Course: Diagnostics I Date: Aug 16, 2007 Class #: 8. Pulse Diagnosis

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1 Course: Diagnostics I Date: Aug 16, 2007 Class #: 8 Pulse Diagnosis Extremely important in clinic. Gives pt constitution very quickly. In Chinese Cun guan chi is the expression for pulse point loc. Cun Cun = 1 st location closest to wrist. Locate me 2 nd using index finger. After you locate the middle position, the index will fit here naturally. Cun very small length measurement Cun on left = Heart and chest. Cun on right = Lungs (tells the truth re smoking!) Guan guan = 2 nd location locate the styloid process, move a little medially. Locate me first using middle finger. Guan means a very large gate (into a city) Guan on left = liver/gallbladder (can show liver qi stag) Guan on right = spleen/stomach Chi chi = 3 rd location. Locate me 3 rd with the ring finger. Chi means large measurement like length of foot. Chi = kidney or lower abdomen Left = yin Right = yang How do you place fingers? How far apart (loose) your fingers are is dependent on how big the patient is. Use the upper edge tip of the finger not the flat pad. The tip edge is the most sensitive area. 1. Lifting - Just touching. Can find exterior conditions easily 2. Pressing heavily pressing checking root. 3. Searching touch medially (medium pressure) - tells what is the nature of the pulse How long to feel pulse? Page 1 of 5

2 At least 50 beats about a minute. Helps feel for irregularity. Time to take pulse: Best time to feel pulse? Ideal is early morning before patient gets up out of bed. Then look at tongue. Can t do ideal usually, so let pt calm down, sit quietly to let heart normalize and rest. Posture: Sitting or lying. Wrist should be same level as the heart. Rest the wrist relax, put em on a pillow, don t hold wrist out ; want no tension Similar to taking bp. Lean back and relax. Lying, standing, sitting all different bp, same is true for left/right side of body. 9 different kinds of manifestations for the 3 locations 3 locations x 3 types of feeling (lift/press/searching) = 9 What is normal pulse? wei shen gen Wei = stomach, shen = spirit, gen = root. If you can feel this is normal pulse. Normal beats: One breath in/out of patient = 4 beats of heat. How to gauge this? Doc must sync breath with pts breath, then feel the # of beats. Frequency: 4 beats 1 breath in/out of patient. Stomach qi: pulse should be non-superficial, not deep, not fast, not slow. Calm and w/regular rhythm. Spirit: soft, gentle, strengthful (power in it) Root: tells how strong pt is, prognosis. 2 meanings: o Press heavily on 3 rd position, is strong with power. This is good root. Root is good = strong pulse in 3 rd position. o No matter what position, can feel strong pulse when press heavily. Can t find a pulse at all, but pt is obviously alive? Some pt s pulses are on the opposite side dorsal side! Term in Chinese: Fan guan mai. Opposite, gate, pulse. This is not wrong, but congenital. Weird, huh? Still, normal. Can also go obliquely toward the dorsal side! This is called Xie fei mai Xie = oblique fly pulse. Still congenital, normal. How many pulses are there? Most books say 28 (pathological pulses). There are a few more, but they are very unusual. Page 2 of 5

3 6 basic categories of pulses. Different books will give different descriptions. See the Pulse Classification Chart for the best detail here. Superficial Pulses (first category) Fu - Floating or Superficial Pulse usually superficial, external problem usually. Does not indicate prolonged disease. Indicates exterior syndrome is attacking. Ie, common cold, w/c, w/h, w/damp. In special conditions can indicate a deficiency, like false shen, yang is floating upward, feels superficial. Pulse floats on the surface. Just touch the skin to feel it--use Lifting technique. Hong (or hong mai) or Surging/Overflowing/Flooding Broad, large, forceful pulse. Large volume, feels like waves surging. Comes vigorously while going gently, just like big waves on shore. Excess heat. 4 yang greats: pulse, fever, thirst, sweat. Ru Soft/Soggy superficial, thready, w/o strength (or weak). floating/weak/thready Think about a thread under a finger can feel it easily. Very thin pulse. No strength. Deficiency and dampness. Qi deficiency with dampness. Spleen qi deficiency with dampness (gas, bloating might be present). lifting touch. San Scattered pulse. o Descritpion: Superficial, scattered, irregular without root. Page 3 of 5

4 Irregular pulse, hardly perceptible. Crisis condition. Depletion of Yuan qi. light, lifting touch. Press heavily and is indistinct. Kou Hollow superficial, large, empty like on the scallion stalk Pulse that feels floating, large, soft and hollow like green onion stalk. Surface is hard, but press and is hollow loss of blood. Mass blood loss yin deficiency Lightly Ge Leather or tympanic pulse superfricial category. Wiry, fast, empty inside. Like feeling a drum head: hard, but empty on inside. Essence defic Blood defic Deep interior syndrome. Prolonged disease (getting deeper) Fast Indicates heat. Slow Indicates cold. Page 4 of 5

5 Deficiency Indicates deficiency duh! Excess. Indicates excess. Wiry pulse falls under this category. Page 5 of 5