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Chapter 15 of 28
濒湖脉学
Pulse Characteristics
The moderate pulse (beating gently and evenly, approximately four beats per respiration) belongs to Yin. Its pulsation is slightly faster than the slow pulse (fewer than four beats per respiration), normally about four beats per respiration, meaning the pulse beats four times between one inhalation and one exhalation. Physician Dai described it as resembling a silk thread on a loom axle, not tightly wound around the center, with the finger feeling gentle and even. Zhang Taisu described it as willow branches dancing in the early spring breeze; Yang Xuanhe described it as a gentle breeze brushing past willow tips.
Normal Pulse and Stomach Qi
The moderate pulse corresponds to the Kun trigram in the Eight Trigrams, to the four seasons (the seasonal transitions, associated with Earth) in terms of seasons, and to the Spleen in the human body. The Cun position belongs to Yang and the Chi position to Yin; the upper and lower pulses are equally matched, floating and large yet soft, without any excess dominance—this is the normal healthy pulse. If it appears outside its corresponding season, it indicates illness. A pulse that is moderate and even, neither floating nor sinking, neither rapid nor slow, neither weak nor faint, represents the manifestation of Stomach Qi (the gentle, vital qi generated by the spleen and stomach). Du Guangting said: "If you wish to know when death will occur, the ancients deduced five types of Earth; Yang Earth must not encounter Yin, and when Yin Earth meets Yin, examine carefully." See the Yuhan Jing (Jade Letter Classic) for details.
Appearance Verse
The moderate pulse is gentle, four beats per respiration flow freely; Like willow tips swaying lightly in the breeze. To seek the spirit (the fundamental vitality of life) within the pulse, The key lies in calmness and gentleness.
Comparison Verse
See the slow pulse chapter.
Clinical Indications Verse
The moderate pulse indicates deficiency of nutritive qi (refined substances flowing within the vessels) and relative excess of defensive qi (protective qi flowing outside the vessels), or it may relate to wind, dampness, or spleen deficiency. In the upper body it may manifest as stiff neck; in the lower body as atrophy and bi-pain (painful obstruction), distinguished by floating, sinking, large, or small qualities.
Floating moderate indicates wind, sinking moderate indicates dampness, moderate and large indicates wind deficiency, moderate and fine indicates damp bi, moderate and rough indicates weak spleen, moderate and weak indicates qi deficiency. Li Shizhen criticized the Maijue (Pulse Song) for claiming that "moderate pulse indicates spleen heat, halitosis, vomiting, tooth pain, and dream encounters with ghosts," calling such claims fabrications unrelated to the true meaning of the moderate pulse.
The essential meaning of the moderate pulse lies in its "gentleness and composure"—it is a marker of pulse having Stomach Qi. Traditional Chinese medicine holds that the pulse values Stomach Qi; a gentle and even pulse reflects healthy spleen and stomach function with adequate production of qi and blood. When it appears in its corresponding season, the moderate pulse is a healthy pulse; however, when it is mixed with floating, sinking, large, fine, rough, or weak qualities, it transforms into a pathological pulse, indicating different pathogeneses such as wind, dampness, or deficiency. This reflects the thinking of "using the normal to assess the abnormal" and "integrating pulse findings with symptoms."
Four beats per respiration corresponds approximately to 60–70 beats per minute, close to the modern normal resting heart rate. Descriptions of even rhythm and soft tension resemble normal sinus rhythm and good vascular elasticity. Pathological moderate pulses may have some empirical overlap with slower heart rates, reduced metabolism, lower vascular tension, or edema, but the ancients classified pathologies using only a single pulse quality, which has limited sensitivity and specificity and cannot replace modern diagnostic methods. In particular, claims such as "moderate pulse indicates spleen heat and halitosis" were already criticized by Li Shizhen, showing that ancient pulse studies themselves were continuously being corrected.
Nourishing Stomach Qi is the foundation of health. In daily life, one may pay attention to eating in moderation, avoiding extreme hunger or overeating, and reducing intake of raw, cold, and greasy foods; maintaining emotional calm, avoiding prolonged anxiety that harms the spleen; keeping a regular daily routine, and exercising moderately to promote the smooth flow of qi and blood. If one notices abnormal pulse patterns or physical discomfort, one should seek medical attention rather than self-diagnosing based on pulse reading alone.
Pulse Characteristics
The hollow pulse (floating, large, and soft, with emptiness in the middle and fullness at the edges) belongs to Yang within Yin. Its pulse is floating, large, and soft; on pressing, the center is empty while the edges are firm. The Maijing (Pulse Classic) states: "Empty in the middle, firm on the outside, shaped like a scallion." Kou means scallion. The Suwen (Plain Questions) does not record the name of the hollow pulse. Liu Sandian said the hollow pulse closely resembles a scallion—under the finger it forms a hollow cavity, with edges but no center. Dai Tongfu said: Nutritive qi flows within the vessels, and the pulse is formed by blood; a hollow pulse indicates blood loss. The Maijing states: when all three positions (Cun, Guan, Chi) show a hollow pulse, survival is possible in chronic illness, but in sudden acute illness the prognosis is often poor.
Li Shizhen criticized the Maijue for describing the hollow pulse as "having ends but no middle," which erroneously depicts the pulse as broken or severed; it also claims the hollow pulse indicates strangury with dampness and qi entering the small intestine, which is contrary to the pattern of blood loss—misleading people greatly.
Appearance Verse
The hollow pulse floats, large, soft like a scallion, Substantial at the edges while the center is empty. 🔥 Fire pathogen attacking the Yang channels may cause upper bleeding; Heat pathogen invading the Yin collaterals may cause lower bleeding.
Comparison Verse
Empty center with firm edges is the hollow pulse; Floating, large, and slow is the vacuous pulse; Hollow with a wiry quality is called the leather pulse; Hollow indicates blood loss, leather indicates blood deficiency.
Clinical Indications Verse
All of the above are pathogenetic classifications from ancient pulse studies, not modern diagnostic criteria.
The core of the hollow pulse lies in its "empty center with firm edges," caused by blood deficiency and inadequate filling of the vessels. The ancients perceived blood loss through pulse fullness, reflecting the understanding that "the pulse is formed by blood." The hollow pulse is often associated with blood loss and Yin injury; when floating, large, soft, and hollow, it suggests blood deficiency with insufficient充盈. Differentiation from the vacuous pulse and leather pulse reflects the refined classification of blood and qi states in pulse diagnosis.
The "hollow" sensation described by the hollow pulse may be understood as a comprehensive tactile impression involving reduced effective circulating blood volume, inadequate vascular filling, and altered pulse pressure. It is a figurative, experience-based pulse quality, not a standardized physiological parameter. Modern assessment of blood loss and its severity relies on objective examinations including blood pressure, heart rate, complete blood count, and imaging. The ancient statement that "in chronic disease survival is possible, in acute disease death follows" reflects empirical observation of prognosis in acute versus chronic blood loss and cannot be directly applied as a modern judgment of life and death; with timely treatment of acute massive hemorrhage today, the prognosis can be significantly improved.
Pay attention to signs of chronic blood loss in the body, such as prolonged heavy menstruation, blood in stool, recurrent epistaxis, or black stools—do not ignore these because "you're used to them." In daily life, protect Yin blood by avoiding prolonged sleep deprivation, excessive fatigue, and overly drying or heating foods. If symptoms such as dizziness, fatigue, or pallor that may be related to anemia appear, seek medical evaluation first to determine the cause rather than self-prescribing blood tonics based on pulse self-assessment.
Note from Bugua: This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek timely medical attention.