Pulse Diagnosis:

A Multi Dimensional Method of Pulse Balancing

Space – Time –  State (Volume-Rate-Quality)

William R. Morris OMD

“The Divine Reason of things… is regarded as the fullness of all powers---ideal space, ideal time, if such can be permitted(1).” Philo

The ideal pulse is an expression of a healthy state. When the factors of space, time, and state are balanced throughout the pulse, then the adaptive capacity of the patient is heightened, and the overall sense of wellness, clarity and focus are improved. Within this multi-dimensional context, this article presents an argument for pulse balancing methods as a style of practice. In addition, a specific process of pulse balancing is discussed that is based on the five phase qualities that relate to each position as discussed in the Ling Shu and other significant texts. The work has been verified through clinical experience and trials are needed for further confirmation.

Space

Space is represented by an even distribution of volume throughout each pulse position. If the pulse volume is similar position to position, it represents an even distribution of Qi and Blood throughout the organism indicating a general state of heightened recovery potential. Most pulse balancing systems such as Japanese and Worsley focus primarily on balanced volume and force from position to position. As a compliment to these ideas, consider the series in Acupuncture Today by the author that addresses some of the implications of volume related to Wei Qi status as well as Eight Extraordinary Vessels citing clinical applications and classical literature(2).

Time

Time is represented by rhythm and rate as well as the arrival and departure of the wave. When these factors are stable, that is the rate does not change inappropriately and the rhythms are even and consistent while the wave has a moderate arrival, it is a positive sign. Detailed discussion of wave as a reflection of time will be in a forthcoming book from the author entitled Neoclassical Pulse Diagnosis; in the interim, Wang Shuhe gives this topic exceptional if not obscure discourse(3).

State

It is in the space-time continuum where experience occurs that is reflected in the pulse as particular qualities. These are the features this article will focus on. The Ling Shu uses five basic qualities including wiry, slippery, hook (flooding), deep, and floating choppy in correspondence with season and elemental influences (see table 2). These seasonal influences correspond to changes of life and experiences that occur between birth and death. As the spring forces emerge in the form of plants, tension occurs in the pulse, when summer occurs, the plants are in full bloom and the pulse expands with a hook-like shape. As fall arrives, the vital forces begin to retreat and the pulse while still filling at the surface becomes uneven and uncertain as retreat begins. When winter arrives the pulse becomes deep.

Qualities

Each and every pulse position has a normal and natural quality that is an expression of an element. This quality when moderate is a healthy expression of the corresponding organ – if it matches the quality that relates to the organ. For instance, the kidney positions are deep, the heart position is mildly flooding, the liver position is mildly wiry, the spleen position is mildly slippery, and the lung position is mildly floating and choppy.

These ideal pulse images correspond to constitution, the seasons, and the nature of the individual organs. Each constitution may present with a predominance of a given quality such as wiry, slippery, hook-like (flooding), deep, and floating hair-like(4). The same is true of each season and each individual organ. These qualities are all moderate expressions in the ideal pulse.

As one examines each position for the correct elemental influences, there are usually only one or two positions in which qualities that do not present with a natural expression of the corresponding organ. If the quality found in a given position does not correspond the related organ, then another influence is present and may provide a fulcrum from which to access the deeper physiology of the individual. For example: if a slippery quality is present in the kidney position, then earth is influencing water.

Within the experience of time and space -- that is, surviving and growing older -- there is a world of experience that can be analyzed with the five phases system of pulse diagnosis. Among these experiences can be that of ignorance in association with dampness and phlegm, passion in relation to fire, isolation in relation to coldness, focus in relation to dryness, or tension with too much change (wind). These states of being represent themselves within the pulse as qualities either throughout the whole pulse, or within certain areas (see table 1). However, this notion does not preclude the necessity of standard differential diagnosis and treatment of the presenting condition.

The Practice of Pulse Balancing

A moment must be taken to establish the virtues and historical basis for pulse balancing approaches in Chinese medicine. The methods of Baek, Worsely and the Japanese with respect to monitoring the pulse for the purpose of determining efficacy of acupuncture treatments have been established. But, such considerations are seldom involved in the practice of the mainstream TCM physicians where it is often used to confirm the diagnosis. However, a closer look will show that significant personalities in the historical development of the medicine considered it important. Take for example Zhang Zhongjing who discusses the use of the pulse to determine efficacy of herbal treatments in various passages throughout the Shang Han Lun. It should be noted however, that he admonished against using the pulse alone without the complete clinical picture placed in analysis. In addition, Dr. He Hanlou has described(5) the discovery of such use in the Golden Cabinet. “If the pulse is minute and harsh on the cun site and thin and tense on the guan site, it is appropriate to activate yang qi by acupuncture in order to soften the harshness and to relax the tenseness, thus bringing about recovery.(6)”

When a particular quality affects one position, it can be said that the element is affecting that organ if there are concomitant signs and symptoms. For example, a slippery pulse in the left guan position represents damp or earth affecting the liver; if it is hooked (flooding), then fire or heat is affecting the liver; if it is deep, then water or cold is affecting the liver; if it is floating and astringent, then metal or dryness is affecting the liver. The presence of an element within a pulse position gives a cycle relationship that may be occurring due to the transmission of evil as pathogens, emotions, or the impact of lifestyle factors such as damage by food and drink or depletion of essence through excessive activities in the bedchamber. 

Table 1

Table 2

Treatment

Treatment using this method of analysis is relatively simple. Use the channel related to the locus of disease process or constitution. Then select the point which corresponds to the quality that is found in a given pulse position. In the example given above the earth is affecting water treat the affected channel with the point that corresponds to the influencing element (see table3). It is rare for the influencing element to remain when these points are used.

In my clinical experience, when the pulse qualities are appropriate to the position, the effects of the acupuncture treatment often last longer than when they reflect inappropriate influences within the orb of influence. 

Table three provides the associated acupuncture points for each possibility. As always, this must fit the pattern differential diagnosis. In addition, these points are easily used if the five-elemental nature of the points has been memorized. If not, the chart is available for quick reference and use will eventuate memorization.

Table3

Table four presents an exercise in using either the principle of the pathogen that is represented by the untoward quality found in a given position. This should be critically analyzed for appropriateness to the case through a ‘confluence’ of signs and symptoms such that the medicinal is appropriate for the patient, the condition, and the climate. It is possible to modify a formula to contain one of these herbs and fits an overall pattern. This will create a level of sophistication in formula design with respect to matching the influences that are occurring from a pathophysiological perspective in Chinese medicine.

Table 4

In Closure

The factors describing experience within the time space continuum can all be observed in the pulse. The time-space-experience model provides a meta-structure by which to organize various features of the pulse. It is not enough to assure balance with respect to volume alone, the time factors and the experiential factors must also be harmonized for the natural powers and full healing potential of the organism to be potentiated.

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1.              Alexandria Po. Thrice Great Hermes, Studies in Hellinistic Theosophy and Gnosis. Weiser; 1906. (Mead GRS, ed.

2.              Morris W. Diagnosis and Treatment of the Night-Time Defensive Qi Cycle. Acupuncture Today. 2002(May 2002).

3.              Shuhe W. The Pulse Classic A Translation of the Mai Jing Blue Poppy Press; 1997. (translator YS-z, ed.

4.              Wu NL WAT. Yellow Emperor's Canon of Internal Medicine China Science and Technology Press; 1996.

5.              Honlao H. Exploration of the effect of acupuncture on string-like pulse. Journal of the American College of Traditional Chinese Medicine. 1987;1: 51-55.

6.              Jing ZZ. Chin Kuei Yao Lueh Long Beach, CA: Oriental Healing Arts Institute. ((translators) HHaWS, ed.