Pulse diagnosis includes two parts: pulse diagnosis and pressure diagnosis. Pulse diagnosis involves examining the pulse; pressure diagnosis involves touching, feeling, and pressing specific areas of the patient’s body to understand the internal changes of diseases or surface reactions, thereby obtaining diagnostic information.
1. Pulse Diagnosis
Pulse diagnosis is a unique method in Traditional Chinese Medicine (TCM) where the practitioner uses their fingertips to palpate specific pulse points. By examining the pulse, the practitioner can perceive different pulse patterns in the patient to understand their condition and diagnose diseases. It is a distinctive diagnostic method in TCM.
(1) Principles of Pulse Formation
The pulse pattern is the manifestation of the pulse’s movement. 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, and besides the heart’s leading role, there must 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 disperse 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 its circulation, and adjusts blood volume; the kidneys store essence, which transforms into qi, serving as the fundamental source of yang qi in the body and the driving force for the functional activities of all organs. The formation of pulse patterns is closely related to the qi and blood of the organs.(2) Clinical Significance of Pulse DiagnosisSince the formation of pulse patterns is closely related to the qi and blood of the organs, when the qi and blood or organs undergo pathological changes, the circulation of blood is affected, leading to changes in pulse patterns. Therefore, by observing changes in pulse patterns, one can determine the location, nature, and the balance of pathogenic and righteous qi, as well as infer the progression and prognosis of diseases.1. Determining the location, nature, and balance of pathogenic and righteous qiAlthough 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 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 divided into cold and heat patterns, and the speed 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 diseasesPulse 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 that the stomach qi is gradually recovering, and the disease is retreating towards recovery; if a long-term illness shows qi deficiency, weakness, or blood loss, and the pulse is flooding, 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 shows a softening pattern, it is a sign of impending recovery; however, if the pulse is rapid and urgent, it indicates a worsening condition (for example, if there is profuse sweating, a quiet pulse, and coolness of the body, it indicates recovery; if the pulse is rapid and urgent, it indicates a worsening condition).
(3) Locations for Pulse Diagnosis
There are various methods for pulse diagnosis, including the comprehensive method, the three positions method, and the cun-kou method. The comprehensive method is mentioned in the “Su Wen: San Bu Jiu Hou Lun,” where the pulse points include the 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 (cervical artery), cun (cuntou), and chi (dorsalis pedis artery). The two pulse diagnosis methods mentioned above have been less commonly used in later generations. Since the Jin Dynasty, the commonly used pulse diagnosis location has been the cun-kou. The cun-kou method first appeared in the “Nei Jing,” advocating for the exclusive use of the cun-kou, as stated in the “Nan Jing,” but this idea was not widely adopted at that time. It was not until the “Mai Jing” by Wang Shuhe in the Jin Dynasty that the exclusive use of the cun-kou for pulse diagnosis was promoted.The cun-kou, also known as the pulse mouth or qi mouth, is located at the radial artery pulse point on 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, as well as the twelve meridians, all begins and ends in the lungs. Therefore, the pathological changes of the organs’ qi and blood can be reflected in the cun-kou. Additionally, the Taiyin Lung Meridian originates in the middle jiao and is associated with the spleen meridian, which shares qi with the spleen and stomach. The spleen and stomach are the foundation of postnatal life and the source of qi and blood production. Therefore, the prosperity and decline of the organs’ qi and blood can be reflected in the cun-kou, making it possible to diagnose the changes in the entire body by exclusively using the cun-kou.The cun-kou is divided into three sections: cun, guan, and chi, with the styloid process of the radius as the landmark. 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: cun, guan, and chi, totaling six pulse sections. The cun, guan, and chi can be further divided into floating, middle, and sinking categories, which is the three positions and nine pulses of the cun-kou method.The divisions of cun, guan, and chi correspond to the organs, and different medical practitioners have varying interpretations. 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. TimingThe 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 quiet. The qi and blood in the meridians are less disturbed, making it easier to identify the disease 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 should be able to examine the patient at any time and place without being bound by these conditions.2. PositionThe patient should be seated or lying supine, with the arms resting at the same level as the heart, the wrists straight and palms facing up, and the wrists supported on a cushion. This allows for unobstructed qi and blood flow, reflecting the true pulse of the body.3. Finger TechniqueThe practitioner and patient should sit side by side, with the left hand pressing the patient’s right hand and the right hand pressing the patient’s left hand. When diagnosing the pulse, the practitioner first places the middle finger on the inner side of the high bone of the palm, then places the index finger on the cun pulse position, and the ring finger on the chi pulse 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 body. The spacing of the fingers should be adjusted according 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 pressure simultaneously, referred to as total pressure; to focus on a specific pulse, one finger can be lifted slightly while pressing on another pulse. 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 and single pressure are often used in combination, making this comparative method of pulse diagnosis quite practical. Single pressure is used to assess the three sections of the cun-kou to determine which meridian and organ are affected, while total pressure is used to assess 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 cun-kou area in children is short and does not allow for three fingers to be placed.4. Lifting and PressingThis is a technique used during pulse diagnosis to explore pulse patterns by varying the pressure and movement of the fingers. The key to holding the pulse 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, during pulse diagnosis, it is essential to pay attention to the changes in pulse patterns between lifting, pressing, and searching. Additionally, when the three pulse sections show distinct differences, the finger positions must be gradually adjusted to search internally and externally. Searching implies looking for something, not merely taking a middle position.5. CalmnessOne 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 maintaining a focused mind, concentrating fully. Therefore, in addition to counting the pulse by breath, the practitioner should also be open-minded and attentive.6. Fifty PulsesEach pulse diagnosis must include at least fifty beats. This means that the time spent on each pulse should not be less than fifty beats on each side. The significance of this is twofold:One is to ensure that there are no missed diagnoses of rapid, knotty, or intermittent pulses. The second is to emphasize that pulse diagnosis should not be rushed; it must aim to clarify the pulse pattern. If the first fifty beats do not yield a clear diagnosis, it can be extended to the second or third fifty beats. In summary, each pulse diagnosis should last 2-3 minutes.
(5) Normal Pulse Patterns
Normal pulse patterns, known as ping mai in ancient texts, are the pulse patterns of healthy individuals without disease. The characteristics of a normal pulse pattern include having pulses in all three sections, with a rate of four beats per breath (or five beats during a leap year, equivalent to 72-80 beats per minute), not floating or sinking, not large or small, being 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 activities of the main organs and environmental conditions. Normal pulse patterns have three characteristics: Having qi: A pulse with qi indicates that the pulse is not floating or sinking, not fast or slow, calm and gentle, and has a consistent rhythm. Even if it is a pathological pulse, if it shows a gradual and gentle pattern, it indicates the presence of qi. A pulse with qi is a normal pulse; a pulse lacking qi indicates a pathological change, and a pulse without qi indicates a true organ pulse, which may be difficult to treat or indicate a poor prognosis. Therefore, the presence or absence of qi in the pulse is significant for judging the prognosis of diseases.Having spirit: A pulse with spirit is characterized by a gentle pulse. For example, a taut and strong pulse still carries 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 qi and spirit in the pulse indicates a harmonious quality; thus, in clinical practice, the diagnosis of qi and spirit is similar.Having root: A strong pulse in the three sections or a strong chi pulse indicates a rooted pulse pattern. If the kidney qi is still present during illness, and the innate foundation is not exhausted, a strong chi pulse can still be felt, indicating vitality. If the pulse is floating, large, and chaotic, and pressing it reveals nothing, it indicates a rootless pulse, signifying a dispersion of vital energy and a critical condition.Normal pulse patterns can vary physiologically due to internal and external factors.Seasonal climate: Due to climatic influences, normal pulses change with the seasons: spring pulses are taut, summer pulses are surging, autumn pulses are floating, and winter pulses are sinking. This reflects the correspondence between humans and nature, as the physiological functions of the body also change with the seasonal climate.Geographical environment: The geographical environment can also affect pulse patterns. For example, in the south, where the terrain is low, the climate is warm, and the air is humid, the muscles are relaxed, leading to finer and softer pulses or slightly rapid pulses; in the north, where the terrain is high, the air is dry, and the climate is cold, the muscles are tense, leading to deeper and firmer pulses.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 or 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 weak qi and blood, leading to weaker pulses.Body type: Taller individuals have longer pulse manifestations; shorter individuals have shorter pulse manifestations. Thin individuals with less muscle mass often have floating pulses, while obese individuals with thick subcutaneous fat often have sinking pulses. Normal variations of the six pulses can be seen without disease, referred to as six yin pulses; if the six pulses are often large and strong without disease, they are called six yang pulses.Emotions: Temporary emotional stimuli can also cause changes in pulse patterns. 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 fear can disrupt qi and cause erratic pulses. This indicates that emotional changes can lead to pulse changes, but once emotions return to calm, the pulse patterns also return to normal.Exertion and rest: Intense exercise or long journeys often lead to rapid pulses; during sleep, pulses tend to slow down; individuals engaged in mental labor often have weaker pulses than those engaged in physical labor.Diet: After meals or alcohol consumption, pulses are often numerous and strong; during hunger, pulses may be slightly slower and weaker.Additionally, some individuals may have pulses that are not felt at the cun-kou but can be felt diagonally from the chi area towards the back of the hand, referred to as slanting pulses; if the pulse appears on the back 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 Patterns
Diseases are reflected in changes in pulse patterns, referred to as pathological pulses. Generally speaking, any pulse pattern outside the normal physiological range or individual physiological variations is considered a pathological pulse. Different pathological pulse patterns reflect different conditions. The earliest pulse study in China, the “Mai Jing,” proposed twenty-four types of pulse patterns, while the “Jing Yue Quan Shu” proposed sixteen types, and the “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 pulse types.Pulse patterns are assessed 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; floating pulses are superficial, while sinking pulses are deep. Rate refers to the speed of the pulse, which can be slow or rapid. 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 specific 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 called a single pulse. Many pulse patterns require comprehensive assessment from multiple aspects of position, rate, shape, and force to differentiate. For example, a weak pulse is formed by a combination of a sinking, small, and weak pulse, while a strong pulse is formed by a combination of sinking, solid, large, taut, and long pulses. A floating, large, and strong pulse indicates a surging pulse. Single pulses often do not fully reflect the essence of the disease, while compound pulses can reflect the condition of the disease from multiple aspects. In addition to the aforementioned twenty-eight pulses, various combinations of pulse patterns can also occur, such as floating tight, floating slow, sinking fine, slippery rapid, etc.1. Classification of Pulse Patterns and Main Diseases(1) Floating Pulse Types Floating pulse types include floating, surging, soft, scattered, hollow, and leather pulses. Because their pulse positions are superficial, they can be easily obtained through floating pressure, thus classified together.① Floating Pulse【Pulse Pattern】: Easily obtained with light pressure, slightly reduced with heavy pressure but not empty, floating like wood on water.【Main Disease】: Exterior syndrome, deficiency syndrome.【Pulse Theory】: Floating pulses indicate exterior conditions, reflecting that pathogenic factors are at the surface level, attacking the skin and muscles, causing the pulse qi to rise and become floating. In cases of internal injury or prolonged illness leading to 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 Pattern】: Extremely large, resembling surging waves, strong on arrival and weak on departure.【Main Disease】: Interior heat syndrome.【Pulse Theory】: The formation of a surging pulse is due to excess yang qi, qi stagnation, and excessive 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 excess or loss of yang.③ Soft Pulse【Pulse Pattern】: Floating and fine, soft like silk in water.【Main Disease】: Deficiency syndrome, damp syndrome.【Pulse Theory】: Soft pulses are primarily associated with deficiency. If both essence and blood are depleted, and yin deficiency cannot support yang, the pulse becomes floating and soft. If dampness obstructs the pulse vessels, a soft pulse may also be observed.④ Scattered Pulse【Pulse Pattern】: Floating and scattered without root, with an irregular rate, resembling scattered willow fluff.【Main Disease】: Dispersed vital energy.【Pulse Theory】: Scattered pulses indicate dispersed vital energy, a critical condition where the qi of the organs is about to fail. Due to heart failure, yin and yang cannot be contained, leading to a floating and scattered pulse that is not tight. If pressure is applied, it may not be felt, indicating a lack of root; if yin fails and yang dissipates, the pulse may be irregular.⑤ Hollow Pulse【Pulse Pattern】: Floating and large, hollow in the middle, like pressing a scallion tube.【Main Disease】: 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 a lack of filling in the pulse vessels. Sudden blood loss can lead to a rapid decrease in blood volume, resulting in insufficient nourishing blood, or excessive loss of fluids leading to a lack of blood filling, causing the pulse to float and become large and hollow.⑥ Leather Pulse【Pulse Pattern】: Floating and strong at the fingertips, hollow in the middle, like pressing a drum skin.【Main Disease】: Blood loss, loss of essence, postpartum, or leakage.【Pulse Theory】: Leather pulses are a combination of taut and hollow pulses, resulting from internal deficiency of essence and blood, causing the qi to float and become hollow, resembling the contraction of cold yin qi.(2) Sinking Pulse Types Sinking pulse types include sinking, hidden, weak, and solid pulses. These pulses are deeper and can only be felt with heavy pressure, thus classified together.① Sinking Pulse【Pulse Pattern】: Not felt with light pressure, only obtained with heavy pressure, like a stone sinking to the bottom of the water.【Main Disease】: Interior syndrome. It can also be seen in healthy individuals.【Pulse Theory】: When the pathogenic factors are internal, the righteous qi is engaged internally, and qi and blood are constrained, the pulse becomes sinking and strong, indicating an interior excess syndrome. If the organs are weak and yang qi is deficient, leading to insufficient qi and blood, the pulse becomes sinking and weak, indicating an interior deficiency syndrome.② Hidden Pulse【Pulse Pattern】: Only felt with heavy pressure on the muscles and bones, and may be hidden and not felt at all.【Main Disease】: Closed pathogenic factors, critical conditions, severe pain.【Pulse Theory】: Hidden pulses occur when pathogenic factors are deeply seated, preventing the pulse qi from circulating, leading to a hidden pulse. If yang qi is weak and about to collapse, a hidden pulse may also be observed. The former is often seen in acute diseases, while the latter is often seen in chronic diseases with declining righteous qi.③ Weak Pulse【Pulse Pattern】: Extremely soft and sinking.【Main Disease】: Deficiency of qi, blood, yin, and yang.【Pulse Theory】: Weak pulses occur due to insufficient yin and blood, which cannot fill the pulse vessels, and weak yang qi cannot propel blood circulation, resulting in a sinking and fine pulse.④ Solid Pulse【Pulse Pattern】: Sinking, solid, large, and long, firm and immovable.【Main Disease】: Cold accumulation, internal solidification.【Pulse Theory】: Solid pulses form due to the firm presence of pathogenic factors, internal cold accumulation, and sinking yang qi, leading to a sinking, solid, large, and long pulse. Solid pulses indicate the presence of qi and blood, with palpable masses indicating solid conditions, while non-palpable masses indicate gaseous conditions. If a solid pulse is observed in cases of blood loss or yin deficiency, it indicates a critical condition of sudden blood loss.(3) Slow Pulse Types Slow pulse types include slow, gentle, rough, and knotty pulses. These pulses are characterized by a slower rate, with less than four to five beats per breath, thus classified together.① Slow Pulse【Pulse Pattern】: The pulse is slow, with less than four beats per breath (equivalent to less than 60 beats per minute).【Main Disease】: Cold syndrome. A slow and strong pulse indicates cold pain or cold accumulation, while a slow and weak pulse indicates deficiency cold. Well-trained athletes may have a slow and strong pulse, which is not considered pathological.【Pulse Theory】: Slow pulses indicate cold syndrome, as insufficient yang qi leads to weak blood circulation. A slow pulse may be strong if cold accumulation obstructs the flow of qi and blood. 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 strong when pressed; slow pulses cannot be generalized as cold syndrome and must be assessed in conjunction with other symptoms.② Gentle Pulse【Pulse Pattern】: Four beats per breath, slow and gentle.【Main Disease】: Damp syndrome, spleen and stomach weakness.【Pulse Theory】: Dampness obstructs the flow of qi, and weakness of the spleen and stomach leads to insufficient qi and blood to fill and propel the pulse, resulting in a gentle pulse. A gentle pulse indicates sufficient qi and blood, with unobstructed circulation. If the pulse becomes gentle during illness, it indicates a recovery of righteous qi.③ Rough Pulse【Pulse Pattern】: Slow, fine, and short, with difficulty in flow, resembling a light knife scraping bamboo.【Main Disease】: Deficiency of essence and blood, qi stagnation, phlegm, or food accumulation.【Pulse Theory】: Rough pulses occur due to deficiency of essence and blood, leading to insufficient nourishment of the pulse vessels, resulting in a pulse that is fine and weak. Qi stagnation, blood stasis, phlegm, or food accumulation can also lead to rough pulses.④ Knotty Pulse【Pulse Pattern】: The pulse is slow, with intermittent stops, with an unpredictable number of stops.【Main Disease】: Excessive yin, qi stagnation, cold phlegm, blood stasis, or accumulation.【Pulse Theory】: Knotty pulses occur due to excessive yin and qi stagnation, leading to obstruction of blood flow. The pulse is slow and weak, with intermittent stops, indicating stagnation of qi and blood. Knotty pulses are often seen in deficiency syndromes, particularly in chronic illnesses with qi and blood deficiency, where the pulse may stop intermittently.(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 classified together.① Rapid Pulse【Pulse Pattern】: The pulse comes in five or more beats per breath.【Main Disease】: Heat syndrome. A strong pulse indicates excess heat, while a weak pulse indicates deficiency heat.【Pulse Theory】: Rapid pulses occur due to excessive internal heat, leading to accelerated blood flow. If the heat is excessive and the righteous qi is not deficient, the pulse is rapid and strong, indicating 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 when pressed, it indicates a dangerous condition of externalized deficiency yang.② Urgent Pulse【Pulse Pattern】: The pulse comes rapidly, with seven or eight beats per breath.【Main Disease】: Extreme yang and depletion of yin, impending loss of vital yang.【Pulse Theory】: In cases of excess heat syndrome, the yang is excessively high, leading to a rapid pulse that becomes firmer when pressed. If yin fluids are depleted, the pulse may be rapid but weak.③ Hurried Pulse【Pulse Pattern】: The pulse is rapid, with intermittent stops, with an unpredictable number of stops.【Main Disease】: Excessive yang heat, qi and blood stagnation, phlegm, or food accumulation.【Pulse Theory】: Rapid pulses occur due to excessive yang heat or stagnation of qi and blood, leading to rapid blood flow. The pulse may stop intermittently due to obstruction of qi and blood flow. Hurried pulses may also be seen in deficiency syndromes, where the pulse may stop intermittently due to depletion of vital energy.④ Moving Pulse【Pulse Pattern】: The pulse feels like a bean, trembling and shaking, slippery and rapid with strength.【Main Disease】: Pain syndromes, shock syndromes. Moving pulses may appear during pregnancy, which can be valuable for early clinical diagnosis.【Pulse Theory】: Moving pulses occur due to the interplay of yin and yang, leading to qi and blood surging, causing the pulse to fluctuate with the movement of qi and blood. Pain and shock can also lead to moving pulses.(5) Deficient Pulse TypesDeficient pulse types include deficient, fine, weak, intermittent, and short pulses, characterized by weak responses to pressure.① Deficient Pulse【Pulse Pattern】: The three sections of the pulse are weak, feeling empty when pressed.【Main Disease】: Deficiency syndrome.【Pulse Theory】: Deficient pulses occur when qi is insufficient to circulate blood, leading to a weak pulse. Blood deficiency leads to insufficient filling of the pulse vessels, resulting in an empty feeling when pressed. Due to qi deficiency, the pulse may float and appear large.② Fine Pulse【Pulse Pattern】: The pulse is fine like a thread, but the response is clear.【Main Disease】: Deficiency of qi and blood, various deficiencies, damp syndrome.【Pulse Theory】: Fine pulses occur due to deficiency of qi and blood, leading to insufficient nourishment of the pulse vessels, resulting in a fine and weak pulse.③ Weak Pulse【Pulse Pattern】: Extremely fine and soft, almost imperceptible.【Main Disease】: Deficiency of qi, blood, yin, and yang.【Pulse Theory】: Weak pulses occur due to insufficient yang qi, leading to an inability to circulate blood, resulting in a weak pulse. Floating pulses indicate yang deficiency, while sinking pulses indicate yin deficiency.④ Intermittent Pulse【Pulse Pattern】: The pulse comes with stops, with a predictable number of stops, taking a long time to return.【Main Disease】: Weakness of organ qi, wind syndrome, pain syndrome.【Pulse Theory】: Intermittent pulses occur due to weakness of organ qi, leading to an inability to connect the pulse, resulting in stops. Wind and pain syndromes can also lead to intermittent pulses due to obstruction of the meridians.⑤ Short Pulse【Pulse Pattern】: The pulse is short at both ends, unable to fill the entire section.【Main Disease】: Qi disease. A strong pulse indicates stagnation, while a weak pulse indicates deficiency.【Pulse Theory】: Qi deficiency leads to an inability to propel blood, resulting in a short and weak pulse. Stagnation of qi and blood or phlegm accumulation can also lead to short pulses, but they must be strong.(6) Excess Pulse Types Excess pulse types include excess, slippery, taut, tight, and long pulses, characterized by strong responses to pressure.① Excess Pulse【Pulse Pattern】: The pulse is strong in all three sections.【Main Disease】: Excess syndrome.【Pulse Theory】: Excess pulses occur due to excessive pathogenic factors and sufficient righteous qi, leading to a strong pulse. Healthy individuals may also exhibit excess pulses, indicating sufficient righteous qi and good organ function. Healthy excess pulses should be calm and gentle, unlike the rapid and hard pulses seen in pathological conditions.② Slippery Pulse【Pulse Pattern】: The pulse flows smoothly, like beads rolling on a plate, with a smooth response.【Main Disease】: Phlegm, food accumulation, excess heat.【Pulse Theory】: Excess pulses occur due to excessive pathogenic factors, leading to a strong pulse. If a slippery pulse is observed in healthy individuals, it indicates a smooth and gentle pulse due to sufficient qi and blood.③ Taut Pulse【Pulse Pattern】: The pulse is straight and long, like pressing a guitar string.【Main Disease】: Liver and gallbladder diseases, phlegm, pain syndromes, malaria.【Pulse Theory】: Taut pulses indicate tension in the pulse qi. The liver governs the flow of qi, and if pathogenic factors obstruct the liver, leading to qi stagnation, taut pulses may be observed. Pain, phlegm, and disharmony between yin and yang can also lead to taut pulses.④ Tight Pulse【Pulse Pattern】: The pulse feels tense, like a taut rope.【Main Disease】: Cold syndrome, pain syndrome.【Pulse Theory】: Tight pulses occur due to cold pathogens invading the body, leading to tension in the pulse. Pain can also lead to tight pulses due to the accumulation of cold pathogens.⑤ Long Pulse【Pulse Pattern】: The pulse is long at both ends, extending beyond its normal position.【Main Disease】: Excessive liver yang, excessive heat, or other excess conditions.【Pulse Theory】: In healthy individuals, excess pulses indicate sufficient righteous qi and unobstructed circulation. If liver yang is excessive, leading to internal heat, the pulse may become long and hard, indicating a pathological condition.(2) Combined Pulses and Main DiseasesCombined pulses refer to the simultaneous presence of multiple pulse patterns. Xu Lingtai referred to this as combined pulses, which can be divided into two-combined, three-combined, and four-combined pulses.The main diseases associated with 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 rapid pulse indicates an exterior heat condition. The following are common combined pulses and their main diseases:1. Combined Pulse: Floating and tight. Main Disease: Exterior cold, wind bi.2. Combined Pulse: Floating and gentle. Main Disease: Exterior deficiency syndrome.3. Combined Pulse: Floating and rapid. Main Disease: Exterior heat.4. Combined Pulse: Floating and slippery. Main Disease: Wind phlegm, exterior syndrome with phlegm.5. Combined Pulse: Sinking and slow. Main Disease: Interior cold.6. Combined Pulse: Taut and rapid. Main Disease: Liver heat, liver fire.7. Combined Pulse: Slippery and rapid. Main Disease: Phlegm heat, internal heat from food accumulation.8. Combined Pulse: Surging and rapid. Main Disease: Qi heat.9. Combined Pulse: Sinking and taut. Main Disease: Liver qi stagnation, water retention.10. Combined Pulse: Sinking and rough. Main Disease: Blood stasis.11. Combined Pulse: Taut and fine. Main Disease: Liver and kidney yin deficiency, liver qi stagnation and spleen deficiency.12. Combined Pulse: Sinking and gentle. Main Disease: Spleen deficiency, water retention.13. Combined Pulse: Sinking and fine. Main Disease: Yin deficiency, blood deficiency.14. Combined Pulse: Taut, slippery, and rapid. Main Disease: Liver fire with phlegm, internal phlegm heat.15. Combined Pulse: Sinking, fine, and rapid. Main Disease: Yin deficiency, blood deficiency with heat.16. Combined Pulse: Taut and tight. Main Disease: Cold pain, cold stagnation in the liver meridian.
(7) Pediatric Pulse Diagnosis
Pediatric pulse diagnosis differs from that of adults, as the cun-kou area in children is small, making it difficult to distinguish the three sections. Additionally, children are prone to fright and crying during examinations, which can disrupt the pulse. Therefore, later practitioners often use a single finger to assess all three sections. The method involves the practitioner holding the child’s hand with the left hand and using the right thumb to press on the child’s pulse at the high bone of the palm, dividing it into three sections to determine the pulse rate. For children over four years old, the midline of the high bone is used as the guan, and a single finger is rolled to search for the three sections; for children aged seven or 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.Pediatric pulse patterns are primarily assessed based on floating, sinking, slow, and rapid patterns to determine exterior, interior, cold, and heat conditions, with strength indicating 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 section. Regardless of whether the pulse is floating or sinking, if it is only felt with heavy pressure, it is considered similar to the solid pulse in adults.
(8) Pulse Patterns and Correspondence
1. Pulse Patterns and Correspondence: This refers to the relationship between pulse patterns and symptoms in determining the nature of the disease. Generally, pulse patterns correspond to symptoms, indicating a harmonious relationship. However, there are times when pulse patterns do not correspond to symptoms, indicating a disharmony. In terms of determining the nature of the disease, corresponding pulse patterns indicate a favorable prognosis, while non-corresponding patterns indicate a poor prognosis. Generally, if there is an excess condition, the pulse may be surging, rapid, slippery, or strong, indicating a correspondence between pulse and symptoms, suggesting that the pathogenic factors are strong and the righteous qi is sufficient to resist them. If the pulse is fine, weak, or intermittent, it indicates a non-correspondence, suggesting that the pathogenic factors are strong and the righteous qi is weak, leading to a risk of pathogenic factors invading. For example, in acute diseases, 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 factors. In chronic diseases, if the pulse is sinking, fine, weak, or intermittent, it indicates a favorable prognosis, suggesting that the pathogenic factors are declining and the righteous qi is recovering. If a new disease presents with a sinking, fine, weak, or intermittent pulse, it indicates that the righteous qi has already declined; if a chronic disease presents with a floating, surging, rapid, or strong pulse, it indicates that the righteous qi is declining while the pathogenic factors remain, indicating a poor prognosis.2. Pulse Patterns and Correspondence: Since there are instances of non-correspondence between pulse patterns and symptoms, one must discern the truth of the pulse and symptoms to determine which to prioritize. In cases where the symptoms are true and the pulse is false, one must prioritize the symptoms. For example, if the symptoms indicate abdominal distension, pain, and constipation, with a red tongue and thick yellow coating, but the pulse is slow and fine, it indicates that the symptoms reflect 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, which is false. In this case, one should prioritize the symptoms over the pulse.In cases where the symptoms are false and the pulse is true, one must prioritize the pulse. For example, in cases of cold damage, if the symptoms indicate cold limbs, but the pulse is slippery and rapid, the pulse reflects true heat; the symptoms reflect a false cold condition due to the internal heat, leading to cold limbs, which is false. In this case, one should prioritize the pulse over the symptoms.
2. Pressure Diagnosis
Pressure diagnosis involves the practitioner directly touching and pressing certain areas of the patient’s body to understand local abnormalities, thereby inferring the location, nature, and severity of the disease.(1) Methods and Significance of Pressure Diagnosis1. Methods① Position: During pressure diagnosis, the patient should be seated or lying supine. Generally, when pressing the chest and abdomen, the patient should lie supine, fully relaxed, with legs straight and hands at their sides. The practitioner stands on the patient’s right side, using one or both hands to perform pressure diagnosis. When pressing on abdominal masses or assessing muscle tension, the patient may be asked to bend their knees to relax the abdominal muscles, facilitating the examination.② Techniques: The techniques for pressure diagnosis can be broadly divided into touching, feeling, pushing, and pressing. Touching involves lightly contacting the patient’s skin, such as the forehead and limbs, to assess temperature and moisture. Feeling involves palpating swollen areas to determine the sensation and characteristics of the swelling. Pushing involves applying slight pressure to the local area to assess the mobility of masses and their relationship with surrounding tissues. Pressing involves applying pressure to specific areas, such as the chest or abdomen, to assess deep tenderness, the shape and texture of masses, and the degree and nature of swelling. In clinical practice, various techniques are used in combination, often starting with touching, followed by pushing and pressing, gradually increasing pressure from light to heavy and from superficial to deep to understand the condition of the disease.During pressure diagnosis, the practitioner should be considerate of the patient, using gentle techniques and avoiding sudden force. In cold weather, the practitioner’s hands should be warmed before examination. Generally, the practitioner should start with light touching, followed by pressing, gradually increasing pressure from light to heavy and from superficial to deep. The practitioner should also instruct the patient to actively cooperate and report their sensations, while observing the patient’s facial expressions to understand their discomfort. Pressure diagnosis should be thorough and careful, not overlooking any area related to the disease.2. SignificancePressure diagnosis is part of pulse diagnosis and an essential component of the four diagnostic methods. It further delves into understanding the location and nature of diseases based on observation, listening, and inquiry. For conditions involving pain, swelling, phlegm, or masses in the chest and abdomen, pressure diagnosis can provide valuable information for diagnosis and differentiation.(2) Content of Pressure DiagnosisPressure diagnosis has a wide range of applications. Clinically, it is commonly used to assess the skin, hands and feet, chest and abdomen, and acupoints, which are described as follows:1. Assessing the SkinAssessing the skin is to determine the temperature, moisture, and swelling of the entire body.Generally, a body with strong yang qi tends to be warm, while a body with weak yang qi tends to be cold.Assessing the skin can reveal not only temperature differences but also the degree of heat, indicating whether the condition is superficial or deep. If the body feels very hot initially but becomes less hot with prolonged pressure, it indicates heat at the surface; if the heat intensifies with prolonged pressure, it indicates heat within.Soft and moist skin that responds well to pressure indicates a deficiency condition; hard and painful areas that resist pressure indicate an excess condition. If light pressure causes pain, the disease is superficial; if heavy pressure causes pain, the disease is deep.Dry skin indicates a lack of sweat or insufficient fluids; shriveled skin indicates a lack of fluids; moist skin indicates sweating or no damage to fluids.Skin that is rough indicates yin injury or internal dry blood.Pressing on swollen areas can help differentiate between edema and gas. If pressing leaves an indentation that does not return immediately, it indicates edema; if it returns quickly, it indicates gas.It can also help determine whether the condition is yin or yang and whether it has formed pus. A hard, non-hot swelling indicates a cold condition; a hot, painful swelling indicates a heat condition. A flat, soft swelling indicates a deficiency condition, while a raised, hard swelling indicates an excess condition. A hard area often indicates no pus, while a soft area may indicate the presence of pus. For deep abscesses in the muscles, the practitioner can use the “responding hand” or “non-responding hand” method to determine the presence of pus. This involves placing one hand on either side of the swelling, applying varying pressure with one hand while the other remains still, waiting for a sense of fluctuation to determine the presence of pus.2. Assessing the Hands and FeetAssessing the hands and feet primarily involves determining temperature to judge the nature of the disease as either deficiency or excess, and to assess prognosis. If both hands and feet are cold at the onset of illness, it indicates yang deficiency and excessive cold, suggesting a cold condition. If the hands and feet are warm, it indicates excessive yang heat, suggesting a heat condition.Assessing the temperature of the hands and feet can also help differentiate between external and internal diseases. If the back of the hands and feet is warm, it indicates an external febrile disease; if the palms are warm, it indicates an internal febrile disease. Additionally, the mutual examination of palm heat and forehead heat can help differentiate between exterior heat and internal heat. If the forehead is hotter than the palms, it indicates exterior heat; if the palms are hotter than the forehead, it indicates internal heat. This diagnostic method has reference value.In pediatrics, cold fingertips indicate a risk of convulsions. A hot middle finger indicates an external wind-cold condition. A cold tip of the middle finger indicates a sign of impending measles. Assessing the temperature of the hands and feet can provide insight into the survival of yang qi, which is crucial for determining the prognosis of certain yang deficiency conditions. In cases of yang deficiency, if the limbs are still warm, it indicates that yang qi is still present and treatment is possible; if the limbs are cold, it often indicates a poor prognosis.3. Assessing the Chest and AbdomenThe division of the chest and abdomen is as follows: the upper part is the chest, and the lower part is the abdomen. The lateral chest area extends from the lower abdomen to the eleventh and twelfth ribs, referred to as the flank. The area just below the xiphoid process is called the heart area. The upper abdomen corresponds to the stomach area, the large abdomen is above the navel, the small abdomen is below the navel, and the lower abdomen refers to the sides of the small abdomen.Assessing the chest and abdomen involves purposefully touching and pressing the chest, flank, and abdomen based on the needs of the condition, and if necessary, tapping to understand the local pathological changes.Assessing the chest and abdomen can be divided into three parts: assessing the interior, assessing the chest and flank, and assessing the abdomen.(1) Assessing the Interior: The interior is located at the apex of the heart, where all pulses converge. Exploring the pulsation of the interior can provide insight into the strength of the zong qi, the nature of the disease, and the prognosis. Ancient practitioners placed great importance on this.The interior pulse should respond to pressure, moving without tension, and be gentle and not urgent, indicating health. If the pulse is weak and lacks strength, it indicates deficiency of zong qi. If the pulse is strong and responds to clothing, it indicates excessive zong qi. If the pulse is large and strong, it indicates a critical condition.In pregnant women, the pulse before and after childbirth or in cases of tuberculosis should be approached with caution. If the pulse is high after fright, extreme anger, or intense exercise, but returns to normal after resting, it is a physiological phenomenon. If the pulse stops completely, it indicates a sign of death. Assessing the interior pulse is significant for determining the presence or absence of pulse, which can help decide life or death.(2) Assessing the Chest and Flank: If the front of the chest is raised and pressing it causes shortness of breath, it indicates lung disease. If pressing the chest and flank causes pain, it may indicate phlegm heat or qi stagnation.The liver is located in the right flank, with its upper boundary at the midline of the clavicle at the fifth rib and its lower boundary aligned with the lower edge of the right rib arch. Therefore, it is generally not palpable below the ribs. If the liver is palpable and enlarged, whether soft or hard, it often indicates qi stagnation or blood stasis; if the surface is uneven, it may indicate liver cancer.Pain in the right flank that feels hot and resists pressure indicates liver abscess. If malaria persists, a mass may appear under the flank, referred to as the “mother of malaria.”(3) Assessing the Abdomen: Assessing the abdomen primarily involves understanding temperature, softness, hardness, fullness, swelling, tenderness, and other conditions to assist in diagnosis and differentiation.To differentiate temperature: By assessing the temperature of the abdomen, one can determine whether the condition is cold or hot, deficient or excessive. If the abdominal wall is cold and prefers warmth, it indicates a deficiency cold condition; if the abdominal wall is hot and prefers coolness, it indicates an excess heat condition.To differentiate pain: For abdominal pain, if pressing relieves pain, it indicates deficiency; if pressing causes pain, it indicates excess. If the local area is hot and painful, it indicates an internal abscess.To differentiate abdominal fullness: If the abdomen feels full and pressing it gives a solid sensation with tenderness, and tapping produces a heavy sound, it indicates fullness; if the abdomen is distended but pressing it feels empty and produces a hollow sound, it indicates gas, often associated with deficiency.If the abdomen is highly distended, resembling a drum, it is referred to as distension. This is a serious condition that can be divided into water distension and gas distension. By placing hands on both sides of the abdomen, one hand can lightly tap while the other feels for a sense of fluctuation. If there is a fluctuation, it indicates water distension; if tapping produces a drum-like sound without fluctuation, it indicates gas distension. Additionally, some individuals with obesity may have a distended abdomen, but if it feels soft and lacks other severe symptoms, it should be differentiated from distension.To differentiate masses: The assessment of masses should consider their size, shape, hardness, tenderness, and other characteristics.Accumulation refers to a mass in the abdomen that may be painful or not. However, accumulation and mass are different. Pain with a specific location indicates accumulation, which belongs to the blood aspect; pain without a specific location indicates a mass, which belongs to the qi aspect.Pain in the left lower abdomen with hard masses indicates the presence of fecal matter in the intestines. Pain in the right lower abdomen with palpable masses indicates intestinal abscess.For intestinal worms, the assessment has three major characteristics: one is a shape resembling a knot; two is that prolonged pressure causes movement; three is that the abdominal wall is uneven, with fluctuations and irregular movements.4. Assessing AcupointsAssessing acupoints involves pressing specific acupoints on the body to infer certain internal diseases based on the changes and responses at these points.Changes at acupoints primarily include the appearance of nodules or cord-like structures, or tenderness and sensitivity. Clinical reports indicate that patients with lung diseases may feel nodules at the lung shu point, while some may experience tenderness at the zhong fu point. Patients with liver diseases may experience tenderness at the liver shu or qi men points. Patients with stomach diseases may feel tenderness at the stomach shu and zu san li points. For intestinal abscesses, tenderness may be felt at the appendicular point.Additionally, pressing acupoints can be used for experimental treatment to assist in differential diagnosis. For example, in cases of biliary colic due to roundworms, pressing on both sides of the gallbladder shu point may relieve pain, while pain from other causes may not respond, aiding in differentiation.· The End · Note:This platform shares health-related graphic information for reference and learning purposes only and should not be used as a basis for medical diagnosis. If needed, please consult a physician for guidance.⊙ Copyright Notice: The article is sourced from the internet; if there is any infringement, please contact us for removal.
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