How does a TCM practitioner diagnose using the pulse? (Part 1) 中医师如何把脉诊病?(一)

Updated: Feb 28

TCM Physician taking the pulse

This article contains Part 1. Read part 2 here to find out about pulse diagnosis of internal organs

Most people believe that the pulse can only be used to measure one’s heart rate. How does a TCM practitioner diagnose the health condition of a patient by taking the pulse then?

This is because in TCM, the rate is not the only characteristic of the pulse that the practitioner feels for. There are other attributes that can be identified, such as strength, thickness, depth, tension etc.

Feeling the pulse

In other words, when a TCM practitioner takes your pulse, apart from counting the number of beats, he/she is also identifying what the pulse feels like. For example, the pulse can feel thin, strong, tight, wiry, rough, deep etc. Each of these pulse types reveals certain information about the patient’s condition. There are more than 20 different pulse types.

In this article, we pick a few common pulse types and share with you what they feel like and what health conditions they signify.

Thin Pulse

What it feels like

  • The pulse feels like a thin thread under the fingers, but is still distinct

Common conditions

  • Insufficient Qi and Blood (Symptoms may include general weakness, being easily tired, or poor function of a certain organ etc.)

  • Presence of dampness (Symptoms may include feeling of heaviness, soreness in limbs, edema etc.)


Slippery Pulse

What it feels like

  • smooth, slippery, like a well-lubricated ball running under the fingers

Common conditions

  • Pregnancy (Pregnant women may often have a slippery pulse, but this should not be used as a definite sign of pregnancy, as the slippery pulse can signify other conditions too.)

  • Excess heat (Symptoms may include fever, red face, sore throat and ulcers, thirst, constipation etc.)

  • Phlegm

  • Can be felt in strong, healthy individuals too

Floating

What it feels like

  • The pulse can be felt easily just by touching the surface of the wrist

  • Upon applying more pressure, the feeling of the pulse diminishes slightly

Common conditions

  • Floating pulses are often found in patients with a cold or flu

  • This is because a floating pulse usually signifies an attack by external pathogenic factors (eg. wind heat, wind cold), that can cause sneezing, phlegm, runny nose etc

Fast

As a reference, a normal pulse beats about 4-5 times per breath (i.e. one inhalation + one exhalation).

What it feels like

  • 5 or more beats per breath

Common conditions

  • Usually signifies heat in the body

Slow

What it feels like

  • Less than 4 beats per breath

Common conditions

  • Usually signifies cold in the body

Note that a TCM practitioner would normally include other diagnosis methods, such as visual examination of the tongue, asking questions etc., in order to provide a more comprehensive and accurate diagnosis for the patient. In the 2nd part of this series, we share with you how TCM practitioners can identify which organs in the body are distressed.

> Continue to part 2


一般上人常认为脉搏只能用来测量心率。那中医师又如何利用把脉来诊断病情呢?

根据中医学,脉搏除了速率之外,还有其他可测量的方面,如力量,厚度,紧张度等。

触觉脉搏

换句话说,中医师把脉时除了算出脉搏跳动的频率外,也在细心感触脉象的跳动法。中医文献记载多过20种脉象,如细脉,紧脉,沉脉,大脉,弦脉,涩脉等。各脉象都能反映病人独特的身体健康状况。

此文章将简介几种常见脉象之感觉及临床意义。


细脉

脉象特点

  • 脉细如线,但应指明显

临床意义

  • 气血虚 (可表现为全身无力,易疲累,或某脏腑功能衰退等症状)

  • 体内有湿气 (可表现为肢体酸重,浮肿等症状)

滑脉

脉象特点

  • 脉搏流利,在手子下感觉圆而滑润

临床意义

  • 怀孕 (虽说孕妇可有滑脉,但不能把滑脉当成妊娠的明确指标,因滑脉也可有其他临床意义)

  • 体内有实热 (症状可包括发热,面红,口舌生疮,咽喉肿痛,口渴,便秘等)

  • 年轻体壮人士也可有滑脉

浮脉

脉象特点

  • 轻轻把手指按在手腕就感触到脉搏

  • 在出力重按时,脉搏感觉稍减

临床意义

  • 感冒病人常有浮脉

  • 浮脉多指外感邪气侵袭身体(如风寒、风热邪气),导致恶寒发热,打喷嚏,流鼻涕等症状

数脉 (Shùo mài)

正常脉率约在一呼一吸的时间内,脉跳4-5次。

脉象特点

  • 一呼一吸脉搏跳动多过5次

临床意义

迟脉

脉象特点

  • 一呼一吸脉搏跳动过4次

临床意义

在中医门诊时,中医师除了脉诊以外,也会参入看舌,问诊等诊断方式来作出个更全面及准确的病情诊断。

此外,中医师也能通过把脉而判断出体内哪一个脏腑有病。 有关详情将在中医诊脉第二部分继续刊登。