What is Pulse diagnosis?
Ever wonder why your practitioner takes so much time feeling your pulses? Wonder what they are feeling?
TCM uses 4 assessment categories, also called Four Pillars, to diagnosis patients — Looking, Listening, Palpation, and Asking. Pulse diagnosis falls into the palpation category. Each of these categories helps the practitioner to build an overall view to the patients health status.
Pulse diagnosis is a powerful diagnostic tool for TCM practitioners as it is an indicator of current health status of body fluids and the Zang Fu organs. It is also an indicator on the strength of Qi, Blood, Yin, and Yang in the body. The pulse changes as rapidly as the body changes, so it is used to get a snapshot of what the immediate health status of the patient is. This is also why your practitioner will check your pulse throughout the treatment, as the pulse should be changing and getting better with the needles or other modalities. Practitioners can even use changes in the pulse in real time to help fine tune their treatments.
There are 3 basic positions on the wrist that the practitioner places their fingers over to feel the pulse. Each position correlates to different Zang Fu organs and it is different for each wrist. The most distal placement is the Cun, which is the Lung/Large Intestine on the right and Heart/Small Intestine on the left. Next is the Guan, which is the Spleen/Stomach on the right and Liver/Gallbladder on the left. The last and most proximal position is the Chi, which is the Kidney/Bladder. The Chi position is slightly different in that while both wrists represent the Kidneys, the right side shows the state of Kidney Yang and the left side represents Kidney Yin.
There is over 30 pulse qualities that practitioners are trained to feel. These qualities are encompassed within a few broad categories — Rate, Strength, Depth, Length, Rhythm, and Quality/Texture. The rate of the pulse is the speed of the pulse, strength describes the force of the pulse under the fingers, depth describes how superficial or deep a pulse is felt, length describes if you can feel the whole pulse under all 3 fingers or not, rhythm describes the flow of blood through the pulse, and quality or texture describes the general feel of the pulse under your finger. Everyones pulse is a mixture of these categories and these combinations make up the 30 qualities. For example, a pulse that feels long in length with a sharp and taut upper edge (like a guitar string) is a wiry pulse, or a pulse that is rough with an uneven rhythm (like a knife on bamboo) is a choppy pulse. Each of these qualities then reflects a different diagnosis or disharmony. Someone with a wiry pulse could be diagnosed with LR Qi Stasis or can in active pain. Someone with a choppy pulse could be diagnosed with Blood Stasis or Blood Deficiency depending on other factors like rate and depth.
To complicate things, each pulse position can have a different quality. The pulse quality is a reflection on the status of the Zang Fu organs and if those organs are in disharmony with each other then the pulse will show each organ’s disharmony. For example, if your Spleen is deficient it can not produce enough healthy blood then the Liver becomes becomes affected leading to Qi & Blood Stagnation. In this scenario, the right Guan would likely be deep and weak, the left Guan could be wiry or choppy. If the Spleen deficiency also impacted the Transportation & Transformation of healthy fluids, an unhealthy build up of dampness could happen along side the Blood Deficiency resulting in a deep, weak, and slippery pulse or even a soggy pulse in the right Guan. If that dampness starts invading the Lungs then the right Cun may also become slippery. If the dampness in the Lungs becomes a cold phlegm (dampness congealed by cold) the pulse may become tight instead of slippery, or if the dampness transforms into a hot phlegm (heat cooks the dampness) then the pulse may become rapid and slippery.
Pulse diagnosis is truly an art and it takes years to master, so doing a full detailed diagnosis on yourself is nearly impossible. You can however compare your pulse to a friends and see what differences you feel! You can check your Spleen/Stomach pulse (right hand in the Guan position) before and after you eat to feel how your digestive process expresses itself. Or if you are starting to feel under the weather, see if your Lung pulse (right hand in the Cun position) is floating (only felt at the surface of the skin).
Note: Tongue and pulse diagnosis is the cornerstone of Chinese Medicine and practitioners spend 4+ years learning how to accurately uses these tools to help their patients. It helps us make an accurate diagnosis when paired with your symptoms, as well as let us know where to insert the needles and which modality would be best to use (moxa, cupping, e-stim, etc). If you have any concerns about your tongue or pulse, make sure to reach out to your practitioner or your doctor.
Interested in learning how Acupuncture & Chinese Medicine can help you take control of your health? Schedule your appointment today!