Why are you taking my pulse?

It’s much more than just your heart rate

There seems to be a ritual performed at the start of each treatment, you may have noticed if you’ve received acupuncture in my practice. I check the bolster to make sure it is snug beneath the crease of your knees. I check the table temperature. I modestly pull the sheets so that the lower legs are visible.

Finally, I place my index, middle, and ring finger on the inside of your wrist to check your pulse. While I am checking the rate of your heart, that isn’t at the forefront of my thoughts.

How we feel it

Classically, acupuncture diagnosis is based on what is going on in the acupuncture meridians that run through the body. There are 12 primary meridians that correspond with our organ systems. For example, the Spleen meridian, Heart meridian, Stomach meridian, etc. If you hear us mention Spleen deficiency, it isn’t necessarily anything that has to do with your anatomical Spleen organ, but rather the meridian that it is associated with. Pathologies generally begin with a blockage in one or several of the organ meridians, which will eventually disrupt the energetic flow in the entire body.

One way to think about this is to picture a typically busy off-ramp that is blocked off during rush hour, let’s say due to an accident where a semi-truck tips over and is blocking all the exit lanes. The natural free flow of traffic must now get off on another exit, which leads to more traffic on the freeway, alternative exit, and the surrounding streets. If we fly a drone over the area of the blocked off exit, we’ll see that the lanes that the off-ramp feeds into is empty, and streets adjacent have far less traffic than usual.

As can be seen, or felt in this instance, when the energetic flow is blocked and building up in one area of the body, that means that there will inevitably be a deficiency in another area. Simple, yet hard to grasp at times as it is not always obvious in determining where the excess and deficiency is based on just symptoms alone. This is where pulse diagnosis comes in handy.

The pulse on the inside of both wrists is divided into 12 sections, with 6 on each arm. Feeling on the superficial aspect of the pulse on the left arm corresponds with the Small Intestine, Gallbladder, and Urinary Bladder meridians. Pressed a bit deeper, the Heart, Liver, and Kidney meridians can be felt. On the right side, the superficial level relates to the Large Intestine, Stomach, and San Jiao (some translate this to the interstitium) meridians. On the deep level, we can feel for the Lung, Spleen, and Pericardium meridians. As I determine the quality of each position, it may feel a bit like I am playing the piano on your wrist.

An ever evolving process

Mastering pulse diagnosis traditionally takes decades upon decades. Until that point is reached, assessing the strength of each position will more than suffice to bring the whole treatment together. More importantly, whether my root treatment has balanced the pulse. Have the areas of excess in the body subdued, and the areas of deficiency in the body replenished by reinforcing the natural free flow of my patient’s qi? This tends to be at the forefront of my rationale during treatment.

Given these points, this aspect of diagnosis is “subjectively objective”, as there is no technology (yet) to neutrally measure or explain the qualities of the pulse in Traditional Chinese Medicine terms. Of course, as a practitioner it’s important to be grounded and present so the pulse can be assessed with as little projection as possible. For this reason, It helps to return to each position throughout the length of the treatment.

Checking the pulse in our patients is an excellent feedback mechanism for us practitioners during the evolution of treatment. It provides the confidence necessary to accept that things are moving as they should within the energetic body.