The Art of Pulse Manifestations: Pulse Diagnosis Wisdom of Classical Chinese Medicine and the Huang’s Medical Circle
Huang Liren, CMASA Victoria Branch
Abstract
As a shining gem in the treasure trove of ethnic medicine, the Huang’s Medical Circle has been passed down for over a thousand years. In recent years, under the inheritance and innovation of two distinguished physicians, Huang Chuanggui and Wang Wencheng, its pulse study has gradually developed a diagnostic system that integrates and correlates with modern medical terminology. Through clinical application of this pulse method, the author deeply comprehends its profound classical Chinese philosophical wisdom and understanding of human life. Particularly in the differentiation of disease mechanisms and treatment based on syndrome differentiation, it provides solid theoretical foundations and practical guidance for clinical practitioners. This paper explores the intrinsic connections between the pulse theories of the Huang’s Medical Circle and classic Chinese medical texts, elaborates on its clinical applications, and proposes diagnostic and therapeutic strategies with real-world case studies. It aims to offer modest insights and references for peers engaged in pulse diagnosis research and clinical practice.
Pulse diagnosis in the Huang’s Medical Circle employs the tips of the index, middle, and ring fingers to palpate the radial artery at the proximal posterior margin of the radial styloid process on both wrists. The three fingers must be aligned and placed flat, with uniform pressure applied to the upper, middle, and lower pulse positions. Combined pulsation points in vertical and horizontal directions form four major pulse groups: horizontal single pulse group, vertical single pulse group, intersecting single pulse group, and meridian pulse group. These four categories are core components of the Huang’s Thousand-Step Pulse system, known as positional pulse groups.
Taking the horizontal single pulse group as an example, the locations and applications of the upper, middle, and lower pulses are explained as follows:
- The horizontal single pulse group formed by pulsation points of the upper pulse corresponds to the heart, lungs, and kidneys, as well as their relationships of coexistence, separation and inhibition, and balance.
- The horizontal single pulse group formed by pulsation points of the middle pulse corresponds to the liver, gallbladder, and spleen, alongside their relationships of coexistence, separation and inhibition, and balance.
- The horizontal single pulse group formed by pulsation points of the lower pulse corresponds to the stomach, intestines, and urinary bladder, with reference to their relationships of coexistence, separation and inhibition, and balance.
Scientific Rationale of Pulse Distribution
Pulses of the lung, gallbladder and intestines lie on the same vertical plane; pulses of the kidney, spleen and bladder share another vertical plane. The lung and large intestine form an exterior-interior relationship, as do the kidney and bladder, enabling convenient cross-reference during pulse diagnosis. Similarly, pulses of the heart, liver and stomach align vertically, reflecting two generating cycles in traditional Chinese medicine: Wood generates Fire, and Fire generates Earth. Clinically, liver deficiency often accompanies heart deficiency, termed dual deficiency of the heart and liver. Heart fire should descend to warm the stomach earth and digest food and water. Insufficient heart fire causes stomach cold, presenting with epigastric pain, poor appetite, indigestion, and clear salivation. Exuberant heart fire scorches stomach earth and consumes body fluids, leading to dry mouth, excessive thirst, polyphagia with rapid hunger, oral ulcers, and constipation.
Additionally, “disharmony of the stomach leads to restless sleep” (Suwen · Nitiaolun). Improper diet disrupts stomach qi, disturbs the heart’s spirit, and results in insomnia and restless nocturnal sleep. Exuberant fire in the heart and stomach is treated with Daocheng San or Qingwei San. For dual deficiency of the heart and spleen (stomach qi deficiency) caused by overthinking, Guipi Decoction is prescribed to harmonize both organs.
In clinical practice, patients with dual deficiency of the heart and liver often suffer from depression, marked by obvious depressions in the heart and liver pulse regions in Huang’s pulse diagnosis.
Clinical Case 1: Senile Insomnia, Somniloquy and Sleepwalking
An elderly female patient aged over 70 of Vietnamese descent was brought for consultation by her daughter.
Huang’s Pulse Diagnosis: Depressed and deficient lung and gallbladder pulses; deficient heart and liver pulses.
Medical inquiry revealed extremely shallow sleep, frequent nightmares, self-talk, shouting, limb restlessness, recurrent sleepwalking and accidental falls. The patient exhibited a sharp emotional pulse fluctuation. Further inquiry confirmed severe grief from family misfortune years prior, followed by chronic insomnia with only 3–4 hours of nightly sleep, progressing to somniloquy and sleepwalking over seven to eight years. Multiple specialist consultations yielded no improvement, causing severe distress for her devoted daughter who shared a bedroom for care.
The patient appeared dull, listless, non-verbal, and avoided eye contact throughout the consultation, with all communication mediated by her daughter.
Disease Mechanism Analysis:
“Why do people suffer from restless sleep? … Damage to the zang-organs and unsettled essence disrupt tranquility, leaving the body unable to relieve illness.” (Suwen · Binneng Lun, Chapter 46).
Prolonged grief injured the lung, which governs the corporeal soul (po) responsible for sleep in ancient medical texts. The heart houses the spiritual soul (shen), which was severely depleted in this patient. The loss of shen and po fully explained her clinical symptoms.
Treatment Principles: Tonify Earth to generate Metal (lung); nourish Wood to promote Fire.
Medication: Bright Life Liver-Tonifying Formula (daytime); Gan Mai Da Zao Pills combined with pearl powder (nighttime).
Treatment Timeline:
- First consultation: 26 February 2025
- Second consultation: 12 March 2025
- Third consultation: 19 March 2025
After three sessions, the patient began responding verbally and addressing the practitioner. Her daughter reported cessation of midnight mumbling and drastic reduction in sleepwalking. Subsequent acupuncture sessions resolved sleepwalking entirely, with strengthened lung and heart pulses. Treatment was then adjusted to address chronic dizziness.
Essence of Orthopedic Pulse Diagnosis
Cervical (Cx), thoracic (Tx), and lumbar (Lx) spinal conditions manifest distinctly within the pulse pathways of the Huang’s Medical Circle.
“East wind arises in spring, manifesting in the liver with associated disorders of the neck; south wind arises in summer, manifesting in the heart with chest and hypochondrial disorders; west wind arises in autumn, manifesting in the lung with shoulder and back disorders; north wind arises in winter, manifesting in the kidney with lumbocrural disorders; central earth corresponds to the spleen, with spinal disorders.” (Suwen · Jinkui Zhenyan Lun).
By reverse deduction, pain in muscles and joints at fixed locations can be attributed to corresponding zang-fu organs. In the Huang’s pulse system: cervical and dorsal pulses overlap with heart and liver pulses; shoulder and elbow pulses overlap with lung and gallbladder pulses; hip and knee pulses overlap with kidney and spleen pulses.
Clinical Case 2: Cervical Spondylosis
Ms. Sarah presented without appointment, complaining of neck stiffness, headache and associated discomforts. Cervical flexion and rotation tests returned positive with severely limited range of motion, indicating cervical facet joint degeneration. Pulse examination identified distinct cervical pulsation points. Precise needling with quick insertion and removal achieved immediate relief within seconds, restoring neck mobility. The patient formally booked follow-up treatment for 13 August 2025. Instant clinical efficacy builds rapid patient confidence in acupuncture and strengthens doctor–patient trust. Symptom relief requires subsequent comprehensive four-examination assessment to address underlying pathologies such as disorders of the eight extraordinary meridians, enabling systematic targeted therapy, activating self-healing capabilities, and eliminating root causes.
For chronic lumbago unresponsive to conventional back-shu points, Weizhong, Kunlun, Huantiao and Baliao points, Huang’s orthopedic pulse diagnosis guides Governor Vessel acupuncture for remarkable curative effects.
Diagnosis via Pulse Contour: Depression, Ridges and Texture
1. Spleen Pulse Diagnosis for Hyperglycemia
Excessive turbid or bulging spleen pulses in Huang’s pulse diagnosis indicate elevated blood glucose or diabetes. Combined with acupuncture and herbal medicine, therapeutic intervention emphasizes dietary modification: reduced rich and fatty foods, regular slow-paced meals, and limited carbohydrate intake after sunset.
Classical Foundations:
- Suwen · Jingmai Bielun: “Food enters the stomach, diffusing refined essence upward to the spleen. The spleen transports nutrients to the lung, regulates water metabolism, and distributes refined substances throughout the body.” This describes normal glucose and nutrient metabolism.
- Huangdi Neijing · Suwen · Qi Bing Lun: “A sweet taste in the mouth arises from excessive five flavours, termed spleen damp-heat (pi dan). Rich and sweet diets cause internal accumulation and obesity.”
- Lingshu · Benzang: A fragile spleen predisposes patients to wasting-thirst disorders (Xiao Ke, diabetes).
Classical texts collectively validate the core relationship between the spleen and diabetes. TCM diabetes treatment prioritizes spleen tonification and turbid-damp elimination using ginseng, astragalus, atractylodes, pueraria and Chinese yam, rather than mere heat-clearing and yin-nourishing methods.
Clinical Case: Prediabetes
A 30-year-old female patient with two children and a history of gestational diabetes presented on 8 February 2025. She reported generalized pruritus, worsening at night, after consuming sweets such as cake and chocolate. Pulse diagnosis revealed excessive and slippery spleen pulses, confirming hyperglycemia. Associated symptoms included irregular defecation, difficult bowel movements, and postprandial distension, presenting a typical pattern of excessive spleen and deficient stomach qi with damp-heat stagnation. Treatment combined spleen-draining and stomach-tonifying acupuncture with modified Banxia Xiexin Decoction and Shenling Baizhu Powder. Complete symptom resolution was achieved within two weeks.
2. Pulse Diagnosis and Treatment for Hypertension
Elevated pulse prominence and intensified pulsation intensity at the kidney and spleen pulse positions indicate hypertension. TCM attributes hypertensive vertigo to water failing to nourish wood and the classical tenet: “All wind-trembling and dizzy disorders pertain to the liver” (Suwen · Zhizhen Dalun). Kidney yin deficiency causes hyperactive liver yang.
Jingyue Quanshu · Vertigo (Ming Dynasty): “Over 80% of vertigo cases stem from deficiency, with only a minority complicated by fire or phlegm. No vertigo arises without deficiency.” This theory underpins modern clinical strategies: kidney yin nourishment with Liuwei Dihuang Pills and Zhibai Dihuang Pills, combined with liver-yang pacifying formulas such as Tianma Gouteng Yin.
Clinical Case: Chronic Hypertension
Ms. Alice, born 1989, suffered from hypertension for 1–2 months. Prior TCM treatment stabilized morning blood pressure at 123/83 mmHg, yet evening readings remained elevated at 140–160/86–99 mmHg, accompanied by dizziness and distending headache.
- First consultation (23 May 2025): Deficient and depressed liver pulse; taut and excessive cun pulse; floating and rapid kidney yin pulse; bright red tongue with no coating. Associated symptoms: irritability, cold limbs, frequent vivid dreams.
- Pattern: Yin deficiency with yang hyperactivity.
- Treatment: Liver and kidney yin-tonifying acupuncture; Tianma Gouteng Yin combined with Wendan Decoction.
- 9 June follow-up: Acupuncture at Zhigou, Daling, Zhaohai, Xingjian, Neiting and Sanyinjiao. Post-treatment blood pressure: 124/96 mmHg. Prescribed modified Tianma Gouteng Yin, Ziyin Ganlu Yin and Zuogui Wan.
Continued biweekly treatment through July and August achieved stable blood pressure of 130/70 mmHg day and night with complete resolution of headache and vertigo by early September.
Positional Pulse Diagnosis: Left, Right, Upper and Lower
The Huang’s Medical Circle incorporates specialized pulses for the eyes, tongue, nose and mouth. Oral pulse assessment evaluates dental health with precise lateral and vertical localization, consistently surprising patients with diagnostic accuracy. Gynecological pulse diagnosis enables unilateral localization of fallopian tube obstruction for targeted acupuncture and herbal therapy, achieving successful pregnancy outcomes.
Clinical Case: Mastitis and Breast Nodule Localization
A previously infertile patient treated for successful conception developed severe mastitis postpartum. Left cervical and thoracic pulse group examination localized tenderness to the right lateral one-third of the right breast. Acupuncture at corresponding reactive points on the right upper limb rapidly alleviated pain. Full recovery was achieved with two additional treatment sessions and modified Xiaoyao Pills.
Lingshu · Xieke Pian: “Pathogenic qi in the lung and heart accumulates in the axilla; liver pathogens settle in the elbows; spleen pathogens localize to the hip joints; kidney pathogens affect the popliteal fossa.” In Huang’s pulse diagnosis: axillary lymphatic disorders correspond to heart pulses in the horizontal single pulse group; elbow conditions (tennis elbow, golfer’s elbow) manifest at the gallbladder pulse position; hip disorders correlate with spleen pulses; and knee pathologies present at kidney pulse positions. This systematic correspondence reflects the profound diagnostic wisdom of traditional physicians.
Clinical Case: Knee Joint Effusion
An elderly female patient born 1947 presented with right popliteal effusion lasting over three months. Hospital fluid aspiration resulted in immediate recurrence with severe mobility impairment. Referred by her daughter, a staff member at Austin Hospital, she commenced treatment on 1 September 2025. Pulse diagnosis revealed dual deficiency of kidney yin and yang, accompanied by unilateral hearing loss and intermittent toe numbness. Decades of skipped breakfast and advanced age had severely depleted kidney and stomach qi. Guided by Lingshu classical theories, treatment prioritized kidney, spleen and stomach tonification. Herbal prescriptions included Baji Yinyang Pills and Duhu Jisheng Pills. Post-treatment patellar mobilization eliminated tenderness instantly. Follow-up sessions significantly improved mobility, reduced numbness, and restored functional stair climbing ability. Her general practitioner expressed surprise at her recovery and requested practitioner contact information. Long-term maintenance treatment is ongoing, with the patient actively inquiring about preventive care intervals. This case further validates the profound clinical value of ancient pulse study and the Huang’s Medical Circle system.
Gynecological Pulse Diagnosis for Assisted Conception
Ovarian and uterine pulse assessment in the Huang’s system, combined with menstrual cycle analysis, evaluates hormonal balance and ovulation quality to guide fertility treatment.
Clinical Case: Successful Assisted Conception
Ms. Chen, a post-90s patient, received several months of constitutional regulation. On 23 August 2025, ovarian pulse examination indicated heightened activity following acupuncture. Confirming imminent ovulation within 2–3 days, she was prescribed Zishen Yutai Pills. Her husband attended consultation on 25 August for kidney-yang tonification and essence-replenishing herbal therapy with Yangzhuang Yijing Pills. Lifestyle guidance included early rest, nutrient-rich bone broths supplemented with angelica, codonopsis, wolfberry, jujube and fresh ginger, and pre-intimacy herbal dosage. Positive pregnancy confirmation was communicated by the patient on 5 September 2025.
Ear Pulse Diagnosis for Tinnitus
Kidney pulse positions correspond to auditory disorders, validating the classic tenet: “The kidney opens into the ears.”
Suwen · Jinkui Zhenyan Lun also states: “Red southern qi connects with the heart, opening into the ears and storing essence within the heart.” Later physicians summarized: “The kidney governs internal yin; the heart regulates external yang… refined clear qi ascends to the sensory orifices, enabling acute auditory function.” This dual heart–kidney etiology underpins tinnitus treatment.
Clinical Case: Chronic Bilateral Tinnitus
Ms. Cecilia, 25, presented with six months of persistent tinnitus with no structural abnormalities detected via Western medical imaging. Initial consultation on 22 July 2025 revealed deficient heart and kidney pulses alongside liver imbalance, kidney yin insufficiency and weakened heart yang. Chronic skipped breakfast since adolescence had depleted stomach and kidney qi.
Lingshu · Kouwen, Chapter 28: “The ears converge ancestral meridians; stomach emptiness weakens ancestral qi, causing downward qi depletion and tinnitus.”
Treatment included mandatory nutrient-dense breakfast, acupuncture to tonify liver yin, kidney yin and heart yang, and targeted point needling at Zhongzhu and Tinggong, combined with continuous Zuogui Wan supplementation. By the third week, kidney pulses normalized with abated fatigue and resolution of high-pitched tinnitus. Subsequent follow-up confirmed complete right-ear recovery with diminished left-ear symptoms. Maintenance biweekly treatment and ongoing herbal therapy continue at the time of writing.
Conclusion
In summary, the pulse study of the Huang’s Medical Circle represents an invaluable treasure of traditional Chinese medicine. Its systematic pulse distribution and pathological correlations align comprehensively with classical TCM theories, offering irreplaceable clinical advantages. Pulse positions frequently serve as critical therapeutic breakthrough points, making post-treatment pulse reassessment standard clinical practice to evaluate efficacy and refine prognosis.
Accessible for early learners, this specialized pulse system enables physicians to enhance diagnostic precision and therapeutic efficacy through diligent practice, critical thinking and flexible adaptation. It delivers remarkable clinical outcomes, showcases the profound wonders of classical Chinese medicine, and strengthens the foundation for TCM development and recognition in overseas communities.
References
- World Federation of Huang’s Medical Circle Professional Associations. Overview of Thousand-Step Pulse. 2023. https://www.huangmedicine.com/2
- Suwen · Nitiaolun
- Suwen · Jinkui Zhenyan Lun
- Suwen · Binneng Lun (Chapter 46)
- Suwen · Qi Bing Lun
- Lingshu · Kouwen (Chapter 28)
- Lingshu · Benzang
- Lingshu · Xieke Pian
- Wang Wencheng (Ed.). Lectures on Advanced Primary Training of Huang’s Thousand-Step Pulse. 2023.
- Pei Jingchun, Wang Ying (Eds.). Internal Medicine of TCM Acupuncture. Shenyang Press, 2001.
- Wang Yongyan (Ed.). Internal Medicine of Traditional Chinese Medicine. Shanghai Science and Technology Press, 1998.
- Zhang Jianhua (Ed.). Illustrated Acupuncture for Common Diseases. Jiangxi Science and Technology Press, 2006.
- Feng Xinghua, Gao Ronglin (Eds.). Clinical Handbook of TCM Internal Medicine. People’s Medical Publishing House, 1996.
