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Pulse Diagnosis: A Multi Dimensional Method of Pulse Balancing

by Will Morris


“The Divine Reason of things… is regarded as the fullness of all powers---ideal space, ideal time, if such can be permitted” (Alexandria 1906).

Space – Time – State (Volume-Rate-Quality)

The ideal pulse is an expression of a healthy state. It has root, spirit and is moderate. Root can be felt in the depths and in the proximal positions. Spirit expresses through stability in terms of rhythm, rate, volume, force and stable qualities over time. Moderation happens when the appropriate quality for each position as well as the season and the geography are present without being extreme.

When the factors of space, time, and state are balanced throughout the pulse, then the adaptive capacity of the patient is heightened, and the overall sense of wellness, clarity and focus are improved. Within this multi-dimensional context, this article presents an argument for pulse balancing methods as a style of practice. In addition, a specific process of pulse balancing is discussed that is based on the five phase qualities that relate to each position as discussed in the Ling Shu. This piece focuses on the state as a quality of being. This is addressed while still being cognizant of the fact that the human being operates within social and ecological environments.

Space

Space is represented by an even distribution of volume throughout each pulse position. When pulse volume is even from position to position, it represents an even distribution of Qi and Blood. This balance throughout the organism indicates heightened potential for recovery. There are many ways to interpret these differences in volume between the positions. Some implicate the wei qi status while others involve the ‘eight extraordinary vessels.’

Time

Time is represented in the pulse through rhythm and rate, arrival and departure of the wave as well as volume differentials along the pathway of diurnal qi flow. When these factors are stable, that is the rate does not change inappropriately and the rhythms are even and consistent while the wave has a moderate arrival, it is a positive sign and the pulse has shen.

State

The state of being may be for purposes of this discussion divided into the five agents and their correspondences. The Ling Shu uses five basic qualities including wiry, slippery, hook (flooding), deep, and floating choppy in correspondence with season and elemental influences (please see table 1). These seasonal influences correspond to changes of life and experiences that occur between birth and death. As the spring forces emerge in the form of plants, tension occurs in the pulse, when summer occurs, the plants are in full bloom and the pulse expands with a hook-like shape. As fall arrives, the vital forces begin to retreat and the pulse while still filling at the surface becomes uneven and uncertain as retreat begins. When winter arrives the pulse becomes deep.


Season
Li Zhi Shen
Nei Jing Chapter 19
Nan Jing Chapter 15
Summer
Surging
Hooked (flooding)
Hook-like
Fall
Hair-like
Floating and Scattered
Hair-like
Winter
Stone-like
Sunken and Stony
Stone-like
Spring
Bowstring
Wiry
Bowstring

Table 1. This table presents the seasonal pulse correlates (Unschuld 1986; Wu NL 1996).


Qualities

Each pulse position ideally expresses the quality of the agent to which it is correlated. When moderate, it can be considered to be an expression of health. For instance, ideally the kidney positions are deep, the heart position is mildly flooding, the liver position is mildly wiry, the spleen position is mildly slippery, and the lung position is mildly floating and choppy. Please see table 2 below.

Organ
Location
Li Zhi Shen
Nei Jing
Chapter 23
Pathogens
Heart Left distal Floating, Large, Scattered Hooked (flooding) Fire
Lung Right distal Floating, Choppy, Short Floating Dryness
Spleen Right middle Harmonious and Moderate Changing Dampness and Phlegm
Liver Left middle Sunken, Long, Bowstring Wiry Wind
Kidney Left proximal Sunken, Replete, Soft Stony Cold

Table 2. This table demonstrates the appropriate pulse quality for each position.


Within the experience of time and space -- that is, surviving and growing older -- there is a world of experience that can be analyzed with the five agents system of pulse diagnosis. Among these experiences can be that of ignorance in association with dampness and phlegm, passion in relation to fire, isolation in relation to coldness, excessive focus in relation to dryness, or tension with too much change (wind). These states of being represent themselves within the pulse as qualities either throughout the whole pulse, or within certain areas. However, this notion does not preclude the necessity of standard differential diagnosis and treatment of the presenting condition.

These ideal pulse images correspond to constitution, the seasons, and the nature of the individual organs. Each constitution may present with a predominance of a given quality such as wiry, slippery, hook-like (flooding), deep, and floating hair-like (Wu 1996). The same is true of each season and each individual organ. These qualities are all moderate expressions in the ideal pulse.

As one examines each position for the correct influences, there are usually only one or two positions in which qualities that do not present with a natural expression of the corresponding organ. If the quality found in a given position does not correspond to the related organ, then another influence is present. For example: if a slippery quality is present in the kidney position, then earth is influencing water. This may provide a ‘fulcrum’ from which to focus the treatment and access the deeper physiology of the individual.

The Practice of Pulse Balancing

A moment must be taken to establish the virtues and historical basis for pulse balancing approaches in Chinese medicine. The methods of Baek, Worsely and the Japanese with respect to monitoring the pulse for the purpose of determining efficacy of acupuncture treatments have been established. But, such considerations are seldom involved in the practice of the mainstream TCM physicians where it is often used to confirm the diagnosis. However, a closer look will show that significant personalities in the historical development of the medicine considered it important. Take for example Zhang Zhongjing who discusses the use of the pulse to determine efficacy of herbal treatments in various passages throughout the Shang Han Lun. It should be noted however, that he admonished against using the pulse alone without the complete clinical picture placed in analysis. In addition, Dr. He Hanlou has described (Honlao 1987) the discovery of such use in the Golden Cabinet. “If the pulse is minute and harsh on the cun site and thin and tense on the guan site, it is appropriate to activate yang qi by acupuncture in order to soften the harshness and to relax the tenseness, thus bringing about recovery” (Jing, 1983).

When a particular quality affects one position, it can be said that the element is affecting that organ if there are concomitant signs and symptoms. For example, a slippery pulse in the left guan position represents damp or earth affecting the liver; if it is hooked (flooding), then fire or heat is affecting the liver; if it is deep, then water or cold is affecting the liver; if it is floating and astringent, then metal or dryness is affecting the liver. The presence of an element within a pulse position gives a cycle relationship that may be occurring due to the transmission of evil as pathogens, emotions, or the impact of lifestyle factors such as damage by food and drink or depletion of essence through excessive activities in the bedchamber.

Treatment

Treatment using this method of analysis is relatively simple. Use the channel related to the locus of disease process or constitution. Then select the point which corresponds to the quality that is found in a given pulse position. In the example given above the earth is affecting water treat the affected channel with the point that corresponds to the influencing element (see table3). It is rare for the influencing element to remain when these points are used.

In my clinical experience, when the pulse qualities are appropriate to the position, the effects of the acupuncture treatment often last longer than when they reflect inappropriate influences within the orb of influence.

Table three provides the associated acupuncture points for each possibility. As always, this must fit the pattern differential diagnosis. In addition, these points are easily used if the five-elemental nature of the points has been memorized. If not, the chart is available for quick reference and use will eventuate memorization.


Pulse Deep Wiry Hook Slippery Floating Choppy
Heart
Left distal
Water affecting Fire
Shaohai (HT 3), Qiangu (SI 2)
Wood affecting Fire
Shaochong (HT 9), Houxi (SI 3)
Fire affecting Fire
Shaofu (HT 8), Yanggu (SI 5)
Earth affecting Fire
Shenmen (HT 7), Xiaohai (SI 8)
Metal Affecting Fire
Tongli (HT 5), Shaoze (SI 1)
Spleen
Right middle
Water affecting Earth
Yinlingquan (SP 9), Neiting (ST 44)
Wood Affecting Earth
Yinbai (SP 1), Xiangu (ST 43)
Fire Affecting Earth
Dadu (SP 2), Jiexi (ST 41)
Earth Affecting Earth
Taibai (SP 3), Zusanli (ST 36)
Metal Affecting Earth
Shangqiu (SP 5), Lidui (ST 45)
Lung
Right distal
Water affecting Metal
Chize (LU 5), Erjian (LI 2)
Wood affecting metal
Shaoshang (LU 11), Sanjian (LI 3)
Fire affecting metal
Yuji (LU 10), Yangxi (LI 5)
Earth affecting metal
Taiyuan (LU 9), Quchi (LI 11)
Metal affecting metal
Jingqu (LU 8), Shangyang (LI 1)
Kidney
Left proximal
Water affecting water
Yingu (KI 10), Zutonggu (UB 66)
Wood affecting water
Yongquan (IK 1), Shugu (UB 65)
Fire affecting water
Rangu (KI 2), Kunlun (UB 60)
Earth affecting water
Taixi (KI 3), Weizhong (UB 40)
Metal affecting water
Fuliu (KI 7), Zhiyin (UB 67)
Liver
Left middle
Water affecting wood
Ququan (LV 8), Xiaxi (GB 43)
Wood affecting wood
Dadun (LV 1), Zulinqi (GB 41)
Fire affecting wood
Xingjian (LV 2), Yangfu (GB 38)
Earth affecting wood
Taichong (LV 3), Yanglingquan (GB 34)
Metal affecting wood
Zhongfeng (LV 4), Zuqiaoyin (GB 44)

Table 3. This table provides point choices in connection with the influences upon a pulse position.


In Closure

The factors describing experience within the time space continuum can all be observed in the pulse. The time-space-experience model provides a meta-structure by which to organize various features of the pulse. It is not enough to assure balance with respect to volume alone, the time factors and the experiential factors must also be harmonized for the natural powers and full healing potential of the organism to be regulated.

Biography

Will Morris serves as president of the Academy of Oriental Medicine at Austin (AOMA). He is an internationally recognized expert in pulse diagnosis and leader. He now serves as the president emeritus of the American Association of Acupuncture and Oriental Medicine. He can be contacted at wmorris@aoma.edu and http://www.pulsediagnosis.com

References

Alexandria, P. (1906). Thrice great hermes, studeines in hellinistic theosophy and gnosis. Newburyport: Weiser.

Honlao, H. (1987). ‘Exploration of the effect of acupuncture on string-like pulse’, Journal of the American College of Traditional Chinese Medicine¸1, 51-55.

Jing, Z. (1983). Chin Kuei Yao Lueh, California: Oriental Healing Arts Institute.

Unschuld, P. (1986). Nanjing. Berkeley: University of California Press.

Wu, N. (1996). Yellow Emperor’s Canon of Internal Medicine. Shandong: China Science and Technology Press.

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