7.Diagnostics-Pulse diagnosis (2).pptx

Dr Zijing Hu (M.B. M.Med) Lecturer: Department of Chinese Medicine Diagnostics Complementary Medicine (Acupuncture) (Pulse diagnosis) Faculty of Health Scie...

Dr Zijing Hu (M.B. M.Med) Lecturer: Department of Chinese Medicine Diagnostics Complementary Medicine (Acupuncture) (Pulse diagnosis) Faculty of Health Sciences University of Johannesburg  Theoretical foundation of pulse diagnosis Heart and blood vessels are two major organs contributing to pulse conditions Qi and blood are the material foundation of pulse conditions Pulse conditions are closely associated with functions of Zang-fu organs  Methods and cautionary notes of pulse diagnosis Methods and positions of pulse diagnosis There are three pulse diagnostic methods: diagnosis in three parts and nine divisions, diagnosis in three arteries and diagnosis in Cunkou area (radial artery). Locations for pulse diagnosis Three-area, nine-region pulse taking method The pulse was first described in The Yellow Emperor’s Inner Classic: Basic Questions. As an age-old pulse diagnostic method, it was also referred to as a general diagnostic method. The pulses are taken in different parts of the body, including the head (upper), the hand (middle) and the foot (lower), with each of it further subdivided into three regions, namely, heaven, man and earth  Three-region pulse taking method The three-region pulse-taking method was first recorded in The Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun, by Zhang Zhongjing) In the Han Dynasty the pulses that were examined at the three regions are ST9 (Renying), cunkou and BL59 (Fuyang). The qi of the twelve channels is detected at cunkou, and the stomach is detected at ST9 (Ren ying) and BL59 (Fuyang). Some advocated replacing BL59 (Fuyang) with KI3 (Taixi) to detect the kidney qi.  The Cunkou pulse-taking method Cunkou, also named qikou, refers to the region where the radial artery can be felt near the styloid process of the radius. The cunkou pulse- taking method was first recorded in The Yellow Emperor’s Inner Classic, and then discussed in detail in The Classic of Difficult Issues (Nan Jing). It was popularized by The Pulse Classic (Mai Jing), and is the most commonly used method nowadays. The Su Wen—Wu Zang Bie Lun states, ‘The stomach is the sea of water and grains, and is therefore the source of the six-fu organs. The stomach receives food from the mouth to nourish qi of the five- zang organs, including the lung. As a result, qi of the five-zang and six-fu organs comes from the stomach and manifests in the Cunkou area.’  The underlying principles of diagnosis in Cunkou area The Cunkou area is overlapped with Taiyuan (LU9). the yuan-source point of the lung meridian. The lung connects with all vessels. Since qi and blood of the zang-fu organs gather at the lung through the vessels, pulsation in this area can reflect physiology and pathology of qi and blood of the zang-fu organs. The lung meridian originates from the middle jiao, which houses the spleen and stomach. In addition, the Cunkou area is located on the ventral aspect of the wrist. It's ideal for pulse palpation because of the thin skin and the vessels are superficial.  Three sections in cunkou Cunkou is divided into three sections, namely, cun, guan and chi.  Method of pulse diagnosis Location The physician first locates the guan position with the middle finger, then the cun and chi positions with the index and ring fingers. Since children have a shorter Cunkou area, the physician can use the thumb or index finger to cover all three positions.  Finger placement The three fingers are slightly flexed, presenting the shape of an arch. The finger tips are kept on the same horizontal level and the pulse is felt with the palmar side of the fingers. The space between the fingers depends upon the height and arm length of the patient. If the patient is tall and has long arms, it is desirable to separate the fingers accordingly. If the patient is short and has short arms, the three fingers are placed more closely.  Touching, pressing and searching Touching, also known as light or superficial pulse-palpation, means to gently contact the skin. Pressing, also known as heavy or deep pulse- palpation, means to exert a strong pressure to reach the bones. Moderate pressing, also known as medium pulse palpation, means to exert moderate pressure to muscles. Searching means to gradually increase finger pressure and search the most palpable pulsation around the three pulse regions (cun, guan and chi)  Feeling the pulse with three fingers simultaneously or with one finger Feeling the pulse with three fingers simultaneously means to apply the same pressure to all three fingers to feel the pulse in the three positions and compare the shape and location of the pulses on both hands. Feeling the pulse with one finger means to feel each position with one finger, with the goal of understanding the characteristics of a pulse in the cun, guan and chi positions respectively. Clinically, the two methods are often used in combination. Pulse taking demonstration  Time Early morning is considered to be the best time Rest before taking the pulse The consulting room should be kept quiet  Position The patient should sit or lie on his/her back. The arm should be kept at the same level as the heart, relaxed and freely stretched. The patient's hand should be rested on a cushion without bending, with the palm up and fingers naturally and slightly bent. In this way, the cunkou region is fully stretched to allow for the smooth local circulation of qi and blood. Breathing The physician needs to regulate his/her breathing and use his/her breathing cycle (inhalation and exhalation) to count the pulse rate of the patient. It’s also important for the physician to be fully concentrated on pulse-feeling.  Elements of pulse diagnosis Level: This refers to the depth of the pulse. A pulse located at the superficial level is called a floating pulse, while a pulse located at the deep level is called a deep pulse. Rate: This refers to the frequency of the pulse. Less than 4 beats in one breath (