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The manifestations of syndromes are diverse and difficult to discern, so attempting to fully grasp their mechanisms solely through the three fingers (cun, guan, chi) is extremely difficult. As the saying goes, "Clear in mind, yet unclear under the fingers." This is a statement born of deep personal experience and an unwillingness to deceive oneself. Although pulse qualities vary endlessly, there are indeed immutable principles regarding the reflection of Yin-Yang (Yin and Yang), exterior-interior (Biao-Li), cold-heat (Han-Re), and deficiency-excess (Xu-Shi) under the fingers. Through profound contemplation, even spirits will understand it.

The first method is "classifying similarities to clarify resemblance" (Bi Lei Yi Xi Qi Si). This clarifies pulses with similar characteristics by comparing their categories to merge observations, and distinguishing their differences to separate them, thereby minimizing diagnostic uncertainty. For instance, Chi (Slow) and Huan (Moderate) pulses seem similar, but Chi pulse beats three times per respiration and is small and weak; Huan pulse beats four times per respiration and is large and leisurely. Chen (Deep) and Fu (Profound) pulses seem similar, but Chen pulse is imperceptible on light pressure and palpable only on heavy pressure; Fu pulse is imperceptible even on heavy pressure and requires pushing the tendons to bone to be felt. Shu (Rapid), Jin (Taut), and Hua (Slippery) pulses seem similar, but Shu pulse is rapid and urgent, beating six times per respiration; Jin pulse beats against the fingers from both sides, resembling a cut rope; Hua pulse flows smoothly, like a round pearl. Fu (Floating), Xu (Deficient), and Kou (Hollow) pulses seem similar, but Fu pulse is abundant on light pressure and deficient on heavy pressure; Xu pulse is slow and large on light pressure but disappears on heavy pressure; Kou pulse is visible on both light and heavy pressure but absent on medium pressure. Ru (Soggy) and Ruo (Weak) pulses seem similar, but Ru pulse is fine, soft, and floating; Ruo pulse is fine, minute, and deep. Wei (Minute) and Xi (Fine) pulses seem similar, but Wei pulse is weaker than Fine, seeming present yet absent, like a spider's thread; Xi pulse is slightly stronger than Minute, extremely fine upon contact, like a single thread. Xian (Wiry) and Chang (Long) pulses seem similar, but Xian pulse resembles a bowstring, straight and stiff, striking the fingers; Chang pulse resembles a long pole, extending beyond its normal position but not striking the fingers. Duan (Short) and Dong (Moving) pulses seem similar, but Duan pulse is a Yin pulse, without head or tail, arriving sluggishly; Dong pulse is a Yang pulse, without head or tail, arriving rapidly and slippery. Hong (Surging) and Shi (Full) pulses seem similar, but Hong pulse resembles floodwater, vast and filling the fingers, slightly reduced on heavy pressure; Shi pulse is solid and full, forceful upon contact, whether light or heavy pressure. Lao (Firm) and Ge (Leather-like) pulses seem similar, but Lao pulse is solid, large, and wiry, holding its position firmly; Ge pulse is empty, large, floating, and wiry, with internal emptiness and external tension. Cu (Crisis), Jie (Knotted), Se (Choppy), and Dai (Intermittent) pulses seem similar, but Cu pulse is rapid with occasional pauses; Jie pulse is knotted, with occasional pauses in a slow rhythm; Se pulse is slow, short, and choppy, pausing with each beat, irregular in rhythm; Dai pulse stops during movement and cannot recover spontaneously, with regular intervals between pauses, unlike occasional stops.

The second method is "contrasting opposites to clarify opposing pulses." This allows one to comprehend one principle through another, preventing confusion between Yin and Yang. For example, Fu (Floating) and Chen (Deep) represent the ascending and descending of the pulse. They are used to examine Yin-Yang and distinguish exterior-interior; Fu corresponds to Heaven, being light and clear; Chen corresponds to Earth, being heavy and turbid. Chi (Slow) and Shu (Rapid) represent the urgency and slowness of the pulse. A healthy pulse beats four times per respiration; if five beats are seen, it indicates robust form and qi, or perhaps a sigh causing an extra beat (five beats), which is a sign of health. Fewer than four beats is Slow, indicating Yin and disease in the Zang organs; more than four beats is Rapid, indicating Yang and disease in the Fu organs. A Rapid pulse in the upper position is Yin within Yang; in the lower position, it is Yang within Yin. A Slow pulse in the upper position is Yin within Yang; in the lower position, it is Yang within Yin. Xu (Deficient) and Shi (Excess) pulses represent the rigidity and flexibility of the pulse. Both depend on internal excess or deficiency, so they must be assessed through pressing. Chang (Long) and Duan (Short) pulses represent the fullness and contraction of the pulse. Chang pulse may appear in the Cun and Chi positions or span all three positions; Duan pulse appears only in the Cun and Chi positions. One must consult the middle position to know this. Extending beyond the middle is Long; falling short of the middle is Short. Hua (Slippery) and Se (Choppy) pulses represent the patency and stagnation of the pulse. The *Qian Jin Fang* states: "Slipperiness indicates abundant blood and scarce qi; because blood is abundant, it flows smoothly. Choppy nature indicates abundant qi and scarce blood; because blood is scarce, it is difficult and scattered." Hong (Surging) and Wei (Minute) pulses represent the prosperity and decline of the pulse. When blood is hot and excessive, qi overflows with it, making the pulse feel vast and surging, thus Hong represents prosperity. When qi is deficient and cold, blood becomes stagnant, feeling fine upon contact, on the verge of disappearing but not quite, thus Wei represents decline. Jin (Taut) and Huan (Moderate) pulses represent the tension and relaxation of the pulse. Jin pulse results from cold injuring Ying Blood, causing vessel spasms, like wind rising and water surging, or cutting a rope. Huan pulse results from wind injuring Wei Qi, causing Ying Blood to stagnate and move slowly. If a Rapid pulse appears at the Guan position, shaped like a bean, trembling distinctly, differing from other positions, it is a Dong (Moving) pulse. Deeply hidden internally, not visible, located beneath the tendons, is a Fu (Profound) pulse. Jie (Knotted) and Cu (Crisis) pulses reflect Yin and Yang. Extreme Yang leads to Cu pulse: rapid with occasional stops. Extreme Yin leads to Jie pulse: slow with occasional stops. However, the eight pulses—Dai, Lao, Xian, Ge, Kou, Ru, Xi, and Ruo—cannot simply be paired. The *San Yin Fang* lists them as pairs, failing to recognize that since they do not strictly follow a Yin-Yang pairing, forcing such connections is arbitrary. Classics state: Large front and small back, small front and large back. Fast arrival and slow departure, slow arrival and fast departure, weak departure but strong arrival. Suddenly large, suddenly small; suddenly long, suddenly short; suddenly rapid, suddenly sparse. These are cases where two pulses appear together, which must be known.

The third method is "distinguishing combined pulses" (Bian Jian Zhi Zhe). This clarifies mutually interacting pulses. Generally, a single pulse presenting as a syndrome is rare; multiple pulses combining to form a syndrome is common. Taking a few examples for illustration: Similarities to Chen and Fu, combined with Shi, Da, Xian, and Chang, constitute the syndrome of Exhaustion (Lao Ji); combinations of Ruan, Fu, and Xi constitute Ru pulse. Combining multiple pulse shapes into one syndrome: Fu and Huan combined indicate Numbness (Bu Ren); Fu and Hua combined indicate Fluid Retention (Yin); Fu, Hong, Da, and Chang combined indicate Wind Vertigo and Epilepsy (Feng Xuan Dian Ji). There are dual-combination pulses and triple/quadruple-combination pulses. However, many diseases also arise from a single pulse appearing alone. For instance, Fu pulse can indicate Wind, Deficiency, or Qi disturbance; this is a case of one pulse corresponding to multiple syndromes.

The fourth method is "examining healthy pulses to determine norms" (Cha Ping Mai Yi Ding Qi Chang). This clarifies the normal pulse of each channel to treat those without illness. Without mastery, there is a risk of misdiagnosing health as disease and prescribing incorrectly. For example: Foot-Jueyin Liver pulse is Xian, Xi, and Chang; Foot-Shaoyin Kidney pulse is Chen, Shi, and Hua; Foot-Taiyin Spleen pulse is Chen, Ruan, and Huan; Foot-Shaoyang Gallbladder pulse is Xian, Da, and Fu; Foot-Yangming Stomach pulse is Fu, Chang, and Huan; Foot-Taiyang Bladder pulse is Hong, Hua, and Chang; Hand-Shaoyin Heart pulse is Hong, Da, and San; Hand-Taiyin Lung pulse is Fu, Se, and Duan; Hand-Jueyin Pericardium pulse is Fu, Da, and San; Hand-Shaoyang Sanjiao pulse is Hong, Da, and Ji; Hand-Yangming Large Intestine pulse is Fu, Duan, and Hua; Hand-Taiyang Small Intestine pulse is Hong, Da, and Jin.

The fifth method is "aligning with seasons to observe changes" (Shun Shi Ling Zhe). The appearances differ according to the season, and the pulse responds accordingly. From Great Cold (Da Han) in December to Spring Equinox (Chun Fen) in February is the First Qi, governed by Jueyin Wind-Wood. The Classic says: "When Jueyin arrives, its pulse is Xian (Wiry)." From Spring Equinox to Minor Fullness (Xiao Man) is the Second Qi, governed by Shaoyin Sovereign Fire. The Classic says: "When Shaoyin arrives, its pulse is Gou (Hooked)." From Minor Fullness to Great Heat (Da Shu) in June is the Third Qi, governed by Shaoyang Minister Fire. The Classic says: "When Shaoyang arrives, its pulse is Da (Large) and Fu (Floating)." From Great Heat to Autumn Equinox (Qiu Fen) in August is the Fourth Qi, governed by Taiyin Wet-Earth. The Classic says: "When Taiyin arrives, its pulse is Chen (Deep)." From Autumn Equinox to Light Snow (Xiao Xue) in October is the Fifth Qi, governed by Yangming Dry-Metal. The Classic says: "When Yangming arrives, its pulse is Duan (Short) and Se (Choppy)." From Light Snow to Great Cold in December is the Sixth Qi, governed by Taiyang Cold-Water. The Classic says: "When Taiyang arrives, its pulse is Da (Large) and Chang (Long)."

The sixth method is "examining True Zang pulses" (Cha Zang Mai). This clarifies untreatable pulses and predicts life expectancy. Arriving and not returning, like flowing water; stopping and not rising, like an overturned cup. If in the Lung, it is faint above and severed below, rootless and desolate. If in the Kidney, it scatters and departs, unable to store, departing like untying a knot, arriving with a snapping motion, expelling all stored essence, arriving like throwing stones. In the Mingmen (Gate of Life) right kidney and left kidney, it is the same, but containing Minister Fire, so upon death, there is a sudden jump in stillness, like a shrimp swimming or fish gliding, a phenomenon of fire about to extinguish flaring up suddenly. If in the Bladder, it floods uncontrollably, rushing like a spring, because it stores fluids and serves as the official of the capital, its dying form is thus. These six aspects are critical points in pulse diagnosis. Scholars who study diligently based on these images will achieve skill through practice, bringing healing power through the three fingers. Those who do not examine reality but merely attempt to depict forms will spoil cleverness with clumsiness, which is laughable. Pulse theory is profound and subtle; it must be understood intuitively. It cannot be sought through words, nor can it be fully captured by diagrams? Pulses like Fu/Chen, Da/Xiao, Chang/Duan, Xian/Xi can be diagrammed. But how can Chi/Shu, Jie/Cu be drawn? To seek the essence of Qibo and Huangdi while remaining bound to superficial tools is to cling to images and fall into folly.