典藏书目

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