JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984

AN INTRODUCTION TO PULSE DIAGNOSIS
By Julian Scott
Pulse diagnosis comes under the heading of the fourth method of diagnosis "to feel"; and as such, it is generally regarded as the least important method of diagnosis; "To see, to hear, to ask" being considered superior. This is not to say that, as a method, it is unimportant. Far from it; a practitioner would be neglecting his duty if he did not take the pulse; but it suffers from some shortcomings which will be discussed. There is much confusion concerning pulse diagnosis, and it is hoped that this article will clear away some misunderstandings and go some way towards reconciling points of view which may appear to be opposed, but which are in fact complementary. HISTORICAL INTRODUCTION The legendary doctor Bian Que who lived during the Warring States period is accorded the distinction of being the first to use pulse diagnosis in the "Records of the Historian" by Su-Ma-Qian. The earliest extant descriptions of pulse taking are in the Nei Jing, which was also compiled in the Warring States period, but it almost certainly includes material from traditions that go back much further, possibly even prior to Bian Que. The other early text is the Nan Jing "The Classic of Difficult Questions" which has some chapters concerning pulse diagnosis. Both the Nei Jing and the Nan Jing emphasise the overall quality of the pulse, although in the Nei Jing there is a brief reference to the three different positions on the radial artery, relating them to the internal organs, much as they are used today. The Nei Jing also mentioned a different system of pulse taking, according to nine different positions on the body, relating them to "Heaven, Earth and Man". This may be a survival of a system of analysis by subdivision into three parts, which was superseded in the Warring States period by the subdivision into two parts characteristic of Yin-Yang. This subdivision into three parts actually survives in Chinese medicine today in the San Jiao or "Three burning spaces", but nowhere else. The positions where the pulse should be taken to find out the relative strengths of Heaven, Earth and Man are as follows: HEAVEN Heaven Earth Man Heaven Earth Man Heaven Earth Man Both sides of forehead, near Taiyang (Extra) point Both sides of cheek at Daying ST-5 In front of ears near Xiaguan ST-7 On the radial artery at Jingqu LU-8 On the hand at Hegu L.I.-4 On the ulnar artery at Shenrnen HE-7 On the leg at Wuli LIV-10 On the leg at Taixi KID-3 On the leg at Jimen SP- 11

EARTH

MAN

There is no further reference to this system in the Nan Jing, so it might be thought that as a system it had died out, having been superseded by the system of taking the pulse at

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JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984

the radial artery (known also as Cun Kou). However, the famous doctor Zhang ZhongJing writing in the 2nd Century AD referred to a system where the pulse was taken at the radial artery, the carotid artery (at Renying, ST-9 point) and the leg artery (at Fuyang BL-59 point) and criticised those who took little notice of the pulse at these last two regions. He felt that misunderstandings would occur if these positions were not used. This view is still held today, in that if no pulse at all can be felt at all three positions, in a patient who suddenly falls unconscious, then the prognosis is poor. Pulse qualities through the ages Some modern texts refer to "the 27 pulse qualities" while other texts refer to 28. If we look back through the ages, we find that different texts have widely different numbers of pulse qualities. The reason for this is not that there is any real disagreement as to the meaning of different pulse qualities but that certain combinations of pulse qualities were sufficiently important to be given a separate name. The number of pulse qualities mentioned in different texts is given in the table below. TEXT Nei Jing Shang Han Lun Mai Jing Hua Sou Li Shi Zhen Zhang Lu PERIOD Warring States, Before 300 BC Later Han, About 150 AD About 250 AD Yuan, 12th Century Ming 1576 Qing NUMBER OF PULSE QUALITIES MENTIONED 21 23 24 30 27 32

Pulse position through the ages Of greatest interest is how to take the pulse at Cun Kou, the radial artery. Over the centuries different writers have ascribed different meanings to the three different positions on each wrist. In the first table we give a selection of interpretations of pulse positions, starting with the Nei Jing, and ending with Dr. J.F. Shen who is currently practising in New York. Two versions appear in bolder type than the others, because these two are commonly used throughout China and the Chinese speaking world. A superficial glance shows that there are many different interpretations, and it may at first be thought that there is genuine disagreement. As we proceed through this article, we shall find that the areas of disagreement are small and are much less than the areas of agreement. It is a tribute to the accuracy of pulse diagnosis that, over the length and breadth of China, and stretching back over 2' thousand years, there is so much agreement. Viewed in this perspective, we can admit that it would be surprising if some of the hundreds of thousands of doctors who have used this method did not have some contribution to make or have some different emphasis. In the table below there is a feature which is somewhat glossed over, and this is the question of where one should look if there is more than one organ at a position. The Nei Jing states that organs are to be found in the "Lateral or Outer" (Wad) position while the parts of the body are

3 2

LEFT Medial/Inner Shanzhong Diaphragm Abdomen HE LIV KID HE LIV KID Yin HE LIV KID HE LIV KID HE LIV KID HE LIV KID RIGHT Medial/Inner Lateral/Outer Chest ST Abdomen LU SP KID LU SP KID Yang LU SP KID LU SP KID LU SP KID LU SP LU SP KID L. Shanzhong GB/Diaphragm BL/L.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 to be found at the "Medial or Inner" (Nei) position.I.I. and both organs can be found both at the superficial level and deep level. Shangzhong ST SJ/S.I. and in the Bin Hu Mai Xue by Li Shi-Zhen it is expressly stated that the two organs are to be found at the same place. As we proceed through the text./Mingmen Chest ST L.I. This example is followed by later texts. BOOK Lateral/Outer Nei Jing Cun Gua n Chi Cun Gua n Chi Cun Gua n Chi Cun Gua n Chi Cun Gua n Chi Cun Gua n Chi Cun Gua n Chi Cun Gua n Chi HE LIV KID S. There is no reference to superficial or deep levels.I. There is of course discussion as to whether this really means medial and lateral or whether it means deep and superficial. but by the Ming dynasty this interpretation was rejected.theories which had previously been separate.I./BL 4 3 .I. Bin hu Mai (1576) by Li Shi Zhen Jing Yue by Zhang Jing Yao (1561-1639) 1792 Yi Zhong The Essentials of Chinese Acupuncture 1964 Dr Shen 1981 HE Diaphragm LIV/GB L./KID/Uterus KID Left-LU-Right Diaphragm Oesophagus SP/ST Duodenum S.I.D. we find that this is the natural outcome of combining the theory of pulse positions with the theory of pulse qualities . GB BL Pericardium GB SI/BL Pericardium GB BL/L.I. GB BL S.I.I. ST Mingmen L. Nan Jing Mai Jing “The Pulse Classic” by Wang Shuo he 210-285 A. So for example it is stated that the Guan position on the left relates to the LIV and incorporates the GB. ST SJ/BL Chest ST L.

This is very important. in asking diagnosis.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 INTRODUCTION TO THE PRACTICE OF PULSE TAKING A) SOME GENERALITIES 1. Weakness of pulse diagnosis The weakness of pulse diagnosis is that there are many factors which can influence the pulse and the practitioner has the task of making allowance for these factors. but often it is not clearly understood. In fact it can be put even more strongly . To this extent taking the pulse is subjective. the pulse is affected by a patient's emotions. the pulse may already be affected. Strengths of pulse diagnosis The main strength of pulse diagnosis is that it can be used on all types of patient. If a patient arrives in a state of high emotion from some recent event. and last. on the other hand emotion is often closely related to disease and quick changes in emotion can often be detected on the pulse. The main influencing factors are: a) State of heart and blood vessels The pulse is due to blood circulating in the blood vessels and pumped by the heart. In looking diagnosis. there is much variation in pigmentation between different races. When disease is still so slight that the patient is unaware of it. who brings his own frame of reference with him. method of diagnosis. Having carried out the three other methods of diagnosis. there will be an overall alteration to the pulse.do not take the pulse unless you know what to expect. there is some subjectivity on the part of the patient as to the relative strength of pain etc. there should be a clear idea of the condition of the patient. By contrast. and give a false indication of the state of disease. 2. If these are affected in any way. Another strength of pulse diagnosis is an extension of this first: pulse diganosis can predict disease before it occurs. So an injury to a limb or even arthritis from Bi syndrome will not show on the pulse. and so there should be a very clear idea of what pulse to expect. the pulse will show this. unless a related organ is also affected. with special reference to the internal organs. Only if it is known what pulse to expect can it be said with certainty whether the pulse and symptoms agree or not. Thus if there is some problem in the channels (meridians) this will not show on the pulse unless the related organ is also affected. then the prognosis is very poor. As an 54 . The purpose of taking the pulse The purpose of taking the pulse is to find the condition of the interior of the body. The third strength of pulse diagnosis is also a weakness. 3. diagnosis by feeling is the fourth. pulse diagnosis is carried out by the practitioner. As mentioned above. It is said that if there is a discrepancy between the pulse and the symptoms in acute disease.

there are two ways in which the arteries are commonly affected hardening of the arteries. The former will give a hard and wiry pulse throughout. As for diet. d) Emotions Emotions affect the pulse immediately. they do not necessarily reflect the current condition of the internal organs. whether they are male or female. while in hot weather (or central heating) the pulse will normally be superficial and rapid. while the latter will give a large and hollow pulse throughout. b) Qi of lung and stomach. The pulse may be a valuable indicator of emotions. exercise and diet The general level of the pulse is related to the general level of Qi in the body. So if a patient has recently taken vigorous exercise the pulse will be more rapid. while prolonged hunger leads to a weak pulse. If an athlete suffers from a fever. Manual workers have large and forceful pulses. but rather tell something about the history of the patient. but sometimes recent emotions are not related to longer term disease. If one beat is dropped after only 40 beats. but more especially to that of the LU and ST. c) Qi of the 5 Zang It is said that if the pulse beats 50 times without any dropped beats. As another example. While these pulses certainly reflect something about the body's condition. but may nevertheless be slower than 76 beats per minute. e) Weather and seasonal variations In cold weather the pulse will normally be deep and slow. then one Zang is affected. the Qi of the 5 Zang is flourishing. Thus overjoy or excessive anger can affect the pulse. According to Li Shi Zhen the following seasonal variations of pulse are normal: In Spring the pulse should be wiry In Summer the pulse should be overflowing In Autumn the pulse should be fine like a hair 65 . Thus it is said that no pulse is properly examined unless at least 50 consecutive beats are taken. the pulse of mental workers is relatively weak and slow. after a meal the pulse will be large and forceful. alcohol will increase the speed of pulse. By contrast. and often the pulse on the right side is larger with right handed workers. if one beat is dropped after thirty beats two Zang are affected. and enlargement of the arteries due to too much exercise when young. his pulse will be more rapid than his normal rate.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 example we may take the slow heart beat characteristic of an athlete.

and is generally thought to give a truer reading. these variations are not as pronounced as in China. On the other hand a valid reading will not be obtained at the end of a gruelling day's work. then the pulse is taken with the patient laying down. emotional condition. weather etc. It is the position adopted in China whenever possible. The fingers should be at right angles to the direction of the artery. so that a reliable recording can be obtained. The preparation for the patient is to give the patient time to settle down and relax so that the pulse truly reflects the state of the internal organs. Clearly it is not practical to carry out pulse diagnosis only in the first hours of the day. This gives reliable readings. and does not relate to the conditions of the past few hours. 76 . to look. (The descriptions of seasonal changes in the Nei Jing are slightly different. to hear and to ask. It is this factor which leads to the recommendation in the Nei Jing that the pulse should be taken at dawn. then the doctor will only use one hand for diagnosis. the wrist should be at the level of the heart when taking the pulse. In some cases the diagnosis will be so clear from these steps that pulse taking is unnecessary. Position Li Shi-Zhen says "At the beginning of a diagnosis. and all three fingers should lightly rest on the pulse at the same time. The most important thing is to be comfortable while taking the pulse. should already have a clear idea of what the pulse should be before he takes it. In principle. In the UK with its relatively mild seasons. let the patient extend his arm placing his palm upwards and relaxing it". If the patient is not well enought to sit up. both to prepare the practitioner and to prepare the patient. With the patient's hands outstretched on the table. Thus if the patient is sitting to one side of the doctor.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 In Winter the pulse should be deep and strong like a stone. secondly with the patient laying down. The practitioner must first of all be calm. but more important. which has a more extreme climate. Guan and Chi positions respectively. and in fact may even be misleading. the index. Some doctors advise taking the patient's right pulse with the doctor's right hand. However all the Chinese doctors I have spoken to stress that this is not essential. middle and ring fingers are placed on the Cun.) ______________________________________________________________________________ B) HOW TO TAKE THE PULSE 1. Preparation Some preparation is needed before taking the pulse. 2. with the hand on the table on a pillow. The former position is the most convenient. He should have already carried out the three other forms of diagnosis. The other preparation that the practitioner should make is to try and determine how much allowance should be made for external factors such as hurry. There are two common ways in which this is obtained firstly with the patient sitting up.

most of the functions of the body are related to the Zang rather than the Fu. the distance between the Cun and Chi positions is about one Cun of the patient. the middle part and the lower part of the body. Blood and Jing respectively. then a clear understanding of the pulse can be reached. The pulse relates to the three jiao i. At this stage it must again be emphasised that the pulse does not relate to the channels (meridians). should Ll ShiZhen's method be used or that of the Nei Jing. If these factors are borne in mind. there will also be dysfunction of the LIV. but now we give important rules to bear in mind when taking the pulse. the reader may justifiably feel confused and wonder whether there is any purpose at all in taking the pulse. In practice the styloid process lies in between the Guan and Cun positions. having more points and being longer. So for example the functions of the LIV are to store blood. The superficial. middle and deep levels relate to Qi. 8 7 . Some of these attributions may seen arbitrary and at variance with other systems of medicine. dominate the tendons and open into the eye. It marks the Guan position. or a mixture of the two. Chinese medicine is a coherent and logical system.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 3. In front of the Guan position is the Cun position. which belongs to Yang and behind the Guan position is the Chi position which belongs to Yin". why does the middle pulse on the left hand side relate more to the LIV than the GB? The reason is that as far as internal medicine is concerned. 2. As a measure of scale. Zang rather than Fu Why does the pulse represent the Zang rather than Fu e.g. 1. WHAT THE PULSE POSITIONS MEAN Referring back to the pulse positions through the ages. even when there is real dysfunction of the GB. provided that the meaning of the terminology is clearly understood. as far as the internal workings of the body are concerned. However. The transplanting of Western ideas of the working of the organs into Chinese medicine is about as successful and fruitful as transplanting the organs themselves. In the next section we will give a reconciliation of the different points of view.e. Where to take the pulse There is little point in changing the words of Li Shi-Zhen "Behind the wrist there is a high bone (the styloid process of the radius). and if so. So although in many ways the GB channel is more important than that of the LIV. and are more likely to go wrong. the upper part. 1. it is to the LIV that the important functions of the body are ascribed. while the function of the GB is merely to store bile and to assist in the function of digestion. The pulse relates to the Zang rather than the Fu. 3. The functions of the LIV are more important and far-reaching than those of the GB. but it has to be accepted that this is the way Chinese medicine has been written. ensure free flowing of Qi.

However. Indeed there really is conflict here. The middle part of the body refers to the area between the diaphragm and the navel. but the Qi and Jing have not had time to be affected. It is anticipating the later sections. Qi being Yang relates to the superficial level.7 "The Origin of Qi and Blood. Correspondingly the pulse is superficial. How can one tell whether the pulse relates to the Zang or to the Jiao? The answer is that often it is not possible to tell merely by taking the pulse. More commonly. Strictly speaking. but some examples will illustrate these principles. which means that there is some strength at the superficial level and some strength at the deep level but that the intermediate level is weak. and this will reflect in the pulse in the corresponding position on both sides being full or empty. The left hand pulse relates to the left hand side of the body and the right hand pulse to the right side. These descriptions appear to be in conflict with the earlier definition that the pulse positions relate to the Zang. and reference would have to be made to other forms of diagnosis.M. The upper part of the body refers to the chest and the area above the diaphragm. So we see 98 . as is the deep pulse. If the middle Jiao is full (a common occurrence) then both the middle pulses will be full. it is well to introduce the idea at an early stage as it helps to clarify many points. Thus if the distal pulses are both empty. Superficial Intermediate and Deep levels To a certain extent this rule anticipates a later section where we discuss the qualities of pulses.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 2.C. Qi is relatively yang and flows externally and performs work functions. The three jiao The distal pulse (Cun) relates to the upper part of the body. No. but that there is nothing wrong with the organs. Blood and Jing are the three main forms of energy in the body. it is common for both the distal pulses to be empty. because the pulse at the different positions can relate either to the Zang or to the three Jiao. and other factors will have to be taken into account. When there is attack of pathogenic energy such as wind-cold (as commonly seen in influenza). This pulse is hollow. As another example we can take the pulse which appears when there has been excessive bleeding in the body. The Qi. Immediately after bleeding there is less blood in the body. the left hand distal pulse may be a little tight. or it may mean that there is relatively little energy in the upper part of the body. the intermediate pulse (Guan) relates to the middle part of the body and the proximal pulse (Chi) relates to the lower part of the body.) Blood is intermediate between Qi and Jing. 3. So if the upper Jiao is empty. a superficial pulse is a clearly defined pulse quality. A definite distinction cannot be made on the basis of the pulse alone. So if there is an injury to left side in the chest area resulting in stagnation of Qi. Jing being Yin relates to the deep level. having both a cooling function and an active function. and the lower part of the body refers to the area below the navel. Blood being intermediate relates to the intermediate level. the energy in one Jiao is full or empty. it may mean that both the HE and LU are injured and weak. Jing (often translated as "essence") is relatively Yin and is the embodiment of the Yin functions of the organs. the body's energy goes up to the superficial level in order to fight the pathogenic energy. (See J.

usually prefer the system of Wang and look for afflictions in the intestine channel in the Cun position. or should one expect the Chi positions to relate to the intestines because the intestine organs are in the lower Jiao? The solution adopted usually depends on the practitioner. because there is a real problem where to look for the intestine pulses. It will be seen on comparing these pulse systems that the most important discrepancy concerns the placing of the pulse relating to the intestines. namely those of Wang Shuo-He as given in the Mai Jing (pulse classic) and those of Li Shi Zhen as given in Bin Hu Mai Xue. with the ST also at the Guan position. It will be seen at a glance that the position of the Zang. which causes confusion among generation after generation of students. Reconciliation of different interpretations We can proceed now to the difficult task of reconciling the apparently differing pronouncements of famous doctors. while the channels are empty as they are in the upper part. So we see that the HE. so we see that there is really an enormous measure of agreement between writers over the ages. In nearly all cases it will be seen that if there is a difference of opinion.e. Should one expect the Cun pulse to relate to the intestines because the corresponding channels are in the upper Jiao. namely that the intestine organs. usually adopt the 10 9 . the Fu. (An example illustrating this will be given later on. First of all we discuss the question of superficial and deep. the LIV and the KID appear at the Cun. We mentioned earlier that the Zang were more important than the Fu in that they had many more functions. Guan and Chi positions on the left hand side. such as when the upper part of the body is empty. Acupuncturists. it either reflects a difference of emphasis. There are other systems in use but they are usually variations or combinations of these two. We chose these two systems to compare because both are in common use at the present time. while the related channels are in the upper part of the body. This can give rise to all sorts of confusing situations. and that any differences are relatively small.Intestines and San Jiao The two systems which we compare in most detail are those shown in large boxes in the diagram. Pulse positions .JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 that the intermediate pulse which relates to blood is relatively empty. but the lower part is full. In this case we can have the intestine organs being full. the pulse positions that are common to all writers. and that the LIV and SP appear on the Cun and Guan on the right hand side.the organs First of all we would draw the reader's attention to the pulse positions that have remained the same through the ages i. whose stock-in-trade is manipulating the channels. or else it relates to a real ambiguity in the information that the pulse supplies. while the superficial and deep pulses. are in the lower part of the body. relating to Qi and Jing are unaffected.) So the two systems give different positions. as they are in the lower part. Pulse position . In my view this reflects a real problem in the body. Herbalists. and that of the ST are nearly the same in all writers. whose potions go directly to the internal organs.

Their main task is to transport the food in various stages of decomposition and to expel the dregs. Again there is no direct way that this can be told from the pulse.e. and so the pulse is superficial. However. insists that the pulses of the organs to be found at one position are at the same depth.if external cold attacks the BL. to insist that one system is correct. for problems in the LU organ can be distinguished at a glance from problems in the L. There is a third view which is held by the Vietnamese school (as represented by N. especially in the Cun position on the right hand. if the patient is also very weak and lacking in KlD-Jing. this is by no means always the case. while the deep part of the pulse. will tend to relate to the Zang. or S. the deep pulse will be empty. or to the L. (usual translation "outer") for the position of the Zang. sore throat etc. channel. The question that remains is whether it is right to regard the superficial part of the pulse as relating to the Fu and the deep as relating to the Zang. However. while the other is wrong. will tend to relate to the Fu. Thus if there is long term constipation giving a fullness in the L. In this case. By contrast. since it relates to Qi. Both these points of view are current in Chinese Medicine to this day. Thus he says that the middle pulse on the right hand side relates to the SP and incorporates the ST..l. The pulse in the lower left Chi position will be superficial. is bigotry. Some writers put them on one side. and other systems of diagnosis have to be used. the BL and Ming Men. Van Nghi) that the superficial pulse relates to the Zang. One can take as example the syndrome of Wind-Heat attacks the LU. This raises again the question of how to tell whether a full pulse in the Cun position relates to the LU or HE organs. On the other hand. this fullness may show on either side. exactly the opposite of the system in the Mai Jing. since it relates to Jing.l.l. This is a superficial syndrome and affects the Qi. This point of view has the support of the Nei Jing.l. while the Zang are at the deep level. Here the discrepancy represents a genuine ambiguity in the body. while the deep pulse relates to the Fu i. However the mainstream of Chinese Medicine seems quietly to ignore this uncomfortable statement in the oldest of books. there is no possibility of ascribing the superficial pulse to the L. and some on the other. while a problem of Jing soon shows as a problem in the Zang. while performing some separation. Similarly an attack of 11 10 . the function of the Zang is to store Jing.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 system of Li. Left and Right The main problems which occur here are where to place the intestines. we can take affections of the lower part . which uses the character Wai. Superficial and deep The Mai Jing seems to indicate that the pulses of the Fu are to be found at the superficial level. The symptoms are clearly LU symptoms with severe cough. So we see already that the superficial part of the pulse. and we should do so also. In my view it is unwise to grant uncritical acceptance of a model which is just a little too elegant.l. Usually there is no confusion. channels. One can find many examples of pathological conditions where a problem of Qi soon shows as a problem in the Fu. Now most of the functions of the Fu require Qi. and maintain that disorder of the intestines appear in the Chi position. As an example. If we return to the rules stated earlier we see that the superficial relates to Qi and the deep relates to Jing. Li Shi-Zhen on the other hand. giving symptoms of cystitis etc.

and recourse should be had to other methods of diagnosis. it is called Floating pulse. 1211 . Ming Men is related to KID Yang which is traditionally placed on the right side.floating. There can be no better way of starting pulse diagnosis than with these qualities. In fact the first thing that is learnt is a simple differentiation of the basic qualities. PULSE QUALITIES In some schools in The West. This view is supported by all the texts through the ages. this is so clearly related to the function of the KID that it would be splitting hairs to look for a difference in the pulse position. In practice. starting of course with the Nei Jing. Once they are understood. We have seen that the superficial level relates to Qi and the deep to Jing. As for the position of Ming Men. due to excess of some Yin pathogenic factor (such as penetration of cold-damp) or Deep and Weak due to absence of Yang Qi. The same principle may be applied to the Deep pulse. more attention is paid to the different pulse positions. for there are usually more similarities in the pulse at different positions than there are differences. How can this situation occur? Excess at the Qi level can come when there is excess of a Yang pathogenic factor. but frequently mentions overall pulse qualities. Fast and Slow Turning to the main qualities of Fast and Slow. deep. but is based upon the four principle pulses . Normally Jing will be associated with the Yin levels of the body." So speaks Li Shi-Zhen in his pulse book. which rarely mentions pulse positions. the most refined diagnosis comes from combination of qualities and positions. even though there are some differences in each position. Hot conditions are usually classified into full heat and empty heat (Yin Xu). In practice. This can arise either due to excess at the Qi level. by elaborating them the entire subject can be clarified. if the Floating pulse is due to deficiency of Jing. Basic principles of pulse qualities "The theory of the pulse is very complicated. this will be a Weak and Floating pulse. to make a definite distinction only by examining the pulse is not possible. In my experience this approach is valid.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 damp-heat in the BL may show in a full tight pulse on either side. For example it will be immediately obvious whether the overall pulse quality is strong or weak. and differentiation according to position only comes later. especially some exterior disease. which may be Deep and Strong. By contrast. In China more attention is paid to the overall quality. Again. and some other basic qualities. The full heat will have a full and rapid pulse while the empty heat will have an empty and rapid pulse. so is the other. or due to deficiency at the Jing level. If the pulse at the superficial level is stronger than that at the deep level. slow and rapid. In this case the pulse will be Floating and Strong. the Fast pulse relates to hot conditions while the slow pulse relates to cold conditions. if one KID pulse is deficient.

Yang deficiency (xu) Excess at Qi level or deficiency at Yin level. In the hollow pulse. To be seen in interior disease due to Yin deficiency or Jing deficiency. Relates to Shi (full conditions. Slippery Relates to phlegm Rough Relates to deficiency of Qi and Blood Strong and Weak While we are discussing the basic qualities. the intermediate level (which relates to blood) is weaker than the pulse at the superficial and deep levels. It can sometimes feel like a strong pulse because at 13 12 . Relates to Xu (empty) conditions when the body is weakened by long term disease etc. one so basic that Li does not even mention it is the differentiation between the strong and weak pulse. This usually relates to obstruction of Qi in the upper part of the body.deep and weak. when the body is basically strong but has been attacked by external pathogenic factor. Floating and strong. and slower pulse on the patient's outbreath. To be seen in superficial disease (Yang excess disease) when the Wei Qi is fighting the pathogenic factor at the superficial level. Usually some internal bleeding problem.Yang Excess Empty heat is Fast and weak . We have already implied that strong relates to a Shi or full condition while weak relates to a Xu or empty condition.Yin Excess Empty cold is slow and weak . Frequently the irregularity is seen as a faster pulse on the patient's in-breath. Full heat is fast and forceful . the only exceptions are the Drumskin pulse which is superficial and weak.Yin deficiency (xu) Relates to cold conditions Full cold is slow and forecful . Floating and weak. Excess at the Yin level or deficiency at Qi level. To be seen in diseases due to deficiency of Yang energy . CLASSIFICATIONS OF MAIN PULSE QUALITIES Speed Fast Slow Depth Floating Related to hot conditions. This pulse is related to blockage of Qi in some part of the body. Relates to cold and stagnation Hollow Deep Strength Strong Weak Quality Tight Wiry Relates to LIV.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 It is appropriate at this point to mention pulses with some irregularity in rhythm. To be seen in deep disease (disease has penetrated deeply to the internal organs) deep and strong. The stagnation is more severe and amounts to obstruction. It is not difficult to recognise full and empty pulses.

or else it will be Slippery.we take as an example the first box. The Hidden pulse is opposite. We also give a few little "boxes" showing some symptoms that might be expected if that pulse quality is found at a particular position. Wiry and Rough These basic qualities refer to the feel that the pulse has under the finger. CLASSIFICATION OF MAIN PULSE QUALITIES Introduction to 27 qualities Once these basic qualities are firmly fixed in the mind. I will not attempt any further description of these pulses than is given in the table of pulse qualities . the Slippery pulse.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 the most superficial layer there appears to be strength. The Tight and the Wiry pulse are similar in nature. it means that the phlegm and heat is affecting the HE or giving rise to the symptoms given.the best way is to find a patient who has very clear signs of LIV Yang rising. It seems a large number of pulse qualities. The Rough pulse is a pulse that is irregular in amplitude and rhythm. and feel their pulse. it is time to proceed to an examination of the 27 pulse qualities given in the table. Their pulse will either be rather Soft. Slippery. Hard and Long. The Slippery pulse again is hard to describe. until this pressure is applied. and are correspondingly hard to describe. with a strong pulse at a very deep layer. These symptoms need not be memorised. Pulse qualities and their meanings English name Floating Deep Pinyin Fu Chen Other translations and description Superficial See text for description See text for description Meaning Pathogenic Wind Yin Xu Qi disease Pathogenic Qi within Qi obstructed Yang Xu Organ disease Oedema (1) 13 14 . It can be confused with a Weak pulse. with the tight pulse only slightly Wiry. The Slippery pulse relates to phlegm or heat. An explanation for the other symptoms in the boxes is left as an exercise to the reader. or extreme cases of the qualities given so far. Brief notes are given in the table by way of explanation. If it is found in the Cun position on the left hand. for it is only felt on quite strong pressure. It will be a Wiry pulse. Qualities of Tight. for they can be deduced . there is little to be felt. It is quite similar to the pulse felt in patients with hardened arteries . but it will be seen that the new qualities are either combinations of qualities given so far. but only the slightest pressure is enough to reach a layer where the pulse is very weak. and the best way to observe this is to find a patient who suffers from catarrh.though this pulse is Wiry.

long and hard a) Empty-Soft. "Like bamboo scraped with a knife".JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 Slow Fast Chi Shuo 60-70 82 = fast 96 = very fast 120 = serious (or nervous) "Like a pearl rolling in a basin" "Rough". ( 10) b) diabetes Lost Yang with Qi and Blood injured Very serious LlV-Wind Phlegm Pain Shi Cold Extreme Qi and Blood Xu (12) Qi accumulation Yin Xu KID empty Jing exhausted Marrow exhausted Yang decayed Often seen in protracted disease. Superficially taut. Irregular amplitude and/or rhythm. empty in middle. Strong at top. strong at bottom Small Wiry Wei Xian "Minute" (11) Hardly discernible "Taut". pulse becomes hollow. "Onion stalk". weak nerves (3) Phlegm Heat Pregnancy Pathogenic Qi Blood and Jing weak Qi obstructed Cold and Damp Pain Pathogenic Cold "Infection" Shi Qi rebellious and fire Wind-stroke (very long) Xu. Slow and soft movement b) Really empty Fills whole area beneath fingers (9) Slippery Choppy Hua Ce Tight Long Short Full Empty Jiu Chang Duan Shi(7) Xu (8) Overflowing Hollow Kou "Scallion". (see text) Cold within Yang Xu HE injured by exercise (2) Heat Yang abundant Yin Xu Qi or Blood Xu Shock. wiry. soft on pressure. "Bow-string". the prognosis is poor Hollow + Weak = loss of blood Hollow + Strong = about to bleed Hollow + Soft = Qi stagnant Hollow and Strong in whole pulse = a) high blood pressure. if deep is selected. especially of Yuan Qi Shi condition Blood Xu Summer Heat Jing Xu and cold pathogenic Qi: dangerous Pathogenic Wind. See text Long. undiscernible 14 15 . (4) Like a rope with one end fastened and the other going round. hard "Weak Floating". especially Wind-Heat Blood Xu (if weak) Deficiency of fluids If after long disease. not dangerous KlD-Qi destroyed: always a sign of danger Drumskin Hard Soft Ge Lao Ruan (13) Ruo San "Leather". Floating and big. Cotton floating on water Weak Scattered Thin or fine and soft If middle depth is selected. (5) Like a pencil (6) Only appears in middle of doctor's finger Full.

often with Yang symptoms Damp Debility Disease has penetrated to zang Wind-Cold on exterior. It is normally related4. (3) Fast The patient's pulse is often faster the first time they come for treatment.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 Thin Xi "Fine" "Thready" Hidden Big Unsteady Fu Da Dong Hidden or sunken beneath muscle. as they do not know what to expect. (2) Slow In Western medicine a normally slow heart beat is often regarded as beneficial to health. Deeper than Deep pulse "Broad". When the pulse is tight at the middle depth only. minute and short with irregular rhythm. Twice as broad as overflowing pulse but not so full and large Rapid. (5) Tight The tight pulse is slightly wiry. The wiry pulse relates to LlV-type obstruction. Fluctuates between light and heavy. In the tight pulse we see obstruction manifested in pain. shaking. Choppy to Qi obstructed or Yang Xu. It is a Xu pulse and is associated both with deficiency of Qi and blood and also with obstruction. pathogenic cold on interior Internal pathogenic heat Yang Ming fever developing Pain Fright. slippery. Hasty Knotted Irregular Cu Jie Dai Halting at times Fast and interrupted Slow and interrupted Stops after set number Decayed Qi Yin Xu . deep fear Qi and Blood wild Sweating in Yang Ming fever (15) In healthy person. accumulation Congealed cold Zang injured HE nerve troubled If stops after 2 or 4 . In a very long pulse. In this case the obstruction occurs because there is not enough energy to move the obstruction . the tight pulse is associated with "infections" in the Western sense of the word. According to Dr. (4) Choppy Also described as small. overwork before puberty Fire Obstruction of Qi Obstruction. (6) Long The long pulse refers to the length under the finger in the direction of the artery.dangerous (1) Deep "Oedema" is my addition. near bone. or due to cold. it seems rather that there is a pencil being moved up and down in the 16 15 .in contrast to the LIV sort where the obstruction is withstanding enormous pressure. This may lead to tiredness and lethargy in later life. In Chinese medicine it may be regarded as a sign that the heart has been enlarged by too much exercise when young. it may mean heat in the blood. Shen.

as opposed to blood pressure that raises at times of high emotion. for this pulse relates to a full condition after a long disease. The scattered quality will go when the patient stops taking the medicines for a while. (10) Hollow "True high blood pressure" relates to high blood pressure that is continuous.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 artery. as they suddenly relax. the pulse can only be felt in the middle of the finger. where the length in the direction of the artery is small i. Article to appear. (15) Unsteady "Yang Ming fever" relates to differentiation of syndromes according to the 6 Jiao. (7) Full The character Shi is the same as Shi for excess or full condition. Quality Slippery Position Cun Guan Chi Left side Heat in HE Vomiting LIV-Heat Dizziness Frequent bloody cloudy Right side Catarrh Vomiting Middle Jiao Stuck: Heat Gurgling intestines 16 17 . (13) The character also means soggy. This is an example of the pulse and the symptoms going the opposite way. (8) Empty The character Xu is the same as Xu for deficient or empty condition. the short pulse indicates a delicate constitution. Not such a serious pulse when the poisoning can be directly related to taking Western medicines.living on their nerves. (9) Overflowing The overflowing pulse spreads out sideways from the artery like a river that is bursting its banks. but screw themselves up to carry out their daily work . This pulse can also appear when there is internal damp. (14) Scattered A dangerous pulse when it appears from natural causes. (12) Drumskin This pulse sometimes appears in patients who are extremely weak inside. In this case it is soft but not weak. They are very likely to suffer from needle shock. the long pulse indicates a strong constitution. In a healthy person. but then falls again. Often related to some internal poisoning. (11) Small This pulse is extremely small. It contrasts with the short pulse.e. In a healthy person. often a sign of cancer. The prognosis is poor if this pulse appears after a prolonged disease.

JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 Choppy Cun Guan Chi urine Palpitations Pain in HE LlV-Blood Xu Knee and back pains Head hot Heart pain Epigastrium full and painful Back and sides painful Pain under umbilicus Overfull HE Hardened arteries True high blood pressure LIV swollen by anger + Hollow: diabetes Prostate trouble Heart pains Lumps LIV dispersing power gone Back and leg pains Hernia Empty KID Easily forgets Cramps Jing/Blood wasted Palpitations Swellings Yin exhaustion KID fire rises tinnitus Weak cough LU-Qi weak SP weak No appitite KID Fire weak or injured “Cold” Asthma Hypogastrium painful Hernia Cold accumulation Full LU Water in LU ST swollen by working after meals Headaches Chest and rib pains Cold and Full Pains in abdomen Abdominal pains Dysentery Qi weak sweating SP weak Tight Cun Guan Chi Overflowing Cun Guan Chi Wiry Cun Guan Chi (12) Soft Cun Guan Chi Scattered Cun Guan Chi Sweats Yang exhaustion Summary of the qualities After studying the qualities in the table. we find that we can analyse them according to the main qualities of depth and quality and strength. and arrange them in the following way: 18 17 .

2. was brought to me by his mother. and tongue diagnosis. In the absence of a clear symptom picture. and then about the individual positions. if the left pulse at the Chi position is more slippery and rapid then the child will be a boy. Fast or slow? 2. Strong or weak? 4. slippery. Some case histories 1. It is not always correct but is often a helpful indication". 6 years old. you have made the basic diagnosis. The pulse was slightly Slippery and Small in all positions except the right Guan position which was Full and Slippery. firstly about the overall pulse. 18 19 . and he complained of an ache in the region of the stomach.P. In order to develop this facility. It is said that if the pulse becomes slippery in pregnancy. Master B. In this case the patient was very shy and refused to put out his tongue for inspection.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 TAUT SOFT Strong Tight Wiry Flooding SUPERFICIAL Weak leather Full Scattered Soft minute Strong Firm hidden DEEP Weak thin weak The pulse and pregnancy The pulse may change in pregnancy. this is not a pathological sign. According to Li Shi-Zhen. However he qualifies it saying "This idea is ancient. When first taking the pulse. Do not be too rigid in sticking to one system of diagnosis. the pulse gave the most reliable information. As far as pulse positions are concerned. The G. sometimes it is not. if the right pulse at the Chi position is more slippery and rapid then the child will be a girl. and that some of the Fu or hollow organs can appear at different places. it is not possible to remember the 27 qualities and have them available for instant access. had said not to worry. remember that the positions relate primarily to Zang or solid organs and the three Jiao. Superficial or deep? 3. ask the following questions. His stools were more or less normal. 1. ______________________________________________________________________________ Concluding remarks 1. Wiry. but she was nevertheless concerned. Sometimes it is a pathological sign. who said that he had been listless. rough? In answering the questions. pale and eating very little.

The Qi is 19 20 . from the obstruction of Qi in the L. it was found to be slightly Rapid. He enjoyed playing all sorts of sports. Mr. On examining the pulse. organ. I asked her if she had a tight feeling in the chest. between the Guan and Cun. it pointed to some obstruction of Qi in the L. The obstruction of Qi in the L. the symptoms of the arm are all empty conditions and result from the channel not being nourished by the organ. After some questioning it appeared that he had been kicked in the abdomen in a football match some years previously. Since the main symptom he complained of was along the L. N. Both Chi pulses were very Small and Soft and Deep. 48 years old had a recurring condition of cystitis. the left Chi pulse was still very Small but Tight and superficial. as a result of treatment.l. 3. 2. On taking his pulse I found that both the Cun positions were Empty. This illustrates that the pulse can change extremely rapidly if the condition of the organs change. She answered that she had had this tight feeling since losing her temper a week previously. The pain occurred along the L. The Tight quality appearing on both sides suggested obstruction of Qi somewhere in the chest region. and Tight on both sides. on his tongue and from his nose. 28 years old suffered from epilepsy. The pulse however was almost unchanged. characteristic of heat and dampness. 26 years old complained of lethargy.I. As a result of an extended course of treatment. Miss S. B. Mr. This showed that although his symptoms were much improved the basic condition of the organs was still the same. His pulse was slightly Rapid. his abdomen became so much Jess distended that he had to buy new trousers. for the Right Cun pulse relates to the L. so that any disorder in the Chi pulse would not relate to the KID. he vomited phlegm over my trousers. but as treatment progressed these muscles relaxed and it was possible to feel the knot deep down. This case is specially interesting. Mrs. which would have had a Tight quality on one side only). and the superficial and tight quality related to the attack of cold.e. R. After this performance the pulses were less Slippery and much better balanced i. channel. (Not in an organ. Once glance at his physique showed that his condition was good. his nose cleared. when. 4. For many years she had contracted cystitis every two or three months that had necessitated the use of antibiotics. His abdomen was swollen and his body covered with hair. but found he could not do so because his shoulder became so painful the day after using it. the right Guan pulse was nearly normal.I. but must relate to the Fu. 23 years old complained of a painful shoulder. but had thought nothing of it.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 From this I deduced that the patient's condition was retention of phlegm in the ST. and Soft (soggy). indicating that she had very weak KID energy.I. This diagnosis was confirmed in a dramatic way a few moments later. Consequently the right Chi pulse is too Full. organ. 5. During the time that she had cystitis. Thus in her case the left Chi pulse related to the bladder.I. Full and Wiry in the left Guan. and the excess body hair disappeared. channel.I.I. His abdominal muscles were completely tense and knotted. and that he could easily revert to the condition he was in before. He had much evidence of sputum. He had tried physiotherapy and other manipulative techniques but with no lasting results. and the right Chi position Full and a little Tight. The Wiry and Rapid left Guan pulse indicates LlV-Yang rising. organ is a full condition in the Lower Jiao. channel and the right Chi pulse relates to the L.

and their meaning when they appear in different positions see "The Web that has no Weaver" by Ted J. As a result. There are a number of texts available in English which will help in further study. (Also available from Felicity Moir. The principles have been elaborated and worked out in the 27 qualities.JOURNAL OF CHINESE MEDICINE NUMBER 14 JANUARY 1984 obstructed in the organ and is unable to reach the channel. Cost £19. Box 202-K. the Cun pulse is weak. N.Y.F. 17a Kensington Park Gardens. NSW Australia.O. This book also contains useful diagrams illustrating the pulse qualities. The text of Li Shi Zhen's Bin Hu Mai Xue is now available in a translation by Hoc Ku Huynh of P. Further reading This article is merely an introduction to pulse diagnosis. J.00) For a description of pulse qualities. 2120 . London W. but to diagnose accurately from the pulse requires much experience. The basis is very simple. Shen published by Educational Solutions Inc.H. 10011. Haymarket. There is no particular magic or mysterious process in building up this experience. 80 Fifth Avenue.ll. Kaptchuk. beyond careful observation and thought. For an unusual approach based on years of clinical experience see "Chinese Medicine" by Dr.. New York.

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