TCM Diagnosis by Looking (Observation) - One of

the 4 Pillars
What is observed by the Practitioner.

Shen (Spirit)

Observing and tuning in to a patient's Shen (spirit) is particularly important to help

determine the overal state and prognosis of an imbalance. The Shen gives vital
imformation about vitality, and mental, emotional, and spiritual well being. The Shen
shows in the eyes, complexion, and state of mind.

Body (appearance)

The Five Elements can be associated with body shapes and constitutions

Wood Type
Slender and tall body shape
Fire Type
Pointed head and chin, small hands, with curly or a small amount of hair
Metal Type
Square and broad shoulders, strong body type, and a triangle shaped face
Earth Type
Large head, larger body and belly, strong legs, and a wide jaw
Water Type
Round face and body with a longer than normal torso
Long Term Body Changes

Emaciated, body, esp. with dry skin

Deficient Blood or Yin
Very large thighs
Spleen Deficiency
Great weight loss over course of long illness
Essential Qi exhausted
Overweight
Deficient Spleen Qi with tendency to Dampness or Phlegm (often with Stagnation of Qi)
Hair loss
Kidney Jing Deficiency or Blood Deficiency
 Musculoskeletal pain, soreness, numbness or heaviness with swelling and restricted
movement
Bi Syndrome (Painful Obstruction syndrome)
Gradual onset of weakness, motor impairment, and muscular atrophy of the limbs:
Wei Syndromes (flaccidity syndrome)
Short term bodily changes

Change in Muscles (e.g. flaccid, wasting)

Spleen disharmony
Change in Tendons (e.g. stiffness, weakness)
Liver disharmony
Change in Blood Vessels (hardening, producing hard pulse)
Heart disharmony
Change in skin (e.g. tone, dryness
Lung disharmony
Change in bones (e.g. brittle)
Kidney disharmony

Appearance and Demeanor

Includes posture and movement of body as a whole and of individual parts, e.g.
eyes, face, mouth, limbs, fingers.

Symptom(s) Cause or Pattern

Overweight with Mental Depression Qi Xu and Excess Damp Phlegm

Loss of Weight in Long Term Illness Exhaustion of Essential Qi

Thin with Dry Skin Blood Xu

Extended Neck Excess Lung Syndrome with Excess Phlegm

Facing Downward Qi Xu with Shortness of Breath, Dislike of Speaking

 Violent Movement of Limbs Wind Diseases, Infantile Convulsions

Weakness, Motor Impairment, and Muscular Atrophy Wei Syndromes

of Limbs

Pain, Soreness, Heaviness and Numbness in Bi Syndromes

Tendons, Bones and Muscles, with Swelling and
Restricted Movement of Joints

Numbness or Impaired Movement of Limbs on One Hemiplegia or Wind Stroke

Side of the Body

Active patient with excessive/jerky movement: Yang, Excess or Heat patterns

Passive manner or lack of movement/slow Yin, deficient, Cold

movement:

Continuous fidgeting, especially of legs: Deficient Kidney Yin

Tremors, convulsions (of whole body or localized): Interior Liver Wind

Head and Face

Hair

Hair relates to Blood or Kidney Jing.

Hair loss and premature graying of the hair may be due to Blood Deficiency or Kidney Jing
Deficiency.
Dandruff usually relates to Liver Blood or Yin Deficiency
Face

Two light and shallow lines between the eyebrows indicates a healthy Liver.
Two deep lines or three line between the eyebrows can indicate a Liver problem, such as
frequent anger
A single line can indicate a more serious Liver problem. This can occur after considerable
hardship.
 Face Color

Represents the strength of the Qi and Blood of the Zang Fu organs, and especially the
Heart.
The complexion should be moist and lustrous.

Red (Excess or Xu Heat)

Whole Face Heat from External Evil or Hyperactivity of Zang Fu

(Excess)

Cheeks, Tidal Fever, Night Sweats Internal Heat (Xu)

Pale (Cold or Loss of Blood)

Pale White Yin Excess or Yang Xu

Bright White with Puffy and Bloated Appearance Yang Qi Xu

Withered White Blood Xu

Yellow (Damp or Xu)

Body, Face, Eyes, and Skin Jaundice

Bright Orange Yang Jaundice (Damp Heat)

Smoky Dark Yin Jaundice (Cold Damp or Long Term Stagnation

Pale Yellow (Not Bright) Blood and Qi Xu

Blue (Cold, Pain, Blood Stagnation, Convulsions)

Pale with Blue Tinge and Severe Pain in the Excess Yin and Cold
Epigastrium and Abdomen

Bluish Purple Face and Lips with Intermittent Pain Stagnation of Heart Blood
Behind the Sternum or Precordial Region

Bluish Purple Face and Lips with High Fever and Infantile Convulsion
Violent Movement of Limbs in Children

Dark Gray (Blood Stagnation and Kidney Xu)

Pale and Dark with Lumbar Soreness and Cold Feet Kidney Yang Xu

Dark without Brightness with Scaly Skin Prolonged Blood Stagnation

Observation of Sense Organs

Eyes

The eyes reflect the state of the Shen and Jing. It is said, "The Jing of the five Yin
and six Yang organs ascends to the eyes." We observe the "expression" of the eyes
to see the spirit.

The Liver opens to the eyes (sense organ associated with Wood element)
Eyesight changes tend to relate to the Liver

Symptom(s) Cause or Pattern

Shining and are Clear Good vitality of Shen & Jing

Redness and Swelling Wind Heat or Liver Fire

Yellow Sclera Jaundice

Ulceration or Canthus Damp Heat

Upward, Straight Forward, or Sideways Staring Liver Wind

Dull or Clouded eyes Disturbed Shen, weakened Jing. Commonly seen i

drug users and long term emotional problems

Nystagmus Disturbance of Liver Wind

Spots in visual field: Deficiency of Liver Blood or Kidney Yin or Jing

Swelling or dark rings under eyes: Deficiency of Kidney

Nose

Symptom(s) Cause or Pattern

Tip of the Nose Relates to Spleen and Stomach

Flapping of Ala Nasi Heat in the Lungs or Qi Xu of both Lung and Kidne

Clear Discharge Wind Cold

Turbid Discharge Wind Heat

Prolonged Turbid Discharge, with Stinking Discharge Rhinitis or Chronic Sinusitis

Mouth and Lips

Color, moisture and appearance. Normal color is pale red, moist and shiny

Symptom(s) Cause or Pattern

Pale Lips Blood Xu

Bluish Purple Lips Retention of Cold or Blood Stagnation

Red and Dry Lips Excess Heat

Breathing through mouth Lung Qi Deficiency

Mouth always slightly open Deficiency

Sudden Collapse with Open Mouth Xu

Sudden Collapse with Lockjaw Excess

Greenish around mouth Liver Blood Stasis or Liver invading Spleen

Teeth and Gums

Teeth are considered an extension of bone and are influenced by Kidneys. Gums
are influenced by the Stomach.

Symptom(s) Cause or Pattern

Moist teeth Good Fluids, and healthy Kidneys

Pale Gums Blood Xu

Redness and Swelling of Gums Stomach Fire

Redness and Swelling of gums with Bleeding Injury of Vessels by Stomach Fire

Throat

Symptom(s) Cause or Pattern

Redness, Swelling, and Soreness Lung and Stomach Heat

Redness and Swelling with Yellow or White Ulcer Toxic Heat in Lung and Stomach
Spots

Slightly sore, dry, red, not swollen, chronic condition Deficient Kidney Yin

Bright Red with Mild Soreness Yin Xu with Hyperactive Fire

False Gray and White Membrane over Throat that is Diphtheria from Heat in the Lung Consuming Yin.
Hard to Remove, and Bleeds Following Removal

Ears

Observe color, discharge, skin tone, any spots or discoloration.

Symptom(s) Cause or Pattern

Burnt Black and Dry and Withered Auricles in Severe Consumption of Kidney essence
Illness

Purulent Discharge Damp Heat of Liver and Gall Bladder

Limbs

Flesh around wrists and ankles should be a good color and firm: indicates a good
condition of the fluids.
Symptom(s) Cause or Pattern
Dry, dull skin on wrists/ankles with withered Exhausted Fluids
flesh
Thenar eminence State of Stomach
Bluish color of venules on thenar eminence Cold in Stomach
Red venules Heat in Stomach
Nails
Symptom(s) Cause or Pattern
Pale Blood Deficiency
Bluish Liver or Heart Blood Stasis
Split Liver Blood Deficiency
 Digital Venule Examination in Children
Examine the venules on the index finger in children under 2.

Use left index finger in boys and right in girls.

Creases in joints of index fingers are called "gates".

Wind Gate
First, crease at mcp articulation
Qi Gate
Second (1st interphalangeal)
Life Gate
Third (distal interphalangeal)
Method: rub finger towards body. Venules may appear.

If venules are only present beyond the Gate of Wind, this indicates mild disease
(invasion by exterior pathogen). If venules extend beyond Gate of Qi: interior, more
severe condition. If venules extend beyond Gate of Life: serious, life-threatening
condition. Bluish venules indicate a Cold pattern whereas red venules indicate aHeat
pattern

Skin

Skin relates to the Lungs in Five Element Theory.

Skin also indicates the condition of the Blood (and therefore the Liver, which stores Blood).
Many skin conditions relate to Heat in the Blood or stasis of Blood and may relate to Liver.
Skin disease can also relate to Heat in the Stomach which can cause Blood Heat.
Indications
Dry skin
Often indicates Deficient Blood
Itchy skin
Wind
Pitting edema
Kidney Yang Deficiency
Venules (spider veins) on the skin are exterior manifestation of the superficial
channels. They are often seen behind the knees or around ankles in older people.
Venule Color Cause or Pattern
 Red Heat
Bluish Cold
Greenish Pain
Purple
359 Blood Stasis

TCM Diagnosis by Listening (and Smelling) - One of

the 4 Pillars
1. Listening

The Sound of the Voice

A loud and course voice indicated an Excess pattern

A weak and low voice indicates a Deficient pattern
A lack of desire to speak indicates a Deficient Cold pattern
Incessant talking indicates a Heat pattern
Hoarse Voice or Loss of Voice

Acute onset of a hoarse voice is usually indicative of Exterior Pathogenic Wind, especially
if the throat is red and sore.
A chronic or recurrent hoarse voice usually indicates an interior disease such as Deficient
Lung Qi or Lung Yin
A gradual loss of voice also usually indicates Deficient Lung Qi or Yin
Loud Voice with Incoherent Speech
This is usually accompanied by impaired mental function and indicates Heat is disturbing
the Shen (Spirit/Mind)
5 Element Associations in the Voice

Shouting is a Liver imbalance

Constant Laughing is a Heart imbalance
Chronic weeping, whimpering, sadness is an Spleen imbalance
Groaning is a Kidney imbalance
Cough

Coughing is usually related to Lung's ability to properly disperse and descend Lung
Qi, leading to rebellious Lung Qi

Wheezing or rattling from the Lung is usually mucus or Phlegm in the Lung
 Explosive or very loud coughing indicates an excess pattern
A weak cough indicates a Deficient pattern
A dry hacking cough is usually indicative of Heat and Dryness in the Lung
An unproductive cough with small amounts of sticky sputum indicates Heat scorching the
fluids
Breathing

Loud and coarse breathing indicates an Excess pattern

Shortness of breath, weak and/or difficult breathing may indicate the Kidney is too weak to
grasp the Qi. This would include a Deficient type asthma.
Loud and coarse breathing with a preference for exhaling indicates pathogens retained in
the Lung. This would include Excess type asthma.
Frequent Sighing

Usually related to Liver Qi Stagnation

Hiccups

Usually related to Rebellious Stomach Qi

BorBorygmus

Usually related to Deficient Spleen Qi or Deficient Spleen Yang, especially if there is loose
stools and bloating.
This can also be due to Liver Qi Stagnation invading the Intestines
2. Smelling

In general, secretions and excretions related to Excess Heat type patterns have a
foul odor. Less odorous secretions and excretions usually relate to Cold and
Deficiency type patterns.

Odors

Urgent diarrhea with foul stools indicates Damp-Heat in the Large Intestine.
Belching with a foul or sour odor indicates retention of food.
Leucorrhoea with a strong or foul odor indicates Damp-Heat in the Lower Jiao affecting
the Uterus.
Chronic Halitosis (Bad breath) indicates Stomach Heat
5 Element Associations of Smell

Rancid "goatish" odors are related to the Liver

 Scorched or burned odors are related to the Heart
Fragrant, sweet, or cloying odors are related to the Spleen
Rank or Rotten odors are related to the Lung
Putrid odors are related to the Kidney

TCM Diagnosis by Asking - One of the 4 Pillars

Questioning or interviewing a patient during intake covers many topics, including:

Past medical history

Origin of the current problem
Living and environmental conditions
Current and past emotional issues, including family relationships, partner relationships,
work issues etc.
Eating patterns and Diet
Specific questions relating to bodily systems
Identification of TCM patterns is done by using paradigms such as the 8 Principles
(Ba Gong), Zang Fu organ diagnosis, Channel diagnosis, as well as other
paradigms. Patterns can be identified generally as in the 8 Principles, or more
specifically as in Zang Fu diagnosis.

Absence of a sign or symptom may, in some cases, be vital to a correct TCM

diagnosis, and absence of symptoms are generally not reported by a patient. For
example, absence of thirst may indicate a cold condition. Keep in mind that all
relevant information is not usually provided by the patient.

Traditionally, there are ten areas of questioning

Common areas of Questioning today:

Chills and Fever

Sweating
Head and Body
Thorax and Abdomen
Food and Taste
Stools and Urine
Sleep
 Ears and Eyes
Thirst and Drink
Pain
Gynecological Conditions
Pregnancy and Childbirth (where appropriate)
Questions should be relevant to the patients condition, as not all questions are useful
in every situation. Additional questions should be asked based on information
provided by the patient as well as what is observed by the practitioner.

Chills and Fever

Chills and Fever in Exterior Patterns

Chills and fever in an Exterior Pattern (unless they are alternating), an invasion or
attack by exogenous pathogenic factors. It is important to distinguish the presence of
chills or fever or both. Chills is not only the feeling of Cold, but also having an
aversion to Cold. The patient does not want to go outside into the Cold, does not like
drafts, and the chills are not alleviated by covering up with blankets. Fever, in this
context, is a subjective sensation of heat rather than actual body temperature.

The initial stages of an Exterior diseases is an acute condition, like the flu or
common cold. When a patient has an aversion to cold and chills, it usually indicates
an invasion of exogenous Wind Cold or exogenous Wind Heat. The patient feels cold
because the pathogenic factor blocks circulation of the body's Defensive Qi (Wei Qi),
which is impaired from circulating and warming the body. The chills and fever occur
simultaneously at the beginning stages of an acute disease because the body is
trying to expel the pathogen. This is the pathogenic/evil Qi struggling with the
antipathogenic/protective Qi.

Wind Cold

Symptoms: chills, aversion to cold, possible fever (especially low grade), usually with
body aches, absence of sweating, headache.

Pulse: superficial/floating and tight.

Wind Heat

Symptoms: Predominantly fever, with only slight aversion to cold or mild chills. Also
thirst, slight or profuse sweating.

Pulse: superficial/floating and rapid.

Alternating Fever and Chills

 This is a half external and half internal condition where there is exterior invasion of
Wind-Cold or Wind-Heat, but the pathogen has penetrated to a deeper level
(Shaoyang) of the body .

Exterior diseases are generally diagnosed according to two paradigms:

The Six Stages (Taiyang, Shaoyang, etc.)

The Four Levels (Wei, Qi, Ying, Blood).
Chills and Fever in Interior Patterns
Interior Excess Heat patterns usually present with a persistent high fever and
aversion to heat, but no chills. Other symptoms may include profuse sweating, thirst,
and a flooding pulse.

Interior Deficient Heat patterns usually present with tidal fever (fever that comes in
'tides', at specific hours of the day, usually in the evening or night). Other symptoms
may include night sweats, 5 palm heat (heat or sweating in the palms of the hands,
soles of the feet, and the chest), and a red tongue body.

Chills without fever usually indicates interior Cold from Deficiency of Yang
If chills are alleviated by covering up with blankets, there will be other symptoms such as
cold limbs, and a deep, slow and weak pulse.
A constant low-grade temperature usually indicates Damp Heat
Fever in the middle of the night
With an adult: This usually indicates Yin Deficiency, especially if accompanied by Night
Sweats
With a child: Retention of Food
Sweating

It is usually beneficial to ask a patient about sweating, even if they don't initially
volunteer the information.

Example Questions:

Do they sweat easily or excessively, and at what times?

Do they have spontaneous sweating without exertion?
In Exterior Patterns sweating can indicate:

Wei Qi (Defensive Qi) is weaker than the pathogenic Qi and can not expel the pathogen.
When other heat signs are present, it may indicate Exterior Wind Heat. If perspiration
breaks the fever, the pathogen has been expelled.
 No sweating is usually an Excess Cold pattern, where cold blocks the pores.
In Interior Patterns sweating is differentiated by:

Time of day

Day time spontaneous perspiration (without exertion) indicates Yang or Qi Deficiency. Wei
Qi can not regulate the pores.
Night time sweats are usually Yin Deficiency. Relative excess of Heat causes pores to open
during the Yin most times.
Area of body

Sweating on the head is usually Stomach Heat or Damp-Heat

Oily sweat on forehead may indicate Collapse of Yang
Sweating only on the arms and/or legs is Stomach and Spleen Deficiency
Sweating only on hands indicates Lung Qi Deficiency or mental anxiety.
Sweating over the whole body indicates Lung Qi Deficiency
Five palm heat (palms of the hands ,soles of the feet, and the chest indicates Yin Deficiency
Condition of illness

Profuse cold sweat during severe illness indicates Yang Collapse

Oily sweat on forehead that are not flowing and looks like pearls may indicate imminent
death from Yang Collapse
Quality of Sweat

Oily sweat indicates severe Yang Deficiency

Yellow sweat indicates Damp Heat
Head and Body

The Head is where all six Yang channels meet. The three Yang channels of the
upper limbs end on the face and the three Yang of the lower limbs begin on face.
Yang channels bring the clear Yang to the head and orifices, enabling clear vision,
hearing, taste, and smell.

Headache
Headache is distinguished according to the onset, time, location, nature of the pain,
condition.

Onset
 Sudden onset and of short duration indicates exterior attack of Wind cold disturbing the
Yang or Qi in the head.
Chronic headaches are often attributed to an interior condition.
Time of Day

Daytime headache indicates Qi or Yang Deficiency

Evening headache indicates Blood or Yin Deficiency
Location

Occipital headache indicates Taiyang channels (BL, SI). Usually caused by Exterior Wind-
Cold or Kidney Deficiency
Frontal headache indicates Yangming channels (LI, ST). Often caused by Stomach Heat or
Blood Deficiency, but can also be caused by exogenous Wind.
Temporal or parietal headache indicates Shaoyang channels (GB, SJ). Usually caused by
exterior Wind-Cold or Wind-Heat in Shaoyang, or Rising Liver Fire affecting Gall Bladder
channel.
Vertex headache indicates Jueyin channels (LIV). Usually caused by Deficient Liver Blood
Whole head headache usually indicates severe Exterior Wind-Cold, or may indicate mild
Deficiency of Blood and Qi.
Nature of Pain

A heavy sensation is usually due to Dampness or Phlegm

'Pain inside the brain' is usually due to Kidney Deficiency
Distending, throbbing, or bursting pain is usually associated with Ascending Liver Yang
Fixed pain in one area with a boring sensation into the head is usually due to Blood
Stagnation
Condition

Headache with aversion to wind or cold usually indicates Exterior invasion of pathogenic
factors
Headache that is worse with Cold indicates a Cold Pattern
Headache that is worse with Heat indicates Heat Pattern
Headache that is worse when fatigued, better when at rest usually indicates Qi Deficiency
Dizziness
Dizziness can be due to Internal Wind, Fire, Phlegm, or Deficiency of Qi and Blood

Internal Wind from Ascending Liver Fire

 Dizziness with loss of balance, often with such signs as tinnitus, headache, nausea, red eyes,
wiry pulse, irritability, and other characteristic signs of Ascending Liver Yang
Phlegm

Mild to severe dizziness with heavy and "foggy" feeling in the head plus other signs e.g.
nausea, excessive sputum, slippery pulse. Phlegm obstructs the head, so that the clear Yang
cannot ascend.
Qi and Blood Deficiency

Slight dizziness, worse when fatigued, accompanied by such signs as fatigue, perhaps
palpitations and difficulty falling asleep, pale tongue and weak pulse.
Acute Onset of Dizziness

Indicates an Excess pattern

Gradual Onset or Chronic Dizziness

Indicates a Deficiency pattern

Pain All Over the Body
Pain that has sudden onset and is accompanied by chills and fever is due to an invasion of
exterior Wind, usually Wind-Cold.
Pain all over the body with fatigue is usually deficiency of Qi and Blood
Postpartum women with dull pain usually indicates Deficient Blood
Postpartum women with severe, fixed or stabbing pain usually indicates Blood Stasis
Muscle pain with hot sensation is usually due to Stomach Heat
Pain with a feeling of heaviness is usually due to Dampness obstructing the muscles
Pain in the Joints, Painful Obstruction Syndrome (Bi Syndrome)
Wandering Bi Pain is usually from wind.
Fixed and very painful joints that are worse in cold weather and improved with heat
indicates Cold Bi.
Fixed pain with numbness and heaviness that is worse when Damp outside indicates Damp
Bi.
Joint pain with swelling and heat in joints may indicate Wind Cold and Damp have turned
to heat.

Lumbar Pain
Continuous dull pain that is better with rest indicates Kidney Deficiency
 Severe pain and stiffness with recent onset indicates lumbar sprain caused by Blood Stasis
Severe pain that is worse in cold and damp but improved by heat indicates an invasion of
exogenous Cold and Damp into the channels of the back.
Fixed and boring pain and an inability to turn at the waist indicates Blood Stasis
Pain that extends up to the shoulders, with other exterior symptoms such as headache, stiff
neck, nasal congestion, etc. indicates exterior Wind attack.
Numbness
Bilateral numbness of the hands and feet, or arms and legs, usually indicates Blood
deficiency
Numbness of fingers (especially the 1st 3 digits), numbness of the elbow and arm on one
side is usually internal Wind and Phlegm (impending Wind-stroke).
Thorax and Abdomen

Areas of the thorax and abdomen can be generally associated with the internal
organs
Thorax:Heart and Lungs, Upper Jiao
Flanks and Ribcage:Liver and Gallbladder
Abdomen:Liver, Intestines, Spleen, Kidney, Bladder
Epigastric area:Spleen and Stomach
Umbilical area:Kidney
Chest Pain
Chest Pain is often Blood Stasis in the Heart from Deficient Yang.
Chest Pain with Cough and copious Yellow Phlegm indicates Phlegm-Heat in Lung.
Hypochondriac Pain
Distention or Discomfort in the hypochondriac region is usually Liver Qi Stagnation.
Severe hypochondriac pain is usually indicative of Liver Blood Stasis.
Epigastric Pain
Can be due to Liver Qi Stagnation or Stomach Heat.
If the pain is dull, it may indicate retention of food in the stomach.
If the pain is better after eating or applying heat it may indicate Deficient Cold in Stomach.
If the pain is worse after eating it may indicate a Deficient pattern.
If there is also fullness in the epigastrium, this indicates an Excess pattern
Lower Abdominal Pain
If relieved by defecation, this indicates Excess
 If worse on defecation, this indicates Deficiency
Causes

Internal Cold
Stagnation of Liver Qi
Stagnation of Liver Blood
Retention of food in Intestines
Blood Stasis in the Intestines
Blood Stasis in the Uterus
Damp Heat in Intestines
Hypogastric Pain
Can be caused by Damp-Heat in the Bladder.
Can be caused by Liver Fire coursing down into the Bladder.
Food and Taste

This gives us information regarding the state of Spleen & Stomach (also the flavors
desired give clues to other Organs according to the five element correspondences).

Appetite and Eating

Condition relieved by eating indicates a Deficiency pattern
Condition aggravated by eating indicates an Excess pattern
Lack of appetite indicates Deficient Spleen Qi
Always hungry even after eating indicates Stomach Heat
Fullness/distention after eating indicates Retention of Food
Prefers warm food indicates a Cold Pattern
Prefers cold food indicates a Heat Pattern
Taste in Mouth
Bitter taste is usually due to an Excess Heat pattern (Liver or Heart)
A constant bitter taste in the mouth is usually due to Liver Fire
A bitter taste in the morning after no sleep is usually due to Heart Fire
A sweet taste may indicate Spleen Deficiency or Damp Heat
A sour taste is usually due to retention of food in Stomach or the Liver invading the
Stomach
 A salty taste is usually due to Kidney Yin Deficiency
A pungent taste is usually due to Lung Heat
Vomiting
Sour vomiting may indicate Liver Invading Stomach
Clear/Watery vomiting may indicate Cold in Stomach with Fluid retention
Vomiting after eating may indicate a Heat Pattern
Sudden & Loud vomiting may indicate Excess pattern
Slow & Weak vomiting may indicate Deficiency pattern
Stools and Urine

A condition alleviated after bowel movement indicates an Excess condition, while a

condition worsening after bowel movement indicate a Deficiency condition.

Constipation
Acute constipation with infrequent dry stools, accompanied by thirst, and a dry yellow
tongue coating indicates heat in stomach and intestines
Constipation in elderly, or women postpartum indicates Deficient Blood and Fluids
Constipation with small, bitty stools indicates Liver Qi Stagnation and Heat in Intestines
Difficult bowel movements with stools that are not dry indicates Liver Qi Stagnation
Constipation with abdominal pain indicates Internal Cold and Yang Deficiency or Liver Qi
Stagnation
Constipation with dry stools and no thirst indicates Kidney or Stomach Yin Deficiency
Alternating constipation and diarrhea indicates Liver Qi invading the Spleen
Diarrhea
With pain indicates Stagnation of Liver Qi, or Liver Heat, or interior Heat or Cold in the
Intestines
Foul odor, especially if urgent indicates Heat
Urgent diarrhea or loose stools with burning sensation in the anus indicates Heat
Absence of odor indicates Cold
Chronic diarrhea indicates Deficient Kidney or Spleen Yang failing to transform food and
fluid
Chronic, daily, and early morning (cocks crow diarrhea) indicates Kidney Yang Deficiency
With mucous indicates Dampness in the Intestines
 Frequent watery or unformed stools indicates Deficient Yang, Deficient Qi, or Dampness
Loose stools with undigested food indicates Deficient Spleen Qi or Deficient spleen Yang
Frequent or urgent stools that are not loose or only slightly loose indicates Sinking of
Spleen Qi or Spleen and Stomach Qi Deficiency
Black or very dark stools indicates Blood Stagnation
With Blood indicates a Heat condition (A patient with Blood in the stool should always be
referred to a western physician to rule out Cancer)
Borborygmus (gurgling in the abdomen)
With loose stools indicates Spleen deficiency
With abdominal distention but no loose stool indicates Liver Qi Stagnation
Flatulence
Stagnation of Liver Qi is often involved
With foul odor indicates Damp-Heat in Spleen, Stomach Heat, or Stagnant Qi in the Small
Intestine
Without odor indicates Deficient Spleen Yang producing interior Cold
Urinary Function
Enuresis/incontinence indicates Kidney Yang Deficiency
Retention of urine indicates Damp Heat in Bladder
Difficult urination, especially with painful and dark urine, indicates Damp-Heat in Bladder
Inability to complete urination, dribbling, or lack of force in urination indicates Kidney Qi
Deficiency, Dampness, or Cold
Frequent and copious urination, especially at night, indicates Kidney Yang Deficiency
Frequent and scanty urination indicates Kidney Qi deficiency
Frequent, scanty, and dark urination indicates Damp-Heat in Bladder
Pain associated with urination

Before urination indicates Stagnation of Qi in the Lower Jiao

During urination indicates Heat in Bladder
After urination indicates Deficiency of Qi
Urine Color

Pale indicates Cold of the Bladder and Kidney, usually from deficient Kidney Yang
Dark, yellow, or reddish indicates Heat
 Turbid or Cloudy indicates Dampness in bladder
Urine Amount

Large amounts indicates Kidney Yang Deficiency

Scanty amount indicates Heat or Dampness obstructing Bladder, Deficient Fluids, or
Kidney Yin Deficiency producing Empty Heat
Sleep

The Heart is the residence of the Shen, and the Blood and Yin nourish the Shen.
When Blood and/or Yin is Deficient, the Shen has no residence and can not rest.

Unable to fall asleep but sleeps well once asleep is usually due to Deficient Heart Blood
Waking often during night is usually Heat disturbing the Shen
This can be due to Kidney Yin failing to nourish Heart Yin, Stomach Heat from retention of
food, etc.
Waking early or unable to fall asleep again indicates Gallbladder Deficiency. This is
common in the elderly as Qi and Blood are weaker.
Dream-disturbed sleep usually indicates Liver Fire and/or Heart Fire
Liver Fire and Heart Fire can be due to Kidney Yin Deficiency
Ears and Eyes

The Kidney opens to the ears, but not all ear disorders are related to the Kidney. The
Shaoyang channels (GB, SJ) travel to the ears, and some Exterior Heat conditions
that affect the Shaoyang can cause ear problems. Dampness and Phlegm can also
obstruct rising of Yang to upper orifices which can affect the ears.

Tinnitus (Ringing in the Ears)

Sudden onset indicates Excess condition, usually of Liver Fire or Liver Wind
Gradual onset indicates Kidney Deficiency
Aggravated by pressing on ears indicates Excess
Alleviated by pressing on ears indicates Deficiency
Loud, high pitched noise like whistle indicates Rising Liver Yang, Liver Fire, or Liver Wind
Low pitched noise like rushing water indicates Kidney Deficiency
Deafness
Sudden onset indicates Excess condition, usually Liver Fire or Liver Wind
 Gradual onset and chronic deafness indicates Deficiency, usually of the Kidney, or of Heart
Blood Deficiency, or Yang Deficiency
Eyes
Pain, swelling, and redness indicates Invasion by Exogenous Wind-Heat or internal Liver
Fire
Blurry vision and floaters indicates Liver Blood Deficiency
Photophobia indicates Liver Blood Deficiency
Pressure in eyes indicates Kidney Yin Deficiency and/or Liver Fire
Dryness of eyes indicates Liver/Kidney Yin Deficiency
Thirst and Drink

For cold liquids indicates Heat

For warm liquids indicates Cold
Thirst for large amounts of Cold Water indicates an Excess Heat Pattern
No Thirst indicates Cold pattern, usually of the Stomach or Spleen
Thirst with no desire to drink indicates Damp-Heat
Thirst with desire to sip liquids slowly, or sip warm liquids indicates Yin Deficiency (of
Stomach or Kidney)

Pain

Excess conditions causing pain are usually due to Qi circulation in the Channels
being obstructed due to stagnation, cold, or heat. Deficient condition that cause pain
are usually due to the channels not being nourished by Yin and Blood. An Excess
condition causes more severe pain, while a deficient one causes more dull pain.

Excess Conditions
Invasion of exogenous pathogens
Interior Cold or Heat
Stagnation of Qi (causes distention more than pain, or vague distending sensation without
location)
Stasis of Blood, usually causes severe, localized, fixed, or boring pain
Obstruction by Phlegm
Retention of Food
 Deficient Conditions
Deficient Qi and Blood
Deficient Yin with consumption of Body Fluids

Gynecological Conditions

Ask about Menstruation, Vaginal Discharge, Pregnancy, and Childbirth. A Woman's

menses give a clear idea of the condition of her Qi and Blood.

See also: Amenorrhea, Dysmenorrhea, Early Menses, Extended Menses, Flooding &
Trickling Menses, Heavy Menses, Irregular Menses, Late Menses, Scanty
Menses, Spotting Menses

Important Questions
Length
Duration
Amount of bleeding
Color
Quality of flow
Pain or other symptoms, before, during and after flow
Menses - Moon Cycle
Early arrival of period indicates Heat in the Blood (red tongue) or Qi Deficiency (pale
tongue)
Late period indicates Blood Deficiency, Blood Stagnation, or Cold
Irregular period indicates Stagnation of Liver Qi or Deficient Spleen Qi
Amount
Heavy blood loss that is bright red indicates Heat in Blood, while pale and more scanty
blood indicates Spleen Qi Deficiency
Abnormal Uterine Bleeding indicates Heat in Blood, Deficient Spleen Qi, Stagnant Qi or
congealed Blood, or Deficient Liver/Kidney Yin
Scanty periods indicates Blood Deficiency or Stagnation of Blood or Cold Obstructing
Amenorrhea indicates Deficient Blood and Qi, Stagnant Qi/Blood Stasis, Deficient
Kidney/Liver Yin, Mucus dampness Obstructing Menses
Color
 Normal color is a dull to medium red
Very dark red or bright red Indicates Heat in the Blood
Pale blood Indicates Deficiency of Blood
Purple/blackish blood Indicates Stasis of Blood or Cold
Quality
Congealed blood with clots Indicates Blood stasis or Cold
Watery blood Indicates Blood or Yin Deficiency
Turbid blood Indicates Blood Heat or Stagnation of Cold
Pain
Before periods indicates Stagnation of Qi or Blood, Cold/Cold Damp Obstructing
During periods indicates Stagnation of Qi or Blood, Stagnation of Cold, or Deficient Blood
and Qi
After periods indicates Qi and Blood Deficiency
Leucorrhoea
Color

White, thin, clear indicates Cold from Spleen or Kidney Yang Deficiency, Exogenous Cold
Damp, or Stagnation of Liver Qi
Yellow, especially if thick and accompanied by vaginal itching or soreness indicates Damp-
Heat in the Lower Jiao
Red and white discharge indicates Damp Heat
Yellow, with pus and blood after menopause indicates Toxic Damp-Heat in the Uterus (the
patient should be referred to a western physician for a complete gynecological exam)
Consistency

Watery indicates Cold Damp

Thick indicates Damp Heat
Odor

Little or no odor indicates Cold

Strong odor indicates heat

Pregnancy and Childbirth

Pregnancy
 Infertility due to Deficiency is usually because of Deficient Blood, Deficient Kidney Jing, or
Cold
Infertility due to Excess is usually because of Damp Heat in Lower Burner or Stasis of
Blood in Uterus
Vomiting during pregnancy indicates Stomach Heat, or Deficiency of Stomach and Chong
Mai
Miscarriage before three months may indicate Deficiency of Blood or Essence (Kidney)
Miscarriage after three months may indicate Stasis of Liver Blood or Sinking of Spleen Qi
Childbirth
Nausea and heavy bleeding after delivery indicates Exhaustion of Chong Mai
Sweating and fever after delivery indicates Exhaustion of Qi and Blood
Postnatal depression may indicate Blood Deficiency has lead to Heart Blood Deficiency

TCM Diagnosis by Palpation (Pulse Diagnosis) -

One of the 4 Pillars
Divisions of the Pulse
Location of the Radial Pulses
The Method of Pulse Diagnosis
Factors Influencing Pulse
In Western medicine, the pulse is only a minor diagnostic tool, it is, however, very
important in TCM. Pulse diagnosis gives information on

1. The state of balance of the body as a whole, i.e. the state of the Qi, Blood, Yin and Yang,
and even the constitution.
2. The state of individual Organs (esp. Yin Organs).
TCM practitioners feel the pulse and note the rate. They discern width or amplitude,
length, how close it is to the surface, how deep and close to the bone, the strength,
and other qualities.

Divisions of the Pulse

Three area of the Pulse:

 Inch or Cun: Distal or Front (at wrist crease)
Bar or Guan: Middle (just medial to radial styloid process)
Cubit or Chi: Proximal or Rear

Three Levels of the Pulse:

Superficial:state of Qi and Yang Organs in general

Middle:state of Blood
Deep:state of Yin and Yin Organs

OR

Superficial:the condition of the Exterior or of the Upper Burner

Middle:Stomach and Spleen diseases
Deep:Interior diseases, esp. Liver and Kidneys
Location of the Radial Pulses

Three positions at each wrist, along the radial artery.

The pulses are palpated at three positions, superficial, middle and deep.

Most texts agree on the following:

The pulse essentially reflects the state of Qi in the different burners of the San Jiao (triple
burner).

Distal:Upper Burner
Middle:Middle Burner
Proximal:Lower Burner

The pulse positions mainly give information regarding the Yin Organs. It is more difficult to
assess the Yang Organs at individual positions (we tend to assess the Intestines in the Lower
Burner position)
In pulse diagnosis, most important thing is to assess

Health of the Qi in general

Relationship of Yin and Yang on the pulse
Relative states of Deficiency and Excess
Whether an exterior pathogen is present
Each pulse position can reflect different phenomena in different situations. For
example: The Lung pulse full can occur as a result of emotional problem (grief)
 affecting Lungs or from Phlegm in Lungs or from an Excess in Large Intestine
channel, such as a tooth abscess.

The Method of Pulse Diagnosis

Feel pulses with the pads of the fingers (most sensitive part)

Hand must be relaxed - neither tense nor flaccid, but flexible and maintained in the
pulse-taking position with the minimum of effort.

Exercise: Tense the hand as much as possible. Then relax and let the hand droop.
Then gradually, with as much attention as possible, put just enough energy into your
hand to lift the fingers. Imagine your fingers are like the leaves of a tree; if you waved
your arm your hand and fingers would float gently after your arm. This is the
optimum condition of the hand for pulse taking, relaxed, flexible but responsive.

Place the third (middle) finger pad on the radial artery just medial to the styloid
process. The index finger is then placed in the distal position at the wrist crease and
the ring finger in the proximal position.

NOTE: on a small person, the fingers will have to be squeezed close together but on
a large person they may need to be spread out.

Try to feel the radial artery pulse with all three fingers. Use equal pressure on all
three fingers and then release the pressure on the middle finger slightly to
compensate for the styloid process. (The pressure of the radial artery on the styloid
can produce an artificial pulse reading if the same amount of pressure is exerted
there. The pulse would then appear to be excessive in the middle position.)

When you can just feel the radial artery, and have adjusted the pressure of your
finger tips, release the pressure equally until you can JUST feel the pulse. This is the
superficial position.

Then press as deeply as possible (maintaining the relative pressure levels as before)
until you cut off the pulse altogether. Release the pressure until the pulse just
returns. This is the deep position.

Timing: Optimum time is early morning, when Yin is calm and Yang has not yet arisen.
Position: Patient's arm should be horizontal and not higher than level of heart. Most
practitioners use a table and place patient's wrists on a small cushion.
Finger Placement: Best to keep all fingers in place as described above, and only lift fingers
slightly to feel different levels.
Breathing: Practitioner must regulate his/her breathing in order to be more receptive.
 Patient's pulse is traditionally correlated with the Practitioner's Breathing Cycle in
order to determine if patient's pulse is slow or rapid. (This was misinterpreted for a
long time in the West).
Normal pulse: 4-5 beats per practitioner's breath.
Three beats or less: Slow Pulse
More than five beats:Rapid Pulse
Also pulse can be counted using a watch according to following table:
Age Rate
1-4 90 or above
4-10 84
10-16 78/80
16-35 76
35-50 72/70
50+ 68
Factors that Influence a Pulse Reading

The 4 Seasons: Pulse is deeper in Winter, more superficial in summer.

Gender: Men's pulses are naturally a little stronger. In men, the LEFT pulse is slightly
stronger and in women the RIGHT pulse is slightly stronger.
Occupation: those doing heavy physical work should have stronger pulse.
Patient should not have just eaten a large meal (1 hr. before OK). Otherwise, Stomach
pulse will read very high and other Organ readings may be depleted.
Allow the patient to rest after arrival at office.
Allow 15 minutes after urination, defecation or ingestion of liquids.
Pulse diagnosis should take place in a calm, restful environment.
Silence should be maintained during procedure.
Western medications can interfere with reading, as can hypertension, and structural
anomalies.

The 29 Pulses in Chinese Medicine (TCM) Pulse

Diagnosis
The Normal Pulse: reflects good Heart Qi and Blood. It should be calm, smooth, soft,
but not too soft, and not slow, rapid, rough or hard. It should be regular. Its quality
should not change very often or easily. Deep level and rear position should be felt
clearly, indicating that the Kidneys are healthy.
 Note: Different sources vary on both their naming conventions and on the total
number of standard pulse images. We have tried to organize this information to
include 29 pulse images and their various names.

The Main Pulse Images

Fu Mai (Floating, Superficial)

Hong Mai (Surging, Flooding)
Ge Mai (Leathery, Drumskin, Tympanic, Hard)
Kou Mai (Hollow or Scallion Stalk, Green Onion)
Ru Mai (Soft or Soggy)
San Mai (Scattered)
Xu Mai (Forceless, Empty, Deficient)
Chen Mai (Deep)
Fu Mai (Hidden)
Lao Mai(Firm, Confined)
Ruo Mai (Weak)
Chi Mai (Slow)
Huan Mai (Slowed down, Moderate, or Relaxed)
Se Mai(Choppy, Hesitant)
Jie Mai(Knotted, Bound)
Shi Mai (Excess, Full, Replete, Forceful)
Hua Mai (Slippery, Rolling)
Jin Mai (Tight, Tense)
Chang Mai (Long)
Xuan Mai (Wiry, Taut)
Wei Mai(Minute, Faint, Indistinct)
Xi Mai(Thready, Thin)
Duan Mai (Short)
Dai Mai (Regularly Intermittent)
Shuo Mai(Rapid)
Ji Mai (Racing, Swift, Hurried)
Cu Mai (Rapid-Irregular, Skipping, Abrupt)
 Dong Mai(Moving, Throbbing, Stirring)
Da Mai(Large, Big)
Fu Mai (Floating, Superficial)
Description: Located in the exterior. With the finger raised, it has a surplus, when pressing down it is
insufficient, weak, or disappears. When pressure is released, it regains full strength.

Indications: External invasion, Yin Xu with Yang floating upwards, Qi or Yang Xu

Etiology: Mainly an exterior condition, syndromes due to Xu, or Yang Qi loosing its root in the lower part
of the body and floating to the upper regions.

Hong Mai (Surging, Flooding)

Description: Floating, large (i.e. wide) comes on exuberant, departs debilitated. "Coming onto the shore with
force and retreating without force"

Indications: Extreme heat; if with thirst, high fever it can be Yangming heat or internal heat. If surging and
forceless, this is Xu surging.

Etiology: This pulse has been said to arrive strong at the chi position and depart at the cun position, thus
its wave like character. The Yang is floating excess and upward, this is a manifestation of fire
floating upward and water drYing internally(i.e. loss of blood, diarrhea)

Ge Mai (Leathery, Drumskin, Tympanic, Hard)

Description: Bowstring and large (wide) with an empty center; feels like the head of a drum. Felt with light
pressure. Floating, large, and hard and resistant to pressure.

Indications: Hemorrhage, Spermatorrhea, Abortion, Excessive Menstrual Flow, Xu Cold

Etiology: The Qi becomes detached and floats to the exterior, the healthy Qi is failing to store sperm and
blood.

Kou Mai (Hollow or Scallion Stalk, Green Onion)

Description: Floating, soft, large body, but empty in the center. Forceless--large and weak.

Indications: Hemorrhage, Damage of Yin, Great Blood Loss (severe diarrhea/hemorrhage)

Etiology: There is failure to fill the vessels by insufficient Ying and Blood causing Yang Qi to detach and
float to the surface.

Sources disagree on the description of this pulse, some say that the beats around the middle
level are palpable(i.e. light or heavy pressure) and the beats at the middle level are impalpable.
Bob Flaws says that "a pulse which is empty in the center is an extreme floating pulse which not
only gets weaker when one presses down but disappears altogether. It only reappears again
when pressure is released to the superficial level."
Ru Mai (Soft or Soggy)

Description: Floating, fine, soft and flexible. Can be felt with light pressure but cannot be obtained by heavy
pressure. "Floating, thready, and soft" "Like a silk thread in water"

Indications: Primarily means Dampness, can be Yin Xu, Blood Xu, Spleen Xu

Etiology: The dampness is obstructing the vessels or the Qi and Blood are unable to fill the vessels giving
it its soft quality. This is distinguished from other floating pulses, which tend to be large(i.e.
wide)

San Mai (Scattered)

Description: Floating, large (ie.wide) and without root; with light pressure it is easily irregular, becoming
scattered and chaotic; with heavy pressure it is impalpable.

Indications: Dispersion of Yuan Qi, Kidney Yuan Qi Xu, severe deficiency and exhaustion of internal organ
Qi

Etiology: This pulse is without root, without definite edges and boundaries, not characterized as an
irregular beat pulse, although it feels chaotic. It is a further progression from the Kou Mai
(Hollow), being even weaker than the Kou Mai. "Like wind blowing hair or scattered leaves"

Xu Mai (Forceless, Empty, Deficient)

Description: Generalized term for various types of forceless pulses or is described as a floating, large, slow,
empty. deficient, soft, forceless pulse image.

Indications: Qi and Blood Xu Can be damage by summerheat.

Etiology:

Chen Mai (Deep)

Description: Located near the bone. Cannot be detected with light or moderate pressure but can be felt with
heavy pressure. (Not to say it is impalpable at lighter pressure)

Indications: Interior patterns. If deep and rapid=Interior heat. If deep and slow=interior cold. If deep and
forceless=Qi and Yang Xu If deep and forceful=excess of internal disease.

Etiology: Pathogens in the interior are obstruction healthy flow of Qi and Blood.

Fu Mai (Hidden)

Description: Difficult to feel, under the sinews, not obvious, requires heavy pressure to obtain. Almost to the
bone. Deeper than the deep pulse.
Indications: Severe pain, extreme stagnation,(of food or of pathogens), syncope, last stage of an illness,
coma, and lack of circulation.

Etiology:

Lao Mai (Firm, Confined)

Description: Pressed superficially or moderately, it does not respond, but can be obtained by heavy pressure.
Hard, firm, not changeable, replete, large, bowstring, and long.

Indications: Internal cold, perhaps hernia, abdominal masses. Can also indicate wind epilepsy, inflexibility,
and cramping, hard accumulations hidden in the interior, running piglet and sudden violent
counterflow.

Etiology: The pathogenic factors are steady, there is interior cold and decline of Yang Qi

Ruo Mai (Weak)

Description: Deep, fine, soft like a thread.

Indications: Simultaneous Qi and Blood Xu

Etiology: Blood Xu results in failure to fill the vessels and Qi Xu results in its forcelessness.

Chi Mai (Slow)

Description: Below 60 BPM or less than 4 beats per practitioners breath.

Indications: Cold syndromes. Forceful and slow=accumulation of cold; Forceless and slow=cold from Xu
Slow and floating=external cold. Slow and deep=interior cold. Slow and choppy=blood disease.
Slow and slippery=Qi disease.

Etiology: There is stagnation of Qi due to cold. There may be other factors as well, such as obstruction of
blood due to accumulation of heat, this pulse must be forceful and excessive when palpated (i.e.
Yangming)

Huan Mai (Slowed down, Moderate, or Relaxed)

Description: As a ping mai, or normal pulse it is level and harmonious, relaxed and forceful. As a bing mai or
abnormal pulse it is relaxed, loose, slack, on the verge of slow. About 60 BPM. The beats come
and go slowly, feels viscous, the rate is like normal but the slowness shows up at the end of a
beat, before a slow pulse.

Indications: Syndromes of Damp, SP/ST Xu Not enough Qi and Blood to fill the vessels.
Etiology: May also be due to wind if floating and relaxed. If it is deep and relaxed is is damp syndrome. If
large and relaxed=liver wind internally, if relaxed and weak it may signify heart Qi Xu

Se Mai (Choppy, Hesitant)

Description: Slow, relaxed, stagnant, difficult, fine, may stop and loose a beat but then recovers. It is not
smoothly flowing. It feels like a knife scraping bamboo.

Indications: Consumption of essence, Blood Xu, Stagnation of Qi, Blood Stagnation, Phlegm or food
stagnation. It can also be due to heart palpitations.

Etiology: Blood and essence failing to nourish the meridians. Blood is not flowing smoothly.

Jie Mai (Knotted, Bound)

Description: Slow, relaxed, stops at irregular intervals.

Indications: Stagnation of Qi due to excess Yin, Blood Stasis due to cold phlegm, Blood Stagnation.
Sometimes abdominal masses, also indicates Heart palpitations.

Etiology: Yin and Yang out of balance due to excess Yin. (This represents an irregular beat or palpitation
stemming from the ventricle of the Heart)
Shi Mai (Excess, Full, Replete, Forceful)

Description: Bowstring, large, hard and replete pulse which has a surplus at all 3 levels of cunkou.

Indications: Excess condition where both pathogenic and anitpathogenic factors are strong.

Etiology: Blood vessels are full with both Qi and Blood

Hua Mai (Slippery, Rolling)

Description: Comes smoothly flowing and uninhibited; feels smooth like pearls rolling in a dish. Beats come
and go fluently and smoothly, feeling slick to the fingers.

Indications: Phlegm retention, indigestion, excess heat. May also indicate dampness. The Hua Mai is
considered normal (ping mai) for women during pregnancy or menstruation.

Etiology: The smooth and slick pulsation is caused by the accumulation of pathogens in the interior with
sufficiency of Qi and Blood.

Jin Mai (Tight, Tense)

Description: Tight, has strength, feels like a taut rope. Feels like a stretched and twisted rope.
Indications: Cold or Pain. Undigested food

Etiology: Caused by the contraction of tense vessels resulting from the conflict between cold and healthy
Qi and the obstruction of Yang Qi

Chang Mai (Long)

Description: Long and can be felt beyond its location. Felt past the cun position.

Indications: Excess liver Yang, Yang and Heat Excess in the Interior, Strong Pathogenic factors

Etiology: A long and smooth pulse can be normal (ping mai) for some people, the long characteristic is
usually present with wiry.

Xuan Mai (Wiry, Taut)

Description: Feels straight, long and tense, like the feeling of pressing a tight string of a musical instrument.
Crisp and distinct edges, tends to reveal itself when one slightly lets up on the pressure.

Indications: Liver and Gall Bladder disease, various painful disorders, phlegm retention, malaria, abnormal
circulation of Qi
Etiology: Tense vascular Qi due to the liver not gently performing its function, can also be due to the
retention of a pathogen in the liver. If wiry, Thready and forceful-like feeling the edge of a knife
is indicative of Stomach Qi exhaustion.

Wei Mai (Minute, Faint, Indistinct)

Description: Insufficient, extremely fine, soft, barely palpable. It may be felt and then sometimes it is lost.
"Extremely Thready and soft"

Indications: Decline of Yang Qi. Yin, Yang, Qi, and Blood Deficiency.

Etiology: The Yang Qi cannot push the blood in the vessels or the Yin/blood cannot fill the vessels.

Xi Mai (Thready, Thin)

Description: Soft, feels like a silken thread, weak, without strength but not scattered by pressure.

Indications: Qi and Blood Xu, various deficiency syndromes, disorders due to Damp. Does not indicate
weakness.

Etiology: Impairment of Ying Blood fails to make the vessels plentiful. Qi is too deficient to move the
blood. May also occur due to compression of vessels by dampness.
Duan Mai (Short)

Description: Does not reach(i.e. fill longitudinally) its location or range. Can be felt most clearly at the Guan
position, more indistinct at the Cun and the Chi.

Indications: Short and forceful indicates Qi Stagnation, Short and weak indicates Qi Xu

Etiology: Qi is failing to move the Blood.

Dai Mai (Regularly Intermittent)

Description: Comparatively relaxed and weak, stops at regular intermittent intervals. These intervals may be
strikingly long.

Indications: Decline of Zang Fu (organ) Qi, Wind Syndromes, Pain, Terror, Fear, Trauma.

Etiology: Flaws: "Patients with this pulse have advanced heart disease according to western medicine and
should be immediately referred to a western doctor"

Shuo Mai (Rapid)

Description: Above 90 BIM, or more than 5 beats per breath.

Indications: Heat Syndromes. Forceful and rapid = excess heat. Weak and rapid = Deficiency Heat.

Etiology: Hyperactivity of heat accelerating Qi and Blood. Rapid pulse may be weak when it's Yin Xu due to a
chronic disease resulting from interior deficient heat. Rapid pulse, when seen in cases of floating of Yang
Xu, must be large and weak with a sense of emptiness.

Ji Mai (Racing, Swift, Hurried)

Description: Very rapid, over 120 BIM, or 7-8 beats per breath.

Indications: Excess of Yang and exhaustion of Yin, impending exhaustion of primary Qi Can also be due to
Heart Palpitations.

Etiology: Exhaustion of Yin in the lower body and excess of Yang in the upper parts. Often accompanies
high temperatures. Swift and wiry=not enough true Yin, overabundance of Yang. Swift and
forceful=Primary Yang will be exhausted.

Note: This can be normal for infants.

Cu Mai (Rapid-Irregular, Skipping, Abrupt)

Description: Rapid and irregularly interrupted.

Indications: Excess Heat, Domination of Yang, Qi, Blood, Phlegm and Food Stagnation. This can be from an
Atrial Fibrillation.

Etiology: This is clinically very severe, Yin and Yang are not in communication.

Dong Mai (Moving, Throbbing, Stirring)

Description: Slippery, rapid, forceful, feels like a bean--strong and throbbing abruptly. "Without head or tail"
This is most distinguished at the Guan position, and is a subcategory of the short pulse.

Indications: Pain, Fright, Shock

Etiology: Conflict between Yin and Yang, disturbance of ascending and descending, leading to faster
circulation of Qi and Blood which makes it appear smooth, rapid, and forceful yet palpable over
a narrow region.

Da Mai (Large, Big)

Description: Large, fills up the fingertip, forceful. Similar to the Hong Mai, but does not have the wave-like
shape

Indications: Advance of a disease due to domination of pathogenic factors and also Deficiency Syndrome.
Etiology: It is possible to differentiate exuberance or decline of pathogenic factors and the health of the Qi
according to whether Large pulse is forceful or weak.