1. Differentiating and analyzing pulse patterns that reflect pulse position can be categorized into four types: first is the fu mai (floating pulse), second is the bu fu bu chen mai (neither floating nor sinking pulse), third is the chen mai (sinking pulse), and fourth is the fu mai (hidden pulse). The method of differentiation is to first determine the “total finger strength” used to press the cun kou (cun position) to the bone. Then, use the corresponding finger strength to identify where the pulse is located at the cun position. Based on the sequence of the cun pulse in the “five positions,” the changes in pulse position can be accurately identified.For ease of discussion, the finger strength used to press to the bone is temporarily referred to as “total finger strength.” Based on “total finger strength,” one can specifically grasp the corresponding finger strength for examining the five positions. For example, to differentiate the floating pulse, the finger strength used should not exceed two-fifths of the “total finger strength.” To differentiate the sinking pulse, the finger strength should be greater than three-fifths of the “total finger strength.” To differentiate the neither floating nor sinking pulse, the finger strength used should be between two-fifths and three-fifths of the “total finger strength.” If the pulse cannot be touched with the “total finger strength,” and requires more than the “total finger strength” to touch, it is a hidden pulse. Using the above methods, the changes in pulse position can be accurately identified. Other pulse patterns that are based on changes in pulse position are referred to as combined pulses. For example, the ru mai (soft pulse) is “fine and soft” combined with “floating,” while the ruo mai (weak pulse) is “fine and soft” combined with “sinking.” Furthermore, the mai fu shuo (floating and rapid pulse) is a combination of the floating pulse and the rapid pulse, while the mai chen shuo (sinking and rapid pulse) is a combination of the sinking pulse and the rapid pulse. Clearly, these are very accurate methods of differentiation.In analyzing changes in pulse position, it is generally believed that the floating pulse indicates exterior conditions, while the sinking pulse indicates interior conditions; this is a general rule. In clinical practice, if the exterior condition pulse is not floating or the interior condition pulse is not sinking, its diagnostic significance is even more important. It is essential to analyze the general rules of pulse position changes and their special meanings together to fully reflect the diagnostic significance of pulse position changes. For example, in the Shang Han Lun (Treatise on Cold Damage), Article 92 states: “If a patient has fever and headache, and the pulse is sinking, if there is no difference, and the body aches, one should rescue the interior with Si Ni Tang (Four Reverse Decoction).” Article 301 states: “In Shaoyin disease, if it begins with fever and the pulse is sinking, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) is the main treatment.”Both of these articles discuss exterior conditions, but the pulse is not “floating” but rather “sinking.” In this case, the comprehensive analysis of the pulse and symptoms is very important. The first article discusses a patient with fever, headache, and body aches, which belongs to the Taiyang exterior condition, and the pulse should be “floating” but is instead “sinking,” indicating a deficiency of Yang Qi and a heavier interior deficiency, hence the use of Si Ni Tang to rescue the interior, which embodies the concept of resolving the exterior while rescuing the Yang. This illustrates that the Shang Han Lun does not abandon the pulse in favor of the symptoms when the pulse and symptoms do not match, thus reflecting the guiding role of pulse position changes in “differentiating syndromes and treating accordingly.” Article 301 discusses the Tai Shao two-sensation syndrome. The disease is in the Shaoyin, and it should not have fever but does, hence it is termed “reversal.” This “fever” is due to the external invasion of wind-cold at the surface. The sinking pulse indicates that the heart and kidney Yang is insufficient to promote. The Shang Han Lun does not arbitrarily discard the pulse when the pulse and symptoms do not match, but rather analyzes the pathological mechanisms within the “normal” and “abnormal” of the pulse and symptoms, clarifying the internal reasons for the mismatch between pulse position changes and symptoms, and seeking appropriate treatment methods. The internal reason is the usual deficiency of heart and kidney Yang combined with the invasion of wind-cold, hence the use of Ma Huang Fu Zi Xi Xin Tang to resolve both the exterior and interior. These examples illustrate that the analysis of pulse position changes should broaden one’s thinking and not be limited to the general understanding of “certain pulses indicate certain syndromes.” If the pulse and symptoms do not match, a deeper analysis is even more necessary.2. Differentiating and analyzing pulse patterns that reflect changes in “frequency”.Pulse patterns reflecting changes in “frequency” can be categorized into three types: first is the chi mai (slow pulse), second is the normal pulse frequency, and third is the shuo mai (rapid pulse). The complex clinical changes in “frequency” can be classified into these three types. Other pulse patterns that are based on changes in pulse frequency are referred to as combined pulses. For example, the cuo mai (prominent pulse) is a rapid pulse combined with “one stop at a time.” Additionally, the sinking and slow pulse is a combination of the slow pulse and the sinking pulse, while the sinking and rapid pulse is a combination of the rapid pulse and the sinking pulse. Changes in frequency are the easiest to differentiate and can be measured using “breath counting” or “timing methods.” It is generally believed that the normal pulse frequency is between four to five beats per breath. A frequency of three beats per breath or less is considered a slow pulse. A frequency of six beats per breath or more is considered a rapid pulse. According to the timing method, a pulse rate of less than 50 beats per minute is a slow pulse, while a normal frequency is between 60-90 beats per minute; if it exceeds the normal pulse frequency, it is a rapid pulse. The pulse frequency in children should be discussed separately.In analyzing changes in frequency, it is generally believed that the rapid pulse indicates heat, while the slow pulse indicates cold. However, this is merely the most general diagnostic significance of the slow and rapid pulses. Practical experience has shown that the slow and rapid pulses are indeed very useful for analyzing the cold and heat of diseases. In addition, changes in pulse frequency have broader significance. For example, organic and functional changes in the heart, as well as pain syndromes, phlegm syndromes, and fluid syndromes, can all provide diagnostic evidence through changes in pulse frequency. Especially in cases of “pulse and symptoms not matching,” the analysis of frequency changes is particularly important. For instance, in Article 213 of the Shang Han Lun, it states: “In Yangming disease, if the pulse is slow, even if sweating occurs, and there is no aversion to cold, the body must be heavy, with shortness of breath, abdominal fullness, and wheezing, with tidal fever, and if there is a desire to relieve, one can attack the interior. If the hands and feet sweat profusely, this indicates that the stool is hard, and Da Cheng Qi Tang (Major Order the Qi Decoction) is the main treatment.” This article discusses a slow pulse that is neither deficient nor cold, but rather indicates a full heat syndrome in the Yangming organ. In this case, it is essential to analyze the reasons for the slow pulse and not simply consider it as “pulse and symptoms not matching.” Because full heat is obstructed in the interior, and the Qi and blood are stagnant, the Yang Qi is also restrained, which can lead to a slow pulse. Therefore, Da Cheng Qi Tang can be used to purge the full heat and eliminate dryness and obstruction. This illustrates that Traditional Chinese Medicine has a unique understanding of changes in pulse frequency, and it is essential to clarify the causes, nature, disease location, and the diseases they indicate, and to analyze the pathological mechanisms comprehensively to fully reflect the diagnostic significance of frequency changes. For example, the prominent pulse is essentially a rapid pulse with the additional change of “one stop at a time,” indicating “Yang excess and Yin deficiency” or “extreme heat injuring Yin,” which is a method of understanding guided by TCM theory. This shows that although the pulse frequency is merely the number of heartbeats, under the guidance of TCM theory, changes in pulse frequency have very broad diagnostic significance. Therefore, the analysis of frequency changes should reflect the guiding role of TCM theory while also considering that the essence of frequency changes is the variation in heartbeats; combining both aspects can better reflect the diagnostic significance of frequency changes.3. Differentiating and analyzing pulse patterns that reflect the size of the pulse body.Pulse patterns reflecting the size of the pulse body can be categorized into three types: first is the normal pulse body, second is the hong mai (large pulse), and third is the xi mai (fine pulse). The sizes of the pulse body that can be palpated in clinical practice fall into these three categories. Other pulse patterns that are based on the pulse body being “large” or “fine” are referred to as combined pulses. For example, the xū mai (deficient pulse) is a large pulse combined with conditions such as “slow, empty, soft,” etc. The wēi mai (minute pulse) is a fine pulse combined with “soft.” The differentiation of pulse body size is based on the normal pulse body. If it is larger than the normal pulse body, it is classified as a large pulse. If it is smaller than the normal pulse body, it is classified as a fine pulse. The standard for a normal pulse body varies from person to person and can be determined by the method of dividing the “five positions.” For details, refer to Chapter 6, which will not be repeated here. In analyzing the size of the pulse body, it is generally believed that the large pulse indicates fullness and heat, while the fine pulse indicates deficiency. In fact, this is a general rule for the large and fine pulses. In addition, both of these pulse patterns have very broad diagnostic significance. For example, regarding the large pulse, the Mai Xue Chan Wei states: “If this pulse appears after a long period of deficiency, or after deficiency and blood loss, it is a bad sign of Yang excess and Yin depletion.” Although this pulse pattern is a large pulse, it does not necessarily indicate fullness; it can be confirmed as a true organ pulse indicating that “stomach Qi has been exhausted”; otherwise, it may not be a bad sign of “Yang excess and Yin depletion.” This illustrates that the diagnostic significance of the large and fine pulses cannot be generalized. It is essential to combine the combined pulses and clinical manifestations for comprehensive analysis. Ancient physicians determined the deficient and full pulses as commonly used pulse patterns, which is one aspect of the comprehensive analysis of the nature of the large pulse and its associated diseases. Therefore, based on the large pulse, one should further differentiate between deficiency and fullness, and not assume that all large pulses indicate fullness. The analysis methods for pulse patterns and their associated diseases in the Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases) are methods worth advocating. This method combines pulse, disease, symptoms, and treatment, conducting a comprehensive analysis, and flexibly applying pulse diagnosis in clinical practice. This is the most important method to reflect the diagnostic role of pulse diagnosis.4. Differentiating and analyzing the smoothness of the pulse.The hua mai (slippery pulse) and se mai (rough pulse) are pulse patterns that reflect the smoothness of the pulse. The smoothness of the pulse can be categorized into three types: first is the normal smoothness, second is the smoother than normal, which is the slippery pulse, and third is less smooth than normal, which is the rough pulse. Among these, the normal smoothness is a necessary condition for a normal pulse pattern. The slippery and rough pulses indicate that the smoothness of the pulse has changed. Therefore, one can use the comprehensive performance of the normal pulse to understand the normal smoothness of the pulse shape, providing a basis for accumulating experience in differentiating the slippery and rough pulses. The differentiation methods for the slippery and rough pulses are difficult to master. This is because the smoothness of the pulse must be judged based on various changes in the pulse. However, the purpose is not to examine other changes in the pulse but specifically to focus on the smoothness of the pulse. Therefore, differentiating the slippery and rough pulses is relatively difficult. The key technique is to press the finger on the spine of the cun pulse, carefully observing the smoothness of the blood flow within the pulse vessel, and then combining other changes for a comprehensive understanding. If the blood flow within the pulse vessel is smooth and smoother than the normal smoothness, it is a slippery pulse. If the flow is difficult and less smooth than normal, it is a rough pulse. The smoothness of the pulse does not have specific indicators; it is difficult to repeatedly understand based on the comprehensive performance of the normal pulse. Therefore, it is essential to strengthen basic practice and accumulate experience in examining the smoothness of the normal pulse to accurately differentiate the slippery and rough pulses. In analyzing the slippery and rough pulses, it is generally believed that the slippery pulse and rough pulse are relative and have opposite properties. However, their associated diseases and diagnostic significance should not be limited to the “relative” or “opposite” forms. Some pulse texts habitually discuss pulse patterns and their associated diseases in terms of “relative” or “opposite” forms; in fact, this method facilitates the distinction of pulse shapes and properties but does not accurately express the diagnostic significance of pulse patterns. Moreover, if one is rigidly bound to this form, it makes the flexible pulse methods rigid and inflexible, which is not conducive to the important role of pulse diagnosis. For example, the diseases associated with the slippery pulse are mostly due to pathogenic factors, but the diseases associated with the rough pulse can be either deficiency or fullness, and one cannot assume that the slippery pulse indicates “fullness” and therefore the rough pulse must indicate “deficiency.” Furthermore, the diseases associated with the slippery pulse are not necessarily all fullness syndromes. Therefore, the analysis of the diseases associated with the slippery and rough pulses must be based on the specific analysis of the smoothness of the pulse and cannot be generalized.5. Differentiating and analyzing the xian mai (string-like pulse).The string-like pulse reflects the tension of the pulse body, and its essence is the increased tension of the pulse body. If the cun pulse has normal tension, it is generally considered a “wei xian” (slightly string-like), which indicates the presence of stomach Qi, specifically manifested as a string-like pulse with a “gentle” appearance. Not all string-like pulses indicate disease; there are distinctions between those indicating “normal,” “disease,” and “death,” primarily depending on the amount of stomach Qi, which can be differentiated based on the degree of “gentleness” of the string-like pulse. The string-like pulse indicating “disease” is the string-like pulse with “less stomach Qi.” The string-like pulse indicating “death” indicates that stomach Qi has been exhausted, representing the degree of a “true organ pulse,” hence indicating death. The method of differentiating the string-like pulse is to first touch the pulse body, then apply pressure to the pulse body, with the finger feeling characteristics such as “pressing like a bowstring”; if the finger is lifted, the pulse body does not rise with the hand. This is a manifestation of increased tension of the pulse body. The occurrence rate of the string-like pulse is very high, and historical pulse texts have many records regarding the string-like pulse and its associated diseases. It is generally believed that there are physiological and pathological string-like pulses. The physiological string-like pulse corresponds to the liver pulse and the spring season. The pathological string-like pulse is often caused by abnormal dispersal, obstructed Qi mechanism, and disharmony of Qi and blood. Its associated diseases are mostly related to liver and gallbladder disorders or cold syndromes, pain syndromes, phlegm syndromes, Qi stagnation, blood stasis, and hernia pain. In addition to some common diseases, conditions such as fluid retention, hanging fluid, and pestilential heat are also associated with the string-like pulse. The Mai Jing states: “The pulse of malaria is string-like.” The Mai Xue Chan Wei states: “The pulse of hepatitis is often string-like.” This illustrates that ancient physicians’ analysis of the string-like pulse and its associated diseases is closely related to common or frequently occurring diseases, continuously integrating new knowledge and gradually accumulating experience, rather than being rigidly bound to a form of “matching pulse and symptoms.”6. Differentiating and analyzing the jin mai (tight pulse) and huan mai (slow pulse).The tight pulse and slow pulse have opposite properties. The essence of the tight pulse is the “tension” or “constriction” of the pulse body, while the essence of the slow pulse is the “relaxation” or “looseness” of the pulse body. Both of these pulse patterns are pathological; there is no such thing as a “normal pulse” in this context. The method of differentiation is as follows: the tight pulse has a “tense” or “constricted” pulse body, with a finger feeling characteristic of “bouncing left and right” or “like cutting rope.” The slow pulse has a “relaxed” or “loose” pulse body, with a finger feeling characteristic of low “tension” or “elasticity.” The slow pulse should be differentiated from the slow pulse. The Mai Jing warns that later generations should not confuse the slow pulse with the relaxed pulse, stating: “If one considers the relaxed pulse as slow, danger will soon follow.” This serves as a reminder to later generations that the “relaxed pulse” and the slow pulse must be strictly distinguished. Otherwise, misdiagnosis and mistreatment may occur, even leading to serious consequences. The fundamental difference between the two is that the slow pulse examines changes in frequency, while the relaxed pulse examines the degree of “relaxation” or “looseness” of the pulse body. They must never be confused. The tight pulse should be differentiated from the string-like pulse. The difference is that the string-like pulse merely indicates increased tension of the pulse body, feeling like a bowstring. The tight pulse, however, indicates that the pulse body is “tense” or “constricted,” and has the characteristic of “bouncing left and right” or “like cutting rope.” These two pulse patterns have certain differences in shape and degree. Therefore, the string-like pulse can be either a normal or pathological pulse, while the tight pulse is always pathological. Some pulse texts have misunderstood the normative shape and practical significance of the relaxed pulse, leading to some inappropriate analyses of the tight or relaxed pulse. For example, the Zhen Jia Zheng Yan states: “Relaxed is the stomach pulse, not indicating disease, and can only be diagnosed if combined with other observations.” In fact, this misunderstands the concept of the relaxed pulse and the “gentle pulse.” In reality, the “gentle pulse” is the stomach pulse. The relaxed pulse is not the gentle pulse, and these are two concepts that must not be confused. Therefore, stating that the relaxed pulse “does not indicate disease” is incorrect, and saying that “it can only be diagnosed if combined with other observations” is also incorrect. For example, in Article 2 of the Shang Han Lun, it states: “In Taiyang disease, if there is fever, sweating, aversion to wind, and the pulse is relaxed, it is called wind-cold.” This is an instance of diagnosing based solely on the relaxed pulse. This illustrates that the relaxed pulse can be diagnosed without combining it with other pulses. Furthermore, in Article 3 of the Shang Han Lun, it states: “In Taiyang disease, whether there is fever or not, there must be aversion to cold, body pain, and vomiting, and if the pulse is tight in both Yin and Yang, it is called cold damage.” This article corresponds with the second article, illustrating that the tight pulse and relaxed pulse have opposite properties. Therefore, it is necessary to clarify the misunderstandings regarding the relaxed pulse.7. Differentiating and analyzing the length of the pulse.The differentiation of long and short pulses is very simple. According to the operational norms of the “light and heavy pulse holding method,” if the cun pulse is excessively positioned at the cun and chi ends, it is a long pulse. If the cun and chi ends are insufficiently positioned, it is a short pulse. A long pulse generally indicates a strong constitution. Although a short pulse is not a typical pulse, it does not necessarily indicate a pathological pulse. For example, if a short pulse is found in a short person without other discomfort, it may not be considered a pathological pulse. It is generally believed that long pulses associated with diseases mostly indicate fullness, while short pulses mostly indicate deficiency. In fact, this is a general rule. For example, short pulses do not always indicate deficiency; in clinical practice, it is not uncommon for a pulse to be short due to Qi stagnation, Qi counterflow, or obstructed Qi mechanism. Therefore, the differentiation and analysis of long and short pulses and their associated diseases cannot be based solely on general rules and must not be formalized.8. Differentiating and analyzing the san mai (scattered pulse).The scattered pulse can be divided into physiological and pathological types. The physiological scattered pulse is characterized by a “large” pulse body that objectively presents a “scattered” appearance, but the pulse body is rounded and without other discomfort. The pathological scattered pulse has a pulse shape that is not rounded, excessively scattered, or overly broad, even blurring the boundaries between the pulse vessel and surrounding tissues. The main difference between physiological and pathological scattered pulses is the degree of scattering. In modern times, the application of the scattered pulse has decreased. The reason for this is that modern pulse texts have not understood the normative shape and practical significance of the scattered pulse. In modern pulse texts, the scattered pulse is described as “floating and scattered without roots.” This is actually just one degree of the scattered pulse, which can only be seen in critical conditions. In fact, the scattered pulse is not necessarily characterized by “floating and scattered without roots” and is not limited to critical conditions. It can be both a pathological pulse and a normal pulse, and sometimes it can even indicate a favorable sign of recovery. For example, the Suwen Mai Yao Jing Wei Lun states: “If the heart pulse beats long, and the tongue cannot speak, if it is soft and scattered, it indicates recovery. If the lung pulse beats firm and long, and there is blood spitting, if it is soft and scattered, it indicates excessive sweating, leading to no further scattering. If the liver pulse beats firm and long, and the color is not green, it indicates a falling sensation, as blood is under the ribs, causing wheezing. If it is soft and scattered, it indicates fluid retention, which is thirst and excessive drinking, easily entering the skin, muscles, and intestines. If the stomach pulse beats firm and long, and the color is red, it indicates a broken hip, and if it is soft and scattered, it indicates food obstruction. If the spleen pulse beats firm and long, and the color is yellow, it indicates shortness of breath, and if it is soft and scattered, it indicates foot swelling, as if it were water. If the kidney pulse beats firm and long, and the color is yellow and red, it indicates a broken waist, and if it is soft and scattered, it indicates blood deficiency, leading to no recovery.” The so-called soft and scattered refers to the pulse shape of the scattered pulse. Clearly, its associated diseases can vary in severity and can also indicate recovery. The so-called “recovery” indicates improvement in the disease. This illustrates that the scattered pulse should not be considered a pulse pattern only seen in critical conditions.9. Differentiating and analyzing the kāo mai (hollow pulse).The hollow pulse is a special pulse shape. It combines various conditions such as “floating, large, soft, central emptiness, and both sides solid” with the basic characteristics of “central emptiness, soft, and both sides solid.” Its essence is a significant depletion of body fluids and blood, leading to insufficient blood volume in the pulse vessel, resulting in a pulse shape change due to the mismatch between vessel contraction and blood loss. Therefore, the occurrence rate of the hollow pulse in clinical practice is low and often transient. If the hollow pulse appears in chronic diseases, it indicates extremely poor self-regulatory function. The historical development of pulse diagnosis shows that ancient physicians have consistently defined the hollow pulse with the basic characteristics of “central emptiness and both sides solid,” and there is generally no dispute. For example, if a patient has lost blood and presents a hollow pulse, it indicates a mismatch between vessel contraction and blood loss. If the blood loss is excessive, the vessels should contract, and if the body’s blood loss regulatory function is good, the vessel contraction should match the amount of bleeding. If there is a delay in adaptive vessel contraction, it indicates that the blood loss regulatory function is poor. This is a method of analysis used by ancient physicians to reflect the functional state of the body through pulse patterns. This analytical method is of great significance in clinical practice. In clinical practice, special attention should be paid to analyzing the functional state of the body based on changes in pulse patterns; this is one of the important roles of pulse diagnosis that must not be overlooked.10. Differentiating and analyzing the xū (deficient) and shí (full) pulses.The deficient and full pulses are based on the premise of a “large” pulse body. The practical significance of these two pulse patterns is to differentiate deficiency and fullness based on a “large” pulse body. If the pulse body is not “large,” it does not meet the conditions for forming deficient and full pulses. It is generally believed that a “large” pulse body indicates fullness, while a “fine” pulse body indicates deficiency. In fact, this is a general rule. A “large” pulse body does not always indicate fullness; further differentiation and analysis are necessary. The deficient and full pulses are specifically aimed at this situation. The method of differentiation is as follows: based on a “large” pulse body, if it is combined with conditions such as “slow, empty, soft,” it is a deficient pulse, indicating deficiency syndrome. If it is “large and long” combined with a “slightly strong” appearance, it is a full pulse, indicating fullness syndrome. In clinical practice, the pulse bodies that can be palpated, aside from normal pulses, are mostly the large and fine types. The “large” represents a type larger than normal, while the “fine” represents a type smaller than normal. Therefore, differentiating deficiency and fullness based on a “large” pulse body is a very important aspect. Ancient physicians reformed the deficient and full pulses and listed them as commonly used pulse patterns, which is precisely the purpose of this. The historical development of pulse diagnosis can illustrate this point. Since the deficient and full pulses are combined pulses, their nature is very clear, so the analysis of the nature of the diseases associated with the deficient and full pulses is relatively simple; all deficient pulses belong to deficiency syndromes, and all full pulses belong to fullness syndromes.11. Differentiating and analyzing the wēi (minute), ru (soft), and ruò (weak) pulses.The minute, soft, and weak pulses are based on the premise of a “fine and soft” pulse body. Among these, the minute pulse does not combine with other conditions. The soft pulse combines with “floating.” The weak pulse combines with “sinking.” These three pulse patterns have similarities and differences and should be differentiated. If the pulse body is not “fine and soft,” it does not meet the basic conditions for forming these three pulse patterns. Due to misunderstandings in modern pulse texts regarding the normative shape and practical significance of the minute pulse, it is mistakenly believed that the minute pulse can only be seen in critical conditions. Therefore, this has affected the differentiation and analysis of the above three pulse patterns. In fact, from the perspective of normative shape and practical significance, the minute pulse has an allowable range of variation and can have different degrees. Therefore, the minute pulse is not exclusively a pulse pattern seen in critical conditions. The soft and weak pulses both contain the conditions for the minute pulse, that is, the pulse body is “fine and soft.” Based on the “fine and soft” pulse body, if it combines with “floating,” it is a soft pulse; if it combines with “sinking,” it is a weak pulse. This indicates that none of these three pulse patterns are exclusively seen in critical conditions. Therefore, the analysis of these three pulse patterns and their associated diseases should be based on the degree of manifestation at the time and should not be generalized. However, overall, these three pulse patterns reflect a relatively poor physical condition of the patient, indicating insufficient Qi and blood, and are mostly associated with deficiency syndromes or deficiency with some fullness.12. Differentiating and analyzing the dòng mai (moving pulse).The differentiation of the moving pulse is generally done by matching the pulse shape recorded in ancient literature; if it matches, it is a moving pulse, and if it does not, it is not a moving pulse. This method of differentiation is too mechanical and rigid. As a result, very few people have seen a moving pulse. The reason is that the normative shape and practical significance of the moving pulse have not been clarified. Due to the difficulty in understanding the classical pulse diagnosis literature, the practical significance of the moving pulse has been buried. Based on the records in classical literature such as the Shang Han Za Bing Lun and Mai Jing, the practical significance of the moving pulse can be excavated again. It has been confirmed that the moving pulse is a non-sinusoidal heart rhythm pulse shape. Therefore, the differentiation of the moving pulse should be combined with the characteristics of non-sinusoidal heart rhythm pulse shapes, and it should not be strictly matched to the pulse shape recorded in ancient literature; the differentiation method can be flexibly mastered. For example, the Mai Jing states: “The moving pulse is seen at the guan position, without head or tail, like a bean, moving and shaking.” The Mai Jing also states: “If the left hand cun pulse is slightly moving, sometimes large and sometimes small, uneven, from the cun to the guan, from the guan to the chi, the three positions are all moving and shaking differently.” This illustrates that ancient physicians did not differentiate the moving pulse using a single method. As long as it is clear that the moving pulse is a non-sinusoidal heart rhythm pulse shape, differentiating the moving pulse is not difficult and is not uncommon in clinical practice. The analysis of the diseases associated with the moving pulse must be combined with the essence of the moving pulse; if only the pulse shape is analyzed, it often strays too far from the topic.13. Differentiating and analyzing the jié mai (bound pulse).The method of differentiating the bound pulse is very simple; any pulse with “intermittence” is a bound pulse. It should be noted that if the pulse is “rapid” and has intermittent occurrences, it is a cuo mai (prominent pulse). This is a pulse pattern differentiated from the bound pulse, as it has another diagnostic significance and is therefore designated as a specific pulse name. Therefore, the bound pulse and the prominent pulse should be distinguished. The bound pulse primarily reflects arrhythmia, equivalent to modern medicine’s sinus arrest. The prominent pulse, in addition to reflecting arrhythmia, can also reflect changes in the cold-heat attributes of the disease, which is important for differentiating the “reversal” syndrome of cold and heat. The analysis of the bound and prominent pulses and their associated diseases must consider both arrhythmia and reflect the unique theoretical aspects of TCM. This is because TCM has a unique understanding of the changes in pulse patterns associated with arrhythmia. For example, the prominent pulse appears on the basis of a rapid pulse, but TCM believes that this is a pathological mechanism of “Yang excess and Yin deficiency” or “extreme heat injuring Yin,” which is a method of understanding guided by TCM theory.14. Differentiating and analyzing the changes in the pulse.The dài mai (代脉) reflects the changes in the pulse, and differentiating whether the changes in pulse patterns indicate disease and the development of the disease has important implications. However, modern pulse texts have misunderstood the practical significance of the代脉, mistakenly considering it as a pulse pattern of “the pulse comes and stops, with a fixed number, and after a long time, it comes again”; therefore, some pulse texts have strayed too far from the differentiation and analysis of the代脉 and its associated diseases. Based on the records in classical pulse diagnosis literature, the practical significance of the代脉 can be excavated again. It has been confirmed that the代脉 primarily reflects changes in the pulse, which is an important aspect of examining and analyzing pulse patterns. For example, according to the rules of pulse patterns changing with the “four seasons,” the pulse in spring should show a string-like appearance. If the pulse in spring is not string-like, it indicates that the changes in the pulse are abnormal, which is significant for analyzing whether the pulse pattern indicates disease. By this method, one can differentiate whether the pulse patterns throughout the year correspond with the “four seasons” and whether they indicate disease. Additionally, one can conduct a comprehensive analysis based on the theory of the five elements’ mutual generation and mutual restraint to clarify the internal relationship between pulse patterns and symptoms. For example, if a woman is three months pregnant, her pulse should show a slippery appearance. If her pulse is not slippery but rough at three months of pregnancy, it indicates that the changes in the pulse are abnormal, and the fetus is not being nourished. These examples illustrate that differentiating and analyzing the changes in the pulse has very important diagnostic significance. Therefore, the代脉 should not be considered a pulse pattern with intermittent occurrences, as this contradicts the practical significance of the代脉.15. Differentiating and analyzing the changes and transformations of pulse patterns.During the course of a disease, changes or transformations in pulse patterns occur, transitioning from one pulse pattern to another, which ancient physicians referred to as 革脉 (革脉). The changes in the pulse have certain rules, and the changes and transformations in pulse patterns during the course of a disease also have certain rules. The代脉 and革脉 respectively differentiate and analyze pulse patterns based on these two aspects of rules, which is the distinction between革脉 and代脉. When ancient physicians diagnosed pulses, they examined both the changes in the pulse and whether the changes in pulse patterns during the disease process conform to the rules, which is very important for analyzing the pathological mechanisms. The more experience one has, the more significant the importance of these two pulse patterns becomes. However, due to the difficulty in understanding the expressions in the Mai Jing, the practical significance of these two pulse patterns has been buried.According to research, modern pulse texts have buried the practical significance of the代脉 and革脉, causing current pulse diagnosis methods to lose their original flexibility. Moreover, this has had a very negative impact on the full utilization of pulse diagnosis’s diagnostic role. Therefore, when comparing current pulse diagnosis methods with those recorded in classical literature, it is evident that they are inferior.From the records in classical pulse diagnosis literature, the methods of pulse diagnosis established by ancient physicians are not only very practical but also flexible. However, since the Mai Jing, pulse diagnosis has undergone changes, losing its original flexibility and adaptability. It has now been discovered that the main reason for this is the difficulty in understanding the expression methods in classical pulse diagnosis literature, which has buried the practical significance of some pulse names, and the practical techniques of pulse diagnosis have not been fully transmitted. Among them, the革脉 and代脉 are not specifically referring to a certain pulse shape but represent two important methods for differentiating and analyzing changes in pulse patterns. The代脉 is differentiated and analyzed according to the physiological changes in pulse patterns, while the革脉 is differentiated and analyzed according to the pathological changes in pulse patterns. Therefore, the clinical application of these two pulse patterns is the most flexible and adaptable, and can be used to examine whether pulse patterns indicate disease, analyze the internal relationship between pulse patterns and symptoms, and diagnose the development and prognosis of diseases. For example, the Mai Jing states: “The three-position pulse changes; in acute diseases, it indicates life, while in chronic diseases, it indicates death.”There is no doubt that this specifically refers to the changes and transformations in pulse patterns during the course of a disease. It means that if an acute disease causes the pulse to change and transform, it indicates that the body’s adaptability or regulatory function is still good, which is a manifestation of vitality, hence it is said that “acute diseases indicate life.” If the pulse only changes and transforms after a long time of illness, it indicates that the body’s adaptability or regulatory function is poor, which is a manifestation of lack of vitality, hence it is said that “chronic diseases indicate death.” For example, if a patient has excessive blood loss, the pulse should be sinking and fine, which conforms to the development rules. If it does not transform into a sinking and fine pulse, it does not conform to the rules, indicating that the blood loss regulatory function is too poor, which is a manifestation of lack of vitality. As Bian Que said: “If a patient has repeated blood loss, the pulse should become sinking and fine; if it remains floating and large, it indicates death.” The so-called “large and bound” refers to the pulse not changing or transforming, rather than a combination of floating and large pulses with bound pulses. The meaning of Bian Que is that in patients with repeated blood loss, the pulse should change to sinking and fine; if the floating and large pulse does not change to a sinking and fine pulse, it indicates that the blood loss regulatory function is too poor, hence indicating death. The so-called “floating and large” refers to the floating and large pulse not changing or transforming, and not a combination of floating and large pulses with bound pulses. From the records in classical pulse diagnosis literature regarding革脉 and牢脉, if the pulse changes or transforms according to the development rules of the disease, it is革脉. If it does not undergo corresponding changes or transformations, it is牢脉. This illustrates that in clinical practice, examining the changes and transformations of pulse patterns according to the development rules of the disease is of great diagnostic significance. Moreover, the development of diseases has certain rules, and changes in pulse patterns must also follow certain rules; if the changes in pulse patterns do not conform to the development rules of the disease, further differentiation and analysis are required. This is very important for clinical differentiation and must not be overlooked.The above illustrates that the twenty-six commonly used pulse patterns selected and established by ancient physicians each have specific targeting, and their diagnostic significance is very important. However, due to the burial or misunderstanding of some of the twenty-six pulse patterns, the differentiation methods for pulse patterns have been affected, and the analysis of pulse patterns and their associated diseases has also been impacted. Therefore, it is essential to master the differentiation and analysis methods for each pulse pattern based on the normative shape and practical significance of the twenty-six commonly used pulse patterns; this is the foundation for differentiating and analyzing complex pulse patterns.· The End · Warm Reminder:This platform shares health-related graphic information for reference and learning purposes only and does not serve as a basis for medical diagnosis. If needed, please use under the guidance of a physician.⊙ Copyright Statement: The article is sourced from the internet; if there is any infringement, please contact us for removal.
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