Pulse examination is a diagnostic method used by ancient medical doctors to assist in identifying a formula–disease pattern. When performed correctly, it offers insight into the movement of gas, fluids, and blood, helping to reveal the presence and general location of an obstructed disease toxin.
However, pulse diagnosis must always remain secondary to the abdominal presentation. While the pulse provides information about internal movement, it rarely offers sufficient precision on its own to determine an exact treatment strategy. Practitioners who rely on pulse interpretation without confirming findings through abdominal examination, tongue coating, and structured questioning are especially prone to error, particularly when symptoms overlap or presentations are complex.
Pulse is not a mystical indicator of a patient’s constitution, emotional state, or organ symbolism, as often described in TCM theory. It is the measurable movement of gas, fluids, and blood within the vessel, and like any movement, it changes in response to an obstruction. A superficial, deep, slippery, wiry, or tight pulse does not represent elemental imbalance, but rather a specific disruption that must be verified through observable, evidence-based indications.
Each pulse quality must be interpreted according to both depth and position. In abdominal diagnosis, we differentiate superficial, submerged, and midline pulsations to identify gas, water, or blood-level disease toxins. Similarly, the radial pulse may suggest the level and location of a toxin, but only when the finding is clear, consistent, and confirmed by other diagnostic evidence.
Within the Materia Medica, several herbs have clearly defined primary pulse indications. Chai Hu (Bupleurum Root) is one such example. It is associated with a tight-wiry pulse at the left middle position of the wrist, felt at the superficial, gas-level depth. This position corresponds to the thoracic and upper hypochondrial regions.
The Pulse Classic (MaiJing) states, “A wiry pulse indicates stiffness and pain in the hypochondriac region.” This is further supported by Dr. Huáng Xuán of the Dr. Tian Heming lineage, who notes that Chai Hu formula structures present with a tight-wiry quality at or above the gas-level depth of the left middle position. When this distinct pulse quality is present at the correct depth and location, it serves as a reliable signal to consider a Chai Hu formula structure only when it is also accompanied by responsive tightness and fullness below the hypochondrium.
Todo Yoshimasu stated:
“When most practitioners cannot reliably distinguish even basic pulse levels or qualities, the outcome of their formula prescriptions becomes a matter of chance rather than certainty. Without a clear and structured method, their formula structures shift aimlessly, guided more by guesswork than by evidence.
There was once a well-known doctor in Japan who relied solely on pulse diagnosis to draw his conclusions. Because he lacked a clear understanding of disease toxins and pattern differentiation, his assessments were based on unfounded presumptions that led to numerous incorrect formula prescriptions.
Pulse diagnosis must always remain secondary to more reliable and tangible methods:abdominal examination, tongue coating, and structured questioning. These are the primary tools for identifying and locating a disease toxin and for confirming the correct formula-disease pattern."
Thus, all herbs and formula structures must ultimately be identified and confirmed through abdominal examination, tongue coating, and primary evidence-based indications. Without these methods, prescribing based solely on pulse qualities becomes speculative and unreliable. Pulse examination therefore supports the diagnostic process, but it must never replace structured, observable, and reproducible clinical evidence.
