PULSE ASSESSMENT

The "Secret" of Chinese Pulse Assessment

By Barbra Esher, AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc

It is generally agreed there are 28 main pulse qualities that can be identified in the 12 different pulse positions (there are many more positions and qualities in the book mentioned above). For the purpose of Asian Bodywork Therapy (ABT), I start students with qualities related to the Eight Principles and the Five Elements.

The Eight Principles is a method of pattern identification, with some elements dating back thousands of years to the Huang Ti Nei Jing and the Shang Han Lun. However, it was formulated into Interior/ Exterior; Hot/Cold; Full/Empty; and Yin/Yang in the early Qing dynasty (late 1600s). It is a useful system for unraveling the genesis and nature of just about any disharmony.

Exterior/Interior identifies the location of the problem, not the etiology. An Exterior condition affects the skin, muscles and/or meridians. It is categorized as Interior when it primarily affects the organs and bones. An Exterior condition can arise from an external pathogenic factor, or it can come from an internal problem and vice versa. Interior/Exterior only describes the location at the moment the pulse is taken. Simply, an Exterior condition manifests as a Floating pulse. It is a pulse felt at the superficial level, using light pressure. An Interior condition is felt with more pressure and is called a Deep pulse.

Hot/Cold describes an aspect of the nature of a pattern. Clinically, Hot manifests as a Rapid pulse. Traditionally, the pulse rate was measured in relation to the practitioners' breath, but for consistency's sake, it might be better to use a watch. Rapid is roughly over 80 beats per minute. Children run a little hotter, temperature wise, than adults; their pulses are more naturally rapid, which doesn't necessarily indicate pathology.

Cold is usually considered less than 65 beats per minute and is described as a Slow pulse; however, someone who is athletic typically has a Slow pulse. In that case, it is not necessarily a cold condition. Interestingly, regular exercise tends to "chill us out," so these people may be treating their hot natures, bringing themselves and their pulses into a more relative balance.

Full/Empty may be the easiest conditions to relate to a pulse type. These conditions are sometimes referred to as Excess/Deficiency, and manifest as Full and Empty pulses. A Full pulse can be a specific pulse often described as hard and rather long, extending beyond the normal pulse position. It also can be used to describe any pulse type that has a bigger, more substantial feel under the fingertips. An Empty pulse indicates a lack of something, such as Qi, Blood, Yin or Yang, and is referred to as a Deficiency. It occupies a shorter space and has a less substantial feel to it. It is used also in the general sense to describe a whole range of different deficiency type/weak pulses.

Yin/Yang can describe a generalization of the other six principles; therefore, a condition that is entirely Yin would be Interior, Cold and Empty. The pulse quality is a combination of Deep-Slow-Weak. A Yang condition is Exterior, Hot and Full; thus, the pulse for a strictly Yang condition is Floating-Rapid-Full. Yin/Yang are more frequently used to describe conditions of emptiness, commonly called Yin or Yang Deficiency. If there is not enough cooling Yin, it is referred to as a Yin Deficiency. This condition is Hot and Empty, manifesting as a Rapid-Empty pulse. If there is not enough warming Yang, it is called a Yang Deficiency. The condition is Cold and Empty, and the pulse appears Slow-Empty. So, in a way, there are only six main pulse types - all of the other qualities being variations of these six.

The pulse quality left out of the table is called a Leisurely or Slowed-Down pulse. It is about the same strength in every position: not too strong or weak, and with a moderate rhythm and rate. This pulse indicates a fairly balanced and healthy individual, and so far, I have never felt it with anyone coming into my clinic! Maybe it was more common in ancient times?

A good way to learn five common pulse qualities is by relating them to the Five Elements and the Yin organs that relate to each one:

The pulse qualities outlined in this article are the simplest to begin with. The more that pulse assessment is consistently practiced, the more the information received will make sense. Get started!