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Pulse Chart

Pulses
Preparation:
1. While taking the pulse in the early morning is best, as the qi and blood are not disturbed, it is rarely practical to do this. Have the
patient sit still a bit before taking the pulse to allow the qi and blood settle in.
2. Place the patient sitting comfortably. The arm should be about level with the heart, not stretched too much but parallel to the ground.
Have them sit comfortably, preferably leaning back in the seat. Place patients arm on a pillow.
Alternately, you can take the patients pulse while he/she is lying down.
Many practitioners ask the patient who are lying down to rest their hands on their stomach since stretching out the arms in this
position will often put too much pressure on the arteries to get a good reading.
How to find the proper position for your fingers on the pulse:
1. Find the styloid process on the radial side of the wrist with your middle finger.
2. Slide your middle finger inward toward the medial side of the arm. It will fall into a small pocket just on the other side of the styloid
process. Your middle finger is now at the Guan or 2nd position.
3. Place your index finger down next to the middle finger in the 1st or Cun position. This position is the closest to the wrist.
4. Drop your ringer finger down naturally and this is the Chi or 3rd position, furthest from the wrist
Will Morris suggests you bend the patients wrist slightly inward (in the direction of the palm) and then find the divot this makes right
around Lung 9 on the radial side of the wrist, right on the transverse crease of the wrist. Place your index finger here, let your middle
finger drop into place, then your ring finger. If you slide your ring finger proximally a little bit you will feel the edge of a big muscle,
the brachioradialis muscle. You should be just distal to the end of that muscle.
If you want all the goodies from Will Morris pulse seminar, read all of the stuff here first, then check out the notes from the seminar
he gave on classic pulses by clicking here.
Region
Cun (1st position)
Guan (2nd position)
Chi (3rd position)

Left side
Heart (xin)
Liver and Gallbladder (gan)
Kidney/ lower abdomen - Shen/ Kidney Yin

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Right side
Lung (fei)
Spleen and Stomach (pi)
Kidney/ lower abdomen Mingmen/ Kidney Yang

Pulse Chart
How to take the pulse:
1. Feel with all 3 fingers at the same time to determine the pulse quality and character overall before you find the character/quality of the
individual positions.
a. Feel all 3 depths: lifting depth, searching/middle depth, and pressing depth.
i. Lifting
Just touching the surface a little. Superficial pulse will be felt this way.
ii. Searching or Middle medium pressure to tell the nature of the pulse.
Maciocia says keep the fingers still to count the pulse. He goes further saying you can also:
1. Push move fingers laterally side to side in each position to feel around the pulse and determine its shape and
qualities.
2. Roll move fingers proximal to distal in each position to determine short, long, moving (and to read pulse in
child aged 1 year of less).
iii. Pressing
Press deeply into both middle and deep levels to determine if the pulse is deep, deficient, normal, hollow, hidden or
empty.
b. Feel for speed.
Normal is considered 4 beats per respiration cycle (one breath in, one breath out). Watch the patient breathe and count the
beats.
c. Feel for rhythm.
Feel for 50 beats in order to determine rhythm or arrhythmia.
2. Feel the individual positions on each side of the body. Be sure to feel at all 3 depths for each individual position also.
What is a normal pulse?
Frequency/Speed
4 beats/respiratory cycle (one breath in/one breath out)
Stomach Qi
Feel for 50 beats to determine this. This is the overall feelnot the feel of the Stomach/Spleen position!
o Not superficial, not deep
o Not fast, not slow
o Calm with regular rhythm.
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Pulse Chart
Spirit (or Shen)
o Soft, gentle, with strength.
No irregularity.
Root
2 meanings:
o Overall pulsestrength at all depths/all positions even when pressing heavily.
o Pulse in the 3rd positions is strong and with power.
Funky Pulse Positions
Fan guan mai or opposite gate pulse patients radial artery runs on the dorsal side of the arm!
Xie fei mai or oblique flying pulse patients radial artery goes at an oblique angle from 3rd position to 1st position, going
diagonally towards the dorsal side.
(Maciocia says when you encounter these you should really take pulses at alternate points on the body to get the reading these positions
would normally indicate. He unfortunately failed to elaborate and tell us where these were!)

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Pulse Chart

Superficial Pulses
Superficial pulses indicate an exterior problem. (In special cases it may indicate the yang floating up and creating a false shen, but by and
large, its an exterior condition. ) Touch very lightly (lifting technique) in order to feel this pulse.
Remember: Cold conditions are indicated by a slow pulse while hot conditions have a fast pulse.
Chinese
name

English name

Description

Indications

Fu

Superficial
Floating

1.

Pulse has most strength at


uppermost level and can be felt
with only slight touch

1.

External pathogen
Circ of qi and blood is focused in the bodys surface to deal with external agent.
Internal circulation temperature is sacrificed to focus on elimination of the
pathogen, in an attempt to keep it from moving deeper.

2.

Can feel w/light touch


Grows faint on hard pressure.

2.

Deficiency
Debilitated pts may have feeble, floating pulse: inability to retain Qi and yang in
interior due to deific of vital orgs.

Floating Combination Pulses


Floating + tight = external cold.
You might also see chills and fever, aversion to cold, tongue pale with thin white coat, no sweating, and/or clear watery nasal
discharge.
Floating + fast = external heat.
You might also see headache, nasal discharge yellow/sticky, sweating, chills and fever (but more fever than chills).
Superficial + slowed down = External deficiency.
What is this external deficient? Sweating is the key point. There will be sweating. They might also have chills and fever.
External damp.
Superficial + slippery = external syndrome, but also has phlegm retention.
Fix the external condition, but also treat the phlegm retention.

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Pulse Chart
Chinese
name

English name

Description

Indications

Hong

Surging
Overflowing
Flooding

1.

Broad, large, forceful

1.

Excess heat.
Heat isnt hard to detect, so this pulse doesnt add much to your diagnosis.

2.

Like dashing waves with forceful


rise, gradual decline.

2.

1.

Superficial, thready, w/o strength.

1.

Force of pulse = pathological condition


Gradual decline of pulse at end = heat syndrome
(due to qi excess not fluid excess)
Deficiency

2.

Superficial, thin, soft.


W/light touch, like thread floating
on H2O.
W/pressing it is faint.

2.

Dampness

1.

Superficial, scattered, indistinct


irregular without root

1.

2.

Irregular, hardly perceptible

Ru

San

Soft
Soggy

Scattered

Crisis pulse

Note: because it feels easily movable (like thread floating), tends to indicate SP Qi
deficiency w/accumulation of dampness.
Depletion of Yuan crisis

Note: These are cases where patients are critically ill, are hospitalized or sent home to
die; diagnosis is usually well-established. Pulse says only that patient is severely ill.

Diffuses on light touch,


faint with heavy pressure
Kou

Hollow

1.

Superficial, large, empty


(like stalk of green onion)

2.

Feels floating, large, soft, hollow


(like a drinking straw or grn onion)

1.

Loss of blood

2.

Yin deficiency

Note: green onion stalk feel means that there is some flow of Qi at vessels surface,
but not much blood in the vessel.

Superficially: can feel it lightly


Mid level: barely there
Deep level: can feel it lightly
Ge

Leather
Tympanic

1.

Wiry, fast, empty inside


(like leather drum head)

2.

Wiry + superficial with aspects of


empty pulse.
(like skin of drum)

Essence, blood deficiency

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Pulse Chart

Deep Pulses
Deep pulses are felt by pressing heavily. Deep and sinking pulses indicate an interior or chronic (prolonged) problem.
If the pulse is strong and deep = internal excess
If the pulse is weak and deep = internal deficiency
Remember: Cold conditions are generally indicated by a slow pulse while hot conditions have a fast pulse.
Chinese name
Chen

English name
Deep
Sinking

Description
1. Most strength @ the lowest level.
Requires deep pressure to feel well.

Indications
1. Internal syndrome
2.

2.

Can only be felt by pressing hard.

Circulation of Qi and blood from internal viscera


to the surface is weak

Note: Circulation in this case is confined to the interior as the body attempts
to deal with a serious disorder threatening the internal organs.
Fu*

Hidden

1.

Can only be felt by pressing hard to bone

2.

Located even deeper than sinking pulse.

Note: Extreme pulse. Can barely detect the pulse


except with deep pressure to or near the level of
the bone. You might get a sense that the pulse is
hidden in the muscles or perhaps resting on the
surface of the bone.

1.

Closing syndrome
(in this case, pulse closes too)

2.

Syncope (loss of consciousness)

3.

Extreme pain

Note 1: Conditions such as LOC (loss of consciousness) and severe pain can
be easily determined w/o taking pulse.
Note 2: There are two kinds of loss consciousnessclosing and opening
syndromes. Closing means everything clenches like a seizure (scream like pig
or sheep). Opening means everything opensmouth, fists, anus, urethra.
Note 3: This is a form of protection to keep the Shen inside.

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Pulse Chart
Lao

Firm
Confined

1.

Full, large, wiry and long

2.

Is a form of hidden pulse. Opposite of


leathery. Very deep, wiry, usually long and
strong.

3.

Deep, taut, wiry, long, large, forceful.


Combined together.

1.
2.
3.
4.

Cold
Internal excess
Shan Disorder (hernia)
Mass

Note: unusual to find this pulse.

Wiry = like guitar string: tight and hard.


Resistant
Ruo

Weak
Frail

1.

Deep, thready, w/o strength

2.

Feels deep and soft.

Qi deficiency and Blood deficiency


Usually from a long term condition. Occurs when the Qi cannot
support the pulse and there isnt enough blood to make the pulse
strong.

Cannot feel this pulse superficially!

Note 1: Usually indicates weakness of SP Qi leading to deficiency of both qi


and blood.
Note 2: Similar to fine pulse, but softer in quality
Note 3: Is basically the opposite of the replete (shi) pulse.

*This Fu is different than that of the superficial pulse called Fu and is a different character when written in Chinese.
Deep Pulse Combinations
Deep + slow = internal cold.
Can be excess/deficient, depending on how strong it hits your finger, depending on how long its been going onlong time =
deficient. (Might also have ingested something cold.) Treat by warming. Tongue may be swollen/teeth marks/watery/cold signs.
Deep + thin = internal and deficiency (generally yin or blood).
Thin is distinct, no matter where located. Shape should be very clear. Thin is under the finger like a thread. This pulse would probably
be fastgenerally a yin deficiency or blood deficiency.
Deep + slowed down = internal and damp/deficient
Spleen qi def will have this type of pulse. Damp is sticky, slows everything down.
Deep + slippery = internal and dampness.

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Pulse Chart

Slow Pulses
Slow is usually less than 60bpm. Exceptions include athletes in great shape who may have much lower pulse than non-athletes.
Slow is usually gauged as 4 beats or less per respiratory cycle (one breath in/out).
Slow pulses usually indicate Cold conditionshowever, Choppy is in this category and it does not indicate Cold.
Chinese name
Chi

English name
Slow

Description
1. Pulse = < 60bpm or 4 beats/breath
2.

Indications
Cold syndrome
Can be:

Pulse with reduced frequency, less than 60


bpm.

Yang deficient or empty cold (slow+weak+deep)


Yin excess or full cold (slow+strong)
Note: must be interpreted in light of other diagnostic info since slow pulse
could be due to other reasons (like very fit athletes).

Huan

Slowed down
Relaxed
Loose
Moderate

1.

60 bpm or more, but the pulse feels sluggish


to you.

2.

Diminished tension in pulse. Normal in


depth, speed, strength, width.

1.

Dampness

2.

Phlegm

3.

Spleen qi deficiency
Look for greasy tongue coating, perhaps MJ discomfort to support your
guess.

Note: Pulse has a softness/looseness due to weakness of Qi + obstructing


effect of damp.
Differs from phlegm-damp in that it has no solidity.

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Pulse Chart
Se

Choppy
Uneven
Hesitant

1.

Pulse is uneven and rough (like scraping


down bamboo with a knife)

2.

Coming and going choppily w/small, fine,


slow, joggling tempo

1.

Qi stagnation

2.

Blood deficiency
Youll see this when the severity of blood disorder is great

3.

Blood stasis/stagnation
You could see this in patients with arteriosclerosis and in severe blood
deficiency, but also in trauma victims who also have qi/blood stagnation

4.

Essence deficiency

5.

Phlegm

6.

Food retention

Usually found in the deep areas, but might be in


middle/searching area.
Feel for brief hesitations or interruptions in
movement.

Note: NEVER indicates Cold!!


Jie

Knotted

1.

2.

Irregularly irregular and slow.


Pulse seems to miss a beat w/o an apparent
pattern

1.

Yin excess

2.

Cold phlegm

Slow pulse with irregular missed beats.


This is a key point to know for the test!

3.

Blood stasis

4.

Qi stagnation

5.

Blockage

6.

Obstruction

Note: Can indicate coronary artery disease when accompanied by chest pain.

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Pulse Chart

Rapid Pulses
Rapid pulses are 5 beats per breath or more. Rapid pulses indicate Heat conditions.
Chinese name
Shuo

English name
Rapid
Fast

Description
1. Is at least > 90bpm or 5 beats per
respiratory cycle (one breath in and out)
2.

A pulse with increased frequency (more


than 90 bpm)

Indications
Heat Syndrome.
Bit more rapid than normal, usually occurs only when serious illness,
when there is fever.
If pulse is strong and rapid = excess (yang excess)
If this pulse is weak and rapid = deficiency (yin deficiency)
This will be thin, fast, and weak
NOTE: Pulse can become rapid from activity prior to pulse taking. Dont
jump to the conclusion of heat without other supporting evidence!

Cu

Ji
Crisis pulse

Abrupt
Hasty
Running
Hurried

Swift

1.

Hurried, rapid, irregular missed beats.


Very fast, irregular irregular like jie mai
pulse.

2.

Hasty and rapid with irregular


intermittence.
Irregular, missed, fast. Similar to knotted.

1.
2.

More than 120bpm or 7 beats per breath


cycle.
Feels hasty and swift, 120-140bpm

Palpitations

1.
2.
3.
4.

Excessive Yang heat


Qi and blood stagnation
Phlegm retention
Food retention

Note: this is like an excess version of knotted pulse. Rapidity indicates heat
and irregular indicates blockage caused by stagnation and/or accumulation.
1.

Depletion of Yuan Qi

Pulse is so rapid (twice as fast as normal) that it is easily detected. The acute
febrile disease involves an easily measured high temperature, usually
pathology can be found in testing.
Consumptive conditions w/such high pulse are generally under emergency
medical care.

Dong

Moving
Spinning Bean

1.
2.

Short, slippery, fast, forceful


Combination of short, tight, slippery, rapid
pulses.

1.

Pain

2.

Frightened

Felt in only ONE position, not all. Also


described as incomplete, without a head or tail,
like a bean. You cannot feel this easily
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Pulse Chart

Deficient Pulses
Also called Empty pulses. Indicate deficient conditions. (Yeah, thats kind of a duh.)
Chinese name
Xu

English name
Empty
Deficiency

Description
1. Forceless on the three regions at all 3 levels
of pressure (key point for this pulse)
2.

A pulse feeling feeble and void

Easy pulse to mistake. Pay attention to the key


point highlighted above.

Wei
Crisis pulse

Minute
Feeble
Faint

1.

Extreme thin and soft

2.

Feels thready and soft; scarcely perceptible

Weaker than the thready pulse.


Feels this way on all levels, all pressures.

Xi

Dai

Thready
Thin
Fine

Intermittent or
Regularly
intermittent

Indications
Deficiency syndrome
Similar to weak, fine, faint pulses.
Occurs when deficiency of blood is more severe than in weak/fine pulses, but
not so deficient as the faint pulse.
So on a scale of severity, least to most severe: 1) weak, 2) fine, 3)
empty/deficient, 4) faint.
1.
2.
3.
4.

Yin deficiency
Yang deficiency
Qi deficiency
Xue deficiency

Extreme exhaustion is obvious to both patient and doc. Pulse lacks substance,
volume, strength; exhaustion of body essences. Prognosis is very bad.
1.
2.
3.
4.
5.
6.

Deficiency due to overstrain and stress


Yin deficiency
Blood deficiency
Qi deficiency
Dampness
Essence deficiency due to chronic illness

Regularly irregular pulse seems to miss a


beat but with definite pattern.

1.
2.

Exhaustion of the organs


Trauma (accident)

A slow pulse pausing at irregular,


predictable intervals.

Usually only see in cases where patient is hospitalized or in advanced disease


stage.

1.

Fine thread
No kidding: it feels like a literal thread and
you can feel it on all levels/depths. It can
even be strong, but slender.
Very distinct and clear. Key point

2.

Always feels like a fine thread, distinctly


perceptible.

1.

2.

This is the only regular irregular pulse!

Example: serious heart disease due to deficiency/blockage, blood


stasis/phlegm.

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Pulse Chart
Duan

Short

1.

Not felt in all 3 positions (depths)

1.

Qi deficiency

2.

Pulse with short extent.

2.

Qi stagnation or block

Short pulse seems to deteriorate from central


pulse position towards the 2 adjacent pulse
positions. Strikes the middle finger sharply,
leaves quickly.

The fact that this pulse strikes hard on the mid finger and leaves quickly can
represent: 1) contraction of Qi aka liver qi stagnation, or 2) deficiency of
Qi.

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Pulse Chart

Excess Pulses
Also called Full pulses. Indicate excess conditions.
Chinese name
Shi

English name
Full
Replete
Forceful
Excess

Description
1. Pulse can be felt strongly on all 3 levels.
Key point.
2.

Felt vigorously and forcefully on both light


and heavy pressure

Slippery
Smooth
Rolling

Gives little info other than condition = excess. Use all other diagnostic skills
to determine the nature of the excess.
Generally, indicates you should not use tonification because this also
indicates the bodys resistance is undamaged.

Very strong
Hua

Indications
1. Excess heat

1.

Smooth, like a row of pearls on a dish


rolling past under your fingers

2.

Beads rolling on a plate

Very regular and orderly, hitting the fingers one


at a time

1.
2.
3.
4.

Dampness
Phlegm
Food retention
Pregnancy (often called happy pulse in China)

While this pulse can be a normal condition it is often good confirmation of


diagnosis of phlegm-damp accumulation
NOTE: Never indicates deficiency!

Slippery Combinations
Slippery is always an excess pulse. Not deficiency!
Slippery + fast = Damp heat. Phlegm heat/fire. Food retention w/heat.
Indicates damp is middle jiao, spleen cant metabolize the water properly.
Indicates Phlegm. Phlegm is primarily stored in the lungs but can also be present in the meridians. Phlegm is more condensed and
sticky than just dampness. This is like dampness, but congealed by either heat cooking the excess liquid off or congealed by cold.
Phlegm in the Lung is literal phlegm that can (eventually) be coughed out. Phlegm in the meridians is invisible phlegm. or it
could be invisible phlegm. Invisible phlegm can cause Shen disturbance by blocking the easy flow of Qi and blood to and from the
heart and brain and it can get blown around by an inner wind and cause a condition such as a stroke. Phlegm, literal or invisible
can cause stagnation and blockage which can lead to an interior condition of fire.
Food retention. Babies get this a lotfood retention leads to fever and internal heat.
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Pulse Chart
Jin

Tight
Tense

1.

Tight, forceful like a stretched rope (thicker


feel than the Xian or Wiry pulse)

2.

Like a tightly stretched cord.

1.

2.
3.
Tight is the hardest no flex
Wiry hard, but will still flex
Slippery soft and flexible

Cold.
Cold stretches and contracts, hence the tight tense pulse.
External cold
Internal cold = tight, slow pulse
Pain
Food retention

Similar to wiry pulse, but not as long.


While pain can easily be reported, cold is sometimes disguised by localized
heat symptoms. This pulse can indicate either exterior or interior cold.

Chang

Xian

Long

Wiry
Stringy
Taut
String-taut
Bowstring

1.

Straight/ beyond position

2.

Pulse w/long extent, prolonged stroke


Shows that the vessels are strong and
flexible.

1.
2.

Excess Yang Qi
Heat

Stringy quality indicates a level of tension, corresponding to a liver


syndrome.

In young people especially: can feel this pulse


across all 3 finger positions at once.

If acute disease, long pulse will occur when there is a strong confrontation
between body resistance and pathogen.

1.

Taut, straight, long, like violin string

2.

Feels straight and long, like musical string


instrument.

1.
2.
3.
4.
5.

Liver
Gallbladder (inflammationalcohol and fried foods make it worse)
Pain
Phlegm
Malaria

Hits all 3 fingers at the same time.


Note: leathery pulse is superficial, feels similar,
but wiry pulse is not a superficial pulse.

Similar to tense pulse, but longer, more tremulous. Severe pain can be easily
reported, but wiry pulse confirms liver and/or gallbladder as the point of
disharmony.

Wiry Pulse Combinations


In order of hardness: 1) tight, 2) wiry, 3) slippery
Wiry + fast = liver heat.
May have a bitter taste in the mouth and/or anger. Hepatitis patients have this pulse in the acute stage. Look at the tongue: the sides
will be red or you might see a red tongue, possibly with a yellow coat.
Wiry + thin = liver and kidney yin deficiency.
Hypertension patients and arteriosclerosis patients can have this pulse. Hits the fingers hard and strong.
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Pulse Chart
Strange Pulses
In addition to the 28 disease pulses, there are 10 strange pulses (very severe conditions) and 7 death pulses. Both indicate dangerous
conditions with poor prognosisyang is almost gone, stomach qi almost gone. This dude is dead, man.

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