Pulse diagnosis

Pulse diagnosis (PD) is a diagnostic tool used for over 3000 years in various Asian countries, which classifies pulse signals from different health conditions and serves as an important reference for clinical diagnosis and home monitoring. ^[1] It is a diagnostic technique used in traditional Chinese medicine, Ayurveda, traditional Mongolian medicine, Siddha medicine, traditional Tibetan medicine, and Unani.

Traditional Chinese medicine

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]

Historical development

Pulse diagnosis has a long history within traditional Chinese medicine, with its earliest systematic descriptions found in the Huangdi Neijing (Yellow Emperor's Classic of Internal Medicine), compiled around the 2nd century BCE. The Huangdi Neijing established the theoretical foundation for pulse diagnosis by describing the relationship between pulse qualities and pathological conditions of the internal organs, and it introduced three methods of pulse palpation, including the "three regions and nine indicators" (三部九候, sanbu jiuhou) method, the renying cunkou (人迎寸口) method, and the cunkou (寸口) method alone. ^[3] In the 3rd century CE, Wang Shuhe (王叔和) authored the Mai Jing (Pulse Classic), the first monograph devoted entirely to pulse diagnosis. This text systematized pulse taking methods and described 24 types of pulse, providing a comprehensive framework that influenced all subsequent developments in pulse diagnosis across East Asia. ^[4] During the Ming dynasty, Li Shizhen (李时珍) wrote the Binhu Maijue (Lakeside Master's Study of the Pulse, 濒湖脉学) in 1564, which refined the classification to 27 types of pulse and remains one of the most widely referenced texts on pulse diagnosis in TCM education and clinical practice today. ^[5] Modern standardized TCM textbooks generally recognize 28 common pulse types for clinical teaching and practice. ^[6]

Pulse diagnosis within the four diagnostic methods

In traditional Chinese medicine, pulse diagnosis (切诊, qie zhen) is one of the four fundamental diagnostic methods known collectively as the "four examinations" (四诊, si zhen). The other three are inspection (望诊, wang zhen), which involves observing the patient's appearance, complexion, and tongue; auscultation and olfaction (闻诊, wen zhen), which involves listening to the patient's voice and breathing and noting bodily odors; and inquiry (问诊, wen zhen), which involves asking the patient about symptoms and medical history. Palpation includes not only pulse taking but also palpation of the body surface. The Huangdi Neijing emphasizes the integration of all four methods for accurate diagnosis, cautioning that reliance on any single method alone may lead to diagnostic errors. ^[7]

Normal pulse

A normal pulse (平脉, ping mai, also called 常脉 chang mai) in TCM is characterized by a rate of approximately four to five beats per breath cycle of the practitioner, corresponding roughly to 60 to 90 beats per minute. The normal pulse has moderate force, can be felt at all three positions (cun, guan, and chi) with a smooth and even rhythm, and possesses a quality described as having "stomach qi" (胃气, wei qi), meaning it feels gentle, harmonious, and orderly. The Huangdi Neijing states that the presence of stomach qi in the pulse is the hallmark of a favorable prognosis, while its absence indicates a serious condition. The normal pulse also varies with the seasons: it tends to be slightly wiry (弦) in spring, slightly surging (洪) in summer, slightly floating (浮) in autumn, and slightly deep (沉) in winter. Individual factors such as age, sex, body constitution, and physical activity can also influence normal pulse presentation. ^{[8] [9]}

Pulse positions and organ correspondences

The main sites for pulse assessment are the radial arteries in the left and right wrists, where the artery passes adjacent to the styloid process of the radius. In traditional Chinese medicine, the pulse is assessed along a region known as the cun kou, extending proximally from the wrist crease for approximately 1.9 cun, which corresponds to about 3 - 5 cm, based on the proportional system in which the forearm length between the wrist and elbow creases is defined as 12 cun. ^[10] 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). ^{[11] [12]}

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. ^[13]

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. ^[14] 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 ^[15] ). 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). ^[16] These 9 positions are used to assess the patient diagnostically, along with the different qualities and speed of the pulse. ^{[17] [18]}

29 Pulse Types

Classical texts and modern interpretations describe 29 distinct pulse types, each with specific characteristics and clinical implications. These include: ^[19]

1. 

   Fu Mai 浮脉

   浮脉 Fu Mai (Floating, Superficial): 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.
2. 洪脉 Hong Mai (Surging, Flooding): Floating, large (wide), comes on exuberant, departs debilitated. "Coming onto the shore with force and retreating without force."
3. 革脉 Ge Mai (Leathery, Drumskin, Tympanic, Hard): Bowstring and large with an empty center; feels like the head of a drum. Floating, large, hard, and resistant to pressure.
4. 芤脉 Kou Mai (Hollow, Scallion Stalk, Green Onion): Floating, soft, large body but empty in the center. Forceless—large and weak.
5. 濡脉 Ru Mai (Soft, Soggy): Floating, fine, soft, and flexible. Can be felt with light pressure but disappears with heavy pressure. "Like a silk thread in water."

6. 

   San Mai 散脉

   散脉 San Mai (Scattered): Floating, large, without root; with light pressure it is irregular and chaotic; with heavy pressure it is impalpable. "Like wind blowing hair or scattered leaves."
7. 虚脉 Xu Mai (Forceless, Empty, Deficient): A generalized term for forceless pulses; floating, large, slow, empty, soft, and weak.
8. 沉脉 Chen Mai (Deep): Located near the bone. Cannot be detected with light or moderate pressure but felt with heavy pressure.
9. 伏脉 Fu Mai (Hidden): Very deep, difficult to feel, under the sinews, requiring heavy pressure to obtain.
10. 牢脉 Lao Mai (Firm, Confined): Not felt superficially, only with heavy pressure. Hard, firm, large, bowstring, and long.
11. 弱脉 Ruo Mai (Weak): Deep, fine, soft, like a thread.

12. 

    Chi Mai 迟脉

    迟脉 Chi Mai (Slow): Below 60 BPM or less than 4 beats per practitioner's breath.
13. 缓脉 Huan Mai (Slowed down, Moderate, Relaxed): Level and harmonious, relaxed and forceful. About 60 BPM, beats come and go slowly.
14. 涩脉 Se Mai (Choppy, Hesitant): Slow, stagnant, difficult, fine, may stop and lose a beat but then recovers. Feels like a knife scraping bamboo.
15. 结脉 Jie Mai (Knotted, Bound): Slow, relaxed, stops at irregular intervals.

16. 

    Shi Mai 实脉

    实脉 Shi Mai (Excess, Full, Replete, Forceful): Bowstring, large, hard, and replete, with surplus at all three positions.
17. 滑脉 Hua Mai (Slippery, Rolling): Smooth, flowing, uninhibited; feels like pearls rolling in a dish.
18. 紧脉 Jin Mai (Tight, Tense): Tight, strong, feels like a taut or twisted rope.

19. 

    Chang Mai 长脉

    长脉 Chang Mai (Long): Long and felt beyond its normal location, extending past the cun position.
20. 弦脉 Xuan Mai (Wiry, Taut): Straight, long, tense, like pressing a tight string of a musical instrument.
21. 微脉 Wei Mai (Minute, Faint, Indistinct): Extremely fine, soft, barely palpable, sometimes lost.
22. 细脉 Xi Mai (Thready, Thin): Soft, like a silken thread, weak but not scattered by pressure.
23. 短脉 Duan Mai (Short): Does not extend to its full range; most distinct at the Guan position.
24. 代脉 Dai Mai (Regularly Intermittent): Relaxed and weak, stops at regular intervals, sometimes long.

25. 

    Shuo Mai 数脉

    数脉 Shuo Mai (Rapid): Above 90 BPM, or more than 5 beats per breath.
26. 疾脉 Ji Mai (Racing, Swift, Hurried): Very rapid, over 120 BPM, or 7–8 beats per breath.
27. 促脉 Cu Mai (Rapid-Irregular, Skipping, Abrupt): Rapid and irregularly interrupted.
28. 动脉 Dong Mai (Moving, Throbbing, Stirring): Slippery, rapid, forceful, feels like a bean—strong and throbbing abruptly.
29. 大脉 Da Mai (Large, Big): Large, fills up the fingertip, forceful. Similar to the Surging pulse but without the wave-like shape.

Computational pulse diagnosis (CPD)

A typical waveform of pulse

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. ^[20]

Traditional Indian medicine (Ayurveda and Siddha-Veda)

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. ^[21]

In Ayurveda, advocates claim that by taking a pulse examination, imbalances in the three Doshas (Vata, Pitta, and Kapha) can be diagnosed. ^[22] The ayurvedic pulse also claims to determine the balance of prana, tejas, and ojas. ^{[23] [21]}

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. ^[24]

Further reading

• Vasant Lad, Secrets of the Pulse: The Ancient Art of Ayurvedic Pulse Diagnosis, The Ayurvedic Press; 2006 ISBN   1-883725-13-5.
• Mahesh Krishnamurthy, Nadi Pariksha - The Sacred Science of Pulse Diagnosis, Jayanthi Enterprises; 2018 ISBN   978-1-7321901-1-5.
• Bob Flaws, The Secret of Chinese Pulse Diagnosis, 1995 ISBN   978-0-9361856-7-5.

References

1. 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. PMID   35203039.
2. 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 .
3. Unschuld, Paul U. (2003). Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. University of California Press. ISBN   978-0-520-23322-5.
4. Wang, Shuhe (1997). The Pulse Classic: A Translation of the Mai Jing. Translated by Yang Shou-zhong. Blue Poppy Press. ISBN   978-0-936185-75-4.{{cite book}}: Check |isbn= value: checksum (help)
5. Li, Shizhen (1998). Binhu Maijue (Lakeside Master's Study of the Pulse). Translated by Bob Flaws. Blue Poppy Press. ISBN   978-0-936185-67-9.{{cite book}}: Check |isbn= value: checksum (help)
6. Deng, Tietao (2016). Diagnostics of Traditional Chinese Medicine (7th ed.). China Press of Traditional Chinese Medicine. ISBN   978-7-5132-3228-4.{{cite book}}: Check |isbn= value: checksum (help)
7. Maciocia, Giovanni (2015). The Foundations of Chinese Medicine: A Comprehensive Text (3rd ed.). Elsevier. ISBN   978-0-7020-5216-3.
8. Maciocia, Giovanni (2018). Diagnosis in Chinese Medicine: A Comprehensive Guide (2nd ed.). Elsevier. ISBN   978-0-7020-4496-0.
9. Zhu, Wenfeng (2007). Diagnostics of Traditional Chinese Medicine (2nd ed.). China Press of Traditional Chinese Medicine. ISBN   978-7-80156-813-2.{{cite book}}: Check |isbn= value: checksum (help)
10. Zhang, Yi (2021). "Interpretation of acupoint location in traditional Chinese medicine teaching: Implications for acupuncture in research and clinical practice". The Anatomical Record. 304 (11): 2372–2380. doi: 10.1002/ar.24618 . ISSN   1932-8494.
11. Themes, U. F. O. (2016-06-12). "Getting started: pulse techniques, procedures and the development of a methodical approach to pulse assessment". Thoracic Key. Retrieved 2025-12-23.
12. Zhu, Xing; Wang, Fanyu; Mao, Jian; Huang, Yulin; Zhou, Peng; Luo, Jingjing. "A Protocol for Digitalized Collection of Traditional Chinese Medicine". Phenomics (Cham, Switzerland). 3 (5): 519–534. doi:10.1007/s43657-023-00104-2. ISSN   2730-5848. PMC   10593717 . PMID   37881314.
13. "The 29 Pulses in Chinese Medicine (TCM) Pulse Diagnosis". Sacred Lotus. Retrieved 31 May 2019.
14. Walsh, Sean; King, Emma (2008). Pulse Diagnosis: A Clinical Guide. Elsevier Health Sciences. ISBN   978-0-7020-4788-6. OCLC   769189437.^{[ page needed ]}
15. Li, Shi Zhen. Lakeside Masters Study of the Pulse. 1999. Boulder; Blue Poppy Press.^{[ page needed ]}
16. Hammer, Leon (2012). Handbook of Contemporary Chinese Pulse Diagnosis. Eastland Press. ISBN   978-0-939616-76-3.^{[ page needed ]}
17. Maciocia, Giovanni (2005). The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Elsevier Churchill Livingstone. ISBN   978-0-443-07489-9.^{[ page needed ]}
18. Franglen, Nora (2007). Simple Guide to Acupuncture: The Five Elements. Five Element School. ISBN   978-0-9546793-2-3.^{[ page needed ]}
19. "The 29 Pulses in Chinese Medicine (TCM) Pulse Diagnosis". www.sacredlotus.com. Retrieved 2025-10-24.
20. Guo, Chaoxun; Jiang, Zhixing; He, Haoze; Liao, Yining; Zhang, David (2022-04-01). "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. ISSN   0010-4825.
21. Lad, Vasant (2005). Secrets of the Pulse: The Ancient Art of Ayurvedic Pulse Diagnosis. Motilal Banarsidass Publishing House. ISBN   978-81-208-2026-5.^{[ page needed ]}
22. "Under pressure - Health - Specials - smh.com.au". www.smh.com.au. 2005-05-19. Retrieved 2017-08-09.
23. Peter Koch, December 1, 2012: Ayurvedische Pulsdiagnose
24. Hajar, R (April 2018). "The Pulse in Medieval and Arab-Islamic Medicine: Part 2". Heart Views. 19 (2): 76–80. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_100_18 . PMC   6219283 . PMID   30505402.