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Massage Today
June, 2003, Vol. 03, Issue 06

The "Secret" of Chinese Pulse Assessment

By Barbra Esher, AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc

The little-known fact about Chinese pulse assessment is this: It's really easy. When I hear teachers go on and on about the need to take 500 pulses before it means anything, I roll my eyes.

Yes, memorizing all 28 pulse qualities takes time; connecting the information to what you feel takes a little longer; and perfecting a more complex system, such as the one described by Dr. Shen in Leon Hammer's comprehensive and eloquent pulse diagnosis tome (800 plus pages), will take quite a bit of discipline, but immediately obtaining usable information you can trust takes only a few hours. These articles will give you an idea of how to complete a qualitative pulse assessment, judging whether qi is weak or strong in each of the 12 main positions. It takes longer to distinguish between the 28 pulse qualities, but when you get confident in assessing the relative strength or weakness in each position, you can start to describe the different qualities of the pulse waves.

Examination Approaches: East vs. West

Although the pulse can give you important information in developing a treatment plan, you must consider it in relation to other signs and symptoms. Actually, looking at the pulse in isolation is contrary to the spirit of Chinese medicine; rather, it must be viewed as an integral piece of a whole complex of symptoms. The Chinese medicine view is broader in scope than the subjective or objective data collected in Western medicine approaches, in which the signs and symptoms are considered directly related to the client's chief concern.

For example, a client presents with lower-back pain. A Western-based practitioner conducts a detailed intake in which he or she asks about the quality of the pain; what relieves and aggravates the pain; the severity of the pain; when the pain started; and how posture, lifestyle and attitude come into play. The practitioner may look at X-rays, MRIs, ROM and other physical exams. Most of this information is thought of as directly relating to the lower-back pain, which yields an assessment and treatment plan.

Suppose the same person with lower-back pain comes to see a practitioner of East-Asian medicine. Many of the results from the same type of examination are considered, but information that appears unrelated can be just as - if not more - important. For example, a weak pulse in the third position can be a tip-off to the presence of lower-back pain even before the client says anything. A slow and deep pulse points to its root cause as a Kidney Yang Deficiency (see corresponding article, but there would have to be other symptoms present to confirm that assessment, such as getting up at night to urinate; cold feet; lack of motivation or will; impotence; and/or a swollen tongue with white coating. At this point, a clear, cohesive picture of the energetic balance of the client develops, including emotions and physical manifestations, so the practitioner can select treatment principles and a plan to obtain optimal results.

Back to pulses. If you are an Asian bodywork therapist (ABT), you gather the above information using the Four Pillars of Assessment, sometimes called the Four Examinations, which are pulses belonging to the "touching" category. Other examinations include looking, hearing, smelling and asking. There are so many strategies under each of these categories that you could spend all day doing an initial intake. I prefer to gather a little bit of information at a time because I find that people don't reveal everything right away anyhow, no matter how thorough the examination. I gather enough information to begin treatment; as clients open up in subsequent visits and I see how they have responded to their last sessions, I can adjust my approach (called "assessment by treatment").

The pulses are examples of how the microcosm reflects the macrocosm. Basically, any part of the body gives you a picture of the entire body. Microsystems developed for the ears, eyes, hands, feet, face and tongue have proved accurate and useful. I'm sure you could come up with a microsystem for elbow assessment and treatment if you were so inclined!

In my next article, I will give you the method for taking the pulse and a map with which to start. For "hands on" pulse instruction, visit for a list of schools that offer in-depth programs in Asian bodywork therapy.

Click here for previous articles by Barbra Esher, AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc.


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