Pulse diagnosis includes two parts: pulse diagnosis and pressure diagnosis. Pulse diagnosis involves examining the pulse at specific points; pressure diagnosis involves touching, feeling, and pressing certain areas of the patient’s body to understand the internal changes of diseases or surface reactions, thus obtaining diagnostic information. Let’s take a look at this article together!
1
Pulse Diagnosis
Pulse diagnosis is a method where the practitioner uses their fingertips to press specific areas to examine the pulse. By feeling the pulse, the practitioner can perceive different pulse qualities to understand the patient’s condition and diagnose diseases. It is a unique diagnostic method in Traditional Chinese Medicine (TCM).
(1) Principles of Pulse Formation
The pulse is the manifestation of the pulse wave. The heart governs the blood vessels, which includes both blood and pulse; the pulse is the residence of blood. The heart and pulse are interconnected; the heart’s rhythmic beating propels blood through the vessels, causing the vessels to produce rhythmic pulsations (thus forming the pulse). The movement of blood within the vessels is driven by the vital energy (Zong Qi).
Blood circulates throughout the body, continuously flowing. In addition to the heart’s leading role, there must also be coordination among various organs. The lungs govern the hundred vessels, meaning that the blood vessels circulating throughout the body converge in the lungs, and the lungs govern Qi. Through the distribution of lung Qi, blood can be dispersed throughout the body; the spleen and stomach are the sources of Qi and blood production, with the spleen governing blood; the liver stores blood, regulates circulation, and adjusts blood volume; the kidneys store essence, which transforms into Qi, serving as the fundamental source of Yang Qi in the body. The functional activities of all organs and tissues are driven by this essence, which can also transform into blood, making it one of the material bases for blood production. Therefore, the formation of the pulse is closely related to the Qi and blood of the organs.
(2) Clinical Significance of Pulse Diagnosis
Since the formation of the pulse is closely related to the Qi and blood of the organs, when the Qi and blood or organs undergo pathological changes, the flow of blood and pulse is affected, leading to changes in the pulse. Thus, by examining changes in the pulse, one can determine the location, nature, and the balance of pathogenic and righteous Qi, as well as infer the progression and prognosis of the disease.
1. Determining the Location, Nature, and Balance of Pathogenic and Righteous Qi
Although the manifestations of diseases are extremely complex, in terms of the depth of the disease location, it is either superficial or deep. The floating or sinking nature of the pulse often reflects the depth of the disease location. A floating pulse indicates a superficial disease; a sinking pulse indicates a deep disease. The nature of the disease can be classified into cold and heat patterns, and the rate of the pulse can reflect the nature of the disease. For example, a slow pulse often indicates a cold pattern, while a rapid pulse often indicates a heat pattern. The struggle between pathogenic and righteous Qi produces pathological changes of deficiency and excess, and the strength or weakness of the pulse can reflect the deficiency or excess of the disease. A weak pulse indicates a deficiency of righteous Qi, while a strong pulse indicates an excess of pathogenic Qi.
2. Inferring the Progression and Prognosis of the Disease
Pulse diagnosis has certain clinical significance in inferring the progression and prognosis of diseases. For example, if a long-term illness shows a gradual softening of the pulse, it indicates a recovery of stomach Qi and a sign of improvement; if a long-term illness shows a weak pulse due to Qi deficiency, blood loss, or prolonged diarrhea, it often indicates a dangerous condition of excess pathogenic Qi and deficiency of righteous Qi.
In cases of externally contracted febrile diseases, if the heat gradually subsides and the pulse becomes softer, it is a sign of recovery; however, if the pulse is rapid and the patient is agitated, it indicates a worsening condition.
(3) Locations for Pulse Diagnosis
There are various methods for pulse diagnosis, including the comprehensive method, three positions method, and cun-kou method. The comprehensive method is mentioned in the “Su Wen: San Bu Jiu Hou Lun,” where the pulse is examined at three locations: head, hands, and feet. The three positions method is found in the “Shang Han Za Bing Lun” by Zhang Zhongjing from the Han Dynasty. The three positions refer to the Renying (carotid artery), cun (radial artery), and chi (dorsalis pedis artery). The latter two methods have been less commonly used since the Jin Dynasty, and the cun-kou method has become the standard method for pulse diagnosis. The cun-kou method first appeared in the “Nei Jing,” advocating for the exclusive use of the cun-kou, but this idea was not widely adopted until the “Mai Jing” by Wang Shuhe in the Jin Dynasty popularized the exclusive use of the cun-kou for pulse diagnosis.
The cun-kou, also known as the pulse mouth or Qi mouth, is located at the radial artery behind the wrist. The theoretical basis for exclusively using the cun-kou is that it is the artery of the Taiyin Lung Meridian, where Qi and blood converge. The movement of Qi and blood in the five organs and six bowels all begins and ends in the lungs, so any changes in the organs’ Qi and blood can be reflected in the cun-kou. Additionally, the Taiyin Lung Meridian originates in the middle jiao and is connected to the spleen meridian, which is also Taiyin. The spleen and stomach are the foundation of postnatal Qi and blood production, so the prosperity and decline of the organs’ Qi and blood can also be reflected in the cun-kou. Therefore, exclusively using the cun-kou allows for the examination of changes in the entire body.
The cun-kou is divided into three sections: cun, guan, and chi, marked by the radial styloid process. The section slightly inward is the guan, the section at the wrist is the cun, and the section at the elbow is the chi. Each hand has three sections, making a total of six pulse positions. The cun, guan, and chi can be further divided into floating, middle, and sinking categories, which is the three positions and nine conditions of the cun-kou method.
The division of cun, guan, and chi corresponds to the organs, and different medical practitioners have varying opinions on this. Currently, the following is commonly accepted:
Left cun corresponds to: heart and zhong (pericardium) Right cun corresponds to: lung and chest
Left guan corresponds to: liver and gallbladder Right guan corresponds to: spleen and stomach
Left chi corresponds to: kidney and lower abdomen Right chi corresponds to: kidney and lower abdomen
(4) Methods and Precautions for Pulse Diagnosis
1. Timing
The best time for pulse diagnosis is in the morning, as the patient is not influenced by food, activity, or other factors, and the internal and external environment is relatively calm. The Qi and blood in the vessels are less disturbed, making it easier to discern the pulse. However, this does not mean that pulse diagnosis cannot be performed at other times.
In general, a quiet internal and external environment is required for pulse diagnosis. Before the diagnosis, the patient should rest for a moment to calm the Qi and blood, and the practitioner should also be calm before starting the diagnosis. The examination room should be kept quiet. In special circumstances, the practitioner can examine the patient at any time and place without being bound by these conditions.
2. Position
The patient should be seated or lying flat, with the arms resting at the same level as the heart, the wrists straight, and the palms facing up, with a cushion under the wrist joint. This allows for unobstructed Qi and blood flow, reflecting the true pulse of the body.
3. Finger Technique
The practitioner and patient sit facing each other. The practitioner uses their left hand to press the patient’s right hand and their right hand to press the patient’s left hand. When pressing the pulse, the practitioner first places the middle finger on the inner side of the radial styloid process, then the index finger on the cun position, and the ring finger on the chi position. Once the positions are correctly placed, the three fingers should be arched, with the fingertips aligned, and the pads of the fingers should contact the pulse. The spacing of the fingers should correspond to the patient’s height; taller individuals should have wider spacing, while shorter individuals should have closer spacing, with a moderate approach being ideal. The three fingers should apply simultaneous pressure, known as total pressure; to focus on a specific pulse quality, one finger can be lifted slightly while pressing the other two fingers. For example, to focus on the cun pulse, slightly lift the middle and ring fingers; to examine the guan pulse, slightly lift the index and ring fingers; to examine the chi pulse, slightly lift the index and middle fingers. In clinical practice, total pressure and single pressure are often used in combination, making this comparative method of pulse diagnosis quite practical. Single pressure can be used to assess which meridian and organ the disease is affecting, while total pressure is used to examine the changes in the five organs and six bowels.
For pediatric pulse diagnosis, the “one-finger (thumb) method” can be used, without dividing into three sections, as the pediatric cun-kou is short and does not allow for three fingers to be placed.
4. Lifting and Pressing
This is a technique used during pulse diagnosis to explore the pulse quality by varying the pressure and movement of the fingers. The key to pulse diagnosis involves three actions: lifting, pressing, and searching. Light pressure on the skin is called lifting, also known as floating or light taking; heavy pressure on the muscles and bones is called pressing, also known as sinking or heavy taking; moderate pressure can be both light and heavy, called searching. Therefore, it is essential to pay attention to the changes in the pulse quality during lifting, pressing, and searching. Additionally, when the three pulse positions show distinct differences, the finger positions should be gradually adjusted to explore both internal and external aspects. Searching means to seek, not to take in the middle.
5. Calmness
One breath consists of one inhalation and one exhalation. During pulse diagnosis, the practitioner’s breathing should be natural and even, using the time of one breath to count the patient’s pulse rate, such as the normal pulse and pathological pulse rates of slow, rapid, etc., all counted by breath. Today, a stopwatch can assist in pulse diagnosis. However, the significance of calmness goes beyond this. Calmness also means to maintain a focused mind and full concentration during pulse diagnosis. Therefore, calmness not only involves counting the pulse by breath but also requires an open mind and complete concentration.
6. Fifty Pulsations
Each pulse diagnosis must consist of at least fifty pulsations. This means that the time spent on each side of the pulse should not be less than fifty beats. This has two significances:
First, it helps to ensure that there are no missed diagnoses of rapid, knotted, or intermittent pulses. Second, it emphasizes that pulse diagnosis should not be rushed; the goal is to clarify the pulse quality. If the first fifty pulsations do not yield clear results, the practitioner may extend the examination to the second or third set of fifty pulsations. In general, each pulse diagnosis should last 2-3 minutes.
(5) Normal Pulse Qualities
The normal pulse, known as the ping pulse, is the pulse of a healthy person without disease. The characteristics of a normal pulse are that all three positions have a pulse, with a rate of four beats per breath (or five beats for a leap year, equivalent to 72-80 beats per minute), not floating or sinking, not large or small, calm and gentle, soft yet strong, with a consistent rhythm. The chi pulse should be taken with a certain strength and may vary with the main activities and environmental conditions.
Normal pulse qualities have three characteristics:
Presence of Stomach Qi: A pulse with Stomach Qi, as described by ancient practitioners, generally means that a normal pulse is neither floating nor sinking, neither fast nor slow, calm and gentle, with a consistent rhythm, indicating the presence of Stomach Qi. Even if the pulse is floating or sinking, if it shows a gentle quality, it indicates the presence of Stomach Qi.
If the pulse has Stomach Qi, it is a normal pulse; if it has little Stomach Qi, it indicates a pathological change; if it has no Stomach Qi, it is a true organ pulse, which may be difficult to treat or untreatable. Therefore, the presence or absence of Stomach Qi is significant for judging the prognosis of diseases.
Presence of Spirit: A pulse with spirit is characterized by a gentle pulse. For example, a strong pulse may still carry a gentle quality; a weak pulse that is not completely powerless is also considered to have spirit. The presence or absence of spirit is significant for judging the prognosis of diseases.
However, it must be combined with the voice, color, and form to make a correct conclusion. The presence of Stomach Qi and spirit both indicate a harmonious quality; thus, in clinical practice, the diagnosis of Stomach Qi and spirit is similar.
Presence of Root: A strong sinking pulse in the three positions indicates the presence of root. If the kidney Qi is still present during illness, and the innate foundation is not exhausted, a strong sinking chi pulse can still be felt, indicating vitality. If the pulse is floating, large, and chaotic, and pressing it reveals nothing, it indicates a lack of root, signifying a critical condition.
Normal pulse qualities can change physiologically due to internal and external factors.
Seasonal Climate: Due to climatic influences, the normal pulse changes with the seasons: spring shows a string-like pulse, summer a surging pulse, autumn a floating pulse, and winter a sinking pulse. This reflects the correspondence between humans and nature, as the physiological functions of the body also change with the seasonal climatic variations.
Geographical Environment: The geographical environment can also affect the pulse. For example, in the south, where the climate is warm and humid, the muscles are relaxed, leading to a finer and softer pulse; in the north, where the terrain is high and the air is dry and cold, the muscles are tense, leading to a sinking and solid pulse.
Gender: Women’s pulses are generally softer and slightly faster than men’s. After marriage and during pregnancy, women’s pulses often appear slippery and rapid.
Age: The younger the individual, the faster the pulse. Infants have a pulse rate of 120-140 beats per minute; children aged five to six have a pulse rate of 90-110 beats per minute; as age increases, the pulse rate gradually slows. Young adults have strong pulses, while the elderly have weaker pulses due to Qi and blood deficiency.
Body Type: Tall individuals have longer pulse manifestations; shorter individuals have shorter pulse manifestations. Thin individuals with less muscle often have floating pulses, while obese individuals with thick subcutaneous fat often have sinking pulses. Commonly seen six pulses that are sinking and fine without disease are called six Yin pulses; six pulses that are large and strong without disease are called six Yang pulses.
Emotions: Temporary emotional stimuli can also cause changes in the pulse. For example, joy can harm the heart and lead to a slow pulse, anger can harm the liver and lead to a rapid pulse, and fright can disturb the Qi and cause erratic pulses. This indicates that emotional changes can lead to pulse changes, but once emotions return to calm, the pulse will also return to normal.
Labor and Rest: Intense exercise or long journeys often result in a rapid pulse; during sleep, the pulse tends to slow down; individuals engaged in mental labor often have weaker pulses than those engaged in physical labor.
Diet: After meals or alcohol consumption, the pulse is often more vigorous; when hungry, it tends to be slower and weaker.
Additionally, some individuals may have pulses that are not felt at the cun-kou but appear at the chi position, referred to as slanting flying pulses; if the pulse appears on the dorsal side of the cun-kou, it is called reverse guan pulse. There are also other anatomical variations of the radial artery that do not belong to pathological pulses.
(6) Pathological Pulse Qualities
Diseases are reflected in changes in the pulse, referred to as pathological pulses. Generally, any pulse that falls outside the normal physiological range or individual physiological variations is considered a pathological pulse. Different pathological pulses reflect different diseases. The earliest pulse study book in China, “Mai Jing,” proposed twenty-four types of pulses, while “Jing Yue Quan Shu” proposed sixteen types, and “Bin Hu Mai Xue” proposed twenty-seven types. Li Shicai’s “Zhen Jia Zheng Yan” added more pathological pulses, leading to modern discussions of twenty-eight types of pulses.
Pulses are examined through four aspects: position, rate, shape, and force. Position refers to the depth of the pulse beneath the skin.
Pulse positions are divided into floating and sinking; those that are shallow and easily felt are floating pulses, while those that are deep and felt only with pressure are sinking pulses. Rate refers to the speed of the pulse; a pulse rate of less than four beats per breath is considered slow, while a rate of five or six beats per breath is considered rapid. Shape refers to the thickness and special characteristics of the pulse, such as a hollow pulse resembling a scallion tube or a pulse resembling a bean. Force refers to the strength or power of the pulse, distinguishing between deficiency and excess. A strong pulse indicates excess, while a weak pulse indicates deficiency.
Among the twenty-eight pathological pulses, there are single pulses and compound pulses. Some pulses exhibit only single changes in position, rate, shape, or force, such as floating and sinking pulses reflecting changes in position, while slow and rapid pulses reflect changes in rate. These single changes form what is known as single pulses.
Many pulses require comprehensive examination of position, rate, shape, and force to differentiate. For example, a weak pulse may be formed by a combination of a sinking, fine, small, and weak pulse, while a strong pulse may be formed by a combination of sinking, solid, large, string-like, and long pulses. A floating, large, and forceful pulse is known as a surging pulse. Such pulses formed by two or more changes are called compound pulses. Single pulses often cannot fully reflect the essence of the disease, while compound pulses can reflect the disease situation from multiple aspects. In addition to the twenty-eight pulses mentioned above, various combinations of pulses often appear, such as floating-tight, floating-slow, sinking-fine, slippery-rapid, etc.
1. Classification of Pulse Qualities and Associated Diseases
(1) Floating Pulse Types Floating pulse types include floating, surging, soft, scattered, hollow, and leather pulses. Because their pulse positions are shallow and can be easily felt, they are grouped together.
① Floating Pulse
[Pulse Quality] Easily felt with light pressure, slightly reduced with heavy pressure but not empty, floating like wood on water.
[Associated Diseases] Exterior syndrome, deficiency syndrome.
[Pulse Theory] Floating pulses indicate exterior conditions, reflecting that the pathogenic factor is located in the meridians and superficial layers. The pathogenic factor invades the skin, causing the defensive Yang to rise and resist, resulting in a floating and forceful pulse. In cases of internal injury and prolonged illness leading to Qi deficiency, the Yang Qi cannot be contained and rises to the surface, resulting in a floating pulse that is often large and weak.
② Surging Pulse
[Pulse Quality] Extremely large, resembling surging waves, strong on arrival and weak on departure.
[Associated Diseases] Internal heat syndrome.
[Pulse Theory] The surging pulse forms due to excess Yang Qi, Qi stagnation, and internal heat, causing the pulse vessels to expand and blood to surge, resulting in a surging pulse. If a surging pulse appears in cases of prolonged illness with Qi deficiency or blood loss, it indicates a dangerous condition of excess pathogenic Qi and deficiency of righteous Qi, or depletion of Yin fluids, leading to solitary Yang Qi rising. At this time, the floating pulse is surging, while the sinking pulse is weak and lacks vitality.
③ Soft Pulse
[Pulse Quality] Floating and fine, like silk in water.
[Associated Diseases] Deficiency syndrome, damp syndrome.
[Pulse Theory] Soft pulses are primarily associated with deficiency. If both essence and blood are injured, and Yin deficiency cannot support Yang, the pulse becomes floating and soft. If Qi deficiency leads to Yang decline, the pulse also becomes floating and soft. If dampness obstructs the pulse vessels, a soft pulse may also be observed.
④ Scattered Pulse
[Pulse Quality] Floating and scattered without root, with an irregular rate, resembling scattered willow fluff.
[Associated Diseases] Dispersed Yuan Qi.
[Pulse Theory] Scattered pulses indicate that Yuan Qi is dispersed, a critical condition where the Qi of the organs is about to collapse. Due to heart failure, Yin and Yang cannot be contained, leading to the pulse being floating and scattered without tension. If pressure is applied, it may not be felt, indicating a lack of root; if Yin declines and Yang dissipates, the pulse may come and go irregularly.
⑤ Hollow Pulse
[Pulse Quality] Floating and large, with a hollow center, like pressing a scallion tube.
[Associated Diseases] Blood loss, Yin injury.
[Pulse Theory] Hollow pulses are often seen in cases of blood loss and Yin injury, indicating a loss of blood and insufficient filling of the pulse vessels. Sudden and excessive blood loss leads to a rapid decrease in blood volume, resulting in insufficient nourishment for the pulse, or significant loss of fluids leading to insufficient blood filling. The loss of Yin and blood results in Yang Qi floating to the surface, forming a large and hollow floating pulse.
⑥ Leather Pulse
[Pulse Quality] Floating and strong, with a hollow center and firm exterior, like pressing a drum skin.
[Associated Diseases] Blood loss, loss of essence, postpartum conditions, or leakage.
[Pulse Theory] Leather pulses are a combination of string-like and hollow pulses, resulting from internal deficiency of essence and blood, causing Qi to float to the surface. This is due to the constraining effect of cold Yin, resulting in a strong exterior and hollow interior.
(2) Sinking Pulse Types Sinking pulse types include sinking, hidden, weak, and firm pulses. These pulses are deeper and can only be felt with heavy pressure, thus they are grouped together.
① Sinking Pulse
[Pulse Quality] Not felt with light pressure, only felt with heavy pressure, like a stone sinking to the bottom of the water.
[Associated Diseases] Internal syndrome. It can also be seen in normal individuals without disease.
[Pulse Theory] When the pathogenic factor is internal, the righteous Qi is engaged internally, and Qi and blood are constrained, resulting in a sinking and forceful pulse, indicating an internal excess syndrome. If the organs are weak and Yang Qi is deficient, leading to insufficient Qi and blood, the pulse will be sinking and weak, indicating an internal deficiency syndrome.
② Hidden Pulse
[Pulse Quality] Only felt with heavy pressure on the muscles and bones, and may be hidden and not felt at all.
[Associated Diseases] Obstruction, critical conditions, severe pain.
[Pulse Theory] Due to the internal presence of pathogenic Qi, the pulse Qi cannot circulate, leading to a hidden pulse. If Yang Qi is weak and about to collapse, it may also present as a hidden pulse. The former is often seen in cases of acute illness, while the latter is often seen in chronic conditions with declining righteous Qi.
③ Weak Pulse
[Pulse Quality] Extremely soft and fine.
[Associated Diseases] Deficiency of Qi, blood, Yin, and Yang.
[Pulse Theory] Weak pulses occur due to insufficient Yin and blood, which cannot fill the pulse vessels. Yang is weak, and there is insufficient force to promote blood circulation, resulting in a sinking and fine pulse.
④ Firm Pulse
[Pulse Quality] Firm and large, with a strong and unyielding quality.
[Associated Diseases] Cold and Yin accumulation, internal excess.
[Pulse Theory] Firm pulses form due to the solidification of pathogenic Qi and internal accumulation of cold, causing Yang Qi to sink. Thus, the pulse is firm and large, remaining strong and unyielding. Firm pulses indicate the presence of Qi and blood, and may indicate solid masses or lumps in the blood; if there are no visible lumps, it indicates solid masses in the Qi.
(3) Slow Pulse Types Slow pulse types include slow, relaxed, rough, and knotted pulses. These pulses are characterized by a slower rate, with less than four to five beats per breath, thus they are grouped together.
① Slow Pulse
[Pulse Quality] The pulse is slow, with less than four beats per breath (equivalent to a pulse rate of less than 60 beats per minute).
[Associated Diseases] Cold syndrome. A slow and forceful pulse indicates cold pain or cold accumulation, while a slow and weak pulse indicates deficiency cold. Athletes who have trained for a long time may have a slow and forceful pulse, which is not considered pathological.
[Pulse Theory] Slow pulses indicate cold syndrome, resulting from insufficient Yang Qi to promote blood circulation. If cold accumulates and obstructs, leading to poor blood flow, the pulse may be slow and forceful. If Yang is deficient and cold, the pulse is often slow and weak. If pathogenic heat accumulates, it may also present as a slow pulse, but it must be forceful.
② Relaxed Pulse
[Pulse Quality] Four beats per breath, with a slow and relaxed quality.
[Associated Diseases] Damp syndrome, spleen and stomach weakness.
[Pulse Theory] Dampness obstructs the Qi mechanism, leading to a relaxed pulse. If the spleen and stomach are weak, Qi and blood are insufficient, leading to a relaxed pulse. A relaxed pulse indicates sufficient Qi and blood, with unobstructed vessels. If the pulse becomes relaxed during illness, it indicates a recovery of righteous Qi.
③ Rough Pulse
[Pulse Quality] Slow, fine, and short, with a rough quality, not flowing smoothly, like a light knife scraping bamboo.
[Associated Diseases] Deficiency of essence and blood, Qi stagnation, phlegm, and food retention.
[Pulse Theory] Rough pulses occur due to deficiency of essence and blood, leading to insufficient nourishment of the pulse vessels. If Qi is insufficient, it cannot promote blood circulation, resulting in a rough pulse. If Qi stagnates, blood clots, phlegm, or food retention obstructs the Qi mechanism, the pulse may also be rough.
④ Knotted Pulse
[Pulse Quality] The pulse is slow, with intermittent stops, and the stops are irregular.
[Associated Diseases] Excess Yin, Qi stagnation, cold phlegm, and blood stasis.
[Pulse Theory] Knotted pulses occur due to excess Yin and Qi stagnation, leading to obstruction of blood flow. The pulse comes slowly, with irregular stops, often seen in cases of cold phlegm and blood stasis. Knotted pulses can also be seen in deficiency syndromes, often due to prolonged illness and Qi and blood deficiency, leading to intermittent stops.
(4) Rapid Pulse Types Rapid pulse types include rapid, urgent, hurried, and moving pulses. These pulses are characterized by a faster rate, with more than five beats per breath, thus they are grouped together.
① Rapid Pulse
[Pulse Quality] The pulse comes with more than five beats per breath.
[Associated Diseases] Heat syndrome. A forceful pulse indicates excess heat, while a weak pulse indicates deficiency heat.
[Pulse Theory] Rapid pulses occur due to internal heat, leading to accelerated blood flow. If the heat is excessive and the righteous Qi is not deficient, the pulse is rapid and forceful, indicating an excess heat syndrome. If prolonged illness has depleted Yin, leading to internal heat, the pulse may be rapid but weak. If the pulse is floating and rapid, with no root upon heavy pressure, it indicates a dangerous condition of deficient Yang Qi.
② Urgent Pulse
[Pulse Quality] The pulse comes rapidly, with seven to eight beats per breath.
[Associated Diseases] Extreme Yang and depleted Yin, indicating imminent loss of Yuan Yang.
[Pulse Theory] Urgent pulses indicate excessive heat, leading to a rapid pulse. If Yin fluids are depleted, the pulse may be rapid and weak.
③ Hurried Pulse
[Pulse Quality] The pulse is rapid, with intermittent stops.
[Associated Diseases] Excessive Yang heat, Qi stagnation, phlegm, and food retention.
[Pulse Theory] Hurried pulses occur due to excessive Yang heat or Qi stagnation, leading to rapid blood flow. The pulse may come rapidly and stop intermittently, indicating a critical condition.
④ Moving Pulse
[Pulse Quality] The pulse is like a bean, moving and shaking, slippery and rapid.
[Associated Diseases] Pain syndromes, shock syndromes. Moving pulses may appear during pregnancy, which can be valuable for early clinical diagnosis.
[Pulse Theory] Moving pulses indicate a disturbance in the balance of Yin and Yang, leading to erratic blood flow. Pain and shock can also lead to moving pulses.
(5) Deficient Pulse Types Deficient pulse types include deficient, fine, weak, intermittent, and short pulses, characterized by weak pulsations.
① Deficient Pulse
[Pulse Quality] The pulse is weak at all three positions, feeling empty upon pressure.
[Associated Diseases] Deficiency syndrome.
[Pulse Theory] Deficient pulses occur due to insufficient Qi to circulate blood, leading to a weak pulse. If Qi is deficient, it cannot contain blood, leading to a relaxed pulse.
② Fine Pulse
[Pulse Quality] The pulse is fine like a thread, but the pulsations are distinct.
[Associated Diseases] Deficiency of Qi and blood, various deficiencies, and damp syndrome.
[Pulse Theory] Fine pulses occur due to deficiency of Qi and blood, leading to insufficient nourishment of the pulse vessels.
③ Weak Pulse
[Pulse Quality] Extremely fine and soft, almost imperceptible.
[Associated Diseases] Deficiency of Qi, blood, and Yin.
[Pulse Theory] Weak pulses occur due to severe deficiency of Qi and blood, leading to an inability to fill the pulse vessels.
④ Intermittent Pulse
[Pulse Quality] The pulse comes with stops, with a fixed number of stops.
[Associated Diseases] Weak organ Qi, wind syndrome, pain syndrome.
[Pulse Theory] Intermittent pulses occur due to weak organ Qi, leading to an inability to maintain a continuous pulse.
⑤ Short Pulse
[Pulse Quality] The pulse is short at both ends, unable to fill the entire area.
[Associated Diseases] Qi disease. A forceful pulse indicates Qi stagnation, while a weak pulse indicates Qi deficiency.
[Pulse Theory] Short pulses occur due to insufficient Qi to circulate blood, leading to a short and weak pulse.
(6) Excess Pulse Types Excess pulse types include excess, slippery, string-like, tight, and long pulses, characterized by strong pulsations.
① Excess Pulse
[Pulse Quality] The pulse is strong and forceful at all three positions.
[Associated Diseases] Excess syndrome.
[Pulse Theory] Excess pulses occur due to excessive pathogenic Qi and sufficient righteous Qi, leading to a strong and forceful pulse.
Normal individuals may also exhibit excess pulses, indicating sufficient righteous Qi and good organ function. Normal individuals’ excess pulses should be calm and gentle, unlike the excessive and hard pulses seen in pathological conditions.
② Slippery Pulse
[Pulse Quality] The pulse flows smoothly, like beads rolling on a plate, with a round and smooth quality.
[Associated Diseases] Phlegm, food retention, and excess heat.
[Pulse Theory] Slippery pulses occur due to internal obstruction of pathogenic Qi, leading to a smooth and flowing pulse.
③ String-like Pulse
[Pulse Quality] The pulse is straight and long, like pressing a guitar string.
[Associated Diseases] Liver and gallbladder diseases, phlegm, pain syndromes, and malaria.
[Pulse Theory] String-like pulses indicate tension in the pulse Qi. The liver governs the flow and regulation of Qi, and if the Qi is obstructed, it may present as a string-like pulse.
④ Tight Pulse
[Pulse Quality] The pulse is tense and tight, resembling a taut rope.
[Associated Diseases] Cold syndrome and pain syndromes.
[Pulse Theory] Tight pulses occur due to cold invasion and obstruction of the Qi, leading to a tense pulse.
⑤ Long Pulse
[Pulse Quality] The pulse is long at both ends, extending beyond its normal position.
[Associated Diseases] Excessive liver Yang, heat, and other excess conditions.
[Pulse Theory] In healthy individuals, the pulse is long and gentle, indicating sufficient righteous Qi. If liver Yang is excessive, leading to internal heat, the pulse may become long and hard, indicating a pathological condition.
(2) Combined Pulses and Associated Diseases
Combined pulses refer to the simultaneous presence of multiple pulse qualities. Xu Lingtai referred to this as combined pulses, which can be divided into two-combined, three-combined, and four-combined pulses.
The associated diseases of combined pulses often correspond to the sum of the diseases indicated by each pulse. For example, a floating pulse indicates an exterior condition, while a rapid pulse indicates heat; thus, a floating and rapid pulse indicates an exterior heat condition. Below are some common combined pulses and their associated diseases:
1. Combined Pulse: Floating and Tight. Associated Disease: Exterior cold, wind obstruction.
2. Combined Pulse: Floating and Relaxed. Associated Disease: Exterior deficiency syndrome.
3. Combined Pulse: Floating and Rapid. Associated Disease: Exterior heat.
4. Combined Pulse: Floating and Slippery. Associated Disease: Wind-phlegm, exterior syndrome with phlegm.
5. Combined Pulse: Sinking and Slow. Associated Disease: Internal cold.
6. Combined Pulse: String-like and Rapid. Associated Disease: Liver heat, liver fire.
7. Combined Pulse: Slippery and Rapid. Associated Disease: Phlegm-heat, internal heat with food retention.
8. Combined Pulse: Surging and Rapid. Associated Disease: Qi heat.
9. Combined Pulse: Sinking and String-like. Associated Disease: Liver Qi stagnation, water retention.
10. Combined Pulse: Sinking and Rough. Associated Disease: Blood stasis.
11. Combined Pulse: String-like and Fine. Associated Disease: Liver and kidney Yin deficiency, liver Qi stagnation and spleen deficiency.
12. Combined Pulse: Sinking and Relaxed. Associated Disease: Spleen deficiency, water retention.
13. Combined Pulse: Sinking and Fine. Associated Disease: Yin deficiency, blood deficiency.
14. Combined Pulse: String-like, Slippery, and Rapid. Associated Disease: Liver fire with phlegm, internal phlegm-heat.
15. Combined Pulse: Sinking, Fine, and Rapid. Associated Disease: Yin deficiency, blood deficiency with heat.
16. Combined Pulse: String-like and Tight. Associated Disease: Cold pain, cold stagnation in the liver meridian.
(7) Pediatric Pulse Diagnosis
Pediatric pulse diagnosis differs from that of adults, as the pediatric cun-kou is small and difficult to divide into three sections. Additionally, children are prone to fright and crying during diagnosis, which can disturb the pulse quality, making it difficult to assess. Therefore, later practitioners often use a single finger to assess all three sections. The method involves the practitioner holding the child’s hand with their left hand and pressing the child’s pulse with their right thumb, dividing it into three sections to determine the pulse rate. For children over four years old, the midpoint of the radial styloid process is used as the guan, and a single finger is rolled to search for the three sections; for children aged seven to eight, the thumb can be moved to examine the three sections; for children aged nine to ten, the three sections can be examined in order; and for those aged sixteen, the adult method of examining the three sections is used.
The pulse qualities in children are primarily determined by floating, sinking, slow, and rapid, indicating exterior, interior, cold, and heat conditions, respectively. The presence of strength or weakness indicates deficiency or excess, without needing to detail the twenty-eight pulses. It should also be noted that children’s kidney Qi is not fully developed, and the pulse may stop at the middle position. Regardless of whether the pulse is floating or sinking, if it is only felt with heavy pressure, it is similar to the firm pulse seen in adults.
The magical method of fingerprint diagnosis in children, observing the fingerprints, is particularly accurate for children.
(8) Pulse and Syndrome Correspondence and Reversal
1. Pulse and Syndrome Correspondence: The correspondence between pulse and syndrome refers to the relationship between the pulse and the corresponding syndrome in determining the disease’s progression. Generally, the pulse and syndrome are consistent, meaning that the pulse corresponds to the syndrome. However, there are times when the pulse and syndrome do not match, indicating a reversal.
From the perspective of determining the disease’s progression, when the pulse and syndrome correspond, it indicates a favorable prognosis; when they do not correspond, it indicates an unfavorable prognosis. Generally, if there is an excess syndrome, the pulse may be surging, rapid, slippery, or strong, indicating a favorable prognosis, suggesting that the pathogenic factor is strong and the righteous Qi is sufficient to resist it. If the pulse is fine, weak, or weak, it indicates an unfavorable prognosis, suggesting that the pathogenic factor is strong and the righteous Qi is weak, making it easy for the pathogenic factor to invade. For example, in acute illnesses, if the pulse is floating, surging, rapid, or strong, it indicates a favorable prognosis, reflecting that the righteous Qi is strong enough to resist the pathogenic factor; in chronic illnesses, if the pulse is sinking, fine, weak, or weak, it indicates a favorable prognosis, suggesting that the pathogenic factor is weak and the righteous Qi is recovering. If a new illness presents with a sinking, fine, weak, or weak pulse, it indicates that the righteous Qi is already weak; if a chronic illness presents with a floating, surging, rapid, or strong pulse, it indicates that the righteous Qi is weak and the pathogenic factor is not retreating, indicating an unfavorable prognosis.
2. Pulse and Syndrome Reversal: Since there are cases where the pulse and syndrome do not correspond, one must discern the true and false nature of the pulse and syndrome to determine whether to prioritize the pulse or syndrome. In cases where the syndrome is true and the pulse is false, one should prioritize the syndrome; in cases where the syndrome is false and the pulse is true, one should prioritize the pulse.
Prioritizing the Pulse over the Syndrome: In cases where the syndrome is true and the pulse is false, one should prioritize the syndrome. For example, if the syndrome shows abdominal distension, pain, and refusal to press, with constipation, red tongue, and thick yellow coating, while the pulse is slow and fine, it indicates that the syndrome reflects an internal heat condition, which is true; the pulse reflects a false appearance due to the heat obstructing blood flow, leading to a slow and fine pulse. In this case, one should prioritize the syndrome over the pulse.
Prioritizing the Syndrome over the Pulse: In cases where the syndrome is false and the pulse is true, one should prioritize the pulse. For example, in cases of cold damage, if the syndrome shows cold limbs while the pulse is slippery and rapid, the pulse reflects true heat; the syndrome reflects false cold due to the internal heat obstructing the flow of Qi, leading to cold limbs. In this case, one should prioritize the pulse over the syndrome.