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The pulse of Taiyang disease presents as Floating (Fu Mai, Floating Pulse). A Floating pulse indicates the pathogen is in the Exterior. A Floating-Forceful (Fu Jin) or Floating-Slow (Fu Chi) pulse both indicate Exterior Cold; a Floating-Rapid (Fu Shu) or Floating-Hong (Fu Hong) pulse both indicate Exterior Heat. A Floating-Fine & Choppy (Fu Xi Se) or Soft & Scattered (Ru San) pulse, when accompanied by corresponding symptoms, all indicate Deficiency. A Forceful-Rapid (Jin Shu) or Forceful-Slippery (Hong Hua) pulse, when accompanied by corresponding symptoms, all indicate Excess.

[Commentary by Xu Xiu] This section uses the Floating pulse to differentiate between Cold, Heat, Deficiency, and Excess. The Floating pulse can be felt with light pressure, its image being clear and distinct, but it most often appears as a combined pulse. For instance: Floating-Forceful and Choppy indicates Cold pathogen in the Exterior; Floating-Wiry and Slow indicates Wind pathogen in the Exterior; Floating-Forceful and Rapid indicates the pathogen is about to transmit inward; a Long pulse while Floating indicates transmission involving the Yangming channel; a Wiry pulse while Floating indicates transmission involving the Shaoyang channel. The key lies in whether there is "Shen" (Spirit/Vitality) in the pulse, meaning the pulse is forceful, which allows for the use of diaphoresis (sweating method) to resolve the exterior. If the pulse is Floating-Slow and Weak, or Floating-Empty and Fine, or Floating-Micro and Choppy, these belong to Floating without force, indicating Yang Deficiency. Warm tonification should be used, and sweating must not be employed. If the Cun (Inch), Guan (Bar), or Chi (Cubit) positions at the Chi position are Weak, Choppy, Slow, and Fine, it indicates internal deficiency with Yin involvement. Urgent warm tonification is required, and reckless sweating is especially contraindicated, lest it precipitate the critical condition of Yang collapse due to erroneous sweating.

Floating-Forceful indicates Wind-Cold; Floating-Rapid indicates Wind-Heat; Floating-Soft indicates Wind-Dampness; Floating-Choppy indicates Wind-Dryness; Floating-Empty indicates Summerheat injury; Floating-Hong indicates Fire Excess.

[Commentary by Xu Xiu] Although the pulse is Floating, different combined pulses indicate different diseases. Generally, Wind patterns often show a Floating pulse, Cold patterns often show a Forceful pulse, Heat patterns often show a Rapid pulse, Dampness patterns often show a Soft pulse, Dryness patterns often show a Choppy pulse, Summerheat patterns often show an Empty pulse, and Fire patterns often show a Hong pulse. These are the common manifestations of external contraction pulse signs. However, external contraction pulses rarely appear alone; they are mostly combined pulses. Clinicians must distinguish them carefully.

[Commentary by Lian Kan] In the six-channel external contraction patterns, Floating indicates Wind, Forceful indicates Cold, Empty indicates Summerheat, Soft indicates Dampness, Choppy indicates Dryness, and Hong indicates Fire. Former sages took this as the basis. However, based on my clinical experience, one cannot strictly adhere to this. For example: Wind has no fixed form. When combined with Cold and Dryness, the pulse is Forceful and Floating; when combined with Summerheat and Dampness, the pulse is Soft, Slow, and Floating. Summerheat and Dampness carrying turbid qi are often inhaled through the mouth and nose, causing disease to originate internally. The pulse often seems Rapid or Slow, or neither Floating nor Sunken but Rapid, or even Soft, Slow, and blurred, with indistinct rate. Even Dryness has no fixed form. Upper Dryness affects Qi, with the right Cun position Floating and Choppy, and deep pressure Rapid; Lower Dryness affects Blood, with the left Guan and Chi positions Fine, Wiry, and Choppy. Fire has no neutral state; the six qi often transform into Fire. If Fire transformation is in the channels or Qi level, the pulse must be Hong and Full. If Fire transforms and enters the Stomach fu organ, combusting with residues, the pulse must be Deep, Solid, and Small, or Deep, Rapid, and Small, or even Deep, Micro, and Hidden. Solid and Small, Micro and Hidden, are all signs of obstruction. Once the interior pathogen is purged, the pulse turns Floating and Slow without sinking/obstruction, and sweating will likely occur within a day to resolve the disease. If the pulse remains Deep and Rapid after sweating, the pathogen is not fully exhausted. If the pulse becomes Floating and Restless after sweating, the pathogen overcomes the healthy Qi. After sweating, the body must become cool and the pulse quiet/still to indicate complete elimination of the pathogen. "Quiet" refers to a Deep and Fine pulse. Although the pulse is Deep and Fine, the rate is distinct, differing from the Choppy, sluggish, and blurred pulse of Summerheat-Dampness. Within a few days, after eating and recovering Qi, the pulse will turn round and Floating. As for Warm diseases and Epidemic diseases, they differ further. Warm diseases include Wind-Warm, Cold-Warm, Damp-Warm, Heat-Warm, Dry-Warm, and Toxic-Warm. The pulse of Wind-Warm is larger on the right than the left, with the left also盛 (Sheng, vigorous/restless), and the skin at the Chi position very hot. The pulse of Cold-Warm, although Hong and Full on the right, is Wiry and Forceful on the left. The pulse of Damp-Warm is Soft and Weak on the right, and Small and Urgent on the left. The pulse of Heat-Warm is Floating at both Cun positions, Slippery on light pressure, and Scattered-Choppy on deep pressure. The pulse of Dry-Warm is mostly Floating-Choppy and Deep-Scattered on the right, and mostly Floating-Wiry and Beating-to-the-finger on the left. The pulse of Toxic-Warm is mostly Floating and Full, becoming more intense with deeper pressure. Although epidemic diseases vary, they generally result from inhaling various mold toxins, brewing into contagious diseases. Their pathology does not exceed Yang Toxin and Yin Toxin. Yang Toxin involves Blood Excess-Heat, with the pulse mostly Right Hand Hong and Beating, Left Hand Wiry, Rapid, Full, and Restless. Yin Toxin involves Qi Deficiency-Cold, with the pulse mostly Soft and Weak, or even Deep, Micro, and seemingly Hidden, or Floating, Large, and Scattered. Although the disease initially originates from external invasion, the formed pattern must emerge from within. Thus, the pulse images of the six excesses (external pathogens) and all epidemic diseases differ so greatly. Therefore, Yu Dongfu said: The difficulty in treating disease lies in recognizing the pattern; the difficulty in recognizing the pattern lies in recognizing the pulse. This is indeed true. I believe that in our country's diagnostic science, palpation ranks last. This does not mean the pulse cannot be relied upon, but rather that relying solely on the pulse makes it unreliable, and rigidly adhering to the pulse makes it even less reliable. One must observe the form and color, examine the tongue and coating, investigate the disease source, estimate the disease location, scrutinize the disease state, and study the disease changes, and then refer to the pulse. Although the pulse image has no fixed form, the treatment method depends on the physician, so one will not be confused by the pulse.

The pulse of Shaoyang disease presents as Wiry (Xian Mai, Wiry Pulse). A Wiry pulse indicates the Half-Exterior Half-Interior level. Wiry and Floating-Large leans towards the Half-Exterior; Wiry and Forceful-Small leans towards the Half-Interior. Wiry-Slow indicates Wind-Cold; Wiry-Rapid indicates Wind-Heat; Wiry-Slippery indicates Phlegm retention; Wiry-Urgent indicates much pain. Floating-Wiry indicates Cold Fluid; Deep-Wiry indicates Heat Fluid. Floating-Wiry and Long indicates pathogen stagnation in the interstices; Floating-Wiry and Rapid indicates Ministerial Fire is abundant. Few Wiry pulses with Solid quality indicate Pathogen Excess and Stomach Strength; Many Wiry pulses with Empty quality indicate Healthy Qi Deficiency and Stomach Weakness. Right Guan position Wiry pressing against the finger indicates Earth Failure and Wood Encroachment (Spleen/Stomach weakness with Liver overacting); Left Guan and Chi positions Wiry, Fine, and Beating-to-the-finger indicate Water Deficiency and Wood Hyperactivity (Kidney Yin deficiency with Liver Yang rising).

[Commentary by Xu Xiu] Whenever the disease pulse is Wiry, it is a sign of Yin hidden within Yang. Generally, although the initial illness is in Shaoyang, it will eventually return to Jueyin over time. It also often presents with Qi knotting and Blood stasis. During the peak of exterior pathogen in external contraction diseases, if the middle pressure of a Floating pulse feels constrained and straight, the middle pressure of a Forceful pulse feels like ridges against the finger, or the middle pressure of a Slippery pulse feels constricting, they should all be treated according to the principles of the Wiry pulse. In harmonizing methods, herbs that resolve knots and open stagnation must be added, so that the Wiry pulse gradually becomes soft and slow, feeling harmonious to the touch. If interior pathogens transmit to the fu organs and zang organs, presenting as Wiry-Slippery due to Pathogen Excess, this occurs in 2-3 out of 10 cases, mostly fu organ diseases. Presenting as Wiry-Fine due to Healthy Qi Deficiency, this occurs in 6-7 out of 10 cases, mostly zang organ diseases. Whenever the middle pressure of a Deep pulse feels strong and straight, or the middle pressure of a Choppy pulse feels fine and urgent, they should all be viewed as belonging to the Wiry pulse category. This is either Liver Yang rising or Liver Yin stagnation. Therefore, in complicated conditions of Shanghan (Cold Damage), Wiry pulses are common; in miscellaneous internal injuries, Wiry pulses account for more than half. Is it only the Shaoyang channel that commonly shows Wiry pulses?

The pulse of Yangming disease presents as Large (Da Mai, Large Pulse). A Large pulse indicates various Excess conditions and also indicates disease progression, generally indicating Yang Abundance. Large leaning to the left indicates Pathogen Excess in the channels; Large leaning to the right indicates Heat Excess in the fu organs. Large, Firm, and Long indicates Stomach Excess-Heat; Large, Firm, and Choppy indicates Stomach fullness and distension. Light pressure Small and Choppy, deep pressure Solid and Large indicates dry accumulation in the intestines; Light pressure Large and Grand, deep pressure Empty indicates Yin Exhaustion and Yang floating away. If all pulses are Large but one position is uniquely Small, it is Excess mixed with Deficiency; if all pulses are Small but one position is uniquely Large, it is Deficiency mixed with Excess. Large anteriorly and Small posteriorly indicates Yang pathogen sinking inward, with variable symptoms; Fluctuating Large and Small indicates loss of Yuan Shen (Primordial Spirit), indicating a critical illness.

[Commentary by Xu Xiu] The Large pulse feels broad to the touch, double the usual size, and differs in Yin/Yang and Excess/Deficiency. Large, Hong, and Beating indicates Heat Excess and Pathogen Excess; Large, Empty, and Soft indicates Yin Deficiency and Yang Hyperactivity. In Shanghan, a Large pulse indicates Yang Abundance; in miscellaneous diseases, a Large pulse indicates Consumption (Xu Lao). For the same Large pulse, one must know that Yang Abundance easily scorches Yin. The Stomach is the fu organ of fluids and juices; one must directly clear Yangming to preserve fluids. If Yin Deficient, unable to sustain Yang, the Kidney is the master of True Yin; one must connect Heart and Kidney so that Essence and Blood naturally suffice. Especially, one must know that when Yang injury affects Yin, clearing heat must be combined with nourishing Yin—this is why Zhang Jingyue created Yü Nv Jian (Jade Woman Decoction). When Yin damage affects Yang, tonifying must be combined with warming—this is why Feng Chuzhan created Quan Zhen Yi Qi Tang (Complete True Vital Qi Decoction). One clears Yangming Excess, the other tonifies Shaoyin Deficiency; both are critical turning points in the life-and-death prognosis of the Large pulse. Clinicians must not mistake the Large pulse for a purely Excess condition without Deficiency.

The pulse of Taiyin disease presents as Soft (Ru Mai, Soft Pulse). A Soft pulse indicates Dampness stagnation and Qi Deficiency. Floating-Soft indicates Wind-Dampness; Deep-Soft indicates Cold-Dampness. Soft combined with Rapid indicates Dampness stagnation transforming into Heat; Soft combined with Choppy indicates Dampness exhaustion transforming into Dryness; Soft combined with Micro indicates Spleen Yang nearing extinction; Soft combined with Fine indicates Spleen Yin nearly dried up.

[Commentary by Xu Xiu] "Ru" is read as "Ruan" (Soft). The pulse is empty, soft, and lacks force, feeling tender and fine to the touch. Light pressure is Floating and Soft, deep pressure is Small and Weak, indicating Spleen channel Dampness stagnation and insufficient Stomach Qi. Although Qi is insufficient, Blood is not yet ruined; it merely contains a soft and stagnant quality. With light pressure coming down, pressing reveals stagnation and lack of flow; with heavy pressure lifting up, raising reveals stagnation and lack of movement. Correlating pulse with syndrome: for Heavy Dampness and Qi stagnation, aromatic and light-drying damp-resolving herbs should be the sovereign, assisted by Qi-regulating and stagnation-guiding herbs. For Persistent Dampness and Qi Deficiency, warm tonification of Middle Qi should be the sovereign, assisted by aromatic and drying herbs to resolve dampness. One must not see a Soft pulse and recklessly use harsh tonification or harsh warming. Only when Soft and Micro is urgent harsh warming needed; when Soft and Fine is urgent harsh tonification needed.

The pulse of Shaoyin disease presents as Fine (Xi Mai, Fine Pulse), sometimes combined with Micro. Fine indicates Yin Deficiency; Micro indicates Yang Deficiency. Cun position Fine and Floating indicates Heart Yin Exhaustion; Chi position Fine and Deep indicates Kidney Yin Extremity Exhaustion. Fine combined with Rapid indicates Yin Deficiency with Fire Hyperactivity; Fine combined with Wiry indicates Water Deficiency and Wood Hyperactivity; Fine combined with Choppy indicates Yin Withered and Yang Knotting; Fine combined with Micro indicates Yin Exhausted and Yang Collapsing. Deep-Fine nearing absence indicates imminent Yin Collapse; Deep-Micro nearing absence indicates impending Yang Collapse.

[Commentary by Xu Xiu] Zhang Zhongjing takes Micro and Fine as the main pulse of Shaoyin disease. Micro indicates Yang Qi衰弱 (decline/weakness); Fine indicates Yin Blood extreme deficiency. Micro means thin, like paper, faint under the finger, indicating Yang Qi Deficiency. Fine means small, like hair, distinct under the finger, indicating Yin Blood Deficiency. Wei Qi moves outside the vessels; Yang Qi Deficiency makes the exterior restraint weak, so the pulse is thin and Micro. Thus, Shaoyin pulse Micro nearing absence is treated by Zhongjing with Tong Mai Si Ni Tang (Pulse-Recovering Cinnamon Twig and Prepared Aconite Decoction) to restore Yang. Ying Qi moves inside the vessels; Yin Blood Deficiency means less substance to fill it, so the pulse is small and Fine. Thus, Jueyin pulse Fine nearing absence is treated by Zhongjing with Dang Gui Si Ni Tang (Angelica Sinensis Cinnamon Twig and Acute Decoction) to save Yin. One restores Yang, the other saves Yin; the two pulses differ in Yin and Yang, requiring careful differentiation. If the physique is robust but the pulse is Fine, with shortness of breath insufficient for respiration, or suffering from heat disease with a Fine pulse and coma unable to maintain consciousness, these are critical signs of the pulse not matching the disease.

The pulse of Jueyin disease presents as Choppy (Se Mai, Choppy Pulse). Choppy indicates Yin Deficiency transforming into Dryness. Initial illness Right Choppy indicates Dampness stagnation and Blood knotting; Chronic illness Left Choppy indicates Blood Deficiency and Essence extremity. Right Cun Floating-Choppy indicates Upper Dryness affecting Qi; Left Guan and Chi Choppy indicates Lower Dryness affecting Blood. Both Cun positions Wiry-Choppy indicate Heart pain and Blood loss; Both Guan positions Wiry-Choppy indicate collateral stasis knotting; Both Chi positions Choppy and Weak indicate Yin and Yang both exhausted. Light pressure Floating-Choppy, deep pressure Rapid-Abundant indicates Yin Deficiency with latent Heat; Light pressure Floating-Large, deep pressure conversely Choppy indicates Yang Abundance with accumulation.

[Commentary by Xu Xiu] The Choppy pulse flows sluggishly, like scraping bamboo with a light knife, or like rain soaking sand, all very descriptive. It arises from Blood Deficiency and fluid Dryness, failing to moisten the meridians, causing vessel obstruction, hence the sluggish and unsmooth flow. Just as objects lacking rain and dew inevitably become dry and rough, humans lacking blood irrigation inevitably become dry and rough. Thus, the Choppy pulse is attributed to diseases of Yin Deficiency transforming into Dryness. This applies only when heat pathogens from the Three Yang channels transmit to the Jueyin channel. If initially seen as Choppy, Rapid, and blurred, it mostly belongs to Phlegm and Food sticking together; or Floating-Choppy, Rapid, and Abundant, it may also indicate Fog injuring the skin and interstices, or Dampness flowing into the joints. Combined with Shanghan Yangming Fu Excess, constipation with Choppy pulse; Warm disease high fever with Choppy pulse; Vomiting/Purging followed by slight wheezing with Choppy pulse; Edema and abdominal distension with Choppy pulse; Xiao Dao (Wasting-Thirst) with great thirst and Choppy pulse; Phlegm patterns with wheezing/fullness and Choppy pulse; Pregnant women with Choppy pulse—all these are signs where the pulse and syndrome contradict each other. Hence, former sages have theories of "Abandoning the Pulse to follow the Syndrome" and "Abandoning the Syndrome to follow the Pulse."