Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

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Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

The twenty-eight pulse types can be understood through four aspects: pulse position, frequency, shape, and the momentum of the pulse. For example, floating and sinking refer to different pulse positions, slow and rapid refer to frequency differences, large and small refer to shape differences, and empty and full refer to the momentum differences. Some pulse types combine several aspects.

The characteristics of the twenty-eight pulses and their associated diseases are described as follows:

15. Xuan Mai (String-like Pulse)

Pulse Characteristics: Straight and long, resembling a bowstring.

Main Diseases: Liver diseases, various pains, phlegm-dampness, malaria.

Explanation: The string-like pulse corresponds to wind and wood, thus indicating liver diseases, wind-phlegm, and various pains. The pulse of malaria is also string-like, making it a primary pulse type for malaria. In cases of deficiency and internal injury, the string-like pulse is often seen, indicating insufficient middle qi, where earth is overcome by wood. The strength of the string can also indicate the strength of stomach qi; a strong string indicates a full condition, while a weak string indicates a deficiency, which can help differentiate between excess and deficiency. If the string is thin and tense, like following the edge of a knife, it indicates a complete lack of stomach qi, often leading to untreatable conditions.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

16. Kuo Mai (Hollow Pulse)

Pulse Characteristics: Both floating and sinking are present, with a unique emptiness in the middle, like pressing on a scallion tube.

Main Disease: Blood loss.

Explanation: The hollow pulse is large and weak, with a feeling of emptiness when pressed, indicating excessive blood loss, where yin blood is deficient internally, and yang qi is scattered externally, resulting in the hollow pulse appearance. If the hollow pulse shows a single string or is accompanied by a rough pulse, it may indicate the presence of blood stasis, representing a combination of deficiency and excess.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

17. Ge Mai (Leather-like Pulse)

Pulse Characteristics: Floating yet firm, hollow inside and hard outside, like pressing on a drum skin.

Main Diseases: Loss of blood and essence, postpartum hemorrhage.

Explanation: The leather-like pulse indicates a strong exterior and hollow interior, where qi is deficient and cannot hold essence and blood, causing it to float outward. Therefore, loss of blood and essence, as well as postpartum hemorrhage, are often associated with this pulse. In cases of cold damage, this pulse may also be present.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

18. Lao Mai (Firm Pulse)

Pulse Characteristics: Firm, large, and long, with a strong pressure when pressed.

Main Diseases: Internal cold and excess, abdominal masses.

Explanation: The firm pulse often indicates a strong disease qi, characterized by internal accumulation of cold and excess, and is not seen in deficiency conditions. The firm pulse indicates excess, with a distinction between qi and blood. Abdominal masses are tangible lumps in the blood aspect; while abdominal pain and hernias are in the qi aspect. The firm pulse is seen in cases of blood loss and yin deficiency, indicating a critical pulse condition.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

19. Ru Mai (Soft Pulse)

Pulse Characteristics: Weak and floating, small.

Main Diseases: Various deficiencies, also indicates dampness.

Explanation: The soft pulse is weak and floating, indicating insufficient qi and blood, thus representing various deficiencies. However, if dampness suppresses the pulse pathway, the pulse may also be weak and floating, which should not be solely interpreted as deficiency. Diagnosis should be combined with other symptoms for accuracy.

Soft pulse, as stated in “Four Diagnostic Methods”, indicates that soft is synonymous with ru, hence soft pulse is ru pulse.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

20. Ruo Mai (Weak Pulse)

Pulse Characteristics: Weak and sinking, small.

Main Disease: Insufficient qi and blood.

Explanation: The weak pulse is similar to the soft pulse. The soft pulse is fine and floating, while the weak pulse is fine and sinking.

After an illness, a weak pulse is a sign of recovery; in new illnesses with excess, a weak pulse indicates a poor prognosis.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

21. San Mai (Scattered Pulse)

Pulse Characteristics: Floating and scattered, not gathering; when pressed, it is absent, with unclear arrival and departure, lacking roots.

Main Disease: Dispersed vital qi.

Explanation: The scattered pulse fills the fingers but does not gather, with unclear arrival and departure, indicating the exhaustion of qi and blood, and a sign that the organ qi is about to collapse.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

22. Xi Mai (Thin Pulse)

Pulse Characteristics: Thin as a thread, with a distinct response to pressure.

Main Disease: Deficiencies of both qi and blood, various deficiencies, dampness invading downwards.

Explanation: The thin pulse results from both qi and blood deficiencies, insufficient to fill the pulse. In healthy individuals, a thin pulse may indicate excessive worry or internal damage to the true essence; if the pulse is thin during a severe illness, it indicates a critical condition.

Small pulse, as stated by He Mengyao: “Small is the opposite of large, also known as thin.” Thus, small pulse is thin pulse.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

23. Fu Mai (Hidden Pulse)

Pulse Characteristics: Requires heavy pressure to feel, may be completely hidden.

Main Diseases: Blockage of evil, syncope, also indicates extreme pain.

Explanation: The hidden pulse indicates a state of yin and yang being concealed, with blockage and stagnation. When evil qi blocks and presses the righteous qi, the righteous qi cannot circulate, resulting in a hidden pulse, which is a sign of yang being hidden; if there is a hidden yin due to cold damage, it may also present as a hidden pulse, indicating a predominance of yin and deficiency of yang, leading to cold extremities. The merging of organ qi can also lead to a hidden pulse due to qi stagnation and severe pain.

If both hands have hidden pulses and the Tai Xi (Tai Chi) and Fu Yang pulses are also absent, it indicates death.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

24. Dong Mai (Moving Pulse)

Pulse Characteristics: Shaped like a bean, trembling and shaking, rapid and forceful.

Main Diseases: Pain, fright.

Explanation: The moving pulse resembles a short pulse, but the short pulse is yin, while the moving pulse is yang, rapid, hard, and slippery, indicating an excess condition. Zhang Zhongjing stated it is a sign of yin and yang clashing. Pain indicates disharmony between yin and yang, where qi is obstructed by blood; fright indicates qi surging and escaping, thus both present as a moving pulse.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

25. Cu Mai (Rapid Pulse)

Pulse Characteristics: Rapid and frequent, with intermittent pauses; the pauses are irregular.

Main Diseases: Excessive yang heat, stagnation of blood, qi, phlegm, and food, also indicates abscesses and swellings.

Explanation: Excessive yang and disharmony with yin lead to a rapid pulse with intermittent pauses. Stagnation of qi, blood, phlegm, food, abscesses, and various heat conditions are often associated with this pulse.

A rapid pulse that is weak and small indicates a sign of collapse, which should not be overlooked.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

26. Jie Mai (Knotted Pulse)

Pulse Characteristics: Slow pulse with intermittent pauses; the pauses are irregular.

Main Diseases: Excessive yin, qi stagnation, phlegm accumulation, and masses.

Explanation: Excessive yin leads to an inability of yang to harmonize, resulting in a slow pulse with intermittent pauses. Conditions such as cold, phlegm, blood stasis, and qi stagnation are often associated with a knotted pulse.

Both knotted and rapid pulses have irregular pauses, differing only in their speed, both resulting from yin and yang obstruction and pulse qi stagnation.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

27. Dai Mai (Intermittent Pulse)

Pulse Characteristics: Pulse comes to a stop, unable to return, and after a long time resumes, with regular pauses.

Main Diseases: Weak organ qi, wind conditions, pain conditions, emotional fright, trauma.

Explanation: The intermittent pulse differs from the knotted and rapid pulses in that it has regular pauses. The “Inner Canon” indicates that the intermittent pulse signifies weak organ qi or a complete loss of spleen qi. However, in cases of cold damage with palpitations, or wind conditions, pain conditions, emotional fright, or trauma, the intermittent pulse may appear due to the disease’s impact on the pulse qi, leading to pauses, which is different from the intermittent pulse caused by weak organ qi or a single organ’s qi deficiency.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

28. Ji Mai (Rapid Pulse)

Pulse Characteristics: Rapid pulse, with seven to eight beats per breath.

Main Diseases: Extreme yang and depletion of yin, impending collapse of vital qi.

Explanation: The rapid pulse indicates extreme depletion of yin below, with excessive yang above, and a shortness of breath. Rapid pulses are often seen in severe cold and warm diseases at their peak, as well as in cases of exhaustion and consumption, indicating a critical condition.

Rapid pulses can differ in the predominance of yin and yang; a rapid pulse that feels firm indicates a lack of control over the original yang, while a rapid pulse that does not feel firm indicates an aggressive yin, with the virtual yang escaping. Both conditions lack harmonious stomach qi, indicating a dangerous stage of illness. If the rapid pulse is neither large nor small, it indicates that stomach qi is still present, and the illness may still be treatable.

Children’s pulses are generally more rapid than adults, and seven to eight beats per breath do not constitute a rapid pulse in children.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

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Philosophy of Traditional Chinese Medicine

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

Determined individuals are as solid as a rock.

Gathering from mountains and rivers, indulging in leisure.

Refining one’s character, not seeking wealth or position.

Not coveting the world, living without fear.

The path of healing, with a heart of kindness.

Serene and carefree, the source of the healing way.

Pulse Diagnosis ‖ The Twenty-Eight Pulses and Their Main Diseases [Part 2]

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