Pulse condition

The form and pace of the pulsation of the vessels, especially at the wrist, as detected by palpation.

Normal pulse (正常脉 zhèng cháng mài): A steady, even pulse with approximately four beats per respiration. Its significance is threefold. Its smoothness and forceful indicate the presence of spirit. It is neither sunken nor floating, and the beat arrives and departs evenly and effortlessly, indicating the presence of stomach qì. Forcefulness at the deep level indicates the presence of root. The pulse may be affected by such factors as age, sex, build, and constitution. The pulse of a child tends to be soft and rapid; that of a woman is softer and slightly faster than a man’s. Obese people tend to have fine and sunken pulses, whereas thin people have large pulses; athletes have moderate pulses, and pregnant women usually have slippery, slightly rapid pulses. These variations are all within the bounds of normal health. Some people display congenital irregularities, such as a particularly narrow artery, which makes the pulse comparatively fine, or a pulse on the back of the wrist, in which the artery runs around the posterior face of the styloid process of the radius, or oblique-running pulse, in which the pulse runs from the cubit position over the posterior face of the styloid process of the radius toward LI-4 (Union Valley, 合谷 hé gǔ). These irregularities have no significance in pattern identification.

Floating pulse (浮脉 fú mài): A pulse superabundant at the superficial level, but insufficient at the deep level, described as being like wood floating on water. A floating pulse is felt as soon as the fingers touch the skin, but becomes markedly less perceptible when further pressure is applied. Although classically associated with exterior patterns, the floating pulse may be indistinct in patients of heavy build, with weak constitutions, or suffering from severe water swelling, even when an exterior pattern is present. A floating pulse may also occur in enduring illnesses or after a major loss of blood, indicating a severe insufficiency of right qì rather than an exterior pattern. It is said that A floating pulse seen in enduring illness is cause for great concern. A floating pulse in these cases differs slightly from the floating pulse occurring in external disease in that it is somewhat less pronounced at the superficial level, and markedly less pronounced at the deep level, for which reason it is sometimes referred to as a vacuous floating pulse. A scattered pulse (散脉 sàn mài, also called dispersed pulse) is a large floating pulse without root, i.e., one that is large at the superficial level but ceases to be felt as soon as the slightest pressure is applied; it is attended by other critical signs and indicates the dispersion of qì and blood and the impending expiration of the essential qì of the organs. A scallion-stalk pulse (芤脉 kōu mài) is a large floating pulse that when pressure is applied feels empty in the middle; it is a sign of heavy blood loss and usually occurs in cases of major hemorrhage.

Sunken pulse (沉脉 chén mài): A pulse that is distinct only at the deep level. A sunken pulse is associated essentially with interior patterns, although the exterior patterns of external diseases may temporarily present with a tight sunken pulse when the body’s yáng qì is obstructed. The hidden pulse (伏脉 fú mài) is even deeper than the sunken pulse and considerable pressure has to be applied in order to feel it. The Bīn-Hú Sphygmology (濒湖脉学 bīn hú mài xué) states, The hidden pulse is found by pressing through the sinews right to the bone. It is associated with fulminant desertion of yáng qì and deep-lying cold, and generally appears in conjunction with severe vomiting, diarrhea, and pain. The weak pulse (弱脉 ruò mài) is sunken and without force and is associated with vacuity of qì and blood. The firm pulse (牢脉 láo mài) is sunken and forceful, and firm and unmoving, hence its name. It is associated with cold pain. In clinical practice, this term is no longer in popular use. The pulse is described as a stringlike sunken pulse or a sunken replete pulse.

Slow pulse (迟脉 chí mài): A pulse that has three or less beats per respiration. The slow pulse is principally associated with cold and with yáng vacuity. It may occur in any disease involving insufficiency of yáng qì or obstruction of qì dynamic, such as cold, phlegm turbidity, and static blood. Occurring during pregnancy, this pulse signifies uterine vacuity cold or insecurity of fetal qì. The moderate pulse (缓脉 huǎn mài), like the slow pulse, is also slower than the standard pulse, although usually it has more than three beats per respiration and is not an indication of morbidity.

Rapid pulse (数脉 shuò mài): A pulse that has six beats per respiration is a rapid pulse; one having between five and six beats is termed a slightly rapid pulse. The rapid pulse is usually quite smooth-flowing, so it is often confused with a slippery pulse. However, the term rapid refers exclusively to the pace, whereas slippery denotes a quality. The Bīn-Hú Sphygmology (濒湖脉学 bīn hú mài xué) clearly points out, Rapid and slippery should not be considered as being the same; rapid refers to the pace only. The rapid pulse is associated with heatbut may sometimes be an indication of vacuity. A forceful rapid pulse indicates repletion heat and is most commonly seen in externally contracted febrile disease. A forceless fine rapid pulse indicates yīn vacuity fire effulgence and is generally seen in depletion patterns, such as are described in Western medicine as pulmonary tuberculosis. A forceless large rapid pulse generally indicates qì vacuity. Most healthy infants have rapid pulses, and a slippery rapid pulse is a normal sign in pregnancy. A pulse with seven or more beats per respiration is known as a racing pulse (疾脉 jí mài). Its significance is the same as that of the rapid pulse, although the possibility of vacuity is greater.

Slippery pulse (滑脉 huá mài): A smooth-flowing pulse classically described as pearls rolling in a dish or small fish swimming. A slippery pulse is commonly seen in pregnancy, particularly in the early stages where extra blood is needed to nourish the fetus. It is also sometimes seen in healthy people, indicating an abundance of qì and blood. Phlegm-rheum patterns and food accumulation may also be characterized by a slippery pulse. The stirred pulse (动脉 dòng mài) is a forceful rapid slippery pulse, like a bean that is bobbing. It is seen in pain, fright, high fevers associated with external diseases, and in pregnancy.

Rough pulse (涩脉 sè mài): A pulse opposite to the slippery pulse, i.e., one that does not flow smoothly and that is classically described as a knife scraping bamboo. The rough pulse is sometimes termed a choppy or dry pulse in English. It tends to be somewhat fine, is generally slightly slower than the normal pulse, and has been described as being fine, slow, short, dry, and beating with difficulty. The rough pulse is often seen in blood stasis patterns and dual vacuity of blood and qì.

Stringlike pulse (弦脉 xuán mài): A long taut pulse that feels like a the string of a musical instrument. It is sometimes called a wiry or bowstring pulse in English. The stringlike pulse is associated with diseases of the liver and gallbladder, and in particular with ascendant hyperactivity of liver yáng. It is also associated with pain and with phlegm-rheum patterns. It may be commonly seen in diseases classified by Western medicine as hypertension, arteriosclerosis, chronic bronchitis, and in diseases characterized by severe pain. The stringlike pulse is generally strong; if forceless, it is termed a vacuous stringlike pulse, indicating vacuity of yīn and hyperactivity of yáng. A tight pulse (紧脉 jǐn mài) is a stringlike pulse that has marked forcefulness. Stringlike denotes a quality, whereas tight denotes a quality and forcefulness. A tight pulse is always stringlike, but a stringlike pulse is not necessarily tight. A tight pulse is associated with cold and pain. A drumskin pulse (革脉 gé mài) is stringlike and empty in the middle. It essentially the as the scallion-stalk pulse (see under floating pulse above).

Soggy pulse (濡脉 rú mài) (濡脉 rú mài): A pulse that is fine, though less distinctly so than a fine pulse, and that tends to be floating. Soggy signifies softness and relative lack of force. The soggy pulse is associated with dual vacuity of blood and qì and with damp encumbrance. A faint pulse (微脉 wēi mài) is extremely fine and forceless, indistinct, and almost imperceptible; it indicates qì and blood vacuity desertion. The vacuous pulse (虚脉 xū mài), like the soggy pulse, is forceless, but differs as it is large rather than fine. The term is also generally used to connote forcelessness, particularly in combinations such as vacuous rapid pulse, vacuous stringlike pulse, etc.

Surging pulse (洪脉 hóng mài): A broad and large pulse that is forceful at all levels, especially the superficial. the coming of each beat is longer and more forceful than the going away, which accounts for the description, Coming forcefully, going away feebly. It is thought of as tempestuous billowing waves, surging over the whole of the finger[tip], with an initial strong swell followed by a sharp but calm ebbing away. A surging pulse indicates exuberant heat and is usually a sign of repletion. Observed in enduring diseases (such as tuberculosis) or in vacuity patterns due to massive bleeding, it indicates that right qì is extremely weak and that the condition is deteriorating. A replete pulse (实脉 shí mài) is similar to a surging pulse, but is as forceful when it departs as when it arrives. It indicates that the body is afflicted by an exuberant evil, but that right qì is still holding firm. A large pulse in clinical practice has roughly the same significance as the surging pulse. However, it should be noted that large refers only to the breadth of the blood vessel as it feels to the touch. It bears no connotations of forcefulness.

Fine pulse (细脉 xì mài), sometimes call a small pulse: A pulse that feels like a well-defined thread under the fingers. The fine pulse indicates dual vacuity of qì and blood or of yīn and yáng, and in particular points to blood and yīn vacuities.

Skipping, bound, and intermittent pulses (促、结、代脉 cù、jié、dài mài): The skipping pulse, or rapid irregularly interrupted pulse (促脉 cù mài), is broken by irregular pauses and is relatively fast. The bound pulse, or slow irregularly interrupted pulse (结脉 jié mài), is slow with pauses at irregular intervals. The intermittent pulse, or a regularly interrupted pulse (代脉 dài mài), is a pulse interspersed with relatively regular pauses. These three are often loosely referred to by term interrupted (结代 jié dài) pulses. The interrupted pulses indicate debilitation of visceral qì, and in particular insufficiency of heart qì. They may also indicate blood stasis or phlegm turbidity obstructing yáng qì in the chest and can be seen in heart bi patterns. Interrupted pulses may also occur in healthy individuals and in patients suffering from emotional depression.

Long pulse (长脉 cháng mài): A long pulse is one that can be felt beyond the inch and cubit positions. If runs straight from head to tail, a feels like long stick. A long pulse that is harmonious and moderate is a sign of effulgent center qì. A long, stringlike and hard pulse that feels like a rope pulled taut indicates a repletion pattern in which evil and right are both exuberant, and is seen in repletion heat binding internally or exuberant heat stirring wind.

Short pulse (短脉 duǎn mài):: A pulse that is felt only at the bar point. The short pulse signifies dual vacuity of blood and qì, or impaired flow of blood and qì. See twenty-eight pulses; stomach, spirit, and root; pulse bereft of stomach qì; seven strange pulses; ten strange pulses.