1. Pulse Secrets
Floating Pulse (Fu Mai): Lightly felt, heavy pressing yields no response; it floats like wood on water. A strong floating pulse indicates wind-heat, while a weak one suggests blood deficiency.
Deep Pulse (Chen Mai): Requires heavy pressure to be felt; like a stone sinking in water. A strong deep pulse indicates cold pain, while a weak one suggests deficiency-cold.
Slow Pulse (Chi Mai): Comes slowly, three beats per breath; a very slow pulse indicates heart disease or excess cold, requiring careful analysis of deficiency and excess.
Rapid Pulse (Shu Mai): Comes quickly, six beats per breath; a rapid pulse requires careful differentiation of floating and deep, deficiency and excess, as the treatment for the fire of the monarch and minister differs.
Weak Pulse (Xu Mai): Weak in form, lacking strength; floating, large, and soft without root. A weak pulse with body heat indicates heat from middle-jiao deficiency, while a weak body indicates qi deficiency.
Full Pulse (Shi Mai): Large and long, with three phases full of strength; a full pulse indicates strong pathogenic qi in new illnesses, while in chronic conditions, it indicates misfortune.
Slippery Pulse (Hua Mai): Slippery in nature, like beads rolling under the fingers; indicates fullness from food stagnation or phlegm-heat in the chest, and in women, it indicates pregnancy.
Choppy Pulse (Se Mai): Choppy in nature, resembling bamboo scraping; fine, slow, and short, indicating blood deficiency, dryness, and qi stagnation. In women, it indicates absence of menstruation unless pregnant.
Surging Pulse (Hong Mai): Full and wave-like; although it comes strong, it leaves gently. A surging pulse indicates strong pathogenic qi and difficulty in treating fullness in the stomach.
Minute Pulse (Wei Mai): Fine as a thread, barely felt; a minute pulse indicates severe deficiency and chronic illness, with sudden onset being difficult to treat.
Tight Pulse (Jin Mai): Tight like a rope; indicates internal and external cold injury, with pain as the main symptom. Floating and deep must be clearly distinguished.
Slow Pulse (Huan Mai): Slow and gentle; indicates a balanced state, or may suggest spleen deficiency with wind-dampness. Careful evaluation is needed to determine if it is a disease or not.
Soft Pulse (Ru Mai): Soft and fine, like cotton floating on water; seen in postpartum conditions, but concerning in healthy individuals.
Weak Pulse (Ruo Mai): Weak and soft, like cotton in water; indicates deficiency of yang qi and blood. Elderly individuals may have it, but the young should avoid it.
Long Pulse (Chang Mai): Long and extended, pressing down feels soft; a long pulse indicates strong heart-kidney connection, while a long and hard pulse indicates fire-related issues.
Short Pulse (Duan Mai): Short and retracted, like a turtle; indicates difficulty in treating various diseases due to deficiency of true yuan qi.
Empty Pulse (Kao Mai): Empty in the middle; feels soft like scallions; indicates heat damaging yin and blood overflowing, leading to red flow.
String-like Pulse (Xian Mai): Stiff and straight, resembling a string; indicates liver-gallbladder issues, with varying degrees of severity.
Dispersed Pulse (San Mai): Floating and chaotic; gradually becomes imperceptible; indicates potential miscarriage or loss of spirit in chronic illness.
Fine Pulse (Xi Mai): Fine as a thread; indicates severe deficiency and stagnation of dampness.
Hidden Pulse (Fu Mai): Requires careful searching; indicates qi stagnation and cold accumulation, leading to nausea.
Moving Pulse (Dong Mai): Pulsating and irregular; indicates pain and shock, especially in severe cases.
Leather-like Pulse (Ge Mai): Taut and urgent; indicates postpartum issues in women or deficiency in men.
Firm Pulse (Lao Mai): Strong and solid; indicates internal accumulation of cold and pain.
Rapid Pulse (Cu Mai): Rapid and intermittent; indicates severe heat and depletion of fluids.
Knotted Pulse (Jie Mai): Slow and intermittent; indicates cold accumulation and emotional distress.
Intermittent Pulse (Dai Mai): Stops and starts; indicates chronic illness and difficulty in treatment.
Fast Pulse (Ji Mai): Rapid and agitated; indicates severe heat and depletion of fluids.
2. Pulse Theory
What is a normal pulse? A normal person has a pulse of four beats per breath, which is gentle and even, indicating vitality. Any deviation indicates a pathological pulse, considering special populations such as the elderly, children, and seasonal variations.
Knowing the normal pulse, the next step is to understand the four pulse types: floating, deep, slow, and rapid. Floating pulse is lightly felt, while deep pulse requires heavy pressure. A pulse with fewer than four beats is slow, while one with more than four is rapid.
What do floating pulses indicate? They often indicate exterior conditions, while deep pulses indicate interior conditions. Slow pulses indicate cold, and rapid pulses indicate heat, with exceptions. For instance, a floating pulse may appear if yin is severely deficient and yang is excessive.
Next, we return to our hands, using the high bone at the wrist as the guan pulse, the front as the cun, and the back as the chi pulse. The left hand’s cun pulse corresponds to the heart and small intestine, the guan pulse corresponds to the liver and gallbladder, and the chi pulse corresponds to the bladder and kidney. The right hand’s cun pulse corresponds to the lung and large intestine, the guan pulse corresponds to the spleen and stomach, and the chi pulse corresponds to the kidney and mingmen.
In the cun, guan, and chi, the cun represents yang, the chi represents yin, floating represents yang, and deep represents yin. By combining floating and deep with slow and rapid, we can generally distinguish between yin and yang, exterior and interior, cold and heat. Additionally, we assess strength; strong indicates excess, while weak indicates deficiency. By examining the pulse’s length, long indicates excess, while short indicates deficiency. This allows us to clarify the distinctions between yin and yang, exterior and interior, cold and heat, and deficiency and excess. Finally, by considering the pulse’s location, we can determine which organ it corresponds to and diagnose the illness.
With this knowledge, we can recombine these pulse types, as clinical practice often presents many combinations, such as floating-slow, floating-rapid, floating-long, and floating-fine. Similarly, deep pulses can be deep-short, deep-strong, or deep-rapid, all requiring careful analysis.
For example, if the left cun pulse is deep, short, and weak, while the cun and guan pulses are normal, we first note that the left cun corresponds to the heart, indicating a heart condition. A short pulse indicates deficiency, and weakness also indicates deficiency. What diseases might arise from a weak heart pulse? The heart governs blood, and its weakness can lead to insufficient blood supply to the brain, resulting in dizziness, memory loss, and fatigue.
If the left chi pulse is deep and rapid, the deep pulse indicates an interior condition, while the rapid pulse indicates heat. This suggests heat in the kidney and bladder, leading to symptoms such as yellow and hot urine, heat in the hands and feet, lower back pain, and night sweats.
For instance, if the cun pulse is floating and rapid, while the chi pulse is deep and fine, the cun pulse indicates yang, rapid indicates heat, floating indicates yang, while the chi pulse indicates yin and fine indicates deficiency. This suggests that yin is insufficient to control yang, leading to a floating yang. Such patients will likely experience dizziness, and treatment may involve nourishing yin and subduing yang.
Lastly, practice is essential. We have many people around us—friends and family—who can serve as practice subjects. Everyone has this condition, and the more we practice, the better we become. When I started, I sometimes saw dozens of patients a day. Afterward, I would compare my findings to see what was correct and what was not, gradually becoming proficient. When diagnosing pulses, it is crucial to analyze comprehensively, considering the location and organ functions. Each organ’s function can indicate potential issues related to cold, heat, exterior, interior, yin, yang, deficiency, and excess. Additionally, one should not rely solely on one diagnosis; the ancient practice of combining the four examinations (observation, listening, inquiry, and palpation) is very reasonable.
Regarding the question of gender prediction, it is said that a rapid pulse in the left hand indicates a boy, while the opposite indicates a girl. My experience shows that this is quite accurate around 40 days, but after four or five months, the accuracy decreases to about 60-70%. Perhaps further improvement is needed.
Pulse diagnosis has a long history in China, being a summary of ancient medical practitioners’ experiences. The famous physician Bian Que from the Spring and Autumn period is renowned for his expertise in observation, listening, inquiry, and palpation, particularly pulse diagnosis. To effectively treat diseases, accurate diagnosis is essential. Modern medicine utilizes various scientific techniques for diagnosis, but in ancient times, physicians relied on observation, inquiry, listening, smelling, and palpation. This was common in many ancient countries, each with its rich experience. Pulse diagnosis in ancient Chinese medicine is a unique diagnostic method, also known as palpation, and is one of the four examinations (observation, listening, inquiry, and palpation) in TCM, serving as an indispensable objective basis for syndrome differentiation and treatment.
3. Pulse Methods
The simplest pulse diagnosis requires distinguishing:
1. Strength vs. Weakness—distinguishing the adequacy of yang qi.
2. Size of the pulse—distinguishing the adequacy of yin and blood.
3. Floating vs. Deep—distinguishing whether yang qi is exterior or interior.
This is sufficient for syndrome differentiation.
Floating pulse indicates yang qi is exterior attacking pathogens (strong), or yang qi is insufficient (weak), or summer yang qi is exterior.
Deep pulse indicates yang qi is interior attacking pathogens (strong), or yang qi is insufficient (weak), or winter yang qi is interior.
A floating pulse with insufficient yang qi (weak) indicates qi is not contained, dispersing outward.
A deep pulse with insufficient yang qi (weak) indicates qi does not disperse outward and can return to its original position.
The key points for syndrome differentiation are:
1. The amount of energy (sufficient or insufficient);
2. The direction of energy (ascending or descending).
This is consistent with the essence of the six meridians discussed in the “Treatise on the Simplest of All Diseases”.
Above is a general discussion, below are specific discussions—
Distinguishing by division: the left hand represents yin blood, while the right hand represents yang qi, or the left hand represents energy storage, while the right hand represents energy production.
Left hand: Cun (Heart) Guan (Liver) Chi (Kidney Yin) governs blood circulation, liver stores blood, and the essence of blood enters kidney yin.
Right hand: Cun (Lung) Guan (Spleen) Chi (Kidney) governs kidney yang, lung governs qi, spleen generates qi, and kidney yang transforms essence into qi.
Men are yang, hence the right hand’s pulse is stronger than the left hand’s pulse.
Women are yin, hence the left hand’s pulse is stronger than the right hand’s pulse.
This is the normal pulse for men and women.
If a woman’s right pulse is stronger than her left pulse, what should be considered?
Before taking medication, one should differentiate whether there is excessive yang that cannot be contained, leading to floating pulses in both cun and chi.
After taking medication, one should differentiate whether yang qi has been supported, accelerating transformation, leading to deeper pulses in both cun and chi.
At the same time, one can observe that the strongest pulses are in the guan position.
The right guan corresponds to the spleen and stomach, which strengthens energy absorption (spleen governs transformation).
The left guan corresponds to the liver, which strengthens energy storage (liver governs blood storage).
The premise is crucial: whether medication has been taken. The same syndrome can have completely different meanings based on the diagnosis.
The essence of yang lies in its ability to descend; the cun pulse is located above (exterior) and should be contained and descended. The middle pulse can be obtained with light pressure.
The essence of yang lies in its ability to contain; the chi pulse is located below (interior) and should be contained and secured. The deep pulse can be obtained with heavier pressure.
The essence of yang lies in its ability to circulate; the guan pulse is located in the middle and should be buoyant and smooth. The moderate pulse can be obtained with light pressure.
In simple terms, the ends are small, and the middle is large—this is the best energy structure in modern society, referred to as the olive shape.
Application of syndrome differentiation—
First, determine whether energy is sufficient or insufficient, then determine whether energy is stored (whether the fire is in place, whether yangming descends, and whether ascending and descending are balanced).
Whether energy is sufficient can be determined by the size of the pulse and whether it is strong or weak; there is no need for detailed discussion.
The relative fire originates in the kidney and first activates in the liver; therefore, if the relative fire is not in place, the liver pulse will be stiff and often tight and strong (indicating qi attacking).
If the relative fire is in place and energy is sufficient, the liver pulse may be stiff but exhibits a gentle and rhythmic quality (like a general who is not angry but commands respect).
However, the more forcefully one presses down, the more rebound strength increases (like a Tai Chi master who appears gentle but is strong inside; the stronger the opponent, the stronger the response).
When using yang, the cun pulse must be floating; if the relative fire is not in place, the cun pulse will also be floating (due to yang qi not being contained and dispersing outward). How to distinguish?
Short-term use of yang (speaking, exercising, using spirit, etc.) will allow the cun pulse to return to a contained state after short-term rest.
If the relative fire is not in place (long-term yang dispersion similar to using yang), the cun pulse will not return to a contained state even after short-term rest.
If the relative fire originates in the kidney, then if the relative fire is not in place, the chi pulse will often be floating (as kidney water is the mother and liver wood is the child; if the child squanders the mother’s savings, the mother must draw from her reserves).
If after resting, the cun pulse remains floating, it indicates that yangming is not descending and the relative fire is not in place, leading to symptoms such as insomnia, vivid dreams, irritability, dry eyes, itchy throat, and tinnitus—this can be inferred from the pulse.
If the cun pulse is floating and the chi pulse is also floating, the relative fire is not in place, confirming that the chi pulse floating is conclusive evidence of long-term yang qi dispersing outward.
If the left chi pulse (kidney yin) is absent, it indicates amenorrhea, dysmenorrhea, or light menstrual flow.
If the right chi pulse (kidney yang) is absent, it indicates impotence, frigidity, infertility, miscarriage, dysmenorrhea, cold hands and feet, depression, memory loss, muscle weakness, and frequent urination.
Other conditions can be inferred based on the functions of the corresponding organs. In the simplest terms, regardless of the organs, one can infer based on yang deficiency symptoms.