Feeling the Pulse

The location for feeling the pulse at the present time is above the wrist where the radial artery throbs. It is divided into three regions : cun, guan and chi. The region opposite to the styloid process of the radius ( the bony eminence behind the palm ) is known as guan, that distal to guan ( i.e. between guan and the wrist joint ) is cun and that proximal to guan is chi. There have been in different ages various descriptions concerning the relationship between these three regions and their corresponding zang - fu organs. They are fundamentally conformable. It is generally acknowledged that the three regions of cun, guan and chi of the left hand reflect respectively the conditions of the heart, liver and kidney ; and those of the right hand reflect the conditions of the lung, spleen and kidney.

In feeling the pulse, let the patient take either sitting or supine position with the arm placed approximately on a level with the heart, wrist extended and palm facing upward. This position facilitates smooth circulation of qi and blood. The doctor, by the side of the patient, first locates the guan region with the middle finger, then the cun and chi regions with the index and ring fingers. The three fingers are slightly flexed, presenting the shape of an arch. The finger tips are kept on the same horizontal level and the pulse is felt with the palmar side of the fingers. The space between each two fingers depends upon the height of the patient. If the patient is tall and has long arms, it is desirable to separate the fingers accordingly. If the patient is short and has short arms, the three fingers are placed more closely. The method of " feeling the pulse ir the guan region with one finger " is adopted in infantile cases, for a baby ' s pulse is not divided into these three regions. The pulse is palpated by exerting three different finger forces, first lightly ( superficial palpation ) , then moderately ( middle palpation ) and finally heavily ( deep palpation ) . Generally the finger force of the same strength is exerted on the three regions at the same time and then feel the three regions separately according to the actual pathological conditions.

The pulse is differentiated in terms depth ( superficial or deep ) , speed ( rapid or slow ) , strength ( forceful or weak ) , shape ( thick or thready, soft or hard ) and rhythm. Different conditions of the pulse indicate different syndromes.

A normal pulse is smooth, even and forceful with the frequency of four beats per breath. However, the pulse may vary due to age, sex, body constitution, emotional state and climatic changes. Due attention should be paid to distinguishing it from an abnormal pulse. Abnormal pulse readings and their clinical significance are as follows.

Superficial pulse ( fu mai )

A superficial pulse can be easily felt with gentle touch. It indicates exterior syndromes, and is present at the early stage of exogenous diseases. Invasion of the body surface by the exogenous pathogenic factor creates its contending with wei qi. The pulsation is superficially situated, hence the superficial pulse. A superficial pulse may also be present in prolonged endogenous diseases. In this case, the pulse is superficial, large and weak, indicating outward floating of yang qi. This is a critical sign of the disease.

Deep pulse ( chen mai )

A deep pulse is felt only on heavy pressure. It indicates interior syndromes. If the pulse is deep and forceful, it indicates interior syndromes of excess type. When the pathogenic factor invades the interior of the body, qi and blood circulation is blocked, presenting a deep and forceful pulse. If the pulse is deep and weak, it indicates interior syndromes of deficiency type.

Slow pulse ( chi mai )

The rate is slow, with less than four beats per breath ( less than sixty beats per minute ) . A slow pulse indicates cold syndromes. Qi contracts and blood flow stagnates on exposure to cold. The retarded circulation of qi and blood produces a slow pulse. If the slow pulse is forceful, it indicates an interior syndrome of excess type caused by retention ofyin cold in the interior. If the slow pulse is weak, it indicates an interior syndrome of deficiency type due to deficiency of yang qi.

Rapid pulse ( shu mai )

The rate is quick, with more than five beats per breath ( more than ( ninety beats per minute ) . A rapid pulse indicates heat syndromes. Induced by pathogenic heat, the blood circulation is accelerated, the result being a rapid pulse. If excess heat is retained in the interior and the antipathogenic qi is still strong, their struggle will induce a rapid and forceful pulse. Deficiency of yin in a prolonged illness produces deficiency - heat in the interior, presenting a rapid and weak pulse. A rapid pulse may also be induced by outward floating of deficiency - yang. In this case, the pulse feels rapid, large, weak and empty.

Pulse of deficiency type ( xu mai )

It is the general term for all the forceless pulses felt on the three regions at the three levels of pressure. The pulse indicates syndromes of deficiency type due to deficiency of qi and blood. Deficiency of qi and blood implies weakness in activating blood circulation, thus producing a pulse of deficiency type.

Pulse of excess type ( shi mai )

It is the general term for all the forceful pulses felt on the three regions at the three levels of pressure. The pulse indicates syndromes of excess type. The struggle waged by the strong antipathogenic qi against the hyperactive pathogenic factor brings on excessive qi and blood, thus creating a pulse of excess type.

Surging pulse ( hong mai )

A surging pulse is broad, large and forceful like roaring waves which come on powerfully and fade away. If a surging pulse lacks the momentum of roaring waves, it is called large pulse. A surging pulse indicates excessive heat, and often occurs together with a rapid pulse. Excessive heat in the interior dilates the blood vessels and accelerates qi and blood circulation, thus producing a surging pulse.

Thready pulse ( xi mai )

A thready pulse feels like a fine thread but is very distinct and clear. It indicates deficiency due to overstrain and stress or deficiency of qi and blood. It is often present in patients with weak body constitution in a prolonged illness manifesting as yin deficiency and blood deficiency. Deficiency of yin and blood means the inability to fill the vessels. Qi is also deficient and unable to activate the blood circulation, hence the thready pulse.

Rolling pulse ( hua mai )

A rolling pulse feels smooth and flowing like pearls rolling on a dish. It indicates phlegm and retained fluid, retention of food and excess heat. When excess type pathogenic factor is retained in the interior, the qi and blood circulation is activated, resulting in a smooth and flowing pulse. This pulse often occurs in women during pregnancy, indicating sufficient and harmonious qi and blood.

Hesitant pulse ( se mai )

A hesitant pulse feels rough and uneven. It indicates stagnation of qi, stagnation of blood, impairment of essence and deficiency of blood. Stagnation of qi and blood means blockage of vessels and impaired circulation of blood. This condition produces a hesitant and forceful pulse. When the essence is impaired and blood is insufficient, the vessels are not filled and blood circulation is retarded. This condition creates a hesitant and weak pulse.

String - taut pulse ( xuan mai )

A string - taut pulse feels taut, straight and long, giving the feeling of a string of a violin. It indicates disorders of the liver and gallbladder, painful syndromes, and phlegm and retained fluid. A string - taut pulse in disorders of the liver and gallbladder is due to disturbance of the liver qi tightening the vessels ; that in painful syndrome is due to tightness of the meridians and vessels ; that in retention of phlegm and fluid in the interior is due to dysfunction of qi in transportation and blood.

Tense pulse ( jin mai )

A tense pulse feels tight and forceful like a stretched rope. It indicates cold, pain and retention of food.As cold is characterized by contraction, the vessels contract on exposure to cold, thus producing a tense pulse. The pulse is also present in painful syndromes, for painful syndromes are usually caused by pathogenic cold.

Soft pulse ( ru mai )

A soft pulse is superficial and thready, and hits the fingers without strength. It indicates damp disorders. Pathogenic damp is characteristically viscous and stagnant, its invasion of the vessels blocks qi and blood and gives rise to a superficial, thready and forceless pulse.

Weak pulse ( ruo mai )

A weak pulse is deep and thready, and hits the fingers without strength. It indicates various syndromes due to deficiency of both qi and blood. When blood is deficient, it fails to fill the vessels : when qi is deficient, the pulse is deprived of strength. So the pulse feels deep, thready and forceless.

Abrupt pulse ( cu mai )

An abrupt pulse feels hurried and rapid with irregular missed beats. It indicates excessive yang heat, stagnation of qi and blood, and retention of phlegm or food. Excessive yang heat means failure of yin to restrain yang and thus produces an abrupt pulse. If this pulse is present in heat syndromes of excess type due to stagnation ofqi and blood, retention of phlegm or food, or swelling and pain, it is abrupt and forceful. An abrupt and weak pulse is a sign

Knotted pulse ( jie mai )

A knotted pulse is slow with irregular missed beats. It indicates excessive yin, accumulation of qi, retention of cold phlegm and stagnant blood. Cold phlegm and stagnant blood block the vessels, while excessive yin means failure of yang to arrive. Hence the knotted pulse.

Regularly intermittent pulse ( dai mai )

A regularly intermittent pulse is slow and weak with missed beats at regular intervals. It is associated with declining zang qi ; it also indicates wind syndromes, painful syndromes and disorders due to emotional fear and fright, or traumatic contusions and sprains. The declining of the qi of the zang means insufficiency ofqi and blood and may create discontinuation ofqi flowing in the vessels. Therefore the pulse is slow and weak with regular missed beats at long intervals. The presence of a regularly intermittent pulse in wind syndromes, painful syndromes and disorders due to emotional fear and fright or traumatic contusions and sprains is due to disturbance of the heart qi leading to discontinuation of the qi flowing in the vessels.

As the process of a disease is complex, the above described abnormal pulses do not often appear in their pure form, the combination of two pulses or more is often present. The condition of a number of pulses present at the same time is called complicated pulse. The indication of a complicated pulse is the combination of indications of each single pulse. For instance, a superficial pulse indicates exterior syndromes, and a tense pulse indicates cold syndromes, a superficial and a tense pulse, therefore, indicates exterior cold syndromes. As a rapid pulse indicates heat syndromes, a superficial and rapid pulse indicates exterior heat syndromes.