Qie Zhen includes two parts: pulse diagnosis and palpation. Pulse diagnosis involves examining the pulse; palpation involves touching, feeling, and pressing specific areas of the patient’s body to understand the internal changes of diseases or surface reactions, thus obtaining diagnostic information for pattern differentiation.
1. Pulse Diagnosis
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Pulse Length
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Pulse Diagnosis
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Clinical Significance of Pulse Diagnosis
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Pulse Rashes
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Pulse Turbulence
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Both Yin and Yang Pulses Tight
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Pulse Diagnosis
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Pulse Diagnosis Locations
Pulse diagnosis is a unique method in Traditional Chinese Medicine (TCM) where the practitioner uses their fingertips to press on specific pulse points to observe the pulse characteristics. By examining the pulse, the practitioner can understand the patient’s condition and diagnose diseases.
(1) Principles of Pulse Formation
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Introduction to Pulse Characteristics
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Critical Pulse Conditions
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Main Diseases Indicated by Pulse
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Development of Pulse Patterns
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Pulse Comparisons and Combinations
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Principles of Pulse Formation
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Elements and Diagrams of Pulse Characteristics
The pulse is the manifestation of the heartbeat. The heart governs the blood vessels, which include both blood and pulse. The pulse is the residence of blood, and the heart and pulse are interconnected. The rhythmic beating of the heart propels blood through the vessels, creating a rhythmic pulse (thus forming the pulse response). The movement of blood within the vessels is driven by Zong Qi (Ancestral Qi). Blood circulates throughout the body, continuously flowing. Besides the heart’s leading role, the coordination of various organs is also essential. The lungs govern the hundred vessels, which means that the blood vessels circulating throughout the body converge in the lungs. The lungs govern Qi, and through the distribution of lung Qi, blood can spread 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 and the driving force for the functional activities of all organs. Essence can also transform into blood, making it one of the material bases for blood production. Therefore, the formation of pulse characteristics is closely related to the Qi and blood of the organs.
(2) Clinical Significance of Pulse Diagnosis
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Pulse Diagnosis
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Pulse Diagnosis
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Pulse Rashes
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Pulse Steaming
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Theoretical Basis of Pulse Diagnosis
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Classification, Methods, and Considerations of Pulse Diagnosis
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Clinical Significance of Pulse Diagnosis
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Origin of Pulse Diagnosis
The formation of pulse characteristics is closely related to the Qi and blood of the organs. When the Qi and blood of the organs undergo pathological changes, the movement of blood and pulse is affected, leading to changes in the pulse characteristics. Therefore, by observing changes in the pulse, one can determine the location, nature, and progression 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 pulse often reflects 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 syndromes, and the pulse’s slow or rapid rate can reflect the nature of the disease. For example, a slow pulse often indicates a cold syndrome, while a rapid pulse often indicates a heat syndrome. 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 syndrome. 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 the disease. 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. In cases of long-term Qi deficiency, weakness, blood loss, or prolonged diarrhea, a flooding pulse may indicate 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, it is a sign of recovery. However, if the pulse is rapid and the patient is agitated, it indicates a worsening condition. (For example, if there is sweating, a quiet pulse, and the heat subsides with a cool body, it indicates recovery; if the pulse is rapid and the patient is agitated, it indicates a worsening condition.)
(3) Locations for Pulse Diagnosis
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Pulse Diagnosis Explanations
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Pulse Diagnosis Explanations
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Pulse Diagnosis Methods
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Pulse Diagnosis Methods
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Pulse Diagnosis Locations and Methods
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Diagnosis of Women’s and Children’s Pulses
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Independence of Pulse Diagnosis Methods
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Pulse Diagnosis Methods for Treating Shen
The locations for pulse diagnosis include the comprehensive examination method, the three positions method, and the cun-kou method. The comprehensive examination method is found in the Suwen (Plain Questions) under the section Three Parts and Nine Pulses. The pulse examination locations include the head, hands, and feet. The three positions method is found in the Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases) written by Zhang Zhongjing during the Han Dynasty. The three positions refer to the Ren Ying (Cun) (Radial Artery), Cun Kou (Cun), and Che (尺) (Ulnar Artery). The above two pulse examination locations have been less commonly used in later generations. Since the Jin Dynasty, the commonly used pulse examination location has been the cun-kou. The cun-kou method first appeared in the Nei Jing (Inner Canon), advocating the exclusive use of the cun-kou, as stated in the Nanjing (Classic of Difficulties). However, this view was not widely adopted until the Mai Jing (Classic of Pulses) written by Wang Shuhe during the Jin Dynasty, which promoted 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 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 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 is associated with the spleen meridian, which shares Qi with the spleen and stomach. 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 be reflected in the cun-kou. Thus, exclusively using the cun-kou allows for the examination of changes in the entire body.
The cun-kou is divided into three parts: Cun, Guan, and Che, marked by the radial styloid process. The area slightly inward from this point is the Guan, the area before the wrist is the Cun, and the area behind the elbow is the Che. Each hand has three parts: Cun, Guan, and Che, making a total of six pulse locations. The Cun, Guan, and Che can be further divided into floating, middle, and sinking states, which is the three parts and nine pulses of the cun-kou method.
The Cun, Guan, and Che correspond to the organs, and different medical practitioners have varying interpretations. Currently, the following is commonly accepted:
Left Cun can indicate: Heart and Zhong (中) (Pericardium) Right Cun can indicate: Lung and Chest
Left Guan can indicate: Liver and Gallbladder and Diaphragm Right Guan can indicate: Spleen and Stomach
Left Che can indicate: Kidney and Lower Abdomen Right Che can indicate: Kidney and Lower Abdomen
(4) Methods and Considerations for Pulse Diagnosis
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Pulse Diagnosis for Life and Death
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Pulse Diagnosis for Clear Evidence
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Pulse Diagnosis for Longevity
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Pulse Diagnosis for Fetal Pulses in the Heart and Kidney Meridians
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Pulse Diagnosis Requirements
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Pulse Diagnosis Essentials for Stomach Shen
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Pulse Diagnosis for Children
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Pulse Diagnosis for Chest and Abdomen
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 quiet. The Qi and blood 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 maintain a calm demeanor before starting the pulse diagnosis. The examination room should also be kept quiet. In special circumstances, the practitioner should be able to examine the patient at any time without being restricted 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 palms facing up, and the wrist joints supported by a cushion. This allows for unobstructed movement of Qi and blood, reflecting the true pulse characteristics of the body.
3. Finger Technique
The practitioner and patient should sit side by side, with the left hand pressing on the patient’s right hand and the right hand pressing on the patient’s left hand. When pressing the pulse, the practitioner should first place the middle finger on the inner side of the radial artery at the wrist, then place the index finger on the Cun pulse position, and the ring finger on the Che pulse position. Once the positions are set, 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, known as total pressing; to focus on a specific pulse characteristic, one finger can be lifted slightly while pressing on another pulse position. In clinical practice, total pressing and single pressing are often used in combination, making this comparative method of pulse diagnosis quite practical. Single pressing can be used to assess the three parts of the cun-kou to determine which meridian and organ are affected, while total pressing is used to examine the changes in the five organs and six bowels.
For children, the “one-finger (thumb) method” can be used to determine the Guan position without dividing into three parts, as the child’s cun-kou area is small 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 characteristics by varying the pressure and movement of the fingers. The three essential actions in pulse diagnosis are 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 is called searching, which involves a combination of light and heavy pressure to explore the pulse characteristics. Therefore, it is essential to pay attention to the changes in pulse characteristics between lifting, pressing, and searching. Additionally, when the three pulse positions show distinct differences, the finger positions must be gradually adjusted to explore both internal and external aspects. Searching means to seek, not to take the middle position.
5. Breathing
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 and pathological pulse rates of slow, rapid, soft, and strong. Today, a stopwatch can be helpful for pulse diagnosis. However, the significance of breathing goes beyond this. “Even” means to maintain a balanced state, requiring the practitioner to concentrate and focus entirely during pulse diagnosis. Therefore, in addition to counting the pulse with “breath,” the practitioner should also maintain an open mind and be fully attentive.
6. Fifty Pulses
Each pulse diagnosis must reach fifty beats. This means that the time spent on each side of the pulse should not be less than fifty beats. The significance of this is twofold:
First, to ensure that there are no missed diagnoses of rapid, knotty, or intermittent pulses. Second, to emphasize that pulse diagnosis should not be rushed; it must aim to clarify the pulse characteristics. If the first fifty beats do not yield clear results, the practitioner can extend the examination to the second or third fifty beats. In summary, each pulse diagnosis should last 2-3 minutes.
(5) Normal Pulse Characteristics
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Normal Breathing
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Observation of Normal Pulse and Physiological Changes
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Normal Coagulation Mechanism
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Observation of Normal Body Temperature and Physiological Changes
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Normal Intracranial Pressure and Hydrocephalus
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Standards for Judging Normal and Abnormal Psychology
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Normal Pulse Characteristics
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Characteristics of Normal Pulse
The normal pulse, known as Ping Mai (平脉), is the pulse of a healthy person without disease. The characteristics of a normal pulse are that all three parts have a pulse, with a breath 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 Che pulse should be taken with a certain strength and may vary with the main activities and environmental conditions. The normal pulse has three characteristics: Wei (胃) (Stomach), Shen (神) (Spirit), and Gen (根) (Root).
Having Wei: A pulse with Wei Qi indicates that the pulse is neither floating nor sinking, neither fast nor slow, calm and gentle, with a consistent rhythm. Even if it is a pathological pulse, if it shows a gentle quality, it indicates the presence of Wei Qi. If the pulse has Wei Qi, it is a normal pulse; if it lacks Wei Qi, it indicates a pathological change. A pulse without Wei Qi indicates a true organ pulse, which may be difficult to treat or indicate a poor prognosis, so the presence or absence of Wei Qi is significant for judging the prognosis of diseases.
Having Shen: A pulse with Shen 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 pulse Shen. The strength or weakness of Shen has certain significance for judging the prognosis of diseases.
However, it is essential to combine the pulse with the voice, color, and form to draw accurate conclusions. The presence of Wei and Shen indicates a harmonious quality; thus, in clinical practice, the diagnostic methods for Wei and Shen are similar.
Having Gen: A pulse with a strong Che pulse indicates that the kidney Qi is still present, and the essence has not been exhausted. If the Che pulse is strong, it indicates vitality. If the pulse is floating, large, and chaotic, and pressing it yields no response, it indicates a lack of root, signifying a critical condition.
The normal pulse varies with internal and external factors, leading to corresponding physiological changes.
Seasonal Climate: Due to climatic influences, the normal pulse changes with the seasons: spring shows a taut pulse, summer a surging pulse, autumn a floating pulse, and winter a sinking pulse. This reflects the human body’s response to the natural seasonal changes, thus the physiological functions also change accordingly, leading to variations in the normal pulse throughout the seasons.
Geographical Environment: The geographical environment can also affect the pulse. For example, in the south, where the terrain is lower, the climate is warmer, and the air is humid, the muscles are relaxed, leading to a finer and softer pulse or slightly rapid pulse; in the north, where the terrain is higher and the air is dry, the climate is colder, 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 or six have a pulse rate of 90-110 beats per minute; as age increases, the pulse rate gradually slows down. 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 mass often have floating pulses, while obese individuals with thick subcutaneous fat often have sinking pulses. Normal variations in the six pulses without disease are referred to as Liuyin Mai (六阴脉); normal variations in the six pulses with large pulses without disease are referred to as Liuyang Mai (六阳脉).
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 fear can disrupt Qi and lead to erratic pulses. This indicates that emotional changes can cause variations in the pulse, but once emotions stabilize, the pulse returns to normal.
Labor and Rest: Intense exercise or long journeys often lead to rapid pulses; 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, the pulse may be slightly slower and weaker.
Additionally, some individuals may have pulses that do not appear at the cun-kou but instead appear at the Che position, referred to as Xie Fei Mai (斜飞脉); if the pulse appears on the dorsal side of the cun-kou, it is called Fan Guan Mai (反关脉); other positions on the wrist are also considered physiological variations of the radial artery anatomy and do not indicate disease.
(6) Pathological Pulse Characteristics
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Pathological Breathing
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Pathological Overview
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Pathological Description
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Pathology
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Pathological Myopia
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Pathological Jaundice
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Pathological Breast Development Treatment Methods
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Pathological Nerve Damage
Diseases are reflected in changes in the pulse, known 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 conditions. The earliest pulse study book in China, the Mai Jing (Classic of Pulses), proposed twenty-four types of pulses, while the Jing Yue Quan Shu (Complete Works of Jing Yue) proposed sixteen types, and the Bin Hu Mai Xue (Pulse Studies of Bin Hu) proposed twenty-seven types. Li Shicai’s Zhen Jia Zheng Yan (Correct Eye of Diagnosis) added more types, leading to a modern discussion of twenty-eight pulses.
Pulse characteristics are observed through four aspects: position, rate, shape, and momentum. The position refers to the depth of the pulse beneath the skin.
Pulse positions are divided into floating and sinking; those that are shallow beneath the skin are floating pulses, while those that are deep within the muscles and bones are sinking pulses. The rate refers to the pulse frequency, which can be slow or rapid. A breath rate of less than four beats is considered slow, while a breath rate of five or six beats is considered rapid. The shape includes the thickness of the pulse vessel and its specific characteristics, such as a hollow pulse resembling a scallion tube or a pulse resembling a bean. The momentum refers to the strength or force 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 momentum, 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 pulse characteristics require comprehensive observation of position, rate, shape, and momentum to differentiate. For example, a weak pulse is formed by a combination of a sinking, small, and weak pulse, while a solid pulse is formed by a combination of sinking, solid, large, taut, and long pulses. A floating, large, and strong pulse is known as a surging pulse. Single pulses often do not fully reflect the essence of the disease, while compound pulses can reflect the condition from multiple aspects. In addition to the aforementioned twenty-eight pulses, various combinations of pulses often appear, such as floating and tight, floating and slow, sinking and fine, slippery and rapid, etc.
1. Classification of Pulse Characteristics and Main Diseases
(1) Floating Pulse Category: The floating pulse category includes six pulses: floating, surging, soft, scattered, hollow, and leather. Because their pulse positions are shallow, they can be easily obtained by floating examination.
① Floating Pulse
[Pulse Characteristics]: Easily obtained with light pressure, slightly reduced with heavy pressure but not empty, and feels buoyant like wood floating on water.
[Main 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, causing the defensive Yang to rise and resist, resulting in a buoyant pulse. In cases of internal injury and prolonged illness, the body may become weak, and Yang Qi cannot be contained, leading to a floating and weak pulse.
② Surging Pulse
[Pulse Characteristics]: Extremely large, resembling turbulent waves, with a strong arrival and weak departure.
[Main Diseases]: Interior 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, Qi deficiency, or blood loss, it indicates a dangerous condition of excess pathogenic Qi and deficiency of righteous Qi.
③ Soft Pulse
[Pulse Characteristics]: Floating and fine, soft like silk in water.
[Main Diseases]: Deficiency syndrome, damp syndrome.
[Pulse Theory]: The soft pulse indicates various deficiencies. 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 Characteristics]: Floating and rootless, with an irregular rhythm, resembling scattered willow fluff.
[Main Diseases]: Dispersed Yuan Qi.
[Pulse Theory]: The scattered pulse indicates that Yuan Qi is dispersed, and the Qi of the organs is about to be exhausted. 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 critical condition.
⑤ Hollow Pulse
[Pulse Characteristics]: Floating and large, with a hollow center, like pressing on a scallion tube.
[Main Diseases]: Blood loss, Yin injury.
[Pulse Theory]: The hollow pulse is often seen in cases of blood loss and Yin injury, indicating that the pulse vessels are not filled due to sudden blood loss or significant loss of fluids, leading to a floating and large hollow pulse.
⑥ Leather Pulse
[Pulse Characteristics]: Floating and strong at the surface, with a hollow center, like pressing on a drum skin.
[Main Diseases]: Blood loss, loss of essence, postpartum, or leakage.
[Pulse Theory]: The leather pulse is a combination of taut and hollow pulses, resulting from internal deficiency of essence and blood, causing the pulse to float and become hollow.
(2) Sinking Pulse Category: The sinking pulse category includes sinking, hidden, weak, and solid pulses. These pulses are deeper and can only be felt with heavy pressure.
① Sinking Pulse
[Pulse Characteristics]: Not felt with light pressure, only felt with heavy pressure, like a stone sinking to the bottom of the water.
[Main Diseases]: Interior syndrome. It can also be seen in normal individuals without disease.
[Pulse Theory]: The pathogenic factor is internal, and the righteous Qi is engaged internally, causing Qi and blood to be trapped, resulting in a strong sinking pulse, indicating an interior excess syndrome. If the organs are weak and Yang Qi is deficient, the pulse may be sinking and weak, indicating an interior deficiency syndrome.
② Hidden Pulse
[Pulse Characteristics]: Only felt with heavy pressure on the muscles and bones, and may not be felt at all in severe cases.
[Main Diseases]: Closed pathogenic factors, critical conditions, severe pain.
[Pulse Theory]: Due to the internal presence of pathogenic factors, the pulse Qi cannot circulate, 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 Characteristics]: Extremely soft and fine.
[Main Diseases]: Deficiency of Qi, blood, Yin, and Yang.
[Pulse Theory]: Insufficient Yin and blood cannot fill the pulse vessels, and weak Yang Qi cannot promote blood circulation, leading to a sinking and fine pulse, resulting in a weak pulse.
④ Solid Pulse
[Pulse Characteristics]: Firm and large when pressed, solid and unyielding.
[Main Diseases]: Cold and Yin accumulation, internal solid masses.
[Pulse Theory]: The solid pulse forms due to the firm presence of pathogenic factors and internal cold accumulation, causing Yang Qi to sink, resulting in a solid and large pulse. The solid pulse indicates the presence of Qi and blood, with tangible masses indicating solid conditions, while intangible masses indicate Qi conditions. If a solid pulse is observed in cases of blood loss or Yin deficiency, it indicates a critical condition.
(3) Slow Pulse Category: The slow pulse category includes slow, gentle, rough, and knotty pulses. These pulses are characterized by a slow rhythm, with a breath rate of less than four to five beats.
① Slow Pulse
[Pulse Characteristics]: The pulse is slow, with a breath rate of less than four beats (equivalent to less than 60 beats per minute).
[Main Diseases]: Cold syndrome. A strong slow pulse indicates cold pain or cold accumulation, while a weak slow pulse indicates deficiency cold. Athletes who have trained for a long time may have a slow but strong pulse, which is not considered pathological.
[Pulse Theory]: The slow pulse indicates a cold syndrome due to insufficient Yang Qi, which cannot effectively promote blood circulation, resulting in a pulse rate of less than four beats. If cold accumulation obstructs the flow of Yang Qi, the pulse may be slow but strong. If Yang Qi is deficient and cold, the pulse is often slow and weak. If pathogenic heat accumulates, it may also lead to a slow pulse, but it must be strong when pressed, indicating a solid condition. The slow pulse should not be generalized as a cold syndrome; the pulse characteristics must be considered.
② Gentle Pulse
[Pulse Characteristics]: A breath rate of four beats, with a slow and gentle rhythm.
[Main Diseases]: 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, 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 Characteristics]: Slow and fine, with a rough rhythm, difficult to flow smoothly, like a light knife scraping bamboo.
[Main Diseases]: Insufficient essence and blood, Qi stagnation, phlegm, and food retention.
[Pulse Theory]: Insufficient essence and blood cannot nourish the pulse vessels, leading to a rough pulse. Qi stagnation, blood stasis, phlegm, and food retention can also obstruct the flow of Qi, resulting in a rough pulse.
④ Knotty Pulse
[Pulse Characteristics]: The pulse is slow, with intermittent stops, and the stops are irregular.
[Main Diseases]: Excessive Yin, Qi stagnation, cold phlegm, and blood stasis.
[Pulse Theory]: Excessive Yin leads to Qi stagnation, obstructing blood flow, resulting in a slow pulse with intermittent stops. 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 Category: The rapid pulse category includes rapid, urgent, hurried, and moving pulses. These pulses are characterized by a rapid rhythm, with a breath rate exceeding five beats.
① Rapid Pulse
[Pulse Characteristics]: The pulse rate exceeds five beats per breath.
[Main Diseases]: Heat syndrome. A strong rapid pulse indicates excess heat, while a weak rapid pulse indicates deficiency heat.
[Pulse Theory]: Excessive heat within the body accelerates the flow of Qi and blood, resulting in a rapid pulse. If the heat is excessive and the righteous Qi is not deficient, the pulse is rapid and strong, indicating an excess heat syndrome. If the pulse is rapid and floating, with no root when pressed, it indicates a dangerous condition of external Yang Qi escaping.
② Urgent Pulse
[Pulse Characteristics]: The pulse is rapid, with a breath rate of seven to eight beats.
[Main Diseases]: Extreme Yang and depleted Yin, indicating impending loss of Yang.
[Pulse Theory]: In cases of excessive heat, the Yang Qi is unrestrained, and the true Yin is in danger, leading to a rapid pulse that becomes stronger when pressed. If Yin fluids are depleted, the pulse may be rapid but weak.
③ Hurried Pulse
[Pulse Characteristics]: The pulse is rapid, with intermittent stops, and the stops are irregular.
[Main Diseases]: Excessive Yang heat, Qi and blood stagnation, phlegm and food retention.
[Pulse Theory]: Excessive Yang heat or stagnation of Qi and blood leads to rapid blood flow, resulting in a hurried pulse. If the pulse is rapid and stops intermittently, it indicates a blockage of Qi and blood flow.
④ Moving Pulse
[Pulse Characteristics]: The pulse feels like a bean, trembling and shaking, slippery and rapid.
[Main Diseases]: Pain syndromes, shock syndromes. The moving pulse can also appear during pregnancy, which is valuable for early clinical diagnosis.
[Pulse Theory]: The moving pulse indicates a disturbance of Yin and Yang, causing Qi and blood to surge, leading to a moving pulse. Pain and shock can also lead to a moving pulse.
(5) Deficient Pulse Category: The deficient pulse category includes deficient, fine, weak, intermittent, and short pulses, characterized by weak responses to pressure.
① Deficient Pulse
[Pulse Characteristics]: The three parts of the pulse are weak and empty when pressed.
[Main Diseases]: Deficiency syndrome.
[Pulse Theory]: Insufficient Qi cannot circulate the blood, leading to a weak pulse. Blood deficiency cannot fill the pulse vessels, resulting in an empty pulse. Due to Qi deficiency, the pulse may float and be weak.
② Fine Pulse
[Pulse Characteristics]: The pulse is fine like a thread, but the response is clear.
[Main Diseases]: Deficiency of Qi and blood, various deficiencies, damp syndrome.
[Pulse Theory]: The fine pulse is caused by deficiency of Qi and blood, where insufficient nutrients cannot fill the pulse vessels, leading to a fine and weak pulse.
③ Weak Pulse
[Pulse Characteristics]: Extremely fine and soft, almost imperceptible.
[Main Diseases]: Deficiency of Yin, Yang, Qi, and blood.
[Pulse Theory]: Weak Yang Qi cannot promote blood circulation, leading to a weak pulse. A weak pulse may indicate a critical condition.
④ Intermittent Pulse
[Pulse Characteristics]: The pulse is felt intermittently, with a fixed number of stops.
[Main Diseases]: Weak organ Qi, wind syndrome, pain syndrome.
[Pulse Theory]: Weak organ Qi leads to insufficient blood flow, causing the pulse to stop intermittently. Wind and pain syndromes can also lead to an intermittent pulse.
⑤ Short Pulse
[Pulse Characteristics]: The pulse is short and does not fill the entire area.
[Main Diseases]: Qi disease. A strong short pulse indicates Qi stagnation, while a weak short pulse indicates Qi deficiency.
[Pulse Theory]: Insufficient Qi cannot support blood flow, leading to a short and weak pulse. Qi stagnation or blood stasis can also lead to a short pulse.
(6) Excess Pulse Category: The excess pulse category includes solid, slippery, taut, tight, and long pulses, characterized by strong responses to pressure.
① Solid Pulse
[Pulse Characteristics]: All three parts of the pulse are strong when pressed.
[Main Diseases]: Excess syndrome.
[Pulse Theory]: Excessive pathogenic factors lead to a strong pulse, indicating a solid condition. A solid pulse can also be seen in healthy individuals, indicating sufficient righteous Qi and good organ function.
② Slippery Pulse
[Pulse Characteristics]: The pulse flows smoothly, like beads rolling on a plate, and feels smooth to the touch.
[Main Diseases]: Phlegm, food retention, excess heat.
[Pulse Theory]: Excessive pathogenic factors lead to a strong pulse, indicating a solid condition. A slippery pulse can also be seen in healthy individuals, indicating sufficient righteous Qi and good organ function.
③ Taut Pulse
[Pulse Characteristics]: The pulse is straight and long, like pressing on a guitar string.
[Main Diseases]: Liver and gallbladder diseases, phlegm, pain syndromes, malaria.
[Pulse Theory]: The taut pulse indicates tension in the pulse Qi. If the liver is obstructed, the pulse may become taut. Pain, phlegm, and Qi stagnation can also lead to a taut pulse.
④ Tight Pulse
[Pulse Characteristics]: The pulse feels tight and tense, like a taut rope.
[Main Diseases]: Cold syndrome, pain syndrome.
[Pulse Theory]: Cold pathogenic factors invade the body, leading to a tight pulse due to tension in the pulse vessels.
⑤ Long Pulse
[Pulse Characteristics]: The pulse is long and extends beyond its normal position.
[Main Diseases]: Excessive liver Yang, heat, and other excess conditions.
[Pulse Theory]: In healthy individuals, a long pulse indicates sufficient righteous Qi and unobstructed circulation. However, if excessive liver Yang or heat is present, the pulse may become long and hard.
(2) Combined Pulses and Main Diseases
Combined pulses refer to the presence of multiple pulse characteristics. Xu Ling Tai refers to combined pulses, which can be divided into two, three, or four combined pulses.
The main diseases indicated by 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. 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 Slow. Main Disease: Cold Damage, 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 Retention.
8. Combined Pulse: Surging and Rapid. Main Disease: Qi Level 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.
12. Combined Pulse: Sinking and Gentle. Main Disease: Spleen Deficiency, Water Retention.
13. Combined Pulse: Sinking and Fine. Main Disease: Yin Deficiency, Blood Deficiency with Heat.
14. Combined Pulse: Taut and Slippery Rapid. Main Disease: Liver Fire with Phlegm, Phlegm Heat Internal Accumulation.
15. Combined Pulse: Sinking and Fine 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
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Diagnosis of Fetal Pulses in the Heart and Kidney Meridians
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Diagnosis of Fetal Pulses in the Hand and Foot Shaoyin Meridians
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Diagnosis of Chest and Abdomen
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Diagnosis of Deficiency in the Interior
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Pulse Diagnosis Requirements
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Pulse Diagnosis Essentials for Stomach Shen
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Diagnosis of Pediatric Pulses
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Diagnosis of Chest and Abdomen
Pediatric pulse diagnosis differs from that of adults, as the cun-kou area in children is small, making it difficult to distinguish the three parts. Additionally, children are easily startled and may cry, which can disrupt the pulse. Therefore, later generations of practitioners often use a single finger to assess the three parts. 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 radial styloid process, determining the pulse rate. For children over four years old, the middle line of the radial styloid process is used as the Guan position, and a single finger can be rolled to assess the three parts. For children aged seven to eight, the thumb can be moved to assess the three parts; for children aged nine to ten, the three parts can be assessed in sequence; and for those aged sixteen, the adult method of assessing the three parts can be used.
The main diseases indicated by pediatric pulses can be determined by floating, sinking, slow, and rapid characteristics, indicating exterior, interior, cold, and heat conditions, respectively. The strength or weakness of the pulse 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 may indicate a solid pulse similar to that of adults.
(8) Pulse Symptoms and Their Correspondence
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Pulse Symptoms and Correspondences
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Pulse Symptoms and Their Correspondence
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Pulse Locations
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Pulse Movements
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Pulse Symptoms and Their Correspondence
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Pulse Symptoms and Their Correspondence
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Pulse Symptoms and Their Correspondence
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Pulse Symptoms and Their Correspondence
1. Pulse Symptoms and Their Correspondence: Pulse symptoms and their correspondence refer to the relationship between the pulse and symptoms in determining the disease’s progression. Generally, the pulse and symptoms are consistent, meaning that the pulse corresponds to the symptoms. However, there are times when the pulse and symptoms do not match, indicating a discrepancy. In terms of disease progression, a corresponding pulse indicates a favorable prognosis, while a non-corresponding pulse indicates a poor prognosis. Generally, if there are excess symptoms, the pulse may be surging, rapid, slippery, or solid, indicating a strong pathogenic factor and sufficient righteous Qi to resist the disease. If the pulse is fine, weak, or intermittent, it indicates a weak righteous Qi and a strong pathogenic factor, which may lead to a poor prognosis. For example, in acute diseases, if the pulse is floating, surging, rapid, or solid, it indicates a favorable prognosis, reflecting sufficient righteous Qi to resist the disease. In chronic diseases, if the pulse is sinking, fine, weak, or intermittent, it indicates a favorable prognosis, suggesting that the pathogenic factor is declining and the righteous Qi is recovering. However, if a new disease presents with a sinking, fine, weak, or intermittent pulse, it indicates that the righteous Qi is already weak; if a chronic disease presents with a floating, surging, rapid, or solid pulse, it indicates that the righteous Qi is weak and the pathogenic factor is not retreating, which is a poor prognosis.
2. Pulse Symptoms and Their Correspondence: Since there are cases where the pulse and symptoms do not correspond, one must discern the truth from the falsehood of the pulse and symptoms to determine whether to prioritize the pulse or the symptoms.
Prioritize Symptoms over Pulse: 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 upon pressure, constipation, red tongue with thick yellow coating, and 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. In this case, one should prioritize the symptoms over the pulse.
Prioritize Pulse over Symptoms: In cases where the pulse is true and the symptoms are false, one must prioritize the pulse. For example, in cases of cold damage, if the symptoms indicate cold limbs while the pulse is slippery and rapid, the pulse reflects true heat; the symptoms indicate false cold due to the internal heat being concealed. In this case, one should prioritize the pulse over the symptoms.
2. Palpation
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Pressing to Move Qi Method
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Pressing Based on Genetic Control Principles
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Structure, Classification, and Naming of Amines
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Properties of Amines
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Pressing Combined with Moxibustion at Jing Points for Treating Increased Muscle Tone After Stroke
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Pressing a Single Point to Treat Toothache
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Methods and Significance of Palpation
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Content of Palpation
Palpation is a method where the practitioner uses their hands to directly touch and press certain areas of the patient’s body to understand local abnormal changes, thereby inferring the location, nature, and severity of the disease.
(1) Methods and Significance of Palpation
1. Methods
① Position: During palpation, the patient should be seated or lying flat. Generally, when palpating the chest and abdomen, the patient should lie flat, fully relaxed, with legs extended and hands at their sides. The practitioner stands on the patient’s right side, using one or both hands to perform the palpation. When palpating for abdominal masses or muscle tension, the patient may be asked to bend their knees to relax the abdominal muscles, facilitating palpation.
② Techniques: The techniques of palpation 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 stroking the area to determine the sensation and characteristics of any swelling. Pushing involves applying slight pressure to move the area back and forth or side to side to assess the mobility of any masses and their relationship with surrounding tissues. Pressing involves applying pressure to the area, such as the chest or abdomen, to determine if there is deep tenderness, the shape and texture of any masses, and the degree and nature of any 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 palpation, the practitioner should be considerate of the patient, using gentle techniques to avoid sudden force. In cold weather, the practitioner’s hands should be warmed before examination. Generally, touching is done first, followed by pressing, with pressure gradually increasing from light to heavy and from superficial to deep. The practitioner should also instruct the patient to cooperate actively, providing feedback on their sensations, and observe the patient’s facial expressions to understand their discomfort. Palpation should be thorough and careful, not overlooking any areas related to the disease.
2. Significance
Palpation is a part of pulse diagnosis and an essential component of the four diagnostic methods. It further investigates the location and nature of the disease based on observation, listening, and inquiry. For conditions such as chest and abdominal pain, swelling, phlegm, and masses, palpation can provide valuable information for diagnosis and pattern differentiation.
(2) Content of Palpation
Palpation has a wide range of applications. Clinically, it is commonly used to palpate the skin, hands and feet, chest and abdomen, and brain points, which are described as follows:
1. Palpation of the Skin
Palpation of the skin is used to assess 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.
Palpation of the skin can reveal not only temperature differences but also help differentiate between superficial and deep conditions. If the body feels very hot upon initial palpation but becomes less hot after prolonged palpation, it indicates a superficial heat condition. If the heat intensifies after prolonged palpation, it indicates an internal heat condition.
Soft and moist skin that is pleasant to touch indicates a deficiency condition, while 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.
Palpating for swelling can help differentiate between edema and emphysema. If pressing leaves an indentation that does not return immediately, it indicates edema; if pressing leaves an indentation that returns immediately, it indicates emphysema.
Palpation can also help determine whether a condition is Yin or Yang and whether it is purulent. 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. If the affected area is hard, it often indicates no pus, while if it is soft and uneven, it may indicate the presence of pus. For deep muscle abscesses, the presence of pus can be determined by feeling for a wave-like sensation or lack thereof. The method involves placing one hand on either side of the swelling, applying varying pressure with one hand while the other remains still, feeling for any wave-like sensation; if present, it indicates pus, and the extent of the wave can indicate the amount of pus.
2. Palpation of Hands and Feet
Palpation of the hands and feet primarily assesses temperature to determine the nature of the disease, whether it is deficient or excess, internal or external, and the prognosis. If both hands and feet are cold at the onset of illness, it indicates Yang deficiency and cold excess, suggesting a cold condition. If the hands and feet are warm, it indicates Yang excess and heat, suggesting a heat condition.
Palpation of the hands and feet can also help differentiate between external and internal diseases. If the back of the hands and feet feels warm, it indicates an external febrile disease; if the palms and soles feel warm, it indicates an internal febrile disease. Additionally, the method of comparing the warmth of the palms with the forehead can help differentiate between exterior heat and internal heat. If the forehead is warmer than the palms, it indicates exterior heat; if the palms are warmer than the forehead, it indicates internal heat. This diagnostic method is of reference value.
In pediatrics, cold fingertips in children 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 presence of Yang Qi, which is crucial for determining the prognosis of certain Yang deficiency conditions. If the limbs are warm, it indicates that Yang Qi is still present and treatment is possible; if the limbs are cold, it indicates a poor prognosis.
3. Palpation of the Chest and Abdomen
The division of the chest and abdomen is as follows: the upper chest is the chest, and the lower chest is the abdomen. The lateral chest area extends from the lower abdomen to the eleventh and twelfth ribs, known as the flank. The area below the xiphoid process is referred to as the heart area. The upper abdomen corresponds to the stomach area, while the lower abdomen is below the navel, and the lower abdomen refers to the sides of the lower abdomen.
Palpation of the chest and abdomen is performed based on the needs of the disease, purposefully touching and pressing the chest, flank, and abdomen, and if necessary, tapping to understand the local pathological conditions.
The content of palpation of the chest and abdomen can be divided into palpation of the interior, palpation of the chest and flank, and palpation of the abdomen.
(1) Palpation of the Interior: The interior is located beneath the left breast, where the apex of the heart beats, and is the convergence of all pulses. Exploring the pulsation of the interior can provide insight into the strength of the Zong Qi, the nature of the disease, and the prognosis. This area is of great importance in traditional practice.
When palpating the interior, a responsive pulse that moves without tension and is neither fast nor slow indicates health. If the pulse is weak and lacks strength, it indicates deficiency of Zong Qi. If the pulse is strong and responsive, it indicates excessive Zong Qi. If the pulse is large and strong, it indicates a critical condition.
In pregnant women, the pulse may be elevated before and after childbirth, or in cases of tuberculosis, caution is advised. If the pulse stops completely, it indicates a critical condition. Palpation of the interior is significant for determining life and death when no pulse is felt.
(2) Palpation of the Chest and Flank: If the front of the chest is elevated and palpation reveals shortness of breath, it indicates lung disease. If palpation of the chest and flank reveals distension and pain, it may indicate phlegm-heat obstruction or internal water retention.
The liver is located within the right flank, with its upper boundary at the midclavicular line at the fifth rib and its lower boundary at the lower edge of the right rib arch. If the liver is palpable, 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, with a warm sensation upon palpation, indicates liver abscess. In cases of prolonged malaria, a mass may appear beneath the flank, referred to as the “mother of malaria.”
(3) Palpation of the Abdomen: Palpation of the abdomen primarily assesses temperature, softness, hardness, distension, swelling, and tenderness to assist in diagnosis and pattern differentiation.
To differentiate temperature, palpation of the abdomen can reveal whether the disease is cold or hot. A cold abdominal wall that prefers warmth indicates a deficiency cold condition, while a hot abdominal wall that prefers cold indicates an excess heat condition.
To differentiate pain, if abdominal pain is relieved by pressure, it indicates a deficiency condition; if it resists pressure, it indicates an excess condition. If the area is hot and painful, it may indicate an internal abscess.
To differentiate distension, if the abdomen feels full and firm upon palpation, with tenderness and a heavy sound upon percussion, it indicates an excess condition; if it feels soft and without tenderness, it indicates a Qi condition, often associated with a deficiency condition.
Severe abdominal distension, resembling a drum, is referred to as distension. This is a serious condition that can be classified into water distension and gas distension. By placing hands on either side of the abdomen, one hand can lightly tap while the other feels for a wave-like sensation. If a wave is felt, it indicates water distension; if there is no wave, it indicates gas distension. Additionally, some individuals with obesity may have a distended abdomen, but if it is soft and without protrusion or other severe symptoms, it should be differentiated from distension.
To differentiate masses, palpation should assess size, shape, hardness, tenderness, and other characteristics.
Accumulation refers to a mass in the abdomen that may be painful or distended. However, accumulation and mass are different. Pain with a fixed location indicates accumulation, while pain without a fixed location indicates a mass, which is associated with Qi conditions.
Pain in the left lower abdomen with a hard mass indicates fecal impaction, while pain in the right lower abdomen with a palpable mass indicates intestinal abscess.
For abdominal parasites, three major characteristics can be observed: first, the mass resembles a knot; second, upon prolonged palpation, it may shift; third, the abdominal wall may feel uneven, with rising and falling sensations upon palpation.
4. Palpation of Acupuncture Points
Palpation of acupuncture points involves pressing specific points on the body to infer certain internal diseases based on the changes and responses at these points.
Changes at acupuncture points primarily manifest as nodules or cord-like structures, or as tenderness and sensitivity. Clinical reports indicate that patients with lung diseases may have nodules at the lung shu point, while tenderness may be present at the middle palace point. Patients with liver diseases may experience tenderness at the liver shu or qi men points. Gastric diseases may show tenderness at the stomach shu and zu san li points. Intestinal abscesses may show tenderness at the appendix point.
Additionally, experimental treatment through finger pressure on acupuncture points can assist in differential diagnosis. For example, in cases of biliary colic, pressing on both sides of the gallbladder shu point may relieve pain, while other causes of abdominal pain may not respond, aiding in differentiation.