TECHNIQUES FOR PULSE DX
Patient's pulse is traditionally correlated with the Practitioner's Breathing Cycle. Chinese pulse diagnosis or Pulse diagnosis or Pulse Examination or Pulse assessment is a diagnostic technique used in Asian Traditional medicine such as Chinese medicine and Chinese medicine.

Pulse diagnosis is one of four diagnostic pillars in Chinese medicine. It is derived from concepts of holism where the parts represent the whole. The radial artery at the wrist is palpated and the observations are classified according to process and form. There are numerous models that provide information about systemic function. Some may give information about the acupuncture channel systems, others explore features such as circulating blood volume. It is a brilliant form of clinical assessment that is documented with 2,000 years of case studies and observations.

PULSE DIAGNOSIS ACP THERAPY

"Pulse Diagnosis " (in Japanese , "Myakushin") is one of many schools of acupuncture therapy.

In this style, the acupuncturist first analyses the patient's complaint by reading the pulse. In Western medicine, the pulse is generally only counted.

However, in Oriental medicine, the therapist also measures the qualities of the pulse - for example, whether the beats are sharply defined or soft, strong or weak, close to the skin surface or deeper in the tissue. To do this, acupuncturists use a combination of modern technology (electronic pulse analysers), and the traditional method of feeling the patient's pulse by hand.

The treatment itself varies according to the ailment and body type of the patient. Japanese- style acupuncture uses small, flexible needles which are sometimes inserted into the pressure points and left for a short period of time, or can be used in combination with massage to stimulate the flow of blood to the skin and muscles.
Therapists will use a gentler style of treatment and softer needles if the patient has a sensitive body.

By these traditional means we can read the energy, vitality, and restorativeness which exists at the root of the human body.

There are two factors that lead to disease; one is blood blockage and the other is decline in immunity.
In these cases pulse diagnosis has been found to be effective.

TECHNIQUE OF PULSE DIAGNOSIS

Pulse diagnosis in Oriental medicine needs three fingers of each hand to check the wrist pulse.
For example, we can read the condition of "the lungs" and "large intestine" by touching the right wrist with the opposite forefinger, "spleen" and "stomach" with the middle finger, and "sanjiao"with the ring finger.

In reverse, touching the left wrist with the right fourfinger, we can read the condition of "small intestine" and "heart". "Liver" and "gall bladder" with the right middle finger, and "kidneys" and "bladder"with the right ring finger.

In pulse diagnosis there are three stages to measure the quality of the pulse; "yin pulse", "yang pulse", and "middle (medium) pulse".

The ideal healthy pulse has a good balance of "yin pulse" and "yang pulse" and the two working in harmony has a vital, lively beat.

Excess pulse : denotes a pulse that is felt in all the three positions and depths. It feels full. This impression is generated by the long, large and forceful character of the pulse.

The excess pulse suggests an excess pattern due to cold accumulation, food stagnation, phlegm retention, Qi and blood stagnation and heat. The physiology can be complex with factors present. When the excess pulse occurs in the presence of heat, the root may be lost since the heat tends to rise. If the vitality is strong, and the pathogens are strong, this pulse can be present in an acute febrile condition. The pathogens may cause an accumulation of qi and blood leading to the large and forceful quality of the excess pulse. The excess pulse can be present in the healthy patient as well.

Deficient pulse : denotes a pulse shape that is large and soft, without force.

This pulse indicates a deficiency pattern. Force is related to qi and yang. Substance related to blood and yin. This pulse lacks both.

SURGING PULSE : denotes a pulse that arrives with force and departs without force. Overall, it is large and forceful like a wave. Pulse is broad, large and forceful like roaring wave which come on powerfully and fade away.

This pulse occurs in the presence of heat which causes the vessels to expand. The wave spreads out and there is less peripheral arterial resistance, therefore the wave collapses readily after hitting the end point. The surging pulse may be seen in acute febrile diseases but can also be found in patients with aortic insufficiency that causes alterations in the flow of blood. The surging pulse can also be seen in peripheral arterial distension, and when there is an increase of blood pressure, either diastolic or systolic. It is a normal pulse in summer.

SLIPPERY PULSE : denotes a pulse that slides quickly and smoothly under the fingers. It is one of the most commonly identified pulse images. The fingers must press into the blood stream in order to feel this pulse. It can be palpated superficially and in the depths, but it is most common in the middle of the blood stream.

There is pressure against the vasculature, due to a bolus of food, phlegm and damp collection, a fetus or accumulations. This causes mild distention of the vessel and turbulence in the blood. The wave passes more quickly under the finger tips under these circumstances. This pulse can be normal.

CHOPPY: denotes a pulse that is rough and not smooth. It involves irregular form, process and traits. That is, rhythm, force and shape. The shape of the vessels or the wave can be rough. The amplitude of the waves can change due to uneven force. The uneven rhythm is a “changing rate at rest.”

IF THE PULSE IS FORCEFUL, the pulse can happen in the presence of phlegm retention and qi, blood or food stagnation. The accumulations impede the circulation of blood in the vessels. If the pulse lacks force, it suggests depletion of blood and essence due to loss of blood, constitution, miscarriage or excessive loss of semen. Excess syndrome sluggish and forceful Qi & Blood stagnation food stagnation phlegm retention Excess pathogens blockage of vessels and impaired circulation of blood. Deficiency syndrome sluggish and weak blood deficiency essence deficiency threaten abortion seminal emission It can occur in medical conditions such as arteriosclerosis (rough vessel sensation), hyperlipemia (uneven volume), severe vomiting and diarrhea (weak and roiugh), chronic cor pulmonale and polycythemia vera, cause blood viscosity increase which results increase of blood adhesives to vascular wall, increase of friction and deceleration of blood flow.

WIRY PULSE : denotes a pulse that feels tense, long and stable. It can be felt with varying levels of pressure. A wiry pulse passes straight under the fingers and can be highlighted by rolling the fingers along the surface of the vessel. It is much like a violin string, and can be divided into excess (shi), deficient (shu) and moderate (bing), corresponding to thicker or thinner strings.

The wiry pulse correlates with liver and gallbladder patterns, phlegm and pain. Medical conditions include hepatitis, cirrhosis and hepatocarcinoma, or vascular diseases such as: an increase of arterial pressure, peripheral resistance, vasotonia and hypertension. The liver is correlated with peripheral nervous control and the neurovascular network contributes to the tension in the arterial wall. When this occurs, the vessels tend to gain tension uniformly. This is common under stress and the moderate wiry pulse is consistent with functional disorders. In Chinese medicine, the liver disperses and regulates the flow of qi. When the liver function is impeded, there can be qi stagnation which can contribute to the generation of heat, and stagnation of blood, food and damp. The wiry pulse is normal in the spring time and in the wood constitution.

HURRIED PULSE : denotes a pulse that is rapid and irregularly irregular. It is agitated and urgent, like a man running and stumbling.

The pulse correlates with excess heat which accelerates the rate. Other pathogenic processes such as cold, phlegm and blood stasis may combine to create irregularities. If it is an excess pattern, it will be forceful. It is often not possible to count a rate, however, the irregularities occur in a way that give the impression of a rapid pulse. The hurried pulse can be normal if it is congenital. Medical conditions that may present with this pulse include irritation of the sympathetic nerve, infection of cardiac muscle. Or sinus tachycardia accompanied with obvious sinus irregularity. The hurried pulse may be constitutional and not suggestive of pathology.

KNOTTED PULSE (jié mài ??) denotes a pulse that is slow and irregularly irregular. is slow with irregular intermittence. After the missed beating, the pulse continues immediately.

The slowness correlates with a cold pattern. The circulation is blocked by any number of pathogens including phlegm, cold and tumors. The pulse can occur in deficiency patterns when the qi and blood are insufficient to fill the channels. Under these circumstances, pathogens can enter the vessels causing arrhythmias. This pulse can be found in healthy people as a congenital circumstance. Medical conditions include coronary heart disease, rheumatic heart disease, hypertensive cardiopathy, pulmonary heart disease, and myocarditis.

INTERMITTENT PULSE (dai mai): denotes a pulse that misses a beat at regular intervals, and the more frequent the missed beat, the more serious the pathology.

Trauma, wind, cold, pain and emotions can cause disorders of the channel qi resulting in forceful missed beats. Deficiency patterns of blood, qi and the viscera result in a thin and weak pulse with regularly missed beats. Normal intermittent pulses can occur in pregnancy, and in congenitally. Two to three months pregnant can see intermittent pulse, it belongs to normal, it also can be congenital. Arrhythmia caused by myocardiac infarction, coronary heart disease, cardiomyopathy, myocarditis, hypertensive heart disease, pulmonary heart disease, cardiac insufficiency, coupled rhythm of extrasystoles or atrioventricular block.

SOGGY PULSE : denotes a pulse that is floating, thready and soft. It feels like a piece of thread floating on water. There is no force and gives way with pressure.

It occurs in progressed disease states with deficiencies of qi, yin and blood which allow the yang to float. If the pulse disappears with pressure, the yang is expiring. The soggy pulse may also occur in the presence of damp which depresses the vessels and impedes the flow of qi and blood. If this pulse develops in a case of a life threatening disease, there may be an acute exacerbation of the condition in the near term. When the soggy pulse occurs in a normal body condition, the prognosis is poor.

HOLLOW PULSE : denotes a pulse that is wide and soft vessel when lightly touched, and hollow when seeking. It can truly be said to be vacuous. There is a three dimensional field of hollowness in the center as one presses and seeks. With pressure, the edges of vessel are clearly felt, the center is obscure.

It suggests a hemorrhage with loss of large amounts of blood quickly. If blood is depleted progressively over time, the vessels can adapt. Here it is more sudden, the vessels retain their shape and it feels as if the center has little presence. Yin depletion can be involved, in which case, the pulse may be more rapid. The yang is present and the yin is not.

LEATHER PULSE : denotes a pulse that is wide and the vessel wall is thick. It is felt superficial without root, or hollow.
It is representative of a progressed state of pathology which is complex and involves both deficiencies and excess. The thickening of the wall often occurs in the presence of excess heat and the pulse is therefore both rapid and forceful. The leather pulse also involves depleted blood essence that is chronic in nature. Examples include chronic abortion metrorrhagia and metrostaxis The thick tension in the vessel is due to essence depletion. It is felt on the surface because the qi floats.,large, tout and tense feature when touching is due to Qi floating which is caused by the essence and the blood deficiency. The hollow character at deep level is a sign of depletion of Qi and blood. Consumptive diseases, such as aplastic anemia, liver disease, uterine bleeding due to retained placenta, serious dehydration cause inadequate circulatory blood volume

SCATTERED PULSE : denotes a pulse that is large, floating and weak. The wall of the vessel is very thin and it spreads like powder in the wind when touched. It lacks force and the form is unclear, the boundary between vessel and the ground substance is vague. The pulse easily disappears when pressing or searching. This causes the rate to be difficult to count if the scattered quality is global.

The viscera are exhausted and there can be organ failure. The qi is exhausted and fails to sustain contact between yin and yang. This pulse occurs in critical conditions and portends a downturn in the case. Before term, it suggests a risk of miscarriage. At full term, it suggests labor. The scattered pulse can happen with arteriosclerotic patches obstructing the flow of blood. Other obstructions such as mitral stenosis can contribute to reduced cardiac output and low circulating blood volume. The scattered pulse requires a weakness in the vessel wall, an obstruction that reduces circulating blood volume will tend to make the pulse thin and weak.

HIDDEN PULSE : denotes a pulse that cannot be felt with normal palpation such as touching, seeking or pressing. It can only be felt when pressing to the bone, or under the tendon. Pathogens obstruct interior

The excessive pathogens obstruct the Yang and Qi. The Qi and blood could not flow into exterior part of body through vessels. Syncope (Yang deficiency) The yang is too weak to push the Qi and blood to flow in the exterior body. During the pregnancy, there may have hidden, which not belong to pathological change Cardiogenic shock, pneumonia of shock type, toxic dysentery, profuse hemorrhage, sever pain etc. can seen hidden pule. It caused by dramatic reduction of blood volume results in the fall of blood pressure.

FIRM PULSE : denotes a pulse that is deep, bowstring, and forceful. It is stable and lacks normal variability.

It suggests pathogenic processes bound at the interior. These may be cold, or accumulations of yin such as hernia or a mass. The yin cold binds the qi, yang and blood at the interior causing the vessels to be deep. This pulse can also have components of heat if it is urgent or rapid. It can also be present when latent pathogens are bound at the interior. Medical conditions include arteriosclerosis and chronic nephritis. The blood vessels lose pliability and there is plenty of blood volume so the blood pressure tends to high.

WEAK PULSE denotes a pulse that is yielding, deep and thin. It can only be felt in deep level be pressing. If more strength is put, the pulse is vague.

DEEP, THREADY AND SOFT Qi and blood insufficiency. The pulse can not be replenished because of insufficiency of Yin-blood, and decline of Yang-Qi, which makes it impossible to push blood forward. Cardiogenic shock, heart failure and chronic consumptive disease. Insufficiency of effective blood volume or cardiac insufficiency and obvious fall of cardiac output, which makes blood vessels become thinner are the mechanism of weak pulse.

MINUTE PULSE : denotes a vessel that is thin and soft to the point of absence. Hammer calls this pulse feeble-absent.
It suggests deficiency of yin, yang, qi and blood. The minute pulse occurs because there is insufficient qi and blood to fill the vessel. If it is not felt with light touch, there is decline of yang. If it loses root, it represents exhaustion of qi or yin. Extensive vomiting, sweating or hemorrhage can cause this condition. It is also found in chronic degenerative conditions.

TIGHT PULSE ): denotes a pulse that is tense, has force, moves side to side and is twisted like a rope.

It occurs in the presence of cold, pain and food stagnation. The cold causes a sudden contraction of the blood vessels causing them to be uneven and move side to side. Tension and force may imply other excess patterns. When the tight pulse occurs in a deficient patient, the only evidence of the tight pulse can be the movement side to side. When there is pain, the tension is the dominant sensation, but the sudden nature causes the side to side movement. This pulse can be caused by sudden vasoconstriction, and sudden increase of cardiac stroke volume. It can happen in allergies, infections, and hernias.

MODERATE PULSE : denotes a pulse that is ideal in terms of form, process and trait. That is the shape is even, the rate is moderate and the waves come and go in a relaxed and even fashion. The vessel wall is neither hard nor yielding and the force is moderate.
It is the ideal pulse. It can represent morbidity if the pulse is sluggish, the movement feels slow. If it is connected to pathology, it can be correlated with qi deficiency, dampness, spleen and stomach deficiency, and chronic diseases. It suggests good prognosis in critical conditions.

MOVING denotes a pulse that is very short and urgent. It can be slippery or have rough vibrations. There is no arrival or departure. It is like a jumping bean. It is most often felt in the left middle positions.
This pulse occurs in the presence of intense pain, fright, shock or allergic reactions to medications. It can also be seen in pregnancy. The moving pulse is a sign of struggle between yin and yang.

RACING PULSE denotes a pulse that is over 140 beats per minute. It is an extreme condition.
If it is forceful, it is excess and likely indicates heat. If it lacks force it is a deficiency pattern with yin exhaustion and hyperactive yang. The pulse may be found in patients with hypertensive cariopathy, coronary heart disease, hyperthyroidism, myocarditis, pericarditis, auricular flutter accompanied with regular 2:1 atrioventricular block or junctional tachycardia.

CORRELATE PULSE WITH BREATHING
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.
Slow Pulse Three beats or less:
Rapid Pulse More than five beats:
Kontera456

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