NMT 150 TCM Synchronous Lecture 11 PDF

NMT150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) LECTURE 11 P U L S E C H A R T I N G A N D TO N G U E D I A G N O S I S POINT SELECTION CASES Author: Neemez Kassam, M.Sc., N.D., R.Ac. PULSE PALPATION 1. Locate the styloid process of the radius using the opposite hand from...

NMT150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) LECTURE 11 P U L S E C H A R T I N G A N D TO N G U E D I A G N O S I S POINT SELECTION CASES Author: Neemez Kassam, M.Sc., N.D., R.Ac. PULSE PALPATION 1. Locate the styloid process of the radius using the opposite hand from the one you are palpating. 2. This marks the spot for your middle finger. 3. Your index and ring finger should fall on the first and third positions, respectively. 4. Be sure to leave enough room between fingers based on the size of the patient. More room for taller and less room for shorter patients. PULSE PALPATION 5. Once you have located the 3 positions, arch your fingers as though you are playing a guitar or violin. The tips of your fingers are more sensitive than the pads. You can feel subtle changes in the pulse with this technique. 6. The 1st position is known as the cun, the 2nd as the guan and the 3rd as the chi 7. After arching your fingers onto the radial artery of both hands, compare the two sides. With all three fingers staying on the same level, begin palpating the superficial level than middle followed by deep. PALPATION You are looking for pulses that stand out for being different from the others at that level. Now you can palpate the cun pulse at all 3 levels. Remember that if one of these pulses stood out from earlier, you may want to palpate another pulse at the same time to use as a reference. Follow the same procedure for the guan and chi pulses. PALPATION Normal Variations of Pulses Seasonal Changes Athletes tend to slower Spring – Wood Element – Wiry Women tend to softer & faster Summer – Fire Element – Children tend to faster Flooding Heavier set individual will be Late summer – Earth Element deep & slow – Slippery Autumn – Metal Element – Thin set individual will be Floating superficial Winter – Water Element – Fasting individuals will have a Sinking deficient/weak pulse INITIAL VARIABLES Speed Fast: >90 bpm = Heat Slow: 90 bpm or > 5 beats per breath. < 60 bpm or < 4 beats per Rapid & Forceful = Heat breath. Excess Slow & Forceful = Cold excess Rapid & Weak = Heat Deficiency Slow & Weak = Cold deficiency Swift Extreme heat and yin exhaustion. Nearing Qi collapse. 140 -180 bpm or 7-8 beats per breath. TYPES OF PULSES Empty Deficiency syndrome. Can be Qi, Blood, Yang or Yin. Check with the symptoms Weak at all three levels. Strong Excess syndrome. Can be cold, heat, phlegm Qi, blood or food stagnation. Forceful at all three levels. TYPES OF PULSES Minute Deficiency syndrome. Barely palpable at any level. Frail Qi and Blood Deficiency. Only palpable at the deep level. TYPES OF PULSES Hidden Thready feeble and hardly palpable Pathogens in the interior Jue Syndrome (syncope, cold limbs) Severe pain Felt only a the very deep level TYPES OF PULSES Hollow / Onion stalk Loss of blood or impairment of yin. The yin is not able to root the yang and you have a break or absent middle level pulse. With loss of blood, there is not enough substance to travel in the artery. Felt at the superficial and deep levels only. TYPES OF PULSES Moving / Spinning bean Has a round shape like a bean, feeling short, slippery, rapid and forceful Pain Fright TYPES OF PULSES Slippery / Rolling Phlegm and fluid retention, excess heat, food stagnation, pregnancy. Analogy: Trying to trap a beach ball in a pool of water by placing pressure on one side. The ball squirts out from under your hands and flies forward. TYPES OF PULSES Soggy / Soft Deficiency syndrome or Damp accumulation. Felt at the superficial level. Flooding / Tidal Excess heat. Waves come on strong and powerful then fade away like a tidal wave. TYPES OF PULSES Thready / Thin Deficiency syndrome or damp. Can be of Qi, blood or yin. Feels like a fine thread under your fingers. Wiry Liver and GB disease, pain, malaria or phlegm and damp retention. Feels like the string of an instrument. Wiry vs. Thready: A wiry pulse will have a distinct edge when you roll over it. A thready pulse does not have this edge. TYPES OF PULSES Choppy / Rough / Hesitant Rough, uneven and “unsmooth” Qi and blood stagnation Food stagnation Forceful and choppy Phlegm retention Essence impairment Blood Deficiency Weak and choppy TYPES OF PULSES Tympanic / Leather Large, hollow and taut like “ the surface of a drum” Loss of Blood Impairment of essence Felt at the superficial level TYPES OF PULSES Confined / Fixed / Prison Long, taut and forceful Cold accumulation Qi or Blood Stagnation Felt at the deep level TYPES OF PULSES Scattered Scattered and uneven Qi exhaustion Felt at the superficial level Tight / Tense Tight and forceful like a stretched rope Cold Syndrome Pain Food Stagnation TYPES OF PULSES Long Long and straight Normal pulse – long and gentle Liver Yang hyperactive Excess Heat syndrome – morbid long pulse (long & wiry) Short Feels short as though it does not span the width of your fingertip Qi stagnation Qi Deficiency Only felt distinctly at Guan location TYPES OF PULSES Hurried / Abrupt Knotted Rapid with irregularly Slow with irregularly missed beats missed beats Excess Heat Excessive Yin (Cold excess) Qi and Blood stagnation Qi stagnation Phlegm retention Cold phlegm retention Food stagnation Blood stagnation Prostration – Abrupt and weak TYPES OF PULSES Intermittent / Regularly intermittent pulse Missed beats at regular intervals Zang Qi deficiency Wind syndrome Pain Emotional fear and fright Injury or trauma GROUP WORK: POINT SELECTION 1. Lung Qi Deficiency 2. Lung Heat 3. Phlegm-Heat in the Lung 4. Heart Blood Deficiency 5. Heart Yin Deficiency POINT SELECTION GUIDELINE Choose 6 points from Lung, LI, Ht, SI, Pc, and TW to treat each of the pathologies 1-5 from previous slide Be able to explain your rationale for use REFERENCES Liangyue, Deng et al. Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press, 1996. Maciocia, Giovanni. The Foundations of Chinese Medicine. 3ed. Philadelphia, PA: Elsevier Ltd, 2015. Tyme. Student Manual on the Fundamentals of Traditional Oriental Medicine. San Diego, CA: Living Earth Enterprises, 1997. Kaptchuk, Ted. The Web That Has No Weaver. Chicago, IL: Congdon & Weed, Inc, 1983.