脉诊

Pulse diagnosis has a long history in Chinese medicine, with detailed material already in the Yellow Emperor's Inner Classic and the Classic of Difficulties (《難經》, Nán Jīng), and reaching a first definitive synthesis in the Pulse Classic (《脈經》, Mài Jīng) of the Jin dynasty physician Wang Shuhe (王叔和). The method places three fingers on the radial artery just behind the patient's wrist. The three finger positions — cun (寸, distal), guan (关, middle), and chi (尺, proximal) — each correspond to particular organs, and at each position the clinician feels at three depths: superficial, middle, and deep. On the left wrist, cun reflects the Heart, guan reflects the Liver, and chi reflects the Kidney; on the right wrist, cun reflects the Lung, guan reflects the Spleen, and chi reflects the Mingmen (the gate-of-life region of the Kidney).

In practice the clinician evaluates five qualities of the pulse together: position (floating or sinking), rate (slow or rapid), shape (thin or thick, long or short), force (strong or weak), and rhythm (regular or irregular). These observations are then condensed into one or more of the twenty-eight named pulse types, each of which carries clinical implications. As with all the four examinations, pulse findings must be integrated with the others, never relied upon in isolation.

Floating pulse (浮, fú): felt easily on light pressure, weakening or disappearing on heavy pressure. Indicates an exterior pattern. The body's defensive qi is mobilized at the surface to fight the pathogen, drawing the pulse outward.

Sinking pulse (沉, chén): not felt on light pressure, requires deep pressure to detect. Indicates an interior pattern — disease has entered the organs, or the qi and blood are weakened and unable to surface.

Slow pulse (迟, chí): fewer than four beats per breath of the clinician (roughly under sixty per minute). Indicates a cold pattern. Cold congeals and stagnates qi, slowing the movement of blood.

Rapid pulse (数, shuò): more than five beats per breath (roughly over ninety per minute). Indicates a heat pattern. Heat accelerates the movement of blood.

Vacuous pulse (虚, xū): all three positions and all three depths are weak and forceless. Indicates a vacuity pattern of any kind.

Replete pulse (实, shí): all three positions and depths feel forceful. Indicates an excess pattern of any kind.

Wiry pulse (弦, xián): straight, taut, and long, "like pressing on a guitar string." Indicates Liver and Gallbladder disorders, pain, phlegm-fluid retention, and malaria.

Slippery pulse (滑, huá): the beats roll smoothly under the fingers "like beads sliding on a plate." Indicates phlegm-fluid retention, food accumulation, and excess heat — and also occurs normally in pregnancy.

Choppy pulse (涩, sè): the beats feel rough and obstructed, "like a light blade scraping bamboo." Indicates damaged essence, blood vacuity, and qi stagnation with blood stasis.

Thin pulse (细, xì): like a fine thread but distinctly felt. Indicates patterns of vacuity, especially blood vacuity and yin vacuity.

Surging pulse (洪, hóng): the beat arrives in great waves — full and powerful coming, weaker going. Indicates intense interior heat at the qi level.

These ten are the pulses encountered most frequently in clinical practice. The remaining eighteen of the standard twenty-eight are catalogued in the Pulse Classic and other dedicated texts.