Pulse diagnosis
Pulse diagnosis (脉诊, Mài Zhěn) is a foundational TCM diagnostic method where the practitioner feels the radial artery at three wrist positions to assess pulse qualities including rate, rhythm, depth, and strength, revealing the state of internal organs, Qi, Blood, and overall health patterns.
Mài Zhěn
Pulse Diagnosis
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Overview
Pulse diagnosis (脉诊, mài zhěn) is one of the most distinctive and sophisticated diagnostic methods in Traditional Chinese Medicine (TCM). It involves the practitioner placing three fingers on the patient's radial artery at the wrist to assess the quality, rhythm, strength, and depth of the pulse, which reflects the condition of the body's internal organs, Qi, Blood, and overall health.
Unlike simply counting heartbeats in Western medicine, TCM pulse diagnosis evaluates multiple qualitative aspects of the pulse to understand the body's internal landscape. The practitioner feels for subtle variations that indicate different patterns of disharmony. Think of it as reading the body's internal story through the rhythm of blood flow—each pulse quality tells something about which organs may be out of balance, whether there's excess or deficiency, and whether the condition is hot or cold in nature.
Pulse diagnosis is part of the 'Four Examinations' (四诊, sì zhěn)—observation, listening/smelling, inquiry, and palpation—with pulse-taking being the primary palpation method. It remains one of the most valued yet challenging skills for TCM practitioners to master.
Historical Context
Pulse diagnosis has been practiced in China for over 2,000 years. The earliest written records appear in the Zuo Zhuan (Chronicle of Zuo), describing physician Qin He using pulse and complexion to diagnose Marquis Jin's illness. The foundational Huangdi Neijing (circa 200 BCE) established pulse as reflecting qi, blood, and organ function, though early emphasis was on prognosis rather than detailed diagnosis.
Wang Shuhe's Mai Jing (Pulse Classic, 3rd century CE) was the first comprehensive pulse text, systematizing 24 pulse types and establishing the wrist as the primary diagnostic site. This made pulse diagnosis teachable and standardized. Li Shizhen's Bin Hu Mai Xue (1564) expanded the classification to 27 types and refined organ-position correspondences, creating the framework still used today. Li Zhongzi later added the 28th pulse type.
While tongue diagnosis gained prominence during the Ming and Qing dynasties, pulse diagnosis remained the preeminent diagnostic method. Today, research combines traditional pulse-taking with modern sensors and computational analysis to quantify and validate this ancient practice.
Comparison
Floating Pulse (Fu Mai)
浮脉Felt with light pressure, disappears with heavy pressure. Like wood floating on water. Indicates external/surface conditions or, if weak, can indicate internal deficiency with Yang floating outward.
Deep Pulse (Chen Mai)
沉脉Only felt with firm pressure. Indicates interior conditions—when forceful suggests interior excess; when weak suggests interior deficiency.
Slow Pulse (Chi Mai)
迟脉Less than 4 beats per breath (under 60 BPM). Indicates cold patterns—forceful means excess cold; weak means deficient cold (Yang deficiency).
Rapid Pulse (Shu Mai)
数脉More than 5 beats per breath (over 90 BPM). Indicates heat patterns—forceful means excess heat; weak means deficient heat (Yin deficiency with empty fire).
Slippery Pulse (Hua Mai)
滑脉Feels smooth and flowing, like pearls rolling on a plate. Indicates phlegm, dampness, food stagnation, or (importantly) pregnancy. Also seen in healthy young people.
Wiry Pulse (Xian Mai)
弦脉Feels taut like a guitar string. Indicates Liver/Gallbladder disorders, pain, phlegm-fluid retention, or emotional tension. Common in hypertension and stress.
Weak Pulse (Ruo Mai)
弱脉Deep, soft, thin, and lacking force. Indicates Qi and Blood deficiency, often seen in chronic illness or constitutional weakness.
Choppy Pulse (Se Mai)
涩脉Uneven, hesitant flow like a knife scraping bamboo. Indicates Blood stasis, Blood deficiency, or essence depletion. Requires attention to other signs.
Three Positions (Cun, Guan, Chi)
寸、关、尺The pulse is felt at three adjacent positions along the radial artery: Cun (inch/distal), Guan (gate/middle), and Chi (foot/proximal). Each position corresponds to different body regions and organs. The Cun position reflects the upper body and Heart/Lung; Guan reflects the middle body and Liver/Spleen; Chi reflects the lower body and Kidneys.
Three Depths (Floating, Middle, Deep)
浮、中、沉取The practitioner applies three levels of pressure: light touch (floating/浮取) to sense superficial conditions, moderate pressure (middle/中取), and firm pressure (deep/沉取) to sense deeper conditions. This reveals whether pathology is at the surface or interior of the body.
Eight Parameters of Pulse
脉象八要素Modern standardization identifies eight measurable elements: depth (superficial to deep), rate (slow to fast), regularity (rhythm), width (narrow to wide), length, smoothness, stiffness, and strength. These help systematically describe any pulse quality.
Twenty-Eight Pulse Types
二十八脉The most commonly used classification includes 28 distinct pulse qualities such as: floating, deep, slow, rapid, slippery, choppy, wiry, tight, weak, and others. Each type indicates specific patterns of imbalance. Some are 'simple' pulses (one quality) while others are 'compound' (combining multiple qualities).
Stomach Qi in the Pulse
脉有胃气A healthy pulse should have 'stomach qi'—meaning it feels gentle, smooth, and rhythmic with a sense of vitality. This reflects adequate digestive function and overall life force. A pulse lacking stomach qi indicates serious illness.
Organ Correspondences
脉位对应脏腑Each pulse position corresponds to specific organs: Left wrist—Cun=Heart, Guan=Liver, Chi=Kidney (Yin); Right wrist—Cun=Lung, Guan=Spleen, Chi=Kidney (Yang). Changes at specific positions indicate problems in corresponding organs.
Practical Application
Taking the Pulse: The patient should rest for at least 15 minutes before diagnosis, sitting or lying with the arm extended at heart level, palm facing up. The practitioner places three fingers (index, middle, ring) on the Cun, Guan, and Chi positions. Diagnosis should take at least one minute, applying floating, middle, and deep pressure at each position—this is called 'three positions, nine indicators' (三部九候).
What to Assess: The practitioner evaluates: rate (normal is 4-5 beats per breath), rhythm (regular or irregular), depth (superficial or deep), width (thin or wide), length, force (strong or weak), and quality (smooth, choppy, wiry, etc.). The overall impression is matched to one of the 28 pulse types, though combinations are common.
Clinical Example: A patient with a floating, rapid pulse at all positions likely has an external heat condition (like early-stage fever). A deep, slow, weak pulse suggests internal cold with Yang deficiency. A wiry, rapid pulse in the Guan position points to Liver fire rising. These findings guide herb and acupuncture point selection.
Clinical Relevance
Pulse diagnosis guides treatment strategy at every level of TCM practice. It helps determine: (1) whether the condition is external (surface) or internal; (2) whether there is excess or deficiency; (3) whether the nature is hot or cold; and (4) which organs are affected. This directly informs herb formula selection and acupuncture point choices.
Certain pulse patterns have strong clinical correlations. A slippery pulse often indicates phlegm, dampness, food stagnation, or pregnancy. A wiry pulse suggests Liver imbalance, pain, or tension. A choppy pulse indicates Blood stasis or deficiency. An intermittent pulse may signal heart conditions requiring careful evaluation.
Modern research using pulse sensors has validated some traditional findings—for example, correlating wiry pulses with arterial stiffness and hypertension. However, pulse diagnosis requires years of training to master, and inter-practitioner reliability remains a challenge, highlighting the importance of combining pulse findings with other diagnostic methods (四诊合参).
Common Misconceptions
"Pulse diagnosis alone can diagnose any disease": While pulse diagnosis is valuable, TCM emphasizes 'four examinations combined' (四诊合参). Relying solely on pulse would be incomplete and potentially inaccurate. Environmental factors, emotions, recent activity, and individual variation all affect the pulse.
"There is one correct pulse interpretation": Different TCM schools have varying organ-position correspondences and pulse interpretations. What matters is consistency within a diagnostic framework and correlation with other findings.
"Modern practitioners cannot learn pulse diagnosis": While challenging, pulse diagnosis can be learned through dedicated practice. It requires patience, sensitivity training, and ideally guidance from experienced practitioners. Modern teaching tools and standardization efforts are making it more accessible.
"Pulse diagnosis is purely subjective and unscientific": Modern research using sensors and waveform analysis has demonstrated measurable differences between pulse types. While the subjective element remains, the underlying phenomena are real and increasingly quantifiable.
Classical Sources
Huáng Dì Nèi Jīng (Yellow Emperor's Inner Classic)
Su Wen, Various chapters脉者，血之府也
The pulse is the residence of Blood. This foundational text describes the pulse as reflecting qi, blood, and organ function.
Mài Jīng (The Pulse Classic)
Complete text脉经是中医脉学的奠基之作
Written by Wang Shuhe (180-270 CE), this was the first systematic text on pulse diagnosis, describing 24 pulse types and establishing standardized methods.
Bīn Hú Mài Xué (The Lakeside Master's Study of the Pulse)
Complete text濒湖脉学增为二十七脉
Compiled by Li Shizhen in 1564, this text expanded pulse types to 27 and modified organ-position correspondences, becoming a primary clinical reference.
Nán Jīng (Classic of Difficulties)
Chapters on pulse独取寸口以诊全身
This text further developed the theory of diagnosing the whole body through the cun kou (wrist pulse) alone.
Modern References
Chinese Pulse Diagnosis: A Contemporary Approach
Develops the 'Dragon Rises Pulse Method' with detailed descriptions of 31 pathological pulse conditions and position charts for Western practitioners.
The Lakeside Master's Study of the Pulse (Bin Hu Mai Xue)
English translation of the classical Ming dynasty text that established the 27-pulse system used in modern clinical practice.
The Secret of Chinese Pulse Diagnosis
Practical guide for Western practitioners on mastering traditional pulse diagnosis techniques.