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Module 1   Lesson 12   Mai Zhen

Pulse diagnosis

What does an acupuncturist feel under three fingers, and how much of it would a colleague also feel?

After this lesson you know the six positions and three depths, you recognise the ten qualities, you link them to the nineteen patterns, and you know why Nogier's VAS measures something else.

Three axes, six qualities depth floating deep Exterior Interior rate rapid slow Heat Cold shape wiry slippery Liver, stagnation Dampness, Phlegm Other sources: third axis Excess versus Deficiency
Schematic. Other sources put Excess versus Deficiency on the third axis (harder, fuller, broader versus softer, emptier, thinner); there, rapid is six beats or more per breath or above 90 per minute, slow three or fewer or below 60.

Know by heart

  • The six positions. Left Cun, Guan, Chi: Heart, Liver, Kidney-Yin. Right: Lungs, Spleen, Kidney-Yang. Index finger on Cun, middle finger on Guan beside the bony prominence, ring finger on Chi; mnemonic: from hand to elbow as from chest to pelvis, Heart and Lungs at the top, the Kidneys at the bottom; left Yin, right Yang.
  • The three depths. Superficial: Qi and the Exterior. Middle: Blood and the Stomach. Deep: Yin and the organs; mnemonic: Qi floats on top, Blood flows in the middle, Yin lies deep.
  • First six, in three pairs. Floating and deep (Exterior or Interior); rapid and slow (Heat or Cold); wiry and slippery (Liver, pain, stagnation versus Dampness, Phlegm, retention of food, pregnancy); mnemonic: where, how fast, how it feels.
  • Then four. Thin: Blood or Yin deficiency. Weak or empty: Qi or Yang deficiency. Choppy: Blood deficiency or Blood stasis. Full: Excess; mnemonic: three times too little, once too much; choppy is the double that can go either way.
  • Rapid and slow as a number. Textbook knowledge: rapid is more than five beats per breath of the practitioner, slow fewer than four; count with a clock.
  • Four patterns with a position. Liver invading the Spleen (5): wiry on the left, weak on the right. Kidney-Yang deficiency (12): deep and weak, especially at Chi. Heart-Fire (15): rapid and overflowing at Cun. Lung- and Wei-Qi deficiency (16): empty, especially at right Cun.
  • Red flags at the pulse. Irregularly irregular: ECG. Above 100, or below 50 with symptoms: GP. Left and right different: blood pressure in both arms.

The rest of this lesson is reference.

Pulse diagnosis: What does an acupuncturist feel under three fingers, and how much of it would a colleague also feel?
The chart as an image, to save or share

Three practice questions from this lesson

You feel the pulse even with light pressure; when you press deeper, it becomes weaker.
  1. Deep: felt only with firm pressure
  2. Floating
  3. Full

Answer: Floating. Floating is Exterior; how it feels is textbook knowledge. Deep is felt only with firm pressure, full is forceful at all three depths. Note: floating and empty is Kidney-Yin deficiency (11), not an Exterior picture.

Taut and hard under the finger, like a guitar string
  1. Choppy
  2. Wiry
  3. Slippery

Answer: Wiry. Wiry: Liver, pain, stagnation. The description is textbook knowledge.

Rolls smoothly under the fingers, like pearls in a bowl
  1. Choppy
  2. Floating
  3. Slippery

Answer: Slippery. Slippery: Dampness, Phlegm, retention of food or pregnancy. Choppy is the opposite, hesitant and rough; floating says something about depth, not about how the pulse rolls.

The rest of this lesson

In the course you get the step-by-step explanation, 20 case-based practice questions, 23 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 1: Foundations.

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