The pulse: How it is taken

Before touching

脈診 mài zhěn

The pulse is the easiest sign in the whole examination to falsify, and it is nearly always the examiner who falsifies it, by rushing. Three calm breaths before starting change what you feel.

Arm

supported and at heart height

Timing

at rest, not just arrived and not after coffee

The examiner

calm too: hurry is contagious

Duration

at least a minute per wrist

Common mistake: Taking the pulse in the first thirty seconds of the consultation, with the patient still standing or just sat down.

Three fingers, three positions

The middle finger goes against the styloid process of the radius and the other two settle either side. The spacing adapts to the patient's build: on a small person the fingers sit together, on a tall one they spread.

Index

the position nearest the hand

Middle

the central position, against the bone

Ring

the furthest position, toward the elbow

Bone landmark

the radial process, always

Common mistake: Placing the fingers by eye. Without the bone landmark, the three positions move at every reading.

Three pressures, not one

You palpate at three levels and the finding is the comparison between them. A pulse that shows only on light touch and one that appears only under pressure tell opposite stories.

Superficial

brushing the skin: the exterior level

Middle

moderate pressure: the Stomach and Spleen level

Deep

pressing to the bone: the interior level

What informs you

at which level it feels strongest

Common mistake: Staying at one pressure. Without varying depth you cannot tell exterior from interior, or deficiency from excess.

Order the taking of a pulse.

1. Let the patient settle and settle yourself↑↓
2. Place the middle finger against the radial process↑↓
3. Take a global impression, varying the three pressures↑↓
4. Compare the three positions with each other↑↓
5. Repeat on the other wrist and compare the two sides↑↓

Does this falsify the reading or is it a finding to record?

• The patient has just walked up three flightsFalsifies the readingA real finding
• The pulse is thin and forceless after ten minutes at restFalsifies the readingA real finding
• They have had two coffees this morningFalsifies the readingA real finding
• The pulse clearly speeds up when one topic comes upFalsifies the readingA real finding
• Their hands are freezing from the cold outsideFalsifies the readingA real finding
• The left pulse is consistently weaker than the rightFalsifies the readingA real finding

In learning, why start with the global impression rather than the positions?

1. Because the positions inform you of nothing
2. Because whoever starts hunting for differences between fingers ends up inventing them, while the global impression is reproducible from day one
3. Because positions are only used in fast pulses