Why I Check Your Pulse
In Traditional Chinese Medicine (TCM), there are several diagnostic tools. The most important is the “interview.” This is the time where we ask questions about your health history as well as current symptoms. We also sometimes ask questions that might seem to be totally unrelated, but all for the purpose of determining what pattern or patterns of disharmony your body might be showing.
The next most important diagnostic tool is pulse diagnosis. This is a beautiful, ancient art. It takes thousands of reps to really fine-tune both the feeling and the interpretation of pulse patterns.
We also use tongue diagnosis, which looks at the tongue shape, color, and coating. The nuances here also reveal a lot about what kinds of patterns might be occurring in the body.
Most people don’t think twice about the questions I ask… and honestly, even the tongue diagnosis doesn’t phase them much.
Pulse diagnosis is a different bear. And I wanted to write a bit more to give a deeper understanding of what I am feeling for and what it can tell me about your health and how your body is adapting.
Most people are familiar with a typical Western medicine pulse taken for vitals. This is usually felt at the radial artery on the inside of the wrist and the primary purpose is for measuring heart rate. This is why a medical professional may also look at their watch or a clock on the wall to get the right count of beats per minute. In physical diagnosis class, we are taught to feel for rate, rhythm, and quality. Rate is the number of beats per minute. Rhythm is basically just regular and irregular. Quality is the part that most of the time is ignored in standard vitals measurement. Often this is just mentioned when it is severe, for instance a “thready” pulse means it’s hard to feel, faint in intensity, and may mean that we have a more significant health crisis on our hands.
TCM views pulse with a lot more nuance. We don’t focus specifically on how many beats per minute. The thing that really sets Chinese Medicine pulse diagnosis apart is the different qualities of pulses. Classically there are 28 (sometimes 27, sometimes 29) pulse types. And these aren’t either/or categories. There are some qualities that often exist together, and even within a category, there are gradients or spectrums that these qualities lie upon. This is really where one piece of the art of Chinese Medicine is very fine tuned and, I think, what makes it very interesting.
The depth of the pulse (floating, deep, hidden/concealed) gives us an idea of whether something is more on the surface, or if it has gone deeper within the body. This can sometimes relate to how long something has been going on, or how deeply it has taken hold.
The speed of the pulse (rapid or slow) gives us insight into heat or cold tendencies within the body or within a specific organ or channel system. The strength or intensity of the pulse (full or empty) helps us understand whether there is more of an excess pattern or a deficiency.
We also pay attention to size (big, thin, minute), flow (flooding, scattered, hollow), rhythm (knotted, intermittent, hurried), and directional or dynamic qualities (long, short, moving). These are less about categories and more about building a fuller picture.
But my favorite category of pulse descriptions uses words to describe shape, tension, or texture and many of these use real life objects to compare the feel in the pulse.
Wiry (Xian) → taut like a guitar string
Tight (Jin) → twisted rope, tense
Slippery (Hua) → smooth, like pearls rolling
Choppy (Se) → rough, uneven, scraping
Soggy (Ru) → soft, superficial, weak
Soft (Ruan) → deep + weak + soft
Weak (Ruo) → deep, thin, forceless
Leather (Ge) → hard surface, empty underneath (like a drum)
Firm (Lao) → deep, strong, tight, fixed
Each one of these descriptions comes together to form a bigger picture of what is happening in the body and in the individual channel/organ systems.
Speaking of individual channel/organ systems - the reason the pulse picture is so deep and wide is that we get to assess each of these different qualities of a pulse at three locations, on each wrist. That gives us 6 spots which each tells us about a pair of organs and the channel that is associated with each. Effectively 12 data points times however many qualities can be felt by the practitioner.
So, while the process doesn’t take but a minute or so, it gives such nuanced layers of information about what is balanced and what is out-of-balance in someone’s body and body systems.
Even if you’re coming in for chiropractic care, you can always ask me to check your pulses. I love getting to share a little more of what I’m feeling and how your body is communicating in that moment.
There’s a reason pulse is my favorite. And you have gotten to glimpse a little behind the curtain of what is happening in my brain when I am feeling your pulse for Chinese Medicine purposes.
Photo by kian zhang on Unsplash
