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   MODERN MEDICINE UNITED WITH NOSTALGIC MEDICINE

   PULSE DIAGNOSIS

 

MEDICINE PULSE DIAGNOSIS

     Arterial Pulse may be observed in a number of locations.  The practicing clinician most frequently examines the radial artery.  The carotid artery is more satisfactory for assessing the pulse contour and for timing cardiovascular events.   A decreased or absent carotid pulse suggest arterial narrowing or occlusion.  

     The Radial Artery may be felt with the pads of your index and middle fingers.  Compress the radial artery at the wrist until a maximum pulsation is detected.   

     The Carotid Artery is more difficult to palpate.  Distract the medial edge of the sternomastoid by hooking your index and middle fingers about it.  Press gently on the carotid artery in the lower half of the neck.  Of course, be careful to avoid the carotid sinus as pressure could produce an undesirable decrease in pulse or blood pressure.  In western medicine, we look for the rate and rhythm of the pulse as well as the amplitude of the pulse.  Check for the contour of the pulse (the speed of its apparent distention; the duration of its peak and the speed of its collapse).    Carotid Artery; A decreased or absent carotid pulse suggests arterial narrowing or occlusion.                    

Normal Pulse                  Arterial pulse pressure is about 30-                                      40mm Hg.  The contour is smooth and                                       rounded. 

 

Small, Weak                   Pressure is diminished with the                                        contour demonstrating a slowed                                        upstroke and prolonged peak.                                         Etiologies generally included,                                        decreased stroke volume as in heart                                        failure, shock and mechanical                                        obstruction to left ventricular output                                         as in aortic stenosis.

 

Large, Bounding              Pressure is increased with the contour                                        frequently demonstrating a rapid rise,                                        peak and rapid fall. Etiologies have                                        been attributed to hyperkinetic states,                                        (e.g., anxiety, exercise, fever, anemia,                                        hyperthyroidism) and abnormally                                       rapid runoff of blood as in aortic                                       regurgitation known as patent ductus                                       arteriosus, and finally increased aortic                                       rigidity as in aging and atherosclerosis.

Pulsus Alternans             This observation can be made when                                        the rhythm is regular.  This type of                                       pulse alternates in amplitude from beat                                       to beat.  If the variation is slight, it can                                       be detected only by                                       sphygomomanometry.  Of course,                                       you note alternating loud and soft                                       sounds or a sudden doubling of the                                       rate as the cuff pressure declines.  This                                       is evidence of left-sided heart                                       failure.    

 

Bigeminal                        This Bigeminal rhythm is found when a                                         normal beat alternates with a                                        premature contraction.  The                                        premature contraction yields                                       diminished stroke volume with the                                        pulse varying in its amplitude,                                        alternating between strong and weak.                                         Rhythm is irregular.

 

Pulsus Paradoxus             The pulse in this case diminishes                                        notably in amplitude on respiration.                                         Again, this is often detectable only by                                        sphygomomanometry.  While the                                        patient is breathing quietly, lower the                                        pressure slowly toward the systolic                                        level.  Record the pressure when the                                        first sounds are heard.  Then drop the                                        pressure very slowly until sounds are                                        perceived throughout the respiratory                                        cycle. Record the pressure reading.                                         When the readings are 10mm Hg or                                         more apart, a paradoxical pulse is                                         present. The etiologies are severe                                         obstructive lung disease and                                         constrictive pericardial disease.

ORIENTAL MEDICINE PULSE DIAGNOSIS

     In Oriental Medicine the pulse, diagnosis is taken from a human subject.  It is then correlated with Poetic Medicine to determine care.  This method of pulse diagnosis yields a detailed picture of the state of the Poetic Organs as well as a reflection of the whole complex of Qi and Blood.  The normal pulse is gentle and calm, relatively slow, has strength, is neither big nor small, and has root when palpating its deepest level.  This is consistent with modern western medicine.  However, areas along the radial artery in order Heart, Liver, Kidney, Lungs and Spleen with the Heart, Liver and Kidneys described on the left and the Lungs and Spleen are described on the right.  

      Palpation in Oriental Medicine also includes recording the Speed, Level, Quality and Strength of the pulse.  The Normal pulse has a rate of four beats per breath, which is approximately 60-80 beats per minute.  

     When evaluating the pulse, indicate the speed.  Always consider the patientsí age and condition in your differential.

     The Levels or depths palpated are said to be Superficial, Middle and Deep.  These are used to indicate the relative progression of disease within the body.       

     The Quality is propertied to point out various body disharmonies and symptoms involved with the characteristics of a particular pathogen. 

     Finally, the Strength can be indications to the relative state of body antipathogenic Qi or the relative strength of the pathogenic Qi.

Left Side Pulses: 

Heart (Chun)     

Superficial no strength  Blood, Qi or Yang xu                                             Deep:                Yang Deficiency.                                          

Choppy:           Exhaustion, stasis, deficiency                                                           and congestion.  

 

Liver (Guan)  

Superficial with strength:     Yang or Heat rising.                             Flooding:                               Heat.                               

Deep, small and weak:        Yin deficiency if rapid.                        Choppy:                                 Stagnation with pain (Usually                                                 Blood deficiency).                                Knotted:                                Qi stagnation with emotional                                                 problems.              

Kidneys:                               

Wiry:                                      Yin deficiency or Liver Qi                                                                   stagnation.                            Superficial:                             External Conditions.                            Hidden:                                  Cold or deficiency                                  

Choppy:                                 Pain in the lower Jiao.                          Soft:                                        Edema.

 

Right Side Pulses:               

Lungs:                   

Excessive and Strong:          If superficial, it could be an                                                                  indication of Large Intestine                                                                  conditions such as constipation                                                                  and hemorrhoids.

Deficient and Superficial:    Lu Qi or Wei Qi deficiency

 

Deep:                       Cold congesting lung and large                                                   intestine.

Deep and Slippery:  Phlegm retention in the chest.

 

                Spleen:

Superficial without strength:          Spleen deficiency.

Superficial and flooding:                 Stomach heat.

Deep:                             Weak digestive function (St Qi)                          

Wiry:                  Liver invading Spleen and Stomach.                               

Superficial, Short Choppy:                 Deficiency.                           

Soft, slippery and deep:     Fluid congestion and Edema.

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