All lessons Module 2: Pulse Lesson 8
The pulse in context
What changes a normal pulse, and how do you read a pulse that changes?
After this lesson you first set every pulse beside its circumstances (season, time of day, build, age, sex, training, exertion, meals, emotion, cycle and pregnancy, medication, the vessel itself), you can tell a slow training pulse from a slow pulse of Cold, you read a pulse as a gauge over time (acute versus chronic, favourable versus unfavourable), and you know when not to interpret a pulse.
Pulse report
| Depth | at all three levels, fullest in the middle |
|---|---|
| Rate | about 66 per minute (normal) |
| Rhythm | regular |
| Width | normal |
| Length | across the three positions |
| Strength | pushes back calmly |
| Smoothness | supple and even |
| Tension | supple |
Pulse report
| Depth | at all three levels, fullest in the middle |
|---|---|
| Rate | about 98 per minute (rapid) |
| Rhythm | regular |
| Width | normal |
| Length | across the three positions |
| Strength | pushes back calmly |
| Smoothness | supple and even |
| Tension | supple |
Pulse report
| Depth | strong at all three levels |
|---|---|
| Rate | about 82 per minute (normal) |
| Rhythm | regular |
| Width | wide |
| Length | beyond the three positions |
| Strength | pushes back strongly |
| Smoothness | supple and even |
| Tension | supple |
Pulse report
| Depth | only with firm pressure |
|---|---|
| Rate | about 62 per minute (normal) |
| Rhythm | regular |
| Width | normal |
| Length | across the three positions |
| Strength | pushes back calmly |
| Smoothness | supple and even |
| Tension | supple |
Pulse report
| Depth | at all three levels, fullest in the middle |
|---|---|
| Rate | about 88 per minute (normal) |
| Rhythm | regular |
| Width | normal |
| Length | beyond the three positions |
| Strength | pushes back calmly |
| Smoothness | even |
| Tension | taut and straight, like a string |
Pulse report
| Depth | at all three levels, fullest in the middle |
|---|---|
| Rate | about 86 per minute (normal) |
| Rhythm | regular |
| Width | normal |
| Length | across the three positions |
| Strength | pushes back calmly |
| Smoothness | rolls smoothly, like pearls under the finger |
| Tension | normal |
Know by heart
- Context first, then the pulse. Let the client sit for five to ten minutes and ask about food, coffee, smoking, exertion, medication, cycle and pregnancy; preferably feel in the morning, before eating (Su Wen 17); mnemonic: who, when, what came before.
- Who: what belongs to the person. Slim more superficial, heavy deeper, tall longer; children faster, older people often harder or weaker; endurance athletes slow and strong; the artery can run differently; mnemonic: the pulse fits the body.
- When: what belongs to the moment. Spring slightly taut, summer fuller, autumn slightly lighter, winter deeper; by day more superficial, at night deeper; after food or exertion faster and fuller, when hungry softer; anger wiry, fright moving (shaking, trembling like a bean).
- The slow pulse. Strong, rooted, without cold or symptoms: training. Deep, weak and slow with cold: Yang deficiency. Slow but strong with Heat and a full, painful abdomen: stuck Heat (textbook, and medical first). Always ask about medication first.
- The pulse as a gauge. It changes in hours to days, faster than the tongue body. Favourable: calmer, more supple, more regular, with a stronger root. Unfavourable: a pulse that does not fit the disease, such as an exhausted, long-ill client with a sudden large, hard or superficial pulse without root.
- Do not interpret. After exertion, coffee or smoking, in panic or in pain; with an irregular pulse (an ECG first); not the rate with a drug or pacemaker that fixes the heart rate; not on an arm with a dialysis fistula.
- Red flags. At rest below 50 with dizziness or fainting, or above 100 without explanation; irregular; suddenly different with chest pain, breathlessness or neurological deficit; late in pregnancy, headache with seeing spots.
The rest of this lesson is reference.
Three practice questions from this lesson
Case. Rower of 27, trains daily, warm hands, no symptoms. Resting pulse 42, regular. He asks whether his slow pulse points to Cold. Which finding says most clearly that it is training?
- The strength and the root of the pulse
- The rate below 50: Cold rarely makes it this slow
- That he is young: young people have no Cold
Answer: The strength and the root of the pulse. The rate is slow in both training and Yang deficiency, so it separates nothing. A firm pulse that stays on deep pressure, warm hands and no symptoms do separate them. Full-Cold would be strong and tight, with cold, pain and an acute onset.
Case. Woman of 61, on a new drug for high blood pressure for three weeks. She is dizzy on standing up and briefly blacked out yesterday. Pulse 46, regular, soft. What do you do first?
- A GP the same day: check medication or conduction
- A GP within a week; meanwhile tonify Yang
- Rest and feel again in a week
Answer: A GP the same day: check medication or conduction. A new slow pulse with dizziness and blacking out shortly after a new drug is medical first: the drug or a conduction disorder. Beta-blockers and some calcium channel blockers slow the heart.
In a healthy client in February you feel the pulse clearly only on firm pressure; it is calm, even and rooted. There are no symptoms. What is most likely?
- A winter pulse: the Yang has drawn inwards
- An Interior pattern with Full-Cold: deep and calm
- Kidney-Yang deficiency: the depth says the Yang falls short
Answer: A winter pulse: the Yang has drawn inwards. In winter a somewhat deeper pulse is normal (Nan Jing 15). Without symptoms and with Stomach-Qi and root it is the season, not a pattern.
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, 17 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 2: Pulse.