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Pulse Diagnosis

Wang Shu He wrote book, Mai Jing

I.

Location of pulses
A.

Classic pulses
1. Ren Yin pulse = ST-9 [heaven] indicates strength of Gu Qi [strong = good px]
2. Cun Kou pulse [earth] = LU-7 most commonly used
a. Why can this pulse be used as the only place to take the pulse today?
i. Fei Chao Bai Mai = Lung faces/meets 100 channels & collaterals
ii. LU is in UJ; all the meridians/collaterals flow towards the Lung
iii. Thus, Qi & Xue flow has close relationship w/ lung (flow follows breaths waves)
3. Fu Yang pulse [human] = ST-42 (highest part of dorsal of foot) if in coma/closing/collapse syndrome, the fu
yang pulse is very important to determine px of patient

B.

Left:
Right:

C.

Yin vs. Yang


i. If pulse is felt more superficially in normal conditions indicates yang organ (LI);
press slightly deeper, but still w/in the 1st level to feel the yin organ (LU)
ii. Move fingers more lateral feel yang more; more medially more yin

KID (yin) is mother of LIV is mother of HT


KID (yang), SP, LU

II. Method of taking pulses


A.

Time to feel pulse


1. Ideally: early morning w/ the rising of the sun (5-6 am)
2. Seasonal changes will occur, too.

B.

Position
1. Arm should be at level of patients heart (a patients arm lying on the table is actually too low when the patient
is supine)
2. Classic position: patient is sitting (or lying down), w/ pulse pillows for height, w/ palm facing upwards
3. As practitioner: sit across from patient to better take both pulses at the same time (for comparison)

C. When taking a pulse, what are we looking for?


1. Traditionally:
Wei = Food Qi
Shen = Spirit (of pulse)
Gen = Rooted or not
2. Normal: 60-90 bpm

Winter: sl. deeper


Summer: more floating

Spring: sl. wiry


Autumn: thinner

III. Discussion of abnormal pulses (28)


A. Categories:

Floating category (fu mai)


Deep category (chen mai)

external syndrome
internal syndrome

[location]

Fast category (shuo/shu mai)


Slow category (chi mai)

heat syndrome
cold syndrome

[frequency]

Excessive category (shi mai)


Deficient category (xu mai)

Excess
Deficiency

[condition, strength, breadth, smoothness]

Yang: ext, heat, excess


Yin: int, cold, deficiency

Internal Oriental Medicine Pulse Diagnosis: Dr. Wu

(F. Yip)

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FLOATING (5)
Floating /
superficial
(f mai)
Soft / Soggy
(ru mai)
Hollow
(kou mai)
Leather /
tympanic
(ge mai)

Heaven layer is felt immediately w/ light touch;


with more pressure, there is less strength, but the
pulse is still there; rooted
Like a piece of wood floating on water.
Superficial + thready/thin + weak (must have all 3)
Distinctive, w/ root
Much stronger than floating/superficial pulse, but
empty as continue to press into the middle;
without root
Like a scallion stalk
Very hard on the surface (like surface of drum),
immediately becomes empty/disappears;
without root

+ strong = excess (cold)


+ weak = ext. xu (wind)
1- Superficial/external
+ fast = Wind-Heat
Syndrome (acute)
+ tight = Wind-Cold
2- Deficiency: Chronic stage
> Yang floating d/t deviation of yin & yang, Yin Xu,
or yang collapse
1- Dampness, invasion or retention (yin pathogen damp
holds up flow of energy)

2- SP Qi Xu (source of damp)
1- Sudden loss of Blood, jin ye, semen/essence
(trauma, over 400 ml of blood; dehydration d/t ST flu; too much
sexual intercourse)

* Loss of body substances w/in a short period of time


1- Over 40 yrs + sudden loss of blood, jin ye, or essence
(has a wiry aspect to it always over 80 yrs = wiry)

Hollow & leather are similar: compare based on level of initial resistance more hollow vs. hard

Scattered
(san mai)

Floating + very weak + very thin


Almost disappears; indistinctive; without root
Like throwing a handful of peach flowers over the
water

1- Exhaustion of internal organ f(x)


2- Exhaustion of Qi & Xue
3- Yin/Yang separation (before death)

Severe
stages: Xu,
last stage

DEEP (3)
Deep / Sinking
(chen mai)

Firm / Fastened
(lao mai)
Hidden /
Deep seated
(f mai)

Strongest at the deepest (earth) layer


> Pulse is felt the best and most clearly at the
deepest level

Deep + large + forceful + long + wiry


(Must have all 5)
Very, very deep will press close to the bone
Pulse will still be clear/distinctive

+ weak = Internal Xu
+ strong = Int. Excess
Internal
+ fast = Int. Heat
syndrome:
+ slow = Int. Cold
1- Accumulation, stagnation/retention of yin pathogens
(excess) [hernia]
- Phlegm, food stagnation, Blood Yu, water/cold
retention
1- If strong = accumulation of yin pathogens (cold)
2- If weak = Blood Xu; yang collapse

FAST (3)
Fast / Rapid
(shuo/shu mai)

Swift
(ji mai)
Running /
Abrupt / Hasty
(cu mai)

Over 90 bpm, but under 139 bpm

Heat
Syndrome:
Extreme
heat:

Faster: 140 180 bpm

+ forceful = Excessive heat


+ thin & weak = Xu heat
+ floating = External heat
+ deep = Internal heat
1- Extremely yang (i.e. summer-heat;
hyperthyroidism)
2- Separation betw/ Yin & Yang (near
death)

1- Excessive heat
Faster than normal pulse w/ irregular stops

2- HT Yin Xu

SLOW (2)
Slow
(chi mai)

40 59 bpm
Can be normal, esp. for athletes

Knotted
(jie mai)

Slow, w/ irregular stops

+ deep = Int. Cold (Yang Xu)


+ weak = Xu Cold
Cold
+ forceful = Excessive Cold
Syndrome:
+ floating = External Wind-Cold
1- HT Yang d.o. HT Yang blockage (Xu type)
2- Retention of yin pathogens

* Knotted and Running are opposite: irregular stops point to Heart then differentiate by speed of pulse

Internal Oriental Medicine Pulse Diagnosis: Dr. Wu

(F. Yip)

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EXCESSIVE (9)
Full / Surging /
Flooding
(hong mai)
Forceful
(shi mai)

Strong, broad/wide, overflowing (like a flood)


comes in fast, but recedes slowly/gently
More position related:
Forceful and strong in all 3 position and 3 levels
Pay attention to the flow

Slippery / Rolling
(hua mai)

Long
(chang mai)
Moderate /
Retarded
(huan mai)

Wiry / Taut /
String
(xuan mai)

Tense / Tight
(jin mai)

Hesitant / Choppy
(se mai)
Moving
(dong mai)

Forceful, (strong or relatively strong), but flows


smoothly
Like beads rolling in a plate
> Slippery is excess, but may have slippery w/o
strength of flow [cannot have slippery & weak]
Shows location:
Felt extended through all 3 positions at the same
level: extended beyond the 1st position, or beyond
the 3rd position

1- Excess & heat syndrome:


> i.e. Yangming Syndrome; children w/ fever; etc.
[shows that the body constitution is not weak]

1- Excess
1- Excessive Heat
2- Retention of phlegm
3- Food stagnation
4- Water retention or dampness
5- Pregnancy
6- Normal
1- Excess; esp. Qi Excess
2- Normal
1- Normal

Focus on frequency:
Slightly slower than a normal, but faster than a
slow pulse: ~ 55-60 bpm
> Not too strong, not too weak

2- SP Qi Xu
3- Dampness retention (yin pathogen [damp] holds pulse

Forceful/strong + straight + long (must be all 3)

1- LIV & GB d.o.

Like a stretched & twisted string of a musical


instrument
> Commonly seen pulse
> Seen in stressed, tense individuals;
w/ hardened vessels, etc.
Short + wiry;
Twisted cord/rope
Felt only in 1 or 2 positions (different from wiry)

2- Retention of phlegm & dampness

to slow it down a bit)

3- Extreme pain: hernia, colic,


4- Malaria

Invasion or retention of Cold (External cold syndrome)

More related to flow - opposite to slippery in flow:


Not smooth, very hesitant, uneven

1- Retention or invasion of yin pathogens, esp. Blood


Stagnation / Stasis; sometimes Blood Xu

Like a knife scrapping along bamboo


Buzzing + strong + short
> Often buzzing in the HT position
> Forceful or overflowing in 1 position, esp. HT

2- If weak: exhaustion of internal organ f(x)


1- Qi disorder;
Yang disorder: HT Yang (insomnia, shen d.o.)

* Can have slippery + wiry: slippery addresses flow of blood, wiry addresses condition of vessels
* Opposite pulses can never be felt at the same time

Internal Oriental Medicine Pulse Diagnosis: Dr. Wu

(F. Yip)

Page 3 of 4

DEFICIENT (6)
Feeble / Empty
(xu mai)
Indistinctive
(wei mai)
Intermittent / regularly
intermittent /
regularly irregular
(dai mai)
Weak
(ruo mai)

Weak in all 3 positions & 3 levels


Opposite of forceful

1- Exhaustion of Qi & Blood


2- Exhaustion of internal organ f(x)

Extremely deep, weak, and thin


Unclear may or may not be able to feel pulse

1- Exhaustion of organs

Rhythm:
Regular stops in a normal or weak pulse

HT
disorder:

Strength:
Deep, thin & without strength

1- Deficiency: esp. Qi Xu (insufficiency of


strength)

2- End of the life


+ weak = HT Xu

Thin / Thready
(xi mai)

Breadth:
Very small/narrow may or may not be weak
Like a piece of silk thread

Short
(duan mai)

Location: Felt in only 1 position


> Often seen combined w/ other Xu pulses

Internal Oriental Medicine Pulse Diagnosis: Dr. Wu

(F. Yip)

+ forceful = HT Excess

1- Blood, jin ye, essence Xu (fluids/volume is


not enough)
1- Qi d.o., esp. Qi weakness
2- Severe pain syndrome
3- Internal organ d.o.

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