28 Classical Pulse Types

The 28 classical pulse types (二十八脉象 èrshí bā mài xiàng) in Traditional Chinese Medicine (TCM) represent a nuanced system of pulse diagnosis, used to assess the health of the Zang-Fu organs, the state of Qi, Blood, Yin, and Yang, and the presence of pathogenic factors such as Wind, Cold, Dampness, Heat, and more. These pulse qualities are evaluated at three depths (superficial, middle, deep) and across six positions (Cun, Guan, Chi on both wrists), giving a full picture of internal health. Each pulse type reflects specific physiological or pathological states.

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Patient's Left Wrist (Palmar side)

______________________________________________

| Cun (寸) | Guan (关) | Chi (尺) |

|-------------------|----------------|-------------|

| Heart / SI | Liver / GB | Kidney Yin |

Patient's Right Wrist (Palmar side)

______________________________________________

| Cun (寸) | Guan (关) | Chi (尺) |

|-------------------|----------------|-------------|

| Lung / LI | Spleen / ST | Kidney Yang / BL |

┌─────────────┐

│ Index Finger│ ➜ Cun (寸) - Distal (near wrist crease)

├─────────────┤

│ Middle Finger│ ➜ Guan (关) - Middle (pulse bar)

├─────────────┤

│ Ring Finger │ ➜ Chi (尺) - Proximal (near elbow)

└─────────────┘

Palpating all three positions at three levels of depth allows the practitioner to gather a full picture of organ function, Yin-Yang balance, and presence of pathogenic factors.

Cun (inch)

Heart / Small Intestine

Lung / Large Intestine

Cun reflects upper burner: Heart/Lung (Shen, respiration)

Guan (bar)

Liver / Gallbladder

Spleen / Stomach

reflects middle burner: Liver/Spleen (digestion, Qi flow)

Chi (cubit's foot)

Kidney Yin / Urogenital

Kidney Yang / Bladder, reproductive

Chi reflects lower burner: Kidney, Bladder, reproductive

TCM Pulse Positions

Palpation Techniques

Abdominal palpation is used to assess organ tenderness, masses, hardness, warmth/cold, and Qi/Blood stagnation. This method is especially emphasized in Japanese Kampo and classical pulse-abdomen diagnostics.

Epigastric fullness

Stomach Qi stagnation

Umbilical area tenderness

Small Intestine or Kidney

pathology

Hardness below the ribs

Liver Qi stagnation or Blood stasis

Softness and flaccidity

Qi or Yang deficiency

Coldness

Yang deficiency or Cold accumulation

Heat or tension

Internal Heat or Damp-Heat

Abdominal Palpation
(腹诊)

1

Palpating along meridians or on acupuncture points helps detect:

Tender points → Blockage or excess
Nodules → Phlegm or stagnation
Cold or warmth → Cold/Heat syndrome
Tension, tightness, spasms → Qi stagnation or Wind
Loss of sensation or numbness → Blood or Qi deficiency, internal Wind

It helps confirm channel involvement, especially in musculoskeletal conditions, pain, or local syndromes.

Meridian and Point Palpation

2

Skin

Warm = Heat; Cold = Cold pathogen

Hands and feet

Cold = Yang deficiency; Sweaty = Damp-Heat or Qi deficiency

Lower back

Cold and pain → Kidney Yang deficiency

Chest

Fullness or pain → Lung, Heart, or Liver imbalance

Back-Shu points

Tenderness on palpation indicates organ pathology

Other Palpation Areas

3

Palpation (切诊 qiè zhěn) is one of the Four Diagnostic Methods (四诊 sì zhěn), along with Looking (望), Listening/Smelling (闻), and Asking (问). Palpation involves touching and feeling the body—particularly the pulse, abdomen, skin, and specific acupuncture points or channels—to obtain valuable diagnostic information. It plays a critical role in understanding the state of Qi, Blood, Yin-Yang, and organ function, especially when combined with other diagnostic pillars. Palpation includes:

Pulse diagnosis (脉诊 mài zhěn) — the most refined and central aspect
Abdominal palpation (腹诊 fù zhěn) — especially in Japanese and classical Chinese practice
Palpation of meridians and points — used to assess pain, sensitivity, or stagnation
Palpation of limbs, joints, skin, chest, back — for signs of Cold, Heat, swelling, or tenderness

Palpation

Pulse Diagnosis

Pulse diagnosis is performed by palpating the radial artery on both wrists using three fingers (index, middle, ring). Each wrist has three positions (Cun 寸, Guan 关, Chi 尺), and each corresponds to Zang-Fu organs. There are 28 classical pulse types, and each gives detailed insight into organ health, pathogenic factors, excess/deficiency, and Yin-Yang balance.