TCM Diagnosis by Palpation (Pulse Diagnosis) - One of the 4 Pillars

• Divisions of the Pulse
• Location of the Radial Pulses
• The Method of Pulse Diagnosis
• Factors Influencing Pulse

In Western medicine, the pulse is only a minor diagnostic tool, it is, however, very important in TCM. Pulse diagnosis 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).

TCM practitioners feel the pulse and note the rate. They discern width or amplitude, length, how close it is to the surface, how deep and close to the bone, the strength, and other qualities.

Divisions of the Pulse

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

Three Levels Can Also Be Viewed As:

Superficial:	The condition of the Exterior or of the Upper Burner
Middle:	Stomach and Spleen diseases
Deep:	Interior diseases, esp. Liver and Kidneys

Location of the Radial Pulses

Three positions at each wrist, along the radial artery. The pulses are palpated at three positions, superficial, middle and deep.

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

Distal:	Upper Burner
Middle:	Middle Burner
Proximal:	Lower Burner

The pulse positions mainly give information regarding the Yin Organs. It is more difficult to assess the Yang Organs at individual positions (we tend to assess the Intestines in the Lower Burner position)

In pulse diagnosis, the most important things to assess:

• Health of the Qi in general
• Relationship of Yin and Yang on the pulse
• Relative states of Deficiency and Excess
• Whether an exterior pathogen is present

Each pulse position can reflect different phenomena in different situations. For example: The Lung pulse full can occur as a result of emotional problem (grief) affecting Lungs or from Phlegm in Lungs or from an Excess in Large Intestine channel, such as a tooth abscess.

The Method of Pulse Diagnosis

Feel pulses with the pads of the fingers (most sensitive part)

Hand must be relaxed - neither tense nor flaccid, but flexible and maintained in the pulse-taking position with the minimum of effort.

Exercise: Tense the hand as much as possible. Then relax and let the hand droop. Then gradually, with as much attention as possible, put just enough energy into your hand to lift the fingers. Imagine your fingers are like the leaves of a tree; if you waved your arm your hand and fingers would float gently after your arm. This is the optimum condition of the hand for pulse taking, relaxed, flexible but responsive.

Place the third (middle) finger pad on the radial artery just medial to the styloid process. The index finger is then placed in the distal position at the wrist crease and the ring finger in the proximal position.

NOTE: on a small person, the fingers will have to be squeezed close together but on a large person they may need to be spread out.

Try to feel the radial artery pulse with all three fingers. Use equal pressure on all three fingers and then release the pressure on the middle finger slightly to compensate for the styloid process. (The pressure of the radial artery on the styloid can produce an artificial pulse reading if the same amount of pressure is exerted there. The pulse would then appear to be excessive in the middle position.)

When you can just feel the radial artery, and have adjusted the pressure of your finger tips, release the pressure equally until you can JUST feel the pulse. This is the superficial position.

Then press as deeply as possible (maintaining the relative pressure levels as before) until you cut off the pulse altogether. Release the pressure until the pulse just returns. This is the deep position.

• Timing: Optimum time is early morning, when Yin is calm and Yang has not yet arisen.
• Position: Patient's arm should be horizontal and not higher than level of heart. Most practitioners use a table and place patient's wrists on a small cushion.
• Finger Placement: Best to keep all fingers in place as described above, and only lift fingers slightly to feel different levels.
• Breathing: Practitioner must regulate his/her breathing in order to be more receptive.

Patient's pulse is traditionally correlated with the Practitioner's Breathing Cycle in order to determine if patient's pulse is slow or rapid. (This was misinterpreted for a long time in the West).

Normal pulse:	4-5 beats per practitioner's breath.
Three beats or less:	Slow Pulse
More than five beats:	Rapid Pulse

Also pulse can be counted using a watch according to following table:

Age	Rate
1-4	90 or above
4-10	84
10-16	78/80
16-35	76
35-50	72/70
50+	68

Factors that Influence a Pulse Reading

• The 4 Seasons: Pulse is deeper in Winter, more superficial in summer.
• Gender: Men's pulses are naturally a little stronger. In men, the LEFT pulse is slightly stronger and in women the RIGHT pulse is slightly stronger.
• Occupation: those doing heavy physical work should have stronger pulse.
• Patient should not have just eaten a large meal (1 hr. before OK). Otherwise, Stomach pulse will read very high and other Organ readings may be depleted.
• Allow the patient to rest after arrival at office.
• Allow 15 minutes after urination, defecation or ingestion of liquids.
• Pulse diagnosis should take place in a calm, restful environment.
• Silence should be maintained during procedure.
• Western medications can interfere with reading, as can hypertension, and structural anomalies.