Pulse Qualities and Mechanisms (A Quick Guide)

Pulse diagnosis is among the more difficult aspects of Chinese medicine to master. One reason for this is incomplete education.
In this article, pulse qualities are described, along with the mechanisms behind these findings and of course their therapeutic indications.
Understanding mechanisms simplifies this study greatly. Complex pulses such as the soggy (ru mai) aren’t so complex when you understand the basis for it’s quantifiable parameters.

SPEED	FAST	SLOW
STRENGTH	FORCEFUL	FORCELESS
LENGTH	LONG	SHORT
WIDTH	WIDE	THIN
DEPTH	SUPERFICIAL	DEEP
RHYTHM	REGULAR	IRREGULAR
ABNORMAL PULSE SHAPES	CHOPPY, WIRY, SLIPPERY

FAST AND SLOW
PULSE	INDICATIONS	MECHANISM
Fast Pulse	Heat	Heat accelerates movement.
fast+forceful	excess heat
fast+thin	deficiency heat
Slow PulseWater element pulse	cold	Cold impedes movement. The so-called “Athletic Pulse” is also a slow pulse, but it only indicates cardiac health.

FORCEFUL AND FORCELESS
PULSE	INDICATIONS	MECHANISM
FORCEFUL Pulses	excess
Surging Pulse (floating, wide, forceful, comes stronger than it goes)Fire element pulse	excessive heat	Heat stimulates the Heart’s function of commanding the Blood leading to increased cardiac output and the forceful pulse. However, heat damages the yin, which leads to a component of deficiency in this pulse. The deficient component is the downslope of the pulse wave which is weaker than the upslope of the pulse wave. Also, this is often considered a floating pulse. When the yin is damaged, it loses its root and floats.
Forceless Pulses	deficiency	deficiency of Qi or Yang gives rise to the forceless pulse.

LONG AND SHORT
PULSE	INDICATIONS	MECHANISM
Long Pulse	excessive heat	Heat accelerates and expands. When the pulse is long and too forceful, this is excessive heat. When the long pulse is moderate in force, this is a healthy pulse.
Short Pulse
short+forceful	Qi stagnation	Stagnation prevents Blood from filling the vessel.
short+forceless	Qi deficiency	Qi can’t push Blood hard enough to fill the vessel.

WIDE AND THIN
PULSE	INDICATIONS	MECHANISM
Wide Pulse	heat
wide+forceful	excessive heat	Heat accelerates and expands.
wide+forceless	deficiency heat	Yang expands the width of the vessel because Yin is too deficient to anchor it.
Thin Pulse	deficiency of Qi, Blood, or Yin	Qi, Blood, or Yin can’t fill the vessel with fluid or pressure to expand the width of the vessel.

SUPERFICIAL AND DEEP
PULSE	INDICATIONS	MECHANISM
Superficial Pulse Metal element pulse
superficial+forceful	exterior syndrome	Yang floats to the exterior (as Wei Qi) to fight off invasion of exterior pathogenic factor. This is reflected metaphorically in the superficial pulse.
superficial+forceless	Yin deficiency	Yang floats to the exterior because Yin cannot anchor it. This is reflected metaphorically in the superficial pulse.
Deep Pulse
deep+forceful	internal cold	pathological cold both injures Yang and impedes its rising. This is reflected metaphorically in the deep pulse.
deep+forceless	Yang deficiency	A deficiency of Yang gives rise to the inability for Qi and Blood to lift upwards. This is reflected metaphorically in the deep pulse.

REGULAR AND IRREGULAR
PULSE	INDICATIONS	MECHANISM
Regular Pulse	health
Intermittent Pulse (regularly irregular)	Rather than focusing too much on the indications of this pulse, I want you to remember that this may be a red flag for you and a referral to a cardiologist may be indicated.
Abrupt Pulse (rapid, irregular rhythm)	heat stagnation or stagnation heat	This pulse indicates stagnation that gives rise to heat, or heat that is causing stagnation. In either case, we have stagnation and heat.
Knotted Pulse (slow, irregular rhythm)	Blood Stagnation	pathological factors (likely cold) impede movement of Blood

ABNORMAL PULSE SHAPES
PULSE	INDICATIONS	MECHANISM
Choppy Pulse	Blood Stagnation
choppy+forceful	Blood Stagnation	excessive pathological factors impede movement of Blood
choppy+forceless	Blood Stagnation	lack of Qi, Blood, or Jing leads to vessels that aren’t filled which inhibits free flow of Blood.
Wiry PulseWood element pulse	Stagnation	Nei Jing says “tendons are the mother of vessels” which is to say that when the Liver becomes dry, so do the tendons, which leads to a hardness in the pulse as it loses the vessels lose their flexibility. Another mechanism is Qi stagnation prevents Blood from circulating outward and so the pressure remains high in the vessels causing the hard (wiry) pulse.
Slippery PulseEarth element pulse	Dampness	Dampness in the Blood increases its viscosity giving rise to a pulse that lacks corners.
	Heat	Heat accelerates the movement of the Blood giving rise to the perception of the pulse losing its corners.