c

Why PulsEs?
ASM 202 r Intemal organ involvernent
t All organshave a connection to lhe pulse
Lecture4 & 8 s Reflection of Stomach Qi

September281h,2006 r Localion ofpoints

c Diagnosis
October261h,2006
c Prognosis
NeemezKassam,M.Sc.,N.D., R.Ac.
! Treatment value
r Prevenrative Care- 4ffg_fl4rgvqq12
G,A-r S\n

Ocf 26^cls\^5etl r1^"$ir--t;;g*"W'o*'

C}.DE
Ft n(lEPS
Rorecr rute P\U,SE
Pulses Palpation @
F*\tacrruS
on rced^a.,* ^"-"t s Location,
location,location
pot+z,,enf

: Pulsesare normally palpatedon the radial arteryby the

wrist.
kfi Riuht
c Procedure:
Cun Hearl Lung l - Lcate the styloid process of the radius using rhe opposite
.tl Guan Liver Spleen hand frcm the one yo are palpating.
chi Kd Yin Kd Yans 2- This marks the spol for your middle finger.
t
3. Your index and ring finger should fall on tbe first and
third positions respectively.
f \?\h+ StAr- -ro,\o1rzqi a.;1* 4- Be sure to leave enough room betwen fingen based on
' -€r^4^+ptac:! the size ofthe palient. More room for taller and hss room
for shoner palienls.

qnncs \,itd\ cdl

t4€+-- tt.,ool-q
t4t+ btoo-cl * ,ran rrra\.g-
,,.,t<ye-\c^r>c- l-+Ta;i,,\d,
qj tS .^f ''r\oRgr-a"-lq 4+Pr^tt P*la+'t Gna"otcf
-
uc,tjr--x sr.1ct-T .e t-, . ?-.-J*t""*.6".,,,1."q3
,Sg^'"1^td*t3'Ar * OtSrtt*
Palpation Palpation
5. Once you havc located th€ 3 positions, arch your fingen a Technique
as though you are playing a guirar or vblin. The rips of e After arching your fingers onto the radial artery ofboth
your frrngers arc more s€nsitivc than the pads. You can fel hands, compare the two sides-
subtlc chmgcs in rhe pulsc wirh this technique. s With all three fmgers staying on the same l,evel, begin
6. The I st position is known as the cun tbe 2nd as the guan palpating th€ superficial level than middle followed by
and the 3rd as thc chi deep.
c You are looking for pulses that sand out for being
different from tbe others at that level-
s Now you can palpate the crur pulse at all 3 levels.
Remember &at if one of these pulses stood out fiorn
earlier, you may waot to palpate anotber putse at the sanrc
tinte as a poinr ofrefererrce-
e Follow the same procedure for tbe guan and chi pulses.
 \

\,*r".{

Palpation
puts*
. NomatVariarionsof . c lnitial Variables
6gnAlV.0-A-'
o Athletesarcslowq s Speed
l Wom re softer & fasts c Fast: >90bpm= Heat
. Chaldm arc fastq <60bpm: Cold
r Slow:
t Hsvier ser individual will be deep& slow
r Moderate:60 90 bprn
. Thin sei individual will bc superficial , . ',t I
r Fasring *,,, n"r. dIo"n"i*u**a
individua," -{'-n'fa c Depth
u!rr!'!rn'rLo^ ot*
Pu'-
e
||c{vec$ c Superficial- Yang - E*t.riorT/ d tA
seasonal changes
. Spring-w@dEtemt-wi1v s Middle - Nomat 5? :i L\V
[U- r*tZAW
i Summs - Fire Elercnt . Floodingf i, Deep- Yin - Interior \4.a: c>,rr -&iT'l^ol sldf-
d btc summer- EarrhElement- StippetyITFSP c lntensily
t Autum - Maal Elcment- noatingargf€ C€ L'LL r srrong_ Excess
,<\-\
- ' A SCcL\a
G wiDttr- wats Element - Sinking
\efpCrC.ra (AC-aO"
l r Weak- Deficiency

i -.-e-.v- 7 -rvr-&:-c*o
c)( Z

3-'€{rrr5rlsL

Cb^ rnc>a.c Types of Pulses

Types of Pulses
Vi{\,l.) -'^ttt\ c Slow
Gltl floating Cwtl GCLI S\.LpaJ-Ao\<,^J:Jh c Cold syndrome. Can be excessor deficient.
s Exterior, Yang syndmme. Exterior influencesare tBh. c < 60 bpm or < 4 beats per breath.
excessin nature. .-F/.r:t c-\t A$t. s-V-r-v- r Slow& Forceful= Coldexces \ .
s May also be an int#or deficiency whercby lhe yin is not r Slow& Weak= (YangXu)
Colddeficiency lt
rooting the yang and it is floating up. e Rapid 6f,5
s Felt only at thesuperficiallewl. s Heat syndmme. Can be excessor deficient- .
q ---(.^:
r Sinking c > 90 bpm or > 5 beats per breath
o Interior, Yin syndmme. Can be deficient or excess. t Rapid& Forceful: HeatExces
C
e Rapid& weak = HeatDeficiency(Yin Xu)
o Deep& weak= InteriorDeficiency
o Swift
c Deep& Strong= InteriorExcess
c Extreme heat and yin exhaustion- Nearing Qi collapse.
s Only felt on deeppalpation-
c 140 -180 bpm or 7-8 beatsper breath. ( jqul ,;v urz-Vr

J'^trt
Typesof Pulses tnooc Tvpes
'^ of Pulses *^Atft"
b\oJAsf
(Y,or€ €IOr\)=
ir5"*
c Errytvb o^.r-tr. i.c-\.e!.O
s Deficierrcy syndmme. Can be Qi, Blood, Yang or Yin.
e Checkwith theS". Ld,e<-on 't
\e(.-\.rrr. .r.\u
Spcr{rg
)\'l<. \-\1 tL ,
e Hollow/Onionstalk(q41'gqyracrrorrr)
\-bro\et.r
\- Y\u\\"
.- L"A\
e loss ofbtood or impaidnentofyin. The fin is notiSle
to root the yangandyou havea breakor absentmiddle
levelpulse. With lossof blood,thercis not enouglr
:":s
cvrf
f\a^4 ,,-O?a= e Qi Xu = faligue, spont. swcat, dizzincs, apathl substance to travel in the arrery..-

f^ ^t
J6n /-cg, Ct.v-,
c Yang Xu = Qi Xu + cold sx . Feltal thesuperlicial anddecplcvcl3.6nly.
*O8S< .r+
c Blood Xu = Pale, pale, pale. I o Minute
o Yin Xu = Blood Xu + heat sx. c Deficiencysyndrome. _ C orrzr.
c w@k d all thc ldels.
{e : S \\1hre r
s Barelypalpableat anyler
c Strong t\rg,nqOnrr\\-({rt-el5 { e Frail
?a
e Excess syndrom?. Can be cold, heat, phlegin Qi, blood or e Qi andBlood Deficiency.
t Only oaloable at the deep level. I t
F-rou^4 q.
i{<.*k
(> -' O . S cir- &*f,, J "^;p(
l
V-ru.t o er^ cnv,." i q. I
ctrtr,r clr'. -Q.rr-Yvr-^-r,'-f- f\.S^:
hc-.: blo,:d 6,s,,us ."-
a1o Krv v\
- St,(P* ta*
>\,{t/* J_ooll-^-v\\ 6,J;l.1r\"f\rt Tl..^_+
Jroo'u^*.1e,_l,lr\,;t I r\xt ,^riVon
cVWn
dti-zp- o.
dti-ze- O. t<i"at@
t<i"au@ *"*'Xd ,t {}'s,{r*7^
ot
T.i"w<6{
 .E*u)

Typesof Pulses *n** Jxnn$Iursf

f,ffi
d.tY.,'t

e Hidden*,#la Slippery/ Rolling gQ1'1 g.n'.1o61-lntr {ttcJC

.5-':"0
t.\9,> \
o Thready &gblgand hardly palpable r Phlegm and fluid retention, excessheat, food stagnation,
d Pathogens in the interior
o Jue Syndrome (syncope, cold limbs)
ry:A
-r
Analogy: Trying to trap a beacb ball in a pool of water by Go**'
n*
pain,exrr,.nitc*t' uX 4 Orr,"lStzgal co-y placing pressure on one side. The ball squirts out from
1 o Severe under your hands and flies foruard.
oFelronlyatheverg$$1s' SiW1.rrffcV-"/,
o Moving / Spinning bean
:uT3?iil:,*l n"#
.'fiS";i F#",r'"''t,
o Hasa roundshapelike a bean,feelingshort,slippery,
d Felt at the superficiallevel- -
F..\.r:h into
6t7 tfu.,*3*
e Flooding / Tidal
c Excessheat. Waves come on strong and powerful then
wrI
fade away like a tidal wave.
7w..e"flc
Serr.s-€ o{-
b |c'tr,^r c^d-, d ir.:i gt(acio6t\ -Sccru>D
tr inO(Q 4 f,rvr.rr\<5r'\ vr:r\\ ge-c*trn Lt$ A ks L4l6n \ \ro bj,- c\rrse to ct[Y\r-r$,4.(r?
(,t-tf"- a e*-^) rw\?.t< (.^,-r^)
Suvq- \1s-.c is,stla"t-v bL.r-:G,ngfS

t""{**:" Typesof Pulses

t
t Types of Pulses
*'
*d*' ,d
a, -;'_u!
e mreadV/Thin
*c*€<ais.*
r<rr.a*
"1fttr-q_.y"g15[lr
hal"t"
(..,. ,*..\\g

:ff..
C.rr.€i_C
\

damp.Canbeol'Qi. blggC-ar
,rlv,.^-CSL"f)
o Feels like a line threYd under your fingef3.'
Chen*-
s Choppy/Rough/Hesirarx
o.l$fllgLunerenand..unsmooth"
e Qi and blood stagnation l
SMeA.vfn>
B1n^cti( l.\sinl"d

Y r Food stagnation Forceful and

i
e Phlegm retention J choPPY
e Wiry \ - O,6l4/tr\\- ^^f\€.o\.1ai,."r.,..q

#s
c Essenceimpairment I --.
weak and
fffiEffifrCE]fig4t{ffi
__--_-{Ft malariaor phlegmanddamp r Brood Deficiency I
!_
relentron' - qk/d."tr\r\r"rsr1., .nooot
*;rrt riu.\l. (e* e.htt .t g-Lr*
oft"blik.#.d"etu -rY\c^\^k
1.[.
o Wiry vs. Thready: A wiry pulse will have a distincl l qr*i^{,^r
I e".rt"i.."€-v.; a.:.1"'fika d.-c=-to\
when you roll over it. A thready pulse does not have this
edse.

cn^-1,'I
W

f Typesof Pulses Typesof Pulses

'
e Tynpoaic/Leeihcr .}Ct)\ k ^,r-t + 6 r ".. e Scanerod \jllt-'r-[ "\w\]*t.
-*,Y*JdtA ^
o hrge, hollowana1au11!!g-' t€aJ{
tit surface
ol,ossof Blood - t4;">5
of a drum"
Si.WSr:fd-a-Q
o Scaneredanduneven
cQi exhaustion ta v Sq
e Impaimentof ess€nce
A
s Fctrarhc$Dcrficiail.€r
t1tr$ar- ct'ro< €ad^tvvc.
*vrc-'t fV*- -
.------,-- lo :r.
. Fclt d thc suEicid c Tightl Tcue
e Cmfinod/ Fixed/ Prison c Tight and forcefirl like a stretched rope
o Long, taut and forceful o Cold Syndrome
eCold aconulation e Pain
.s-Vu*
oQi or BloodStagnation ,_ , _-s A S{-'- c Food Slagnation
-
e Fch a tlrc dep lftt -zV-\€ \-
/*7:X
- pwr-\\aA '. !p v\ i\^ov\, Cc
I Itop"f:

-\,ncULr^KA) ox-crr>a Cc\cl. eyWlr-a.v-e

 Typesof Pulses Typesof Pulses
*'Lorg $g4-+*!sta -[cvgfuner \c, oiffi /Abrpt C.Rt^'t C5uvt'16ep&<'. (ffi
c long and strzight s Rapid with irregularly missed beats
{ccQ W^C lC_ (af^L€5r'r8
\ c Excess Heal
e Nomal putse - long and genlle
c Qi and Blood sragnation
e Liver Yang hlAeractive
o Phlcgn retention
€ Excess Hml syndrcme - morbid long pulse (long & wiry)
c Food slagnation
e $hqr taVc>*,.ort \w-r. to€<A $ Prostration - Abrupt and weak
o Feels short as though it does not span the width ofyour e: Xndtcrt
fingertip e Slowwilh irregularlymissedbeas
c Qi sragnation e Excessive Yin (Cold excess)
oQi Deficiency c Qi stagnation
c orrly Ht distirctly d G@ lGdion c Cold pblegm rctention
. Blood stagnation

Typesof Pulses Tongue Diagnosis

r$:ifui*nl#+kpi**y.a*irrhiim'l*e c Hislory
c Missed beats at regularintervals * r,\Ol vu\\ V'rr.Ov": s TCM Tongue
eZang Qi dcfrciency v
uh@^\Aqa $^\t e Inspection
e windsyndrcme c Evaluation
Gp.in n J\€C-tf\4
s Body Shape
c Emotional fear and fright
e Body Motility
o Injury or trauma
c Body Color
c Coating
o Distribution
c Diagnosis

f{istory TCM Tongue

o Datesback to the ShangDynasty which beganc.I600 . n"H#-n
Sffio,nl?,hffi*€,f,* ;,
B.C. and erded c.1000. c The tongue is the out-looking ofrhe Spleen
e Emperorswould have their own doctos who would e The StomachQi is displayed by the coat
analyzetongue and pulse, the first thing every morning. e The Spleentnverses the root and spreadsover the lower
e Used as a window to the interior. surface(underside)4 6\sry- * t tnte."cn th{
o The Kidney channel lerminates at the root v

o The Earth element is responsible for taste

JU\Atra > (y-,r'pcngrlc&*ul-(

-
\-- \,
ST
 *@fo'
f o"*
t*

Inspection
e Havepatient in a relaxed uprightposition
s Use natural light or ifnot possible then rlse the same
tighrsourceeveryrime 6f,446:\Arl!+6|- perof- lr,
c Use natural white light when possible I

c Havepatientstickoul tonguenaturally
c Thisnreanslelaxed undp@! Fldt S;ttdl-
s Inspectthe top sidefirst includingsides
e Thenview the undersidef -NOf
-and
c Be sur€ to view body color, vessels any coat

:lqEf g!-g.gt-d" tor grgSJeded again

Do not have tonsue out > 20 sec

Evaluation Evaluation
Body Shape Body Shape
o Differentiates excess from deficiency r *ryb
c Organ slatus e Excesssyndrome
e Qi and blood status
" Tender (Smooth)
t Deficiencv svndrome
. Swollen
e Damp & phlegm accumulation
eThio & small
vyytrF s Yang Deliciency
--{.ei Deficiencv-sro\ r Teeth prints
se!'erQ'- 5€6;{ st cr.t\ o.RcL
" Bl*d D"fi"i-", . Damp & phlegm accumulation \
c Yin Deficiencv s Qi Deficiency

sfltaal(zi drl - rn;1t\:€e $:nrcneirrnrncrrzrce*

''
o€ \,rlnp\cD€"^^s'{\\ - ti c;tr-CTh.,e

Evaluatioir Evaluation
Body Shape Body Motility
c Prickled(Papulo), Cf,t<fr €{rrorvrqlln"v\D "L{ s Ligid \
o HearSyndronr (g_xf ".fro,, s Hearinvading
eericardiumPCeCie.igY/
?l,tf Sr?f f
s Excess Heat impairing body fluids
-- Firsrd oitr\ 4 Kci.'.uA ci-v\
C@* c Yin Deficiency\&r>65f
.HtS.r,"*lr"{tr'"6 ,'^, Q1or. or^" St&

€K-H
f-ettad6 Mi|tr
: i$ff*fit""**a.a.\
o Nori $Ur**
\ctS,F
s\
Flaccid _rJtth 6{14s..oqf cq t\6\
Szil^rtru-o) t Qi, blood or yin deficiedcy'-i€.V,rg.7t." "t% .
lr.atr^+ 9 St$Qi
'offiilffiim" orYin exhaustion
s Heat impairing body lluids
\, -(.r" - t€sn"r*^! rl\ cv>:D
Lrs 4 .i2l\6,\-?L f\A,^.A/' AC*d t-^6l*
'fi:.
q"[ V-o,a? Ch c,.cftwe-
6..:l-ae*:tj-be c'*gm,*=-Q ... {"\ ^^dr
t$o€>t{- ttTlr-g.,..a V\dL'.r(besn", d^ow.3<r)
lP n"rr:. tu- .fsfl.h .,€ cr.<f
l r
1r, (vd.ka-to
Fo{nA%X
lcr.t.^-r, V.a^!e "^\rnr.<rtfS)qa^, -) Stu,r-ra<h g1 (...*
( u-
 Evaluation t 61
Evaluation
Body Motility Body Color
oi&*ttirg ur^d.,l.l.iql€(iscrtnnc- cop c Condition of :
t- o Yin organs
o Qi, blood or yang deficiencY ,
-UnCA,trl
-\rw2t" o Blood
^e r-'-..a
ExtremelrA.r
heat mzrrramo
producing -;.a
wind Dalvr
'rcrgrA\
P'\\n
e Nutritive Qi
o C.hronic lllness
e *artotcA&n he-nev-.Jg\ ,s in*.qaiu<mla;
c Wind sroke Sqn \
O€ T r A ffi-#rai-+

e Threatening sign ofwind stroke

fs\orvo€
tre;*cns,e.6-
I

Evaluation Evaluation
'
Coating Coating
c Inquire about any food which may bave stained lhe o Color
tongue o Manifestationof StomachQi
o Coffee o Ki&reys alsoinvolvedwith coat
o Candy
s Thickness =fl"rfCtC-a{- ,rr+Ztk+l=
s Oranges
s Intensityofparhogtnic factor
s Herbal tinctures
o Some herbal teas
o Somejuices
-Y €r"t^is {s".c[to duo co\tsrn'v^

r'V\AfV Swlc6faur<rr j..l.j!5 lur.kxl

'
{rr\avY- {v\cY\e .Jrr.rr'I
*n

EvaluationCoating
Distribution
o Locationofthe pathogenicinfluerrce o Use the tongue to rule in or rule out any differentials
o Organsaffected e Be sure to establisha baselinebeforejumping to any
conclusions
c Use the tongue to monitor treatment and prcgress
Nc>![ r j.rsr.., o..ll-( cv-\clcs/
o Try to avoid seeingwhat you wanl to see '? -
Ccr\'Sr"rr- C\.\Av..tZJ) e "Let the tonguebe your guide !"
; CCVl-f,r'^g \'

t ho.rtn n( : w)c J\EleAq^r-A SD not usetoDsc diagagsls-alouc

"GI|
eA.r.'r\al S ?",* *u1J..J=t
$:a[Czrvt
\ = .-^:<ra.\t
2:31..rt2i4r-\$

{': akLt-ra