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The condition of pulselessness has various causes. In chronic illness, pulselessness indicates Qi exhaustion and is fatal; in acute illness, pulselessness due to Qi stagnation is treatable. Conditions such as Shanghan (Cold Damage), gout, phlegm accumulation, amenorrhea, worry and fright, traumatic injury, Guan-Ge (obstruction with vomiting and diarrhea), excessive vomiting and diarrhea, and pulse patterns inconsistent with the seasonal climate运 (Qi movement) should not be overly feared.

Generally speaking, if the spring pulse does not exceed the normal wiry (Xian) quality, or if a choppy (Se) pulse suppresses the wiry pulse with deficient Qi, the disease will manifest in autumn. If there is no wiry quality in spring, the absence of vital Qi in spring illness indicates the time of death. One must also consider the pulse qualities that overcome each other. A spring wiry pulse with a moderate (Huan) quality indicates equilibrium; abundant Qi signifies health, while deficient Qi leads to illness in late summer. The absence of a wiry pulse in spring illness allows one to predict the time of death. A spring wiry pulse accompanied by a hook-like (Gou/Hong) quality suggests easy recovery with supportive treatment; a spring wiry pulse with a slippery (Hua) quality indicates slower resolution with suppressing treatment. The principles of victory, defeat, support, and suppression can be understood through examples.

Pulse and symptoms may appear contradictory but are not truly so, leading to changes in the disease without causing harm. Extreme excess conditions may present with emaciated signs, often due to cold-dampness, with a deep (Chen) and fine (Xi) pulse. Extreme deficiency conditions may present with full/exuberant signs, with a vacuous and large (Xu Da) pulse that is irregular. Deficiency diseases with fine pulses may result from taking cold-natured herbs, causing the pulse to beat firmly against the fingers. Yin deficiency with sweating, mistakenly treated with Ginseng (Renshen), results in a strong pulse. In Shanghan with constipation, a slow (Chi) pulse and excess stomach heat indicate the need for purgation; gout with constipation is not necessarily problematic.

The essentials of pulse diagnosis are three: Ju (lifting), An (pressing), and Xun (searching). Light pressure to feel the pulse is called Ju. Heavy pressure to seek the pulse is called An. Neither light nor heavy, searching meticulously, is called Xun. Initially holding the pulse with light pressure, if the pulse is felt between the skin and hair, it is Yang, associated with the Fu organs, and corresponds to the Heart and Lungs. Pressing heavily, if the pulse is found beneath the muscle, it is Yin, associated with the Zang organs, and corresponds to the Liver and Kidneys. With neither light nor heavy pressure, if the pulse is felt between flesh and blood, it indicates harmony between Yin and Yang, representing the neutral state, and corresponds to the Spleen and Stomach. If the pulse is not visible at floating, middle, or deep levels, one must search meticulously. If the pulse appears faintly or intermittently, it indicates hidden Yin and Yang. This applies to all six positions.

The characters Up, Down, Come, Go, Arrival, and Stop constitute the spirit and mechanism of the pulse. Without understanding these six characters, one cannot distinguish between deficiency/excess and Yin/Yang. Up is Yang, Come is Yang, Arrival is Yang; Down is Yin, Go is Yin, Stop is Yin. "Up" refers to the pulse moving from the Chi position up to the Cun position, indicating Yang arising from Yin. "Down" refers to the pulse moving from the Cun position down to the Chi position, indicating Yin arising from Yang. "Come" refers to the pulse emerging from the bone-flesh junction to the skin surface, representing the ascending of Qi. "Go" refers to the pulse returning from the skin surface to the bone-flesh junction, representing the descending of Qi. The beating is called "Arrival," and the pause is called "Stop."