Pulse Evaluation copyright MMXV Matthew Wood and Francis Bonaldo Dimension I. Height (High/Low). High: occupies the top level of the pulse and beats towards the surface; indicates blood and nerve force to the capillaries to defend against the environmental stress; or, indicates immunological excess, high blood pressure, high blood. Low: occupies the lowest level of the pulse and beats towards the bone; indicates blood and nerve force being preserved in the interior to preent heat, energy, and nutritional loss. II. Length (Long/Short). Long: felt beyond the typical end of the pulse in the proximal position. If long and gentle indicates good nutrition. If long and hard indicates heat hardening tissues resulting in inflammation, pain, and convulsion (equal to the cord-like pulse). Short: first feels like three little blips under the three fingers, then either the distal or proximal pulse or both drop down even to absence. Indicates weakness, lack of nerve force and blood to the kidneys (if lower pulse out) or lungs or heart (if upper out), or both. III. Width (Wide/Narrow). Wide: wide caliber, indicates rich blood, good sustenance, excess of blood, heat in the blood, or toxins in the blood. Narrow: thin caliber, indicates poor nutrition, wasting. Combined with the weak pulse becomes the small pulse. IV. Magnitude (Large/Small). Large: combines the high, wide, and long, and is usually also strong. Indicates good nutrition and strength of nerve force, hence also usually strong; can indicate excess, common in large, beefy or strong people who can overbuild, high blood pressure, high blood sugar. Adrenal cortical dominance. If there is a combination large and obscure pulse there are food allergies stimulating corticol secretion, high blood pressure, etc. Small: combines the low, narrow, and weak pulses, indicating low nutrition and nerve force. Usually in the low middle to low level. Time V. Speed (Rapid/Slow). Rapid: indicates the presence of heat and fever. Slow: indicates slow function or presence of cold or both. More chronic than rapid pulse.
VI. Rest (Sudden/Rare). This value called rarity in Greek medicine, refers to the amount of space between the beats. Sudden: the beat rises suddenly, the apex is maintained slightly long (can be flattened on top), drops suddenly, does not rest between beats, then rises again quickly. Known as the quick pulse in Greek medicine. Associated with mental tension, obsessive/ compulsive, lack of rest in thought, often present with heat but sometimes with cold. Rare: there is a long interval between each beat; the pulse feels leisurely, relaxed, and graceful; indicates mental rest, meditative thought, relaxation. If combined with the strong or large pulse and very even, indicates cardiac tone due to exercise; called the athletic pulse. VII. Acceleration (Flooding/Tight). This pulse value was called celerity in Greek medicine. It refers to the sudden rise of the pulse from the bottom to the top of the wave. Flooding: the pulse wave rises strongly to the top then falls away quickly and weakly, hence is likened to the wave of the surf coming in with force and leaving meekly. Indicates acceleration of blood and nerve force towards the perimeter, either to eliminate toxins during a disease crisis, or due to too strong expulsive power and too weak a retentive capacity. Can indicate a tendency to bleeding and fluid loss, not enough yin to hold down the yang, nervousness with lack of groundedness. Tight: this pulse is usually compared to the tense pulse. The former shows constriction from cold whereas the latter shows constriction from tension. The tight pulse is constrained so that it cannot rise completely; to release it therefore vibrates to the side. The tense pulse, on the other hand, vibrates up and down. VIII. Regularity (Irregular Rapid/Irregular Slow). The beat becomes irregular (hoping around with different speed, location, and force from beat to beat), but not equivalent to the choppy pulse, which feels more opposed. After a while, the pulse begins to drop a beat on an irregular basis. Indicates that heat has damaged the heart following the rapid pulse. This pulse can be either irregular rapid or irregular slow. Tone IX. Tension (Tense/Relaxed). When nerves are stimulated they contract and then relax. When they remain too long in the contracted state we may speak of tension. This can occur due to (1) innate contraction in the nerve, (2) cold causing a slow recovery from contraction, (3) heat causing constant stimulation and inability to relax, (4) compression causing lack of room for complete
relaxation to occur, and (5) dryness causing inability to relax. Tense: the pulse is tense lengthwise, like a tendon pulled tight. As the tension increases it becomes harder and thinner. Indicates innate contraction in the nerve. Indicates need for an acrid relaxant remedy. Relaxed: pulse hangs down in the middle, like a loose clothesline; also the bottom of the vessel expands outwards like a car tire needing air. Indicates the need for an astringent, sometimes mineralizing remedy, sometimes warming remedy. X. Tight/Loose. Similar to the above but tension or its lack is from side to side or top to bottom, not lengthwise. Tight: twangy, from side to side or up to down, indicates recent chill, need for diaphoretics. Loose: the fit of the heart beat and the wall of the artery is loose, and pulse feels loose. Indicates need for exercise. XI. Compression (Firm/Empty). Firm: due to an excess of pressure, the pulse cannot expand fully so it is low, hard, and strong. Empty: under pressure of the finger, the large, high pulse is easily compressed; on deeper pressure the pulse disappears. Indicates that the periphery capillaries, blood, and nerve force have been exhausted, usually by excessive voluminous fluid or energy loss. XII. Hard/Soft. Hard. The pulse hardens from heat, dryness, and cold, and this indicates difficulty in movement in the body, severe tension. Soft. Feels like a soft, floaty feeling, but not overly compressible. Indicates dampness or nerve prostration. Fluids XIII. Blood Viscosity (Thick/Thin). This value was called fluxility in Greek medicine. Thick: the blood inside the vessel feels thick and fills out the vessel, so that the pulse is wide. Indications the largely same as the wide pulse. Tendency towards heat. Thin: blood feels thin in substance and is cool. Often felt after a cooling remedy has been given and the blood thins out. XIV. Blood Stagnation (Choppy/Beaded). Choppy: This pulse changes speed, intensity, and direction from beat to beat but does not loose a beat. If the pulse is strong it indicates congealed blood or coagulation due to shock or sudden accident; if weak it shows that congealed blood has exhausted the impulse. Beaded: congealed blood is settling on the walls of the arteries, causing bead-like deposits and a torturous vessel.
XV. Slippery. The pulse slips by the finger easily; excess horizontality - Bonaldo. Slippery Excess: excess oils, steroid drugs, hormones, pregnancy, poor blood cleansing, phlegm. Slippery Deficient: feels rapid, nonresistant. Heat pushing the blood; exhausted fever. XVI. Desiccation (Leathery/Flat). These pulses arise from drying creating weakness. Leathery: The pulse feels like a stretched leather drumhead in the high level with a not very strong pulse beating upwards from below. The pulse below is unrooted. It feels like air is making the leathery surface feel buoyed up. This pulse indicates drying creating gas and bloating, and drying on the surface. Flat: The flat pulse is the opposite of the leathery; there is not enough qi and blood to raise up the pulse and it flattens off on the top of the middle level. It indicates lack of nutrition flowing into an organ, depending on the position the flat pule occupies; frequently it is in the kidneys. XVII. Vessel Wall (Hollow/Hard-walled). Hollow: The vessel wall is easily compressed, like an onion-stalk but is empty in the interior. This indicates sudden precipitous fluid loss from sweating, bleeding, diarrhea, menses. After stopping the loss, mineralizing remedies are needed. Hard-walled: The vessel wall feels hard like a PVC pipe, is hard to compress, and encloses a thin, watery blood. Indicates hardening of the arteries, high blood pressure, salt imbalance. XVIII. Toxicity (Obscure/Vibratile). The body responds to toxins by either an allergic reaction (which causes the vibratile pulse), or by suppressing the reaction, resulting in an obscure pulse. Obscure: water seeps out of the vessels into the interstitital fluids, resulting in a layer of water and sometimes filminess that obscures the edges of the vessel and the wave, so that the beat feels obscure. This pulse indicates the need for an elimination diet, or for alteratives or laxatives to open channels of elimination. Vibratile: feels like the finger is on a bee or fly and the wings are buzzing under the finger tip. Usually felt in only one pulse (frequently the heart or liver position). Indicates acute allergic reaction during the pulse palpation. Strength XVII. Strength (Strong/Weak). Strong: The strong pulse is similar to the large pulse; a surplus of blood and energy makes for a strong beat. However, the strong pulse can appear independently from the large. If the strong pulse is rapid it indicates a powerful, hot fever. It may feel pounding or throbbing. Weak: The weak pulse frequently appears with the narrow to form the small pulse, because a
lack of energy will usually occur with a lack of blood (pulse narrow). However, weakness can occur as a feature in a number of other pulses.