Pulse diagnosis includes two parts: pulse examination and palpation. Pulse examination involves feeling the pulse; palpation is the method of touching, pressing, and feeling certain 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 method where the practitioner uses their fingertips to press on specific areas of the pulse to observe the pulse patterns. By examining the pulse, the practitioner can perceive different pulse patterns in the patient to understand the condition and diagnose diseases. It is a unique diagnostic method in Traditional Chinese Medicine (TCM).
(1) The Principle 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 rhythmic beating of the heart 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 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 disperse throughout the body; the spleen and stomach are the sources of qi and blood transformation, 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 and the driving force for the functional activities of all organs. Moreover, essence can transform into blood, making it one of the material bases for blood production. Therefore, the formation of pulse patterns is closely related to the qi and blood of the organs.
(2) Clinical Significance of Pulse Diagnosis
Since 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 movement of blood and pulse is affected, leading to changes in pulse patterns. Thus, 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 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 and sinking of the pulse can often reflect the depth of the disease location. A floating pulse indicates a superficial disease location; a sinking pulse indicates a deep disease location. The nature of the disease can be divided 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 leads to pathological changes of deficiency and excess, and the strength or weakness of the pulse can reflect the deficiency or excess patterns of the disease. A weak and feeble pulse indicates a deficiency of righteous qi, while a strong and forceful pulse indicates an excess of pathogenic qi.
2. Inferring the Progression and Prognosis of Diseases
Pulse diagnosis has certain clinical significance in inferring the progression and prognosis of diseases. For instance, if a long-standing illness shows a gradual softening of the pulse, it indicates a recovery of stomach qi and a sign of disease retreating towards recovery; if a long-standing illness presents with qi deficiency, weakness, or blood loss, and shows a flooding pulse, it often indicates a situation 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 the patient is agitated, it indicates a worsening condition.
(3) Locations for Pulse Diagnosis
There are various methods for pulse diagnosis, including the comprehensive examination method, the three positions method, and the cun-kou method. The comprehensive examination method is mentioned in the “Su Wen: San Bu Jiu Hou Lun,” where the pulse examination locations 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 (carotid artery), cun (cuneiform), and jueyin (dorsalis pedis artery). The latter two pulse examination locations have been less commonly used in later generations; since the Jin Dynasty, the commonly selected pulse examination location has been the cun-kou. The cun-kou method first appeared in the “Nei Jing,” advocating the exclusive use of the cun-kou, as stated in the “Nan Jing,” but this idea was not widely adopted at the time until the “Mai Jing” by Wang Shuhe in the Jin Dynasty popularized the exclusive use of the cun-kou method for pulse diagnosis.
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 for pulse diagnosis is that the cun-kou is the artery of the Taiyin Lung Meridian, where qi and blood converge. The movement of qi and blood in the five organs, six bowels, and twelve meridians all begins and ends in the lungs. Therefore, changes in the qi and blood of the organs can be reflected in the cun-kou. Additionally, the Taiyin Lung Meridian originates in the middle jiao and shares the same Taiyin nature with the spleen meridian, connecting with the qi of the spleen and stomach, which are the foundation of postnatal life and the source of qi and blood transformation. Thus, the prosperity and decline of the organs’ qi and blood can be reflected in the cun-kou, making it possible to diagnose changes in the entire body by examining the cun-kou.
The cun-kou is divided into three sections: cun, guan, and chi, marked by the high bone (styloid process of the radius). The area slightly inward is the guan, the area before the wrist is the cun, and the area behind the elbow is the chi. Each hand has three sections: cun, guan, and chi, totaling six pulse positions. The cun, guan, and chi can be further divided into floating, middle, and sinking states, which is the three sections and nine states of the cun-kou method.
The division of the cun, guan, and chi corresponds 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 with diaphragm 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 patients are not influenced by food, activity, and other factors, and the internal and external environment is relatively calm. The qi and blood in the meridians are in a less disturbed state, 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 maintain a calm demeanor before starting the pulse diagnosis. The examination room should be kept quiet. In special circumstances, pulse diagnosis can be performed anytime and anywhere without being restricted by these conditions.
2. Positioning
The patient should be seated or lying flat, with the arms resting at the same level as the heart, the wrists straight and palms facing up, and the wrist joints supported by a cushion. This allows for unobstructed movement of qi and blood, reflecting the true pulse patterns of the body.
3. Finger Technique
The practitioner and patient sit facing each other. The practitioner uses their left hand to examine the patient’s right hand and their right hand to examine the patient’s left hand. When examining the pulse, the middle finger is first placed on the inner side of the high bone at the guan pulse position, followed by the index finger at the cun pulse position, and the ring finger at 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 body size; 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 on the pulse, referred to as total pressure; to focus on a specific pulse pattern, one finger can be slightly lifted while examining a particular pulse, such as lifting the middle and ring fingers slightly when examining the cun pulse, lifting the index and ring fingers when examining the guan pulse, and lifting the index and middle fingers when examining the chi pulse. In clinical practice, total pressure 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 examine the changes in the five organs and six bowels.
For pediatric pulse diagnosis, the “one-finger (thumb) method” can be used to determine the guan position without subdividing 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 Pressing
This is a technique used during pulse diagnosis to explore pulse patterns 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; and applying moderate pressure is called searching, which seeks to find the pulse pattern. Therefore, it is essential to pay attention to the changes in pulse patterns during lifting, pressing, and searching. Additionally, when the three pulse positions show discrepancies, the finger positions must be gradually adjusted to explore further. Searching implies seeking, not merely taking.
5. Calmness
One inhalation and one exhalation is considered one breath. 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 patterns and pathological pulse patterns of slow, rapid, soft, and forceful, 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 and attentive mindset during pulse diagnosis. Therefore, besides counting the pulse by breath, one should also be open-minded and tranquil, fully concentrating.
6. Fifty Pulses
Each pulse diagnosis must include at least fifty beats. This means that the time spent on each pulse examination should not be less than fifty beats on each side. The significance of this is twofold:
First, to ensure that there are no missed diagnoses of rapid, irregular, or intermittent pulses. Second, it emphasizes that pulse diagnosis should not be rushed; it must aim to clarify the pulse patterns. If the first fifty beats are still unclear, one can extend the examination to the second or third set of fifty beats. In general, each pulse examination should last 2-3 minutes.
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