Pulse Diagnosis

Front 1

Six pulse categories

Back 1

superficial or deep
slow or rapid
forceful or forceless

Front 2

Characteristics of a normal pulse

Back 2

Has an even and gentle pulsation in all three positions, beats 4-5 times in one breath (of the practitioner), approximately 60-90 beats/min. Full of stomach Qi, full of Spirit, puse is rooted.

Front 3

*Floating pulse image
(superficial)
Fu Mai

Back 3

forceful on superficial depth, decreasing in strength with depth (but without feeling empty)

Like wood floating on the surface of water

Front 4

Floating pulse indications

Back 4

exterior syndrome or deficiency syndrome

Front 5

floating + forceful

Back 5

exterior excess
exogenous factors invade the exterior of the body, defense yang qi rises against it. The yang pushes the qi and blood to the surface to defend the body from attack.

Front 6

floating + moderate

Back 6

exterior deficiency
exogenous factors invade the exterior of the body, defense yang qi rises against it. The yang pushes the qi and blood to the surface to defend the body from attack.

Front 7

floating + forceless + thin

Back 7

yin, blood exhaustion
yin is deficient and can't anchor the yang, or

Front 8

floating + forceless

Back 8

yang exhaustion
yang is nearing exhaustion, too weak to match yin, yang will float to the surface as separation yin and yang begins

Front 9

*Submerged pulse image
(deep, sunken)
Chen Mai

Back 9

absent on superficial depth, increasing in stregth with depth; distinct only when pressing down on bones and tendons

Like a stone thrown into a well, it must sink to the bottom.

Front 10

Submerged pulse indications

Back 10

interior syndrome

Front 11

submerged + forceful

Back 11

interior excess
pathogenic factors accumulate in the body, obstructing the outward movement of the qi, blood and yang

Front 12

submerged + forceless

Back 12

interior deficiency
Qi and blood deficiency cannot fill the channels or viscera

Front 13

Autumn pulse

Back 13

floating

Front 14

Winter pulse

Back 14

submerged pulse

Front 15

When is a floating pulse normal?

Back 15

pulse in Autumn, or in thin people; also in patients on vasodilating pharmaceuticals

Front 16

When is a submerged pulse normal?

Back 16

pulse in Winter, or in a heavy person

Front 17

*Slow pulse image
Chi Mai

Back 17

Pulse frequency is less than 3 beats per breath (40-60 bpm), but with regular rhythm

Front 18

Slow pulse indications

Back 18

cold syndrome or
qi deficiency

Front 19

slow + forceful

Back 19

cold accumulation
Cold causes contraction. Cold invades the body, the qi and blood become stagnant.

Front 20

slow + forceless

Back 20

deficiency cold
Cold causes contraction. Deficiency of yang produces cold, the qi and blood becomes stagnant.

Front 21

When is slow pulse normal?

Back 21

Pulse in some healthy persons, like athletes or those engaged in heavy physical labor.

Front 22

*Rapid pulse image
Shuo Mai

Back 22

Pulse frequency is more than 5 beats per breath (90-140 bpm), with regular rhythm

Front 23

Rapid pulse indications

Back 23

heat syndrome

Front 24

rapid + forceful

Back 24

excess heat
Excessive pathogenic heat increases the circulation of the qi and blood which causes the pulse to quicken

Front 25

rapid + thin

Back 25

yin deficiency
yin deficiency causes a relative hyperactivity of yang which causes the pulse to quicken

Front 26

rapid + hollow

Back 26

blood deficiency
blood deficiency causes a relative hyperactivity of yang which causes the pulse to quicken

Front 27

*Excessive pulse image
(full, replete)
Shi Mai

Back 27

Long, wide, and forceful (sense of fullness). Pulse can be felt in all three positions and at all three depths.

Front 28

Excessive pulse indications

Back 28

excess syndrome
hyperactivity of pathogenic factors vs. strong antipathogenic qi
ex: pathogenic cold accumulation, food stagnation, phlegm retention, qi or blood stagnation

Front 29

Excessive pulse as normal pulse

Back 29

When pulse is strong and calm it indicates that the person has sufficient atipathogenic qi and zang fu organ functions.

Front 30

*Deficient pulse image
(empty, vacous)
Xu Mai

Back 30

Wide, forceless at all three positions with either light or heavy pressure, slack (sense of emptiness in this pulse).

Front 31

Deficiency pulse indications

Back 31

deficiency syndrome

Front 32

floating + deficient

Back 32

qi deficiency
-pulse will be forceless

Front 33

submerged + deficient

Back 33

internal deficiency

Front 34

choppy + deficient

Back 34

blood deficiency

Front 35

rapid + deficient

Back 35

yin deficiency

Front 36

slow + deficient

Back 36

yang deficiency

Front 37

Large pulse image
Da Mai

Back 37

Wide, the vessel is wide and thick

Front 38

wide + forceful

Back 38

excess heat
excess pathogenic heat in the interior dilates the blood vessels and accelerates the qi and blood circulation

Front 39

wide + forceless

Back 39

deficiency
extreme deficiency of essence or yin cannot anchor the yang, so yang floats to the lateral margins of the vessels

Front 40

*Thin pulse image
(fine, thready, "small")
Xi Mai

Back 40

Width is very thin, feels like fine thread, but very distinct and clear without interruption of rhythm when pushing on the pulse.

Front 41

Thin pulse indications

Back 41

Qi, blood, or yin deficiency
Excess - dampness

Front 42

When thin pulse is normal

Back 42

Thin pulse more commonly encountered in females than males; if person has smaller constitution, not pathological

Front 43

Long pulse image
Chang Mai

Back 43

long and straight, extend beyond usuall three pulse positions

Front 44

Long pulse indications

Back 44

excess syndromes:
Liver yang rising
Excess interior heat

Front 45

When is long pulse normal

Back 45

When long pulse is moderate in strenth can also be a sign of health in normal person.

Front 46

Short pulse image
Duan Mai

Back 46

Pulse cannot be felt in all three positions.

Front 47

Short pulse indications

Back 47

qi disease

Front 48

short + forceful

Back 48

qi stagnation
qi stagnation fails to move the blood, so vessel is not stretched, the pulse is short

Front 49

short + forceless

Back 49

qi deficiency
qi too weak to move blood, blood circulation is slow and blood in vessels will stagnate

Front 50

*Slippery pulse image
(rolling)
Hua Mai

Back 50

The pulse is quick (though not rapid), slippery, smooth. It is rounded inside the vessel. Like a pearl rolling on a plate

Front 51

Slippery pulse indications

Back 51

excess heat
phlegm or dampness
food stagnation

Front 52

When is slippery pulse normal?

Back 52

Pregnant women in whom it indicates sufficient and harmonious qi and blood. In absence of any pathogenic changes the slippery pulse can be found in the normal person.

Front 53

*Choppy pulse image
(rough, hesitant, sluggish)
Se Mai

Back 53

Pulse seems to be slow and not smooth. Vessel is thin. Rhythm is irregular in force and fullness. Like knife scraping bamboo.

Front 54

Choppy pulse indications

Back 54

excess syndrome
deficiency syndrome

Front 55

choppy and forceful

Back 55

excess syndrome: qi & blood stagnation; food stagnation; phlegm stagnation

Front 56

choppy and forceless

Back 56

deficiency syndrome: blood deficiency; essence deficiency; threatened abortion; seminal emission

Front 57

*Flooding pulse image
(overflowing, surging)
Hóng Mái

Back 57

Easily felt at superficial depth, wide and forceful although fades gently. Vessel is wide and thick. Like ocean wave that comes strongly, but leaves calmly.

Front 58

Flooding pulse indication

Back 58

excess heat on the qi level

Front 59

When flooding pulse is normal

Back 59

in the Summer

Front 60

*Rapid Irregular Pulse Image
(hasty, abrupt, skipping)
Cù Mài

Back 60

Rapid, irregular pauses
feels agitated and urgent, like a man running and suddenly falling down

Front 61

Rapid irregular pulse indications

Back 61

excess syndrome
deficiency of zang fu organs

Front 62

rapid irregular + forceful

Back 62

excess heat
stagnation (pathogen causes blockages)
Excess heat can give rise to stagnation and stagnation can cause heat.

Front 63

rapid irregular + forceless

Back 63

yin and yang disharmony
Yin deficiency gives rise to a rapid pulse. In time, leads to deficiency of yang which limits Heart's ability to push the blood, resulting in irregular pauses.

Front 64

When rapid irregular pulse is normal.

Back 64

In cases of congenital variation

Front 65

*Slow irregular pulse image
(knotted, bound)
Jié Mái

Back 65

Slow, irregular pauses; after missed beat, the pulse immediately resumes

Front 66

slow irregular pulse indication

Back 66

excess syndrome: stagnation, cold, tumor or mass
deficiency syndrome: Heart qi deficiency

Front 67

When slow irregular pulse is normal.

Back 67

In cases of congenital variation

Front 68

*Consistently irregular pulse
(intermittent, regularly intermittent)
Dài Mài

Back 68

regularly missed beats, long pauses

Front 69

Consistently irregular pulse indications

Back 69

excess syndromes
deficiency syndromes

Front 70

consistently irregular + rapid

Back 70

wind syndrome
pain
emotional shock

Front 71

consistently irregular + forceless

Back 71

qi and/or blood deficiency
zang fu organ qi deficiency

Front 72

When consistently irregular pulse is normal

Back 72

in congenital variation; also found during 2nd and 3rd month of pregnancy.

Front 73

*Soggy pulse image
(weak-soft, soft)
Rú Mài

Back 73

Superficial, thin, forceless. If pressed becomes weaker and weaker.
Like a strand of cotton floating on water, feels very thin and indistinct.

Front 74

Soggy pulse indications

Back 74

dampness
deficiency syndrome (if pulse disappears when pressed, the yang is expiring)

Front 75

abnormal soggy pulse indications

Back 75

If this pulse present in a young or otherwise strong patient, the prognosis is not good. Excessive diseases with deficient pulses do not suggest a good prognosis.

Front 76

*Frail pulse image (weak)
Ruò Mài

Back 76

deep, thin, forceless
if more pressure applied, the pulse is lost

Front 77

Frail pulse indications

Back 77

yin, yang, qi or blood deficiency syndrome
sign of decline

Front 78

Hollow pulse image
(scallion stalk)
Kōu Mài

Back 78

floating, wide, and slack, with obscure center; pulse is wide and soft when touched lightly, hollow when seeking, with pressure edges of vessel clearly felt but center is obscure

Front 79

Hollow pulse indications

Back 79

severe condition, loss of blood or yin condition

Front 80

hollow and forceless

Back 80

loss of blood

Front 81

hollow + rapid

Back 81

yin depletion

Front 82

Leather pulse image
(tympanic, drum-skin)
Gé Mài

Back 82

large (thick and wide), rapid and forceful when lightly touched, but hollow when pressed deeply

Front 83

Leather pulse indications

Back 83

blood loss; essence exhaustion; abortion; metrorrhagia and metrostaxis

Front 84

Scattered pulse image
Sàn Mài

Back 84

superficial, scattered without root, uneven rhythm (when seeking or pressing, pulse disappears, rate hard to count)

Front 85

Scattered pulse indications

Back 85

exhaustion of qi, functional failure of zang fu organs; critical condition; when pulse appears in pregnancy in 3rd trimester, labor is imminent; if pulse present in 2nd trimester, means potential miscarriage

Front 86

Hidden pulse image
Fú Mài

Back 86

Pulse cannot be felt when touching, seeking, or pressing. Only by pressing very heavily to the bone can it be felt. Pulsation comes from beneath tendons and bone.

Front 87

Hidden pulse indications

Back 87

pathogens obstructing the interior
syncope (yang deficiency)

Front 88

Hidden pulse normal

Back 88

During pregnancy, woman may have a hidden pulse. In absence of other signs and symptoms this pulse would not indicate pathological change.

Front 89

Confined pulse image (firm)
Láo Mài

Back 89

deep, forceful, wide, taut, long, stable
Deeply located, it cannot be felt by light or moderate pressure

Front 90

Confined pulse indications

Back 90

Interior excess cold syndrome (Hernia, lumps, and masses)

Front 91

Faint pulse (minute pulse) image
Wēi Mài

Back 91

Vessel is extremely thin and forceless. It seems to be felt, and then not felt. When pressing deeply, the vessel and pulse become vague.

Front 92

Faint pulse indications

Back 92

yin, yang, qi or blood deficiency syndrome
sign of decline

Front 93

*Wiry pulse image
(string-taut, taut, string-like)
Xián Mài

Back 93

Long, taut, stable (not vibrating), forceful whether under pressure of the fingers or not. Like a string stretched on a musical instrument.

Front 94

Wiry pulse indications

Back 94

Lv/GB disease
phlegm
pain
malaria

Front 95

Wiry pulse pathogenesis in Lv/GB disease

Back 95

Wirly pulse is manifestation of tense vascular qi. Lv fails to disperse and govern the flow of qi, qi accumulates and strongly pushes the blood which increases the vasotonia and gives rise to the wiry pulse.

Front 96

Wiry pulse pathogenesis in phlegm, pain and malaria

Back 96

Wiry pulse is yin hidden within yang. Pulse caused by qi and blood stagnation. Phlegm, pain and malaria result in imbalance between yin and yang, increasing the tension of vascular qi.

Front 97

When is wiry pulse normal?

Back 97

Spring

Front 98

*Tight pulse image (tense)
Jŭn Mài

Back 98

Pulse rises and falls with strength and vibrates to the left and right.
Tense and taut, forceful, vibrating (unstable, movable)
Like fingers on a tightly stretched and twisted chord, snapping back and forth.

Front 99

Tight pulse indications

Back 99

Cold pattern
food stagnation
pain

Front 100

Moderate pulse image
(slowed-down, lax, retarded, leisurely)
Huăn Mài

Back 100

Pulse beats four times per practitioner's breath, faster than slow pulse.
Feels slow, though normal in rate when timed

Front 101

Normal Moderate pulse

Back 101

Pulse is vigorous with equal intervals, moves smoothly, and is the same in all three positions.

Front 102

Morbid Moderate pulse

Back 102

Pulse is sluggish; it's movement feels slow. Usually accompanied by other pulse qualities.

Front 103

Moderate pulse indications

Back 103

Dampness syndrome
Spleen and Stomach deficiency

Front 104

Moving pulse image
(stirred, spinning bean, bouncing)
Dòng Mài

Back 104

Shape is short and round, slippery and rapid, forceful in the middle position.
Like a bean bouncing in the vessel, with well defined peaks, but without head or tail.

Front 105

Moving pulse indications

Back 105

Sign of struggle between yin and yang.
pain
fright

Front 106

When is a moving pulse normal?

Back 106

Can be seen in pregnant women in their first trimester, at which time this is considered a normal pulse.

Front 107

Racing pulse image
(hurried, urgent, swift)
Jí Mài

Back 107

Extremely rapid. More than 7 times per breath (140-180 bpm). Rhythm is regular.

Front 108

racing + forceful

Back 108

hyperactivity of yang and excessive heat
critical pulse

Front 109

racing + forceless

Back 109

yin exhaustion and antipathogenic qi collapse
critical pulse

Front 110

What are the seasonal changes in pulse quality?

Back 110

Spring - Wiry
Summer - Flooding
Autumn - Floating
Winter - Deep