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Source｜China Traditional Chinese Medicine News
Written by｜Li Xiaoling, Gansu University of Chinese Medicine; Liang Yonglin, Shenzhen University Affiliated South China Hospital; Wu Yuhong
△China Traditional Chinese Medicine News, March 24, 2023, Page 7
Pulse diagnosis is a method where practitioners use their fingers or palms to touch, feel, press, and apply pressure to certain areas of the patient to understand their condition and diagnose diseases. Based on the three diagnostic methods of observation, listening, and inquiry, accurate pulse diagnosis can provide more information for practitioners to differentiate syndromes, allowing for more precise treatment. As stated in the “Nanjing – Difficult Issues, Chapter 61”: “To know by touching is called skillful.” Touching implies contact, closeness, and pressure. It is often said that practice makes perfect; pulse diagnosis requires practitioners to master basic theories and methods, as well as engage in long-term, repeated training and careful observation to truly grasp the fundamental skills of pulse diagnosis and effectively apply them in clinical practice. The seemingly simple pulse diagnosis contains profound techniques. Below, we will popularize some of the ‘skills’ of pulse diagnosis.
｜The ‘Skill’ of Pulse Diagnosis｜
In ancient times, pulse diagnosis specifically referred to the examination of the pulse, but the method of pressing has been recorded in texts such as the “Huangdi Neijing” and “Shanghan Lun” and has been richly developed in later generations. Therefore, pulse diagnosis mainly includes two parts: pulse examination and pressing.
Pulse diagnosis is a method where practitioners use their fingers to press on certain superficial arteries of the patient to experience the pulse’s characteristics, thereby understanding the body’s condition and differentiating diseases. The heart beats rhythmically, pushing blood through the vessels, so the pulse’s rhythm generally corresponds to the heart’s beating frequency. The pulse image reflects the state of Qi and blood to some extent: when Qi and blood are sufficient, the pulse is smooth and strong; when Qi and blood are deficient, the pulse is thin, weak, or soft; Qi stagnation and blood stasis may present with a choppy pulse. Additionally, the lung’s respiratory movements significantly influence the pulse; a calm breath results in a gentle pulse, while rapid breathing leads to a quickened pulse. The spleen governs blood, ensuring it flows within the vessels without overflowing, while the liver stores blood, regulating its volume and promoting smooth circulation of Qi and blood through the meridians. The kidneys store essence, which is the root of Yuan Qi; when kidney Qi is abundant, the pulse throughout the body is strong and continuous.
The skills of pulse diagnosis are reflected in various aspects such as timing, posture, calming the mind, and defining the points of examination, which will be explained in detail below.
Timing
The best time for pulse diagnosis is early morning, as people have not yet eaten or engaged in activities, and the internal and external environments of the body are relatively stable, minimizing external interference on Qi and blood. At this time, the pulse can accurately reflect the state of the internal organs, meridians, and the dynamics of Qi and blood, as well as the pathological conditions. Practitioners should take the pulse for no less than 50 beats, which helps in carefully discerning the pulse rhythm and reducing or avoiding missed or incorrect diagnoses.
Posture
During pulse diagnosis, the correct posture for the patient is to sit upright or lie supine, with the forearm naturally extended forward, at the same level as the heart, the wrist straight, the palm facing up, and the fingers relaxed. The practitioner should place a soft pulse pillow under the patient’s wrist to fully expose and extend the cun (寸), guan (关), and chi (尺) areas.
Calming the Mind
Practitioners should maintain natural and even breathing during pulse diagnosis, calming the mind and spirit, using their own breath to count the patient’s pulse rate. They should concentrate their thoughts, focusing on the pulse under their fingers, carefully discerning the pulse image.
Defining the Points of Examination
Practitioners typically use the index, middle, and ring fingers of either hand to examine the pulse. When pressing down, the middle finger is first placed on the inner side of the wrist’s high bone, which is the ‘defining point.’ Then, the index and ring fingers are placed in succession. The index, middle, and ring fingers correspond to the cun, guan, and chi areas, respectively. The three fingers should be slightly arched and inclined, with the fingertips aligned and at a 45° angle to the patient’s skin, ensuring that the tips and pads of the fingers are in close contact with the pulse.
Finger Pressure
After placing the fingers, practitioners should adjust the pressure applied and combine it with the search for the pulse. Lightly pressing the cun pulse is called ‘floating’; applying heavier pressure, even to the bone, is called ‘deep’; and varying the pressure from light to heavy while searching for the most pronounced pulse in the cun, guan, and chi areas is called ‘searching method.’
Finger Techniques
Finger techniques are divided into total pressing and single pressing. Using three fingers with equal pressure to examine the pulse is called ‘total pressing,’ which allows for an overall assessment of the pulse’s shape, position, and strength; using one finger to examine a specific pulse area is called ‘single pressing,’ which is to understand the conditions of the cun, guan, and chi pulses.
｜The ‘Skill’ of Pressing Diagnosis｜
Pressing diagnosis is a method where practitioners directly touch or press certain areas of the patient’s body to understand local temperature, moisture, softness, hardness, tenderness, swelling, or other abnormal changes, thereby inferring the location, nature, and severity of the disease. The skills of pressing diagnosis can be reflected in various methods such as touching, feeling, pressing, and tapping.
Touching Method
The touching method refers to practitioners gently touching or sliding their hands over the patient’s skin to assess warmth, moisture, etc., to distinguish whether the disease is due to external invasion or internal injury, and to judge the balance of Yin and Yang and the sufficiency of fluids and blood.
Feeling Method
The feeling method refers to practitioners applying slight pressure to a specific area to determine the presence of pain or masses, or to assess the extent and degree of swelling, thereby differentiating the location and nature of the disease.
Pressing Method
The pressing method refers to practitioners applying firm pressure to a specific area of the patient’s body to assess for deep tenderness or masses, as well as the shape, size, texture, and mobility of any masses, thereby differentiating the nature of the internal organs and the presence of pathogenic factors.
Tapping Method
The tapping method refers to practitioners tapping on a specific part of the patient’s body to create vibrations that produce sound, wave sensations, or vibrations, which help determine the nature and extent of the disease.
The differences between the touching, feeling, and pressing methods lie in the varying degrees of pressure applied and the depth of the areas reached.Touching uses light pressure on the skin, feeling applies slightly more pressure to reach the muscle layer, and pressing uses firm pressure to reach the bones or deep abdominal cavity. In clinical practice, these methods can be used in combination.
The order of pressing diagnosis generally starts with touching, followed by pressing, from light to heavy, and from shallow to deep, beginning with healthy areas and gradually moving towards the diseased areas, examining from far to near and from top to bottom. Practitioners should pay attention to the lighting, temperature, and quietness of the examination room before performing the diagnosis, and ensure patient privacy is protected. The operation must be meticulous, precise, standardized, comprehensive, and focused, exposing the examined areas sequentially and encouraging patient cooperation to accurately reflect the sensations of the disease location.
Pressing diagnosis is usually conducted purposefully based on the findings from observation, listening, and inquiry, combined with the patient’s abnormal sensations and changes in morphology, to further explore the location, nature, and severity of the disease for comprehensive analysis, allowing for more accurate judgments. Therefore, pressing diagnosis not only further confirms the findings from observation but also supplements the deficiencies of observation, and can highlight key points for inquiry, especially playing a crucial role in diagnosing abdominal diseases.
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