1 Regions and methods for taking pulse
1.4.1.1.1 Regions for taking pulse
Cunkou is the usual region selected to take pulse. Cunkou, also known as ¡°qikou¡±(opening of qi) or ¡°maikou¡± (opening of pulse), refers to pulsation of radial artery on the wrist.
Cunkou is located on the pulsation of the lung meridian where qi and blood in the lung meridian flows by. Besides, qi and blood from all viscera circulates through the lung and converges over cunkou. The lung meridian starts from the middle energizer and converges with the spleen meridian. Since the spleen and the stomach are the sources of qi and blood and function as postnatal base of life, cunkou can reflect the conditions of the gastric qi. On the other hand, the lung meridian is the meridian from where all the other meridians begin and end their circulation, because the circulation of qi and blood in all the twelve meridians starts from and ends at the lung meridian, finally converging over cunkou. That is why cunkou can reflect the conditions of all viscera, qi, blood and meridians in the body.
Pulse over cunkou is divided into three parts, curt, guan and chi. The part slightly below the styloid process of radius is guan pulse, the part anterior the guan pulse is the cun pulse, and the part posterior the guan pulse is the chi pulse (see Fig. 3). Both hands have three divisions of pulse, i.e. cun pulse, guan pulse and chi pulse..So altogether there are six divisions of pulse.
Clinically the correspondence of cunkou pulse and the viscera is decided according to the description in Neijing (Canon of Medicine), that is the upper pulse (cun pulse) corresponds to the upper part of the body and the lower pulse (chi pulse) corresponds to the lower part of the body:
The left cun pulse and the corresponding viscera: the heart and tanzhong (the part between the breasts).
The right cun pulse and the corresponding viscera: the lung and the thorax.
The left guan pulse and the corresponding viscera: the liver and the gallbladder.
The right guan pulse and the corresponding viscera: the spleen and the stomach.
The chi pulse and the corresponding viscera: the kidney and the lower abdomen.
The right chi pulse and the corresponding viscera.the kidney and the lower abdomen.
Such a theory about the relationship between the cunkou pulse and the corresponding viscera is significant in clinical diagnosis. However, the application should be flexible and based on the synthetic analysis of the data obtained from the four diagnostic methods.
1.4.1.1.2 The methods for taking pulse
The following points should be borne in mind in taking pulse.
Time: Early morning is the ideal time for taking pulse because the conditions of the pulse are not affected by food and other activities. However, this requirement is difficult to fill in clinical practice. To ensure accurate pulse taking, the patient should rest for a while to tranquilize the heart and breath before the taking of pulse.The pulse should be taken at least for one minute each time in order to correctly examine the conditions of the pulse.
Normal and calm breath: Normal and calm breath means that the doctor keeps his or her own breath quiet to examine the pulse of the patient and calculate the beat of the pulse according to his or her own cycle of exhalation and inhalation. Healthy people breathe 16 - 18 times one minute under normal conditions. And the pulse beats 4 - 5 times in a cycle of exhalation and inhalation, about 60 - 90 beats per minute.
Posture: The patient sits erect or lies in supination and the forearms stretches out naturally to the level of the heart. The wrist is put straight, the palm turns over and the fingers are relaxed to extend the cunkou region and enable qi and blood to flow freely.
Arrangement of fingers: The three fingers of the doctor are put at the same level and slightly arched to press the pulse with the belly of the fingers. The middle finger presses on the gnan pulse, the index finger presses on the region anterior the guan pulse (distal to the heart region), the ring finger on the chi pulse posterior to the guan pulse (proximal to the heart region). The arrangement of the fingers is made according to the conditions of the patient's arm. In diagnosing diseases in children, ¡°one finger is used to press just the gnan pulse¡±. It is unnecessary to divide the pulse into three parts in this case.
General pressure and single pressure: General pressure means to press the pulse with three fingers to distinguish the conditions of cun, gnan and chi pulses on
both hands. Single pressure means to examine the pulse on one hand with just one finger to differentiate the states of cun, gnan and chi pulses. Clinically these two methods are used according to the pathological conditions in question.
Lifting, pressing and searching: Lifting, pressing and searching refer to flexible pressure of pulse in order to distinguish the conditions of pulse. Light pressure means ¡°lifting¡±; heavy pressure means ¡°pressing¡±; and mobile moderate pressure means ¡°searching¡± which is used to look for the most obvious region of the pulse. In the procedure of diagnosis, doctors should pay attention to the use of these three methods to distinguish the variations of pulse.
Examining the conditions of pulse: The conditions of the pulse refers to the sensation of pulse felt by the fingers. The examination of pulse conditions means to distinguish the features of pulse according to the position of pulse, the rhythm of pulse, the shape of pulse and the strength of pulse.
