Friday, October 22, 2010

The mystery of pulses

In a comment on my sister blog on five element treatments, I was asked by Sean to include pulse pictures with my treatments. I made a conscious decision not to do so for various reasons, some of which I am sure will raise eyebrows (but then a lot of what I write probably raises more eyebrows than I am aware of!). To do so, I must place pulse-taking in a five element context, and here there will inevitably be differences with the purpose and methods of pulse-taking for other systems of acupuncture.

We take pulses for the following main reasons:
At the start of treatment to assess the overall strength or weakness of a patient’s energy, and to gauge the relative balance of the elements and their officials one to another;
During and at the end of treatment: to assess change (but there are some major provisos here which I will discuss).

It is important to be aware from the start exactly what a pulse picture does not tell us.  It does not tell us what the patient’s guardian element (CF) is, sadly, some of us may think, for perhaps this would make our work easier. What it can do is indicate that treatment directed at one element has changed the balance of energy, but not whether this element is the guardian element.

We take a pulse reading at the start of treatment, at various points during treatment if we are looking for some change which will demand further treatment, such as an Entry/Exit block, and at the end of treatment. We have a blessedly simple form of pulse notation to do this, compared with the 27 notional pulses of other systems. We assess whether the energy of one element and its officials is in a state of (relative) balance, which we note as a check pulse (a tick), whether it is depleted (a minus pulses) or whether it is in excess (a plus pulse). We assess 12 pulses, two for each of the five elements, plus two further for the two Fire functions of Heart Protector (Pericardium) and Three Heater. In each case we feel the pulses at two depths, with all the 6 yang pulses at the superficial level and all the 6 yin at the deeper level.

It is rare for there to be sufficient discrepancy between the yin and yang pulses of any particular element for us to need to correct this (by taking from the relatively stronger and giving to the relatively weaker using the junction (luo) point), but it does happen. So, for all general purposes, we treat the two officials of an element as one, and usually, but not always, treat both yin and yang aspects of an element at any treatment.

This sets the scene for our pulse-taking. How then do we assess change? The major proviso here is that energy does not necessarily shift quickly after needling. It can change so markedly that our pulse reading picks it up, but it may not if change is slower and less dramatic. It can take hours, if not days, for the elements to show any improvement, and this lapse in time will be reflected in the pulses. To rely on perceiving a pulse change as evidence of good treatment is therefore not necessarily an accurate way of doing things, and to interpret no change in pulses as a sign of inadequate treatment is just as meaningless.

And this is where we need to learn to move away from a reliance on what we think the pulses are telling us to increased reliance on our observation of possible change in the patient. Does the patient look happier, quieter, pinker, less white, talk less, talk more? All these are, I believe, more reliable indicators of positive changes than any changes picked up on the pulses. And since energy continues to change long after the patient has left us, and is always completely different when they come back the next time, there seems little point in spending too much time on writing down a final pulse picture, which only gives what will be a temporary snapshot of energy in process of continuous change.

So my advice to all those struggling to feel, let alone interpret, pulses has always been to avoid over-reliance on something which is so ephemeral and delicate. Instead, use as many other powers of observation to interpret what is going on with a patient’s energy. For example, does my patient look as if they are absolutely desperate (Husband/Wife imbalance, perhaps), even if I can’t feel the left pulses as weaker than the right? Do they rub their eyes or ears, even if I can’t feel sufficient discrepancy between the pulses of SI and GB to tell me absolutely that there is an Entry/Exit block there? These are the kinds of aids I use to round out my pulse reading.

We should always remember that our fingers may be clumsy instruments for interpreting the incredibly subtle manifestations of body and soul which pulses represent

So, Sean, I hope this explains why I don’t include pulse pictures.


  1. Nora,
    Thank you for clarifying why you decided not to include pulse pictures in your treatment blog.

    A few comments on you clarification if I may.
    My training to date had stressed an importance in taking pulses throughout and at the end of treament as a means of assessing how tratment was progressing and had finished. I would think that energy must change quickly in the case where a CV/GV block, E/E, IDs, EDs or H/W protocol is being used as I would expect the pulse picture to be a key component in determining if the particular block had been cleared. It puzzles me slightly therefore as to why pulse picture is not so reliant or energy is delayed for treatment otherwise?

    So your statement "And since energy continues to change long after the patient has left us, and is always completely different when they come back the next time, there seems little point in spending too much time on writing down a final pulse picture, which only gives what will be a temporary snapshot of energy in process of continuous change." intrigues me although I can relate to it.

    As you reminded however CSOE changes are also a useful feedback mechanism of treatment.

    Experience I'm sure is also a key component here and I suspect certain veils are lifted for us the longer we are in practice!

    Thank you,
    - Sean

  2. You are right, of course, Sean, in saying that there will be some obvious pulse changes after certain treatments, and I think I should have emphasized that more. What I was trying to say, however, was that what happens in theory doesn't always translate itself into practice because our pulse-taking may not be sensitive enough to pick up all the changes. And that we therefore need to add whatever additional information we can gain to what our fingers may be telling us.

    A few veils certainly lift after we have been in practice for a bit, whilst others descend! I remember saying to JR that I felt that I could not really interpret the pulses properly, and he said that this had happened to him, and then after a few weeks he found his pulse-taking had moved to another level. When I am not sure what I am feeling I like to think that I am moving on to this other level, although of course I may not be! We have to practise with humility, as I always say.

  3. Have you any thoughts as to why treatment of points to clear blocks usually bring about (hopefully) clearly identifable pulse changes which are readable during treatment whilst treatments on other points may not?

  4. That’s an interesting question, Sean. I think this is because blocks are what they say they are, i.e., blocked energy, and when they are cleared there is a rush of energy through the system much like a dam being released. This may (or may not!) be sufficiently strong to be detected more easily than other kinds of changes in energy. Treatment other than blocks is directed at strengthening underlying weaknesses in the elements, and changes will usually take place more slowly over a longer period, and may therefore be less easy to detect. Of course, all this depends on the level of our skills in pulse interpretation. Hope this helps.