All lessons Module 2: Pulse Lesson 3
Depth and strength
How do you feel superficial, deep, full and empty, and how do you recognise their special forms?
After this lesson you read every pulse as a profile in three levels, you tell eleven qualities of depth and strength apart with the four-step check (how it feels, what it means, what you confuse it with, what decides), you know for each pair the technique that decides, and you know which of these pulses are medical first.
Know by heart
- Two questions. Depth says where (Exterior or Interior), strength says how much (Excess or Deficiency). Feel three levels, write down the profile, and only then give a name; mnemonic: first where, then how much.
- Floating and deep. Floating (superficial): distinct with light pressure, less with deep pressure, but not gone; Exterior, and when chronic and without strength, Deficiency. Deep: only with firm pressure; Interior, with strength Excess, without strength Deficiency; mnemonic: wood on water, stone on the bottom.
- Full and empty. Full: big and forceful at all three levels; Excess. Empty: big and soft, gives way under pressure; Qi deficiency; mnemonic: full pushes back, empty gives way.
- Four relatives on top. Soggy (soft): thin and soft, gone with moderate pressure; Dampness or Deficiency. Scattered: big, without edge or root, uneven; exhaustion. Hollow (empty stalk): middle empty, the wall returns in the depth; loss of Blood. Leather (drum skin): hard on top, empty underneath; loss of Essence or Blood; mnemonic: silk, fluff, stalk, drum.
- Three relatives in the depth. Weak: deep, thin and soft; Qi and Yang deficiency. Firm (fixed): deep, hard, broad and long; accumulation of Cold. Hidden: only against the bone; obstruction, or extreme Deficiency; mnemonic: soft, fixed, tucked away.
- The technique that decides. Soggy or weak: where does it lie? Leather or firm: where is the hardness? Hollow or empty: does the wall return in the depth? Deep or hidden: do you have to push the tendons aside?
- Red flags. Hollow or leather after blood loss, scattered or hidden in a client who is ill, a pulse missing at one arm with a cold, pale hand: medical first, often emergency services (112 in Europe, 999 in the UK, 911 in North America). Firm with a palpable swelling: a GP or primary care doctor.
The rest of this lesson is reference.
Three practice questions from this lesson
A pulse is distinct with light pressure. If you press deeper, it becomes less but stays; if you let go, it is back at once. Which quality?
- Floating
- Soggy
- Empty
- Scattered
Answer: Floating. Floating: abundant on top, less under pressure (Li Shizhen). Soggy is thin and gone already with moderate pressure; empty is big and soft and yields everywhere; scattered fades with medium pressure and is gone in the depth.
You press through a big, soft pulse and just above the bone you feel a wall again. What distinguishes this pulse from empty?
- The wall that returns in the depth: it is hollow
- The rate: empty is slow and hollow rather rapid
- The length: hollow is shorter than empty
Answer: The wall that returns in the depth: it is hollow. Hollow is a hollow stalk: an empty middle with a wall. Empty only becomes softer and emptier under pressure, without a wall underneath.
What does a pulse mean that cannot be felt with light pressure and is thin and soft in the depth?
- Qi and Yang deficiency
- Dampness on the Exterior
- Accumulation of Cold
Answer: Qi and Yang deficiency. Deep, thin and soft is weak: Qi and Yang deficiency. Dampness on the Exterior gives soggy (on top) rather; accumulation of Cold gives firm (deep and hard).
The rest of this lesson
In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 18 case-based practice questions, 24 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 2: Pulse.