Pulse Potential: An Introduction to Pulse Diagnosis in TCM

There are many ways of checking in with your health—physical, mental, and spiritual—in Traditional Chinese Medicine (TCM). In the Western medicine tradition, you will often get weighed and measured, and your blood pressure is taken. With Eastern medicine, a practitioner will ask questions, gaining important insight into a patient’s medical history, symptoms and daily routines, in addition to conducting a tongue diagnosis as well as a pulse diagnosis. Pulse diagnosis is one of the main diagnostic tools in Chinese medicine, and is very different from a standard blood pressure check: in checking the quality or type of pulse at very specific points on the wrists, the practitioner can determine the health of different internal organs, feeling the energy levels of the different meridian energy organ systems. Using this information, they can then prescribe a unique combination of herbs, acupuncture, and other techniques and potential changes to a patient’s routine in order to help them on their journey to healing.

So what is a practitioner actually watching for when they take your pulse? What does each type of pulse mean? And how does each different type of pulse indicate balance or imbalance, qi flow or stagnation? It’s important to note, before we get into the details, that pulse diagnosis takes years and years of practice to master as it’s an extremely intricate and advanced system of diagnosis. As such, this is just a very cursory introduction to the concept.

Areas of Pulse:

There are 3 main points  on each of the wrists that correspond to different internal organs. Those points are cun, guan, and chi.

On the left hand:

• cun corresponds to the heart
• guan to the liver
• chi to the kidney

On the right hand:

• cun corresponds to the lung
• guan to the spleen
• chi to the kidney

You can see the location of these different points in the diagram below.

Levels of Pulse:

There are 3 levels of pulse at which the practitioner can gather information about your health. One way to think about this is the amount of pressure the practitioner can apply to the point. The 3 pulse levels are:

• Superficial: the practitioner is pressing lightly and can gather information about the qi, or energy in the body
• Middle: the practitioner is applying slightly more pressure and can learn about the blood
• Deep: the practitioner is applying yet more pressure and can get information about yin, or organ level

Types of Pulses:

When a practitioner presses on the 3 diagnostic points (cun, guan, and chi), they are checking not just for the number of beats per breath, or rate of the pulse—as in Western medicine—but also for the quality: they are feeling for subtler sensations as well as noting the feel of the vessel itself. There are more than 30 pulse characteristics, but we can break them up into larger categories: depth, length, and quality.

• Depth: If a practitioner can only feel your pulse at the superficial level, but not when they apply more pressure and check at the middle and deep levels, then your pulse may be characterized as feeble, superficial, or faint. This may indicate the presence of an exterior illness, such as a cold. A pulse felt deeper down, on the other hand, will tell the practitioner more about the qi and yin of your internal organs
• Length: A practitioner places three fingers—ring, middle and pointer—on your radial artery, at the three different diagnostic points, when they are checking your pulse. If they are only able to feel your pulse under one or two of those fingers, your pulse is short. Depending on the other qualities of the pulse, this could mean that your qi is not strong enough to move your blood through your body. This could also indicate a qi blockage at the corresponding organ.
• Quality: There are many qualities of pulse that a practitioner is looking for. Your pulse could be thin and thready, choppy or uneven, rolling, slippery or smooth. These are essentially textures of your pulse that a trained practitioner knows how to identify and interpret. They each say something about your deficiency or excess, qi, yin, and even yang.

It’s important to keep in mind that a lot of factors can affect your pulse, outside of just the state of your blood, qi and yin. The seasons can affect pulse: pulse is deeper in winter, more superficial in summer; whether you have just eaten a meal or had something to drink; whether you do lots of manual labor, whether you are pregnant. All of these things are ingredients in your pulse reading. Remember that pulse reading is extremely intricate and also relative: what’s almost as important as the assessment itself is how your pulse this week compares to your pulse last week: what has shifted, what we can continue to work on. Your acupuncturists takes all the information gathered during pulse diagnosis into account when creating your unique treatment plan.