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Pulse Diagnosis and Palpation
Brief History of Pulse Diagnosis
1. Bian Que: Already applied pulse diagnosis in clinical practice
2. “Neijing”: “Three Parts and Nine Pulses Theory” and “Only Taking the Cun Position”
3. Zhang Zhongjing: “Ping Mai Bian Zheng” (Differentiating Patterns through Pulse)
4. Wang Shuhe: Authored “Mai Jing” (Pulse Classic), recording 24 types of pulse patterns
5. Li Shizhen: Authored “Bin Hu Mai Xue”, recording 27 types of pulse patterns
6. Zhou Xue Ting: Authored “San Zhi Chan”, using the slow pulse as a standard for assessment
7. Huang Gong Xiu: Authored “Mai Li Qiu Zhen” (Seeking Truth in Pulse Theory)
8. Zhao Shao Qin: Authored “Wen Kui Mai Xue” (Literary Pulse Studies)
1. Principles of Pulse Formation
1. The heart is the main organ for pulse formation
“The heart governs blood, its fullness is in the pulse”
“The heart houses the pulse, the pulse shelters the spirit”
2. Qi and blood are the material basis for pulse formation
“Qi is the commander of blood, blood is the mother of Qi”
“When Qi moves, blood moves”
“If the pulse does not move on its own, it follows Qi and arrives; Qi moves, the pulse responds”
3. The relationship of other organs with pulse formation
The lungs govern Qi, influencing all pulses
The spleen governs transformation and transportation, controlling blood, and is the source of Qi and blood generation;
“The pulse is based on stomach Qi”
The liver stores blood and regulates blood volume
The kidneys store essence, being the root of Yuan Qi, the driving force of organ functions
2. Locations and Methods of Pulse Diagnosis
(1) Locations for Pulse Diagnosis
1. Comprehensive Diagnosis Method (Three Parts and Nine Pulses):
Upper, Middle, Lower
2. Zhang Zhongjing’s Three-Part Diagnosis Method: Cun (Cun Position), Fu Yang, Tai Xi
3. Cun Position Diagnosis: The Cun position refers to a section of the radial artery on the inner side of the radial styloid process, also known as “Qi Kou” or “Pulse Mouth”
Why can the Cun pulse reflect the changes in the five organs and six bowels?Principle of Cun Position Diagnosis
“Only taking the Cun position to determine the life and death of the five organs and six bowels, what does this mean?”
“Why is the Cun position uniquely responsible for the five organs?”
Locating Cun, Guan, and Chi
• 1. First locate Guan: using the radial styloid process as a marker
• 2. Then locate Cun and Chi: Cun is before Guan, Chi is after Guan
Cun Position and Organ Correspondence
• Correspondence Principle:
1. Upper corresponds to upper, lower corresponds to lower: resembling an inverted human figure
“Nanjing – Eighteen Difficulties”: “Upper part corresponds to heaven, governing diseases above the chest to the head; Middle part corresponds to humanity, governing diseases from the diaphragm to the navel; Lower part corresponds to earth, governing diseases below the navel to the feet”
2. Exterior and interior correspondence: based on the relationship of organs and meridians
The lungs and large intestine correspond to the right Cun, the heart and small intestine correspond to the left Cun
Principle of Cun, Guan, Chi and Organ Correspondence
Principle of Cun Position and Organ Correspondence
Left hand Right hand
Heart (Emperor Fire) Lung (Metal)
Liver (Wood) Spleen (Earth)
Kidney (Water) Kidney (Minister Fire)
Yin, Blood, Essence Yang, Qi
Left corresponds to heart, liver, kidney; right corresponds to lung, spleen, life
Principle of Cun, Guan, Chi and Organ Correspondence
1. This correspondence aligns with the principles of the Five Elements:
2. It conforms to the principles of Yin and Yang (Qi and Blood): the lungs govern Qi, the spleen Qi governs ascent, the Mingmen fire, and the lesser fire generates Qi, thus Qi is abundant on the right as Yang; the heart governs blood, the liver stores blood, the kidneys store essence, essence and blood share the same source, thus blood is abundant on the left as Yin
Methods and Precautions for Pulse Diagnosis
1. Calmness and Position
Calmness: “When a person exhales, the pulse moves again; when inhaling, the pulse also moves again. When breathing is calm, the pulse moves five times, and this is called a calm person”
Position: Sitting or lying down at heart level
• 2. Best time for pulse diagnosis: early morning, in a quiet environment
Pulse Diagnosis Methods
Finger Technique: Fingers slightly arched and inclined, using the finger pads against the pulse ridge. Taller individuals should use a looser grip, shorter individuals should use a tighter grip, and for children, use the thumb to locate the Guan position
1. Lifting: Light touch
2. Pressing: Firm touch
3. Searching: Moderate touch
Following methods, pushing methods, total pressing, single pressing
3. Elements of Pulse Patterns and Characteristics of Normal Pulse
(1) Eight Elements Constituting Pulse Patterns
Pulse Position: Depth of the pulse vessel
Pulse Rate: Frequency of the pulse
Pulse Length: Length of the pulse movement
Pulse Strength: Strength of the pulse
Pulse Width: Thickness of the pulse vessel
Flow Rate: Degree of smoothness of the pulse
Tension: Degree of relaxation of the pulse vessel
Uniformity: Rhythm of the pulse movement
4. Normal Pulse
The normal pulse has the following characteristics
1. Stomach: The pulse is gentle, moderate, and smooth
“A weak and smooth pulse indicates the presence of stomach Qi”
“A lack of stomach Qi indicates illness” “No stomach Qi indicates death”
2. Spirit: The response should be strong, with a regular rhythm
“If the response is orderly and sequential, this indicates the presence of spirit.”
3. Root: The Chi pulse is deep and strong, pressing it does not stop
“Even if the Cun and Guan are absent, the Chi is still not absent; with such flow, there is no worry of extinction.”
Characteristics of Normal Pulse
Pulse Position: Not floating or sinking, can be obtained in the middle
Pulse Rate: Neither fast nor slow, one breath equals four beats
Pulse Strength: Gentle and moderate, the response should be strong
Pulse Shape: Not too large or small, not slippery or rough
Pulse Rhythm: Even without interruption
5. Common Pulse Patterns and Clinical Significance
1. Floating Pulse, Sinking Pulse
2. Slow Pulse, Rapid Pulse
3. Flooding Pulse, Thin Pulse
4. Long Pulse, Short Pulse
5. Weak Pulse, Strong Pulse
6. Slippery Pulse, Rough Pulse
7. String-like Pulse, Tight Pulse
8. Knotted Pulse, Intermittent Pulse, Rapid Pulse
1. Floating Pulse
[Pulse Characteristics] Easily felt with light touch, reduces with firm pressure
Excessive when lifted, insufficient when pressed
Cui’s “Pulse Classic”: “Floating pulse corresponds to heaven, easily felt with light touch, floating on top like wood on water.”
“Pulse Diagnosis Samadhi”: “Floating pulse appears immediately upon light touch, slightly reduces with pressure but does not disappear”
Pulse Position Classification: Floating Pulse
[Clinical Significance] Indicates exterior syndrome, also indicates interior deficiency (deficient Yang escaping outward)
1) Indicates exterior syndrome – external pathogens invade, the body’s righteous Qi tends toward the exterior, hence the pulse is floating
2) Indicates interior deficiency – prolonged illness leads to depletion of essence and Qi, Yin cannot contain Yang, deficient Yang escapes outward.
“In autumn, if this is obtained, there should be no harm; if prolonged illness, it can indeed be alarming”
The difference between the two: the exterior syndrome pulse is floating but has a root; the interior deficiency pulse is floating and has no root
2. Sinking Pulse
[Pulse Characteristics] Not felt with light touch, only felt with firm pressure
Insufficient when lifted, excessive when pressed
“Bin Hu Pulse Studies”: “Like a stone thrown into water, it must reach the bottom.”
“Pulse Classic Compilation”: “Has a deep and sinking tendency”
“Pulse Classic Misinterpretation”: “Not felt with light touch on the skin, gradually felt when pressing into the muscle, and further pressing into the bones reveals strength; this is a sinking pulse.”
Pulse Position Classification: Sinking Pulse
[Clinical Significance] Indicates interior syndrome
Commonly seen in diarrhea, edema, vomiting, Qi stagnation, etc.
Sinking and strong – indicates interior excess: Qi and blood are trapped within; often caused by water, cold, or stagnation (cold contracts, water sinks, stagnation causes Yang Qi to be trapped)
Sinking and weak – indicates interior deficiency: Yang Qi is weak and cannot rise
3. Slow Pulse
[Pulse Characteristics] Pulse comes slowly, less than four beats per breath (less than 60 times per minute)
“Pulse Classic Compilation”: “Slow pulse comes and goes slowly, three beats per breath”
“Pulse Diagnosis Essentials”: “Slow means insufficient; between breaths, the pulse only reaches three beats”
Pulse Rate Classification: Slow Pulse
[Clinical Significance] Indicates cold syndrome, also indicates heat accumulation in the interior
1) Indicates cold syndrome – strong indicates excess cold; weak indicates deficient cold
Excess cold: cold pathogens stagnate, Yang Qi fails to circulate
Deficient cold: Yang Qi is weak and fails to warm and transport
In cases of Yang deficiency, the pulse is often slow and weak. Symptoms include aversion to cold, diarrhea, abdominal pain relieved by pressure, etc.
“The author often sees early morning diarrhea, often with a slow and weak pulse, especially in both Chi positions, using Si Shen Wan to tonify Mingmen fire and warm spleen Yang.” – Liu Guanjun
2) Also indicates heat syndrome: heat pathogens accumulate, obstructing the pulse
Commonly seen in interior heat excess syndromes (Yangming organ excess syndrome, intestinal typhoid, meningitis, etc.)
“Four Diagnostic Essentials”: “Slow pulse belongs to the organs that govern cold; this is a fixed principle, and it is common. If discussing its changes, it can also indicate heat syndrome, which should not be overlooked. The reason is that heat pathogens obstruct, the pathways are not smooth, losing their normal rhythm, thus the pulse becomes slow.”
“In the Treatise on Cold Damage”: “In Yangming disease, if the pulse is slow and there is tidal fever… it can attack the interior, Da Cheng Qi Decoction is indicated”
“In cases of meningitis, often due to increased intracranial pressure, high fever and slow pulse appear; the pulse and symptoms must be considered together, do not misdiagnose as cold.” – Liu Guanjun
4. Rapid Pulse
[Pulse Characteristics] Pulse comes rapidly, five to six beats per breath
“Bin Hu Pulse Studies”: “Six beats per breath, pulse flows thin and rapid”
“Pulse Classic Enlightenment”: “Not like slippery pulse which flows smoothly, rapid pulse is excessively rapid.”
Pulse Rate Classification: Rapid Pulse
[Clinical Significance] Indicates heat syndrome, also indicates deficiency syndrome
1) Indicates heat syndrome – due to heat forcing blood to move erratically, hence the pulse is rapid
Commonly seen in external heat, stomach heat, intestinal heat, lung abscess, intestinal abscess, sores, or Yin deficiency with excess fire, etc.
“Nanjing – Nine Difficulties”: “Rapid pulse indicates heat”
“Pulse and Medicine Link”: “All rapid pulses are due to fire toxicity”
2) Indicates deficiency syndrome – depletion of essence and blood, Yuan Qi deficiency, pulse comes weak and rapid. Commonly seen in individuals with prolonged deficiency.
5. Flooding Pulse
[Pulse Characteristics] Pulse is wide, surging, filling the fingers, comes strong and goes weak
“Diagnosis Essentials”: “Flooding pulse is extremely large, resembling a flood, comes strong and goes weak, filling the fingers.”
“Bin Hu Pulse Studies”: “Flooding pulse comes with a wave-like motion, goes weak and comes strong”
“Pulse Theory Seeking Truth”: “Flooding pulse is both large and rapid”
Pulse Width Classification: Flooding Pulse
[Clinical Significance] Indicates severe heat (Qi level heat)
Interior heat is abundant, Qi is strong, blood surges, hence the pulse is flooding
Flooding and strong indicates excess, often seen in severe internal heat, accompanied by high fever, irritability, thirst, vomiting blood, sores, and sweating due to heat.
“In the Treatise on Cold Damage”: “If there is great thirst that does not resolve, and the pulse is flooding and large, Bai Hu Decoction is indicated”
“In the Essentials of the Golden Chamber”: “In intestinal abscess, if the pulse is flooding and rapid, pus has formed, do not purge.”
Pulse Width Classification: Flooding Pulse
Also indicates deficiency syndrome: if flooding and weak, it does not indicate excess heat, but rather a sign of Yin essence depletion, solitary Yang about to escape.
In cases of prolonged illness with Qi deficiency, or deficiency of essence and blood, or prolonged diarrhea, if flooding pulse appears, it indicates a critical condition of Yin damage and Yang dispersion.
6. Thin Pulse
[Pulse Characteristics] Pulse is thin like a thread, response is evident, does not stop with pressure
“Pulse Classic”: “Thin pulse is slightly larger than micro, often present, but thin”
“Diagnosis Essentials”: “Thin, straight, and soft, resembling a thread, more evident than micro”
“Bin Hu Pulse Studies”: “Smaller than micro but often present, thin, straight, and soft, like a thread responding to the finger”
Pulse Width Classification: Thin Pulse
[Clinical Significance] Indicates deficiency of Qi and blood, various deficiencies; indicates damp invasion
1) Insufficient Qi and blood cannot fill the pulse vessels, hence the pulse is thin and weak
Commonly seen in prolonged illness with Qi and blood depletion, elderly and weak individuals, blood loss, night sweats, spontaneous sweating, Yang deficiency with aversion to cold, deficiency bloating, diarrhea, etc.
“Pulse Classic Misinterpretation”: “Indicates blood deficiency and Qi depletion”
“In the Treatise on Cold Damage”: “Cold hands and feet, pulse thin and about to disappear, Dang Gui Si Ni Decoction is indicated”
Pulse Width Classification: Thin Pulse
2) Indicates damp invasion: spleen deficiency with excess damp or invasion of damp pathogens, hence the pulse is thin
Commonly seen in cases of damp invasion, or internal obstruction of spleen and stomach, or stagnation in meridians, often seen as thin pulse
“In the Essentials of the Golden Chamber”: “In cases of Taiyang disease with joint pain and distress, if the pulse is sinking and thin, this is called damp obstruction”
“Pulse Diagnosis Samadhi”: “Damp obstruction leads to soft pulse, self-sweating, and loss of essence, all have thin pulse”
7. Weak Pulse
[Pulse Characteristics] Extremely soft and sinking
“Pulse Classic”: “Weak pulse is extremely soft and sinking, pressing it feels like it is about to disappear”
“Pulse Theory Seeking Truth”: “Sinking, thin, and weak, lifting it feels like nothing, pressing it is felt”
Pulse Strength Classification: Weak Pulse
[Clinical Significance] Indicates deficiency of Yang Qi or deficiency of both Qi and blood
Yang deficiency cannot warm and transport, hence the pulse is weak and about to disappear
Commonly seen in individuals with depleted Yuan Qi, weak Yang Qi. Symptoms include pale face, cold limbs, shortness of breath, spontaneous sweating, weakness of muscles and bones, nocturnal emissions, diarrhea, etc.
“Diagnosis Essentials”: “Weak indicates Yang is trapped, true Qi is weak”
“In the Essentials of the Golden Chamber”: “In healthy individuals, if the pulse is weak and thin, it indicates spontaneous sweating.”
8. Slippery Pulse
[Pulse Characteristics] Flows smoothly, like beads rolling on a plate, response is round and smooth
“Diagnosis Essentials”: “Slippery pulse flows smoothly, comes and goes like beads on a plate, indicating the presence of phlegm and food stagnation, and excess heat”
1) Indicates phlegm and fluid: phlegm is a slippery substance, phlegm damp accumulates in the body, causing the pulse to appear slippery
“Su Wen – Pulse Essentials”: “Slippery indicates excess Yin Qi”
2) Indicates food stagnation: food stagnation transforms into heat, Qi and blood surge
“Essentials of the Golden Chamber”: “If the pulse is rapid and slippery, it indicates excess, this is due to food stagnation, should be purged with Da Cheng Qi Decoction”
3) Indicates excess heat: righteous Qi is strong, evil Qi is real, Qi and blood surge
“In the Treatise on Cold Damage”: “In cases of cold damage, if the pulse is slippery and there is a pulse, it indicates internal heat, Bai Hu Decoction is indicated”
Pulse Flow Rate Classification: Slippery Pulse
1) Indicates pregnancy pulse: Qi and blood are abundant
“Complete Book of Gynecology”: “In women, if the pulse is slippery and rapid, it indicates pregnancy”
“Pulse Classic”: “If the Chi pulse is slippery, it is a good sign of pregnancy, if it does not disperse, the fetus will be viable for three months, but if it does not disperse, it can be distinguished in five months”
2) Seen in healthy individuals: Slippery and gentle is common in healthy individuals, especially evident in young women
“Complete Book of Gynecology”: “If a healthy person’s pulse is slippery and gentle, this is a good sign of nourishing Wei and Ying”
9. Rough Pulse
[Pulse Characteristics] Comes and goes with difficulty, like a light knife scraping bamboo
“Bin Hu Pulse Studies”: “Like rain touching sand, like a sick silkworm eating leaves”
“Pulse Classic”: “Thin and slow, comes and goes with difficulty, or stops and comes again”
Pulse Flow Rate Classification: Rough Pulse
[Clinical Significance] Indicates injury to essence, blood deficiency, phlegm and food stagnation, Qi stagnation, and blood stasis
1) Rough and weak – indicates injury to essence, blood deficiency
Commonly seen in blood loss, loss of essence, amenorrhea, stillbirth, or cold essence Yang atrophy
“Essentials of the Golden Chamber”: “If a man’s pulse is floating and weak, it indicates infertility, cold essence”
“Diagnosis Essentials”: “Rough indicates blood deficiency, lack of sweat, blood stasis pain, injury to essence”
Pulse Flow Rate Classification: Rough Pulse
2) Rough and strong – indicates excess syndrome (phlegm, food stagnation, blood stasis)
Qi, blood, food, and phlegm obstruct the pulse pathway, causing the pulse to flow poorly
“Essentials of the Golden Chamber”: “If the Cun pulse is floating and large, but becomes rough, it indicates food stagnation”
Indicates blood stasis: commonly seen in chest obstruction, abdominal masses, symptoms of dysmenorrhea, amenorrhea, and adnexal masses, chronic ectopic pregnancy masses, etc.
“Su Wen – Pulse Essentials”: “Rough indicates heart pain”
10. Long Pulse
[Pulse Characteristics] The pulse body is longer, exceeding Cun, Guan, Chi
“Diagnosis Essentials”: “Long pulse is long and straight, both ends are clear, goes straight up and down, like following a long pole”
“Bin Hu Pulse Studies”: “Long pulse is neither large nor small, it is long and straight, like following the end of a long pole”
“Overly long pulse is named long, while string-like is not, but tense”
Pulse Length Classification: Long Pulse
[Clinical Significance] Indicates Yang syndrome, excess syndrome, heat syndrome.
Often caused by excess evil Qi, righteous Qi not declining, and the struggle between evil and righteous
Long and flooding – indicates internal heat; for deep heat, mania;
“Pulse Classic”: “If the pulse is floating, flooding, and long, it indicates dizziness and mania”
Long and string-like – indicates liver Qi rising, Qi stagnation transforming into fire
“Su Wen – Pulse Essentials”: “Long indicates Qi treatment”
In healthy individuals, Qi and blood are abundant, essence is full, and the pulse Qi is surplus
11. Short Pulse
[Pulse Characteristics] Only appears at the Guan position, not evident elsewhere
Li Zhongzi: “Both ends are low and sinking, the middle is protruding and floating”
“Bin Hu Pulse Studies”: “Does not reach the original position, responds at the Guan position and returns, cannot fill the entire area”
[Clinical Significance] Short indicates Qi disease, strong indicates Qi stagnation, weak indicates Qi damage
Qi stagnation cannot expand, Qi deficiency cannot promote, hence the pulse is short
“Pulse Diagnosis Samadhi”: “Stomach Qi is blocked, cannot regulate all pulses, or due to phlegm, Qi, food accumulation, obstructing the Qi pathway, hence the pulse appears short and rough”
12. String-like Pulse
[Pulse Characteristics]: Straight and long, like pressing a guitar string
“Pulse Classic”: “Pressing it feels like a bowstring”
“Pulse Classic Misinterpretation”: “Resembles a zither string, pressing it does not move, it is taut under the finger, called string-like”
“Bin Hu Pulse Studies”: “Like a drawn bowstring, pressing it does not move, taut like pressing a zither string”
Pulse Tension Classification: String-like Pulse
[Clinical Significance]: Indicates liver and gallbladder diseases, various pain syndromes, phlegm and malaria
String-like indicates liver pulse, representing Qi stagnation
Commonly seen in liver Qi stagnation, rib pain, abdominal pain, cold obstruction, hernia, malaria, etc.
“In the Treatise on Cold Damage”: “If the pulse is string-like, there must be tension in both sides”
“In the Essentials of the Golden Chamber”: “If the pulse is sinking and string-like, it indicates internal pain from suspended fluid”
“In the Treatise on Internal Medicine”: “Yang string-like headache, Yin string-like abdominal pain”
13. Hollow Pulse
[Pulse Characteristics] Floating and large, hollow in the middle, like pressing a scallion tube
[Clinical Significance] Indicates blood loss
Pulse Theory: Yin blood cannot maintain Yang Qi, hence Yang Qi disperses
“Essentials of the Golden Chamber”: “If the pulse is extremely weak and hollow, it indicates clear diarrhea, blood loss, and loss of essence”
“Complete Book of Gynecology”: “Hollow pulse indicates solitary Yang detaching from Yin, blood loss, loss of essence, Qi has nowhere to return, Yang has nowhere to attach”
14. Tight Pulse
[Pulse Characteristics] Pulse shape is tight and urgent, like pulling a rope
“Pulse Classic”: “Like cutting a rope”
“Diagnosis Essentials”: “Tight pulse is strong, left and right can be felt, like twisting a rope, like cutting a tight rope”
Pulse Tension Classification: Tight Pulse
[Clinical Significance] Indicates cold syndrome, pain syndrome, food stagnation
Cold contracts, hence the pulse vessel shrinks
Commonly seen in cold pathogens invading, causing cold damage, fever, headache, cough, abdominal pain or distension, vomiting, diarrhea, hernia, etc.
“Pulse Classic Misinterpretation”: “Tight indicates cold and pain”
“Essentials of the Golden Chamber”: “Tight pulse is like a rope that is not constant, indicating food stagnation”
“Tight pulse indicates headache from wind-cold, abdominal stagnation due to food accumulation”
15. Slow Pulse
[Pulse Characteristics] One breath equals four beats, comes and goes slowly
Has two meanings
1) Pulse vessel is gentle, pulse comes gently, with a leisurely feeling. Indicates presence of spirit, normal stomach pulse
2) Pulse vessel is slow, pulse comes lazily
“Pulse Classic”: “Comes and goes slowly, slightly faster than slow”
[Clinical Significance] Often indicates spleen deficiency or damp obstruction
16. Leather Pulse
[Pulse Characteristics] Hollow in the middle, firm on the outside, like pressing a drum skin
“Bin Hu Pulse Studies”: “Hollow pulse, string-like and hollow, like pressing a drum skin”
“Medical Reality”: “Leather pulse is strong on the outside”
Xu Chunfu: “Leather indicates skin, floating, string-like, large and hollow, indicating internal deficiency and external urgency”
Pulse Tension Classification: Leather Pulse
[Clinical Significance] Indicates blood loss, loss of essence, postpartum bleeding, etc.
Leather indicates internal deficiency of essence, Qi has nowhere to attach and floats outward
“Essentials of the Golden Chamber”: “In women, it indicates postpartum bleeding; in men, it indicates blood loss and loss of essence”
“In the Treatise on Cold Damage”: “If the pulse is string-like and large, string-like indicates reduction, reduction indicates cold, hollow indicates deficiency, cold and deficiency are in conflict, this is called leather”
Reproductive anemia often presents with this type of pulse, the pulse shape is large, pressing it reveals hollowness, indicating severe anemia. Additionally, tumors, liver cirrhosis, etc., can also be seen.
Comparison of Hollow Pulse and Leather Pulse
Both pulses are hollow and strong on the outside, indicating internal deficiency of Yang
Hollow Pulse: Soft skin and hollow, indicates blood loss or signs of blood loss
Leather Pulse: Firm skin and hollow, indicates essence deficiency and cold
17. Firm Pulse
[Pulse Characteristics] Strong, long, sinking, felt only with firm pressure
Li Zhongzi: “Firm has two meanings, strong and solid, also deeply located”
“Pulse Theory”: “Sinking and strong, firm and unmovable, strong and long, this is the nature of firm”
[Clinical Significance] Indicates internal cold, hernia, and masses
Pulse Theory: Internal cold accumulates, Yang Qi sinks, hence the pulse is deep and strong.
18. Weak Pulse
[Pulse Characteristics] Extremely soft and sinking
“Pulse Classic”: “Weak pulse is extremely soft and sinking, pressing it feels like it is about to disappear”
“Pulse Theory Seeking Truth”: “Sinking, thin, and weak, lifting it feels like nothing, pressing it is felt”
Pulse Strength Classification: Weak Pulse
[Clinical Significance] Indicates deficiency of Yang Qi or deficiency of both Qi and blood
Yang deficiency cannot warm and transport, hence the pulse is weak and about to disappear
Commonly seen in individuals with depleted Yuan Qi, weak Yang Qi. Symptoms include pale face, cold limbs, shortness of breath, spontaneous sweating, weakness of muscles and bones, nocturnal emissions, diarrhea, etc.
“Diagnosis Essentials”: “Weak indicates Yang is trapped, true Qi is weak”
“In the Essentials of the Golden Chamber”: “In healthy individuals, if the pulse is weak and thin, it indicates spontaneous sweating.”
19. Moist Pulse
[Pulse Characteristics] Floating and soft, like cotton floating on water
“Pulse Classic”: “Extremely soft and floating”
“Shui Boren”: “Moist indicates lack of strength, soft and weak, responding like cotton floating on water, light touch comes and heavy touch goes”
[Clinical Significance]: Indicates various deficiencies, also indicates dampness
Commonly seen in cases of Qi deficiency, spontaneous sweating, fatigue, shortness of breath, etc.
“Diagnosis Essentials”: “Moist indicates both Qi and blood are sufficient, indicates blood deficiency, indicates lack of blood, indicates fatigue, indicates spontaneous sweating, indicates coldness, indicates obstruction”
“Brief Discussion on Color and Pulse Diagnosis”: “Moist pulse often reflects excess dampness, hence moist pulse indicates dampness, so in cases of fatigue, skin swelling, and sores, the pulse is often moist, pressing it feels like mud and does not feel refreshing”
20. Hidden Pulse
[Pulse Characteristics] Deeper than sinking pulse, requires firm pressure to feel, even hidden and not present
“Diagnosis Essentials”: “Pressing the muscle to the bone, the shape is first obtained”
[Clinical Significance] Indicates closure of evil, critical pain (hidden but strong)
Often due to internal evil Qi, pulse Qi cannot circulate
In cases of Qi closure, cold closure, heat closure, extreme pain, cholera, etc., it can be seen
Hidden and weak – indicates Qi and blood deficiency, Yin withered and Yang exhausted, “heart failure pulse hidden”
21. Moving Pulse
[Pulse Characteristics] Pulse beats like a bean, felt at the Guan position
“Pulse Classic”: “Moving pulse is felt at the Guan position, has no head or tail, large like a bean, shaking and swaying”
[Clinical Significance] Commonly seen in cases of fright, pain
22. Rapid Pulse
[Pulse Characteristics] Rapid and intermittent, with no fixed number of stops
“Pulse Classic”: “Rapid pulse comes and goes rapidly, sometimes stops and comes again”
“Bin Hu Pulse Studies”: “Comes and goes rapidly, sometimes stops and comes again, like a sudden jolt, slow and fast are not constant”
Pulse Uniformity: Rapid Pulse
[Clinical Significance] Indicates Yang excess heat
Excess heat within, obstructing the pulse pathway, causing the pulse to flow poorly
“Cui’s Pulse Classic”: “Yang excess leads to rapid pulse, lung abscess with Yang toxicity”
“Bin Hu Pulse Studies”: “Rapid pulse indicates fire, its cause can be analyzed in five ways, often seen in coughing and phlegm accumulation, or in cases of mania and toxic sores”
23. Knotted Pulse
[Pulse Characteristics] Slow and intermittent, with no fixed number of stops
“In the Treatise on Cold Damage”: “If the pulse comes slowly, sometimes stops and comes again, it is called a knotted pulse”
“Pulse Classic Misinterpretation”: “Pulse comes slowly, sometimes stops, with no fixed number”
“Diagnosis Essentials”: “Slow and intermittent, sometimes seen as a stop”
Pulse Uniformity: Knotted Pulse
[Clinical Significance] Indicates excess Yin and Qi stagnation
Yin cold stagnates, heart Yang is suppressed
Commonly seen in cases of Qi stagnation, blood stasis, cold phlegm, food stagnation, and masses
“Cui’s Pulse Classic”: “Excess Yin leads to knotted pulse, masses and accumulations”
“Diagnosis Essentials”: “Knotted pulse indicates excess Yin, leading to Qi stagnation”
24. Intermittent Pulse
[Pulse Characteristics] Pulse comes and stops, with a fixed number of stops, takes a long time to return
“Pulse Classic”: “Intermittent pulse comes rapidly, stops in the middle, cannot return by itself, hence it moves again”
“Living Book”: “Comes and goes slowly, stops in the middle, cannot return by itself, hence it moves again, called intermittent”
Pulse Uniformity: Intermittent Pulse
[Clinical Significance] Indicates organ Qi deficiency
1) Organ Qi deficiency, unable to continue, hence the pulse stops and is difficult to recover
“Diagnosis Essentials”: “Intermittent pulse indicates organ deficiency, a critical condition”
“Heart pain seizes food, pulse three beats and one stop, cannot return for a long time”
2) Also indicates pain syndrome, emotional distress, trauma
“If frightened, Qi becomes chaotic”
25. Rapid Pulse
[Pulse Characteristics] More than seven beats per breath
[Clinical Significance] Commonly seen in cases of Yang hyperactivity without restraint, true Yin is about to collapse. Indicates weakness, Yang Qi about to collapse
Note: “Supraventricular tachycardia” can reach 160 beats per minute or more, but does not belong to critical conditions or death conditions
Distinguishing between Rapid, Knotted, and Intermittent Pulses
All three pulses are irregular pulse patterns, but
1) Rapid and Knotted pulses are irregular stops; Intermittent pulse has regular stops
2) Knotted and Intermittent pulses are slow with stops; Rapid pulse is fast with stops
Comparison of Pulse Patterns, Combined Pulses, and True Organ Pulses
1. Comparison of Similar Pulses
1) Pulse Position Types:
Floating – Floating, Hollow, Weak, Moist, Flooding
Sinking – Sinking, Hidden, Firm, Weak
2) Pulse Rate Types:
Slow – Slow, Weak, Rough, Knotted
Rapid – Rapid, Flooding, Slippery, Rapid
3) Pulse Width Types:
Large (Thick) – Large, Weak, Flooding, Hollow, Strong
Small (Thin) – Thin, Weak, Moist, String-like
4) Pulse Strength Types:
Weak – Weak, Weak, Moist, Micro
Strong – Strong, String-like, Tight
2. Combined Pulses and Their Main Disease Patterns
• Concept: Two or more pulses appearing simultaneously are called combined pulses
• Causes: (1) Righteous Qi has both abundance and deficiency, evil Qi often accompanies
(2) The pulse’s position, rate, shape, strength, rhythm
• Main Disease: The total of the diseases indicated by each pulse
Floating Rapid Pulse = Floating (Exterior) + Rapid (Heat) indicates exterior heat syndrome
Sinking Rapid = Interior Heat
String-like Rapid = Liver Qi stagnation transforming into fire
6. Abnormal Pulses / True Organ Pulses
Severe conditions, stomach Qi is depleted, true organ pulses appear
1) No Stomach Pulse: String-like and hard, not soft, like following a knife edge
Yuan Dao Pulse, Dan Shi Pulse
2) No Root Pulse: Floating and large, with no root, disappears upon pressure
Boiling Pot Pulse, Fish Swimming Pulse, Shrimp Floating Pulse
3) No Spirit Pulse: Pulse rate is disordered, pulse shape is scattered
Bird Pecking Pulse, Roof Leak Pulse, Loose Knot Pulse
7. Pulse Symptoms: Following, Reversing, and Following Abandoning1) Pulse Symptoms Correspondence
(1) Pulse symptoms match
Excess syndrome: New disease, acute disease – Yang pulse, strong pulse
Deficiency syndrome: Chronic disease, slow disease – Yin pulse, weak pulse
(2) Pulse symptoms do not match
2) Pulse Symptoms Following and Abandoning – commonly used for cold-heat, deficiency-excess, true-false
(1) True symptoms, false pulse – abandon pulse, follow symptoms
Abdominal pain, constipation, red tongue with yellow coating – dryness and heat in the stomach and intestines
Sinking and slow pulse – heat accumulation in the stomach and intestines, pulse pathway is obstructed
(2) False symptoms, true pulse – abandon symptoms, follow pulse
Cold limbs with body heat, thirst, red tongue – false cold
Flooding and rapid pulse – heat closed internally, Yang is blocked externally – true heat
Summary
1) Indicates cold – Slow, Tight, Weak
2) Indicates heat – Rapid, Flooding, Slippery, Rapid
3) Indicates deficiency – Weak, Weak, Thin, Moist
4) Indicates excess – Strong, String-like, Tight
5) Indicates pain – String-like, Tight, Intermittent, Rapid (Moving, Hidden)
6) Indicates blood stasis – Rough, Knotted
7) Indicates phlegm and fluid – Slippery, Rough, String-like, Rapid, Knotted
8) Indicates deficiency and dampness – Thin, Slow, Moist
9) Indicates food accumulation – Slippery, Rapid, Rough, Tight (Short)
10) Indicates Yin exhaustion and Yang detachment – Weak, Rapid (Scattered)
11) Indicates pulse rhythm disorder – Rapid, Knotted, Intermittent
Significance of Pulse Diagnosis
1. Differentiating diseases
2. Explaining pathogenesis
3. Guiding treatment
4. Inferring prognosis
Palpation Diagnosis
1. Methods of Palpation Diagnosis: Touch, Feel, Press, Tap
Significance of Palpation Diagnosis
2. Precautions
Serious attitude, graceful demeanor, adhere to medical ethics
Gentle, skilled, and agile techniques, avoid stimulation
Start light, then heavier, from shallow to deep, closely observe
2. Content of Palpation Diagnosis
Palpate the chest and ribs, palpate the abdomen, palpate the skin, palpate the Shu points
(1) Palpate the chest
1. Palpate the chest: virtual inside (apex of the heart)
Normal – moves without tension, slow without urgency
Abnormal – weak: indicates deficiency of Zong Qi
Its movement should be felt through clothing: indicates external leakage of Zong Qi
2. Palpate under the ribs:
(2) Palpate the abdomen (stomach area, abdominal area)
1. Palpate the stomach area
2. Palpate the large abdomen
Palpating it feels full, painful and resists pressure, dull sound when tapping – indicates excess syndrome
Palpating it feels empty, painful and prefers pressure, hollow sound when tapping – indicates deficiency syndrome
Distinguish swelling: has a wave-like feeling – water swelling; no wave-like feeling – Qi swelling
Distinguish intestinal abscess
Distinguish accumulation
Distinguish roundworms
(3) Palpate the skin
1. Distinguish cold and heat:
Skin hot and prefers cold – Yang syndrome, heat syndrome
Skin cold and prefers warmth – Yin syndrome, cold syndrome
2. Observe moisture and dryness:
Skin moist – sweating or body fluids not harmed
Skin dry – no sweating or body fluids harmed
3. Diagnose swelling
Water swelling – pressing it leaves a dent
Qi swelling – pressing it leaves a dent, then rises again
4. Examine sores and ulcers
Yin syndrome – pressing it feels hard and not hot, root is flat and swollen
Yang syndrome – pressing it feels high and hot, root is tight
Palpate the skin
Diagnose “skin”: from the inner elbow to the horizontal line of the palm
Skin relaxed (loose) – indicates heat
Skin tense (tight) – indicates cold
Skin very hot – indicates heat
Skin cool – indicates Yang deficiency
Skin soft, moist, and warm – indicates harmonious Qi and blood
Skin dry and rough – indicates fluid depletion, Qi and blood deficiency
(4) Palpate the hands and feet
1. Distinguish hand and foot temperature
Both cold – indicates Yang deficiency or excess Yin
Both hot – indicates Yin deficiency or excess Yang
2. Distinguish palm temperature
Hot palms and feet – indicates internal heat
In children with measles, if the middle finger tip is cold – indicates rash
(5) Palpate the Shu points
Has certain significance for judging disease location
Lung disease: Zhongfu, Feishu, Taiyuan
Liver disease: Qimen, Gan Shu, Taichong
Stomach disease: Wei Shu, Zusanli
Intestinal abscess: Right lower abdomen tenderness, tenderness at the appendix point
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