Pulse Synergy 1 Flashcards
Right cun
Lung (respiratory)
Right Guan
Spleen (taiyin)/Stomach (yang ming)
Right Chi
Kidney (urinary function)
Kidney stones
bird’s beak - right chi
Neck and shoulder pain
Right chi
Acute injuries, frozen shoulder, bone spurs
Right Chi
Du Mai
Beyond the Right chi
Left cun
Heart and SI
Left guan
Liver and GB (Anxiety, depression, stress)
Left Chi
Kidney (reproductive)
Low back and lower body
Left chi
Gynecological disorders
Left Chi
3 criteria of pulse
- Shape
- Jump
- Level
Shapes of pulses
- straight
- convex: beans, rainbow, turtle
- concave
- shapeless
3 criteria of a pulse jump
- Velocity (rate)
- Strength (forceful or weak)
- Resistance/Impedance (flow)
- Amplitude (magnitude at which the blood vessel expands)
What is Jump aspect of a pulse?
- pulsation aspects of pulse
- sensation of the force against your finger
- we usually talk about WEAK or STRONG
What is the strength of a Pulse Jump?
- strong or weak
- normal strength relative to each person’s constitution
eg Michael Phelp’s normal pulse felt on most everyone here would be considered strong
What is the significance of Pulse Jump - strength?
Determines presence of heat, acute inflammation pain (acute, excess and heat conditions) - too strong: expanding or swelling (Tx = shrinking it back) - too weak: empty
UFO Pulse
more superficial than superficial. Weak on the surface and as you press down it becomes stronger and stronger.
Can mean the dead pulse of Lu and Lung cancer
What is the amplitude of the pulse jump?
- magnitude at which the blood vessel expands
What is the significance of the amplitude of the pulse jump?
- HIGH AMPLITUDE: More heat, expanding eg high blood pressure
- LOW AMPLITUDE: 1. Stagnation: low amplitude and forceful
a. Vessel wall has plaque
b. viscosity of blood is high
2. Deficiency: low amplitude and weak
low amplitude with high blood pressure means?
more stagnation than heat - use more blood moving than heat clearing herbs
high amplitude with low blood pressure meaning?
use more heat clearing
low amplitude with low blood pressure
use tonic herbs (dont use tonic herbs with someone with excess fire)
invisible high blood pressure -
weak, slow blood pressure, fatigue, tired
3 criteria of a pulse level
The depth at which a pulse is felt
- Superficial
- Mid level - normal
- Deep pulse
Superficial pulse level
Dx: Heat causing DRYNESS
- the more floating, the more dryness
- When you touch the surface gently, will feel the pulse jump
- Mostly felt at the RIGHT CUN
- dryness goes to YANG MING (ST and LI) - no spicy, greasy, rich food
Deep pulse level
water, dampness -
- pulse of taiyin (Sp and Lu)
- skin problem
- spleen contains dampness, lots of water retention
- when there is dampness, there is a SKIN PROBLEM
myth
superficial pulse = exterior condition
interior pulse = condition
NOT TRUE
Unless Right Cun = then it means exterior condition (any other position does not mean exterior condition) - use Yin Qiao San or Ge Gen Tang (15%)
significance of pulse level
normally chi is superficial
Guan is mid level and
Chi is deepest
dampness pulse
deep and dirty
unclear vessel border
What are the 3 criteria of a basic pulse inspection?
- FEEL THE DIAMETER (SHAPE)
- thick = expanding (straw)
- thin = constriction (rubber band) - FEEL THE STRENGTH OF THE PULSE (JUMP)
- Strong (forceful) = excess
- weak = deficiency - FEEL THE LEVEL
- superficial = dryness
- deep = dampness
How to feel the strength of a pulse?
- WEAK: if no rebound, you press down and it just collapses
- STRONG: if rebounds, you press down and it will not disappear - strong on all levels
strong pulse on all levels
high BP
fast HR
Weak pulse
Low BP
Slow HR
no rebound
Confirm weak pulse by taking the blood pressure and heart rate
two most important factors of a basic pulse inspection
- SHAPE
- JUMP
- diagnosis is inconclusive when one is missing
- eg forceful and thick = UTI while forceful and thin = bone spur
what does a thick or thin pulse refer to?
Diameter of artery
- normal = size of an acupuncture guide tube
- thick = refers to artery enlargement. The entire artery is wider in diameter
What makes a pulse thick?
- heat, inflammation, pressure expanding the diameter of the lumen
- sympathetic excitement
- qi deficiency (vessel wall becomes flaccid and loses elasticity)
- certain expanding conditions in the body
What is the difference between a thick and big pulse?
- thick is just shape
- Big is thick (shape), expanding and forceful (jump)
What is a thin pulse (shape)?
- narrow in diameter
- constriction of the artery (BAD) Must open with an Opener such as Dang Gui
- a thin pulse has the diameter of an acupuncture needle or paper edge
- thinness of a pulse does not refer to the thinness of the arterial wall
What makes a pulse thin?
- sudden temporary narrowing (like spasm) from exposure to cold (usually will be thin and strong)
- chronic stagnation, causing poor blood flow (usually will be thin and weak) - PAIN (use Dang Gui or Chuan Xiong)
- blockage deprives the tissues in that location from normal blood flow and oxygen
- results in damage, degeneration and narrowing of arteries
- thin must be combined with SHAPE, either STRONG or WEAK to make a complete pulse sign
significance of Pulse Jump - Velocity
- fast or flow
- signficance:
- thyroid function
- nervous tension level
- determine if there is an abscess with a high fever (Zhen Ren Huo Ming Yin)
- MSG, caffeine, soda, synthroid, hormone, estrogen,
progesterone FLOATING, FAST, WEAK on all positions, but mostly
and easiest on the RIGHT CUN) - patient will also have gu mai (this is
where the systolic and diastolic, upcoming and down-going
pulses can both be felt). *Usually you should only feel the
upcoming pulse.
What can blood pressure and heart rate help you evaluate?
- excess or deficiency
- heat or cold
what does it mean if systolic is above 140 and diastolic is above 90 and heart rate is fast (>85)?
Excess
Heat
No matter what a person complains of (eg tiredness and weakness) if high BP and HR, then there is EXCESS HEAT! DO NOT TONIFY!!!
what formulas would you not give to type 1 excess heat patients?
Si Ni Tang,
Shi Quan Da Bu Tang,
Ba Wei Di Huang Wan,
You Gui Wan
What is the equation for deciding which formula to prescribe?
P=T/R
Pressure = Tension over Radius
What does a Type 1 pulse mean?
Excess heat = Big Pulse (forceful and expanding).
What herbs are good for Type 1 excess patients?
Excess heat = Xuan Shen, Jue Ming Zi, He Ye, Hai Zao, Kun (cold and salty herbs) Bu to lower the tension. Also add Mao Dong Qing for peripheral schlerosis
can also bleed such patients
what is the formula for high blood pressure, fast heart rate and edema?
Miao Dong Qing (with edema) or Di Long 40% (no edema)
Xuan Shen 20%
Hai Zao 20%
He Ye or Jue Ming Zi or Xia Ku Cao 20%
Type II BP and HR = ?
Systolic = LOW (below 95) diastolic = LOW (below 60) HR = slow (below 60) - Deficiency - Cold Pulse = small pulse
What does it mean if there is a deficient cold condition with a small pulse?
Pressure is low, like a flat tire
No Power
What is the treatment principle for a small pulse?
DIRECTLY tonify the qi and “fill the tire
pressure” with Sheng Mai San, Shi Quan Da
Bu Tang, and Huang Qi Jian Zhong Tang.
- Indirectly tonify the Kidney Yang to support the Earth;
Spleen can then support the Lung to produce more qi.
Xian Mao and Yin Yang Huo 20% each in a formula to
tonify deficiency. Works great! So this is a great
alternative if qi tonics don’t work. Try this!
- Another way to indirectly tonify qi is to relieve Liver qi
stagnation. So Liver overacting on SP/ST will interfere
with Earth’s ability to digest and absorb food. Gui Pi Tang
is the best. May be combined with Xiao Yao San too.
- Check the finger nails for color, shape, & ridges. Mees’
lines in chemo patients. Type 2 patients will show pale
color.
What does it mean if there are blue/greenish or dark black lines in PC-6 area?
Blood stagnation
shen disturbance, nervousness, anxiety,
excessive mental activities, most likely
insomnia
What is type 3 BP and HR?
Type Blood Pressure : systolic = high (above 140)
diastolic = normal (below 75)
HR = slow (below 65)
Patient not on blood pressure medication
Indication = blood stagnation. Check ear for dark coloration.
What is the amplitude of a pulse?
the expansion of the vessel
What sort of amplitude does hypothyroid have?
Limited amplitude Artery does not expand Low Pressure Patient will complain of tiredness Blood is dirty and muddy. We need to clean the blood.
What will be the symptom of low tension and large radius?
Low Pressure with low tension and large radius
Patient will complain of tiredness
Blood is dirty and muddy. We need to clean the blood.
What herbs can be used to bring energy back, and make the diameter of the artery smaller?
Sheng Mai San + Shen Zhu Yu
Liver is deep and scattered because the radius is large
What is the fomrula for patient complaining of tiredness with blood stasis?
- 20% tonifying herbs – Shi Quan Da Bu Tang 30% – Sheng Mai San 20% – Wu Wei Zi 15% - good for all types of Liver damage – Zhe Chong Yin 17% – Zheng Gu Zi Jin Dan 17%
Type 4 vital signs BP and HR?
Blood Pressure
– Systolic = Low (below 90)
– Diastolic = Low (below 60)
Heart rate
– Fast (>80 or 100)
Radius Low, Tension High, Pressure Normal
Chronic, severe def-heat, Low immune system
What are the indications of type 4 vital signs?
Indications: Def-heat; General fatigue, nervous (high HR), ADD, quick tempered, sensitive - Tuberculosis falls under this type (yin-def) – Affects the HT, Liver, KD, Lung
What doos do Yin deficient type 4 patients need to eat?
• Type 4 patients need to eat more need to eat more protein,meat, zinc, etc.
In general, they need more
nutrition
What formulas do you use for type 4?
To tonify the yin:
- Da Bu Yin Wan
- Zuo Gui Wan
- Zhi Bai Di Huang Wan
- Yin Xu in Lung = mai men dong
- Dry cough = Bai He Gu jin Tang, Sha Shen Mai Men Dong
What herbs for insomnia?
15-20% of following herbs plus any other herbs you would like to add:
- Bai He 15-20%
- He Huan Pi 15-20%
- Zhi Zi 15-20%
What herb and formula is good for cough?
Bai He is good for cough
Qing Zao Jiu Fei Tang formula (Eliminate dryness and moisten lungs decotion) and get patient to drink lots of honey.
What herb is good for nasal conditions and coughs?
Di Long
Di Long is good for allergy, cough, nasal
congestion, any nasal issues; especially good for
asthma; also good for skin conditions. Salty, so
good for solid mass.
25%
What are the areas Dr Chang examines for color and temperature?
Dr. Chang frequently examines the coloration,
temperature, and texture of the forearm, palm,
face, neck, and T1 area.
When examining the body what does the red color mean?
redness = inflammation. Especially red areas in the ear
When examining the body what does the blue color mean?
blue = blood stagnation
When examining the body what does the hot temperature mean?
hot = heat, fire
When examining the body what does a cold temperature mean?
cold, possibly deficiency
When examining the body what does a smooth texture of the skin mean?
smooth = phlegm in the blood
emotional conditions
When examining the body what does a rough texture of the skin mean?
sand-paper like
damp accumulation
water retention
What does soft muscle like tofu mean?
Weakness
What does a pale facial complexion mean?
Anemia
What does a red facial complexion mean?
Heat
What does a dark facial complexion mean?
Blood stagnation
What does bluish/greenish or dark black lines mean in the PC6 area?
PC6: shen disturbance, nervousness, anxiety,
excessive mental activities, most likely insomnia
If the vein from PC 6 extends all the way up to the heart area at the elbow shows that this nervousness already affects the heart- palpatations, SOB, chest pain
Also the skin around this area will also be darker than the skin further up the forearm. This shows nervousness or stuck periods.
the darker the color the more stagnant the blood
What do blue lines in the Lu 10 area mean?
Cold stomach
bad digestion
weak respiratory system
What does a brownish color (dark skin) and/or blue veins in Ht 3 area at elbow crease mean?
Blood stasis, may have heart problems such as infaction, angina, or heart circulation problem
What do bluish/greenish or dark black lines at PC area in elbow crease mean?
shen disturbance, nervousness, anxiety,
excessive mental activities, most likely
insomnia
What does a reddish color at PC area in elbow crease mean?
reddish = irritation
What does a brownish color (dark skin) and dark black, blue or green veins mean in Lu area at elbow crease?
A dark skin means a lung dysfunction
Dark veins means a Lu infection such as a cough or allery
