TCM Diagnostics

TCM Diagnostics

The art of diagnosis is a lifetime voyage in the interpretation of the presenting signs and symptoms of the syndrome complexes. A viable diagnosis is totally dependent on competent knowledge of TCM theory. This cannot cannot be stressed enough. What separates a good acupuncturist from an excellent one is his understanding of TCM theory and how to apply this knowledge. n the other hand! a competent TCM theorist means nothing if they cannot interpret the data correctly.

"n TCM! diagnosis of disease is the process of discriminating patterns of disharmony! or the syndrome complexes. This can be divided into two parts. The first part is to thoroughly examine the patient! like a crime scene investigator as " mentioned before. The second part of diagnosis is logically interpreting the information gathered in the examinations! or to discriminate patterns of imbalance.

Traditionally! TCM examination is divided into four parts! commonly referred to as the #$our %illars of Diagnosis.& These are 'uestioning the patient! observing the patient! palpating the patient! and auscultation ( olfaction. )ets look at these in more detail.

"t is said that if you listen to the patient! the diagnosis is rendered. This is general idea in the patient interview. When the practitioner 'uestions the patient in TCM! " believe ,- of the time the diagnosis is correct. "t is like throwing apples in a bag. The ones with the most apples is the primary diseased organ ( pathway. "t is there for vital to understand the presenting sign and symptoms to categori/e dysfunction. "n TCM this is called pattern discrimination. This is the main form of diagnosis and treatment. "t is symptom based. Much of the 'uestions reflect the five element correspondences and the primary

functions of the organs. Therefore proper understanding of the functions of the internal organs and the $ive 0lement characteristics is crucial to diagnosis.

"n TCM! there are ten basic 'uestions that lead to one hundred 'uestions. 1ere are the main classic 'uestions in TCM diagnostics2

)ow energy * "ndicates deficiency of +i. "f energy is lower in the end of the day 3in deficiency. "f patient is more deficient in the morning 3ang deficiency. "f the patient is constantly tired throughout the day! indicates overall +i deficiency.

0xcess or hyperactivity can be possible excess yang heat  ! excess interior heat! or excess yang 'i rising.

Chills indicate invasion of pathogenic cold  . $ever indicate invasion of pathogenic heat  .

Chills with fever indicates exterior syndromes of wind(cold or .  * symptoms include severe chills with mild  * wind(heat  Wind(Cold  fever! no sweating! general body aches! headache! pulse will feel floating and slow. Wind(1eat   * symptoms include mild chills with  * severe fever! sweats! excess thirst! and a floating and rapid pulse.

$ever without chills with aversion to heat is do to excess heat in the . 5ymptoms include profuse sweating! severe thirst! and a interior  surging pulse. $ever at night is mainly do to 3in deficiency.

Chills without fever indicates interior cold syndromes  . 5ymptoms include chilled appearance! cold extremities! and a deep! slow! and weak

functions of the organs. Therefore proper understanding of the functions of the internal organs and the $ive 0lement characteristics is crucial to diagnosis.

"n TCM! there are ten basic 'uestions that lead to one hundred 'uestions. 1ere are the main classic 'uestions in TCM diagnostics2

)ow energy * "ndicates deficiency of +i. "f energy is lower in the end of the day 3in deficiency. "f patient is more deficient in the morning 3ang deficiency. "f the patient is constantly tired throughout the day! indicates overall +i deficiency.

0xcess or hyperactivity can be possible excess yang heat  ! excess interior heat! or excess yang 'i rising.

Chills indicate invasion of pathogenic cold  . $ever indicate invasion of pathogenic heat  .

Chills with fever indicates exterior syndromes of wind(cold or .  * symptoms include severe chills with mild  * wind(heat  Wind(Cold  fever! no sweating! general body aches! headache! pulse will feel floating and slow. Wind(1eat   * symptoms include mild chills with  * severe fever! sweats! excess thirst! and a floating and rapid pulse.

$ever without chills with aversion to heat is do to excess heat in the . 5ymptoms include profuse sweating! severe thirst! and a interior  surging pulse. $ever at night is mainly do to 3in deficiency.

Chills without fever indicates interior cold syndromes  . 5ymptoms include chilled appearance! cold extremities! and a deep! slow! and weak

pulse.

Alternating chills and fever indicate intermediate syndrome  . ther symptoms might include bitter taste in mouth! thirst! and fullness in chest.

Absence of perspiration in exterior syndromes indicate invasion of . pathogenic cold  %resence of perspiration in exterior syndromes indicate invasion of  or both wind(heat   or . wind or heat  %erspiration at night 6night sweats7! which stops upon awakening! indicates 3in deficiency with hyperactivity of 3ang heat.

$re'uent %erspiration that worsens with activity deficient +i and deficient 3ang +i.

%rofuse perspiration that is accompanied with high fever! mental restlessness8! thirst! preference to cold drinks! and a surging pulse indicates excess heat from excess 3ang heat being expelled out by perspiring.

%oor appetite is a weakness in 5pleen and 5tomach +i. %ossible symptoms include prolonged illness and poor appetite! loose stools! lassitude! pale tongue! white thin coating on the tongue. %oor appetite with chest fullness! abdominal fullness! thick and sticky coated tongue indicates stagnation of +i of the 5pleen and 5tomach  caused by food retention or stagnation of dampness  .

"ncreased or excess appetite is typical with excess 5tomach heat   or  or . 5tomach fire 

"ncreased appetite without a desire to eat is typical of 3in deficiency  . causing internal heat 

5weet tastes indicates 5pleen +i deficiency and ( or damp ( heat. 5our tastes indicates food retention in the 5tomach or lack of harmony between the )iver and 5tomach. 5alty tastes are caused by :idney 3in deficiency. )ack of taste sensation is caused by 5pleen +i deficiency. %ungent tastes are caused by in;balances in the )ung! usually )ung heat.

=itter vomiting is a result of )iver and >all =ladder heat.
Cold syndromes! or any syndrome in which heat is not noticed causes lack of thirst. "n this case the body fluids are not being consumed because of the cold.

The presence of thirst in a patient indicates heat or retention of damp   in the interior preventing the body fluids from ascending. phlegm 

Constipation is usually due to excess heat   or excess usage of body . fluids  )oose stools indicate mainly deficiency of 5pleen   or dampness invading the 5pleen 

Watery stools with undigested foods usually means a deficiency of 3ang . of the 5pleen and the :idney  =loody stools with mucous is usually a result of damp heat in the  and stagnation of +i in the "ntestines. "ntestines 

Dark color urine usually indicates heat syndromes  . Clear and abundant amounts of urine usually indicates cold  or an absence  . of heat  Turbid ( Cloudy urine indicates damp heat  . @ed urine usually indicates damage of a vessel due to heat  . Clear increased amounts of urine indicates weak :idney +i and =ladder . controlling the urine  )ittle volume and yellow urine with accompanied urgency and painful urination usually indicated damp heat in the =ladder  . Dribbling and felling of retention of urine usually indicates :idney +i ! possible damp heat! and stagnation of blood or stones. deficiency 

"nsomnia accompanied with di//iness and palpitations is usually caused by the inability of the blood to nourish the 1eart and the 5pleen.

"nsomnia with restlessness in the mind and a dream disturbed sleep usually indicates 1eart heat or fire.

Di//iness is usually a symptom of fire! wind or phlegm.

deficiency of +i ! blood deficiency!

The head is the meeting place of all the 3ang pathways. The +i of all the ang and $u flow to the head. "f any of the external pathogenic evils attack the head or neck and damages the yang pathways! or if +i and blood stagnates as a result of internal diseases! the head and brain lack nourishment and a headache is sure to follow.

@ecent onset and short duration is usually a result of wind cold  . >radual onset are usually of interior etiology  .

Day;time headaches are usually a result of +i deficiency or 3ang deficiency. 0vening headaches are usually caused by blood deficiency or 3in deficiency.

Cervical spine headaches! especially at the nape of the neck 6>reater 3ang Channels7 are usually caused by :idney +i deficiency or invasion of wind ( cold. $orehead headache =right 3ang Channels7 are usually caused by =lood deficiency or 5tomach heat. Temporal headaches 6 )esser 3ang Channels7 are usually a result of invasion of wind ( heat! wind ( cold! or from interior )iver and >all =ladder $ire rising.

Top of the head headache 6Terminal 3in Channels7 are usually a result of )iver blood deficiency. Whole head headache is usually a result of invasion of wind ( cold.

1eavy feeling headache is a result of either phlegm or dampness. 1eadache that is inside the head is usually a result of :idney +i deficiency. Throbbing headache is usually a result of )iver 3ang rising. A dull! boring headache is usually a result of blood stagnation.

Continuous and dull deficiency.

pain in the back is usually a result of :idney +i

@ecent! severe! and stiff back pain is usually a result of =lood stagnation. 5evere pain that is aggravated by cold and damp weather and is comforted by heat is usually a result of pathogenic cold and dampness invading the back. =oring pain is usually a result of =lood stagnation. %ain in the shoulders and upper back is usually a result of exterior conditions * wind ( cold! wind ( heat! etc.

%ain in the oints that moves from oint to oint is usually a result of Wind. $ixed oint pain that is very painful is usually a result of invasion of Cold. $ixed oint pain that is associated with swelling and numbness is usually a result of invasion of dampness

=ilateral arm and leg numbness! or hand and feet numbness is usually a result of blood deficiency. ?nilateral numbness of fingers! elbows! and arm 6especially the first three digits7 is usually a result of Wind and %hlegm.

A rapid! sudden onset that is associated with chills and fever is usually a result of Wind ( Cold. %ain that " felt all over with associated tiredness is usually a result of =lood deficiency. %ain that is in al the muscles and has an associated hot sensation is usually a result of 5tomach 1eat. %ain all over that is associated with a feeling of heaviness is usually a result of "nvasion of dampness in the muscles.

The thorax is under the direct influence of the )ung and 1eart ang. The sides of the body are >all =ladder $u.

mainly influenced by the )iver ang and the

The abdomen is influenced by the )iver! 5pleen! "ntestines! :idney! and =ladder.

%ain in the chest is usually a result of =lood stagnation in the 1eart that is usually caused by 3ang deficiency. Chest pain that is associated with a productive yellow cough is usually a result of )ung heat. Abdominal distension and fullness is usually a result of )iver +i stagnation.

0pigastric pain is usually a result of either $ood retention in the 5tomach or 5tomach heat. 0pigastric pain that is very dull and not severe in nature is usually a result of 5tomach cold deficiency.

Most all ear conditions are due to :idneys because the :idneys open to the ear. All the )esser 3ang pathways flow to the ear and therefore external pathogenesis of these pathways such as 1eat! Dampness! and %hlegm can affect the ear.

Tinnitus * A sudden onset is usually a condition of )iver;$ire or )iver;Wind. A gradual onset is usually a condition of Deficiency of :idneys.

A loud high pitch noise is usually a condition of )iver $ire! or )iver Wind.

)iver 3ang rising!

A low pitch noise is usually a condition of :idney +i deficiency

Deafness that is chronic in nature is usually a condition of :idney +i deficiency. =lood and 1eart deficiency! deficiency of +i! and 3ang +i deficiency

%ain in the eyes is usually a condition of )iver because of the relationship to the opening of that viscera.

bservation This is the process in which the practitioner gathers information by the observation of changes in the patient9s body. The most common parts

that are inspected are the tongue and the face. Changes in the appearance of the body can give the practitioner clues in the nature of disease and pathology.

bservation of the $ace * ne part of the observation examination is face diagnosis. This was written in the 1uang ei Bing. "n TCM the face is another landmark! like tongue! or the vital organs. "mpairment of the organs can therefore reflect in the face. This can manifest in facial complexion! texture! or moisture in the corresponding area.

"t was already established that the )iver opens and controls the eyes. "t is said that all the organs reflect in the eyes. Different appearances of redness! moisture! and textures in parts of the eye can reflect in impairment in the corresponding areas of the eye.

bservation of the Tongue * Along with pulse diagnosis! this is can be the deciding factor in determining patterns of disease. This diagnostic procedure is much easier to master that pulse diagnosis. The tongue is a map of the internal organs.

The tongue can be divided into three sections ?pper =urner! Middle

=urner! and )ower =urner. The ?pper =urner consists of the 1eart and )ung. The Middle =urner consists of the )iver! 5pleen! >all =ladder! and 5tomach. The )ower =urner consists of the :idneys! =ladder! and "ntestines. ne can simply note changes in geography of the tongue and link them to a organ. $or example! a red tip indicates 1eart dysfunction! specifically heat in the 1eart. "f there is white coating present only in the back of the tongue indicates dysfunction in the :idneys! specifically +i deficiency of the :idneys. The practitioner simply has to memori/e key patterns of disease and the location of the organs in the tongue to be a successful tongue diagnostician.

Close attention is paid to the tongue to determine pathology. The TCM practitioner evaluates the patients tongue color! shape! and coating. )ets look at the specific conditions that are encountered in tongue pathology.

Tongue %roper  %ale Tongue2 "ndicates xu 6Deficient7 and cold syndromes or symptoms due to yang +i deficiency and insufficiency of +i and blood. @ed Tongue2 "ndicates heat syndromes! mostly shi types 60xcess7 of disease caused by interior heat! or symptoms of fire preponderance due to yin deficiency. Deep @ed Tongue2Denotes the excessive heat seen in febrile disease due to invasion of exogenous pathogenic heat which as been transmitted from the exterior to the interior of the body. "t also can be seen in miscellaneous diseases due to a preponderance of fire caused by yin deficiency! or seen in diseases of accumulated fire in the liver channel. %urplish Tongue2 5hows the syndrome of blood stagnation. A tongue with purplish spots or petechiae also indicates blood stagnation.

Tongue Appearance  $labby Tongue2 A flabby tongue body with teeth marks on the pale in color indicates a yang deficiency of the spleen and leading to accumulation and obstruction of phlegm;dampness. tongue with a deep red color indicates excessive pathogenic attacking the heart and spleen.

margin and kidney A flabby heat

Thin and 5mall Tongue2 This indicates consumption and deficiency of

blood and yin. A thin and small tongue with a pale color denotes deficiency of both 'i and blood. A thin dry tongue with a deep red color is mainly due to a preponderance of fire and great exhaustion of body fluids. @igid Tongue2 5een in febrile diseases due to the invasion of exogenous pathogenic heat transmitted into the pericardium or due to an obstruction of pathogenic phlegm. "t may also be seen in high fever leading to consumption of body fluids and preponderance of pathogenic heat. "t is a prodrome of wind;stroke 6cerebral stroke7. Deviated Tongue2 This is a prodrome of wind;stroke. Cracked Tongue2 Cracks on the tongue with deep red color indicate excessive heat. A cracked pale tongue indicates insufficiency of yin and blood. 1owever! a cracked tongue of long term duration without any other symptoms can be considered normal.

Tongue Coating  Thinness and Thickness2 >enerally! if substantial pathogenic factors such as damp! phlegm or food accumulation occur and cause obstruction! they further affect the spleen and stomach leading to the ascent of turbid 'i and forming of a thick tongue coating. A white thin tongue coating is formed if nonsubstantial pathogenic factors such as wind! heat! dryness! or cold attack the bodyE or if the pathogenic factors stay on the body surfaceE or if body resistance is weak during the disease development. Moistness and Dryness2 The normal tongue coating is moist! which indicates that plenty of body fluid is flowing upward. "f the tongue coating is dry! it is due to body fluids failing to moisten the tongue. A dry tongue coating may also be present in some febrile diseases where pathogenic heat consumes the body fluid. A slippery tongue coating may be due to pathogenic damp;humor floating over the tongue surface. 5ticky and Curdled Tongue Coating2 A sticky coating is due to hyperactivity of endogenous pathogenic phlegm and damp rising tot he tongue! and is mostly seen in diseases caused by pathogenic damp;heat or phlegm;humor. A curdled tongue coating is the outcome of food accumulation in the stomach leading to the ascent of turbid 'i to the tongue surface. "t is also seen in disease caused by phlegm;damp. %eeled Tongue Coating2Mostly due to deficiency of 'i and yin. "f peeled tongue is accompanied by a sticky coating! it indicates a complicated disease condition to which the body resistance is weakened.

o Tongue Coating2 Changes in the tongue coating indicate fluctuation in the disease condition. $or example! if a 'i deficiency of the stomach is manifested by a lack of tongue coating at an early stage! the tongue coating will reappear after the stomach 'i is recovered. "f a disease has no tongue coating! then suddenly appears! this indicates a perverse flow of stomach 'i! or excessive pathogenic heat. "f a disease has a tongue coating at the beginning! which disappears abruptly! this indicates stomach yin fluid has decreased. "f a thick coating gradually turns into a thin white coating! this indicates that pathogenic 'i is being gradually weakened! and the disease condition is becoming milder.

>enerally! an observation of the thinness and thickness of the tongue coating will indicate the depth of pathogenic 'i. The tongueFs moistness or dryness shows the body fluid condition. The degree of stickiness of the tongue coating indicates the dampness of the stomach and spleen. The appearance or disappearance of tongue coating signified the cure or worsening of the disease condition.

Color of Tongue Coating  White Coating2 "ndicates exterior;cold syndromes. A white and thin coating is seen mostly in exterior syndromes! while a white and thick coating appears in interior;cold syndromes. "f there is a powder;like whitish coating covering the tongue surface! it is caused by the internal accumulation of summer;humid heat and is usually seen at the onset of pestilential diseases. 3ellow Coating2 "ndicates interior and heat syndromes. A light yellow tongue coating is seen in cases of slight fever. A deep yellow color indicates high fever. =rownish tongue coatings represent an accumulation of pathogenic heat. >rayish Coating2 Denotes interior;heat syndrome or interior;cold syndrome. A grayish black and slippery coating on the tongue usually indicates symptom;complex due to cold;damp in the interior. A grayish! yellow! and sticky tongue coating usually indicates the accumulation of damp;heat. >rayish and dry tongue coatings are usually due to the consumption of body fluid by excessive heat. =lack Coating2 This is often seen at the serious and dangerous stage of disease! and indicates extreme heat or cold. A black! yellow! and dry coating with thorns on the tongue surface usually denotes consumption of body fluid by extreme heat. A black and slippery tongue coating shows excessive cold due to yang deficiency.

The pulse is an invaluable diagnostic procedure. "f done properly! it can provide the doctor with instructions in their course of treatment. %ulse diagnosis is crucial for all aspects in acupuncture. The pulses can determine which organ and pathway is imbalanced! where the disease is located in the body! how far to insert the needles! how to manipulate the needles! how long a session should last! and the patient9s prognosis. ?ltimately! with tongue diagnosis! pulse palpation can be the maor determining factor and basis of treatment

The 1eart is obviously noted as regulating the pulses. 1owever! it is much more complex! or integrated than this. "n TCM! the pulses are associated with the internal organs! +i! and blood. $or example! blood circulation is a cooperative effort brought on by the 1eart! )ung! )iver! and 5pleen ang. The 1eart controls the circulation of blood! the 5pleen controls the containment of the blood in the blood vessels! the )iver stores the blood! and the )ung and 5pleen contribute to the pushing of blood though out the vessels and body. The +i and blood has almost a symbiotic relationship. "t is said that the blood is the mother of +i! and the +i is the ruler of blood. This explains how the blood nourishes the +i and +i regulates! or pushes the blood in the blood vessels. Without nourishment +i cannot function and without the 3ang function of movement that the +i provides! of blood cannot function. 3ou can therefore see how the state of +i and blood can influence the pulses.

There is nothing easy about mastering pulse palpation. "t takes years to fully appreciate the art of feeling the +i in the radial artery. 1owever! with in a few years of palpating pulses! your fine touch and pulse perceptions become easier and the images will become much more clear. "nitially it is encouraged to spend more time in pulse palpation. "n China it is not uncommon to spend twenty to twenty;five five minutes in evaluating the pulses. bviously! this is not time effective in a busy clinic. $ive to ten minutes is sufficient enough time when learning pulse diagnosis.

When taking the pulse! clear your thoughts and focus entirely on the

patients +i. Try to /one in on the radial pulse and start to decipher the images. "t is said in ancient texts that the doctor doesn9t palpate the pulse! but rather listens to the pulses. This reflects the importance of concentration and focus.

"n classic Chinese texts! the pulses should be taken under optimal conditions. %roviding the proper setting assures the doctor of true and clear findings.

%atient %osition 

The pulses should always be taken in the recumbent! or sitting position. The wrist should be at the same level as the heart. Make sure the patient is comfortable. "f the patient cannot sit! take the pulses standing with the elbow bent and relaxed and the wrist at the heart level.

Doctor %osition 

"t is important to note that the doctor must be comfortable when taking the pulse. "f the doctor is uncomfortable! their concentration isn9t optimal and the pulse palpation is hurried and sloppy. Traditionally! the doctor takes the pulses sitting on a desk or table. The doctor9s arm is rested on the desk or table with their arms at G- degrees to the patient9s. The doctor9s right hand interprets the patients left radial artery! and the doctor9s left hand interprets the patient9s right radial artery. There should be no switching of positions. After a while of taking pulses! your index finger! middle finger! and ring finger will become very sensitive and comfortable in their respected positions.

There are many different opinions on the six pulse positions. The most popular comes from )i 5hi;hen described in his text! #%ulse Diagnosis& written in HIJK. The three pulse positions are cun * front(distal position! guan * middle position! and the chi *

last(proximal position.

Cun

)ung

>uan Chi 5pleen(5tomac h :idney 3in

Cun 1eart

>uan )iver

Chi :idney 3ang

These positions are located at the radial artery at the styloid process of the radius on both wrists. "t is believed that the patients +i and blood in the pathways and its associated organ are felt at these positions. Therefore! the status of a patient9s health is reflected in the pulses.

When examining the pulse! the doctor should always use his index finger for reading the cun position! middle finger to read the guan position! and ring finger to read the chi position. This was discussed earlier in the doctor positioning. "t is mentioned again because of its significance.

When taking the pulses. The doctor must Asses the 'i and blood in all positions as well as all three depths. The pulses can be interpreted in three depths! superficially! slightly deeper! and deep. "n classic texts! these are referred to a heaven! man! and earth. The depths describe where the +i and blood are located at! where the disease is located at! and what part of the body is affected.

5uperficial Middle  Deep 

?pper =ody ; 0xternal "nfluences Middle =ody ; %athway level )ower =ody ; rgan level

"f the pulse is predominant in the cun position! it is said that the +i and blood is superficial! ust underneath the epidermis. This is usually indicative of external evils like wind and heat or 3ang excess. The cun position can diagnose disease from the diaphragm to the head.

"f the pulse is located in the guan position! the +i and blood is located in the pathways where it is supposed to be. This is located between the epidermis and the muscles. The guan position diagnoses disease from the umbilicus to the lower diaphragm.

"f the pulse is felt in the chi position! the +i and blood is at the visceral level. This means that the +i is very weak and the organ is either involved or is diseased itself. The chi position diagnoses disease from the below the umbilicus.

The level in which the +i and blood are manifesting determines needling depths. "f the pulses are very superficial! the +i is flowing superficially and therefore needling should be shallow. "f the pulses are located in the middle position! the +i and blood are flowing in their respected pathways and needling is deeper. "f the pulses are deep! to the bone! the +i and blood is located in the organs and needling is deep. When you look at references in acupuncture texts on needling depths! the determining factor is where the +i and blood is located. This is rarely discussed. $or example! when reviewing needling depths of 1egu 6)";K7 the range is from -.L cun to H.- cun. A superficial pulse will be needled at -.L cun ! the middle pulse is needled -.I cun! and the deep pulse is needled at H.- cun.

To determine pathological pulses! one must establish normal images 6%ing Mai7. The following characteristics of a normal! healthy pulse are as follows2

This means if the pulse is strong and patterns of it9s beat is distinct. "f the can be felt coming and going with good force! it has spirit. "f it is faint! irregular! 1

choppy! or once and a while ceases! it is said that the pulse is without spirit. "f the pulses at the last! Chi position and 2 it is felt all the way to the radial bone! it is said to be strongly rooted. "n classics it states that if the pulses are rooted! the patient9s health is good. Bust as the roots of a tree that deeply plants and anchors deep in the ground! the patient9s health is deeply anchored. 3 The pulses should posses some slippery 'uality. When one feels comfortable in feeling all the pulse images! identifying this slightly slippery 'uality will be appreciated. "f the pulses feel tense or large and not slightly slippery! it looses its harmony! and is said to lack 5tomach +i.

A person9s pulses are subect to the ever changing environment. To maintain the balance between the interior and the exterior! the body changes and is reflected in the normal pulse. During the springtime the 3ang +i becomes more prominent. The pulse will be increasingly stronger and slightly wiry. During the summertime the heat will cause the pulses to be overflowing. During the autumn the 3ang +i slowly weakens and the pulses will become empty! floating! and fine. During the winter the pulses sink deep because of the cold climate and they become deep and strong.

When imbalances of body! mind! and spirit inflict the body! physical changes immediately follow. A person can suffer with pain! fatigue! and organic dysfunction. $ortunately! physical changes are also present in the pulse images. "n TCM! they label these pathological changes as =ing Mai and categori/e them into twenty;nine pulse images. The twenty;nine images are classified into four easily felt categories. "n the =ing 1u  ! it states that there are four principles! or essential images Mai ue  that nearly all pulses poses. They are fast! slow! floating ( superficial! and deep.

When a beginning student of TCM starts to tackle these pulse categories! it seems overwhelming and even impossible to feel all twenty;nine images. "f one sticks to the four categories of pulses! pulse diagnosis can be less of a headache and more of a wonderful tool of ancient wisdom.

)ets look in more detail on some of the pathological pulses. @emember that feeling the pulses takes time. Don9t get discouraged in the beginning. %ulse palpation is an art as well as a science. With that in mind! be diligent! patient! and determined and success is sure to follow.

4

%ulse "mage2 %ulse has most strength at upper;most level! and can be only be felt on a slight touch. )i 5hi hen describes this as feeling like a piece of wood floating on water. "t is very strong at the surface and disappears on deeper palpation! like when the piece of wood is pushed under water and then reappears when light pressure is applied.

A floating pulse appears when 3ang +i is excess. This image is mostly seen in cases of Wind. This can be Wind! Wind(Cold! or Wind(1eat. Wind(Cold * "f the image is floating and tight. Wind(1eat * "f the image is floating and rapid.

"f the floating pulse is also forceless and empty in deep position it is indicative of Deficiency

%ositions $elt2

Cun %osition2 This is mainly felt in the cun 6front7 position. This is in the upper iao. The )ung and 1eart ang occupy these positions. The )ung is the most vulnerable organ to the exterior. "t is therefore subective to wind! heat! and cold. "f the )ung is weak! these pathogens invade the body and can yield a floating pulse. As we mentioned earlier! )ung controls the Wei +i! or the immune system. A floating pulse in the right cun position almost always means a flu ( cold is present! in progression! or ending. >uan %osition2 When the 5pleen is deficient and it affect the entire middle iao! a floating pulse will appear in this position on the right arm. "f the )iver +i is over;abundant a floating pulse in the left guan position will be present.

%ulse "mage2 %ulse has most strength at lowest level and re'uires deep pressure to feel. "t is said to feel like a cotton ball on sand in the superficial position and very strong and rigid in the deep position.

"f the pulse is weak and deep it indicates deficiency of +i. pulse is full and deep it indicates interior cold or heat.

%ositions $elt2

This can be felt in all the positions.

"f the

>uan %osition2 A deep pulse in the guan position is indicative of cold stagnation in the middle iao * 5tomach ( 5pleen. Chi %osition2 A deep pulse in the chi position is very common. translates to weakness in :idney +i and :idney 3uan +i.

This

%ulse "mage2 %ulse is less than J- beats per minute or if the pulse beats three times in a respiration.

%athology2

Cold in the interior! or severe 'i deficiency.

"f the pulse is slow it indicates invasion of cold. "f the pulse is slow and floating it is due to invasion of wind ( cold. "f the pulse is slow and empty it indicates deficiency of 3ang.

%ositions $elt2

This can be felt in all the positions.

>uan %osition2 A slow pulse in the guan position is indicative of cold stagnation in the middle iao * 5tomach ( 5pleen and )iver which can lead to painful spasms in the muscles and tendons.

Chi %osition2 A slow pulse in the chi position translates to weakness due to cold retention in :idneys.

%ulse "mage2

%athology2

%ulse is greater than ,- beats per minute.

1eat! either excess or deficient

This pulse image occurs when there is excess 3ang +i. "f the pulse is rapid and floating it is indicative of superficial heat. "f the pulse is rapid and deep it is indicative of internal heat. "f the pulse is rapid and strong it indicates excess heat. "f the pulse is rapid and lacks strength it indicates deficient heat! or 3in deficiency.

%ositions $elt2

This can be felt in all the positions. Cun %osition2 When a rapid pulse is felt in the front left position it indicates 1eart heat bla/ing upward. "f felt in the front right position it is indicative of )ung dryness.

Chi %osition2A rapid pulse in the chi position translates fire bla/ing upward due to :idney 3in deficiency.

%ulse "mage2 This pulse describes the strength of pulse. ?nder firm pressure! the empty pulse feels soft and weak. 1owever! an empty pulse is felt with light or heavy pressure! but feels forceless to the

fingers.

An empty pulse reflects a weakness of the body and leads to a lowered state of resistant. Whether the pulse is rapid or slow! an empty pulse is always due to deficiencies. This pulse image reflects a state of deficient +i and blood.

%ositions $elt2 Cun %osition2This is mainly felt in the cun 6front7 position. This is in the upper iao. The )ung and 1eart ang occupy these positions. "f the 1eart blood is deficient leading to mal;nourishment of the 1eart! this position on the left becomes empty. >uan %osition2 When food stagnates and the 5tomach swells because of deficiencies! the process of transformation and transportation function of the 5pleen is lost. A empty pulse is then felt in this position.

%ulse "mage2 This pulse describes the strength of pulse. "t is present upon deep and superficial pressure. "t is felt as a full throbbing pulse. %ulse can be felt strongly on all three levels at the same time.

A full pulse reflects states of excess. This pulse image reflects the struggle of the body9s excess +i and blood and a normal energy level.

%ositions $elt2 Cun %osition2A full pulse at this position reflects excess heat and wind in the upper iao. This can lead to symptoms such as headache! fever! soar throat! and stuffiness in the chest. >uan %osition2Accumulated heat in the middle iao * 5pleen(5tomach causes a full pulse at this position. 5ymptoms such as stuffiness and abdominal distension.

%ulse "mage2 %ulse feels like pearls coursing through the pulse! with a definitive rolling 'uality. The pulse 'uickly hits each individual finger and ust as 'uickly rolls away. "t feels like slippery little balls that remain even. A slippery pulse usually occurs with a rapid pulse.

%athology2 Dampness of any variety! phlegm! pregnancy! heat.

A slippery pulse indicates a mild illness. "t is a result of an abundance of 3ang +i in the body. "t also can be caused by heat from the )iver or the :idney fire that cause the blood to heat up. "t is seen very often in pathologies with increased dampness and phlegm. %regnant females very often have a slippery pulse reflecting abundant +i and blood in the body. 1ealthy people that have abundant +i and blood can also present with a slight slippery pulse.

%ositions $elt2 Cun %osition2A slippery pulse at this position reflects when the +i accumulates in the chest and diaphragm! interfering with the descending function. This leads to symptoms of acid reflux! vomiting! stiff tongue! and coughing.

>uan %osition2A slippery pulse at this position reflects )iver heat t and 5pleen dampness. This is very common in this position on both the right and left arms.

%ulse "mage2 %ulse is uneven and rough. Classically defined as a knife scraping bamboo . "t is fine! short! and slow. "t also moves at irregular depths! like a silkworm eating at a leaf. The will not stop periodically like that of a intermittent pulse. The choppy pulse is felt in the superficial middle! and deep pulses unlike the minute pulses.

%athology2 =lood deficiency or +i and blood stagnation.

A choppy pulse usually is indicative of deficiency of 3in blood. "t can also be felt when there is invasion of cold damp that penetrates the organs and causes stagnation of blood circulation. "n pregnant women! a choppy pulse reflects insufficient blood and nourishment of the fetus.

%ositions $elt2 Cun %osition2A choppy pulse at this position reflects damaged 1eart blood that can lead to chest pain. >uan %osition2A choppy pulse at this position reflects weakness and deficiency of the 5tomach ( 5pleen causing fullness and swelling.

%ulse "mage2 This pulse feels long in its beat rate. "f it is long ! soft! and calm it indicates health. "f it is long tight! like a string it indicates disease.

%athology2 This pulse image can reflect the strong health of an individual. "n diseased patients! this pulse reflects excess 3ang heat in the blood! wind phlegm! or internal heat in the 5tomach or )arge "ntestines.

%ulse "mage2 This pulse image feels short and its beats are strong! but it rises and falls abruptly.

%athology2 +i and blood deficiencies

This pulse is felt when +i becomes weak and is not able to circulate evenly.

%ulse "mage2 This pulse image feels taught! long! and strong in nature. "t can be felt in light or heavy palpation. "t is said to feel like a bow string! very firm and fixed. "t can also be compared to a sting instrument! very springy and elastic in nature. "t feels like a thin musical string that bounds up against the fingers evenly but with force. This is very commonly felt! especially in the )iver 6>uan7 position.

%athology2

+i stagnation! especially in )iver! can also be phlegm

This is commonly found in cases of liver +i stagnation. "t can also be present if there is excess heat 6fast pace7 and cold 6slow pace7. %atients that have spasms! stiffness! and pain in the body will also yield a wiry pulse. 0xcess phlegm can lead to a wiry pulse. "n general! if the disease is mild! the pulse is wiry and soft. "f the disease is sever! the pulse is wiry and hard.

%ositions $elt2 Cun %osition2A wiry pulse at this position reflects accumulated phlegm in the chest and diaphragm. >uan %osition2A wiry pulse at this position reflects )iver and >all =ladder disease! primarily +i stagnation. 0xcess cold in the 5tomach can also yield a wiry pulse in this position.

%ulse "mage2 0xactly what it says. %ulse simply feels thinner than it should. "t feels like a thin string of thread. "t s felt as weak! soft! and without strength.

%athology2

=lood or 'i deficiency.

This is seen in cases of deficiencies and failure of +i and blood. "t can also be seen in disharmonies of the even emotions! weakness in 3ang +i! internal damage to ing! and penetration of dampness.

%ositions $elt2 Cun %osition2A thin pulse at this position reflects severe deficiency if +i.

>uan %osition2A thin pulse at this position reflects 5pleen ( 5tomach deficiency.

%ulse "mage2 %ulse feels taught like a rope! thicker than wiry! feels as if the pulse evenly hits the fingers in different places with every beat.

%athology2 Cold! usually causing stagnation.

Cold of any nature will produce a tight pulse. )iver! )ungs! 5pleen(5tomach! and :idneys.

Cold can attack the

%ositions $elt2 Cun %osition2A tight pulse at this position reflects cold damage. "n the left position it reflects external cold. "n the right position it reflects internal cold. >uan %osition2A tight pulse at this position reflects 5pleen ( 5tomach cold damage. Chi %osition2A tight pulse at this position reflects deficiency and cold of the :idneys.

%ulse "mage2 5trength of the pulse is minimal! and with more pressure cannot be felt at all.

%athology2 +i deficiency

%ositions $elt2 Cun %osition2A weak pulse at this position reflects weakness in the 1eart and )ungs >uan %osition2A weak pulse at this position reflects 5pleen ( 5tomach weakness. Chi %osition2A weak pulse at this position reflects deficiency of the :idneys.

%ulse "mage2 @egularly is irregular for this pulse image. %ulse seems to miss a beat and then pauses.

%athology2

1eart organ disharmony or exhaustion of the organs

"t can also be felt after three months of pregnancy. "ndicating deficient +i.

5ome information can be gathered from listening to the speech and respiration. "f the speech is loud and robust! it indicates excess. the voice is weak and timid! it indicates weakness and deficiencies. Weak breathing is indicative of deficient +i. $orceful breathing indicates presence of excess heat.

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