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 patients’ 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.
