Diagnosis: Pulse

Axes first, name afterwards

A pulse is not recognised by its name: you place it on four axes and the name follows. Starting from the names is what makes the pulse feel impossible to learn.

Depth

superficial ↔ deep

Speed

slow ↔ rapid

Strength

forceful ↔ weak

Contour

thin ↔ broad

Common mistake: Trying to memorise twenty-eight pulses before you can place one on the axes.

A thin, rapid pulse with no force. What does it describe?

1. Excess heat
2. Yang deficiency
3. Deficiency with heat

Three positions and three depths

Each wrist is read in three positions — near the wrist, middle, toward the elbow — and at three depths in each. You do not have to feel everything on day one: first compare whether one position stands out from the others.

Distal position, left wrist

Heart

Middle position, left wrist

Liver

Distal position, right wrist

Lung

Middle position, right wrist

Spleen and Stomach

Common mistake: Hunting for a pulse name at each position before you can compare positions with each other.

Match each position with the organ read there.

Sort each finding onto the pulse axis it describes.

• You have to press hard to find itDepthSpeedStrengthContour
• Over ninety beats per minuteDepthSpeedStrengthContour
• It collapses as soon as you pressDepthSpeedStrengthContour
• It feels like a very narrow threadDepthSpeedStrengthContour
• You feel it the moment you touchDepthSpeedStrengthContour
• Under sixty beats per minuteDepthSpeedStrengthContour

A clearly superficial pulse in someone with fever and aversion to cold since yesterday. What does it say?

1. That the problem is in the Heart
2. That the defence is fighting at the surface
3. That there is serious yang deficiency

A pulse that rolls under the finger, rounded and fluid, in someone with a thick greasy coating. What does it indicate?

1. Internal dryness
2. Blood deficiency
3. Accumulated damp or phlegm

A taut, long pulse with the feel of a guitar string. What does it point to first?

1. The Liver: something jammed, or pain
2. The Spleen: failing transformation
3. The Kidney: spent reserve

Order the steps of taking a pulse.

1. Let the patient settle for a few minutes↑↓
2. Place the three fingers on the three positions↑↓
3. Assess the overall pulse at the three depths↑↓
4. Compare position by position and wrist to wrist↑↓
5. Name what you found↑↓

Sort each pulse by the picture it suggests.

• Thin and weak in every positionDeficiencyExcess heatStagnation
• Rapid, full and forcefulDeficiencyExcess heatStagnation
• Taut as a string, especially on the leftDeficiencyExcess heatStagnation
• Deep and collapsing under pressureDeficiencyExcess heatStagnation
• Broad and overflowing past the fingerDeficiencyExcess heatStagnation
• Rough, dragging irregularlyDeficiencyExcess heatStagnation

A rapid pulse in someone who just ran up four flights of stairs. Do you record it as heat?

1. Yes: rapid is rapid
2. No: let them settle and take it again
3. Yes, but note that they were running

A pulse found only under pressure, slow and without force. Build the reading.

All positions normal except the left middle, clearly taut. What do you conclude?

1. That the overall pulse is wiry
2. That the reading was taken badly
3. That the imbalance is concentrated in the Liver

A pale, swollen tongue with a rapid, forceful pulse. What do you do with the contradiction?

1. Look for the explanation: usually a deficient base with something acute on top
2. Discard the pulse, which is more easily misread
3. Discard the tongue, which changes slowly

Match each pulse with the axes that define it.