Hi Dan -

The map is not the terrain. I must understand the reason for what I palpate. For instance, I had a patient with a slow pulse, but no other confirming signs of cold. I finally discovered that the man had exposure to heavy metals in factory settings. I used agents such as mu zei, gan cao, jin yin yua and tu fu ling. I also asked him to increase his garlic consumption so that the sulphur content would assist in binding out the metals. As you can see, this collection of medicinals is on the cool side, yet his pulse corrected over a six week period. This suggests that the heavy metal scenario was correlated with the slow pulse since the herbs were intentionally designed to bind out metals.

There are three issues here. First is the sensation of the pulse. Second is the name that we assign to the impression. The third is the meaning that we assign to the events that we observe and name. So, in essence, I attempt to keep my thinking parsed out in terms of the sensation, the label and the interpretation. In other words, I don't label a pulse 'hot' or 'cold.' I will label it according to the conventional labels listed below as an expression of the state approved knowledges in TCM universities of China. The family lineage traditions have many other terms for identifying thermal elements.

The pulse may be paradoxical. In other words the jin mai (tight pulse)  will vibrate side to side whereas the pulse crest in the presence of heat  will tend to hit straight on (this phenomena is not discussed anywhere in the literature and is based upon my 28 years of clinical experience). This is because the heat causes slight relaxing of the vessel and the wave peaks in the same spot, given other normal factors. When it comes to rate, the mixing of hot and cold, yin and yang may result in a normal rate. Rate can be unreliable as a determinant of hot and cold in complex conditions.

Hongºé    Surging/Overflowing/Flooding Broad, large and forceful A pulse beating like dashing waves with forceful rising and gradual decline   
Excess heat. Excess heat syndromes are rarely difficult to detect, so this pulse type adds little information. The force of the pulse indicates that the condition is pathologically excessive, the gradual decline shows that the syndrome is primarily one of heat (qi excess) rather than fluid excess.

Chi ³Ù    Slow Pulse is less than 60 beats per minute.(4 beats/breath)    A pulse with reduced frequency (less than 60 beats per minute)    Cold syndrome
A slow pulse may also indicate a person at rest who normally has a high level of physical activity, so must be interpreted in light of other diagnostic information.

Shuo Êý    Rapid/ Fast > 90 beats/min. £¨5 beats/breath£©    A pulse with increased frequency (> 90 beats per minute)    Heat syndrome
The rapid pulse is quite a bit more rapid than a normal pulse, and usually occurs only when there is a serious illness and mainly when there is a fever. The pulse can become rapid from activity prior to pulse taking.

Shi ʵ    Full/ Replete/ Forceful/ Excess Pulse can be felt strongly on all three levels    A pulse felt vigorously and forcefully on both light and heavy pressure    Excess/heat
This pulse gives relatively little information other than that the condition is one of excess; one must further determine the nature of the excess in order to select a therapeutic strategy. This pulse, however, generally rejects the use of tonification strategies, as it indicates that the body resistance is undamaged.

Jin ½ô    Tight/Tense Tight, forceful like a stretched rope A pulse felt like a tightly stretched cord    Cold, pain, food retention
This is similar to the wiry pulse, but not as long. While pain can be easily reported, a cold syndrome is sometimes disguised by localized heat symptoms; this pulse can indicate either exterior or interior chill.

Chang³¤    Long Straight/ beyond position    A pulse with lengthy extent and prolonged stroke Excess Yang Qi/Heat
Particularly in young people, the pulse is felt rather easily across all three finger positions, as is characteristic of the long pulse. The prolonged stroke shows that the vessels are both strong and flexible. A stringy quality indicates a certain level of tension, that corresponds with a liver syndrome. In cases of acute disease, a long pulse will occur when there is a strong confrontation between the body's resistance and the pathogenic factor.

Will





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Warmly,

Will


William R. Morris, DAOM, MSEd, LAc
http://theccrt.com/
http://www.aoma.edu/
http://www.pulsediagnosis.com/

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