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TCM Acupuncture Theory - Pulse Diagnosis
General Theory and Clinical Significance

Pulse diagnosis is one of the more important diagnostic tools used in Chinese and Japanese acupuncture and herbal medicine. While tongue diagnosis provides valuable clinical information, the pulse can be used to gain a deep understanding of the patient on many levels. "Mastering" pulse diagnosis is difficult without the guidance of a skilled teacher. However, even at basic levels, the pulse provides the practitioner with immediate and specific information that can help clarify contradictory diagnostic information and symptomology.

Location of the Pulse: The Guan (Second) Position is found opposite the styloid process of the radius, the Cun Position is found between the Guan Position and the wrist and the Chi position is found at a point equal the distance between Guan and Cun.

Designation	Sensation	Indications
By Depth:
Floating (superficial)	easily felt at the superficial level not as significant as you feel deeper	external condition/pathogen + empty = yin a/or blood def + rapid = wind heat + tight/slow = wind cold
Sinking (deep)	felt only at the deep level	interior condition/obstruction + rapid = internal heat + slow = internal cold + slippery = internal damp/phlegm + empty = qi or yang def
By Frequency:
Slow	less than 4 beats per breath (< 60bpm )	cold condition a/or pathogenic factor + floating = exterior wind cold + sinking/empty = yang def
Rapid	more than 5 beats per breath ( > 90bpm )	hot condition a/or pathogenic factor + floating = external wind heat + sinking = internal heat + full = excess heat + empty = empty heat
By Quality/Shape:
Hesitant (choppy)	rough and uneven	blood a/or jing stagnation
Slippery	smooth with a viscous sensation	excess dampness, retention of food, pregnancy + rapid = damp heat + slow = cold damp obstruction
Tight	tension with side to side movements (thicker than a wiry pulse)	excess cold - interior or exterior, commonly associated with pain
Wiry	tension with no side to side movements (thinner than a tight pulse)	LV/GB disharmony
By Width:
Big (excess, overflowing)	broad but with distinct edges	excess heat, commonly in ST or Intestines
Thin (thready, fine)	fine but with distinct edges	blood a/or qi deficiency
By Strength:
Empty (deficient)	wide but not strong, disappears with slight pressure, forceless	blood a/or qi deficiency
Full (excess)	wide and strong, felt with strength at all levels	excess condition, often excess heat with rebellious Qi
By Length:
Short	not felt in all 3 positions	qi deficiency
Long	felt beyond the 3 positions	excess, heat, generally considered normal in absence of other qualities
By Rhythm:
Hurried (abrubt)	rapid with irregularly missed beats	heat agitating qi & blood
Intermittent	regularly skipped beats	heart disharmony, exhaustion of zang qi
Knotted	slow with irregularly missed beats	cold obstruction, ht qi or yang deficiency, general def of Qi, Blood a/or Jing

Description of a healthy ("normal") pulse

The pulse should be felt in all 9 positions
The quality of the pulse should have "spirit" and not collapse or feel
hard or unyielding
The rhythm should be even and balanced and regular beats of 60-90bpm

Factors which influence the Pulse

Age - the strength and quality of the pulse will decline as a person ages.
Gender - Men are generally stronger on the left and Women are generally
stronger on the right.
Seasonal Influences:
·· Spring - more wiry
·· Summer - stronger
·· Winter - deeper