Classic Pulse Diagnosis.doc

8/15/2019 Classic Pulse Diagnosis.doc

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Classic Pulse Diagnosis – Winter 2009

Will Morris and Yuxia Qiu - instructorswww.CatsTCMNotes.co

Page ! o" 2!

Course# Classic Pulse Diagnostics Date# Marc$ 2!-22% 2009

Classic Pulse Diagnosis

T$ere&s a lot o" stu"" written a'out (ulses% (ro'a'l) all o" it 'etter t$an * a (utting it toget$er% 'ut w$at

*& o""ering )ou $ere is Will Morris& et$od o" s)steaticall) ta+ing (ulses% a+ing sense o" w$at )ou"ind%

T$is aterial coes "ro $is Classic Pulse Diagnostics wee+end seinar% o""ered at t$e ,cade) o"

riental Medicine in Marc$ o" 2009.

a(() reading. /eel "ree to distri'ute t$is docuent as )ou see "it% as long as you do it for free!! *" * "ind

)ou&re a+ing one) o"" o" t$is *& going to 'e co(iousl) and legall) (issed.

The Ground Level

sing t$e (ulse to inter(ret t$e $ealt$ o" a client is a 1er) old art "or and ta+es )ears to aster. T$iswill gi1e )ou t$e 'asics "oundation to wor+ wit$% starting )ou on t$e (at$ to 'ecoing con1ersant in

(ulses. To reall) get great )ou $a1e to wor+ at it% ta+e a lot o" (ulses% and ost i(ortantl) o" all% learn

to trust )our own instincts a'out w$at )ou "eel.

ee'er t$at two (eo(le "eeling t$e sae (ulse a) $a1e di""erent descri(tions o" t$at (ulse. ne

(erson a) sa) it&s wir) and t$e next sa)s it&s sli((er). Can t$e) 'ot$ 'e rig$t3 Quite (ossi'l) so. T$isis a 1er) su'4ecti1e ex(erience5 ,s )ou&re learning to ta+e (ulses )ou&ll a+e )our li"e a lot si(ler and

will "eel less insecure a'out w$at )ou "eel i" )ou 4ust acce(t t$is as a "act#

Different people will get different findings from the same pulse.

ee'er too t$at t$e (ulse is an excellent wa) to "ind out w$at&s $a((ening in t$e 'od). You can use

w$at )ou "eel and )our anal)sis o" t$at to dri1e )our in6uir) 7t$e 6uestions )ou as+ )our (atient8 and

a) 1er) well get uc$ ore in"oration t$an )ou would 4ust ') sitting and as+ing t$e diagnostic6uestions we learn in Diagnosis ! and 2. ut t$e (ulse isn&t t$e only wa) to get in"oration% nor is it

)our onl) diagnostic tool. Co'ine t$e (ulse "indings wit$ 6uestions:answers "ro t$e (atient

inter1iew% tongue diagnosis% (oints t$at are tender on t$e 'od)% etc. in order to "or )our (atterndi""erentiations and treatent (lans.

The Uber BasicsPulses are ; diensional. T$e) are also reall) si(le at t$eir 'asic le1els. Pulses consist o"#

☯ Tu'es# t$e 1essels☯ Pu(# t$e $eart

☯ /luid# t$e 'lood

☯


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=ee( t$e ec$anical (arts in1ol1ed $ere in ind.

Ideal and Pathological Pulses

Ideal Pulses

You can&t understand w$at (ulse (at$ologies are unless )ou $a1e a 1ision o" w$at a $ealt$) or ideal

(ulse loo+s li+e. ,n ideal (ulse#

☯ as root

W$at t$e $ec+ does t$at ean3 T$e ter >root& consists

o" two di""erent 1ectors:eanings#

o oot can re"er to t$e chi (osition% t$e ;rd

(osition (roxial to t$e "irst (osition at t$e wrist. , (ulse

s$ould 'e strong $ere as t$is is t$e (osition o" t$e

=idne) "ro w$ic$ our energ) and original Qi

"lows5

o oot can also re"er to t$e dee(est le1el o" t$e (ulse

w$en )ou (ress 1erticall) "ro t$e s+in. You (ress

down so t$at t$e 1essel is s6uis$ed not 6uite "lat% 'ut de"initel) s6uis$ed. 7=ind o" li+e ste((ing on a

garden $ose 'ut not until it&s totall) closed o"".8 *")ou (ress down to t$is le1el and )ou still "eel t$e

(ulse% t$en it&s said to $a1e ?root.@

☯ as Atoac$ QiT$is is as su'4ecti1e as it gets5 T$is is sort o" t$e


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)ou get t$e curl o" t$e wa1e and t$en t$e 6uic+ colla(se o" t$e energ).

• *n autun% t$e (ulse will "eel oderate again% or (er$a(s a little c$o(().

• *n winter t$e (ulse is going inward and t$us is slig$tl) dee(er. ,s t$e da)s gets$orter and t$e energ) o" (lants goes inward% so does our energ).

o Matc$es in (osition and is e1enl) distri'uted t$roug$-out t$e (ositions.

Pathological PulsesPulse $as ; 'asic as(ects to it#

☯ /or – t$e s(atial co(onent o" t$e (ulse. T$is is also called t$e s$a(e.☯ Tie – ra(id% slow% urgent% arr$)t$ic% etc.

☯ Trait – "orce"ulness% so"tness% $ardness% etc.

Pulses are a $idden world e1en t$oug$ t$e) are a ; diensional s$a(e– we can&t see t$e so we $a1e toex(lore t$e wit$ our "ingerti(s. ere are t$e (ulses )ou are li+el) to "ind.

Moderate (ulse

We discussed t$is in t$e ideal (ulse. Moderate (ulses are 4ust t$at – oderate.

/loating (ulse/loating (ulses are "elt su(er"iciall) wit$ t$e

"ingers resting on t$e s+in or a)'e (ressing

just a little.

*n a (er"ect world t$e root o" t$e (ulse is still

(resent. ,n un$ealt$) (erson $owe1er a)

not $a1e a root. T$is is an ?e(t)@ (ulse. Youig$t also re"er to it as ?"loating wit$out

root.@ T$is is ost o"ten due to Qi xu 7or soeties to Yin xu8. T$e gra($ic is a "loating (ulse wit$out root in t$e iddle (osition.

Dee( (ulse

Dee( (ulses can 'e "ound ') (ressing to t$e ?organ de(t$@ or at least wa) in. T$egra($ic 'elow s$ows )ou a (ulse t$at is dee( in t$e iddle.


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Hong (ulse

You can "eel t$is (ulse on all ; "ingers and it sees li+e it extends (ast )ou "ingers. To"eel "or t$is% o1e )our ring "inger (roxial u( t$e 1essel and see i" )ou can still "eel it.

*" so% t$is is a long (ulse.

A$ort (ulse

You cannot "eel t$is (ulse in all ; (ositions. Don&t con"use t$is wit$ a (ulse t$at is dee(

in one (osition. Des(ite t$e drawings 'elow )ou won&t "eel it at t$e dee(est le1el.

W$) would one $a1e t$is3 ,natoical 1ariation% traua% organ de"icienc)% ganglion

c)sts and ot$er t$ings altering t$e structure o" t$e 1essel% and stagnation. T$ere isstagnation soew$ere in t$e 'od) w$ic$ is not letting t$e Qi t$roug$ to anot$er organ.

lood "low is i(eded and stagnant 6i is "ailing to o1e t$e 'lood so t$at t$e (ulse

(ositions are not "illed. Deficiency or stagnation are the primary reasons.

Aurging (ulseT$is is a (ulse t$at arri1es wit$ "orce and de(arts

wit$out "orce li+e an ocean wa1e $itting t$e s$ore.

1erall it is 'road% large and "orce"ul li+e a wa1e.T$e (ulse is 'road% large% "orce"ul% coes on

(ower"ull)% 'ut "ades awa) 'ecause t$ere&s notenoug$ Qi to sustain t$e wa1e. -7


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Ali((er) (ulse

To "eel a sli((er) (ulse )ou $a1e to (ress (ast t$e 1essel wall le1el and into t$e 'loodstrea. You won&t "eel it i" )ou are (ressing too su(er"iciall). 7You will li+el) descri'e it

as ?wir)@ i" )ou don&t (ress dee(l) enoug$.8

easons "or sli((er) (ulse# tur'ulence o" t$e 'lood inside t$e 1essel. T$is can 'e caused ') da(ness% ($leg% (regnanc)% "ood stagnation% tuors% etc% all o" w$ic$ s(ace

consuing e1ents w$ic$ (ress on t$e 1ascular s)ste and cause t$is tur'ulence. Gle1ated

sugars% and li(ids and ot$er cra(ola "loating in t$e 'lood strea suc$ as cast o""s "roin"ections t$at $a1e 'een +illed o"" ') acro($ages can also cause sli((er) (ulse.

ere is soe tur'ulence caused ') (artial occlusion o" t$e 1essel wall. Pa) no attention

to t$e "orula stu""# t$is is 4ust an illustrati1e gra($ic5

*" )ou $old )our "ingers "lat and run one "ingerti( across t$e li+e )ou&re struing aguitar )ou get an idea o" w$at sli((er) "eels li+e. 7Aoe (eo(le sa) t$at sli((er) sees to

"low sidewa)s w$ile wir) "eels ore 1ertical.8 T$is (ulse slides 6uic+l) and soot$l)

under )our "ingers.

C$o(() (ulse

*t&s roug$ rat$er t$an soot$. T$e "or is irregular as are t$e r$)t$% "orce 7strengt$8and s$a(e 7$ow it sees to "eel in "or under )our "ingers8. T$e s$a(e o" t$e 'lood

1essel a) 'e roug$ or t$e 'lood "lowing t$roug$ it a) "eel roug$. T$e a(litude

71olue o" 'lood in t$e 1essel8 o" t$e wa1e can c$ange due to t$e une1en "orce o" t$is

(ulse. T$e une1enness o" t$e (ulse relates to tie% "or% and (rocess – all o" t$esec$ange. G1en t$e s$a(e o" t$e wa1e "eels roug$.


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T$is is a co(lex (ulse ade ore co(lex ') (oor translations o1er t$e )ears "ro

classical C$inese to odern% "ro odern C$inese to Gnglis$. ne text suggests t$at i")ou are trul) seeing a c$o(():roug$ (ulse t$ere s$ould also 'e roug$ s+in 'etween H 9

and H I.

, (ulse ig$t 'e c$o(() due to ($leg retention and 6i% 'lood or "ood stagnation. T$eseaccuulations i(ede t$e soot$ circulation o" 'lood in t$e 1essels. *" t$is (ulse is

"orceless it suggests de(letion o" 'lood% loss o" essence due to lost 'lood% lost

constitutional strengt$% iscarriage or e1en excessi1e loss o" seen.

Wir) (ulse

Hong% tense% sta'le% "elt wit$ 1ar)ing le1el o" (ressure. Passes straig$t under "ingers andcan 'e $ig$lig$ted ') rolling )our "ingers along t$e sur"ace o" t$e 1essel – "eels li+e )our

"ingers are on a 'owstring 7guitar% 1iolin% etc.8. You can di1ide t$is into excess% de"icient%

and oderate w$ic$ 1aries in t$ic+ness. Gxcess is t$ic+er% de"icient is t$inB'ut all are

wir) in t$is scenario.

W$) (ulses ig$t 'e wir)#

☯ Qi stagnation and stress.Wir) (ulses a) a((ear as a result o" 6i stagnation:stress. T$is is a

neuro1ascular co(lex# stress signals t$e ner1es to 'e on $ig$ alerts w$ic$ in

turn (uts 'lood 1essels on orange alert too. T$is results in a wir) (ulse.

Atagnation o" Qi in an) organ% not 4ust t$e Hi1er% can result in a wir) (ulse as

well% t$oug$ i" t$ere is stress t$e Hi1er ixes in and starts tal+ing a'out it too.

☯ ardness o" t$e 1essels.Deterine i" t$e 1essel wall is su((le and so"t or tig$t and $ard. *t a) 'e

tig$t and $ard due to stress or due to a lac+ o" 1ascular $ealt$ or it a) get

tense in t$e (resence o" cold. ,nd ') t$e wa)% don&t con"use $ardness wit$t$ic+ness – $ardness is 4ust t$at# $ard.

Wir) (ulses can 'e excess% de"icient or oderate. *n t$e (rogression t$ere&s (lain old Qi)u – 1ascular tension. Qi )u can create $eat a+ing it ore urgent and tense and "orce"ul.

W$en )ou $a1e a Qi )u in a de"icient s)ste )ou won&t "eel so uc$ excess $ere. You

can e1en $a1e a t$read) wir).

urried (ulse

T$is is an arrhythmic (ulse. *t is rapid and irregularl) irregular. *t&s agitated and urgent%

o"ten descri'ed as a an running and stu'ling. T$is can 'e an une1en "iring o" t$e ,J

node in t$e $eart. T$e ore "re6uent a issed 'eat is t$e worse it is and is li+el) to 'ecardio(at$olog).

Dr. Morris suggests )ou use ore 'ioedical ters "or arr$)t$ic (ulses– $is notes sa)

regular:irregular or irregular:irregular and notes t$e count w$ere t$e 'eats are issed or


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t$at it can&t 'e counted. W$)3 ecause )ou usuall) need to re"er t$ese "ol+s to a edical

doctor5 T$is is 'etter "or re"errals and cardiologists are ore li+el) to ta+e )ou seriousl).

=notted (ulse

=notted is slow and irregularl) irregular. ,"ter issing a 'eat t$e (ulse continues

iediatel).

Alow indicates a cold (attern and circulation could 'e 'loc+ed ') ($leg% cold% tuors or

an) nu'er o" (at$ogens. *t can occur in de"iciencies w$en Qi and lood are insu""icientto "ill t$e c$annels so t$at (at$ogens "ill in t$e ga( and cause t$e arr$)t$ia.

*nterittent (ulse

T$is is a (ulse t$at isses a 'eat at regular inter1als. ,s (re1iousl) discussed% t$e ore

"re6uent t$e iss% t$e ore serious t$e case. *" it&s reall) "re6uent li+e a iss e1er) E

'eats t$is is re"era'le5 ,not$er 'li( a'out irregular (ulses# soeties t$e 'eat isn&tissed% 'ut t$e intensit) o" t$e 'eats c$anges – (ress dee(er to see i" t$e 'eat is still

issed.

*" t$e a(litude coes and goes it eans t$at t$e itoc$ondria aren&t reco1ering 6uic+l)

in t$e s)ste and t$at t$e s)ste is t$ere"ore soew$at "atigued. T$is is a $eart Qi

de"icienc). suall) onl) see t$is in elderl) "ol+s. Can also 'e 'lood stasis an)w$ere int$e 'od) – t$is is t$e $eart (u(ing against a stagnation 7scar tissues% etc.8 and "atiguing

t$e $eart.

Aogg) Pulse

/loating% t$read)% and so"t. T$ere&s no "orce and it gi1es wa) under (ressure.

*ndications#☯ Progressed states o" disease wit$ xu o" Qi% Yin and lood% all o" w$ic$ allow

t$e Yang to "loat. *" t$e (ulse disa((ears w$en )ou (ress t$e )ang is ex(iring.☯ You ig$t also see a sogg) (ulse wit$ da(ness w$ic$ is de(ressing t$e

1essels

ollow Pulse

/eels wide 'ut distinct w$en )ou "eel it side to side and touc$ lig$tl). *t also "eels 1er)

so"t to t$e touc$. *" )ou (ress down% it sees to go awa) entirel). T$is is trul) 1acuous.

*t&s +ind o" li+e a 7so"t8 soda straw or i" )ou want to 'e traditional a'out it t$en it "eelsli+e a green onion – )ou can "eel t$e 1essel% 'ut it "eels totall) e(t) inside.

Peo(le at ei4ing ni1ersit) sa) it&s "elt wit$ $eorr$agic conditions. T$is is (rett)se1ere 'lood loss% a)'e internal 'leeding. T$is can also indicate a loss o" essence.

Heat$er Pulse

*t&s wide across and t$e 1essel wall is t$ic+. ut it&s su(er"icial and wit$out root7$ollow8. You "ind t$is ost in old en. *" )ou "ind it in an age ina((ro(riate (lace li+e


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in a )oung (erson can indicate cocaine use% ulti(le (ersonalit) disorders% ritual a'use

and ore. Hoo+ at t$e 1essel wall drawing 'elow.

Acattered Pulse

Harge% "loating% and wea+. T$e wall o" t$e 1essel is 1er) t$in and sees to s(read li+e

(owder in t$e wind w$en )ou (ress into it. T$is (ulse lac+s "orce and t$e "or is unclear.G1en t$e 'oundar) 'etween t$e wall o" t$e 1essel and t$e surrounding ground su'stance

is indistinct and it&s $ard to "eel t$e di""erence 'etween t$e.

T$e rate is di""icult to count and t$e scattered 6ualit) is "elt t$roug$out all (ulse

(ositions.

Hoo+ at t$e gra($ic 'elow to see t$e re(resentation o" t$e t$in wall co(ared to t$e

noral one.

o() Pulse

=% t$is isn&t a traditional classic (ulse (er se. ut $ere )ou go an)$ow. /eel t$is 6ualit)o" (ulse ') sliding )our "ingers "ro side to side radiall) and ulnarl) 7as o((osed to

(roxial:distal8. You will 'e a'le to "eel t$e s$a(e o" t$e 1essel and it will (ro'a'l) "eel

large "ro side to side.

Jessel walls can 'e t$ic+ 7see t$e gra($ic a'o1e8 due to $ig$ at$letic training or due to a

(at$olog) in t$e 1ascular s)ste suc$ as $ardening o" t$e arteries. /eel "or t$e $ardnessor su((leness o" t$e 1essel.

☯ *" due to at$letic training t$e 1essel will "eel su((le and ro() w$ic$ is 'etter

t$an $ard. You will (ro'a'l) see 'ig 1eins t$at stand out on t$e 'ac+ o" t$e

at$lete&s $ands and lower ars. Au((le 1essels nonet$eless indicate t$at t$e

1ascular s)ste is o1erwor+ed due to $ea1) dut) exercise "or a long tie.

*" )ou see t$is ro(iness in a +id or teen w$o is 1er) at$letic t$is can 'e 'ad.1erwor+ at t$is age is not good "or t$e 'od)5 T$is indicates t$at t$e 'lood

isn&t in su""icient contact wit$ t$e 1essels so )ou need $er'al treatents to


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'ring t$e 'lood 'ac+ into contact wit$ t$e 1essels.

☯ *" t$is ro() 6ualit) is due to 1ascular (at$olog) t$e 1essel will "eel $ard to t$e

touc$. T$is is decidedl) (at$ological and indicates at$erosclerosis.

o() ig$t also 'e called wir)% 'ut it&s not t$e sae.

idden PulseT$is is a (ulse t$at can&t 'e "elt wit$ noral (al(ation li+e touc$ing% see+ing% (ressing.

You can onl) "ind t$is ') (ressing to t$e 'one. *t ig$t 'e $iding under t$e tendon. T$isis caused ') (at$ogens o'structing t$e interior. suall) a (rett) se1ere (at$olog) li+e a

tuor "oration.

/ir Pulse

T$is is dee( down% 'owstring "eeling% "orce"ul. T$is is not a Qi de(letion% 'ut a (at$olog)

latent in t$e interior. T$is (ulse is sta'le and lac+s noral 1aria'ilit). *t&s got tension%

de(t$ and "orce"ulness.

T$e cardio s)ste reall) should $a1e 1ariations 'ecause it is a relati1el) c$aotic (rocess.. . Hac+ o" noral $eart rate 1aria'ilit) is a (redictor o" cardiac (at$olog):ortalit). *"1aria'ilit) is too extree or totall) wit$out 1aria'ilit) t$at&s 'ad.

Wea+ (ulseYielding% dee(% t$in. You can onl) "eel t$is at t$e dee( le1el ') (ressing. Too uc$

strengt$ o" (al(ation and t$e (ulse 'ecoes 1ague.

Minute PulseT$is denotes a 1essel t$at is t$in and so"t to t$e (oint o" a'sence.

T$is (ulse occurs w$en t$ere is insu""icient 'lood to "ill t$e 1essel. *" )ou cannot "eel t$iswit$ a lig$t touc$ it indicates a decline o" Yang. *" it loses root it re(resents ex$austion o"

Qi or Yin.

Tig$t Pulse

T$is (ulse is tense% "orce"ul% ?twisted li+e a ro(e@ and o1es side to side.

T$e tension and "orce indicate an excess% o"ten (ain.

*" t$e 1essel "eels twisted li+e a ro(e t$is can indicate at$erosclerosis.

*" t$e (ulse doesn&t $it )our "ingers in t$e sae (lace or "eels li+e it is dancing "ro sideto side% t$is is anot$er indicator o" a tig$t (ulse. Mo1ing side to side is t$e 'est indicatort$at t$ere is cold. *n a de"icient (atient t$is ig$t 'e t$e onl) indicator o" a tig$t (ulse

)ou get. Yang de"icienc) causing cold would 'e an exa(le o" t$is.


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Tig$t (ulses can also indicate "ood stagnation% sudden 1asoconstriction o" an) etiolog)%

and sudden increase in cardiac stro+e 1olue. *t can occur in allergies% in"ections% and$ernias.

Mo1ing Pulse

T$is is a s$ort and urgent (ulse. *t can 'e sli((er) or roug$ wit$ no arri1al or de(artureli+e a little 4u(ing 'ean. You will ost o"ten "eel it in t$e le"t iddle (osition. Patients

wit$ t$is (ulse are usuall) $a1ing an extree eotional crisis.

You ig$t also see it in intense (ain% "rig$t% s$oc+% or allergic reactions to eds as well

as in (regnanc). asicall)% t$is s$ows a struggle 'etween Yin and Yang.

acing Pulse1er !E0'(. T$is is an extree condition suc$ as tac$)cardia% (ericarditis% )ocarditis

and ot$er 1er) serious t$ings )ou can&t needle awa). e"er% re"er% re"er5 r call 9-!-!% 9-

!-!% 9-!-!5

T$is indicates $eat and lots o" it. *" it lac+s "orce it&s a de"icienc) suc$ as )in ex$austionor $)(er Yang.

Techniques or !eeling the Pulse

Now )ou +now t$e ideal (ulses and t$e noenclature "or (at$ological (ulses. Next we learn $ow to

(ro(erl) (lace t$e "ingers and $ow to "ind t$e ; 1ertical de(t$s o" t$e (ulse. T$is is a little di""erent "ro

w$at was co1ered in Diagnostics% w$ic$ recoended t$at )ou use t$e st)loid (rocess as )ouranatoical ar+er. Due to anatoical 1ariation% t$is isn&t as relia'le as t$e et$od 'elow w$ic$ is ore

'ullet (roo" "or getting )our "ingers into t$e rig$t (laces.

Patient placement

/irst% decide w$ere )ou want )our (atient to 'e – l)ing on t$e treatent ta'le or seated% (re"era'l)

sitting in a c$air across a ta'le "ro )ou. * a going to recoend )ou sit across t$e ta'le "ro )our

(atient% es(eciall) w$en )ou are in learning ode. Git$er wa)% )our (atient&s wrists s$ould 'ea((roxiatel) at t$e le1el o" t$e $eart.


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*" )ou need to ta+e t$e (ulse wit$ t$e (atient on t$e ta'le it is recoended t$at )ou (lace t$e (atient&s$ands on t$eir stoac$ or c$est wit$ t$e el'ows slig$tl) "lexed so t$at t$ere is no tension on t$e ner1e or

'lood 1essel tissues.

Practitioner placement

G1en t$oug$ * recoend t$e sitting (osition% es(eciall) w$en )ou are learning to ta+e (ulses and are

using t$e learning tools )ou&ll "ind later% in a real-world clinic situation w$ere )ou (lace )our (atient islargel) de(endent u(on t$e s(ace )ou $a1e a1aila'le. You $a1e ; 'asic o(tions#

☯ Patient and (ractitioner seated across "ro eac$ ot$er wit$ a ta'le 'etween to rest t$e $ands

on.☯ Patient seated% ($)sician standing

☯ Patient l)ing% ($)sician standing

egardless% )ou t$e (ractitioner% s$ould 'e co(letel) relaxed. Don&t rise )our el'ows% reac$% strain.

Place )our (atient&s $ands so t$at )ou can reac$ 'ot$ at t$e sae tie co"orta'l). T$e goal "or )ou isto not o'iliKe too an) large uscles. T$e less e""ort )ou can (ut into reac$ing t$e (atient&s $ands t$e

ore sensiti1e )ou will 'e at (ic+ing u( t$e (ulse 6ualities5 Don&t contort )oursel". Lust re(osition t$e

(atient5 7*t wor+ed 'est "or e to o1erla( t$e (atient&s $ands slig$tl). 8

*NAGT Pic

ere is $ow )ou (lace )our "ingers (ro(erl) to "ind t$e cun% guan% andc$i (ositions.

1) end t$e (atient&s wrists 4ust slig$tl) so )ou can clearl) see

t$e t$enar einence. Place )our index "inger on t$eeinence and slide it toward t$e wrist. *t will "all into (lace

and sto(. T$at&s t$e "irst (osition – t$e Cun (osition.

2) You s$ould 'e a'le to "eel a little di( wit$ )our ring "inger

(roxial to t$e "irst (osition. T$is is at t$e edge o" a largeuscle in t$e "orear. T$is is t$e ;

rdor C$i (osition.

3) Place )our iddle "inger in 'etween. T$is is t$e guan

(osition.

4) Place )our t$u's on t$e 'ac+ o" t$e (atient&s wrists rat$er

t$an stic+ing t$e out to t$e side li+e a $itc$$i+er.

Do t$is on both wrists at t$e sae tie. ,lign )our "ingers wit$ t$e arter) i" )ou need to. Aoeties

t$e) are in a straig$t line down t$e wrist or a) 'e at an angle. se )our "inger ti(s w$ic$ $a1e t$e ost

ner1e endings.

*" )ou $a((en to 'e a guitar (la)er% $a1e soe scarring% or ner1e daage use t$e (ortion o" )our "ingers

t$at are t$e ost sensiti1e.


13/21

Techniques or Taking the Pulse

ere&s t$e $ow-to ste( ') ste( o" ta+ing t$e (ulse. Gac$ 'old $eading 'elow is a ste( )ou ta+e in

gat$ering t$e (ulse data. Don&t 4udge w$at )ou "ind% 'ut "eel it and record it. We&ll get to t$e anal)sis

later on.

!irst Impressions

=% t$is is w$ere it gets a little di""icult. *t&s not t$at t$is is a tec$nicall) di""icult s+ill. T$e $ard (art on t$e contrar) is turning o"" )our ind a"ter so an) seesters o" 'eing a criticall)

t$in+ing student.

You don&t use )our ind to get )our "irst i(ression an) ore t$an )ou do wal+ing down t$e

street or going to a (art) w$en )ou get "irst i(ressions o" (eo(le. You don&t $a1e to t$in+ o"

words or "eelings t$at go wit$ )our "irst i(ressions% t$e) $a((en autoaticall)5 T$is is t$e

sae t$ing )ou&re going "or wit$ )our "irst i(ressions o" a (erson&s (ulse. Wit$ )our "ingers in (lace% turn o"" )our 'rain and ste( into t$at ?(ulse (art)5@

Press in and "eel t$at (ulse "or t$e "irst tie. Don&t s(end ore t$an I – !I seconds. *" )ou s(end

too long )our ind will 'utt in and start 'ull)ing )ou into t$in+ing t$ings and t$en t$e deal is 'lown. Tr) to let ; words or t$oug$ts 4ust $it )our 'rain and 6uic+l) write t$e down. *" )ou

onl) get one% t$at&s "ine. T$ese are )our "irst i(ressions. Don&t 4udge t$e.

* cannot e($asiKe enoug$ $ow critical t$ese "irst i(ressions are. During t$e (ulse seinar in

w$ic$ * learned t$is we did a ?s(eed dating@ sort o" t$ing wit$ (ulses. al" o" t$e roo sat still

w$ile t$e rest o" us o1ed "ro c$air to c$air 6uic+l) getting "irst i(ressions o" eac$ (ulse andt$at was it.

Aide'ar#

Aoeties it&s di""icult to trust )our own intuition andi(ressions. T$ere are eleents o" ,erican culture t$at do

not necessaril) encourage t$is 'e$a1ior. ut it&s critical inC$inese Medicine and it&s critical in (ulse diagnostics.

*" )ou $a1e trou'le wit$ t$is and can&t tell w$at )ou&re "eeling%* "eel )our (ain. *& rig$t t$ere wit$ )ou. Too+ e an aw"ul

lot o" t$era() to e1en "igure out t$at t$is was an issue "or e5

*" )our issues aren&t t$at critical% *&d recoend soe Qigong.


14/21

Ta"e the Pulse #ate at the Beginning o the Pulse Ta"ing

) law in Texas we are re6uired to record t$e PM 7'eats (er inutes8 (ulse rate o" eac$ (atient

we seen in clinic "or t$e "irst tie. To do a reall) good (ulse anal)sis do it each tie. Not onl)

t$at% )ou&re going to go o1er'oard and do it ; ties. ut we&ll 4ust start wit$ one "or now.

Count t$e 'eats (er inute. * recoend )ou count "or a "ull inute instead o" counting "or (arts o" a inute and ulti(l)ing. You o"ten can&t "eel arr$)t$ias in (artial inutes. You&ll

need a cloc+ wit$ a swee( $and.

The $verall Impression

Next )ou will "eel t$e (ulse wit$ all "ingers at t$e sae tie. You record onl) w$at is

consistent across all "ingers. Don&t (a) attention to indi1idual 1ariations at t$is (oint in t$e (rocess.

/irst% "eel "or Cotton.*& going to introduce )ou to a conce(t called ?cotton.@ Wit$ )our "ingers in (lace on t$e

sur"ace o" t$e s+in% (ress in and note $ow uc$ ground su'stance is 'etween t$e s+in and t$e

1essel wall at t$e Qi le1el 7descri'ed 'elow8. *" )ou "eel tissues% "luid% an) +ind o" ?stu""@

'etween t$e s+in and t$e 1essel wall t$is is cotton. Hater )ou&ll learn t$at t$is eanssoet$ing i(ortant. /or now% o1e on to t$e t$ree le1els.

Now% "eel all T$ree He1els.sing all "ingers% "eel to t$e Qi le1el% t$e lood le1el and t$e rgan le1el. T$ese are t$e ;

de(t$s to a (ulse. You "eel t$ese ') (ressing down 1erticall) wit$ )our "ingerti(s.

1. Qi He1elT$is is t$e ost su(er"icial le1el o" t$e (ulse. You are 'asicall) "eeling t$e 1essel wall.

T$e energ) )ou are "eeling $ere is indicati1e o" t$e energ) 6ualit) o" t$e ner1e su((l) to

,not$er side'ar# , Word a'out Words

G1en t$oug$ t$ere&s a standard >dictionar)& o" (ulse words w$ic$ )ou

learned in t$e Ideal and Pathological Pulse section% t$ose words a)

not 'e t$e ones t$at (o( into )our ind during )our "irst i(ressionsor e1en during t$e next ($ases o" (ulse ta+ing. T$at&s "ine. Write

down )our words w$ate1er t$e) a) 'e. Lust translate t$e into t$e

TCM (ulse noenclature w$en )ou&re done.

,s an exa(le% * +e(t writing ?so"t@ a'out a (ulse and later learned

t$at is ?)ielding@ in TCM-A(ea+% eaning t$at it o""ers no resistance

against t$e "orce * (laced against it. ,ll * +new at t$e tie was t$at it"elt li+e a cotton-'all.


15/21

t$e organs re(resented ') t$e (osition on t$e wrist 7cun% guan or c$i8

2. lood He1el

T$is denotes t$e 1essel&s su((l) o" 'lood to an organ. T$is is "elt dee(er t$an t$e le1el o"

t$e 1essel wall. You are (ressing down into t$e 'lood su((l) and "eeling t$e 6ualit) o"

t$e 'lood at t$is le1el.

3. rgan He1el

T$is is t$e dee(est le1el to t$e (ulse and )ou are s6uis$ing t$e 1essel (rett) "lat% 'ut nottotall) cutting o"" t$e 'lood su((l) t$roug$ t$e 1essel. T$is allows )ou to "eel t$e

energetic 6ualit) o" t$e organ tissues t$esel1es. , good (ulse at t$is le1el o" (ressing

indicates decent Qi to t$e organ% e1en against resistance.

ecord an)t$ing odd or (at$ological )ou "eel at an) le1el. *" )ou don&t "eel an)t$ing s(ecial%

t$at&s no crie and don&t worr) a'out it.

Let %ideight %ide

Hea1e t$e "ingers o" )our rig$t $and in (lace% 'ut li"t u( to t$e lig$tl) rest on t$e s+in le1el. Now

"eel t$e le"t side ') itsel" wit$ all t$ree "ingers. ,gain% onl) (a) attention to w$at is consistentacross all t$ree "ingers.

Do t$e sae wit$ t$e ot$er side.

Does it "eel sli((er) in all ; (ositions3 Wea+3 Wir)3 Do all ; )ield to (ressure and o""er no

resistance% +ind o" li+e (ressing on a cotton 'all3 *s one side noticea'l) wea+er t$an t$e ot$er3

The Triple Burner 'or Upper( )iddle( and Lower *iaos+

You "eel t$e u((er% iddle and lower 4iaos ') "eeling wit$ 'ot$ index "ingers% t$en 'ot$ iddle

"ingers% t$en wit$ 'ot$ ring "ingers. ecord w$at )ou "eel. Don&t t$in+ a'out w$at t$is ig$tean% 4ust "eel and record5

((er Liao:urner

Hi"t t$e iddle and ringer "ingers u( so t$e) are resting at 4ust t$e s+in le1el. /eel t$e (ulse onl) in t$e Cun (osition wit$ )our index "ingers. /eel it at all ; de(t$s and record

w$at )ou "ind.

Middle Liao/eel t$e (ulse wit$ onl) t$e iddle "ingers% li"ting t$e index and ring "ingers so t$e) are

4ust resting lig$tl) on t$e s+in.

Hower Liao

/eel t$e (ulse in t$e C$i (osition onl) wit$ t$e ring "ingers. ,gain% li"t t$e ot$er "ingers

u( to rest onl) at t$e s+in le1el.


16/21

The Principal Positions

Now )ou "eel one (osition at a tie% 'ut onl) on one side at a tie. Please assue )ou lea1e t$e

unused "ingers in (lace 'ut le"t u( to t$e s+in le1el. *& getting reall) tired o" t)(ing t$at5 You

can le"t t$e o"" entirel) i" )ou want% 'ut w$en )ou&re "irst learning it&s a (ain in t$e 'utt to +ee($a1ing to "ind t$e (laceent.

Atart wit$ t$e distal (ositions and do t$e in t$is order% sto((ing a"ter eac$ one to record w$at)ou "eelBagain% no 4udging and anal)King )et5 /eel eac$ at all ; le1els. You onl) $a1e to record

w$at "eels (at$ological. *" it "eels noral )ou can 4ust s+i( t$at.

1. He"t distal 7cun8

2. ig$t distal

3. He"t iddle 7guan8

4. ig$t iddle

5. He"t (roxial 7c$i86. ig$t (roxial

Ta"e the Pulse #ate at the ,nd o the Pulse Ta"ing

Yu(% ta+e it again and record it. You could do (artial inutes and ulti(l) "or t$is one. *

recoend at least ;0 seconds 7ties 28 "or accurac) t$oug$.

Ta"e the Pulse #ate -ter ,.ertion

,gain3 Yes% one ore tie% t$is tie wit$ a little ini-stress test.

1. a1e t$e (atient stand. Place )oursel" next to t$e so t$at )ou can su((ort one o" t$eir wrists

and so t$at )ou can see t$e swee( $and o" a cloc+. /ind a (ulse (oint on t$e wrist w$ere )oucan count t$e (ulse easil).

2. a1e )our (atient swing t$eir "ree ar around in a circle ra(idl) "or a'out 20 seconds. Youdon&t $a1e to count t$e (ulse w$ile t$e) are doing t$is )ou 4ust $a1e to 'e read) to count it as

soon as t$e) sto(. e sure t$e) aren&t going to w$ac+ t$eir $and on soet$ing in t$e (rocess5

3. a1e t$e (atient sto( a"ter a'out 20 seconds and iediatel) do a (ulse count. !I seconds

ulti(lied ') E "or t$is last (ulse s$ould 'e su""icient. You&re 4ust loo+ing to see $ow uc$

t$e (ulse 4u(s as co(ared to t$e resting rate.


17/21

!iguring $ut /hat It )eans

Now it&s tie to anal)Ke w$at )ou gat$ered in t$e last ste(. You +now t$e 'asics o" t$e Gig$t

Diagnostics Princi(les. T$e si(listic a((lication o" t$is is#☯ Gxcess:De"icient

o Gxcess# "ull and o1erl) strong t)(e (ulseso De"icient# wea+ t)(e (ulses

☯ *nterior:Gxterior

o *nterior is dee(o Gxterior is su(er"icial:"loating

☯ eat:Cold

o eat is "asto Cold )ields a slow (ulse

☯ Yin:)ang

o ,s a rule and o1erall% )in is "ound on t$e rig$t w$ile )ang is "ound on t$e le"t. *n (racticewit$ t$e =idne) (ulse% $owe1er% t$is is re1ersed. =idne) Yin is t$e le"t ;

rd (osition w$ile

=idne) Yang is on t$e rig$t in t$e ;rd

(osition.

se t$e (ulses outlined in t$e Pat$ological Pulses section to "les$ t$is out. ,lso% use t$ese general rules

to $el( )ou anal)Ke#☯ !orce indicates de"icienc) or excess☯ /idth o" a (ulse "ro side to side indicates in"oration a'out t$e lood.☯ -mplitude or volume indicates t$e 6ualit) o" Qi and Yang☯ 0ardness o" t$e 1essel or t$e wa) t$e (ulse "eels indicates a de"icienc) o" Yin

☯ Urgency and %urging indicates $eat. Note t$at t$is isn&t ex(ressed as ?"ast@ 'ut ?urgent.@ , (ulse can feel "ast% 'ut t$e 'eats (er inute does not re"lect ra(idit). '1iousl)% rapid (ulsesindicate $eat as well.

☯ Tightness or slowness O Cold☯ !loating indicates wind in t$e exterior ☯ Changing (ulse indicates wind in t$e interior

☯ %lipperiness and cotton indicate da(ness or ($leg.

Ao does moist s"in es(eciall) w$en )ou&re in a cliate controlled en1ironent or it&s not

>sweat)& weat$er. ) t$e sae to+en% "eel t$e s+in "or dryness as t$ere reall) is no (ulse6ualit) t$at would indicate t$is.

☯ !loating 1 urgent or truly rapid 1 slippery O Auer eat

!irst %tep2

/or eac$ o" t$e (ulse 6ualities )ou wrote on )our Pulse Data /or% 4ot an anal)sis o" t$at (ulse.

se t$e (at$ological (ulses as a guideline and draw on w$at )ou $a1e learned in )our/oundations% Diagnostics% Gnergetics% etc. classes to $el( )ou anal)Ke w$at eac$ sign eans.

*&1e (ro1ided a sa(le (ulse data "or and anal)sis to gi1e )ou an idea o" w$at t$is loo+s li+e

on t$e "ollowing (ages.


18/21

%ample Pulse Data !orm Nae Patient Date Marc$ 2;% 2009

,ge /eale% ; )ears o" age lood Pressure Not ta+en

PM egin R /irst *(ressions Cotton). Wir). Alig$tl) o().

PM Gnd

PM Gxertion !20

Principal Positions %ectional Positions

Distals De(t$s in all (ositions

He"t Tense and rootless. sing a li"ting tec$ni6ue%"eels sli((er)

Qi -----

ig$t T$read)% rootless. Alig$tl) sli((er) lood ------

Middles rgan ------

He"t arder t$an distal% sli((er) at 'lood le1el.

ootless

Aides

ig$t Wir). Ali((er) and "orce"ul at 'lood le1el.

ootless

He"t Wir)% no root

Proxials ig$t More rooted t$an le"t

He"t rgent% wit$out "orce or root.Ali((er) at 'lood le1el.

urners:Liaos

ig$t rgent. /orce"ul. ((er Tense% dee(% wit$out root

Middle Wir)% "orce"ul% wit$out root

Hower --------

Now let&s 'rea+ t$is down.

☯ T$e (ulse counts

T$e di""erences in t$e (ulse counts "ro t$e 'eginning to t$e end as well as t$e

di""erence 'etween resting (ulse and exertion (ulse indicate a blood deiciency.

Di""erences s$ould c$ange t$is uc$ in a non-'lood de"icient (atient. ,n)t$ing oret$an a !0 (oint di""erence "ro 'eginning to end can indicate 'lood de"icienc).

☯ De(t$ in all (ositions

T$is section re"ers to an)t$ing w$ic$ is "elt consistentl) in all 6 positions "or eac$

de(t$. *" a 6ualit) is not "elt across all "ingers at a gi1en de(t$% don&t write it down.,s )ou can see "ro t$is (atient&s (ulse% not$ing consistent was "elt across all "ingers

at an) le1el.

☯ AidesT$is re"ers to an)t$ing "elt consistentl) on all ; "ingers "or eac$ side.


19/21

T$e He"t side (ulse tells )ou a'out t$e $ealt$ o" t$e organs o1erall% t$e $ealt$ o" t$econstitution% t$e 6ualit) o" t$e (re-natal essence% and t$e 6ualit) o" t$e 'lood.

T$e ig$t side gi1es )our in"oration a'out digesti1e $ealt$% t$e $ealt$ o" t$e

ac6uired (ostnatal Qi% and Qi o1erall.

You can see t$at t$e He"t is wir) and wit$out root. *t was s(ringtie w$en t$is

docuent was written% so a little wir) is to 'e ex(ected% 'ut t$is is a'o1e noral. *t isalso rootless indicating de"icienc) o" organs% o1erall constitution% (renatal essence or

'lood.

T$e rig$t $as ore root% so t$ere&s a 'alance di""erence 'etween t$e le"t and rig$t

o1erall.

☯ T$e u((er 4iao is tense and rootless o1erall indicating a de"icienc) and dee(indicating an interior condition. T$e iddle 4iao is sli((er) (ro'a'l) indicating

da(ness% "orce"ul (ossi'l) indicating excess% 'ut wir) s$owing 3i stagnation and

rootless indicating an underl)ing de"icienc). Not$ing consistent in t$e ;rd:lower 4iao (ositions "elt on 'ot$ sides% so not$ing was recorded.

☯ T$e (rinci(le (ositionso He"t:distal – $eart Tense%

rootless% sli((er).

Will Morris inter(reted t$is as phlegm misting the heart% indicated ') t$etension and sli((eriness.

o ig$t distal – lungT$read)% rootless% and slig$tl) sli((er).

Will&s inter(retation was not a 'lood de"icienc)% 'ut a Lung 4in .u.

o He"t iddle – li1er arder t$an distal% sli((er) at 'lood le1el. ootless.

ee'er t$e le"t was wir) o1erall as well. Will inter(rets t$is a 3i stagnation

o the Liver. Ali((er) indicates not 4ust da(ness% 'ut an o'struction soew$erew$ic$ causes tur'ulence in t$e 'lood strea instead o" t$e noral soot$ "low.

Qi stasis can cause t$is as well as da(ness. ootless:de"icienc) underl)ing.

o ig$t iddle – s(leen

Wir)% sli((er):"orce"ul at t$e 'lood le1el% rootless. ,gain% 3i stagnation

aecting the %pleen&% da( accuulation% underl)ing s(leen 6i de"icienc)..

o He"t (roxial – +idne) )inrgent% 'ut "orceless:rootless. Ali((er).

T$is was inter(reted as e(t) $eat – urgency indicating heat% 'ut wea+ and


20/21

Classic Pulse Diagnosis – Winter 2009

Will Morris and Yuxia Qiu - instructorswww.CatsTCMNotes.co

Page 20 o" 2!

"orceless indicating de"icienc). ,dded u(# 5idney 4in Deiciency

o ig$t (roxial – +idne) )angrgent and "orce"ul. Urgent indicates soe heat and "orce is excess.

1erall t$ere&s a lot o" "orcelessness indicating 3i deiciency.

%econd %tep2

T$is is a ste( in w$ic$ )ou 'uild a "lowc$art o" w$at )ou see and w$at is causing w$at. T$is is

true data inter(retation. Write down t$e 'road t$ings )ou see in )our anal)sis o" t$e (ulse (ositions. /or instance% i" )ou saw Qi de"icienc) in t$e =idne)% t$e A(leen% and Hung% )ou&d

write down ?Qi xu – =*% AP% H@ rat$er t$an $a1ing ; se(arate entries.

sing our exa(le ?Patient @% t$e ini-"lowc$art would s$ow#lood u

Qi Atagnation – HJ and ML:A(

Qi u

P$leg Misting t$e TYin u - S =* wit$ e(t) $eat% S H w:($leg

Third %tep2

T$in+ a'out w$at caused w$at. Hoo+ing at our sa(le (atient% notice t$e Qi de"icienc). Qi

de"icienc) can cause 'lood de"icienc) as well as Qi stagnation and t$e da( signs 7($leg in t$e

Hung and P$leg Misting t$e eart8. Could t$e Qi stagnation $a1e generated enoug$ $eat to 'egin daaging Yin3 Aees (rett) li+el).

Ta+e )our ini-"lowc$art and draw soe lines on it indicating w$at led to w$at to a+e t$e (icture clearer in )our $ead. ,rrow $eads are a c$allenge in ) wi() gra($ics (ac+age. Aorr)

a'out t$at.

T$at&s +ind o" a train-wrec+ and $ard "or e to wra( ) 'rain around% so * ta+e it one ste(

"urt$er and do t$is#

http://www.catstcmnotes.com/http://www.catstcmnotes.com/


21/21

,rrow $eads or not% it&s loo+ing li+e t$e Qi de"icienc) could 'e t$e root o" all e1il. T$is is t$eroot o" t$e (ro'le w$ile t$e ot$er ani"estations are t$e 'ranc$es. Your treatent (lan s$ould

t$ere"ore address Qi de"icienc).

Using /hat 4ou6ve Gathered

Your "inal ste( is using w$at )ou&1e gat$ered. '1iousl)% unless )ou 'ecoe a (ulse guru 7w$ic$ ta+esa li"etie o" stud)8% )ou are not going to use t$is in"oration in isolation. Co'ine w$at )ou learn in

t$e (ulses wit$ tongue diagnosis% o'ser1ation% listening% (al(ation% etc. se t$e (ulse data to dri1e )our

6uestions to )our (atients and )ou will "ind )ou are as+ing ore eaning"ul targeted 6uestions and

getting 'etter data 'ac+ "ro )our clients.

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