Advanced Pulse Diagnosis James Ramholz
In relation to the human human body, body, yang is above the middle and on the the back; back; yin is is below below the middle and on the front. The eversion of a sphere helps illustrates the internal/external division and transformation of yin and yang. The exterior surface of the sphere is yang, and the interior surface is yin. The interior purple and exterior gold surfaces of the sphere change places in 4‐dimensional space/time. The transformation starts at the top left corner and moves clockwise. In this process, yang and yin change place using the most natural way and, therefore, the least amount of energy. The eversion of a sphere is a 4‐ dimensional Taiji diagram. When the process gets to the midpoint [lower right corner], the figure can can be be divided in cross‐section to reveal the Bagua , an octagon or eight‐sided figure. That the Bagua lies at the midpoint on the most stable pathway through this process underscores its importance in Chinese theory and medicine.
Copyright 2002, 2003 2003 by by James James Ramholz
Table of Contents The Normal Pulse Wave The Normal
Basic Pulse Qualities
3 4 5
15 16 17 18 19 20 21
22
Basic Pulse Wave Dynamics The Normal Pulse in 3‐D The Normal Pulse in Cross‐section
Normal Pulse Positions
6 7 8 9 10 11 12 13
The Importance of Location 1 and 2 Longitudinal Depths 3 Longitudinal Depths Interior and Exterior Perspectives More on Organs and Channels Dong Han Developments, Developments, I: 9‐sectors Model Dong Han Developments, Developments, II: 27‐sectors Model 5 Longitudinal Depths
Floating and Sinking Fast and Slow Slippery and Choppy Long and Short Wiry and Soft Knotting in the Classical Fashion Dong Han Developments, III: Cancer Movement Picture: Jiang Picture: Jiang Jing Jing Explaining Some Details of the Breast Cancer Pulse at NYC Seminar
Basic Pulse Wave Dynamics The geometry of the Normal wave form The Normal pulse (Zheng chang mai) is recognized by its unique symmetry and uniform relation to breathing—2 beats on the inhale and 2 on the exhale.
Y-axis b
In yin/yang theory (base‐2), a Normal wave is defined
c
as the self element of a position (wiry for Wood, etc.) plus stomach qi. In terms of 5‐Phases (base‐5), the
a a
rising and spreading movement is Wood; the cresting
c
X- axis d d
movement or expanding outward from a point is Fire; the descending movement is Metal; and the trough or crystallizing to a single point movement is Water. Earth can be considered either the last 18o of each, or the substantialness of the whole wave. The top figure shows the wave movement in time,
Yin of Yang
b
c
yang of Yang
a
moving left to right. The bottom figure shows the wave expressed in its energetic or state space. Instead of continuing along the timeline (X‐axis) as in the top picture, the wave completes each cycle by returning. All energetic values and possibilities can be illustrated in it.
yin of Yin
d
yang of Yin
Basic Pulse Wave Dynamics The Relation of State or Phase Space to Time
1.
0. 5
2.
4.
6.
-0. 5
1.
-1.
0. 5 1.
0. 5
2.
2.
4.
6.
4.
6.
-0. 5
-0. 5
-1.
-1.
1.
0. 5
2.
4.
6.
-0. 5
In the series of figures on the left side, the rotation
-1.
along the circle is mapped to the timeline. The
1.
0. 5
figure above shows the completed cycle. Then, the 2.
-0. 5
-1.
4.
6.
series repeats itself again with the sequence on the left. All energetic values and possibilities can be diagramed in this state space to illustrate the qualities of each pulse position.
Basic Pulse Dynamics 3‐dimensions and rotational aspect of the basic pulse wave
The pulse wave in each position can be described in 3‐dimensions. The X‐axis is related to the length along the artery and time (frequency). The Y‐axis is related to depth (amplitude). The Z‐axis is related to the width of the pulse, and the position’ position’s overall capacity when considered with the amplitude. The rotational force of the movement is called the torque. Y
As the Normal pulse moves forward along the X‐axis from Proximal to Distal, it can also rotate clockwise, clockwise, expressing 6– 6–Qi qualities in cross‐ section.
Considered together, together, the longitudinal longitudinal and rotational movements express how 5‐Phases and 6‐Qi are inter‐related and mutually engendering. engendering.
Z X
Normal Pulse 3‐D Cross‐section in Yin/Yang and 5‐Phases
Pulses can express both a yin/yang (inner/outer) or a 5‐Phase cross‐section relating to their associated qualities. For example, the Hollow or Onion Stalk (Kou) pulse pulse takes its name and shape from the contrast of the empty yin or inner portion portion—Kidney, Liver and Spleen core—to the outer portions. It indicates blood depletion. Classically described, when pressing down from skin to bone (along the Y‐axis), tension can be felt at the surface, then softness or emptiness at the blood depth, and then tension again in the deeper part. When your sensitivity is stronger you can also feel the wall of the Onion Stalk character character along the outer edges or third dimension.
Kidney Liver Spleen Heart Lung
The Importance of Pulse Positions and Physical Locations to the Qualities
Space, Time, and Qualities are inseparable aspects of the diagnostic information from the pulses.
As it says in the Nan Jing , In each case, one determines on the basis of the Nan Jing , “ In location of the movements in the conduits whether the influences—in case of an illness—proceed contrary to1 or in accordance with2 their proper course.” Unschuld translation, Difficulty 4
1. Ni , Ni , counterflow 2. Zheng , Zheng , correct
One and Two Depths Zang and Fu Fu
From skin to bone, each position can be seen as a single space associated with the zang organ zang organ of that position; or it can be divided into 2 depths, related to both the zang and fu.. zang and fu
Proximal The Zang and Zang and Fu refer Fu refer to the solid and hollow organs, respectively. They reflect the storage and transformative capacity of
Hollow organs
the Phase associated with that position. Like all other pulse models, each depth can be viewed in combination with another to describe a single movement, or as different sectors or spaces with their own separate movements, qualities, and diagnostic information.
Solid organs
Middle
Distal
3 Depths From the Nan Jing and Mai Jing
From skin to bone, each pulse position can be divided into 3 depths: qi, blood, and adapted depth (in other pulse systems, this is referred to as the organ depth). This model reflects
Proximal
Skin, meridians, emotions
both channel and organ influences. The distal position can reflect the body from the head to the diaphragm; the middle position from the diaphragm to the navel or groin; and the proximal proximal position from the navel or groin to the feet.
Current physiological processes
Organs and deeper or habituated patterns
Middle
Distal
Interior and Exterior Perspectives
Upper back
Chest or Front S k i n
Middle of back
S u r f a c e
B o n e
B o n e
Diaphragm line
Abdomen Lower back
Navel line
Lower Abdomen
More on Channels and Organs Nan Jing Difficulty Difficulty 18
The 3 Depth Model, seen earlier, presents the basis for a combined channel and organ pulse perspective. Nan Jing, Difficulty Nan Jing, Difficulty 18, further examines the pulse positions from both an organ and channel perspective.
Heart Shaoyin
Lung Taiyin
Liver Tzuyin
Spleen Taiyin
Kidney Shaoyin
San Jiao Shaoyang
This perspective shows the basic 5‐Phase networking and connection between the positions for the organs. But because most channels transverse the entire body, this perspective does not reveal the correct
Creation (Sheng) Cycle
channel symmetry, flow, and connection between positions. This problem was solved in the Dong Han system. Like a Chinese puzzle, the channel symmetry and interactions are only revealed when examining the pulses at a different scale.
Control (Ke) Cycle
More about 3 Depths Model Dong Han Development, V
Proximal
Middle
In the Dong Han system, we often examine the qualities of several different combined positions, positions,
Distal
sectors, or depths in order to interpret things not previously previously accounted for in classical pulse diagnosis. diagnosis. Many ideas from Western medicine can be found in this type of organization.
Skin, meridians, emotions
Current physiologic al processes
Movements on the dividing line between the qi and blood depths often relate to the sensory level [yellow dotted line]. Problems related to the sensory system associated with a particular organ can often be found here. For example, ears in the kidney position, etc.
Organs Organs and deeper or habituated patterns
Movements on the dividing line between the blood and adapted depths often relate to the endocrine level [red dotted line]. Problems related to the endocrine system associated with a particular organ can often be found here. For example, adrenals in the kidney position, etc.
Dong Han Development , I Based on Nan Jing Difficulty Difficulty 18 Proximal
In the Dong Han system, each pulse position is subdivided into a smaller scale fractal image of all 3 jiaos. In this way, the whole 3 jiaos. In body can be examined from the perspective of each respective organ or phase. For example, if this is the right wrist, then we are examining the upper middle and lower jiao lower jiao from the perspective of the Earth phase.
When divided a position position from skin to bone into 3 depths, we create 9‐sectors in each. We can even first divide the position into zang and fu before before dividing it into 3‐depths; zang and fu in which case each depth has its own 9‐ sectors. Doing so, we can examine the relation of either or both the spleen or stomach channels to the whole body in all three jiaos three jiaos..
Middle
Distal
Dong Han Development , II More on Nan Jing Difficulty Difficulty 18
We can go still another step further than our
previous development on the Nan Jing. When including the 3rd dimension, the width of the artery, the 9‐sectors model develops into a 27‐ sectors model. In this way we can see both left and right sides of the body on one wrist. We can also first divide each position up into zang and fu before examining both depths in terms of 27‐sectors. This is a “basic unit” in the Dong Han system, and it can be interpreted in several different ways.
Later, we will continue to divide each position
in a variety of other ways, too. As long as we are consistent with theory and can demonstrate clinical effectiveness, all of these pulse models will be an important and useful development of classical theory.
Proximal
Middle
Distal
Five Depths Nan Jing Difficulty 5
From skin to bone, each pulse position can be divided into 5 depths. This pulse model is not always strictly related to channel and organ influences. Instead, each depth is related to the types of tissue associated with the Lung, Heart, Spleen, Liver, and Kidney: skin, capillaries, connective tissue, muscles, and bone respectively. This is the first pulse model that dramatically changes our diagnostic perspective. Using it, we can examine highly localized and even isolated problems; not simply relate general information about the position. Each of these 5 depths can be looked at in combination with others to describe a single movement, movement, sometimes across several positions. They can also be seen as individual sectors or separate spaces with their own waves qualities and information.
Proximal
Middle
Distal
Choosing a Particular Pulse Model
With the wide variety of pulse models possible, the question arises as to which does a practitioner choose to apply—one or another? It is not a matter of choice for the practitioner. The patient will already have “chosen” or presented their problem in their own way. That is why the variety of pulse models exists in the first place.
Basic Pulse Qualities Symmetry Breaking of the Normal Pulse
The Normal pulse (Zheng chang mai) is
b
recognized by its unique symmetry and uniform relation to breathing—two beats on the
Y-axis
inhale and two on the exhale. This reflects the
c
respiratory and cardiovascular circulations—qi
X-axis
a
and blood—moving and working in harmony.
d
All other pulse qualities, their combinations, and their diagnostic meanings are derived from the breakdown in symmetry of the Normal
b
pulse. yang of Yang
In the Dao De Jing , Lao Tzu says that the Dao created the One, One created Two, and Two
a
created myriad things.
Yin of Yang
c
yin of Yin
yang of Yin d
Floating and Sinking Qualities Floating and Sinking refer to the most superficial and greatest depth at which you find the pulse movement. A Floating pulse is felt as soon as the fingers touch the skin, but disappears when further pressure is applied. A Sinking pulse feels distinct only at the deep level. A Sunken pulse is essentially associated with interior patterns, although the exterior patterns of external diseases may temporarily present with a tight Sunken pulse when the body’s yang qi is obstructed.
Slow and Fast Qualities
A Slow pulse has 3 or fewer beats per respiration. The Slow pulse is principally associated with cold and yang vacuity. It may occur in any disease involving insufficiency of yang qi or obstruction of qi movement, such as cold, phlegm turbidity, and static blood.
A Rapid pulse has more than 4 beats per respiration. One having between 5 and 6 beats is termed a slightly Rapid; more than 6 beats is very Rapid. The Rapid pulse is associated with heat but may, sometimes, be an indication of depletion. A forceless fine Rapid pulse indicates yin vacuity fire effulgence and is generally seen in depletion patterns. A forceful Rapid pulse indicates repletion heat and is most commonly seen in febrile diseases.
Slippery and Choppy Qualities
A Slippery pulse found system‐wide is usually indicative of excess qi in the body. It does not necessarily indicate that the mucus is stagnating and forming blockages but rather that the body is in the process of secreting it. It is also sometimes seen in healthy people, indicating an abundance of qi and blood.
A Choppy pulse does not flow smoothly and is classically described as “a knife scraping bamboo.” The rough pulse is often seen in blood stasis patterns and dual vacuity of blood and qi.
Long and Short Qualities A Short pulse does not longitudinally fill its
position. It will not last long since it does not have enough support to create that energy much longer; or it can indicate a localized problem. The movement is becoming more yin. A Long pulse is a movement that extends beyond its
own position. The movement is becoming more yang. It is often seen when one position is sending its influence to another position along the Sheng cycle.
Long and Large (along the vertical dimension) are yang in comparison to Short and Small. Large and Small generally indicate qi or yang qualities, while Long and Short indicate blood or yin qualities. So a Large pulse is yang of yang, a Small pulse is yin of yang, a Long pulse is yang of yin, and Short pulse is yin of yin.
Wiry and Soft Qualities
A Wiry pulse feels like a string of a musical instrument. The stringlike pulse is commonly associated with diseases of the liver and gallbladder, and in particular with ascendant hyperactivity of liver yang. It is also associated with neuromuscular tension, pain, and phlegm ‐ rheum patterns. The Wiry pulse is generally strong. But if forceless, it is termed a vacuous stringlike pulse, indicating the vacuity of yin and hyperactivity of yang.
A Soft pulse is without strength and indicates depletion of the yin and blood and depletion of jing.
Knotting in the Classical Tradition
This movement is described by Li Shi zhen as one that misses a beat at irregular intervals. It is an irregular pulsation indicative of energy blockages and aggregation of yin such as seen in phlegm blockages, tumors, cancer, or blood clots.
Cancer Movement Dong Han Development, III
The standard definition of Knotting (jie) in TCM is one that misses a beat at irregular intervals. In the Dong Han system, this term is modernized to include a movement that seems to be cresting, flattening, and stopping. But even while it is stopping or flattening at the crest there is still some movement going on inside it. Sometimes when the pulse rises to the top of its arch you can feel a vibratory quality without any descending motion. It may also feel like a small tornado on its side; what we nicknamed “spinners.” This vibrating or spinning quality indicates that the energy is concentrating and creating an aggregation, and can be interpreted in several ways. If the movement Knots irregularly, you can suspect a cyst or hematoma. But if it Knots with each beat, you should suspect cancer.
Jiang Jing Breast Cancer Seminar in NYC
In the discussion of a case study during the Breast Cancer seminar in NYC, note the Dong Han style drawings of the Knotting pulse movements on the white board.
