Last article I wrote about the very basis of Traditional Chinese Medicine (TCM), yin yang theory. Now I will explore what is often considered the basis of TCM diagnosis, the pulse.
Pulse diagnosis is extremely subjective and is frequently the most challenging thing to learn for a student of Chinese Medicine. I say learn because it can literally take years to master. My teachers taught me to be patient and figure that after thirty years of feeling pulses, I could then feel like I have a good handle on the process.
The practice of pulse diagnosis has evolved over the centuries. Originally it was documented in the “Classic of Difficulties” and then further expanded on in the “Pulse Classic” in 280 A.D.
Although there are still discrepancies in both the method of taking the pulse and the interpretation of the pulse, for the most part, the entire process of pulse diagnosis is quite similar. Ultimately, the pulse reflects the overall state of qi in the body.
In modern times, the primary pulse used for TCM diagnosis is the radial pulse. While taking the pulse, the patients arm should be level and should be held below the level of the heart. The practitioner uses his or her three middle fingers and places the index finger just proximal to where the thumb meets the inner wrist crease. The middle and ring finger fall into place behind the index finger and slightly further up the forearm.
The pulse is evaluated at all three finger positions as well as at three different depths. The “superficial” pulse is felt gently, and without pressure to the radial pulse. This level of the pulse corresponds more specifically to the state of qi as well as the state of the yang organs. It is also believed that this level of the pulse reflects exterior diseases. To reach the deep pulse, we press quite hard until just as the pulse disappears, we back off a tiny bit. This “deep” level of the pulse reveals the state of yin as a whole as well as the general state of the yin organs. The deep pulse also reflects the nature of interior diseases. In between the superficial pulse and the deep pulse is the “middle” pulse. The “middle” pulse reflects the state of blood in the body. This includes how the blood flows thru the body as a whole as well as how the blood flows thru each specific organ. The middle pulse also reflects the state of the stomach and spleen.
The positioning of each finger along the inner wrist also reflects a different part of the body. The index finger, which is most distal, reflects the “upper burner” or those organs found in the upper part of the body. This includes the heart and the lungs. The middle finger rests on the pulse that indicates the health of those organs found in the central torso. This includes the stomach, spleen, liver, and gall bladder. The most proximal position which is felt with the ring finger reveals the state of the lower burner organs. This includes kidneys, bladder, and reproductive organs.
Within the practice of Chinese pulse diagnosis, the pulse should have three main merits. First off, the pulse should have Stomach qi. This reflects a calm and gentle, yet soft and full quality in the center. The pulse should also have spirit. A pulse strong in spirit will be strong, steady, and regular. Lastly, the pulse should have a strong root. A pulse with a strong root will be strong and clear in both the deep positions as well as the rear position or under the ring finger.
The discussion on the quality of the pulse is too large for this article. Just know that when your acupuncturist feels your pulse, they will be writing words such as empty, full, slippery, choppy, long, thin, tight, wiry, hollow, knotted and floating to name a few. There are many more words used to describe the quality of the pulse and each word describes a different state of pathology.
Janice Dauw grew up in New York City and went on to receive her B.S. in Horticulture from Oregon State University. Later she attended the Oregon College of Oriental Medicine and received her masters degree in Acupuncture and Oriental Medicine in 1996. She is licensed thru the Hawaii State Board of Medical Examiners and is nationally certified thru the NCCAOM. While maintaining a very busy private practice for 11 years in the Corvallis, OR area, she also worked as the acupuncturist for Oregon State University Student Health services. In 2007 she and her husband moved to their land in HPP. She took a hiatus from her medical work for 2 years and helped build their new home. Currently, she keeps busy seeing patients three days a week, immersing herself in her garden, and enjoying the beauty and aloha that Hawaii is so abundant in.