The pulse: The three positions

What each finger reports

The three positions correspond to the three floors of the trunk, and the distribution of organs differs between wrists. It is a map that only works if the fingers are placed rigorously.

Position nearest the hand

upper floor: Heart and Lung

Central position

middle floor: Liver, Gallbladder, Spleen and Stomach

Position toward the elbow

lower floor: Kidney, Bladder and intestines

Left and right wrists

a different distribution on each

Common mistake: Reading the positions with the fingers badly placed. Without the bone landmark the map means nothing.

In which position would you expect the finding?

• Palpitations with light sleepNearest the handThe central oneThe furthest, toward the elbow
• Heavy digestion with distensionNearest the handThe central oneThe furthest, toward the elbow
• Chronic low back pain with night urinationNearest the handThe central oneThe furthest, toward the elbow
• Persistent cough with a weak voiceNearest the handThe central oneThe furthest, toward the elbow
• Irritability with flank painNearest the handThe central oneThe furthest, toward the elbow
• Weak knees and ringing earsNearest the handThe central oneThe furthest, toward the elbow

The pulse is normal in the two upper positions and clearly weak in the two lower ones. What does that suggest?

1. That the reading was badly taken
2. A weak base: the root is short even though the top still holds
3. That there is heat in the upper body

What do you do when a position says one thing and the rest of the examination says another?

1. Give more weight to the global impression and the other signs, and record the discrepancy for next time
2. Change the diagnosis to follow the position: it is the finest datum
3. Discard the position: it never informs

Order the positional reading.

1. Take the global impression of the wrist↑↓
2. Press one finger at a time, lifting the other two↑↓
3. Compare the three positions with each other↑↓
4. Repeat on the other wrist↑↓
5. Compare the two sides and record only what is reproducible↑↓

Why are both wrists always taken?

1. Out of habit: the pulse is the same on both
2. To take longer and convey calm
3. Because each wrist reports on different organs, and the comparison between sides is itself a finding