Qualities and diagnostics of the radial pulse in Chinese medicine
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| Nature of the taking the Pulse | subjective, subject to sudden changes due to immediate experience
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| Radial Pulse taking first seen in the...? | Classic of Difficulties aka the Nan Jing
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| The radial Pulse has 3 regions and 3 depths creating a total of 9 specific positions | 3 regions: cun (distal) Upper Burner, chi (proximal) Lower Burner and guan Middle Burner (between them)
3 depths: superficial, moderate and deep
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| Correspondences between the regions and the ZangFu (organs) | Left wrist: cun-Heart (HT), guan-Liver (LR), and chi-Kidney Yin (KD Yin)
Right wrist: cun-Lungs (LU), guan-Spleen/Stomach (SP/ST), and chi-Kidney Yang (KD yang)
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| the 3 depths of the radial Pulse and their significance | superficial = state of Qi and Yang organs; Wei level (external invasion)
moderate = state of Blood and SP/ST organs
deep = state of Yin and Yin organs
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| the most important aspect of taking the pulse | not necessarily organ or channel correspondence, but rather how the Qi is flowing, the relationship between Yin and Yang, and the level at which the Qi is flowing, whether Qi is deficient, and if there is evidence of an external invasion.
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| the Mai Jing c. 280 (Pulse Classic), the Golden Mirror of Medical Traditions 1742 (Yi Zong Jin Jian) and Pulse Study of Bin Hu Lake 1564 (Bin Hu Mai Xue) | most common sources for organ and pulse attributions
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| It is possible for the positions to reflect pathology of the Yin-Yang paired organ as well | The LU position (Right wrist, cun) could indicate an issue with the LU or an [acute] issue with the LI
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| Taking the pulse in the early morning when Yin is calm and Yang has not yet come forth | Best time to take the Pulse
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| Position of arm and body during Pulse taking | patient: legs not crossed, arm not above chest, if sitting feet flat, if arms supine at sides
practitioner: feet flat on ground, posture upright, breathing calm, use opposite hand from wrist - index finger in cun region using pads not tips of fingers
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| 4 ways of moving [practitioner] fingers during pulse taking | 1. lifting - SF (superficial) strength
2. pressing - Deep and Mod level strength
3. pushing - Shape (medial-lateral) qualities
4. rolling - proximal-distal length and qualities
additional 5. searching - rate
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| 3 aspects of normal pulse | 1. has ST-Qi
2. has Spirit
3. has Root
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| ST-Qi in Pulse | gentle, calm and slow (not too slow); 4 B/Br cycle; not rough
gives body to Pulse (Sea of Food and origin of Qi and Blood)
if rough or hard = impaired
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| Spirit in Pulse | soft with strength - not big or small, regular
should not change quality easily or frequently
reflects HT-Qi and Blood
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| Root in Pulse | deep level felt clearly and rear position felt clearly
indicates strong healthy KD
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| When taking a 1 year old's pulse versus a 10 year old's pulse versus a relatively large person's pulse | 10 years old: squeeze fingers together
1 year old: use index finger and roll
large person: spread fingers
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| 3 factors to consider when taking the Pulse | season - deep winter vs high summer will have different effects on Pulse
gender - normal for an average female may be different than normal for an average male
occupation - physical labor may cause pulse to feel especially strong for example
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| Good state of Mind (Shen), Qi and Essence (Jing) should correspond to what qualities of the Pulse? | Spirit, ST-Qi and Root all present in Pulse
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| How many Pulse qualities | 28
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| Order of Pulse taking methodology | 1. feel P as whole
2. feel for Spirit, ST-Qi, then Root
3. feel 3 levels and 3 positions
4. feel strength of p
5. feel overall quality of P (if present)
6. feel quality of individual positions
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| Fú or Floating Pulse quality | felt w/ light pressure at the SF level, just resting like a butterfly search for EPF (external pathogenic factor/ external invasion) with slight pressure the state of Qi and Yang organs
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| Clinical significance of the Fú or Floating Pulse quality according to Maciocia in FCM | 1. external condition i.e. Wind-Cold or Wind-Heat invasion
(Tight = Cold and Rapid = Heat)
2. internal condition: Floating at the SF level w/ Empty* at the Deep level = Yin deficiency
3. RARE: anemia or cancer - Qi is deficient and floating to surface
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| Wang Shu He | Mai Jing (Pulse Classic, c.280)
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| Li Shi Zhen | Ming dynasty (around the 12 or 1300s)
communication of Pulses
8 EV Pulses
systematized locations and qualities
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| Li Dong Huang | Earth School
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| Lu Huan Su | School of Cooling and Cold
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| Zong Zi He | School of Attacking and Purging
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| Zu Dan Shi | School of Nourishing Yin
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| Su Wen on Diagnosis | Pulse taking not as important, rather taking into account the appearance of person
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| Nan Jing | Systematized Palpation and Pulse taking became more important and popular
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| Han Dynasty effect on Pulse | Gender separation became very important and modest as well - Pulse taking became very important to avoid undressing
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| Remember to look for the strength and not just pathology | to remember when diagnosing Pulses
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| Significance of SJ-4 in Pulse taking | put your thumb here [on patient] when taking Pulses - awakens Pulse
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| Yang aspect of the Pulse | Height, that is whether it is floating or deep
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| Yin aspect of the Pulse | Width, that is whether it is thin or big
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| Rapid Pulse (above 4 B/Br cycle) indicates | 1. rebellious Qi
2. Qi stagnation
3. Heat
4. Body type (not pathological)
5. Urgent type of person
6. Overworked
To confirm Pulse Diagnosis look to the Tongue
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| To confirm Pulse Diagnoses should | Look to the Tongue
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| The rate of the Pulse can be different at different positions | the overall Pulse could be rapid and slow at specific positions and a variety of combination of that dynamic
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| Superficial Pulses | 1. Floating
2. Flooding
3. Scattered
4. Leathery
5. Empty
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| Important to remember about the Fú or Floating Pulse quality | It is not necessarily pathological - Floating Pulse upon slight pressure is a 'present' Pulse. If Floating higher than that could signify Pathology - or in combination with other qualities
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| With a Fever, a Cold or the Flu it is normal to have which Pulse quality present | Fú or Floating Pulse quality
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| If I am sick am my Pulse is not Floating what can I do to activate my Wei Qi? | Stimulate the Jing Wells
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| Flooding Pulse quality | will be wider and higher than a typical floating Pulse
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| Clinical Significance of the Flooding Pulse | extreme interior Heat - either Empty or Full
could be from a Wind invasion bypassing LU directly to ST (would feel this at the Guan region at the SF level)
This is considered an Excess Pulse [though the Heat may arise from an Empty condition]
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| Scattered Pulse quality | consider it like holding a finger above a sparkler, that is hitting hte finger at various places
usually found in Cun regions at the SF level
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| Clinical Significance of the Scattered Pulse | lack of sleep and w/ tension in the shoulder blade can cause a scattered Pulse in the Right Cun SF position (HT).
this is considered a Deficient Pulse
KD Yang/SJ Pulse (Left Chi SF) = losing Jing
Usually only found in one position at a time
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| Leathery Pulse quality | long & wiry,
long - consistent across all 3 SF regions and beyond
wiry - hard like a wire and cannot be 'pushed through'
unlikely [not impossible] to see other Pulse qualities simultaneously in other positions
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| Clinical Significance of the Leather Pulse | common in the elderly
very deficient Pulse
Heat has been created due to Qi stagnation - the body trying to hold onto resources
trauma can cause this Pulse
loss of Blood or Essence, KD Yin, Body Fluids can cause this Pulse
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| Empty Pulse quality | Will have SF Pulse, and possibly Mod Pulse [would be a deficient Pulse], but there will be NO Pulses found at the Deep positions
This is considered a 'Rootless SF Pulse'
Can occur in a single region or multiple
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| Clinical Significance of the Empty Pulse | Qi deficiency
Yang Qi is escaping
Loss Leak or Blockage of Qi
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| Deep Level Pulses | 1. Deep
2. Firm
3. Hidden
4. Weak
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| Deep Pulse quality | similar to Floating Pulse, the Deep Pulse is a 'present Pulse', but in addition to other qualities can become pathological
also similar to Floating Pulse, may need to press a little deeper to assess qualities
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| Firm Pulse quality | This is a Long, Wiry and Deep Pulse (Deep version of Leathery Pulse)
Long - consistent across and beyond all 3 Deep regions
Wiry - hard, cannot be pushed through
uncommon Pulse
other Pulse qualities in other positions usually absent
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| Clinical Significance of the Firm Pulse | deep struggle/ internalized trauma
stubborn Phlegm, Heat accumulation and many other possibilities
want to assess along with Rate and consider whether Blood Stasis is present by assessing the Tongue
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| Hidden Pulse quality | below Deep Pulse, can be normal or pathological
consistent "blip" @ bone level, maybe hard to find again, check many times, will rise and go away
associated with Divergents
charted at the Deep level w. other qualities
can have anything charted above
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| Clinical Significance of Hidden Pulse | Menopause, pregnancy
divergent channel issues
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| Difference between the Empty and the Weak Pulse | Weak is the inverse of Empty
Empty is SF
Weak is Deep
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| Weak Pulse Quality | inverse of the Empty Pulse
Deep level present, Moderate level deficient or absent, and SF level always absent
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| Clinical Significance of the Weak Pules | Weakness of Yang Qi
This IS a Deficient Pulse, but is not synonymous with a Deficient Pulse
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| Sizes of Pulses can be felt at any level along with other qualities | 1. Big/ Wide
2. Thin
3. Minute
4. Short
5. Long
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| Big/Wide Pulse Size quality | lateral-medial expression (rolling)
covers large part of pad of finger
can be at any level
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| Clinical Significance of the Big/Wide Size Pulse | usually Excess, but can be Deficient
Heat or Prolapse
If Big and Forceless can be long-term Qi deficiency
Force determines Excess or Deficiency
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| Thin Size Pulse quality | lateral-medial expression (rolling)
will cover small section of finger pad
wil not be pushing back like Tight or Wiry Pulses
can be at any level
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| Clinical Significance of the Thin Pulse Size | Fluid deficiency
Blood deficiency
Dehydration
common after menstruation
generally very common
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| Minute Size Pulse quality | seems to come and go "is it there?"
covers small part of finger pad like a thread
like a string coming up instead of a BB
can be at any level
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| Clinical Significance of the Minute Pulse Size | Qi, Blood or Fluid exhaustion
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| Short Size Pulse quality | can be any amount of shorter than all 3 positions
not position specific
can be at any depth
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| Clinical Significance of Short Size Pulse | ST-Qi stagnation among others
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| Long Size Pulse quality | consistent across and beyond 3 positions
at any level
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| Clinical Significance of the Long Size Pulse | Heat
Long-term stagnation
Excess
Transitions
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