1. PULSE DIAGNOSIS AAC WEEKLY ROUNDS Carlos Alvarez, BBA Dr. Fayi Wu Physician Supervisor

2. Pulse Diagnosis in TCM Acupuncture Theory Pulse and tongue diagnosis are two of the more important diagnostic tools in Chinese medicine. They are both used to derive a TCM diagnosis for your condition which is used to plan your treatment. Of the diagnostic tools, pulse diagnosis is one of the more important tools used in Chinese and Japanese acupuncture and herbal medicine. While tongue diagnosis provides valuable clinical information, the pulse can be used to gain a deep understanding of the patient on many levels. "Mastering" pulse diagnosis is difficult without the guidance of a skilled teacher. Even at basic levels, however, the pulse provides immediate and specific information that can help clarify contradictory diagnostic information and symptomology.

3. Common Pulse Locations and Related Meridians Alternative Meridian Relationships Pulse Levels Pulse Descriptions, Qualities and Clinical Significance Description of a Healthy ("Normal") Pulse Influential Factors Sources Acupuncture Theory Related Resources Discuss Acupuncture Theory COMMON PULSE LOCATIONS

4. Left Wrist Right Wrist Cun (inch) - 1st position HT / SI LU / LI Guan (barr) - 2nd position LV / GB SP / ST Chi (foot) - 3rd position KD / UB PC / TH Location of the Pulse: The Guan (Second) Position is found opposite the styloid process of the radius, the Cun Position is found between the Guan Position and the wrist and the Chi position is found at a point equal the distance between Guan and Cun. Common Pulse Locations and Related Meridians

5. Alternative Meridian Relationships Pulse Classic: Left Wrist Right Wrist Cun (inch) - 1st position HT / SI LU / LI Guan (barr) - 2nd position LV / GB SP / ST Chi (foot) - 3rd position KD / UB Mingmen / Lower Burner Golden Mirror of Medical Traditions: Left Wrist Right Wrist Cun (inch) - 1st position HT / PC LU / Chest Guan (barr) - 2nd position LV / GB SP / ST Chi (foot) - 3rd position KD / LI / SI PC / TH

6. Alternative view used in China: Left Wrist Right Wrist Cun (inch) - 1st position HT LU Guan (barr) - 2nd position LV SP Chi (foot) - 3rd position KD Yin KD Yang Clinical significance of the Pulse at varying levels: superficial (skin level) - generally shows exogenous pathogens middle - generally shows state of ST/SP Qi deep (bone level) - generally shows internal conditions

7. Pulse Descriptions, Qualities and Clinical Significance Designation Sensation Indications

8. By Depth: Floating (superficial) easily felt at the superficial level not as significant as you feel deeper external condition/pathogen + empty = yin a/or blood deficiency + rapid = wind heat + tight/slow = wind cold

9. Sinking (deep) felt only at the deep level interior condition/obstruction + rapid = internal heat + slow = internal cold + slippery = internal damp/phlegm + empty = qi or yang deficiency

10. By Frequency: Slow less than 4 beats per breath (< 60bpm ) cold condition a/or pathogenic factor + floating = exterior wind cold + sinking/empty = yang def

11. Rapid more than 5 beats per breath ( > 90bpm ) hot condition a/or pathogenic factor + floating = external wind heat + sinking = internal heat + full = excess heat + empty = empty heat

12. By Quality/Shape: Hesitant (choppy) rough and uneven blood a/or jing stagnation Slippery smooth with a viscous sensation excess dampness, retention of food, pregnancy + rapid = damp heat + slow = cold damp obstruction Tight tension with side to side movements (thicker than a wiry pulse) excess cold - interior or exterior, commonly associated with pain Wiry tension with no side to side movements (thinner than a tight pulse) LV/GB disharmony

13. By Width: Big (excess, overflowing) broad but with distinct edges excess heat, commonly in ST or Intestines Thin (thready, fine) fine but with distinct edges blood a/or qi deficiency By Strength: Empty (deficient) wide but not strong, disappears with slight pressure, forceless blood a/or qi deficiency Full (excess) wide and strong, felt with strength at all levels excess condition, often excess heat with rebellious Qi By Length: Short not felt in all 3 positions qi deficiency Long felt beyond the 3 positions excess, heat, generally considered normal in absence of other qualities By Rhythm: Hurried (abrubt) rapid with irregularly missed beats heat agitating qi & blood Intermittent regularly skipped beats heart disharmony, exhaustion of zang qi Knotted slow with irregularly missed beats cold obstruction, ht qi or yang deficiency, general def of Qi, Blood a/or Jing

14. Description of a healthy ("normal") pulse The pulse should be felt in all 9 positions The quality of the pulse should have "spirit" and not collapse or feel hard or unyielding The rhythm should be even and balanced and regular beats of 60- 90bpm Factors which influence the Pulse Age - the strength and quality of the pulse will decline as a person ages. Gender - Men are generally stronger on the left and Women are generally stronger on the right. Seasonal Influences: Spring - more wiry Summer - stronger Winter - deeper

15. QUESTIONS? Thank you Carlos Alvarez, 2 nd phase Oriental Medicine