Pulse Diagnosis in TCM Acupuncture Theory

TCM Theory

Pulse Diagnosis in TCM Acupuncture Theory

One of the most common questions that people ask about acupuncture is: "Why does my acupuncturist check my pulse?"

Pulse and tongue diagnosis are two of the more important diagnostic tools in Chinese medicine. They are both used to derive a TCM diagnosis for your condition which is used to plan your treatment. Of the diagnostic tools, pulse diagnosis is one of the more important tools used in Chinese and Japanese acupuncture and herbal medicine. While tongue diagnosis provides valuable clinical information, the pulse can be used to gain a deep understanding of the patient on many levels. "Mastering" pulse diagnosis is difficult without the guidance of a skilled teacher. Even at basic levels, however, the pulse provides immediate and specific information that can help clarify contradictory diagnostic information and symptomology.

Common Pulse Locations and Related Meridians
Left Wrist Right Wrist
Cun (inch) - 1st position HT / SI LU / LI
Guan (barr) - 2nd position LV / GB SP / ST
Chi (foot) - 3rd position KD / UB PC / TH

Location of the Pulse: The Guan (Second) Position is found opposite the styloid process of the radius, the Cun Position is found between the Guan Position and the wrist and the Chi position is found at a point equal the distance between Guan and Cun.

Alternative Meridian Relationships
Pulse Classic:
Left Wrist Right Wrist
Cun (inch) - 1st position HT / SI LU / LI
Guan (barr) - 2nd position LV / GB SP / ST
Chi (foot) - 3rd position KD / UB Mingmen / Lower Burner
Golden Mirror of Medical Traditions:
Left Wrist Right Wrist
Cun (inch) - 1st position HT / PC LU / Chest
Guan (barr) - 2nd position LV / GB SP / ST
Chi (foot) - 3rd position KD / LI / SI PC / TH
Alternative view used in China:
Left Wrist Right Wrist
Cun (inch) - 1st position HT LU
Guan (barr) - 2nd position LV SP
Chi (foot) - 3rd position KD Yin KD Yang

Clinical significance of the Pulse at varying levels
superficial (skin level) - generally shows exogenous pathogens
middle - generally shows state of ST/SP Qi
deep (bone level) - generally shows internal conditions

Pulse Descriptions, Qualities and Clinical Significance




By Depth:
Floating (superficial) easily felt at the superficial level
not as significant as you feel deeper
external condition/pathogen
+ empty = yin a/or blood def
+ rapid = wind heat
+ tight/slow = wind cold

Sinking (deep) felt only at the deep level interior condition/obstruction
+ rapid = internal heat
+ slow = internal cold
+ slippery = internal damp/phlegm
+ empty = qi or yang def
By Frequency:
Slow less than 4 beats per breath (< 60bpm ) cold condition a/or pathogenic factor
+ floating = exterior wind cold
+ sinking/empty = yang def
Rapid more than 5 beats per breath ( > 90bpm ) hot condition a/or pathogenic factor
+ floating = external wind heat
+ sinking = internal heat
+ full = excess heat
+ empty = empty heat
By Quality/Shape:
Hesitant (choppy) rough and uneven blood a/or jing stagnation
Slippery smooth with a viscous sensation excess dampness, retention of food, pregnancy
+ rapid = damp heat
+ slow = cold damp obstruction
Tight tension with side to side movements (thicker than a wiry pulse) excess cold - interior or exterior, commonly associated with pain
Wiry tension with no side to side movements (thinner than a tight pulse) LV/GB disharmony
By Width:
Big (excess, overflowing) broad but with distinct edges excess heat, commonly in ST or Intestines
Thin (thready, fine) fine but with distinct edges blood a/or qi deficiency
By Strength:
Empty (deficient) wide but not strong, disappears with slight pressure, forceless blood a/or qi deficiency
Full (excess) wide and strong, felt with strength at all levels excess condition, often excess heat with rebellious Qi
By Length:
Short not felt in all 3 positions qi deficiency
Long felt beyond the 3 positions excess, heat, generally considered normal in absence of other qualities
By Rhythm:
Hurried (abrubt) rapid with irregularly missed beats heat agitating qi & blood
Intermittent regularly skipped beats heart disharmony, exhaustion of zang qi
Knotted slow with irregularly missed beats cold obstruction, ht qi or yang deficiency, general def of Qi, Blood a/or Jing

Description of a healthy ("normal") pulse
  • The pulse should be felt in all 9 positions
  • The quality of the pulse should have "spirit" and not collapse or feel hard or unyielding
  • The rhythm should be even and balanced and regular beats of 60-90bpm

Factors which influence the Pulse
  • Age - the strength and quality of the pulse will decline as a person ages.
  • Gender - Men are generally stronger on the left and Women are generally stronger on the right.
  • Seasonal Influences:
    ·· Spring - more wiry
    ·· Summer - stronger
    ·· Winter - deeper

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