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Pulse is the residence of blood. Its source lies in Jing-Qi (Essence and Qi), governed by Shen (Spirit), with water and grain essence as its foundation. The vessels do not move on their own but change within the meridians and collaterals following the Yuan-Zhen Qi (Primal True Qi) of the five Zang organs. This becomes manifest at the Qi-Kou (Cunkou pulse, located at the radial artery). It represents the accumulation of Yin and Yang. Since Xuanyuan and Qibo, down to the *Nan Jing* (Classic of Difficult Issues) and Zhang Zhongjing, the essentials were first concisely summarized. Later, during the Jin Dynasty, Wang Shuhe gained fame for his pulse diagnosis and compiled the *Mai Jing* (Pulse Classic), which can be described as comprehensive and detailed. Unfortunately, he erroneously placed the diagnosis of the Large Intestine and Small Intestine at the two Cun positions, causing confusion in locations; thus, despite its merits, its flaws could not be concealed. Subsequently, the arrogant Gao Yangsheng created the names "Seven Tables, Eight Interiors, Nine Channels," compiling them into the *Mai Jue* (Pulse Rhymes), and absurdly established diagrams. Pulse should be understood through the Heart's function; how can it be grasped merely by form? These vulgar and erroneous statements greatly deviate from the classic principles. Quack doctors habitually recite this book, taking it as a starting point, yet even when their hair turns white, they remain ignorant of pulse theory. Errors are passed down, confusing future generations, who remain unaware to this day. Thus, the *Mai Jue* became popular while the *Mai Jing* was hidden; furthermore, the diagnostic methods of the *Nei Jing* (Inner Canon), Bian Que's *Nan Jing*, and Zhang Zhongjing's pulse methods fell into obscurity and disrepute.

In the Song Dynasty, Pang Anchang began to grasp the classic principles, distinguishing between the Ying-Kou (Carotid pulse) and Qi-Kou pulses. Dai Tongfu of Xishan further wrote corrections, refuting these errors. Cui Zixu's *Four-Character Pulse Method*, Hua Borin's *Diagnosis Essentials*, and Li Yanwen's *Elucidation of Four Diagnostic Methods* presented profound theories. Li Shizhen's *Pulse Studies* and *Treatise on the Eight Extraordinary Vessels* provided detailed explanations. All these contributed significantly to later learners and served as guides for the times. If a physician masters these, what disease would remain incurable? Therefore, if pulse understanding is unclear, symptoms cannot be distinguished; if symptoms are not distinguished, treatment cannot be applied. How can pulse diagnosis fail to be analyzed?

The floating (Fu), sinking (Chen), slow (Chi), rapid (Shu), slippery (Hua), choppy (Se), deficient (Xu), excess (Shi), long (Chang), short (Duan), surging (Hong), fine (Xi), wiry (Xian), tight (Jin), knotted (Kou), soggy (Ru), minute (Wei), weak (Ruo), deep-hidden (Fu), moving (Dong), hurried (Cu), knotted/stopped (Jie), firm (Lao), leathery (Ge), relaxed (Huan), scattered (San), and intermittent (Dai) pulses—these twenty-seven types constitute the general outline of pulse diagnosis. Understanding them section by section is inherently easy. However, Hua Borin stated that the essential提纲 (outline) does not go beyond floating, sinking, slow, rapid, slippery, and choppy. While seemingly too simple, this is insufficient to exhaustively describe all pulses. One must particularly examine Yin-Yang overacting or hiding, Five Elements generating and overcoming, upward/downward and coming/going movements, and arrival/cessation patterns. Some have fixed locations that cannot be reversed; some have specific frequencies that cannot be confused; some resemble each other; some are similar yet hard to distinguish; some mix true and false; some differ in having Stomach Qi, lacking Stomach Qi, or having little Stomach Qi; some conform to the four seasons while others contradict them; some correspond or oppose the symptoms; one disease may present multiple pulse types; one pulse type may accompany multiple symptoms. There are cases where incorrect medications cause unstable organ Qi and changing pulses; there are cases where correct medication yields no symptom progression but stable pulses; there are cases where the patient is ill but the pulse is normal, or the pulse is abnormal but the patient seems well; there are cases where stopping good medicine briefly leads to deficiency collapse; there are differences between young/old and strong/weak; contraindications for new vs. chronic diseases; predetermined longevity or premature death; pure Yin or pure Yang constitutions; corresponding or opposite physical forms; combined use of listening, asking, and observing; and abnormalities in monks, nuns, widows, virgins, and boys. Furthermore, distinctions exist among the poor, rich, noble, base, upright, and deceitful, as well as variations due to Six Qi and Seven Emotions. Additionally, there are True Zang Pulses, Extraordinary Pulses, Tai Su Pulses, Tian He Pulses, Ying Kou Pulses, Guan Ge Pulses, Pregnancy Pulses, Five Rebellious Pulses, Six Extinct Pulses, and Seven Solitary Pulses. All must be carefully distinguished and precisely identified, kept in mind without loss. Upon palpation, life and death, fortune and misfortune, become immediately apparent under the fingers. Only then can one divine and understand profoundly.

I note: Ancient sages said, "I recall that ancient excellent physicians never treated illness without first diagnosing the pulse, a practice dating back to Xuanyuan and Qibo." Distinguishing humans from ghosts, men from women, was merely superficial. Within the subtle space of breath, life and death are determined. For instance, the talented man from Jibei had an unchanging complexion, yet his pulse indicated impending death according to fatal signs. Alas, this demonstrates mastery of pulse diagnosis. However, pulse diagnosis is only one of the Four Diagnostic Methods. I regret that modern transmission is often inaccurate, relying solely on the *Mai Jue*, leading to medical errors. Few advocate clarifying this path. Even when enlightened scholars emerge, they face isolation due to high standards and many critics. Thus, like Bian He holding his jade, few recognize their value. Sigh! People today, though fortunate to live in peaceful times, spared from bandits and disasters, suffer from Yin-Yang imbalances and willingly die at the hands of quacks. These quacks act as agents of heavenly disaster, fulfilling karmic retribution, yet also bringing suffering upon themselves. This is truly a cause for tears.

I believe that if a physician does not understand pulse, they cannot distinguish diseases; if they do not understand true/false and similar/dubious pulses, they cannot differentiate pulse types; if they cannot differentiate pulse types, they cannot assess the deficiency or excess of Yuan Qi, nor comprehend the major principles of life and death. Is pulse diagnosis merely for treating illness? The twenty-seven pulses (floating, sinking, slow, rapid, etc.) form the outline and are generally easy to recognize. Variations in combination require more memorization; similarities require comparative analysis, both of which are understandable. However, the true/false and dubious pulses are difficult. As Su Dongpo said, "Great excess presents with deficiency-like symptoms; extreme deficiency presents with excess-like symptoms." The difficulty in distinguishing pulses makes being a physician challenging. Regarding the twenty-seven pulses and previous discussions on Yin-Yang interactions, respiration rates, locations, presence/absence of Stomach Qi, and correspondence with seasonal symptoms—all diagnostic methods should follow the *Nei Jing*, *Nan Jing*, Zhang Zhongjing, Wang Shuhe's *Mai Jing*, Hua Borin's *Ji Yao*, and Li Shizhen's *Mai Xue*. These are orthodox traditions, bright as sun and stars, requiring no further elaboration. At critical junctures of true vs. false pulses, a slight error can reverse life and death. Although ancient sages mentioned this, they did not fully elucidate it, causing later learners to confuse treatments and kill patients. Therefore, I humbly attempt to analyze each type in detail. Though I have not reached the deepest mysteries, I clarify deficiency and excess, allowing life and death to be known in one palpation, and prevention before illness occurs. By preserving spirit under the fingers and recognizing qi omens beforehand, perhaps the profound teachings of Xuanyuan and Qibo will be revealed, rather than the rigid views of contemporary quacks. Superior practitioners seeking completeness must master all Four Diagnostic Methods. Here, I specifically list doubtful and similar pulse conditions. Without effort here, correcting errors will never be achieved.