Diagnostic Methods Final Review

Paco Vilar
Diagnostic Methods in TCM
TCM Diagnosis is usually done by one of 4 methods
Looking (Observation)
Hearing and Smelling (Audio-Olfactory)
Asking (Interrogation / Questioning)
Feeling (Palpation)
Table of Contents

Looking (Observation)
Asking (Interrogation / Questioning)
Feeling (Palpation)
Hearing and Smelling (Audio-Olfactory)
Diagnosis by Looking
Observation
Diagnosis by Observation
Shen (Spirit) state of vitality, mental, emotional and
spiritual being
Characteristics of Healthy Shen
Healthy complexion
Firm muscles
Clear face color
Eyes with glitter
Even breathing
Mind is clear
Diagnosis by Observation
Characteristics of Lack of Shen
Unhealthy complexion
Withered muscles
Dark facial color
Uncontrollable eye movement
Mind is unclear
Breathing is stertorous (snoring or gasping sound)
Diagnosis by Observation
Body Conditions
Large, barrel-like chest and epigastrium Stomach Excess
Large upper thighs disproportionate to body Spleen
Deficiency
Thin / emaciated body long-standing Blood/Yin deficiency
Fat body Spleen Yang retaining Dampness or Phlegm
Diagnosis by Observation
Hair
Head hair reflects state of Kidney-Essence
Falling hair can indicate Blood deficiency
Premature graying of hair decline of Kidney-Essence

Face Color Indications
Face Color
Positive indication clear color, moist appearance;
Stomach-Qi is intact
Negative indication dry and lifeless color
White color deficiency, Cold, Blood deficiency, Yang
Deficiency
Dull-pale white complexion Blood Deficiency
Bright-white complexion Yang Deficiency
Face Color Indications
Yellow Color Spleen deficiency or Dampness (or both)
Bright-orange-yellow Damp-Heat with prevalence of Heat
Smoky, hazy yellow Damp-Heat with prevalance of
Dampness
Withered, dried-up yellow Heat in Stomach and Spleen
Sallow yellow color Stomach and Spleen deficiency
Dull-pale yellow Cold-Damp in Stomach and Spleen
Pale Yellow, red spots Spleen deficiency, Liver-blood stasis
Clear, moist yellow between eyebrows Stomach-Qi
recovering but affecting Stomach and Spleen
Dried up yellow between eyebrows Poor prognosis
Face Color Indications
Red color indicates Heat, either Full or Empty
Whole face is red Full-Heat
Only cheeks red Empty-Heat
Green color
Liver pattern
Interior Cold
Pain
Interior Wind
Face Color Indications
Blue Color
Dark Bluish under eyes Cold in Liver channel
White-bluish Cold, Chronic Pain
Dull-Bluish Heart-Yang deficiency w/ Blood Stasis, chronic
pain
In Children Liver-Wind
Black Color indicates Cold, pain, Kidney Yin deficiency
Black, moist-looking Cold
Dried-up, burnt color Heat, usually Empty-Heat from
Kidney-Yin deficiency
Face Color Indications
Bluish color in center of forehead Heart suffering from
shock
Greenish nose Liver Qi or Liver Blood stasis
Red tip of the nose Spleen deficiency
Very short chin possible Kidney deficiency
Diagnosis by Observation
Eyes reflect the state of the
Mind and the Essence
Different parts are related to
different organs
Corners of Eye Heart
Upper eyelid Spleen
Lower eyelid Stomach
Sclera Lungs
Iris Liver
Pupil - Kidney
Eye Diagnosis
Red in Corners of Eye Heart-Fire
Red in Sclera Lung-Heat
Yellow sclera Damp-Heat
Whole eye red, painful, swollen Wind-Heat, Liver-Fire rising
Dull white corners = Heat
Pale white corners = Blood Deficiency
Swelling under eyes = Kidney Deficiency
Nose Diagnosis
Tip of the Nose
Green or Blue Abdominal pain
Yellow Damp-Heat
White Blood deficiency
Red Heat in Lung and Spleen
Grey impairment of Water movement
Nose Diagnosis
Bridge of the Nose
Greenish bridge Liver Qi stagnation
Grey or Dark bridge Liver Blood stasis
Red bridge Liver Fire
Nose moist and shiny disease is not serious
If dry Heat in Stomach or Large Intestine
If dry and Black Fire-Poison
Ear Diagnosis
Shiny and slightly Moist earlobes good prognosis
Swelling and pain in ear (or middle ear) Lesser Yang Fire
Swollen ear pathogenic factor, Full pattern
Thin ear Qi or Blood deficiency
Long and Full ear lobe strong Kidneys, good constitution
Thin, small ear lobe Poor constitution
Mouth and Lip Diagnosis
Lip normal colors will be pale-red, moist and shiny
Very pale Emptiness of Blood or Yang
Too red and dry Heat in Spleen/Stomach
Purple or bluish Blood stasis
Mouth always slightly open Empty pattern
Breathing only through mouth Lung-Qi deficiency
Greenish around mouth Liver-Blood stasis and invasion of
Spleen by Liver-Qi
Mouth and Lip Diagnosis
Teeth under influence of the Kidneys
Moist teeth good state of body fluids and Kidneys
Dry teeth exhaustion of body fluids, Kidney-Yin deficiency
Gums under influence of the Stomach
Swollen, painful, bleeding Heat in Stomach
Swollen, bleeding, no pain Empty-Heat
Very pale Blood deficiency
Throat Diagnosis
Acute pain, redness, swelling Wind-Heat
Chronic pain, redness, swelling Stomach-Heat
Throat sore and dry, not swollen nor red Lung and
Kidney Yin with Empty Heat
Erosion, redness, swelling Toxic Heat
Tonsil Diagnosis
Swollen, normal color Phlegm OR Dampness with Qi
deficiency
Chronic red and swollen Heat in ST/LI or Empty-Heat in
Lung channel
Acute red and swollen Wind-Heat and Toxic Heat
Limb Diagnosis
Swollen joints on four limbs Wind-Damp obstruction (Bi
Syndrome)
Red and hot joints Damp Heat
Joint pain and swelling Dampness or Phlegm
Pain worse at night Blood stasis
Tremors and spasms Liver Wind
Fine tremors Liver Blood deficiency or Kidney Yin
deficiency
Limb Diagnosis
Pale nails Blood deficiency
Bluish nails Liver-Blood stasis
Thenar eminence state of the Stomach
Bluish venules on thenar Cold in Stomach
Bluish short venules Empty pattern
Red venules Heat in the Stomach
Limb Diagnosis
Creases on the Finger
Joints are called Gates
Venules on Gate of Wind
exterior pathogenic
invasion
Venules past Gate of
Wind interior, more
severe disease
Past Gate of Life serious,
life-threatening disease
Bluish venules Cold
pattern
Red venules Heat
Pattern
Skin Diagnosis
Skin
Dry skin Liver-Blood deficiency
Itchy skin Wind
Pitting edema true edema or Water Edema (Kidney Yang
deficiency)
Non-pitting edema Qi edema (Qi stagnation)
Bright clear yellow skin Yang jaundice (Damp-Heat)
Dull-yellow Yin jaundice (Damp-Cold)
Venules appearing Fullness in Blood-connecting channels
Red Heat
Bluish Cold
Greenish Pain
Purple Blood stasis
Tongue Diagnosis

Body Color condition of Blood,
Nutritive Qi and Yin organs
Body Shape state of Blood and
Nutritive Qi
Coating State of Yang organs
Moisture State of Body fluids

Tongue Color Indications
Pale-red NORMAL
Pale color Yang deficiency (if wet/swollen) or Blood (if dry)
Pale or orangey sides Liver-Blood deficiency
Red tongue with coating Full-Heat
Red tongue, no coating Empty-Heat
Red tip Heart-Fire or Heart Empty-Heat
Red sides Liver-Fire or GB Heat; Liver Yin deficiency
Red center Stomach-Heat
Deep red Same indications as Red but the condition is more severe
Tongue Color Indications
Purple Blood stasis
Reddish-purple Heat and Blood stasis
Bluish-purple Cold and Blood stasis
Purple sides Liver-Blood stasis
Purple center Blood stasis in Stomach
Bluish purple sides in Women Blood Stasis in Uterus
Tongue Body Shape Indications
Thin Blood deficiency (if Pale) or Yin deficiency (Red and Peeled)
Swollen Dampness and Yang deficiency (Pale) or Damp-Heat
(Red or normal)
Stiff Interior Wind
Flaccid Body Fluid deficiency
Long Heat, especially Heart-Heat
Short Interior Cold (pale and wet) or Extreme Yin Deficiency (red
and peeled)
Cracks Full-Heat or Yin deficiency

Tongue Body Shape Indications
Short horizontal cracks Stomach-Yin deficiency
Long-deep midline crack reaching tip Heart pattern
Shallow-wide midline crack not reaching tip Stomach-
Yin deficiency
Quivering: Spleen-Qi deficiency or Wind
Deviated Interior Wind
Teethmarks (scalloped) Spleen-Qi deficiency
Tongue Coating Indications
Thin-white coating Normal
Thick coating Presence of a pathogenic factor
Thicker coating Strong pathogenic factor
Absence of Coating Stomach-Yin deficiency and / or
Kidney-Yin deficiency (if red all over)
White coating Cold pattern (normal if thin)
Tongue Coating Indications
Yellow Full-Heat pattern
Grey/black either Extreme Cold (wet) / Extreme Heat
(dry)
Dry Heat injuring the body fluids
Too wet Yang-Qi deficiency with Dampness
Sticky or Slippery Dampness or Phlegm

Diagnosis by Asking
(Questioning, Interrogation)
Chills and Fever
Chilliness patient feels cold, but reluctant to go out to
the cold
Aversion to cold and Chilly Wind-Cold or Wind-Heat
invasion
Wind-Cold -> Fever may be present
If fever is predominant with slight aversion to cold
Exterior Wind-Heat invasion
Fever subjective feeling of heat
Fever without aversion to cold Interior Heat pattern

Chills and Fever
Chilliness, better when covered up Yang Deficiency
Chilliness, not better when covered up Exterior Wind-Cold
Interior Disease, chilliness Interior Cold from Yang
Deficiency
Low fever getting worse in afternoon or only happening in
afternoon Yin deficiency
Constant low grade temperature Damp-Heat pattern
Fever in middle of the night Yin deficiency (adult) or Food
retention (child)
Sweating
Main considerations
Pattern type (Exterior or Interior)
Area of the Body
Time of the Day
Condition of Illness
Quality of the Sweat

Sweating
Pattern Indications
Exterior indicates a relatively deficient condition
Wind-Cold, sweating Deficient
Wind-Cold, no sweat Excess
Interior wide variety of possibilities; use other criteria for final
diagnosis (body area, time of day, conditions, quality)
Yang deficiency
Yin deficiency
Excess Yang (Heat or Fire)
Damp-Heat
Sweating
Area of the Body
Only on head Stomach-Heat or Damp-Heat
Oily sweat on forehead Collapse of Yang
Only on arms and legs Stomach and Spleen deficiency
Only on hands Lung-Qi deficiency or nerves
Whole body Lung-Qi deficiency
On palms, soles and chest Yin deficiency (5-Palm Sweat)
Sweating
Time of the Day
During day-time Yang deficiency
During night-time Yin deficiency or Damp-Heat
Condition of Illness
Profuse cold sweat during severe illness Collapse of Yang
Oily sweat on forehead, not flowing Collapse of Yang,
danger of imminent death
Quality of Sweat
Oily Severe Yang Deficiency
Yellow Damp-Heat
Head and Body
Head all the Yang channels meet, brings clear Yang to
orifices; enables sight, hearing, taste and smell
Headaches distinguished by the following
Onset
Time
Location
Character of pain
Condition

Headaches
Onset
Recent onset, short duration Exterior Wind-Cold headache
Gradual onset, in attacks Interior type headache

Time of Day
Day-time Qi or Yang deficiency
Evening Blood or Yin deficiency
Headaches
Location
Nape of Neck Greater Yang channels [Tai Yang] (exterior
Wind-Cold or Interior Kidney deficiency)
Forehead Bright Yang channels [Yangming] (Stomach-
Heat or Blood deficiency)
Temples and Side of Head Lesser Yang channels [Shao
Yang] (exterior Wind Cold or Wind-Heat in Shao Yang or Liver
and Gall-Bladder Fire rising)
Vertex Terminal Yin channels [Xue Jin] (usually Liver-Blood
deficiency)
Whole Head Tai Yin headache (exterior Wind-Cold)
Headaches
Characteristics of Pain
Heavy feeling Dampness or Phlegm
Pain inside the head, hurting brain Kidney Deficiency
Distending, throbbing Liver-Yang rising
Boring, like a nail Blood stasis
Condition
With aversion to wind or cold Exterior invasion
Aggravated by cold Cold pattern
Aggravated by heat Heat pattern
Aggravated by fatigue, better with rest Qi deficiency
Dizziness
Four Different factors to consider
Wind
Fire
Phlegm
Deficiency
Identifying the cause is done by integration of
accompanying symptoms and signs
Dizziness
Severe giddiness, loss of balance Internal Wind
Slight, with heavy head Phlegm
Slight, aggravated when tired Qi deficiency
Sudden onset of dizziness Full pattern
Gradual onset Empty pattern
Body Pain
Pain in the Whole Body
Sudden onset, chills and fever Exterior Wind-Cold
Pail all over, tiredness Qi-Blood deficiency
Women after childbirth, dull pain Blood deficiency
Women after childbirth, severe pain Blood stasis
Pain in arms/shoulders, walking only Liver-Qi stagnation
Pain in all muscles, hot flesh sensation Stomach-Heat
Pain with feeling of heaviness Dampness obstructing
muscles
Body Pain
Pain in the Joints
Wandering joint to joint from Wind
Fixed and very painful from Cold
Fixed, with swelling and numbness from Dampness
Backache
Continuous, dull Kidney deficiency
Recent onset, severe with stiffness Back sprain causing Blood stasis
Severe pain, aggravated by cold and damp weather, better with heat
Invasion of Exterior Cold and Damp to back channels
Boring pain, unable to turn waist Blood stasis
Pain in the back, extending to shoulders Exterior Attack
Body Pain
Numbness
Numbness of arms and legs OR hands and feet on both
sides Blood deficiency
Numbness on fingers, elbow and arm, one side only
(especially first three fingers) Internal Wind and Phlegm
(may indicate impending Wind-Stroke)
Thorax and Abdomen
Thorax under influence of Heart and Lungs, flanks are
under control of Liver and Gall-Bladder


Abdomen influenced by Liver, Intestines, Spleen,
Kidneys and Bladder
Thorax and Abdomen
Pain in the Chest often Blood stasis in Heart, usually
from Yang deficiency
Chest pain + cough with profuse yellow sputum Lung-
Heat
Distension and stuffiness of hypochrondrium Liver-Qi
stagnation
If the pain is severe Liver-Blood stasis


Thorax and Abdomen
Epigastric pain Food retention in Stomach or Stomach-Heat
Dull but not very severe - Deficient-Cold in the Stomach
Alleviated by eating Empty type
Aggravated by eating Full type
Fullness in the epigastrium Spleen Deficiency or Dampness
Abdominal pain relieved by bowel movements Full
Abdominal pain aggravated by b. movements Empty
Hypogastric pain Damp-Heat in the Bladder
Food and Taste
Food
Condition relieved by eating Empty
Condition aggravated by eating Full
Lack of appetite Spleen-Qi deficiency
Always hungry Stomach-Heat
Fullness / distension after eating Retention of Food
Preference for Hot food (temperature) Cold pattern
Preference for Cold food Heat pattern
Food and Taste
Taste
Bitter taste Full-Heat pattern, Liver or Heart
Liver-Fire -> bitter taste is more or less constant
Heart-Fire -> with insomnia, only in morning with no sleep
Sweet taste Spleen deficiency or Damp-Heat
Sour taste retention of food in Stomach or Liver and
Stomach disharmony
Salty taste Kidney-Yin deficiency
Lack of Taste sensation Spleen deficiency
Pungent taste Lung-Heat
Food and Taste
Vomit
Sour vomit invasion of Stomach by Liver
Bitter vomiting Liver and Gall-Bladder Heat
Clear-watery vomiting Stomach-Cold with fluid retention
Vomiting soon after eating Heat pattern
Sudden vomiting, loud noise Full pattern
Slow vomiting, weak noise Empty pattern

Stools
Stools
Aggravation after bowel movement Empty pattern
Better after bowel movement Full pattern
Acute constipation, thirst, dry yellow coating Heat in Stomach
and Intestines
Constipation in old people or women after childbirth Blood
deficiency
Small, bitty stools Liver-Qi stagnation and Heat in Intestines
Constipation + abdominal pain Internal Cold + Yang
Deficiency
Dry stools, no thirst Kidney and/or Stomach-Yin deficiency
Alternating constipation/diarrhea Stagnant Liver-Qi invading
Spleen
Stools
Diarrhea
Pain accompanying diarrhea Liver or Heat
Foul smell Heat
No smell Cold
Chronic diarrhea Spleen Yang, or Kidney-Yin deficiency or
both
Chronic diarrhea every day early morning Kidney-Yang
deficiency
With abdominal pain Interior Cold in Intestines
With mucus in stools Dampness in Intestines
With blood in stools Damp-Heat in Intestines
Loose stools, undigested food Spleen-Qi deficiency
Burning sensation in anus while passing - Heat
Stools
Stools and Diarrhea
Black or very dark stools Blood stasis
Bright red splashing blood coming first Damp-Heat in the
intestines
Turbid blood first, painful anus Blood-Heat
Stool first then watery blood Spleen-Qi not controlling Blood
Borborygmi (gurgling abdomen) and loose stools Spleen
deficiency
Borborygmi, abdominal distension, no loose stools Liver-Qi
stagnation
Flatulence usually Liver-Qi stagnation
Foul smelling Damp-Heat in Spleen or Stomach-Heat
No smell Interior Cold from Spleen-Yang deficiency
Urine
Function
Enuresis or incontinence Kidney Deficiency
Retention of urine Damp-Heat in the Bladder
Difficult urination Damp-Heat in Bladder or Kidney
Deficiency
Very frequent copious urination Kidney deficiency
Frequent scanty urination Qi deficiency
Amount
Large amounts of urine Kidney-Yang deficiency
Scanty urination Kidney-Yin deficiency
Urine
Pain
Pain before urination Qi stagnation in Lower Burner
Pain during urination Heat in the Bladder
Pain after urination Qi deficiency
Color
Pale Urine Cold pattern
Dark Urine Heat pattern
Turbid/cloudy urine Dampness in Bladder
Copious, clear and pale urine during exterior invasion of
Wind-Cold or Wind-Heat Pathogen is not in the Interior

Sleep and Energy
Insomnia
Unable to fall asleep, but sleeping well after Heart-Blood
deficiency
Waking up many times at night Kidney-Yin deficiency
Dream-disturbed sleep Liver-Fire or Heart-Fire
Restless sleep with dreams Retention of Food
Waking up early, failing to fall asleep Gall-Bladder
deficiency
Growing older, waking up early Physiological decline of Qi
and blood
Sleep and Energy
Lethargy
Sleepy after eating Spleen-Qi deficiency
General lethargy, heavy body Retention of Dampness
If there is dizziness Phlegm
Extreme lethargy, cold feeling Kidney-Yang deficiency
Lethargic stupor, interior heat Pericardium invasion by Heat
Lethargic stupor, throat rattling, slippery pulse, sticky tongue
- Phlegm
Ears and Eyes
Tinnitus
Onset
Sudden onset Full condition (Liver-Fire or Liver-Wind)
Gradual onset Empty condition (Kidney deficiency)
Pressure
Aggravated with hands on ears Full condition
Alleviated with hands on ears Empty condition
Character of Noise
Loud, high pitch noise like a whistle rising Liver-Yang,
Liver-Fire or Liver-Wind rising
Low pitch noise, like rushing water Kidney deficiency
Ears and Eyes
Deafness
Sudden onset Full pattern
Gradual onset Empty condition
Chronic cases Kidney deficiency or Heart-Blood deficiency
or Upper Burner Qi deficiency or Yang Qi deficiency

Ears and Eyes
Eyes
Pain, swelling, eye redness Exterior Wind-Heat or Interior
Liver-Fire
Blurred vision, floaters Liver-Blood deficiency
Photophobia Liver-Blood deficiency
Pressure in the eyes Kidney-Yin deficiency
Dryness Liver and/or Kidney Yin deficiency
Thirst
Thirst with desire to drink large amounts of cold water
Full-Heat pattern
Absence of thirst Cold pattern, usually Stomach or
Spleen
Thirst, no desire to drink Damp-Heat
Sip liquids slowly or warm liquids Yin deficiency
Desire to drink cold liquids Heat pattern
Desire to drink warm liquids Cold pattern
Pain

Stagnation of Qi causes distension more than pain, or a
distending pain, having no fixed location
Blood stasis causes severe, boring pain, with a fixed
location in a small area
Can be caused by Full and Empty conditions

Pain
Excess conditions that can cause Pain
Invasion of exterior pathogenic factors
Interior Cold or Heat
Stagnation of Qi or Blood
Obstruction by Phlegm
Food retention
Deficiency conditions that can cause Pain
Blood and Qi deficiency
Consumption of Body Fluids from Yin deficiency
Pain
Characteristic Empty Full Cold Heat
Pressure Alleviated Aggravated - -
Food Alleviated Aggravated - -
Type Dull-lingering Sharp Cramping Burning
Temperature - -
Better with
Heat
Better with
Cold
Bowel
Movements
Aggravated Alleviated Aggravated Alleviated
Posture
Better lying
down
Better sitting
down
- -
Onset Slow, gradual Sudden - -
Vomiting Aggravated Alleviated Aggravated Alleviated
Rest /
Movement
Better with Rest
Better with
Movement
Better with
Movement
Worse with
Movement
Womens Issues - Menstruation
Menstruation Cycle
Period always early Blood Heat or Qi deficiency
Period always late Blood deficiency or Blood stagnation or
Cold
Irregular periods (early / late) Liver-Qi stagnation or Liver-
Blood or Spleen deficiency
Amount of Blood loss
Heavy loss of blood Heat in Blood or Qi deficiency
Scanty periods Blood deficiency or Stagnation of Blood or
Cold

Womens Issues - Menstruation
Color of Blood
Dark-red or bright-red Blood Heat
Pale blood Blood deficiency
Purple or blackish blood Blood stasis or Cold
Fresh-red blood Empty-Heat from Yin deficiency
Quality of Blood
Congealed blood with clots Blood stasis or Cold
Watery blood Blood or Yin deficiency
Turbid blood Blood Heat or Cold stagnation
Womens Issues - Menstruation
Menstrual Pain
Pain before periods Blood or Qi stagnation
Pain during periods Blood-Heat or Cold stagnation
Pain after periods Blood deficiency



Womens Issues - Menstruation
Leucorrhoea Color
White discharge Cold pattern from Spleen or Kidney Yang
deficiency or Exterior Cold-Damp or Liver-Qi stagnation
Yellow discharge Heat pattern, usually Damp-Heat in the
Lower Burner
Greenish discharge Damp-Heat in Liver channel
Red and white Damp-Heat
Yellow discharge with pus and blood after menopause
Toxic Damp-Heat in the uterus
Womens Issues - Menstruation

Leucorrhoea Consistency
Watery consistency Cold-Damp pattern
Thick consistency Damp-Heat pattern
Leucorrhoea Smell
Fishy smell Damp-Cold
Leathery smell Damp-Heat

Womens Issues - Pregnancy
Infertility
Empty Conditions Blood or Kidney-Essence deficiency
Full Conditions Damp-Heat in Lower burner or Blood in
Uterus
Vomiting during pregnancy Stomach and Penetrating
vessel deficiency
Miscarriage before three months Blood or Essence
deficiency associated with Kidney deficiency
Miscarriage after three months Liver-Blood stasis or
Sinking of Spleen-Qi
Womens Issues - Childbirth
Nausea and heavy bleeding after delivery Exhaustion
of the Penetrating Vessel
Sweating and fever after delivery Exhaustion of Qi and
Blood
Post-natal depression usually due to Blood deficiency
leading to Heart-Blood deficiency
Diagnosis by Palpation
Feeling (Pulse, Abdomen)
Palpation
Diagnosis by feeling generally includes the following
Palpation of the pulse
Palpation of the skin
Palpation of the limbs
Palpation of the hands
Palpation of the chest
Palpation of the abdomen
Palpation of the points

Performed by placing
fingers along the Radial
Artery.

Pressure is applied with
different kinds of strength
at three different points.

The patients arm should
be horizontal and not held
higher than heart level.

Pulse Diagnosis

We use the pads of the
fingers to take the pulse
because they are the most
sensitive area.

We place the first three
fingers (not counting the
thumb) on the Radial
artery.
Pulse Diagnosis
Pulse is felt by moving the
fingers in 4 different ways:
Lifting (upwards)
Pressing (downwards)
Pushing (side to side)
Rolling (proximal distal)
We also keep the fingers still
(searching) in order to be
able to decide the speed of
the pulse.
Pulse Diagnosis
Pulse Diagnosis
Sections of Pulse
Inch (CUN) - Front
Barrier (GUAN) - Middle
Cubit (CHI) Back

Pulse Depth
Superficial resting fingers very gently on the artery
Deep almost obliterate pulse then release very slightly
Middle in between these two kinds of pressure
Altogether, 3 Sections x 3 Depths = The 9 Regions
Pulse Diagnosis







Correspondence of each organ and section / level
according to the Mai Jing (Pulse Classic)
Deep Pulse
Chinese Name
Chen Mai, a.k.a. Sinking
Description
Can only be felt with heavy pressure; felt near the bone
Clinical Significance
Indicates an interior condition
Indicates the Yin organs to be the problem
Indications
Deep and Weak: Yang and Qi deficiency
Deep and Full: a) Stasis of Qi; b) Blood in the Interior;
c) Interior Cold or Heat
Floating Pulse
Chinese Name
Fu Mai
Description
Can be felt with a light pressure, resting fingers on artery
Clinical Significance
Indicates presence of exterior pattern from pathogen
Indications
Floating and Tight: Wind-Cold
Floating and Rapid: Wind-Heat
Floating Superficial / Empty Deep: Yin deficiency
Slow Pulse
Chinese Name
Chi Mai
Description
Three beats per respiration cycle (breath) of practicioner
Can also be counted using a watch
Clinical Significance
Indicates a Cold pattern
Indications
Slow and Empty Empty-Cold from Yang Deficiency
Slow and Full Full Cold
SLOW Pulse






Typical Slow Pulse Speeds (estimated)

Age (Year) Rate (beat/min)
1 4 90 or more
4 10 84
10 16 78 / 80
16 35 76
35 50 70 / 72
50+ 68
Rapid Pulse
Chinese Name
Shu Mai
Description
5 or more beats per cycle (or higher than slow chart)
Clinical Significance
Indicates a Heat pattern
Indications
Rapid and Empty Empty-Heat from Yin Deficiency
Rapid and Full Full Heat or Excessive Heat
Empty Pulse
Chinese Name
Xu Mai (a.k.a. Vacuous, Deficiency)
Description
Feels rather big, but soft; feels empty with more pressure
Clinical Significance
Indicates Qi or Qi AND Blood deficiency
Full Pulse
Chinese Name
Shi Mai (a.k.a. Excess type, Replete)
Description
Feels full; rather hard and long
Clinical Significance
Indicates a Full pattern
Indications
Full and Rapid Full-Heat
Full and Slow Full-Cold
Slippery Pulse
Chinese Name
Hua Mai
Description
Feels smooth, round, oily to the touch; rolls under fingers
Feels like rolling pearls in a porcelain bowl
Clinical Significance
Indicates Phlegm, Dampness, Food retention, Pregnancy
Indications
Its full by definition, but can be weak as well
It can be weak, indicating Phlegm, Dampness and Qi deficiency
Choppy Pulse
Chinese Name
Se Mai a.k.a. Hesitant, Rough
Description
Rough under the fingers; like a jagged edge
Feels like a knife scraping bamboo
Also means a pulse that changes rapidly in rate and quality
Clinical Significance
Indicates stasis or deficiency of blood
Could mean exhaustion of fluids, especially after profuse
sweating or vomiting
Long Pulse
Chinese Name
Chang Mai
Description
Longer than normal; extends slightly beyond normal pulse
Clinical Significance
Indicates a Heat pattern
May indicate that there is no Pathological condition
Short Pulse
Chinese Name
Duan Mai
Description
Occupies shorter space than normal position
Clinical Significance
Indicates a severe Qi deficiency
Frequently appears on Front position; either left or right
Specifically denotes deficiency of Stomach-Qi
Overflowing
Pulse
Chinese Name
Hong Mai, a.k.a. Surging, Flooding
Description
Feels big and extending beyond normal pulse position
Superficial; generally overflows normal pulse channel
Clinical Significance
Indicates an Extreme Heat pattern
Frequently appears during Fever, and Interior Heat diseases
Indications
Overflowing and Empty on pressure Empty Heat from Yin deficiency
Fine Pulse
Chinese Name
Xi Mai, a.k.a. Thready, Thin
Description
Feels thinner than normal
Clinical Significance
Indicates a deficiency of Blood
May indicate Dampness with severe Qi deficiency
Indications
Thin and Rapid Heat brought by Yin deficiency
Minute Pulse
Chinese Name
Wei Mai, a.k.a. Faint
Description
Thinner than the Fine pulse; harder to feel; very small
Clinical Significance
Severe deficiency of Qi and Blood
Tight Pulse
Chinese Name
Jin Mai, a.k.a. Tense
Description
Feels twisted, like a thick rope
It also can be felt as it vibrates
Clinical Significance
Indicates a Cold pattern, exterior (i.e. Wind-Cold) or Interior
May indicate pain from an interior condition
Indications
Tight and Floating Exterior Cold
Tight and Deep Interior Cold
Wiry Pulse
Chinese Name
Xian Mai, a.k.a. Stringlike, Bowstring
Description
Feels taut, like a guitar string
Thinner, more taut and harder than the Tight pulse
No fluidity or wave-like qualities
Clinical Significance
May indicate Liver disharmony
May indicate Pain
May indicate Phlegm
Slowed-Down
Pulse
Chinese Name
Huan Mai, a.k.a. Moderate
Description
Four beats per respiration cycle
Clinical Significance
Generally considered a healthy pulse
If Dampness is suspected by other signs, it can be used to
indicate its presence
Hollow Pulse
Chinese Name
Kong/Kou Mai, a.k.a. Scallion-stalk
Description
Felt at superficial and deep; any middle pressure makes it
empty
Clinical Significance
Indicates a loss of Blood
Usually appears after a hemorrhage
Indications
Hollow and slightly Rapid Forthcoming loss of Blood
Leather Pulse
Chinese Name
Ge Mai, a.k.a. Drumskin
Description
Hard, tight and stretched superficially; empty at Deep level
Large pulse, not thin
Clinical Significance
Indicates severe deficiency of Kidney-Essence or Yin
Firm Pulse
Chinese Name
Lao Mai, a.k.a. Confined, Prison
Description
Only felt at Deep level; felt hard and rather wiry
Could be described as a Wiry pulse at the Deep level
Clinical Significance
Indicates Interior Cold (if it is also Slow)
Indicates Interior Stagnation and Pain
Soggy Pulse
Chinese Name
Ru Mai, a.k.a. Soft, Weak-Floating
Description
Only felt on superficial level; very soft and slightly floating
Disappears when pressure is applied to feel Deep level
Clinical Significance
Indicates presence of Dampness if there are other signs that
represent a Qi deficiency
May also indicate lack of Yin or Essence
Weak Pulse
Chinese Name
Ruo Mai, a.k.a. Frail
Description
Only felt on Deep level; also soft
Clinical Significance
Indicates a deficiency of Yang or of Blood
Scattered Pulse
Chinese Name
San Mai
Description
Small and relatively superficial
Feels as if it was broken into small dots
Clinical Significance
Severe deficiency of Qi and Blood, especially Kidney-Qi
ALWAYS indicates a serious condition
Hidden Pulse
Chinese Name
Fu Mai
Description
As if it was hidden beneath the bone
Extreme case of Deep pulse
Clinical Significance
Extreme deficiency of Yang
If strong, indicates an obstruction of Cold
Moving Pulse
Chinese Name
Dong Mai, a.k.a. Spinning-Bean
Description
It is short and trembles under the finger
Does not have a definite shape; shaking and also slippery
Combination of short, tight, slippery and rapid pulses
Clinical Significance
Indicates shock, anxiety, fright or extreme pain
Found in people with deep emotional problems, especially fear,
or those who have suffered severe emotional shock
Hasty Pulse
Chinese Name
Cu Mai, a.k.a. Abrupt, Skipping, Hurried
Description
Rapid pulse, stops at irregular intervals
Clinical Significance
Indicates extreme Heat and a deficiency of Heart-Qi
Also felt in conditions of Heart-Fire
Knotted
Pulse
Chinese Name
Jie Mai, a.k.a. Bound
Description
Slow and stops at irregular intervals
Clinical Significance
Indicates cold
Indicates deficiency of Heart-Qi or Heart-Yang
Intermittent
Pulse
Chinese Name
Dai Mai, a.k.a. Regularly Interrupted
Description
Stops at regular intervals; feel the pulse and feel the stops
Clinical Significance
Indicates a serious internal problem of one or more Yin
organs
If it stops every four beats or less, the condition is serious
It can also indicate a serious heart problem (in the Western
medical sense)
Racing Pulse
Chinese Name
Ji Mai, a.k.a. Swift
Description
Pulse is very rapid, but agitated and very urgent
Clinical Significance
Indicates an Excess of Yang, with Fire in the body exhausting
Yin
Pulse Groupings
Deep Floating Slow Rapid Empty Full
Deep Floating Slow Rapid Empty Full
Firm Hollow Knotted Hasty Weak Overflow
Hidden Leather Choppy Hurried Fine Wiry
Soggy Moving Minute Tight
Rolling Soggy Long
Short Firm
Scattered
Pulses in 8 Principles

8 Principles General Pulse
Quality
Description Specific Pulse Quality
Exterior (Yang) superficial Felt with light
pressure
Superficial; floating; hollow;
leather; soft
Interior (Yin) deep Felt with deep
pressure
Deep; Firm; Hidden
Hot (Yang) rapid More than 80 BPM
(>5 per breath)
Rapid; Hasty; Moving
Cold (Yin) slow Less than 65 BPM
(3> per breath)
Slow; Tight; Knotted; Intermittent
(not necessarily slow but often)
Full (Yang) full Large, long,
substancial
Full; Big; Overflowing; Wiry; Tight;
Long; Slippery; Flooding;
Empty (Yin) empty Small, short,
insubstancial
Empty; Weak; Fine; Minute; Short;
Scattered; Choppy
Palpating the Body
There are three different palpation techniques:
Touching - Light touch of the patients skin
Detecting temperature, moisture and sweat
Stroking stroking in the skin and deeper tissues of the
patient
Usually carried out in chest, abdomen and limbs
Determines presence of tenderness and swelling
Pressing pressing relatively hard to deeper levels
Usually done in the abdomen
Determines presence of pain or masses
Skin Palpation
Three major points of focus
Temperature of the skin
Moisture of the skin
Texture of the skin
We do this by three different methods:
Touching
Stroking
Pressing