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Floating Pulse
浮脉

Floating pulse is a superficially located pulse which can be felt by light touch and grows faint on hard pressure, usually indicating an exterior pattern.

Floating and powerful pulse suggests exterior excess pattern while floating and weak pulse suggests exterior deficiency pattern.

Floating pulse is a yang pulse. If it appears in exterior pattern it indicates that the healthy qi is driving the pathogenic qi out of the body. When an external pathogen assails the body surface, defense yang resists the pathogen at the surface level. Exuberant healthy qi fighting with external pathogenic qi at the surface level results in floating and powerful pulse, indicating exterior excess pattern; however, when healthy qi is in deficiency failing to provide power to the pulse, it gives rise to floating and weak pulse, indicating exterior deficiency pattern.*

Floating and tight pulse appears when a patient externally contracts wind-cold, because cold congeals and makes the blood vessels contract. Floating and rapid pulse occurs when a patient externally contracts wind-heat, because heat makes the heart beat fast.

If this pulse is seen in a thin person or observed in autumn, it is usually considered a healthy pulse.

There are three more pulses that are also floating: dissipated pulse*, hollow pulse* and drumskin pulse*.

Sunken Pulse
沉脉

Sunken pulse is a deeply located pulse which can only be felt when pressing hard, also called deep pulse, indicating interior pattern.

This pulse can be seen in healthy people, especially the overweight in winter time, because there is more fatty tissue in the wrist region of these people.

Sunken pulse is a yin pulse. Sunken pulse appears when pathogenic qi is exuberant inside the bod1, because yang qi has to fight the pathogenic qi inside the body in this case and it cannot extend the pulse out, resulting in sunken pulse.

If healthy qi is exuberant, it gives the pulse energy to be powerful. Therefore, sunken powerful pulse indicates interior excess pattern, usually observed in qi stagnation, blood stasis, food retention, or phlegm-retained fluid pattern. If healthy qi is deficient, it gives the pulse less energy, resulting in weak pulse indicating deficiency pattern, usually observed in qi and blood deficiency, yang deficiency, or viscera or bowel deficiency.

There are two other pulses that are sunken as well: hidden pulse* and firm pulse*.

Slow Pulse
迟脉

Slow pulse refers to a pulse with less than four beats to one cycle of the physician's respiration (<60 beats per minute), indicating cold pattern.

This pulse can also be seen in the pattern of heat pathogen accumulating and binding in the interior, and sometimes even in healthy people.

Cold is yin pathogen which decreases the body metabolism, including heart beating. Therefore, the pulse is slow.

Yang brightness bowel pattern* is caused by heat pathogen accumulating and binding with food waste in the abdomen. But the pulse is slow. That is because the heat and food waste form dry feces which produces toxin, and the toxin makes the heart beat more slowly. Therefore, slow pulse does not always suggest cold patterns.

Pulses in athletes and people who do a lot of physical exercise are relatively slow.

Moderate pulse* and relaxed pulse* are usually discussed together with slow pulse and are of the same type.

Rapid Pulse
数脉

Rapid pulse refers to a pulse with more than five or six beats to one cycle of the physician's respiration (about 90-130 beats per minute), mostly indicating heat pattern, and occasionally indicating interior deficiency pattern.

Heat pertains to yang and increases body metabolism including heart beating. Therefore, the pulse is rapid. Rapid pulse can also be seen in deficiency pattern as when the heart has to do extra work by beating fast to meet the body's needs, but in this case, the pulse must be weak.

Racing pulse* is also a fast pulse.

Vacuous Pulse
虚脉

Vacuous pulse is a feeble and void* pulse, indicating deficiency pattern, mostly suggesting dual deficiency of qi and blood.

Qi has power that can move the blood. When qi is in deficiency, the blood moves without force and the pulse becomes feeble. When qi is so deficient that it fails to contract the vessels, the pulse becomes void. However, in the pattern of dual deficiency of qi and blood, if qi is still strong enough to contract the vessels, the pulse is usually thin and weak.

Replete* Pulse
实脉

Replete pulse is a forceful pulse at all three sections, cun /inch, guan /bar and chi /cubit, also called forceful pulse, indicating excess pattern.

In excess pattern, both healthy qi and pathogenic qi are exuberant and they battle forcefully, making qi and blood flow strongly, resulting in powerful pulse.

When this pulse is observed in a severe disease, it may indicate deficient yang floating outward, because outward floating of deficient yang gives rise to forceful feeling of the pulse.*

This pulse can also be observed in strong and healthy people.

Surging Pulse
洪脉

Surging pulse refers to a pulse beating like dashing waves with forceful rising and gradual decline, also called flooding pulse, indicating yang brightness pattern, or qi aspect heat pattern.

In this case, the pathogenic heat is in exuberance and forcefully attacks the body. Meanwhile, the healthy qi is also in exuberance, making the pulse rise forcefully and decline gradually.

Large pulse* and long pulse* are in this category.

Fine Pulse
细脉

Fine pulse refers to a pulse as thin as a silk thread, straight and soft, feeble yet always perceptible upon hard pressure, usually indicating dual deficiency of qi and blood, and occasionally suggesting dampness-caused disease.

When blood is in deficiency, it cannot fill the blood vessels properly, so the pulse becomes thin; and if qi is in deficiency, it cannot circulate the blood forcefully, and the pulse becomes feeble. Dampness is sticky. When dampness exerts force to the vessels and makes them contract, it can make the vessels thin.

Soggy pulse*, weak pulse*, short pulse* and faint pulse* are also thin pulses, and also indicate qi deficiency.

Slippery Pulse
滑脉

Slippery pulse is a pulse coming and going smoothly like beads rolling on a plate, usually indicating phlegm-dampness, retained food or excess heat.

Phlegm-dampness and retained food can generate heat. Phlegm-heat, dampness-heat, or heat with retained food is sticky and can make the pulse wave short, and it can act on the heart and make the heart beat strongly, making the peak of the wave of the pulse high, and then slippery pulse occurs.

Slippery pulse can also be observed in pregnant women, young people or people at the prime of life, if their qi and blood are highly exuberant and their heart is working powerfully.

Stirred pulse* is also slippery.

Rough Pulse
涩脉

Rough pulse is a small, fine, slow and shaking pulse, coming and going unsmoothly, like scraping bamboo with a knife, indicating qi stagnation, blood stasis, phlegm, food accumulation, essence damage, or blood deficiency.

Qi stagnation, blood stasis, phlegm and accumulated food can all obstruct blood movement in the vessels. Unsmooth qi and blood flow gives rise to rough pulse, but the pulse should be strong, because healthy qi is still exuberant. When essence or blood is in deficiency, they may not be able to nourish the blood vessels properly and the blood vessels may lose their smoothness. Then qi and blood move with difficulty, resulting in rough pulse and the pulse in this case should be weak.

String-Like Pulse
弦脉

String-like pulse is a straight, long and taut* pulse, like a musical string to the touch, indicating liver and gallbladder diseases, pain, phlegm-retained fluid, etc. or deterioration of stomach qi.

The liver governs sinews and has free coursing function which facilitates qi movement. When the liver loses its free coursing function in the vessels, the vessels lose their flexibility and become hard, manifesting as string-like pulse.

Soft string-like pulse indicates that the disease is not severe while hard string-like pulse indicates that the disease is serious. Pain, phlegm-retained fluid, emotional upset, cold or heat can cause string-like pulse when they affect the free coursing function of the liver. String-like pulse can also appear in aged people, because their essence and blood are not exuberant and cannot efficiently nourish their vessels, and then the vessels lose their elasticity, resulting in string-like pulse.

Tight pulse* is similar to string-like pulse as it is like tight stretched cord.

Bound* Pulse
结脉

Bound pulse is a moderate weak pulse, pausing at irregular intervals, usually indicating yin exuberance with binding of qi, cold phlegm, or blood stasis. This pulse can also occur in qi and blood deficiency pattern.

Exuberance of yin cold, binding of qi, cold phlegm, and blood stasis can all stagnate heart yang qi, making heart yang weak in generating beats, giving rise to moderate weak pulse. If the stagnated heart yang qi generates a very weak beat that cannot be transported to the radial artery, there is a pause pulse.

Intermittent pulse* and skipping pulse* also beat with pauses.

Combined Pulse
相兼脉

Pulse conditions usually do not exist in a single form in clinical practice. Instead, two or more pulses usually appear simultaneously in a disease.

Generally speaking, the disease indicated by a combined pulse is the disease indicated by the two single pulses combined.

Floating pulse indicates exterior pattern and tight pulse indicates cold pattern; therefore, floating tight pulse* is usually observed in exterior cold pattern. Moderate pulse does not indicate any disease; therefore, floating moderate pulse* just indicates exterior pattern. Rapid pulse indicates heat, and floating rapid pulse* is usually seen in exterior heat pattern. Sunken pulse usually indicates interior pattern and slow pulse usually indicates cold pattern; therefore, sunken slow puke* is usually seen in interior cold pattern. String-like pulse usually indicates liver qi depression or water-fluid retention, and sunken string-like pulse* is usually observed in liver qi depression or water-fluid internally retained. Rough pulse indicates blood stasis, especially blood stasis due to yang deficiency and cold congelation; therefore, sunken rough pulse* is mostly observed in interior blood stasis pattern. Fine pulse indicates yin-blood deficiency, and sunken fine rapid pulse* is usually observed in yin deficiency with interior heat. Tight pulse indicates cold and pain, and string-like tight pulse* is mostly seen in pain pattern caused by cold stagnating in the liver vessel. Slippery pulse indicates phlegm-dampness, retained food or excess heat; therefore, string-like slippery rapid pulse* is usually observed in liver fire with phlegm complication*, liver-gallbladder dampness heat, or liver yang harassing upward, or phlegm-fire internally retention. Surging pulse indicates yang brightness pattern or heat in qi aspect, and surging rapid pulse* is seen in yang brightness meridian pattern, or exuberance heat in qi aspect.