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Shu Mai (Rapid Pulse) manifests as five to six beats per respiration cycle, feeling very rapid under the fingers. The Hua Mai (Slippery Pulse), Dong Mai (Pulsating Pulse), Jin Mai (Tight Pulse), and Cu Mai (Hasty Pulse) all belong to the category of Shu Mai. They do not resemble the smooth flow of the Slippery Pulse, the trembling motion of the Pulsating Pulse, nor the excessive urgency of the Ji Mai (Excessively Rapid Pulse). (This statement is from Zhang Lu. Additionally, Li Shizhen's *Binhu Maixue* states in the "Form" poem: "In each breath, the Rapid pulse often beats six times; Yin deficiency and Yang excess inevitably lead to mania and restlessness; distinguish deficiency and excess by floating and sunken, superficial and deep; only in children is it considered auspicious." In the "Similarity" poem, he adds: "The Rapid pulse beats one time more than the normal pulse; the Tight pulse resembles the Rapid but feels like a plucked string; when the Rapid pulse stops intermittently, it is named Cu Mai; when the Rapid pulse appears at the Guan position with the form of the Pulsating Pulse." He also says: "Seven beats per breath is the Ji Mai (Extreme Pulse), eight beats is Tuo Mai (Depletion Pulse), and nine beats is Jue Mai (Severed Pulse)." Shu Mai is caused by the internal struggle between cold and heat, or the impact of wind and fire. Therefore, when people see a Rapid pulse, they mostly treat it as a Heat syndrome. However, one must know that pulses have true and false distinctions, and Rapid pulses have deficiency and excess variations. It is necessary to observe accompanying symptoms and pulses, as well as whether the pulse is forceful or weak, to differentiate them. If the Rapid pulse is accompanied by Hong (Surging) and Hua (Slippery) qualities and is extremely forceful, it may indicate steaming internal heat or the activation of latent fire, and should be treated as an Excess condition. If it is fine, small, yet strong and slippery, or fine, rapid, and soft, even if there is body fever, warm treatment is required. One might guide Yang back into Yin, causing the rapidness to subside naturally; or tonify essence to transform Qi, causing the rapidness to disappear naturally; or warm the middle and release the exterior, allowing Qi to relax naturally; or disperse congestion and remove stagnation, causing the rapidness to vanish naturally. Moreover, in cases where there are no heat signs and symptoms indicate deficiency-cold, presenting a Xu (Deficient) and Rapid pulse, warm tonification might still be insufficient. How can one mistakenly use bitter-cold herbs simply because the pulse is rapid? (Zhang Jingyue said: "Interior Rapid pulses indicate heat, but true heat syndromes do not always present with a Rapid pulse. In cases of deficiency and damage, where both Yin and Yang are distressed and Qi and Blood are chaotic, such pulses are common. Lin Zhihan said: 'One must understand that Rapid pulses can indicate Cold.' For example, if the pulse is Floating, Rapid, large, and weak, and hollow upon deep pressure, this is Yin excess forcing Yang to float outward, representing false heat. Physicians who fail to examine the duration of the disease, the forcefulness of the pulse, and its pulsatory strength, indiscriminately administering cold agents, rapidly destroying Stomach Qi, should not this be feared?)"

Chi Mai (Slow Pulse) manifests as fewer than four beats per respiration cycle, feeling slow upon both light and heavy pressure. Dai Mai (Intermittent Pulse), Se Mai (Choppy Pulse), Jie Mai (Knotted Pulse), and Fu Mai (Deeply Hidden Pulse) all belong to the category of Chi Mai. They do not resemble the irregular rhythm of the Choppy Pulse or the leisurely pace of the Huan Mai (Moderate Pulse). (This statement is from Zhang Lu. Additionally, Li Shizhen's poem states: "The Slow pulse beats three times per breath; Yang fails to overcome Yin, resulting in cold Qi and Blood; distinguish superficial and deep to determine exterior and interior; eliminate Yin cold by benefiting the source of Fire." In the similarity poem, he adds: "Three beats per breath is called Slow; slightly faster than Slow is Moderate; Slow and fine and difficult to discern is Choppy; Floating, Slow, and large is inferred as Deficiency." He also says: "Two beats per breath is Bai Mai (Decayed Pulse)." Chi Mai is due to deficiency-cold failing to flourish and Yang Qi failing to circulate freely, thus appearing sluggish. If Chi Mai presents with a Floating quality, it indicates Exterior Cold; if with a Sunken quality, Interior Cold; if with a Choppy quality, Blood pathology; if with a Slippery quality, Qi pathology; if accompanied by Slippery and Large qualities, it often indicates Wind-Phlegm causing head bi-syndrome; if accompanied by Fine and Small qualities, it indicates deficiency of True Yang; if Yin-Cold accumulates internally leading to diarrhea, or Yuan Qi fails to nourish the exterior leading to chills and spasms, these are all due to Yuan Qi deficiency, and aggressive attack therapies should not be used rashly. However, there are cases where pathogenic Heat is knotted internally and Cold is constrained externally, resulting in a Slow pulse at the Qikou position; there are cases where all Yangming Fu-organ symptoms are present, yet the pulse is Slow but forceful; there are cases where Taiyang disease presents with a Floating pulse, but after mistaken purgation leads to Jie Xiong (Chest Binding), the pulse becomes Slow; and there are cases where residual heat remains unclarified, resulting in a generally Slow and sluggish pulse. The key lies in understanding the onset and termination of the pulse and observing symptoms to differentiate deficiency and excess. How can one simply identify a Slow pulse as Cold without investigating the differences in Slipperiness, Choppy nature, deficiency, and excess? (Zhang Jingyue said: "Although Slow pulses typically indicate Cold, after the initial resolution of Shanghan (Cold Damage), when residual heat remains, the pulse is often Slow and Slippery. Seeing a Slow pulse does not allow for a general conclusion of Cold. Lin Zhihan said: 'One must understand that Slow pulses can indicate Heat.' For instance, when pathogenic Heat is congested and collaterals are obstructed, losing their normal rhythm, the pulse may paradoxically become Slow. He further stated: 'Differentiating pulses requires combining them with symptom examination.' If the pulse is weak upon lifting and pressing, it indicates Cold; if forceful upon lifting and pressing, accompanied by chest/diaphragm fullness, constipation, and dark urine, it indicates Heat. The choppy/sluggish sensation is precisely due to pathogenic Heat accumulating internally, causing meridians to become sluggish and the pulse to move slowly.)