Pulse Diagnosis in Chinese Medicine: History, Doctrine, and How to Read the Pulse
libre
Pulse diagnosis in Chinese medicine is a diagnostic method that reads the state of the body by feeling the pulse at the wrist and other points, and it stands as the pinnacle of traditional Chinese diagnostics. The successes achieved in pulse research outpaced the corresponding branch of European medical science both in time and in content, and anticipated much of what is still used today.
What is pulse diagnosis and where did it come from?
Pulse diagnosis rests on the relationship between the pulse and the heart, which together form the organs of the cardiovascular system. The pulse and the heart are interrelated and inseparable in this view of the body.
The heart "drives" the blood through the vessels through all the organs, and this movement is manifested in the pulse, which thus makes it possible to determine the state of the body as a whole and its individual parts.
This theoretical interpretation was given to pulse diagnosis by Chinese physicians in the 5th century BC (more details: Development of Chinese medicine). Historians are fairly unanimous on this date. Folk tradition attributes the discovery of the pulse method of recognizing diseases to the name of Bian Que (read more: Medicine of ancient China), about whom there are many legends.
The chronicle "Shi-ji" ("Historical Notes"), belonging to Sim Qian, is the first work to summarize significant material and give a systematic picture of the history of China from ancient times to the end of the 2nd century BC. It narrates one of the most famous episodes attributed to Bian Que.
When the dignitary Jian Zi from the principality of Zhou and the prince of the principality of Gou fell into a prolonged faint, everyone thought that they died. Bian Qiyue happened to be in those places at that time. The first thing he did was to feel the pulse on the hands of the supposedly dead and by the pulse he was convinced that they were alive. With the help of acupuncture the famous physician cured both of them.
What does the early literature on the pulse contain?
An extensive literature on the pulse already existed in China by the beginning of our era. In 280 A.D., the book "Meitii" was published, in which Wang Shu-he described 35 types of pulse — an unusually detailed classification for the period.
How is the pulse examined? Technique and points
The pulse method can be performed at eleven different points on the body, though one is used far more than the rest. The recognized examination points are:
- the radial artery,
- the ulnar artery,
- the temporal artery,
- the arteries of the feet,
- the atrial region,
- three points on the aorta, reached by pressing on the abdominal walls,
- but most often the pulse is examined at the pulsation point of the radial arteries of the hands.
The radial pulsation point is, according to Chinese physicians, the "concentration point" of the pulse — "chen-kou". Such concentration points are held to be characteristic of all other processes occurring in the body, which is why this location carries so much diagnostic weight.
How does the physician position the hands and fingers?
Pulse examination is performed on both hands, but always starting with the right. The doctor feels the patient's right-hand pulse with his own left hand, and the patient's left-hand pulse with his own right hand. The patient places the hand palm upwards, resting the lower forearm and upper hand on a special pad — a measure as original and remarkable as the use of both hands for the purpose.
The physician places three fingers on the artery — the ring finger, middle finger, and index finger — while the thumb rests on the posterior lower surface of the forearm. The pulse is not examined with all fingers at once, but with each of the three fingers in succession.
Where are the classic pulse points located?
- The middle finger determines the pulse at the point "guan mo", located on the palm side at approximately the level of the styloid process of the radius. "Guan mo" means "obstructing the pulse", a name chosen to emphasize the median position of this point between the other two — "jin mo" and "chi mo".
- The index and ring fingers examine the points called "inch" ("jin mo") and "foot" ("chi mo"). In the inch — the phalanx of the middle finger — the distance is measured from the point "jin" to the end of the wrist bone of the thumb; in the foot, the distance is measured from the point "chi" to the elbow crease. These are the locations of the classical points.
What does each pulse point indicate?
Each of the three points corresponds to a region of the body in Chinese pulse diagnosis. According to Chinese doctors:
- a pulse at the jin point indicates a condition in the upper body,
- the guan point indicates the middle part of the body,
- and the chi point reflects the organs in the lower third of the body.
Because the organs lie at different depths, Chinese physicians varied the force of finger pressure to change the "depth of penetration" into the body. Three levels of pressure are distinguished:
- very light pressure — "tui" — gives information about the external organs closest to the surface,
- medium pressure — "xun" — about organs of medium depth,
- and "an" — pressing the artery to the bone — gives an idea of the organs hidden deepest in the body, up to the bone marrow.
How does the individual approach shape pulse examination?
The principle of an individual approach to the patient runs through every part of pulse research, applied with the same methodicalness and consistency that marks how the theories of Chinese medicine are put into practice in China. The reading is adjusted to the body in front of the physician rather than treated as a fixed procedure.
In people of small stature, the fingers are placed more tightly together for pulse examination, while in those of large stature they are placed further apart — the moment where the "inch" and "foot" measurements prove useful.
A further striking instruction is that the pulse is timed not by the clock but by the patient's breathing, even though the Chinese were among the first to measure time accurately — in the Zhou era, around the 8th–7th centuries BC, they determined the length of the year as 365.25 days. Each pulse count lasts for nine complete inspirations.
The norm was recognized as 3–5 pulse beats for each full respiratory cycle. A more frequent pulse was explained as an increase, and a slowed pulse as a decrease, in body temperature, each carrying its own diagnostic value. Chinese physicians attributed a faster pulse to the prevalence of "heat" — the active, strong beginning — and a slower one to the prevalence of "cold" — the passive, weak beginning. There is a clear correspondence here between ancient Chinese and modern points of view.
What properties of the pulse are assessed?
Pulse examination determines a defined set of properties: frequency, rhythmicity, filling, tension, and the size of the pulse wave, while comparing the pulse on both hands establishes its simultaneity and similarity. These are the same measurable qualities modern clinicians recognize.
Chinese medicine seeks to establish several additional qualities beyond these: the depth of the pulse, its "vigor", its compliance or inconsistency with the general condition of the subject and the syndrome of the disease, and the presence of the "root" of the pulse.
What is the "root" of the pulse?
The "root" of the pulse is the concept that the pulse, like all phenomena, has a deep, sustaining foundation. Chinese physicians — Wang Shu-he among the first — located the root pulse at the point "chi" on the hands and at three points on the legs, taking great interest in the types of pulse found on the legs.
A pulse considered "not indigenous" is one palpable under light pressure "ju" but disappearing under strong pressure "an". The disappearance of the pulse at the "root" points is regarded as a prognostically very unfavorable phenomenon.
What does the depth of the pulse reveal?
The depth of the "laying" of the pulse is assumed in advance to differ according to a person's complexion, character, sex, and the time of year and day. It is read as a baseline that varies from one individual to another rather than a single fixed value.
Obese individuals are characterized by greater depth and thin ones by less; in the period of the winter equinox the pulse "lays" deeper than in summer. It is also deeper in people of a closed, balanced, calm character than in those who are egoistic, vain and restless. A more superficial pulse is observed in men, a deeper one in women.
In general, everything characterized by the predominance of female "yin" corresponds to a greater depth of "laying" of the pulse, while the male "yang" corresponds to less. If the patient's pulse depth does not correspond to the disease, this too is regarded as an unfavorable symptom.
What does the "vigor of the pulse" mean?
A disturbance of the "vigor of the pulse" is likewise considered an unfavorable symptom. This definition only partly coincides with the strength of the pulse; it implies rather a pulse that is sufficiently full, rhythmic and moderate in frequency.
Where Western practice distinguishes the jumping, dicrotic, or alternating pulse by a defined set of properties, Chinese medicine uses these definitions more widely and developed the doctrine of pulse types far further. It counts several hundred shades in all, with at least 74 prescribed for practical use — the sum total of more than two thousand years of work by the physicians of China since the time of Bian Que.
Which pulse is considered "moderate"?
The "moderate" pulse is regarded as the one most consistent with the norm. It is four pulse waves passing calmly in one respiratory cycle, with a medium depth of occurrence, medium frequency and medium filling.
This type is a kind of exception among the huge number of other forms, in that it has no "opposite pair". It is difficult to say exactly what explains this principle of classification — perhaps the same dialectically competing "yang" and "yin" — but the fact is indisputable: all other forms of pulse are described as "opposite pairs".
What are the main types of pulse?
Six basic types of pulse are arranged in pairs: superficial and deep, frequent and infrequent, free and astringent. Many other types are also represented in pairs, of which only a few examples can be given:
- full and empty,
- overt and covert,
- long and short,
- soft and hard,
- tense and diffuse,
- fast and slow, and so on.
These names largely speak for themselves, and practitioners of Chinese medicine recognize so many types of pulse that it is not possible to enumerate them all.
What is the paradoxical pulse?
The paradoxical pulse is a group of seven pulse forms regarded as prognostically unfavorable, each carrying its own vivid, often metaphorical name in keeping with the Chinese language:
- "cho jo" (the nibble of a bird),
- "wu li",
- "xia yu",
- "tan shi",
- "yu xiang" (fish swimming),
- "fu fei",
- "tei su" (untying a knot).
Having discovered any of these paradoxical types, the physician feels obliged to treat the patient with great caution. An unfavorable prognosis is also established when there is a discrepancy between the type and nature of the pulse on one hand and the condition of the patient on the other.
Chinese physicians seek to establish the adequacy or inadequacy of the pulse to the general syndrome of the disease — a position that deserves special attention. It proves the desire of Chinese physicians to consider the totality of the phenomena under study, rather than limiting themselves to the pulse method, in which some are inclined to see almost the only means of Chinese diagnosis.
While Western specialists have largely narrowed the field of investigating the adequacy and inadequacy of the pulse, Chinese medicine still uses these signs widely in establishing prognosis. The adequacy of the pulse to the existing clinical syndrome is treated as an important and favorable prognostic sign, while inadequacy is treated as a phenomenon suggesting a very severe course of the disease.
How does the pulse guide the prescription of therapeutic agents?
The principles of pulse diagnosis are used directly to guide the prescription of therapeutic agents, with Chinese physicians choosing drugs based on the patient's general condition together with the state of the pulse. The same complaints can call for opposite treatments depending on the pulse:
- A patient who complains of chills, headache and fever, and who also has a tense "floating" pulse, is prescribed strong diaphoretics.
- With the same complaints but a weak "floating" pulse, those drugs are considered contraindicated, and strengthening, cardiac means are prescribed instead.
The whole system of pulse diagnosis is practically inseparable from the doctrine of indications and contraindications for particular therapeutic agents. With a frequent and imperceptible pulse, acupuncture and moxibustion are contraindicated; with a deep and tense pulse, diuretics and laxatives are recommended.
Through the in-depth development of the doctrine of the pulse, Chinese doctors were long ahead of the medicine of many countries, achieving markedly better results in recognizing diseases through this method of diagnosis. The accumulated data are well worth the interest of modern medicine, which may yet draw on them to enrich contemporary clinical diagnostics.
