All lessons Module 2: Pulse Lesson 4
Rate and rhythm
How fast, how regular, and when is a rhythm a reason to refer?
After this lesson you count a pulse with your breath and by the clock, you tell eight qualities of rate and rhythm apart with the four-step check, you set the rate against Heat and Cold with the strength alongside, you know what training, medication, fever, the thyroid and coffee change in the rate, and you refer every irregular pulse for an ECG first.
Know by heart
- Counting. Four to five beats per breath of your own is normal, about 60 to 90 per minute. Also count by the clock: half a minute times two, and a whole minute as soon as the rhythm falters; mnemonic: breath and clock, two watches.
- Slow and rapid. Slow: fewer than four per breath, below 60; Cold, with strength Full, without strength Yang deficiency. Rapid: more than five, above 90; Heat, with strength Full, thin and without strength Empty; mnemonic: the rate says how warm, the strength says full or empty.
- Moderate, hurried, moving. Moderate (calm): four per breath, supple; healthy, slack with Dampness or Spleen deficiency. Hurried (racing): seven to eight, around 120 or more; extreme Heat or collapse. Moving: short, smooth, rapid, a trembling bean at guan; fright and pain.
- Three pulses that stop. Hasty: rapid, stops at unpredictable moments. Knotted: slow, stops at unpredictable moments. Intermittent: stops at a fixed count, with a long pause; mnemonic: stumbling fast, faltering slow, pausing on the beat.
- The ECG rule. Every pulse that stops or is irregularly irregular goes to a GP or primary care doctor for an ECG first. Only after that a TCM name.
- Context first. Training and beta blockers slow the pulse. Fever (just over eight beats per degree Celsius), an overactive thyroid, blood loss, stress and exertion speed it up; mnemonic: first what the body is doing, then Heat or Cold.
- Red flags. At rest 120 or more, or below 50 with dizziness or fainting: the same day. With chest pain, breathlessness or fainting: emergency services (112 in Europe, 999 in the UK, 911 in North America). Rapid and weak after blood loss: emergency.
The rest of this lesson is reference.
Three practice questions from this lesson
You breathe calmly, about 15 times per minute, and count five beats per breath. Around which rate is the pulse?
- Around 75 per minute
- Around 50 per minute
- Around 110 per minute
Answer: Around 75 per minute. Five times fifteen is 75: a normal rate. With faster breathing of your own, the same number per breath would come out higher; that is why you also count by the clock.
Why do you count a faltering pulse for a whole minute?
- Because in half a minute you miss the pauses and the count
- Because the pulse only gets going after half a minute
- Because you then also feel depth and strength better
Answer: Because in half a minute you miss the pauses and the count. With an irregular pulse, half a minute times two is too coarse; also count how often a beat drops out and whether that happens at a fixed count.
In a 19-year-old the pulse speeds up on the in-breath and slows on the out-breath; a beat never drops out. What is it?
- The ordinary variation with breathing
- Knotted: faltering slow on the out-breath
- Hasty: stumbling fast on the in-breath
Answer: The ordinary variation with breathing. Knotted and hasty really stop. A rate that rises and falls with the breath without a pause is normal, especially in young people.
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, 21 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 2: Pulse.