Transcript for:
Introduction to Pulse Diagnosis

so this video is an introduction to pulse diagnosis we're going to be talking about how to evaluate the pulse using the letters r d s q and then we'll talk about the diagnostic information you can get from that so if you're just starting out with pulse diagnosis you're in the right place and as always this video is brought to you by people like you who support this channel so to everyone who supports this channel whether it's through joining the patreon hitting the super thanks button or just liking this video and sharing it with your friends thank you so let's go ahead and talk about pulse diagnosis so when I was a supervisor in the clinic one thing I would ask students is what skill would you like to work on and the number one answer I would always get is pulse diagnosis it turns out when you wanted to learn how to take the Pulse the best way to do it is to take a lot of pulses so say you take 10 pulses every day you can take the weekends off that means you're taking 50 pulses a week that's like 200 pulses per month and so after five months you've taken over a thousand pulses so hopefully if you've taken a thousand pulses and written them all down in your pulse log in your pulse Journal hopefully after that you'll have learned something about how to take the Pulse but I think the problem here is at least when I was starting out when people tell me to take take the Pulse I'd just be kind of like I'm not entirely sure what I'm supposed to be feeling I'm not sure what I'm feeling for and sometimes it was difficult because a lot of my teachers were not very helpful with this they'd say things like oh just sit and ask each of the officials ask of the organs how they're doing or reach out with your Chi and see how the the pulse is doing and that just never made a whole lot of sense to me so what we're going to do here is talk about more of a systematic approach to evaluating the pulse how can we do this in a systematic way where we're asking a series of questions to get some valuable information about what's going on in the pulse and so the way I like to do this is using the letters r d s q and so this stands for rate depth strength and quality so here what we're doing is we're basically going through and asking ourselves a series of questions we put our fingers on the pulse and we first ask what's the rate is it fast or is it slow then we ask what's the depth is it superficial or is it deep what's the strength is it strong and forceful or is it weak and forceless and we get the quality we can say what's the quality we're really here asking about like which of the 28 pulse images apply but if you're just starting out chances are you don't know the 28 pulse images and they can be really confusing so instead we can just start asking ourselves some additional questions about the quality of the pulse we can ask things like what's the diameter of the vessel is the Diane is it a very large or is it very narrow does the vessel have a hard distinct Edge when you feel it can you feel that edge on the vessel and how is the blood flowing through the vessel is it flowing smoothly or is it flowing unsmoothly roughly and so here we can start this is just a way that we can go through this list of questions so when you put your fingers on the pulse you're not like I don't I guess it feels like a pulse instead you can go through and start asking yourself these questions and actually get some really good information just through these simple questions so let's go through each one one by one we start with the rate this is the first thing when you put your fingers on the pulse we can ask ourselves what's the rate is it faster is it slow and this is actually really easy to do because you just count the beats in the olden times they counted the beats in accordance with their breath the breath of the practitioner so if if you felt the pulse and it had four beats for every one of your breath or less that meant it was a slow pulse if you were counting the beats and it had five beats or more for every one of your breaths that means the pulse was fast or rapid uh so that was kind of the old way nowadays most people have clocks and wrist watches so we just say a slow pulse is anything less than 60 beats per minute and a rapid pulse is anything greater than 90 beats per minute so this is what you do you put your fingers on the pulse and you ask is it fast or is it slow how do you know you count the Beats if it's less than 60 beats per minute you you're feeling a slow pulse if it's greater than 90 beats per minute you're feeling a rapid pulse and so when you're first starting out you probably just want to count the beats with a clock maybe after you've taken a hundred or a thousand pulses you'll start to have an idea of what constitutes slow and rapid and so he can just kind of tell without counting that oh this feels pretty slow or oh this feels pretty fast or maybe it's neither maybe it's neither slow nor rapid it's just normal and in between but that's where we can start out with the rate is it slow or is it fast next we can move on to the depth we're feeling is it superficial or is it deep really what we're saying here is do we feel the pulse on the surface or do we have to press in more to feel it deeper towards the bone or if you can say how much pressure is needed before you start to feel the pulse Can You Feel the pulse with light pressure or do you need heavy pressure to in order to feel the pulse and so those are just ways of saying is it superficial or is it deep so if you feel the pulse near the surface and you feel it with light pressure that's a superficial or a floating pulse if you feel the pulse near the bone or you have to use heavy pressure in order to feel the pulse that's a deep pulse and again this is something that when you're first starting out you might not have a good reference point of what constitutes superficial and what constitutes deep but as you take a lot of pulses they'll start to give you an idea of oh this is really superficial versus oh this is really deep but for now you can just start by asking yourself is the is it superficial or is it deep or how hard do I have to press in order to feel the pulse and then after you take a lot of pulses you start to calibrate uh what these two things mean I will say I think one of the the biggest mistakes people make when they first start taking the pulse is they automatically press too deep they come in and they just clamp down really hard at the wrist on the pulse oh one way it was described to me by a Five Element practitioner is he said think about a butterfly landing on the surface of your skin that's how light your touch should be at the start so when you're starting off just lay your fingers on the wrist like the way a butterfly would land on your hand and then slowly go in deeper until you can start to feel the pulse and then you can just start to calibrate can I feel it do I just need to go in a little bit with very light pressure and I can feel the pulse or do I really have to sink in with really heavy pressure in order to feel the pulse and that's how we can start to calibrate is it superficial or is it deep so that's our second one D is depth is it superficial or is it deep after that we get to strength is it strong or is it weak and it turns out these terms might be a little might be confusing when we talk about other pulse images so instead of saying is it strong or is it weak it might be better to say is it forceful or is it forceless does the pulse have force or not and what we mean here is when we press into the pulse how strongly is the pulse pushing back against our fingers when the pulp when we feel it against our fingers is it pushing really hard like really strongly and forcefully or is it pushing back on was it very forceless or very weak maybe another way we can think about it is if you think about a waveform a strong uh strong pulse or a forceful pulse has a waveform with a large amplitude that would be a forceful pulse pushing against your fingers whereas a forceless pulse would be like a waveform with a smaller amplitude that would be more of a forceless pulse so we talk about this on the one hand we could say that uh we have these two words excess and deficient or replete and vacuous we could say deficient uh deficient pulse is forceless it doesn't hit your fingers very hard whereas an access pulse is forceful now this is actually a little bit confusing when when we talk about the 28 pulse images this can mean a couple different things for some people when you say deficient or excess these are just general terms for a forceless or forceful pulse sometimes when we say deficient in excess that means something more specific so like a deficient pulse might describe a pulse that's forceless floating and thin but for now we can just say we can maybe just stick to the terms forceless and forceful when you feel the pulse what's its strength how hard is it pushing back against your fingers is it forceful or is it forceless and again this might take a while this might be that when you're you're first feeling pulses you don't have a good gauge or a good calibration of what constitutes strong versus weak or forceful versus forceless so this might be something where you have to take a couple hundred pulses to calibrate what constitutes forceful and what constitutes forceless but when you're starting out this is a question that you can start asking yourself very deliberately to sort of begin that process of calibration when I take the Pulse what's its rate is it faster is it slow what's its depth do I feel it on the surface or closer to the Bone and what the strength is it strong and forceful or weak and forceless after that we get into quality and like we said there are a lot of things we can say about quality technically we could talk about the 27 or 28 or 29 pulse images it changed throughout time uh depending on which book you're reading but some of those pulse images can be very vague very complicated the descriptions are very poetic like oh it feels like uh pearls rolling on a plate It Feels Like a Knife scraping across bamboo uh so maybe that can be a little bit complicated so maybe if you're just starting out you can start by asking again some some simple questions we can ask things like what is the diameter of the vessel so when we feel when we put our fingers on the pulse we're feeling that vessel how how wide is it beneath our our fingers does it have a wide diameter a big diameter like a drinking straw or does it have a very small diameter is it narrow like a piece of string or like a thread and so when you look at that diameter we can say is it thin or is it large thin means it has a narrow small diameter whereas large means it's wide or has a large diameter and so this is what we mean by the word thin and large so when we say thin and narrow diameter we can say thin or fine or thready those all mean the same thing those are all different translations of the pulse hemod so we're basically but we're asking what's the diameter of the vessel and this was one that was really confusing to me when I was first starting out because a lot of times I'd be in clinic and people would be like oh yeah the pulse feels very thin and for some reason back then when I heard thin I was thinking about the quality of the blood like the viscosity of the blood like like if a person was on blood thinners then their blood was thin and watery versus uh versus somebody who had thick blood like it was thick and syrupy and felt like molasses so initially when people said oh yeah this pulse was really thin I thought that's not what I thought they were talking about it wasn't until much later when when I I read a book about it that it that I realized that the word thin is actually referring to the diameter of the vessel and again we have a couple ways this gets translated in English we can say it's thin it's fine it's thread-like or it's thready those all mean the same thing and those are all referring to the diameter of the pulse so another thing another question we can ask ourselves about the quality of the pulse is is there a hard Edge to the vessel maybe hard Edge isn't quite the right term we can say is there a distinct Edge to the vessel that when you're feeling this vessel can you feel a distinct Edge or is it just kind of soft and Squishy and goopy and so I've had I mean I've had some patients where I feel I'm feeling for the pulse and at first I thought I was feeling their tendon I thought oh they have their their tendon is in a weird place and only later I after a couple seconds I realized oh that's their pulse it's just it's just that they're pulse The Vessel was so uh tauts it had a a distinct Edge that it felt more like a tendon other people you feel though you feel their pulse and you can't really tell a distinct Edge is just kind of really soft and Squishy so if you start asking can you feel that distinct Edge we're basically asking about is the pulse wiring is it wiry or not turns out there's no word for not wire we just say either it's wiry or it's not and so here we say a wiring means the the vessel is like a zither string or it's crisp and it has crisp and distinct edges and so when we say zither we're referring to a class of stringed instruments so in Chinese they had the Gucci This is a Gucci a stringed instrument they also had the gujung which I'm not entirely sure what the difference is I think a gujong is larger and it has more bridges in the middle anyway basically when we say wiry we're saying it's like a a string like a guitar string something a wiry string like that and that's what we're feeling we're feeling this hardness or these distinct edges so when we get to Quality that's another question we can ask ourselves is do do you feel this distinct Edge to the vessel itself another one we can ask and this is kind of weird but how is the blood flowing through the vessel is it flowing very smoothly and very evenly or is it flowing not smoothly is it flowing is it rough is it uneven and so here we're actually when we describe the flow we can use these words slippery and choppy so a slippery pulse is a smooth pulse when we say slippery we're not talking about the quality of the vessel or the size of the vessel or the texture we're talking about how is the blood flowing through that vessel is it flowing nice and smoothly versus a rough or choppy pulse would be not smooth it would be rough and so um maybe if we wanted to draw it out we could say that a slippery pulse is a very nice smooth comes and goes very evenly whereas a choppy pulse is is more erratic and it doesn't come and go as easily and so that's what we're talking about when we're talking about how is the blood flowing through the vessel does it flow nice and smoothly or is it a little bit more erratic we could say that another aspect of this like rough or choppy pulse is are the Beats even so with a with a smooth pulse you expect the the Beats to be nice and even whereas a choppy pulse it might speed up and slow down sometimes it's three beats per breath sometimes it's five beats per breath and it it doesn't have that even rate that can also be an aspect of the choppy pulse but you can start to think about this is a little bit weird it's a little bit subtle to feel but you can start to think about as that pulse hits your fingers as it goes up and down how smoothly is it going up and down how smoothly is it coming and going as it hits your fingers and that's that's what we talk about when we mean slippery versus choppy and this might be one that you actually have to have someone demonstrate to you what it is you might have to go in the clinic and find a very slippery pulse find a pregnant patient and um feel their pulse and be like oh yes that's very slippery and just know that when you're feeling for that you're feeling for how is the blood flowing through the vessel so those are just some basic questions we can ask to get a sense of what the pulse is telling us and so instead of just feeling like what's what's going on here what am I supposed to be feeling or even if you've been in the clinic in the while some sometimes I get students that they go in there and they just immediately jump to oh the pulse feels soggy it's like well maybe you can stop and go through uh start at the beginning go through slowly and systematically say what is the rate is it faster is it slow what is the depth is it superficial or is it deep what is the strength is it forceful or forceless what is the quality as in uh what's the diameter of the vessel does it have a distinct Edge how is the blood flowing through and so turns out actually asking these questions can give you a lot of information and this is also useful because then when we go on to those 27 or 28 or 29 pulse images it turns out when we start studying those we actually already have a lot of information that we can apply to those 28 pulse images so if you look at here we have a chart of the 29 pulse images and if we start to read into these it turns out just by asking those simple questions we've already covered a lot of these pulse images so we have things like when we ask the rate we were asking is it faster is it slow well we have the slow pulse the rapid pulse and the racing pulse and so just by asking what's the rate we've already covered three of those 29 pulse images remember slow is less than 60 beats per minute rapid is greater than 90 beats per minute and racing is like super rapid it's greater than 120 beats per minute or seven or eight beats per practitioner breath so we did rate then we did depth is it superficial or is it deep well it turns out we've already covered some of those so superficial and floating means the same thing it means I feel the pulse right on the surface deep means I have to push in deeper towards the bone and then we have a hidden pulse and that just means very very deep so when we talk about depth we've already covered three of the 29 pulse images uh again when we talk about strength is it forceful or is it forceless this maybe applies to these pulse images um for some people when we say deficient and excess those are just general terms for uh is it forceful or is it forceless and excess pulse is a general term for a forceful pulse a deficient pulse is a general term for a force list pulse but then in some books and some contexts where actually we mean a little bit more than that that when we say deficient we don't just just mean it's forceless we mean it's forceless floating and fine or narrow in diameter so that may or may not apply here but that that kind of gets you started in that direction when you start asking about quality we asked about the diameter of the vessel and so that's two of our 29 is fine versus large we have a thin pulse a fine pulse a thready pulse is referring to a narrow diameter of the vessel whereas a large pulse is referring to a wide diameter of the vessel we start asking about quality we get into things like how is the blood flowing is it slippery or is it choppy again this is how smoothly is the blood flowing if it's flowing nice and smoothly that's a slippery pulse if it's not flowing smoothly then it's a rough or choppy pulse and then so when we so basically when we went through that rdsq that actually covered almost half of the 29 pulses so just by asking those simple questions we've already gone a pretty far away into learning our 29 pulse images and and being able to know what's going on but it turns out even after that just by asking those questions we can get some information on the other pulse images as well because a lot of these other pulse images are just combinations of those attributes that we already asked about here's what I mean um let's talk about a soggy pulse what is a soggy pulse does it mean that you poured too much milk on your cereal and now and that's what the pulse feels like no it turns out when we say a soggy pulse rumai that's just a combination of those other attributes we talked about a soggy pulse is faux floating or superficial in depth it's fine or thin in terms of diameter and it's forceless in terms of its strength so if you were taking the pulse and you say you go through your rdsq you say oh the the depth is it's superficial I feel it right on the surface and the strength is it's forceless it's not very it's not pushing very hard against my fingers and when I feel for the diameter it feels very arrow in diameter so then you could say oh this pulse is floating forceless and fine or you could say this is a soggy pulse when you feel those three things you have felt a soggy pulse we can go to the weak pulse what do we mean by weak pulse we don't do it turns out we don't just mean it's forceless when we say weak it's deep fine and forceless so when we feel for the depth oh we have to push in with a lot of pressure and we feel the pulse near the bone when we feel for the diameter it's narrow or thin or fine in diameter and when you ask about the strength that's relatively forceless if you feel a pulse that is deep fine and forceless congratulations you have felt a weak pulse when we talk about a faint pulse the faint pulse is very very fine very very narrow and very very forceless so if you feel if you feel the pulse and the vessel is very very narrow such that you can almost hardly feel it and the strength is very very forceless like you can almost not feel it pushing against your fingers you felt a faint pulse and then again when you talked about the quality uh we talked about asking can you feel a distinct Edge in the pulse uh is there a hard Edge or crisp Edge to that vessel and it turns out that actually applies to two different pulse images both the wirey pulse and a tight pulse so it turns out a wiry pulse has a distinct Edge but it's also narrow in diameter so it has that hard Edge and it's a fine or thin pulse whereas a tight pulse is it has that distinct Edge but it's very large in diameter it has a it's thicker so one is one is more like a thin guitar string uh maybe uh what's the thinnest one the eadg like an F string on your guitar it's very thin whereas the tight pulse is more like a rope that's been twisted up and so it's a much thicker pulse but it still has that hard distinct Edge so it turns out just by asking this this questions going through systematically rdsq rate depth strength and quality that actually gets us most of the way in terms of these 29 pulse images and so that's why I like to take this systematic approach when we take the Pulse instead of trying to come up with a poetic description of each of those pulse images we can more clearly Define it in terms of these attributes and then this is just another way that we can uh sort of organize it this is a chart that comes from uh secrets of Chinese pulse diagnosis by Bob flaws and so this is another way that we can organize these pulse images that uh some of the pulses are floating pulses when you feel it superficially these are your options it can be floating scowling stock drum skin soggy deficient surging scattered those are all floating pulses we have deep pulses the Deep hidden confined and weak pulse are all by definition deep pulsive and then we can talk about the rate that we have certain pulses that are by definition slow pulses and by definition rapid pulses so again by asking some of these simple questions about rate depth and strength that can kind of help us organize uh these 20 these kind of confusing 29 pulse images so that's another way that this this is helpful and then I just want to talk about some of these pulse images because some of them are kind of confusing just because of translation issues and so for example when you talk about uh the depth of the pulse the Chinese term is fumai that means floating or superficial and so these floating and superficial are just two words that are different translations of fuma so somebody says floating and somebody says superficial those mean the exact same thing both of those are words are referring to Uma so I have had that come up in in classes where either our textbook uses different terms or sometimes I just tend to use them interchangeably superficial versus floating and students will last week what's the difference between a superficial pulse and a floating pulse it turns out they're the exact same thing they're just different translations of the word fuma and unfortunately this is just a common thing that happens when we learn Chinese medicine in English so another one is the thin pulse in Chinese this is shimai so we can say thin fine or thready or thread-like so whenever you see any of these words thin fine thready they all mean the same thing and they're all referring to the diameter of the vessel and this one was kind of funny I remember once being in school and somebody asked one of the teachers like what's the difference between a thin pulse and a thready pulse and so this teacher went on this this long explanation it was like 10 minutes and you could tell she was kind of grasping like she was maybe just making something up and she went on this uh 10 minute explanation about the subtle differences between a thin pulse and a thready pulse and it turns out there's no difference these pulse images are the same they're just different translations of the word himai and it's referring to the diameter of the vessel so thin fine and thready we can use interchangeably they they're all referring to a narrow diameter in the vessel another one uh why am I slippery we're talking about this smooth motion of the smooth flowing of blood through the vessel we can say slippery or rolling I feel like most people in the world use the word slippery but when I took my California licensing exam they use the term rolling and so that was something that I I had to study and I had to get used to so that when I was looking at my case studies and it said it's a rolling pulse I had to know in my mind oh they mean slippery so these are again two translations of the word huama which means a slippery or rolling pulse the opposite of that is a a choppy rough or hesitant pulse sumai rough choppy or hesitant and again it's referring to how the blood is flowing through but these are all different translations of the word SEMA so we can use these uh and can be used interchangeably sometimes different books will say different things sometimes this is kind of an annoying thing about Bensky when you get to the Bensky formulas book sometimes he will use two different translations in the same chapter that you'll have one formula that says oh this has a rough pulse and then you'll flip to the next Formula says this has a choppy pulse and it's really confusing because you might think that those are two different things it turns out they're just two different translations of the same Chinese word and I'm assuming that just that book had several authors so different different authors use different translations but really rough choppy or hesitant is one that I don't see as often but you might see come up these are all different translations of sumai and it's referring to how smoothly the pulse is going through the vessel so now that we've kind of talked about what we're trying what we're feeling for beneath our fingers uh when we put our when we put our fingers on the pulse what questions can we ask what are we feeling for we can now go on to when we feel those things what does that mean diagnostically and again this can give us even though we're asking very simple questions this can give us a lot of good information about what's going on diagnostically so let's talk about that remember we started with a rate rdsq the R means rate we're asking is it fast or is it slow and basically when we when we determine is it faster is it slow this is telling us about the presence of heat or cold in the body so think about like just in physics heat causes things to speed up and cold causes things to slow down well the same thing is true in the body that when there's heat that causes the heart rate to speed up that causes the blood to speed up when there's cold cold is a Yin pathogen it causes things to slow down so the pulse slows down the blood moving through the vessel slows down so when we ask is it fast or is it slow a slow pulse means there's some sort of cold in the body or cold condition whereas a rapid pulse means there's some kind of heat in the body now the thing to be careful here is the rate of the pulse is just telling us temperature is it hot or is it cold it's not telling us for example what kind of heat is there is it excess heat or is it deficiency heat we don't really know where is the heat coming from is it uh heart heat is it stomach fire is it heat due to liver and kidney in deficiency we don't know when we ask about the rate we're just asking we just are getting information about is it hot or is it cold if we want to know what kind of heat and where is it coming from we have to investigate further with other signs and symptoms we talk about depth we are asking is it superficial or is it deep do we feel the pulse on the surface or are we pushing in closer to the Bone and basically the depth of the pulse can tell us about the depth of the pathogen or the depth of the disease so for a superficial pulse that's a sign of an exterior pattern with a deep pulse that's a sign of an interior pattern so basically if you feel the pulse on the surface that means that there's a condition on the surface if you feel the pulse deeper in that means you're feeling a condition that is deeper in the body and so it turns out this this this is mostly true there are some exceptions to this where I think in certain patterns of Yin deficiency where when the yin is deficient the Yang will float upwards and outwards and so it's possible that you'll be feeling a floating pulse because of Yin deficiency but generally in a very basic beginner way we can think that the depth of the pulse tells you the depth of the condition or the depth of the pathogen if you feel it on the surface you're feeling a surface condition if you're feeling it deeper in the body you're feeling a a an interior condition so that strength is it forceful or is it forceless when we uh put our fingers on the pulse how strongly is the pulse pushing back against our fingers well the strength of the pulse is going to tell us the the strength of either the strength of the pathogen or the strength of the right G so a forceful pulse tells us there's an excess condition and a force list pulse tells us that it's a deficiency condition and so again strength of the pulse strength of the pathogen and so then maybe you can see where we're going with this is we can kind of combine these together so if I feel a pulse that's floating rapid and forceful well if it's floating it's on the exterior if it's rapid it's heat if it's uh forceful it's excess that's in excess exterior heat condition so we can kind of we can actually take these different things and combine them together and they should make sense so when you talk about strength is it forceful or forceless that can tell us about excess versus deficiency and maybe if you're if you're thinking ahead and if you've learned this in your fundamentals class you can you can think that if you've learned about eight principal diagnosis maybe you're starting to see how these two things connect together so remember in fundamentals when we talk about eight principal diagnosis this is a very basic diagnostic frame where when we get a patient we're asking ourselves a series of questions is it hot or is it cold is it exterior or is it interior is it excess or is it deficient and is it Yang or is it Yin well hopefully you can guess by now that we can get a lot of this information just by asking those basic questions about the pulse so when we do our eight principal diagnosis is it hot or is it cold the way we determine that is by the rate if the pulse is rapid that's a heat condition if the pulse is slow that's a cold condition is it exterior or interior well we can get that from the depth of the pulse that in exterior condition an external attack of wind cold uh heat on the exterior those are exterior conditions and we feel that with a superficial pulse is it excess or is deficient that's determined by the strength of the pulse so if we feel a very forceful pulse that's the next condition if we feel a weak pulse or a forceless pulse that's deficient condition so this is something that can be very useful to you in the clinic this is also can be very useful to you when you're taking a test and you have case studies you can go and look at the polls and you can ask those you can look for those same qualities about is the pulse Rapid or slow is it forceful or forceless is it superficial or is it deep and that can help you with your eight principal diagnosis and then you can kind of use a process of elimination if you're doing like zong Fu patterns um if it's a if it's an excess heat condition you could probably rule out Yong the spleen Yong deficiency or something like that you can actually use this on your case studies and in the clinic when we talk about the quality we were asking those questions about like what's the diameter of the vessel is there a distinct Edge um how's the blood flowing it turns out these things are not quite as straightforward diagnostically so I think it's good to start asking these questions to sensitize your fingers but in terms of diagnostic information it's a little bit more complicated because there can be several things that are going on that can cause the pulse to feel a certain way so some of them are straightforward and some of them are not so when you ask about what's the diameter of the vessel we're asking is it a wide diameter or a narrow diameter uh basically said is the pulse thin or fine or thready or is it large or the thin pulse when that diameter is small basically what's happening is there's not enough stuff to fill the vessel because there's not enough substance filling the vessel The Vessel shrinks and it starts to feel thin or fine or threading and so usually when they say there's not enough stuff either there's not enough blood filling the vessel or there's not enough Yin substance or Yin fluids filling the vessel to give the vessel its proper diameter so if you if you feel the pulse and it's thin in diameter you know there's there's not enough substance filling the vessel but that could be blood or that could be Yin when you feel a large pulse uh there's actually a couple possibilities here and so it can get kind of confusing it could be that uh a large pulse means you have too much stuff filling the filling the vessel you have excess dampness excess phlegm uh stagnant blood filling up the vessel and that's why it feels large but again we can also sometimes have cases where like if there's deficiency things start to lose their root and they start to float upward and outward so sometimes with certain cases of say like Yin deficiency or other types of Qi deficiency other types of deficiency that can actually cause the The Vessel to expand in diameter and so it will feel large but then when you push into it there's nothing there and so just the large diameter by itself doesn't really tell you a whole lot we have to look at other things and so that's why at large when you talk about the the 27 versus 28 versus 29 pulse images large is not usually included in the 27. if you expand to 29 then they'll say a Dom I a large pulse but it turns out the large pulse isn't isn't really great as a distinctive pulse image because it can mean a couple different things but it's still something that's good to look at when you're a feeling for the pulse what's the diameter of the vessel is it wide or is it narrow and we talked about is there a hard Edge to the vessel is there a distinct crisp Edge is like is it soft and Squishy where you can't really feel anything or is there definitely a distinct Edge to that vessel and then like we said there are actually two qualities that are like this we have the wiry pulse and the tight pulse and the difference is a wiry pulse has a hard Edge but it's narrow in diameter it's a thin pulse whereas a tight pulse has a hard Edge but it's um large in diameter it's a it's a wide vessel but again the these can mean a couple different things or I guess really what we could say what it means is this is a sign that of a constraint that things are not flowing smoothly so if you feel this hard Edge it means that things are not flowing smoothly but the reason why things are not flowing smoothly it turns out there's a couple couple possibilities it could so we could say it's liver patterns the the liver is responsible for governing free coursing so if the liver is not free coursing you have liver cheese stagnation that could be a wiry pulse but maybe the reason the liver isn't uh free coursing the cheese because the liver is deficient and so it could be that liver deficiency is causing the pulse to be wired liver liver blood deficiency Livery in deficiency is causing the pulse to be wiring or it could be that you don't have enough Chi you don't have enough uh mode of chi and you don't have enough moving the chi through it you have a weak spleen and that's why that's why there's constraint and things are not moving that's why you feel it or it could be that you have a pain condition pain causes things to tense up and that's why the pulse feels wiry or it could be that there's some other obstruction maybe there's phlegm or dampness that's making it so the QI can't flow smoothly and that's why the pulse feels wiry in terms of a tight pulse it could be that there's cold obstructing the frame the free-flowing of tea and that's why it feels you feel this hard Edge it feels tight or wiring so basically when you feel this hard Edge it means there's some sort of constraint but we don't necessarily know where that constraint is coming from so we would have to ask additional questions and we have to line it up with our other signs and symptoms that we can we can say oh do I feel an edge The Vessel yes I feel an edge to the vessel that means there's some sort of constraint well then we have to ask the the follow-up question what is causing that constraint so why are we it's it's not quite as straightforward as fast versus slow and then how is the blood flowing through the vessel here again we said slippery versus choppy and again each of these since we're just describing how the blood is Flowing they can mean a couple different things so we say slippery the the blood is Flowing very smoothly through the vessel what's causing the blood to flow smoothly well it could be just the person who's a normal healthy person and that's how your blood is supposed to flow so it could just be slippery means you're healthy and could also mean that the blood is Flowing smoothly because there's heat heat causes things to speed up and because it speeds up it tends to go a little bit more smoothly it has the heat causes this nice swirling movement of blood through the vessel so maybe slippery means there's heat it could be there's a phlegm dampness or food stagnation that some of the these excesses result in a very smooth it's like the blood is riding along On This wave of dampness makes it really smooth pregnancy it tends to result in a slippery pulse so again when we're we're asking how's the blood flowing you say oh the blood is Flowing smoothly that could actually mean several different things and same thing with choppy when we say rough or choppy we're basically saying the blood is not flowing smoothly well if the blood is not flowing smoothly there are a couple possibilities it could be that the blood is not flowing because there's not enough Chi to move the blood smoothly so it could be Qi deficiency it could be the blood isn't flowing smoothly because there's not enough blood to flow smoothly that that's there's blood deficiency it could be that there's some blood stasis or liver cheese stagnation something's causing the blood not to flow smoothly and that's why we feel a rough or a choppy pulse so again these qualities aren't quite as straightforward um if you start to feel these things you might have to ask certain more follow-up questions about why are these things happening but I think at least when you're starting out and you're beginning to sensitize your fingers to the pulse it's still a good idea to ask these questions that as you're going through rate depth strength are pretty straightforward right you just count the Beats uh depth is it superficial or is it deep you might have trouble in the beginning you'll have to calibrate by feeling 100 pulses um strength same thing is it forceful or forceless you might have to take 100 pulses but you can ask how how is the pulse pushing against your fingers and then you can start to ask about these qualities um and just maybe know that for now it might the diagnostic information isn't going to be quite as straightforward you should still ask yourself those questions so you have an idea of what's going on but just the diagnosis isn't going to be quite as straightforward and so that's why I go back to there's this quote from judon she where he says the diseases in human beings fall into four categories known as cold heat repletion and vacuity therefore the student of pulse should take the floating deep slow and Rapid pulses as the rains in observing disease conditions this is an unchanging principle so here what we're basically saying is we can go back to these Basics even though we have these 27 or 29 pulse images that have very poetic descriptions we can still go back to these Basics about rate depth and strength and gain a lot of diagnostic information so if you're a beginner just starting out I would say this is a good place to start is by taking Judean cheese example of talking about floating deep slow and rapid if anything I would just uh I would modify this slightly because he talked about excess versus deficiency and uh slow versus rapid where I I think like what we said that might have to do more with the strength so I might modify judanchi and say we should look at the rate depth and strength and that will give us very basic information about Heat versus cold uh exterior versus interior and excess versus deficiency so that's a very basic place you can start and again this can actually take you a very long way in terms of diagnosis whether you're diagnosing a patient in the clinic or whether you're dealing with a case study on a test asking those simple questions can really help you with that and then finally just because we're talking about pulse I'll briefly mention the positions we have the three positions the the the tomb the Guan and the chur the three positions of the pulse and basically this is something this is maybe a little bit more advanced thing that you can just basically what I'm trying to say is there's really there's not a big consensus on it this is one interpretation of these three positions it turns out different different books will say different things different styles of acupuncture will interpret these three positions differently so for example originally in the Nanjing it looked kind of like this but it was talking specifically about the channel so they didn't say long and large intestine they said hand tie in and hand Yong Ming because when you're feeling the pulse you were feeling the state of the cheat in the channels and then other people came along and said no we can actually feel stuff in the organ so when we say long large intestine we mean the organs in the in the my Gene in the then the Ben who my Jing it was saying more that no it's not really specific to that it's more uh about the the three burner so that the soon position you're feeling things in the upper body and the upper burner from the diaphragm upward in the Guan position you're feeling the middle gel so things from the diaphragm to the umbilicus and in the trur position you're feeling things in the lower jowl from the um the umbilicus downward and so some people look at it like that I had some people in school that it was basically like this except for their chur position they didn't look at pericardium and sanjao they said one is kidney in and one is kidney young so that's another way to look at it that the right rear position tells you about kidney Young and the left rear position tells you about kidney in so there are there are a lot of different ways that you can interpret this and I think kind of they're all true and we should keep that in mind so so um Bob flaws gives the example of if you're if you if the pulse feels wiry in the Tomb position well maybe you're feeling something in the lung because that's associated with the lung or maybe you're just feeling something in the upper body maybe it's a headache because the head is in the upper jaw and that's an upper jaw condition so maybe that wiry tune position is actually a headache maybe it's shoulder pain we don't really know we have to investigate a little bit deeper so we talk about these positions it's really going to depend and it's going to depend a lot on your style that the way J.R Worsley Five Element people look at the pulse might be slightly different than the way uh Japanese style practitioners Ikeda style practitioners look at the pulse so this is probably going to depend on your school and your system but if you're a beginner if you're just starting out in the clinic and you're starting to take the Pulse and you want to know something about these three positions I think maybe a good place to start is just ask yourself of these positions which one is the strongest and which one is the weakest and again so you're just starting to sensitize your fingers and so if you if you feel like oh this guy's pulse it's it's really forceful and wiry and hard in the Guan position that's good information and then you can start to ask things further of when I feel that does that mean he has a liver condition or does that mean something else that there's something else going on in the middle jail so it can start to it can give you a starting place at least of where to look and then you can maybe get more specific depending on your specific style or teacher or school and so with uh positions it's again a little bit more complicated so maybe if you're starting out you can just start with which of these three positions on each side which one is the strongest and which one is the weakest and I would do that after you go through your uh questions about the pulse as a whole this is another thing where I think that I see a lot of students and they take the Pulse and they immediately say oh it's really wiry and the liver position or like oh it's really deep and weak in the kidney position and they jump to that and they forgot to go through what does the pulse feel like overall what it is what is is its rate what is its depth what is its strength so I would start with the pulse overall what are those qualities and then after that when you get a general overall idea of is it hot or is it cold is it excess or is it deficient is it a anterior exterior after you ask those questions then you can go into the individual positions about what's going on in the three jowl what's going on in the individual channels or organs and do that as their next step so that is post-diagnosis again the sources we used for that for this are uh uh the secrets of pulse diagnosis by Bob flaws The Secret of Chinese pulse diagnosis by Bob flaws was one source and Leisure Jen's pulse studies an illustrated guide by Lee Shen ching and William Morris was another source so if you want to learn more these are very good books to get that um I think the Bob flaws book I really like his descriptions of all the pulses in here but it's it's just text it's a little it's a little bit drier but it does have really good descriptions at least you're done it's like the the information is basically the same but what's nice about this one is it has pictures so if you're more if you want to visualize uh the pulse in terms of waveforms this can be a good book to get so I'll put uh links to each one below and I think with both of these I have older editions so I think this is the the second edition if you go on Amazon they have a third edition out and this is a first edition if you go on Amazon they have a second edition that's a hardcover book so I think these are um these are good and the other difference is the price is I think this one mine says 24.95 on the back I think the Third Edition was selling for like thirty dollars whereas this one the hardcover version on Amazon was selling I think for like seventy dollars so it's a little it's a bit more but I think if you're serious about pulse diagnosis if you're one of those people that you want to go get very detailed about the 29 pulse images and you really want to be able to use those diagnostically then it might be worth that money to get um something like Leisure gen's pulse study so this is another book that I like that I recommend but even if you're not uh you're not interested in these books or you don't want to get that detailed in the 29 pulse images yet I think it's it's still a good starting point to start with rdsq rate depth strength and quality whenever you feel a pulse start by asking these questions what's the rate is it fast or slow what's the depth is it superficial or is it deep what's the strength is it forceful or is it forceless and then you can get into more subtle questions about what's the diameter of a vessel is there an edge to the vessel how smoothly is the blood flowing even if you um aren't ready to start memorizing the word for word definition of each of the 29 pulse images if you're not ready for that this is a good starting place where you can start to get some good information so that is our introduction to pulse diagnosis again uh thank you to everybody who supports the website and the channel so if you got value out of this video and you want to give something back there are several ways to do it you you can join the patreon that's like a monthly subscription it's a monthly donation and it it comes with a few little extras I've been trying to write some blog entries on that patreon feed if you want to just do a one-time donation you can do it below this video with the super thanks button or the buy me a coffee also anyone who buys if you buy the courses buy the merchandise I have T-shirts and and mugs that helps support the channel but I know that a lot of people are students and they don't have a lot of extra fun so just if you like the video or share it with your friends that also helps us helps out a lot so uh thank you um to everyone who supports us and we'll see you in the next one