Pulse Diagnosis: Basic Knowledge and its Application in Diagnosis

Pulse diagnosis is one of the important diagnostic methods in traditional Chinese medicine. By palpating the pulse, the physician can identify the patient’s health condition through the distinctive characteristics of the pulse beat.

I. Concept of Pulse Diagnosis:

Pulse diagnosis is a diagnostic method based on palpating the pulse to identify changes in the rhythm, force, form, and feeling of the pulse beat.

II. Main Pulse Types:

1. Floating Pulse:

• Characteristics: The pulse is superficial, felt with light pressure, and weakens with deep pressure but does not disappear entirely.

• Indication: Superficial conditions, diseases of the surface of the body.

• Analysis:

• Strong: Superficial fullness – evil Qi invades the superficial level, Qi and blood are full, vital Qi is strong.

• Weak: Superficial deficiency – vital Qi is weak, Qi and blood are insufficient, evil Qi invades, causing diseases such as cold, wind-cold, and damp-heat.

• Disease Location: Meridians and muscles, evil Qi invades the superficial level, the defensive Qi and evil Qi clash, causing the pulse to be superficial.

2. Deep Pulse:

• Characteristics: The pulse is deep, not felt with light pressure, and can only be felt with deep pressure.

• Indication: Internal conditions, diseases of the internal organs.

• Analysis:

• Strong: Internal fullness – evil Qi invades the internal organs, Qi and blood are full, vital Qi is strong.

• Weak: Internal deficiency – internal organs are weak, Qi and blood are insufficient, evil Qi invades causing diseases such as spleen deficiency, kidney deficiency, and liver stagnation.

• Disease Location: Internal organs are affected, evil Qi is trapped internally, vital Qi fights against evil Qi internally. If internal organs are weak, Qi and blood are insufficient -> weak.

3. Slow Pulse:

• Characteristics: The pulse is slow, 3 beats per breath (below 60 beats per minute).

• Indication: Cold conditions, diseases caused by cold evil.

• Analysis:

• Strong: Cold stagnation – cold evil invades internally, Qi and blood are full, vital Qi is strong.

• Weak: Deficiency cold – yang Qi is deficient, cold evil invades internally, Qi and blood are insufficient.

• Disease Location: Cold evil restricts Qi function, Qi and blood circulation is slow, strong indicates cold invasion internally, weak indicates yang deficiency leading to external cold. Damp-heat or accumulated heat block the circulation of blood.

4. Rapid Pulse:

• Characteristics: The pulse is rapid, 5 beats per breath or more (above 90 beats per minute).

• Indication: Heat conditions, diseases caused by heat evil.

• Analysis:

• Strong: Real heat – heat evil is strong internally, Qi and blood are full, vital Qi is strong.

• Weak: Empty heat – yin deficiency leads to internal heat, Qi and blood are insufficient.

• Disease Location: Heat evil promotes rapid blood circulation -> strong. Long-term illness leads to yin deficiency and internal heat -> weak. Empty yang leads to external swelling -> weak (empty and large weakness).

5. Empty Pulse:

• Characteristics: The pulse is weak, lacking force, and feels like emptiness when pressed.

• Indication: Empty conditions, diseases caused by Qi and blood deficiency.

• Analysis: Qi deficiency leads to weak blood circulation -> weak floating pulse, blood deficiency, both Qi and blood are deficient.

6. Full Pulse:

• Characteristics: All three pulse levels have strength, upper, middle, and lower levels are strong.

• Indication: Full conditions, diseases caused by strong evil Qi.

• Analysis: Strong evil Qi, vital Qi is not deficient, the clash between evil and vital Qi causes the pulse to be strong.

7. Active Pulse:

• Characteristics: The pulse is smooth, round, and active, like a marble rolling in a plate.

• Indication: Phlegm, food stagnation, and real heat.

• Analysis: Phlegm is abundant, food stagnation, evil Qi is flourishing, Qi is full and blood is smooth. Pregnant women -> Qi and blood are strong. Similar to the rapid pulse in that it is smooth and round.

8. Slippery Pulse:

• Characteristics: The pulse is slow, subtle, and short, the pulse arrival is very difficult, the pulse is small and short, arrives slowly, stagnates and is not smooth.

• Indication: Qi stagnation, blood stasis, essence deficiency, and blood deficiency.

• Analysis: Qi stagnation, blood stasis block the pulse channels, blood circulation is slow and blocked, if vital Qi is not deficient -> strong, if essence deficiency and blood deficiency -> weak.

9. Bound Pulse:

• Characteristics: The pulse is large, like a large wave surging, arriving strongly but gradually declining, lasting for a relatively long time before fading.

• Indication: Strong heat evil, diseases caused by strong heat evil.

• Analysis: Strong heat evil in the internal organs causes the pulse channels to expand, blood circulation is strong. If the disease is long-standing, Qi deficiency, blood loss, nine orifices can also occur, strong evil and weak vital Qi is very dangerous.

10. Thin Pulse:

• Characteristics: The pulse is small like a thread, deep and soft, weak, and lacking force.

• Indication: Both Qi and blood deficiency, diseases like consumption, yin deficiency.

• Analysis: Both Qi and blood deficiency cannot fill the meridians, Qi deficiency makes the pulse weak, blood circulation is weak, and lacking force. In addition, damp evil stagnation, fever causes coma.

11. 弦 Pulse (Tight Pulse):

• Characteristics: The pulse is straight and long, does not move when pressed, and is tense like a string of a lute.

• Indication: Liver and gallbladder, pain conditions.

• Analysis: Liver governs free flow, likes harmony and smoothness. Qi stagnation, free flow is obstructed, affecting the pulse -> tight and tense.

12. Tense Pulse:

• Characteristics: The pulse is tense and forceful like touching a twisted rope, feels tense and tight when pressed, and is larger in form than the Tight Pulse.

• Indication: Cold conditions, pain conditions.

• Analysis: When cold evil and vital Qi are intensely clashing, the pulse channel becomes tense and tight.

13. Weak Pulse:

• Characteristics: The pulse is floating and thin (soft and weak), like silk in water, felt with light pressure, only with a little force, it feels like it’s not there. Like bubbles on the surface of the water.

• Indication: Damp conditions, empty conditions.

• Analysis: Nourishing blood is deficient, the pulse channel is not full, blood deficiency and Qi floating causes this. Damp evil is trapped internally, causing yang Qi to go to the surface.

14. Large Pulse (Intermittent Pulse):

• Characteristics: The pulse beat is irregular and sometimes stops, the pulse arrival is slow and weak, and sometimes stops following a certain pattern and stops for a long time.

• Indication: Organ Qi deficiency, pain, trauma.

• Analysis: Organ Qi deficiency, Qi and blood deficiency, insufficient primordial yang causes the pulse to not beat continuously. Or pain conditions, trauma causes the pulse to not be continuous.

15. Knotted Pulse:

• Characteristics: The pulse beat is irregular and the intervals are also irregular, the pulse arrival is delayed.

• Indication: Yin is prosperous and Qi is knotted, cold phlegm and blood stasis.

• Analysis: Yin is prosperous but yang is not harmonized, causing Qi function to be blocked; Cold hinders blood circulation, Qi is knotted and blocked, pulse Qi is blocked.

16. Hurried Pulse:

• Characteristics: The pulse beat is irregular, there are intervals, the pulse arrives quickly.

• Indication: Yang heat is strong, Qi stagnation and blood stasis, phlegm and food stagnation.

• Analysis: Yang heat is strong causing imbalance between yin and yang, leading to irregular pulse, strong yang heat causes rapid pulse.

17. Scattered Pulse:

• Characteristics: The pulse is large and scattered, like pollen scattered by the wind in the air, sometimes fast, sometimes slow, no pattern.

• Indication: A woman about to give birth, if the baby is not due, it is a sign of miscarriage. If a patient is ill for a long time and suddenly has this pulse, it is critical.

III. Combining Pulse Types:

In addition to the basic pulse types above, there are combinations of pulse types for more accurate diagnosis. For example:

• Floating Tight Pulse: Superficial cold condition or wind-damp with pain.

• Floating Rapid Pulse: Superficial heat condition.

• Floating Active Pulse: Superficial condition with phlegm or indication of wind-phlegm.

• Deep Slow Pulse: Internal cold condition or spleen-stomach yang deficiency.

• Tight Tense Pulse: Cold pain condition or cold stagnation in the liver meridian.

• Tight Rapid Pulse: Liver fire, such as liver fire rising upwards.

• Tight Thin Pulse: Liver and kidney yin deficiency or blood deficiency and liver stagnation.

• Active Rapid Pulse: Indication of phlegm-heat, phlegm-fire, or internal heat with food stagnation.

• Bound Rapid Pulse: Strong heat in the Qi level, seen in external heat illness.

• Deep Tight Pulse: Liver Qi stagnation, internal damp accumulation.

• Deep Slippery Pulse: Blood stasis.

• Deep Thin Rapid Pulse: Indication of yin deficiency, blood deficiency with heat.

• Deep Full Pulse: Internal fullness such as internal heat stagnation.

IV. Notes:

• Pulse diagnosis is a complex diagnostic method that requires the physician to have professional knowledge and experience.

• The results of pulse diagnosis need to be combined with other diagnostic methods such as urine, stool, tongue, complexion, etc. to arrive at an accurate conclusion.

• Pulse diagnosis can change over time and according to the body’s conditions, so it is necessary to palpate the pulse multiple times to accurately assess the disease condition.

V. Conclusion:

Pulse diagnosis is a useful diagnostic method in traditional Chinese medicine. Understanding the types of pulses and how to analyze them, combined with other diagnostic methods, will help physicians to provide effective treatment.