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Those whose pulse colors appear red, black, or green indicate cold and heat pathogens. Among them, a greenish hue with a short quality indicates a deficiency of vital energy (Qi). This fully demonstrates the profound and extensive nature of classical medical theories.

The *Cui Zhenren Mai Jue* (Pulse Instructions by Master Cui), in one volume, was written by Cui Jiayan, a Daoist recluse of the Song Dynasty. It was first recorded in Jiao Hong's *Guo Shi Jing Ji Zhi* (Bibliography of National History). Later, Li Dongyuan of the Jin-Yuan period and Li Shizhen of the Ming Dynasty both incorporated its content. The *Siku Quanshu Zongmu Tiyao* (General Outline of the Complete Library of the Four Treasuries) of the late Qing Dynasty and the *Yi Zong Jin Jian* (Golden Mirror of Medicine) also included it. This book is concise yet captures the essentials, making it easy to memorize, and serves adequately as a textbook for students of medicine; this goes without saying. Mr. Yu further edited and revised it, making it even more precise and substantial.

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[Note by Rongzhai] This section was originally the fourth section, titled "Gou Xuan" (Extracting the Essence). Its attributes were drawn from four passages by Qibo, one by Bian Que, five by Zhang Zhongjing, plus one concluding remark by Mr. Yu; totaling eleven entries. These texts are empty and lack specificity, failing verification against facts. Mr. He Lianchen did not offer his own commentary but merely appended two discussions on pulse diagnosis by Wang Yanchang to the final entry, adding an annotation stating: "These two entries (by Wang Yanchang) truly capture the reality and principles of pulse diagnosis." This reveals that the ten entries cited by Mr. Yu above fail to grasp the true reality and logic of pulse diagnosis. Such profound insight and implicit criticism target the dross within classic works, subjecting them to disposal via "preservation without discussion." Currently, I have discarded all eleven of these obscure and useless texts entirely. Instead, I have moved the two pulse discussions by Wang Yanchang, cited by Mr. He, into Section 2 ("Four-Character Pulse Instructions") as footnotes. Here, I have incorporated the opening paragraph of Jiang Baio's "Review of Traditional Chinese Medicine Pulse Studies" (published in Issue 4 of *Zhongyi Xin Shengming* [New Life of TCM]) by a contemporary scholar. This preliminarily introduces some practical aspects of the rationale behind pulses using actual text, hopefully rendering the content more substantive ("flesh and blood") rather than overly broad and unsubstantiated ("large but inappropriate"). The original text by Mr. Jiang is as follows:

"The pulsation of the pulse is centered on the heart, which governs blood circulation. Blood circulation begins in the arteries and ends in the veins, with the heart serving as the hub of departure and return. The heart possesses functions of relaxation (diastole) and contraction (systole), along with fluid pressure to regulate blood flow. During each systole of the left ventricle, blood flows from the left ventricle into the arteries, causing arterial expansion. Due to their elasticity, the arterial walls undergo a wave-like motion, which constitutes the pulse. The pulse is essentially a shockwave of kinetic energy originating from the heart; thus, the state of cardiac action can be inferred from the pulse. Since it is known that the pulse aligns with cardiac pulsation, the theory of 'Three Regions and Nine Locations' in the *Neijing* (Inner Canon) and the theory of 'Regional Organ Diagnosis' in the *Mai Jing* (Classic of Pulse Diagnosis) cannot be relied upon. Given that the pulse depends on cardiac action and arterial wall tension, the rhythmic expansion and contraction of the brachial artery and radial artery should naturally correspond, leaving no basis for the distinction of Cun, Guan, and Chi positions; thus, the concept of 'Three Regions' lacks validity. As for 'Nine Locations,' it is equally baseless; how can blood vessels be layered? Blood volume within the vessel often exceeds the lumen's capacity. The pulse's movement and cessation are palpable upon pressing; in emaciated individuals, it may even be visible. Unless after severe hemorrhage, or suffering from cardiac diseases or other direct/indirect malignant anemias, the pulse does not exhibit abnormalities. Therefore, superficial and deep palpation can verify the fullness or emptiness of the pulse, whereas moderate pressure finds no distinct point. The theory of regional organ diagnosis first appeared in the *Mai Fa Zan* (Ode to Pulse Methods) cited in the *Mai Jing*, which claims the left Cun-Guan-Chi corresponds to the Heart, Liver, and Kidney, while the right Cun-Guan-Chi corresponds to the Lung, Spleen, and Mingmen (Gate of Vitality). This is highly unreliable. Organs may be diseased without manifesting in the pulse; even if they do, it is indirectly due to pathogens affecting cardiac blood circulation. What the pulse reflects are changes in cardiac blood circulation, unrelated to the primary diseased organ. Physicians must correlate observed complication symptoms to explore the reasons for hemodynamic changes before determining which organ is diseased.

"The *Mai Jing* and *Mai Jue* classify twenty-seven types of pulses. Xu Huixi's *Mai Jue Qi Wu* added the 'Rapid' (Ji) pulse, bringing the total to twenty-eight. Based on my limited understanding, these can be divided into two main categories: revealing whether the pumping force of the left ventricle is strong or weak, further subdivided into five items: (1) Relation to cardiac output volume. (2) Relation to vessel characteristics. (3) Relation to heart rate speed. (4) Relation to blood pressure. (5) Various functional disorders of cardiac tissue. Among the twenty-eight pulses, I consider eighteen to be reasonable based on my views, classified as follows:

"(1) Relation to Cardiac Pumping Force
Full pumping volume ── Full (Hong) pulse.
Weak pumping volume ── Empty (Kou), Minute (Wei), Weak (Ruo) pulses.

"(2) Relation to Vessel Characteristics
Coarse vessels with full pumping volume ── Full (Hong) pulse.
Fine vessels with full pumping volume ── String-taut (Xian) pulse.
Reduced vessel tension ── Soft (Ru) pulse.
Microscopic atrophy and hardening of vessels ── Tight (Jin), Leathery (Ge) pulses.
Vasoconstriction (peripheral arterial constriction) ── String-taut (Xian), Slow (Chi) pulses.
Vasodilation (peripheral arterial dilation) ── Rapid (Shu), Full (Hong) pulses.

"(3) Degree of Heartbeat
Sluggish heartbeat ── Slow (Chi) pulse.
Hyperactive heartbeat ── Rapid (Shu) pulse.

"(4) Relation to Blood Pressure
Hypertension ── Firm (Lao) pulse.
Hypotension ── Soft (Ru) pulse.

"(5) Cardiac Tissue Functional Disorders
Mitral stenosis with heart failure ── Soft (Ru), Deep/Floating-under-pressure (Fu), Fine (Xi) pulses.
Aortic valve insufficiency ── Rapid (Ji) pulse.
Aortic stenosis ── Moderate/Slow (Huan) pulse.
Valvular insufficiency ── Hasty (Cu), Knotted (Jie), Intermittent (Dai) pulses.
Vascular embolism ── Hasty (Cu), Knotted (Jie), Intermittent (Dai) pulses.

"The five principles listed above are closely interrelated. The remaining ten pulses—Floating (Fu), Deep (Chen), Slippery (Hua), Choppy (Se), Deficient (Xu), Excess (Shi), Long (Chang), Short (Duan), Scattered (San), and Moving (Dong)—are insufficient to stand as independent pulse categories. Floating and Deep refer to the physician's palpation technique. Slippery is similar to Full; Choppy resembles Moderate. Deficient and Excess are relative terms. Long, Short, Scattered, and Moving do not adequately represent pulse qualities, so they are not elaborated upon.

"According to traditional theory: Based on the magnitude of the left ventricle's driving force, distinguishing the twenty-eight pulses, excluding the four pulses ('Long, Short, Scattered, Moving') that inadequately represent pulse qualities, the special pulses of 'Hasty, Knotted, Intermittent,' and the two pulses referring to palpation action ('Floating, Deep')—totaling nine pulse images—we derive nineteen distinct pulses. Thus, Full, Slippery, Rapid, Excess, Tight, String-taut, Rapid/Ji, and Firm belong to those with strong cardiac driving force; Minute, Choppy, Slow, Weak, Deficient, Soft, Fine, Deep, Moderate, Leathery, and Empty belong to those with weak cardiac driving force. Furthermore, regarding the ten characteristic pulses in the *Shanghan Lun* (Treatise on Cold Damage), excluding Floating and Deep, Large, Slippery, Moving, and Rapid belong to strong cardiac driving force; Weak, Choppy, String-taut, and Minute belong to weak cardiac driving force. Although this analysis is rough, it is considered a shortcut for those studying pulseology.

"From the deduction of the above text, we can understand: The slowness or rapidity of pulse beats relates to the speed of blood flow; the hardness or softness of the pulse relates to the strength of cardiac diastole and systole; the cadence of the pulse wave relates to the opening and closing of heart valves. By observing physiological abnormalities of the heart, we directly observe the impact of pathogens on cardiac blood circulation and indirectly master pathological mechanisms (i.e., diseases associated with each pulse) and prognosis (i.e., contraindications between pulse and symptoms). Although this is merely a beginning, the theory aligns with reality. Secondly, dividing cardiac pumping force into two main categories in this text parallels the ancient medical concept of 'Yin and Yang of Pulses.' The *Shanghan Lun* classifies Floating, Large, Slippery, Moving, and Rapid as Yang, and Deep, Weak, Choppy, String-taut, and Slow as Yin. This text considers Yang pulses as those with strong cardiac driving force and Yin pulses as those with weak cardiac driving force. Although perspectives differ, the principles are consistent. Moreover, the ideological arguments of this text revolve entirely around the theory expounded by Ke Yunbo: 'There are ten types of pulses, divided into Yin and Yang, possessing five methods; Floating and Deep are pulse body, Large and Weak are pulse momentum, Slippery and Choppy are pulse qi, Moving and String-taut are pulse shape, Slow and Rapid are pulse rhythm.' This understanding is profound and contains sound reasoning, serving as a stepping stone for further study of TCM pulseology."