If the pulse and heart rate are not the same, it is considered a knotted substitution pulse from a TCM perspective, where a knotted pulse means that the pulse rate is slow and stops suddenly and with a regular stop. The substitution pulse is the pulse comes to a rapid number and then a stop, but the pause is not regular. Chinese medicine believes that the knot is born in place of death, but from the perspective of modern medicine this method is not necessarily correct. From the perspective of Western medicine, this condition is generally considered to be an arrhythmia, most commonly atrial fibrillation, which is caused by the heart’s ventricles beating faster, but a portion of the pulse does not travel down, resulting in a heart rate faster than the pulse rate. It is also not excluded that it is sinus arrhythmia, atrial premature beats, ventricular premature beats, atrioventricular block, etc. Generally, patients with this condition will have symptoms of chest tightness, palpitations and panic, so it is recommended to check electrocardiogram, cardiac enzymes, or 24h ambulatory electrocardiogram, coronary CT, etc. to clarify the diagnosis.