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After a child reaches one year of age, the wrist is short and narrow, making pulse diagnosis difficult. The practitioner uses a single finger to rotate and press laterally to distinguish the Cun (Inch), Guan (Bar), and Chi (Cubit) positions, employing light pressure (Fu/Float), medium pressure, and heavy pressure (Chen/Sink) to examine the pulse. There are nine examination methods for the left hand and nine for the right hand. For children aged three to five, a pulse rate of seven to eight beats per respiration that is fine and rapid indicates a healthy state. An increased rate indicates Heat, while a decreased rate indicates Cold. (From *Jicheng*)

Floating Pulse (Fu Mai): Tangible upon light touch on the skin surface. It governs Exterior syndromes, belongs to the Fu organs, and is Yang in nature. It is caused by Wind pathogenic factors and the Six Exogenous Pathogens. A floating pulse with force indicates Exterior Excess, while a floating pulse without force indicates Exterior Deficiency; both present as Floating. In cases of prolonged weakness or impending death, the pulse may also be weak and floating, which serves to differentiate between exogenous and endogenous diseases. (From *Xinfa*)

The Scattered Pulse (San Mai) is extremely weak and floating, governing the dispersion of Spirit and depletion of Qi. The Chop-pulse (Kou Mai) floats like an onion stalk, governing blood loss. The Drums-skin Pulse (Ge Mai) floats like pressing a drum, governing loss of essence. The Soft Pulse (Ru Mai) is floating, soft, and fine, governing dampness injury and blood deficiency. The Surging Pulse (Hong Mai) is floating and forceful, governing vomiting and distension, and also indicates Yang excess with Yin deficiency. The Deficient Pulse (Xu Mai) is floating and weak, governing blood deficiency. (Chen Xiuyuan)

Deep Pulse (Chen Mai): Tangible only after heavy pressure below the muscle layer. It governs Interior syndromes, belongs to the Zang organs, and is Yin in nature. It is caused by Seven Emotions and dietary injuries. However, patients with violent anger, edema, severe abdominal pain, or plague where sweating and purgation fail to expel the pathogen may also present with a Deep pulse. (From *Xinfa*)

The Hidden Pulse (Fu Mai) sinks deeply to the bone, governing internal stagnation of Heat. The Ge Mai is hard at the bottom when deep; the Weak Pulse (Ruo Mai) is fine and soft when deep, governing Qi decline, though it may appear in individuals of high status. (Chen Xiuyuan)

Slow Pulse (Chi Mai): Two or three beats per respiration, or even one beat per respiration. It governs Cold and is Yin in nature. Forceful Slow pulse indicates Cold pain; weak Slow pulse indicates Deficient pain. Injuries from Summerheat, food stagnation, water retention, cold wind forcing sweat, and stagnation of Qi and Blood all present with a Slow pulse. (Chen Xiuyuan)

The Moderate Pulse (Huan Mai) is Slow but unhurried; the Choppy Pulse (Se Mai) is Slow and non-flowing, governing blood deficiency. the Knotted Pulse (Jie Mai) is Slow with occasional pauses, governing accumulations, also indicating mild Yang and Qi stagnation, blood obstruction, and phlegm retention. the Intermitting Pulse (Dai Mai) is Slow with regular pauses, governing Qi exhaustion, but is harmless in pregnancy. (Chen Xiuyuan)

Rapid Pulse (Shu Mai): Five to six beats per respiration, or seven to eight beats. It governs Heat and is Yang in nature. Forceful Rapid pulse indicates Excess Heat; weak Rapid pulse indicates Deficient Heat. However, patients with severe internal pain, those about to sweat, those with impending collapse of deficient Yang, dysentery,痞 (Pi) ulcers, postpartum women, asthma, and cough may also present with a Rapid pulse. (Chen Xiuyuan)

The Slippery Pulse (Hua Mai) is Rapid and smooth, governing phlegm and food accumulation. the Tight Pulse (Jin Mai) is Rapid and twisting/tense, governing Cold and Pain. the Hasty Pulse (Cu Mai) is Rapid with occasional pauses, governing stagnant Fire in the Triple Burner. the Moving Pulse (Dong Mai) appears at the Guan position, governing Pain and Fright; in men, it indicates Yang collapse; in women, uterine bleeding. (Chen Xiuyuan)

the Large Pulse (Da Mai) is thick and large like a finger or chopstick. It governs Excess, indicating abundant pathogenic factors and declining Stomach Qi, hence the pulse is Large but not relaxed. (Chen Xiuyuan)

the Surging Pulse (Hong Mai) is Large and boiling; the Solid Pulse (Shi Mai) is Large and hard. (Chen Xiuyuan)

the Fine Pulse (Xi Mai) is small and thin like a thread. It governs Deficiency and is Yin in nature. It also indicates impending depletion of True Yin. (Chen Xiuyuan)

the Micro Pulse (Wei Mai) is Fine and indistinct, indicating Yang Qi nearly exhausted. the Soft Pulse (Ru Mai) is Fine and superficially floating; the Weak Pulse (Ruo Mai) is Fine and deeply sinking. (Chen Xiuyuan)

the Short Pulse (Duan Mai) comes short, not reaching up to Cun or down to Chi. It governs constitutional weakness, alcohol injury, and Qi stagnation in the Triple Burner with undigested food. (Chen Xiuyuan)

the Long Pulse (Chang Mai) comes long, extending up to Yuji and down to Chize. It governs constitutional strength and is a normal pulse. (Chen Xiuyuan)

the Deficient Pulse (Xu Mai) feels weak under the finger. It governs Deficiency. Fever indicates Summerheat injury; absence of fever indicates blood deficiency. (Chen Xiuyuan)

Weak when Deep and Small governs Blood Deficiency. Soft when Floating and Small governs Qi Deficiency. Micro when vague governs the extinction of Yang Qi in the eyes. Choppy when dry and obstructed governs Blood Deficiency and dead blood (stasis). Fine when small in shape governs Cold Qi. Short when contracted in shape governs Qi damage. (Chen Xiuyuan)

the Solid Pulse (Shi Mai) feels forceful under the finger. It governs Excess, also heat stagnation, food injury, Qi pain, and delirium. (Chen Xiuyuan)

Slippery when Solid and smooth governs Blood disease. Long when Solid and extended governs Qi stagnation. Surging when Solid and boiling governs extreme Heat and also internal Deficiency. String-taut when Solid and straight governs Liver pathogens, masses, hernia, and malaria. (Chen Xiuyuan)

the Moderate Pulse (Huan Mai) has four beats per respiration, calm and unhurried. It governs the recovery of Zheng Qi and is a normal pulse. Harmonious Moderate pulse indicates Zheng recovery; lethargic Moderate pulse indicates Dampness invasion. (Chen Xiuyuan)

All six positions of both hands initially reflect the Lung pulse because the Lung is the canopy of the Zang and Fu organs; any organ pathology affects the Lung and manifests in the pulse. Heart disease presents with Surging pulses in all six positions; Liver disease with String-taut pulses; Kidney disease with Deep pulses; Lung disease with Choppy pulses; Spleen disease with Moderate pulses. Turbid feeling under the finger indicates strong pathogens; clear feeling indicates Zheng recovery. Pulses with Shen (Spirit) are auspicious; those without Shen are ominous. Forceful pulses indicate Heat and Excess; weak pulses indicate Cold and Deficiency. This is the most reliable method. (Chen Xiuyuan)

For internal Deficiency diseases, a Weak pulse is appropriate, while Large and Surging pulses are contraindicated. For external contraction diseases, Yang pulses are appropriate, while Yin pulses are contraindicated. (Chen Xiuyuan)

Pulses with Wei Qi (Stomach Qi), Shen (Spirit), and harmony are auspicious; those conforming to the seasons are auspicious; those generating mutually productive relationships with the five colors of the face are auspicious; the opposite is inauspicious. (Chen Xiuyuan)

What is the pulse of a healthy person? Four beats per respiration. What are the constant pulses of the five Zang organs? Heart should be Surging, Lung Choppy, Liver String-taut, Spleen Moderate, Kidney Deep, combined with a harmonious Qi, which is the Wei Qi. What are the normal seasonal pulses? Spring String-taut, Summer Surging, Autumn Choppy, Winter Deep, and Moderate at the end of each season. What are the different pulses of men and women? Men are Yang, with Cun larger than Chi; Women are Yin, with Chi larger than Cun. (Chen Xiuyuan)

Sparrow-pecking continuously, stopping then starting again, indicates Liver exhaustion. Water dripping from a leaking roof, one drop every half hour, indicates Stomach exhaustion. Beating stone, deep and string-taut, pulsating under the finger, indicates Kidney exhaustion. Suddenly dense then sparse, chaotic like untied cords, indicates Spleen exhaustion. Base still but tip shaking, like a fish swimming, indicates Heart exhaustion. Shrimp swimming slowly, suddenly leaping once, indicates Large Intestine exhaustion. Cauldron boiling, empty and floating, lacking roots, indicates Lung exhaustion. (Chen Xiuyuan)

Diagnosing external contractions: initially, the pathogen enters the meridians, remaining in the Exterior. Mild cases show surging Floating pulses at Cun; severe cases show surging Floating pulses at Guan and Chi. Once transmitted to the Interior, if internal Heat is severe, the pulse becomes Deep. Diseases in the Upper Jiao manifest at Cun; Middle Jiao at Guan; Lower Jiao at Chi. (Wang Hangao)

If the Cun pulse is Hidden without Deficiency signs, it is due to Wind-Cold closure, representing Exterior Deficiency, and sweating therapy is contraindicated. If the Chi pulse is Hidden without Deficiency signs, it is due to Damp-Heat closure, representing Interior Deficiency, and promoting urination or defecation is contraindicated. (Wang Hangao)

Left pulse weak, Right pulse strong: governs excessive sweating, seminal emission, and Liver Qi stagnation. Right pulse weak, Left pulse strong: governs abdominal pain and irritability. Misuse of warming pills/powders will generate Liver Heat and symptoms like slippery seminal emission. (Wang Hangao)

Right pulse strong, Left pulse absent: governs Phlegm accumulation and Qi Deficiency. Left pulse strong, Right pulse absent: governs food stagnation and Liver Qi stagnation. (Wang Hangao)

Reversed pulse images result from extreme stagnation and blockage. For example, Liver disease shows String-taut pulse at Left Guan; stagnation makes it String-taut and Fine; extreme stagnation makes it Fine and Knotted, or even Hidden. However, the String-taut quality may appear in the counteracting meridian, hence String-taut at Right Guan. Other cases follow this logic. (Wang Hangao)

Those who preserve Jing for a long time have strong pulses at both Chi positions, so all six pulses feel Solid upon heavy pressure, and they do not suffer from seminal emission. (Wang Hangao)

Men with strong Right pulse and sunken, fine, weak Left pulse: governs Qi weakness and internal Damp-Heat, leading to seminal emission within days. If Chi pulse is weak, seminal emission has already occurred. Women with such pulses suffer from white turbidity or leukorrhea. Pulses with Knotted qualities indicate leukorrhea. (Wang Hangao)

Strong Cun pulse, weak Chi pulse: governs Yang Excess and Yin Deficiency. Prone to upper Heat/lower Cold, upper Excess/lower Deficiency, floating Yang rising, and Deficient Cold. (Wang Hangao)

Weak Cun pulse, strong Chi pulse: governs Yang Deficiency and Yin Excess. Prone to Wind-Cold and Damp-Heat. Careful differentiation is required. (Wang Hangao)

Healthy individuals: No pulse upon light pressure indicates Exterior Deficiency, based on habitual sweating. Even with external contraction, sweating agents must be used cautiously. No pulse upon heavy pressure indicates Interior Deficiency, based on habitual diarrhea. Even with stagnation, purgative agents must be used cautiously. Slow and weak pulse upon medium pressure indicates Middle Qi Deficiency, based on inability to eat and weak spirit. Only congenital Double-Hidden pulses (Six Yin Pulses) are excluded, as these individuals can eat and have strong spirits. (Wang Hangao)

When one position shows three or four pulse images, e.g., Right Cun is Surging (Lung Heat); Surging and Slippery indicates Phlegm; a thread of Fine within indicates that although Fine, the force is strong, visible within the Surging-Slippery image, governing upper Jiao pain. If it is Fine rather than Hasty, Knotted, String-taut, or Large, the pain is due to Stagnant Heat, not Excess Fire. Treatment should resolve stagnation, clear Lung, and transform Phlegm, avoiding cold/cooling herbs and attacking therapies. Others follow this pattern. (Wang Hangao)

In consumption diseases with hematemesis, if the pulse is Floating but disappears upon heavy pressure, it indicates rootless Qi about to collapse. For all Deficiency, elderly, chronic, and postpartum diseases, having a pulse upon heavy pressure is crucial. In excessive sweating, if the pulse is weak on light pressure but strong on heavy pressure, it indicates unexpressed sweat; stopping it is impossible. If strong on light pressure but absent on heavy pressure, collapse is imminent. Only pulses felt at both Floating and Deep levels with moderate force indicate recovery. (Wang Hangao)

Cold contraction causes aversion to cold; Left Three Positions are Floating and Rapid, causing fever and pain. Left Yuji is also Floating, Rapid, and Fine, causing severe headache. If Right Three Positions are also Floating and Rapid, there is food aversion. Without Wind, there is no sweat; without Yangming Heat, there is no thirst. (Wang Hangao)

If the two Guan positions show irregular rates with Knotted or Hasty qualities upon heavy pressure, it indicates Stagnation. One must resolve Liver and Spleen Stagnation. In miscellaneous diseases, resolve Stagnation first, then treat the disease. Cases where pulse and symptoms match but treatment fails often involve unresolved Stagnation. (Wang Hangao)

Note: *Chu Shi Yi Shu* contains much knowledge on pulse diagnosis. Identifying pulses requires distinguishing their images. Floating pulse is light and clear above, visible on light touch, like wood floating on water. Deep pulse is heavy and turbid below, felt only on heavy touch, like a stone sinking. Slow pulse is sluggish, indicating insufficiency. Rapid pulse is urgent, indicating excess. Large pulse is thick, like a chopstick or finger. Fine pulse is thin, like silk or thread. Short pulse does not reach its proper position. Long pulse exceeds its proper position. Deficient pulse is slow, large, and soft, weak on pressure. Solid pulse is seen at both Floating and Deep levels, large and long with a String-taut quality, forceful on pressure. Moderate pulse is even and harmonious, like spring breeze blowing willow tips. Soft pulse is Floating and soft, like silk in water, visible on light touch. Surging pulse resembles turbulent floodwaters. Floating and forceful, vigorous onset and declining termination, is the Large/Gou pulse. Choppy pulse is rough and slow, like scraping bamboo with a sharp knife. Slippery pulse flows continuously, like pearls rolling on a plate. String-taut pulse is rigid and straight, capable of lifting heavy weights, a sign of force. Weak pulse is soft and fine, unable to lift a feather, a sign of weakness. Chop-pulse is hollow inside, solid yet empty, like squeezing an onion stalk. Drums-skin pulse is hollow inside, solid yet empty, like pressing a drum skin. Tight pulse is urgent and forceful, i.e., not loose, like twisting cords. Scattered pulse is Floating, scattered, and weak, i.e., not gathered, like poplar catkins drifting. Hidden pulse sinks deeply, felt only by pushing tendons to the bone. Knotted pulse is Slow with occasional stops. Hasty pulse is Rapid with occasional stops. Moving pulse dips at both ends, rises in the middle, shaped like a bean, trembling vigorously. Intermitting pulse is Slow with central stops, unable to recover itself, stopping regularly at fixed intervals, like the succession of seasons without error. Once pulse images are distinguished, multiple images in one position can be identified. This volume focuses on pediatric diagnosis, so pulse theory is not fully covered; for comprehensive study, refer to *Mai Jing*. (Tili Zi)

Left Cun (Exterior) Small Intestine (Interior) Heart - Governs Upper Jiao
Left Guan (Exterior) Gallbladder (Interior) Liver - Governs Middle Jiao
Left Chi (Exterior) Bladder (Interior) Kidney - Governs Lower Jiao
The high bone behind the palm is the Guan position; anterior to Guan is Cun; posterior to Guan is Chi. In pulse diagnosis, place fingers relative to the high bone behind the palm, starting with Guan, then Cun and Chi. For shorter individuals, fingers are placed closely; for taller individuals, fingers are spaced apart. This is a fixed rule.

Right Cun (Exterior) Large Intestine (Interior) Lung - Governs Upper Jiao
Right Guan (Exterior) Stomach (Interior) Spleen - Governs Middle Jiao
Right Chi (Exterior) Pericardium (Interior) Mingmen - Governs Lower Jiao