How does Pulse Diagnosis work in Chinese Medicine?

 

I recently returned from an intensive seven day workshop in Amherst, MA on pulse diagnosis. It was the in-person culmination of a year-long online course focused on how to prescribe classical Chinese herbal formulas using pulse diagnosis. Not only did I learn a lot, but the course was held at the Sirius Community Center in Amherst.

The center is really cool because they grow a lot of their own fruit and vegetables, and they have a resident who focuses on connecting with communities. They teach about sustainability, composting, setting up bio gas kitchens, outdoor showers and the like. The center is also open every Thursday for a community meal, which is most often attended by people who don’t have enough to eat. And I learned all about composting toilets, which I had never used or seen before!

Pulse diagnosis is an important component of Chinese medicine because the quality of your pulse can tell me a lot about what’s going on with your health. If you’ve been to BodaHealth for acupuncture, chances are that you’ve had your pulse taken. In Western medicine, a health care provider may feel your pulse to determine its rate particularly when you’re in a health crisis or in the emergency room.

In Chinese medicine, however, a practitioner can gather a lot of information about your health from careful study of your pulse. In most cases, they feel your pulse at the wrist, and unlike Western medicine, your practitioner will feel the pulse on both sides of your body. That’s because the pulse on your left provides information about the Yang, or functional properties, of your body—how things are working. In contrast, the right pulse tells your practitioner about Yin aspect of your body, which is related to solid substances. This includes your organs, blood, muscle and other tissue.

A practitioner uses three fingers to take your pulse at the wrist, keeping their middle finger next to the hard knob of your radial bone (on the thumb side of your wrist). Their index and ring fingers will naturally land on the two positions on either side, giving your practitioner three positions on your pulse to assess. The position nearest your wrist crease is called the Cun; the middle position is the Guan; and the position farthest from the wrist crease is called the Chi.

Each of the pulse positions correspond to different systems and areas of your body. So when I feel someone’s pulse and find differences in its quality between the different positions, it gives me a clue to the status of the associated underlying organ systems. For example, if your pulse feels exceptionally strong or weak in every position but one, I may suspect that the system related to that position is weak or has some kind of pathology that I need to address.

There are at least 28 different kinds of pulses, and some are hard to describe. However, here are some general examples of what your practitioner is feeling and what your pulse can reveal:

– Rate. This is simply the number of heartbeats per minute, and is usually what your Western provider is measuring. This is also true in Chinese medicine, but in Chinese medicine your pulse rate is measured in relation to the rate of your breath. Normally, your pulse has four to five beats per breath, inhaling and exhaling. A pulse that is much faster than that indicates heat somewhere in your body, as heat speeds things up overall. Slower than four or five beats usually point to some kind of cold condition, as cold contracts and slows. It’s important to know that there are some things that can affect your pulse rate. For example, well-trained athletes tend to have a slow pulse and small women tend to have a pulse that’s faster. But in Chinese medicine these pulses may be within the range of normal for these individuals and not considered to be a problem.

– Depth. The level where you can feel someone’s pulse also provides information. For example, if you have to press hard to find someone’s pulse, this pulse is deep. This means that any imbalance or disease that may be present is deeper in the interior of your body. In contrast, a pulse that’s immediately felt right on the surface is superficial or floating, with can indicate a more superficial condition such as the common cold or flu.

– Force. How forceful your pulse feels tells me about the nature of your energy. A weak or forceless pulse generally points to a deficiency. This is also true of a pulse that spreads out and feels soggy when you feel it. However, a strong and lively pulse that can be easily felt may be a sign of good energy.

Your practitioner takes into account rate, depth and force when they’re feeling your pulse. And to make this diagnostic art even more complicated, there are at least 28 different kinds of pulses described in the Chinese classical literature. Here are a few of the different types of pulses:

• This feels like a tight guitar string, is long, strong and is common in people who are very stressed or tense.
• As already discussed, a rapid pulse indicates some kind of heat in the system. This can be anything from a fever to inflammation.
• This is when missed beats are felt either at regular or random intervals. An irregular pulse usually points to some kind of Heart or blood depletion.
• This is similar to wiry, but not as taut and large as a wiry pulse. It often indicates a cold condition.
• A weak pulse that feels soft and thin when pressed or has very little force, and can’t be felt at the most superficial level. This kind of pulse if a sign of deficiency.
• This kind of pulse is felt at the most superficial level, but is lost when pressure is applied. It indicates that a pathology is at the external level of your body.
• A long pulse is energetic, lively and felt past the Chi position toward the elbow. It is usually a sign of dryness in the body, such as in the digestion or blood.

The bottom line is that this recent course will be invaluable to me in the clinic. Chinese pulse diagnosis is a nuanced and complicated art. It can take years of experience and study for an acupuncturist to become skillful at it. With rate, depth, force and the various pulse types, there are infinite variations—each offering detailed information about a patient. Needless to say, I find Chinese pulse diagnosis fascinating! Thank you Nadine Zach, Sharon Weizenbaum and the White Pine Circle for hosting this amazing workshop!

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