Pulse Diagnosis
1. The pulse is the residence of blood, connecting all parts of the body. The radial artery at the wrist is the main point of diagnosis. The pulse is taken at the high bone, hence the name “Guan” (关), which is measured at the cun (寸) and chi (尺). The fish (鱼) refers to the fish border (鱼际); the ze (泽) refers to the chi ze (尺泽); the high bone (高骨) is located at the prominent area behind the wrist.
Note: The fish refers to the fish border; ze refers to the chi ze; high bone is located at the prominent area behind the wrist.
2. The right cun (寸) corresponds to the lung and chest, while the left cun corresponds to the heart and diaphragm. The right guan (关) corresponds to the spleen and stomach, and the left guan corresponds to the liver and gallbladder. The three divisions correspond to the three jiao (三焦), two chi (尺) correspond to the two kidneys, the left small bladder, and the right large intestine. The Mingmen (命门) belongs to the kidneys, the source of life energy. If one lacks two chi, they will surely die without recovery. The guan pulse is divided; the right is for food, the left is for wind.
Note: This explains the method of dividing the three divisions of the pulse corresponding to the organs.
3. There are seven types of pulse diagnosis: floating, sinking, rapid, slow, and searching left and right. For men, the left is strong, and for women, the right is favorable. The left chi is always weak for men, while the left chi is always strong for women. There are also three divisions, known as heaven, earth, and man. Each division has three pulses, totaling nine pulse conditions. The forehead, cheeks, and in front of the ears correspond to the cun, while the three yin pulses at the feet correspond to the liver, kidneys, and spleen-stomach.
Note: The “Neijing” (内经) describes seven types of pulse diagnosis. There are also three divisions and nine pulse diagnosis methods, detailed in the “Suwen: Theory of Three Divisions and Nine Pulses” (素问·三部九侯论).
4. The cun pulse is the main point, with fifty pulses combined. If it does not move fully, it indicates danger. If it is more sparse, it cannot be stopped. A short pulse indicates death within the year, and a fixed period is difficult to survive.
5. The five organs each have their own pulse. The heart is floating and scattered, the lung is floating and short, the liver is sinking and wiry, the kidney is sinking and slippery, and the spleen is slow and steady. The pulse is balanced and harmonious in all four seasons. In spring, it is wiry; in summer, it is surging; in autumn, it is fine; and in winter, it is sinking.
Note: This describes the pulses of the five organs and the balanced pulses of the four seasons.
6. Excessive strength indicates illness from the outside, while insufficient weakness indicates illness from within. Dietary strain and fatigue are diagnosed at the right guan; strength indicates excess, while weakness indicates deficiency.
Note: This distinguishes between external and internal causes of excess and deficiency in pulse patterns.
7. When diagnosing pulse diseases, it is best to do so at dawn, when the spirit is calm and the breath is regulated. One inhalation and exhalation count as one breath. The pulse should be even and harmonious. If the pulse is even, there are no diseases; if it is uneven, it indicates distress.
Note: Pulse diagnosis is best done in the early morning (平旦). The reason is that in the morning, “yin energy has not yet moved, yang energy has not yet dispersed, food has not yet been consumed, the meridians are not yet full, the collaterals are balanced, and the qi and blood are not yet chaotic, thus allowing for accurate diagnosis of the pulse.”
8. Three pulses are slow, indicating cold; six pulses are rapid, indicating heat. Slow pulses indicate cold, while rapid pulses indicate heat. Slow and rapid pulses must be distinguished. Floating and sinking pulses must be differentiated, as well as slow and rapid pulses, to discern internal and external causes. External causes are from nature, while internal causes are from humans. Nature has yin and yang, wind, rain, and clarity. Humans have joy, anger, worry, sadness, fear, and shock. Floating and sinking must be distinguished, and slippery and rough must be clarified. Rough indicates blood stagnation, while slippery indicates qi obstruction.
Note: The pulse’s location is governed by floating and sinking; the pulse’s arrival is governed by slow and rapid; the pulse’s body is governed by slippery and rough.
9. Floating pulses are superficial, while sinking pulses are deep. Muscle pulses are in the middle, and the locations correspond. Floating without strength is weak, sinking without strength is weak, sinking with great strength is firm, and floating with great strength is rebellious. When all three divisions have strength, it is called excess. When all three divisions lack strength, it is called deficiency. When all three divisions lack strength and are small upon palpation, they seem to exist but are faint; this is called a fine pulse. When all three divisions lack strength and are large upon palpation, they are loose and diffuse; this is called a scattered pulse. Only the middle division lacking strength is called a hollow pulse. Pushing on the muscles and bones, the hidden pulse can be sought.
10. Three pulses are slow, six pulses are rapid. Four pulses are slow, and seven pulses are rapid. Slow indicates a knot, rapid indicates a hurry; all these diagnoses are governed by the pulse count. If the pulse moves and stops, it cannot return to normal; if the pulse count is not correct, it is difficult to recover.
11. The shape is like a pearl, slippery and unpredictable. It comes and goes with stagnation; rough pulses can be verified. A wiry pulse is fine and straight, and strong. A tight pulse is thicker than a wiry pulse, strong and bouncy. The pulse comes strong and goes weak; a surging pulse is prominent. If it is large, it is broad; if it is small, it is thin. If it moves like beans, it does not shift. If it is long, it is distant; if it is short, it is contracted.
Note: The above describes the shapes of twenty-eight pulse types.
12. Floating yang governs the exterior, wind invades the six qi. A strong floating pulse indicates excess, while a weak floating pulse indicates deficiency. A floating slow pulse indicates cold, while a floating slow pulse indicates wind dampness. A floating slippery pulse indicates summer heat, while a floating scattered pulse indicates extreme deficiency. A floating surging pulse indicates excess yang, while a floating large pulse indicates excess. A floating fine pulse indicates deficiency of qi, while a floating rough pulse indicates deficiency of blood. A floating rapid pulse indicates wind heat, while a floating tight pulse indicates wind cold. A floating wiry pulse indicates wind fluid, while a floating slippery pulse indicates wind phlegm.
13. Sinking yin governs the interior, seven emotions, qi, and food. A sinking large pulse indicates excess in the interior, while a sinking small pulse indicates deficiency. A sinking slow pulse indicates cold in the interior, while a sinking slow pulse indicates dampness. A sinking tight pulse indicates cold pain, while a sinking rapid pulse indicates extreme heat. A sinking rough pulse indicates qi stagnation, while a sinking slippery pulse indicates phlegm and food. A sinking hidden pulse indicates closure and stagnation. A sinking wiry pulse indicates fluid disease.
14. Slippery yang indicates deficiency, weak yin indicates illness, and fine pulses indicate various deficiencies, while scattered pulses indicate extreme deficiency. A rebellious pulse indicates injury to essence and blood, while a half-pregnancy indicates miscarriage. A firm pulse indicates hernia and abdominal masses, while a cold pain in the heart and abdomen indicates deficiency. Deficiency indicates various deficiencies, while excess indicates various excesses; a hollow pulse indicates blood loss, which can be observed.
15. Slow cold indicates organ issues, yin cold is related. A strong cold pain indicates excess cold, while a weak cold indicates deficiency cold. Rapid heat indicates excess in the residence, while rapid fine indicates yin injury. A strong pulse indicates excess heat, while a weak pulse indicates deficiency sores. Slow dampness indicates spleen and stomach issues, while a firm large pulse indicates damp obstruction. Rapid indicates yang stagnation, while a knot indicates yin stagnation. A replacement pulse indicates qi deficiency, while a sudden pain indicates qi obstruction, leading to pain and sores, especially in women during the third month of pregnancy.
16. Slippery indicates phlegm disease, while guan indicates food wind. The cun pulse indicates vomiting, while the chi pulse indicates blood and pus. Rough indicates deficiency dampness, while the chi pulse indicates essence and blood injury. The cun pulse indicates sweating and fluid loss, while the guan pulse indicates fluid loss. The wiry guan indicates fluid, while the wood invades the spleen meridian. The cun wiry indicates headache, while the chi wiry indicates abdominal pain. Tight indicates cold pain, while surging indicates fire injury; movement indicates pain and heat, while sweating indicates shock and madness. If it is long, it indicates qi treatment; if it is short, it indicates qi disease; if it is fine, it indicates qi decline; if it is large, it indicates disease progression.
Note: The above summarizes the diseases indicated by various pulse types.
17. The pulse indicates diseases, with appropriate and inappropriate signs, yin and yang in order or disorder, and auspicious or ominous signs can be inferred. The pulse of wind stroke prefers floating and slow, while a firm and large pulse indicates danger. In febrile diseases, the pulse prefers floating and surging. A sinking fine and small pulse indicates danger. If the pulse is calm after sweating, and the body is cool, it is safe; if the pulse is agitated after sweating, it indicates severe heat. Yang conditions show yin pulses, indicating danger; yin conditions show yang pulses, indicating survival.
Note: The “Shanghan Lun” (伤寒论) states: “In yang diseases, if yin pulses are present, death is imminent; in yin diseases, if yang pulses are present, survival is possible.” In summary, life and death depend on the trend of evil and righteousness.
18. Fatigue injures the spleen, and the pulse should be weak. Spontaneous sweating and an agitated pulse indicate death is unavoidable. The malarial pulse is wiry; a wiry slow pulse indicates much cold, while a wiry rapid pulse indicates much heat. Replacement and scattering indicate difficulty. Diarrhea and dysentery indicate a sinking small and slippery pulse, while a large floating pulse indicates excess heat. Vomiting and reverse stomach indicate a floating slippery pulse. A sinking rapid fine and rough pulse indicates colon issues. In cholera, the pulse is replaced; the tongue is rolled and contracted, and the limbs are cold.
Note: “Juefu” refers to the floating pulse of the limbs.
19. A cough pulse is often floating; floating and slippery are easy to treat, while a sinking and tight pulse indicates imminent death. Shortness of breath with shoulder elevation indicates a floating slippery pulse is favorable, while a sinking rough pulse indicates cold limbs, indicating a reverse condition. In fire heat conditions, a surging and rapid pulse is favorable; a weak and spiritless pulse indicates a fundamental detachment. Bone steaming heat indicates a rapid and weak pulse; heat and rough indicate a small pulse, which will lead to death. Extreme fatigue and various deficiencies indicate a floating soft and weak pulse; a failing double wiry pulse indicates fire heat and fine rapid pulse.
20. In cases of blood loss, the pulse must show a hollow pulse; a slow small pulse is favorable, while a rapid large pulse is concerning. Blood accumulation in the interior indicates a firm large pulse, while a sinking rough and weak pulse indicates a rare recovery.
In the three consumptions, a large rapid pulse indicates life, while a fine, small, and rough pulse indicates danger. Frequent urination and obstruction indicate a yellow nose, while a large pulse indicates treatment; a rough small pulse indicates death. Epilepsy indicates heavy yin, while mania indicates heavy yang; a floating surging pulse indicates auspicious signs, while a sinking rapid pulse indicates calamity. Epilepsy prefers a floating slow pulse, while a sinking small rapid pulse indicates urgency; however, a wiry pulse without stomach indicates certain death.
21. Abdominal pain has nine types; a fine slow pulse indicates quick recovery, while a large floating pulse indicates prolonged illness. Hernia belongs to liver disease; a wiry and urgent pulse indicates life, while a weak and urgent pulse indicates death. Jaundice and damp heat prefer a surging and rapid pulse; a large floating pulse is acceptable, while a fine rough pulse is difficult to treat. Swelling pulses are large and surging; fine and sinking pulses are difficult to diagnose. The five organs indicate accumulation, while the six bowels indicate gathering; strong excess can lead to life, while fine and sinking pulses are difficult to recover. Poisoning leads to abdominal swelling; a tight and fine pulse indicates life, while a large floating pulse indicates deep evil.
22. In cases of abscesses and sores that have not yet ruptured, a surging and large pulse is favorable; once they have ruptured, a surging and large pulse is most unfavorable. In cases of lung abscesses, the cun pulse is rapid and strong. In cases of lung atrophy, the pulse is rapid and weak. In cases of abscesses with white color, the pulse should be short and rough; a rapid and large pulse indicates loss of qi and blood. In cases of intestinal abscesses, a rapid and slippery pulse is favorable, while a sinking fine pulse indicates imminent death.
Note: The above summarizes the trends of pulse types and their corresponding diseases.
23. For women with children, yin interacts with yang; if the shaoyin (少阴) is very active, the fetus is already formed. If it is slippery and scattered, the fetus will be three months old; if it does not scatter upon palpation, it can be distinguished in five months. The left side indicates male, while the right side indicates female; pregnancy and lactation are the main concerns. A woman’s abdomen is like a winnowing basket, while a man’s abdomen is like a cauldron.
24. The pulse has a reverse guan, moving at the back of the arm; it is separated by the lieque (列缺) and does not affect the symptoms.
25. Meridian pulse diseases are well documented; the shape of the pulse must be measured. The liver pulse is like a knife, the heart pulse is like a bean, and the spleen pulse is like a sparrow pecking. The lung pulse is like hair, without roots; the pulse moves like a floating wave. The kidney pulse is about to end, coming like a stone, going like a loose rope. The life pulse is about to end, like a shrimp swimming and a fish soaring. The pulse arrives like a spring, ending at the bladder.
Note: The above twenty-five points are the basic content of pulse diagnosis at the cun.
26. The elbow corresponds to the waist and abdomen, the hand to the thigh and foot. The outer chi corresponds to the shoulder and back, while the inner chi corresponds to the chest and front. The palm corresponds to the abdomen, and the fish corresponds to the stomach. Cold and heat are present, and diseases arise from heat and cold.
27. The chi pulse corresponds; a cold chi indicates deficiency and diarrhea, while a hot chi indicates warm diseases. Wind diseases show a slippery chi, while arthritic diseases show a rough chi; a large chi indicates abundance, while a small chi indicates depletion.
28. Diagnosis of the navel above and below indicates the stomach above and intestines below. The abdominal skin indicates cold and heat, corresponding to the stomach and intestines. The stomach prefers cold drinks, while the intestines prefer hot soup. Heat should not be scorching, and cold should not be freezing.
Note: The above three points are methods for pulse diagnosis of the chest and abdomen. The chi refers to the skin on the inner side of the forearm (ulnar side).
Note: The above twenty-eight points are extracted from the “Yizong Jinjian: Essentials of the Four Examinations” (医宗金鉴·四诊心法要诀).