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From the perspective of determining disease through pulse diagnosis: a floating pulse indicates Wind, a tight pulse indicates Cold, a deficient pulse indicates Summerheat, a soggy pulse indicates Dampness, a rapid pulse indicates Dryness, and a pulse reflecting Fire indicates Heat/Fire; these are the pulses corresponding to the six exogenous pathogens. Excessive joy damages the Heart, resulting in a scattered pulse; excessive anger damages the Liver, resulting in a tense pulse; excessive fear damages the Kidney, resulting in a deep pulse; excessive shock damages the Gallbladder, resulting in a trembling pulse; excessive thought damages the Spleen, resulting in a short pulse; excessive sorrow damages the Lung, resulting in a choppy pulse; excessive grief damages the Heart, resulting in an hurried pulse; these are the pulses resulting from injury by the seven emotions. Thus, the pulse indicates disease. (Once the disease is clearly identified, treatment decisions will naturally be determined.)

However, it all revolves around Yin and Yang, deficiency and excess as the guiding principles. Generally, if the pulse is excess, the symptoms must also be excess (distinguishing between cold-excess and heat-excess); if the pulse is deficient, the symptoms must also be deficient (distinguishing between fire-deficiency and water-deficiency). If the pulse is excess but the symptoms are not, either the symptoms are false or the pulse is false; if the pulse is deficient but the symptoms are not, either the pulse is false or the symptoms are false. For instance, although there is external vexation and heat, if the pulse is weak and faint, it must be due to Yang deficiency. Although there is abdominal distension and fullness, if the pulse is weak and faint, it must be due to Stomach Qi deficiency. How can one treat deficiency-fire or deficiency-distension as excess? In such cases, one should follow the deficiency indicated by the pulse, rather than the excess indicated by the symptoms. If the symptoms present as external cold, but the pulse is slippery and rapid, it must be false cold. If there is diarrhea with clear water, but the pulse is deep and solid, it must be false diarrhea. How can one treat false cold or false diarrhea as deficiency? In such cases, one should follow the excess indicated by the pulse, rather than the deficiency indicated by the symptoms. However, while excess patterns can have false manifestations, deficiency patterns do not have false manifestations. False excess patterns are unpredictable; one must seek other symptoms and correlate them with pulse findings to reveal the falsehood. If the pattern belongs to deficiency, the symptoms are evident. Even if there is false cold or false diarrhea, appearing superficially as deficiency, careful examination reveals that the cold is only external, while internally there are symptoms like vexation. The diarrhea of clear water occurs because dry stool is retained internally, and the water flows around it; the pulse will be slippery, rapid, and forceful, resembling excess pulse and excess symptoms. How can one say that symptoms have false deficiency, while the pulse cannot be trusted?

In all these cases, the pulse is true and without falsehood, corresponding to the symptoms. If one relies solely on the pulse for treatment without observing and identifying the symptoms, then the pulse becomes difficult to interpret. Why? Zhang Zhongjing stated: In cold damage, a floating and large pulse indicates pathogenic factors at the exterior, which can be treated with sweating methods. However, if the pulse is floating and large, accompanied by hardness below the heart and heat indicating involvement of the zang organs, purgation should be used, not sweating. This shows that a floating pulse does not always indicate exterior pathogen suitable for sweating. He also stated: A hurried pulse indicates flourishing Yang, suitable for using Ge Gen Huang Qin Huang Lian Tang. However, if the pulse is hurried accompanied by cold limbs, it indicates collapse of deficiency, requiring moxibustion and warming methods. This shows that a hurried pulse does not always indicate flourishing Yang. Furthermore, he stated: A slow pulse indicates cold, and a deep pulse indicates interior syndrome. However, in Yangming disease, if the pulse is slow but there is no aversion to cold and the body sweats, Da Cheng Qi Tang should be used. This shows that not all slow pulses indicate cold. In Shaoyin disease, if fever appears initially with a deep pulse, Ma Huang Fu Zi Xi Xin Tang should be used to induce slight sweating. This shows that a deep pulse does not always indicate interior syndrome.