Professional Documents
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Pulses
Preparation:
1. While taking the pulse in the early morning is best, as the qi and blood are not disturbed, it is rarely practical to do this. Have the
patient sit still a bit before taking the pulse to allow the qi and blood settle in.
2. Place the patient sitting comfortably. The arm should be about level with the heart, not stretched too much but parallel to the ground.
Have them sit comfortably, preferably leaning back in the seat. Place patients arm on a pillow.
Alternately, you can take the patients pulse while he/she is lying down.
Many practitioners ask the patient who are lying down to rest their hands on their stomach since stretching out the arms in this
position will often put too much pressure on the arteries to get a good reading.
How to find the proper position for your fingers on the pulse:
1. Find the styloid process on the radial side of the wrist with your middle finger.
2. Slide your middle finger inward toward the medial side of the arm. It will fall into a small pocket just on the other side of the styloid
process. Your middle finger is now at the Guan or 2nd position.
3. Place your index finger down next to the middle finger in the 1st or Cun position. This position is the closest to the wrist.
4. Drop your ringer finger down naturally and this is the Chi or 3rd position, furthest from the wrist
Will Morris suggests you bend the patients wrist slightly inward (in the direction of the palm) and then find the divot this makes right
around Lung 9 on the radial side of the wrist, right on the transverse crease of the wrist. Place your index finger here, let your middle
finger drop into place, then your ring finger. If you slide your ring finger proximally a little bit you will feel the edge of a big muscle,
the brachioradialis muscle. You should be just distal to the end of that muscle.
If you want all the goodies from Will Morris pulse seminar, read all of the stuff here first, then check out the notes from the seminar
he gave on classic pulses by clicking here.
Region
Cun (1st position)
Guan (2nd position)
Chi (3rd position)
Left side
Heart (xin)
Liver and Gallbladder (gan)
Kidney/ lower abdomen - Shen/ Kidney Yin
Right side
Lung (fei)
Spleen and Stomach (pi)
Kidney/ lower abdomen Mingmen/ Kidney Yang
Pulse Chart
How to take the pulse:
1. Feel with all 3 fingers at the same time to determine the pulse quality and character overall before you find the character/quality of the
individual positions.
a. Feel all 3 depths: lifting depth, searching/middle depth, and pressing depth.
i. Lifting
Just touching the surface a little. Superficial pulse will be felt this way.
ii. Searching or Middle medium pressure to tell the nature of the pulse.
Maciocia says keep the fingers still to count the pulse. He goes further saying you can also:
1. Push move fingers laterally side to side in each position to feel around the pulse and determine its shape and
qualities.
2. Roll move fingers proximal to distal in each position to determine short, long, moving (and to read pulse in
child aged 1 year of less).
iii. Pressing
Press deeply into both middle and deep levels to determine if the pulse is deep, deficient, normal, hollow, hidden or
empty.
b. Feel for speed.
Normal is considered 4 beats per respiration cycle (one breath in, one breath out). Watch the patient breathe and count the
beats.
c. Feel for rhythm.
Feel for 50 beats in order to determine rhythm or arrhythmia.
2. Feel the individual positions on each side of the body. Be sure to feel at all 3 depths for each individual position also.
What is a normal pulse?
Frequency/Speed
4 beats/respiratory cycle (one breath in/one breath out)
Stomach Qi
Feel for 50 beats to determine this. This is the overall feelnot the feel of the Stomach/Spleen position!
o Not superficial, not deep
o Not fast, not slow
o Calm with regular rhythm.
Diagnostics I Summer 2007
CatsTCMNotes.com
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Pulse Chart
Spirit (or Shen)
o Soft, gentle, with strength.
No irregularity.
Root
2 meanings:
o Overall pulsestrength at all depths/all positions even when pressing heavily.
o Pulse in the 3rd positions is strong and with power.
Funky Pulse Positions
Fan guan mai or opposite gate pulse patients radial artery runs on the dorsal side of the arm!
Xie fei mai or oblique flying pulse patients radial artery goes at an oblique angle from 3rd position to 1st position, going
diagonally towards the dorsal side.
(Maciocia says when you encounter these you should really take pulses at alternate points on the body to get the reading these positions
would normally indicate. He unfortunately failed to elaborate and tell us where these were!)
Pulse Chart
Superficial Pulses
Superficial pulses indicate an exterior problem. (In special cases it may indicate the yang floating up and creating a false shen, but by and
large, its an exterior condition. ) Touch very lightly (lifting technique) in order to feel this pulse.
Remember: Cold conditions are indicated by a slow pulse while hot conditions have a fast pulse.
Chinese
name
English name
Description
Indications
Fu
Superficial
Floating
1.
1.
External pathogen
Circ of qi and blood is focused in the bodys surface to deal with external agent.
Internal circulation temperature is sacrificed to focus on elimination of the
pathogen, in an attempt to keep it from moving deeper.
2.
2.
Deficiency
Debilitated pts may have feeble, floating pulse: inability to retain Qi and yang in
interior due to deific of vital orgs.
Pulse Chart
Chinese
name
English name
Description
Indications
Hong
Surging
Overflowing
Flooding
1.
1.
Excess heat.
Heat isnt hard to detect, so this pulse doesnt add much to your diagnosis.
2.
2.
1.
1.
2.
2.
Dampness
1.
1.
2.
Ru
San
Soft
Soggy
Scattered
Crisis pulse
Note: because it feels easily movable (like thread floating), tends to indicate SP Qi
deficiency w/accumulation of dampness.
Depletion of Yuan crisis
Note: These are cases where patients are critically ill, are hospitalized or sent home to
die; diagnosis is usually well-established. Pulse says only that patient is severely ill.
Hollow
1.
2.
1.
Loss of blood
2.
Yin deficiency
Note: green onion stalk feel means that there is some flow of Qi at vessels surface,
but not much blood in the vessel.
Leather
Tympanic
1.
2.
Pulse Chart
Deep Pulses
Deep pulses are felt by pressing heavily. Deep and sinking pulses indicate an interior or chronic (prolonged) problem.
If the pulse is strong and deep = internal excess
If the pulse is weak and deep = internal deficiency
Remember: Cold conditions are generally indicated by a slow pulse while hot conditions have a fast pulse.
Chinese name
Chen
English name
Deep
Sinking
Description
1. Most strength @ the lowest level.
Requires deep pressure to feel well.
Indications
1. Internal syndrome
2.
2.
Note: Circulation in this case is confined to the interior as the body attempts
to deal with a serious disorder threatening the internal organs.
Fu*
Hidden
1.
2.
1.
Closing syndrome
(in this case, pulse closes too)
2.
3.
Extreme pain
Note 1: Conditions such as LOC (loss of consciousness) and severe pain can
be easily determined w/o taking pulse.
Note 2: There are two kinds of loss consciousnessclosing and opening
syndromes. Closing means everything clenches like a seizure (scream like pig
or sheep). Opening means everything opensmouth, fists, anus, urethra.
Note 3: This is a form of protection to keep the Shen inside.
Pulse Chart
Lao
Firm
Confined
1.
2.
3.
1.
2.
3.
4.
Cold
Internal excess
Shan Disorder (hernia)
Mass
Weak
Frail
1.
2.
*This Fu is different than that of the superficial pulse called Fu and is a different character when written in Chinese.
Deep Pulse Combinations
Deep + slow = internal cold.
Can be excess/deficient, depending on how strong it hits your finger, depending on how long its been going onlong time =
deficient. (Might also have ingested something cold.) Treat by warming. Tongue may be swollen/teeth marks/watery/cold signs.
Deep + thin = internal and deficiency (generally yin or blood).
Thin is distinct, no matter where located. Shape should be very clear. Thin is under the finger like a thread. This pulse would probably
be fastgenerally a yin deficiency or blood deficiency.
Deep + slowed down = internal and damp/deficient
Spleen qi def will have this type of pulse. Damp is sticky, slows everything down.
Deep + slippery = internal and dampness.
Pulse Chart
Slow Pulses
Slow is usually less than 60bpm. Exceptions include athletes in great shape who may have much lower pulse than non-athletes.
Slow is usually gauged as 4 beats or less per respiratory cycle (one breath in/out).
Slow pulses usually indicate Cold conditionshowever, Choppy is in this category and it does not indicate Cold.
Chinese name
Chi
English name
Slow
Description
1. Pulse = < 60bpm or 4 beats/breath
2.
Indications
Cold syndrome
Can be:
Huan
Slowed down
Relaxed
Loose
Moderate
1.
2.
1.
Dampness
2.
Phlegm
3.
Spleen qi deficiency
Look for greasy tongue coating, perhaps MJ discomfort to support your
guess.
Pulse Chart
Se
Choppy
Uneven
Hesitant
1.
2.
1.
Qi stagnation
2.
Blood deficiency
Youll see this when the severity of blood disorder is great
3.
Blood stasis/stagnation
You could see this in patients with arteriosclerosis and in severe blood
deficiency, but also in trauma victims who also have qi/blood stagnation
4.
Essence deficiency
5.
Phlegm
6.
Food retention
Knotted
1.
2.
1.
Yin excess
2.
Cold phlegm
3.
Blood stasis
4.
Qi stagnation
5.
Blockage
6.
Obstruction
Note: Can indicate coronary artery disease when accompanied by chest pain.
Pulse Chart
Rapid Pulses
Rapid pulses are 5 beats per breath or more. Rapid pulses indicate Heat conditions.
Chinese name
Shuo
English name
Rapid
Fast
Description
1. Is at least > 90bpm or 5 beats per
respiratory cycle (one breath in and out)
2.
Indications
Heat Syndrome.
Bit more rapid than normal, usually occurs only when serious illness,
when there is fever.
If pulse is strong and rapid = excess (yang excess)
If this pulse is weak and rapid = deficiency (yin deficiency)
This will be thin, fast, and weak
NOTE: Pulse can become rapid from activity prior to pulse taking. Dont
jump to the conclusion of heat without other supporting evidence!
Cu
Ji
Crisis pulse
Abrupt
Hasty
Running
Hurried
Swift
1.
2.
1.
2.
Palpitations
1.
2.
3.
4.
Note: this is like an excess version of knotted pulse. Rapidity indicates heat
and irregular indicates blockage caused by stagnation and/or accumulation.
1.
Depletion of Yuan Qi
Pulse is so rapid (twice as fast as normal) that it is easily detected. The acute
febrile disease involves an easily measured high temperature, usually
pathology can be found in testing.
Consumptive conditions w/such high pulse are generally under emergency
medical care.
Dong
Moving
Spinning Bean
1.
2.
1.
Pain
2.
Frightened
Pulse Chart
Deficient Pulses
Also called Empty pulses. Indicate deficient conditions. (Yeah, thats kind of a duh.)
Chinese name
Xu
English name
Empty
Deficiency
Description
1. Forceless on the three regions at all 3 levels
of pressure (key point for this pulse)
2.
Wei
Crisis pulse
Minute
Feeble
Faint
1.
2.
Xi
Dai
Thready
Thin
Fine
Intermittent or
Regularly
intermittent
Indications
Deficiency syndrome
Similar to weak, fine, faint pulses.
Occurs when deficiency of blood is more severe than in weak/fine pulses, but
not so deficient as the faint pulse.
So on a scale of severity, least to most severe: 1) weak, 2) fine, 3)
empty/deficient, 4) faint.
1.
2.
3.
4.
Yin deficiency
Yang deficiency
Qi deficiency
Xue deficiency
Extreme exhaustion is obvious to both patient and doc. Pulse lacks substance,
volume, strength; exhaustion of body essences. Prognosis is very bad.
1.
2.
3.
4.
5.
6.
1.
2.
1.
Fine thread
No kidding: it feels like a literal thread and
you can feel it on all levels/depths. It can
even be strong, but slender.
Very distinct and clear. Key point
2.
1.
2.
Pulse Chart
Duan
Short
1.
1.
Qi deficiency
2.
2.
Qi stagnation or block
The fact that this pulse strikes hard on the mid finger and leaves quickly can
represent: 1) contraction of Qi aka liver qi stagnation, or 2) deficiency of
Qi.
Pulse Chart
Excess Pulses
Also called Full pulses. Indicate excess conditions.
Chinese name
Shi
English name
Full
Replete
Forceful
Excess
Description
1. Pulse can be felt strongly on all 3 levels.
Key point.
2.
Slippery
Smooth
Rolling
Gives little info other than condition = excess. Use all other diagnostic skills
to determine the nature of the excess.
Generally, indicates you should not use tonification because this also
indicates the bodys resistance is undamaged.
Very strong
Hua
Indications
1. Excess heat
1.
2.
1.
2.
3.
4.
Dampness
Phlegm
Food retention
Pregnancy (often called happy pulse in China)
Slippery Combinations
Slippery is always an excess pulse. Not deficiency!
Slippery + fast = Damp heat. Phlegm heat/fire. Food retention w/heat.
Indicates damp is middle jiao, spleen cant metabolize the water properly.
Indicates Phlegm. Phlegm is primarily stored in the lungs but can also be present in the meridians. Phlegm is more condensed and
sticky than just dampness. This is like dampness, but congealed by either heat cooking the excess liquid off or congealed by cold.
Phlegm in the Lung is literal phlegm that can (eventually) be coughed out. Phlegm in the meridians is invisible phlegm. or it
could be invisible phlegm. Invisible phlegm can cause Shen disturbance by blocking the easy flow of Qi and blood to and from the
heart and brain and it can get blown around by an inner wind and cause a condition such as a stroke. Phlegm, literal or invisible
can cause stagnation and blockage which can lead to an interior condition of fire.
Food retention. Babies get this a lotfood retention leads to fever and internal heat.
Diagnostics I Summer 2007
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Pulse Chart
Jin
Tight
Tense
1.
2.
1.
2.
3.
Tight is the hardest no flex
Wiry hard, but will still flex
Slippery soft and flexible
Cold.
Cold stretches and contracts, hence the tight tense pulse.
External cold
Internal cold = tight, slow pulse
Pain
Food retention
Chang
Xian
Long
Wiry
Stringy
Taut
String-taut
Bowstring
1.
2.
1.
2.
Excess Yang Qi
Heat
If acute disease, long pulse will occur when there is a strong confrontation
between body resistance and pathogen.
1.
2.
1.
2.
3.
4.
5.
Liver
Gallbladder (inflammationalcohol and fried foods make it worse)
Pain
Phlegm
Malaria
Similar to tense pulse, but longer, more tremulous. Severe pain can be easily
reported, but wiry pulse confirms liver and/or gallbladder as the point of
disharmony.
Pulse Chart
Strange Pulses
In addition to the 28 disease pulses, there are 10 strange pulses (very severe conditions) and 7 death pulses. Both indicate dangerous
conditions with poor prognosisyang is almost gone, stomach qi almost gone. This dude is dead, man.