Pulse

Table of contents

The normal pulse

The pulse should have three qualities, which are described as having Stomach-Qi, having spirit and having a root.

Stomach-Qi

A pulse is said to have Stomach-Qi when it feels ‘gentle’, ‘calm’ and is relatively slow (four beats per respiratory cycle).

A pulse with Stomach-Qi is not rough. The Stomach is the Sea of Food, the Root of the Post-Heaven Qi and the origin of Qi and Blood. For this reason, it gives ‘body’ to the pulse. If the pulse feels too rough or hard, it indicates that the Stomach function is impaired. The ‘Simple Questions’ in chapter 19 says: ‘The Stomach is the Root of the 5 Yin organs; the Qi of the Yin organs cannot reach the Lung channel [i.e. the radial artery on the Lung channel] by itself but it needs Stomach-Qi ... if the pulse is soft it indicates that it has Stomach-Qi and the prognosis is good.

This particular quality of being ‘soft’ (but not too soft), ‘gentle’, ‘calm’ and ‘not rough’ is important: beginners often take a rough and hard quality of the pulse as being ‘healthy’.

Spirit

The pulse is said to have spirit when it is soft but with strength, neither big nor small, and regular. It should also be regular in its quality: that is, it should not change quality very easily and frequently. A pulse that has these qualities reflects a good state of Heart-Qi and Blood.

Root

A pulse is said to have root in two different senses. It has a root when the deep level can be felt clearly, and also when the Rear position can be felt clearly. Having a root indicates that the Kidneys are healthy and strong.

Thus a pulse that has spirit, Stomach-Qi and root indicates a good state of the Mind, Qi and Essence, respectively.

When interpreting the pulse one should therefore pay attention to the following elements and in this order:

1. Feel the pulse as a whole 2. Feel whether the pulse has spirit, Stomach Qi and root 3. Feel the three levels and the three positions 4. Feel the strength of the pulse 5. Feel the overall quality of the pulse (if there is one) 6. Feel the quality of individual pulse positions

Pulse

Pulse

NameClinical SignificanceFeelingKindAspectBody Psych
Invasion of external Wind Yin deficiency (interior conditions)

This pulse can be felt with a light pressure of the fingers, just resting the fingers on the artery.

Floating Deep Slow Rapid Empty Full
depth rate strength size length shape rhythm
Pathogenic factor in the Interior (Deep-Full) Yang deficiency (Deep-Weak)

This pulse is the opposite to floating: it can only be felt with a heavy pressure of the fingers and is felt near the bone.

Deep
depth rate strength size length shape rhythm
Cold patternEmpty-Cold (Slow and Weak) Full-Cold (Slow and Full)

This pulse has three beats per respiration cycle

Slow
rate
Heat pattern Full-Heat (Rapid and Full) Empty-Heat (Rapid and Floating-Empty)

This pulse has more than five beats per each respiration cycle

Rapid
rate
Qi deficiency

The Empty pulse feels rather big but soft.

Empty
strength
Full pattern Full-Heat (Full-Rapid) Full-Cold (Full-Slow)

This pulse feels full, rather hard and rather long.

Full
strength
Phlegm Dampness Retention of food Pregnancy

A Slippery pulse feels smooth, rounded, slippery to the touch, as if it were oily. It slides under the fingers.

Other
shape
Blood deficiency Exhaustion of Body Fluids

This pulse feels rough under the finger

Other
shape
Heat pattern

This pulse is basically longer than normal

Full
length
Severe Qi deficiency Stomach-Qi deficiency

Occupies a shorter space than the normal position

Empty
length
Full-Heat Empty-Heat (Overflowing-Empty)

This pulse feels big, extending beyond normal pulse position.

Full
size
Blood deficiency Dampness with severe Qi deficiency

This pulse is thinner than normal

Empty
size
Severe deficiency of Qi and Blood

It is extremely thin, small and difficult to feel

Empty
size
Cold Exterior Cold (Tight-Floating) Interior Full-Cold (Tight-Full-Deep) Interior Empty-Cold (Tight-Weak-Deep) Pain

This pulse feels twisted like a thick rope

Full
shape
Liver disharmony Pain Phlegm

This pulse feels taut like a guitar string. The Wiry pulse really hits the fingers.

Other
shape
G

This pulse has four beats for each respiration cycle

Slow
rate
Haemorrhage Forthcoming haemorrhage (Hollow and Rapid)

Empty in the middle, felt superficial and deep.

Floating
shape
Severe deficiency of Kidney-Essence Severe deficiency of Kidney-Yin

This pulse feels hard and tight at the superficial level and stretched like a drum, but it feels completely Empty at the deep level. It is a large pulse, not thin.

Floating
depth
Blood stasis Interior Cold (Firm and Slow) Pain

Wiry pulse at the deep level

Deep
shape
Dampness with Qi deficiency Deficiency of Yin Deficiency of Essence

The Soggy pulse feels very soft and is only slightly floating.

Empty
other
Yang deficiency Blood deficiency

Felt only at the deep level

Empty
strength
Severe deficiency of Qi and Blood Severe deficiency of Kidney-Qi Serious condition

This pulse feels very small and is relatively superficial

Empty
strength
Severe Yang deficiency

This pulse feels as if it were hidden beneath the bone

Deep
depth
Shock anxiety fright pain

The Moving pulse has a round shape like a bean; it is short and it ‘trembles’ under the finger

Rapid
length
Severe Heat Deficiency of Heart-Qi Heart-Fire

This pulse is Rapid and it stops at irregular intervals

Rapid
rhythm
Cold with deficiency of Heart-Yang

This pulse is Slow and it stops at irregular intervals

Slow
rhythm
Serious problem in Internal Organ Heart problem (in Western medical sense)

This pulse stops at regular intervals

Other
rhythm
Fire exhausting Yin

This pulse is very rapid, but it also feels very agitated and urgent

Rapid
rate

Pulse Positions

Pulse positions

NameSidePositionOrganOverviewBody Psych
left
distal

Skin—Ht Blood/Yin Def, Ht Fire/Stagnation Superficial—Home Middle—Ht Qi/Yang def, Damp affecting Ht Absent—Blocked/stag

left
middle

Superficial—Lr Blood/Yin def, Lr Fire Middle—Home Deep—GB Qi def, GB damp Absent—Blocked/stag

left
proximal

Middle—Ki blood/yin def Deep—Home Absent—Ki Qi/ yang def Blocked/stag

right
distal

Skin—Lu Blood/Yin Def, Lu heat (infection) Superficial—Home Middle—Lu Qi/Yang def, Lu Damp Absent—Blocked/stag

right
middle

Superficial—St Yin def, St Fire Middle—Home Deep—Sp Qi/Yang def, Sp damp Absent—Blocked/stag

right
proximal

Middle—Ki or Bl infection or inflammation, neck shoulder pain Deep—Home Absent—Blocked/stag

Summary

Pulse Kinds

The 28 pulse qualities can be grouped into six groups of pulses with similar qualities :

  • The Floating kind: Floating – Hollow – Leather
  • The Deep kind: Deep – Firm – Hidden
  • The Slow kind: Slow – Knotted
  • The Rapid kind: Rapid – Hasty – Hurried – Moving
  • The Empty kind: Empty – Weak – Fine – Minute – Soggy – Short – Scattered
  • The Full kind: Full – Overflowing – Wiry – Tight – Long

It may help us to understand the nature of pulse qualities if we realize that they reflect different aspects of the pulse: for example, Slow and Rapid clearly refer to an irregularity of the rate of the pulse, while Knotted, Hasty and Intermittent refer to an irregularity of the rhythm.

Pulse aspects

These different aspects are:

  • According to depth: Floating – Deep – Hidden – Firm – Leather
  • According to rate: Slow – Rapid – Slowed-down – Hurried – Moving
  • According to strength: Empty – Full – Weak – Scattered
  • According to size: Overflowing – Fine – Minute
  • According to length: Long – Short – Moving
  • According to shape: Slippery – Choppy – Wiry – Tight
  • – Moving – Hollow – Firm

  • According to rhythm: Knotted – Hasty – Intermittent
  • Invasion of external Wind
  • Yin deficiency (interior conditions)
  • Invasion of external Wind
  • Yin deficiency (interior conditions)