Pulse diagnosis is one of the most representative special diagnostic methods in traditional Chinese medicine (TCM) and has been emphasized by various generations of medical practitioners in the long history of development. It remains widely used in clinical practice in China today and continues to serve as an important method of diagnosis in TCM.[2]
The main sites for pulse assessment are the radial arteries in the left and right wrists, where it overlays the styloid process of the radius, between the wrist crease and extending proximal, approximately 5cm in length (or 1.9 cun, where the forearm is 12 cun). In traditional Chinese medicine, the pulse is divided into three positions on each wrist. The first pulse closest to the wrist is the cun (inch, 寸) position, the second guan (gate, 關), and the third pulse position furthest away from the wrist is the chi (foot, 尺).[citation needed]
There are two main systems of diagnostic interpretation of pulse findings utilised in the Chinese medicine system. The first is eight principle diagnosis (Cun Kou) utilise overall pulse qualities, looking at changes in the assessed parameters of the pulse to derive one of the traditional 29 pulse types. The traditional 29 pulse types include Floating, Soggy, Empty, Leathery, Scattered, Hollow, Deep, Firm, Hidden, Long, Surging, Short, Rapid, Hasty, Hurried, Moderate, Slow, Knotted, Full, Thready, Minute, Slippery, Choppy, Wiry, Tight, Weak, Regularly intermittent, rapid-irregular, and Stirred. They are analyzed based on several factors, including depth, speed, length, and fluid level. Some pulses are a combination of more than one factor.[3]
The second approach focuses on individual pulse positions, looking at changes in the pulse quality and strength within the position focused on the cause and not the symptoms, with each position having an association with a particular body area.[4] For example, each of the paired pulse positions can represent the upper, middle and lower cavities of the torso, or are associated individually with specific organs. (For example, the small intestine is said to be reflected in the pulse at the left superficial position, and the heart at the deep position.)
Various classic texts cite different arrangements to the pairings of organs, some omitting the second organ from the pulse entirely while others show organ systems reflecting the acupuncture channels (Wuxing, five phase pulse associations), and another the physical organ arrangement used in Chinese herbal medicine diagnosis (Li Shi Zhen[5]). Generally, the commonly used organ associations are: first position on the left hand represents the heart in the deep position and small intestine is in the superficial position, the second, deep is the liver and superficial is the gallbladder, and third the kidney yin is deep and the bladder superficial. On the right hand, the first deep position is representative of the lungs and superficially the large intestine, the second of the spleen and stomach, and the third represents the kidney yang at a deep level and uterus or the pericardium and the san jiao in the deep position. The strengths and weaknesses of the positions are assessed at 3 depths each, namely fu (floating or superficial, 浮), zhong (middle, 中) and chen (deep, 沉).[6] These 9 positions are used to assess the patient diagnostically, along with the different qualities and speed of the pulse.[7][8]
29 pulse types
Classical texts and modern interpretations describe 29 distinct pulse types, each with specific characteristics and clinical implications. These include[9]:
Floating (浮Fu Mai): Felt clearly with light pressure; weak or absent with deeper pressure. Regains strength when pressure is released.
Deep (Chen Mai): Not palpable with light or moderate pressure; only appears under heavy pressure, close to the bone.
Hidden (伏Fu Mai): Extremely deep and difficult to detect; requires pressing to the bone to perceive.
Firm (Lao Mai): Hard, long, and resistant; only appears with heavy pressure and remains unchanging.
Weak (Ruo Mai): Deep, fine, and soft; lacks strength and is difficult to detect.
Slow (Chi Mai): Fewer than 60 BPM or four beats per breath; rhythm is steady but delayed.
Moderate (Huan Mai): Relaxed and harmonious; beats are even and slightly slow, with a soft, smooth quality.
Choppy (Se Mai): Uneven and rough; pulse may hesitate or feel like a knife scraping bamboo.
Knotted (Jie Mai): Slow with irregular pauses; rhythm is inconsistent and stops unpredictably.
Full (Shi Mai): Forceful and broad at all three positions and depths; feels replete and unyielding.
Slippery (Hua Mai): Smooth and flowing, like pearls rolling on a dish; beats are continuous and slick.
Tight (Jin Mai): Tense and forceful, like a twisted rope; vibrates under the fingers.
Long (Chang Mai): Extends beyond its normal position; can be felt past the cun location.
Wiry (Xuan Mai): Taut and straight, like a stretched string; feels tense and resilient.
Minute (Wei Mai): Extremely fine and soft; barely perceptible and may disappear intermittently.
Thready (Xi Mai): Thin and soft, like a silk thread; clear but lacks strength.
Short (Duan Mai): Does not extend fully across the pulse positions; most distinct at the guan.
Intermittent (Dai Mai): Regular pauses in the pulse; intervals may be long and predictable.
Rapid (Shuo Mai): More than five beats per breath; rhythm is fast and steady.
Racing (Ji Mai): Extremely rapid, over seven beats per breath; feels urgent and forceful.
Abrupt (Cu Mai): Rapid with irregular pauses; rhythm is fast but skips beats unpredictably.
Moving (Dong Mai): Short, forceful, and throbbing; felt like a bean under the finger, often localized at the guan.
Large (Da Mai): Broad and full; fills the fingertip but lacks the wave-like quality of the surging pulse.
Surging (Hong Mai): Wide and forceful on arrival, fading on departure; resembles a wave crashing and receding.
Leather (Ge Mai): Floating, wide, and hard with an empty center; feels like a drum surface.
Hollow (Kou Mai): Floating and soft with a large body but empty in the center; disappears under pressure.
Soft (Ru Mai): Floating, fine, and flexible; felt with light pressure but vanishes with deeper touch.
Scattered (San Mai): Floating and forceless; lacks boundaries and becomes chaotic under pressure.
Empty (Xu Mai): General term for a pulse that is forceless, soft, and lacking substance at all levels.
Computational pulse diagnosis (CPD)
Computational pulse diagnosis (CPD) is a technique that applies modern sensing and computational methods to the traditional practice of pulse diagnosis. Conventional pulse diagnosis (PD), widely used in Chinese and other traditional medical systems, relies on tactile assessment of the radial artery to evaluate pulse shape, rhythm, and strength, but its results vary with practitioner experience and training. CPD seeks to replicate this process by employing sensors to capture wrist pulse signals and algorithms to process and analyze them. The procedure typically involves four stages: signal acquisition, preprocessing, feature extraction, and recognition. Advances in machine learning and signal processing have enabled CPD to be investigated for applications in cardiovascular, metabolic, and other health conditions. While significant progress has been reported in both experimental studies and clinical applications, further work is needed to establish standardized datasets and evaluation benchmarks.[10]
Traditional Indian medicine (Ayurveda and Siddha-Veda)
This section needs expansion. You can help by adding to it. (December 2017)
Ayurvedic pulse measurement is done by placing index, middle and ring finger on the wrist. The index finger is placed below the wrist bone on the thumb side of the hand (radial styloid). This index finger represents the Vata dosha. The middle finger and ring finger are placed next to the index finger and represents consequently the Pitta and Kapha doshas of the patient. Pulse can be measured in the superficial, middle, and deep levels thus obtaining more information regarding energy imbalance of the patient.[13]
Indian Physician taking pulse
In ancient Islamic medicine
Doctor taking woman's pulse. Avicenna's Canon manuscript
Pulse diagnosis, or pulsology, was part of medicine in the medieval Islamic world. The Canon of Medicine, published in 1025, included instructions on how to analyse the pulse and from such examination, physicians considered that they could identify problems ranging from jaundice to dropsy, diphtheria, pregnancy, and anxiety.[14]
Further reading
Vasant Lad, Secrets of the Pulse: The Ancient Art of Ayurvedic Pulse Diagnosis, The Ayurvedic Press; 2006 ISBN1-883725-13-5.
Mahesh Krishnamurthy, Nadi Pariksha - The Sacred Science of Pulse Diagnosis, Jayanthi Enterprises; 2018 ISBN978-1-7321901-1-5.
↑ Guo, Chaoxun; Jiang, Zhixing; He, Haoze; Liao, Yining; Zhang, David (2022). "Wrist pulse signal acquisition and analysis for disease diagnosis: A review". Computers in Biology and Medicine. 143 105312. doi:10.1016/j.compbiomed.2022.105312. PMID35203039.
↑ Fenfen, Zhang; Guoshuang, Zhu; Jiali, Chen; Jianhong, Zhang; Sihui, Dong; Shaomin, Cheng (December 2023). "Current status and trends in the modernization of pulse diagnosis research: a bibliometric analysis based on CiteSpace and VOSviewer". Digital Chinese Medicine. 6 (4): 405–415. doi:10.1016/j.dcmed.2024.01.004.
↑ Maciocia, Giovanni (2005). The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Elsevier Churchill Livingstone. ISBN978-0-443-07489-9.[pageneeded]
1 2 Lad, Vasant (2005). Secrets of the Pulse: The Ancient Art of Ayurvedic Pulse Diagnosis. Motilal Banarsidass Publishing House. ISBN978-81-208-2026-5.[pageneeded]
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