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Physical Manifestation: The pulse is large, wiry, and tense; it can be felt upon light palpation (superficial touch); upon heavy pressure, it feels empty in the center, resembling the sensation of pressing on a drum skin.

Predominant Diseases: The Ge pulse primarily indicates exterior cold syndromes and also belongs to deficiency of the middle jiao. A Ge pulse at the left Cun position indicates deficiency of heart blood causing pain. A Ge pulse at the right Cun position indicates decline of lung metal and qi stagnation. Encountering a Ge pulse at the left Guan position suggests pathology from hernia or abdominal masses (Jia-Jia). Encountering a Ge pulse at the right Guan position indicates pain due to deficiency of spleen earth. A Ge pulse at the left Chi position confirms emptiness of essence. A Ge pulse at the right Chi position raises concern for life-threatening conditions. In women, obtaining this pulse suggests spontaneous abortion or continuous uterine bleeding (Lou-Xia).

[Commentary]: The Ge pulse represents the image of leather. There is an excess of pathogenic factors on the exterior, while there is insufficiency within. It is exactly like a drum skin: tight on the outside and empty on the inside. When lifted lightly, the pulse appears wiry and large; is this not the image of tension? When pressed deeply, the pulse feels suddenly hollow; is this not the image of central emptiness? Because there is cold pathogen on the exterior, the image of wiriness and tension appears; because of the deficiency of qi and blood in the middle, the image of emptiness becomes manifest. Zhang Zhongjing said: "The Ge pulse is wiry and knotted (Kou); wiry indicates cold, knotted indicates deficiency. Deficiency and cold combine, this is named Ge. In men, it indicates loss of blood and essence; in women, spontaneous abortion and leakage." Wang Shuhe stated: "If the pulses in all three positions are Ge, a chronic patient will die, but an acute patient will survive." Li Shizhen said: "This is a combination of the Kou and Wiry pulses, thus both indicate signs of blood loss. Various pulse texts consider it identical to the Lao pulse, hence some have Ge without Lao, or Lao without Ge, causing confusion and inability to distinguish. They do not know that Ge is superficial while Lao is deep, Ge indicates deficiency while Lao indicates excess, and their forms and symptoms are entirely different." The *Jia Yi Jing* states: "When the pulse comes turbid and changing like surging springs, the disease advances and the complexion deteriorates; when it goes continuously like a broken string, death ensues." This refers to the pulse coming turbid and altered, urgent like a gushing spring, exiting without returning. Observing its description as "surging spring," it implies that upon superficial palpation, it is not only wiry and large but also rapid, pounding, and slippery; describing it as "broken string" implies that upon deep palpation, it is not only suddenly hollow but completely lacks root, hence it is said to indicate death. Wang Kuang considered the Yi pulse to rise from the Cun position above to the Yuji area, rushing straight up like boiling water overflowing; how does this relate to the Ge pulse? Zhu Danxi said: "Like pressing on a drum skin"; this metaphor is most apt and intimate regarding the meaning of emptiness inside and tension outside.