All lessons Module 2: Pulse Lesson 1
Feeling the pulse: position, depth and technique
Where do you place your fingers, how deep do you press, and what does a healthy pulse feel like?
After this lesson you can explain why the pulse is taken at the wrist, you find the three positions and adapt your grip to the arm, you know the two common maps of the organs, you work with three levels and three movements to a fixed protocol, you recognise the features of a healthy pulse and the variants of the vessel, and you know which findings go to a doctor first.
Pulse report
| Depth | at all three levels, fullest in the middle |
|---|---|
| Rate | about 70 per minute (normal) |
| Rhythm | regular |
| Width | normal |
| Length | across the three positions |
| Strength | pushes back calmly |
| Smoothness | supple and even |
| Tension | supple |
Know by heart
- Why the wrist. At the cun kou, the Lung channel at the wrist, all the vessels meet (Nan Jing 1), and there the Stomach-Qi that nourishes all the organs shows itself (Su Wen 11); mnemonic: one artery, the whole body.
- The grip. Middle finger first on guan, next to the protruding bone on the thumb side; index finger on cun, towards the hand; ring finger on chi. Fingertips in one line, feeling with the pad; further apart on a long arm; mnemonic: middle on the bone, the rest follows.
- Three positions. Cun: above the diaphragm. Guan: diaphragm to navel. Chi: navel to feet (Nan Jing 18). In every map left Heart, Liver, Kidney and right Lungs, Spleen, Kidney (Ming Men); the Fu shift from map to map.
- Three levels, five depths. Light, medium, deep; in beans 3 Lungs, 6 Heart, 9 Spleen, 12 Liver, to the bone Kidneys (Nan Jing 5). You find the deep level by pressing until the pulse disappears and releasing until it just comes back.
- Three movements. Lifting (ju), searching (xun), pressing (an); first three fingers together (zong an), then each separately (dan an); on each side at least fifty beats or one minute; mnemonic: lift, search, press; together, apart; fifty.
- The healthy pulse. Shen: supple, with strength, regular. Stomach-Qi: calm and even, 4 to 5 beats per breath of your own, about 60 to 90 per minute. Root: felt at chi on deep pressure.
- Red flags. Pulse weaker or absent on one side: blood pressure on both arms, with a difference of 10 mmHg or more to a GP or primary care doctor. Cold, pale, painful or numb hand without a pulse: emergency services (112 in Europe, 999 in the UK, 911 in North America). Irregularly irregular: ECG. Rapid at rest with chest pain, breathlessness or fainting: emergency services (112).
The rest of this lesson is reference.
Three practice questions from this lesson
A colleague asks why you feel the pulse at the wrist and not at the neck. Which two classical reasons do you give?
- All the vessels meet there, and the Stomach-Qi shows itself there
- The Kidneys lie closest under the skin there, and the Heart opens there
- The pulse is fastest there, and you feel the Liver best there
Answer: All the vessels meet there, and the Stomach-Qi shows itself there. The cun kou lies on the Lung channel: there all the vessels meet (Nan Jing 1). The Stomach nourishes the Zang and its Qi appears at the wrist (Su Wen 11).
Case. You are taking the pulse of a tall man with long arms; your three fingers lie close together. What goes wrong?
- You miss the positions: spread your fingers to the arm's length
- Nothing: the distance between the fingers does not matter
- You feel too briefly: fifty beats are needed on each side
Answer: You miss the positions: spread your fingers to the arm's length. The positions scale with the arm: further apart on a long arm, closer together on a short one. With the fingers close together you miss chi or feel beside cun.
Why do you ease off the middle finger a fraction when you press equally with three fingers?
- The bone under guan makes that position seem stronger
- Because guan is the least important of the three positions
- Because the middle finger has a strong pulse of its own
Answer: The bone under guan makes that position seem stronger. Under guan lies the protruding bone; there you push the artery more easily against a hard floor, so that guan seems stronger than it is. The thumb has a strong pulse of its own, not the middle finger.
The rest of this lesson
In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 17 case-based practice questions, 19 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 2: Pulse.