Pulse-Taking

Pulse-Feeling

The Formation of Pulse Conditions and the Clinical Significance of Pulse-Feeling

The substance of a pulse is the blood, and the power of a pulse is the Qi. Blood and vessels form a functional unit, in which the heart governs the blood and vessels. Heart-Qi is the power of blood circulation, and blood flow is confined to the vessels. As said in The Basic Questions, “The major collateral of the stomach, known as Xuli, runs through the diaphragm and lung, originates from the lower left part of the breast, and responds to the hand. This is ascribed as the initial Qi in the vessels.” Also, the volume and quality of blood plays an important role in the whole process.

The pulse condition is not only related to the heart, blood, and vessels, but also to the overall functional activities of the Zang–Fu organs. The Lung meets all vessels. The Qi and blood circulating all over the body converge into the Lung. The Lung dominates Qi, and blood circulation depends on the dispersing of Lung Qi. The normal flow of blood needs the controlling function of the Spleen, and the source of blood is the essential substances from food. The Liver stores blood and is in charge of conducting. It regulates the circulation volume of blood. The kidney stores essence, which can transform itself into blood and Qi. It is one of the basic materials for blood production. The condition of a pulse is closely linked to the functional activities of the Zang–Fu organs. Therefore, we can know the relationship between the visceral state and the disease condition by means of pulse-feeling.

Any pathological changes in the Qi and blood may alter the condition of blood flow in the organs, resulting in a change of the pulse condition. Thus, through pulse-feeling we may predict the location, the nature of a disease, the condition of the body’s anti-pathogenic (resistance) and pathogenic factors, and its prognosis.

The characteristics of the pulse — whether floating or deep — correlate with the depth of the location. A floating pulse often indicates that the disease is in the exterior, while a deep pulse indicates that it is in the interior.

The disease can be classified into cold or heat syndromes, and the rate of the pulse reflects the nature of the disease. For instance, a slow pulse indicates a cold syndrome, whereas a rapid pulse indicates a heat syndrome. In the pathological changes, specifically relating to the confrontational situation between pathogenic factors and body immunity, which result in two conditions: deficiency and excess.

It must be pointed out that the relations between the pulse condition and disease are very complicated. Clinically, the pulse may agree with the syndrome; for example, a strong pulse is present in an excess syndrome and a weak pulse is found in a deficiency syndrome. Sometimes, the pulse may contradict the observed symptoms; in this case the four diagnostic methods should be used to resolve this complicated situation.

Pulse-Feeling and Precaution

The circulation of the Qi and blood of the Zang–Fu organs and the 12 meridians starts from and ends at the Cunkou; any pathological changes of the Zang–Fu organs can be seen from the condition of the Cunkou pulse.

Pulse division at the Cunkou and the corresponding viscera: Cunkou is divided into three portions — Cun, Guan, and Chi. The Guan region is located near the styloid process of the radius. Between the Guan and the wrist joint is the Cun. On the other side is the Chi.

 

The Classic of Difficulties says, “There are three portions, Cun, Guan, Chi, and nine regions of superficial, middle, and deep. The upper portion corresponds to Heaven and reflects diseases from the chest to the head; the middle portion to the Human and reflects diseases between the diaphragm and umbilicus; the lower portion to Earth and reflects diseases from below the umbilicus to the feet.”

The most important practice is to concentrate your mind and devote your heart to pulse-feeling, and to utilize not only your knowledge but also your wisdom. “Keep tranquil when taking the pulse”; a good time for this is the morning. The Basic Questions of the Inner Canon of the Yellow Emperor says, pulse-feeling should be on “Yin-Qi never moving, Yang-Qi never dispersing, before taking the food, the meridians are not flourishing and Qi with blood is less disturbed” . Pulse-taking is best performed at a time when both patient and doctor are relaxed; cultivating meditation will help reach inner heart tranquility. At that time, there should be no effect of food intake and other physical activities on the patient. The internal environment should be relatively calm, so that it is easy to recognize a patient’s true pulse or morbid changes in the pulse condition.

During pulse-feeling, a patient should sit or be in a lying posture, extend the arm with their palm facing upward on a soft pad near heart level.

When pulse-feeling, the doctor uses his right hand on the patient’s left hand and vice versa, and should first put the middle finger on the Guan, and then the index finger is on the Cun while the ring finger is on the Chi. Since the pad of the finger is the most sensitive part, in order to maximize sensitivity the fingers should arch and the tips line up and the pads of the fingers rest at the pulse points. The spaces of the fingers should be adjusted according to the patient’s height, while the fingers have been placed, and all three are simultaneously used to feel the pulse, or to feel the individual’s visceral pulse condition. Identification of the pulse condition is usually done by applying three grades of finger force on the three pulse levels.

One breath consists of a single inhalation and exhalation. The doctor should breathe evenly and concentrate on the three fingers. The pulse beats in one breath are counted. A clock or watch may also be used to count the pulse beats. In adults, the normal rate of the pulse is four or five beats for one breath. Three beats for each breath is slow and six is rapid.

At least 50 pulse beats should be felt each time. The Miraculous Pivot  states, “When feeling the pulse, one should count the pulsations. If there is no intermittence in 50 successive pulsations, the Qi can reach all the five Zang-viscera”. The current duration of pulse-feeling is based on the discussion of The Miraculous Pivot . If one is using a clock or watch, pulse-feeling should last no less than 1 min. If necessary, the duration may be extended to 3–5 min for a less experienced doctor, because it is difficult to accurately judge the pulse condition in a shorter time.

 Recognizing the Regular Pulse

A healthy person has a regular pulse that has a frequency of about four or five beats per breath (or 72–82 beats per minute). It is neither superficial nor deep, stable, peaceful, harmonious, and forceful with regular rhythms.

The Miraculous Pivot  recognizes the soft and moderate pulse as being full of stomach Qi. The stomach is the reservoir of food, the source of nutrients for Qi and blood.

The characteristics of a healthy pulse:

 

(1)	Being full of spirit (vitality). Spirit is based on the essence, Qi, and blood. It can be detected in a regular pulse. A soft and forceful pulse with a unified rhythm suggests the existence of vitality.
(2)	Being rooted. If heavy pressure is put on the Chi region, and the pulse is forceful, this pulse indicates the existence of Kidney-Qi. The importance of the Chi region to the body is just like that of the root to the tree.

A normal pulse changes within a normal range, with changes in the internal and external environmental factors, such as seasons, geographical variations, gender, age, constitution, emotion, exercise, and diet, affecting the body. All these changes should be distinguished from the changes due to a disease.

 The Abnormal Pulse

An abnormal pulse reflects various pathological changes of a disease. The Basic Questions  states, “To know the interior according to the exterior would ensure the correct diagnosis” and “A good diagnostician distinguishes the Yin and Yang first by observing the complexion and feeling the pulse … should analyze the seasonal pulse changes to recognize which is responsible for the disease; should analyze the floating, deep, slippery or choppy pulse in the Chi and Cun pulse region to understand where the pathologic position is” . For instance:

All others are considered in the category of abnormal pulses. The pulse condition is identified by its location, beating, quality, shape, and force. The pulse features suggest the health problems.

 

(1)	The floating pulse  can be sensitively detected through the superficial beating by a light touch, but becomes weak and constant when a higher pressure is applied. This pulse indicates an exterior syndrome. A floating pulse implies asthenia syndrome, such as Liver Yang rising, and Yin deficiency with floating-up Yang-Qi syndrome; a floating weak pulse implies external asthenia. A floating pulse has also been detected in an internal syndrome of consummating essence without strength.
(2)	The deep or sunken pulse  only responds to the finger when pressed on. This pulse indicates an interior syndrome. If it is forceful, the pulse indicates an interior syndrome of excess; if it is weak, an interior syndrome of deficiency.
(3)	The slow pulse  is one with three or less beats per breath (<60/min). This pulse indicates a cold syndrome. If it is forceful, the pulse indicates cold accumulation; if it is forceless, Yang-Qi deficiency. It also can be seen in some internal asthenia heat syndromes.
(4)	The rapid or fast pulse  is one with more than five or six beats per breath (90–110/min). This pulse indicates a heat syndrome. If it is forceful, the pulse indicates the presence of excessive heat; if it is forceless or rootless, heat in a Qi deficiency or Yin deficiency condition; sometimes it is the asthenic Yang floating to external under Yin excess.
(5)	The swift pulse  beats over seven times per breath (≥140/min). This pulse indicates loss of control of hyperactive Yang, declination of Yin and near-depletion of essential Qi.
(6)	The deficient or weak pulse  is feeble and empty, and can be felt to be forceless and void to the fingers. This pulse indicates deficiency of both Qi and blood, especially in Qi asthenia.
(7)	The excessive (or powerful) pulse  is a powerful sensation under light, moderate, and heavy pressure. This pulse indicates the excess syndrome or that the body is functioning well.
(8)	The surging (or full) pulse  is felt to be of large size, its beating like roaring, dashing waves that rise forcefully as well as decline suddenly. This pulse indicates exuberant internal heat.
(9)	The faint (or thin) pulse  is an extremely thready (thin) and weak pulse, and only faintly palpable; it is quite sensitive under pressure. This pulse indicates deficiency of Yang-Qi and deficiency of Yin, asthenia of both Qi and blood, and overstrain or diseases due to pathogenic dampness.
(10)	The scattered pulse  is rootless and diffuse with irregular or arrhythmic beats, disappearing under pressure. This pulse indicates exhaustion of Qi, depletion of primordial Qi, visceral essence near the margin to exhaust, and asthenic Yang floating externally. It occurs when the Qi of the Zang–Fu organs is exhausted due to heart failure and scattering of Yang-Qi or depletion of Yin and Yang, or failure of blood circulation. It is usually seen in heart attacks or critical cases.
(11)	The wiry (or taut) pulse  appears straight, energetic, like pressing on the strings of an instrument, fine but clearly perceptible under pressure. A wiry pulse is a sign of the deficiency syndrome indicating disorders of the liver and gall bladder, pain syndrome, and retention of phlegm or fluid, which is pathogenic dampness.
(12)	The slippery (or smooth) pulse  beats freely and smoothly, flowing like beads rolling on a plate. This pulse indicates retention of phlegm, fluid and dyspepsia food, and excessive heat. It is also seen among young and strong people and pregnant women with ample Qi and blood.
(13)	The astringent (or unsmooth) pulse  is fine, short, and slow, coming and going in an inhibited manner like scraping a piece of bamboo. If it is weak, this pulse indicates injury to vital essence and insufficiency of blood or retention of phlegm and undigested food; if powerful, it suggests Qi stagnation and blood stasis.
(14)	The long pulse  is longer, going beyond its normal region. This pulse indicates abundance of Liver-Yang and internal heat syndrome.
(15)	The short pulse  is of short distance, and is palpable only at the Guan region but cannot be felt at the Cun and Chi regions. If it is forceful, this pulse indicates stagnation of Qi and slowness of blood or retention of phlegm or undigested food; if short and forceless, it suggests deficiency of Qi and blood.
(16)	The soft pulse  is superficial and thin as well as sensitive and weak under light pressure. This pulse indicates insufficiency of Qi and blood, or dampness syndrome.
(17)	The hollow pulse  feels superficial, large, and hollow, like a scallion stalk or pressing the tubal leaf of a green onion. This pulse indicates severe loss of blood and impairment of Yin.
(18)	The tense pulse  appears like the pulling of a rope or a stretched, twisted cord and flicks the finger. This pulse indicates cold syndromes, pain and retention of undigested food, leading to contracted vessels and a tense pulse.
(19)	The moderate pulse  is one with four beats per breath (60–70/min) and feels powerful or sluggish. This pulse indicates dampness syndrome or weakness of the spleen and stomach.
(20)	The feeble or weak pulse  feels extremely soft, deep, and thready (thin) as well as sensitive and weak under pressure. This pulse indicates deficiency of both Qi and blood.
(21)	The hidden (or indistinct) pulse  is felt only under heavy pressure; it is difficult to feel. This pulse indicates an internal syndrome caused by a deep invasion of the body by pathogenic factors, which obstruct the meridian Qi, and this leads to syncope, severe pain, and declined Yang.
(22)	The running (or rapid and intermittent) pulse  feels hasty and rapid, with irregular intervals. This pulse indicates exuberance of Yang heat, stagnation of Qi and blood, and retention of phlegm and food. If it is forceful, the pulse indicates exuberance of Yang and heat, or disharmony between Yin and Yang, stagnation of Qi and blood, retention of phlegm and undigested food and carbuncles, in a heat excess syndrome; if weak, the pulse indicates weakness of Qi and insufficiency of blood.
(23)	The knotted (or slow and intermittent) pulse  feels slow and retarded, with occasional irregular intervals. When it is powerful, this pulse indicates stagnation of Qi due to abundant Yin and retention of phlegm by cold and blood stasis; when weak, it signifies declination of Qi and blood.
(24)	The slow–intermittent–regular pulse  feels slow and weak, may lose a beat, and then pause at regular or longer intervals. This pulse indicates declination Qi in the Zang organs and asthenia primordial Qi, or wind and pain syndromes, or fright and traumatic injury.