邢锡波老医师研究祖国医学脉诊历数十年，对于脉学理论曾做过系统、深入的探讨，并在长时间的临床实践中，潜心体会，验证各种脉象与疾病变化的关系，认真探索其中的规律，积累了丰富的诊脉经验。《脉学阐微》一书系邢锡波医师根据中医脉学理论的基本精神，结合自己几十年的临床经验，在晚年编著的。书中重点阐发了脉诊的作用，正确的诊脉方法，各种脉象变化的临床意义。对二十八部脉的体状、主病、鉴别等都作了系统、清晰的归纳，并有选择地摘引了一些古人对脉诊的论述。不但阐明了脉诊在中医辩证中的重要性，而且对现代医学的某些疾病，在其发生、发展变化中的脉象演变规律，作了明确的阐述，对于从事中西医结合临床工作的同志，有一定的参考价值。邢锡波医师对于中医诊断学中的“四诊合参”一向身体力行。本书对于各种脉象，从脉位、脉力、脉率、脉形各个角度进行了分析和对比，并附以图象，详加说明，使读者能清楚地领会各脉的特征。我们在整理过程中，主要从字句、标点、编排等方面作了一些修改，内容稍有补充和调整，如有不妥，望读者批评指正。
河北新医大学
脉学阐微
一、脉诊的意义
祖国医学的脉诊，已有几千年的历史。历代医家在长期的临床实践中，很早就发现了“心主脉”这个科学道理，认识到气血旺盛是人体防御疾病和消除疾病的重要条件，任何致病因素侵袭人体，总是损伤气血的功能，促使机体的气血津液发生变化。而脉象是反映气血变化的重要标志，所以脉象的变化，与人体抗病机能的强弱和病势盛衰有着密切关系。病势重则需要的抗病机能强，故现洪大滑数之脉。病在外，则人体气血抗病机能即趋向于外，故现浮脉。病在内，则人体抗病之机能趋向于内，故现沉脉。这种脉象的变化，是随着机体防御机能的改变而出现的。古人在临床上体会到，机体防御疾病机能与气血的循行有密切关系，故利用脉搏的变化以指导诊断。脉搏的浮沉迟数，是机体与疾病矛盾斗争的体现。临床诊察要根据脉象来诊察疾病的性质，部位、与演变，并通过望，闻、问、切全面结合，才能得到疾病的真实情况，作出正确的诊断，制订出符合病情行之有效的治疗方法。中医辨证，虽为四诊合参，而对于分阴阳、定虚实、明部位、订治则，则均需取决于脉象，故脉诊是辨证的依据，立法的准则，是四诊的重要组成部分之一。中医辨证，如不精通脉理和疾病脉象的演变规律，就不能精炼地运用辨证技巧，早期测知疾病的演变情况，及时用药控制疾病的发展。通过长期的临床体验，证实任何疾病的转变过程，多先有脉象变化，然后始有症状发生。利用脉象的变化，可早期测知疾病演变，变被动为主动，能攻能防，机动灵活，收到事半功倍之效。学习脉诊，除精通理论外，还要经过长期实地练习，做到既有理论，又有技巧，以熟练的应用于临床辨证。
二、切脉的方法及注意事项
1．选时间：诊脉以平旦为最好，《素问?脉要精微论》云，“诊法常以平旦，阴气未动，阳气未散，饮食未进，经脉未盛，络脉调匀，气血未乱，故乃可诊有过之脉。”早晨机体内外环境均较安静，脉象能如实反映病情，医者可获无内外因素干扰的资料。古人很早就注意到，由于体力活动、精神、饮食之干扰，都能使脉象出现一时性变化，如疾行、剧动后脉弦数有力，愤怒后脉多弦大，饮酒之后洪大弦滑，食后右脉浮滑等。以上所述系诊脉理想时间，但非指其他时间不能诊脉。明?汪机曾说：“若迂有病则随时皆可以诊，不可以‘平旦’为拘也。”
2．病人的体位：诊脉时，病人最好端坐，将前臂自然向前展平，在腕下放以松软的脉枕或布袋。如不能坐可以仰卧，将手向前伸平，但忌侧卧，因为侧卧下面的臂部受压，或上臂扭转，都可以影响气血流通，可能影响脉搏变化，故古人诊脉强调平臂。《医存》云：“病者侧卧，则在下之臂受压，而脉不能行，若复其手，则腕扭而脉行不利，若低其手，则血下注而脉滞，若举其手，则气上窜而脉驰，若身复则气压而脉困，若身动则气扰而脉忙。’以上种种，皆因血行有碍，影响脉象之正常形象，故病者诊脉宜正坐或正卧，直腕仰掌，乃可诊脉。
3。布指和单按总按：诊脉下指，首以中指端按掌后高骨内侧(桡骨头定为关部)关部，然后把食指放在中指之前，从关前至鱼际的适中距离的寸脉之上，然后放无名指于中指之后的尺脉部位上。病人臂长者布指略疏，臂短者布指略密，总以适中为度。部位取准后，三指用同样力量，按诊三部脉象，谓之总按，用以探寻寸关尺三部，和左右手脉的全部情况，为浮为沉，寸关尺三部俱沉，抑寸关尺的某一部沉；三部俱浮，抑某一都浮。是尺盛于寸，或寸盛于尺，是左大于右，还是右脉大于左脉，都要通过总按，以比较左右和尺寸各部脉象的变化。疾病影响整个机体时，则六脉发生相应变化，如外邪侵袭体表身发冷热，则六脉皆浮，而右脉浮大或浮滑，必较左脉为甚；如寸大于尺多为阴虚阳亢，高血压病、心脏病多见之。加压时，三指用力要均匀适度，认真探索脉象变化，如脉搏至数的快慢，节律是否正常等。然后再根据某部脉象的反常，采取单按法，即用中指和食指，或中指与无名指在反常脉的部位，反复寻按，认真探索脉象性状。加右关脉独沉，知胃有宿疾；若右关脉沉滑，为食热塞滞；如右关脉现沉弦，为肝气犯胃；若右关脉独沉涩为脾胃虚寒。若右脉偏沉，惟右寸浮大为风热犯肺。若右尺浮滑，为湿热下注，或风火下犯膀肮，可有尿急尿频淋血等症。这些情况，通过单按，就可以清楚地看出其腹部独特的变化，以作为诊断时的重要根据。
4．脉象的齐变和独异不同，初诊与久按有别：人体受外邪侵袭，或情欲损伤，影响整体时，则两手之脉均将发生变化。如外感风寒，或温热，则左右脉皆浮紧，或浮大、滑数，其脉皆右脉大于左脉。如急性胃炎，身发冷热，恶呕不思食，是局部病变而影响整体时，其脉象多六脉弦数，或弦滑，右关较甚。急慢性肝炎，脉弦大或弦数，六脉俱弦，以左关为甚。脉象齐变，是六脉都发生变化。独异，是六脉中某一部脉异常，如慢性病未影响整体，常某一脉独异。如慢性胃病，右关脉多沉弦，或沉滑，或沉涩，慢性胃病发作时，未影响到整体者不发热，仅脘胀痛、灼心呕吐、消化不良等症，右关浮大弦滑较甚。如脾虚胃弱，右关细弱，湿热壅滞下焦(泌尿系感染)，尺脉多沉滑，或弦数，较寸关部为明显。肺热咳喘，右寸多滑数，或沉滑，均说明脉象与脏腑之关系。
初按与久按不同，脉有初按大，按久索然，有初按濡软，按久搏指，亦有下指微弦，按久微缓者。张登《诊宗三昧》载有初诊久按不同说谓：“诊客邪暴病，应指浮象可证。若切虚赢久病，当以根气为本，如下指浮大，久按索然者，正气大虚之象。”在初按时，其气血外趋抗病力猛，故脉现浮大，由于正气不足，后继无力，故久按索然，这种脉象，不论新病久病，虽现灼热烦扰，皆正气不足，虚阳外露之象。如初下指脉象濡软，久按搏指，为里病表和之象，是里病初显尚未尽透。如下指微弦，按久缓和，多为久病向愈之象，大抵病人之脉，初下指虽见乏力，或弦细不和，按之十余至，而惭觉雍容和缓，为病势缓解，气血调和之象。如按久微涩，不能应指，或渐觉弦硬者，多为正气虚损太甚，外邪未解之象，预后较差。
5，诊脉要专念虑、平气息：一呼一吸谓之一息，平息即以正常一呼一吸的时间，数病人脉搏的至数。古人以自己的呼吸测病人脉搏至数，故脉的迟数，均以一息几次计算，现在有秒表，对于诊脉有一定的帮助。为练习诊脉的基本功，仍以争取不用表为宜。平息另一意义具有平调之意。古人谓诊脉应慎容止，专念虑，调鼻息，要达到思想集中，心平气和，全神贯注以诊脉象。
6．运指应注意举、按、寻：为诊脉时运用指力的轻重和挪移以探索脉象的手法。持脉主要有三：即举、按、寻。轻手循之曰举，重手取之曰，不轻不重委曲求之日寻。初持脉时轻手以候之，脉见于皮肤之间者，用以察阳气之盛衰，重手得之脉于肌肉之下曰按，按法用以测阴气之盈虚。不轻不重而取之，其应于血肉之间者曰寻，以候脾胃之强弱。换言之，举是轻轻地按在皮肤之上，按是向下按至筋骨，寻是推寻，是体察脉搏的性状。正常脉象平滑柔软，有弹性而不强硬。设脉象搏动时，有坚硬如铅笔样感觉，或如绳索及蛇行样感觉，则多为动脉硬化象征。体察这种脉象，非用寻法不能发觉。
持脉时，应注意脉搏的频率与节律。正常人一息四至，即一分钟约60-80次，妇女与儿童较快，身体素弱者亦可稍快。节律，包括脉搏的间隔，脉力的强弱,波幅的高低，一般间隔匀调，脉力一致，波幅上下整齐。青少年与老年人在正常情况下，有时可发生呼吸性不整脉,就是在吸气时较快，呼气时较慢，诊断时一般容易忽略，而用机械描记较易发现。另有挠动脉位置异常者，多在列缺上绕向手背(即反关脉，切之脉浮，无诊断意义)。
7．候脉必满五十:《灵枢；根结篇》说：“持其脉口，数其至也，五十动而不一代者，五脏皆受气”。汉张仲景也十分重视五十动的说法，曾在《伤寒论》序言中批判那些仓卒持脉，随便作出诊断的医生：“动数发息，不满五十，短期未知决诊，九候曾无仿佛，……夫欲视死别生，实为难矣。”考其意义，一方面用以了解五十动中有无促，结、代脉，并可了解五脏的全部情况；另一方面说明诊脉不能草率从事，必须以辨清脉象为目的(如果第一个五十动仍看不清楚，可延至第二第三个五十动。一般时间，是五到十分钟，必要时可以多一些)。
8．指法的运用：人之三指参差不齐，持脉时必使指头齐平，节节相对，方可按脉。又三指端之皮肉，食指感觉最灵敏，中指最厚，无名指更厚，故诊脉时必须用指端棱起如线者，名曰指目，以按脉之脊，方能脉象显然。若指甲不加勤剪，指不能直立，以指端厚肉按脉，易生错觉。诊脉以三指平按，或三指垂直下按，均不适当。最好以35度斜按，不但指目感觉较灵敏，也便于推寻。
三、三部九候的诊法与配合脏腑
目前，一般临床常用的是独取寸口的诊脉法，寸口脉即桡骨动脉，分为寸、关、尺三个部位，以挠骨小头处为关部，关前为寸，关后为尺，两手寸关尺共六部分管脏腑。每部又有浮，中，沉三候，三部脉共九候，合称三部九候。另有一种三部九候诊法，是一种全身性的诊脉方法，亦称“遍诊法’。在《素问、三部九候论》篇中有详细记载。上部(头部)上部天：两额之动脉，以候头角之气。上部地：两颊之动脉，以候口齿之气。上部人：耳前之动脉，以候耳目之气。中部(手部)中部天：手太阴(寸口部)以候肺。中部地：手阳明(合谷穴)以候胸中气，中部人：手少阴(神门穴)以候心。下部(足部)下部天：足厥阴(五里或太冲穴)以候肝。下部地：足少阴(太溪穴)以候肾。下部人；足太阴(箕门穴或冲阳穴)以候脾胃。附：寸、关、尺部位图诊脉运指图历代医家关于寸关尺的分配脏腑见解不同，据《素问?脉要精微论》：1．左寸，外以候心，内以候膻中。右寸，外以候肺，内以候胸中。2．左关，外以候肝，内以候膈。右关，外以候胃，内以候脾。3．左尺，外以候肾，内以候腹中。右尺，外以候肾，内以候腹中。后世大致以《内经》为根据，略有变更。《难经》以小肠、大肠分别配心，肺。以右肾为命门。《脉经》以三焦配右尺，张景岳则以膀胱大肠配左尺。以三焦、命门、小肠配右尺。《医宗金鉴》则以右寸候胸中、肺，左寸候包络、心；右关候胃、脾，左关候胆、肝；两尺候两肾，左尺配小肠、膀胱，右尺配大肠；又以三部分候三焦。以上仅举有代表性者数种，余从略(表一)。
学说左寸右寸左关右关左尺右尺
Lao Physician Xing Xibo has studied the pulse diagnosis (Pulse Diagnosis) of traditional Chinese medicine for decades. He conducted systematic and in-depth discussions on pulse theory (Pulse Theory), and through long-term clinical practice, he deeply experienced and verified the relationship between various pulse patterns (Pulse Patterns) and disease changes. He carefully explored the laws within, accumulating rich experience in pulse taking. The book *Mai Xue Chan Wei* (Elucidation of Pulse Studies) was compiled by Physician Xing Xibo in his later years, based on the basic spirit of traditional Chinese pulse theory and combined with his decades of clinical experience. The book focuses on elucidating the role of pulse diagnosis, correct methods of pulse taking, and the clinical significance of various pulse pattern changes. It systematically and clearly summarizes the physical characteristics, associated diseases, and differentiation of the twenty-eight pulse types, and selectively quotes ancient discussions on pulse diagnosis. It not only clarifies the importance of pulse diagnosis in TCM syndrome differentiation (Syndrome Differentiation), but also explicitly expounds the evolutionary laws of pulse patterns in the occurrence and development of certain modern medical diseases, providing a certain reference value for comrades engaged in integrated traditional Chinese and Western medicine clinical work. Physician Xing Xibo has always practiced "combining the four diagnostic methods" (Four Diagnostic Methods) in TCM diagnostics. This book analyzes and compares various pulse patterns from the perspectives of pulse position (Pulse Position), pulse force (Pulse Force), pulse rate (Pulse Rate), and pulse shape (Pulse Shape), accompanied by illustrations and detailed explanations, enabling readers to clearly understand the characteristics of each pulse. During the compilation process, we made some modifications mainly in wording, punctuation, and arrangement, with slight additions and adjustments to the content. If there are any inadequacies, we hope for readers' criticism and correction.
Hebei New Medical University
Elucidation of Pulse Studies
I. The Significance of Pulse Diagnosis
Pulse diagnosis in traditional Chinese medicine has a history of thousands of years. Physicians in past dynasties discovered the scientific principle that "the Heart governs the vessels" (Heart Governs Vessels) early on through long-term clinical practice. They recognized that vigorous Qi and Blood (Qi and Blood) are important conditions for the human body to defend against and eliminate diseases. Any pathogenic factor invading the human body always damages the function of Qi and Blood, promoting changes in the body's Qi, Blood, Body Fluids (Body Fluids), and Jin-Ye (Jin-Ye). Pulse patterns are an important sign reflecting changes in Qi and Blood; therefore, changes in pulse patterns are closely related to the strength of the body's anti-disease mechanism and the prosperity or decline of the disease trend. When the disease trend is severe, a stronger anti-disease mechanism is required, thus presenting with洪大滑数 (Hong Da Hua Shu - Surging, Large, Slippery, Rapid) pulses. When the disease is external, the body's Qi and Blood anti-disease mechanism tends outward, thus presenting with floating pulses (Floating Pulse). When the disease is internal, the body's anti-disease mechanism tends inward, thus presenting with deep pulses (Deep Pulse). These changes in pulse patterns appear along with changes in the body's defense mechanism. Ancient clinicians realized that the body's disease-defense mechanism is closely related to the circulation of Qi and Blood; therefore, they utilized changes in the pulse to guide diagnosis. The floating, deep, slow, and rapid nature of the pulse reflects the contradictory struggle between the body and the disease. Clinical examination must diagnose the nature, location, and evolution of the disease based on pulse patterns. By comprehensively combining inspection (Inspection), auscultation and olfaction (Auscultation and Olfaction), inquiry (Inquiry), and palpation (Palpation), one can obtain the true situation of the disease, make a correct diagnosis, and formulate effective treatment methods suitable for the condition. Although TCM syndrome differentiation relies on the combination of the four diagnostic methods, determining Yin and Yang (Yin and Yang), defining deficiency and excess (Deficiency and Excess), clarifying locations, and establishing treatment principles all depend on pulse patterns. Thus, pulse diagnosis is the basis for syndrome differentiation, the standard for formulating treatments, and an important component of the four diagnostic methods. In TCM syndrome differentiation, if one does not master pulse theory and the evolutionary laws of disease pulse patterns, one cannot skillfully apply differentiation techniques, early detect disease evolution, and timely use medication to control disease development. Through long-term clinical experience, it has been confirmed that in the transformation process of any disease, pulse pattern changes often occur first, followed by the onset of symptoms. Utilizing pulse pattern changes allows for early detection of disease evolution, turning passivity into initiative, enabling both attack and defense, being flexible and agile, and achieving twice the result with half the effort. Learning pulse diagnosis requires not only mastering theory but also long-term practical exercise, ensuring both theoretical knowledge and technical skills to be applied proficiently in clinical syndrome differentiation.
II. Methods and Precautions for Pulse Taking
1. Selecting Time: The best time for pulse diagnosis is at dawn (Ping Dan - Early Morning). As stated in *Su Wen: Mai Yao Jing Wei Lun* (Plain Questions: Essential Meaning of Pulse Examination): "The method of diagnosis is usually performed at dawn, when Yin Qi has not yet moved, Yang Qi has not yet dispersed, food and drink have not been taken, meridians are not yet full, collateral vessels are balanced, and Qi and Blood are not yet disturbed; thus, abnormal pulses can be diagnosed." In the morning, the internal and external environments of the body are relatively quiet, and pulse patterns can truthfully reflect the condition, allowing physicians to obtain data free from internal and external interference. Ancient people noticed early on that physical activity, mental state, and diet can cause temporary changes in pulse patterns. For example, after brisk walking or intense movement, the pulse may become wiry, rapid, and forceful; after anger, the pulse is often wiry and large; after drinking alcohol, it becomes surging, large, wiry, and slippery; after eating, the right-side pulse may become floating and slippery. The above describes the ideal time for pulse diagnosis, but it does not mean that other times are unsuitable. Wang Ji of the Ming Dynasty said: "If a patient is ill, diagnosis can be performed at any time; one should not be constrained by 'dawn'."
2. Patient's Posture: During pulse diagnosis, the patient should ideally sit upright, extending the forearm naturally forward and flat, placing a soft pulse pillow or cloth bag under the wrist. If sitting is not possible, the patient may lie supine with the hand extended forward, but side-lying should be avoided because the lower arm is compressed, or the upper arm is twisted, which can affect the flow of Qi and Blood and potentially influence pulse changes. Therefore, ancient practitioners emphasized keeping the arm level during pulse taking. *Yi Cun* states: "If a patient lies on their side, the lower arm is compressed, and the pulse cannot flow freely. If the hand is turned back, the wrist twists, impeding pulse flow. If the hand is lowered, blood flows downward, causing pulse stagnation. If the hand is raised, Qi rushes upward, causing pulse acceleration. If the body rolls over, pressure compresses Qi, making the pulse sluggish. If the body moves, Qi is disturbed, making the pulse hurried." All these situations hinder blood flow, affecting the normal appearance of the pulse. Therefore, patients should sit upright or lie straight with the wrist straight and palm facing up for accurate pulse diagnosis.
3. Finger Placement and Single vs. Total Pressing: When placing fingers for pulse diagnosis, first press the inner side of the radial styloid process (defined as the Guan position) with the tip of the middle finger. Then place the index finger before the middle finger at the Cun position, at an appropriate distance from the front of the Guan to the thenar eminence. Finally, place the ring finger behind the middle finger at the Chi position. For patients with longer arms, fingers are placed slightly wider; for shorter arms, slightly closer, generally aiming for appropriateness. After accurately positioning, press the three positions (Cun, Guan, Chi) with equal force using all three fingers, known as total pressing (Total Pressing). This is used to explore the entire situation of the Cun, Guan, and Chi positions on both hands, determining if they are floating or deep, whether all three positions are deep or shallow, or if only specific positions are so. It compares whether the Chi is stronger than the Cun, or vice versa, and whether the left is larger than the right, or the right larger than the left. All these variations are compared through total pressing. When a disease affects the whole body, all six pulses change correspondingly. For example, when external pathogens invade the surface causing fever and chills, all six pulses float, with the right-side floating or floating-slippery pulse being more pronounced than the left. If Cun is larger than Chi, it often indicates Yin deficiency with Yang hyperactivity, common in hypertension and heart disease. When applying pressure, the force of the three fingers must be uniform and moderate, carefully exploring pulse changes such as rate and rhythm. Then, based on abnormalities in specific positions, use single pressing (Single Pressing), using the middle and index fingers, or middle and ring fingers, to repeatedly search and press the abnormal pulse area, carefully exploring its characteristics. If the Right Guan pulse alone is deep, it indicates chronic stomach disease; if Right Guan is deep and slippery, it indicates food heat stagnation; if Right Guan is deep and wiry, it indicates Liver Qi invading the Stomach; if Right Guan is deep and choppy alone, it indicates Spleen and Stomach deficiency cold. If the right-side pulse is predominantly deep, but Right Cun is floating and large, it indicates Wind-Heat attacking the Lungs. If Right Chi is floating and slippery, it indicates Damp-Heat pouring downward or Wind-Fire attacking the Bladder, possibly accompanied by symptoms like urgent/frequent urination and hematuria. These conditions can be clearly seen through single pressing, revealing unique abdominal changes, serving as an important basis for diagnosis.
4. Simultaneous Changes vs. Unique Anomalies, Initial vs. Long Pressing: When the human body is invaded by external pathogens or damaged by emotional desires, affecting the whole, both hands' pulses will change. For example, in external contraction of Wind-Cold or Warmth, both left and right pulses may be floating-tight, or floating-large, slippery-rapid, with the right pulse generally larger than the left. In acute gastritis with fever/chills, nausea, and loss of appetite, where a local lesion affects the whole, the pulse is often wiry-rapid or wiry-slippery across all six positions, most pronounced at Right Guan. In acute/chronic hepatitis, the pulse is wiry-large or wiry-rapid, with all six pulses wiry, most pronounced at Left Guan. Simultaneous change means all six pulses change. Unique anomaly means one specific position among the six is abnormal. For chronic diseases not affecting the whole, often one pulse is uniquely anomalous. For chronic stomach disease, Right Guan is often deep-wiry, deep-slippery, or deep-choppy. During flare-ups without systemic impact, there is no fever, only epigastric distension/pain, burning sensation/vomiting, indigestion, etc., with Right Guan being particularly floating-large, wiry, and slippery. For Spleen deficiency and weak Stomach, Right Guan is fine and weak. For Damp-Heat stagnation in the Lower Jiao (urinary tract infection), Chi pulse is often deep-slippery or wiry-rapid, more obvious than Cun/Guan. Lung Heat with cough/wheezing shows Right Cun as slippery-rapid or deep-slippery, illustrating the relationship between pulse patterns and Zang-Fu organs.
Initial pressing differs from long pressing. Some pulses are large initially but become empty upon long pressing; some are soft initially but become forceful upon long pressing; some are slightly wiry initially but become relaxed upon long pressing. Zhang Deng's *Zhen Zong San Mei* records this difference: "For acute external pathogens and sudden diseases, a floating image responding to the finger confirms the diagnosis. For chronic deficiency and wasting diseases, root Qi is fundamental. If the pulse is floating and large initially but becomes empty upon long pressing, it is a sign of severe Zheng Qi (Upright Qi) deficiency." Initially, Qi and Blood rush outward for strong anti-disease power, hence the floating-large pulse. Due to insufficient Zheng Qi and lack of subsequent strength, it becomes empty upon long pressing. Regardless of new or old disease, even if showing heat and irritability, this is a sign of insufficient Zheng Qi and exposed deficient Yang. If the pulse is soft initially but forceful upon long pressing, it indicates interior disease with exterior harmony, meaning interior disease is just appearing and not fully revealed. If slightly wiry initially but relaxing upon long pressing, it is mostly a sign of recovery in chronic illness. Generally, if the pulse feels weak or wiry-fine and discordant initially, but after ten-plus beats feels harmonious and relaxed, it indicates alleviation of disease trend and harmonization of Qi and Blood. If long pressing reveals slight chopiness, inability to respond to the finger, or gradual stiffness, it indicates severe Zheng Qi damage and unresolved external pathogens, suggesting a poorer prognosis.
5. Focus and Calm Breathing: One exhalation and inhalation constitute one breath (Xi). "Ping Xi" (Calming Breath) means counting the patient's pulse beats within the time of a normal breath. Ancients measured patient pulse rates using their own breathing, so pulse slowness (Chi) and rapidity (Shu) were calculated by beats per breath. Although stopwatches help now, avoiding them is better for practicing basic skills. "Ping Xi" also implies balancing. Ancients stated that pulse diagnosis requires careful demeanor, focused thoughts, and regulated nasal breathing, achieving concentration, calmness, and full attention to the pulse.
6. Finger Movements: Lifting, Pressing, and Searching: These are techniques using varying finger pressure and movement to explore pulse patterns. There are three main methods: Lifting (Ju), Pressing (An), and Searching (Xun). Lightly touching is called Lifting; heavily grasping is called Pressing; neither light nor heavy, seeking gently, is called Searching. Initially, lightly touch to observe; if the pulse is felt between the skin, it assesses the abundance or deficiency of Yang Qi. Heavily pressing to feel the pulse below the muscle is called Pressing, used to measure the fullness or emptiness of Yin Qi. Neither light nor heavy, feeling it between flesh and blood, is called Searching, used to assess the strength of Spleen and Stomach. In other words, Lifting is lightly pressing on the skin; Pressing is pressing down to the bone/tendon; Searching is pushing and exploring the pulse's nature. Normal pulses are smooth, soft, elastic, and not stiff. If the pulse feels hard like a pencil, or like a rope or snake moving, it often symbolizes arteriosclerosis. Observing such pulses requires the Searching method.
When holding the pulse, pay attention to frequency and rhythm. A normal person has four beats per breath, approximately 60-80 beats per minute. Women and children are faster; those constitutionally weak may also be slightly faster. Rhythm includes intervals, force, and amplitude. Generally, intervals are regular, force is consistent, and amplitude is neat. Adolescents and elderly people may sometimes have respiratory arrhythmia (faster on inspiration, slower on expiration), which is easily ignored in diagnosis but easily detected by mechanical recording. Those with abnormal radial artery position often have the pulse winding towards the dorsal hand above Lieque (Contrary Gate Pulse); this pulse is floating and has no diagnostic significance.
7. Counting Fifty Beats: *Ling Shu: Gen Jie Pian* states: "Hold the pulse opening, count the beats. If there are fifty beats without an intermittent pulse, the Five Zang Organs all receive Qi." Zhang Zhongjing of the Han Dynasty also valued the concept of fifty beats, criticizing in the preface of *Shang Han Lun* those who hastily take pulses and make casual diagnoses: "Beats are numerous, breaths are few, less than fifty, short-term unknown, decision unclear, nine inspections are nowhere to be found... To distinguish death from life truly is indeed difficult." Its significance lies in understanding whether there are Cu (Hasty), Jie (Knotted), or Dai (Intermittent) pulses within fifty beats, and understanding the full condition of the Five Zang Organs. It also explains that pulse diagnosis cannot be rushed; the goal must be to clearly differentiate pulse patterns (if the first fifty beats are unclear, extend to the second or third fifty. Generally five to ten minutes, more if necessary).
8. Application of Finger Techniques: Human fingers vary in length. During pulse taking, fingertips must be aligned, joints opposite each other, to press the pulse properly. Among the fingertips, the index finger is most sensitive, the middle finger thickest, and the ring finger thickest still. Therefore, one must use the raised edge of the fingertip, called the "Finger Eye" (Zhi Mu), to press the pulse ridge, making the pulse pattern clear. If nails are not trimmed frequently, fingers cannot stand upright; pressing with thick flesh at the fingertip easily causes illusions. Flat pressing or vertical pressing with three fingers is inappropriate. Best is a 35-degree oblique angle, which makes the Finger Eye more sensitive and facilitates searching.
III. Three Regions and Nine Inspections Method and Corresponding Zang-Fu Organs
Currently, the commonly used clinical method is taking only the Cun Kou (Cun Kou Pulse) pulse. The Cun Kou pulse is the radial artery, divided into Cun, Guan, and Chi positions. The radial head is the Guan position, Cun is anterior to Guan, and Chi is posterior to Guan. The six positions (Cun, Guan, Chi on both hands) manage Zang-Fu organs. Each position has three inspections: Floating (Fu), Middle (Zhong), and Deep (Chen). The three regions and nine inspections total nine inspections, collectively called "Three Regions and Nine Inspections." Another method is also called "Full Body Inspection" (Bian Zhen Fa), detailed in *Su Wen: San Bu Jiu Hou Lun*. Upper Region (Head): Upper Heaven: Arteries at both temples, to inspect Qi of head corners. Upper Earth: Arteries at both cheeks, to inspect Qi of mouth and teeth. Upper Human: Artery in front of ears, to inspect Qi of eyes and ears. Middle Region (Hand): Middle Heaven: Hand Taiyin (Cun Kou position) to inspect Lung. Middle Earth: Hand Yangming (Hegu Acupoint) to inspect Qi of chest. Middle Human: Hand Shaoyin (Shenmen Acupoint) to inspect Heart. Lower Region (Foot): Lower Heaven: Foot Jueyin (Wuli or Taichong Acupoint) to inspect Liver. Lower Earth: Foot Shaoyin (Taixi Acupoint) to inspect Kidney. Lower Human: Foot Taiyin (Jimen or Chongyang Acupoint) to inspect Spleen and Stomach. Attachment: Diagrams of Cun/Guan/Chi positions and finger movements. Physicians throughout history had different views on assigning Zang-Fu to Cun/Guan/Chi. According to *Su Wen: Mai Yao Jing Wei Lun*: 1. Left Cun: Exterior inspects Heart, Interior inspects Dan Zhong. Right Cun: Exterior inspects Lung, Interior inspects Chest Center. 2. Left Guan: Exterior inspects Liver, Interior inspects Diaphragm. Right Guan: Exterior inspects Stomach, Interior inspects Spleen. 3. Left Chi: Exterior inspects Kidney, Interior inspects Abdomen. Right Chi: Exterior inspects Kidney, Interior inspects Abdomen. Later generations largely followed *Nei Jing* with slight changes. *Nan Jing* paired Small Intestine and Large Intestine with Heart and Lung respectively, and defined Right Kidney as Ming Men (Gate of Life). *Mai Jing* paired Triple Energizer with Right Chi, while Zhang Jingyue paired Bladder and Large Intestine with Left Chi, and Triple Energizer, Ming Men, and Small Intestine with Right Chi. *Yi Zong Jin Jian* inspected Chest Center and Lung with Right Cun, Pericardium and Heart with Left Cun; Stomach and Spleen with Right Guan, Gallbladder and Liver with Left Guan; Both Kides with Both Chis, Left Chi paired with Small Intestine and Bladder, Right Chi with Large Intestine; and divided Triple Energizer into three parts. The above lists representative examples; others are omitted (Table 1).
School | Left Cun | Right Cun | Left Guan | Right Guan | Left Chi | Right Chi
--- | --- | --- | --- | --- | --- | ---
Su Wen | Heart, Dan Zhong | Lung, Chest Center | Liver, Diaphragm | Stomach, Spleen | Kidney, Abdomen | Kidney, Abdomen
Nan Jing | Heart, Small Intestine | Lung, Large Intestine | Liver, Gallbladder | Stomach, Spleen | Kidney, Bladder | Kidney, Triple Energizer, Large Intestine
Mai Jing | Heart, Small Intestine | Lung, Large Intestine | Liver, Gallbladder | Stomach, Spleen | Kidney, Bladder | Kidney, Triple Energizer