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The Ge pulse (Reed Pulse) feels like pressing on a drum skin. It indicates diseases such as blood loss, seminal emission, miscarriage, metrorrhagia and metrostaxis, abdominal distension and fullness, wind-stroke, and conditions caused by dampness invasion.

The Lao pulse (Firm Pulse) resembles the Chen (Deep) or Fu (Hidden) pulses; it is large and long, with a slight Xian (Wiry) quality. Bian Que stated: A Lao and long pulse corresponds to the Liver. Zhang Zhongjing stated: Cold causes firmness and solidity, presenting an image of stability. Xu Donggao stated: Deep in position and forceful upon pressure, with movement that does not shift, this is the essence of the Lao pulse. It indicates diseases such as heart and abdominal pain, hernia with testicular swelling and atrophy (Shan Tui), mass formations (Zha Jia), shortness of breath and rapid respiration, and edema of the skin. Therefore, the Ge and Lao pulses are indeed as different as heaven and earth.

Zhang Zhongjing stated: Xian (Wiry) indicates Cold; Kou (Hollow) indicates Deficiency. The combination of Deficiency and Cold is named Ge (Reed). In men, it primarily indicates blood loss or loss of essence; in women, it primarily indicates miscarriage or continuous bleeding. The *Mai Jing* (Pulse Classic) states: If the pulses in all three positions are Ge, a chronic patient will die, while an acute patient will survive. Binhu (Li Shizhen) stated: This is the combination of the Kou (Hollow) and Xian (Wiry) pulses; thus, both indicate signs of blood loss. Various pulse manuals confuse Lao and Ge, sometimes mentioning only Lao without Ge, or vice versa, leading to indistinguishable concepts. One must not fail to realize that Ge is superficial (Fu) while Lao is deep (Chen); Ge indicates Deficiency while Lao indicates Excess; their forms and indicated symptoms are entirely different. Furthermore, if a Lao pulse appears when Yuan Qi (Original Qi) is about to perish, it is an ominous sign. The Lao pulse is contraindicated in Yin-deficient blood-loss diseases, as this represents an Excess pulse appearing in a Deficiency disease. This distinction must not be overlooked.

The Lao pulse is deep, forceful, and fixed in position, clearly indicating the pathological image of Yin-Cold coagulation. In contrast, the Shi (Solid/Excess) pulse can be felt in both superficial and deep positions; it is large and long, beating forcefully under the fingers like a drum, moving rhythmically with respiration, and its position can shift. This indicates diseases of Yang-excess and Excess-Heat. Although the physical forms of these two pulses are vaguely similar, the diseases they indicate differ vastly; the key lies in the "movement," specifically whether the position shifts or remains fixed. Only Xu Donggao uniquely grasped the essence of the Lao pulse, his insight surpassing antiquity. Upon reviewing medical formularies, I encountered cases where Jiegu's (Zhang Yuansu's) method for treating a Shi pulse involved administering Ginger and Aconite. This must not have been a true Shi pulse, but rather a Lao pulse. Such distinctions require careful analysis.

The Kou pulse is large and hollow, resembling a green onion, with walls on either side but empty in the center. Tongfu stated: Ying Qi (Nutritive Qi) circulates within the vessels; the vessel takes blood as its form. The emptiness in the middle of the Kou pulse is the image of blood depletion. The Ge pulse feels like a drum skin upon pressure. Although their physical forms differ, generally speaking, both primarily indicate syndromes of blood loss and Yin exhaustion.