a solitary slippery pulse, one must guard against hemiplegia.

The choppy pulse arises from blood deficiency or essence injury, manifesting as gastric inversion, collapse of Yang, and profuse sweating. Cold-dampness invading the Ying level causes blood bi; in women, unless pregnant or ill, it indicates amenorrhea.

A pulse that is irregular, resembling a diseased silkworm eating leaves or a light knife scraping bamboo skin, being both short and difficult, is called the choppy pulse. It belongs to Yin and corresponds to the Metal element. It indicates blood exhaustion, essence depletion, night sweats, heart pain, and numbness. If a healthy person presents a choppy pulse, it indicates insufficiency of the True Yuan.

The tight pulse results from heat constrained by cold, indicating pain, sores, and poisoning. Experts consider a tight and fine pulse to indicate hernia and mass formations; a tight and deficient-large pulse indicates insufficiency of Shen Qi.

A pulse that comes and goes with force, tight and urgent like a twisting rope, snapping against the fingers on both sides, is called the tight pulse. It represents the struggle between Yin and Yang. It indicates cold, pain, tendon spasms, sores, and toxins. One might ask why the tight pulse is not merged with the rapid or slow pulses? The answer is: slow and rapid are described by frequency, while tight and relaxed are described by morphology; their distinctions are far-reaching.

The relaxed pulse (Huǎn Mài, Relaxed Pulse) is caused by decline of Ying Qi and insufficiency of Wei Qi; deficiency generates dampness, which in turn generates wind. However, seeking Shen Qi within the pulse lies in its leisurely and harmonious nature.

A pulse that feels scattered upon pressure, like a lute string left unadjusted for a long time, loose and disordered, is called the relaxed pulse. It belongs to Yin and corresponds to the Earth element. It indicates deficiency of disease, wind pathogens, exterior deficiency, damp-bi, and blood deficiency. If it is moderate in floating and sinking, and leisurely and uniform, it is the normal pulse of the Spleen.

The small pulse (Xiǎo Mài, Small Pulse) is continuous like silk, unceasing in floating and sinking. It is unfavorable for youths in Spring and Summer, but suitable for the elderly and weak in Autumn and Winter.

A pulse shape half the size of a normal person's is called the small pulse. It belongs to Yin and indicates disease deficiency. A small and urgent pulse warns of hernia and masses; fluctuating size indicates relapse from overexertion. If a healthy person has small pulses in both hands that flow smoothly up and down, it indicates a pure constitution and is not pathological.

The large pulse (Dà Mài, Large Pulse) does not indicate Yang excess but rather blood deficiency; blazing ministerial fire indicates heat diseases. A full pulse accompanied by stomach Qi rebellion requires early treatment; collapse of Yin causing cough and dysentery is also distressing.

A pulse shape double the size of a normal person's is called the large pulse. It belongs to Yang. If both hands move freely up and down, it indicates a robust constitution and is not pathological. If the pulse becomes large only after contracting disease, or suddenly becomes large after a long illness, it indicates excess pathogens. The Classics state: "Large indicates disease progression." It also states: "Emaciated form with long pulse and excessive Qi leads to death," which refers to this phenomenon.

The knotted pulse (Kōu Mài, Knotted Pulse) is floating, large, soft, and loose; it disappears upon pressing, seeming to sink into the center. It indicates loss of blood, seminal emission, and night sweats, where True Yin fails to support, allowing false Yang to follow.

A pulse that is floating, large, and soft, becoming faint and near-extinction upon heavy pressure, is called the knotted pulse. It represents Yin departing and Yang remaining, a sign of blood collapse. It primarily indicates upper and lower hemorrhage, seminal emission, and night sweats.

"Knotted" refers to the onion bulb (*Allium fistulosum*). This term does not appear in the *Su Wen*. Liu Sandian said: "What does the knotted pulse resemble?" It is very much like an onion bulb; under the fingers, it forms a cavity, having edges but no center. The *Mai Jing* also states: "Empty in the center, solid on both sides." To say it is empty and lacking in the center implies a lack of Stomach Qi; how can it be said that those with chronic diseases survive and those with acute diseases die?

The wiry pulse (Xián Mài, Wiry Pulse) is long and tense. Both the Jia and Yi meridians (Liver and Gallbladder) are affected. Symptoms include fluid retention, phlegm, cold, and heat, varying greatly. If Stomach Qi is absent, death is feared.

A pulse that is straight and long, prominent under the fingers, feeling like pressing a lute string, is called the wiry pulse. It belongs to Yang within Yin and corresponds to the Wood element. It indicates Liver disease, Shaoyang cold, flowing fluids, and pain. A wiry and激 (agitated) pulse indicates anger; a wiry and large pulse indicates deficiency; alternating slow and rapid rates indicate malaria. Hard and urgent like a newly strung bowstring indicates absence of Stomach Qi; if accompanied by anorexia, Earth is overcome by evil, making it difficult to treat.

The hidden pulse (Fú Mài, Hidden Pulse) feels as if lost, never without cause. It indicates alternating vomiting and diarrhea, frequent abdominal pain, shortness of breath, retained phlegm, and food stagnation. These nuances must be recognized accurately.

A pulse that is felt only when pressing heavily to the bone is called the hidden pulse. It belongs to Yin and corresponds to the Water element. It indicates accumulations, hernias, shortness of breath, depression, cholera, and severe abdominal pain. A hidden and rapid pulse is described as heat-jue, though this is rarely seen; even if seen, cold-cooling herbs should not be rashly used. A hidden, slow, and choppy pulse indicates extreme Yin and impending extinction of Yang.

The reason for the intermittent pulse (Zhǐ Mài, Intermittent Pulse) need not be guessed; it arises from fluids, phlegm, Qi, blood, and food. Intermittence at a rapid rate indicates consumption of Yin; intermittence at a slow rate indicates danger to True Yang.

A pulse that is either rapid or slow, pausing occasionally before resuming, is called the intermittent pulse. It is a sign of sudden damage to Yin and Yang. When Yang is extreme and Yin cannot harmonize, there is intermittence at a rapid rate. When Yin is excessive and Yang cannot enter, there is intermittence at a slow rate. Ancient texts named these Cu (Surging/Intermittent) and Jie (Knotted/Intermittent). Gradual regression indicates survival; gradual progression indicates death. Zhang Zhongjing stated that Cu and Jie are both pathological pulses, implying they are close to death. How can one argue that slow intermittence indicates masses and cold, while rapid intermittence indicates Qi stagnation, abscesses, mania, and anger?

The soggy pulse (Rú Mài, Soggy Pulse) indicates decline of True Qi of Yin and Yang. Damp-phlegm and cold-diarrhea mutually destroy each other. Frequent fright and sweating lead to mental exhaustion; how can life endure such conditions?

A pulse that is extremely soft, fine, and thread-like, appearing as if present but actually absent, is called the soggy pulse. It is a sign of mutual damage to Yin and Yang. It indicates dampness invasion, spontaneous sweating, cold, bi-syndrome, and terror. Seeing this pulse in the elderly after illness is favorable; seeing it in healthy youths is unfavorable.

The restless pulse (Zào Mài, Restless Pulse) rises to the skin, coming vigorously and receding slowly, accelerating then slowing. It suggests apparent excess but true deficiency, with disharmony of Yin and Yang leading to severe illness.

A pulse that varies between large and tight, with unpredictable speed, is called the restless pulse. It belongs to Yang within Yin and Yin within Yang. It indicates pain, fright, alcohol intoxication, violent anger, and trauma. Relapse from overexertion depletes essence and blood; heat occupies the interior, cold affects the exterior, and Yin-Yang disharmony produces this pulse. If a healthy person obtains it, their nature will likely be inferior. After sweating or purging, fever, irritability, thirst, and a restless pulse are difficult to treat. Although the *Mai Jing* covers many methods, it omits the restless pulse. Perhaps it is implied that wiry, tight, flooding, and rapid pulses are all types of restlessness.

Of the above sixteen pulses, although simplified from complexity to unity, there are vast differences within this simplicity and precision that cannot be fully detailed here. I briefly describe several to illustrate the rest. For example, floating indicates the exterior; however, in cases of Yin deficiency, the pulse is necessarily floating, large, and forceless. How can one generally speak of the exterior and use dispersing methods? Deep indicates the interior; however, when exterior pathogens are initially severe, cold constrains the skin and hair, preventing Yang Qi from reaching the exterior, so the pulse first appears deep and tight. How can one generally speak of the interior and use attacking methods internally? Slow indicates cold; however, after Taiyang disease subsides, residual heat may remain. Although the pulse is slow, its shape may carry slipperiness. How can one generally speak of cold and use warming methods for the Middle Jiao? Rapid indicates heat; however, in deficiency syndromes, where Qi and blood are chaotic, the pulse must be rapid and restless. The more rapid, the more deficient; the more deficient, the more restless. How can one generally speak of heat and use cooling/descending methods? Soggy and small pulses certainly indicate deficiency, yet in cases of extreme pain and obstruction, such pulses occasionally appear; can one suddenly tonify? Wiry and hidden pulses resemble excess, yet in cases of severe True Yin deficiency, blockage occurs beyond normal limits; can one suddenly reduce/draining?

Furthermore, floating pulse indicates the exterior, and treatment should ideally involve sweating; this is the norm. Yet there are cases suitable for purging. Zhang Zhongjing said: "If the pulse is floating and large, the epigastrium is hard, and heat belongs to the Zang organs, attack it without inducing sweating." Deep pulse indicates the interior, and treatment should ideally involve purging; this is the norm. Yet there are cases suitable for sweating. In Shaoyin disease, upon initial onset, if there is fever and a deep pulse, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) is used to induce slight sweating. For rapid pulses, Ge Gen Qin Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) is commonly used to clear heat; if rapid with cold extremities indicating collapse, moxibustion and warming are indispensable, disregarding the notion that rapid indicates Yang excess. For slow pulses, Gan Jiang Fu Zi (Dried Ginger and Aconite) is commonly used to warm; if the Yangming pulse is slow, without aversion to cold, with body sweating, Da Cheng Qi Tang (Major Order the Qi Decoction) is used, disregarding the notion that all slow pulses indicate cold. In Yang excess cases, people know the pulse is floating and large; at its extreme, it反而 hides. This is like the top line of Qian hexagram: "Arrogant dragon will have cause to repent." In Yin deficiency cases, people desire the pulse to be soggy and small; at its extreme, it反而 becomes restless and rapid. This is like the top line of Kun hexagram: "Dragons fight in the wild." In Lung disease obtaining a Liver pulse, although it is "I control slight evil," the decline of the primary organ can be predicted. The Classics state: "When Qi is insufficient, what one normally controls lightly insults [the controller]." In Heart disease obtaining a Kidney pulse, one knows it is a hostile pathogen overcoming me, yet the Classics also mention the theory of Qi deficiency attracting pathogens. All such cases are supplementary to the main entries, possessing their own principles. If one acts recklessly without consulting the Four Diagnostic Methods, overturning the patient's fate would happen in the flip of a hand. Regarding the minute details of Cun, Guan, and Chi positions, attempting to determine hundreds of Zang-Fu diseases, how can the errors be enumerated?