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[Physical Manifestation] The physical manifestation of the Jie Pulse (Knotted Pulse) is one of condensation and stagnation, with an occasional pause during a slow rhythm. Its movement is like walking slowly while fatigued, occasionally stumbling a step, which captures the essence of the Knotted Pulse.

[Pathogenesis] The Knotted Pulse belongs to Yin-Cold patterns and also arises from coagulation and accumulation. If seen at the Left Cun position (corresponding to the Heart), it indicates Heart-Cold causing pain; if seen at the Right Cun position (corresponding to the Lung), it indicates Lung-Qi deficiency with Cold coagulation; if seen at the Left Guan position (corresponding to the Liver/Gallbladder), it manifests as Hernia or Jia-Masses (abdominal masses); if seen at the Right Guan position (corresponding to the Spleen/Stomach), it indicates Phlegm stagnation and Food retention; if seen at the Left Chi position (corresponding to the Kidney/Yin), it is associated with Wei Syndrome (flaccidity syndrome); if seen at the Right Chi position (corresponding to the Kidney/Yang), it indicates suffering due to Yin-Cold.

[Commentary] The meaning of "Jie" (Knot) is condensation without dispersion, appearing as an occasional pause amidst a sluggish rhythm. Ancient physicians likened it to someone walking slowly and tiredly, occasionally tripping for a step, which vividly portrays the spirit of the Knotted Pulse. Generally, Heat causes circulation to flow freely, while Cold causes stagnation; this is the natural principle. Within Yin-Cold conditions, if accompanied by condensation, it is like the severe weather of mid-winter where flowing water turns to hard ice. When the Shao-Huo (Ministerial Fire) is weak and the Middle Qi is deficient and cold, losing its vigorous transformative function, then Blood, Qi, Phlegm, and Food will entangle each other. This leads to the obstruction of transportive mechanisms, resulting in the Knotted Pulse. Yue Ren (Bian Que) stated: "Severe knotting indicates severe accumulation; slight knotting indicates slight Qi deficiency. A Floating Knot indicates external painful accumulations; a Deep Knot indicates internal accumulations." Thus, we know that a Knotted Pulse with force indicates excess accumulation, whereas a Knotted Pulse without force indicates true Qi weakness, violating normal transformation. The correct treatment is solely warm tonification. Zhang Zhongjing said: "Pulse feeling like tracing a long bamboo pole is called Yin-Jie (Yin Knot); pulse feeling grand like a chariot canopy is called Yang-Jie (Yang Knot)." Wang Shuhe said: "A pulse that trembles like hemp seeds, rotating and retracting, gathering and scattering irregularly, is called Jie, indicating death." Although these three are all named Jie, their meanings differ. Finding it in the Floating layer indicates Yang-Jie; finding it in the Deep layer indicates Yin-Jie; frequent pauses with irregular intervals indicate an untreatable condition. From this, we can deduce that the manifestations of the Knotted Pulse cannot be summarized by a single aspect. The False Canon states: "Coming and going, gathering and returning." Compared to the definition of "an occasional pause during a slow rhythm," this is akin to sleep-talking.

[Physical Manifestation] The physical manifestation of the Dai Pulse (Intermittent Pulse) is like succession or replacement, with pauses occurring at regular intervals. It cannot recover spontaneously; after a long time, it beats again.

[Pathogenesis] The Dai Pulse primarily indicates organ decline, representing a critical and ominous sign. Failure of Spleen-Earth leads to vomiting and diarrhea. Cold invading the middle jiao causing loss of appetite and abdominal pain is difficult to save. If the pulse stops after two beats, death occurs in three to four days; if it stops after four beats, death occurs in six to seven days. Reasoning through these sequences aligns with the classic principles.

[Commentary] "Dai" means succession or replacement, like the changing of seasons, which never misses its time. The pauses in the Jie (Knotted) and Cu (Rapid) pulses have no fixed number; the pause in the Dai Pulse has a fixed number. In Jie and Cu pulses, the pause is followed immediately by the next beat; in the Dai Pulse, there is a long delay before recovery. The *Neijing* (Classic of Internal Medicine) states that the appearance of a Dai Pulse indicates the decline of Zang-Qi and the exhaustion of Spleen-Qi. However, in cases of palpitations due to Shanghan (Cold Damage), pregnancy at three months, excessive emotional stress, severe trauma, or pain syndromes in Wind disorders, the Dai Pulse is not necessarily fatal and should not be judged as certain death. Hua Borren said: "For those without disease who are emaciated and show a Dai Pulse, it is a critical sign. For those with disease whose Qi and Blood are temporarily damaged, it is merely a pathological pulse." This refers to acute illnesses. If a patient with chronic illness shows a Dai Pulse and hopes for recovery, it happens in less than one in ten thousand cases. The *Neijing* says: "Dai indicates Qi decline." And: "Dai combined with Scattered pulse indicates death." The appearance of a Dai Pulse indicates Spleen-Earth decline; the appearance of a Scattered pulse indicates Kidney-Water exhaustion. If both appear together, even a sage physician would retreat in dismay. Generally, five beats per respiration indicate sufficient Qi in the Five Zang organs (Lung, Heart, Spleen, Liver, Kidney). Therefore, fifty beats without a single pause conform to the Great Expansion Number and are considered a Normal Pulse. Conversely, pauses occur. If Kidney Qi fails to arrive, there is a pause every forty beats; if Liver Qi fails, every thirty beats; if Spleen Qi fails, every twenty beats; if Heart Qi fails, every ten beats; if Lung Qi fails, every four or five beats. Dai Tongfu said: "The Three Regions and Nine Positions require fifty beats per position, originating from the *Nanjing*. However, the False Canon's Song of the Five Zang uses forty-five beats as the standard, deviating from the classic intent." The False Canon further claims: "Forty-one pauses indicate one Zang is exhausted, leading to death within four years." This absurdity violates reason more than any other claim. How could a person survive four years after one Zang is exhausted? Extensive examination of the *Neijing* reveals that the meaning of the Dai Pulse has another interpretation. For instance, the *Xuanming Wuqi Pian* chapter says: "The Spleen pulse is Dai." The *Xiéqì Zàngfǔ Bìngxíng Pian* chapter says: "Those with yellow complexion have a Dai pulse." These refer to the normal seasonal manifestation of Zang-Qi, not a pause. The *Pingren Qixiang Lun* chapter says: "In late summer, a soft and weak Stomach-Qi pulse is normal; only Dai without Stomach-Qi indicates death." This refers to death due to lack of Stomach-Qi, not defining Dai as a pause. When it says "fifty beats without one Dai," "Dai" here refers to numerical alternation. If a pulse is generally uniform but suddenly becomes strong or weak, this is a morphological change, as mentioned in the *Pingren Qixiang Lun*. If the Spleen prospers in all four seasons and changes accordingly, this is climatic succession, as described in the *Xuanming Wuqi* chapters. Pulses without fixed patterns and varying constantly are all termed Dai. By observing their changes to understand the condition, one can fully grasp their subtleties. Huang Guiyan from Shanxian County suffered severe heart pain preventing eating. His pulse stopped every three beats and took a long time to recover. Shi Lizewei said: "When the Qi of the Five Zang does not arrive, death is imminent day or night." I said: "Ancients stated that severe pain often presents with a Dai pulse. Zhou Meiwo said: 'Young people with a Dai pulse die; old people with a Dai pulse live.' Mr. Guiyan is advanced in age and suffers chest/abdominal pain; although he has a Dai pulse, there is no need to worry." Indeed, Guiyan recovered after twenty days. Thus, unless a physician is widely read, it is difficult to exhaust the variations of the pulse.