TCM Pulse Diagnosis

TCM Pulse Diagnosis

Pulse diagnosis remains a cornerstone of Traditional Chinese Medicine (TCM), providing invaluable insights into the body's internal dynamics and energy flow. Within TCM, the art of pulse diagnosis extends beyond mere palpation; it encompasses a profound understanding of the body's energetic balance and health. In this guide, we explore the intricacies of the 29 TCM pulses, each offering unique diagnostic clues and implications.

Also, there's a bonus chart all the way at the bottom! Now, let's dive into TCM pulse diagnosis!

A Brief History of TCM Pulse Examination:

The Nine Regions of Pulse: 

The method of pulse-taking using the Nine Regions, as described in the Huang Di Nei Jing Su Wen (黃帝內經素問), provides a detailed understanding of the body's Qi circulation. This ancient practice was prevalent until the shift to radial artery pulse examination.

The Nine Regions encompass various parts of the body, each associated with specific Qi functions:

  1. Upper Head (Tai Yang): Represents the Qi of the head.
  2. Middle Head (Ju Liao - ST 3): Reflects the Qi of the mouth.
  3. Lower Head (Er Men - SJ 21): Corresponds to the Qi of the ears and eyes.
  4. Upper Hand (Jing Qu - LU 8): Indicates the Qi of the Lungs.
  5. Middle Hand (He Gu - LI 4): Reflects the Qi of the mid-thorax region.
  6. Lower Hand (Shen Men - HT 7): Represents the Qi of the Heart.
  7. Upper Leg (Wu Li - LV 10 or Tai Chong - LV 3): Reflects the Qi of the Liver.
  8. Middle Leg (Tai Xi - KD 3): Corresponds to the Qi of the Kidneys.
  9. Lower Leg (Ji Men - SP 11 or Chong Yang - ST 42): Indicates the Qi of the Spleen and Stomach.

By examining the pulse in these specific regions, practitioners gain insights into the state of Qi circulation and overall health.


Radial Artery Pulse (Cun, Guan, Chi): 

As per Nan Jing (難經), pulse assessment occurs at the Portal of Cun (Inch), offering insights into the vitality of the Yin and Yang organs. Cun, Guan, and Chi represent the key pulse positions. 

Radial Artery Pulse Left Right
Front (Cun) HT - SI LU - LI
Middle (Guan) LV - GB SP - ST
Rear (Chi) KD - UB PC - SJ (TB)
Note on Naming Conventions:
It's important to note that different sources may vary in their naming conventions and the total number of standard pulse images. In this post, we aim to encompass 29 pulse images along with their various names to provide a comprehensive understanding of TCM pulse diagnosis.
29 Pulses in TCM:
superficial pulse
Superficial Pulse (浮脈 - 부맥 - Fu Mai) 

🤏Feeling: Felt even with light pressure. When pressing down, it is weak or disappears. When pressure is released, it regains full strength.

  • Superficial and Tight: Wind Heat
  • Superficial and Rapid: Wind Cold
  • Superficial and Deficient: Yin Deficiency

Deep pulse

Deep Pulse (沈脈 - 침맥 - Chen Mai)

🤏Feeling: Can only be felt with heavy pressure and felt near the bone

  • Deep and Full: Qi Stagnation, Blood Stagnation, Interior Heat, Interior Cold
  • Deep and Weak: Qi Deficiency, Yang Deficiency

Slow pulse

Slow Pulse (遲脈 - 지맥 - Chi Mai)

🤏Feeling: 3 beats per respiration (of the practitioner)

  • Slow: Cold
  • Slow and Weak: Empty Cold due to Yang Deficiency
  • Slow and Full: Full Cold

Rapid pulse

Rapid Pulse (數脈 - 삭맥 - Shu Mai)

🤏Feeling: More than 5 beats per respiration (of the practitioner)

  • Rapid: Heat
  • Rapid, Superficial, Empty: Empty Heat due to Yin Deficiency
  • Rapid, Full: Full Heat

Deficient pulse

Deficient Pulse (虛脈 - 허맥 - Xu Mai) 

🤏Feels big at first but empty once you press down with more pressure

  • Deficiency: Qi Deficiency

Full Pulse (實脈 - 실맥 - Shi Mai)

🤏Feeling: Feels full, hard, and long. Surplus feeling at all 3 levels (Superficial, Middle, Deep)

  • Full: Full
  • Full, Rapid: Full Heat
  • Full, Slow: Full Cold

Slippery Pulse (滑脈 - 활맥 - Hua Mai) 

🤏Feels like a pulse slipping under the fingers. Flows smoothly and uninhibited.

  • Slippery: Phlegm, Damp, Food Stagnation, or Pregnancy

Choppy Pulse (澀脈 - 삽맥 - Se Mai) 

🤏Feeling: Feels rough with a jagged wave. Rate and quality may change rapidly. May stop and lose a beat, then recovers.

  • Choppy: Blood Deficiency or Exhaustion of Fluids

Long Pulse (長脈 - 장맥 - Chang Mai)

🤏Feeling: Longer than normal and extends beyond the normal pulse position. Felt past the cun position.

  • Long: Heat

Short Pulse (短脈 - 단맥 - Duan Mai)

🤏Feeling: Shorter than normal and occupies shorter space than the normal pulse position. Can be felt most clearly at the Guan position, more indistinct at the Cun and the Chi.

  • Short: Severe Qi Deficiency or Stomach Qi Deficiency

Flooding Pulse (洪脈 - 홍맥 - Hong Mai)

🤏Feeling: Feels big and then loses force. Extends beyond the normal pulse position. "Coming onto the shore with force and retreating without force" like a flooding river.

  • Flooding: Full Heat
  • Flooding, Deficiency: Empty Heat due to Yin Deficiency

Thready Pulse (細脈 - 세맥 - Xi Mai)

🤏Feeling: Feels thinner than normal, like a silken thread. Without strength but not scattered by pressure.

  • Thready: Blood Deficiency or Damp with Severe Qi Deficiency

Faint Pulse (微脈 - 미맥 - Wei Mai)

🤏Feeling: Difficult to feel, extremely thin and small. Barely palpable. May be felt and then sometimes lost.

  • Faint: Severe Qi and Blood Deficiency

Tight Pulse (緊脈 - 긴맥 - Jin Mai)

🤏Feeling: Feels like a twisted tight rope.

  • Tight: Cold, Pain
  • Tight, Superficial: Exterior Cold
  • Tight, Full, Deep: Interior Full Cold
  • Tight, Weak, Deep: Interior Empty Cold

Wiry Pulse (弦脈 - 현맥 - Xuan Mai)

🤏Feeling: Feels like guitar string. Straight, long, and tense. Distinct edges.

  • Wiry: Liver pattern, Pain, Phlegm

Moderate Pulse (緩脈 - 완맥 - Huan Mai)

🤏Feeling: 4 beats per respiration (of the practitioner)

  • Moderate: Healthy pulse, no pathology

Hollow pulse

Hollow Pulse (芤脈 - 규맥 - Kou Mai)

🤏Feeling: Felt at the superficial level, lost at middle level, felt again at deep level

  • Hollow: Post Hemorrhage
  • Hollow, Rapid: Pre Hemorrhage
Leathery Pulse

Leathery Pulse (革脈 - 혁맥 - Ge Mai)

🤏Feeling: Feels hard and tight at the superficial level, but feels empty at the deep level. Feels like the head of a drum. Felt with light pressure. Resistant to pressure.

  • Leather: Severe Kidney Yin or Essence Deficiency

Firm pulse

Firm Pulse (牢脈 - 뢰맥 - Lao Mai) 

🤏Feeling: Felt only at the deep level. Feels hard and wiry.

  • Firm: Blood Stagnation, Pain
  • Firm, Slow: Interior Cold

Soft pulse

Soft Pulse (濡脈 - 유맥 - Ru Mai)

🤏Feeling: Felt only at the superficial level. Feels soft and slightly floating. Disappears with strong pressure.

  • Soft: Damp with Qi Deficiency, Yin Deficiency, Essence Deficiency

weak pulse

Weak Pulse (弱脈 - 약맥 - Ruo Mai)

🤏Feeling: Felt only at the deep level. Feels soft.

  • Weak: Yang Deficiency, Blood Deficiency

Scattered pulse

Scattered Pulse (散脈 - 산맥 - San Mai)

🤏Feeling: Feels very small and relatively superficial. Feels like a broken wave of dots. Scattered and chaotic.

  • Scattered: Severe Qi and Blood Deficiency, Severe Kidney Qi Deficiency

Hidden pulse

Hidden Pulse (伏脈 - 복맥 - Fu Mai)

🤏Feeling: Feels 'hidden' under the bone. Felt only at a very deep level and difficult to feel.

  • Hidden: Severe Yang Deficiency

Throbbing pulse

Throbbing Pulse (動脈 - 동맥 - Dong Mai)

🤏Feeling: Feels short and shaking. Somewhat slippery. Strong and throbbing abruptly.

  • Throbbing: Shock, fear, anxiety, fright, severe pain, deep emotional problems
Rapid-Irregular Pulse (促脈 - 촉맥 - Cu Mai)

Rapid-Irregular Pulse (促脈 - 촉맥 - Cu Mai) 

🤏Feeling: Rapid and stops at irregular intervals

  • Rapid-irregular: Extreme Heat, Heart Qi Deficiency, Heart Fire

Knotted pulse

Knotted Pulse (結脈 - 결맥 - Jie Mai) 

🤏Feeling: Slow and stops at irregular intervals

  • Knotted: Cold, Heart Yang Deficiency

Regularly Intermittent Pulse (代脈 - 대맥 - Dai Mai)

🤏Feeling: Stops at regular intervals

  • Regularly-intermittent: Severe Internal Organ disease, Heart disease

Large Pulse (大脈 - 대맥 - Da Mai)

🤏Feeling: Fills up the fingertip, forceful. Similar to Flooding Pulse, without the wave-like shape

  • Large: Exterior Pathogenic Factor invading Interior, Qi and Blood Deficiency

Racing Pulse (急脈 - 급맥 - Ji Mai) 

🤏Feeling: Very rapid, agitated, urgent

  • Racing: Yang Excess, Fire exhausting Yin

We just went over the TCM pulse diagnosis and 29 TCM pulses! Understanding these pulses aids in effective TCM treatment and prescribing herbal formulas!

Can you recall them all?

TCM pulses

Each pulse reflects specific patterns and imbalances within the body, guiding TCM practitioners towards tailored treatment approaches.

Understanding the nuances of TCM pulses empowers us to decipher the body's energetic landscape, facilitating precise diagnoses and effective therapeutic interventions.

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