TCM III - Pulse diagnosis

Question 1

The pulse

Answer 1

• The pulse is an energetic representation of the organs, channels and vital substances – like a radio station into which the organs transmit information
• There is a vast arena of information to be found within what initially seems to be a tiny depth
• It is not possible to arrive at an accurate TCM diagnosis without taking the pulse
• Book: Ann Cecil-Sterman; The Art of Pulse Diagnosis

Question 2

Taking a pulse: Finger position

Answer 2

• Place the index, middle and ring fingers above the radial artery & radial bone
• The distal position is located at the wrist joint; it corresponds with the acupuncture point LU-9
• The middle and proximal positions are each located one anatomical inch (cun) proximally
• One cun is defined as the width of the patient’s thumb. Slightly spread your fingers when taking an adult’s pulse. When taking a child’s pulse, your fingers must touch each other

Question 3

Defining the pulse arena

Answer 3

• The distance between the skin and radial bone is defined as 15 beans
• Your fingers barely touching the skin is defined as 1 bean of pressure
• Pressing strongly as if you wanted to leave a mark on the radial bone is defined as 15 beans of pressure
• This opens up an arena that can be subdivided into three depths;
  1. 1-6 beans
  2. 6-11 beans
  3. 11-15 beans
• Thus, we arrive at 9 positions per wrist; we can tune into the pulse

Question 4

Wei Qi, Ying Qi and Yuan Qi

Answer 4

There are three energetic layers; Wei, Ying and Yuan:
1. The superficial pulse layer (1-6 beans) Is the arena of Wei Qi and tell something about the state of the immune system
2. The moderate pulse layer (6-11 beans) is the arena of Ying (nutritive) Qi and tell something about the state of Blood and Body Fluids
3. The deep pulse layer (11-15 beans) is the arena of Yuan (constitutional) Qi

Question 5

The pulses of the six Yin organs - location

Answer 5

The location of the pulse of each Yin organ is:
* Left hand:
o Heart = Distal point (at the wrist joint)
o Liver = Middle point
o Kidney = Proximal point
* Right hand:
o Lungs = Distal point (at the wrist joint)
o Spleen = Middle point
o Kidney = Proximal point

Question 6

The pulses of the six Yin organs

Answer 6

• This is the most common way of taking the pulse
• In each position, we feel for the strength and ‘volume’ of the pulse
• A strong pulse indicates abundant Qi, or stasis. A weak pulse indicates Qi deficiency
• Volume is an indication of Blood or Fluids. A full-bodied pulse indicates that there is ample Blood or Fluids

Question 7

Normal pulses on the right wrist.

Answer 7

• The Lung pulse (distal) should be strong at the Ying (moderate) level, Indicating that Lung Qi Is strong, and scatter at the Wei (superficial) level, indicating that the Lungs disperse Wei Qi
• The Spleen pulse (middle) should be strong at the Ying (moderate) level, indicating that Spleen Qi is strong, and feel full at the Ying level, indicating that the patient is well hydrated
• The Kidney Yang pulse (proximal) should only be felt at the deepest (Yuan) level where it should be strong and slightly tight
• N/B: The right is generally associated with Yang

Question 8

Normal pulses on the left rest

Answer 8

• The Heart pulse (distal) should be relaxed and full in the Ying (moderate) level, indicating that there is ample Blood to anchor Shen, and scatter at the Wei (superficial) level, indicating that there is joy and connection with life
• The Liver (middle) pulse should be full and slightly tight at the Ying (moderate) level, indicating there is ample Blood and Liver stores it well
• The Kidney Yin (proximal) pulse should only be felt at the deepest (Yuan) level where it should be strong and slightly tight
• N.b. The left is generally associated with Blood and Yin

Question 9

Pulse qualities

Answer 9

• Rapid = Heat
• Slow = Cold
• Wiry = Qi Stagnation (It feels forceful, as if a guitar string is hitting your fingers – more likely on the left)
• Slippery (has no clear articulation) = Damp
• Tight = moderate Blood or Fluid deficiency
• Thin or Empty = Blood or Fluid deficiency
• Choppy or Thready (feels like a pin coming up to your fingers) = severe Blood or Fluid deficiency
• N.b: Blood usually = left, Fluid usually = right