DIAGNOSIS

BY
PALPATION
DME-312 HANDOUTS 7,8,9

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

PULSE DIAGNOSIS

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
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
Superficial

Deep

SI
GB
UB

HT

Deep
Distal /
Front

Superficial

LI
LU
ST

LR
KD
Yin

Middle

SP
TB

Proximal /
Rear

KD
Yang

Correspondence of each organ and section / level

according to the Mai Jing (Pulse Classic)

PULSE DIAGNOSIS
Main importance of Pulse Diagnosis
1. Gives detailed information about state of internal organs
2. Reflects whole complex of Qi and Blood
Other Notes
. Pulse counts as a clinical manifestation that shows you
the entire body
. The tongue also does this, but with less clarity

PULSE DIAGNOSIS
Drawbacks to Pulse Diagnosis
Extremely subjective
Skill is subtle and hard to master
Subject to external, short-term influences
Advantages to Pulse Diagnosis
It can reflect older disharmonies not showing on tongue,
as well as others due to discoloration or physical
manipulation of it (such as scraping)

PULSE DIAGNOSIS
What you should pay attention to (IN THIS SPECIFIC ORDER)
1. Feel the Pulse as a whole
2. Feel whether the pulse has spirit, Stomach Qi and root
3. Feel the three levels and the three positions
4. Feel the strength of the pulse
5. Feel the quality of the pulse

PULSE DIAGNOSIS
Qualities of Pulse that we are looking for
Force
Movement
Rate

Rhythm
Shape
Presence of Shen

PULSE DIAGNOSIS
What is a Normal Pulse?
Has Stomach-Qi
Feels gentle, calm and relatively slow (4 beats per
respiratory cycle / breath)
Has Spirit
Soft but with strength; neither big or small
Regulated should not change type very easily
Has root
Deep level is clearly felt along with rear position
Kidneys are felt strong

PULSE DIAGNOSIS
Factors that affect the Pulse
Seasons
Pulse is deeper in wintertime; superficial in summertime
Gender
Male pulse is naturally stronger than womens
Men have stronger left pulse; women, the right pulse
Men have stronger front pulse; women, the rear
Occupation
People who perform strong physical labor should have a
stronger pulse than those who do not

PULSE DIAGNOSIS
Factors that affect the Pulse
Body build
Pulse will be stronger, larger and longer in robust, large
people; weaker, smaller and shorter in small, frail people
Menstruation
Becomes slippery the week before the onset, especially on
the right rear position; then it becomes weak and slower
Pregnancy
Becomes slippery, therefore it is considered normal
Fan Guan Mai and Xie Fei Mai
These are abnormalities on the pulse

PULSE DIAGNOSIS
Fan Guan Mai is a radial artery
displacement that is present in
about 5% of people.
The radial artery lies in the
dorsal aspect of the arm
instead of the inner aspect.
In these cases, the pulses on
the nine regions of the head,
hand and feet are
recommended.

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)

14

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 DIAGNOSIS
28 Different Pulse Qualities (with similar Grouping)
(The groups have been been grouped on a Yin-Yang level)
Deep

Floating

Slow

Rapid

Empty

Full

Deep

Floating

Slow

Rapid

Empty

Full

Firm

Hollow

Knotted

Hasty

Weak

Overflow

Hidden

Leather

Choppy

Hurried

Fine

Wiry

Moving

Minute

Tight

Rolling

Soggy

Long

Short

Firm

Soggy

Scattered

PULSE DIAGNOSIS
8 Principles

General
Description
Pulse Quality

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

SKIN PALPATION
Palpating the skin involves focusing on three major topics:
Temperature of the skin

Moisture of the skin

Texture of the skin

We do this by three different methods:

Touching

Stroking

Pressing

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
Key things to Know
Temperature

Subjective feeling of heat does not always correspond to the

objective feeling of heat of the skin
Skin feels hot to the touch often indicates Damp-Heat
Cold feeling indicates Cold pattern; often felt in loins, lower
abdomen or lower back (indicates Kidney-Yang deficiency)
Hot on first touch, ceasing to feel hot with sustained
pressure indicates Wind-Heat invasion, still on exterior
Skin over vessel hot on medium pressure but not on heavy
pressure interior Heat in Middle Jiao or Heart
Skin hot on heavy pressure nearly nearing the bone
Empty Heat from Yin deficiency

SKIN PALPATION
Key Things to Know
Moisture and Texture

Moist skin may indicate invasion of the Exterior by WindCold, or more commonly, Wind-Heat
Moist skin with absence of exterior symptoms indicates
spontaneous sweating from Lung-Qi deficiency
Dry skin indicates Blood or Lung-Yin deficiency
Rough-like skin may indicate Painful Obstruction
Syndrome from Wind
Scaly and dry skin indicates exhaustion of body fluids
Swollen skin with a pit left after pressing indicates oedema
Swollen skin, no pit indicates retention of Dampness

LIMB PALPATION
Key Things to Remember:
Hands and feet cold to the touch indicate Yang deficiency

Whole arm and leg feel cold indicate Kidney-Yang

deficiency (Empty-Cold)

Only forearm and lower leg feel cold may indicate Interior
Cold from Qi stagnation (Full-Cold)

Only hands and feet feel cold may indicate Qi stagnation

Limbs feeling hot indicate a Heat pattern

Hands hot on the dorsum indicate Full-Heat

Hands hot on palms indicate Empty-Heat from Yin

deficiency

CHEST PALPATION
Process
Palpate the area over the left
ventricle of the heart (called
Interior Emptiness or Xu Li in
Chinese Medicine)
Pulse of heart can be felt in this
area; sometimes seen
Area reflects the state of Zong Qi
(Gathering Qi)

CHEST PALPATION
Key Things to Remember
Faint but clear pulsation indicates Gathering Qi deficiency
Too strong pulsations indicate outpouring of Gathering
Qi, i.e. a state of hyperactivity due to over-pushing oneself
Pulsation not felt indicates Phlegm or a hiatus hernia
Area below xyphoid process feeling full and painful on
pressure indicates a Full pattern

ABDOMEN PALPATION
The Abdomen is generally palpated in 5 areas:
Hypochondrium
Epigastrium
Umbilical area

Lateral-lower abdomen
Central-lower abdomen

ABDOMEN PALPATION
Hypochondrium
Includes the lateral side of
the rib cage and area
immediately below it
Reflects state of the Liver
and Gall-Bladder

ABDOMEN PALPATION
Epigastrium
Area contained between
the xyphoid process,
costal margins and the
umbilicus
Reveals the condition of
the Stomach and Spleen

ABDOMEN PALPATION
Umbilical Region
It is the area right around
the umbilicus
It reflects the state of the
Kidneys, the Penetrating
and Directing Vessels
Umbilical area has a
palpable pulse as well

ABDOMEN PALPATION
Lateral-lower Abdomen
Also called Shao Fu

Reflect the state of the

Intestines and the
Penetrating Vessel

ABDOMEN PALPATION
Central-lower Abdomen
Also called Xiao Fu

Reflects the state of the

Small Intestine, Kidneys,
Bladder, Uterus and Liver

JAPANESE HARA DX
Step 1: Compare Big and
Small Abdomen

Big Abdomen Deficient

LU or SP
Small Abdomen Deficient
LV or KD

JAPANESE HARA DX
Step 2: Determin Nan Jing
Abdominal Diagnosis Area:

SP Umbilical, CV7 CV12

HT Substernal, CV12 CV15
LU Right of Navel / Right Ab
LV Lower left of Navel / Left
Ab
KD Subumbilical, CV7 Pubis

POINT PALPATION
Main point of point palpation is checking for tenderness
Very tender on superficial pressure Full condition on
that channel or local stagnation
Pressure relieves pain Empty condition on that channel
Pressure relieves but then causes discomfort mixed
Deficiency and Excess condition
All acupuncture points (and Ah Shi points) can be used
diagnostically.

POINT PALPATION
Main Points for Palpation Diagnosis
Front Collecting (Mu) Points
Back Transporting (Shu) Points
Lower Sea Points

Source (Yuan) Points

Ah Shi Points

FRONT MU POINTS
Mu raise, collect, enlist,
recruit
Points where the Qi of the
relevant organs get collected

BACK SHU POINTS

Points are all located on the
Bladder channel
Reflect specifically the
condition of the relevant
internal organ instead of its
channel

BACK SHU POINTS

LOWER SEA POINTS

Points are used to treat their respective Yang organs

Organ

Point

Channel

Organ

Point

L.Int.

ST-37

Yang Ming

Stomach

ST-36

San Jiao

UB-39

Shao Yang

Gall-Bladder

GB-34

S. Int.

ST-39

Tai Yang

U. Bladder

UB-40

YUAN POINTS

If the 5 Yin organs are diseased, abnormal reactions will

appear at the 12 Source points. If we know the
correspondence of Source points to the relevant Yin organ,
we can diagnose when a Yin organ is diseased.
Spiritual Axis, Ch. 1

YUAN POINTS
Source Points for the Yin Organs
Yin Organ

Source Point

Lungs

LU-9 Taiyuan

Heart

PE-7 Daling

Spleen

SP-3 Taibai

Liver

LIV-3 Taichong

Kidneys

KI-3 Taixi

AH SHI POINTS
Ah Shi Theory
If there is soreness on pressure (whether on a channel or
not), there is a point
Body is completely covered by different channels so every
area is irrigated by them
Pressure and description of the condition will reflect the
channel which it is closest to

REFERENCE /
CREDITS

Kaptchuk, Ted - The Web that has no Weaver

Maciocia, Giovanni Diagnosis in Chinese Medicine
Maciocia, Giovanni Foundations of Chinese Medicine
Xin Nong, Cheng Chinese Acupuncture and
Moxibustion
Zheng, Li Shi - Pulse Diagnosis
Flaws, Bob The Secret of Chinese Pulse Diagnosis