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**Physical Manifestation:** The Kou pulse (Kou Mai, 芤脉) resembles a plant named "Kou," which is very similar in shape to *Allium fistulosum* (Cibotium onion/Scallion); it is perceptible at both the superficial (Fu, 浮) and deep (Chen, 沉) levels, but feels empty at the middle level (Zhong Hou, 中候).

**Predominant Diseases:** Due to its hollow center, the Kou pulse primarily indicates blood loss. A Kou pulse at the left Cun position (Left Cun, 左寸) indicates loss of blood governed by the Heart. A Kou pulse at the right Cun position (Right Cun, 右寸) indicates damage to the Yin of the Ministerial Official (Lung, 肺). A Kou pulse entering the left Guan position (Left Guan, 左关) indicates that Liver Blood fails to be stored. A Kou pulse appearing at the right Guan position (Right Guan, 右关) indicates that Spleen Blood fails to control. If the Kou pulse is present at the left Chi position (Left Chi, 左尺), it signifies hematochezia (blood in stool) as an ailment. If the Kou pulse is present at the right Chi position (Right Chi, 右尺), it signifies flaming fire leading to the leakage of essence.

**Commentary:** The meaning of the Kou pulse is the image of having pulse qi on both sides but being empty in the center. Kou is a plant name, and its shape is indistinguishable from that of a scallion. Suppose one uses fingers to simulate touching a scallion: upon superficial palpation, the finger touches the outer skin; upon middle palpation, the finger falls into the hollow center; upon deep palpation, the finger touches the inner/bottom skin. Through such examination, the name and image of the Kou pulse become clear in mind and eye, leaving no room for doubt. Liu Sandian said: "What does the Kou pulse resemble? It is exactly like a scallion. Under the fingers, it feels like a cavity, with edges but no center." Wang Shuhe said: "The Kou pulse is floating, large, and soft; when pressed, the center is empty while the sides are solid." The statements of these two masters leave no omission in describing the Kou pulse. Dai Tongfu said: "Ying Qi circulates within the vessels, and the vessel takes blood as its form. The Kou pulse is empty in the center, which is the sign of blood depletion." The Apocryphal Canon (referring to pseudo-apocryphal texts like *Mai Jue*) stated: "There is [pulse] at both ends, none in the middle." By substituting the character "head" (Tou, 头) for "side" (Bian, 边) from *Mai Jing*, it failed to clarify the principle of emptiness at the middle level. This implies a complete interruption of pulse qi between upper and lower, resulting in a diagnosis of absolute Yin or absolute Yang deficiency. It further stated: "Kou at Cun indicates accumulated blood in the chest; Kou at Guan indicates intestinal abscess." This treats the Kou pulse as a excess pulse of blood stasis and accumulation, rather than the empty pulse of a deficient patient who has lost blood. Despite Li Shizhen's profound knowledge and clarity, he also adopted this statement as the main song for predominant diseases. Is this not a lapse in judgment among thousands of considerations? The Apocryphal Canon also stated: "Kou governs strangury, with Qi entering the Small Intestine." What connection does this have with signs of blood loss? Such various heresies and errors mislead people significantly, necessitating detailed refutation. Even Wang Shuhe's *Mai Jing* states: "If all three positions show a Kou pulse, it is survivable if obtained in chronic illness, but fatal if obtained in acute illness." However, patients with sudden massive blood loss often present with a Kou pulse; can it truly be said that obtaining it in acute illness leads to death? His words also contain flaws. As for the various discussions on the Kou pulse cited by Liu Xiaozhai, most are forced interpretations and cannot be fully trusted.