IMPORTANT MESSAGE TO ALL ACU THERAPISTS.

DIAGNOSIS PART IS VERY IMPORTANT IN ALL PATHY.

WHY DOES A PRACTITIONER TAKE THE PATIENT'S PULSE?*

In Traditional Medical Acupuncture pulse diagnosis is used to check a variety of functions. Primary
among these are the condition of the patient's blood and qi, an invisible type of life force or energy
that travels through the body's acupuncture meridians. Using pulse diagnosis, an acupuncturist can
determine areas of the body that may have disruptions or blockages of qi, and may also be able to
determine the condition of certain internal organs.

TAKING THE PULSE.

Over time, a variety of locations have been used in the process of pulse diagnosis. Originally, pulses
were felt at nine locations, three on the head, three on the hands, and three on the legs. Some
practitioners still examine the pulse at these locations, along with other pressure points along the
body.

In modern times, however, the majority of practitioners perform a simplified version of pulse
diagnosis. This simplified version focuses on the radial artery above the wrist, examining three
finger positions (cun, guan and chi), and felt at three depths (superficial, intermediate and deep).
Both wrists are palpated, one wrist at a time. The results of these readings are used to categorize a
patient's pulse.

How Many Pulses Are There? What Do They Mean?

The exact number of pulses that can be taken has yet to be determined. Some textbooks list only a
dozen or so types of pulses. Others list 28 or 40. Generally, however, there are approximately two
dozen types of pulses that are recognized by most practitioners.

THESE PULSES INCLUDE:

TYPES OF PULSE.

Choppy Bowstring Deep

Feeble Faint Fast
Gliding Floating Forceful
Hollow Hasty Hidden
Irregular Hurried Intermittent
Moderate Knotted Long
Relaxed Moving Rapid
Short Rough Scattered
Slow Sinking Slippery
Surging Soggy Superficial
Tight Swift Thready
Weak
Many of these pulses can be lumped into broad categories. For instance, a rapid pulse is often
defined as having more than five beats to a breath. A rapid pulse can be considered either forceful
or weak, which would indicate either an excess or deficiency of qi. Similarly, slow pulses (which are
also measured using a patient's breathing) can be categorized as forceful or weak. Other main
categories of pulses include floating, deep, slippery, rough, irregular, and bowstring.

CAN YOU DIAGNOSE ACURATE THROUGH THE PLUSE.

THE SIGNIFICANCE OF TRADITIONAL PULSE DIAGNOSIS IN THE MODERN PRACTICE OF CHINESE

MEDICINE.

INTRODUCTION.

The changing setting in which Chinese medicine is practiced in modern versus ancient times,
especially with the advent of advanced technological medical diagnostics, has raised questions as to
the value of pulse diagnosis. Should its use be limited to confirming a diagnosis reached by other
means? Or, does the pulse information add critical information that can greatly alter the treatment
strategy? Training in pulse diagnosis is often quite limited; further, the requisites for carrying out a
traditional style diagnosis are sometimes absent from the clinical setting, making the results of the
pulse taking less certain. How does one get the desired information under such circumstances?

Several years ago, an acupuncturist in the U.S. wrote to me saying:

I've been practicing for over five years now and have a busy practice; but, I'm totally disheartened
about my abilities. The biggest difficulties are diagnostic. I graduated school as one of the best
students in my class, yet neither I nor any of my classmates had any clear sense of tongue or pulse
diagnosis. I've gone to endless seminars, but theory isn't doing it for me. All the theory is useless if
you're unsure of your diagnosis. What I need is an experienced practitioner to work with who can
and will tell me if what I'm seeing on the tongue and feeling in the pulse is correct. Otherwise, I feel
as if I'm fantasizing all the time. Is that what Chinese medicine is all about?

This practitioner has recognized something that many others, who feel more confident despite
limited training, may ignore: there is a great potential to simply "fantasize" the diagnostic signs,
that is, to read into it something that is not really present. But, this is not what Chinese medicine is
about; rather, there is a clearly defined method of pulse taking (and tongue examination, as well as
other important diagnostic techniques) that can lead to reasonably well-defined syndrome
determination.

The information presented below is aimed at examining the traditional and modern roles of pulse
diagnosis, the techniques for taking the pulse, the interpretation of various pulse forms, and some
of the controversies that exist regarding the use of pulse diagnosis.
THE ORIGINAL PLACE OF PULSE DIAGNOSIS IN THE CHINESE TRADITION.

Pulse diagnosis is one of the original set of four diagnostic methods that are described as an
essential part of traditional Chinese medical practice.

The other three diagnostic

METHODS ARE:

inspection: general observations of the patient, including facial expression; skin color and texture;
general appearance, and the shape, color, and distinctive markings of the tongue and the nature of
its coating; and smelling (noting any unusual smell of the body, mouth, or urine);

listening: to the quality of speech (including responsiveness to questions, rapidity of talking,

volume of the voice); to the respiration; and to sounds of illness, such as coughing, gurgling from
the intestines; and

inquiring: obtaining information about the patient's medical history and their symptoms and signs,
such as chills/fever, perspiration, appetite and dietary habits, elimination, sleep, and any pains;
also, for women inquiring about menstruation, pregnancy, leukorrhea and other gyno-obstetric
concerns.

All of these diagnostic methods yield information that helps to determine the syndrome and
constitution to be treated. While the Chinese pulse and tongue diagnosis methods, because of their
frequent mention and somewhat unique quality among traditional medical systems, receive much
attention, the other aspects of diagnosis cannot be ignored or downplayed.

The Chinese term indicating a blood vessel or a meridian (which are two interlinked concepts; see
Drawing a concept: jingluo) is mai, and the same term is used to describe the pulse. Pulse feeling is
called qiemai, which is part of the general diagnostic.

Pulse diagnosis

It gives information on :

1. The state of balance of the body as a whole, i.e. the state of the Qi, Blood, Yin and Yang, and even
the constitution.

2. The state of individual Organs (esp. Yin Organs).

Three area of the Pulse:

Inch or Cun: Distal or Front (at wrist crease)

Bar or Guan: Middle (just medial to radial styloid process)

Cubit or Chi: Proximal or Rear

Three Levels of the Pulse:

Superficial: state of Qi and Yang Organs in general

Middle: state of Blood

Deep: state of Yin and Yin Organs

Also .....

Superficial: the condition of the Exterior or of the Upper Burner

Middle: Stomach and Spleen diseases

Deep: Interior diseases, esp. Liver and Kidneys

The state of Qi in the different burners of the San Jiao (triple burner).

Distal: Upper Burner

Middle: Middle Burner

Proximal: Lower Burner

Important assessment

1. Health of the Qi in general

2. Relationship of Yin and Yang on the pulse

3. Relative states of Deficiency and Excess

4. Whether an exterior pathogen is present

PULSE DIAGNOSIS Part - 1

HOW TO CHECK PULSE

Pulse diagnosis has always been an enigmatic as well as complex field. Not surprisingly,
acupuncture colleges offer little formal education in this area even though Li Shi Zhen's Pulse
Diagnosis

( 1)and various editions of the Huang Di Nei Jing have been available for many years. Even when
some of the classical literature on pulses is part of the curriculum, many students complain they
receive obscure and conflicting advice when trying to sense the pulse movement and accurately
interpret the information it can provide. Two new books, a translation of the Li Shi Zhen from Blue
Poppy Press and Dr. Leon Hammer's work from Eastland Press, are promised shortly and should
help to amend and renew serious study in this field.

(2)Most basic movements can be observed in any of nine fundamental positions.

(3) on each wrist. The division of each wrist into three depths forms a grid in which "the area and
nature of the disease can be determined from the wrist pulse."

(4) In this nine-sector grid, the cun position indicates diaphragm to crown, the guan position
indicates navel to diaphragm, and the chi position navel to feet. The superficial comprises
emotional, exterior, and meridian activity, the middle shows organic or metabolic activity, and the
deep level shows the bone-level or innermost activity. Together, these sectors create a hologram of
the entire body, similar in nature to the mapping of the ear, feet, or eyes.

Mathematically, this nine-sector grid forms 486 simple combinations. Because each state is never
seen alone but combined with one or more types of energy.

(5) the possibilities quickly expand

(6) In developing a model of this sophistication, we can create a diagnosis system as rich and as
varied as there are conditions or patients. we can anticipate a method of diagnosis and treatment
that is truly as unique as the patient. Ultimately, we can have a far richer description than 5-
elements; we could calculate 5 elements of 5-elements of 5-elements. A model this detailed gives us
a much clearer picture of cancer, AIDS, and other forms of chronic illness.

Unfortunately, no current American text exploits this level of sophistication and complexity.
Typically contemporary texts divide the pulse levels into the yang and yin organs, then specify a
diagnosis method using Eight Confirmations in the cun, guan, or chi positions. Many different types
of problems are reduced to the same, simple rubrics- -"stagnated liver energy," "dampness in the
spleen," etc. As a result, complicated and chronic problems can easily be misunderstood,
misdiagnosed, and inappropriately treated. Compounding this problem is the difficulty of the
subject matter itself, differentiating and interpreting subtle activity inherent in pulses especially for
chronic and catastrophic illnesses which present highly complex pulse patterns.

PULSE DIAGNOSIS Part - 2

THE THEORY OF THE PULSE

is very complicated but it is based upon the four principles--floating, sinking, slow, and rapid. Once
they are understood, by elaborating on them, the entire subject can be clarified.

Li Shi Zhen asks us to divide the pulse into yang and yin vectors along vertical and horizontal lines
of symmetry, a type of fourfold analysis. For him, pulse diagnosis is an art of deconstruction, a
geometry of meaning.

THE MODEL THAT BEST INCLUDES BOTH THESE DIMENSIONS

is the Tai Chi diagram, a broad and familiar abstraction that can also be used to decipher the
particulars of its applications. It is the classic emblem of complementary opposites, cyclic continuity
in time, and harmonious interrelationship--all essential parameters of health in the human body.
Yang rises vertically and accelerates horizontally; yin sinks vertically and decelerates horizontally.
Using the Tai Chi symbol as our paradigm, we can analyze how yang and yin should ideally
communicate, exchange, and balance.

THE CIRCLE ITSELF

is a traditional symbol of unity. The sine wave through the diameter of the circle is the ideal and
basic pulse wave. It is the result of balance, interaction, and harmony. Any deviation from it
provides information on how yin and yang have changed from that balance and what are the
consequences for health. All 27 pathological pulse states discussed by Li Shi Zhen can be derived
from it.

Tai Chi is process-orientated, coherent, evolving, and interactive in contrast to the typical emphasis
on substance or "solid" components. In it, yang and yin are more than their sum; they create and
dynamically balance each other. As a complex system, the Tai Chi diagram can be seen in a wide
range of natural scales and applications--the double-helix of the DNA molecule, the change of day
and night, the spiral nature of galaxies. Because this symbol is found at the heart of Taoist
philosophy, the Chinese 60-year calendar, feng shui, martial arts, and a variety of other systems, it
can be used as a basis for analysis and comparison of those systems.

We can simplify the work of Li Shi Zhen one step further by creating a list of the most fundamental
pulses. As a basic group, they illustrate a view of the essential dimensions and types of energies
found in all pulses. It is important to note that they are derived from a balanced pulse state and
fulfill Li Shi Shen's fourfold criteria:

Healthy or Balanced

Floating & Sinking

Rapid & Slow

Big/Small, Long/Short

Slippery & Choppy

Knotted

PULSE DIAGNOSIS Part - 3

THE HEALTHY OR BALANCED PULSE.

When Li Shi Zhen speaks of the different qualities of a normal pulse in section 3.2 (8), the
descriptions he uses are not "normal" nor "healthy" in either a theoretical or clinical sense. This
data entirely contradicts the pathological indications described later in the book by the terms
scattered, choppy, blocked, wiry, tight, slippery, soft, etc. Only the description of the middle pulse of
the spleen and stomach feeling "regular, neither fast nor slow" comes close to accurately portraying
the energetic balance, coordination, and harmony expected in a healthy person. Clearly, these
descriptions are typical of critical problems associated with those organs.
INHERENT TO THIS SYSTEM

is the communication and symmetry of yin and yang. The sine wave is formed from the synergy and
coordination between yin and yang. Their dynamic is nonlinear, not simply the sum of isolated or
independent elements. This relationship is as important as the constituents and becomes their
context as well as genesis. The Tai Chi movement represents the ability of living systems to
continuously regulate and renew themselves and to regulate this process in such a way that their
integrity and structure is maintained--what is today sometimes called autopoiesis.

WE WOULD EXPECT

other systems to be derived from this one, and in fact we see it at the heart of many illustrations in
Chinese philosophical and medical literature. Whereas a machine is geared to output a specific
product, a living organism is primarily concerned with renewing itself. We should expect to see this
sine wave in all healthy relationships and in the pulse positions of a healthy person. Therefore, any
deviation from this wave movement provides us with important information about what is
happening to the energy of the patient or the body's response to disease and the environment. It is
the way systems cycle or energetically perpetuate themselves.

PULSE DIAGNOSIS Part - 4

PULSE WAVE ENERGY SEGMENT.

AB qi Yang/yang function

BC qi Yin/yang function

CD xue Yin/yin capacity

DE xue Yang/yin capacity

The Normal pulse is often identified with the stomach energy because it is the organ which supplies
nourishment and support for all others. Together with the spleen, the earth Phase absorbs,
coordinates, and transforms; five elementally, it is at the center of the sine wave movement. The
dampness or substantial quality sometimes attributed to its pulse character is indicative of that
nurturing and supportive role. That central importance is emphasized in the seasonal 5-Phase
scheme: each Phase communicates with the spleen before cycling to the next Phase in the shen
cycle.

In a perfectly healthy person, all the pulses would present this smooth, balanced sine wave
movement connected at all positions and depths- -and it should be present during the entire year,
not only in late summer. While the seasonal energy will have some influence in the pulses, emotions
have a much stronger and immediate influence. The energy movements of the four seasons add
their wave shapes to the patient's energetic movement. The interactions of those two wave forms
uniquely describe the patient's reaction to the seasonal change.
THE BASIC WAVE CAN BE FURTHER ANALYZED BY dividing it into its yang and yin components.
The normal pulse begins with an ascending or yang movement. The convex portion indicates the
yang energy or qi of the movement [ABC], while the concave portion describes the state of yin
energy or blood of each organ [CDE]. To determine the balance within this movement, check the
size, angles, and texture of the yang portion and compare it to the yin portion. Ideally, the yin and
yang portions of each pulse should be symmetrical, hold the same capacity, and display the same
textures. A sharper angle of ascent indicates that the pulse contains more yang energy or heat; a
smoother angle indicates that yin is more prevalent. If the ascending movement is more prominent,
the pulse will have a tendency to float; when the descending movement is more prominent it will
have a tendency to sink.

When the rising movement is dominant it can also have a tendency to be more superficial or
express an acute syndrome. If it is a chronic condition the syndrome expressed will be light,
superficial, or immediate.

If the pulse begins with a descending motion (the sine wave is reversed), the organ energy is
reversing and, if more than one pulse position presents this reversal, the mother-son rule of the 5-
Phase theory is breaking down and the condition is more critical.

SYMPTOMS ARE CREATED BY CONTRAST IN FUNCTION

energy, or movement. The capacity of a pulse movement to create symptoms can be measured by
the area of the yang [ABC] or yin [CDE] portion of the pulse. For example, if the yin portion of the
pulse is larger, then the yin energy has the greater capacity to express a symptom. The pulse is not
necessarily obliged to express this capacity, but we can see the potential for expression. And our
diagnosis does not have to rely solely on the patient's report of their symptoms; we can observe
problems before the patient can be aware of them. This capability of pulse reading is essential in
discriminating the root of the problem from the branch; as well as in cases where the patient has
forgotten, is unaware, or is hiding aspects of the condition.

THESE ELEMENTARY RULES can be applied repeatedly as tools to analyze any pulse shape or
energy. Taking the first half or yang portion as our focus, the movement going up is yang of yang
while the second movement of the first half of the basic wave is yin of yang. In the yin portion of the
basic wave, the movement descending is yin of yin; the movement ascending to the horizontal axis
is yang of yin. The yang of yin portion connects to the next pulse position, feeding its yang of yang
movement.

THE CLINICAL IMPLICATIONS

of this fourfold analysis are far-reaching.

PULSE DIAGNOSIS Part - 5

FLOATING (FU) & SINKING (CHEN)

Floating and Sinking refer to the movement on the vertical axis of symmetry independent of the
horizontal. The Floating pulse is found at the superficial level and the sinking pulse in the deep
level. Generally, the Floating pulse indicates yang excessiveness due to wind or heat, and the
Sinking pulse indicates yin excessiveness due to cold energy. Floating and Sinking refer primarily to
the depth at which the pulse is found. Floating and Sinking can also refer to the direction the energy
is moving along the vertical axis, even when found at different pulse depths or sectors. We may
sense degrees of a Floating or Sinking state as a stronger yang of yang movement or yin of yin
movement.

RAPID (SHUO) & SLOW (CHI)

Rapid and Slow refer to movement alone the horizontal axis of symmetry and the speed of the pulse
movement when compared to the patient's breathing. The normal or balanced pulse is four beats
per breath. A Rapid pulse is more than 4 beats per breath. A Slow pulse is less than 2 beats per
breath. A pulse can become Rapid due to a "deficiency of yin and an excess of yang" energy. The
Slow pulse results from "a deficiency of yang and an excess of yin"(22). In general, the Slow pulse
indicates cold energy and Rapid pulse indicates hot energy. If the pulse moves faster than 6 beats or
slower than 2 it is an extremely critical sign, usually indicative of death; yang and yin no longer
communicate with each other and are about to be cut.

WHEN THE PULSE

is excessively fast, the energy will be cut at the chi position, move towards the cun, and finally
disappear. When the pulse is excessively slow, the energy will cut off at the cun position and move
towards the chi and finally disappear. For these two examples simply compare the energy of
someone who just came out of a sauna and is about to faint from the heat to someone who was
exposed to freezing weather and is about to pass out.

WHEN THE PULSE

are slow in comparison to the rate of breathing, we can say that the patient does not have sufficient
yang energy or that his interior can be cold or damp. The Rapid pulse indicates that there is too
much heat, that the condition is affecting the upper warmer, or that it is taking place at the surface.
It could be excessiveness or it could be a condition caused by an attack of perverse energy, etc. Heat
in the interior, for example near the bone, will be found in the deep level but will present a rapid
movement. A slow movement at the superficial level indicates cold energy invading at the surface of
the body.

Big & Small, Long (chang) & Short (duan)

PULSE DIAGNOSIS Part - 6

BIG & SMALL, LONG (Chang) & SHORT (Duan).

Big and Small refer to the vertical dimension of the wave form, its amplitude. In general they
indicate the amount of active qi available at a given moment. Long and Short refer to the horizontal
dimension of the wave, its frequency. These pulses indicate the capacity of the related organs, and
are often related to the hot and cold energy balance. Big and Long pulses indicate that the qi flow is
greater than the blood flow, while the Small and Short pulses indicate that the blood flow is greater
than the qi flow.

THE HORIZONTAL DIMENSION OF THE PULSE. wave indicates what the capacity the wave form
holds. Compare the vertical movement to voltage and the horizontal to wattage. So if it is Big and
Long it means that the output is strong, but if it is Small and Short it means that the output is
diminished but the movement can still last for an extended period of time. When the pulse is Small
it means that it will not last because it does not have enough energy support to continue. Endurance
or the capacity of a particular stress, that is how long it will last, depends on the horizontal
movement.

SLIPPERY (HUA) & CHOPPY(SE)

These two states describe specific textures of the pulse wave and not necessarily the shape itself.
The previous pulse states show a yang/yin scale in specific dimensions, these two pulse states are a
comparison between the qi and blood and illustrate the relationship of qi within the blood and the
blood within the qi--similar to the portion of the Tai Chi symbol which shows yang within yin, and
yin within yang.

The Slippery pulse feels

"round and smooth and flows evenly"

The sensation is like touching oil or wet and hard beads, it curves evenly up and then back down. In
general it indicates dampness or that qi is deficient in comparison to blood.

That a Slippery pulse can be created when yuan qi fails "and is unable to hold liver and kidney fire."

Typically you can expect mucus secretion or, if it is the dominant character, a blockage to the blood
flow with very low qi movement. You will commonly verify a mucus problem by looking at the
spleen's relationship to the other involved organs. It can be found in women during pregnancy; and,
if over forty, it will be evident in the menopause pattern.

THE CHOPPY PULSE

feels "thin, minute, and short and has an uneven flow, beating three and five times with an irregular
rhythm." It is often described as feeling like touching very fine sandpaper or a "knife scraping
bamboo.

In terms of our Tai Chi model, the horizontal movement of the qi is not supported by the yin energy.
Like the knife, the momentum pushes forward but is carried in a jerky motion. In general, it feels
very thin and irregular, making it sometimes difficult to flow. It indicates a dry condition, where qi
is more abundant then blood. It can often be observed in anemic patients and in those recovering
from surgery because of blood loss.