Universal Herbalism: Weekend Three- Holistic Evaluation III

Transcription

1 Pulse Evaluation The hand is the most delicate instrument for diagnosis that can be conceived by the mind of man when it has been educated, when a doctor learns how to use it, to have his eyes at his fingers ends... A doctor should have just as sensitive hands as a blind person. Then he can detect the slightest variation of the pulse from normal to abnormal. -Dr. Eli Jones (1915) The pulse is holistic: it shows general functional operations and changes occurring in systems, organs, and tissues. This has been the universal approach to pulse evaluation in traditional medicine throughout the world. -Matthew Wood Up until this point in our studies of holistic evaluation, we have observed the intake and interview process, as well as the foundations of tongue evaluation. Here we will be entering the vast territory of pulse analysis. I was to place a disclaimer here stating that this is a massive area of study that requires nothing more than practice, practice, and more practice. In order to be able to understand the varying nuances and dynamics of the pulse, one must feel many different pulses. Pulse evaluation can be quite complex, though it is an invaluable method of analyzing underlying tissue state imbalances and the state of the internal organs and systems of the body. Whereas tongue diagnosis is reliant on our visual perceptions, taking the pulse is reliant upon our feeling sense- and as such is much more susceptible to interpretation from person to person. I remember one of the first healers I apprenticed with when I was 19 years old, who was an old school Osteopath, always told me when doing hands on healing that I needed to learn to see with my hands. That always stuck with me, and this teaching is immensely valuable in regards to taking a pulse. You have to learn to see and perceive through the tips of your fingers. Analysis of the pulse is centralized around the circulatory system- that is, the flowing of the blood through the vasculature. The central focus of circulation is important in many traditions of medicine from around the world, including folk traditions, old naturopathy, Physiomedicalism, Eclecticism, hydrotherapy and osteopathy. The blood touches every organ, system, tissue, and cell of the body- not just the blood flowing through the vessels, but the extracellular space that bathes the tissues which from the old definition of blood is a part of it. I like to think of this in a bit of a philosophical sense, that the blood bathes and touches every part of the self- thus through observing the pulse, we observe the whole pattern of the individual. I encourage you to always feel the pulse of your client- whether you feel like you know what you are doing or not. Just feel the pulse and write down how it feels. It s somewhat similar to the process of attuning to the felt sensations in plants- you receive a vision, a sound, or a feeling tone that has some form of meaning embedded within it. It is about taking a non-linear phenomenon and experience and translating it into an understandable form, we need only to decipher its meaning. This is true to taking the pulse as well. So anytime anyone is asking you 1

2 for help, you are doing consultation work, or just giving someone a hand with some herbs, take the time to take their pulse, locate your consciousness in the tips of your fingers, and extend your feeling sense into their body. If anything it will help to clarify their constitution or underlying tissue state- whether get as in depth and detail on the organ systems or not. Remember, as herbalists we don t have the fancy technology modern physicians have- we are thus reliant on what we can extract through our senses and capacities for feeling. This is how all the old doctors and ancient physicians were able to diagnose and therefore treat all manner of disease. In the modern day, all physicians do with the pulse is count the number of beats, which is merely a watered down version of one of the refined methods of holistic evaluation. Our concern here isn t the number of beats per minute, but rather the specific quality, the language of the blood as it courses through the body and touches all of the internal organs. Here I will lay down the basics to pulse evaluation, some basic terminology, anatomy, the positions, organ rulerships, and some of the primary pulse patterns to get you started. From there it s up to you to practice and refine this skill. Years ago, when I decided between whether to be a homeopath or an herbalist, I can my destiny with the cause o herbalism because I didn t want to have to depend on a repertory or a book to find the indicated solution. I wanted to hone my own energetic sensitivity with direct sensorial evaluation methods, such as pulse diagnosis, because I felt that these, rather than books or machines, would improve me as a person. Each healing event should be an energetic, psychological, and spiritually improving learning experience for both parties, Otherwise, something dead has entered the picture; one side is not growing. -Matthew Wood Anatomy and Pulse Positions To approach the inner wrist, to hold the hands, to feel the temperature and texture of the skin is to enter an inner world where the body and spirit start to speak in an immediate way about the past and present. -Kay Parent, AHG To properly take the pulse, it can be helpful to have a little roadmap so to speak, so you know where and what you are working with. It can be helpful to have a little bit of an anatomical understanding of the positions and the parts of the body involved. There are 3 primary positions where we observe the pulse, which are referred to as the proximal (3rd), medial (2nd), and distal (1st) positions. Distal is the most distant from the middle of the body, and hence is the closest to the hand. Proximal is in closes proximity to the core of the body, and medial is in between the two. The pulse itself that is felt is the blood coursing through the radial artery, which sits on top of the radius- one of the primary long bones of the lower arm. located on the thumb side of the forearm. If you feel along your radius, you eventually come to a large bump just below the root of the thumb. This is called the epicondyle and is the primary reference point for locating the pulse positions. The fingers to use for taking the pulse are the index, middle and ring fingers. The index finger should always be located on the distal position (1st position), that is, closest to the thumb, with the middle and ring fingers following up the wrist on the medial (2nd) and proximal 2

3 (3rd) positions. Within each of these 3 positions, the pulse is felt at the superficial, middle, and deep levels, or what some will call the upper, middle and lower levels. While I ve noticed that many traditions recognize these 3 levels, what is often practiced is 2 levels: superficial and deep. I will mention these 3 levels again a little later. Traditionally, the right write is palpated with the left hand, and the left hand palpated with the right, though some practitioners will use the same hand to palpate both pulses of the patient. Some prefer to use their left hand to palpate so they can write down notes (if they are right handed that is). Different traditions have different ideas around the proper placement of the fingers. The way I was taught by Matthew Wood was that this distal position is on top of the epicondyle (the bump beneath the thumb), with the medial position being just proximal to it in the low spot, and the proximal position being next to it. He always describes these positions as up on the hill (the epicondyle), down in the swamp (medial), and up the slope (proximal)- which is quite fitting because that s literally how the positions feel. Other traditions have the distal position being in the space proximal to the epicondyle. Organ System Correspondences to the Pulse Thus, we have 3 positions and 2 levels of the pulse, taking it on both wrists brings us to a total of 12 pulse positions, which correspond directly to the 12 organ systems of Chinese Medicine and the 12 Signs of the zodiac of Western Astrology. This is a very unique aspect of the Chinese system for taking pulses that we do not see in Ayurveda, Greek Medicine, nor in the Physiomedicalist and Eclectic Traditions. It s important to consider the fact that in Chinese Medicine, when they say the word spleen for example, they are not talking about the physical spleen in your body, which is really a lymphatic and immune organ. Spleen in Chinese Medicine is really the entire digestion and absorption power throughout the organism. We do not have time to get into too much detail on each organ system here, please consult a good reference book on Chinese Medicine for this information such as The Web That Has No Weaver or Between Heaven and Earth which are good places to start. But as a good general principle, know that all of the organs which correspond to the superficial pulse positions are the yang organs, which are hollow by nature, and the deep pulse positions correspond to the yin organs, which are deeper in the body and solid by nature. Thus, just by knowing your yin and yang organs can be a very helpful way in getting to remember the different pulse positions organ correspondences. Another good learning tool is that the yin organs progress from the upper parts of the body in the distal positions (heart/lung) into the middle parts of the body in the medial position (spleen/liver), and into the lower parts of the body with the proximal position (kidneys). This is outlined very nicely in Margi Flints book The Practicing Herbalist, of which there is an attached drawing below. 3

4 Below is a chart of these 12 positions and their organ correspondences. It s nice to draw up a copy of this chart and put it on your bathroom mirror so you can study it a little bit every day in order to memorize the correspondences: Organ Correspondences and Pulse Positions Left Wrist Right Wrist Pulse Position Superficial Deep Superficial Deep Distal Small Intestine Heart Large Intestine Lung Medial Gall Bladder Liver Stomach Spleen Proximal Bladder Kidneys Triple Burner Pericardium To briefly define the Triple Burner and Pericardium. The Triple Burner is basically an upper, middle and lower space of the body which governs the proper relationship between Elemental Fire and Water. The pericardium, or Heart Protector can be thought of as the febrile mechanism, or internal temperature regulation which diverts the flow of blood through the periphery and core of the body, as well as regulating the pores of the skin to release or trap internal heat in the system (IE fever). We could essentially think of it as peripheral circulation. Kidney Yin and Yang is essentially looking at the primary Water and Fire Elements of the body- moisture and temperature- respectively. Many western herbalists use a much simpler model for analyzing the pulse, essentially doing away with the superficial and deep positions and using a system of 6 positions, 3 on each wrist. This of course leaves out a few organs, chiefly the intestines and the bladder. This is the style long used by Matthew Wood, Margi Flint, and many other non TCM oriented western herbalists whom have used it to great evaluation and diagnostic effect and thus treatment: The Simplified 6 Pulse Positions Pulse Position Left Wrist Right Wrist Distal Heart Lung Medial Liver and Gall Bladder Stomach and Spleen Proximal Kidney Yin Kidney Yang The 3 depths of the pulse mentioned earlier- superficial, middle and deep- correspond in Chinese Medicine to the state of the Qi, Blood, and Organs, respectively. This also relates quite nicely with the 3 levels of arterial circulation, which consists of the arteries (deepest level), arterioles (middle level), and the capillary beds (closest to the surface or periphery). Thus, when we are feeling the pulse closer to the surface, we can note that the blood is shunted from the core and to the periphery, which may indicate sympathetic excess and heat. 4

5 If the blood is obscured and hard to find except in the deeper positions, it could be that there is poor peripheral circulation, coldness (blood is trying to preserve heat) and the problem is lodged deeper in the organs of the body. A pulse in the middle is typically regarded as being healthy. The 12 Pulse Positions, TCM Organs, and Astrological Signs TCM Organ Astrological Sign Body Area Pulse Position Pericardium (aka Heart Protector) Aries Head Right Wrist, Proximal Triple Burner Taurus Throat Right Wrist, Proximal Lungs Gemini Arms Right Wrist, Distal Stomach Cancer Middle Right Wrist, Medial Heart Leo Chest Left Wrist, Distal Small Intestine Virgo Abdomen Left Wrist, Distal Kidneys Libra Waist Left Wrist, Proximal Large Intestine Scorpio Groin Right Wrist, Distal Liver Sagittarius Thighs Left Wrist, Medial Gall Bladder Capricorn Knees Left Wrist, Medial Bladder Aquarius Calves Left Wrist, Proximal Spleen Pisces Feet Right Wrist, Medial 5

6 Primary Pulse Patterns I would like to at least compile for you some charts and lists of the primary pulse patterns that have been used in the Chinese, Greek/Arabic, and Western Herbal traditions that are the main ones you will want to look for in the pulse. Now this is a pretty massive amount of material to cover- hands down the most comprehensive book on this topic is Matthew Wood s Traditional Western Herbalism and Pulse Evaluation. Before learning imbalanced pulse patterns, it s helpful to first understand what a healthy pulse is like. It should be relatively slow, about 4 or 5 beats per respiratory cycle, beating more in the middle position (not too high or low), calm but with strength. It should neither be big, nor small, regular in it s rhythm, and clearly felt at the base positions described above. In Chinese Medicine there are 28 primary pulse qualities, but the most important ones are the first 6, which describe depth, speed and strength. It is considered best to really get to know these pulses first before jumping into the more refined ones. Generally speaking, these are read in the pulse as a whole to determine the overall state of the person, or their current constitutional state. From there each position is felt one at a time to asses the state of the specific internal organs. In Matthew s book, he breaks down the various manifestations of the pulse based on different polarities in 5 different categories, which are: dimension, time, tone, blood & vessel, and power. This is a very nice classification system for pulses as you see both sides of each reflection of the pulse, making for a much easier system to study that a bunch of random types of pulses. These are broken down as follows: Dimension Height: high/low Length: long/short Width: wide/narrow Magnitude: large/small Time Speed: rapid/slow Rest: quick/rare Acceleration: flooding/ oppressed Regularity: irregular/even Tone Tension: tense/ relaxed Tightness: tight/loose Fullness: full/empty Hardness: hard/soft Blood/ Vessel Viscosity: thick/thin Fluxility: slippery/ nonresistant Blood Coagulation: choppy/ beaded Vessel Wall: hollow/hardwalled Toxic Blood: vibratile/ obscure Power Strength: strong/weak Lift: firm/flat Desiccation: leathery/ planar Disappearing: hidden/faint Fragmented: scattered/ intermittent 6

7 I d like to briefly describe some of the more primary pulse patterns that are best for beginners and getting a sense for some common and relatively easy to feel pulses. We will start with the 6 patterns that Michael Tierra says are the most important ones to learn first: high/low, rapid/ slow, and full/empty. Then I will mention a few other ones worth learning. An important consideration is the these different types of pulses will often be combined together, with the exception of course with the opposite quality (IE a high pulse cannot be low, a tense pulse cannot be relaxed etc). Height High: The high pulse is also called the floating, elevated, or superficial pulse. Just as it sounds, the pulse will be felt with very light finger pressure- the top 3rd of the artery is full and enlarged- yet it weakens when pressure is placed on it, but it won t disappear. It indicates there is an excess of blood to the periphery, or the capillary beds, as well as the head and is commonly associated with heat patterns and the excitation tissue state (but not always). The high pulse can also indicate a weakness or tension in the deeper organs. Low: The low pulse is also called deep or sinking, and is indicated by being felt only at the deepest level with heavy finger pressure- it cannot be detected with light touch. If it cannot be felt even upon pressing on the radius (the bone) it is considered hidden. If we think of the high pulse as being related to heat conditions or acute illnesses where the vital force is trying to push something outwards, the low pulse often indicates coldness or deficiency of energy, or stagnation of fluids and toxicity. We can see the blood is not making its way to the surface, the periphery, or up into the head. Speed Rapid: A rapid pulse is also simply called fast, and is indicated by 6 or more beats per respiration (1 inhalation and 1 exhalation). This typically equates to around 75 beats per minute. This is primarily a heat pattern, it s opposite- slow- indicates a cold pattern. This can be due to fever, yin deficiency or lack of fluids holding down the Fire, or due to stress placed on the heart. Slow: A standard pulse is around 4-5 beats per respiration, and fast is 6 or above, thus the slow pulse is less than 4 beats per respiration. As mentioned above, it indicates cold patterns either from invading cold or lack of internal heat. It is oftentimes related to chronic health issues, or simply aging. Strength Strong: A strong pulse, as the name indicates, will typically beat against the finger with excessive force, which can indicate an underlying constitutional strength and vigor, but also too much heat, pain or inflammation. It can also be high, large, and hard- though the hard pulse cannot be compressed whereas the strong one can. The strong pulse is often associated with fever, where it is pounding or throbbing under the finger. Weak: Here we see a general lack of strength and force in the pulse. It is typically felt at the deep level and is soft and fine, indicating deficient yang. The weak pulse also describes a general lack of Qi and nerve force. Matthew mentions the importance of noting whether a 7

8 weak pulse is wide (the vessel wall feels wide) or narrow (the vessel wall feels limited and thin). The first is acute, the latter a chronic state. Fullness Full: This pulse is also referred to as excess in Chinese Medicine. It is oftentimes equated with the large pulse, but the primary difference here is that the large pulse indicates lots of nutrients and vital strength, whereas the full pulse indicates excesses in the body needing evacuation. It can also be confused with the high pulse, but that one will typically get weaker upon stronger pressure, whereas the full pulse will be felt that way superficially and deep. The full pulse expresses due to humors in the blood and the need for opening the channels of elimination through alteratives. Empty: The empty pulse tends to beat in the upper positions but disappears upon stronger pressure. There is a sense of it being forceless, soft and slow- typically indicated some form of Qi deficiency, lack of vitality and exhaustion. The full pulse shows us that there is too much stuff in the system that needs to be evacuated. Emptiness, being the opposite, shows that there has been too much loss of fluids, nutrients and the system is weakened. The periphery is weak and thus has a leak, indicating astringents- rather than adaptogens and tonics to try and build up the Qi. Tension Tense: The tense pulse feels taught and wiry, like pressing on a tight guitar string. The pulse feels stretched lengthwise, and will feel tight under the finger, you can almost roll the vessel under your finger. This pulse is typically associated with excess vata, or nervous energy, wind, or stagnant Qi. It is associated with the wind/tension tissue state and responds well to nervine sedatives (especially if there is heat) and acrid relaxant/anti-spasmodics. Relaxed: The opposite tissue state of wind/tension is the relaxation tissue state, which can also be felt in the pulse. It feels as though the pulse is sagging, like a clothes line hanging down from each end of the pulse. The vessel wall has lost it s tone and is like the walls of a tire that needs more air. It will primarily be felt as the proximal and distal positions are high and the medial position sinks down low. Like all relaxed tissue states, it calls for astringents. Hardness Hard: One important consideration for the hard pulse is that it is not simply because the blood vessel wall has become hardened off. This is what Ayurveda and Matthew call the hard-walled pulse, where the pulse is hard on the surface, or the wall of the vessel, but soft on the interior. The hard pulse is hard inside and outside- all the way through, not just on the vessel wall. It is difficult to compress and is associated with malnutrition, dryness, pain, and nervous sensitivity. Here we don t think so much of nervous tension, but rather a certain blockage, an excess or deficiency, or just plain exhausted. It can also be due to coagulated blood or cold hardened blood leading to dryness, and very often with inflammation- heat baking down the fluids are hardening. One could determine if the pattern is heat or cold based on the speed of the pulse (rapid or slow). 8

9 Soft: As the polarity to hardness, the soft pulse is indicated by an easily compressible vessel, often the relaxation tissue state (water flowing in and out of the organism) as well as nervous debility or exhaustion. We see that the peripheral circulation and nervous innervation are weakened- thus it has a Water Element component as well as a neural component. It is similar to the relaxed pulse, but differs in that the root of the relaxed pulse is due to lack of tone, whereas the soft pulse is from nervous exhaustion and fluid discharge. Regularity Irregular: Irregularity of the pulse is expressed as random changes in its speed, location, strength and interval. We can think of it as missing a beat. This is the be differentiated from the intermittent pulse which is missing a beat as well, though at regular intervals (IE misses a beat every 4 regular beats or something like that). Irregular, is as it sounds, missing a beat at random or in a non-pattern based way. Another differentiation is when a pulse is irregular in speed, location, and strength, but doesn t miss a beat, it is considered choppy. The irregular pulse is due to poor force throughout the nervous system, especially impacting the heart- thus it is commonly associated with heart palpitations. It can be associated with heat (fast) or cold (slow). Even: Just as it sounds, an even pulse has a steady rhythm, strength, and location. Matthew calls it the athletic pulse and is an indication of good cardiovascular tone. Fluxility Slippery: The slippery pulse feels smooth and rounded to the touch as the blood slides or rolls under the fingers like pearls in a porcelain basin. It seems to move forward in the vessel, as opposed to beating up and down- like it is slipped under the finger. (MW) This is a super important pulse in TCM. Tierra says this is best learned by feeling the pulse of a pregnant or menstruating woman. Think of it as lots of oils in the blood, making it thicker and more yang in quality. It can also be associated with accumulation of fluids, or the damp/ stagnation tissue state (IE canker or ama). Matthew calls this the excess slippery pulse. Non-Resistant: This is what Matthew calls the deficient slippery pulse, thus showing that he actually divides the slippery pulse into 2 different expressions. This pulse is described as being weak, small, and frequent, it will feel rapid even though the counts per minute are not technically considered rapid. It passes swiftly under the finger without making a hard or deep impression. The strike on the finger lacks force. Here we see too much heat in the system leading to exhaustion due to fluid loss. The above pulses are good places to start in your analysis and understanding of pulses. Again, there are many more nuances than the few described above, but those are relatively easy patterns to decipher and get you the hang for feeling certain qualities. In general, I like to make note primarily of: 1) Speed, 2) Depth, and 3) Strength. Thus you are noting whether the pulse is fast or slow, high or low, and weak or strong. From there you can check its regularity, hardness, and tone, or whether it is irregular or even, hard or soft, and tense or relaxed (of course some people may not express some of these polarities). This gives you a 9

10 good starting place for the general constitutional picture of the person and will assists in the proper selection of remedies. For now, it s good to just get a feel for the general patterns in the pulse as a whole before getting into detail on all the organ systems. A Few Practical Considerations An important thing to remember in all of holistic evaluation is that we are looking for testimonies of 3. Meaning that it is best and ideal to find 3 areas of correspondences to a particular tissue state, disease, or constitutional state. This is why you are learning a handful of different techniques for evaluation, not just interview, or just tongue, but intake and interview, tongue and pulse analysis, as well as medical astrology. To me these all put together provides an extremely detailed picture of what is going on and greatly assists in proper evaluation and thus remedy selection. That being said, Michael Tierra notes that sometimes there will be conflicting information found in the tongue and the pulse, in which case the tongue holds more precedent as it always shows the most current underlying patterns of the individual. When taking someones pulse, the arm should be horizontal and level with their heartdefinitely not being higher than the heart as the blood is being pumped up against gravity. I typically take the pulse towards the end of the consultation, after the client has had a chance to settle in, get comfortable with me (hopefully) and has since digested any food they ate beforehand and settled from any exercise. This is because the pulse is very easily affected by changes in activity, digestion, emotional and mental states, fatigue, exercise etc. So it is generally considered best to take someones pulse no sooner than 1 hour after eating or drinking, and typically once they have settled down after strenuous movement- even climbing a set of stairs can change things quite a bit. Remember our goal is to find the baseline pulse quality, what their standard or norm is. External influences have an impact upon the pulse as well, such as very hot or cold weather, seasonal fluctuations, high winds etc. Generally, mens pulses tend to be stronger on the left (yang side), and women s are typically stronger on the right (yin side). In closing, the ways to improve upon this skill rest solely on practicing taking many different pulses of different people in different states- you can even practice on yourself. Try taking your pulse when you have to go to the bathroom, then take it once you have relieved yourself. Take your pulse when you are really tired, and perhaps after drinking a cup of coffee. Take it when you are stressed (if you can remember!) and take it after yoga, meditation or spaces of peace. This is how you really start to learn this material- make it a habit! Also feel the pulses of friends, co-workers, colleagues, family members, and anyone else who will stick their arm out for you! Study works on pulse diagnostics, again I recommend Matthew Wood s newer book called Traditional Western Herbalism and Pulse Evaluation. Familiarize yourself with the similarities and differences amongst the various qualities of the pulses, as well as the terminology used. Be patient with this process, it takes years to learn and lifetimes to master, but discipline and dedication to learning you can learn this vital skill that will help you and your clients immensely. 10