October 8, 2015

How pulse diagnosis works

Secrets of Chinese Medicine pulse diagnosis

The pulse is measured in both Western medicine and Chinese medicine, but there are key differences.  In Western medicine, we typically measure the heart rate, which is taken with blood pressure as part of a standard physical exam. In Chinese medicine, pulse diagnosis is a significantly more developed art form, a tool that practitioners use to assess the health of all the major organ systems of the body. In a sense, pulse diagnosis is like the “MRI” of traditional medical systems. Before modern imaging techniques, healthcare practitioners needed ways of evaluating what was happening inside the bodies of their patients. Although technology has developed significantly over time, pulse diagnosis remains a very helpful tool in assessment and diagnosis.

What does an Acupuncturist look for when they check your pulse?

In addition to assessing the heart rate at the radial pulse (the pulse felt next to the wrist), traditional pulse diagnosis also assesses up to 28 different qualities of the pulse. Each of these qualities gives the practitioner information about the state of the patient’s health and well-being. We’ll discuss a few of the most important qualities.

Pulse Qualities

These are some example of the major pulse qualities. In Chinese medicine, each type of pulse quality relates to a Chinese diagnosis, as well as particular physical and mental/emotional symptoms:


  • A fast pulse indicates excessive “heat” in the body. This pulse is often present when there is a fever, an inflammatory condition, or increased stress on the nervous system.
  • A slow pulse indicates a “cold” condition or could point to a particular body system that functioning in an inefficient or sluggish way. This pulse is often present when there are problems with blood circulation, cold hands and feet, etc.


  • A strong pulse indicates “excess” of some kind in the body. This pulse is often present with stress, anger, high blood pressure, and headaches.
  • A weak pulse indicates a “deficiency” of some kind in the body. This pulse is often present with fatigue, weakness, insomnia, low blood pressure, and depression.


  • A thin or thready pulse indicates “Blood deficiency” or “Fluid deficiency”. This pulse is often fatigue, weakness, insomnia, nutrient deficiencies, and sub-optimal digestive absorption.
  • One of the most typical wide pulses is called a rolling or slippery pulse. This pulse indicates food stagnation in the intestines, or a build-up of phlegm somewhere in the body. This pulse is often present with a variety of digestive problems and sinus/allergy congestion issues.

These and other pulse qualities help us determine what is happening in the body on a macro level. The positions of the pulse show us more specifically where these things are happening.

Pulse Positions

Over the past 2000 years, Chinese physicians have mapped out the which pulse positions correlate to which parts of the body. The graphic above shows the specifics.

Pulse diagnosis and pulse positions drawing.

Image from Bridgetown Acupuncture and Herbal Clinic.

Using the Pulse for Differential Diagnosis – – A case of low back pain

One of the benefits of pulse diagnosis is the ability to help us make a differential diagnosis. This type of diagnosis differentiates the cause of a particular symptom. For example, if someone has low back pain, that pain could be caused by 2, 3, or 4 different factors. Differential diagnosis identifies which factor(s) are most likely causing the pain.

To elaborate, let’s say a patient has low back pain. The acupuncturist feels their pulse, and asks a few questions about what’s happening:

  • If the low back pain is sharp, tense and knotted, and the pulse is strong, it’s a case of “excess” type low back pain
  • If the low back pain is dull, the back feels weak, and the patient feels generally drained and tired, it’s a case of “deficiency” type low back pain.

Depending on the differential diagnosis, the acupuncturist will then select the appropriate acupuncture points, herbal medicine formulas, and dietary and lifestyle recommendations.

The Pulse and the Body-Mind Connection – – how does Chinese Medicine look at stress?

The pulse can be a great tool for better understanding the connection between body, mind, and lifestyle behaviors. To see how this works, let’s take a look at two cases of stress that commonly show up at the clinic:

  • If someone is stressed, and the pulse is strong, especially in the Liver position (see graphic above), the acupuncturist would then ask the patient the following questions:
    • Do you typically experience your stress as anger, irritation and frustration frequently or easily?
    • When stressed, do you get headaches?
    • Does your stress tend to collect in your upper back, shoulders and neck?
    • Do you tend to feel a lot more relaxed, happy and energized after exercise, and/or after a couple drinks?

These symptoms are all related to “excessive” functioning of the Liver and the Liver meridian.

  • If someone is stressed, and the pulse is weak, especially in the Spleen/Stomach position, the acupuncturist would then ask the patient the following questions:
    • Do you worry a lot, or have obsessive or ruminating thoughts?
    • When stressed, do you get stomach issues?
    • Does your stress tend to collect in your stomach and abdomen?
    • Do you tend to feel even more tired after exercise, and sleepy and foggy headed after a couple drinks?

These symptoms are all related to “deficient” functioning of the Spleen/Stomach organs and Spleen/Stomach meridians.

Getting a pulse diagnosis at the clinic

Pulse diagnosis is often a part of the first acupuncture appointment, and always part of our herbal consultations. You can also get a pulse diagnosis check-up as part of a holistic health counseling appointment with either Andrei or Courtney.

4 Comments on “How pulse diagnosis works

Skip Rush
March 18, 2018 at 12:43 pm

A brief, though brilliant description of pulse diagnosis in TCM. It’s easy to read, concise and helpful to practitioner and patient alike. Thank you. Dr HJ Skip Rush; Princeville Kauai, HI.

Jeremy Riesenfeld, M.Ac., L.Ac.
June 5, 2018 at 4:45 pm

Thanks Skip!

John Stafford
May 12, 2018 at 3:52 am

New to this type of diagnostic tool. Have read several times and am now looking to learn more about pulse diagnosis with a view to find some appropriate training

Jeremy Riesenfeld, M.Ac., L.Ac.
June 5, 2018 at 4:33 pm

Hi John,

Glad that you’re interested! I recommend the Hammer-Shen method of pulse diagnosis if you really want to go deep in your studies…


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