Traditional Chinese Medicine Diagnosis | Key Focus 06 (Pulse Diagnosis and Pressure Diagnosis)

Pulse characteristics: The sensation of the pulse beating felt by the fingers (the image of the pulse should be indicated by the fingers). The formation of pulse characteristics is driven by the heart’s beating; the material basis is the circulation of Qi and blood; the coordination of the organs ensures the normal pulse characteristics.Recommended reading for pulse studies: “Binhuh Pulse Studies”【Pulse Diagnosis Locations】Comprehensive examination method / Three parts and nine positions examination method (three parts: head, hands, feet; each part is further divided into three positions: heaven, earth, human), three-part diagnosis method (Renying, Cunkou, Fuyang), Cunkou diagnosis method.【Cunkou Diagnosis Method】1. Cunkou (Qi mouth, pulse mouth) location: the inner side of the radial styloid process, where the radial artery pulsates. 2. Cunkuan Chiwang The back high bone (radial styloid) inner side is the Guan, the front of Guan is Cun, the back of Guan is Chi.3. The three parts and nine positions of Cunkou diagnosis refer to Cun, Guan, Chi, and the nine positions refer to floating, middle, and deep (distinguished from the comprehensive examination method’s three parts and nine positions).4. The main principle of diagnosing the pulse solely at Cunkou ① The Cunkou pulse is located at the Taiyuan point of the Lung meridian, where the Taiyuan is the “meeting of pulses” (the convergence of Qi from the twelve meridians). ② The Cunkou pulse belongs to the hand Taiyin Lung meridian, and the Lung governs all pulses, thus the Cunkou pulse can reflect the Qi and blood status of the five organs and six bowels.③ The anatomical position of the Cunkou pulse is superficial, facilitating palpation and differentiation of strength.5. Cunkou differentiates the organs

“Huangdi Neijing”: The left Cun externally corresponds to the heart, internally corresponds to the zhong (middle). The right Cun externally corresponds to the lung, internally corresponds to the chest. The left Guan externally corresponds to the liver, internally corresponds to the diaphragm. The right Guan externally corresponds to the stomach, internally corresponds to the spleen. The left Chi externally corresponds to the kidney, internally corresponds to the abdomen. The right Chi externally corresponds to the kidney, internally corresponds to the abdomen. 【Pulse Diagnosis Considerations】1. Time The ideal time is early morning.2. Body position Sitting or lying down, arms relaxed, at the same level as the heart, straight wrists, palms facing up, with a pulse pillow under the wrist.3. Finger techniques① Finger placement: The middle finger indicates Guan (index finger indicates Cun, ring finger indicates Chi, pay attention to finger order), spacing is determined based on the patient’s height (for children: one finger indicates Guan).② Finger movement: Light touch/floating: apply light pressure to the skin. Firm touch/deep: apply heavier pressure to the muscles and bones. Searching/middle: moderate finger strength to find the most prominent pulse characteristics. Total pressure: three fingers apply pressure simultaneously. Single pressure: one finger applies pressure alone. Note to apply pressure lightly first, then heavier.4. Regulating breath/calmness (definition)① Count breaths, one inhale and one exhale counts as one breath, in normal conditions, one breath corresponds to 4-5 pulse beats (70-90 beats per minute). ② When the doctor palpates the pulse, they must regulate their breathing and concentrate fully on their fingers. 5. Each pulse examination should last no less than fifty beats The single-hand clinical examination should last no less than 1 minute, and the double-hand examination should last 3-5 minutes.【Elements of Pulse Characteristics】 include position, frequency, shape, and force. 1. Position (pulse position) The depth of the pulse’s manifestation; superficial is floating, deep is sinking. 2. Frequency (pulse rate) The frequency of the pulse; normal pulse is 4-5 beats per breath, slow pulse is less than 4 beats per breath, rapid pulse is more than 5 beats per breath.3. Shape and force ① Pulse length: the axial range of the pulse’s manifestation. ② Pulse width: the radial range of the pulse’s manifestation, i.e., the thickness felt by the fingers (different from the thickness of blood vessels). ③ Pulse strength: the strength of the pulse. ④ Uniformity: whether the pulse rhythm is uniform; whether the pulse strength and size are consistent. ⑤ Smoothness: the degree of smoothness of the pulse. ⑥ Tension: refers to the tension or relaxation of the pulse vessel. 【Normal Pulse Characteristics】Normal pulse characteristics (平脉, 常脉) include:1. All three parts (Cun, Guan, Chi) are present, with 4-5 beats per breath, neither floating nor sinking, neither fast nor slow, calm and gentle, with a consistent rhythm.2. Presence of Wei, Shen, and Gen (definition)① Presence of Wei: The pulse is calm, gentle, and smooth. (Judging the function of the spleen and stomach, the rise and fall of Qi and blood, and the prognosis of diseases.)② Presence of Shen: The pulse is soft and strong, with a regular rhythm. (Judging the rise and fall of heart Qi and the overall vitality.)③ Presence of Gen: The deep pulse should be strong, especially at the Chi position. (Judging the surplus and deficiency of kidney essence and the rise and fall of kidney Qi.) Physiological variations of the pulse (all normal) Gender: Women tend to have finer, more rapid, and weaker pulses than men.Age: Children have rapid pulses, young adults have strong pulses, and the elderly often have string-like pulses.Body type: Thin individuals tend to have floating pulses, while overweight individuals tend to have sinking pulses, and athletes often have slow but strong pulses. Variations in pulse position: Oblique pulse (the pulse is not felt at the Cun but is felt at the Chi and slants towards the back of the hand); Reverse Guan pulse (the pulse is felt on the back side of the Cun).【Key! Common Pulse Characteristics and Their Significance】1. Floating PulsePulse position is superficial, easily felt with light pressure, slightly reduced with heavy pressure but not empty, and feels abundant when lifted. Indicates exterior syndrome, also seen in deficiency Yang externalization. 2. Sinking PulsePulse position is deep, not felt with light pressure, only felt with heavy pressure.Indicates interior syndrome (strong: interior excess, weak: interior deficiency).3. Slow PulsePulse rate is slow, with less than four beats per breath (less than 60 bpm).Indicates cold syndrome (strong: excess cold, weak: deficient cold), interior excess heat syndrome.4. Rapid PulsePulse rate is fast, with more than five beats per breath (greater than 90 bpm).Indicates heat syndrome (strong: excess heat, weak: deficient heat), deficiency syndrome (Qi and blood deficiency, especially heart Qi and blood deficiency).5. Flooding PulsePulse is wide and strong, resembling surging waves, with a strong arrival and weak departure.Indicates excessive heat (excess), excessive evil and deficient righteousness (deficiency).6. Large PulsePulse is wide but lacks a surging quality.Indicates excessive evil disease progression.Also seen in healthy individuals (calm and gentle, all three parts are large).7. Fine PulsePulse is fine like a thread, but the pulse should be distinct.Indicates deficiency of Qi and blood, various deficiencies, and dampness syndrome.8. Weak PulsePulse is extremely soft, deep, fine, and weak (deep, fine, soft).Indicates severe deficiency of Qi and blood, and Yang deficiency.9. Scattered PulseFloating and scattered without root, slightly pressed and it disappears, with an irregular count.Indicates scattered Yuan Qi, and the Qi of the organs is declining.10. Deficient PulseAll three parts of the pulse are weak when lifted, and empty when pressed. (It is a general term for weak pulse characteristics.)Indicates deficiency syndrome (Qi and blood deficiency, various organ deficiencies).11. Excess PulseAll three parts of the pulse are strong when lifted and pressed. (It is a general term for strong pulse characteristics.)Indicates excess syndrome.Also seen in healthy individuals.12. Slippery PulseFlows smoothly, feels round and smooth under the fingers, like beads rolling on a plate.Indicates phlegm-dampness, food stagnation, and excess heat.Also seen in healthy individuals or pregnant women (but pregnancy does not necessarily present with slippery pulse).13. Rough PulsePulse is fine and slow, with a rough and uneven rhythm, like a light knife scraping bamboo, with uneven pulse strength.Indicates Qi stagnation, blood stasis, phlegm and food obstruction, injury to essence, and blood deficiency (strong indicates excess, weak indicates deficiency).14. Long PulsePulse shape is long, with straight ends, exceeding the normal position.Indicates Yang heat, heat syndrome, and excess syndrome.Also seen in healthy individuals.15. Short PulseEnds are both short, not reaching the three parts.Indicates Qi disease: strong indicates Qi stagnation, weak indicates Qi deficiency.16. String-like PulseStraight and long, like pressing a guitar string, with strong and hard pulse strength.Indicates liver and gallbladder disease, pain, phlegm and fluid, deficiency labor, and declining stomach Qi.Also seen in healthy elderly individuals.17. Tight PulsePulse is tense and strong, resembling a taut rope, firm and beats against the fingers.Indicates excess cold, pain, and food retention.18. Slow PulseFour beats per breath, slow and lazy (frequency between normal and slow pulse).Indicates dampness syndrome, and spleen and stomach weakness.Also seen in healthy individuals.19. Hollow PulseFloating, large, and hollow, like pressing a scallion tube.Indicates significant blood loss and injury to Yin.20. Leather-like PulseFloating and beats against the fingers, hollow outside and firm inside, like pressing a drum skin.Often indicates loss of blood, loss of essence, postpartum, leakage, and Yang Qi floating outward.21. Firm PulsePulse is deep, not responding to light or moderate pressure, large and long, slightly string-like, strong, and firm (deep, solid, large, string-like, long).Indicates internal cold and excess, hernia, and accumulation (blood stasis).22. Weak PulseExtremely soft, deep, fine, and weak (deep, fine, soft).Indicates deficiency of Qi and blood, and Yang deficiency.23. Moist PulseFloating and fine, weak pulse strength, almost imperceptible when pressed (floating, fine, soft).Indicates various deficiencies and dampness obstruction (especially external dampness).24. Hidden PulsePulse is deeply hidden, only felt with heavy pressure on the muscles and bones, and may not be felt at all.Indicates evil closure, syncope, and extreme pain.25. Moving PulsePulse shape is like a bean, slippery, rapid, and strong, especially evident at the Guan position.Indicates pain and fright.26. Rapid PulsePulse comes rapidly and stops irregularly, with no fixed count.Indicates excessive Yang heat, stagnation of Qi and blood, and also indicates weakness of organ Qi.27. Knotted PulsePulse comes slowly and stops irregularly, with no fixed count.Indicates excessive Yin, Qi stagnation, cold phlegm, blood stasis, and deficiency of Qi and blood.28. Intermittent PulsePulse comes slowly and stops irregularly, with a fixed count, taking a long time to return.Indicates weakness of organ Qi, also indicates pain, fright, and trauma.29. Rapid PulsePulse comes rapidly, with seven to eight beats per breath (greater than 140 bpm).Indicates extreme Yang and depletion of Yin, Yuan Qi about to escape.Also seen after intense exercise; infants have seven beats per breath as a normal pulse.【Summary of Abnormal Pulse Characteristics】1. Abnormal pulse position: floating, moist, scattered, hollow, leather-like, sinking, hidden, firm, weak. 2. Abnormal frequency/pulse rate: slow, slow, rough, knotted, rapid, rapid, urgent, moving. 3. Abnormal pulse length: long, string-like, firm, short.4. Abnormal pulse width: flooding (large), hollow, fine, weak, moist, rough. 5. Abnormal pulse strength: weak, moist, fine, deficient, hollow, flooding, moving, solid, string-like, tight, leather-like. 6. Abnormal uniformity: whether the pulse rhythm is uniform; whether the pulse strength and size are consistent. 7. Abnormal smoothness: slippery, moving, rough. 8. Abnormal tension: hollow, tight, string-like, leather-like. 【Differentiation of Similar Pulse Characteristics】1. Classification:Six categories of pulses (floating, sinking, slow, rapid, deficient, excess)① Floating pulse types: floating, flooding, moist, scattered, hollow, leather-like. ② Sinking pulse types: sinking, hidden, firm, weak. ③ Slow pulse types: slow, slow, rough, knotted. ④ Rapid pulse types: rapid, rapid, urgent, moving. ⑤ Deficient pulse types: deficient, fine, weak, intermittent, short. ⑥ Excess pulse types: excess, slippery, tight, long, string-like. 2. Differentiation① Floating, hollow, scattered, deficient are similar: pulse position is superficial. Different:

② Sinking, hidden, firm are similar: pulse position is deeper, not felt with light pressure. Different:

③ Slow, slow, knotted are similar: pulse rate is slower. Different:

④ Flooding, excess are similar: pulse strength is strong. Different:

⑤ Fine, weak, moist, micro are similar: pulse shape is fine and weak. Different:

⑥ Hollow, leather-like are similar: floating, large, and hollow. Different:

⑦ Short, moving are similar: both are short. Different:

⑧ Knotted, intermittent, rapid are similar: both have abnormal rhythms, with irregular stops. Different:

【Combined Pulses and Their Associated Diseases】

1. String-like rapid pulse indicates liver depression transforming into fire, liver and gallbladder damp-heat, etc. 2. String-like slippery rapid pulse indicates liver fire with phlegm, wind Yang disturbing, phlegm fire accumulation, etc. 3. String-like fine pulse indicates liver and kidney Yin deficiency, blood deficiency with liver depression, liver depression with spleen deficiency. 4. Slippery rapid pulse indicates phlegm heat, phlegm fire, internal heat, food accumulation. 5. Flooding rapid pulse indicates excessive heat in the Qi level, often seen in externally contracted heat diseases. 6. Fine rapid pulse indicates Yin deficiency with excessive fire. 【True Organ Pulses】 Pulses without Wei, Shen, and Gen are called true organ pulses, also known as strange pulses, defeated pulses, dead pulses, and absolute pulses. Seven absolute pulses: Boiling pot pulse, fish swimming pulse, shrimp swimming pulse, leaking roof pulse, bird pecking pulse, untangling pulse, stone bouncing pulse.【Diagnosis of Women’s Pulses】1. Diagnosis of menstrual pulses: During a woman’s menstrual period, if Qi and blood are harmonized, the pulse appears slippery and rapid. If the left Guan Chi pulse is suddenly larger than the right Guan Chi pulse, without other discomfort, it indicates that menstruation is approaching.If the Cun Guan pulse is harmonized but the Chi pulse is either absent or fine and rough, it indicates that menstruation may be excessive. For amenorrhea: ① Chi pulse is weak and fine and rough indicates deficiency of blood as a deficiency closure syndrome. ② Chi pulse is string-like and rough indicates Qi stagnation and blood stasis as an excess closure syndrome. ③ String-like slippery pulse often indicates phlegm dampness obstructing the uterus. 2. Diagnosis of pregnancy pulse, diagnosis of fetal death pulse, diagnosis of labor pulse (for reference only) ① If a woman stops menstruating after marriage, and the pulse appears slippery, rapid, and harmonious, especially at the Chi position, along with abnormal eating habits, cravings for sour foods, or vomiting, it indicates pregnancy. If the pulse is also slippery and rapid after a nap, it should not be diagnosed as pregnancy pulse. ② During pregnancy, if the pulse is deep, smooth, and strong, it indicates harmonious Yang Qi and normal pregnancy. If the pulse is deep but rough and weak, it may indicate potential harm to the fetus or fetal death. ③ When a pregnant woman is about to give birth, the Chi pulse becomes urgent and rapid, and the pulse on both sides of the middle finger becomes more pronounced and vigorous than usual. 【Diagnosis of Children’s Pulses】1. One-finger three-part diagnosis method for children under 3 years old: one finger indicates three positions. For ages 3-5: use the midline of the high bone as the Guan, rolling one finger to find the three parts. For ages 6-8: move the thumb to diagnose the three parts. For ages 9-10: sequentially use fingers to diagnose Cun, Guan, Chi pulses. For ages 10 and above: use the adult three-part diagnosis method. 2. Children’s pulse characteristics ① Normal pulse rate: 2-3 years old has 6-7 beats per breath (100-120 bpm), 5-10 years old has 6 beats per breath (100 bpm). ② Only diagnose floating, sinking, slow, rapid, strong, and weak (floating and rapid indicate Yang, sinking and slow indicate Yin, strong indicates excess, weak indicates deficiency). 【Diagnosis of Unique Pulses】Unique pulses: Special pulse characteristics that differ from normal pulses or other pulses in the same individual during illness.“Unique situations hide treachery.”1. Differences between the overall pulse and normal pulse. 2. Compare the left and right hands, Cun, Guan, and Chi. 【Pressure Diagnosis】Several important concepts:1. Xu LiLocated between the fourth and fifth ribs below the left breast, slightly inside the nipple, where the apex of the heart beats, is the place where all pulses converge.Pressing Xu Li can measure the strength of the Zong Qi, the deficiency or excess of diseases, and the prognosis.① Normal:Moves without prominence, slow without urgency, with a regular rhythm.If due to fright, great anger, or intense exercise, Xu Li moves high, and returns to normal after a moment of rest, it is not pathological. In obese individuals, the Xu Li pulse may not be prominent due to a thicker chest wall, which is also normal.② Abnormal:Weak movement indicates internal deficiency of Zong Qi; movement that responds to clothing indicates external leakage of Zong Qi; pressing it feels large and strong indicates heart Qi exhaustion (critical condition); pressing it feels scattered and unresponsive indicates heart Qi exhaustion (critical condition); a scattered and rapid pulse, with a high chest and wheezing indicates heart and lung Qi exhaustion.2. Breast abscessCharacterized by localized tenderness in the breast, accompanied by redness, swelling, and heat.3. Breast lumpA lump in the breast with clear boundaries, smooth surface, movable without adhesion, and painless.4. Breast hyperplasia (mammary gland hyperplasia)Multiple nodules in the breast, unclear boundaries, no adhesion, long course, and slow development.5. Breast cancerIrregular mass, rapidly enlarging, hard texture, irregular shape, unclear boundaries, often with palpable lumps in the armpit, and bloody discharge from the nipple, often indicating breast cancer.6. Abdominal masses① Abdominal mass: Fixed abdominal mass, immovable upon palpation, with localized pain; belongs to the blood level (blood stasis).② Accumulation: Mass that is movable upon palpation, with diffuse pain; belongs to the Qi level (Qi stagnation).Cover photo taken at Dajue Temple