The heart governs the blood vessels, and the heartbeat pumps blood into the meridians, facilitating its circulation and forming the pulse. The heartbeat is a sign of life and the driving force behind the pulse manifestation. The frequency and rhythm of the pulse are closely related to the normalcy of the heartbeat. As recorded in the “Su Wen: On the Essentials of Pulse Diagnosis,” it states: “The pulse is the residence of blood.” The meridians serve as the channels for the flow of Qi and blood. A smooth flow in the meridians is a necessary condition for the circulation of Qi and blood. The pulse also has the role of constraining, controlling, and promoting blood along the meridians, which is key to the continuous circulation of Qi and blood. Therefore, the structure and functional state of the pulse can directly affect its manifestation.Qi and blood are the fundamental substances that constitute and maintain human life activities, and they also form the material basis for pulse manifestation. The abundance or deficiency of blood directly affects the fullness and smoothness of the meridians. Qi is the material basis and driving force for the transformation of blood. The movement of blood within the meridians relies on the propulsion of Qi, and the strength of the heart also depends on the regulation of Qi. Thus, it is evident that they have a significant impact on the pulse manifestation. When Qi and blood are sufficient, the pulse is gentle and strong; when Qi and blood are deficient, the pulse is thin and weak; when Qi stagnates and blood stasis occurs, the pulse is thin and choppy.The formation of the pulse is related to the heart and also relies on the coordination of other organs. The lungs govern all the meridians, meaning that the blood circulating throughout the body converges in the lungs, where the lung Qi distributes the blood to all parts of the body. If the lung’s function of governing Qi and respiration declines, it will manifest as a weak or even intermittent pulse. The spleen and stomach are the foundation of postnatal life, serving as the source of Qi and blood transformation. They can process food and absorb its essence. When Qi and blood are abundant, and the essence of food is well absorbed, the pulse reflects this as having stomach Qi. A pulse with stomach Qi is a normal pulse; a pulse with little stomach Qi indicates illness; a pulse without stomach Qi indicates death. The liver governs the smooth flow of Qi and blood, facilitating the meridians. If the liver’s function of smooth flow is obstructed, it will lead to Qi stagnation and blood stasis, resulting in a thin and wiry pulse; if liver Yang is hyperactive, the pulse may be wiry and rapid; if the liver stores insufficient blood, the pulse will be thin and weak. The kidneys store the essence, serving as the foundation of congenital life and the root of all organ functions. When kidney Qi is sufficient, the pulse is strong and continuous, indicating vitality. Thus, the formation of the pulse is closely related to the overall activity of the organs.I. Locations for Pulse DiagnosisDiagnosing the pulse at the wrist is a common method, but there are many other locations for pulse diagnosis.Three Regions and Nine Positions Method:The Three Regions and Nine Positions Method, also known as the Comprehensive Diagnosis Method, primarily features the examination of related arteries in the upper, middle, and lower regions of the body. The diagnostic locations are divided into three regions: upper (head), middle (hands), and lower (feet), with each region further divided into three positions: heaven, earth, and human, resulting in a total of nine positions.Renying and Cun Kou Diagnosis Method:The Renying and Cun Kou Diagnosis Method refers to diagnosing the pulse at two locations: the Renying position and the Cun Kou position. These two locations are compared to provide a comprehensive analysis of the pulse. This diagnostic method is simple; the Cun Kou primarily reflects the internal organ conditions, while the Renying reflects the surface conditions.Zhang Zhongjing’s Three Regions Diagnosis Method:In Zhang Zhongjing’s “Shang Han Lun,” it is recorded: “If the pulse at the Cun is not as deep as the Chi, and the pulse at the hand is not as deep as the foot, the Renying, Cun, and Chi are not referenced together; if the pulse is rapid, it is not more than fifty beats, and the diagnosis is unknown.” Thus, the Cun, Renying, and Chi are the pulse diagnosis locations. The conditions at the Cun and Renying have been mentioned above. The Chi pulse primarily reflects the Qi of the spleen and stomach.Cun Kou Pulse Diagnosis Method:The radial artery at the wrist is known as the Cun Kou, also referred to as the “Qi Kou” or “Pulse Kou.” The Cun Kou pulse diagnosis method involves examining the pulse at the Cun Kou to infer the physiological functions and pathological responses of the body. Traditional Chinese Medicine considers the Cun Kou to be the original point of the Taiyang Lung Meridian, serving as a major pulse point. The physiological and pathological activities of the organs can be reflected in the Cun Kou pulse. Moreover, the Cun Kou, Taiyin Lung Meridian, and Taiyin Kidney Meridian are both Taiyin meridians. The spleen and stomach are the organs responsible for the reception and transformation of the five viscera and six bowels, serving as the source of Qi and blood transformation, and are closely related to all organs in the body. Therefore, the Cun Kou diagnosis method can assess the abundance and deficiency of Qi and blood, Yin and Yang of the organs, and their overall condition. The Cun Kou pulse can be divided into three parts: Cun, Guan, and Chi. The Guan is located at the prominent bone of the wrist (the radial styloid process), the Cun is at the wrist’s edge, and the Chi is at the elbow’s edge. Both hands have three parts: Cun, Guan, and Chi, totaling six pulse locations. The left Cun reflects the heart, the left Guan reflects the liver and gallbladder, and the left Chi reflects the kidneys; the right Cun reflects the lungs, the right Guan reflects the spleen and stomach, and the right Chi reflects the kidneys.2. Methods of Pulse DiagnosisTiming:The best time for pulse diagnosis is early in the morning before getting out of bed and before eating, as the pulse is a very sensitive physiological indicator. Its changes are closely related to the movement of Qi and blood and can be influenced by environmental factors, diet, exercise, and emotions. Therefore, in the early morning, when the internal and external environments are relatively stable, it can more accurately reflect the body’s basic condition, making it easier to identify abnormal pulse patterns. However, in practice, not every patient can prepare in this way. In summary, a quiet internal and external environment is needed during pulse diagnosis. The doctor’s mood should be calm, and the patient’s pulse should be steady. Before diagnosis, the patient should rest for a while to allow the Qi and blood to stabilize, and the examination room should be kept quiet to prevent external factors from affecting the patient’s emotions and leading to misdiagnosis. The doctor should regulate their breathing and count the patient’s pulse beats during inhalation, with each pulse diagnosis lasting at least one minute, ideally 2-3 minutes.Position:During pulse diagnosis, the patient should sit or lie down comfortably, with the forearm naturally extended forward, at the same level as the heart. The wrist should be relaxed, with the palm facing up and the fingers slightly bent. A soft pulse pillow should be placed at the wrist joint to keep the Cun Kou area straight and exposed, allowing for smooth Qi and blood flow, which will reflect the true pulse. The patient should remove any bracelets, watches, or other accessories to prevent obstruction of blood flow and affect the pulse examination.Finger Positioning:The doctor and patient should sit side by side, with the left hand pressing on the patient’s right hand and the right hand pressing on the patient’s left hand. When palpating the pulse, the doctor should first use the middle finger to locate the Guan position on the inner side of the prominent bone of the wrist, then use the index finger to locate the Cun position, and the ring finger to locate the Chi position. For children, the Cun Kou area is very short, so the “One Finger Positioning Method” is often used, where the thumb or index finger is used to press on the Cun, Guan, and Chi positions simultaneously.Finger Placement:When palpating the pulse, the doctor’s three fingers should be arched, using the pads of the fingers to touch the pulse. The density of finger placement can be adjusted according to the patient’s height; taller patients should have a looser placement, while shorter patients should have a denser placement.Finger Pressure:The doctor can lightly touch the skin with their fingers, known as “floating pressure”; if the fingers apply more pressure, even pressing down to the tendons to observe the pulse, it is called “heavy pressure”; pressure that is between light and heavy, or moving the fingers back and forth to carefully observe the pulse, is called “medium pressure.” After evenly placing the three fingers, the same pressure should be used to palpate the three pulse parts, known as “total pressure”; to focus on a specific pulse, only one finger is used with more pressure, known as “single pressure.” In clinical practice, total pressure and single pressure are often used together. Typically, total pressure is performed first, followed by single pressure to clearly understand the overall pulse condition and the changes in each part.3. Considerations for Pulse DiagnosisDuring pulse diagnosis, one must concentrate, be attentive, and calm to avoid subjective misinterpretation. It is also important to consider the patient’s gender, age, and changes in the internal and external environment that may affect the pulse. For example, women’s pulses are generally thinner than men’s, and during menstruation, the left Guan and Chi pulses may appear fuller without symptoms of fever, no bitter taste in the mouth, and no abdominal distension, indicating that menstruation is approaching. The pulse may be weak or thin during heavy menstruation; in cases of amenorrhea, the Chi pulse may be weak and thin, indicating a deficiency of essence and blood; a wiry and strong Chi pulse may indicate Qi stagnation and blood stasis. In children, the pulse is often rapid, and in the elderly, the pulse is often harder; in summer, the pulse may be fuller; in winter, the pulse may be deeper and smaller; after drinking alcohol, the pulse is often rapid; after eating, the pulse is usually stronger; after exercise, the pulse is often rapid; athletes may have a slower pulse, etc. Additionally, due to anatomical variations in the radial artery, the pulse may not be felt at the Cun Kou but rather on the thumb’s wrist side, known as the “reversed Guan pulse.” During clinical diagnosis, it is important to check for the presence of a reversed Guan pulse.4. Normal Pulse PatternsNormal pulse patterns, also known as regular or common pulses, are the pulse manifestations of healthy individuals under physiological conditions. A normal pulse is characterized by 4-5 beats per breath (equivalent to 70-80 beats per minute), with the pulse not being floating or deep, not large or small, calm and gentle, strong yet not rapid or slow, and with a consistent rhythm. This indicates that the organ functions are robust, Yin and Yang are balanced, Qi and blood are abundant, and the spirit is calm, which is a sign of health. The ancients summarized the normal pulse as having “stomach Qi,” “spirit,” and “root.”Having Stomach Qi:Having stomach Qi means that the pulse has stomach energy, and the pulse is gentle and calm, which is a manifestation of having stomach Qi. Even if the pulse is pathological, whether floating or deep, as long as there is a harmonious appearance, it indicates the presence of stomach Qi. The “Su Wen: On the Phenomena of Healthy Individuals” states: “Humans rely on food and water for sustenance; thus, if one is deprived of food and water, they will die; if the pulse lacks stomach Qi, it is also death.” This shows that the abundance or deficiency of stomach Qi is crucial for diagnosing and predicting diseases. The famous Ming dynasty physician Zhang Jingyue stated: “If the pulse is initially rapid and then slows down, it indicates the arrival of stomach Qi; if it is initially slow and then becomes rapid, it indicates the departure of stomach Qi.” He also said: “Generally, the pulse should not be excessive or insufficient, and there should be a calm and gentle state, which is the pulse of stomach Qi.” In summary, a pulse with stomach Qi should not be floating or deep, not rapid or slow, but calm and gentle.Having Spirit:The characteristics of having spirit are: first, the pulse is gentle and strong. The “Complete Book of Jingyue: On the Spirit of the Pulse” records: “Dongyuan said: The pulse of a healthy person does not seek its spirit, yet spirit is always present; the pulse of a sick person should seek the presence or absence of spirit… A pulse with strength indicates the presence of spirit; if it is cold and weak, it is without spirit.” A strong yet gentle pulse reflects the balance of hardness and softness, Yin and Yang, and is one of the main characteristics of a normal pulse. Second, the pulse rhythm is consistent. The regularity of the pulse rhythm reflects the Qi of the organs, especially the strength or weakness of the heart Qi. When the organ Qi is abundant, it can smoothly propel the blood to flow within the vessels, resulting in an orderly pulse. If the organ Qi is insufficient, it cannot promote blood flow, leading to an irregular pulse. The “Differentiation Records” states: “Regardless of whether the pulse is floating, deep, rapid, or slow, if it is orderly and consistent, it indicates the presence of spirit. If it is scattered or inconsistent, it may be present or absent, sometimes continuous and sometimes interrupted, or it may desire to continue but cannot, or desire to connect but cannot… all of these indicate a lack of spirit, which is to be feared.”Having Root:This is primarily reflected in a strong pulse at the Chi position. The Chi position reflects the kidneys, which store the essence and are the root of the organs. A strong pulse at the Chi position indicates the presence of kidney Qi and vitality. Here, the term “deep” refers to the Chi pulse being relatively deep; the medium pressure may not be obvious, but a strong deep pressure is sufficient. This is a physiological distinction between the Chi pulse and the Cun and Guan pulses.5. Common Pulse Patterns in DiseasesWhen a person is ill, the pulse pattern changes, referred to as a pathological pulse. The so-called main disease refers to the symptoms revealed by the pathological pulse. Common pathological pulses and their main diseases include the following:Floating Pulse:This pulse is easily felt with light pressure but diminishes with heavy pressure. A floating pulse indicates an exterior condition and often occurs in chronic internal injuries. When external pathogens invade the surface, the Qi and blood tend to move towards the skin, causing the pulse to be superficial and easily felt with light pressure, while heavy pressure weakens the pulse. Additionally, in chronic illness, the body may become weak, causing the floating Yang to rise to the surface, resulting in a floating and weak pulse.Deep Pulse:This pulse is located deep within, not felt with light pressure, and only becomes clear with heavy pressure. Clinically, it is often seen in interior conditions. A strong deep pulse indicates an interior excess condition, while a weak deep pulse indicates an interior deficiency condition. If pathogens are trapped in the interior, causing Qi and blood stagnation, and Yang Qi cannot be expressed, the pulse will be deep and strong. If the organs are weak and the righteous Qi is insufficient, leading to Yang deficiency and Qi sinking, the pulse will be deep and weak.Slow Pulse:This pulse is characterized by a slow arrival, with fewer than four beats per breath (more than 60 beats per minute). Clinically, it is seen in cold conditions. A strong pulse indicates an excess cold condition, while a weak pulse indicates a deficiency cold condition. Cold can cause Qi stagnation, leading to a slow and weak pulse. However, a slow pulse can also occur due to the accumulation of heat, which obstructs the flow of blood. Therefore, a slow pulse cannot be uniformly classified as a cold condition; clinical diagnosis should consider the pulse symptoms.Rapid Pulse:This pulse is characterized by a rapid arrival, with five to six beats per breath (more than 90 beats per minute). Clinically, it is often seen in heat conditions. A strong pulse indicates an excess heat condition, while a weak pulse indicates a deficiency heat condition. When external heat pathogens invade, or when there is excessive heat in the organs, the movement of Qi and blood accelerates, resulting in a rapid and strong pulse; in chronic illness with Yin deficiency, the pulse may be rapid and weak due to internal heat. Additionally, insufficient heart Qi can lead to a scattered pulse, which may also present as rapid and weak.Weak Pulse:This pulse is characterized by a lack of strength in all three pulse positions, feeling empty and weak under pressure. It indicates a deficiency condition, often due to both Qi and blood deficiency. When the body lacks Qi and blood, it cannot circulate blood, leading to a weak pulse as the blood cannot fill the vessels, resulting in an empty feeling.Excess Pulse:This pulse is characterized by strength in all three pulse positions, indicating fullness. It represents an excess condition. When pathogenic Qi is strong and righteous Qi is not deficient, the righteous and pathogenic forces clash, leading to a pulse that is strong and full.Slippery Pulse:This pulse flows smoothly, resembling the rolling of a marble under the fingers. It indicates phlegm, food stagnation, or excess heat, where pathogenic factors are abundant, causing Qi and blood to surge, resulting in a smooth pulse. In young individuals, a slippery pulse is a sign of abundant Qi and blood; in pregnant women, it indicates sufficient Qi and blood to nourish the fetus, which is a physiological phenomenon.Choppy Pulse:This pulse is characterized by a thin and choppy quality, resembling the sound of a knife scraping bamboo skin, and is the opposite of a slippery pulse. It indicates damage to the essence, blood deficiency, Qi stagnation, or blood stasis. Damage to the essence and blood leads to insufficient nourishment of the meridians, causing a choppy pulse; Qi stagnation and blood stasis lead to a choppy and strong pulse, indicating an excess condition.Wiry Pulse:This pulse is straight and long, resembling a guitar string, with a straight and tense feeling under the fingers. It indicates liver and gallbladder diseases, pain conditions, phlegm, and malaria. When the liver fails to regulate Qi, it leads to a tense pulse due to Qi stagnation, causing the pulse to become tight and unable to expand.6. Women’s and Children’s PulsesDue to physiological differences, the pulse patterns of women and children differ from those of adults.Women’s Pulse:Women undergo four processes: menstruation, pregnancy, childbirth, and lactation. The pulse diagnosis will also change accordingly. ① Menstrual Pulse Diagnosis: If a woman’s menstruation is normal, the pulse during menstruation will be slightly slippery, especially the left Guan and Chi pulses, which may suddenly become fuller than the right hand without symptoms of fever, no bitter taste in the mouth, and no abdominal distension, indicating that menstruation is approaching. If the Cun and Guan pulses are harmonious, but the Chi pulse is weak or thin, it indicates heavy menstruation; in cases of amenorrhea, the Chi pulse may be weak and thin, indicating a deficiency of essence and blood; a wiry and strong Chi pulse may indicate Qi stagnation and blood stasis. ② Pregnancy Pulse Diagnosis: After menstruation stops, the pulse becomes slippery and rapid, especially at the Chi position, accompanied by decreased appetite, cravings for sour foods, or vomiting, indicating pregnancy; if the left Cun pulse is slippery and rapid, it indicates that blood is gathering to nourish the fetus. When diagnosing pregnancy pulses, the above two points can be referenced. A slippery and slightly rapid pulse in women does not necessarily indicate pregnancy; it should be considered in conjunction with age and menstrual history. In cases of amenorrhea, the pulse is often weak and thin or wiry and strong, while pregnancy pulses exhibit a slippery quality. Additionally, physical exhaustion may also lead to a rapid pulse; pregnancy pulses are often rapid and slippery, with a gentle quality. ③ Labor Pulse Diagnosis: When a woman is about to give birth, the pulse will differ from usual. Pulsations may appear in the normally non-pulsating joints of the fingers or around the neck, indicating the onset of labor.Children’s Pulse:Children have not yet fully developed Qi and blood, being in a state of immature Yang and Yin, thus their pulse differs from that of adults. The Cun Kou pulse position is narrow, making it difficult to distinguish between the Cun, Guan, and Chi positions. Additionally, children may become frightened or cry during examination, causing Qi to become disordered, making it challenging to accurately assess. In clinical practice, children’s pulses should be distinguished from those of adults. ① Diagnostic Method: The Cun Kou in children is shorter, so the “One Finger Positioning Method” is the primary method for diagnosing children’s pulses. This involves using one finger (thumb or index finger) to assess all three pulse positions. For children under three years old, the doctor uses their right thumb to press on the prominent bone of the wrist without distinguishing between the three parts, focusing on the pulse count; for children aged 3-5 years, the middle line of the prominent bone is used as the Guan position, with one finger rolling to explore the three pulse positions; for children aged 6-8 years, the finger position can be adjusted to diagnose the three parts; for children aged 9-14 years, the three parts can be diagnosed sequentially, and for those over 15 years, the adult method can be used. ② Normal Pulse Patterns: Children’s organs are delicate, and their Qi and blood are not fully developed, but they are full of vitality and grow rapidly. Therefore, healthy children’s pulse patterns are generally harmonious and faster than those of adults. For children under three years old, the pulse is typically six to seven beats per breath (100-120 beats per minute); for children aged 4-10 years, the pulse is about five to six beats per breath (around 100 beats per minute); for children aged 10-15 years, the pulse is about four beats per breath (75 beats per minute), which is similar to adults. ③ Pathological Pulse Patterns: Children’s diseases are generally simpler, so their pathological pulses are not as complex as those of adults. Children’s pulses are typically assessed for floating, deep, slow, rapid, and six types of pulses to differentiate between exterior and interior conditions, cold and heat, and deficiency and excess. Floating pulses are often seen in exterior conditions, with a strong floating pulse indicating an exterior excess and a weak floating pulse indicating an exterior deficiency; deep pulses are often seen in interior excess, with a strong deep pulse indicating an interior excess and a weak deep pulse indicating an interior deficiency; slow pulses are often seen in cold conditions, with a strong slow pulse indicating excess cold and a weak slow pulse indicating deficiency cold; rapid pulses are often seen in heat conditions, with a floating rapid pulse indicating exterior heat and a deep rapid pulse indicating interior heat, with a strong rapid pulse indicating excess heat and a weak rapid pulse indicating deficiency heat. Additionally, children may also exhibit slippery, knotted, or intermittent pulses, which can occur in congenital heart disease or acute myocarditis, although these types of pulses are relatively rare.End

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