The pulse is an essential diagnostic tool in Chinese medicine for understanding a patient’s health. Unlike Western pulse reading, which focuses on counting the number of beats per minute, Chinese medicine pulse diagnosis evaluates the state of a patient’s internal organs. For example, someone presenting with anxiety will be treated differently depending on whether their pulse is “thin” in the heart position, “weak” in the kidney position, or “wiry” in the liver position. Each pulse quality reflects an imbalance at the organ level reflecting the patient’s disease.
Pulse Diagnosis
Chinese pulse diagnosis developed thousands of years ago as a child of necessity. Ancient practitioners did not have x-ray or MRI machines to pinpoint pain and disease and lacked lab tests to evaluate blood imbalances. Instead, they had to rely on the human body to divulge clues explaining a person’s illness. The pulse does a fantastic job parsing out detailed information about organ function, blood levels, and disease states.
Pulse Quantifies Disease States
Western medicine quantifies diseases. For example, practitioners categorize headaches as migraines, cluster headaches, tension headaches, menstrual migraines, etc. Likewise, acupuncturists classify disorders into pattern imbalances – headache resulting from Liver Qi stagnation, Kidney yin deficiency, Heart and Spleen Blood deficiency, or Liver Yang Rising, to name just a few.
Pulse Influences Treatment Plan
It is vital to ascertain the correct pattern diagnosis, for this drives the creation of a treatment plan. The proper treatment resolves internal organ imbalances, which eases symptoms and pain. The wrong pattern diagnosis will not harm the patient, but it will not help them either. Information derived from the pulse helps determine the correct pattern imbalance – that’s why feeling the pulse, along with examining the tongue, are two of the most important diagnostic tools in an acupuncturist’s arsenal.
Making Sense of Chinese Pulse Diagnosis
Pulse diagnosis may seem to require a sophisticated understanding of Chinese medicine, taking years to recognize the dozens of distinct pulse qualities fully. Yet, the truth is that interpreting the pulse is not so much complex as it is intuitive. Think of an artist who paints a scenic landscape – the process is not complicated but instead built on experience and practice. The artist knows what colors work well together, understands perspective and shadowing, recognizes how the viewer’s eye draws to certain aspects of the canvas.
So too, pulse assessment is nuanced rather than sophisticated, instinctual more than intricate. It took many years before I could decode pulse characteristics to reveal clues on the inner workings of a patient’s health. But now that I can, the pulse adds a rich perspective that enhances my treatments’ quality.
How To Feel The Pulse
Taking the pulse begins with palpating the radial artery of each wrist with three fingertips. Each finger position reflects a different organ in the body. For example, the left wrist represents the heart, liver, and kidney yin, while the right wrist reflects the lungs, spleen, and kidney yang. The kidneys have two positions, reflecting their significance as foundational organs in the body – all life begins and ends with the kidneys. In addition, the spleen refers to the digestive system, including the stomach. In modern Western anatomy, the spleen is an insignificant organ. But Chinese medicine taps the name spleen to represent the process of converting food into energy and blood.
To access proper pulse-taking position, place the pointer, middle, and ring finger over the radial artery of each wrist – the thumb side of the wrist on the inside. The tip of each finger will feel blood traveling through the radial artery. Now, press down one finger at a time to sense the distinct quality of each position.
Questions To Ask About The Pulse
Here are some questions to ask when performing pulse diagnosis. First, which wrist position feels stronger – the one closest to the thumb, furthest away, or in the middle? Even though the fingers are right next to each other, you will feel differences in quality from one position to another. Second, combining the three positions, which pulse is stronger overall – left or right wrist? Third, does the pulse feel broad or thin against your fingertips? Fourth, is the pulse rate fast (more than 90 beats/minute), slow (fewer than 60 beats/minute), or somewhere in the middle? Finally, can you feel the pulse at the surface of the skin, or do you have to press down to palpate it?
The acupuncturist documents all of these qualities when assessing the pulse. It may seem complicated only because it’s a new experience. Remember the first time you tried riding a bicycle or driving a car? Overwhelming, right? But look at you now – you don’t have to think twice about doing either of those “complicated” activities. By the time you’ve felt a few thousand pulses, it’s as easy as driving to work for a seasoned motorist.
Interpreting Pulse Qualities
Here are a few scenarios to help you understand the thought process when performing pulse diagnosis. For example, holding three fingertips to the left wrist, a pulse strong in the second and third positions but weak in the first (closest to the hand), reflects Heart Qi deficiency. That’s because the first position on the left wrist represents the heart, and a weak pulse reflects deficient Qi in that organ.
If the overall pulse quality is thin (feels like a taut thread over your fingertips), the patient most likely had blood deficiency. The pulse of a blood sufficient patient will be full, feeling like a soft rope, not thin like a thread. Alternatively, a strong pulse that feels like a guitar string vibrating against the fingertips indicates the patient’s body is holding stress, either physical or emotional. This pulse is called “wiry” and reflects that the body is literally “holding on” to stress. You can feel the stress in a wiry pulse – it has an uneasy feeling.
More Pulse Qualities
Another significant pulse attribute is depth. There are three levels of the pulse – surface, middle, and deep. A surface pulse, called “floating,” indicates that the patient is currently fighting off a pathogenic attack (virus). The disease may be intense, like the flu or cold, but it is not deep-rooted and will not last a long time. Alternatively, a deep pulse requires the practitioner to push to the bottom level and reflects more chronic, deep-rooted health conditions. Such conditions require longer-term treatment, as they affect the internal organs.
Dozens of Pulses
Traditional Chinese medicine designates 28 to 36 distinct pulse diagnosis qualities depending on the textbook. We have already discussed some of these above, including floating, thin, fast, and slow. A slippery pulse indicates excess phlegm in the body, while a wiry pulse reflects stress lodged in the body. A tight pulse indicates pain, and a thready pulse reflects extreme weakness and deficiency.
Recognizing pulse qualities gives the acupuncturist a powerful tool for identifying an accurate pattern diagnosis and creating an effective treatment plan. For example, a patient presenting with a slippery pulse and thick white tongue coating will typically have Spleen Qi deficiency with dampness and benefit from including acupoints ST36, SP9, and ST40. Furthermore, someone with a wiry pulse will almost always have Liver Qi stagnation and feel transformative stress relief if the acupuncturist uses the acupoint LV3, which circulates Qi to reduce stress.
Pulse Diagnosis Conclusions
To sum up our brief overview of Chinese pulse diagnosis, remember these three facts:
- The pulse measures the state and quality of Qi in the body.
- Acupuncture influences and redirects the Qi to facilitate healing.
- For this reason, the pulse guides the acupuncturist when formulating a correct diagnosis and effective treatment plan.
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Key phrase: Pulse Diagnosis