DIAGNOSIS

BY
PALPATION
DME-312 HANDOUTS 7,8,9
PALPATION
Diagnosis by feeling generally includes the following
• Palpation of the pulse
• Palpation of the skin
• Palpation of the limbs
• Palpation of the hands
• Palpation of the chest
• Palpation of the abdomen
• Palpation of the points
PULSE DIAGNOSIS

Performed by placing fingers

along the Radial Artery.

Pressure is applied with

different kinds of strength at
three different points.

The patient’s arm should be

horizontal and not held
higher than heart level.
PULSE DIAGNOSIS

We use the pads of the

fingers to take the pulse
because they are the most
sensitive area.

We place the first three

fingers (not counting the
thumb) on the Radial artery.
PULSE DIAGNOSIS
Pulse is felt by moving the
fingers in 4 different ways:
• Lifting (upwards)
• Pressing (downwards)
• Pushing (side to side)
• Rolling (proximal – distal)

We also keep the fingers still

(searching) in order to be
able to decide the speed of
the pulse.
PULSE DIAGNOSIS

Sections of Pulse
• Inch (CUN) - Front
• Barrier (GUAN) - Middle
• Cubit (CHI) - Back

Pulse Depth
• Superficial – resting fingers very gently on the artery
• Deep – almost obliterate pulse then release very slightly
• Middle – in between these two kinds of pressure

Altogether, 3 Sections x 3 Depths = The 9 Regions

PULSE DIAGNOSIS
Superficial Deep Superficial
Deep

SI LI
Distal /
HT Front LU
GB ST
Middle SP
LR
UB TB
KD Proximal / KD
Yin Rear Yang

Correspondence of each organ and section / level

according to the Mai Jing (Pulse Classic)
PULSE DIAGNOSIS
Main importance of Pulse Diagnosis
1. Gives detailed information about state of internal organs
2. Reflects whole complex of Qi and Blood

Other Notes
• Pulse counts as a clinical manifestation that shows you
the entire body
• The tongue also does this, but with less clarity
PULSE DIAGNOSIS
Drawbacks to Pulse Diagnosis
• Extremely subjective
• Skill is subtle and hard to master
• Subject to external, short-term influences

Advantages to Pulse Diagnosis

• It can reflect older disharmonies not showing on tongue,
as well as others due to discoloration or physical
manipulation of it (such as scraping)
PULSE DIAGNOSIS
What you should pay attention to (IN THIS SPECIFIC ORDER)
1. Feel the Pulse as a whole
2. Feel whether the pulse has spirit, Stomach Qi and root
3. Feel the three levels and the three positions
4. Feel the strength of the pulse
5. Feel the quality of the pulse
PULSE DIAGNOSIS
Qualities of Pulse that we are looking for
• Force
• Movement
• Rate
• Rhythm
• Shape
• Presence of Shen
PULSE DIAGNOSIS
What is a Normal Pulse?
• Has Stomach-Qi
• Feels “gentle”, “calm” and relatively slow (4 beats per
respiratory cycle / breath)
• Has Spirit
• Soft but with strength; neither big or small
• Regulated – should not change type very easily
• Has root
• Deep level is clearly felt along with rear position
• Kidneys are felt strong
PULSE DIAGNOSIS
Factors that affect the Pulse
• Seasons
• Pulse is deeper in wintertime; superficial in summertime
• Gender
• Male pulse is naturally stronger than women’s
• Men have stronger left pulse; women, the right pulse
• Men have stronger front pulse; women, the rear
• Occupation
• People who perform strong physical labor should have a
stronger pulse than those who do not
PULSE DIAGNOSIS
Factors that affect the Pulse
• Body build
• Pulse will be stronger, larger and longer in robust, large
people; weaker, smaller and shorter in small, frail people
• Menstruation
• Becomes slippery the week before the onset, especially on
the right rear position; then it becomes weak and slower
• Pregnancy
• Becomes slippery, therefore it is considered normal
• Fan Guan Mai and Xie Fei Mai
• These are abnormalities on the pulse
PULSE DIAGNOSIS
Fan Guan Mai is a radial artery
displacement that is present in
about 5% of people.

The radial artery lies in the

dorsal aspect of the arm
instead of the inner aspect.

In these cases, the pulses on

the nine regions of the head,
hand and feet are
recommended.
DEEP PULSE

Chinese Name
• Chen Mai, a.k.a. Sinking
Description
• Can only be felt with heavy pressure; felt near the bone
Clinical Significance
• Indicates an interior condition
• Indicates the Yin organs to be the problem
Indications
• Deep and Weak: Yang and Qi deficiency
• Deep and Full: a) Stasis of Qi; b) Blood in the Interior;
c) Interior Cold or Heat
FLOATING PULSE

Chinese Name
• Fu Mai
Description
• Can be felt with a light pressure, resting fingers on artery
Clinical Significance
• Indicates presence of exterior pattern from pathogen
Indications
• Floating and Tight: Wind-Cold
• Floating and Rapid: Wind-Heat
• Floating Superficial / Empty Deep: Yin deficiency
SLOW PULSE

Chinese Name
• Chi Mai
Description
• Three beats per respiration cycle (breath) of practicioner
• Can also be counted using a watch
Clinical Significance
• Indicates a Cold pattern
Indications
• Slow and Empty – Empty-Cold from Yang Deficiency
• Slow and Full – Full Cold
SLOW PULSE

Typical Slow Pulse Speeds (estimated)

Age (Year) Rate (beat/min)

1–4 90 or more
4 – 10 84
10 – 16 78 / 80
16 – 35 76
35 – 50 70 / 72
50+ 68
RAPID PULSE

Chinese Name
• Shu Mai
Description
• 5 or more beats per cycle (or higher than slow chart)
Clinical Significance
• Indicates a Heat pattern
Indications
• Rapid and Empty – Empty-Heat from Yin Deficiency
• Rapid and Full – Full Heat or Excessive Heat
EMPTY PULSE

Chinese Name
• Xu Mai (a.k.a. Vacuous, Deficiency)
Description
• Feels rather big, but soft; feels empty with more pressure
Clinical Significance
• Indicates Qi or Qi AND Blood deficiency
FULL PULSE

Chinese Name
• Shi Mai (a.k.a. Excess type, Replete)
Description
• Feels full; rather hard and long
Clinical Significance
• Indicates a Full pattern
Indications
• Full and Rapid – Full-Heat
• Full and Slow – Full-Cold
SLIPPERY PULSE

Chinese Name
• Hua Mai
Description
• Feels smooth, round, oily to the touch; rolls under fingers
• Feels like “rolling pearls in a porcelain bowl”
Clinical Significance
• Indicates Phlegm, Dampness, Food retention, Pregnancy
Indications
• It’s full by definition, but can be weak as well
• It can be weak, indicating Phlegm, Dampness and Qi deficiency
CHOPPY PULSE

Chinese Name
• Se Mai a.k.a. Hesitant, Rough
Description
• Rough under the fingers; like a jagged edge
• Feels like “a knife scraping bamboo”
• Also means a pulse that changes rapidly in rate and quality
Clinical Significance
• Indicates stasis or deficiency of blood
• Could mean exhaustion of fluids, especially after profuse
sweating or vomiting
LONG PULSE

Chinese Name
• Chang Mai
Description
• Longer than normal; extends slightly beyond normal pulse
Clinical Significance
• Indicates a Heat pattern
• May indicate that there is no Pathological condition
SHORT PULSE

Chinese Name
• Duan Mai
Description
• Occupies shorter space than normal position
Clinical Significance
• Indicates a severe Qi deficiency
• Frequently appears on Front position; either left or right
• Specifically denotes deficiency of Stomach-Qi
OVERFLOWING
PULSE
Chinese Name
• Hong Mai, a.k.a. Surging, Flooding
Description
• Feels big and extending beyond normal pulse position
• Superficial; generally “overflows” normal pulse channel
Clinical Significance
• Indicates an Extreme Heat pattern
• Frequently appears during Fever, and Interior Heat diseases
Indications
• Overflowing and Empty on pressure – Empty Heat from Yin
deficiency
FINE PULSE

Chinese Name
• Xi Mai, a.k.a. Thready, Thin
Description
• Feels thinner than normal
Clinical Significance
• Indicates a deficiency of Blood
• May indicate Dampness with severe Qi deficiency
Indications
• Thin and Rapid – Heat brought by Yin deficiency
MINUTE PULSE

Chinese Name
• Wei Mai, a.k.a. Faint
Description
• Thinner than the Fine pulse; harder to feel; very small
Clinical Significance
• Severe deficiency of Qi and Blood
TIGHT PULSE

Chinese Name
• Jin Mai, a.k.a. Tense
Description
• Feels twisted, like a thick rope
• It also can be felt as it “vibrates”
Clinical Significance
• Indicates a Cold pattern, exterior (i.e. Wind-Cold) or Interior
• May indicate pain from an interior condition
Indications
• Tight and Floating – Exterior Cold
• Tight and Deep – Interior Cold
WIRY PULSE

Chinese Name
• Xian Mai, a.k.a. Stringlike, Bowstring
Description
• Feels taut, like a guitar string
• Thinner, more taut and harder than the Tight pulse
• “No fluidity or wave-like qualities”
Clinical Significance
• May indicate Liver disharmony
• May indicate Pain
• May indicate Phlegm
SLOWED-DOWN
PULSE
Chinese Name
• Huan Mai, a.k.a. Moderate
Description
• Four beats per respiration cycle
Clinical Significance
• Generally considered a healthy pulse
• If Dampness is suspected by other signs, it can be used to
indicate its presence
HOLLOW PULSE

Chinese Name
• Kong/Kou Mai, a.k.a. Scallion-stalk
Description
• Felt at superficial and deep; any middle pressure makes it
empty
Clinical Significance
• Indicates a loss of Blood
• Usually appears after a hemorrhage
Indications
• Hollow and slightly Rapid – Forthcoming loss of Blood
LEATHER PULSE

Chinese Name
• Ge Mai, a.k.a. Drumskin
Description
• Hard, tight and stretched superficially; empty at Deep level
• Large pulse, not thin
Clinical Significance
• Indicates severe deficiency of Kidney-Essence or Yin
FIRM PULSE

Chinese Name
• Lao Mai, a.k.a. Confined, Prison
Description
• Only felt at Deep level; felt hard and rather wiry
• Could be described as a Wiry pulse at the Deep level
Clinical Significance
• Indicates Interior Cold (if it is also Slow)
• Indicates Interior Stagnation and Pain
SOGGY PULSE

Chinese Name
• Ru Mai, a.k.a. Soft, Weak-Floating
Description
• Only felt on superficial level; very soft and slightly floating
• Disappears when pressure is applied to feel Deep level
Clinical Significance
• Indicates presence of Dampness if there are other signs that
represent a Qi deficiency
• May also indicate lack of Yin or Essence
WEAK PULSE

Chinese Name
• Ruo Mai, a.k.a. Frail
Description
• Only felt on Deep level; also soft
Clinical Significance
• Indicates a deficiency of Yang or of Blood
SCATTERED PULSE

Chinese Name
• San Mai
Description
• Small and relatively superficial
• Feels as if it was broken into small dots
Clinical Significance
• Severe deficiency of Qi and Blood, especially Kidney-Qi
• ALWAYS indicates a serious condition
HIDDEN PULSE

Chinese Name
• Fu Mai
Description
• As if it was hidden beneath the bone
• Extreme case of Deep pulse
Clinical Significance
• Extreme deficiency of Yang
• If strong, indicates an obstruction of Cold
MOVING PULSE

Chinese Name
• Dong Mai, a.k.a. Spinning-Bean
Description
• It is short and “trembles” under the finger
• Does not have a definite shape; shaking and also slippery
• Combination of short, tight, slippery and rapid pulses
Clinical Significance
• Indicates shock, anxiety, fright or extreme pain
• Found in people with deep emotional problems, especially
fear, or those who have suffered severe emotional shock
HASTY
PULSE
Chinese Name
• Cu Mai, a.k.a. Abrupt, Skipping, Hurried
Description
• Rapid pulse, stops at irregular intervals
Clinical Significance
• Indicates extreme Heat and a deficiency of Heart-Qi
• Also felt in conditions of Heart-Fire
KNOTTED
PULSE
Chinese Name
• Jie Mai, a.k.a. Bound
Description
• Slow and stops at irregular intervals
Clinical Significance
• Indicates cold
• Indicates deficiency of Heart-Qi or Heart-Yang
INTERMITTENT
PULSE
Chinese Name
• Dai Mai, a.k.a. Regularly Interrupted
Description
• Stops at regular intervals; feel the pulse and feel the stops
Clinical Significance
• Indicates a serious internal problem of one or more Yin organs
• If it stops every four beats or less, the condition is serious
• It can also indicate a serious heart problem (in the Western
medical sense)
RACING PULSE

Chinese Name
• Ji Mai, a.k.a. Swift
Description
• Pulse is very rapid, but agitated and very urgent
Clinical Significance
• Indicates an Excess of Yang, with Fire in the body exhausting
Yin
PULSE DIAGNOSIS
28 Different Pulse Qualities (with similar Grouping)
(The groups have been been grouped on a Yin-Yang level)

Deep Floating Slow Rapid Empty Full

Deep Floating Slow Rapid Empty Full
Firm Hollow Knotted Hasty Weak Overflow
Hidden Leather Hurried Fine Wiry
Moving Minute Tight
Soggy Long
Short
Scattered
PULSE DIAGNOSIS
8 Principles General Description Specific Pulse Quality
Pulse Quality
Exterior superficial Felt with light Superficial; floating; hollow;
(Yang) pressure leather; soft
Interior (Yin) deep Felt with deep Deep; Firm; Hidden
pressure
Hot (Yang) rapid More than 80 Rapid; Hasty; Moving
BPM (>5 per
breath)
Cold (Yin) slow Less than 65 Slow; Tight; Knotted;
BPM (3> per Intermittent (not necessarily
breath) slow but often)
Full (Yang) full Large, long, Full; Big; Overflowing; Wiry;
substancial Tight; Long; Slippery;
Flooding;
Empty (Yin) empty Small, short, Empty; Weak; Fine; Minute;
insubstancial Short; Scattered; Choppy
SKIN PALPATION
Palpating the skin involves focusing on three major topics:
• Temperature of the skin
• Moisture of the skin
• Texture of the skin

We do this by three different methods:

• Touching
• Stroking
• Pressing
PALPATING THE BODY
There are three different palpation techniques:
• Touching - Light touch of the patient’s skin
• Detecting temperature, moisture and sweat
• Stroking – stroking in the skin and deeper tissues of the
patient
• Usually carried out in chest, abdomen and limbs
• Determines presence of tenderness and swelling
• Pressing – pressing relatively hard to deeper levels
• Usually done in the abdomen
• Determines presence of pain or masses
SKIN PALPATION
Key things to Know
• Temperature
• Subjective feeling of heat does not always correspond to the
objective feeling of heat of the skin
• Skin feels hot to the touch – often indicates Damp-Heat
• Cold feeling indicates Cold pattern; often felt in loins, lower
abdomen or lower back (indicates Kidney-Yang deficiency)
• Hot on first touch, ceasing to feel hot with sustained pressure
– indicates Wind-Heat invasion, still on exterior
• Skin over vessel hot on medium pressure but not on heavy
pressure – interior Heat in Middle Jiao or Heart
• Skin hot on heavy pressure nearly nearing the bone – Empty
Heat from Yin deficiency
SKIN PALPATION
Key Things to Know
• Moisture and Texture
• Moist skin may indicate invasion of the Exterior by Wind-
Cold, or more commonly, Wind-Heat
• Moist skin with absence of exterior symptoms indicates
spontaneous sweating from Lung-Qi deficiency
• Dry skin indicates Blood or Lung-Yin deficiency
• Rough-like skin may indicate Painful Obstruction
Syndrome from Wind
• Scaly and dry skin indicates exhaustion of body fluids
• Swollen skin with a pit left after pressing indicates oedema
• Swollen skin, no pit indicates retention of Dampness
LIMB PALPATION
Key Things to Remember:
• Hands and feet cold to the touch indicate Yang deficiency
• Whole arm and leg feel cold indicate Kidney-Yang
deficiency (Empty-Cold)
• Only forearm and lower leg feel cold may indicate Interior
Cold from Qi stagnation (Full-Cold)
• Only hands and feet feel cold may indicate Qi stagnation
• Limbs feeling hot indicate a Heat pattern
• Hands hot on the dorsum indicate Full-Heat
• Hands hot on palms indicate Empty-Heat from Yin
deficiency
CHEST PALPATION

Process
• Palpate the area over the left
ventricle of the heart (called
“Interior Emptiness” or Xu Li in
Chinese Medicine)
• Pulse of heart can be felt in this
area; sometimes seen
• Area reflects the state of Zong Qi
(Gathering Qi)
CHEST PALPATION
Key Things to Remember
• Faint but clear pulsation indicates Gathering Qi deficiency
• Too strong pulsations indicate “outpouring” of Gathering
Qi, i.e. a state of hyperactivity due to over-pushing oneself
• Pulsation not felt indicates Phlegm or a hiatus hernia
• Area below xyphoid process feeling full and painful on
pressure indicates a Full pattern
ABDOMEN PALPATION
The Abdomen is generally palpated in 5 areas:
• Hypochondrium
• Epigastrium
• Umbilical area
• Lateral-lower abdomen
• Central-lower abdomen
ABDOMEN PALPATION

Hypochondrium
• Includes the lateral side of
the rib cage and area
immediately below it
• Reflects state of the Liver
and Gall-Bladder
ABDOMEN PALPATION

Epigastrium
• Area contained between
the xyphoid process,
costal margins and the
umbilicus
• Reveals the condition of
the Stomach and Spleen
ABDOMEN PALPATION

Umbilical Region
• It is the area right around
the umbilicus
• It reflects the state of the
Kidneys, the Penetrating
and Directing Vessels
• Umbilical area has a
palpable pulse as well
ABDOMEN PALPATION

Lateral-lower Abdomen
• Also called Shao Fu
• Reflect the state of the
Intestines and the
Penetrating Vessel
ABDOMEN PALPATION

Central-lower Abdomen
• Also called Xiao Fu
• Reflects the state of the
Small Intestine, Kidneys,
Bladder, Uterus and Liver
JAPANESE HARA DX

Step 1: Compare Big and

Small Abdomen

• Big Abdomen Deficient –

LU or SP
• Small Abdomen Deficient –
LV or KD
JAPANESE HARA DX
Step 2: Determin Nan Jing
Abdominal Diagnosis Area:

• SP – Umbilical, CV7 – CV12

• HT – Substernal, CV12 – CV15
• LU – Right of Navel / Right Ab
• LV – Lower left of Navel / Left
Ab
• KD – Subumbilical, CV7 -
Pubis
POINT PALPATION
Main point of point palpation is checking for tenderness
• Very tender on superficial pressure – Full condition on
that channel or local stagnation
• Pressure relieves pain – Empty condition on that channel
• Pressure relieves but then causes discomfort – mixed
Deficiency and Excess condition

All acupuncture points (and Ah Shi points) can be used

diagnostically.
POINT PALPATION
Main Points for Palpation Diagnosis
• Front Collecting (Mu) Points
• Back Transporting (Shu) Points
• Lower Sea Points
• Source (Yuan) Points
• Ah Shi Points
FRONT MU POINTS

Mu – “raise, collect, enlist,

recruit”

Points where the Qi of the

relevant organs get collected
BACK SHU POINTS

Points are all located on the

Bladder channel

Reflect specifically the

condition of the relevant
internal organ instead of its
channel
BACK SHU POINTS
LOWER SEA POINTS
Points are used to treat their respective Yang organs

Organ Point Channel Organ Point

L.Int. ST-37 Yang Ming Stomach ST-36
San Jiao UB-39 Shao Yang Gall-Bladder GB-34
S. Int. ST-39 Tai Yang U. Bladder UB-40
YUAN POINTS

“If the 5 Yin organs are diseased, abnormal reactions will

appear at the 12 Source points. If we know the
correspondence of Source points to the relevant Yin organ,
we can diagnose when a Yin organ is diseased.”

Spiritual Axis, Ch. 1

YUAN POINTS
Source Points for the Yin Organs

Yin Organ Source Point

Lungs LU-9 Taiyuan
Heart PE-7 Daling
Spleen SP-3 Taibai
Liver LIV-3 Taichong
Kidneys KI-3 Taixi
AH SHI POINTS
Ah Shi Theory
• If there is soreness on pressure (whether on a channel or
not), there is a point
• Body is completely covered by different channels so
every area is irrigated by them
• Pressure and description of the condition will reflect the
channel which it is closest to
REFERENCE /
CREDITS
• Kaptchuk, Ted - “The Web that has no Weaver
• Maciocia, Giovanni – “Diagnosis in Chinese Medicine”
• Maciocia, Giovanni – “Foundations of Chinese Medicine”
• Xin Nong, Cheng – “Chinese Acupuncture and
Moxibustion”
• Zheng, Li Shi - “Pulse Diagnosis”
• Flaws, Bob – “The Secret of Chinese Pulse Diagnosis”