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[Body Image] The morphology of the Ge pulse (Leather Pulse) is characterized by a large, wiry, and tense body; it can be felt upon light palpation (superficial touch), but feels hollow upon heavy pressure, resembling the sensation of pressing on leather.
It is exactly like drum skin: taut and urgent on the outside, yet empty inside. Therefore, it is detected immediately upon superficial palpation; if pressed heavily, it feels empty without substance.

[Main Diseases] The Ge pulse primarily indicates exterior cold and also belongs to deficiency in the middle jiao. If the Ge pulse appears at the Left Cun position, it indicates deficiency pain of Heart Blood. If the Ge pulse is at the Left Guan position, it suggests pathology such as hernia or masses (Zhijia). If the Ge pulse is found at the Left Chi position, it definitely indicates emptiness of essence.
If the Ge pulse appears at the Right Cun position, it indicates decline of Metal (Lung Qi) and qi stagnation. If the Ge pulse is at the Right Guan position, it indicates Spleen/Stomach deficiency with pain. If the Ge pulse is found at the Right Chi position, it warns of danger to life. In women, this pulse indicates spontaneous abortion (half-birth) or metrorrhagia (continuous bleeding).
The pulse resembles leather, indicating excess pathogenic factors at the exterior and insufficiency within. Because there is exterior cold pathogen, the wiry and urgent image appears first; because of the deficiency of qi and blood in the center, the empty image becomes prominent. Various diseases in men are mostly due to insufficiency of essence and blood. Women suffering from spontaneous abortion or metrorrhagia also have an empty pulse because blood is suddenly lost.

Palpating it reveals the image of leather. When lifting lightly, the pulse is wiry and urgent; is this not the image of tension? When pressing deeply, the pulse is suddenly hollow; is this not the image of central emptiness? Zhang Zhongjing said: "The pulse is wiry and large; wiry implies reduction [of yang], large implies void like the Kou pulse; reduction implies cold, void implies deficiency; deficiency and cold clashing together is named Ge." This section serves as a footnote explaining the Ge pulse. Ge resembles leather, feeling full and urgent under the fingers. Now saying "the pulse is wiry and large," these four characters alone can fully describe the shape of the Ge pulse. The following lines "wiry implies reduction..." further elucidate the reason for being called Ge. Wang Shuhe said: "If the pulses in all three positions are Ge, a chronic patient will die, while an acute patient will survive." Li Shizhen said: "This is the combination of the Kou pulse and the Xian pulse, thus serving as a sign of loss of essence and blood. Most pulse manuals consider Ge and Lao pulses to be the same. Thus, some texts mention only Ge without Lao, or only Lao without Ge, causing confusion. They do not know that Ge is superficial and Lao is deep; Ge is deficient and Lao is excess; their forms and syndromes are different." The *Jia Yi Jing* states: "Muddy and turbulent, rushing like a gushing spring, the disease advances and the complexion deteriorates; lingering and departing like a broken string, death ensues." This refers to the pulse coming turbulently and changing rapidly, urgent like a gushing spring, exiting without returning. Observing the term "gushing spring," it implies that upon superficial palpation, it is not only wiry and large, but also rapid, forceful, and slippery. Observing the term "broken string," it implies that upon deep palpation, it is not only suddenly hollow, but completely lacks root. Hence it says "death." Wang Kuang considered this to be the Yi pulse (Overflowing Pulse) because of the term "gushing spring" in the *Jia Yi Jing*, thereby forcing an interpretation. He did not know that the Yi pulse rises from the Cun position up through the Yuji point, rushing straight upward like boiling water overflowing; what does this have to do with the Ge pulse? Zhu Danxi said: "Like pressing on drum skin." This metaphor best captures the meaning of emptiness inside and urgency outside. Boren mistakenly interpreted Ge as meaning "transformation/change." If it meant transformation, it would be one of the strange pulses (Guai Mai); but is the Ge pulse truly a strange pulse? Then where does the meaning of transformation lie?